Pyrexia of Unknown Origin (PUO)

Question 1

What is the definition of PUO?

Answer 1

This is a fever of over 38.3oC more than 3 times either in 3 outpatient appointments, 3x in hospital and with at least worth of investigation with no cause

Question 2

What re the major causes of PUO?

Answer 2

Idiopathic
Infection - eg empyema
Connective tissue disease eg RA, polymyalgia
Tumours - lymphomas 
Drug eatctions 
Others - alcoholic hepatitis

Question 3

What re the 3 types of PUO?

Answer 3

Nososomial - develops in hospital after 3 days as an inpatient
Neutropenic with high neutrophils
HIV-associated - HIV already diagnosed

Question 4

What are some of the key hostly questions of PUO?

Answer 4

Travel 
Occupations 
FH - TRAPS 
Pattern of fever
Skin raises?
Systemic symptoms?

Question 5

What re the key investigations

Answer 5

Urinaluysis and urine microscopy 
CXR
FBC + WCC
CRP + ESR
Blood cultures 
Creatinine 
LFT

Question 6

What is the specific investigation for tropical travel?

Answer 6

Blood film for malaria parsers or borreila

Question 7

What is the specific investigation for a new heart murmur?

Answer 7

ECG

ECHO

Question 8

What is the specific investigation for headaches?

Answer 8

Temporal artery biopsy

Question 9

What is the specific investigation for microscopic haematuria?

Answer 9

ANCA(vasculitis) Renal US(ca)

Question 10

What is the specific investigation for TB?

Answer 10

Mantoux test

Question 11

What is the term for the management of PUO?

Answer 11

Therapeutic trial

Question 12

What re some of the therapeutic trials?

Answer 12

Anti-TB medication
Steroids for vasculitis
Antibiotics

Question 13

What is fabricated fever?

Answer 13

Self induced fever due to injection of a noxious substance