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Pyrexia of unknown origin Flashcards

1
Q

What is a normal temperature?

A

37’C

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2
Q

What is fever?

A

Elevation of body temp above normal (37)

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3
Q

How much can temperature vary normally?

A

0.8’C

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4
Q

What is SIRS?

A

Systemic inflammatory response syndrome (SIRS)

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5
Q

What are pyrogens?

A

Substances which cause fever

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6
Q

What are the two types of pyrogens?

A

Endogenous

Exogenous

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7
Q

What is an example of endogenous pyrogens?

A

Cytokines

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8
Q

What is an example of exogenous pyrogens?

A

Endotoxins from G-ve bacteria

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9
Q

What is the old definition of pyrexia?

A

Temp >38.8
Multiple occasions
At least 3 wks
One wk hospital evaluation

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10
Q

What is the modern definition of pyrexia?

A

3 outpatient visits OR
3 days in hospital OR
1 week outpatient investigation

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11
Q

What is nosocomial PUO?

A

Develops in hospital, undiagnosed after 3 days

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12
Q

What is neutropenic PUO?

A

Undiagnosed fever in patient with neutrophils <500/mm^3

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13
Q

What is HIV-associated PUO?

A

Fever in patient with HIV infection, present and undiagnosed >3days inpatient, >4wks outpatient

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14
Q

What are causes of classical PUO?

A 
Infection
Malignancy
Inflammatory
Other
No diagnosis
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15
Q

What bacteria is the most common cause of PUO?

A

Mycobacterium

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16
Q

What are initial investigations for PUO?

A 
CXR
Urinalysis and urine microscopy
FBC, WCC
CRP, ESR
Blood cultures
Urea, creatinine, electrolytes, LFTs
17
Q

What investigations would be indicated for tropical travel?

A

Blood for malarial parasites, dengue, HIV
Bone marrow for leishmaniasis
(less likely >21 days return)

18
Q

What investigations would be indicated for new murmur?

19
Q

What investigations would be indicated for headaches?

A

Temporal artery biopsy (TA)

20
Q

What investigations would be indicated for micro-haematuria?

A

Auto-antibodies +/- renal biopsy (polyarteritis)

US (renal Ca)

21
Q

What investigations would be indicated for TB contact?

A

Sputum smear
Bone marrow
Mantoux

22
Q

What investigations would be indicated for drug misuse?

A

Screen for blood-borne viruses

23
Q

What are invasive investigations for PUO?

A

Tissue for culture and histology
Bone marrow and liver biopsy
Diagnostic laparotomy

24
Q

When would a therapeutic trial happen in PUO?

A

Suspected mycobacterial infection

25
Q

What is the response of temporal arteritis to steroids?

A

Dramatic - within 48hrs

26
Q

What is a fabricated fever?

A

Real but self-induced

Self-injection

27
Q

What is the treatment for PUO?

A

Young - often spontaenous

NSAIDs/steroids

Infection (13 decks)

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