Pyrexia of Unknown Origin

Question 1

What is the definition of a fever?

Answer 1

Elevation of body temperature above normal (37c)

Variation of up to 0.8c daily, low in morning, high in early evening

Question 2

What is a pyrogen?

Answer 2

Substances which cause fever

Question 3

What are the different types of PUO?

Answer 3

Classical PUO
Nosocomial PUO
Neutropenic PUO
HIV associated PUO

Question 4

What is nosocomial PUO?

Answer 4

Develops in hospital, undiagnosed after 3 days

Question 5

What is neutropenic PUO?

Answer 5

Undiagnosed fever in patient with neutrophils <500/mm3

Question 6

What is HIV associated PUO?

Answer 6

Fever in a patient with HIV infection, present and undiagnosed for more than 3 days inpatient or 4 weeks outpatient

Question 7

What are the causes of classical PUO?

Answer 7

Infection
Malignancy
Inflammatory

Question 8

What are the common causes of HIV associated PUO?

Answer 8

Mycobacterium tuberculosis
Mycobacterium avium
Unknown
Cytomegalovirus

Question 9

What initial investigations should be done for PUO?

Answer 9

CXR
Urinalysis and urine microscopy 
FBC and differential WCC 
CRP and ESR 
Blood cultures taken at different times
Urea, creatinine, LFTs, electrolytes

Question 10

What investigations should be done for recent tropical travel?

Answer 10

Blood for malarial parasites, dengue, HIV

Bone marrow for leishmaniasis

Question 11

What investigations should be done for a new murmur?

Answer 11

Echocardiography

Question 12

What investigations should be done for headaches?

Answer 12

Temporal artery biopsy

Question 13

What investigations should be done for microhaematuria?

Answer 13

Auto-antibodies and renal biopsy

USS renal

Question 14

What investigations should be done for TB contact?

Answer 14

Sputum smear
Bone marrow
Mantoux test

Question 15

What is a fabricated fever?

Answer 15

Fever is real but self-induced