Fever Of Unknown Origin

Question 1

originally defined as an illness of >3 weeks’ duration with fever of ≥38.3°C (≥101°F) on two occasions and an uncertain diagnosis despite 1 week of inpatient evaluation.

Answer 1

FUO

Question 2

FUO isnow defined as follows:

1. Fever ≥38.3°C (≥101°F) on at least two occasions
2. Illness duration of ≥3 weeks
3. No known immunocompromised state
4. Diagnosis that remains uncertain after a thorough history-taking,physical examination, and the following obligatory investigations:

Answer 2

(ESR) and C reactive protein (CRP) level; platelet count; leukocyte count and differential; measurement of levels of hemoglobin, electrolytes, creatinine, total protein, alkaline phosphatase, alanine aminotransferase,aspartate aminotransferase, lactate dehydrogenase, creatine kinase,ferritin, ANA, and rheumatoid factor; protein electrophoresis; urinalysis; blood cultures (n = 3); urine culture; chestx-ray; abdominal ultrasonography; and tuberculin skin test (TST) orinterferon γ release assay (IGRA).

Question 3

(defined as repeated episodes of fever interspersed with fever-free intervals of at least 2 weeks and apparent remission of the underlying disease), the chance of attaining an etiologic diagnosis is <50%.

Answer 3

recurrent fever

Question 4

is by far the most common diagnosis of FUO among the neoplasms.

Answer 4

malignant lymphoma

Question 5

is the most common infectiousdisease associated with FUO in elderly patients, occurring much moreoften than in younger patients.

Answer 5

Tuberculosis

Question 6

can present at any age, is Uncommon but can often be diagnosed easily in a patient with FUO who presents with urticaria, bone pain, and monoclonal gammopathy

Answer 6

Schnitzler syndrome

Question 7

is characterized by an elevated body temperature that is associated with moderate to strenuous exercise lasting from half an hour up to several hours WITHOUT an-increase in CRP level or ESR; typically these patients sweat during the-temperature elevation

Answer 7

Exercise-induced hyperthermia

Question 8

(fever artificially induced by thepatient—for example, by IV injection of contaminated water) should beconsidered in all patients but is more common among young women in health care professions

Answer 8

Factitious fever

Question 9

the patient is normothermic but manipulates the thermometer. Simultaneous measurements at Different body sites (rectum, ear, mouth) should rapidly identify this diagnosis.
Another clue is a dissociation betweenpulse rate and temperature

Answer 9

fraudulent fever,

Question 10

FUO in the elderly results from an atypical manifestation of a common disease, among which two of which are most frequently involved

Answer 10

giant cell arteritis and polymyalgia rheumatica

Question 11

FUO with headache should prompt microbiologic examination of cerebrospinal fluid(CSF) for organisms including

Answer 11

herpes simplex virus (especiallytype 2), Cryptococcus neoforman
Mycobacterium tuberculosis.

Question 12

True or false:
In central nervous system tuberculosis, the CSF typically has elevated Protein and lowered glucose concentrations, with a mononuclear pleocytosis.

Answer 12

True

Question 13

A TST is included in the obligatory investigations, but it may yield false negative results in patients with

Answer 13

miliary tuberculosis
malnutrition
immunosuppression

Question 14

If fever persists beyond how many hours after-discontinuation of the suspected drug, it is unlikely that this drug is the cause

Answer 14

72 hours

Question 15

When the first-stage diagnostic tests do-not lead to a diagnosis,____ should be performed, especiallywhen the ESR or the CRP level is elevated.

Answer 15

scintigraphy

Question 16

True or false:

In patients with recurrent fever lasting >2 years,it is very unlikely that the fever is caused by infection or malignancy

Answer 16

True

Question 17

accumulates in tissues with a high rate of glycolysis, which Occurs not only in malignant cells but also in activated leukocytes and thus permits the imaging of acute and chronic inflammatory processes.

Answer 17

FDG or Fluorodeoxyglucose

Question 18

True of false

temporal artery biopsy is still recommended for patients ≥55 years of age in a later stage of thediagnostic protocol

Answer 18

True

Question 19

True or false:

FDG-PET/CT will not be useful in vasculitis limited to the temporal arteries because of the small diameter of these vessels and the high levels of FDG uptake in the brain

Answer 19

True

Question 20

Because FDG-PET/CT is highly sensitive in detecting these 3 diseases , the value of bone marrow biopsy as a screening procedure is probably further reduced

Answer 20

lymphoma
carcinoma
osteomyelitis

Question 21

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

Answer 21

FDG-PET /CT

Question 22

True or false

Empirical therapeutic trials with antibiotics, glucocorticoids, oral antituberculous agents should be avoided in FUO except when a patient’s condition is rapidly deteriorating after the aforementioned diagnostic tests have FAILED to provide a definite diagnosis.

Answer 22

True

Question 23

If the fever does not respond after how many weeks of empirical antituberculous treatment, another diagnosis be considered

Answer 23

6 weeks of ptb Tx

Question 24

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

Answer 24

Colchicine

Question 25

a recombinant Form of the naturally occurring IL-1 receptor antagonist (IL-1Ra),blocks the activity of both IL-1α and IL-1β. It is extremely effective in the treatment of many autoinflammatory syndromes,such as familial Mediterranean fever, cryopyrin-associated periodic syndrome, tumor necrosis factor receptor–associated periodic syndrome, mevalonate kinase deficiency (hyper IgD syndrome) and Schnitzler syndrome

Answer 25

Anakinra