By Marc S. Sabatine
Prepared via citizens and attending physicians at Massachusetts normal medical institution, this PDA model of Pocket Medicine is among the best-selling references for scientific scholars, interns, and citizens at the wards and applicants reviewing for inner drugs board checks. In bulleted lists, tables, and algorithms, this easy-to-navigate hand held reference presents key scientific information regarding universal difficulties in all parts of inner drugs. clients can customise the content material by means of including their very own notes and reviews. This completely up-to-date moment variation contains new entries on neurological difficulties, rather stroke and seizures.
Platform: Palm OS, home windows CE, and Pocket laptop hand held devices
Read or Download Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (4th Edition) PDF
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Extra resources for Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (4th Edition)
CCB; caution w/ adenosine (can precip. AF); have defibrillator ready • AF/AFL w/ conduction down accessory pathway: need to Rx arrhythmia and c pathway refractoriness; use procainamide, ibutilide, flecainide or cardiovert; avoid CCB & ␤B (ineffective) and dig/adenosine (can T refractoriness of pathway S c vent. rate S VF) • Long term: Rx tachycardias w/ radiofrequency ablation or antiarrhythmics (IA, IC) consider pathway ablation if asx but AVRT or AF inducible on EPS (NEJM 2003;349:1803) risk of SCD related to how short R-R interval is in AF and if SVT inducible w/ exercise WIDE-COMPLEX TACHYCARDIAS (WCTS) Etiologies • Ventricular tachycardia (VT) • SVT conducted with aberrancy: either fixed BBB, rate-dependent BBB (usually RBBB), conduction via an accessory pathway, or atrially-triggered ventricular pacing Monomorphic ventricular tachycardia (MMVT) • All beats look similar; predominantly upward in V1 ϭ RBBB-type vs.
If refractory HTN, recurrent HF, UA, or worse CKD, revasc. indicated (JACC 2006;47:1) For atherosclerosis: stenting T restenosis vs. PTA alone, but no clear improvement in BP or renal function vs. qxd 7/7/10 2:36 PM Page 30 Aptara Inc AORTA 1-30 AORTIC ANEURYSM Definitions • True aneurysm (involves all 3 layers of aorta) vs. false (rupture contained in adventitia) • Location: root (annuloaortic ectasia), thoracic aortic aneurysm (TAA), thoracoabdominal aortic aneurysm, abdominal aortic aneurysm (AAA) • Type: fusiform (circumferential dilation) vs.
MV leaflet (may be fixed, variable, or nonexistent) and papillary muscle displacement. Gradient (∇) worse w/ c contractility (digoxin, ␤-agonists), T preload, or T afterload. -directed regurg. -directed regurg. , perforating artery compression (bridging), T coronary perfusion • Syncope: ⌬s in load-dependent CO, arrhythmias Clinical manifestations (70% are asymptomatic at dx) • Dyspnea (90%): due to c LVEDP, MR, and diastolic dysfunction • Angina (25%) even w/o epicardial CAD; microvasc. dysfxn (NEJM 2003;349:1027) • Arrhythmias (AF in 20–25%;VT/VF) S palpitations, syncope, sudden cardiac death Physical exam • Sustained PMI, S2 paradox.