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typically shows leukocytoclastic vasculitis.
Decreased complement levels and increased ESR are present.
Presence of mixed cryoglobulinemia in the serum can be found in patients chronically infected with hepatitis C virus.
POLYARTERITIS NODOSA
Definition
This systemic necrotizing arteritis affects medium-sized muscular arteries, with occasional involvement of small muscular arteries.
See Table 2-1 .
Who Should Be Suspected?
Candidates are middle-aged or elderly individuals presenting with nonspecific symptoms of fatigue, arthralgias, weakness, or fever. These symptoms can be associated with signs of multisystem involvement such as hypertension, renal insufficiency, neurologic dysfunction, skin lesions, muscle involvement, or abdominal pain.
The condition is more common in men than women and may be preceded by hepatitis B or C infection.
Laboratory Findings
Diagnosis is based on clinical manifestations and confirmed by biopsy of involved organs. Laboratory studies are not diagnostic.
Elevated ESR and CRP.
Serologic tests are useful to rule out other autoimmune disorders and narrow down the differential diagnosis. ANCA test is usually negative in polyarteritis nodosa patients.
TAKAYASU ARTERITIS
See Chapter 3 , Cardiovascular Disorders.
See Table 2-1 .
Chapter 3
Cardiovascular Disorders
Craig S. Smith
Chest Pain
Chest Pain: Acute Coronary Syndromes
Chest Pain: Nonatherosclerotic Ischemia
Chest Pain: Inflammatory
Vasculitis
Antiphospholipid Antibody Syndrome
Henoch-Schönlein Purpura
Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome)
Takayasu Syndrome (Arteritis)
Thromboangiitis Obliterans (Buerger Disease)
Infectious (Secondary) Vasculitis
Thrombophlebitis, Septic
Pericarditis (Acute) and Pericardial Effusion
Chest Pain: Hyperadrenergic States
Chest Pain: Noncardiac Etiology
Acute Aortic Syndromes
Chest Pain: Musculoskeletal
Dyspnea
Congestive Heart Failure
Systolic Dysfunction/Dilated Cardiomyopathy (DCM)
Myocarditis
Heart Failure with Preserved Ejection Fraction (HF p EF)
Pericardial Constriction
Syncope and Sudden Cardiac Arrest
Syncope
Sudden Cardiac Arrest
Hypertension
Hyperlipidemia
Disorders of Lipid Metabolism
Acid Lipase Deficiencies
Metabolic Syndrome
Atherogenic Dyslipidemia
Hyperalphalipoproteinemia (HDL-C Excess)
Severe Hypertriglyceridemia (Type I) (Familial Hyperchylomicronemia Syndrome)
Familial Hypercholesterolemia (Type II)
Polygenic Hypercholesterolemia (Type IIA)
Familial Combined Hyperlipidemia (Types IB, IV, V)
Familial Dysbetalipoproteinemia (Type III)
Abetalipoproteinemia (Bassen- Kornzweig Syndrome)
Hypobetalipoproteinemia
Tangier Disease
Lecithin–Cholesterol Acyltransferase Deficiency (Familial)
Atherosclerosis
This Chapter focuses on the common presenting symptoms and conditions of cardiovascular disorders and the differential diagnoses to be considered in the evaluation of the patient. Chest pain, dyspnea, syncope/sudden cardiac death, hypertension, and dyslipidemia are discussed and further subdivided by clinical presentation and diagnostic approach.
CHEST PAIN
CHEST PAIN: ACUTE CORONARY SYNDROMES
Definition
Chest pain accounts for over 6 million annual emergency department visits and 3 million hospital admissions in the United States. The differential diagnosis for chest pain is broad and ranges from benign musculoskeletal conditions to life-threatening emergencies.
The prevalence of chest pain etiology varies greatly by location of the patient interaction. Acute coronary syndromes account for <2% of outpatient chest pain visits as opposed to 15% of emergency room visits. Of central importance in the evaluation of the patient with chest pain is a thorough history and physical supported by ancillary testing to determine if emergent treatment is required.
Initial clinical assessment is focused on immediate threats to life: acute coronary syndrome, aortic dissection, pulmonary embolism,
Decreased complement levels and increased ESR are present.
Presence of mixed cryoglobulinemia in the serum can be found in patients chronically infected with hepatitis C virus.
POLYARTERITIS NODOSA
Definition
This systemic necrotizing arteritis affects medium-sized muscular arteries, with occasional involvement of small muscular arteries.
See Table 2-1 .
Who Should Be Suspected?
Candidates are middle-aged or elderly individuals presenting with nonspecific symptoms of fatigue, arthralgias, weakness, or fever. These symptoms can be associated with signs of multisystem involvement such as hypertension, renal insufficiency, neurologic dysfunction, skin lesions, muscle involvement, or abdominal pain.
The condition is more common in men than women and may be preceded by hepatitis B or C infection.
Laboratory Findings
Diagnosis is based on clinical manifestations and confirmed by biopsy of involved organs. Laboratory studies are not diagnostic.
Elevated ESR and CRP.
Serologic tests are useful to rule out other autoimmune disorders and narrow down the differential diagnosis. ANCA test is usually negative in polyarteritis nodosa patients.
TAKAYASU ARTERITIS
See Chapter 3 , Cardiovascular Disorders.
See Table 2-1 .
Chapter 3
Cardiovascular Disorders
Craig S. Smith
Chest Pain
Chest Pain: Acute Coronary Syndromes
Chest Pain: Nonatherosclerotic Ischemia
Chest Pain: Inflammatory
Vasculitis
Antiphospholipid Antibody Syndrome
Henoch-Schönlein Purpura
Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome)
Takayasu Syndrome (Arteritis)
Thromboangiitis Obliterans (Buerger Disease)
Infectious (Secondary) Vasculitis
Thrombophlebitis, Septic
Pericarditis (Acute) and Pericardial Effusion
Chest Pain: Hyperadrenergic States
Chest Pain: Noncardiac Etiology
Acute Aortic Syndromes
Chest Pain: Musculoskeletal
Dyspnea
Congestive Heart Failure
Systolic Dysfunction/Dilated Cardiomyopathy (DCM)
Myocarditis
Heart Failure with Preserved Ejection Fraction (HF p EF)
Pericardial Constriction
Syncope and Sudden Cardiac Arrest
Syncope
Sudden Cardiac Arrest
Hypertension
Hyperlipidemia
Disorders of Lipid Metabolism
Acid Lipase Deficiencies
Metabolic Syndrome
Atherogenic Dyslipidemia
Hyperalphalipoproteinemia (HDL-C Excess)
Severe Hypertriglyceridemia (Type I) (Familial Hyperchylomicronemia Syndrome)
Familial Hypercholesterolemia (Type II)
Polygenic Hypercholesterolemia (Type IIA)
Familial Combined Hyperlipidemia (Types IB, IV, V)
Familial Dysbetalipoproteinemia (Type III)
Abetalipoproteinemia (Bassen- Kornzweig Syndrome)
Hypobetalipoproteinemia
Tangier Disease
Lecithin–Cholesterol Acyltransferase Deficiency (Familial)
Atherosclerosis
This Chapter focuses on the common presenting symptoms and conditions of cardiovascular disorders and the differential diagnoses to be considered in the evaluation of the patient. Chest pain, dyspnea, syncope/sudden cardiac death, hypertension, and dyslipidemia are discussed and further subdivided by clinical presentation and diagnostic approach.
CHEST PAIN
CHEST PAIN: ACUTE CORONARY SYNDROMES
Definition
Chest pain accounts for over 6 million annual emergency department visits and 3 million hospital admissions in the United States. The differential diagnosis for chest pain is broad and ranges from benign musculoskeletal conditions to life-threatening emergencies.
The prevalence of chest pain etiology varies greatly by location of the patient interaction. Acute coronary syndromes account for <2% of outpatient chest pain visits as opposed to 15% of emergency room visits. Of central importance in the evaluation of the patient with chest pain is a thorough history and physical supported by ancillary testing to determine if emergent treatment is required.
Initial clinical assessment is focused on immediate threats to life: acute coronary syndrome, aortic dissection, pulmonary embolism,
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