Vascular Neurology - Questions And Answers  (PDF Version)

    SOURCE :
        Vascular Neurology - Questions And Answers

    AUTHORS :
        Nancy Futrell, MD
            Director - Intermountain Stroke Center - Salt Lake City, Utah
        Dara G. Jamieson, MD
            Associate Professor of Clinical Neurology - New York Presbyterian Hospital - Weill Medical College of Cornell University - New York, New York

    SUMMARY :
        STROKE IS THE THIRD MOST COMMON CAUSE of death and disability in the US. It is a complex disease, with many causes, many presentations, and many levels of severity. Despite recent medical advances, stroke remains a diffi cult disease to diagnose and treat. In recognition of the importance of this common disorder, the American Board of Psychiatry and Neurology (ABPN) instituted a new subspecialty examination in 2005. According to the ABPN’s website, this exam is intended “to offi cially establish the fi eld of vascular neurology as a definite area of subspecialization in neurology and child neurology and to provide a means of identifying properly trained and experienced vascular neurologists.”
        Vascular Neurology: Questions and Answers, is intended to be a comprehensive study guide for the ABPN’s vascular neurology subspecialty exam. In addition, this book can be used by any physician who wants to thoroughly and systematically review the topic of vascular neurology, self-assess his or her skills, or prepare for another examination that contains questions on this important topic.

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Hurst's - The Heart  (CHM Version)

    SOURCE :
        Hurst's - The Heart - 12th Edition.chm

    AUTHORS :
        Valentin Fuster, Richard A. Walsh, Robert A. O'Rourke, Philip Poole-Wilson

    SUMMARY :
        It is 41 years since The Heart was published as the first multidisciplinary and comprehensive textbook on cardiovascular disease. This 12th edition of Hurst’s The Heart with 115 chapters written by preeminent and dedicated experts in each of the specialized areas has innovative features that separate it from prior editions.
        The 12th edition includes authorship by many physicians from Europe, enabling multiple experts from several institutions and different countries to collaborate, thus providing a worldwide perspective on treatment of diseases such as hypertrophic obstructive cardiomyopathy, dilated cardiomyopathies, systemic hypertension, acute rheumatic fever, and neoplastic heart disease.
        The previous chapter on hypertension has been divided into three more detailed chapters concerning epidemiology, pathophysiology, and diagnosis and treatment.
        Chapters concerned with the human genome, cardiovascular practice guidelines, and evolving imaging technology for assessing coronary and non-coronary atherosclerotic disease and plaque characterization have been extensively revised. The most recent advances in pathophysiology and treatment for pulmonary hypertension and for the management of heart failure have been incorporated, and major advances including controversies in interventional cardiology are detailed.
        Additional revised chapters focus on the diseases of the aorta, cardiovascular drug interactions, and surgical and non-surgical approaches to carotid arterial disease and peripheral vascular disease. In the chapter on treatment of cardiac arrhythmias, cardiovascular drug interactions have been updated to include the antiplatelet drugs, the statins, angiotensin 2 receptor blockers, and the new antianginal drug ranolazine. Chapter 105, Diseases of the Aorta, has been expanded and updated to include the medical treatment of acute aortic syndromes, and the chapter on cardiocerebral and cardiopulmonary resuscitation details the AHA modified approach to CPR.
        The ACC/AHA Clinical Practice Guidelines and other alternative guidelines (such as those of the European Society of Cardiology) are more clearly elucidated in this edition than previously and are related to a specific chapter (Chapter 11) introducing this topic and defining several different classification systems.
        The 12th edition of Hurst’s The Heart includes appropriate classic and recent references, many updated just prior to publication with some still in press at the time of publication.
        The editors and associate editors are grateful to the excellent group of authors who participated in the 12th edition of Hurst’s The Heart for their extraordinary and timely contribution. The quick turnaround time for a textbook of this size and complexity is a tribute to the hard work and dedication of our authors.

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Bradycardia - ACLS Algorithm

    Definition :
        Greek  Bradykardía ( βραδυκαρδία ), "HEART SLOWNESS"
        Bradycardia - Defined As A Heart Rate Of < 60 Beats Per Minute, Which May Be Physiologically Normal For Some Patients, Or May Be Inadequate For Others
    Classification :
        Based On Symptoms :
            Symptomatic Bradycardia
                Badycardia With Symptoms Such As : Fatigue, Weakness, Dizziness, Lightheadedness, Fainting, Chest Discomfort, Palpitations Or Shortness Of Breath
            Asymptomatic Bradycardia :
                Bradycardia Which Is Physiologically Normal
                No Associated Symptoms
        Based On Origin :
            Atrial - Such As : Sinus Bradycardia And Sick Sinus Syndrome
                Sinus Bradycardia
                    Usually Found In Young, Healthy Adults, And Athletes (50 - 85 %)
                    Due To :
                        Conditioned Heart Muscle - Higher Stroke Volume - Fewer Contractions To Circulate The Same Volume Of Blood
                        Vagal Tone Changes During Respiration :
                            Expiration - Increase Heart Rate

                Sick Sinus Syndrome
                    Collection Of Conditions In Which The ECG Indicates Sinus Node Dysfunction
                    Bradycardia-Tachycardia Syndrome
                        Sinus Bradycardia, Sinus Arrest, Or Exit Block Combined With Sinoatrial And Atrioventricular Nodal Conduction Disturbances And Tachyarrhythmias
                        Characterized By Bursts Of Atrial Tachycardia Interspersed With Periods Of Bradycardia - Paroxysmal Atrial Flutter Or Fibrillation May Also Occur)

SICK SINUS SYNDROME

            AV Nodal Bradycardia Or AV Juctional Rhythm

                Due To :
                    Absence Of The Electrical Impulse From The Sinus Node,
                    Rate Of Depolarization Of The SA Node Falls Below The Rate Of The AV Node
                    Electrical Impulses From The SA Node Fail To Reach The AV Node Because Of SA Or AV Block
                    Electical Impulse Originating From An Ectopic Focus Somewhere In The AV Junction
                ECG Findings :
                    Normal QRS Complex Accompanied With An Inverted P Wave Either Before, During, Or After The QRS Complex
                    Normal QRS Complex With Prolonged PR

                Protective Mechanism For The Heart To Compensate For A SA Node That Is No Longer Handling The Pacemaking Activity, And Is One Of A Series Of Backup Sites That Can Take Over Pacemaker Function When The SA Node Fails To Do So
                Etiology :
                    Physiologic Junctional Escape Complex :
                        Due To Excessive Vagal Tone On The SA Node
                    Pathological Junctional Escape Complex :
                        SInus Bradycardia, Sinus Arrest, Sinus Exit Block, Or AV Block
            Ventricular
                Known As Ventricular Escape Rhythm Or Idioventricular Rhythm
                    Above The His Bundle, Known As Junctional Rhythm
                        Range Between 40 And 60 Beats Per Minute With A Narrow QRS Complex
                    Below The His Bundle, Known As Ventricular Rhythm
                        Range Between 20 And 40 Beats Per Minute With A Wide QRS Complex
                Compensatory Mechanism That Arises When There Is Lack Of Electrical Impulse Or Stimuli From The Atrium
            Infantile Bradycardia
                Normal Heart Rate Infants : 120 - 160 Beats Per Minute
                Infantile Bradycardia : Infants With Heart Rate Of Less Than 100 Beats Per Minute
    Management (ACLS Algorithm) :

        Initial Treatment :
            Support Of Airway And Breathing (Box 2)
            Provide Supplementary Oxygen, Place The Patient On A Monitor, Evaluate Blood Pressure, And Oxyhemoglobin Saturation, And Establish Intravenous (IV) Access.
            Obtain An ECG To Better Define The Rhythm
            While Initiating Treatment, Evaluate The Clinical Status Of The Patients And Identify Potential Reversible Causes
            SEARCH AND TREAT POSSIBLE CONTRIBUTING FACTORS :
                6H - Hypovolemia, Hypoxia, Hydrogen Ion (Acidosis), Hypo / Hyperkalemia, Hypoglycemia, Hypothermia
                6T - Toxins, Cardiac Tamponade, Tension Pneumothorax, Thrombosis, Thromboembolism, Trauma
            IDENTIFY SIGNS & SYMPTOMS Of POOR PERFUSION Caused By Bradycardia (Box 3)
                Such As : Acute Altered Mental Status, Ongoing Chest Pain, Hypotension, Or Others Signs Of Shock
        Bradycardia With ADEQUATE PERFUSION (Box 4A) :
            Observe And Monitor For Any Signs Of Deterioration (POOR PERFUSION)
        Bradycardia With POOR PERFUSION (Box 4) :
            Provide Immediate Therapy For Patients With Hypotension, Acute Altered Mental Status, Chest Pain, Congestive Heart Failure, Seizures, Syncope, Or Other Signs Of Shock Related To The Bradycardia
            Prepare For Transcutaneous Pacing
                CLASS I INTERVENTION FOR SYMPTOMATIC BRADYCARDIA
                    Non-Invasive, And Can Be Performed By ECC Providers At The Bedside
                Indications :
                    Symptomatic Bradycardia
                    In Patients Who Do Not Respond To Atropine (Or Second-Line Drugs - If These Do Not Delay Definitive Management)
                    Use Without Delay In High-Degree AV Block (Mobitz Type 2 Second Degree AV Block, And Complete Heart Block) - Severely Symptomatic Patients
                Limitation :
                    Painful And May Fail To Produce Effective Mechanical Capture
                    If Cardiovascular Symptoms Are Not Caused By The Bradycardia, The Patients May Not Improve Despite Effective Pacing
                Verify Mechanical Capture And Re-Assess The Patient's Condition
                Use Analgesia And Sedation For Pain Control, And Try To Identify The Cause Of The Bradyarrhythmia
                If Transcutaneous Pacing Is Ineffective (INCONSISTENT CAPTURE) - Prepare For TRANSVENOUS PACING And Consider Obtaining EXPERT Consultation.

            Consider Atropine
                FIRST LINE DRUG For Acute Symptomatic Bradycardia (CLASS IIA)
                    Atropine Administration Should Not Delay Implementation Of External Pacing For Patients With POOR PERFUSION
                Recommended Dose :
                    0.5 mg IV While Awaiting Pacer - May Repeat To A Total Dose (Maximum) Of 3 mg Every 3 To 5 Minutes
                    Doses Of < 0.5 mg May Paradoxically Result In Further Slowing Of The Heart Rate
                Caution :
                    In The Presence Of Acute Coronary Ischemia Or Myocardial Infarction, Increased Heart Rate May Worsen Ischemia Or Increase The Zone Of Infarction
                    Likely To Be Ineffective Following Cardiac Transplantation
                        Transplanted Heart Lacks VAGAL INNERVATION)
                        Paradoxical Slowing Of The Heart Rage ANd High Degree AV Block During Administration Of Atropin In Patients Post Cardiac Transplantation
                IF INEFFECTIVE - BEGIN PACING
            Consider Epinephrine Or Dopamine While Awaiting Pacer Or If Pacing Ineffective
                SECOND LINE DRUG - CLASS IIB - Epinephrine And Dopamine
                Indications :
                    Symptomatic Bradycardia Or Hypotension, When The Bradycardia Is Unresponsive To Atropine And As Temporizing Measures While Awaiting The Availability Of A Pacemaker
                Doses :
                    Epinephrine 2 - 10 mcg/min (INFUSION)
                        Start At 2 mcg/min, And Titrate To Patient Response
                    Dopamine 2 - 10 mcg/kgwt/min
                        α- And β-Adrenergic Actions
                        Start At 2 mcg/kgwt/min, And Titrate To Patient Response
                        Can Be Added To Epinephrine Or Administered Alone
                    Glucagon 3mg Initially, Then Followed By Infusion At 3mg/hr If Necessary
                        Improvement In Heart Rate, Symptoms And Signs Associated With Bradycardia  Based On One Case Series
                        GIVEN TO IN-HOSPITAL PATIENTS With Symptomatic DRUG-INDUCED Bradycardia Which Are Not Responding To Atropine (β-Blocker Or Calcium Channel Blocker Overdose)
                Assess Intravascular Volume And Support As Needed
            Prepare For TRANSVENOUS PACING (Box 5).
                Treat Contributing Causes
                Consider Expert Consultation

Henry's Clinical Diagnosis And Management By Laboratory Methods  (CHM Version)

    SOURCE :
        Henrys Clinical Diagnosis And Management By Laboratory Methods - 21st Edition

    AUTHORS :
        Richard A. McPherson, MD
            Harry P. Dalton Professor and Chairman, Division of Clinical Pathology, Virginia Commonwealth University - Director, Clinical Pathology, Medical College of Virginia Hospitals, Richmond, Virginia, USA
        Matthew R. Pincus, MD PhD
            Professor, Department of Pathology, State University of New York Health Sciences Center at Brooklyn - Chairman, Department of Pathology and Laboratory Medicine, New York Harbor Veterans Affairs Health Care System, Brooklyn and New York, New York, USA

    SUMMARY :
        The role of clinical pathology and laboratory medicine continues to grow as the single largest component of objective scientific data within the medical record of patients. The ever-increasing ease with which conventional laboratory analyses can be provided and the broadening diversity of measurements with esoteric assays contribute to clinical management from prenatal days to newborn screening through childhood, adulthood, and into geriatric ages. This life-long trail of medical observations and laboratory test results is now being organized into a continuous and contemporaneous electronic medical record. The challenge for future medicine lies in how best to use all of this information to provide counseling to patients about behavior modifications and disease risk amelioration based on a wide range of medical data with an expanding core of genetic testing, in addition to traditional measures of organ function and metabolism revealed through chemical, hematological, microbiological, and other laboratory disciplines.
        The expansion in knowledge of the human genome and its conversion into proteomic phenotypes of the human body present a range of opportunities for exploring health and disease as never before practiced. The methods of examination both for nucleic acids and protein expression of genes will surely transform the way that laboratories provide clinical diagnostic services for decades to come. Numerous applications to clinical testing have already come to fruition in microbiology, coagulation, tissue typing, genetic diseases, cancer and hematologic malignancies. The environment provided by clinical laboratories that demands rigor in analysis, quality control, professional competencies, and cost-effective operations will also foster the application of this new knowledge and these new methods into accepted standard of practice. We should expect that the most successful future practitioners of laboratory medicine will be those well versed in and prepared to pursue advances in informatics, basic analytic methods, communications with clinical colleagues, and participation in national and international efforts to standardize and implement complex changes in our profession. It is at multiple levels of society that the laboratory can serve from individual patient testing through public health initiatives for disease prevention, and extending to industry and government policies for health care and its reform to support best practices and promote health and well being in a climate of limited financial resources.
        The 21st edition of this book comes at nearly the century mark since its inception with its first publication in 1908. It has remained throughout that time as the authoritative source of information for residents, students, and other trainees in the discipline of clinical pathology and laboratory medicine and for physicians and laboratorians in that practice. The 21st edition incorporates new discoveries and applications in all chapters to fulfill its mission of being a comprehensive textbook that is up-to-date and readable. Most notable in the format of this edition is the use of color throughout the book with inclusion of many more images and graphical figures than before. One of our goals has been to present laboratory findings in a rendition as close as possible to actual practice as encountered in the real-life conditions of working at the bench. This approach has allowed each author the opportunity to incorporate figures that illustrate diagnostic principles and interpretations.

DEPOSIT FILES

Doppler Ultrasound in Obstetrics And Gynecology(PDF Version)

    SOURCE :
        Doppler Ultrasound in Obstetrics And Gynecology - 2nd Edition

    AUTHORS :
        Dev Maulik
        Ivica Zalud

    SUMMARY :
        Expanded and updated edition highlighting current standards and breakthroughs in the technology of Doppler ultrasound. Includes latest advances in 3D and color doppler and 4D fetal echocardiography Includes more than 500 illustrations, including more than 150 in color.

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Surgery - Blueprints Series(CHM Version)

    SOURCE :
        Surgery - Blueprints Series - 5th Edition

    AUTHORS :
        Karp, Seth J.; Morris, James P.G.; Zaslau, Stanley

    SUMMARY :
        It has been 12 years since the first five books in the Blueprints series were published. Originally intended as board review for medical students, interns, and residents who wanted high-yield, accurate clinical content for U.S. Medical Licensing Examination (USMLE) Steps 2 and 3, the series now also serves as a guide to students during third-year and senior rotations. We are extremely proud that the original books and the entire Blueprints brand of review materials have far exceeded our expectations and have been dependable reference sources for so many students.
        The fifth edition of Blueprints Surgery has been significantly revised. Reorganization of the Table of Contents creates a more logical flow to the chapters. Every chapter includes updates to reflect current practices in the field. A new chapter in the gastrointestinal section explores bariatric surgery. Similar to the previous edition, sample operative reports are included in an appendix. As Blueprints is used in a wider range of clinical settings, students have had the opportunity to review and comment on what additional material would be useful. In response, an increased number of figures, including radiographic studies, photographs, and drawings, integrate with the text. This fifth edition is the first to include a color insert, showing detailed depictions of surgical techniques. The Questions and Answers sections include 25% more material for USMLE Board review. Finally, suggestions for additional reading are available online, along with an additional 50 USMLE-format questions and answers for further self-study.
        We sincerely hope this edition preserves the original vision of Blueprints to provide concise, useful information for students and that the additional material enhances this vision.

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Psychiatry - Blueprints Series  (PDF Version)

    SOURCE :
        Psychiatry - Blueprints Series - 5th Edition

    AUTHORS :
        M. J. Murphy R.L. Cowan (Author)

    SUMMARY :
        Part of the highly regarded Blueprints series, Blueprints Psychiatry provides students with a concise review of what they need to know in their psychiatry rotations or the Boards. Each chapter is brief and includes pedagogical features such as bolded key words, tables, figures, and key points. A question and answer section at the end of the book includes 100 board-format questions with complete rationales. This edition includes new images, more USMLE study questions, and a Neural Basis section for each major diagnostic category.
        A companion Website includes a question bank and fully searchable text.

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ECG Success - Exercises In ECG Interpretation - Shirley Jones (PDF Version)

    SOURCE :
        ECG Success - Exercises In ECG Interpretation - Shirley Jones

    AUTHORS :
        Shirley A. Jones

    SUMMARY :
        No one is born knowing how to read ECG strips. We learn to do many things in a lifetime, and nearly all of them get better with practice. If you’re planning to use this book, ECG isn’t completely new to you––you have a good idea of what’s involved in generating and interpreting a tracing.
        ECG Success covers all the information you will need––anatomy and physiology, practice, and case scenarios, and relevant emergency care––to help you feel competent and in control, whether the situation involves an emergency or just a nonthreatening ECG.
        This book has staying power. You will find its content useful across a spectrum of situations, from classroom study through clinical experience and later in actual practice.
        Take your time now, and use ECG Success to improve your skills. Once you run into a genuine emergency you will have only minutes, or less, to interpret the ECG correctly and ensure the right treatment for the patient.

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Central Nervous System Diseases And Inflammation(PDF Version)

    SOURCE :
        Central Nervous System Diseases And Inflammation

    AUTHORS :
        Thomas E. Lane (Editor), Monica Carson (Editor), Conni Bergmann (Editor), Tony Wyss-Coray (Editor)

    SUMMARY :
        Edited and authored by top names in the field, this book provides a succinct reference on inflammatory central nervous system disease. It focuses on current areas of investigation in the fields of neuroimmunology, virology, pharmacology, and disease. Sections focus on specific categories of diseases, examining the pharmacological, virological, and immunological effects of and on the disease. This book’s unique organization provides a concise overview of inflammatory CNS disease.
        This volume serves as a succinct and well-organized reference volume focused on inflammatory CNS disease to a wide audience. The text is comprised of four sections revolving around current areas of interest in the fields of neuroimmunology, virology, pharmacology and disease. Sections of this text focus on a specific category of diseases as well as the pharmacological, virological, and immunological effects of and on the disease.
        Although many have covered this topic, few have provided a volume as concise and efficient. Each disease is broken down on a variety of scientific levels without getting into the history of the disease. This approach provides a succinct overview of a specific subject encompassing interrelated topics pertaining to neurology, immunology and disease. The information provided in Central Nervous System Diseases and Inflammation will be useful for researchers, clinicians, as well as a valuable resource for students interested in the fascinating arena of neuroinflammation.

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