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 advisor is a transportable model of our best-selling every year up-to-date textual content of common medication, present scientific prognosis & therapy. In a convenient disease-per-page layout, it offers middle diagnostic and remedy details in bulleted lists for over 500 ailments and issues encountered within the ambulatory and inpatient settings. It covers all universal or vital diagnoses in inner drugs. additionally it is 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" characteristic of the Lange present sequence, every one access comprises offering indicators and proceedings, tools of confirming the analysis, and short connection with instructed remedies. The target is to supply the reader with reassurance that she or he is heading in the right direction with a specific analysis and to supply simple therapy details.

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Reference Ost D et al: Evaluation and management of the solitary pulmonary nodule. 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.

Reference Light RW: Pleural effusions. Med Clin North Am 1977;61:1339. [PMID: 21999] Chapter 2 Pulmonary Diseases 39 Spontaneous Pneumothorax ■ Essentials of Diagnosis • Primary spontaneous pneumothorax occurs in the absence of underlying disease; secondary pneumothorax complicates preexisting pulmonary disease (eg, asthma, COPD) • Primary spontaneous pneumothorax occurs in tall, thin boys and young men who smoke • Abrupt onset of ipsilateral chest pain (sometimes referred to shoulder or arm) and dyspnea • Decreased breath sounds over involved hemithorax, which may be bronchial but distant in 100% pneumothorax; hyperresonance, tachycardia, hypotension, and mediastinal shift toward contralateral side if tension is present • Chest x-ray diagnostic with retraction of lung from parietal pleura, often best seen by end-expiratory film ■ Differential Diagnosis • • • • ■ Myocardial infarction Pulmonary emboli Pneumonia with empyema Pericarditis Treatment • Assessment for cause, eg, pneumocystis pneumonia, lung cancer, COPD • Immediate decompression by needle thoracostomy if tension suspected • Spontaneous pneumothoraces of less than 15% followed by serial radiographs and observation in the hospital; pneumothoraces greater than 15% treated by aspiration of air through small catheter or by tube thoracostomy depending on clinical setting • Secondary pneumothoraces (eg, due to COPD, cystic fibrosis) usually require chest tube • Discontinue smoking • Risk of recurrence is high (up to 50% in those with primary spontaneous pneumothorax) • Therapy for recurrent pneumothorax includes surgical pleurodesis or stapling of the ruptured blebs ■ Pearl Pneumothorax during menstruation (catamenial pneumothorax) suggests endometriosis.

Am J Med 1997;102:459. [PMID: 9217643] 1 26 Essentials of Diagnosis & Treatment Dilated Cardiomyopathy 1 ■ Essentials of Diagnosis • A cause of systolic dysfunction, this represents a group of disorders that lead to congestive heart failure • Symptoms and signs of congestive heart failure: exertional dyspnea, cough, fatigue, paroxysmal nocturnal dyspnea, cardiac enlargement, rales, gallop rhythm, elevated venous pressure, hepatomegaly, and dependent edema • Electrocardiography may show nonspecific repolarization abnormalities and atrial or ventricular ectopy but is not diagnostic • Echocardiography reveals depressed contractile function and cardiomegaly • Cardiac catheterization useful to exclude ischemia as a cause ■ Differential Diagnosis Causes of dilated cardiomyopathy: • Alcoholism • Post viral myocarditis • Sarcoidosis • Postpartum • Doxorubicin toxicity • Endocrinopathies (thyroid disease, acromegaly, pheochromocytoma) • Hemochromatosis • Idiopathic ■ Treatment • Treat the underlying disorder when identifiable • Abstention from alcohol • Routine management of systolic dysfunction, including with vasodilators (ACE inhibitors or a combination of hydralazine and isosorbide dinitrate), beta-blockers, spironolactone, and low-sodium diet; digoxin and diuretics for symptoms ■ Pearl Causes of death: one-third pump failure, one-third arrhythmia, onethird stroke, of which the latter is most preventable.

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