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

By Lawrence M Tierney Sanjay saint Mary A Whooley YUAN

ISBN-10: 007137826X

ISBN-13: 9780071378260

This stand-alone pocket advisor is a conveyable model of our best-selling each year up-to-date textual content of common drugs, present scientific analysis & remedy. In a convenient disease-per-page structure, it presents middle diagnostic and remedy info 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 medication. it's 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 medication and kinfolk medication. in accordance with the preferred "Essentials of analysis" function of the Lange present sequence, each one access comprises featuring indicators and proceedings, tools of confirming the prognosis, and short connection with prompt remedies. The target is to supply the reader with reassurance that she or he is heading in the right direction with a selected prognosis and to supply simple remedy details.

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Extra info for Essentials of Diagnosis & Treatment, 2nd Edition

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N Engl J Med 1997;336:267. [PMID: 8995091] Chapter 1 Cardiovascular Diseases 29 Acute Rheumatic Fever ■ Essentials of Diagnosis • A systemic immune process complicating group A beta-hemolytic streptococcal pharyngitis • Usually affects children between the ages of 5 and 15; rare after 25 • Occurs 1–5 weeks after throat infection • Diagnosis based on Jones criteria (two major or one major and two minor) and confirmation of recent streptococcal infection • Major criteria: erythema marginatum, migratory polyarthritis, subcutaneous nodules, carditis, and Sydenham’s chorea; the latter is the most specific, least sensitive • Minor criteria: fever, arthralgias, elevated erythrocyte sedimentation rate, elevated C-reactive protein, PR prolongation on ECG, and history of rheumatic fever ■ Differential Diagnosis • • • • • • ■ Juvenile or adult rheumatoid arthritis Endocarditis Osteomyelitis Systemic lupus erythematosus Lyme disease Disseminated gonococcal infection Treatment • Bed rest until vital signs and ECG become normal • Salicylates and nonsteroidal anti-inflammatory drugs reduce fever and joint complaints but do not affect the natural course of the disease; rarely, corticosteroids may be used • If streptococcal infection is still present, penicillin is indicated • Prevention of recurrent streptococcal pharyngitis in patients less than 25 years old (a monthly injection of benzathine penicillin is most commonly used) ■ Pearl Inappropriate tachycardia in a child with a recent sore throat suggests rheumatic fever.

Reference Elliott P: Cardiomyopathy. Diagnosis and management of dilated cardiomyopathy. Heart 2000;84:106. [PMID: 20321212] Chapter 1 Cardiovascular Diseases 27 Hypertrophic Obstructive Cardiomyopathy (HOCM) ■ Essentials of Diagnosis • Asymmetric myocardial hypertrophy causing dynamic obstruction to left ventricular outflow below the aortic valve • Sporadic or dominantly inherited • Obstruction is worsened by increasing left ventricular contractility or decreasing filling • Symptoms are dyspnea, chest pain, and syncope; a subgroup of younger patients is at high risk for sudden cardiac death (1% per year), especially with exercise • Sustained, bifid (rarely trifid) apical impulse, S4 • Electrocardiography shows exaggerated septal Q waves suggestive of myocardial infarction; supraventricular and ventricular arrhythmias may also be seen • Echocardiography with hypertrophy, evidence of dynamic obstruction from abnormal systolic motion of the anterior mitral valve leaflet ■ Differential Diagnosis • • • • • ■ Hypertensive heart disease Restrictive cardiomyopathy (eg, amyloidosis) Aortic stenosis Ischemic heart disease Athlete’s heart Treatment • Beta-blockers are the initial drug of choice in symptomatic patients, especially those with evidence of dynamic obstruction • Calcium channel blockers may also be useful • Otherwise, surgical myectomy, percutaneous transcoronary septal reduction with alcohol, or dual-chamber pacing are considered; automatic implantable cardiac defibrillator, amiodarone in patients at high risk for sudden death is controversial • Natural history is unpredictable; sports requiring high cardiac output should be discouraged • All first-degree relatives evaluated with echocardiography • Prophylaxis for infective endocarditis is required ■ Pearl Hypertrophic cardiomyopathy is the pathologic feature most frequently associated with sudden death in athletes.

J Am Coll Cardiol 1999;33:1071. [PMID: 10091838] 1 28 Essentials of Diagnosis & Treatment Restrictive Cardiomyopathy 1 ■ Essentials of Diagnosis • Characterized by impaired diastolic filling with preserved left ventricular function • Causes include amyloidosis, sarcoidosis, hemochromatosis, scleroderma, carcinoid syndrome, endomyocardial fibrosis, and postradiation or postsurgical fibrosis • Clinical manifestations are those of the underlying disorder; congestive heart failure with right-sided symptoms and signs usually predominates • Electrocardiography may show low voltage and nonspecific ST–T wave abnormalities; supraventricular and ventricular arrhythmias may also be seen • Echo-doppler shows increased wall thickness with preserved contractile function and mitral and tricuspid inflow velocity patterns consistent with impaired diastolic filling ■ Differential Diagnosis • • • • • ■ Constrictive pericarditis Hypertensive heart disease Hypertrophic obstructive cardiomyopathy Aortic stenosis Ischemic heart disease Treatment • Sodium restriction and diuretic therapy for patients with evidence of fluid overload; diuresis must be cautious, as volume depletion may worsen this disorder • Digitalis is not indicated unless systolic function becomes impaired or atrial fibrillation occurs • Treatment of underlying disease causing the restriction if possible ■ Pearl Hemochromatosis is characterized by diagnostic T2-weighted images of the heart and other involved organs; one-third of patients have whiter right upper quadrants on plain chest films.

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

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