MAYO CLINIC INTERNAL MEDICINE BOARD REVIEW TWELFTH EDITION MAYO CLINIC SCIENTIFIC PRESS Mayo Clinic Atlas of Regional Anesthesia and Ultrasound- Guided Nerve Blockade Edited by James R. Hebl, MD, and Robert L. Lennon, DO Mayo Clinic Preventive Medicine and Public Health Board Review Edited by Prathibha Varkey, MBBS, MPH, MHPE Mayo Clinic Infectious Diseases Board Review Edited by Zelalem Temesgen, MD Just Enough Physiology By James R. Munis, MD, PhD Mayo Clinic Cardiology: Concise Textbook, Fourth Edition Edited by Joseph G. Murphy, MD, and Margaret A. Lloyd, MD Mayo Clinic Electrophysiology Manual Edited by Samuel J. Asirvatham, MD Mayo Clinic Gastrointestinal Imaging Review, Second Edition By C. Daniel Johnson, MD Arrhythmias in Women: Diagnosis and Management Edited by Yong- Mei Cha, MD, Margaret A. Lloyd, MD, and Ulrika M. Birgersdotter- Green, MD Mayo Clinic Body MRI Case Review By Christine U. Lee, MD, PhD, and James F. Glockner, MD, PhD Mayo Clinic Gastroenterology and Hepatology Board Review, Fifth Edition Edited by Stephen C. Hauser, MD Mayo Clinic Guide to Cardiac Magnetic Resonance Imaging, Second Edition Edited by Kiaran P. McGee, PhD, Eric E. Williamson, MD, and Matthew W. Martinez, MD Mayo Clinic Neurology Board Review, First Edition [2 Volumes] Edited by Kelly D. Flemming, MD, and Lyell K. Jones Jr, MD Mayo Clinic Critical Care Case Review Edited by Rahul Kashyap, MBBS, J. Christopher Farmer, MD, and John C. O’Horo, MD Mayo Clinic Medical Neurosciences, Sixth Edition Edited by Eduardo E. Benarroch, MD, Jeremy K. Cutsforth- Gregory, MD, and Kelly D. Flemming, MD Mayo Clinic Principles of Shoulder Surgery By Joaquin Sanchez- Sotelo, MD Mayo Clinic Essential Neurology, Second Edition By Andrea C. Adams, MD Mayo Clinic Antimicrobial Handbook: Quick Guide, Third Edition Edited by John W. Wilson, MD, and Lynn L. Estes, PharmD Mayo Clinic Critical and Neurocritical Care Board Review Edited by Eelco F. M. Wijdicks, MD, PhD, James Y. Findlay, MB, ChB, William D. Freeman, MD, and Ayan Sen, MD MAYO CLINIC INTERNAL MEDICINE BOARD REVIEW TWELFTH EDITION EDITOR- IN- CHIEF Christopher M. Wittich, MD, PharmD Consultant, Division of General Internal Medicine Mayo Clinic, Rochester, Minnesota Professor of Medicine Mayo Clinic College of Medicine and Science SENIOR ASSOCIATE EDITOR Thomas J. Beckman, MD Consultant, Division of General Internal Medicine Mayo Clinic, Rochester, Minnesota Professor of Medicine and of Medical Education Mayo Clinic College of Medicine and Science ASSOCIATE EDITORS Sara L. Bonnes, MD Nerissa M. Collins, MD Nina M. Schwenk, MD Christopher R. Stephenson, MD Jason H. Szostek, MD MAYO CLINIC SCIENTIFIC PRESS OXFORD UNIVERSITY PRESS 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. 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Mayo Foundation for Medical Education and Research 2020 All rights reserved. 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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, readers are urged to check the package insert for each drug for any change in indications and dosage and for added wordings 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 US 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. 9 8 7 6 5 4 3 2 1 Printed by Sheridan Books, Inc., United States of America To my mentors Drs Thomas J. Beckman and Paul S. Mueller for their endless support, inspiration, and wisdom. Christopher M. Wittich, MD, PharmD Foreword Publication of the Mayo Clinic Internal Medicine Board chapters on physician well- being and hospital internal Review, Twelfth Edition, coincides with important milestones medicine emphasize the importance of those areas to the for the Department of Medicine at Mayo Clinic, including practice of internal medicine. All the authors are Mayo the department’s inception 50 years ago and the 25th Clinic experts primarily focused on caring for patients, anniversary of this book. Providing medical education across and the editors are experienced internists who are expert the training continuum has been a part of the Department diagnosticians and medical educators. of Medicine’s primary mission since the beginning. The This textbook will be an important resource for anyone department has robust medical education programs for preparing to become certified in internal medicine or seeking medical students, residents, fellows, and physicians in practice. to provide state- of- the- art care to patients. The Mayo Clinic Internal Medicine Board Review is an example of the department’s dedication to lifelong learning by internal Amy W. Williams, MD medicine physicians. Chair, Department of Internal Medicine The current edition builds on years of knowledge, Mayo Clinic, Rochester, Minnesota refinement, and expertise from the Department of Medicine. Professor of Medicine Chapters have been revised to include the most up- to- date Mayo Clinic College of Medicine and Science knowledge for the practice of medicine. Two entirely new Prefacea The Mayo Clinic Internal Medicine Board Review, Twelfth and state- of- the- art. I  am especially grateful to the associ- Edition, is the result of the dedicated efforts of Mayo Clinic ate editors, Thomas J. Beckman, MD, Sara L. Bonnes, MD, physicians in multiple specialties whose primary mission is to Nerissa M. Collins, MD, Nina M. Schwenk, MD, Christopher put the needs of the patient first. The field of internal medicine R. Stephenson, MD, and Jason H. Szostek, MD, who are all out- is constantly changing as science is advanced, and this textbook standing general internists and medical educators. I would like was written to provide readers with the essential elements for to thank Amy W. Williams, MD, Chair of the Department of the practice of internal medicine. Readers preparing for the Internal Medicine at Mayo Clinic in Rochester, Minnesota, and American Board of Internal Medicine (ABIM) Certification Karthik Ghosh, MD, Chair of the Division of General Internal and Maintenance of Certification examinations will find the Medicine, who provided the resources to make this textbook textbook comprehensive and easy to study. Additionally, read- a success. I also thank Michael W. O’Brien for his administra- ers who want a reference or a general knowledge review in tive support. This book would not exist without the dedica- internal medicine will find this textbook an important addition tion of the Mayo Clinic Scientific Publications staff, including to their medical library. Joseph G. Murphy, MD, Chair; Randall J. Fritz, DVM, Alyssa The Twelfth Edition features revised chapters that high- B. Quiggle, PhD, Colleen M. Sauber, MEd, and LeAnn M. Stee, light current knowledge in the practice of internal medicine. editors; Kenna L. Atherton, manager; Kristin M. Nett and Additionally, this edition includes over 200 new multiple-c hoice Emelina R. Bly, editorial assistants; and John P. Hedlund, proof- questions designed to underscore key teaching points. Each reader. I gratefully acknowledge the support of Mayo Clinic question includes a rationale in a standard format that describes Scientific Press and Oxford University Press. Finally, I thank why the correct answer is right and why each incorrect answer Laura M. Sadosty, in the Department of Medicine, who organ- is wrong. This edition includes color-c oded section tabs, and ized over 90 physician authors— a remarkable feat indeed! within each chapter, key facts and key definitions are highlighted In the spirit of the previous editions, I trust that Mayo Clinic separately from the main text to improve knowledge retention. Internal Medicine Board Review, Twelfth Edition, will serve those New chapters have been added on physician well- being and hos- in the pursuit of mastering the art and science of internal medicine. pital internal medicine. The goal was to create a book that is comprehensive, useful, and easy to study. Christopher M. Wittich, MD, PharmD I wish to thank all the authors for their depth of knowl- edge and dedication to making this edition clinically relevant Editor- in- Chief a Cover images (selected to illustrate the breadth of knowledge required to be an internist), clockwise from the left: Figure 26.18. dermatomyositis: Gottron papules; Figure 41.8. chronic myeloid leukemia; Figure 11.7C. computed tomogram showing aortic dissection.