Fever of Unknown Origin History

  • CC:
    • Documentation of the fever: route of measurement? Readings? Frequency?
    • Onset: when? Frist time? Sudden\gradual? Intermittent\continuous? Getting better\worse?
    • Time: specific time of day? More at night?
    • Aggravating\relieving factors: antipyretics?
    • Severity: affecting ADL?
  • Associated sx:
    • Constitutional: fever, wt loss, loss of appetite, night sweats, chills?
    • CNS: headache, photophobia, stiff neck, confusion?
    • Resp: chest pain, cough\sputum, hemoptysis, ENT Sx?
    • GI: N\V, diarrhea, abdominal pain, jaundice?
    • GU: dysuria, hematuria, vaginal discharge?
    • Rhemua: joint pain, muscle aches, rash?
  • PMHx:
    • Diseases:
      • Chronic ds (HTN, DM, DLP)
      • Infections (HIV)
      • Autoimmune ds
      • Malignancy
    • Medications: steroids, abx, chemo
    • Surgery (transplant, dental, urine cath), hospitalization, trauma
    • Blood transfusions, IV drug use, tattoos
    • Allergies
  • FMHx:
    • Similar complaint?
    • Same diseases as in PMHx?
  • Social Hx:
    • Occupation, marital status, children?
    • Smoking, alcohol, recreational drugs?
    • Travel Hx, contact with sick pts\animals?
      • Where? Duration?
      • Activities: accommodation? Hiking? Diet? Sexual contact?
      • Vaccinations? Anti-malarial prophylaxis?
    • Diet (raw milk), exercise


  • Definition of Fever of Unknown Origin (FUO)?
    • Classic FUO:
      • ≥ 38.3° C
      • ≥ 3 weeks
      • Measure in 3 outpatient visits or 3 inpatient days
  • DDx of FUO?
    • Infections: TB, CMV, EBV
    • Malignancy: lymphoma, leukemia, RCC
    • Vasculitis\connective tissue ds: still’s ds
    • Drug fever
    • Factitious fever
  • Definition of SIRS?
    • Two or more of:
      • Fever or hypothermia
      • Hyperventilation or PaO2 < 32
      • Tachycardia
      • High WBC (> 12,000)


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