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X
- •Preface
- •Contents
- •Introduction
- •Prevention
- •Harm Reduction
- •Decision-Making/Differential Diagnosis
- •Screening
- •Health Maintenance
- •References
- •Physical Exam
- •Vaccinations
- •Introduction
- •Symptoms
- •Other History
- •Physical Exam
- •Lab Tests
- •Differential Diagnosis
- •Treatment
- •Prevention
- •Long Covid
- •References
- •Introduction
- •Provider Perspectives
- •Portable Medical Summary
- •Education
- •Employment
- •Specialist-Dominated Care
- •Internist-Dominated Care
- •Condition-Specific Medical Knowledge
- •Medication Reconciliation/Polypharmacy
- •Secondary Medical Conditions
- •Behavioral Health
- •Health Maintenance
- •Sexual Health
- •Sexual Abuse
- •Contraception
- •Cervical Cancer Screening
- •Health Disparities
- •Ethical Considerations
- •Conclusion
- •References
- •Introduction
- •Outpatient Assessment
- •Social History
- •Medications
- •Functional Assessment
- •Geriatric Syndromes
- •Delirium
- •Confusion Assessment Method (CAM): Short version [14]
- •Delirium Evaluation
- •Depression
- •Medication Management
- •Preventing Future Falls
- •Polypharmacy
- •Sensory Loss
- •Vision
- •Hearing Loss
- •Osteoporosis
- •Sleep Disorders
- •Advanced Care Planning
- •Home Care
- •References
- •History
- •Palliative Care/Hospice Care
- •Constipation
- •Nausea/Vomiting
- •Pain
- •Conclusion
- •References
- •Introduction
- •Definitions
- •Decision-Making
- •Identification
- •Key History
- •Workup
- •Management
- •Risky or Unhealthy Alcohol Use
- •Risky Opioid Use or OUD
- •References
- •Introduction
- •History
- •Physical Exam
- •Type 1 Diabetes
- •Type 2 Diabetes
- •Lifestyle Changes
- •Metformin
- •GLP-1 Receptor Agonists (Exenatide, Liraglutide, Dulaglutide, Lixisenatide)
- •DPP-4 Inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin)
- •SGLT-2 Inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin)
- •Thiazolidinediones (Pioglitazone)
- •Alpha-Glucosidase Inhibitors (AGIs) (Acarbose, Miglitol)
- •Insulin
- •References
- •Subclinical Hypothyroidism
- •Treatment Challenges
- •Hyperthyroidism
- •Brief Introduction
- •Key H&P
- •Decision-Making/Differential Diagnosis
- •Treatment
- •Graves’ Disease
- •Hypothyroidism
- •Brief Introduction
- •Key H&P
- •Decision-Making/Diagnosis
- •Treatment
- •Overt Hypothyroidism
- •Radioactive Iodine (RAI)
- •Surgery
- •Treatment: Subclinical Hyperthyroidism
- •Thyroid Nodules
- •Brief Introduction
- •Key H&P
- •Decision-Making/Differential Diagnosis
- •Treatment
- •References
- •Introduction
- •History
- •Medical History
- •Family History
- •Social History
- •Physical Exam
- •Decision-Making/Differential Diagnosis
- •Screening Population
- •Testing Lipid Levels: Fasting vs. Non-fasting
- •Treatment
- •Treatment Strategies
- •Lifestyle Modification
- •Statins
- •Fibrates
- •Fish Oil
- •Other Non-statin Medications
- •Monitoring After Initiating Therapy
- •References
- •Introduction
- •History
- •Who Should Lose Weight?
- •Treatment
- •Diet
- •Physical Activity
- •Pharmacotherapy
- •Long-Term Follow-Up After Uncomplicated Bariatric Surgery
- •References
- •Brief Introduction
- •Decision-Making/Differential Diagnosis
- •Acute Cough
- •Subacute Cough
- •Chronic Cough
- •Evaluation/Investigation
- •Disease-Specific Features
- •Acute Cough
- •Subacute Cough
- •Chronic Cough
- •Treatment
- •References
- •Introduction
- •Sudden-Onset Dyspnea
- •Acute-Onset Dyspnea
- •Episodic Dyspnea
- •Chronic Dyspnea
- •Treatment
- •References
- •Introduction
- •Acute Sinusitis
- •Chronic/Recurrent Sinusitis
- •Physical Findings
- •Diagnosis
- •Diagnostic Tests
- •Additional Evaluation
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Key H&P
- •Rapid Antigen Detection Tests
- •Treatment
- •Symptomatic Treatment
- •References
- •Introduction
- •ICSD3 Classifies Sleep Disorders into Seven Major Categories [4]
- •Prevalence
- •Sleep History
- •STOP-Bang Questionnaire
- •Understanding ESS Score
- •Focused Physical Exam
- •Definition
- •Risk Factors
- •Pathophysiology
- •Diagnosis
- •Treatment: OSAHS/SDB (Usual Therapy)
- •References
- •Brief Introduction
- •Decision-Making/Differential Diagnoses
- •Physical Examination
- •Measuring Blood Pressure
- •Diagnostic Studies
- •Clinical Quality Measure
- •Assessment
- •Treatment
- •Lifestyle Management
- •Pharmacological Interventions
- •Refractory or Resistant Hypertension
- •References
- •Chest Pain
- •History
- •Physical Exam
- •Differential Diagnosis
- •Potentially Life-Threatening
- •Acute Coronary Syndromes
- •Aortic Dissection
- •Pulmonary Embolism
- •Pneumothorax
- •Non-Life-Threatening Causes
- •Gastroesophageal Reflux Disease
- •Pleuritic Chest Pain
- •Cervical Angina
- •Pericarditis
- •Chronic Angina
- •Herpes Zoster
- •Muscular Pain
- •Rib Fracture
- •Costochondritis
- •Esophageal Spasm
- •Diagnostic Testing
- •Electrocardiogram
- •Blood Testing
- •Imaging
- •Chest X-Ray
- •X-Ray C-Spine
- •Transthoracic Echocardiogram
- •References
- •Introduction
- •Laboratory Evaluation
- •Hypoproliferative Anemias
- •Microcytic Anemia
- •Differential Diagnosis
- •Iron Deficiency Anemia
- •Epidemiology
- •Pathophysiology
- •Key History
- •Physical Exam
- •Laboratory Evaluation
- •Diagnosis
- •Treatment
- •Normocytic Anemia
- •Differential Diagnosis [6]
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Diagnosis
- •Treatment
- •Macrocytic Anemia
- •Differential Diagnosis [2]
- •Megaloblastic Anemia
- •Vitamin B12 Deficiency
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Diagnosis
- •Folic Acid Deficiency
- •Hyperproliferative Anemia
- •Hemolytic Anemia
- •Intrinsic Hemolytic Anemia
- •Sickle Cell Anemia
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Diagnosis
- •Treatment
- •Thalassemia
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Hereditary Spherocytosis (HS)
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Deficiency)
- •Epidemiology
- •Pathophysiology
- •History Physical Exam
- •Laboratory Evaluation
- •Extrinsic Hemolytic Anemia
- •Autoimmune Hemolytic Anemia
- •Warm Autoimmune Hemolytic Anemia (WAHA)
- •Epidemiology
- •Pathophysiology
- •Laboratory Evaluation
- •Cold Autoimmune Hemolytic Anemia
- •Epidemiology
- •Pathophysiology
- •Laboratory Assessment
- •Conclusion
- •References
- •Introduction
- •Differential Diagnosis
- •Decision-Making/Treatment
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Papulosquamous
- •Psoriasiform
- •Pityriasiform
- •Lichenoid
- •Erythroderma
- •Eczematous
- •Dermal
- •Vascular
- •Vesiculobullous
- •Infectious
- •Autoimmune, Intraepidermal
- •Autoimmune, Subepidermal
- •Noninflammatory
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Non-scarring Alopecias
- •Androgenetic Alopecia
- •Focal Hair Loss
- •Diffuse Hair Loss
- •Scarring Alopecia
- •Lymphocytic
- •Acne Keloidalis
- •Neutrophilic
- •References
- •Introduction
- •Key H&P
- •History
- •Medications
- •Social History
- •Physical Examination
- •Differential Diagnosis
- •Decision-Making
- •Treatment
- •References
- •Introduction
- •Key H&P
- •History
- •Physical Examination
- •Differential Diagnosis
- •Intrinsic Shoulder Pain
- •Decision-Making
- •Treatment
- •Rotator Cuff Injury
- •Adhesive Capsulitis
- •References
- •Introduction
- •Key H&P
- •History
- •Medications
- •Social History
- •Physical Examination
- •Differential Diagnosis
- •Decision-Making
- •Treatment
- •Pharmacotherapy
- •Non-pharmacotherapy
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Vertigo
- •Central vs. Peripheral Vertigo
- •BPPV
- •Meniere’s Disease
- •Labyrinthitis/Vestibular Neuritis
- •Migrainous Vertigo
- •Presyncope
- •Disequilibrium
- •Lightheadedness
- •Dix-Hallpike Maneuver
- •Nystagmus
- •Hearing Evaluation
- •Romberg Testing
- •Other Diagnostic Testing
- •Treatment
- •BPPV
- •Vestibular Neuritis/Labyrinthitis
- •Meniere’s Disease
- •Disequilibrium
- •Presyncope
- •Lightheadedness
- •References
- •Introduction
- •History

Handbook
ofOutpatient
Medicine
ElanaSydney·
EleanorWeinstein·
LisaM.RuckerEditors
SecondEdition
123

Handbook of Outpatient
Medicine

Elana Sydney • Eleanor Weinstein
Lisa M. Rucker
Editors
Handbook of
Outpatient Medicine
Second Edition

Editors
Elana Sydney
Department of Medicine
Albert Einstein College of
Medicine, Jacobi Medical
Center
Bronx, NY, USA
Eleanor Weinstein
Department of Medicine
Albert Einstein College of
Medicine, Jacobi Medical
Center
Bronx, NY, USA
Lisa M. Rucker
Department of Medicine
Albert Einstein College of
Medicine, Jacobi Medical
Center
Bronx, NY, USA
ISBN 978-3-031-15352-5 ISBN 978-3-031-15353-2 (eBook)
https://doi.org/10.1007/978-3-031-15353-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to
Springer Nature Switzerland AG 2018, 2022
This work is subject to copyright. All rights are solely and exclusively licensed by
the Publisher, whether the whole or part of the material is concerned, specically
the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,
reproduction on microlms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or
by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service
marks, etc. in this publication does not imply, even in the absence of a specic
statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and
information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral
with regard to jurisdictional claims in published maps and institutional
afliations.
This Springer imprint is published by the registered company Springer
Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

We dedicate this book to our patients who have
taught us so much over the years.

Preface
The practice of medicine in the outpatient setting has become
increasingly complex and challenging in recent years.
Pressures of time and of decision-making regarding patients
with multiple comorbidities may test even the most-seasoned
clinicians. The busy clinician needs an easy-to-use, quick reference that can help guide assessments and therapeutic plans
on the spot. As practicing general internists and teachers for
decades, we know very well how critical it is to have a clear
idea quickly about how to approach the patient sitting across
from you in the exam room. Our goal of revising the first edition of Handbook of Outpatient Medicine, originally published in 2018, was to provide an updated roadmap for the
common problems that present themselves to the outpatient
adult provider.
This book is organized into several sections. The first section deals with the approach to special populations, such as
the older adult and the teen with chronic medical problems
transitioning to adult care. The remaining sections focuse on
specific symptoms, diagnoses, and organ systems. Each chapter includes an algorithm to efficiently guide the user along
the decision points of making the diagnosis and/ or determining the best treatment. The sections are written by experienced outpatient clinicians and based on current evidence
and up-to-date recommendations by respected organizations
such as the US Preventive Services Task Force.
Quotidian topics like diabetes and hypertension are presented in more detail. Other common issues less reliably
included in textbooks are covered here as well. These topics
include obesity, sleep apnea, hair loss, and new to this second

viii
Preface
edition, post-covid care, and addiction medicine. Although
this book is certainly not intended to be an exhaustive compendium of medicine, it does address most of the diagnoses
and chief complaints presented to an outpatient internal
medicine practitioner. Additionally, the approach to diagnosis
and treatment represents a variety of medical centers across
the country as well as internationally.
Written and organized in an easy-to-follow style, this book
can aid physicians, medical students, nurse practitioners, and
physician assistants. We hope you find this reference to be
useful.
Bronx, NY, USA ElanaSydney
EleanorWeinstein
LisaM.Rucker

Contents
Part I General Considerations
1 Screening/Physical Exam/Health Maintenance � � � � � � 3
Joseph Conigliaro and Sandeep Kapoor
2 Covid-19 for the Primary Care Clinician: Current
Recommendations—Don’t Blink! � � � � � � � � � � � � � � � � � 45
Matthew Love
3 Transition Care of Teens with Chronic Health
Conditions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 61
Catherine Waymel and Kamala Gullapalli Cotts
4 Care of the Elderly Patient � � � � � � � � � � � � � � � � � � � � � � � 87
Veronica M. LoFaso
5 Care at the End of Life: Palliative and Hospice
Care—Symptom Management � � � � � � � � � � � � � � � � � � � 117
Tabitha N. Goring and Ingrid L. Nelson
6 Substance Use Disorder � � � � � � � � � � � � � � � � � � � � � � � � � 137
Kimberly Cartmill
Part II Endocrine
7 Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 159
Ari Geliebter
8 Thyroid Dysfunction � � � � � � � � � � � � � � � � � � � � � � � � � � � � 179
Nancy A. LaVine

x
Contents
9 Lipids � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 195
Anjali Manavalan
10 Obesity � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 211
Jacinth S. Ruddock and Gayotri Goswami
Part III Respiratory
11 Cough � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 235
Israa Soghier and Kiyoshi Kinjo
12 Shortness of Breath � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 251
Kiyoshi Kinjo
13 Sinusitis or Rhinosinusitis � � � � � � � � � � � � � � � � � � � � � � � 265
Shuchita Khasnavis
14 Sore Throat � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 279
Lori Ciuffo
15 Sleep Apnea � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 289
Jhansi Nalamati and Dushyant Damania
Part IV Cardiac
16 Hypertension � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 309
Jitendra Barmecha
17 Chest Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 333
Adarsh Katamreddy
18 Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 355
Benjamin Cohen
19 Edema � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 391
Valerie Jorge Cabrera

Contents
Part V Dermatologic
20 Rash � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 403
Alexander Howell and Karthik Krishnamurthy
21 Alopecia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 427
Clara Barranco and Karthik Krishnamurthy
Part VI Orthopaedic
22 Knee Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 445
Mitsuyo Kinjo
23 Shoulder Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 457
Mitsuyo Kinjo
24 Back Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 473
Mitsuyo Kinjo
Part VII Neurologic
25 Dizziness � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 487
Robert Kennedy Jr
xi
26 Headache � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 507
Schantal Polanco
Part VIII Gynecologic
27 Vaginal Discharge � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �525
Lucille M. Torres-Deas,
Nicole C. Habibe Burgos, and Athina Vassilakis
28 Contraception � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 543
Athina Vassilakis and Natasha Natarajan
Соседние файлы в папке Библиотека им академика М.И. Перельмана
