Pyrexia Of Unknown Origin

Question 1

What’s the definition of PUO?

Answer 1

Temp >38 on multiple occasions
Illness >3wks
No diagnosis after >1wk inpatient

Question 2

Common infective causes of PUO?

Answer 2

TB
Abscesses
Infective endocarditis
Brucellosis

Question 3

Common autoimmune/connective tissue causes of PUO?

Answer 3

Adult onset Stills disease
Temporal arteritis
Wegeners gramulomatosis

Question 4

Common neoplastic causes of PUO?

Answer 4

Leukaemia
Lymphoma
Renal cell carcinoma

Question 5

What are ‘other’ common causes of PUO?

Answer 5

Drugs
Thromboembolism
Hyperthyroidism
Adrenal insufficiency (addisons)

Question 6

What should you ask in the history of a patient with PUO?

Answer 6

Chronology of symptoms
Pet/animal exposure
Travel
Occupation
Medications
Family history
Vaccination history
Sexual contacts

Question 7

What should you look out for on examination?

Answer 7

Lymph nodes
Stigmata of endocarditis
Evidence of weight loss
Joint abnormalities

Question 8

What bloods should you do for investigating PUO?

Answer 8

FBC, U&E, LFTs, CRP, TFTs
Blood cultures
Bone profile
Clotting
B12 and folate
Ferritin
LDH
Immunoglobulins and autoimmune screen

Question 9

What micro/virology should you do for investigating PUO?

Answer 9

HIV
Hepatitis b and c
Syphilis
MSU
Sputum culture
Viral swabs
CMV an EBV serology

Question 10

What imaging should you do to investigate PUO?

Answer 10

CXR
CT thorax/abdo/pelvis
Transthoracic echo