Fever of Unkown Origin Flashcards
What is the most important step in the diagnostic workup of FUO?
potentially diagnostic clues (PDC)
______ is all localizing signs, symptoms, and abnormalities potentially pointing toward a diagnosis
PDC
True about FUO workup EXCEPT
a. antibiotics and glucocorticoid tx can mask many diseases
b. Abdominal CT is preferred over Abdominal UTZ
c. Immunologic serology other than that included in obligatory tests has low diagnostic yield
d. Performing more than three blood cultures or more than one urine culture is useless in patients with FUO in the absence of PDCs
B
Repeating blood or urine cultures is useful only when previously cultured samples were collected during antibiotic treatment or within ______ after its discontinuation
1 week
True about FUO workup EXCEPT
a. Microbiologic serology is indicated in the workup of patients with FUO
b. A TST is included in the obligatory investigations
c. A TST may yield false negative result in miliary TB
d. echocardiography, sinus radiography, radiologic or endoscopic evaluation of the gastrointestinal tract, and bronchoscopy should not be used as screening
A
True about FUO workup EXCEPT
a. nutritional supplements, should be discontinued early in the evaluation to exclude drug fever.
b. If fever persists beyond 72 h after discontinuation of the suspected drug, it is unlikely that this drug is the cause
c. TST will be positive even in the malnourished or the immunosuppressed
d. NOTA
C
a noninvasive method allowing delineation of foci in all parts of the body on the basis of functional changes in tissues; uses radioactive tracer
Scintigraphy
Advantage of scintigraphy compared to CT and MRI
CT and MRI routinely provide information only on part of the body, while scintigraphy readily allows whole-body imaging
FDG accumulates in tissues with a high rate of _______
glycolysis
Cells with high rate of glycolysis include
malignant cells, in activated leukocytes, and permits the imaging of acute and chronic inflammatory processes
FDG-PET offers the advantages of higher resolution, greater sensitivity in _____________
chronic low-grade infections
FDG-PET has high degree of accuracy in evaluating _________
the central skeleton
T/F Bone marrow aspiration is always useful in the absence of PDCs for bone marrow disorders
F
Giant cell arteritis often involves large arteries and in most cases can be diagnosed by ______
FDG-PET
T/F
FDG-PET is preferred over temporal artery biopsy for patients = 55 years of age in a later stage of the diagnostic protocol
F; temporal artery is preferred
When should liver biopsy be performed?
Later in the dx given there’s PVC for liver disease
T/F in patients with persisting FUO, waiting for new PDCs to appear probably is better than ordering more screening investigations
T
T/F In a patient with FUO and without dx, waiting for new further diagnostic workup is warranted when the patient deteriorates
T
T/F Empirical therapeutic trials with antibiotics, glucocorticoids, or antituberculous agents should not be given in FUO even when a patient’s condition is rapidly deteriorating after the aforementioned diagnostic tests have failed to provide a definite diagnosis
F
In hemodynamic instability or __________ is a good indication for empirical antibiotic therapy.
neutropenia
If the fever does not respond after ________of empirical antituberculous treatment, another diagnosis should be considered
6 weeks
_______ is highly effective in preventing attacks of familial Mediterranean fever but is not always effective once an attack is well under way
Colchicine
If the fever persists and the source remains elusive after completion of the later-stage investigations, supportive treatment with ______ can be helpful
NSAID
T/F Early empirical trials with glucocorticoids is recommended in patients with FUO
F
decrease the chances of reaching a diagnosis for which more specific and sometimes life-saving treatment might be more appropriate, such as malignant lymphoma
