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Pocket MEDICINE - Wolters Kluwer Health
Pocket N ot e b o o k Pocket Medicine Fifth Edition Edited by Marc S. Sabatine, MD, MPH Associate Professor of Medicine Harvard Medical School LWBK1256-FM_pi-x.indd 1 The Massachusetts General Hospital Handbook of Internal Medicine 14/05/13 6:52 PM Executive Editor: Rebecca Gaertner Product Manager: Kristina Oberle Vendor Manager: Bridgett Dougherty Manufacturing Coordinator: Beth Welsh Marketing Manager: Kim Schonberger Creative Director: Doug Smock Production Service: Aptara, Inc. © 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA LWW.com All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. Printed in China Library of Congress Cataloging-in-Publication Data Pocket medicine (Sabatine) Pocket medicine / [edited by] Marc S. Sabatine. — Fifth edition. p. ; cm. Preceded by Pocket medicine / edited by Marc S. Sabatine. 4th ed. c2011. Includes bibliographical references and index. ISBN-13: 978-1-4511-8237-8 ISBN-10: 1-4511-8237-6 ISBN-13: 978-1-4511-8887-5 ISBN-10: 1-4511-8887-0 I. Sabatine, Marc S., editor of compilation. II. Title. [DNLM: 1. Internal Medicine–Handbooks. 2. Clinical Medicine–Handbooks. WB 39] RC55 616–dc23 2013019655 DISCLAIMER Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of the information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. LWBK1256-FM_pi-x.indd 2 10 9 8 7 6 5 4 3 2 1 5/23/13 11:47 AM CONTENTS Contributing Authors Foreword Preface vi ix x CARDIOLOGY Neal A. Chatterjee, Ada Stefanescu, William J. Hucker, David M. Dudzinski, Marc S. Sabatine, Michelle O’Donoghue Electrocardiography Chest Pain Noninvasive Evaluation of CAD Coronary Angiography and Revascularization Acute Coronary Syndromes PA Catheter and Tailored Therapy Heart Failure Cardiomyopathies Valvular Heart Disease Pericardial Disease Hypertension Aortic Aneurysms Acute Aortic Syndromes Arrhythmias Atrial Fibrillation Syncope Intracardiac Devices Cardiac Risk Assessment for Noncardiac Surgery Peripheral Artery Disease 1-1 1-3 1-4 1-5 1-6 1-12 1-14 1-17 1-20 1-25 1-28 1-30 1-31 1-32 1-35 1-37 1-39 1-40 1-41 PULMONARY Ian J. Barbash, Kathryn A. Hibbert, Atul Malhotra Dyspnea Pulmonary Function Tests Asthma Anaphylaxis Chronic Obstructive Pulmonary Disease Hemoptysis Bronchiectasis Solitary Pulmonary Nodule Obstructive Sleep Apnea Interstitial Lung Disease Pleural Effusion Venous Thromboembolism Pulmonary Hypertension Respiratory Failure Mechanical Ventilation Acute Respiratory Distress Syndrome Sepsis 2-1 2-1 2-2 2-4 2-5 2-7 2-7 2-8 2-8 2-9 2-11 2-13 2-16 2-18 2-19 2-22 2-23 GASTROENTEROLOGY Zachary A. Zator, Andrew S. de Lemos, Lawrence S. Friedman Esophageal and Gastric Disorders Gastrointestinal Bleeding Diarrhea, Constipation and Ileus Diverticular Disease Inflammatory Bowel Disease Intestinal Ischemia LWBK1256-FM_pi-x.indd 3 3-1 3-3 3-5 3-9 3-10 3-12 14/05/13 6:52 PM Pancreatitis Abnormal Liver Tests Hepatitis Acute Liver Failure Cirrhosis Hepatic Vascular Disease Ascites Biliary Tract Disease 3-13 3-15 3-17 3-20 3-21 3-25 3-26 3-27 NEPHROLOGY Andrew S. Allegretti, Andrew L. Lundquist, Hasan Bazari Acid-Base Disturbances Sodium and Water Homeostasis Potassium Homeostasis Renal Failure Glomerular Disease Urinalysis Nephrolithiasis 4-1 4-6 4-10 4-12 4-16 4-18 4-19 HEMATOLOGY-ONCOLOGY Andrew M. Brunner, Sheheryar K. Kabraji, Mark M. Awad, Andrew J. Aguirre, Daniel J. DeAngelo, David P. Ryan Anemia Disorders of Hemostasis Platelet Disorders Coagulopathies Hypercoagulable States Disorders of Leukocytes Transfusion Therapy Myelodysplastic Syndromes Myeloproliferative Neoplasms Leukemia Lymphoma Plasma Cell Dyscrasias Hematopoietic Stem Cell Transplantation Lung Cancer Breast Cancer Prostate Cancer Colorectal Cancer Chemotherapy Side Effects Pancreatic Tumors Oncologic Emergencies Cancer of Unknown Primary Site 5-1 5-6 5-7 5-10 5-11 5-12 5-13 5-14 5-15 5-17 5-21 5-24 5-26 5-28 5-30 5-32 5-33 5-34 5-35 5-36 5-37 INFECTIOUS DISEASES Ana A. Weil, Emily P. Hyle, Nesli Basgoz Pneumonia Fungal Infections Infections in Immunosuppressed Hosts Urinary Tract Infections Soft Tissue and Bone Infections Infections of the Nervous System Bacterial Endocarditis Tuberculosis HIV/AIDS Tick-Borne Diseases Fever Syndromes LWBK1256-FM_pi-x.indd 4 6-1 6-3 6-4 6-5 6-6 6-9 6-12 6-15 6-17 6-20 6-22 14/05/13 6:52 PM ENDOCRINOLOGY Kelly B. Lauter, Marc N. Wein, Michael Mannstadt Pituitary Disorders Thyroid Disorders Adrenal Disorders Calcium Disorders Diabetes Mellitus Lipid Disorders 7-1 7-3 7-7 7-11 7-13 7-16 RHEUMATOLOGY Zachary S. Wallace, Eli Miloslavsky, Robert P. Friday Arthritis—Overview Rheumatoid Arthritis Adult Onset Still’s Disease & Relapsing Polychondritis Crystal Deposition Arthritides Seronegative Spondyloarthritis Infectious Arthritis & Bursitis Connective Tissue Diseases Systemic Lupus Erythematosus Vasculitis IgG4-Related Disease Cryoglobulinemia Amyloidosis 8-1 8-3 8-4 8-5 8-7 8-9 8-11 8-15 8-17 8-20 8-21 8-22 NEUROLOGY Michael P. Bowley, Todd M. Herrington, Eyal Y. Kimchi, Sarah Wahlster, Tracey A. Cho Change in Mental Status Seizures Alcohol Withdrawal Stroke Weakness & Neuromuscular Dysfunction Headache Back and Spinal Cord Disease 9-1 9-3 9-5 9-6 9-8 9-10 9-11 CONSULTS Kiran H. Lagisetty, Jennifer F. Tseng, Katherine T. Chen, Stella K. Kim Surgical Issues Ob/Gyn Issues Ophthalmic Issues 10-1 10-3 10-4 APPENDIX ICU Medications & Treatment of Hypotension/Shock Antibiotics Formulae and Quick Reference 11-1 11-3 11-4 ABBREVIATIONS 12-1 INDEX I-1 PHOTO INSERTS Radiology Echocardiography & Coronary Angiography Peripheral Blood Smears & Leukemias Urinalysis ACLS LWBK1256-FM_pi-x.indd 5 P-1 P-9 P-13 P-15 ACLS-1 14/05/13 6:52 PM CONTRIB U T I N G A U T H O R S Andrew J. Aguirre, MD, PhD Hematology-Oncology Fellow, Dana-Farber/Partners CancerCare Hematology/Oncology Program Andrew S. Allegretti, MD Internal Medicine Resident, Massachusetts General Hospital Mark M. Awad, MD, PhD Hematology-Oncology Fellow, Dana-Farber/Partners CancerCare Hematology/Oncology Program Ian J. Barbash, MD Internal Medicine Resident, Massachusetts General Hospital Nesli Basgoz, MD Associate Chief and Clinical Director, Infectious Disease Division, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Hasan Bazari, MD Clinical Director, Nephrology Unit, Massachusetts General Hospital Program Director, Internal Medicine Residency, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Michael P. Bowley, MD, PhD Neurology Resident, Partners Neurology Residency Andrew M. Brunner, MD Internal Medicine Resident, Massachusetts General Hospital Neal A. Chatterjee, MD Internal Medicine Resident, Massachusetts General Hospital Katherine T. Chen, MD, MPH Associate Professor of Obstetrics, Gynecology, and Reproductive Science Associate Professor of Medical Education Vice-Chair of Ob/Gyn Education, Career Development, and Mentorship Icahn School of Medicine at Mount Sinai, New York Tracey A. Cho, MD Associate Program Director, Partners-Harvard Neurology Residency Assistant Professor of Neurology, Harvard Medical School Assistant Neurologist, Massachusetts General Hospital Andrew S. de Lemos, MD Transplant Hepatology Fellow, Massachusetts General Hospital Daniel J. DeAngelo, MD, PhD Adult Leukemia Program, Dana-Farber Cancer Institute & Brigham and Women’s Hospital Associate Professor of Medicine, Harvard Medical School LWBK1256-FM_pi-x.indd 6 14/05/13 6:52 PM David M. Dudzinski, MD, JD Cardiology Fellow, Massachusetts General Hospital Robert P. Friday, MD, PhD Attending Physician, Rheumatology Unit, Massachusetts General Hospital Associate Director, Rheumatology Fellowship Program, Massachusetts General Hospital Instructor in Medicine, Harvard Medical School Lawrence S. Friedman, MD Anton R. Fried, MD, Chair, Department of Medicine, Newton-Wellesley Hospital Assistant Chief of Medicine, Massachusetts General Hospital Professor of Medicine, Harvard Medical School Professor of Medicine, Tufts University School of Medicine Todd M. Herrington, MD, PhD Neurology Resident, Partners Neurology Residency Kathryn A. Hibbert, MD Pulmonary and Critical Care Fellow, Harvard Medical School William J. Hucker, MD, PhD Cardiology Fellow, Massachusetts General Hospital Emily P. Hyle, MD Assistant in Medicine, Infectious Disease Division, Massachusetts General Hospital Instructor in Medicine, Harvard Medical School Sheheryar K. Kabraji, BM, BCh Internal Medicine Resident, Massachusetts General Hospital Stella K. Kim, MD Director, Clinical Research in Opthalmology Director, Opthalmology Residency Rotation Program Associate Professor of Opthalmology UT MD Anderson Cancer Center Eyal Y. Kimchi, MD, PhD Neurology Resident, Partners Neurology Residency Kiran H. Lagisetty, MD Surgical Resident, Beth Israel Deaconess Medical Center Kelly B. Lauter, MD, PhD Internal Medicine Resident, Massachusetts General Hospital Andrew L. Lundquist, MD Nephrology Fellow, BWH/MGH Joint Nephrology Fellowship Program Atul Malhotra, MD Associate Physician, Divisions of Pulmonary & Critical Care and Sleep Medicine, Brigham and Women’s Hospital Associate Professor of Medicine, Harvard Medical School LWBK1256-FM_pi-x.indd 7 14/05/13 6:52 PM Michael Mannstadt, MD Attending Physician, Endocrine Unit, Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School Eli Miloslavsky, MD Rheumatology Fellow, Massachusetts General Hospital Michelle O’Donoghue, MD, MPH Investigator, TIMI Study Group and Associate Physician, Cardiovascular Division, Brigham and Women’s Hospital Affiliate Physician, Cardiology Division, Massachusetts General Hospital Assistant Professor of Medicine, Harvard Medical School David P. Ryan, MD Clinical Director, Massachusetts General Hospital Cancer Center Chief of Hematology/Oncology, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Marc S. Sabatine, MD, MPH Chairman, TIMI Study Group and Physician, Cardiovascular Division, Brigham and Women’s Hospital Affiliate Physician, Cardiology Division, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Ada Stefanescu, MD, CM Internal Medicine Resident, Massachusetts General Hospital Jennifer F. Tseng, MD, MPH Chief, Division of Surgical Oncology, Beth Israel Deaconess Medical Center Associate Professor of Surgery, Harvard Medical School Sarah Wahlster, MD Neurology Resident, Partners Neurology Residency Zachary S. Wallace, MD Internal Medicine Resident, Massachusetts General Hospital Ana A. Weil, MD, MPH Internal Medicine Resident, Massachusetts General Hospital Marc N. Wein, MD, PhD Endocrinology Fellow, Massachusetts General Hospital Zachary A. Zator, MD Internal Medicine Resident, Massachusetts General Hospital LWBK1256-FM_pi-x.indd 8 17/05/13 10:57 PM F O R E WO R D To the 1st Edition It is with the greatest enthusiasm that I introduce Pocket Medicine. In an era of information glut, it will logically be asked, “Why another manual for medical house officers?” Yet, despite enormous information readily available in any number of textbooks, or at the push of a key on a computer, it is often that the harried house officer is less helped by the description of differential diagnosis and therapies than one would wish. Pocket Medicine is the joint venture between house staff and faculty expert in a number of medical specialties. This collaboration is designed to provide a rapid but thoughtful initial approach to medical problems seen by house officers with great frequency. Questions that frequently come from faculty to the house staff on rounds, many hours after the initial interaction between patient and doctor, have been anticipated and important pathways for arriving at diagnoses and initiating therapies are presented. This approach will facilitate the evidence-based medicine discussion that will follow the workup of the patient. This well-conceived handbook should enhance the ability of every medical house officer to properly evaluate a patient in a timely fashion and to be stimulated to think of the evidence supporting the diagnosis and the likely outcome of therapeutic intervention. Pocket Medicine will prove to be a worthy addition to medical education and to the care of our patients. LWBK1256-FM_pi-x.indd 9 Dennis A. Ausiello, MD Physician-in-Chief, Massachusetts General Hospital Jackson Professor of Clinical Medicine, Harvard Medical School 14/05/13 6:52 PM P R E FA C E To my parents, Matt and Lee Sabatine, to their namesake grandchildren Matteo and Natalie, and to my wife Jennifer Written by residents, fellows and attendings, the mandate for Pocket Medicine was to provide, in a concise a manner as possible, the key information a clinician needs for the initial approach to and management of the most common inpatient medical problems. The tremendous response to the previous editions suggests we were able to help fill an important need for clinicians. With this fifth edition come several major improvements including a thorough updating of every topic, the addition of several new topics (including treatment of anaphylaxis, approach to inpatient nutritional issues, chemotherapy side effects, and workup of a fever in a recent traveler), and inclusion of additional photomicrographs. We have also added a new section on Consults in which non-internal medicine specialists provide expert guidance in terms of establishing a differential diagnosis for common presenting symptoms and initiating an evaluation in anticipation of calling a consult. As always, we have incorporated key references to the most recent high-tier reviews and important studies published right up to the time Pocket Medicine went to press. We welcome any suggestions for further improvement. Of course medicine is far too vast a field to ever summarize in a textbook of any size. Long monographs have been devoted to many of the topics discussed herein. Pocket Medicine is meant only as a starting point to guide one during the initial phases of diagnosis and management until one has time to consult more definitive resources. Although the recommendations herein are as evidence-based as possible, medicine is both a science and an art. As always, sound clinical judgement must be applied to every scenario. I am grateful for the support of the house officers, fellows, and attendings at the Massachusetts General Hospital. It is a privilege to work with such a knowledgeable, dedicated, and compassionate group of physicians. I always look back on my time there as Chief Resident as one of the best experiences I have ever had. I am grateful to several outstanding clinical mentors, including Hasan Bazari, Larry Friedman, Nesli Basgoz, Mort Swartz, Eric Isselbacher, Bill Dec, Mike Fifer, and Roman DeSanctis, as well as the late Charlie McCabe and Peter Yurchak. This edition would not have been possible without the help of two individuals in the TIMI Study Group Chairman’s Office. Melinda Cuerda, my academic coordinator, was an invaluable resource for this edition. She shepherded every aspect of the project from start to finish, with an incredible eye to detail to ensure that each page of this book was the very best it could be. Pamela Melhorn, my executive assistant, expertly manages the Chairman’s Office, miraculously coordinating the complex clinical, research, and educational missions. Lastly, special thanks to my parents for their perpetual encouragement and love and, of course, to my wife, Jennifer Tseng, who, despite being a surgeon, is my closest advisor, my best friend and the love of my life. I hope that you find Pocket Medicine useful throughout the arduous but incredibly rewarding journey of practicing medicine. LWBK1256-FM_pi-x.indd 10 Marc S. Sabatine, MD, MPH 14/05/13 6:52 PM
