Toronto Notes 2018

1374 Pages·2018·33.626 MB·English

by  Tina Binesh Marvasti, Sydney McQueen

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e e NOTe ES e
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e COMePREHENSIVE MEDICAL ReEFERENCE e
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s s& REVIEW FOR MCCQE AsND USMLE II s
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o Edoitors-in-Chief: Tina Binesh Moarvasti & Sydney McQueen o
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Production Managers: Ilya Mukovozov & Kirill Zaslavsky
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2018
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Toronto Notes
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c Comcprehensive medical refcerence and review for thce c
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e Mediceal Council of Canada Quealifying Exam (MCCQE)e Part I and e
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s sthe United States Medicsal Licensing Exam (USMsLE) Step 2 s
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34th Edition.
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e e Editores-in-Chief: e e
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s s Tina Binesh Masrvasti and Sydney McQueens s
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. .Wherever the art o.f medicine is loved, . .
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f f there is alsof a love of humanity. f f
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Toronto Notes for Medical Students, Inc.
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Toronto, Ontario, Canada
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Thirtry-fourth Edition r r r
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Coopyright © 2018 – Toronto Notes for Moedical Students, Inc. o o
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Preface – From the Editors
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oDear Readers, o Australian Medicaol School Association, among o
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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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For the past 33 years we have remained committed to
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organizations included Community Affairs, the
o oTina Binesh Marvasti, MSc, MD/PhD Coandidate and o
Ontario Medicalc Student Weekend (OMSW), the c c c
. . Sydney McQueen, MSc, MD/PhD C.andidate .
University of eToronto Class Councils, Save A Child’s e e e
Editors-in-Chief, Toronto Notes 2018
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Heart, Earth Tones, Medical Student Research Day
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Grant (MSERG), Daffydil, the Conference of the
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e4 e e Toronto Notes 201e8
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Acknowledgements
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o Woe would like to acknowledge the excepotional work of all previous Toronto Nootes (formerly MCCQE Notes) o
b bEditors-in-Chief and their editorial teambs. The 34th edition of this text was madbe possible with their contributions. b
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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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o 20o15 (31th ed.): Justin Hall and Azra Premoji o o
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. .2014 (30th ed.): Miliana Vojvodic and. Ann Young . .
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r r 2013 (29th ed.): Curtis Woodforrd and Christopher Yao r r
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2012 (28th ed.): Jesse M. Klostranec and David L. Kolin
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b b 2011 (27th ed.): Yinbgming Amy Chen and Christopher Tranb b
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m m 2010 (26th ed.)m: Simon Baxter and Gordon McSheffreym m
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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k k 2005 (21st ed.): Blair John kNormand Leonard and Jonathan Chi-Wkai Yeung k
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o o 2004 (20th ed.): Andreoa Molckovsky and Kashif S. Pirzada o o
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2003 (19th ed.): Prateek Lala and Andrea Waddell
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2002 (18th ed.): Neety Panu and Sunny Wong
m 2001 m(17th ed.): Jason Yue and Gagan Ahujam m m
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c c2000 (16th ed.): Marcus Law and Brianc Rotenberg c c
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e e 1999 (15th ed.): Sofia Ahmed ande Matthew Cheung e e
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s s 1998 (14th ed.): Marilyn Abrsaham and M Appleby s s
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o o 1997 (13th ed.): Williaom Harris and Paul Kurdyak o o
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e e 1996 (12th ed.): Meichael B. Chang and Laura J. Macnow e e
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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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f f All former Chief Editors fromf 1991 (7th ed.) to 1985 (1st ed.) f f
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Student Contributors
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Edoitors-in-Chief Production Managers oClinical Handbook Editors STAT Notes Editoro Atlas Editor BMC Production Editorso
bTina Binesh Marvasti Ilya Mukovozov b Waleed S. Ahmed Mina Faheim b Ali Helmi Matan Berson b
e Sydney McQueen Kirill Zaslavsky e Claudia Frankfurter e Natividad Chen e
m m Kimia Sorouri m m
PRIMARY AND OTHER SmPECIALTIES MEDICINE m SURGERY m 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
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Taraneh (Tara) Tofigehi Sukhmani Sodhi Graham Mazeereeuw Alexander Sapa Mark Shafarenkeo Shubham Shan e
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Chapter Esditors Chaspter Editors Chapster Editors s
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Ethicaol, Legal, and Family Medicine oCardiology and Infectious Diseases Goeneral Surgery Orthopedics o
Oroganizational Medicine Mohammed Firdouse o Cardiac Surgery Zane Brickman oand Thoracic Michael Dzingala o
bSabrina Agnihotri Simran Mundi b Manpreet Basuita Robyn Elphinstonbe Surgery Tyler Hauer b
e Arash Khairandish Gary Tran e Yehia Fanous Rochelle Melvien Amanpreet Brar e
m 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 mTianyang (Day) Dai Gynecology Sirajm Zahr m
Pauline Sawicki oMark Barszczyk Corita Vincent o Maria Daniel o o
c Tian Yang (Darren) Liu c Neurology Tammy Ryan cPlastic Surgery c
Clinical Pharmacolog.y 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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f Pediatrics Roseafnna Presutti Neurosfurgery Talha Maqbool f
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Dermatoklogy Jessie Peng k Respirology Annk Mansur k
Arvino Ighani Shirley Poon oGeriatric Medicine Sameer Kushwaha Coelina Nahanni Urology o
Saroah Park o Victoria Chuen Albert Lee oNardin Samuel Viranda H. Jayalath o
bStephanie Zhou Population Health abnd Jessica Mak b Anand Lakhani b
e Epidemiology e Rheumatologye Obstetrics Ahmad Mousa e
m 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
oJonah Himelfarb o Daniel Q. Li o o
c Yasmin Nasirzadeh c Fady Sedarous c c
. . Tarek Bin Yamee.n .
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Copy Editorfs f f f
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Armin Akbadeh Helen Genis kJethro Kwong Leedan Cohen Mkammon Arunima Sivanand k
Melissoa Allwood Salwa Hasan o Kimberley Lam Mirriam Mikohail Sivisan Suntheralingam o
Amoira Balbaa Kizanee Jegatheeswaoran Min Joon Lee Sara Miraloi Jaya Tanwani o
Cbhloe Cadieux Danielle Jeong b Chantal Li Jason (Jabewoo) Park Fang Zhou (Faith) Xu b
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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 e Lucas Lin Dani Seayeau e e
Andrea Lam r Ryan Park r r r
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Faculty Contributors, University of Toronto
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k All contrkibuting professors have been appointekd at the University of Toronto. k k
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b Dabvid Adam, MD, FRCPC Ablice Cheung, MD, FRCPC bJonathan C. Irish, MD, MSc, FRCSC b
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Division of Dermatology Division of Endocrinology and Metabolism Department of Otolaryngology -
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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
o and Community Medicine o Department of Medicine o Department of Medical Imoaging o
c University of Toronto c St. Michael’s Hospital c Joint Department of Mecdical Imaging c
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e e e University of Toroneto e
e Jillian Baker, MD, MeSc, FRCPC Allison Chris, MDe, MSc, FRCPC e e
r Pediatrician and Prediatric Hematologist Division of Clinrical Public Health Julie Johnstonr, MD (FRCPC), MScCH r
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s St. Michael’s Hsospital and Dalla Lana Sschool of Public Health Departmenst of Pediatrics s
k The Hospitakl for Sick Children k The Hoskpital for Sick Children k
o Faculty oof Medicine, University of Toronto Maria oCino, HonBSc, MSc, MD, FRCPC Divisoion of Pediatric Medicine o
o o Divoision of Gastroenterology Unoiversity of Toronto o
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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
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Faculty of Medicine Department of Medicine
o University of Toronto o Mount Sinai Hospital and o Gabor Kandel, MD, FRCPoC o
c c University Health Networck Division of Gastroentercology, c
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e Matthew Binnie, MD e e Department of Medeicine e
e Division of Respiroloegy Michelle Farrugiae, M.D., MEd., FRSCS St. Michael’s Hosepital e
r University Healthr Network Department of rObstetrics and Gynecology r r
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s St. Michael’s Hsospital Mount Sinais Hospital Sari L. Kivses, MD, FRCSC s
k k Departmeknt of Obstetrics and Gynecology Departmkent of Obstetrics and Gynecology k
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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
m m m m m
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
m University Health Network m Mark Freedman, MD, FRCPC m Toronto Western Hospital m m
Toronto General Hospital Department of Emergency Medicine
o o o o o
Sunnybrook Health Sciences Centre Chloe Leon, MD, FRCPC
c c c c c
Arthur Bookman, MD, FRCPC Division of Brain and Therapeutics
. . . . .
e Division of Rheumatoloegy Tanna Gemini, MD, eFRCPC Department of Psycehiatry e
e Department of Mediecine Division of Nephreology Centre for Addicetion and Mental Health e
r University Healthr Network Department of rMedicine r r
f f f f f
s Toronto Westesrn Hospital Sunnybrooks Health Sciences Centre Armando sLorenzo, MD, FRCSC s
k k k Divisionk of Urology k
o o o o o
John Byrne, MD, MB, BCh, BAO Jeremy Hall, MD, FRCSC Department of Surgery
o o o o o
Division of Vascular Surgery Division of Orthopedic Surgery The Hospital for Sick Children
b b b b b
Department of Surgery Department of Surgery
e e e e e
University of Toronto St. Michael’s Hospital Todd Mainprize, MD, FRCSC
m m m m m
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
m Department of Medicine m Community Medicine m Eric Massicotte, MD, MSc, FRCmSC m
Mount Sinai Hospital Joint Centre for Bioethics Department of Neurosurgery
o o o o o
Sunnybrook Health Sciences Centre University Health Network
c c c c c
Vicky Chau, MD, MScCH, FRCPC Toronto Western Hospital
. . . . .
e Division of Geriatric Meedicine Sender Herschorn, MeDCM, FRCSC e e
e Department of Mediecine Division of Urologey e e
fr University Healfthr Network Department off rSurgery fr fr
s s Sunnybrooks Health Sciences Centre and s s
k k k k k
Women’s College Hospital
o o o o o
o o o o o
b b b b b
e e7 e e Toronto Notes 2018e
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o o o o
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. . . .
e e e e
Faculty Contributors, University of Toronto
e e e e
r r r r
f f f f
s s s s
k k k k
o o o o
Michael McDonald, MD, FRCPC Evan Propst, MD, MSc, FRCSC Herbert P. von Schroeder, MD, MSc, FRCSC
o o o o
Division of Cardiology and Division of Head and Neck Surgery Divisions of Orthopedic Surgery and
b b b b
eThe Multi-Organ Transplant Program e Department of Otolaryngology e Plastic Surgery e
m Department of Medicine m The Hospital for Sick Children m Department of Surgery m
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 m Mount Sinai Hospital m Gynecologic Oncologist m m
Department of Family and Sunnybrook Health Sciences Centre
o o o o
Community Medicine Michelle Sholzberg, MDCM, MSc, FRCPC Department of Obstetrics and Gynecology
c c c c
University Health Netw.ork Division of Hematolo.gy University of Toron.to .
e e e e
Toronto Western Hospital Department of Medicine
e e e e
St. Michael’s Hospital Oshrit Wanono, MD, FRCPC
r r r r
Istvan Mucsi,f MD PhD, FRCPC, FASN f Division off Child and Adolescent Psychiatry f
s s s s
Department of Medicine (Nephrology) Marisa Sit, MD, FRCSC Department of Psychiatry
k k k k
University of Toronto Department of Ophthalmology Centre for Addiction and Mental Health
o o o o
Kidnoey Transplant Program Uoniversity Health Network o o
Tboronto General Hospital bToronto Western Hospital bKyle R. Wanzel, MD, MEd, FRCSC b
eUniversity Health Network e e Division of Plastic Surgery e
m m Kevin Skarratt, MD, FRCPC m St. Joseph’s Health Centre m
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, FRCmP St. Michael’s Hospital m m
Melinda Musgrave, MD, PhD, FRCSC Division of Neurology
o o o o
Division of Plastic and Recconstructive Surgery University Health Netwcork Alice Wei, MD CM, McSc, FRCSC c
Department of Surgery. . Division of General. Surgery .
e e e e
St. Michael’s Hospital Joyce So, MD, PhD, FRCPC, FCCMG Department of Surgery
e e e e
The Fred A. Litwin Family Centre University Health Network
r r r r
George Oreopfoulos, MD, MSc, FRCSC in Genetic Mfedicine f f
s s s s
Division of Vascular Surgery Department of Medicine Fay Weisberg, MD, FRCSC
k k k k
Departoment of Surgery Mouont Sinai Hospital and Divoision of Reproductive Endocrinology o
Univoersity Health Network Uoniversity Health Network aond Infertility o
b b bDepartment of Obstetrics and Gynecology b
eRichard Pittini, MD, MEd, FRCSC, FACOG e Diana Tamir, MD, FRCPC e University of Toronto e
m Department of Obstetrics and Gynaecology m Department of Anesthesia and m 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, mFRCPC Piero Tartaro, MD, FRCPC m University Health Network m m
Department of Microbiologyo Division of Gastroenteroloogy Toronto General Hospitaol o
University Health Networck and Department of Medicince c c
Mount Sinai Hospital . Sunnybrook Health S.ciences Centre Jensen Yeung, MD,. FRCPC .
e e e e
Departments of Laboratory Medicine & Division of Dermatology
e e e e
Pathobiology and Medicine Joshua C. Teichman, MD, MPH, FRCSC Department of Medicine
r r r r
University of Tforonto Ophthalmoflogy and Vision Sciences Women’s Cfollege Hospital f
s s s s
k Trilliumk Health Partners k k
Ramesoh Prasad, MBBS,MSc,MA,PhD, FRCPC Univoersity of Toronto Eugoene Yu, MD, FRCPC o
Facuolty of Medicine, University of Toronto o Doivision of Neuroradiology o
Dbivision of Nephrology bFernando Teixeira, MD, FRCPC bDepartment of Medical Imaging b
eDepartment of Medicine e Department of Emergency Medicine e University Health Network e
m St. Michael’s Hospital m St. Michael’s Hospital m m
Mary Preisman, MD, FRCPC Martina Trinkaus, MD, FRCPC
Department of Psychiatry Division of Hematology
Mount Sinai Hospital m Department of Medicine m m m
o St. Michael’s Hospital o o o
Laila Premji, MD, FRCPCc c c c
Division of Paediatric M.edicine . . .
e e e e
Department of Paediatrics
e e e e
The Hospital forr Sick Children r r r
f f f f
s s s s
k k k k
o o o o
o o o o
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e8 e e Toronto Notes 201e8
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. . . . .
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Table of Contents
e e e e e
r r r r r
f f f f f
s s s s s
k k k k k
o o o o o
Index Abbreviations
o o o o o
b b b b b
1. Common Unit Conversions
e e e e e
m m m m m
2. Commonly Measured Laboratory Values
3. Ethical, Legal, and Organizational Medicine.............................................. ELOM
m 4. Anesthesia and Periopmerative Medicine .................m................................m A m
o o o o o
5. Cardiology and Cardiac Surgery....................................................... C
c c c c c
. . . . .
e 6. Clinical Pharemacology........................e................................e....... CP e
e e e e e
r 7. Dermatorlogy............................r................................r........... D r
f f f f f
s s s s s
k 8. Emkergency Medicine.................k................................k............... ER k
o o o o o
o 9. oEndocrinology ..................o................................o................... E o
b b b b b
e e10. Family Medicine..............e................................e...................... FM e
m m m m m
11. Gastroenterology................................................................... G
12. General Surgery and Thoracic Surgery ................................................. GS
m m m m m
13. Geriatric Medicine .................................................................. GM
o o o o o
c 14. Gynecology ..c................................c................................c..... GY c
. . . . .
e e e e e
15. Hematology ....................................................................... H
e e e e e
r r r r r
f 16. Infectiofus Diseases .....................f................................f............ ID f
s s s s s
k 17. Mekdical Genetics ....................k................................k............... MG k
o o o o o
o 18. oMedical Imaging.................o................................o................... MI o
b b b b b
e e19. Nephrology..................e................................e...................... NP e
m m m m m
20. Neurology......................................................................... N
21. Neurosurgery...................................................................... NS
m m m m m
22. Obstetrics......................................................................... OB
o o o o o
c 23. Ophthalmologyc................................c................................c..... OP c
. . . . .
e e e e e
e 24. Orthopediecs ..............................e................................e......... OR e
r r r r r
f 25. Otolaryfngology ........................f................................f............ OT f
s s s s s
k k k k k
o 26. Poediatrics ........................o................................o................. P o
o o o o o
27. Plastic Surgery..................................................................... PL
b b b b b
e e e e e
28. Population Health and Epidemiology ................................................... PH
m m m m m
29. Psychiatry......................................................................... PS
30. Respirology ....................................................................... R
m m m m m
31. Rheumatology ..................................................................... RH
o o o o o
c c c c c
32. Urology........................................................................... U
. . . . .
e e e e e
e 33. Vascular Seurgery ..........................e................................e......... VS e
r r r r r
f f f f f
s 34. Indexs s s s
k k k k k
o o o o o
o o o o o
b b b b b
e e9 e e Toronto Notes 2018e
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