Read Online Premium E-Books IM Essentials Text American College of IM Essentials Text is an abbreviated medical textbook organized by the For Full BOOK ONLINE BEST PDF Premium E-Books IM Essentials Text. IM Essentials Text is based on the national core curriculum and written by clerkship directors to cover all of the key content needed for students to get the most. Includes FREE access to the online version of IM Essentials containing both questions and text plus flashcards! See access code inside. text.
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Produced by ACP and the Clerkship Directors in Internal Medicine (CDIM), IM Essentials Text and IM Essentials Questions are the next. Download as PDF, TXT or read online from Scribd. Flag for .. Based upon student feedback, IM Essentials 2 con- clerkship directors or clerkship faculty, representing 45 tains twice as many Correction of dosage error in text. Crit Care Med. 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. Download Best Book IM Essentials Text, PDF FILE Download IM Essentials.
Embed Size px. Panic attack May be indistinguishable from angina. Organized by traditional subspecialty internal medicine topics, IM Essentials Text contains more than differential diagnosis tables and treatment algorithms, as well as over color plates, imaging studies, and electrocardiograms to optimize your learning. Pleuritic chest pain and shortness of breath in patients at risk for thromboembolism. Chest pain with exertion, heart failure, syncope.
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Order Now. Table of Contents. Sample pages of IM Essentials Questions. IM Essentials Questions is a self-assessment question book that uses clinically based, MKSAP-style questions to assess mastery of important internal medicine concepts and identify areas in which additional study is needed. 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. The physical examination may reveal decreased breath sounds on the affected side; if a tension pneumothorax is present, hypotension and tracheal deviation to the opposite 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; selected 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, 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. Organized by traditional subspecialty internal medicine topics, IM Essentials Text contains more than differential diagnosis tables and treatment algorithms, as well as over color plates, imaging studies, and electrocardiograms to optimize your learning. SlideShare Explore Search You. Submit Search.
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