Bratton’s Family Medicine Board Review – 5th Edition

Bratton's Family Medicine Board Review - 5th EditionPrepare for your ABFM boards – find your weak spots and eliminate them now! Handy in print and as an eBook, Bratton’s Family Medicine Board Review is the essential practice test for those facing the ABFM exams. Opening with the basic requirements of the ABFM Board certification process, it provides crucial background information on all three AFBM exams and their formats, describes a typical exam day, and offers excellent test-taking advice—taking the mystery out of the exam process.

Features:

  • 1,800 multiple-choice questions drawn from common clinical situations, presented in ABFM-exam format
  • Detailed explanation supporting each answer
  • Key points highlighted throughout
  • Additional reading suggestions after each correct answer
  • Pictorial atlas offers clinical photographs and lab smears

Now with the print edition, enjoy the bundled interactive eBook edition, offering tablet, smartphone, or online access to:

  • Complete content with enhanced navigation
  • A powerful search tool that pulls results from content in the book, your notes, and even the web
  • Cross-linked pages, references, and more for easy navigation
  • Highlighting tool for easier reference of key content throughout the text
  • Ability to take and share notes with friends and colleagues
  • Quick reference tabbing to save your favorite content for future use
  • Interactive Q&A with more than 1,800 questions

Get It Here:

 Bratton’s Family Medicine Board Review

Aortic Dissection- Brief Discussion

Stanford classificationAortic Dissection is a condition in which the aortic intima tears, exposing a diseased media that is split in two longitudinally by the force of the blood flow. This dissection usually progresses distally for a variable distance. Medial degeneration is often idiopathic but may be the result of cystic medial necrosis, especially in Marfan’s syndrome.

Associations: It is commonly seen in patients with Marfan syndrome. There is also an association with the following:
• hypertension (history of hypertension in 80% of cases);
• pregnancy;
• trauma.

Disease Classification:  Aortic dissection is classified according to whether there is involvement of the ascending aorta
(Stanford classification). This has practical and prognostic implications.

Epidemiology:
• Peak age 60 years
• Male/female ratio 2:1.

Clinical presentation:
1.Common: There is central chest pain in 90% of cases, classically a ‘tearing’ pain that migrates to the back (interscapular) as dissection proceeds. A dissected aorta found incidentally in a patient without pain is usually chronic and therefore low risk. Thoracic back pain of sudden onset is also common.

2. Uncommon:
• Syncope.
• Stroke.
• Acute pulmonary oedema.
• Pulseless electrical activity arrest.

Physical signs Continue reading “Aortic Dissection- Brief Discussion”

Introduction To Cardiac Tumors

Cardiac TumorsMost cardiac tumors are secondary deposits. Cardiac metastasis occurs most commonly with lung and breast carcinomas. The most commonprimary cardiac tumor is a myxoma; 75% of myxomas occur in the left atrium, the remainder in the right atrium and ventricle. Myxomas usually arise from the endocardium at the border of the fossa ovalis as a pedunculated mass. This may prolapse through the mitral valve (MV) mimicking mitral stenosis.

Epidemiology: 
The prevalence of myxoma is estimated at 2 per 100,000, most commonly in those aged 30–60 years. The female to male ratio is 2:1.

Clinical presentation:
Myxomas are discovered when individuals present withconstitutional upset or the effects of MV obstruction, or the tumour is an incidental finding. Symptoms include

  • fever,
  • malaise,
  • exertional
    dyspnoea and
  • weight loss.
  • Transient
    pulmonary oedema,
  • paroxysmal
    nocturnal dyspnoea,
  • haemoptysis,
  • dizziness and syncope may occur.
  • The first presentation may be due to an embolic phenomenon.
  • Malignant tumors usually present acutely with haemorrhagic pericardial effusions or heart block.
  • Renal cell cancer invading the IVC may present with signs of right heart failure and a renal mass.
  • Carcinoid metastasis to the tricuspid valve may present with facial flushing and bronchospasm.

Continue reading “Introduction To Cardiac Tumors”

Current Diagnosis and Treatment Cardiology, Fourth Edition (LANGE CURRENT Series)

current cardiologyConcise, clinically focused coverage of the major disease entities and therapeutic challenges in cardiology

For more than 70 years, professors, students, and clinicians have trusted LANGE for high-quality, current, concise medical information in a convenient, affordable, portable format. Whether for coursework, clerkships, USMLE prep, specialty board review, or patient care, there’s a LANGE book that guarantees success.

“An excellent reference and review for practicing physicians — Family Medicine reviewing an earlier edition

  • Covers all the important management issues in cardiology
  • Includes special topics such as pregnancy and heart disease, the use of anticoagulants in heart disease, and the perioperative evaluation of heart disease patients
  • Each chapter written by experts in the field
  • Logically organized into six sections:
    Prevention of Cardiovascular Disease, Ischemic Heart Disease, Arrhythmias, Valvular Disease, Cardiomyopathy and Heart Failure, and Systemic Diseases and the Heart
  • Consistent chapter presentation includes Essentials of Diagnosis, Clinical Findings, Diagnostic Studies, Treatment, Prevention, and Prognosis
  • More than 235 illustrations, including ECGs, imaging studies, drawings, graphs and charts
  • NEW CHAPTER on Antiplatelet Therapy • Emphasis on must-know information makes it perfect for board review

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Continue reading “Current Diagnosis and Treatment Cardiology, Fourth Edition (LANGE CURRENT Series)”

Arterial Blood Gas Sampling

Arterial Blood gas procedureArterial Blood Gas Sampling is done to measure the oxygen and carbon dioxide tensions and acid–base status of arterial blood.

Indications: Arterial blood gas sampling was a research procedure until the mid-1960s but is now widely performed,either by direct arterial puncture or from indwelling arterial lines.
Indications include:
• respiratory failure (type I or II);
• renal failure;
• hepatic failure;
• cardiac failure;
• drug intoxication (aspirin and narcotics);
• endogenous acid overproduction(ketoacidosis or lactic acidosis);
• severe illness, cause unknown.

Contraindications:  Care should be taken in the presence of bleeding disorders. Renal physicians will be appropriately unimpressed if an arterial blood
gas sample is taken from an arteriovenous fistula.

What The Patients Should Know Before The Procedure:  The procedure should be explained to the patient. The possibility of requiring more than one attempt should be mentioned.

A Brief Description Of The Practical Procedure: 

1.Before investigation: The patient should be lying or sitting comfortably and an appropriate site is selected. The radial artery of the non-dominant arm is most commonly used, but the brachial or femoral arteries can be used. Make sure you have enough sterile gauze to apply immediate pressure after the procedure. Continue reading “Arterial Blood Gas Sampling”

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Introduction To Cushing’s Syndrome

Cushing syndromeDefinition: Cushing syndrome is a hormonal disorder and it describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol. Cushing syndrome is also known as Hypercortisolism.

Causes:

1. Use Of Glucocorticosteroid Medicines: The most common cause of Cushing syndrome is the excessive use of  corticosteroid medicine. Prednisone, dexamethasone and Prednisolone are the examples of these medicines. The glucocorticosteroid given externally mimic the actions of the body,s normal hormone cortisol. These drugs are mainly used in the treatment of asthma, skin allergies, inflammatory diseases, etc.

2. Excess Production of the hormone Cortisol In The Body: The other cause is the excessive production of the hormone cortisol from the body. This hormone is normally produced from the adrenal glands in response to ACTH (adrenocorticotropic hormone) from the Pituitary gland. This hormone in turn is controlled by CRH (Corticotropic releasing hormone) from the hypothalamus. Some of the causes for excess production of cortisol in the body include:

  • A pituitary gland tumor that release too much ACTH leading to excess stimulation of adrenal glands to produce cortisol.
  • Tumors of the adrenal gland that produce excess cortisol.
  • Tumors elsewhere in the body that may produce ACTH or CRH.

Clearing Some Confusing Terminologies: 

1. Cushing Disease: refers to the pituitary dependent cause of cushing syndrome, that is when the syndrome is caused by the excess production of ACTH from the pituitary gland.

2. Cushing Triad: A condition unrelated to cushing syndrome that is caused by an increased intracranial pressure.

Clinical Features Of Cushing Syndrome:

A full blown case of Cushing syndrome presents with the following signs and symptoms:

  • Rounded moon like face
  • Weigh gain
  • A fat pad in the upper back.
  • Thin arms and legs.
  • Central obesity ( A lemon on tooth pick appearance).
  • Hirsutisim
  • Thinning of the skin with easy bruising and purple striae.
  • Backache
  • Bone tenderness and pain
  • Acne
  • Slow healing of the wounds
  • Fatigue
  • Proximal muscle weakness
  • High blood pressure
  • High blood sugar levels
  • Depression and anxiety
  • Osteoporosis
  • Pathological bone fractures
  • Irregular menstrual cycles
  • Sexual dysfunction
  • Headache

Continue reading “Introduction To Cushing’s Syndrome”

Introduction to Loop Diuretics

Introdloop diureticsuction: A diuretic is a medicine that causes an increase in urine and the amout of water excreted from the kidneys. Loop diuretics are the drugs that act on the the ascending loop of Henle in the kidney to cause diuresis and are so named as loop diuretics.

Mode of Action:

Loop diuretics inhibit the Na+/K+/2Cl- co-transporter in the thick ascending loop of Henle, in the kidneys and stop the transport of sodium chloride out of the tubule into the interstitial tissue, causing a decrease in sodium and chloride re-absorption. They act on the chloride-binding site and have a direct inhibiting effect on the carrier.

Inhibition of this transporter leads to a significant increase in concentration of ions in the tubule and reduced hypertonicity in the surrounding interstitium, causing less water to be reabsorbed into the blood. This causes more urine to be produced and a decrease in blood volume.

Clinical Uses: Loop diuretics are basically used for following conditions;

  • Edema associated with heart failure
  • Fluid accumulation in renal impairment or nephrotic syndrome.
  • Edema with Hepatic cirrhosis
  • Hypertension
  • Sometimes as an adjuvant in cerebral or pulmonary edema where rapid diuresis is required.

Examples of Loop Diuretics: Common drugs in the group of loop diuretics include:

  • Bumetanide
  • Ethacrynic acid
  • Furosemide (Lasix)
  • Torsemide

Continue reading “Introduction to Loop Diuretics”