PUO

Question 1

Define PUO

Answer 1

temp > 38.3C, recorded on multiple occasions, present for at least three weeks, defied diagnosis after one week of hospital evaluation OR 3 OUTPATIENT VISITS OR 3 DAYS IN HOSPITAL

Question 2

define fever

Answer 2

elevation of body temperature above normal (37C), variation of up to 0.8C daily (circadian rhythm): low in early morning, high in early evening, Part of the systemic inflammatory response syndrome (SIRS)

Question 3

what is a pyrogen

Answer 3

substances which cause fever
endogenous e.g. cytokines
exogenous e.g. endotoxins from G-ve bacteria
act at hypothalamic thermoregulatory centre to cause reduced heat loss and hence fever

Question 4

what are other forms of PUO?

Answer 4

nosocomial, neutropenic, HIV associated.

Question 5

what are the most common causes/ thought causes?

Answer 5

myco.Tuberculosis, myso.Avium

Question 6

what initial ix would you do?

Answer 6

simple first - cxr, urinalysis, fbc, wcc, crp, esr, blood cultures, urea, creatinine, electrolytes, lft’s.

Question 7

next stage ix?

Answer 7

hx of = tropical travel (malarial parasites, dengue, hiv, leichmaniasis etc…), new murmur, headaches, jaw claudication, microhaematuria, TB contact, drug misuse.

Question 8

imaging?

Answer 8

CT PET, invasive - temporal artery biopsy, culture tissues, bone marrow and liver ix, diagnostic laparotomy (rarely done)

Question 9

Tx

Answer 9

NSAID’s, steroids, no tx, therapeutic trials, sometimes it’s a fabricated fever.