The practice of outpatient medicine in the 21st century has become fast-paced and challenging. The busy practitioner learns to make accurate decisions regarding diagnoses and treatments, individualizing them based on the patients’ particular characteristics and desires. Patients typically present with more than one issue, spanning from wanting information about a vaccine to having symptoms of an acute and serious infectious disease, while also needing care of their chronic conditions. In order to function in a timely manner, the provider needs a reliable resource to aid in making efficient decisions. This text is designed to fulfill this purpose.
Now fully revised and expanded, Handbook of Outpatient Medicine, 2e provides a quick, portable, algorithm-based guide to diagnosis and management of common problems seen in adult patients. Written by experienced primary care practitioners, this text emphasizes efficient decision-making necessary in the fast-paced realm of the medical office. It covers general considerations such as the physical examination, care of special populations, and pain management and palliative care. It also focuses on common symptoms and disorders by system, including endocrine, respiratory, cardiac, orthopedic, neurologic, genitourinary, and gynecologic. For each disorder, symptoms, red flags, algorithms for differential diagnosis, related symptoms and findings, laboratory workup, treatment guidelines, and clinical pearls are discussed. One of the major updates in this edition is a chapter dedicated to COVID-19. This chapter focuses on COVID-19 diagnosis, care and sequelae, including what to do after discharge from the hospital. Since the global pandemic has affected medicine as a whole, many of the chapters also discuss COVID-19 as a differential diagnosis. Newer and higher quality photos have also been added in several chapters to help illustrate techniques more efficiently, including new imaging modalities for chest pain.
Author(s): Eleanor Weinstein, Elana Sydney, Lisa M. Rucker
Edition: 2
Publisher: Springer
Year: 2023
Language: English
Tags: Outpatient Medicine; Family Medicine; General Practice; Primary Care
Preface
Contents
Part I: General Considerations
Chapter 1: Screening/Physical Exam/Health Maintenance
Introduction
Intersection of Public Health and Primary Care
Social Determinants of Health (SDOH) [1]
Prevention
Harm Reduction
Decision-Making/Differential Diagnosis
Screening
Physical Exam
Vaccinations
Health Maintenance
References
Chapter 2: Covid-19 for the Primary Care Clinician: Current Recommendations—Don’t Blink!
Introduction
Symptoms
Other History
Physical Exam
Lab Tests
Differential Diagnosis
Treatment
Prevention
Long Covid
References
Chapter 3: Transition Care of Teens with Chronic Health Conditions
Introduction
Barriers in Transition Care
Patient and Family Perspectives
Provider Perspectives
Initial Evaluation of Teens with Chronic Health Conditions Transitioning to Adult Providers
Portable Medical Summary
Assessment of Functional Status
Education
Living Arrangement and Family Support
Employment
Health Insurance and Benefits Relevant to the Transitioning Adult
Medicaid, Medicare, SSI, and SSDI
Medical Decision-Making and Guardianship
Local Resources for Intellectual and Developmental Disabilities (IDD)
Unique Considerations in Teens and Young Adults with Chronic Health Conditions Transitioning to Adult Providers
Specialist-Dominated Care
Internist-Dominated Care
Condition-Specific Medical Knowledge
Medication Reconciliation/Polypharmacy
Secondary Medical Conditions
Behavioral Health
Anxiety and Depression
Health Maintenance
Sexual Health
Sexual Abuse
Contraception
Cervical Cancer Screening
Health Disparities
Ethical Considerations
Conclusion
References
Chapter 4: Care of the Elderly Patient
Introduction
Outpatient Assessment
Tips for Effective Communication
Past Medical and Surgical History
Social History
Medications
Review of System for Older Adults
Physical Examination: Evaluate for Pertinent Findings in the Geriatric Patient
Functional Assessment
Health Promotion and Disease Prevention
Vaccines for Individuals over 65 Years of Age [6]
Primary and Secondary Disease Prevention
Lifestyle and Behaviors
Geriatric Syndromes
Urinary Incontinence (See Table 4.2)
Dementia (See Chapter on Cognitive Impairment)
Delirium
Confusion Assessment Method (CAM): Short version [14]
Delirium Evaluation
Depression
Medication Management
Falls and Immobility
Examination of the Older Adult After a Fall [16]
Get Up and Go Test [17]
Preventing Future Falls
Polypharmacy
Sensory Loss
Vision
Hearing Loss
Malnutrition and Unexplained Weight Loss
Osteoporosis
Sleep Disorders
Advanced Care Planning
Elder Abuse and Neglect
Home Care
References
Chapter 5: Care at the End of Life: Palliative and Hospice Care—Symptom Management
History
Palliative Care/Hospice Care
Role of the Primary Care Physician in Palliative Care/Hospice
When to Refer
Starting the Conversation/Important Documents
Management of Common Symptoms in Palliative Care
Shortness of Breath
Constipation
Nausea/Vomiting
Pain
Conclusion
References
Chapter 6: Substance Use Disorder
Introduction
Definitions
Decision-Making
Identification
Key History
Workup
Management
Risky or Unhealthy Alcohol Use
Risky Opioid Use or OUD
References
Part II: Endocrine
Chapter 7: Diabetes
Introduction
Diagnosis of DM
Screening for DM
Key H&P in Early DM
History
Physical Exam
Healthcare Maintenance in the Patient with Diabetes [11]
Treatment of DM
Type 1 Diabetes
Type 2 Diabetes
Lifestyle Changes
Pharmacological Therapy in T2D
Choice of Therapy
Metformin
Sulfonylureas (Glimepiride, Glyburide, Glipizide) and Meglitinides (Repaglinide, Nateglinide)
GLP-1 Receptor Agonists (Exenatide, Liraglutide, Dulaglutide, Lixisenatide)
DPP-4 Inhibitors (Sitagliptin, Saxagliptin, Linagliptin, Alogliptin)
SGLT-2 Inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin)
Thiazolidinediones (Pioglitazone)
Alpha-Glucosidase Inhibitors (AGIs) (Acarbose, Miglitol)
Insulin
References
Chapter 8: Thyroid Dysfunction
Hypothyroidism
Brief Introduction
Key H&P
Decision-Making/Diagnosis
Treatment
Overt Hypothyroidism
Subclinical Hypothyroidism
Treatment Challenges
Hyperthyroidism
Brief Introduction
Key H&P
Decision-Making/Differential Diagnosis
Treatment
Graves’ Disease
Radioactive Iodine (RAI)
Surgery
Treatment: Subclinical Hyperthyroidism
Thyroid Nodules
Brief Introduction
Key H&P
Decision-Making/Differential Diagnosis
Treatment
References
Chapter 9: Lipids
Introduction
Key History and Physical
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
Principles of Therapy
Treatment Strategies
Lifestyle Modification
Statins
Fibrates
Fish Oil
Other Non-statin Medications
Monitoring After Initiating Therapy
References
Chapter 10: Obesity
Introduction
Key History and Physical Exam
History
Physical Examination and Diagnostics
Who Should Lose Weight?
Treatment
Management of Obesity
Diet
Physical Activity
Pharmacotherapy
Weight-Loss Surgery and Procedures
Long-Term Follow-Up After Uncomplicated Bariatric Surgery
References
Part III: Respiratory
Chapter 11: Cough
Brief Introduction
Decision-Making/Differential Diagnosis
Acute Cough
Subacute Cough
Chronic Cough
Evaluation/Investigation
Disease-Specific Features
Acute Cough
Subacute Cough
Chronic Cough
Treatment
References
Chapter 12: Shortness of Breath
Introduction
Decision-Making/Differential Diagnosis and Key History and Physical Exam
Sudden-Onset Dyspnea
Acute-Onset Dyspnea
Episodic Dyspnea
Chronic Dyspnea
Treatment
References
Chapter 13: Sinusitis or Rhinosinusitis
Introduction
Acute Sinusitis
Chronic/Recurrent Sinusitis
Symptoms of Acute Sinusitis
Symptoms of Chronic Sinusitis
Physical Findings
Diagnosis
Diagnostic Tests
Treatment of Acute Sinusitis
Treatment of Chronic Sinusitis
Additional Evaluation
References
Chapter 14: Sore Throat
Introduction
Decision-Making/Differential Diagnosis
Key H&P
Rapid Antigen Detection Tests
Treatment
Symptomatic Treatment
References
Chapter 15: Sleep Apnea
Introduction
ICSD3 Classifies Sleep Disorders into Seven Major Categories [4]
Prevalence
Sleep History
Screening Questionnaires to Assess the Risk of OSA
STOP-Bang Questionnaire
Understanding ESS Score
Focused Physical Exam
OSA/SDB (Obstructive Sleep Apnea/Sleep-Disordered Breathing)
Definition
Risk Factors
Pathophysiology
Diagnosis
Differential Diagnosis of Excessive Daytime Sleepiness (EDS)
Complications and Consequences of Untreated Sleep Apnea
Treatment: OSAHS/SDB (Usual Therapy)
Treatment of CSA
References
Part IV: Cardiac
Chapter 16: Hypertension
Brief Introduction
Scope of the Problem
History and Review of Systems
Decision-Making/Differential Diagnoses
Physical Examination
Measuring Blood Pressure
Diagnostic Studies
Clinical Quality Measure
Assessment
Treatment
Lifestyle Management
Pharmacological Interventions
Office, Home Blood Pressure Monitoring (HBPM), and Ambulatory Blood Pressure Monitoring (ABPM)
Refractory or Resistant Hypertension
Role of Digital Health in Hypertension
References
Chapter 17: Chest Pain
Chest Pain
History
Physical Exam
Differential Diagnosis
Potentially Life-Threatening
Acute Coronary Syndromes
Aortic Dissection
Pulmonary Embolism
Pneumothorax
Non-Life-Threatening Causes
Gastroesophageal Reflux Disease
Pleuritic Chest Pain
Cervical Angina
Pericarditis
Chronic Angina
Herpes Zoster
Muscular Pain
Rib Fracture
Costochondritis
Esophageal Spasm
Approach to Management in the Primary Care Setting
Diagnostic Testing
Electrocardiogram
Blood Testing
Imaging
Chest X-Ray
X-Ray C-Spine
Transthoracic Echocardiogram
Diagnostic Testing for Obstructive Coronary Artery Disease
Treatment of Non-Life-Threatening Causes of Chest Pain
References
Chapter 18: Anemia
Introduction
Key History and Physical Exam
Laboratory Evaluation
Hypoproliferative Anemias
Microcytic Anemia
Differential Diagnosis
Iron Deficiency Anemia
Epidemiology
Pathophysiology
Key History
Physical Exam
Laboratory Evaluation
Diagnosis
Treatment
Normocytic Anemia
Differential Diagnosis [6]
Anemia of Chronic Disease/Inflammation (AOCD)
Epidemiology
Pathophysiology
Key History and Physical Exam
Laboratory Evaluation
Diagnosis
Treatment
Macrocytic Anemia
Differential Diagnosis [2]
Megaloblastic Anemia
Vitamin B12 Deficiency
Epidemiology
Pathophysiology
History and Physical Exam
Laboratory Evaluation
Diagnosis
Folic Acid Deficiency
Hyperproliferative Anemia
Hemolytic Anemia
Intrinsic Hemolytic Anemia
Sickle Cell Anemia
Epidemiology
Pathophysiology
Key History and Physical Exam
Laboratory Evaluation
Diagnosis
Treatment
Thalassemia
Epidemiology
Pathophysiology
Key History and Physical Exam
Laboratory Evaluation
Diagnosis and Management
Hereditary Spherocytosis (HS)
Epidemiology
Pathophysiology
Key History and Physical Exam
Laboratory Evaluation
Diagnosis and Management
Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Deficiency)
Epidemiology
Pathophysiology
History Physical Exam
Laboratory Evaluation
Diagnosis and Management
Extrinsic Hemolytic Anemia
Autoimmune Hemolytic Anemia
Warm Autoimmune Hemolytic Anemia (WAHA)
Epidemiology
Pathophysiology
History and Physical Exam
Laboratory Evaluation
Diagnosis and Management
Cold Autoimmune Hemolytic Anemia
Epidemiology
Pathophysiology
History and Physical Exam
Laboratory Assessment
Diagnosis and Management
Conclusion
References
Chapter 19: Edema
Introduction
Differential Diagnosis
Key History and Physical Exam
Decision-Making/Treatment
References
Part V: Dermatologic
Chapter 20: Rash
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
Chapter 21: Alopecia
Introduction
Decision-Making/Differential Diagnosis
Non-scarring Alopecias
Androgenetic Alopecia
Focal Hair Loss
Diffuse Hair Loss
Scarring Alopecia
Lymphocytic
Central Centrifugal Cicatricial Alopecia (CCCA) (Fig. 21.5)
Mixed Neutrophilic and Lymphocytic
Acne Keloidalis
Neutrophilic
Key History and Physical Exam
Treatment (Table 21.1) [1–4, 6, 8–10]
References
Part VI: Orthopaedic
Chapter 22: Knee Pain
Introduction
Key H&P
History
Past Medical and Surgical History
Medications
Social History
Physical Examination
Differential Diagnosis
Acute Knee Pain Not Associated with Activity
Decision-Making
Treatment
References
Chapter 23: Shoulder Pain
Introduction
Key H&P
History
Past Medical and Surgical History
Physical Examination
Differential Diagnosis
Intrinsic Shoulder Pain
Decision-Making
Treatment
Tendinitis, Bursitis, and Arthritis
Rotator Cuff Injury
Adhesive Capsulitis
References
Chapter 24: Back Pain
Introduction
Key H&P
History
Past Medical and Surgical History
Medications
Social History
Physical Examination
Differential Diagnosis
Decision-Making
Treatment
Pharmacotherapy
Non-pharmacotherapy
References
Part VII: Neurologic
Chapter 25: Dizziness
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
Head Impulse Test, Skew Deviation, Saccadic Pursuit, and Direction-Changing Nystagmus
Romberg Testing
Other Diagnostic Testing
Treatment
BPPV
Vestibular Neuritis/Labyrinthitis
Meniere’s Disease
Disequilibrium
Presyncope
Lightheadedness
References
Chapter 26: Headache
Introduction
Key History and Physical Exam
History
Physical Examination
References
Part VIII: Gynecologic
Chapter 27: Vaginal Discharge
Introduction
History
Physical Exam
Can You Omit a Speculum Exam?
When Is a Bimanual Exam (BME) Necessary?
Diagnosis
Additional Testing
Treatment
References
Chapter 28: Contraception
Introduction
Decision-Making
Key History and Physical
Treatment
References
Part IX: Genitourinary
Chapter 29: Dysuria
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
Chapter 30: Acute Kidney Injury
Introduction
Differential Diagnosis
Key History and Physical Exam
Decision-Making/Treatment
References
Chapter 31: Prostate Problems
Introduction
Prostatitis
Decision-Making/Differential Diagnosis
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)
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
Part X: Gastroenterologic
Chapter 32: Abdominal Pain
Introduction
Key History and Physical Exam
Decision-Making/Differential Diagnosis
Treatment
References
Chapter 33: Abnormal Liver Tests
Introduction
Key History and Physical Exam
Decision-Making/Differential Diagnosis
Liver Studies
Establishing Patterns of Abnormalities
Treatment
References
Part XI: Psychiatric
Chapter 34: Depression/Anxiety
Introduction
Key History and Physical Exam and Differential Diagnoses
Treatment
Clinical Challenges
References
Chapter 35: Insomnia
Introduction
Key History and Physical Exam
History
Social History
Medical History
Medication History
Physical Exam
Differential Diagnosis
Decision-Making
Treatment
Behavioral and Psychological Therapies
Cognitive Behavioral Therapy for Insomnia (CBT- I)
Multicomponent Brief Therapies
Stimulus Control
Sleep Restriction Therapy
Relaxation Therapy
Sleep Hygiene
Other Behavioral and Psychological Therapies
Medications
References
Chapter 36: Memory Loss and Cognitive Impairment
Brief Introduction
Key H&P/Decision-Making
Differential Diagnosis
Treatment
Key Points
References
Index
