Internal Medicine

Download Approach to Internal Medicine: A Resource Book for Clinical by David Hui (auth.) PDF

By David Hui (auth.)

This booklet presents an built-in symptom-based and issue-based process with quick access to excessive yield medical info. for every subject, conscientiously prepared sections on diversified diagnoses, investigations and coverings are designed to facilitate sufferer care and exam education. - quite a few medical pearls and comparability tables aid increase studying. - foreign devices (US and metric) facilitate program in daily scientific perform. - Many hugely very important, not often mentioned subject matters in drugs are coated (e.g., smoking cessation, weight problems, transfusion reactions, needle stick accidents, code prestige dialogue, interpretation of gram stain, palliative care). - crucial reference for each scientific scholar, resident, fellow, working towards health care professional, nurse, and health practitioner assistant. - 3rd version has new layout with reader pleasant improvements.

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BMI is usually >35 kg/m2. Treatment options include respiratory stimulants, ventilatory support, oxygen therapy, and weight loss Respiratory Acidosis: Hypoventilation SPECIFIC ENTITIES (CONT’D) NARCOLEPSY—severe daytime hypersomnolence, cataplexy (loss of postural tone, usually with emotions), sleep paralysis (usually happens after sleep– wake transition), hypnagogic hallucinations (visual or auditory hallucinations during drowsiness) RESTLESS LEG SYNDROME  PATHOPHYSIOLOGY—associated with iron deficiency, hypoparathyroidism, uremic neuropathy, diabetic neuropathy, rheumatoid arthritis, and fibromyalgia  CLINICAL FEATURES—desire to move extremities, associated with paresthesias, dysesthesias, and motor restlessness (floor pacing, leg rubbing).

7 APPROACH—‘‘radiation of chest pain, diaphoresis, hypotension, and S3 suggest acute MI. Chest pain that is pleuritic, sharp or stabbing, positional or reproduced by palpation decreases likelihood of acute MI. On ECG, any ST ", new Q waves, or new conduction D make acute MI very likely. Normal ECG is very powerful to rule out MI’’ JAMA 1998 280:14 INVESTIGATIONS BASIC  LABS—CBCD,    lytes, urea, Cr, glucose, troponin/ CK Â3 q8h, AST, ALT, ALP, bilirubin, INR/PTT, Mg, Ca, PO4, albumin, lipase, fasting lipid profile, HbA1C IMAGING—CXR, echocardiogram (first 72 h), MIBI/thallium (>5 days later) ECG—q8h Â3 or with chest pain STRESS TESTS—ECG, echocardiogram, MIBI once stable (>48 h post-MI)  CORONARY CATHETERIZATION DIAGNOSTIC AND PROGNOSTIC ISSUES RATIONAL CLINICAL EXAMINATION SERIES: IS THIS PATIENT HAVING A MYOCARDIAL INFARCTION?

Initial aortic tear and subsequent extension of a false lumen along the aorta may also occlude blood flow into any of the following vascular structures:  CORONARY—acute myocardial infarction (usually RCA)  BRACHIOCEPHALIC, LEFT SUBCLAVIAN, DISTAL AORTA— absent or asymmetric peripheral pulse, limb ischemia  RENAL—anuria, renal failure  CAROTID—syncope/hemiplegia/death  ANTERIOR SPINAL—paraplegia/quadriplegia, anterior cord syndrome CLASSIFICATION SYSTEMS  STANFORD—A ¼ any ascending aorta involvement, B ¼ all others PATHOPHYSIOLOGY (CONT’D) DEBAKEY—I ¼ ascending and at least aortic arch, II ¼ ascending only, III ¼ originates in descending and extends proximally or distally RISK FACTORS  COMMON—hypertension, age, male  VASCULITIS—Takayasu arteritis, giant cell arteritis, rheumatoid arthritis, syphilitic aortitis  COLLAGEN DISORDERS—Marfan syndrome, Ehlers– Danlos syndrome, cystic medial necrosis  VALVULAR—bicuspid aortic valve, aortic coarctation, Turner syndrome, aortic valve replacement  OTHERS—cocaine, trauma  CLINICAL FEATURES RATIONAL CLINICAL EXAMINATION SERIES: DOES THIS PATIENT HAVE AN ACUTE THORACIC AORTIC DISSECTION?

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