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David Hui Alexander A Leung Raj Padwal Editors Approach to Internal Medicine A Resource Book for Clinical Practice Fourth Edition 123 Approach to Internal Medicine Approach to Internal Medicine A Resource Book for Clinical Practice Fourth Edition Edited by David Hui, MD, MSc Alexander A Leung, MD, MPH, FRCPC, MRCP(UK), FACP Raj Padwal, MD, MSc, FRCPC With Assistance from Christopher Ma, MD Editors David Hui, MD, MSc The University of Texas MD Anderson Cancer Center Houston, TX USA Raj Padwal, MD, MSc, FRCPC University of Alberta Edmonton, AB Canada Alexander A Leung, MD, MPH, FRCPC, MRCP(UK), FACP University of Calgary Calgary, AB, Canada Editors: David Hui, Alexander A Leung, Raj Padwal Assistant Editor: Christopher Ma 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 Fourth edition, first printing, September 2015 Approach to Internal Medicine: A Resource Book for Clinical Practice Additional material to this book can be downloaded from http://extras.springer.com ISBN 978-3-319-11820-8 ISBN 978-3-319-11821-5 DOI 10.1007/978-3-319-11821-5 (eBook) Library of Congress Control Number: 2015952117 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2016 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) To Ella, Rupert and Nancy David Hui To Miriam Alexander A Leung To Stephanie and Sarah Raj Padwal To Bryan, Sarah, Michael, and May Christopher Ma 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 contained within this manual Preface Practice is science touched with emotion Confessio Medici, Stephen Paget, 1909 In this fourth edition of Approach to Internal Medicine, we have substantially updated the content to provide practicing clinicians and trainees with a practical, evidence-based, and concise resource for everyday clinical use, bedside teaching and examination preparation Approach to Internal Medicine consists of over 250 internal medicine topics classified under 17 subspecialties 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 Unique to Approach to Internal Medicine, we have included multiple comparison tables aimed at highlighting the distinguishing features between various clinical entities, and numerous clinical pearls and mnemonics (marked by ★) In addition to International System (SI) units, this edition also provides US customary units [in square brackets] for quick reference For this new edition, we are very fortunate to have recruited a new assistant editor, Dr Christopher Ma, who brings with him a wealth of knowledge and the perspective of a chief medicine resident The JAMA Rationale Examination Series has now been updated with new data 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 also would like to thank the editorial and production teams at Springer for their expert guidance and support throughout this mammoth project Finally, we would like to thank all previous and current users of this manual for their support and feedback 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 appropriate clinical resources prior to applying information in this manual for direct patient care This is particularly important since patterns of practice and clinical evidence evolve constantly We welcome any constructive feedback to help make this manual a more accurate, practical, comprehensive, and userfriendly resource David Hui, MD, MSc The University of Texas MD Anderson Cancer Center Houston, TX, USA Alexander A. Leung, MD, MPH, FRCPC, MRCP(UK), FACP University of Calgary, Calgary, AB, Canada Raj Padwal, MD, MSc, FRCPC University of Alberta Edmonton, AB, Canada Christopher Ma, MD Department of Medicine, University of Alberta, Edmonton, AB, Canada 528 Insulin, 72, 93, 94, 112, 115, 116, 222, 294, 381–384, 386, 399, 407, 408, 450, 457, 474, 475, 486, 489, 491, 505 principles of use, 387–389 Insulin resistance syndrome, 72 Intensive care admission criteria, 99 general issues, 99–102 mechanical ventilation, 99 preventative strategies, 99 procedures, 100 prognosis, 101 sedation, 99 weakness, 99–100 International prognostic index follicular lymphoma, 195 Hodgkin’s lymphoma, 192 non-Hodgkin’s lymphoma, 195 Internuclear ophthalmoplegia (INO), 347, 348, 349 Interstitial lung disease, 4, 6, 14, 17, 18–20, 24, 25, 37, 102, 165, 250, 251, 318, 319 Intoxication, 43–44, 78, 101, 115–117, 120, 337, 432 Intracerebral hemorrhage, 104, 118, 164, 270 Intrahepatic cholestasis, 143 of pregnancy, 471, 472 Intubation, 2, 3, 5, 6, 15, 22, 88, 99, 101, 105, 106, 112, 115, 120, 121, 271, 304, 383, 423, 452, 465, 466 impending, Iodine uptake study, 392 Irinotecan, 205, 206, 217, 218, 220, 226, 247, 255, 257 Iron deficiency anemia, 139, 160, 161, 219 Iron index, 482 Irritable bowel syndrome (IBS), 125, 138, 141, 142–143, 266, 325, 448 Ischemia criteria, 30 Ischemic cardiomyopathy, 38, 104 Ischemic colitis, 128, 131, 134, 136, 137, 140 Ischemic stroke, 11, 33, 34, 164, 337, 338, 341, 342, 355 Isolations, 40, 165, 261, 276, 281, 299, 301, 304 Index Isometric exercises, 52 Itraconazole, 3, 264, 293, 300–302, 412, 438 J Janeway lesions, 61 Jaundice, 52, 59, 135, 143, 145–147, 149, 155–156, 157, 161, 162, 201, 203, 209, 222, 223, 225, 227, 229, 230, 268, 321, 391, 459, 471, 472 Joint aspirations, 310 Joint pain crystal arthropathy, 309, 324 osteoarthritis, 324 rheumatoid arthritis, 314 septic arthritis, 310 systemic lupus erythematosus, 316 Jones criteria, 58 Jugular venous pressure (JVP), 18, 33, 36, 37, 39, 41, 50, 57, 59, 75, 78, 81, 109, 466, 472 K Karnofsky performance status, 204, 229, 336, 440, 453 Keratoconjunctivitis sicca, 309, 315, 316 Keratoderma blennorrhagica, 321–322 Kernig sign, 269 Kidney mass, 129, 229 Killip class classification, 29, 31, 33 King’s College criteria, 115, 145 acetaminophen overdose, 115 Knee examination, 334 Korsakoff ’s amnesia, 119 Krukenberg tumor, 217 Kussmaul breathing, 119, 447 Kwashiorkor syndrome, 141 L Labral tear, 334 β-Lactamase resistance, 283 Lactic acidosis, 112–113 Lacunar stroke, 338 Lambert–Eaton syndrome (LES), 360, 361, 373 Latent tuberculosis, 280 Index Lee criteria, 486 Leg pain, 63 Leg swelling, 10, 12, 15, 176, 229 unilateral, 10, 176 Leptomeningeal meningitis, 196–197 Leptospirosis, 38, 193, 259, 265, 268 Leser–Trelat sign, 217, 421 Lesions acneiform, 412 exanthematous, 413–414 nodules, 422 papulosquamous, 410 pigmented, 418 pruritic, 409–411 ulcers, 417 vesicular/bullous, 422, 424 Letrozole, 212, 249 Leukemia acute lymphoblastic leukemia, 186, 188–189, 197 acute myelogenous leukemia, 185–188, 202 chronic lymphocytic leukemia, 186, 189–191, 193, 199, 201 chronic myelogenous leukemia, 111, 166, 184–185, 252 definition, 185 Leukemic cutis, 186 Leukocyte alkaline phosphatase, 159, 184 Leukocytoclastic vasculitis, 327 Lewy body dementia, 363, 373, 429 Lhermitte’s sign, 253, 337, 349, 366, 459 LHRH agonists, 211, 233, 234, 247, 403 Libman–Sacks endocarditis, 60, 317 Lichen planus, 148, 410, 411, 412 Li Fraumeni syndrome, 209, 225, 244, 335 Ligament tear, 309, 334 Light chain deposition disease, 79, 80, 198, 199, 483 Light’s criteria, 13 Likelihood ratio, 441, 479 Linitis plastica, 217 Lipase, 28, 30, 126, 129, 140, 144, 153, 157, 216, 218, 220, 225, 226, 235, 291, 292, 385, 458 Lithium toxicity, 116 Livedo reticularis, 175, 317, 327, 329, 422, 483 529 Liver enzymes, 115, 136, 143, 144, 146, 156, 252, 291, 295, 313, 412, 467 Liver failure acute, 143–145 chronic, 149–151 encephalopathy, 144, 145, 149–151, 152 fulminant, 144, 145, 471 hepatitis B, 145–147 hepatitis C, 145, 147–148, 294–295 jaundice, 144–147, 149, 150, 155–156 Liver metastases, 221, 222, 224, 229, 238, 442 Liver transplant, 14, 72, 134, 145, 148–152, 154, 156, 228 Lobular carcinoma in situ (LCIS), 208, 210 Lofgren’s syndrome, 313, 314, 316, 319, 482 Long thoracic nerve, 368, 375 Lower GI bleed, 134–135 IBD, 134–135 Lower motor neuron, 253, 323, 343, 347, 348, 378 Low molecular weight heparins (LMWH), 11, 31, 33, 99, 112, 169, 172, 174, 175, 178, 179, 469, 470, 478, 488, 489 Lumbar puncture, 111, 186–188, 196, 197, 261, 266, 270–272, 292, 296, 348, 349, 352, 355, 356, 364, 372, 373, 431, 433 Lumbosacral radiculopathy, 323 Lung abscess, 7, 9, 14, 425 Lung cancer, 15, 16, 24, 25, 124, 203–206, 238, 239, 253, 293, 360, 361, 396, 399, 425, 446, 470, 480–481 Lung cavities, 24 Lung metastases, 420 Lung resection assessment, 486 Lupus, 10, 79, 81, 85, 86, 90, 170, 172–175, 259, 260, 316–319, 331, 410, 414, 421–422, 477, 478 in pregnancy, 477 Lyme disease, 38, 124, 193, 260, 261–262, 312–314, 319, 348 Lymphadenopathy, 12, 15–17, 61, 160, 166, 186, 188, 190, 191, 193, 194, 198, 220, 261–263, 266–268, 274, 280, 291, 294, 300, 313, 316, 317, 393, 397, 482, 484 530 Lymphoblastic lymphoma, 186, 188, 193, 196, 197 Lymphocytosis, 19, 139, 189–191, 194, 349 Lymphoma definition, 185 Hodgkin’s, 165, 181, 185, 191–193, 194, 201, 253, 293, 360 non-Hodgkin’s, 165, 186, 189, 190, 193–198, 253, 291, 293, 410, 457 small lymphocytic, 186, 189, 193 Lymphoplasmacytic lymphoma, 189, 193, 198 M Macrocytic anemia, 117, 161, 162–163 Macrolides, 8, 9, 74, 112, 127, 286, 414 Malabsorption, 94, 139, 140–141, 182, 371, 401–403, 405, 459, 460, 462, 483, 484 Malaria, 155, 161, 168, 182, 183, 262, 266–267 Malar rash, 316–317, 421 Malignant hypertension, 78, 168, 346 Malignant pleural effusion, 204, 206, 238 Malnourishment, 140, 461 Mammogram, 209, 210, 238, 242, 244 Management, 2, 3, 5, 8–9, 11, 13–16, 18, 19, 21, 22, 28, 30–33, 37, 42, 44, 47, 55, 57–59, 61–62, 64, 67, 69–71, 78–80, 84–86, 88, 90–95, 103–105, 110, 112–114, 116–121, 123–125, 127, 130, 131, 133–136, 138, 139, 141–142, 144–145, 147, 148, 150, 152, 154, 156, 157, 160–168, 170, 172, 174, 175, 177, 183–185, 187, 189, 190, 192, 195–196, 200, 205–208, 210–211, 214, 216–218, 220, 222–231, 233, 236–238, 255–257, 260, 261, 263–264, 271, 273, 276, 279, 281, 292, 294, 296, 297, 311–313, 315, 317, 320, 323, 325, 326, 328, 335, 336, 342, 347, 348, 350, 352–354, 356, 358, 359, 361, 362, 365, 372, 378, 383–386, 389, 390, 392–397, 399–401, 403, 405, 407–411, 413, 415, 420, 422–428, 431, 433, Index 435–437, 439, 442–444, 446–451, 454–455, 457–458, 460, 463, 468, 470–475, 481, 485–489 principles, 454, 494 Mantle cell lymphoma, 189, 193–194, 197 Marantic endocarditis, 60 Marasmus syndrome, 141 Marginal zone lymphoma, 189, 193, 194 Mastectomy, 210–211, 238, 244, 477 Maternal medicine, 473 McDonald criteria, multiple sclerosis, 349 Mechanical back pain, 323 Mechanical heart valve, 47, 175, 489 Mechanical ventilation, 2, 5, 22, 99, 103–105, 107, 110, 112, 304, 373, 452, 489 Median nerve, 368, 369, 371, 372, 375, 376 Mediastinal lymphoma, 193 Mediastinal masses, 24, 124, 188, 191, 192, 197 Medical fitness to drive, 490–491 Medication-induced headaches, 355 Medications, 2, 9–12, 15, 16, 19, 20, 22, 32, 35, 37, 39, 44, 45, 57–59, 61, 62, 66, 70, 72, 75, 77, 85, 86, 92, 97–98, 104, 108, 109, 113, 114, 119–121, 126, 131, 137, 139, 140, 142, 146, 147, 149, 152, 155, 156, 159–161, 163–169, 193, 222, 255, 259–261, 263, 266, 281, 288, 293, 304, 309, 317, 326, 347, 351–357, 360, 362, 365, 371, 382, 388, 390, 391, 395, 398, 401, 403–407, 412, 413, 424, 427–429, 433–435, 437, 438, 440, 441, 443, 447, 449, 450, 453, 459, 462, 466, 467, 472, 474, 476, 484, 487–488, 490, 494 in pregnancy, 476 Mediterranean fever, 128, 259, 268, 313, 314, 319 Medullary cystic kidney disease, 85–87 Medullary sponge kidney, 85–87, 95 Medullary syndromes, 346 Melanoma, 24, 35, 177, 193, 202, 215, 237, 244, 246, 250–252, 293, 335, 337, 396, 397, 402, 416, 418–421 Melena, 131, 132, 134, 217 Membranoproliferative glomerulonephritis (MPGN), 78, 80–82, 189, 483 Index Membranous glomerulonephritis (MGN), 78, 80, 82, 317 Meniere’s disease, 357–359 Meningitis, 90, 92, 108, 112, 152, 164, 196, 261, 268–272, 274, 289, 292, 296, 299–301, 317, 330, 345, 351, 352, 355, 359, 429, 431–433, 484 leptomeningeal, 196–197 Meniscal tear, 325, 334 Mesothelioma, 24, 35, 206–207, 238, 247, 253, 425 Metabolic acidosis, 4, 22, 38, 83, 84, 87–89, 93, 112, 115, 119, 120, 446, 447 diabetic ketoacidosis, 128, 383–385 Metabolic alkalosis, 22, 89–90, 92, 403 Metabolic cardiomyopathy, 38 Metabolic syndrome, 29, 71–72, 311, 408, 475 Methadone conversion, 444–445 Methanol overdose, 119 Methicillin resistant Staphylococcus aureus (MRSA), 7, 9, 62, 107, 108, 112, 264, 276, 279, 283, 285–287, 290, 304, 309, 410, 414 Methotrexate, 78, 136, 162, 189, 195–197, 202, 214, 231, 247, 255–257, 293, 313, 315–322, 328, 330, 337, 403, 411, 415, 421, 423, 477, 482 Metronidazole, 8, 9, 125, 127, 130, 131, 136–138, 152, 273, 275, 286, 289, 290, 413, 438, 474 Micafungin, 299, 301, 303 Microangiopathic hemolytic anemia (MAHA), 78, 167, 168, 182, 477 Microcytic anemia, 160–161 Microscopic polyangiitis (MPA), 78, 82, 326, 327, 330, 332 Mid-systolic click, 50, 60 Migraines, 67, 68, 123, 337, 351, 355–356, 357 Migrainous vertigo, 358 Minimal change disease (MCD), 78–80, 81–82, 191 Mitral regurgitation, 29, 37, 38, 43, 49–54, 58, 59–60 Mitral stenosis, 4, 15, 39, 43, 45, 47, 48, 50–53, 56, 57–59, 353, 470, 485, 487 531 Mitral valve prolapse, 51–53, 59, 60, 87 Mixed connective tissue disease, 35, 316, 318, 331 Mixed hypertriglyceridemia, 70, 72 Modified Duke’s criteria, 61 Monoarthritis gout, 311–312 septic arthritis, 309–311 Monobactam, 284 Monoclonal antibodies, 250, 267, 315 Monoclonal gammopathy, 189 Monoclonal gammopathy of undetermined significance (MGUS), 199, 200 Mononeuritis multiplex, 327, 329, 371, 373, 381 Mononeuropathy, 329, 371, 375, 377, 381 Morphine, 31, 32, 37, 42, 90, 91, 95, 99, 130, 157, 164, 170, 256, 443–445, 455 Motor cortex, 352, 377 MR angiography, 64, 378 MRI head, 12, 91, 159, 196, 229, 336, 341, 348, 349, 352, 355, 357, 358, 364, 378 MR venography, 378 Mucosa associated lymphoid tissue (MALT), 193, 194, 196, 197 Mucositis, 124, 201, 246, 247, 250–252, 256, 257, 450, 451 treatment, 256 Multiple endocrine neoplasia (MEN) syndromes, 274, 397, 398, 402 Multiple myeloma, 79, 83, 85, 89, 189, 198–200, 201, 239, 252, 253, 259, 294, 322, 326, 402, 457 Multiple sclerosis, 123, 124, 141, 270, 325, 347, 349–350, 357, 359, 362, 373, 377, 378, 409, 429, 448 Multisystem disorders, 482–484 Murmurs diastolic murmurs, 27, 51–53, 56 innocent, 53 maneuvers, 51–52 systolic murmurs, 51–53 Muscle strength grading, 377 Myasthenia gravis (MG), 22, 25, 100, 124, 207, 344, 347, 360–361, 377, 378, 468 thymoma, 24, 90, 207–208, 360–361 532 Mycobacterium avium complex (MAC), 137, 182, 183, 291–294 Mycosis fungoides, 193, 197, 198, 410 Myelodysplastic syndrome, 163, 184, 185, 187, 202, 259 Myelofibrosis (MF), 159, 166, 182, 183, 184–185 Myelopathy, 99, 314, 315, 337, 349, 366, 484 Myeloproliferative disorders chronic myelogenous leukemia, 111, 166, 184–185 essential thrombocytosis, 184–185 polycythemia rubra vera, 159, 166, 173, 184 Myocardial infarction peri-operative, 484–486 posterior infarction, 33 right ventricular infarction, 31 territory, 75 Myoclonus, 114, 351, 363, 364, 443–444 Myopathy, 70, 95, 100, 113, 117, 124, 141, 143, 316, 319, 325, 331, 332, 377, 378, 390, 391, 399 Myotomes, 367–368, 378 N Narcolepsy, 20, 21, 351 Narrow complex tachycardia, 45, 73 Nausea and vomiting adrenal insufficiency, 123 chemotherapy-induced, 254–255 palliative setting, 448 Neck stiffness, 259, 261, 263, 266, 269, 270, 341 Necrotizing enterocolitis, 265 Necrotizing fasciitis, 108, 176, 275, 276–277, 290 Necrotizing pancreatitis, 156, 157 Needle stick injury, 304 Negative predictive value, 479 Negligence, 490, 492 Nephritic syndrome, 80, 81, 85, 147, 317 Nephrotic syndrome, 12, 70, 79, 80, 81, 83, 85, 90, 147, 153, 154, 173, 317, 390, 401 Nerve roots, 323, 324, 343, 366, 368–371, 377 Index Neurocardiogenic syncope, 354, 434 Neuroendocrine tumors, 139, 206, 221, 222, 237, 244, 399 Neurogenic claudication, 322, 324 Neurogenic syncope, 353, 354, 434 Neuroimaging, 292, 340, 355, 378–379 Neuroleptic malignant syndrome (NMS), 113–114, 269, 377, 490 Neuropathy, 21, 29, 62, 83, 99, 117, 141, 148, 152, 161, 163, 191, 198, 213, 248, 250–252, 261, 275, 281, 294, 315–317, 327, 329, 330, 348, 354, 361, 366, 371–376, 381, 382, 386, 416, 435, 450, 459, 474, 482, 483 Neutropenia, 148, 164–165, 194, 213, 299, 301, 315, 316 febrile, 165, 213, 256, 263–265, 301 Neutropenic fever, 213, 259, 263–265, 301 New York Heart Association (NYHA) classification, 29, 42, 43, 101, 470, 484, 491 Niacin deficiency, 222 Nicotine addiction, 480 Nikolsky’s sign, 414 Non-alcoholic steatohepatitis (NASH), 49, 143, 145, 149 Non-Hodgkin’s lymphoma, 165, 186, 189, 190, 193–198, 202, 240, 253, 291, 293, 410, 457 Non-invasive positive pressure ventilation (NIPPV), 105, 107, 447 Non-ketotic hyperosmolar hyperglycemia (NKH), 463 Non-nucleoside reverse transcriptase inhibitors (NNRTI), 294 Non-seminoma, 234–236 Non-small cell lung cancer, 203, 205, 206 Non-ulcer dyspepsia, 126, 127 Normal pressure hydrocephalus (NPH), 357, 365, 429, 431, 434, 474, 475 Normocytic anemia, 83, 161–162 Nosocomial infections, 304 Nosocomial pneumonia, 7, 8, 112 NSAIDs-induced gastropathy, 127 NSAIDs-induced renal failure, 79 Nucleoside reverse transcriptase inhibitors (NRTI), 281, 294 Number needed to treat (NNT), 343, 480 533 Index Numbness multiple sclerosis, 349 stroke/TIA, 339 Nutrition, 9, 97, 107, 117, 119, 128, 136, 141, 145, 157, 216, 256, 264, 299, 401–403, 427, 433, 446, 450, 457–463 O Obesity, 1, 10, 20, 22, 25, 26, 29, 33, 38, 41, 45, 46, 49, 64, 66, 70, 72, 82, 105, 127, 130, 145, 149, 215, 219, 225, 229, 277, 311, 324, 331, 356, 382, 386, 387, 394, 397, 399, 400, 407, 416, 417, 436, 457–458, 460, 463, 467, 474, 475, 486 Obscure GI bleed, 134 Obstetrical medicine, 465–478 Obstructive lung disease, 150, 164, 487 Obstructive sleep apnea, 20–22, 105, 159, 457 Obturator nerve, 370, 374, 376, 381 Occult GI bleed, 134 Octreotide, 133, 134, 144, 151, 222, 223, 257, 353, 389, 395, 448, 455 Oculocephalic reflexes, 101 Oculomotor nerve lesions, 345 Odds ratio (OR), 480 Opening snap, 51, 52, 56, 57 Opiate overdose, 117, 398 Opioid use, 443, 448, 449 Optic atrophy, 329, 346, 362, 391, 459 Optic neuritis, 203, 281, 346, 349, 350 Oral airways, 106 Oropharyngeal dysphagia, 124–125 Orthostatic proteinuria, 85 Oseltamivir, 297, 298 Osler nodes, 61 Osmolar gap, 88, 113, 114, 116, 119, 433 Osteitis fibrosa, 83 Osteoarthritis (OA), 309, 311, 312, 324–325, 395, 401, 457 Osteomyelitis, 12, 61, 164, 259, 277–279, 288, 290, 299, 309 Osteoporosis, 23, 139, 178, 202, 212, 234, 249, 394, 395, 399, 401, 403–406, 427, 435, 443, 480 risk assessment, instrument, 429 Ovarian ablation, 211, 212 Overdose acetaminophen, 115, 117 digoxin, 43, 44, 433 opioids, 117 Overflow incontinence, 435, 436 Overlap syndrome, 316, 377 Oxaliplatin, 217, 218, 220, 226, 247, 255–257 Oxazolidinones, 287 Oximetry, 66, 102, 103, 110, 116, 159 Oxygen saturation gap, 116 P Paclitaxel, 34, 205, 206, 208, 211, 212, 214, 216, 218, 238, 247, 248, 255, 257, 420 Pain control, 31, 95, 107, 131, 164, 226, 256, 322–325, 356, 406, 433, 442–445, 447–449, 470, 477, 487 Palindromic rheumatism, 309, 313, 314, 315, 319 Palliative dyspnea, 446–447 medication route, 441 nausea and vomiting, 448 pain control, 442–445 sedation, 447, 493 Palliative care, 237, 439–455, 494 Palliative performance scale (PPS), 440, 453, 454 Palliative prognostic index (PPI), 453 Palliative prognostic score (PaP), 453 Palmar xanthoma, 72 Palpable purpura, 259, 317, 327, 329, 330, 424 Palpitations atrial fibrillation, 45–49 pheochromocytoma, 45, 397, 398 P-ANCA, 15, 78, 79, 81, 82, 135, 327, 330, 332, 450 Pancoast tumor, 16–17, 203 Pancolitis, 135, 136 Pancreatic cancer, 143, 155, 157, 226, 239, 240 Pancytopenia, 163, 170, 186, 188, 198, 201, 207, 250, 300, 459 multiple myeloma, 198 534 Papilledema, 65, 335, 346, 355, 356 Pappenheimer bodies, 182 Papulosquamous lesions, 410, 421 Paranasal sinus lymphoma, 197 Parapneumonic effusion, 7, 13–14 Parasomnia, 20 Parkinson’s disease, 113, 120, 357, 362–365, 373, 429, 437 Paroxysmal hemicrania, 356 Paroxysmal nocturnal hemoglobinuria (PNH), 10, 163, 170, 173, 175, 186 Parvovirus B19, 163, 318, 326, 329, 413 Pelvic inflammatory disease, 128, 240, 275, 310 Pemphigus vulgaris, 414, 415–416 Penciclovir, 297 Penicillin allergy, 127, 288–289 Penicillins, 18, 35, 58, 59, 61, 78, 127, 162, 164, 165, 259, 260, 268, 271, 275–277, 282–284, 288–289, 290, 304, 326, 350, 410, 414, 416, 422, 423, 432, 474, 490 Peptic ulcer disease (PUD), 27, 28, 125–128, 131, 133, 134, 140, 239, 317, 402 Percutaneous coronary intervention (PCI), 29, 31–35, 485, 487, 491 Performance status, 195, 197, 204–205, 207, 213, 214, 216–218, 221, 226, 229, 230, 264, 336, 440, 441, 450, 453 Pericardial effusion, 4, 36, 37, 163, 188, 204, 206, 314, 390, 446 Pericarditis, 7, 27–30, 34, 35–37, 45, 49, 50, 58, 61, 74, 75, 78, 150, 153, 154, 182, 201, 300, 314, 316–318, 342, 484 Peri-operative assessment, 484–490 Perioral dermatitis, 412, 413 Peripartum cardiomyopathy, 471 Peripheral blood smear, 159, 182, 187 Peripheral nerves, 335, 343, 368–371, 374–377 Peripheral neuropathy, 62, 83, 117, 148, 152, 161, 163, 198, 251, 252, 261, 281, 316–317, 327, 330, 361, 366, 371–376, 377, 416, 435, 459, 474, 482, 483 Index Peripheral vascular disease (PVD), 33, 62–64, 66–68, 71, 276, 277, 381, 417, 480 Peritoneal carcinomatosis, 238, 450 Peritonitis, 97, 128–130, 152–154, 240, 265, 275, 290, 461 Peroneal nerve, 365, 370, 373, 376, 395 Pheochromocytoma, 38, 45, 65, 66, 159, 221, 230, 244, 259, 318, 381, 382, 396, 397, 398, 481 Photophobia, 49, 322, 356, 358 Photosensitivity, 49, 246, 252, 309, 316, 317, 332, 413, 421, 422 Pigmented lesions, 418 Pitting edema, 39, 63, 176, 321 Pituitary tumors, 394–395, 397–399, 407 Pityriasis rosea, 409, 410, 411 Plasma cell dyscrasias, 198, 483 Platelet activation pathway, 171 Platinating agents, 247 Pleural based disease, 24 Pleural effusion, 4, 8, 10, 12–14, 19, 22, 25, 27, 28, 35, 38, 40, 45, 74, 97, 111, 151, 204, 206, 215, 238, 268, 280, 314, 316, 318, 390, 446, 447, 483, 484 Plummer–Vinson syndrome, 161, 215 Pneumocystis jirovecii pneumonia (PJP), 19, 24, 102, 104, 202, 250, 286, 291–294 Pneumonia, 4–6, 7–9, 12–15, 18, 19, 22, 24, 27, 28, 37, 40, 43, 48, 54, 61, 90, 99, 102, 104, 107–108, 112, 117, 120, 123, 125, 127, 128, 140, 152, 156, 162, 164–166, 205, 251, 263, 264, 268, 269, 271, 282, 289–292, 295–297, 300, 301, 304, 316, 338, 351, 431, 432, 434, 446, 462, 470, 480, 489, 490 recurrent, Pneumonia severity of illness score (PSI), Podagra, 311 POEMS syndrome, 198, 200 Polyarteritis nodosa (PAN), 78, 146, 148, 259, 260, 316, 326, 327, 329, 330, 332, 349, 416 Polyarthritis fever, 58, 314 rheumatoid arthritis, 314 Index seronegative spondyloar thropathies, 320, 321 systemic lupus erythematosus, 317 Polycystic kidney disease, 65, 66, 83, 85–87, 159, 229, 272 Polycystic ovarian syndrome (PCOS), 406, 407, 408, 412, 474 Polycythemia rubra vera (PRV), 159, 166, 173, 182, 184–186 Polymyalgia rheumatica (PMR), 309, 312–314, 319, 328, 329, 331, 355 Polymyositis, 100, 113, 225, 309, 314, 316, 318, 31, 319, 332, 377, 378, 449 Polyneuropathy, 49, 99, 200, 329, 330, 371, 378, 381 Polypharmacy, 427, 436, 437 Polyuria diabetes insipidus, 92, 395 diabetes mellitus, 382 hypercalcemia, 92, 198, 254, 396, 402 Porphyria, 90, 123, 128, 148, 351, 407, 414, 421, 422, 482, 483–484 Porphyria cutanea tarda, 414, 422, 484 Portal hypertension, 14, 17, 69, 149–151, 153, 154, 182, 228, 315 Portal vein thrombosis, 153, 228 Portopulmonary hypertension, 151 Positive predictive value, 479 Posterior infarction, 33 Posterior pituitary deficiency, 395–396 Post nasal drip, 1, 14–15 Postpartum thyroiditis, 475, 476 Post-test probability, 176, 479 Post transfusion purpura (PTP), 181 Post transplant lymphoproliferative disorders (PTLD), 194, 197 Postural proteinuria, 85 Power of attorney, 428, 441 Precordial examination, 50 Preeclampsia, 168, 467–468, 471, 472, 475–478 Pregnancy, 10, 11, 22, 34, 39, 45, 49, 51, 58, 65, 67, 69, 70, 80, 114, 118, 123, 128, 143, 144, 155, 167, 169, 173, 175–177, 206, 211, 240, 272, 273, 275, 281, 294, 305–307, 317, 331, 353, 372, 381, 387, 390, 392, 394, 400, 406, 407, 415, 416, 465–478, 481 535 Pre-operative workup, 216 Pre-test probability, 10, 73, 479 Priapism, 164 Primary biliary cirrhosis (PBC), 70, 143, 149, 155, 156, 165, 318, 403, 409 Primary CNS lymphoma, 194, 196 Primary sclerosing cholangitis (PSC), 135, 149, 156, 157, 321 Primitive reflexes, 344, 429 Proctitis, 135–136 Prognostication, 232, 453–454 Prolactinoma, 394, 395, 407 Prolonged QT interval, 401 Prolymphocytic leukemia, 189 Prophylaxis asplenic patients, 164 hepatitis B, 266, 294, 304 HIV, 266, 291, 304 neisseria meningitides, 282 traveler, 265–266, 305 Proprioception changes, 163, 274, 346, 349, 357, 362, 371, 434, 459 Prostate cancer, 231–234, 238, 239, 241, 243, 253, 435, 453 Prostate specific antigen (PSA), 232, 239, 241 Prosthetic joint infections, 279 Protease inhibitor (PI), 6, 70, 148, 281, 294, 381, 473 Proteinuria, 65, 68, 80–84, 85, 86, 199, 206, 229, 250, 251, 268, 316, 317, 381, 386, 467, 468, 483 Pruritus, 84, 148, 155, 156, 159, 184, 191, 194, 224, 225, 262, 268, 409, 411, 412, 443, 455, 471, 472 Pseudo-exacerbation, 349 multiple sclerosis, 349 Pseudogout, 309–314, 319 Pseudomembranous colitis, 138 Pseudomonas, 6–9, 15, 107, 260, 263, 269, 276, 282, 283, 290, 309 Pseudo-renal failure, 79 Pseudotumor cerebri, 270, 355, 356, 457 Psoriasis vulgaris, 410–412 Psoriatic arthritis (PA), 35, 309, 311, 312, 314, 319, 320, 321, 322, 411 Ptosis, 16, 207, 344, 346, 347, 360, 361 536 Pulmonary embolism (PE), 1, 4, 5, 10–12, 13, 15, 17, 22, 25, 27, 28, 30, 38, 43, 45, 47, 49, 50, 61, 75, 102, 104, 108, 109, 159, 176, 177, 338, 353, 446, 469, 470, 490 Pulmonary eosinophilia, 166 Pulmonary function test, 2, 7, 25–26, 204, 286 Pulmonary hypertension, 4, 10, 15, 17–18, 19, 20, 24–27, 38, 41, 50, 56–59, 103, 109, 164, 176, 316–319, 353, 446, 457, 470 Pulmonary regurgitation, 51–53, 56, 222 Pulse, 17, 18, 27, 39, 41, 43, 45, 49, 50, 52, 54, 56, 57, 62, 63, 66, 82, 100, 102, 109, 116, 131–134, 328, 329, 353, 382, 386, 413, 417, 466 irregularly irregular, 49 Pulseless disease, 328 Pulse pressure, 41, 49, 54, 56, 132, 466 wide, 49, 56 Pulsus alternans, 49 Pulsus paradoxus, 1, 4, 36, 37, 49 Pyelonephritis, 78, 79, 112, 123, 128, 199, 228, 272, 273, 304, 322, 473 Pyoderma gangrenosum, 135, 313, 314, 319, 321, 416, 417 Pyridoxine deficiency, 141 Q Q fever, 60, 259, 261, 265, 266, 472 QT prolongation, 48, 188, 250–252, 341, 443 R Radial nerve, 369, 374, 375 Radiculopathy, 198, 322, 323, 366–371, 373 Rai staging, 190 Ramsay Hunt syndrome, 347, 348 Ranson’s criteria, 157 Rapidly progressive glomerulonephritis (RPGN), 78, 81, 82, 85, 330, 483 Raynaud’s phenomenon, 67, 68, 200, 316, 318, 478, 483 Reactivation tuberculosis, 280, 281 Index Reactive hypoglycemia, 389 Rectal cancer, 219, 220–221, 225, 235 Reed-Sternberg cell, 185, 191 Refeeding syndrome, 94, 463 Reflex syncope, 354 Rehabilitation criteria, 494 Relative risk reduction (RRR), 213, 221, 242, 342, 480 Relative risk (RR), 5, 7, 8, 48, 73, 74, 101, 105, 114, 120, 213, 221, 242, 267, 342, 350, 465, 473, 480 Renal artery stenosis (RAS), 42, 43, 64–66, 69, 77, 89, 92, 396, 398 Renal cell carcinoma, 24, 177, 228–230, 244, 253 Renal colic, 128 Renal crisis, 318 Renal cysts, 244 Renal failure glomerulopathies, 80, 82 hypercalcemia, 43, 77, 79, 116, 156, 199, 254, 402 Renal osteodystrophy, 83–84 Renal replacement, 78–80, 83, 84, 96–97, 99, 112, 120, 144, 149, 151 dialysis, 78–80, 84 Renal tubular acidosis, 88 Renal ultrasound, 78, 80, 84, 86, 87 Renin, 66, 89, 90, 93, 151, 229, 396–398, 466 Research ethics, 493 Resource allocation, 493 Respiratory acidosis, 22, 88 Respiratory alkalosis, 22, 88, 94, 115, 465 Respiratory failure hypercarbic, 103 hypoxemic, 103 Restless leg syndrome, 20, 21, 83, 363 Restrictive cardiomyopathy, 37, 49, 50 Restrictive lung disease, 19, 20, 164, 320 Resuscitation CPR, 101, 452 intubation, 101, 110, 112, 115, 116, 120, 304, 452 shock, 111, 115, 121, 134, 414 Retinopathy, 65, 66, 141, 164, 200, 203, 381, 382, 386, 397, 474, 475 Index Revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar), 119 Rhabdomyolysis, 79, 93, 95, 113–114, 120, 121, 296, 351, 352, 377, 401, 434 Rheumatic fever, 38, 51, 54, 57, 58–59, 260, 313, 314, 319 Rheumatoid arthritis (RA), 6, 13, 16, 18, 19, 21, 27, 35, 54, 82, 88, 182, 259, 309, 310, 314–316, 318, 319, 324–326, 331, 360, 366, 372, 377, 405, 417, 482 Rheumatoid factor (RF), 18, 19, 61, 78, 79, 260, 310, 313, 315, 316, 320, 321, 327, 331, 361, 364, 378, 450, 483 Rhythm, 10, 20, 44–47, 56, 58, 73–75, 434, 446, 471 irregularly irregular, 45 Rickettsial infections, 261, 268 North America, 261 outside of North America, 268 Riedel’s lobe, 150 Right heart catheterization, 18, 151 Right ventricular infarction, 31–33 Rigidity, 114, 120, 128–130, 197, 259, 261, 263, 266, 339, 362–364, 429 Rimantadine, 297, 298 Rinne test, 359 Risk reduction cardiac, 33, 48, 431 ECG exercise stress test, 30 glycemic control, 458 hyperlipidemia, 70, 342, 459 hypertension, 34, 48, 64, 342, 431, 458 post-MI, 33, 338 Rocky Mountain spotted fever, 260, 261, 265, 413 Rooting reflex, 344 Rosacea, 412, 413, 421, 422 Roth spots, 61 Rouleaux, 182 S Sacroiliitis, 268, 320, 321 Salicylate overdose, 115 537 Salmonella, 134, 137, 138, 164, 260, 265–267, 277, 282, 290, 291, 293, 313, 321 Sarcoidosis, 12, 17–19, 24, 25, 38, 45, 78, 92, 124, 145, 182, 183, 193, 253, 260, 300, 309, 311, 313, 314, 316, 319, 331, 347–349, 390, 395, 396, 398, 402, 409, 410, 424, 482 Saturday night palsy, 375 Scabies, 409, 410 Scarlet fever, 38, 58, 165, 260, 413, 414 Schistosomiasis, 143, 149, 153, 230, 265, 266, 268, 482 Sciatica, 320, 322, 323 Sciatic nerve, 329, 370–371, 374, 376 Scleroderma, 18, 19, 38, 78, 123–127, 138, 139, 142, 202, 206, 234, 309, 314, 316, 318, 319, 331, 332, 377, 448 Seborrheic dermatitis, 409, 410, 411, 422 Seborrheic keratosis, 217, 418, 421 Secretion of inappropriate anti-diuretic hormone (SIADH), 7, 90, 91, 203, 461 Seizures alcohol withdrawal, 117–120, 352, 490 first time, 352 in pregnancy, 118, 317, 467, 476–477, 481 Selective estrogen receptor modulators (SERMs), 211–212, 249 Seminoma, 234–236, 238, 293 Sensitivity, 3, 38, 64, 69, 106, 139, 175, 176, 183, 184, 241–243, 267, 270, 273, 278, 281, 282–289, 296, 354, 386–388, 441, 479 Sensorineural hearing loss, 358, 359 Sensory ataxia, 357, 361, 365 Sensory cortex, 338 Sentinel lymph node biopsy, 211, 419, 420 Sepsis, 4, 7, 22, 30, 33, 38, 41, 43, 49, 77–79, 100, 101, 104, 109, 110, 111–112, 116, 120, 140, 143–145, 152, 154–157, 164, 165, 168, 170, 173, 181, 182, 199, 219, 261, 262, 264, 265, 277, 283, 289–291, 309, 312, 314, 319, 325, 327, 371, 378, 389, 391, 398, 415, 432, 446, 460, 461, 463, 467, 471, 473, 489, 490 538 Septic arthritis, 61, 279, 290, 309–311 Septic transfusion, 181 Sequestration crisis, 163, 164 Serology hepatitis B, 145–147, 471 rheumatology, 309–334 Seronegative spondyloarthropathies, 83, 319–322 Serotonin, 113, 114, 168, 171, 221, 222, 269, 446 Serotonin syndrome, 113, 114, 269 Serum-ascites albumin gradient (SAAG), 154 Shigella, 134, 137, 138, 265, 266, 282, 290, 293, 313, 321 Shilling’s test, 459 Shock acute coronary syndrome, 29, 31, 32, 34 sepsis, 30, 33, 38, 41, 43, 49, 110–112 tamponade, 108 Shoulder examination, 333 Shoulder instability, 333, 334 Sick euthyroid syndrome, 390 Sickle cell anemia, 137, 161 Sickle cell crisis, 163–164 Siderocytes, 182 Simple kidney cysts, 86 Sister Mary Joseph nodule, 217 Situational syncope, 354 Sixth nerve palsy, 356 Sjogren’s syndrome, 6, 88, 194, 314, 315, 316, 331, 332, 410 Sleep disorders, 17, 20, 21, 325, 351 Sliding scale, 489 Small bowel obstruction, 128–130 Small cell lung cancer, 204, 205–206, 360, 361 Small lymphocytic lymphoma (SLL), 185, 186, 189, 190, 193, 194 Smoke inhalation, 121–122 Smoking cessation, 2, 5, 6, 34, 43, 84, 127, 160, 206, 386, 405, 480–481, 487 Smoldering multiple myeloma (SMM), 199, 200 Snout reflex, 344 Soft tissue infections, 275–277 Solitary plasmacytoma of bone, 200 Index Solitary pulmonary nodule, 16–17, 25, 48, 206 lung cancer, 15, 25, 205 Solitary thyroid nodule, 393–394 Sorafenib, 228, 230, 251, 256, 257 Spastic gait, 357 Spasticity, 343, 349, 350, 431, 459 Specificity, 69, 176, 210, 229, 241–243, 270, 273, 278, 281, 296, 328, 441, 479 Spherocytes, 182 Spinal cord compression, 108, 141, 192, 195, 253, 314, 322, 323, 366, 445, 448, 449 malignant, 253 Spinal stenosis, 62, 63, 324, 435 Spirituality, 441 Splenomegaly, 61, 117, 149, 159, 161–163, 167, 182–183, 184, 185, 188–191, 267, 313, 315, 391, 483 Spondylolisthesis, 322–324 Spontaneous bacterial peritonitis (SBP), 8, 11, 28, 31, 40, 42, 48, 55, 56, 63, 65–67, 102, 111, 112, 131, 132, 134, 151–153, 154, 354, 466–468 Spur cells, 182 Squamous cell carcinoma, 18, 24, 161, 165, 205, 206, 216, 224, 230, 231, 237, 238, 242, 293, 410, 416, 420 Staghorn calculi, 95 Staphylococcal scalded skin syndrome (SSSS), 260, 413, 414 Stasis dermatitis, 409, 410 Status epilepticus, 351, 352, 432 ST elevation, 28, 29, 31, 33, 34, 36, 37, 40, 73–75, 114 Stem cell transplant, 170, 175, 181, 185, 187, 190, 192, 194–198, 200, 201–202, 264, 265, 299 Steroids complications, 489 myopathy, 319 physiologic dose, 89, 488 replacement, 395, 399, 400 stress dose, 399, 400, 469, 488 Stevens-Johnson syndrome (SJS), 414, 415 Stigmata of chronic liver disease, 146, 147, 149 Index Still’s disease, 182, 193, 259, 312, 313, 314, 319 Stomach cancer, 238 Stomatocytes, 182 Storage pool disease, 171, 172 Streptogramins, 287 Stress dose, 399, 400, 469, 488 Stress incontinence, 436 Stroke, 11, 22, 28, 30, 31, 33–35, 43, 45, 48, 56, 59, 61, 62, 65–67, 70, 74, 102, 120, 121, 124, 141, 152, 159, 164, 174, 175, 184, 234, 269, 316, 317, 327, 328, 337–342, 345, 347, 348, 351, 353–355, 358, 362, 365, 377–379, 381, 386, 430, 432, 434, 435, 448, 457, 465, 467, 468, 486, 487, 489–491 risk factors, 48 Struvite stones, 95 Subacute combined degeneration, 161, 163, 459 Subacute cutaneous lupus, 421 Subarachnoid hemorrhage, 90, 92, 270, 379, 431 Subclinical hypothyroidism, 390 Submersion injury, 121 Subscapular nerve, 375 Suckling reflex, 339 Sudden death, 29, 43, 44, 57, 60, 74, 118, 353 hypertrophic obstructive cardiomyopathy (HOCM), 43, 48, 54 Sulfa antibiotic, 286, 292 Sunitinib, 224, 230, 251, 256, 257 Superior vena cava syndrome, 16, 203, 206 Supratherapeutic INR, 180 Sural nerve, 370 Surface lung markings, Swan Ganz catheterization, 23 Sympathetic response, 396 Sympathomimetic overdose syndromes, 114, 116 Syncope aortic stenosis, 55, 353 hypertrophic obstructive cardiomyopathy, 38 Syndrome X, 72 539 Syphilis, 56, 82, 124, 193, 259–262, 265, 274, 275, 284, 291, 309, 324, 359, 410, 416, 417, 422, 472 Systemic anaplastic large cell lymphoma, 198 Systemic inflammatory response syndrome (SIRS), 111 Systemic lupus erythematosus (SLE), 6, 13, 18, 19, 24, 35, 38, 56, 60, 61, 78, 79, 82, 104, 162, 164, 167, 169, 173, 175, 182, 193, 194, 206, 234, 309, 313–315, 316–319, 325–327, 331, 332, 349, 360, 377, 410, 421, 422, 424, 449, 478, 482 Systolic dysfunction, 38, 41, 68, 75 Systolic murmurs, 51–54, 60 T Tabes dorsalis, 274, 361, 362, 365 Tachycardia, 5, 10, 18, 30, 36–38, 41, 44, 45, 50, 67, 73, 75, 76, 93, 99, 109, 114, 116, 118, 121, 131, 132, 134, 137, 259, 261, 263, 266, 373, 389, 391, 397, 398, 442, 471, 484, 485 Takayasu’s aortitis, 326–328 Tamoxifen, 70, 145, 210–212, 244, 249, 402 Tamponade, 4, 27, 35–37, 49, 50, 108–110, 134, 206, 353, 446 Target cells, 161, 182 Tarsal tunnel syndrome, 376 T-cell lymphoma, 189, 193, 194, 197, 252 Tear drop cells, 182 Telangiectasia, 17, 131, 186, 200, 225, 318, 319, 413, 420–422 Temporal arteritis, 63, 326, 327, 328, 329, 331, 355, 416 Tender points, 326 Tendon xanthoma, 70, 72 Tensilon test, 361 Tension headaches, 356 Testicular cancer, 234–237, 293 Testicular lymphoma, 197 Tetracyclines, 8, 43, 124, 127, 138, 143, 156, 283, 286, 359, 413, 415, 421–424, 460, 474 Thalassemia index, 161 Thiamine deficiency syndromes, 119 540 Thin basement disease, 86 Third nerve palsy, 335, 339, 360, 361 Thoracentesis, 13, 14, 111, 151, 204, 207, 238, 253, 280, 447, 465 Thoracic outlet obstruction, 17 Thromboangiitis obliterans, 62, 326 Thrombocytopenia post-operative, 490 in pregnancy, 11, 167–169, 317, 467 Thrombocytosis, 93, 166–167, 207, 229, 422, 460 Thrombolytics, 11, 14, 338, 342 ACS, 28–35 stroke, 11, 337–344 Thrombophilia, 10, 173, 174, 176, 177, 469, 470, 489 Thrombotic stroke, 337 Thrombotic thrombocytopenic purpura (TTP), 78, 79, 115, 161, 162, 167, 168–169, 173, 182, 269, 477, 478 Thymoma, 24, 90, 207–208, 253, 360, 361 Thyroid cancer, 177, 393, 397 Thyroiditis, 48, 82, 390–392, 475, 476 Thyroid storm, 269, 391, 392, 476, 489, 490 Tilt table testing, 354 TIMI score, 30–31 Tinea infections, 412 Tinea versicolour, 412 Todd’s paralysis, 337, 351, 352 Tonic clonic seizure, 352, 467 Tonsillar herniation, 337 Topoisomerase inhibitors, 186, 247 TORCHES infections, 472 Total parenteral nutrition (TPN), 87, 88, 130, 136, 145, 155, 254, 461, 462–463 Toxic epidermal necrolysis (TEN), 414–416 Toxic megacolon C difficile, 136 inflammatory bowel disease, 136 Toxic shock syndrome, 260, 401, 413, 414 Toxoplasma, 263, 291–293, 472, 473 Tracheostomy tubes, 105, 106 Transaminitis, 70, 317 Transesophageal echocardiogram, 61 Transfusion infection risks, 152 Index Transfusion reactions, 104, 180–181 Transfusion related acute lung injury (TRALI), 181 Transient arterial occlusion, 52, 53 Transient ischemic attack (TIA), 11, 31, 45, 48, 59, 62, 65, 70, 71, 328, 338, 339, 340–342, 351, 358, 378, 381, 386, 486, 489, 491 Transitional cell carcinoma, 165, 229, 231 Transtentorial herniation, 337 Trastuzumab, 210–214, 218, 250, 255 Traveler’s fever, 137, 265–268 Treatment response criteria lymphoma, 196 solid tumors, 159, 165 Tremor, 49, 68, 116, 118, 119, 152, 349, 361–365, 391, 397, 429, 442 Trendelenburg gait, 357, 365 Treponema pallidum, 260, 274, 327, 450 Triad asthma, Tricuspid regurgitation, 18, 50–53, 57, 58, 59, 61, 150, 153, 154, 182, 222 Tricuspid stenosis, 50–52, 60, 222, 353 Trigeminal nerve lesions, 345 Troponin, 1, 5, 8, 10, 28, 30, 33, 37, 41, 47, 103, 104, 109, 111, 113, 120, 152, 341, 352, 354, 385, 433, 487, 504 Trousseau’s sign, 401 Trusteeship, 428 Truth telling, 451–452 Tuberculin skin test, 260, 279, 280, 474 Tuberculosis HIV co-infection, 292, 293 in pregnancy, 473 Tuberous xanthoma, 70, 72 Tumor lysis syndrome, 187, 189, 196, 202, 254 Tumor markers, 209, 232, 235–237, 239–240, 241, 503–504 Turner’s syndrome, 27, 406 Tylenol overdose, 115, 145 Typhlitis, 265 Typhoid fever, 39, 193, 265, 266, 267 Typhus, 260, 261, 265, 268, 413 Tyrosine kinase inhibitors, 184, 185, 190, 224, 250 Index U Ulcerative colitis, 6, 135–138, 156, 219, 242, 321, 326, 417, 425 Ulcers, 11, 63, 120, 126–128, 133, 135, 140, 147, 157, 164, 165, 259, 261, 263, 266, 277, 278, 290, 309, 316–318, 330, 382, 399, 410, 416–417, 422, 482 Ulnar nerve, 369–371, 374, 375 Uncal herniation, 337 Unconscious patient, 106 Undifferentiated connective tissue disease, 316 Undulant fever, 268 Upper GI bleed, 15, 131–134, 150, 215, 217 Upper motor neuron, 323, 343–345, 347–349, 365, 378 Uremia, 35, 78, 87, 116, 123, 128, 141, 182, 317, 351, 371, 409, 444, 447, 448 Ureteral calculus, 95–96 Urethritis, 272, 274, 320–322, 435 Urge incontinence, 231, 431, 435, 436 Uric acid stones, 95, 199 Urinalysis hematuria, 229 proteinuria, 229 Urinary incontinence, 14, 233, 253, 337, 351, 435–436 Urinary tract infection, 85, 86, 272–275, 290, 304, 387, 473, 474 recurrent, 87, 273 Urine chloride, 90 Urine electrolytes, 77, 78, 88, 90, 92, 93, 396 Urine net charge (UNC), 88 Urticaria, 180, 191, 289, 409, 412, 422, 423 Usual interstitial pneumonia, 18, 19 V Vaccination, 2, 5, 9, 146, 147, 164, 266, 280, 281, 294, 297, 304, 416 Vaginitis, 273, 299, 435 Valacyclovir, 256, 297, 348, 416 Valganciclovir, 298 541 Valsalva maneuver, 40, 51, 66, 100, 355, 366, 455 Valvular cardiomyopathy, 38, 104, 471 Valvular diseases aortic regurgitation, 4, 11, 66 aortic sclerosis, 54 aortic stenosis, 4, 27, 28, 37, 38, 446, 485 mitral regurgitation, 29, 54 mitral stenosis, 4, 353, 470 mitral valve prolapse, 60 in pregnancy, 471 rheumatic fever, 54 tricuspid regurgitation, 222 Vancomycin, 9, 61, 62, 97, 108, 112, 137, 138, 167, 181, 264, 271, 276, 277, 279, 283, 287–290, 311, 359, 414, 422, 474, 507 dosing, 138, 283 Vancomycin resistant enterococci (VRE), 283, 286, 287, 304 Varicella zoster virus (VZV), 143, 162, 202, 263, 269, 270, 297, 298, 347, 414, 415, 416 Vascular dementia, 429, 430 Vasoocclusive pain crisis, 164 Vasopressors, 109, 110, 111, 112, 120, 414, 423, 470 Vasovagal syncope, 351, 354, 491 Venous filling time, 61 Venous insufficiency, 63, 176, 275 Venous thromboembolism, 10, 99, 173, 174, 466, 467, 469–470, 489 in pregnancy, 469 Venous ulcers, 416 Ventilation indications, 105–108 modes, 106–107 settings, 106–107 weaning, 107 Verruca vulgaris, 421 Vertebral osteomyelitis, 278 Vertigo, 115, 328, 345, 347, 348, 351, 357, 358, 361, 434 Vesicles, 232, 322, 348, 412, 414, 416 Vestibular ataxia, 361 542 Vestibular neuronitis, 357 Vincristine, 90, 166, 189, 192, 195, 248, 255, 336, 371, 421, 423 Vinorelbine, 205–207, 211, 214, 248, 255 Viral load, 148, 291, 294, 295, 473 Virchow’s node, 215, 217 Virchow’s triad, 10 Virilization, 397, 407, 408 Visual field defects, 346, 407 Vitamin B12 deficiency, 140, 141, 161–163, 218, 349, 362, 377, 430, 459–460 Vitamin deficiency, 89, 94, 95, 141, 163, 371 Von Hippel–Lindau syndrome, 229, 244 Von Willebrand’s disease, 170–172, 490 Voriconazole, 299, 301–303 V/Q mismatch, 102–104, 151 W Waldenstrom’s macroglobulemia, 198 Wallenberg syndrome, 346 Warfarin, 11, 15, 33, 47, 48, 55, 59, 169–172, 174, 175, 178, 180, 324, 437, 438, 469, 470, 488, 490 Warts, 224, 421 Weakness Guillain–Barré syndrome, 99 ICU, 99 inflammatory myopathies, 377 Lambert–Eaton syndrome, 360 multiple sclerosis, 347, 349–350 myasthenia gravis, 207, 360, 377 stroke/TIA, 339 Weber test, 345, 359 Wegener’s granulomatosis (WG), 38, 326, 330, 332 Weight gain, 20, 39, 96, 153, 188, 209, 212, 213, 234, 249, 386, 389, 390, 397, 399, 407, 450, 481 Index Weight loss, 12, 15, 16, 20, 21, 61, 67, 120, 124, 127, 128, 130, 131, 139, 140, 145, 155, 159–161, 163, 166, 168, 184, 189, 191, 192, 194, 199, 203, 205–207, 209, 215–217, 219, 224, 225, 227, 229–231, 234, 254, 259, 261, 263, 266, 280, 315, 317, 318, 322, 328, 329, 355, 356, 362, 366, 382, 387, 391, 392, 398, 405–408, 427, 436, 440, 449–451, 457–460, 463, 471, 476, 482–484 Well’s criteria, 11, 176 pulmonary embolism, 11 Well’s criteria for DVT, 176 Wernicke’s aphasia, 343 Wernicke’s encephalopathy, 119 West Nile virus encephalitis, 271 Wheezing asthma exacerbation, 1, 486 COPD exacerbation, 4, 487 Whipple’s disease, 259, 312–314, 319, 484 Whipple’s procedure, 226 Whipple’s triad, 389 Wilson’s disease, 89, 144, 145, 149, 150, 324, 362 Wolff–Parkinson–White syndrome, 49, 74, 76 Wrist examination, 333, 360 X Xanthelasma, 70, 72, 156 Y Yersinia, 134, 137, 138, 266, 282, 293, 313, 321, 482 Z Zanamivir, 297, 298