Mayo Clinic Internal Medicine Review EIGHTH EDITION pptx

Mayo Clinic
Internal Medicine Review
Editor-in-Chief
Amit K. Ghosh, MD
MAYO CLINIC SCIENTIFIC PRESS
EIGHTH EDITION
Master the Internal Medicine Boards
Written by experienced faculty at Mayo Clinic, this EIGHTH EDITION is
a completely revised and updated study tool that has proved invaluable
for the American Board of Internal Medicine certification or maintenance
of certification as well as general practice review by physicians around
the world.
Using this source, physicians will access a virtual blueprint for exam
preparation and acquire clear guidance on question format, types of
questions, and hints on topics commonly encountered on the test.
Providing more than 350 MULTIPLE-CHOICE QUESTIONS that simulate the current exam format, this
must-have guide will equip readers with the resources they need to anticipate testing challenges and pass
the exam. Here are just a few of the great features found in the EIGHTH EDITION.
• NEW—chapter on HOSPITAL MEDICINE
• QUESTION-AND-ANSWER segments and expertly written explanatory notes at the end of each chapter
• STRATEGIES AND RECOMMENDATIONS on how to approach the board exam
• CURRENT PHARMACY TABLES that highlight indications, toxic effects, and drug interactions
• TYPICAL CLINICAL SCENARIOS
• EXTENSIVELY EDITED CHAPTERS on cardiology, pulmonology, nephrology, critical care, geriatrics,
preventive medicine, hematology, infectious diseases, women’s and men’s health
• DETAILED INDEX for quick retrieval of information
• GREAT ILLUSTRATIVE TOOLS—lucid images, algorithms, and summary tables that reflect major
practices, therapies, and medications utilized in the field
ABOUT THE EDITOR
AMIT K. GHOSH, MD, is Consultant, Division of General
Internal Medicine, Mayo Clinic, Rochester, Minnesota; and

Associate Professor of Medicine, College of Medicine, Mayo Clinic
CONTENTS INCLUDE:
• The Board Examination
• Allergy
• Cardiology
• Critical Care Medicine
• Dermatology
• Endocrinology
• Gastroenterology and Hepatology
• General Internal Medicine
• Genetics
• Geriatrics
• Hematology
• HIV Infection
• Hospital Medicine
• Hypertension
• Infectious Diseases
• Medical Ethics
• Men’
s Health
• Nephrology
• Neurology
• Oncology
• Preventive Medicine
• Psychiatry
• Pulmonary Diseases
• Rheumatology
• V
ascular Diseases
• Women’s Health

450
250
Over
TABLES and
FIGURES
Mayo Clinic Internal Medicine Review
EIGHTH
EDITION
Ghosh
Ghosh8_FinalCover 5/22/08 9:04 AM Page 1
Mayo Clinic
Internal Medicine Review
EIGHTH EDITION
Editor-in-Chief
Amit K. Ghosh, MD
Associate Editors
Christopher M. Wittich, MD, PharmD
Deborah J. Rhodes, MD
Thomas J. Beckman, MD
Randall S. Edson, MD
Dennis K. McCallum, PharmD
Mayo Clinic
Internal Medicine Review
EIGHTH EDITION
MAYO CLINIC SCIENTIFIC PRESS
INFORMA HEALTHCARE
ISBN-13 9781420084788
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.
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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 otherwise—
without the prior written consent of the copyright holder, except for brief quo-
tations 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,
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E-mail:
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Catalog record is available from the Library of Congress
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, 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 impor-
tant when the recommended agent is a new or infrequently employed drug.
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
PREFACE
edical advances have been occurring at breathtaking speed, with diagnostic and treatment
options becoming available for conditions for which none previously existed. However, several
aspects of health care remain the same. Patients continue to rely heavily on clinicians for help in
understanding the burgeoning evidence in medical research and for providing optimal health
care. Clinicians remain steadfast in their quest to meet the needs of their patients and to encourage
innovation in meeting those needs. The focus on patient safety and quality of care remains a key-
stone of medical practice, and multidisciplinary care with a system-based approach is increas-
ingly being adopted to manage chronic disorders. The associated demands and challenges mandate
that physicians remain abreast of the latest developments in medicine. To assist physicians in this
endeavor, the Department of Internal Medicine at Mayo Clinic provides continuing medical
education updates and resources in a timely manner. This book, Mayo Clinic Internal Medicine
Review, is designed to meet the needs of practicing clinicians and physicians-in-training by updating
their knowledge of internal medicine and helping to prepare them for the internal medicine cer-
tification and maintenance of certification examinations administered by the American Board
of Internal Medicine (ABIM).
The success of the earlier editions of this textbook is exemplified by the number of books pub-
lished. The positive reaction to and the success enjoyed by the earlier editions prompted the
Department of Internal Medicine to proceed with the publication of the eighth edition. Each
chapter has been thoroughly updated, and a new chapter on hospital medicine has been added.
The goal is to provide an update in internal medicine that is readable and easy to study.
This book is divided into chapters based on subspecialty topics and written by authors with
expertise in the respective fields of medicine. Bulleted items highlight elements that are impor-
tant concepts. The repetition of important points in the chapters reinforces the essential aspects
of the topics and serves as an additional aid in review of the subjects. Multiple-choice ques-
tions appear at the end of each chapter; there are more than 350 multiple-choice questions in

this edition. Correct answers and detailed explanations follow the questions.
I am grateful to all the individuals who contributed ideas and suggestions for improvement
during the development of this book. I thank the esteemed authors of the previous editions for
their input into this edition and for permitting the use of some of the materials from previous
editions. I am indebted to all authors for their immense effort and contributions to this edi-
tion. I 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 edition. The
support and cooperation of the publisher, Informa Healthcare, are also gratefully acknowledged.
I trust that the eighth edition of Mayo Clinic Internal Medicine Review will continue to update
and advance the reader’s knowledge of internal medicine.
Amit K. Ghosh, MD
Editor-in-Chief
ix
M
DEDICATED TO
All students of medicine, whatever their level of experience
and whatever their needs
v
FOREWORD
he eighth edition of Mayo Clinic Internal Medicine Review is a reflection of the continued com-
mitment by the faculty of the Department of Internal Medicine to its mission to “serve the patient
and advance the science.” There are substantial differences from the previous edition as a result
of extensive revisions. All chapters were updated, 12 new authors and 2 new associate editors
were recruited, a new chapter on hospital medicine was added, and new tables, figures, and ques-
tions and answers were included. These changes and improvements are consistent with the theme
eloquently articulated by William J. Mayo, MD, in 1928: “The glory of medicine is that it is
constantly moving forward, that there is always more to learn.”
*
My hope is that the reader will

find the contents of this book informative, enjoyable, and, most of all, useful in our shared objective
of understanding, preventing, diagnosing, and treating the diseases that still plague the human race.
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.
vii
T
PREFACE TO THE FIRST EDITION
or more than 2 decades, the staff of the Mayo Clinic and faculty of the Mayo Graduate School
of Medicine have provided in-house didactic presentations for residents and fellows preparing
for the internal medicine certifying examination administered by the American Board of Internal
Medicine (ABIM). The extreme popularity of the Mayo “board reviews” among the residents
and fellows and other physicians prompted the initiation of “Mayo Internal Medicine Board
Review” courses in August 1992 to all physicians. Nearly 200 physicians in 1992 and twice that
number in August 1993 attended the courses offered in Rochester, Minnesota. The popularity
and the great demand for the course syllabus inspired us to write this book for candidates preparing
for the ABIM examinations in internal medicine. This book, Mayo Internal Medicine Board
Review 1994-95, will be used as the course syllabus for the “Mayo Internal Medicine Board
Review” courses to be held in 1994 (July 24-30) and 1995 (July 23-29) in Rochester, Minnesota.
This is not a comprehensive textbook of medicine. It is rather analogous to a guide or a note-
book containing selected topics deemed important for candidates preparing for the certifying or
recertifying examinations offered by the ABIM in 1994 and 1995. The authors of this book
assume that the candidates preparing for the board examinations will have studied at length a
standard textbook of medicine before reading this review. The chapters are divided by subspecialty
topics. As a means of underscoring the important clinical points for the boards, many paragraphs

are followed by selected “pearls.” Some of these pearls may seem repetitious, but this approach
is intentional. We hope this format will aid readers in recapitulating the salient points of the topic
under discussion. The questions at the end of each chapter are intended to familiarize the can-
didates with the format of the ABIM examination. Answers to these questions and their expla-
nations are at the end of the book.
My coauthors and I are truly pleased to present this book and anticipate that it will be valuable
to anyone preparing for the certifying and recertifying examinations in internal medicine of the
ABIM. We look forward to hearing comments and suggestions from readers.
Udaya B. S. Prakash, MD
January 1994
xi
F
PRODUCTION STAFF
xiii
Mayo Clinic Section of Scientific Publications
Randall J. Fritz, DVM Editor
LeAnn M. Stee Editor
Roberta J. Schwartz Production editor
Traci J. H. Post Scientific publications specialist
Alissa K. Baumgartner Copy editor/proofreader
John P. Hedlund Copy editor/proofreader
Mayo Clinic Section of Illustration and Design
Jonathan Goebel Designer
James E. Rownd Cover illustrator
Deborah A. Veerkamp Production designer
Jonalle M. Sauer Production designer
xix
CONTRIBUTORS FOR PHARMACY REVIEW

Alma N. Adrover, PharmD, MS
Scott E. Apelgren, MS, BCPS, BCOP, BCNSP
Jeffrey J. Armon, PharmD
Sansana Donna Boontaveekul, PharmD, MS
Lisa K. Buss, PharmD
Sarah L. Clark, PharmD
Julie L. Cunningham, PharmD, BCPP
Magali P. Disdier, PharmD, PhD
Lynn L. Estes, PharmD
Anna C. Gunderson, PharmD
Heidi D. Gunderson, PharmD
Robert W. Hoel, RPh, PharmD
Todd M. Johnson, PharmD
Philip J. Kuper, PharmD, BCPS
Scott Luther Larson, PharmD, BCPS
Jennifer D. Lynch, PharmD
Kari L. B. Matzek, PharmD
Kevin W. Odell, PharmD
John G. O’Meara, PharmD
Narith N. Ou, PharmD
Lance J. Oyen, PharmD
Virginia H. Thompson, RPh
Roger A. Warndahl, RPh
Christopher M. Wittich, MD, PharmD
Robert C. Wolf, PharmD
Haitham S. Abu-Lebdeh, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Timothy R. Aksamit, MD

Consultant, Division of Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine, College of Medicine, Mayo Clinic
Robert C. Albright, Jr., DO
Consultant, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Thomas J. Beckman, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
Margaret Beliveau Ficalora, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Instructor in Medicine, College
of Medicine, Mayo Clinic
Eduardo E. Benarroch, MD
Consultant, Department of Neurology, Mayo Clinic, Rochester,
Minnesota; Professor of Neurology, College of Medicine, Mayo
Clinic
Peter A. Brady, MB,ChB, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
Robert D. Brown, Jr., MD
Chair, Department of Neurology, Mayo Clinic, Rochester,
Minnesota; Professor of Neurology, College of Medicine, Mayo
Clinic
Sean M. Caples, DO
Senior Associate Consultant, Division of Pulmonary and Critical
Care Medicine, Mayo Clinic, Rochester, Minnesota; Assistant

Professor of Medicine, College of Medicine, Mayo Clinic
Brian A. Crum, MD
Consultant, Department of Neurology, Mayo Clinic, Rochester,
Minnesota; Assistant Professor of Neurology, College of
Medicine, Mayo Clinic
Lisa A. Drage, MD
Consultant, Department of Dermatology, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Dermatology,
College of Medicine, Mayo Clinic
Stephen B. Erickson, MD
Consultant, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Lynn L. Estes, PharmD
Infectious Diseases Pharmacy Specialist, Mayo Clinic, Rochester,
Minnesota; Assistant Professor of Pharmacy, College of
Medicine, Mayo Clinic
Fernando C. Fervenza, MD, PhD
Consultant, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
Amit K. Ghosh, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
William W. Ginsburg, MD
Consultant, Division of Rheumatology, Mayo Clinic,
Jacksonville, Florida; Associate Professor of Medicine, College
of Medicine, Mayo Clinic
C. Christopher Hook, MD

Consultant, Division of Hematology, Mayo Clinic, Rochester,
Minnesota; Assistant Professor of Medicine, College of
Medicine, Mayo Clinic
Barry L. Karon, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
CONTRIBUTORS
xv
Kyle W. Klarich, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
Scott C. Litin, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Professor of Medicine, College
of Medicine, Mayo Clinic
Conor G. Loftus, MD
Consultant, Division of Gastroenterology and Hepatology,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine, College of Medicine, Mayo Clinic
Karen F. Mauk, MD, MSc
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Bryan McIver, MB,ChB, PhD
Consultant, Division of Endocrinology, Diabetes, Metabolism,
Nutrition, Mayo Clinic, Rochester, Minnesota
Virginia V. Michels, MD
Emeritus Consultant, Department of Medical Genetics, Mayo

Clinic, Rochester, Minnesota; Professor of Medical Genetics,
College of Medicine, Mayo Clinic
Clement J. Michet, Jr., MD
Consultant, Division of Rheumatology, Mayo Clinic, Rochester,
Minnesota; Associate Professor of Medicine, College of
Medicine, Mayo Clinic
Martha P. Millman, MD, MPH
Consultant, Division of Preventive, Occupational and
Aerospace Medicine, Mayo Clinic, Rochester, Minnesota;
Instructor in Preventive Medicine, College of Medicine, Mayo
Clinic
Kevin G. Moder, MD
Consultant, Division of Rheumatology, Mayo Clinic, Rochester,
Minnesota; Associate Professor of Medicine, College of
Medicine, Mayo Clinic
Timothy J. Moynihan, MD
Consultant, Division of Medical Oncology, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Oncology, College
of Medicine, Mayo Clinic
Paul S. Mueller, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
James S. Newman, MD
Consultant, Division of Hospital Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of History of
Medicine, College of Medicine, Mayo Clinic
Robert Orenstein, DO
Consultant, Division of Infectious Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College

of Medicine, Mayo Clinic
John G. Park, MD
Consultant, Division of Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine, College of Medicine, Mayo Clinic
John J. Poterucha, MD
Consultant, Division of Gastroenterology and Hepatology,
Mayo Clinic, Rochester, Minnesota; Associate Professor of
Medicine, College of Medicine, Mayo Clinic
Abhiram Prasad, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota; Associate Professor of Medicine, College
of Medicine, Mayo Clinic
Rajiv K. Pruthi, MBBS
Consultant, Division of Hematology, Mayo Clinic, Rochester,
Minnesota; Assistant Professor of Medicine, College of Medicine,
Mayo Clinic
Deborah J. Rhodes, MD
Consultant, Division of Preventive, Occupational and Aerospace
Medicine, Mayo Clinic, Rochester, Minnesota; Assistant Professor
of Medicine, College of Medicine, Mayo Clinic
Otis B. Rickman, DO
Consultant, Division of Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine, College of Medicine, Mayo Clinic
David J. Rosenman, MD
Consultant, Division of Hospital Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
xvi

Thomas R. Schwab, MD
Consultant, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
Gary L. Schwartz, MD
Consultant, Division of Nephrology and Hypertension, Mayo
Clinic, Rochester, Minnesota; Associate Professor of Medicine,
College of Medicine, Mayo Clinic
Robert E. Sedlack, MD, MHPE
Consultant, Division of Gastroenterology and Hepatology,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine and of Medical Education, College of Medicine,
Mayo Clinic
Lynne T. Shuster, MD
Consultant, Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Peter C. Spittell, MD
Consultant, Division of Cardiovascular Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
David P. Steensma, MD
Consultant, Division of Hematology, Mayo Clinic, Rochester,
Minnesota; Associate Professor of Medicine and of Oncology,
College of Medicine, Mayo Clinic
Bruce Sutor, MD
Consultant, Division of Assessment and Consultation, Mayo
Clinic, Rochester, Minnesota; Assistant Professor of Psychiatry,
College of Medicine, Mayo Clinic
Karen L. Swanson, DO

Consultant, Division of Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, Minnesota; Assistant Professor of
Medicine, College of Medicine, Mayo Clinic
Zelalem Temesgen, MD
Consultant, Division of Infectious Diseases, Mayo Clinic,
Rochester, Minnesota; Associate Professor of Medicine, College
of Medicine, Mayo Clinic
Charles F. Thomas, Jr., MD
Consultant, Division of Pulmonary and Critical Care Medicine,
Mayo Clinic, Rochester, Minnesota; Associate Professor of
Medicine, College of Medicine, Mayo Clinic
Prathibha Varkey, MD, MPH
Consultant, Division of Preventive, Occupational and Aerospace
Medicine, Mayo Clinic, Rochester, Minnesota; Associate
Professor of Medical Education, of Medicine, and of Preventive
Medicine, College of Medicine, Mayo Clinic
Thomas R. Viggiano, MD
Consultant, Division of Gastroenterology and Hepatology,
Mayo Clinic, Rochester, Minnesota; Professor of Medicine,
College of Medicine, Mayo Clinic
Abinash Virk, MD
Consultant, Division of Infectious Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
Gerald W. Volcheck, MD
Consultant, Division of Allergic Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
Amy W. Williams, MD
Consultant, Division of Nephrology and Hypertension, Mayo

Clinic, Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
John W. Wilson, MD
Consultant, Division of Infectious Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine, College
of Medicine, Mayo Clinic
xvii
1. The Board Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Amit K. Ghosh, MD
2. Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Gerald W. Volcheck, MD
3. Cardiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Kyle W. Klarich, MD, Peter A. Brady, MB,ChB, MD, Abhiram Prasad, MD, Barry L. Karon, MD
4. Critical Care Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .149
Otis B. Rickman, DO
5. Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Lisa A. Drage, MD
6. Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201
Bryan McIver, MB,ChB, PhD
7. Gastroenterology and Hepatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257
Robert E. Sedlack, MD, MHPE, Conor G. Loftus, MD, Thomas R. Viggiano, MD, John J. Poterucha, MD
8. General Internal Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329
Scott C. Litin, MD, Karen F. Mauk, MD, MSc
9. Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .361
Virginia V. Michels, MD
10. Geriatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .379
Margaret Beliveau Ficalora, MD
11. Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .409

David P. Steensma, MD, Rajiv K. Pruthi, MBBS
12. HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .473
Zelalem Temesgen, MD
13. Hospital Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .503
James S. Newman, MD, David J. Rosenman, MD
xxi
TABLE OF CONTENTS
14. Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .525
Gary L. Schwartz, MD
15. Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .565
Abinash Virk, MD, Robert Orenstein, DO, Lynn L. Estes, PharmD, John W. Wilson, MD
16. Medical Ethics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .667
C. Christopher Hook, MD, Paul S. Mueller, MD
17. Men’s Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .681
Thomas J. Beckman, MD, Haitham S. Abu-Lebdeh, MD
18. Nephrology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .691
Fernando C. Fervenza, MD, PhD, Thomas R. Schwab, MD, Amy W. Williams, MD, Robert C. Albright, Jr., DO,
Stephen B. Erickson, MD
19. Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .747
Brian A. Crum, MD, Eduardo E. Benarroch, MD, Robert D. Brown, Jr., MD
20. Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .801
Timothy J. Moynihan, MD
21. Preventive Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .839
Prathibha Varkey, MD, MPH, Martha P. Millman, MD, MPH
22. Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .861
Bruce Sutor, MD
23. Pulmonary Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .883
John G. Park, MD, Timothy R. Aksamit, MD, Karen L. Swanson, DO, Charles F. Thomas, Jr., MD, Sean M. Caples, DO
24. Rheumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .971
Clement J. Michet, Jr., MD, Kevin G. Moder, MD, William W. Ginsburg, MD

25. Vascular Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1037
Peter C. Spittell, MD
26. Women’s Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1059
Lynne T. Shuster, MD, Deborah J. Rhodes, MD
xxii
Mayo Clinic
Internal Medicine Review
EIGHTH EDITION