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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at expertconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. Swanson’s FAMILY MEDICINE REVIEW Swanson’s FAMILY MEDICINE REVIEW A PROBLEM-ORIENTED APPROACH 8th Edition Editor-in-Chief Alfred F. Tallia, Professor and Chair Family Medicine and Community Health MD, MPH Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey Co-Editors Joseph E. S cherger, Vice President, Primary Care Marie E. Pinizzotto, MD Chair of Academic Affairs MD, MPH Eisenhower Medical Center Rancho Mirage, California Nancy W. Dickey, President Emerita, Texas A&M Health Science Center Professor, Family and Community Medicine MD Professor and Interim Chair, Clinical and Translational Medicine Executive Director, Rural and Community Health Institute Texas A&M Health Science Center College of Medicine College Station, Texas 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 SWANSON’S FAMILY MEDICINE REVIEW, EIGHTH EDITION ISBN: 978-0-323-35632-9 Copyright © 2017 by Elsevier, Inc. All rights reserved. Previous editions copyrighted 2013, 2009, and 2003 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechan- ical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data Names: Tallia, Alfred F., editor. | Scherger, Joseph E., editor. | Dickey, Nancy, editor. Title: Swanson’s family medicine review : a problem-oriented approach / editor-in-chief, Alfred F. Tallia, co-editors, Joseph E. Scherger, Nancy W. Dickey. Other titles: Family medicine review Description: 8th edition. | Philadelphia, PA : Elsevier, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2015049807 | ISBN 9780323356329 (pbk. : alk. paper) Subjects: | MESH: Family Practice | Examination Questions Classification: LCC RC58 | NLM WB 18.2 | DDC 616.0076--dc23 LC record available at http://lccn.loc.gov/2015049807 Content Strategist: Suzanne Toppy Content Development Specialist: Janice Gaillard Publishing Services Manager: Patricia Tannian Project Manager: Ted Rodgers Design Direction: Amy Buxton Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 To the lasting memory of Dr. Richard Swanson An extraordinary physician and educator Contributors Lani K. Ackerman, MD Noemi C. Doohan, MD, PhD Associate Professor Family Physician Family Medicine Ukiah Valley Medical Center Texas A&M Health Science Center College Ukiah, California of Medicine, Kinder Fayssoux, MD College Station, Texas Family physician Center for Family Medicine Scott and White Clinic Eisenhower Medical Associates, College Station, Texas La Quinta, California Adity Bhattacharyya, MD, FAAFP Negin Field, MD Assistant Professor Resident Physician Family Medicine and Community Health Family Medicine Rutgers Robert Wood Johnson Medical School Eisenhower Medical Center New Brunswick New Jersey Rancho Mirage, California Michael Bogey, MD Kory Gill, DO Emergency Medicine Program Director Eisenhower Medical Center, Family Medicine and Sports Medicine Rancho Mirage, California Texas A&M Health Science Center College of Medicine Family Medicine Residency Robert Chen, MD College Station, Texas Clinical Assistant Professor David F. Howarth, MD, MPH Family Medicine and Community Health Rutgers Robert Wood Johnson Medical School Associate Professor of Family Medicine New Brunswick, New Jersey Department of Family Medicine and Community Health Director of Geriatric Training Amanda Curnock, MD Rutgers Robert Wood Johnson Medical School Physican and Co-Director Argyros 365 Primary care New Brunswick, New Jersey Eisenhower Medical Center Alexandra G. Ianculescu, MD, PhD La Quinta, California Resident Physician André de Leon, MD, MS Internal Medicine Core Faculty Eisenhower Medical Center Non-Surgical Sports Medicine/Family Medicine Rancho Mirage, California Eisenhower Family Medicine Residency Glenn M. Jabola, MD Rancho Mirage, California Family Medicine Tate de Leon, MD, MS Eisenhower Medical Center Core Faculty Rancho Mirage, California Family Medicine James D. King II, MD Eisenhower Family Medicine Residency Rancho Mirage, California Primary Care and Sports Medicine Baylor Scott & White Nancy W. Dickey, MD College Station, Texas President Emerita, Texas A&M Health Science Center Orthopedist Professor, Family and Community Medicine Baylor Scott and White Healthcare Professor and Interim Chair, Clinical and Translational College Station, Texas Medicine Martha Lansing, MD Executive Director, Rural and Community Health Institute Associate Professor and Vice Chair Texas A&M Health Science Center College of Medicine Family Medicine and Community Health College Station, Texas Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey Contributors vii Anna Lichorad, MD Damoun A. Rezai, MD Assistant Professor Resident Physician Family Medicine Family Medicine Texas A&M College of Medicine, Eisenhower Medical Center Bryan, Texas La Quinta, California Benjamin Mahdi, MD, MPH Beatrix Roemheld-Hamm, MD, PhD Family Medicine Professor Eisenhower Medical Center Family Medicine and Community Health Rancho Mirage, California Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey Laura E. Marsh, MS, MD, CAQSM Joseph E. Scherger, MD, MPH Clinical Associate Professor Family Community Medicine Vice President, Primary Care Texas A&M Health Science Center Marie E. Pinizzotto, MD Chair of Academic Affairs Bryan, Texas Eisenhower Medical Center Physician Rancho Mirage, California Central Texas Sports Medicine and Orthopaedics John F. Simmons, MD Bryan, Texas Assistant Professor Barbara Jo McGarry, MD Family Medicine Associate Professor Director of the Advanced Obstetrical Track Family Medicine and Community Health Texas A&M Family Medicine Residency Program Director, Family Medicine Residency Bryan, Texas Rutgers Robert Wood Johnson Medical School Alex Spinoso, MD New Brunswick, New Jersey Family Medicine Carmen Morales-Litchard, MD Eisenhower Medical Center Universidad Xochicalco Rancho Mirage, California Tijuana, Mexico Maureen Strohm, MD, MSEd Family Medicine Eisenhower Medical Center Vice President of Graduate Medical Education/DIO Palm Desert, California HCA Far West Division Henderson, Nevada Gregory A. Pecchia, DO Alfred F. Tallia, MD, MPH Staff Physician Family and Geriatric Medicine Professor and Chair Eisenhower Medical Center Family Medicine and Community Health Rancho Mirage, California Rutgers Robert Wood Johnson Medical School, Director New Brunswick, New Jersey Eisenhower Wellness Institute K. Douglas Thrasher, DO, FAAFP Eisenhower Medical Center La Quinta, California Chairman Department of Family Medicine Bhavika Shivlal Rakholia, BA, MD Eisenhower Medical Center Resident Physician La Quinta, California Family Medicine Sangeetha Vinayagam, MD Eisenhower Medical Center Rancho Mirage, California Family Medicine Eisenhower Medical Center Joshua J. Raymond, MD, MPH Rancho Mirage, California Assistant Professor Family Medicine and Community Health Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey Preface This is the eighth edition of Swanson’s Family Medicine As with the previous edition, distinguished family Review. As an enduring and marvelous educational tool physicians Nancy W. Dickey, MD, President Emerits for several generations of clinicians, this text is a testi- of the Texas A&M Health Science Center and professor mony to the founding genius of Dr. Richard Swanson, of family and community medicine in the Texas A&M the family physician who gave birth to the Review. The College of Medicine, and Joseph E. Scherger, MD, MPH, text continues to be not only an effective tool for family Vice President for Primary Care and Academic Affairs physicians preparing for certification or recertification, at Eisenhower Medical Center and founding dean of the but also an excellent review for clinicians simply desiring Florida State University College of Medicine, served as to hone their familiarity with the basic concepts pertinent my co-editors on this edition. As a team, we reviewed to primary care. the chapters and case problems for relevance, and chose The primary goals of the eighth edition are to update areas of emphasis and ways to organize the content. We the content and retain the special essence that made selected the content to reflect the broad core of knowl- previous editions such valued and popular educational edge required of every family physician. We also received instruments. The book is divided into 11 sections. Ten valuable input from other family medicine clinicians with represent a clinical area of Family Medicine, while the special expertise in specific content areas. eleventh section is a popular illustrated review. We recruited as chapter authors the finest practicing Each section contains chapters covering specific sub- family medicine experts from academic centers across jects relevant to that section. Each chapter presents clini- the United States. They reaffirmed and updated chapter cal cases that simulate actual clinical situations, providing content on the basis of thorough needs analyses, includ- the learner with a sense of reality designed to enhance ing opinions of readers, participants, and faculty in live retention of content. Each clinical case is followed by continuing medical education conferences, expert opin- questions concerning diagnosis and management. The ion, and other accepted methodologies. The editors and question section is followed by an answer section, which authors anticipate that the reader will both enjoy and provides a detailed discussion relevant to each question. profit from the work that went into preparing this vol- Finally, each chapter contains a short summation of key ume. Happy studying and learning! learning points and selected readings and references, including websites. This time tested learning methodol- Alfred F. Tallia, MD, MPH ogy is designed to increase retention and to expand and Editor-in-Chief refine the reader’s knowledge of the diagnostic methods, therapeutics, and patient management techniques pre- sented by each case. Acknowledgments As editor-in-chief, I am indebted to many individuals Thanks to Janice Gaillard, Suzanne Toppy, Ted for their support and assistance in the preparation of Rodgers, and the staff at Elsevier for their inspiration and the eighth edition of Swanson’s Family Medicine Review. support. Finally, much gratitude to our colleagues in the To begin, I wish to thank my two co-editors, Nancy W. academic and clinical communities that we call home for Dickey, MD, and Joseph E. Scherger, MD, MPH, for their help and understanding of the demands that prepa- their hard work and understanding. ration of this edition required. Collectively, we would like to thank our spouses, Eliz- abeth Tallia, Carol Scherger, and Frank Dickey; and our Alfred F. Tallia, MD, MPH entire families, as well as those of the authors, for their Editor-in-Chief sacrifice of time and their understanding as we prepared this edition.