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Y3R5: Medicine I 🩺 > L9: Pyrexia of Unknown Origin > Flashcards

L9: Pyrexia of Unknown Origin Flashcards

1
Q

Def of PUO

A
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2
Q

New Def of PUO

A
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3
Q

Etiology & Epidemeology of PUO

A
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4
Q

PUOs that persist for more than 1 year are less likely to be caused by an infection or neoplasm and are much more likely to be the result of a …..

A

granulomatous disease (the most common cause in these cases).

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5
Q

Causes of Nosocomial PUO

A
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6
Q

Drugs Causing Nosocomial PUO

A

(antibiotics induced Clostridium difficile colitis, and drug fever)

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7
Q

Immobilization Issues Causing Nosocomial PUO

A

decubitus ulcers, deep-vein thrombophlebitis, and pulmonary embolism

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8
Q

Pyrexia in HIV Patient

A
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9
Q

PUO in Transplant Patient

A
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10
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

A
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10
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • 0-1 Months
A
  • bacterial or fungal infections related to underlying condition or surgical complications
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11
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • 1-6 Months
A

CMV ,opportunistic infections as PJP

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11
Q

According to time following transplantation (IN SOLID ORGAN RECIPIENTS)

  • > 6 Months
A

bacterial pneumonia, community acquired infections, Post-transplant lymphoproliferative disorder(PTLD)

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11
Q

Def of Classic PUO

A
  • Temperature >38.3 C (100.9 F)
  • Duration of >3 weeks
  • Evaluation of at least 3 outpatient visits or 3 days in
    hospital
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11
Q

Etiology of Classic PUO

A
  • Infection
  • Malignancy
  • Collagen vascular disease
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12
Q

Def of Nosocomial PUO

A
  • Temperature >38.3 C
  • Patient hospitalized β‰₯ 24 hours but drug-induced no fever or incubating on admission
  • Evaluation of at least 3 days
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12
Q

Etiology of Nosocomial PUO

A
  • Clostridium difficile enterocolitis
  • Pulmonary embolism
  • Septic thrombophlebitis
  • Sinusitis
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13
Q

def of Immune deficient (neutropenic) PUO

A
  • Temperature >38.3 C
  • Neutrophil count ≀ 500 per mm3
  • Evaluation of at least 3 days
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14
Q

Etiology of Immune deficient (neutropenic) PUO

A

οƒ˜ Opportunistic bacterial infections

οƒ˜ Aspergillosis

οƒ˜ Candidiasis,

οƒ˜ Herpes virus

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15
Q

Def of HIV associated PUO

A
  • Temperature >38.3 C
  • Duration of >4 weeks for outpatients, >3 days for inpatients
  • HIV infection confirmed
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16
Q

Etiology of HIV associated PUO

A
  • Cytomegalovirus,
  • Mycobacterium avium- intracellulare complex,
  • Pneumocystis carnii pneumonia,
  • Drug-induced,
  • Kaposi’s sarcoma, lymphoma
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17
Q

Etiologies of PUO

A

Same as first Page

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18
Q

Etiologies of PUO

  • Infections
A
  • Specifc Locations
  • Soecific Organisms
  • Specific Patient Groups
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19
Q

Etiologies of PUO

  • Infections (Specifc Location)
A
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19
Etiologies of **PUO** - Infections (Specic Organsims)
 Tuberculosis (particularly extra pulmonary)  Brucella  Viral infections: CMV-EBV  HIV-1 infection  Fungal infections: Aspergillus spp, Candida spp.
19
Bacteria Causing **PUO**
20
Viruses Causing **PUO**
21
Fungi Causing **PUO**
1. Candida albicans 2. Cryptococcus neoformans 3. Histoplasma capsulatum 4. Aspergillus spp. 5. Coccidioides immitis 6. Pneumocystis jiroveci
22
Parasites Causing **PUO**
1. Plasmodium–Malaria 2. Leishmania 3. Trypanosoma 4. Toxoplasma 5. Wuchereria bancrofti 6. Babesia microti
23
Etiologies of **PUO** - Specific Patients Groups
24
Etiologies of **PUO** - Specific Patients Groups (imported Infections)
Malaria, dengue, rickettsia, brucella, amoebic liver abscess, enteric fever, leishmaniasis
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Etiologies of **PUO** - Specific Patients Groups (HIV-Positive Patients)
disseminated Mycobacterium avium complex, Pneumocystis jiroveci (carnii) pneumonia, CMV and others
26
Etiologies of **PUO** - Specific Patients Groups (Nosocomial Infections)
infections related to prosthetic materials and surgical procedures
27
Etiologies of **PUO** - Malegnancies
28
Etiologies of **PUO** - Malegnancies (Hematologic Malignancies)
οƒœ Lymphoma οƒœ Leukemia οƒœ Myeloma
29
Etiologies of **PUO** - Malegnancies (Solid Tumors)
οƒœ Renal οƒœ Liver οƒœ Colon οƒœ Stomach οƒœ Pancreas
30
Etiologies of **PUO** - Connective Tissue Disorders
31
Etiologies of **PUO** - Connective Tissue Disorders (Older Adults)
οƒœ Giant cell arteritis οƒœ Polymyalgia Rheumatica
32
Etiologies of **PUO** - Connective Tissue Disorders (Younger Adults)
33
Miscellaneous Causes of **PUO**
- CVS - RESP - ENDO/META - GIT - HEMA - INHERITED - DRUGS - FACTITIOUS
34
Miscellaneous Causes of **PUO** - Xardiovascular
οƒ˜ Atrial myxoma οƒ˜ Aortitis οƒ˜ Aortic dissection
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Miscellaneous Causes of **PUO** - Respiratory
οƒ˜ Pulmonary embolism (PE) οƒ˜ Sarcoidosis οƒ˜ Extrinsic allergic alveolitis
36
Miscellaneous Causes of **PUO** - GIT
οƒ˜ IBD οƒ˜ Granulomatous hepatitis οƒ˜ Alcoholic liver disease οƒ˜ Pancreatitis
37
Miscellaneous Causes of **PUO** - Endocrine/Metabolic
οƒ˜ Thyrotoxicosis οƒ˜ Thyroiditis οƒ˜ Pheochromocytoma οƒ˜ Adrenal insufficiency
38
Miscellaneous Causes of **PUO** - Hematological
οƒ˜ Hemolytic anemia οƒ˜ PNH (Paroxysmal nocturnal hemoglobinuria) οƒ˜ TTP (Thrombotic thrombocytopenic purpura) οƒ˜ Myeloproliferative disorders
39
Miscellaneous Causes of **PUO** - Inherited
οƒ˜ FMF (Familial Mediterranean Fever) οƒ˜ Periodic fever syndromes
40
Miscellaneous Causes of **PUO** - Drug reactions
οƒ˜ Antibiotic fever οƒ˜ Drug hypersensitivity reactions
41
Characters of **Factitious fever**
42
Categories of Drug-Induced fever
- Antibiotic Induced fever - Cardiovascular system drug induced fever
43
Examples of Antibiotic Induced fever
 Erythromycin  Isoniazid  Penicillin  Nitrofurantoin  Quinidine
44
Examples of Cardiovascular system drug induced fever
 Captopril  Atropine  Clofibrate  Hydralazine  Hydrochlorothiazide  Alfa methyl dopa  Nifedipine
45
approach to a patient with PUO
46
approach to a patient with PUO - Stage I
οƒ˜ Careful history taking οƒ˜ Physical examination οƒ˜ Screening tests
47
approach to a patient with PUO - Stage II
οƒ˜ Review the history οƒ˜ Repeating physical examination
48
approach to a patient with PUO - Stage III
οƒ˜ Specific diagnostic tests οƒ˜ Noninvasive investigations
49
approach to a patient with PUO - Stage IV
Invasive tests
50
What to ask during Hx Taking in a patient with PUO?
- Duration and characteristics of the fever - Travel history or exposure to people who have traveled to regions endemic for particular diseases - Exposure to unpasteurized dairy products - Presence of rash, conjunctivitis. Mucous membrane changes, and arthritis - Presence of associated cough, weight loss, or lymphadenopathy
51
What to ask during Hx Taking in a patient with PUO? - Duration and characteristics of the fever
οƒœ Number of spikes per day οƒœ Timing of the temperature elevation οƒœ Whether the temperature returns to normal or below normal
52
What to ask during Hx Taking in a patient with PUO? - Travel history or exposure to people who have traveled to regions endemic for particular diseases
οƒœ Cat-scratch disease οƒœ Rat-bit fever οƒœ Leptospirosis
53
What to ask during Hx Taking in a patient with PUO? - Exposure to unpasteurized dairy products
Brucellosis
54
What to ask during Hx Taking in a patient with PUO? - Presence of rash, conjunctivitis. Mucous membrane changes, and arthritis
οƒœ Juvenile arthritis οƒœ SLE οƒœ Kawasaki syndrome
55
What to ask during Hx Taking in a patient with PUO? - Presence of associated cough, weight loss, or lymphadenopathy
οƒœ Lymphoma οƒœ Leukemia οƒœ Neuroblastoma οƒœ TB οƒœ HIV
56
Physical Examination in **PUO**
57
minimal diagnostic work up to qualify a case of **PUO**
58
Microbiological investigation of **PUO**
- Microscopy - Culture - Antigen detection - Nucleic acid detection - Immunological Tests
59
Microbiological investigation of **PUO** - Microscopy
60
Microbiological investigation of **PUO** - Microscopy (Blood Film)
οƒœ For direct identification of the organism as for malaria or trypanosomiasis οƒœ Atypical lymphocytes ( EBV,CMV,HIV-1, hepatitis, Toxoplasma)
61
Microbiological investigation of **PUO** - Microscopy (Sputum)
For mycobacteria and fungi
62
Microbiological investigation of **PUO** - Microscopy (Stool)
for ova ,cysts and parasites
63
Microbiological investigation of **PUO** - Microscopy (Urine)
for WBCs, RBCs, schistosoma ova, mycobacteria (early morning urine for three days)
64
Microbiological investigation of **PUO** - Microscopy (LM)
L/M examination of biopsy for (bacteria, mycobacteria, fungi, leishmania and other parasites)
65
Microbiological investigation of **PUO** - Microscopy (EM)
E/M for viruses, protozoa(e.g. microsporidia) and other fastidious organisms (e.g. T.whipplei)
66
Microbiological investigation of **PUO** - Culture
67
Microbiological investigation of **PUO** - Antigen Detection
68
Microbiological investigation of **PUO** - Antigen Detection (Blood)
for HIV p24 antigen, Cryptococcal antigen, Histoplasma antigen, aspergillus ELISA.
69
Microbiological investigation of **PUO** - Antigen Detection (BAL)
Aspergillus antigen
70
Microbiological investigation of **PUO** - Antigen Detection (CSF)
Cryptococcal antigen
71
Microbiological investigation of **PUO** - Antigen Detection (Nasopharyngeal-Throat Swap)
respiratory viruses
72
Microbiological investigation of **PUO** - Antigen Detection (Urine)
For Legionella antigen
73
Microbiological investigation of **PUO** - Nucleic acid detection
74
Microbiological investigation of **PUO** - Nucleic acid detection (Blood)
75
Microbiological investigation of **PUO** - Nucleic acid detection (CSF)
76
Microbiological investigation of **PUO** - Nucleic acid detection (Nasopharyngeal aspirate or throat swab)
77
Microbiological investigation of **PUO** - Nucleic acid detection (BAL)
78
Microbiological investigation of **PUO** - Nucleic acid detection (Tissue Specimens)
79
Microbiological investigation of **PUO** - Nucleic acid detection (urine)
80
Microbiological investigation of **PUO** - Nucleic acid detection (Stool)
81
Microbiological investigation of **PUO** - Immunological Tests
82
Microbiological investigation of **PUO** - Other Tests
83
Endocarditis & PUO
84
Hepatobiliary infections & PUO
85
Osteomyelitis & PUO
86
Rickettsial & chlamydial infections & PUO
87
Systemic bacterial illnesses & PUO
88
Viruses & PUO
89
Fungal infections & PUO
90
Parasitic infections & PUO
91
Lymphomas & PUO
92
Leukemias & PUO
93
Solid tumors & PUO
94
Regional enteritis & PUO
95
Granulomatous hepatitis & PUO
96
Collagen-vascular and autoimmune diseases & PUO
97
PUO & Rash
98
Another Name of FMF
99
Def of **FMF**
100
Causes of **FMF**
101
Pathophysiology of FMF
102
CP of **FMF**
103
Complications of FMF
104
Dx of **FMF**
105
TTT of FMF
106
Managment of PUO
107
Managment of PUO
108
Managment of Nosocomial PUO
109
..

Y3R5: Medicine I 🩺 (47 decks)

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