Ferri's Practical Guide: Fast Facts for Patient Care E-Book

TABLE OF CONTENTS

Section I: Surviving the Wards

Chapter 1: SURVIVING THE WARDS

A. Charting, 1

1. Admission Orders, 1

2. Lab shorthand notation, 1

3. Dictating the H&P, 1

4. Progress (SOAP) Note, 3

5. Consult note, 3

6. Discharge summary, 3

7. Pronouncing death while on call, 3

8. Discharge against medical advice (AMA), 3

B. Evaluating the Labs, 4

C. Formulary, 34

1. IV Drips, 34

Section II: The Differential Diagnosis: Zebras or Horses?

Chapter 2: THE DIFFERENTIAL DIAGNOSIS: ZEBRAS OR HORSES?

• Abdominal distention, 35

• Abdominal pain, 35

• Adnexal mass, 36

• Adrenal masses, 36

• Amenorrhea, 36

• Amnesia, 37

• Anisocoria, 37

• Arthritis and rash, 37

• Back pain, 37

• Breast mass, 37

• Breath odor, 37

• Bullous diseases, 38

• Chest pain (nonpleuritic), 38

• Chest pain (pleuritic), 38

• Clubbing, 38

• Color changes, cutaneous, 38

• Coma, normal computed tomography, 38

• Cough, 39

• Cyanosis, 39

• Diplopia, binocular, 39

• Dyspnea, 39

• Dysuria, 40

• Edema, generalized, 40

• Edema, leg, unilateral, 40

• Edema of lower extremities, 40

• Elevated hemidiaphragm, 40

• Emboli, arterial, 40

• Encephalopathy, metabolic, 41

• Fever and jaundice, 41

• Fever and rash, 41

• Flank pain, 41

• Flushing, 41

• Genital discharge, 41

• Genital sores, 42

• Gynecomastia, 42

• Halitosis, 42

• Hearing loss, acute, 42

• Hemarthrosis, 42

• Hematuria, 42

• Hemiparesis/Hemiplegia, 42

• Hemolysis and Hemoglobinuria, 43

• Hemoptysis, 43

• Hepatomegaly, 43

• Hirsutism, 43

• Hoarseness, 44

• Hydrocephalus, 44

• Hydronephrosis, 44

• Hyperpigmentation, 44

• Hypertrophic osteoarthropathy, 44

• Hypogonadism , 44

• Hypopigmentation, 44

• Hypotension, postural, 44

• Jaundice, 45

• Joint swelling, 45

• Jugular venous distention, 45

• Leg cramps, nocturnal, 45

• Leg ulcers, 45

• Leukocoria, 45

• Livedo reticularis, 46

• Lymphadenopathy, 46

• Miosis, 46

• Muscle weakness, 46

• Mydriasis, 47

• Myelopathy and myelitis, 47

• Myotonia, 47

• Nail clubbing, 47

• Neck mass, 47

• Nystagmus, 47

• Ophthalmoplegia, 47

• Palpitations, 48

• Papilledema, 48

• Paraplegia, 48

• Paresthesias, 48

• Pelvic mass, 48

• Pneumonia, recurrent, 48

• Polyuria, 49

• Popliteal swelling, 49

• Postmenopausal bleeding, 49

• Proptosis, 49

• Proteinuria, 49

• Pruritus, 49

• Pruritus ani, 49

• Ptosis, 49

• Purpura, 50

• Red eye, 50

• Seizures, 50

• Spastic paraplegias, 50

• Splenomegaly, 50

• Taste and smell loss, 50

• Urinary retention, acute, 50

• Vertigo, 51

• Vision loss, acute, painful, 51

• Vision loss, acute, painless, 51

• Vision loss, chronic, progressive, 51

• Visual field defects, 51

• Vocal cord paralysis, 51

• Weakness, acute, emergent, 51

• Weight gain, 51

• Weight loss, 51

• Wheezing, 51

SECTION III: Diseases and Disorders

Chapter 3: CARDIOVASCULAR DISEASE

A. Diagnostic aids in cardiology, 53

1. Cardiovascular formulas, 53

2.The cardiac cycle, 53

3.ECG: interpretation, 53

4.Cardiac stress testing, 60

5.Echocardiogram, 60

6.Radial artery cannulation (A-line), 64

7.Central venous access (CVP line), 64

8.Pulmonary artery (PA) catheterization (Swan-Ganz), 66

B. Coronary artery disease, 66

1. Chronic stable angina, 66

2. Coronary artery syndromes (ACS), 70

C. Heart failure (HF), 74

D. Valvular heart disease, 77

1. Cardiac murmurs, 77

2. Mitral stenosis (MS), 78

3. Mitral regurgitation (MR), 80

4. Mitral valve prolapse, 81

5. Aortic stenosis, 81

6. Aortic regurgitation (AR), aortic insufficiency (AI), 83

7. Infective endocarditis, 84

8. Prosthetic valves, 86

E. Pericardial disease, 87

1. Pericarditis, 87

2.Pericardial effusion, 88

3.Cardiac tamponade, 89

4.Constrictive pericarditis, 89

F. Adult congenital heart disease, 90

• Patent foramen ovale (PFO), 90

• Atrial septal defect, 90

• Ventricular septal defect (VSD), 90

• Patent ductus arterious (PDA), 91

• Tetralogy of Fallot, 91

G. Cardiomyopathies, 92

• Dilated (congestive ) cardiomyopathy, 92

• Restrictive cardiomyopathy, 92

• Hypertrophic cardiomyopathy (HCM), 93

• Arrhythmogenic right ventricular dysplasia (ARVD), 94

• Takotsubo cardiomyopathy (stress cardiomyopathy , SC), 94

H. Myocarditis, 94

I. Diseases of the aorta, 95

• Thoracic aortic aneurysm, 95

• Acute aortic syndromes (Aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer), 96

• Abdominal aortic aneurysm, 97

J. Arrhythmias, 97

1. AV conduction defects, 97

a. First-degree heart block, 97

b. Second-degree heart block, 98

c. Third-degree heart block, 98

2. Pacemakers, 99

3. Approach to the patient with tachycardia, 99

4. Atrial fibrillation and atrial flutter, 100

a. Atrial fibrillation, 100

b. Atrial flutter, 105

5.Supraventricular tachycardias (SVT), 106

a. Paroxysmal atrial tachycardias (PAT, paroxysmal supraventricular tachycardia [PSVT]), 106

b. Wolff-Parkinson-White syndrome (WPW), 107

c. Atrial tachycardia, multifocal atrial tachycardia (MAT), 108

d. Sick sinus syndrome (SSS, tachy-brady syndrome, brady-tachy syndrome), 108

6.Ventricular Arrhythmias, 109

a. Long QT syndrome (LQTS), 109

b. Short QT syndrome, 110

c. Brugada syndrome, 110

d. Ventricular Tachycardia (VT), 110

e. Torsades de pointes, 111

K. Peripheral arterial disease (PAD), 112

L. Cardiac risk assessment for noncardiac surgery, 113

M. Hypotension, 113

N. Acute cardiogenic shock, 115

O. Dyslipidemia, 115

P. Metabolic syndrome, 117

Q. Syncope, 117

R. Hypertension, 118

1. Hypertensive crises, 119

2. Renal artery stenosis (RAS), 119

3. Eclampsia, 121

Chapter 4: DERMATOLOGY

A. Herpes zoster (Shingles), 122

B. Pressure ulcers, 122

C. Psoriasis, 123

Chapter 5: ENDOCRINOLOGY

A. Diabetes mellitus (DM), 124

1. Diabetic ketoacidosis, 126

2. Hyperosmolar syndrome, 130

B. Hypoglycemia, 130

C. Anterior pituitary disorders, 131

1. Hypopituitarism, 131

2. Anterior pituitary hyperfunction secondary to pituitary neoplasms, 134

D. Fluid hemostasis disorders, 135

1. Diabetes insipidus (DI), 135

2. Syndrome of inappropriate antidiuretic hormone (SIADH) secretion, 135

E. Thyroid disorders, 137

• Interpretation of thyroid function studies, 137

• Hyperthyroidism, 138

• Thyroid storm, 139

• Hypothyroidism, 139

• Subclinical hypothyroidism, 141

• Myxedema coma, 141

• Thyroiditis, 141

• Evaluation of thyroid nodule, 141

• Thyroid carcinoma, 142

F. Calcium homeostasis disorders, 143

• Calcium formulas, 143

• Hypercalcemia, 143

• Hypocalcemia, 145

G. Adrenal gland disorders, 147

• Cushing syndrome, 147

• Primary adrenocortical insufficiency (Addison disease), 149

• Disorders of mineralocorticoid secretion, 150

a. Hypoaldosteronism, 150

b. Hyperaldosteronism (Conn's syndrome), 150

H. Pheochromocytoma, 151

I. Carcinoid syndrome, 152

J. Multiple endocrine neoplasia, 152

Chapter 6: GASTROENTEROLOGY

A. Acute gastrointestinal bleeding, 154

B. Disorders of the esophagus, 156

• Dysphagia, 156

a) Oropharyngeal dysphagia, 156

b) Esophageal dysphagia, 156

• Esophageal motility disorders, 156

• GERD, 157

• Barrett esophagus, 157

• Esophageal tumors, 158

C. Disorders of stomach and duodenum, 158

• Peptic ulcer disease, 158

• Gastroparesis, 159

• Gastric cancer, 159

D. Disorders of the pancreas, 160

• Acute pancreatitis, 160

• Chronic pancreatitis, 162

• Pancreatic adenocarcinoma, 163

• Neuroendocrine pancreatic neoplasms, 163

a) Gastrinoma, 163

b) Insulinoma, 163

E. Disorders of small and large bowel, 164

• Diarrhea, 164

• Constipation, 166

• Malabsorption, 166

• Celiac disease, 167

• Inflammatory bowel disease, 167

a) Crohn's disease, 167

b) Ulcerative colitis, 168

• Microscopic colitis, 170

• Irritable bowel syndrome, 170

• Appendicitis, 170

• Diverticular disease, 171

• Small bowel obstruction, 172

• Adynamic ileus, 172

• Ischemic bowel disease, 172

a) Mesenteric ischemia, 172

b) Mesenteric thrombosis, 173

13.Colorectal neoplasia, 173

• Colorectal carcinoma, 173

F. Disorders of the liver, 174

• Approach to the patient with abnormal liver enzymes, 174

• Viral hepatitis, 174

• Hepatitis A, 174

• Hepatitis B, 177

• Hepatitis C, 178

• Hepatitis D, 180

• Hepatitis E, 180

3. Autoimmune hepatitis, 180

4. Cholestastic liver disease, 181

• Primary biliary cirrhosis (PBC), 181

• Primary sclerosing cholangitis (PSC), 181

• Complications of liver disease, 182

• Cirrhosis, 182

• Ascites/Paracentesis, 184

• Varices, 186

• Portal hypertension, 186

• Hepatic encephalopathy (HE), 186

• Hepatorenal syndrome (HRS), 187

• Spontaneous bacterial peritonitis, 188

• Hepatocellular carcinoma (HCC), 188

• Fulminant hepatic failure (FHF), 189

• Liver abscess, 189

6. Vascular disorders of the liver, 190

a. Budd-Chiari syndrome, 190

b. Portal vein thrombosis, 190

7. Hepatic cysts, 191

8. Hepatic Adenoma (HA), 191

G. Metabolic liver disease, 191

• Alcoholic hepatitis, 191

• Nonalcoholic fatty liver disease (NAFLD), 192

• Hereditary hemochromatosis, 192

• Alpha-1 Antitrypsin deficiency, 193

• Wilson's disease, 193

H. Disorders of gallbladder, 193

• Cholelithiasis, 193

• Acute cholecystitis, 194

CHAPTER 7: HEMATOLOGY/ONCOLOGY

• Approach to the patient with anemia, 195

• Anemia secondary to maturation defects or underproduction, 195

• Iron deficiency anemia, 195

• Cobalamin (Vitamin B 12) deficiency, 195

• Folate deficiency, 196

• Inflammatory anemia (anemia of chronic disease [ACD]), 197

• Sideroblastic anemia, 197

• Acquired hemolytic anemia, 197

• Autoimmune hemolytic anemia (AIHA), 197

• Microangiopathic hemolytic anemia, 198

• Paroxysmal nocturnal hemoglobinuria (PNH), 198

• Hemolytic transfusion reaction, 199

• Congenital hemolytic anemias, 199

• Sickle cell syndrome, 199

• Thalassemia, 200

• Glucose-6 phosphate dehydrogenase (G6PD) deficiency, 201

• Hereditary spherocytosis, 201

• Bone marrow failure syndromes, 201

• Aplastic anemia, 201

• Pure red cell aplasia (PRCA), 201

• Thrombocytopenia, 202

• Neutropenia, 202

C. Myelodysplastic syndromes, 204

D. Myeloproliferative disorders, 204

• Polycythemia vera, 204

• Essential thrombocythemia, 205

• Chronic myeloid leukemia, 206

• Primary myelofibrosis, 206

• Acute myeloid leukemia (AML), 207

• Acute lymphoblastic leukemia (ALL), 207

E. Multiple myeloma and related disorders, 207

• Multiple myeloma (MM), 207

• Monoclonal gammopathy of undetermined significance (MGUS), 209

• Waldenstrom's macroglobulinemia, 209

• AL amyloidosis, 209

F. Lymphoid malignancies, 209

• Non-Hodgkin lymphoma, 209

• Chronic lymphocytic leukemia (CLL), 210

• Hairy cell leukemia, 212

• Hodgkin lymphoma, 212

G. Bleeding disorders, 213

• Evaluation of suspected bleeding disorder, 213

• Hemophilia, 213

• Von Willebrand's disease (vWD), 213

• Coagulopathy of liver disease, 214

• Disseminated intravascular coagulation (DIC), 215

• Vitamin K deficiency, 215

H. Platelet disorders, 216

• Immune (idiopathic )thrombocytopenic purpura (ITP), 216

• Heparin-induced thrombocytopenia (HIT), 216

• Thrombotic thrombocytopenic purpura (TTP), 218

• Hemolytic-uremic syndrome (HUS), 218

• HELLP syndrome, 218

I. Thrombotic disorders, 219

• Hypercoagulable state, 219

• Antiphospholipid syndrome, 220

• Venous thromboembolism (DVT), 221

J. Oncologic urgencies and emergencies, 224

• Tumor lysis syndrome, 224

• Superior vena cava syndrome, 224

• Brain metastases, 224

Chapter 8: INFECTIOUS DISEASES

A. HIV/AIDS, 226

B. Hospital-acquired infections, 232

C. Pneumonia, 233

D. Abscess, 234

• Breast abscess/Mastitis, 234

• Lung abscess, 234

• Liver abscess, 235

• Pelvic abscess, 235

• Perirectal abscess, 236

• Peritonsillar abscess, 236

• Retropharyngeal abscess, 237

E. Skin/Soft tissue/Bone/Joint infections, 237

• Cellulitis, 237

• Methicillin-resistant Staphylococcus aureus, 239

• Toxic shock syndrome (TSS), 239

• Diabetic foot infections, 240

• Necrotizing fasciitis, 240

• Muscle ("Gas Gangrene"), 241

• Bites, 241

• Osteomyelitis, 241

• Septic arthritis, 242

• Septic bursitis, 242

• Skin infestations, 243

• Scabies (Sarcoptes scabei), 243

• Bed bugs, 243

• Lice (pediculosis), 244

F. Fever of unknown origin (FUO), 244

G. Sexually transmitted diseases, 244

• Chlamydia trachomatis infection, 244

• Neisseria gonorrhoeae infection, 244

• Pelvic inflammatory disease (PID), 246

• Genital warts, 247

• Vaginitis, 247

• Genital ulcers, 247

• Syphilis, 247

• Herpes simplex virus (HSV) infection, 248

• Chancroid (Haemophilus ducreyi), 249

• Lymphogranuloma venereum (LGV), 250

7. Male genital tract infections, 250

a. Balanitis, 250

b. Epididymo-orchitis, 250

H. Infectious GI syndromes, 250

• Clostridium difficile infection (CDI), 250

• Salmonella infection, 251

• Campylobacter infection, 252

• Shigella infection, 252

• Vancomycin-resistant enterococci (VRE), 254

• Parasitic infections, 255

• Amebiasis, 255

• Giardia infection, 255

• Cryptosporidium infection, 256

7.Peritonitis, 256

a. Primary (SBP), 256

b. Secondary (bowel perforation, ruptured appendix/diverticula), 256

I. Central nervous system infections, 256

• Lumbar puncture (LP), 256

• Bacterial meningitis, 258

• Viral meningitis, 260

• Encephalitis, 260

a. Herpes simplex encephalitis, 260

b. West Nile virus (WNV) encephalitis, 261

• Brain abscess, 261

• Spinal epidural abscess, 262

• Subdural empyema, 263

J. Urinary tract infections, 263

• Cystitis, 263

• Pyelonephritis, 263

• Perinephric abscess, 264

• Prostatitis, 264

K. Tick-Borne diseases, 265

• Lyme disease, 265

• Ehrlichiosis and anaplasmosis, 265

• Babesiosis, 266

• Rocky Mountain spotted fever (RMSF), 266

L. Fungal infections, 266

• Systemic candidiasis, 266

• Histoplasmosis, 268

• Aspergillosis, 269

• Blastomycosis, 269

• Mucormycosis, 270

• Cryptococcosis, 270

• Coccidiodomycosis, 271

• Sporotrichosis, 271

• Tinea, 272

M. Viral infections, 272

• Influenza, 272

• Herpes simplex (HSV), 273

N. Tuberculosis, 274

CHAPTER 9: NEPHROLOGY

A. Renal fluids and electrolyte formulas, 277

B. Water balance, 277

C. Replacement fluids, 277

D. Acid-base disorders, 277

• Approach to acid-base disorders, 277

• Metabolic acidosis, 278

• Renal tubular acidosis (RTA), 280

• Respiratory acidosis, 281

• Metabolic alkalosis, 282

• Respiratory alkalosis, 285

E. Disorders of sodium homeostasis, 286

• Hyponatremia, 286

• Hypernatremia, 287

F. Disorders of potassium homeostasis, 288

• Hypokalemia, 288

• Hyperkalemia, 290

G. Disorders of magnesium metabolism, 292

• Hypomagnesemia, 292

• Hypermagnesemia, 293

H. Disorders of phosphate metabolism, 293

• Hypophosphatemia, 293

• Hyperphosphatemia, 294

J. Acute kidney injury (AKI), 294

K. Chronic kidney disease (CDK), 294

L. Glomerular disease, 298

• Nephrotic syndrome, 298

• Nephritic syndrome, 300

M. Tubulointerstitial disorders, 302

1. Acute tubular necrosis, 302

N. Kidney cystic disorders, 303

O. Urolithiasis, 303

Chapter 10: NEUROLOGY

A. Diagnostic aids, 306

1. Spinal dermatomes, 306

2. Key areas determining sensory level, 306

3. Key muscles determining motor level, 306

4. Grading of muscle strength, 306

5. Grading of deep tendon reflexes, 306

6. Testing of cranial nerves, 306

B. Epilepsy, 306

• Partial (focal epilepsy), 306

• Idiopathic general epilepsy,309

• Status epilepticus, 310

C. Stroke, 310

1. Transient ischemic attack (TIA), 310

2. Ischemic stroke, 312

3. Acute hemorrhagic stroke, 314

a. Intracranial hemorrhage, 314

b. Subarachnoid hemorrhage, 315

4. Sinus venous thrombosis, 317

5. Stroke prevention: asymptomatic carotid stenosis, 317

D. Headaches, 318

• Migraine (aura, trigger), 318

• Tension-type headache (bilateral, vice-like), 319

• Cluster headache (unilateral, lacrimation, periorbital), 319

• Idiopathic intracranial hypertension (IIH; pseudotumor cerebri), 320

E. Movement disorders, 321

• Parkinson's disease (PD), 321

• Ataxia, 322

• Essential tremor, 322

• Dystonia, 322

• Chorea, 323

• Tardive dyskinesia (TD), 323

• Myoclonus, 324

• Tourette's syndrome, 324

• Wilson's disease, 324

• Restless legs syndrome (RLS), 325

F. Dementia, 325

G. Multiple sclerosis (MS), 327

H. Disorders of the spinal cord, 329

• Compressive myopathies, 329

• Infectious myopathies, 330

• Inflammatory myopathies, 330

• Endocrine-related myopathies, 330

• Idiopathic transverse myelitis, 331

I. Peripheral neuropathies, 331

• General approach, 331

• Mononeuropathies, 331

• Carpal tunnel, 331

• Bell's palsy, 332

• Polyneuropathies, 333

• Diabetic neuropathy, 333

• Charcot-Marie-Tooth disease (CMT), 333

• Guillain-Barré syndrome (GBS), 334

• Chronic inflammatory demyelinating polyneuropathy (CIDP), 334

J. Amyotrophic lateral sclerosis, 335

K. Neuromuscular junction disorders, 336

• Myasthenia gravis (MG), 336

• Lambert-Eaton myasthenic syndrome, 336

L. Head injury, 337

• Epidural hematoma, 337

• Subdural hematoma, 337

• Concussion, 338

CHAPTER 11: PULMONARY AND CRITICAL CARE

A. Chest x-ray, 340

• Evaluating the chest x-ray, 340

• Calcification on chest x-ray, 340

• Cardiac enlargement, 340

• Cavitary lesion on chest x-ray, 342

• Mediastinal masses or widening on chest x-ray, 342

B. Use and interpretation of pulmonary function tests, 343

C. Pulmonary formulas, 344

D. Mechanical ventilation, 345

E. Acute Respiratory Distress Syndrome (ARDS), 352

F. Asthma, 352

G. Chronic obstructive pulmonary disease (COPD), 356

H. Pulmonary vascular disease, 358

• Pulmonary embolism (PE), 358

• Pulmonary hypertension, 362

I. Diffuse parenchymal lung disease, 364

1. Interstititial lung disease (ILD), 364

J. Granulomatous lung disease, 365

1. Sarcoidosis, 365

2. Granulomatosis with polyangiitis (Wegener's granulomatosis), 366

K. Pleural disease, 367

1. Pleural effusion/Thoracentesis, 367

L. Lung cancer, 368

M. Respiratory failure classification, 371

1. Hypoxemic ("type I") respiratory failure, 371

2. Hypercapnic ("type II") respiratory failure, 371

CHAPTER 12: RHEUMATOLOGY

A. Arthrocentesis, 372

B. Arthritis, monarticular and oligoarticular, 373

C. Arthritis, polyarticular, 373

D. Vasculitic syndromes, 373

E. Systemic lupus erythematosus (SLE), 373

F. Rheumatoid arthritis (RA), 380

G. Spondyloarthropathies, 381

H. Systemic sclerosis, 382

I. Enteropathic arthritis, 384

J. Crystal-induced arthritides, 384

1. Gout, 384

K. Idiopathic inflammatory myopathies, 386

CHAPTER 13: Interdisciplinary medicine

A. Rhabdomyolysis, 387

B. Shock, 388

C. Hypothermia, 388

D. Heat stroke, 394

E. Malignant hyperthermia, 395

F. Neuroleptic malignant syndrome (NMS), 396

G. Anaphylaxis, 396

H. Alcohol withdrawal, 397

I. Acute poisoning, 398

• Acetaminophen poisoning, 398

• Amphetamine overdose, 400

• Barbiturate overdose, 400

• Cocaine overdose, 401

• Ethanol poisoning, 402

• Ethylene glycol, isopropyl alcohol, and methanol poisoning, 402

• Carbon monoxide poisoning, 403

APPENDIX

1. Cardiac arrest algorithm, 405

2. Immediate post-cardiac arrest care algorithm, 406

3. Bradycardia with a pulse algorithm, 407

4. Tachycardia with a pulse algorithm, 408