Pocket MEDICINE Fifth Edition Edited by MARC S S ABATINE , MD, MPH ASSOCIATE P ROFESSOR OF MEDICINE HARVARD MEDICAL S CHOOL The Massachusetts General Hospital Handbook of Internal Medicine Health Philadelphia • Baltimore • New York • London Buenos Aires • Hong Kong • Sydney • Tokyo 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 abovementioned copyright Printed in China Not authorised for sale in United States, Canada, Australia, New Zealand, Puerto Rico, and United States Virgin Islands 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: Internal Medicine–Handbooks 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 pm, EST 10 CONTENTS Contributing Authors Foreword Preface 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 PULMONARYQ 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 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 Pancreatitis Abnormal Liver Tests Hepatitis Acute Liver Failure Cirrhosis Hepatic Vascular Disease Ascites Biliary Tract Disease NEPHROLOGY Andrew S Allegretti, Andrew L Lundquist, Hasan Bazari Acid-Base Disturbances Sodium and Water Homeostasis Potassium Homeostasis Renal Failure Glomerular Disease Urinalysis Nephrolithiasis 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 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 ENDOCRINOLOGY Kelly B Lauter, Marc N Wein, Michael Mannstadt Pituitary Disorders Thyroid Disorders Adrenal Disorders Calcium Disorders Diabetes Mellitus Lipid Disorders 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 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 CONSULTS Kiran H Lagisetty, Jennifer F Tseng, Katherine T Chen, Stella K Kim Surgical Issues Ob/Gyn Issues Ophthalmic Issues APPENDIX ICU Medications & Treatment of Hypotension/Shock Antibiotics Formulae and Quick Reference ABBREVIATIONS INDEX PHOTO INSERTS Radiology Echocardiography & Coronary Angiography Peripheral Blood Smears & Leukemias Urinalysis ACLS CONTRIBUTING AUTHORS 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 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 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 18 Normal abdomen CT at level of pancreas (Radiology 101, 3rd ed, 2009.) Echocardiography 1 Parasternal long-axis view allows visualization of the right ventricle (RV), ven- tricular septum (VS), posterior wall (PW) aortic valve cusps, left ventricle (LV), mitral valve, left atrium (LA), and ascending thoracic aorta (Ao) *Pulmonary artery (Top: From Mayo Clinic Proceedings [Tajik AJ, Seward JB, Hagler DJ, et al Two-dimensional real-time ultrasonic imaging of the heart and great vessels: Technique, image orientation, structure identification, and validation Mayo Clinic Proceedings, 1978;53:271–303], with permission Bottom: From Oh JK, Seward JB, Tajik AJ The Echo Manual, 3rd ed Philadelphia: Lippincott Williams & Wilkins, 2006 By permission of Mayo Foundation for Medical Education and Research All rights reserved.) 2 Parasternal short-axis view at the level of the aorta: LA, left atrium; PV, pul- monary valve; RA, right atrium; RVOT, right ventricular outflow tract (Top: From Mayo Clinic Proceedings [Tajik AJ, Seward JB, Hagler DJ, et al Twodimensional real-time ultrasonic imaging of the heart and great vessels: Technique, image orientation, structure identification, and validation Mayo Clinic Proceedings, 1978;53:271–303], with permission Bottom: From Oh JK, Seward JB, Tajik AJ The Echo Manual, 3rd ed Philadelphia: Lippincott Williams & Wilkins, 2006 By permission of Mayo Foundation for Medical Education and Research All rights reserved.) Parasternal short-axis view at the level of the papillary muscles: AL, anterolateral papillary muscle; PM, posteromedial papillary muscle; RV, right ventricle; VS, ventricular septum; LV, left ventricle (Top: From Mayo Clinic Proceedings [Tajik AJ, Seward JB, Hagler DJ, et al Two-dimensional real-time ultrasonic imaging of the heart and great vessels: Technique, image orientation, structure identification, and validation Mayo Clinic Proceedings, 1978;53:271– 303], with permission Bottom: From Oh JK, Seward JB, Tajik AJ The Echo Manual, 3rd ed Philadelphia: Lippincott Williams & Wilkins, 2006 By permission of Mayo Foundation for Medical Education and Research All rights reserved.) 4 Apical four-chamber view: Note that at some institutions the image is re- versed so that the left side of the heart appears on the right side of the screen LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle (Top: From Mayo Clinic Proceedings [Tajik AJ, Seward JB, Hagler DJ, et al Two-dimensional real-time ultrasonic imaging of the heart and great vessels: Technique, image orientation, structure identification, and validation Mayo Clinic Proceedings, 1978;53:271–303], with permission Bottom: From Oh JK, Seward JB, Tajik AJ The Echo Manual, 3rd ed Philadelphia: Lippincott Williams & Wilkins, 2006 By permission of Mayo Foundation for Medical Education and Research All rights reserved.) Coronary Angiography Peripheral Blood Smears Normal smear Hypochromic, microcytic anemia due to iron-deficiency 3 Macrocytic anemia due to pernicious anemia; note macro-ovalocytes and hypersegmented neutrophils 4 Spherocytes due to autoimmune hemolytic anemia Sickle cell anemia 6 Schistocytes 7 Teardrop shaped RBC (dacrocyte) 8 Acanthocytes 9 Nucleated RBC 10 Rouleaux Leukemias 1 AML with Auer rod 2 ALL CML CLL All photos excluding Leukemias Fig 4: From Wintrobe’s Clin Hematol 12th ed, 2009: Leukemias Fig From Devita, Hellman, and Rosenberg’s Cancer: Princip & Prac of Oncol 8th ed, 2008 Urinalysis 1 “Muddy brown” or granular cast (courtesy Nicholas Zwang, MD) 2 Hyaline cast (courtesy Nicholas Zwang, MD) 3 “Waxy broad” cast (courtesy Nicholas Zwang, MD) 4 Renal tubular epithelial cell (courtesy Nicholas Zwang, MD) RBC cast (Dis of Kidney & Urinary Tract, 8th ed, 2006.) 6 WBC cast (Clin Lab Medicine, 2nd ed, 2002.) 7 Calcium oxalate crystals (courtesy Mallika Mendu, MD) Calcium monohydrate (arrow), calcium dihydrate (dashed arrow), and amorphous calcium crystals (arrowhead) 8 “Struvite” magnesium ammonia phosphate crystals (courtesy Brett Carroll, MD) Cystine crystals (Clin Lab Medicine, 1994.) 10 Sulfadiazine “shock of wheat” crystals (courtesy Nicholas Zwang, MD) ACLS ALGORITHMS Figure ACLS-1 ACLS Tachycardia Algorithm Figure ACLS-2 ACLS Bradycardia Algorithm Figure ACLS-3 VF/Pulseless VT, Asystole & PEA Algorithms