2017
T ronto Notes
COMPREHENSIVE MEDICAL REFERENCE & REVIEW FOR MCCQE I AND USMLE II
Editors-in-Chief: Jieun Kim & Ilya Mukovozov
Production Managers: Tina Binesh Marvasti & Sydney McQueen
, 2017
Toronto Notes
Comprehensive medical reference and review for the
Medical Council of Canada Qualifying Exam Part I and the
United States Medical Licensing Exam Step 2
33rd Edition
Editors-in-Chief:
Jieun Kim and Ilya Mukovozov
Wherever the art of medicine is loved,
there is also a love of humanity.
–Hippocrates
Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada
, Thirty-third Edition
Copyright © 2017 – Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada.
Typeset and production by Type & Graphics Inc.
ISBN 978-1-927363-31-7 (33rd ed.)
All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2017 is provided for the sole use of
the purchaser. It is made available on the condition that the information contained herein will not be sold or
photocopied. No part of this publication may be used or reproduced in any form or by any means without prior
written permission from the publisher. Every effort has been made to obtain permission for all copyrighted
material contained herein. Previous editions copyright © 1985 to 2017.
Cover illustration: David Moratto
Cover design layout: Jieun Kim
Illustrations: Biomedical Communications, University of Toronto
Notice:
THIS PUBLICATION HAS NOT BEEN AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY
THE MEDICAL COUNCIL OF CANADA NOR DOES IT RECEIVE ENDORSEMENT BY THE MEDICAL
COUNCIL AS REVIEW MATERIAL FOR THE MCCQE PART I. THIS PUBLICATION HAS NOT BEEN
AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY THE NATIONAL BOARD OF MEDICAL
EXAMINERS U.S.A. NOR DOES IT RECEIVE ENDORSEMENT BY THE NATIONAL BOARD AS REVIEW
MATERIAL FOR THE USMLE.
The editors of this edition have taken every effort to ensure that the information contained herein is accurate and
conforms to the standards accepted at the time of publication. However, due to the constantly changing nature of
the medical sciences and the possibility of human error, the reader is encouraged to exercise individual clinical
judgement and consult with other sources of information that may become available with continuing research.
The authors, editors, and publisher are not responsible for errors or omissions or for any consequences from
application of the information in this textbook, atlas, or software and make no warranty, expressed or implied,
with respect to the currency, completeness, or accuracy of the contents of the publication. In particular, the
reader is advised to check the manufacturer’s insert of all pharmacologic products before administration.
FEEDBACK AND ERRATA
We are constantly trying to improve the Toronto Notes and welcome your feedback. If you have found an error in
this edition please do not hesitate to contact us. As well, we look forward to receiving any comments regarding
any component of the Toronto Notes package and website.
Please send your feedback to:
Alternatively, send mail to: Toronto Notes for Medical Students
Editors-in-Chief
c/o The Medical Society
1 King’s College Circle, Room 2260
Toronto, Ontario M5S 1A8
Canada
email:
Tel: 1-416-946-3047 Fax: 1-416-978-8730
Library of Congress Cataloging-in-Publication Data is available upon request
2 Toronto Notes 2017
, Dedicated to all
past and present contributors
and
supporters of Toronto Notes
who have made the production of the 2017 edition possible!
The Toronto Notes is dedicated to helping fund many charitable endeavours and medical student initiatives at the University
of Toronto’s Faculty of Medicine. Programs that have received Toronto Notes funding include:
Community Affairs Projects Medical School Clubs
• Saturday Program for Inner City High School • Books with Wings
and Grade 8 students • Women in Medicine
• St. Felix Mentorship Program for Inner City children • University of Toronto International Health Program
• Parkdale Mentorship Program for Grade 10-12 students • Complementary and Alternative Medicine
• WoodGreen Community Centre • Peer Support for Students
• Let’s Talk Science • History of Medicine Society
• Growing Up Healthy • Faculty of Medicine Yearbook
Annual Faculty Showcase Events Scholarships and Bursaries
• Bruce Tovee Lecture Series • Nishant Fozdar Memorial Award
• Daffydil, in support of the Canadian Cancer Society • Graduating Medical Class Scholarships and Bursaries
• Earthtones Benefit Concert
• Convocation and Ceremonies
Note:
Many of you have wondered about the Toronto Notes logo, which is based on the rod of Asclepius, the Greek god of
medicine. The rod of Asclepius consists of a single serpent entwined around a staff. This icon symbolizes both rebirth,
by way of a snake shedding its skin, and also authority, by way of the staff.
In ancient Greek mythology, Asclepius was the son of Apollo and a skilled practitioner of medicine who learned
the medical arts from the centaur Chiron. Asclepius’ healing abilities were so great that he was said to be able to bring
back people from the dead. These powers displeased the gods, who punished Asclepius by placing him in the sky as
the constellation Orphiuchus.
The rod of Asclepius is at times confused with the caduceus, or wand, of Hermes, a staff entwined with two serpents
and often depicted with wings. The caduceus is often used as a symbol of medicine or medical professionals, but there
is little historical basis for this symbolism.
As you may have guessed, our logo uses the rod of Asclepius that is modified to also resemble the CN Tower – our
way of recognizing the university and community in which we have been privileged to learn the art and science of
medicine.
Thomas O’Brien, MD
Class of 2009
M.D. Program, University of Toronto
3 Toronto Notes 2017
T ronto Notes
COMPREHENSIVE MEDICAL REFERENCE & REVIEW FOR MCCQE I AND USMLE II
Editors-in-Chief: Jieun Kim & Ilya Mukovozov
Production Managers: Tina Binesh Marvasti & Sydney McQueen
, 2017
Toronto Notes
Comprehensive medical reference and review for the
Medical Council of Canada Qualifying Exam Part I and the
United States Medical Licensing Exam Step 2
33rd Edition
Editors-in-Chief:
Jieun Kim and Ilya Mukovozov
Wherever the art of medicine is loved,
there is also a love of humanity.
–Hippocrates
Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada
, Thirty-third Edition
Copyright © 2017 – Toronto Notes for Medical Students, Inc.
Toronto, Ontario, Canada.
Typeset and production by Type & Graphics Inc.
ISBN 978-1-927363-31-7 (33rd ed.)
All rights reserved. Printed in Toronto, Ontario, Canada. Toronto Notes 2017 is provided for the sole use of
the purchaser. It is made available on the condition that the information contained herein will not be sold or
photocopied. No part of this publication may be used or reproduced in any form or by any means without prior
written permission from the publisher. Every effort has been made to obtain permission for all copyrighted
material contained herein. Previous editions copyright © 1985 to 2017.
Cover illustration: David Moratto
Cover design layout: Jieun Kim
Illustrations: Biomedical Communications, University of Toronto
Notice:
THIS PUBLICATION HAS NOT BEEN AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY
THE MEDICAL COUNCIL OF CANADA NOR DOES IT RECEIVE ENDORSEMENT BY THE MEDICAL
COUNCIL AS REVIEW MATERIAL FOR THE MCCQE PART I. THIS PUBLICATION HAS NOT BEEN
AUTHORED, REVIEWED, OR OTHERWISE SUPPORTED BY THE NATIONAL BOARD OF MEDICAL
EXAMINERS U.S.A. NOR DOES IT RECEIVE ENDORSEMENT BY THE NATIONAL BOARD AS REVIEW
MATERIAL FOR THE USMLE.
The editors of this edition have taken every effort to ensure that the information contained herein is accurate and
conforms to the standards accepted at the time of publication. However, due to the constantly changing nature of
the medical sciences and the possibility of human error, the reader is encouraged to exercise individual clinical
judgement and consult with other sources of information that may become available with continuing research.
The authors, editors, and publisher are not responsible for errors or omissions or for any consequences from
application of the information in this textbook, atlas, or software and make no warranty, expressed or implied,
with respect to the currency, completeness, or accuracy of the contents of the publication. In particular, the
reader is advised to check the manufacturer’s insert of all pharmacologic products before administration.
FEEDBACK AND ERRATA
We are constantly trying to improve the Toronto Notes and welcome your feedback. If you have found an error in
this edition please do not hesitate to contact us. As well, we look forward to receiving any comments regarding
any component of the Toronto Notes package and website.
Please send your feedback to:
Alternatively, send mail to: Toronto Notes for Medical Students
Editors-in-Chief
c/o The Medical Society
1 King’s College Circle, Room 2260
Toronto, Ontario M5S 1A8
Canada
email:
Tel: 1-416-946-3047 Fax: 1-416-978-8730
Library of Congress Cataloging-in-Publication Data is available upon request
2 Toronto Notes 2017
, Dedicated to all
past and present contributors
and
supporters of Toronto Notes
who have made the production of the 2017 edition possible!
The Toronto Notes is dedicated to helping fund many charitable endeavours and medical student initiatives at the University
of Toronto’s Faculty of Medicine. Programs that have received Toronto Notes funding include:
Community Affairs Projects Medical School Clubs
• Saturday Program for Inner City High School • Books with Wings
and Grade 8 students • Women in Medicine
• St. Felix Mentorship Program for Inner City children • University of Toronto International Health Program
• Parkdale Mentorship Program for Grade 10-12 students • Complementary and Alternative Medicine
• WoodGreen Community Centre • Peer Support for Students
• Let’s Talk Science • History of Medicine Society
• Growing Up Healthy • Faculty of Medicine Yearbook
Annual Faculty Showcase Events Scholarships and Bursaries
• Bruce Tovee Lecture Series • Nishant Fozdar Memorial Award
• Daffydil, in support of the Canadian Cancer Society • Graduating Medical Class Scholarships and Bursaries
• Earthtones Benefit Concert
• Convocation and Ceremonies
Note:
Many of you have wondered about the Toronto Notes logo, which is based on the rod of Asclepius, the Greek god of
medicine. The rod of Asclepius consists of a single serpent entwined around a staff. This icon symbolizes both rebirth,
by way of a snake shedding its skin, and also authority, by way of the staff.
In ancient Greek mythology, Asclepius was the son of Apollo and a skilled practitioner of medicine who learned
the medical arts from the centaur Chiron. Asclepius’ healing abilities were so great that he was said to be able to bring
back people from the dead. These powers displeased the gods, who punished Asclepius by placing him in the sky as
the constellation Orphiuchus.
The rod of Asclepius is at times confused with the caduceus, or wand, of Hermes, a staff entwined with two serpents
and often depicted with wings. The caduceus is often used as a symbol of medicine or medical professionals, but there
is little historical basis for this symbolism.
As you may have guessed, our logo uses the rod of Asclepius that is modified to also resemble the CN Tower – our
way of recognizing the university and community in which we have been privileged to learn the art and science of
medicine.
Thomas O’Brien, MD
Class of 2009
M.D. Program, University of Toronto
3 Toronto Notes 2017
