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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3063_Библиотеки_им_академика_М_И_Перельмана
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Editors
INTERNAL MEDICINE
Charles Faselis, M.D.
Chairman of Medicine
VA Medical Center
Washington, DC
Professor of Medicine
George Washington University School of Medicine
Washington, DC
Joseph J. Lieber, M.D.
Associate Professor of Medicine
Associate Program Director in Medicine
Site Director, Internal Medicine Residency Program
Mount Sinai School of Medicine
New York, NY
Associate Director of Medicine
Elmhurst Hospital Center
Queens, NY
Frank P. Noto, M.D.
Assistant Professor of Internal Medicine
Site Director, Internal Medicine Clerkship and Sub-Internship
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Icahn School of Medicine at Mount Sinai
New York, NY
Hospitalist
Elmhurst Hospital Center
Queens, NY
Manuel A. Castro, M.D., AAHIVS
Diplomate of the American Board of Internal Medicine
Certified by the American Academy of HIV Medicine
Wilton Health Center (Private Practice)
Wilton Manors, FL
Nova Southeastern University
Clinical Assistant Professor of Medicine
Fort Lauderdale-Davie, FL
LECOM College of Osteopathy
Clinical Assistant Professor of Medicine
Bradenton, FL
Raj Dasgupta, M.D., F.A.C.P., F.C.C.P., F.A.A.S.M.
Assistant Professor of Clinical Medicine
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine
Assistant Program Director of Internal Medicine residency
Associate Program Director of Sleep Medicine fellowship
Keck School of Medicine of USC
University of Southern California
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Los Angeles, CA
PSYCHIATRY AND ETHICS
Alina Gonzalez-Mayo, M.D.
Psychiatrist
Dept. of Veteran’s Administration
Bay Pines, FL
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We want to hear what you think. What do you like or not like about the Notes? Please email us
at medfeedback@kaplan.com.
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Section I
INTERNAL MEDICINE
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1
Preventive Medicine
Cancer Screening
Regular screening is recommended for cancers of the colon, breast, cervix, and lung.
Colon Cancer
Patients with no significant family history of colon cancer should begin screening at age 50.
The choices are:
Patients who have a single first-degree relative with colorectal cancer diagnosed age <60 or
multiple first-degree relatives with colon cancer diagnosed at any age should undergo
colonoscopy starting at one of the following, whichever age occurs earlier:
Colonoscopy every 10 years (preferred screening modality)
Fecal occult blood testing every year
Sigmoidoscopy with barium enema every 5 years
Age 40
Age that is 10 years younger than the age at which the youngest affected relative was
diagnosed
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In this group of high-risk patients, colonoscopy should be repeated every 5 years.
Breast Cancer
The 3 tests used to screen for breast cancer are mammogram, manual breast exam, and self-
breast exam. The American Cancer Society no longer recommends monthly self-breast exam
alone as a screening tool.
Cervical Cancer
The screening test of choice for the early detection of cervical cancer is the Papanicolaou
smear (“Pap” test). Women should be tested annually, starting at age 21.
Screening can stop at age 65.
Lung Cancer
Current lung cancer screening guidelines recommend the following:
Patients age ≥50, screen with mammogram (with or without clinical breast exam) every 1–2
years
Patients with very strong family history should consider prophylactic tamoxifen
“Very strong family history” is defined as multiple first-degree relatives
Patients age <30, screen annually if using conventional methods or every 2 years if using
liquid-based methods
Patients age ≥30, screen every 2 years if >3 normal annual PAP smears
Patients age 55–80 with >30 pack-years of smoking, screen annually with low dose CT
(non-contrast)
Must be current smoker or has quit ˂15 years—
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Patients age >80, have quit >15 years, or have other medical problems (e.g., severe COPD)
significantly limiting life expectancy or ability to undergo surgery, no screening is
recommended
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Travel Medicine
Hepatitis
Hepatitis A infection is travelers’ most common vaccine-preventable disease. Hepatitis A
infection is possible wherever fecal contamination of food or drinking water may occur. If a
patient is leaving within 2 weeks of being seen, both the vaccine and immune serum globulin
are recommended.
A booster shot given 6 months after the initial vaccination confers immunity for approximately
10 years.
Hepatitis B vaccination is recommended for patients who work closely with the indigenous
population. Additionally, patients who plan to engage in sexual intercourse with the local
populace or to receive medical or dental care, and those who plan to remain abroad for >6
months, should be vaccinated.
Malaria
For travel to Mexico, Central America (except to Panama), or the Caribbean, chloroquine is
acceptable prophylaxis for malaria. For travel to areas where chloroquine resistance is
common, mefloquine is the agent of choice. Doxycycline is an acceptable alternative to
mefloquine, although photosensitivity can be problematic.
For patients who are pregnant and require chemoprophylaxis for malaria, the combination of
atovaquone and proguanil is the preferred regimen.
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Rabies
Rabies vaccination is recommended for travel to areas where rabies is common among
domesticated animals (India, Asia, Mexico). Chloroquine can blunt the response to the
intradermal form of rabies vaccine. Therefore, when both malaria prophylaxis and rabies
prophylaxis are required, the intramuscular form of the vaccine should be administered.
Rabies vaccination is not considered a routine vaccination for most travelers.
Yellow Fever
Yellow fever vaccine is required for travel to sub-Saharan Africa and certain South American
countries.
Typhoid
Typhoid vaccination is recommended for patients who are traveling to developing countries
and will have prolonged exposure to contaminated food and water.
Polio
Adults who are traveling to developing countries and have never received a polio vaccine
should receive 3 doses of the inactivated polio vaccine. Patients who have been previously
immunized should receive a one-time booster. The live attenuated polio vaccine is no longer
recommended because of the risk of vaccine-associated disease.
Meningitis
Patients traveling to areas where meningococcal meningitis is endemic or epidemic (Nepal,
sub-Saharan Africa, northern India) should be immunized with the polysaccharide vaccine.
Additionally, Saudi Arabia requires immunization for pilgrims to Mecca. Patients with
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