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Y3R5: Medicine I 🩺 > L9: Pyrexia of Unknown Origin > Flashcards

L9: Pyrexia of Unknown Origin Flashcards

1
Q

Def of PUO

A
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2
Q

New Def of PUO

A
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3
Q

Etiology & Epidemeology of PUO

A
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4
Q

PUOs that persist for more than 1 year are less likely to be caused by an infection or neoplasm and are much more likely to be the result of a …..

A

granulomatous disease (the most common cause in these cases).

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5
Q

Causes of Nosocomial PUO

A
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6
Q

Drugs Causing Nosocomial PUO

A

(antibiotics induced Clostridium difficile colitis, and drug fever)

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7
Q

Immobilization Issues Causing Nosocomial PUO

A

decubitus ulcers, deep-vein thrombophlebitis, and pulmonary embolism

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8
Q

Pyrexia in HIV Patient

A
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9
Q

PUO in Transplant Patient

A
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10
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

A
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10
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • 0-1 Months
A
  • bacterial or fungal infections related to underlying condition or surgical complications
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11
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • 1-6 Months
A

CMV ,opportunistic infections as PJP

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11
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • > 6 Months
A

bacterial pneumonia, community acquired infections, Post-transplant lymphoproliferative disorder(PTLD)

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11
Q

Def of Classic PUO

A
  • Temperature >38.3 C (100.9 F)
  • Duration of >3 weeks
  • Evaluation of at least 3 outpatient visits or 3 days in
    hospital
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11
Q

Etiology of Classic PUO

A
  • Infection
  • Malignancy
  • Collagen vascular disease
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12
Q

Def of Nosocomial PUO

A
  • Temperature >38.3 C
  • Patient hospitalized ≥ 24 hours but drug-induced no fever or incubating on admission
  • Evaluation of at least 3 days
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12
Q

Etiology of Nosocomial PUO

A
  • Clostridium difficile enterocolitis
  • Pulmonary embolism
  • Septic thrombophlebitis
  • Sinusitis
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13
Q

def of Immune deficient (neutropenic) PUO

A
  • Temperature >38.3 C
  • Neutrophil count ≤ 500 per mm3
  • Evaluation of at least 3 days
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14
Q

Etiology of Immune deficient (neutropenic) PUO

A

 Opportunistic bacterial infections

 Aspergillosis

 Candidiasis,

 Herpes virus

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15
Q

Def of HIV associated PUO

A
  • Temperature >38.3 C
  • Duration of >4 weeks for outpatients, >3 days for inpatients
  • HIV infection confirmed
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16
Q

Etiology of HIV associated PUO

A
  • Cytomegalovirus,
  • Mycobacterium avium- intracellulare complex,
  • Pneumocystis carnii pneumonia,
  • Drug-induced,
  • Kaposi’s sarcoma, lymphoma
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17
Q

Etiologies of PUO

A

Same as first Page

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18
Q

Etiologies of PUO

  • Infections
A
  • Specifc Locations
  • Soecific Organisms
  • Specific Patient Groups
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19
Q

Etiologies of PUO

  • Infections (Specifc Location)
A
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19
Q

Etiologies of PUO

  • Infections (Specic Organsims)
A

 Tuberculosis (particularly extra pulmonary)
 Brucella
 Viral infections: CMV-EBV
 HIV-1 infection
 Fungal infections: Aspergillus spp, Candida spp.

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19
Q

Bacteria Causing PUO

A
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20
Q

Viruses Causing PUO

A
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21
Q

Fungi Causing PUO

A
  1. Candida albicans
  2. Cryptococcus neoformans
  3. Histoplasma capsulatum
  4. Aspergillus spp.
  5. Coccidioides immitis
  6. Pneumocystis jiroveci
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22
Q

Parasites Causing PUO

A
  1. Plasmodium–Malaria
  2. Leishmania
  3. Trypanosoma
  4. Toxoplasma
  5. Wuchereria bancrofti
  6. Babesia microti
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23
Q

Etiologies of PUO

  • Specific Patients Groups
A
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24
Q

Etiologies of PUO

  • Specific Patients Groups (imported Infections)
A

Malaria, dengue, rickettsia, brucella, amoebic liver
abscess, enteric fever, leishmaniasis

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25
Q

Etiologies of PUO

  • Specific Patients Groups (HIV-Positive Patients)
A

disseminated Mycobacterium avium complex, Pneumocystis jiroveci (carnii) pneumonia, CMV and others

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26
Q

Etiologies of PUO

  • Specific Patients Groups (Nosocomial Infections)
A

infections related to prosthetic materials and surgical procedures

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27
Q

Etiologies of PUO

  • Malegnancies
A
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28
Q

Etiologies of PUO

  • Malegnancies (Hematologic Malignancies)
A

 Lymphoma
 Leukemia
 Myeloma

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29
Q

Etiologies of PUO

  • Malegnancies (Solid Tumors)
A

 Renal
 Liver
 Colon
 Stomach
 Pancreas

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30
Q

Etiologies of PUO

  • Connective Tissue Disorders
A
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31
Q

Etiologies of PUO

  • Connective Tissue Disorders (Older Adults)
A

 Giant cell arteritis
 Polymyalgia Rheumatica

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32
Q

Etiologies of PUO

  • Connective Tissue Disorders (Younger Adults)
A
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33
Q

Miscellaneous Causes of PUO

A
  • CVS
  • RESP
  • ENDO/META
  • GIT
  • HEMA
  • INHERITED
  • DRUGS
  • FACTITIOUS
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34
Q

Miscellaneous Causes of PUO

  • Xardiovascular
A

 Atrial myxoma
 Aortitis
 Aortic dissection

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35
Q

Miscellaneous Causes of PUO

  • Respiratory
A

 Pulmonary embolism (PE)
 Sarcoidosis
 Extrinsic allergic alveolitis

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36
Q

Miscellaneous Causes of PUO

  • GIT
A

 IBD
 Granulomatous hepatitis
 Alcoholic liver disease
 Pancreatitis

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37
Q

Miscellaneous Causes of PUO

  • Endocrine/Metabolic
A

 Thyrotoxicosis
 Thyroiditis
 Pheochromocytoma
 Adrenal insufficiency

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38
Q

Miscellaneous Causes of PUO

  • Hematological
A

 Hemolytic anemia
 PNH (Paroxysmal nocturnal hemoglobinuria)
 TTP (Thrombotic thrombocytopenic purpura)
 Myeloproliferative disorders

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39
Q

Miscellaneous Causes of PUO

  • Inherited
A

 FMF (Familial Mediterranean Fever)
 Periodic fever syndromes

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40
Q

Miscellaneous Causes of PUO

  • Drug reactions
A

 Antibiotic fever
 Drug hypersensitivity reactions

41
Q

Characters of Factitious fever

42
Q

Categories of Drug-Induced fever

A
  • Antibiotic Induced fever
  • Cardiovascular system drug induced fever
43
Q

Examples of Antibiotic Induced fever

A

 Erythromycin
 Isoniazid
 Penicillin
 Nitrofurantoin
 Quinidine

44
Q

Examples of Cardiovascular system drug induced fever

A

 Captopril
 Atropine
 Clofibrate
 Hydralazine
 Hydrochlorothiazide
 Alfa methyl dopa
 Nifedipine

45
Q

approach to a patient with PUO

46
Q

approach to a patient with PUO

  • Stage I
A

 Careful history taking
 Physical examination
 Screening tests

47
Q

approach to a patient with PUO

  • Stage II
A

 Review the history
 Repeating physical examination

48
Q

approach to a patient with PUO

  • Stage III
A

 Specific diagnostic tests
 Noninvasive investigations

49
Q

approach to a patient with PUO

  • Stage IV
A

Invasive tests

50
Q

What to ask during Hx Taking in a patient with PUO?

A
  • Duration and characteristics of the fever
  • Travel history or exposure to people who have traveled to regions endemic for particular diseases
  • Exposure to unpasteurized dairy products
  • Presence of rash, conjunctivitis. Mucous membrane changes, and arthritis
  • Presence of associated cough, weight loss, or lymphadenopathy
51
Q

What to ask during Hx Taking in a patient with PUO?

  • Duration and characteristics of the fever
A

 Number of spikes per day
 Timing of the temperature elevation
 Whether the temperature returns to normal or below normal

52
Q

What to ask during Hx Taking in a patient with PUO?

  • Travel history or exposure to people who have traveled to regions endemic for particular diseases
A

 Cat-scratch disease
 Rat-bit fever
 Leptospirosis

53
Q

What to ask during Hx Taking in a patient with PUO?

  • Exposure to unpasteurized dairy products
A

Brucellosis

54
Q

What to ask during Hx Taking in a patient with PUO?

  • Presence of rash, conjunctivitis. Mucous membrane changes, and arthritis
A

 Juvenile arthritis
 SLE
 Kawasaki syndrome

55
Q

What to ask during Hx Taking in a patient with PUO?

  • Presence of associated cough, weight loss, or lymphadenopathy
A

 Lymphoma
 Leukemia
 Neuroblastoma
 TB
 HIV

56
Q

Physical Examination in PUO

57
Q

minimal diagnostic work up to qualify a case of PUO

58
Q

Microbiological investigation of PUO

A
  • Microscopy
  • Culture
  • Antigen detection
  • Nucleic acid detection
  • Immunological Tests
59
Q

Microbiological investigation of PUO

  • Microscopy
60
Q

Microbiological investigation of PUO

  • Microscopy (Blood Film)
A

 For direct identification of the organism as for malaria or trypanosomiasis

 Atypical lymphocytes ( EBV,CMV,HIV-1, hepatitis, Toxoplasma)

61
Q

Microbiological investigation of PUO

  • Microscopy (Sputum)
A

For mycobacteria and fungi

62
Q

Microbiological investigation of PUO

  • Microscopy (Stool)
A

for ova ,cysts and parasites

63
Q

Microbiological investigation of PUO

  • Microscopy (Urine)
A

for WBCs, RBCs, schistosoma ova, mycobacteria (early morning urine for three days)

64
Q

Microbiological investigation of PUO

  • Microscopy (LM)
A

L/M examination of biopsy for (bacteria, mycobacteria, fungi, leishmania and other parasites)

65
Q

Microbiological investigation of PUO

  • Microscopy (EM)
A

E/M for viruses, protozoa(e.g. microsporidia) and other fastidious organisms (e.g. T.whipplei)

66
Q

Microbiological investigation of PUO

  • Culture
67
Q

Microbiological investigation of PUO

  • Antigen Detection
68
Q

Microbiological investigation of PUO

  • Antigen Detection (Blood)
A

for HIV p24 antigen, Cryptococcal antigen, Histoplasma antigen, aspergillus ELISA.

69
Q

Microbiological investigation of PUO

  • Antigen Detection (BAL)
A

Aspergillus antigen

70
Q

Microbiological investigation of PUO

  • Antigen Detection (CSF)
A

Cryptococcal antigen

71
Q

Microbiological investigation of PUO

  • Antigen Detection (Nasopharyngeal-Throat Swap)
A

respiratory viruses

72
Q

Microbiological investigation of PUO

  • Antigen Detection (Urine)
A

For Legionella antigen

73
Q

Microbiological investigation of PUO

  • Nucleic acid detection
74
Q

Microbiological investigation of PUO

  • Nucleic acid detection (Blood)
75
Q

Microbiological investigation of PUO

  • Nucleic acid detection (CSF)
76
Q

Microbiological investigation of PUO

  • Nucleic acid detection (Nasopharyngeal aspirate or throat swab)
77
Q

Microbiological investigation of PUO

  • Nucleic acid detection (BAL)
78
Q

Microbiological investigation of PUO

  • Nucleic acid detection (Tissue Specimens)
79
Q

Microbiological investigation of PUO

  • Nucleic acid detection (urine)
80
Q

Microbiological investigation of PUO

  • Nucleic acid detection (Stool)
81
Q

Microbiological investigation of PUO

  • Immunological Tests
82
Q

Microbiological investigation of PUO

  • Other Tests
83
Q

Endocarditis & PUO

84
Q

Hepatobiliary infections & PUO

85
Q

Osteomyelitis & PUO

86
Q

Rickettsial & chlamydial infections & PUO

87
Q

Systemic bacterial illnesses & PUO

88
Q

Viruses & PUO

89
Q

Fungal infections & PUO

90
Q

Parasitic infections & PUO

91
Q

Lymphomas & PUO

92
Q

Leukemias & PUO

93
Q

Solid tumors & PUO

94
Q

Regional enteritis & PUO

95
Q

Granulomatous hepatitis & PUO

96
Q

Collagen-vascular and autoimmune diseases & PUO

97
Q

PUO & Rash

98
Q

Another Name of FMF

99
Q

Def of FMF

100
Q

Causes of FMF

101
Q

Pathophysiology of FMF

102
Q

CP of FMF

103
Q

Complications of FMF

104
Q

Dx of FMF

105
Q

TTT of FMF

106
Q

Managment of PUO

107
Q

Managment of PUO

108
Q

Managment of Nosocomial PUO

Y3R5: Medicine I 🩺 (47 decks)

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