Examination Medicine: A Guide To Physician Training - Plot & Excerpts
The term ‘pyrexia of unknown origin’ is used only for patients with a fever >38.3°C for more than 3 weeks, for whom no diagnosis has been made during a week of intensive study. The common causes of PUO are listed in Table 13.1.Table 13.1Important causes of pyrexia of unknown origin The history1. Ask about the chronological development of symptoms. Gastrointestinal tract symptoms should be sought (e.g. subphrenic abscess, diverticular abscess, cholangitis, appendiceal abscess, liver abscess, Crohn’s disease, metastatic cancer in the abdomen, Whipple’s disease). Note any preceding acute infections (e.g. diarrhoeal illness, boils). a. Chest pain may suggest pericarditis, multiple pulmonary emboli or, rarely, intraluminal dissection of the aorta.b. Joint pain may suggest rheumatoid arthritis, SLE, vasculitis, atrial myxoma or endocarditis.c. Dysuria or rectal pain may indicate prostatic abscess or urinary tract infection.d. Headache and joint or muscle pain may indicate giant cell arteritis.e. Night sweats may indicate lymphoma, tuberculosis, brucellosis, endocarditis or an abscess.2. Ask about place of residence and overseas travel (e.g.
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