Systemic Syndrome/FUO

Question 1

Which of the following is part of the criteria for FUO?
A. Fever >101 F on one occasion
B. Duration of fever lasting at least 1 week
C. Uncertain diagnosis after 2 weeks of study in the hospital

Answer 1

NONE!

A. Fever >101 F on SEVERAL occasion
B. Duration of fever lasting at least THREE week
C. Uncertain diagnosis after ONE weeks of study in the hospital

Question 2

Name the 3 major categories causing FUO

Answer 2

Infectious (TB, abscess, endocarditis, osteomyelitis) 
Malignant (usually hematologic: Leukemia/lymphoma)
Noninfectious inflammatory (Rheumatic conditions)

Question 3

Work up for FUO

Answer 3

DO ALL THE THINGS!!!

Question 4

Which of the following is a signpost for rheumatologic systemic syndrome?
A. Low ESR, C-reactive protein
B. Thrombopenia, Leukopenia 
C. Anemia of acute inflammation
D. Liver dysfunction
E. Multisystem involvement

Answer 4

D. increased LFT, decreased albumin, decreased synthesis of clotting factors
AND E

A. HIGH ESR, C-reactive protein
B. ThromboCYTOSIS, LeukoCYTOSIS (increased platelets, WBC)
C. Anemia of CHRONIC inflammation

Question 5

Which of the following is a characteristic of anemia of inflammation?
A. Microchromic/microcytic
B. Low serum Fe
C. High TIBC
D. Low % saturation of transferrin
E. Low Ferritin

Answer 5

B

A. NORMOchromic/NORMOcytic
C. LOW TIBC
D. NORMAL/LOW NORMAL % saturation of transferrin
E. NORMAL/INCREASED Ferritin

Question 6

Testicular pain & swelling in non-infectious systemic inflammatory condition suggests ____

Answer 6

Polyarthritis nodosa (PAN)

….just ‘cause

Question 7

Which of the following is NOT a criteria for Giant Cell Arthritis?
A. New onset/type of localized headache
B. Tenderness to palpation or decreased pulsation in carotid artery
C. Age of onset > 50 y/o
D. ESR > 50 mm/h
E. Abnormal artery biopsy

Answer 7

B. TEMPORAL artery

Biopsy shows lots of mononuclear cell infiltration/granulomatous inflammation, usually w/ multi-nucleated giant cells

Question 8

Polymyalgia rheumatica present with pain in all the following areas EXCEPT:
A. Neck
B. Shoulder
C. Knees
D. Hip girdle
E. Upper arms

Answer 8

C

Polymyalgia rheumatica is one of the signs that would make you suspicious of GCA

Question 9

Common diagnosis in adults >65 w/ FUO

Answer 9

Giant cell arteritis

Question 10

T/F: Temporal artery biopsy is positive 90% of the time in GCA.

Answer 10

False. only 60%

Question 11

T/F: MRI is helpful method in evaluating FUO and diagnosing large vessel vasculitis, including GCA.

Answer 11

False. PET/CT

Question 12

Yamaguchi Criteria is used to diagnose \_\_\_\_. Which of the following is a MAJOR criteria? How many need to be met?
A. Fever of 39 C x 3 days
B. Arthralgia > 3 weeks 
C. Skin rash
D. Leukopenia

Answer 12

Still’s disease
How many need to be met? 5 total, at least 2 major

C

A. Fever of 39 C x ONE WEEK
B. Arthralgia > TWO weeks
D. Leukocytosis (>10,000), 80% granulocytes

Question 13

Which of the following is NOT a MINOR criteria of Still's Disease?
A. Sore throat
B. Lymphadenopathy
C. Hepatomegaly or splenomegaly
D. Positive ANA and RF
E. Abnormal LFTs

Answer 13

D. NEGATIVE ANA and RF