i would highly recommend to do ESR and CRP. We had a patient with idiopathic thoracic pains, and a slowly developing cyst in the back of her head. We handled her in primary care, with a normal referral to hospital with waiting times. Only when the ESR was over 100, we got our asses in gear, and it turned out to be myelomatosis, diagnosed by chest x ray in hospital and followed up further. ESR is incredibly nice to have as part of the initial workup, and CRP should be used to follow up the patient as a marker of disease response, especially in infectious disease
Thanks for the comment! Sinus tach is briefly covered in my Approach to Palpitations video: ru-vid.com/video/%D0%B2%D0%B8%D0%B4%D0%B5%D0%BE-ep7nkE4KvLk.html
doc you should do a textbook for medstudents and name strong internal medicine i will surely buy it i hope you seriously think about it and i suggest you let the subscribers vote . thanks for every thing you are doing for us
Great video series. loving it as a resident. Just one small thing. please, for the love of all that is good and beautiful in this world, start using the SI in the United States. You are giving us european doctors a headache every time we are studying from American videos and American books. Love from Greece. Υou are everything we needed while we were in medical school. Thank you for your great service to the spread of medical knowledge.
Lol. If it were up to me, we would! But gotta admit, using Fahrenheit for temperature isn't as bad as using "stone" for weight... (looking at you UK...)
Thanks for the concise information but I want to ask whether VTE should be considered in the workup (eg, D-dimer) [many textbooks include it as a possible cause of PUO].
I believe that uncomplicated VTE (i.e. an uninfected thrombosis not directly associated with a systemic disease) is a profoundly rare cause of FUO as defined partially by duration of illness > 3 weeks and an unremarkable initial work-up. I know that it shows up on some textbook lists as a cause of FUO, but if you actually dig into the literature on where that association initially came from (which I had an opportunity to do after being consulted on a malpractice case), the primary/original evidence is predominantly a handful of old case reports (from a time period when some now-better established causes of FUO hadn't even been formally described in the literature yet!). With such a low pretest probability for VTE, and poor specificity for d-dimer (it's elevated in many patients with malignancy and active autoimmune disease), an elevated d-dimer wouldn't change my decision about getting bilateral leg ultrasounds, or a CTPA instead of a routine chest CT. I don't think we should even assume the sensitivity of d-dimer for a >3 week old clot is reasonably good; studies looking at d-dimer as an initial test for VTE have all looked at acute VTE. I know some clinicians check d-dimer, and explicitly incorporate a VTE work-up into their FUO algorithm. I'm not asserting that this is necessarily wrong, but I'm not convinced it's the right thing either. tl;dr: I don't routinely check d-dimer or look for VTE in my work-up for FUO (unless a symptom or exam finding pointed in that direction), but I wouldn't criticize a clinician who chose to do so.
I made a blood temperature control needle that makes the body any temperature but people arent letting it be made available The needle also makes heart liver and kidney a normal temperature and only changes blood temperature and can make any part of the body any temperature you want
I'm a bit surprised not to see pulmonary embolism as one of the mentioned possible etiologies of FUO, as PE is a much more common phenomenon than some of the reasons mentioned (Adult onset Still's disease is literally a one in a million diagnosis), and close to 60% of PE patients will experience fever.
Doctor strong please make some videos on haematology and rheumatology symptoms like anaemia, generalized lymphadenopathy, pancytopenia, organomegaly joint pain ,etc
I've got some of these already. 8 videos on RBCs: ru-vid.com/group/PLYojB5NEEakXQ2w_ujs_XAED4PQ4JFfij 14 videos on hemostasis (e.g. platelets, coagulation cascade): ru-vid.com/group/PLYojB5NEEakW19w1r2T-QKQLrlO-kaXws
I am a former patient diagnosed with this, alongside double pneumonia and pericarditis. I was 22 and weighed 9 stones at 5'7 (that soon dropped to 7.5 stones). Not a fun time friends. Not a fun time at all. All good now though- that was almost 10 years ago. I looked like a corpse.
FUO is a symptom, not any one specific disease. Certainly one can die from a disease that could present as an FUO (e.g. cancer, tuberculosis, etc...), but there are plenty of causes of FUO that are generally not fatal.
