Fever of Unkown Origin

Question 1

What is the most important step in the diagnostic workup of FUO?

Answer 1

potentially diagnostic clues (PDC)

Question 2

______ is all localizing signs, symptoms, and abnormalities potentially pointing toward a diagnosis

Answer 2

PDC

Question 3

True about FUO workup EXCEPT

a. antibiotics and glucocorticoid tx can mask many diseases
b. Abdominal CT is preferred over Abdominal UTZ
c. Immunologic serology other than that included in obligatory tests has low diagnostic yield
d. Performing more than three blood cultures or more than one urine culture is useless in patients with FUO in the absence of PDCs

Answer 3

B

Question 4

Repeating blood or urine cultures is useful only when previously cultured samples were collected during antibiotic treatment or within ______ after its discontinuation

Answer 4

1 week

Question 5

True about FUO workup EXCEPT

a. Microbiologic serology is indicated in the workup of patients with FUO
b. A TST is included in the obligatory investigations
c. A TST may yield false negative result in miliary TB
d. echocardiography, sinus radiography, radiologic or endoscopic evaluation of the gastrointestinal tract, and bronchoscopy should not be used as screening

Answer 5

A

Question 6

True about FUO workup EXCEPT

a. nutritional supplements, should be discontinued early in the evaluation to exclude drug fever.
b. If fever persists beyond 72 h after discontinuation of the suspected drug, it is unlikely that this drug is the cause
c. TST will be positive even in the malnourished or the immunosuppressed
d. NOTA

Answer 6

C

Question 7

a noninvasive method allowing delineation of foci in all parts of the body on the basis of functional changes in tissues; uses radioactive tracer

Answer 7

Scintigraphy

Question 8

Advantage of scintigraphy compared to CT and MRI

Answer 8

CT and MRI routinely provide information only on part of the body, while scintigraphy readily allows whole-body imaging

Question 9

FDG accumulates in tissues with a high rate of _______

Answer 9

glycolysis

Question 10

Cells with high rate of glycolysis include

Answer 10

malignant cells, in activated leukocytes, and permits the imaging of acute and chronic inflammatory processes

Question 11

FDG-PET offers the advantages of higher resolution, greater sensitivity in _____________

Answer 11

chronic low-grade infections

Question 12

FDG-PET has high degree of accuracy in evaluating _________

Answer 12

the central skeleton

Question 13

T/F Bone marrow aspiration is always useful in the absence of PDCs for bone marrow disorders

Answer 13

F

Question 14

Giant cell arteritis often involves large arteries and in most cases can be diagnosed by ______

Answer 14

FDG-PET

Question 15

T/F
FDG-PET is preferred over temporal artery biopsy for patients = 55 years of age in a later stage of the diagnostic protocol

Answer 15

F; temporal artery is preferred

Question 16

When should liver biopsy be performed?

Answer 16

Later in the dx given there’s PVC for liver disease

Question 17

T/F in patients with persisting FUO, waiting for new PDCs to appear probably is better than ordering more screening investigations

Answer 17

T

Question 18

T/F In a patient with FUO and without dx, waiting for new further diagnostic workup is warranted when the patient deteriorates

Answer 18

T

Question 19

T/F Empirical therapeutic trials with antibiotics, glucocorticoids, or antituberculous agents should not be given in FUO even when a patient’s condition is rapidly deteriorating after the aforementioned diagnostic tests have failed to provide a definite diagnosis

Answer 19

F

Question 20

In hemodynamic instability or __________ is a good indication for empirical antibiotic therapy.

Answer 20

neutropenia

Question 21

If the fever does not respond after ________of empirical antituberculous treatment, another diagnosis should be considered

Answer 21

6 weeks

Question 22

_______ is highly effective in preventing attacks of familial Mediterranean fever but is not always effective once an attack is well under way

Answer 22

Colchicine

Question 23

If the fever persists and the source remains elusive after completion of the later-stage investigations, supportive treatment with ______ can be helpful

Answer 23

NSAID

Question 24

T/F Early empirical trials with glucocorticoids is recommended in patients with FUO

Answer 24

F
decrease the chances of reaching a diagnosis for which more specific and sometimes life-saving treatment might be more appropriate, such as malignant lymphoma

Question 25

Anakinra MOA

Answer 25

IL-1 receptor antagonist

Question 26

Drug extremely effective for familial Mediterranean fever, cryopyrin-associated periodic syndrome, tumor necrosis factor receptor–associated periodic syndrome, hyper-IgD syndrome, and Schnitzler’s syndrome

Answer 26

Anakinra

Question 27

T/F therapeutic trial with anakinra can be considered in patients whose FUO has not been diagnosed after later-stage diagnostic tests

Answer 27

T

Question 28

The majority of fevers are caused by treatable diseases, and the risk of death related to FUO is, of course, dependent on the _______________

Answer 28

underlying disease