Fever of Unknown Origin

Fever of Unknown Origin Quiz

Test your knowledge on the diagnosis and management of Fever of Unknown Origin (FUO). This quiz contains carefully crafted questions designed to challenge both your clinical understanding and practical application of FUO concepts.

12 questions covering essential aspects of FUO
Multiple choice and clinical scenario-based questions
Engaging format for medical professionals and students alike

12 Questions3 MinutesCreated by DiagnosingDoctor152

True about the definition of Fever of Unknown Origin (FUO):

Fever of >38 C

Illness duration of ≥ 2 weeks

No immunocompromised state

No known comorbids

In patients with unexplained symptoms localized to the central nervous system, GI tract, or joints, they should be tested for?

Q fever

Whipple's disease

Coccidiodomycosis

Malaria

You're the intern at the OPD and you have quiet a group this morning. Which of the following patients scheduled warrants the diagnosis of fever of unknown origin (FUO)?

29 y/o woman with nearly daily fever of 38.3 C for 3 weeks. You saw her a week prior with facial rash, bilateral athralgias and fatigue. Lab work-up revealed proteinuria, anemia, and positive test for antinuclear antibodies (ANA) at a titer of >1:640

64 y/o man you saw 3 weeks ago. At the time, he had 1 week of twice-daily fever up to 39.2 C, rigors and a sore throat. He has since recovered and is asymptomatic now, but no cause was found despite extensive testing

26 y/o woman on mycophenolate mofetil, tacrolimus, and prednisone after having undergone kidney transplant 1 year ago. She has had fevers >38.3 C for just over 3 weeks. Evaluation 2 weeks ago included unrevealing results of ESR and CRP levels, CBC, electrolytes, LDH, ferritin, ANA, RF, urinalysis and urine culture, CXR, abdominal ultrasound and tuberculin skin test

45 y/o man with 4 weeks of nearly daily fevers to 38.5 C and crippling shin pain. You saw him 1 week ago and comprehensive exam done including ESR, CRP, CBC, electrolytes, LDH, ferritin, ANA, RF, urinalysis, blood and urine culture, CXR, abdominal ultrasound and tuberculin skin test have all been unrevealing

Which of the following statements regarding the epidemiology and prognosis of FUO is true?

For patients with FUO, an etiologic diagnosis is more likely in elderly patients than in young patients

FUO is usually caused by a very rare disease that escaped diagnosis during the initial obligatory workup

In patients with FUO, the ultimate inability to find an etiologic diagnosis portends a very poor prognosis

In both Western countries and countries outside the West, infection accounts for over half of FUO cases

Factitious fever means:

Fever artificially induced by the patient

Elevated body temperature associated with moderate to strenuous exercise lasting for half an hour up to several hours

Patient is normothermic but manipulates the thermometer

None of the above

What is the most important step in the diagnostic workup?

Getting all necessary laboratory tests

Thorough and complete history and physical examination

Biopsy

Imagings (CT scan, ultrasound, x-ray, etc.)

In a patient that you are working up for FUO, you already obtained a complete history and PE, stopped antibiotic treatment and glucocorticoids and have taken all obligatory tests. Still, you have potentially diagnostic clues (PDCs) that are absent or misleading, which is the next best step?

Do a PET CT scan

Do a biopsy

Do cryoglobulin test and funduscopy

Do blood cultures

50 y/o male taxi driver evaluated for fever and weight loss of uncertain etiology. He developed symptoms 3 months ago. He had daily fevers as high as 39.4 C with night sweats and fatigue. He also had loss of appetite and lost 50 lbs when compared to his last annual examination. He has no exposures or ill contacts. Past medical history significant for DM taking high dose insulin, obesity and OSA. He has never received blood transfusion and married with one sexual partner for 25 years. On exam, no focal findings identified. Multiple labs performed that have shown nonspecific findings only with exception of an elevated calcium level. CBC showed WBC of 15.7 with segmenter predominance 80% and lymphocytes of 15%. Peripheral blood smear is normal. ESR elevated. Rheumoatic panel, ferritin, liver and kidney functions normal. Serum protein electropheresis demonstrated polyclonal gammopathy. HIV, CMV and EBV tests negative. Blood culture, chest radiograpgh and PPD test negative. CT scan of chest, abdomen and pelvis shows borderline enlargement of lymph nodes in the abdomen and retroperitoneum to 1.2 cm. What would be the next best step in determining the etiology of fever in this patient?

Empiric treatment with corticosteroids

Empiric treatment for Mycobacterium tuberculosis

Needle biopsy of enlarged lymph nodes

Positron emission tomography (PET)-CT imaging

True or False: Empirical therapeutic trials with antibiotics, glucocorticoids, or anti-TB agents should be avoided in FUO except when a patient's condition is rapidly deteriorating after the diagnostic tests failed to provide a definite diagnosis

True

False

True or False: A negative TST or IGRA exclude a diagnosis of tuberculosis

True

False

BONUS:

1. If you were to choose which character you are in Money Heist, who would you be and why?

PS. If hindi ka nanonood, manood ka na HAHAHA

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