Family Medicine PDF
Preview Family Medicine
Clinical Sciences Review for Medical Licensure Developed at The University of Oklahoma, College of Medicine Ronald S. Krug, Series Editor Suitable Reviews for: United States Medical Licensing Examination (USMLE), Step 2 Federation Licensing Examination (FLEX) Family Medicine Jeffrey G. Hirsch Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest Jeffrey G. Hirsch, M.D. Metro Medical Associates Family Practice Medicine 120 North Robinson First National Center Arcade Oklahoma City, OK 73102 USA Library of Congress Cataloging-in-Publication Data Hirsch, Jeffrey G. Family medicine I Jeffrey G. Hirsch. p. cm. - (Oklahoma notes) Includes bibliographical references and index. ISBN·13: 978·0·387·94185·1 e-ISBN·13: 978·1·4684·0476·0 DOl: 10.1007/978-1-4684-0476-0 1. Family medicine-Outlines, syllabi, etc. I. Title. II. Series. [DNLM: 1. Family Practice-outlines. WB 18 H6683f 1994) RC59.H55 1994 616-dc20 DNLMIDLC 93-44257 Printed on acid-free paper. © 1994 Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production managed by Jim Harbison; manufacturing supervised by Jacqui Ashri. Camera-ready copy prepared by the author. 987654321 ISBN-13: 978-0-387-94185-1 To Marilyn and Emanuel, who encouraged me to dream. To Regina, Hannah and Adam, who dream with me. Preface to the ()~~ In 1973 the University of Oklahoma College of Medicine instituted a requirement for pas age of the Part 1 National Boards for promotion to the third year. To assist students in preparation for this examination a two-week review of the basic sciences was added to the Curriculum in 1975. Ten review texts were written by the faculty. In 1987 these basic science review texts were published as the Okla homa Notes ("Okie Notes") and made available to all students of medicine who were preparing for comprehensive examinations. Over a quarter of a million of these texts have been sold nationally. Their clear, concise outline format has been found to be extremely useful by students preparing themselves for nationally standardized examinations. Over the past few years numerous inquiries have been made regarding the avail ability of a Clinical Years series of "Okie Notes." Because of the obvious utility of the basic sciences books, faculty associated with the University of Oklahoma College of Medicine have developed texts in five specialty areas: Medicine, Neu rology, Pediatrics, Psychiatry, and Surgery. Each of the these texts follows the same condensed outline format as the basic science texts. The faculty who have prepared these texts are clinical educators and therefore the material incorpo rated in these texts has been validated in the classroom. Each author has endeavored to distill the "need to know" material from their field of expertise. While preparing these texts, the target audience has always been the clinical years student who is preparing for Step 2 examinations. A great deal of effort has gone into these texts. I hope they are helpful to you in studying for your licensure examinations. Ronald S. Krug, Ph.D. Series Editor Preface Studying for licensure examinations is like eating a twelve course meal: if you try and do it in five minutes, it will make you sick. As you prepare, pace yourself, don't memorize but review, and, most importantly, a few days before the exam try and get some rest. I don't think I've ever heard of a soul who looked forward to this examination and I can assure you no one has ever walked out saying "What a wonderful experience." Think of this ordeal as a rite of passage and try to remem ber that most of you will make it through. In the preparation of this text, the following sources were extensively consulted: Casciato, D.A. et al.: Manual of Clinical Oncology. Ed. 2. Boston, Little, Brown and Co., 1992. Griffith, H.W. et al.: The 5 Minute Clinical Consultant. Ed. 1. Philadelphia, Lea and Febiger, 1993. Hacker, N.F. et al.: Essentials of Obstetrics and Gynecology. Ed. 2. Philadelphia, W.B. Saunders, 1992. Rakel, Robert E. et al.: Current Therapy, 1993. Philadelphia, W.B. Saunders, 1993. Rakel, Robert E. et al.: Textbook of Family Practice. Ed. 4. Philadelphia, W.B. Saunders, 1990. Taylor, R.B. et al.: Family Medicine, Principles and Practice. Ed. 4. New York, Springer-Verlag, 1994. Wilson, J.D. et al.: Harrison's Principles of Internal Medicine. Ed. 12., New York, McGraw-Hill, 1991. Woodley, M. et al.: Manual of Medical Therapeutics. Ed. 27. Boston, Little, Brown and Co., 1993. Wyngaarden, J.B. et al.: Cecil Textbook of Medicine. Ed. 19. Philadelphia, W.B. Saunders, 1992. I'd like to thank Dr. Ron Krug for his continued support and guidance not only in the preparation of this text but through the years. Thanks to Linda Newman for proofing this text and to Jon and Phyllis Fowler for their expertise in laser printing. Good luck in your studies and remember what Winston Churchill said: "Never, never, never, give up!" J.G. Hirsch Oklahoma City Contents Preface to the Oklahoma Notes ... ....... ....... ...... ........ .................. vii Preface ....................................................................................... ix Dermatology ............................................................ 1 Terminology.... ...... ...... ... .... ....... ......... ...... ........ ..... ..... ...... .... 1 Papulosquamous Eruptions ................................................. 1 Pyodermas ............................................................................ 5 Viral Infection ...................................................................... 7 Infestations .......................................................................... 8 Dermatitis ............................................................................. 9 Vascular Disorders .............................................................. 11 Hyperplasia .......................................................................... 13 Neoplasia, Benign ................................................................ 13 Neoplasia, Premalignant ..................................................... 15 Neoplasia, Malignant ........................................................... 16 Ophthalmology......... .......... ...... ...... ...... ........ ....... .... 18 Diseases of the Outer Eye .................................................... 18 Refractive Errors ................................................................. 18 Diseases of the Lids ............................................................. 19 Diseases of the Conjunctiva ................................................. 20 Diseases of the Lens ............................................................. 21 Glaucoma ........... ................ ...... ..... .... ..... .... ........... .... ..... ...... 22 Diseases of the Retina .......................................................... 23 Ocular Tumors ..................................................................... 24 Otorhinolaryngology ... ............................. ............... 26 Ear ........................................................................................ 26 Sinus ..................................................................................... 33 Nose ...................................................................................... 35 Oral Cavity ........................................................................... 37 Throat ................................................................................... 41 Larynx 42 xii Contents Pulmonary .............................................................. . 46 Infections ............................................................................ . 46 Pleural Effusion .................................................................. . 55 Chronic Obstructive Pulmonary Disease .......................... .. 57 Lung Cancer ........................................................................ . 60 Interstitial Lung Disease ..................................................... . 61 Pulmonary Embolus ........................................................... . 63 Sleep Apnea ........................................................................ . 65 Cardiology .............................................................. . 66 Coronary Heart Disease ...................................................... . 66 Hypertension ...................................................................... . 68 Acute Myocardial Infarction .............................................. . 71 Congestive Heart Failure .................................................... . 72 Arrhythmias ........................................................................ . 74 Valvular Heart Disease ....................................................... . 80 Infections ............................................................................ . 84 Cardiomyopathy ................................................................. . 91 Acute Rheumatic Fever ...................................................... . 94 Gastroenterology .................................................... . 96 Esophagus ........................................................................... . 96 Stomach ............................................................................... . 98 Small and Large Bowel ....................................................... . 102 Gallbladder .......................................................................... . 110 Liver 112 Pancreas 116 Nephrology ............................................................. . 120 Glomerulonephritis ............................................................. . 120 Acute Renal Failure ............................................................ . 122 Chronic Renal Failure ....................................................... .. 126 Urology 128 Kidney 128 Bladder 132 Urethra 134 Prostate 135 Testicle 140 Gynecology (Including Breast) ................................ 142 Vulva/Vagina ........................................................................ 142 Cervix ................................................................................... 148 Uterus ................................................................................... 151 Fallopian Tubes ................................................................... 153 Ovary .................................................................................... 154 Pelvic Inflammatory Disease ............................................... 156 Breast ................................................................................... 158 Contents xiii Obstetrics 166 Diagnosis of Pregnancy... .... ...... .... .... ..... .... .... ..... .... ..... ....... 166 Initial Prenatal Visit ... ....... ... .... .... ...... .... ........ ..... ........ ......... 166 Interval Screening '" .... ...... ..... ... ...... .... ........ ..... .... .... ........ ... 167 Labor and Delivery .............................................................. 168 Apgar Scores ........................................................................ 170 Orthopedics/Rheumatology .................................... 171 Osteomyelitis ....................................................................... 171 Arthritis ................................................................................ 173 Systemic Lupus Erythematosis ........................................... 176 Endocrinology/Metabolic Disease .......................... 179 Diabetes Mellitus ................................................................. 179 Thyroid Disease ................................................................... 181 Parathyroid Disease ............................................................. 186 Osteoporosis ......................................................................... 188 Gout ...................................................................................... 190 Hyperlipoproteinemias ........................................................ 191 Neurology 194 Headaches 194 Seizures ................................................................................ 199 Infection ............................................................................... 203 Neoplasia .............................................................................. 207 Stroke ................................................................................... 209 Hematology .............................................................. 214 Red Blood Cell Disorders .................................................... 214 White Blood Cell Disorders ................................................. 219 Lymphoma ....... ... ..... .... ... .... ......... ..... ....... .... ....... .... ..... ........ 226 Self-Assessment Examination ................................. 228 Answers ................................................................... 246 CHAPTER ONE DERMATOLOGY I. TERMINOLOGY A. Macule 1. A flat circumscribed lesion different in color from surrounding skin. B. Patch 1. A macule >1 cm in diameter. C. Papule 1. An elevated, circumscribed lesion of any color <1 cm in diameter. D. Nodule 1. A papule >1 crn in diameter. E. Plague 1. A nodule >2 cm in diameter. F. Vesicle 1. An elevated, marginated lesion filled with clear fluid <1 cm G. Bullae 1. A vesicle >1 cm H. Pustule 1. A well-marginated focal accumulation of pus within the skin. I. Wheal 1. A transient elevated lesion in the upper dermis containing fluid. II. PAPULOSQUAMOUS ERUPTIONS A. Psoriasis 1. DEFINITION a. An acute or chronic, unpredictable disease characterized by erythematous plaques with superimposed silvery scales of unknown etiology. 2. DIAGNOSIS a. By visual inspection of commonly affected area such as scalp, elbows, knees and buttock but lesions can occur anywhere. b. Ridges and pits in nails. c. Auspitz's sign = punctate bleeding site when scale is removed. d. Biopsy may be necessary. 1
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