Fever of Unknown Origin

Question 1

Fever of unknown origin

Answer 1

1. Fever >= 38.3 at least two occasions
2. Illness duration of >= 3 weeks
3. No known immunocompromised state
4. Diagnosis that remains uncertain after a thorough hx taking, PE, and obligatory investigations

Question 2

repeated episodes of fever interspersed with fever-free intervals of at least 2 weeks and apparent remission of the underlying disease

Answer 2

Recurrent fever

Question 3

More common infectious disease diagnoses of FUO

Answer 3

Atypical presentations of endocarditis, diverticulitis, vertebral osteomyelitis, and extrapulmonary tuberculosis

Question 4

NIID causes of FUO

Answer 4

large vessel vasculitis, polymyalgia rheumatica, sarcoidosis, familial mediterranean fever, and adult-onset Still’s disease

Question 5

Most common diagnosis of FUO among the neoplasms

Answer 5

Malignant lymphoma

Question 6

Elevated body temperature that is associated with moderate to strenuous exercise lasting from half an hour up to several hours without an increase in CRP level or ESR

Answer 6

Exercise-induced hyperthermia

Question 7

fever artificially induced by the patient, considered in all patients but is more common among young women in health care processions

Answer 7

Factitious fever

Question 8

patient is normothermic but manipulates the thermometer

Answer 8

Fraudulent fever

Question 9

Most frequent presentations in the elderly with FUO

Answer 9

Giant cell arteritis and polymyalgia rheumatica

Question 10

most common infectious disease associated with FUO in elderly patients

Answer 10

Tuberculosis

Question 11

most important step in the diagnostic work-up for FUO

Answer 11

search for potentially diagnostic clues (PDCs)

Question 12

defined as all localizing signs, symptoms, and abnormalities potentially pointing toward a diagnosis

Answer 12

Potentially diagnostic clues (PDCs)

Question 13

Structured approach to patients with FUO

Answer 13

Question 14

Obligatory investigations in FUO

Answer 14

ESR or CRP, CBC, elec, crea, TPAG, protein electrophoresis, Alk phos, AST/ALT, LDH, ck, ANA, RF, UA, Blood cultures x 3, Urine culture, CXR , Abd Utz, TST or IGRA

Question 15

First-stage diagnostic tests for FUO

Answer 15

Obligatory investigations-> Cryoglobulin and fundoscopy -> FDG/PET/CT

Question 16

Later-stage diagnostic tests for FUO

Answer 16

CT and abdominal CT , temporal artery biopsy (>= 55 years)

Question 17

Indication for antibiotic tx in FUO

Answer 17

hemodynamic instability , neutropenia

Question 18

drug which is highly effective in preventing attacks of familial mediterranean fever

Answer 18

colchicine

Question 19

a recombinant form of naturally occurring IL-1 receptor antagonist (IL-1Ra), blocks the activity of both IL-1a and IL-1B, can be considered in patients whose FUO has not been diagnosed after later-stage diagnostic tests

Answer 19

Anakinra