Home >> Medicine >> ForumTopic: Diagnostic Criteria for Major diseases -From Harrison 17ed
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| superbdoc Total Posts: 273 | Posted: Mon Mar 16, 2009 09:37 pm 1. Diagnostic Criteria for Autoimmune Hepatitis An international group has suggested a set of criteria for establishing a diagnosis of autoimmune hepatitis. * Exclusion of liver disease caused by genetic disorders, viral hepatitis, drug hepatotoxicity, and alcohol are linked with such inclusive diagnostic criteria as hyperglobulinemia, autoantibodies, and characteristic histologic features. This international group has also suggested a comprehensive diagnostic scoring system that, rarely required for typical cases, may be helpful when typical features are not present. Factors that weigh in favor of the diagnosis include » female gender; » predominant aminotransferase elevation; . » presence and level of globulin elevation; » presence of nuclear, smooth muscle, LKM1, and other autoantibodies; » concurrent other autoimmune diseases; » characteristic histologic features (interface hepatitis, plasma cells, rosettes); » HLA DR3 or DR4 markers; and » response to treatment . Improvement of fatigue, anorexia, malaise, and jaundice tends to occur within days to several weeks; Biochemical improvement occurs over the course of several weeks to months, with a fall in serum bilirubin and globulin levels and an increase in serum albumin. Therapy should continue for at least 12–18 months. After tapering and cessation of therapy, the likelihood of relapse is at least 50%, even if posttreatment histology has improved to show mild chronic hepatitis, and the majority of patients require therapy at maintenance doses indefinitely Weighing against the diagnosis are ► predominant alkaline phosphatase elevation, ► mitochondrial antibodies, ► markers of viral hepatitis, ► history of hepatotoxic drugs or excessive alcohol, ► histologic evidence of bile duct injury, or ► such atypical histologic features as fatty infiltration, iron overload, and viral inclusions. |
| superbdoc Total Posts: 273 | Posted: Fri Mar 20, 2009 03:03 pm The lack of specificity of a clinical diagnosis of Ventilator-Associated Pneumonia (VAP) has led to efforts to improve the diagnostic criteria. The Clinical Pulmonary Infection Score (CPIS) was developed by weighting of the various clinical criteria usually used for the diagnosis of VAP (Table 251-7). Use of the CPIS allows the selection of low-risk patients who may need only short-course antibiotic therapy or no treatment at all. [IMG]https://i39.tinypic.com/33lk10p.jpg[/IMG] Moreover, studies have demonstrated that the absence of bacteria in gram-stained endotracheal aspirates makes pneumonia an unlikely cause of fever or pulmonary infiltrates. These findings, coupled with a heightened awareness of the alternative diagnoses possible in patients with suspected VAP, can prevent inappropriate treatment for this disease. Furthermore, data show that the absence of an MDR pathogen in tracheal aspirate cultures eliminates the need for MDR coverage when empirical antibiotic therapy is narrowed. Since the most likely explanations for the mortality benefit of bronchoscopic quantitative cultures are decreased antibiotic selection pressure (which reduces the risk of subsequent infection with MDR pathogens) and identification of alternative sources of infection, a clinical diagnostic approach that incorporates such principles may result in similar outcomes. |
| mpge Total Posts: 35 | Posted: Sat Mar 21, 2009 02:21 am Most patients with diabetes mellitus die of atherosclerosis and its complications. Aging and rampant obesity in the U.S. population underlie a current epidemic of type 2 diabetes mellitus. The abnormal lipoprotein profile associated with insulin resistance, known as diabetic dyslipidemia, accounts for part of the elevated cardiovascular risk in patients with type 2 diabetes. While diabetic patients often have LDL cholesterol levels near average, the LDL particles tend to be smaller and denser, and, therefore, more atherogenic. Other features of diabetic dyslipidemia include low HDL and elevated triglyceride levels. Hypertension also frequently accompanies obesity, insulin resistance, and dyslipidemia. Indeed, the ATP III guidelines now recognize this cluster of risk factors and provide criteria for diagnosis of the "metabolic syndrome" (Table 235-3). Despite legitimate concerns regarding whether clustered components confer more risk than an individual component, the metabolic syndrome concept has considerable clinical utility. Clinical Identification of the Metabolic Syndrome—Any Three Risk Factors Risk Factor Defining Level Abdominal obesity Men (waist circumference) >102 cm (>40 in.) Women >88 cm (>35 in.) Triglycerides >1.7 mmol/L (>150 mg/dL) HDL cholesterol Men <1.0 mmol/L (<40 mg/dL) Women <1.3 mmol/L (<50 mg/dL) Blood pressure 130/85 mmHg Fasting glucose >6.1 mmol/L (>110 mg/dL) Overweight and obesity are associated with insulin resistance and the metabolic syndrome. However, the presence of abdominal obesity is more highly correlated with the metabolic risk factors than is an elevated body-mass index (BMI). Therefore, the simple measure of waist circumference is recommended to identify the BMI component of the metabolic syndrome. Some male patients can develop multiple metabolic risk factors when the waist circumference is only marginally increased, e.g., 94–102 cm (37–39 in.). Such patients may have a strong genetic contribution to insulin resistance. They should benefit from life-style changes, similarly to men with categorical increases in waist circumference. |
| superbdoc Total Posts: 273 | Posted: Sun Mar 22, 2009 11:43 pm CDC Criteria for Diagnosis of Chronic Fatigue Syndrome A case of chronic fatigue syndrome is defined by the presence of: * Clinically evaluated, unexplained, persistent or relapsing fatigue that is of new or definite onset; is not the result of ongoing exertion; is not alleviated by rest; and results in substantial reduction of previous levels of occupational, educational, social, or personal activities; and *Four or more of the following symptoms that persist or recur during six or more consecutive months of illness and that do not predate the fatigue: - Self-reported impairment in short-term memory or concentration - Sore throat - Tender cervical or axillary nodes - Muscle pain - Multijoint pain without redness or swelling - Headaches of a new pattern or severity - Unrefreshing sleep - Postexertional malaise lasting 24 h |
| superbdoc Total Posts: 273 | Posted: Sun Mar 22, 2009 11:46 pm Diagnostic Criteria of Behçet's Disease Recurrent oral ulceration plus two of the following: Recurrent genital ulceration Eye lesions Skin lesions Pathergy test |
| superbdoc Total Posts: 273 | Posted: Sun Mar 22, 2009 11:49 pm Transudative and exudative pleural effusions are distinguished by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none: 1. pleural fluid protein/serum protein >0.5 2. pleural fluid LDH/serum LDH >0.6 3. pleural fluid LDH more than two-thirds normal upper limit for serum The above criteria misidentify ~25% of transudates as exudates. If one or more of the exudative criteria are met and the patient is clinically thought to have a condition producing a transudative effusion, the difference between the protein levels in the serum and the pleural fluid should be measured. If this gradient is greater than 31 g/L (3.1 g/dL), the exudative categorization by the above criteria can be ignored because almost all such patients have a transudative pleural effusion. If a patient has an exudative pleural effusion, the following tests on the pleural fluid should be obtained: description of the fluid, glucose level, differential cell count, microbiologic studies, and cytology. |
| superbdoc Total Posts: 273 | Posted: Sun Mar 22, 2009 11:52 pm A prediction rule for the clinical diagnosis of Hypersensitivity Pneumonitis (HP) has been developed by the International HP Study Group. The most important tool in diagnosing HP continues to be a high index of suspicion! 6 significant predictors of HP (exposure to a known antigen, positive predictive antibodies to the antigen, recurrent episodes of symptoms, inspiratory crackles, symptoms developing 4–8 h after exposure, and weight loss[/i]) It is clear, however, that the diagnosis of HP is established by (1) consistent symptoms, physical findings, pulmonary function tests, and radiographic tests; (2) a history of exposure to a recognized antigen; and (3) ideally, identification of an antibody to that antigen. In some circumstances, BAL and/or lung biopsy may be needed. |
| mpge Total Posts: 35 | Posted: Mon Mar 23, 2009 02:37 am The 1987 Revised Criteria for the Classification of Rheumatoid Arthritis (RA) 1. Guidelines for classification a. 4 of 7 criteria are required to classify a patient as having rheumatoid arthritis(RA). b. Patients with 2 or more clinical diagnoses are not excluded. 2. Criteria a. Morning stiffness: Stiffness in and around the joints lasting 1 hour before maximal improvement. b. Arthritis of 3 or more joint areas: At least three joint areas, observed by a physician simultaneously, have soft tissue swelling or joint effusions, not just bony overgrowth. The 14 possible joint areas involved are right or left proximal interphalangeal, metacarpophalangeal, wrist, elbow, knee, ankle, and metatarsophalangeal joints. c. Arthritis of hand joints: Arthritis of wrist, metacarpophalangeal joint, or proximal interphalangeal joint. d. Symmetric arthritis: Simultaneous involvement of the same joint areas on both sides of the body. e. Rheumatoid nodules: Subcutaneous nodules over bony prominences, extensor surfaces, or juxtaarticular regions observed by a physician. f. Serum rheumatoid factor: Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5% of normal control subjects. g. Radiographic changes: Typical changes of RA on posteroanterior hand and wrist radiographs that must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints. Criteria a–d must be present for at least 6 weeks. Criteria b–e must be observed by a physician. |
| superbdoc Total Posts: 273 | Posted: Mon Mar 23, 2009 07:01 pm Asbury described the following diagnostic criteria for GBS variants with sensory loss and areflexia: 1) the onset must be rapid; 2) the distribution must be widespread and symmetric; 3) recovery must be complete or nearly so; 4) CSF protein must be elevated with few or no cells; and 5) electrodiagnostic results must be characteristic of a demyelinating process in the peripheral nerve. |
| mpge Total Posts: 35 | Posted: Tue Mar 24, 2009 04:53 am The Durie-Salmon staging criteria system for Multiple Myeloma, Myeloma Variants, and Monoclonal Gammopathy of Unknown Significance It is based on the Hemoglobin, calcium, M component, and degree of skeletal involvement; the total-body tumor burden is estimated to be Low (stage I), Intermediate (stage II), or High (stage III), and Stages are further subdivided on the basis of renal function -[A if serum creatinine <177 mol/L (<2 mg/dL), B if >177 (>2)]. Patients in stage IA have a median survival of >5 years and those in stage IIIB about 15 months. This staging system has been found not to predict prognosis after treatment with high-dose therapy or the novel targeted therapies that have emerged. |
| superbdoc Total Posts: 273 | Posted: Tue Mar 31, 2009 06:27 pm The Classic neurofibromatosis (NF-1) described by von Recklinghausen is an autosomal dominant disorder that affects approximately 1 in 4000 people. Patients with NF-1 develop Schwann cell tumors and pigmentation abnormalities. Orthopaedic problems are frequent in patients with this type of neurofibromatosis, with spinal deformity being the most common. Central neurofibromatosis(NF-2) also is an autosomal dominant disorder; however, it is much less common. It is characterized by bilateral acoustic neuromas. NF-2 neurofibromatosis does not have any bony involvement or orthopaedic Clinical Criteria for Diagnosis of Neurofibromatosis Type 1 To make the diagnosis of neurofibromatosis, two of the following features are necessary: ► A minimum of 6 café-au-lait spots larger than 1.5 cm in diameter in a postpubertal patient and larger than 5 mm in diameter in prepubertal patients ► 2 or more neurofibromas of any type or 1 plexiform neurofibroma ► Freckling in the inguinal or axillary regions ► Optic glioma ► 2 or more iris Lisch nodules by slit-lamp examination ► A distinctive osseous lesionScoliosis is the most common osseous defect associated with neurofibromatosis. ► A first-degree relative with a definitive diagnosis of neurofibromatosis |
| superbdoc Total Posts: 273 | Posted: Wed Apr 08, 2009 08:06 pm SUMMARY 1. Durie Salmon Staging for Multiple Myeloma 2. Duke Criteria for Infective endocarditis 3. Jones Criteria for Rheumatic Fever 4. Framingham’s Criteria for CHF 5. Ghent Criteria for Marfan Syndrome 6. CDC Criteria for Diagnosis of Chronic Fatigue Syndrome 7. American Rheumatism Association Diagnostic Criteria for R.A 8. Modified New York Criteria for Ankylosing Spondylitis 9. McDonald criteria for Multiple Sclerosis 10. Ranson Criteria to Predict Severity of Acute Pancreatitis 11. Balthazar CT severity index for acute pancreatitis. 12. Revised Criteria for the Diagnosis of Celiac Disease (CD) Proposed by the ESPGHAN 13. Child-Pugh Classification of Severity of Liver Disease 14. ROME II Diagnostic Criteria for Functional Abdominal Pain 15. NINDS-ADRDA Diagnostic criteria for Alzheimer's Disease (AD) |
| superbdoc Total Posts: 273 | Posted: Fri Apr 24, 2009 01:25 pm Staphylococcal toxic shock syndrome is a multisystemic1 illness that occurs infrequently, with an incidence less than 0.05 cases per 100,000 population2,3. It is caused by Exotoxin-producing strains of Staphylococcus aureus. The Centre for disease control has established major, minor, and exclusionary criteria to aid diagnosis4. Major Criteria: Fever > 38.9 Rash (diffuse macular erythroderma) Desquamation Hypotension / orthostatic syncope Minor Criteria: Multisystem involvement (3 or more criteria must be met) Gastrointestinal: vomiting or diarrhea at onset of illness Muscular: severe myalgia or creatine kinase level twice upper limit of normal for laboratory Mucous membrane: vaginal, oropharyngeal, or conjunctival hyperemia Renal: blood urea nitrogen or creatinine level at least twice upper limit of normal for laboratory, or >5 white blood cells per high-power field in absence of urinary tract infection Hepatic: total bilirubin, aspartate aminotransferase, or alanine aminotransferase at least twice upper limit of normal for laboratory Hematologic: platelets <100,000/mm3 Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent. Exclusionary Criteria: Normal results on the following tests (if performed): Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for Staph aureus) Absence of other explanation for the clinical presentation. Treatment in such cases is mainly supportive. It is aimed at correcting the multiorgan dysfunction with circulatory and inotropic support, maintaining respiratory and renal function, parenteral antibiotics, and correction of disturbed haematological indices and electrolytes. |
| superbdoc Total Posts: 273 | Posted: Sat Jun 27, 2009 03:34 am do contribute  |