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

By David Hui (auth.)

This booklet offers an built-in symptom-based and issue-based technique with quick access to excessive yield scientific info. for every subject, rigorously prepared sections on assorted diagnoses, investigations and coverings are designed to facilitate sufferer care and exam education. - quite a few scientific pearls and comparability tables support increase studying. - foreign devices (US and metric) facilitate program in daily medical perform. - Many hugely vital, infrequently mentioned issues 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 professional, nurse, and healthcare professional assistant. - 3rd version has new structure with reader pleasant improvements.

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10 Pleural Effusion SPECIFIC ENTITIES TREATMENT ISSUES (CONT’D)  RELATIVE CONTRAINDICATIONS—TIA within 6 months, FAT EMBOLISM oral anticoagulation, pregnancy or within 1 week postpartum, non-compressible puncture sites, traumatic CPR, uncontrolled hypertension (SBP >185 mmHg, DBP >110 mmHg), advanced liver disease, infective endocarditis, active peptic ulcer, thrombocytopenia ANTICOAGULATION DURATION  PATHOPHYSIOLOGY—embolism  FIRST PULMONARY EMBOLISM WITH REVERSIBLE OR TIME-LIMITED RISK FACTOR—anticoagulation    for at least 3 months UNPROVOKED PE—at least 3 months of treatment.

Contraindicated in severe hypertension and arrhythmias APPROACH TO DIAGNOSIS OF STABLE CAD—start with history, physical, rest ECG, and CXR. If low probability, do not investigate further. If high probability, proceed with management. If intermediate probability ! stress test ! cardiac CT, MIBI or stress echo ! g. troponin) at least twice separated by 6–8 h and serial ECG. Despite all appropriate investigations, MI missed rate is 2–5% ECG CHANGES IN ACUTE MI—see APPROACH TO ECG p. 5 mm  RISK GROUPS—low = 0–2, intermediate = 3–4, high = 5–7.

PFT shows mainly restrictive lung disease pattern TREATMENTS—prednisone 1 mg/kg PO daily Obstructive Sleep Apnea DIFFERENTIAL DIAGNOSIS OF SLEEP DISORDERS HYPERSOMNOLENCE  SLEEP DISRUPTION—obstructive sleep apnea (OSA), periodic limb movement disorder  INADEQUATE SLEEP TIME—medicine residents, shift workers  INCREASED SLEEP DRIVE—narcolepsy, primary CNS hypersomnolence, head injury, severe depression, medications INSOMNIA  ACUTE—stress, travel through time zones, illness, medications (steroids), illicit drugs (stimulants)  CHRONIC—conditioned, psychiatric disorders, poor sleep hygiene, medical disorders, pain, restless leg syndrome, circadian rhythm disorder PARASOMNIA—sleep walking, sleep terrors, nocturnal seizures, rapid eye movement behavior disorder PATHOPHYSIOLOGY ABNORMAL PHARYNX ANATOMY—decreased upper airway muscle tone and reduced reflexes protecting pharynx from collapse, increased hypercapnic set point !

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