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FIRST EXPOSURE TO
INTERNAL MEDICINE:
HOSPITAL MEDICINE
To my students, from whom I learn every day;
to my colleagues in internal medicine at the University of Kentucky,
it’s a joy to work with you all;
to my fellow clerkship directors around the country,
you inspire me with your idealism and dedication;
and to my family, my foundation.
Charles H. Griffith III, MD, MSPH
FIRST EXPOSURE TO
INTERNAL MEDICINE:
HOSPITAL MEDICINE
Charles H. Griffith III, MD, MSPH
Inpatient Internal Medicine Clerkship Director
Division of General Internal Medicine
University of Kentucky
Lexington, Kentucky
Andrew R. Hoellein, MD, MS
Ambulatory Internal Medicine Clerkship Director
Division of General Internal Medicine
University of Kentucky
Lexington, Kentucky
Christopher A. Feddock, MD, MS
Med-Peds Residency Program Director
Division of General Internal Medicine
University of Kentucky
Lexington, Kentucky
Heather E. Harrell, MD
Medicine Clerkship Director
Director of the Fourth Year Program
University of Florida College of Medicine
Gainesville, Florida
New York / Chicago / San Francisco / Lisbon / London / Madrid / Mexico City
Milan / New Delhi / San Juan / Seoul / Singapore / Sydney / Toronto
Copyright © 2007 by the McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United
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DOI: 10.1036/0071459014
v
CONTENTS
Contributors xi
Preface xvii
Acknowledgments xx
SECTION I GENERAL 1
Chapter 1 Introduction to Inpatient Internal Medicine/ 3
General Inpatient Skills
Heather E. Harrell
Chapter 2 Diagnostic and Therapeutic Decision Making 11
Cynthia H. Ledford
Chapter 3 Procedures 17
Deanna Todd Tzanetos
Chapter 4 Intensive Care Medicine 23
Ketan P. Buch
Chapter 5 Advanced Cardiac Life Support 33
Eric Alper
Chapter 6 Interpretation of the Electrocardiogram 39
Alison L. Bailey
SECTION II CARDIOVASCULAR 55
Chapter 7 Chest Pain 57
D. Stephen Goggans
Chapter 8 Acute Coronary Syndromes 62
Pat F. Bass
Chapter 9 Congestive Heart Failure 68
Charles H. Griffith
Chapter 10 Hypertensive Urgency/Emergency 78
Christopher A. Feddock
For more information about this title, click here
Chapter 11 Arrhythmias 83
Carabeth W. Russell
Chapter 12 Shock 91
Dan Henry
SECTION III PULMONARY 97
Chapter 13 Chronic Obstructive Pulmonary Disease 99
Lisa Bellini
Chapter 14 Respiratory Failure 106
David M. Hiestand
Chapter 15 Deep Venous Thrombosis and Pulmonary Embolism 113
Thomas D. Painter
Chapter 16 Evaluation of Dyspnea 121
R. Scott Morehead
Chapter 17 Pneumonia 127
Simrit Bhullar
James R. McCormick
Malkanthie I. McCormick
Chapter 18 Pleural Effusion 136
Paula Bailey
Chapter 19 Acute Respiratory Distress Syndrome 142
Janet N. Myers
Russell C. Gilbert
Chapter 20 Pneumothorax 148
Anthony Bottiggi
Andrew Bernard
Chapter 21 Chest X-ray Interpretation 155
Eric Bensadoun
SECTION IV GASTROINTESTINAL 169
Chapter 22 Abdominal Pain 171
Carol D. Spears
Bernard R. Boulanger
Shushanth Reddy
Chapter 23 Nausea and Vomiting in the Hospitalized Patient 180
Lisbeth Selby
vi CONTENTS
Chapter 24 Gastrointestinal Hemorrhage 186
Misha Rhodes
Chapter 25 Pseudomembranous Colitis 193
Christine Yasuko Todd
Chapter 26 Inflammatory Bowel Disease 198
Douglas Bazil Tzanetos
Chapter 27 Evaluation and Management of Ascites 207
Michelle L. Rossi
Chapter 28 Complications of Portal Hypertension 216
Alexander I. Reiss
Chapter 29 Acute and Chronic Pancreatitis 225
Kristy S. Deep
Chapter 30 Cholelithiasis, Pcholecystitis, and Cholangitis 234
Phillip K. Chang
Richard Schwartz
Chapter 31 Evaluation of Jaundice 239
L. Chad Hood
SECTION V RENAL 245
Chapter 32 Acute Renal Failure 247
David W. Rudy
Chapter 33 Chronic Kidney Disease and Complications 255
Lisa M. Antes
Joel A. Gordon
Chapter 34 Acid-Base Disorders 263
Joel A. Gordon
Lisa M. Antes
Chapter 35 Hyponatremia and Hypernatremia 272
Matthew Fitz
Paul Hering
Chapter 36 Hyperkalemia 279
Matthew Fitz
Chapter 37 Basics of Fluid Management 283
Lisa M. Antes
Joel A. Gordon
CONTENTS vii
SECTION VI ENDOCRINE 293
Chapter 38 Diabetic Ketoacidosis and Hyperosmolar 295
Hyperglycemic State
Dan Henry
Chapter 39 Inpatient Glycemic Control 300
Christopher S. Newell
Chapter 40 Hypercalcemia 304
Steven Durning
John Poremba
SECTION VII INFECTIOUS DISEASE 311
Chapter 41 Inpatient HIV-Related Conditions 313
Terri Postma
Chapter 42 Fever in the Hospitalized Patient 319
Christine Yasuko Todd
Chapter 43 Fever of Unknown Origin 323
Raymond Y. Wong
Chapter 44 Cellulitis 328
Andrew J. Koon
Chapter 45 Pressure Ulcers 332
Caridad A. Hernandez
Chapter 46 Meningitis 337
Edward Cutolo
Chapter 47 Pyelonephritis 344
Deborah A. Humphrey
Chapter 48 Infective Endocarditis 349
Craig J. Hoesley
Ritu A. Kumar
Chapter 49 Sepsis and Systemic Inflammatory 358
Response Syndrome
Andrew Bernard
Paul Kearney
Chapter 50 Inpatient Antibiotic Choice 362
Asha Ramsakal
viii CONTENTS
SECTION VIII HEMATOLOGY-ONCOLOGY 371
Chapter 51 Approach to Anemia and Thrombocytopenia 373
Sharon F. Green
Robert T. Means
Chapter 52 Issues in Blood Transfusions 383
Mark M. Udden
Chapter 53 Oncologic Emergencies 389
Kanchan Kamath
Chapter 54 Leukemia, Lymphoma, and Multiple Myeloma 396
Mark M. Udden
SECTION IX MUSCULOSKELETAL 405
Chapter 55 Infectious Arthritis 407
Erica Friedman
SECTION X NEUROLOGIC 413
Chapter 56 Altered Mental Status 415
Christopher A. Feddock
Chapter 57 Seizures 420
Meriem Bensalem-Owen
Chapter 58 Stroke 428
Sibu P. Saha
M. Salik Jahania
Chapter 59 Syncope 432
Jennifer R. Kogan
Susan Day
SECTION XII OTHER 439
Chapter 60 Alcohol Withdrawal 441
Christopher A. Feddock
Chapter 61 Overdose and Toxicology 447
Ashutosh J. Barve
Chapter 62 Pain Management in the Hospitalized Patient 455
Winifred G. Teuteberg
CONTENTS ix
Chapter 63 Nutrition in the Hospitalized Patient 463
Cortney Youens Lee
Paul Kearney
Chapter 64 Suicide 469
Bruce L. Houghton
Chapter 65 End-of-Life Care Issues 474
Eric I. Rosenberg
Index 481
x CONTENTS
xi
CONTRIBUTORS
Eric Alper, MD
Medicine Clerkship Director
Associate Professor of Medicine
University of Massachusetts
Medical School
Worcester, Massachusetts
Chapter 5
Lisa M. Antes, MD
Associate Professor of Medicine
Internal Medicine Assistant
Inpatient Clerkship Director
Roy J. and Lucille A. Carver
College of Medicine at
The University of Iowa
Iowa City, Iowa
Chapters 33, 34, 37
Alison L. Bailey, MD
Fellow in Cardiovascular Medicine
University of Kentucky
Lexington, Kentucky
Chapter 6
Paula Bailey, MD, MHA
Assistant Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 18
Ashutosh J. Barve, MD, PhD
Fellow in Gastroenterology
University of Louisville
Louisville, Kentucky
Chapter 61
Pat F. Bass III, MD, MPH, MS
Assistant Professor of Internal
Medicine and Pediatrics
LSUHSC—Shreveport
Shreveport, Louisiana
Chapter 8
Lisa Bellini, MD
Associate Dean for Graduate
Medical Education
University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 13
Eric Bensadoun, MD
Associate Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 21
Meriem Bensalem-Owen, MD
Assistant Professor of Neurology
University of Kentucky
Lexington, Kentucky
Chapter 57
Andrew Bernard, MD
Assistant Professor of Surgery
University of Kentucky
Lexington, Kentucky
Chapters 20, 49
Copyright © 2007 by the McGraw-Hill Companies, Inc. Click here for terms of use.
xii CONTRIBUTORS
Simrit Bhullar, DO
Fellow in Pulmonary and Critical
Care Medicine
University of Kentucky
Lexington, Kentucky
Chapter 17
Anthony Bottiggi, MD
Fellow in Surgical Critical Care
University of Kentucky
Lexington, Kentucky
Chapter 20
Bernard R. Boulanger, MD, FACS
Associate Professor of Surgery
University of Kentucky
Lexington, Kentucky
Chapter 22
Ketan P. Buch, MBBS, FCCP
Assistant Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 4
Phillip K. Chang, MD
Assistant Professor of Surgery
University of Kentucky
Lexington, Kentucky
Chapter 30
Edward Cutolo, MD
Associate Professor of Medicine
University of South Florida
Tampa, Florida
Chapter 46
Susan Day, MD
Clinical Associate Professor of
Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 59
Kristy S. Deep, MD
Fellow in Academic Internal Medicine
University of Kentucky
Lexington, Kentucky
Chapter 29
Steven Durning, MD, FACP
Associate Professor of Medicine
Uniformed Services University of
the Health Sciences
Bethesda, Maryland
Chapter 40
Christopher A. Feddock, MD, MS,
FAAP
Med-Peds Residency Program
Director
Division of General Internal Medicine
University of Kentucky
Lexington, Kentucky
Chapters 10, 56, 60
Matthew Fitz, MD
Assistant Professor of Medicine
and Pediatrics
Loyola University Medical Center
Maywood, Illinois
Chapters 35, 36
Erica Friedman, MD
Associate Dean for Undergraduate
Medical Education
Associate Professor of Medicine
Mount Sinai School of Medicine
New York, New York
Chapter 55
Russell. C. Gilbert, MD
Assistant Professor of Medicine
Uniformed Services University of
the Health Sciences
Bethesda, Maryland
Chapter 19
CONTRIBUTORS xiii
Misha Rhodes, MD
Assistant Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 24
D. Stephen Goggans, MD
Assistant Professor of Medicine
Medical College of Georgia
Augusta, Georgia
Chapter 7
Joel A. Gordon, MD
Professor and Vice Chair for
Education
Internal Medicine Inpatient
Clerkship Director
Roy J. and Lucille A. Carver
College of Medicine at
The University of Iowa
Iowa City, Iowa
Chapters 33, 34, 37
Sharon F. Green, MD, MA
Fellow in Academic Internal Medicine
University of Kentucky
Lexington, Kentucky
Chapter 51
Charles H. Griffith III, MD, MSPH
Inpatient Internal Medicine
Clerkship Director
Division of General Internal Medicine
University of Kentucky
Lexington, Kentucky
Chapter 9
Heather E. Harrell, MD
Medicine Clerkship Director
Director of the Fourth Year Program
University of Florida College of
Medicine
Gainesville, Florida
Chapter 1
Dan Henry, MD
Professor of Clinical Medicine
Course Director, Multidisciplinary
Ambulatory Experiences and
Advanced Clinical Experiences
University of Connecticut School
of Medicine
Farmington, Connecticut
Chapters 12, 38
Paul Hering, MD
Professor of Medicine
Loyola University Medical Center
Maywood, Illinois
Chapter 35
Caridad A. Hernandez, MD
Assistant Professor and Chief,
Hospitalist Section
University of Florida
Gainesville, Florida
Chapter 45
David M. Hiestand, MD, PhD
Assistant Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 14
Craig J. Hoesley, MD
Associate Professor of Medicine
University of Alabama at
Birmingham
Birmingham, Alabama
Chapter 48
L. Chad Hood, MD
Adjunct Clinical Assistant
Professor
University of Florida
Gainesville, Florida
Chapter 31
Bruce L. Houghton, MD
Associate Professor of Medicine
Creighton University
Omaha, Nebraska
Chapter 64
Deborah A. Humphrey, DO, FACP
Assistant Professor of Medicine
University of South Florida
Tampa, Florida
Chapter 47
M. Salik Jahania, MD
Assistant Professor of Surgery
University of Kentucky
Lexington, Kentucky
Chapter 58
Kanchan Kamath, MD
Assistant Professor of Medicine
University of South Florida
Tampa, Florida
Chapter 53
Paul Kearney, MD
Professor of Surgery
University of Kentucky
Lexington, Kentucky
Chapters 49, 63
Jennifer R. Kogan, MD
Assistant Professor of Medicine;
Director of Undergraduate
Education
University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 59
Andrew J. Koon, MD
Assistant Professor of Medicine
University of South Florida
Tampa, Florida
Chapter 44
Ritu A. Kumar, MD
Fellow in Infectious Diseases
University of Alabama at
Birmingham
Birmingham, Alabama
Chapter 48
Cynthia H. Ledford, MD
Assistant Clinical Professor of
Medicine and Pediatrics
The Ohio State University
Columbus, Ohio
Chapter 2
Cortney Youens Lee, MD
Surgery Resident
University of Kentucky
Lexington, Kentucky
Chapter 63
James R. McCormick, MD, FCCP
Professor
Pulmonary/Critical Care Medicine
Associate Chief of Staff for
Education
University of Kentucky and
VA Medical Center
Lexington, Kentucky
Chapter 17
Malkanthie I. McCormick, MD
Associate Professor of Medicine
University of Kentucky
Lexington, Kentucky
Chapter 17
Robert T. Means, Jr., MD
Professor and Associate Chair for
Research
University of Kentucky
Lexington, Kentucky
Chapter 51
xiv CONTRIBUTORS