Table Of ContentiJ:HIRD EDITION
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MASTER THE WARDS
Internal
Medicine
Handbook
• Core diseases and disorders organized by chief complaint
• Highlighted "don't miss" diagnoses and things
to look out for in your patients
• Tips and "must know" items for impressing attendings
Conrad Fischer, MD
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MASTER THE WARDS
Internal Medicine Handbook
THIRD EDITION
CONRAD FISCHER, MD
New York Chicago San Francisco Athens London
Madrid Mexico City Milan New Delhi
Singapore Sydney Toronto
Copyright© 2016 by McGraw-Hill Education.All rights reserved. Except as permitted under the United States Copyright
Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database
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ISBN: 978-l-25-964124-4
MHID: 1-25-964124-4
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Dedication
This book is dedicated to Sudheer Chauhan, MD, Associate
Director, Residency Program, at the Jamaica Hospital Medical
Center.
Dr. Chauhan is the single greatest general internist I have ever
met. He is a true gentleman with a generous spirit, a heart full
of renewable energy, and a knowledge of medicine second to
none. Dr. Chauhan's wisdom, excellent guidance to students,
and consummate dedication to the art and science of medicine
are an inspiration to all who are fortunate enough to work
with him.
SatChitAnanda
truth + wisdom = blissful happiness
Acknowledgments
The author wishes to acknowledge the expert attention to
detail of:
Kenneth J. Steier, DO, MPH, MHA, MGH, MBA
Dean of Clinical Medicine and Professor
Touro College of Osteopathic Medicine
The author also wishes to thank the following doctors for their
kind permission to use the images that appear in this book:
Beppy Edasery, MD and Arnn Kottarathara, MD
Mohammad Babury, MD and Mahendra C. Patel, MD
Contents
How to Use This Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Introduction .................... ................... .. .. xix
How to Survive the Internal Medicine Clerkship ............. xxiii
Chapter 1: Cardiology .................................... 1
Chest Pain .. .... ....... ... ..... ........... ... .. ... . 1
Hypotension .... .............. ...................... 4
Acute Coronary Syndrome (ACS) ......................7
Non-ST-Elevation MI (NSTEMI) .. .............. ..... . 13
ST-Elevation MI (STEMI) ... ..... ..... .... .. ... .. ... 13
Ambulatory Coronary Artery Disease (CAD)/
Angina .. .... ....... ... ..... ........... ..... ... 16
Congestive Heart Failure (CHF) ........................ 18
Acute Pulmonary Edema ............................ 18
Hypertensive Crisis (Emergency) ...................... 24
Cardiomyopathy ... ... .. ... .......... ...... ... .. ... 24
Hypertrophic Obstructive Cardiomyopathy
(HOCM) .... ....... .... ..... .......... .. ....... 26
Arrhythmias ......................................... 27
Atrial Fibrillation and Flutter ......................... 28
Supraventricular Tachycardia (SVT) .............. ..... 33
Wolff-Parkinson-White Syndrome (WPW) .............. 35
Multifocal Atrial Tachycardia (MAT) .... .... ..... .. ... 37
Ventricular Tachycardia (VT) ......................... 37
Ventricular Fibrillation ............................. .40
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Master the Wards: Internal Medicine Handbook
Bradycardia .. .... ....... ... ..... ..... ...... ... .. ... .. .41
Sick Sinus Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Syncope ..... .... .. ... .. ... ..... ..... .... .. ... .. ... .. 44
Valvular Heart Disease .................................. 47
Aortic Regurgitation (AR) and
Mitral Regurgitation (MR) ............................ 48
Aortic Stenosis (AS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Mitral Stenosis ... ....... ... ...... .......... ... ...... .. 51
Mitral Valve Prolapse ....... ..... .............. .. ... ... 53
Pericardial Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Pericarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Pericardia! Tamponade. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Constrictive Pericarditis ... ... ..... ........... ... .. ... .. 57
Peripheral Artery Disease (PAD) ......................... 58
Aortic Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Abdominal Aortic Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Thoracic Aortic Aneurysm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Pregnancy and Heart Disease ............................6 1
Chapter 2: Endocrinology .................................. 63
Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Thyroid Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Hypothyroidism and Hyperthyroidism . . . . . . . . . . . . . . . . . . . . 73
Thyroid Nodules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Adrenal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Hypercortisolism ...... ..... ..... ..... .... ..... .. ... .. 77
Hyperaldosteronism (Conn's Syndrome) ................... 79
Hypoadrenalism (Addison's Disease) ...................... 80
Pheochromocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
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Contents
Adrenal "Incidentaloma" .................. .. ........ 81
Congenital Adrenal Hyperplasia ....................... 82
Hypercalcemia .. .. ... .. ............. .... .. ......... 83
Hypocalcemia ..................................... 86
Pituitary Disorders ................................... 87
Hyperprolactinemia .... .. ... ..... ..... .... .. ... ..... 88
Acromegaly .... .. ... .. ... .......... .... .. ... ...... 89
Panhypopituitarism .................. ...............9 0
Chapter 3: Gastroenterology .............................. 93
Gastrointestinal Bleeding .... ..... ..... .... .. ... ..... 93
Orthostatic Hypotension .... .......... .... .. ... ...... 94
Esophageal Varices ................. ................ 95
Epigastric Pain ....... .. ................. .. ........ 99
Zollinger-Ellison Syndrome (ZES) .................... 102
Diabetic Gastroparesis ............................. 103
Gastroesophageal Reflux Disease (GERO) ............. 104
Pancreatitis ...................................... 105
Infectious Diarrhea .... .. ... .... ...... ...... ... .. .. 107
Malabsorptive Diseases ............................... 110
Celiac Disease .................................... 111
Whipple's Disease ................................. 112
Chronic Pancreatitis ... .. ... .......... .... .. ... .... 112
Lactose Intolerance .... .. ............. .... .. ....... 113
Carcinoid Syndrome ............................... 113
Irritable Bowel Syndrome (IBS) ...................... 114
Inflammatory Bowel Disease (IBD) ................... 115
Constipation .... ..... .. ... .......... .... .. ... ..... 117
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Master the Wards: Internal Medicine Handbook
Diverticular Disease ................................. 118
Diverticulitis ..................................... 118
Cholecystitis .... .. ... .. ... ...... .... .... .. ... .. .. 119
Ascending Cholangitis ............................. 119
Liver Disease ....................................... 120
Viral Hepatitis .. ....... ... .... .. .......... ... ..... 122
Cirrhosis ... .... ....... ... ... .. ........... ... .... 124
Hemochromatosis ................................. 125
Wilson's Disease .......... ..... .............. ..... 126
Primary Biliary Cirrhosis (PBC) ..................... 127
Primary Sclerosing Cholangitis (PSC) ............. .. .. 127
Autoimmune Hepatitis ............................. 127
Esophageal Disorders ................................ 127
Esophageal Cancer ...... ... ..... ........... ... .... 128
Esophageal Spasm ...... ... ..... .............. .... 129
Achalasia ........................................ 129
Esophageal Candidiasis ..... ..... .............. ..... 130
Rings and Webs ..................................... 130
Schatzki's Ring ...................... .... .. ... .. .. 130
Plummer Vinson Syndrome ......................... 130
Zenker's Diverticulum .............................. 131
Scleroderma .... ....... ... ...... .......... ... ..... 131
Mallory-Weiss Tear ......... ................... .... 131
Chapter 4: Hematology ................................. 133
Anemia ......................................... 133
Microcytic Anemia ................................ 137
Macrocytic Anemia (MCV >100 fl) ................... 139
Vitamin B Deficiency ..... .... ..... .......... ..... 140
12
viii
Contents
Folate Deficiency .... ... ... ........ .. ... ... ... ..... 141
Hemolytic Anemia ...... ... ................ ... .... 141
Sickle Cell Disease ................................ 143
Coagulation Disorders ................................ 146
Von Willebrand's Disease ... ................ ... ..... 147
Immune (or Idiopathic) Thrombocytopenic
Purpura (ITP) .. ..... ... ..... ..... ...... ... .. ... 147
Warfarin Overdose, Vitamin K Deficiency,
and Liver Disease ............................... 148
Disseminated Intravascular Coagulopathy (DIC) ........ 149
Clotting Factor Deficiencies ........................... 151
Hemophilia .. ... ....... ... .......... .... .. ... .... 151
Factor XI and XII Deficiencies ....................... 151
Hypercoagulable States/Thrombophilia .. ...... ........ 152
Hematological Malignancies .......................... 152
Chronic Lymphocytic Leukemia (CLL) ................ 152
Chronic Myelogenous Leukemia (CML) ........ ....... 153
Pancytopenia .... ..... .. ... .......... .... ..... .... 154
Aplastic Anemia .................................. 155
Myelodysplastic Syndrome ... ...... .......... ....... 155
Myelofibrosis ... .......... .......... ......... ..... 156
Hairy Cell Leukemia. .............................. 156
Polycythemia Vera ....... ......... ................. 157
Essential Thrombocythemia .. .......... .... ..... .... 158
Acute Leukemia .................................. 158
Leukostasis Reaction ............................... 159
Lymphoma ...... .......... .......... .... ..... .... 160
Myeloma ........................................ 161
Waldenstrom's Macroglobulinemia ...... ...... ... .... 163
ix
