Pyrexia of unknown origin

Question 1

What is normal body temperature?

Answer 1

36.0-37.0 (36.5)

Question 2

What is the definition of a fever?

Answer 2

Elevation of body temperature above 37 degrees

Variation of 0.8C daily

Question 3

What does SIRS stand for?

Answer 3

Systemic Inflammatory Response Syndrome

Question 4

What is the name of a substance which causes fever?

Answer 4

Pyrogens

Question 5

What are different types of pyrogens?

Answer 5

Endogenous cytokines

Exogenous endotoxins from –ve bacteria

Question 6

What is the definition of Pyrexia of Unknown origin?

Answer 6

Temp >38.3
Recorded on multiple occasions
Present for at least 3 weeks

Question 7

What are the different types of PUO?

Answer 7

Classical
Nosocomial (HAI)
Neutropenic
HIV-associated

Question 8

What are some of the causes of HIV related PUO?

Answer 8

Mycobacterium tuberculosis

Question 9

What initial investigations would you do in PUO?

Answer 9

CXR
Urinalysis or urine microscopy
FBC 
CRP
Blood cultures
Urea
Creatinine
Electrolytes

Question 10

What are the main causes of PUO?

Answer 10

TB

Malignancy

Question 11

What further investigations should you do in someone with PUO who has been travelling?

Answer 11

Blood microscopy - malarial parasites

Dengue

Question 12

What tests can you undertake to test for TB?

Answer 12

Sputum smear
Bone marrow
Mantoux

Question 13

What imaging techniques can be used in PUO?

Answer 13

CT scan
CT PET scan
TOE ultrasound

Question 14

What is a fabricated fever?

Answer 14

Fever is real but self-induced

self injection common