Fever and PUO

Question 1

3 Criteria for Pyrexia of Unknown Origin?

Answer 1

1. 2-3 week prolonged illness
2. fever above 38.3C
3. no dx after intelligent investigations

Question 2

oral or ear temps are higher?

Answer 2

ear is closer to core temp

Question 3

what id the diurnal pattern of temp?

Answer 3

lowest in morning, highest in afternoon (0.5-1.0C)

Question 4

body temp regulated by?

Answer 4

pre-optic region of anterior hypothalamus

Question 5

why is fever adaptive?

Answer 5

increase core temp activates immune mechanisms quicker at optimum 39.5C

Question 6

Why is fever maladaptive?

Answer 6

expensive to maintain

Question 7

rigor is feeling of?

Answer 7

intense cold
uncontrollable shivering
pallor
piloerection

Question 8

short duration fever most likely from?

Answer 8

infection

self-limiting viral

Question 9

What is meningococcaemia?

Answer 9

meningococcus septicaemia, rash, affect brain, joints etc.

Question 10

why is falciparum malaria dangerous?

Answer 10

short liver phase, quicker onset

Question 11

why post-splenectomy more susceptible to infections?

Answer 11

missing a big chunk of macrophages

Question 12

Toxic Shock syndrome from which bacteria?

Answer 12

staph or strep, super antigen and get overwhelming immune response with hypotension and rash

Question 13

necrotising fasciitis usually from?

Answer 13

group A strep pyogenes

Question 14

what bug can be associated with endocarditis?

Answer 14

staph aureus on a damage valve

Question 15

at risk patients for severe illness include?

Answer 15

1. recent travel
2. asplenics
3. neutropaenics
4. elderly, DM, IVDU

Question 16

warning bells for acute fever?

Answer 16

Rapid onset
Rigors
severe muscle pain
impaired conscious

vomit
severe headache
rash
jaundice

Question 17

What to be aware of for fever management?

Answer 17

Day 1: “Normal WCC and CRP”, improvement with panadol and IV fluids

Question 18

prolonged fever: watch out for?

Answer 18

animal exposure
TB
travel
toddlers
meds
sexual contacts

Question 19

PUO differentials and percentages?

Answer 19

20% infections
30% CT disorders (RA, Immuno)
30% Malignancies
10% other: IVDU, benign

Question 20

most common cause of SBE (subacture bacterial endocarditis)?

Answer 20

viridans strep

Question 21

examples of CT and immuno syndromes?

Answer 21

RA
Polymyalgia rheumatica
acute thyroiditis
SLE

Question 22

Sutton’s Law for invasive tests?

Answer 22

“go where the money is”

eg. biopsy

Question 23

PUO in immunosupressed with what usually?

Answer 23

HIV

Transplantation