-
ACUTE BACTERIAL PROSTATITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Fever
- -Irritative voiding symptoms
- -Perineal or suprapubic pain; exquisite tenderness common on rectal
- Examination
- -Positive urine culture
-
CHRONIC BACTERIAL PROSTATITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Irritative voiding symptoms
- -Perineal or suprapubic discomfort, often dull and poorly
- -Localized
- -Positive expressed prostatic secretions and culture
-
BLADDER CANCER
- ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 1570)
- -Irritative voiding symptoms
- -Gross or microscopic hematuria
- -Positive urinary cytology in most patients
- -Filling defect within bladder noted on imaging
-
BENIGN PROSTATIC HYPERPLASIA
- ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 921)
- -Obstructive or irritative voiding symptoms
- -May have enlarged prostate on rectal exam
- -Absence of urinary tract infection, neurologic disorder, stricture
- disease, prostatic or bladder malignancy
-
PROSTATE CANCER
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Prostatic induration on DRE or elevation of PSA
- -Most often asymptomatic
- -Rarely: systemic symptoms (weight loss, bone pain).
-
RENAL CELL CARCINOMA
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Gross or microscopic hematuria
- -Flank pain or mass in some patients
- -Systemic symptoms such as fever, weight loss may be prominent
- -Solid renal mass on imaging
-
ADULT RHEUMA TOlD ARTHRITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Usually insidious onset with morning stiffness and pain in affected joints
- -Symmetric polyarthritis with predilection for small joints of the hands and feet;
- deformities common with progressive disease
- -Radiographic findings; juxta-articular osteoporosis, joint erosions, and joint space
- narrowing
- -Rheumatoid factor and antibodies tcyclic citrul!inated peptides, (anti-CCP) are present in 70-80%
- -Extra-articular manifestations: subcutaneous nodules, pleural effusion;
- pericarditis, lymphadenopathy, splenomegaly with leukopenia and vasculitis
-
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Occurs mainly in young women
- -Rash over areas exposed to sunlight
- -Joint symptoms in 90% of patients.
- -Multiple system involvement
- -Anemia, leukopenia, thrombocytopenia
- -Glomerulonephritis, central nervous system disease, and complications of
- anti phospholipid antibodies are major sources of disease morbidity
- -Serologic findings: ANA (100%), anti-native DNA, antibodies (-213), and low
- serum complement levels (particularly during disease flares)
-
SYSTEMIC SCLEROSIS (SCLERODERMA)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Limited disease (80%): thickening of skin confined tthe face, neck, and
- distal extremities
- -Diffuse disease (20%): widespread thickening of skin, including truncal
- involvement, with areas of increased pigmentation and depigmentation
- -Raynaud phenomenon and ANA are present in virtually all patients
- -Systemic features of gastroesophageal reflux, hypmotility of Gl tract,
- pulmonary fibrosis, pulmonary hypertension, and renal involvement
-
IDIOPATHIC INFLAMMATORY MYOPATHIES (POLYMYOSITIS and DERMATOMYOSITIS)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Bilateral proximal muscle weakness
- -Characteristic cutaneous manifestation in dermatomyositis (Gottron
- papules, heliotrope rash)
- -Diagnostic tests: elevated creatine kinase, muscle biopsy, EMG, MRI
- Increased risk of malignancy, particularly in dermatomyositis
-
SJOGREN SYNDROME
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Women are 90% of patients; the average age is 50 years
- -Dryness of eyes and dry mouth (sicca components) are the most
- common features; they occur alone or in association with rheumatoid
- arthritis or other connective tissue diseases
- -Rheumatoid factor and other autoantibodies common
- -Increased incidence of lymphoma
-
POL YMYALGIA RHEUMATICA (PMR) & GIANT CELL ARTERITIS (GCA)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Age over 50 years
- -GCA is characterized by visual abnormalities, and a markedly
- elevated ESR
- -The hallmark of PMR is pain and stiffness in shoulders and hips
- lasting for several weeks without other explanation
-
ANKYLOSING SPONDYLITIS (AS. MARIE-STRUMPELL DISEASE)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Chronic low backache in young adults, generally worst in the morning
- -Progressive limitation of back motion and of chest expansion
- -Transient (50%) or persistent (25%) peripheral arthritis
- -Anterior uveitis in 20-25%
- -Diagnostic radiographic changes in sacroiliac joints
- -HLA-827 testing is most helpful when there is an indeterminate probability
- of disease
-
PSORIATIC ARTHRITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Psoriasis precedes onset of arthritis in 80% of cases
- -Arthritis usually asymmetric, with "sausage" appearance of fingers and
- toes but a polyarthritis that resembles rheumatoid arthritis alsoccurs
- -Sacroiliac joint involvement common; ankylosis of the Sl joints may occur
- -Radiographic findings: osteolysis, pencil-in-cup deformity,; relative lack of osteoporosis, bony ankylosis; asymmetric Sl and atypical
- -syndesmophytes
-
REACTIVE ARTHRITIS (formerly called REITER'S SYNDROME)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -50-80% of patients are HLA-B27 positive
- -Oligoarthritis, conjunctivitis, urethritis, and mouth ulcers most common
- features
- -Usually follow dysentery or a sexually transmitted infection
-
GOUTY ARTHRITIS
- ESSENTIAL OF DIAGNOSIS (CMDT)
- -Acute onset, typically nocturnal and usually monarticular, often involving
- the first MTP joint
- -Polyarticular involvement more common in patients with long-standing
- disease
- -Identification of urate crystals in joint fluid or tophi is diagnostic
- -Dramatic therapeutic response to NSAIDs
- -With chronicity, urate deposits in subcutaneous tissue, bone, cartilage,
- joints, and other tissues
-
NONGONOCOCCAL SEPTIC ARTHRITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Acute onset of inflammatory monoarlicular arthritis, most often in large
- weight-bearing joints and wrists
- -Previous joint damage or injection drug abuse common risk factors
- -Infection with causative organisms commonly found elsewhere in body
- -Joint effusions are usually large, with WBC counts commonly > 50KimcL
-
GONOCOCCAL SEPTIC ARTHRITIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Prodromal migratory polyarthralgias
- -Tenosynovitis most common sign
- -Purulent monarthritis in 50%
- -Characteristic skin lesions
- -Most common in young women during menses or pregnancy
- -Symptoms of urethritis frequently absent
- -Dramatic response tantibiotics
-
LYME DISEASE (LYME ARTHRITIS, LYME BORRELIOSIS)
- ESSENTIALS OF DIAGNOSIS (CMDT 2011, p. 1415)
- -Erythema migrans
- -Headache or stiff neck
- -Arthralgias, arthritis, and myalgias; arthritis is often chronic and recurrent
- -Wide geographic distribution, with most US cases in NE, mid-Atlantic,
- upper Midwest, and Pacific coastal regions
-
ACUTE RHEUMATIC FEVER (ARF)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Uncommon in the US; more common in developing countries
- -Peak incidence ages 5-15 years
- -Diagnosis based on Jones criteria and confirmation of streptococcal
- infection
- -May involve mitral and other valves acutely, rarely leading to heart failure
-
OSTEOPOROSIS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Fracture propensity of spine, hip, pelvis, and wrist from
- demineralization
- -Serum PTH, calcium, phosphorus, and alkaline phosphatase usually
- normal
- -Serum 2-hydroxyvitamin D levels often low as a comorbid condition
-
OSTEOMALACIA
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Painful proximal muscle weakness (especially pelvic girdle); bone pain and
- tenderness
- -Decreased bone density from defective mineralization
- -Laboratory abnormalities may include increases in alkaline phosphatase,
- decreased 25 OH-D3, or hypocalcemia, hypophosphatemia, secondary
- -hyperparathyroidism
- -Classic radiologic features may be present
-
PAGET'S DISEASE (OSTEITIS DEFORMANS)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Often asymptomatic
- -Bone pain may be first symptom
- -Kyphosis, bowed tibias, large head, deafness, and frequent fractures
- -Serum calcium and phosphate normal, ALP elevated, urinary
- hydroxyproline elevated
- -Dense, expanded bones on radiographs
-
PRIMARY HYPERPARATHYROIDISM (PHPT)
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Frequently detected incidentally by screening
- -Renal calculi, polyuria, hypertension, constipation, fatigue, mental changes
- -Bone pain; rarely, cystic lesions and pathologic fractures
- -Serum and urine calcium elevated; urine phosphate high with low to
- normal serum phosphate; alkaline phosphatase normal televated
- -Elevated PTH
-
HYPOPARATHYROIDISM
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Tetany, carpopedal spasms, tingling of lips and hands, muscle and
- abdominal cramps, psychological changes
- -Positive Chvostek sign and Trousseau phenomenon
- -Serum calcium low; serum phosphate high; alkaline phosphatase normal;
- calcium excretion reduced
-
HYPOTHYROIDISM
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Weakness, fatigue, cold intolerance, constipation, weight change,
- depression, menorrhagia, hoarseness
- -Dry skin, bradycardia, delayed retum of deep tendon reflexes
- -Anemia, hyponatremia, hyperlipidemia
- -FT 4 level is usually low
- -TSH elevated in primary hypothyroidism
-
THYROTOXICOSIS- HYPERTHYROIDISM
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Sweating, weight loss or gain, anxiety, palpitations, loose stools, heat
- intolerance, irritability, fatigue, weakness, menstrual irregularity
- -Tachycardia; warm, moist skin, stare, tremor
- -In Grave's disease: goiter often with bruit, ophthalmopathy
- -Suppressed TSH in primary hyperthyroidism, increased T4, FT4, T3, FT3
-
TYPE 1 DIABETES MELLITUS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Polyuria, polydipsia, and weight Joss associated with random plasma
- glucose >= 200 mgldL
- -Plasma glucose of 126 mgldL or higher after an overnight fast,
- documented on more than one occasion
- -Ketonemia, ketonuria, or both
- -Islet autoantibodies are frequently present (not present in Idiopathic
- Type 1)
-
TYPE 2 DIABETES MELLITUS
- ESSENTIALS OF DIAGNOSIS (CMDT)
- -Most patients are over 40 years and obese
- -Polyuria and polydipsia
- -Ketonuria and weight loss generally are uncommon at time of diagnosis
- -Candidal vaginitis in women may be an initial manifestation
- -Many patients have few or nsymptoms
- -Plasma glucose of 126 mgldL or higher after an overnight fast on more
- than one occasion
- -After 75 g oral glucose, diagnostic values are 200 mgldL or more 2
- hours after the oral glucose
- -Hypertension, dyslipidemia, and atherosclerosis are often associated
|
|