Internal Medicine potx

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Internal
Medicine
Edited by Bruce F. Scharschmidt, MD
ASSOCIATE EDITORS
Robert J. Alpern, MD
Edward J. Benz, Jr., MD
Devron H. Char, MD
Richard A. Jacobs, MD, PhD
Emmet B. Keeffe, MD
Stephen C. Lazarus, MD
Susan Philip, MD, MPH
Michael J. Aminoff, MD, DSc, FRCP
Jeffrey P. Callen, MD, FACP
Andrew R. Hoffman, MD
Joel S. Karliner, MD
Fredric B. Kraemer, MD
Biff F. Palmer, MD
Shaun Ruddy, MD
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cambridge university press
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S
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ao Paulo, Delhi
Cambridge University Press
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www.cambridge.org
Information on this title: www.cambridge.org/9780521709408
C
2007, 2006, 2002, PocketMedicine/Internal Medicine by PocketMedicine.com, Inc.
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.
First published 2007
Printed in the United States of America
A catalog record for this publication is available from the British Library.
Library of Congress Cataloging in Publication Data
Internal medicine / [edited by] Bruce F. Scharschmidt.
p.;cm.
ISBN-13: 978-0-521-70940-8 (pbk.)
ISBN-10: 0-521-70940-7 (pbk.)
1. Internal medicine – Handbooks, manuals, etc. I. Scharschmidt,
Bruce. II. Title.
[DNLM: 1. Internal Medicine – Handbooks. WB 39 I5985 2007]
RC55.I475 2007
616 – dc 222007016973
ISBN 978-0-521-70940-8 paperback
Cambridge University Press has no responsibility for
the persistence or accuracy of URLs for external or
third-party Internet Web sites referred to in this publication
and does not guarantee that any content on such
Web sites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and
up-to-date information that is in accord with accepted standards and practice at
the time of publication. Nevertheless, the authors, editors, and publisher can make

no warranties that the information contained herein is totally free from error, not
least because clinical standards are constantly changing through research and
regulation. The authors, editors, and publisher therefore disclaim all liability for
direct or consequential damages resulting from the use of material contained in
this book. Readers are strongly advised to pay careful attention to information
provided by the manufacturer of any drugs or equipment that they plan to use.
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AFFILIATIONS
editor
Bruce F. Scharschmidt, MD
Vice President, Clinical Development
Chiron Corporation
associate editors
cardiology
Joel S. Karliner, MD
Professor of Medicine
School of Medicine
University of California, San Francisco
Associate Chief of Medicine for Research and Staff Cardiologist
VA Medical Center, San Francisco
dermatology
Jeffrey P. Callen, MD, FACP
Professor of Medicine (Dermatology)
Chief, Division of Dermatology
University of Louisville School of Medicine
Louisville, Kentucky
endocrinology, metabolism and bone disorders
Andrew R. Hoffman, MD

Professor of Medicine
Associate Chair for Academic Affairs
Department of Medicine
Stanford University and VA Palo Alto Health Care System
Stanford, California
Fredric B. Kraemer, MD
Associate Chief of Staff for Research and Development
VA Palo Alto Health Care System
Palo Alto, California
Professor of Medicine
Chief, Division of Endocrinology, Gerontology and Metabolism
Stanford University School of Medicine
Stanford, California
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iv Affiliations
gastroenterology, hepatology and nutrition
Emmet B. Keeffe, MD
Professor of Medicine
Chief of Hepatology
Co-Director, Liver Transplant Program
Stanford University Medical Center
Stanford, California
head, eye, ear, nose and throat
Devron H. Char, MD
President, Tumori Foundation
Clinical Professor, Department of Ophthalmology
Stanford University School of Medicine
Stanford, California

hematology
Edward J. Benz, Jr., MD
Richard and Susan Smith Professor of Medicine
Harvard Medical School
Boston, Massachusetts
President, Dana-Farber Cancer Institute
Boston, Massachusetts
infectious diseases
Richard A. Jacobs, MD, PhD
Clinical Professor of Medicine and Infectious Diseases
School of Medicine
University of California, San Francisco
Susan Philip, MD, MPH
Medical Director, San Francisco City Clinic
San Francisco Department of Public Health
Assistant Clinical Professor of Medicine
School of Medicine
University of California, San Francisco
kidney and urologic disease
Robert J. Alpern, MD
Ensign Professor of Medicine
Dean, Yale School of Medicine
Yale University
New Haven, Connecticut
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Affiliations v
Biff F. Palmer, MD
Professor of Internal Medicine
Director of Renal Fellowship Program

Department of Medicine
Division of Nephrology
University of Texas Southwestern Medical School
Dallas, Texas
neurology
Michael J. Aminoff, MD, DSc, FRCP
Professor of Neurology and Executive Vice Chair
Department of Neurology
School of Medicine, University of California San Francisco
Attending Neurologist
UCSF Medical Center
San Francisco
with contributions by Dr. Aminoff and
Chad Christine, MD
Assistant Clinical Professor of Neurology
Department of Neurology
School of Medicine
University of California, San Francisco
pulmonary medicine
Stephen C. Lazarus, MD
Professor of Medicine
Director, Fellowship Program in Pulmonary and Critical Care Medicine
Associate Director, Adult Pulmonary Laboratory
Senior Investigator, Cardiovascular Research Institute
School of Medicine
University of California, San Francisco
rheumatology, allergy and immunology
Shaun Ruddy, MD
Elam C. Toone Professor Emeritus
Department of Internal Medicine

Medical College of Virginia
VCU Health Systems
Richmond, Virginia
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NOTICE
Because of the dynamic nature of medical practice and drug
selection and dosage, users are advised that decisions regard-
ing drug therapy must be based on the independent judg-
ment of the clinician, changing information about a drug (e.g.,
as reflected in the literature and manufacturer’s most current
product information), and changing medical practices.
While great care has been taken to ensure the accuracy of the
information presented, users are advised that the authors, edi-
tors, contributors, and publisher make no warranty, express
or implied, with respect to, and are not responsible for, the
currency, completeness, or accuracy of the information con-
tained in this publication, nor for any errors, omissions, or
the application of this information, nor for any consequences
arising therefrom. Users are encouraged to confirm the infor-
mation contained herein with other sources deemed authorita-
tive. Ultimately, it is the responsibility of the treating physician,
relying on experience and knowledge of the patient, to deter-
mine dosages and the best treatment for the patient. Therefore,
the author(s), editors, contributors, and the publisher make no
warranty, express or implied, and shall have no liability to any
person or entity with regard to claims, loss, or damage caused,

or alleged to be caused, directly or indirectly, by the use of infor-
mation contained in this publication.
Further, the author(s), editors, contributors, and the publisher
are not responsible for misuse of any of the information pro-
vided in this publication, for negligence by the user, or for any
typographical errors.
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Contents
Preface page xxix
Abdominal Aortic Aneurysm (AAA) 1
Abscesses and Fistulas 5
Acanthosis Nigricans 7
Acne 9
Acromegaly 12
Actinic Keratosis 15
Acute Acalculous Cholecystitis 16
Acute Bacterial Meningitis 18
Acute Fatty Liver of Pregnancy 21
Acute Heart Failure 23
Acute Lymphoblastic Leukemia 29
Acute Myeloblastic Leukemia 37
Acute Myocarditides 41
Acute Pancreatitis 45
Acute Pericarditis 48
Acute Renal Failure 50

Acute Respiratory Acidosis 55
Acute Respiratory Alkalosis 56
Acute Respiratory Failure/Monitoring 58
Adenocarcinoma of the Ampulla of Vater 62
Adenovirus 63
Adrenal Insufficiency 66
Adrenal Tumors 70
Adult Optic Neuropathies 74
Age Related Maculopathy 80
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Air Embolus 83
Alcohol Abuse, Dependence, and Withdrawal 85
Alcoholic Liver Disease (ALD) 89
Allergic Rhinitis 93
Alopecia 96
Alpha-1-Antitrypsin 100
Alzheimer’s Disease 101
Amaurosis Fugax 103
Amblyopia 104
Amebiasis 106
Amebic Liver Abscess 109
Amyloidosis 111
Amyotrophic Lateral Sclerosis (ALS) 115
Analgesic Nephropathy And NSAID-induced ARF 117
Anaphylaxis 120
Anemias Secondary to Systemic Disease 122
Anisakiasis 125

Anorectal Tumors 126
Anorexia Nervosa 129
Antibiotic-Associated and Pseudomembranous Colitis 133
Antiphospholipid Antibodies 135
Aortic Coarctation 138
Aortic Dissection 140
Aortic Insufficiency (AI) 143
Aortitis 146
Aphasia 149
Aplastic Anemia 150
Apparent Mineralocorticoid Excess 153
Appendicitis 153
Arterial Embolus 156
Ascariasis 160
Ascites 162
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Aspergillosis 166
Asthma 171
Atelectasis 176
Atherosclerotic Occlusive Disease 179
Atopic Dermatitis 187
Atrial Fibrillation (AF) 188
Atrial Flutter 191
Atrial Premature Complexes 194
Atrial Septal Defect (ASD) 195
Atrial Tachycardia (AT) 197
Atrioventricular Block 198
Autoimmune Hepatitis (AIH) 201

Autonomic Dysfunction 204
Autosomal Dominant Polycystic Renal Disease 206
Autosomal Recessive Polycystic Renal Disease 208
AV Reentrant Tachycardia (AVRT) 209
AV-Nodal Reentrant Tachycardia (AVNRT) 211
Back or Neck Pain 213
Bacterial Arthritis 214
Bacterial Pneumonia 218
Balanitis 220
Bartter’s Syndrome 223
Bell’s Palsy 224
Benign Disorders of the Rectum and Anus 225
Benign Prostatic Hyperplasia 228
Benign Tumors of the Liver 232
Biliary Tract Motility Disorders 235
Biotin Deficiency 238
Bladder Tumors 239
Blastocystis Hominis Infection 242
Blastomyces Dermatitidis 243
Blepharitis 246
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Brain Abscess 248
Brain Death 249
Bronchiectasis 250
Bronchiolitis 253
Bronchitis, Acute 257
Budd-Chiari Syndrome 259
Buerger’s Disease 261

Bulimia Nervosa 263
Bullous Pemphigoid 266
Candidiasis 270
Candidiasis: Oral 272
Carcinoid 273
Cardiac Arrest 277
Cardiac Trauma 280
Cardiac Tumors 281
Cat Scratch Disease 286
Cecal Volvulus 288
Celiac Sprue and Malabsorption 289
Cellulitis 292
Cerebrovascular Disease & Stroke 294
Cervical Spine Disorders 297
Chediak Higashi Syndrome 298
Cheilitis 299
Cholangiocarcinoma 299
Choledochal Cysts 302
Cholestasis 305
Cholestasis of Pregnancy 308
Chordae Tendineae Rupture 309
Chromium Deficiency 310
Chronic Acalculous Cholecystitis 311
Chronic Bundle Branch Block and Hemi-blocks 312
Chronic Coronary Artery Disease (CAD) 314
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Contents xiii
Chronic Granulomatous Disease 317
Chronic Heart Failure 318

Chronic Kidney Disease 327
Chronic Lymphocytic Leukemia 333
Chronic Myelogenous Leukemia 336
Chronic Obstructive Pulmonary Disease 340
Chronic Pancreatitis 343
Chronic Renal Failure 346
Chronic Respiratory Acidosis 351
Chronic Respiratory Alkalosis 352
Chronic Respiratory Failure 353
Churg Strauss Disease 357
Clostridium Infections 360
Cluster Headache 362
Coccidioides Immitis 363
Colon Polyps and Tumors 367
Coma 370
Complications of Human Immunodeficiency Virus Type 1
(HIV-1) Infection 371
Condyloma Acuminata 388
Confusion & Delirium 389
Congenital Qualitative Platelet Disorders 390
Conjunctival Tumors 393
Constipation and Fecal Impaction 394
Constrictive Pericarditis 397
Contact Dermatitis 398
Contraception for the Internist 399
Corneal Ulcer 403
Coronary Artery Injury 406
Coronary Syndromes, Acute 407
Coronavirus/Common Cold 413
Cough 414

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Crigler-Najjer Syndrome Type 1 417
Crigler-Najjer Type 2 419
Crohn’s Disease 420
Croup 424
Cryptococcus Neoformans 426
Cryptosporidiosis 430
Crystal-Induced Arthritis 432
Cushing’s Syndrome 435
Cutaneous Larva Migrans 439
Cutaneous Lupus Erythematosus (LE) 441
Cutaneous Vasculitis 444
Cyclosporiasis 447
Cyst of Tunica Albuginea of Testis 449
Cystic Fibrosis 449
Cystic Fibrosis 452
Cysticercosis 455
Cystinuria 458
Cystitis and Pyelonephritis 458
Cytomegalovirus 461
Deep Venous Thrombosis 463
Dementia 467
Dent’s Disease 468
Dermatofibroma 469
Diabetes Insipidus 470
Diabetes Mellitus, Type 1 472
Treatment Goals 474
Diabetes Mellitus, Type 2 475

Diabetic Retinopathy 479
Diarrhea 482
Dientamoeba Fragilis Infection 485
Diphtheria 487
Disorders of Neutrophil Function 489
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Contents xv
Disseminated Intravascular Coagulation, Thrombotic
Thrombocytopenic Purpura, Hemolytic Uremic Syndrome
(DIC/TTP/HUS) 490
Diverticulitis and Diverticular Disease 494
Drug Allergy 497
Drug and Toxin-induced Liver Diseases 500
Drug Eruptions 503
Dubin-Johnson Syndrome 508
Dyspepsia 509
Dysphagia 512
Dyspnea 514
Echinococcosis 517
Ehlers-Danlos Syndrome 520
Encephalitis 522
Enteral and Parenteral Nutrition 524
Enterobiasis (Pinworm) 530
Enteroviruses 532
Epididymitis and Orchitis 535
Epilepsies 536
Episcleritis and Scleritis 537
Erectile Dysfunction 539
Erysipelas and Cellulitis 543

Erythema Multiforme Major; Aka Stevens Johnson Syndrome
(see also Drug Eruptions) 545
Erythema Nodosum 548
Esophageal Cancer 550
Esophageal Infections and Inflammation 551
Esophageal Motor Disorders 556
Essential Tremor 559
Excessive Daytime Sleepiness 560
Exfoliative Dermatitis 561
Eyelid Lesions 562
Fanconi Syndrome 563
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Fever of Unknown Origin 564
Fibromas 568
Fibromyalgia 568
Filariasis 571
Folic Acid/Cobalamin (Vitamin B12) Deficiency 575
Folliculitis and Furunculosis 580
Food Allergies 582
Food Poisoning 586
Foreign Bodies and Bezoars 589
Fulminant Hepatic Failure 592
Galactosemia 596
Gallbladder Cancers 599
Gallstone Disease 600
Gastric Adenocarcinoma 604
Gastric Carcinoids 605
Gastric Lymphoma 606

Gastric Stromal Tumor 607
Gastroenteritis 608
Gastroesophageal Reflux Disease 610
Gastrointestinal Bleeding 613
Gastropathy 617
Geographic Tongue 621
Giant Cell Arteritis 622
Giardiasis 623
Gilbert’s Syndrome 625
Gitelman’s Syndrome 626
Glaucoma 626
Glomerular Diseases 630
Glucocorticoid-Remediable Aldosteronism 634
Glycogen Storage Disease 635
Goiter 638
Gonorrhea 640
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Contents xvii
Gordon Syndrome (Pseudohypoaldosteronism Type 2) 644
Granuloma Annulare 645
Granulomatous Liver Disease 646
Granulomatous Vasculitis 647
Haemophilus Infections 651
Hairy Cell Leukemia 653
Hantavirus Pulmonary Syndrome 654
Hartnup’s Disease 656
Head and Neck Cancer 657
Head Trauma 662
Hearing Loss 663

Helicobacter Pylori 665
Hemiballismus 669
Hemochromatosis 670
Hemophilia A and B 673
Hepatic Encephalopathy 677
Hepatic Veno-occlusive Disease 680
Hepatitis A and E 682
Hepatitis B 685
Hepatitis C 688
Hepatitis Delta Virus 693
Hepatorenal Syndrome 694
Hereditary Elliptocytosis (HE) and Hereditary
Pyropoikilocytosis (HPP) 696
Hereditary Spherocytosis 698
Hernia 700
Herpes Labialis 701
Herpes Simplex 702
Herpes Type 1/Type 2 703
Herpes Zoster 707
Hidradenitis Suppurativa 708
High-Oxygen-Affinity Hemoglobins 710
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Hirsutism (Dermatology) 711
Hirsutism (Endocrinology) 714
Histoplasma Capsulatum 718
Homocystinuria 722
Hookworm 725
Horner’s Syndrome 727

Human Herpes 6 728
Human Immunodeficiency Virus Type 1 (HIV-1) 729
Huntington’s Disease 735
Hydatid Cyst Disease 736
Hydrocele 738
Hypercalcemia 738
Hypercholesterolemia 742
Hyperemesis Gravidarum 746
Hyperkalemia 747
Hypermagnesemia 750
Hypernatremia 751
Hyperoxaluria 754
Hyperphosphatemia 757
Hypersensitive Carotid Syndrome and Syncope 759
Hypertension 760
Hyperthermia 767
Hyperthyroidism 770
Hypertriglyceridemia 773
Hypocalcemia 777
Hypoglycemia 780
Hypogonadism in Men 783
Hypokalemia 786
Hypomagnesemia 789
Hyponatremia 791
Hypophosphatemia 794
Hypopituitarism 796
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Hypothermia 799

Hypothyroidism 802
Ichthyosis 804
Idiopathic (Immune) Thrombocytopenic Purpura (ITP) 808
Immune Hemolytic Anemia 810
Immunodeficiency Disorders, Congenital 818
Impetigo 822
Infectious Diarrheas 825
Infective Endocarditis 829
Influenza 833
Influenza, Avian 834
Inguinofemoral Hernia 836
Inner Ear Disorders Producing Vertigo 837
Insomnia 840
Interstitial Lung Diseases 841
Intertrigo 845
Intervertebral Disc Disease 847
Intestinal Flukes 848
Intestinal Motor Disorders 850
Intracranial Hypertension 853
Intracranial Hypotension 854
Intraocular Infection 855
Intraocular Tumors 859
Intravascular, Non-immune Hemolytic Anemia –
Microangiopathic Hemolytic Anemias 860
Iron Deficiency 866
Irritable Bowel Syndrome 870
Ischemic Bowel Disease 874
Isosporiasis 877
JawSwelling and Masses 878
Keloids 882

Laceration or Myocardial Perforation 883
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Laryngotracheitis 884
Laxative Abuse 885
Legionella Infections 887
Leishmaniasis, Cutaneous 889
Leishmaniasis, Visceral 891
Leptospirosis, Relapsing Fever and Rat-bite Fever 893
Leukocytosis: Neutrophil 896
Leukopenia 900
Leukoplakia 904
Lichen Planus 905
Liddle’s Syndrome 907
Liver Fluke Infections 907
Liver Flukes 909
Liver Transplantation 911
Localized Scleroderma 915
Low-Oxygen-Affinity Hemoglobins 917
Lung Abscess 918
Lung Cancer 921
Lung Fluke 925
Lyme Disease 927
Lymphadenitis and Lymphangitis 930
Lymphomas 932
Lysosomal Diseases 937
Magnesium Deficiency 940
Malaria 942
Malignant Tumors of The Liver 947

Marasmus 949
Marfan’s Syndrome 952
Measles 954
Mediastinal Masses 957
Megacolon 960
Melanoma 964
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Contents xxi
Menopause 967
Menstrual Cycle Disorders for the Generalist 970
Metabolic Acidosis 973
Metabolic Alkalosis 977
Methemoglobinemia 980
Migraine Headache 982
Miliaria 984
Mineralocorticoid Disorders 986
Miscellaneous Intestinal Protozoa 989
Mitral Insufficiency (MR) 990
Mitral Stenosis (MS) 993
Mitral Valve Prolapse 996
Molluscum Contagiosum 997
Motor Neuron Diseases 998
Mucopolysaccharidoses 1000
Mucormycosis 1004
Multifocal Atrial Tachycardia (MAT) 1007
Multiple Endocrine Neoplasia 1 1008
Multiple Endocrine Neoplasia 2 1012
Multiple Sclerosis 1016
Mumps 1017

Muscular Dystrophies 1020
Musculoskeletal Problems 1021
Myasthenia Gravis 1025
Myasthenic (Lambert-Eaton) Syndrome 1027
Myelodysplastic Syndrome 1028
Myeloma and Gammopathies 1033
Myeloproliferative Disorders 1037
Myoclonus 1039
Narcolepsy 1040
Nephrogenic Diabetes Insipidus 1042
Neurofibromatosis 1043
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Nevi and Pigmented Lesions 1047
Niacin Deficiency 1050
Nocardiosis 1051
Nonalcoholic Fatty Liver Disease 1053
Nongranulomatous Systemic Vasculitis 1056
Nonmelanoma Skin Cancers: Basal Cell Carcinoma 1060
Nonmelanoma Skin Cancers: Squamous Cell Carcinoma 1063
Non-steroidal Anti-Inflammatory Drugs 1066
Nontuberculous Mycobacterial Infections 1069
Obesity 1071
Obstructive Sleep Apnea 1075
Occupational Pulmonary Disease 1078
Onychomycosis – Tinea Unguium 1083
Oral Cancer 1085
Oral Lichen Planus 1086
Orbital Cellulitis 1087

Orbital Tumors 1088
Orchitis and Epididymitis 1089
Osteoarthritis 1092
Osteogenesis Imperfecta 1096
Osteomalacia and Rickets 1099
Osteomyelitis 1103
Osteonecrosis 1105
Osteoporosis 1108
Other Cardiomyopathies 1112
Other Clotting Factor Deficiencies 1114
Otitis Externa 1118
Otitis Media 1120
Paget Disease 1122
Pain Syndromes 1124
Pancreatic Cancer 1125
Pancreatic Cysts 1128
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Papillary Muscle Dysfunction and Rupture 1130
Paracoccidioidomycosis 1132
Parainfluenza 1134
Paralytic Poliomyelitis 1136
Parkinson’s Disease and Parkinsonism 1137
Paronychia 1139
Parvovirus B19 1140
Patent Ductus Arteriosus 1142
Pediculosis 1144
Pelvic Inflammatory Disease 1145
Pemphigus Vulgaris and Pemphigus Foliaceus 1149

Peptic Ulcer Disease 1151
Pericardial Tamponade 1154
Peripheral Neuropathies 1155
Perirectal Abscesses and Fistulas 1157
Peritoneal Tumors 1159
Peritonitis 1161
Persistent Vegetative State 1163
Pharyngitis 1164
Pheochromocytoma 1165
Phimosis and Paraphimosis 1169
Phosphate Deficiency 1171
Photosensitivity 1172
Pituitary Tumors 1174
Pityriasis Rosea 1177
Pleural Diseases: Effusion/Empyema 1178
Pleural Tumors 1183
Pneumothorax 1186
Polymyositis and Related Disorders 1189
Porphyria, Acute 1193
Portal Hypertensive Bleeding 1195
Postconcussion Syndrome or Postconcussive Syndrome 1198
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Preeclamptic Liver Disease/HELLP 1199
Pregnancy Complications for the Internist 1201
Pressure Ulcers 1204
Priapism 1205
Primary Biliary Cirrhosis 1209
Primary Hyperparathyroidism 1211

Primary Sclerosing Cholangitis 1214
Prion Disorders (Creutzfeldt-Jakob Disease) 1217
Prolactinoma and Galactorrhea 1219
Prostate Cancer 1222
Prostatitis 1225
Protein-Losing Enteropathy 1227
Pruritus 1228
Pseudohypoaldosteronism 1230
Pseudomonas Infections 1231
Psittacosis 1234
Psoriasis 1236
Pulmonary Embolism 1240
Pulmonary Hypertension 1244
Pulmonary Stenosis (PS) 1249
Pulmonary Valve Insufficiency (PI) 1250
Purine and Pyrimidine Metabolic Disorders 1252
Pyogenic Granuloma 1256
Pyogenic Liver Abscess 1257
Pyridoxine Deficiency 1258
Rabies 1259
Radiation Enteritis and Colitis 1262
Raynaud’s Syndrome 1265
Recurrent Aphthous Stomatitis 1269
RedCell Enzymes 1270
Refractive Disorders (Ametropias) 1272
Renal Artery Stenosis 1277