Table Of ContentFOURTH EDITION
CASE FILES
®
Internal Medicine
Eugene C. Toy, MD
The John S. Dunn, Senior Academic Chair and Program Director
The Methodist Hospital Ob/Gyn Residency Program
Houston, Texas
Vice Chair of Academic Affairs
Department of Obstetrics and Gynecology
The Methodist Hospital
Houston, Texas
Clinical Professor and Clerkship Director
Department of Obstetrics and Gynecology
University of Texas Medical School at Houston
Houston, Texas
Associate Clinical Professor
Weill Cornell College of Medicine
John T. Patlan Jr., MD
Associate Professor of Medicine
Department of General Internal Medicine
MD Anderson Cancer Center
Houston, Texas
New York Chicago San Francisco Lisbon London Madrid Mexico City Milan
New Delhi San Juan Seoul Singapore Sydney Toronto
00_Toy-IM_FM_pi-xiv.indd i 10/13/12 12:32 PM
Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written permission
of the publisher.
ISBN: 978-0-07-176853-5
MHID: 0-07-176853-X
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-176172-7,
MHID: 0-07-176172-1.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every
occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the
trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales
promotions, or for use in corporate training programs. To contact a representative please e-mail us at
[email protected].
Case Files® is a registered trademark of The McGraw-Hill Companies, Inc. All rights reserved.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge,
changes in treatment and drug therapy are required. The authors and the publisher of this work have
checked with sources believed to be reliable in their efforts to provide information that is complete
and generally in accord with the standard accepted at the time of publication. However, in view of the
possibility of human error or changes in medical sciences, neither the editors nor the publisher nor
any other party who has been involved in the preparation or publication of this work warrants that the
information contained herein is in every respect accurate or complete, and they disclaim all responsibility
for any errors or omissions or for the results obtained from use of the information contained in this work.
Readers are encouraged to confi rm the information contained herein with other sources. For example and
in particular, readers are advised to check the product information sheet included in the package of each
drug they plan to administer to be certain that the information contained in this work is accurate and that
changes have not been made in the recommended dose or in the contraindications for administration. This
recommendation is of particular importance in connection with new or infrequently
used drugs.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors
reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under
the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute,
disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent.
You may use the work for your own noncommercial and personal use; any other use of the work is strictly
prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO
GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETE-
NESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY
INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or
guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for
any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom.
McGraw-Hill has no responsibility for the content of any information accessed through the work. Under
no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special,
punitive, consequential or similar damages that result from the use of or inability to use the work, even if
any of them has been advised of the possibility of such damages. This limitation of liability shall apply to
any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
DEDICATION
To our coach Victor, and our father-son teammates Bob & Jackson, Steve
& Weston, Ron & Wesley, and Dan & Joel. At the inspirational JH Ranch
Father-Son Retreat, all of us, including my loving son Andy, arrived as
strangers, but in 6 days, we left as lifelong friends.
– ECT
To my parents who instilled an early love of learning and of the written word,
and who continue to serve as role models for life.
To my beautiful wife Elsa and children Sarah and Sean, for their patience and
understanding, as precious family time was devoted to the completion of
“the book.”
To all my teachers, particularly Drs. Carlos Pestaña, Robert Nolan, Herbert
Fred, and Cheves Smythe, who make the complex understandable, and who
have dedicated their lives to the education of physicians, and served as role
models of healers.
To the medical students and residents at the University of Texas-Houston Medical
School whose enthusiasm, curiosity, and pursuit of excellent and compassionate
care provide a constant source of stimulation, joy, and pride.
To all readers of this book everywhere in the hopes that it might help them to grow
in wisdom and understanding, and to provide better care for their patients who
look to them for comfort and relief of suffering.
And to the Creator of all things, Who is the source of all knowledge and healing
power, may this book serve as an instrument of His will.
– JTP
00_Toy-IM_FM_pi-xiv.indd iii 10/13/12 12:32 PM
This page intentionally left blank
CONTENTS
Reviewers / vii
Preface / ix
Acknowledgments / xi
Introduction / xiii
Section I
How to Approach Clinical Problems ........................................................................1
Part 1. Approach to the Patient. ...............................................................................2
Part 2. Approach to Clinical Problem Solving .........................................................9
Part 3. Approach to Reading ..................................................................................12
Section II
Clinical Cases ..........................................................................................................17
Sixty Case Scenarios ...............................................................................................19
Section III
Listing of Cases .....................................................................................................521
Listing by Case Number .......................................................................................523
Listing by Disorder (Alphabetical) .......................................................................524
Index / 527
00_Toy-IM_FM_pi-xiv.indd v 10/13/12 12:32 PM
This page intentionally left blank
REVIEWERS
Adam Banks
University of Texas – Houston Medical School
Class of 2012
Irving Basan~ez
University of Texas – Houston Medical School
Class of 2012
Hubert M. Chodkiewicz
University of Texas – Houston Medical School
Class of 2012
Stephen Fisher
University of Texas – Houston Medical School
Class of 2012
Amber Gill
University of Texas – Houston Medical School
Class of 2012
Alicia Hernandez
University of Texas – Houston Medical School
Class of 2013
Matthew Hogue
University of Texas – Houston Medical School
Class of 2012
Michael Holmes
University of Texas – Houston Medical School
Class of 2012
Cassandra Kuchta
University of Texas – Houston Medical School
Class of 2013
Luke Martin
University of Texas – Houston Medical School
Class of 2012
Colin J. Massey
University of Texas – Houston Medical School
Class of 2012
Janice Wilson
University of Texas – Houston Medical School
Class of 2012
vii
00_Toy-IM_FM_pi-xiv.indd vii 10/13/12 12:32 PM
This page intentionally left blank
PREFACE
I have been deeply amazed and grateful to see how the Case Files® books have been
so well received, and have helped students to learn more effectively. In the 10 short
years since Case Files®: Internal Medicine has first made it in print, the series has
now multiplied to span the most of the clinical and the basic science disciplines,
and has been translated into over a dozen foreign languages. Numerous students
have sent encouraging remarks, suggestions, and recommendations, Three com-
pletely new cases have been written. Updated or new sections include health main-
tenance, nephritic syndrome, arthritis, diabetes, heart failure, and hyperlipidemia.
This fourth edition has been a collaborative work with my wonderful coauthors and
contributors, and with the suggestions from four generations of students. Truly, the
enthusiastic encouragement from students throughout not just the United States
but worldwide provides me the inspiration and energy to continue to write. It is thus
with humility that I offer my sincere thanks to students everywhere ... for without
students, how can a teacher teach?
Eugene C. Toy
ix
00_Toy-IM_FM_pi-xiv.indd ix 10/13/12 12:32 PM
