Approach to Internal Medicine: A Resource Book for Clinical by David Hui, Alexander A. Leung, Raj Padwal

By David Hui, Alexander A. Leung, Raj Padwal

This totally up-to-date 4th variation of presents an built-in symptom- and issue-based process with quick access to excessive yield scientific details. for every subject, conscientiously prepared sections on diversified diagnoses, investigations, and coverings are designed to facilitate sufferer care and exam instruction. various medical pearls and comparability tables are supplied to aid increase studying, and overseas devices (US and metric) are used to facilitate software 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 additional. The fourth version contains many reader-friendly advancements resembling higher formatting, intuitive ordering of chapters, and incorporation of the latest directions for every subject. Approach to inner drugs continues to function an important reference for each clinical pupil, resident, fellow, training doctor, nurse, and health care professional assistant.

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Factor Xa inhibitors (rivaroxaban, apixaban) and direct thrombin inhibitors (dabigatran) not recommended for initial treatment of hemodynamically unstable PE; may consider in stable patients MANAGEMENT CONT’D under supervision of physician familiar with novel anticoagulant therapy THROMBOLYTICS—controversial as increased risk of intracranial bleed and multiple contraindications (see below). Consider only if hemodynamically unstable or life-threatening pulmonary embolism. 5 million IU over 2 h.

Absence of pain of sudden onset decreases likelihood of dissection. Normal aorta and mediastinum on CXR help to exclude diagnosis” JAMA 2002 287:17 D. Hui et al. 4. ]) PROGNOSIS · TYPE A—with surgery, 1-month survival 75–80%, 10-year survival 55% Acute Coronary Syndrome CARDIAC MYOCARDIAL —myocardial 1-month survival >90%, 10-year survival 56% MANAGEMENT ABC—O2 to keep sat >95%, IV, antihypertensive therapy (keep HR <60 and SBP <120 mmHg. 25–3 μg/ kg/min, maximum 10 μg/kg/min) TREAT UNDERLYING CAUSE—Type A (emergent surgical repair, endovascular stenting, longterm blood pressure control).

MEDIASTINUM WIDENING—right paratracheal stripe >4 mm, azygous region >4 mm, hilar APPROACH TO CHEST XRAY INTEPRETATION CONT’D involvement, AP window, tracheal deviation, carina angle widening 6. HEART · · 7. LUNGS · · · · · 8.  65) BILATERAL HILAR ADENOPATHY—neoplasm (lymphoma, metastases), infections (viral, TB, fungal), nonspecific inflammation (sarcoidosis, silicosis, Berylliosis, connective tissue disease) LUNG MASS ABUTTING THE HILUM MEDIASTINAL MASSES SUPERIOR MEDIASTINUM (above horizontal line drawn between sternomanubrial joint and T4 vertebra)—thyroid goiters, cystic hygromas, adenopathy, aneurysm ANTERIOR MEDIASTINUM (in front of heart border) ★5 T’s★ Thymoma Thyroid (retrosternal) · Teratoma · Terrible lymphoma · Tumor—bronchogenic carcinoma MIDDLE MEDIASTINUM (between anterior heart border and vertebral bodies)—infections (TB, fungal), neoplastic (bronchogenic, lymphoma, metastases, neurogenic, mesothelioma), sarcoidosis, aneurysm, cysts (bronchogenic, pericardial, esophageal), Castleman’s disease (giant LN hyperplasia) POSTERIOR MEDIASTINUM—neural tumors (sheath tumors [schwannomas, neurofibromas], ganglion cell tumors [neuroblastoma, ganglioneuroma]), non-neural tumors (mesenchymal, vertebral, lymphoma), Bochdalek’s hernia · · 25 Approach to Pulmonary Function Tests SIGNS FOR DISEASE PROCESSES HEART FAILURE—vascular redistribution/bat wings, cardiomegaly, peribronchial cuffing, Kerley B lines, pulmonary edema, pleural effusion COPD—hyperinflation, hemidiaphragm height <1 cm on lateral film, large retrosternal airspace, peripheral vessels end bluntly CYSTIC FIBROSIS—hyperinflation (flattened diaphragms, large retrosternal airspace), prominent interstitial markings (upper lobes progressing to the lower lobes), bronchiectasis (peribronchial cuffing, “tram tracks,” ring shadows), cysts, scarring (retraction of hilar regions), pulmonary arterial hypertension (pulmonary arteries dilatation), pneumothorax CT CHEST PROTOCOLS HIGH RESOLUTION—1 mm cut every 1 cm (10% of chest only).

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