The Cleveland Clinic Intensive Review of Internal Medicine PDF
Preview The Cleveland Clinic Intensive Review of Internal Medicine
P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs The Cleveland Clinic Foundation Intensive Review of Internal Medicine FIFTHEDITION i P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs ii P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs The Cleveland Clinic Foundation Intensive Review of Internal Medicine FIFTH EDITION EDITORS JAMES K. STOLLER, MD, MS JeanWallBennettChair Head,ClevelandClinicRespiratoryTherapy ExecutiveDirector,LeadershipDevelopment TheClevelandClinicFoundation Cleveland,Ohio FRANKLIN A. MICHOTA, Jr., MD, FACP DirectorofAcademicAffairs DepartmentofHospitalMedicine TheClevelandClinicFoundation Cleveland,OH BRIAN F. MANDELL, MD, PhD ViceChairman,DepartmentofAcademicMedicine DepartmentofRheumaticandImmunologicDisease Editor-in-Chief TheClevelandClinicJournalofMedicine TheClevelandClinicFoundation Cleveland,Ohio iii P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs AcquisitionsEditor:SonyaSeigafuse ManagingEditor:KerryBarrett ProjectManager:AliciaJackson SeniorManufacturingManager:BenjaminRivera MarketingManager:KimberlySchonberger Designer:HollyMcLaughlin CoverDesigner:ChristineJenny ProductionService:Aptara,Inc. ©2009LIPPINCOTTWILLIAMS&WILKINS,aWOLTERSKLUWERbusiness 530WalnutStreet Philadelphia,PA19106USA LWW.com Allrightsreserved.Thisbookisprotectedbycopyright.Nopartofthisbookmaybe reproducedinanyformbyanymeans,includingphotocopying,orutilizedbyany informationstorageandretrievalsystemwithoutwrittenpermissionfromthe copyrightowner,exceptforbriefquotationsembodiedincriticalarticlesand reviews.Materialsappearinginthisbookpreparedbyindividualsaspartoftheir officialdutiesasU.S.governmentemployeesarenotcoveredbythe above-mentionedcopyright. PrintedinChina LibraryofCongressCataloging-in-PublicationData TheClevelandClinicintensivereviewofinternalmedicine/editors,JamesK.Stoller, FranklinA.MichotaJr.,BrianF.Mandell.–5thed. p.;cm. Includesbibliographicalreferencesandindex. ISBN-13:978-0-7817-9079-6 ISBN-10:0-7817-9079-4 1.Internalmedicine–Outlines,syllabi,etc. 2.Internalmedicine–Studyguides. I.Stoller,JamesK. II.Michota,FranklinA. III.Mandell,BrianF.,1951- IV.ClevelandClinicFoundation. [DNLM:1.InternalMedicine–ExaminationQuestions. WB 18.2 C6352009] RC46.C5482009 616.0076–dc22 2008054709 Carehasbeentakentoconfirmtheaccuracyoftheinformationpresentedandto describegenerallyacceptedpractices.However,theauthors,editors,andpublisher arenotresponsibleforerrorsoromissionsorforanyconsequencesfromapplication oftheinformationinthisbookandmakenowarranty,expressedorimplied,with respecttothecurrency,completeness,oraccuracyofthecontentsofthepublication. Applicationoftheinformationinaparticularsituationremainstheprofessional responsibilityofthepractitioner. Theauthors,editors,andpublisherhaveexertedeveryefforttoensurethatdrug selectionanddosagesetforthinthistextareinaccordancewithcurrent recommendationsandpracticeatthetimeofpublication.However,inviewof ongoingresearch,changesingovernmentregulations,andtheconstantflowof informationrelatingtodrugtherapyanddrugreactions,thereaderisurgedtocheck thepackageinsertforeachdrugforanychangeinindicationsanddosageandfor addedwarningsandprecautions.Thisisparticularlyimportantwhenthe recommendedagentisaneworinfrequentlyemployeddrug. SomedrugsandmedicaldevicespresentedinthepublicationhaveFoodand DrugAdministration(FDA)clearanceforlimiteduseinrestrictedresearchsettings.It istheresponsibilityofthehealthcareprovidertoascertaintheFDAstatusofeach drugordeviceplannedforuseintheirclinicalpractice. Topurchaseadditionalcopiesofthisbook,callourcustomerservicedepartmentat (800)638-3030orfaxordersto(301)223-2320.Internationalcustomersshould call(301)223-2300. VisitLippincottWilliams&WilkinsontheInternet:atLWW.com.Lippincott Williams&Wilkinscustomerservicerepresentativesareavailablefrom8:30amto 6pm,EST. 10 9 8 7 6 5 4 3 2 1 iv P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs To my parents, for instilling the values that allowed this book to be, and to Terry and Jake, for inspiring and tolerating my passion to make it happen. J.K.S. To my wife and children for their ongoing support of a career that focuses my attention as much outside the home as it does inside. F.A.M. This textbook began several editions ago as a labor of love and commitment to lifelong professional education by Jamie Stoller and DavidLongworth,thefirstcoursedirectors.TheannualInternalMedicine Review course, and this text’s existence as a vibrant experience, would be impossible without the dedication and clinical expertise of the many Cleveland Clinic physician educators noted within these pages. On a personal note, I gratefully acknowledge the patience and support of my family during this enterprise of late night editing sessions. B.F.M. v P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs vi P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs Contributors ABBY ABELSON, MD Interim Chair, Department of JULIA BREYER-LEWIS, MD Professor, Department of Rheumatic and Immunologic Diseases; Vice Chair Medicine,DivisionofNephrology;Physician,Department for Education, Orthopaedic and Rheumatology Institute; ofMedicine,DivisionofNephrology,VanderbiltUniversity Rheumatology Education Program Director; Director of SchoolofMedicine,Nashville,Tennessee Education, Center for Osteoporosis and Metabolic Bone AARON BRZEZINSKI, MD Center for Inflammatory Bowel Disease, The Cleveland Clinic Foundation, Cleveland, Disease,DepartmentofGastroenterologyandHepatology, Ohio TheClevelandClinicFoundation,Cleveland,Ohio LOUTFIS.ABOUSSOUAN,MD Staff,RespiratoryInstitute,The MARIE M. BUDEV, MD Assistant Medical Director, Lung ClevelandClinicFoundation,Cleveland,Ohio Transplant Program, Department of Pulmonary, Allergy, andCriticalCareMedicine,TheClevelandClinicFounda- DAVID J. ADELSTEIN, MD Department of Hematology, tion,Cleveland,Ohio TheClevelandClinicFoundation,Cleveland,Ohio CAROLA.BURKE,MD Director,CenterforColon,Polyp,and GERALD B. APPEL, MD Professor of Clinical Medicine, Cancer Prevention, Department of Gastroenterology and ColumbiaUniversityCollegeofPhysiciansandSurgeons; Hepatology,TheClevelandClinicFoundation,Cleveland, Director,DepartmentofClinicalNephrology,Department Ohio of Medicine, Columbia Presbyterian Center of New York PresbyterianHospital,NewYork,NewYork JEFFREYT.CHAPMAN,MD StaffPhysician,Respiratoryand Transplant Institute, The Cleveland Clinic Foundation, WENDYS.ARMSTRONG,MD DepartmentofInfectiousDis- Cleveland,Ohio eases,TheClevelandClinicFoundation,Cleveland,Ohio LESLIE CHO, MD Section Head, Preventive Cardiology and RehabilitationDirector,Women’sVascularCenter,Depart- ALEJANDRO C. ARROLIGA, MD Head, Section of Critical ment of Cardiovascular Medicine, The Cleveland Clinic Care Medicine, Department of Pulmonary, Allergy, and Foundation,Cleveland,Ohio CriticalCareMedicine,TheClevelandClinicFoundation, Cleveland,Ohio MINA K. CHUNG, MD Staff, Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart CHARLES J. BAE, MD Assistant Professor, Department of and Vascular Institute, Molecular Cardiology, Lerner Re- Medicine,ClevelandClinicLernerCollegeofMedicineof search Institute, The Cleveland ClinicFoundation, Cleve- CaseWesternUniversityStaff,NeurologicalInstitute,The land,Ohio ClevelandClinicFoundation,Cleveland,Ohio DANIELA.CULVER,MD Staff,RespiratoryInstituteandDe- RACHIDBAZ,MD Moffitt,CancerCenter,Tampa,Florida partmentofPathology,TheClevelandClinicFoundation, Cleveland,Ohio PELINBATUR,MD Staff,MedicineInstitute,Women’sHealth ROSSANAD.DANESE,MD DivisionofEndocrinology,Uni- Specialist, Independence Cleveland Clinic Foundation, versityHospitalsofCleveland,Cleveland,Ohio FamilyHealthCenter,Independence,Ohio STEVEN R. DEITCHER, MD Vice President, Medical Affairs, GERALD J. BECK, MD Section Head, Clinical Trials Design Nuvelo,Sunnyvale,California andAnalysis,DepartmentofQuantitativeHealthSciences, TheClevelandClinicFoundation,Cleveland,Ohio JOHNA.DUMOT,MD Staff,DepartmentofGastroenterology andHepatology,TheClevelandClinicFoundation,Cleve- DAVIDE.BLUMENTHAL,MD DepartmentofRheumatology, land,Ohio MetroHealthMedicalCenter,Cleveland,Ohio RAEDA.DWEIK,MD Director,PulmonaryVascularProgram, BRIAN BOLWELL, MD Chairman, Department of Hemato- Respiratory Institute, The Cleveland Clinic Foundation, logicOncologyandBloodDisorders;ViceChiefofStaff Cleveland,Ohio vii P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs viii Contributors CHARLESFAIMAN,MD DepartmentofEndocrinology,Dia- VIDYASAGAR KALAHASTI, MD Staff Cardiologist, Depart- betes,andMetabolism,TheClevelandClinicFoundation, ment of Cardiovascular Medicine, The Cleveland Clinic Cleveland,Ohio Foundation,Cleveland,Ohio KRISTIN A. ENGLUND, MD Staff, Department of Infectious MATT KALAYCIO, MD Professor, Department of Medicine, Diseases, The Cleveland Clinic Foundation, Cleveland, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio Ohio MATTHEWA.KAMINSKI,MD CardiologyFellow,Department KATHLEEN FRANCO-BRONSON, MD Staff Psychiatrist, De- ofCardiovascularMedicine,TheClevelandClinicFounda- partment of Psychiatry and Psychology; Associate Dean tion,Cleveland,Ohio CCLCM, The Cleveland Clinic Foundation, Cleveland, Ohio SAMIR R. KAPADIA, MD Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, JORGE GARCIA, MD Assistant Professor, Department of Ohio Medicine, Cleveland Clinic Lerner College of Medicine ofCaseWesternUniversityAssociateStaff,Departmentof THOMASF.KEYS,MD Consultant,DepartmentofPost-Acute Medicine, The Cleveland Clinic Foundation, Cleveland, SolidTumorOncology,TheClevelandClinicFoundation, Ohio Cleveland,Ohio OSSAM KHAN, MD Associate Staff, Department of Hospi- BRIAN P. GRIFFIN, MD Director, Cardiovascular Disease talMedicine,TheClevelandClinicFoundation,Cleveland, Training Program, The John and Rosemary Brown En- Ohio dowedChairinCardiovascularMedicine,USAssociateEd- itor, Heart, The Cleveland Clinic Foundation Cleveland, ALICE I. KIM, MD Staff, Department of Infectious Diseases, Ohio TheClevelandClinicFoundation,Cleveland,Ohio RICHARD GRIMM, MD Section of Cardiac Imaging, Depart- YULIY.KIM,MD SeniorFellow,BostonAdultCongenitalSer- vice,Children’sHospital,Boston,Massachusetts ment of Cardiovascular Medicine, The Cleveland Clinic Foundation,Cleveland,Ohio RICHARDA.KRASUSKI,MD HeartandVascularInstitute,The ClevelandClinicFoundation,Cleveland,Ohio CARMELHALLEY,MD AdvancedFellowinHeartFailure,De- partmentofCardiovascularMedicine,TheClevelandClinic RICHARDLANG,MD Chairman,DepartmentofGeneralIn- Foundation,Cleveland,Ohio ternalMedicine,TheClevelandClinicFoundation,Cleve- land,Ohio AMIRH.HAMRAHIAN,MD Staff,DepartmentofEndocrinol- ogy,TheClevelandClinicFoundation,Cleveland,Ohio CAROL A. LANGFORD, MD Director, Center for Vasculitis Care and Research, Department of Rheumatic and Im- CHRISTOPHERJ.HEBERT,MD StaffPhysician,Departmentof munologicDiseases,OrthopaedicandRheumatologicIn- NephrologyandHypertension,TheClevelandClinicFoun- stitute,TheClevelandClinicFoundation,Cleveland,Ohio dation,Cleveland,Ohio JOYCE K. LEE, MD Chief Resident, Neurological Institute, ROBERT E. HOBBS, MD Staff, Heart and Vascular Institute, Department of Neurology, The Cleveland Clinic Founda- TheClevelandClinicFoundation,Cleveland,Ohio tion,Cleveland,Ohio SUSAN B. LEGRAND, MD Vice Chairman, Department of EDWARDP.HORVATH,JR.,MD DepartmentofVeteransAf- Cardiovascular Medicine, The Cleveland Clinic Founda- fairsMedicalCenter,Cleveland,Ohio tion,Cleveland,Ohio CARLOSM.ISADA,MD ProgramDirector,FellowshipTrain- ANGELOA.LICATA,MD Director,CenterforSpaceMedicine; ing,ViceChairman,DepartmentofInfectiousDiseases,The Consultant,DepartmentofEndocrinology,TheCleveland ClevelandClinicFoundation,Cleveland,Ohio ClinicFoundation,Cleveland,Ohio AMIRK.JAFFER,MD AssociateProfessorofMedicine,Uni- ALAN E. LICHTIN, MD Staff Hematologist-Oncologist, De- versityofMiamiMillerSchoolofMedicine;Chief,Medicine partmentofHematology/Oncology,TheClevelandClinic Service;DivisionChief,DepartmentofMedicine,Univer- Foundation,Cleveland,Ohio sityofMiamiHospital,Miami,Florida MICHAELLINCOFF,MD Director,CenterforClinicalResearch HANI JNEID, MD Assistant Professor of Medicine, Depart- andViceChairmanforClinicalResearch,LernerResearch mentofCardiology,BaylorCollegeofMedicine;Assistant Institute; Director, Cleveland Clinic Coordinating Center DirectorofInterventionalCardiology,DepartmentofCar- for Clinical Research (C5 Research); Vice Chairman, De- diology,TheMichaelE.DeBakeyVAMedicalCenter,Hous- partmentofCardiovascularMedicine,TheClevelandClinic ton,Texas Foundation,Cleveland,Ohio P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs Contributors ix CAREENY.LOWDER,MD DivisionofOphthalomology,Cole JOSEPHG.PARAMBIL,MD Staff,DepartmentofPulmonary EyeInstitute,TheClevelandClinicFoundation,Cleveland, andCriticalCare,TheClevelandClinicFoundation,Cleve- Ohio land,Ohio JAMESM.LUTHER,MD,MSCI InstructorinMedicine,Divi- MANSOURA.PARSI,MD CenterforEndoscopyandPancre- sionofClinicalPharmacology,VanderbiltUniversityMed- atobiliaryDisorders,DigestiveDiseaseInstitute,TheCleve- icalCenter,Knoxville,Tennessee landClinicFoundation,Cleveland,Ohio ANUJ MAHINDRA, MD Fellow, Department of Hematology VICTOR L. PEREZ, MD Division of Ophthalmology, Cole andMedicalOncology,TheClevelandClinicFoundation, EyeInstitute,TheClevelandClinicFoundation,Cleveland, Cleveland,Ohio Ohio BRIAN F. MANDELL, MD Professor and Vice Chairman of MELISSA PECK PILIANG, MD Associate Staff, Department Academic Medicine, Department of Rheumatic and Im- of Dermatology and Anatomic Pathology, The Cleveland munologicDisease,CenterforVasculitisCareandResearch, ClinicFoundation,Cleveland,Ohio Cleveland Clinic Lerner College of Medicine, Cleveland, MARCA.POHL,MD RayW.GiffordJr.EndowedChairinHy- Ohio pertension,DepartmentofNephrologyandHypertension, PETERJ.MAZZONE,MD DepartmentofPulmonary,Allergy, SectionHead,ClinicalHypertensionandNephrology,The andCriticalCareMedicine,TheClevelandClinicFounda- ClevelandClinicFoundation,Cleveland,Ohio tion,Cleveland,Ohio BRADL.POHLMAN,MD Director,LymphomaProgram,Taus- ATUL C. MEHTA, MD Vice Chairman, Department of Pul- sig Cancer Institute, The Cleveland Clinic Foundation, monary,Allergy,andCriticalCareMedicine,TheCleveland Cleveland,Ohio ClinicFoundation,Cleveland,Ohio LEOPOLD POZUELO, MD Section Head, Consultation- ADIE.MEHTA,MD ViceChairman,RespiratoryInstitute,The Liaison Psychiatry, The Cleveland Clinic Foundation, ClevelandClinicFoundation,Cleveland,Ohio Cleveland,Ohio TAREKMEKHAIL,MD Director,LungCancerMedicalOncol- SARINYA PUWANANT, MD Clinical Fellow, Advanced Car- ogyProgram,TheClevelandClinicTaussigCancerCenter, diacImaging,DepartmentofCardiovascularMedicine,The TheClevelandClinicFoundation,Cleveland,Ohio ClevelandClinicFoundation,Cleveland,Ohio CHAD MICHENER, MD Staff, Deaprtment of Obstetrics, YINGQIAN,MD OphthalmologyResident,ColeEyeInstitute, GynecologyandWomen’sHealthInstitute,TheCleveland TheClevelandClinicFoundation,Cleveland,Ohio ClinicFoundation,Cleveland,Ohio ANITHA RAJAMANICKAM, MD Associate Staff, Department FRANKLIN A. MICHOTA, MD Head, Section of Hospital of Hospital Medicine, The Cleveland Clinic Foundation, Medicine,DepartmentofGeneralInternalMedicine,The Cleveland,Ohio ClevelandClinicFoundation,Cleveland,Ohio S. SETHU K. REDDY, MD Chairman and Program Director, HALLEC.F.MOORE,MD Staff,SolidTumorOncology,Taus- DepartmentofEndocrinology,DiabetesandMetabolism, sig Cancer Institute, The Cleveland Clinic Foundation, TheClevelandClinicFoundation,Cleveland,Ohio Cleveland,Ohio JOEL E. RICHTER, MD Professor of Medicine and Chair, SHERIF B. MOSSAD, MD Staff Physician, Department of Department of Medicine, Temple University School of Infectious Diseases, Medicine Institute, The Cleveland Medicine,Philadelphia,Pennsylvania ClinicFoundation,Cleveland,Ohio CURTISM.RIMMERMAN,MD StaffCardiologist,Department JOSEPH V. NALLY, JR., MD Nephrologist, Department of ofCardiovascularMedicine,TheClevelandClinicFounda- Nephrology,TheClevelandClinicFoundation,Cleveland, tion,Cleveland,Ohio Ohio STEVENK.SCHMITT,MD StaffPhysician,DepartmentofIn- CHRISTIANNASR,MD QualityControlOfficer,Department fectiousDiseases,TheClevelandClinicFoundation,Cleve- ofEndocrinologyandMetabolismInstitute,TheCleveland land,Ohio ClinicFoundation,Cleveland,Ohio MARTIN J. SCHREIBER, JR., MD Chairman, Department of CRAIGNIELSEN,MD Staff,DepartmentofInternalMedicine, NephrologyandHypertension,TheClevelandClinicFoun- TheClevelandClinicFoundation,Cleveland,Ohio dation,Cleveland,Ohio ROBERTM.PALMER,MD Head,SectionofGeriatricMedicine, PRIYANKASHARMA,MD AssociateStaff,DepartmentofHos- DepartmentofGeneralInternalMedicine,TheCleveland pital Medicine, The Cleveland Clinic Foundation, Cleve- ClinicFoundation,Cleveland,Ohio land,Ohio P1:OSO LWBK178-FM LWBK178-Stoller-v1.cls January8,2009 23:47 Printer:Prepress-Gibbs x Contributors ROYL.SILVERSTEIN,MD Staff,DepartmentofBloodDisor- HOLLYL.THACKER,MD Head,SectionofWomen’sHealth, dersandHematologicMalignancies,TaussigCancerCenter, DepartmentsofGeneralInternalMedicineandObstetrics TheClevelandClinicFoundation,Cleveland,Ohio andGynecology,TheClevelandClinicFoundation,Cleve- land,Ohio EDYE.SOFFER,MD Co-Director,GIMotilityLaboratory,Di- visionofGastroenterology,CenterforDigestiveDiseases, KARL S. THEIL, MD Staff Pathologist; Director, Pathology CedarsSinaiMedicalCenter,LosAngeles,California Residency Program, Department of Clinical Pathol- ogy, The Cleveland Clinic Foundation, Cleveland, TYLERSTEVENS,MD DigestiveDiseaseInstitute,TheCleve- Ohio landClinicFoundation,Cleveland,Ohio KENNETH J. TOMECKI, MD ViceChairman,Departmentof JAMESK.STOLLER,MD JeanWallBennettChairofEmphy- Dermatology,TheClevelandClinicFoundation,Cleveland, sema Research; Head, Cleveland Clinic Respiratory Ther- Ohio apy,DivisionofMedicine;ExecutiveDirector,Leadership Development, The Cleveland Clinic Foundation, Cleve- BENNIE R. UPCHURCH, MD Staff Physician, Digestive Dis- land,Ohio easeInstitute,TheClevelandClinicFoundation,Cleveland, Ohio CHRISTY J. STOTLER, MD Hematology Oncology Fellow, TaussigCancerInstitute,TheClevelandClinicFoundation, NIZAR ZEIN, MD Digestive Disease Institute, The Cleveland Cleveland,Ohio ClinicFoundation,Cleveland,Ohio ALANJ.TAEGE,MD Director,HIVCare,DepartmentofIn- ROBERT S. ZIMMERMAN, MD Interim Chairman and Pro- fectiousDiseases,TheClevelandClinicFoundation,Cleve- gram Director, Department of Endocrinology, The Cleve- land,Ohio landClinicFoundation,Cleveland,Ohio
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