Kochars clinical medicine for students

KOCHAR’S CLINICAL MEDICINE FOR STUDENTS FIFTH EDITION KOCHAR’S CLINICAL MEDICINE FOR STUDENTS FIFTH EDITION EDITOR-IN-CHIEF DARIO M TORRE, MD, MPH, FACP Associate Professor of Medicine Medical College of Wisconsin/Zablocki VA Medical Center Medicine Clerkship Director Milwaukee, Wisconsin EDITORS GEOFFREY C LAMB, MD, FACP Associate Professor of Medicine Division of General Internal Medicine Associate Director, Joint Quality Office Froedtert Hospital and Medical College of Wisconsin Milwaukee, Wisconsin JEROME J VAN RUISWYK, MD, MS, FACP Associate Professor of Medicine Medical College of Wisconsin Associate Chief of Staff for Clinical Affairs Zablocki VA Medical Center Milwaukee, Wisconsin RALPH M SCHAPIRA, MD, FACP, FCCP Professor and Vice-Chairman of Medicine Medical College of Wisconsin Chief of Medicine Zablocki VA Medical Center Milwaukee, Wisconsin CONSULTING EDITOR MAHENDR S KOCHAR, MD, MS, MACP, FRCP (LONDON) Professor of Medicine Senior Associate Dean, Graduate Medical Education Medical College of Wisconsin Milwaukee, Wisconsin Acquisitions Editor: Nancy Anastasi Duffy Associate Managing Editor: Liz Stalnaker Marketing Manager: Jennifer Kuklinski Design Coordinator: Teresa Mallon Associate Production Manager: Kevin Johnson Compositor: Maryland Composition Copyright ᭧ 2009 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from any material contained herein This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages, and precautions Printed in the United States of America Library of Congress Cataloging-in-Publication Data Kochar’s clinical medicine for students / editor in chief, Dario M Torre ; editors, Geoffrey C Lamb, Jerome Van Ruiswyk, Ralph M Schapira ; consulting editor, Mahendr S Kochar.—5th ed p ; cm Rev ed of: Kochar’s concise textbook of medicine / editor-in-chief, Kesavan Kutty 4th ed c2003 ISBN-13: 978-0-7817-6699-9 Clinical medicine Internal medicine I Torre, Dario M II Kochar’s concise textbook of medicine III Title: Clinical medicine for students [DNLM: Clinical Medicine Internal Medicine Primary Health Care WB 115 K756 2008] RC46.T328 2008 616—dc22 2007031544 The publishers have made every effort to trace the copyright holders for borrowed material If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity 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: http://www.LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST 06 07 08 09 10 10 To Alessia, innocent rainbow, beautiful, eternal flower in the garden of my life Dario Torre To students, who always challenge and inspire their teachers Geoffrey Lamb, Jerome Van Ruiswyk, Ralph Schapira, Mahendr Kochar FOREWORD Twenty-five years of Kochar! Following the 4th edition of Kochar’s Concise Textbook of Medicine, faculty and students around the country can now welcome its new incarnation, Kochar’s Clinical Medicine for Students, reconceived in its overall structure and rewritten in every detail The new Kochar helps students meet the core tenet of professionalism in internal medicine—fulfilling a duty of expertise for each and every patient—but also moves with its students into the 21st century The principles and the insistence on rigor in the clinical essentials are the same, but these days, we all learn in new ways, and we access information differently The new Kochar is true to the basics, while adapting itself to the needs of a new generation From the beginning, Dr Kochar conceived a book that could be read by students during their 3rd year clerkship Throughout its earlier editions, Kochar has prided itself on providing exactly the information that students and residents needed to take care of their patients, in a way that they could quickly access and effectively apply In a word, it was ‘‘concise.’’ The new edition does this today, and to the same high standards as the previous four editions, as would be expected of a text in use in medical schools throughout the country Under the general editorship of Dr Dario Torre, it is almost entirely rewritten, brought upto-date in every respect He and the section editors and faculty of the Medical College of Wisconsin have done right by their readers The table of contents reflects the curriculum guide of the Clerkship Directors in Internal Medicine and the website of the United States Medical Licensing Examination There has been a growing national consensus in medical education that every graduating student should have mastered basic clinical skills, and the 5th edition of Kochar opens with an entirely new section, ‘‘Key Manifestations and Presentations of Disease.’’ This section describes all the key symptoms and findings that clinicians look for in patients, and links these to a basic understanding of physiology All by itself, this section could be used in introduction to clinical medicine and basic ‘‘doctoring’’ courses throughout the country The section editor, also Dr Torre, and chapter authors have created something that covers all the common problems, while still remaining concise In other words, it contains all the basics, with just the right amount of material for which all students can be held accountable The ‘‘Diseases and Disorders’’ section is organized by traditional organ systems Every chapter has been rewritten in detail, and the majority of authors are new to the 5th edition While maintaining the goals of clarity and conciseness, the level of expertise is appropriate for residents in internal medicine and family medicine, and this edition keeps faith with the view of Dr Kochar that general medicine and primary care are essential to the practice of every specialty and subspecialty A new ‘‘Ambulatory Medicine’’ section of 18 chapters, edited by Dr Jerome Van Ruiswyk, has been developed for those clerkships that have also an ambulatory component Finally, this edition of Kochar is linked to an interactive website, which supplements each section’s description with multimedia materials, images, and demonstrations of findings in support of the vii viii FOREWORD text For instance, cardiology is supported with multiple EKGs, dermatology with striking images Students will also appreciate the interactive online multiple-choice questions Innovation and tradition are the hallmarks of the new Kochar The new General Editor for this edition is Dr Dario Torre, Associate Professor of Medicine and Internal Medicine Clerkship Director at the Medical College of Wisconsin Dr Geoffrey Lamb has written several sections and joins the group as Associate Editor Two editors remain from the 4th edition: Dr Jerome Van Ruiswyk, in writing the new section on ‘‘Ambulatory Medicine’’, one which we can ask all students to read at the start of their ambulatory rotations with adult patients, and Dr Ralph Schapira’s guidance is retained throughout, especially in the Pulmonary section Although he is no longer an editor, the presence of Dr Kesavan Kutty, editor of the 2nd, 3rd and 4th editions, is gratefully retained in the section chapter on tuberculosis The editors and authors of the new Kochar have thought carefully about what essential knowledge and skills students still need in the contemporary world of medicine—high speed, informationdense and less time than ever between students and patients But as Dr Kochar wrote in 1982, ‘‘there is only one way to learn clinical medicine, and that is at the bedside,’’ where everything is anchored in the students’ own experience with their patients The new Kochar’s Clinical Medicine will keep them on course Louis N Pangaro, MD, FACP Vice Chair for Educational Programs Department of Medicine Uniformed Services University of the Health Sciences F Edward He´bert School of Medicine Past President, Clerkship Directors of Internal Medicine 870 INDEX Psychosomatic disorder See also Psychiatric abnormality chest pain from, 35, 36 dyspnea from, 57, 58 Ptosis, myasthenia gravis, 689–693, 690t, 691 PTSD See Posttraumatic stress disorder Pubic lice, 806t, 808 See also Parasites PUD See Peptic ulcer disease Pulmonary disorder See also Chronic obstructive pulmonary disease; Dyspnea; Lung; Pneumonia chest pain from, 32t, 33t, 34, 36 dyspnea from, 58, 59 embolism, 54–56, 55t, 58, 59 hypertension, 54–56, 55t tuberculosis, 261–265, 262t, 264, 265t hemoptysis from, 98, 99–100, 99t indications for tuberculin skin testing, 265t recommendations for prevention, 747t syphilis serologic result v., 364t treatment, 263–265, 264t Pulmonary nodule, solitary, 269–272, 270, 271 Purkinje system, 205 Pyelonephritis, cystitis v., 330t Pyrazinamide, 263, 264t Pyridoxine, 538 Pyruvate kinase deficiency, 27t Q Quinidine, 218 autoimmune hemolytic anemia from, 590t Quinine, 509t -induced thrombocytopenia, 137–138, 138t, 139 Quinolones, cellulitis treatment, 334t R RA See Rheumatoid arthritis Radiation, hematuria from, 95t Ramsay-Hunt syndrome, 51 Rapid antigen test (RAT), 804 Rash, 72–75, 73t See also Dermatitis; Dermatophytosis; Scleroderma fever with, 72–75, 73t hypersensitivities, 74 infection, 72–74 inflammatory bowel disease, 74–75 juvenile rheumatoid arthritis, 75 malignancies and collagen vascular diseases, 74 porphyria cutanea tarda, 75 rheumatic diseases, 113–115, 113t, 115t sarcoidosis, 74–75 Stills’ disease, 74–75 Whipple’s disease, 75 petechiae, 22t, 344t, 349–357, 350, 351f, 353, 354t, 355t, 364t RAT See Rapid antigen test Raynaud’s phenomenon, 113t Reactive arthritis, 301t, 302–303 Rectal prolapse, eating disorder causing, 711–715, 713t, 714t Red cell cytoskeleton, 586 See also Hematuria Reiter’s syndrome, 112, 301t, 302–303 Renal calculi, 535–538 hematuria from, 95t hypercalcemia, 393, 394t treatment, 537–538 vomiting from, 117t Renal cell cancer, 77, 78t, 95t Renal failure See also Glomerulonephritis acute, 504–511, 505t, 506t, 508, 509t, 510t, 511t diagnosis, 507–508, 508, 509t, 510t indications for dialysis, 510–511, 511t treatment, 508–511, 511t chronic, 512–519, 513t–514t, 515t, 518t, 519t clinical manifestations, 515–517 etiology, 512–515, 513t–514t, 515t treatment and prevention, 518–519, 519t hypercalcemia, 393, 394t medication side effect, 553t metabolic acidosis, 7, 9–10, 11, 12t, 57, 511t, 711–715, 713t, 714t postpartum, 525t Renal insufficiency, 311t See also Hyperkalemia antidepressant medications causing, 699t dementia and delirium evaluation, 838t dyslipidemia associated with, 779t Renal replacement therapy, 518 Renal transplantation, 526 Renal tubular acidosis (RTA), 10 Renal tubular defects, hypercalcemia, 393, 394t Renal tubular reabsorption, 392 See also Parathyroid disorders Respiratory acidosis, 10, 11, 12 Respiratory alkalosis, 10–11, 11, 12 Restrictive cardiomyopathies, 182–183, 182t Retinopathy, diabetic, 385 Rheumatic diseases, 113–115, 113t, 115t Rheumatoid arthritis (RA), 110, 279–287, 280, 281, 282, 282t, 283t, 284t, 286t, 287 See also Arthritis American College of Rheumatology criteria for, 183t complications, 285–287, 286t digital gangrene related to, 287 etiology, 279 extra-articular manifestations of, 286t juvenile, 75 systemic lupus erythematosus v., 114 treatment, 283–285 Rh(D) incompatibility, recommendations for prevention, 747t Ribavirin, impaired hepatic bilirubin uptake from, 102t Rickets, 398–399, 399t Rifabutin, 263, 264t Rifampin, 263, 264t, 462 acute interstitial nephritis from, 531–532, 532t autoimmune hemolytic anemia from, 590t INDEX endocarditis treatment, 355t impaired hepatic bilirubin uptake from, 102t Risperdal, 710t Rituxan, 284t Rituximab, 598 Rivastigmine, 839 Rosacea, 730–731 Rouleau formation (multiple myeloma), 30t, 612–616, 614t RTA See Renal tubular acidosis Ruptured abdominal aortic aneurysm, 5, S S-adenosylmethionine, osteoarthritis treatment, 276–277 SAH See Subarachnoid hemorrhage Salicylate nonacetylated, osteoarthritis treatment, 276–277 toxicity, 9–10, 9t, 11, 311t fever from, 78 hypoglycemia from, 389t Salicylic acid, 720 Salmeterol, asthma treatment, 235t, 236, 236t Salt restriction, 311t Sarcoidosis, 74–75, 311t See also Lung cardiac, 182t, 183, 184t chest radiograph classification and prognosis, 267t cholestasis from, 455t dilated cardiomyopathy from, 179t extrapulmonary manifestations of, 267t pulmonary, 266–268, 267t SCD See Sickle cell disease Schistocytes, 30t Schizophrenia, 707–710, 709t, 710t clinical manifestations, 708 diagnosis, 708–709, 709t etiology, 707–708 treatment, 709–710, 710t Scleroderma, 110, 110, 111, 294–297 See also Joint pain; Rash nephrotic syndrome from, 529t renal involvement, 525t Scorpion venom, pancreatitis associated with, 483t Seborrheic dermatitis, 720 Seizures, 121–124, 122t, 123t, 124, 665–667 antidepressant medications causing, 699t bacterial meningitis, 338–340, 339, 339t central nervous system disorders causing, 124 classification of, 122t delirium tremens v., 124 dialysis for, 511t drugs/medications causing, 124 eating disorder causing, 711–715, 713t, 714t eclampsia v., 124 hyperosmolar states v., 124 hypoglycemia causing, 389t hysterical, 122t loss of consciousness disorders v., 123t metabolic disorders causing, 124 871 migraine headache, 124 panic attack, 124 porphyria v., 124 psychogenic, 124 sleep disorders, 124 syncope, 124 transient ischemic attack, 124 uremia causing, 515t vomiting with, 117t Selective serotonin reuptake inhibitors (SSRIs), 704–705, 706t, 713 Sepsis syndrome, 343–348, 344t, 345t, 346t, 347t See also Shock clinical manifestations, 345–346, 346t diagnosis, 346–347, 347t etiology, 343–345, 344t, 345t treatment, 347–348 Seronegative spondyloarthropathies, 300–304, 301t Seroquel, 710t Sexually transmitted disease (STD), 61, 66, 805–811, 806t, 808, 810t See also Acquired immunodeficiency syndrome; Syphilis chancroid ulcers, 806t, 808, 810 donovanosis, 806t, 808 genital ulcers, 806–807, 806t, 809 gonorrhea, 806, 806t herpes simplex virus, 806t, 807, 809, 810 human papillomavirus, 806t, 808, 811 lymphogranuloma venereum, 806t, 808 pelvic inflammatory disease, 806t, 807, 809, 810 pubic lice, 806t, 808 syphilis, 806t, 807–808, 810, 810t trichomonas, 806t, 809, 810 urethritis, 806t vaginitis, 806–807, 806t candidal, 806t, 807 Sexually transmitted infection (STI), 61, 62t, 66 Shock, 125–129, 126t, 127t, 128 See also Hypotension; Sepsis syndrome cardiogenic, 126t, 127–129, 128 determination of hemodynamic subgroups in, 128 clinical stages of, 127t differential diagnosis of, 126t hypovolemic, 125–126, 126t septic, 480t vascular, pancreatitis associated with, 483t vasodilatory, 126–127, 126t Shock wave lithotripsy, nephrolithiasis requiring, 537 Shohl’s solution, 538 SIADH See Syndrome of inappropriate antidiuretic hormone Sibutramine, 760 Sickle cell disease (SCD), 27t, 29, 95t, 577–579 narcotic addiction problem, 579 nephrotic syndrome from, 529t osteomyelitis from, 358–359, 359t renal involvement, 525t Sildenafil, 683 nitrates contraindicated with, 156 Simvastatin, myocardial infarction risk treatment, 156 872 INDEX Sinusitis, 803t, 804 cough associated with, 37, 38 Sjoăgrens syndrome, 286t, 298299 SLE See Systemic lupus erythematosus Sleep disorders See also Insomnia; Narcolepsy circadian rhythm disturbance, 251t obstructive sleep apnea v., 251t seizures v., 124 sleep deprivation, 251t Sleep disturbance, depression, 697t Slurred speech, Wilson’s disease manifestation, 473t Small bowel obstruction, 4, See also Fluid and electrolyte disorders Smoking cessation, 253t, 749–752, 750t, 782 See also Coronary artery disease Fagerstrom test for nicotine dependence, 750t Sodium bicarbonate, 538 Sodium nitroprusside, hypertensive emergency treatment, 553t, 774t Somnolence See also Drowsiness hypercalcemia causing, 393, 394t Sotalol, 218, 219 Speech/language studies, dementia and delirium evaluation, 838t Spermicide, 826t Spherocytosis, 27t, 30t, 585–587, 586 Spironolactone, heart failure risk management, 175, 176 Spleen abscess, 356 splenomegaly, 567–568, 567t Spondyloarthritis See Arthritis Sponge (contraceptive device), 826t Spontaneous bacterial peritonitis, 480t Squamous cell carcinoma, 733–734 SSRIs See Selective serotonin reuptake inhibitors ST elevation myocardial infarction, 162–168, 166t, 167t Starvation eating disorder, 711–715, 713t, 714t hirsutism from, 821 hypoglycemia from prolonged, 389t Statins, 781t myocardial infarction risk treatment, 156 STD See Sexually transmitted disease Steroids, 679 anabolic, 455t intravenous, 527 oral, 739 side effects from, 739 topical, 720 Stills’ disease, 74–75 Stool impaction See also Constipation urinary incontinence associated with, 840t Streptococcal pharyngitis, 803–804, 803t Streptokinase, pulmonary embolism treatment, 258 Streptomycin, 263, 264t Stress testing angina requiring, 152–154, 153t Stress ulcer, 448–449 Stroke See also Aneurysm; Aorta; Atrial fibrillation; Transient ischemic attack intracerebral hemorrhagic, 660–661, 662 ischemic, 50t, 652–659, 653, 654t, 655t, 657 clinical manifestations, 654–656, 654t, 655t diagnosis, 656–657, 657 dizziness from, 50t etiology, 652–653, 653 management, 658–659 menopausal hormone therapy causing, 819t subarachnoid hemorrhagic, 661–664 as thrombosis risk factor, 253t Struvite stones, 536–537 Subarachnoid hemorrhage (SAH), 661–664 clinical manifestations, 663 urgent CT for, 663 Substance abuse, 753–756, 754t, 755t See also Smoking cessation; specific substance clinical manifestations, 753–754, 754t criteria for, 754t diagnosis, 754–755, 755t etiology, 753 panic attack associated with, 703t seizures from, 124t syncope from, 132t, 133 treatment, 755–756 Sucralfate, 449 Suicide, risk factors, 701t, 707 Sulfa drugs, liver disease from, 469t Sulfamethoxazole, hypoglycemia from, 389t Sulfasalazine refractory arthritis treatment, 303 rheumatoid arthritis treatment, 284 ulcerative colitis treatment, 493–494 Sulfonamides acute interstitial nephritis from, 531–532, 532t pancreatitis associated with, 483t serum sickness from, 74 Sulfonylurea agents diabetes mellitus treatment, 382, 383t hypoglycemia from, 389t Sumatriptan, 669 migraine headache management, 669 Sweating See also Hot flashes hypoglycemia, 389t ‘‘night sweats,’’ myelofibrosis with myeloid metaplasia, 567–568, 567t panic attack, 703t seizure premonition, 123t Syncope, 130–136, 131t, 132t, 135 See also Dizziness and vertigo cardiac, 131, 131t, 132t medications causing, 131, 131t, 132t, 133 neurally mediated, 130, 131t, 132t neurologic disease, 131, 131t, 132t, 133 orthostatic hypotension, 131, 131t, 132t, 133 psychiatric disorders, 131, 131t, 132t, 133 tonic-clonic seizure v., 121–124, 122t, 123t, 124 Syndrome of inappropriate antidiuretic hormone(SIADH), 421, 425–426, 425t INDEX Syphilis, 221, 362–365, 364t, 365t, 806t, 807–808, 810, 810t causes of false positive serologic results, 364t nephrotic syndrome from, 529t recommendations for prevention, 747t treatment, 365t, 810t Systemic abnormality, altered mental status from, 20t, 21 Systemic lupus erythematosus (SLE), 110, 114, 288–293, 289t, 290, 292t, 523t American College of Rheumatology criteria for diagnosis of, 289t etiology, 288 hematuria from, 95t nephrotic syndrome from, 529t renal involvement, 523t, 527t rheumatoid arthritis v., 114 treatment, 293, 527t T Tachycardia See also Arrhythmia adrenal neoplasm causing, 437t bacteremia causing, 346t clinical stages of shock, 127t as medication side effect, 553t pulmonary embolism symptom, 254t Tachypnea, pulmonary embolism symptom, 254t Tamponade, cardiac, 200–202, 201t, 202 Tamsulosin, 846 Temporal arteritis, 305, 306–309, 306t Temporomandibular joint dysfunction syndrome, headache from, 81 Tendon reflexes, absent or hypoactive, Guillain-Barre´ syndrome, 58, 59 Tension See also Fatigue; Hypertension headache from, 81 Terbutaline, 236t asthma treatment, 230t, 235t, 236, 236t Testosterone dutasteride block v., 846 peripheral edema from, 70 Tetracycline cellulitis treatment, 334t pancreatitis associated with, 483t Thalassemias, 26t, 27t, 29, 30t, 580–584, 581 Thalidomide, 568 Theophylline, 236t asthma treatment, 235t, 236, 236t nausea and vomiting from, 117t seizures from, 124t Thiamine deficiency, Wernicke-Korsakoff syndrome from, 21 Thiazide, 484t, 538 See also Diuretics Thiazolidinediones, diabetes mellitus treatment, 383–384, 383t Thiouracil, fever from, 78 Thirst (severe), diabetic ketoacidosis, 3, 8t, 9, 378, 386–387 Thoracocentesis, 244–245, 244t, 245t 873 Thrombocythemia, essential, 565–567, 566t Thrombocytopenia, 100, 137–140, 138t, 139 eating disorder causing, 711–715, 713t, 714t myelofibrosis with myeloid metaplasia, 567–568, 567t nephrotic syndrome from, 529t Thrombocytopenic purpura idiopathic, 593–594, 594t thrombotic hematuria from, 95t hemolytic uremic syndrome and, 595–598, 596t, 597t Thrombolytic agents, pulmonary embolism treatment, 258 Thyroid diseases, 401, 401–412, 402, 404t, 405, 406, 407, 407t, 409t, 410t, 411t, 412 dementia and delirium evaluation, 838t euthyroid sick syndrome, 412 hyperthyroidism, 404–409 clinical manifestations, 404–405, 404t Graves’ disease, 405, 405–407, 406, 407, 407t thyroiditis, 408–409 toxic multinodular goiter, 408 hypothyroidism clinical manifestations, 409–419, 409t diagnosis, 410, 410t etiology, 409 therapy and complications, 410–411 thyroid nodules, evaluation of, 411–412, 411t, 412 Thyroid gland anatomy, 401, 401 Thyroid hormone synthesis, 401, 401–402, 402 peripheral circulation and metabolism, 402–403 Thyroid nodules, 411–412, 411t, 412 Thyroid stimulating hormone, 414, 414 See also Pituitary diseases Thyroiditis, 408–409 TIA See Transient ischemic attack TIBC See Total iron-binding capacity Tinea infections See Dermatophytosis Tinnitus, 50t, 118t Tiotropium, asthma treatment, 235t, 236, 236t Tissue plasminogen activator, pulmonary embolism treatment, 258 TMP-SMX, acquired immunodeficiency syndrome treatment, 372–373, 372t TMP-SMZ, cellulitis treatment, 334t, 336 Tolbutamide, autoimmune hemolytic anemia from, 590t Tolterodine, 683, 842 Tonic-clonic seizures, 122t Topiramate migraine headache management, 669 seizure treatment, 666 Torsades de pointes, 213 Total iron-binding capacity (TIBC), 30 Toxic multinodular goiter, 408 Tracheal obstruction, 54–56, 55t Transfusions, 579, 584, 587 platelet, contraindication for, 598 874 INDEX Transient ischemic attack (TIA), 833 See also Coronary artery disease; Ischemia defined, 652 seizures v., 124 Transplantation heart, 176 liver, 461, 464, 465, 481 lung, 242 rejection, 532t renal, 526 Trauma dysuria from, 61, 62t, 66 osteomyelitis, 358–359, 359t Tremor, adrenal neoplasm symptom, 437t Tremors altered mental status with, 22t hypoglycemia, 389t multiple sclerosis, 680–683, 681t, 682 panic attack, 703t Parkinson’s disease, 675t Wilson’s disease manifestation, 473t Trichomonas, 61, 62t, 65t, 66, 806t, 809, 810 Tricuspid regurgitation, 194–195 Tricuspid stenosis, 195–196 Trimethoprim, 509t Trimethoprim/sulfamethoxazole, 331 Trousseau’s sign, 397, 397–398 Tubal ligation (contraceptive device), 826t Tuberculin skin testing, 265t Tuberculosis, 261–265, 262t, 264, 265t See also Pleural effusions etiology, 261, 262t hemoptysis from, 98, 99–100, 99t indications for tuberculin skin testing, 265t recommendations for prevention, 747t syphilis serologic result v., 364t treatment, 263–265, 264t Tumor, 644t See also Cancer; Malignancy acoustic neuroma, 51 adrenal adenoma, 329–430, 430 adrenal mass, 439–440, 439t, 440t anterior pituitary, 416–417, 417t brain, seizures from, 124t hypoglycemia from, 389t -induced thrombocytopenia, 137–138, 138t, 139 pancreatitis associated with, 483t pheochromocytoma, 436–439, 437t, 438t pituitary, Cushing’s syndrome, 429–434, 430, 431t, 432, 433, 433t -related hypercalcemia, 391–392, 393t Twitching of finger/foot/face, altered mental status with, 22t U Ulcer chancroid, 806t, 808, 810 colitis, 15–16 chronic ulcerative, 490–496, 491t, 492, 493t genital, 806–807, 806t, 809 osteomyelitis from, 358–359, 359t peptic, 4, 6, 13–14, 14t, 515t PUD, 442–449, 445, 446, 447t clinical manifestations, 443 complications, 444t, 447–448 diagnosis, 443–444 etiology, 442–443 hypercalcemia causing, 393, 394t perforated, 4, 6, 13–14, 14t, 117t treatment, 444–447, 445, 446 uremia causing, 515t rheumatic diseases with, 113t stress, 448–449 upper GI tract, 448 Unstable angina, 157–162, 158t–159t Upper respiratory tract infection, 801–804, 803t Uremia, 512–519, 513t–514t, 515t, 518t, 519t clinical manifestations, 515–517 etiology, 512–515, 513t–514t, 515t hypoglycemia from, 389t treatment and prevention, 518–519, 519t Urethral infection, 61, 62t, 66 Urethral stricture, 95t Urethritis, 806t urinary incontinence associated with, 840t Uric acid, abnormal BUN from, 509t Uric acid stones, 536–537 Urinary incontinence, 840–842, 840t, 841t common causes of, 841t Urinary tract infection (UTI), 328–332, 329t, 330t, 332t antibiotics for, 332t cystitis v pyelonephritis, 330t dysuria, 61, 62t, 64t, 66 epidemiology by age, 329t glossary for, 329t microbes causing, 330t Urine output See also Dysuria diminished/absent, dark-colored, glomerulonephritis, 520–527, 521, 521t, 522t, 523t, 525t, 526t, 527t polyuria diabetes insipidus, 421–424, 422t, 423t, 424, 424t diabetic ketoacidosis, 3, 8t, 9, 378, 386–387 Urokinase, pulmonary embolism treatment, 258 Urolithiasis, 61, 62t, 66 Ursodeoxycholic acid, 458–459, 461, 462 Urticaria, 738–739 UTI See Urinary tract infection V Vaccination, 745t Vaginitis, 61, 62t, 66, 806–807, 806t bacterial, 65t candidal, 806t, 807 urinary incontinence associated with, 840t yeast, 61, 62t, 65t, 66 Vagus nerve stimulator, 667 INDEX Valproic acid, 469t, 484t pancreatitis associated with, 483t seizure treatment, 666 Valvular heart diseases, 58, 59 See also Heart failure aortic regurgitation, 188–191, 189t causes of, 189t physical signs of, 190t aortic stenosis, 186–188 mitral regurgitation, 192–194, 193t causes of, 193t mitral stenosis, 191–192 tricuspid regurgitation, 194–195 tricuspid stenosis, 195–196 Vancomycin cellulitis treatment, 334t endocarditis treatment, 355t meningitis therapy, 341t pneumonia treatment, 326 Variant angina, 162 Vascular insufficiency osteomyelitis from, 358–359, 359t, 360, 361 Vascular lesion, 14t, 15 Vasectomy, 826t Vasodilation See also Cirrhosis metabolic acidosis manifestation, 7, 9–10, 11, 12t, 57, 511t, 711–715, 713t, 714t Vasodilatory shock, 126–127, 126t Venlafaxine, 819 Venous thromboembolic disease, 252–258, 253t, 254t, 255, 258t diagnosis, 254t, 255 etiology, 252, 253t menopausal hormone therapy causing, 819t treatment, 257–258, 258t Verapamil, beta blockers v., 161 Vertigo, 48–53, 49t, 50t, 52 See also Dizziness and vertigo benign paroxysmal positional, 50–53, 52 cerebellar hemorrhage, 660 multiple sclerosis, 680–683, 681t, 682 Violaceous striae, hypercortisolemia clinical manifestations, 431t Viral hepatitis (A, B, C, D, E), 463–464, 464t See also Hepatitis Visual disturbance aura/flashing lights, 123t giant cell arteritis (blindness), 309 painful monocular blindness (multiple sclerosis), 680–683, 681t, 682 renal causes, 522t rheumatic disease causing, 113–115, 113t, 115t seizure premonition, 123t Wilson’s disease manifestation, 473t Vitamin B12 deficiency, 21, 26t, 29, 141, 573–374 dementia and delirium evaluation, 838t jaundice from, 102t Vitamin C abuse, 535 Vitamin D See also Parathyroid disorders calcium kinetics, 392 physiologic functions of, 391 Vitamin E, 527 875 Voice changes, myasthenia gravis, 689–693, 690t, 691 Vomiting, 118t–119t adrenal neoplasm, 437t bacteremia, 346t bacterial meningitis, 338–340, 339, 339t brain infection, 117t bulimia, 119t cardiopulmonary disease, 117t cerebellar hemorrhage, 660 demyelinating disease, 117t eating disorder, 711–715, 713t, 714t endocrine disease, 117t enteric infection, 117t fever with, 119t gastroenteritis, 2, 5, 117t GI tract conditions causing, 117t glomerulonephritis, 520–527, 521, 521t, 522t, 523t, 525t, 526t, 527t heart disease, 119t hypercalcemia, 393, 394t increased intracranial pressure, 117t inflammatory disease, 117t ketoacidosis, 119t labyrinthine disease, 117t malignancy causing, 117t medication side effect, 117t, 553t metabolic disease, 117t nephrolithiasis, 117t postoperative, 117t pregnancy causing, 117t psychiatric abnormality causing, 117t pyelonephritis, 330t seizure disorder causing, 117t seizure premonition, 123t Von Willebrand disease, 606–609, 607t classification/frequency of, 607t diagnosis, 608 hemophilia v., 604t Vulgaris acne, 728730 W Waldenstroăms macroglobulinemia, 615 Warfarin, 257, 311t atrial fibrillation treatment, 219 chronic stable angina v., 155 Warts, human papillomavirus, treatments for, 811 Water balance disorders, 539–545 hypernatremia, 543–545, 544t, 545t hyponatremia, 481, 539–543, 540, 540t, 541t, 542t Wegener’s granulomatosis, 305, 306t, 307, 308, 309 hematuria from, 95t hemoptysis from, 98, 99–100, 99t renal involvement with, 523t, 525t Weight gain See also Eating disorders; Obesity antidepressant medications causing, 699t depression, 697t Weight loss, 141–144, 142t See also Eating disorders adrenal neoplasm, 437t causes of involuntary, 142t 876 INDEX Weight loss (contd.) coronary artery disease management, 156 with decreased appetite, 142–143 depression, 697t endocarditis, 344t, 349–357, 350, 351f, 353, 354t, 355t, 364t malabsorption diarrhea with, 43–45 myelofibrosis with myeloid metaplasia, 567–568, 567t with normal/increased appetite, 141–142, 142t rheumatic diseases, 113–115, 113t, 115t Wernicke-Korsakoff syndrome, 21 Whipple’s disease, 75 Wilson’s disease, 105, 471–473, 472, 473t hemolytic anemia from, 473t jaundice from, 102t Y Yeast vaginitis, 61, 62t, 65t, 66 See also Vaginitis Z Zalcitabine, dilated cardiomyopathy from, 179t Zidovudine, dilated cardiomyopathy from, 179t Zinc therapy, Wilson’s disease treatment, 473 Zollinger-Ellison syndrome, 448 Zyprexa, 710t Plate Varicella Courtesy of Janet A Fairley, MD, University of Iowa, School of Medicine Plate Meningococcemia Courtesy of Janet A Fairley, MD Plate Herpes simplex virus infection Courtesy of Janet A Fairley, MD Plate Herpes zoster virus infection Courtesy of Janet A Fairley, MD Plate Erythema chronicum migrans Courtesy of Janet A Fairley, MD Plate Drug rash Plate Coxsackie virus Courtesy of Janet A Fairley, MD Plate Secondary syphilis Courtesy of Janet A Fairley, MD Plate Mononucleosis after ampicillin Courtesy of Janet A Fairley, MD Erysipelas Facial cellulites, with a well-demarcated border due to group A b-hemolytic streptococci Plate 10 Pernicious anemia The PMN has hyper- Plate 12 Sickle cell anemia showing the charactersegmented nuclei istic sickle cells Plate 11 Plate 13 Hemoglobin C disease: many target cells Plate 14 Peripheral smear Spherocytes are small, globular, and without central pallor Plate 15 Psoriasis A typical erythematous plaque over the knee Koebner phenomenon, as the linear extension of the lesion above the knee, is seen in the site of a previous knee surgery Plate 16 Psoriasis of the nails Whitish discoloration of the nail with pits Lifting of the nail from the plate (onycholysis) and subungual debris are also common findings in psoriatic nails 17 Tinea capitis with kerion formation owing to Trichophyton tonsurans Plate Plate 18 Onychomycosis due to Trichophyton rubrum Brownish-white discoloration of the nail plate, with accumulation of subungual debris The findings can sometimes be difficult to differentiate from those of psoriasis, and a fungal culture may be needed Basal cell carcinoma The pearly quality of the lesion, telangiectases, and central ulceration are typical features of basal cell carcinoma of the skin Plate 19 Plate 20 Squamous cell carcinoma Plate 21 Malignant melanoma, superficial spreading type ...KOCHAR’S CLINICAL MEDICINE FOR STUDENTS FIFTH EDITION KOCHAR’S CLINICAL MEDICINE FOR STUDENTS FIFTH EDITION EDITOR-IN-CHIEF DARIO M TORRE, MD, MPH, FACP Associate Professor of Medicine Medical... Title: Clinical medicine for students [DNLM: Clinical Medicine Internal Medicine Primary Health Care WB 115 K756 2008] RC46.T328 2008 616—dc22 2007031544 The publishers have made every effort to trace... patient’s clinical problem With that in mind, we have developed the 5th edition of Kochar’s Clinical Medicine for Students to link theoretical information more closely to the practice of medicine