Oxford American Handbook of Clinical Medicine

873 Pages·2013·16.64 MB·English

by  John A. Flynn

OXFORD
AMERICAN
HANDBOOK OF
CLINICAL
MEDICINE
Second Edition
Published and forthcoming Oxford American Handbooks
Oxford American Handbook of Clinical Medicine
Oxford American Handbook of Anesthesiology
Oxford American Handbook of Cardiology
Oxford American Handbook of Clinical Dentistry
Oxford American Handbook of Clinical Diagnosis
Oxford American Handbook of Clinical Pharmacy
Oxford American Handbook of Critical Care
Oxford American Handbook of Disaster Medicine
Oxford American Handbook of Emergency Medicine
Oxford American Handbook of Endocrinology and Diabetes
Oxford American Handbook of Geriatric Medicine
Oxford American Handbook of Hospice and Palliative Medicine
Oxford American Handbook of Infectious Diseases
Oxford American Handbook of Nephrology and Hypertension
Oxford American Handbook of Neurology
Oxford American Handbook of Obstetrics and Gynecology
Oxford American Handbook of Oncology
Oxford American Handbook of Otolaryngology
Oxford American Handbook of Pediatrics
Oxford American Handbook of Physical Medicine and Rehabilitation
Oxford American Handbook of Psychiatry
Oxford American Handbook of Pulmonary Medicine
Oxford American Handbook of Radiology
Oxford American Handbook of Reproductive Medicine
Oxford American Handbook of Rheumatology
Oxford American Handbook of Sports Medicine
Oxford American Handbook of Surgery
Oxford American Handbook of Urology
OXFORD
AMERICAN
HANDBOOK OF
CLINICAL
MEDICINE
Second Edition
EDITED BY
JOHN A. FLYNN, MD, MBA, MED
GENERAL INTERNAL MEDICINE
AND RHEUMATOLOGY
JOHNS HOPKINS UNIVERSITY
MICHAEL J. CHOI, MD
MEDICINE AND NEPHROLOGY
JOHNS HOPKINS UNIVERSITY
L. DWIGHT WOOSTER, MD
MEDICINE AND PULMONARY DISEASE
JOHNS HOPKINS UNIVERSITY
3
1
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Library of Congress Cataloging-in-Publication Data
Oxford American handbook of clinical medicine / edited by John A. Flynn, Michael
J. Choi, L. Dwight Wooster.— 2nd ed.
p. ; cm.—(Oxford American handbooks)
Adapted from: Oxford handbook of clinical medicine / Murray Londmore, et al. 8th
ed. 2010.
Includes bibliographical references and index.
ISBN 978–0–19–991494–4 (alk. paper)—ISBN 978–0–19–998515–9 (alk. paper)—
ISBN 978–0–19–998516–6 (alk. paper)
I. Flynn, John A., MD. II. Choi, Michael J. III. Wooster, L. Dwight (Lyman
Dwight)
IV. Oxford handbook of clinical medicine. V. Series: Oxford American handbooks.
[DNLM: 1. Clinical Medicine—Handbooks. WB 39]
LC Classification not assigned
616—dc23 2012038115

9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
Preface
The Hippocratic Oath is a pledge by all physicians to practice medicine
ethically and honestly. As part of that oath, our beliefs hold a promise
“to teach (our students) this art, if they desire to learn it, without fee or
covenant; to give a share of precepts and oral instruction and all the other
learning to … pupils who have signed the covenant and have taken an oath
according to the medical law…”. Clearly, as we were embarking on writing
and editing this medical text, we were not dwelling on the magnitude of
this late 5th-century Greek work. We were, nonetheless, thinking about
and motivated by the long-standing tradition in medicine of sharing medi-
cal knowledge with colleagues, especially with our students of medicine. In
contrast to the early days of medicine, this sharing of medical knowledge is
distributed to all cultures and all countries and is incredibly more open to
all who “desire to learn it.”
The Oxford American Handbook of Clinical Medicine is particularly writ-
ten for physicians-in-training; students in medical school and physicians in
their residency. The tradition of teaching and sharing medical information
had its beginnings at our hospital more than 120 years ago. It is here that
Sir William Osler wrote and published, in 1892, T he Principles and Practice
of Medicine . This book was heralded as the most current work of clinical
management of patients based on known scientific principles. In addition
to his review of the science of medicine, Osler’s text provided sage advice
on the art of compassionate patient care. Unlike in the days of Osler, we
now have access to current medical information at the speed of electrons
with our various hand-held devices, search engines, and electronic medical
records. As a result, now more than ever, our trainees must assiduously
balance the science of medicine with the art of medicine. Although this
handbook is replete with medical information, as authors and editors we
also worked diligently to balance the art and compassionate delivery of
medicine with the facts of clinical decisions. We are acutely aware of new
health care policies, both local and national, of clinical cost containment,
of the importance of quality medical outcomes with high efficiency, and
with goals of professionalism. In this new edition, we have attempted to
incorporate these aspects into medical decision-making processes and rec-
ommendations for accurate diagnosis and treatment.
This book aims to present both the science and the art of patient man-
agement. Our trainees are challenged in their clinical years to remember
and assimilate an enormous volume of medical information; additionally,
students of medicine are applying and synthesizing this material within the
context of their care of patients in the hospital and the outpatient envi-
ronment. The process of integrating medical knowledge with patient care
is a repetitive one, in which learning will come in many forms and from
numerous sources. This book is one of those sources. The O xford American
Handbook of Clinical Medicine is designed as a reference when contemplat-
ing symptoms and signs and medical conditions. Although relatively small
and constructed to fit into pockets or backpacks, this text is formatted to
accommodate the growth and development of your medical knowledge.
The contributors of this manual have the understanding and experience
to emphasize one of the grandest sources of medical knowledge—your
patients. As you interact with each patient, questions will arise; use each
clinical question and each patient experience to stimulate your quest for
medical knowledge. Allow your patients to become the foundations of this
knowledge; allow your patient’s illnesses and their reactions to their ill-
nesses and treatments to formulate your compassion and your art of medi-
v
cine. Relish the journey; it will last a lifetime.
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Acknowledgments
We, the three editors of the O xford American Handbook of Clinical Medicine ,
express our most profound gratitude to all of the authors who have con-
tributed to this book. These contributors are highly respected colleagues
from the Johns Hopkins School of Medicine. They have been fastidious in
their development of these chapters, incorporating the most recent evi-
dence-based guidelines into clinical practice.
We also have the distinct privilege of participating in the care of our patients
while teaching physicians-in-training within Johns Hopkins Medicine. The
care of patients, the recognition of their ills, the definition of their clinical
problems, and the provision of their care are the foundations of the prac-
tice of medicine. This privilege of caring, cemented by medical knowledge, is
commonly a bilateral interaction shared mutually whether with our patients
or with our students. Through these interactions we have learned as much
as we have imparted.
The sharing of medical information with our colleagues, our students, and
our patients is imperative for successful health care. The presentation of
current, accurate, and dependable medical knowledge is essential for suc-
cessful, evidence-based quality outcomes for our patients. Our participation
in writing and editing this medical text was motivated by our indebtedness
to our patients and our students.
We also wish to acknowledge all of the efforts provided by Oxford University
Press, in particular Andrea Seils, Senior Editor of Clinical Medicine. She has
served throughout this effort as a steadfast advocate for the excellence and
clarity of this text. Her many hours of dedication and profound patience
are greatly appreciated.
JF would like to thank his children, Emilee, John, Sarah, Jayne, Christian,
Patrick, and W. Andrew for their constant support of one another as our
family advances. He also wishes to thank Bill Baumgartner for his mentor-
ship. Most importantly he must thank Monica—his wife, his life—for her
infinite support and strength during the past 35 years of being together.
MC would like to thank his wife Mia, his son Chris, and his daughter Julia for
their endless support and infinite patience. They have forgiven him far too
many things. He would like to thank his parents for always doing their best
for him. He would also like to thank his mentor Pedro Fernandez, on behalf
of all of his mentees, for simply making us better doctors.
DW extends his appreciation to his fiancé e, Tina Blasi, who has unequivo-
cally supported his decision to work on this text; she has been his cor-
nerstone and source of encouragement. Tina’s love and devotion are his
emotional foundations from which he changed professional paths and
expanded his professional and personal horizons. Additionally, his children
Ashley, Margaux, and Tyler are universally helpful in contributing to his
energy and ideas, and to his wish for better health care for them and for
their children. He also wishes to thank Mike Weisfeldt for giving him the
opportunity to join the faculty of Johns Hopkins’ Medicine.
Finally, we wish to dedicate this book to Dr. Frederick L. Brancati for being
a constant source of strength, courage, and guidance to us, through not
only his words but through his actions.
vii
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Contents
Preface v
Acknowledgments vii
List of contributors xi
Symbols and abbreviations xiii
1 Thinking about medicine 1
2 Epidemiology 26
3 Clinical skills 36
4 Symptoms and signs 7 0
5 Cardiovascular medicine 88
6 Pulmonary medicine 150
7 Gastroenterology 202
8 Renal medicine 250
9 Endocrinology 284
10 Neurology 328
11 Rheumatology and musculoskeletal conditions 398
12 Oncology 420
13 Surgery 438
14 Infectious diseases (ID) 518
15 Hematology 608
16 Geriatric medicine 642
17 Biochemistry 654
18 Radiology 684
19 Practical procedures 718
20 Emergency Medicine 734
Index 8 00