Pyrexia Of Unknown Orifin

Question 1

PUO definition

Answer 1

Persistent fever 38.3° that evades diagnosis for at least 3 weeks with 1 week of investigation in hospital

Question 2

4 categories of causes of PUO

Answer 2

Infective 17-35%
Inflammatory 24-36%
Neoplastic 10-20%
Miscellaneous 3-15%

Question 3

Percentage of cases that remain undiagnosed

Answer 3

51%

Question 4

Key points in History taking of fever

Answer 4

Pattern - episodic, consistent
General health of patient during fever episodes
Associated past and current symptoms
Past medical history
Surgical history
Drugs history including OTC, alternative, herbal, recreational
Travel history important
Social hx including Occupation, environment , animal and sexual exposures

Question 5

Main cause of PUO in Immunocompromised

Answer 5

Infections

Question 6

Main cause of PUO in children

Answer 6

Infections

Question 7

Main cause of PUO in children

Answer 7

Infections

Question 8

Main cause of PUO in more than 65 yo

Answer 8

Inflammation

Question 9

Red flags symptoms in PUO

Answer 9

Weight loss
Increased lethargy
Drenching night sweats
Inability to perform activities on daily basis
Changes in symptomatology And physical exam

Question 10

Important points in examination of PUO

Answer 10

Full spine and joints exam
Skin rashes, ulcers, scars, bites, pressure areas
Abnormalities of hair and nails
Dentition review
Temporal arteries
Fundoscopy
Breast examination
Pelvic or rectal exam
Implant exam

Question 11

Investigation principle

Answer 11

2 stages of baseline tests
Specific tests then

Question 12

Is blanket testing appropriate in PUO

Answer 12

No

Question 13

Baseline set of investigation include

Answer 13

FBC
Renal electrolytes
LFT
CRP
ESR
clotting screen
Créatine kinase
HIV test
Chest X-ray
Ultrasound
Urine dipstick