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Category Archives: Differential Diagnosis

Acute Potassium Disorders


Disorders of potassium homeostasis are common in hospitalized patients and may be associated with severe adverse clinical outcomes, including death. Prevention and proper treatment of hyper- and hypokalemia depend on an understanding of the underlying physiology. The total body potassium content of a 70-kg adult is about 3500 mmol (136.5 g), of which only 2% […]

Evaluation of Chronic Heart Failure


Table 28-3 and 28-4, taken from the European Society of Cardiology heart failure guideline, recommend a routine assessment to establish the diagnosis and likely cause of heart failure. Once the diagnosis of heart failure has been made, the first step in evaluating heart failure is to determine the severity and type of cardiac dysfunction, by […]

The Differential Diagnosis of Abnormal Serum Uric Acid Concentration


Reference range: 4.0-8.5 mg/dL or 237-506 mmol/L for males >17 years old; 2.7-7.3 mg/dL or 161-434 mmol/L for females >17 years old Uric acid is the metabolic end-product of the purine bases of DNA. In humans, uric acid is not metabolized further and is eliminated unchanged by renal excretion (the net result of filtration, secretion, […]

Clinical Skills – Cluster the Clinical Findings


It is often challenging to decide whether clinical data fit into one problem or several problems. If there is relatively long list of symptoms and signs, and an equally long list of potential explanations, one approach is to tease out separate clusters of observations and analyze one cluster at a time. Several clinical characteristics may […]

The Physical Examination – Heart


The Splitting of Heart Sounds While these events are occurring on the left side of the heart, similar changes are occuring on the right side, which involves the right atrium, tricuspid valve, RV, pulmonic valve, and pulmonary arteries. Right ventricular and pulmonary arterial pressures are significantly lower than corresponding pressures on the left side. Note that […]