The Brigham Intensive Review of Internal Medicine

4th Edition - December 31, 2024
Imprint: Elsevier
Authors: Ajay K. Singh, Joseph Loscalzo
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 7 7 6 5 2 - 3
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 7 7 6 5 3 - 0

Based on the popular review course from Harvard Medical School’s teaching affiliate, the Brigham and Women’s Hospital, The Brigham Intensive Review of Internal Medicine, Four… Read more

The Brigham Intensive Review of Internal Medicine

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Based on the popular review course from Harvard Medical School’s teaching affiliate, the Brigham and Women’s Hospital, The Brigham Intensive Review of Internal Medicine, Fourth Edition, provides in-depth coverage on all specialties of internal medicine, as well as palliative care, occupational medicine, psychiatry, and geriatric medicine. Ideal for preparing for certification or recertification, this highly regarded, authoritative review tool keeps you up to date with tremendous changes in the field, incorporating detailed discussions in every chapter, essential learning points, more than 600 review questions, numerous tables and figures, and more.

Title of Book
Cover image
Title page
Table of Contents
Copyright
Contributors
Section 1. Infectious Disease
1. Pneumonia and Respiratory Infections
Acute Bronchitis
Community-Acquired Pneumonia
2. HIV Infection and AIDS
History and Epidemiology
Signs and Symptoms
Establishing the Diagnosis
Initial Evaluation
Initiation of Therapy
Hepatitis Co-infection
Regimens for Initial Antiretroviral Therapy
Recommended Initial Regimens for Most People With HIV
INSTI Plus Two NRTIs:
INSTI Plus One NRTI:
Recommended Initial Regimens in Certain Clinical Situations
Nucleos(t)ide Reverse Transcriptase Inhibitors
Integrase Strand Transfer Inhibitors
Nonnucleoside Reverse Transcriptase Inhibitors
Protease Inhibitors
Goals of Therapy
Monitoring and Routine Follow-Up Care
HIV Prevention
3. Infective Endocarditis
Pathophysiology
Predisposing Factors for Infective Endocarditis
Cardiac Abnormalities
High Risk
Moderate Risk
Low Risk
Patient Characteristics
Findings
Vascular Phenomena
Immunologic Phenomena
Clinical Features
Specific Infective Endocarditis Syndromes
Native Valve Infective Endocarditis
Injection Drug Use Infective Endocarditis
Cardiac Device Infective Endocarditis
Prosthetic Valve Endocarditis
Diagnosis and Workup of Infective Endocarditis
Major Criteria
Blood Culture Positive for Infective Endocarditis
Echocardiogram Positive for Infective Endocarditis
Minor Criteria
Treatment of Infective Endocarditis
Antimicrobial Therapy
Class I Recommendations
Class IIa Recommendations
Class IIb Recommendations
Medical Treatment of Infective Endocarditis Complications
Surgical Indications in Infective Endocarditis
Class I Recommendations
Class IIa Recommendations
Antibiotic Prophylaxis for Infective Endocarditis
4. Immunizations
Basic Principles of Immunization
Precautions and Contraindications
Adult Immunization Recommendations
Influenza
Pneumococcus
Meningococcus
Haemophilus Influenzae B
Tetanus, Diphtheria, Pertussis
Measles, Mumps, Rubella
Varicella Zoster Virus
Varicella Vaccine
Zoster Vaccine
Human Papillomavirus
Hepatitis A Virus
Hepatitis B Virus
Pragmatic Considerations
Spacing of Multiple Immunizations
Special Risk Groups
Timing of Vaccines for Persons With Immunosuppression
Close Contacts of Immunocompromised Persons
SARS-CoV- 2 Vaccines
Respiratory Syncytial Virus (RSV) vaccine
5. Tropical Infections
Fever
Malaria
Clinical Features
Diagnosis, Treatment, and Prevention
Babesiosis
Dengue, Chikungunya, and Zika
Rickettsial Infections
Typhoid
Clinical Features
Diagnosis, Treatment, and Prevention
Meningococcal Infection
Leptospirosis
Diarrhea
Intestinal Protozoa
Infections
Underlying Gastrointestinal Unmasked by Enteric Infections
Postinfectious Processes
Skin Diseases
Cutaneous Larva Migrans (Creeping Eruption)
Furuncular Myiasis
Cutaneous Leishmaniasis
Common Chronic Infections of Immigrants
American Trypanosomiasis (Chagas Disease)
Clinical Features
Diagnosis and Treatment
Intestinal Roundworm Infections
Clinical Features
Diagnosis, Treatment, and Prevention
Schistosomiasis (Bilharzia)
Clinical Features
Diagnosis, Treatment, and Prevention
Strongyloidiasis
Clinical Features
Diagnosis, Treatment, and Prevention
Cysticercosis
Clinical Features
Diagnosis, Treatment, and Prevention
Summary
6. Sexually Transmitted Infections
The Ulcerative Sexually Transmitted Infections
Genital Herpes Simplex Virus
Epidemiology
Etiology and Pathogenesis
Clinical Manifestations
Diagnosis
Treatment
Pregnancy
Immunocompromised Hosts
Syphilis
Background and Epidemiology
Transmission, Disease Stages, and Clinical Manifestations
Diagnosis and Screening
Treatment
Follow-Up After Treatment
Management of Sex Partners
Lymphogranuloma Venereum
Granuloma Inguinale
Chancroid
Nonulcerative Sexually Transmitted Infections
Genital Chlamydia trachomatis Infections
Epidemiology
Clinical Manifestations
Diagnosis and Screening
Treatment and Follow-Up
Gonorrhea
Background
Clinical Manifestations
Diagnosis
Treatment
Nongonococcal Urethritis and Epididymitis
Etiologies and Clinical Manifestations
Diagnosis
Treatment
Follow-Up
Pelvic Inflammatory Disease
Etiology
Complications
Diagnosis
Treatment
Bacterial Vaginosis
Trichomoniasis
7. Dermatologic Manifestations of Infectious Disease
Cutaneous Fungal Infections
Superficial Fungal Infections
Cutaneous Deep Fungal Infections
Systemic Fungal Infections
Cutaneous Bacterial Infections
Cutaneous Viral Infections
Human Papillomavirus: Warts/Condyloma
Molluscum Contagiosum
HIV Infection–Related Skin Findings
Bugs and Bites: Tick-Borne
Pediculosis
Flies, Fleas, and Mosquitoes
Scabies
Bites
Sexually Transmitted Infections
Syphilis
8. New Therapeutics in Infectious Disease
Introduction
The Right Antimicrobial Agent for the Right Patient at the Right Time
Host Factors
Clinical Syndrome and Pathogen(s) Identified
Key Pharmacology Concepts
Combination Therapy
Antibacterial Agents
Antibacterial Resistance Mechanisms
Principles of Pharmacokinetics and Pharmacodynamics (PK-PD)
Antituberculous Agents
Antiviral Agents
Antifungal Agents
Antiparasitic Agents
9. Board Simulation: Infectious Disease
10. Infectious Disease Summary
Staphylococcus aureus Infection
Clinical Presentation
Evaluation
Treatment
Infective Endocarditis
Epidemiology and Microbiology
Diagnosis
Treatment
Prophylaxis
Clostridioides difficile
Epidemiology and Risk Factors
Nosocomial Transmission
Clinical Presentation
Treatment
Travel Medicine
Prevention
Traveler’s Diarrhea
Fever in the Returning Traveler
Lyme Disease
Epidemiology
Clinical Presentation
Laboratory Diagnosis
Treatment
Post-Lyme Disease Syndrome
HIV Infection and AIDS
Epidemiology
Natural History
Opportunistic Infections
Treatment
Monitoring
Pre-exposure Prophylaxis
Sexually Transmitted Infections
Chlamydia
Gonorrhea
Syphilis
Bacterial Meningitis
Epidemiology and Risk Factors
Clinical Presentation
Diagnosis
Treatment
Prophylaxis
Section 2. Hematology and Oncology
11. Breast Cancer
Risk Factors
Prevention
Screening
Pathology and Staging
Stage 0 Breast Cancer (Carcinoma In Situ)
Stage I, II, and III Breast Cancer (Nonmetastatic)
Local Therapy
Systemic Therapy
Stage IV Breast Cancer (Metastatic)
Hormone-Receptor–Positive/HER2-Negative Disease
HER-Positive Cancer
Triple-Negative Breast Cancer
Other Targeted Therapies for Breast Cancer
Palliation of Metastatic Breast Cancer
Summary of Breast Cancer Treatment
12. Lung Cancer
Overview
Risk Factors
Smoking
Radon, Asbestos, and Other Exposures
Lung Cancer in Never-Smokers
Clinical Presentation of Lung Cancer
Paraneoplastic Syndromes
Hematologic Abnormalities
Syndrome of Inappropriate Antidiuretic Hormone Secretion
Hypercalcemia
Cushing Syndrome
Pancoast Syndrome
Thrombosis
Hypertrophic Pulmonary Osteoarthropathy
Lambert–Eaton Syndrome
Lung Cancer Diagnosis
Screening
Non–Small Cell Lung Cancer
Pathology
Histology
Staging of Non–Small Cell Lung Cancer
Treatment
Stage I – III Non-small Cell Lung Cancer
Targeted Therapy for Metastatic NSCLC
Chemotherapy in metastatic NSCLC
Immunotherapy in metastatic NSCLC
Small Cell Lung Cancer
Pathology of Small Cell Lung Cancer
Diagnosis and Staging of Small Cell Lung Cancer
Treatment
Limited-Stage Small Cell Lung Cancer
Extensive-Stage Small Cell Lung Cancer
13. Gastrointestinal Cancers
Gastric Cancer
Histology Types of Gastric Cancer
Risk Factors for Gastric Cancer
Clinical Presentation and Management of Gastric Cancer
Nutritional
Environmental
Occupation (Rubber, Coal Workers)
Medical
Hereditary
Esophageal Cancer
Risk Factors for Esophageal Cancer
Clinical Presentation and Management of Esophageal Cancer
Pancreatic Cancer
Risk Factors for Pancreatic Cancer
Convincing Evidence for Risk
Likely Risk
Clinical Presentation and Management of Pancreatic Cancer
Liver Cancer
Risk Factors for Liver Cancer
Clinical Presentation and Management of Liver Cancer
Colorectal Cancer
Risk Factors for Colorectal Cancer
Pathological Features and Presentation of Colorectal Cancer
Management of Colorectal Cancer
14. Genitourinary Cancers
Prostate Cancer
Epidemiology and Risk Factors
Screening and Diagnosis
Treatment of Localized Prostate Cancer
Treatment of Prostate Cancer Recurrence and Advanced Disease
Renal Cell Carcinoma
Epidemiology
Clinical Presentation and Diagnosis
Treatment
Bladder Cancer
Epidemiology
Clinical Presentation and Diagnosis
Treatment
Testicular Cancer
Epidemiology
Clinical Presentation and Diagnosis
Treatment
15. Leukemia
Chronic Myelogenous Leukemia
Diagnosis
Therapy and Prognosis
Acute Myelogenous Leukemia
Diagnosis
Therapy
Prognosis
Acute Lymphoblastic Leukemia
Diagnosis
Therapy
Prognosis
Chronic Lymphocytic Leukemia
Diagnosis and Staging
Therapy
Prognosis
Related B-Cell Leukemias
16. Non-Hodgkin and Hodgkin Lymphoma
Overview of the Lymphatic System and Lymphocyte Immunology
Non-Hodgkin Lymphoma
Clinical Presentation of Non-Hodgkin Lymphoma
Evaluation of Non-Hodgkin Lymphoma
History
Physical Examination
Laboratory Evaluation
Imaging Evaluation
Tissue Evaluation
Pathologic Characterization of Non-Hodgkin Lymphoma
Staging of Non-Hodgkin Lymphoma
Classification of Non-Hodgkin Lymphoma
Highly Aggressive Non-Hodgkin Lymphoma
Aggressive Non-Hodgkin Lymphoma
Indolent Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Clinical Presentation of Hodgkin Lymphoma
Epidemiology
Systemic Symptoms
Patterns of Lymph Node Involvement
Evaluation of Hodgkin Lymphoma
Staging of Hodgkin Lymphoma
Classifications of Hodgkin Lymphoma
Pathology of Hodgkin Lymphoma
Treatment of Classic Hodgkin Lymphoma
Chemotherapy Regimens
Long-Term Consequences of Radiation Therapy
Treatment of Nodular Lymphocyte–Predominant Hodgkin Lymphoma
17. Multiple Myeloma
Epidemiology
Clinical Presentation: Diagnostic Criteria
Staging System
General Considerations for Therapeutic Management
Monitoring: Response Criteria
Autologous stem cell transplantation: Maintenance therapy
Relapsed and Refractory Multiple Myeloma
Recent Developments and Future Perspectives for Investigational Agents
Adjunctive Treatment: Supportive Care
Anemia
Skeletal Lesions: Hypercalcemia
Renal Insufficiency
Infections
Thromboembolic Complications
Hyperviscosity Syndrome
Spinal Cord Compression
Some Clinical Pearls in the Management of Multiple Myeloma Patients
Future Directions
18. Oncologic Emergencies
Superior Vena Cava Syndrome
Spinal Cord Compression
Tumors Commonly Associated With Cord Compression
Symptoms
Evaluation
Treatment
Brain Metastasis
Pericardial Effusion and Tamponade
Intestinal or Urinary Tract Obstruction
Tumor Lysis Syndrome
Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hypercalcemia
Syndrome of Inappropriate Antidiuretic Hormone
Complications Related to Cancer Treatment
Fever and Neutropenia
Typhlitis
Pulmonary Complications
Cytokine Release Syndrome
19. Cancer Immunotherapy
Mechanisms of Immune Checkpoint Inhibitors
Indications for Immune Checkpoint Inhibitors
Immune-Related Toxicities
Conclusion
20. Disorders of Platelets and Coagulation
Normal Hemostasis
Clinical Evaluation and Coagulation Tests
Screening Tests of Hemostasis
Specific Disorders
von Willebrand Disease
Qualitative Platelet Disorders
Hemophilia A
Hemophilia B and C
Acquired Hemophilia and von Willebrand Disease
Immune Thrombocytopenia
Heparin-Induced Thrombocytopenia
Thrombotic Thrombocytopenic Purpura
Disseminated Intravascular Coagulation
Hypercoagulable States
Antiphospholipid Antibody
21. Anemia and Hemoglobinopathies
Evaluation of Anemia
Hypoproliferative Anemias
Microcytic Hypochromic Anemias
Iron Deficiency Anemia
Normocytic Normochromic Anemias
Anemia of Inflammation
Macrocytic Anemias
Folate and Vitamin B12 Deficiency
Hyperproliferative Anemias
Acquired Hyperproliferative Anemias
Immune Hemolytic Anemias (Coombs Positive)
Autoimmune Hemolytic Anemia
IgG-Mediated Immune Hemolytic Anemia
IgM-Mediated Immune Hemolytic Anemia (Cold Hemagglutinin Disease)
Drug-Induced Immune Hemolytic Anemia
Paroxysmal Cold Hemoglobinuria
Nonimmune Hemolytic Anemias
Paroxysmal Nocturnal Hemoglobinuria
Thrombotic Thrombocytopenic Purpura
Hereditary Hemolytic Anemias
Hereditary Conditions of the Red Blood Cell Membrane
Hereditary Conditions of Red Blood Cell Metabolism (Enzymopathies)
Hemoglobinopathies (Hereditary Conditions of Abnormal Hemoglobin)
Thalassemias
Sickle Cell Syndromes
Sickle Cell Anemia
Hemoglobin SC Disease
Management of Sickle Cell Disease
Sickle Cell Trait
22. Board Simulation: Hematology
23. Board Simulation: Hematology and Oncology
Acknowledgment
24. Oncology Summary
Selected Cancers
Breast Cancer
Lung Cancer
Gastrointestinal Malignancies
Esophageal Cancer
Gastric Cancer
Pancreatic Cancer
Colorectal Cancer
Genitourinary Malignancies
Prostate Cancer
Bladder Cancer
Testicular Cancer
Non-Hodgkin and Hodgkin Lymphoma
Targeted Therapy
BCR/ABL
KIT
EGFR
ALK gene rearrangements
Microsatellite Instability/Mismatch Repair
KRAS
PARP
Section 3. Rheumatology
25. Rheumatoid Arthritis
Epidemiology
Pathology and Pathogenesis
Diagnosis
Clinical Manifestations of Rheumatoid Arthritis
Laboratory Testing
Musculoskeletal Imaging
Special Considerations
Treatment
Traditional Non-DMARD Pharmacotherapy
Traditional Synthetic DMARDs
Biological DMARDs
Targeted Synthetic DMARDs
Summary
26. Acute Monoarticular Arthritis
Evaluation of a Patient With Acute Monoarticular Arthritis
History and Physical Examination
Diagnostic Studies
Common
Less Common
Rare Causes
Imaging Studies
Synovial Biopsy
Differential Diagnosis
Noninflammatory: <2000 WBC/mm3 (2 × 109/L)
Inflammatory: >2000 WBC/mm3 (2 × 109/L)
Septic Arthritis
Pathogenesis
Gram-Positive Cocci
Gram-Negative Cocci
Gram-Positive Bacilli
Gram-Negative Bacilli
Anaerobes
Spirochetes
Mycoplasma
Microbiology
Age
Local Factors
Systemic Factors
Risk Factors
Clinical Features
Diagnostic Workup
Therapy
Lyme Disease
Viral
Mycobacterial and Fungal
Gonococcal Arthritis
Crystal-Induced Monoarticular Arthritis
Gout
Epidemiology and Risk Factors
Clinical Presentations
Diagnostic Workup
Treatment
Calcium Pyrophosphate Crystal Deposition Disease (Pseudogout)
Basic Calcium Phosphate Deposition Disease
Calcium Oxalate
Lipid-Laden Crystals
Osteoarthritis
Hemarthrosis
Reactive Arthritis
Systemic Diseases
Genitourinary
Gastrointestinal
Summary
27. Systemic Lupus Erythematosus and Related Disorders
History and Epidemiology
Genetics, Hormones, and the Immune System
Clinical Manifestations
Cutaneous
Acute Cutaneous Lupus Erythematosus
Subacute Cutaneous Lupus Erythematosus
Chronic Cutaneous Lupus Erythematosus
Lupus Nonspecific Skin Disease
Treatment
Pulmonary
Cardiac
Musculoskeletal
Hematologic
Renal
Neurologic
Drug-Induced Systemic Lupus Erythematosus
Autoantibodies
Diagnosis
Treatment of Systemic Lupus Erythematosus
Antimalarials
Corticosteroids
Methotrexate and Leflunomide
Azathioprine
Cyclosporine
Mycophenolate Mofetil
Tacrolimus
Cyclophosphamide
Belimumab
Other Biologics and Other Therapies
Treatment Approaches
Conclusion
Antiphospholipid Syndrome
Clinical Features
Antibodies
Diagnosis
Treatment
Sjögren Syndrome
Clinical
Keratoconjunctivitis Sicca
Xerostomia
Vaginal Dryness
Diagnosis of Sjögren Syndrome
Other Clinical Findings
Systemic Sclerosis (Limited and Diffuse Cutaneous)
Limited Cutaneous Systemic Sclerosis (CREST)
Diffuse Cutaneous Systemic Sclerosis
Organ Involvement
Cutaneous
Pulmonary Disease
Renal Disease
Cardiac Disease
Gastrointestinal Disease
Musculoskeletal Involvement
Treatment
Mixed Connective Tissue Disease and Overlap Syndrome
Idiopathic Inflammatory Myopathies: Polymyositis, Dermatomyositis, and Inclusion Body Myositis
Clinical Symptoms
Skin
Pulmonary
Cardiac
Gastrointestinal
Laboratory Abnormalities
Differential Diagnosis
Diagnosis
Malignancy Association
Treatment
Conclusion
28. Systemic Vasculitis
Clinical Presentation
Antineutrophil Cytoplasmic Autoantibody Vasculitis
Granulomatosis With Polyangiitis (Wegener)
Diagnosis
Treatment
Microscopic Polyangiitis
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)
Treatment
Polyarteritis Nodosa
Diagnosis
Treatment
Drug-Induced Vasculitis
Cryoglobulinemic Vasculitis
Giant Cell Arteritis and Takayasu Arteritis
Behçet Disease
Primary Central Nervous System Vasculitis
Treatment Strategies in Vasculitis
29. Common Soft Tissue Pain Syndromes
Overview
Classification of Disorders
Pathophysiology
Presentation
Patient Demographics and Common Presentations
Specific Soft Tissue Pain Disorders
Causes of Shoulder Pain
Physical Examination: Shoulder
Elbow Pain
Olecranon Bursitis
Wrist and Hand Disorders
Pelvis and Hip
Soft tissue disorders around the knee
Foot Pain
Fibromyalgia
Establishing the Diagnosis of a Soft Tissue Pain Disorder
Ancillary Studies
Therapy
30. Laboratory Tests in Rheumatic Disorders
Acute-Phase Proteins
Comparison of Erythrocyte Sedimentation Rate and C-Reactive Protein
Rationale for Using Multiple Tests
Systemic Lupus Erythematosus
Antibodies to DNA
Anti-Smith Antibodies and Antiribonucleoprotein Antibodies
Anti-Ro/SSA and Anti-La/SSB Antibodies
Antinucleoprotein Antibodies
Systemic Sclerosis (Scleroderma)
Polymyositis/Dermatomyositis
Antiribosomal P Protein Antibodies
Antihistone Antibodies
Rheumatoid Factors
Antibodies to Citrullinated Proteins
Antineutrophil Cytoplasmic Antibodies
Drug-Associated Antineutrophil Cytoplasmic Antibodies
Antiglomerular Basement Membrane Antibody Disease
Antiphospholipid Antibodies
Lupus Anticoagulants
Anticardiolipin Antibodies
Anti–Beta-2-Glycoprotein I Antibodies
False-Positive Serologic Test for Syphilis
Associated Disorders
Testing for Ankylosing Spondylitis
Testing for Lyme Disease
Enzyme-Linked Immunosorbent Assay
Western Blot
Cautions to Be Considered in Interpretation
False Positives With ELISA
Lack of Sensitivity in Early Disease
Effects of Antibiotic Therapy
Interlaboratory Variation
Persistence of Positivity
Usefulness of Serologic Tests
Complement
CH50
Plasma C3 and C4 Levels
Clinical Significance
Inherited Complement Deficiency
C1 Inhibitor Deficiency
Uric Acid
Synovial Fluid
Examination of Synovial Fluid
Routine Culture
Gonococcal Arthritis
When Should Cultures Be Sent for Unusual Organisms?
Synovial Fluid Crystal Analysis
Immunoglobulins
31. Rheumatologic Therapeutic Agents
Principles of disease-modifying antirheumatic drugs (DMARDs)
Conventional DMARDs
Immunosuppressive agents
Biologic DMARDs
Targeted synthetic DMARDs (JAK inhibitors)
Miscellaneous
Glucocorticoids
Hypouricemic agents and gout management
32. Board Simulation: Rheumatic and Immunologic Disease
33. Rheumatology Summary
Idiopathic Autoimmune Disorders
Rheumatoid Arthritis
Polymyalgia Rheumatica
Spondyloarthritis
Rheumatic Diseases
Infectious Diseases
Malignant Diseases
Systemic Lupus Erythematosus
Medications and Toxins
Permissive Disease States
Injury
Antiphospholipid syndrome
Scleroderma
Other Connective Tissue Diseases
Sjögren Syndrome
Idiopathic Inflammatory Myopathies
Adult-Onset Still Disease
Sarcoidosis
Mixed Connective Tissue Disease
The Vasculitides
Large-Vessel Vasculitides
Giant Cell Arteritis
Takayasu Arteritis
Medium-Vessel Vasculitides
Polyarteritis Nodosa
Kawasaki Disease
Small-Vessel Vasculitides
ANCA-Associated Vasculitides
Leukocytoclastic Vasculitis
Immune Complex–Mediated Small-Vessel Vasculitides
Other Inflammatory Arthritides
Crystal Arthropathies
Infectious Arthritis
Noninflammatory Rheumatic Disorders
Osteoarthritis
Regional Musculoskeletal Disorders
Fibromyalgia
Summary
Section 4. Pulmonary and Critical Care Medicine
34. Asthma
Epidemiology
Assessment and Management of Asthma
Defining Good Asthma Control
Achieving Good Asthma Control
Making the Correct Diagnosis
Reducing Environmental Triggers of Asthma
Treating With Appropriate Medications
Safety of long-acting beta agonists (LABAs) when used together with inhaled corticosteroids (ICS)
Use of long-acting muscarinic-antagonist bronchodilators in asthma
Single inhaler for maintenance and rescue therapy (SMART)
Anti-inflammatory rescue (“AIR”)
“Biologics” to treat severe asthma
Helping Patients Prepare for Asthmatic Attacks
Consulting a Specialist
35. Pleural Diseases
Pleural Effusion
Clinical Features of Pleural Effusions
Diagnostic Evaluation of a Pleural Effusion
Chest Imaging
Pleural Aspiration/Thoracentesis
Pleural Fluid Analysis
Characteristics and Management of Common Transudative and Exudative Pleural Effusions
Transudative Effusions
Congestive Heart Failure
Hepatic Hydrothorax
Peritoneal Dialysis
Urinothorax
Nephrotic Syndrome
Exudative Effusions
Parapneumonic Pleural Effusions and Empyema
Tuberculosis
Chylothorax
Malignancy
Autoimmune Diseases
Asbestosis
Hemothorax
Pleural Tumors
36. Evaluation of the Dyspneic Patient in Primary Care
Introduction
Epidemiology
Mechanism
Dyspnea and Exercise Physiology
Pathophysiology of Disorders Associated with Exertional Dyspnea
Pulmonary Causes of Dyspnea
Upper Airway
Lower airway/lung
Cardiac
Neuromuscular
Psychogenic
Other
Cardiovascular Causes of Dyspnea
Pulmonary Vascular Disease
Disorders of Peripheral Oxygen Transport and Use
Multifactorial Causes of Dyspnea
Diagnostic Evaluation
History
Physical Examination
Diagnostic Testing
Therapy
Summary
37. Chronic Obstructive Pulmonary Disease
Definition of Chronic Obstructive Pulmonary Disease
Pathogenesis
Classification of Chronic Obstructive Pulmonary Disease
Clinical Presentation
Demographics and Symptoms
Physical Examination
Differential Diagnosis
Pulmonary Function Testing
Arterial Blood Gases and Assessment of Oxygenation
Thoracic Imaging
Blood Tests
Summary of Diagnosis of Chronic Obstructive Pulmonary Disease
Therapy for Chronic Obstructive Pulmonary Disease
Goals of Therapy
Disease Prevention
Vaccinations
Therapy of Stable Disease
Pharmacotherapy
Interventional Therapy for Chronic Obstructive Pulmonary Disease
Summary of the Approach to Individuals With Stable Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease Exacerbations
Definition
Etiology
Prevention
Assessment of the Patient With Exacerbation
Treatment
Antibiotics
Corticosteroids
Bronchodilators
Supportive Therapies
COPD Management During COVID-19
38. Venous Thromboembolic Diseases
Pathophysiology
Clinical Risk Factors
Clinical Risk Factors
Thrombophilias
Pathophysiology of Deep Vein Thrombosis
Pathophysiology of Pulmonary Embolism
Diagnosis
Deep Vein Thrombosis
Clinical Findings
Laboratory Evaluation
Imaging
Pulmonary Embolism
Clinical Findings
Clinical Decision Rule
Laboratory Evaluation
Electrocardiogram
Imaging
Risk Stratification for Pulmonary Embolism
Management
Anticoagulation Strategies
Duration of Anticoagulation
Use of Aspirin
Primary Therapy
Thrombolysis
Catheter-Assisted and Surgical Interventions
Inferior Vena Cava Filters
Heparin-Induced Thrombocytopenia
Prevention
Options for Prophylaxis
Duration of Prophylaxis
Recommendations
39. Sleep Apnea
Definition of Obstructive Sleep Apnea
Epidemiology
Pathophysiology
Upper Airway Anatomy
Upper Airway Muscle Control
Collapsibility
Arousal Threshold
Feedback Loops
Lung Volume
Clinical Evaluation for Obstructive Sleep Apnea
Consequences of Obstructive Sleep Apnea
Hypertension
Cardiovascular Morbidity and Mortality
Cerebrovascular Disease
Heart Failure
Diabetes Mellitus Type 2
Motor Vehicle Crashes
Treatment of Obstructive Sleep Apnea
Medical Therapy
Positive Airway Pressure Therapy
Oral Appliances
Surgery
Pharmacotherapy
A Brief Comment on Central Sleep Apnea
Summary
40. Interstitial Lung Diseases
Evaluation and Diagnosis of Suspected Interstitial Lung Disease
Nomenclature
Radiology and Histology
Common ILD Subtypes
Idiopathic Pulmonary Fibrosis
Connective Tissue Disease–Associated Interstitial Lung Disease
Hypersensitivity Pneumonitis
Smoking-Related Interstitial Lung Disease
Drug-Induced Interstitial Lung Disease
Occupational-Related Interstitial Lung Disease
Progressive Fibrosing Interstitial Lung Disease
Conclusion
41. PulmonaryFunction Tests
Technical Considerations
Spirometry: Measurement, Values, and Flow-Volume Loops
Lung Volumes: Measurement and Values
Diffusion Capacity for Carbon Monoxide: Measurement and Correction Factors
Obstructive Ventilatory Deficits
Definition and Characteristics
Differential Diagnosis
GOLD Criteria and Confidence Intervals
Bronchodilator Responsiveness
How Pulmonary Function Tests Guide Treatment
Restrictive Ventilatory Deficits
Definition and Characteristics
Differential Diagnosis
Grading Severity
Reduced Diffusing Capacity for Carbon Monoxide
Definition, Characteristics, and Physiology of Decreased Diffusing Capacity for Carbon Monoxide
Clinical Utility and Meaning of Diffusing Capacity for Carbon Monoxide
Differential Diagnosis
Association of Diffusing Capacity for Carbon Monoxide With Functional Capacity
Mixed Disorders: Interpreting Mixed Obstructive and Restrictive Deficits
Respiratory Muscle Forces: Maximal Inspiratory Pressure and Maximal Expiratory Pressure
Definition
Differential Diagnosis
Clinical Utility: When to Order, How to Interpret, Further Testing
Advanced Pulmonary Function Tests
Resistance and Compliance
Bronchoprovocation
42. Chest X-Ray Refresher
Hemoptysis
Chronic Interstitial Lung Diseases
Obstructive Lung Diseases
43. Agents in Pulmonary Diseases
Inhaled Medications for Airways Disease
Inhaler Types
Metered Dose Inhaler (MDI)
Dry Powder Inhaler (DPI)
Soft Mist Inhaler (SMI)
Asthma
Antileukotriene Agents
Mechanism of Action
Agents
Dosing
Adverse Effects
Monitoring
Biologic Agents
Anti-IgE Therapy
Anti-Interleukin (IL)-5 Therapy
Anti-IL-4 Therapy
Chronic Obstructive Pulmonary Disease
Roflumilast (Daliresp)
Mechanism of Action
Dosing
Adverse Effects
Monitoring
Azithromycin (Zithromax)
Mechanism of Action
Dosing
Adverse Effects
Monitoring
Cystic Fibrosis
CFTR Modulators
Monitoring
Agents
Idiopathic Pulmonary Fibrosis
Antifibrotics
Indications
Pirfenidone (Esbriet)
Nintedanib (Ofev)
Pulmonary Arterial Hypertension
Nitric Oxide Pathway
Phosphodiesterase 5 Inhibitors
Riociguat (Adempas)
Endothelin Pathway
Agents
Mechanism of Action
Dosing
Adverse Effects
Monitoring
Prostacyclin Pathway
Agents
Mechanism of Action
Dosing
Adverse Effects
Monitoring
Smoking Cessation
Nicotine Replacement Therapy
Dosing
Adverse Effects
Varenicline (Chantix)
Mechanism of Action
Dosing
Adverse Effects
Bupropion (Wellbutrin)
Mechanism of Action
Dosing
Adverse Effects
44. Mechanical Ventilation
Introduction
Indications
Invasive Ventilation
Respiratory Mechanics
Adjunctive Therapies
Complications of Invasive Ventilation
Mechanical Ventilation and COVID-19
Liberation From Mechanical Ventilation
Noninvasive Mechanical Ventilation
Summary
45. Sepsis Syndrome
Definitions
Epidemiology
Clinical Presentation and Diagnosis
Organ Hypoperfusion
Organ Dysfunction
Pathophysiology
Management
Early Management
Source Control
Initial Resuscitation
Corticosteroids
Glucose Control
Summary
46. Essentials of Hemodynamic Monitoring
Invasive Hemodynamic Monitoring
Arterial Lines
Central Venous Pressure
Pulmonary Artery Catheter
Noninvasive Hemodynamic Monitoring
Summary
47. Arterial Blood Gases
Technical Considerations: How to Obtain an Arterial Blood Gas
Hypoxemia
Alveolar-To-Arterial Gradient and the Alveolar Gas Equation
Effects of Supplemental Oxygen
Carboxyhemoglobinemia and Methemoglobinemia
Acid-Base Disorders
Hypercapnia and Acute Respiratory Acidosis
Compensatory Mechanisms
Chronic Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
Mixed Disorders
Expected Compensation
True Mixed Acid-Base Disorders
48. Sedation, Agitation, and Sleep Deprivation
Sedation
Indications and Goals
Management Strategies
Medications
Agitation/Delirium
Causes of Delirium
Assessment
Prevention/Treatment
Sleep
Factors Affecting Sleep in the ICU
Assessment
Outcomes Related to Poor Sleep in the ICU
Strategies to Improve Sleep in the ICU
Nonpharmacologic
Pharmacologic
Summary
49. Board Simulation:: Critical Care
50. Board Simulation: Pulmonary Medicine
51. Pulmonary and Critical Care Medicine Summary
Diagnostic Evaluation of Lung Disease
Chest Radiography
Pulmonary Function Testing
Respiratory Disorders
Asthma
Chronic Obstructive Pulmonary Disease
Diffuse Parenchymal Lung Diseases
Venous Thromboembolic Disease
Obstructive Sleep Apnea
Critical Care
Shock and Sepsis
Mechanical Ventilation
Arterial Blood Gas Interpretation
Section 5. Endocrinology
52. Pituitary Disorders
Pituitary Anatomy and Physiology
Pituitary Lesions
Pituitary Adenomas
Prolactinomas
Differential Diagnosis of Hyperprolactinemia
Diagnosis
Management
Acromegaly
Diagnosis
Management
Cushing Disease
Thyroid-Stimulating Hormone and Gonadotropin-Producing Pituitary Adenomas
Physiologic
Pharmacologic
Pathophysiologic
Genetic Syndromes Associated With Pituitary Tumors
Hypopituitarism
Differential Diagnosis
Destruction of the Pituitary Gland
Destruction of the Pituitary Stalk
Hypothalamic Causes
Clinical Presentation, Diagnosis, and Management of Pituitary Hormone Deficiencies
Adrenocorticotropic Hormone (Corticotropin) Deficiency
Thyroid-Stimulating Hormone (Thyrotropin) Deficiency
Luteinizing Hormone and Follicle-Stimulating Hormone (Gonadotropin) Deficiency
Growth Hormone (Somatotropin) Deficiency
Prolactin Deficiency
Posterior Pituitary Deficiency
Etiology
Clinical Presentation
Diagnosis
Management
53. Thyroid Disease
Screening for Thyroid Disease
Hyperthyroidism
Etiology: Unregulated Production of Excessive Thyroid Hormone
Possible Diagnosis
Biochemical and Laboratory Findings
Treatment
Etiology: Release of Preformed (Stored) Thyroid Hormone
Possible Diagnosis
Biochemical and Laboratory Findings
Treatment
Hypothyroidism
Thyroid Nodules
Summary
54. Reproductive and Androgenic Disorders
Female Reproductive Endocrinology
Amenorrhea
Hypothalamic and Pituitary Gland Disorders
Ovarian Dysfunction (Spontaneous Primary Ovarian Insufficiency/Premature Ovarian Failure)
Evaluation of the Patient With Amenorrhea
Laboratory Evaluation and Diagnostic Tests
Treatment
Male Reproductive Endocrinology
Male Hypogonadism Symptoms
Physical Examination
Laboratory Assessment
Primary Hypogonadism
Secondary Hypogonadism
Treatment
55. Adrenal Disorders
Glucocorticoids
Regulation of the Hypothalamic-Pituitary-Adrenal Axis
Physiologic and Pathophysiologic Actions of Glucocorticoids
Cushing Syndrome
Clinical Features of Cushing Syndrome
Screening for Cushing Syndrome
Investigations to Identify the Cause of Cushing Syndrome
ACTH-Dependent
ACTH-Independent
Differential Diagnosis
Pseudo-Cushing Syndrome
Management
Medical Therapies for Cushing Syndrome
Adrenal Insufficiency
Etiology
Clinical Features
Primary
Secondary
Diagnosis
Differential Diagnosis
Management
Regulation of Renin-Angiotensin-Aldosterone Axis
Primary Aldosteronism
Diagnosis
Treatment
Secondary Hyperaldosteronism
Other Causes of Mineralocorticoid excess
Hypoaldosteronism With Suppressed Plasma Renin Activity
Hyperaldosteronism With Elevated Plasma Renin Activity
Pheochromocytoma and Paraganglioma
Clinical Features
Diagnosis
Treatment
Pheochromocytoma and Genetic Syndromes
Adrenal Incidentaloma
Congenital Adrenal Hyperplasia
Clinical
Hormonal
Radiographic Evaluation of Tumor Phenotype
56. Disorders of Calcium Metabolism
The Parathyroid Glands and Parathyroid Hormone
Hypercalcemia
Primary Hyperparathyroidism
PTH-Mediated
Non–PTH-Mediated
Stones
Bones
Abdominal Groans
Psychic Moans
Other
Non–Parathyroid Hormone–Mediated Hypercalcemia
Fluids
Medications
Other
Hypocalcemia
Hypoparathyroidism
Hypoparathyroidism
Resistance to PTH Action
Medications That Prevent Osteoclastic Bone Resorption
Vitamin D Disorders
Acute Complexation or Deposition of Calcium
Pseudohypoparathyroidism
Vitamin D Deficiency
Chronic Kidney Disease
Miscellaneous
Treatment
Acute
Chronic
57. Diabetes Mellitus:: Principles of Diagnosis and Therapy
Introduction
Classification
Type 1 Diabetes
Type 2 Diabetes
Monogenic Diabetes
Gestational Diabetes Mellitus
Other Specific Types of Diabetes
Diagnosis
Categories of Risk for Diabetes
Screening for Diabetes
Prevention of Diabetes and Its Complications
Prevention of Type 1 Diabetes
Prevention of Type 2 Diabetes
Prevention of Complications
General Preventive Care Practices
Treatment of Cardiovascular Risk Factors
Treatment of Hyperglycemia
Glycemic Goals
Individualizing HbA1c Goals
Hyperglycemia Treatment Strategies
Type 1 Diabetes or Primary Insulin Deficient states
Type 2 Diabetes
Overall Therapeutic Strategy
Insulin Preparations
Insulin Delivery Options
Insulin Regimens for Type 1 Diabetes
Multiple Daily Injections
Insulin Pumps
Amylin Analogs
Overall Therapeutic Strategy
Behavioral Change and Lifestyle Measures
Diet
Exercise
Selection and Progression of Therapy in Type 2 Diabetes
Specific Treatment Pathways
T2DM with Established ASCVD
T2DM With CHF
T2DM With CKD
Patients Without CVD or CKD
Insulin Regimens in Type 2 Diabetes
Metabolic Surgery (a.k.a. Weight Loss Surgery, Bariatric Surgery)
Obesity Medications
Special Populations
Pregnancy
Hospitalized Patients
58. Diabetes Mellitus: Control and Complications
Introduction
Control
Real-Time Glucose Measurements
Measuring Long-Term Glucose Control
Complications of Diabetes: General Overview
Acute Complications
Hypoglycemia
Hyperglycemia
Chronic Complications
Overview
Glucose Hypothesis
Major Trials Examining the Glucose Hypothesis
Role of Blood Pressure, Lipids, and Lifestyle
Complications of Diabetes: Specific Conditions
Retinopathy
Nephropathy
Neuropathy
Cardiovascular Disease
Musculoskeletal Complications of Diabetes
Hepatic Complications
Dermatologic Complications
Neurocognitive Complications
59. Diabetes Mellitus: Therapeutics
Outline
60. Metabolic Syndrome
Definition
Prevalence
Pathogenesis
Clinical Significance
Management of Metabolic Syndrome
General Considerations
Management of Obesity in Metabolic Syndrome
Reduction of Insulin Resistance With Drug Therapy
Treatment of Dyslipidemia in Metabolic Syndrome
Treatment of High Blood Pressure
Treatment for Proinflammatory and Prothrombotic State
Unusual Conditions Associated With Metabolic Syndrome
Summary
61. Metabolic Bone Diseases
Osteoporosis
Role of Calcium
Role of Vitamin D
Exercise
Bone Remodeling and Treatment of Osteoporosis
Hormone Therapy
Estrogen Agonists/Antagonists
Calcitonin
Bisphosphonates
Bisphosphonate Holiday
RANKL Inhibitor (Denosumab)
Parathyroid Therapy
Abaloparatide
Sclerostin Inhibitor (Romosozumab)
Secondary Fracture Prevention
Osteomalacia
Alteration in the Metabolism of Vitamin D
Phosphate Deficiency
Miscellaneous Mineralization Defects
Paget’s Disease of Bone
62. Board Simulation: Endocrinology
63. Endocrine Summary
Pituitary Tumors
Prolactinoma
Clinical Features
Evaluation
Treatment
Acromegaly
Clinical Features
Evaluation
Treatment
Other Pituitary Disorders
Diabetes Insipidus
Clinical Features
Evaluation
Treatment
Lymphocytic Hypophysitis
Presentation of Hypothyroidism
Clinical Features
Evaluation
Treatment
Hypothyroidism During Pregnancy
Clinical Features
Evaluation
Treatment
Hyperthyroidism During Pregnancy
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Evaluation
Clinical Features
Hypothyroidism
Hyperthyroidism
Thyroid Nodules
Thyroid Cancer
Osteoporosis
Hypercalcemia
Hypoparathyroidism
Adrenal Failure
Adrenal Nodules and Tumors
Primary Aldosteronism
Clinical Features
Evaluation
Treatment
Pheochromocytoma
Clinical Features
Evaluation
Treatment
Cushing Syndrome
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Clinical Features
Evaluation
Treatment
Preventing Complications
Gestational Diabetes
Hyperglycemia in the Hospital
Hirsutism
Male Hypogonadism
Diabetes Mellitus
Endocrine Syndromes
Multiple Endocrine Neoplasia
Multiple Endocrine Neoplasia 1 and 4
Multiple Endocrine Neoplasia 2 and 3
Autoimmune Polyendocrine Syndrome
Section 6. Nephrology and Hypertension
64. Acute Kidney Injury
Regulation of Glomerular Filtration
Mechanisms of Reduced Glomerular Filtration
Postrenal Causes of Acute Kidney Injury
Prerenal Causes of Acute Kidney Injury
Intravascular Volume Depletion
Peripheral Vasodilation
Decreased Cardiac Output
Intrarenal Vasoconstriction
Impaired Autoregulatory Responses
Intrinsic Causes of Acute Kidney Injury
Tubular Etiologies of Acute Kidney Injury
Glomerular
Nephrotic Syndrome and Acute Kidney Injury
Rapidly Progressive Glomerulonephritis
Tubular
Acute Tubular Necrosis
Acute Interstitial Nephritis
Intratubular Obstruction
Vascular
Thrombotic Microangiopathy
Vasculitis
Glomerular Etiologies of Acute Kidney Injury
Vascular Etiologies of Acute Kidney Injury
Common Scenarios of Acute Kidney Injury in Hospitalized Patients
Postoperative Acute Kidney Injury
Postintravenous Contrast and Angiographic Procedure–Associated Acute Kidney Injury
Management of Acute Kidney Injury
Prevention
Targeted Treatment
Indications for Renal Replacement Therapy
Summary
65. Electrolyte Disorders
Sodium Disorders
Hyponatremia
Diagnostic Approach
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Euvolemic Hyponatremia
Treatment of Hyponatremia
Iatrogenic
Hypernatremia
Diagnostic Approach
Central Diabetes Insipidus
Nephrogenic Diabetes Insipidus
Gestational Diabetes Insipidus
Water Deficit
Ongoing Water Losses
Insensible Losses
Total
Treatment of Hypernatremia
Potassium Disorders
Hypokalemia
Treatment of Hypokalemia
Treatment of Hyperkalemia
Hyperkalemia
66. Acid-Base Disturbances
Signs and Symptoms of Acid-Base Disorders
Definitions
Analysis of Acid-Base Disorders
Compensations
Metabolic Acidosis
Anion-Gap Metabolic Acidosis
Lactic Acidosis
Salicylate Overdose
Oxoproline
Ketoacidosis
Treatment of Metabolic Acidosis in Chronic Kidney Disease
Hyperchloremic Acidosis
Pathophysiology
Causes
Clinical Features
Laboratory Data
Management: Bicarbonate Supplementation
Pathophysiology
Causes
Clinical Features
Laboratory Data
Management
Metabolic Alkalosis
Chloride-Responsive Alkalosis
Chloride-Unresponsive Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
67. Dialysis and Kidney Transplantation
Preparing the Patient for Renal Replacement Therapy
Hemodialysis Versus Peritoneal Dialysis
Technical Aspects of Hemodialysis
Technical Aspects of Peritoneal Dialysis
Vascular Access
Complications Related to Dialysis Access
Anemia Management
Bone Disease and Mineral Metabolism Management
Evaluation of the Patient for Kidney Transplantation
Transplant Medications
Maintenance Therapies
Antimetabolites
Calcineurin Inhibitors
Mammalian Target of Rapamycin Inhibitors
Belatacept
Induction and Antirejection Therapies
Polyclonal Antibodies
Monoclonal Antibodies
Infectious Posttransplant Complications
Noninfectious Posttransplant Complications
68. Hematuria and Proteinuria
Hematuria
Risk Factors for Malignancies
Evaluation of Hematuria
History
Examination
Laboratory Evaluation
Imaging
Approach to the Patient With Hematuria
Proteinuria
Classification of Proteinuria
Classification of Overt Proteinuria
Differential Diagnosis
Evaluation of Proteinuria
History
Physical Examination
Laboratory Evaluation
Imaging
Kidney Biopsy
Therapy of Specific Kidney Conditions
General Management of Proteinuria
69. Parenchymal Renal Disease
Syndromes of Nephronal Injury
Isolated Glomerular Hematuria
Isolated Nonnephrotic Proteinuria
Nephrotic Syndrome
Acute Nephritic Syndrome
Unexplained Acute Kidney Injury
Important Causes of Nephrotic Syndrome
Minimal Change Disease
Focal and Segmental Glomerulosclerosis
Membranous Glomerulopathy
Primary Causes
Secondary Causes
Nephritic Syndrome
Important Causes of Nephritic Syndrome
Postinfectious Glomerulonephritis
IgA Nephropathy or Berger Disease
Primary Causes
Secondary Causes
Rapidly Progressive or Crescentic Glomerulonephritis
Four Classes of Crescentic Glomerulonephritis Based on Pathogenetic Mechanisms
Antiglomerular Basement Membrane Nephritis (Type 1)
Lupus Nephritis (Example of Type 2)
Antineutrophil Cytoplasmic Antibody–Associated Vasculitis (Example of Type 3): Wegener’s Granulomatosis (Renamed as Granulomatosis With Polyangiitis)
Rash
Arthralgia
Heme
Central Nervous System
Acknowledgment
70. Chronic Kidney Disease
Staging and Classification of Chronic Kidney Disease
Epidemiology of Chronic Kidney Disease
Screening for Chronic Kidney Disease
Stage 1
Stage 2
Stage 3
Stage 4
Stage 5
NKF KDOQI Guidelines for Chronic Kidney Disease Screening in Patients With Hypertension
In Patients With Hypertension Found to Have Chronic Kidney Disease
Measurement of Kidney Function
Use of Serum Creatinine
Creatinine Clearance Measurement by 24-Hour Urine Collection
Cystatin C
Management of Chronic Kidney Disease Progression
KDOQI Action Plan by Stage of Chronic Kidney Disease
Renal Protection
Control of Blood Pressure
Adjunctive Strategies in Retarding Progression
Complications of Chronic Kidney Disease
Anemia
Erythropoiesis-Stimulating Agents
Iron Supplementation to Treat Chronic Kidney Disease Anemia
Sexual Dysfunction
Male Sexual Dysfunction
Female Sexual Dysfunction
Amenorrhea in Women With Chronic Kidney Disease
Definition of CKD-MBD
Definition of Renal Osteodystrophy
Metabolic Bone Disease
Hyperphosphatemia
Renal Bone Disease
71. Essential and Secondary Hypertension
Definition of Hypertension
Primary Hypertension
Management of Hypertension
Common
Uncommon
Clinical Clues for Secondary Hypertension
Lifestyle Modifications
Pharmacotherapy
Hypertension Syndromes
Hypertension Emergencies
Malignant Hypertension
Resistant Hypertension
Endocrine Hypertension Syndromes
Primary Aldosteronism
Cushing Syndrome
Pheochromocytoma
Measure Blood Pressure (BP) Accurately
Consider “White Coat Hypertension”
Consider Pseudoresistance
Consider Secondary Causes
ACTH Dependent
ACTH Independent
Hypertension in the Elderly
Hypertension in Diabetic Patients
Hypertension in Pregnancy
Chronic Hypertension
Preeclampsia
Management of Mild Preeclampsia
Management of Severe Preeclampsia
Eclampsia
Management of Eclampsia
Gestational Hypertension
Renovascular Hypertension
Major Causes
Minor Causes
72. Urinalysis
Practical Aspects to Specimen Collection
Physical Properties of Urine
Chemical Properties of Urine
Specific Gravity
Urine pH
Glucose
Ketones
Protein
Summary of Key Points in Proteinuria
Blood
Summary of Key Points on Positive Dipstick for Blood
Leukocyte Esterase and Nitrites
Microscopic Examination
Cells
Casts
Crystals
Lipids
Organisms
Urinalysis Patterns in Kidney Disease
Heavy Proteinuria With Fatty Casts or Bland Sediment
Dysmorphic Red Blood Cells or Red Blood Cell Casts With Proteinuria
Hematuria With Dysmorphic Red Blood Cells and Pyuria
Isolated Hyaline Casts
Isolated Hematuria With Monomorphic Red Blood Cells
Renal Tubular Epithelial Cells, Epithelial Cell Casts, and Granular Casts
White Blood Cells, White Blood Cell Casts, Granular Casts, and Mild Proteinuria
Dipstick Urinalysis Screening
Acknowledgments
73. Board Simulation: Nephrology and Hypertension
74. Nephrology Summary
Diabetic Nephropathy
Clinical Features
Pathology
Diagnosis
Treatment and Prognosis
Lifestyle Changes
Optimize Glycemic Control
Optimize Hypertension Management
Low-Protein Diet (Controversial)
Hypertensive Nephropathy/Nephrosclerosis
Clinical Features and Diagnosis
Pathogenesis
Pathology
Treatment and Prognosis
Cystic Diseases of the Kidney
Autosomal Dominant Polycystic Kidney Disease
Autosomal Dominant Tubulointerstitial Kidney Disease
Medullary Sponge Kidney
Renal Cell Cancer
Nephrolithiasis
Management of Kidney Stones
Section 7. Digestive Diseases and Disorders of the Pancreas and Liver
75. Esophageal Disorders
Esophageal Anatomy and Physiology
The Symptoms of Esophageal Disease
Gastroesophageal Reflux Disease
Epidemiology
Clinical Findings
Diagnosis
Upper Endoscopy
Intraesophageal Ambulatory pH Monitoring
Multichannel Intraluminal Impedance
Management
Clinical Course and Prognosis
Barrett Esophagus
Esophageal Structural Abnormalities
Rings and Webs
Esophageal Diverticula
Inflammatory and Infectious Disorders
Eosinophilic Esophagitis
Pill Esophagitis
Infectious Causes of Esophagitis
Esophageal Motility Disorders
Achalasia
Diffuse Esophageal Spasm
Ineffective Esophageal Motility
Hypertensive Peristalsis (Nutcracker Esophagus)
Scleroderma
Questions
76. Peptic Ulcer Disease
Pathophysiology
Causes of Peptic Ulcer Disease
Helicobacter pylori
Nonsteroidal Antiinflammatory Drugs
Zollinger-Ellison Syndrome (Gastrinoma)
Other Causes of Gastroduodenal Ulcers
Clinical Presentation
Diagnostic Evaluation of Peptic Ulcer Disease
Testing for Helicobacter pylori
Endoscopic and Radiographic Evaluation
Treatment of Peptic Ulcer Disease
Antisecretory Therapy
Proton-Pump Inhibitors
H2-Receptor Antagonists
Helicobacter pylori Eradication Therapy
Endoscopic Treatment of Peptic Ulcer Disease
Surgical Treatment of Peptic Ulcer Disease
Follow-up of Peptic Ulcer Disease
77. Diarrhea and Malabsorption
Normal Intestinal Physiology
Acute Diarrhea
Etiology
Evaluation
Physical Examination
Initial Laboratory Evaluation
Stool Studies
Radiologic Evaluation
Endoscopic Evaluation
Bacteria
Viruses
Protozoa
Treatment
Supportive Therapy
Antidiarrheal Agents
Empiric Antibiotic Therapy
Chronic Diarrhea
Etiology
Osmotic Diarrhea
Secretory Diarrhea
Steatorrheal Diarrhea
Inflammatory Diarrhea
Dysmotility Diarrhea
Osmotic Causes
Secretory Causes
Steatorrheal (Fatty) Causes
Inflammatory Causes
Evaluation
History
Physical Examination
Initial Evaluation
Additional Laboratory Tests
Endoscopic Evaluation
Additional Testing
Approach to Evaluation Based on Pathophysiologic Mechanism
Treatment
78. Inflammatory Bowel Disease
Epidemiology
Pathology
Ulcerative Colitis
Crohn Disease
Clinical Presentation
Ulcerative Colitis
Complications
Laboratory Findings
Endoscopic and Radiographic Findings
Crohn Disease
Ileocolitis
Colitis and Perianal Disease
Jejunoileitis
Gastroduodenal Disease
Complications
Laboratory Findings
Endoscopic and Radiographic Findings
Complications
Serologic Markers
Differential Diagnosis of Ulcerative Colitis and Crohn Disease
Indeterminate Colitis
Atypical Colitides
Infectious
Bacterial
Mycobacterial
Parasitic
Viral
5-Aminosalicylic Acid Agents
Extraintestinal Manifestations
Treatment
Glucocorticoids
Antibiotics
Azathioprine and Mercaptopurine
Methotrexate
Cyclosporine
Anti–Tumor Necrosis Factor Therapy
Inhibitors of Leukocyte Adhesion
Interleukin Antagonists
Small Molecules
Janus kinase Inhibitors
Sphingosine 1-phosphate receptor modulators
Nutritional Therapies
Surgical Therapy
Ulcerative Colitis
Crohn Disease
Small Intestinal Disease
Colorectal Disease
Distal Ulcerative Colitis
Extensive Ulcerative Colitis
Inflammatory Crohn Disease
Fistulizing Crohn Disease
Ulcerative Colitis
Crohn Disease of Small Intestine
Crohn Disease of Colon and Rectum
Cancer in Inflammatory Bowel Disease
79. Pancreatic Disease
Acute Pancreatitis
Pathogenesis
Etiology
Clinical Presentation
Diagnosis
Disease Classification
Determination of Severity
Treatment Considerations
Nutritional Support
Antibiotic Prophylaxis
Treatment of Pancreatic Necrosis
Role of ERCP
Prognosis and Aftercare
Chronic Pancreatitis
Pathogenesis
Etiology
Clinical Features
Diagnosis
Imaging Studies
Functional Testing
Treatment
Exocrine Insufficiency
Pain Management
Complications and Prognosis
Pancreatic Neoplasms
Pancreatic Ductal Carcinoma
Pathogenesis
Diagnosis and Staging
Treatment of Resectable Disease
Management of Unresectable Disease
Cystic Neoplasms
Diagnostic Techniques
Mucinous Cystic Neoplasms
Intraductal Papillary Mucinous Neoplasms
Serous Cystadenomas
Solid Pseudopapillary Neoplasms
80. Liver Disease
Serum Transaminases
Disease Testing
Alkaline Phosphatase
Gamma-Glutamyl Transpeptidase
5′-Nucleotidase
Bilirubin
Unconjugated
Conjugated
Albumin and Gamma-Globulins
Prothrombin Time
Antimitochondrial Antibody
Serum Ceruloplasmin
Serum Ferritin
Antismooth Muscle Antibodies
Antinuclear Antibody
Lactate Dehydrogenase
Ultrasound
Computed Tomography and Magnetic Resonance Imaging
Enhanced Magnetic Resonance Cholangiography
Liver Biopsy
Noninvasive Markers of Fibrosis
81. Cirrhosis
Causes of Cirrhosis
Clinical Features of Cirrhosis
Complications of Cirrhosis
Ascites
Diagnostic Evaluation of Ascites
Treatment of Ascites
Complications of Ascites
Portal Hypertension
Hepatorenal Syndrome
Hepatic Encephalopathy
Clinical Features of Hepatic Encephalopathy
Laboratory Abnormalities in Hepatic Encephalopathy
Common Precipitants of Hepatic Encephalopathy
Treatment of Hepatic Encephalopathy
Pulmonary Abnormalities in Cirrhosis
Hepatopulmonary Syndrome
Portopulmonary Hypertension
Hepatic Hydrothorax
Hepatocellular Cancer
Prognosis of Cirrhosis
Treatment of Cirrhosis
82. Hepatitis B and C
Hepatitis B
Natural History and Clinical Manifestations
Acute Hepatitis B Virus Infection
Chronic Hepatitis B Virus Infection
Extrahepatic Manifestations
Hepatitis D
Diagnosis
Management
Acute Hepatitis B
Chronic Hepatitis B
Interferon
Nucleos(t)ide Analogues
Virology
Hepatitis C
Natural History
Acute Hepatitis C
Chronic Hepatitis C
Extrahepatic Manifestations of Hepatitis C Virus Infection
Diagnosis
Management
83. Board Simulation: Gastroenterology
84. Hepatology Summary
Acute Hepatitis
Infectious Causes of Hepatitis
Autoimmune Hepatitis
Cholestasis
Primary Biliary Cholangitis
Spectrum of Presentations
Extrahepatic Manifestations
Criteria for Diagnosis
Treatment
Primary Sclerosing Cholangitis
Description
Manifestations
Criteria for Diagnosis
Treatment
Clinical Features
Criteria for Diagnosis
Differential Diagnosis
Complications
Treatment
Criteria for Diagnosis
Special Features
Caveat
Treatment: Lifelong Therapy Required
Chronic Hepatitis
Conditions That Can Lead to Cirrhosis
Wilson Disease
Nonalcoholic Fatty Liver Disease
Alcoholic Liver Disease
Spectrum
Peripheral Manifestations
Treatment
Section 8. Cardiovascular Disease
85. Cardiac Examination
General
Eye Examination
Oral Cavity
General Skin Examination
Skeleton and Joints
Thyroid Gland
Jugular Venous Pressure
Carotid Artery Examination
Lung Examination
Abdominal Examination
Peripheral Arterial Examination
Heart Inspection
Auscultation of the Heart
Specific Valvular Conditions
Aortic Stenosis
Aortic Regurgitation
Mitral Stenosis
Mitral Regurgitation
Tricuspid Regurgitation
Tricuspid Stenosis
Pulmonic Stenosis and Regurgitation
Continuous Murmurs
Other Congenital Heart Disease Murmurs
Atrial Septal Defect
Ventricular Septal Defect
Innocent Murmur
Significance of Murmurs
Other Sounds
Pericardial Rub
Maneuvers
Murmur of Hypertrophic Cardiomyopathy
Prosthetic Heart Valves
Blood Pressure
86. Acute Coronary Syndromes
Pathophysiology
Diagnosis
Clinical Presentation
Physical Examination
Electrocardiogram
Cardiac Biomarkers
Cardiac-Specific Markers
Treatment
Basic Management
Management of ST-Segment Elevation Myocardial Infarction
Emergent Reperfusion
Fibrinolysis
Percutaneous Coronary Intervention
Immediate Medical Therapies for ST-Segment Elevation Myocardial Infarction
Absolute Contraindications
Relative Contraindications
Management of Non–ST-Segment Elevation Acute Coronary Syndromes
Immediate Medical Therapies for Non–ST-Segment Elevation Acute Coronary Syndromes
Additional Therapies
Cardiac Catheterization
Assign 1 Point for Each of the Following Factors, if Present
Sum the Points (Out of a Possible 7 Total) to Determine Risk
Complications
Cardiogenic Shock
Mechanical Complications
Dysrhythmias
Other Complications
Secondary Prevention
MINOCA
87. Valvular Heart Disease
Mitral Stenosis
Etiology and Pathology
Pathophysiology
Symptoms
Physical Examination
Laboratory Evaluation
Management
Mitral Regurgitation
Etiology and Pathology
Pathophysiology
Symptoms
Physical Examination
Laboratory Evaluation
Management
Aortic Stenosis
Etiology and Pathology
Pathophysiology
Symptoms/Natural History
Physical Examination
Laboratory Evaluation
Management
Clinical Indicators of Severe Aortic Stenosis
Physical Examination
Transthoracic Echocardiography
Indications for Aortic Valve Replacement
Aortic Regurgitation
Etiology and Pathology
Pathophysiology
Symptoms
Physical Examination
Laboratory Evaluation
Management
Tricuspid Stenosis
Etiology and Pathology
Pathophysiology
Symptoms
Physical Examination
Laboratory Evaluation
Management
Tricuspid Regurgitation
Etiology and Pathology
Pathophysiology
Symptoms
Physical Examination
Laboratory Evaluation
Management
Prosthetic Valves
88. Heart Failure
Introduction
Etiology and Precipitants of Heart Failure
Presenting Features and Evaluation of Heart Failure Symptoms
Signs
Laboratory Evaluation
Markers of Prognosis
Imaging and Hemodynamic Assessment
Acute Decompensated Heart Failure
Pharmacologic Treatment of Heart Failure With Reduced EF
Diuretics
ACE Inhibitors, ARBs, and ARNIs
Beta-Adrenergic Blockers
Aldosterone Antagonists
SGLT2 Inhibitors
Other Treatments
Mishaps of Medical Therapies
Device-Based Therapies
Implantable Electrical Devices
Transcatheter Mitral Valve Repair
Mechanical Circulatory Support
Heart Failure With Preserved Systolic Function
High-Output Heart Failure
Specific Cardiac Disorders Presenting With Heart Failure
Myocarditis
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
Stress Cardiomyopathy
Cardiac Amyloidosis
Restrictive Cardiomyopathy Versus Constrictive Pericarditis
Cor Pulmonale
89. Pericardial Disease
Acute Pericarditis
Etiology
Clinical Features
Management
Cardiac Tamponade
Etiology
Pathophysiology
Clinical Features
Management
Constrictive Pericarditis
Etiology
Pathophysiology
Clinical Features
Management
Effusive-Constrictive Pericarditis
90. Arrhythmias
Bradyarrhythmias
Sinus Node Dysfunction
Sinus Bradycardia
Tachycardia Bradycardia Syndrome
Sinoatrial Exit Block
Diagnosis and Treatment
Atrioventricular Conduction Disorders
First-Degree Atrioventricular Block
Second-Degree Atrioventricular Block, Mobitz Type I
Second-Degree Atrioventricular Block, Mobitz Type II
Third-Degree Atrioventricular Block
Diagnosis and Treatment
Supraventricular Tachyarrhythmias
Tachyarrhythmias Involving the Sinus Node
Inappropriate Sinus Tachycardia
Postural Orthostatic Tachycardia Syndrome
Sinus Node Reentry
Diagnosis and Treatment
Focal Atrial Tachycardia
Diagnosis and Treatment
Multifocal Atrial Tachycardia
Atrial Flutter
Diagnosis and Treatment
Atrial Fibrillation
Diagnosis and Treatment
Atrioventricular Nodal Reentry
Diagnosis and Treatment
Accessory Pathway–Dependent Tachycardia
Diagnosis and Treatment
Junctional Tachycardia
Diagnosis and Treatment
Ventricular Arrhythmias
Syndromes Associated With Ventricular Arrhythmias and Sudden Cardiac Death
Brugada Syndrome
Long QT Syndrome
Arrhythmogenic Right Ventricular Cardiomyopathy
Cardiomyopathies
Idiopathic Ventricular Tachycardia
Outflow Tract Tachycardia
Fascicular Ventricular Tachycardia
Diagnosis and Treatment
Ischemic Ventricular Tachycardia
Diagnosis and Treatment
Bundle Branch Reentry
Polymorphic Ventricular Tachycardia
Questions
91. Cardiovascular Disease Prevention
Hypercholesterolemia/Dyslipidemia
Normal Lipid Metabolism
The Cholesterol Hypothesis
Low-Density Lipoprotein Cholesterol
Monogenic Disorders Causing Hypercholesterolemia/Dyslipidemia
Disorders of Low-Density Lipoprotein
Disorders of Triglyceride-Rich Lipoproteins: Chylomicron and Very-Low-Density Lipoprotein
Disorders of High-Density Lipoprotein
Additional Nonstatin LDL-Lowering Therapies
Bempedoic Acid
Inclisiran
Evinacumab
Triglyceride-Lowering Therapies
Hypertension
Cigarette Smoking
Diabetes Mellitus
Emerging CV Risk Factors
High-Sensitivity C-Reactive Protein
Colchicine
Lipoprotein(a)
Polygenic risk score
92. Adult Congenital Heart Disease
Simple Lesions
Atrial Septal Defect
Simple Complexity
Moderate Complexity
Ventricular Septal Defect
Pulmonary Stenosis
Moderate Lesions
Coarctation of the Aorta
Tetralogy of Fallot
Ebstein Anomaly
Severe Lesions
Transposition of the Great Arteries
Single Ventricle and Fontan Circulation
Eisenmenger Syndrome
Summary
Questions
93. Peripheral Vascular Diseases
Peripheral Artery Disease
Clinical Manifestations of Peripheral Artery Disease
Differential Diagnosis
Management of Peripheral Artery Disease
Screening for Peripheral Artery Disease
Noninvasive Tests of Peripheral Artery Disease
Prognosis of Peripheral Artery Disease
Medical Treatment of Peripheral Artery Disease
Revascularization Treatment for Peripheral Artery Disease
Approach to Revascularization for Peripheral Artery Disease
Aortic Aneurysm and Dissection
Clinical Presentation
Management
Screening
Diagnosis
Treatment
Abdominal Aortic Aneurysm
Thoracic Aortic Aneurysm
Thoracic Aortic Dissection
Classification
Clinical Presentation
Management
Diagnosis
Treatment
Carotid Artery Disease
Classification
Clinical Presentation
Diagnosis
Management
Symptomatic Patients (Recent TIA or Minor Ischemic Stroke Within 6 Months)
Asymptomatic Patients
In All Patients
Renovascular Disease
Venous Insufficiency and Lymphedema
Venous Insufficiency
Lymphedema
Clinical Presentation
Management
Questions
94. Pulmonary Hypertension
Epidemiology
Pathophysiology
1 PAH
2 PH Due to Left Heart Disease
3 PH Due to Lung Diseases and/or Hypoxia
4 PH Due to Pulmonary Artery Obstructions
5 PH With Unclear and/or Multifactorial Mechanisms
Classification
Revised Hemodynamic Classification of PH
Group I: Pulmonary Arterial Hypertension
Group 2: Pulmonary Hypertension Caused by Left Heart Disease
Group 3: Pulmonary Hypertension Caused by Lung Disease or Hypoxemia
Group 4: Chronic Thrombotic Pulmonary Hypertension
Group 5: Pulmonary Hypertension Caused by Unknown or Multifactorial Mechanisms
Clinical Presentation
Diagnostic Evaluation
Focused History
Physical Examination
Office Testing
Echocardiography
Pulmonary Artery Catheterization
Adjunctive Studies
Management
Background Therapy
Diuretics
Oxygen
Anticoagulation
Rehabilitation and Exercise
Pregnancy and Reproductive Health
Immunization
Iron Supplementation
Psychosocial Care
Vasodilators
Calcium Channel Antagonists
Cyclic Guanosine Monophosphate Potentiators
Endothelin Receptor Antagonists
Prostacyclin Analogues
Combination Therapy
Lung Transplantation
Questions
95. Electrocardiogram Refresher
Electrocardiogram Fundamentals
P-Wave Abnormalities
Right Atrial Enlargement
Left Atrial Enlargement
Cardiac Conduction Abnormalities
Atrioventricular Conduction Abnormalities
First-Degree Atrioventricular Block
Second-Degree Atrioventricular Block
Third-Degree Atrioventricular Block
Atrioventricular Dissociation
Intraventricular Conduction Abnormalities
Right Bundle Branch Block
Incomplete Right Bundle Branch Block
Left Bundle Branch Block
Incomplete Left Bundle Branch Block
Hemiblocks
Bifascicular Block
Trifascicular Block
Ventricular Hypertrophy
Left Ventricular Hypertrophy
Right Ventricular Hypertrophy
Combined Ventricular Hypertrophy
Myocardial Infarction/Ischemia
Prior Transmural or Q Wave Infarction
Acute Myocardial Infarction
Myocardial Ischemia
Electrolyte Abnormalities
Hyperkalemia
Hypokalemia
Hypercalcemia
Hypocalcemia
Drug-Induced Electrocardiogram Changes
Acquired Long QT Syndrome
Digitalis Toxicity
Cardiac Drugs
Noncardiac Drugs
Tricyclic Antidepressant Poisoning
Miscellaneous Conditions
Chronic Obstructive Pulmonary Disease
Acute Pulmonary Embolism
Acute Pericarditis
Hypothermia
Central Nervous System Disorders
Atrial Septal Defects
Dextrocardia
96. Board Simulation: Cardiology
97. Cardiology Summary
Primary Prevention
Atherosclerotic Vascular Disease
Acute Coronary Syndrome
Valvular Heart Disease
Cardiac Arrhythmias
Congenital Heart Disease in Adults
Pulmonary Hypertension
Pericardial Disease
Cardiomyopathy and Congestive Heart Failure
COVID-19 and Cardiovascular Disease
Questions
Section 9. Neurology
98. The Neurologic Examination
Functional Neurologic Disorders
Neurologic Examination of the Awake/Interactive Patient
Mental Status
Psychiatric Examination
Neurologic Mental Status Examination
Cranial Nerves
I: Olfactory
II: Optic
III, IV, VI: Oculomotor, Trochlear, Abducens
V: Trigeminal
VII: Facial
VIII: Vestibulocochlear
IX, X: Glossopharyngeal, Vagus
XI: Spinal Accessory
XII: Hypoglossal
Motor
Appearance
Tone
Strength
Bradykinesia Testing
Sensation
Reflexes
Coordination
Gait
Neurologic Examination of the Less-Awake/Less-Interactive Patient
Mental Status
Cranial Nerves
Motor
Sensation
Reflexes
99. Stroke Prevention
Assessing the Risk of First Stroke: Recommendations
Nonmodifiable Risk Factors and Risk Assessment
Age
Low Birth Weight
Race/Ethnicity
Genetic Factors
Genetic Factors: Recommendations
Well-Documented and Modifiable Risk Factors
Physical Inactivity
Physical Activity: Recommendations
Dyslipidemia
Total Cholesterol
High-Density Lipoprotein Cholesterol
Triglycerides
Treatment of Dyslipidemia
Dyslipidemia: Recommendations
Diet and Nutrition
Diet and Nutrition: Recommendations
Hypertension
Hypertension: Recommendations
Obesity and Body Fat Distribution
Obesity and Body Fat Distribution: Recommendations
Diabetes Mellitus
Glycemic Control
Diabetes Mellitus and Hypertension
Lipid-Altering Therapy and Diabetes Mellitus
Diabetes Mellitus, Aspirin, and Stroke
Diabetes: Recommendations
Cigarette Smoking
Cigarette Smoking: Recommendations
Atrial Fibrillation
Risk Stratification in Patients With Atrial Fibrillation
Selecting Treatment to Reduce Stroke Risk in Patients With Atrial Fibrillation
Atrial Fibrillation: Recommendations
Other Cardiac Conditions
Acute Myocardial Infarction
Cardiomyopathy
Valvular Heart Disease
Patent Foramen Ovale and Atrial Septal Aneurysms
Cardiac Tumors
Aortic Atherosclerosis
Other Cardiac Conditions: Recommendations
Asymptomatic Carotid Artery Stenosis
Assessment of Carotid Stenosis
Endarterectomy for Asymptomatic Carotid Stenosis
Endovascular Treatment for Asymptomatic Carotid Stenosis
Screening of Asymptomatic Carotid Stenosis
Asymptomatic Carotid Stenosis: Summary and Gaps
Asymptomatic Carotid Stenosis: Recommendations
Sickle Cell Disease
Sickle Cell Disease: Recommendations
Migraine
Migraine: Recommendations
Metabolic Syndrome
Metabolic Syndrome: Recommendations
Alcohol Consumption
Alcohol Consumption: Recommendations
Sleep-Disordered Breathing
Sleep-Disordered Breathing: Recommendations
Hypercoagulability
Acquired Hypercoagulable State: Relationship to Ischemic Stroke
Hypercoagulability: Recommendations
Antiplatelet Agents for Primary Prevention of Stroke
Antiplatelet Agents and Aspirin: Recommendations
Conclusion
100. Neurocognitive Disorders
Alzheimer Disease
Overview
Clinical Presentation
Diagnostic Criteria
Workup
Structural Imaging
Additional Tests
Stages of Alzheimer Disease Dementia
Differential Diagnosis
Treatment of Alzheimer Disease
Cholinesterase Inhibitors
N-Methyl-D-Aspartate Antagonists
Mild Cognitive Impairment
Clinical Presentation
Workup
Structural Imaging
Functional Imaging
Differential Diagnosis
Treatment
Dementia With Lewy Bodies and Parkinson Disease Dementia
Differential Diagnosis
Features of Dementia With Lewy Bodies
Workup
Structural Imaging
Functional Imaging
Treatment
Other Parkinsonism Syndromes
Progressive Supranuclear Palsy
Corticobasal Degeneration
Vascular Dementia/Vascular Cognitive Impairment
Overview
Cardiovascular
Metabolic
Habits
Demographics
Clinical Features
Differential Diagnosis
Workup
Structural Imaging
Functional Imaging
Treatment
Frontotemporal Dementia
Overview
Differential Diagnosis
Workup
Structural Imaging
Functional Imaging
Treatment
Limbic-Predominant Age-Related TDP-43 Encephalopathy (LATE)
Overview
Differential Diagnosis
Workup
Structural Imaging
Functional Imaging
Treatment
101. Seizure Disorders
Classification
Clinical Diagnoses
Differential Diagnosis
Diagnostic Studies and Evaluation
Management
Initiating treatment
Nonspecific
Specific
Neurodevelopmental Problems
Acquired Pathology (Secondary to Trauma, Stroke, or Infection)
Foreign Tissue
Vascular Malformation
Choosing the Right AED Regimen
Refractory and Recurrent Seizures
Stopping Medications
Management of Epilepsy During Pregnancy
Social and Legal Issues
102. Board Simulation: Neurology
103. Neurology Summary
Evaluation of Weakness
Evaluation of Sensory Symptoms
Evaluation of Visual Symptoms
Common Neurologic Conditions
Seizures
Headache
Infectious Neurologic Syndromes
Ischemic Stroke
Intracerebral Hemorrhage
Guillain-Barré Syndrome
Myasthenia Gravis
Peripheral Neuropathies
Amyotrophic Lateral Sclerosis
Dementia, Delirium, and Other Cognitive Impairments
Parkinsonism, Tremor, and Other Movement Disorders
Multiple Sclerosis and Other Demyelinating Diseases
Dizziness and Vertigo
Peripheral
Central
Benign Paroxysmal Positional Vertigo (BPPV)
Vestibular Neuronitis and Labyrinthitis
Cervicogenic Vertigo
Ménière Disease
Migraine
Vertebrobasilar Insufficiency Transient Ischemic Attacks
Multiple Sclerosis (MS)
Section 10. General Internal Medicine
104. Preoperative Evaluation and Management Before Major Noncardiac Surgery
American College of Cardiology/American Heart Association Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery
Risk Assessment
Percutaneous Coronary Intervention Before Surgery and Management After Percutaneous Coronary Intervention
Beta-Blockers
Statins
Aspirin
Bridging Anticoagulation
Bacterial Endocarditis Prophylaxis
Glucocorticoids in Surgical Patients
Pulmonary Risk Factors and Risk Reduction
Questions
105. Basic Principles of Epidemiology and Biostatistics
Screening for Disease Control
Question 1
Validity and Yield of a Screening Test
What Influences the Sensitivity, Specificity, and Predictive Value?
Bias in the Interpretation of Screening Results
Measurement of Data: Measures of Disease Frequency and Measures of Association
Question 2
Measures of Disease Frequency
Calculation of Measures of Disease Frequency
Question 3
Measures of Association
Calculation of Measures of Association
Question 4
Overview of Epidemiological Study Designs and the Interpretation of Study Results
Question 5
What Kind of Study Design Was This?
What Is the Magnitude of the Association Between the Exposure and the Outcome?
Is This Observed Association Valid?
Question 5a
Question 5b
106. Contraception
Efficacy of Contraceptive Methods
Long-Acting Reversible Contraception
Short-Acting Hormonal Contraception
Combined Hormonal Contraception
Short-Acting Progestin-Only Contraception
Barrier Methods
Emergency Contraception
Eligibility for Contraceptive Methods
Special Populations
Adolescents
Obese Patients
History of Cancer
Individuals History of Breast Cancer
Other Malignancies
Other Medical Problems
Questions
107. Board Simulation:: Women’s Health
Questions
108. Dermatology for the Internist
Premalignant and Malignant Skin Neoplasms
Nonmelanoma Skin Cancers
Melanoma
Benign Skin Growths
Nevi
Seborrheic Keratosis
Acrochordon
Keratin-Filled Cysts
Acne and Rosacea
Acne Pathogenesis and Therapy
Rosacea/Periorificial Dermatitis
Dermatitis
Atopic Dermatitis
Contact Dermatitis
Drug Rashes
Autoimmune Connective Tissue Diseases
Lupus Erythematosus
Autoimmune Disorders of Skin Thickening
Dermatomyositis
Papulosquamous Diseases
Pigmentary Disorders
Bullous Disorders
Hair and Nails
Coronavirus Disease 2019 (COVID-19)
Questions
109. Occupational Medicine
Occupational Medicine Epidemiology
Occupational Medicine History
Disability and Return to Work Authorization
Organs-Based Highlights of Occupational Illnesses and Diseases
Musculoskeletal and Peripheral Nervous System
Special Senses
Immune System
Respiratory System (Upper and Lower)
Cardiovascular System
Gastrointestinal and Renal Systems
Reproductive System
Central Nervous System
Psychological Stressors, Mental and Behavioral Illness, and Substance Abuse
Occupational Medicine During the Pandemic
Summary
110. Allergy and Immunology
Allergic Rhinitis and Conjunctivitis
Asthma
Immunotherapy for the Treatment of Allergic Asthma and Rhinoconjunctivitis
Asthma and Aspirin Sensitivity: Aspirin-Exacerbated Respiratory Disease
Urticaria and Angioedema
Angioedema
Allergic Bronchopulmonary Aspergillosis
Food Allergy
Anaphylaxis
Hymenoptera Allergy and Anaphylaxis
Management of Anaphylaxis
Exercise-Induced Anaphylaxis
Adverse Reactions to Medications
Mastocytosis and Mast Cell Activation Syndromes
Immunodeficiencies
Questions
111. Psychiatry Essentials
Depression
Diagnosis
Screening for Depression
Suicide
Suicide Risk Assessment
Managing Risk of Suicide
Treatment of Depression in Adults
Psychotherapy
Antidepressant Medications
Psychopharmacologic Approaches to Refractory Depression
Adjunctive Antidepressant Treatment With Esketamine
Bipolar Disorder
Distinguishing Unipolar and Bipolar Depression
Treatment and Prevention of Bipolar Disorder
Treatment of Bipolar Depression
Lithium
Lamotrigine
Atypical Antipsychotics
Clinical Manifestations
Acute Treatment
Anxiety Disorders
Panic Disorder
Generalized Anxiety Disorder
Clinical Manifestations and Diagnosis
Drug Therapy
Psychotherapy in the Treatment of Panic Disorder and Generalized Anxiety Disorder
Treatment of Generalized Anxiety Disorder
Schizophrenia and Related Disorders
Antipsychotic Medications
Somatization
Somatization Disorder
Treatment of Somatic Symptom Disorders
Delirium
Clinical Features
Approach to the Patient
Management
Medication Management
112. Geriatrics
Frailty and Multimorbidity
Polypharmacy
Dementia
Background
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
Delirium
Background
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
Late-Life Depression
Background
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
Urinary Incontinence
Background
Epidemiology
Pathophysiology
Clinical Presentation
Diagnosis
Treatment
Falls
Background
Epidemiology
Risk Factors
Evaluation
Management
Hypertension in Older Adults
Pain Management in Older Adults
Health Screening in Older Adults
Perioperative Issues in the Elderly
113. Palliative Care
Introduction
Communication
Ask-Tell-Ask3
Deepening the Conversation
Responding to Emotion
Goals of Care Discussion
REMAP Model of Goals of Care Discussion3
Pain
Pain Assessment
Initial Opioid Prescribing
Long-Acting Opioids
Example 1: Opioid Escalation
Opioid Conversion
Example 2: Equianalgesic Conversion
Opioid Toxicity
Buprenorphine and Methadone
Adjuvant Pain Medications
Procedural Pain Interventions
Nausea and Vomiting
Nausea Mechanisms
Nausea Treatment
Dyspnea
Anorexia
Fatigue
Palliative Care in Clinical Practice
Palliative Care in Hospitalized Patients
Palliative Care in the ICU
Palliative Care in Ambulatory Practice
Congestive Heart Failure
Chronic Kidney Disease
Oncology
Summary
114. Board Simulation:: General Internal Medicine
115. Internal Medicine Health Screening Strategies
Cancer Screening
Breast Cancer
Cervical Cancer
Prostate Cancer
Colorectal Cancer
Lung Cancer
Cardiovascular Screening
Hypertension
Abdominal Aortic Aneurysm
Cholesterol/Lipid Screening
Cardiovascular Screening
Diabetes Mellitus
Lifestyle Factors
Obesity
Alcohol and Tobacco Abuse
Infectious Disease/Sexually Transmitted Infections
Human Immunodeficiency Virus
Hepatitis C Virus
Osteoporosis
Section 11. Board Practice
116. Approach to the Internal Medicine Board Examination
Acknowledgment
117. Board Practice 1
Questions
Answers
118. Board Practice 2
119. Board Practice 3
Section 12. Q&A Section - ONLINE ONLY
E1. Infectious Diseases
E2. Hematology and Oncology
E3. Rheumatology
E4. Pulmonary and Critical Care Medicine
E5. Endocrinology
E6. Nephrology and Hypertension
E7. Gastroenterology
E8. Cardiovascular Disease
E9. General Internal Medicine
Index

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Ajay K. Singh

Joseph Loscalzo

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