When the HOs are desperate

Saturday, April 10, 2010

A fancy way of doctors saying that they have absolutely no idea what is causing the fever is PUO- Pyrexia of unknown origin or more commonly termed FUO, Fever of unknown origin.

When doctors come across patients who were admitted for evaluation of PUO, they were forced to put on their thinking cap, generating differentials that could suggest a cause for the patient's on going chronic fever. In reality, they know just as much as the patient at that point of time and I do admit, it takes hell of a gut for a doctor to admit that he doesn't know what is wrong with you or what is causing the fever.

This 24 y.o female patient was referred from the OPD for evaluation for her 2 week history of unsettling fever. The HO is indeed stressed out to find out the exact cause by looking at all the tests he/she ordered

Pleural Effusion

Just this week, I've come across 2 patients with massive pleural effusion. Thought of sharing with my fellow colleagues since this is indeed a popular topic for bedside discussion or even exam.

This 80 y.o patient presented to the A&E with 2/7 progressive SOB and subsequently an AP CXR was taken
A 55 y.o patient with a known history of DM and HPT presented with generalized edema, ascites, peripheral upper and lower limb swelling and facial puffiness.

Pleural effusion can be divided into unilateral or bilateral.
1) What are the common causes for pleural effusion
2)What is the difference between transudation and exudation. What is the Light's criteria?
3)What are the clinical signs of pleural effusion
4)What are the investigations that you would order for the above patients to find out the underlying aetiology.