Clinical Clerkship ELA Content

Total Page:16

File Type:pdf, Size:1020Kb

Clinical Clerkship ELA Content CUSM Clerkship Engaged Learning Content 2020-2021 Contents Emergency Medicine Clerkship Curriculum ................................................................................................. 2 Family Medicine Clerkship Curriculum ........................................................................................................ 3 Internal Medicine Clerkship Curriculum ...................................................................................................... 5 Neurology Clerkship Curriculum .................................................................................................................. 8 Obstetrics and Gynecology .......................................................................................................................... 9 Psychiatry Clerkship Curriculum ................................................................................................................ 13 Surgery Clerkship Curriculum .................................................................................................................... 15 6/17/20 Emergency Medicine Week Discussion Topic1 Cases to Review Additional Conditions 1 ▪ Respiratory ▪ Acute Exacerbation of Asthma ▪ Acute Pelvic Distress ▪ Airway Inflammatory Disease ▪ Trauma Management/Respiratory ▪ Bell Palsy (Idiopathic Failure Facial Paralysis) ▪ Bacterial Pneumonia ▪ Congestive Heart ▪ Extremity Fracture and Neck Failure/Pulmonary Pain Edema ▪ Lightning and Electrical Injury ▪ Drowning ▪ Penetrating Trauma to the ▪ Ectopic Pregnancy Chest, Abdomen, and ▪ Emerging Infections Extremities ▪ Facial Laceration ▪ Resuscitation and Critical Care ▪ Fever Without a Source Medicine Practices in the in the 1- to 3-Month-Old Emergency Department Infant ▪ Trauma and Extremes of Age ▪ Frostbite and ▪ Seizure Induced by Traumatic Hypothermia Brain Injury ▪ Heat-Related Illnesses ▪ Swallowed Foreign Body ▪ Hyperemesis 2 ▪ Chest Pain ▪ Atrial Fibrillation Gravidarum and OB ▪ Cardiac Arrest ▪ Myocardial Infarction, Acute Emergencies Less Than ▪ Noncardiac Chest Pain 22 Weeks’ Gestation ▪ Pulmonary Embolism ▪ Hyperkalemia Due to ▪ Regular Rate Tachycardia Renal Failure ▪ Sickle Cell Crisis ▪ Low Back Pain 3 ▪ Abdominal Pain ▪ Acute Abdominal Pain ▪ Nephrolithiasis ▪ Gastrointestinal ▪ Acute Diarrhea ▪ Rabies/Animal Bite Bleeding ▪ Acute Pyelonephritis ▪ Rash With Fever ▪ Shock ▪ Anaphylaxis ▪ Red Eye ▪ Gastrointestinal Bleeding ▪ Scrotal Pain ▪ Hemorrhagic Shock ▪ Septic Arthritis ▪ Intestinal Obstruction ▪ Sexual Assault ▪ Sepsis ▪ Skin and Soft Tissue 4 ▪ Altered Mental ▪ Acetaminophen Toxicity Infections Status ▪ Anti-muscarinic Toxidrome ▪ Streptococcal Pharyngitis ▪ Headache ▪ Bacterial Meningitis (“Strep Throat”) ▪ Poisoning ▪ Cocaine Intoxication ▪ Transfusion ▪ Diabetic Ketoacidosis Complications ▪ Ethanol Withdrawal ▪ Febrile Seizure ▪ Headache ▪ Hypertensive Encephalopathy ▪ Stroke ▪ Syncope 1 From the National Clerkship Directors in Emergency Medicine recommendations 6/17/20 Family Medicine Week Discussion Topic2 Cases to Review Additional Conditions 1 Health Adult Male Health Maintenance ▪ Electrolyte maintenance: ▪ Health Maintenance in Adult Disorders ▪ Breast Cancer Female ▪ Labor and Delivery ▪ Cervical Cancer ▪ Breast Diseases ▪ Postpartum Care ▪ Colon Cancer Major Depression ▪ Prenatal Care ▪ Coronary Artery Substance Abuse ▪ Medical Ethics Disease Tobacco Use ▪ Postoperative Fever ▪ Depression ▪ Obesity ▪ Prostate Cancer ▪ Tuberculosis 2 Chronic disease ▪ Cerebrovascular management: Accident/Transient Ischemic ▪ Coronary Artery Attack Disease ▪ Chronic Kidney Disease ▪ Type 2 Diabetes ▪ Chronic Pain Management Mellitus ▪ Congestive Heart Failure ▪ Substance ▪ Diabetes Mellitus Use/Abuse ▪ Dyspnea (Chronic Obstructive Pulmonary Disease) ▪ Hyperlipidemia ▪ Hypertension ▪ Irritable Bowel Syndrome ▪ Lower Extremity Edema ▪ Obstructive Sleep Apnea ▪ Thyroid Disorders 3 Geriatric patients: ▪ Dementia ▪ Fall Risk in Elderly ▪ Geriatric Anemia Patients ▪ Geriatric Health Maintenance ▪ Movement Disorders Break 4 Pediatric Patients: ▪ Abdominal Pain and Vomiting in ▪ Abuse/Neglect a Child ▪ Diet/Exercise ▪ Acute Causes of Wheezing and ▪ Family/Social Stridor in Children Support ▪ Adolescent Health Maintenance ▪ Developmental Disorders 2 From the Society of Teachers of Family Medicine National Clerkship Curriculum, 2018 6/17/20 ▪ Growth and ▪ Limping in Children Development ▪ Well-Child Care ▪ Hearing ▪ Lead Exposure ▪ Nutritional Deficiency ▪ Potential for Injury ▪ Sexual Activity ▪ Substance Use ▪ Tuberculosis ▪ Vision 5 Common acute ▪ Family Planning-Contraceptives presentations: ▪ Family Violence ▪ Intimate Partner ▪ Fever and Rash and Family ▪ Hematuria Violence ▪ HIV, AIDS, and Other Sexually ▪ Sexually Transmitted Infections Transmitted ▪ Jaundice Infections ▪ Lower Gastrointestinal Bleeding ▪ Menstrual Cycle Irregularity ▪ Musculoskeletal Injuries ▪ Skin Lesions ▪ Sting and Bite Injuries ▪ Vaginitis 6 Common acute ▪ Acute Diarrhea presentations: ▪ Acute Low Back Pain ▪ Adverse Drug Reactions and Interactions ▪ Allergic Disorders ▪ Chest Pain ▪ Palpitations ▪ Pneumonia ▪ Upper Respiratory Infections ▪ Wheezing and Asthma ▪ Dyspepsia and Peptic Ulcer Disease ▪ Joint Pain ▪ Migraine Headache 6/17/20 Internal Medicine Week Discussion Topic3 Cases to Review Additional Conditions 1 Cardiovascular ▪ Aortic Dissection, Marfan Syndrome ▪ Headache/Tempora ▪ Chest Pain ▪ Atrial Fibrillation, Mitral Stenosis l Arteritis ▪ Acute ▪ Congestive Heart Failure due to ▪ Health Myocardial Critical Aortic Stenosis Maintenance Infarction ▪ Endocarditis (Tricuspid)/Septic ▪ Dyslipidemia Pulmonary Emboli ▪ Heart Failure ▪ Hypercholesterolemia ▪ Hypertension ▪ Hypertension, Outpatient ▪ Venous ▪ Limb Ischemia (Peripheral Vascular Thromboemb Disease) olism ▪ Myocardial Infarction, Acute ▪ Syncope—Heart Block 2 Pulmonology, ▪ Chronic Cough/Asthma ENT ▪ Chronic Obstructive Pulmonary ▪ Cough Disease ▪ Dyspena ▪ Pleural Effusion, Parapneumonic ▪ Upper ▪ Pulmonary Embolism Respiratory Complaints ▪ COPD/Obstruc tive Airway Disease ▪ Smoking Cessation 3 GI ▪ Acute Sigmoid Diverticulitis ▪ Abdominal ▪ Acute Viral Hepatitis, Possible Pain Acetaminophen Hepatotoxicity ▪ GI Bleeding ▪ Chronic Diarrhea ▪ Liver Disease ▪ Cirrhosis, Probable Hepatitis C– Related ▪ Painless Jaundice, Pancreatic Cancer ▪ Pancreatitis, Gallstones ▪ Peptic Ulcer Disease ▪ Ulcerative Colitis 3 From the Clerkship Directors in Internal Medicine and Society of General Internal Medicine, 2006 6/17/20 4 Hematology, ▪ Hemoptysis, Lung Cancer Oncology ▪ Hypercalcemia/Multiple Myeloma • Anemia ▪ Immune Thrombocytopenic • Common Purpura Cancers ▪ Iron Deficiency Anemia ▪ Lymphocytosis/CLL ▪ Pericardial Effusion/Tamponade Caused by Malignancy ▪ Sickle Cell Crisis Break 5 Endocrine ▪ Adrenal Insufficiency ▪ Diabetes ▪ Alcoholic Ketoacidosis Mellitus ▪ Delirium/Alcohol Withdrawal ▪ Obesity ▪ Diabetic Ketoacidosis ▪ Substance ▪ Hypertensive Abuse Encephalopathy/Pheochromocytom a ▪ Hyponatremia, Syndrome of Inappropriate Secretion of Antidiuretic Hormone ▪ Oligomenorrhea Caused by Hypothyroidism and Hyperprolactinemia ▪ Thyrotoxicosis/Graves Disease ▪ Transfusion Medicine ▪ Type 2 Diabetes Diagnosis and Management 6 ID, Neuro ▪ Alzheimer Dementia Pneumonia ▪ Anaphylaxis/Drug Reactions ▪ Altered Mental ▪ Bacterial Meningitis Status ▪ Community-Acquired Pneumonia ▪ Fever ▪ Dizziness/Benign Positional Vertigo ▪ Rash ▪ HIV and Pneumocystis Pneumonia ▪ HIV Infection ▪ Neutropenic Fever, Vascular ▪ Major Catheter Infection Depression ▪ Syphilis ▪ Nosocomial ▪ Transient Ischemic Attack Infections ▪ Tuberculosis (Pulmonary), Cavitary Lung Lesions 6/17/20 7 Renal ▪ Acute Glomerulonephritis, ▪ Dysuria Poststreptococcal Infection ▪ Fluid, ▪ Acute Kidney Injury Electrolyte and ▪ Nephrotic Syndrome, Diabetic Acid-Based Nephropathy Disorders ▪ Urinary Tract Infection with Sepsis ▪ Acute Renal in the Elderly Failure ▪ Chronic Kidney Disease 8 MSK and Rheum ▪ Acute Monoarticular Arthritis— ▪ Back Pain Gout ▪ Knee Pain ▪ Acute Pericarditis Caused by ▪ Rheumatologic Systemic Lupus Erythematosus Problems ▪ Low Back Pain ▪ Osteoarthritis ▪ Osteoporosis ▪ Rheumatoid Arthritis 6/17/20 Neurology Table 4.3 Engaged Learning Activities – Weekly Topic List and Assigned Case Studies Discussion Topic4 Cases to Review Prior to Meeting5 Tuesday Thursday Week 12n- ▪ Cognitive Selected Cases: Selected Cases: 1 1p Impairment, Acute ▪ Alzheimer Dementia ▪ Dermatomyositis or Chronic ▪ Migraine Headache ▪ Foot Drop ▪ Focal or Diffuse ▪ Parkinson Disease ▪ Median Nerve Motor Disturbance, Mononeuropathy Acute or Chronic ▪ Pain, Acute or Chronic Sensory Dysfunction (Hypesthesia or Paresthesia) Faculty: Elias Giraldo, MD Faculty: Dhrupad Joshi, DO Week 12n- ▪ Acute Stroke Selected Cases: Selected Cases: 2 1p (Ischemic or ▪ Acute Cerebral Infarct ▪ Cerebral Concussion Hemorrhagic) or ▪ Stroke in a Young Patient ▪ Metastatic Brain Tumor TIA (Acute Ischemic) ▪ Pseudotumor ▪ Acute Vision Loss ▪ Subarachnoid Hemorrhage Cerebri/Idiopathic ▪ Brain Death Intracranial Hypertension ▪ Head Trauma ▪ Increased Intracranial Pressure Faculty: Elias Giraldo, MD Faculty: Elias Giraldo, MD Week 12n- ▪ CNS Infection Selected Cases: Selected Cases: 3 1p ▪ Encephalopathy ▪ Absence Versus Complex ▪ Acute Disseminated (Acute or Partial Seizures Encephalomyelitis Subacute) ▪ New-Onset Seizure, Adult ▪ Huntington Disease ▪ Status Epilepticus ▪ New-Onset Seizure, Child ▪ Viral Meningitis Faculty: Dhrupad Joshi, DO Faculty: Lisa Sovory, MD Week 12n- ▪ Guillain-Barre Selected
Recommended publications
  • Spectrum of Benign Breast Diseases in Females- a 10 Years Study
    Original Article Spectrum of Benign Breast Diseases in Females- a 10 years study Ahmed S1, Awal A2 Abstract their life time would have had the sign or symptom of benign breast disease2. Both the physical and specially the The study was conducted to determine the frequency of psychological sufferings of those females should not be various benign breast diseases in female patients, to underestimated and must be taken care of. In fact some analyze the percentage of incidence of benign breast benign breast lesions can be a predisposing risk factor for diseases, the age distribution and their different mode of developing malignancy in later part of life2,3. So it is presentation. This is a prospective cohort study of all female patients visiting a female surgeon with benign essential to recognize and study these lesions in detail to breast problems. The study was conducted at Chittagong identify the high risk group of patients and providing regular Metropolitn Hospital and CSCR hospital in Chittagong surveillance can lead to early detection and management. As over a period of 10 years starting from July 2007 to June the study includes a great number of patients, this may 2017. All female patients visiting with breast problems reflect the spectrum of breast diseases among females in were included in the study. Patients with obvious clinical Bangladesh. features of malignancy or those who on work up were Aims and Objectives diagnosed as carcinoma were excluded from the study. The findings were tabulated in excel sheet and analyzed The objective of the study was to determine the frequency of for the frequency of each lesion, their distribution in various breast diseases in female patients and to analyze the various age group.
    [Show full text]
  • Breastfeeding and Women's Mental Health
    BREASTFEEDING AND WOMEN’S MENTAL HEALTH Julie Demetree, MD University of Arizona Department of Psychiatry Disclosures ◦ Nothing to disclose, currently paid by Banner University Medical Center, and on faculty at University of Arizona. Goals and Objectives ◦ Review the basic physiology involved in breastfeeding ◦ Learn about literature available regarding mood, sleep and breastfeeding ◦ Know the resources available to refer to regarding pharmacology and breast feeding ◦ Understand principles of psychopharmacology involved in breastfeeding, including learning about some specific medications, to be able to counsel a woman and obtain informed consent ◦ Be aware of syndrome described as Dysphoric Milk Ejection Reflex Lactation Physiology https://courses.lumenlearning.com/boundless-ap/chapter/lactation/ AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 A Few Numbers ◦ About 80% of US women breastfeed ◦ 10-15% of women suffer from post partum depression or anxiety ◦ 1-2/1000 suffer from post partum psychosis Depression and Infant Care ◦ Depressed mothers are: ◦ More likely to misread infant cues 64 ◦ Less likely to read to infant ◦ Less likely to follow proper safety measures ◦ Less likely to follow preventative care advice 65 Depression is Associated with Decreased Chance of Breastfeeding ◦ A review of 75 articles found “women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.” 1 Depressive Symptoms and Risk of Formula Feeding ◦ An Italian study with 592 mothers participating by completing the Edinburgh Postnatal Depression Scale immediately after delivery and then feeding was assessed at 12-14 weeks where asked if breast, formula or combo feeding.
    [Show full text]
  • Unilateral Galactorrhea Associated with Low-Dose Escitalopram
    Case Report Unilateral Galactorrhea Associated with Low-dose Escitalopram P. Bangalore Ravi, K. G. Guruprasad1, Chittaranjan Andrade2 ABSTRACT Galactorrhea is a rare adverse effect of selective serotonin reuptake inhibitor treatment. We report a 27-year-old woman who developed unilateral breast engorgement with galactorrhea 18 days after initiation of escitalopram (10 mg/day). The symptom remitted 7 days after withdrawal of escitalopram and did not subsequently recur during maintenance therapy with agomelatine (25 mg/day). Key words: Agomelatine, escitalopram, galactorrhea, prolactin, selective serotonin reuptake inhibitor, unilateral breast engorgement INTRODUCTION about the future, low self-confidence, diminished interest in daily activities, and diminished interest in social life, Galactorrhea refers to the discharge of milk from the poor appetite, and poor sleep. These symptoms were breast, unassociated with recent childbirth or nursing. exacerbated by domestic stress and absence of social Galactorrhea occurs when serum prolactin levels are support. A diagnosis of moderate depression with raised for reasons ranging from pituitary tumors to drug somatic symptoms was made, and she was started on treatments. A number of drugs, including psychotropic escitalopram 5 mg/day along with clonazepam 0.75 mg/day. She was instructed to increase the dose of drugs, cause hyperprolactinemia, some doing so consistently escitalopram to 10 mg/day after 4 days and taper and (e.g., certain antipsychotics), and some, rarely (e.g., certain withdraw the clonazepam at the rate of 0.25 mg/week. antidepressants).[1,2] We herein report an unusual case of galactorrhea resulting from escitalopram use. After about 18 days of treatment, she developed painless engorgement of her left breast associated with CASE REPORT galactorrhea.
    [Show full text]
  • Breast Concerns
    Section 12.0: Preventive Health Services for Women Clinical Protocol Manual 12.2 BREAST CONCERNS TITLE DESCRIPTION DEFINITION: Breast concerns in women of all ages are often the source of significant fear and anxiety. These concerns can take the form of palpable masses or changes in breast contours, skin or nipple changes, congenital malformation, nipple discharge, or breast pain (cyclical and non-cyclical). 1. Palpable breast masses may represent cysts, fibroadenomas or cancer. a. Cysts are fluid-filled masses that can be found in women of all ages, and frequently develop due to hormonal fluctuation. They often change in relation to the menstrual cycle. b. Fibroadenomas are benign sold tumors that are caused by abnormal growth of the fibrous and ductal tissue of the breast. More common in adolescence or early twenties but can occur at any age. A fibroadenoma may grow progressively, remain the same, or regress. c. Masses that are due to cancer are generally distinct solid masses. They may also be merely thickened areas of the breast or exaggerated lumpiness or nodularity. It is impossible to diagnose the etiology of a breast mass based on physical exam alone. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the U.S. Skin or nipple changes may be visible signs of an underlying breast cancer. These are danger signs and require MD referral. 2. Non-spontaneous or physiological discharge is fluid that may be expressed from the breast and is not unusual in healthy women. 3. Galactorrhea is a spontaneous, multiple duct, milky discharge most commonly found in non-lactating women during childbearing years.
    [Show full text]
  • Management of Prolonged Decelerations ▲
    OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others.
    [Show full text]
  • Evaluation of Nipple Discharge
    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
    [Show full text]
  • Spontaneous Remission of Cancer and Wounds Healing
    Open Access Austin Journal of Surgery Special Article – Spontaneous Remission Spontaneous Remission of Cancer and Wounds Healing Shoutko AN1* and Maystrenko DN2 1Laboratory for the Cancer Treatment Methods, Saint Abstract Petersburg, Russia The associativity of the spontaneous cancer remission with surgical 2Department of Vascular Surgery, Saint Petersburg, trauma is considering in term of the competition of healing process outside the Russia tumor for circulating morphogenic cells, providing proliferation in any tissues *Corresponding author: Shoutko AN, Laboratory for with high cells renewing, malignant preferably. The proposed competitive the Cancer Treatment Methods, A.M. Granov Russian mechanism of Spontaneous cancer Remission phenomenon (SR) assumes Research Center for Radiology and Surgical Technologies, the partial distraction the trophic supply from tumor to offside tissues priorities, 70 Leningradskaya str., Pesochney, St. Petersburg, Russia like extremely high fetus growth, wound healing after incomplete resection, fight with infections, reparation of a multitude of non-malignant cells injured Received: September 24, 2019; Accepted: October 25, sub lethally by cytotoxic agents, and other kinds of an extra-consumption 2019; Published: November 01, 2019 the host lymphopoietic resource mainly in the conditions of its current deficit. The definition of a reduction of tumor morphogenesis discusses as preferable instead of the activation of anticancer immunity. Pending further developments, it assumes that the nature of the SR phenomenon is similar to the rough exhaustion of lymphopoiesis at conventional cytotoxic therapy. The main task for future investigations for more reproducible SR is to elucidate of the phase of a cyclic lymphopoietic process that is optimal for surgery outside the tumor as well as for other activities, provoked morphogenesis in surrounding tissues.
    [Show full text]
  • Ethnicity and Geriatric Assessment
    Gallo_FM_i-xviii 8/1/05 5:23 PM Page i HANDBOOK OF GERIATRIC ASSESSMENT Fourth Edition Edited by Joseph J. Gallo, MD, MPH Associate Professor Department of Family Practice and Community Medicine Department of Psychiatry University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Hillary R. Bogner, MD, MSCE Assistant Professor Department of Family Practice and Community Medicine University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Terry Fulmer, PhD, RN, FAAN The Erline Perkins McGriff Professor & Head, Division of Nursing New York University New York, New York Gregory J. Paveza, MSW, PhD Interim Associate Vice President for Academic Affairs University of South Florida – Lakeland Lakeland, Florida Gallo_FM_i-xviii 8/1/05 5:23 PM Page ii World Headquarters Jones and Bartlett Publishers 40 Tall Pine Drive Sudbury, MA 01776 978-443-5000 [email protected] www.jbpub.com Jones and Bartlett Publishers Canada 6339 Ormindale Way Mississauga, ON L5V 1J2 CANADA Jones and Bartlett Publishers International Barb House, Barb Mews London W6 7PA UK Jones and Bartlett’s books and products are available through most bookstores and online booksellers. To contact Jones and Bartlett Publishers directly, call 800-832-0034, fax 978-443-8000, or visit our website at www.jbpub.com. Substantial discounts on bulk quantities of Jones and Bartlett’s publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones and Bartlett via the above contact information or send an email to [email protected]. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.
    [Show full text]
  • Burns, Hypertrophic Scar and Galactorrhea
    Karimi H et al. Injury & Violence 117 J Inj Violence Res. 2013 Jun; 5(2): 117-119. doi: 10.5249/ jivr.v5i2.314 Case Report Burns, hypertrophic scar and galactorrhea Hamid Karimi a , Samad Nourizad a ,* , Mahnoush Momeni a, Hosein Rahbar a, Mazdak Momeni b, Khosro Farhadi c a Faculty of Medicine, Tehran University of Medical Sciences,Tehran, Iran. b Baylor College of Medicine, Houston, Texas, USA. c Department of Anesthesiology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. KEY WORDS Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four Burns months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the Hypertrophic scar high level of prolactin were detected. Galactorrhea She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. Received 2012-09-28 Accepted 2013-01-23 © 2013 KUMS, All rights reserved *Corresponding Author at: Dr. Samad Nourizad: Department of Anesthesiology, Tehran University of Medical Science, Tehran, Iran, Email: [email protected] (Nourizad S.). © 2013 KUMS, All rights reserved Introduction sis, i.e.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Nipple Discharge-1
    Nipple Discharge Epworth Healthcare Benign Breast Disease Symposium November 12th 2016 Jane O’Brien Specialist Breast and Oncoplastic Surgeon What is Nipple Discharge? Nipple discharge is the release of fluid from the nipple Based on the characteristics of presentation Nipple Discharge is categorized as: • Physiologic nipple discharge • Normal milk production (lactation) • Pathologic nipple discharge 27-Jun-20 2 • Nipple discharge is the one of the most commonly encountered breast complaints • 5-10% percent of women referred because of symptoms of a breast disorder have nipple discharge • Nipple discharge is the third most common presenting symptom to breast clinics (behind lump/lumpiness and breast pain) • Most nipple discharge is of benign origin 27-Jun-20 3 • Less than 5% of women with breast cancer have nipple discharge, and most of these women have other symptoms, such as a lump or newly inverted nipple, as well as the nipple discharge • Mammography and ultrasound have a low sensitivity and specificity for diagnosing the cause of nipple discharge • Nipple smear cytology has a low sensitivity and positive predictive value • The risk of an underlying malignancy is increased if the nipple discharge is spontaneous and single duct 27-Jun-20 4 Physiological Nipple Discharge • Fluid can be obtained from the nipples of 50–80% of asymptomatic women when massage/squeezing used. • This discharge of fluid from a normal breast is referred to as 'physiological discharge' • It is usually yellow, milky, or green in appearance; does not occur spontaneously;
    [Show full text]
  • Central Fever: a Challenging Clinical Entity in Neurocritical Care
    eISSN 2508-1349 J Neurocrit Care 2020;13(1):19-31 https://doi.org/10.18700/jnc.190090 Central fever: a challenging clinical entity in neurocritical care Review Article Keshav Goyal, MD, DM1; Neha Garg, MD2; Parmod Bithal, MD3 Received: July 18, 2019 1Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute Revised: December 12, 2019 of Medical Sciences, New Delhi, India Accepted: December 13, 2019 2Institute of Liver and Biliary Science, Delhi, India 3Department of Anesthesiology, King Fahd Medical City, Riyadh, Saudi Arabia Corresponding Author: Keshav Goyal, MD, DM Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, 710, New Delhi 110029, India Tel: +91-11-26588700-4111 E-mail: [email protected] Fever is probably the most frequent symptom observed in neurointensive care by healthcare providers. It is seen in almost 70% of neurocritically ill patients. Fever of central origin was first described in the journal Brain by Erickson in 1939. A significant number of patients develop this fever due to a noninfectious cause, but are often treated as having an infectious fever. Unjustified use of antibi- otics adds to the increased cost of treatment and the emergence of resistant strains, contributing to additional morbidity. Since fever has a detrimental impact on the recovery of the acutely injured brain and contributes to an increased stay in the neurointensive care unit (NICU), timely and accurate diagnosis of the cause of fever in the NICU is imperative. Here, we try to understand the underlying mechanism, risk factors, clinical characteristics, diagnosis and management options of the central fever.
    [Show full text]