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- •Preface
- •Contents
- •Contributors
- •Abbreviations
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Screening
- •Vaccinations
- •References
- •Key History and Physical Exam
- •Health Maintenance
- •Introduction
- •Barriers in Transition Care
- •Patient and Family Perspectives
- •Provider Perspectives
- •Portable Medical Summary
- •Assessment of Functional Status
- •Education
- •Living Arrangement and Family Support
- •Employment
- •Medicaid, Medicare, SSI, and SSDI
- •Medical Decision-Making and Guardianship
- •Local Resources
- •Specialist-Dominated Care
- •Internist-Dominated Care
- •Medication Reconciliation/Polypharmacy
- •Secondary Medical Conditions
- •Behavioral Health
- •Anxiety
- •Condition-Specific Medical Knowledge
- •Health Maintenance
- •Sexual Health
- •Sexual Abuse
- •Contraception
- •Cervical Cancer Screening
- •Health Disparities
- •Ethical Considerations
- •Conclusion
- •References
- •Introduction
- •Outpatient Assessment
- •Tips for Effective Communication
- •Past Medical and Surgical History
- •Social History
- •Medications
- •Review of System for Older Adults
- •Functional Assessment
- •Health Promotion and Disease Prevention
- •Vaccines for Individuals Over 65 Years of Age [6]
- •Primary and Secondary Disease Prevention [10]
- •Lifestyle and Behaviors
- •Geriatric Syndromes
- •Urinary Incontinence (Table 3.2)
- •Dementia (See Chap. 35)
- •Delirium
- •Depression
- •Medication Management
- •Falls and Immobility
- •Polypharmacy
- •Sensory Loss
- •Vision
- •Hearing Loss
- •Malnutrition and Unexplained Weight Loss
- •Osteoporosis
- •Sleep Disorders
- •Advanced Care Planning
- •Elder Abuse and Neglect
- •Home Care
- •References
- •Palliative Care vs. Hospice Care
- •Shortness of Breath
- •Constipation
- •Nausea
- •Pain
- •Advance Care Planning
- •Hospice Care
- •References
- •Testing for HIV in the Primary Care Setting
- •Educate
- •Testing for HIV
- •Test to Detect HIV [13]
- •Care Recommendations at/near the First Visit
- •Timing of ART After an OI
- •Prevention of HIV
- •Finally, a Bit of Humanity
- •References
- •Introduction
- •Metformin
- •Diagnosis of DM
- •Screening for DM
- •Key H&P
- •History
- •Physical Exam
- •Healthcare Maintenance in the Diabetic Patient
- •Treatment
- •Type 1 Diabetes
- •Type 2 Diabetes
- •Lifestyle Changes
- •Pharmacological Therapy in T2D
- •Choice of Therapy
- •Adverse Effects
- •Adverse Effects
- •Adverse Effects
- •Thiazolidinediones (Pioglitazone)
- •Adverse Effects
- •Adverse Effects
- •Insulin
- •References
- •Introduction
- •Key H&P
- •History
- •Medical History
- •Family History
- •Social History
- •Physical Exam
- •Decision-Making/Differential Diagnosis
- •Screening Population
- •Testing Lipid Levels: Fasting vs. Non-fasting
- •Assessing Risk for ASCVD
- •Treatment
- •Patient Population to Treat
- •Goals of Treatment
- •Treatment Strategies
- •Lifestyle Modification
- •Statins
- •Fibrates
- •Monitoring After Initiating Therapy
- •References
- •Hypothyroidism
- •Introduction
- •Key H&P
- •Decision-Making/Differential Diagnosis
- •Treatment
- •Overt Hypothyroidism
- •Subclinical Hypothyroidism
- •Treatment Challenges
- •Hyperthyroidism
- •Introduction
- •Key H&P
- •Decision-Making/Differential Diagnosis
- •Treatment
- •Graves’ Disease
- •Thyroid Nodules
- •Introduction
- •Key H&P
- •Decision-Making/Differential Diagnosis
- •Treatment
- •References
- •Introduction
- •Key History and Physical Exam
- •History
- •Physical Examination and Diagnostics
- •Who Should Lose Weight?
- •Treatment
- •Management of Obesity
- •Diet
- •Physical Activity
- •Weight-Loss Surgery
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Key History and Physical Exam
- •Treatment
- •References
- •Introduction
- •Sudden-Onset Dyspnea
- •Acute-Onset Dyspnea
- •Episodic Dyspnea
- •Chronic Dyspnea
- •Treatment
- •References
- •Introduction
- •Acute Sinusitis
- •Chronic/Recurrent Sinusitis
- •Symptoms of Acute Sinusitis
- •Symptoms of Chronic Sinusitis
- •Physical Findings
- •Diagnosis
- •Diagnostic Tests
- •Treatment of Acute Sinusitis
- •Risk Factors for Resistance to Antibiotics
- •Treatment of Chronic Sinusitis
- •Additional Evaluation
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Key History and Physical Exam
- •Diagnosis of Bacterial Pharyngitis
- •Modified Centor score [7]
- •Treatment
- •References
- •Introduction
- •Prevalence
- •Sleep History
- •STOP-Bang Questionnaire
- •Understanding ESS Score
- •Focused Physical Exam
- •Definition
- •Risk Factors
- •Pathophysiology
- •Diagnosis
- •Treatment of CSA
- •References
- •Introduction
- •Scope of the Problem
- •Key History and Physical Exam
- •Decision-Making/Differential Diagnoses
- •Physical Examination
- •Measuring Blood Pressure
- •Laboratory Tests
- •Treatment
- •Lifestyle Management
- •Pharmacological Interventions
- •Clinical Quality Measure
- •Refractory or Resistant Hypertension
- •Role of Digital Health in Hypertension
- •References
- •Introduction
- •Key History and Physical Exam
- •Gender and Cardiac Disease Presentation
- •Imaging
- •References
- •Introduction
- •Key History and Physical Exam
- •Diagnosis and Evaluation
- •Hypoproliferative Anemias
- •Microcytic Anemias
- •Iron-Deficiency Anemia
- •Treatment
- •Normocytic Anemia
- •Anemia of Chronic Inflammation (ACI)
- •Macrocytic Anemia
- •Megaloblastic Anemia
- •Vitamin B12 Deficiency
- •Folate Deficiency
- •Hyperproliferative Anemias
- •Defects in Red Cell Membrane
- •Defects in Red Blood Cell Metabolism
- •Hemoglobinopathies
- •Sickle Cell Disease
- •Thalassemias
- •Hemolytic Anemia
- •References
- •Introduction
- •Differential Diagnosis
- •Key History and Physical Exam
- •Decision-Making/Treatment
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Papulosquamous
- •Psoriasiform
- •Pityriasiform
- •Lichenoid
- •Erythroderma
- •Eczematous
- •Dermal
- •Vascular
- •Vesiculobullous
- •Infectious
- •Autoimmune, Intraepidermal
- •Autoimmune, Subepidermal
- •Noninflammatory
- •History and Physical Examination
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Non-scarring Alopecias
- •Pattern (Androgenetic)
- •Focal Hair Loss
- •Diffuse Hair Loss
- •Scarring Alopecia
- •Lymphocytic
- •Mixed Neutrophilic and Lymphocytic
- •Neutrophilic
- •Key History and Physical Exam
- •History
- •Physical Exam
- •Treatment (Table 20.1) [1–6]
- •References
- •Introduction
- •Key History and Physical Exam
- •History
- •Past Medical and Surgical History
- •Medications
- •Social History
- •Physical Examination
- •Differential Diagnosis
- •Knee Pain Associated with Activity
- •Diffuse Pain
- •Anterior Knee Pain
- •Medial Knee Pain
- •Lateral Knee Pain
- •Posterior Knee Pain
- •Decision-Making
- •Treatment
- •References
- •Introduction
- •Key History and Physical Exam
- •History
- •Past Medical and Surgical History
- •Physical Examination
- •Differential Diagnosis
- •Pain from Surrounding Structures
- •Intrinsic Shoulder Pain
- •Decision-Making
- •Treatment
- •Tendinitis, Bursitis, and Arthritis
- •Rotator Cuff Injury
- •Adhesive Capsulitis
- •References
- •Introduction
- •Key History and Physical Exam
- •History
- •Past Medical and Surgical History
- •Medications
- •Social History
- •History Elements for Back Pain
- •Physical Examination
- •Differential Diagnosis
- •Serious Conditions
- •Mechanical Back Pain
- •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
- •Key History and Physical Exam
- •Dix-Hallpike Maneuver
- •Nystagmus
- •Hearing Evaluation
- •Romberg Testing
- •Other Diagnostic Testing
- •Treatment
- •BPPV
- •Vestibular Neuritis/Labyrinthitis
- •Meniere’s Disease
- •Disequilibrium
- •Presyncope
- •Lightheadedness
- •References
- •Introduction
- •Key History and Physical Exam
- •History
- •Physical Examination
- •References
- •Introduction
- •Bacterial Vaginosis
- •Vulvovaginal Candidiasis
- •Vaginal Trichomoniasis
- •Other Infectious Causes of Vaginitis
- •Noninfectious Causes Of Vaginitis
- •Key History and Physical Exam
- •Diagnostic Evaluation
- •Treatment
- •References
- •Introduction
- •Decision-Making
- •Key History and Physical Exam
- •Treatment
- •References
- •Introduction
- •Decision-Making/Differential Diagnosis
- •Etiology of Dysuria in Both Men and Women
- •Etiologies of Dysuria in Men
- •Etiologies of Dysuria in Women
- •Key History and Physical Exam
- •Treatment
- •References
- •Introduction
- •Differential Diagnosis
- •Key History and Physical Exam
- •Decision-Making/Treatment
- •References
- •Introduction
- •Prostatitis
- •Decision-Making/Differential Diagnosis
- •Acute Bacterial Prostatitis
- •Chronic Bacterial Prostatitis
- •Other Chronic Etiologies
- •Key History and Physical Exam
- •Treatment
- •Benign Prostatic Hyperplasia
- •Decision-Making/Differential Diagnosis
- •Key History and Physical Exam
- •Treatment
- •Prostate Cancer
- •Decision-Making/Differential Diagnosis
- •Key History and Physical Exam
- •Treatment
- •References
- •Introduction
- •Key History and Physical Exam
- •Decision-Making/Differential Diagnosis
- •Treatment
- •References
- •Introduction
- •Key History and Physical Exam
- •Decision-Making/Differential Diagnosis
- •Liver Studies

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 ofElderly � � � � � � � � � � � � � � � � � � � � � 53
Veronica M. LoFaso
4 End-of-Life Care/Pain Management/Palliative � � � � � 81
Tabitha N. Goring
5 Care ofHIV 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 ofBreath � � � � � � � � � � � � � � � � � � � � � � � � � � � � 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
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