Toronto Notes 2018

1374 Pages·2018·32.626 MB·English

by  Tina Binesh Marvasti, Sydney McQueen (eds.)

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e e NOTe ES
TOe RONTe O e
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2 18e
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COMePREHENSIVE MEDICAL ReEFERENCE
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& REVIEW FOR MCCQE AsND USMLE II
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Editors-in-Chief: Tina Binesh Moarvasti & Sydney McQueen
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Production Managers: Ilya Mukovozov & Kirill Zaslavsky
2018
Toronto Notes
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Comcprehensive medical refcerence and review for thce
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Medical Council of Canada Qualifying Exam (MCCQE) Part I and
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the United States Medical Licensing Exam (USMLE) Step 2
34th Edition.
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Editors-in-Chief:
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Tina Binesh Marvasti and Sydney McQueen
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Wherever the art of medicine is loved,
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there is alsof a love of humanity.
– Hippocrates
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Toronto Notes for Medical Students, Inc
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Toronto, Ontario, Canada
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Thirtry-fourth Edition
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Coopyright © 2018 – Toronto Notes for Medical Students, Inc.
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Toronto, Ontario, Canada.
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Typeset and production by Type &e Graphics Inc.
ISBN 978-1-927363-40-9 (34th ed.)
All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2018 is provided for the sole use of
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Cover fillustration: Matan Berson and Natividafd Chen
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Illustrations: Biomedical Communications, University of Toronto
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THIS PUBLICATION HAS NOT BEEN AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY
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EXAMINERS U.So.A NOR DOES IT RECEIVE ENDORSEMENT BY THE NATIONAL BOARD AS REVIEW
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MATERIAL FOR THE USMLE.
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The editors of this edition have taken every efforrt to ensure that the information containerd herein is accurate and
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confosrms to the standards accepted at the timse of publication. However, due to the consstantly changing nature of
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Thfomas O’Brien, MD
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Class of 2009, M.D. Program, University of Toronto
3 Toronto Notes 2018
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Preface – From the Editors
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Dear Readers, Australian Medicaol School Association, among
b others. We wouldb like to thank you for supporting
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As the Editors-in-Chief of Toronto Notes 2018, we are these initiatives through your purchase of Toronto
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proud to present the 34th Edition! Notes 2018
Toronto Notes began humbly in 1985 from a set of We would like to highlight the exceptional work of our
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student notes circulated among medical students at team, composed of over 150 medical students, medical
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the University ofc Toronto. Over time, Toronto Notes illustrators, and faculty members at tche University of
has grown ineto one of the premier study resources Toronto Faculty of Medicine. Weithout the tireless
for generations of medical trainees in Canada aned effort expended by these indivieduals, the production
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abroad. This rich history solidified our commitfment of Toronto Notes 2018 woulfd not have been possible.
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to publish a comprehensive study resource for In particular, we wouldk like to highlight the work
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medical students engaged in clinical rotations and of the executive team, all of whom made personal
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studying for both the Canadian MCCQE Part 1 and sacrifices in balabncing their clinical and academic
USMLE Step 2. duties with the responsibilities asked of them: our
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production managers, Ilya Mukovozov and Kirill
For the past 33 years we have remained committed to
Zaslavsky, our associate editors, Graham Mazereeuw,
our original vision. The 2018 edition of Toronto Notes
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contains significant improvements and new editions
Tara Tofighi, Sheliza Halani, and our oEBM editors,
including: Alexander Sapa, Keeth Krishnan, Shucbham Shan, Jin
1. A brand enew Medical Genetics chapter with Kyu Kim, Sukhmani Sodhi, Arnave .Agarwal. We also
evidencee based medicine highlights. e e
want to highlight the work of Rajkumari Chatterjee
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app contains hundreds of questions allowing users Notes 2018 enhances your medical knowledge and
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to tsest themselves on the content contained within allows you to perform bestter on both your clinical
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Toronto Notes. rotations and licensing exams. On behalf of the
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Toronto Notes 2018 is produced by bToronto Notes b
your studies and academic endeavours.
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for Medical Students Inc., which is a non-for-profit
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organization supporting various charity organizations
and medical student initiatives in the city of
Sincerely,
Toronto and across thme globe. This year, sponsored m m
organizations included Community Affairs, the
o Tina Binesh Marvasti, MSc, MD/PhD Coandidate and
Ontario Medicalc Student Weekend (OMSW), the c
Sydney McQueen, MSc, MD/PhD Candidate
University of eToronto Class Councils, Save A Child’s e
Editors-in-Chief, Toronto Notes 2018
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(MRSDs) The Medical Student Education Ressearch
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Grant (MSERG), Daffydil, the Conference of the
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4 Toronto Notes 2018
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Acknowledgements
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Woe would like to acknowledge the excepotional work of all previous Toronto Nootes (formerly MCCQE Notes)
Editors-in-Chief and their editorial teams The 34th edition of this text was made possible with their contributions.
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2017 (33rd ed.): Jieun Kim and Ilya Mukovozov
2016 (32nd ed.): Zamir Merali and Justin D. Woodfine
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2015 (31th ed.): Justin Hall and Azra Premji
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2014 (30th ed.): Miliana Vojvodic and Ann Young
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2013 (29th ed.): Curtis Woodford and Christopher Yao
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2012 (28th ed.): Jesse M. Klostranec and David L. Kolin
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2011 (27th ed.): Yingming Amy Chen and Christopher Tran
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2010 (26th ed.): Simon Baxter and Gordon McSheffrey
2009 (25th ed.): Sagar Dugani and Danica Lam
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2008 (24th ed.): Rebecca Colman and Ron Somogyi
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2007 (23rd ed.): Marilyn Heng and Joseph Ari Greenwald
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2006 (22nd ed.): Carolyn Jane Shiau and Andrew Jonathan Toren
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2005 (21st ed.): Blair John Normand Leonard and Jonathan Chi-Wai Yeung
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2004 (20th ed.): Andrea Molckovsky and Kashif S. Pirzada
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2003 (19th ed.): Prateek Lala and Andrea Waddell
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2002 (18th ed): Neety Panu and Sunny Wong
2001 (17th ed.): Jason Yue and Gagan Ahuja
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2000 (16th ed.): Marcus Law and Brian Rotenberg
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1999 (15th ed.): Sofia Ahmed and Matthew Cheung
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1998 (14th ed.): Marilyn Abraham and M Appleby
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1997 (13th ed.): William Harris and Paul Kurdyak
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1996 (12th ed.): Michael B. Chang and Laura J. Macnow
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1995 (11th ed.): Ann L. Mai and Brian J. Murray
1994 (10th ed.): Kenneth Pace and Peter Ferguson
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1993 (9th ed.): Joan Cheng and Russell Goldman
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1992 (8th ed.): Gideon Cohen-Nehemia and Shanthi Vasudevan
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All former Chief Editors from 1991 (7th ed.) to 1985 (1st ed.)
5 Toronto Notes 2018
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Student Contributors
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Editors-in-Chief Production Managers oClinical Handbook Editors STAT Notes Editor Atlas Editor BMC Production Editors
Tina Binesh Marvasti Ilya Mukovozov Waleed S. Ahmed Mina Faheim Ali Helmi Matan Berson
Sydney McQueen Kirill Zaslavsky Claudia Frankfurter Natividad Chen
Kimia Sorouri
PRIMARY AND OTHER SmPECIALTIES MEDICINE SURGERY m
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Associate Editors EBM Editors Associate Editors EBM Editors Associate Editors EBM Editors
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Sheliza Halani Arnav Agarwal Samik Doshi Keeth Krishnan Sangwoo Leem Jin Kyu Kim
Taraneh (Tara) Tofighi Sukhmani Sodhi Graham Mazereeuw Alexander Sapa Mark Shafarenko Shubham Shan
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Chapter Esditors Chaspter Editors Chapter Editors
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Ethicaol, Legal, and Family Medicine oCardiology and Infectious Diseases Goeneral Surgery Orthopedics
Oroganizational Medicine Mohammed Firdouse Cardiac Surgery Zane Brickman and Thoracic Michael Dzingala
Sabrina Agnihotri Simran Mundi Manpreet Basuita Robyn Elphinstone Surgery Tyler Hauer
Arash Khairandish Gary Tran Yehia Fanous Rochelle Melvin Amanpreet Brar
m Jason Gencher m Zacharie Cloutier Otolaryngologym
Anesthesia and Medical Genetics Nephrology Jeff Metz Ragavan Ganeshathasan
Perioperative Medicine Spencer van Mil Endocrinology Tamoor Afzaal Alexander Tigert Armin Rahmani
Lior Krimus Jesse Creamer Sarah Cao Stephen Szeto
Abdulkarim Muhaseen Mmedical Imaging Ahmed Shah Tianyang (Day) Dai Gynecology Siraj Zahr
Pauline Sawicki Mark Barszczyk Corita Vincent Maria Daniel o
Tian Yang (Darren) Liu c Neurology Tammy Ryan Plastic Surgery
Clinical Pharmacology Zafir Syed Gastroenterolo.gy Ikreet Cheema Michal Sheinis Josephine D’Abbondanza
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Rushi Gandhi Jinhui (Bill) Yan Raghad Al-Saqqar Dhruv Kumar Jain Evelyn Waugh Maya Deeb
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Pamela Leung James Bao Tal Milman Matthew Lee
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Pediatrics Roseafnna Presutti Neurosfurgery Talha Maqbool
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Dermatoklogy Jessie Peng k Respirology Annk Mansur
Arvino Ighani Shirley Poon oGeriatric Medicine Sameer Kushwaha Coelna Nahanni Urology
Saroah Park Victoria Chuen Albert Lee Nardin Samuel Viranda H. Jayalath
Stephanie Zhou Population Health and Jessica Mak Anand Lakhani
Epidemiology e Rheumatologye Obstetrics Ahmad Mousa
Emergency Medicine Arjun Sithampmarapillai Hematology Patrina Chemung Emily Bartsch m
Cecilia Alvarez-Veronesi Vishalini Sivarajah Lianne Rotin Stephanie Wan Stephanie Searle Vascular Surgery
Omri Arbiv Xin (Kevin) Wang Curtis Sobchak Asha Behdinan
Matt Piaseczny Psychiatry Joshua Mehta
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Ayan Dey Ophthalmology
Jonah Himelfarb Daniel Q. Li
Yasmin Nasirzadeh Fady Sedarous
Tarek Bin Yameen
Copy Editorfs
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Armin Akbadeh Helen Genis Jethro Kwong Leedan Cohen Mkammon Arunima Sivanand
Melissoa Allwood Salwa Hasan o Kimberley Lam Mirriam Mikhail Sivisan Suntheralingam
Amoira Balbaa Kizanee Jegatheeswaran Min Joon Lee Sara Miraloi Jaya Tanwani
Cbhloe Cadieux Danielle Jeong Chantal Li Jason (Jabewoo) Park Fang Zhou (Faith) Xu
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Alon Coret Jason Jia Emily (Yujin) Li Austin Pereira Eric (Yu Hang) Zheng
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Ari Cuperfain Shicheng (Tony) Jin Helen Liu Casey Rosen
Taylor Dear Eshita Kapoor Marissa Lu Leigha Rowbottom
Megan Drupals Brij Karmur Alexandra Majerski Shihab Sarwar
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BMC ILLUSTRATORS
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Jerry Gu Lucas Lin Dani Sayeau
Andrea Lam Ryan Park
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6 Toronto Notes 2018
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Faculty Contributors, University of Toronto
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All contributing professors have been appointed at the University of Toronto.
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Dabvid Adam, MD, FRCPC Ablice Cheung, MD, FRCPC Jonathan C. Irish, MD, MSc, FRCSC
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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
Ruby Alvi, MD, CCFP, MHSc Chi-Ming Chow, MDCM, MSc, FRCPC Nasir Jaffer, MD, FRCPC
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Department of Family Division of Cardiology Division of Abdominal Imaging
and Community Medicine Department of Medicine Department of Medical Imoaging
University of Toronto St. Michael’s Hospital Joint Department of Medical Imaging
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Jillian Baker, MD, MeSc, FRCPC Allison Chris, MDe, MSc, FRCPC e
Pediatrician and Prediatric Hematologist Division of Clinrical Public Health Julie Johnstonr, MD (FRCPC), MScCH
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St. Michael’s Hsospital and Dalla Lana School of Public Health Departmenst of Pediatrics
The Hospitakl for Sick Children k The Hoskptal for Sick Children
Faculty of Medicine, University of Toronto Maria oCino, HonBSc, MSc, MD, FRCPC Divisoion of Pediatric Medicine
o Divoision of Gastroenterology University of Toronto
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Abdollah Behzadi, MD, MBA, FRCSC, FACS University Health Network
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Division of Thoracic Surgery Toronto Western Hospital David Juurlink, BPhm, MD, PhD, FRCPC
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Department of Surgery Division of Clinical Pharmacology
University of Toronto Hanna Faghfoury, MDCM, FRCPC, FCCMG and Toxicology
The Fred A Litwin Family Centre Departments of Medicine and Pediatrics
Katherine Bingham, MD, MPH, CCFP-EM in Genetic Medicine Sunnybrook Health Sciences Centre
Faculty of Medicine Department of Medicine
University of Toronto Mount Sinai Hospital and Gabor Kandel, MD, FRCPoC
University Health Network Division of Gastroentercology
Matthew Binnie, MD e Department of Medeicine
Division of Respiroloegy Michelle Farrugiae, M.D., MEd., FRSCS St. Michael’s Hospital
University Healthr Network Department of rObstetrics and Gynecology r
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St. Michael’s Hospital Mount Sinais Hospital Sari L. Kivses, MD, FRCSC
k Departmeknt of Obstetrics and Gynecology Departmkent of Obstetrics and Gynecology
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Ari Bitnun, MD, MSc, FRCPC University of Toronto St. Michael’s Hospital and
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Division of Infectious Diseases The Hospital for Sick Children
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The Hospital for Sick Children Alfonso Fasano, MD, PhD, FRCPC
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Division of Neurology Wai-Ching Lam, MD, FRCSC
Andrea Boggild, MSc, MD, FRCPC University Health Network Department of Ophthalmology and
Tropical Disease Unit and Toronto Western Hospital Vision Science
Division of Infectious Diseases University Health Network
University Health Network Mark Freedman, MD, FRCPC m Toronto Western Hospital
Toronto General Hospital Department of Emergency Medicine
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Sunnybrook Health Sciences Centre Chloe Leon, MD, FRCPC
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Arthur Bookman, MD, FRCPC Division of Brain and Therapeutics
Division of Rheumatoloegy Tanna Gemini, MD, eFRCPC Department of Psycehiatry
Department of Mediecine Division of Nephreology Centre for Addiction and Mental Health
University Healthr Network Department of rMedicine r
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Toronto Western Hospital Sunnybrook Health Sciences Centre Armando sLorenzo, MD, FRCSC
k k Divisionk of Urology
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John Byrne, MD, MB, BCh, BAO Jeremy Hall, MD, FRCSC Department of Surgery
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Division of Vascular Surgery Division of Orthopedic Surgery The Hospital for Sick Children
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Department of Surgery Department of Surgery
University of Toronto St Michael’s Hospital Todd Mainprize, MD, FRCSC
Department of Neurosurgery
Simon Carette, MD, FRCPC Philip C. Hébert, MA, PhD, MD, FCFPC Sunnybrook Health Sciences Centre
Division of Rheumatology Department of Family and
Department of Medicine Community Medicine m Eric Massicotte, MD, MSc, FRCSC
Mount Sinai Hospital Joint Centre for Bioethics Department of Neurosurgery
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Sunnybrook Health Sciences Centre University Health Network
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Vicky Chau, MD, MScCH, FRCPC Toronto Western Hospital
Division of Geriatric Meedicine Sender Herschorn, MDCM, FRCSC
Department of Mediecine Division of Urologey
University Health Network Department off rSurgery
Sunnybrooks Health Sciences Centre and
Women’s College Hospital
7 Toronto Notes 2018
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Faculty Contributors, University of Toronto
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Michael McDonald, MD, FRCPC Evan Propst, MD, MSc, FRCSC Herbert P. von Schroeder, MD, MSc, FRCSC
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Division of Cardiology and Division of Head and Neck Surgery Divisions of Orthopedic Surgery and
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The Multi-Organ Transplant Program Department of Otolaryngology Plastic Surgery
Department of Medicine The Hospital for Sick Children Department of Surgery
University Health Network University Health Network
Toronto General Hospital Amanda Selk, MD, FRCSC
Department of Obstetrics and Gynecology Danielle Vicus, MD, MSc
Azadeh Moaveni, MD, CCFP Mount Sinai Hospital Gynecologic Oncologist m
Department of Family and Sunnybrook Health Sciences Centre
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Community Medicine Michelle Sholzberg, MDCM, MSc, FRCPC Department of Obstetrics and Gynecology
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University Health Network Division of Hematology University of Toronto
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Toronto Western Hospital Department of Medicine
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St. Michael’s Hospital Oshrit Wanono, MD, FRCPC
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Istvan Mucsi,f MD PhD, FRCPC, FASN f Division off Child and Adolescent Psychiatry
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Department of Medicine (Nephrology) Marisa Sit, MD, FRCSC Department of Psychiatry
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University of Toronto Department of Ophthalmology Centre for Addiction and Mental Health
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Kidnoey Transplant Program Uoniversity Health Network o
Tboronto General Hospital bToronto Western Hospital Kyle R. Wanzel, MD, MEd, FRCSC
University Health Network Division of Plastic Surgery
Kevin Skarratt, MD, FRCPC St. Joseph’s Health Centre
Ally Murji, MD, MPH, FRCS(C) Department of Emergency Medicine
Department of Obstetrics and Gynecology Sunnybrook Health Sciences Centre Jeffrey Wassermann, MD, FRCPC
Mount Sinai Hospital Department of Anesthesia
m Elizabeth Slow, MD, PhD, FRCP St. Michael’s Hospital m
Melinda Musgrave, MD, PhD, FRCSC Division of Neurology
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Division of Plastic and Reconstructive Surgery University Health Netwcork Alice Wei, MD CM, McSc, FRCSC
Department of Surgery Division of General. Surgery
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St. Michael’s Hospital Joyce So, MD, PhD, FRCPC, FCCMG Department of Surgery
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The Fred A. Litwin Family Centre University Health Network
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George Oreopfoulos, MD, MSc, FRCSC in Genetic Mfedi ine f
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Division of Vascular Surgery Department of Medicine Fay Weisberg, MD, FRCSC
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Departoment of Surgery Mouont Sinai Hospital and Divoision of Reproductive Endocrinology
University Health Network University Health Network aond Infertility
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Richard Pittini, MD, MEd, FRCSC, FACOG Diana Tamir, MD, FRCPC University of Toronto
Department of Obstetrics and Gynaecology Department of Anesthesia and m
University of Toronto Pain Management Anna Woo, MD CM, SM, DABIM, FRCPC
Sunnybrook Health Sciences Centre University Health Network Division of Cardiology
Department of Medicine
Susan M. Poutanen, MD, MPH, FRCPC Piero Tartaro, MD, FRCPC University Health Network
Department of Microbiologyo Division of Gastroenteroloogy Toronto General Hospitaol
University Health Network and Department of Medicince c
Mount Sinai Hospital . Sunnybrook Health Sciences Centre Jensen Yeung, MD, FRCPC
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Departments of Laboratory Medicine & Division of Dermatology
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Pathobiology and Medicine Joshua C. Teichman, MD, MPH, FRCSC Department of Medicine
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University of Toonto Ophthalmoflogy and Vision Sciences Women’s College Hospital
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k Trilliumk Health Partners k
Ramesoh Prasad, MBBS,MSc,MA,PhD, FRCPC Universty of Toronto Eugoene Yu, MD, FRCPC
Facuolty of Medicine, University of Toronto o Doivision of Neuroradiology
Dbivision of Nephrology bFernando Teixeira, MD, FRCPC Department of Medical Imaging
Department of Medicine Department of Emergency Medicine University Health Network
St. Michael’s Hospital St. Michael’s Hospital
Mary Preisman, MD, FRCPC Martina Trinkaus, MD, FRCPC
Department of Psychiatry Division of Hematology
Mount Sinai Hospital Department of Medicine
St. Michael’s Hospital
Laila Premji, MD, FRCPCc
Division of Paediatric M.edicine
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Department of Paediatrics
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The Hospital for Sick Children
8 Toronto Notes 2018
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Table of Contents
Index Abbreviations
1 Common Unit Conversions
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2 Commonly Measured Laboratory Values
3. Ethical, Legal, and Organizational Medicine.............................................. ELOM
4. Anesthesia and Periopmerative Medicine ................. ............................... A
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5. Cardiology and Cardiac Surgery..................... ............................. . . C
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6. Clinical Pharmacology............................................................... CP
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7. Dermatology............................ . .......................... . . ....... D
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8. Emergency Medicine................. ............................. . ........... ER
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9. Endocrinology ..................................................................... E
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10. Family Medicine............... . .................................................. FM
11. Gastroenterology.......... . ............................. . ...................... G
12. General Surgery and Thoracic Surgery ................................................. GS
13. Geriatric Medicine ... ............................... ............................. GM
14. Gynecology ................................................................... ... GY
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15. Hematology .. ............................ .. ............................. ...... H
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16. Infectious Diseases .................... ... ........................... .. ........ ID
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17. Medical Genetics .................... . .......................... ................ MG
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18. Medical Imaging................. ............................ . ............... MI
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19 Nephrology................................................... .................... NP
20. Neurology............... ................................ ........................ N
21. Neurosurgery...................................................................... NS
22. Obstetrics........ ............................... ............................... OB
23. Ophthalmology . ............................ . ............................ .. . OP
24. Orthopediecs . ............................... ..................................... OR
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25. Otolaryfngology ....................... . ............................. . .......... OT
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26. Poediatrics ......................... .............................. ............... P
27. Plastic Surgery................................................... ................. PL
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28. Population Health and Epidemiology ............................. . ................... PH
29. Psychiatry............... . ............................. . ....................... PS
30. Respirology ....................................................................... R
31. Rheumatology ..... ............................... ............................. . RH
32. Urology........................................................................... U
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33. Vascular Surgery ........................... ............................... ....... VS
34. Index
9 Toronto Notes 2018