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13 Palliative and End-of-Life Care help to mitigate tensions. Before starting clinical research, investigators should complete training in the ethics of clinical research, which is widely available. Physicians also should be critical consumers of clini­ cal re...

SECTION 1 Pain Cardinal Manifestations and Presentation of Diseases PART 2 Section 1 Pain James P. Rathmell, Howard L. Fields Pain: Pathophysiology and Management The province of medicine is to preserve and restore health and to relieve suffering. Understandi...

14 Pain: Pathophysiology and Management Cardinal Manifestations and Presentation of Diseases PART 2 Section 1 Pain James P. Rathmell, Howard L. Fields Pain: Pathophysiology and Management The province of medicine is to preserve and restore health and to relie...

15 Chest Discomfort David A. Morrow Chest Discomfort Chest discomfort is among the most common reasons for which patients present for medical attention at either an emergency depart­ ment (ED) or an outpatient clinic. The evaluation of nontraumatic chest disco...

16 Abdominal Pain positron emission tomography offers advantages of improved diag­ nostic performance and fewer nondiagnostic studies than singlephoton emission CT. EXERCISE ELECTROCARDIOGRAPHY Exercise electrocardiography has historically been commonly employ...

17 Headache perforation of abdominal viscera. A diagnosis of anemia may be more helpful than the white blood cell count, especially when com­ bined with the history. The urinalysis may reveal the state of hydration or rule out severe renal disease, diabetes, o...

18 Low Back Pain Steven P. Cohen, Eric J. Wang Low Back Pain EPIDEMIOLOGY Low back pain (LBP) is among the leading causes of years lived with disability worldwide and the principal cause of work-related disability in nearly all industrialized countries. Betwee...

19 Neck Pain Fan Jiang, Soichiro Takamiya, Michael G. Fehlings Neck Pain Neck pain is a highly prevalent global problem. In the United States, it is the fourth leading cause of disability and can affect people of all ages, genders, and professions. The lifetim...

SECTION 2 Alterations in Body Temperature PAIN ARISING IN THE SHOULDER REGION ■ ■THORACIC OUTLET SYNDROMES The thoracic outlet contains the first rib, the subclavian artery and vein, the brachial plexus, the clavicle, and the lung apex. Injury to these structu...

20 Fever PAIN ARISING IN THE SHOULDER REGION ■ ■THORACIC OUTLET SYNDROMES The thoracic outlet contains the first rib, the subclavian artery and vein, the brachial plexus, the clavicle, and the lung apex. Injury to these structures may result in postural or mov...

21 Fever and Rash can aggravate the condition of patients with preexisting impairment of cardiac, pulmonary, or CNS function. Children with a history of febrile or nonfebrile seizure should be aggressively treated to reduce fever. However, it is unclear what t...

22 Fever of Unknown Origin example, an eschar may suggest the diagnosis of scrub typhus or rickett­ sialpox (Fig. A1-33A) (Chap. 192) in the appropriate setting. In other illnesses (e.g., anthrax) (Fig. A1-52) (Chap. S4), an ulcer or eschar may be the only ski...

SECTION 3 Nervous System Dysfunction ANTIBIOTICS AND ANTITUBERCULOUS THERAPY Antibiotic or antituberculous therapy may irrevocably diminish the ability to culture bacteria. However, hemodynamic instability or neutropenia is a good indication for empirical anti...

23 Syncope ANTIBIOTICS AND ANTITUBERCULOUS THERAPY Antibiotic or antituberculous therapy may irrevocably diminish the ability to culture bacteria. However, hemodynamic instability or neutropenia is a good indication for empirical antibiotic therapy. If the TST...

24 Dizziness and Vertigo ■ ■FURTHER READING Brignole M et al: 2018 ESC Guidelines for the diagnosis and manage­ ment of syncope. Eur Heart J 39:1883, 2018. Brignole M et al: Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole. Eur Heart...

25 Fatigue therapy. Vestibular suppressant medications should not be used, as they will increase the imbalance. Evaluation by a neurologist is important not only to confirm the diagnosis but also to consider any other associ­ ated neurologic abnormalities that...

27 Numbness, Tingling, and Sensory Loss weakness usually is due to lower motor neuron or peripheral nerve dis­ ease, such as in a facial palsy. Weakness of part of a limb is commonly due to a peripheral nerve lesion such as an entrapment neuropathy. Relatively...

28 Gait Disorders, Imbalance, and Falls Jessica M. Baker, Gerald Pankratz Gait Disorders, Imbalance, and Falls PREVALENCE, MORBIDITY, AND MORTALITY Gait and balance problems are common in the elderly and contribute to the risk of falls and injury. Gait disorde...