Pyrexia

Question 1

What is a fever?

Answer 1

Elevation of temp above 37

Part of systemic inflammatory response syndrome

Question 2

What is pyrogens?

Answer 2

Substances which cause fever
-Cytokines
-Endotoxins
Causes reduced heat loss = fever

Question 3

What defines a pyrexia of unknown origin?

Answer 3

3 outpatient visits or
3 days in hospital or
One week of outpatient invesitgation

Question 4

Types of pyrexia with unknown origin?

Answer 4

Classical
Nosocomial (in hospital)
Neutropenic (neutrophils<500/mm3)
HIV associated

Question 5

What are the causes of classical PUO?

Answer 5

Infection
Malignancy
Inflammatory

Question 6

What are the causes of HIV associated PUO?

Answer 6

M. tuberculosis

M. avium

Question 7

What are the PUO investigations?

Answer 7

CXR
Urinalysis
FBC and WBC count
CRP and ESR
Blood cultures
U+E's LFT's

Question 8

What are other special investigations for PUO?

Answer 8

Travel = blood for malaria, dengue, HIV
Murmur = ECG
Headaches = temporal artery biopsy
Haematuria = auto-antibodies +/- renal biopsy
TB contact = sputum smear and mantoux
Drug misuse = BB virus

Question 9

What is PUO treatment?

Answer 9

TB = TB treatment
Vasculitis = steroids
Temporal arteritis = steroids