Essentials of Diagnosis & Treatment, 2nd Edition by Lawrence M Tierney Sanjay saint Mary A Whooley YUAN

By Lawrence M Tierney Sanjay saint Mary A Whooley YUAN

This stand-alone pocket consultant is a conveyable model of our best-selling every year up-to-date textual content of normal drugs, present scientific prognosis & therapy. In a convenient disease-per-page structure, it offers middle diagnostic and therapy details in bulleted lists for over 500 illnesses and issues encountered within the ambulatory and inpatient settings. It covers all universal or very important diagnoses in inner drugs. it is also diagnoses in pediatrics, surgical procedure, obstetrics & gynecology, urology, neurology, psychiatry, dermatology, ophthalmology, otolaryngology, and toxicology which are of relevance within the day-by-day perform of inner drugs and relations drugs. in keeping with the preferred "Essentials of analysis" function of the Lange present sequence, each one access contains offering indicators and proceedings, tools of confirming the analysis, and short connection with suggested remedies. The aim is to supply the reader with reassurance that she or he is on target with a specific analysis and to supply easy therapy details.

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Reference Ambrose JA et al: Unstable angina: current concepts of pathogenesis and treatment. Arch Intern Med 2000;160:25. [PMID: 10632302] 1 16 Essentials of Diagnosis & Treatment Acute Myocardial Infarction 1 ■ Essentials of Diagnosis • Prolonged (> 30 minutes) chest pain, associated with shortness of breath, nausea, left arm or neck pain, and diaphoresis; can be painless in diabetics • S4 common; S3, mitral insufficiency on occasion • Cardiogenic shock, ventricular arrhythmias may complicate • Electrocardiography shows ST elevation or depression, T wave inversion, or evolving Q waves; however, can be normal or unchanged in up to 10% • Elevated cardiac enzymes (troponin, CKMB) • Regional wall motion changes by echo • Non-Q wave infarct may mean additional jeopardized myocardium ■ Differential Diagnosis • Stable or unstable angina • Tietze’s syndrome (costochondritis) • Aortic dissection • Cervical radiculopathy • Carpal tunnel syndrome ■ • • • • • • Esophageal spasm or reflux Pulmonary embolism Cholecystitis Pericarditis Pneumothorax Pneumonia Treatment • Monitoring, aspirin, and analgesia for all; heparin for most • Reperfusion by thrombolysis or angioplasty in selected patients with either ST segment elevation or new left bundle branch block on ECG • Glycoprotein IIb/IIIa inhibitors considered in non-Q wave infarcts • Beta-blockers for heart rate and blood pressure control, and survival advantage when given chronically • Nitroglycerin for recurrent ischemic pain; also useful for relieving pulmonary congestion and reducing blood pressure • ACE inhibitor may confer survival benefit ■ Pearl Monitoring for prompt treatment of ventricular fibrillation remains the most cost-effective intervention to prolong life.

PMID: 9287377] 1 30 Essentials of Diagnosis & Treatment Acute Pericarditis 1 ■ Essentials of Diagnosis • Inflammation of the pericardium due to viral infection, drugs, myocardial infarction, autoimmune syndromes, renal failure, cardiac surgery, trauma, or neoplasm • Common symptoms include pleuritic chest pain radiating to the shoulder (trapezius ridge) and dyspnea; pain improves with sitting up and expiration • Examination may reveal fever, tachycardia, and an intermittent friction rub; clinical manifestations of cardiac tamponade may occur in any patient • Electrocardiography usually shows PR depression, diffuse ST segment elevation followed by T wave inversions • Echocardiography may reveal pericardial effusion ■ Differential Diagnosis • • • • • • ■ Acute myocardial infarction Aortic dissection Pulmonary embolism Pneumothorax Pneumonia Cholecystitis Treatment • Aspirin or nonsteroidal anti-inflammatory agents such as ibuprofen or indomethacin to relieve symptoms; rarely, steroids for recurrent cases • Hospitalization for patients with symptoms suggestive of significant effusions or cardiac tamponade ■ Pearl Patients with uremic pericarditis characteristically are afebrile, and many lack ST segment elevation.

Am J Respir Crit Care Med 2000;162(3 Part 1):782. [PMID: 10988081] 2 42 Essentials of Diagnosis & Treatment Asthma 2 ■ Essentials of Diagnosis • Episodic wheezing, colds; chronic dyspnea or tightness in the chest; can present as cough • Some attacks triggered by cold air or exercise • Prolonged expiratory time, wheezing; if severe, pulsus paradoxus and cyanosis • Peripheral eosinophilia common; mucus casts, eosinophils, and Charcot-Leyden crystals in sputum • Obstructive pattern by spirometry supports diagnosis, though may be normal between attacks • With methacholine challenge, absence of bronchial hyperreactivity makes diagnosis unlikely ■ Differential Diagnosis • • • • • • ■ Congestive heart failure Chronic obstructive pulmonary disease Pulmonary embolism Foreign body aspiration Pulmonary infection (eg, strongyloidiasis, aspergillosis) Churg-Strauss syndrome Treatment • Avoidance of known precipitants, inhaled corticosteroids in persistent asthma, inhaled bronchodilators for symptoms • In patients not well controlled on inhaled corticosteroids, longacting inhaled beta-agonist (eg, salmeterol) • Treatment of exacerbations: oxygen, inhaled bronchodilators (β2 agonists or anticholinergics), systemic corticosteroids • Leukotriene modifiers (eg, montelukast) may provide an option for long-term therapy in mild to moderate disease • For difficult-to-control asthma, consider exacerbating factors such as gastroesophageal reflux disease and chronic sinusitis ■ Pearl All that wheezes is not asthma, especially over age 45.

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