Current Medical Diagnosis and Treatment Study Guide

575 Pages·2015·21.73 MB·English

CURRENT
Medica l Diagnos is
& Trea tment
Study Guide
Second Edition
Edited by
Gene R. Quinn, MD, MS
Division of Cardiovascular Disease
Department of Medicine
Beth Israel Deaconess Medical Center
Boston
Nathaniel W. Gleason, MD
Maxine A. Papadakis, MD
Stephen J. McPhee, MD
Department of Medicine
University of California
San Francisco
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
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Contents
Preface v 30. Crohn Disease 199
31. Diarrhea 205
Skin Disorders 1 32. Lower Gastrointestinal Bleeding 216
1. Atopic Dermatitis 2 33. Upper Gastrointestinal Bleeding 221
34. Viral Hepatitis 226
2. Contact Dermatitis 7
35. Acute Pancreatitis 241
3 . P s o r i a s i s 1 2
36. Chronic Pancreatitis 248
Pulmonary/Ear, Nose, 37. Ulcerative Colitis 255
and Throat Disorders 17
Gynecologic/Urologic
4. Asthma 18
Disorders 263
5 . C h r o n i c O b s t r u c t i v e
38. Breast Cancer 264
P u l m o n a r y D i s e a s e 2 9
39. Benign Prostatic Hyperplasia 274
6 . C o u g h 3 7
40. Dysmenorrhea 280
7. Dyspnea 43
41. Prostate Cancer 284
8. Lung Cancer 48
9. Pharyngitis 56
Musculoskeletal Disorders 291
1 0 . P n e u m o n i a 6 0
42. Low Back Pain 292
11. Pulmonary Embolism 70
43. Gout 298
12. Sinusitis (Bacterial) 79
44. Knee Pain 304
Heart/Hypertension/Lipid 45. Rheumatoid Arthritis 313
46. Systemic Lupus Erythematosus 321
Disorders 85
13. Acute Myocardial In arction 86 Kidney/Electrolyte Disorders 329
14. Aortic Regurgitation 94
47. Glomerulonephritis 330
15. Aortic Stenosis 99
48. Hypokalemia 338
16. Chest Pain 105
49. Hyponatremia 342
17. Dyslipidemia 111
50. Acute Kidney Injury 349
18. Heart Failure 117
51. Chronic Kidney Disease 354
19. Hypertension 126
52. Kidney Stone Disease 361
20. Mitral Regurgitation 140
53. Metabolic Acidosis 367
21. Mitral Stenosis 145
54. Nephrotic Syndrome 373
22. Shock 149
Nervous System/Psychiatric
Hematologic Disorders 155
Disorders 379
23. Hypercoagulable States 156
55. Altered Mental Status 380
24. Iron De ciency Anemia 164
56. Dementia 387
25. D eep Venous T rombosis and
57. Depression 394
T romboembolism 168
58. Epilepsy 401
26. Vitamin B De ciency Anemia 175
12 59. Bacterial Meningitis 408
Gastrointestinal/Liver/ 60. Myasthenia Gravis 415
61. Parkinson Disease 420
Pancreas Disorders 179
62. Stroke 426
27. Acute Cholecystitis 180
63. Smoking Cessation 435
28. Cirrhosis 185
64. Substance Abuse 441
29. Colorectal Cancer 193
iii
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iv CONTENTS
Endocrine/Metabolic 74. Obesity 512
75. Osteoporosis 518
Disorders 447
65. Adrenocortical Insu ciency 448 I
nfectious Disorders 525
66. Cushing Syndrome 456
76. Fever 526
67. ype 1 Diabetes Mellitus 463
77. HIV-AIDS 532
68. ype 2 Diabetes Mellitus 470
78. Healthcare-Associated In ections 547
69. H yperaldosteronism (Aldosteronism) 482
79. In ective Endocarditis 553
70. Hypercalcemia 487
80. Sepsis 561
71. Primary Hyperparathyroidism 492
72. Hyperthyroidism 499
Index 567
73. Hypothyroidism 506
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Preface
• Medical and nursing students, physician’s assistants,
Purpose
nurse practitioners, house o cers, and practicing phy-
Current Medical Diagnosis and Treatment (CMDT) is the
sicians will nd the clear organization and current liter-
leading internal medicine textbook known or its com-
ature re erences use ul in devising proper management
prehensive coverage o current inpatient and outpatient
or patients with these conditions
care with diagnostic tools relevant to day-to-day practice.
Facilitating its use ulness, this CMDT Study Guide, second
edition, directs readers through a case analysis o 80 o the Organization
most common topics in internal medicine. T e CMDT T e CMDT Study Guide provides comprehensive yet
Study Guide provides a comprehensive and clearly orga- s u c c i n c t i n o r m a t Ci Mo nDT. SEtuadyc hG uide topic
n ized syn opsis o each medical topic that helps the bregaidnse wr ith a patient presentation, ollowed by Learning
review and study or a variety o examinations, such as the Objectives and 9 Questions to help the learner work
medicine clerkship shel exam, USMLE Step 2 examina- through the topic in the context o the patient presented.
tions, ABIM internal medicine boards, and recerti cation Answers to the 9 questions are organized as Salient
examinations. As such it will be very use ul to medical, Features, How to T ink T rough the Problem, Key
nursing (Adult and Family Nurse Practitioner Certi cation Features (which contain Essentials o Diagnosis, General
Exam), pharmacy, and other health pro essional students, Considerations, and Demographics), Symptoms and
Physician Assistant National Certi ying Exam (PANCE), Signs, Dif erential Diagnosis, Laboratory, Imaging, and
to house o cers, and to practicing physicians. T e CMDT Procedural Findings, reatments, Outcomes, and When
Study Guide is engaging and patient-centered since each o to Re er and When to Admit. Re erences are then pro-
the 80 topics begins with presentation o a typical patient vided that contain current literature citations complete
to help the reader think in a step-wise ashion through the with PubMed (PMID) numbers. T e CMDT Study Guide
various clinical problem-solving aspects o the case. For is a complete source o patient care in ormation or these
each topic, the CMDT Study Guide provides PubMed’s 80 most common clinical problems! T e 80 topics in the
re erences to the most current and pertinent MEDLINE CMDT Study Guide were selected as the core topics or
articles or that topic. Each re erence provides PMID num- the learner because o their importance to the eld o
bers to acilitate retrieval o the relevant articles. internal medicine.
T e CMDT Study Guide ollows the organization
o Quick Medical Diagnosis and Treatment (QMDT)
Outstanding Features
(or Quick Dx & Rx at www.accessmedicinemhmedical.
• E ighty common internal medicine topics use ul to com) and the QMDT App, and is divided into 11 sections:
learners and practitioners or patient care and to pre- • Skin Disorders
pare or examinations • Pulmonary/Ear, Nose, & T roat Disorders
• M aterial drawn rom the expert source, Current Medical • Heart/Hypertension/Lipid Disorders
Diagnosis and Treatment 2016, including tables about • Hematologic Disorders
laboratory tests and treatments • Gastrointestinal/Liver/Pancreas Disorders
• I n-depth, consistent, and readable ormat organized • Gynecologic/Urologic Disorders
in a way that allows or quick study and easy access to • Musculoskeletal Disorders
in ormation • Kidney/Electrolyte Disorders
• E mphasis on a standard approach to clinical problem- • Nervous System/Psychiatric Disorders
solving with Learning Objectives, Salient Features, • Endocrine/Metabolic Disorders
Symptoms and Signs, reatment, Outcomes, When to • In ectious Disorders
Re er and When to Admit, and Re erences
v
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vi PREFACE
Intended Audience Acknowledgments
Medical students on their internal medicine clerkship will We thank our Current Medical Diagnosis and Treatment
nd this Study Guide a use ul aid as they care or patients authors or their contributions to it and we are grate ul to
with these common medical problems. T e Study Guide the many students, residents, and practitioners who have
will assist medical students, PA students, and NP students made use ul suggestions to this book. We hope that you
taking their internal medicine rotation and house o cers will share with us your comments about tChMe DT Study
to review the core topics as they prepare or standardized Guide.
examinations. Practicing physicians, physician assistants Gene R. Quinn, MD, MS
and nurse practitioners will similarly nd the CMDT Study Nathaniel W. Gleason, MD
Guide use ul in order to stay current in clinical problem- Maxine A. Papadakis, MD
solving, while providing a concise summary o relevant Stephen J. McPhee, MD
diagnostic laboratory, microbiologic, and imaging studies
and treatments, and recent relevant publications.
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Skin Disorders Musculoskeletal
Disorders
Pulmonary/Ear, Kidney/Electrolyte
Nose and Throat Disorders
Disorders
Heart/ Nervous System/
Hypertension/ Psychiatric
Lipid Disorders Disorders
Hematologic Endocrine/
Disorders Metabolic
Disorders
Gastrointestinal/ Infectious
Liver/Pancreas Disorders
Disorders
Gynecologic/
Urologic
Disorders
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Skin Disorders
Pulmonary/Ear, Nose, and Throat Disorders
Heart/Hypertension/Lipid Disorders
Hematologic Disorders
Gastrointestinal/Liver/Pancreas Disorders
Gynecologic/Urologic Disorders
Musculoskeletal Disorders
Kidney/Electrolyte Disorders
Nervous System/Psychiatric Disorders
Endocrine/Metabolic Disorders
Infectious Disorders
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2
Atopic Dermatitis
1
A 30-year-old woman presents to her primary care clinician with
an itchy rash on her hands, wrists, and arms. She states she has had
similar rashes before, which had gone away with over-the-counter
hydrocortisone cream, the rst episode occurring when she was very
young. Her past medical history includes asthma. She takes loratadine
occasionally for allergic rhinitis. Physical examination reveals plaques on
the hands, wrists, and antecubital folds, which are mildly exudative and
without scale. Laboratory testing shows eosinophilia on a complete blood
count with di erential and an elevated serum immunoglobulin E (IgE)
level.
LEARNING OBJECTIVES
Learn the clinical mani estations and objective f ndings o atopic dermatitis, and the
f ndings that distinguish it rom other skin conditions
Understand the associated diseases that predispose to atopic dermatitis
Know the di erential diagnosis o atopic dermatitis
Learn the treatments or each clinical pattern o atopic dermatitis
Know which patients are likely to have recurrent atopic dermatitis and how to prevent ares
QUESTIONS
1. What are the salient eatures o this patient’s problem?
2. How do you think through her problem?
3. What are the key eatures, including essentials o diagnosis and general considerations,
o atopic dermatitis?
4. What are the symptoms and signs o atopic dermatitis?
5. What is the di erential diagnosis o atopic dermatitis?
6. What are the laboratory f ndings in atopic dermatitis?
7. What are the treatments or atopic dermatitis?
8. What are the outcomes, including complications, prognosis, and prevention, o atopic
dermatitis?
9. When should patients with atopic dermatitis be re erred to a specialist?
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