Table Of ContentMayo Clinic
Internal Medicine
Concise Textbook
Mayo Clinic
Internal Medicine
Concise Textbook
Editors-in-Chief
Thomas M. Habermann, MD
Amit K. Ghosh, MD
MAYO CLINIC SCIENTIFIC PRESS
INFORMA HEALTHCARE
ISBN-13 9781420067491
The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO CLINIC SCIENTIFIC
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Library of Congress Cataloging-in-Publication Data
Mayo Clinic internal medicine concise textbook / edited by Thomas M. Habermann, Amit K. Ghosh.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4200-6749-1 (hb : alk. paper)
ISBN-10: 1-4200-6749-4 (hb : alk. paper) 1. Internal medicine--Handbooks, manuals, etc. I.
Habermann, Thomas M. II. Ghosh, Amit. III. Mayo Clinic. IV. Title: Internal medicine concise textbook.
[DNLM: 1. Internal Medicine--Handbooks. 2. Communicable Diseases--therapy--Handbooks. WB 39
M4727 2007]
RC55.M34 2007
616--dc22
2007027847
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 regulations, and the constant flow of information relat-
ing 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 recommended agent is a new or infrequently employed drug. Readers are instructed to use caution
while writing drug prescriptions and to verify the information, if necessary, with a local pharmacy to check on
drug-drug interactions and to review the risk profile assessment of patients before writing prescriptions.
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.
Printed in Canada
CONTRIBUTORS
Haitham S. Abu-Lebdeh, MD Brian A. Crum, MD
Consultant, Division of General Internal Medicine, Mayo Consultant, Department of Neurology, Mayo Clinic; Assistant
Clinic; Assistant Professor of Medicine, College of Medicine, Professor of Neurology, College of Medicine, Mayo Clinic;
Mayo Clinic; Rochester, Minnesota Rochester, Minnesota
Timothy R. Aksamit, MD Lisa A. Drage, MD
Consultant, Division of Pulmonary and Critical Care Medicine, Consultant, Department of Dermatology, Mayo Clinic;
Mayo Clinic; Assistant Professor of Medicine, College of Assistant Professor of Dermatology, College of Medicine, Mayo
Medicine, Mayo Clinic; Rochester, Minnesota Clinic; Rochester, Minnesota
Robert C. Albright, Jr., DO Stephen B. Erickson, MD
Consultant, Division of Nephrology and Hypertension, Mayo Consultant, Division of Nephrology and Hypertension, Mayo
Clinic; Assistant Professor of Medicine, College of Medicine, Clinic; Assistant Professor of Medicine, College of Medicine,
Mayo Clinic; Rochester, Minnesota Mayo Clinic; Rochester, Minnesota
Thomas J. Beckman, MD Lynn L. Estes, PharmD
Consultant, Division of General Internal Medicine, Mayo Infectious Disease Pharmacist Specialist, Mayo Clinic; Assistant
Clinic; Assistant Professor of Medicine, College of Medicine, Professor of Pharmacy, College of Medicine, Mayo Clinic;
Mayo Clinic; Rochester, Minnesota Rochester, Minnesota
Thomas Behrenbeck, MD Fernando C. Fervenza, MD, PhD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic; Consultant, Division of Nephrology and Hypertension, Mayo
Associate Professor of Medicine, College of Medicine, Mayo Clinic; Associate Professor of Medicine, College of Medicine,
Clinic; Rochester, Minnesota Mayo Clinic; Rochester, Minnesota
Eduardo E. Benarroch, MD Amit K. Ghosh, MD
Consultant, Department of Neurology, Mayo Clinic; Professor Consultant, Division of General Internal Medicine, Mayo
of Neurology, College of Medicine, Mayo Clinic; Rochester, Clinic; Associate Professor of Medicine, College of Medicine,
Minnesota Mayo Clinic; Rochester, Minnesota
Peter A. Brady, MD William W. Ginsburg, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic; Consultant, Division of Rheumatology, Mayo Clinic,
Assistant Professor of Medicine, College of Medicine, Mayo Jacksonville, Florida; Associate Professor of Medicine, College
Clinic; Rochester, Minnesota of Medicine, Mayo Clinic; Rochester, Minnesota
Robert D. Brown, Jr., MD Thomas M. Habermann, MD
Chair, Department of Neurology, Mayo Clinic; Professor of Consultant, Division of Hematology, Mayo Clinic; Professor
Neurology, College of Medicine, Mayo Clinic; Rochester, of Medicine, College of Medicine, Mayo Clinic; Rochester,
Minnesota Minnesota
Darryl S. Chutka, MD C. Christopher Hook, MD
Consultant, Division of Preventive and Occupational Medicine, Consultant, Division of Hematology, Mayo Clinic; Assistant
Mayo Clinic; Associate Professor of Medicine, College of Professor of Medicine, College of Medicine, Mayo Clinic;
Medicine, Mayo Clinic; Rochester, Minnesota Rochester, Minnesota
ix
DEDICATED TO
My father, who dedicated his life to medicine and represents the so many
who have provided opportunities and examples for each of us in our careers.
Thomas M. Habermann, MD
v
FOREWORD
M
ayo Clinic Internal Medicine: Concise Textbookreflects the continued commitment by the faculty of the Department of Internal
Medicine to its mission of scholarship. One of the key traditions in medicine is the passing of knowledge from physician to physi-
cian. In 1928, William J. Mayo, MD, wrote, “The glory of medicine is that it is constantly moving forward, that there is always
more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort.”*This book is a response
to these themes. My hope is that it will aid in the care of patients.
Nicholas F. LaRusso, MD
Chair, Department of Internal Medicine
Mayo Clinic, Rochester, Minnesota
*Mayo WJ. The aims and ideals of the American Medical Association. Proceedings of the 66th Annual Meeting of the National Education Association
of the United States, 1928. p. 158-63.
vi
PREFACE
S
cientific observations and clinical advances are moving at a remarkable pace. These changes require physicians to remain abreast
of the latest developments not only in their areas of expertise but also in areas beyond their sphere of expertise. To assist physicians
in this endeavor, the Department of Medicine at Mayo Clinic remains committed to providing information to physicians in a
timely manner. Mayo Clinic Internal Medicine: Concise Textbookis designed to meet the needs of medical students, nurse practi-
tioners, physician assistants, physicians-in-training, and practicing clinicians by updating their knowledge of internal medicine
and providing a concise review of internal medicine.
The overall approach to learning medicine can be summed up in two questions: What is it? What do you do for it? The
goal is to have a concise review that is readable and easy to follow with algorithms, diagrams, radiographs, and pathologic find-
ings. This book is divided into subspecialty topics, each chapter written by an author(s) with clinical expertise in the designated
topic. Images and tables are provided. Each chapter has bulleted items that highlight key points. These may be summary points
from previous paragraphs or new points. Bulleted items also address typical clinical scenarios. These scenarios emphasize classic
clinical presentations. Pharmacy tables are included with many of the chapters. The scenarios and pharmacy tables highlight two
key points. First, general internists, subspecialists, nurse practitioners, physician assistants, and family physicians diagnose dis-
eases in internal medicine. Second, the predominant type of patient management is pharmacologic. Knowledge of the indications,
toxic effects, and drug interactions is of paramount importance.
We thank everyone who contributed to the development of this book. We are indebted to all authors for their contribu-
tions. We thank the staffs of the Section of Scientific Publications, Department of Medicine, and Division of Media Support
Services at Mayo Clinic for their contributions to this book. The support and cooperation of the publisher, Informa Healthcare,
are gratefully acknowledged.
We trust that this book will serve as an update and advance the reader’s knowledge of internal medicine.
We hope that you enjoy this review as much as we have.
Thomas M. Habermann, MD
Amit K. Ghosh, MD
Editors-in-Chief
vii
Description:Now for the first time, a new diagnosis and treatment guide with even more focus on the most commonly encountered disorders than ever before. All major internal medicine diseases and disorders are covered in this new succinct evidence-based guide to treatment and diagnosis in internal medicine. Orga
