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Pocket MEDICINE Fifth Edition Edited by MARC S SABATINE, MD, MPH ASSOCIATE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL 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 o cial duties as U.S government employees are not covered by the above-mentioned 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 rm 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 e ort 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 ow 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 ANTIBIOTICS The following tables of spectra of activity for different antibiotics are generalizations Sensitivity data at your own institution should be used to guide therapy FORMULAE AND QUICK REFERENCE CARDIOLOGY Fick cardiac output Oxygen consumption (L/min) = CO (L/min) × arteriovenous (AV) oxygen difference CO = oxygen consumption/AV oxygen difference Oxygen consumption must be measured (can estimate w/ 125 mL/min/m2, but inaccurate) AV oxygen di erence = Hb (g/dL) × 10 (dL/L) × 1.36 (mL O 2/g of Hb) × (SaO2— SvO2) SaO2 is measured in any arterial sample (usually 93—98%) SvO2 (mixed venous O2) is measured in RA, RV or PA (assuming no shunt) (nl ~75%) PULMONARY CXR in heart failure • ↑ cardiac silhouette (in systolic dysfxn, not in diastolic) • Pulmonary venous hypertension: cephalization of vessels (vessels size > bronchi in upper lobes), peribronchial cuffing (fluid around bronchi seen on end → small circles), Kerley B lines (horizontal 1—2-cm lines at bases), ↑ vascular pedicle width, loss of sharp vascular margins, pleural effusions (~75% bilateral) • Pulmonary edema: ranges from ground glass to consolidation; often dependent and central, sparing outer third (“bat wing” appearance) Dead space = lung units that are ventilated but not perfused Intrapulmonary shunt = lung units that are perfused but not ventilated NEPHROLOGY Anion gap (AG) = Na − (Cl + HCO3) (normal = [alb] × 2.5; typically 12 ± mEq) Delta-delta (ΔΔ) = [Δ AG (ie, calc AG - expected) / Δ HCO3 (ie, 24 - measured HCO3)] Urine anion gap (UAG) = (U Na + U K) − U Cl HEMATOLOGY ✓ PTT q6h after every Δ (t1⁄2 of heparin ~90 min) and then qd or bid once PTT is therapeutic ✓ CBC qd (to ensure Hct and plt counts are stable) Warfarin-heparin overlap therapy • Indications: when failure to anticoagulate carries ↑ risk of morbidity or mortality (eg, DVT/PE, intracardiac thrombus) • Rationale: (1) Half-life of factor VII (3—6 h) is shorter than half-life of factor II (60— 72 h); ∴warfarin can elevate PT before achieving a true antithrombotic state (2) Protein C also has half-life less than that of factor II; ∴theoretical concern of hypercoagulable state before antithrombotic state • Method: (1) Therapeutic PTT is achieved using heparin (2) Warfarin therapy is initiated (3) Heparin continued until INR therapeutic for ≥2 d and ≥4—5 d of warfarin (roughly corresponds to ~2 half-lives of factor II or a reduction to ~25%) OTHER NOTES ABBREVIATIONS 5′-NT 5′-nucleotidase 6-MP 6-mercaptopurine AAA abdominal aortic aneurysm AAD antiarrhythmic drug Ab antibody ABE acute bacterial endocarditis ABG arterial blood gas abnl abnormal ABPA allergic bronchopulmonary aspergillosis abx antibiotics AC assist control ACE angiotensin converting enzyme ACEI ACE inhibitor ACI anemia of chronic inflammation ACL anticardiolipin antibody ACLS advanced cardiac life support ACS acute coronary syndrome ACTH adrenocorticotrophic hormone ACV acyclovir ADA adenosine deaminase ADH antidiuretic hormone ADL activities of daily living AF atrial fibrillation AFB acid-fast bacilli AFL atrial flutter AFP ɑ-fetoprotein AFTP ascites fluid total protein AG aminoglycoside anion gap Ag antigen AGN acute glomerulonephritis AI aortic insufficiency AIDS acquired immunodefic synd AIH autoimmune hepatitis AIHA autoimmune hemolytic anemia AIN acute interstitial nephritis AIP acute interstitial pneumonia AKI acute kidney injury ALF acute liver failure ALL acute lymphoblastic leukemia ALS amyotrophic lateral sclerosis ALT alanine aminotransferase AMA anti-mitochondrial antibody AMI anterior myocardial infarction AML acute myelogenous leukemia amy amylase ANA antinuclear antibody ANCA antineutrophilic cytoplasmic Ab AoD aortic dissection AoV aortic valve APC activated protein C APL acute promyelocytic leukemia APLA antiphospholipid Ab APS antiphospholipid Ab synd ARB angiotensin receptor blocker ARDS acute resp distress synd ARV antiretroviral ARVC arrhythmogenic RV CMP AS aortic stenosis ASA aspirin ASD atrial septal defect AST aspartate aminotransferase asx asymptomatic AT atrial tachycardia ATII angiotensin II ATIII antithrombin III ATN acute tubular necrosis ATRA all-trans-retinoic acid AV atrioventricular AVA aortic valve area AVB atrioventricular block AVNRT AV nodal reentrant tachycardia AVR aortic valve replacement AVRT a/w AV reciprocating tachycardia AZA azathioprine A alkaline phosphatase b/c because BAL bronchoalveolar lavage βB beta-blocker BBB bundle branch block BCx blood culture BD bile duct BDZ benzodiazepines bili bilirubin associated with BIPAP bilevel positive airway pressure BIV biventricular BM bone marrow bowel movement BMD bone mineral density BMI body mass index BMS bare metal stent BNP B-type natriuretic peptide BOOP bronchiolitis obliterans with organizing pneumonia BP blood pressure BPH benign prostatic hypertrophy BRBPR bright red blood per rectum BS breath sounds ... 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... Pocket MEDICINE Fifth Edition Edited by MARC S SABATINE, MD, MPH ASSOCIATE PROFESSOR OF MEDICINE HARVARD MEDICAL SCHOOL The Massachusetts General Hospital Handbook of Internal Medicine. .. 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