Mayo Clinic Internal Medicine Concise Textbook Mayo Clinic Internal Medicine Concise Textbook Editors-in-Chief Thomas M. Habermann, MD Amit K. Ghosh, MD MAYO CLINIC SCIENTIFIC PRESS INFORMA HEALTHCARE ISBN-13 9781420067491 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. ©2008 Mayo Foundation for Medical Education and Research. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopying, recording, or oth- erwise—without the prior written consent of the copyright holder, except for brief quotations embodied in critical articles and reviews. Inquiries should be addressed to Scientific Publications, Plummer 10, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. For order inquiries, contact Informa Healthcare, Kentucky Distribution Center, 7625 Empire Drive, Florence, KY 41041. E-mail: [email protected]. www.informahealthcare.com Library of Congress Cataloging-in-Publication Data Mayo Clinic internal medicine concise textbook / edited by Thomas M. Habermann, Amit K. Ghosh. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-4200-6749-1 (hb : alk. paper) ISBN-10: 1-4200-6749-4 (hb : alk. paper) 1. Internal medicine--Handbooks, manuals, etc. I. Habermann, Thomas M. II. Ghosh, Amit. III. Mayo Clinic. IV. Title: Internal medicine concise textbook. [DNLM: 1. Internal Medicine--Handbooks. 2. Communicable Diseases--therapy--Handbooks. WB 39 M4727 2007] RC55.M34 2007 616--dc22 2007027847 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 relat- ing 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. Readers are instructed to use caution while writing drug prescriptions and to verify the information, if necessary, with a local pharmacy to check on drug-drug interactions and to review the risk profile assessment of patients before writing prescriptions. 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 health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice. Printed in Canada CONTRIBUTORS Haitham S. Abu-Lebdeh, MD Brian A. Crum, MD Consultant, Division of General Internal Medicine, Mayo Consultant, Department of Neurology, Mayo Clinic; Assistant Clinic; Assistant Professor of Medicine, College of Medicine, Professor of Neurology, College of Medicine, Mayo Clinic; Mayo Clinic; Rochester, Minnesota Rochester, Minnesota Timothy R. Aksamit, MD Lisa A. Drage, MD Consultant, Division of Pulmonary and Critical Care Medicine, Consultant, Department of Dermatology, Mayo Clinic; Mayo Clinic; Assistant Professor of Medicine, College of Assistant Professor of Dermatology, College of Medicine, Mayo Medicine, Mayo Clinic; Rochester, Minnesota Clinic; Rochester, Minnesota Robert C. Albright, Jr., DO Stephen B. Erickson, MD Consultant, Division of Nephrology and Hypertension, Mayo Consultant, Division of Nephrology and Hypertension, Mayo Clinic; Assistant Professor of Medicine, College of Medicine, Clinic; Assistant Professor of Medicine, College of Medicine, Mayo Clinic; Rochester, Minnesota Mayo Clinic; Rochester, Minnesota Thomas J. Beckman, MD Lynn L. Estes, PharmD Consultant, Division of General Internal Medicine, Mayo Infectious Disease Pharmacist Specialist, Mayo Clinic; Assistant Clinic; Assistant Professor of Medicine, College of Medicine, Professor of Pharmacy, College of Medicine, Mayo Clinic; Mayo Clinic; Rochester, Minnesota Rochester, Minnesota Thomas Behrenbeck, MD Fernando C. Fervenza, MD, PhD Consultant, Division of Cardiovascular Diseases, Mayo Clinic; Consultant, Division of Nephrology and Hypertension, Mayo Associate Professor of Medicine, College of Medicine, Mayo Clinic; Associate Professor of Medicine, College of Medicine, Clinic; Rochester, Minnesota Mayo Clinic; Rochester, Minnesota Eduardo E. Benarroch, MD Amit K. Ghosh, MD Consultant, Department of Neurology, Mayo Clinic; Professor Consultant, Division of General Internal Medicine, Mayo of Neurology, College of Medicine, Mayo Clinic; Rochester, Clinic; Associate Professor of Medicine, College of Medicine, Minnesota Mayo Clinic; Rochester, Minnesota Peter A. Brady, MD William W. Ginsburg, MD Consultant, Division of Cardiovascular Diseases, Mayo Clinic; Consultant, Division of Rheumatology, Mayo Clinic, Assistant Professor of Medicine, College of Medicine, Mayo Jacksonville, Florida; Associate Professor of Medicine, College Clinic; Rochester, Minnesota of Medicine, Mayo Clinic; Rochester, Minnesota Robert D. Brown, Jr., MD Thomas M. Habermann, MD Chair, Department of Neurology, Mayo Clinic; Professor of Consultant, Division of Hematology, Mayo Clinic; Professor Neurology, College of Medicine, Mayo Clinic; Rochester, of Medicine, College of Medicine, Mayo Clinic; Rochester, Minnesota Minnesota Darryl S. Chutka, MD C. Christopher Hook, MD Consultant, Division of Preventive and Occupational Medicine, Consultant, Division of Hematology, Mayo Clinic; Assistant Mayo Clinic; Associate Professor of Medicine, College of Professor of Medicine, College of Medicine, Mayo Clinic; Medicine, Mayo Clinic; Rochester, Minnesota Rochester, Minnesota ix DEDICATED TO My father, who dedicated his life to medicine and represents the so many who have provided opportunities and examples for each of us in our careers. Thomas M. Habermann, MD v FOREWORD M ayo Clinic Internal Medicine: Concise Textbookreflects the continued commitment by the faculty of the Department of Internal Medicine to its mission of scholarship. One of the key traditions in medicine is the passing of knowledge from physician to physi- cian. In 1928, William J. Mayo, MD, wrote, “The glory of medicine is that it is constantly moving forward, that there is always more to learn. The ills of today do not cloud the horizon of tomorrow, but act as a spur to greater effort.”*This book is a response to these themes. My hope is that it will aid in the care of patients. Nicholas F. LaRusso, MD Chair, Department of Internal Medicine Mayo Clinic, Rochester, Minnesota *Mayo WJ. The aims and ideals of the American Medical Association. Proceedings of the 66th Annual Meeting of the National Education Association of the United States, 1928. p. 158-63. vi PREFACE S cientific observations and clinical advances are moving at a remarkable pace. These changes require physicians to remain abreast of the latest developments not only in their areas of expertise but also in areas beyond their sphere of expertise. To assist physicians in this endeavor, the Department of Medicine at Mayo Clinic remains committed to providing information to physicians in a timely manner. Mayo Clinic Internal Medicine: Concise Textbookis designed to meet the needs of medical students, nurse practi- tioners, physician assistants, physicians-in-training, and practicing clinicians by updating their knowledge of internal medicine and providing a concise review of internal medicine. The overall approach to learning medicine can be summed up in two questions: What is it? What do you do for it? The goal is to have a concise review that is readable and easy to follow with algorithms, diagrams, radiographs, and pathologic find- ings. This book is divided into subspecialty topics, each chapter written by an author(s) with clinical expertise in the designated topic. Images and tables are provided. Each chapter has bulleted items that highlight key points. These may be summary points from previous paragraphs or new points. Bulleted items also address typical clinical scenarios. These scenarios emphasize classic clinical presentations. Pharmacy tables are included with many of the chapters. The scenarios and pharmacy tables highlight two key points. First, general internists, subspecialists, nurse practitioners, physician assistants, and family physicians diagnose dis- eases in internal medicine. Second, the predominant type of patient management is pharmacologic. Knowledge of the indications, toxic effects, and drug interactions is of paramount importance. We thank everyone who contributed to the development of this book. We are indebted to all authors for their contribu- tions. We thank the staffs of the Section of Scientific Publications, Department of Medicine, and Division of Media Support Services at Mayo Clinic for their contributions to this book. The support and cooperation of the publisher, Informa Healthcare, are gratefully acknowledged. We trust that this book will serve as an update and advance the reader’s knowledge of internal medicine. We hope that you enjoy this review as much as we have. Thomas M. Habermann, MD Amit K. Ghosh, MD Editors-in-Chief vii