Best Practice

Evaluation of nephrotic syndrome

2013-05-16

Nephrotic syndrome is defined as the presence of proteinuria (>3.5 g/24 hours), hypoalbuminemia (<3.0 g/dL), edema, and hyperlipidemia. This is in contrast to nephritic syndrome, which is typically defined as the presence of acute kidney injury (renal dysfunction), hypertension, and an active urinary sediment (red cells and red cell casts). Patients presenting with proteinuria without the other components of nephrotic syndrome are described as having nephrotic-range proteinuria. Nephrotic syndrome is not a disease; it is a constellation of several symptoms that can be caused by several renal diseases. The challenge is to determine any underlying disease causing the nephrotic syndrome in any given patient. Generally, patients with either nephrotic or nephritic syndrome require subspecialty treatment, and prompt consultation with a nephrologist is advised.

Nasal polyps

2013-05-16

Nasal polyps (NP) are swellings of the mucosal lining of the paranasal sinuses and are considered to represent a subgroup of chronic rhinosinusitis. They are made up of a mixture of loose connective tissue, edema, inflammatory cells (mostly eosinophils), glandular cells, and capillaries. They are covered with varying types of epithelium, mostly respiratory pseudostratified epithelium with ciliated cells and goblet cells. They are associated with nasal congestion and blockage, rhinorrhea, posterior nasal drip, and decreased sense of smell.

Cholera

2013-05-16

A secretory diarrheal illness caused by the gram-negative bacterium . Secretion of the cholera enterotoxin leads to continued activity of adenylate cyclase in intestinal epithelial cells and secretion of water and accompanying salts into the gut lumen.

Urinary tract infections in women

2013-05-16

A urinary tract infection (UTI) is an infection of the kidneys, bladder, or urethra. Infectious cystitis is the most common type of UTI, which is caused by a bacterial infection of the bladder. Pyelonephritis is an infection of the kidney that often occurs via bacterial ascent, and urethritis is an infection causing an inflammation of the urethra.

Evaluation of short stature

2013-05-15

Short stature is defined as a height that is 2 or more standard deviations below the mean for age and gender within a population (below the 2.5th percentile).

Poison ivy, oak, and sumac

2013-05-15

Poison ivy, oak, and sumac ( species) dermatitis is the prototypical allergic contact dermatitis of the northern US. It is caused by skin contact with soluble oleoresins (urushiols), resulting in severe acute dermatitis.

Open-angle glaucoma

2013-05-15

Glaucoma is a neurodegenerative condition primarily due to dysfunction in outflow of the nutrient-rich fluid, aqueous humor, constantly flowing through the eye. Aqueous humor, created in the ciliary body, passes through the pupil into the small area between the iris and the cornea, called the anterior chamber. The fluid then flows into the periphery of the chamber or angle, which is unblocked in open-angle glaucoma. This angle is where the fluid travels through the trabecular meshwork and into blood vessels. Open-angle glaucoma is characterized by an anatomically open angle but with an obstructed and slowed drainage system outflow. The mechanism of blockage is unclear. An increase in intraocular pressure results, characterized by retinal ganglion cell damage, then peripheral vision loss in early disease and central vision loss in late disease.

Gestational hypertension

2013-05-15

Gestational hypertension is defined by sustained BP readings of ≥140/90 mmHg during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria (<300 mg in 24 hours). It more often occurs in the second half of pregnancy. All manifestations of gestational hypertension are presumptive until retrospectively confirmed by complete resolution of hypertension and any other new abnormalities by 12 weeks postpartum; otherwise, other diagnoses should be considered.

Evaluation of vaginal bleeding

2013-05-14

Abnormal vaginal bleeding can be menstrual related (e.g., menorrhagia) or nonmenstrual related (e.g., intermenstrual or postcoital bleeding). Clinical definitions related to this topic include:

Down syndrome

2013-05-14

Down syndrome (DS), or trisomy 21, is the most common genetic form of intellectual disability, occurring in 1 in 691 births. In addition to having characteristic physical features, short stature, and hypotonia, individuals with DS have a distinctive cognitive and behavioral profile. They also have a higher frequency of associated medical conditions, including congenital heart and GI defects and thyroid, hematologic, audiologic, and visual abnormalities.

Failure to thrive

2013-05-14

Failure to thrive (FTT) is a descriptive term and refers to less than expected growth over time during the first 3 years of life when tracked on appropriate growth charts for children of the same age and sex. However, the definition varies between different healthcare providers, and the criteria used to diagnose the condition must be specified. FTT can be a pejorative term. Undernutrition is a descriptive term for poor growth and is preferred because it is more specific than FTT; it does not compound the possible failure parents may feel due to their infant's poor growth.

Necrotizing fasciitis

2013-05-14

Necrotizing fasciitis is a life-threatening subcutaneous soft-tissue infection that may extend to the deep fascia, but not into the underlying muscle. The causal organisms may be aerobic, anaerobic, or mixed flora. Two main clinical forms exist. Type I necrotizing fasciitis is a polymicrobial infection with an anaerobe such as or and a facultative anaerobe such as an Enterobacteriaceae or non-group A streptococcus. Type II necrotizing fasciitis is most commonly a monomicrobial infection with (group A streptococci).

Acute asthma exacerbation in children

2013-05-14

An asthma exacerbation is an acute or subacute episode of airflow obstruction occurring on a background of chronic airway inflammation and airway hyperresponsiveness. The exacerbation is initiated by a trigger that produces bronchoconstriction and increased mucus production, thereby worsening asthma symptoms such as wheeze, cough, dyspnea, and respiratory distress.

Contraception

2013-05-14

The US has one of the highest rates of unintended pregnancy in the developed world. About half of all pregnancies in the US are unintended. Of these, approximately 40% end in abortion.

Wiskott-Aldrich syndrome

2013-05-14

Wiskott-Aldrich syndrome (WAS) is an X-linked recessive condition and is characterized by the clinical triad of thrombocytopenia, eczema, and recurrent infections. Thrombocytopenia, with low platelet volume, is present from birth and is universal. Other features manifest over time and are variable, particularly immunodeficiency, which affects innate humoral and cellular immune responses, and a susceptibility to develop leukemia and lymphoma. There is a spectrum of disease severity, which correlates with expression of WAS protein (WASp) in hematopoietic cells. With rare exceptions, carriers are completely asymptomatic.

Evaluation of coma

2013-05-14

Coma is the absence of consciousness.

Patent foramen ovale

2013-05-14

Patent foramen ovale (PFO) is the persistent patency of a congenital opening or foramen ovale in the interatrial septum, which normally closes after birth. Notably, PFO is a potential cause of paradoxical embolism leading to CVA.

Evaluation of menorrhagia

2013-05-14

Menorrhagia has been classically defined as blood loss of ≥80 mL per month during cyclic menses. As menstrual blood volume is difficult to gauge, the term is commonly used to denote excessive volume and/or excessive duration (>1 week) of menstrual bleeding. The condition is common among women of reproductive age. Prevalence increases with age, peaking between 30 and 49 years of age, when about 1 in 20 women each year consults a primary care physician for bleeding.

Evaluation of dyspareunia

2013-05-14

Dyspareunia, or painful sexual intercourse, is a common complaint among women.

Evaluation of olfactory loss

2013-05-14

Olfactory loss has been linked to a variety of causes and can profoundly influence a patient's quality of life.