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Hematology

Monoclonal gammopathy of undetermined significance

Monoclonal gammopathy of undetermined significance What every physician needs to know about monoclonal gammopathy of undetermined significance: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignant asymptomatic disorder, characterized by the presence of a monoclonal protein (M-protein) in the absence of end-organ damage, that can be attributable to plasma cell proliferation. It is defined by…
Gastroenterology Hepatology

Liver transplantation: indications/evaluation

How can I be sure that the patient has sufficient indications for liver transplantation? Patients that are candidates for liver transplantation have either acute or chronic end-stage liver disease. Manifestations of end-stage liver disease include synthetic dysfunction, inflammatory activity, and complications of portal hypertension. 1. Coagulopathy. Prolongation of the prothrombin time and international normalization ratio…
Dermatology

Lymphomatoid Papulosis

Are You Confident of the Diagnosis? What you should be alert for in the history Lymphomatoid papulosis (LyP) is characterized by a chronic relapsing course with grouped or disseminated papulonodular lesions involving the trunk and/or extremities. The duration of the disease may vary from less than 1 year to several decades. The eruption is generally…
Hospital Medicine

Acute tubular necrosis

I. What every physician needs to know. Acute kidney injury (AKI) is defined as an abrupt decline in kidney function. The traditional paradigm classifies AKI into prerenal, intrinsic renal, and postrenal etiologies based on the portion of renal anatomy most affected. Acute tubular necrosis (ATN), an intrinsic renal etiology of AKI, occurs with prolonged ischemic…
Cardiology

Cardiopulmonary Exercise Testing

1) General description of procedure, equipment, technique General description: In clinical medicine there are a variety of physiologic measurements that evaluate cardio-respiratory function. Many of these measurements are performed with patients at resting state or while patients carry out simple maneuvers. Prominent examples include spirometry, measurement of lung volumes, pulmonary diffusion capacity of carbon monoxide,…
Features

Managing systolic heart failure

Primary care providers can help significantly reduce heart failure exacerbations and improve their patients' overall quality of life.
Cardiology

Management of Pulmonary Hypertension

I. Pulmonary Arterial Hypertension: What Every Physician Needs To Know. Pulmonary arterial hypertension (PAH) is a disorder specific to the pulmonary arteries, resulting in an increase in pulmonary artery pressure (PAP), and pulmonary vascular resistance (PVR), leading to right ventricular (RV) dysfunction, right heart failure, and death. Pulmonary hypertension (PH) refers to elevated pressure in…
Obstetrics and Gynecology

Twin gestations – di/di

Diamniotic/Dichorionic Twin Gestation 1. What every clinician should know Clinical features and incidence According to the division of Vital Statistics of the National Centers for Health Statistics, the United States national twin birth rate reached an all time high of 33.9 per 1000 live births (3.4%) in 2014. Among non-Hispanic black mothers the twin birth…
Cardiology

Use of the Echocardiogram to Define the Presence, Extent, and Etiology of Cardiac Dysfunction

Indications and patient selection Introduction Heart failure (HF) is a clinical syndrome characterized by breathlessness and fatigue. Hemodynamically, HF is caused by the inability to generate adequate cardiac output to meet end organ and peripheral perfusion demands, or to do so only at the expense of elevated cardiac filling pressure. The diagnosis of HF is…
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