By David Hui, Alexander A. Leung, Raj Padwal
This absolutely up-to-date 4th variation of offers an built-in symptom- and issue-based process with easy accessibility to excessive yield scientific details. for every subject, rigorously geared up sections on varied diagnoses, investigations, and coverings are designed to facilitate sufferer care and exam training. various medical pearls and comparability tables are supplied to aid improve studying, and overseas devices (US and metric) are used to facilitate program in daily medical practice.
The e-book covers many hugely very important, infrequently mentioned issues in medication (e.g., smoking cessation, weight problems, transfusion reactions, needle stick accidents, code prestige dialogue, interpretation of gram stain, palliative care), and new chapters on end-of-life care and melancholy were extra. The fourth version contains many reader-friendly advancements similar to greater formatting, intuitive ordering of chapters, and incorporation of the newest directions for every subject. Approach to inner medication continues to function a vital reference for each scientific scholar, resident, fellow, training healthcare professional, nurse, and doctor assistant.
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Extra resources for Approach to Internal Medicine: A Resource Book for Clinical Practice
Majority of tears found in ascending aorta at right lateral wall where the greatest shear force is produced AORTIC TEAR AND EXTENSION—aortic tear may produce a tearing, ripping sudden chest pain radiating to the back. Aortic regurgitation can produce diastolic murmur. Pericardial tamponade may occur, leading to hypotension or syncope. 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 PATHOPHYSIOLOGY CONT’D CLASSIFICATION SYSTEMS · STANFORD—A = any ascending aorta involvement, B = all others · DEBAKEY—I = ascending and at least aortic arch, II = ascending only, III = 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?
Unlikely to be malignant if significant change in <30 days or no change in 2 years CALCIFICATION CLUES · MALIGNANCY —eccentric calcification or noncalcified · TUBERCULOSIS OR HISTOPLASMOSIS—central/ complete calcification · BENIGN HAMARTOMA—popcorn calcification · · MANAGEMENT TREAT UNDERLYING CAUSE —if low probability, observation with serial CT scans. If medium probability, bronchoscopy with biopsy/ brush or transthoracic (CT/US-guided) biopsy. If high probability, thoracotomy with resection or video-assisted thoracoscopy (for patients who cannot tolerate thoracotomy medically and physiologically) SPECIFIC ENTITIES PANCOAST TUMOR · PATHOPHYSIOLOGY—superior sulcus tumors (mostly squamous cell carcinoma) invading and compressing the paravertebral sympathetic chain and brachial plexus · CLINICAL FEATURES—shoulder and arm pain (C8, T1, T2 distribution), Horner’s syndrome (upper lid ptosis, lower lid inverse ptosis, miosis, anhydrosis, enophthalmos, loss of ciliary-spinal reflex), and neurological symptoms in the arm (intrinsic muscles weakness and atrophy, pain and paresthesia of 4th and 5th digit).
Note that patients may have both obstructive and restrictive disease Note: general rule for the lower limit of normal for most PFT results is 80% of predicted (FEV1, FVC, DLCO, TLC) but less accurate for FEV1/FVC ratio and for patients of extremes of age OVERALL APPROACH Obstructive Restrictive Parenchymal Extraparenchymal (inspiratory) Extraparenchymal (inspiratory + expiratory) ANALYZING DLCO FEV1/FVC ↓ MIP N MEP N ↓ ↓ ↓ N/↑ N ↓/N/↑ N N/↓ N/↓ N N N/↓ ANALYZING DLCO CONT’D REFERENCE VALUES FOR DLCO High Normal Borderline low Mild decrease Moderate decrease Severe decrease TLC N/↑ % predicted >140% 81–140% 76–80% 61–75% 41–60% <40% OBSTRUCTIVE DISEASE PRESENT —DLCO usually normal in asthma and chronic bronchitis but ↓ in emphysema RESTRICTIVE DISEASE PRESENT —DLCO adjusted for alveolar volume usually ↓ in interstitial lung diseases and atelectasis and normal in neuromuscular diseases, chest wall abnormalities, and obesity ISOLATED DLCO ABNORMALITY WITHOUT OBVIOUS OBSTRUCTIVE OR RESTRICTIVE DISEASE—↓ DLCO may result from anemia, ↑ carboxyhemoglobinemia, PE, and pulmonary hypertension; ↑ DLCO may result from pulmonary hemorrhage, obesity, left-to-right shunts, and polycythemia 2 CARDIOLOGY Bryan Jonathan Har Aortic Dissection DIFFERENTIAL DIAGNOSIS CARDIAC infarction, angina, myocarditis · VALVULAR —aortic stenosis, aortic regurgitation · PERICARDIAL—pericarditis · VASCULAR—aortic dissection RESPIRATORY · PARENCHYMAL—pneumonia, cancer · PLEURAL—pneumothorax, pneumomediastinum, pleural effusion, pleuritis · VASCULAR—pulmonary embolism, pulmonary hypertension GI—esophagitis, esophageal cancer, GERD, peptic ulcer disease, Boerhaave’s, cholecystitis, pancreatitis OTHERS—musculoskeletal, shingles, anxiety · MYOCARDIAL—myocardial PATHOPHYSIOLOGY ANATOMY—layers of aorta include intima, media, and adventitia.
Approach to Internal Medicine: A Resource Book for Clinical Practice by David Hui, Alexander A. Leung, Raj Padwal