| Uploader: | Emoblonde16 |
| Date Added: | 12.08.2015 |
| File Size: | 26.20 Mb |
| Operating Systems: | Windows NT/2000/XP/2003/2003/7/8/10 MacOS 10/X |
| Downloads: | 38786 |
| Price: | Free* [*Free Regsitration Required] |
IM blogger.com - Free Download
Dec 28, · IM Essentials Text is part of the IM Essentials suite of study materials produced for students through a collaboration of the American College of Physicians and the Clerkship Directors in Internal Medicine. Also available is IM Essentials Questions, . Oct 20, · IM Essentials Text is one part of the IM Essentials suite of study materials produced for students through a collaboration of the American College of Physicians and the Clerkship Directors in. IM Essentials was developed by ACP and the CDIM to help students prepare for the Internal Medicine Clerkship, Shelf Exam and USMLE Step 2.
Im essentials pdf download
See access code inside. PCI is most appropriately used in patients who do not respond to medical therapy. A repeat stress test is indicated if there is a change in symptoms but should not be performed routinely. ACS refers to a spectrum of diseases, including unstable angina, Non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction, based on electrocardiographic ECG changes and the presence of cardiac biomarkers see Chapter 3.
Patients with acute cardiac ischemia classically present with substernal pressure, tightness, im essentials pdf download, or heaviness, with radiation to the jaw, shoulders, back, or arms. The pain may be accompanied by dyspnea, diaphoresis, and nausea. ACS should be particularly suspected in patients with atherosclerotic disease risk factors such as diabetes, im essentials pdf download, hypertension, and hyperlipidemia. Pain that increases with exertion is, im essentials pdf download.
The differential diagnosis of chest pain includes cardiac, pulmonary, gastrointestinal, musculoskeletal, im essentials pdf download, and psychiatric causes Table 1. Frequent but not always exertional chest pain that is often not sharp or positional and radiates to both arms. Pain not easily reproducible. An S3 is occasionally present. ECG changes or elevated cardiac enzymes in initial workup followed by stress testing or catheterization. Pleuritic chest pain and shortness of breath in patients at risk for thromboembolism, im essentials pdf download.
In low-probability patients, a normal D-dimer can exclude the diagnosis. If intermediate or high probability, ventilation-perfusion scan or spiral CT is indicated. Substernal chest discomfort that can be sharp, dull, or pressure-like in nature, often relieved with sitting forward; usually pleuritic.
ECG changes may include ST-segment elevation usually diffuse or more specifically but less commonly PR-segment depression. Sudden onset of pleuritic chest pain and dyspnea in a smoker or COPD patient. Chest radiograph or CT scan confirms the diagnosis.
Pulse or blood pressure differential useful but uncommonly present. Chest radiograph may show a widened mediastinal silhouette, pleural im essentials pdf download, or both. Intense retrosternal pain after vomiting; often associated with ethanol use. Pneumomediastinum on CXR can be seen.
Chest pain with exertion, heart failure, syncope. Typical systolic im essentials pdf download at the base of the heart radiating to the neck. May be indistinguishable from angina. Often diagnosed after a negative evaluation for ischemic heart disease. Often associated with palpitations, sweating, and anxiety. Typically more reproducible chest pain, im essentials pdf download. Includes muscle strain, costochondritis, and fracture.
Should be a diagnosis of exclusion. Burning-type chest discomfort usually precipitated by meals and not related to exertion. It is often worse upon lying down and improved with sitting. Low-risk patients without evidence of MI are evaluated with exercise or pharmacologic stress testing, as indicated.
Higher-risk patients or those with STsegment elevations undergo urgent cardiac catheterization. Cocaine use can cause chest pain and ST-segment changes due to vasospasm, even in patients without significant occlusive coronary artery disease, and may result in myocardial injury.
Pericarditis is characterized by sudden onset of sharp, stabbing, substernal chest pain im essentials pdf download radiation along the trapezius ridge. Often, the pain is worse with inspiration and lying flat and is alleviated with sitting and leaning forward. Given the ephemeral nature of the friction rub, its absence does not rule out pericarditis. The classic rub consists of three components: occurring during atrial systole, ventricular systole, and ventricular diastole.
An echocardiogram may be helpful if there is im essentials pdf download of significant pericardial effusion or pericardial tamponade. Acute pericarditis secondary to infection viral or bacterial may be preceded or accompanied by symptoms of an upper respiratory tract im essentials pdf download and fever. In patients with acute pericarditis, hospitalization is prompted by an associated MI, pyogenic infection, or tamponade. Outpatient management is appropriate if other potentially serious causes of chest pain are excluded, hemodynamic status is normal, and a moderate or large pericardial effusion is excluded by echocardiography.
In the absence of a specific cause for acute peri. Although dissection is fairly rare compared to other chest pain causes an incidence of 3 per im essentials pdf download, patients per yearit can be rapidly life threatening.
An early diastolic murmur due to acute aortic insufficiency may be heard, particularly if the dissection involves the ascending aorta, but the presence or absence of a diastolic murmur is not useful in ruling in or ruling out dissection. When aortic dissection is suspected, imaging the aorta is indicated.
Because of an increased risk of coronary artery dissection and tamponade with dissection progression, dissections involving im essentials pdf download ascending aorta and. Figure 1. Electrocardiogram showing sinus rhythm with diffuse ST-segment elevation consistent with acute pericarditis, im essentials pdf download.
Aortic stenosis is a cause of exertional chest pain and may also be accompanied by dyspnea, palpitations, and exertional syncope due to a diminished cardiac output see Chapter 9. Physical examination reveals a systolic, crescendo-decrescendo murmur best heard at the second right intercostal space, with radiation to the right carotid im essentials pdf download. A transthoracic echocardiogram is the diagnostic test of choice for patients with suspected aortic stenosis.
Patients with spontaneous esophageal rupture typically have severe retching and vomiting followed by excruciating retrosternal chest and upper abdominal pain. These symptoms are followed by the rapid development of odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock. Many cases are related to excessive alcohol ingestion, im essentials pdf download. Chest radiography may show pneumomediastinum, although computed tomography is more sensitive for making this diagnosis. Patients with acute cholecystitis frequently present with right upper quadrant and lower chest pain that may radiate to the right shoulder and is associated with nausea, vomiting, and fever see Chapter On physical examination, deep palpation during inspiration can elicit pain in the right upper quadrant and cause inspiratory arrest Murphy sign.
Physical examination findings are nonspecific but may include tachypnea and tachycardia. ECG readings may also show findings of right ventricular strain, but the most common finding is sinus tachycardia.
A negative D-dimer, a test for PE with a high specificity but low sensitivity, can exclude the diagnosis when clinical suspicion is low. When suspicion is moderate or high, however, a spiral computed tomography scan or a ventilation-perfusion lung scan is an appropriate initial approach Pleuritic chest pain can also be a manifestation of pneumonia and is associated with fever, chills, cough, purulent sputum, and dyspnea see Chapter The physical examination may show wheezing or crackles and signs of consolidation, such as dullness to percussion, egophony, and bronchophony.
Chest x-ray is considered the gold standard for pneumonia diagnosis and is an appropriate initial diagnostic test for any case of chest pain with a possible pulmonary etiology. Pneumothorax should be considered in any patient with sudden onset of pleuritic chest pain and dyspnea see Chapter It is most common in smokers, especially those with chronic obstructive pulmonary disease, im essentials pdf download.
The physical examination may reveal decreased breath sounds on the affected side; if a tension pneumothorax is present, hypotension and tracheal deviation to the im essentials pdf download side of the pneumothorax may be noted.
Chest radiography shows a lack of lung markings on the affected side. In tension pneumothorax, there is a shift of the mediastinum away from the side of the pneumothorax, whereas hydropneumothorax is identified by the presence of concomitant pleural fluid.
Although sometimes difficult to differentiate from ischemic cardiac chest pain, GERD pain often lasts minutes to hours and resolves spontaneously or with antacids see Chapter Other symptoms may include heartburn, regurgitation, chronic cough, sore throat, and hoarseness. On physical examination, patients may exhibit wheezing, halitosis, dental erosions, and pharyngeal erythema. In unclear cases, it is most appropriate to exclude cardiac causes of chest pain before evaluating gastrointestinal causes.
For patients with a high probability of GERD, empiric treatment with a proton pump inhibitor for 4 to 6 weeks is an appropriate initial diagnostic and therapeutic approach. Musculoskeletal Causes Musculoskeletal causes of chest pain are more common in women than in men. Frequent causes of musculoskeletal chest pain include costochondritis, arthritis, and shoulder rotator cuff injuries. Musculoskeletal chest pain has an insidious onset and may last for hours to weeks. It is most recognizable when sharp and localized to a specific area of the chest; however, it can also be poorly localized.
The pain may be worsened by turning, deep breathing, or arm movement. Chest pain may or may not be reproducible by chest palpation; pain reproduced by palpation does not exclude ischemic heart disease. The cardiovascular examination often is normal. For musculoskeletal chest pain, the history and physical examination are keys to the diagnosis; im essentials pdf download radiographic studies and laboratory tests may be indicated depending on the clinical circumstances.
Psychiatric Causes Chest pain can be a manifestation of severe anxiety and panic attacks. Patients may complain of sweating, im essentials pdf download, trembling, or shaking; sensations of choking, shortness of breath, or smothering; nausea or abdominal distress; or feeling dizzy, unsteady, or lightheaded.
On physical examination, tachycardia and tachypnea may be present, but the cardiovascular and pulmonary examinations are otherwise unremarkable. Generalized anxiety and panic attacks may be treated with cognitive behavioral therapy and selective serotonin reuptake inhibitors or venlafaxine.
Panic disorder stands alone among the anxiety spectrum disorders as a condition for which there is evidence that the combination of cognitive behavioral therapy and pharmacotherapy is superior to either treatment modality alone.
Psychosomatic chest pain is a clinical diagnosis; other causes of chest pain are usually excluded by a careful history and physical examination.
Skin Causes Herpes zoster can present in patients with thoracic dermatomes and lead to chest pain. Pain is classically described as intense, burning, and localized to the dermatome involved.
Physical exam reveals unilateral vesicular lesions, although pain often precedes the appearance of these classic lesions. Pain persisting after the disappearance of the skin findings postherpetic neuralgia is also common. Evaluation of the patient with acute chest pain. N Engl J Med. Outpatient diagnosis of acute chest pain in adults. Am Im essentials pdf download Physician.
Donwload MKSAP 18 PDF direct link
, time: 3:55Im essentials pdf download
Oct 20, · IM Essentials Text is one part of the IM Essentials suite of study materials produced for students through a collaboration of the American College of Physicians and the Clerkship Directors in. Download ebook IM Essentials Questions (Through a collaboration of the American College of Physicians and the Clerkship Directors in Internal Medicine) pdf free medical Download medical books free. IM Essentials Questions By (author): The American College of Physicians, Clerkship Directors in Internal Medicine IM Essentials Questions prepares you for the internal medicine clerkship with . IM blogger.com - Free download Ebook, Handbook, Textbook, User Guide PDF files on the internet quickly and easily.
No comments:
Post a Comment