Diagnostic approach to the patient with jaundice.
Prim Care. 2011 Sep;38(3):469-8…

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Rational use of laboratory testing in the initial evaluation of soft tissue and joint complaints.

Prim Care. 2010 Dec;37(4):673-89, v

Authors: Waits JB

The rational use of laboratory testing to investigate early, undifferentiated joint pain depends heavily on a detailed history and careful physical examination. Nevertheless, several diagnostic tests have some discriminatory function in the initial evaluation of soft tissues and joint complaints, given the correct clinical context. Arthrocentesis frequently gives the best results when compared with other tests in the differential diagnosis of monoarticular and polyarticular joint pain. There is also a role for radiographs, and less frequently, magnetic resonance imaging. Although overuse of an arthritis panel is not recommended, for an appropriately chosen patient, complete blood cell count, serum uric acid, C-reactive protein (or erythrocyte sedimentation rate), rheumatoid factor, antiecyclic citrullinated peptide, and antinuclear antibody titers form a reasonable screening panel when rheumatic disease is suspected based on the clinical condition. Other tests might include a purified protein derivative, anti-Borrelia titers, and antibodies for antistreptolysin O. However, many rheumatic conditions can be diagnosed or at least suspected on clinical grounds alone, and a careful history and physical examination are absolutely essential for the appropriate use of any laboratory testing.

PMID: 21050950 [PubMed - indexed for MEDLINE]

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Arthrocentesis and therapeutic joint injection: an overview for the primary care physician.

Prim Care. 2010 Dec;37(4):691-702, v

Authors: Bettencourt RB, Linder MM

Athrocentesis and therapeutic joint injection is a safe and useful primary care procedure. Fluid collection and analysis from effused joints is important to establish a cause and therefore inform appropriate management. Therapeutic joint injection can give patients significant, rapid, localized pain relief.

PMID: 21050951 [PubMed - indexed for MEDLINE]

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Treatment options for end stage renal disease.

Prim Care. 2008 Sep;35(3):407-32, v

Authors: Crawford PW, Lerma EV

The latest National Health and Nutrition Study revealed an increasing incidence of kidney disease among aging baby boomers, as the incidence of diabetes mellitus and hypertension rises. Because of this trend, a greater proportion of a primary care physician’s practice will involve patients with chronic kidney disease, and consequently, end stage renal disease. Unfortunately, far too many of these chronic kidney disease patients are referred to a nephrologist very late. More often than not, the opportunity for secondary preventive intervention, with the goal of avoiding renal replacement therapy, is lost. This article addresses the various treatment options for patients with end stage renal disease.

PMID: 18710662 [PubMed - indexed for MEDLINE]

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Management of the kidney transplant recipient.

Prim Care. 2008 Sep;35(3):433-50, v

Authors: Padiyar A, Akoum FH, Hricik DE

The short-term outcomes of kidney transplant recipients have improved dramatically in the past 20 years, in large part resulting from the availability of more potent immunosuppressive drugs capable of preventing or treating acute allograft rejection. Ironically, side effects from these same immunosuppressants play a role in the long-term morbidity and mortality of this patient population. As kidney transplant recipients survive for longer periods of time with functioning allografts, primary care physicians will likely become more involved in their management, mandating at least a basic understanding of immunosuppression and its complications.

PMID: 18710663 [PubMed - indexed for MEDLINE]

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Approach to fluid and electrolyte disorders and acid-base problems.

Prim Care. 2008 Jun;35(2):195-213, v

Authors: Palmer BF

Employing a systematic approach to the interpretation of serum chemistries is the most effective way to ensure abnormalities are detected and correctly interpreted. This article reviews a series of steps that can be used in both the outpatient and inpatient settings. These steps will help to ensure the clinician identifies not only overt abnormalities but also subtle disturbances that may lay hidden in a routine set of serum chemistry values.

PMID: 18486713 [PubMed - indexed for MEDLINE]

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Related Articles

Approach to the patient with renal disease.

Prim Care. 2008 Jun;35(2):183-94, v

Authors: Lerma EV

There are various ways by which a patient with renal disease can present as either an initial outpatient or an inpatient consultation. Some patients can present with incidental hematuria and/or proteinuria. Symptoms generally vary but are more commonly noted with advanced stages of chronic kidney disease. A systematic, well organized approach is of utmost necessity in arriving at the correct diagnosis. A multitude of laboratory and ancillary studies, including a percutaneous renal biopsy (performed when necessary), are available to arrive at the right diagnosis. An algorithmic approach to hematuria and proteinuria is also presented.

PMID: 18486712 [PubMed - indexed for MEDLINE]

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Immunodeficiency overview.

Prim Care. 2008 Mar;35(1):159-73, viii

Authors: Morimoto Y, Routes JM

Primary immunodeficiencies are challenging in primary care settings, where clinicians often encounter patients with a history of recurrent infection. With advances in diagnostics and therapeutics, these disorders have been better understood and more successfully treated, yet their prognosis depends on early recognition of the disorder and initiation of the appropriate management. Because the primary care physician is most often the first physician encountered by a patient with immunodeficiency, primary care practitioners should be familiar with these rare but important disorders. This article provides an overview of the diagnosis and treatment of primary immunodeficiencies and two of the most common primary immunodeficiencies: common variable immunodeficiency and selective IgA deficiency.

PMID: 18206723 [PubMed - indexed for MEDLINE]

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