Ebook Principles of ambulatory medicine (7th edition): Part 2

(BQ) Part 2 book Principles of ambulatory medicine presents the following contents: Cardiovascular problems, musculoskeletal problems, metabolic and endocrinologic problems, neurologic problems, selected general surgical problems, gynecology and women’s health, selected problems of the eyes, common disorders of the skin,...

P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls • S E C T I O N May 6, 2006 11:34 Char Count= • Cardiovascular Problems 62: Coronary Artery Disease 63: Postmyocardial Infarction Care and Cardiac Rehabilitation 64: Cardiac Arrhythmias 65: Common Cardiac Disorders Revealed by Auscultation of the Heart 66: Heart Failure 67: Hypertension 947 P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 6, 2006 948 11:34 Char Count= P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls •◗ C h a p t e r May 6, 2006 • Coronary Artery Disease Nisha Chandra-Strobos and Glenn A Hirsch Pathogenesis 949 Risk Factors 950 Diagnosis 951 History 951 Physical Examination 952 Electrocardiography 952 Cardiac Stress Testing 953 Ambulatory Electrocardiography 955 Electron-Beam Computed Tomography 955 Cardiac Catheterization and Coronary Angiography 956 Computed Tomography Coronary Angiography Treatment of Angina Pectoris 957 958 General Therapeutic Considerations 958 Lipids and Diet 958 Alcohol 959 Antioxidants 959 Fish Oil and ω-3 Fatty Acids 959 Postmenopausal Hormone Replacement Therapy 959 Physical Conditioning 960 Medical Treatment 960 Percutaneous Coronary Intervention 964 Surgical Management 965 Other Therapies 966 Unstable Angina 966 Variant Angina 967 Angina with Normal Coronary Arteries 967 Silent Ischemia 967 Coronary Artery Disease in Women 967 Summary 968 11:34 Char Count= Chest pain is one of the most common complaints of patients in an ambulatory practice The major early objective in the diagnosis of patients with chest pain is separating noncardiac from cardiac etiologies Chapters 42 and 59 describe the various causes of noncardiac chest pain This chapter describes the pathogenesis of coronary artery disease (CAD) and its most common clinical symptom, angina pectoris Chapter 63 describes the posthospital medical care and rehabilitation of patients who had a myocardial infarction (MI) CAD caused by atherosclerosis is one of the most common ailments in the Western world, and it remains the leading nontraumatic cause of disability and death in the United States Increased public awareness and health education have reduced CAD mortality by >20% in the last 25 years However, CAD still affects approximately 13,000,000 Americans Cardiovascular disease accounts for 38% of the total mortality in the United States or approximately the same number of deaths as the next five leading causes combined (cancer, chronic lower respiratory diseases, accidents, diabetes mellitus, and influenza and pneumonia) Of these cardiovascular deaths, coronary heart disease accounts for 53% (1) Chest pain is one of the most common presenting symptoms of patients with CAD who seek medical attention Health care providers must understand the appropriate diagnostic evaluation and subsequent therapeutic options for patients with chest pain A detailed history and physical examination are essential when evaluating patients with chest pain They cannot be replaced by sophisticated procedures; rather, they guide the clinician in selecting the most appropriate diagnostic evaluation PATHOGENESIS CAD presents in a variety of ways, largely related to the underlying pathophysiology of plaque formation and atherosclerosis The endothelium plays an integral role in defending against atherosclerosis, modulating vascular tone, and preventing intravascular thrombosis These endothelial functions are adversely affected by CAD risk factors, even before the development of overt atherosclerosis In the earliest stages of disease, circulating monocytes adhere to vascular endothelial cells (via adhesion molecules) and migrate into the intima of the blood vessel, where they 949 P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 950 May 6, 2006 11:34 Section / Cardiovascular Problems ingest oxidatively modified low-density lipoprotein (LDL) and become trapped as foam cells Collections of foam cells, known as fatty streaks, may be present even in early childhood Foam cells die, leading to the development of a lipid core Smooth muscle cells are signaled to migrate from the media, destroying the internal elastic lamina of the vessel in the process Calcification of the plaque occurs early and can be visualized noninvasively by electronbeam computed tomography (EBCT; see later discussion) The arterial wall progressively thickens and remodels Encroachment of plaque into the lumen of a coronary artery occurs late in the atherosclerotic process, reflecting advanced disease Arterial cross-sectional area is reduced by approximately 40% before a lesion is visible as “significant” CAD on catheterization, a finding demonstrated by use of in vivo intravascular ultrasound (2) Atherosclerotic progression is accelerated by three processes: endothelial dysfunction, inflammation, and thrombosis Advanced lesions may be calcified and fibrotic, but more concerning are plaques that have a core of lipid and necrotic tissue surrounded by a thin fibrous cap This cap contains collagen, and its characteristics are closely related to the risk of plaque rupture, the major cause of acute coronary syndromes Specifically, a thinner fibrous cap is more likely to rupture A ruptured plaque exposes the highly thrombogenic underlying collagen matrix and leads to rapid thrombus formation Complete occlusion of a coronary vessel by thrombus on a ruptured plaque typically causes an acute transmural MI characterized by ST-segment elevation on the electrocardiogram (ECG) Nonocclusive thrombus can cause unstable angina or an MI without ST-segment elevation Nonocclusive thrombus may not cause symptoms but instead may change plaque geometry and lead to rapid plaque growth MIs are classified by their appearance on 12-lead ECG during the acute phase as either ST-segment elevation or non–ST-segment elevation and are treated differently (3–6) It is important to recognize that an acute MI often arises from rupture of an atherosclerotic plaque that caused 20 minutes, myocardial necrosis (i.e., an MI) is more likely to have occurred The discomfort of angina pectoris usually is midline and substernal, sometimes with radiation to the shoulder, arm, hand, or fingers, usually to the left Radiation down the inside of the arm into the fingers supplied by the ulnar nerve is classic Pain also may radiate into the neck, lower jaw, or interscapular region Occasionally, a patient has pain only in a referred location and experiences no chest discomfort at all The pain of myocardial ischemia is diffuse and cannot easily be localized Rarely is the patient able to point with one finger to the location When pain can be localized in this way, it likely is noncardiac in origin The elderly, especially the P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 952 May 6, 2006 11:34 Section / Cardiovascular Problems frail elderly, are more likely than are younger patients to experience atypical symptoms such as dyspnea, confusion, or dyspepsia rather than pain The Canadian Cardiovascular Society (CCS) Classification System was designed to provide a simple way of grading anginal symptoms (16) Class I angina occurs with strenuous, rapid, or prolonged exertion but not with ordinary physical activity Patients with class II angina experience slight limitation of ordinary activity Class II angina occurs on walking or climbing stairs rapidly; walking uphill; walking or climbing stairs after a meal, in cold, or in wind; or under emotional stress Class III angina produces marked limitations of ordinary physical activity Angina occurs on walking one or two blocks on level terrain or climbing one flight of stairs under normal conditions and at a normal pace With class IV angina, the most severe type, the patient is unable to carry on any physical activity without discomfort, and anginal symptoms may be present at rest A higher CCS class is associated with more extensive CAD and a higher risk of CAD events Precipitating Factors The single most important diagnostic feature of the discomfort of myocardial ischemia is its predictable relationship to exertion, emotional stress, or other situations that may either increase myocardial oxygen demand or reduce supply The cause of atypical pain, pain in an unusual location or of an unusual character, may be clarified by this relationship Pain that is experienced at rest, if it is caused by ischemia, suggests unstable angina or MI Anxiety and mental stress are important and often overlooked provoking factors in many patients Angina is more likely to occur during cold or windy weather because of increased peripheral vascular resistance and, consequently, increased myocardial work Other triggers include sexual intercourse or a heavy meal Relief of Ischemic Pain Because angina is fundamentally caused by a discrepancy between oxygen supply and demand, relief of pain is achieved by increasing coronary blood flow or decreasing oxygen demand Most people must stop or at least slow the activity responsible for precipitating the pain before it is relieved Angina often is relieved by sublingual nitroglycerin, but the practitioner and the patient both need to realize that relief of chest pain by nitroglycerin is not specific for myocardial ischemia (17) For example, the pain of esophageal spasm can also be relieved by nitroglycerin Physical Examination The physical findings in patients with CAD are nonspecific A complete cardiovascular examination should focus on identifying markers of hypertension and dyslipidemia, peripheral vascular disease, or diabetes mellitus Severe aortic valve disease (stenosis or regurgitation) or pulmonary hypertension without CAD can cause angina pectoris either from left or right ventricular wall strain, respectively, leading to myocardial ischemia Electrocardiography A 12-lead ECG should be obtained as soon as possible in a patient with suspected CAD, although in many cases the ECG is completely normal The most reliable ECG sign of chronic ischemic heart disease is the presence of a prior MI as manifested by two or more pathologic Q waves in a particular myocardial territory (e.g., anterior, lateral, inferior, etc.) (Fig 62.1A) The differential diagnosis of Q waves on ECG includes prior MI, healed myocarditis, hypertrophic cardiomyopathy, an infiltrative myocardial disorder such as amyloidosis or sarcoidosis, and Wolff-Parkinson-White syndrome (usually with characteristic findings of preexcitation; see Chapter 64) Nonspecific ST-T wave changes, conduction abnormalities (except for left bundle-branch block [LBBB], discussed later), and arrhythmias not help establish the diagnosis of myocardial ischemia However, ST-segment depression with a flat or downsloping ST segment is suggestive of subendocardial ischemia (Fig 62.1B) It is seldom present on the resting ECG of patients with ischemic heart disease unless they are experiencing angina at the time the tracing is recorded On the other hand, transient ischemic changes are seen commonly when a patient with CAD is exercised to a point at which chest pain develops Such ECG changes, appearing with exercise or pain and resolving with rest or with the resolution of pain, usually are an indication of myocardial ischemia Therefore, the necessity of repeating the ECG at rest or after the chest pain has resolved cannot be overemphasized ST-segment elevation during chest pain (Fig 62.1C) suggests acute myocardial injury (e.g., MI) or variant angina (discussed later) T-wave inversion on an ECG taken at rest is a nonspecific finding but can occur after infarction or as a specific transient finding in a patient experiencing angina Therefore, ECG changes noted during episodes of chest pain not only can confirm the diagnosis of myocardial ischemia but also may indicate the extent and location of the ischemic myocardium As a general rule, the more widespread the changes on ECG, the greater the extent of myocardium that is involved STsegment elevation in the absence of chest pain is common on the resting ECG of healthy young adults and is caused by rapid or “early” repolarization of the ventricle This pattern (Fig 62.1D) usually is noted in the mid–left chest leads (V2 –V4 ) but may be more widespread ST-segment elevation from pericarditis is diffuse and can be associated with PR-segment depression in the limb leads (except aVR, which may show PR-segment elevation) Char Count= P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 6, 2006 11:34 Chapter 62 / Coronary Artery Disease Char Count= 953 A B C D FIGURE 62.1 Electrocardiographic strips from patients with suspected ischemic heart disease A: Q waves suggestive of prior myocardial infarction B: ST-segment depression developing after exertion C: ST-segment elevation during coronary artery spasm (variant angina) D: Early repolarization (a normal variant) The presence of ST-T abnormalities in an otherwise healthy person is a nonspecific finding and should not be considered confirmation of CAD There is a high association of LBBB with organic heart disease (see Chapter 64), especially CAD Right bundle-branch block (RBBB), on the other hand, is seen commonly in the absence of other cardiac abnormalities Cardiac Stress Testing Exercise Electrocardiography The exercise stress test is a means of establishing the diagnosis of myocardial ischemia It also can be used to assess the efficacy of antianginal therapy, to identify patients who are likely to have more severe CAD and a large area of myocardium at risk, and to assess serially the degree of conditioning or exercise capacity in patients of all age groups The American College of Cardiology (ACC)/American Heart Association (AHA) exercise testing guidelines outline the recommendations for the use of exercise testing in establishing the diagnosis of CAD, in assessing risk and prognosis in patients with symptoms or a prior history of CAD, and the use of exercise testing after MI (18,19) The usefulness of exercise testing in establishing the diagnosis of CAD is based in part on the likelihood that the patient has this condition (i.e., the “pretest probability” of CAD) This can be determined by the patient’s age, gender, and symptoms For example, exercise testing would not be expected to greatly improve the ac- curacy of diagnosing CAD in an older patient with typical angina (who has a high pretest probability of CAD) nor in a young, asymptomatic individual (who has a low pretest probability of CAD) The usefulness of stress testing in these situations would be limited by false-negative and false-positive findings, respectively The ACC/AHA guidelines recommend exercise testing to diagnose CAD in adult patients with an intermediate pretest probability of CAD based on gender, age, and symptoms (18,19) For patients with known CAD, the guidelines recommend stress testing for those with a significant change in clinical status Patients with unstable angina, decompensated heart failure, severe aortic stenosis, or uncontrolled hypertension should not be referred for stress testing because of an unacceptably high risk for provoking a cardiac event during exercise Exercise stress testing is based on the rationale that, as the work performed by the patient increases, cardiac work is increased The increased cardiac work results in increased myocardial oxygen utilization, with a subsequent increased demand in coronary blood flow If narrowed or obstructed coronary arteries prevent the required increase in coronary blood flow, myocardial ischemia may occur and be manifested as chest pain and/or ECG changes (20) The simplest and least expensive exercise stress test is the graded, symptom-limited exercise treadmill test The test requires 12-lead ECG monitoring of the patient while walking on a treadmill at workloads that can be progressively increased by increasing the speed and inclination of the treadmill A stationary bicycle ergometer (with hand P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 954 May 6, 2006 11:34 Section / Cardiovascular Problems FIGURE 62.2 Algorithm for determining the appropriate stress test See text for a description of the procedures pedals) can be substituted for a treadmill, permitting the patient to exercise with his or her arms instead of legs Although it is not commonly used, this method of stress testing permits exercise by a patient who may otherwise be unable to so because of lower-extremity claudication, arthritis, or amputation It also may be useful in the evaluation of patients who have chest pain predominantly or exclusively with work that involves the arms and shoulders A simple algorithm can be used to decide the type of stress test to recommend (Fig 62.2) First, the patient’s ability to exercise should be assessed If the patient can walk up a flight of stairs carrying laundry or groceries, for example, a treadmill exercise protocol can generally be chosen to allow the patient to achieve a level of cardiac work that permits meaningful information to be obtained from the test If the patient cannot perform this task, or one that is comparable, a pharmacologic stress test with cardiac imaging (discussed later) should generally be recommended The patient’s baseline ECG should be reviewed to determine the presence of baseline ST-segment abnormalities that might lower the predictive value of exerciseinduced changes False-positive stress tests are often encountered in women, in patients taking medications such as digoxin or amiodarone, and in patients with left ventricular hypertrophy or mitral valve prolapse (21) For these patients and in those with baseline ST-segment abnormalities, intraventricular conduction defects (i.e., LBBB or RBBB), or other conduction system disorders (e.g., WolffParkinson-White syndrome), the diagnostic accuracy of the exercise stress test can be enhanced by concurrent radioisotopic or echocardiographic imaging (see later discussion) The choice between radioisotopic or echocardiographic imaging depends largely on the expertise of local laboratories Radioisotope Imaging Radioisotope imaging can enhance the specificity of stress testing by evaluating myocardial function or flow (22) Radioisotope imaging can be used in conjunction with either treadmill exercise testing or pharmacologic stress testing, using either dobutamine to increase cardiac work or adenosine or dipyridamole to alter coronary blood flow (see later discussion) Commonly used imaging modalities include radioisotope imaging with thallium 201 (201 Tl)– and/or technetium 99 (99 Tc)–based agents (e.g., 99m Tcsestamibi) The usefulness of 201 Tl as a perfusion tracer is based on its ability to function as an analogue of ionic potassium It is very efficiently extracted by healthy myocardial cells, and uptake is proportional to regional perfusion and myocardial viability 99m Tc-sestamibi has a shorter half-life (6 hours) than does 201 Tl (73 hours), allowing administration of a larger tracer dose This and its higher emission energy make it an excellent agent for cardiac imaging 99m Tc-sestamibi is particularly useful in obese patients and in patients with large breasts (because of possible attenuation of the radioisotopic images in the area of the anterior myocardium) Both 201 Tl and 99m Tc-sestamibi can be used to assess regional myocardial blood flow, either by planar imaging or by single-photon emission computed tomography (SPECT) Imaging usually occurs at two separate times: the stress scan, obtained very shortly after the patient has exercised or received a pharmacologic agent, and the rest scan, obtained either before or several hours after stress The radioisotope is injected intravenously at the time of peak exercise (or at the time of peak infusion during a pharmacologic stress test), and scintigraphic images are obtained shortly thereafter, depicting regional myocardial perfusion at the time of peak stress The rest scan typically is obtained several hours later and shows redistribution of the isotope Ischemia is indicated by the filling in of a cold spot defined on the stress images (i.e., normalization or “redistribution” of a radioisotopic defect), and infarction is indicated by a persisting cold spot or one with only partial redistribution Radioisotope imaging with stress gated blood pool scans (multiple-gated acquisition [MUGA]) also can be used to assess myocardial ischemia To allow for continuous imaging during exercise, stress MUGA is performed with the patient exercising on a semirecumbent bicycle The rationale for this test is based on the fact that myocardium that becomes ischemic during graded exercise develops regional wall-motion abnormalities that can be detected by sequential image analyses This type of imaging labels the blood pool with a radioisotope and gates image acquisition to the ECG Right and left ventricular volumes, regional left ventricular wall motion, and global and regional ejection fractions can be measured, both at rest and with stress The cost of stress testing with radioisotope scanning usually is several times that of a standard exercise test Stress Echocardiography Two-dimensional echocardiography can be used instead of radioisotope scanning to detect areas of regional myocardial dysfunction (as evidenced by a wall-motion Char Count= P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 6, 2006 11:34 Chapter 62 / Coronary Artery Disease abnormality) with exercise or pharmacologic stress (23,24) Typically, baseline images are first obtained at rest to determine the adequacy of the echocardiographic images If these images are technically inadequate (e.g., because of obesity or severe obstructive lung disease), an intravenous ultrasound contrast agent can be used if available; if not, radioisotope images are preferable If the rest images are technically adequate, the patient undergoes treadmill exercise stress and then images are reacquired immediately, using special software to allow for direct comparison of pre-exercise and postexercise images If pharmacologic stress testing with dobutamine (see Pharmacologic Stress Testing) is used, the dose of dobutamine is increased in stepwise fashion, and echocardiographic images typically are obtained each time the dose is increased The safety of dobutamine stress echocardiography is comparable to that of a routine exercise stress test (23,25,26) The sensitivity, specificity, and cost of the test are similar to those of radioisotopic stress testing Stress echocardiography may be preferred in some cases because additional information is provided that is not obtained with radioisotopic scanning (e.g., presence of pericardial effusion, ventricular hypertrophy, or valvular abnormality) It also avoids exposure to radioactivity Pharmacologic Stress Testing Patients who are unable to exercise because of physical limitations can be evaluated after intravenous administration of dipyridamole, adenosine, or dobutamine in conjunction with an imaging modality Dipyridamole and adenosine dilate all coronary vessels and generally increase flow to all areas of the heart Enhanced dilation of normal coronary arteries, compared to that of significantly narrowed vessels, augments differences in flow that usually are not apparent at rest These agents are suitable for use with radioisotopic imaging modalities that may readily demonstrate this flow heterogeneity After administration of dipyridamole or adenosine followed by either 201 Tl or 99m Tc-sestamibi (i.e., the stress image), myocardium supplied by a narrowed coronary artery typically demonstrates a perfusion defect that “fills in” during the rest image Because of its ultrashort duration of action, adenosine is preferable to dipyridamole for this test Dobutamine is a β -receptor agonist that at high dosages (20–40 μg/kg/min intravenously) increases myocardial contractility and heart rate in a similar manner and extent to exercise Heart rate may not be affected to the same extent as contractility, and atropine often is administered intravenously to increase the heart rate to the maximal predicted heart rate for age Dobutamine can be used in conjunction with either echocardiography or radioisotopic imaging for diagnosis of CAD Mild side effects (e.g., nausea, flushing, and headache) are common with dipyridamole, adenosine, and dobutamine Dipyridamole and adenosine (but not dobutamine) Char Count= 955 can produce severe bronchospasm and therefore must be used with caution or not at all in patients with asthma or chronic obstructive pulmonary disease Adenosine can cause transient heart block, typically lasting several seconds Because dobutamine increases atrioventricular conduction, it should not be used in patients with atrial flutter and should be used carefully in patients with atrial fibrillation Implications of an Abnormal Stress Test If treadmill exercise stress testing is performed, factors affecting prognosis include the degree of ST-segment depression, time to development of ST-segment depression during exercise, duration of the ST-segment depression in recovery, and speed of heart rate decline during recovery In addition, an ischemic ECG response that is accompanied by hypotension generally implies a large amount of myocardium at risk Prognostic information from pharmacologic stress testing-induced ECG abnormalities is less reliable The number, size, and location of abnormalities evident on stress imaging studies reflect the location and extent of functionally significant coronary stenoses (27) Both radioisotopic and echocardiographic imaging can detect left ventricular dilation with stress, a finding that suggests global, severe ischemia Lung uptake of a radioisotopic tracer indicates stress-induced left ventricular dysfunction and suggests multivessel CAD Many studies have shown that high-risk abnormal stress tests are associated with an increased risk for cardiac events On the other hand, normal radioisotopic or echocardiographic stress tests are associated with a favorable prognosis In a review of 16 studies involving almost 4,000 patients over years, a negative perfusion scan was associated with a 0.9% rate of cardiac death per year, similar to that of the general population (28) Ambulatory Electrocardiography The ambulatory ECG (Holter monitor) may be useful for detecting myocardial ischemia However, it is not a good tool for screening patients to make the diagnosis of CAD In patients with CAD who are symptomatic during ambulatory ECG monitoring, ST-segment elevation or depression can be observed during episodes of pain and at other times as well (silent ischemia; see later discussion) In patients with silent ischemia, the ambulatory ECG is particularly useful for quantifying the degree and frequency of ischemia and assessing the efficacy of therapy Electron-Beam Computed Tomography Studies in the 1970s demonstrated that coronary calcification (detected by cardiac fluoroscopy) was useful in identifying patients with angiographically significant CAD (29) P1: PNW GRBT129-62 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 956 May 6, 2006 11:34 Char Count= Section / Cardiovascular Problems A B FIGURE 62.3 Anatomic representation of the coronary arteries These vessels are represented as they would be seen on the angiogram No attempt has been made to convey the third dimension Careful study of the changes in position of the various branches with rotation of the heart is essential to intelligent interpretation of arteriograms A: Anteroposterior B: Lateral (Modified from Abrams HL, Adams DF The coronary arteriogram: structural and functional aspects [First of two parts] N Engl J Med 1969;281:1276, with permission.) EBCT is a highly sensitive technique for detecting coronary artery calcium and may be useful for diagnosing CAD noninvasively (11) ECG gating allows data acquisition within one or two breath-holds, making it a rapid test with limited radiation exposure The images obtained by this technique allow the determination of a calcium score, which is an index of calcium deposition in multiple arterial segments and is a good approximation for overall plaque burden in the coronary tree High calcium scores are associated with increased risk for MI (30) The test offers improved discrimination over conventional risk factors in the identification of people with CAD (31) The negative predictive value of EBCT is high The test is particularly useful for screening asymptomatic individuals with multiple risk factors, in whom an abnormal EBCT should prompt further testing and/or treatment A very low EBCT score would be reassuring (32) Cardiac Catheterization and Coronary Angiography Coronary angiography is defined as the radiographic visualization of the coronary vessels after injection of radiopaque contrast medium (33) This technique provides direct information about the presence of CAD and defines the distribution and severity of obstructive coronary lesions It is considered the “gold standard” to confirm the diagnosis of CAD The images obtained are stored as either 35-mm cine film or, more commonly, a digital recording Percutaneous or cutdown techniques of the femoral or brachial arteries allow insertion of sheaths for the intro- duction of selective catheters for the right and left coronary ostia, saphenous bypass grafts, or internal mammary arteries Arteriography is performed as part of cardiac catheterization, which may include left ventriculography and hemodynamic assessment Figure 62.3 shows diagrammatically the coronary arteries and their branches as they appear on coronary arteriography The three major coronary arteries are the left anterior descending, left circumflex, and right coronary artery The coronary tree can be divided into 29 segments, but the extent of disease usually is defined as one-vessel, two-vessel, three-vessel, or left main disease, with significant disease taken to mean the presence of ≥50% reduction in diameter (some operators and texts use ≥70% reduction in diameter) The 1999 ACC/AHA Guidelines for Coronary Angiography outline the indications and contraindications for the procedure (33) The guidelines recommend arteriography for patients with CCS class III or IV angina while receiving medical treatment (marked limitations of ordinary physical activity because of angina or angina at rest, discussed earlier) and those with high-risk criteria on noninvasive testing regardless of angina severity It may be reasonable to consider coronary arteriography for patients whose angina has improved with medical treatment but remains present, those in whom noninvasive testing has shown evidence of worsening disease, those who cannot tolerate medical therapy, those with angina who cannot be adequately risk stratified because of disability or illness, and those whose occupation involves the safety of others (e.g., pilots, bus drivers) and who have abnormal, but not high-risk, stress test results P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1948 May 16, 2006 16:20 Index Immunoglobulin E-mediated hypersensitivity, 598 Immunologic tests, 1340 Immunotherapy, 438f, 439–440 Impetigo, 466 Implantable cardioverter-defibrillator therapy, 1006–1007 Impulse conduction/generation, 992–995, 993f, 994f, 995f Incontinence, 203 Indinavir, 585t, 586t–587t Indolones, 353t Indomethacin, 1286 Infectious Disease Society of America, 494, 579 Inflammatory acne, 1899–1901 Infliximab, 1275–1276 Influenza, 611t, 616 Influenza A/B, 481, 485 Inhalants, 424–425 INS See U.S Immigration and Naturalization Service Insect venom allergies, 454 Insects, 629 Insomnia, 101–104, 101f, 102t, 103t, 104t end of life care and, 204 management of, 110 rebound/withdrawal, 112 Institute of Medicine, 229 Insulin, 749, 1302–1304 allergic reactions to, 1317 initiation of, 1313 injection devices/technique, 1312–1313 intermediate-acting, 1310–1311 long-acting, 1311 mixtures, 1311–1312 NPH, 1313–1314 preparations, commercial, 1312 pumps, 1315–1316 rapid-acting, 1309–1310, 1310t, 1311f requirements, 1316–1317 therapies, 1309–1317, 1310t, 1311f transfer, 1306 for Type I, 1313 for Type II, 1313, 1314–1315, 1316 Insulinoma, 1392–1393 Intelligence quotient (IQ), 324 Interactive Preventive Services Selector, 224, 224f Interferon, 333t, 592 Interleukins, 439 International Association for Medical Assistance to Travelers, 609 International Association for the Study Of Obesity (IASQ), 246 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 3, 5t International Classification of Sleep Disorders, 2nd edition (ICSD-2), 100 International Index of Erectile Function, 88 International Labor Organization (ILO), 128 International Prostate Symptom Score, 800 Interpersonal therapy (IPT), 340 Interstitial cystitis, 534 Interstitial patterns, 884–886, 886t Intracranial abnormalities, 1546 Intraductal carcinoma, 1779 Intrauterine contraceptives, 1709–1710 Iodide, 1354–1355 Ipratropium, 445 bromide, 920 topical, 476 IPT See Interpersonal therapy IQ See Intelligence quotient Iron-deficiency anemia, 17, 19, 820–823, 821t, 822t, 823t Irritable bowel syndrome (IBS) definition of, 679 diagnosis of, 680 epidemiology/prevalence of, 679 history of, 680–683, 683t pathogenesis of, 679–680 prognosis for, 686 treatment of, pharmacotherapy as, 683–684, 684t Ischemic heart disease, 1613–1615, 1614t Ischial bursitis, 1216 Islet cell transplantation, 1318 Isoniazid (INH), 506–508, 507t, 511–512 Itraconazole, 598 Ixodes scapularis, 560 J Japanese encephalitis, 611t, 616 Jarisch-Herxheimer reaction, 556 JCAHO See Joint Commission on Accreditation of Health Care Organizations Jet lag, 111, 628–629, 629f Jewish, 252 John Hopkins Bayview Medical Center, 976 Johnson, Lyndon B., 179 Johnson, Virginia, 81 Joint Commission on Accreditation of Health Care Organizations (JCAHO), 635 Joint National Committee on the Prevention, Detection, and Evaluation and Treatment of High Blood Pressure, 790–791 Juvenile delinquency, 163 K Kaolin, 524 Katz index of activities of daily living, 181 Kava-kava (Piper methysticum), 67, 69t Kegel exercises, 87 Ketoconazole, 91 Kidney, 748, 1096 See also Chronic kidney disease Kidney disease, 1098 Kidney Early Evaluation Program, 773 Klebsiella pneumoniae, 150, 603 Knee anatomy of, 1183–1184, 1184f–1185f collateral/cruciate ligament injuries to, 1186–1188 extensor mechanism disruption of, 1189 general evaluation of, 1184–1185 meniscal injuries to, 1185–1186 patella dislocation of, 1188–1189, 1188f patellofemoral pain of, 1189–1191 septic, 1191 Korsakoff psychosis, 386–387 L Labeling effect, 213 Labral tears, 1147 Lactose intolerance, 698–699 Lactulose, 689–690, 729 Lamivudine, 585t, 586t–587t Lamotrigine, 345, 1524–1525 Language, 1473 Language Line Services, 635 Lansoprazole, 652t Laser devices, 802 Lateral epicondylitis (tennis elbow) definition/epidemiology/etiology of, 1153 diagnosis of, 1153–1154 management of, 1154 Laxatives, 689–692 LBD See Lewy body dementia LCR See Ligase chain reaction L-Dopa See Levodopa Lead time bias, 213 Leflunomide, 1274 Left ventricular hypertrophy (LVH), 1110–1111 Legionnaires disease, 493, 597 Length bias, 213 Leukoplakia, 1876–1877, 1876f Leukotriene, 439 Leukotriene modifiers, 445 Levetiracetam, 1525–1526 Levodopa (L-Dopa), 77t, 333t, 1562–1565 Levofloxacins, 551, 598, 624–625, 625t Levonorgestrel, 162 Lewy body dementia (LBD), 363 LHRH See Luteinizing hormone-releasing hormone Lichen planus, 1748–1749 Lichen sclerosus, 1748 Lid margin tumors, 1819 Lidocaine, 200t abnormalities, 1074 patches, 202 prilocaine, 93 topical, 87, 93 Ligament injury, 1129–1130, 1129t Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index Ligase chain reaction (LCR), 547 Likelihood ration (LR), 18 Linezolid, 508 Lipid(s), 958–959, 982, 1570–1571 composition/nomenclature of, 1395–1396, 1395f, 1396t diagnosis/treatment of, 1399–1400 metabolism, common secondary disorders of, 1405–1406 transport, 1396–1397, 1396f Lipoatrophy, 1317 Lipohypertrophy, 1317 Lipoprotein(s) composition/nomenclature of, 1395–1396, 1395f, 1396t diagnosis of, 1399–1400, 1408–1411, 1409t disorders, 1407–1408 drug therapy for, 1416–1421, 1417t, 1418t low-density, 1405 pathophysiology of, 1402–1405, 1404f risk factors, 1397–1399, 1398t treatments for, 1408–1411, 1409t, 1411–1416, 1412t, 1413t Lithium, 77t, 344–345, 345t Live attenuated vaccines, 582 Liver, 717 See also Cirrhosis; Hepatitis diseases, 1341–1342, 1393 enzymes, 726 transplantation, 729 Local alveolar osteitis (dry socket), 1869 Long QT interval syndrome, 1021 Loperamide, 524, 625, 685 Lopinavir, 585t, 586t–587t Loratadine, 200t Lorazepam, 151, 203, 205, 320–321, 321t, 397t Lost Boys/Girls of Sudan, 634 Low back pain, 1165 anatomy/biomechanics of, 1166–1167, 1166f, 1167f common regional back syndromes and, 1171–1178, 1172t, 1173t, 1175f, 1176f, 1176t diagnosis/treatments for, 1171 evaluation of, 1167–1171 management of, 1175f, 1179–1181, 1179t medical back pain syndromes and, 1178–1179 Lower extremity ulcers, 1649 characteristics/types of, 1651–1655, 1652t diagnostic laboratory aids for, 1654–1655 history, 1650 natural history/management of, 1655–1658 physical examination of, 1650–1651, 1651f Lower leg acute compartment syndrome and, 1193 anatomy of, 1191–1192, 1191f bone/soft-tissue tumors of, 1195–1196 chronic/exertional compartment syndrome and, 1194–1195 DVT and, 1196 general evaluation of, 1192 pain, acute, 1192 pain, exertional, 1193–1195 shin splints and, 1194–1195, 1195f stress fractures of, 1193–1195 Lower motor neuron, 1477–1478 LR See Likelihood ratio Lumbar puncture, 1480–1481 Lumbosacral spine, 1166–1167, 1166f, 1167f, 1168–1169 Lumbosacral strain syndrome, 1171–1174, 1172t Lung abscess, 604–606, 606t with aerobic infections, 604, 606t with anaerobic infections, 604, 606t antimicrobial treatments for, 604–606, 606t bacteriology/clinical presentation for, 603–604 definition of, 603 laboratory examinations for, 604, 605f function tests for COPD, 893–895, 894f Lung cancer, 124, 125t adjuvant therapies for, 939 chemoprophylaxis and, 940–941 chemotherapeutic agents for, 940 diagnostic procedures for, 931–933 epidemiology of, 925–927, 926t followup of patients with, 940 histology of, 928 history of, 928–930 non-small cell, 933–935, 934t, 935t, 936–939, 937t physical examination for, 930–931 pleural effusions and, 941–942 screening for, 927–928 small cell, 935–936, 936t, 939 solitary pulmonary nodule in, 942–943 staging of, 933–936 treatment of, 936–940 Luteinizing hormone-releasing hormone (LHRH), 805 LUTs See Urinary tract, lower LVH See Left ventricular hypertrophy Lyme disease clinical manifestations/stages of, 560–563, 561f, 562f diagnosis of, 563–564 epidemiology of, 560, 561t immunizations for, 611t, 617–618 prevention of, 565 treatments for, 564–565, 565t Lymph node biopsy, 865–866, 865t Lymphadenopathy, 865–866, 865t Lymphogranuloma venereum, 542–543 Lysergic acid diethylamide (LSD), 424 16:20 Char Count= 1949 M Macular degeneration, age-related, 1804–1807, 1806f Magnetic resonance imaging (MRI), 363, 460, 600–601, 678, 1483 Malaria doxycyclines for, 621 prophylaxis, 618–623, 619t, 620f, 621f, 622f Male erectile disorder See also Erectile dysfunction assessment of, 88–89, 89t diagnostic classification of, 88 treatment of, 89–92, 90t Male hypogonadism, 1457–1463, 1457t, 1459f, 1460f Male orgasmic disorder assessment of, 93 diagnostic classification of, 93 treatment of, 93–94 Male osteoporosis, 1447–1449, 1447t Male reproductive physiology, 1454–1457, 1455t Male sexual disorders, 87–94 Malingering, 304–305 MAO inhibitors, 69t Marijuana, 77t, 414t, 421–422 Masochism, 96 Massachusetts Male Aging Study, 78 Massage therapy, 70–71, 71t MAST (Michigan Alcoholism Screening Test), 388–389, 403, 403t, 407 Masters, William, 81 Masturbation, 84 Maturity-onset diabetes of the young (MODY), 255 MCH See Mean corpuscular hemoglobin MCHC See Mean corpuscular hemoglobin concentration MCV See Mean corpuscular volume MDMA See 3,4Methylenedioxymethamphetamine MDR See Multidrug-resistant Mean corpuscular hemoglobin (MCH), 819 Mean corpuscular hemoglobin concentration(MCHC), 819 Mean corpuscular volume (MCV), 819, 821 Measles, 611t, 616 Medial epicondylitis (golfer’s elbow) definition/epidemiology/etiology of, 1154 diagnosis of, 1154–1155 management of, 1155 Median nerve, 1590–1593, 1590f, 1591f Mediastinoscopy, 933 Mediastinotomy, 933 Medicaid, 179, 595 Medical Therapy of Prostatic Symptoms (MTOPS), 801 P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1950 May 16, 2006 16:20 Index Medicare, 137, 138, 142 geriatric medicine and, 178–179 programs, 189 Medicare Hospice Benefit, 196 Medication(s), 1140 antispasmodic, 684 for bipolar disorders, 344 class, 44 controller, 443 counts, 47–48 elderly and, 181–184 headaches caused by, 1497–1498 rescue, 443 simplification of, 52 stimulant, 113–114, 114t for travelers, 630 Medications, over-the-counter (OTC), 4–5, 298 MEDLINE database, 13 Medullary carcinomas, 1364 MedWatch, 70 Mefloquine, 619, 622f Meglitinides, 1308–1309 Melanosis coli, 689 Memantine, 366 Memory, 1473 Men prostatitis and, 534 acute bacterial, 534–535 chronic bacterial, 535 nonbacterial, 535 symptomatic UTIs, 534–535 Mendelian disorders hemochromatosis as, 253–255, 254t hereditary cancers and, 255, 256t M´eni`ere syndrome, 1538, 1844–1845 Meningococcal meningitis, 273–274, 274t, 611t, 616–617 Menopause, 1784 clinical considerations on, 1785–1789, 1785t, 1786t, 1788t definition/physiology of, 1785 summary of therapeutic considerations on, 1789–1794, 1791t, 1792t, 1793t, 1794t Mental illness, in elderly cognitive assessment of, 359–360, 360t depression as, 360 depression/brain disease as, 361 depression-induced cognitive impairment as, 361 general principles of, 359–360 major depression as, 360–361 mild cognitive impairment as, 362 paranoia as, 362 paraphrenia, 362 psychogeriatric disorders, 360–367 psychosocial factors of, 359–360 schizophrenia as, 362 suspiciousness as, 362 Meperidine, 199t, 201t, 418 Mesalamine, 700 Metabolic abnormalities, 1545 Metabolic equivalents (METs), 242, 243t Metatarsalgia, 1211–1212 Methadone, 199t, 201t, 202 detoxification, 418 maintenance, 427–428 Methamphetamines, 156, 419 Methicillin-resistant Staphylococcus aureus (MRSA), 597, 607–608 Methotrexate, 1272–1273 Methotrimeprazine, 200t 3,4-Methylenedioxymethamphetamine (MDMA), 422–423 Methylphenidate, 113, 200t, 419 Methyltestosterone (MT), 80–81 Metoclopramide, 77t, 652t, 656 Metolazone, 738 Metronidazole, 162, 602, 702 MI See Myocardial infarction Microalbuminuria, 789 Microarray technology, 260 MICROMEDEX, 638, 788 Micronutrients, 236, 236t Migraines, 68 Migrant farm workers, 634 Miliaria, 1902 Mine Safety and Health Agency (MSHA), 126 Mineralocorticoid deficiency/excess, 1380 Mini-Mental State Examination, 187, 590–591 Mirtazapine, 205, 334t–335t, 336 Mitochondrial inheritance, 252 Mitral regurgitation, 1041 acute causes/epidemiology of, 1045 management of, 1045 natural history/symptoms of, 1045 physical findings for, 1045 chronic causes/epidemiology of, 1042 laboratory evaluation of, 1042–1043, 1043f, 1043t management of, 1043–1045, 1044t natural history/symptoms of, 1042 physical findings for, 1042 Mitral stenosis causes/epidemiology of, 1047 laboratory evaluation of, 1048 management of, 1048–1049 natural history/symptoms of, 1047–1048 physical findings for, 1048 Mitral valve prolapse (MVP), 606 causes/epidemiology of, 1045–1046 laboratory evaluation of, 1047 management of, 1047 natural history/symptoms of, 1046 physical findings for, 1046 Mobitz-I second-degree atrioventricular block, 1024–1025, 1024f Mobitz-II second-degree atrioventricular block, 1024–1025, 1024f Modification of Diet in Renal Disease, 775 MODY See Maturity-onset diabetes of the young Molluscum contagiosum, 1919 Monoamine oxidase inhibitors (MAOIs), 334t–335t, 336–338 Monocucleosis, infectious, 488 complications with, 862 epidemiology/pathogenesis of, 861 laboratory features of, 862, 862t other causes of, 863 signs/symptoms of, 861–862, 861t treatment of, 862–863 Mononeuropathy, 1326 Mood disorders adjustment disorders as, 330–331 bereavement as, 330–331 bipolar disorders as atypical antipsychotics for, 346 cyclothymic, 346 diagnosis of, 342–343, 343t initial treatments for, 343–344 lamotrigine for, 345 lithium for, 344–345, 345t maintenance therapy for, 344 medications for, 344 prognosis for, 346 valproate for, 345–346 bupropion for, 334, 335t–336t corticosteroids and, 333t depressive disorders as heredity of, 347 identification of, 331–332 screening for, 332 dysthymic disorders as diagnosis of, 341–342, 342t prognosis for, 342 treatment of, 342 family counseling for, 346–347 major depressive disorders as antidepressants for, 334–339, 335t–336t CAM for, 337 counseling/psychotherapy for, 339–341, 340t diagnosis of, 332–334, 333t ECT for, 341 treatment of, 334 prevalence of, 330 public health impact of, 329 St John’s wort (Hypericum perforatum) for, 67–68, 69t, 321t, 337 SSRIs for, 334, 335t–336t, 337–339 suicide prevention and, 347–348 TCAs for, 334t–335t, 336, 338–339 venlafaxine for, 334, 335t–336t, 338 Morphine, 199, 199t, 201t, 206–208, 418 Mosquitoes, 618 Motion sickness, 629, 1539 Moxibustion, 637 MRI See Magnetic resonance imaging MRSA See Methicillin-resistant Staphylococcus aureus Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index MSHA See Mine Safety and Health Agency MT See Methyltestosterone MTOPS See Medical Therapy of Prostatic Symptoms Multicenter Automatic Defibrillator Implantation Trial, 1007 Multicenter Unsustained Tachycardia Trial, 1007 Multidrug-resistant (MDR), 501, 510 Multifocal atrial tachycardia, 1013, 1013f Multiple myeloma, 771 Multisomatoform disorders, 300, 300t Mumps, 611t, 616 Murmurs, heart, 1029–1031, 1030t Muscle cramps, 1600 Muscle injury, 1127–1128, 1128f Musculoskeletal injuries general approach to, 1132, 1132t patient evaluation for, 1125–1127, 1126t types of, 1127–1132, 1128f, 1129t, 1130f MUSE (medicated urethral system for erection), 91 Mushroom poisoning, 525 MVP See Mitral valve prolapse Mycobacterium avium, 582 Mycobacterium avium complex, 583 Mycobacterium tuberculosis, 604 Mycostatin liquids, 592 Myelodysplastic syndromes, 828 Myocardial infarction (MI) epidemiology of, 971 hospital discharge/risk stratification and, 974, 974f, 975f, 976, 976t management/rehabilitation after, 974–984, 974f, 975f, 975t, 976t, 977t, 983t patients with unstable angina and, 973, 984 physical conditioning after, 984–989, 986t, 987t, 988f, 989f survivors of, 971–973, 972f survivors of cardiac arrest/no, 973–974 Myoclonus, 203–204 Myofascial pain syndromes, 1220–1221 N N gonorrhoeae, 487 NAATs See Nucleic acid amplification tests Nail conditions, 1209–1211, 1209f, 1210f Naltrexone, 333, 333t, 400–401, 428 NAMCS See National Ambulatory Medical Care Survey Naphazolines, 444 Narcolepsy, 105–106, 105t, 113–114, 113t, 114t Narcotics, 77t long/short-lasting, 200 side effects of, 202–204, 203t, 204t Narcotics Anonymous, 429 NARES See Nonallergic rhinitis with eosinophilia National Ambulatory Medical Care Survey (NAMCS) data, 5, 12, 171 definitions of, National Cancer Comprehensive Network, 146 National Cancer Institute, 146, 151 National Center for Complementary and Alternative Medicine (NCCAM), 61 National Center for Infectious Diseases, 638 National Comorbidity Survey, 318 National Health Ambulatory Medical Care Survey, 1125 National Health and Nutrition Examination Surveys (NHANES), 233, 539, 790 National Health and Social Life Survey (NHSLS), 78, 96 National Health Interview Survey, 223 National Hospice and Palliative Care Organization, 197 National Institute for Occupational Safety and Health (NIOSH), 118 National Institute on Alcohol Abuse and Alcoholism, 383 National Institutes of Health (NIH), 61, 311, 624 National Institutes of Health Consensus Conference, 781 National Institutes of Mental Health (NIMH), 347 National Kidney Foundation, 738, 767 National Library of Medicine, 13 National Prevention Information Network, 575–576 National Society of Genetic Counselors, 257 Native Americans, 369 Nausea, 151, 202, 203t NCCAM See National Center for Complementary and Alternative Medicine N-diethyl-m-toluamide (DEET), 569 Neck pain anatomy/sources of, 1157–1158, 1158f evaluation of, 1158–1160, 1159t pain with neurologic findings and, 1160–1162 pain without neurologic findings and, 1162 syndromes associated with, 1160–1165, 1161t, 1163f, 1164f Necrotizing fasciitis, 471 Needles, 573 Neisseria gonorrhoeae, 547–548 Neisseria lactamia, 487 Nelfinavir, 585t, 586t–587t 16:20 Char Count= 1951 NEO-PI-R See Neuroticism, Extroversion, and Openness-Personality Index Revised Neoplasia, 744 Nephrolithiasis, 1443 Nephropathy, 1330 Neurohormonal system, 1060 Neuroleptics, 183, 344 Neurologic disease, 1263–1264 Neurologic symptoms diagnostic procedures for, 1479–1484 examination/history, 1471–1479, 1472f, 1473f Neuromuscular diseases, 1325–1327 Neuromuscular system, 747 Neuroticism, Extroversion, and Openness-Personality Index Revised (NEO-PI-R), 95 Neurovascular examination, 1478 New York Heart Association, 68 NGU See Nongonococcal urethritis NHANES See National Health and Nutrition Examination Surveys NHSLS See National Health and Social Life Survey Niacin, 1419 Nicotine, 110, 357, 700 chewing gum, 373t, 374 lozenges, 373t, 374 nasal spray, 373t, 374–375 patch, 373t, 374 as smoking cessation product, 373–375, 373t vaccine, 373t, 375 vapor inhaler, 373t, 375 Nicotinic acid, 1419 Nifedipine, 91, 630 Nightmares, 109–110 NIH See National Institutes of Health NIMH See National Institutes of Mental Health NIOSH See National Institute for Occupational Safety and Health Nitrates, 960–962, 1077 Nitric oxide, 91 Nitroglycerin, 91 Nizatidine, 652t NLEA See Nutrition Labeling and Education Act NMDA See N-methyl-(D-aspartate N-methyl-D-aspartate (NMDA), 202 NNT See Number needed to treat Nocardia, 603 Nocturnia, 1064 Nonallergic rhinitis, 447–448, 447t, 448t Nonallergic rhinitis with eosinophilia (NARES), 447 Noncardiac chest pain, 869, 880, 881t evaluation of, 881 therapy for, 881–882 Nongonococcal urethritis (NGU), 550 P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1952 May 16, 2006 16:20 Index Nonherbal supplements chondroitin sulfate as, 68–69, 69t coenzyme Q10, 68, 69t drug interactions with, 69–70, 69t glucosamine sulfate as, 68–69, 69t overview of, 64 regulations for, 65, 65t SAMe, 69, 69t Nonnucleoside reverse transcriptase inhibitors (NRTI), 584–585, 585t, 594 Nonrapid eye movement (NREM), 101 Nonscarring alopecia, 1902–1903 Nonsteroidal anti-inflammatory drugs (NSAIDs), 183, 344, 660, 761, 1232, 1247, 1286, 1494 allergies to, 451, 452–453, 453t for inflammation, 201 for rheumatoid arthritis, 1268–1271, 1269t, 1270t, 1271t Norephinephrine, 310, 339 Norfloxacin, 624–625, 625t Norgestrel, 162 Normoglycemia, 1304–1305 Nortriptyline, 182, 338 NREM See Nonrapid eye movement NRP See Federal National Response Plan NRTI See Nonnucleoside reverse transcriptase inhibitors; Nucleoside reverse transcriptase inhibitors NSAIDs See Nonsteroidal anti-inflammatory drugs Nucleic acid amplification tests (NAATs), 547 Nucleoside reverse transcriptase inhibitors (NRTI), 584–585, 585t, 594 Number needed to treat (NNT), 20–21 NURSE (Name, Understand, Respect, support, and Explore), 195 Nutrition assessments on, 234, 234f clinical manifestations of deficiency/excess in, 236, 237t, 238t patient’s nutrition information as, 235–236, 235t of elderly, 184–185 principles of, 228 select, 236 calories and, 238, 238t, 239t fiber and, 240, 240t salt and, 239, 239t sugar and, 239, 239t vegetarian diets as, 230f, 237–238 standard information/recommendations on dietary reference intake as, 229 guidelines as, 229, 230f, 231t, 232t, 233t labeling as, 229, 234f nutritional survey data as, 233–234 organic food standards as, 229–232 RDAs as, 229 Nutrition Labeling and Education Act (NLEA), 229, 234f O Obesity, 245–246 adolescents and, 154t, 155–157 epidemiology of, 1423 etiology of, 1423–1424 evaluation of, 1425–1428, 1425t, 1426t, 1427t management of, 1428–1434, 1428t, 1429t, 1431t, 1432t, 1434f pharmacotherapy for, 1432–1434, 1432t prevention of, 1435 sequelae of, 1424–1425, 1424t Obsessive compulsive disorder (OCD) description of, 307, 311, 311t epidemiology/natural history/origins of, 312 evaluation/treatments for, 312–313 personality, 325t, 327 Occupational diseases, 118 air pollution and, 129 diagnosis of, 119–120 economic/social factors for, 119 followup of, 124–126, 126t hazards in community/home, 128–129, 128t HAZMAT and, 129–130, 130t health physicians and, 127–128, 127t, 128t physicians/health care institutions and, 128 taking history of, 120, 120f toxin-host interaction with, 119 work related, 120–124, 121t–123t, 125t workers’ compensation programs and, 127 Occupational Safety and Health Administration (OSHA), 118, 126 Blood-Borne Pathogens Standard, 128 OCD See Obsessive compulsive disorder Ocular disease, 1263 Office of Refugee Resettlement, 633 Ofloxacins, 551, 625, 625t Olanzapine, 353–354, 353t, 362 Older American Act, 179 Olecranon bursitis, 1215 Omeprazole, 652t, 657 On Lok care program, 189 Onychomycosis (tinea unguium), 1915–1916 Opening snaps, 1029 Opiates, 116, 205, 414t Opioid analgesics, 417–419 Opioids, 201t, 431–432 Opium, tincture of, 685 Optic neuritis, 508 Oral bisphosphonates, 1760 Oral cavity, 592–593, 1864, 1865f Oral cholecystogram, 1668 Oral contraceptives, 69t, 333t Oral glucose tolerance test, 1297t, 1298 Oral lesions, 592 Oral rehydration solution (ORS), 624–625, 631 Oral/dental problems acute acute herpetic gingivostomatitis as, 1867–1868 acute necrotizing ulcerative gingivitis (Vincent infection/trench mouth) as, 1866–1867 herpes simplex labialis as, 1868 local alveolar osteitis (dry socket) as, 1869 pericoronitis (third molar/wisdom tooth pain) as, 1866, 1866f sialadenitis as, 1868–1869 toothaches (pulpitis) as, 1864–1866 chronic angular cheilosis as, 1873–1874 common tongue conditions as, 1875–1876, 1875f dental caries as, 1873 denture problems as, 1872–1873 erythroplakia/leukoplakia as, 1876–1877, 1876f halitosis as, 1874 periodontal disease (pyorrhea), 1869–1872, 1869f, 1870f squamous cell carcinoma as, 1877, 1877f thrush (oral candidiasis) as, 1874 xerostomia as, 1874–1875 Organic brain syndrome, 1632 Orthophosphate, 764 Orthopnea, 1064 Oseltamivir, 483, 484t OSHA See Occupational Safety and Health Administration Osler, Sir William, 63 Osteoarthritis causes/epidemiology/predisposing factors of, 1224–1226, 1225t clinical features/diagnosis of, 1227–1230, 1227t, 1229f differential diagnosis for, 1230 management of, 1230–1235, 1231f pathophysiology of, 1226–1227, 1226f Osteomalacia, 783, 1445–1446, 1445t Osteomyletis acute, 598, 599t, 602 bacteriology/clinical presentation for, 599, 600f chronic, 598, 599t, 602 contiguous infection, 599 definition of, 598, 599t hematogenous, 599, 600f laboratory evaluation of, 600–601 later complications with, 602–603 Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index prosthetic joint infections and, 599–600 treatments for antimicrobial, 602 prophylaxis, 603 with unconfirmed infections, 602 with vascular insufficiency, 600, 601f Osteonecrosis, 1148 Osteoporosis, 1789 bone densitometry and, 1756–1758, 1757f epidemiology of, 1754 prevention of, 1758–1759 risk factors of, 1754–1755, 1754t screening for, 1755–1756, 1755t treatment of, 1759–1761, 1759t Osteotomy, 1234 OTC See Medications, over-the-counter Otosclerosis, 1843–1844 Otitis externa (swimmer ear), 1838–1839 Ovarian carcinoma, 1767, 1767t Overeaters Anonymous, 158 Over-the-counter See Medications, over-the-counter Oxazepam, 321t, 397t Oxcarbazepine, 1525 Oxybutynin, 203 Oxycodone, 199t, 201t, 418 Oxymetazolines, 444 Oxymorphone, 199t P Pacemaker therapy, 1006 Pacific Islanders, 178, 369 Paget disease of bone, 1449–1452 Palliative care, 193 Pamidronate, 201 Panax species (ginseng), 67, 69t Pancreas, 1318 Pancreatic pain, 673–676, 674t–675t Panic disorders description of, 307, 308 epidemiology/natural history/origins of, 308–310, 309t evaluation/treatments for, 310–311 Pantoprazole, 652t, 657 Pap smears, 594 Papaverine, 92 Papillary carcinomas, 1363–1364 Paraneoplastic syndromes, 930 Paraneoplastic vasculitis of muscle/nerve, 1587 Paranoia, 325t, 328 Paraphilias exhibitionism and, 95 fetishism and, 95 frotteurism and, 95 masochism and, 96 pedophilia and, 95 sadism and, 96 transvestitic fetishism and, 95 treatments for, 96 voyeurism and, 96 Paraproteinemic neuropathies, 1587 Parasites, 640 Parasomnias arousal disorders as, 109 nightmares as, 109–110 Parathyroid adenoma, 1442–1442 Parathyroid hormone assays, 1442 Parkinson disease, 361, 1632 autonomic dysfunction and, 1567 dementia and, 1566–1567 differential diagnosis or, 1559–1560, 1560t epidemiology of, 1559 manifestations of, 1560–1561 natural history of, 1561–1562 pathogenesis of, 1559 psychosis and, 1566 support organizations for, 1567 treatment of early, 1562–1564, 1563t moderate, 1563t, 1564–1565 severe, 1565–1566 Paronychia, 473 Paroxetine, 93, 337, 361, 431 Paroxysmal supraventricular tachycardia, 1011–1013, 1012f Patella dislocation, 1188–1189, 1188f Patient Outcomes Research Team study (PORT), 495 Patients, ambulatory, 3, 5t alternative-care for, 4–5, 6t care for, 4, 6t self-care for, 4–5, 6t PCP See Phencyclidine PCR See Polymerase chain reaction PDE See Phosphodieterase type inhibitors PE See Premature ejaculation Pectin mixtures, 524 Pediculosis, 1922–1923, 1923f Pedophilia, 95 Pelvic floor muscle exercises, 812 Pelvic inflammatory disease, 1741–1743, 1742t Penicillamine, 136 Penicillin, 150, 479, 602, 604 allergies to, 467t, 470 benzathine, 554, 555 G, 467, 554, 598 parenteral benzathine, 487 resistance to, 487, 607 Pentetate calcium trisodium (CaDTPA), 136 Pentetate zinc trisodium (ZnDTPA), 136 Peptic ulcer diseases diagnosis of, 661–662 duodenal ulcer as, 659, 666, 667t dyspepsia as, 668–669 epidemiology/natural history of, 659 gastric ulcer as, 659, 666 gastritis, 669 Helicobacter pylori and, 660, 662–663, 663t pathophysiology of, 659–660 postgastrectomy syndromes as, 666 16:20 Char Count= 1953 risk factors associated with, 660–661 therapy for nonpharmacologic, 663–664 pharmacologic, 664–666, 664t, 665t surgical, 666 Zollinger-Ellison syndrome as, 666–668 Pepto-Bismol See Bismuth subsalicylate Percutaneous coronary intervention, 964–965 Percutaneous transthoracic needle aspiration, 933 Perforator varicosities, 1659–1660 Pericoronitis (third molar/wisdom tooth pain), 1866, 1866f Perilymph fistula, 1538 Periodic leg movement disorder (PLMD), 108–109 Periodic leg movements in sleep (PLMS), 108–109 Periodontal disease (pyorrhea), 1869–1872, 1869f, 1870f Periodontitis, 1872 Peripheral aortic aneurysms, 1647–1648 Peripheral neuropathy approach to patient with, 1582–1583, 1582t, 1583t, 1584t compression/entrapment and, 1588–1597, 1589t, 1590f, 1591f definitions/pathophysiology of, 1581–1582 investigations into, 1583–1586, 1585t less common problems associated with, 1597–1598 other problems associated with, 1600 specific causes of, 1586–1588, 1588t therapeutic principles of, 1598–1600 Peripheral smear, 829, 831, 831t Peritoneal dialysis, 794–795 Peritonsillar abscess, 489 Permanent resident alien, 632 Peroneal nerve, 1594–1595 Perphenazines, 362 Personality antisocial, 325t, 326–327 with anxious/fearful, 325t, 327 management of, 327–328 avoidant, 325t, 327 borderline, 325t, 326 classification methods/definition of, 324–325 concept of, 324 dependent, 325t, 327 development of, 325 disorders classification methods/definition of, 324–325 concept of, 324 conceptualization of, 325 subtyping of, 325, 325t P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1954 May 16, 2006 16:20 Index Personality—continued with dramatic cluster, 326–327 with eccentric/odd cluster, 325t, 328 histrionic, 325t, 326 narcissistic, 325t, 326 OCD, 325t, 327 paranoid, 325t, 328 passive-aggressive, 327 schizoid, 325t, 328 schizotypal, 325t, 328 somatization/manifestation of, 294 traits, management of, 326–327 Perthes test, 1660 PET See Positive emission tomography Pharmacogenomics, 259–260 Pharmacology, clinical, 8–9 Pharyngitis acute rheumatic fever and, 486–487 antibiotics and, 486–487 bacterial causes of, 487–488 chronic/relapsing sore throat and, 488, 488t epidemiology of, 485 GABHS, 485–488, 486t gonococcal, 487 recurrent, 488 Pharyngoconjunctival fever, 488 Phenazopyridine, 203, 532 Phencyclidine (PCP), 423–424, 528 Phenobarbital, 1522–1523 Phenolphthalein, 692 Phenothiazines, 353t Phentolamine, 92 Phenylpropanolamines, 444 Phenytoin, 77t, 200t, 431, 1521–1522 Pheochromocytoma, 1098, 1380 Phobias description of, 307, 315, 315t epidemiology/natural history/origins of, 316 evaluation/treatments for, 316–317 social, 316 Phosphodieterase type inhibitors (PDE 5), 82, 91 Phosphorus, 783–786, 784f, 784t, 786f Photosensitivity, 1925–1926 Phyllodes tumor, 1773 Physical Activity and Public Health: A Recommendation from the Centers for Disease Control and Prevention and American College of Sports Medicine, 245 Physician’s Desk Reference, 823 Piper methysticum (kava-kava), 67, 69t Piperazines, 353t Piperidines, 353t Pituitary diseases clinical presentation of, 1367–1368, 1368t pituitary failure as, 1371–1373 pituitary tumors/disorders of pituitary hyperfunction as, 1368–1371 Plague, 611t, 617–618 Planned Parenthood, 161 Platelets, disorders, 839–843, 841t Pleural effusions, 887–888, 888t, 889f, 941–942 Pleuritis, 497 Pleurodynia, 497 Pleuropulmonary disease, 1262–1263 PLMD See Periodic leg movement disorder PLMS See Periodic leg movements in sleep Pneumatosis cystoides intestinalis, 677 Pneumoconiosis, 119 Pneumocystis carinii pneumonia, 493 Pneumocystis jiroveci (carinii) pneumonia, 589–590 Pneumonia antimicrobial therapy and, 495–497, 496t causes/syndromes, 492–494, 492t evaluation of, 494 followup of, 497 hospitalization and, 494–495, 495t management of, 494–497 PCP, 582 prevention, 497 primary influenza viral, 493 Pneumonia, community-acquired (CAP), 492–494, 492t, 495–496 Pneumonia Severity Index, 494 Pneumothorax, 888–889 Podofilox, 545 Podophyllin, 545 Poikilocytosis, 829 Poison centers, 126 Polio, 272, 611t, 614 Pollens, 442–446, 443t Polydipsia, 1385–1386 Polyethylene glycol (PEG), 689–690 Polygenic/multifactorial inheritance, 252 Polymerase chain reaction (PCR), 483, 547, 563 Polymorphisms, 252 Polymyalgia rheumatica, 1498–1499, 1498t Polyuria, 1385–1386 PORT See Patient Outcomes Research Team study Positive emission tomography (PET), 931 Postcholecystectomy syndrome, 1671 Posterior tibialis tendinitis/rupture, 1199–1200 Postgastrectomy syndromes, 666 Postmyocardial infarction syndrome, 983–984 Postpartum thyroid dysfunction, 1357 Postthrombotic syndrome (PTS), 857 Posttraumatic stress disorder (PTSD), 641 description of, 307, 317, 318t epidemiology/natural history/origins of, 317–319 evaluation/treatments for, 319 Potassium balance, 746, 749–750 chloride, 751, 751t citrate, 763–764 deficient intake of, 749, 750t depletion, 746–748, 747f, 748f, 748t hydroxide, 592 wet mount preparation, 1917, 1918f restriction, 782 PPD See Purified protein derivative PPIs See Proton pump inhibitors Praziquantel, 626–627 Predictive values, 18 Prednisone, 200t Preeclampsia, 1118–1119, 1118t Preexcitation syndrome, 1019–1021, 1019f, 1020f Pregnancy, 160–161, 529, 623, 630, 1118–1120, 1119t, 1528–1529, 1611–1612 arrhythmias in, 1021–1022 CKD and, 793 contraception/diagnosing, 1713–1714 diagnosing, 1713–1714 patient with prosthetic valve and, 1054 rheumatoid arthritis and, 1277 syphilis and, 553, 556 thyroid dysfunction during postpartum/, 1356–1357 unplanned, 1714 VTE and, 856 Premature atrial/junctional contractions, 1010–1011, 1010t Premature ejaculation (PE) assessment of, 92 diagnostic classification of, 92 treatment of, 92–93 Premature hyperplasia, 1773 Premenstrual dysphoric disorder, 1728–1729 Prepatellar bursitis, 1215–1216 Presbycusis, 1844 Preventive care for community/families, 221–224, 222t–223t components of, 213t, 214–221, 215t–219t, 220t for established conditions, 221 evaluation of, 212–214, 213t overview of, 211 patient motivation in, 226 practice of, 223–226, 224f, 225f terminology for, 212, 212f tertiary, 221 Prevotella, 603 Priapism, 833–834 Primaquine, 619, 621–623 Primary Care Evaluation of Mental Disorders (PRIME-MD), 284, 284t, 300 Primary sclerosing cholangitis (PSC), 727–728 PRIME-MD See Primary Care Evaluation of Mental Disorders Primidone, 1523, 1557 Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index Principles and Practice of Medicine (Osler), 63 Procainamides, 1002–1003 Prochlorperazine, 151 Proctalgia fugax, 1690–1691 Proctosigmoidoscopy, 706 Progesterone, 77t Proguanil, 619 Prolactinomas, 1461 Promethazine, 418 Propanolol, 354, 1557–1558 Prophylaxis, 162 Prostaglandin E1 , 91–92 Prostatectomy, 803, 804 Prostate-specific antigen (PSA), 24 Prostatitis, 534, 806 acute bacterial, 534–535 chronic bacterial, 535 nonbacterial, 535 Prostatodynia, 535, 806 Prosthetic valve, patient with, 1051 complications of, 1052 management of, 1053, 1054t physical/laboratory findings of, 1052–1053 pregnancy and, 1054 Prostrate cancer, 803 biopsy, 804 staging of, 804–805, 805t treatment of, 805–806 Protease inhibitors, 69t Proteins, 734, 780 glycosylated, 1319–1320 Proteinuria assessment of patients with, 734–735 constant isolated, 736 detection methods for, 733–734 hematuria with, 741–742 intermittent, 735 nephrotic, 736–737, 736t nonisolated, 736 nonnephrotic, 735–736 orthostatic, 735–736 persistent, 735 quantitation of, 734 significance of, 737–738 treatment of patients with, 738–739 Proton pump inhibitors (PPIs), 652t, 656 Protriptyline 5, 114 Pruritus, 203–204 Pruritus ani diagnosis of, 1681–1683, 1682t, 1683f treatment of, 1683–1684 PSA See Prostate-specific antigen PSC See Primary sclerosing cholangitis Pseudodementia, 361 Pseudodiseases, 213 Pseudoephedrine hydrochloride, 94 Pseudomonas, 150 Pseudomonas aeruginosa, 493 Psoriasis clinical presentation of, 1910–1911, 1911f definition/prevalence of, 1910 Psychiatric illnesses, 44 Psychogeriatric disorders, 360–367 Psychosis, 352t, 1566 Psychosocial problems assessment of competence/commitment/ decision-making capacity and, 285 comorbid substance abuse and, 284 comorbidity in patient’s family and, 284 epidemiology of, 279–280, 280t formulation of, 283, 283t, 284t information gathering about, 281–283, 282t mental illness screening and, 284–285, 286f syndromal diagnosis of, 280 Psychotherapy, 319 alcoholism and, 399 efficacy of, 292 forms of counseling within, 290–292 general principles of, 286–288 management of abnormal behavior, 289–290 treatment techniques in, 288–289 PTS See Postthrombotic syndrome PTSD See Posttraumatic stress disorder Pulmonary diseases, 370, 1622 Pulmonary embolism, 877–878 Pulmonary fibrosis, 124 Puncture wounds, 473 Puria, 741 Purified protein derivative (PPD), 503, 504–505, 579–580, 639 Pyrazinamide, 506, 507t Q Quality-adjusted life years (QALY), 22 Quetiapine, 353, 353t Quinidine, 1002 Quinolones, 508, 549, 625, 625t R Rabeprazole, 652t, 657 Rabies, 274–275, 611t, 615–616 Radial keratotomy, 1800 Radial nerve, 1594 Radiation therapy, 805 Radiation-associated thyroid carcinomas, 1363–1364 Radioisotope imaging, 954 Radiology, 646, 677–678 Radiotherapy anorexia/nausea/vomiting and, 151 corticosteroids and, 149 cumulative dosages and, 149 patient experience with, 147–148, 147t side effects of, 148–149, 148t 16:20 Char Count= 1955 symptomatic response to, 148–149, 148t Radon, 927–928 Ramelteon, 113 Ramipril Efficacy in Nephropathy 2, 779 RAND Corporation, 127 Randomized controlled trial (RCT), 20–21 Ranitidine, 652t Rapes, 161–162 Rapid eye movement (REM), 101, 105 Rapid plasma reagin (RPR), 554 Rash, 203–204 RAST (Radioallergosorbent testing), 441 Raynaud phenomenon, 1221–1223, 1221t, 1223t RBCs See Red blood cells RCT See Randomized controlled trial RDAs See Recommended daily allowances RDI See Respiratory disturbance index RDS See Respiratory distress syndrome Receiver operating curve (ROC), 17 Recommended daily allowances (RDAs), 229 Rectal biopsy, 689 Rectal prolapse, 1691–1692 Red blood cells (RBCs), 618, 740, 741–742 Refractive errors correction of presbyopia and, 1800–1801 corrective surgery, 1799–1801 surgery techniques for, 1800 Refugees, 632, 633 Reidel thyroiditis, 1356 Reinforcement, 52 Relative risk reduction (RRR), 20–21 The Relaxation Response, 319 REM See Rapid eye movement Renal biopsy, 777–778 Renal diseases, 1342, 1393, 1624–1625 Renal imaging techniques, 776–777, 777t Renal sonography, 776 Renal systems, 593–594 Renal transplantation, 795–796, 795t Residual daytime sedation, 112 Resperisdone, 205 Respiratory depression, 202 Respiratory distress syndrome (RDS), 484 Respiratory disturbance index (RDI), 106 Respiratory tract infections, 497–498 Respiratory tract infections, lower acute bronchitis as diagnosis of, 490–491 epidemiology of, 490, 490t prevention of, 492 treatment of, 491–492 P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1956 May 16, 2006 16:20 Index Respiratory tract infections, lower—continued pleuritis and, 497 pleurodynia and, 497 pneumonia antimicrobial therapy and, 495–497, 496t causes/syndromes, 492–494, 492t evaluation of, 494 followup of, 497 hospitalization and, 494–495, 495t management of, 494–497 prevention, 497 Respiratory tract infections, upper antihistamines for, 476 common cold as clinical features of, 474–475 epidemiology/transmission of, 474 patient education for, 476 prevention of, 476 treatment of, 475–476 epiglottitis as, 489 flu syndrome as clinical diagnosis/features of, 482–483 complications, 484–485 diagnostic tests for, 483 epidemiology of, 481–482, 482f treatments for, 483–484, 484t pharyngeal abscesses as, 489 pharyngitis acute rheumatic fever and, 486–487 antibiotics and, 486–487 bacterial causes of, 487–488 chronic/relapsing sore throat and, 488, 488t epidemiology of, 485 GABHS, 485–488, 486t gonococcal, 487 self-care/telephone assessment of, 489–490 sinusitis as, 476 antibiotics and, 479, 480t chronic, 481 clinical diagnosis/features of, 477–478 complications/followup of, 479–480 diagnostic approach to, 478, 478t epidemiology of, 477 examination of, 478 radiologic examinations of, 478 treatments for, 478–479 Respiratory tract manifestations, 589 Restless leg syndrome (RLS), 108–109, 115–116, 115t, 1600 Reston, James, 63 Retinopathy, 1331–1333, 1333t Retrograde ejaculation, 93 Retropharyngeal abscess, 489 Rheumatoid arthritis, 1254 course of, 1264–1265 differential diagnosis of, 1265, 1265t epidemiology of, 1255 extra-articular diseases and, 1260–1264, 1262f, 1262t history of, 1255–1256, 1256t laboratory tests for, 1256–1260 management of, 1265–1277, 1266t pathogenesis of, 1255 pharmacologic agents for, 1266t, 1276–1277 physical examination of, 1256–1258, 1256t, 1257f, 1258f pregnancy and, 1277 radiology on, 1260, 1261f surgery on, 1277 Rheumatoid nodules, 1262, 1262f Rheumatoid vasculitis, 1264 Rhinitis medicamentosa, 476 Ribavirin, 592 Ribonucleic acid (RNA), 260 Rifabutin, 508 Rifampin, 506, 507t, 508, 607 Rifapentine, 508 Rimantadine, 483, 484t Rinne test, 1835 Risk factors, 213 Risperidone, 353, 353t, 355, 362 Ritonavir, 91, 585t, 586t–587t Rivastigmine, 366 RLS See Restless leg syndrome RNA See Ribonucleic acid ROC See Receiver operating curve Rocky Mountain spotted fever (RMSF), 561t, 565–566 Rolfing, 71 Rosacea (acne rosacea), 1901 Rotator cuff tear, 1143–1144 Rotator cuff tendinitis, 1142–1143 RPR See Rapid plasma reagin RRR See Relative risk reduction Rubella, 611t, 616 Ryan White Comprehensive AIDS Relief Emergency (CARE), 595 S Sacroiliitis, 1281 Sadism, 96 St John’s wort (Hypericum perforatum), 67–68, 69t, 321, 337 Salmonella, 516, 520, 521, 524 Salt, 239, 239t SAMe (S-adenosylmethionine), 69, 69t Sampling bias, 19 Saquinavir, 91, 585t, 586t–587t SARS See Severe acute respiratory syndrome Saw palmetto (Serenoa repens), 67 Scabies, 1922 Scandinavian Simvastatin Survival Study, 21 Scarring alopecia, 1902, 1903–1904 SCC See Squamous cell carcinoma Schatzki ring, 653 Schilling test, 826–827, 827t Schistosomiasis, 625–627, 626f, 728 Schizoaffective disorder-manic type, 343 Schizoid personality, 325t, 328 Schizophrenia antipsychotics for, 352–353, 353t causes of, 350 diagnosis of, 351, 351t differential diagnosis for, 351–352, 352t in elderly, 362 epidemiology of, 349–350 natural history of, 350–351 prognosis for, 352–358 treatments for, 352–358 Schizotypal personality, 325t, 328 Sciatic nerve, 1596 Scleroderma of esophagus, 651–652, 652t Sclerotherapy, 1661 Scorpions, 630 SDB See Sleep-disordered breathing Sedation, 203 Sedative hypnotics, 420–421 Seizures alcohol-related, 1510 brain tumors and, 1510–1511 causes of, 1508–1511, 1509t cerebrovascular diseases and, 1511 classifications of epileptic, 1507–1508 complex partial, 1507 epidemiology of, 1508 epileptic, 1504, 1505t evaluation of, 1511–1514, 1511t generalized absence, 1505–1506 generalized tonic-clonic, 1504–1505 infections and, 1511 localization-related/partial, 1506 myoclonic/myoclonus, 1506 natural history/prognosis of, 1508 posttraumatic, 1510 psychogenic nonepileptic, 1512 types, 1504–1507, 1505f Selection bias, 213 Selective estrogen receptor modulators (SERMs), 1793–1794, 1794t Selective serotonin reuptake inhibitors (SSRIs), 69t, 329, 361, 684, 980–981 for anxiety, 310, 313, 320 for mood disorders, 334, 335t–336t, 337–339 for sexual disorders, 77t, 84, 93 for sleep disorders, 114 Semimembranosus gastrocnemius bursitis, 1216–1217 SERMs See Selective estrogen receptor modulators Serotonin, 151, 310, 353 Serous ottis media, 1840–1841 Serum ferritin, 822–823, 822t Serum iron, 822 Sertraline, 93, 205, 361 Serum gastric measurements, 662 Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index Serum potassium, 738 Serum urea nitrogen (SUN), 774 Seventh Day Adventists, 237 Severe acute respiratory syndrome (SARS), 493, 609 Sex hormone-binding globulin (SHBG), 88 Sexual disorders, 73, 1330, 1788 antidepressants and, 77t, 87 common general approaches for, 79–80, 79t general characteristics of, 78–79, 78t tripartite model of etiology in, 75–76, 76t, 77t female, 80–87 female sexual pain disorders as assessment/treatment of, 85–87 diagnostic classification of, 84–85 FOD as antidepressant-related side effects and, 84, 85t diagnostic classification of, 83 directed masturbation and, 84 treatments for, 83–84 FSAD as assessment of, 81–82 diagnostic classification of, 81 oral pharmacologic treatments for, 82–83 other somatic treatments for, 83 psychiatric treatments for, 82 gender identity assessment of, 95 complications of, 95 course of, 94–95 etiology/prevalence of, 94 treatments for, 95 HSDD as assessment of, 76t, 77t, 80, 87–88 diagnostic classification of, 87 pharmacologic treatments for, 80–81 treatments for, 80, 88 HSR as, 74 alternative model for women and, 75 four phases of, 74–75 male erectile disorder as assessment of, 88–89, 89t diagnostic classification of, 88 treatment of, 89–92, 90t male orgasmic disorder assessment of, 93 diagnostic classification of, 93 treatment of, 93–94 male sexual disorders as, 87–94 nonparaphilic sexual compulsion as, 96 paraphilias as exhibitionism and, 95 fetishism and, 95 frotteurism and, 95 masochism and, 96 pedophilia and, 95 sadism and, 96 transvestitic fetishism and, 95 treatments for, 96 voyeurism and, 96 PE as assessment of, 92 diagnostic classification of, 92 treatment of, 92–93 resulting from medical conditions/ substance abuse, 94 sexual aversion disorder as assessment of, 87 diagnostic classification of, 87 treatment of, 87 SSRIs for, 77t, 84, 93 Sexual Dysfunction due to a General Medical Condition and Substance Induced Sexual Dysfunction, 94 Sexual Health Inventory for Men, 88 Sexuality, 979 of adolescents, 98 development of, 158–159, 158t, 159t, 160f aging and, 97 of children, 97–98 homosexuality and assessment/management of, 97 characteristics of, 96 development of, 96 predisposing factors for, 96 psychosocial consequences of, 96–97 Sexually transmitted diseases (STDs), 574, 1692–1693 See also specific diseases adolescents and, 160–161 cervicitis as, 546–547, 546f chancroid as, 541–542 chlamydia trachomatis, 542, 548–549 epididymitis and, 550–551 genital ulcer disease as, 538–539, 539t genital warts as, 543–545, 544t alternative treatments for, 545–546 counseling for, 546 patient-applied therapy for, 545 provider-administered therapy for, 545 granuloma inguinale (donavonosis) as, 542 HSV as, 539–541, 541t lymphogranuloma venereum as, 542–543 neisseria gonorrhoeae as, 547–548 NGU as, 550 syphilis as, 551 classification of, 552–553, 552t contact evaluation of, 556 diagnosis of, 553–554 followup/treatments for, 554–556 HIV, 556 Jarisch-Herxheimer reaction and, 556 latent, 552t, 553, 555 neuro, 555 pregnancy and, 553, 556 16:20 Char Count= 1957 primary, 552, 552t, 555 secondary, 552–553, 552t, 555 tertiary, 552t, 553, 555 urethritis as, 546–547, 546f in women, 529 Sheehan syndrome, 1371 Shigella, 520, 521, 526 Shigellosis, 524 Shin splints, 1194–1195, 1195f Shoulder pain anatomy/function of, 1134–1136, 1135f, 1136t diagnostic approach to, 1136–1139, 1136t, 1138t glenohumeral disorders of, 1145–1148 management strategies for, 1139–1142, 1140f, 1141t periarticular disorders of, 1142–1145 referred, 1148–1150, 1149f Sialadenitis, 1868–1869 Sick sinus syndrome, 1009–1010 Sickle cell disorders, 831–834 Sigmoidoscopy, flexible, 678 Sildenafil citrate, 91 Silhouette sign, 882, 883t Simethicone, 685 Sinoatrial node, 993, 995f Sinus bradycardia, 1009 Sinus tachycardia, 1008–1009 Sinusitis, 476 antibiotics and, 479, 480t chronic, 481 clinical diagnosis/features of, 477–478 complications/followup of, 479–480 diagnostic approach to, 478, 478t epidemiology of, 477 examination of, 478 radiologic examinations of, 478 treatments for, 478479 Sjogren ă syndrome, 1264 Skin biopsy, 1889 cancer actinic keratosis as, 1893–1894, 1894t atypical moles as, 1890–1891 melanoma as, 1891–1893, 1892t nonmelanoma as, 1893, 1894–1896 definitions/examinations of, 1881–1882 infestations pediculosis as, 1922–1923, 1923f scabies as, 1922 lesions, 1330–1331 localized viral infections of herpes infection as, 1919–1922, 1922f molluscum contagiosum as, 1919 wart as, 1918–1919 topical therapeutics for, 1882–1889, 1883t–1888t P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1958 May 16, 2006 16:20 Index Skin infections bites and, 472–473 carbuncles as, 468 cellulitis as causes of, 470 wound infections as, 469–470, 470t complications of, 468 cutaneous anthrax and, 471–472 cutaneous diphtheria and, 471 ecthyma as, 466 erysipelas as, 466 folliculitis as, 468 furunculosis as, 468 hidradenitis suppurativa as, 468 impetigo as, 466 intertriginous, 473 management of, 466–467, 467t necrotizing fasciitis as, 471 paronychia as, 473 puncture wounds and, 473 S aureus and, 465, 470 S pyogenes and, 465, 468–469, 470 secondarily infected ulcers as, 471 Skull, 1479 SLE See Systemic lupus erythematosus Sleep apnea, 1099 central, 107, 115 course of, 107 diagnosis of, 107–108 epidemiology of, 106–107, 107t obstructive, 106–107, 114 presentation of, 107 benzodiazepines and, 111–113, 112t, 116, 204 disordered breathing, 1080 hygiene measures, 110 nocturnal, 113 paralysis, 105–106 restriction therapy, 111 terrors, 109, 116 walking, 109, 116 Sleep disorders circadian manipulations and, 111 clinical presentations of, 101–104, 101f, 102t, 103t, 104t confusional states and, 116 EDS as chronic fatigue and, 104t, 105 chronic insufficient sleep and, 105 clinical features of, 104, 104t differential diagnosis of, 104–105 idiopathic hypersomnia and, 106 narcolepsy and, 105–106, 105t, 113–114, 113t, 114t enuresis and, 116 epidemiology/overview of, 100 hygiene measures and, 103t, 110 hypnotic medications and, 111–113, 112t idiopathic hypersomnolence and, 113–114, 113t, 114t insomnia as, 101–104, 101f, 102t, 103t, 104t management of, 110 management of, 112–116 behavioral, 110–111 parasomnias and arousal disorders as, 109 nightmares as, 109–110 physiology of, 100–101, 101f PLMS as, 108–109 referrals for, 116–117 relaxation techniques and, 110–111 RLS as, 108–109, 115–116, 115t, 1600 SDB as, 114–115 course of, 107 diagnosis of, 107–108 epidemiology of, 106–107, 107t presentation of, 107 sleep restriction therapy and, 111 sleep terrors as, 109, 116 sleepwalking as, 109, 116 SSRIs for, 114 stimulus control therapy and, 111 TCAs for, 114, 116 Sleep Heart Study, 114 Sleep-disordered breathing (SDB) course of, 107 diagnosis of, 107–108 epidemiology of, 106–107, 107t presentation of, 107 Sleeping pills, 183 Small intestinal pain, 673, 674t–675t Smoking, 368, 982, 1571–1572 See also Cigarettes; Tobacco use cessation, 373–375, 373t, 1416 passive, 371 Snakes, 630 Snoring evaluation of, 1854–1855 nonapneic, 1855–1856 pathophysiology of, 1854 SNS See Strategic National Stockpile Social Security Act Title II, 137–138 (See also Disability Insurance) Title XVI, 140 Social Security Administration, 137, 139 Social Security Disability, 127, 595 Society for Clinical and Experimental Hypnosis, 319 Sodium valproate, 1522 Solatol, 1004 Solitary nodules, 889 Solitary pulmonary nodule, 942–943 Solitary thyroid nodule, 1362 Solvents, 424–425 Somatization adjustment disorders and description of, 295 management of, 296 diagnosis/working formulation and, 294–295, 295t disorders body dysmorphic disorders as, 303–304, 304t conversion disorders as, 300–301, 300t description of, 298, 298t factitious disorder with physical symptoms as, 304–305, 304t hypochondriasis as, 301–302, 301t malingering, 304–305 management of, 299 multisomatoform disorders as, 300, 300t pain, 302–303, 303t undifferentiated, 300, 300t with voluntary symptom production, 304–305, 304t illness behavior and, 293 life story and, 294 as manifestation of personality, 294 psychosocial factors affecting medical conditions and description of, 296–297, 297t management of, 297 as reinforced behavior, 294 as symptom of disease, 293–294 Sonography, 531 Sore throats, chronic/relapsing, 488, 488t Spectatoring, 82 Speech recognition test, 1836 Spherocytes, 829 Spinal stenosis, 1177–1178 Spine, 1479–1480 Spironolactone, 782 Spondyloarthopathies, 1178 Spondyloarthritis, 1280–1281, 1281t Sputum, 505 Sputum cytology, 931–932 Squamous cell carcinoma (SCC), 647, 1877, 1877f, 1895 SSI See Supplemental Security Income SSRIs See Selective serotonin reuptake inhibitors Staphylococcus aureus, 426, 465, 470, 477, 516 Staphylococcus epidermidis, 530 Staphylococcus pyogenes, 465, 468–469, 470, 477 Statins, 69t, 91 Stavudine, 586–587t STDs See Sexually transmitted diseases Steno study, 789 Stenosing tenosynovitis, 1218 Stephania tetrandra, 65 Stereotactic biopsy, 1776 Sterilization, 1711–1712 Steroids adrenocorticotropic hormones as, 1382–1383 adverse effects of, 1381–1382, 1382t anabolic androgenic, 424–425 intermittent therapy of, 1382 pharmacologic uses of, 1381–1384, 1382t Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index topical, 1382 withdrawal from acute/chronic glucocorticoid therapy, 1383–1384 Stevens-Johnson syndrome, 67, 345 Stimulants, 77t, 419–420 Stools, 694–695, 697 Strategic National Stockpile (SNS), 136 Streptococcus bovis, 607 Streptococcus pneumoniae, 477, 598 Streptococcus pyogenes, 602 Streptococcus viridans, 607 Streptomycin, 508, 569 Strokes, 361 Struvite, 758 Subarachnoid hemorrhage, 1546 Subdeltoid (subacromial) bursitis, 1143 Substance P, 310 related use disorders, 383 Substance abuse adolescents and, 164–165, 164t, 166t comorbid, 284 management of, 417 sexual disorders resulting from medical conditions/, 94 sleep and, 103 substance dependence and, 412 Sucralfates, 652t Sucrose, 239 Sudan, 634 Sudden Cardiac Death in Heart Failure, 1007 Sugar, 239, 239t Suicide, 165–166 Sulfamethoxazole, 479 Sulfasalazine, 700, 1273–1274, 1286 Sulfonylureas, 1306–1308, 1307t Sulfosalicyclic acid, 733–734 SUN See Serum urea nitrogen Sunblocks, 1925–1926 Sunburn, 629 Sunscreens, 1925–1926 Superficial venous thrombophlebitis (SVT), 857 Supplemental Security Income (SSI), 137, 140, 595 Surrogates, 193 Surviving Schizophrenia, 356 SVT See Superficial venous thrombophlebitis Swallowing, 645 Swimmer ear (ottis externa), 1838–1839 Syncope/near syncope from cardiac abnormalities, 1544–1545 from circulatory failure/hypotension, 1540 definitions/pathophysiology of, 1539–1540 diagnostic tests for, 1548–1551, 1550t differential diagnosis of, 1540, 1541t from drug overdose, 1546 general approach for, 1546–1547 history of, 1547 incidence/mortality and, 1540 from intracranial abnormalities, 1546 from metabolic abnormalities, 1545 mimic, 1551 neurocardiogenic, 1540–1543, 1544f physical examination of, 1547–1548 Synovial fluid, 1260 Syphilis, 551 classification of, 552–553, 552t contact evaluation of, 556 diagnosis of, 553–554 followup/treatments for, 554–556 foreign-born patients with, 640 HIV, 556 Jarisch-Herxheimer reaction and, 556 latent, 552t, 553, 555 meningovascular, 553 neuro, 555 pregnancy and, 553, 556 primary, 552, 552t, 555 secondary, 552–553, 552t, 555 tertiary, 552t, 553, 555 as vulvovaginitis, 1743 Syphilitic meningitis, 553 Systemic lupus erythematosus (SLE), 771 T Tabes dorsalis, 553 Tadalafil, 91 Tailoring, 52 Tamoxifen, 333, 333t Tampon-related ulceration, 1743 Tanacetum parthenium (feverfew), 66, 69t Tanner staging, 171 Tardive dyskinesia, 356 Tarsal tunnel syndrome, 1595 TB See Tuberculosis TCAs See Tricyclic antidepressants Tegaserod, 685, 692 Telangiestasia, 1659 Temporal bone fractures, 1842 Temporomandibular joint syndrome, 1502 TEN See Toxic epidermal necrolysis Tendon injury, 1128–1129 Tennis elbow See Lateral epicondylitis Tenofovir, 586–587t Tenosynovitis, 1217–1218 TENS See Transcutaneous electrical nerve stimulation Testosterone, 80–81, 155 metabolites/secretion/transport of, 1455–1457, 1456f, 1457t replacement, 88, 1461–1463, 1462t Tetanus, 269, 611t, 614–615 16:20 Char Count= 1959 Tetanus-diphtheria vaccine, 171–173 Tetracyclines, 532t, 555, 617 Theophylline, 69t, 115, 920 Thiazides, 738, 763, 780, 1074, 1109 Thiazolidinediones, 1308 Thienopyridines, 858 Thioxanthenes, 353t Third National Health and Nutrition Examination Survey, 768 The 36-Hour Day, 365 Thoracoscopy, 933 Thrombocytopenia, 593 Thrombocytosis, 843 Thromboembolization, 833 Thrombosis, 856–857, 1546 Thrombosis, deep vein (DVT), 857, 1196 Thrush (oral candidiasis), 592, 1874 Thyroid carcinomas, 1363–1365 diseases, 1338–1341, 1339t dysfunction caused by amiodarone/iodide, 1354–1355 during pregnancy/postpartum, 1356–1357 functions, 1338, 1341–1344, 1341t, 1342t, 1344t hormones, 333t, 1337–1338, 1338t hyperthyroidism and, 1344–1350, 1344t hypothyroidism and, 1350–1354, 1351t neoplasms, 1360–1365, 1361t nodules, 1360–1362, 1361t physiology, 1336–1338, 1337f, 1338t screening for, 1357–1358 thyrotoxicosis and, 1344–1350, 1344t Thyroidal radioiodide uptake tests, 1340 Thyroiditis, 1355–1356 Thyroid-stimulating hormone (TSH), 363, 1338–1339 Thyrotoxicosis, 1344–1350, 1344t Thyroxine, 1339, 1339t, 1343–1344, 1353, 1359–1360 Tiagabine, 1525 Tibial nerve, 1594–1595 Tibolone, 81 Tic douloureux, 1501–1502 Tick-borne encephalitis, 611t, 617–618 Tick-borne illnesses babesiosis as, 561t, 567–568, 568f ehrlichioses as, 566 HGA as, 561t, 566–567 HME as, 561t, 566 Lyme disease as clinical manifestations/stages of, 560–563, 561f, 562f diagnosis of, 563–564 epidemiology of, 560, 561t prevention of, 565 treatments for, 564–565, 565t relapsing fever as, 561t, 568 RMSF as, 561t, 565–566 P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1960 May 16, 2006 16:20 Index Tick-borne illnesses—continued southern tick-associated rash illness as, 567 tularemia as, 561t, 568–569 viral infections/, 569 Tilt-table testing, 1549–1551, 1550t Tinea capitis, 1914–1915 Tinea corporis, 1915 Tinea cruris, 1915 Tinea faciei, 1915 Tinea manum, 1915 Tinea pedis, 1915 Tinea unguium (onychomycosis), 1915–1916 Tinea versicolor, 1916–1917, 1916f, 1917t TMP-SMX See Trimethoprimsulfamethoxazole TNF-α See Tumor necrosis factor-α Tobacco use cancer and, 370, 925–926 causes/risk factors of, 369 course of habit and, 369–370 diagnosis/recognition of, 371 health consequences of, 370–371 prevalence of, 368–369, 368t primary prevention of, 369 quitting/relapse patterns with, 370 recommended office approach for, 376–380, 377f, 378f, 379f relapse prevention with, 376 treatments for, 371–372 organized, 375–376 pharmacologic, 373–375, 373t weight gain and, 375 Tolterodine, 203 Tongue conditions, 1875–1876, 1875f Tonsillitis, chronic, 488 Toothaches (pulpitis), 1864–1866 Topiramate, 1525 Torsade de Pointes, 1021 Torsemide, 780, 782 TOSCA See Toxic Substances Control Act Total iron binding capacity, 822–823 Toxic epidermal necrolysis (TEN), 1927t–1928t, 1929–1930 Toxic shock syndrome, 1743 Toxic Substances Control Act (TOSCA), 119 Toxoplasma, 580 Toxoplasma gondii, 582 Toxoplasmosis, 863, 864t Trandelenburg test, 1660 Tranquilizers, 654 Transcient ischemic attack, 1573 Transcutaneous electrical nerve stimulation (TENS), 202 Transcutaneous laser ablation, 1661 Transference, 45 Transient ischemic attacks, 1538 Transtubular potassium concentration gradient, 750 Transurethral microwave thermotherapy (TUMT), 802 Transurethral resection of prostate (TURP), 803 Transvestitic fetishism, 95 TRAPS See Tumor necrosis factor receptor-associated periodic syndrome Trauma/instability, 1146–1147 Traumatic ossicular injury, 1842 Traumatic perforation of tympanic membrane, 1842 Travelers care of, 609–610 dengue and, 627, 627f diarrhea and, 624–625, 624t food/water and, 623–624 health kit, international, 631–632 immunizations for, 610t anthrax, 611t, 617–618 cholera, 611–614, 611t diphtheria, 611t, 614–615 hepatitis A, 269, 611t, 615 hepatitis B, 269–271, 270t, 611t, 615 influenza/measles/mumps/ rubella, 272–273, 272t, 611t, 616 Japanese encephalitis, 611t, 616 Lyme disease, 611t, 617–618 meningococcal meningitis, 273–274, 274t, 611t, 616–617 miscellaneous, 611t, 617–618 plague, 611t, 617–618 polio, 274, 611t, 614 rabies, 274–275, 611t, 615–616 TB, 275, 611t, 616 tetanus, 269, 611t, 614–615 tick-borne encephalitis, 611t, 617–618 timing of, 618 typhoid fever, 611t, 614 typhus, 611t, 617–618 varicella, 611t, 615 yellow fever, 610–611, 611t, 612f, 613f malaria prophylaxis and, 618–623, 619t, 620f, 621f, 622f miscellaneous health concerns for, 630–631 accidents as, 629 air travel/jet lag, 628–629, 629f high altitude as, 629–630 HIV as, 628 insects as, 629 medications as, 630 motion sickness as, 629 scorpions/snakes as, 630 STDs as, 630 sunburn as, 629 schistosomiasis and, 625–627, 626f Trazodone, 112, 334–336, 334t–335t, 336t–337t, 654 Treating Tobacco Use and Dependence (2000), 376 Tremor/other abnormal movements caused by cerebellar dysfunction, 1558 classification/definition of, 1554, 1554t essential, 1557–1558 evaluation of, 1555–1556, 1555t orthostatic/primary writing, 1558–1559 physiologic/exaggerated physiologic, 1556 Trench mouth (acute necrotizing ulcerative gingivitis), 1866–1867 Triamterene, 782 Triazoles, 598 Trichinosis, 525 Trichloroacetic acid, 545 Trichomonas, 1739, 1739f Trichomoniasis, 97 Tricyclic antidepressants (TCAs), 69t, 87, 361, 451, 684 for anxiety, 319 for mood disorders, 334t–335t, 336, 338–339 for nerve pain, 202 for sleep disorders, 114, 116 Trigeminal neuralgia, 1501–1502 Triglyceride(s), 1409–1410 reduction, 1415 synthesis, 1402 Triiodothyronine, 1339, 1339t, 1354 Trimethoprim, 479 Trimethoprim-sulfamethoxazole (TMP-SMX), 532, 532t, 534, 582, 617, 624–625, 625t Triptans, 1491–1493 TSH See Thyroid-stimulating hormone Tubal litigation, 1712 Tuberculin tests, 582 Tuberculosis (TB), 574, 598, 638, 1631 causes of, 502 course/management of, 506–511 diagnosis of, 503–505 drug resistance to, 502–503, 508–509 drug therapy for, 506–508, 507t epidemiology of, 501–502 extrapulmonary, 460–461 foreign-born patients with, 639 HIV and, 502–503, 505–506, 590 immunizations, 275, 611t, 616 laboratory evaluation of, 505 MDR, 501, 510 Mycobacterium, 604 nonpulmonary, 508 primary/reactivation, 502 Tuberculosis Genotyping Program, 501 Tularemia, 561t, 568–569 Tumor necrosis factor receptorassociated periodic syndrome (TRAPS), 461 Tumor necrosis factor-α (TNF-α), 439, 1274–1276, 1286 Tumors, 1179 TUMT See Transurethral microwave thermotherapy TURP See Transurethral resection of prostrate Char Count= P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls May 16, 2006 Index Tympanosclerosis, 1843 Typhim V, 614 Typhoid fever, 611t, 614 Typhus, 611t, 617–618 U Ulcerative colitis, 525, 699–701, 699t, 700t Ulcers See also specific ulcers duodenal, 659, 666, 667t gastric, 659, 666 leg, 666, 658, 339 secondarily infected, 471 Ulnar nerve, 1593–1594 Ultrasonography, 677–678, 1361 United Kingdom Prospective Diabetes Study, 789 United States Preventive Services Task Force, 24 Units on Aging, 179 Upper motor neuron, 1477–1478 Urethral syndrome (Dysuria-pyuria syndrome), 533–534 Urethritis, 535, 546–547, 546f Uric acid, 758, 758t Urinalysis, 530, 760, 774 Urinary calculus disease general measures of, 762 hyperoxaluria and, 764 hyperuricosuria and, 764 prevention treatments of, 762–765, 762t Urinary dipstick, 733 Urinary incontinence, 807 clinical syndromes of, 808–809 drug therapy for, 812, 812t evaluation of, 809–810, 809t functional, 808 mixed, 808–809, 811–812 onset-reset, 809 overflow, 808 pathophysiology of, 808 stress, 808, 812–815 treatment of, 810–815, 812t, 813t–814t urge, 808, 811–812 Urinary spasms, 203 Urinary stone(s) analysis of, 760 calcium, 757–758, 757t, 762–763 causes/types of, 757–759, 757t, 758t, 759t cystine, 758–759 diagnostic workup for patients with, 759–760 disease, 754 acute colic, 754–757, 757f hypercalciuria and, 761–762, 762t laboratory assessment of, 760–761, 761t natural history of, 759, 759f struvite, 758 uric acid, 758, 758t urinalysis and, 760 urinary calculus disease and general measures of, 762 hyperoxaluria and, 764 hyperuricosuria and, 764 prevention treatments of, 762–765, 762t Urinary tract infections (UTIs), 66 acute pyelonephritis as, 536–537 antimicrobial therapy for, 532, 532t asymptomatic bacteriuria as, 537 bacterial cystitis as, 534 diagnostic evaluations for, 529–531 epididymitis as, 535 general considerations for, 528–529 imaging and, 531 infected catheterized patients, 536 interstitial cystitis as, 534 men/symptomatic, 534–535 persistent, 536 prostatitis as, 534 acute bacterial, 534–535 chronic bacterial, 535 nonbacterial, 535 prostatodynia as, 535 recurrent infection/relapse type, 536 urethral syndrome as, 533–534 urethritis as, 535 urine examinations and, 529–531 women/clinical syndromes mimicking, 533–534 women/management of first/occasional/uncomplicated, 531–532, 532t recurrent/reinfection type, 532–533 Urinary tract, lower (LUTs) examination of, 798–799 symptoms, 798, 798t therapeutic strategies for, 800–803, 801t, 802t Urine culture, 530–531 culture-negative, 531 examinations, 529–531 glucose, 1318–1319 Urodynamic testing, 810 Urogenital symptoms, 1787–1788, 1788t Urticaria acute/chronic, 450–451 management of, 451 prognosis for, 451 U.S Citizenship and Immigration Services, 632 U.S Congress, 167 U.S Department of Agriculture (USDA), 229 U.S Department of Health and Human Services (DHHS), 229, 633 U.S Department of Homeland Security, 632 U.S Department of Labor, 126 U.S Department of State, 638 U.S Immigration and Naturalization Service (INS), 632 U.S Preventive Services Task Force (USPSTF), 212, 214–221, 224 16:20 Char Count= 1961 U.S Public Health Service (USPHS), 125, 579 Agency for Toxic Substances and Disease Registry of, 129 U.S Renal Disease System, 768 U.S Surgeon General, 255 USDA See U.S Department of Agriculture USPHS See U.S Public Health Service USPSTF See U.S Preventive Services Task Force Uterine carcinoma, 1766–1767, 1766t UTIs See Urinary tract infections V Vaccination Certificate Requirements for International Travel and Health Advice to Travelers, 609 Vaccines Havrix, 615 Vaqta, 615 Vagina, 1735, 1736t Vaginal atrophy, 1739–1740 Vaginal infections, 529 Vaginismus assessment/treatments for, 86–87 diagnostic classification of, 84–85 Vaginitis, 97 Valacyclovir, 541t Valproate, 345–346 Valvular heart disease, 1618–1619 Vancomycin, 702 Vardenafil, 91 Varicella, 611t, 615 Varicose veins, 1658–1662 Vasectomy, 1712 Vasodilators, 1076–1077, 1078t Vasomotor symptoms, 1786–1787, 1793t Venereal Disease Research Laboratory, 553, 554 Venlafaxine, 87, 114, 334, 335t–336t, 338 Venous thromboembolism (VTE) diagnosis of, 848–850, 848t, 849f pregnancy/management of, 856 recurrent, 856 risk factors for, 845–848, 846t, 847t treatment of, 850–856, 850t, 852t, 853t, 854t, 855t Ventricular premature beats, 1017–1019, 1017f, 1018f Ventricular tachycardia, 1017–1019, 1017f, 1018f Vertebrae fractures, 1178–1179 Vertigo acute prolonged, 1534–1535, 1535t benign paroxysmal positional, 1536–1537, 1536f, 1536t, 1537f bilateral loss of vestibular function and, 1538–1539 disorders causing, 1534–1539, 1534t, 1535t evaluation of, 1533–1534 recurrent, 1536–1539, 1536f, 1536t, 1537t P1: PBU GRBT129-121 GRBT129/Barker- 2568G GRBT129-Barker-v14.cls 1962 May 16, 2006 16:20 Index Vibrio, 526 Vibrio vulnificus, 520, 526 Vietnamese Ameriasians, 634 Vincent angina, 488 Vincent infection (acute necrotizing ulcerative gingivitis), 1866–1867 Violence, 163–164 domestic, alcoholism and, 09t, 408–409, 408t violence prevention, 163–164 Virilization, 1729–1732 Vitamin B12 , 750, 825–828 C, 476 D, 785–786, 786f, 786t, 787f Vocational rehabilitation eligibility for, 140 physician’s role in, 141 services, 140–141 Volvulus, 677 Vomiting, 151, 523–524 Voriconazole, 598 Voyeurism, 96 VTE See Venous thromboembolism Vulva, 1734–1735, 1734t Vulvar glands, 1735 Vulvar lesions, 1762–1763 Vulvar papules, 1747–1748, 1747t Vulvar ulcerations, 1743 Vulvodynia, 86, 1749–1750, 1750f, 1750t Vulvovaginitis atrophic vaginitis as, 1739–1740 bacterial vaginosis as, 1738–1739, 1738f Bartholin gland cyst, 1743–1747, 1744t–1746t Candida and, 1735–1738, 1736t chlamydial/gonococcal infections as, 1741 condylomata acuminata as, 1747 cytolytic vaginosis as, 1740–1741 desquamative inflammatory vaginitis as, 1740–1741 hyperpigmented/hypopigmented vulva lesions as, 1748 lichen planus as, 1748–1749 lichen sclerosus as, 1748 miscellaneous lesions as, 1743–1747, 1744t–1746t pelvic inflammatory disease as, 1741–1743, 1742t syphilis as, 1743 tampon-related ulceration as, 1743 toxic shock syndrome as, 1743 trichomonas as, 1739, 1739f vaginal atrophy as, 1739–1740 vulvar papules as, 1747–1748, 1747t vulvar ulcerations as, 1743 W Warfarin, 67, 69t, 1630 Warts, 1918–1919 genital, 543–545, 544t alternative treatments for, 545–546 counseling for, 546 patient-applied therapy for, 545 provider-administered therapy for, 545 Water metabolism, disorders of hyponatremia as, 1386–1390, 1388t polyuric disorders as, 1384–1386, 1385t Waterborne outbreaks, 520 WB See Western blot WBCs See White blood counts Weber test, 1835 Weight gain, 375 loss, 1428–1429, 1432–1433 management, 245–246, 1231 Wender Utah Rating Scale, 167 Western blot (WB), 576 White blood counts (WBCs), 530, 546 WHO See World Health Organization Wilson disease, 724 Wisconsin Sleep Cohort, 114 Women alcoholism and, 404 CAD in, 967–968 Cambodian, 636–637 clinical syndromes mimicking UTIs, 533–534 health of, 1697–1700, 1698f, 1700t HIV and, 594 HSR and, 75 management of UTIs first/occasional/uncomplicated, 531–532, 532t recurrent/reinfection type, 532–533 pregnant, 508 STDs in, 529 Workers’ compensation programs, 127 World Health Assembly, 612 World Health Organization (WHO), 388 X Xerostomia, 149, 1874–1875 Xylometazolines, 444 Y Yeast infections candidiasis as, 1916 fungal culture and, 1917–1918 potassium hydroxide wet mount preparation as, 1917, 1918f tinea versicolor as, 1916–1917, 1916f, 1917t Yellow fever, 610–611, 611t, 612f, 613f Yersinia, 521 Yohimbe, 69t Yohimbine, 91 Z Zalephon, 112 Zanamivir, 483, 484t Zidovudine, 586–587t Ziehl-Nielson stain, 604 Zinc lozenges, 475, 475t Ziprasidone, 353–354, 353t ZnDTPA See Pentetate zinc trisodium Zoledronic acid, 201 Zollinger-Ellison syndrome, 666–668 Zolpidem, 112, 116, 204 Zonisamide, 1525–1526 Zoster immunizations, 275 Char Count= ... those most often used 30–45 1 2 h 30–45 1 2 h 30– 120 Several hours 20 –30 1 2 h 1–1.5 h 1 2 h 1 2 h 1 2 h 60 15–30 30 30–60 30 s Onset 6–8 h 24 h 6–8 h 24 h 8h 24 h 8h >24 h 4–6 h 24 h 24 h 24 h h... PNW GRBT 129 - 62 GRBT 129 /Barker- 25 68G GRBT 129 -Barker-v14.cls May 6, 20 06 948 11:34 Char Count= P1: PNW GRBT 129 - 62 GRBT 129 /Barker- 25 68G GRBT 129 -Barker-v14.cls •◗ C h a p t e r May 6, 20 06 • Coronary... Used in the Treatment of Anginaa Class ◗ TABLE 62. 2 P1: PNW GRBT 129 - 62 11:34 Char Count= 961 P1: PNW GRBT 129 - 62 GRBT 129 /Barker- 25 68G GRBT 129 -Barker-v14.cls 9 62 May 6, 20 06 11:34 Section / Cardiovascular