, FOURTH EDITION
™
LANGE Q&A
INTERNAL MEDICINE
Yashesh Patel, MD, MSc, FRCPC
Assistant Professor
University of Toronto
Division of General Internal Medicine
Mount Sinai Hospital
Toronto, Ontario
Canada
Barry J. Goldlist, MD, FRCPC, FACP
Professor and Head
Division of Geriatric Medicine
University of Toronto
Toronto, Ontario
Canada
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 States of America. Except as permitted under the
United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or
retrieval system, without the prior written permission of the publisher.
0-07-150966-6
The material in this eBook also appears in the print version of this title: 0-07-147364-5.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names
in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more
information, please contact George Hoare, Special Sales, at or (212) 904-4069.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is
subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or
any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strict-
ly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,
ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN
BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of
cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work.
Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that
result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall
apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
DOI: 10.1036/0071473645
, Professional
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We hope you enjoy this
McGraw-Hill eBook! If
you’d like more information about this book,
its author, or related books and websites,
please click here.
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Contents
Preface ................................................................................................................................................................... v
Acknowledgments ............................................................................................................................................ vii
1. Cardiology ..................................................................................................................................................... 1
Questions ........................................................................................................................................................ 1
Answers and Explanations ........................................................................................................................ 23
2. Skin ............................................................................................................................................................... 35
Questions ...................................................................................................................................................... 35
Answers and Explanations ........................................................................................................................ 45
3. Endocrinology ............................................................................................................................................ 51
Questions ...................................................................................................................................................... 51
Answers and Explanations ........................................................................................................................ 68
4. Gastroenterology ........................................................................................................................................ 79
Questions ...................................................................................................................................................... 79
Answers and Explanations ........................................................................................................................ 92
5. Hematology ................................................................................................................................................. 99
Questions ...................................................................................................................................................... 99
Answers and Explanations ...................................................................................................................... 112
6. Oncology ..................................................................................................................................................... 119
Questions .................................................................................................................................................... 119
Answers and Explanations ...................................................................................................................... 129
7. Diseases of the Nervous System ........................................................................................................... 135
Questions .................................................................................................................................................... 135
Answers and Explanations ...................................................................................................................... 148
8. Kidneys ....................................................................................................................................................... 157
Questions .................................................................................................................................................... 157
Answers and Explanations ...................................................................................................................... 168
iii
,iv Contents
9. Muscles and Joints ................................................................................................................................... 175
Questions .................................................................................................................................................... 175
Answers and Explanations ...................................................................................................................... 191
10. Infection ..................................................................................................................................................... 199
Questions .................................................................................................................................................... 199
Answers and Explanations ...................................................................................................................... 217
11. Immunology and Allergy ........................................................................................................................ 229
Questions .................................................................................................................................................... 229
Answers and Explanations ...................................................................................................................... 235
12. Diseases of the Respiratory System ...................................................................................................... 239
Questions .................................................................................................................................................... 239
Answers and Explanations ...................................................................................................................... 252
13. Clinical Pharmacology ............................................................................................................................. 259
Questions .................................................................................................................................................... 259
Answers and Explanations ...................................................................................................................... 267
14. Comprehensive Review ........................................................................................................................... 275
Questions .................................................................................................................................................... 275
Answers and Explanations ...................................................................................................................... 294
References ......................................................................................................................................................... 307
Index ................................................................................................................................................................... 309
, Preface
The practice of internal medicine requires both the USMLE, making it an ideal study guide for indi-
breadth and depth of knowledge. To acquire mas- viduals preparing for licensing examinations.
tery of the subject requires extensive reading and The questions and answers reflect the increas-
clinical experience. The knowledge base is also con- ing growth of knowledge in the field of internal
stantly expanding and changing as medicine enters medicine. As a result, reviewing the answers gives
the era of molecular biology and large randomized the reader a “mini review” of basic concepts and
clinical trials. This textbook provides a review of the pathophysiology in internal medicine, allowing the
major issues in internal medicine by presenting a reader to approach clinical problems in an appro-
wide variety of typical examination questions and priate manner.
referenced answers. Finally, since the last edition was published, the
The text is organized by topic to facilitate in- list of references has been expanded and updated to
depth review but contains a large comprehensive reflect current knowledge in the field of internal
test that mimics the typical examination format. medicine.
The content has been organized to reflect the areas
tested on Step 2 of the United States Medical Yashesh Patel, MD, MSc, FRCPC
Licensing Examination (USMLE Step 2). The format Barry J. Goldlist, MD, FRCPC, FACP
of the questions is modeled after the format used on
v
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.
,This page intentionally left blank
, Acknowledgments
I would like to thank the countless medical students Goldlist for giving me the opportunity to work on
and residents who teach me and compel me to learn the latest edition of the book with him.
every day. Thanks to the patience of my family
and friends for putting up with my absences while Yashesh Patel, MD, MSc, FRCPC
I worked on the book. Finally, thanks to Barry
vii
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.
, This page intentionally left blank
™
LANGE Q&A
INTERNAL MEDICINE
Yashesh Patel, MD, MSc, FRCPC
Assistant Professor
University of Toronto
Division of General Internal Medicine
Mount Sinai Hospital
Toronto, Ontario
Canada
Barry J. Goldlist, MD, FRCPC, FACP
Professor and Head
Division of Geriatric Medicine
University of Toronto
Toronto, Ontario
Canada
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 States of America. Except as permitted under the
United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or
retrieval system, without the prior written permission of the publisher.
0-07-150966-6
The material in this eBook also appears in the print version of this title: 0-07-147364-5.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names
in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in
this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more
information, please contact George Hoare, Special Sales, at or (212) 904-4069.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is
subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile,
disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or
any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strict-
ly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY,
ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN
BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be
uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of
cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work.
Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that
result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall
apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
DOI: 10.1036/0071473645
, Professional
Want to learn more?
We hope you enjoy this
McGraw-Hill eBook! If
you’d like more information about this book,
its author, or related books and websites,
please click here.
, For more information about this title, click here
Contents
Preface ................................................................................................................................................................... v
Acknowledgments ............................................................................................................................................ vii
1. Cardiology ..................................................................................................................................................... 1
Questions ........................................................................................................................................................ 1
Answers and Explanations ........................................................................................................................ 23
2. Skin ............................................................................................................................................................... 35
Questions ...................................................................................................................................................... 35
Answers and Explanations ........................................................................................................................ 45
3. Endocrinology ............................................................................................................................................ 51
Questions ...................................................................................................................................................... 51
Answers and Explanations ........................................................................................................................ 68
4. Gastroenterology ........................................................................................................................................ 79
Questions ...................................................................................................................................................... 79
Answers and Explanations ........................................................................................................................ 92
5. Hematology ................................................................................................................................................. 99
Questions ...................................................................................................................................................... 99
Answers and Explanations ...................................................................................................................... 112
6. Oncology ..................................................................................................................................................... 119
Questions .................................................................................................................................................... 119
Answers and Explanations ...................................................................................................................... 129
7. Diseases of the Nervous System ........................................................................................................... 135
Questions .................................................................................................................................................... 135
Answers and Explanations ...................................................................................................................... 148
8. Kidneys ....................................................................................................................................................... 157
Questions .................................................................................................................................................... 157
Answers and Explanations ...................................................................................................................... 168
iii
,iv Contents
9. Muscles and Joints ................................................................................................................................... 175
Questions .................................................................................................................................................... 175
Answers and Explanations ...................................................................................................................... 191
10. Infection ..................................................................................................................................................... 199
Questions .................................................................................................................................................... 199
Answers and Explanations ...................................................................................................................... 217
11. Immunology and Allergy ........................................................................................................................ 229
Questions .................................................................................................................................................... 229
Answers and Explanations ...................................................................................................................... 235
12. Diseases of the Respiratory System ...................................................................................................... 239
Questions .................................................................................................................................................... 239
Answers and Explanations ...................................................................................................................... 252
13. Clinical Pharmacology ............................................................................................................................. 259
Questions .................................................................................................................................................... 259
Answers and Explanations ...................................................................................................................... 267
14. Comprehensive Review ........................................................................................................................... 275
Questions .................................................................................................................................................... 275
Answers and Explanations ...................................................................................................................... 294
References ......................................................................................................................................................... 307
Index ................................................................................................................................................................... 309
, Preface
The practice of internal medicine requires both the USMLE, making it an ideal study guide for indi-
breadth and depth of knowledge. To acquire mas- viduals preparing for licensing examinations.
tery of the subject requires extensive reading and The questions and answers reflect the increas-
clinical experience. The knowledge base is also con- ing growth of knowledge in the field of internal
stantly expanding and changing as medicine enters medicine. As a result, reviewing the answers gives
the era of molecular biology and large randomized the reader a “mini review” of basic concepts and
clinical trials. This textbook provides a review of the pathophysiology in internal medicine, allowing the
major issues in internal medicine by presenting a reader to approach clinical problems in an appro-
wide variety of typical examination questions and priate manner.
referenced answers. Finally, since the last edition was published, the
The text is organized by topic to facilitate in- list of references has been expanded and updated to
depth review but contains a large comprehensive reflect current knowledge in the field of internal
test that mimics the typical examination format. medicine.
The content has been organized to reflect the areas
tested on Step 2 of the United States Medical Yashesh Patel, MD, MSc, FRCPC
Licensing Examination (USMLE Step 2). The format Barry J. Goldlist, MD, FRCPC, FACP
of the questions is modeled after the format used on
v
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.
,This page intentionally left blank
, Acknowledgments
I would like to thank the countless medical students Goldlist for giving me the opportunity to work on
and residents who teach me and compel me to learn the latest edition of the book with him.
every day. Thanks to the patience of my family
and friends for putting up with my absences while Yashesh Patel, MD, MSc, FRCPC
I worked on the book. Finally, thanks to Barry
vii
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.
, This page intentionally left blank
