Primary Care Medicine : Office Evaluation and Management of the Adult Patient

by Goroll, Allan H.

• ISBN13: 9780397511303
• ISBN10: 0397511302
• Format: Hardcover
• Copyright: 1995-01-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS

Summary

This is the innovative resource for up-to-the-minute, reliable guidance on managing a full range of frequently seen problems. From cost-effective diagnostic strategies, current treatment recommendations, and indications for referral and hospital admissions, to information on screening, patient education compliance, and continuity of care... you'll quickly find solid, evidence-based answers to your most pressing questions. And, you'll never have to search through back issue disks because each new quarterly update disk is cumulative and complete with:

Table of Contents

Contributors	p. xiii
Preface	p. xix
Acknowledgments	p. xxi
Principles of Primary Care	p. 1
The Practice of Primary Care
The Tasks of Primary Care	p. 1
Approaches to Encouraging Compliance	p. 5
Approaches to Common Ethical and Legal Issues in Primary Care Practice	p. 6
Selection and Interpretation of Diagnostic Tests	p. 9
Health Maintenance and the Role of Screening	p. 14
Estimating and Communicating Risk and Prognosis	p. 17
Choosing among Treatment Options	p. 19
Immunization	p. 21
Systemic Problems	p. 37
Screening for HIV-1 Infection	p. 37
Evaluation of Chronic Fatigue	p. 41
Evaluation of Weight Loss	p. 47
Evaluation of Overweight and Obesity	p. 51
Evaluation of Fever	p. 57
Evaluation of Lymphadenopathy	p. 63
Approach to the Patient with HIV-1 Infection	p. 67
Cardiovascular Problems	p. 80
Screening for Hypertension	p. 80
Screening for Hyperlipidemia	p. 83
Bacterial Endocarditis Prophylaxis	p. 87
Rheumatic Fever Prophylaxis	p. 90
Exercise for Prevention of Cardiovascular Disease	p. 92
Evaluation of Hypertension	p. 101
Evaluation of Chest Pain	p. 108
Evaluation of the Asymptomatic Systolic Murmur	p. 120
Evaluation of Leg Edema	p. 125
Evaluation of Arterial Insufficiency of the Lower Extremities	p. 129
Evaluation of Syncope	p. 133
Evaluation of Palpitations	p. 141
Evaluation of Atrial Fibrillation in the Outpatient Setting	p. 146
Management of Hypertension	p. 149
Coronary Heart Disease Risk Factor Prediction Chart	p. 164
Approach to the Patient with Hypercholesterolemia	p. 164
Outpatient Management of Atrial Fibrillation	p. 179
Management of Ventricular Irritability in the Ambulatory Setting	p. 186
Management of Chronic Stable Angina	p. 194
Cardiovascular Rehabilitation and Secondary Prevention of Coronary Heart Disease	p. 208
Management of Chronic Congestive Heart Failure	p. 215
Potassium Supplementation in Congestive Heart Failure	p. 225
Management of Valvular Heart Disease	p. 227
Management of Hypertrophic Cardiomyopathy	p. 236
Management of Peripheral Arterial Disease	p. 236
Management of Peripheral Venous Disease	p. 242
Stress Testing	p. 249
Respiratory Problems	p. 257
Screening for Lung Cancer	p. 257
Tuberculosis Screening and Prophylaxis	p. 259
Evaluation and Prevention of Occupational and Environmental Respiratory Disease	p. 262
Evaluation of Chronic Dyspnea	p. 267
Evaluation of Chronic Cough	p. 271
Evaluation of Hemoptysis	p. 276
Evaluation of Pleural Effusions	p. 279
Evaluation of the Solitary Pulmonary Nodule	p. 284
Evaluation of Clubbing	p. 288
Approach to the Patient with Sleep Apnea	p. 290
Management of Chronic Obstructive Pulmonary Disease	p. 293
Management of Asthma	p. 304
Management of Tuberculosis	p. 316
Management of the Common Cold	p. 322
Management of Sarcoidosis	p. 326
Evaluation of Interstitial Lung Disease	p. 330
Approach to the Patient with Acute Bronchitis or Pneumonia in the Ambulatory Setting	p. 333
Approach to the Patient with Lung Cancer	p. 342
Smoking Cessation	p. 348
Gastrointestinal Problems	p. 357
Screening for Gastric Cancer	p. 357
Screening for Colorectal Cancer	p. 359
Examination of the Anorectum and Sigmoid Colon with Digital Rectal Examination, Anoscopy, and Sigmoidoscopy	p. 363
Prevention of Viral Hepatitis	p. 368
Evaluation of Abdominal Pain	p. 375
Evaluation of Nausea and Vomiting	p. 384
Evaluation of Dysphagia and Suspected Esophageal Chest Pain	p. 389
Approach to the Patient with Heartburn and Reflux (Gastroesophageal Reflux Disease)	p. 394
Evaluation of Jaundice	p. 399
Evaluation of the Patient with an Incidental Asymptomatic Elevation in Serum Transaminase (Aminotransferase) Levels	p. 403
Evaluation of Gastrointestinal Bleeding	p. 404
Evaluation and Management of Diarrhea	p. 408
Approach to the Patient with Constipation	p. 420
Approach to the Patient with Anorectal Complaints	p. 425
Management of Hemorrhoids	p. 430
Approach to the Patient with an External Hernia	p. 431
Management of Peptic Ulcer Disease	p. 434
Management of Asymptomatic and Symptomatic Gallstones	p. 447
Management of Hepatitis	p. 453
Management of Cirrhosis and Chronic Liver Failure	p. 463
Management of Pancreatitis	p. 470
Management of Inflammatory Bowel Disease	p. 474
Approach to the Patient with Functional Gastrointestinal Disease	p. 484
Management of Diverticular Disease	p. 493
Management of Gastrointestinal Cancers	p. 496
Hematologic and Oncologic Problems	p. 506
Hematology	p. 506
Screening for Anemia	p. 506
Screening for Sickle Cell Disease and Sickle Cell Trait	p. 507
Evaluation of Anemia	p. 509
Evaluation of Erythrocytosis (Polycythemia)	p. 518
Evaluation of Bleeding Problems and Abnormal Bleeding Studies	p. 522
Management of Common Anemias	p. 531
Outpatient Oral Anticoagulant Therapy	p. 536
Approach to the Patient with Lymphoma	p. 541
Oncology	p. 550
Approach to the Patient with Metastatic Tumor of Unknown Origin	p. 550
Approach to Staging and Monitoring	p. 555
Comprehensive Care of the Cancer Patient	p. 559
Principles of Cancer Drug Therapy	p. 564
Principles of Radiation Therapy	p. 571
Management of Chronic Cancer Pain and Palliative Care	p. 576
Management of Chronic Cancer Pain	p. 576
Pallitative Care	p. 583
Managing the Gastrointestinal Complications of Cancer and Cancer Treatment	p. 588
Complications of Cancer: Oncologic Emergencies and Paraneoplastic Syndromes	p. 593
Endocrinologic Problems	p. 598
Screening for Diabetes Mellitus	p. 598
Screening for Thyroid Cancer	p. 601
Evaluation of Thyroid Nodules	p. 604
Approach to the Patient with Hypercalcemia	p. 609
Evaluation of Hypoglycemia	p. 614
Evaluation of Hirsutism	p. 619
Evaluation of Gynecomastia	p. 623
Evaluating Galactorrhea and Hyperprolactinemia	p. 625
Evaluation of Suspected Diabetes Insipidus	p. 628
Approach to the Patient with Diabetes Mellitus	p. 630
Approach to the Patient with Hyperthyroidism	p. 646
Approach to the Patient with Hypothyroidism	p. 654
Glucocorticoid Therapy	p. 660
Gynecologic Problems	p. 667
Screening for Breast Cancer	p. 667
Screening for Cervical Cancer	p. 671
Screening for Ovarian Cancer	p. 674
Screening for Endometrial Cancer	p. 676
Vaginal Cancer and Other Effects of Diethylstilbestrol Exposure	p. 678
Approach to the Woman with Abnormal Vaginal Bleeding	p. 680
Evaluation of Secondary Amenorrhea	p. 685
Evaluation of Breast Masses and Nipple Discharges	p. 691
Evaluation of Vulvar Pruritus	p. 693
Medical Evaluation of Female Sexual Dysfunction	p. 695
Approach to the Patient with Menstrual or Pelvic Pain	p. 698
Approach to the Patient with a Vaginal Discharge	p. 702
Approach to the Menopausal Woman	p. 707
Approach to Fertility Control	p. 713
Approach to the Infertile Couple	p. 721
Approach to the Woman with an Unplanned Pregnancy	p. 727
Management of Breast Cancer	p. 730
Management of the Woman with Genital Tract Cancer	p. 734
Genitourinary Problems	p. 739
Screening for Syphilis	p. 739
Screening for Chlamydial Infection	p. 741
Screening for Prostate Cancer	p. 743
Screening for Asymptomatic Bacteriuria and Urinary Tract Infection	p. 747
Screening for Cancers of the Lower Urinary Tract	p. 749
Evaluation of the Patient with Hematuria	p. 751
Evaluation of the Patient with Proteinuria	p. 754
Evaluation of Scrotal Pain, Masses, and Swelling	p. 759
Medical Evaluation and Management of Erectile Dysfunction	p. 761
Approach to Dysuria and Urinary Tract Infections in Women	p. 770
Approach to Incontinence and Other Forms of Lower Urinary Tract Dysfunction	p. 776
Approach to the Patient with Nephrolithiasis	p. 782
Approach to the Male Patient with Urethritis	p. 787
Approach to the Patient with Gonorrhea	p. 790
Approach to Benign Prostatic Hyperplasia	p. 794
Management of Acute and Chronic Prostatitis	p. 798
Management of Urinary Tract Infection in Men	p. 802
Management of Syphilis and Other Sexually Transmitted Diseases	p. 805
Management of the Patient with Chronic Renal Failure	p. 808
Management of Genitourinary Cancers in Men	p. 813
Musculoskeletal Problems	p. 821
Screening for Osteoporosis	p. 821
Evaluation of Acute Monoarticular Arthritis	p. 823
Evaluation of Polyarticular Complaints	p. 827
Evaluation of Back Pain	p. 835
Evaluation of Neck Pain	p. 844
Approach to the Patient with Muscle Cramps	p. 847
Approach to the Patient with Shoulder Pain	p. 850
Evaluation of Hip Pain	p. 857
Evaluation of Knee Pain	p. 860
Approach to Minor Orthopedic Problems of the Elbow, Wrist, and Hand	p. 864
Approach to Minor Orthopedic Problems of the Foot and Ankle	p. 868
Approach to the Patient with Asymptomatic Hyperuricemia	p. 873
Management of Rheumatoid Arthritis	p. 876
Management of Osteoarthritis	p. 888
Management of Gout	p. 894
Approach to the Patient with Fibromyalgia	p. 899
Approach to the Patient with Lyme Disease	p. 903
Approach to the Patient with Polymyalgia Rheumatica or Temporal Arteritis	p. 911
Management of Paget's Disease	p. 915
Approach to the Patient with Raynaud's Phenomenon	p. 919
Prevention and Management of Osteoporosis	p. 922
Neurologic Problems	p. 931
Approach to the Patient with Headache	p. 931
Evaluation of Dizziness	p. 941
Focal Neurologic Complaints: Evaluation of Nerve Root and Peripheral Nerve Syndromes	p. 947
Evaluation of Tremor	p. 954
Evaluation of Dementia	p. 956
Approach to the Patient with a Seizure	p. 962
Management of Transient Ischemic Attack and Asymptomatic Carotid Bruit	p. 970
Management of Multiple Sclerosis	p. 975
Management of Alzheimer's Disease and Related Dementias	p. 978
Use of Psychotropic Drugs in the Elderly	p. 984
Approach to the Patient with Parkinson's Disease	p. 986
Management of Bell's Palsy (Idiopathic Facial Mononeuropathy)	p. 991
Management of Tic Douloureux (Trigeminal Neuralgia)	p. 993
Dermatologic Problems	p. 995
Screening for Skin Cancers	p. 995
Evaluation of Pruritus	p. 1001
Evaluation of Purpura	p. 1005
Evaluation of Disturbances in Pigmentation	p. 1008
Evaluation of Urticaria and Angioedema	p. 1011
Approach to the Patient with Hair Loss	p. 1015
Disturbances of Skin Hydration: Dry Skin and Excessive Sweating	p. 1019
Management of Dry Skin	p. 1019
Approach to Excessive Sweating	p. 1021
Approach to the Patient with Dermatitis	p. 1023
Atopic or Contact Dermatitis	p. 1023
Management of Seborrheic Dermatitis	p. 1025
Management of Acne	p. 1027
Management of Rosacea and Other Acneiform Dermatoses	p. 1030
Management of Psoriasis	p. 1033
Management of Intertrigo and Intertriginous Dermatoses	p. 1037
Management of Corns and Calluses	p. 1039
Approach to Bacterial Skin Infections	p. 1040
Cellulitis	p. 1040
Management of Pyoderma	p. 1042
Management of Superficial Fungal Infections	p. 1045
Management of Cutaneous and Genital Herpes Simplex	p. 1049
Management of Herpes Zoster	p. 1054
Management of Warts	p. 1056
Management of Scabies and Pediculosis	p. 1060
Management of Skin Trauma: Bites and Burns	p. 1063
Animal and Human Bites	p. 1063
Management of Minor Burns	p. 1065
Management of Skin Ulceration	p. 1067
Minor Surgical Office Procedures for Skin Problems	p. 1070
Ophthalmic Problems	p. 1075
Screening for Open-angle Glaucoma	p. 1075
Evaluation of the Red Eye	p. 1076
Evaluation of Impaired Vision	p. 1081
Evaluation of Eye Pain	p. 1085
Evaluation of Dry Eyes	p. 1087
Evaluation of Common Visual Disturbances: Flashing Lights, Floaters, and Other Transient Phenomena	p. 1089
Evaluation of Exophthalmos	p. 1091
Evaluation of Excessive Tearing	p. 1093
Management of the Patient with Age-Related Macular Degeneration	p. 1094
Management of Glaucoma	p. 1096
Management of Cataracts	p. 1098
Management of Diabetic Retinopathy	p. 1100
Corrrection of Vision	p. 1103
Contact Lenses	p. 1103
Refractive Surgery	p. 1104
Ear, Nose and Throat Problems	p. 1106
Screening for Oral Cancer	p. 1106
Evaluation of Hearing Loss	p. 1108
Approach to Epistaxis	p. 1112
Evaluation of Facial Pain and Swelling	p. 1115
Evaluation of Smell and Taste Disturbances	p. 1117
Approach to the Patient with Hoarseness	p. 1120
Evaluation of Tinnitus	p. 1123
Approach to the Patient with Otitis	p. 1125
Approach to the Patient with Sinusitis	p. 1127
Approach to the Patient with Pharyngitis	p. 1131
Approach to the Patient with Hiccups	p. 1135
Approach to the Patient with Chronic Nasal Congestion and Discharge	p. 1137
Approach to the Patient with Excessive Snoring	p. 1143
Management of Aphthous Stomatitis	p. 1144
Management of Temporomandibular Joint Dysfunction	p. 1145
Psychiatric and Behavioral Problems	p. 1147
Approach to the Patient with Anxiety	p. 1147
Strategies for Stress Management	p. 1155
Approach to the Patient with Depression	p. 1157
Approach to the Patient with Alcohol Abuse	p. 1169
Approach to the Patient with Sexual Dysfunction	p. 1178
Approach to the Somatizing Patient	p. 1183
Approach to the Angry Patient	p. 1187
Approach to the Patient with Insomnia	p. 1188
Management of Obesity	p. 1193
Approach to Eating Disorders	p. 1205
Approach to the Substance-abusing Patient	p. 1211
Approach to the Patient with Chronic Nonmalignant Pain	p. 1217
Screening for Domestic Violence	p. 1226
Allied Fields	p. 1227
Alternative/Complementary Therapies: Evidence-Based Guides	p. 1227
Caring for the Adolescent Patient	p. 1233
Index	p. 1237
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