Mi - Pyrexia of Unknown Origin Flashcards
define classical PUO
> 38.3 degress for 3 weeks with 3+ days in hospital or 3 OPD appts
what causes classical PUO
infection, cancer, vascular
define nosocomial PUO
temp >38.3 degrees , pt hospitalised for >24 hours but no fever on admission. 3 days evaluation
what causes nosocomial PUO
hospitals eg c.diff, sepsis, PE
name 2 other types of PUO
immune deficiency
HIV associated
give the %s of fever caused by:
- infection
- cancer
- inflammation
- PUO
30%
20%
25%
35%
give Hx Qs of PUO
b sx, localising sx
meds
hx of pets / animal contact
IVDU, sexual Hx
foreign travel - where, when, busy, activities inc animals / water
what is involved in PUO exam
top to toe inc ENT and derm
fundoscopy
feel each verterbrae for tenderness
temporal artery exam (GCA)
name PUO bloods / Ix
routine admission ones - FBC, U&Es, LFTs, CRP, CXR, cultures, urine dip
PUO standard: 2 cultures, urine/stool culture inc parasites, CMV/EBV serology, HIV/HBV/HCV
extras: CK, ferritin, LDH, ANA, ANCA, RhF, TFTs
PET scan, echo, biopsies, LP, BM aspirate
when does IgG vs IgM peak post infection
IgG = 2-3 weeks rise, positive for life
IgM = 1-2 weeks peak, gone after 6 weeks
define Duke’s criteria for endocarditis
major
- blood cultures positive for IE
- endocardial involvemnet
minor
- predisposing factors
- temp >38
- vascular phenomena
- immunological phenomena
- microbio evidence
name viral causes of PUO
CMV, EBV, HIV, hep
name parasitic causes of PUO
malaria
schistosomiosis
toxoplasmosis
trypanosomiasis
name fungal causes of PUO
cryptococcis
histoplasmosis
coccidiodes
name bacterial causes of PUO
q fever
brucella
bartonella
mycobacteria eg TB
enteric fever
zoonoses
which system helps Drs identify why bugs to screen for based on Hx
RIPL - rare and imported diseases
name the old person inflamm cause of PUO
GCA
name the young person cause of PUO
adult onset stills
what is adult onset stills
major
- 39 degrees for 1+ week
- leucocytosis
- rash
- arthralgia > 2 weeks
minor
- sore throat
describe the rash in adult onset stills
salmon pink
what blood marker is high in adult onset stills
ferritin
over 50. headache, jaw claudication, visual changes. Dx?
GCA
what Ix should you do for GCA and what is the result?
ESR >50
what cancers can cause PUO
lymphoma esp NHL
leukaemia
renaal cell carcinoma
hepatocellular carcinoma
list other miscellaneous causes of PUO
thyroiditis
addisons
pe
drug fever - ADRs
Ix of IE
cultures, echo, serology
Ix for TB
CXR, mycobacteria culture, sputum culture for acid fast bascili
HIV
Ix for CNS tuberculosis
MRI / CT
LP
HIV
Ix for GCA
ESR
temporal artery biopsy
visual acuity
Mx for GCA
prednisolone
define sepsis
disordered host response to infection
define septic shock
resistant to Tx for sepsis leading to end organ failure
Mx for sepsis
start IV Abx immediately
