Primary Care Medicine: Office Evaluation and Management of the Adult Patient 6th Edition ← ↑ → © 2009 Lippincott Williams & Wilkins Philadelphia 530 Walnut Street, Philadelphia PA 19106 978-0-7817-7513-7 0-7817-7513-2 © 2009 by LIPPINCOTT WILLIAMS & WILKINS, a Wolters Kluwer business © 2006 and 2000 by Lippincott Williams & Wilkins © 1995, 1987, and 1981 by JB Lippincott 530 Walnut Street, Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19016, via email at [email protected] or via our website at lww.com (products and services). Printed in the United States of America. Acquisitions Editor: Sonya Seigafuse Managing Editor: Ryan Shaw Project Manager: Nicole Walz Senior Manufacturing Manager: Benjamin Rivera Marketing Manager: Kimberly Schonberger Design Coordinator: Risa Clow Production Services: Aptara, Inc. Library of Congress Cataloging-in-Publication Data Primary care medicine : office evaluation and management of the adult patient / [edited by] Allan H. Goroll, Albert G. Mulley Jr. — 6th ed. p.; cm. Includes bibliographical references and index. ISBN 978-0-7817-7513-7 ISBN 0-7817-7513-2 1. Family medicine. 2. Ambulatory medical care. I. Goroll, Allan H. II. Mulley, Albert G. [DNLM: 1. Primary Health Care—methods. 2. Ambulatory Care—methods. W 84.6 P94916 2009] RC46.G56 2009 616—dc22 2008045935 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, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with 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 important 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 clinician to ascertain the FDA status of each drug or device planned for use in their clinical practice. The publishers have made every effort to trace copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet at: LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 10 9 8 7 6 5 4 3 2 1 ← ↑ → Primary Care Medicine: Office Evaluation and Management of the Adult Patient 6th Edition © 2009 Lippincott Williams & Wilkins Front of Book Editors Authors Dedication Preface Acknowledgments Foreword to the First Edition Table of Contents Part 1 Principles of Primary Care Chapter 1 The Practice of Primary Care Chapter 2 Selection and Interpretation of Diagnostic Tests Chapter 3 Health Maintenance and the Role of Screening Chapter 4 Estimating and Communicating Risk and Prognosis Chapter 5 Choosing Among Treatment Options Chapter 6 Immunization Part 2 Systemic Problems Chapter 7 Screening for HIV-1 Infection Chapter 8 Evaluation of Chronic Fatigue Chapter 9 Evaluation of Weight Loss Chapter 10 Evaluation of Overweight and Obesity Chapter 11 Evaluation of Fever Chapter 12 Evaluation of Lymphadenopathy Chapter 13 Approach to the Patient with Human Immunodeficiency Virus (HIV) Infection Part 3 Cardiovascular Problems Chapter 14 Screening for Hypertension Chapter 15 Screening for Hyperlipidemia Chapter 16 Infective Endocarditis Prophylaxis Chapter 17 Rheumatic Fever Prophylaxis Chapter 18 Exercise for Prevention of Cardiovascular Disease Chapter 19 Evaluation of Hypertension Chapter 20 Evaluation of Chest Pain Chapter 21 Evaluation of the Asymptomatic Systolic Murmur Chapter 22 Evaluation of Leg Edema Chapter 23 Evaluation of Arterial Insufficiency of the Lower Extremities Chapter 24 Evaluation of Syncope Chapter 25 Evaluation of Palpitations Chapter 26 Management of Hypertension Chapter 27 Approach to the Patient with a Lipid Disorder Chapter 28 Outpatient Management of Atrial Fibrillation Chapter 29 Management of Ventricular Irritability in the Ambulatory Setting Chapter 30 Management of Chronic Stable Angina Chapter 31 Cardiovascular Rehabilitation and Secondary Prevention of Coronary Heart Disease Chapter 32 Approach to the Patient with Chronic Congestive Heart Failure Chapter 33 Management of Valvular Heart Disease Chapter 34 Management of Peripheral Arterial Disease Chapter 35 Management of Peripheral Venous Disease Chapter 36 Stress Testing and Other Noninvasive Studies for Detection of Coronary Disease Part 4 Respiratory Problems Chapter 37 Screening for Lung Cancer Chapter 38 Tuberculosis Screening and Prophylaxis Chapter 39 Evaluation and Prevention of Occupational and Environmental Respiratory Disease Chapter 40 Evaluation of Chronic Dyspnea Chapter 41 Evaluation of Subacute and Chronic Cough Chapter 42 Evaluation of Hemoptysis Chapter 43 Evaluation of Pleural Effusions Chapter 44 Evaluation of the Solitary Pulmonary Nodule Chapter 45 Evaluation of Clubbing Chapter 46 Approach to the Patient with Sleep Apnea Chapter 47 Management of Chronic Obstructive Pulmonary Disease Chapter 48 Management of Asthma Chapter 49 Management of Tuberculosis Chapter 50 Management of the Common Cold Chapter 51 Management of Sarcoidosis Chapter 52 Approach to the Patient with Acute Bronchitis or Pneumonia in the Ambulatory Setting Chapter 53 Approach to the Patient with Lung Cancer Chapter 54 Smoking Cessation Part 5 Gastrointestinal Problems Chapter 55 Screening for Gastric Cancer Chapter 56 Screening for Colorectal Cancer Chapter 57 Prevention of Viral Hepatitis Chapter 58 Evaluation of Abdominal Pain Chapter 59 Evaluation of Nausea and Vomiting Chapter 60 Evaluation of Dysphagia and Suspected Esophageal Chest Pain Chapter 61 Approach to the Patient with Heartburn and Reflux (Gastroesophageal Reflux Disease) Chapter 62 Evaluation of Jaundice Chapter 63 Evaluation of Gastrointestinal Bleeding Chapter 64 Evaluation and Management of Diarrhea Chapter 65 Approach to the Patient with Constipation Chapter 66 Approach to the Patient with Anorectal Complaints Chapter 67 Approach to the Patient with an External Hernia Chapter 68 Management of Peptic Ulcer Disease Chapter 69 Management of Asymptomatic and Symptomatic Gallstones Chapter 70 Management of Hepatitis Chapter 71 Management of Cirrhosis and Chronic Liver Failure Chapter 72 Management of Pancreatitis Chapter 73 Management of Inflammatory Bowel Disease Chapter 74 Approach to the Patient with Functional Gastrointestinal Disease Chapter 75 Management of Diverticular Disease Chapter 76 Management of Gastrointestinal Cancers Part 6 Hematologic and Oncologic Problems Chapter 77 Screening for Anemia Chapter 78 Screening for Sickle Cell Disease and Sickle Cell Trait Chapter 79 Evaluation of Anemia Chapter 80 Evaluation of Erythrocytosis (Polycythemia) Chapter 81 Evaluation of Bleeding Problems and Abnormal Bleeding Studies Chapter 82 Management of Common Anemias Chapter 83 Outpatient Oral Anticoagulant Therapy Chapter 84 Approach to the Patient with Lymphoma Chapter 85 Approach to the Patient with Metastatic Tumor of Unknown Origin Chapter 86 Approach to Staging and Monitoring Chapter 87 Comprehensive Care of the Cancer Patient Chapter 88 Principles of Cancer Drug Therapy Chapter 89 Principles of Radiation Therapy Chapter 90 Management of Chronic Cancer Pain and Palliative Care Chapter 91 Managing the Gastrointestinal Complications of Cancer and Cancer Treatment Chapter 92 Complications of Cancer: Oncologic Emergencies and Paraneoplastic Syndromes Part 7 Endocrinologic Problems Chapter 93 Screening for Diabetes Mellitus Chapter 94 Screening for Thyroid Cancer Chapter 95 Evaluation of Thyroid Nodules Chapter 96 Approach to the Patient with Hypercalcemia Chapter 97 Evaluation of Hypoglycemia Chapter 98 Evaluation of Hirsutism Chapter 99 Evaluation of Gynecomastia Chapter 100 Evaluation of Galactorrhea and Hyperprolactinemia Chapter 101 Polyuria and Polydipsia: Evaluation of Suspected Diabetes Insipidus Chapter 102 Approach to the Patient with Diabetes Mellitus Chapter 103 Approach to the Patient with Hyperthyroidism Chapter 104 Approach to the Patient with Hypothyroidism Chapter 105 Glucocorticoid Therapy Part 8 Gynecologic Problems Chapter 106 Screening for Breast Cancer Chapter 107 Screening for Cervical Cancer Chapter 108 Screening for Ovarian Cancer Chapter 109 Screening for Endometrial Cancer Chapter 110 Screening for and Prevention of Intimate Partner Violence Chapter 111 Approach to the Woman with Abnormal Vaginal Bleeding Chapter 112 Evaluation of Secondary Amenorrhea Chapter 113 Evaluation of Breast Masses and Nipple Discharges Chapter 114 Evaluation of Vulvar Pruritus Chapter 115 Medical Evaluation of Female Sexual Dysfunction Chapter 116 Approach to the Patient with Menstrual or Pelvic Pain Chapter 117 Approach to the Patient with a Vaginal Discharge Chapter 118 Approach to the Menopausal Woman Chapter 119 Approach to Fertility Control Chapter 120 Approach to the Infertile Couple Chapter 121 Approach to the Woman with an Unplanned Pregnancy Chapter 122 Management of Breast Cancer Chapter 123 Management of the Woman with Genital Tract Cancer Part 9 Genitourinary Problems Chapter 124 Screening for Syphilis Chapter 125 Screening for Chlamydial Infection Chapter 126 Screening for Prostate Cancer Chapter 127 Screening for Asymptomatic Bacteriuria and Urinary Tract Infection Chapter 128 Screening for Cancers of the Lower Urinary Tract Chapter 129 Evaluation of the Patient with Hematuria Chapter 130 Evaluation of the Patient with Proteinuria Chapter 131 Evaluation of Scrotal Pain, Masses, and Swelling Chapter 132 Medical Evaluation and Management of Erectile Dysfunction Chapter 133 Approach to Dysuria and Urinary Tract Infections in Women Chapter 134 Approach to Incontinence and Other Forms of Lower Urinary Tract Dysfunction Chapter 135 Approach to the Patient with Nephrolithiasis Chapter 136 Approach to the Male Patient with Urethritis Chapter 137 Approach to the Patient with Gonorrhea Chapter 138 Approach to Benign Prostatic Hyperplasia Chapter 139 Management of Acute and Chronic Prostatitis Chapter 140 Management of Urinary Tract Infection in Men Chapter 141 Management of Syphilis and Other Sexually Transmitted Diseases Chapter 142 Management of the Patient with Chronic Kidney Disease Chapter 143 Management of Genitourinary Cancers in Men Part 10 Musculoskeletal Problems Chapter 144 Screening for Osteoporosis in Postmenopausal Women Chapter 145 Evaluation of Acute Monoarticular Arthritis Chapter 146 Evaluation of Polyarticular Complaints Chapter 147 Approach to the Patient with Back Pain Chapter 148 Evaluation of Neck Pain Chapter 149 Approach to the Patient with Muscle Cramps Chapter 150 Approach to the Patient with Shoulder Pain Chapter 151 Evaluation of Hip Pain Chapter 152 Evaluation of Knee Pain Chapter 153 Approach to Minor Orthopedic Problems of the Elbow, Wrist, and Hand Chapter 154 Approach to Common Problems of the Foot and Ankle Chapter 155 Approach to the Patient with Asymptomatic Hyperuricemia Chapter 156 Management of Rheumatoid Arthritis Chapter 157 Management of Osteoarthritis Chapter 158 Management of Gout Chapter 159 Approach to the Patient with Fibromyalgia Chapter 160 Approach to the Patient with Lyme Disease Chapter 161 Approach to the Patient with Polymyalgia Rheumatica or Giant-Cell (Temporal) Arteritis Chapter 162 Management of Paget’s Disease Chapter 163 Approach to the Patient with Raynaud’s Phenomenon Chapter 164 Prevention and Management of Osteoporosis Part 11 Neurologic Problems Chapter 165 Approach to the Patient with Headache Chapter 166 Evaluation of Dizziness Chapter 167 Focal Neurologic Complaints: Evaluation of Nerve Root and Peripheral Nerve Syndromes Chapter 168 Evaluation of Tremor Chapter 169 Evaluation of Dementia Chapter 170 Approach to the Patient with a Seizure Chapter 171 Management of Transient Ischemic Attack and Asymptomatic Carotid Bruit Chapter 172 Management of Multiple Sclerosis Chapter 173 Management of Alzheimer’s Disease and Related Dementias Chapter 174 Approach to the Patient with Parkinson’s Disease Chapter 175 Approach to the Patient with Bell’s Palsy (Idiopathic Facial Mononeuropathy) Chapter 176 Management of Tic Douloureux (Trigeminal Neuralgia) Part 12 Dermatologic Problems Chapter 177 Screening for Skin Cancers Chapter 178 Evaluation of Pruritus Chapter 179 Evaluation of Purpura Chapter 180 Evaluation of Disturbances in Pigmentation Chapter 181 Evaluation of Urticaria and Angioedema Chapter 182 Approach to the Patient with Hair Loss Chapter 183 Disturbances of Skin Hydration: Dry Skin and Excessive Sweating Chapter 184 Approach to the Patient with Dermatitis Chapter 185 Management of Acne Chapter 186 Management of Rosacea and Other Acneiform Dermatoses Chapter 187 Management of Psoriasis Chapter 188 Management of Intertrigo and Intertriginous Dermatoses Chapter 189 Management of Corns and Calluses Chapter 190 Approach to Bacterial Skin Infections Chapter 191 Management of Superficial Fungal Infections Chapter 192 Management of Cutaneous and Genital Herpes Simplex Chapter 193 Management of Herpes Zoster Chapter 194 Management of Warts Chapter 195 Management of Scabies and Pediculosis Chapter 196 Management of Skin Trauma: Bites and Burns Chapter 197 Management of Skin Ulceration Part 13 Ophthalmologic Problems Chapter 198 Screening for Open-Angle Glaucoma Chapter 199 Evaluation of the Red Eye Chapter 200 Evaluation of Impaired Vision Chapter 201 Evaluation of Eye Pain Chapter 202 Evaluation of Dry Eyes Chapter 203 Evaluation of Common Visual Disturbances: Flashing Lights, Floaters, and Other Transient Phenomena Chapter 204 Evaluation of Exophthalmos Chapter 205 Evaluation of Watery Eyes Chapter 206 Management of the Patient with Age-Related Macular Degeneration Chapter 207 Management of Glaucoma Chapter 208 Management of Cataracts Chapter 209 Management of Diabetic Retinopathy Chapter 210 Correction of Vision Part 14 Ear, Nose, and Throat Problems Chapter 211 Screening for Oral Cancer Chapter 212 Evaluation of Hearing Loss Chapter 213 Approach to Epistaxis Chapter 214 Evaluation of Facial Pain and Swelling Chapter 215 Evaluation of Smell and Taste Disturbances Chapter 216 Approach to the Patient with Hoarseness Chapter 217 Evaluation of Tinnitus Chapter 218 Approach to the Patient with Otitis Chapter 219 Approach to the Patient with Sinusitis Chapter 220 Approach to the Patient with Pharyngitis Chapter 221 Approach to the Patient with Hiccups Chapter 222 Approach to the Patient with Chronic Nasal Congestion and Discharge Chapter 223 Approach to the Patient with Excessive Snoring Chapter 224 Approach to the Patient with Aphthous Stomatitis Chapter 225 Management of Temporomandibular Joint Dysfunction Part 15 Psychiatric Problems Chapter 226 Approach to the Patient with Anxiety Chapter 227 Approach to the Patient with Depression Chapter 228 Approach to the Patient with an Alcohol Problem Chapter 229 Approach to the Patient with Sexual Dysfunction Chapter 230 Approach to the Somatizing Patient Chapter 231 Approach to the Angry Patient Chapter 232 Approach to the Patient with Insomnia Chapter 233 Management of Obesity Chapter 234 Approach to Eating Disorders Chapter 235 Approach to Drug Abuse and Dependence Chapter 236 Approach to the Patient with Chronic Nonmalignant Pain Part 16 Allied Fields Chapter 237 Herbal Supplements Commonly Used as Complementary or Alternative Therapy Chapter 238 Caring for the Adolescent Patient Chapter 239 Approach to Frailty in Older Adults Back of Book