Tài liệu Case Files Internal Medicine, THIRD EDITION pdf

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Contributor / vii
Acknowledgments / ix
Introduction / xi
Section I
How to Approach Clinical Problems . . . . . . . . . . . . . . . . . . . . .1
Part 1. Approach to the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Part 2. Approach to Clinical Problem Solving . . . . . . . . . . . . . . . . . . . . . . .9
Part 3. Approach to Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Section II
Clinical Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Sixty Case Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Section III
Listing of Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .549
Listing by Case Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .551
Listing by Disorder (Alphabetical) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .552
Index / 555
CONTENTS
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Molly Dudley Class of 2009
University of Texas Health Science Center at San Antonio
San Antonio, Texas
Approach to congestive heart failure
Approach to HIV and pneumocystits pneumonia
Approach to hypertension
Approach to Arthritis
Approach to low back pain
Approach to endocarditis
Approach to lung disease
Approach to lung cancer
Approach to health maintenance
vii
CONTRIBUTOR
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The curriculum that evolved into the ideas for this series was inspired by
Philbert Yau and Chuck Rosipal, two talented and forthright students, who
have since graduated from medical school. It has been a tremendous joy to
work with my excellent coauthors, especially Dr. John Patlan, who exemplifies
the qualities of the ideal physician—caring, empathetic, and avid teacher, and
who is intellectually unparalleled. I am greatly indebted to my editor,
Catherine Johnson, whose exuberance, experience, and vision helped to shape
this series. I appreciate McGraw-Hill’s believing in the concept of teaching
through clinical cases. I am also grateful to Catherine Saggese for her excellent
production expertise, and Cindy Yoo for her wonderful editing. I cherish the
ever-organized and precise Gita Raman, senior project manager, whose friend-
ship and talent I greatly value; she keeps me focused, and nurtures each of my
books from manuscript to print. It has been a privilege and honor to work with
one of the brightest medical students I have encountered, Molly Dudley who
was the principal student reviewer of this book. She enthusiastically provided
feedback and helped to emphasize the right material. I appreciate Dorothy
Mersinger and Jo McMains for their sage advice and support. At Methodist,
I appreciate Drs. Judy Paukert, Dirk Sostman, Marc Boom and Alan Kaplan
who have welcomed our residents; John N. Lyle VII, a brilliant administrator
and Barbara Hagemeister, who holds the department together. Without my
dear colleagues, Drs. Weilie Tjoa, Juan Franco, Waverly Peakes, Nicolas
Stephanou, and Vincente Zapata, this book could not have been written. Most
of all, I appreciate my ever-loving wife Terri, and our four wonderful children,
Andy, Michael, Allison, and Christina, for their patience and understanding.
Eugene C. Toy
ACKNOWLEDGMENTS
ix
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Mastering the cognitive knowledge within a field such as internal medicine is
a formidable task. It is even more difficult to draw on that knowledge, procure
and filter through the clinical and laboratory data, develop a differential diag-
nosis, and, finally, to make a rational treatment plan. To gain these skills, the
student learns best at the bedside, guided and instructed by experienced
teachers, and inspired toward self-directed, diligent reading. Clearly, there is
no replacement for education at the bedside. Unfortunately, clinical situa-
tions usually do not encompass the breadth of the specialty. Perhaps the best
alternative is a carefully crafted patient case designed to stimulate the clinical
approach and the decision-making process. In an attempt to achieve that
goal, we have constructed a collection of clinical vignettes to teach diagnostic
or therapeutic approaches relevant to internal medicine.
Most importantly, the explanations for the cases emphasize the mecha-
nisms and underlying principles, rather than merely rote questions and
answers. This book is organized for versatility: it allows the student “in a rush”
to go quickly through the scenarios and check the corresponding answers, and
it allows the student who wants thought-provoking explanations to obtain
them. The answers are arranged from simple to complex: the bare answers, an
analysis of the case, an approach to the pertinent topic, a comprehension test
at the end, clinical pearls for emphasis, and a list of references for further read-
ing. The clinical vignettes are purposely placed in random order to simulate
the way that real patients present to the practitioner. A listing of cases is
included in Section III to aid the student who desires to test his/her knowl-
edge of a certain area, or to review a topic, including basic definitions. Finally,
we intentionally did not use a multiple choice question format in the case sce-
narios, because clues (or distractions) are not available in the real world.
INTRODUCTION
xi
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How to Approach
Clinical Problems
SECTION
I
➤ Part 1. Approach to the Patient
➤ Part 2. Approach to Clinical Problem Solving
➤ Part 3. Approach to Reading