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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3055_Библиотеки_им_академика_М_И_Перельмана.pdf
xii
Kamala Gullapalli Cotts, MD Department of Medicine,
The University of Chicago, Chicago, IL, USA
Dushyant Damania, MBBS Department of Internal
Medicine, Icahn school of Medicine Mount Sinai Bronx VA,
Bronx, NY, USA
Shadi Dowlatshahi, MD, MSc Department of Internal
Medicine, Oregon Health and Science University, Portland,
OR, USA
Martin Fried, MD Department of Internal Medicine, New
York University Langone Health - Brooklyn, Brooklyn, NY,
USA
Ari Geliebter, MD Division of Endocrinology, Montefiore
Medical Center/Albert Einstein College of Medicine, Bronx,
NY, USA
Tabitha N. Goring, MD Hospital Medicine Service,
Department of Medicine, Memorial Sloan Kettering Cancer
Center, New York, NY, USA
Gayotri Goswami, MD, FACE Division of Endocrinology
and Metabolism, Department of Medicine, North Central
Bronx Hospital, Bronx, NY, USA
Elizabeth R. Jenny-Avital, MD, M Phil Department of
Medicine, Albert Einstein College of Medicine Jacobi Medical
Center, Bronx, NY, USA
Sanjay Jumani, MD Internal Medicine - Pediatrics Residency
Program, The University of Chicago, Chicago, IL, USA
Sandeep Kapoor, MD Division of General Internal Medicine,
Northwell Health, New Hyde Park, NY, USA
Department of Emergency Medicine, Northwell Health, New
Hyde Park, NY, USA
Department of Psychiatry and Behavioral Health, Northwell
Health, New Hyde Park, NY, USA
Robert Kennedy Jr., MD University of Maryland Upper
Chesapeake Medical Center, Bel Air, MD, USA
Contributors
xiii
Shuchita Khasnavis, MD Department of Medicine, North
Central Bronx Hospital, Bronx, NY, USA
Kiyoshi Kinjo, MD, MSc Department of Internal Medicine,
Okinawa Chubu Hospital, Uruma City, Okinawa, Japan
Mitsuyo Kinjo, MD, MPH Department of Medicine,
Okinawa Chubu Hospital, Uruma City, Okinawa, Japan
Karthik Krishnamurthy, DO, FAOCD, FAAD Department
of Dermatology, Orange Park Medical Center, Orange Park,
FL, USA
Nancy A. LaVine, MD General Internal Medicine, Northwell
Health, New Hyde Park, NY, USA
Dan L. Li, MD, PhD Department of Internal Medicine,
Jacobi Medical Center, Bronx, NY, USA
Veronica M. LoFaso, MD, MS Division of Geriatrics and
Palliative Medicine, Department of Medicine, Weill Cornell
Medical College, NY Presbyterian Hospital, New York, NY,
USA
Alejandra Sanchez Lopez, MD Department of Medicine,
Albert Einstein College of Medicine, Jacobi Medical Center,
Bronx, NY, USA
Alyssa Miceli, DO Department of Dermatology, Orange
Park Medical Center, Orange Park, FL, USA
Ashutosshh Naaraayan, MD Department of Medicine,
Montefiore New Rochelle Hospital, New Rochelle, NY, USA
Jhansi Nalamati, MD, FAASM, FACP, FCCP Division of
Pulmonary Medicine, Department of Medicine, Albert
Einstein College of Medicine, North Central Bronx Hospital
and Jacobi Medical Center, Bronx, NY, USA
Schantal Polanco, MD Jacobi Medical Center, Bronx, NY,
USA
Daniel Pomerantz, MD, MPH Department of Medicine,
Montefiore New Rochelle Hospital, New Rochelle, NY, USA
Contributors
xiv
Sreekala Raghavan, MD Department of Medicine,
Montefiore Medical Center/Albert Einstein College of
Medicine, Bronx, NY, USA
Jacinth S. Ruddock, MD Department of Internal Medicine,
North Central Bronx Hospital, Bronx, NY, USA
Niraj K. Shenoy, MD Department of Medicine (Hematology
and Oncology), Mayo Clinic, Rochester, NY, USA
Israa Soghier, MBChB, MS Jacobi Medical Center,
Pulmonary Critical Care, Bronx, NY, USA
Aaron D. Storms, MD Department of Medicine, Keck
School of Medicine of USC, Los Angeles, CA, USA
Zaldy S. Tan, MD, MPH Division of Geriatric Medicine,
Department of Medicine, UCLA Alzheimer’s and Dementia
Care Program, David Geffen School of Medicine, University
of California Los Angeles, Los Angeles, CA, USA
Athina Vassilakis, MD, MPH Department of Medicine,
Columbia University Medical Center, New York, NY, USA
Contributors
xv
Abbreviations
A1c Hemoglobin A1c
AC Acromioclavicular
ABRS Acute bacterial rhinosinusitis
AIN Acute interstitial nephritis
AKI Acute kidney injury
ARS Acute rhinosinusitis
ATN Acute tubular necrosis
AGIs Alpha-glucosidase inhibitors
ACC American College of Cardiology
AHA American Heart Association
ARBs Angiotensin receptor blockers
ACEIs Angiotensin-converting enzyme inhibitors
AHI Apnea-Hypopnea index
AVM Arteriovenous malformation
ASA Aspirin
ASCVD Atherosclerotic cardiovascular disease
BPH Benign prostate hypertrophy
BDZRA Benzodiazepine Receptor Agonist
CURB 65 Confusion, Uremia, Respiratory distress, Blood
pressure<90/60, age 65
CVD Cardiovascular Disease
CSA Central Sleep Apnea
CXR Chest X ray
xvi
CDH Chronic daily headache
CKD Chronic kidney disease
CVT Chronic venous thrombosis
CBT Cognitive behavioral therapy
CI Confidence interval
CAD Coronary artery disease
CP Chest pain
DVT Deep vein thrombosis
DM Diabetes mellitus
DPP-4 Dipeptidyl peptidase 4
ER Emergency room
ESRD End-stage renal disease
FENa Fractional excretion of sodium
FeUrea Fractional excretion of urea
GERD Gastroesophageal reflux disease
GFR Glomerular filtration rate
GAS Group A Streptococcus
HC Hemicranias continua
HTN Hypertension
HRS Hepatorenal syndrome
HDL-c High-density lipoprotein cholesterol
H&P History and physical
HIV Human immunodeficiency virus
IV Intravenous access
IVFs Intravenous fluids
LFTs Liver function tests
LDL-c Low-density lipoprotein cholesterol
LP Lumbar puncture
MO Medication overuse
NSF Nephrogenic systemic fibrosis
NSAIDs Non-steroidal anti-inflammatory drugs
NTG Nitroglycerin
OHS Obesity hypoventilation syndrome
OSAHS Obstructive sleep apnea/hypopnea syndrome
OCST Out of center sleep testing
O
2
Oxygen
PH Paroxysmal hemicranias
PICC Peripherally inserted central catheters
Abbreviations
xvii
PSG Polysomnography
PAP Positive airway pressure
PPIs Proton pump inhibitors
PE Pulmonary embolism
ROM Range of motion
RADT Rapid antigen detection testing
RBCs Red blood cells
RR Relative risk
SUNCT Short lasting unilateral neuralgiform headache
SDB Sleep disordered breathing
SGLT-2 Sodium-glucose transporter 2
SNP Split night polysomnography
SAH Subarachnoid hemorrhage
SDH Subdural hematoma
SVC Superior vena cava
TMJ Temporal mandibular joint
TTH Tension-type headache
TZD Thiazolidinediones
TSH Thyroid stimulating hormone
TTE Transthoracic echo
TAC Trigeminal autonomic cephalalgia
T1D Type 1 diabetes
T2D Type 2 diabetes
US Ultrasound
UA Urinalysis
USPSTF US preventive services task force
VLDL-c Very low-density lipoprotein cholesterol
WBCs White blood cells
Abbreviations
Part I
General Considerations
3© Springer International Publishing AG 2018
E. Sydney et al. (eds.), Handbook of Outpatient Medicine,
https://doi.org/10.1007/978-3-319-68379-9_1
Introduction
Traditional medical pedagogy stresses the importance of a
complete patient history and physical exam. Though this is
extremely relevant for the purposes of learning and perfect-
ing skills, the reality of clinical practice does not allow the
clinician to complete a full examination at each patient visit.
Therefore, clinicians need to decide how to narrow the focus.
When is it appropriate to perform focused history taking and
examinations? What can the clinician use to guide these deci-
sions? Evidence-based recommendations for screening can
support the decision process and help guide the content of
the encounter with the patient and the care provided. This
chapter will highlight the importance of thoughtful screening
to better inform the physical examination and health mainte-
nance planning.
Chapter 1
Screening/Physical Exam/
Health Maintenance
Sandeep Kapoor
S. Kapoor, MD (*)
Division of General Internal Medicine, Northwell Health,
New Hyde Park, NY 11042, USA
Department of Emergency Medicine, Northwell Health,
New Hyde Park, NY 11042, USA
Department of Psychiatry and Behavioral Health, Northwell
Health, New Hyde Park, NY 11042, USA
e-mail: skapoor@northwell.edu
4
Decision-Making/Differential Diagnosis
Screening
The utilization of sensitive and specific screening tools can
serve to guide the decision-making process and the formula-
tion of differential diagnoses. Screenings are utilized to help
identify early-stage disease processes where early identifica-
tion and treatment have been demonstrated to improve out-
comes. Safety, risk, cost-effectiveness, and predictive value
need to be considered when deciding which screenings are to
be conducted.
Screening is constant throughout the care of the patient.
The action of screening exists while taking a history, while
conducting a physical exam and even beyond a visit when
reviewing laboratory results. Clinicians are charged with
investigating relevant nuggets of information that may align
with an illness script, and to satisfy this expectation, they need
to arm themselves with screening tools that can facilitate the
process.
The US Preventive Services Task Force [1] (USPSTF) is an
independent panel of experts in primary care and prevention.
This panel systematically reviews the literature for evidence
of effectiveness and develops recommendations for clinical
preventive services. The USPSTF highlights over 50 “A-” and
“B-”rated recommendations based on a patient’s gender, age,
and certain risk factors (Table 1.1) [2]. The Task Force assigns
one of five letter grades (A, B, C, D, or I) to each recommen-
dation based on the evidence of effectiveness (Table 1.2) [3].
These recommendations are updated periodically.
Clinicians are accustomed to a multitude of evidence-
based screenings that are already part of the usual clinical
care (e.g., blood pressure, weight, HBA1c, hepatitis, HIV test-
ing, etc.). In addition, the USPSTF as well as other similar
panels makes recommendations for screening for behavioral
conditions and risky behaviors such as depression [4], seden-
tary lifestyle, and alcohol use [5]. These recommendations
encourage conversations about issues that are very relevant
to a patient’s health and the care delivered.
S. Kapoor
5
Table 1.1 2016 Modified USPSTF A and B recommendations
Topic Description Grade
Release date of
current
recommendation
Bacteriuria screening: pregnant
women
The USPSTF recommends screening for
asymptomatic bacteriuria with urine culture
in pregnant women at 12–16 weeks’ gestation
or at the first prenatal visit, if later
A July 2008
Blood pressure screening: adults The USPSTF recommends screening for high
blood pressure in adults aged 18 years or
older. The USPSTF recommends obtaining
measurements outside of the clinical setting
for diagnostic confirmation before starting
treatment
A October 2015
Cervical cancer screening The USPSTF recommends screening for
cervical cancer in women ages 21–65 years
with cytology (Pap smear) every 3 years or
for women ages 30–65 years who want to
lengthen the screening interval, screening
with a combination of cytology and human
papillomavirus (HPV) testing every 5 years
A March 2012
(continued)
1. Screening/Physical Exam/Health Maintenance