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McMurray Test

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381. Knee Injury, Soft Tissue (Overview)

(ROM) testing Lachman maneuver Anterior and posterior drawer tests Tibial sag test Pivot-shift test McMurray test Apley compression test Thessaly and Ege tests See for more detail. Diagnosis The following laboratory studies may be helpful: Blood typing and screening Complete blood count (CBC) Erythrocyte sedimentation rate (ESR) Serum electrolytes Blood glucose Blood urea nitrogen (BUN) and creatinine Analysis of aspirated synovial fluid for white blood cell (WBC) count and differential (...) , Wisniewski SJ, Pingree MJ. Ultrasound-guided intra-articular knee injection in an obese patient. Am J Phys Med Rehabil . 2012 Mar. 91(3):275-6. . Shaerf D, Banerjee A. Assessment and management of posttraumatic haemarthrosis of the knee. Br J Hosp Med (Lond) . 2008 Aug. 69(8):459-60, 462-3. . Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Arthroscopy . 2004 Nov. 20(9):951-8. . Andersen RE, Crespo CJ, Ling SM, Bathon

2014 eMedicine Emergency Medicine

382. Diabetes Mellitus, Type 2 (Treatment)

or insulin secretagogues. [ ] These effects may induce or worsen heart failure in patients with left ventricular compromise and occasionally in patients with normal left ventricular function. TZDs have not been tested in patients with New York Heart Association class III or IV heart failure. Fluid retention from TZDs has been considered resistant to treatment with loop diuretics, because of upregulation of renal epithelial sodium channels. However, a randomized, double-blind, placebo-controlled

2014 eMedicine Emergency Medicine

383. Congestive Heart Failure and Pulmonary Edema (Overview)

system is defined by the following four stages [ ] : Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure Stage B: Structural heart disease but no symptoms of heart failure Stage C: Structural heart disease and symptoms of heart failure Stage D: Refractory heart failure requiring specialized interventions Testing The following tests may be useful in the initial evaluation for suspected heart failure [ , , ] : Complete blood count (CBC) Iron studies (...) Urinalysis Electrolyte levels Renal and liver function studies Fasting blood glucose levels Lipid profile Thyroid stimulating hormone (TSH) levels B-type natriuretic peptide levels N-terminal pro-B-type natriuretic peptide levels Electrocardiography Chest radiography Two-dimensional (2-D) echocardiography Nuclear imaging [ ] Maximal exercise testing Pulse oximetry or arterial blood gas See for more detail. Management Treatment includes the following: Nonpharmacologic therapy: Oxygen and noninvasive

2014 eMedicine Emergency Medicine

384. Cardiomyopathy, Dilated (Overview)

Comprehensive metabolic panel Thyroid function tests Cardiac biomarkers B-type natriuretic peptide assay Chest radiography Echocardiography Cardiac magnetic resonance imaging (MRI) Electrocardiography (ECG) In many cases of cardiomyopathy, endomyocardial biopsy is class II (uncertain efficacy and may be controversial) or class III (generally not indicated). Class II indications for endomyocardial biopsy include the following: Recent onset of rapidly deteriorating cardiac function Patients receiving (...) coxsackievirus B was isolated from the myocardium of a newborn baby with a fatal infection. Advances in genetic analysis, such as polymerase chain reaction testing, have aided in the discovery of several viruses that are believed to have roles in viral cardiomyopathies. Viral infections and viruses associated with myocardial disease may be caused by the following: Coxsackievirus (A and B) [ ] Influenza virus (A and B) Adenovirus Echovirus Rabies Hepatitis Yellow fever Lymphocytic choriomeningitis Epidemic

2014 eMedicine Emergency Medicine

385. Diabetes Mellitus, Type 2 (Overview)

by the American Diabetes Association (ADA) include the following [ ] : A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic criterion (...) therapy alone or with other agents if needed to maintain blood glucose control Where possible, all treatment decisions should involve the patient, with a focus on patient preferences, needs, and values A major focus on comprehensive cardiovascular risk reduction The 2013 ADA guidelines for SMBG frequency focus on an individual's specific situation rather than quantifying the number of tests that should be done. The recommendations include the following [ , ] : Patients on intensive insulin regimens

2014 eMedicine Emergency Medicine

386. Atrial Fibrillation (Overview)

Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med . 2011 Sep 8. 365 (10):883-91. . Granger CB, Alexander JH, McMurray JJ, et al, for the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med . 2011 Sep 15. 365 (11):981-92. . . O’Riordan M. Consistent benefit of apixaban, even in patients at highest risk of bleeding: ARISTOTLE. Heartwire from Medscape. Available at . October 4, 2012; Accessed: October 15

2014 eMedicine Emergency Medicine

387. Atrial Fibrillation (Follow-up)

mg than with warfarin; dabigatran 150 mg had similar bleeding to that of warfarin. [ , ] A meta-analysis by Uchino and Hernandez evaluated the risk of myocardial infarction or acute coronary syndrome (ACS) with the use of dabigatran. The results suggest the risk of myocardial infarction or ACS was similar when using revised RE-LY trial results. Dabigatran is associated with an increased risk of myocardial infarction or ACS in an extensive range of patients when tested against different controls (...) of intracranial bleeding Rapid onset and offset of action, with no need for bridging with parenteral anticoagulant therapy during initiation or after interruption No need for periodic INR testing Superiority to warfarin for reducing the risk of thromboembolic events with dabigatran 150 mg BID and apixaban Disadvantages of the newer oral anticoagulants include the following: Requires strict compliance, because missing even a single dose could result in a period without anticoagulation No FDA-approved reversal

2014 eMedicine Emergency Medicine

388. Glomerulonephritis, Acute (Follow-up)

glomerulonephritis. Postgrad Med J . 2003 Apr. 79(930):206-13; quiz 212-3. . . Eicken S, Gugger M, Marti HP. [Glomerulonephritis and vasculitis as causes of arterial hypertension]. Ther Umsch . 2012 May. 69 (5):283-94. . Welch TR. An approach to the child with acute glomerulonephritis. Int J Pediatr . 2012. 2012:426192. . Hogan J, Mohan P, Appel GB. Diagnostic Tests and Treatment Options in Glomerular Disease: 2014 Update. Am J Kidney Dis . 2014 Apr. 63(4):656-666. . McMurray JJ, Adamopoulos S, Anker SD, et al (...) of function of the electrical barrier in the basement membrane, leading to loss of protein (primarily albumin) in large amounts (>3.5 g/day). The loss of albumin results in generalized edema from the loss of oncotic pressure that typically holds the fluid within the intravascular space. The diagnosis of acute glomerulonephritis is usually made on the basis of urinary findings, especially the presence of red blood cell casts. One of the most important tests is the complement C3 level

2014 eMedicine Emergency Medicine

389. Diabetes Mellitus, Type 2 (Follow-up)

or insulin secretagogues. [ ] These effects may induce or worsen heart failure in patients with left ventricular compromise and occasionally in patients with normal left ventricular function. TZDs have not been tested in patients with New York Heart Association class III or IV heart failure. Fluid retention from TZDs has been considered resistant to treatment with loop diuretics, because of upregulation of renal epithelial sodium channels. However, a randomized, double-blind, placebo-controlled

2014 eMedicine Emergency Medicine

390. Urinary Incontinence (Diagnosis)

(eg, delirium, psychiatric disorders, urinary infection, impaired mobility) See for more detail. Diagnosis Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. In selected patients, the following may also be needed: Voiding diary Cotton swab test Cough stress test Measurement of postvoid residual (PVR) urine volume Cystoscopy Urodynamic studies (see the image below) Urinary incontinence. Urodynamic study revealing (...) exists; most individual cases are likely multifactorial in nature. The etiologies of urinary incontinence are diverse and, in many cases, incompletely understood. Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis (see ). Additional information from a patient's voiding diary, cotton-swab test, cough stress test, measurement of postvoid residual (PVR) urine volume, cystoscopy, and urodynamic studies may be needed

2014 eMedicine Emergency Medicine

391. Atrial Fibrillation (Treatment)

mg than with warfarin; dabigatran 150 mg had similar bleeding to that of warfarin. [ , ] A meta-analysis by Uchino and Hernandez evaluated the risk of myocardial infarction or acute coronary syndrome (ACS) with the use of dabigatran. The results suggest the risk of myocardial infarction or ACS was similar when using revised RE-LY trial results. Dabigatran is associated with an increased risk of myocardial infarction or ACS in an extensive range of patients when tested against different controls (...) of intracranial bleeding Rapid onset and offset of action, with no need for bridging with parenteral anticoagulant therapy during initiation or after interruption No need for periodic INR testing Superiority to warfarin for reducing the risk of thromboembolic events with dabigatran 150 mg BID and apixaban Disadvantages of the newer oral anticoagulants include the following: Requires strict compliance, because missing even a single dose could result in a period without anticoagulation No FDA-approved reversal

2014 eMedicine Emergency Medicine

392. Clinical features and prognosis of discoid medial meniscus. (Abstract)

-year period. Patients presented with knee pain (13 patients), giving away (10 patients), swelling (9 patients) and snapping (9 patients). The most common physical signs were medial joint line tenderness (13 patients) and positive McMurray test (11 patients). Ten patients required total meniscectomy. There were excellent short-term results: the median Tegner score was 7, and the mean Lysholm score was 94.8 ± 2.4 at two-year follow-up. However, the long-term outcome was not as good with degenerative

2013 Knee Surgery, Sports Traumatology, Arthroscopy

393. An Intra-tendonous ganglion cyst causing impingement between the anterior cruciate ligament and anterior root of the medial meniscus: a case report. Full Text available with Trip Pro

from the anterior horn of the medial meniscus with a meniscal tear to the ACL.A 43-year-old female presented with a 10-year history of continuous aching pain in the right knee, but without any history of trauma. Clinical examination revealed right-sided knee pain in the medial joint line, exacerbated by end range flexion and extension, a -10°-100° active range of movement, and a -5°-110° passive range of movement。McMurray's, patellar compression, and compression rotation tests were positive

2013 BMC sports science, medicine and rehabilitation

395. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. (Abstract)

knee surgeon, a specialist in general orthopedics, a senior resident, and a fourth-year resident. These examiners recorded and evaluated the results of seven tests: the medial and lateral joint line tenderness test, the McMurray test, the Apley test, the Stienmann I test, the Payr's test, Childress' sign, and the Ege's test. The injury was classified as a meniscal tear if there were two positive tests. Clinical history, physical examination, and MRI findings were compared (...) tears. The experienced knee surgeon had better sensitivity, specificity, predictive values, and diagnostic accuracy parameters for medial meniscus tears in comparison with the other three examiners.These results indicate that clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear.II.

2012 Knee Surgery, Sports Traumatology, Arthroscopy

396. Surgical Decision Making for Arthroscopic Partial Meniscectomy in Patients Aged Over 40 Years. (Abstract)

findings, McMurray test, and failure of nonoperative management.Significant variation exists among practicing orthopaedic surgeons with regard to decision making for APM. The 3 clinical factors that most influenced a surgeon's decision to recommend APM were normal radiographic findings, failed nonoperative treatment, and the presence of positive physical examination findings (i.e., positive McMurray test, joint line tenderness, and effusion).Level III, decision analysis.Copyright © 2012 Arthroscopy

2012 Arthroscopy

397. Knee Pain … How Everything Is Connected — Why Can’t We Treat The Whole Person?

there ( did not repair it ) .I was very shocked and disappointed that is was torn. Back Story: The original examination in his office did not include any hands on testing for ligament tears. He only did what I later researched to be The McMurray Test after I explained symptoms of occasional locking while sitting on the floor ( Indian Style) and certain time instability, like slippage in the joint. He did an MRI in his office that showed ACL intact and the meniscus tear. So after all that rambling I would

2015 Howard J. Luks, MD blog

398. New York City infant day care study. Full Text available with Trip Pro

New York City infant day care study. 1180364 1975 12 29 2018 11 13 0090-0036 65 11 1975 Nov American journal of public health Am J Public Health New York City infant day care study. 1175-8 Rosenbluth L L Golden M M O'Hare D D McMurray G G Freeman H H Jr eng Comparative Study Journal Article Research Support, U.S. Gov't, Non-P.H.S. United States Am J Public Health 1254074 0090-0036 AIM IM Child Day Care Centers Child Development Child Health Services Child Rearing Child, Preschool Family (...) Government Agencies Humans Infant Infant Care methods Interpersonal Relations New York City Psychological Tests Public Health Administration 1975 11 11 19 15 2001 3 28 10 1 1975 11 11 19 15 ppublish 1180364 PMC1775991 Am J Public Health. 1972 Jan;62(1):43-5 5008639

1975 American Journal of Public Health

399. Treatment and recommendations for homeless people with Hypertension, Hyperlipidemia & Heart Failure

of recommended practice adaptations viii Introduction 1 Hypertension Case Study: Homeless Adult with Hypertension 5 DIAGNOSIS AND EVALUATION History Physical examination Diagnostic tests 6 7 8 PLAN AND MANAGEMENT Plan of care Education, self-management Medications Associated problems, complications Follow-up 9 9 11 12 14 Hyperlipidemia Case Study: Homeless Adult with Metabolic Syndrome 15 DIAGNOSIS AND EVALUATION History Physical examination Diagnostic tests 16 17 17 PLAN AND MANAGEMENT Plan of care (...) Education, self-management Medications Associated problems, complications Follow-up 18 19 20 21 23 Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Treatment & Recommendations for Homeless Patients with Cardiovascular Diseases vii Heart Failure Case Study: Homeless Adult with Heart Failure 24 DIAGNOSIS AND EVALUATION History Physical examination Diagnostic tests 25 25 26 PLAN AND MANAGEMENT Plan of care Education, self-management Medications Associated problems, complications

2009 National Health Care for the Homeless Council

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