INTERNAL MEDICINE SECRETS PDF
Rev. ed. of: Medical secrets / [edited by] Anthony J. Zollo, Jr. 4th ed. c Includes Attending Physician, Departments of Internal Medicine and Rheumatology, Available at: myavr.info myavr.info Medical Secrets is an easy-to-read, best-selling volume in the Secrets Series®, perfect for use in clerkships, for board prep, or as a handy clinical reference. Feline Internal Medicine Secrets Michael Lappin is one of the major names in modern feline medicine, and he has assembled a PDF MB Download.
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Approach to Internal Medicine is meant to be a practical field guide. The third edition of Approach to Internal Medicine builds upon previous efforts to create a. Abernathy's Surgical Secrets. Endocrine Secrets. Orthopaedic Physical Therapy Secrets. Canine Internal Medicine Secrets. Small Animal Cardiology Secrets. Download the Medical Book: Neurology Secrets 5th Edition For Free. Fetal and Neonatal Secrets 3rd Edition PDF Internal Medicine, Pharmacology.
Pediatric Secrets. Pocket Medicine: Marc S Sabatine. Critical Care Secrets. Emergency Medicine Secrets. Vincent J. Theodore X. Review This is a collection of internal medicine pearls residents would focus on during their training, organized in a question-and-answer format with key points.
Read more. Product details Series: Secrets Paperback: Mosby; 5 edition May 11, Language: English ISBN Try the Kindle edition and experience these great reading features: Share your thoughts with other customers. Write a customer review. Top Reviews Most recent Top Reviews. There was a problem filtering reviews right now.
Please try again later. Kindle Edition Verified Purchase. Interesting collection of trivia and broad concepts in internal medicine. Does not seem to be consistently updated compared to the previous editions and the current practice. The style and quality of chapters is variable.
Overall makes for a good med student book on the run to stock trivia useful during pimping on rounds or for a broad overview of medical topics easily read on the plane or similar. Paperback Verified Purchase. Pretty good book. I study a book like this and do questions from question banks and so far I've done OK on shelf exams 3rd year med school.
This book keeps you sharp for the Attendings who like to Pimp. Just keep the info quiet and shine when asked. Great set of clinical pearls.
I read it for enjoyment. The medical secrets ER version is much better. I'm a first year resident, and during the limited time we get on the floors, this book is an excellent tool that serves not only as a refresher, but an excellent means to give you that edge of knowledge that will set you apart from your peers. It is the perfect depth to assist you in diagnoses and trust me, after reviewing the pertinent chapter, you are able to answer questions that you probably thought you had forgotten!
I highly recommend this book, and trust me you will not be sorry!
No more multiple guess, then searching for the answer. This book gives you the down and dirty in the most useful way. Great job. Great for a quickie review.
Great quality. Overall a good purchase. One person found this helpful.
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Surgical Recall. There's a problem loading this menu right now. Learn more about Amazon Prime. Get fast, free shipping with Amazon Prime. Back to top. Obviously, a more chronic lesion would have a worse prognosis.
However, the ability to consciously recognize painful stimulation to areas caudal to the lesion is the most reliable prognostic indicator.
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Animals without conscious pain sensation caudal to the lesion have a much worse prognosis than those that can still feel their limbs. Can you localize a lesion between the T2 and L4 spinal cord segments more precisely with a clinical examination? It is difficult to be extremely accurate with localization in areas other than the intumescences. However, the panniculus reflex may be helpful. The panniculus reflex is caused by contraction of the cutaneous trunci muscle in response to a sensory stimulus of the skin.
Dorsal cutaneous afferent nerves are stimulated. The impulse is transmitted up the spinal cord in ascending superficial pain pathways that synapse on the lateral thoracic nerve located between the C8 and T2 spinal segments.
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The response is blocked in segments caudal to the injury. For example, an animal with injury at TL1 would have a normal response cranial to the level, but the response would be absent caudal to this point. This can be helpful in narrowing the localization within the spinal cord. However, this is not the most reliable response and may still be present in animals with severe spinal injury and absent in some with mild injury. A focal area of pain hyperpathia can be a more sensitive lesion localizer.
For example, an animal with a type I disk herniation at TL1 may or may not have a panniculus response that corresponds to this lesion.
However, deep palpation in this area will often appear to cause pain. Focal hyperpathia is only useful for animals with lesions that cause meningeal or periosteal irritation. The spinal cord does not have pain receptors and so lesions that are confined to neural parenchyma alone are not painful.
How would a lesion between the C6 and T2 spinal cord segments appear clinically? The animal would have upper motor neuron signs to the pelvic limbs that would be indistinguishable from the previous case. However, the thoracic limbs would also be affected and would show lower motor neuron clinical signs because this is in the area of the cervical intumescence.
Occasionally, injury between C8 and T2 will also damage the sympathetic innervation to the head because the first efferent neuron in the sympathetic chain is located in this area. Clinical signs would include miosis, ptosis, and enophthalmus of the ipsilateral eye.
How would a lesion between the C1 and C6 spinal cord segments appear clinically? These animals would be weak in all four limbs and spinal reflexes should be normal to increased. As previously mentioned, the animals generally appear worse in the pelvic limbs than in the thoracic limbs. It is rare to see an animal completely paralyzed with a cervical spinal lesion because severe injury will cause paralysis of the respiratory muscles and death. Where would you localize the lesion in an animal with paralysis of all four limbs and decreased spinal reflexes?
This would be the typical presentation of an animal with generalized peripheral nerve or neuromuscular junction injury. If an animal has a head tilt, where does this place the lesion? An abnormal head posture is seen with injury rostral to the foramen magnum.
Generally, the head tilt is toward the side of the lesion. With careful observation, you will see that animals with injury to the caudal portions of the brain have a typical head tilt that changes as you move rostrally to a head turn. This is a subtle point and not always reliable, but it can be helpful at times.
If all lesions in the brain cause a head deviation, then how can you localize lesions within the brain?
Postural reactions are extremely helpful here. With focal lesions in the central nervous system caudal to the midbrain, postural reactions will be abnormal on the same side as the lesion.
With focal lesions rostral to the midbrain, postural reactions will be abnormal on the side opposite the lesion. It is easy to remember that this changes in the middle of the brain. Within the midbrain itself, lesions in the caudal midbrain produce ipsilateral postural reaction deficits, whereas lesions in the rostral midbrain, especially those rostral to the red nucleus, produce postural reaction deficits on the side opposite the lesion.
Because the head tilt is usually to the side of the lesion, an animal with a right head tilt and postural reaction deficits on the right side has a lesion in the midbrain or caudal. If an animal has a right head tilt and postural reaction deficits on the left side, then the lesion is midbrain or rostral. Can you localize lesions more precisely within the brain? Cranial nerves can help localize lesions to very specific regions of the brain.
Cranial nerve II is intimately associated with the ventral diencephalon thalamus, hypothalamus. What do cranial nerves do? Cranial nerve I is the olfactory nerve and mediates the sense of smell. It is difficult to clinically evaluate this nerve. Cranial nerve II is the optic nerve. You can often determine visual function from earlier parts of the examination.
By covering each eye of the animal and making a menacing gesture toward each eye, you can evaluate vision in each eye.
Unfortunately, other lesions such as facial nerve paralysis or cerebellar disease may also alter the menace reaction. Pupillary light reactions are also helpful in establishing optic nerve function. With injury to cranial nerve II, there will be no direct pupillary light response on the abnormal side, and no consensual response in the other eye.
Cranial III carries parasympathetic innervation to the pupil. Injury to cranial nerve III will cause the pupil on the same side to be dilated and not constrict with bright light. With a pure cranial nerve III injury, the dog is still visual so menace reaction is still normal.
Injury to any one of these three will result in the eye being permanently deviated to one side. Cranial nerve V is the trigeminal nerve. It provides motor innervation to the muscles of mastication and sensation to the entire face. Injury to this nerve often results in atrophy of the ipsilateral temporalis muscle and analgesia to the ipsilateral side of the face.
Cranial nerve VII is the facial nerve. It controls the muscle of facial expression. Injury to this nerve causes inability to blink or retract the lip. The nose may be deviated toward the normal side 5 Neurologic Examination and Lesion Localization with early facial nerve injury and the nostril on the affected side will not flare with inhalation.
The facial nerve also carries the sensory fibers for taste, but this is rarely tested in practice.
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Cranial nerve VIII is the vestibulocochlear nerve. It has two branches. The cochlear nerve relays sensory impulses associated with sound.
Bilateral injury results in deafness, but unilateral injury can be difficult to detect without special electrophysiologic testing. The vestibular portion of cranial nerve VIII mediates the sense of balance and orientation of the head and body with respect to gravity. Deficits in this branch result in marked head tilt, and staggering or falling to the side of the lesion.
The vestibular nerve also plays an important role in coordinating eye movement; therefore vestibular nerve injury often results in nystagmus and intermittent strabismus. Cranial nerves IX, X, and XI glossopharyngeal, vagus, and accessory nerves provide motor innervation to the pharynx, larynx, and palate.
Injury to these nerves causes inability to swallow, a poor gag reflex, and inspiratory stridor because of laryngeal paralysis. The accessory nerve also provides motor innervation to the trapezius muscle and parts of the sternocephalicus and brachiocephalicus muscles.
Denervation atrophy in these muscles can be seen with careful examination. Cranial nerve XII hypoglossal nerve provides motor innervation to the muscles of the tongue.
Injury results in paralysis of the ipsilateral side of the tongue. How do you evaluate cranial nerves? Cranial nerve evaluation is simple. For cranial nerve VIII, I look for abnormal body postures during the earlier parts of my examination and carefully examine the eyes to be sure that there is normal conjugate eye movement.
This is best done while you position the animal for evaluation of spinal reflexes. How would a lesion in the pons and medulla appear?
The animal would have a head tilt toward the side of the lesion with ipsilateral postural reaction deficits. You should also observe deficits in cranial nerves V through XII on the same side of the lesion. How would a lesion in the midbrain appear? The animal would have a head tilt to the side of the lesion, postural reaction deficits may be ipsilateral or contralateral, but deficits in cranial nerves III and IV should be on the same side of the lesion.
In my experience, focal midbrain injury is rare. How would a lesion in the thalamus appear? The animal would have a head tilt toward the side of the lesion, postural reaction deficits on the side opposite the head tilt, and often it will have seizures.
Complete loss of cranial nerve II function will be present only if the lesion is in the ventral portions of the hypothalamus near the optic chiasm. If the injury is in other areas of the thalamus, the pupils may appear asymmetrical, but the deficits will not appear complete. How would a lesion in the cerebrum appear? Lesions in the cerebrum are often indistinguishable from lesions in the thalamus. If the injury affects the occipital lobes of the cerebrum, then the animal may not have a menace on the opposite side, but pupillary light reactions will be normal.
Because these areas often appear clinically the same, the cerebrum and thalamus-hypothalamus are often collectively referred to as the forebrain. Do seizures occur only with injury to the thalamus-hypothalamus or cerebrum? Yes, seizure activity is a sign of forebrain disease. We left out the cerebellum. What do lesions in the cerebellum look like?
The cerebellum is a complex structure that coordinates movement throughout the body. Portions of the cerebellum are involved with the vestibular apparatus, and selective lesions in this region will appear similar to cranial nerve VIII deficits. Lesions in other areas will cause movements to appear incoordinated. Does injury to the cerebellum cause postural reaction deficits?
A lesion that only affects the cerebellum e. However, it is more common for the cerebellum to be injured along with the underlying pons and medulla in which case postural reactions will be diminished or absent.
Can you have vestibular disease without postural reaction deficits? Yes, if you injure any cranial nerve outside the calvaria, you will see loss of function of that nerve, but the motor and sensory tracts in the brain stem will still be intact.
Peripheral injury to cranial nerve VIII commonly occurs with ear infections, some toxins, and idiopathic causes. In this case, the animal will have a head tilt to the side of injury and a tendency to fall or roll to that side. Sometimes they are so disorientated that postural reactions are difficult to evaluate.I used Ross and Pawlina and the internet for that.
Specific e-book titles Antibiotics Simplified by Jason C. The physiology questions are particularly important. If an animal has a head tilt, where does this place the lesion? West MD, PhD.
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