Pocket Primary Care

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PocketN ot e b o o kPocket PrimaryCareEdited byMeghan M. Kiefer, MDCurtis R. Chong, MD, PhD, MphilA Massachusetts General Hospital HandbookLWBK1305-FM.indd 123/12/13 7:37 AM

Executive Editor: Rebecca GaertnerProduct Manager: Kristina OberleVendor Manager: Bridgett DoughertyManufacturing Coordinator: Beth WelshMarketing Manager: Stephanie ManzoCreative Director: Doug SmockProduction Service: Aptara, Inc. 2014 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER businessTwo Commerce Square2001 Market StreetPhiladelphia, PA 19103 USALWW.comAll rights reserved. This book is protected by copyright. No part of this book may bereproduced in any form by any means, including photocopying, or utilized by anyinformation storage and retrieval system without written permission from the copyrightowner, exceptfor brief quotations embodied in critical articles and reviews. Materialsappearing in thisbook prepared by individuals as part of their official duties as U.S.government employeesare not covered by the above-mentioned copyright.Printed in ChinaLibrary of Congress Cataloging-in-Publication DataPocket primary care (Kiefer)Pocket primary care / edited by Meghan Kiefer, Curtis Chong.p. ; cm.Includes bibliographical references and index.ISBN 978-1-4511-2826-0 (alk. paper)I. Kiefer, Meghan, editor of compilation. II. Chong, Curtis, editor ofcompilation. III. Title.[DNLM: 1. Primary Health Care–Handbooks. W 49]RC46616–dc232013045100DISCLAIMER Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, andpublisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, withrespect to the currency, completeness, or accuracy of the contents of the publication.Application of the information in a particular situation remains the professional responsibility of the practitioner.The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations andpractice 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 drugreactions, the reader is urged to check the package insert for each drug for any change inindications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.Some drugs and medical devices presented in the publication have Food and DrugAdministration (FDA) clearance for limited use in restricted research settings. It is theresponsibility of the health care provider to ascertain the FDA status of each drug or deviceplanned for use in their clinical practice.To purchase additional copies of this book, call our customer service department at(800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301)223-2300.Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams& Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.10 9 8 7 6 5 4 3 2 1LWBK1305-FM.indd 223/12/13 7:37 AM

CONTENTSContributing AuthorsforewordPrefaceviiixxviixxviiiGeneral medicineEdited by: Meghan M. KieferRoutine VisitDisease ScreeningHealth LiteracyCounseling PatientsEvidence-Based MedicineChronic PainChronic Opioid UseImmunizationsInfertilityObesityTobacco yEdited by: Kenta Nakamura, Ada StefanescuCoronary Artery DiseaseAortic DiseaseAtrial Fibrillation and FlutterCarotid DiseaseChest Pain and Noninvasive TestingHeart FailureDyslipidemiaHypertensionLower Extremity Edema & UlcersPalpitationsPeripheral Artery DiseasePre-Flight AssessmentPre-Operative Risk AssessmentSports and Exercise ClearanceSudden Cardiac DeathSyncopeValvular Heart 82-282-322-332-342-36DermatologyEdited by: Sarah N. Gee, H. Ray JalianApproach to Skin LesionsAcneAlopeciaAtopic DermatitisCommon Benign GrowthsBurnsDermatitisCutaneous Drug EruptionsMelanomaPsoriasisRheumatologic Skin DiseaseRosaceaScabiesNonmelanoma Skin CancerTineaLWBK1305-FM.indd 3-1923/12/13 7:37 AM

Topical CorticosteroidsUrticariaWound Care3-213-233-24EndocrineEdited by: Marc N. WeinAdrenal NodulesCalcium DisordersCushing SyndromeDiabetes MellitusDiabetes InsipidusHyperprolactinemiaMale HypogonadismOsteoporosisPolycystic Ovary SyndromeThyroid DisordersVitamin D ASTROENTEROLOGYEdited by: Zachary A. ZatorAbdominal PainAbnormal Liver Function TestsCeliac DiseaseCirrhosisConstipationDiarrheaDiverticular DiseaseDysphagiaGallstonesGastrointestinal BleedingGastroesophageal Reflux DiseaseH. pylori DiseaseHemorrhoidsInflammatory Bowel DiseaseIrritable Bowel SyndromeJaundicePancreatitisPeptic Ulcer -175-185-205-225-225-24Hematology and oncologyEdited by: Curtis R. ChongAbnormal WBC CountAnemiaFolate & Vitamin B12 DeficiencyBleeding DisordersDVT and Pulmonary EmbolusHemochromatosisLymphadenopathy & Splenic DisordersPlatelet 15Infectious diseaseEdited by: Bryn Boslett, Emily A. KendallBites and InfestationsBacterial Endocarditis ProphylaxisFever of Unknown OriginLWBK1305-FM.indd 47-17-27-323/12/13 7:37 AM

Hepatitis BHepatitis CHIV/AIDSHerpes Simplex VirusOther Viral HepatitidesPneumocystis (PCP) ProphylaxisPharyngitisPneumoniaSexually Transmitted InfectionsSkin & Soft Tissue InfectionsTick-Borne IllnessesTravel MedicineTuberculosisURI and InfluenzaHerpes ZosterUrinary Tract 37-257-277-307-317-33MusculoskeletalEdited by: Allen ChangBack PainFibromyalgiaFoot & Ankle DisordersGout and PseudogoutHand DisordersHip PainKnee PainMonoarticular ArthritisMuscle PainOsteoarthritisPolymyalgia RheumaticaPolyarticular ArthritisRheumatologic TestsSystemic Lupus ErythematosusShoulder 18-228-23NeurologyEdited by: Renuka Tipirneni, Sarah WahlsterBell’s PalsyConcussionDiplopiaDizziness and VertigoWeaknessHeadachePeripheral NeuropathyParkinson’s DiseaseRestless Legs SyndromeSeizureStroke, TIA, & Poststroke 20Ophthalmology and ENTEdited by: Rachel M. Huckfeldt, Aaron K. RemenschneiderAllergic RhinitisEye TraumaHearing LossHoarsenessLWBK1305-FM.indd 510-110-210-410-623/12/13 7:37 AM

Jaw & Dental PainOtitisRed EyeSinusitisSnoringVision ited by: Leah K. Bauer, Sarah E. WakemanAttention Deficit Hyperactivity Disorder (ADHD)Alcohol Use DisordersAnxiety DisordersBipolar DisorderDepressionCare of the “Difficult Patient”Domestic ViolenceEating DisordersObsessive-Compulsive DisorderPsychotic DisordersPsychotropic MedicationsInsomnia and Sleep DisordersSomatoform DisordersSubstance Use DisordersSuicide Risk -1211-1311-1511-1711-1711-19PulmonaryEdited by: Katie R. FamousAsthmaChronic Obstructive Pulmonary Disease (COPD)Chronic CoughDyspneaHemoptysisPulmonary NodulesObstructive Sleep ted by: Andrew AllegrettiChronic Kidney DiseaseHematuriaNephrolithiasisPotassium DisordersProteinuriaSodium Disorders13-113-313-413-613-813-10Women’s HealthEdited by: Sara U. Schwanke KhiljiAbnormal Uterine BleedingAmenorrheaBreast DiseaseCervical Cancer ScreeningContraceptionDysmenorrheaMenopausePelvic PainPelvic Inflammatory DiseaseVaginitisLWBK1305-FM.indd 2/13 7:37 AM

Men’s HealthEdited by: Allen ChangBPH & Lower Urinary Tract SymptomsMale Sexual DysfunctionProstate CancerProstatitisScrotal & Testicular Lesions15-115-315-415-615-7GeriatricsEdited by: D. Clay AckerlyDementiaEnd-of-life & Advance Care PlanningFall PreventionUrinary I-1Visit us tprimarycareQuestions, comments, feedback? E-mail [email protected]BK1305-FM.indd 723/12/13 7:37 AM

CONTRI B U T I N G A U T H O R SJeremy S. Abramson, MDDirector, Center for Lymphoma, Massachusetts General Hospital CancerCenter; Assistant Professor of Medicine, Harvard Medical School(Lymphadenopathy & Splenic Disorders) MGH ’03D. Clay Ackerly, MD, MScAssistant Chief Medical Officer, Non-Acute, Massachusetts GeneralHospital; Associate Medical Director, Population Health and ContinuingCare, Partners HealthCare; Instructor in Medicine and Health CarePolicy, Harvard Medical School (Geriatrics Section Editor) MGH ’12George A. Alba, MDInternal Medicine Resident, Massachusetts General Hospital (ObstructiveSleep Apnea, Jaundice) MGH ’14Andrew Allegretti, MDNephrology Fellow, Massachusetts General Hospital (Renal/UrologySection Editor) MGH ’13Ashwin N. Ananthakrishnan, MBBS, MPHAttending Physician, GI Unit, Massachusetts General Hospital; AssistantProfessor of Medicine, Harvard Medical School (Abdominal Pain, Celiacdisease, Diverticular disease, Gastrointestinal Bleeding, Hemorrhoids,H. pylori Disease, inflammatory bowel disease, peptic ulcer disease)George L. Anesi, MD, MAInternal Medicine Resident, Massachusetts General Hospital (Hemoptysis,Allergic Rhinitis) MGH ’14Steven J. Atlas, MD, MPHDirector, Practice-Based Research & Quality Improvement Network, GeneralMedicine Division, Massachusetts General Hospital; Attending Physician,General Medicine Division, Masachusetts General Hospital; AssociateProfessor of Medicine, Harvard Medical School (Back Pain) MGH ’90Aaron L. Baggish, MDAssociate Director, Cardiovascular Performance Program; AttendingPhysician, Division of Cardiology, Massachusetts General Hospital;Assistant Professor of Medicine, Harvard Medical School (Sports andExercise Clearance) MGH ’05Matthew C. Baker, MDInternal Medicine Resident, Massachusetts General Hospital (Muscle Pain,Hip Pain) MGH ’14Jason G. Barrera, MD, PhDInternal Medicine Resident, Massachusetts General Hospital (MaleHypogonadism) MGH ’14Miriam Baron Barshak, MDAssociate Physician, Infectious Disease Division, Massachusetts GeneralHospital; Assistant Professor of Medicine, Harvard Medical School(Pharyngitis, Urinary Tract Infections)LWBK1305-FM.indd 823/12/13 7:37 AM

Leah K. Bauer, MDAdministrative Chief Resident, Massachusetts General Hospital/McLeanPsychiatry (Psychiatry Section Co-Editor, Bipolar Disorder, PsychotropicMedications)Jonathan F. Bean, MD, MS, MPHAssociate Professor of Physical Medicine & Rehabilitation, SpauldingRehabilitation Hospital, Harvard Medical School (Fall Prevention)Seth K. Bechis, MD, MSUrology Resident, Department of Urology, Massachusetts GeneralHospital (Nephrolithiasis)Rachel Bender Ignacio, MDInfectious Disease Fellow, University of Washington (Skin and Soft TissueInfections) MGH ’11Rebecca A. Berman, MDDivision of General Medicine Residency Program Director, Brigham andWomen’s Hospital; Instructor of Medicine, Harvard Medical School(Health Literacy)Matthew Bevers, MD, PhDChief Resident, Neurology, Partners Neurology Residency (Diplopia)Ishir Bhan, MD, MPHAttending Physician, Nephrology Unit, Massachusetts General Hospital;Instructor in Medicine, Harvard Medical School (Sodium disorders,Potassium Disorders, Chronic Kidney Disease, Hematuria, Proteinuria)MGH ’04Shamik Bhattacharyya, MD, MSNeurology Resident, Partners Neurology Residency (Parkinson’s Disease,Tremor)Michael F. Bierer, MD, MPHAttending Physician, General Medicine Division, Massachusetts GeneralHospital; Assistant Professor of Medicine, Harvard Medical School(Chronic Pain, Chronic Opioid Use, Alcohol Use Disorders) MGH ’88Shana L. Birnbaum, MDAssistant Physician, General Medicine Division, Massachusetts GeneralHospital; Instructor in Medicine, Harvard Medical School(Contraception, Cervical Cancer Screening) MGH ’02Kimberly G. Blumenthal, MDAllergy and Immunology Fellow, Massachusetts General Hospital (AtopicDermatitis, Asthma, Sinusitis) MGH ’12Marcy B. Bolster, MDDirector, Rheumatology Fellowship Training Program, MassachusettsGeneral Hospital; Attending Physician, Division of Rheumatology;Associate Professor of Medicine, Harvard Medical School (PolyarticularArthritis, Shoulder Pain)LWBK1305-FM.indd 923/12/13 7:37 AM

Bryn Boslett, MDInfectious Disease Fellow, University of California San Francisco(Infectious Disease Section Co-editor, Fever of Unknown Origin,Pneumocystis (PCP) Prophylaxis, STIs) MGH ’13Marjory A. Bravard, MDAssistant in Medicine, Massachusetts General Hospital; Instructor inMedicine, Harvard Medical School (Hepatitis C, Other Viral Hepatidides,Burns) MGH ’13Brian P. Brennan, MD, MMScAssociate Director of Translational Neuroscience Research, BiologicalPsychiatry Laboratory, McLean Hospital; Instructor in Psychiatry,Harvard Medical School (Obsessive-Compulsive Disorder)Laura N. Brenner, MDPulmonary & Critical Care Fellow, Massachusetts General Hospital/BethIsrael Deaconesss Medical Center (Chronic Cough) MGH ’13Judith A. Briant, MDInternal Medicine Resident, Massachusetts General Hospital (HerpesZoster, Bacterial Endocarditis Prophylaxis) MGH ’14Lynne Brodsky, MDAttending Physician, Department of Medicine, Massachusetts GeneralHospital-Chelsea HealthCare Center; Assistant Professor of Medicine,Harvard Medical School (Menopause)Andrew M. Brunner, MDHematology-Oncology Fellow, Dana-Farber Cancer Institute/Massachusetts General Hospital/Partners CancerCare (Abnormal WBCCount) MGH ’13Dana M. Carne, MD, MBAClinical Instructor in Medicine, Massachusetts General Hospital (Gout &Pseudogout, Nonmelanoma Skin Cancer) MGH ’13Brett J. Carroll, MDInternal Medicine Resident, Massachusetts General Hospital (Pharyngitis)MGH ’14Rodrigo Cerda, MD, MPHInstructor in Medicine, Massachusetts General Hospital (Tinea) MGH ’13Laura Certain, MD, PhDInfectious Disease Fellow, Massachusetts General Hospital/Brigham &Women’s Hospital Combined Infectious Disease Program (UrinaryTract Infections) MGH ’12Kyle J. Chambers, MDOtolaryngology Resident, Massachusetts General Hospital/MassachusettsEye and Ear Infirmary (Otitis)LWBK1305-FM.indd 1023/12/13 7:37 AM

Allen Chang, MDAttending Physician, Department of Medicine, UMass Memorial MedicalCenter; Assistant Professor, University of Massachusetts MedicalSchool, Worcester, MA (Musculoskeletal Section Editor, Men’s HealthSection Editor, Systemic Lupus Erythematosus) MGH ’12Quinn Taylor Charbonneau, DPMPodiatry Resident, Massachusetts General Hospital (Foot & AnkleDisorders)Justin A. Chen, MDAttending Physician, Department of Psychiatry, Massachusetts GeneralHospital; Instructor in Psychiatry, Harvard Medical School (Care of the“Difficult” Patient, ADHD, Suicide Risk Assessment)Xingxing S. Cheng, MDInternal Medicine Resident, Massachusetts General Hospital (PotassiumDisorders) MGH ’14Garrett Matthew Chinn, MD, MSAttending Physician, General Medicine Division, Massachusetts GeneralHospital; Instructor in Medicine, Harvard Medical School (Psoriasis,Rosacea) MGH ’12Josalyn L. Cho, MDAssociate Director, Pulmonary and Critical Care Fellowship Program,MGH/BIDMC Attending Physician, Pulmonary and Critical Care Unit,Massachusetts General Hospital; Instructor in Medicine, HarvardMedical School (Pulmonary Nodules) MGH ’06Curtis R. Chong, MD, PhD, MPhilHematology-Oncology Fellow, Dana-Farber Cancer Institute/Massachusetts General Hospital/Partners CancerCare (Hematologyand Oncology Section Editor, Counseling Patients, Evidence-based Medicine,Routine Visit, Hypertension, URI & Influenza, Back Pain, Alcohol UseDisorders, Coronary Artery Disease) MGH ’11Jacqueline Chu, MDInternal Medicine Resident, Massachusetts General Hospital(Immunizations) MGH ’14Kathy Chuang, MDClinical Fellow in Neuromuscular Medicine, Massachusetts GeneralHospital/Brigham & Women’s Hospital Neuromuscular Program(Peripheral Neuropathy)Raymond T. Chung, MDDirector of Hepatology, Vice Chief, Gastroenterology, MassachusettsGeneral Hospital; Associate Professor of Medicine, Harvard MedicalSchool (Hepatitis B, Other viral hepatitides)Deborah S. Collier, MDAttending Physician, Rheumatology Division, Massachusetts GeneralHospital; Assistant Professor of Medicine, Harvard Medical School(Fibromyalgia; Monoarticular Arthritis)LWBK1305-FM.indd 1123/12/13 7:37 AM

Fernando M. Contreras-Valdes, MDCardiology Fellow, Beth Israel Deaconess Medical Center (Valvular HeartDisease) MGH ’12Rebecca Cook, MD, MScInternal Medicine-Pediatrics Resident, Massachusetts General Hospital/MassGeneral Hospital for Children (Shoulder Pain, Pelvic Pain)MGH ’15Kathleen E. Corey, MD, MPHCo-director and Director of Clinical and Translational Research, MGHWeight Center, Massachusetts General Hospital; Attending Physician,Gastroenterology Unit, Massachusetts General Hospital; Director,MGH Fatty Liver Clinic, GI Unit, Massachusetts General Hospital;Instructor in Medicine, Harvard Medical School (Abnormal LiverFunction Tests, Cirrhosis, Jaundice, Gallstones, Pancreatitis) MGH ’06Frank Cortazar, MDInternal Medicine Resident, Massachusetts General Hospital (SodiumDisorders) MGH ’14Francis X. Creighton, Jr., MDOtolaryngology Resident, Massachusetts General Hospital/MassachusettsEye and Ear Infirmary (Otitis)Paul F. Currier, MD, MPHAttending Physician, Pulmonary and Critical Care Unit, MassachusettsGeneral Hospital; Assistant Professor of Medicine, Harvard MedicalSchool (Dyspnea)Doreen DeFaria Yeh, MD, FACCAttending Physician, Susbspeciality Education Coordinator, Division ofCardiology, Massachusetts General Hospital; Instructor in Medicine,Harvard Medical School (Hypertension, Valvular Heart Disease, Pre-FlightAssessment) MGH ’06Marie B. Demay, MDPhysician in Medicine, Endocrine Division, Massachusetts GeneralHospital; Professor of Medicine, Harvard Medical School (Vitamin Ddeficiency)Amit P. Desai, MDGastroenterology Fellow, New York Presbyterian Hospital (Gallstones,Inflammatory Bowel Disease) MGH ’13Erin Murphy DeBiasi, MDPulmonary & Critical Care Fellow, Yale School of Medicine (CervicalCancer Screening) MGH ’13Gillian R. Diercks, MDChief Otolaryngology Resident, Massachusetts General Hospital/Massachusetts Eye and Ear Infirmary (Snoring)LWBK1305-FM.indd 1223/12/13 7:37 AM

Abigail L. Donovan, MDDirector, First Episode and Early Psychosis Program, MassachusettsGeneral Hospital; Assistant Clinical Professor of Psychiatry, HarvardMedical School (Psychotic Disorders)Marlene L. Durand, MDPhysician in Medicine, Infectious Disease Unit, Massachusetts GeneralHospital; Associate Professor of Medicine, Harvard Medical School(Bacterial Endocarditis Prophylaxis) MGH ’84A. Brooke Eastham, MDDermatology Resident, Massachusetts General Hospital/HarvardCombined Dermatology Residency Program (Rheumatologic SkinDisease)Meredith Eicken, MDInternal Medicine-Pediatrics Resident, Massachusetts General Hospital/MassGeneral Hospital for Children (Abnormal Uterine Bleeding)MGH ’15Mark Eisenberg, MDAttending Physician, Department of Medicine, Massachusetts GeneralHospital-Charlestown HealthCare Center; Assistant Professor ofMedicine, Harvard Medical School (Pneumocystis (PCP) Prophylaxis,Pneumonia, Substance Use Disorders)Jeffrey M. Ellenbogen, MD, MMScDirector, The Sound Sleep Project, Johns Hopkins University; AttendingPhysician, Sleep Medicine, Johns Hopkins Hospital; Assistant Professorof Neurology, Johns Hopkins University (Insomnia and Sleep Disorders)Anne D. Emmerich, MDAttending Physician, Department of Psychiatry, Massachusetts GeneralHospital; Clinical Instructor in Psychiatry, Harvard Medical School(Depression)Katie R. Famous, MD, PhDPulmonary & Critical Care Fellow, University of California San Francisco(Pulmonary Section Editor) MGH ’13Pouneh K. Fazeli, MD, MPHAttending

pocket primary care (kiefer) pocket primary care / edited by Meghan kiefer, Curtis Chong. p. ; cm. Includes bibliographical references and index. ISbN 978-1-4511-2826-0 (alk. paper) I. kiefer, Meghan, editor of compilation. II. Chong, Curtis, editor of compilation. III. title. [DNLM: