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Master the Internal Medicine Boards
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Written by experienced faculty at Mayo Clinic, this EIGHTH EDITION is Mayo Clinic
a completely revised and updated study tool that has proved invaluable
for the American Board of Internal Medicine certification or maintenance 2TAB5LES0 and
of certification as well as general practice review by physicians around Ghosh Internal Medicine Review
the world.
FIGURES
Using this source, physicians will access a virtual blueprint for exam
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preparation and acquire clear guidance on question format, types of
questions, and hints on topics commonly encountered on the test. EIGHTH EDITION
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Providing more than 350 MULTIPLE-CHOICE QUESTIONS that simulate the current exam format, this o
must-have guide will equip readers with the resources they need to anticipate testing challenges and pass
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the exam. Here are just a few of the great features found in the EIGHTH EDITION.
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•NEW—chapter on HOSPITALMEDICINE n
•QUESTION-AND-ANSWER segments and expertly written explanatory notes at the end of each chapter i
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•STRATEGIES AND RECOMMENDATIONS on how to approach the board exam
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•CURRENT PHARMACY TABLES that highlight indications, toxic effects, and drug interactions
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• TYPICALCLINICALSCENARIOS t
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•EXTENSIVELY EDITED CHAPTERS on cardiology, pulmonology, nephrology, critical care, geriatrics,
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preventive medicine, hematology, infectious diseases, women’s and men’s health n
•DETAILED INDEX for quick retrieval of information a
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•GREAT ILLUSTRATIVE TOOLS—lucid images, algorithms, and summary tables that reflect major
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practices, therapies, and medications utilized in the field
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CONTENTS INCLUDE: c
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• The Board Examination • Geriatrics • Neurology
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• Allergy • Hematology • Oncology
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• Cardiology • HIV Infection • Preventive Medicine
• Critical Care Medicine • Hospital Medicine • Psychiatry e
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• Dermatology • Hypertension • Pulmonary Diseases
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• Endocrinology • Infectious Diseases • Rheumatology e
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• Gastroenterology and Hepatology • Medical Ethics • Vascular Diseases
• General Internal Medicine • Men’s Health • Women’s Health
• Genetics • Nephrology
EIGHTH
EDITION
Editor-in-Chief
ABOUT THE EDITOR
Amit K. Ghosh, MD
AMIT K. GHOSH, MD, is Consultant, Division of General
Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
Associate Professor of Medicine, College of Medicine, Mayo Clinic
MAYO CLINIC SCIENTIFIC PRESS
Mayo Clinic
Internal Medicine Review
EIGHTH EDITION
Mayo Clinic
Internal Medicine Review
EIGHTH EDITION
Editor-in-Chief
Amit K. Ghosh, MD
Associate Editors
Christopher M. Wittich, MD, PharmD
Deborah J. Rhodes, MD
Thomas J. Beckman, MD
Randall S. Edson, MD
Dennis K. McCallum, PharmD
MAYO CLINIC SCIENTIFIC PRESS
INFORMA HEALTHCARE
ISBN-13 9781420084788
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.
©1994, 1996, 1998, 2000, 2002, 2004, 2006, 2008 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, recording, or otherwise—
without the prior written consent of the copyright holder, except for brief quo-
tations 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 Informa Healthcare, Kentucky Distribution Center,
7625 Empire Drive, Florence, KY 41042 USA.
E-mail: [email protected].
www.informahealthcare.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 regulations, 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 impor-
tant when the recommended 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.
Printed in Canada
PREFACE
M
edical advances have been occurring at breathtaking speed, with diagnostic and treatment
options becoming available for conditions for which none previously existed. However, several
aspects of health care remain the same. Patients continue to rely heavily on clinicians for help in
understanding the burgeoning evidence in medical research and for providing optimal health
care. Clinicians remain steadfast in their quest to meet the needs of their patients and to encourage
innovation in meeting those needs. The focus on patient safety and quality of care remains a key-
stone of medical practice, and multidisciplinary care with a system-based approach is increas-
ingly being adopted to manage chronic disorders. The associated demands and challenges mandate
that physicians remain abreast of the latest developments in medicine. To assist physicians in this
endeavor, the Department of Internal Medicine at Mayo Clinic provides continuing medical
education updates and resources in a timely manner. This book, Mayo Clinic Internal Medicine
Review, is designed to meet the needs of practicing clinicians and physicians-in-training by updating
their knowledge of internal medicine and helping to prepare them for the internal medicine cer-
tification and maintenance of certification examinations administered by the American Board
of Internal Medicine (ABIM).
The success of the earlier editions of this textbook is exemplified by the number of books pub-
lished. The positive reaction to and the success enjoyed by the earlier editions prompted the
Department of Internal Medicine to proceed with the publication of the eighth edition. Each
chapter has been thoroughly updated, and a new chapter on hospital medicine has been added.
The goal is to provide an update in internal medicine that is readable and easy to study.
This book is divided into chapters based on subspecialty topics and written by authors with
expertise in the respective fields of medicine. Bulleted items highlight elements that are impor-
tant concepts. The repetition of important points in the chapters reinforces the essential aspects
of the topics and serves as an additional aid in review of the subjects. Multiple-choice ques-
tions appear at the end of each chapter; there are more than 350 multiple-choice questions in
this edition. Correct answers and detailed explanations follow the questions.
I am grateful to all the individuals who contributed ideas and suggestions for improvement
during the development of this book. I thank the esteemed authors of the previous editions for
their input into this edition and for permitting the use of some of the materials from previous
editions. I am indebted to all authors for their immense effort and contributions to this edi-
tion. I 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 edition. The
support and cooperation of the publisher, Informa Healthcare, are also gratefully acknowledged.
I trust that the eighth edition of Mayo Clinic Internal Medicine Reviewwill continue to update
and advance the reader’s knowledge of internal medicine.
Amit K. Ghosh, MD
Editor-in-Chief
ix
DEDICATED TO
All students of medicine, whatever their level of experience
and whatever their needs
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FOREWORD
T
he eighth edition of Mayo Clinic Internal Medicine Review is a reflection of the continued com-
mitment by the faculty of the Department of Internal Medicine to its mission to “serve the patient
and advance the science.” There are substantial differences from the previous edition as a result
of extensive revisions. All chapters were updated, 12 new authors and 2 new associate editors
were recruited, a new chapter on hospital medicine was added, and new tables, figures, and ques-
tions and answers were included. These changes and improvements are consistent with the theme
eloquently articulated by William J. Mayo, MD, in 1928: “The glory of medicine is that it is
constantly moving forward, that there is always more to learn.”*My hope is that the reader will
find the contents of this book informative, enjoyable, and, most of all, useful in our shared objective
of understanding, preventing, diagnosing, and treating the diseases that still plague the human race.
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.
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Description:Written by experienced faculty at Mayo Clinic, this Eighth Edition is a completely revised and updated study tool that has proved invaluable for the American Board of Internal Medicine certification or maintenance of certification as well as general practice review by physicians around the world. Us
