Approach to Internal Medicine Pulmonary Medicine Pages 1–24 Cardiology Pages 25–66 Nephrology Pages 67–88 Critical Care Pages 89–110 Approach to Internal Medicine Gastroenterology Pages 111–142 A Resource Book for Clinical Practice Hematology Pages 143–184 Third Edition Oncology Pages 185–232 by David Hui, MD, M.Sc., FRCPC Edited by Alexander Leung, BSc(Med), MD(STIR ), DABIM, MRCP(UK ), FRCPC and Raj Padwal, MD, M.Sc., FRCPC Infectious Diseases Pages 233–272 Rheumatology Pages 273–296 Neurology Pages 297–336 Endocrinology Pages 337–360 Dermatology Pages 361–376 Geriatrics Pages 377–388 Palliative Care Pages 389–402 Nutrition Pages 403–408 Obstetric Med Pages 409–416 General Med Pages 417–430 13 ACLS Page 431 Index Pages 443–458 David Hui MD, M.Sc., FRCPC The University of Texas M.D Anderson Cancer Center Houston, TX 77030 USA dhui@mdanderson.org Author: David Hui Associate editors: Alexander Leung, Raj Padwal First edition, first printing, April 2006 Second edition, first printing, August 2007 Second edition, second printing, November 2007 Second edition, third printing, March 2008 Second edition, fourth printing, July 2008 Second edition, fifth printing, November 2008 Second edition, sixth printing, June 2009 Third edition, first printing, January 2011 Approach to Internal Medicine: A Resource Book for Clinical Practice Additional material to this book can be downloaded from http://extras.springer.com ISBN 978-1-4419-6504-2 e-ISBN 978-1-4419-6505-9 DOI 10.1007/978-1-4419-6505-9 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010933485 # Springer ScienceỵBusiness Media, LLC 2006, 2007, 2011 All rights reserved This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer ScienceỵBusiness Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid free paper Springer is part of Springer ScienceỵBusiness Media (www.springer.com) To Ella and Rupert David Hui Disclaimer Approach to Internal Medicine is meant to be a practical field guide Dosages of medications are provided for quick reference only Readers should consult other resources before applying information in this manual for direct patient care The author, editors, and publisher of Approach to Internal Medicine cannot be held responsible for any harm, direct or indirect, caused as a result of application of information tained within this manual vii Preface Practice is science touched with emotion Confessio Medici, Stephen Paget, 1909 The third edition of Approach to Internal Medicine builds upon previous efforts to create a practical, evidence based, and concise educational resource for everyday clinical use and examination preparation Approach to Internal Medicine now has an expanded repertoire of over 250 internal medicine topics, classified under 17 subspecialties With the input of a new editor and publisher, we were able to significantly expand and update the content and substantially improve the layout, while maintaining the same conciseness and practicality found in previous editions Under each topic, the sections on differential diagnoses, investigations, and treatments are designed for the rapid retrieval of high yield clinical information and can be particularly useful when one is all alone assessing a patient at o’clock in the morning Other sections contain many clinical pearls that are intended to help one to excel in patient care We also included many comparison tables aimed at highlighting the distinguishing features between various clinical entities and numerous mnemonics (marked by w) In addition to everyday practice, Approach to Internal Medicine can be effectively used as an examination study guide and teaching script For this new edition, we are very fortunate to have recruited a new associate editor, Dr Alexander Leung, who brings with him a wealth of knowledge and outstanding commitment to medical education We are most grateful to our section editors and contributors for their meticulous review of each subspecialty, providing expert input on the most up to date information We would also like to take this opportunity to thank Jean Claude Quintal as a resident reviewer and the Canadian Federation of Medical Students for its support of the previous edition Finally, we would like to thank all previous and current users of this manual for their support and feedback We are pleased that Springer has taken this title under its direction and has helped to improve its quality in preparation for international release In addition to International System (SI) units, this edition also provides US customary units [in square brackets] for quick reference We would particularly like to thank Laura Walsh, senior editor, and Stacy Lazar, editorial assistant, from Springer for their expert guidance and support throughout this mammoth project from design to production We would also like to thank Walter Pagel, director of scientific publishing at M.D Anderson Cancer Center, for believing in this work and making this collaboration possible While every effort has been made to ensure the accuracy of information in this manual, the author, editors, and publisher are not responsible for omissions, errors, or any consequences that result from application of the information contained herein Verification of the information in this manual remains the professional responsibility of the practitioner Readers are strongly urged to consult other appro priate clinical resources prior to applying information in this manual for direct patient care This is ix Index B-cell lymphoma 170–171, 173–174, 176, 179, 260 Behcet’s disease 234, 276–277, 282, 288–289, 291, 308 Bell’s palsy 307–308 Bence Jones proteinuria 179 Benign positional vertigo 309, 315–316 Benzodiazepines overdose 103 Bernard-Soulier syndrome 154–155 Bilevel positive airway pressure (BIPAP) 1, 4, 18, 94, 96, 395 Binet staging .171 Biological anticancer therapy 121, 192, 195, 210, 249 Bioprosthetic heart valve 156 Bitemporal hemianopia .305 Bladder cancer 70, 117, 208–209 Blast crisis in CML 165–166 Bleeding 10, 20, 28, 30–31, 42, 47–48, 73, 75–76, 81, 93–94, 100, 115, 118–120, 126, 129–131, 133, 143–146, 150–155, 157, 159–162, 180, 187, 198, 201, 203, 205–206, 208, 212, 218, 230, 238, 246, 286, 288, 299–300, 362, 369, 380, 385–386, 391, 423, 425–427 post-operative 425–426 Bleeding diathesis 20, 30, 93, 153–155, 159, 161 Bleomycin toxicity .227 b-blocker overdose 103–104 b-blockers 29–30, 37–39, 41–42, 51, 58–61, 103–106, 119, 134, 280, 314, 341–342, 345, 363, 381, 409, 411, 414, 424 Blood pressure 26, 29–30, 36, 40, 43–44, 49, 56–60, 68, 71, 74–76, 85, 95, 98–99, 104, 289, 291, 300, 302, 339, 348, 404, 409, 429 Blue bloater BODE index Body mass index (BMI) 4, 17–18, 21, 58, 132, 157, 338, 354, 357, 403–404, 406 Bone density testing 124, 212, 355, 398 Bone marrow transplant 172, 227 Bone metastases 208, 391–392 blastic 392 Borrelia burgdorferi 174, 234–235, 247, 273, 277–278, 289 Bouchard’s nodes 286, 294 Brachytherapy 196, 211–212, 219 Bradycardia 27, 39, 42–43, 57, 59, 63, 82, 91, 103–104, 108, 146, 241, 312, 343, 414, 422 Bradykinesia 320–321 Brain death 91–92 Brain metastasis 299 Brain tumors 9, 30, 214, 227, 297–299, 309, 311, 319, 332–333 BRCA syndromes 225 Break-bone fever 241 Breaking bad news 390, 399–400 445 Breast cancer 20, 189–195, 215, 219–221, 223–225, 228, 347, 410, 415 Breast examination 190–191, 222–223 Broca’s aphasia 304 Bronchiectasis 1, 3, 5, 8, 12, 16, 21, 33, 251, 279, 374, 394, 397 Bronchiolitis obliterans 5, 16, 21, 182, 278–279 Bronchiolitis obliterans organizing pneumonia (BOOP) 5, 16 Bronchogenic carcinoma 21 Brucellosis 173, 233, 239, 241 Brudzinski sign 242 Bruit abdominal .60, 68, 116, 338 carotid 302, 306, 340 B-type natriuretic peptide 37 Buerger’s disease 288, 367, 418 Buerger’s test .55, 338 Bullous lesions 365, 371 Bullous pemphigoid 365–366 Bundle branch blocks 9, 31, 44, 63–64 Burkitt’s lymphoma .174–177 Burr cells 163 C CA 125 217, 219–221, 223 CA 15–3 190, 220–221 CA 19–9 197, 205, 219–221 Cachexia 4, 46, 52, 125–126, 328, 332, 394, 396–398, 400 pancreatic cancer 404 CAGE questionnaire 105 Calcium channel blockers 15, 29–30, 38, 41–42, 51, 58–60, 104–105, 113, 126, 134, 158, 281, 314, 373, 386, 396, 411 Calcium channel blockers overdose 104 Calcium oxalate stone 68, 75, 84, 276 Calcium pyrophosphate deposition disease (CPPD) 276 Caloric testing 91, 315 Campylobacter 120, 122–124, 174, 239, 253, 258, 260, 283, 329 Canadian cardiac society (CCS) classification 27, 61, 422 C ANCA 13, 68–69, 71–72, 277, 289, 291, 293, 398 Cancer of the Anal Canal 204 Cancer of Unknown Origin 219–220 Candidiasis 113, 231, 236, 259, 265–266, 268–269, 363, 397 Capacity 5, 17, 21–22, 94–95, 125, 155, 378, 403, 422–423, 427 Capecitabine 146, 192, 194–196, 198–200, 226, 230–231 Carbapenems 249, 253–254, 257 Carbon monoxide poisoning .101 Carboplatin 168, 175, 187, 194, 214, 216, 218–220, 226, 230, 298 Carcinoembryonic antigen (CEA) 186, 196–197, 199–200, 205, 219–221, 353 Carcinoid heart disease .201–202 Carcinoid syndrome 185, 201–202, 281 Cardiomyopathy 33–34, 38–40, 43–48, 51, 53, 63–64, 93, 105, 181, 187, 195, 227, 235, 281, 312, 411, 414, 420 in pregnancy 411, 414 Cardiopulmonary resuscitation (CPR) 10, 30, 32, 90–91, 107, 399, 411, 428 Carnett’s test .116 Carotid bruit 302, 340 Carotid endarterectomy 303, 422–423 Carpal tunnel syndrome 278, 347 Caspofungin 237, 266, 268–269 Castleman’s disease 21, 173, 178 Catheter-associated bacteriuria 244–245 Cauda equina syndrome 228, 284–285 Cavernous sinus lesions .305 CD4 count 259, 261, 413 Celiac disease 72, 124–125, 144, 177, 354, 361, 374 Cellulitis 55, 149, 158, 247, 253, 258 Central pontine myelinolysis 80 Central venous catheterization 157 Central venous pressure (CVP) 36, 98, 100, 153, 171, 175–176, 228 Central venous saturation 90 Cephalosporins 68, 123, 149, 234, 253–254, 257, 365, 372–373, 413, 426 Cerebellar disorders 308, 315, 319–320 Cerebellopontine angle lesions 305 Cerebrospinal fluid analysis .244 Cervical radiculopathy 323 Cervicitis 245, 282, 284 CHADS2 criteria 42 Chemotherapeutic agents 226–227 Chemotherapy-induced diarrhea 231 Chemotherapy-induced lung injury 93 Chemotherapy-induced nausea and vomiting 229–230, 396 Chest pain acute coronary syndrome 26 aortic dissection 26, 28, 30–31 aortic stenosis 26, 28 pericarditis 26–28, 30–31 pneumonia 26 pulmonary embolism 26, 28 Chest radiography (CXR) 1, 3–4, 6, 9–19, 25–28, 33, 35–37, 41, 43, 48–53, 68, 92–93, 96–98, 100, 102, 106, 108–109, 111, 116–117, 119, 143, 149, 156, 158, 163, 172, 175, 186, 188–190, 196–197, 199, 204–206, 208, 210, 213, 215, 217–218, 222, 228, 234, 237, 239, 242, 250–251, 259–260, 262, 264, 277, 289, 291, 310, 312, 319, 339, 342, 353, 367, 369, 374, 381, 395, 398, 410, 420, 423–424 Cheyne-Stokes breathing 395 Child-Pugh classification 132 Chlamydia 6, 16, 47, 52, 174, 244–246, 253, 255, 259, 262, 282–283, 374, 413 Index 446 Chloromas 167 Cholecystitis 25–26, 115, 117, 284, 412 Cholestasis 125, 128, 138–139, 361, 407, 411–412 Cholinergic syndromes 102–104 Chronic bronchitis 3–4, 12, 23 Chronic cough 12, 113, 250 Chronic daily headaches 314 Chronic diarrhea 83, 120, 122, 124 Chronic fatigue syndrome 288 Chronic kidney disease 28, 57–59, 67, 73–74, 145, 267, 273, 346–347, 352, 389, 409 Chronic liver disease 130–135, 138, 163, 270 Chronic lymphocytic leukemia (CLL) 72, 146, 151–153, 164, 166–167, 170–171, 173, 175, 179, 181, 226 Chronic mesenteric ischemia .56, 115, 118 Chronic myelogenous leukemia (CML) 100, 143, 150, 164–167, 226–227 Chronic myelomonocytic leukemia (CMML) 165 Chronic phase in CML 165–166, 181 Chronic renal failure 47, 57, 70, 91, 104, 157, 250, 275, 352 Churg-Strauss syndrome (CSS) 149, 173, 288, 291 Chvostek’s sign 352 Cidofovir 265 Cirrhosis 5, 10, 12, 15, 42, 60, 67, 72, 78–79, 90, 105, 118–119, 128–139, 148, 164, 205–206, 220–221, 239, 267, 343, 352, 354, 374, 403, 420 Cisplatin .83, 175, 187–189, 196, 198, 202, 204, 209, 213–214, 216, 218–219, 226, 230–231, 260, 298, 327 Clark’s levels 369 Claudication neurogenic 284–285 Vascular 54–56 Clindamycin 7–8, 54, 123, 237, 245–248, 253, 255, 257–260, 364–365, 413, 424 Clostridium difficile colitis 122–123, 260 Clotting disorders 152, 154, 156 Clubbing 10, 13–14, 16, 53, 121, 133–134, 146, 185, 283, 344, 374–375 Cluster headaches .314 Coagulation pathway 154 Coccidioidomycosis 15, 20, 149, 173, 238, 259, 267, 349, 374 Cockcroft-Gault formula 67 Code status 399 Cognitive impairment 31, 378–380, 392–393 Colorectal cancer 120–121, 198–200, 220–221, 223, 225, 228, 261 Coma 80–81, 91, 102–104, 108–109, 135, 152, 310, 343, 410, 422 Communication skills 378, 390, 399, 429 Community acquired pneumonia 6–7, 100, 257, 260 Competency 378 Complements 71–72, 100, 153, 157, 243, 257, 280, 288 Conditioning 16, 181–182, 332 Conductive hearing loss 317 Confidentiality .428 Conflict of interest .428 Confusion assessment method (CAM) 377, 381, 383 Congenital adrenal hyperplasia 78, 348, 357–358, 364 Congestive heart failure (CHF) 12, 15, 28, 35, 42, 54, 137, 156, 367 Conn’s syndrome 57 Consent 382, 427–428 Consent for procedures .427 Constipation 59, 61, 86, 126–127, 135, 202, 215, 217, 226–227, 229, 241, 281, 321, 328, 337, 343, 353, 385, 392, 395–398, 419, 421 Constipation score 126, 396–397 Constrictive pericarditis 32–33, 43–44, 134, 136–137, 164, 278 Contact dermatitis 257, 361, 365, 371–373 Contact isolation 235 Continuous positive airway pressure (CPAP) 17–18, 37, 94, 96, 143, 424 Contrast nephropathy 69–70 Coomb’s test 145–146, 151, 153 COPD exacerbation 3–5, 8, 33, 94, 394 Cornell criteria 64 Coronary artery bypass graft surgery 31 Cotswolds staging .172 Cough 1, 3–4, 6, 8, 10, 12–13, 15–17, 32, 35, 37–38, 58, 91, 95, 113–114, 116, 147, 149, 185, 189, 195, 213, 215, 217–218, 228, 233–234, 237, 239–240, 250, 263–264, 267, 345, 370, 384 Coumadin induced skin necrosis .160 Cranial nerves 107, 169, 177, 298, 301, 304–308, 316, 329, 420 C-reactive protein (CRP) 13, 27, 57, 61, 121, 150, 233, 235, 274, 276, 278, 280, 282, 289–290, 292, 322, 398, 400, 421 CREST syndrome 281 Critical illness neuromuscular disorders .333 Crohn’s disease 121, 125, 177, 223, 374 Cross-leg palsy 331 Cryoglobulinemia 17, 68–69, 72, 132, 156, 170, 174, 178, 233, 288–289, 292, 372, 420–421 Cryptococcosis 34, 173, 259, 267 Cryptogenic organizing pneumonia (COP) 3, 5, 8, 15–16, 20, 33, 42 CT chest 5–6, 9–11, 13–17, 19, 21, 26, 42, 53, 92–93, 134, 149, 172, 175, 186, 188–189, 196, 200, 202, 204, 219–220, 222, 228, 234, 251, 266, 289, 319, 410, 420 CT head 80, 102, 111, 135, 186, 208, 213, 243, 260, 298–299, 302–303, 307, 310, 312, 314–316, 322, 333–334, 380–381, 410 Cushing’s Disease 346–347, 350, 352 Cushing’s Syndrome 57, 79, 143, 215, 285–286, 337, 346, 350–352 Cutaneous lupus erythematosus 371–372 Cyanide poisoning .109 Cyclophosphamide 13, 16, 71–72, 146, 167–169, 171, 173, 175–177, 181–182, 189, 193, 208, 226, 230–231, 279–281, 289, 291, 298, 420 Cystic kidney diseases 57, 73, 75–76, 143, 207, 244 Cystine stones 84 D Daptomycin 247, 255 Deafness 317 Death brain death criteria 91–92 post myocardial infarction 426 DeBakey classification 25 Decontamination .104–105 Deep vein thrombosis (DVT) 4, 8–10, 13, 40, 54–56, 100, 121, 143, 152, 156–161, 283, 300, 367, 410, 425 Dejerine syndrome 306 Delirium alcoholism 105–107 hepatic encephalopathy 135 hypercalcemia 390 hyperglycemia 104 hypernatremia 381 hypoglycemia 385 hyponatremia 381 meningitis 422 overdose 382 post-operative 31, 426 seizures 106–107 Delirium tremens .105–107 Dementia 6, 30, 112, 126, 176, 185, 215, 235, 246, 298, 315, 319, 321, 323, 328, 377–381, 383, 405, 422, 425 Dengue fever 173, 239, 241 Depression 17–18, 27, 30–33, 36, 57, 59, 62, 64–65, 82, 102–103, 105, 108, 126, 132, 170, 178, 204, 280, 287, 302, 308, 318, 321–322, 332, 339, 343, 350, 352, 370, 377–382, 389–390, 392, 394–398, 403–404, 414, 419 palliative setting 390 Dermatitis herpetiformis 72, 124, 361, 365 Dermatomes 324 Dermatomyositis 17, 34, 101, 112, 173, 204, 234, 276–277, 280–282, 293, 332 Dermatophyte infections 363 DeWeese’s test 55 Index Dexamethasone suppression test 346, 350–351 Diabetes .7, 27–28, 30, 35, 40, 42, 53, 56–59, 61, 69, 71, 73–74, 81–82, 101, 104, 107, 111, 115, 124–126, 130, 132, 156, 180, 198, 201, 204, 217, 242, 244, 247–250, 252, 266–267, 273, 276, 286, 292, 300, 305, 327–328, 331–332, 337–343, 347–348, 361–362, 367, 371, 375, 384, 396–397, 403–404, 409, 413–414, 418, 420, 423, 427 in pregnancy 413–414 Diabetes insipidus 69, 81, 104, 347–348, 384, 420 Diabetes mellitus complications 337 insulin 337–338 oral hypoglycemics 338 Diabetic foot ulcer .248 Diabetic ketoacidosis (DKA) 77, 83, 115, 337–339 Diabetic nephropathy 70, 74, 78 Diabetic neuropathy 18, 27, 124, 247 Diabetic retinopathy 414 Dialysis acute indications 74 chronic indications 74 continuous renal replacement therapy (CRRT) 85 hemodialysis (IHD) 68–70, 74, 85 peritoneal dialysis (PD) 10, 68–70, 74, 85–86 Diarrhea acute 122–123, 239, 258, 282 antibiotics-associated 123 carcinoid tumors 201–202 chemotherapy-induced 231 chronic 83, 122, 124, 239 inflammatory bowel disease 120–122 irritable bowel syndrome 127 Diastolic dysfunction 34, 36–38, 59 Diastolic murmurs 25, 46–47, 49 Diffuse airspace disease 20 Diffuse Body Pain 287 Diffuse idiopathic skeletal hyperostosis (DISH) 286 Diffuse large B cell lymphoma 170, 174, 260 Digibind .39, 105 Digoxin intoxication 38–39 Dilated cardiomyopathy 40, 51, 63, 105, 235 Diplopia .177, 189, 290, 304, 306–308, 316, 318, 344, 427 Dipyridamole/adenosine MIBI 28 Direct thrombin inhibitors 29, 161 Discharge .2, 8, 29, 91, 120, 161, 190, 192, 218, 227, 233–234, 237, 239, 244–246, 269, 273, 390, 429 Disc herniation 285 Discord lupus .371 Disposition 378, 429 447 Disseminated intravascular coagulation (DIC) 10, 20, 93, 101, 138, 145, 151–152, 154, 156–157, 163, 167–168, 235, 240, 411–412, 415, 426 Diuretics 29, 37, 39, 50–51, 58–60, 68, 74, 78–81, 83, 118–119, 125, 134–135, 137, 139, 162, 275, 339, 349, 352, 367, 371–372, 381, 384, 395, 411, 425 Dizziness 12, 15, 39–40, 59, 118–120, 144–146, 202, 227, 313, 315–316, 342, 382 Dobutamine echocardiography 28 Docetaxel 187, 193–194, 196, 198, 211, 226, 230–231 Doll’s eyes response 91 Donor 162–163, 168, 170, 176, 180–182 stem cell transplant 163, 168, 176, 180–182 Do not resuscitate orders .91, 338 Doxorubicin 169, 173, 175–176, 178, 180, 189, 193–195, 202, 209, 216–218, 226, 230–231, 260 Driving limitations .426 Drop attacks 382 Drop head syndrome 333 Droplet isolation 235, 269 Drug eruptions 256, 361–362, 364, 372–373 Drug-induced systemic lupus 280 Drug-related exanthems 372 Ductal carcinoma in situ (DCIS) 189, 191, 223 Dupuytren’s Contracture 133, 146, 375 Dying 236, 390–391, 395 Dysarthria .80, 301, 304, 316, 321, 421 Dysbetalipoproteinemia 62 Dyspepsia 113–115, 119, 127, 281, 412, 419 Dysphagia 80, 112–114, 185, 189, 195–197, 281, 301, 306, 316, 345, 397, 398, 400, 406, 421 esophageal cancer 195–196 Dysphagia 80, 83, 112–114, 185, 189, 195–197, 281, 301, 306, 316, 345, 397–398, 400, 406, 421 Dysphonia 304, 345, 421 Dysplastic nevi 368, 370 Dysplastic nevus syndrome 368, 370 Dyspnea acute coronary syndrome 27 acute respiratory distress syndrome 93 aortic stenosis 33, 48, 422 asthma exacerbation .3, 8, 33, 394 congestive heart failure 15, 35 COPD exacerbation 3, 8, 33, 394 flash pulmonary edema 38 hypoxemia 134 interstitial lung disease 3, 8, 33 metabolic acidosis 33 palliative setting 394–395 pleural effusion 33, 188 pneumonia 3, 6, 8, 33, 394 pulmonary embolism 8, 33, 394 pulmonary hypertension 33, 50, 92, 394 respiratory alkalosis 19, 103 tamponade 32–33 Dystonia 320, 322, 333 E Eaton-Lambert syndrome 185, 319 ECG exercise stress test 27–28 Echinocandin 266, 268 Eclampsia 409–410, 412, 414–415 ECOG performance status 175, 187, 390 Eczema 190, 247, 361–363 Ehrlichia 235–236, 253 Eisenmenger syndrome 15, 52 Elderly 38–39, 59, 69, 93, 103, 194, 218, 244, 247, 250, 292, 297, 314, 317, 334, 343–345, 361, 366, 377, 381–382, 384–386 Electrocardiogram (ECG) 4, 9, 15, 19, 25–28, 30–33, 36–37, 39, 41, 48–53, 56–57, 62–65, 82–83, 92–93, 98, 102, 106, 108–109, 116, 234, 259, 302, 312, 315, 339–340, 352–353, 374, 381, 383, 395, 403, 420, 423–424 Elevated liver enzymes 227, 409 Elliptocytosis 138, 163 Embolic stroke 299–300, 302 Emesis 103, 112 Emphysema 4–5, 23, 134, 420 Empiric antibiotics 54, 162, 234, 243, 249, 257–258 Empyema 6, 8, 11, 21, 79, 241, 374 Encephalitis 79, 81, 135, 172, 235, 238–239, 241, 243–244, 260, 263, 309–310, 313, 333, 378, 381 Endocarditis 3, 8, 10, 20, 33, 35, 38, 40, 47–54, 68–69, 72, 98, 156, 159, 161, 164, 233–235, 242, 253, 256, 258, 266, 273, 276–277, 279, 282, 288–289, 292, 299–300, 374, 394, 411, 420, 422, 424 Endocarditis prophylaxis 54, 411, 424 Endoscopy 104, 113–116, 119–121, 123–124, 134, 144, 196, 198, 203, 210, 219, 225–226, 260 Endotracheal tubes 19, 89, 94–95, 269 Engraftment 181–182 Enterofeeding 229, 378, 380 Enteropathic arthritis (EA) 283 Eosinophilia 3, 11, 15, 69, 148–149, 172, 204, 238, 289, 291, 361 Epilepsy 135, 310, 333, 414, 426 Epirubicin 193, 196, 198, 209, 226, 230 Erlotinib 187, 205, 227, 231, 363 Erosive osteoarthritis 286 Eruptive xanthoma 61 Index 448 Erysipelas 247, 253 Erythema migrans .234–235 Erythema multiforme 172, 267, 276–277, 282, 365–366, 372 Erythema nodosum 122, 121, 172, 234, 250, 266–267, 276–277, 279, 282–283, 291, 373–374, 420 Erythrocyte sedimentation rate (ESR) 13, 15, 51, 53, 121, 127, 149–150, 163, 172–173, 233, 235, 248–249, 274, 276, 278, 280, 282, 284, 286–287, 289–292, 302, 314, 322, 327, 344, 367–368, 383, 398, 421 Esophageal cancer 25–26, 195–196, 374, 406 Esophageal dysphagia .112 Esophagitis 25–26, 112–114, 118–119, 148, 260, 265 Essential thrombocytosis (ET) 43, 164–167 Essential tremor 59 Ethics 395, 427–428 Ethnic neutropenia 148 Ethylene glycol overdose 107 Etoposide 167–168, 173, 175–176, 182, 187, 189, 202, 214, 216, 226, 230, 298 Euthanasia 395, 428 Evan’s syndrome 151, 153 Exanthematous lesions 364–365 Exanthems 233–234, 364–365 drug-related 372–373 Exemestane 192, 227 Exercise induced asthma 2–3 Extended spectrum b-lactamase (ESBL) 253 Extraocular eye movements 306, 318 Eye lymphoma 176 F Facial droop 305, 307 stroke/TIA, 305, 307 Facial nerve lesions 307 Facial nerve palsy 235 Facial telangiectasia 118, 364, 371 Factor V Leiden 8–9, 156, 158–159 Falls 83, 301, 313, 315, 320, 338, 377, 382–383, 385, 390, 405 Famciclovir 265, 366 Familial adenomatous polyposis (FAP) 197–199, 204, 223, 225–226, 297 Familial benign hypocalciuric hypercalcemia 353–354 Familial combined hyperlipidemia 62 Familial dyslipidemia 62 Fanconi’s anemia 153 Fanconi’s syndrome 78 Fat embolism 10, 20, 93, 147 Fatigue 5, 27, 35, 51, 55, 73, 138, 144–146, 167, 169–172, 174, 178, 180, 185, 188–190, 193, 195, 197, 199, 202–204, 207, 209–210, 212–213, 215, 217–218, 226–227, 235, 250, 263, 278, 280, 287–288, 290, 308–309, 313, 322, 338, 343–344, 349, 357, 389–390, 394, 397, 405, 420–421 Febrile neutropenia 148, 181, 193, 230, 236–238, 268–269 Fecal osmotic gap 124 Felty syndrome 278 Femoral nerve 326, 331 Ferritin 121, 125, 128, 134, 138, 144–145, 147, 150, 277, 420 Fever endocarditis 3, 8, 47, 50–53, 233–235, 241–242, 253, 258, 276–277, 282, 288, 374, 420, 422 neurological symptoms 241–242 neutropenic 148, 233, 237–238 NYD 233 polyarthritis 51, 122, 277, 283, 365, 422 post-operative 247, 302, 422, 425 rash 149, 235 sepsis 3, 6, 8, 19, 33, 137, 148, 162, 178, 238, 244, 258, 275, 277, 286, 344 skin infections 147, 274 of unknown origin (FUO) 233–234 urinary symptoms 68, 127, 212 with travel 238–241 Fibrates 61–62, 79, 332, 339, 425 Fibromyalgia 18, 127, 287–288, 332 Fixed drug eruption 372–373 Flaccidity 303 Flash pulmonary edema 38, 60 Fluconazole 181, 231, 237–238, 245, 260, 265–269, 386 5-flucytosine 268 Fludarabine 138, 146, 171, 175, 178, 181, 226, 230 Fluoroquinolones 7, 63, 97, 100, 123, 128, 241, 245, 255, 257, 413 5-fluorouracil 193, 196, 198–200, 202, 204–205, 226, 230–231, 370–372 Flushing 59, 61, 80, 201–202, 364, 371 Focal liver lesion 205 Focal Neurological Deficits 25, 152, 176, 291, 297, 301, 378–379 stroke 301 Focal nodular hyperplasia (FNH) 205–206 Focal segmental glomerulosclerosis (FSGS) 68, 70–72, 172 Follicular lymphoma 170, 173–175 Follicular lymphoma international prognostic index (FLIPI) 175 Fondaparinux 9, 29, 89, 100, 157, 161 Foot examination 338 Foscarnet .265 Fracture index for postmenopausal women 355 Fragmented cells 163 Frailty 377, 381 Frontotemporal dementia 378–379 Functional dyspepsia 113–114, 127 Fungal infections 228, 234, 236, 238, 243, 265–267, 367 Futility 428 G Gail model 190 Gait assessment 322, 377 Gallavardin phenomenon 46–47 Gallstone pancreatitis 117, 139 Gallstones 61, 138, 202 Ganciclovir 265 Gastric cancer 114–115, 190, 196–198, 220–221, 225 Gastroesophageal reflux disease (GERD) 1, 12, 25–26, 112–113, 260, 281, 398, 412 Gastroparesis 111, 113, 115, 337, 340, 397 Gemcitabine 175, 187–188, 192, 194, 205, 209, 216, 220, 226, 230 Geriatrics 377–386 Germ cell tumor 20, 212–213, 215–216, 219–221, 228 Gestational diabetes 337–338, 413–414 Gestational hypertension 409 Gestational thrombocytopenia 415 Get up and go test 377, 383 Giant cell arteritis (GCA) 25, 233, 276, 289–290 GI Bleed 12, 94, 97, 118–120, 129, 134–135, 144–145, 195, 197, 203, 238, 350, 380, 406–407, 421 lower 120 upper 12, 118–120, 134, 195, 197 Gitelman’s syndrome 79 Glabellar tap reflex 304 Glanzmann’s thrombasthenia 154–155 Glasglow coma scale (GCS) 90–91, 94, 102, 104, 108–109 Gleason score 210–212 Glioblastoma Multiforme 297–298 Global aphasia .301 Glomerulopathies 70–73, 75 Glucocorticoids 3, 5, 61, 115, 121, 273, 283, 286, 348–352, 355, 358, 363, 368, 371, 373–374, 410 complications 273, 352 Gluten 124, 361, 406 Glycemic control 100, 340, 404, 407, 414 Goiter 1, 17, 21, 57, 104, 146, 343–345, 414 GOLD classification Gonadal failure 420 chemotherapy-induced 216 Goodpasture disease 12–13 Gottron’s papules 281 Gout 59, 69, 84, 273, 275–278, 282 Graft versus host disease 181–182 Graft versus leukemia effect 180 Graham Steell murmur 15, 46, 49 Index Gram negative bacilli 52, 234, 242, 248, 252–253, 260, 273 Gram negative cocci 234, 252 Gram positive bacilli 6, 252 Gram positive cocci 234, 252 Gram stain 1, 4, 6, 11–13, 53, 93, 97, 100, 135–137, 147, 234–235, 237, 239, 242–243, 245, 247, 251–253, 264, 273–275, 277–278, 280, 282, 367, 395 Grand mal seizures 106 Grasping reflex 304 Graves disease 343–346, 414 in pregnancy 414 Groin skin lesions .363 Guardianship .378 Guillain-Barre syndrome (GBS) 18, 79, 91, 122, 243, 263, 308, 328–329 H HACEK organisms 253 Hachinski ischemic score .379 Hairy cell leukemia 164–165, 170–171, 174 Hand examination 161, 282, 285, 294, 301–302, 323, 328, 363, 370 Hasenclever score 173 Headaches 12, 17, 39, 59, 106–107, 109, 143, 165, 169, 176–177, 185, 190, 192, 202, 213, 233–237, 239–243, 263, 287–288, 290, 297–298, 302, 306, 312–315, 320, 347–349, 356, 370, 380, 409, 412, 419 meningitis 176, 235, 240–244, 246, 257, 260, 263, 313, 315, 380 Hearing impairment 317, 384–385 Heartburn 112–115 Heart disease 14, 33–34, 37–38, 40, 42, 49–54, 57, 63, 105, 117–119, 194, 201–202, 300, 312–313, 338, 343, 374–375, 411, 424–425 in pregnancy 42, 105, 411 Heart failure 4, 7, 12, 15, 21, 27–29, 33–40, 44, 48–52, 54, 59, 67–68, 98–99, 134, 136–137, 156, 164, 202, 221, 312, 385–386, 389, 391, 403, 409, 420, 422 left sided 14, 35–36, 49 Heart sounds .32, 44–46 Heavy chain deposition disease 178 Heberden’s nodes 286 Heinz bodies 163 Helicobacter pylori 115, 174 Hemangioma 14, 180, 205–206, 208 hepatic 205–206 Hematopoietic stem cell transplant .180–182 Hematuria 13, 68, 70–72, 75–76, 207–209, 233, 239–240, 244, 280, 291, 421 Hemochromatosis 34, 40, 64, 128, 132–135, 205, 276, 286, 337, 372, 420 449 Hemodynamic instability 5, 9, 28, 30, 39, 48, 81, 89, 94, 104, 119 Hemolysis 82–83, 126, 138, 145, 147, 151, 153, 157, 409 Hemolytic uremic syndrome (HUS) 68, 138, 145, 151–152, 156, 227, 242, 415 Hemoptysis 8–10, 12–13, 15–16, 49–50, 68, 75, 118, 185, 187, 233, 250–251, 267, 289 pulmonary embolism 8–12, 15 Hemorrhagic stroke 9, 299, 301 Hemostasis 119, 154, 161, 274, 425 Henoch-Schonlein purpura (HSP) .72, 288–289, 291–292 Heparin 4, 9, 29–30, 42, 85, 89, 100, 119–120, 151–152, 154–157, 159–161, 354–355, 407, 410–411, 425–426 Heparin induced thrombocytopenia and thrombosis (HITT) 85, 151–152, 156, 160–161, 426 Heparinoid 160–161 Hepatic adenoma 205, 207 Hepatic diseases 134, 292, 411 in pregnancy 292, 411 Hepatic encephalopathy 134–136, 406 Hepatic hydrothorax 134 Hepatitis B 128–131, 133, 135, 147, 207, 239, 261–262, 269, 412 vaccination .129, 261–262, 269 Hepatitis C 128–132, 135, 207, 261–262, 422 HIV coinfection 262 Hepatocellular carcinoma 129–131, 134, 205–206, 220, 262, 420 Hepatomegaly 13, 32, 35, 50, 52, 133–134, 143, 169–170, 181, 195, 197, 277, 421 Hepatopulmonary syndrome .134 Hepatorenal syndrome 134 Herceptin 227 Hereditary breast cancer syndromes 224 Hereditary cancer syndromes 224–225 Hereditary non-polyposis colorectal cancer (HNPCC) 197–199, 204, 215, 217, 223–225 Herniation syndromes 297–298 Herpes simplex virus (HSV) 113, 128, 173, 181–182, 227, 231, 236, 241–245, 257, 259–260, 265, 333, 365–366 5-HIAA (5-hydroxyindoleacetic acid) 201–202, 221 Highly active antiretroviral therapy (HAART) 153, 259, 261–262, 352, 413 Hilar enlargement 21 Hip examination 56, 116, 228, 242, 274, 285, 294, 318, 355, 383 Hirsutism 348, 350, 357–358, 403 Histoplasmosis 6, 14–15, 20, 34, 128, 173, 238, 259, 261, 266, 349, 374, 420 History geriatrics 377–386 taking 257, 264, 290, 390, 413, 425 Hives 363 HMG-CoA reductase inhibitors 61 Hodgkin’s lymphoma 149, 163, 167, 169–177, 181–182, 227–228, 260–261, 318, 361, 403 Home oxygen Homonymous hemianopia 300–301, 305 Hormonal agents 192, 217, 227, 392 Horner’s syndrome 10, 13–14, 185, 318–319 Hospital admission and discharge .429 Hospital isolation measures 148, 269 Howell Jolly bodies 147, 163 HSV encephalitis 243, 260, 333 Human immunodeficiency virus (HIV) CNS involvement 238, 267 GI involvement 53, 102, 129, 157, 178, 203, 260, 289, 291, 328, 398, 412, 415, 420–422, 428 in pregnancy 413, 415 prophylaxis 152, 238–239, 245, 261, 269, 413 pulmonary involvement 260 Hungry bone syndrome 83 Hydromorphone 89, 392–393 Hyperaldosteronism 79, 81–82, 348–349 Hyperbilirubinemia 128, 138, 414 Hypercalcemia 38, 57, 65, 67, 69, 81, 83, 101, 104, 111, 115, 126, 135, 139, 171–172, 174, 178, 180, 185, 206–207, 209–210, 215, 227, 229, 347, 353–354, 356, 368, 381–382, 384, 390, 392, 396, 420 cancer 115, 126, 139, 185, 206–207, 209–210, 215, 227, 347, 353, 392, 396 Hypercarbic respiratory failure 93 Hypercholesterolemia 61–62, 139 Hyperchylomicronemia 62 Hypercoagulable states deep vein thrombosis 158 pulmonary embolism 9–10 recurrent thrombosis 158 Hyperemesis gravidarum 111, 411–412, 414 Hyperglycemia diabetic ketoacidosis 338–339 non-ketotic hyperosmolar hyperglycemia (NKH) 339 Hyperkalemia 30, 37–39, 58, 60, 64–65, 68, 73–74, 78, 82–83, 229, 310, 348 Hyperkinetic movement disorders 322 Hyperlipidemia 61–62, 69, 71, 104, 130, 138–139, 275, 303, 338, 362 Hypernatremia 38–39, 81, 332, 381 Hyperprolactinemia .346 Hypersensitivity pneumonitis 15–16, 20 Hypersensitivity reactions 257, 363, 365–366, 373 Hypersensitivity vasculitis 288, 372–373 Hypersomnolence 17–18 Index 450 Hypersplenism 130, 148, 151, 153, 278, 415, 420 Hypertension aortic dissection .25, 28, 30, 49, 57, 60 Conn’s 348 cushing’s syndrome 57 hyperaldosteronism 348–349 pheochromocytoma .34, 57, 143, 281, 348–349 post-operative 392, 425–426 in pregnancy 409 Hypertensive cardiomyopathy 34 Hypertensive emergency 57–58 Hypertensive retinopathy 57, 338, 348 Hypertensive urgency 57–58 Hyperthyroidism 15, 19, 39, 42, 44–45, 57, 65, 90, 111, 124, 233, 309, 318, 332, 337, 344–346, 353–355, 361, 374, 412, 414, 420 in pregnancy 414 Hypertrichosis 180, 357, 421 Hypertriglyceridemia 61–62, 80, 227 Hypertrophic cardiomyopathy 40, 43, 45–48, 53, 64, 312 Hypertrophic obstructive cardiomyopathy (HOCM) 38, 42, 45, 48 Hypertrophic osteoarthropathy .185, 374–375 Hypertrophy criteria 63–64 Hyperventilation 19, 78, 83, 94, 315 Hyperviscosity syndrome 178, 180 Hypnic headaches .314 Hypocalcemia 63, 65, 89, 101, 139, 229, 309, 332, 352–353, 414 Hypogammaglobulinemia 5, 8, 170, 189 Hypoglycemia 39, 59, 83, 100, 103, 105, 107–108, 128–129, 203, 206, 226, 240, 299, 309–310, 337, 340–342, 385, 412, 414, 425, 427 Hypokalemia 18, 38–39, 63, 65, 78–79, 81–82, 86, 89, 104–105, 108, 126, 135, 332, 347–348, 396, 406 Hypokinetic movement disorders .320 Hypomagnesemia 38–39, 63, 78–79, 81, 83, 89, 105, 126, 135, 227, 276, 381, 396 Hyponatremia acute 80 chronic 80 hyperosmolar 80 hypoosmolar 79–80 isoosmolar 80 pseudo 80 Hypophosphatemia 18, 83–84, 89, 103, 105, 227, 332, 352–353 Hypotension 8, 25, 27, 29–30, 32–33, 48, 52, 59, 89–90, 97, 100, 103–105, 107–109, 118–120, 122–123, 129, 135, 137, 140, 146, 149, 168, 201–202, 227, 233, 235, 237–239, 248, 257, 312–313, 315, 328, 337, 344, 348–349, 352, 365, 373, 382–383, 385 Hypothermia 64, 81, 91, 103, 107–108, 343, 381 Hypothyroidism 10, 17, 32, 34, 39, 42, 57, 61, 79–80, 98, 107–108, 126, 135–137, 145–147, 173, 180–181, 202, 220, 227, 276, 281, 287, 328, 332, 343, 345–347, 356–357, 361, 378, 381, 390, 394, 396, 414, 420–421 in pregnancy 414 Hypoventilation 15, 18, 78, 92–93, 146, 403 Hypovolemia 71, 80–81, 118–119, 229 Hypoxemia 4, 8, 15–18, 35, 38, 92–94, 96–97, 101, 104, 108–109, 134–135, 147, 233, 235, 237, 239 Hypoxemic respiratory failure 93 I Idiopathic hirsutism 357–358 Idiopathic/immune thrombocytopenic purpura (ITP) 132, 151–153, 170, 415 Idiopathic pulmonary fibrosis 16, 20–21, 374 IgA nephropathy 70–73, 75, 76, 288, 361 Imaging abdominal X-rays (AXR) 396 chest radiography CT chest neurology 297, 302 Imatinib 149, 166, 169, 203, 227, 231 Immune reconstitution syndrome (IRIS) .262 Immunization 147–148, 163, 233–234, 237, 239, 261, 269–271, 365 Immunocompromised patients 266–267 Impetigo 247, 365–366 Incidentaloma 348 adrenal 348–349 Incontinence 12, 68, 103, 210, 212, 228, 231, 244, 298, 310, 312, 323, 377–380, 383–385, 403 Incoordination 135, 308, 319–320, 382 Indirect factor Xa inhibitors .160–161 Indolent lymphomas 175 Infection control 269–270 Inferior vena cava obstruction 207 Inflammatory arthritis 278, 283, 286 Inflammatory back pain .284 Inflammatory bowel disease (IBD) 5, 8, 118, 120–123, 120–122, 125, 127, 129, 155, 156, 174, 212, 220, 223, 234, 239, 273, 276–277, 282–283, 367, 374, 405, 420 extra-intestinal manifestations 121, 283 Inflammatory cardiomyopathy 34 Inflammatory myopathies 279, 281, 292–293, 332 Influenza vaccination 2, 4, 7, 148, 239, 261, 264 Infusion reactions 194, 228, 269 Inhaled medications Inotropes 28–30, 98–100, 399 Insomnia 12, 17, 42, 106, 350, 390, 418–419, 421 Insulin 59, 62, 82–83, 100, 104, 201, 261, 337–342, 347, 350, 357–358, 397, 403, 407, 414, 423, 425, 427 principles of use 341–342 Insulin resistance syndrome 62 Intensive care admission criteria 89 general issues 89–92 mechanical ventilation 89 preventative strategies 89 procedures 89–90 prognosis 90 sedation 89 weakness 89 International prognostic index follicular lymphoma 175 Hodgkin’s lymphoma 173 non-Hodgkin’s lymphoma 175 Internuclear ophthalmoplegia (INO) .306–308 Interstitial lung disease 3, 5, 8, 12, 15–17, 20–21, 23, 33, 92, 148, 281 Intoxication 38–39, 68, 91, 103, 105, 107, 135, 299, 380 Intracerebral hemorrhage 93, 106, 147, 243 Intrahepatic cholestasis of pregnancy 411–412 Intubation 1–2, 4–5, 13, 18, 78, 89–91, 94–95, 97, 99–100, 103–104, 108–109, 243, 269, 311, 338, 373, 399 impending Iodine uptake study 345 Irinotecan 187, 196, 198–200, 226, 230–231 Iron deficiency anemia 144, 163, 199 Iron index 420 Irritable bowel syndrome (IBS) 124, 126–127, 239, 287, 396 Ischemia criteria 28 Ischemic cardiomyopathy 34, 93 Ischemic colitis 115, 118, 120, 122, 125 Ischemic stroke 9, 30, 147, 299, 302–303, 313 Isolations 36, 148, 235, 251, 265, 267, 269 Isometric exercises 45 Itraconazole 3, 237, 261, 266–268, 363, 386 J Janeway lesions 53 Jaundice 46, 52, 121, 128–131, 133, 138–140, 145–146, 163, 181, 185, 190, 201, 203–207, 209, 218, 240, 283, 344, 405, 411–412 Index Joint aspirations 274 Joint pain crystal arthropathy 286 osteoarthritis 273, 275–276, 285–287, 347, 353, 403 rheumatoid arthritis 5, 11, 13, 15–16, 18, 25, 32, 47, 71, 78, 164, 233, 273, 276–280, 282, 286, 288, 292, 318, 323, 328, 332, 355, 368, 420 septic arthritis 53, 258, 273–274 systemic lupus erythematosus 279–281 Jones criteria 51 Jugular venous pressure (JVP) 15, 30, 32–36, 43–44, 46, 50, 52, 64, 68, 71, 98, 412 K Karnofsky performance status 186, 208, 298, 400 Keratoconjunctivitis sicca 273, 278–279 Keratoderma blennorrhagica .283 Kernig sign 242 Kidney mass 57, 116 Killip class classification 27 King’s College criteria 103, 129 acetaminophen overdose 103 Knee examination 295 Korsakoff’s amnesia .107 Krukenberg tumor .197 Kussmaul breathing 107, 395 Kwashiorkor syndrome 126 L Labral tear 295 b-lactamase resistance 253 Lactoacidosis .340 Lacunar stroke .299 Lambert–Eaton syndrome (LES) 318–319, 328 Latent tuberculosis 251 Lee criteria 423 Leg pain 56 Leg swelling 8, 10, 13, 158, 207 unilateral 8, 158 Leptomeningeal meningitis 176 Leptospirosis 34, 173, 233, 238, 240 Leser-Trelat sign 197, 370 Lesions acneiform 363 exanthematous 364–365 nodules 371 papulosquamous 362 pigmented 368 pruritic 361, 363 ulcers 368 vesicular/bullous 365, 371 Letrozole 192–193, 227 451 Leukemia acute lymphoblastic leukemia 167, 169–170, 177 acute myelogenous leukemia 166–168, 181 chronic lymphocytic leukemia 167, 170–171, 173, 179, 181 chronic myelogenous leukemia 100, 150, 165–166, 227 definition 166 Leukemic cutis 167 Leukocyte alkaline phosphatase 165 Leukocytoclastic vasculitis 289 Lewy body dementia 321, 328 Lhermitte’s sign 228, 298, 308, 323, 405 LHRH agonists 192, 211–212, 227 Libman-Sacks endocarditis 52, 279 Lichen planus 132, 362–363 Li Fraumeni syndrome 190, 204, 225, 297 Ligament tear 273, 295 Light chain deposition disease 69–70, 178, 421 Light’s criteria 11 Likelihood ratio 417 Linitis plastica 197 Lipase 26–27, 62, 114, 116, 125, 129, 136, 139, 196–197, 199, 204–205, 213, 259–260, 339, 404 Lithium toxicity 104 Livedo reticularis 157, 280, 288, 291, 371–372, 421 Liver enzymes 103, 128, 130, 138–139, 227, 259, 262, 277, 409 Liver failure acute 128–130 chronic 132–135 encephalopathy 128–129, 132–133, 135 fulminant 128–129 hepatitis B 129–130 hepatitis C 129, 131, 262 jaundice .128, 130–131, 133 Liver metastases 201, 203, 207, 391 Liver transplant 12, 103, 119, 129, 132–137, 139, 206 Lobular carcinoma in situ (LCIS) 189, 191 Lofgren’s syndrome 276–277, 279, 282, 420 Long thoracic nerve 330 Lower GI bleed 120 Lower GI bleed 120 IBD 120 Lower motor neuron 228, 285, 303, 307, 333 Low molecular weight heparins (LMWH) 9–10, 29–30, 89, 100, 152, 155–156, 159–161, 410–411, 415, 425 Lumbar puncture 100, 167–169, 176–177, 235, 239, 242–244, 260, 264, 267, 307–308, 310, 313–314, 322, 327, 329, 380, 382 Lumbosacral radiculopathy 285 Lung abscess 6, 8, 12, 374 Lung cancer 12–13, 20–21, 185–187, 220–221, 228, 261, 318–319, 347, 350, 374, 394, 411, 418–419 Lung cavities 20 Lung metastases 370 Lung resection assessment 424 Lupus 8–9, 69–70, 75, 79, 154–157, 233–234, 242, 279–281, 292, 322, 362, 365, 371–372, 415, 420 in pregnancy 415 Lyme disease 34, 112, 173, 234–236, 239, 276–277, 282, 308 Lymphadenopathy 10, 13–14, 53, 144, 146, 149, 151, 167, 169–174, 177–178, 219–220, 233, 235, 237, 239–241, 246, 250, 259, 262, 266, 277, 279–280, 345, 348, 420–422 Lymphoblastic lymphoma 167, 169, 174, 176–177 Lymphocytosis 16, 124, 170–172, 174, 308 Lymphoma definition 167 Hodgkin’s 149, 163, 167, 169–174, 181, 261, 318 non-Hodgkin’s 149, 167, 169–171, 173–178, 227–228, 259–260, 361, 403 small lymphocytic 167, 170, 173 Lymphoplasmacytic lymphoma 170, 174, 178 M Macrocytic anemia 105, 145–147 Macrolides 7, 63, 100, 114, 255, 257, 365 Malabsorption 83, 124–126, 163, 327, 352, 354–355, 405, 407, 421–422 Malaria 138, 145, 152, 164–165, 236, 238–240 Malar rash 279–280, 371 Malignant hypertension 57, 68, 151 Malignant pleural effusion 186–187, 220 Malnourishment 125, 406 Mammogram 158, 190–191, 219, 223, 225 Management 1–7, 9, 11–19, 11–121, 26, 28–30, 33, 37, 39, 41–42, 48, 50–52, 54, 56, 58, 61, 68–70, 74–76, 78–84, 93–94, 99–102, 104–106, 108–109, 111, 113–114, 117, 123–124, 126, 129, 131–132, 134, 136–139, 143–151, 153, 155–157, 159, 165–171, 173, 175–176, 180, 187–189, 191–192, 195–196, 198–200, 202–206, 208–209, 211, 214, 216–220, 230–231, 234–235, 237, 243, 245, 247, 249, 251, 260–261, 264, 274–275, 277–278, 280, 283–284, 286, 288–289, 298, 302–303, 307–312, 314, 316–317, Index 452 319–320, 322, 327–328, 333–340, 342–343, 345–353, 355, 357–358, 361–362, 364, 366–367, 369–372, 374–375, 377–378, 380, 382–385, 389, 392, 394–398, 403–407, 409–410, 412–413, 419, 422–425, 429 principles 429 Mantle cell lymphoma 170, 173–174, 177 Marantic endocarditis 52 Marasmus syndrome 126 Marginal zone lymphoma 170, 173–174 Mastectomy 191–192, 219, 225, 415 Maternal Medicine .409 McDonald criteria multiple sclerosis 308 Mechanical back pain 284 Mechanical heart valve 157 Mechanical ventilation 1–2, 4, 19, 89, 93–95, 97, 99–100, 329, 399, 425 Median nerve 325, 327–328, 331 Mediastinal lymphoma 174 Mediastinal masses 21, 112, 169, 171–172, 177 Medical fitness to drive 426–427 Medication induced headaches 202, 236, 287, 298, 412 Medications 1–2, 8, 10, 13, 15–18, 29, 31–34, 39–40, 50–53, 55, 57, 61, 67–68, 75, 81, 94–95, 97–98, 101–102, 106–108, 113–115, 118, 120, 122–126, 130–133, 135, 138–139, 143–146, 148–149, 151, 153, 173, 202, 230, 233–234, 237, 239, 252, 257, 260, 270, 273, 280, 288, 306, 311–315, 318, 320, 322, 337, 341, 343–344, 346, 349, 352, 354–355, 357, 363–364, 373, 377–378, 382–383, 385–386, 390–392, 395–397, 400, 405, 407, 409, 412–414, 421, 424–426, 429 in pregnancy 412–414 Mediterranean fever 115, 233, 241, 276–277, 282 Medullary cystic kidney disease 75–76 Medullary sponge kidney 75–76, 84 Medullary syndromes 306 Melanoma 20, 32, 159, 170, 173, 181, 195, 204, 219, 225–227, 261, 297, 299, 348, 353, 367–371 Melena 118, 120, 197 Membranoproliferative glomerulonephritis (MPGN) 68, 70, 72, 75, 130, 132, 170, 421 Membranous glomerulonephritis (MGN) 68, 70–71, 280 Meniere’s disease 315–317 Meningitis 79, 81, 97, 135, 147, 176, 235, 240–244, 246, 257, 260, 263, 265, 267, 280, 291, 305, 309–310, 313, 317, 378, 380–382, 422 Meningitis 79, 81, 97, 135, 147, 176, 240–244, 246, 257, 260, 263, 267, 280, 291, 305, 309–310, 313, 315, 317, 378, 380–382, 422 LEPTOMENINGEAL 176 Meniscal tear 286, 295 Mesothelioma 21, 32, 188, 220, 226, 228, 374 Metabolic acidosis 3, 8, 19, 33, 74, 77–78, 82, 96, 101, 103–104, 107, 394–395 diabetic ketoacidosis 115, 338–339 Metabolic alkalosis 18, 78–79, 81, 354 Metabolic cardiomyopathy 34 Metabolic syndrome 27, 61–62, 275 Methadone conversion 393 Methanol overdose 107 Methicillin resistant Staphylococcus aureus (MRSA) 6, 8, 54, 97, 100, 237, 247, 249–250, 253–255, 262, 269, 273 Methotrexate 68, 121, 146, 169–170, 176–177, 181, 193, 195, 209, 226, 230–231, 260, 277–281, 283–284, 289–291, 299, 362, 366, 371–372, 415, 420 Metronidazole 7, 113–114, 117, 121–123, 136, 238, 245–246, 248, 255, 257–258, 364, 386, 413 Micafungin 266, 268 Microangiopathic hemolytic anemia (MAHA) 68, 151–152, 163, 409 Microcytic anemia .144 Microscopic polyangiitis (MPA) 72, 288–289, 291, 293 Mid-systolic click 44, 52 Migraines 59, 299, 309, 313–315 Migrainous vertigo 316 Minimal change disease (MCD) .68–72, 172 Mitral regurgitation 27, 33–34, 38, 43–46, 48, 51–52 Mitral stenosis 3, 12, 35, 38, 42, 44–47, 49–51, 312, 411, 422, 424 Mitral valve prolapse 45–47, 51–53, 76 Mixed connective tissue disease 32, 279–281, 292 Mixed hypertriglyceridemia 62 Modified Duke’s criteria 53 Monoarthritis gout 273 septic arthritis 273–274 Monobactam .254 Monoclonal antibodies 227, 278, 309 Monoclonal gammopathy 170 Monoclonal gammopathy of undetermined significance (MGUS) 179–180, 327 Mononeuritis multiplex 289, 291, 327, 329, 337 Mononeuropathy 291, 327, 332, 337 Morphine 29, 33, 37, 79–80, 84, 89, 117, 139, 147, 153, 231, 392–393 Motor Cortex 310, 332 MR angiography 56, 333 MRI head 10, 80, 143, 176, 298, 302, 307–308, 310, 314–316, 322, 333 MR venography 333 Mucosa associated lymphoid tissue (MALT) 173–174, 176–177 Mucositis 112, 181–182, 199, 226–227, 230–231, 397–398 treatment 181, 230–231, 398 Multiple endocrine neoplasia (MEN) syndromes 201, 245, 345, 349 Multiple myeloma 69, 73–74, 78, 145, 170, 178–181, 227–228, 233, 261, 284, 288, 353, 403 Multiple sclerosis 107, 111–112, 126, 243, 287, 306–309, 315, 317, 320, 328, 332–333, 378, 396 Multi-system disorders 420 Murmurs diastolic murmurs 25, 46–47, 49 innocent 47 maneuvers 35, 45–46, 48 systolic murmurs 45–47, 51–52 Muscle strength grading .332 Myasthenia gravis (MG) 18, 21, 89, 112, 189, 306–308, 318–319, 332, 333, 343, 410 thymoma .21, 189, 318–319 Mycobacterium avium complex (MAC) 123, 164–165, 259–262 Mycosis fungoides 174, 177, 361–362 Myelodysplastic syndrome 146, 165, 168, 181, 233 Myelofibrosis (MF) 143, 150, 163–167 Myelopathy 89, 278, 298, 308, 323, 422 Myeloproliferative disorders chronic myelogenous leukemia .100, 150, 165–166 essential thrombocytosis 165–166 polycythemia rubra vera 143, 150, 156, 165–166 Myocardial infarction peri-operative 59, 147, 424 posterior infarction 30 right ventricular infarction 29–30 territory 64 Myoclonus 102, 309, 320, 322, 392–393 Myopathy 18, 61, 83, 89, 105, 126, 128, 281, 287, 332–333, 343–344, 350 Myotomes 324–325, 333 N Narcolepsy .17–18, 309 Narrow complex tachycardia 40, 63 Nausea and vomiting adrenal insufficiency 111, 349 chemotherapy-induced 229–230 palliative setting 395–396 Neck stiffness 233–234, 237, 239, 242 Necrotizing enterocolitis .238 Necrotizing fasciitis 97, 158, 247–248, 253, 258 Necrotizing pancreatitis .139 Needle stick injury 261, 269–270 Negative predictive value 417 Negligence 426, 428 Index Nephritic syndrome 70–71, 74–75, 132, 137, 280 Nephrotic syndrome 10, 61, 69–72, 74, 79, 132, 156, 280, 343, 352 Nerve roots 285, 303, 323, 325–327, 332 Neurocardiogenic syncope 312, 382 Neuroendocrine tumors 124, 201–202, 219, 225 Neurogenic claudication 284–285 Neurogenic syncope 310, 312, 382 Neuroimaging 301, 313, 333–334 Neuroleptic malignant syndrome (NMS) 101–102, 241, 332, 426 Neuropathy 18, 27, 42, 54, 73, 89, 105, 124, 126, 132, 145–146, 172, 178, 180, 185, 193, 215, 227, 235, 247–248, 252, 261, 278–280, 288–291, 313, 319, 323, 327–333, 337–338, 340, 367, 384, 396–397, 405, 420–421, 427 Neutropenia 132, 148, 168, 170, 180–181, 193, 228–230, 236–238, 266, 268–269, 278–279 febrile 148, 168, 170, 180–182, 193, 228–230, 236–238, 269 Neutropenic fever 148, 233, 237–238, 266, 406 New York heart association (NYHA) classification 27, 35, 37–38, 90, 275, 411, 422, 426 Niacin deficiency 201 Nicotine addiction .418 Nikolsky’s sign .366 Non-alcoholic steatohepatitis (NASH) 42, 128, 130, 132 Non-Hodgkin’s Lymphoma 149, 167, 169–171, 173–178, 182, 227–228, 259–260, 361, 403 Non-invasive positive pressure ventilation (NIPPV) 94, 96, 395 Non-ketotic hyperosmolar hyperglycemia (NKH) 339 Non-nucleoside reverse transcriptase inhibitors (NNRTI) 252, 261 Non-seminoma 212–214 Non-small cell lung cancer 186–187 Non-ulcer dyspepsia 113–114 Normal pressure hydrocephalus (NPH) 315, 322, 341–342, 378, 380, 382–383, 414 Normocytic anemia .73, 145 Nosocomial infections 269 Nosocomial pneumonia 6–7, 100 NSAIDs-induced gastropathy .114 NSAIDs-induced renal failure 69 Nucleoside reverse transcriptase inhibitors (NRTI) 252, 261 Number needed to treat (NNT) 303, 418 Numbness multiple sclerosis 303, 337 stroke/TIA 304, 316 Nutrition 8, 85, 96, 105, 121–122, 126, 129, 139, 237, 265, 354, 377, 382, 390, 398, 403–404, 406–407 453 O Obesity 1, 8, 17–18, 21, 23, 27, 30, 34, 36, 40–41, 43, 56–57, 61, 72, 94, 114, 117, 130, 133, 195, 198, 204, 207, 216, 247, 275, 286, 292, 314, 338, 340, 348, 350, 352, 357, 367, 384, 403, 406, 409, 413, 423 Obscure GI bleed .120 Obstetrical medicine 152, 412 Obstructive lung disease 134, 147, 424 Obstructive sleep apnea 17–18, 94, 143, 403 Obturator nerve 326, 331, 337 Occult GI bleed 12, 118–120, 144–145 Octreotide 119, 129, 135, 202, 231, 311, 342, 347, 396 Oculocephalic reflexes 91 Oculomotor nerve lesions 305 Odds ratio (OR) 418 Opening snap 44–46, 49–50 Opiate overdose 103, 105 Opioid Use 127, 392, 396 Optic atrophy 290, 306, 319, 344, 405 Optic neuritis 185, 252, 306, 308–309 Oral airways 95 Oropharyngeal dysphagia 112–113 Orthostatic proteinuria 74–75 Oseltamivir 264–265 Osler nodes 53 Osmolar gap 77, 101–102, 104, 107 Osteitis fibrosa 73 Osteoarthritis (OA) 273, 275–276, 278, 285–286, 347, 353, 403 Osteomyelitis 10, 53, 147, 233, 248–249, 256, 258, 265, 273, 338 Osteoporosis 19, 59, 124, 139, 160, 181, 192, 212, 227, 350, 353–355, 377, 383, 392, 418 Osteoporosis risk assessment instrument 355 Ovarian ablation 192–193 Overdose acetaminophen 103, 128 digoxin 38–39, 382 opioids 392 Overflow incontinence 384 Overlap syndrome 279, 332 Oxaliplatin 196, 198–200, 226, 230 Oxazolidinones 255 Oximetry 58, 91–92, 99, 104, 143 Oxygen saturation gap 104 P Paclitaxel 29, 31, 187, 193–194, 216, 218–220, 226, 230–231 Pain control .28, 84, 96, 117, 147, 205, 231, 284–285, 287, 314, 356, 391–393, 395–397, 411, 415, 424 Palindromic rheumatism 273, 276–278, 282 Palliative dyspnea 53, 188–189, 199, 202, 209, 389, 394–395, 400 medication route 391 nausea and vomiting 111, 127, 395–396 pain control 205, 391, 395–396 sedation 395, 428 Palliative care 91, 219, 389–401, 429 Palliative performance scale (PPS) 390, 401 Palliative prognostic index (PPI) 400 Palliative prognostic score (PaP) 400 Palmer xanthoma 61–62 Palpable purpura 233, 280, 288–289, 291, 373 Palpitations atrial fibrillation 39–41, 49, 52, 108, 344 pheochromocytoma 39, 348–349 P-ANCA 13, 69, 71–72, 121, 289, 291, 293, 398 Pancoast tumor 14 Pancolitis .121–122 Pancreatic cancer 128, 138–139, 205, 220–221 Pancytopenia .147, 153, 167, 169, 181, 187, 189, 227, 266, 405 multiple myeloma .178, 181, 227 Papilledema 57, 297, 306, 314 Pappenheimer bodies 163 Papulosquamous lesions .362 Paranasal sinus lymphoma 177 Parapneumonic effusion 6, 11 Parasomnia 17 Parkinson’s disease 102, 107, 315, 320–322, 328, 379, 385 Paroxysmal hemicrania 314 Paroxysmal nocturnal hemoglobinuria (PNH) 9, 146, 153, 156–157, 167 Parvovirus B19 147, 281, 288, 291, 364–365 Pelvic inflammatory disease 115, 221, 246 Pemphigus vulgaris .365–366 Penciclovir 265 Penicillin allergy 114, 257, 373 Penicillins 15, 32, 51, 54, 68, 114, 123, 146, 148–149, 233–234, 240, 243, 246–248, 253–254, 257–258, 270, 288, 365, 372–373, 380, 413, 426 Peptic ulcer disease (PUD) 25–26, 111, 113, 115, 118–120, 125, 220, 280, 353 Percutaneous coronary intervention (PCI) 26, 29, 31, 144, 423–424 Performance status 175, 177, 186–188, 194, 196, 198, 200, 208, 216, 237, 298, 390, 397, 400 Pericardial effusion 3, 8, 32–33, 146, 168, 186, 188, 278, 343, 394 Index 454 Pericarditis 6, 25–28, 30–33, 40, 43–44, 51, 53, 64, 68, 134, 136–137, 164, 181, 266, 278–279, 281, 303, 422 Peri-operative assessment 422–425 Perioral dermatitis .363–364 Peripartum cardiomyopathy 411 Peripheral blood smear 143, 163, 168 Peripheral nerves 297, 303, 325–327, 329–332 Peripheral neuropathy 54, 73, 105, 132, 145–146, 178, 215, 227, 235, 252, 279–280, 288–289, 291, 319, 323, 327–332, 338, 367, 384, 405, 420–421 Peripheral vascular disease 54–56, 59, 247, 337–338, 367 Peritoneal carcinomatosis 220, 398 Peritonitis 86, 115–117, 135–137, 221, 238, 246, 258 Peroneal nerve 323, 326, 331, 347 Pheochromocytoma 34, 39, 57, 60, 143, 201, 208, 225, 233, 281, 337, 348–349 Photophobia 42, 283, 314, 316 Photosensitivity 43, 226–227, 273, 279–280, 292, 364, 371–372 Pigmented lesions .368 Pink puffer Pitting edema 35, 55, 158, 283 Pituitary tumors 346, 349, 351–352 Pityriasis rosea .362 Plasma cell dyscrasias 178 Platelet activation pathway 154 Platinating agents .226 Pleural based disease 21 Pleural effusion 3, 7–12, 16, 18, 21, 25–26, 31, 33, 36, 40, 64, 86, 100, 134, 186–188, 195, 215, 220, 241, 250, 278–279, 281, 343, 394–395, 422 Plummer-Vinson syndrome 144, 195 Pneumocystis jirovecii pneumonia (PJP) 16, 20, 92–93, 227, 255, 259–262, 413 Pneumonia 3, 5–8, 10–12, 15–16, 19–20, 25–26, 33, 36, 38, 42, 47, 52–53, 79, 89, 92–93, 97, 100, 105, 108, 111, 113–115, 125, 135, 139, 146–149, 187, 236, 238, 241–243, 252–253, 257–260, 262–264, 266–267, 269, 279, 300, 310, 365, 374, 380–382, 394, 406, 410, 418, 425–426 recurrent Pneumonia severity of illness score (PSI) 6–7 Podagra .275 POEMS syndrome 178, 180 Polyarteritis nodosa (PAN) 68–69, 130–131, 233, 288, 291, 308 Polyarthritis fever 51, 122, 277, 283, 365, 422 rheumatoid arthritis 277, 279 seronegative spondyloar thropathies 283 systemic lupus erythematosus 279 Polycystic kidney disease 57, 73–76, 143, 207, 244 Polycystic ovarian syndrome (PCOS) 356–358, 364, 413 Polycythemia rubra vera (PRV) 143, 150, 156, 164–167 Polymyalgia rheumatica 273, 276–277, 282, 289–290, 292 Polymyositis 89, 101, 204, 273, 277, 279–282, 292–293, 332–333, 397 Polyneuropathy 42, 89, 180, 291, 327, 333, 337 Polypharmacy 377, 385 Polyuria diabetes insipidus 81, 347 diabetes mellitus 338 hypercalcemia .81, 178, 229, 347, 353 Porphyria .79, 115, 132, 309, 357, 365, 371–372, 420–421 Porphyria cutanea tarda 365, 372, 421 Portal hypertension 12, 14, 60, 133–135, 137, 164, 206, 278 Portal vein thrombosis 136 Portopulmonary hypertension 134 Poser criteria 308 Poser criteria for multiple sclerosis 308 Positive predictive value .417 Posterior infarction 30 Posterior pituitary deficiency .347 Post nasal drip 1, 12 Postpartum thyroiditis 344, 414 Post-test probability 417 Post transfusion purpura (PTP) 162 Post transplant lymphoproliferative disorders (PTLD) 174, 177 Postural proteinuria 75 Power of attorney 378, 390 Precordial examination 44 Preeclampsia 152, 409–410, 412, 414–415 Pregnancy 8–10, 19, 30, 34, 39, 42, 45, 51, 58, 60, 70, 102, 105, 111, 115, 128, 138, 151–152, 156–159, 187, 192, 218, 221, 244–246, 251–252, 261, 270–271, 280, 292, 311, 328, 337, 345–346, 356–357, 366–367, 409–415 Pre-operative workup 196 Pre-test probability 8, 417 Priapism .147 Primary biliary cirrhosis (PBC) 128, 132–133, 138, 148, 281, 343, 354, 361 Primary CNS lymphoma 174, 176 Primary sclerosing cholangitis (PSC) 121, 128, 132, 138–140, 223, 283 Primitive reflexes 304, 378–379 Proctitis 121–122 Progesterone challenge test 357 Prognostication 211, 400–401 Prolactinoma 346–347, 356–357 Prolonged QT interval 352 Prolymphocytic leukemia 170 Prophylaxis asplenic patients 147–148 hepatitis B 239, 261, 269 HIV .259, 261, 269–270 neisseria meningitides 152, 269 traveler 239–240, 270 Proprioception changes 246, 306, 308, 315, 320, 382, 405 Prostate cancer 210–211, 220, 222, 224, 228, 383, 400 Prostate specific antigen (PSA) 158, 210–212, 219–220, 222, 353, 398 Prosthetic joint infections 250 Protease inhibitor (PI) 5, 252, 261, 269, 337 Proteinuria 57–59, 70–76, 179, 187, 208, 227, 240, 279–280, 337, 340, 409, 420–421 Pruritus 73, 132, 138–139, 143, 165, 172, 174, 203–204, 235, 239, 361, 363, 392, 411–412 Pseudo-exacerbation 308 multiple sclerosis 308 Pseudogout 273–277, 282 Pseudomembranous colitis 123 Pseudomonas 5–7, 12, 97, 234, 236, 241, 247, 253, 258, 273 Pseudo-renal failure 69 Pseudotumor cerebri 243, 313–314, 403 Psoriasis vulgaris 362–363 Psoriatic arthritis (PA) 11, 19, 20, 32, 98, 273, 275–277, 282–284, 304, 363, 409 Ptosis 14, 189, 304–306, 318–319 Pulmonary embolism (PE) 1, 3–4, 8–12, 15, 19, 21, 23, 25–26, 28, 33, 37–38, 40, 42–44, 53, 64, 92–93, 97, 143, 156, 157–161, 279, 300, 312, 394, 410, 425–426 Pulmonary eosinophilia .149 Pulmonary function test 2, 5, 21–23, 424 Pulmonary hypertension 3–4, 8, 12, 14–17, 21, 23, 25, 33, 35, 37, 43–44, 49–52, 92, 98, 134, 147, 158, 279, 281, 312, 394, 403, 411 Pulmonary regurgitation 45–47, 49, 201 Pulse 15, 25, 34, 36, 38, 40, 43–44, 46–47, 49–50, 55–56, 72, 90–91, 104, 118–120, 180, 289–290, 312, 368 irregularly irregular 43 Pulseless disease 289 Pulse pressure 36, 43, 46–47, 49 wide 43, 49 Pulsus alternans 43 Pulsus paradoxus 1, 3, 32–33, 43 Pyelonephritis 68–69, 111, 115, 178, 207, 244–245, 269, 284, 412 Pyoderma gangrenosum 121, 276–277, 282–283, 367–368 Pyridoxine deficiency 126 Q Q fever 52, 233, 235, 238–239 QT prolongation 42, 168, 302, 392 Index R Radial nerve 326, 330 Radiculopathy 178, 284–285, 323, 325–328, 337 Rai staging 170 Ramsay Hunt syndrome 307–308 Ranson’s criteria 130 Rapidly progressive glomerulonephritis (RPGN) 68, 70, 72, 75, 291, 421 Raynaud’s phenomenon 59, 180, 279–281, 415, 421 Reactivation tuberculosis 236, 250–251, 259 Reactive hypoglycemia 342 Rectal cancer 120–121, 198–200, 204, 220–221, 223, 225, 228, 261 Reed-Sternberg cell 167, 171 Refeeding syndrome 83, 406–407 Reflex syncope 312 Rehabilitation criteria 429 Relative risk reduction (RRR) 193, 200, 223, 303, 418 Relative risk (RR) 1, 6–7, 42, 62–63, 90, 94–95, 102, 108, 240, 259, 270, 303, 418 Renal artery stenosis (RAS) 37–38, 56–58, 60, 67, 78, 81, 199, 348–349 Renal cell carcinoma 20, 159, 207–208, 225, 228 Renal colic 115 Renal crisis 281, 343, 350 Renal cysts 225 Renal failure glomerulopathies 70, 72 hypercalcemia 38, 67, 69, 104, 139, 178, 215, 229, 353 Renal osteodystrophy 73–74 Renal replacement 68–70, 73–74, 85, 89, 100, 107, 129, 133, 135 dialysis 68–70, 74 Renal tubular acidosis 78 Renal ultrasound 56, 91, 205, 207 Renin 58, 78–79, 82, 134, 207, 348–349 Research ethics 428 Resource allocation .428 Respiratory acidosis 18, 77 Respiratory alkalosis 19, 77, 83, 103 Respiratory failure hypercarbic 93 hypoxemic 93 Restless leg syndrome 17–18, 73, 320 Restrictive cardiomyopathy 33, 43–44 Restrictive lung disease 17, 147, 283 Resuscitation CPR 90–91, 399 intubation .90–91, 99–100, 103–104, 108, 269, 399 shock 99–100, 103, 108, 120, 365 Retinopathy 57, 126, 147, 180, 185, 337–338, 340, 348, 414, 427 455 Revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar) 106 Rhabdomyolysis 69, 82–83, 101, 108, 263, 310–311, 332, 352, 382 Rheumatic fever 34, 47, 50–51, 234, 253, 276–277, 282 Rheumatoid arthritis (RA) 5, 11, 13, 15–18, 25, 31–32, 47, 71, 78, 98, 164, 168, 173–174, 233, 273, 276–280, 282, 286, 288, 292, 318, 323, 328, 332, 355, 368, 397, 420 Rheumatoid factor (RF) 15–16, 53, 68–69, 233, 235, 274, 276–279, 282–283, 289, 292, 319, 322, 398, 421 Rhythm 9, 17, 39–42, 49, 51, 62–64, 383, 394, 411 irregularly irregular 40, 43 Rickettsial infections 235, 240–241 North America 235 outside of North America 240 Riedel’s lobe 133 Right heart catheterization 15, 134 Right ventricular infarction 29–30 Rigidity 102, 104, 108, 116–117, 177, 233, 235, 237, 239, 300, 320–321, 378 Rimantadine 264–265 Rinne test 317 Risk reduction cardiac .30, 42, 380 ECG exercise stress test 27 glycemic control 404 hyperlipidemia 61, 303, 404 hypertension 30, 42, 56, 303, 380, 404 post-MI 30, 303 Rocky Mountain spotted fever 234–235, 239, 364 Rooting reflex 304 Rosacea 363–364, 371 Roth spots 53 Rouleaux 163 S Sacroiliitis 241, 282–283 St Gallen guideline .193 Salicylate overdose 103 Salmonella 120, 122–124, 234, 239, 241, 248, 253, 258–260, 283 Sarcoidosis 10, 15–16, 20–21, 34, 40, 68, 81, 112, 128, 164–165, 173, 228, 234, 266, 273, 275–277, 279, 282, 292, 307–308, 347, 349, 353, 356, 361, 374, 420 Saturday night palsy 330 Scabies .361–362 Scarlet fever 34, 51, 149, 234, 253, 364–365 Schistosomiasis 128, 132, 136, 209, 238–239, 420 Sciatica 282, 284–285 Sciatic nerve 291, 327, 331 Scleroderma 15–16, 34, 68, 111–113, 115, 124, 126, 182, 187, 212, 273, 277–282, 292, 332, 396, 420 Seborrheic dermatitis 361–363 Seborrheic keratosis 197, 368, 370 Secretion of inappropriate anti-diuretic hormone (SIADH) 79–80, 185 Seizures alcohol withdrawal 105–107, 311, 426 first time 311 in pregnancy 105, 280, 409–410, 414–415, 419 Selective estrogen receptor modulators (SERMs) 192, 277, 355 Seminoma 212, 214–215, 219, 261 Sensitivity 3, 34, 56, 60–61, 96, 124, 157–158, 164–165, 222–224, 241–243, 245, 249, 251–253, 264, 312, 333, 340–341, 417 Sensorineural hearing loss 316–317 Sensory ataxia 315, 319, 323 Sensory Cortex 300 Sentinel lymph node biopsy 192, 369–370 Sepsis 3, 6, 8, 19, 28, 30, 33, 37–38, 43, 67, 69, 84, 90, 93, 98–101, 104, 107–108, 125, 128–129, 136–140, 147–148, 152–153, 156, 162, 164, 178, 182, 199, 235–236, 238, 244, 247, 256–259, 269, 273–275, 277, 282, 286, 289, 327, 333, 337, 342, 344, 349–350, 366, 381, 406–407, 426, 394 Septic arthritis 53, 250, 258–259, 273–274 Septic transfusion 162 Sequestration crisis 147 Serology hepatitis B 130, 133, 412 rheumatology 273–295 Seronegative Spondyloarthropathies 72, 282–283 Serotonin 101–102, 151, 154, 201–202, 241, 314, 394, 398 Serotonin syndrome 101–102, 241 Serum-ascites albumin gradient (SAAG) 137 Shigella 120, 122–124, 239, 253, 260, 283, 358 Shilling’s test .405 Shock acute coronary syndrome 27–30 sepsis 28, 30, 43, 84, 98–101, 108, 128, 152, 247 tamponade 98 Shoulder examination 17, 27, 108, 285, 294–295, 305 Shoulder instability 294–295 Sick euthyroid syndrome 343 Sickle cell anemia 78, 122, 145 Sickle cell crisis 10, 72, 78, 122, 138, 145, 147, 156, 164, 248, 286 Index 456 Siderocytes 163 Simple kidney cysts 76 Sister Mary Joseph nodule 197 Situational syncope .312 Sixth nerve palsy 314 Sjogren’s syndrome 5, 78, 174, 277–279, 292–293, 361 Sleep disorders 15, 17–18, 287, 309 Sliding scale 342, 414, 425 Small bowel obstruction 116 Small cell lung cancer 186–187, 318–319, 350 Small lymphocytic lymphoma (SLL) 166–167, 170–171, 173–174 Smoke inhalation .108–109 Smoking cessation 2, 4–5, 31, 38, 74, 114, 143, 187, 340, 418–419, 424 Smoldering multiple myeloma (SMM) 179–180 Snout reflex 304 Soft tissue infections 247–248 Solitary plasmacytoma of bone 180 Solitary pulmonary nodule 13, 21, 42, 187 lung cancer 13, 21, 187 Solitary thyroid nodule 345 Sorafenib 206, 208, 227, 231 Spastic gait 315, 322 Spasticity 303, 308–309, 380, 405 Specificity 60, 158, 190, 208, 222–224, 242, 245, 249, 251, 264, 290, 333, 417 Spherocytes 163 Spinal cord compression 97, 126, 172, 175, 228, 284–285, 323, 392, 396–397 malignant 228 Spinal stenosis 54, 56, 285, 384 Spirituality 390–391 Splenomegaly 32, 52–53, 105, 133, 143, 145–146, 150–151, 164–167, 169–172, 174, 233, 235, 237, 239–241, 266, 277–278, 344, 397, 421 Spondylolisthesis 284–285 Spontaneous bacterial peritonitis (SBP) 7, 10, 26, 28, 35, 37, 46, 55, 58, 61, 91, 100, 118, 120, 135, 137, 312–313, 409 Spur cells .163 Squamous cell carcinoma 14, 20, 144, 149, 187, 196, 203, 209–210, 219, 224, 261, 362, 367, 370 Staghorn calculi 84 Staphylococcal scalded skin syndrome (SSSS) 234, 364–365 Stasis dermatitis 361 Status epilepticus 310 ST elevation 26–28, 30, 32–33, 36, 62, 64, 102 Stem cell transplant 153, 157, 163, 166, 168, 171, 173–178, 180–182, 238, 266 Steroids complications 425 myopathy 28 physiologic dose 333 replacement .5, 73, 89, 100, 286–287, 351, 425 stress dose 350–351, 410, 425 Stevens-Johnson syndrome (SJS) 261, 365–366 Stigmata of chronic liver disease 130–131, 133 Still’s disease 163, 164, 233, 276–277, 282 Stomach cancer 220 Stomatocytes .163 Storage pool disease 154–155 Streptogramins 255 Stress dose 350–351, 410, 425 Stress incontinence 384 Stroke 9, 18, 26, 28, 30–31, 38, 40, 42–43, 46, 48–49, 52–53, 55, 57, 63, 92, 98, 107–108, 112–113, 126, 135, 143, 147, 156–157, 165, 213, 242, 279–280, 288–289, 299–307, 309–310, 312–313, 315–316, 320, 322, 332–334 risk factors 42 Struvite stones 84 Subacute combined degeneration 145–146, 320, 405 Subacute cutaneous lupus 371 Subarachnoid hemorrhage .79, 81, 243, 333, 380 Subclinical hypothyroidism 343 Submersion injury .108 Subscapular nerve .330 Suckling reflex 300, 304 Sudden death 27, 38–39, 50, 52, 63, 168, 312, 411 hypertrophic obstructive cardiomyopathy (HOCM) 38, 45, 48 Sulfa antibiotic 255, 260 Sunitinib 203, 208, 227, 231 Superior vena cava syndrome 14, 185, 187, 228 Supratherapeutic INR 161–162 Sural nerve 31, 159 Surface lung markings Swan-Ganz catheterization 93 Sympathetic response 348 Sympathomimetic overdose syndromes 102–104 Syncope aortic stenosis 8, 25, 43, 46, 48, 312, 422 hypertrophic obstructive cardiomyopathy 38 Syndrome X 62 Syphilis 49, 71, 112, 173, 233–234, 236, 238, 245–246, 254, 259, 273, 286, 317, 362, 367, 372, 413 Systemic anaplastic large cell lymphoma 178 Systemic inflammatory response syndrome (SIRS) 99–100 Systemic lupus erythematosus (SLE) 5, 11, 15–17, 20, 32, 34, 49, 52–53, 68–69, 71–72, 93, 146, 148, 151–152, 156–157, 164, 173–174, 187, 212, 273, 276–277, 279–282, 286, 288–289, 292–293, 308, 318, 332, 361, 371–372, 374, 397, 415, 420 Systolic dysfunction 34, 36–37, 59 Systolic murmurs 45–47, 51–52 T Tabes dorsalis 246, 319–320, 323 Tachycardia 4, 8–9, 15, 28, 32–33, 36, 39–41, 43, 48, 59, 63, 65, 82, 98–99, 102, 104, 106, 108–109, 118, 120, 122, 233, 235, 237, 328, 342, 344, 348–349, 391, 411, 421–422 Takayasu’s aortitis 25, 54, 68, 233, 288–289 Tamoxifen 61, 130, 191–193, 217, 225, 227, 353 Tamponade 3, 8, 25, 31–33, 43–44, 97–98, 119, 188, 312, 394 Target cells 144, 163 Tarsal tunnel syndrome .331 T-cell lymphoma 174, 177, 227 Tear drop cells .163 Telangiectasia 14, 118, 167, 180, 204, 281, 364, 370–371 Temporal arteritis 54, 288–290, 292, 313–314, 367 Tender points 287 Tendon xanthoma 61–62 Tensilon test 307, 319 Tension headaches 314 Testicular cancer 212–214, 261 Testicular lymphoma 177 Tetracyclines 128, 253, 255, 372–373, 413 Thalassemia index .144 Thiamine deficiency syndromes 107 Thin basement disease 76 Third nerve palsy 297, 301, 318–319 Thoracentesis 11–12, 100, 134, 186, 188, 220, 228, 251, 395 Thoracic outlet obstruction 14 Thromboangiitis obliterans 54, 288 Thrombocytopenia post-operative 426 in pregnancy 10, 105, 151–152, 157, 159, 280, 292, 415 Thrombocytosis 82, 150, 165–166, 188, 207, 372, 406 Thrombolytics 9, 11, 299, 302 ACS 161 stroke 9, 299 Thrombophilia 9, 156, 158, 410 Thrombotic stroke .299 Index Thrombotic thrombocytopenic purpura (TTP) 68–69, 138, 145, 151–152, 156, 163, 242, 415 Thymoma 21, 79, 189, 228, 318–319 Thyroid cancer 159, 345–346, 349 Thyroiditis 42, 71, 343–345, 414 Thyroid storm 241, 344–345, 414, 426 Tilt table testing 312–313 TIMI score 28 Tinea infections 363 Tinea versicolour 363 Todd’s paralysis 299, 310 Tonic clonic seizure .409 Tonsillar herniation 299 Topoisomerase inhibitors 226 TORCHES infections .413 Total parenteral nutrition (TPN) .77–78, 117, 121, 128–130, 138, 229, 406–407 Toxic epidermal necrolysis (TEN) .365–366 Toxic megacolon C difficile 122–123 inflammatory bowel disease 122 Toxic shock syndrome 234, 253, 352, 364–365 Toxoplasma 236, 259, 261, 413 Tracheostomy tubes 94–95 Transaminitis .280 Transesophageal echocardiogram 53 Transfusion infection risks 135 Transfusion reactions 93, 162–163 Transfusion related acute lung injury (TRALI) 162–163 Transient arterial occlusion 45–46 Transient ischemic attack (TIA) 10, 40, 42, 52, 55, 57, 289, 300, 302–303, 309, 316, 333, 337, 340, 423, 426 Transitional cell carcinoma 149, 207, 210 Transtentorial herniation .298 Transtubular potassium gradient (TTKG) 82 Trastuzumab 191–195, 198, 227, 230 Traveler’s fever 239 Treatment response criteria lymphoma 176 solid tumors 143, 149 Tremor .42, 59, 104, 106, 135, 308, 319–322, 344, 348, 378, 391 Trendelenburg gait 315, 323 Treponema pallidum 234, 245–246, 289, 398 Triad asthma Tricuspid regurgitation 15, 44–46, 50, 52, 134, 136–137, 164, 201 Tricuspid stenosis 43–46, 53, 201, 312 Trigeminal nerve lesions .305 Troponin 1, 4, 6, 9, 26–28, 30, 33, 37, 92–93, 98, 100–101, 108, 135, 302, 310, 312, 339, 381, 424 Trousseau’s sign 352 Trusteeship 378 Truth telling 399–400, 427 Tuberculin skin test 234, 250–251, 261 457 Tuberculosis HIV co-infection 260 in pregnancy 413 Tuberous xanthoma 61 Tumor lysis syndrome 176, 229 Tumor markers 190, 213–214, 220–222 Turner’s syndrome .356 Tylenol overdose 103, 129 Typhlitis .238 Typhoid fever 34, 173, 238–239, 241 Typhus 234–235, 238, 240, 364 Tyrosine kinase inhibitors 192, 203, 227 U Ulcerative colitis 5, 121–122, 124, 138–139, 198, 223, 283, 288, 368, 374 Ulcers 10, 25–26, 30, 55, 100, 108, 111, 113–115, 118–121, 125, 132, 139, 147, 149, 220, 233, 235, 237, 239, 245, 248–249, 258, 266, 273, 279–280, 283, 289, 291, 338, 350, 353, 361, 366–368, 371, 392, 420 Ulnar nerve 326–327, 330 Uncal herniation 299 Unconscious patient 95 Undifferentiated connective tissue disease 279 Undulant fever 241 Upper GI bleed 12, 118–120, 134, 195, 197 Upper motor neuron 303, 305, 307–308, 322, 333 Uremia 32, 68, 77, 104, 111, 115, 126, 163, 280, 309, 327, 361, 392, 395–396 Ureteral calculus 84 Urethritis 244–245, 282–284, 384 Urge incontinence 210, 380, 384 Uric acid stones .84, 178 Urinalysis hematuria 208, 244 proteinuria 208 Urinary incontinence 12, 212, 298, 377, 383–384 Urinary tract infection 75, 244–246, 258, 269, 412 recurrent 76, 245 Urine chloride 79 Urine electrolytes 68, 73, 85, 338–339, 366, 381–382 Urine net charge (UNC) 78 Urticaria162–163, 172, 257, 288, 361–363, 371–373 Usual interstitial pneumonia 15–16 V Vaccination 2, 4, 7, 130–131, 148, 219, 239, 251–252, 261–262, 264, 269–270 Vaginitis 245, 265, 384 Valacyclovir 231, 265, 308, 366 Valganciclovir 265 Valsalva maneuver 14, 35, 45, 90, 314, 411 Valvular cardiomyopathy 34 Valvular diseases aortic regurgitation 3, 8, 53 aortic sclerosis 47 aortic stenosis 3, 8, 34, 47, 422 mitral regurgitation 27, 53 mitral stenosis 3, 411, 422 mitral valve prolapse 53 in pregnancy 411 rheumatic fever 47 tricuspid regurgitation 53, 201 Vancomycin 8, 54, 86, 97, 100, 122–123, 151, 237, 243, 247, 249–250, 253, 255–258, 274, 317, 365, 372, 413 Vancomycin 8, 54, 86, 97, 100, 122–123, 151, 237, 243, 247, 249–250, 253, 255–258, 274, 317, 365, 372, 413 dosing 123, 256 Vancomycin resistant enterococci (VRE) 253, 255, 269 Varicella zoster virus (VZV) 128, 146, 182, 236, 241–242, 265, 307, 365–366 Vascular dementia 378, 380 Vasoocclusive pain crisis 147 Vasopressors 98–100, 108, 365, 373 Vasovagal syncope 310, 312 Venous filling time 55 Venous insufficiency 55, 158, 247 Venous thromboembolism 8, 89, 156, 410 in pregnancy 410 Venous ulcers 367 Ventilation indications 94–95 modes 94–96 settings 96 weaning 96 Verruca vulgaris 371 Vertebral osteomyelitis 249–250 Vertigo 103, 290, 305–306, 309, 315–316, 319, 382 Vesicles 210, 283, 308, 361, 363, 365–366 Vestibular ataxia 319 Vestibular neuronitis 315–316 Vincristine 79, 150, 169–170, 173, 175–176, 180, 226, 230, 298, 327, 371–372 Vinorelbine 188, 192, 194, 216, 226, 230 Viral load 132, 259, 261–262, 413 Virchow’s node 195, 197 Virchow’s triad Virilization 348, 357–358 Visual field defects 305 Vitamin B12 deficiency 125, 145–147, 198, 308, 320, 332, 379, 405–406, 415 Vitamin deficiency 126, 327 Von Hippel–Lindau syndrome 207, 225 Von Willebrand’s disease 154–155, 426 Voriconazole 266–269 V/Q mismatch 92–93, 134 Index 458 W Waldenstrom’s macroglobulemia 178 Wallenberg syndrome 306 Warfarin 9–10, 13, 30, 42, 48, 52, 152–157, 159–162, 286, 385–386, 410–411, 425–426 Warts 203, 370–371 Weakness guillain-Barre syndrome 89 ICU 89 inflammatory myopathies 332 lambert-Eaton syndrome 318–319 multiple sclerosis 307–308 myasthenia gravis .189, 318, 332 stroke/TIA 300 Weber test 317 Wegener’s granulomatosis (WG) 12–13, 20, 34, 93, 233, 276–277, 282, 288–289, 291, 293 Weight gain .17, 35, 85, 136, 168, 190, 192–193, 212, 215, 340, 342–343, 348, 350, 357, 398, 419 Weight loss 10, 13, 17–18, 53, 58, 62, 108, 112, 114–115, 117–118, 124–125, 130, 138, 143–146, 149, 151, 165, 170, 172, 175, 178, 185, 187–190, 195–197, 199, 203–204, 206–207, 209–210, 213, 215, 217–218, 229, 233–234, 237, 239, 250, 278, 280–281, 284, 290–291, 314, 320, 323, 338, 340, 344, 349, 355–358, 384, 390, 397–398, 403–405, 407, 411, 420–422, 444 Well’s criteria 9, 158 pulmonary embolism Well’s criteria for DVT 158 Wernicke’s aphasia 304 Wernicke’s encephalopathy .107 West Nile virus encephalitis 244 Wheezing asthma exacerbation 1, 424 COPD exacerbation 3, 424 Whipple’s disease 233, 276–277, 282, 422 Whipple’s procedure 205 Whipple’s triad 342 Wilson’s disease 78, 128–129, 133–134, 286, 320 Wolff-Parkinson-White syndrome 43, 65 Wrist examination 294, 318 X Xanthelasma 61, 138 Y Yersinia 120, 122, 124, 239, 253, 260, 283 Z Zanamivir 264–265 Selected Internal MedicineTopics Integrated Symptom-Based and Issue-Based Approach from ApproachtoInternalMedicine, 3rd Edition David Hui, MD, M.Sc., FRCPC — Signs and Symptoms Abdominal Bruits 60 Abdominal Mass 116 Abdominal Pain 115 Amenorrhea 358 Anasarca 137 Anorexia 399 Ascites 136 Ataxia 321 Back Pain 286 Bloody Diarrhea 121 Bradycardia 39, 63, 431 Chest Pain 26 Chronic Cough .12 Claudication 54 Clubbing 376 Cognitive Impairment 380 Coma 383 Confusion 383 Constipation 126 Diarrhea 124 Diplopia 308 Dizziness 317 Dysarthria 305 Dyspepsia 113 Dysphagia 112 Dyspnea 3, 396 Facial Droop 308 Falls 384 Fever and Headaches 241 Fever in the HIV patient 260 Fever and Rash 236 Fever in the Returned Traveler 238 Fever of Unknown Origin 235 Gait Difficulties 324 Headaches 315 Hearing Impairment 318 Heart murmurs 45 Hematemesis 118 Hematochezia 120 Hematuria 75 Hemoptysis 12 Hirsutism 359 Hypertension 57 Jaundice 138 Joint Pain Monoarthritis 275 Joint Pain Oligoarthritis 284 Joint Pain Polyarthritis 279 Lymphadenopathy 172 Melena 118 Movement Disorders 322 Nausea and Vomiting 111, 397 Obesity 405 Pain 289, 393 Palpable Purpura 290 Palpitations 39 Photosensitivity 373 Pigmented Lesion 370 Polyuria 349 Pruritus 363 Ptosis 319 Rash 236, 281, 373 374, 447 Seizures 311 Syncope 313 Tachycardia 40, 62, 433 Tremors 322 Ulcer 368 Unilateral Leg Swelling 158 Urinary Incontinence 385 Vertigo 317 Vesicles 367 Weakness 333 Weight Loss 399 Wheezing O Approach to Physical Examination Back Exam 282 Cardiac Exam 43 Murmurs 46 Joint Exam 285 Neurologic Exam Brachial Plexus 327 Cranial Nerves 305 Gait 324 Nerve Roots 325 327 Peripheral Nerves 305, 327 & JAMA Rational Clinical Examination Series Abdominal Aortic Aneurysm 56 Abdominal Bruits 60 Airflow Obstruction Alcohol Problem 105 Aortic Dissection 25 Aortic Regurgitation 47 Appendicitis 116 Arrhythmia 40 Ascites 136 Back Pain 286 Breast Cancer 190 Carotid Bruit 303 Carpal Tunnel Syndrome 330 Cholecystitis 117 Clubbing 376 Community Acquired Pneumonia Congestive Heart Failure 33 Death Post Cardiac Arrest 92 Deep Vein Thrombosis 158 Dementia 381 Dyspepsia 113 Elevated JVP 36 Falls 385 Goiter 346 Hearing Impairment 319 Hepatomegaly 133 Hypovolemic 118 Influenza 265 Irritable Bowel Syndrome 127 Knee Injury 297 Lumber Puncture 245 Malnourishment 125 Melanoma 370 Meningitis 244 Migraine 315 Myasthenia Gravis 320 Myocardial Infarction 27 Osteoporosis 356 Osteomyelitis 250 Parkinson’s Disease 323 Penicillin Allergy 259 Peripheral Arterial Disease 55 Pleural Effusion 10 Pulmonary Embolism Septic Arthritis 275 Shoulder Injury 296 Splenomegaly 164 Spontaneous Bacterial Peritonitis 137 Stroke 303 Systolic Murmur 46 Tamponade 32 Temporal Arteritis 292 Urinary Tract Infection 246 Urinary Incontinence 386 Vertigo 317 Ventilator Associated Pneumonia 97 i Approach to Investigations Abdominal X ray 117 Arterial Blood Gas 77 Ascitic Fluid Analysis 135 Chest X ray 19 CSF Analysis 245 CT Head 335 Electrocardiogram 62 Gram stain, Culture and Sensitivity 254 Peripheral Smear 163 Pleural Fluid Analysis 11 Pulmonary Function Test 21 Rheumatology Serologies 292 Syphilis Testing 247 Tumor Markers 220 @ Therapeutics Tables Antibiotics 255 Anticoagulants 160 Antifungal Agents 270 Antineoplastic Agents 225 Antiviral Agents 267 Opioids 393 ⁄ Laboratory Abnormalities Anemia macrocytic 146 Anemia microcytic 144 Anemia normocytic 145 Creatine Kinase Elevation 101 Creatinine Elevation 67, 73 Eosinophilia 148 Hyperbilirubinemia 138 Hypercalcemia 355 Hypercapnia 17 Hyperglycemia 339 Hyperkalemia 82 Hypernatremia 81 Hyperprolactinemia 348 Hypocalcemia 354 Hypoglycemia 344 Hypokalemia 81 Hypomagnesemia 83 Hyponatremia 79 Hypophosphatemia 83 Hypoxemia 92 INR Elevation 154 Iron Indices Abnormalities 144 Lactate Elevation 100 Liver Enzyme Elevation 128 Lymphocytosis 170 Metabolic Acidosis 77 Metabolic Alkalosis 78 Monoclonal Gammopathy 179 Neutropenia 148 Polycythemia 143 Proteinuria .74 PTT Elevation 152 Thrombocytopenia 150 Thrombocytosis 150 Troponin Elevation 28 TSH Abnormalities 345 348 - Commonly Used Formulas A a Gradient 93 Anion Gap 77 Body Mass Index 405 Cockcroft Gault Formula .67 Hypernatremia Correction .81 Hyponatremia Correction 79 Ideal Body Mass 408 Osmolar Gap 104 Post Test Probability 419 Spot Urine:Cr Ratio 67 Serum Ascites Albumin Gradient 137 hMedical Emergencies Addisonian Crisis 351 Alcohol Withdrawal 106 Altered Level of Consc ousness 380 Anaphylaxis 375 ARDS 94 Arrhythmia 39, 431 Chest Pain aortic dissection 25 Chest Pain myocardial infarction .26 Comatose State .92 Diabetic Ketoacidosis 340 Dyspnea Status Asthmaticus Endocarditis .54 Febrile neutropenia 239 GI Bleed Lower 120 GI Bleed Upper 119 Hepatic Failure 129 Hyperkalemia 82 Hypertensive Emergency .58 Hypothermia 108 Meningitis 245 Myxedema Coma 345 Necrotizing Fasciitis 247 Overdose 104 Seizure Status Epilepticus 312 Sepsis 100 Severe Abdominal Pain 117 Shock .98 Smoke Inhalation 108 Spinal Cord Compression 286 Stroke 304 Tamponade .32 Thyroid Storm 347 Toxic Megacolon 122 459 ... Approach to Internal Medicine builds upon previous efforts to create a practical, evidence based, and concise educational resource for everyday clinical use and examination preparation Approach to. .. Second edition, sixth printing, June 2009 Third edition, first printing, January 2011 Approach to Internal Medicine: A Resource Book for Clinical Practice Additional material to this book can be... General Internal Medicine University of Calgary, Calgary, AB, Canada Research Fellow, Division of General Internal Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA