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Primary Care Mentor: Your Clerkship & Shelf Exam Companion

by Marianne M. Green, Jennifer A. Bierman, James J. Foody, Russell G. Robertson, Gary J. Martin

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Foreword, vi
Preface, viii
Contributors, ix
Part One: Overview of Primary Care, 1
Chapter 1. Office Management and the Principles of Diagnosis and Management of Ambulatory Patients, 1
I. Introduction to Ambulatory Medicine, 1
II. Differences in Inpatient Versus Ambulatory Care, 1
III. Principles of Diagnosis and Treatment, 2
IV. Role of Students, 5
V. Learn What It Means to Be Someone’s “Doctor”, 6
Chapter Self-Test Questions, 7
Chapter 2. Communicating with Patients, 8
I. Overview, 8
II. Structured Framework Is Key to Effective Interview, 8
Resources, 15
Chapter Self-Test Questions, 15
Chapter 3. Clinical Epidemiology and Principles of Quantatative Decision Making, 17
I. Consider These Two Problems, 17
II. Overview, 18
III. Topics of Clinical Epidemiology and Medical Decision Making., 18
IV. Decision Making in Uncertainty: Decision Analysis, 40
V. Costs and Cost-Effectiveness, 41
References, 45
Chapter 4. Prevention and Screening, 47
I. Epidemiology, 47
II. Diseases for Which to Screen in Most Adults, 50
III. Cancer, 53
IV. Immunizations, Chemoprevention, and Counseling, 56
Resources, 57
Chapter Self-Test Questions, 58
Chapter 5. Preoperative Evaluation, 59
I. Overview, 59
II. Preoperative Testing, 60
III. Preoperative Cardiac Assessment and Perioperative Management, 60
IV. Preoperative Pulmonary Evaluation, Risk Assessment, and Risk Reduction Strategies for Patients Undergoing Noncardiothoracic, 66
V. Preoperative Evaluation of Patients on Antithrombotic or Anticoagulant Therapy, 70
VI. Preoperative Evaluation and Management of Endocrine Disorders, 71
Resources, 74
Chapter Self-Test Questions, 75
Part Two: Diagnosis and Management of Common Outpatient Symptoms, 77
Chapter 6. Headache, 77
I. Background, 77
II. Approach to the Patient, 81
III. Treatment, 82
Resources, 88
Chapter Self-Test Questions, 89
Chapter 7. Common Sleep Disorders, 91
I. Introduction, 91
II. Insomnia, 91
III. Obstructive Sleep Apnea (OSA), 97
IV. Restless Leg Syndrome (RLS)/Periodic Leg Movements of Sleep (PLMD), 100
Resources, 104
Chapter Self-Test Questions, 105
Chapter 8. Dizziness, 107
I. Background, 107
II. Epidemiology, 107
III. Approach to the Patient, 107
IV. Classification of Type of Dizziness, 108
V. Vertigo, 108
VI. Presyncope, 112
VII. Disequilibrium, 113
VIII. Vague Lightheadedness, 114
IX. Treatment, 114
Resources, 116
Chapter 9. Chest Pain, 118
I. Pathophysiology, 118
II. Epidemiology, 118
III. Signs and Symptoms, 119
IV. History and Physical, 119
V. Laboratory Tests, 121
VI. Management, 122
Resources, 123
Chapter Self-Test Questions, 124
Chapter 10. Sinusitis, Bronchitis, and Pharyngitis, 126
I. Sinusitis, 126
II. Acute Bronchitis, 129
III. Pharyngitis, 132
Resources, 138
Chapter Self-Test Questions, 140
Chapter 11. Abdominal Pain, 142
I. Introduction, 142
II. Approach to the Patient, 144
III. Management (Tables 11.5, 11.6, and 11.7), 156
IV. Referral or Consultations, 164
Resources, 165
Chapter 12. Diarrhea, 167
I. Definitions and Overview, 167
II. Evaluation, 172
III. Management, 175
Resources, 178
Chapter Self-Test Questions, 178
Chapter 13. Musculoskeletal Pain, 180
I. Introduction, 180
II. Shoulder Pain, 181
III. Carpal Tunnel Syndrome, 187
IV. Osteoarthritis (OA), 189
V. Low Back Pain, 191
VI. Patellofemoral Syndrome, 194
Resources, 197
Chapter Self-Test Questions, 197
Chapter 14. Dermatology in Primary Care, 199
I. Overview, 199
II. Acne Vulgaris, 201
III. Eczema, 206
IV. Psoriasis, 210
V. Superficial Fungal Infections, 213
VI. Skin Cancer, 216
Resources, 219
Chapter Self-Test Questions, 220
Chapter 15. Fatigue, 221
I. Definition, 221
II. Classification, 221
III. Epidemiology, 222
IV. Etiology, 223
V. Pathophysiology, 225
VI. Clinical Assessment, 226
VII. Management, 228
VIII. Prognosis, 230
Resources, 231
Chapter Self-Test Questions, 231
Chapter 16. Erectile Dysfunction, 233
I. Epidemiology, 233
II. ED Risks, 233
III. Erectile Physiology, 233
IV. Pathophysiology of Erectile Dysfunction, 234
V. Approach to the ED Patient, 240
VI. Indications for Specialty Referral, 242
VII. Management, 242
Resources, 248
Chapter Self-Test Questions, 249
Chapter 17. Anxiety and Depression, 250
I. Background and Epidemiology, 250
II. Diagnostic Approach, 250
III. Treatment, 253
IV. Follow-Up and Referral, 256
Resources, 258
Chapter Self-Test Questions, 259
Chapter 18. Somatization, 260
I. Pathophysiology, 260
II. Signs and Symptoms, 261
III. History and Physical Examination, 262
IV. Differential Diagnosis, 263
V. Laboratory Evaluations, 265
VI. Management, 265
Resources, 268
Part Three: Diagnosis and Management of Common Chronic Illnesses, 269
Chapter 19. Congestive Heart Failure, 269
I. Overview, 269
II. Approach to CHF Patient, 270
III. Management, 271
Resources, 276
Chapter Self-Test Questions, 276
Chapter 20. Hypertension, 278
I. Overview, 278
II. Benefits of Treatment, 278
III. Definition, 279
IV. Etiology, 279
V. BP Measurement, 281
VI. Evaluation, 281
VII. Patients to Treat, 282
VIII. Nonpharmacologic Treatment (Table 20.4), 283
IX. General Principles of Drug Treatment, 285
X. Medications, 286
XI. Refractory HTN, 289
Resources, 291
Chapter Self-Test Questions, 292
Chapter 21. Asthma, 294
I. Definition, 294
II. Burden of Asthma: Epidemiology and Economics, 294
III. Pathogenesis, 295
IV. Pathophysiology, 296
V. Natural History, 296
VI. Diagnosis, 297
VII. Differential Diagnosis, 298
VIII. Management, 299
IX. Referral to Pulmonary Specialist, 305
Resources, 306
Chapter Self-Test Questions, 307
Chapter 22. Chronic Obstructive Pulmonary Disease, 309
I. Definition, 309
II. Epidemiology, 309
III. Risk Factors, 310
IV. Pathophysiology, 311
V. Natural History, 311
VI. Diagnosis, 311
VII. Differential Diagnosis, 313
VIII. Staging of COPD, 314
IX. Management, 314
X. End-of-Life Planning, 319
XI. Prognosis, 320
XII. Referral to Pulmonary Specialist, 321
Resources, 322
Chapter Self-Test Questions, 323
Chapter 23. Diabetes, 324
I. Introduction, 324
II. Epidemiology, 324
III. Classification and Diagnosis, 324
IV. Complications, 326
V. Management, 329
Resources, 335
Chapter Self-Test Questions, 335
Chapter 24. Hyperlipidemia, 337
I. Pathophysiology and Epidemiology, 337
II. Signs and Symptoms, 337
III. History and Physical Examination, 338
IV. Differential Diagnosis, 338
V. Laboratory Testing, 339
VI. Management, 339
Resources, 343
Chapter Self-Test Questions, 345
Chapter 25. Obesity, 346
I. Pathophysiology, 346
II. Epidemiology, 348
III. Prevention, 349
IV. Signs and Symptoms, 349
V. History and Physical Examination, 350
VI. Differential Diagnosis, 351
VII. Management, 352
Resources, 356
Chapter Self-Test Questions, 357
Part Four: Diagnosis and Management of Age-Related Conditions, 359
Chapter 26. Well-Child Visit, 359
I. Fundamentals of Well-Child Examination, 359
II. Age-Specific Examination Guidelines, 362
Resources, 374
Chapter Self-Test Questions, 374
Chapter 27. Fever in Children, 376
I. Definition, 376
II. Epidemiology, 376
III. Pathophysiology, 376
IV. Differential Diagnosis, 377
V. History and Physical Examination, 378
VI. Diagnostic Evaluation, 381
VII. Management, 387
Resources, 390
Chapter 28. Otitis Media in Children, 391
I. Infectious Versus Noninfectious Otitis Media, 391
II. Anatomy and Function, 391
III. Pathophysiology of AOM, 392
IV. Microbiology, 392
V. Risk Factors, 392
VI. Epidemiology, 393
VII. Examining the Ear, 393
VIII. Diagnosis, 394
IX. Management, 396
Resources, 398
Chapter Self-Test Questions, 399
Chapter 29. Geriatric Conditions, 400
I. Overview, 400
II. Assessment, 402
III. Other Important Concepts, 405
Resources, 405
Chapter Self-Test Questions, 406
Part Five: Women's Health, 409
Chapter 30. Benign Breast Disease, 409
I. Introduction, 409
II. Fibrocystic Disease, 410
III. Breast Pain, 411
IV. Breast Cysts, 413
V. Fibroadenomas, 413
VI. Nipple Discharge, 414
Resources, 416
Chapter Self-Test Questions, 416
Chapter 31. Preconception Care, 418
I. Preconception Evaluation, 418
II. Specific Preconception Counseling, 421
Resources, 424
Chapter Self-Test Questions, 424
Chapter 32. Hormone Replacement Therapy, 426
I. Background, 426
II. Epidemiology and Diagnosis of Menopause, 427
III. Symptoms of Menopause, 428
IV. Benefits of HRT, 429
V. Risks of HRT, 430
VI. Side Effects of HRT, 430
VII. Contraindications to HRT, 431
VIII. Formulations of HRT, 431
IX. Alternatives to HRT, 432
X. Summary, 434
Resources, 436
Chapter Self-Test Questions, 436
Chapter 33. Menstrual Disorders, 438
I. Normal Menstrual Cycle, 438
II. Primary Amenorrhea, 438
III. Secondary Amenorrhea, 440
IV. Dysfunctional Uterine Bleeding (DUB), 441
V. Dysmenorrhea, 446
Resources, 448
Chapter Self-Test Questions, 449
Chapter 34. Female Genital Symptoms, 450
I. Pathophysiology, 450
II. Epidemiology, 451
III. Patient History, 452
IV. Physical Examination, 452
V. Differential Diagnosis, 453
VI. Management, 457
Resources, 460
Chapter Self-Test Questions, 461
Chapter 35. Pap Smear and Cervical Cancer Screening, 462
I. Pathophysiology of Cervical Cancer, 462
II. Epidemiology of Cervical Cancer, 463
III. Prevention of HPV and Cervical Cancer, 463
IV. Pap Smear, 464
V. Interpretation and Management of Pap Smear Results, 466
Resources, 470
Chapter Self-Test Questions, 470
Chapter 36. Osteoporosis, 472
I. Definitions, 472
II. Pathophysiology, 472
III. Epidemiology, 473
IV. Risk Factors, 473
V. History Key Components, 473
VI. Physical Examination Findings Suggesting Osteoporosis, 474
VII. Screening Guidelines, 475
VIII. Diagnosis, 475
IX. Evaluation for Secondary Osteoporosis, 476
X. Management, 477
XI. Monitoring, 479
Resources, 480
Chapter Self-Test Questions, 480
Chapter 37. Intimate Partner Violence, 482
I. Overview, 482
II. Definition of IPV, 482
III. Demographics, 482
IV. Description of Relationship Pattern in IPV, 483
V. Medical Presentation of IPV, 483
VI. Barriers to IPV Identification, 484
VII. Screening for IPV, 484
VIII. Assessing Safety, 485
IX. Intervention Strategies, 485
X. Legal Concerns, 486
XI. Summary, 486
Resources, 487
Answers to Self-Test Questions, 489
Abbreviations, 505
Key Contacts and Notes, 512
Index, 517

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