1.General Approach to the Patient; Health Malntenance Dlsease Prevention; Common Symptoms[Stephen J. McPhee],MD, [Steven A. Schroeder], MD 1
General Approach to the Patient 1
Health Maintenance Disease Prevention 2
Infectious Diseases 3
Cardiovascular Cerebrovascular Diseases 5
Preface 11
Physical Inactivity Sedentary Lirestyle 12
Cancer 13
Authors 15
Accidents Violence 16
Substance Abuse: Alcohol IIIicit Drugs 17
Pain 19
Common Symptoms 19
Fever Hyperthermia 29
Weight Loss 31
Fatigue 32
2. Preoperative Evaluation[Joshua S. Adler], MD, [Lee Goldman], MD,MPH 35
Physiologic Effects of Anesthesia Surgery 35
Evaluation of the Asymptomatic Patient 35
Cardiac Risk Assessment 36
Pulmonary Evaluation in Non-Lung Resection Surgery 40
Evaluation of the Patient With Liver Disease 42
Neurologic Evaluation 43
11. Systemic Hyertension[Barry M.Massie],MD 44
Management of Endocrine Diseases 44
Renal Disease 45
3. Gerlatric Medicine[Nell M. Resnick], MD 47
Greneral Principoes of Geriatric Medicine 47
Evaluation of the Elderly 50
Physical Examination 51
Mental Status Examination 53
Evaluation of Functional Capacity in the Elderly 53
Laboratory Examinations Imaging 54
The Frail Elderly the Five I s 54
Intellectual Impairment 55
Immobility(Chair-or Bed-Bound) 58
Instability(Physical Instability,Falls, Unstable Gait) 59
Urinary Incontinence 62
Iatrogenic Drug Reactions 65
Overview of Special Considerations in Treating the Elderly 66
4. Cancer[Hope S. Rugo],MD 71
Incidence Etiology 71
Prevention of Cancer 74
Primary Prevention 74
Secondary Prevention 78
Special Topics in Prevention 79
Staging of Cancer 80
Primary Cancer Treatment 80
Surgery Radiation Therapy 80
Systemic Cancer Therapy 82
Adjuvant Chemotherapy for Micrometastases 93
Toxicity Dose Modification of Chemotherapeutic Agents 94
Evaluation of Tumor Response 99
Tumor Size 99
Tumor Markers 100
General Well-Being, Performance Status, Supportive Care 101
Cancer Complications: Diagnosis Management 102
Oncologic Emergencies 102
Other Complications 105
The Paraneoplastic Syndromes 107
Novel Therapies for Cancer Treatment 108
Expectations About the End of Life 111
The End of Life 111
Diagnosis of the End of Life 111
5. Care at the End of Life[Michael W. Rabow],MD, [Robert V.Brody],MD 111
The Role of the Physician at the End of Life 112
Caring for the Family 112
The Limits of Care at the End of Life 113
The Setting Structure of Care 113
Ethical Legal Background 113
Advance Diectives 114
DNAR Orders 114
Hospice Care 115
Cultural Issues 115
The Specific Tasks of Caring 116
Symptom Management 116
Psychologic, Social, Spiritual Issues 119
Nutrition Hydration 119
Withdrawal of Support 119
Tasks After Death 121
The Pronouncement Death Certificate 121
Autopsy Organ Donation 122
Follow-Up Griving 122
6. Skin, Hair, Naiis[Timothy G. Berger],MD 124
Diagnosis of Skin Disorders 124
Principoes of Dermatologic Therapy 124
Common Dermatoses 129
Pigmented Lesions 129
Scaling Disorders 133
Vesicular Dermatoses 146
Weeping or Encrusted Lesions 151
Pustular Disorders 153
Figurate Erythemas 159
Blistering Diseases 163
Papules 165
Violaceous to Purple Papules Nodules 169
Pruritus(Itching) 171
Inflammatory Nodules 175
Photodermatitis 177
Ulcers 178
Miscellaneous Dermatologic Disorders 180
Pigmentary Disorders 180
Baldness(Alopecia) 182
Nail Disorders 183
Dermatitis Medicamentosa(Drug Eruption) 184
7. Eye[Paul Riordan-Eva],FRCS,FRCOphth, [Daniei G. Vaughan],MD 189
Symptoms of Ocular Disease 189
Ocular Examination 190
Ophthalmologic Referrals 192
Refractive Errors 193
Disorders of the Lids Lacrimal Apparatus 194
Conjunctivitis 195
Corneal UIcer 198
Pinguecula Pterygium 198
Acute(Angle-Closure)Glaucoma 200
Open-Angle Glaucoma 201
Uveitis 202
Cataract 204
Retinal Detachrnent 204
Vitreous Hemorrhage 205
Age-Related Macular Degeneration 205
Central Branch Retinal Vein Occlusions 206
Central Branch Retinal Artery Occlusions 207
Amaurosis Fugax 208
Retinal Disorders Associated With Systemic Diseases 208
Anterior Ischemic Optic Neuropathy 211
Optic Neuritis 211
Optic Disk Swelling 212
Ocular Motor Palsies 212
Orbhital Cellulitis 213
Dysthyroid Eye Disease 213
Ocular Trauma 214
Principles of Treatment of Ocular Infections 215
Techniques Used in the Treatment of Ocular Disorders 219
Precautions in Management of Ocular Disorders 221
Adverse Ocular Effects of Systemic Drugs 221
8. Ear, Nose, Throat[Robert K. Jackier],MD, [Michael J. Kaplan],MD 223
Diseases of the Ear 223
Diseases of the Nose Paranasal Sinuses 237
Diseases of the Oral Cavity Pharynx 246
Diseases of the Salivary Glands 252
Diseases of the Larynx 253
Tracheostomy Cricothyrotomy 256
Foreign Bodies in the Upper Aerodigestive Tract 257
Diseases Presenting as Neck Masses 258
Otolaryngologic Manifestations of HIV Infection 260
Dyspnea 264
9.Lung[Mark S.Chesnutt],MD, [Thomas J.Prendergast],MD 264
Symptoms Sings of Lung Disease 264
Cough 265
Hemoptysis 266
Physical Examination 267
Pulmonary Function Tests 268
Disorders of the Airways 271
Pulmonary Infections 292
Pulmonary Nodules, Masses, Tumors 308
Interstitial Infiltrative Lung Diseases 316
Disorders of the Pulmonary Circulation 321
Enviruonmental Occupational Lung Disorders 332
Pleural Diseases 338
Disorders of Control of Ventilation 344
Acute Respiratory Failure 346
Acute Respiratory Distress Syndrome(ARDS) 348
10. Heart[Barry M. Massie],MD, [Thomas M. Amidon],MD 351
Symptoms Signs 351
Diagnostic Testing 354
Congenital Heart Disease 355
Valvular Heart Disease 360
Coronary Heart Disease 369
Disturbances of Rate Rhythm 397
Conduction Disturbances 412
Cardiac Failure 416
Myocarditis the Cardiomyopathies 427
Acute Rheumatic Fever Rheumatic Heart Disease 431
Diseases of the Pericardium 433
Pulmonary Hypertension Heart Disease 436
Neoplastic Diseases of the Heart 438
Cardiac Involvement in Miscellaneous Systemic Diseases 438
The Cardiac Patient Surgery 439
The Cardiac Patient Pregnancy 441
Management of Hypertension 445
Hypertensive Urgencies Emergencies 463
Diseases of the Aorta 467
12. Blood Vessels Lymphatics[Lawrence M. Tiemey,Jr.],MD, [Louis M.Messina],MD 467
Atherosclerotic Occlusive Disease 472
Vasomotor Disorders 482
Venous Diseases 485
Diseases of the Lymphatic Channels 493
Hypotension Shock 495
13.Blood[Charles A.Linker],MD 499
Anemias 499
Neutropenia 517
Leukemias Other Myeloproliferative Disorders 518
Lymphomas 529
Disorders of Hemostasis 535
Hypercoagulable States 547
Blood Transfusions 549
14. Alimentary Tract[Kenneth R.McQuaid],MD 553
Symptoms Signs of Gastrointestinal Disease 553
Diseases of the Peritoneum 573
Diseases of the Esophagus 578
Diseases of the Stomach Duodenum 595
Diseases of the Small Intestine 613
Diseases of the Colon Rectum 628
Anorectal Diseases 651
15.Liver,Biliary Tract, Pancreas[Lawrence S. Friedman], MD 656
Jaundice (Icterus) 656
Diseases of the Liver 659
Diseases of the Biliary Tract 683
Diseases of the Pancreas 691
16. Breast[Armando E.Giuliano],MD 698
Benign Breast Disorders 698
Fibrocystic Disease 698
Fibroadenoma of the Breast 699
Nipple Discharge 699
Fat Necrosis 700
Breast Abscess 700
Disorders of the Augmented Breast 701
Carcinoma of the Female Breast 701
Carcinoma of the Male Breast 721
17. Gynecology[H.Trent MacKay],MD,MPH 723
Abnormal Premenopausal Bleeding 723
Postmenopausal Vaginal Bleeding 724
Premenstrual Syndrome (Premenstrual Tension) 725
Dysmenorrthea 726
Vaginitis 726
Effects of Exposure to Diethylstilbestrol in Utero 728
Cyst Abscess of Bartholin s Duct 728
Cervical Polyps 728
Cervicitis 728
Cervical Intracpithelial Neoplasia 729
Carcinoma of the Cervix 730
Leiomyoma of the Uterus 732
Carcinoma of the Endometrium 733
Carcinoma of the Vulva 734
Endometriosis 734
Genital Prolapse 735
Pelvic Inflammatory Disease 736
Uterine Prolapse 736
Ovarian Tumors 738
Persistent Anovulation 741
Painful Intercourse 742
Infertility 743
Contraception 745
Rape 753
Menopausal Syndrome 754
18. Obstetrics[William R.Crombleholme],MD 758
Diagnosis Differential Diagnosis of Pregnancy 758
Essentials of Prenatal Care 758
Nutrition in Pregnancy 761
Travel Immunizations During Pregnancy 762
Vorniting of Pregnancy Hyperemesis Gravidarum 762
Spontaneous Abortion 762
Recurrent(Habitual)Abortion 764
Ectopic Pregnancy 764
Preeclampsia-Eclampsia 765
Gestational Trophoblastic Neoplasia 768
Third-Trimester Bleeding 769
Medical Conditions Complicating Pregnancy 770
Surgical Complications During Pregnancy 777
Prevention of Hemolytic Disease of the Newborn 779
Prevention of Preterm(Premature)Labor 779
Lactation 780
Puerperal Mastitis 780
19. Allergic Immunologic Disorders[Jeffrey L.Kishiyama],MD, [Daniel C.Adelman],MD 783
Allergic Diseases 783
Atopic Disease 784
Allergic Rhinitis 784
Anaphylaxis,Urticaria, Angioedema 788
Drug Allergy 789
Immune Complex Disease(Serum Sickness) 790
Pseudoallergic Reactions 790
Cells Involved in Immunity 791
Clinical Immunology 791
Tests for Cellular Immunity 793
Immunoglobulin Structure Function 794
Immunodeficiency Disorders 796
Common Variable Immunodeficiency 796
Selective Immunoglobulin A Deficiency 797
Diseases of Immunoglobulin Overproduction 797
Autoimmunity 798
Tests for Autoantibodies Associated With Autoimmune Disease 799
Autoimmune Diseases 799
Immunogenetics Transplantation 801
Genetic Control of the Immune Response 801
Associations Between HLA Antigens Specific Diseases 801
Clinical Transplantation 802
Mechanism of Action of Immunosuppressive Drugs 804
Immunomodulating Therapies 805
20. Arthritis Musculoskeletal Disorders[David B. Hellmann], MD, FACP, [John H. Store],MD,MPH 807
Diagnosis Evaluation 807
Degenerative Crystal-Induced Arthritis 808
Pain Syndromes 815
Autoimmune Diseases 826
Vasculitis Syndromes 841
Seronegative Spondyloarthropathies 846
Infections Arthritis 850
Infections of Bones 853
Tumors Tumor-Like Lesions of Bone 856
Other Rheumatic Disorders 857
Some Orthopedic Procedures for Arthritic Joints 858
21. Fluid Electrolyte Disorders[Toshihiro Okuda],MD,PhD,[Kiyoshi Kurokawa],MD,MACP, [Maxine A.Papadakis],MD 860
Diagnosis of Fluid Electrolyte Disorders 860
Treatment of Specific Fluid,Electrolyte, Acid-Base Disorders 861
Disorders of Sodium Concentration 861
Disorders of Calcium Concentration 870
Disorders of Phosphorus Concentration 872
Disorders of Magnesium Concentration 874
Hyperosmolar Disorders Osmolar Gaps 875
Acid-Base Disorders 875
Fluid Management 884
Disorders of Potassium Concentration 886
22. Kidney[Suzanne Watnick],MD, [Gail Morrison],MD 886
Approach to Renal Disease 886
Acute Renal Failure 890
Chronic Renal Disease 895
Glomerulonephropathies 902
Tubulointerstitial Diseases 911
Cystic Diseases of the Kidney 913
Medullary Sponge Kidney 915
Multisystem Diseases With Variable Kidney Involvement 915
23. Urolgy[Joseph C.Presti,Jr.], MD, [Marshall L. Stoller],MD, [Peter R. Carroll],MD,FACS 917
Urologic Evaluation 917
Evaluation of Hematuria 921
Genitourinary Tract Infections 922
Acute Cystitis 923
Acute Pyelonephritis 924
Chronic Bacterial Prostatitis 926
Acute Bacterial Prostatitis 926
Nonbacterial Prostatitis 927
Prostatodynia 928
Acute Epididymitis 928
Urinary Stone Disease 929
Urinary Incontinence 933
Male Erectile Dysfunction Sexual Dysfunction 936
Benign Prostatic Hyperplasia 939
Malignant Genitourinary Tract Disorders 946
Prostate Cancer 946
Bladder Cancer 951
Cancers of the Ureter Renal Pelvis 954
Primary Tumors of the Kidney 954
Secondary Tumors of the Kidney 955
Primary Tumors of the Testis 955
Secondary Tumors of the Testis 957
Headache 959
24. Nervous System[Michael J.Aminoff],MD,FRCP] 959
Facial Pain 962
Epilepsy 965
Neurologic Causes of Syncope 969
Sensory Disturbances 970
Weakness Paralysis 970
Transient Ischemic Attacks 970
Stroke 973
Intracranial Spinal Space-Occupying Lesions 980
Nonmetastatic Neurologic Complications of Malignant Disease 985
Pseudotumor Cerebri 985
Selected Neurocutaneous Diseases 986
Movement Disorders 987
Dementia 994
Multiple Sclerosis 994
Vitamin E Deficiency 995
Spasticity 995
Subacute Combined Degeneration of the Spinal Cord 996
Wernicke s Encephalopathy 996
Myelopathy of Human T Cell Leukemia Virus 996
Myelopathies in AIDS 996
Stupor Coma 997
Head Injury 999
Spinal Trauma 1000
Syringomyelia 1001
Motor Neuron Diseases 1001
Peripheral Neuropathies 1002
Discogenic Neck Back Pain 1009
Brachial Lumbar Plexus Lesions 1013
Disorders of Neuromuscular Transmission 1013
Myopathic Disorders 1015
Periodic Paralysis Syndrome 1017
25. Psychiatric Disorders[Stuart J.Eisendrath],MD, [Jonathan E. Lichtmacher],MD 1019
Psychiatric Assessment 1020
Treatment Approaches 1021
Common Psychiatric Disorders 1022
Substance Use Disorders 1062
Delirium, Dementia, Other Cognitive Disorders 1071
Geriatric Psychiatric Disorders 1074
Psychiatric Problems Associated With Hospitalization Medical Surgical Disorders 1075
26. Endocrinology[Paul A.Fitzgerald],MD 1079
Common Presentations in Endocrinology 1079
Diseases of the Hypothalamus Pituitary Gland 1083
Diseases of the Thyroid Gland 1092
The Parathyroids 1115
Metabolic Bone Disease 1121
Diseases of the Adrenal Cortex 1126
Diseases of the Adrenal Medulla 1135
Pancreatic Neuroendocrine Tumors 1138
Diseases of the Testes 1139
Amenorrhea Menopause 1142
Multiple Endocrine Neoplasia 1148
Clinical Use of Glucocorticoids 1149
27. Diabetes Mellitus Hypoglycemia[John H.Karam],MD 1152
Diabetes Mellitus 1152
Diabetic Coma 1186
The Hypoglycemic States 1192
28.Lipid Abnormalities[Robert B. Baron],MD,MS 1198
Lipids Lipoproteins 1198
Lipoproteins Atherogenesis 1198
Lipid Fractions the Risk of Coronary Heart Disease 1200
Therapeutic Effects of Lowering Cholesterol 1200
Clinical Presentations 1202
Screening for High Blood Cholesterol 1202
Secondary Conditions That Affect Lipid Metabolism 1202
Treatment of High LDL Cholesterol 1205
High Blood Triglycerides 1209
29. Nutrition[Robert B. Baron],MD,MS 1211
Nutritional Requirements 1211
Assessment of Nutritional Status 1215
Nutritional Disorders 1220
Eating Disorders 1225
Disorders of Vitamin Metabolism 1227
Diet Therapy 1232
Nutritional Support 1234
30. General Problems In Infectious Diseases[Richard A.Jacobs],MD,PhD 1241
Fever of Unknown Origin(FUO) 1241
Infections in the Immunocompromised Patient 1243
Nosocomial Infections 1246
Infections of the Central Nervous System 1248
Animal Human Bite Wounds 1250
Sexually Transmitted Diseases 1251
Infections in Drug Users 1252
Acute Infectious Diarrhea 1253
Traveler s Diarrhea 1254
Active Immunization Against Infectious Diseases 1257
Recommended Immunization of Infants, Children, Adolescents 1257
Recommended Immunization of Adults 1257
Recommended Immunization for Travelers 1262
Hypersensitivity Tests Desensitization 1264
31. HIV Infection[Mitchell H.Katz],MD, [Harry Hollander],MD 1266
Epidemiology 1267
Pathophysiology 1269
Pathogenesis 1269
Etiology 1269
Clinical Findings 1270
Differential Diagnosis 1279
Prevention 1280
Treatment 1282
Course Prognosis 1293
32. Infectious Eiseases:Viral Rickettsial[Alain Bouckenooghe],MD, [Wayne X.Shandera],MD 1295
Viral Diseases 1295
Human Herpesviruses 1296
Major Vaccine-Preventable Viral Infections 1306
Other Neurotropic Viruses 1312
Other Systemic Viral Diseases 1317
Common Viral Respiratory Infections 1320
Adenovirus Infections 1323
Other Exanthematous Viral Infections 1323
Viruses Gastroenteritis 1324
Viruses That Produce Several Syndromes 1325
Typhus Group 1326
Rickettsial Diseases 1326
Spotted Fevers 1329
Other Rickettsial Rickettsial-Like Diseases 1331
33.Infectious Diseases:Bacterial Chlamydial[Henry F.Chambers],MD 1334
Infections Caused by Gram-Positive Bacteria 1334
Infective Endocarditis 1346
Infections Caused by Gram-Negative Bacteria 1351
Nocardiosis 1367
Actinomycosis 1367
Infections Caused by Mycobacteria 1368
Infections Caused by Chlamydiae 1373
34. Infectious Diseases:Spirochetal[Richard A.Jacobs],MD,PhD 1376
Syphilis 1376
Non-Sexually Transmitted Treponematoses 1386
Miscellaneous Spirochetal Diseases 1387
Relapsing Fever 1387
Leptospirosis 1388
Rat-Bite Fever 1388
Lyme Disease 1389
35. Infectious Diseases:Protozoal Helminthic[Robert S.Goldsmith],MD,MPH,DTM H 1396
Protozoal Infections 1396
African Trypanosomiasis(Sleeping Sickness) 1396
American Trypanosomiasis(Chagas Disease) 1398
Amebiasis 1400
Pathogenic Free-Living Amebas 1405
Babesiosis (Piroplasmosis) 1406
Balantidiasis 1407
Coccidial Microsporidial Infections: Cryptosporidiosis,Isosporiasis, Sarcocystosis 1407
Giardiasis 1410
Leishmaniasis 1412
Malaria 1416
Toxoplasmosis 1427
Helminthic Infections 1429
Trematode(Fluke)Infections 1429
Cestode Infections 1436
Nematode (Roundworm)Infections 1443
36. Infectious Diseases:Mycotic[Richard J.Hamill],MD 1463
Candidiasis 1463
Histoplasmosis 1464
Coccidioidomycosis 1465
Pneumocystosis 1467
Cryptococcosis 1469
Aspergillosis 1470
Blastomycosis 1471
Mucormycosis 1471
Paracoccidioidomycosis 1472
Sporotrichosis 1472
Penicillium marneffei Infections 1472
Chromomycosis 1473
Mycetoma 1473
Other Opportunistic Mold Infections 1473
Antifungal Therapy 1474
37. Anti-infective Chemotherapeutic Antibiotic Agents[Richard A.Jacobs],MD,PhD, [B.Joseph Guglielmo]PharmD 1476
Some Principles of Antimicrobial Therapy 1476
Penicillins 1484
Cephalosporins 1489
Other β-Lactam Drugs 1493
Erythromycin Group(Macrolides) 1494
Azalides 1495
Tetracycline Group 1496
Chloramphenicol 1497
Aminoglycosides 1497
Polymyxins 1500
Antituberculous Drugs 1500
Sulfonamides Antifolate Drugs 1503
Sulfones Used in the Treatment of Leprosy 1505
Specialized Drugs Used Against Bacteria 1505
Streptogramins 1507
Quinolones 1507
Pentamidine Atovaquone 1510
Urinary Antiseptics 1510
Antifungal Drugs 1511
Systemically Active Drugs in Urinary Tract Infections 1511
Antiviral Chemotherapy 1515
38. Disorders Due to Physical Agents[Richard Cohen], MD,MPH, [Brent R.W.Moelleken],MD,FACS 1520
Disorders Due to Cold 1520
Disorders Due to Heat 1525
Burns 1528
Electric Shock 1532
Ionizing Radiation Reactions 1533
Drowning 1535
Other Disorders Due to Physical Agents 1537
39.Poisoning[Kent R.Oison],MD 1541
Initial Evaluation of the Patient With Poisoning or Drug Overdose 1541
The Symptomatic Patient 1541
Antidotes Other Treatment 1546
Diagnosis of Poisoning 1548
Clinical Laboratory Tests in Management of Poisoning 1549
Treatment of Common Specific Poisonings(Alphabetical Order) 1551
40. Medical Genetics[Reed E.Pyeritz],MD,PhD 1574
Introduction to Medical Genetics 1574
Genes Chromosomes 1575
Mutation 1576
Genes in Individuals 1577
Genes in Families 1578
Disorders of Multifactorial Causation 1580
Chromosomal Aberrations 1581
The Techniques of Medical Genetics 1582
Cytogenetics 1582
Biochemical Genetics 1584
DNA Analysis 1585
Prenatal Diagnosis 1587
Neoplasia:Chromosomal DNA Analysis 1589
Selected Genetic Disorders 1591
Acute Intermittent Porphyria 1591
Alkaptonuria 1592
Down s Syndrome 1593
Gaucher s Disease 1594
Homocystinuria 1594
Klinefelter s Syndrome 1595
Homocysteine Arterial Occlusive Disease 1595
Marfan s Syndrome 1596
41. Diagnostic Testing Medical Declsion Mading[C.Diana Nicoll],MD,PhD,[Michael Pignone],MD,MPH, [William M.Detmer],MD,MSc 1598
Benefits; Costs Risks 1598
Performance of Diagnostic Tests 1599
Test Characteristics 1599
Use of Tests in Diagnosis Management 1602
Odds-Likelihood Ratios 1603
The Internet in Clinical Practice 1609
42. Informatics in Patient Care: The Internet, Telemedicine, Clinical Decision Support[Justin V.Graham],MD, [Rick G. Kulkaml],MD 1609
Information Reliability Quality Assessment 1610
Health Information Security 1611
Patient-Clinician E-Mail Communication 1612
Interactive Forums 1613
Telemedicine 1614
Clinical Decision Support Systems 1614
Appendix:Therapeutic Drug Monitoring Laboratory Reference Ranges[C.Diana Nicoll], MD,PhD 1617
Index 1627