Table Of ContentExpertConsuml t.co
http://medical.dentalebooks.com
MobiSleea.r chEaxbplaen.d able.
ACCESiSto na nyI nternet-dreevaidcye
SEARCaHl Elx peCrto nsutlitt lyeosuo wn
LINtKo P ubMeadb stracts
http://medical.dentalebooks.com
FerriP'rsa ctical
Guide
FasFta ctfso rP atient
Care
http://medical.dentalebooks.com
pagien tentiloebnftla alnlky
This
http://medical.dentalebooks.com
FerriP'rsa ctical
Guide
FasFta ctfso rP atient
Care
NintEhd ition
FREDF .F ERRMID,, F ACP
�
� BROWN
� AlperMte dical School
CliniPcraolf essor
AlpeMretd icSaclh ooaltB rownU niversity
ProvidenRcheo,d Ies land
Authcoorn tfaoccrto mmenatbso utthb eo ok:
fred_freorwr.eni d@ub
http://medical.dentalebooks.com
ELSEVIER
MOSBY
1060J ohFn.K ennedByl vd.
Ste1 080
PhiellapdhPiA1a ,910 3-2899
FERRI'PRSA CITACLG UDIEF:A SFTA CTFSO RP ATINETC ARE ISBN78:1-9-45-547459-6
Copyr©i ghtb yM osbayni, m proifEn lts evier Inc.
Copyri2g0h1t4© byM osbIyn,c .,
ana ffiloi2fEa0 lt1se21e 0,Iv0 ni27ce0,.r0 240,0 11,9 9189,9 51,99 11,9 87
Alrli grhetsse rvNeodp .a rotft hpiusb claitimoanyb er epruocdeodrt rnasimttienad n fyo romrb ya ny
meanesl,te orcniocrm echiaacnli,n clupdhiontgo cnogrp,ey cioirndgor,a nyif normasttioornaa gned
retriseyvsmat,lew ithpoeurtim ssiinwo rnin tgi ftrhopemu bslhieDre.at iolnsh owt os eepke rimssion,
furtihfneorr maatbioonut htPe u bilsrh'epse rimssiopnosl iacnidoe usar r arngeemntwsi tohr ganiza
tiosnusca hst hCeo pyrCilgaehrta nCceen taenrtd hCeo pyrLiigchetn Asgienngcc yab,ne f ounadt o ur
webs:iw twew.elsevierr.mcsioismo./n pse
Thibso ok anidn vdtiihdeuc aolrn itbutciooannntise di ni atr ep rotecutndeedcr o pyrbiygt hhtPe ub
lhiers [othearsm atybh ean no tehdee rin).
Notices
Knoewdlgaen db esptr atcicient hfiise alrdce o ntsantclhya nnggA.is n ewr eseaarncdeh x peri
encber oadoeunur n dresatndicnhgna,g eisrn e seamrecthh opdrseo,sf sipornatacilc oerms ,e di
catlr eatmmeanybt e comneec essPararyc.t nietriason dr esearmcuhtsea rlsw aryeslo ynt heir
owne xpreienacnedk noewdlgiene vaulatinagn du sianngyi nofrmtai,om nethodcso,m pounds,
ore xpreiemntdse scrhiebereidnI .nu sisnugc ihno frmatoirmo ent hodss htohuebleymd in dful
oft heoiwrns afeatnytd h sea feotfoy t he,ir nsclupdairntfgioe wrsh otmh ehya vaep reosfsional
respsoinibtiyl.
Witrhe spteoca tny dorrpu hga rmacepurtouidcctiasdl te inf,ri eeaddaerraesd vitsoec dh eck
thmeo sctru reinfnto rmaptrioovni [dioe)ndp roceudrefse atuorr[e idbi yt) h mea naucftuorfe r
eacphr oudctto abdme intieesrdt,ov ertihfryee cmomendeddo soerf romultahm,ee thaondd
duartioofna dmitnrtiaisoann,dc onatirnadtoiincsI.ti st hree spsoinibtioylfp raicttionreelrys,
inogn t heoiwrne xpeenrciaen d knowolfte hdepgiaeret nittsom, a ekd aigno,st eods etremine
dosagaensdt hbee sttr eatmfoeerna tc h indpiatviieadnnutda, l tt aoka ela lp rpoprisaatfee ty
precautTioot nhsfe.lu lstee xteonftt h lea wn,eh iettrh Peu bilshneortr h aeut horcsor,n ittbou,r s
ore doirt,sa ssuamneyl iaibtfyio larn yi nujrayn d/doaram get op ernssoo rp ropearsat y mat
teorf p rodutcsl iaibtnyieg,lil egncoero thweirsoerf, r oamn yu soer o peraotfia onnmy ethods,
proudctisnt,sr uocntsoi,ri decaosna ntiedi nth mea treihaelri en.
libroafCr oyn grCeastsa loging-iDna-tPau blication
FerriF,r eFd.a ,u trh.o
[Parctigcuailtdo et h cea roeft hmee dipcataile] n t
Ferrip'rasc tigcuail:df ea sfta cftospr a ticeanrteF r eFd.F er-r-Nii.t nhe dition.
I
p.;e m.
Pratcicgauli de
PrecebdyeP dr atcical gtuhciead ree t thoomef e dipcaatli eFnrteFd .F er8rtieh.d c.2 101.
I
Inucdlebsi ibolagprhirceeafrle nacnedis n xd.e
ISB9N7 81--4557-44[5p9b-k6. )
IT.i tIlITe.i.t Plreat:ci cgauli. d e
[DNML:1 C.l iicnMaeld incei--Hoaonkd2sb..C liicnLaalb oraTteocnrhiyuq es--dHbaonoks.
3.D iganoissD,if feerntianld-bHosao.Wk B 39]
RC55
616--dc23 2013042887
SenCioonrtS etrantte JagmieMsset r:ri tt
ContDeenvte lSoppemceinMaatrl iHiao slmta:n
PublSiesrvhiiMcnaegns a Hgeemraa:ml iRanjie rnadbabu
ProjMeacnta Sgaerrav:aT nhaaanvm ani
SenBioooDrke siLgonFueo grri:on e
MarkMeatnianDggee bsrah:iD sa s
Workitnogg ether
!I�
tog rolwi brairni es
PrniteidnC hina BookAi d
lnlemaldioenavl elocpoiunngt ries
Lasdtgi iitts h per innuhtmte tbpr9:: / /m8 ed7i ca6l. de5n ta4le b3o oWk\2s\ .t\\clo 1sm t(\olm•t' \J\\ w\boko.11l..lo tg
Thaetu hwoirs sh eatco kwnlogeedt hfelo wlionpgh ycsiiansh vawech nootb rtuied
tot hbioso akn tdos everalo feFe dri'rsCti liionnAisdciv aoslr .
TanyaA liM,D MarkJ .F aganM,D
CliniAcsasli staPnrto fessoofr Director
Medicine MedicaPlr imarCya reU nit
DepartmeonftM edicine RhodeI slanHdo spital
AlperMte dicaSlc hool ProfessoofMr e dicine
BrownU niversity AlperMte dicaSlc hool
ProvidenRcheo,d eI sland BrownU niversity
ProvidenRcheo,d eI sland
MelL .A nderson, FMADC,P
AssistaPnrto fessoofMr e dicine TimothWy. FarrelMlD,
UniversoifCt oyl oraSdcoh ooolf CliniAcsasli staPnrto fessor
Medicine DepartmeonftF amilMye dicine
DenveVre teraAnfsf aiMresd icaCle nter AlperMte dicaSlc hool
DenverC,o lorado BrownU niversity
ProvidenRcheo,d eI sland
MichelSlteo zeAkn varM,D
AssistaPnrto fess(oCrl inical) GlennG .F ortM,D , MPH, FACP,F IDSA
AlperMte dicaSlc hool CliniAcsaslo ciaPtreo fessoofMr e dicine
BrownU niversity AlperMte dicaSlc hool
ProvidenRcheo,d eI sland BrownU niversity
Chief
SudeepK aurA ulakhM,D , CM, FRCPC
InfectiDoiusse ases
AssistaPnrto fessoofMr e dicine
OurL adyo fF atimHao spital
TuftUsn iversSicthyo oolf M edicine
NortPhr ovidenRcheo,d eI sland
BaystaMteed icaCle nter
SpringfiMealsds,a chusetts PaulF .G eorgeM,D
AssistaPnrto fessor
LynnB owlbyM,D , FACP
DepartmeonftF amilMye dicine
MedicaDli rector
AlperMte dicaSlc hool
DukeO utpatiCelnitn ic
BrownU niversity
DukeI nternMaeld iciRnees idency
ProvidenRcheo,d eI sland
Program
DurhamN,o rtCha rolina SajeeHva nda,M D
Director
GauravC houdharMyD,
DivisioofHn o spitaMleidsitc ine
AssistaPnrto fessoofMr e dicine
RhodeI slanHdo spital
AlperMte dicaSlc hool
CliniAcsasli staPnrto fessor
BrownU niversity
ofM edicine
ProvidenRcheo,d eI sland
AlperMte dicaSlc hool
Alexandra DegenhMaDr dt, BrownU niversity
Director ProvidenRcheo,d eI sland
MultipSlcel eroCseinst er
TayloHra rrisoMnD,
New YorkM ethodiHsots pital
AssistaPnrto fessoofNr e urology
BrooklyNne,w York
DepartmeonftN eurology
JosephA .D iazM,D EmoryU niversity
AssociaPtreo fessoofMr e dicine AtlantGae,o rgia
DivisioofGn e neraIln ternMaeld icine
JennifJeerr emiaMhD,
MemoriaHlo spitoafRl hodeI sland
CliniAcsaslo ciaPtreo fessoofMr e dicine
AlperMte dicaSlc hool
AlperMte dicaSlc hool
BrownU niversity
BrownU niversity
ProvidenRcheo,d eI sland v
ProvidenRcheo,d eI sland
http://medical.dentalebooks.com
Contributors
vi
PowelH .K azanjiaMnD, JoanneM . SilviMaD,
ProfessaonrdC hief CliniAcsasli staPnrto fessor
DivisioofIn n fectiDoiusse ase DepartmeonftF amilMye dicine
DirectoofHr IV Program AlperMte dicaSlc hool
UniversoiftM yi chigMaend icaCle nter BrownU niversity
ProfessoofIr n ternMaeld icine ProvidenRcheo,d eI sland
UniversoiftM yi chigMaend icaSlc hool
DominicTka mmaro,M D
AnnA rborM,i chigan
AssociaDtier ector
KellAy. M cGarryM,D CategoriIcnatle rnMaeld iciRnees idency
PrograDmi rector Co-Director
GeneraIln ternMaeld iciRnees idency Medicine-PediRaetsriidcesn cy
Program DivisioofGn e neraIln ternMaeld icine
RhodeI slanHdo spital RhodeI slaHnods pital
AssociaPtreo fessoofMr e dicine AssociaPtreo fessoofMr e dicine
AlperMte dicaSlc hool AlperMte dicaSlc hool
BrownU niversity BrownU niversity
ProvidenRcheo,d eI sland ProvidenRcheo,d eI sland
LynnM cNicolM!D, IriTso ng,M D
AssistaPnrto fessoofMr e dicine AssistaPnrto fessor
AlperMte dicaSlc hool DepartmeonftM edicine
BrownU niversity AlperMte dicaSlc hool
Geriatrician BrownU niversWiotmye n andI nfants
DivisioofGn e riatrics Hospital
RhodeI slaHnods pital ProvidenRcheo,d eI sland
ProvidenRcheo,d eI sland
MargareTtr yforosM,D
MelissNao thnaglMeD, CliniAcsasli staPnrto fessor
AssistaPnrto fessoofFr a milMye dicine DepartmeonftF amilMye dicine
AlperMte dicaSlc hool AlperMte dicaSlc hool
BrownU niversity BrownU niversity
ProvidenRcheo,d eI sland ProvidenRcheo,d eI sland
CarolyJn.O 'ConnorM,D MarcS .W einbergM,D , FACP
AssistCalnitn iPcraolf essor CliniPcraolf essoofMr e dicine
YalUen iversSicthyo oolf M edicine BostoUnn iversSicthyo oolf M edicine
DepartmeonftM edicine CliniAcsaslo ciaPtreo fessoofMr e dicine
St.M ary'Hso spital AlperMte dicaSlc hool
WaterburCyo,n necticut Chieoff N ephrology
RogeWri lliaMmesd icaCle nter
SteveMn. Opal,M D
ProvidenRcheo,d eI sland
ProfessoofMr e dicine
InfectiDoiusse asDei vision Wen-ChiWhu , MD
AlperMte dicaSlc hool AssociaPtreo fessoofMr e dicine
BrownU niversity AlperMte dicaSlc hool
ProvidenRcheo,d eI sland BrownU niversity
Cardiologist
PaulA .P irraglMiDa,, M PH
ProvidenVcAe M edicaCle nter
AssistaPnrto fessoofMr e dicine
ProvidenRcheo,d eI sland
AlperMte dicaSlc hool
BrownU niversity
RhodeI sland Hospital
ProvidenRcheo,d eI sland
HarlaGn. R ichM,D
DirectoofEr n doscopy
RhodeI slaHnods pital
AssociaPtreo fessoofMr e dicine
AlperMte dicaSlc hool
BrownU niversity
ProvidenRcheo,d eI sland
http://medical.dentalebooks.com
Thimsa nuiaaslc oncrieesfree nfcoterh beu ysc liniinnc eieaodfni mmetdei a
mediiconamfrla otniI.tp sur poistseo p orvdieaf sata nedffi ciweantyto i dnetyi f
imptoarnctl inliacbaaotlro,ar nydd,ai gnoismtaigcii onnrfgm oant.i
To tli itmssii zea ptooc kreeetfer nclee,es sm phahsaibsse epnl acoend
paotphhyosgiayon ledp idlegomy,iw oitmhoe re mpahsoins apccrtaiclli icnianl
fromtai.oC nlcianalilo grimtsah ntda bhlaevsbe e euns eedx ntseivteholruyg hout
thmea nutaosl i miypfd lfficiuttl opainctdso e nhanrcceeo elcoltnoi fp rincipal
poinItithss .o ptehdtia tcso ncsiytslweei hleltl hpre ed aepra,tc riuldarurliyn g
an taiccvleii cnsaevlcri ew,h etni mteor eaides x etmrelliytm e.id
Thceo mnbaiotnoi fp arcctaicll cianilfin romaotnwi itdhur gt herapeoutics, pr
ceudersd,ig antoisicam gniga,n lda baotyrom redimcaieknste h miasn uuanli que
anudes ufln,to o nltyom edircseailnd teasn sdut dnetbsu t taolp asrcoct igin
phsyiciaanandlse l dhi etahpl orefssioIwn iaslthsot .h ankm atnthyhe o usands
ofp hiycsianhsva emw ahdote h per ieodri taib oetnsssle liemnre dipcuabhll is
ing andt hafhtuou tepr ues sew riflnildt heidsi ttihomeno t su esflum edical
hadnbotohkta hte wyie lvlrep ucrhadsuerg ti hnetairirgn .i n
FredF .F errMiD,, FACP
PearolfsW isdomi nM edicine
1.Co mmtohnni gosc ccuorm monly.
2.W heyno hue ahroob feattihsn,ok fh osrensto,z ebras.
3.P laycoeub re tosnu ncommmaoinnef sttiaoonfcs o mmcoonn tdiiornaset,rh
thacno mmmoanin efsttiaoonfus n comcmoonnd itions.
4.I wfh ayto auer d oiinwsgo rnkgki,e peo nd oiintg.
5.I wfh ayto auer d oiinnsgto w ornkgsi,tp od ogii nt.
Iyfo duo nk'ntow wh tat od od,o 'ndto a ntyihgn.
67.. Abaolnvlvee,e lrte saug reogney to uprta ient.
FromM atzR :P rincipolfem se dicine.
NV StatJe M ed 77:99-1011,9 77.
vii
http://medical.dentalebooks.com
Ia lesxont deas petchiaastnl omk ys onDsrV,.i FtF.o e rarnid CDhrsrit.po heA.rF erri
frot hehierli pnt h per eaptairaonnrd ve ieowft hmea unsctra intpdo t haetu hso r
ancdo nuttroiorbfts h felo wliontge xwthsho va es evreads v laaa ubrleeus croei tnh e
deevlopmofet nhnteit nhe ditofit ohmnia sn ual:
GoldmL,aS nca hefrA I( ed:G so)ld'msCa ecniMle dic2i4tnhee d,. Philadelphia,
Saurnsd2,e01 .2
VincJeLAn,bt ar haEm,M oorFeA e,t a l( ed:T se)txbooofCk r itCiaecr,6a tleh d .
PhliaedlpShaiuaen,rd 2s0,1 1 .
MediKcnaoelwd lgSee- lAsfsessmPoergnmrt (a MKSA1P)6P .hl iapdheilAam,e rican
Colgleeo fP hycsiia2n01s.2,
GieltrDb NM,o eliglnR eC,rE iloplooGusM e,ta lT:hS ea onrfGdu itdoAe n mtciirobial
Ther2a01p,3y4 3dre dA.n mtciiorbiTahalep ryIc,n2, 0 1.2
Usseo rfo ubro oakere ncaoguetrdou steh aeob vneto erde rfneectee xftoasrd
dtiioinfnarolmt aioonnt hteo pdisiccssus eidtn h miasn .u al
FredF errMiD,
viii
http://medical.dentalebooks.com