Toronto notes 2016: Comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam Part I and the United States Medical Licensing Exam Step 2 PDF
Preview Toronto notes 2016: Comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam Part I and the United States Medical Licensing Exam Step 2
TORONTO NOTES 22 1166 COMPREHENSIVE MEDICAL REFERENCE & REVIEW FOR MCCQE AND USMLE II Editors-in-Chief: Zamir Merali & Jason D. Woodfine Production Managers: Jieun Kim & Ilya Mukovozov 2016 Toronto Notes Comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam Part I and the United States Medical Licensing Exam Step 2 32nd Edition Editors-in-Chief: Zamir Merali and Jason D. Woodfine Wherever the art of medicine is loved, there is also a love of humanity. – Hippocrates Toronto Notes for Medical Students, Inc. Toronto, Ontario, Canada Thirty-second Edition Copyright © 2016 – Toronto Notes for Medical Students, Inc. Toronto, Ontario, Canada. Typeset and production by Type & Graphics Inc. ISBN 978-1-927363-26-3 (32nd ed.) All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2016 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 written permission from the publisher. Every effort has been made to obtain permission for all copyrighted material contained herein. Previous editions copyright © 1985 to 2016. Cover design: Ashley Hui 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 PART I. 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 continuing research. The authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this textbook, atlas, or software and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. In particular, the reader is advised to check the manufacturer’s insert of all pharmacologic products before administration. FEEDBACK AND ERRATA We are constantly trying to improve the Toronto Notes and welcome your feedback. If you have found an error in this edition please do not hesitate to contact us. As well, we look forward to receiving any comments regarding any component of the Toronto Notes package and website. Please send your feedback to: [email protected] Alternatively, send mail to: Toronto Notes for Medical Students Editors-in-Chief c/o The Medical Society 1 King’s College Circle, Room 2260 Toronto, Ontario M5S 1A8 Canada email: [email protected] Tel: 1-416-946-3047 Fax: 1-416-978-8730 Library of Congress Cataloging-in-Publication Data is available upon request 2 Toronto Notes 2016 Dedicated to all past and present contributors and supporters of Toronto Notes who have made the production of the 2016 edition possible! The Toronto Notes is dedicated to helping fund many charitable endeavours and medical student initiatives at the University of Toronto’s Faculty of Medicine. Programs that have received Toronto Notes funding include: Community Affairs Projects Medical School Clubs • Saturday Program for Inner City High School • Books with Wings and Grade 8 students • Women in Medicine • St. Felix Mentorship Program for Inner City children • University of Toronto International Health Program • Parkdale Mentorship Program for Grade 10-12 students • Complementary and Alternative Medicine • WoodGreen Community Centre • Peer Support for Students • Let’s Talk Science • History of Medicine Society • Growing Up Healthy • Faculty of Medicine Yearbook Annual Faculty Showcase Events Scholarships and Bursaries • Bruce Tovee Lecture Series • Nishant Fozdar Memorial Award • Daffydil, in support of the Canadian Cancer Society • Graduating Medical Class Scholarships and Bursaries • Earthtones Benefit Concert • Convocation and Ceremonies Note: Many of you have wondered about the Toronto Notes logo, which is based on the rod of Asclepius, the Greek god of medicine. The rod of Asclepius consists of a single serpent entwined around a staff. This icon symbolizes both rebirth, by way of a snake shedding its skin, and also authority, by way of the staff. In ancient Greek mythology, Asclepius was the son of Apollo and a skilled practitioner of medicine who learned the medical arts from the centaur Chiron. Asclepius’ healing abilities were so great that he was said to be able to bring back people from the dead. These powers displeased the gods, who punished Asclepius by placing him in the sky as the constellation Orphiuchus. The rod of Asclepius is at times confused with the caduceus, or wand, of Hermes, a staff entwined with two serpents and often depicted with wings. The caduceus is often used as a symbol of medicine or medical professionals, but there is little historical basis for this symbolism. As you may have guessed, our logo uses the rod of Asclepius that is modified to also resemble the CN Tower – our way of recognizing the university and community in which we have been privileged to learn the art and science of medicine. Thomas O’Brien, MD Class of 2009 M.D. Program, University of Toronto 3 Toronto Notes 2016 Preface – From the Editors Dear Readers, As the Editors-in-Chief of Toronto Notes 2016 we are in the city of Toronto. This year Toronto Notes proud to present this updated edition. for Medical Students has supported organizations including medical school clubs, community outreach Toronto Notes began humbly in 1985 from a set of groups, student bursaries and scholarships, and the student notes circulated among medical students at Canadian Cancer Society. Your purchase of Toronto the University of Toronto. Over time, Toronto Notes Notes 2016 is much appreciated by these well- has grown into one of the premier study resources for deserving groups. generations of Canadian medical school graduates. This rich history has led to our firm commitment to We would like to highlight the exceptional work of publish a comprehensive study resource for medical our team, composed of over 150 medical students, students engaged in clinical rotations and studying medical illustrators/artists, and faculty members for both the USMLE Step 2 and Canadian MCCQE at the University of Toronto Faculty of Medicine. Part 1. Without the tireless effort expended by these individuals the production of Toronto Notes 2016 For over 30 years we have remained committed to would not have been possible. In particular, we would our original vision. The 2016 edition of Toronto Notes like to highlight the work of the executive team, all of contains significant improvements including: whom made personal sacrifices in balancing clinical work with the responsibilities asked of them. We also 1. A new emphasis on ‘Approaches to Common want to highlight the work of Jesse Lu and Kota Talla, Clinical Presentations’ in addition to traditional without whom the production of the Toronto Notes content organized by disease. Quiz App would not have been possible. Lastly, we 2. A completely revised Psychiatry chapter would like to thank our partners at Type & Graphics incorporating the DSM-V in a quick-to-reference Inc., particularly Enrica Aguilera, for their guidance and readable format. during the production of Toronto Notes 2016. 3. The Toronto Notes Quiz App, which is available for free on iTunes and Google Play. This app We hope you find Toronto Notes 2016 enhances your contains hundreds of questions allowing users to medical knowledge and allows you to perform better test themselves on the content contained within on both your clinical rotations and licencing exams. Toronto Notes. We continue to encourage feedback – this year, we 4. A significantly improved interactive eBook with have read and incorporated every piece of feedback many new high-quality colour images. we received about the previous edition of Toronto 5. A brand-new Clinical Handbook that is more Notes. On behalf of the Toronto Notes 2016 team, we concise, has numerous new figures, and features wish you success in your studies. approaches to hundreds of common clinical situations. Sincerely, Toronto Notes 2016 is produced by Toronto Notes Zamir Merali, BSc. and Jason D. Woodfine, BSc. for Medical Students Inc., which is a non-for-profit Editors-in-Chief, Toronto Notes 2016 organization supporting various charity organizations MD Program, University of Toronto 4 Toronto Notes 2016 Acknowledgements We would like to acknowledge the exceptional work of all previous Toronto Notes (formerly MCCQE Notes) Editors-in-Chief and their editorial teams. The 32nd edition of this text was made possible with their contributions. 2015 (31th ed.): Justin Hall and Azra Premji 2014 (30th ed.): Miliana Vojvodic and Ann Young 2013 (29th ed.): Curtis Woodford and Christopher Yao 2012 (28th ed.): Jesse M. Klostranec and David L. Kolin 2011 (27th ed.): Yingming Amy Chen and Christopher Tran 2010 (26th ed.): Simon Baxter and Gordon McSheffrey 2009 (25th ed.): Sagar Dugani and Danica Lam 2008 (24th ed.): Rebecca Colman and Ron Somogyi 2007 (23rd ed.): Marilyn Heng and Joseph Ari Greenwald 2006 (22nd ed.): Carolyn Jane Shiau and Andrew Jonathan Toren 2005 (21st ed.): Blair John Normand Leonard and Jonathan Chi-Wai Yeung 2004 (20th ed.): Andrea Molckovsky and Kashif S. Pirzada 2003 (19th ed.): Prateek Lala and Andrea Waddell 2002 (18th ed.): Neety Panu and Sunny Wong 2001 (17th ed.): Jason Yue and Gagan Ahuja 2000 (16th ed.): Marcus Law and Brian Rotenberg 1999 (15th ed.): Sofia Ahmed and Matthew Cheung 1998 (14th ed.): Marilyn Abraham and M Appleby 1997 (13th ed.): William Harris and Paul Kurdyak 1996 (12th ed.): Michael B. Chang and Laura J. Macnow 1995 (11th ed.): Ann L. Mai and Brian J. Murray 1994 (10th ed.): Kenneth Pace and Peter Ferguson 1993 (9th ed.): Joan Cheng and Russell Goldman 1992 (8th ed.): Gideon Cohen-Nehemia and Shanthi Vasudevan All former Chief Editors from 1991 (7th ed.) to 1985 (1st ed.) 5 Toronto Notes 2016 Student Contributors Editors-in-Chief Production Managers Clinical Handbook Editors Electronic Content Editors Zamir Merali Jieun Kim Caleigh Campbell Jesse Lu Justin D. Woodfine Ilya Mukovozov Sabah Khan Kota Talla Sharon Lee Chief Copy Editor Copy Editors BMC Production Editors Tu Nguyen Catherine Brown Priyanka Kapil Christina Reppas Ashley Hui Henry Chen Stephanie Lapinsky Nikki Schneider Susan Le Leema Dookhoo Olivia Li Melissa Sheehan Daniel Glatt Anthony Mak David Smith Jacqui Hayworth Zamir Merali William Stuart Lindsay Herzog Janet Nguyen Jason D. Woodfine Richard Hoang Chris Noel Issac Yang Andrea Hunt Jonathan Park Erik Yao Sandra Huynh Mohini Patel PRIMARY AND OTHER SPECIALTIES MEDICINE SURGERY Associate Editors EBM Editors Associate Editors EBM Editors Associate Editors EBM Editors Lindsey Chapman Shany Gertzbein Hart Stadnick Alex Cressman Hasaan Chaudhry Alex Cressman Meghna Rajaprakash Kevin Yau Nardin Samuel Shany Gertzbein Chapter Editors Chapter Editors Chapter Editors Ethical, Legal, and Family Medicine Cardiology and Infectious Diseases General Surgery Orthopedics Organizational Medicine Mark Bamberger Cardiac Surgery Vanda McNiven Ming Hao (Dennis) Amedeo Falsetto Yang Lei Saurabh Kalra David Armstrong Kimberly Stewart Guo Scott Kim Sarah Whynot Mena Gewarges Marie Yan Kelsey Ragan Anesthesia and Sagar Rohailla Elizabeth Shin Otolaryngology Perioperative Medicine Medical Imaging Nephrology Anna Goulding Eileen Heo Sidharth Saini Endocrinology Eric Coomes Gynecology Soroush Larjani David Wang Tara Justice Tamara Gimon Dalia Bibr Mario Moscovici Clinical Pharmacology Ilia Makedonov Katie Bies Farah Jazuli Pediatrics Neurology Christine Edwards Plastic Surgery Ahmed Faress Gastroenterology Adi Kartolo James Wang Scott Turcotte Dermatology Lucy Li Kevin Pivavarov Yi (Emma) Quan Oren Zarnett Mengzhu Jiang Fahad Masud Melanie Wong Jeremy Zung Neurosurgery Emily Stewart Leah Smith Oliver Ayling Urology Geriatric Medicine Respirology Holly Lee Matthew Lenardis Emergency Medicine Population Health Ayan Dey Alex Kumachev Kai Yang Prateek Sehgal and Epidemiology Navjot Rai Obstetrics Kelvin Wong Catherine Brown Hematology Dalia Bibr Vascular Surgery Michael Wong Brahim Redouane Rheumatology Katie Bies Keith Gunaratne Psychiatry Hart Goldhar Susan Armstrong Christine Edwards Jordan Bawks Hiten Naik Amy Miles James Wang Raman Srivastava Ophthalmology Thomas Andrew Berk Carl Shen BMC ILLUSTRATORS Meriem Benlamri Sam Holmes Sonia Seto Kristen Browne Ashley Hui Madeline Spacher Cassandra Cetlin Susan Le Kelly Speck Natalie Cormier Derek Ng Caitlyn Swanberg Naveen Devasagayam Melissa Phachanhla Sara Vukson Wendy Gu Kateryna Procunier Emilie Wiens Erina He 6 Toronto Notes 2016 Faculty Contributors, University of Toronto All contributing professors have been appointed at the University of Toronto. David Adam, MD, FRCPC Alice Cheung, MD, FRCPC Jonathan C. Irish, MD, MSc, FRCSC Division of Dermatology Division of Endocrinology and Metabolism Department of Otolaryngology - Department of Medicine Department of Medicine Head and Neck Surgery St. Michael’s Hospital St. Michael’s Hospital University Health Network Anne M. R. Agur, BSc, MSc, PhD Chi-Ming Chow, MDCM, MSc, FRCPC Nasir Jaffer, MD, FRCPC Division of Anatomy Division of Cardiology Division of Abdominal Imaging Department of Surgery Department of Medicine Department of Medical Imaging University of Toronto St. Michael’s Hospital Joint Department of Medical Imaging University of Toronto Iqbal Ahmed, MD, FRCSC Allison Chris, MD, MSc, FRCPC Department of Ophthalmology Division of Clinical Public Health David Juurlink, BPhm, MD, PhD, FRCPC and Vision Science Dalla Lana School of Public Health Division of Clinical Pharmacology University of Toronto and Toxicology Maria Cino, HonBSc, MSc, MD, FRCPC Departments of Medicine and Pediatrics Ruby Alvi, MD, CCFP, MHSc Division of Gastroenterology Sunnybrook Health Sciences Centre Department of Family University Health Network and Community Medicine Toronto Western Hospital Lorraine Kalia, MD, PhD, FRCPC University of Toronto Division of Neurology Isabella Devito, MD, FRCPC University Health Network Meyer Balter, MD, FRCPC Department of Anesthesia and Toronto Western Hospital Division of Respiratory Medicine Pain Management Department of Medicine University Health Network and Gabor Kandel, MD, FRCPC Mount Sinai Hospital Mount Sinai Hospital Division of Gastroenterology, Department of Medicine Nirit Bernhard, MSc, MD, FRCPC Alfonso Fasano, MD, PhD, FRCPC St. Michael’s Hospital Department of Pediatrics Division of Neurology Hospital for Sick Children University Health Network Sari L. Kives, MD, FRCSC Toronto Western Hospital Department of Obstetrics and Gynecology Kate Bingham, MD, MPH, CCFP-EM St. Michael’s Hospital and Faculty of Medicine Mark Freedman, MD, FRCPC The Hospital for Sick Children University of Toronto Department of Emergency Medicine Sunnybrook Health Sciences Centre Wai-Ching Lam, MD, FRCSC Matthew Binnie, MD Department of Ophthalmology and Division of Respirology Natasha Gakhal, MD, FRCPC Vision Science University Health Network Division of Rheumatology University Health Network St. Michael’s Hospital Department of Medicine Toronto Western Hospital Women’s College Hospital Ari Bitnun, MD, MSc, FRCPC Chloe Leon, MD, FRCPC Division of Infectious Diseases Barry J. Goldlist, MD, FRCPC Division of Brain and Therapeutics The Hospital for Sick Children Division of Geriatric Medicine Department of Psychiatry Department of Medicine Centre for Addiction and Mental Health Andrea Boggild, MSc, MD, FRCPC University Health Network Tropical Disease Unit and Armando Lorenzo, MD, FRCSC Division of Infectious Diseases Jeremy Hall, MD, FRCSC Division of Urology University Health Network Division of Orthopedic Surgery Department of Surgery Toronto General Hospital Department of Surgery The Hospital for Sick Children St. Michael’s Hospital Arthur Bookman, MD, FRCPC Todd Mainprize, MD, FRCSC Division of Rheumatology Philip C. Hébert, MA, PhD, MD, FCFPC Department of Neurosurgery Department of Medicine Department of Family and Sunnybrook Health Sciences Centre University Health Network Community Medicine Toronto Western Hospital Joint Centre for Bioethics Eric Massicotte, MD, MSc, FRCSC Sunnybrook Health Sciences Centre Department of Neurosurgery Mark Boulos, MD, MSc, CSCN(EEG), FRCPC University Health Network Division of Neurology and Sleep Medicine Sender Herschorn, MDCM, FRCSC Toronto Western Hospital Department of Medicine Division of Urology Sunnybrook Health Sciences Centre Department of Surgery Michael McDonald, MD, FRCPC Sunnybrook Health Sciences Centre and Division of Cardiology and Simon Carette, MD, FRCPC Women’s College Hospital The Multi-Organ Transplant Program Division of Rheumatology Department of Medicine Department of Medicine University Health Network Mount Sinai Hospital Toronto General Hospital 7 Toronto Notes 2016 Faculty Contributors, University of Toronto Adam C. Millar, MD, MScCH Angela Punnett, MD, FRCPC Herbert P. von Schroeder, MD, MSc, FRCSC Division of Endocrinology and Metabolism Department of Pediatrics Divisions of Orthopedic Surgery and Department of Medicine The Hospital for Sick Children Plastic Surgery Mount Sinai Hospital Department of Surgery Graham Roche-Nagle, University Health Network Yvette Miller-Monthrope, MD, FRCPC MD, MBA, FRCSI, EBSQ-VASC Division of Dermatology Division of Vascular Surgery Oshrit Wanono, MD, FRCPC Department of Medicine University Health Network Division of Child and Adolescent Psychiatry Women’s College Hospital Toronto General Hospital Department of Psychiatry Centre for Addiction and Mental Health Azadeh Moaveni, MD, CCFP Amanda Selk, MD, FRCSC Department of Family and Department of Obstetrics and Gynecology Kyle R. Wanzel, MD, MEd, FRCSC Community Medicine Mount Sinai Hospital Division of Plastic Surgery University Health Network St Joseph’s Health Centre Toronto Western Hospital Rajiv Shah, MD, MSc, FRCSC Department of Obstetrics and Gynecology Richard Ward, MBBS, MRCP, FRCPath Eva Mocarski, MD, FRCSC St. Michael’s Hospital Division of Hematology Department of Obstetrics and Gynecology Department of Medicine St. Michael’s Hospital Marisa Sit, MD, FRCSC University Health Network Department of Ophthalmology Ally Murji, MD, MPH, FRCS(C) and Vision Science Jeffrey Wassermann, MD, FRCPC Department of Obstetrics and Gynecology University Health Network Department of Anesthesia Mount Sinai Hospital Toronto Western Hospital St. Michael’s Hospital Melinda Musgrave, MD, PhD, FRCSC Kevin Skarratt, MD, FRCPC Alice Wei, MD CM, MSc, FRCSC Division of Plastic and Reconstructive Surgery Department of Emergency Medicine Division of General Surgery Department of Surgery Sunnybrook Health Sciences Centre Department of Surgery St. Michael’s Hospital University Health Network Peter Tai, MD, FRCPC Sharon Naymark, MD, FRCPC Division of Neurology Fay Weisberg, MD, FRCSC Department of Pediatrics University Health Network Division of Reproductive Endocrinology St. Joseph’s Health Centre Toronto Western Hospital and Infertility Department of Obstetrics and Gynecology George Oreopoulos, MD, MSc, FRCSC Diana Tamir, MD, FRCPC University of Toronto Division of Vascular Surgery Department of Anesthesia and Department of Surgery Pain Management Michael Wiley, BSc, MSc, PhD University Health Network University Health Network Division of Anatomy Department of Surgery Susan Poutanen, MD, MPH, FRCPC Gemini Tanna, MD, FRCPC University of Toronto Department of Microbiology Division of Nephrology University Health Network and Department of Medicine Anna Woo, MD CM, SM, DABIM, FRCPC Mount Sinai Hospital Sunnybrook Health Sciences Centre Division of Cardiology Department of Medicine Ramesh Prasad, MBBS, MSc, FRCPC Piero Tartaro, MD, FRCPC University Health Network Division of Nephrology Division of Gastroenterology Toronto General Hospital Department of Medicine Department of Medicine St. Michael’s Hospital Sunnybrook Health Sciences Centre Jensen Yeung, MD, FRCPC Division of Dermatology Mary Preisman, MD, FRCPC Fernando Teixeira, MD, FRCPC Department of Medicine Department of Psychiatry Department of Emergency Medicine Women’s College Hospital Mount Sinai Hospital St. Michael’s Hospital Eugene Yu, MD, FRCPC Evan Propst, MD, MSc, FRCSC Martina Trinkaus, MD, FRCPC Division of Neuroradiology Division of Head and Neck Surgery Division of Hematology Department of Medical Imaging Department of Otolaryngology Department of Medicine University Health Network The Hospital for Sick Children St. Michael’s Hospital 8 Toronto Notes 2016 Table of Contents Index Abbreviations 1. Common Unit Conversions 2. Commonly Measured Laboratory Values 3. Ethical, Legal, and Organizational Medicine.............................................. ELOAM 4. Anesthesia and Perioperative Medicine ................................................. A 5. Cardiology and Cardiac Surgery....................................................... C 6. Clinical Pharmacology............................................................... CP 7. Dermatology....................................................................... D 8. Emergency Medicine................................................................ ER 9. Endocrinology ..................................................................... E 10. Family Medicine.................................................................... FM 11. Gastroenterology................................................................... G 12. General Surgery.................................................................... GS 13. Geriatric Medicine .................................................................. GM 14. Gynecology ....................................................................... GY 15. Hematology ....................................................................... H 16. Infectious Diseases ................................................................. ID 17. Medical Imaging.................................................................... MI 18. Nephrology........................................................................ NP 19. Neurology......................................................................... N 20. Neurosurgery...................................................................... NS 21. Obstetrics......................................................................... OB 22. Ophthalmology..................................................................... OP 23. Orthopedics ....................................................................... OR 24. Otolaryngology .................................................................... OT 25. Pediatrics ......................................................................... P 26. Plastic Surgery..................................................................... PL 27. Population Health and Epidemiology ................................................... PH 28. Psychiatry......................................................................... PS 29. Respirology ....................................................................... R 30. Rheumatology ..................................................................... RH 31. Urology........................................................................... U 32. Vascular Surgery ................................................................... VS 33. Index 9 Toronto Notes 2016
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