presentation on PUO for consultant to do?

sportswear

im a res year student in vincents.

i was asked by a consultant on rounds today to:

"present to him a complete breakdown of the management of pyrexia of unknown origin using patient x as a reference"


its due for monday.


basically what does he mean by present. do i just look it all up and write it down and read it out to him???
- sort of like i would do for a history????

any suggestions on how to handle the "complete breakdown" bit

also if anyone knows of any nice articles\publications dealing with the issue that would also be sound.


thanks.

Vorsprung

Which consultant is it?

Always start by saying "i'd do a full history and complete exam". Then go through investigations, so start with blood tests and blood cultures, then urine tests (dipstick, MSU), then radiological. When you give a test, always say why you're doing that particular test (ie do FBC looking for raised WCC which would suggest infection).

Then using the results in that patient's chart, say how you'd treat them. So start with ABC, make sure they've a patent airway, they have adequate O2 saturation and are haemodynamically stable. The go through your treatments based on the investigations.

sportswear

Mr. Mc Nicholas,

Resp. Medicine

thanks

im sure it'll be a good laugh anyway

DrIndy

PUO is a HUGE differential.

Think - common infections ALWAYS FIRST - chest, urine etc....
Rare bacterial infections - ricketsia, leptospirosis, brucella, actinomycosis, Salmonella
Viral infections - EBV, CMV, HIV, Hepatitis B,C, Coxsakie
Parasites
TUBERCULOSIS - CAUSES ANYTHING AND EVERYTHING
Is the patient immunocompetent? (Fungal etc....)
Is this patient returning from a tropical/subtropical/north american country?
Any insect bites? Tick borne diseases.....
Endocarditis
Abscess

Then
Lymphoma
Vasculitis
Inflammatory autoimmune diseases

Then
Is this a drug fever? Trying LESS antibiotics might cure it.

Examine EVERYWHERE, (strip them down if neccessary to find any bites/rashes)

From this work out the correct investigations (I'm not going to give you every answer!) and remember to culture at least 3 times everywhere, check of TB, Do an echo, CT, US Abdomen.

Good luck - its a HUGE topic, so keep it succint....

tallaght01

don't do 3 CSF cultures though :P

DrIndy

:d

PoleStar

No way

Used to work in Vincents!

Doing surgery tho so not much help, as the medics say, we are just big thickos who "know nothing but do everything" ha!

MacNich is alright tho he wont give you a hard time.