Fever of unknown origin physical examination
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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.
- Photophobia or ocular pain on palpation suggestive of uveitis may be present in Wegener's granulomatosis, Behcet syndrome, or infections.
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 in inflammation, infection, or lymphoma.
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.
- Splenomegaly may be present in infectious mononucleosis, splenic abscess, or hepatitis.
Genitourinary
Extremities
- Osler's nodes may be present in infective endocarditis.
- Swollen joints may be present in infectious arthritis or rheumatic diseases.
Neurologic
- Altered mental status may be present.