Associate Professor of Internal Medicine and. Pediatrics Now in its fourth edition, Step-Up to Medicine has been completely revised based on exten-. We hope that the new edition of Step-Up to Medicine continues to be a valuable tool for students during the clinical years of medical school. However, we. Clinical pearls, full-color illustrations, and “Quick Hits” provide essential information in Step-Up to Medicine, Fourth Edition delivers exactly what you need to.
|Language:||English, Spanish, Indonesian|
|Genre:||Politics & Laws|
|Distribution:||Free* [*Registration Required]|
“Kama is the enjoyment of appropriate objects by the five senses of hearing, feeling, seeing Kama Sutra. Step Microsoft Excel Step by Step. Step-Up to Medicine PDF is aimed at serving as a single “study tool” to you will now have access to new questions focused on clinical. Editorial Reviews. Review. Doody's Book Review Service, Sally Ling, MD, University of Case Files Internal Medicine, Fifth Edition (LANGE Case Files) Kindle Edition. Eugene C. Toy Case Files Family Medicine, Fourth Edition Kindle Edition.
Other diuretics are only for symptomatic relief ACEIs- venous and arterial dilation leading to decreased preload and afterload. Prolong survival in combination with diuretic.
Premature Atrial Complexeso Early beat in atria which can be due to excess adrenergic stim, drugs, alcohol, tobacco, ischemia, electrolytes, infection o Early P waves that look different than normal and normal QRS.
Can cause palpitations or give rise to Paroxysmal SVTs. Tachyarrhythmias- Afib- Chaotic, rapid pattern with irregular, rapid ventricular rate. Atria quiver continuously with a rate over bpm which is transmitted to the ventricles through an AV node which only allows of these beats through.
If patient is hemodynamically unstableimmediate cardioversion A flutter One automaticity focus bpm in atriumregular atrial contractions.
Tx-Radiofrequency ablation of re-entrant loop. If concurrent Heart Disease or LV dysfxn then increased risk of cardiac death, must evaluate. Prognosis- If non-sustained and not after an MI and no underlying heart disease, prognosis is good. Amio if this doesnt work. VFib- multiple foci in ventricles fire rapidly leading to a chaotic quivering of ventricles and no cardiac output.
Defibrillate again 60 secs after epi. If Successful: o Continue IV infusion of the antiarrhythmic that helped. If this doesnt help pacemaker o Sick Sinus Syndrome-Persistent, spontaneous sinus bradycardia causing dizziness, confusion, syncope, fatigue, CHF. NO tx required. Escape rhythm usually occurs with Ventricular pacemaker establishing heart rate of Add in anticoagulation Hypertrophic Cardiomyopathy- most AD mutation, some spontaneous mutations exist o Diastolic Dysfunction develops due to stiff wall.
Restrictive Cardiomyopathy o Infiltration of myocardium results in impaired diastolic ventricular filling due to decreased ventricular compliance.
Due to sarcoid, amyloid, hemochromatosis, scleroderma, carcinoid. EKG shows electrical alternans. If due to renal disease do dialysis.
The closer the opening snap is to S2, the worse the stenosis. Must do AV replacement if symptomatic. If asymptomatic NO TX. No balloon angioplasty lots of recurrent stenoses Aortic Regurg- Regurg-ed blood increases LV ventricular and diastolic volumedilation of LV and hypertrophycompensation fails leading to increased left sided pressures and Pulmonary Pressures. Fatal within 6 wks if untreated.
Longer time to death. Can embolize to brain or periphery. Sterile deposits of fibrin and platelets along the closure line of the valve. Presents with regurg murmur. Also TC diastolic rumble murmur.
Only large defects will result in pulm HTN in this one and also result in CHF, growth failure and recurrent lower Respiratory infections. Small shunts dont produce ANY problems. Leads to increaseds LV afterload. Aortic Angio is best test if planning surgery.
Surgical for Type A. Femoral Cutdown and Fogarty Cath.
Usually triggered by catheterization or arteriogram. Split-thickness graft if doesnt heal. Atrial Myxoma- fatigue, malaise, syncope, low-pitched diastolic murmur that changes with varying positions diastolic plop. Can embolize and become metastatic. No use of accessory muscles o Emphysema- enlargement of air spaces distal to terminal bronchioles due to destruction Centrilobular- smokers- upper lobe destruction limited to respiratory bronchioles Panlboular- in alpha 1 antitrypsin- both proximal AND distal acini at the bases.
Pink Puffer- thin due to increased energy usage for breathing. Pts lean forward. Barrel Chested. Tacvhypnea with pursed lips.
Use of accessory muscles. Symptoms improve within 1 yr. Inhaled Beta2 Agonists- symptomatic relief. Can use salmeterol Ipratropium- slower onset but longer lasting than beta2s. Combination of the two better than either one alone Corticosteroids- slows down decrease in FEV1 over time but NO benefit to pulmonary function Acute Exacerbations- steroids and moxifloxacin with the above agents.
Can be continuous or only during sleep Pulmonary Rehab- goal is to improve exercise tolerance Vaccination- against Influenza yearly and Strep Pneumo q yrs o Complications Acute exacerbation due to infection with strep pneumo, hemophilus influenzae, moracxella or mycoplasdma. Daily if mod. If hyPERcarbia occurs, sign of decreasing ventilation. Inhaled steroids less side effects than systemic. Supplemental O2, ABx if infxn caused, Intubation if in impending respiratory failure.
Bronchiectasis- permanent, abnormal dilation and destruction of bronchial walls. Damages cilia. Usually in childhood. Less common today due to modern antibiotics o Causes- CF, Infection, airway obstruction o Clinical Features- chronic cough with large amounts of mucopurulent, foulsmelling sputum. PFTs show obstruction. Invasive though so selected pts. SCLC- chemo in both limited and extensive. Radiation ONLY if limited. Radiation as adjunct. Otherwise, usually asymptomatic Three ways to get it: pleural cells making fluid, drainage of fluid into space, decreased drainage out of the space.
Transudative vs Exudative you know. Tx- transudative gets diuretics and Na restriction. Exudative must treat underlying disease. Recurrence is common. Respiratory distress does not occur due to sufficient respiratory reserve.
Tx- if small and asymptomatic- observe should resolve in 10d o If larger, supplemental O2 and chest tube Secondary- to COPD, TB, CF, neoplasm or asthma- more life-threatening due to lack of pulmonary reserve.
Haematology Chapter 6: Nephrology Chapter 7: Rheumatology Chapter 8: Neurology Chapter Psychiatry Chapter Ophthalmology Chapter Dermatology Chapter It consists of 3 parts. Part 1 and 2 are written based exams while paces are all about your clinical knowledge and skills.
MRCP part 1 is consist of multiple choice questions.
Hope these notes assist you in your exams. DMCA Disclaimer: Please bear in mind that we do not own copyrights to these books.
We highly encourage our visitors to download original books from the respected publishers. If someone with copyrights wants us to remove this content, please contact us immediately.
If you feel that we have violated your copyrights, then please contact us immediately.