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Abdominal Ultrasound

Background An abdominal ultrasound is a test that utilizes pulsed high-frequency sound waves (2–5 MHz) to create images of the abdominal organs without ionizing radiation. It creates real-time two-dimensional images of the various abdominal organs that can be displayed in either the longitudinal or transverse planes. There are a few different versions of the abdominal ultrasound. The right upper quadrant ultrasound, a foreshortened test, only includes…

Introduction to Anesthesia

An anesthesiologist takes care of patients in the periods immediately before, during, and immediately after surgery, which are known as the preoperative, perioperative, and postoperative periods, respectively. In the perioperative period, the goals of an anesthesiologist can be broadly broken down into three components: 1. Keeping the patient safe, above all else. This includes monitoring the patient’s vital signs and responding to changes that may be…

Glycemic Considerations for Tests and Procedures

Background Achieving glycemic control is imperative for patients with diabetes undergoing tests and procedures, many of which require dietary restrictions. For these patients, mismanagement of diabetes medications during fasting periods can have dangerous consequences including hypo- or hyperglycemia. This chapter will review glycemic management and guidelines for patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) undergoing tests and procedures in both the inpatient…

Anticoagulation Management in the Periprocedural Period

General Considerations for Periprocedural Anticoagulation When evaluating a patient on anticoagulation during the periprocedural period, it is important to review the bleeding risk, both for the procedure and the individual patient, and the thromboembolic risk of the patient. The bleeding risk guides how early to hold anticoagulants prior to the procedure and how long to wait after the procedure to restart anticoagulation. The same patient at…

Nuances and Characteristics of Tests

This book embarks on medical tests and procedures and how they interface with pharmacologic interventions. In general, testing can include: ■ The questions asked of patients with chief concerns at their histories ■ Physical exam maneuvers performed on the patient ■ Laboratory, imaging tests, and procedures performed to elucidate further information With each diagnostic intervention, a positive or negative observation is elicited and funneled into the…

Palliative Medicine

1 What is palliative care? A specialized medical care approach for people with serious illness that focuses on providing relief from the symptoms and stress of serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses, social workers, and other specialists who work together with a patient’s…

Geriatrics

1 What changes in organ function occur in advanced age? See Table 18.1 . Table 18.1 Changes in Organ Systems With Aging and Their Consequences System Aging-Related Change Consequence of this Change Skin Xerosis (dry skin) Frequent, diffuse pruritus Cardiovascular Decreased LV compliance and relaxation Elevated LV end-diastolic pressures, greatly increased prevalence of heart failure Renal With loss of muscle mass, decreased creatinine clearance not reflected…

Neurology

Overview and Approach to the Patient 1 What is localization? The process of determining which part(s) of the nervous system are malfunctioning in order to produce the patient’s signs or symptoms. Localization is key to the neurologic evaluation and often plays an important role in neurology teaching rounds. After the history and physical examination are presented, a discussion begins to “localize the lesion.” A differential diagnosis…

Endocrinology

Diabetes Mellitus and Glycemic Disorders 1 List the three main categories of diabetes mellitus (DM) Type 1: Previously called insulin-dependent DM or juvenile-onset DM Type 2: Previously called non–insulin-dependent DM or adult-onset DM Gestational diabetes mellitus (GDM): Diabetes diagnosed in pregnancy 2 Describe type 1 DM Type 1 DM is generally due to autoimmune destruction of the pancreatic beta cells, leading to absolute insulin deficiency, and…

Oncology

General Issues 1 Define carcinogenesis The alteration of normal cells into malignant cells via a multistage evolution of genetic and epigenetic changes. The cells can escape the normal checkpoints of their host. 2 What are the known gene categories that influence the mechanisms of neoplasia? Oncogenes Tumor suppressor genes Regulators of cell death (apoptosis) Mutation control genes (includes mismatch repair genes) 3 Describe the effects of…

Parkinsonism and Other Movement Disorders

Movement disorders in older adults can be broadly classified into the akinetic-rigid hypokinetic conditions, in which voluntary movement is reduced, and hyperkinetic conditions, in which excess involuntary movements called dyskinesias are present ( Box 64-1 ). Dyskinesias can be further classified into tremor, dystonia, tics, myoclonus, and chorea. This distinction is as not absolute as, for example, in Parkinson disease (PD), the most common akinetic-rigid syndrome,…

Disorders of the Autonomic Nervous System

This chapter focuses on the consequences of aging on autonomic cardiovascular control. The neurobiology of aging and the effects of aging on gastrointestinal and urinary tract function are detailed in other sections in this book. The chapter first provides a brief summary of autonomic pathways involved in cardiovascular control, and the methods used to assess their function. The chapter then reviews the effect of aging on…

Long-Term Stroke Care

Stroke is an ancient disease, recognized since the time of Hippocrates, when the term apoplexy was used to describe someone being suddenly struck down. The lay term stroke emerged in the seventeenth century, and this term has only more recently replaced apoplexy in the medical literature. Despite centuries of reports of this condition and early understanding of its cause, rigorous scientific exploration was slow to gain…

Stroke : Clinical Presentation, Management, and Organization of Services

Introduction Stroke and transient ischemic attacks (TIAs) are the most common clinical manifestations of disease of cerebral blood vessels. Other manifestations of cerebrovascular disease are subclinical and include cerebral white matter lesions, “silent” brain infarcts, and cerebral microbleeds. This chapter focuses mainly on stroke and TIA, with less emphasis on subclinical cerebrovascular disease. In terms of therapy, the chapter does not deal with primary prevention but,…

Stroke : Epidemiology and Pathology

Stroke Epidemiology This chapter is concerned with the study of patterns and risk factors associated with stroke and the pathologic changes observed in stroke. The major types of stroke are ischemic stroke (due to cerebral vessel occlusion) and hemorrhagic stroke (due to bleeding from cerebral vessel). In epidemiologic tradition, stroke has been defined as “rapidly developing clinical signs of focal disturbance of cerebral function lasting more…

Headache and Facial Pain

Introduction Worldwide, headache disorders are one of the most prevalent medical complaints. This will continue because of the changing demographic of aging populations and because people experience headaches more commonly in their later years. Headaches are often more severe in older people, and secondary causes occur with increased incidence. Primary headache disorders (migraine, tension-type headache, and cluster headache) may persist into old age, although incidence and…

Epilepsy

Introduction Epileptic seizures are typically short lived and transitory but nonetheless have the potential for considerable disability because of the unpredictable nature of attacks, the risk of injury they bring, and neurologic impairment from repeated seizures and adverse effects of treatment. Driving is restricted, and there is social embarrassment, stigma, and impact on employment. Fundamental questions regarding the neurobiology of epilepsy, reasons for its development, factors…

Intellectual Disability in Older Adults

Definition and Causes Intellectual disability (ID) is the current term used to describe what in the United Kingdom has been known as learning disability and in the United States as mental retardation. The World Health Organization's International Classification of Diseases (ICD-10) still uses the term mental retardation , and its report on healthy aging in this population uses the term intellectual disabilities . In Australia the…

Mental Illness in Older Adults

Introduction Mental illness is common in older adults, and those who have a concurrent physical illness are particularly vulnerable. Although these conditions tend to be underdetected and undertreated, their outcome with appropriate management is often excellent. This chapter reviews the main mental health disorders aside from dementia. Depression and Anxiety in Older Adults Despite the commonly held negative stereotypes of aging as mainly loss and decrepitude,…