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
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...)
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
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
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.
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: ua-cam.com/play/PLYojB5NEEakXQ2w_ujs_XAED4PQ4JFfij.html 14 videos on hemostasis (e.g. platelets, coagulation cascade): ua-cam.com/play/PLYojB5NEEakW19w1r2T-QKQLrlO-kaXws.html
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.
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.
Doctor Strong, your easy to understand videos are a life raft in my final year of medical school. May you be blessed with many healthy years ahead
While almost all of videos are trying to prepare people for paper exams; you sir, make practical videos, teaching medicine actually!
that's amazing.
Thank you! That's the goal - to teach the medicine actually need for the care of patients.
Amazing lecture Dr. Eric👍🏻 please keep sharing your knowledge and wisdom
Great compilation of fuo. Thanks for your efforts.
Dr.Strong, thank you for this video. It's really helpful for me
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
Thats was a great lecture dr strong. Thank you very much
Excellent video!! Would love to see more of these approach videos like approach to sinus tachycardia/ inappropriate sinus tachycardia
Thanks for the comment! Sinus tach is briefly covered in my Approach to Palpitations video: ua-cam.com/video/ep7nkE4KvLk/v-deo.html
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...)
@@StrongMed so true
Thanks a lot dr for this video 🙏🏽
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
YT is a better medium for info than regular old text. Sincerly, a soon be intern.
@@agd712 yes i agree with you now that iam in my last year of medschool youtube has taught a lot of things
Thank you doctor 🤲
Dear prof and colleague can’t thank you enough amazing lecture 👍🏼 why echoheart is not done in tier 1 ?
Will be great if you can do videos for each branch: Nephrology, pulmonology,...
Thanks Sir for this excellent videos
Sir plz upload more videos on this topic.. approach to symptoms
Thanks a bunch sir.
Please make next video on approach to Seizure / Hemiparesis / paraparesis
Excellent video, can you do one for hematology?
Thank you Doctor Eric Strong. Oh I just found this lecture despite I subscribe with bell :) . Very good lecture, very informative,
Thank you so much it was very helpful
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
Gratitude now I know .
Amazing contant! Thank you :-)
I like ur video sir..tq
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.
Thank goodness someone recognizes that a drug can cause a FUO.
If a person shows some infection on lungs ? Should it be analysed ?
Best video
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: ua-cam.com/play/PLYojB5NEEakXQ2w_ujs_XAED4PQ4JFfij.html
14 videos on hemostasis (e.g. platelets, coagulation cascade): ua-cam.com/play/PLYojB5NEEakW19w1r2T-QKQLrlO-kaXws.html
Xcellant
Love you sir😊☺☺☺
I loved your video Sir
Thank you!
I read the title wrong and was very confused why you chose to analyze 'Fire of an Unknown Origin' by the Blue Oyster Cult.
Well Pyrexia comes from Greek word Pyretos which means fire.So Pyrexia=Fire😅
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.
❤❤❤❤❤❤❤
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.
I realise this is an academic video for those who are studying or otherwise vocationally interested. My bad.
11:50
Can people die due to FUO???
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.
ADLs? Full form
ADL = Activities of Daily Living (e.g. moving around one's home, bathing, using the toilet, getting dressed, feeding oneself)