x Preface particularly important since patterns of practice and clinical evidence evolve constantly We welcome any constructive feedback to help make this manual a more accurate, practical, comprehensive, and user friendly resource David Hui, MD, M.Sc., FRCPC(Med Onc) Author, Approach to Internal Medicine Assistant Professor (tenure track), The University of Texas M.D Anderson Cancer Center, Houston, TX, USA Alexander Leung, BSc(Med), MD(STIR), DABIM, MRCP(UK), FRCPC Associate Editor, Approach to Internal Medicine Clinical Scholar, Division of General Internal Medicine University of Calgary, Calgary, AB, Canada Research Fellow, Division of General Internal Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Raj Padwal, MD, M.Sc., FRCPC Associate Editor, Approach to Internal Medicine Associate Professor, Clinical Pharmacology, Clinical Epidemiology and General Internal Medicine, University of Alberta Edmonton, AB, Canada Section Editors PULMONARY MEDICINE Mohit Bhutani, MD, FRCPC, FACP Assistant Professor of Medicine Division of Pulmonary Medicine Department of Medicine University of Alberta Edmonton, AB, Canada Training Program President Elect Canadian Association for Study of Liver Division of Gastroenterology Department of Medicine University of Alberta Edmonton, AB, Canada CARDIOLOGY Mustafa Toma, MD, FRCPC Fellow, Advanced Heart Failure and Cardiac Transplantation Cleveland Clinic Foundation Cleveland, OH, USA HEMATOLOGY Michael H Kroll, MD, FACP Professor of Medicine and Chief Benign Hematology The University of Texas M.D Anderson Cancer Center Houston, TX, USA Jason Andrade, MD, FRCPC Fellow, Cardiology Division of Cardiology University of British Columbia Vancouver, BC, Canada NEPHROLOGY Alan McMahon, MD, FRCPC Associate Professor of Medicine Division of Nephrology and Transplant Immunology, Department of Medicine University of Alberta Edmonton, AB, Canada CRITICAL CARE Wendy Sligl, MD, FRCPC Assistant Professor of Medicine Divisions of Infectious Diseases and Critical Care Medicine, Department of Medicine University of Alberta Edmonton, AB, Canada GASTROENTEROLOGY Winnie Wong, MD, FRCPC Associate Professor of Medicine Director, Gastroenterology Subspecialty ONCOLOGY Sharlene Gill, MD, FRCPC Associate Professor of Medicine Division of Medical Oncology, British Columbia Cancer Agency University of British Columbia Vancouver, BC, Canada INFECTIOUS DISEASES A Mark Joffe, MD, FRCPC Professor of Medicine Division of Infectious Diseases, Department of Medicine University of Alberta and Royal Alexandra Hospital Edmonton, AB, Canada RHEUMATOLOGY Elaine Yacyshyn, MD, FRCPC Assistant Professor of Medicine Director, Rheumatology Subspecialty Training Program Division of Rheumatology Department of Medicine University of Alberta Edmonton, AB, Canada xi xii NEUROLOGY Brian Thiessen, MD, FRCPC Assistant Professor of Medicine Department Of Medical Oncology British Columbia Cancer Agency Division of Neurology Vancouver General Hospital Vancouver, BC, Canada ENDOCRINOLOGY Laurie E Mereu, MD, FRCPC Associate Professor of Medicine Division of Endocrinology Department of Medicine University of Alberta Edmonton, AB, Canada DERMATOLOGY Susan Y Chon, MD, FAAD Assistant Professor of Medicine Department of Dermatology Division of Internal Medicine The University of Texas M.D Anderson Cancer Center Houston, TX, USA GERIATRICS Fiona Lawson, MD, FRCPC Assistant Professor of Medicine Division of Geriatrics Department of Medicine University of Alberta Edmonton, AB, Canada PALLIATIVE CARE Eduardo Bruera, MD Professor of Medicine and Chair Department of Palliative Care and Rehabilitation Medicine Division of Cancer Medicine Section Editors The University of Texas M.D Anderson Cancer Center Houston, TX, USA Sriram Yennurajalingam, MD Assistant Professor of Medicine Department of Palliative Care and Rehabilitation Medicine Division of Cancer Medicine The University of Texas M.D Anderson Cancer Center Houston, TX, USA NUTRITION Raj Padwal, MD, M.Sc., FRCPC Associate Professor of Medicine Divisions of Clinical Epidemiology Clinical Pharmacology and General Internal Medicine, Department of Medicine University of Alberta Edmonton, AB, Canada OBSTETRICAL MEDICINE Winnie Sia, MD, FRCPC Assistant Professor of Medicine and Obstetrics and Gynecology Divisions of General Internal Medicine and Maternal Fetal Medicine University of Alberta Edmonton, AB, Canada GENERAL INTERNAL MEDICINE Peter Hamilton, MBBCh, FRCPC Professor of Medicine Division of General Internal Medicine Department of Medicine University of Alberta Edmonton, AB, Canada Contributors GENERAL: Jean-Claude Quintal, MD ONCOLOGY: Francine Aubin, MD; Anna Tinker, MD; Emma Beardsley, MD; Robyn Macfarlane, MD; Sophie Sun, MD DERMATOLOGY: Elizabeth Farley, MD; Catherine Riddel, BA; Glynda Caga-Anan, BA NUTRITION: Leanne Mulesa, RD; Miranda Wong, RD Contents Pulmonary Medicine Asthma Exacerbation COPD Exacerbation Pneumonia Pulmonary Embolism Pleural Effusion 10 Chronic Cough 12 Hemoptysis 12 Solitary Pulmonary Nodule 13 Pulmonary Hypertension 14 Interstitial Lung Disease 15 Obstructive Sleep Apnea 17 Respiratory Acidosis: Hypoventilation 18 Respiratory Alkalosis: Hyperventilation 18 Hypoxemia 19 Ventilation Issues 19 Approach to Chest Imaging 19 Approach to Pulmonary Function Tests 21 Cardiology Aortic Dissection Acute Coronary Syndrome Pericardial Diseases: Pericarditis and Tamponade Heart Failure Digoxin Intoxication Atrial Fibrillation Syncope Cardiac Examination Aortic Stenosis Aortic Regurgitation Mitral Stenosis Mitral Regurgitation Endocarditis Peripheral Vascular Disease Hypertension Hyperlipidemia Smoking Issues Approach to ECG 25 25 26 32 33 38 39 43 43 47 49 50 51 52 54 57 61 62 62 xiii xiv Contents Nephrology Acute Renal Failure: Pre renal Acute Renal Failure: Renal Acute Renal Failure: Post renal Glomerulopathies Chronic Kidney Disease Proteinuria Hematuria Cystic Kidney Diseases Metabolic Acidosis Metabolic Alkalosis Hyponatremia Hypernatremia Hypokalemia Hyperkalemia Hypomagnesemia Hypophosphatemia Ureteral Calculi Hypertension Approach to Dialysis 67 67 68 70 70 73 74 75 76 77 78 79 81 81 82 83 83 84 84 85 Critical Care 89 Intensive Care Issues 89 Hypoxemia 92 Acute Respiratory Distress Syndrome 93 Ventilation Issues 94 Shock 97 Sepsis and Septic Shock 99 Lactic Acidosis 101 Rhabdomyolysis 101 Toxicology 102 Alcohol Withdrawal and Complications of Alcoholism 105 Hypothermia 107 Smoke Inhalation 108 Anaphylaxis 109 Gastroenterology 111 Nausea and Vomiting 111 Dysphagia 112 Dyspepsia 113 Acute Abdominal Pain 115 Upper GI Bleed 118 Lower GI Bleed 120 Inflammatory Bowel Disease Exacerbation 120 Acute Diarrhea 122 Chronic Diarrhea 124 Malabsorption Syndromes 125 Constipation 126 Acute Liver Failure 128 Hepatitis B 130 Hepatitis C 131 Chronic Liver Disease: Cirrhosis 132 ... Edmonton, AB, Canada GENERAL INTERNAL MEDICINE Peter Hamilton, MBBCh, FRCPC Professor of Medicine Division of General Internal Medicine Department of Medicine University of Alberta Edmonton,... Approach to ECG 25 25 26 32 33 38 39 43 43 47 49 50 51 52 54 57 61 62 62 xiii xiv Contents... of Medicine Division of Endocrinology Department of Medicine University of Alberta Edmonton, AB, Canada DERMATOLOGY Susan Y Chon, MD, FAAD Assistant Professor of Medicine Department of Dermatology