May 142015

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.


  • 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

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May 142015

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.

• 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 »

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May 142015

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.

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 »

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