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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2892_Библиотеки_им_академика_М_И_Перельмана
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x CONTRIBUTORS
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Daniel A. Nadelman, MS4
Medical Student
University of Michigan Medical School
Ann Arbor, Michigan
Adult Male Health Maintenance
Diabetes Mellitus
Acute Low Back Pain
Nathan J. Vengalil, MS4
Medical Student
University of Michigan Medical School
Ann Arbor, Michigan
Adult Male Health Maintenance
Male Genitourinary Conditions
Kevin M. Wheelock, MS4
Medical Student
University of Michigan Medical School
Ann Arbor, Michigan
Cerebrovascular Accident/Transient Ischemic Attack
Male Genitourinary Conditions
PREFACE
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We appreciate all the kind remarks and suggestions from the many medical
students over the past 3 years. Your positive reception has been an incredible
encouragement, especially in light of the short life of the Case Files® series. In this
fifth edition of Case Files®: Family Medicine, the basic format of the book has been
retained. Improvements were made in updating many of the chapters. New cases
include Substance Use Disorder, Asthma, Obstructive Sleep Apnea, Osteoporosis,
and Opioid Use Disorder and Chronic Pain Management. We reviewed the clinical
scenarios with the intent of improving them; however, their “real-life” presentations
patterned after actual clinical experience were accurate and instructive. We had utilized focus groups of students to create a more user-friendly format for the digital
platform such as bullet points for the case summary for faster reading and more
plentiful use of subheadings throughout the text. We have used entrustable professional activities (EPA) corresponding to the learning objectives. The summary to
the case scenarios are in bullet style to allow for easier reading. The multiple-choice
questions (MCQs) have been carefully reviewed and rewritten to ensure that they
comply with the National Board and the US Medical Licensing Examination format. Through this fifth edition, we hope that the reader will continue to enjoy
learning diagnosis and management through the simulated clinical cases. It certainly is a privilege to be teachers for so many students, and it is with humility that
we present this edition.
Eugene C. Toy
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ACKNOWLEDGMENTS
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The curriculum that evolved into the ideas for this series was inspired by two
talented and forthright students, Philbert Yau and Chuck Rosipal, who have since
graduated from medical school. It has been a pleasure to work with Dr. Don Briscoe,
a brilliant, compassionate, and dedicated teacher and leader; Dr. Bruce Britton, who
is an excellent teacher and communicator; and most recently Dr. Joel Heidelbaugh,
who has an amazing breadth of knowledge and brings a fresh perspective. I am
greatly indebted to my editors, Bob Boehringer, whose experience and vision
helped to continue this series. I appreciate McGraw Hill’s believing in the concept
of teaching through clinical cases; I am also grateful to Catherine Saggese for
her excellent production expertise and Madison Tucky, who has grown into
a diligent and trustworthy editor, for her wonderful editing. Iam thankful to
Revathi Viswanathan for the outstanding and precise project management. At the
University of Texas Medical School at Houston, I appreciate Dr. Patricia Butler for
her encouragement, Dr. Sean Blackwell for his example, role model, and inspiration. As always, I appreciate Allison’s amazing skill, knowledge, and expertise; she
somehow knows how to put the electrical impulses in the authors’ brains into words,
phrases, and ideas without our having to saying anything—she is a medical editing
wizard extraordinaire! Most of all, I appreciate my ever-loving wife, Terri, and four
wonderful children, Andy and his wife, Anna; Michael and his wife, Nadine;
Allison; and Christina and her husband, Andy, for their patience, encouragement,
and understanding.
Eugene C. Toy
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INTRODUCTION
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Mastering the cognitive knowledge within a field such as family medicine is a
formidable task. It is even more difficult to draw on that knowledge, procure, and filter through the clinical and laboratory data, develop a differential diagnosis, and,
finally, form a rational treatment plan. To gain these skills, the student often learns
best at the bedside, guided and instructed by experienced teachers, and inspired
toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside. Unfortunately, clinical situations usually do not encompass the
breadth of the specialty. Perhaps the best alternative is a carefully crafted patient
case designed to stimulate the clinical approach and decision-making. In an attempt
to achieve that goal, we have constructed a collection of clinical vignettes to teach
diagnostic or therapeutic approaches that are relevant to family medicine. Most
importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely rote questions and answers.
is book is organized for versatility to allow the student “in a rush” to go
quickly through the scenarios and check the corresponding answers, as well as
enable the student who wants thought-provoking explanations to take a slower
path. e explanations are arranged from simple to more complex: a summary of
the pertinent points, the bare answers, an analysis of the case, an approach to the
topic, a comprehension test at the end for reinforcement and emphasis, and a list of
resources for further reading. e clinical vignettes are purposely placed in random
order to simulate the way that real patients present to the practitioner. Section II
includes a listing of cases to aid the student who desires to test his or her knowledge of a certain area or to review a topic, including basic denitions. Finally, we
intentionally did not primarily use MCQ format because clues (or distractions) are
not available in the real world. Nevertheless, several MCQs are included at the end
of each scenario to reinforce concepts or introduce related topics.
HOW TO GET THE MOST OUT OF THIS BOOK
Each case is designed to simulate a patient encounter with open-ended questions.
At times, the patient’s complaint is different from the most concerning issue, and
sometimes extraneous information is given. The answers are organized with four
different parts.
PART I
1. Summary. The salient aspects of the case are identified, filtering out the extrane-
ous information. Students should formulate their summary from the case before
looking at the answers. This is in bullet form now. A comparison to the summa-
tion in the answer will help to improve their ability to focus on the important
data, while appropriately discarding the irrelevant information—a fundamental
skill in clinical problem solving.
2. A Straightforward Answer is given to each open-ended question.
xv
xvi INTRODUCTION
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Table 1 • SYNOPSIS OF ENTRUSTABLE PROFESSIONAL ACTIVITIES
EPA 1 Gather a history and perform a physical examination
EPA 2 Prioritize a differential diagnosis following a clinical encounter
EPA 3 Recommend and interpret common diagnostic and screening tests
EPA 4 Enter and discuss orders and prescriptions
EPA 5 Document a clinical encounter in the patient record
EPA 6 Provide an oral presentation of a clinical encounter
EPA 7 Form clinical questions and retrieve evidence to advance patient care
EPA 8 Give or receive a patient handover to transition care responsibly
EPA 9 Collaborate as a member of a interprofessional team
EPA 10 Recognize a patient requiring urgent or emergent care and initiate evaluation
and management
EPA 11 Obtain informed consent for tests and/or procedures
EPA 12 Perform general procedures as a physician
EPA 13 Identify system failures and contribute to a culture of safety and improvement
3. The Analysis of the Case, which comprises two parts:
a. Objectives of the Case: A listing of the two or three main principles that
are crucial for a practitioner to manage the patient. Again, the students are
challenged to make educated “guesses” about the objectives of the case upon
initial review of the case scenario, which helps to sharpen their clinical and
analytical skills. We have included the EPA(s) corresponding to the objective
for instructors and curriculum overseers (see Table 1).
b. Considerations: A discussion of the relevant points and a brief approach to
the specific patient.
PART II
The Approach to the Disease Process, which has two distinct parts:
a. Definitions or Pathophysiology: Terminology or basic science correlates
that are pertinent to the disease process.
b. Clinical Approach: A discussion of the approach to the clinical problem in
general, including tables, figures, and algorithms.
PART III
The Comprehension Questions for each case is composed of several multiplechoice questions that either reinforce the material or introduce new and related
concepts. Questions about material not found in the text have explanations in
the answers.
PART IV
Clinical Pearls list several clinically important points that summarize the text and
allow for easy review of the material, such as before an examination.
LISTING OF CASES
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LISTING BY CASE NUMBER
CASE NO. DISEASE CASE PAG E
1 Adult Male Health Maintenance 18
2 Dyspnea (Chronic Obstructive Pulmonary Disease) 28
3 Joint Pain 38
4 Prenatal Care 48
5 Well-Child Care 62
6 Allergic Disorders, Anaphylaxis, and Conjunctivitis 76
7 Tobacco Use and Cessation 86
8 Clinician Well-Being 96
9 Anemia in the Geriatric Patient 104
10 Acute Diarrhea 112
11 Adult Female Health Maintenance 122
12 Musculoskeletal Injuries 132
13 Skin Lesions 146
14 Hematuria 156
15 Thyroid Disorders 166
16 Male Genitourinary Conditions 176
17 Electrolyte Disorders 186
18 Geriatric Health Maintenance and End-of-Life Issues 200
19 Upper Respiratory and Ear Infections 212
20 Chest Pain 222
21 Chronic Kidney Disease 234
22 Vaginitis and Other Vaginal Infections 244
23 Lower Gastrointestinal Bleeding 252
24 Pneumonia 260
25 Major Depression and Other Mood Disorders 270
26 Postpartum Care 282
27 Heart Failure 294
28 Family Planning—Contraceptives 308
29 Adolescent Health Maintenance 324
30 Hypertension 334
31 Abdominal Pain and Vomiting in a Child 344
32 Dementia 352
33 Obesity 362
34 Migraine and Other Headache Syndromes 374
35 Hyperlipidemia 388
xvii
xviii LISTING OF CASES
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36 Family Violence 398
37 Limping in Children 410
38 Postoperative Fever 422
39 Acute Causes of Wheezing and Stridor in Children 434
40 Irritable Bowel Syndrome 446
41 Substance Use Disorder 456
42 Palpitations 472
43 Sting and Bite Injuries 484
44 Cerebrovascular Accident/Transient Ischemic Attack 494
45 HIV, AIDS, and Other Sexually Transmitted Infections 506
46 Jaundice 520
47 Dyspepsia and Peptic Ulcer Disease 534
48 Fever and Rash 546
49 Breast Diseases 558
50 Menstrual Cycle Irregularity 568
51 Diabetes Mellitus 578
52 Adverse Drug Reactions and Interactions 594
53 Acute Low Back Pain 604
54 Autism Spectrum Disorder 614
55 Movement Disorders 624
56 Wheezing and Asthma 634
57 Obstructive Sleep Apnea 648
58 Osteoporosis 658
59 Opioid Use Disorder and Chronic Pain Management 666
60 Lower Extremity Edema 680
LISTING BY DISORDER (ALPHABETICAL)
CASE NO. DISEASE CASE PAGE
31 Abdominal Pain and Vomiting in a Child 344
39 Acute Causes of Wheezing and Stridor in Children 434
10 Acute Diarrhea 112
53 Acute Low Back Pain 604
29 Adolescent Health Maintenance 324
11 Adult Female Health Maintenance 122
1 Adult Male Health Maintenance 18
52 Adverse Drug Reactions and Interactions 594
6 Allergic Disorders, Anaphylaxis, and Conjunctivitis 76
9 Anemia in the Geriatric Patient 104
54 Autism Spectrum Disorder 614
LISTING OF CASES xix
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49 Breast Diseases 558
44 Cerebrovascular Accident/Transient Ischemic Attack 494
20 Chest Pain 222
21 Chronic Kidney Disease 234
8 Clinician Well-Being 96
32 Dementia 352
51 Diabetes Mellitus 578
47 Dyspepsia and Peptic Ulcer Disease 534
2 Dyspnea (Chronic Obstructive Pulmonary Disease) 28
17 Electrolyte Disorders 186
28 Family Planning—Contraceptives 308
36 Family Violence 398
48 Fever and Rash 546
18 Geriatric Health Maintenance and End-of-Life Issues 200
27 Heart Failure 294
14 Hematuria 156
45 HIV, AIDS, and Other Sexually Transmitted Infections 506
35 Hyperlipidemia 388
30 Hypertension 334
40 Irritable Bowel Syndrome 446
46 Jaundice 520
37 Limping in Children 410
60 Lower Extremity Edema 680
23 Lower Gastrointestinal Bleeding 252
25 Major Depression and Other Mood Disorders 270
16 Male Genitourinary Conditions 176
50 Menstrual Cycle Irregularity 568
34 Migraine and Other Headache Syndromes 374
55 Movement Disorders 624
12 Musculoskeletal Injuries 132
3 Nontraumatic Joint Pain and Swelling 38
33 Obesity 362
57 Obstructive Sleep Apnea 648
59 Opioid Use Disorder and Chronic Pain Management 666
58 Osteoporosis 658
42 Palpitations 472
24 Pneumonia 260
38 Postoperative Fever 422
26 Postpartum Care 282
4 Prenatal Care 48
13 Skin Lesions 146
43 Sting and Bite Injuries 484
41 Substance Use Disorder 456
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