Mi - Pyrexia of Unknown Origin

Question 1

define classical PUO

Answer 1

> 38.3 degress for 3 weeks with 3+ days in hospital or 3 OPD appts

Question 2

what causes classical PUO

Answer 2

infection, cancer, vascular

Question 3

define nosocomial PUO

Answer 3

temp >38.3 degrees , pt hospitalised for >24 hours but no fever on admission. 3 days evaluation

Question 4

what causes nosocomial PUO

Answer 4

hospitals eg c.diff, sepsis, PE

Question 5

name 2 other types of PUO

Answer 5

immune deficiency
HIV associated

Question 6

give the %s of fever caused by:
- infection
- cancer
- inflammation
- PUO

Answer 6

30%
20%
25%
35%

Question 7

give Hx Qs of PUO

Answer 7

b sx, localising sx
meds
hx of pets / animal contact
IVDU, sexual Hx
foreign travel - where, when, busy, activities inc animals / water

Question 8

what is involved in PUO exam

Answer 8

top to toe inc ENT and derm
fundoscopy
feel each verterbrae for tenderness
temporal artery exam (GCA)

Question 9

name PUO bloods / Ix

Answer 9

routine admission ones - FBC, U&Es, LFTs, CRP, CXR, cultures, urine dip
PUO standard: 2 cultures, urine/stool culture inc parasites, CMV/EBV serology, HIV/HBV/HCV
extras: CK, ferritin, LDH, ANA, ANCA, RhF, TFTs
PET scan, echo, biopsies, LP, BM aspirate

Question 10

when does IgG vs IgM peak post infection

Answer 10

IgG = 2-3 weeks rise, positive for life
IgM = 1-2 weeks peak, gone after 6 weeks

Question 11

define Duke’s criteria for endocarditis

Answer 11

major
- blood cultures positive for IE
- endocardial involvemnet
minor
- predisposing factors
- temp >38
- vascular phenomena
- immunological phenomena
- microbio evidence

Question 12

name viral causes of PUO

Answer 12

CMV, EBV, HIV, hep

Question 13

name parasitic causes of PUO

Answer 13

malaria
schistosomiosis
toxoplasmosis
trypanosomiasis

Question 14

name fungal causes of PUO

Answer 14

cryptococcis
histoplasmosis
coccidiodes

Question 15

name bacterial causes of PUO

Answer 15

q fever
brucella
bartonella
mycobacteria eg TB
enteric fever
zoonoses

Question 16

which system helps Drs identify why bugs to screen for based on Hx

Answer 16

RIPL - rare and imported diseases

Question 17

name the old person inflamm cause of PUO

Answer 17

GCA

Question 18

name the young person cause of PUO

Answer 18

adult onset stills

Question 19

what is adult onset stills

Answer 19

major
- 39 degrees for 1+ week
- leucocytosis
- rash
- arthralgia > 2 weeks
minor
- sore throat

Question 20

describe the rash in adult onset stills

Answer 20

salmon pink

Question 21

what blood marker is high in adult onset stills

Answer 21

ferritin

Question 22

over 50. headache, jaw claudication, visual changes. Dx?

Answer 22

GCA

Question 23

what Ix should you do for GCA and what is the result?

Answer 23

ESR >50

Question 24

what cancers can cause PUO

Answer 24

lymphoma esp NHL
leukaemia
renaal cell carcinoma
hepatocellular carcinoma

Question 25

list other miscellaneous causes of PUO

Answer 25

thyroiditis addisons pe drug fever - ADRs

Question 26

Ix of IE

Answer 26

cultures, echo, serology

Question 27

Ix for TB

Answer 27

CXR, mycobacteria culture, sputum culture for acid fast bascili HIV

Question 28

Ix for CNS tuberculosis

Answer 28

MRI / CT LP HIV

Question 29

Ix for GCA

Answer 29

ESR temporal artery biopsy visual acuity

Question 30

Mx for GCA

Answer 30

prednisolone

Question 31

define sepsis

Answer 31

disordered host response to infection

Question 32

define septic shock

Answer 32

resistant to Tx for sepsis leading to end organ failure

Question 33

Mx for sepsis

Answer 33

start IV Abx immediately