Pyrexia of unknown origin

Question 1

What is the definition of a fever?

Answer 1

• Elevation of body temperature above 37 degrees

Question 2

How does fever vary during the day?

Answer 2

• Temperature is higher or lower by around 0.8C,

low in the morning, higher in the evening

Question 3

What is a pyrogen?

Answer 3

• Substances which cause fever
  Endogenous - Cytokines
  Exogenous - Endotoxins and -Ge bacteria

Question 4

What is a nosocomical definition of pyrexia of unknown origin?

Answer 4

Develops in hospital - Undiagnosed after 3 days

Question 5

What is Neutropenic definition of pyrexia of unknown origin?

Answer 5

Undiagnosed fever in patient with neutrophils <500/mm3

Question 6

What is HIV- Associated pyrexia of unknown origin?

Answer 6

Fever in a patient with a HIV-Infection, present and undiagnosed for more than three days in an inpatient

Question 7

What are the causes of HIV-related pyrexia of unknown origin?

Answer 7

Mycobacterium tuberculosis

Mycobacterium avium

Question 8

What investigation would you preform and differentials would you expect of someone that has recently travelled?

Answer 8

• Blood for malaria parasites, Dengue, HIV, Bone marrow for leishmaniasis

Question 9

Would investigation would you preform if a new murmur was heard?

Answer 9

• Echocardiography (trans-oesophageal echo)

Question 10

What investigation would be preformed if a headache was heard?

Answer 10

• Temporal artery biopsy

Question 11

What investigations would be performed if micro-heamturia?

Answer 11

• Auto-antibodies and renal biopsy

Question 12

What investigations would be performed if there was TB contact?

Answer 12

• Sputum smear, bone marrow, and mantoux test

Question 13

What investigations would be performed if there was drug misuse?

Answer 13

• Screen for blood born viruses

Question 14

What are the therapeutic options for a suspected mycobacterium infection

Answer 14

Anti-tuberculous therapy (

Suspected vasculitis or connective tissue disorder (Steroids)