Step-Up to Medicine

550 Pages·2008·18.98 MB·English

by  Steven S. Agabegi

Thipsa gei ntentiloenfbatll alnyk .
Stept-oUM pe dicine
SecoEnddi tion
Thipsa gei ntentiloenfbatll alnyk .
Stept-oMU epd icine
SecoEnddi tion
STEVESN.A GABEGMID,
Resident
DepartomfOe rntth opSauerdgiecr y
UniverosfCi itnyc innati
CincinOnhaitoi ,
ELIZABEDT.HA GABEGMID,
Resident
Departomfe nOtp hthalmology
UniverosfCi itnyc innati
CincinOnhaitoi ,
I
.WoltKelrusw eLri ppiWnicloltit&a W misl kins
@
Health
Philade•lB pahlitai m•o NreewY or•kL ondon
BuenoAsi r•eH so ngK ongS·y dne·yT okyo
PublriB:s ehtety Sun
SenMiaonra gingS tEadcLie.Sty eo brr:i ng
MarkeMtainnaggj eern:nKi ufkelri nski
PrdouctEidointB oertM:ha rtz
Design CoHoorldRlieyinM dac tLoaru:g hlin
ComposIinttoerr:nT aytepisoentaatlni Cdno gm position
SecoEnddi tion
Copyr©i 2g0ht0250,0L 8i ppiWnicloltita Wmisl kia nWso,l Ktleurwbseu rs iness.
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35W1e sCta mdSetnr eet 53W0a lnSuttr eet
BaltiMmDo2 r1e02,1 PhiladePAl1 p9h61i 0a,
FirEsdti tCioopny,r ©i g2h0t0 5 LiWpiplilnicaWomitslt k ins
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Alrli grhetsse rTvheibdso. oi kps r otebcyct oepdy rNiogp hatro.tft hbioso mka yb er eprodiunac nefydo romrb y amneya ns,
inclupdhiontgo coopruy tiinlgbi,yz eadin nyf ormsattoiroaanng dre e trsiyesvtawlei mt hworuitt pteernm issitohne from
copyroiwgnhetr .
Thepu bliissnho etr res(paoansm s aitbtolefper r odluicatyb ,ni elgiltigoeron tchee,r fwoirs ei)an njyu ry rfersoaumnl yt ing
matecroinatla hienreeTdih nip.su blicatioinn fcoornmrtaeatliianottsnoi ngge pnreirnacloi fmp eldeiscc aartleh saht ounlodt
bec onstarssu peedc iinfsitcr ufcoitrni doinvspi adtuiaeMlan ntusf.a cptruordeiurncsft'o rmaantpdia ocnk iangsee srhtosu ld
ber eviefwocerud r riennfto rmiantcilouncd,oi nntgr ainddiocsaataginepodsrn ,es c,a utions.
Prinitnte hdUe n itSetda otfAe mse rica
LibroafCr oyn gress Cataloging-in-Publication Data
AgabeSgtie,vS e.n
Stept-omu epd icSitneev SeA.ng abeEglii,z aDb.Ae gtahb egi.-2nd ed.
I
p.;e m-. (Stuepps eries)
Inclbuidbelsi ographiacnaidln dreexf.e rences
ISNB-1937:8 -10-77-87153-5
ISNB-100-:71 87-7153-6
l.I ntemrendailc ine-Osuytllleiatnbce2i.s,.C , l incilcearlk ship-sOyultlelatibcn3i.e,.P s h,y sicians­
Licenses-SUtnaitteesd-E xaminagtuiiodneIss.A-. gS atbueEdglyii ,z aDb.eI tITh.i tlIeI.I . Series.
[DNLlM.:C linMiecdailc ine-OutClliinnMeiescd.ai l-c P2ir.no eblaenmds ExeWr c1i8sA.e22s5 .9 s
2008]
RC59.2A03058
61-6dc22
2007047325
Carheab se etna kteocn o nftihraemc curoaftc hiyen formparteisoeannn ttdeo dd e scgreinbeer aaclcleyp ted practices. How­
evetrha,eu theodrist,ao nrpdsu ,b liasrnheeo rrte sponfsoirb leoerro r moirsss oirfo onrs caonnys equfernoacmpe psl ication
oft hien formiantt hibioosno akn mda kneo w arrtaye,nx preosris mepdl wiietdrh,e spteotc htce u rrency, coorm pleteness,
accuroaftc hcyeo ntentthpseu bolfi cAaptpiloinco.aft t hiiionsnf ormianatp iaornt icular sitthupear otfieosns iroenmaali ns
responsoiftb hipelr iatcyt itioner.
Thaeu theodrist,ao nrpdsu ,b lihsahveeexr e retveeder fyrf to etnos utrheda rtu sge lecatnido nd ossefatog reit nth h tiesx t
ariena ccordwaintcchue r rreencto mmenadnapdtr iaocnatstti h cteei moefp ublicHaotwieovinenv.r i ,eo wfo ngoriensge arch,
chanignge osv ernrmeegnutl aatnitdoh cneos n,s ftlaonowtfi nformraetliatotodni r nutggh eraanpddyr urge acttihroeen asd,e r
iusr gteocd h etchkpe a ckiangsefe orerta cdhr ufgoa rn y chianin ngdei caatniddoo snasag ned afdodrwe adr nianngpdsr e­
cautiTohniisssp. a rticiumlpaorrwlthya entnth e recomamgeeinnasdt e nde wi nforre qeumepnltoldyyre udg .
Somder uagnsdm edidceavli pcreess einntt hepidus b lichaatvFieoo onad n Ddr uAgd minist(rFaDtAci)l oena rfaonrc e
limiteidnr eussterr iecsteesader tchtI iitns tg hsre.e sponsoifhb eiallciattrhpye r ovidaesrcse rttthoFae Di Ans taotfu se ach
druogrd evipclea nfnoeurds ient heir pcrlaicntiiccael.
Thpeu blihsahvemera sde ev eerfyf tootr tr accoep yrightf obhroo rlrdoewresd Imfa tthehareviiyean la.d vertently over­
lookaendyt ,h ewyi blelp leatsoe dm tahkneee cesasrarrayn geamtte hfneit rossp tp oryt.u nit
Top urchaadsdei tcioopniaoeflts h bioso cka,ol ulcr u stosmeerrvd iecpea rtamt(e 8n0t60 3)8 -3o0r3f a0ox rdetros
(30212)3 -2I3n2t0e.r ncautsitoonsmahelor usl d( 03c12a)2l 3l- 230L0i.pVpiisWniictlo ltita Wmisl koinnt sh Ien ternet:
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atLW Wc.omL.i ppincott WWiillklciiunassmt ossm eerrvr iecper eseanrtaeav taiivlfearsbo lme a 8m:t 3o60p mE,S T.
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109 8 7 6 5 4 3 2 1
Preface
Wew rotthefe i resdti toifSo tne pt-MoU epd idcuirnioenu gr oft hepsaet ieWnhtastt: e s,ti (fas n)y;w oulydo uo rder
thiyreda orfm edisccahlo boelc awuesc eo unlodft i nad nexWth?a tt hidesi efrfendtiiaagln oWosuilsd? aydomui t
review tbhoawotak sc oncyiescteo ,v etrhede broefa dtthhpe a titeotn hthe o spiHtoawul r?g entth piirsso blIesm ?
pathoelnocgoyu ndtuerrietndhg ie n temrendailc cilneer kc­onsulwtiattahis opne cinaelciesstsW ahrayit?st hter eat­
shiapn d ctohrer espeonndd-irnogt atisohnee lxNfaB mM­Em enotfc hoiBceef?o lroeo kaitnt gha en swetrasks,eo me
inatOiuogrno .aw la st oc reaas tien "glset utdoyo l" tot ismpteaoa r nes wtehre se qubeesctaituhoseness e qaurees ­the
thirdm-eydeiascrta uld etnhhteas s asnlede x peonfste ry intgi oynoswu i blelf acweidti hnc linpircaaclt ice.
toe xtrpaecrtt iinnefnotr mfartoimmou nl tispoluer ces. Inl igohftt h ree ceenmtp haosnei vsi dencem-ebdais­ed
Updataepsp etahrr ougthhoseue tc oenddi tAidodne.d cinweeh, a vaed deasd e cttioto hnae p penidnitxr oducing
"QuiHcikt isnt" h mea rgriensi nfkoerfyca eca tnsdp earltsh.be a siocfs biosatnadtt ihkseet cyio cnsc,er petqsu iirne d
Thequ estsieornavsse s eal f-assteosoasllm,le onwti ngc rsittui­acpaplrlayit shmieen dgi lciatle rature.
denttost hitnhkr oucglhi nsicceanla wriitohsao nustw er We hotpheay to uwi ll tfhiibnsod ou ks efduulr itnhge
choices intfhletuiheron ucpgirhnotgc Mesossq.tu estiocnlsi nyiecaaorlfms e disccahlo ol.
end "iwnh aatrt eh aep propnreixasttt eei pnsm a naging
thpisa tieInmta?g"i ne aysot uhrcesl eilnfit caikaicnna gr e SteavneEd l izAagbaebtehg i
v
Thipsa gei ntentiloenftba llalnyk .
Contents
Praecf.e ................v ..C.h.a.pt.5.e. Dr.i s.e.aso.efts. h .eC e.nt raanld
Chapt1.e rDi seasoefts h eC ardiovascular PeripheNrearlv ouSsy ste.m.s. ....1..9.4
Syste.m. .................1. .............. C.er.e.b.ro.vascu(lSatrr. oDk.ie.s).e 1a9.s4.e ..
IscheHmeiaDcri ts ease .....1. ..... MovemDeinsto r.d.er.s. .......2.0.1.. .. .
Arrhyt.h.m.i.a.s. ..... .......1..8.. ... Trem.o.r ...... ...... ..2.0.3. .
Tachyarrhythmias ..2.0. Demen.t.ia. ...... .... ..2.0..4 ...
Bradyarrhythmias. .....2..8.. .........A.l.t.e Mreendt al Status ..2.0.7
Diseoafst ehHsee aMruts cle. ..3.0. DemyeliDniasteiansge .. .2.11
PericDairsdei.aa !s es ...3.2. CNSN eopla.s.ms. ... .......2. .1 4
ValvuHleaarDr its e.a se ...3.6. HeaTdr au.m.a ..... ..... ..2.1..6 .
CongenHietaDarilts ease. ..4.4. NeuromusDciusle.aa rs es .. .21.9
Diseoafst ehVsea csulature. ..4.7. NeurocutSaynnedoruo.sm es .. .22.1
Sho.c.k. ........... ......5..7.. . ...... SpinCaolrD di se.as.e.s. .. .... ..22..2 .
CardNieaocp lasms. ..6.1. MiscellCaonnedonius.ts i o .. .22.3
Chapt2.e Dri seasoefts h eP ulmonary Chapt6.e Cro nnectTiivses auned J oint
Syste.m. ..................6.2.. ...... Diseas.e.s. ...............2.3..7. ....
ObstruLcutnDigiv see .a ses ..6.2. ConnecTtiisvsDeui es eases ..2.3.7
LunNge opla.s ms .. .. 70 RheumaAtrotihdr( iRAt)i.s .. .24.3
Diseoafst ehPsel eura ....7.4. .. Crystal-AIrntdhurci.et.di d.e.s. 2.4.8 .....
InterstiDtiisael(a IsLLe.uD n)g .. ..8 0 MyopatahniPdea siS ny ndro.m.es. .25.3. ..
RespirFaatiolruyr e. ..8.6. SeroneSgpaotnidvyel oart.h.r.o2p.5a6.t .hi es
Diseoafst ehPseu lmonary Vacsul.it.i.s .............2..5..8.. .....
Vasculature. .. ..9 5
MiscellTaopniecosu.s .... 1.0.1
Chapt7.e Dri seasoefts h eR enal
Chapt3.e Dri seasoefts h eG astrointestinal andG enitouriSnyasrtye. m. ......2.6..3
RenFaali l.u.r e .. .26.3
Syste.m. ..................1.0.6. .....
ProteiannuHdre imaa t.u ria .. .27.3
Diseoafst ehCseo l.on. .... .... 1..0 .6.
GlomerDuilsaera se ..2.7.6
Diseoafst ehLsei v.e r .. 1.31
(Glomerulonephropathies)
Diseoasfte hGsea llblaanddd er
TubulointDeirssetaisteisa l. .2.8.0
BiliTararc.yt .. 1.2 5
RenCayls tDiics ea.s es .. .28.2
Diseoafst ehAsep pendix ..13.0
RenVaaslc uDliasre ase ..2.8.3
Diseoafst ehPsea ncr.e as .. 1.3 1
StonaensOd b stru.c tions.. .28.4
GastroinBtleesetd.ii nnagl .. 1.3 6
Neopl.a sms .. .28.8
Diseoafst ehEses opha.g.u s ...1 4 0
MiscellCaonnedoiu.ts i ons.. .29.2
Diseoafst ehSset oma.c h .. 1.4 5
Diseoafst ehSsem aIlnlt estin.e. 1..5 0
InflammBaotwoDerilys e(aIsBeD ). .1.5.2 Chapt8.e Frl uiEdlse,c troalnydt es,
Acid-BaDsies ord.e.r.s. ........2.9..3. .
Chapt4.e Ern docrainndeM etabolic VolumDei sor.de.r s .. 2.9 3
Disea.s.e.s. ...............1.5..7. .... Sodi.u m .2 96
Diseoafst ehTseh yrGoliadn. d ..1. 5 7 Calucm.i ..30.0
Diseoasfte hPsei tuiGtlaarnyd .. . .16.5 Potas.si..um. .... ...... .3.0 3
Diseoafse Ptsah rea thGylraon.id d.s .. 1.07. Magnes.i.um. .... ...... 3..0 6
Diseoasfte hAsed reGnlaaln ds.. .17.2. Phosp.h ate ..30.7
Diseoafse Ptsah nec r.e as .. 1.97 Acid-DBiassoer ders ..30.8
vii
ViiiC ONNTTES
e
Chapt9e.Hr e matoloDgiisce ases Chapt12e.rA mbulatoMreyd ici.n.e. ........4.0.8..
andN eoplas.m.s. ...........3.1..5. .. CardiovDaissceual.sa.er...s . ........4.0 8
Anemi.a s.. . . . . .. 3..1 5. . . . .H e.a d.a. c..h e. .. .. ... .. ... .4.1.. 5. .............
PlatDeilseotr .d e.r s. . . ..3. 2 .8 . . . .U ppeRre. s pirDaitsoerays es ..41.8
DisorodfCe orasg ulation 0 03 03 1 GastroinDtiesseta.is.n.e.as..l. .. ....4.2 2
Anticoag.u.l.at.i.o.n. ..0 .03 .03 .6 . MusculosPkreolbelteamls. ...43.2. ..
PlasCmealD li sor.d ers 0 03 03 8 Diseoafst ehEsey e. .......4.4.2 .........
Lymhpoma.s. ..... ...0. 03 .04 .0 SleDeips or.d ers .. ..4.4.7 ..
Leukem.i as • 0.3 43 MiscellTaopniecosu s • 40 48
MyeloprolDiifseorradteirvse0.. 0 .3 46 HealMtahi nten.a .n. c.e ....4.55. ......
Chapt10e.r I nfectDiiosuesa s.e.s. .........3.4..8. .A pepndix. • 40 59
Infecotfti hoUenp sp aenrd RadiogrIanptheircp r.e tatio• n40 59
LIonwfeeRrceo tsftip hoiCenrTe sarn tatocrrtaysl • 0.3 48 PEhlyescEitxcraaomlci aInrnPadtetieaior.rogp lnrr. sae mt a••t 4400i 67o33n
Workuapn Mda nageomfe nt
NervSoyusst em. .. 3.5 5
Infecotfti hoGenas s trointestinal CommoPnr obloentm hsWe a rd.s • 40 77
BasSitca tiasntEdiv cisd ence-
Tra(cSteA el sCoh ap3t)e. r. .......35.9. ..
BasMeedd ic.i ne ... ....4.8.2. ......
Infecotfti hoGene sn itourinary
Tract . . . .3 6.2 Q.u e.s t..i o.n s. .• 0 0 0 0 0 0 0 0 0 0 0• 0•0 4 0 80 70 0 0 0 0 0 0 0 0
SexuTarlalnys mDiitsteeads es
(STD.s.) .. .....3 .67. .An.sw.e rs • 0 0 0 0 0 0 0 0 0 0 0• 0•0 5 0 00 30 0 0 0 0 0 0 0 0
Wounda nd TSiosfsItun ef ec.ti.o.n3s.7 .6 ..
Infecotfti hoBeno sn aensjd o in.t.s. 3.7.8 .A.bb vrieat.i ons • • 0 0 0 0• •00 5 0 10 50 0
ZoonoasneAdsr thropod-Borne AnatoAmbibcr evi.a tions . 5.51
Dise.as.e.s ..............3.8.1.. ....... DosaAgbeb revi.a tions . 5.1 5
CommoFnu ngIanlf ections. .3.84. Gas/CompAobubnrde vi.a tion.s 5 .51
CommoPna rasitic. Inf.e. c.3t8.i7o ns General Abbreviatio.n 5s.1. 5
FevaenrSd e ps.i s. . . . ... 3 .8. 7 . . . . U.n io.tfM e.a s.Au brber evi.a tio.n 5s8.1
MiscellIannfeeocutsi ons.. . 3.9 3
Ind.e x . 5.1 9
Chapt11e.r D iseasoefts h eS kiann d
HypersensiDtiisvoirtdy.e. r.s. ....3.9..5
CommoDne rmatoPlroogbil.ce m.s. .3. 9 5
AlleRregaicct .i ons .. 4.0 5