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By S. Gunock. Life Pacific College. 2017.

Family Practice and General Internal Medicine 39 The Profession Specialists in internal medicine primarily treat adults trusted 80mg inderal, although some also treat adolescents. Internists, as they are often called, inti- mately understand all the major organ systems. They diagnose and treat acute and chronic diseases, usually from practices based in offices. They also visit patients hospitalized for problems that fall under the domain of internal medicine. Every day internists see and treat a wide range of patients with a great array of illnesses. A typical day might see an internist treat- ing colds and flu as well as diabetes and heart problems. In medical school it is often said that internal medicine is an intellectual medical specialty because internists often diagnose and treat based on discussion with their patients, rather than relying on extensive tests and procedures. Some internists are board certified in internal medicine and another internal medicine specialty, such as cardiology or gas- troenterology. This enables these physicians to have a general inter- nal medicine practice, but also to be experts in a particular aspect of internal medicine. Like family practice, internal medicine offers close and long-term relationships with patients. An internist is often in charge of over- all patient management because of this relationship. If a patient has a problem that requires specialty treatment, the internist often coor- dinates that care. Internal medicine can be a challenging specialty because of the diversity and intellectual stimulation it offers to its practitioners. Like family practitioners, internists must make themselves avail- able to their patients, sometimes outside of business hours.

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Section XXVI provides a list of diagnostic acute generic inderal 40mg on line, chronic, and cancer pain management at their and therapeutic techniques that may be used throughout annual meetings as well. Review of the pharmacology of the drugs listed in Many review courses offer audio tapes of lectures. The examination contains major advantage of this medium is the ability to use questions regarding the indications, pharmacokinetics, commuting time to review pertinent topics. Hearing 1 TEST PREPARATION AND PLANNING 3 material that has previously been read tends to solidify material should be used more frequently. An example2 Perhaps the best learning method is to review the follows: available information regarding a patient one is currently Briefly review previously studied material. Application of this knowledge in the clinical Survey new material to study. Problem-based learning sessions, which are becom- ing more prevalent in clinical meetings and symposia, are STUDY SKILLS also effective in focusing on a clinical condition and link- ing that clinical situation to a knowledge base. When read- Question-and-answer textbooks may be helpful in ing about the management of a specific syndrome, what identifying gaps in knowledge and, if self-testing is done is the principal treatment modality? Practice dition, the primary goal may be regaining strength and examinations increase one’s confidence in the test-taking flexibility, while many of the specific treatments merely process and increase familiarity with the format. Understanding the pathophysiology of a specific condi- tion helps you remember the clinical features of and GENERAL STUDY TECHNIQUE management principles of the disorder. Assess your confidence in your knowledge and under- PLANNING MATERIAL TO COVER standing of a topic. If not, continue to read and The material to be studied will depend to a great extent review. Write out a brief summary of the material you on the range and depth of material covered in residency have studied. If possible, discuss the material with other depth during training need only be reviewed briefly, trainees or with colleagues.

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The form as an excrescence of the joint capsule in internal classical osteosarcoma dominates in children and ado- knee lesions associated with degenerative changes in lescents buy generic inderal 80mg online, while all of the other malignant tumors rarely the knee. Large popliteal cysts can sometimes prove slightly irksome, but disappear spontaneously, at the lat- Tibial shaft est by the completion of growth. Malignant tumors occur less commonly in the shaft Of the malignant soft tissue tumors, the rhabdomyo- area compared to the metaphysis. As a medullary cav- sarcoma is the commonest in children and adolescents. One tumor that particu- Diagnosis larly affects the tibia is the adamantinoma, a low-grade Since the knee only has a thin soft tissue covering, tumors malignant tumor that occurs only in the tibia ( Chap- in this area are usually diagnosed at a relatively early ter 4. The knee should always be x-rayed if pain of Soft tissue tumors unclear origin that is not clearly load-related In contrast with the pelvis and upper thigh, soft tissue persists for longer than 4 weeks. Particular tumors are easier to diagnose in the knee area since they attention is indicated if the pain occurs at night. Lipomas are It is important to distinguish between the pain associated observed, as are desmoids. Further investigations Malignant tumors can be dispensed with if clinical examination shows no Therapeutic strategies abnormalities in the toddler and the pains alternate or The strategies for dealing with malignant tumors are occur simultaneously on the right and left sides. Only a few of these criteria is not fulfilled, an x-ray must always be special features of tumors in the knee region will be men- recorded. All malignant tumors in the knee area must be surgi- 3 The primary imaging procedure is always the plain cally removed. Two common tumors that occur around the knee a wide resection with a margin of healthy tissue.

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Arthrography may be contraindicated in patients with IMAGING MODALITIES coagulopathy 80mg inderal with amex. With acute or subacute injuries, soft tissue or radiography (with or without applied stress), conven- marrow edema is seen. With chronic injuries, struc- tional arthrography, magnetic resonance imaging tural abnormalities may be seen. It is of limited value (MRI), which may be combined with arthrography for evaluating bone cortex and soft tissue calcifica- (referred to as MRA), computed tomography (CT), tion. There are several relative and absolute con- which may be combined with arthrography, ultra- traindications to MRI, including claustrophobia, sonography, and radionuclide bone scans. Because of the popularity of MRI, there may be a prolonged MODALITY STRENGTHS AND wait time for obtaining an examination. WEAKNESSES CT is superior to other modalities for fine bone detail, and is an important tool for depicting the anatomy of Plain radiography is widely available, relatively inex- complex fractures. Three-dimensional CT reforma- pensive, and provides excellent detail of bony struc- tions are extremely useful in the management of tures and soft tissue calcifications. This is especially true with the newer tissue resolution has slightly improved with digital generation (multislice) scanners that significantly 107 Copyright © 2005 by The McGraw-Hill Companies, Inc. CT is often utilized as a surrogate for retear of a repaired knee meniscus, and detection of MRI, in cases where MRI is contraindicated. With CT is indicated for demonstrating the extent and exception of anatomic areas where various position- anatomy of fractures. It is also useful for evaluation complex elbow with older generation scanners.