HARRISON'S INTERNAL MEDICINE SELF-ASSESSMENT AND BOARD REVIEW Editorial Board ANTHONY S FAUCI, MD Chief, Laboratory of Immunoregulation Director, National Institute of Allergy and Infectious Diseases National Institutes of Health Bethesda EUGENE BRAUNWALD, MD Distinguished Hersey Professor of Medicine Harvard Medical School Chairman, TIMI Study Group, Brigham and Women’s Hospital Boston DENNIS L KASPER, MD William Ellery Channing Professor of Medicine Professor of Microbiology and Molecular Genetics Harvard Medical School Director, Channing Laboratory Department of Medicine Brigham and Women’s Hospital Boston STEPHEN L HAUSER, MD Robert A Fishman Distinguished Professor and Chairman, Department of Neurology University of California, San Francisco San Francisco DAN L LONGO, MD Scientific Director, National Institute on Aging National Institutes of Health Bethesda and Baltimore, Maryland J LARRY JAMESON, MD, PhD Professor of Medicine Vice-President for Medical Affairs and Lewis Landsberg Dean Northwestern University Feinberg School of Medicine Chicago JOSEPH LOSCALZO, MD, PhD Hersey Professor of the Theory and Practice of Medicine Harvard Medical School Chairman, Department of Medicine Physician-in-Chief, Brigham and Women’s Hospital Boston HARRISON'S INTERNAL MEDICINE SELF-ASSESSMENT AND BOARD REVIEW For use with the 17th edition of HARRISON’S PRINCIPLES OF INTERNAL MEDICINE EDITED BY CHARLES WIENER, MD Professor of Medicine and Physiology Vice Chair, Department of Medicine Director, Osler Medical Training Program The Johns Hopkins University School of Medicine Baltimore Contributing Editors Gerald Bloomfield, MD, MPH Cynthia D Brown, MD Joshua Schiffer, MD Adam Spivak, MD Department of Internal Medicine The Johns Hopkins University School of Medicine Baltimore New York Chicago San Francisco Lisbon London Madrid Mexico City New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2008, 2005, 2001, 1998, 1994, 1991, 1987 by The McGraw-Hill Companies, Inc All rights reserved Manufactured in the United States of America Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher 0-07-164131-9 The material in this eBook also appears in the print version of this title: 0-07-149619-X All trademarks are trademarks of their respective owners Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark Where such designations appear in this book, they have been printed with initial caps McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs For more information, please contact George Hoare, Special Sales, at george_hoare@mcgraw-hill.com or (212) 904-4069 TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc (“McGraw-Hill”) and its licensors reserve all rights in and to the work Use of this work is subject to these terms Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent You may use the work for your own noncommercial and personal use; 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If you’d like more information about this book, its author, or related books and websites, please click here For more information about this title, click here CONTENTS Preface SECTION I vii INTRODUCTION TO CLINICAL MEDICINE Questions Answers SECTION II NUTRITION Questions Answers SECTION III 283 293 DISORDERS OF THE GASTROINTESTINAL SYSTEM Questions Answers SECTION IX 237 254 DISORDERS OF THE URINARY AND KIDNEY TRACT Questions Answers SECTION VIII 175 202 DISORDERS OF THE RESPIRATORY SYSTEM Questions Answers SECTION VII 103 130 DISORDERS OF THE CARDIOVASCULAR SYSTEM Questions Answers SECTION VI 55 71 INFECTIOUS DISEASES Questions Answers SECTION V 47 50 ONCOLOGY AND HEMATOLOGY Questions Answers SECTION IV 18 307 321 RHEUMATOLOGY AND IMMUNOLOGY Questions Answers 345 358 v vi SECTION X CONTENTS ENDOCRINOLOGY AND METABOLISM Questions Answers SECTION XI NEUROLOGIC DISORDERS Questions Answers SECTION XII 379 393 421 435 DERMATOLOGY Questions Answers 457 460 References 465 Color Atlas 473 PREFACE People who pursue careers in Internal Medicine are drawn to the specialty by a love of patients, mechanisms, discovery, education, and therapeutics We love hearing the stories told to us by our patients, linking signs and symptoms to pathophysiology, solving the diagnostic dilemmas, and proposing strategies to prevent and treat illness It is not surprising given these tendencies that internists prefer to continue their life-long learning through problem solving This book is offered as a companion to the remarkable 17th edition of Harrison’s Principles of Internal Medicine It is designed for the student of medicine to reinforce the knowledge contained in the parent book in an active, rather than passive, format This book contains over 1000 questions, most centered on a patient presentation Answering the questions requires understanding pathophysiology, epidemiology, differential diagnosis, clinical decision making, and therapeutics We have tried to make the questions and the discussions timely and relevant to clinicians All answer discussions are referenced to the relevant chapter(s) in the par- ent book and often contain useful figures or algorithms appropriate to the question We recommend this book to students and clinicians looking for an active method of lifelong learning and as a resource for preparing for the Internal Medicine board examination We appreciate the confidence of the editors of Harrison’s,17th edition, to allow us to this book We thank our families and loved ones who had to watch us pore over page proofs to come up with original questions and answers All of the authors are (or were) affiliated with Osler Medical Training Program at the The Johns Hopkins School of Medicine The dedicated physicians of the Osler Medical Service inspire us daily to constantly learn and improve We thank them for their constant appreciation of high standards and their dedication to outstanding patient care Many of the case presentations derive from actual patients we’ve cared for, and we thank the patients of Johns Hopkins Hospital for their nobility and their willingness to participate in our clinical and educational missions vii Copyright © 2008, 2005, 2001, 1998, 1994, 1991, 1987 by The McGraw-Hill Companies, Inc Click here for terms of use NOTES NOTES NOTES NOTES NOTES NOTES NOTES COLOR ATLAS Figure III-21 Figure II-3 Copyright © 2008, 2005, 2001, 1998, 1994, 1991, 1987 by The McGraw-Hill Companies, Inc Click here for terms of use COLOR ATLAS Figure III-6 Figure IV-2 Figure IV-57 Figure IV-121 COLOR ATLAS Figure VI-32 Figure IV-158 Figure VI-30 Figure V-115 COLOR ATLAS Figure XI-62 Figure X-14 Figure XII-6 Figure XII-3 COLOR ATLAS Figure XII-8 Figure XII-11 Figure XII-9 COLOR ATLAS Figure XII-13 Figure XII-12 Figure XII-15 COLOR ATLAS Figure XII-19 Figure XII-16 Figure XII-18 COLOR ATLAS Figure I-36 Figure VIII-76 Figure IX-49