care, postoperative care after PTCA,CABG Endocarditis

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1 Ambulatory Internal Medicine Appendix A Residents completing the internal medicine residency should have an in-depth knowledge of the presentation, diagnosis, and management of the following conditions commonly managed by internists in the outpatient setting. If a resident does not encounter these conditions in a clinical setting he or she should actively seek additional experience through supplemental reading and through related rotations in the remainder of their postgraduate training. Allergy/Immunology Allergic rhinitis/sinusitis Asthma Contact dermatitis Drug allergies Hypersensitivity pneumonitis Hypersensitivity (small vessel) vasculitis Primary immunodeficiency Urticaria Cardiology Arrhythmias atrial arrhythmias, conduction abnormalities, pacemaker management, ventricular arrhythmias Congestive heart failure acute and chronic Coronary artery disease angina pectoris (stable and unstable), myocardial infarction follow-up care, postoperative care after PTCA,CABG Endocarditis Hypertension chronic/stable hypertension, hypertensive crisis, secondary hypertension Myocardial disease cardiomyopathy, myocarditis Pericardial disease acute pericarditis, Preoperative evaluation of the cardiac patient Valvular heart disease Vascular disease aneurysm (atherosclerotic, mycotic), arterial insufficiency, chronic venous stasis, deep venous thrombosis Dermatology Abscess Cellulitis Condyloma Cyst Eczematous reaction pattern atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, stasis dermatitis Erythema nodosum Follicular disease acne, rosacea Malignancy and premalignancy actinic keratosis, basal cell carcinoma, melanoma, squamous cell carcinoma Molluscum contagiosum Papulosquamous reaction pattern fungal/yeast infections, lichen planus, psoriasis, seborrheic dermatitis, syphilis Paronychia Pityriasis rosea Scabies Skin ulcers 1

2 Skin signs of systemic disease dermatomyositis, diabetes mellitus, gastrointestinal polyposis, inflammatory bowel disease, internal malignancy, Kaposi s sarcoma, liver disease, lupus erythematosus, rheumatoid arthritis, scleroderma, sepsis, thrombocytopenia, thyroid disease Vascular reaction pattern drug hypersensitivity, erythema multiforme, toxic epidermal necrolysis, urticaria, vasculitis, viral exanthems Vesiculobullous reaction pattern bullous pemphigoid, herpes simplex, herpes zoster, pemphigus vulgaris, varicella Warts Endocrinology Adrenal disorders hypercortisolism, hypoadrenalism (acute and chronic) Bone disorders osteopenia/osteoporosis, Paget s disease of bone Diabetes mellitus diabetic ketoacidosis, insulin dependent diabetes, non-insulin dependent diabetes Metabolic disorders hyperosmolar state, hypoglycemia, hyponatremia/ hypernatremia, lipid disorders, obesity Panhypopituitarism Parathyroid disorder hypercalcemia, hyperparathyroidism, hypocalcemia Reproductive/sexual disorders change in sexual function, contraception, galactorrhea, hirsutism, hypogonadism, menstrual disorders, menopause, virilization Thyroid disorders goiter, hyperthyroidism, hypothyroidism, nodule Gastroenterology and Hepatology Abdominal pain/acute abdomen Ascites Biliary tract disease acute cholecystitis, cholelithiasis Cholestatic liver disease, primary biliary cirrhosis, primary sclerosing cholangitis Cirrhosis (including complications) Diarrhea acute, chronic Gastroesophageal reflux disease complicated (esophageal stricture, Barrett s esophagus), uncomplicated Gastrointestinal bleeding lower, occult, upper Hepatitis drug-induced, viral Infiltrative liver diseases acquired, inherited, metabolic Inflammatory bowel disease Intestinal disorders, diverticulitis, hemorrhoids, irritable bowel syndrome, malabsorption, maldigestion, mesenteric vascular disease Malnutrition, assessment of nutritional status Motility disorder colon, esophagus, gastroparesis, small intestine Neoplasms benign colon polyps, cancer (colon, esophageal, gastric, hepatobiliary, pancreatic) Pancreatitis acute, chronic Peptic ulcer disease complicated ulcer (bleeding, obstruction, perforation), Helicobacter pylori induced gastritis, uncomplicated ulcer Peritoneal disease Hematology/Oncology Hemochromatosis Hemostasis and thrombosis abnormal coagulation (abnormal prothrombin and partial thromboplastin times), anticardiolipin antibody syndrome, anticoagulation, disseminated intravascular coagulation, (hypercoagulable state, hyperviscosity syndrome 2

3 Initial diagnosis and chronic management of various malignancies, in collaboration with oncologist Leukocyte disorders immunosuppression, leukemoid reaction, neutropenia, Myeloproliferative disorders chronic myelogenous leukemia, polycythemia vera Platelet disorders thrombocytopenia, thrombocytosis, platelet dysfunction Polycythemia, secondary Red cell disorders anemia, hemoglobinopathy (e.g., sickle cell disease) Infectious Disease Conjunctivitis Endocarditis Fever of unknown origin Gastrointestinal gastroenteritis, infectious diarrhea, peritonitis, viral hepatitis Genitourinary cervicitis, epididymitis, pelvic inflammatory disease, prostatitis, sexually transmitted diseases (gonorrhea, chlamydia, trichomonas, herpes simplex, syphilis), urethritis, urinary tract infection, vaginitis Infection in the immunosuppressed patient Respiratory bronchitis, pharyngitis, pneumonia (community and nosocomial), sinusitis, upper respiratory infection Rheumatologic/ musculoskeletal osteomyelitis, septic arthritis Sepsis/septic shock syndrome Skin infections cellulitis, ulcers Tuberculosis active infection, positive tuberculin skin test Viral cytomegalovirus, herpes simplex, influenza, mononucleosis, varicella zoster Nephrology Acid-base disorders Acute renal failure acute tubular necrosis, drug-induced (radiocontrast, analgesics, etc.), interstitial, atheroembolic Chronic renal failure conservative management (before dialysis) Fluid and electrolyte disorders Glomerular diseases acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome Hypertension hypertensive crisis, secondary hypertension Kidney disease in systemic illness diabetes mellitus, hypertension Neoplasia bladder carcinoma, renal cell carcinoma Nephrolithiasis diagnosis of renal stone disease, management of acute renal colic Obstructive uropathy Urinary tract infection cystitis, pyelonephritis Polycystic kidney disease Urologic disorders bladder outlet obstruction, erectile dysfunction, incontinence, prostate cancer detection, prostatic hypertrophy, prostatitis Neurology Cerebrovascular disease stroke, TIA Dementias Headache Peripheral neuropathy Radiculopathy, cervical and lumbar Seizure disorders Sleep disorders Vertigo (including benign positional vertigo, labyrinthitis) 3

4 Ophthalmology Blepharitis Cataracts Conjunctivitis Corneal abrasions and infections Detachment of retina or vitreous (recognition of) Dry eye syndromes Foreign bodies, external and superficial Herpes zoster ophthalmicus Hordeolum, chalazion Keratitis, corneal ulcer Orbital or periorbital cellulitis Pinguecula, pterygium Scleritis, episcleritis Subconjunctival hemorrhage Uveitis Otolaryngology Ears Acute labyrinthitis Benign positional vertigo Cerumen impaction Eustachian tube dysfunction Otitis Sensorineural hearing loss Nose Epistaxis Nasal polyps Rhinitis (allergic, medication-related, vasomotor) Sinusitis Throat Laryngitis Oral cavity masses or lesions Peritonsillar abscess Pharyngitis Sleep apnea Preventive Health Care Alcohol abuse screening Aspirin therapy Blood pressure screening Cancer screening breast, cervical, colorectal, prostate Cholesterol screening Dementia screening Depression screening Diabetes-related health care maintenance Diabetes screening Dietary recommendations Domestic violence Exercise HIV screening Hormone replacement therapy Immunizations hepatitis A/B, influenza, pneumococcal, rubella, Td Obesity 4

5 Osteoporosis Sexual health contraception, HIV risks, STD risks and screening Smoking cessation Thyroid function screening Tuberculosis screening Psychiatry/Substance Abuse Adjustment disorders grief, life-cycle changes Alcohol abuse diagnosis, intervention skills, rehabilitation, withdrawal syndrome Anxiety disorders Bipolar disorder Cocaine, marijuana, sedative abuse diagnosis, intervention skills, rehabilitation, withdrawal syndromes Cognitive disorders Delirium Dementia Eating disorders High-risk behavior for HIV Major depression, dysthymia Panic disorders Pain acute, chronic Personality disorders Principles of addiction medicine and intervention techniques Schizophrenia Sexual dysfunction Sleep disorders Somatization Tobacco cessation Pulmonary Airways disease asthma, bronchiectasis, bronchitis, chronic obstructive pulmonary disease, upper airway obstruction Aspiration pneumonia Congenital lung disease alpha 1-antitrypsin deficiency, cystic fibrosis, dysmotile cilia syndrome Infection atypical mycobacteria, empyema, lung abscess, pneumonia (community- acquired, hospital- acquired, in immunosuppressed patient), pulmonary mycoses, tuberculosis Interstitial disease collagen vascular disease, drug-induced, eosinophilic pneumonia, hypersensitivity, idiopathic pulmonary fibrosis, sarcoidosis Neoplasia lung cancer, mediastinal mass, solitary nodule Occupational disease asbestos-related, occupational asthma, pneumoconiosis Pleuritis/pleural disease pleural effusion, pneumothorax, neoplastic, nonneoplastic Prevention avoidance of respiratory irritants/allergens, immunization, smoking cessation Sleep-disordered breathing Vascular lung disease pulmonary hypertension (cor pulmonale, primary), thromboembolism, vasculitis (Wegener s, pulmonary/ renal syndromes) Rheumatology Crystal-induced synovitis Degenerative joint disease Fibromyalgia Inflammatory myopathy Occupational/sports-related overuse syndromes Achilles tendonitis, iliotibial 5

6 band, lateral epicondylitis, plantar fasciitis, rotator cuff tendonitis, trochanteric bursitis Osteomyelitis Osteoporosis and complications Polymyalgia rheumatica Regional pain syndromes acute or chronic bursitis (hip, shoulder, knee), acute or chronic tendonitis (shoulder, elbow, wrist), back pain, foot pain, neck pain Rheumatoid arthritis Scleroderma Septic arthritis gonococcal, nongonococcal Seronegative spondyloarthritis Systemic lupus erythematosus Vasculitis temporal (granulomatous), polyarteritis and hypersensitivity angiitis 6