Fever of unknown origin physical examination: Difference between revisions

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Revision as of 18:47, 23 March 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: febris continua e causa ignota; febris e causa ignota; febris E.C.I.; fever/pyrexia of obscured/undetermined/uncertain/unidentifiable/unknown focus/origin/source; fever/pyrexia without a focus/origin/source; FUO; PUO

Physical Examination

Vitals

Temperature

A fever is often present. The periodicity of fever may have clinical significance in selected contexts.

Pulse

Weak or absent pulse may be present in Takayasu's arteritis.

Rate

Physiologically, fever is accompanied by tachycardia.
Relative bradycardia (Faget's sign) may be present in legionellosis, brucellosis, psittacosis, leptospirosis, drug fever, or factitious fever.

Skin

Janeway lesions may be present in infective endocarditis.
Petechiae may be present in Rocky Mountain spotted fever.
maculopapular, vesicular, or petechial rash may be present in typhus.
An eschar at the site of the tick bite may be present in tick-borne diseases.
Swollen lymph nodes may be present. Lymphadenopathy may represent reactive lymphoid hyperplasia (suggestive of inflammation or infection) or underlying malignant processes such as lymphoma.

Head

Temporal artery tenderness may be present in temporal arteritis.

Eyes

Roth's spots or conjunctival hemorrhage may be present in infective endocarditis.

Mouth

Oral thrush caused by candidiasis may be present in HIV/AIDS.
Tenderness with a palpable abscess may be present in periodontal disease.

Neck

Cervical lymph nodes may be present.

Lungs

Rales or rhonchi may be present in pneumonia.
Fremitus with diminished breath sounds may be present in pneumonia.

Heart

Heart murmurs may be present in endocarditis secondary to infections (infective endocarditis), systemic lupus erythematosus (Libman-Sacks endocarditis), or chronic diseases (marantic endocarditis)..

Abdomen

Abdominal tenderness may be present in intra-abdominal infections.
Rebound tenderness may be present in intra-abdominal infections.
An acute abdomen may be present in intra-abdominal infections.
Guarding may be present in intra-abdominal infections.
Flank pain may be present in psoas muscle abscess, perinephric abscess, or pyelonephritis.
An inguinal mass may be present in psoas muscle abscess.

Genitourinary

Prostatic enlargement may be present in prostatic abscess.

Extremities

Osler's nodes may be present in infective endocarditis.

Neurologic

Altered mental status may be present.

References

@@ Line 10: / Line 10: @@
 ==Physical Examination==
-===Appearance of the Patient===
 ===Vitals===
 ====Temperature====
+{{Details|Fever of unknown origin history and symptoms|'''Fever patterns and their clinical significance'''}}
 * A [[fever]] is often present.  The [[Fever of unknown origin history and symptoms#Fever patterns|periodicity of fever]] may have clinical significance in selected contexts.
 ====Pulse====
+* Weak or absent [[pulse]] may be present in [[Takayasu's arteritis]].
 =====Rate=====
-* Physiologically, fever is accompanied by [[tachycardia]]
+* Physiologically, fever is accompanied by [[tachycardia]].
-* [[Faget's sign|Relative bradycardia (Faget's sign)]] may be present
+* [[Faget's sign|Relative bradycardia (Faget's sign)]] may be present in [[legionellosis]], [[brucellosis]], [[psittacosis]], [[leptospirosis]], [[drug fever]], or [[fever|factitious fever]].
 ===Skin===
+* [[Janeway lesion]]s may be present in [[infective endocarditis]].
+* [[Petechiae]] may be present in [[Rocky Mountain spotted fever]].
+* [[Rash|maculopapular, vesicular, or petechial rash]] may be present in [[typhus]].
+* An [[eschar]] at the site of the tick bite may be present in [[tick-borne disease]]s.
+* [[Swollen lymph nodes]] may be present. [[Lymphadenopathy]] may represent reactive lymphoid hyperplasia (suggestive of [[inflammation]] or [[infection]]) or underlying malignant processes such as [[lymphoma]].
 ===Head===
-* Abnormalities of the head/hair may include ___
+* [[Temporal artery]] [[tenderness]] may be present in [[temporal arteritis]].
 ===Eyes===
+* [[Roth's spot]]s or [[conjunctival hemorrhage]] may be present in [[infective endocarditis]].
-* Ophthalmoscopic exam may be abnormal with findings of ___
+===Mouth===
+* [[Oral thrush]] caused by [[candidiasis]] may be present in [[HIV]]/[[AIDS]].
-===Ears===
+* [[Tenderness]] with a palpable [[abscess]] may be present in [[periodontal disease]].
-===Nose===
-===Throat===
 ===Neck===
-* [[Jugular venous pressure]] may be elevated
+* Cervical [[lymph nodes]] may be present.
-* [[Carotid bruits]] may be present
-* [[Lymph nodes]] may be present
-* [[Thyromegaly]] may be present
-* [[Hepatojugular reflux]] may be present
 ===Lungs===
-* [[Pulmonary edema]] and [[rales]] may be present
+* [[Rales]] or [[rhonchi]] may be present in [[pneumonia]].
-* [[Wheezing]] may be present
+* [[Fremitus]] with diminished [[breath sounds]] may be present in [[pneumonia]].
-* Consolidation may be present with reduced breath sounds auscultated
-* [[Rales]] may be present
-* [[Egophony]] may be present
-* Chest movement may be asymmetric
 ===Heart===
-* A [[heave]] may be present
+* [[Heart murmurs]] may be present in [[endocarditis]] secondary to [[infection]]s ([[infective endocarditis]]), [[systemic lupus erythematosus]] ([[Libman-Sacks endocarditis]]), or chronic diseases ([[marantic endocarditis]])..
-* A [[thrill]] may be present
-* A [[friction rub]] may be present
-====Auscultation====
+===Abdomen===
-* [[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
+* [[Abdominal tenderness]] may be present in [[intra-abdominal infection]]s.
-* [[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
+* [[Rebound tenderness]] may be present in [[intra-abdominal infection]]s.
-* [[Heart sounds#Third heart sound S3|S3]]
+* An [[acute abdomen]] may be present in [[intra-abdominal infection]]s.
-* [[Heart sounds#Fourth heart sound S4|S4]]
+* Guarding may be present in [[intra-abdominal infection]]s.
-* [[Heart sounds#Summation Gallop|Gallops]]
+* [[Flank pain]] may be present in [[psoas muscle]] [[abscess]], perinephric abscess, or [[pyelonephritis]].
-* A [[systolic murmur]] best heard at the base may be present
+* An inguinal mass may be present in [[psoas muscle]] [[abscess]].
-* A [[systolic murmur]] best heard at the apex may be present
-* A [[diastolic murmur]] may be present
-===Abdomen===
+===Genitourinary===
-* [[Abdominal distention]] may be present
+* Prostatic enlargement may be present in [[prostate|prostatic]] [[abscess]].
-* [[Abdominal tenderness]] may be present
-* [[Rebound tenderness]] may be present
-* An [[acute abdomen]] may be present
-* An abdominal mass may be present
-* Guarding may be present
-* [[Hepatomegaly]] may be present
-* [[Splenomegaly]] may be present
-* Genitourinary exam if relevant
 ===Extremities===
-* [[Clubbing]] may be present
+* [[Osler's node]]s may be present in [[infective endocarditis]].
-* [[Cyanosis]] may be present
-* [[Edema]] may be present
 ===Neurologic===
-* Mental status may be altered
+* [[Altered mental status]] may be present.
-* Conjunctivae: Roth's spots or conjunctival hemorrhage in infective endocarditis
-* Oropharynx: oral thrush in HIV/AIDS
-* temporal artery (eg, temporal arteritis)
-* [[Relative bradycardia]] (s/o [[legionellosis]], [[brucellosis]], [[psittacosis]], [[leptospirosis]], [[drug fever]], [[fever|factitious fever]])
 ==References==