Mayo Clinic Medical Manual This page intentionally left blank Mayo Clinic Medical Manual Editors Guilherme H. M. Oliveira, M.D. Gillian C. Nesbitt, M.D. Joseph G. Murphy, M.D. MAYO CLINIC SCIENTIFIC PRESS TAYLOR & FRANCIS GROUP ISBN 0849390877 The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO CLINIC SCIENTIFIC PRESS are marks of Mayo Foundation for Medical Education and Research. ©2006 by Mayo Foundation for Medical Education and Research. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, record- ing, or otherwise—without the prior written consent of the copyright holder, except for brief quotations embodied in critical articles and reviews. Inquiries should be addressed to Scientific Publications, Plummer 10, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. For order inquiries, contact Taylor & Francis Group, 6000 Broken Sound Parkway NW, Suite #300, Boca Raton, FL 33487. www.taylorandfrancis.com Catalog record is available from the Library of Congress. Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the contents of the publication. This book should not be relied on apart from the advice of a qualified health care provider. The authors, editors, and publisher have exerted efforts to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regu- lations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the rec- ommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice. PREFACE The urge to write this book—and it was indeed an urge—arose because of two reasons. The first was the lack of a book that approached patient care from the viewpoint of on-call medical residents. New residents faced with admitting a sick patient in the middle of the night have three priorities: one, a working diagnosis; two, a management plan that will get the patient through the night; and three, deciding when to call for help from the attending physician. This on-call manual seeks to empower residents to reach a working diagnosis and to develop a short-term management plan using the clinical history, physical examination, and essential on-call investigations. The layout of the book allows the reader to look up signs, symptoms, and laboratory abnormalities; to develop a list of differential diag- noses; and to formulate a management plant. Residents were recruited to write all the chapters in conjunction with the attend- ing staff. In conclusion, this Manual intends to be a uniquely useful tool for young doctors. We hope we have been able to blend the simplicity and focus essential to the the neophyte with the knowledge and precision required by the expert. v This page intentionally left blank LIST OF CONTRIBUTORS Andrea C. Adams, M.D. Consultant, Department of Neurology, Mayo Clinic; Assistant Professor of Neurology, Mayo Clinic College of Medicine; Rochester, Minnesota Timothy R. Aksamit, M.D. Consultant, Division of Pulmonary and Critical Care Medicine, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Robert C. Albright, Jr., D.O. Consultant, Division of Nephrology and Hypertension, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Amindra S. Arora, M.B.B.Chir. Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Rendell W. Ashton, M.D. Fellow in Pulmonary and Critical Care Medicine, Mayo School of Graduate Medical Education and Instructor in Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota Rebecca S. Bahn, M.D. Consultant, Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic; Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Kiran M. Bambha, M.D. Fellow in Gastroenterology and Hepatology, Mayo School of Graduate Medical Education and Instructor in Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota J. D. Bartleson, M.D. Consultant, Department of Neurology, Mayo Clinic; Associate Professor of Neurology, Mayo Clinic College of Medicine; Rochester, Minnesota T. Jared Bunch, M.D. Fellow in Cardiovascular Diseases, Mayo School of Graduate Medical Education and Assistant Professor of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota John B. Bundrick, M.D. Consultant, Division of General Internal Medicine, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota vii Kevin A. Bybee, M.D. Resident in Cardiovascular Diseases, Mayo School of Graduate Medical Education and Instructor, Mayo Clinic College of Medicine, Rochester, Minnesota Casey R. Caldwell, M.D. Consultant, Division of Primary Care Internal Medicine, Mayo Clinic; Instructor in Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Sean M. Caples, D.O. Senior Associate Consultant, Division of Pulmonary and Critical Care Medicine, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Paul E. Carns, M.D. Consultant, Department of Anesthesiology, Mayo Clinic; Assistant Professor of Anesthesiology, Mayo Clinic College of Medicine; Rochester, Minnesota Gregory D. Cascino, M.D. Consultant, Department of Neurology, Mayo Clinic; Professor of Neurology, Mayo Clinic College of Medicine; Rochester, Minnesota Yoon-Hee K. Cha, M.D. Formerly, Student, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota; presently, Chief Resident in Neurology, UCSF, San Francisco, California Suresh T. Chari, M.D. Consultant, Division of Gastroenterology and Hepatology, Mayo Clinic; Associate Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Lin Y. Chen, M.D. Resident in Internal Medicine, Mayo Graduate School of Medicine; Instructor in Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Lisa S. Chow, M.D. Fellow in Endocrinology, Diabetes, Metabolism, Nutrition, Mayo School of Graduate Medical Education and Instructor in Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota David Allan Cook, M.D. Resident in Gastroenterology and Hepatology, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota Douglas J. Creedon, M.D. Senior Associate Consultant, Division of Obstetrics, Mayo Clinic, Rochester, Minnesota Arjun Deb, M.D. Resident in Cardiovascular Diseases, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota viii Ives R. De Chazal, M.D. Fellow in Critical Care Medicine, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota Ramona S. deJesus, M.D. Senior Associate Consultant, Division of Primary Care Internal Medicine, Mayo Clinic; Instructor in Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Shamina Dhillon, M.D. Fellow in Gastroenterology and Hepatology, Mayo School of Graduate Medical Education and Instructor in Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota Lisa A. Drage, M.D. Consultant, Department of Dermatology, Mayo Clinic; Assistant Professor of Dermatology, Mayo Clinic College of Medicine; Rochester, Minnesota William F. Dunn, M.D. Consultant, Division of Pulmonary and Critical Care Medicine, Mayo Clinic; Associate Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Grace K. Dy, M.D. Fellow in Pulmonary and Critical Care Medicine, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota Jon O. Ebbert, M.D., M.Sc. Consultant, Division of Primary Care Internal Medicine, Mayo Clinic; Assistant Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Randall S. Edson, M.D. Consultant, Division of Infectious Diseases, Mayo Clinic; Professor of Medicine, Mayo Clinic College of Medicine; Rochester, Minnesota Scott D. Eggers, M.D. Senior Associate Consultant, Department of Neurology, Mayo Clinic; Assistant Professor of Neurology, Mayo Clinic College of Medicine; Rochester, Minnesota Lynn L. Estes, Pharm.D. Infectious Disease Pharmacist Specialist, Mayo Clinic; Assistant Professor of Pharmacy, Mayo Clinic College of Medicine; Rochester, Minnesota Luke T. Evans, M.D. Resident in Gastroenterology and Hepatology, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota Fernando C. Fervenza, M.D. Consultant, Division of Nephrology, Mayo Clinic; Associate Professor of Medicine,