Pyrexia of Unknown Origin Flashcards

1
Q

Define Fever

A

Elevation of body temperature above normal (37C), Variation of up to 0.8C daily, part of systemic inflammatory response sydrome

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2
Q

What are pyrogens?

A

substances which cause fever

Endogenous - cytokines
Exogenous - endotoxins from G-ve bacteria

They act as a hypothalamic thermoregulatory centre to cause reduced heat loss and hence fever

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3
Q

What is the Petersdorf and Beeson definition of pyrexia of unknown origin?

A

Temperature of over 38.3C, recorded on multiple occasions and present for at least 3 weeks. Diagnosis after one week of hospital evaluation

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4
Q

What is nosocomial pyrexia of unknown origin?

A

Develops in hospital and is diagnosed after 3 days

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5
Q

What is neutropenic PUO?

A

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

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6
Q

What is HIV-associated PUO?

A

Fever in a patient with HIV infection present and undiagnosed for more than three days in an inpatient/ four weeks in an outpatient

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7
Q

How do you assess PUO?

A

History - in depth

Examination - thorough including skin, eyes, mouth, nails and lymph nodes. REPEAT IT

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8
Q

What investigations should be done if PUO is suspected ?

A

CXR, Urinalysis and Urine Microscopy, FBC, WCC, CRP and ESR, Blood Cultures, Urea, Creatinine, Electrolytes and LFT’s

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9
Q

What should be done if tropical travel seems to be the cause?

A

Blood for malarial parasites, dengue, HIV, bone marrow

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10
Q

What should be done if a new murmur is suspected?

A

ECHO

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11
Q

What should be done if the patient is experiencing headaches?

A

Temporal artery biopsy

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12
Q

What tests should be done if patient is experiencing micro haematuria?

A

Auto-antibodies and renal biopsy, ultrasound

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13
Q

What should be done if TB is suspected?

A

Sputum smear, bone marrow, mantoux test

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14
Q

What should be done if drug misuse is suspected?

A

Screen for blood-borne viruses

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15
Q

What is the treatment for PUO?

A

Therapeutic trial, anti TB therapy (if TB suspected, steroids (vasculitis or connective tissue disorder)

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16
Q

What is a fabricated fever?

A

Fever is real but self-induced. Self injection is common

17
Q

What is the outcome of PUO?

A

Spontaneous resolution of PUO in young people compared with old patients.

Some respond to steroids or NSAIDS without a diagnosis required