Practical Guide to the Care of the Medical Patient, 8th Edition: Expert Consult: Online and Print

597 Pages·2010·6.45 MB·English

by  Fred F. Ferri MD FACP

Practical Guide
to the Care of the
Medical Patient
Eighth Edition
FRED F. FERRI, MD, FACP
Clinical Professor
Alpert Medical School at Brown University
Providence, Rhode Island
Author contact for comments about the book:
[email protected]
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
PRACTICAL GUIDE TO THE CARE OF THE MEDICAL PATIENT ISBN: 978-0-323-07158-1
Copyright © 2011, 2007, 2004, 2001, 1998, 1995, 1991, 1987 by Mosby, Inc., an affiliate
of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Permissions may be
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Notice
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment and drug therapy may
become necessary or appropriate. Readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product
to be administered, to verify the recommended dose or formula, the method and duration of
administration, and contraindications. It is the responsibility of the practitioner, relying on
their own experience and knowledge of the patient, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all appropriate safety
precautions. To the fullest extent of the law, neither the Publisher nor the Editor assumes
any liability for any injury and/or damage to persons or property arising out of or related to
any use of the material contained in this book.
Library of Congress Cataloging-in-Publication Data
Ferri, Fred F.
Practical guide to the care of the medical patient.—8th ed. / Fred F. Ferri.
p. ; cm.—(Practical guide series)
Includes bibliographical references and index.
ISBN 978-0-323-07158-1
1. Internal medicine—Handbooks, manuals, etc. 2. Diagnosis—Handbooks, manuals, etc.
I. Title. II. Series: Practical guide series (Philadelphia, Pa)
[DNLM: 1. Clinical Medicine—Handbooks. 2. Diagnosis, Differential—Handbooks.
3. Laboratory Techniques and Procedures—Handbooks. WB 39 F388p 2011]
RC55.P84 2011
616—dc22 2010007359
Acquisitions Editor: James Merritt
Developmental Editor: Andrea Vosburgh
Publishing Services Manager: Linda Van Pelt
Project Manager: Sharon Lee
Design Direction: Lou Forgione
Working together to grow
libraries in developing countries
Printed in China www.elsevier.com|www.bookaid.org|www.sabre.org
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors
The author wishes to acknowledge the following physicians who have
contributed to this book and to several editions of Ferri’s Clinical Advisor.
Sonya S. Abdel-Razeq, MD Michelle Stozek Anvar, MD
Clinical Assistant Instructor Clinical Instructor
Department of Obstetrics and Division of General Internal Medicine
Gynecology/Resident Education Rhode Island Hospital
State University of New York at Buffalo Clinical Instructor
Women’s and Children’s Hospital Alpert Medical School
Buffalo, New York Brown University
Providence, Rhode Island
Tanya Ali, MD
Clinical Assistant Professor of Medicine Etsuko Aoki, MD, PhD
Department of Medicine Department of Hematology
Alpert Medical School Nagoya Medical Center
Brown University Nagoya, Japan
Providence, Rhode Island
Vasanthi Arumugam, MD
Philip J. Aliotta, MD, MSHA, FACS Assistant Professor
Clinical Instructor Department of Medicine
Department of Urology Mount Sinai School of Medicine
School of Medicine and Biomedical New York, New York;
Sciences Attending Physician
State University of New York at Buffalo Division of Infectious Diseases
Buffalo, New York Department of Medicine
Medical Director Elmhurst Hospital Center
Center for Urologic Research of Elmhurst, New York
Western New York
Williamsville, New York Sudeep Kaur Aulakh, MD, CM, FRCPC
Associate Professor of Medicine
George O. Alonso, MD Albany Medical College
Director Albany, New York
Department of Infection Control
Elmhurst Hospital Center Michael Benatar, MBCHB, DPhi
Elmhurst, New York Assistant Professor of Neurology
Instructor in Medicine Department of Neurology
Mount Sinai School of Medicine Emory University
New York, New York Atlanta, Georgia
Ruben Alvero, MD Sheenagh M. Bodkin, MD
Associate Professor Internal Medicine
Obstetrics and Gynecology The Center for Women’s Health
University of Colorado Health Sciences Providence, Rhode Island
Center Lynn Bowlby, MD
Aurora, Colorado Attending Physician
Srividya Anandan, MD Division of General Internal Medicine
Attending Physician Rhode Island Hospital
Internal Medicine Clinical Instructor of Medicine
Harvard Vanguard Medical Associates Alpert Medical School
Quincy, Massachusetts Brown University
Providence, Rhode Island
Mel L. Anderson, MD, FACP
Assistant Professor of Medicine Joanna Brown, MD
University of Colorado School of Medicine Fellow
Denver Veterans Affairs Medical Center Adolescent/Young Adult Program
Denver, Colorado Children’s Hospital
Boston, Massachusetts
vi Contributors
Jonathan Burns, MA, MD Mark J. Fagan, MD
Assistant Clinical Instructor Director
Department of Family Medicine Medical Primary Care Unit
Alpert Medical School Rhode Island Hospital
Brown University Associate Professor of Medicine
Providence, Rhode Island Alpert Medical School
Brown University
Gaurav Choudhary, MD
Providence, Rhode Island
Assistant Professor of Medicine
Alpert Medical School Gil M. Farkash, MD
Brown University Assistant Clinical Professor
Providence, Rhode Island State University of New York at Buffalo
School of Medicine
Maria A. Corigliano, MD, FACOG
Buffalo, New York
Clinical Assistant Professor
Department of Obstetrics and Timothy W. Farrell, MD
Gynecology Clinical Assistant Instructor
State University of New York at Buffalo Department of Family Medicine
Buffalo, New York Alpert Medical School
Brown University
John E. Croom, MD, PhD
Providence, Rhode Island
Co-Director
Comprehensive Epilepsy Center Christopher A. Ferri, MS
Saint Luke’s Mid America Brain and University of New England
Stroke Institute College of Osteopathic Medicine
Neurological Consultants of Kansas Biddeford, Maine
City, Inc.
Kansas City, Missouri Vito F. Ferri, DO
University of New England
George T. Danakas, MD, FACOG College of Osteopathic Medicine
Clinical Assistant Professor Biddeford, Maine
Department of Obstetrics and
Gynecology Tamara G. Fong, MD, PhD
State University of New York at Buffalo Instructor in Neurology
Buffalo, New York Beth Israel Deaconess Medical Center
Harvard Medical School
Alexandra Degenhardt, MD Boston, Massachusetts
Director
Multiple Sclerosis Center Glenn G. Fort, MD, MPH, FACP,
New York Methodist Hospital FIDSA
Brooklyn, New York Clinical Associate Professor of
Medicine
Joseph A. Diaz, MD Alpert Medical School
Assistant Professor of Medicine Brown University
Division of General Internal Medicine Chief
Memorial Hospital of Rhode Island Infectious Diseases
Alpert Medical School Our Lady of Fatima Hospital
Brown University North Providence, Rhode Island
Providence, Rhode Island
Genna Gekht, MD
Christine M. Duffy, MD, MPH Chief Resident in Neurology
Fellow Department of Neurology
Center for Gerontology and Health Care Emory University
Research Atlanta, Georgia
Alpert Medical School
Brown University Paul F. George, MD
Providence, Rhode Island Assistant Clinical Instructor
Department of Family Medicine
Jane V. Eason, MD Alpert Medical School
Attending Physician Brown University
Division of Infectious Diseases Pawtucket, Rhode Island
Elmhurst Hospital Center
Elmhurst, New York
Instructor in Medicine
Mount Sinai School of Medicine
New York, New York
Contributors vii
David R. Gifford, MD, MPH Christine Healy, DO
Assistant Physician Assistant Clinical Instructor
Division of Geriatrics Department of Family Medicine
Rhode Island Hospital Brown Medical School
Assistant Professor of Community Providence, Rhode Island
Health and Medicine
Alpert Medical School Jennifer Roh Hur, MD
Brown University Assistant Professor of Clinical
Providence, Rhode Island Medicine
Indiana University School of Medicine
Cindy Gleit, MD Indianapolis, Indiana
Assistant Clinical Instructor
Department of Family Medicine Richard S. Isaacson, MD
Alpert Medical School Resident in Neurology
Brown University Beth Israel Deaconess Medical Center
Providence, Rhode Island Harvard Medical School
Boston, Massachusetts
Rebecca A. Griffith, MD
Attending Physician Jennifer Jeremiah, MD
Department of Medicine Clinical Associate Professor of
Morristown Memorial Hospital Medicine
Morristown, New Jersey Alpert Medical School
Brown University
Joseph F. Grillo, MD Providence, Rhode Island
Fellow
Department of Infectious Diseases Michael P. Johnson, MD
Roger Williams Medical Center Staff Physician
Providence, Rhode Island Division of General Internal Medicine
Rhode Island Hospital
Michele Halpern, MD Assistant Professor of Medicine
Attending Physician Alpert Medical School
Division of Infectious Diseases Brown University
Sound Shore Medical Center of Providence, Rhode Island
Westchester
New Rochelle, New York Powel H. Kazanjian, MD
Clinical Assistant Professor of Medicine Professor and Chief
New York Medical College Division of Infectious Disease
Valhalla, New York Director of HIV Program
University of Michigan Medical Center
Mustafa A. Hammad, MD Professor of Internal Medicine
Clinical Neurophysiology Fellow University of Michigan Medical School
Department of Neurology Ann Arbor, Michigan
Emory University
Atlanta, Georgia Joseph J. Lieber, MD
Associate Director of Medicine
Sajeev Handa, MD Chief
Director Medical Consultation Service
Division of Hospitalist Medicine Elmhurst Hospital Center
Rhode Island Hospital Clinical Associate Professor of
Clinical Instructor of Medicine Medicine
Alpert Medical School Mount Sinai School of Medicine
Brown University New York, New York
Providence, Rhode Island
Mara Linscott, MD
Alex Harrison, MD Department of Medicine
Cardiology Fellow Women and Infants Hospital of Rhode
Division of Cardiology Island
University of California, Irvine Providence, Rhode Island
UCI Medical Center
Orange, California Zeena Lobo, MD
Attending Physician
Taylor Harrison, MD Division of Infectious Diseases
Assistant Professor of Neurology Elmhurst Medical Center
Department of Neurology Elmhurst, New York
Emory University
Atlanta, Georgia
viii Contributors
Michael Maher, MD Melissa Nothnagle, MD
Assistant Professor of Internal Assistant Professor of Family
Medicine Medicine
Alpert Medical School Alpert Medical School
Brown University Brown University
Rhode Island Hospital Providence, Rhode Island
Providence, Rhode Island
Gail M. O’Brien, MD
Achraf A. Makki, MD, MSC Medical Director
Resident Adult Ambulatory Services
Department of Neurology Rhode Island Hospital
Emory University Clinical Associate Professor of
Atlanta, Georgia Medicine
Alpert Medical School
Joseph R. Masci, MD
Brown University
Director of Medicine
Providence, Rhode Island
Elmhurst Hospital Center
Professor of Medicine Carolyn J. O’Connor, MD
Mount Sinai School of Medicine Assistant Clinical Professor
Elmhurst, New York Yale University School of Medicine
Department of Medicine
Daniel T. Mattson, MD, MSC (Med)
St. Mary’s Hospital
St. Louis Neurological Institute
Waterbury, Connecticut
St. Louis, Missouri
Steven M. Opal, MD
Kelly A. McGarry, MD
Professor of Medicine
Associate Program Director
Infectious Disease Division
General Internal Medicine Residency
Alpert Medical School
Program
Brown University
Rhode Island Hospital
Providence, Rhode Island
Assistant Professor of Medicine
Alpert Medical School Mina B. Pantcheva, MD
Brown University Internal Medicine
Providence, Rhode Island Roger Williams Medical Center
Providence, Rhode Island
Lynn McNicoll, MD
Assistant Professor of Medicine Pranav M. Patel, MD
Alpert Medical School Assistant Professor of Medicine
Brown University Division of Cardiology
Geriatrician University of California
Division of Geriatrics UCI Medical Center
Rhode Island Hospital Orange, California
Providence, Rhode Island
Peter Petropoulos, MD, FACC
Lonnie R. Mercier, MD Clinical Assistant Professor
Clinical Instructor Alpert Medical School
Department of Orthopedic Surgery Brown University
Creighton University School of Department of Veterans Affairs
Medicine Providence, Rhode Island
Omaha, Nebraska
Paul A. Pirraglia, MD, MPH
Dennis J. Mikolich, MD, FACP, FCCP Assistant Professor of Medicine
Chief Alpert Medical School
Division of Infectious Diseases Brown University
VA Medical Center; Rhode Island Hospital
Clinical Associate Professor of Providence, Rhode Island
Medicine
Alpert Medical School Sharon S. Hartman Polensek, MD,
Brown University PhD
Providence, Rhode Island Clinical Associate
Department of Neurology
Takuma Nemoto, MD Emory University
Research Associate Professor of Atlanta, Georgia
Surgery
State University of New York at Buffalo
Buffalo, New York
Contributors ix
Maurice Policar, MD Sean I. Savitz, MD
Chief of Infectious Diseases Assistant Professor of Neurology
Elmhurst Hospital Center University of Texas
Elmhurst, New York; Houston, Texas
Assistant Professor of Medicine
Mount Sinai School of Medicine Jack L. Schwartzwald, MD
New York, New York Clinical Assistant Professor of
Medicine
Arundathi G. Prasad, MD Rhode Island Hospital
Clinical Instructor Providence, Rhode Island
Department of Obstetrics and
Gynecology/Resident Education Harvey M. Shanies, MD, PhD
State University of New York at Buffalo Director of Critical Care Medicine
Women’s and Children’s Hospital Vassar Brothers Medical Center
Buffalo, New York Poughkeepsie, New York
Kittichai Promrat, MD Deborah L. Shapiro, MD
Assistant Professor Chief
Division of Gastroenterology Division of Rheumatology
Department of Medicine Elmhurst Hospital Center
Alpert Medical School Elmhurst, New York
Brown University Clinical Assistant Professor of
Chief Medicine
Gastroenterology Section Mount Sinai School of Medicine
Providence Veterans Affairs Medical New York, New York
Center Grace Shih, MD
Providence, Rhode Island Assistant Clinical Instructor
John Ragsdale, MD Department of Family Medicine
Clinical Assistant Professor of Family Alpert Medical School
Medicine Brown University
Alpert Medical School Providence, Rhode Island
Brown University Joanne M. Silvia, MD
Providence, Rhode Island Assistant Clinical Instructor
Chaitanya V. Reddy, DO Department of Family Medicine
Assistant Clinical Instructor Alpert Medical School
Department of Family Medicine Brown University
Alpert Medical School Providence, Rhode Island
Brown University U. Shivraj Sohur, MD, PhD
Providence, Rhode Island Assistant Professor of Neurology
Harlan G. Rich, MD Harvard Medical School
Director of Endoscopy Boston, Massachusetts
Rhode Island Hospital Dominick Tammaro, MD
Associate Professor of Medicine Associate Director
Alpert Medical School Categorical Internal Medicine
Brown University Residency
Providence, Rhode Island Co-Director
Hemant K. Satpathy, MD Medicine-Pediatrics Residency
Assistant Professor Division of General Internal Medicine
Department of Family Medicine Rhode Island Hospital
Chief Resident Associate Professor of Medicine
Department of OB/GYN Alpert Medical School
Creighton University Medical Center Brown University
Omaha, Nebraska Providence, Rhode Island
Ruby Satpathy, MD Iris Tong, MD
Fellow, Cardiology Assistant Professor
Department of Internal Medicine Department of Medicine
Creighton University Warren Alpert Medical School
Omaha, Nebraska Brown University Women and Infants
Hospital
Providence, Rhode Island
x Contributors
Margaret Tryforos, MD Dennis M. Weppner, MD, FACOG
Clinical Assistant Professor Associate Professor of Clinical
Department of Family Medicine Gynecology/Obstetrics
Alpert Medical School State University of New York at Buffalo
Brown University Clinical Chief
Providence, Rhode Island Department of Gynecology/Obstetrics
Millard Fillmore Hospital
Eroboghene E. Ubogu, MBBS(Hons)
Buffalo, New York
Assistant Professor of Neurology
Case Western Reserve University Wen-Chih Wu, MD
School of Medicine Assistant Professor of Medicine
Staff Neurologist Alpert Medical School
Louis Stokes Cleveland Veterans Affairs Brown University
Medical Center Cardiologist
Cleveland, Ohio Providence VA Medical Center
Providence, Rhode Island
Tom J. Wachtel, MD
Physician-in-Charge Beth J. Wutz, MD
Division of Geriatrics Clinical Assistant Professor of Medicine
Rhode Island Hospital Division of Internal Medicine/Pediatrics
Professor of Community Health and Kajeida Health–Buffalo General Hospital
Medicine State University of New York at Buffalo
Alpert Medical School Buffalo, New York
Brown University
Providence, Rhode Island Cindy Zadikoff, MD, FRCPC
Assistant Professor of Neurology
Tara M. Wayt, DO Parkinson’s Disease and Movement
University of New England Disorders Center
College of Osteopathic Medicine Davee Department of Neurology and
Biddeford, Maine Clinical Neurological Sciences
Feinberg School of Medicine
Marc S. Weinberg, MD, FACP
Northwestern University
Clinical Professor of Medicine
Chicago, Illinois
Boston University School of Medicine
Clinical Associate Professor of Medicine Scott J. Zuccala, DO, FACOG
Alpert Medical School; Staff Physician
Chief of Nephrology Mercy Hospital of Buffalo
Roger Williams Medical Center Buffalo, New York
Providence, Rhode Isalnd
Preface
This manual is a concise reference for the busy clinician in need of immediate
medical information. Its purpose is to provide a fast and efficient way to iden-
tify important clinical, laboratory, and diagnostic imaging information.
To limit its size to a pocket reference, less emphasis has been placed on
pathophysiology and epidemiology, with more emphasis on practical clinical
information. Clinical algorithms and tables have been used extensively through-
out the manual to simplify difficult topics and to enhance recollection of prin-
cipal points. It is hoped that its concise style will help the reader, particularly
during an active clinical service, when time to read is extremely limited.
For the 8th edition we have added color images to most of the medical
disorders online to facilitate identification and understanding of these illnesses
and help with Board preparation.
The combination of practical clinical information with drug therapeutics,
procedures, diagnostic imaging, and laboratory medicine makes this manual
unique and useful, not only to medical residents and students, but also to
practicing physicians and allied health professionals. I wish to thank the many
thousands of physicians who have made the prior editions a best-seller in
medical publishing and hope that future users will find this edition the most
useful medical handbook that they will ever purchase during their training.
Fred F. Ferri, MD, FACP
Pearls of Wisdom in Medicine
1. Common things occur commonly.
2. When you hear hoofbeats, think of horses, not zebras.
3. Place your bets on uncommon manifestations of common conditions,
rather than common manifestations of uncommon conditions.
4. If what you are doing is working, keep on doing it.
5. If what you are doing is not working, stop doing it.
6. If you don’t know what to do, don’t do anything.
7. Above all, never let a surgeon get your patient.
From Matz R: Principles of Medicine,
NY State J Med 77:99-101, 1977