Blueprints medicine

this is for non-commercial use by Russian-speakers only! if you are not a Russian-speaker delete this file immediately! ,qaHHbll1 CKaH npe,qHo3Ha'"leH IlI1Wb ,qIlR : PYCCKI1X nOllb30BaTellel1Bpa'"lel1 11 Y'"leHblX, B OC06eHHOCTI1 6ECnJlATHOrO pacnpocTpaHeHI1R CKaHlftpOBaHO nOTOM 1ft KPOBblO MYCAH� 3T �HT.PY Vincent B Young • William A Kormos • Allan H Goroll < not for sale! > < He �nH npo�� ! > BLUEPRINTS MEDICINE Third Edition Vincent B Young, MD, PhD Assistant Professor Departments of Internal Medicine, Microbiology & Molecular Genetics National Food Safety and Toxicology Center Michigan State University College of Human Medicine East Lansing, Michigan William A Kormos, MD, MPH Instructor in Medicine and Medical Education Harvard Medical School Massachusetts General Hospital Boston, Massachusetts Faculty Advisor Allan H Goroll, MD Associate Professor of Medicine Harvard Medical School Associate Physician Massachusetts General Hospital Boston, Massachusetts fl) Blackwell Publishing < not for sale! > < He �nH npo�� ! > < C�aH � �e�aB��oHBepC�H MYC� 9T WpoHT PY © 20U4 by Blackwell Publishing Blackwell Publishing, Inc , 350 Main Street, Malden, Massachusetts 02148-5018, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia All rights reserved No part of this publication may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review 03 04 05 06 ] ISBN: 1-4051-0335-3 Library of Congress Cataloging-in-Publication Data Young, Vincent B Blueprints medicine / Vincent B Young, William A Kormos, Allan H Gorol1.-3rd ed p.; cm.-(Blueprints) Rev ed of: Blueprints in medicine 2nd ed c2001 Includes index ISBN 1-4051-0335-3 I Internal medicine-Outlines, syllabi, etc [DNLM: I Internal Medicine-Examination Questions 2004] Kormos, William A II Goroll, Allan H Blueprints in medicine IV Title V Series WB 18.2 Y 78b III Young, Vincent B RC59.Y68 2004 616'.0076-dc21 2003001502 A catalogue record for this title is available from the British Library Acquisitions: Nancy Anastasi Duffy Development: Julia Casson Production: Debra Lally Cover design: Dick Hannus Interior design: Mary McKeon Typesetter: SNP Best-set Typesetter Ltd., Hong Kong Printed and bound by Capital City Press in Berlin, VT For further information on Blackwell Publishing, visit our website: blackwellpublishing.com www Notice: The indications and dosages of all drugs in this book have been recommended in the medical litera­ ture and conform to the practices of the general community The medications described not necessarily have speCific approval by the Food and Drug Administration for use in the diseases and dosages for which they are recommended The package insert for each drug should be consulted for use and dosage as approved by the FDA Because standards for usage change, it is advisable to keep abreast of revised recommendations, particu­ larly those concerning new drugs > Reviewers viii Preface ix Acknowledgments .x Abbreviations xi Cardiovascular Part I Chest Pain Shock Coronary Artery Disease Myocardial Infarction Heart Failure 20 15 27 Bradyarrhythmias Tachyarrhythmias 31 Hypertension 37 Valvular Heart Disease 10 Cardiovascular Disease 11 Syncope Part II Respiratory 41 47 51 55 57 61 12 Dyspnea 13 Cough 14 Chronic Obstructive Pulmonary Disease .64 15 Asthma 68 16 Pulmonary Embolism 73 17 Interstitial Lung Disease 18 Pleural Effusions 19 Lung Cancer Part ((( Renal Acid-Base Disturbances 21 Fluid and Electrolytes 22 Acute Renal Failure 23 Chronic Renal Failure 24 Glomerular Disease 25 Nephrolithiasis 26 Hematuria 20 .77 82 91 95 99 103 85 89 106 09 112 < not for sale! > < He �nH npo�� ! > Part IV Infectious Diseases 27 Fever and Rash 28 Pneumonia 29 Sexually Transmitted Diseases 115 Part V Gastrointestinal Abdominal Pain Diarrhea 39 Peptic Ulcer Disease and Gastritis 40 Inflammatory Bowel Disease 41 Hepatitis 42 Cirrhosis 43 Cholestatic Liver Disease 38 37 165 44 Pancreatitis 45 Colorectal Cancer 169 172 180 184 199 Weight Loss 47 Hyperthyroidism 48 Hypothyroidism 49 Diabetes Mellitus 50 Hypercalcemia 51 Diseases of the Adrenal Gland 52 Pituitary Disease 53 Nutritional Disorders 54 Hyperlipidemia Part VII Rheumatology .201 203 206 209 214 217 221 189 192 195 46 176 152 163 149 158 136 133 127 121 140 145 117 HIV Part II: Prophylaxis and Treatment of Opportunistic Part VI Endocrine 36 Meningitis HIV Part I: Initial Care of the HIV-Infected Patient 35 34 Infective Endocarditis 33 Gastroenteritis Infections in HIV 32 Urinary Tract Infections Tuberculosis 31 30 225 230 233 55 Acute Monoarticular Arthritis 235 56 Low Back Pain 57 Rheumatoid Arthritis 58 Seronegative Spondyloarthropathies 59 Connective Tissue Diseases 60 Vasculitis 61 Amyloidosis 238 241 244 247 251 254 < not for sale! > < He �nH npo�� ! > < Part VIII Hematology/Oncology 62 Anemia 63 Hemolytic Anemia 64 Adenopathy 257 259 Leukemia and Lymphoma 69 Acute Complications of Cancer Therapy 70 Paraneoplastic Disorders Prostate Cancer 68 Index Bleeding Disorders Ques tions Breast Cancer Ans wers > 65 9T �pOHT py 66 67 MYC� CKaM H �e�aBID-KoHBepCHH 264 267 269 273 277 280 284 287 290 306 319 vii James Fletcher Class of 2003 Eastern Virginia Medical School Norfolk, Virginia Danny Liaw, MD Intern, Department of Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts Nancy Pandhi, MD Resident, Shenandoah Valley Family Practice Residency Front Royal, Virginia Diane Rychlik, MD Class of 2002 Spartan Health Sciences University School of Medicine Vieux Fort, St Lucia Edward O Senu-Oke, MD Resident, Eastern Virginia Medical School Norfolk, Virginia Jason Sluzevich, MD Resident, Department of Dermatology University Hospital Cincinnati, Ohio viii n 1997, the first five books in the Blueprints series were published as board review for medical Istudents, interns, and residents who wanted high-yield, accurate clinical content for USMLE Steps & Six years later, we are proud to report that the original books and the entire Blueprints brand of review materials have far exceeded our expectations The feedback we've received from our readers has been tremendously helpful and pivotal in deciding what direction the third edition of the core books will take The student-to-student approach was highly acclaimed by our readers, so resident contributors have been recruited to ensure that the third edition of the series continues to provide the content and approach that made the original Blueprints a success It was suggested that the review questions should reflect the current format of the Boards, so new board-format questions have been included in this edition with full explanations provided in the answers Our readers asked for an enhanced art program, so a second color has been added to this edition to increase the usefulness of the figures and tables What we've also learned from our readers is that Blueprints is more than just Board review for USMLE Steps & Students use the books during their clerkship rotations and subin­ ternships Residents studying for USMLE Step often use the books for reviewing areas that were not their specialty Students in physician aSSistant, nurse practitioner, and osteopath pro­ grams use Blueprints either as a companion or in lieu of review materials written specifically for their areas However you use Blueprints, we hope that you find the books in the series informative and useful Your feedback and suggestions are essential to our continued success Please send any comments you may have about this book or any book in the Blueprints series to blue@bos.blackwellpublishing.com The Publisher Blackwell Publishing e are grateful for the continued support that we have received for Blueprints Medicine WWe hope that this edition will continue to serve as a useful review for the USMLE as well as a reference during day-to-day activities in patient care We wish to thank all of the people at Blackwell Publishing who helped us with prepara­ tion of this work We appreciate the input of the medical student and resident reviewers who worked hard to ensure that the Blueprints series continues to maintain a high standard of excellence Finally we wish to thank our families for all of their support during this project " 5-ASA 5-aminosalicylic acid EBV ABGs arterial blood gases ECG electrocardiography ACE angiotensin-converting enzyme EF ejection fraction ACTH adrenocorticotropic hormone EGD esophagogastroduodenoscopy ADH antidiuretic hormone EMG electromyography AI aortic insufficiency ERCP endoscopic retrograde AIDS acquired immunodeficiency syndrome ALL acute lymphocytic leukemia ESR erythrocyte sedimentation rate ALT alanine transaminase FEV forced expiratory volume E pstein-Barr virus cholangiopancreatography AMS acute myelogenous leukemia FNA fine needle aspiration ANA antinuclear antibody FTA-ABS fluorescent treponemal antibody ARDS adult respiratory distress syndrome ASD arterial septal defect FVC forced vital capacity absorption ASO anti-streptolysin GFR glomerular filtration rate AST aspartate transaminase GH growth hormone AV atreoventricular GI gastrointestinal BE barium enema GU genitourinary BP blood pressure HAV hepatitis A virus BUN blood urea nitrogen HbA1C glycosylated hemoglobin CAD coronary artery disease HIV human immunodeficiency virus CALLA common acute lymphoblastic HLA human leukocyte antigen leukemia antigen HR heart rate CBC complete blood count HS hereditary spherocytosis CHF congestive heart failure Ig immunoglobulin CK creatine kinase 1M intramuscular CLL chronic lymphocytic leukemia INH isoniazid CML chronic myelogenous leukemia INR international normalized ratio CMV cytomegalovirus JVP jugular venous pressure CNS central nervous system KUB kidneys/ureter/bladder COPD chronic obstructive pulmonary LDH lactate dehydrogenase disease LES lower esophageal sphincter CPK creatine phosphokinase LFTs liver function tests CSF cerebrospinal fluid LP lumbar pressure CT computed tomography LV left ventricular CVA cerebrovascular accident LVH left ventricular hypertrophy CXR chest x-ray Lytes electrolytes DIC disseminated intravascular MCHC mean corpuscular hemoglobin coagulation concentration DKA diabetic ketoacidosis MCV mean corpuscular volume DM diabetes mellitus MEN multiple endocrine neoplasia DTRs deep tendon reflexes MHC major histocompatibility complex DVT deep venous thrombosis MI myocardial infarction < not for sale ! < > < He �nH npo�� ! > CKati III �e",aBI)-KOHBepcJo1:R MYCAH,I{ 9T CllpoHT py > Index Levothyroxine, 2m, 207, 223 Lev's disease, 27 Lid lag, 204 Lidocaine, 34, 78 lisinopril, 24t Lispro, 2t Listeriosis, 49, Lithium, 206-207, Liver cancer of, 87, 301-302, coagulopathy and, 269, 271 failure of, , 83 fatty, 81-1 82, 84 functions of, 84 transplant of, 86, Loefflel-'s syndrome, 252 Long QT syndrome, 32, 35, 53t Lopinavir, 56t Lovastatin, 232 Low back pain, 238-240, 244-246, 292-293, 307 Low-density lipoprotein (LDL), 9, 13, 230-232, 23 l t, 306-307 Lumbar puncture (LP), 20, I SO-l S I Lumpectomy, 274-275 Lung biopsy, 79, 87 Lung cancer, 85-88 adenopathy and, 267-268 back pain and, 240 case study on, 295, diagnosis of, 86-88, 87f epidemiology of, 85 hyperaldosteronism and, 8, 220 hypercalcemia and, 4-2 ' paraneoplastic disorders with, 287-288 pathophysiology of, 85-86 screening for, treatment of, 88 Lung volumes, 59f Luteinizing hormone (LH), 221 Luteinizing hormone-releasing hormone (LHRH), 279 Lycopene, 277 Lyme disease arthritis and, 235-237 bradyarrhythmia from, 27, 29 meningitis and, 50 rash of, 18, 20, 35-1 36, treatment of, 237 Lymphadenopathy, 281 Lymph node biopsy, 268 Lymphogranuloma venereum, 207 Lymphoma, 72-1 73, 267-268, 280-283 anemia and, 264, 288 causes of, 280-28 classification of, 2RO diagnosis of, 281-282, 282f GuilialO-Barre syndrome and, 288 HIV disease and, 53f, 58-1 59, 62 leukemia stage of, 280 meningitis and, 50 rash with, 1 9t Sjogren's syndrome and, 250 thyroid, 207 treatment of, 283 tumor lysis syndrome and, 285 Macrocytosis, I RS, 259, 260t Macroglobulinemia, 25U Macules, 1 7, 1 8t-1 9t Malabsorption syndromes, 201 amyloidosis and, 255t cholestasis and, 89 diagnosis of, 70 Malaria, 264-265, 265f Malar rash, 248 Metastatic disease back pain from, 238-240 breast cancer and, 275-276 meningitis and, 50 paraneoplastic disorders and, 287-289 pleural effusions from, 83-84 prostate cancer and, 278-27'9 Metformin, 1 , 292 Methimazole, 204-205, 205t Methotrexate anemia from, 260 for breast cancer, 275 for connective tissue disease, 250 for graft-versus-host disease, 286 for IBD, 78 interstitial lung disease and, 78 for rheumatoid arthritis, 243, 307 side effects of, 284t, 307 for Takayasu's arteritis, 253 Methyldopa, , 265 Methylene blue, 265 Malnutrition, 202_ See also Nutrition Mcthylxanthines, 66, 70 Mammography, 274, 276, Marfan's syndrome, , 47 Mass effect, tumor, 86, 222 Metocl0pl-amide, 285 Mastectomy, 275 McBurney's point, 66 Mediastinoscopy, 87 Megacolon, toxic, 78, 79t Melena, 73 , 84, 260 Melphalan, 78, 256 Meningitis, 149-1 bacterial vs_ viJ-ai 49-150, l t diagnosis of, 50 epidemiology of, 149 etiology of, 49-1 50 49t Lyme disease with, 23 rash with, 1 8t treatment of, I S vaccines and, 50 Menopause breast cancer and, 273, 275t cholesterol and, 230 iron deficiency and, 263 Menstrual disorders, 221-222, 263 6-Mercaptopurine, 92t Mesalamine, 77-1 78 Mesothelioma, 83-85 Metabolic disorders abdominal pain with, 65 pancreatitis and, 92 uremia and, 03 Metanephrine, Metaproterenol, 66 329 Metoprolol, 7-18, 24t Metronidazole for Crohn's disease, 78, 79t for gastroenteritis, 142t-1 43t pancreatitis and, 92t for peptic ulcer, I 74 for STDs, I 2Rt Miconazole, 28t Microalbuminuria, 0, , 307 Microcytosis, 259, 26af, 262t Miglitol, 2 Migratory polyarthralgia, 235 Milk-alkali syndrome, 93, Milrinone, Mincralocorticoids, 54t, 93, 97, 7, 220_ See also Steroids Minerals, 225 See also Diet Miner's lung, 79t Minimum inhibitory concentration (Mle), 48 Minocycline, 243 Mitral regurgitation, -45, 43t, 298, 312 Mitral stenosis, -45, 43t, , 53t Mixed connective tissue disorder, 247-250 Molluscum contagiosum, 58-1 59 Mononeuritis multiplex, 252 Mononucleosis, 1 9t, 264, 267-268 Montelukast, 70 < not for sale ! > < He �nH npo�� ! > 330 < CRaH � �e�aBID-ROHBepc�H MYC� 9T �poHT py > Blueprints Med icine MorphinE' for MI, 7, pancreatitis and, 94 for pulmonary edema, 24 Muller's sign, 44 Multiple endocrine neoplasia (MEN) syndromes, , 8, 221 , 297, 311 Multiple myeloma, 255 anemia with, 260f, 263 hack pain and, 238-239 hypercalcemia and, 4-2 treatment of, 256 Mumps, 192 Munnurs, heart, 43-44, 43t, 146 Murphy's sign, 66-1 67 Mussel's 'ign, 44 Myasthenia gravis, 249 complex (MAC), 58-1 59, 60t Mycosis fungoides, 1 9t lvIycobacterium alJiulII Myelodysplastic syndrome CMOS), 260, 26 t, 263, 271 Myeloma See Multiple myeloma Myelophthisis, 260, 261 t, 263 Myelosuppression, 284-285 Myocardial infarction (MI), 5-19 cardiac enzymes and, 6-1 care after, diagnosis of, 6- , 7f, 294-295, 309-3 ECG for, H i-l 7, 7f, 295f, 309 epidemiology of, I S ketoacidosis and, 2 pacemakers and, 29-30 pathogenesis of, 5-16 ST-elevation, 5, 18 tachyarrhythmia after, 32 treatment of; 7-1 Myocardial ischemia, 3-4, 32, 53t Myoxoma, 52t, 53t Nafcillm, 147, NatriuretiC hormones, 95 Neck cancer of, 4, 287 painful 203 stiff, I SO Nedocromil, 70 Nelfinavir, L 56t Neomycin, 87 Nephropathy, diabetic, H13, 107, 2m, 3, 307 Nephrosis, 38, 06- 08 Nephrotic syndrome amyloidosis and 255t hyperlipidemia and, 231 pleural effusions from, 82 syphilis and Neural tube defects, 226t, 228-229 Neurocardiogenic syncope, , 52t, 53t Neurohumoral response, Neuropathy amyloidosis and, 255t chemotherapy and, 284t diabetic, 0, vitamin B " and, 226t, 26 Neutropenia, 284 Nevirapine, 56t Niacin 226t, 227, 232, 307 Nicotinamide adenine dinucleotide, 227, 266 Nifedipine, Nilutamide, 279 NipplE' discharge, 273-274, 1 Nonbacterial thromhotic endocardial (NBTE) lesion 146 Necrolytic migratory erythema 288 Neisseria meningitidis, Nephrolithiasis, 09-1 1 , 66-1 67 antiretrovirals and, 56t classification of, 09 clinical Features of, 09-1 0, I I Ot, 12 diagnosis of, 1 etiology of, 09 parathyroid surgery for, referred pain from, 238 treatment of, I 0-1 1 UTls and, 09, 35 vitamin C and, 226t Nitrofurantoin, 78, 135, 265 Nitroglycerin, 3, 7, 24, 309 Nitroprusside, I I I , 6-3 Nizatidine, 74 Myxedema, 204, 206-207 Neisseria gOllorrhoeae See Nephritis, 06-1 08 drug-induced, interstitial, 99, 03 SLE and, 250 treatment of, 07-108 Gonorrhea 49 Non-Hodgkin's lymphoma (NHL), 72-1 73, 268, 280-283, 288 See also Lymphoma Nonnucleoside inhibitors, 5, 56t Non-small cell cancers, 85, 88 NonsterOidal anti-inflammatory drugs (NSAIDs) for arthritis, 23 asthma and, 68 for back pain, 239 bleeding disorders and, 270-271 for cardiovascular di,ease, 2, 7, 50, 3 colorectal cancer and, 96 interstitial lung diseasE' and, 78 meningitis and, I SO peptic ulcer and, 72-1 74 renal failure and, 99 side effects of, 242, SLE and, 250 for spondylarthropathy, 245-246 Norepinephrine, B Norwalk agent, 40 Nosocomial infections, 1�9 Nucleoside analogues 55, 56t 5'-Nucleotidase, 90 Nutrition, 225-229, 226t See also Diet ObeSity, 37, 7, 96 Occupational hazards, 77-7R, 80-BI Olsalazine, 78 Omeprazole, 74 Oncogenes, 273-274, 1 Opportunistic infections, 53f, 55-1 62 See also HIV disease clinical features of, 58-1 59 risks for, 58 treatment of, 59-162, 60t-161t Oral contraceptives, 38, 73, 89 Orchiectomy, 279 Oseltamivir, 60t Osler's nodes, Osmotic fragility test, 266 Osteitis fibrosa cystica, 5-2 Osteoarthritis, 235 Osteoclast-activating factor (OAF), 287 Osteomyelitis, 238 Osteoporosis sterOids and, 78, 253 vitamin D and , 226t, 228 Ovarian cancer, 204, 287 Ovaries polycystic, 222 torsion of, 65-166 Oxyphenisatin, Oxytocin, 22 l t Pacemakers, 29, 54t, 1�6 Paclitaxel, 276, 284t Paget's disease, Pamidronate, 6, 276 Pancoast tumor, 86 Pancreas divisum, 92 < not for sale ! < > < He �nH npo�� ! > CKati III �e",aBIQ-KOHBepcJo1:R MYCAH,I{ 9T c.l>POHT py > Index Pancreatic cancer, 90, 22 , 238, 287-288 Pancreatic pseudocyst, 94, Pancreatitis, , 92-194 causes of 92 chronic, 94 diagnosis of, 66-167, 193 drug-induced, 56t, 92t, hypel'glycemia and, hypertriglyceridemia and, 230 Ranson criteria for, 93t referred pain from, 238 treatment of, 93-1 94 Pancytopenia, 263, 265f, 271 Panhypopituitarism, 206-207, 221-224, 297-298, Panic attacks, 57, Papanicolaou smear, , Papilledema, 94, 50 Papules, 1 7, 1 8t- I I 9t, 254 Paracentesis, 85- 86 Paraneoplastic disorders, 86, 287-289 Parathyroid hormone (PTH), 4-2 Parathyroid hormone-related polypeptide (PTHrP), 287 Parietal pleura, 82 Pamxysmal nocturnal hemoglobinuria, 264, 265f Parvovirus, 40 Pauci-Immune disease, 1U6-107, PCP, See Plleumncystis carinii pneumonia Peak expiratory flow (PEF) 69 Pellagra, 226t, 227 Pelvic inflammatory disease (PI D), 27-1 , 28t 65-1 66 Pelvic pain, 127 Penicillamine, 1 , 243, 250 Penicillin anemia from, 265 interstitial lung disease and 78 for opporturtistic infections, l tiOt for syphilis, 29t Pentamidine, 6Ot, Peptic ulcer disease, 72- 75, 74f, 232, 242 Percutaneous balloon angioplasty, 49 Percutaneous balloon valvuloplasty, 46 Percutaneous transluminal coronary angioplasty (PTCA), 4, 8- 9, 309 Pergolide, 223 Pericarditis, chest pain fmm, 3-4 ECG for, 4t, 5, 305f, M l and, SLE and, 248t Ul"emic syndmme and, 00 Perinuclear antineutrophil cytoplasmic antibodies (P-ANCA), 77, 90 Peripheral arterial disease (PAD), 48 Peripheral smear, 261 t, 266 Peritoneovenous shunt, 86 Peritonitis ascites and, 86 dialysis and, 05 spontaneous, 86- 87, uremia and, 03 Pertussis, 62 Petechiae, I 7, 1 8t-1 l 9t, 27U, 28 , 285 Phenformin, 1 Phenoxybenzamine, Phenylephrine, Phenytoin , 36, 267 Pheochromocytoma, 7-220 diagnosis ot; hyperglycemia and, hypertension and, 38 seven Ps of, treatment of, 9-220 Philadelphia chromosome, 2H I Pioglitazone, 21 1-2 Pituitary, 22 -224 22 I t Pituitary tumor 22 -224 hypothymidism and, 206-207 imaging of, 222, 223f treatment of, 222-224 Plasmapheresis, Plasmin, 269-270 Platelet disorders, 270-27 Pleural effUSions, 82-84 83f Pleuritic pain, Pneumococcal vaccine, 64 331 Pneumonitis, hypersensltivity, 77-Hl Pneumothorax, 57-58 case study on, 300f, chest pain from 3-4 chest tube for, from needle biopsy, 87 shock fi·om tracheal deviation with, Poisoning acid-basp disturbances and, 93 carbon monoxide, 5 tood, 40-1 44 l 42t-1 43t hepatitis from, 82 lead, 65 Pollution, air, 64, 85 Polyarteritis nodosa ( PAN), 07, 25 -253 biopsy for, 252t diagnosis of, 252-253 ischemic bowel With, l fi5 rash with 1 9t treatment of, 253 Polycystic kidney disease, 03 Polycystic ovary syndrome, 222 Polyglandular autoimmune syndromes, 218 Polymorphonuclear lymphrn:ytes (PMNs), 77, 28t, 13U PolymYOSitis, 247-250 288 autoantibodies in, 249t clinical features of, 248t interstitial lung disease and, 78 treatment of, 25U Polyps, 77, 95-1 96, 97t, 222, 224 10 PolYPOSlS, familial, %, 97t Porphyria, 65, 67 Portosystemic shunts 87 Postgastrectomy syndrome, 75 Poststreptococcal glomerulonephritis (PSGN) 07, 1 3, Pneumoconioses, 77-8 Pnellmocystis carillii pneumonia (PCP), 24t, 53f, 58 See also HN disease chest x-ray of, 59f prophylaxis for, I GOt Potassium imbalances, 97-98, 98f PPO test, 62 Pravastatin, 232 Prednisolone, 283 Pneumonia, -1 26 community-acquired, , 24t-1 25t consolidatIOn signs in, 21 , I 23 cough with, -62 diagnosis of, 22-1 23, 221" dyspnea with, 57-58 eosinophilic 252 epidemiology of, , 23t- 25t pleural effusions from, 82-83 prognosis with, , 23 treatment of, 23-1 26, 24t-125t Prednisone for arthritis, 243 for connective tissue disease, 250 tor hyperthyroidism 204 for lBO, 78 for ITP 271 tor multiple myeloma 256 for panhypopituitarism, 223 side effects of, 78 253, 308, for vasculitis, 253 Pregnancy antibiotics and, 35 < not for sale ! > < He �nH npo�� ! > 332 < c�aH � �e�aBID-�OHBepC�H MYC� 9T �pOHT py > Blueprints Med icine ectopic, 27, 30, 165- 66 folate during, 229 hyperthyroidism and, 205 postpartum necrosis and, 222 re�piratory alkalosis and, 93 Preload, 20, H Presyncope, Primaquine, 265 Primary biliary cirrhosis (PBe), I R9- Primary sclerosing cholangitis (PSC) 89- Prinzmetal's angina, 6, 309 Procainamide, 32t Prochlorperazine, 285 Progressive multifocal leukoencephalopathy (PM!.), 53f Prolactin, 22l t, 222 Prolactinoma, 221 , 274 Propafenone, 32t Propranolol, 205 Propto�i�, 2()4 Pulmonary function testing [PFT) , 59t, 62 Red cell distribution width, 261 Pulse, Quincke's, 44 Pulseless disease, 252 Reentry mechanism, l f Reiter's syndrome, 244-246, 308 Pulsus paradoxus, 6-7, 69 Pulsus parvus et tardus, 43 Purkinje cells, 288 Purpura, 1 7, 25 -252, 271, 282 See also specific types, e.g , Henoch­ Schonlcin purpura Pustules, 1 P waves, 2Rf-30f; 32-34, 298f, 2-3 Pyelonephritis, 1 2, 30, 33, 238 Pyloroplasty, 74 Pyoderma gangrenosum, 77 Pyru.inamide, 37-139 Pyridoxine See Vitamin B(, Pyruvate kinase defiCiency, 264-265 QT syndrome, 32, 35, 53t, Prostacyclin, 250 Quervain's thyroiditis, 203-204, 305, 318 Quincke'� pulse, 44 Prostaglandins, 99 Quinidine, 32t, 271 Prostate cancer, 23R-239, 277-279 Pm'tatectomy, 27R Quinolones, 25t, 28t, , 187 PropylthlOuracil, 2U4-205, 205t Pro�tate-specific antigen (PSA), 277-27') Prostatitis, 238, 277 Protea�e inhibitors, 55, 56t Proteinuria, 00, 107 Proton pump inhihitors, 74 Pseudocyst, pancreatic, 94, b Pseudogout, 6, 235-237 Pseudopolyps, 77 Psoriasi�, 1 9t, 244-246 p24 antigen assay, 5 Pulmonary capillary wedge pressure (PCWP), 6-8 Pulmonary edema, cough with, -62 pulmonary function tests and, 59t treatment of, 23-24 Pulmonary embolism (PE), 73-76 chest pain from, 3-4 diagnosis ot; 74, 294f; 309 dyspnea with, 57-58 ECG for, 74, 294f, 309 endocarditis and, 145 epiderriiology of, 73 pleural effusions from, R2 pulmonary function tests and, 59t risks for, 73 �hock from, syncope and, 53t, 73 treatment of, 75 Quinine, 265 Q waves, 4t 7, 5- 6, 7f Radiation therapy for breast cancer, 274 for lung cancer, 88 for pituitary tumor, 223 for prostate cancer, 279 Radon gas, 85 Ranitidine, 74 Ranson criteria for pancreatitis, 93t Rapidly progressive glomerulonephritis (RPGN), 07 Rash, 1 7-1 20, I 8t-1 l 9t classification of, I drug reactions with, 56t, 242, 243 gonococcal, 295-296, of graft-versus-host disease, 285 heliotrope, 248 of herpes zoster, of HIV disease, 54 of Lyme disease, 1 8, 20, 35-136, malar, 248 of Reiter's syndrome, 245 syphilitic, Reed-Sternberg cell, 282 Renal cell carcinoma, 1 2, 4-2 Renal disease, 91-1 amyloidosis and, 255t connective tissue disease and, 248-250 diabetic, 03, 07, 209, 3, 307 end-stage, 03, 107 shock and, vascuhtis and, 252-253 Renal failure acute, 99-1 02, 0l f, anemia and, 99, 103-lO , 260f, 262-265 chronic, 03-1 05, 302, end-stage, 03, 07 hyperlipidemia and, 23 metabolic acidosis and, 93 Renin-angiotensin system, 21 , 95, 99, 03, 7f Residual volume (Ry), 59f, 66 Respiratory disorders, 57-88 Reticulocytes, 259, 264 Retinoic acid syndrome, 282 Retinopathy antimalarials and, 243 CAD and, CMY, 59 diabetic, 0, hypertension and, 38 Retroviral syndrome, 54 Rhabdomyolysis, 97 Rheumatic fever, -43, 43t, 46 Rheumatoid arthritis, 24 -243, 24 case study on, 292, 307 diagnosis of, 24 2t interstitial lung disease and, 7R treatment of, 242-243 , 307 vasculitis with, Rheumatoid factor (RF), 242, 252 Rheumatoid nodules, 24 , 243 Rheumatology, 235-256 Ribavirin, 253 Riboflavin, 228 Rifabutin, 60t Rifampin, 37-1 39, 60t Rimantadine, 60t Raynaud's phenomenon, 248-250 Ritonavir, 56t Rituximab, 282 Recommended daily allowance (RDA), 225 See also Diet Red blood cell defects, 264, 265[, 288 Rofecoxib, 242 Rocky Mountain spotted fever, 20, 50, 252 < not for sale! < > < He �nH npo�� ! > CRaH � �e�aBD-RoHBepc�H MYC� ST �POHT � py Index Rose spots, 1 8t Rosightazone, 1-2 Rotavirus, 40 Roth spots, 45 Rubella, 1 Sexually transmitted diseases (STDs), 7- 32 adenopathy in, 267 aortic aneurysm from, 48 aortitis from, arthritis and, , 235-237, 295-296, 10 Rubeola, 1 diagnosis of 29- 30 Sacroiliitis, 245, 246f Saddle anesthesia, 238-239, 307 Salmonellosis, 42t, 143, , 77, 244 risks for, treatment of, 28t-I 29t vasculitis and, 252 adenopathy and, 267-268 hypercalcemia and, , hypopituitarism with, 222 interstItial lung disease and, 78-79 nephrolithiasis and, 09 rheumatoid factor in, 242 Sausage digits, 245 Schilling's test, 63t, 70 Schistocyte, 262f Sciatica, 238-239, 307 Scleroderma See Sclerosis Sclerosing cholangitis, 77, I tl9-1 , 317 Sclerosis, 247-250 autoantibodies in, 249t clinical features of, 248t interstitial lung disease and, 78 treatment of, 250, Sclerotherapy, 87 Scoliosis, 57, 59t Scrofula, 36 Scurvy, 226t, 228 Seizures hypoglycemia and, Spider telangiectasia, 85 Spine bamboo, 245, 246f stenosis of, 238-240, 245 Spironolactone, 25, 97, Sarcoidosis cough with, Spherocytosis 264, 265f, 306 prevention of, Saquin avir, 56t Sezary's syndrome, 1 9t Sheehan's syndrome, 222-223, 297 anaphylactic, 6-8, 30 I , diagnosis of, 7-8 Ml and, , renal failure and, 00 toxic, 1 8t, 20 treatment of, types of, 6t Sickle cell disea�e, l 65, 262t; 264-265, 265f Sick sinus syndrome, 28f Siderohlastic anemia, 259, 260£, 262t, 263 I Rh, Spondyloarthropathies, 244-246 aortic insufficiency and, arthritis and, 235-236 clinICal features of, 244-245 diagnosis of, 245, 246f mixed connective tissue disease and, 247 treatment of, 245-246 types of, 244 Spontaneous hacterial peritonitis (SBP), tl6- 87, Staphylococcal infections arthritis and, 235-237 endocarditis from, 14 5- 48, gastroenteritis from, 42t meningitis from, 49t, l S I pneumonia from, 23t, 24t rash from, 1 Starling's law, 21 f, 82, 84 Statins, 232 Sigmoidoscopy, 96, 97t, Stavudine, 56t Silicosis, 79 Steatosis, 56t Simvastatin, 232, 306-307 ST-e1evation myocardial infarction Sinoatrial node, 27 Sinusitis, -62, 25 , 294 Sjogren 's syndrome, 247-250, 24Rt, 249t Skin tags, 222 Skin test, tuberculosis, 7, 55, 308 5- 6, Stem cell transplant [SCT), 282, 28 5-286 Steroids adrenal glands and, 6-7, 7, 220 as antiemetic, 2tl5 leukemia and, 281 Sleep disturbances, 38, 69, 20 , 206 pyridoxine and, 227 Small cell cancers, 85, 88, 287-288 for asthma, 70, 71 t-72t syncope and, 52t, 53t Smoking cataracts and, 78, 253 uremia and, 03 Selenium, 277 Sellar tumor, 222 Sengstaken-Blakemore tube, 87 Sentinel loop of bowel, 93 asthma and, 68 bladder cancer and, CAD and, , 230-2 cardiovascular disease and, 48 colorectal cancer and, 96 COrD and, 64 Sentinel lymph node mapping, 275 cough from, 61-62 Sepsis hypertension and, 37 leukemia and, lung cancer and, 85 leukocyte count and, 236t peptic ulcers and, 73 renal failure and, 00 pneumonia and 23t shock from, 6-8 Serum-ascites albumin gradient (SAAG), 86t, 220 Splenorenal shunt, Shigellosis, 42t, I 77, 244 Shock, 6-8 Sodium chromoglycate, 70 Sodium imbalances, 95-97 Somatostatin, 7, 223 333 Spermicides, 33 Spirometry, 59f, 65-66 rheumatoid factor in, 242 • Sotalol, 32t meningitis and, I SO rash with, I 8t-1 I 9t 20 > for arthritis, 243 cholestasis from, 89 for connective tissue disease, 250 for COPD, 66 for gout, 237 for graft-versus-host disease, 286 for hepatitis, 83 for hypercalcemia, hyperglycemia and for hyperthyroidism, 204 for lBO, 7R for interstitial lung disease, 80-8 for meningitis, metabolic alkalosis and, 93, 97 for retinoic acid syndrome, 282 side effects of, 8, 253 < not for sale ! > < He �nH npo�� ! > 334 Bluepri nts Med icine for syncope, 54t for uveitis, 246 Stevens-Johnson syndrome, I I 9t Streptococcal infection endocarditis from, 45- 8, 4-3 glomerulonephritis after, 07, 1 3, 314 HIV disease and, 58 , 60t meningitis from, 49t, peritonitis from, pneumonia from, 23t, 24t rash from, 1 Streptokinase, 8, 84, 270, 309 See also Thrombolysis Streptomycin, 7- Stress test See Exercise stress test Stroke See Cerebrovascular accident Tamponade, 6-7, , 52t, 57 Syncope, -54 aortic stenosis and, 43t Target cell, 262f diagnosis ot; -54, 53t Teardrop cell, 26If epidemiology of, hypoglycemia and, pathophysiology of, , 52t Telangiectasia, 5, 248t, 249 Temporal arteritis, -253, 293 pulmonary embolism and, 53t, 73 Tenofovir, 56t tachyarrhytlimia and, 32 Tenosynovitis, 236 Takayasu's arteritis and, 25 Tetracyclines treatment of, 54t pancreatitis and, 92t Syndrome of inappropriate secretion of antidiuretic hormone (SIADH), 86, 287 for peptic ulcer, 74 for Reiter's syndrome, 245 for UTIs, Syphilis, - See also Sexually transmitted diseases adenopathy and, 267-268 aortic aneurysm from, 48 aortitis from, 41 Thalassemia, 260-26 , 262t Thallium-20l perfUSion scan, I I , 2f Theophylline, 66, 70 Thiamine See Vitamin B J arthntis and, Thiazolidinediones, 1 -2 Stroke volume, 20-2 chancre of, l f Thoracentesis, 84 Struma ovarii, 204 diagnosis of, 30, Thoracoscopy, 88 Struvite stones, 09, l l Ut, I I I ST-segment changes, 4t, 0, l I t, 74 Subendocardial infarction, I S Suhstance abuse HIV disease and, 59 incidence of, 27 meningitis and, 50 Thoracostomy, 84 Thrombin, 269, 271 rash with, 1 8, 20 Thromboangiitis obliterans, 48 rheumatOId factor in, 242 Thrombocytopenia, 269 acid-base disturbances and, 93 secondary, 268 anemia and, 265 adenopathy and, 267-268 stages of, 1- drug-induced, 75, treatment o f, 29t leukemia and, anemia and, 260 arthritis and, 236-237 cardiomyopathy from, 22 cirrhosis and, 84-1 86 colorectal cancer and, 96 endocarditis and, 5-146 heart disease and, 3, hepatitis and, 1-1 83, 307 HIV disease and, 52 pancreatitis and, 92 pneumonia and, 23t rashes and, 1 8t- 1 9t STDs and, 29 vitamin deficiencies in, 225, 227 weight loss from, 20 withdrawal from, 65 Sucralfate, 74 Sucrose lysis test, 266 Systemic lupus erythematosus (SLE), 247-250 aortic insufficiency and, autoantibodies in, 249t contraindications to, 8, 309 for Ml, 8- 80-8 pathogenesis of, 247-248 rash with, 1 9t rheumatoid factor in, 242 treatment of 250 vasculitis with, 251 Systemic vascular resistance (SVR), 6-8 Tabes dorsalis, Tachyarrhythmias, -3 algorithm for, 33f case study on, 298, 2-3 diagnosis of; 32-35, 33f, 34f Sulfamethoxazole, 50 hyperthyrOIdism and, 204-205 Sulfonylureas, 1 Supraventricular tachycardia (SVT), 32-35, 33f SVC syndrome, 86 for arterial occlusion, 49 interstitial lung disease and, 78, Sulfadiazine, 60t 246 treatment of, Thrombolysis, 270 clinical features of 248t Sulbactam, 87 Sulfasalazine, 77- 78, 79t, 243, rash with, 1 9t mechanisms of, MI and, I S pulmonary embolism and, 73-74 risks for, -32 shock and, syncope and, 53t treatment of, 32t, 35 Swan-Ganz catheter, Takayasu's arteritis, 48, 25 -253 Swan neck deformity, 24 l f Tamm-Horsfall mucoprotein, 09 Sweet's syndrome, 288-289 Tamoxifen, 275-276, 1 for pleural effusions, 84 for pulmonary embolism, 75 Thrombophlebitis, 288 Thrombotic thrombocytopenic purpura (TIP), 42t, 264-265, 27 , Thyroglobulin antibody, 207 Thyroid-binding globulin (TBG), 204 Thyroid cancer, 207 Thyroid disorders, 203-208 anemia with, 260f bradyarrhythmia from, 27 cardiomyopathy and, 22 case studies on, 299-300, 306, 3-3 causes of, 203, 206 diagnosis of, 204, 207 ECG for, 204, 207 hypercalcemia and, hyperlipidemia and, 23 hypertension and, 38 radioactive iodine and, 205 risks for, 206 Sjogren's syndrome and, 250 tachyarrhythmia from, I < not for sale ! < > < He �nH npo�� ! > CKaH � �e�aBV-ROHBepc�H MYC� ST WpoHT PY > I ndex treatment of 204-205, 207 Triptorelin, 279 weight loss with, 2U I Troglitazone, 2 Thyroiditis, 203-204 granulomatous, 203-2U4, 305, !l Hashimoto's, 206-207, 8, Thyroid-stimulating hormone (TSH), 34, 203-207, 22 t, 222 Thyrotoxicosis, 204 Trousseau's syndrome, 86, 288 Urine microalbumin, Ursodiol, 90- case study on, 293-294, 294f Urticaria, ] 7, I 8t- 1 9t 308 Tiotropium, 66 diagnosis of 7, 8f 270, 309 See also Thrombolysis Tocopherol See Vitamin E Urokinase, 84 See also Thrombolysis adenopathy and, 267-268 cough with, ti l -62 Tissue plasminogen activator (tPA), ] , treatment of 34-1 Urine cytology, ] 3- 1 Thyroxine (T,), 203-205, 207, 222, Tirofiban, !l risks for, 33 Troponin, Tuberculosis (TB), 36- 39, 20 drug-resistant, 8-1 39, 308 Uterine cancer, 275 Uveitis, 244, 246 U waves, 97 epidemiology of 36 hematuria with, 1 HlV disease and, 53f ] 58- 59, I tiOt Vaccine(s) hepatitis, , 0t, 83 HIV disease and, Torsade de pointes, 32, 33f 34f; hypercalcemia and, ] influenza, 66, 49, ] 60t Total body water (TBW), 95-96 hypopituitarism with, 222 meningitis and, ] 50 meningitis and, 50 pneumococcal, 64 Total lung capacity (TLC), 59f, 66 Total parenteral nutrition (TPN), 225, 228 p athogenesis of pleural effusions from, 83 pneumonia and, 23t, 24t- 25t Vaginitis, 28t, 30, 53f Vagotomy, 74 Valdecoxib, 242 ToxIC megacolon, 78, 79t reactivation, Toxic shock syndrome, 1 8t, 20 risks for, Valproic acid, '12t Toxoplasmosis, 267-268 skin test for, 7, 5, 308 Valvular heart disease, ] -46 HIV disease and, 53f 55, 58, 59f test for, ()2 cardiomyopathy from, 22 treatment of, 7- case study on, 298, prophylaxis fo r, ] 60t Tubular necrosis, 00 risks for, ] Tumor lysis syndrome, 285 Trace elements, 225, 22!l Typhoid fever, 1 8t Tracheal deviation, Tzanck preparation, 20 Transfusion transmitted virus (TTY), 81 , 48 Transjugular intrahepatic portosystemic shunt (TIPS), 87 Transplantation bone marrow, 2R2, 2!l5-286 cardiac, 26 contraindications to, !l6, graft-versus-host disease and, 285-286 liver, 86, renal, 05 stem cell, 2R2, 285-286 Transrectal prostate biopsy, 278 CHF and, 20 clinical features of 42 43, 43t diagnosis of 43-44, 43t, 45f endocarditis and, -42, 43t, 45- epidemiology ot; Ulcers Transient ischemic attacks (TIAs) , , aphthous, 59, 7 etiology o f -42 hemolysis from, 264 genital, 29t pathogenesis of 42 peptic, 72- 75, 74f, 232, 242 syncope and, S ] Ulcerative colitis, 76-] 78 case study on, 304, tachyarrhythmia and, treatment of, 44-46 cholcstasis with, Vancomycin, 236, 285 colorectal cancer and, 96, 7t Varicella-zoster virus Crohn's disease vs., 76, 79t diagnosis of 77, 79t syphilis and, ] treatment of, 77-1 78 UremIa, 99-100, 03-] 05 platelet disorders and, -272 treatment of O ] -l O2 HIV disease and, ] 58, pam from, rash with, ] 9t Vasculitis, 5, 25 ] -253 biopsy for, 252t diagnosis of 252-253 Uremic frost l OO, hypersensitivity, Transurethral resection of prostate Ureteroscopy, 1 pancreatitis with, 92 Urethritis, 28t, ] 30, 308 Trastuzumab, 276 Uric acid stones, l O9, l I Ot, I I I Triamterene, 86 Urinalysis, 34 Trichomoniasis, 28t Urinary tract infections CUTIs) , 28t, Tricyclic antidepressants (TCAs), 32, 35 Triglycerides, 230-232, 232t Triiodothyronine (T3) , 203-205, 222 Trimethoprim-sulfamethoxazole, 5, 60t, 260 ] 30, 33-1 arth ritis and, 244-245 diagnosis of ] 34f nephrolithiasis and, 09, pathogenesis of 3 prevention o f I ()1 t meningitis and, ] 49 Transudates, R4 (TURP), 277 335 I 9t, -253 rashes with, 1 9t rheumatoid arthritis with, 24 treatment of 253 types of 25] Vasopressin, 7, 2 t, 223-224 Vasovagal syncope , 52t, 53t Ventilation/perfusion (V/Q), 4, 64 65, 74, 309 Ventricular tachycardia, 32-35, 33f 34f < not for sale ! > < He �nH npo�� ! > 336 Bluepri nts Med icine Verapamil, 13 Very low-density lipoproteins (VLDL), 23U-232 Vesicular rash, 1 7, 1 8t-1 9t Vesnarinone, 25 Vibrio cholerae, 42t renal failure from, 00-1 , 07 Vomiting abdominal pain with, I fifi bloody, 73 , 84 chemotherapy and, 285 cholangitis with, 89 electrolyte imbalances from, 96-97 gastroenteritis and, 40 Vinblastine, 78 HIV disease and, 54 Vincristine, 283 metabolic alkalosis and, 93 Virchow's node, 268 Virchow's triad, 73 Visceral pleura, 82 Vitamins, 225-229, 226t Vitamin A, , 4-2 5, 225, 226t Vitamin B" 225, 226t, 227 Vitamin B,,, 226t, 227 Vitamin Bll, 226t, 228 anemia and, 260f, 262-263 neuropathy and, 226t, 26 Schilling's test for, 263t Weight loss, 20 -202 See also Diet adenopathy and, 267 amyloidosis and, 254 p araneoplastic disorders and, 289 Wellen's sign, Wernicke-Korsakoff syndrome, 226t, 227 pancreatitis and, 92 Western blot, 55 UTIs and, 34 Wilson's disease, , 84-1 85, 228 von Willebrand's disease (vWD), 269, 271, 315 V/Q See Ventilation/perfusion Withdrawal syndromes, 65 Wolff-Parkinson-White syndrome (WPW) , , 32, 33f 35 Vulvovaginitis, 28t, 30, 53t, Xanthelasma, 23 Waldenstrom's macroglohulinemia, 250 Xanthoma, 0, Xerosis, 2 Warfarin, 270-272, 288 after arterial occlusion, 49 for atrial fibrillation, 3 Vitamin C, 226t, 228 after pulmonary embolism, 75 Vitamin D, 225-227 vitamin E and, 226t deficiency of, treatment of, 253 vitamin K and, 227 Xerostomia, 248t D-Xylose test, 70 Zafirlukast, 70 Zalcitabine, 56t Zenamivir, 60t hypercalcemia and, 4-2 Warts, genital, 29t metabolism of, 99, 03 Watson-Schwartz test, Zidovudine Wegener's granulomatosis, -253 Zileuton, 70 osteoporosis and, , 226t, 228 Vitamin E, , 226t, 227 Vitamin K, , 226t, 227, 269-272 Vitiligo, 206 diagnosis of, 252-253, 252t, 308 interstitial lung disease and, 78, 80-8 (AZTJ, 56t, Zinc, 228 Zoledronate, Zoster See Varicella-zoster virus < not for sale ! > < He �nH npo�� ! > Bl ue rints < C�aH � �e�aB��OHBepC�H MYC� 9T WpoHT PY > CLASSIC Blue rints Classic Blueprints provide the essentials you need during rotations and for review before Steps and of the USMlE Blackwel l's Blueprints • Medicine • Pediatrics series offers a com plete • Psychiatry • OB/GYN study package • Surgery • Family Medicine • Emergency Medicine • Neurology • Cardiology • Radiology Blue rints CLIN ICAL CASES Blueprints Clinical Cases are based on symptoms to lead students through steps to a d iagnosis Each book is written by residents and complements the Blueprints classic books and Blueprints O&A books • Medicine • Pediatrics • Psychiatry • OB/GYN • Surgery • Neurology • Emergency Medicine • Family Medicine Blue rints Q & A Blueprints O&A Step and Blueprints O&A Step Each series provides review questions and complete answer options for content most likely covered on the USMlE a nd in-service exams - In Bookstores Now or call 800·2 6·2 522 flJ Blackwe l l Pu blish i ng • Medicine • Pediatrics • Psychiatry • OB/GYN • Surgery code bluead03 < not for sale ! > < He �nH npo�� ! > < c�aH � �e�aBID-�oHBepc�H MYC� 9T WpOHT PY TH E IN A PAGE SERI ES II' ALL the information for Clinicals and Rotations - IN A PAGE II' Vital Information on Diseases you will encounter II' High Yield and Concise II' Saves Time and Helps you remember - IN A PAGE IN A PAGE MEDICINE I N A PAGE SURGERY SCOTT KAHAN M D SCOTT KAHAN MD Ja/luary 2()O3 JOHN RAVES M D and Oetohe r 2003 IN A PAGE PEDIATRICS SCOTT KAHAN M D and IN A PAGE SIGNS & SYMPTOMS KATHLEEN DeANTONIS MD SCOTT KAHAN MD February 2003 ELLEN SMITH M D and December 2003 IN A PAGE EMERGENCY MEDICINE J EFFREY CATE RINO M D and SCOTT KAHAN MD May 2003 IN A PAGE OB/GYN & WOMEN'S HEALTH PHYLLIS L CARR, M D KAREN FREUND M D HOPE A RICCIOTTI M D and SCOTT KAHAN M D Fehruarv 2004 Blackwe l l Pu blishing I n Bookstores now or cal l -800-2 6-2522 or order online at: www.blackwellpublishing.com > < not for sale ! > < He �nH npo�� ! > Plate I Papilledema exudates and retinal hemorrhages in hypertensive retinopathy Plate Rapidly progressive (crescentric) glomerulonephritis Appearance of cellular crescents on l ight microscopy Plate Calcium oxalate dihydrate crystals commonly seen in nephrolithiasis N Engl J Med 992;326: I 42 Used with permission Plate Coffin-lid shaped struvite crystals commonly seen in nephrolithiasis N Engl J Med 992;326: I 42 Used with permission Plate Maculopapular rash on the back of a patient with acne vulgaris Plate Petechi and purpura on the legs of a patient with allergic vasculitis < not for sale ! > < He �nH npo�� ! > < CKaH K �e�aBD-KoHBepCKH Plate MYC� ST �pOHT py D iffuse erthema on an AIDS patient with acute drug eruption Plate Vesicles and bulla on a patient with bullous pemphigoid Plate Urticaria on a patient with acute allergic reaction Plate 10 Macular rash on the soles of the feet of a patient with secondary syphilis Plate I I Gram stain appearance of urethral discharge showing G ram-negative intracellular diplococci > CKaH � �e�QBV-KoHBepcKH MYC� 9T �pOHT py < < not for sale ! > < He �nH npo�� ! > Plate 13 > Hepatitis A: Typical appearance of jaundice and dark urine in viral h eptatitis; the patient is no longer Plate 12 suffering from fever or malaise Multiple acid-fast bacteria in a caseating mediastinal lymph node Sputum samples from a patient with active primary pul monary tuberculousis usually not reveal such large numbers of organisms except in cases of miliary or cavitary disease Plate 15 Diabetic retinopathy fundoscopic examination shows microaneurysms exudates Plate 14 Colonoscopic view of cecum showing annular ulcerated bleeding carcinoma Plate Urate crystal (gout) N eedle-shaped crystals that are yellow (negative bi refringence) when parallel to the polarized light axis (yellow patches) (red dots) and hard < not for sale ! > < He �nH npo�� ! > < CKaH K �e�aBD-KOHBepCKH MYC� Plate 18 ST �pOHT py > Peripheral blood smear in myelofibrosis N umerous teardrop cells are present Plate 17 Calcium pyrophosphate (pseudogout) Rhomboid-shaped crystals that are blue (positive birefringence) when parallel to the axis Plate Plate 19 21 Plate 20 Peripheral smear for question # I Plate 22 Myeloblasts in peripheral smear in CML Parasitic ring forms in malaria Petechiae of the lower limbs due to severe thrombocytopenia associated with AML < not for sale ! > < He ,IIJIR npoJlilDl ! > • • • • • ISBN - 4051 - 0335 - [...]... of is an important consideration, especially in younger both types of pain In musculoskeletal disorders, pain patients with no other cardiac risk factors < not for sale! 4 • > < He �nH npo�� ! > Blueprints Medicine is more easily localized and worsens with movement or palpation Pain ranges from darting, lasting seconds, to a prolonged dull ache that lasts for days In herpes zoster, because pain may... large-gauge needle should be epinephrine subcutaneously should be given inserted in the midclavicular second intercostal space of the affected side immediately < not for sale ! > < He �nH npo�� ! > 8 • Blueprints Medicine In the patient with hypotension and increased JVP, an echm:ardiugram may help determine the underlying cause For example, echocardiographic findings seen in pericardial tamponade include... MANIF ESTATIO N S H i story The typical manifestation uf symptomatic CAD is angina pectoris, characterized as a substernal pres- < not for sale ! > < He �nH npo�� ! > 10 • Blueprints Medicine sure, heaviness, burning, squeezing, or choking The discomfort is rarely well localized or described as sharp pain Radiation to the J·aw shoulder back or arms can occur In so-called stable... time points This technique is semiquantitative, estimating the amount of ischemic or infarcted myocardium by the size of the defect seen on the images < not for sale ! > < He �nH npo�� ! > 12 • Blueprints Medicine Figure 3-2 • Thallium-201 myocard ial perfusion scans On the exercise scan there is a large area of very reduced uptake in the i nferior wall of the left ventricle (arrow), with normal redistribution... Left main coronary disease or left main equivalent (proximal left anterior descending [LAD] stenosis plus proximal left circumflex artery stenosisJ < not for sale ! > < He �nH npo�a� ! > 14 • • • Blueprints Medicine Three-vessel disease, especially with decreased ejection fraction Severe proximal LAD stenosis after surviving ventricular tachycardia/fibrillation or with "myo­ cardium at risk" on noninvasive... pul­ monary congestion arises They can also give clues as to whether systolic or diastolic failure is present Cardiovascular findings include: • • • • • • CKaH H �e�aBD-KOHBepCHH MYC� 9T �pOHT py > Blueprints Medicine - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - • < Laterally displaced and/or enlarged point of maximal impulse (more in systolic dysfunction) Sinus... ("tailored therapy") It is not clear that prolonged intravenous infusions improve duration or quality of life < not for sale ! > < He �nH npo�� ! > 26 • < CKaH H �e�aBD-KOHBepCHH MYC� 9T �pOHT py > Blueprints Medicine Automatic implantable cardiac defibrillators (AICDs) are used in patients who have experienced ventricular fihrillation, symptomatic ventricular tachycardia, or cardiac arrest The routine... Ventricular rupture (peak incidence within 3 to 5 days of AMI) Other mechanical complications (ventricular septal defect, mitral papillary rupture) < not for sale ! > < He �nH npo�� ! > 16 • < > Bl ueprints Medicine Death occurring more than I month after an AMI can be caused by reinfarction, progressive heart failure, or sudden arrhythmias pain and ST elevation on the electrocardiogram, the differential... arterial and venous dilator In addition, it is a coronary vasodilator, which can relieve ischemia when present Oxygen is used to improve systemic oxygen delivery and decrease pulmonary vasoconstriction N o > Blueprints Medici n e • M C�aH H �e�aB��OHBepCHH MYC� 9T �pOHT py Additional measures for patients with pulmonary edema include positive pressure ventilation (via face mask) and inotropic agents, such... mortality Again, ade­ quate blood pressure must be present Other con­ traindications include bradycardia (HR < 50), second- or third-degree AV block, or LV dysfunc- < not for sale ! > < He �nH npo�� ! > 18 • Blueprints Medici n e tion with CHF Tachycardia in AMI may represent impending cardiogenic shock The treatment plan will now depend on the clinical suspicion of AMI and the electrocardiogram The possibilities ... Cataloging-in-Publication Data Young, Vincent B Blueprints medicine / Vincent B Young, William A Kormos, Allan H Gorol1.-3rd ed p.; cm.- (Blueprints) Rev ed of: Blueprints in medicine 2nd ed c2001 Includes index... ISBN 1-4051-0335-3 I Internal medicine- Outlines, syllabi, etc [DNLM: I Internal Medicine- Examination Questions 2004] Kormos, William A II Goroll, Allan H Blueprints in medicine IV Title V Series... sale! > < He �nH npo�� ! > BLUEPRINTS MEDICINE Third Edition Vincent B Young, MD, PhD Assistant Professor Departments of Internal Medicine, Microbiology