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60 • realisctaiscew si tcho ncidsies cussions prepayroeu f ort hef amilmye dicine clerksahnidps helefx am • Clinipceaalr lcsa,s ceo rrelatainodn s, Q&Asr einfolrecaer ning • Primetre achyeosu h owt oa pproacclhi nical probleamnsd t ransittioto hne w ards TOY BRISCOE BRITTON HEIDELBAUGH • • • • Eapm C. Ta,; MD Broce Brittml, MD Alai•tanfort EDducealaltio nal Programt Profasofo Fra miMlediciyn e and Community Profuaor and Vke ChaoifMr ed icedaucationl Medicine Deartmenp to fO betetria and Gynecology FamiMlediciyn e Director ofM edicSamld ent McGoveMrend iSccahlo aotTl h eU ninraityEd w::ation ofexaTa HealStcihe nCenctere at Houaton Department ofFam ilyand Community (UTHcaltb) Medicine HcU8Wn. Teaa Ea.um VirginMedicali a School Norfolk. V.irginja Donald Briscoe, MD, PAAPP Director, � MediciReaidencnye ProJP'2M Joel.J.Heidelbi mP., MD, FAAFPF,A CG and Chair ClinP.iarofeuolr Dep�t of FamilyMedicine . Hou•ton Departmenta of FamiMlediciyn e and Urology MethodHioai.tp ital C1erlcabip Director Family Medicine ClDirectore rbhip Department ofF amiMedicinel y Texu A&M Collrge of Medicine- Hou.ton Univenity of Mkhipn Medical School C:ampua Ann Arbor, Michipn Chief MedicOafD.cer.l Vecino Health C-enter1 A.JOciate ProfaaoofrC linFamily.ia l Medicine Hcuaccn Methodia lnltitutz fur Aadcmic Medicine Hou.ton. Temu New York Chkago SanF=id& co Athma London Madrid Mmco CityMilan New Delhi SinpporSydneye Torontu Copyri©g h2t0 16b yM cGraw-HiEldlu catioAnl.lr ightress ervedE.x cepatsp ermittuendd ethre UniteSdt ates CopyriAgchtot f 1 976n,op arto fth isp ublicamtaiybo enr eproduocrde ids tribuitnane yd fo rmo rb yan y meanso,r storienad d atabasree troire svyaslt ewmi,th outhte p riworri ttpeenr missoiftho enp ublisher. ISBN9:7 8-1-25-958302-5 MHID: 1-25-958302-3 Them ateriinath li se Booakl saop pearsi nth ep rivnetr sioofthn i sti tlIeS:B N9:7 8-1-25-958770-2, MHID: 1-25-958770-3. eBoocko nversbiyco ond eMantra Versi1o.n0 Alltr ademarkasr etra demarkso fth eirre specotiwvnee rRsa.th ethran puta trademark syamftbeoerlv eroyc urcrence ofa tradem arked namew,e u sen amesi nan editofarsihailo onn lyan,d toth e beneofiftt hetr ademarokw newri, thn o intentioofin n fringemoefthn ettr ademarkW.h erseu cdhe signatiaopnpesa irn th isb ookt,h ehya vbee epnr intweidth initicaalp s. McGraw-Hill Educatioarne aevBaoiolkasab tls ep eciqaulan tityd iscounttosu seas premiumansd sales promotioorfon rsu sei nc orporatratien inpgr ograTmosc .o ntaacr te presentpalteiavvsiees, ti hteC ontaUcstp agaet www.mhprofessional.com. Previeoduisti ocnosp'y ri©g 2h0t12, 2200100b7,y T heM cGraw-HCiolmlp anieInsc,.A lrli ghrtess erved. CasFei leiss®a r egisttreardeedm arokf M cGraw-HEidlulc atGiloonb Halo ldinLgLsC,.A lrli ghrtess erved. Notice Mediciinsane ever-changisncgi enAcsen .e wr esearancdh cliniecxaple riebnrcoea doeunrkn owledgceh,an geisn treatmentan d drug therapayr ree quirTehdea .u thoransd thep ublisohfthe irsw orhka vceh eckweidth s ourcbeesl ieved tob er eliaibnthl eei erff orttosp roviidnefo rmatthiaotin s c ompleantde g enerailnacl cyo rwdi thth es tandaarcdc epted atth et imoef p ublicaHtioowne.v eirnv, i eowf th ep ossiboiflh iumant y erroorrc hangeisnm edicsacli encneesi,th er thee ditnoorrsth ep ublisnhoeranr y otherp artyw hoh asb eeinn volivneth de p reparatioorpn u blicaotfthi iosnw ork warrantsth atth e informatcioonnt ainheedr eiinsi ne verrye speacctc uraotrce o mpleantde ,th eyd isclaalilm responsifobri anlyi teyr roorrso missioornfo sr ther esuolbttsa infreodm useo fth e informaticoonn taiinneth di s workR.e adearres e ncouratgoec do nfirmth e informaticoonn taihneerde wiinth o thers ourcFeosr.e xampanlde in particularr,e adearresa dvisteocd h ecthke p roduicntfo rmatisohne eitn cluidneth de p ackaogfee acdrhu gth eyp lant o adminitsotb eecr e rtthaaitnth e informatcioonnt aiinnthe ids w orki sa ccuraantde t hacth angehsa vneo tb eemna dei n ther ecommenddoesdoe r i nth ec ontraindicatifoorna sd ministraTthiirosen c.o mmendaitsoi fpo arnt icuilmarp ortance inc onnectiwointhn ewo ri nfrequenutsleydd r ugs. TERMSO F USE Thiiss a copyrighwtoerdkan d McGraw-HEidlulc atianodn itlsi censroersse ravlerl i ghitnas n dt oth e workU.s e ofth isw orki ss ubjetcott h estee rmsE.x cepatsp ermitutnedde thre CopyriAgchtto f1 976an d the rightots tore and retrieovneec opoyf th e worky,o um ayn otd ecompidlies,a ssemrbelvee,re sneg inereerp,r odumcoed,i fyc,r eate derivawtiovrek bsa seudp ontr,an smitd,i stribudties,s eminsaetlpelu,,b liosrsh u blictheen sweo rko ran y parto fi t withoMuctG raw-HEidlulc atiopnr'isoc ro nseYnotu.m ayu seth e workfo r youorw nn oncommerancdi aple rsonal usean;y otheru seo fth ew orki ss trictplroyh ibiYtoeurdri. g thotu set hweo rkma yb et erminiafty eodufa ilt oc omply witthhe set erms. THE WORK ISP ROVIDED "AS IS.M"c GRAW-HILLE DUCATION AND ITSL ICENSORSM AKE NO GUARANTEESO R WARRANTIES AS TO THE ACCURACYA,D EQUACYO R COMPLETENESSO F OR RESULTST O BEO BTAINED FROM USING THE WORK,IN CLUDING ANY INFORMATIONT HAT CAN BE ACCESSETDH ROUGHTHE WORK VIAH YPERLINK OR OTHERWISEAND, EXPRESSLDYI SCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESFSO RA PARTICULARP URPOSE. McGraw-Hillan dE idtulsci actieonns ors don otw arrant orguar antee thathte fu nctiocnosn taiinnthe edw orkw ilmle eyto urre quiremoerthn attsi tosp eration wilble u ninterrourpe trreodfrr ee .N eitheMrc Graw-HEidlulc atinoonri tlsi censsohrasbl ell iabtloye o uo ran yone elsfoer any inaccurearrcoyor, r o missiroeng,ar dloefsc sa usien,th e worko rfo ra nyd amagerse sultithnegr efrom. McGraw-HEidlulc athiaosnn o r esponsifobrith leic toyn teonfant y informatiaocnc esthsreodu gthhe w orkU.n denro circumstsanhcaeMlscl G raw-Hill Eduancd/aotirio tnls i censboelr isa bfolrean y indirect, isnpceicdipeaunlnt,ia tilv,e , consequeonrts iiamli ldara magtheast r esufrlotm th e useo fo ri nabitloiu tsyeth ew orke,v einf an y oft hemh asb een advisoefthd e possiboifls iutyc dham agesT.h ilsi mitaotifol ni abishlalilta yp pltyoan y claiomrc ausweh atsoever whethseurc chl aiomrc ausarei seisnc ontractto,r otro therwise. DEDICATION Tom yi ncredeidbiltCeoa rt herJionhen swohno,s iem aginaktnioownns o b ounds, whosceo mpasshiaonsno l imiatnsdw, h osber illiisaan w coen detrob ehold. Ih avbee esnof ortutnoah taevy eo ua sm yo nea ndo nleyd itfootrrh eCsaes Fei lbeoso ks. Youh avbee efnr ieenndc,o uraagnedor c,c asiboenaarolef tr h weh ip. Ours ucceasrsleea sr gdeulety o y oua ndI w ilall wabyesi ndebttoey do u. -ECT Tom yf rieannddsc olleaagtHu oepsi tSaali nNti colianSs t M.a rca ndH opital UniversJiutsatiirniein Ce anpH aitiHeani,t i. -DB Tot hset udernetssi,d efnatcsu,la tnydp ,a tieonfEt VsM S:t hbee stte achIec rosu ld evehra ve. Andt oM aya ndS eanf:ot rh eiinr.fi npiattei eanncdle o ve. -BB Tom ys tudeanntdrs e sidwehnott se amceha sm ucha sI stritvote e atchhe m. Tom yd edicactoeldl eaignau ceasd efmiacm imleyd icwihnoei nspmiert eob ecomae greatteearc ahnedrc linician. ToJ acquGiw,y netahn,dL ilfyoalr o vianngds uppormtei.n g -JJH This page intentionally left blank CONTENTS ContriIbv uitio rs PrefIi axc e AcknowleIdx g ments IntrodIxu ic tion SectiIo n Howt oA pproaCclhi niPcraolb lems 1 ................................................................... Par1t.A pproatcoht heP atient 2 ................................................................................................. Par2t.A pproatcohC liniPcraolb lSeoml vi.n..g. ............................ 7 ............. .. .... ................ .. . Par3t.A pproatcohR eading 8 ...................................................................................................... SectiIoIn ListionfCg a ses 13 .•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...• ListbiynC ga sNeu mber.. ..............................................1.5 .............. .. .... ................ .. .... ................ .. ListibnyDg i sorder (Alphabetical) 16 .......................................................................................... SectiIolnl CliniCcaasle s 19 ••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...• SixCtays Sec enar.i.o.s. ................................................................2..1.. ................... ......................... SectiIoVn RevieQwu estions 659 ...................................................................................................................... IndIe x6 71 This page intentionally left blank CONTRIBUTORS JessK.i cAnad rewsM,D ChieRfe sidePnotr,t smouFtahm ilMye dicine EasteVrinr ginia MSecdhiocoall PortsmouVtihr,g inia CongesHteiavreFt a ilure FamiPllya nning-Contraceptives MajoDre pression PostparCtaurme SanIa.Kh an,D O ResideFnatm,i lMye diciRnees idePnrcoyg ram HoustoMne thodiHsots pital Houston, Texas ChesPta in ElectrDoilsyotred ers GeriaHterailcMt ahi ntenance HealMtahi ntenainnAc deu lFte male Hematuria Laboarn dD elivery MusculoskIenljeutraile s SkiLne sions ThyroiDdi sorders UppeRre spiraItnofreyc tions SteveLne]w.i MsD,, M PH ChieRfe sidePnotr,t smouFtahm ilMye dicine EasterVni rgiMneidai cSaclh ool NorfolkV,i rginia FamiVliyeo nlce Hyperlipidemia MigraiHneea dache Obesity William F.M ollenkoMpf,D ResidePnotr,t smoFuatmhi Mleyd icine EasteVrinr ginia MSecdhiocoall PortsmouVtihr,g inia ChronKiicd nDeiys ease LoweGra strointBelseteidnianlg Pneumonia Vaginitis vii viiiC ONTRIBUTORS DustMya riNea rducciM,D Resident, Family Medicine Residency Program HoustoMne thodiHsots pital HoustoTne,x as AcutDei arrhea AdulMta lHee alMtahi ntenance AlleDrigsiocr ders Dyspnea (COhbrsotnriucPc utlimvoen Dairsye ase) GeriaAtnreimci a JoiPnati n MedicEatlh ics PrenaCtaarle TobaUcsceo Well-CChairled TuanD .N guyen, MD, MPH, MBA Resident, Family MediPcrionger aRme sidency HoustoMne thodiHsots pital HoustoTne,x as ElectrDoilsyotred ers KartikS idhar MedicSatlu dent Classo f2 016 UniverosifMt iyc higMaend icSaclh ool AnnA rboMri,c higan CerebrovaAscccuildaern t/TIrsancshieAemtnittca ck HIV,A IDSa,n dO theSre xuaTlrlayn smiItntfeedc tions Palpitations Stianngd B itIen juries SubstaAnbcues e Elizabeth R.C ochrWaanr dM,D ,M appScMiB,B S( Hons} ResidePnotrt,s moutFha miMley dicine EasteVrinr giMneidai cSaclh ool NorfolkV,i rginia AbdomiPnaailan n dV omitiinna gC hild AdolesHceeanltMt ahi ntenance Dementia Hypertension SheBa. Wi ckland MedicSatlu dent Clasosf2 016 UniverosifMt iyc higMaend icSaclh ool AnnA rboMri,c higan ChronPiaciM na nagement LoweErx tremEidteym a ObstruSclteiAevppen ea Osteoporosis WheezianngdA sthma PREFACE We apprecailatlth eek inrde maraknsd s uggestfrioomnt sh em anym edicsatlu dents ovetrh ep as3t y earYso.u rp ositrievcee pthiaosbn e ena ni ncredeinbcloeu rage­ mente,s peciianll ilgyoh ftt hes horlti feo ft heC asFei lesseCPJr iIenst .h ifosu rtehd i­ tioonfC asFei leFsaCPJm:i Mleyd icitnheeb, a sifocr mato ft heb ookha sb eerne tained. Improvemewnetrsem adei nu pdatimnagn yo ft hec hapteNresw. c aseisn clude SubstaAnbcues eA,s thmSal,e eApp neaO,s teoporCohsriosn,Pi aci Mna nagement, andL egS welliWneg r.e viewtehdec linisccaeln arwiiotsth h ei nteonfti mproving themh;o wevetrh,e "irre al-plriefes"e ntaptaitotnesr anfteedar c tucalli niecxaple ri­ encwee rea ccuraatnedi nstrucThtei vmeu.l tiple-cqhuoeisctei( oMnCsQ s)h ave beecna refurlelvyi ewaenddr ewritttoee nns utrhea tth ecyo mplwyi tthh eN ational Boaradn dU SMLE formatT.h rougthh ifosu rtehd itiwoenh ,o pet hatth er eader wilclo ntintuoee n jolye arndiinagg noasnidms a nagemetnhtr outghhe s imulated cliniccaasleI stc. e rtaiinsl pyar ivitleobg eet eachfoerrs so m anys tudenatnsdi, ti s withhu militthyaw te p resetnhtie sd ition. ix

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with altered mental status or a head injury, pupillary size, symmetry, and . including the low-density lipoprotein (LDL) levels, which have prognostic testing. For example, a patient who complains of upper abdominal pain and . For instance, with breast cancer, an annual or biannual mammogram is.
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60 • realisctaiscew si tcho ncidsies cussions prepayroeu f ort hef amilmye dicine clerksahnidps helefx am • Clinipceaalr lcsa,s ceo rrelatainodn s, Q&Asr einfolrecaer ning • Primetre achyeosu h owt oa pproacclhi nical probleamnsd t ransittioto hne w ards TOY BRISCOE BRITTON HEIDELBAUGH • • • • Eapm C. Ta,; MD Broce Brittml, MD Alai•tanfort EDducealaltio nal Programt Profasofo Fra miMlediciyn e and Community Profuaor and Vke ChaoifMr ed icedaucationl Medicine Deartmenp to fO betetria and Gynecology FamiMlediciyn e Director ofM edicSamld ent McGoveMrend iSccahlo aotTl h eU ninraityEd w::ation ofexaTa HealStcihe nCenctere at Houaton Department ofFam ilyand Community (UTHcaltb) Medicine HcU8Wn. Teaa Ea.um VirginMedicali a School Norfolk. V.irginja Donald Briscoe, MD, PAAPP Director, � MediciReaidencnye ProJP'2M Joel.J.Heidelbi mP., MD, FAAFPF,A CG and Chair ClinP.iarofeuolr Dep�t of FamilyMedicine . Hou•ton Departmenta of FamiMlediciyn e and Urology MethodHioai.tp ital C1erlcabip Director Family Medicine ClDirectore rbhip Department ofF amiMedicinel y Texu A&M Collrge of Medicine- Hou.ton Univenity of Mkhipn Medical School C:ampua Ann Arbor, Michipn Chief MedicOafD.cer.l Vecino Health C-enter1 A.JOciate ProfaaoofrC linFamily.ia l Medicine Hcuaccn Methodia lnltitutz fur Aadcmic Medicine Hou.ton. Temu New York Chkago SanF=id& co Athma London Madrid Mmco CityMilan New Delhi SinpporSydneye Torontu Copyri©g h2t0 16b yM cGraw-HiEldlu catioAnl.lr ightress ervedE.x cepatsp ermittuendd ethre UniteSdt ates CopyriAgchtot f 1 976n,op arto fth isp ublicamtaiybo enr eproduocrde ids tribuitnane yd fo rmo rb yan y meanso,r storienad d atabasree troire svyaslt ewmi,th outhte p riworri ttpeenr missoiftho enp ublisher. ISBN9:7 8-1-25-958302-5 MHID: 1-25-958302-3 Them ateriinath li se Booakl saop pearsi nth ep rivnetr sioofthn i sti tlIeS:B N9:7 8-1-25-958770-2, MHID: 1-25-958770-3. eBoocko nversbiyco ond eMantra Versi1o.n0 Alltr ademarkasr etra demarkso fth eirre specotiwvnee rRsa.th ethran puta trademark syamftbeoerlv eroyc urcrence ofa tradem arked namew,e u sen amesi nan editofarsihailo onn lyan,d toth e beneofiftt hetr ademarokw newri, thn o intentioofin n fringemoefthn ettr ademarkW.h erseu cdhe signatiaopnpesa irn th isb ookt,h ehya vbee epnr intweidth initicaalp s. McGraw-Hill Educatioarne aevBaoiolkasab tls ep eciqaulan tityd iscounttosu seas premiumansd sales promotioorfon rsu sei nc orporatratien inpgr ograTmosc .o ntaacr te presentpalteiavvsiees, ti hteC ontaUcstp agaet www.mhprofessional.com. Previeoduisti ocnosp'y ri©g 2h0t12, 2200100b7,y T heM cGraw-HCiolmlp anieInsc,.A lrli ghrtess erved. CasFei leiss®a r egisttreardeedm arokf M cGraw-HEidlulc atGiloonb Halo ldinLgLsC,.A lrli ghrtess erved. Notice Mediciinsane ever-changisncgi enAcsen .e wr esearancdh cliniecxaple riebnrcoea doeunrkn owledgceh,an geisn treatmentan d drug therapayr ree quirTehdea .u thoransd thep ublisohfthe irsw orhka vceh eckweidth s ourcbeesl ieved tob er eliaibnthl eei erff orttosp roviidnefo rmatthiaotin s c ompleantde g enerailnacl cyo rwdi thth es tandaarcdc epted atth et imoef p ublicaHtioowne.v eirnv, i eowf th ep ossiboiflh iumant y erroorrc hangeisnm edicsacli encneesi,th er thee ditnoorrsth ep ublisnhoeranr y otherp artyw hoh asb eeinn volivneth de p reparatioorpn u blicaotfthi iosnw ork warrantsth atth e informatcioonnt ainheedr eiinsi ne verrye speacctc uraotrce o mpleantde ,th eyd isclaalilm responsifobri anlyi teyr roorrso missioornfo sr ther esuolbttsa infreodm useo fth e informaticoonn taiinneth di s workR.e adearres e ncouratgoec do nfirmth e informaticoonn taihneerde wiinth o thers ourcFeosr.e xampanlde in particularr,e adearresa dvisteocd h ecthke p roduicntfo rmatisohne eitn cluidneth de p ackaogfee acdrhu gth eyp lant o adminitsotb eecr e rtthaaitnth e informatcioonnt aiinnthe ids w orki sa ccuraantde t hacth angehsa vneo tb eemna dei n ther ecommenddoesdoe r i nth ec ontraindicatifoorna sd ministraTthiirosen c.o mmendaitsoi fpo arnt icuilmarp ortance inc onnectiwointhn ewo ri nfrequenutsleydd r ugs. TERMSO F USE Thiiss a copyrighwtoerdkan d McGraw-HEidlulc atianodn itlsi censroersse ravlerl i ghitnas n dt oth e workU.s e ofth isw orki ss ubjetcott h estee rmsE.x cepatsp ermitutnedde thre CopyriAgchtto f1 976an d the rightots tore and retrieovneec opoyf th e worky,o um ayn otd ecompidlies,a ssemrbelvee,re sneg inereerp,r odumcoed,i fyc,r eate derivawtiovrek bsa seudp ontr,an smitd,i stribudties,s eminsaetlpelu,,b liosrsh u blictheen sweo rko ran y parto fi t withoMuctG raw-HEidlulc atiopnr'isoc ro nseYnotu.m ayu seth e workfo r youorw nn oncommerancdi aple rsonal usean;y otheru seo fth ew orki ss trictplroyh ibiYtoeurdri. g thotu set hweo rkma yb et erminiafty eodufa ilt oc omply witthhe set erms. THE WORK ISP ROVIDED "AS IS.M"c GRAW-HILLE DUCATION AND ITSL ICENSORSM AKE NO GUARANTEESO R WARRANTIES AS TO THE ACCURACYA,D EQUACYO R COMPLETENESSO F OR RESULTST O BEO BTAINED FROM USING THE WORK,IN CLUDING ANY INFORMATIONT HAT CAN BE ACCESSETDH ROUGHTHE WORK VIAH YPERLINK OR OTHERWISEAND, EXPRESSLDYI SCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESFSO RA PARTICULARP URPOSE. McGraw-Hillan dE idtulsci actieonns ors don otw arrant orguar antee thathte fu nctiocnosn taiinnthe edw orkw ilmle eyto urre quiremoerthn attsi tosp eration wilble u ninterrourpe trreodfrr ee .N eitheMrc Graw-HEidlulc atinoonri tlsi censsohrasbl ell iabtloye o uo ran yone elsfoer any inaccurearrcoyor, r o missiroeng,ar dloefsc sa usien,th e worko rfo ra nyd amagerse sultithnegr efrom. McGraw-HEidlulc athiaosnn o r esponsifobrith leic toyn teonfant y informatiaocnc esthsreodu gthhe w orkU.n denro circumstsanhcaeMlscl G raw-Hill Eduancd/aotirio tnls i censboelr isa bfolrean y indirect, isnpceicdipeaunlnt,ia tilv,e , consequeonrts iiamli ldara magtheast r esufrlotm th e useo fo ri nabitloiu tsyeth ew orke,v einf an y oft hemh asb een advisoefthd e possiboifls iutyc dham agesT.h ilsi mitaotifol ni abishlalilta yp pltyoan y claiomrc ausweh atsoever whethseurc chl aiomrc ausarei seisnc ontractto,r otro therwise. DEDICATION Tom yi ncredeidbiltCeoa rt herJionhen swohno,s iem aginaktnioownns o b ounds, whosceo mpasshiaonsno l imiatnsdw, h osber illiisaan w coen detrob ehold. Ih avbee esnof ortutnoah taevy eo ua sm yo nea ndo nleyd itfootrrh eCsaes Fei lbeoso ks. Youh avbee efnr ieenndc,o uraagnedor c,c asiboenaarolef tr h weh ip. Ours ucceasrsleea sr gdeulety o y oua ndI w ilall wabyesi ndebttoey do u. -ECT Tom yf rieannddsc olleaagtHu oepsi tSaali nNti colianSs t M.a rca ndH opital UniversJiutsatiirniein Ce anpH aitiHeani,t i. -DB Tot hset udernetssi,d efnatcsu,la tnydp ,a tieonfEt VsM S:t hbee stte achIec rosu ld evehra ve. Andt oM aya ndS eanf:ot rh eiinr.fi npiattei eanncdle o ve. -BB Tom ys tudeanntdrs e sidwehnott se amceha sm ucha sI stritvote e atchhe m. Tom yd edicactoeldl eaignau ceasd efmiacm imleyd icwihnoei nspmiert eob ecomae greatteearc ahnedrc linician. ToJ acquGiw,y netahn,dL ilfyoalr o vianngds uppormtei.n g -JJH This page intentionally left blank CONTENTS ContriIbv uitio rs PrefIi axc e AcknowleIdx g ments IntrodIxu ic tion SectiIo n Howt oA pproaCclhi niPcraolb lems 1 ................................................................... Par1t.A pproatcoht heP atient 2 ................................................................................................. Par2t.A pproatcohC liniPcraolb lSeoml vi.n..g. ............................ 7 ............. .. .... ................ .. . Par3t.A pproatcohR eading 8 ...................................................................................................... SectiIoIn ListionfCg a ses 13 .•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...• ListbiynC ga sNeu mber.. ..............................................1.5 .............. .. .... ................ .. .... ................ .. ListibnyDg i sorder (Alphabetical) 16 .......................................................................................... SectiIolnl CliniCcaasle s 19 ••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...•••...• SixCtays Sec enar.i.o.s. ................................................................2..1.. ................... ......................... SectiIoVn RevieQwu estions 659 ...................................................................................................................... IndIe x6 71 This page intentionally left blank CONTRIBUTORS JessK.i cAnad rewsM,D ChieRfe sidePnotr,t smouFtahm ilMye dicine EasteVrinr ginia MSecdhiocoall PortsmouVtihr,g inia CongesHteiavreFt a ilure FamiPllya nning-Contraceptives MajoDre pression PostparCtaurme SanIa.Kh an,D O ResideFnatm,i lMye diciRnees idePnrcoyg ram HoustoMne thodiHsots pital Houston, Texas ChesPta in ElectrDoilsyotred ers GeriaHterailcMt ahi ntenance HealMtahi ntenainnAc deu lFte male Hematuria Laboarn dD elivery MusculoskIenljeutraile s SkiLne sions ThyroiDdi sorders UppeRre spiraItnofreyc tions SteveLne]w.i MsD,, M PH ChieRfe sidePnotr,t smouFtahm ilMye dicine EasterVni rgiMneidai cSaclh ool NorfolkV,i rginia FamiVliyeo nlce Hyperlipidemia MigraiHneea dache Obesity William F.M ollenkoMpf,D ResidePnotr,t smoFuatmhi Mleyd icine EasteVrinr ginia MSecdhiocoall PortsmouVtihr,g inia ChronKiicd nDeiys ease LoweGra strointBelseteidnianlg Pneumonia Vaginitis vii viiiC ONTRIBUTORS DustMya riNea rducciM,D Resident, Family Medicine Residency Program HoustoMne thodiHsots pital HoustoTne,x as AcutDei arrhea AdulMta lHee alMtahi ntenance AlleDrigsiocr ders Dyspnea (COhbrsotnriucPc utlimvoen Dairsye ase) GeriaAtnreimci a JoiPnati n MedicEatlh ics PrenaCtaarle TobaUcsceo Well-CChairled TuanD .N guyen, MD, MPH, MBA Resident, Family MediPcrionger aRme sidency HoustoMne thodiHsots pital HoustoTne,x as ElectrDoilsyotred ers KartikS idhar MedicSatlu dent Classo f2 016 UniverosifMt iyc higMaend icSaclh ool AnnA rboMri,c higan CerebrovaAscccuildaern t/TIrsancshieAemtnittca ck HIV,A IDSa,n dO theSre xuaTlrlayn smiItntfeedc tions Palpitations Stianngd B itIen juries SubstaAnbcues e Elizabeth R.C ochrWaanr dM,D ,M appScMiB,B S( Hons} ResidePnotrt,s moutFha miMley dicine EasteVrinr giMneidai cSaclh ool NorfolkV,i rginia AbdomiPnaailan n dV omitiinna gC hild AdolesHceeanltMt ahi ntenance Dementia Hypertension SheBa. Wi ckland MedicSatlu dent Clasosf2 016 UniverosifMt iyc higMaend icSaclh ool AnnA rboMri,c higan ChronPiaciM na nagement LoweErx tremEidteym a ObstruSclteiAevppen ea Osteoporosis WheezianngdA sthma PREFACE We apprecailatlth eek inrde maraknsd s uggestfrioomnt sh em anym edicsatlu dents ovetrh ep as3t y earYso.u rp ositrievcee pthiaosbn e ena ni ncredeinbcloeu rage­ mente,s peciianll ilgyoh ftt hes horlti feo ft heC asFei lesseCPJr iIenst .h ifosu rtehd i­ tioonfC asFei leFsaCPJm:i Mleyd icitnheeb, a sifocr mato ft heb ookha sb eerne tained. Improvemewnetrsem adei nu pdatimnagn yo ft hec hapteNresw. c aseisn clude SubstaAnbcues eA,s thmSal,e eApp neaO,s teoporCohsriosn,Pi aci Mna nagement, andL egS welliWneg r.e viewtehdec linisccaeln arwiiotsth h ei nteonfti mproving themh;o wevetrh,e "irre al-plriefes"e ntaptaitotnesr anfteedar c tucalli niecxaple ri­ encwee rea ccuraatnedi nstrucThtei vmeu.l tiple-cqhuoeisctei( oMnCsQ s)h ave beecna refurlelvyi ewaenddr ewritttoee nns utrhea tth ecyo mplwyi tthh eN ational Boaradn dU SMLE formatT.h rougthh ifosu rtehd itiwoenh ,o pet hatth er eader wilclo ntintuoee n jolye arndiinagg noasnidms a nagemetnhtr outghhe s imulated cliniccaasleI stc. e rtaiinsl pyar ivitleobg eet eachfoerrs so m anys tudenatnsdi, ti s withhu militthyaw te p resetnhtie sd ition. ix

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with altered mental status or a head injury, pupillary size, symmetry, and . including the low-density lipoprotein (LDL) levels, which have prognostic testing. For example, a patient who complains of upper abdominal pain and . For instance, with breast cancer, an annual or biannual mammogram is.
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