Toronto notes 2016: Comprehensive medical reference and review for the Medical Council of Canada Qualifying Exam Part I and the United States Medical Licensing Exam Step 2

1383 Pages·2016·36.183 MB·English

by  Zamir Merali, Jason D. Woodfine (eds.)

TORONTO NOTES
22 1166
COMPREHENSIVE MEDICAL REFERENCE
& REVIEW FOR MCCQE AND USMLE II
Editors-in-Chief: Zamir Merali & Jason D. Woodfine
Production Managers: Jieun Kim & Ilya Mukovozov
2016
Toronto Notes
Comprehensive medical reference and review for the
Medical Council of Canada Qualifying Exam Part I and the
United States Medical Licensing Exam Step 2
32nd Edition
Editors-in-Chief:
Zamir Merali and Jason D. Woodfine
Wherever the art of medicine is loved,
there is also a love of humanity.
– Hippocrates
Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada
Thirty-second Edition
Copyright © 2016 – Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada.
Typeset and production by Type & Graphics Inc.
ISBN 978-1-927363-26-3 (32nd ed.)
All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2016 is provided for the sole use of
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material contained herein. Previous editions copyright © 1985 to 2016.
Cover design: Ashley Hui
Illustrations: Biomedical Communications, University of Toronto
Notice:
THIS PUBLICATION HAS NOT BEEN AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY
THE MEDICAL COUNCIL OF CANADA NOR DOES IT RECEIVE ENDORSEMENT BY THE MEDICAL
COUNCIL AS REVIEW MATERIAL FOR THE MCCQE PART I. THIS PUBLICATION HAS NOT BEEN
AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY THE NATIONAL BOARD OF MEDICAL
EXAMINERS U.S.A. NOR DOES IT RECEIVE ENDORSEMENT BY THE NATIONAL BOARD AS REVIEW
MATERIAL FOR THE USMLE.
The editors of this edition have taken every effort to ensure that the information contained herein is accurate and
conforms to the standards accepted at the time of publication. However, due to the constantly changing nature of
the medical sciences and the possibility of human error, the reader is encouraged to exercise individual clinical
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2 Toronto Notes 2016
Dedicated to all
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Thomas O’Brien, MD
Class of 2009
M.D. Program, University of Toronto
3 Toronto Notes 2016
Preface – From the Editors
Dear Readers,
As the Editors-in-Chief of Toronto Notes 2016 we are in the city of Toronto. This year Toronto Notes
proud to present this updated edition. for Medical Students has supported organizations
including medical school clubs, community outreach
Toronto Notes began humbly in 1985 from a set of groups, student bursaries and scholarships, and the
student notes circulated among medical students at Canadian Cancer Society. Your purchase of Toronto
the University of Toronto. Over time, Toronto Notes Notes 2016 is much appreciated by these well-
has grown into one of the premier study resources for deserving groups.
generations of Canadian medical school graduates.
This rich history has led to our firm commitment to We would like to highlight the exceptional work of
publish a comprehensive study resource for medical our team, composed of over 150 medical students,
students engaged in clinical rotations and studying medical illustrators/artists, and faculty members
for both the USMLE Step 2 and Canadian MCCQE at the University of Toronto Faculty of Medicine.
Part 1. Without the tireless effort expended by these
individuals the production of Toronto Notes 2016
For over 30 years we have remained committed to would not have been possible. In particular, we would
our original vision. The 2016 edition of Toronto Notes like to highlight the work of the executive team, all of
contains significant improvements including: whom made personal sacrifices in balancing clinical
work with the responsibilities asked of them. We also
1. A new emphasis on ‘Approaches to Common want to highlight the work of Jesse Lu and Kota Talla,
Clinical Presentations’ in addition to traditional without whom the production of the Toronto Notes
content organized by disease. Quiz App would not have been possible. Lastly, we
2. A completely revised Psychiatry chapter would like to thank our partners at Type & Graphics
incorporating the DSM-V in a quick-to-reference Inc., particularly Enrica Aguilera, for their guidance
and readable format. during the production of Toronto Notes 2016.
3. The Toronto Notes Quiz App, which is available
for free on iTunes and Google Play. This app We hope you find Toronto Notes 2016 enhances your
contains hundreds of questions allowing users to medical knowledge and allows you to perform better
test themselves on the content contained within on both your clinical rotations and licencing exams.
Toronto Notes. We continue to encourage feedback – this year, we
4. A significantly improved interactive eBook with have read and incorporated every piece of feedback
many new high-quality colour images. we received about the previous edition of Toronto
5. A brand-new Clinical Handbook that is more Notes. On behalf of the Toronto Notes 2016 team, we
concise, has numerous new figures, and features wish you success in your studies.
approaches to hundreds of common clinical
situations. Sincerely,
Toronto Notes 2016 is produced by Toronto Notes Zamir Merali, BSc. and Jason D. Woodfine, BSc.
for Medical Students Inc., which is a non-for-profit Editors-in-Chief, Toronto Notes 2016
organization supporting various charity organizations MD Program, University of Toronto
4 Toronto Notes 2016
Acknowledgements
We would like to acknowledge the exceptional work of all previous Toronto Notes (formerly MCCQE Notes)
Editors-in-Chief and their editorial teams. The 32nd edition of this text was made possible with their contributions.
2015 (31th ed.): Justin Hall and Azra Premji
2014 (30th ed.): Miliana Vojvodic and Ann Young
2013 (29th ed.): Curtis Woodford and Christopher Yao
2012 (28th ed.): Jesse M. Klostranec and David L. Kolin
2011 (27th ed.): Yingming Amy Chen and Christopher Tran
2010 (26th ed.): Simon Baxter and Gordon McSheffrey
2009 (25th ed.): Sagar Dugani and Danica Lam
2008 (24th ed.): Rebecca Colman and Ron Somogyi
2007 (23rd ed.): Marilyn Heng and Joseph Ari Greenwald
2006 (22nd ed.): Carolyn Jane Shiau and Andrew Jonathan Toren
2005 (21st ed.): Blair John Normand Leonard and Jonathan Chi-Wai Yeung
2004 (20th ed.): Andrea Molckovsky and Kashif S. Pirzada
2003 (19th ed.): Prateek Lala and Andrea Waddell
2002 (18th ed.): Neety Panu and Sunny Wong
2001 (17th ed.): Jason Yue and Gagan Ahuja
2000 (16th ed.): Marcus Law and Brian Rotenberg
1999 (15th ed.): Sofia Ahmed and Matthew Cheung
1998 (14th ed.): Marilyn Abraham and M Appleby
1997 (13th ed.): William Harris and Paul Kurdyak
1996 (12th ed.): Michael B. Chang and Laura J. Macnow
1995 (11th ed.): Ann L. Mai and Brian J. Murray
1994 (10th ed.): Kenneth Pace and Peter Ferguson
1993 (9th ed.): Joan Cheng and Russell Goldman
1992 (8th ed.): Gideon Cohen-Nehemia and Shanthi Vasudevan
All former Chief Editors from 1991 (7th ed.) to 1985 (1st ed.)
5 Toronto Notes 2016
Student Contributors
Editors-in-Chief Production Managers Clinical Handbook Editors Electronic Content Editors
Zamir Merali Jieun Kim Caleigh Campbell Jesse Lu
Justin D. Woodfine Ilya Mukovozov Sabah Khan Kota Talla
Sharon Lee
Chief Copy Editor Copy Editors BMC Production Editors
Tu Nguyen Catherine Brown Priyanka Kapil Christina Reppas Ashley Hui
Henry Chen Stephanie Lapinsky Nikki Schneider Susan Le
Leema Dookhoo Olivia Li Melissa Sheehan
Daniel Glatt Anthony Mak David Smith
Jacqui Hayworth Zamir Merali William Stuart
Lindsay Herzog Janet Nguyen Jason D. Woodfine
Richard Hoang Chris Noel Issac Yang
Andrea Hunt Jonathan Park Erik Yao
Sandra Huynh Mohini Patel
PRIMARY AND OTHER SPECIALTIES MEDICINE SURGERY
Associate Editors EBM Editors Associate Editors EBM Editors Associate Editors EBM Editors
Lindsey Chapman Shany Gertzbein Hart Stadnick Alex Cressman Hasaan Chaudhry Alex Cressman
Meghna Rajaprakash Kevin Yau Nardin Samuel Shany Gertzbein
Chapter Editors Chapter Editors Chapter Editors
Ethical, Legal, and Family Medicine Cardiology and Infectious Diseases General Surgery Orthopedics
Organizational Medicine Mark Bamberger Cardiac Surgery Vanda McNiven Ming Hao (Dennis) Amedeo Falsetto
Yang Lei Saurabh Kalra David Armstrong Kimberly Stewart Guo Scott Kim
Sarah Whynot Mena Gewarges Marie Yan Kelsey Ragan
Anesthesia and Sagar Rohailla Elizabeth Shin Otolaryngology
Perioperative Medicine Medical Imaging Nephrology Anna Goulding
Eileen Heo Sidharth Saini Endocrinology Eric Coomes Gynecology Soroush Larjani
David Wang Tara Justice Tamara Gimon Dalia Bibr Mario Moscovici
Clinical Pharmacology Ilia Makedonov Katie Bies
Farah Jazuli Pediatrics Neurology Christine Edwards Plastic Surgery
Ahmed Faress Gastroenterology Adi Kartolo James Wang Scott Turcotte
Dermatology Lucy Li Kevin Pivavarov Yi (Emma) Quan Oren Zarnett
Mengzhu Jiang Fahad Masud Melanie Wong Jeremy Zung Neurosurgery
Emily Stewart Leah Smith Oliver Ayling Urology
Geriatric Medicine Respirology Holly Lee Matthew Lenardis
Emergency Medicine Population Health Ayan Dey Alex Kumachev Kai Yang
Prateek Sehgal and Epidemiology Navjot Rai Obstetrics
Kelvin Wong Catherine Brown Hematology Dalia Bibr Vascular Surgery
Michael Wong Brahim Redouane Rheumatology Katie Bies Keith Gunaratne
Psychiatry Hart Goldhar Susan Armstrong Christine Edwards
Jordan Bawks Hiten Naik Amy Miles James Wang
Raman Srivastava
Ophthalmology
Thomas Andrew Berk
Carl Shen
BMC ILLUSTRATORS
Meriem Benlamri
Sam Holmes Sonia Seto
Kristen Browne
Ashley Hui Madeline Spacher
Cassandra Cetlin
Susan Le Kelly Speck
Natalie Cormier
Derek Ng Caitlyn Swanberg
Naveen Devasagayam
Melissa Phachanhla Sara Vukson
Wendy Gu
Kateryna Procunier Emilie Wiens
Erina He
6 Toronto Notes 2016
Faculty Contributors, University of Toronto
All contributing professors have been appointed at the University of Toronto.
David Adam, MD, FRCPC Alice Cheung, MD, FRCPC Jonathan C. Irish, MD, MSc, FRCSC
Division of Dermatology Division of Endocrinology and Metabolism Department of Otolaryngology -
Department of Medicine Department of Medicine Head and Neck Surgery
St. Michael’s Hospital St. Michael’s Hospital University Health Network
Anne M. R. Agur, BSc, MSc, PhD Chi-Ming Chow, MDCM, MSc, FRCPC Nasir Jaffer, MD, FRCPC
Division of Anatomy Division of Cardiology Division of Abdominal Imaging
Department of Surgery Department of Medicine Department of Medical Imaging
University of Toronto St. Michael’s Hospital Joint Department of Medical Imaging
University of Toronto
Iqbal Ahmed, MD, FRCSC Allison Chris, MD, MSc, FRCPC
Department of Ophthalmology Division of Clinical Public Health David Juurlink, BPhm, MD, PhD, FRCPC
and Vision Science Dalla Lana School of Public Health Division of Clinical Pharmacology
University of Toronto and Toxicology
Maria Cino, HonBSc, MSc, MD, FRCPC Departments of Medicine and Pediatrics
Ruby Alvi, MD, CCFP, MHSc Division of Gastroenterology Sunnybrook Health Sciences Centre
Department of Family University Health Network
and Community Medicine Toronto Western Hospital Lorraine Kalia, MD, PhD, FRCPC
University of Toronto Division of Neurology
Isabella Devito, MD, FRCPC University Health Network
Meyer Balter, MD, FRCPC Department of Anesthesia and Toronto Western Hospital
Division of Respiratory Medicine Pain Management
Department of Medicine University Health Network and Gabor Kandel, MD, FRCPC
Mount Sinai Hospital Mount Sinai Hospital Division of Gastroenterology, Department of
Medicine
Nirit Bernhard, MSc, MD, FRCPC Alfonso Fasano, MD, PhD, FRCPC St. Michael’s Hospital
Department of Pediatrics Division of Neurology
Hospital for Sick Children University Health Network Sari L. Kives, MD, FRCSC
Toronto Western Hospital Department of Obstetrics and Gynecology
Kate Bingham, MD, MPH, CCFP-EM St. Michael’s Hospital and
Faculty of Medicine Mark Freedman, MD, FRCPC The Hospital for Sick Children
University of Toronto Department of Emergency Medicine
Sunnybrook Health Sciences Centre Wai-Ching Lam, MD, FRCSC
Matthew Binnie, MD Department of Ophthalmology and
Division of Respirology Natasha Gakhal, MD, FRCPC Vision Science
University Health Network Division of Rheumatology University Health Network
St. Michael’s Hospital Department of Medicine Toronto Western Hospital
Women’s College Hospital
Ari Bitnun, MD, MSc, FRCPC Chloe Leon, MD, FRCPC
Division of Infectious Diseases Barry J. Goldlist, MD, FRCPC Division of Brain and Therapeutics
The Hospital for Sick Children Division of Geriatric Medicine Department of Psychiatry
Department of Medicine Centre for Addiction and Mental Health
Andrea Boggild, MSc, MD, FRCPC University Health Network
Tropical Disease Unit and Armando Lorenzo, MD, FRCSC
Division of Infectious Diseases Jeremy Hall, MD, FRCSC Division of Urology
University Health Network Division of Orthopedic Surgery Department of Surgery
Toronto General Hospital Department of Surgery The Hospital for Sick Children
St. Michael’s Hospital
Arthur Bookman, MD, FRCPC Todd Mainprize, MD, FRCSC
Division of Rheumatology Philip C. Hébert, MA, PhD, MD, FCFPC Department of Neurosurgery
Department of Medicine Department of Family and Sunnybrook Health Sciences Centre
University Health Network Community Medicine
Toronto Western Hospital Joint Centre for Bioethics Eric Massicotte, MD, MSc, FRCSC
Sunnybrook Health Sciences Centre Department of Neurosurgery
Mark Boulos, MD, MSc, CSCN(EEG), FRCPC University Health Network
Division of Neurology and Sleep Medicine Sender Herschorn, MDCM, FRCSC Toronto Western Hospital
Department of Medicine Division of Urology
Sunnybrook Health Sciences Centre Department of Surgery Michael McDonald, MD, FRCPC
Sunnybrook Health Sciences Centre and Division of Cardiology and
Simon Carette, MD, FRCPC Women’s College Hospital The Multi-Organ Transplant Program
Division of Rheumatology Department of Medicine
Department of Medicine University Health Network
Mount Sinai Hospital Toronto General Hospital
7 Toronto Notes 2016
Faculty Contributors, University of Toronto
Adam C. Millar, MD, MScCH Angela Punnett, MD, FRCPC Herbert P. von Schroeder, MD, MSc, FRCSC
Division of Endocrinology and Metabolism Department of Pediatrics Divisions of Orthopedic Surgery and
Department of Medicine The Hospital for Sick Children Plastic Surgery
Mount Sinai Hospital Department of Surgery
Graham Roche-Nagle, University Health Network
Yvette Miller-Monthrope, MD, FRCPC MD, MBA, FRCSI, EBSQ-VASC
Division of Dermatology Division of Vascular Surgery Oshrit Wanono, MD, FRCPC
Department of Medicine University Health Network Division of Child and Adolescent Psychiatry
Women’s College Hospital Toronto General Hospital Department of Psychiatry
Centre for Addiction and Mental Health
Azadeh Moaveni, MD, CCFP Amanda Selk, MD, FRCSC
Department of Family and Department of Obstetrics and Gynecology Kyle R. Wanzel, MD, MEd, FRCSC
Community Medicine Mount Sinai Hospital Division of Plastic Surgery
University Health Network St Joseph’s Health Centre
Toronto Western Hospital Rajiv Shah, MD, MSc, FRCSC
Department of Obstetrics and Gynecology Richard Ward, MBBS, MRCP, FRCPath
Eva Mocarski, MD, FRCSC St. Michael’s Hospital Division of Hematology
Department of Obstetrics and Gynecology Department of Medicine
St. Michael’s Hospital Marisa Sit, MD, FRCSC University Health Network
Department of Ophthalmology
Ally Murji, MD, MPH, FRCS(C) and Vision Science Jeffrey Wassermann, MD, FRCPC
Department of Obstetrics and Gynecology University Health Network Department of Anesthesia
Mount Sinai Hospital Toronto Western Hospital St. Michael’s Hospital
Melinda Musgrave, MD, PhD, FRCSC Kevin Skarratt, MD, FRCPC Alice Wei, MD CM, MSc, FRCSC
Division of Plastic and Reconstructive Surgery Department of Emergency Medicine Division of General Surgery
Department of Surgery Sunnybrook Health Sciences Centre Department of Surgery
St. Michael’s Hospital University Health Network
Peter Tai, MD, FRCPC
Sharon Naymark, MD, FRCPC Division of Neurology Fay Weisberg, MD, FRCSC
Department of Pediatrics University Health Network Division of Reproductive Endocrinology
St. Joseph’s Health Centre Toronto Western Hospital and Infertility
Department of Obstetrics and Gynecology
George Oreopoulos, MD, MSc, FRCSC Diana Tamir, MD, FRCPC University of Toronto
Division of Vascular Surgery Department of Anesthesia and
Department of Surgery Pain Management Michael Wiley, BSc, MSc, PhD
University Health Network University Health Network Division of Anatomy
Department of Surgery
Susan Poutanen, MD, MPH, FRCPC Gemini Tanna, MD, FRCPC University of Toronto
Department of Microbiology Division of Nephrology
University Health Network and Department of Medicine Anna Woo, MD CM, SM, DABIM, FRCPC
Mount Sinai Hospital Sunnybrook Health Sciences Centre Division of Cardiology
Department of Medicine
Ramesh Prasad, MBBS, MSc, FRCPC Piero Tartaro, MD, FRCPC University Health Network
Division of Nephrology Division of Gastroenterology Toronto General Hospital
Department of Medicine Department of Medicine
St. Michael’s Hospital Sunnybrook Health Sciences Centre Jensen Yeung, MD, FRCPC
Division of Dermatology
Mary Preisman, MD, FRCPC Fernando Teixeira, MD, FRCPC Department of Medicine
Department of Psychiatry Department of Emergency Medicine Women’s College Hospital
Mount Sinai Hospital St. Michael’s Hospital
Eugene Yu, MD, FRCPC
Evan Propst, MD, MSc, FRCSC Martina Trinkaus, MD, FRCPC Division of Neuroradiology
Division of Head and Neck Surgery Division of Hematology Department of Medical Imaging
Department of Otolaryngology Department of Medicine University Health Network
The Hospital for Sick Children St. Michael’s Hospital
8 Toronto Notes 2016
Table of Contents
Index Abbreviations
1. Common Unit Conversions
2. Commonly Measured Laboratory Values
3. Ethical, Legal, and Organizational Medicine.............................................. ELOAM
4. Anesthesia and Perioperative Medicine ................................................. A
5. Cardiology and Cardiac Surgery....................................................... C
6. Clinical Pharmacology............................................................... CP
7. Dermatology....................................................................... D
8. Emergency Medicine................................................................ ER
9. Endocrinology ..................................................................... E
10. Family Medicine.................................................................... FM
11. Gastroenterology................................................................... G
12. General Surgery.................................................................... GS
13. Geriatric Medicine .................................................................. GM
14. Gynecology ....................................................................... GY
15. Hematology ....................................................................... H
16. Infectious Diseases ................................................................. ID
17. Medical Imaging.................................................................... MI
18. Nephrology........................................................................ NP
19. Neurology......................................................................... N
20. Neurosurgery...................................................................... NS
21. Obstetrics......................................................................... OB
22. Ophthalmology..................................................................... OP
23. Orthopedics ....................................................................... OR
24. Otolaryngology .................................................................... OT
25. Pediatrics ......................................................................... P
26. Plastic Surgery..................................................................... PL
27. Population Health and Epidemiology ................................................... PH
28. Psychiatry......................................................................... PS
29. Respirology ....................................................................... R
30. Rheumatology ..................................................................... RH
31. Urology........................................................................... U
32. Vascular Surgery ................................................................... VS
33. Index
9 Toronto Notes 2016