IM Essentials Text

482 Pages·2015·34.835 MB·English

by  Philip A. Masters et al.

I
Designed for the Internal Medicine Clerkship
IM Essentials §2
A Medical KnowledgQ Self-Assessment Program® (MKSAP®) rot Students
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Philip A. Masters, MD, FACP
Senior Physician Educator
American College of Physicians
Editor-in-Chief
BACP
CDIM
American College of Physicians Clerkship Directors in Internal Medicine

Contents
Foreword ...........................................................................................ill 3 Gastroenterology and Hepatology
Contributing Authors ...................................................................vi
High Value Care Recommendations........................................72
16 Approach to Abdominal Pain ...........................................73
I Cardiovascular Medicine Seth Politano, DO and Eric Hsieh, MD
17 Dyspepsia ................................................................................78
High Value Care Recommendations............................................2
Chad S. Miller, MD
1 Approach to Chest Pain .........................................................3
18 Gastroesophageal Reflux Disease......................................81
Eric Goren, MD
Corina Ungureanu, MD
2 Chronic Stable Angina...........................................................6
19 Peptic Ulcer Disease..............................................................84
John Varras, MD
Karen Szauter, MD
3 Acute Coronary Syndrome...................................................11
20 Approach to Liver Chemistry Tests .................................86
Michael Picchioni, MD
Jonathan S. Appelbaum, MD
4 Conduction Blocks and Bradyarrhythmias....................15
21 Hepatitis ...................................................................................89
Robert Trowbridge, MD
Carlos Palacio, MD
5 Supraventricular Arrhythmias .........................................18
22 Cirrhosis...................................................................................93
ChadS. Miller, MD
MarkJ. Fagan, MD
6 Ventricular Arrhythmias......................................................23
23 Diseases of the Gallbladder and Bile Ducts ..................98
Robert Trowbridge, MD
Nora L. Porter, MD
7 Heart Failure ...........................................................................27
24 Acute Pancreatitis................................................................101
Alpesh N. Amin, MD
Nora L. Porter, MD
8 Valvular Heart Disease.........................................................32
25 Approach to Diarrhea........................................................104
H. Douglas Walden, MD
Lynda Misra, DO
9 Vascular Disease......................................................................37
26 Inflammatory Bowel Disease...........................................109
Leigh Simmons, MD and Robert Trowbridge, MD
Susan T. Hingle, MD
27 Approach to Gastrointestinal Bleeding.........................113
2 Endocrinology and Metabolism Gauri Agarwal, MD
High Value Care Recommendations.........................................44
10 Hypothalamic and Pituitary Disorders .........................45 4 General Internal Medicine
Eric Goren, MD
High Value Care Recommendations......................................118
11 Thyroid Disease......................................................................48
28 Diagnostic Decision Making ............................................119
Nona Kwong, MD and Erik K. Alexander, MD
D. Michael Elnicki, MD
12 Adrenal Disease......................................................................54
29 Therapeutic Decision Making .........................................123
Cynthia A. Bums, MD
Brian Heist, MD and D. Michael Elnicki, MD
13 Diabetes Mellitus...................................................................60
30 Health Promotion, Screening, and Prevention .........127
Nona Kwong, MD and ErikK. Alexander, MD
L. James Nixon, MD and Briar Duffy, MD
14 Diabetic Ketoacidosis and Hyperglycemic
31 Hypertension........................................................................132
Hyperosmolar Syndrome....................................................65
Thomas M. DeFer, MD
Nona Kwong, MD and Erik K Alexander, MD
32 Dyslipidemia ........................................................................136
15 Osteoporosis ...........................................................................67
Gary Tabas, MD and D. Michael Elnicki, MD
Mark D. Corriere, MD
33 Obesity....................................................................................141
L. James Nixon, MD and Briar Duffy, MD
34 Approach to Low Back Pain..............................................144
Sarita Worrier, MD

35 Approach to Cough.............................................................148 58 Tuberculosis......................................................................245
Kendall Novoa-Takara, MD Bipin Thapa, MD
36 Smoking Cessation.............................................................152 59 Infective Endocarditis............................................................249
Nadia Ismail, MD Fred A. Lopez, MD
37 Depression..............................................................................156 60 Urinary Tract Infection......................................................252
Karen E. Kirkham, MD Irene Alexandraki, MD
38 Substance Abuse...................................................................160 61 Sexually Transmitted Diseases .......................................256
Bipin Thapa, MD Sara B. Fazio, MD
39 Disorders of Menstruation and Menopause ...............163 62 HIV Infection.........................................................................260
Sara B. Fazio, MD Juan Reyes, MD
40 Approach to Syncope .........................................................168 63 Osteomyelitis.........................................................................264
Gretchen Diemer, MD David C. Tompkins, MD
41 Approach to Lymphadenopathy......................................172 64 Sepsis Syndrome .................................................................267
Heather Harrell, MD Isaac O. Opole, MD
42 Approach to Involuntary Weight Loss............................174 65 Health Care-Associated Infections.................................271
Danelle Cayea, MD, MS Gonzalo Bearman, MD
43 Comprehensive Geriatric Assessment .........................177
Jenny Wright, MD and Anne Eacker, MD
7 Nephrology
44 Palliative Care........................................................................181
Susan Glod, MD High Value Care Recommendations......................................276
45 Genetics and Genetic Testing............................................185 66 Approach to Kidney Disease ...........................................277
Robert Robinson, MD and Madhusree Singh, MD John A. Walker, MD
46 Common Dermatologic Disorders.................................188 61 Fluid and Electrolyte Disorders......................................282
Matthew Burday, DO Mary Jane Barchman, MD
68 Calcium and Phosphorus Metabolism.........................288
Mary Jane Barchman, MD
5 Hematology
69 Acid-Base Disorders...........................................................291
High Value Care Recommendations......................................198 Joseph Charles, MD
47 Anemia ...................................................................................197 70 Acute Kidney Injury...........................................................295
Reed E. Drews, MD Harold M. Szerlip, MD
48 Sickle Cell Disease ..............................................................205 71 Chronic Kidney Disease....................................................300
Reed E. Drews, MD Matthew J Diamond, DO
49 Thrombocytopenia..............................................................208 72 Nephrolithiasis......................................................................307
Richard S. Eisenstaedt, MD Scott Herrle, MD
50 Hematopoietic Stem Cell Disorders ...............................211
Richard S. Eisenstaedt, MD
8 Neurology
51 Multiple Myeloma.................................................................216
Richard S. Eisenstaedt, MD High Value Care Recommendations......................................212
52 Bleeding Disorders..............................................................220 73 Headache................................................................................313
Joel Appel, DO Jonathan S. Appelbaum, MD
53 Thrombophilia......................................................................224 74 Approach to Meningitis and Encephalitis....................316
Amy Hayton, MD and Lawrence Loo, MD Fred A. Lopez, MD
54 Transfusion Medicine.........................................................228 75 Stroke and Transient Ischemic Attack .........................321
Dennis Chang, MD Jane P. Gagliardi, MD
76 Altered Mental Status, Dementia, and Delirium..........327
Jennifer S. Bequette, MD and Valerie J. Lang, MD
6 Infectious Disease Medicine
77 Peripheral Neuropathy......................................................333
High Value Care Recommendations......................................234 Christopher A. Klipstein, MD
55 Approach to Fever.................................................................235 78 Approach to Selected Movement Disorders...............336
Joseph T. Wayne, MD Bryan Ho, MD and Lianne Marks, MD, PhD
56 Common Upper Respiratory Infections.......................238 79 Seizures and Epilepsy.........................................................339
Jennifer Bierman, MD Martha Hlafka, MD
57 Community-Acquired Pneumonia.................................241 80 Other Neurologic Diseases ..............................................344
Irene Alexandraki, MD Amalia Landa Galindez, MD

9 Oncology
11 R heum atology
High Value Care Recommendations......................................,150 High Value Care Recommendations......................................416
81 Lung Cancer...........................................................................351 97 Approach to Joint Pain ......................................................417
AlyssaC. McMunuinun. MD Thomas M. DeFer, MD
82 Breast Cancer........................................................................354 98 Approach to Knee and Shoulder Pain .........................422
Kathleen F. Ryan, MD Joseph Rencic, MD
83 Colorectal Cancer................................................................358 99 Osteoarthritis........................................................................425
Kathleen F. Ryan, MD Robert Pargamcnt, MD
84 Cervical Cancer ...................................................................361 100 Crystal Induced Arthritis.................................................429
Asra R. Khan. MD Sean Whelton, MD
85 Prostate Cancer ...................................................................366 101 Infectious Arthritis..............................................................432
Eric H. Green, MD Thomas M. De Fer, MD
86 Skin Cancer...........................................................................369 102 Rheumatoid Arthritis.........................................................435
Monica Ann Shaw, MD Alda Maria Gortzaga, MD
87 Lymphoid Malignancies ...................................................373 103 Systemic Lupus Erythematosus......................................440
Merry Jennifer Markham. MD Kimberly Tartaglia, MD
88 Oncologic Urgencies and Emergencies .......................379 104 Spondyloarthritis.................................................................444
Maria Dungo, MD and Liana Nikolaenko, MD Thomas M. De Fer, MD
105 Other Rheumatologic Conditions.................................448
Kevin M. McKown, MD
10 Pulmonary Medicine
106 Systemic Vasculitis..............................................................453
High Value Care Recommendations........................................384 Ernie L. Esquivel, MD
89 Interpretation of Pulmonary Function Tests .............385
Mysti D. W. Schott, MD Index ................................................................................................457
90 Approach to Dyspnea..........;...............................................388
Nina Mingioni, MD Color Plates ................................................................Back of Book
91 Pleural Effusion ......................................................................391
Roderick Go, DO Errata......................................https://ime.acponline.org/errata
92 Asthma .......................................................................................395
Patricia Short, MD
93 Chronic Obstructive Pulmonary Disease.....................400
Carlos Palacio, MD
94 Obstructive Sleep Apnea......................................................404
David V. Gugliotti, MD
95 Diffuse Parenchymal Lung Diseases .............................407
Feroza Daroowalla, MD
96 Pulmonary Vascular Disease ..............................................411
Aipesh N. Amin, MD
Previous Author Acknowledgments
ACP would like to thank the following people who contributed to
earlier versions of the chapters listed below.
Cardiovascular Medicine
Chapter 2: Dr. Anna C. Maio
Chapter 5: Dr. Charin L. Hanlon
Chapter 6: Dr. Steven J. Durning, Dr. Mark C. Haigney,
and Dr. Suma Pokala
Chapter 7: Dr. James L. Sebastian
Endocrinology and Metabolism
Chapter 15: Dr. Melissa A. McNeil and Dr. Janine M. Frank
Gastroenterology and Hepatology
Chapter 16: Dr. Priya Radhakrishnan
Chapter 17: Dr. Brown J. McCallum
Chapter 18: Dr. Brown J. McCallum and Dr. Shalini Reddy
Chapter 19: Dr. Brown J. McCallum
Chapter 26: Dr. Brown J. McCallum
General Internal Medicine
Chapter 34: Dr. Lawrence I. Kaplan and Dr. Rosa Lee
Chapter 37: Dr. Hugo A. Alvarez
Chapter 40: Dr. Lawrence I. Kaplan
Chapter 43: Dr. Ivonne Z. Jimenez-Velazquez
Chapter 46: Dr. Hanah Polotsky and Dr. Robert Jablonover
Hematology
Chapter 50: Dr. Mark M. Udden
Chapter 51: Dr. Mark M. Udden
Chapter 52: Dr. Diane C. Sliwka
Infectious Disease
Chapter 56: Dr. Robert W. Nelson, Jr.
Chapter 64: Dr. Charin L. Hanlon
Nephrology
Chapter 69: Dr. Tomoko Tanabe
Pulmonary Medicine
Chapter 89: Dr. Kevin D. Whittle
Rheumatology
Chapter 102: Dr. Kathryn A. Naus, Dr. Kyla Lokitz,
and Dr. Seth Mark Bemy
Chapter 103: Dr. Saba Khan and Dr. Seth Bemey
XIV
High Value Care Recommendations
The High Value Care initiative of the American College of Physicians
is an effort to improve health care outcomes by encouraging physi­
cians to provide care with proven benefit and to reduce harms and
costs by avoiding unnecessary interventions. The initiative integrates
the important concept of health care value (balancing clinical ben­
efit with costs and harms) for a given intervention into various edu­
cational materials to address the needs of medical students, trainees,
practicing physicians, and patients.
To incorporate high value care principles into IM Essentials, we
have highlighted high value care recommendations throughout this
book (in bold) that meet the definition below. In addition, we have
aggregated each section’s recommendations at the beginning of the
section so that they can be reviewed in one location.
High Value Care Recommendation: A recommendation to choose
diagnostic and management strategies for patients in specific clinical
situations that balance clinical benefit with cost and harms with the
goal of improving patient outcomes.
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