This is a convenient new review e-book, consisting of nearly 1000 case-based problems. Whether you're studying for the board, recertifying, or just looking for a convenient way to make sure your patient-care skills stay sharp, this internal medicine self assessment tool makes review easy and enjoyable.
* Comprehensive. An extensive library of questions covers all of adult internal medicine, plus Psychiatry, Neurology, Dermatology, and more.
Before embarking on policy reforms to improve access, national policy-makers need to have
a clear understanding of the factors that are contributing to high prices and poor avail-
ability; this will help ensure that their response is tailored to the national context. Table 1.3
lists a number of possible policy options and specific actions that are open to governments
for reducing prices and improving availability.
It might seem bizarre that scientists
should turn to deadly snakes to
discover new medicines to treat
life threatening conditions like
hypertension (high blood pressure).
but medicine and snake venom
share a common aim – to change
biological function. Venoms
are extremely complex, each
containing as many as 100 differen
substances, and scientists believe
they can yield a wide range of
Research into the brazilian pit viper
venom produced the ﬁrst in a new
class of anti-hypertensive medicines
– the angiotensin-converting enzym
Having cancer doesn’t mean that you’ll have pain. But if you do, you can
manage most of your pain with medicine and other treatments.
This booklet will show you how to work with your doctors, nurses, and others
to find the best way to control your pain. It will discuss causes of pain, medicines,
how to talk to your doctor, and other topics that may help you.
Chapter 1 - People who have cancer don’t always have pain. Everyone is
different. But if you do have cancer pain, you should know that you don’t have to
accept it. Cancer pain can almost always be relieved....
Juvenile hormones (JHs) of insects are sesquiterpenoids that regulate a
great diversity of processes in development and reproduction. As yet the
molecular modes of action of JH are poorly understood. TheMethoprene-tolerant (Met) gene of Drosophila melanogasterhas been found to be
responsible for resistance to a JH analogue (JHA) insecticide, methoprene.
Previous studies onMethave implicated its involvement in JH signaling,
although direct evidence is lacking.
GlutathioneS-transferases (GSTs) play critical roles in detoxification,
response to oxidative stress, regeneration of S-thiolated proteins, and cata-lysis of reactions in nondetoxification metabolic pathways. Liver GSTs
were purified from the anoxia-tolerant turtle,Trachemys scripta elegans.
Purification separated a homodimeric (subunit relative molecular mass¼
34 kDa) and a heterodimeric (subunit relative molecular mass¼32.6 and
36.8 kDa) form of GST.
The recent charges faced by two healers from Ecuador for “criminal negligence causing
death and administering, trafficking in and importing into Canada a controlled substance,”
(Carr: 3 November 2002, Canadian Press) have widespread implication for traditional
healers. The two medicine men are currently facing lengthy court cases as a result of the
death of an individual during a ceremony in the community of Wikwemikong. The case of
the men from Ecuador rests in the notion of “trafficking controlled substances.
Traditional Asian medicine has been in existence for more than 5000 years. It relies on
using animal and plant substances, which form the basis of raw ingredients for prescription
medicine and manufactured patent medicines. The raw ingredients may be used directly
after some preparation (grinding, washing, boiling, drying etc.) or may be made into
factory-processed forms such as plasters, pills or tablets and packaged in mass quantities
for national or worldwide distribution.
The American Society for Reproductive Medicine (ASRM) is the specialty
society for physicians that focus on infertility. The organization has a Practice
Committee that issues regular reports, including guidelines on minimal
standards for providing ART, informed consent, and on the number of
embryos to be transferred in IVF procedures. The guidelines are distributed
to all members of ASRM, are published in the Society's journal, Fertility and
Sterility, and are available to the public on ASRM's website (www.asrm.org).
Non-Small Cell Lung Cancer
NSCLC Stages I and II
Surgery In patients with NSCLC stages IA, IB, IIA and IIB (Table 85-2) who can tolerate operation, the treatment of choice is pulmonary resection. If a complete resection is possible, the 5-year survival rate for N0 disease is about 60–80%, depending on the size of the tumor. The 5-year survival drops to about 50% when N1 (hilar node involvement) disease is present.
The extent of resection is a matter of surgical judgment based on findings at exploration.
At an international Consensus Conference held
in 1991 at the offices of the International Olympic
Committee in Lausanne, a small group of experts
conducted a comprehensive review of the available
information and concluded that ‘Diet significantly
influences athletic performance’. This
statement is unequivocal: what we eat and drink,
how much we consume and when it is consumed
can all have positive or negative effects on performance
in training and in competition.
Thyroid Disease (See also Chap. 335) In pregnancy, the estrogen-induced increase in thyroxine-binding globulin causes an increase in circulating levels of total T 3 and total T4. The normal range of circulating levels of free T4, free T3, and thyroidstimulating hormone (TSH) remain unaltered by pregnancy.
The thyroid gland normally enlarges during pregnancy. Maternal hyperthyroidism occurs at a rate of ~2 per 1000 pregnancies and is generally well tolerated by pregnant women. Clinical signs and symptoms should alert the physician to the occurrence of this disease.
Opioid and COX Inhibitor Combinations When used in combination, opioids and COX inhibitors have additive effects. Because a lower dose of each can be used to achieve the same degree of pain relief, and their side effects are nonadditive, such combinations can be used to lower the severity of dose-related side effects. Fixed-ratio combinations of an opioid with acetaminophen carry a special risk. Dose escalation as a result of increased severity of pain or decreased opioid effect as a result of tolerance may lead to levels of acetaminophen that are toxic to the liver.
Decision-making for the implementation of specialized nutrition support (SNS). CVC, central venous catheter; PICC, peripherally inserted central catheter. (Adapted from previous chapter by Lyn Howard, MD.)
The first step in deciding to administer SNS is to consider the nutritional implications of the disease process. Is the condition or its treatment likely to impair food intake and absorption for a prolonged period of time? For example, a well-nourished individual can tolerate approximately 7 days of starvation while experiencing a systemic response to inflammation (SRI).
Small Cell Lung Cancer
A simple two-stage system is used. In this system, limited-stage disease (seen in about 30% of all patients with SCLC) is defined as disease confined to one hemithorax and regional lymph nodes (including mediastinal, contralateral hilar, and usually ipsilateral supraclavicular nodes), while extensive-stage disease (seen in about 70% of patients) is defined as disease exceeding those boundaries. Clinical studies such as physical examination, x-rays, CT and bone scans, and bone marrow examination are used in staging.
Aprofession is characterized by skill based on a unique body of knowledge, a
code of ethics, and a social contract with society or government that grants it a
certain degree of autonomy in exchange for self-regulation. The responsibilities
of self-regulation in the medical profession are complex and involve many
levels of oversight aimed at guaranteeing the continuing competence of
practicing physicians. Today, professional associations in the United States play
a significant role in upholding the ethical, educational, scientific, and practice
standards of the medical profession.
After 40 the muscle fibbers shrink and replaced slowly with a tough fibrous tissue.Muscle changes often begin in the 40s in women. Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue. This is most noticeable in the hands, which may appear thin and bony. Muscles may become rigid with age and may lose tone, even with regular exercise. Loss of muscle mass reduces strength which contributes to fatigue, weakness, and reduced activity tolerance. Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones....
I am delighted to have the opportunity to edit this important issue of Obstetrics and
Gynecology Clinics of North America on the topic of Medical Complications in Pregnancy.
The broad field of medicine changes rapidly, with constantly occurring new
breakthroughs, approaches, and recommendations. The area of medical disorders in
pregnancy encompasses a broad range of diseases; a woman may have a long-term
chronic disorder that can have major implications for undertaking a pregnancy. Yet,
other medical conditions are unique to pregnancy but also influence gestational