Pocket Medicine: The Massachusetts General Hospital Handbook by Marc S Sabatine
By Marc S Sabatine
The Pocket medication handbook from Massachusetts common health facility, Boston, presents key scientific information for college kids and citizens. It contains parts of inner drugs, cardiology, pulmonary, gastroenterology, nephrology, hematology-oncology, infectious ailments, endocrinology, and rheumatology.
Read or Download Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series) PDF
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The Pocket medication guide from Massachusetts common health facility, Boston, offers key scientific information for college students and citizens. It comprises components of inner drugs, cardiology, pulmonary, gastroenterology, nephrology, hematology-oncology, infectious ailments, endocrinology, and rheumatology.
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Extra resources for Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook Series)
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Clinical manifestations (NEJM 2004;351:2195) • Pericarditis: chest pain that is pleuritic, positional (T by sitting forward), radiates to trapezius; may be absent in tuberculous, neoplastic, post-XRT, and uremic pericarditis; Ϯ fever; Ϯ s/s of systemic etiologies • Effusion: ranges from asx to tamponade (see below) Physical exam • Pericarditis: multiphasic friction rub best heard at LLSB w/ diaphragm of stethoscope (leathery sound w/ up to 3 components: atrial contraction, ventricular contraction, ventricular relaxation) that is notoriously variable and evanescent • Effusion: distant heart sounds, dullness over left posterior lung field due to compressive atelectasis from pericardial effusion (Ewart’s sign) Diagnostic studies (EHJ 2004;25:587; Circ 2006;113:1622) • ECG: may show diffuse STE (concave up) & PR depression (except in aVR: ST T & PR c), TWI; classically and in contrast to STEMI,TWI do not occur until STs normalize Stages: STE & PR T (I); ST & PR normalize (II); diffuse TWI (III);Tw normalize (IV).
5 cm (JACC 2010;55:986). In Pts unfit for surgery: T aneurysm mortality but no ⌬ in overall mortality over medical Rx (NEJM 2010;362:1872). EVAR noninferior (? superior) to open repair in ruptured AAA w/ favorable anatomy (Ann Surg 2009;250:818). 5%/y if Ͻ6 cm vs. 7% if Ͼ6 cm; AAA: ϳ1%/y if Ͻ5 cm vs. 4 cm/y for AAA • Serial imaging first 3, 6, 9, & 12 mo, then annually • Screening for CAD, PAD, and aneurysms elsewhere, espec. popliteal. 25% of Pts w/ TAA will also have AAA. , pectus, ectopia lentis, MVP; Ehlers-Danlos type IV (type III procollagen): translucent skin; bowel or uterine rupture; Loeys-Dietz; annuloaortic ectasia, familial AoD; PCKD • Congenital aortic anomaly: bicuspid aortic valve or coarctation (eg, in Turner’s) • Aortitis:Takayasu’s, giant cell arteritis, Behçet’s, syphilis • Pregnancy: typically in 3rd trimester; can also see spont.
3 suggestive, as is septum Ͼ15 mm; other findings include dynamic outflow obstruction, SAM, MR • MRI: hypertrophy ϩ patchy delayed enhancement (useful for dx & prognosis) • Cardiac cath: subaortic pressure ∇; Brockenbrough sign ϭ T pulse pressure postextrasystolic beat (in contrast to AS, in which pulse pressure c postextrasystole) Treatment (NEJM 2004;350:1320) • Heart failure ᮎ inotropes/chronotropes: -blockers, CCB (verapamil), disopyramide. Vasodilators only if systolic dysfxn. Avoid digoxin.