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Board Review from ACP MEDICINE BOARD REVIEW FROM MEDSCAPE Case-Based InternalInternal Medicine Self-Assessment Questions CLINICAL ESSENTIALS CARDIOVASCULAR MEDICINE DERMATOLOGY ENDOCRINOLOGY GASTROENTEROLOGY HEMATOLOGY IMMUNOLOGY/ALLERGY INFECTIOUS DISEASE INTERDISCIPLINARY MEDICINE METABOLISM NEPHROLOGY NEUROLOGY ONCOLOGY PSYCHIATRY RESPIRATORY MEDICINE RHEUMATOLOGY www.acpmedicine.com BOARD REVIEW FROM MEDSCAPE Case-Based Internal Medicine Self-Assessment Questions Director of Publishing Cynthia M. Chevins Director, Electronic Publishing Liz Pope Managing Editor Erin Michael Kelly Development Editors Nancy Terry, John Heinegg Senior Copy Editor John J. Anello Copy Editor David Terry Art and Design Editor Elizabeth Klarfeld Electronic Composition Diane Joiner, Jennifer Smith Manufacturing Producer Derek Nash © 2005 WebMD Inc. All rights reserved. No part of this book may be reproduced in any form by any means, including photocopying, or translated, trans- mitted, framed, or stored in a retrieval system other than for personal use without the written permission of the publisher. Printed in the United States of America ISBN: 0-9748327-7-4 Published by WebMD Inc. Board Review from Medscape WebMD Professional Publishing 111 Eighth Avenue Suite 700, 7th Floor New York, NY 10011 1-800-545-0554 1-203-790-2087 1-203-790-2066 [email protected] The authors, editors, and publisher have conscientiously and carefully tried to ensure that recommended measures and drug dosages in these pages are accurate and conform to the standards that prevailed at the time of publication. The reader is advised, however, to check the product information sheet accompanying each drug to be familiar with any changes in the dosage schedule or in the contra- indications. This advice should be taken with particular seriousness if the agent to be administered is a new one or one that is infre- quently used. Board Review from Medscape describes basic principles of diagnosis and therapy. Because of the uniqueness of each patient and the need to take into account a number of concurrent considerations, however, this information should be used by physicians only as a general guide to clinical decision making. Board Review from Medscape is derived from the ACP Medicine CME program, which is accredited by the University of Alabama School of Medicine and Medscape, both of whom are accredited by the ACCME to provide continuing medical education for physicians. Board Review from Medscape is intended for use in self-assessment, not as a way to earn CME credits. EDITORIAL BOARD Editor-in-Chief Janet B. Henrich, M.D. David C. Dale, M.D., F.A.C.P. Associate Professor of Medicine and Obstetrics and Professor of Medicine, University of Washington Gynecology, Yale University School of Medicine, New Medical Center, Seattle, Washington Haven, Connecticut (Hematology, Infectious Disease, and General Internal (Women’s Health) Medicine) William L. Henrich, M.D., F.A.C.P. Founding Editor Professor and Chairman, Department of Medicine, Daniel D. Federman, M.D., M.A.C.P. University of Maryland School of Medicine, Baltimore, The Carl W. Walter Distinguished Professor of Medicine Maryland and Medical Education and Senior Dean for Alumni (Nephrology) Relations and Clinical Teaching, Harvard Medical School, Boston, Massachusetts Michael J. Holtzman, M.D. Selma and Herman Seldin Professor of Medicine, and Director, Division of Pulmonary and Critical Care Associate Editors Medicine, Washington University School of Medicine, Karen H. Antman, M.D. St. Louis, Missouri Deputy Director for Translational and Clinical Science, (Respiratory Medicine) National Cancer Institute, National Institutes of Health, Bethesda, Maryland Mark G. Lebwohl, M.D. (Oncology) Sol and Clara Kest Professor and Chairman, Department of Dermatology, Mount Sinai School of Medicine, New John P. Atkinson, M.D., F.A.C.P. York, New York Samuel B. Grant Professor and Professor of Medicine (Dermatology) and Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri Wendy Levinson, M.D., F.A.C.P. (Immunology) Vice Chairman, Department of Medicine, The University of Toronto, and Associate Director, Research Christine K. Cassel, M.D., M.A.C.P. Administration, Saint Michael’s Hospital, Toronto, President, American Board of Internal Medicine, Ontario, Canada Philadelphia, Pennsylvania (Evidence-Based Medicine and General Internal Medicine) (Ethics, Geriatrics, and General Internal Medicine) Mark Feldman, M.D., F.A.C.P. D. Lynn Loriaux, M.D., Ph.D., M.A.C.P. Professor of Medicine and Chair, Department of William O. Tschumy, Jr., M.D., Chair of Internal Medicine, Oregon Health Sciences University, Portland, Medicine and Clinical Professor of Internal Medicine, Oregon University of Texas Southwestern Medical School of (Endocrinology and Metabolism) Dallas; and Director, Internal Medicine Residency Program, Presbyterian Hospital of Dallas, Dallas, Texas (Gastroenterology) Shaun Ruddy, M.D., F.A.C.P. Elam C. Toone Professor of Internal Medicine, Raymond J. Gibbons, M.D. Microbiology and Immunology, and Professor Emeritus, Director, Nuclear Cardiology Laboratory, The Mayo Division of Rheumatology, Allergy and Immunology, Clinic, Rochester, Minnesota Medical College of Virginia at Commonwealth (Cardiology) University, Richmond, Virginia (Rheumatology) Brian Haynes, M.D., Ph.D., F.A.C.P. Professor of Clinical Epidemiology and Medicine and Jerry S. Wolinsky, M.D. Chair, Department of Clinical Epidemiology and The Bartels Family Professor of Neurology, The Biostatistics, McMaster University Health Sciences University of Texas Health Science Center at Houston Centre, Hamilton, Ontario, Canada Medical School, and Attending Neurologist, Hermann (Evidence-Based Medicine, Medical Informatics, and General Hospital, Houston, Texas Internal Medicine) (Neurology) CONTENTS EDITORIAL BOARD PREFACE CLINICAL ESSENTIALS Ethical and Social Issues 1 Reducing Risk of Injury and Disease 2 Diet and Exercise 3 Adult Preventive Health Care 7 Health Advice for International Travelers 7 Quantitative Aspects of Clinical Decision Making 11 Palliative Medicine 12 Symptom Management in Palliative Medicine 15 Psychosocial Issues in Terminal Illnessc 17 Complementary and Alternative Medicine 20 1 CARDIOVASCULAR MEDICINE Heart Failure 1 Hypertension 7 Atrial Fibrillation 12 Supraventricular Tachycardia 14 Pacemaker Therapy 15 Acute Myocardial Infarction 18 Chronic Stable Anginai 25 Unstable Angina/Non–ST Segment Elevation MI 30 Diseases of the Aorta 31 Pericardium, Cardiac Tumors, and Cardiac Trauma 35 Congenital Heart Disease 39 Peripheral Arterial Disease 43 Venous Thromboembolism 45 2 DERMATOLOGY Cutaneous Manifestations of Systemic Diseases 1 Papulosquamous Disorders 3 Psoriasis 5 Eczematous Disorders, Atopic Dermatitis, Ichthyoses and 9 Contact Dermatitis and Related Disorders 11 Cutaneous Adverse Drug Reactions 13 Fungal, Bacterial, and Viral Infections of the Skin 17 Parasitic Infestations 19 Vesiculobullous Diseases 21 Malignant Cutaneous Tumors 23 Benign Cutaneous Tumors 26 Acne Vulgaris and Related Disorders 29 Disorders of Hair 31 Diseases of the Nail 33 Disorders of Pigmentation 35 3 ENDOCRINOLOGY Testes and Testicular Disorders 1 The Adrenal 3 Calcium Metabolism and Metabolic Bone Disease 5 Genetic Diagnosis and Counseling 8 Hypoglycemia 13 Obesity 15 4 GASTROENTEROLOGY Esophageal Disorders 1 Peptic Ulcer Diseases 2 Diarrheal Diseases 5 Inflammatory Bowel Disease 6 Diseases of the Pancreas 8 Gallstones and Biliary Tract Disease 11 Gastrointestinal Bleeding 16 Malabsorption and Maldigestion 17 Diverticulosis, Diverticulitis, and Appendicitis 21 Enteral and Parenteral Nutritional Support 22 Gastrointestinal Motility Disorders 24 Liver and Pancreas Transplantation 25 5 HEMATOLOGY Approach to Hematologic Disorders 1 Red Blood Cell Function and Disorders of Iron Metabolism 4 Anemia: Production Defects 5 Hemoglobinopathies and Hemolytic Anemia 10 The Polycythemias 15 Nonmalignant Disorders of Leukocytes 17 Transfusion Therapy 22 Hematopoietic Cell Transplantation 26 Hemostasis and Its Regulation 31 Hemorrhagic Disorders 33 Thrombotic Disorders 35 6 IMMUNOLOGY/ALLERGY Innate Immunity 1 Histocompatibility Antigens/Immune Response Genes 3 Immunogenetics of Disease 5 Immunologic Tolerance and Autoimmunity 7 Allergic Response 8 Diagnostic and Therapeutic Principles in Allergy 10 Allergic Rhinitis, Conjunctivitis, and Sinusitis 11 Urticaria, Angioedema, and Anaphylaxis 14 Drug Allergies 16 Allergic Reactions to Hymenoptera 18 Food Allergies 21 7 INFECTIOUS DISEASE Infections Due to Gram-Positive Cocci 1 Infections Due to Mycobacteria 8 Infections Due to Neisseria 14 Anaerobic Infections 16 Syphilis and Nonvenereal Treponematoses 21 E. coli and Other Enteric Gram-Negative Bacilli 24 Campylobacter, Salmonella, Shigella, Yersinia, Vibrio, Helicobacter 27 Haemophilus, Moraxella, Legionella, Bordetella, Pseudomonas 30 Brucella, Francisella, Yersinia Pestis, Bartonella 33 Diseases Due to Chlamydia 36 Antimicrobial Therapy 40 Septic Arthritis 45 Osteomyelitis 50 Rickettsia, Ehrlichia, Coxiella 52 Infective Endocarditis 54 Bacterial Infections of the Upper Respiratory Tract 57 Pneumonia and Other Pulmonary Infections 64 Peritonitis and Intra-abdominal Abscesses 72 Vaginitis and Sexually Transmitted Diseases 75 Urinary Tract Infections 77 Hyperthermia, Fever, and Fever of Undetermined Origin 79 Respiratory Viral Infections 82 Herpesvirus Infections 84 Enteric Viral Infections 88 Measles, Mumps, Rubella, Parvovirus, and Poxvirus 90 Viral Zoonoses 93 Human Retroviral Infections
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