Primary Care Medicine

CONTENTS
Contributors viii
Preface xiii
Foreword to the First Edition xiv
Acknowledgments xv
SECTION I
Principles of Primary Care
Chapter 1 The Purpose and Practice of Primary
Care 1
Chapter 2 Selection and Interpretation of Diagnostic
Tests 9
Chapter 3 Health Maintenance and the Role of
Screening 18
Chapter 4 Estimating and Communicating Risk
and Prognosis 23
Chapter 5 Choosing among Treatment Options 26
Chapter 6 Immunization 29
Appendix 6-1: Vaccination for
Travel 44
SECTION II
Systemic Problems
Chapter 7 Screening for HIV Infection 47
Chapter 8 Evaluation of Chronic Fatigue 50
Chapter 9 Evaluation of Weight Loss 56
Chapter 10 Evaluation of Overweight and
Obesity 62
Chapter 11 Evaluation of Fever 70
Chapter 12 Evaluation of Lymphadenopathy 81
Chapter 13 Approach to the Patient with Human
Immunodeficiency Virus (HIV)
Infection 85
Chapter 14 Screening for Hypertension 99
Chapter 15 Screening for Hyperlipidemia and
Associated Coronary Heart Disease Risk
Factors 102
Chapter 16 Infective Endocarditis Prophylaxis 109
Chapter 17 Prevention of Rheumatic Fever and
Rheumatic Heart Disease 112
SECTION III
Cardiovascular Problems
Chapter 18 Primary Prevention of Coronary Heart
Disease 115
Appendix 18-1: Medical Screening of
Potential Exercisers 127
Appendix 18-2: The Exercise
Prescription 130
Chapter 19 Evaluation of Hypertension 134
Chapter 20 Evaluation of Chest Pain 144
Chapter 21 Evaluation of the Asymptomatic Systolic
Murmur 158
Chapter 22 Evaluation of Leg Edema 164
Appendix 22-1: Screening for Occult
Malignancy in Persons with Unprovoked
Deep Vein Thrombosis 171
Appendix 22-2: Evaluation for Upper
Extremity DVT 172
Chapter 23 Evaluation of Arterial Insufficiency
of the Lower Extremities 172
Chapter 24 Evaluation of Syncope 178
Chapter 25 Evaluation of Palpitations 187
Appendix 25-1: Evaluation of Atrial
Fibrillation in the Outpatient Setting 195
Chapter 26 Management of Hypertension 200
Chapter 27 Approach to the Patient with a Lipid
Disorder 221Chapter 28 Outpatient Management of Atrial
Fibrillation 2 4 7
Chapter 29 Management of Ventricular Irritability in
the Ambulatory Setting 262
Chapter 30 Management of Chronic Stable Angina 273
Chapter 31 Secondary Prevention of Coronary Heart
Disease after a Recent Acute Coronary
Syndrome 296
Chapter 32 Approach to the Patient with Chronic
Congestive Heart Failure 310
Appendix 32-1: Managing Disorders of
Serum Potassium in Congestive Heart
Failure 332
Chapter 33 Management of Valvular Heart
Disease 334
Appendix 33-1: Approach to
Hypertrophic Cardiomyopathy and Patent
Foramen Ovale 347
Chapter 34 Management of Peripheral Artery
Disease (P AD) 3 5 0
Chapter 35 Management of Peripheral Venous
Disease 3 5 7
Chapter 36 Noninvasive Studies for Coronary Heart
Disease 370
Appendix 36-1: Perioperative Medical
Evaluation 382
SECTION IV
Respiratory Problems
Chapter 37 Screening for Lung Cancer 395
Chapter 38 Tuberculosis Screening and
Prophylaxis 399
Chapter 39 Evaluation and Prevention of
Occupational and Environmental Lung
Disease 404
Chapter 40 Evaluation of Chronic Dyspnea 410
Chapter 41 Evaluation of Subacute and Chronic
Cough 415
Chapter 42 Evaluation of Hemoptysis 422
Chapter 43 Evaluation of Pleural Effusions 425
Chapter 44 Evaluation of the Solitary Pulmonary
Nodule 431
Appendix 44-1: Evaluation of Multiple
Incidental Pulmonary Nodules 436
Chapter 45 Evaluation of Clubbing 436
Chapter 46 Approach to the Patient with Obstructive
Sleep Apnea 439
Chapter 47 Management of Chronic Obstructive
Pulmonary Disease 44 7
Chapter 48 Management of Asthma 468
Chapter 49 Approach to the Patient with
Tuberculosis 489
Appendix 49-1: Approach to the Patient
With Nontuberculous Mycobacterial Lung
Disease 496
Chapter 50 Approach to Acute Uncomplicated
Respiratory Tract Infection 497
Chapter 51 Management of Sarcoidosis 504
Appendix 55-1: Evaluation of Interstitial
Lung Disease 508
Chapter 52 Outpatient Approach to Acute
Lower Respiratory Tract Infection—
Acute Bronchitis and Pneumonia 514
Chapter 53 Approach to the Patient with Lung
Cancer 5 2 9
Chapter 54 Smoking Cessation 537
Appendix 54-1: Pulmonary Consequences
of Other Forms of Smoking 545
SECTION V
Gastrointestinal Problems
Chapter 55 Screening and Case Finding for
Gastrointestinal Cancers 5 4 7
Chapter 56 Screening for Colorectal Cancer 550
Appendix 56-1: Examination of the
Anorectum and Sigmoid Colon with
Digital Rectal Examination, Anoscopy,
and Sigmoidoscopy 556Chapter 57 Screening for and Prevention of Viral
Hepatitis 5 60
Chapter 58 Evaluation of Abdominal Pain 570
Appendix 58-1: Management of the
Abdominal Aortic Aneurysm 581
Chapter 59 Evaluation of Nausea and Vomiting 582
Chapter 60 Evaluation of Dysphagia and Suspected
Esophageal Chest Pain 588
Chapter 61 Approach to the Patient with Heartburn
and Reflux (Gastroesophageal Reflux
Disease) 593
Chapter 62 Evaluation of Jaundice 600
Appendix 62-1: Evaluation of the
Asymptomatic Patient with an Incidental
Elevation in a Liver Function Test 603
Chapter 63 Evaluation of Gastrointestinal
Bleeding 607
Chapter 64 Evaluation and Management of
Diarrhea 612
Chapter 65 Approach to the Patient with
Constipation 626
Chapter 66 Approach to the Patient with Anorectal
Complaints 632
Chapter 67 Approach to the Patient with an External
Hernia 640
Chapter 68 Management of Peptic Ulcer
Disease 643
Chapter 69 Management of Asymptomatic and
Symptomatic Gallstones 655
Chapter 70 Management of Hepatitis 661
Appendix 70-1: Recommended Direct-
Acting Antiviral (DAA ) Programs for
Hepatitis C Virus Infection 680
Chapter 71 Management of Cirrhosis and Chronic
Liver Failure 682
Chapter 72 Management of Pancreatitis 691
Chapter 73 Management of Inflammatory Bowel
Disease 695
Chapter 75 Management of Diverticular Disease 716
Chapter 76 Management of Gastrointestinal
Cancers 7 2 0
SECTION VI
Hematologic and Oncologic
Problems
Chapter 77 Screening for Anemia 739
Chapter 78 Screening for Sickle Cell Disease and
Sickle Cell Trait 741
Chapter 79 Evaluation of Anemia 743
Chapter 80 Evaluation of Erythrocytosis
(P olycy themia) 7 5 4
Appendix 80-1: Other Myeloproliferative
Disorders—Primary Myelofibrosis 758
Chapter 81 Evaluation of Bleeding Problems and
Abnormal Bleeding Studies 759
Chapter 82 Management of Common Anemias 771
Appendix 82-1: Management of
Asplenia 778
Chapter 83 Outpatient Oral Anticoagulant
Therapy 780
Chapter 84 Approach to the Patient with
Lymphoma 790
Chapter 85 Approach to the Patient with Metastatic
Cancer of Unknown Primary Origin 801
Chapter 86 Approach to Staging and Monitoring 807
Chapter 87 Comprehensive Care of the Cancer
Patient 810
Appendix 87-1: Cancer Prevention 816
Chapter 88 Principles of Cancer Drug Therapy 818
Chapter 89 Principles of Radiation Therapy 829
Chapter 90 Assessment and Relief of Chronic Cancer
Pain and Palliative Care 834
Chapter 91 Managing the Gastrointestinal Complications
of Cancer and Cancer T reatment 848
Chapter 92 Complications of Cancer: Oncologic SECTION VII
Endocrinologic Problems
Chapter 93 Screening for Type 2 Diabetes Mellitus 861
Appendix 93-1: Screening for Gestational
and Type 1 Diabetes 868
Chapter 94 Screening for Thyroid Cancer 870
Chapter 95 Evaluation of Thyroid Nodules 872
Chapter 96 Approach to the Patient with
Hypercalcemia 8 7 9
Chapter 97 Evaluation of Hypoglycemia 885
Chapter 98 Evaluation of Hirsutism 890
Appendix 98-1: Approach to an
Incidentally Encountered Adrenal
Mass 895
Chapter 99 Evaluation of Gynecomastia 897
Chapter 100 Evaluation of Galactorrhea and
Hyperprolactinemia 90 1
Chapter 101 Evaluation of Suspected Diabetes
Insipidus 905
Chapter 102 Approach to the Patient with Diabetes
Mellitus 908
Chapter 103 Approach to the Patient with
Hyperthyroidism 940
Chapter 104 Approach to the Patient with
Hypothyroidism 949
Chapter 105 Glucocorticoid Therapy 959
SECTION VIII
Gynecologic Problems
Chapter 106 Screening for Breast Cancer 967
Chapter 107 Screening for Cervical Cancer 975
Chapter 108 Screening for Ovarian Cancer 981
Chapter 109 Screening for Endometrial Cancer 984
Chapter 110 Screening for and Prevention of Intimate
Partner Violence 987
Appendix 110-1: Screening for Firearm
Chapter 111 Approach to the Woman with Abnormal
Vaginal Bleeding 991
Chapter 112 Evaluation and Symptomatic
Management of Secondary
Amenorrhea 998
Chapter 113 Evaluation of Breast Masses and Nipple
Discharges 1005
Chapter 114 Evaluation of Vulvar Pruritus 1009
Chapter 115 Medical Evaluation of Female Sexual
Dysfunction 1 0 1 3
Chapter 116 Approach to the Patient with Pelvic
Pain 1017
Appendix 116-1: Premenstrual
Syndrome/Premenstrual Dysphoric
Disorder 1022
Chapter 117 Approach to the Patient with an
Abnormal Vaginal Discharge 1024
Chapter 118 Approach to the Menopausal
Woman 1030
Appendix 118-1: Evaluation of
Flushing 1038
Chapter 119 Approach to Fertility Control 1039
Chapter 120 Approach to the Infertile Couple 1049
Chapter 121 Approach to the Woman with an
Unplanned Pregnancy 1057
Chapter 122 Management of Breast Cancer 1063
Chapter 123 Management of the Woman with Genital
Tract Cancer 1076
SECTION IX
Genitourinary Problems
Chapter 124 Screening for Syphilis 1083
Chapter 125 Screening for Chlamydia and Gonorrhea
Infection 1086
Chapter 126 Screening for Prostate Cancer 1090
Chapter 127 Screening for Asymptomatic Bacteriuria
and Urinary Tract Infection 1095Chapter 129 Evaluation of the Patient with
Hematuria 1101
Chapter 130 Evaluation of the Patient with
Proteinuria 1 1 0 7
Chapter 131 Evaluation of Scrotal Pain, Masses, and
Swelling 1113
Chapter 132 Medical Evaluation and Management of
Erectile Dysfunction 1116
Chapter 133 Approach to Dysuria and Urinary Tract
Infections in Women 1130
Apendix 133-1: Evaluation of Sterile
Pyuria 1140
Chapter 134 Approach to Urinary Incontinence 1141
Chapter 135 Approach to the Patient with
Nephrolithiasis 1150
Chapter 136 Approach to the Male Patient with
Urethritis 1157
Chapter 137 Approach to the Patient with
Gonorrhea 1161
Chapter 138 Approach to Benign Prostatic
Hyperplasia 1 1 65
Chapter 139 Management of Acute and Chronic
Prostatitis 1 1 7 0
Appendix 139-1: Urine and Prostatic
Fluid Collections in Men 1175
Chapter 140 Management of Urinary Tract Infection in
Men 1176
Chapter 141 Management of Syphilis and Other
Sexually Transmitted Diseases 1181
Chapter 142 Management of the Patient with Chronic
Kidney Disease 1185
Chapter 143 Management of Genitourinary
Cancers 1195
SECTION X
Musculoskeletal Problems
Chapter 144 Screening for Osteoporosis in
Postmenopausal Women 1213
Appendix 144-1: Screening for
Osteoporosis in Men 1216
Chapter 145 Evaluation of Acute Monoarticular
Arthritis 1217
Chapter 146 Evaluation of Polyarticular
Complaints 1221
Chapter 147 Approach to the Patient with Back
Pain 1233
Chapter 148 Evaluation of Neck Pain 1251
Chapter 149 Approach to the Patient with Muscle
Soreness or Cramps 1255
Chapter 150 Approach to the Patient with Shoulder
Pain 1259
Chapter 151 Evaluation of Hip Pain 1266
Chapter 152 Evaluation of Knee Pain 1271
Chapter 153 Approach to Minor Orthopedic
Problems of the Elbow, Wrist, and
Hand 1278
Chapter 154 Approach to Common Problems
of the Foot and Ankle 1283
Chapter 155 Approach to the Patient with
Asymptomatic Hyperuricemia 1 2 89
Chapter 156 Management of Rheumatoid
Arthritis 1293
Chapter 157 Management of Osteoarthritis 1313
Chapter 158 Management of Gout 1325
Chapter 159 Approach to the Patient with
Fibromyalgia 1334
Chapter 160 Approach to the Patient with Lyme
Disease 1 3 43
Chapter 161 Approach to the Patient with
Polymyalgia Rheumatica or Giant-Cell
(Temporal) Arteritis 1353
Chapter 162 Management of Paget Disease 1360
Chapter 163 Approach to the Patient with Raynaud
Phenomenon 1364
Chapter 164 Prevention and Management of
Osteoporosis 1 3 69
Appendix 164-1: Management of
Osteoporosis in Men 1384SECTION XI
Neurologic Problems
Chapter 165 Approach to the Patient with
Headache 1387
Chapter 166 Evaluation of Dizziness 1397
Chapter 167 Focal Neurologic Complaints: Evaluation
of Nerve Root and Peripheral Nerve
Syndromes 1405
Chapter 168 Evaluation of Tremor 1413
Chapter 169 Evaluation of Dementia 1416
Chapter 170 Approach to the Patient with
a Seizure 1427
Chapter 171 Management of Transient Ischemic
Attack and Asymptomatic Carotid
Bruit 1436
Chapter 172 Management of Multiple
Sclerosis 1446
Chapter 173 Management of Alzheimer
Disease 1453
Chapter 174 Approach to the Patient with Parkinson
Disease 1466
Chapter 175 Approach to the Patient with
Bell Palsy (Idiopathic Facial
Mononeuropathy) 1474
Chapter 176 Management of Tic Douloureux
(T rigeminal Neuralg ia) 1 4 7 7
SECTION XII
Dermatologic Problems
Chapter 177 Screening for Skin Cancers 1481
Chapter 178 Evaluation of Pruritus 1488
Chapter 179 Evaluation of Purpura 1494
Chapter 180 Evaluation of Disturbances in
Pigmentation 1 49 7
Chapter 181 Evaluation of Urticaria and
Angioedema 1502
Chapter 182 Approach to the Patient with Hair
Loss 1507
Chapter 183 Disturbances of Skin Hydration:
Dry Skin and Excessive Sweating 1513
Chapter 184 Approach to the Patient with
Dermatitis 1517
Chapter 185 Management of Acne Vulgaris 1524
Chapter 186 Management of Rosacea and Other
Acneiform Dermatoses 1 5 2 8
Chapter 187 Management of Psoriasis 1531
Chapter 188 Management of Intertrigo and
Inter trig inous Dermatoses 1 5 3 7
Chapter 189 Management of Corns and
Calluses 1540
Chapter 190 Approach to Bacterial Skin
Infections 1542
Chapter 191 Management of Superficial Fungal
Infections 1 5 49
Chapter 192 Management of Cutaneous
and Genital Herpes Simplex 1555
Chapter 193 Management of Herpes
Zoster 1562
Chapter 194 Management of Warts 1567
Chapter 195 Management of Scabies and
Pediculosis 1571
Chapter 196 Management of Skin Trauma: Bites
and Burns 1574
Chapter 197 Management of Skin
Ulceration 1581
Appendix 197-1: Minor Surgical Office
Procedures for Skin Problems 1585
SECTION XIII
Ophthalmologic Problems
Chapter 198 Screening for Open-Angle
Glaucoma 1589
Chapter 199 Evaluation of the Red Eye 1591
Chapter 200 Evaluation of Impaired Vision 1597
Chapter 201 Evaluation of Eye Pain 1601Chapter 202 Evaluation of Dry Eyes 1604
Chapter 203 Evaluation of Common Visual
Disturbances: Flashing Lights,
Floaters, and Other Transient
Phenomena 1606
Chapter 204 Evaluation of Exophthalmos 1608
Chapter 205 Evaluation of Watery Eyes 1610
Chapter 206 Management of the Patient
with Age-Related Macular
Degeneration 1612
Chapter 207 Management of Glaucoma 1615
Chapter 208 Management of Cataracts 1619
Chapter 209 Management of Diabetic
Retinopathy 1623
Chapter 210 Correction of Vision 1626
SECTION XIV
Ear, Nose, and Throat Problems
Chapter 211 Screening for Oral Cancer 1631
Chapter 212 Evaluation of Hearing Loss 1634
Appendix 212-1: Audiometry 1639
Chapter 213 Approach to Epistaxis 1640
Chapter 214 Evaluation of Acute Facial Pain and
Swelling 1643
Chapter 215 Evaluation of Smell and Taste
Disturbances 1647
Appendix 215-1: Halitosis 1650
Chapter 216 Approach to the Patient with
Hoarseness 1651
Chapter 217 Evaluation of Tinnitus 1655
Chapter 218 Approach to the Patient with Otitis 1657
Chapter 219 Approach to the Patient with
Sinusitis 1660
Chapter 220 Approach to the Patient with
Pharyngitis 1667
Chapter 221 Approach to the Patient with Hiccups
Chapter 222 Approach to the Patient with Chronic
Nasal Congestion and Discharge 1676
Chapter 223 Approach to the Patient with Excessive
Snoring 1684
Chapter 224 Approach to the Patient with Aphthous
Stomatitis 1685
Chapter 225 Evaluation and Management of
T emporomandibular Disorders 1 688
SECTION XV
Psychiatric and Behavioral Problems
Chapter 226 Approach to the Patient with
Anxiety 1693
Appendix 226-1: Strategies for Stress
Management 1704
Chapter 227 Approach to the Patient with
Depression 1 7 0 7
Chapter 228 Approach to the Patient with an Alcohol
Use Disorder 1727
Chapter 229 Approach to the Patient with Sexual
Dysfunction 1 7 42
Chapter 230 Approach to the Patient with Somatic
Symptom Disorder 1751
Chapter 231 Approach to Difficult Patient
Interactions 1 7 5 7
Chapter 232 Approach to the Patient with
Insomnia 1760
Appendix 232-1: Restless Legs
Syndrome 1768
Chapter 233 Approach to Eating Disorders 1771
Appendix 233-1: Night-Eating
Syndrome 1780
Chapter 234 Approach to Drug Use Disorders 1782
Appendix 234-1: Treating Opioid
Use Disorder in the Primary Care
Setting 1793
Chapter 235 Management of Obesity 1797
Appendix 235-1: Treating Obesity as
a Chronic Disease—Using the Chronic SECTION XVI
Multidisciplinary and Allied Fields
Chapter 236 Pain Management: Approach to the
Patient with Chronic Nonmalignant
Pain 1815
Chapter 237 Herbal Supplements Commonly Used
as Complementary or Alternative
Therapy 1827
Appendix 237-1: Organic Foods 1833
Chapter 238 Caring for the Adolescent Patient 1834
Chapter 239 Primary Care Geriatrics— Optimizing
Cognitive and Physical Function
in Older Adults and Caring for the
V ulnerable 1 845
Appendix 239-1: Use of Antipsychotic
Drugs and Other Psychopharmacologic
Agents in the Elderly 1849
Index 1853