The Toronto notes 2012 : comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam, part 1 and the United States Medical Licensing Exam, step 2

1800 Pages·2012·4.12 MB·English

by  Klostranec

COMPREHENSIVE MEDICAL REFERENCE & REVIEW FOR MCCQE I & USMLE II
Editors-in-Chief:
Jesse M. Klostranec and David L. Kolin

2012
THE TORONTO NOTES
Comprehensive medical reference and review for the
Medical Council of Canada Qualifying Exam Part 1 and the
United States Medical Licensing Exam Step 2
28th Edition
Editors-in- Chief:
Jesse M. Klostranec and David L. Kolin
He who studies medicine without books
sails an uncharted sea,
but he who studies medicine without patients
does not go to sea at all.
- Sir William Osler
~
Toronto Notes for Medical Students, Inc.
~
Toronto, Ontario, Canada
Twenty-eighth Edition
Copyright© 2012-Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada.
Typeset and production by Type & Graphics Inc.
ISBN 978-0-9809397-7-4 (28th ed.)
All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2012 is provided for the sole use of
the purchaser. It is made available on the condition that the information contained herein will not be sold or
photocopied. No part of this publication may be used or reproduced in any form or by any means without prior
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material contained herein. Previous editions copyright© 1985 to 2012.
Cover design: Dale Podolsky
Illustrations: Biomedical Communications, University of Toronto
Notice:
THIS PUBLICATION HAS NOT BEEN AUTHORED, REVIEWED OR OTHERWISE SUPPORTED BY
THE MEDICAL COUNCIL OF CANADA NOR DOES IT RECEIVE ENDORSEMENT BY THE MEDICAL
COUNCIL AS REVIEW MATERIAL FOR THE MCCQE. THIS PUBLICATION HAS NOT BEEN
AUTHORED, REVIEWED OR OTHERWISE SUPPORTED BY THE NATIONAL BOARD OF MEDICAL
EXAMINERS U.S.A. NOR DOES IT RECEIVE ENDORSEMENT BY THE NATIONAL BOARD AS
REVIEW MATERIAL FOR THE USMLE.
The editors of this edition have taken every effort to ensure that the information contained herein is accurate
and conforms to the standards accepted at the time of publication. However, due to the constantly changing
nature of the medical sciences and the possibility of human error, the reader is encouraged to exercise
individual clinical judgement and consult with other sources of information that may become available with
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In particular, the reader is advised to check the manufacturer's insert of all pharmacologic products before
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Library of Congress Cataloging-in-Publication Data is available upon request
2 Toronto Notes 2012
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Class of 2009
M.D. Program, University of Toronto
Toronto Notes 2012 3
Preface - From the Editors
Dear readers, and writing chapter content, copy editing, and including
the latest evidence-based medicine summaries. We would
We proudly present the 28th edition of Toronto Notes, the particularly like to highlight the significant contributions
product of contributions from more than 190 individuals. of the associate editors, who helped to coordinate the
The text originally began as a set of review notes passed work on all of the chapters. With the hard work and
among students to help prepare for medical licensing dedication of such a remarkable staff, our experience as
exams, and has now grown to become an unrivaled, editors-in-chief can be accurately described as getting
annually updated, essential reference for medical students out of the way of numerous more intelligent and talented
and residents all over the world. The current edition individuals. We were routinely amazed by their work.
includes 29 chapters covering 27 medical specialties with
indispensable clinical pearls, evidence-based medicine Producing the study package, while a long and arduous
highlights, and helpful mnemonics. It is widely regarded task, is not the sole undertaking of the Toronto Notes
as a must-have resource for the medical trainee. team - there also exists the important work of getting
the publication into the hands of you, the reader. On
The complete Toronto Notes study package also includes this front, we appreciate the hard work of the production
the clinical handbook and a wide variety of online managers, Jeffrey Alfonsi and Joshua Levitz. They
material. The handbook editors, Jonathan Hong and worked tirelessly to collect orders, coordinate sales, and
Kamini Raghuram, worked closely with the chapter market our product. We are also grateful to those who
editors to update this resource. The handbook contains have helped us in our marketing endeavours, notably
quick reference information for the wards, clinic, and Mr. Garrett Taylor, Dr. Dante Morra, and Dr. Philippe
OR, including differential diagnoses, investigations, and Gailloud. It has been an exciting year from a marketing
treatment options. Online material includes a colour atlas, perspective with several new initiatives and we look
as well as the unparalleled Functional Neuroanatomy™ forward to continuing them with the help of such great
and ECG Made Simple™ learning software packages. partnerships.
For the first time we are including advanced cardiac life
support (ACLS) flash cards with the clinical handbook, We also extend our gratitude to those who have helped
so trainees can have quick access to the algorithms facilitate the production process. Medical Education at
while on the wards. In response to requests from our St. Michael's Hospital in Toronto graciously allowed us to
readership, we have also just launched the first eBook use the exceptional facilities at the Li Ka Shing Knowledge
version of Toronto Notes. We hope that these features Institute for our meetings. The previous editors-in-chief,
of the Toronto Notes 2012 study package will meet your Amy Chen and Christopher Tran, enabled a smooth
medical education needs. transition between editorial teams. And we are also
grateful to our publisher, Type & Graphics, for their
The 2012 edition of Toronto Notes is prepared by the endless patience with our numerous requests and for
Toronto Notes for Medical Students Inc., a non-profit being flexible with our ever-changing schedule. We were
corporation, and proceeds from sales fund university very happy to continue our long-standing relationship
and community groups, charities, and medical student with them over the past year.
scholarships. On behalf of all of those who have benefited
from these programs, we would like to thank you, the We hope you find Toronto Notes to be an indispensable
reader, for your support of Toronto Notes 2012. resource during your journey towards becoming a health
care professional. On the behalf of the current editorial
One oft he unique aspects oft his publication is the number team, we hope you set your goals and dreams high, one
of individuals who are involved with its production day they become a reality, and that Toronto Notes helps
each year. We are indebted to all past members of the you get there.
Toronto Notes team, giants who graciously allowed us
to stand on their shoulders. The editorial team of this Sincerely,
edition consisted of 56 staff physicians, affiliated with the
University of Toronto, who generously donated their time
to serve as faculty reviewers. The team also consisted of 12
talented medical illustrators, led by Merry Wang and Tobi
Lam, from the Biomedical Communications program at
the University of Toronto. Finally, this edition would Jesse M. Klostranec, PhD, and David L. Kolin, PhD
not have been possible without the hard work of the 127 Editors-in-Chief, Toronto Notes 2012
medical student editors, who were responsible for editing MD Program, University of Toronto
4 Toronto Notes 2012
Student Contributors
Editors-in-Chief Production Managers Handbook Editors Atlas Editors and
Jesse Klostranec Jeffrey Alfonsi Jonathan Hong Medical Imaging
David Kolin Joshua Levitz Kamini Raghuram Steve Giilck
Rebecca Zhu
Associate Editors: Medicine Associate Editors: Surgery Associate Editors: Primary Medicine and Other Specialties
Ernest Chiu Tony Soeyonggo Kenneth Lee
MelodyQu Shelly Wang Raheem Peerani
EBM Editor: Medicine EBM Editor: Surgery EBM Editor: Primary Medicine and Other Specialties
Ana Nikolic Trisha Roy David Katz
Chapter Editors: Gastroenterology Neurosurgery Psychiatry
Mihan Han Stephana Chang Melanie Beswick
Ethics, Legal and Hanna Lee Daipayan Guha Tara McGregor
Organizational Medicine Jenny Wang Amparo Wolf Chris Zroback
Rami Shoucri
General Surgery Obstetrics Respirology
Anesthesia Daniel Kagedan Kim Lazare Calvin Ke
LeiDu Rachel Rae Lynn Sterling Marcus Miller
Keerat Grewal Kenneth Van Dewark Jennifer Sy Terence Yung
Alexander White Phil Zhang
Ophthalmology Rheumatology
Cardiology and Cardiovascular Geriatric Medicine Corey Boimer MeghanHo
Surgery Jillian Alston Raageen Kanjee Danielle Rodin
Gur Chandhoke Andrea Kirou-Mauro ZaidMammo Alexandra Saltman
Colleen Parker Melinda Li
Darwin Yeung Orthopedics Urology
Gynecology Joshua Bennitz Dhiraj Dhanjani
Clinical Pharmacology AncaMatei Andrea Chan Mohammad Hajiha
Andrew Gao Eva Seto Eric Crawford Nobuhiko Okubo
Kapil Goela Yimeng Zhang
Otolaryngology
Dermatology Hematology Lisa Caulley
Adam Durbin Cheryl Foster Lara Gotha
Jonathan Levy Christe Henshaw Gavin le Nobel
Jane Ridley Larissa Liontos Cheryl Volling
Jessica Woolfson
Infectious Disease Pediatrics Copy Editors
Emergency Medicine Marcus Barron Navneet Binepal Erin Boyd
Nelab Alingary Melanie Finkbeiner Bryan Li Carl Bradley
Michael Misch Stephen Gauthier Amber Makino Erica Burry
Brodie Nolan Laura Wagner Anjali Rastogi Jessica Chin
Alexandra Cristian
Endocrinology Medical Imaging Plastic Surgery Chris Gilchrist
Priyanka Hansraj Kevin Lian Ashley Guttman Sofia Khan
Subhani Ragunathan Peter Yang James Jung Alexander Koculym
TinaZhu Maria-Alexandra Petre Kapilan Kugathasan
Nephrology Dale Podolsky Caeser Lim
Family Medicine Anna Holland TiffanyLo
Sarah Basma Michael Li Population and Gavinn Niroopan
Karen Dobkin Julie Wright Community Health Matthew Orava
Vanessa Rambihar Jennifer Loo Jessica Page
Ashley Zaretsky Neurology Nikita Patel Craig Peters
Matthew Burke Arielle Rochman Tal Platzker
Kristen Krysko Kate Querengesser
Melissa Mackenzie Lauren Willoughby
Janice Wong Savio Yu
Biomedical Communications Illustrators
Barbara Brehovsky Andrea Gauthier Bonnie Tang
Production Editors Natalia Burachynsky TobiLam Merry Wang
Tobi Lam Leanne Chan Julie Man
Merry Wang Marina Chang Andreea Margineanu
Enid Hajderi Stefania Spano
Toronto Notes 2012 5
Faculty Contributors, University of Toronto
All contributing professors have been appointed at the University of Toronto.
David Adam, MD, FRCPC Isabella Devito, MD, FRCPC Sender Herschorn, MD, FRCSC
Division of Dermatology Assistant Professor Professor and Chair
Department of Medicine Department of Anesthesia and Pain University Division of Urology
St. Michael's Hospital Management Sunnybrook Health Sciences Centre
University Health Network and Women's College Hospital
Anne M.R. Agur, BSc (OT), MSc, PhD and Mount Sinai Hospital
Professor, Division of Anatomy Sheila Jacobson, MD, FRCPC
Department of Surgery Jason Dodge, MD, MEd, FRCSC Department of Pediatrics
Assistant Professor The Hospital for Sick Children
Ruby Alvi, MD, CCFP, MHSc Division of Gynecologic Oncology
Assistant Professor, Department of Family Department of Obstetrics and Jonathan C. Irish, MD, MSc, FRCSC,
and Community Medicine Gynecology FACS
Princess Margaret Hospital Professor, Department of Otolaryngology
Hosanna Au, MD, FRCPC - Head and Neck Surgery
Associate Professor Andrew Dueck, MD, MSc, FRCSC, Chief, Department of Surgical Oncology
Department of Pediatrics FACS,RPVI University Health Network
The Hospital for Sick Children Assistant Professor
Division of Vascular Surgery Nasir Jaffer, MD, FRCPC
Stacey Bernstein, MD, FRCPC Sunnybrook Health Sciences Centre Associate Professor, Faculty of Medicine
Associate Professor Department of Medical Imaging
Department of Pediatrics Marc A. Freeman, MD, FRCPC Mount Sinai Hospital, University Health
The Hospital for Sick Children Program Director, Nuclear Medicine Network, Women's College Hospital
Department of Medical Imaging,
Matthew Binnie, MD, FRCP Mount Sinai Hospital Cheryl Jaigobin, MD, FRCPC
Assistant Professor University Health Network, Division of Neurology
Division of Respirology Women's College Hospital Department of Medicine
Department of Medicine University Health Network
St. Michael's Hospital Jeannette Goguen, MD, FRCPC
Division of Endocrinology David Juurlink, BPhm, MD, PhD,
Andrea Boggild, MSc, MD, DTMH, and Metabolism FRCPC
FRCPC Department of Medicine Associate Professor of Medicine,
Tropical Disease Unit St. Michael's Hospital Pediatrics, and Health Policy,
Toronto General Hospital Management, and Evaluation
Wayne Gold, MD, FRCPC Head, Division of Clinical Pharmacology
Priscilla Chiu, MD, PhD, FRCSC Division oflnfectious Diseases and Toxicology
Division of General Surgery Department of Medicine Sunnybrook Health Sciences Centre
The Hospital for Sick Children Toronto General Hospital
Gabor Kandel, MD, FRCPC
Chi-Ming Chow, MDCM, MSc, FRCPC, Barry J. Goldlist, MD, FRCPC, FACP, Associate Professor
FACC,FASE AGSF Division of Gastroenterology
Associate Professor, Division of Professor and Director Department of Medicine
Cardiology, Department of Medicine Division of Geriatric Medicine St. Michael's Hospital
St. Michael's Hospital Department of Medicine
University Health Network Sari L. Kives, MD, FRCSC
Tae-Bong Chung, MD, FRCPC Assistant Professor, Department of
Assistant Professor Jeremy A. Hall, MD, MEd, FRCSC Obstetrics and Gynecology
Department of Medical Imaging Orthopaedic Trauma and Upper St. Michael's Hospital
Mount Sinai Hospital Extremity Surgeon The Hospital for Sick Children
St. Michael's Hospital
Tulin Cil, MD, MEd, FRCSC Wai-Ching Lam, MD, FRCSC
Assistant Professor Philip C. Hebert, MA, PhD, MD, FCFPC Associate Professor, Department of
Division of General Surgery Associate Professor Ophthalmology and Vision Science
Department of Surgery Department of Family Toronto Western Hospital
Princess Margaret Hospital and Community Medicine
Ethics Consultant, Clinical Ethics Centre Perla Lansang, MD, FRCPC
Sunnybrook Health Sciences Centre Assistant Professor
Division of Dermatology
Sunnybrook Health Sciences Centre
6 Toronto Notes 2012
Armando Lorenzo, MD, FRCSC Andrea V. Page, MD, FRCPC Margaret A. Thompson, MD, FRCPC,
Assistant Professor Division of Infectious Diseases FACMT
Division of Urology Department of Medicine Department of Emergency Medicine
Department of Surgery University Health Network St. Michael's Hospital
The Hospital for Sick Children Director, Ontario Poison Control Centre
Blake C. Papsin, MD, MSc, FRCSC, The Hospital for Sick Children
Ryan Mai, MD, FRCPC FACS,FAAP
Department of Anesthesia Cochlear Americas Chair in Auditory Martina Trinkaus, MD, FRCPC
St. Michael's Hospital Development Division of Hematology
Professor, Department of Otolaryngology Department of Medicine
Todd Mainprize, MD, FRCSC - Head and Neck Surgery St. Michael's Hospital
Department of Neurosurgery The Hospital for Sick Children
Sunnybrook Health Science Centre Division of Plastic Jeffrey Tyberg, MD, FRCPC
and Reconstructive Surgery Department of Emergency Medicine
Heather McDonald-Blumer, MD, MSc, University of Toronto Sunnybrook Health Sciences Centre
FRCPC
Program Director, Division of Vikramaditya Prabhudesai, MBBS, MSc, Michael Weinstein, MD, FRCPC, FAAP
Rheumatology, Department of Medicine FRCR Assistant Professor and Director
Program Director, Core Internal Division of Medical Imaging Department of Pediatrics
Medicine St. Michael's Hospital The Hospital for Sick Children
University of Toronto
Ramesh Prasad, MBBS, MSc, FRCPC, Michael Wiley, BSc, MSc, PhD
Filomena Meffe, MD, FRCSC, MSc FACP Professor and Division Chair
Associate Professor, Department of Associate Professor Division of Anatomy
Obstetrics and Gynecology Division of Nephrology Department of Surgery
Director, Undergraduate Medical Department of Medicine
Education St. Michael's Hospital Anna Woo, MD SM, FRCPC, FACC
St. Michael's Hospital Associate Professor
Martin Schreiber, MD, FRCPC, MEd Division of Cardiology
Azadeh Moaveni, MD, CCFP Associate Professor Department of Medicine
Lecturer, Department of Family and Division of Nephrology Toronto General Hospital
Community Medicine Department of Medicine
Undergraduate Hospital Program St. Michael's Hospital Eugene Yu, MD, FRCPC
Director Assistant Professor, Medical Imaging
Toronto Western Hospital Fran E. Scott, MD, CCFP, FRCPC, MSc and Otolaryngology -Head and Neck
Associate Professor Surgery
Melinda Musgrave, MD, PhD, FRCSC Division of Epidemiology Division ofNeuroradiology
Assistant Professor Dalla Lana School of Public Health Department of Medical Imaging
Division of Plastic University Health Network
and Reconstructive Surgery John Teshima, MD, FRCPC, MEd
Department of Surgery Assistant Professor Tanya L. Zakrison, MHSc, MD, FRCSC,
St. Michael's Hospital Department of Psychiatry MPH
Sunnybrook Health Sciences Centre Division of General Surgery
Ali Naraghi, MD, FRCR Department of Surgery
Associate Professor Taufik A. Valiante, MD, PhD, FRCSC St. Michael's Hospital
Department of Medical Imaging Assistant Professor, Division of
University Health Network Neurosurgery, Department of Surgery
Women's College Hospital Co-Director, Epilepsy Program
University Health Network
Markku T. Nousiainen, MD, MSc,
FRCSC Herbert P. von Schroeder, MD, MSc,
Assistant Professor FRCSC
Division of Orthopedic Surgery, Associate Professor
Department of Surgery Divisions of Orthopedic and Plastic
Sunnybrook Health Sciences Centre Surgery
Holland Orthopedic & Arthritic Centre Department of Surgery
University Health Network
Toronto Notes 2012 7
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8 Toronto Notes 2012