Approach to internal medicine phần 3

Anderson Cancer Center, Houston, TX, USA Alexander Leung, BScMed, MDSTIR, DABIM, MRCPUK, FRCPC Associate Editor, Approach to Internal Medicine Clinical Scholar, Division of General Inter

particularly important since patterns of practice and clinical evidence evolve constantly We welcome any constructive feedback to help make this manual a more accurate, practical, comprehensive, and user friendly resource

David Hui, MD, M.Sc., FRCPC(Med Onc)

Author, Approach to Internal Medicine

Assistant Professor (tenure track), The University of Texas M.D Anderson Cancer Center, Houston, TX, USA

Alexander Leung, BSc(Med), MD(STIR), DABIM, MRCP(UK), FRCPC

Associate Editor, Approach to Internal Medicine

Clinical Scholar, Division of General Internal Medicine University of Calgary, Calgary, AB, Canada Research Fellow, Division of General Internal Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Raj Padwal, MD, M.Sc., FRCPC

Associate Editor, Approach to Internal Medicine

Associate Professor, Clinical Pharmacology, Clinical Epidemiology and General Internal Medicine, University of Alberta Edmonton, AB, Canada

Section Editors

PULMONARY MEDICINE

Mohit Bhutani, MD, FRCPC, FACP

Assistant Professor of Medicine

Division of Pulmonary Medicine

Department of Medicine

University of Alberta

Edmonton, AB, Canada

CARDIOLOGY

Mustafa Toma, MD, FRCPC

Fellow, Advanced Heart Failure

and Cardiac Transplantation

Cleveland Clinic Foundation

Cleveland, OH, USA

Jason Andrade, MD, FRCPC

Fellow, Cardiology

Division of Cardiology

University of British Columbia

Vancouver, BC, Canada

NEPHROLOGY

Alan McMahon, MD, FRCPC

Associate Professor of Medicine

Division of Nephrology and Transplant

Immunology, Department of Medicine

University of Alberta

Edmonton, AB, Canada

CRITICAL CARE

Wendy Sligl, MD, FRCPC

Assistant Professor of Medicine

Divisions of Infectious Diseases

and Critical Care Medicine, Department of

Medicine

University of Alberta

Edmonton, AB, Canada

GASTROENTEROLOGY

Winnie Wong, MD, FRCPC

Associate Professor of Medicine

Director, Gastroenterology Subspecialty

Training Program President Elect Canadian Association for Study of Liver Division of Gastroenterology Department of Medicine University of Alberta Edmonton, AB, Canada HEMATOLOGY Michael H Kroll, MD, FACP Professor of Medicine and Chief Benign Hematology

The University of Texas M.D Anderson Cancer Center

Houston, TX, USA ONCOLOGY Sharlene Gill, MD, FRCPC Associate Professor of Medicine Division of Medical Oncology, British Columbia Cancer Agency University of British Columbia Vancouver, BC, Canada INFECTIOUS DISEASES

A Mark Joffe, MD, FRCPC Professor of Medicine Division of Infectious Diseases, Department of Medicine University of Alberta and Royal Alexandra Hospital

Edmonton, AB, Canada RHEUMATOLOGY Elaine Yacyshyn, MD, FRCPC Assistant Professor of Medicine Director, Rheumatology Subspecialty Training Program

Division of Rheumatology Department of Medicine University of Alberta Edmonton, AB, Canada

xi

Brian Thiessen, MD, FRCPC

Assistant Professor of Medicine

Department Of Medical Oncology

British Columbia Cancer Agency

Division of Neurology

Vancouver General Hospital

Vancouver, BC, Canada

ENDOCRINOLOGY

Laurie E Mereu, MD, FRCPC

Associate Professor of Medicine

Division of Endocrinology

Department of Medicine

University of Alberta

Edmonton, AB, Canada

DERMATOLOGY

Susan Y Chon, MD, FAAD

Assistant Professor of Medicine

Department of Dermatology

Division of Internal Medicine

The University of Texas

M.D Anderson Cancer Center

Houston, TX, USA

GERIATRICS

Fiona Lawson, MD, FRCPC

Assistant Professor of Medicine

Division of Geriatrics

Department of Medicine

University of Alberta

Edmonton, AB, Canada

PALLIATIVE CARE

Eduardo Bruera, MD

Professor of Medicine and Chair

Department of Palliative Care

and Rehabilitation Medicine

Division of Cancer Medicine

The University of Texas M.D Anderson Cancer Center Houston, TX, USA

Sriram Yennurajalingam, MD Assistant Professor of Medicine Department of Palliative Care and Rehabilitation Medicine Division of Cancer Medicine The University of Texas M.D Anderson Cancer Center Houston, TX, USA

NUTRITION Raj Padwal, MD, M.Sc., FRCPC Associate Professor of Medicine Divisions of Clinical Epidemiology Clinical Pharmacology and General Internal Medicine, Department of Medicine University of Alberta

Edmonton, AB, Canada OBSTETRICAL MEDICINE Winnie Sia, MD, FRCPC Assistant Professor of Medicine and Obstetrics and Gynecology Divisions of General Internal Medicine and Maternal Fetal Medicine University of Alberta Edmonton, AB, Canada GENERAL INTERNAL MEDICINE Peter Hamilton, MBBCh, FRCPC Professor of Medicine Division of General Internal Medicine Department of Medicine

University of Alberta Edmonton, AB, Canada

Contributors

GENERAL: Jean-Claude Quintal, MD

ONCOLOGY: Francine Aubin, MD; Anna Tinker, MD; Emma Beardsley, MD; Robyn Macfarlane, MD; Sophie Sun, MD

DERMATOLOGY: Elizabeth Farley, MD; Catherine Riddel, BA; Glynda Caga-Anan, BA

Pulmonary Medicine 1

Asthma Exacerbation 1

COPD Exacerbation 3

Pneumonia 6

Pulmonary Embolism 8

Pleural Effusion 10

Chronic Cough 12

Hemoptysis 12

Solitary Pulmonary Nodule 13

Pulmonary Hypertension 14

Interstitial Lung Disease 15

Obstructive Sleep Apnea 17

Respiratory Acidosis: Hypoventilation 18

Respiratory Alkalosis: Hyperventilation 18

Hypoxemia 19

Ventilation Issues 19

Approach to Chest Imaging 19

Approach to Pulmonary Function Tests 21

Cardiology 25

Aortic Dissection 25

Acute Coronary Syndrome 26

Pericardial Diseases: Pericarditis and Tamponade 32

Heart Failure 33

Digoxin Intoxication 38

Atrial Fibrillation 39

Syncope 43

Cardiac Examination 43

Aortic Stenosis 47

Aortic Regurgitation 49

Mitral Stenosis 50

Mitral Regurgitation 51

Endocarditis 52

Peripheral Vascular Disease 54

Hypertension 57

Hyperlipidemia 61

Smoking Issues 62

Approach to ECG 62

xiii

Nephrology 67

Acute Renal Failure: Pre renal 67

Acute Renal Failure: Renal 68

Acute Renal Failure: Post renal 70

Glomerulopathies 70

Chronic Kidney Disease 73

Proteinuria 74

Hematuria 75

Cystic Kidney Diseases 76

Metabolic Acidosis 77

Metabolic Alkalosis 78

Hyponatremia 79

Hypernatremia 81

Hypokalemia 81

Hyperkalemia 82

Hypomagnesemia 83

Hypophosphatemia 83

Ureteral Calculi 84

Hypertension 84

Approach to Dialysis 85

Critical Care 89

Intensive Care Issues 89

Hypoxemia 92

Acute Respiratory Distress Syndrome 93

Ventilation Issues 94

Shock 97

Sepsis and Septic Shock 99

Lactic Acidosis 101

Rhabdomyolysis 101

Toxicology 102

Alcohol Withdrawal and Complications of Alcoholism 105

Hypothermia 107

Smoke Inhalation 108

Anaphylaxis 109

Gastroenterology 111

Nausea and Vomiting 111

Dysphagia 112

Dyspepsia 113

Acute Abdominal Pain 115

Upper GI Bleed 118

Lower GI Bleed 120

Inflammatory Bowel Disease Exacerbation 120

Acute Diarrhea 122

Chronic Diarrhea 124

Malabsorption Syndromes 125

Constipation 126

Acute Liver Failure 128

Hepatitis B 130

Hepatitis C 131