FOURTH EDITION CASE FILES ® Internal Medicine Eugene C. Toy, MD The John S. Dunn, Senior Academic Chair and Program Director The Methodist Hospital Ob/Gyn Residency Program Houston, Texas Vice Chair of Academic Affairs Department of Obstetrics and Gynecology The Methodist Hospital Houston, Texas Clinical Professor and Clerkship Director Department of Obstetrics and Gynecology University of Texas Medical School at Houston Houston, Texas Associate Clinical Professor Weill Cornell College of Medicine John T. Patlan Jr., MD Associate Professor of Medicine Department of General Internal Medicine MD Anderson Cancer Center Houston, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto 00_Toy-IM_FM_pi-xiv.indd i 10/13/12 12:32 PM Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved. 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DEDICATION To our coach Victor, and our father-son teammates Bob & Jackson, Steve & Weston, Ron & Wesley, and Dan & Joel. At the inspirational JH Ranch Father-Son Retreat, all of us, including my loving son Andy, arrived as strangers, but in 6 days, we left as lifelong friends. – ECT To my parents who instilled an early love of learning and of the written word, and who continue to serve as role models for life. To my beautiful wife Elsa and children Sarah and Sean, for their patience and understanding, as precious family time was devoted to the completion of “the book.” To all my teachers, particularly Drs. Carlos Pestaña, Robert Nolan, Herbert Fred, and Cheves Smythe, who make the complex understandable, and who have dedicated their lives to the education of physicians, and served as role models of healers. To the medical students and residents at the University of Texas-Houston Medical School whose enthusiasm, curiosity, and pursuit of excellent and compassionate care provide a constant source of stimulation, joy, and pride. To all readers of this book everywhere in the hopes that it might help them to grow in wisdom and understanding, and to provide better care for their patients who look to them for comfort and relief of suffering. And to the Creator of all things, Who is the source of all knowledge and healing power, may this book serve as an instrument of His will. – JTP 00_Toy-IM_FM_pi-xiv.indd iii 10/13/12 12:32 PM This page intentionally left blank CONTENTS Reviewers / vii Preface / ix Acknowledgments / xi Introduction / xiii Section I How to Approach Clinical Problems ........................................................................1 Part 1. Approach to the Patient. ...............................................................................2 Part 2. Approach to Clinical Problem Solving .........................................................9 Part 3. Approach to Reading ..................................................................................12 Section II Clinical Cases ..........................................................................................................17 Sixty Case Scenarios ...............................................................................................19 Section III Listing of Cases .....................................................................................................521 Listing by Case Number .......................................................................................523 Listing by Disorder (Alphabetical) .......................................................................524 Index / 527 00_Toy-IM_FM_pi-xiv.indd v 10/13/12 12:32 PM This page intentionally left blank REVIEWERS Adam Banks University of Texas – Houston Medical School Class of 2012 Irving Basan~ez University of Texas – Houston Medical School Class of 2012 Hubert M. Chodkiewicz University of Texas – Houston Medical School Class of 2012 Stephen Fisher University of Texas – Houston Medical School Class of 2012 Amber Gill University of Texas – Houston Medical School Class of 2012 Alicia Hernandez University of Texas – Houston Medical School Class of 2013 Matthew Hogue University of Texas – Houston Medical School Class of 2012 Michael Holmes University of Texas – Houston Medical School Class of 2012 Cassandra Kuchta University of Texas – Houston Medical School Class of 2013 Luke Martin University of Texas – Houston Medical School Class of 2012 Colin J. Massey University of Texas – Houston Medical School Class of 2012 Janice Wilson University of Texas – Houston Medical School Class of 2012 vii 00_Toy-IM_FM_pi-xiv.indd vii 10/13/12 12:32 PM This page intentionally left blank PREFACE I have been deeply amazed and grateful to see how the Case Files® books have been so well received, and have helped students to learn more effectively. In the 10 short years since Case Files®: Internal Medicine has first made it in print, the series has now multiplied to span the most of the clinical and the basic science disciplines, and has been translated into over a dozen foreign languages. Numerous students have sent encouraging remarks, suggestions, and recommendations, Three com- pletely new cases have been written. Updated or new sections include health main- tenance, nephritic syndrome, arthritis, diabetes, heart failure, and hyperlipidemia. This fourth edition has been a collaborative work with my wonderful coauthors and contributors, and with the suggestions from four generations of students. Truly, the enthusiastic encouragement from students throughout not just the United States but worldwide provides me the inspiration and energy to continue to write. It is thus with humility that I offer my sincere thanks to students everywhere ... for without students, how can a teacher teach? Eugene C. Toy ix 00_Toy-IM_FM_pi-xiv.indd ix 10/13/12 12:32 PM