Table Of ContentLANGE
2009
CURRENT
Medical Diagnosis
& Treatment
FO R T Y - E I G H T H E D I T I O N
Edited by
Stephen J. McPhee, MD
Professor of Medicine
Division of General Internal Medicine
Department of Medicine
University of California, San Francisco
Maxine A. Papadakis, MD
Professor of Clinical Medicine
Associate Dean for Student Affairs
School of Medicine
University of California, San Francisco
With Associate Authors
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
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Contents
Authors ix Urinary Incontinence 66
Preface xv Weight Loss & Malnutrition 68
Pressure Ulcers 69
1. Disease Prevention & Health Promotion 1 Pharmacotherapy & Polypharmacy 70
Vision Impairment 70
Michael Pignone, MD, MPH, & René Salazar, MD Hearing Impairment 70
Prevention of Infectious Diseases 3 Elder Abuse 71
Prevention of Cardiovascular Disease 6
Prevention of Osteoporosis 11 5. Palliative Care & Pain Management 72
Prevention of Physical Inactivity 12 Michael W. Rabow, MD, & Steven Z. Pantilat, MD
Prevention of Overweight & Obesity 13
Cancer Prevention 15 Definition & Scope of Palliative Care 72
Prevention of Injuries & Violence 17 Pain Management 72
Substance Abuse: Alcohol & Illicit Drugs 18 Principles of Pain Management 72
Pain at the End of Life 73
2. Common Symptoms 21 Pharmacologic Pain Management Strategies 74
Nonpharmacologic Treatments 82
Ralph Gonzales, MD, MSPH, & Paul L. Nadler, MD Palliation of Other Common Symptoms 82
Cough 21 Dyspnea 82
Dyspnea 23 Nausea & Vomiting 82
Hemoptysis 26 Constipation 83
Chest Pain 27 Delirium & Agitation 83
Palpitations 29 End-of-Life Care 83
Lower Extremity Edema 31
Fever & Hyperthermia 33 6. Dermatologic Disorders 90
Involuntary Weight Loss 35 Timothy G. Berger, MD
Fatigue & Chronic Fatigue Syndrome 36
Acute Headache 38 Principles of Dermatologic Therapy 90
Dysuria 40 Common Dermatoses 95
Pigmented Lesions 95
3. Preoperative Evaluation Scaling Disorders 97
& Perioperative Management 44 Vesicular Dermatoses 109
Weeping or Crusted Lesions 114
Joshua S. Adler, MD, & Hugo Q. Cheng, MD Pustular Disorders 116
Evaluation of the Asymptomatic Patient 44 Erythemas 121
Cardiac Risk Assessment & Reduction 44 Blistering Diseases 126
Pulmonary Evaluation in Non–Lung Resection Papules 127
Surgery 48 Violaceous to Purple Papules & Nodules 130
Evaluation of the Patient with Liver Disease 49 Pruritus (Itching) 131
Preoperative Hematologic Evaluation 50 Inflammatory Nodules 136
Neurologic Evaluation 51 Epidermal Inclusion Cyst 137
Management of Endocrine Diseases 52 Photodermatitis 138
Renal Disease 54 Ulcers 139
Antibiotic Prophylaxis of Surgical Site Miscellaneous Dermatologic Disorders 140
Infections 54 Pigmentary Disorders 140
Baldness (Alopecia) 141
4. Geriatric Disorders 56 Nail Disorders 142
C. Bree Johnston, MD, MPH, G. Michael Harper, MD, Dermatitis Medicamentosa (Drug Eruption) 143
& C. Seth Landefeld, MD 7. Disorders of the Eyes & Lids 147
Assessment of the Older Adult 56
Management of Common Geriatric Problems 58 Paul Riordan-Eva, FRCS, FRCOphth
Dementia 58 Refractive Errors 147
Depression 62 Disorders of the Lids & Lacrimal Apparatus 148
Delirium 63 Conjunctivitis 149
Immobility 64 Pinguecula & Pterygium 151
Falls & Gait Disorders 64 Corneal Ulcer 152
iii
iv CMDT 2009 CONTENTS
Acute Angle-Closure Glaucoma 153 Coronary Heart Disease (Atherosclerotic
Chronic Glaucoma 154 Coronary Artery Disease,
Uveitis 155 Ischemic Heart Disease) 308
Cataract 156 Disturbances of Rate & Rhythm 331
Retinal Detachment 157 Bradycardias & Conduction Disturbances 344
Vitreous Hemorrhage 158 Congestive Heart Failure 348
Age-Related Macular Degeneration 158 Myocarditis & the Cardiomyopathies 358
Central & Branch Retinal Vein Occlusions 159 Acute Rheumatic Fever & Rheumatic
Central & Branch Retinal Artery Occlusions 159 Heart Disease 364
Amaurosis Fugax 160 Diseases of the Pericardium 366
Retinal Disorders Associated with Pulmonary Hypertension & Pulmonary
Systemic Diseases 161 Heart Disease 370
Ischemic Optic Neuropathy 163 Neoplastic Diseases of the Heart 372
Optic Neuritis 163 Cardiac Involvement in Miscellaneous
Optic Disk Swelling 164 Systemic Diseases 373
Ocular Motor Palsies 164 Traumatic Heart Disease 373
Dysthyroid Eye Disease 164 The Cardiac Patient & Pregnancy 374
Orbital Cellulitis 165 Cardiovascular Screening of Athletes 375
Ocular Trauma 165
Ultraviolet Keratitis (Actinic Keratitis) 166 11. Systemic Hypertension 376
Chemical Conjunctivitis & Keratitis 166 Michael Sutters, MD, MRCP (UK)
Treatment of Ocular Disorders 167
Approach to Hypertension 377
Precautions in Management of
Drug Therapy: Current Antihypertensive Agents 387
Ocular Disorders 167
Resistant Hypertension 400
Adverse Ocular Effects of Systemic Drugs 171
Hypertensive Urgencies & Emergencies 400
8. Ear, Nose, & Throat Disorders 173
12. Blood Vessel & Lymphatic Disorders 404
Lawrence R. Lustig, MD, & Joshua Schindler, MD
Joseph H. Rapp, MD, Rajabrata Sarkar, MD, PhD,
Diseases of the Ear 173 & Catherine K. Chang, MD
Diseases of the Nose & Paranasal Sinuses 186
Atherosclerotic Peripheral Vascular Disease 404
Diseases of the Oral Cavity & Pharynx 195
Nonatherosclerotic Vascular Disease 411
Diseases of the Salivary Glands 200
Arterial Aneurysms 412
Diseases of the Larynx 201
Venous Diseases 416
Tracheostomy & Cricothyrotomy 206
Diseases of the Lymphatic Channels 421
Foreign Bodies in the Upper Aerodigestive Tract 206
Shock 422
Diseases Presenting as Neck Masses 207
13. Blood Disorders 427
9. Pulmonary Disorders 209
Charles A. Linker, MD
Mark S. Chesnutt, MD, James A. Murray, DO,
& Thomas J. Prendergast, MD Anemias 427
Neutropenia 444
Disorders of the Airways 209
Leukemias & Other Myeloproliferative Disorders 444
Pulmonary Infections 237
Lymphomas 457
Pulmonary Neoplasms 253
Stem Cell Transplantation 462
Interstitial Lung Disease (Diffuse Parenchymal
Blood Transfusions 464
Lung Disease) 255
Disorders of the Pulmonary Circulation 260 14. Disorders of Hemostasis
Environmental & Occupational Lung & Antithrombotic Therapy 467
Disorders 269
Pleural Diseases 275 Patrick F. Fogarty, MD
Disorders of Control of Ventilation 280 Platelet Disorders 467
Acute Respiratory Failure 282 Disorders of Coagulation 477
Acute Respiratory Distress Syndrome 284 Antithrombotic Therapy 482
10. Heart Disease 287 15. Gastrointestinal Disorders 487
Thomas M. Bashore, MD, Christopher B. Granger, MD, Kenneth R. McQuaid, MD
Patrick Hranitzky, MD, & Manesh R. Patel, MD Symptoms & Signs of Gastrointestinal Disease 487
Congenital Heart Disease 287 Diseases of the Peritoneum 508
Valvular Heart Disease 294 Diseases of the Esophagus 513
䊲
CONTENTS CMDT 2009 v
Diseases of the Stomach & Duodenum 529 Nutrition in Pregnancy 689
Diseases of the Small Intestine 542 Travel & Immunizations during Pregnancy 690
Diseases of the Colon & Rectum 554 Vomiting of Pregnancy (Morning Sickness)
Anorectal Diseases 577 & Hyperemesis Gravidarum (Pernicious
Vomiting of Pregnancy) 690
16. Liver, Biliary Tract, Spontaneous Abortion 690
& Pancreas Disorders 582 Recurrent (Habitual) Abortion 692
Ectopic Pregnancy 692
Lawrence S. Friedman, MD
Preeclampsia-Eclampsia 693
Jaundice 582 Gestational Trophoblastic Disease
Diseases of the Liver 585 (Hydatidiform Mole & Choriocarcinoma) 696
Diseases of the Biliary Tract 616 Third-Trimester Bleeding 697
Diseases of the Pancreas 623 Medical Conditions Complicating Pregnancy 697
Surgical Complications during Pregnancy 704
17. Breast Disorders 630
Prevention of Hemolytic Disease of the
Armando E. Giuliano, MD Newborn (Erythroblastosis Fetalis) 705
Prevention of Preterm (Premature) Labor 705
Benign Breast Disorders 630
Lactation 706
Fibrocystic Condition 630
Puerperal Mastitis 707
Fibroadenoma of the Breast 631
Nipple Discharge 632
20. Musculoskeletal &
Fat Necrosis 632
Immunologic Disorders 708
Breast Abscess 632
Disorders of the Augmented Breast 633 David B. Hellmann, MD, MACP,
Carcinoma of the Female Breast 633 & John B. Imboden, Jr., MD
Carcinoma of the Male Breast 653 Diagnosis & Evaluation 708
Degenerative & Crystal-Induced Arthritis 708
18. Gynecologic Disorders 655
Pain Syndromes 715
H. Trent MacKay, MD, MPH Autoimmune Diseases 726
Vasculitis Syndromes 743
Abnormal Premenopausal Bleeding 655
Seronegative Spondyloarthropathies 752
Postmenopausal Vaginal Bleeding 657
Infectious Arthritis 755
Premenstrual Syndrome (Premenstrual Tension) 657
Infections of Bones 758
Dysmenorrhea 658
Other Rheumatic Disorders 761
Vaginitis 658
Allergic Diseases 762
Cervical Polyps 660
Atopic Disease 763
Cyst & Abscess of Bartholin Duct 660
Primary Immunodeficiency Disorders 764
Effects of Exposure to Diethylstilbestrol in Utero 660
Cervical Intraepithelial Neoplasia (Dysplasia 21. Fluid & Electrolyte Disorders 766
of the Cervix) 661
Carcinoma of the Cervix 663 Kerry C. Cho, MD, Masafumi Fukagawa, MD, PhD,
Leiomyoma of the Uterus (Fibroid Tumor) 664 & Kiyoshi Kurokawa, MD, MACP
Carcinoma of the Endometrium 665 Disorders of Sodium Concentration 767
Carcinoma of the Vulva 666 Hyperosmolar Disorders & Osmolar Gaps 773
Endometriosis 667 Disorders of Potassium Concentration 773
Pelvic Organ Prolapse 668 Disorders of Calcium Concentration 776
Pelvic Inflammatory Disease (Salpingitis, Disorders of Phosphorus Concentration 780
Endometritis) 668 Disorders of Magnesium Concentration 782
Ovarian Cancer & Ovarian Tumors 670 Acid–Base Disorders 784
Polycystic Ovary Syndrome 671 Fluid Management 793
Female Sexual Dysfunction 672
Infertility 673 22. Kidney Disease 794
Contraception 675
Suzanne Watnick, MD, & Gail Morrison, MD
Rape 682
Menopausal Syndrome 683 Assessment of Renal Disease 794
Acute Renal Failure 797
19. Obstetrics & Obstetric Disorders 686 Chronic Kidney Disease 803
Glomerulonephropathies 811
William R. Crombleholme, MD Nephrotic Disease in Primary
Diagnosis of Pregnancy 686 Renal Disorders 817
Essentials of Prenatal Care 686 Nephrotic Disease from Systemic Disorders 819
䊲
vi CMDT 2009 CONTENTS
Diseases Demonstrating Nephritic Discogenic Neck Pain 903
& Nephrotic Components 820 Brachial & Lumbar Plexus Lesions 906
Tubulointerstitial Diseases 821 Disorders of Neuromuscular Transmission 906
Cystic Diseases of the Kidney 823 Myopathic Disorders 909
Multisystem Diseases with Variable Kidney Periodic Paralysis Syndrome 911
Involvement 825
25. Psychiatric Disorders 912
23. Urologic Disorders 827
Stuart J. Eisendrath, MD, &
Marshall L. Stoller, MD, Christopher J. Kane, MD, FACS, Jonathan E. Lichtmacher, MD
& Maxwell V. Meng, MD, FACS Common Psychiatric Disorders 912
Hematuria 827 Substance Use Disorders (Drug Dependency,
Genitourinary Tract Infections 828 Drug Abuse) 951
Acute Cystitis 828 Delirium, Dementia, & Other Cognitive
Acute Pyelonephritis 829 Disorders (Formerly: Organic
Acute Bacterial Prostatitis 830 Brain Syndrome) 959
Chronic Bacterial Prostatitis 831 Psychiatric Problems Associated with
Nonbacterial Prostatitis 831 Hospitalization & Illness 962
Prostatodynia 832
Acute Epididymitis 832 26. Endocrine Disorders 965
Urinary Stone Disease 833
Paul A. Fitzgerald, MD
Interstitial Cystitis 837
Male Erectile Dysfunction & Diseases of the Hypothalamus & Pituitary Gland 965
Sexual Dysfunction 838 Diseases of the Thyroid Gland 976
Male Infertility 840 The Parathyroids 1004
Benign Prostatic Hyperplasia 842 Metabolic Bone Disease 1012
Diseases of the Adrenal Cortex 1020
24. Nervous System Disorders 848 Pheochromocytoma & Paraganglioma 1031
Pancreatic & Duodenal
Michael J. Aminoff, MD, DSc, FRCP
Neuroendocrine Tumors 1034
Headache 848 Diseases of the Testes & Male Breast 1035
Facial Pain 852 Amenorrhea & Menopause 1040
Epilepsy 854 Multiple Endocrine Neoplasia 1048
Dysautonomia 860 Clinical Use of Corticosteroids 1050
Sensory Disturbances 861
Weakness & Paralysis 862 27. Diabetes Mellitus & Hypoglycemia 1052
Transient Ischemic Attacks 862
Umesh Masharani, MB, BS, MRCP(UK)
Stroke 864
Intracranial & Spinal Tumors 873 Diabetes Mellitus 1052
Nonmetastatic Neurologic Complications Diabetic Coma 1083
of Malignant Disease 878 The Hypoglycemic States 1089
Pseudotumor Cerebri (Benign Intracranial
28. Lipid Disorders 1095
Hypertension) 878
Selected Neurocutaneous Diseases 879 Robert B. Baron, MD, MS
Movement Disorders 880
Lipoproteins & Atherogenesis 1095
Dementia 887
Lipid Fractions & the Risk of Coronary
Multiple Sclerosis 887
Heart Disease 1096
Vitamin E Deficiency 889
Therapeutic Effects of Lowering Cholesterol 1096
Spasticity 889
Secondary Conditions That Affect
Myelopathies in AIDS 890
Lipid Metabolism 1097
Myelopathy of Human T Cell Leukemia
Clinical Presentations 1098
Virus Infection 890
Screening for High Blood Cholesterol 1098
Subacute Combined Degeneration of the
Treatment of High Low-Density
Spinal Cord 890
Lipoprotein Cholesterol 1101
Wernicke Encephalopathy 890
High Blood Triglycerides 1104
Stupor & Coma 890
Head Injury 893 29. Nutritional Disorders 1107
Spinal Trauma 894
Syringomyelia 895 Robert B. Baron, MD, MS
Degenerative Motor Neuron Diseases 895 Protein-Energy Malnutrition 1107
Peripheral Neuropathies 896 Obesity 1108
䊲
CONTENTS CMDT 2009 vii
Eating Disorders 1111 Spotted Fevers 1250
Disorders of Vitamin Metabolism 1113 Other Rickettsial & Rickettsial-Like Diseases 1252
Diet Therapy 1118 Kawasaki Disease 1254
Nutritional Support 1120
33. Bacterial & Chlamydial Infections 1256
30. Common Problems in Infectious
Brian S. Schwartz, MD, & Henry F. Chambers, MD
Diseases & Antimicrobial Therapy 1126
Infections Caused by Gram-Positive Bacteria 1256
Richard A. Jacobs, MD, PhD,
Infective Endocarditis 1270
B. Joseph Guglielmo, PharmD,
Infections Caused by Gram-Negative Bacteria 1275
& Peter V. Chin-Hong, MD
Actinomycosis 1290
Common Problems in Infectious Diseases 1126 Nocardiosis 1291
Fever of Unknown Origin 1126 Infections Caused by Mycobacteria 1291
Infections in the Immunocompromised Patient 1128 Infections Caused by Chlamydiae 1294
Hospital-Associated Infections 1132
Infections of the Central Nervous System 1135 34. Spirochetal Infections 1297
Animal & Human Bite Wounds 1137
Susan S. Philip, MD, MPH, &
Sexually Transmitted Diseases 1139
Richard A. Jacobs, MD, PhD
Infections in Drug Users 1140
Acute Infectious Diarrhea 1141 Syphilis 1297
Infectious Diseases in the Returning Traveler 1142 Non-Sexually Transmitted Treponematoses 1305
Traveler’s Diarrhea 1145 Selected Spirochetal Diseases 1306
Antimicrobial Therapy 1146 Relapsing Fever 1306
Hypersensitivity Tests & Desensitization 1154 Rat-Bite Fever 1307
Immunization Against Infectious Diseases 1158 Leptospirosis 1308
Recommended Immunization of Infants, Lyme Disease (Lyme Borreliosis) 1309
Children, & Adolescents 1158
35. Protozoal & Helminthic Infections 1315
Recommended Immunization of Adults 1158
Recommended Immunization Philip J. Rosenthal, MD
for Travelers 1173
Protozoal Infections 1315
31. HIV Infection & AIDS 1176 African Trypanosomiasis
(Sleeping Sickness) 1315
Mitchell H. Katz, MD, & Andrew R. Zolopa, MD American Trypanosomiasis
Epidemiology 1176 (Chagas Disease) 1317
Etiology 1179 Leishmaniasis 1318
Pathogenesis 1179 Malaria 1320
Pathophysiology 1179 Babesiosis 1329
Clinical Findings 1180 Toxoplasmosis 1330
Differential Diagnosis 1189 Amebiasis 1332
Prevention 1189 Infections with Pathogenic
Treatment 1193 Free-Living Amebas 1335
Course & Prognosis 1204 Coccidiosis (Cryptosporidiosis, Isosporiasis,
Cyclosporiasis, Sarcocystosis)
32. Viral & Rickettsial Infections 1205 & Microsporidiosis 1336
Giardiasis 1338
Wayne X. Shandera, MD, &
Other Intestinal Flagellate Infections 1339
Vicente F. Corrales-Medina, MD
Trichomoniasis 1340
Viral Diseases 1205 Helminthic Infections 1340
Human Herpesviruses 1205 Trematode (Fluke) Infections 1340
Major Vaccine-Preventable Viral Infections 1217 Liver, Lung, & Intestinal Flukes 1342
Other Neurotrophic Viruses 1224 Cestode Infections 1343
Other Systemic Viral Diseases 1231 Intestinal Nematode (Roundworm) Infections 1346
Common Viral Respiratory Infections 1236 Invasive Nematode (Roundworm) Infections 1350
Adenovirus Infections 1242 Filariasis 1353
Other Exanthematous Viral Infections 1243
Viruses & Gastroenteritis 1244 36. Mycotic Infections 1357
Enteroviruses That Produce
Several Syndromes 1245 Samuel A. Shelburne, MD, & Richard J. Hamill, MD
Rickettsial Diseases 1247 Candidiasis 1357
Typhus Group 1247 Histoplasmosis 1358
䊲
viii CMDT 2009 CONTENTS
Coccidioidomycosis 1359 Staging of Cancer 1429
Pneumocystosis (Pneumocystis jiroveci Types of Cancer 1429
Pneumonia) 1361 Lung Cancer 1429
Cryptococcosis 1363 Hepatobiliary Cancers 1436
Aspergillosis 1364 Alimentary Tract Cancers 1441
Mucormycosis 1365 Cancers of the Genitourinary Tract 1455
Blastomycosis 1366 Primary Cancer Treatment 1466
Paracoccidioidomycosis (South American Systemic Cancer Therapy 1466
Blastomycosis) 1366 Toxicity & Dose Modification of
Sporotrichosis 1366 Chemotherapeutic Agents 1466
Penicillium marneffei Infections 1367 Cancer Complications: Diagnosis
Chromoblastomycosis (Chromomycosis) 1367 & Management 1482
Mycetoma (Maduromycosis Other Complications 1486
& Actinomycetoma) 1367 The Paraneoplastic Syndromes 1488
Other Opportunistic Mold Infections 1367 Alternative & Complementary Therapies
Antifungal Therapy 1369 for Cancer 1491
37. Disorders Due to Physical Agents 1370 40. Clinical Genetic Disorders 1493
Brent R. W. Moelleken, MD, FACS, Reed E. Pyeritz, MD, PhD
& Jacqueline A. Nemer, MD, FACEP Acute Intermittent Porphyria 1493
Cold & Heat 1370 Alkaptonuria 1494
Burns 1376 Down Syndrome 1495
Electrical Shock Injury 1379 Fragile X Mental Retardation 1496
Radiation Reactions 1381 Gaucher Disease 1496
Near Drowning 1382 Disorders of Homocysteine Metabolism 1497
Disorders Due to Environmental Factors 1383 Klinefelter Syndrome 1498
Marfan Syndrome 1499
38. Poisoning 1388 Hereditary Hemorrhagic Telangiectasia 1500
Kent R. Olson, MD
41. Complementary &
Initial Evaluation: Poisoning or Overdose 1388 Alternative Medicine 1501
The Symptomatic Patient 1388
Antidotes & Other Treatment 1391 Ellen F. Hughes, MD, PhD, & Kevin Barrows, MD
Diagnosis of Poisoning 1394 Herbal Medicines 1502
Selected Poisonings 1396 Dietary Supplements 1508
Acupuncture 1512
39. Cancer 1417
Mind-Body Medicine 1515
Hope S. Rugo, MD
Appendix: Therapeutic Drug
Incidence & Etiology 1417
Monitoring & Laboratory
Environmental, Infectious, & Therapeutic
Reference Intervals 1524
Carcinogens 1419
Prevention of Cancer 1420 C. Diana Nicoll, MD, PhD, MPA
Primary Prevention 1420
Secondary Prevention (Early Detection) 1427 Index 1535
Special Topics in Prevention 1428
䊲
Authors
Joshua S. Adler, MD Todd Cassese, MD
Associate Professor of Clinical Medicine, Division of Chief Medical Resident, Moffitt-Long Hospital,
General Internal Medicine, University of California, Department of Medicine, University of California, San
San Francisco; Medical Director, Ambulatory Care, UC Francisco
San Francisco Medical Center
