Everand Logo

Welcome to Everand!

  • Discover millions of ebooks, audiobooks, and so much more with a free trial

    Only $11.99/month after trial. Cancel anytime.

    Internal Medicine Bulletpoints Handbook: Intended For Healthcare Practitioners and Students at all Levels
    Internal Medicine Bulletpoints Handbook: Intended For Healthcare Practitioners and Students at all Levels
    Internal Medicine Bulletpoints Handbook: Intended For Healthcare Practitioners and Students at all Levels
    Ebook193 pages2 hours

    Internal Medicine Bulletpoints Handbook: Intended For Healthcare Practitioners and Students at all Levels

    By Robert M. Gullberg M.D., FACP

    5/5

    ()

    Read preview

    About this ebook

    Dr. Robert Gullberg is Board Certified in Internal Medicine and has three decades of clinical experience. He knows how to communicate the intricacies of Internal Medicine to medical students, PA students, and nursing students of all levels. He utilizes bullet points, which are handy for quick reference and memorization, and he has handpicked the most common topics you need to know. "Internal Medicine Bulletpoints Handbook" is essential to building a sturdy foundational knowledge of Internal Medicine.

    Dr. Gullberg delivers differential diagnoses to your fingertips, and common problems one sees in the clinic and hospital are reviewed. The 17 chapters in this book cover General Principles of Patient Care, Allergy, Cardiology, Dermatology, Endocrinology, Gastroenterology, Hematology, Infectious Diseases, Nephrology, Neurology, Oncology, Office Medicine, Pulmonary, Rheumatology, Sedation in the ICU, Common Hospital Orders, and Medical Syndromes.
    LanguageEnglish
    PublisherBookBaby
    Release dateJan 30, 2015
    ISBN9781483548111
    Internal Medicine Bulletpoints Handbook: Intended For Healthcare Practitioners and Students at all Levels

    Related to Internal Medicine Bulletpoints Handbook

    Related ebooks

    Medical For You

    View More
    View More

    Related podcast episodes

    Related articles

    • Article

      Opinion: Why Medical School Should Start At Age 28

      Feb 17, 2020

      The axe of autonomy must rip at the root of doctors' dependence on the fickle medical profession for career and life satisfaction and financial security. Medicine should be an individual's…

      6 min read

    • Article

      The problem: Epilepsy

      Mar 2, 2021

      The problem: Epilepsy
      3 min read

    • Article

      When The Horse Wobbles

      Oct 5, 2023

      When The Horse Wobbles
      6 min read

    • Article

      Medical Marvels

      Jul 9, 2020

      Medical Marvels
      3 min read

    • Article

      Slithering Danger

      Jun 1, 2018

      Slithering Danger
      5 min read

    • Article

      Ask The Expert

      Mar 19, 2020

      Q EACH SPRING, I GET AN ITCHY RASH ON MY NECK AND ARMS, WHICH GOES BY ITSELF. COULD THIS BE AN ALLERGY? A This sounds like polymorphic light eruption (PLE), caused by sensitivity to ultraviolet light in the sun’s rays (which can penetrate windows a

      3 min read

    • Article

      Beware the ALPHA-GAL!

      May 27, 2021

      Beware the ALPHA-GAL!
      3 min read

    • Article

      Consultants

      Nov 20, 2018

      Consultants
      6 min read

    • Article

      Allergies EXPLAINED

      Apr 1, 2023

      Allergies EXPLAINED
      7 min read

    • Article

      Ataxia Explained

      Apr 15, 2021

      Ataxia Explained
      3 min read

    • Article

      Is the World Making You Sick?: The chemicals in our everyday lives are, argues immunologist Claudia Miller.

      Jul 24, 2014

      In 1962, physicist and historian Thomas Kuhn proposed that science makes progress not just through the gradual accumulation and analysis of knowledge, but also through periodic revolutions in perspective. Anomalies and incongruities that may have bee

      7 min read

    • Article

      Snake Oil

      Jun 1, 2018

      Snake Oil
      3 min read

    • Article

      Alleviating Allergies

      Sep 16, 2021

      Alleviating Allergies
      10 min read

    • Article

      All Choked Up

      Feb 28, 2020

      All Choked Up
      7 min read

    • Article

      SEIZURES Not Always Epileptic!

      Jul 30, 2020

      SEIZURES Not Always Epileptic!
      13 min read

    • Article

      How To Diagnose An Allergy

      Oct 29, 2020

      How To Diagnose An Allergy
      3 min read

    • Article

      All About Allergies

      Oct 29, 2020

      All About Allergies
      2 min read

    • Article

      Beating Adrenal Fatigue

      Jan 22, 2023

      Beating Adrenal Fatigue
      4 min read

    • Article

      Ask The Expert

      Mar 15, 2023

      Q WHY DO I STILL GET HORRIBLE ALTERED TASTE AND SMELL FOLLOWING VIRAL INFECTIONS? THESE AREN’T TO DO WITH COVID, BUT THEY DID START HAPPENING AFTER I HAD IT IN 2021. A During COVID infection, around half of people report altered taste and smell (paro

      3 min read

    • Article

      Dr Gill

      Oct 12, 2022

      When comparing the incidence of dementia in 250,000 Danish people diagnosed with shingles to age-matched general population controls, researchers had expected to see an increase in dementia rates – perhaps from neuroinflammation, cerebral vasculopath

      3 min read

    • Article

      On The Lookout for Lyme

      Aug 10, 2023

      On The Lookout for Lyme
      5 min read

    • Article

      Asthma – What You Need To Know

      Aug 8, 2019

      THIS CHRONIC LUNG DISEASE affects around one in 11 children and adults, and costs the NHS a billion pounds each year. But although many think their asthma control is ‘good enough’, two out of three daily deaths are preventable. Unfortunately, a rec

      2 min read

    • Article

      I Am Al’s Lymphoma

      Oct 7, 2022

      More specifically, I am Al’s Primary Cutaneous T-Cell Lymphoma. Even more specifically, I’m Al’s Anaplastic Large Cell Lymphoma. Or, you could just call me Cancer, but you’re better off not calling me at all, and hoping that I never call you. Al is f

      9 min read

    • Article

      Anaphylactic Shock

      Jan 31, 2024

      Anaphylactic Shock
      1 min read

    • Article

      Ask The Expert

      Jun 10, 2021

      A Grapefruit is a healthy option for most of us, but it can cause interactions with certain drugs. It’s thought to inhibit the action of liver enzymes that normally break down the medication we take, and so will increase the blood level of some drugs

      3 min read

    Related categories

    Reviews for Internal Medicine Bulletpoints Handbook

    5/5

    17 ratings0 reviews

    What did you think?

    Tap to rate

    Review must be at least 10 words

      Book preview

      Internal Medicine Bulletpoints Handbook - Robert M. Gullberg M.D., FACP

      9781483548111

      General Principles

      Occam’s (Ockham) Razor- this is the Law of succinctness- use the simplest explanation of an effect. This is a very common principle that comes into play in medical diagnoses. Remember it. Don’t complicate things. There is probably one diagnosis with many effects rather than many diagnoses. Attributed to 14th century English logician and Franciscan friar Father William of Ockham.

      Regarding a diagnosis- when a horse is running past you, call it a horse and not a zebra.

      In other words, look for the common diagnosis first before you look for a rare diagnosis. For example, a cellulitis of the leg from MSSA or beta-strep is much more common than cellulitis from Vibrio vulnificus. Don’t look for Vibrio initially unless there are extenuating circumstances.

      Call a horse a horse first, but don’t get married to the diagnosis if patients don’t respond appropriately.

      Be an Accurate History Taker- Develop this important skill. For example, when asked about alcoholic beverage intake, each of these men said they drank only one alcoholic beverage a week: There IS a difference. Get the point. Specify volume and type.

      Each of these men are drinking one alcoholic beverage a week

      Three Points From Sherlock Holmes that Apply to Medicine

      (Being a More Complete Healthcare Practitioner, by Dr. Gullberg)

      Dr. Watson to Sherlock Holmes- I am baffled….when I hear you give your reasons, your deductions seem to be so ridiculously simple that I could easily do it myself, though at each successive instance of your reasoning I am baffled until you explain your process. And yet I believe that my eyes are as good as yours. Sherlock’s response: "Quite so, my dear Watson. You see, but you do not observe. The distinction is clear. For example, you have frequently seen the steps which lead up the hall to this room, at least one hundred times. Tell me then, how many steps are there? Dr. Watson: How many? I don’t know. I have no idea. Sherlock: Quite so! You have not observed. And yet you have seen. That is just my point. Now, I know that there are 17 steps, because I have both seen and observed."—from A Scandal in Bohemia.

      Conclusion: Don’t just look at the patient; observe them.

      Dr. Watson on Sherlock: Here I had heard what he heard, I had seen what he had seen, and yet from his words it was evident that he saw clearly not only what had happened but what was about to happen, while to me the whole business was still confused.- fromThe Red-Headed League. Sherlock Holmes to Dr. Watson: Elementary, my dear Watson. It is one of those instances where the reasoner can produce an effect which seems remarkable to his neighbor, because the latter has missed the one little point which is the basis of the deduction.- from The Crooked Man. Sherlock Holmes: I am glad to have all of the details,whether they seem important to you (the client) or not. -fromThe Adventure of Copper Beaches

      Conclusion: Deduce the problem by searching the details.

      Sherlock Holmes: I had come to conclusions (on the case) before I ever entered the room. -from The Adventure of the Speckled Band

      Conclusion: Know what you are looking for before you enter the patient’s room and what questions you are going to ask.

      A person should keep his little brain attic stocked with all the furniture that they are likely to use, and the rest they can put away in the lumber-room of their library where they can get it if they want it. –Sherlock Holmes

      Allergy

      Allergic rhinitis- up to 25% of people are affected by A.R. It occurs usually after 6 years of age. Cross-reactivity occurs, i.e. birch pollen with apple/potato skin. The visible wind-blown pollens are the cause of AR, not the insect-pollinated plants. (too heavy to float) Plants responsible for hayfever include: pine/birch/olive trees, grasses (rye), weeds, (ragweed-Ambrosia, mugwort-Artemisia) and golden rod. Managing Allergic Rhinitis- Avoid the allergen. Intranasal steroids- beclo- methasone (Vancenase), triamcinolone (Nasacort), budesonide (Rhinocort), fluticasone (Flonase), mometasone (Nasonex). Antihistamines- H1 antagonists- 1st generation- cross BBB and cause drowsiness, + anticholinergic side effects- diphenhydramine (Benadryl), cyproheptadine (Periactin), Azelastine (Astelin) nasal spray/eye drops. 2nd generation- don’t cross BBB- cetirizine (Zyrtec), loratadine (Claritin), astemizole/ terfenadine (Hismanal/Seldane; dropped by FDA for fatal reactions). 3rd generation- levocetirizine (Xyzol-very potent), desloratadine (Clarinex), and fexofenadine (Allegra). Olopatadine (Patanase) drops/eyes and spray/nasal. Topical decongestants- pseudoephidrine or oxymetazoline (Afrin), etc. eyes/nasal. Cromolynmast cell stabilizer- Nasalcrom or Intal inhaler. Leukotriene receptor antagonist- montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo), can be helpful.

      Anaphylaxis-The most aggressive stinging insects are vespid wasps but other hymenoptera such as honey and bumblebees will sting also. Apitoxin is the venom. It contains mellitin, apamin, adolapin, phospholipase, hyaluronidase, histamine, dopamine, and proteases. 1% of the population is allergic to beestings. Treatment- epinephrine (adrenaline; a catecholamine) IM/SQ, .5 mg 1:1000), may repeat in 5 minutes. High volume fluids, O2, IV steroids, and antihistamines (H1 and H2 blockers). Causes- Idiopathic- 40% Foods- in kids, peanuts. Bee stings in adults. Insect bites- fire ants. Semen. Latex. Monosodium glutamate. Food colors. Topical meds. Exercise. Neuromuscular blockers. Antibiotics. Extreme cold/hot.

      Urticaria- Causes-Drug reactions- insulin, vaccines, meds (aspirin, beta-lactams, sulfa, anticonvulsants, ibuprofen, clotrimazole) Food additives (MSG). Food (shellfish, nuts, scombroid). Transfusions. Infections- i.e. rhinovirus, viral exanthems. Bites/Stings. Collagen Vascular- (SLE). Vasculitis- serum sickness. Physical triggers- heat (exercise), cold, sunlight, pressure. Chronic-idiopathic, stress. Treatment- 2nd and 3rd generation H1 blockers. Avoidance of allergan. Also can use doxepin, and steroids for flare-ups.

      Hypersensivity Reactions- Type 1- allergic, anaphyllaxis, atopy. Mediated by IgE, IgG4. Type 2- cytoxic, antibody dependent -Grave’s, Hem. Anemia. Goodpasture’s, Myasthenia gravis. Mediated by IgM or IgG and complement Type 3- immune IgG-IgM complexes and complement- serum sickness, Arthus reaction, SLE, RA, Stevens-Johnson Syndrome, hypersensitivity pneumonitis. Type 4- delayed hypersensitivity, cell-mediated immunity. Contact dermatitis, MS, transplant rejection. Mediated by T-cells

      Types of allergens- an allergen is an antigen capable of stimulating a Type-1 hypersensitivity reaction in atopic individuals through IgE responses. A hereditary predisposition is called atopy.

      Common allergens- Animal products- fel d 1 protein in cat saliva, dog/cat dander, cockroach, dust mite excreta, wool. Drugs- penicillin, salicylates, sulfa. Foods- celery, corn, egg whites, pumpkin, legumes-peanuts (peas, soybeans) milk, seafood, sesame, tree nuts-pecans/almonds, wheat, banana, pineapple,avocado, kiwi, strawberry, shellfish-shrimp,oysters. Insect stings- bee/wasp venom, mosquito bites Mold spores- airborn basidiospores such as mushrooms, rusts, puffballs, aspergillus. Latex- Type 1 anaphylaxis and Type 4 allergic dermatitis. Metal- nickel. Plant pollens- rye grass, weeds such as ragweed, trees like birch, willow, poplar, pine.

      Dysgammaglobulinemia- IgA deficiency- most common inherited immunoglobulin deficiency. 1/333 people. Recurrent infections of mouth, airways, and digestive tract, GU tract. Associated with autoimmune diseases. No specific Rx. Most are asymptomatic. IgG deficiency- four subtypes, not common. IgM deficiency- 1/3000 population. Associated with increased frequency of URIs, asthma, allergic rhinitis. Mixed variable.

      Notes:

      Cardiology

      Cardiac auscultation-

      Sytoloic Heart Failure- most common cause is CAD and aging, alcohol, aortic stenosis, noncompliance with meds. Rx- ACE inhibitors, carvedilol/metoprolol (tartrate-immediate release, succinate is long-acting release), and diuretics are DOC. AICD (Automatic implantable Cardioverter Defibrillator) in patients with NY Class 2-3, EF 35% or less. It is the leading cause of hospitalization in patients older than 65 years in US. Diet- 2 gram Na restriction, 50 ounce/day fluid restriction is key for compliance. New York Heart Association (NYHA) is a functional classification system. Class I-mild, no limitation of activity. No SOB with ordinary activity. Class II- mild, slight limitation of activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or SOB Class III- moderate, marked limitation of activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitations, and SOB Class IV- severe, unable to carry out any physical activity without discomfort. Symptoms are at rest also. Discomfort increased with activity.

      Aortic Stenosis- up to 25% adults develop it. Common symptoms- syncope, CP or CHF (AS triad) Can be silent. The heart murmer- 2nd right intercostal space, radiates to carotids. Watch for LVH, and angina pectoris flare ups. Valve area normally 1.5-2.0 square cms. < 0.8 square cms is considered severe AS. Pathology in most patients is bifid valve (with stenosis; not regurgitation) or aortic sclerosis (calcified). Treatment is AV replacement or balloon valvuloplasty No need for prophylaxis since AHA guidelines changed in 2007. Watch for aortic dilatiation in bifid valve patients.

      Atrial fibrillation-

      6 seconds= 30 boxes; x 10= rate= 185

      Atrial fib is the most common cardiac arrhythmia. Quality of life tends to be poorer without control. (lose atrial kick) 8% in people over 80 years old have it. Causes- HTN, heart disease (CAD or valvular), chronic lung disease, hyperthyroidism, alcohol abuse are the most common. Treatment- 1) anticoagulation with either warfarin, Pradaxa (dabigatran), a direct thrombin inhibitor, Xarelto, Eloquis, Lixiana. Adjust dose with CrCl. 2) Rate control-metoprolol, diltiazem. Infrequently digoxin. 3) Rhythm control-chemically with amiodarone (Pacerone)/ or dronedarone (Multaq), dofetilide (Tikosyn), or Direct Current Conversion. Ablation is used for cases that aren’t controlled.

      Atrial flutter 4:1

      Third degree heart block-

      Patients present with significant bradycardia and sometimes hypotension. Causes are cardiac ischemia; especially inferior wall MI, Lyme’s, idiopathic Treatment is a dual chamber pacemaker. Atropine may be given if hypotensive, but usually has no effect.

      Acute Myocardial Infarction- location of STEMI- II, III, AVF- inferior (especially smokers)= right coronary artery disease. Anterior septal- V1-V2, anterior-lateral- I, AVL, V3-V6.-LAD/circumflex artery disease. (widow maker’s disease) Markers include CPK-MB fraction and troponin levels. Immediate treatments include oxygen and nitroglycerin. Most cases are treated with thrombolysis (Plavix-clopidogrel or Effient-prasugrel or Brilinta -ticagrelor, heparin or LMWH, and aspirin), and PCI (percutaneous coronary intervention)- bare-metal stents or drug-eluding stents are primarliy used. Other meds used are the glycoprotein IIb/IIIa inhibitors-block platelet and thrombin interaction (abciximab-Reopro or eptifibatide-Integrilin), and now bivalirudin (Angiomax), a direct thrombin inhibitor, similar to hirudin, the chemical in leech saliva. All risk factors must be neutralized for future prevention. (smoking, high cholesterol, obesity, diabetes, HTN are the common ones). Five types of MI: Type 1- spontaneous MI secondary to plaque rupture Type 2- MI secondary to increased oxygen demand Type 3- acute MI associated with sudden death Type 4- MI associated with percutaneous angioplasty or stents Type 5- MI associated with CABG. Scoring of MI for mortality in first 14 days- TIMI (Thrombosis in MI)- Mnemonic = AMERICA (7 Points)- Age>65, Markers- increased, EKG- ST segment changes. Risk factors- 3 or more risk factors- age, family history, diabetes, high cholesterol,

      Enjoying the preview?
      Page 1 of 1