Đang tải... (xem toàn văn)
(BQ) Part 2 book Essentials for the Canadian medical licensing exam - Review and prep for MCCQE part I presents the following contents: Hematology, neurology, obstetrics and gynecology, oncology, ophthalmology, orthopedics and rheumatology, psychiatry, pulmonary medicine, urology.
CHAPTER 11 Hematology Surabhi Rawal, Dr Sapna Rawal, and Dr Ahmed Galal SPLENOMEGALY RATIONALE CLINICAL BOX Major Causes of Splenomegaly Splenomegaly is usually suggestive of an underlying disorder, rather than a 1◦ splenic pathology Therefore, Rx is aimed at the underlying etiology CAUSAL CONDITIONS ICE MASS: Infectious Congestive splenomegaly/ Chronic liver disease Extramedullar hematopoiesis Malignancy Table 11.1 Causal Conditions of Splenomegaly Demand for ↑ splenic function Clearance of abnormal RBCs • • • • • • • • • • • • • • Abnormalities of RBC shape (hereditary spherocytosis/elliptocytosis) Hemoglobinopathies (thalassemias) Nutritional anemias Acute (infectious mononucleosis, hepatitis, SBE) Chronic (TB, AIDS, malaria, brucellosis, syphilis) Bacterial septicemia Splenic abscess RA (Felty syndrome) SLE Collagen vascular diseases Drug reactions Myelofibrosis Marrow toxicity (chemotherapeutic agents, radiotherapy) Marrow infiltration (solid tumors, leukemia, storage diseases) Altered splenic circulation • • • • Cirrhosis Portal vein obstruction Splenic vein obstruction CHF Splenic infiltration • • • • • Storage diseases (Niemann-Pick, Gaucher, nonlipoid) Amyloidosis Malignancy (leukemias, lymphomas, metastases) Splenic cysts Myeloproliferative disorders Infection Amyloidosis Sarcoidosis, Storage disease Autoimmune Extramedullary hematopoiesis 289 290 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I APPROACH See Figure 11.1 CLINICAL BOX Hypersplenism • Cytopenia 2◦ to splenomegaly of most etiologies • Key features are splenomegaly, hyperplastic bone marrow, modest pancytopenia • Occasional RBC spherocytosis, typically reticulocytosis • Treat underlying disease • Avoid splenectomy when possible to avoid risk of OPSI • If necessary administer vaccines versus Strep pneumo, HiB, N meningitidis, and annual influenza vaccine and prophylactic Abx Tx CLINICAL BOX Dx of Splenomegaly on Exam Castell method: If the spleen is normal, percussion in the lowest intercostal space (eighth to ninth) in the left anterior axillary line of the supine patient elicits a resonant note throughout the respiratory cycle If percussion on full inspiration produces a dull note (Castell sign), this is suggestive of splenic enlargement BLEEDING TENDENCY/BRUISING RATIONALE Bleeding that is spontaneous or excessive/delayed in relation to the inciting trauma must be examined for underlying pathology APPLIED SCIENTIFIC CAUSES See Figure 11.2 CAUSAL CONDITIONS The clinical history should consider likely etiologies: Personal history of bleeding diathesis Family history of bleeding diathesis Medication use 291 Figure 11.1 Approach to splenomegaly 292 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I Figure 11.2 Coagulation cascade CLINICAL BOX C2 L E O B o x Reporting Child Abuse Medications that Affect Coagulability Children with extensive bruises may represent child abuse and there may be a requirement for reporting Affect platelet function: FANTAStic Queen • Folate antagonists • ASA • NSAIDs • Thiazide diuretics • Alcohol abuse • Sulfa/β-lactam Abx • Quinidine Affect coagulation pathway: Abx that affect gut flora and induce Vit K deficiency Table 11.2 Causal Conditions of Bruising and Bleeding Coagulation Disorders (2◦ Hemostasis) Purpuric Disorders (1◦ Hemostasis) Platelet Plug Formation Quantitative Defects ↓ Production ↑ Destruction Splenomegaly Qualitative Defects • Nonimmune • ↓ Megakaryopoe• ↑ Sequestration • Inherited (von Wille(TTP/HUS, sis (aplastic anemia, brand, Bernard DIC, infection) toxic, displacement) Soulier, Glanzmann • Ineffective megakar- • Immune (ITP, • Acquired (uremia, SLE, quinidine) yopoesis (B12 /folate ASA, NSAIDs, deficiency, folate antiplatelet agents) antagonist) Vascular Response Fibrin Clot • Congenital (collagen • Inherited (factor disease, herediVIII, IX deficiency) tary hemorrhagic • Acquired (liver telangiectasia) disease, Vit K deficiency, antico• Acquired (vasculitis, steroids) agulants, inhibitors) • Fibrinolysis (DIC, inhibitors) Chapter 11 • Hematology 293 C2 L E O B o x Prenatal Dx and Counseling • Counseling on prenatal Dx of sickle cell disease and thalassemia should be nondirective and not restricted to those willing to have an abortion • Reproductive decisions must not be forced by the results of tests • Because the only pragmatic options for mothers are abortion or no children, it is vital that women not be pressured into prenatal Dx APPROACH Figure 11.3 Approach to bleeding and bruising CLINICAL BOX Tests for Hemostasis 1◦ • Platelet count • Platelet function test 2◦ • PTT—intrinsic pathway factors (VII, IX, XI, XII), monitor heparin Rx • PT-INR —extrinsic pathway factor (VII), monitor warfarin Rx • IT —measures fibrinogen deficiency or ↓ prothrombin activation 294 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I CLINICAL BOX C2 L E O B o x PTT 1:1 Dilution Blood Transfusion Refusal If PTT corrects with 1:1 dilution = absolute deficiency in factor level In patients who are bleeding but refuse blood transfusion, it must be determined whether the decision can be justified within the context of a relatively stable set of values If a coherent and consistent justification does not exist, identify a substitute decision maker If PTT remains high = factor inhibitor present HYPERCOAGULABLE STATE DEFINITION • Hypercoagulable conditions may be inherited or acquired, and can pose the risks of potential venous thrombosis and PE • Thrombophilia refers to the congenital deficiency of a normal protein such that there is an ↑ risk of thrombotic events CAUSAL CONDITIONS Table 11.3 Causal Condition for Hypercoagulable State Inherited Thrombophilia (5-min duration, 545 hypotonia/floppy infant/child, 549–552 amenable to rapid treatment, 549 central neural disease, 549 central neural investigation, 551 muscular investigation, 551 peripheral neural investigation, 551 UMN vs LMN lesion, 549 monitoring tissue perfusion, 546 respiratory emergencies, 546 restoration of tissue perfusion, 546 resuscitation, 546 shock, 546 Pedigree symbols, 554 Pelvic fractures, 497 Pelvic mass, 267, 392–398 benign vs malignant ovarian masses, 394 DDx of, 392, 397 lab markers in, 395 diagnostic imaging of, 395 focused Hx, 394 investigation, 395 management, 396 peri/post menopause, 392 physical exam, 394 pre adolescent, 392 reproductive, 393 specialty care referral in, 396 Pelvic organs in abdomen, 272 Pelvic pain, 390, 398, 399 acute pelvic pain, 398 chronic/recurrent, 398 CPP, 401 management, 399–402 pharmacotherapy, 401 physical therapy, 401 psychotherapy, 401 specialty care referral in, 403 EP, 399–400 laparoscopic surgery, 401 management, 401 GI, 398 gyne, 398 hemodynamic status, 398 MSK, 398 pregnancy status, 399 systemic, 398 urologic, 398 Pelvic pathology investigation, Dysmenorrhea, 361 Pelvic prolapse/relaxation, 403 adjunct Rx for concomitant Sx, 405 classifying, 403 cystocele, 403 cystourethrocele, 403 evaluation, 405 management, 405 nonsurgical management, 405 pelvic floor muscle training, 406 pessaries, 406 rectocele, 403 uterine prolapse, 403 vaginal vault prolapse, 403 Penetrating injury, 118 Penicillin, 181 Penicillin G, 432 Penicillin V, 178 Pentamidine, 141 Periarticular pain, 521–523 Pericarditis, 46 Perichondritis, 169 Perimenopause, 368, 409 Periodic health exam, 182–183 Periodontal infections, 181 Perioral dermatitis, 73 Periorbital puffiness, 134 Peripheral nerve injuries, 120–122, 329 artery disease, 31 assess injury severity, 122 bibasilar reticular patterns, 619 causes and types of, 121 vs central vertigo, 176 general inspection, 121 localize the lesion, 122 pertinent HX, 121 Rx and mechanism of recovery for, 122 sensory distribution of, 121 Peritoneal abdominal pain, 527 Peritoneal irritation, 221 Peritoneal signs, 279 Peritonsillar abscess, 546 Persistent pulmonary hypertension, 620 Personal directives, 10 Personality disorder, 593–596 Pertinent Hx, 84 Pessaries, 406 Pharmacological options, 33 Pharyngitis, 177 approach to, 177 causal condition of, 177 sore throat score in diagnosis of, 178 tests for complications of, 177 Phendimetrazine, 145 Phenothiazines, 305 Phentermine, 145 Phentolamine, 37 Index Phenytoin, 157, 329, 650 Pheochromocytoma, 95, 276, 278 classic triad of, 275 Photoallergy vs Phototoxic drug reaction, 68 Photo-distributed macules, 68 Phototoxic vs Photoallergy drug reaction, 68 Physical inactivity, 317 Physician –pharmaceutical interactions, 23 Physiologic gynecomastia, 153 Physiologic jaundice, 259 PID complications, 386 acute, 386 chronic, 386 Pituitary masses, 156 Pl Eff (see Pleural effusion) Placental hypoperfusion, 35 Placental ischemia, 35 Plan B, 380 Plantar fasciitis, 506 Plaques, 67, 70 Plasma glucose levels, 142, 144 Platelet count, 35 Pleural abnormalities, 635–638 Pleural effusion/Pleural Abnormalities, 635–638 PMS spectrum of disorders, 374 classification, 374 PMDD, 374 PMS, 374 Sx clusters associated with, 373 behavioral, 373 emotional, 373 physical, 373 Pneumonia, 529, 582, 617 Eff in setting of, 638 Pneumothorax, 109, 636 Poisoning, 91–94 anticholinergic, 91 approach to poisoned patient, 91–93 common toxidrome, 92 depressive states, 92 enhanced elimination, 93 excitation states, 92 gastric decontamination, methods of, 93 specific antidotes, 93 supportive care, 93 toxicology problems, common, 94 hallucinogens, 91 household products, 91 metabolic acidosis, 91 metals, 91 serotonin, 91 sympathomimetic, 91 TCAs, 91 typical poisons, 91 Polar (cold), 130 Polyarthritis, 518–521 approach to, 519 Polycythemia vera, 298–300 approach to, 300 causal conditions of, 299 characteristics, 299 criteria of, 299 Polydipsia, 652 Polyhydramnios, 441 Polymenorrhea, vaginal bleeding, 368 Polymyxin B, 88 Polyuria, 148–150, 652 approach to the diagnosis of, 150 differential diagnosis of, 149 vs Frequency, 653 Popliteal pulses, 57 Population health, determinants, 211–213 determinants of health, 212 disease prevention, 212–213 preventative medicine, 212 Population screening, cervical cancer, 388 in special populations, 390–391 Porphyrin, 650 Position of safety splinting, 117 Postauricular ecchymosis, 119 Postcoital insertion of a copper IUD, 381 Postcoital vaginal bleeding, 368 Postdates pregnancy, 427 Posterior shoulder pain, 491 Postinfectious glomerulonephritis, 345, 574 Postinflammatory hyperpigmentation, 69 Postmenopausal vaginal bleeding, 368, 370 Postmenopausal women, spine XR in, 411 Postovulation family planning method, 376 Postpartum (puerperium) care, 436 postpartum complications, 437 postpartum blues, 437 postpartum depression, 437 postpartum fever, 437 PPH, 437 Postpartum thyroiditis, 133 Poststreptococcal glomerulonephritis, 177 Poststroke rehab, 319 Post-term pregnancy, management, 570 Post-thrombotic syndrome, 639 Potassium, 93 PRBCs in Trauma, indications for transfusion, 104 Precocious puberty, 151 diagnosing the cause of, 152 Prediabetes, 138 Prednisone, 124 Preeclampsia–eclampsia, 34 Preexisting vulnerabilities, 608 719 Pregestational diabetes, 438 Pregnancy, 272 associated hypertension, 34–36 confirmation of, 424 β-HCG, 424 transabdominal U/S, 424 transvaginal U/S, 424 counseling in, 425 four major hypertensive disorders in, 34 gestational age, 35 GTPAL, 423 infectious diseases during, management, 570 laboratory tests in, 35 Mx of pregnancy-associated HTN, 36 myometrial activity in, 428 physiological concerns associated with, 421 breasts, 421 CV, 421 endocrine, 421 GI, 421 hematologic, 421 renal, 421 respiratory, 421 skin, 421 uterine, 421 Pregnancy loss, 418 (see also Abortion; Miscarriage; Recurrent pregnancy loss) Premature hair graying, 134 Premature menopause, 410 Prematurity, 571–573 low birth weight versus, 571 Premenopause, 368, 409 vaginal bleeding, 370 Prenatal diagnosis indications, 553 tests, 555 Prenatal screening tests, types of, 424 Prenatal women, 426 Preoperative medical evaluation, 188–190 allergies, 188 cardiac evaluation, 189 chronic medical conditions, 188 general operative risk for surgery, 190 last menstrual period, 189 medications, 188 pulmonary evaluation, 190 recent illnesses, 188 smoking/ETOH, 189 Presyncope vs syncope, 51 Preterm birth, 429 Preterm delivery 1◦ pathogenic processes leading to, 429 decidual hemorrhage, 429 fetal stress, 429 720 Index Preterm delivery (continued) inflammation/infection (chorioamnionitis, decidual), 429 maternal stress, 429 pathologic uterine distension, 429 premature activation of the maternal or fetal HPA axis, 429 Priapism, classification of, 672–673 Prickly heat, 96 Primary hyperparathyroidism, 159 Primary infantile hyperparathyroidism, 159 Primary survey, burns, 88 PRL secretion, control of, 155 Professionalism, 21–23 challenges to, 22 with CMA policy, 22 physician –pharmaceutical interactions, 23 physicians and industry, 22 Prolapse/Pelvic Relaxation (see Pelvic prolapse) Prophylaxis, 583 Propylthiouracil, 135 Prostate cancer, 660 in Canada, 660 Proteinuria, 345–347 approach to, 346 causal condition of, 346 definitions, 346 nephritic syndromes, 346 nephrotic syndromes, 347 severity, 346 Proteinuric renal disease, 34 Protracted anaphylaxis, 84 Proxy decision makers, 208 Proxy directives, 10 Prudent use of clinical resources, 17–18 Pruritus, 75–77 (see also Atopic dermatitis; Obstructive biliary disease) Pseudohyperkalemia, causes of, 341 Pseudohypertension, 32 Pseudoseizures, Fx suggesting, 332 Pseudostrabismus, Beware of, 477 Psoriasis vulgaris, 72 clinical signs of, 72 and PBC, 76 treatment body lesions, 72 facial and intertriginous lesions, 72 scalp lesions, 72 Psychiatric disorders, 608 issue, 221 Psychotherapies, 596 Psychotic patient/disordered thought, 600–603 (see also Delirium) Puberty (see also Menstrual pain) stages of, 364 adrenarche, 364 gonadarche, 364 menarche, 364 pubarche, 364 tanner staging, 364 Public health notification, 233 Pulmonary medicine, 43, 613–643 (see also Dyspnea) Pulse, types anacrotic pulse, 56 corrigan pulse, 56 dicrotic pulse, 56 pulseless, 130 pulsus alternans, 56 pulsus bisferiens, 56 pulsus paradoxus, 56 pulsus parvus et tardus, 56 Puncture wounds, 122 Pupil abnormalities, 473–477 12 CN function, assessment, 474 mechanism of, 473 neurologic causes of, 477 swinging flashlight test, 474 Pustules, 67, 70 Pyelonephritis, indications for hospital admission, 648 Pyloric stenosis, 529, 531 Pyrogens, exogenous versus endogenous, 585 Pyuria, 644–648 Quinine, 141 R heart failure, (backward failure), 53 Rabies, 107 prophylaxis, 107 vaccine, 107 Raccoon eyes, 119 Radial Head Fracture, 494 Radiation burns, 88 medical/therapeutic, 88 UV, 88 Radiation colitis, 230 Radioiodine therapy, 134 Radiologic Imaging vs Angiography, 232 Ranitidine, 86 RAP SOS, 243 Rash(es), 199, 573 chicken pox, 573 erythema infectiosum, 573 herpes simplex: hsv or 2, 573 impetigo, 573 measles, 573 roseola infantum, 573 Receding gingival/gums, 181 Rectocele, 403 Rectum, anatomy of the, 247 Recurrent abortion, 416 Recurrent pregnancy loss, 417–418 lab investigations, 417 anatomic, 417 endocrine, 417 environmental/toxicologic, 417 genetic/chromosomal, 417 immunologic, 417 microbiologic, 417 thrombophilic, 417 Red eye, 469–473 approach to, 470 association between systemic conditions and, 471 commonest causes of, 469 ocular anatomy, 470 treatment of, 472 allergic, 472 bacterial, 472 chlamydial, 472 viral, 472 Red urine, causes of non–RBC, 650 Regional anesthesia, 122–124 Regurgitation, 220 classification of, 58 Renal amylodosis, 347 Renal colic, 658 location of, 659 Renal failure, 163, 187 acute, 353–357 approach to, 355 causal condition of, 354 chronic vs acute on chronic, 353 complications, 357 differentiate acute versus chronic, 353 differentiate prerenal vs intrinsic, 355 eliminate offending agent, 357 identify cause, 355 initial management of, 357 initiate disease-specific therapies, 357 intrinsic vs postrenal ARF, 355 management of, 356 chronic, 357–360 approach to, 360 causal condition of, 359 renal function, 358 Renal insufficiency, 657 Renal parenchymal disease, 30 ◦ Renal salt retention, , 52 Renal tubular acidosis, 93 Renin-angiotensin-aldosterone system, 29 Renovascular disease, 32 Research ethics, 18–21 clinical equipoise, 20 conflicts of interest in research, 21 consent, 20–21 disclosure, 20–21 REBS, 19–20 Index regulatory framework, in Canada, 19–20 research regulatory framework, 19–20 scholarly merit, 20 Resource allocation decisions, 16–18 clinical decision making and, 16 fair access to health care, 17 prudent use of clinical resources, 17–18 Resp acid –base imbalance, 616 Resp depression, 88 Respiratory distress, 619–623 child with wheeze, approach to, 623 in children, signs of, 620 in delivery room, approach to, 620 in newborn, approach to, 621 resp failure approach to, 627 warning signs of, 621 wheeze in pediatrics, 623 Respiratory emergencies, acutely ill infant/child, 543, 546 bacterial tracheitis, 546 croup, 546 epiglottitis, 546 lower airway disorders, 547 asthma, 547 bronchiolitis, 547 foreign body, 547 peritonsillar abscess, 546 retropharyngeal abscess, 546 upper airway disorders, 546 Restlessness, 36 Resuscitation, 89, 103 Retinal edema, 35 Retinopathy, 139 Retropharyngeal abscess, 546 Reye syndrome, 582 Rhabdomyolysis, 163 Rheumatoid arthritis vs Osteoarthritis, 519 Rheumatology, orthopedics 486–525 Rhinorrhea, 177, 643 (see also Sore throat) approach to, 177 causal condition of, 177 Rickets, 163 Risk-taking behavior, 112 Rosacea vs Acne, 71 Roseola infantum, 573 management, 575 Rotator cuff impingement, 491 tear, 491 tendinopathy, 491 Rubella, 570 Rupture, 506 arteriovenous malformation, 125 spleen, 282 Ruptured membranes, 443 Russell sign, 186 Salbutamol, 42 Salicylate intoxication, 141 Salicylates, 93–94, 650 ◦ Salicylates, , 305 Saline, 93 Salivary glands, 181 ◦ Salt retention, , 52 ◦ Salt retention, , 52 Salter-Harris Fractures, 488 SAMPLE Hx, 102 Samter triad, 180 Sarcoidosis, 159 Sarcoma, 272 Scales, 68 Scalp biopsy, 80 Scaphoid fractures, 495 Scapulothoracic bursitis, 492 Scar, 68 Scarlet fever, 574 Scarring, 123 alopecia, 79 Schizoid PD, 593 Schizotypal PD, 593 Scholarly merit, 20 Scopolamine, 176 Scotomas, 156 Scrotal mass (see also Scrotal Pain), 661–664 DDx of, 662 differentiation, 661 evaluation of, 662 painless scrotal mass, 662 Scrotal pain, 664–666 Scrotum from abdomen, descent of testicles into, 665 SDMs, 8–10 Secondary mood disorders, causes of, 598 Secondary sex characteristics, 151 Secondary survey, burns, 88 Second-trimester abortion, 420 Seddon’s classification, 121 Seizure (Epilepsy), 141, 187, 331–333, 451 classification by etiology, 331 classification by type, 331–332 psychosocial impact of, 332 Selective arterial embolization, 232 Self-limiting disease, 82 Self-regulation, 24 Semen analysis, 670 Sengstaken-Blakemore balloon, 229 Sensory loss, patterns of, 327 Sepsis/Septic shock, 40, 581 endemic, 582 epidemic, 582 pandemic, 582 physical signs, 581 Septal deformity, 179 Septic abortion, 416 Septic arthritis, 518, 582 Serotonin, 91 721 Serum, 146–148 Ca2+ , 161 CR, 35 sickness, 78 tumor markers, 271 UA level, 35 Sexual addiction/sexual compulsion, 605 Sexual attraction to disability, 605 Sexual dysfunction, 134 male and female, 603 Sexual maturation, 150–152 classification scheme of abnormal, 150 delayed puberty, 151 diagnosing the cause of, 152 differential diagnosis of, 150 precocious puberty, 151 diagnosing the cause of, 152 secondary sex characteristics, 151 Sexual paraphilias, 603 subtypes of, 604 Sexuality, 605 Sexually concerned patient, 603–606 Sexually transmitted infections (STI), 382–387, 574 1◦ , 382 2◦ , 382 preventative measures, 382 Shaken Baby Syndrome, 119 Shifting Dullness Test, 271 Shock acutely ill infant/child, 543–544 four major categories of, 100 cardiogenic, 100 distributive, 100 hemorrhagic, 100 hypovolemic, 100 general presentation of, 101 tissue hypoperfusion, 100 tissue hypoxia 2◦ , 100 Shoulder, pain, 489–492 Sibutramine, 145 Sickle cell disease, 317 SIDS (see Sudden infant death syndrome) Sigmoidoscopy, 286 Sildenafil, 671 Silver sulfadiazine, 88–89 Simvastatin, 148 Situational syncope, 49 Sitz Bath, 288 Six grades, intensity murmur, 59 Skin (see also Macules; Papules) rash, 67–70 skin wounds, 122–124 (see also Bites) approach to patient with, 123 Cs of Wound Closure, 123 tape, 124 tumor/ulcers, 73–75 Skull fractures, 118–119 Slater-Harris classification, 487 722 Index SLE lesions, 68 Sleep apnea, 32, 144 Sleep problems, 194–196 (see also Headache) diagnosis and management of, 195 important causes of transient poor sleep, 196 sleep hygiene for all patients, 196 Smell dysfunction, 179–180 causal condition of, 179 Smoking cessation, 316, 619 drug therapy for, 619 Snake bites, 106 Somatization, 223 Sore throat (Rhinorrhea), 177–179, 573 GABHS: S pyogenes, 573 Sound, abnormal heart, 58–59 Speech abnormalities, 319–320 conservative management for, 319 schematic of, 320 Speech/language delay, 539 Spermatogenesis, 667 hormonal and paracrine regulation of, 668 Spermicides, contraception, 377 Sphincter innervation and dysfunction, 655 Sphincter of oddi dysfunction, 223 SPIKES Protocol, 14, 208 Spinal compression, 513–515 Spinal cord compression, 451 Spinal injury prevention, 125 Spinal trauma, 125–128 clearing the C-spine, 128 corticosteroids in spinal trauma, 127 determination of spinal level, 126–127 Hx and P/E, 125 special airway considerations, 125–126 type of injury, 125 anterior cord, 125 brown-sequard, 125 central cord, 125 complete, 125 incomplete, 125 Spine, disorder of, 512 Spinnbarkeit, 376 Spironolactone, 34, 53 Splenomegaly, 134, 272, 289–290 Split heart sounds, 58 Sponge, contraception, 377 Spontaneous epidural hematoma, 125 Spousal abuse, 203–204, 610–611 risk factors of, 203 SPPINE, 127 Stable angina, 45 Staging, 451 breast cancer, management and, 450 Staples, 124 Starling’s law, 52–53 Stature (see also Abnormal stature) Status asthmaticus, 546, 616 STEMI, 45 ◦ PCI for, 46 adjunctive Rx in, 46 antithrombotic Rx in, 46 Sterilization, 380 tubal ligation, 380 vasectomy, 380 Steroids, 80 STI (see Sexually transmitted infections) Stiff-man syndrome, 137 Stillbirth, 418–419 fetal mortality rate, 418 in Canada, 418 infant mortality rate, 418 investigating, 418 fetal, 419 maternal, 419 placental, 419 Stool incontinence, 246–248 Stool retention clues, 243 Strabismus and/or Amblyopia, 477–481 approach to, 479 causal conditions for, 479 test for, 481 Streamline flow, 55 Streptococcal infections, 574 acute rheumatic fever, 574 postinfectious glomerulonephritis, 574 scarlet fever, 574 Streptococcal vaginitis (group A), 382 Streptococcus pneumoniae, 174 Stress fractures, 487–488 ulcer prophylaxis, 229 vs urgency UI, 655 Stridor approach to, 622 vs wheeze, 624 Stroke, 451 PEx findings useful in, 318 predicting the etiology of, 318 prevention, 318 Subacute thyroiditis, 133, 135 Subcapsular bursitis, 492 Subfertile male, evaluation of, 669 Submersion injury, causes of, 112 Substance abuse, 190–191 common drugs of, 191 Subungual Hematoma vs Melanoma, 82 Sudden cardiac death, 187 Sudden infant death syndrome (SIDS), 579–580 Suicidal behavior, 606–608 Sulfa drug, 650 Sulfonamides, 582 Sulphonylureas, 139, 141 Supracondylar fracture, 494 Surgery, general, 267–288 (see also Abdominal pain; Ascites; Bowel obstruction; Organomegaly; Pelvic masses) abdominal distension, 267–272 approach to patient with, 268 abdominal mass, 272–280 anorectal pain, 286–288 Suspected fracture, approach to, 489 Sutures, 124 closure techniques, 124 Swallowing, difficulty, 218–219 phases of, 218 Sweating, 141 Swinging flashlight test, 474 Sympathomimetics, 91 Symptothermal family planning method, 376 Syncope, 49–52 approach to, 50 causes of, 52 Hx of, 52 vs presyncope, 51 relationship between BP, CO, and SVR, 49 CO and preload, 51 CO, SV, and HR, 49 SV and after load, 51 SV, contractility, preload, and afterload, 49 Syphilis, 383–384, 570 1◦ , 384 2◦ , 384 3◦ , 384 gumma, 384 neurosyphilis, 384 Systemic autoimmune rheumatic diseases, 520 Systemic tissue perfusion, overwhelming reduction in, 38 Systolic murmurs, 59–63 Tachyarrhythmias, 47 Tachycardia, 55, 134 Tachypnea, 613, 621 Tadalafil, 671 TAILS, 296 Takayasu arteritis, 55 Tall stature, 578 Tanner staging, 364 Target organ damage in HTN, 31 Taste dysfunction, 179–180 causal condition of, 179 TBI differential Dx of, 122 etiology of, 118 presentation of, 119 TBSA, estimation, 90 TBV, estimating, 104 TCAs, 91, 94 Index Teeth abnormalities, 181 Telangiectasia, 67 Telogen Effluvium, 80 Temperature, abnormal (see Fever) Tendon injury, 115 Tension, 109 Teratogenic disorders, 559 Down syndrome, 559 Fragile X syndrome, 561 Klinefelter syndrome, 560 Turner syndrome, 560–561 Terminal hair, in female, 157 Tertiary hyperparathyroidism, 159 Testicular torsion, 530–531 Testicular cancer, 661–662 risk factors, 661 Testicular Torsion vs Acute Epididymitis, 666 Testicular, penile enlargement, 151 Tetracycline, 229 Thelarche, 364 Therapeutic paracentesis, 53 Thermal burns, 86 local effects of, 87 Thermoregulation, pathophysiology of, 98 Thiazides, 55, 159 diuretics, 33–34 Thiazolidinediones, 139 Thionamides, 134 Thoracentesis, 636 Thoracic trauma common injuries associated with, 109 emergencies, 109 initial Tx of, 110 Thoracotomy, indications for immediate ED, 111 Thought disorders, 600–603 Threatened abortion, 416 Thromboembolism, cardiac sources of, 315 Thromboprophylaxis, 641 Thrombosis, 638 clinical screening tests for, 294 HIT with subsequent, 294 Thyroid (see also Hyperthyroidism; Hypothyroidism) acropathy, 134 bruit, 134 cancer, 133 disease, 132–136 gland, 132 hormone synthesis, 132 imaging, 135 malignancy, 133 storm, 95 Thyroiditis, 134 Thyrotoxicosis, 76, 134 Tibial fractures, 503 Tick-borne illness, 106 Timing of Onset, 233 Tinea Versicolor (Pityriasis Versicolor), 68 Tingling, 326–327 Tinnitus, 169–172 causal condition of, 170–171 management of, 172 Tissue hypoperfusion, 100 ◦ hypoxia , 100 zone of coagulation, 87 zone of hyperemia, 87 zone of stasis, 87 Tonic pupils, 475–477 Tonic-Clonic Seizures, emergency Rx of, 333 Topical anthralin, 80 Topical contact sensitizers, 80 Topical minoxidil, 80 Tourniquets and Clamps, Risks of, 131 Toxic adenoma, 133, 135 Toxic multinodular goiter, 133, 135 Toxidrome, common, 92 Toxoplasmosis, 570 Transillumination, 280 Transudative vs Exudative Pl Eff, 636 Trauma/Accidents, 100–104 ◦ survey in, 103 disposition, 103 injury prevention, 103–104 potential complications of, 103 primary survey, ABCDE’s, 102 resuscitation, 103 shock, 100–101 top causes of, 100 trauma center/advanced care, 103 wound healing, 101 approach, 102 causal condition of, 101–102 sequence of, 101 Traumatic Fractures, 488 Tremor, 141 differential Dx of, 326 Trendelenburg gait, 507 test, 500 Trichomoniasis, 382 Trigger finger, 496 Trisomies, 416 Trochanteric bursitis, 498 Trousseau sign, 164 Truth telling, 13–14, 222 ethical consideration, 13–14 legal consideration, 13–14 patient-centered protocol, 14 Tubal ligation, 380 Tuberculosis, 159 Tubo-ovarian abscesses, 397 Tumor, 67 lysis syndrome, 451 mass effects, 156 Tuning Forks Test, 172 Turbulent flow, 55 723 Turner syndrome, 560–561 anticipatory care, 562 Type Hypersensitivity, 75 Type 1–4 Hypersensitivity Reactions, 78 Type DM, risk factors for, 137 UA/NSTEMI, 45 angiography in, 46 TIMI risk score for, 46 Uenza epidemics, 583 UGI Bleed approach to, 228 differential Dx of, 227 H pylori Rx (7 d), 229 high risk criteria for rebleed, 229 outcomes, 229 UI (see Urinary incontinence) Ulceration, 68 Ulcerative vaginitis TSS, 382 Ulcers/tumor, skin, 73–75 Ultrasonography, 280 Ultrasound Imaging, 664 UMN vs LMN lesion, 334 Unilateral edema, 638–642 Unilateral RAS, 30 Untreated hernias complications, 279 Upper airway disorders, 546 Upper back, pain, 510–511 Upper resp tract disorders (see Wheezing) Upper vs Lower GI Bleed, 225 Uremia, 37, 93 Ureterosigmoidostomy, 93 Urethral Injuries, Tx of, 129 Urethroscopy, 386 Urge incontinence (UI), 406 Urinary albumin secretion, 31 Urinary frequency, approach to the diagnosis of, 150 Urinary incontinence, 652–657 Urinary infections (UI), 406–408, 529 management, 407 SI, 407 urge incontinence (UI), 407–408 urodynamic SI, 407–408 in women, evaluation, 407 Urinary obstruction, 657–661 causes of, 657 renal function and, 657 sign and symptoms of, 658 Urinary tract injuries, 128–129 imaging, 129 infection/stones, 223 involvement, 644 antibiotherapy for, 648 classification of, 645 indication for, 645 pathogens responsible for, 648 risk factors of, 645 in women, acute pain at micturition, 647 724 Index Urinary tract injuries (continued) mechanism and P/E features of, 128 urethral injuries, Tx of, 129 Urodynamic SI, 408 Urogenital atrophy, 410 Urogenital Sx, 410 Urolithiasis, 530, 652 Urology, 644–675 (see also Urinary tract injuries; Urinary incontinence; Urinary Obstruction) Urothelial cancer screening, 651 Urothelial carcinoma, 651 Urticaria, 199 Urticaria/anaphylaxis, 77–79 Uterine leiomyomas, 396 Uterine prolapse, 403 Uterine, 272 Uteroplacental circulation, 35 Vaccines, 198 Vacuum extraction forceps, 435 Vaginal bleeding (see also Abnormal vaginal bleeding) DVB, 368 endometrial biopsy/cytologic studies, indications for, 368–369 excessive, 363–373 intermenstrual (IMB), 368 irregular, 363–373 menometrorrhagia, 368 menorrhagia, 368 metrorrhagia, 368 PMS/PMDD, 373–375 (see also PMS spectrum of disorders) polymenorrhea, 368 postcoital, 368 postmenopausal, 368 U/S, indications for, 368 Vaginal candidiasis, 382, 383 Vaginal complaints, 381–387 (see also individual entries) HPV, 385 physical exam, 381 PID classical triad, 386 sexually transmitted illnesses, 381 vaginal discharge, 381–384 vulvar itch, 381 vulvovaginitis, 382 Vaginal discharge, 381–384 Vaginal exam in labor management, 430 Vaginal trichomoniasis, 383 Vaginal vault prolapse, 403 Vaginitis, types, 382 Valgus vs Varus, 501 Valve stenosis, classification of, 58 Vardenafil, 671 Varicella zoster, 570 Varicocele, 664 Vascular capacitance, 49 Vascular dementia, 31 Vascular injury, 129–131 arterial injury, 130 compartment syndrome, 130 Dx Test, 131 initial assessment for, 131 mechanism of, 36–37 Tx of arterial bleeding, 131 Vascular permeability, 53 Vasculitis, 316, 618 Vasectomy, 380 Vasomotor rhinitis, 179 Vasomotor Sx, 410 Vasospasm edema, 35 Vasovagal syncope, 49 Venous insufficiency, 53 Ventricular tachyarrhythmias, 65 Vertigo, 175–176 approach to, 175 Vesicles, 67, 70 Vestibular nerve lesion, 221 Violence, Family (see Family) Virilization, 157–158 Virtue ethics, Visual disturbances/loss, 481–485 acuity loss, 156 approach to, 481–482 changes, 141 common causes of, 482 defects, clinical correlates of, 481 field defects, 156 fluorescein angiography indications, 484–485 VITAMINNCDE, 598 Vitiligo, 134 Voice deepening, 151 Voice generation, 319 Volume depletion, signs of, 233 Voluntarism, Volvulus, 267 Vomiting/Nausea, 36, 220–222 approach to, 222 causes of, 221 definition of, 220 pharmacological Rx of, 236 physiology of, 220 system-based differential Dx of, 221 Vulvar itch, 381 Vulvovaginitis, 382 atrophic vaginitis, 383 infectious, 383 vaginal candidiasis, 383 vaginal trichomoniasis, 383 Warfarin, 641 Warm ischemia, 130 Water deprivation test, 149 diuresis vs osmotic, 149 WBC (see White blood cell) Weakness, 333–335 localization of, 334 Wegener granulomatosis, 346 Weight (see also Abnormal weight) Weight gain (see Obesity) Weight loss, 186–188 advising healthy weight loss, 187 causal conditions, 186 chronic disease, 186 hospitalization criteria, 187 lab investigations of, 186 Well’s criteria, 639–640 Wheal, 67 Wheezing (Asthma), 623–625, 643 approach to, 622 vs Stridor, 624 Whiplash, 510 White blood cell abnormalities, 307–309 approach to, 309 causal conditions of, 308 White coat HTN, 32–33 Withdrawal, 190–191 Withholding information, 207 Work-related health, 213–214 common occupational exposures, 214 Work-related injuries, 521 Wound closure, 123 methods of, 124 Rx after, 124 take home points, 124 types of, 123 ◦ closure, 123 delayed primary closure, 123 primary closure, 123 Wound healing, 101 Wrist injury, 115–117 indications for surgical consultation in, 117 initial assessment of, 116 innervation and function, 115 muscles of, 115 Wrist, pain, 495–496 complications of wrist fracture, 495 fracture, 495 Yuzpe Method, 380 Zone of tissue Zone of coagulation, 87 Zone of hyperemia, 87 Zone of stasis, 87 ... bleeding diathesis Family history of bleeding diathesis Medication use 29 1 Figure 11.1 Approach to splenomegaly 29 2 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part. .. hypercoagulability states 29 5 29 6 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I CLINICAL BOX Diagnostic Testing 1◦ • • • 2? ?? • • • Tests Compression U/S: gold standard in... 3 12 Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I APPLIED SCIENTIFIC CONCEPTS Brain parenchyma is not pain sensitive Figure 12. 2 Neurovascular/serotonin theory