BOOK
Medicine Morning Report: Beyond the Pearls E-Book
Rajkumar Dasgupta | R. Michelle Koolaee | Rajkumar Dasgupta | R. Michelle Koolaee
(2016)
Additional Information
Book Details
Abstract
Practical, concise, and easy to read, Medicine Morning Report: Beyond the Pearls covers essential material you’ll find on USMLE and shelf exams and sharpens your clinical decision-making skills. Using an in-depth case format, it prepares you to correctly analyze a clinical vignette in the style of a morning report conference, helping you formulate a clinically sound, evidence-based approach to realistic patient scenarios.
- Covers key content found on the USMLE, with pearls for the Step1, Step 2 and Step 3 exams – ideal for exam preparation and clinical rotations.
- Each case presents a high-yield topic in a morning report/grand rounds format, and includes must-know "pearls," an in-depth discussion of differentials and treatment, and assessment questions that support USMLE and shelf preparation.
- "Beyond the Pearls" tips and secrets (evidence based, with references) make this text unique.
- Key basic science concepts reinforce important information in a clinical context.
- Written and edited by experienced teachers of review courses and medical students. Each case has been reviewed by board certified attending/practicing physicians.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Medicine Morning Report | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Preface | vii | ||
| Contributors | viii | ||
| Table Of Contents | xii | ||
| Case 1 A 63-Year-Old Female With Change in Mental Status and Slurred Speech | 1 | ||
| What is the first step in evaluating acute neurologic changes? | 1 | ||
| In suspecting an ischemic stroke, what initial history element is critical to obtain? | 1 | ||
| What questions should be asked to exclude other possible diagnoses related to decreased cognition and slurred speech? | 2 | ||
| Considering the time-sensitive nature of the initial assessment, how should the exam be focused? | 2 | ||
| What signs or symptoms are highly predictive for an ischemic stroke? | 3 | ||
| What additional neurologic deficits are commonly seen in a cerebrovascular accident? | 3 | ||
| What additional diagnostic studies can be performed in the evaluation of an ischemic stroke? | 5 | ||
| What treatments can be started for secondary prevention of stroke? | 6 | ||
| What nonpharmacologic treatments or assessments are important prior to discharge from the hospital? | 6 | ||
| References | 7 | ||
| Case 2 A 61-Year-Old Male With Constipation | 8 | ||
| What are the preventative medical guidelines for adults? | 8 | ||
| What are some screening tests that could be recommended to this patient based on his age and symptoms? | 8 | ||
| What kinds of polyps occur in the colorectal region? | 9 | ||
| What are the risk factors for development of colorectal carcinoma? | 10 | ||
| What are the symptoms associated with left-sided versus right-sided colorectal carcinomas? | 12 | ||
| What is the mechanism for development of colorectal carcinoma? | 12 | ||
| What are syndromes associated with development of colorectal carcinoma? | 12 | ||
| What is the management of colorectal carcinoma? | 12 | ||
| What is the prognosis of colorectal carcinoma? | 13 | ||
| What kind of follow-up is recommended following treatment of colorectal carcinoma? | 14 | ||
| References | 15 | ||
| Case 3 A 37-Year-Old Female With a Palpable Breast Mass | 16 | ||
| How is a female breast examined? | 16 | ||
| What are some other questions you may want to ask the patient? | 16 | ||
| What are the most common causes of breast masses or lumps? | 16 | ||
| What are some clinical features that may distinguish fibrocystic change from cancer? | 17 | ||
| What are identifiable risk factors for breast carcinoma? | 18 | ||
| What are some clinical findings of breast carcinoma? | 19 | ||
| What are the most common neoplasms of the breast? | 20 | ||
| What findings affect the prognosis of breast cancer? | 21 | ||
| What are the patient’s treatment options? | 23 | ||
| What is the recommended frequency of screening for breast cancer? | 23 | ||
| References | 24 | ||
| Case 4 A 65-Year-Old Male With Acute Chest Pain | 25 | ||
| What is the differential diagnosis of a patient presenting with acute chest pain? | 25 | ||
| What is angina? | 25 | ||
| This patient presents with typical anginal chest pain. How do you define typical angina? | 25 | ||
| What is unstable angina? | 25 | ||
| Which aspects of the history and physical exam should be included when evaluating a patient suspected of having an acute myocardial infarction? | 26 | ||
| Which therapies should this patient receive upon presentation? | 27 | ||
| How do you manage a patient with an ST-segment elevation myocardial infarction (STEMI)? | 28 | ||
| What medical therapies are used to treat patients with STEMI and why? | 28 | ||
| What are contraindications to thrombolytic therapy? | 29 | ||
| What complications can occur following STEMI? | 30 | ||
| What long-term medical therapies are indicated for individuals who have survived a STEMI? | 30 | ||
| References | 31 | ||
| Case 5 A 31-Year-Old Male With Human Immunodeficiency Virus, Cough, and Shortness of Breath | 32 | ||
| How is a cough characterized? | 32 | ||
| Based on this drug regimen, what can one presume about the patient’s HIV status? | 33 | ||
| What is the skin lesion pictured in Figure 5.1? | 33 | ||
| What other skin lesion mimics KS? | 33 | ||
| Describe the findings on the CXR (shown in Fig. 5.2). | 33 | ||
| What is the next appropriate step in management? | 35 | ||
| How do you evaluate for and manage a potential case of active tuberculosis? | 35 | ||
| What is the next best step in management? | 35 | ||
| Describe the lung lesion you see in the left lingula. How does this alter the differential? | 36 | ||
| What are these lesions? | 36 | ||
| Does this patient require systemic treatment for KS? | 37 | ||
| What confirmatory stain for KS is seen in the pathology slide shown in Figure 5.5? | 37 | ||
| Does the presence of pulmonary KS in this patient adequately explain his symptoms? What other diagnostic testing can be done during bronchoscopy? | 38 | ||
| Interpret the pathology slides. | 40 | ||
| What is the treatment for Cryptococcus neoformans pneumonia? What further diagnostic testing is essential prior to initiation of antifungal therapy? | 40 | ||
| References | 41 | ||
| Case 6 A 54-Year-Old Male With Worsening Weakness | 42 | ||
| In evaluating worsening lower extremity weakness, what types of questions are important to ask first? | 42 | ||
| What questions on the review of systems are also important to note in this case? | 43 | ||
| How is muscle strength assessed and graded on physical exam? | 43 | ||
| What signs are concerning for respiratory compromise in acute neuromuscular disease? | 44 | ||
| What is the differential diagnosis at this point? | 44 | ||
| How should interpretation of the CSF be approached? | 45 | ||
| What objective studies can be performed to assess the need for intubation? | 45 | ||
| How is Guillain-Barré syndrome (GBS) characterized? | 46 | ||
| What are the expected diagnostic findings associated with GBS? | 46 | ||
| What infections have been associated with GBS? | 47 | ||
| How is acute treatment approached? | 47 | ||
| How does CIDP compare to AIDP? | 47 | ||
| How should rehabilitation be approached? | 48 | ||
| References | 49 | ||
| Case 7 A 56-Year-Old Male With 3 Weeks of Fever | 50 | ||
| What do you think about his admission diagnosis? | 50 | ||
| What is the differential diagnosis? | 50 | ||
| Which other tests should be ordered? | 50 | ||
| What do you think about this diagnosis? | 51 | ||
| What is the likely diagnosis now, and what other tests should you order? | 51 | ||
| How do you respond? | 52 | ||
| Does this rule out infective endocarditis? What should you do now? | 54 | ||
| What are some of the complications to worry about? | 55 | ||
| Does this patient need valve replacement surgery? | 56 | ||
| Which antibiotic regimen would you now use? | 56 | ||
| How should you advise him? | 58 | ||
| References | 59 | ||
| Case 8 A 25-Year-Old Female With Polyuria and Polydipsia | 60 | ||
| How does the history help narrow your differential diagnosis? | 60 | ||
| What is your differential diagnosis? | 60 | ||
| What is the definition of diabetic ketoacidosis? | 61 | ||
| What are the most common precipitating factors of DKA? | 61 | ||
| What clinical manifestations in the history and physical exam would make you concerned about a diagnosis of DKA? | 61 | ||
| What laboratory abnormalities would you expect in this patient? | 62 | ||
| What is your initial management? | 63 | ||
| How do you monitor therapy? | 64 | ||
| How do you complete your therapy? | 64 | ||
| References | 64 | ||
| Case 9 A 22-Year-Old Female With Joint Pain | 65 | ||
| Why is the duration of this patient’s joint pain important? | 65 | ||
| What is meant by the term oligoarthritis, and why is the number of joints involved in arthritis important? | 66 | ||
| Why is it important to ask about the duration of morning stiffness? | 67 | ||
| What is the definition of synovitis and what does it indicate? | 67 | ||
| How would you summarize the findings and the most likely differential diagnoses? | 68 | ||
| What are other physical exam findings in RA? | 68 | ||
| What are RFs and how should one interpret positive anti-CCP antibodies? | 71 | ||
| What is the recommended initial treatment for RA? | 72 | ||
| What therapies are available if the patient does not respond to or has intolerance to MTX? | 72 | ||
| When should biologic therapy be considered for RA? | 72 | ||
| What are the side effects and risks of the biologic medications? | 73 | ||
| References | 76 | ||
| Case 10 A 62-Year-Old Female With Epigastric Pain and Nausea | 78 | ||
| What pathologies should you be thinking about in this patient? How should you proceed? | 78 | ||
| When is an EGD indicated? | 78 | ||
| What are common visual findings of gastritis on EGD? | 79 | ||
| How is Helicobacter pylori infection diagnosed? | 81 | ||
| What are the recommendations for management of H. pylori infection? | 82 | ||
| What are some complications of H. pylori infection? | 83 | ||
| What is the etiology of peptic ulcer disease? | 84 | ||
| What are some complications associated with peptic ulcer disease? | 84 | ||
| What are the major indications for peptic ulcer surgery? | 84 | ||
| What are causes for recurrent ulcers in patients who have undergone previous ulcer surgery? | 86 | ||
| References | 86 | ||
| Case 11 A 69-Year-Old Male With “Congestive Heart Failure” | 87 | ||
| Why is it unsatisfactory to accept a diagnosis of “congestive heart failure” at face value? Why should you never simply put “congestive heart failure” in the problem list of your patient’s chart? | 87 | ||
| What symptoms are suggestive of CHF? | 88 | ||
| What signs are seen in CHF? | 88 | ||
| How is examining the jugular veins used to determine volume status? How do you examine for jugular venous distention? | 89 | ||
| What is the differential diagnosis of dilated cardiomyopathy? | 90 | ||
| What medications are shown to have a mortality benefit in systolic heart failure? What medications that are sometimes used in patients with systolic heart failure do not have a mortality benefit? What medications should be avoided? | 91 | ||
| Which nonpharmacologic treatments are indicated in patients with an EF of 35% or less? Which of these are indicated in your patient? | 92 | ||
| References | 94 | ||
| Case 12 A 68-Year-Old Male With Weakness and Fatigue | 95 | ||
| What are some things to think about when someone complains of weakness and malaise? | 95 | ||
| What pathologies should you be considering based on this history? | 95 | ||
| How does this change your differential diagnosis? | 97 | ||
| What labs should you order next? | 98 | ||
| What are the initial steps in evaluating hyponatremia? | 98 | ||
| How can we understand ADH effects? | 100 | ||
| What controls the release of ADH? | 101 | ||
| What are the next steps in evaluating the patient’s hyponatremia? | 101 | ||
| What are the principles of treating hyponatremia? | 103 | ||
| What are the pharmacologic therapies for SIADH? | 105 | ||
| How would you summarize the evaluation of hyponatremia in this case? | 105 | ||
| References | 106 | ||
| Case 13 A 65-Year-Old Male With Dysphagia | 107 | ||
| What is your differential diagnosis for dysphagia? | 107 | ||
| What is the significance of the absence of tongue fasciculations? | 107 | ||
| With the previous exam, what could the proximal muscle weakness indicate? | 108 | ||
| What other conditions can you consider with a unilateral ptosis? | 108 | ||
| What is the next step in diagnosis? | 108 | ||
| What neurodiagnostic test would be appropriate? | 109 | ||
| What are treatment options for myasthenia gravis? | 109 | ||
| References | 110 | ||
| Case 14 A 60-Year-Old Male With Acute Headache and Fever | 111 | ||
| What medical emergency must you consider in this patient based solely on these initial symptoms? | 111 | ||
| What factors should be considered when evaluating the cause of a patient’s suspected meningitis? | 111 | ||
| What are Kernig’s and Brudzinski’s signs, and how reassuring is it that they are normal in this patient? | 113 | ||
| What is your differential diagnosis at this point? | 113 | ||
| Can you clinically distinguish meningitis from encephalitis, and is this distinction important? | 116 | ||
| What is the most critical diagnostic test that should be performed as soon as possible? | 116 | ||
| What CSF studies should you perform? | 116 | ||
| Should brain imaging always be performed prior to an LP? | 116 | ||
| Should you start empiric antibiotics? If so, which antibiotics would be most appropriate? | 117 | ||
| Should you add glucocorticoids? | 118 | ||
| Does this CSF profile help further narrow your differential? | 118 | ||
| What is your presumptive diagnosis, and how will you confirm the diagnosis? | 119 | ||
| Is there any role for a repeat LP? | 120 | ||
| Should you provide, or should you have provided, chemoprophylaxis for his close contacts? | 120 | ||
| References | 121 | ||
| Case 15 A 66-Year-Old Male With Progressive Dyspnea on Exertion | 123 | ||
| With shortness of breath, what organ systems should be considered as a potential cause? | 123 | ||
| What clues in the history might point toward CHF? | 123 | ||
| What is your differential diagnosis? | 124 | ||
| What labs would you order and why? | 125 | ||
| How should you proceed with his workup? | 126 | ||
| How would you diagnose COPD? | 126 | ||
| What is the difference between emphysema and chronic bronchitis? | 127 | ||
| Why is emphysema a disease of expiratory flow limitation? | 128 | ||
| How does the physiology of the lung change in someone with COPD? | 129 | ||
| How should you institute management for this patient? | 129 | ||
| What are therapeutic strategies for smoking cessation? | 130 | ||
| What are some nonmedical interventions for COPD? | 131 | ||
| What about acute management of COPD exacerbations? | 131 | ||
| References | 132 | ||
| Case 16 A 26-Year-Old Female With Joint Pain | 133 | ||
| What are critical questions to ask in anyone with a history of joint pain? | 133 | ||
| How does this information help you to form a differential diagnosis? | 134 | ||
| What is synovial thickening and how do you test for it? What does it mean? | 134 | ||
| What is your differential diagnosis at this point? | 134 | ||
| How did the autoantibody profile help establish this diagnosis? | 136 | ||
| What are the classification criteria for SLE and how are they helpful in this case? | 136 | ||
| How would you approach treatment acutely? | 137 | ||
| How do you approach treatment chronically in this patient? | 137 | ||
| What is the patient’s prognosis? | 138 | ||
| How do you approach therapy now? What changes should be made? | 139 | ||
| References | 140 | ||
| Case 17 A 57-Year-Old Male With Blurred Vision | 141 | ||
| Why is it important to ask about eye pain and redness in association with vision loss? | 141 | ||
| When should a diabetic patient be initially screened for diabetic retinopathy? | 142 | ||
| What are the three primary types of age-related cataracts? | 143 | ||
| How would you classify this patient’s disease on the spectrum of diabetic retinopathy? | 143 | ||
| What is diabetic macular edema? | 143 | ||
| What types of retinal imaging should you obtain on this patient? | 144 | ||
| What is the next step in the management of this patient? | 146 | ||
| What are the options for treatment of this patient’s macular edema? | 146 | ||
| References | 146 | ||
| Case 18 A 52-Year-Old Male With Radiating Leg Pain | 148 | ||
| What symptoms associated with acute low back pain could potentially warrant emergent management? | 148 | ||
| What other red flags should be elicited on the history? | 148 | ||
| What specific symptom description can help differentiate between a referred pain and radiculopathy? | 149 | ||
| How can sensation and muscle function contribute to the diagnosis? | 150 | ||
| What special exam maneuvers are good for diagnosing acute radiculopathy? | 150 | ||
| What is the differential diagnosis? | 151 | ||
| What is the natural history of acute low back pain and associated radiculopathy? | 152 | ||
| Is a definitive diagnosis or further testing necessary before beginning management? | 152 | ||
| How can conservative management be approached initially? | 152 | ||
| What other studies can be used in the event MRI is contraindicated? | 154 | ||
| What interventional and surgical options are available for treatment of radiculopathy? | 155 | ||
| References | 156 | ||
| Case 19 A 78-Year-Old Male With Palpitations and Lightheadedness | 158 | ||
| How would you interpret this ECG? | 158 | ||
| What are the common presenting signs and symptoms of atrial fibrillation? | 158 | ||
| How do you classify the types of atrial fibrillation? | 158 | ||
| What is the pathophysiology of atrial fibrillation? | 159 | ||
| What are some underlying etiologies of atrial fibrillation? | 159 | ||
| What are the criteria for hospitalization for atrial fibrillation? | 160 | ||
| What medications could you use to control the pulse rate? | 160 | ||
| What lab and imaging studies do you want to send at this point? | 160 | ||
| Should this patient be offered rhythm control as treatment for his arrhythmia? | 160 | ||
| When would you choose electric and/or pharmacologic cardioversion over rate control? | 161 | ||
| Should this patient be referred for elective electrocardioversion? | 161 | ||
| If electric cardioversion is successful, how would you manage the patient after sinus rhythm is restored? | 161 | ||
| What are some other treatment options for atrial fibrillation if rate or rhythm control is not successful? | 162 | ||
| Do patients with atrial fibrillation need lifelong anticoagulation for stroke prevention? | 162 | ||
| References | 163 | ||
| Case 20 A 56-Year-Old Male With Acute Cough and Fever | 164 | ||
| What are some important initial questions to ask in a patient who presents with a cough? | 164 | ||
| What is at the top of your differential? | 165 | ||
| How does the information gathered from taking a thorough social history influence your initial evaluation and management of patients with suspected pneumonia? | 165 | ||
| What diagnostic test should you perform next? | 167 | ||
| Does this CXR help narrow your differential? | 167 | ||
| What are the typical and atypical pathogens? Why does it matter to distinguish them? | 167 | ||
| Why is it important to ask about recent contact with the health-care system, including recent antibiotic use, in a patient diagnosed with pneumonia? | 167 | ||
| Should laboratory testing be performed in this patient? | 169 | ||
| What is the most likely pathogen in this patient? | 169 | ||
| Should this patient be hospitalized or treated as an outpatient? Are there any tools to guide us in our decision? | 170 | ||
| What should be the initial empiric antibiotic therapy? How long should he be treated for? | 171 | ||
| What potential factors may lead to treatment failure? | 171 | ||
| What are some strategies for preventing pneumonia-related morbidity and mortality in adults? | 172 | ||
| References | 174 | ||
| Case 21 A 34-Year-Old Female With Left Lower Extremity Edema | 175 | ||
| What are common causes of peripheral edema and the mechanism? | 175 | ||
| What are causes of unilateral peripheral edema? | 175 | ||
| What are risk factors for development of DVT? | 175 | ||
| How would you proceed with her care to make a diagnosis? | 176 | ||
| What inherited coagulopathies should be considered for recurrent DVT? | 177 | ||
| How should therapy be instituted for this patient? | 177 | ||
| What is your differential diagnosis for chest pain? | 179 | ||
| How should you proceed with her care to make a diagnosis? | 180 | ||
| What imaging modalities can be used to diagnose pulmonary embolism? | 180 | ||
| What therapy should be instituted for this patient and how would it change if she were hypotensive and hypoxemic? | 180 | ||
| When can patients be treated as outpatients for pulmonary embolism? | 182 | ||
| References | 183 | ||
| Case 22 A 25-Year-Old Male With Seizures | 184 | ||
| What questions are important to ask witnesses about the convulsion to determine what caused his seizure? | 184 | ||
| What are some different types of seizures? | 184 | ||
| How do you correctly distinguish epileptic seizures from other types of events? | 185 | ||
| Does it seem that the patient had an epileptic seizure? What type of seizure does it sound like, and why does it seem that he had it? What are the next steps for the evaluation of this patient? | 186 | ||
| How is epilepsy defined? | 186 | ||
| What is the reason to admit to the hospital for this patient? | 186 | ||
| What is the next step in treating this patient? | 187 | ||
| Why did this patient likely have this admission for status epilepticus? What should be considered in the follow up of this patient and need for specialist care? | 187 | ||
| What is the reason for the patient’s symptoms? What is the next best step in this patient’s treatment and evaluation? | 187 | ||
| What is the underlying reason for the hyponatremia? | 188 | ||
| References | 189 | ||
| Case 23 A 58-Year-Old Female With Dyspnea on Exertion and Renal Failure | 190 | ||
| What are helpful ways to elicit a history of RP? | 190 | ||
| How is diffuse SSc distinguished from limited SSc? | 191 | ||
| What skin changes are seen in patients with SSc? | 192 | ||
| What are possible causes of this patient’s dyspnea? | 192 | ||
| What is your differential diagnosis? | 194 | ||
| What is the role of autoantibody testing at this point in the patient’s presentation? | 195 | ||
| Is concurrent vasculitis a common finding with SSc? | 196 | ||
| What is the significance of “honeycombing”? | 197 | ||
| How would you treat the renal disease in this patient? | 197 | ||
| How would you treat ILD in this patient? | 198 | ||
| References | 198 | ||
| Case 24 A 46-Year-Old Male Referred for Hyperglycemia | 200 | ||
| Does your patient have diabetes? | 200 | ||
| What elements of the physical exam are important for you to focus on in an outpatient with type 2 diabetes? | 201 | ||
| What are some secondary causes of diabetes and how can the physical exam be helpful in diagnosing them? | 202 | ||
| In the short period of time you have to spend with him today, what is important for you to accomplish? | 203 | ||
| What is the patient’s goal hemoglobin A1C? What other oral medication options are available to help achieve it? | 204 | ||
| What additional medications are indicated for the patient? | 205 | ||
| How will you treat your patient’s persistent hyperglycemia at this point? | 206 | ||
| If his fasting blood sugars are now at goal, why is his HbA1C still elevated? What needs to be done to fix this? | 207 | ||
| What should you tell him? | 208 | ||
| References | 209 | ||
| Case 25 A 23-Year-Old Female With Dysuria | 210 | ||
| What is the differential diagnosis of a patient presenting with dysuria? | 210 | ||
| Cystitis was mentioned as a type of UTI. What are the other types of UTIs? | 210 | ||
| What clinical clues help differentiate between the different types of UTIs? | 211 | ||
| Does the physical exam help narrow the differential diagnosis? | 211 | ||
| What additional testing is appropriate at this time? | 211 | ||
| How does one interpret a urine dipstick test for infection? | 212 | ||
| How does one interpret a microscopic exam of the urine? | 212 | ||
| How does one interpret a urine culture? | 212 | ||
| What are the typical organisms that cause UTI? | 213 | ||
| How would you treat this patient? | 213 | ||
| How does the treatment of complicated UTI differ? | 213 | ||
| References | 214 | ||
| Case 26 A 40-Year-Old Female With Headaches | 216 | ||
| Why is it important to ask the patient for a description of the headache? | 216 | ||
| What are contraindications to the use of triptans for migraine? | 217 | ||
| What would you do next to aid in the diagnosis of this patient’s headache? | 217 | ||
| Which extraocular muscle is involved? | 218 | ||
| What tests should you order next? | 218 | ||
| What other findings would you look for if you still suspect an increase in intracranial pressure? | 218 | ||
| What is the pathway of CSF production and excretion? | 219 | ||
| What are some treatment options for this patient with idiopathic intracranial hypertension? | 219 | ||
| References | 220 | ||
| Case 27 A 35-Year-Old Male With Substernal Chest Pain | 221 | ||
| How should you approach chest pain? | 221 | ||
| What is most likely in this patient? | 221 | ||
| What other conditions should be considered? | 222 | ||
| How do you manage a patient who presents with GERD? | 222 | ||
| What is the mechanism of reflux in GERD? | 223 | ||
| What are some risk factors and/or precipitating factors for GERD? | 223 | ||
| What are some indications to refer a patient for endoscopy? | 225 | ||
| Besides endoscopy, what are some other tests that can be used in someone presenting with GERD, and what are their indications? | 225 | ||
| What types of changes can be seen on endoscopy in a person with GERD? | 227 | ||
| What are some histologic changes associated with GERD-induced esophagitis, and how do these compare with the histology seen in other causes of esophagitis? | 227 | ||
| What are some long-term consequences of GERD? | 228 | ||
| What are some therapy options for patients with GERD refractory to twice-daily PPI? | 231 | ||
| What are some long-term adverse consequences that can be seen after a Nissen fundoplication? | 232 | ||
| References | 233 | ||
| Case 28 A 62-Year-Old Male With Dyspnea at Rest and Lower Extremity Edema | 235 | ||
| What is the differential diagnosis for dyspnea at rest? | 235 | ||
| What additional laboratory test would you order at this point? | 235 | ||
| What is the role of BNP? | 235 | ||
| What diagnostic tests are needed for evaluation of heart failure? | 237 | ||
| What are risk factors for heart failure in this patient? | 237 | ||
| What is the functional difference between systolic and diastolic heart failure? | 237 | ||
| How do you assess functional capacity in heart failure patients? | 237 | ||
| What medications are used in treatment of acute heart failure? | 238 | ||
| What are reasons for patients to have an acute exacerbation? | 239 | ||
| What preventive measures should be taken for patients with heart failure upon discharge? | 239 | ||
| References | 240 | ||
| Case 29 A 34-Year-Old Male With Chronic Bilateral Gluteal Pains | 241 | ||
| Why is it important to ask about joint stiffness in the morning? | 241 | ||
| What are the Schober’s and Patrick tests? | 242 | ||
| What is the significance of the Achilles tendon swelling? | 242 | ||
| What is your differential diagnosis at this point? | 243 | ||
| What would be the best first imaging test to order? | 243 | ||
| How would you proceed with treatment? | 244 | ||
| How do you decide who needs an anti-TNF-alpha inhibitor? | 244 | ||
| What tests should be ordered before considering starting someone on an anti-TNF-alpha inhibitor? | 244 | ||
| References | 245 | ||
| Case 30 A 20-Year-Old Female With Polyuria and Polydipsia | 246 | ||
| Why should you ask about nocturia? | 246 | ||
| What tests would you order initially? | 247 | ||
| What is your differential diagnosis at this point? | 247 | ||
| What test would you order next? | 248 | ||
| How would you treat this patient? | 249 | ||
| What is the long term management of CDI? | 249 | ||
| References | 251 | ||
| Case 31 A 76-Year-Old Female With Eye Pain and Decreased Vision | 252 | ||
| What findings should point you toward an eye problem as the etiology of a headache? | 252 | ||
| What is your differential diagnosis at this point? | 253 | ||
| What is the primary goal in treating this patient’s angle closure? | 253 | ||
| What types of medications can be used to lower intraocular pressure? | 253 | ||
| What is the most important next step in this patient’s management? | 255 | ||
| References | 256 | ||
| Case 32 A 43-Year-Old Male With Left Leg Erythema and Pain | 257 | ||
| What is your differential diagnosis? | 257 | ||
| Which pathogens should you be worried about causing cellulitis? | 259 | ||
| Which life-threatening emergency conditions should you consider when evaluating someone with a presumptive diagnosis of cellulitis? | 259 | ||
| If there is no clear diagnosis after a thorough history and physical are obtained, which further testing can be performed? | 260 | ||
| Which antibiotics would you empirically start? | 262 | ||
| Should you be concerned about the spread of erythema beyond the borders? | 262 | ||
| If the patient’s cellulitis has not definitively improved (clinically, by vitals, and/or by laboratory parameters) after 48 hours of gram-positive beta-lactam antibiotics, what is the next best step? | 262 | ||
| What can be done to prevent future bouts of cellulitis? | 265 | ||
| References | 266 | ||
| Case 33 A 25-Year-Old Female With Excessive Daytime Sleepiness | 268 | ||
| What are common causes of excessive daytime sleepiness in adults? | 268 | ||
| Why might a history of snoring be medically important? | 268 | ||
| What are parasomnias? | 269 | ||
| Why is it important to ask about driving in patients with excessive daytime sleepiness? | 269 | ||
| What is the Epworth Sleepiness Scale? | 270 | ||
| What is a sleep study? | 271 | ||
| What are the treatment options for hypersomnolence? | 271 | ||
| What is narcolepsy and how is it diagnosed? | 273 | ||
| What is the pathophysiology of narcolepsy? | 273 | ||
| How is narcolepsy treated? | 274 | ||
| References | 276 | ||
| Case 34 A 31-Year-Old Female With a Systolic Heart Murmur | 277 | ||
| What is the differential diagnosis of a systolic heart murmur? What is the most likely diagnosis in your patient? | 277 | ||
| What is MVP? | 278 | ||
| What is dynamic auscultation and how can it be used to help diagnose systolic murmurs? | 279 | ||
| If systolic murmurs are supposed to increase with increased amount of blood in the heart and vice versa, why are you finding that the opposite is occurring in your patient? | 280 | ||
| Given that you are confident that your patient’s murmur is MVP, do you even have to order an echocardiogram? | 280 | ||
| What follow-up is recommended for her echocardiogram findings? Does she ever need another one? | 281 | ||
| What do you tell her about her diagnosis and what she can do to help her symptoms? | 281 | ||
| Does your patient need antibiotic prophylaxis before going for dental procedures? | 282 | ||
| References | 283 | ||
| Case 35 A 57-Year-Old Male With Shortness of Breath | 284 | ||
| What is concerning about this presentation, and how should you proceed? | 284 | ||
| What is the differential diagnosis for a solitary pulmonary nodule? | 285 | ||
| What are the basic types of pleural effusions? | 285 | ||
| What additional testing should be performed on exudative effusions? | 286 | ||
| What are the common clinical and radiologic findings that may lead to a diagnosis of malignancy over nonmalignant causes? | 287 | ||
| What is the assessment of risk for malignancy? | 287 | ||
| What are the general features of a malignant effusion? | 287 | ||
| What are some diagnostic procedures for this patient? | 287 | ||
| What are the most common histologic subtypes of lung carcinoma? | 287 | ||
| What is the clinical significance of subtyping invasive adenocarcinoma? | 289 | ||
| What is the patient’s pathologic staging of non-small cell lung cancer? | 289 | ||
| What is the treatment and prognosis of his lung cancer? | 289 | ||
| What are the syndromes associated with different types of lung carcinoma? | 292 | ||
| What is the new classification of lung adenocarcinoma? | 292 | ||
| References | 293 | ||
| Case 36 A 68-Year-Old Male With Right Knee Pain | 294 | ||
| How does the history help to narrow your differential diagnosis? | 294 | ||
| What is your differential diagnosis? | 294 | ||
| What is the pathogenesis of OA? | 296 | ||
| What are the key physical exam features of OA? | 297 | ||
| What are the risk factors for OA? | 297 | ||
| How do you differentiate OA from an inflammatory arthritis? | 298 | ||
| What are the radiographic features of OA? | 298 | ||
| What are some pharmacologic treatments for OA? | 300 | ||
| What are some nonpharmacologic treatments for OA? | 300 | ||
| When do you refer patients for joint replacement? | 300 | ||
| References | 302 | ||
| Case 37 A 20-Year-Old Female With Chronic Fatigue | 303 | ||
| What should be reasonably considered in a young female with new fatigue? | 303 | ||
| What are the pathologic causes of macrocytic anemia and how do you work it up? | 303 | ||
| What etiologies should be considered for a patient with vitamin B12 deficiency? | 304 | ||
| What are common causes of malabsorption syndromes? | 305 | ||
| What is the histology of a normal small intestine? | 307 | ||
| What are the histologic findings in a small intestine affected by celiac sprue? | 310 | ||
| What are some disorders that may show histologic overlap with celiac disease/GSE? | 310 | ||
| What are the clinical laboratory tests used in diagnosing celiac disease? | 310 | ||
| What kind of follow-up testing is recommended for a patient diagnosed with celiac disease? | 311 | ||
| References | 312 | ||
| Case 38 A 32-Year-Old Female With Bilateral Hand Numbness | 313 | ||
| How can occupational history contribute to the evaluation in this case? | 313 | ||
| What additional questions are important to ask related to the numbness and tingling in her hands? | 313 | ||
| How is optic neuritis commonly tested on physical exam? | 314 | ||
| What is the importance of this electrical sensation running down the back? | 315 | ||
| What is your differential diagnosis at this point? | 316 | ||
| What are the criteria for diagnosis of multiple sclerosis? | 317 | ||
| How should she be treated acutely? | 318 | ||
| What treatment should be initiated for chronic management? | 318 | ||
| In advanced forms of MS, what symptomatic treatments are available? | 318 | ||
| References | 320 | ||
| Case 39 A 22-Year-Old Male With Hematuria | 321 | ||
| What is the significance of dark-colored urine? | 321 | ||
| What is the significance of this patient’s hypertension? | 322 | ||
| What is your differential diagnosis at this point? | 323 | ||
| What labs would you order to evaluate for specific types of glomerulonephritis? | 324 | ||
| When is a renal biopsy indicated? | 324 | ||
| What are the contraindications to a renal biopsy? | 324 | ||
| What information can be obtained from a renal biopsy? | 324 | ||
| What are the treatment options? | 327 | ||
| References | 328 | ||
| Case 40 A 54-Year-Old Male With Chronic Cough and Weight Loss | 329 | ||
| What infection control measure should be immediately instituted? | 329 | ||
| What is the differential diagnosis of chronic cough with constitutional symptoms? | 329 | ||
| What initial tests should be ordered? | 330 | ||
| What is the difference between latent TB infection and active TB disease? | 330 | ||
| What is the utility of a tuberculin skin test or an interferon-gamma release assay (IGRA), such as QuantiFERON-TB Gold In-Tube test, in a patient suspected of having active pulmonary TB? How do these screening tests work? | 330 | ||
| What risk factors does this patient have for infection with Mycobacterium tuberculosis? What risk factors does he have for progression from latent infection to active TB disease? | 331 | ||
| Does this patient have TB disease? | 332 | ||
| Does this confirm the diagnosis of TB? If so, what treatment should you start? | 333 | ||
| Why should you be cautious about using fluoroquinolones for community-acquired pneumonia when TB is also in the differential diagnosis? | 334 | ||
| What is TB treatment failure? What are some reasons for treatment failure? | 334 | ||
| Another patient on your medicine service is under evaluation for TB because of an abnormal CXR and chronic cough with weight loss. He has three negative sputum smears. Is the diagnosis of TB excluded? What other tests should be ordered? | 335 | ||
| References | 336 | ||
| Case 41 A 57-Year-Old Male With Exertional Chest Pain | 337 | ||
| In the outpatient setting, what are the most likely causes of chest pain? | 337 | ||
| What features of the patient’s presentation are consistent with chest pain of cardiac origin? | 338 | ||
| What medications should you prescribe and what tests should you order at this visit? | 338 | ||
| Is an exercise ECG stress test recommended for this patient? | 339 | ||
| Which stress tests are acceptable and which should be avoided if the patient has a left bundle branch block? | 341 | ||
| What if the patient has a pacemaker? | 341 | ||
| What if the patient has chronic obstructive pulmonary disease (COPD)? | 341 | ||
| In addition to reviewing lifestyle modifications with him again, what medications are indicated to better control his angina? | 343 | ||
| Given the result of his stress test, does your patient need a cardiac catheterization (coronary angiography)? | 344 | ||
| References | 345 | ||
| Case 42 A 45-Year-Old Female With Fatigue and Headache | 346 | ||
| How should you begin to evaluate fatigue? | 346 | ||
| What are the key elements to this patient’s fatigue history that help narrow down the differential diagnosis? What questions do you want to ask further? | 347 | ||
| What are the next steps in evaluating this patient’s anemia? | 348 | ||
| What is the evaluation of microcytic anemia? | 352 | ||
| What are the first labs to send out in a patient with microcytic anemia? What is important to know about iron-deficiency anemia? | 354 | ||
| How is iron deficiency anemia managed? | 355 | ||
| References | 357 | ||
| Case 43 A 55-Year-Old Male With Fever and Abdominal Pain | 358 | ||
| What is concerning about his physical exam? | 358 | ||
| Knowing that he has a decent chance at having cirrhosis based on exam, how would you approach this patient? | 358 | ||
| What is cirrhosis and how is it diagnosed? | 360 | ||
| What are the most common causes of cirrhosis? | 362 | ||
| What are some complications of cirrhosis? | 362 | ||
| How do you interpret these results, and how should you proceed? | 365 | ||
| How is SBP diagnosed? | 365 | ||
| How is SBP treated? | 366 | ||
| What are some signs and symptoms of hepatic encephalopathy? | 367 | ||
| What is the role of transplant in cirrhosis? | 368 | ||
| References | 368 | ||
| Case 44 A 28-Year-Old Female With Difficult-to-Control Hypertension | 370 | ||
| When should you be concerned about secondary hypertension? | 370 | ||
| What are the causes of secondary hypertension? What clues should you look for on history or physical exam? | 370 | ||
| Does this finding increase your suspicion for any causes of the patient’s hypertension? | 371 | ||
| What is the epidemiology of pheochromocytomas? | 372 | ||
| What is the pathophysiology of the disease? | 372 | ||
| What are the risk factors for pheochromocytoma? What other conditions are associated with pheochromocytoma? | 372 | ||
| Where are pheochromocytomas located? | 373 | ||
| How do pheochromocytomas commonly present? | 373 | ||
| What should your approach be to workup? | 373 | ||
| What is the best test to initiate a workup? | 373 | ||
| Are there any special precautions to take when sending this workup? | 374 | ||
| Given the elevated levels, what should your approach be to imaging studies? What are the radiographic features of the disease? | 374 | ||
| How should you treat the patient? | 375 | ||
| References | 377 | ||
| Case 45 A 35-Year-Old Female With Subacute Progressive Bilateral Lower Extremity Edema | 378 | ||
| What is the significance of foamy urine? | 378 | ||
| What is the differential diagnosis of systemic edema (anasarca)? | 378 | ||
| What is an easy and quick test to perform to evaluate for proteinuria? | 379 | ||
| What is the significance of 3+ protein on urinary dipstick? What is the best way to quantify the amount of protein excreted? | 379 | ||
| What is the definition of nephrotic syndrome? | 379 | ||
| What is the differential diagnosis? | 379 | ||
| What is Homans’ sign? | 380 | ||
| What are the possible complications of nephrotic syndrome? | 380 | ||
| What is FSGS? | 381 | ||
| What is the FSGS variant associated with HIV? | 382 | ||
| How should you proceed with treatment? | 383 | ||
| References | 383 | ||
| Case 46 A 40-Year-Old Female With Facial Rash and Persistent Cough | 385 | ||
| What are the most common etiologies of a chronic cough? | 385 | ||
| How does the patient’s skin exam affect the differential diagnosis? | 385 | ||
| What is the most likely diagnosis? How can this be confirmed? | 386 | ||
| Why is it important to check the AFB smear and culture in this case? | 388 | ||
| What illnesses can mimic the clinical presentation of sarcoidosis? | 388 | ||
| What is the CXR scoring system for sarcoidosis? | 391 | ||
| What are the clinical manifestations of sarcoidosis? | 391 | ||
| What is the significance of hypercalcemia and hypercalciuria in this patient? | 392 | ||
| What type of neurologic involvement is seen in sarcoidosis? | 392 | ||
| What are the mainstays of treatment for sarcoidosis? | 393 | ||
| What etiologies or organ-specific involvement of sarcoidosis may best explain her new symptoms? | 393 | ||
| What is the prognosis for patients with sarcoidosis? | 395 | ||
| References | 395 | ||
| Case 47 A 63-Year-Old Male With Acute Polyarticular Arthritis | 397 | ||
| What is the differential diagnosis for this patient’s joint pain? | 397 | ||
| How does the physical exam in this case help to narrow the differential diagnosis? | 398 | ||
| What is the single best test to help determine the diagnosis? | 398 | ||
| How do you interpret the synovial fluid analysis results? | 400 | ||
| What are the treatment options for this patient with acute gout? | 401 | ||
| What drug would you start for this patient? | 402 | ||
| How should allopurinol therapy be monitored and what is the goal of therapy? | 402 | ||
| What are the safety concerns with allopurinol? | 403 | ||
| What is another treatment option in this patient? | 403 | ||
| What are other crystals that can cause arthritis? | 404 | ||
| References | 406 | ||
| Case 48 A 67-Year-Old Male With Syncope | 407 | ||
| What are the considerations for the differential diagnosis of this patient’s presenting symptom? | 407 | ||
| Given this physical exam, what do you think is the most likely cause of this patient’s syncope? | 407 | ||
| What are the physical exam findings of aortic stenosis? | 408 | ||
| What maneuvers are performed to accentuate or diminish the murmur associated with aortic stenosis, and why do they have that effect? | 408 | ||
| This patient presents with syncope. What are other presenting symptoms of aortic stenosis, and what are their implications on prognosis? | 409 | ||
| Why do these symptoms develop in aortic stenosis? | 409 | ||
| What causes aortic stenosis, and what are the risk factors? | 410 | ||
| How is aortic stenosis confirmed? | 411 | ||
| What is the treatment for aortic stenosis? | 412 | ||
| References | 413 | ||
| Case 49 A 63-Year-Old Male With a Unilateral Pleural Effusion | 414 | ||
| What can cause pleural effusions? | 414 | ||
| When should a thoracentesis be performed? | 416 | ||
| What tests should be performed on pleural fluid? | 416 | ||
| How can cell differential aid in the diagnosis of pleural effusions? | 416 | ||
| When should a tube thoracotomy (chest tube) be performed for a pleural effusion? | 416 | ||
| How would you characterize the pleural fluid in this case? What is your differential diagnosis? | 418 | ||
| References | 419 | ||
| Case 50 A 55-Year-Old Male With Hand Tremors | 420 | ||
| What is the initial differential diagnosis of tremor, and what parts of the history are important? | 420 | ||
| What are the cardinal features of Parkinson’s disease? | 420 | ||
| What is the expected tremor for Parkinson’s disease? | 420 | ||
| What is an appropriate treatment for Parkinson’s disease? What categories of medications can be used to treat him? | 421 | ||
| How do you treat this problem? | 422 | ||
| What stage of sleep do these attacks occur in? | 422 | ||
| What are other nonmotor symptoms that need to be addressed by both neurologists and primary care physicians in patients with Parkinson’s disease? | 422 | ||
| What single intervention should be done to help in the diagnosis? | 422 | ||
| Other than medication, what can cause behavioral changes and memory problems in a patient with Parkinson’s disease? | 422 | ||
| References | 423 | ||
| Case 51 A 35-Year-Old Male With Fatigue and Rash | 424 | ||
| What is your differential diagnosis? | 424 | ||
| What further testing needs to be performed to help establish a diagnosis? | 424 | ||
| What is the etiology of Lyme disease? | 425 | ||
| Is it unusual that the patient does not recall a tick bite? | 425 | ||
| What are the clinical stages of Lyme disease? | 426 | ||
| How is Lyme disease diagnosed? | 427 | ||
| How should this patient be treated? If he had presented with other manifestations of Lyme disease, how would treatment differ? | 427 | ||
| What is the most likely etiology of these findings? What further testing should be performed? | 428 | ||
| How could these tick-borne diseases have been prevented? | 429 | ||
| References | 431 | ||
| Case 52 A 45-Year-Old Female With Nausea, Vomiting, and Abdominal Pain | 432 | ||
| What is concerning about this presentation? | 432 | ||
| How should you begin workup of this patient? | 432 | ||
| What other abnormalities are found in DKA? | 433 | ||
| Why isn’t the patient’s potassium very low? | 433 | ||
| What are the causes of hypokalemia? | 433 | ||
| How do you confirm renal potassium losses? | 435 | ||
| What are the different types of renal potassium losses? | 436 | ||
| References | 439 | ||
| Case 53 A 57-Year-Old Female With Cavitary Lung Lesions | 441 | ||
| What are some causes of cavitary lung lesions? | 441 | ||
| In general, when should you consider systemic vasculitis as a diagnosis? | 441 | ||
| What is the best way to elicit the cause of this patient’s cavitary lung lesions? | 443 | ||
| What is your differential diagnosis? | 443 | ||
| What are the respiratory manifestations of GPA? | 445 | ||
| How do you establish a diagnosis of ANCA-associated vasculitis, particularly in this case? | 446 | ||
| What are some other common manifestations of GPA? | 447 | ||
| How do you approach treatment for GPA? | 448 | ||
| References | 449 | ||
| Case 54 A 40-Year-Old Female With Weight Gain and Amenorrhea | 450 | ||
| How should you approach investigating whether a patient has common symptoms that are due to a secondary, treatable cause or are manifestations of lifestyle or genetic predispositions to metabolic abnormalities? | 450 | ||
| How does the physical exam help with your diagnostic evaluation? | 451 | ||
| What are some conditions that may mimic the physical exam findings of Cushing’s syndrome? | 451 | ||
| Who should undergo testing for Cushing’s syndrome? | 452 | ||
| What are other conditions that cause laboratory results consistent with hypercortisolism? | 452 | ||
| What should the initial screening tests be for this patient? | 453 | ||
| When should referral be made to an endocrinologist? | 453 | ||
| What is the next step in management once hypercortisolism is confirmed? | 454 | ||
| What is the corticotropin-releasing hormone stimulation test? | 455 | ||
| What percentage of patients with Cushing’s disease have a normal brain MRI? | 455 | ||
| What is the treatment for Cushing’s disease? | 456 | ||
| What are some specific medical treatments for Cushing’s disease? | 456 | ||
| References | 457 | ||
| Case 55 A 58-Year-Old Male With Chest Pain | 458 | ||
| What do you consider in your differential diagnosis of the chest pain in this patient? | 458 | ||
| What other historical elements can you use to elicit the history in a patient with chest pain? | 458 | ||
| What physical exam clues can you use with a chief complaint of chest pain? | 458 | ||
| Does this patient have angina? | 461 | ||
| What are the risk factors for coronary artery disease? | 461 | ||
| Given historical components, what is this patient’s pretest probability of underlying coronary artery disease? | 462 | ||
| How do you classify the acute coronary syndromes? | 462 | ||
| What is the pathophysiology of the acute coronary syndromes? | 463 | ||
| How would you initially workup this patient? | 463 | ||
| Given his ECG, what are your concerns? | 466 | ||
| How do you diagnose unstable angina? | 466 | ||
| What is your immediate approach to this patient? | 467 | ||
| What is this patient’s risk of mortality? | 468 | ||
| What is the next approach to management? | 469 | ||
| References | 471 | ||
| Case 56 A 70-Year-Old Male With Iron Deficiency Anemia | 472 | ||
| Does the patient still need iron supplementation? | 472 | ||
| What are some considerations of abdominal pain in this patient? | 473 | ||
| What is the differential diagnosis of a gastric submucosal mass? | 473 | ||
| What are the benign and malignant histologic features of gastric stromal tumors? | 475 | ||
| What are the common immunoperoxidase stains used to differentiate different spindle cell neoplasms? | 475 | ||
| What are risk factors for aggressive behavior in a GIST? | 476 | ||
| What are additional treatment options that may be considered in GISTs? | 476 | ||
| References | 481 | ||
| Case 57 A 56-Year-Old Male With Cough and Shortness of Breath | 482 | ||
| What is likely to be the cause of his cough and shortness of breath? | 482 | ||
| What studies should you order? | 482 | ||
| What do you want to do now? | 482 | ||
| How do you interpret this arterial blood gas? | 484 | ||
| How do you interpret the patient’s CXR? | 484 | ||
| Does this change your differential? | 484 | ||
| What is ARDS? | 485 | ||
| How do you diagnose ARDS? | 486 | ||
| Does the patient meet the criteria for the diagnosis of ARDS? | 486 | ||
| How would you classify his ARDS? | 486 | ||
| How is ARDS treated? | 486 | ||
| What is the goal of low tidal volume ventilation? | 487 | ||
| Does a patient’s position during mechanical ventilation matter in ARDS? | 487 | ||
| Does the amount of IV fluids given to patients with ARDS affect their outcomes? | 487 | ||
| Is there anything else we can do to help treat ARDS? | 487 | ||
| References | 488 | ||
| Case 58 A 55-Year-Old Male With Diabetes on an Angiotensin-Converting Enzyme (ACE) Inhibitor | 490 | ||
| How do you manage these symptoms in the emergency room setting? | 490 | ||
| How do you read the patient’s ECG? | 490 | ||
| What are the ECG changes found in hyperkalemia? | 491 | ||
| What are the clinical manifestations of hyperkalemia? | 491 | ||
| How do you emergently treat hyperkalemia? | 492 | ||
| How you do lower serum potassium levels? | 493 | ||
| What are the causes of hyperkalemia? | 495 | ||
| What are the causes of hyperkalemia in this patient? | 496 | ||
| References | 497 | ||
| Case 59 A 34-Year-Old Male With Generalized Weakness | 498 | ||
| What aspects of the patient’s social history would influence the decision to initiate ART? | 498 | ||
| What are the benefits and risks of starting ART now in this patient? | 499 | ||
| Is there a CD4 cell count threshold that should determine when ART should be started? | 500 | ||
| What antiretroviral medications are currently used in devising an ART regimen? | 500 | ||
| How is an ART regimen constructed? | 501 | ||
| What antiretroviral combinations are recommended in initial therapy for HIV, and what would make one prescribe one over the other? | 503 | ||
| How should patients started on ART be monitored? | 505 | ||
| Case 60 A 65-Year-Old Male With Muscle Weakness | 507 | ||
| What questions are helpful to ask in anyone who complains of weakness? | 507 | ||
| What are the critical “red flags” to be aware of in someone with symptoms of myopathy? | 507 | ||
| How do you examine the nailfold capillaries, and when is this of value? | 508 | ||
| What is your differential diagnosis at this point? | 509 | ||
| What is the difference between myopathy and myositis? | 512 | ||
| What type of diagnostic workup should be performed immediately? | 513 | ||
| What tests should be performed next to establish a diagnosis? | 513 | ||
| What is the role of autoantibody testing in this case? | 514 | ||
| How would you approach treatment acutely? | 514 | ||
| What are some general treatment options for long-term therapy of DM? | 515 | ||
| References | 516 | ||
| Case 61 A 43-Year-Old Female With Fevers | 517 | ||
| What are the potential causes of dizziness while sitting or standing that resolve when supine? | 517 | ||
| These vitals are concerning for what clinical syndrome? | 517 | ||
| What is your differential diagnosis? | 518 | ||
| What labs would you like to order and why? | 518 | ||
| How do you interpret these data? | 518 | ||
| What is the diagnosis? | 520 | ||
| How would you classify her degree of sepsis? | 520 | ||
| How is sepsis treated? | 521 | ||
| Does the patient need to be started on mechanical ventilation? | 521 | ||
| What are the goals of therapy in sepsis? | 522 | ||
| References | 523 | ||
| Case 62 A 54-Year-Old Male Who “Stops Breathing at Night” | 525 | ||
| How is insomnia defined? How would you assess this patient’s insomnia? | 525 | ||
| What is your differential diagnosis for this patient’s pauses in breathing during sleep? | 526 | ||
| What additional studies would you consider in patients with central sleep apnea in the absence of cardiac disease? | 527 | ||
| References | 532 | ||
| Index | 533 | ||
| A | 533 | ||
| B | 535 | ||
| C | 536 | ||
| D | 539 | ||
| E | 540 | ||
| F | 541 | ||
| G | 542 | ||
| H | 543 | ||
| I | 544 | ||
| J | 545 | ||
| K | 545 | ||
| L | 546 | ||
| M | 547 | ||
| N | 548 | ||
| O | 549 | ||
| P | 549 | ||
| Q | 551 | ||
| R | 552 | ||
| S | 552 | ||
| T | 554 | ||
| U | 555 | ||
| V | 556 | ||
| W | 556 | ||
| X | 557 | ||
| Y | 557 | ||
| Z | 557 | ||
| Inside Back Cover | ibc1 |