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Major criteria
1. Low glomerular filtration rate, as indicated by serum creatinine greater than 1.5 mg/dl or
24-hour creatinine clearance lower than 40 ml/minute
2. Absence of shock, ongoing bacterial infection, fluid losses and current treatment with
nephrotoxic drugs
3. No sustained improvement in renal function (decrease in serum creatinine to 1.5 mg/dl or
less or increase in creatinine clearance to 40 ml/minute or more) following diuretic
withdrawal and expansion of plasma volume with 1.5 l of a plasma expander
4. Proteinuria lower than 500 mg/day and no ultrasonographic evidence of obstructive
uropathy or parenchymal renal disease
Additional criteria
1. Urine volume lower than 500 ml/day
2. Urine sodium lower than 10 mEq/l
3. Urine osmolality greater than plasma osmolality
4. Urine red blood cells less than 50 per high-power field
5. Serum sodium concentration lower than 130 mEq/l
All major criteria must be present for the diagnosis of hepatorenal syndrome. Additional criteria
are not necessary for the diagnosis, but provide supportive evidence.
Type I: Rapid and progressive impairment of renal function as defined by a doubling of the
initial serum creatinine to a level higher than 2.5 mg/dl or a 50% reduction of the initial 24-hour
creatinina clearance to a level lower than 20 ml/minute in less than 2 weeks
Type II: Impairment in renal function (serum creatinine 41.5 mg/dl) that does not meet the
criteria of type I
Diagnostic Criteria for Zollinger-Ellison Syndrome (ZES)
Diagnostic criteria for ZES include the following:
1. Elevated levels of Basal Acid Output (BAO), greater than 15 mEq in unoperated patients
and greater than 5 mEq if previous acid-reducing surgery has been performed;
2. Elevated level of fasting serum gastrin (>100 pg/mL until 1994, >200 pg/mL since 1994);
3. Abnormal results from stimulation testing with secretin (an increase of >200 pg/mL
postinjection) or with calcium (an increase >395 pg/mL);
4. Positive histologic confirmation of gastrinoma; or
5. A combination of these criteria.
The tests used most commonly to establish a diagnosis of ZES are the fasting serum gastrin
concentration and BAO evaluation. Measurement of gastric pH is important to exclude
achlorhydria as a cause of secondary hypergastrinemia. Patients taking Proton Pump Inhibitors
(PPIs), those who have undergone massive small bowel resection, or those who have renal
insufficiency, G-cell hyperplasia, or gastric outlet obstruction may have gastrin levels between
150 and 1000 pg/mL Hence, for patients with suspected ZES with an equivocal fasting serum
gastrin concentration, a secretin stimulation test should be performed.
Diagnostic Criteria for Wilson's disease
1. Low serum ceruloplasmin levels < 20 mg/dL (Normal range 20-50 mg/dL).
2. Kayser - Fleischer rings in eyes.
3. High liver copper levels > 250 micrograms/g dry weight (Normal range <35
micrograms/g dry weight).
4. High 24 hr urinary copper levels > 100 micrograms /d or > 1.6 mmol/d (Normal range
<50 micrograms/d or < 0.8 mmol/d).
5. Radioisotope copper studies using 64Cu, 67Cu or 65Cu, which assesses ability to
incorporate copper into ceruloplasmin.
Liver biopsy is very helpful for making the diagnosis of Wilson's disease, especially in patients
with normal ceruloplasmin levels and no evidence of Kayser-Fleischer rings. Hepatic copper
concentrations greater than 250 micrograms/g dry weight (normal is <35 micrograms) are often
found in untreated patients with Wilson's disease.
Identification of the Wilson's disease gene has made molecular diagnosis of this disease possible,
but population-based screening is not feasible or recommended at this time. Genetic testing
probably has had its biggest impact on screening of first-degree relatives of an affected person.
Severity Criteria for Acute Pancreatitis
Ranson Criteria to Predict Severity of Acute Pancreatitis
1. When three or more of the following are present on admission, a severe course complicated by
pancreatic necrosis can be predicted with a sensitivity of 60-80%:
• Age over 55 years.
• White blood cell count over 16,000/uL.
• Blood glucose over 200 mg/dL.
• Serum lactate dehydrogenase (LDH) over 350 units/L.
• Aspartate aminotransferase (AST, SGOT) over 250 units/L.
2. Development of the following in the first 48 hours indicates a worsening prognosis:
• Hematocrit drop of more than ten percentage points.
• Blood urea nitrogen (BUN) rise greater than 5 mg/dL.
• Arterial PO2 of less than 60 mm Hg.
• Serum calcium of less than 8 mg/dL.
• Base deficit over 4 meq/L.
• Estimated fluid sequestration of more than 6 L.
3. Mortality rates correlate with the number of criteria present:
Variable Criterion
Oxygenation defect Partial pressure of oxygen <80 mm Hg or alveolar–arterial
oxygen gradient ≥15 mm Hg while breathing ambient air
Pulmonary vascular Positive findings on contrast-enhanced echocardiography or
dilatation abnormal uptake in the brain (>6%) with radioactive lung-
perfusion scanning
Liver disease Portal hypertension (most common) with or without cirrhosis
Degree of severity
Mild * Alveolar–arterial oxygen gradient ≥15 mm Hg, partial
pressure of oxygen ≥80 mm Hg
Moderate * Alveolar–arterial oxygen gradient ≥15 mm Hg, partial
pressure of oxygen ≥60 to <80 mm Hg
Severe * Alveolar–arterial oxygen gradient ≥15 mm Hg, partial
pressure of oxygen ≥50 to <60 mm Hg
Very severe * Alveolar–arterial oxygen gradient ≥15 mm Hg, partial
pressure of oxygen <50 mm Hg (<300 mm Hg while the
patient is breathing 100% oxygen)
All criteria were determined by means of positive contrast-enhanced echocardiography (i.e.,
microbubble opacification of the left heart chambers three to six cycles after right atrial passage).
The abbreviated formula for the alveolar–arterial gradient is as follows:
PAO2−PaO2 = (FIO2 [Patm–PH2O] – [PaCO2/0.8]) – PaO2,
where PAO2 denotes partial pressure of alveolar oxygen, PaO2 partial pressure of arterial oxygen,
FIO2 fraction of inspired oxygen, Patm atmospheric pressure, PH2O partial pressure of water vapor
at body temperature, and PaCO2 partial pressure of arterial carbon dioxide (0.8 corresponds to
the standard gas-exchange respiratory ratio at rest); the normal range is 4 to 8 mm Hg (0.5 to 1.1
kPa). The normal range for the partial pressure of oxygen is 80 to 100 mm Hg (10.7 to 13.3 kPa)
at sea level, while the patient is at rest and breathing ambient air. For patients older than 64 years
of age, a value of ≤70 mm Hg (9.3 kPa) for PaO2 or ≥20 mm Hg for the alveolar-arterial gradient
is often used. Ambient air is the respired gas unless otherwise indicated. To convert millimeters
of mercury to kilopascals, multiply by 0.133.
Revised Criteria for the Diagnosis of Celiac Disease (CD) Proposed by the ESPGHAN
Definite diagnosis of CD
History and clinical presentation compatible with CD
1. Serological screening compatible with CD: antigliadin antibody (AGA) antiendomysium
antibody (AEA), tissue transglutaminase (tTG) antibody.
2. Histological findings compatible with CD: villous atrophy
3. Obvious clinical and serological response to a gluten free diet (GFD)
4. Subject >2 years old
5. Rule out other clinical conditions mimicking CD
Possible Clinical Manifestations of CD
A- Typical symptoms
• Chronic diarrhea
• Failure to thrive
• Abdominal distention
B- Atypical symptoms
I- Secondary to malabsorption
• Sideropenic anemia
• Short stature
• Osteopenia
• Recurrent abortions
• Hepatic steatosis
• Recurrent abdominal pain
• Gaseousness
II- Independent of malabsorption
• Dermatitis herpetiformis
• Dental enamel hypoplasia
• Ataxia
• Alopecia
• Primary biliary cirrhosis
• Isolated hypertransaminasemia
• Recurrent aphthous stomatitis
• Myasthenia gravis
• Recurrent pericarditis
• Psoriasis
• Polyneuropathy
• Epilepsy (with or without intracranial calcifications)
• Vasculitis
• Dilatative cardiomyopathy
• Hypo/hyperthyroidism
Serologic Screening Tests for the Diagnosis of CD
Hepatocyte 0 None
Ballooning 1 Few balloon The term "few" means rare but
cells definite ballooned hepatocytes as
well as cases that are diagnostically
borderline
2 Many Most cases with prominent
cells/prominent ballooning also had Mallory's
ballooning hyalin, but Mallory's hyaline is not
scored separately for the NAS
A total score of 5-6 is considered grade A (well-compensated disease); 7-9 is grade B (significant
functional compromise); and 10-15 is grade C (descompensated disease). These grades correlate
with one- and two-year patient survival.
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Ancillary Testing
Provide a brief description of the test methods and report the result so that it is easily understood
by the clinician.
Interpretation/Result
Negative for Intraepithelial Lesion or Malignancy (when there is no cellular evidence of
neoplasia, state this in the General Categorization above and/or in the Interpretation/Result
section of the report, whether or not there are organisms or other non-neoplastic findings)
Organisms:
• Trichomonas vaginalis
• Fungal organisms morphologically consistent with Candida species
• Shift in flora suggestive of bacterial vaginosis
• Bacteria morphologically consistent with Actinomyces species.
• Cellular changes consistent with Herpes simplex virus
Other non neoplastic findings (Optional to report; list not inclusive):
• Reactive cellular changes associated with
• inflammation (includes typical repair)
• radiation
• intrauterine contraceptive device (IUD)
• Glandular cells status post hysterectomy
• Atrophy
Other
• Endometrial cells (in a woman > 40 years of age)
(Specify if ‘negative for squamous intraepithelial lesion’)
GLANDULAR CELL
• Atypical
• endocervical cells (NOS or specify in comments)
• endometrial cells (NOS or specify in comments)
• glandular cells (NOS or specify in comments)
• Atypical
• endocervical cells, favor neoplastic
• glandular cells, favor neoplastic
• Endocervical adenocarcinoma in situ (AIS)
• Adenocarcinoma
• endocervical
• endometrial
• extrauterine
• not otherwise specified (NOS)
Other Malignant Neoplasms: (specify)
Minor criteria:
• Bilateral ankle edema
• Nocturnal cough
• Dyspnea on ordinary exertion
• Hepatomegaly
• Pleural effusion
• Decrease in vital capacity by one third from maximum recorded
• Tachycardia (heart rate>120 beats/min.)
Minor criteria are acceptable only if they can not be attributed to another medical condition (such
as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or the nephrotic syndrome).
The Framingham Heart Study criteria are 100% sensitive and 78% specific for identifying
persons with definite congestive heart failure.
Diagnostic Criteria for Cystic Fibrosis (CF)
One or more typical phenotypic features of CF:
• Chronic sinopulmonary disease
• Characteristic gastrointestinal and nutritional abnormalities
• Salt loss syndromes
• Obstructive azoospermia
or
or
PLUS
An elevated sweat chloride concentration (greater than 60 meq/L) on two or more occasions
or
or
In vivo demonstration of characteristic abnormalities in ion transport across the nasal epithelium
Finding Definition
Recurrent oral Minor aphthous, major aphthous, or herpetiform ulcers observed
ulceration by the physician or patient, which have recurred at least three
times over a 12-month period
Recurrent genital Aphthous ulceration or scarring observed by the physician or
ulceration patient
Eye lesions Anterior uveitis, posterior uveitis, or cells in the vitreous on slit-
lamp examination; or retinal vasculitis detected by an
ophthalmologist
Skin lesions Erythema nodosum observed by the physician or patient,
pseudofolliculitis, or papulopustular lesions; or acneiform nodules
observed by the physician in a postadolescent patient who is not
receiving corticosteroids
Positive pathergy test Test interpreted as positive by the physician at 24 to 48 hours
• For the diagnosis to be made, a patient must have recurrent oral ulceration plus at least
two of the other findings in the absence of other clinical explanations.
• Clinical Criteria for Do-Not-Resuscitate (DNR) Orders in Acute Stroke
• A DNR order may be written any time that two of the following clinical criteria are
present and the prognosis has become clear for and shared whenever possible between
physician(s), patient, and family (or appropriate surrogate).
• 1. Severe Stroke
Clinically severe stroke produces persisting (more than 24 hours) and sometimes
deteriorating neurological deficit, often with early impairment of consciousness leading
to total dependency of the patient in activities of daily living. The patient must have little
or no active movement on at least one side of the body, with either impaired
consciousness, global aphasia, or lack of response indicating cognition (Glasgow Coma
Scale score of less than 9, Canadian Neurological Scale score of less than 5.0).
• 2. Life-Threatening Brain Damage
Life-threatening brain damage is associated with brain stem compression caused by large
intracerebral hemorrhage (ICH), usually with intraventricular extension; large
hemispheric infarction with midline shift; infratentorial strokes involving multiple levels
in the brain stem; or cerebellar lesions.*
• 3. Significant Comorbidities
The following nonneurological conditions are important risk factors for death within the
first month after stroke: pneumonia, pulmonary embolism, sepsis, recent myocardial
infarction, cardiomyopathy, and life-threatening arrhythmias. These comorbid factors
should be considered part of expected consequences of severe stroke pointing to an
increased likelihood of death in the subacute phase of stroke.
• *Fatal outcome of ICH is associated with a volume of > 60 mL on CT scans. Currently
available data lack precision in quantifying imaging criteria and size of life-threatening
hemispheric infarctions and infratentorial lesions.
ACR Criteria for the Classification of Giant-Cell Arteritis
Three of the following five criteria were required to meet American College of Rheumatology
(ACR) classification criteria for giant-cell arteritis:
1. Age 50 years or older,
2. New-onset localized headache,
3. Temporal artery tenderness or decreased temporal artery pulse,
4. Erythrocyte sedimentation rate of at least 50 mm/h, and
5. Abnormal artery biopsy specimen characterized by mononuclear infiltration or
granulomatous inflammation.
These criteria have a reported sensitivity of 93.5% and a reported specificity of 91.2% for the
classification of giant-cell arteritis compared with other vasculitides.
Diagnostic Criteria for Cholangitis
The diagnostic criteria for cholangitis are:
a. fever or abdominal pain in the right upper quadrant;
b. endoscopic or radiologic (sonography or CT) evidence of biliary tract obstruction owing
to stones, stricture, or tumor; and
c. laboratory evidence of hyperbilirubinemia and elevated alkaline phosphatase.
Definition and Stages of Chronic Kidney Disease (CKD)
NKF Definition of Chronic Kidney Disease
• Kidney damage for three or more months, as defined by structural or functional
abnormalities of the kidney, with or without decreased GFR, manifested by pathologic
abnormalities or markers of kidney damage, including abnormalities in the composition
of the blood or urine or abnormalities in imaging tests
• GFR < 60 mL per minute per 1.73 m2 for three months or more, with or without kidney
damage
Diffuse Limited*
Skin involvement Distal and proximal Distal to elbows, face
extremities, face, trunk
Raynaud’s Onset within 1 year or at May precede skin disease
phenomenon time of skin changes by years
Organ Pulmonary (interstitial Gastrointestinal;
involvement fibrosis); renal pulmonary arterial
(renovascular hypertensive hypertension after 10-15
crisis); gastrointestinal; years of disease in <10% of
cardiac patients; biliary cirrhosis
Nail fold Dilatation and dropout Dilatation without
capillaries significant dropout
Antinuclear Anti-topoisomerase 1 Anticentromere
antibodies
* Also referred to as CREST( calcinosis, Raynaud’s, esophageal dysmotility, sclerodactyly,
telangiectasia).
Syphilis, primary
Clinical description: A stage of infection with Treponema pallidum characterized by one or
more chancres (ulcers); chancres might differ considerably in clinical appearance.
Laboratory criteria for diagnosis: Demonstration of T. pallidum in clinical specimens by
darkfield microscopy, direct fluorescent antibody (DFA-TP), or equivalent methods.
Case classification:
• Probable: a clinically compatible case with one or more ulcers (chancres) consistent with
primary syphilis and a reactive serologic test (nontreponemal: Venereal Disease Research
Laboratory [VDRL] or rapid plasma reagin [RPR]; treponemal: fluorescent treponemal
antibody absorbed [FTA-ABS] or microhemagglutination assay for antibody to T.
pallidum [MHA-TP])
• Confirmed: a clinically compatible case that is laboratory confirmed
Syphilis, secondary
Clinical description: A stage of infection caused by T. pallidum and characterized by localized
or diffuse mucocutaneous lesions, often with generalized lymphadenopathy. The primary chancre
may still be present.
Laboratory criteria for diagnosis: Demonstration of T. pallidum in clinical specimens by
darkfield microscopy, DFA-TP, or equivalent methods
Case classification:
• Probable: a clinically compatible case with a nontreponemal (VDRL or RPR) titer greater
than or equal to 4
• Confirmed: a clinically compatible case that is laboratory confirmed
Syphilis, latent
Clinical description: A stage of infection caused by T. pallidum in which organisms persist in
the body of the infected person without causing symptoms or signs. Latent syphilis is subdivided
into early, late, and unknown categories based on the duration of infection.
Case classification:
Probable: no clinical signs or symptoms of syphilis and the presence of one of the following:
• No past diagnosis of syphilis, a reactive nontreponemal test (i.e., VDRL or RPR), and a
reactive treponemal test (i.e., FTA-ABS or MHA-TP)
• A past history of syphilis therapy and a current nontreponemal test titer demonstrating
fourfold or greater increase from the last nontreponemal test titer
Neurosyphilis
Clinical description: Evidence of central nervous system infection with T. pallidum
Laboratory criteria for diagnosis: A reactive serologic test for syphilis and reactive VDRL in
cerebrospinal fluid (CSF)
Case classification:
Probable: syphilis of any stage, a negative VDRL in CSF, and both the following:
• Elevated CSF protein or leukocyte count in the absence of other known causes of these
abnormalities
• Clinical symptoms or signs consistent with neurosyphilis without other known causes for
these clinical abnormalities
Confirmed: syphilis of any stage that meets the laboratory criteria for neurosyphilis
Syphilis, late, with clinical manifestations other than neurosyphilis (late benign syphilis and
cardiovascular syphilis)
Clinical description: Clinical manifestations of late syphilis other than neurosyphilis may
include inflammatory lesions of the cardiovascular system, skin, and bone. Rarely, other
structures (e.g., the upper and lower respiratory tracts, mouth, eye, abdominal organs,
reproductive organs, lymph nodes, and skeletal muscle) may be involved. Late syphilis usually
becomes clinically manifest only after a period of 15-30 years of untreated infection.
Laboratory criteria for diagnosis: Demonstration of T. pallidum in late lesions by fluorescent
antibody or special stains (although organisms are rarely visualized in late lesions)
Case classification:
• Probable: characteristic abnormalities or lesions of the cardiovascular system, skin, bone,
or other structures with a reactive treponemal test, in the absence of other known causes
of these abnormalities, and without CSF abnormalities and clinical symptoms or signs
consistent with neurosyphilis
• Confirmed: a clinically compatible case that is laboratory confirmed
Comment: Analysis of CSF for evidence of neurosyphilis is necessary in the evaluation of late
syphilis with clinical manifestations.
Syphilitic Stillbirth
Clinical case definition: A fetal death that occurs after a 20-week gestation or in which the fetus
weighs greater than 500 g and the mother had untreated or inadequately treated* syphilis at
delivery
Comment: For reporting purposes, syphilitic stillbirths should be reported as cases of congenital
syphilis.
*Inadequate treatment consists of any non-penicillin therapy or penicillin given less than 30 days
before delivery.
Classification of Neutropenia
Acquired neutropenia
• Postinfectious: varicella, measles, rubella, hepatitis A and B, mononucleosis, influenza,
cytomegalovirus, parvovirus, acquired immunodeficiency syndrome (AIDS), S. aureus,
brucellosis, tularemia, rickettsia, Mycobacterium tuberculosis, sepsis.
• Drug induced: Antineoplastic agents, procainamide, antithyroid drugs, sulphasalazine,
phenothiazines, semisynthetic penicillins, nonsteroidal anti-inflammatory agents,
aminopyrine derivatives, benzodiazepines, barbiturates, gold compounds, sulfonamides,
propranolol, dipyridamole, digoxin, acetyldigoxin, sulfamethoxizole, anticonvulsants
• Benign familial neutropenia
• Chronic benign neutropenia of childhood
• Chronic idiopathic neutropenia
• Autoimmune neutropenia
• Isoimmune neutropenia
• Neutropenia associated with immunologic abnormalities
• Neutropenia associated with metabolic diseases
• Neutropenia due to increased margination
• Nutritional deficiency
Intrinsic defects
• Kostmann syndrome (severe infantile agranulocytosis)
• Myelokathexis/neutropenia with tetraploid nuclei
• Cyclic neutropenia
• Shwachman-Diamond-Oski syndrome
• Chediak-Higashi syndrome
• Reticular dysgenesis
• Dyskeratosis congenital
II. Oral symptoms: a positive response to at least one of the following questions:
1. Have you had a daily feeling of dry mouth for more than 3 months?
2. Have you had recurrently or persistently swollen salivary glands as an adult?
3. Do you frequently drink liquids to aid in swallowing dry food?
III. Ocular signs-that is, objective evidence of ocular involvement defined as a positive result for
at least one of the following two tests:
1. Schirmer's I test, performed without anaesthesia (</=5 mm in 5 minutes)
2. Rose bengal score or other ocular dye score (>/=4 according to van Bijsterveld's scoring
system)
IV. Histopathology: In minor salivary glands (obtained through normal-appearing mucosa) focal
lymphocytic sialoadenitis, evaluated by an expert histopathologist, with a focus score >/=1,
defined as a number of lymphocytic foci (which are adjacent to normal-appearing mucous acini
and contain more than 50 lymphocytes) per 4 mm2 of glandular tissue
For primary SS
In patients without any potentially associated disease, primary SS may be defined as follows:
a. The presence of any 4 of the 6 items is indicative of primary SS, as long as either item IV
(Histopathology) or VI (Serology) is positive
b. The presence of any 3 of the 4 objective criteria items (that is, items III, IV, V, VI)
c. The classification tree procedure represents a valid alternative method for classification,
although it should be more properly used in clinical-epidemiological survey
For secondary SS
In patients with a potentially associated disease (for instance, another well defined connective
tissue disease), the presence of item I or item II plus any 2 from among items III, IV, and V may
be considered as indicative of secondary SS
Exclusion criteria:
• Past head and neck radiation treatment
• Hepatitis C infection
• Acquired immunodeficiency disease (AIDS)
• Pre-existing lymphoma
• Sarcoidosis
• Graft versus host disease
• Use of anticholinergic drugs (since a time shorter than 4-fold the half life of the drug)
• Criteria for the Diagnosis of Behçet’s Disease
• For the diagnosis to be made, a patient must have recurrent oral ulceration plus at least
two of the other findings in the absence of other clinical explanations.
Finding Definition
Recurrent oral Minor aphthous, major aphthous, or herpetiform ulcers observed
ulceration by the physician or patient, which have recurred at least three
times over a 12-month period
Recurrent genital Aphthous ulceration or scarring observed by the physician or
ulceration patient
Eye lesions Anterior uveitis, posterior uveitis, or cells in the vitreous on slit-
lamp examination; or retinal vasculitis detected by an
ophthalmologist
Skin lesions Erythema nodosum observed by the physician or patient,
pseudofolliculitis, or papulopustular lesions; or acneiform nodules
observed by the physician in a postadolescent patient who is not
receiving corticosteroids
Positive pathergy test Test interpreted as positive by the physician at 24 to 48 hours
• For the diagnosis to be made, a patient must have recurrent oral ulceration plus at least
two of the other findings in the absence of other clinical explanations.
Criteria for the Classification of Wegener's Granulomatosis (WG)
1. Nasal or oral inflammation: Development of painful or painless oral ulcers or purulent or
bloody nasal discharge
2. Abnormal chest radiograph: Chest radiograph showing the presence of nodules, fixed
infiltrates, or cavities
3. Urinary sediment: Microhematuria (>5 red blood cells per high power field) or red cell
casts in urine sediment
4. Granulomatous inflammation on biopsy: Histologic changes showing granulomatous
inflammation within the wall of an artery or in the perivascular or extravascular area
(artery or arteriole)
For purposes of classification, a patient shall be said to have Wegener's granulomatosis if at least
2 of these 4 criteria are present. The presence of any 2 or more criteria yields a sensitivity of
88.2% and a specificity of 92.0%
Classification Criteria for Osteoarthritis
ACR Classification Criteria for Osteoarthritis of the Hip
Traditional format
Hip pain plus at least two of the following:
• ESR of less than 20 mm per hour
• Femoral or acetabular osteophytes on radiographs
• Joint space narrowing on radiographs
Classification-tree format
Hip pain plus femoral or acetabular osteophytes on radiographs
or
Hip pain plus joint space narrowing on radiographs and an ESR of less than 20 mm per hour
Traditional format
Knee pain plus osteophytes on radiographs and at least one of the following:
• Patient age older than 50 years
• Morning stiffness lasting 30 minutes or less
• Crepitus on motion
Classification-tree format
Knee pain and osteophytes on radiographs
or
Knee pain plus patient age of 40 years or older, morning stiffness lasting 30 minutes or less and
crepitus on motion
ACR Classification Criteria for Osteoarthritis of the Hand
* - 10 selected joints are the second and third distal interphalangeal joints, the second and third
proximal interphalangeal joints and the first carpometacarpal joints (of both hands).
Diagnostic Criteria for Adult Respiratory Distress Syndrome (ARDS)
Acute Respiratory Distress Syndrome (ARDS) is a syndrome of inflammation and increased
permeability associated with a constellation of clinical, radiologic, and physiologic abnormalities
unexplained by elevations in left atrial or pulmonary capillary pressure.
All definitions of this syndrome include patients who meet the following criteria:
• Identifiable associated condition
• Acute onset
• Pulmonary artery wedge pressure </=18 mm Hg or absence of clinical evidence of left
atrial hypertension
• Bilateral infiltrates on chest radiography
• Acute lung injury (ALI) is present if Pao2/Fio2 ratio is </= 300
• Acute respiratory distress syndrome is present if Pao2/Fio2 ratio </= 200
ARDS = acute respiratory distress syndrome; Pao2 = partial pressure of arterial oxygen; Fio2 =
percentage of inspired oxygen.
Clinical Conditions Associated with Development of Acute Respiratory Distress Syndrome
Direct lung injury
• Pneumonia
• Aspiration of gastric contents
• Inhalation injury
• Near drowning
• Pulmonary contusion
• Fat embolism
• Reperfusion pulmonary edema post lung transplantation or pulmonary embolectomy
Indirect lung injury
• Sepsis
• Severe trauma
• Acute pancreatitis
• Cardiopulmonary bypass
• Massive transfusions
• Drug overdose
Clinical Conditions Associated with Disseminated Intravascular Coagulation (DIC)
and
Requirements:
a. Serological
b. At least 3 clinical features
c. Association of hand oedema, Raynaud´s and acrosclerosis requires at least one other
feature
1. Cerebral cortical dysplasia and cerebral white matter migration tracts occurring together are
counted as one rather than two features of TSC.
2. When both lymphangiomyomatosis and renal angiomyolipomas are present, other features of
tuberous sclerosis must be present before TSC is diagnosed.
3. White matter migration lines and focal cortical dysplasia are often seen in individuals with
TSC; however, because these lesions can be seen independently and are relatively nonspecific,
they are considered a minor diagnostic criteria for TSC.
NIH Diagnostic Criteria for Neurofibromatosis
Diagnosis of Neurofibromatosis Type 1 (NF1)
1. Six or more café au lait macules over 5 mm in greatest diameter in prepubertal
individuals and over 15 mm in greatest diameter in postpubertal individuals
2. Two or more neurofibromas of any type or one plexiform neurofibroma
3. Freckling in the axillary or inguinal regions (Crowe´s sign)
4. Optic glioma
5. Two or more Lisch nodules (iris harmartomas)
6. A distinctive osseous lesion such as sphenoid dysplasia or thinning of long bone cortex
with or without pseudoarthrosis
7. A first-degree relative (parent, sibling, or offspring) with NF1 by the above criteria
The criteria are met in an individual if two or more of the features listed are present.