Download Essentials of Diagnosis and Treatment by Lawrence M. Tierney, Clinton E. Thompson, Sanjay Saint PDF

By Lawrence M. Tierney, Clinton E. Thompson, Sanjay Saint

Pack this convenient advisor into your lab coat pocket and you are wearing a powerhouse of knowledge on greater than 500 issues. And it is going at any place you pass - health facility, health facility, rounds or perhaps reviewing for forums.

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N Engl I Med 2000;343:269. [PMID: (UI: 10911010] + 0172-02/CH02 3/12/02 8:51 AM Chapter 2 Pulmonary Diseases 45 Cystic Fibrosis • Essentials of Diagnosis • A generalized autosomal recessive disorder of the exocrine glands • Cough, dyspnea, recurrent pulmonary infections often due to pseudomonas; symptoms of malabsorption, infertility • Increased thoracic diameter, distant breath sounds, rhonchi, clubbing, nasal polyps • Hypoxemia; obstructive or mixed pattern by spirometry; decreased diffusing capacity • Sweat chloride> 60 meq/L • Genetic testing for gene mutation can confirm diagnosis even if sweat test is negative • Differential Diagnosis • • • • • + Asthma Bronchiectasis Congenital emphysema (

Reference Carretero OA et aJ: Essential hypertension. Part I: definition and etiology. Circulation 2000; 101 :3295. [PMID: 10645931] + 0172-01/CH01 3/12/02 8:50 AM Chapter 1 Cardiovascular Diseases 35 Deep Venous Thrombosis • Essentials of Diagnosis • • • • Dull pain or tight feeling in the calf or thigh Up to half of patients are asymptomatic in the early stages Increased risk: congestive heart failure, recent major surgery, neoplasia, oral contraceptive use by smokers, prolonged inactivity, varicose veins, hypercoagulable states (eg, protein C deficiency, nephrotic syndrome) Physical signs unreliable Doppler ultrasound and impedance plethysmography are initial tests of choice (less sensitive in asymptomatic patients); venography is definitive Pulmonary thromboembolism, especially with proximal, abovethe-knee deep vein thrombosis • Differential Diagnosis + • • • • • Calf strain or contusion Cellulitis Ruptured Baker cyst Lymphatic obstruction Congestive heart failure, especially right-sided • Treatment • • Anticoagulation with intravenous heparin (goal PTT twice normal) for 5 days followed by oral warfarin for 3-6 months; thrombolytics in acute phlebitis may prevent valvular damage and postphlebitic syndrome Subcutaneous low-molecular-weight heparin may be substituted for intravenous heparin NSAlDs for associated pain and swelling For idiopathic and recurrent cases, hypercoagulable conditions should be considered, although factor V Leiden should be sought on a first episode without risk factors in patients of European ethnicity Postphlebitic syndrome (chronic venous insufficiency) is common following an episode of deep venous thrombosis and should be treated with graduated compression stockings, local skin care, and, in many, chronic warfarin administration • Pearl The left If)wer extremity is 1 cm greater in circumference that the right in 90% of the population at any point ofmeasurement.

PMJD: 10903658] + 0172-01/CH01 3/12/02 8:50 AM Chapter 1 Cardiovascular Diseases 17 Atrial Fibrillation • Essentials of Diagnosis • • • • • • The most common chronic arrhythmia Causes include mitral valve disease, hypertensive and ischemic heart disease, dilated cardiomyopathy, alcohol use, hyperthyroidism, pericarditis, cardiac surgery; many are idiopathic ("lone" atrial fibrillation) Complications include precipitation of cardiac failure, arterial embolization Palpitations, shortness of breath, chest pain common Irregularly irregular heartbeat, variable intensity Sl' occasional S,; S4 absent in all Electrocardiography shows ventricular rate of 80-l70/min in untreated patients; if associated with an accessory pathway, the ventricular rate can be> 200/min with wide QRS and antegrade conduction through the pathway • Differential Diagnosis + • • • • Multifocal atrial tachycardia Atrial flutter or tachycardia with variable block Sinus arrhythmia Normal sinus rhythm with multiple premature contractions • Treatment • • • • Control ventricular response with digoxin, beta-blocker, calcium channel blocker-choice depending upon contractile state ofleft ventricle Cardioversion with countershock in unstable patients with acute atrial fibrillation; elective countershock or antiarrhythmic agents (eg, ibutilide, procainamide, amiodarone, sotalol) in stable patients once a left atrial thrombus has been ruled out or effectively treated Chronic warfarin or aspirin in aJi patients not cardioverted With elective cardioversion, anticoagulation for 4 weeks prior to and 4 weeks after the procedure unless transesophageal echocardiography excludes a left atrial thrombus • Pearl Atrialfibrillation is a relatively uncommon rhythm in acute myocardial infarction and implies the presence ofpericarditis.

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