5 minute clinical consult 2016 pdf free download

5 minute clinical consult 2016 pdf free download

Not loaded yet? Tags Type your tag names separated by a space and hit enter. Charles Lewis. Description Practical and highly organized, The 5-Minute Clinical Consult is a reliable, go-to resource for clinicians in primary care, family medicine, emergency medicine, nursing, and pediatrics. By commenting in comment box its easier for us to reupload Books.

Publisher: Skyscape Medpresso Inc. Product details. Version History Here you can find the changelog of 5-Minute Clinical Consult since it was posted on our website on The latest version is 2.

Early referral increases the chance for transplant success 5 [A]. Sometimes associated with ocular symptoms ocular rosacea. However, males are at greater risk for progression to later stages. Excessive facial warmth and redness are the predominant presenting complaints.

Itching is generally absent. At times, entire face may be involved. Inflammatory papules are prominent; pustules and telangiectasia may be present. Comedones are absent unlike acne vulgaris.

Women usually have lesions on the chin and cheeks, whereas the nose is commonly involved in men. Use of mild, nondrying soap is recommended; local skin irritants should be avoided. Avoidance of triggers Reassurance that rosacea is completely unrelated to poor hygiene Treat psychological stress if present.

Topical steroids should not be used, as they may aggravate rosacea. Avoid oil-based cosmetics: Others are acceptable and may help women tolerate symptoms Electrodesiccation or chemical sclerosis of permanently dilated blood vessels Possible evolving laser therapy Support physical fitness. A rosacea treatment system cleanser, metronidazole 0. Azelaic acid Finacea is very effective as initial therapy; azelaic acid topical alone is effective for maintenance 3 [A]. Precautions: Tetracyclines may cause photosensitivity; sunscreen is recommended.

Significant possible interactions: Tetracyclines: Avoid concurrent administration with antacids, dairy products, or iron. Broad-spectrum antibiotics: may reduce the effectiveness of oral contraceptives; barrier method is recommended. Second Line Topical erythromycin Topical clindamycin lotion preferred Can be used in combination with benzoyl peroxide; commercial topical combinations are available Possible use of calcineurin inhibitors tacrolimus 0.

For severe cases, oral isotretinoin at 0. Isotretinoin is teratogenic; pregnancy Category X Avoid topical tretinoin as it may cause retinoid embryopathy; class C 1. A smaller percentage will seek medical advice. Keratin plug obstructs follicle os, causing sebum accumulation and follicular distention. Propionibacterium acnes, an anaerobe, colonizes and proliferates in the plugged follicle. Severe acne may worsen with smoking. Females may worsen 1 week prior to menses.

Most common areas affected are face, chest, back, and upper arms areas of greatest concentration of sebaceous glands 4. Topical retinoids are 1st-line agents for maintenance. Avoid long-term antibiotics for maintenance. Avoid topical antibiotics as monotherapy. Recommended vehicle type Dry or sensitive skin: cream or ointment Oily skin, humid weather: gel, solution, or wash Hair-bearing areas: lotion, hydrogel, or foam Apply topical agents to entire affected area, not just visible lesions.

Mild soap daily to control oiliness; avoid abrasives Avoid drying agents with keratinolytic agents. Gentle cleanser and noncomedogenic moisturizer help decrease irritation. Keratinolytic agents alpha-hydroxy acids, salicylic acid, azelaic acid side effects include dryness, erythema, and scaling; start with lower strength, increase as tolerated 6,7 [A].

Tretinoin Retin-A, Retin A Micro, Avita, Atralin varying strengths and formulations: apply at bedtime; wash skin, let skin dry 30 minutes before application Retin-A Micro, Atralin, and Avita are less irritating, and stable with BP May cause an initial flare of lesions; may be eased by day course of oral antibiotics Avoid in pregnant and lactating women. Adapalene Differin : 0. Do not use topical and oral antibiotic together. Pugashetti R, Shinkai K. Treatment of acne vulgaris in pregnant patients.

Dermatol Ther. The acne continuum: an age-based approach to therapy. Semin Cutan Med Surg. Admani S, Barrio VR. Evaluation and treatment of acne from infancy to preadolescence.

Acne vulgaris. Acne: the role of medical nutrition therapy. J Acad Nutr Diet. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. Diagnosis and treatment of acne. New insights into the management of acne: an update from the Global Alliance to improve outcomes in Acne group. Optimizing use of oral antibiotics in acne vulgaris.

Dermatol Clin. Heymann WR. Oral contraceptives for the treatment of acne vulgaris. Retinoids and azelaic acid to treat acne and hyperpigmentation in skin of color.

J Drugs Dermatol. Botanical and phytochemical therapy of acne: a systematic review. Phytother Res. UnitedVRG Diet and acne update: carbohydrates emerge as the main culprit. Full results for changes in therapy take 8 to 12 weeks. Decrease topical frequency to every day or to every other day for irritation. Use BP every time a topical or oral antibiotic is used.

NSTEMI is defined by the rise and fall of cardiac biomarker values preferably cardiac troponin higher than the 99th percentile upper reference limit and accompanied by one of the following: symptoms of ischemia, new ST-segment T-wave changes, development of pathologic Q waves on ECG, or imaging evidence of new regional wall motion abnormality 1. UA, although clinically indistinguishable from NSTEMI in an appropriate clinical setting, newonset anginal chest pain, or change in typical anginal pattern, or development of angina at rest, or change in typical anginal equivalent , can be differentiated from NSTEMI by a lack of elevation in cardiac biomarkers based on two or more samples collected at least 6 hours apart.

Presentation of coronary events in women is, on average, 10 years later than in men, with comparable rates of occurrence 2. Incidence Age-adjusted coronary heart disease CHD incidence rates per 1, person-years : white men, Troponin concentration rises 3 to 6 hours after onset of ischemic symptoms but can be delayed from 8 to 12 hours troponin T is not specific in patients with renal dysfunction.

Patients with negative biomarkers within 6 hours of the onset of symptoms should have biomarkers remeasured 8 to 12 hours from onset of symptoms Chest x-ray Consider transthoracic echocardiography if not recently performed 1 [B]. Fasting lipid profile, preferably within 24 hours Complete blood count CBC , basic metabolic panel, activated partial thromboplastin time aPTT Other laboratory tests: Lactate dehydrogenase: increases within 24 hours, peaks 3 to 6 days, baseline 8 to 12 days not routinely ordered Leukocytes: increase within several hours after MI, peak in 2 to 4 days Brain natriuretic peptide BNP : increases with MI, may not indicate heart failure Pregnancy Considerations Findings mimicking NSTEMI in pregnancy: ST depression after anesthesia, increase in CK-MB after delivery, and mild increase in troponin in preeclampsia and gestational hypertension.

Spontaneous coronary dissection is a rare cause of ST elevation in pregnancy. Transesophageal echocardiography, contrast chest CT scan, or MRI generally are reserved for differentiating ACS and other causes of chest pain from aortic dissection. Test Interpretation Subendocardial myocardial necrosis may be present. ST-segment elevation myocardial infarction STEMI occurs when coronary blood flow ceases following thrombotic occlusion of a large coronary artery usually affected by atherosclerosis, causing transmural ischemia.

This is accompanied by release of serum cardiac biomarkers and ST elevation and likely a Q wave when infarction develops on an ECG. Prevalence increases with age and is higher in men 5. Plaques that are rough and eccentric are more unstable, thrombogenic, and prone to rupture. Medications: Ask if recent use of phosphodiesterase-5 inhibitors if recent use, avoid concomitant nitrates.

Alcohol and drug abuse especially cocaine PHYSICAL EXAM General: restless, agitated, hypothermia, fever Neurologic: dizziness, syncope, fatigue, asthenia, disorientation especially in the elderly UnitedVRG Cerebrovascular CV : dysrhythmia, hypotension, widened pulse pressure, S3 and S4, jugular venous distention JVD Respiratory: dyspnea, tachypnea, crackles GI: abdominal pain, nausea, vomiting Musculoskeletal: pain in neck, back, shoulder, or upper limbs Skin: cool skin, pallor, diaphoresis Geriatric Considerations Elderly patients may have an atypical presentation, including silent or unrecognized MI, often with complaints of syncope, weakness, shortness of breath, unexplained nausea, epigastric pain, altered mental status, delirium.

Patients with diabetes mellitus may have fewer and less dramatic chest symptoms. Blake, MD. Lewis S. Blevins Jr.

David Bode, MD. Dwight D. Aaron R. Bolduc, MD. Kimberly Bombaci, MD. Brandon W. Bonds, MD. Katrina A. Booth, MD. Azra Borogovac, MD. Marie L. Professor of Medicine. Emily Bouley, MD. Andrew Boylan, MD. Rachel Bramson, MD. Jay A. Brieler, MD. Louis, Missouri. Jacob Michael Bright, DO. Captain of Medical Corps, U. Army Family Medicine Residency Program. Emma Brooks, MD.

Christine M. Broszko, MD. Benjamin P. Brown, MD. Matthew C. Michael L. Psychiatrist Christus St. Patrick Hospital Lake Charles, Louisiana. Theodore R.

Lieutenant Colonel of Medical Corps, U. McNair Washington, DC. Karen Browning, MD. Karen Brubaker, MD. Darren S. Bryan, MD. Matthew E. Bryant, MD. Family Practice Physician Dwight D. Merima Bucaj, DO. Andrew D. Buchan, DO. Nitin Budhwar, MD. Han Q. Christopher W. Tiffany Burca, DO. John R. Burk, MD. Harold J. Bursztajn, MD. David C. Bury, DO. Jason N. Butler, DO, MS. Stephen D. Cagle Jr. Mitchell A. Associate Professor of Surgery.

Boris E. Calderon, DO. Daniel Callaway, MD. Ryan J. Callery, MD. Christinne D. Canela, MD. Patrick M. Carey, DO. Samuel B. Carli, MD. Amanda M. Carnes, MD. Rachel Marinch Carpenter, MD. Jewell P. Carr, MD. Noel J. Dana G. Kevin A. One for myself and one for my preceptor because I enjoyed it so much.

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