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LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page i Aptara Inc P O C K E T NOTEBOOK Pocket M E D I C I N E Fourth Edition Edited by MARC S.SABATINE,M.D.,M.P.H. ASSOCIATE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL The Massachusetts General Hospital Handbook of Internal Medicine LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page ii Aptara Inc Acquisitions Editor:Sonya Seigafuse Product Manager:Kerry Barrett Production Manager:Bridgett Dougherty Senior Manufacturing Manager:Benjamin Rivera Marketing Manager:Kim Schonberger Design Coordinator:Doug Smock Production Service:Aptara © 2011by LIPPINCOTT WILLIAMS & WILKINS,a WOLTERS KLUWER business Two Commerce Square 2001Market Street Philadelphia,PA 19103 USA LWW.com All rights reserved.This book is protected by copyright.No part of this book may be reproduced in any form by any means,including photocopying,or utilized by any information storage and retrieval system without written permission from the copyright owner,except for brief quotations embodied in critical articles and reviews.Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Pocket medicine/ edited by Marc S.Sabatine.–4th ed. p.;cm. “The Massachusetts General Hospital Handbook of Internal Medicine.” Includes bibliographical references and index. ISBN-13:978-1-60831-905-3 (domestic :alk.paper) ISBN-10:1-60831-905-9 (domestic :alk.paper) ISBN-13:978-1-4511-0335-9 (international :alk.paper) ISBN-10:1-4511-0335-2 (international :alk.paper) 1. Internal medicine–Handbooks,manuals,etc. I. Sabatine,Marc S. II. Massachusetts General Hospital. [DNLM: 1. Internal Medicine–Handbooks. 2. Clinical Medicine–Handbooks. WB 39 P7394 2011] RC55.P63 2011 616–dc22 2010024523 DISCLAIMERCare has been taken to confirm the accuracy of the information presented and to describe generally accepted practices.However,the authors,editors,and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty,expressed or implied,with respect to the currency,completeness,or accuracy of the contents of the publication.Application of the information in a particular situation remains the professional responsibility of the practitioner. 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Visit Lippincott Williams & Wilkins on the Internet:at LWW.com.Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm,EST. 10 9 8 7 6 5 4 3 2 1 LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page iii Aptara Inc CONTENTS Contributing Authors vi Foreword ix Preface x CARDIOLOGY Rajat Gupta,Viviany R.Taqueti,David M.Dudzinski,Rory B.Weiner, Michelle O’Donoghue,Marc S.Sabatine Electrocardiography 1-1 Chest Pain 1-3 Noninvasive Evaluation of CAD 1-4 Coronary Angiography and Revascularization 1-5 Acute Coronary Syndromes 1-6 PA Catheter and Tailored Therapy 1-12 Heart Failure 1-14 Cardiomyopathies 1-17 Valvular Heart Disease 1-20 Pericardial Disease 1-25 Hypertension 1-28 Aortic Aneurysm 1-30 Acute Aortic Syndromes 1-31 Arrhythmias 1-32 Atrial Fibrillation 1-35 Syncope 1-37 Intracardiac Devices 1-39 Cardiac Risk Assessment for Noncardiac Surgery 1-40 PULMONARY Mary Berlik Rice,Kathryn A.Hibbert,Atul Malhotra Dyspnea 2-1 Pulmonary Function Tests (PFTs) 2-1 Asthma 2-2 Chronic Obstructive Pulmonary Disease 2-5 Hemoptysis 2-7 Solitary Pulmonary Nodule 2-7 Obstructive Sleep Apnea (OSA) 2-8 Interstitial Lung Disease 2-9 Pleural Effusion 2-11 Venous Thromboembolism (VTE) 2-13 Pulmonary Hypertension (PHT) 2-16 Respiratory Failure 2-18 Mechanical Ventilation 2-19 Acute Respiratory Distress Syndrome 2-22 Sepsis 2-23 GASTROENTEROLOGY Louis J.Cohen,Andrew S.de Lemos,Lawrence S.Friedman Esophageal and Gastric Disorders 3-1 Gastrointestinal Bleeding 3-3 Diarrhea,Constipation,and Ileus 3-5 Diverticular Disease 3-9 Inflammatory Bowel Disease 3-10 LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page iv Aptara Inc Intestinal Ischemia 3-12 Pancreatitis 3-13 Abnormal Liver Tests 3-15 Hepatitis 3-17 Acute Liver Failure 3-20 Cirrhosis 3-21 Hepatic Vascular Disease 3-25 Ascites 3-26 Biliary Tract Disease 3-27 NEPHROLOGY Andrew L.Lundquist,Eugene P.Rhee,Hasan Bazari Acid-Base Disturbances 4-1 Sodium and Water Homeostasis 4-6 Potassium Homeostasis 4-10 Renal Failure 4-12 Glomerular Disease 4-16 Urinalysis 4-18 Nephrolithiasis 4-19 HEMATOLOGY-ONCOLOGY Andrew J.Aguirre,Franklin W.Huang,David B.Sykes,David T.Ting, Daniel J.DeAngelo,David P.Ryan Anemia 5-1 Disorders of Hemostasis 5-6 Platelet Disorders 5-7 Coagulopathies 5-10 Hypercoagulable States 5-11 Disorders of Leukocytes 5-12 Transfusion Therapy 5-13 Myelodysplastic Syndromes (MDS) 5-14 Myeloproliferative Neoplasms (MPN) 5-15 Leukemia 5-17 Lymphoma 5-21 Plasma Cell Dyscrasias 5-24 Hematopoietic Stem Cell Transplantation (HSCT) 5-26 Lung Cancer 5-28 Breast Cancer 5-30 Prostate Cancer 5-32 Colorectal Cancer (CRC) 5-33 Pancreatic Tumors 5-35 Oncologic Emergencies 5-36 Cancer of Unknown Primary Site 5-37 INFECTIOUS DISEASES Roby P.Bhattacharyya,Rachel P.Simmons,Nesli Basgoz Pneumonia 6-1 Fungal Infections 6-3 Infections in Susceptible Hosts 6-4 Urinary Tract Infections (UTI) 6-5 Soft Tissue and Bone Infections 6-6 Infections of the Nervous System 6-9 Bacterial Endocarditis 6-12 Tuberculosis 6-15 LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page v Aptara Inc HIV/AIDS 6-17 Tick-Borne Diseases 6-21 Fever of Unknown Origin (FUO) 6-23 ENDOCRINOLOGY Alaka Ray,Geoffrey A.Walford,Michael Mannstadt Pituitary Disorders 7-1 Disorders of Multiple Endocrine Systems 7-2 Thyroid Disorders 7-3 Adrenal Disorders 7-7 Calcium Disorders 7-11 Diabetes Mellitus 7-13 Lipid Disorders 7-16 RHEUMATOLOGY Gwen C.Crevensten,Katherine P.Liao,Robert P.Friday Arthritis—Overview 8-1 Rheumatoid Arthritis (RA) 8-3 Relapsing Polychondritis 8-4 Crystal Deposition Arthritides 8-5 Seronegative Spondyloarthritis 8-7 Infectious Arthritis & Bursitis 8-9 Connective Tissue Diseases 8-11 Systemic Lupus Erythematosus (SLE) 8-15 Vasculitis 8-17 Cryoglobulinemia 8-21 Amyloidosis 8-22 NEUROLOGY David Y.Hwang,Atul Maheshwari,Mikael L.Rinne,David M.Greer Change in Mental Status 9-1 Seizures 9-3 Alcohol Withdrawal 9-5 Stroke 9-6 Weakness & Neuromuscular Dysfunction 9-8 Headache 9-10 Back and Spinal Cord Disease 9-11 APPENDIX ACLS Algorithms 10-1 ICU Medications 10-4 Antibiotics 10-6 Formulae and Quick Reference 10-7 ABBREVIATIONS 11-1 INDEX I-1 PHOTO INSERTS Radiology P-1 Echocardiography P-9 Coronary Angiography P-13 Peripheral Blood Smears P-13 Leukemias P-14 Urinalysis P-15 LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page vi Aptara Inc CONTRIBUTING AUTHORS Andrew J.Aguirre,MD,PhD Internal Medicine Resident,Massachusetts General Hospital Nesli Basgoz,MD Associate Chief and Clinical Director,Infectious Disease Division, Massachusetts General Hospital Associate Professor of Medicine,Harvard Medical School Hasan Bazari,MD Attending Physician,Nephrology Unit,Massachusetts General Hospital Program Director,Internal Medicine Residency,Massachusetts General Hospital Associate Professor of Medicine,Harvard Medical School Roby P.Bhattacharyya,MD,PhD Internal Medicine Resident,Massachusetts General Hospital Louis J.Cohen,MD Internal Medicine Resident,Massachusetts General Hospital Gwen C.Crevensten,MD Internal Medicine Resident,Massachusetts General Hospital Andrew S.de Lemos,MD Gastroenterology Fellow,Massachusetts General Hospital Daniel J.DeAngelo,MD,PhD Clinical Director,Adult Leukemia Program,Dana-Farber Cancer Institute & Brigham and Women’s Hospital Associate Professor of Medicine,Harvard Medical School David M.Dudzinski,MD,JD Cardiology Fellow,Massachusetts General Hospital Robert P.Friday,MD,PhD Attending Physician,Rheumatology Unit,Massachusetts General Hospital Associate Director,Rheumatology Fellowship Program,Massachusetts General Hospital Instructor in Medicine,Harvard Medical School Lawrence S.Friedman,MD Chair,Department of Medicine,Newton-Wellesley Hospital Assistant Chief of Medicine,Massachusetts General Hospital Professor of Medicine,Harvard Medical School Professor of Medicine,Tufts University School of Medicine David M.Greer,MD,MA Director,Neurological Consultation Service,Massachusetts General Hospital Program Director,Partners Neurology Residency Program Associate Professor of Neurology,Harvard Medical School LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page vii Aptara Inc Rajat Gupta,MD Internal Medicine Resident,Massachusetts General Hospital Kathryn A.Hibbert,MD Pulmonary and Critical Care Fellow,Harvard Medical School Franklin W.Huang,MD,PhD Internal Medicine Resident,Massachusetts General Hospital David Y.Hwang,MD Neurology Resident,Partners Neurology Residency Katherine P.Liao,MD,MPH Rheumatology Fellow,Brigham and Women’s Hospital Andrew L.Lundquist,MD Internal Medicine Resident,Massachusetts General Hospital Atul Maheshwari,MD Neurology Resident,Partners Neurology Residency Atul Malhotra,MD Associate Physician,Divisions of Pulmonary & Critical Care and Sleep Medicine,Brigham and Women’s Hospital Medical Director of the Brigham Sleep Disorders Program Associate Professor of Medicine,Harvard Medical School Michael Mannstadt,MD Assistant Physician,Endocrine Unit,Massachusetts General Hospital Instructor in Medicine,Harvard Medical School Michelle O’Donoghue,MD,MPH Investigator,TIMI Study Group and Associate Physician,Cardiovascular Division,Brigham and Women’s Hospital Affiliate Physician,Cardiology Division,Massachusetts General Hospital Instructor in Medicine,Harvard Medical School Alaka Ray,MD Internal Medicine Resident,Massachusetts General Hospital Eugene P.Rhee,MD Nephrology Fellow,BWH/MGH Joint Nephrology Fellowship Program Mary Berlik Rice,MD Internal Medicine Resident,Massachusetts General Hospital Mikael L.Rinne,MD,PhD Neurology Resident,Partners Neurology Residency David P.Ryan,MD Clinical Director,Massachusetts General Hospital Cancer Center Associate Chief of Hematology/Oncology,Massachusetts General Hospital Associate Professor of Medicine,Harvard Medical School LWBK634_FM[i-x].qxd 7/6/10 10:03PM Page viii Aptara Inc Marc S.Sabatine,MD,MPH Vice Chair,TIMI Study Group and Associate Physician,Cardiovascular Division,Brigham and Women’s Hospital Affiliate Physician,Cardiology Division,Massachusetts General Hospital Associate Professor of Medicine,Harvard Medical School Rachel P.Simmons,MD Infectious Disease Fellow,Massachusetts General Hospital and Brigham and Women’s Hospital David B.Sykes,MD,PhD Hematology-Oncology Fellow,Dana-Farber/Partners CancerCare Hematology/Oncology Program Viviany R.Taqueti,MD Internal Medicine Resident,Massachusetts General Hospital David T.Ting,MD Hematology-Oncology Fellow,Dana-Farber/Partners CancerCare Hematology/Oncology Program Geoffrey A.Walford,MD Endocrinology Fellow,Massachusetts General Hospital Rory B.Weiner,MD Cardiology Fellow,Massachusetts General Hospital