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Handbook of
Outpatient Medicine
Elana Sydney · Eleanor Weinstein
Lisa M. Rucker Editors
123
Handbook of Outpatient
Medicine
Elana Sydney
Eleanor Weinstein • Lisa M. Rucker
Editors
Handbook of
Outpatient Medicine
ISBN 978-3-319-68378-2 ISBN 978-3-319-68379-9 (eBook)
https://doi.org/10.1007/978-3-319-68379-9
Library of Congress Control Number: 2017960768
© Springer International Publishing AG 2018
This work is subject to copyright. All rights are reserved by the Publisher,
whether the whole or part of the material is concerned, specifically the rights of
translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduc-
tion on microfilms 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 specific
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 pub-
lication. Neither the publisher nor the authors or the editors give a warranty,
express 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 affiliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Editors
Elana Sydney, MD
Assistant Professor of Medicine
Department of Medicine
Albert Einstein College of
Medicine
Jacobi Medical Center
Bronx, NY, USA
Lisa M. Rucker, MD
Professor of Medicine
Department of Medicine
Albert Einstein College of
Medicine
Jacobi Medical Center
Bronx, NY, USA
Eleanor Weinstein, MD
Associate Professor of Medicine
Department of Medicine
Albert Einstein College of
Medicine
Jacobi Medical Center
Bronx, NY, USA
v

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 ref-
erence that can help guide assessments and therapeutic plans
on the spot. As practicing general internists and teachers for
decades, we know too 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 was to provide such a
roadmap for the common problems that present themselves
to the outpatient adult provider.
This book is organized into two main 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 second section focuses on
specific symptoms, diagnoses, and organ systems. Each chap-
ter includes an algorithm to efficiently guide the user along
the decision points of making the diagnosis and/or determin-
ing the best treatment. The sections are written by experi-
enced outpatient clinicians and based on current evidence
and up-to-date recommendations by respected organizations
such as the US Preventive Services Task Force.
vi
Quotidian topics like diabetes and hypertension are pre-
sented in more detail. Other common issues less commonly
included in textbooks are covered here as well. These topics
include obesity, sleep apnea, and hair loss. 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 medicine practitioner.
Additionally, the approach to diagnosis and treatment repre-
sents 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 physi-
cian assistants. We hope you find this reference to be useful.
Bronx, NY, USA Elana Sydney, MD
Eleanor Weinstein, MD
Lisa M. Rucker, MD
Preface
vii

Contents

Part I General Considerations
1 Screening/Physical Exam/Health Maintenance � � � � � 3
Sandeep Kapoor
2 Transition Care of Teens with Chronic
Health Conditions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 27
Kamala Gullapalli Cotts and Sanjay Jumani
3 Home Care/Care ofElderly � � � � � � � � � � � � � � � � � � � � � 53
Veronica M. LoFaso
4 End-of-Life Care/Pain Management/Palliative � � � � � 81
Tabitha N. Goring
5 Care ofHIV Patients � � � � � � � � � � � � � � � � � � � � � � � � � � � 97
Elizabeth R. Jenny-Avital
Part II Endocrine
6 Diabetes � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 119
Ari Geliebter
7 Lipids � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 137
Dan L. Li
8 Thyroid Dysfunction � � � � � � � � � � � � � � � � � � � � � � � � � � � 153
Nancy A. LaVine
9 Obesity � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 167
Gayotri Goswami and Jacinth S. Ruddock
viii
Part III Respiratory
10 Cough � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 187
Israa Soghier and Kiyoshi Kinjo
11 Shortness ofBreath � � � � � � � � � � � � � � � � � � � � � � � � � � � � 201
Kiyoshi Kinjo
12 Sinusitis � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 215
Shuchita Khasnavis
13 Sore Throat � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 225
Lori Ciuffo
14 Sleep Apnea � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 233
Jhansi Nalamati and Dushyant Damania
Part IV Cardiac
15 Hypertension � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 251
Jitendra Barmecha
16 Chest Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 271
Magda M. Amer
17 Anemia � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 283
Niraj K. Shenoy and Hernando J. Cordero
18 Edema � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 299
Valerie Jorge Cabrera
Part V Dermatologic
19 Rash � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 311
Alyssa Miceli and Karthik Krishnamurthy
20 Hair Loss � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 331
Alyssa Miceli and Karthik Krishnamurthy
Part VI Orthopedic
21 Knee Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 345
Mitsuyo Kinjo
22 Shoulder Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 357
Mitsuyo Kinjo
23 Back Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 371
Mitsuyo Kinjo
Contents
ix
Part VII Neurologic
24 Dizziness � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 387
Robert Kennedy Jr.
25 Headache � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 407
Schantal Polanco
Part VIII Gynecologic
26 Vaginal Discharge � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 421
Alejandra Sanchez Lopez
27 Contraception � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 437
Athina Vassilakis
Part IX Genitourinary
28 Dysuria � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 451
Martin Fried
29 Acute Kidney Injury � � � � � � � � � � � � � � � � � � � � � � � � � � � 465
Valerie Jorge Cabrera
30 Prostate Problems � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 477
Martin Fried
Part X Gastroenterologic
31 Abdominal Pain � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 493
Rosemarie L. Conigliaro and Sreekala Raghavan
32 Abnormal Liver Tests � � � � � � � � � � � � � � � � � � � � � � � � � � 507
Sreekala Raghavan and Rosemarie L. Conigliaro
Part XI Psychiatric
33 Depression/Anxiety � � � � � � � � � � � � � � � � � � � � � � � � � � � � 521
Daniel Pomerantz and Ashutosshh Naaraayan
34 Insomnia� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 533
Shadi Dowlatshahi and Aaron D. Storms
35 Memory Loss/Cognitive Impairment � � � � � � � � � � � � � 549
Jarrod A. Carrol and Zaldy S. Tan
Index � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 563
Contents
xi

Contributors

Magda M. Amer, MD, FACP Department of Internal
Medicine, Florida Hospital Flagler/Florida Health Care Plans
FHCP, Palm Coast, FL, USA
Jitendra Barmecha, MD, MPH, SFHM, FACP Department
of Internal Medicine, SBH Health System, Bronx, NY, USA
Valerie Jorge Cabrera, MD Department of Internal
Medicine, Section of Nephrology, Yale University School of
Medicine, New Haven, CT, USA
Jarrod A. Carrol, MD Department of Geriatrics, Palliative
and Continuing Care, West Los Angeles Medical Center,
Kaiser Permanente, West Los Angeles Medical Center, Los
Angeles, CA, USA
Lori Ciuffo, MD Department of Ambulatory Medicine,
North Central Bronx Hospital, Bronx, NY, USA
Rosemarie L. Conigliaro, MD Department of Internal
Medicine, Montefiore Medical Center/Albert Einstein
College of Medicine, Bronx, NY, USA
Hernando J. Cordero, MD Department of Medicine, Jacobi
Medical Center, Bronx, NY, USA