Table of Contents

 

 

 

 

Contributors

vii

 

Preface

xi

 

Acknowledgments

xiii

 

Foreword to the First Edition

v

PART I

PRINCIPLES OF PRIMARY CARE

 

Chapter 1

The Practice of Primary Care   John D. Stoeckle

1

Chapter 2

Selection and Interpretation of Diagnostic Tests

10

Chapter 3

Health Maintenance and the Role of Screening

16

Chapter 4

Estimating and Communicating Risk and Prognosis

20

Chapter 5

Choosing Among Treatment Options

23

Chapter 6

Immunization   Regina C. Larocque and Edward T. Ryan

27

PART II

SYSTEMIC PROBLEMS

 

Chapter 7

Screening for HIV-1 Infection   Stephen L. Boswell

50

Chapter 8

Evaluation of Chronic Fatigue

54

Chapter 9

Evaluation of Weight Loss

61

Chapter 10

Evaluation of Overweight and Obesity

66

Chapter 11

Evaluation of Fever

73

Chapter 12

Evaluation of Lymphadenopathy

82

Chapter 13

Approach to the Patient with Human Immunodeficiency Virus (HIV) Infection   Stephen L. Boswell

87

PART III

CARDIOVASCULAR PROBLEMS

 

Chapter 14

Screening for Hypertension   Katharine K. Treadway

102

Chapter 15

Screening for Hyperlipidemia   G. Sherry Haydock and Mason W. Freeman

106

Chapter 16

Infective Endocarditis Prophylaxis

112

Chapter 17

Rheumatic Fever Prophylaxis

115

Chapter 18

Exercise for Prevention of Cardiovascular Disease

118

Chapter 19

Evaluation of Hypertension   Katharine K. Treadway

127

Chapter 20

Evaluation of Chest Pain

136

Chapter 21

Evaluation of the Asymptomatic Systolic Murmur

152

Chapter 22

Evaluation of Leg Edema

158

Chapter 23

Evaluation of Arterial Insufficiency of the Lower Extremities   David C. Brewster

164

Chapter 24

Evaluation of Syncope

169

Chapter 25

Evaluation of Palpitations

178

Appendix 25.1

Evaluation of Atrial Fibrillation in the Outpatient Setting

186

Chapter 26

Management of Hypertension   Katharine K. Treadway

190

Appendix 26.1

Coronary Heart Disease Risk Factor Prediction Chart

207

Chapter 27

Approach to the Patient with a Lipid Disorder   Mason W. Freeman

208

Chapter 28

Outpatient Management of Atrial Fibrillation

227

Chapter 29

Management of Ventricular Irritability in the Ambulatory Setting

237

Chapter 30

Management of Chronic Stable Angina

246

Chapter 31

Cardiovascular Rehabilitation and Secondary Prevention of Coronary Heart Disease

262

Chapter 32

Approach to the Patient with Chronic Congestive Heart Failure

274

Appendix 32.1

Managing Disorders of Serum Potassium in Congestive Heart Failure

292

Chapter 33

Management of Valvular Heart Disease   Richard R. Liberthson and Ignacio Inglessis

294

Appendix 33.1

Approach to Congenital and Hereditary Nonvalvular Heart Disease

305

Chapter 34

Management of Peripheral Arterial Disease   David C. Brewster

308

Chapter 35

Management of Peripheral Venous Disease   Nancy L. Cantelmo and David C. Brewster

314

Chapter 36

Stress Testing and Other Noninvasive Studies for Detection of Coronary Disease

324

PART IV

RESPIRATORY PROBLEMS

 

Chapter 37

Screening for Lung Cancer

332

Chapter 38

Tuberculosis Screening and Prophylaxis   Benjamin T. Davis

336

Chapter 39

Evaluation and Prevention of Occupational and Environmental Respiratory Disease   L. Christine Oliver

339

Chapter 40

Evaluation of Chronic Dyspnea

345

Chapter41

Evaluation of Subacute and Chronic Cough

351

Chapter 42

Evaluation of Hemoptysis

356

Chapter 43

Evaluation of Pleural Effusions

360

Chapter 44

Evaluation of the Solitary Pulmonary Nodule

366

Chapter 45

Evaluation of Clubbing

370

Chapter 46

Approach to the Patient with Sleep Apnea

372

Chapter 47

Management of Chronic Obstructive Pulmonary Disease

377

Chapter 48

Management of Asthma

390

Chapter 49

Management of Tuberculosis   Benjamin T. Davis

403

Chapter 50

Management of the Common Cold   William A. Kormos

408

Chapter51

Management of Sarcoidosis

413

Appendix 51.1

Evaluation of Interstitial Lung Disease

417

Chapter 52

Approach to the Patient with Acute Bronchitis or Pneumonia in the Ambulatory Setting   William A. Kormos

421

Chapter 53

Approach to the Patient with Lung Cancer   Jeffrey W. Clark

432

Chapter 54

Smoking Cessation   Nancy A. Rigotti

439

PART V

GASTRONITESTINAL PROBLEMS

 

Chapter 55

Screening for Gastric Cancer

447

Chapter 56

Screening for Colorectal Cancer   Michael J. Barry

450

Appendix 56.1

Examination of the Anorectum and Sigmoid Colon with Digital Rectal Examination, Anoscopy, and Sigmoidoscopy   Patrick S. Yachimski and Lawrence S. Friedman

454

Chapter 57

Prevention of Viral Hepatitis   Jules L. Dienstag

459

Chapter 58

Evaluation of Abdominal Pain   James M. Richter

467

Chapter 59

Evaluation of Nausea and Vomiting

479

Chapter 60

Evaluation of Dysphagia and Suspected Esophageal Chest Pain

484

Chapter 61

Approach to the Patient with Heartburn and Reflux (Gastroesophageal Reflux Disease)   Francis X. Campion and James M. Richter

490

Chapter 62

Evaluation of Jaundice   James M. Richter

496

Appendix 62.1

Evaluation of the Patient with an Incidental Asymptomatic Elevation in Serum Aminotransferase (Transaminase) Levels

500

Chapter 63

Evaluation of Gastrointestinal Bleeding   James M. Richter

501

Chapter 64

Evaluation and Management of Diarrhea   James M. Richter

506

Chapter 65

Approach to the Patient with Constipation   James M. Richter

520

Chapter 66

Approach to the Patient with Anorectal Complaints

525

Appendix 66.1

Management of Hemorrhoids

532

Chapter 67

Approach to the Patient with an External Hernia

533

Chapter 68

Management of Peptic Ulcer Disease

537

Chapter 69

Management of Asymptomatic and Symptomatic Gallstones

549

Chapter 70

Management of Hepatitis   Jules L. Dienstag

555

Chapter 71

Management of Cirrhosis and Chronic Liver Failure

568

Chapter 72

Management of Pancreatitis   James M. Richter

578

Chapter 73

Management of Inflammatory Bowel Disease   Deanna Nguyen and James M. Richter

582

Chapter 74

Approach to the Patient with Functional Gastrointestinal Disease

593

Chapter 75

Management of Diverticular Disease

604

Chapter 76

Management of Gastrointestinal Cancers   Jeffrey W. Clark

607

PART VI

HEMATOLOGIC AND ONCOLOGIC

 

Chapter 77

Screening for Anemia

 

Chapter 78

Screening for Sickle Cell Disease and Sickle Cell Trait

625

Chapter 79

Evaluation of Anemia

627

Chapter 80

Evaluation of Erythrocytosis (Polycythemia)

637

Chapter 81

Evaluation of Bleeding Problems and Abnormal Bleeding Studies

641

Chapter 82

Management of Common Anemias

651

Chapter 83

Outpatient Oral Anticoagulant Therapy   Elaine M. Hylek

657

Chapter 84

Approach to the Patient with Lymphoma   Jeremy S. Abramson

665

Chapter 85

Approach to the Patient with Metastatic Tumor of Unknown Origin   Jeffrey W. Clark

675

Chapter 86

Approach to Staging and Monitoring   Jeffrey W. Clark

681

Chapter 87

Comprehensive Care of the Cancer Patient   Jeffrey W. Clark

685

Chapter 88

Principles of Cancer Drug Therapy   Jeffrey W. Clark

690

Chapter 89

Principles of Radiation Therapy   Theodore Hong and Thomas Delaney

699

Chapter 90

Management of Chronic Cancer Pain and Palliative Care

704

Part 1

Management of Chronic Cancer Pain   Linda A. King and J. Andrew Billings

704

Part 2

Palliative Care   Eric L. Krakauer

712

Chapter 91

Managing the Gastrointestinal Complications of Cancer and Cancer Treatment   Jeffrey W. Clark

718

Chapter 92

Complications of Cancer: Oncologic Emergencies and Paraneoplastic Syndromes   Jeffrey W. Clark

723

PART VII

ENDOCRINOLOGIC PROBLEMS

 

Chapter 93

Screening for Diabetes Mellitus   David M. Slovik

726

Chapter 94

Screening for Thyroid Cancer   David M. Slovik

732

Chapter 95

Evaluation of Thyroid Nodules   David M. Slovik

735

Chapter 96

Approach to the Patient with Hypercalcemia   David M. Slovik

741

Chapter 97

Evaluation of Hypoglycemia   David M. Slovik

747

Chapter 98

Evaluation of Hirsutism   David M. Slovik

752

Appendix 98.1

Approach to an Incidentally Encountered Adrenal Mass

757

Chapter 99

Evaluation of Gynecomastia   David M. Slovik

758

Chapter 100

Evaluation of Galactorrhea and Hyperprolactinemia   David M. Slovik

761

Chapter 101

Polyuria and Polydipsia: Evaluation of Suspected Diabetes lnsipidus   David M. Slovik

765

Chapter 102

Approach to the Patient with Diabetes Mellitus   David M. Slovik

768

Chapter 103

Approach to the Patient with Hyperthyroidism   David M. Slovik

788

Chapter 104

Approach to the Patient with Hypothyroidism   David M. Slovik

798

Chapter 105

Glucocorticoid Therapy   David M. Slovik

806

PART VIII

GYNECOLOGIC PROBLEMS

 

Chapter 106

Screening for Breast Cancer

812

Chapter 107

Screening for Cervical Cancer

818

Chapter 108

Screening for Ovarian Cancer

823

Chapter 109

Screening for Endometrial Cancer

825

Chapter 110

Screening for and Prevention of Intimate Partner Violence

828

Chapter 111

Approach to the Woman with Abnormal Vaginal Bleeding   Shana L. Birnbaum

830

Chapter 112

Evaluation of Secondary Amenorrhea   Shana L. Birnbaum

836

Chapter 113

Evaluation of Breast Masses and Nipple Discharges

843

Chapter 114

Evaluation of Vulvar Pruritus   Shana L. Birnbaum

847

Chapter 115

Medical Evaluation of Female Sexual Dysfunction   Susan E. Bennett and Shana L. Birnbaum

850

Chapter 116

Approach to the Patient with Menstrual or Pelvic Pain   Shana L. Birnbaum

854

Chapter 117

Approach to the Patient with a Vaginal Discharge   Shana L. Birnbaum

860

Chapter 118

Approach to the Menopausal Woman   Shana L. Birnbaum

865

Chapter 119

Approach to Fertility Control   Shana L. Birnbaum

872

Chapter 120

Approach to the Infertile Couple   Shana L. Birnbaum

883

Chapter 121

Approach to the Woman with an Unplanned Pregnancy   Shana L. Birnbaum

890

Chapter 122

Management of Breast Cancer

895

Chapter 123

Management of the Woman with Genital Tract Cancer

903

PART IX

GENITOURINARY PROBLEMS

 

Chapter 124

Screening for Syphilis

908

Chapter 125

Screening for Chlamydial Infection   Benjamin Davis

910

Chapter 126

Screening for Prostate Cancer   Michael J. Barry

913

Chapter 127

Screening for Asymptomatic Bacteriuria and Urinary Tract Infection

918

Chapter 128

Screening for Cancers of the Lower Urinary Tract

920

Chapter 129

Evaluation of the Patient with Hematuria   Leslie S.-T. Fang

923

Chapter 130

Evaluation of the Patient with Proteinuria   Hasan Bazari

927

Chapter 131

Evaluation of Scrotal Pain, Masses, and Swelling

933

Chapter 132

Medical Evaluation and Management of Erectile Dysfunction

936

Chapter 133

Approach to Dysuria and Urinary Tract Infections in Women   Leslie S.-T. Fang

947

Chapter 134

Approach to Incontinence and Other Forms of Lower Urinary Tract Dysfunction   John D. Goodson

953

Chapter 135

Approach to the Patient with Nephrolithiasis   Leslie S.-T. Fang

962

Chapter 136

Approach to the Male Patient with Urethritis   John D. Goodson

967

Chapter 137

Approach to the Patient with Gonorrhea   Benjamin Davis

971

Chapter 138

Approach to Benign Prostatic Hyperplasia   Michael J. Barry

974

Chapter 139

Management of Acute and Chronic Prostatitis   John D. Goodson

980

Appendix 139.1

Urine and Prostatic Fluid Collections in Men

984

Chapter 140

Management of Urinary Tract Infection in Men   John D. Goodson

985

Chapter 141

Management of Syphilis and Other Sexually Transmitted Diseases   Benjamin Davis

988

Chapter 142

Management of the Patient with Chronic Kidney Disease   Hasan Bazari

991

Chapter 143

Management of Genitourinary Cancers in Men

998

PART X

MUSCULOSKELETAL PROBLEMS

 

Chapter 144

Screening for Osteoporosis in Postmenopausal Women   David M. Stovik

1005

Appendix 144.1

Screening for Osteoporosis in Men

1008

Chapter 145

Evaluation of Acute Monoarticular Arthritis

1008

Chapter 146

Evaluation of Polyarticular Complaints

1012

Chapter 147

Approach to the Patient with Back Pain

1023

Chapter 148

Evaluation of Neck Pain

1038

Chapter 149

Approach to the Patient with Muscle Cramps

1043

Chapter 150

Approach to the Patient with Shoulder Pain   Jesse B. Jupiter and David Ring

1046

Chapter 151

Evaluation of Hip Pain

1053

Chapter 152

Evaluation of Knee Pain

1057

Chapter 153

Approach to Minor Orthopedic Problems of the Elbow, Wrist, and Hand   Jesse B. Jupiter and David Ring

1064

Chapter 154

Approach to Common Problems of the Foot and Ankle   Christopher P. Chiodo, Jesse B. Jupiter and David Ring

1069

Chapter 155

Approach to the Patient with Asymptomatic Hyperuricemia

1075

Chapter 156

Management of Rheumatoid Arthritis

1078

Chapter 157

Management of Osteoarthritis

1093

Chapter 158

Management of Gout

1102

Chapter 159

Approach to the Patient with Fibromyalgia

1108

Chapter 160

Approach to the Patient with Lyme Disease

1114

Chapter 161

Approach to the Patient with Polymyalgia Rheumatica or Giant-Cell (Temporal) Arteritis

1123

Chapter 162

Management of Paget’s Disease   David M. Slovik

1129

Chapter 163

Approach to the Patient with Raynaud’s Phenomenon

1134

Chapter 164

Prevention and Management of Osteoporosis   David M. Slovik

1138

PART XI

NEUROLOGIC PROBLEMS

 

Chapter 165

Approach to the Patient with Headache   Amy A. Pruitt

1150

Chapter 166

Evaluation of Dizziness   Amy A. Pruitt

1160

Chapter 167

Focal Neurologic Complaints: Evaluation of Nerve Root and Peripheral Nerve Syndromes   Amy A. Pruitt

1168

Chapter 168

Evaluation of Tremor   Amy A. Pruitt

1176

Chapter 169

Evaluation of Dementia   Amy A. Pruitt

1179

Chapter 170

Approach to the Patient with a Seizure   Amy A. Pruitt

1187

Chapter 171

Management of Transient Ischenric Attack and Asymptomatic Carotid Bruit   Amy A. Pruitt

1196

Chapter 172

Management of Multiple Sclerosis   Amy A. Pruitt

1202

Chapter 173

Management of Alzheimer’s Disease and Related Dementias   M. Cornelia Gremens

1207

Appendix 173.1

Use of Antipsychotic Drugs and Other Psychopharmacologic Agents in the Elderly

1219

Chapter 174

Patient with Parkinson’s Disease   Amy A. Pruitt

1221

Chapter 175

Approach to the Patient with Bell’s Palsy (Idiopathic Facial Mononeuropathy)   Amy A. Pruitt

1228

Chapter 176

Management of Tic Douloureux (Trigeminal Neuralgia)   Amy A. Pruitt

1231

PART XII

DERMATOLOGIC PROBLEMS

 

Chapter 177

Screening for Skin Cancers   Arthur J. Sober and Peter C. Schalock

1233

Chapter 178

Evaluation of Pruritus   Peter C. Schalock and Arthur J. Sober

1240

Chapter 179

Evaluation of Purpura

1245

Chapter.180

Evaluation of Disturbances in Pigmentation   Peter C. Schalock and Arthur J. Sober

1249

Chapter.181

Evaluation of Urticaria and Angioedema

1254

Chapter 182

Approach to the Patient with Hair Loss   Peter C. Schalock and Arthur J. Sober

1260

Chapter 183

Disturbances of Skin Hydration: Dry Skin and Excessive Sweating   Peter C. Schalock and Arthur J. Sober

1265

Part 1

Management of Dry Skin

1265

Part 2

Approach to Excessive Sweating

1267

Chapter 184

Approach to the Patient with Dermatitis   Peter C. Schalock and Arthur J. Sober

1269

Part 1

Atopic or Contact Dermatitis

1269

Part 2

Management of Seborrheic Dermatitis

1274

Chapter 185

Management of Acne   Peter C. Schalock and Arthur J. Sober

1276

Chapter 186

Management of Rosacea and Other Acneiform Dermatoses   Peter C. Schalock and Arthur J. Sober

1280

Chapter 187

Management of Psoriasis   Peter C. Schalock and Arthur J. Sober

1283

Chapter 188

Management of Intertrigo and Intertriginous Dermatoses   Peter C. Schalock and Arthur J. Sober

1289

Chapter 189

Management of Corns and Calluses   Peter C. Schalock and Arthur J. Sober

1292

Chapter 190

Approach to Bacterial Skin Infections   Peter C. Schalock and Arthur J. Sober

1294

Part 1

Cellulitis

1294

Part 2

Management of Pyoderma

1297

Chapter 191

Management of Superficial Fungal Infections   Peter C. Schalock and Arthur J. Sober

1300

Chapter 192

Management of Cutaneous and Genital Herpes Simplex

1306

Chapter 193

Management of Herpes Zoster

1312

Chapter 194

Management of Warts   Peter C. Schalock and Arthur J. Sober

1315

Chapter 195

Management of Scabies and Pediculosis   Peter C. Schalock and Arthur J. Sober

1320

Chapter 196

Management of Skin Trauma: Bites and Burns

1323

Part 1

Animal and Human Bites   Ellie J.C. Goldstein

1323

Part 2

Management of Minor Burns   Peter C. Schalock and Arthur J. Sober

1326

Chapter 197

Management of Skin Ulceration   Peter C. Schalock and Arthur J. Sober

1328

 

Appendix to Section 12: Minor Surgical Office Procedures for Skin Problems   Pierre E. De Delva and Charles J. McCabe

1332

PART XIII

OPHTHALMOLOGIC PROBLEMS

 

Chapter 198

Screening for Open-Angle Glaucoma   James W. Hung and Claudia V. Richter

1336

Chapter 199

Evaluation of the Red Eye   Nicoletta Fynn-Thompson and Claudia U. Richter

1338

Chapter 200

Evaluation of Impaired Vision   James W. Hung and Claudia U. Richter

1345

Chapter 201

Evaluation of Eye Pain   Audrey Ahuero and Claudia U. Richter

1348

Chapter 202

Evaluation of Dry Eyes   Claudia U. Richter and Audrey Ahuero

1352

Chapter 203

Evaluation of Common Visual Disturbances: Flashing Lights, Floaters, and Other Transient Phenomena   Claudia U. Richter

1354

Chapter 204

Evaluation of Exophthalmos   Mark P. Hatton and Claudia U. Richter

1356

Chapter 205

Evaluation of Watery Eyes   Mark P. Hatton and Claudia U. Richter

1359

Chapter 206

Management of the Patient with Age-Related Macular Degeneration   Tina Scheufele Cleary and Claudia U. Richter

1361

Chapter 207

Management of Glaucoma   Laura C. Fine and Claudia U. Richter

1363

Chapter 208

Management of Cataracts   Claudia U. Richter and Laura C. Fine

1367

Chapter 209

Management of Diabetic Retinopathy   Tina Scheufele Cleary and Claudia U. Richter

1370

Chapter 210

Correction of Vision   Kristie J. Bennett and Claudia V. Richter

1373

PART XIV

EAR, NOSE, AND THROAT PROBLEMS

 

Chapter 211

Screening for Oral Cancer   John P. Kelly

1375

Chapter 212

Evaluation of Hearing Loss   Neil Bhattacharyya

1377

Appendix 212.1

Audiometry

1382

Chapter 213

Approach to Epistaxis   Neil Bhattacharyya

1383

Chapter 214

Evaluation of Facial Pain and Swelling   John P. Kelly

1386

Chapter 215

Evaluation of Smell and Taste Disturbances   Neil Bhattacharyya

1389

Appendix 215.1

Halitosis

1392

Chapter 216

Approach to the Patient with Hoarseness   Neil Bhattacharyya

1393

Chapter 2l7

Evaluation of Tinnitus   Neil Bhattacharyya

1398

Chapter 218

Approach to the Patient with Otitis   Neil Bhattacharyya

1400

Chapter 219

Approach to the Patient with Sinusitis   William A. Kormos

1402

Chapter 220

Approach to the Patient with Pharyngitis   William A. Kormos

1407

Chapter 221

Approach to the Patient with Hiccups

1413

Chapter 222

Approach to the Patient with Chronic Nasal Congestion and Discharge   Neil Bhattacharyya

1415

Chapter 223

Approach to the Patient with Excessive Snoring   Neil Bhattacharyya

1422

Chapter 224

Approach to the Patient with Aphthous Stomatitis

1424

Chapter 225

Management of Temporomandibular Joint Dysfunction

1426

PART XV

PSYCHIATRIC PROBLEMS

 

Chapter 226

Approach to the Patient with Anxiety   John J. Worthington III

1428

Appendix 226.1

Strategies for Stress Management   William E. Minichiello

1437

Chapter 227

Approach to the Patient with Depression   John J. Worthington III and Scott L. Rauch

1439

Chapter 228

Approach to the Patient with an Alcohol Problem   Michael F. Bierer and Eleanor Z. Hattna

1454

Chapter 229

Approach to the Patient with Sexual Dysfunction   Linda C. Shafer

1469

Chapter 230

Approach to the Somatizing Patient   Ilana M. Braun and Arthur J. Barsky III

1476

Chapter 231

Approach to the Angry Patient   Ilana M. Braun and Arthur J. Barsky III

1481

Chapter 232

Approach to the Patient with Insomnia   Jeffrey B. Weilburg

1483

Appendix 232.1

Restless Leg Syndrome

1491

Chapter 233

Management of Obesity   Carolyn Crimmins Hintlian

1492

Chapter 234

Approach to Eating Disorders   Nancy A. Rigotti

1507

Appendix 234.1

Night Eating Syndrome

1513

Chapter 235

Approach to Drug Abuse and Dependence   E. Nalan Ward

1514

Appendix 235.1

Adult Attention-Deficit/Hyperactivity Disorder

1522

Chapter 236

Approach to the Patient with Chronic Nonmalignant Pain

1525

PART XVI

ALLIED FIELDS

 

Chapter 237

Herbal Supplements Commonly Used as Complementary or Alternative Therapy   Ernie-Paul Barrette

1536

Chapter 238

Caring for the Adolescent Patient   Laurence J. Ronan

1542

Chapter 239

Approach to Frailty in Older Adults   Claus Hamann and Kenneth L. Minaker

1550

 

Index

1555