By David Hui, Alexander A. Leung, Raj Padwal
This totally up to date 4th version of presents an built-in symptom- and issue-based method with quick access to excessive yield scientific details. for every subject, rigorously equipped sections on various diagnoses, investigations, and coverings are designed to facilitate sufferer care and exam guidance. various scientific pearls and comparability tables are supplied to assist improve studying, and foreign devices (US and metric) are used to facilitate program in daily medical practice.
The booklet covers many hugely vital, infrequently mentioned subject matters in drugs (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 variation contains many reader-friendly advancements reminiscent of greater formatting, intuitive ordering of chapters, and incorporation of the newest instructions for every subject. method of inner drugs keeps to function an important reference for each scientific pupil, resident, fellow, practising health care provider, nurse, and health care provider assistant.
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Additional resources for Approach to Internal Medicine: A Resource Book for Clinical Practice (4th Edition)
Unfractionated heparin may be used concurrently SURGICAL—embolectomy. Consider if thrombolysis failed or contraindicated or if hemodynamically unstable IVC FILTER—if anticoagulation contraindicated TREATMENT ISSUES CONTRAINDICATIONS TO THROMBOLYTIC THERAPY · ABSOLUTE CONTRAINDICATIONS—history of hemorrhagic stroke or stroke of unknown origin, ischemic stroke in previous 3 months, malignant intracranial neoplasm, suspected aortic dissection, active bleeding, major trauma in previous 2 months, intracranial surgery or head injury within 3 weeks · RELATIVE CONTRAINDICATIONS—TIA within 6 months, oral anticoagulation, pregnancy or within 1 week postpartum, non-compressible puncture sites, traumatic/prolonged (>10 min) CPR, uncontrolled hypertension (SBP >185 mmHg, DBP >110 mmHg), recent bleeding (<2–4 weeks), current use of anticoagulants, advanced liver disease, infective endocarditis, active peptic ulcer, thrombocytopenia ANTICOAGULATION DURATION · · · · FIRST PULMONARY EMBOLISM WITH REVERSIBLE OR TIME-LIMITED RISK FACTOR—anticoagulation for at least 3 months UNPROVOKED PE—at least 3 months of treatment.
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).
Systemic steroids ineffective CMAJ 2004 171:2 Am J Respir Crit Care Med 2011 183:6 NEJM 2014 370:22 HYPERSENSITIVITY PNEUMONITIS · PATHOPHYSIOLOGY —inhaled organic antigens → immune response → acute, subacute, or chronic granulomatous pneumonia · DIAGNOSIS—major criteria (compatible symptoms, antigen exposure, imaging findings, lavage lymphocytosis, histologic findings (poorly formed granulomas), reexposure triggers symptoms); minor criteria (bilateral crackles, ↓ DLCO, hypoxemia). Combination of major and minor criteria will help raise suspicion of hypersensitivity pneumonitis.
Approach to Internal Medicine: A Resource Book for Clinical Practice (4th Edition) by David Hui, Alexander A. Leung, Raj Padwal