The Root of Ambulatory Care(¿Ü·¡ Áø·á Áöħ¼), ÀÌÁø¿ì, ±ºÀÚÃâÆÇ»ç ³»¿ë °Ë»ö °á°ú :
20 ÆäÀÌÁö: 1
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Dizziness (¾îÁö·³Áõ, Çö±âÁõ)
on)
Hypoglycemia
..°Ë»ç¸¦ ½ÃÇàÇØµµ ÀüüÀÇ 19%¿¡¼´Â dizzinessÀÇ ¸íÈ®ÇÑ Áø´ÜÀ» ¾Ë ¼ö°¡ ¾ø´Ù.
Differential diagnosis of Central and Peripheral vertigo
The Dix-Hallpike(Nylen-Barany) test´Â peripheral vestibulopathy¿Í central vestibulopathy¸¦
°¨º°Çϴµ¥ µµ¿òÀÌ µÈ´Ù.
¸»Ãʼº ÁßÃß¼º
¾ÈÁøÀÇ ¹æÇâ...
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Chest pain (°¡½¿ÅëÁõ, ÈäÅë)
..ÈäÅëÀº ÀϽÃÀûÀÌ°í °¡º¿î ÁúȯÀÇ Áõ»óÀÏ ¼öµµ ÀÖÁö¸¸, acute myocardial
infarctionÀ̳ª aortic dissectionó·³ Áï°¢ÀûÀÎ Ä¡·á°¡ ÇÊ¿äÇÑ ½É°¢ÇÑ º´ÀÏ ¼öµµ
ÀÖ´Ù. ÇÏÁö¸¸ °¡Á¤ÀÇÇÐ ¿Ü·¡¸¦ ã´Â ´ëºÎºÐÀÇ È¯ÀÚ´Â acute myocardial
infarction °°Àº ½É°¢ÇÑ ÁúȯÀº µå¹°´Ù.
Common causes of chest pain
£ Musculoskeletal origin : Èä°û¿°ÁÂ, ±âħ...
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Impaired hearing (û·Â Àå¾Ö)
the
basilar membrane of the cochlea ; when excessive, these forces
can cause cell death.
Drug induced - aminoglycosides, loop diuretics, quinidine,
salicylate (reversible), erythromycin
Meniere¡¯s disease - fluctuating hearing loss (usually u...
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Chronic Obstructive Pulmonary Disease (¸¸¼ºÆó¼âÆóÁúȯ, ¸¸¼ºÆó¼âÆóº´)
ar emphysema¸¦ °¡Áø Èí¿¬ÀÚ, È£Àü
µÇÁö ¾Ê´Â õ½Ä, ¼³¸íµÇÁö ¾Ê´Â °£°æÈ, ¶Ç´Â Áúȯ °¡Á··ÂÀÌ ÀÖ´Â °æ¿ì ÀǽÉÇØ ºÁ¾ß ÇÑ´Ù.
Exacerbating factors
..Infection : (Acute tracheobronchitis : primarily bacterial - S.pneumoniae,
H.influenza, M.catarrhalis etc.)
..Air pollution
..Pneumonia
..Pul...
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Hypothyroidism (°©»ó»ùÀúÇÏÁõ, °©»ó¼±±â´ÉÀúÇÏÁõ)
..À¯º´·üÀº ÀüüÀα¸ÀÇ 1~3%À̸ç, ¿©¼º¿¡¼ ÃÖ¼Ò 2¹è ÀÌ»ó ³²¼ºº¸´Ù ¸¹ÀÌ ¹ß
»ýÇϸç, ÀüüÀûÀ¸·Î ³ªÀ̰¡ Áõ°¡ÇÒ¼ö·Ï À¯º´·üÀÌ ¿Ã¶ó°¡´Â ¾ç»óÀ» º¸ÀδÙ.
Common causes of Hypothyroidism
Primary (90~95%) - TSH¡è/Free T4¡é
Hashimoto¡¯s thyroiditis
Treated Grave¡¯s disease
..Postablative(I131 tx or op)
..Sub...
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Purpura (ÀÚ»ö¹Ý, ÀÚ»ö¹Ýº´)
..ÇÇÇϳª Á¡¸·ÇÏ·Î Ç÷¾×ÀÌ extravasationµÇ¾î »ý±â´Â Àû°¥»ö ȤÀº ÀÚ»öÀÇ ¹ÝÁ¡
Petechiae (<2mm)
- Ç÷¼ÒÆÇ Àå¾Ö¿¡¼ ÈçÈ÷ ¹ß»ý : Ç÷¼ÒÆÇ Áõ°¡ÁõÀ̳ª °¨¼ÒÁõ ¸ðµÎ ¿øÀÎÀÌ µÉ ¼ö ÀÖÀ¸¸ç, °¨¼Ò
Áõ¿¡ ÀÇÇÑ ÀÚ¹ÝÁõÀº Ç÷¼ÒÆÇ ¼öÄ¡°¡ 5¸¸°³ ÀÌ»óÀ̸é Àß ¹ß»ýÇÏÁö ¾Ê´Â´Ù.
Ecchymosis/Bruise(>2mm)
- Ç÷¾×ÀÀ°í Àå¾Ö¿¡ ÈçÈ÷ ¹ß»ý
..ÀϹÝÀûÀ¸·Î ¼Õ°¡¶ô µîÀ¸·Î ´·¶À» ¶§ »ö±òÀÌ ¼Ò½ÇµÇÁö ¾Ê´Â Á¡À¸·Î È«¹ÝÀÌ...
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Hyperlipidemia (°íÁöÁúÇ÷Áõ)
..Ç÷Áß Total cholesterolÀ̳ª TriglycerideÀÇ Áõ°¡¸¦ ÀǹÌÇÏÁö¸¸, ¾ö¹ÐÇϰԴ Áö
´Ü¹éÀÇ ´ë»ç ÀÌ»ó¿¡ ÀÇÇØ ¹ß»ýÇÏ´Â dyslipidemia¶ó ÇÒ ¼ö ÀÖ´Ù.
ATP III Classification of LDL,Total, HDL cholesterol and triglyceride
LDL cholesterol - Primary Target of Therapy
h 100 Optimal
100~129 Near o...
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Obesity (ºñ¸¸, ºñ¸¸Áõ)
..ºñ¸¸Àº ´Ü¼øÇÑ ÀÇÁö·ÂÀ̳ª ÀÚ±â°ü¸®ÀÇ ¹®Á¦°¡ ¾Æ´Ï¶ó, ½Ä¿åÁ¶Àý ±×¸®°í ¿©·¯
Áúº´À» ¾ß±âÇÒ ¼ö ÀÖ´Â ¿¡³ÊÁö´ë»ç°¡ º¹ÇÕÀûÀ¸·Î °áÇÕµÈ ¹®Á¦ÀÌ´Ù.
..Epidemiology :
Overweight : 33~50% in U.S. men and women 20years and older
Obesity : 25% in U.S. men and women 20years and older
(NHANES III, 1998~1994)
Body M...
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Pleural effusions (°¡½¿¸·»ïÃâ, È丷»ïÃâ)
..The accumulation of fluid in the pleural space can result from
i. Increased hydrostatic pressure
(e.g., Congestive Heart Failure)
ii. Decreased oncotic pressure
(e.g., Nephritic syndrome with hypoalbuminemia)
iii. Increased capillary perme...
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Heart failure (½ÉÀå±â´É»ó½Ç, ½ÉÀåºÎÀü)
..Heart failureÀÇ ¿øÀÎÁúȯ
- °íÇ÷¾Ð ¹× ±×¿Í °ü·ÃµÈ °ü»óµ¿¸ÆÁúȯ : 66%
- °ü»óµ¿¸ÆÁúȯ : 10%
- ÆÇ¸·Áúȯ : 10%
1. Dyspnea on exertion
2. Orthopnea
3. Fatigue
4. Edema
5. Paroxysmal noctural dyspnea
..Cardiogenic asthma´Â ¹ßÀÛ¼º ¾ß°£ È£Èí ¹× ±âħ°ú °ü·ÃÀÌ ÀÖÀ¸¸ç ±â°üÁö °æ
·Ã¿¡ ÀÇÇÑ 2Â÷ÀûÀΠõ¸íÀÌ Æ¯Â¡À̰í...
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Tension type headache (±äÀåÇüµÎÅë)
..¾çÃø¼º(21%¿¡¼´Â ÆíÃø¼º), °æµµ ³»Áö ÁߵÀÇ ºñ¹Úµ¿¼º ¹× ±äÀ强À» °®´Â
µÎÅë
The International Classification of Headache Disorders
(International Headache Society 2004)
i. Migraine
ii. Tension-type headache(TTH)
iii. Cluster headache and other trigeminal autonomic cep...
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Sexual dysfunction in Men (³²¼º ¼º±â´É Àå¾Ö)
..The persistent inability to attain or maintain penile erection sufficient for sexual
intercourse.
Fig 1. Mechanics of erection. (A) In the flaccid state, arterial vessels are constricted and venous vessels
are noncompressed. (B) On erection,...
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Diabetes Mellitus Type II (´ç´¢º´ Á¦IIÇü)
Classification
¢º Type I diabetes : ¥â-cell destruction,
- Immune mediated
- Idiopathic
¢º Type II diabetes : insulin resistance with relative insulin deficiency to a predominantly
secretary defect with insulin resistance
¢º Gestational diabete...
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Irritable bowel syndrome (°ú¹Î´ëÀåÁõÈıº)
Rome II criteria of IBS
12 weeks or more of abdominal discomfort or pain in the past 12months that has
2 of 3 features :
1. Relief with defecation
2. Association with a change in the frequency of stools
3. Association with a change in the fo...
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Prostatitis (Àü¸³»ù¿°)
..Àü¸³¼±¿°Àº »ý¸íÀ» À§ÇùÇÏ´Â ÆóÇ÷ÁõÀ» ÀÏÀ¸Å³ ¼ö ÀÖ´Â ±Þ¼º ¼¼±Õ¼º °¨¿°ºÎ
ÅÍ, ¼Òº¯ Çö¹Ì°æ °Ë»ç³ª ¹è¾ç °Ë»ç¿¡ À½¼ºÀÌ ³ª¿À´Â ¾Ö¸Å¸ðÈ£ÇÑ ¸¸¼º ºÒÄè°¨
¶Ç´Â Áö¼ÓÀûÀÎ µ¿Åë±îÁö Æ÷ÇÔÇÏ´Â ±¤¹üÀ§ÇÑ ¿°ÁõÀ» Æ÷ÇÔÇÑ´Ù.
..In America, every year approximately 2 million physician visits include the
diagnosis of prostatitis, but its widespread pr...
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Edema (ºÎ±â, ºÎÁ¾)
..ºÎÁ¾Àº Á¶Á÷°£¾×ÀÌ ºñÁ¤»óÀûÀ¸·Î ÃàÀûµÇ¾î ÀÖ´Â »óŸ¦ ¸»Çϸç, ÈçÈ÷ ½Åü
Áß dependent partÀÎ legs¿¡ È£¹ßÇÑ´Ù.
1. Onset?
Measured in hours to days :
Acute onset - eg. Celluitis, DVT, Compartment syndrome etc
Chronic onset - eg. Systemic process, Medication, Chronic venous insuffi...
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Hematuria (Microscopic) (Ç÷´¢)(¹Ì¼¼Ç÷´¢)
..The initial determination of microscopic hematuria should be based on
microscopic examination of urinary sediment from a freshly voided, clean-catch,
midstream urine specimen.
..Recommended definition of microscopic hematuria : ¡Ã 3 RBC/HPF f...
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Shoulder pain (¾î±úÅëÁõ, °ß°©ÅëÁõ)
..¾î±ú ÁÖÀ§ÀÇ º¹ÀâÇÑ ±¸Á¶¹°¿¡µµ ºÒ±¸ÇÏ°í °¡Á¤ÀÇÇÐ ¿Ü·¡¿¡¼ º¸ÀÌ´Â ¾î±úÅë
ÁõÀÇ ¿øÀÎÀº ¸î °¡Áö·Î ¸¹Áö ¾Ê´Ù.
- Impingement syndrome
- Adhesive capsulitis (frozen shoulder)
- Glenohumeral instability
- Acromioclavicular joint problem
..Apley scratch test°¡ Á¤»óÀÌ¸é ´Éµ¿¿îµ¿Àº Á¤»óÀÌ¸ç ¼öµ¿Àû ¿îµ¿Æò°¡¸¦ ÇÒ ÇÊ
¿ä...
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Fatigue (ÇÇ·Î)
..For the primary care physician, fatigue is a challenge requiring a broad
approach, sound clinical reasoning, negotiation, and interpersonal skills.
..ȯÀÚµéÀº ´ëºÎºÐ Àڽſ¡°Ô ¾î¶² ±âÁúÀûÀÎ ÁúȯÀÌ »ý°åÀ» °ÍÀ¸·Î »ý°¢ÇÏ´Â
°æÇâÀÌ ÀÖ°í Á¤½ÅÀûÀÎ Áõ»óÀÌ ÀÖ´Ù°í ÇÏ´õ¶óµµ ȯÀÚµéÀº ±×·± Áõ»óµéÀÌ ±â
ÁúÀûÀÎ Áúȯ¿¡ ÀÇÇÑ ...
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Acute gastroenteritis£Acute diarrhea (±Þ¼º À§Àå¿° - ±Þ¼º ¼³»ç)
..Definition : Increased stool weight to more than 200g/day
(Á¤»ó´ëº¯ : ÇÏ·ç 200g ÀÌÇÏ, ¼öºÐÇÔ·® 60~85%, ¹èº¯È½¼ö ÁÖ 3ȸ~ÇÏ·ç 3ȸ)
..Clinically, defined as the passage of more than three abnormally loose stool per
24hrs
Acute diarrhea : 7~14ÀÏ ÀÌÇÏ
¢º °¨¿°¼º ȤÀº ¾àÁ¦³ª µ¶¼Ò°¡...