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دانلود کتاب Ferri's Clinical Advisor 2021: 5 Books in 1
دانلود کتاب مشاور بالینی Ferri's 2021: 5 کتاب در 1
مشخصات کتاب
Ferri's Clinical Advisor 2021: 5 Books in 1
دسته بندی: بیماری ها: طب داخلی ویرایش: 1 نویسندگان: Fred Ferri سری: ISBN (شابک) : 9780323713337, 9780323758871 ناشر: Elsevier سال نشر: 2021 تعداد صفحات: 4065 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 520 مگابایت
قیمت کتاب (تومان) : 42,000
در صورت تبدیل فایل کتاب Ferri's Clinical Advisor 2021: 5 Books in 1 به فرمت های PDF، EPUB، AZW3، MOBI و یا DJVU می توانید به پشتیبان اطلاع دهید تا فایل مورد نظر را تبدیل نمایند.
توجه داشته باشید کتاب مشاور بالینی Ferri's 2021: 5 کتاب در 1 نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب مشاور بالینی Ferri's 2021: 5 کتاب در 1
پاسخ های سریع را برای اطلاع از تصمیمات تشخیصی و درمانی روزانه خود بیابید! مشاور بالینی Ferri’s 2021 از قالب محبوب «5 کتاب در 1» استفاده می‌کند تا حجم وسیعی از اطلاعات را به شیوه‌ای کاربرپسند و مرتبط بالینی ارائه دهد. این مرجع پرفروش به طور قابل توجهی به روز شده است تا به شما دسترسی آسانی به پاسخ‌ها در مورد 1000 بیماری رایج پزشکی، از جمله بیماری‌ها و اختلالات، تشخیص‌های افتراقی، الگوریتم‌های بالینی، آزمایش‌های آزمایشگاهی، و دستورالعمل‌های عمل بالینی - که همه توسط متخصصان در زمینه‌های کلیدی بالینی به دقت بررسی شده‌اند، فراهم کند. الگوریتم‌های گسترده، همراه با صدها شکل و جدول جدید، تضمین می‌کنند که شما با روش‌های پزشکی امروزی آشنا می‌شوید. شامل به روز رسانی های مهم در سراسر، پوشش تمام جنبه های تشخیص و درمان فعلی است. دارای 27 موضوع کاملاً جدید از جمله رینوسینوزیت مزمن، انفارکتوس تحت بالینی مغز، سندرم رفلاکس سرفه، پنومونیت تشعشع، کاتاتونی، بیماری کلیوی مرحله نهایی، و سندرم تناسلی ادراری یائسگی، و غیره. شامل ضمائم جدید که گیاهان رایج را در پزشکی و فعالیت های گیاهی یکپارچه در برابر درد و بیماری های مزمن پوشش می دهد. مراقبت تسکینی؛ و ارزیابی قبل از عمل دسترسی آنلاین به راهنمای آموزشی بیمار را به دو زبان انگلیسی و اسپانیایی ارائه می دهد. نسخه کتاب الکترونیکی پیشرفته همراه با خرید. کتاب الکترونیکی پیشرفته شما به شما امکان می دهد به تمام متن ها، شکل ها و مراجع کتاب در دستگاه های مختلف دسترسی داشته باشید.
توضیحاتی درمورد کتاب به خارجی
Find fast answers to inform your daily diagnosis and treatment decisions! Ferri’s Clinical Advisor 2021 uses the popular "5 books in 1" format to deliver vast amounts of information in a clinically relevant, user-friendly manner. This bestselling reference has been significantly updated to provide you with easy access to answers on 1,000 common medical conditions, including diseases and disorders, differential diagnoses, clinical algorithms, laboratory tests, and clinical practice guidelines—all carefully reviewed by experts in key clinical fields. Extensive algorithms, along with hundreds of new figures and tables, ensure that you stay current with today's medical practice. Contains significant updates throughout, covering all aspects of current diagnosis and treatment. Features 27 all-new topics including chronic rhinosinusitis, subclinical brain infarction, reflux-cough syndrome, radiation pneumonitis, catatonia, end-stage renal disease, and genitourinary syndrome of menopause, among others. Includes new appendices covering common herbs in integrated medicine and herbal activities against pain and chronic diseases; palliative care; and preoperative evaluation. Offers online access to Patient Teaching Guides in both English and Spanish. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
فهرست مطالب
CLINICAL DISORDERS Ferri’s CLINICAL ADVISOR 2021 Copyright Section Editors Contributors Dedication Preface Ferri’s Clinical Advisor 2021—How to Use This Book Abdominal Aortic Aneurysm Suggested Readings Abdominal Compartment Syndrome ?Treatment Suggested Readings Abnormal Uterine Bleeding Suggested Reading Abruptio Placentae Incidence (In U.S.): 9.6 per 1000 births; 80% occur before the onset of labor Risk Factors: Hypertension (greatest association), trauma, polyhydramnios, multifetal gestation, smoking, use of cocaine, chorio... Recurrence Rate: 5% to 17%, some studies showing a 5- to 10-fold increase in risk; with two prior episodes, 25% Absence Seizures Incidence: 1 to 10 cases per 100,000 population Peak Incidence: 6 to 7 yr Prevalence: Represents up to 18% of all pediatric epilepsy syndromes Predominant Sex and Age: More common in girls than in boys, absences typically begin between 4 and 8 yr ?Treatment ?Pearls & Considerations Suggested Reading Suggested Reading Acetaminophen Poisoning Achalasia ?Pearls & Considerations Suggested Readings Achilles Tendon Rupture Incidence: In the general population, Achilles tendon ruptures occur in 18 per 100,000 individuals per year and are the most com... Peak Incidence: 30- to 40-year-old males Predominant Age: 30- to 55-years-old Risk Factors: General risk factors include recreational athletes, stop-and-go sports (e.g., basketball, tennis, and soccer), pre... ?Treatment Suggested Readings Acne Vulgaris Suggested Readings Acoustic Neuroma Suggested Readings Acquired Immunodeficiency Syndrome Incidence (In U.S.) Prevalence (In U.S.): The cumulative number of AIDS diagnoses in the U.S. exceeds 1.2 million Predominant Sex: Men constitute approximately 75% of incident AIDS diagnoses in the U.S.; more than half of AIDS diagnoses occur... Predominant Age: The predominant age group diagnosed with AIDS is 25 to 59 yr of age Peak Incidence: Ages 25 to 59 yr Genetics ?Treatment Acromegaly Incidence: 3 to 4 new cases per 1 million persons annually Prevalence: 50 to 60 cases per 1 million persons, with some estimates as high as 90 cases per 1 million persons Predominant Sex: No sexual predominance Mean Age at Diagnosis: Men: 40 yr; women: 45 yr Risk Factors Actinic Keratosis Incidence: In regions of the northern hemisphere, 11% to 25% of adults have a minimum of one AK. In regions closer to the equato... Peak Incidence: The risk of squamous cell carcinoma in patients with AK is 6% to 10%. Risk factors associated with increased ris... Prevalence Predominant Sex and Age: Males > females, age 65 to 74. Occurs most in those with fair complexions who burn rather than tan foll... Genetics: There is increased frequency of nonmelanoma skin cancers connected to squamous cell cancers with the genetic condition... Risk Factors ?Pearls & Considerations Suggested Reading Actinomycosis Geographic Distribution Suggested Reading ?Diagnosis Acute Bronchitis ?Pearls & Considerations Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) Incidence: Unknown Prevalence: Unknown Predominant Sex and Age: Although recent data is lacking, data from a retrospective study in 1986 suggested a male predominance ... Peak Incidence: Unknown Risk Factors: Elderly patients seem to be at greatest risk. Other risk factors include significant underlying medical illness, s... Genetics: None ?Treatment ?Pearls & Considerations Suggested Readings Acute Coronary Syndrome ?Basic Information Incidence: In the U.S., cardiovascular disease accounts for approximately 841,000 deaths each yr. The estimated annual incidence... Predominant Sex and Age: In evaluating chest pain, male gender and older age are important clinical factors that can identify AC... Risk Factors: Hypertension, diabetes mellitus, dyslipidemia, tobacco use, and family history of premature CAD (CAD in a male fir... Laboratory Tests ?Treatment ?Pearls & Considerations Suggested Readings Acute Glomerulonephritis Related Content Suggested Readings Acute Kidney Injury ?Diagnosis ?Treatment Suggested Readings Acute Liver Failure Incidence: Affects approximately 2000 people/yr in U.S. and 1-8 people per million population in the U.K Predominant Sex and Age: Seen more often in women (90% of cases), average age 38 yr Risk Factors Related Content Suggested Readings Acute Lower Gastrointestinal Bleeding Incidence Peak Incidence: The rate of lower GI bleeding, including that necessitating hospitalization, is higher in the elderly Predominant Sex and Age: 24.2/100,000 in males versus 17.2/100,000 in females. This increases 200-fold by the ninth decade of li... Risk Factors: Risk factors include NSAID use, aspirin use, alcohol abuse, GI malignancy, atrial fibrillation, coagulopathies, pr... ?Treatment Suggested Readings Acute Lymphoblastic Leukemia Suggested Readings Acute Mesenteric Ischemia Incidence Predominant Sex and Age Genetics: No specific genetic predisposition but may be related to underlying factors such as cardiac disease, atherosclerosis, ... Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Acute Myeloid Leukemia Suggested Readings Acute Pelvic Pain in Women Peak Incidence: Women of reproductive age report the greatest amount of acute pelvic pain Prevalence: Acute pelvic pain is a very broad term with multiple etiologies, thus not lending itself to a single calculable prev... Predominant Sex and Age: Women of reproductive age report the greatest amount of acute pelvic pain Gynecologic Causes Early Pregnancy/Postpartum-Related Causes Nonobstetric or Gynecologic Causes Suggested Readings Acute Respiratory Distress Syndrome Related Content Suggested Readings Acute Respiratory Failure (ARF) ?Diagnosis ?Treatment Acute Stress Disorder Prevalence: The prevalence of ASD varies according to the nature of the traumatic event. Prevalence is estimated at less than 20... Predominant Age: ASD can be diagnosed at all ages. Children tend to manifest symptoms differently (e.g., frightening dreams that... Predominant Sex: ASD occurs more frequently in females compared with males. Rate of incidence in individuals who do not identify... Genetics: Differential function of the serotonin transporter may mediate differential responses to trauma. The 5-HTTLPR may cons... Risk Factors: Greater perceived severity of the trauma (i.e., catastrophic interpretations of the event, exaggerated appraisals ... ?TREATMENT ?PEARLS & CONSIDERATIONS SUGGESTED READINGS Acute Tubular Necrosis ?Pearls & Considerations Acute Urinary Retention (AUR) Incidence Prevalence: Estimates are 40/100,000 in males and 3/100,000 in females. Prevalence has increased as average lifespan has increas... Genetics: None known Suggested Readings Adhesive Capsulitis (Frozen Shoulder) INCIDENCE ?Pearls & Considerations Suggested Readings Adnexal Masses Prevalence: Because the etiology of adnexal masses is so broad and ranges from benign to malignant and can be gynecologic or non... Predominant Sex and Age: Adnexal masses can be found in females of all ages ranging from childhood to the reproductive years to ... Risk Factors: It is important to consider risk factors for malignancy. While age is the most important independent risk factor f... ?Treatment Suggested Readings Adrenal Incidentaloma Prevalence: Adrenal incidentalomas are found in about 5% of the population (4% to 7% on advanced imaging, up to 10% on autopsy) Predominant Sex and Age: Prevalence increases with age Genetics: Vary based on etiology of the incidentaloma Risk Factors: More common in Caucasian, obese, diabetic, and hypertensive patients ?Pearls & Considerations Related Topics Suggested Readings Adrenal Insufficiency Prevalence: 10 to 15 per 100,000 persons ?Treatment Suggested Readings Adult-Onset Still Disease Genetics: Studies suggest a genetic component. Various HLA antigens have been linked to both susceptibility (class II types DRB1... ?Diagnosis Suggested Readings Akathisia Incidence: Varies widely from 21% to 75%. Occurrence higher with first generation, or typical, antipsychotics, particularly high... Prevalence: Varies from 20% to 35%. Reported prevalence rates vary between 5% and 36.8% Predominant Sex and Age: Akathisia occurs predominantly in younger patients. Incidence appears to decrease with age Risk Factors: Younger age when treated with antipsychotic medications, Parkinson disease, traumatic brain injury (TBI), encephal... Genetics: Generally, akathisia is not considered a highly heritable condition, but a genetic predisposition to or family history... ?Treatment Suggested Readings Alcohol Use Disorder Incidence (In U.S.) Prevalence (In U.S.): 7% of population ≥18 yr Predominant Sex Peak Incidence: 20 to 40 yr. The most common age range for initial treatment of alcohol dependence is 35 to 45 yr. However, the ... Genetics: More common with a family history of alcoholism and in patients of Irish, Scandinavian, and Native American descent ?Pearls & Considerations Suggested Readings Alcoholic Hepatitis Prevalence: Approximately 25% to 30% Predominant Sex and Age: The majority of patients are males. Males are two times as likely as women to abuse alcohol. However, w... Genetics: No genetic predilection for any one race. In the U.S., however, there is increased incidence in minority groups Risk Factors: Drinking multiple alcohol types, drinking alcohol between meal times, poor nutrition, female gender, obesity, Hisp... ?Treatment ?Pearls & Considerations Suggested Readings Aldosteronism (Hyperaldosteronism, Primary) Prevalence: 5% to 13% of patients with hypertension; 11% to 23% of patients with resistant hypertension ?Treatment Suggested Readings Allergic Rhinitis Suggested Readings Alopecia Incidence: Depends on etiology, for example Genetics: Depends on etiology, for example Nonscarring Scarring History: A careful history must be taken and should include time course for hair loss, the pattern of hair loss, any recent chan... Physical Examination Nonscarring Scarring ?Treatment Alpha-1-Antitrypsin Deficiency Suggested Readings Alzheimer Disease Incidence: Risk doubles every 5 yrs after the age of 65; above the age of 85, the annual incidence is about 10% Prevalence: Currently an estimated 5.4 million Americans have AD; 3% of the population between the ages of 65 and 74, 17% betwee... Predominant Sex: Female greater than male ?Diagnosis History & General Physical Examination Mental Status Testing: Brief mental status testing can be done easily and quickly in the office. Commonly used cognitive tests t... Suggested Readings Amaurosis Fugax Incidence (In U.S.): An uncommon but important presentation of carotid artery disease Amblyopia Incidence (In U.S.): 1% to 5% of the general population. Amblyopia is the leading cause of vision loss in children. It is also t... Prevalence (In U.S.): High incidence in premature infants with drug-dependent mothers and in neurologically impaired children. C... Predominant Sex: None Predominant Age: Childhood Peak Incidence: Childhood ?Treatment ?Pearls & Considerations Suggested Reading Amebiasis Incidence (In U.S.): 1.2 cases per 100,000 U.S. population. Highest in institutionalized patients, travelers to/immigrants from ... Prevalence: In U.S.: 4% (80% of infections asymptomatic). In the developing world: Still accounts for 9% of all deaths in childr... Predominant Sex Predominant Age: Second through sixth decades Peak Incidence: Peaks at age 2 to 3 yr and >40 yr ?Pearls & Considerations Suggested Readings Amenorrhea ?Diagnosis ?Treatment Suggested Readings Amyloidosis Incidence (In U.S.): Between 1500 and 3500 new cases are diagnosed annually. The most common type is AL Suggested Readings Amyotrophic Lateral Sclerosis Incidence Suggested Readings Anaerobic Infections Suggested Readings Anal Fissure ?Pearls & Considerations Anaphylaxis ?Pearls & Considerations Suggested Readings Anemia, Aplastic Incidence: The annual incidence of aplastic anemia is 2 cases per million in the Western population and 2 to 3 times higher in A... Suggested Readings Anemia, Autoimmune Hemolytic ?Basic Information ?Pearls & Considerations Suggested Readings Anemia, Inflammatory ?Diagnosis ?Treatment Author: Bharti Rathore, MD Suggested Readings Anemia, Iron Deficiency ?Treatment ?Pearls & Considerations Anemia, Pernicious ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Anemia, Sideroblastic ?Diagnosis ?Treatment Suggested Reading Angina Pectoris ?Pearls & Considerations Suggested Readings Angioedema Incidence: 100 to 3000/100,000 persons (for urticaria and angioedema) Lifetime Prevalence: Approximately 20% of the population experiences urticaria and/or angioedema at some time during life. The p... Demographics ?Diagnosis Suggested Readings Angular Cheilitis Incidence: Unknown Peak Incidence: Advanced age Prevalence: Suspected of causing 0.5% to 5% of lip infections in adults Predominant Sex and Age: This form of lip inflammation has a predilection for the elderly, seen with denture use as an example Genetics: No identified correlation Risk Factors: These include dry mouth, nutritional deficiencies (B vitamins, iron), immunosuppression, or chronic irritation as ... ?Treatment Ankle Fracture ?Diagnosis ?Treatment Suggested Readings Ankle Sprain Prevalence: One case/10,000 people each day Suggested Readings Ankylosing Spondylitis Prevalence: Between 0.1% and 1% of the population. Varies with prevalence of HLA-B27 and ethnicity. Much higher in those with po... Predominant Age at Onset: 15 to 35 yr, usually symptoms present before age 45 Predominant Sex: Male:female ratio 2 to 3:1 Suggested Readings Anorectal Fistula ?Pearls & Considerations Suggested Reading Anorectal Stricture Incidence: 5% to 10% of post-radical hemorrhoidectomy surgeries Authors: W. Peyton Adkins, MD, and Craig Blakeney, MD Suggested Readings Anorexia Nervosa Incidence/Prevalence (In U.S.) Predominant Sex: Female:male ratio is 9:1. Approximately 0.5% to 1% of women between the ages of 15 and 30 yr have anorexia nerv... Predominant Age: Adolescence to young adulthood is the predominant age. Mean age of onset is 17 yr. Approximately 0.5% to 1% of ... Suggested Reading Anorexia-Cachexia Syndrome Associated with Malignancy Incidence: Estimates of the prevalence of cancer cachexia vary widely due to variable diagnostic criteria used in prior studies.... ?Treatment Anoxic Brain Injury Incidence Prevalence Risk Factors: Same as risk factors for cardiorespiratory arrest: age, race, hypertension, hyperlipidemia, tobacco use, drug or a... Varies per extent of insult from death to long-term care facility to acute rehabilitation to return to home Referral to a neurologist is appropriate for help with prognostication ?Pearls & Considerations Suggested Readings Anthrax ?Pearls & Considerations Suggested Reading Antibody-Mediated Autoimmune Encephalitis Incidence: It is difficult to estimate incidence as testing for encephalitis is relatively new. The most common form is anti-N-m... Peak Incidence: It is difficult to estimate incidence because testing for these diseases is relatively new. The estimated annual... Prevalence: It is difficult to estimate prevalence as testing for disease is relatively new Predominant Age and Sex: Anti-NMDAR predominantly affects young women, with a median age at presentation of 21 to 23 yr Genetics: There are no known genetic risk factors for developing autoimmune encephalitis Risk Factors ?Pearls & Considerations Suggested Readings Antiphospholipid Antibody Syndrome Prevalence Predominant Age: Young to middle-aged adults Risk Factors Prognosis Genetics: Some APS-positive families exist, and human leukocyte antigen (HLA) studies have suggested associations with HLA DR7, ... Related Content Suggested Readings Anxiety (Generalized Anxiety Disorder) Incidence (In U.S.): 6% to 9% per yr in adult primary care clinics; 1-yr incident rate per 100 persons/yr of 1.12 Peak Incidence: Peak incidence tends to occur later relative to other anxiety disorders, such as phobias; cumulative incidence o... Prevalence (In U.S.): In general population: Lifetime morbid risk of 9%; 12-month prevalence of 2.9%; lifetime prevalence in the... Predominant Sex: Women are more frequently affected (2:1 ratio) but may present for treatment less often (3:2 female:male) Predominant Age Genetics: Concordance rates in dizygotic twins and monozygotic twins are not different (0% to 5%) Suggested Readings Aortic Coarctation Genetics: Although most cases are sporadic and no specific genetic mutations have been identified, there have been case reports ... ?Pearls & Considerations Suggested Readings Aortic Dissection Incidence: 2.6 to 3.5 per 100,000 person-yr; more frequent in winter as compared to other seasons, although no clear reason has ... Predominant Sex and Age: Males (65%) females (35%), ages 60 to 80 yr; mean = 63 yr Risk Factors (Table 2) ?Treatment Suggested Readings Aortic Regurgitation ?Treatment Related Content Suggested Readings Aortic Stenosis Medical Suggested Readings Aphthous Ulcers Incidence: Unknown Peak Incidence: Adolescence Prevalence: One in five individuals have been affected by aphthous ulcers in their lifetime Predominant Sex And Age: Most commonly affects women, adolescents, and young adults under the age of 40 Genetics: Up to 40% of patients have a family history of aphthous ulcers Risk Factors: Genetic factors, stress, trauma, tobacco, viral and bacterial infections, nutritional deficiencies, endocrine and ... ?Treatment Suggested Readings Appendicitis ?Pearls & Considerations Suggested Readings Arrhythmogenic Right Ventricular Dysplasia Prevalence: 1:2000 to 5000 persons. It is one of the leading causes of arrhythmic cardiac arrest in young people and athletes Predominant Sex and Age: Mean age, 31 yr (range, 12 to 50 yr), predominantly male Risk Factors: Family history of ARVD (present in nearly 50% of affected patients) Genetics ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Asbestosis Suggested Readings Ascariasis Incidence (In U.S.) Prevalence (In U.S.): Estimated at 4 million, the majority of which live in the rural southeastern part of the country; ascarias... Predominant Sex: Both sexes probably equally affected, with a possible slight female preponderance Predominant Age: Most common in children from ages 2 to 10 yr old and decreases after age 15; infections tend to cluster in fami... Peak Incidence: Unknown Neonatal Infection: Probable transmission, though not specifically studied ?Pearls & Considerations Suggested Readings Ascites ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Aspergillosis Incidence & Prevalence Risk Factors Allergic Aspergillosis Allergic Bronchopulmonary Asperg-illosis (ABPA) Aspergillomas (“Fungus Balls”) Invasive Aspergillosis Extrapulmonary Dissemination ABPA Aspergillomas INVASIVE ASPERGILLOSIS ABPA Aspergillomas: CXR or CT scans usually show the characteristic intracavity mass (Figs. E3 and E4) partially surrounded by a cres... ABPA Aspergillomas Invasive Aspergillosis Suggested Readings Suggested Readings Aspiration Pneumonia Incidence (In U.S.) Peak Incidence: Elderly patients in hospitals or nursing homes Prevalence (In U.S.): Unknown (unreliable data) Predominant Sex: Males and females affected equally Predominant Age: Elderly Community-acquired aspiration pneumonia Hospital-acquired aspiration pneumonia Suggested Readings Asthma ?Pearls & Considerations Suggested Readings Asthma-COPD Overlap Syndrome Prevalence Predominant Sex and Age Genetics Risk Factors ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Astrocytoma ?Diagnosis Related Content Suggested Readings Ataxia Incidence: Hereditary ataxia can affect 1 in 50,000 people in the U.S Peak Incidence: Can affect all age groups. Hereditary ataxias peak in young adulthood. Ataxia after age 65 is commonly secondary... Prevalence: 13.9 per 10,000 Predominant Sex and Age: Ataxia can affect both sexes in equal proportions Genetics: The most common type of inherited ataxia in the U.S. is Friedreich ataxia (FA), which is autosomal recessive. The seco... Risk Factors ?Treatment Ataxia Telangiectasia Incidence: 1/40,000 live births; it is estimated that 1.4% to 2% of whites in the U.S. carry one defective AT gene. It is the se... Peak Incidence: Childhood (onset at age 1 to 5 yr) Predominant Sex: Males and females are equally affected Genetics: Condition is autosomal recessive and progressive. The defective gene, designated ATM (for AT mutated), has been mapped... ?Treatment ?Pearls & Considerations Atelectasis ?Pearls & Considerations Atopic Dermatitis Major Features Suggested Readings Atrial Fibrillation ?Pearls & Considerations Suggested Readings Atrial Flutter ?Pearls & Considerations Related Content Suggested Reading Atrial Myxoma ?Treatment Atrial Septal Defect ?Diagnosis Suggested Readings Atrioventricular Dissociation ?Pearls & Considerations Attention Deficit Hyperactivity Disorder Peak Incidence: Diagnosis is usually first made in school-aged children (6 to 9 yr) Prevalence: Five percent to 10% of school-aged children (most prevalent neurodevelopmental disorder among children); up to 5% of... Predominant Sex: Among children, male predominance with ratio of 2:1 to 4:1. Among adults, ratio is closer to 1:1 (sex differenc... Predominant Age: Some symptoms must occur before age 12 yr. Symptoms (especially motoric hyperactivity) tend to diminish with ag... Genetics: Strong polygenetic component. First-degree relatives of ADHD patients have 5 times greater risk of ADHD relative to co... Risk Factors: Possible risk factors include in utero tobacco/drug exposure or hypoxia, low birth weight, prematurity, pregnancy,... Related Content Suggested Readings Autism Spectrum Disorder Incidence (In U.S.): Autism spectrum disorder afflicts up to 3% of children in the United States Prevalence: 1:68 (1:42 for boys, 1:189 for girls). It is unclear whether the increase in prevalence reflects an expansion of the... Predominant Sex and Age: Male:female ratio of 2 to 5:1. Lifelong Peak Incidence: Before age 3 yr Risk Factors: Prenatal and perinatal risk factors identified include hypoxia-related obstetric complications, use of valproic ac... Genetics Suggested Readings Autoimmune Hepatitis ?Diagnosis ?Pearls & Considerations Related Content Suggested Readings Autosomal Dominant Polycystic Kidney Disease (ADPKD) Incidence: ADPKD prevalence was reported to be between 1 in 400 and 1 in 1000 live births based on earlier studies from Denmark ... ?Diagnosis Suggested Readings AV Malformations, Cerebral Incidence Prevalence: Estimated about 1.3 per 100,000 Predominant Sex and Age Risk Factors Genetics ?Treatment ?Pearls & Considerations Suggested Readings Babesiosis Incidence (In U.S.): From 2011 to 2015 the CDC was notified of 7612 cases of babesiosis. Cases were reported in 27 states, with ... Prevalence (In U.S.) Predominant Sex: Males (most likely through increased exposure to vectors during recreational or occupational activities) Predominant Age: Severity apparently increasing with age greater than 50 yr or neonate Peak Incidence: Spring and summer months, May through September Genetics: None known Congenital Infection: Definite evidence of vertical transmission Neonatal Infection: Many cases of perinatal transmission Blood Transfusion: Many instances. Blood donation screening for antibodies to and DNA from B. microti has been shown to signific... ?Pearls & Considerations Suggested Readings Baker Cyst ?Diagnosis ?Treatment Balanitis Incidence (In U.S.): More common in uncircumcised males and in diabetic patients Prevalence (In U.S.): One study reports that 11% of adult men seen in a urology clinic and 3% of male children (mostly uncircumc... Predominant Sex: Almost exclusive to males but can affect clitoris Peak Incidence: All ages, especially in sexually active men. It occurs in one quarter of male sex partners of women infected wit... Suggested Readings Barrett Esophagus Symptoms ?Treatment Suggested Readings Bartholin Gland Cyst and Abscess ?Treatment Related Content Author: Deanna Benner, MSN, APRN Suggested Readings Bartter Syndrome Suggested Readings Basal Cell Carcinoma Prevalance INCIDENCE Risk factors: Fair skin, increased sun exposure, use of tanning salons with ultraviolet A or B radiation, history of irradiation... ?Treatment Suggested Readings Basic Calcium Phosphate Crystal Deposition Disease Prevalence: Often asymptomatic and incidentally found; therefore, prevalence is not established Predominant Sex: Females > males PrePredominant Age: Incidence increases with age (30 to 78 yr) Risk Factors: Most cases have spontaneous onset. May arise from trauma, infection, or overuse Genetics: Not understood, Caucasian predominance Associated clinical conditions: Aging, osteoarthritis, diabetes mellitus, chronic kidney disease, hyperparathyroidism, calcium p... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Bedbug Bite ?Treatment ?Pearls & Considerations Suggested Readings Behçet Disease Prevalence Predominant Sex: Equal sex distribution Genetics: No clear pattern of inheritance can be determined. Familial disease was noted in 15% of affected children Age: Peak age of onset is between 20 and 40 yr ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Bell Palsy Incidence: 20 to 30 cases per 100,000 Peak Incidence: Patients less than 70 yr old and pregnant females, especially during the third trimester and first postpartum wk... Predominant Sex and Age: Sexes are equally affected. The median age is 40 Risk Factors: Diabetes and pregnancy ?Pearls & Considerations Related Content Suggested Readings Benign Paroxysmal Positional Vertigo Incidence: Incidence increases with advancing age. Unrecognized BPPV can be found in about 10% of certain geriatric populations,... Prevalence: Lifetime prevalence is 2.4%. Reported prevalence is 10.7 and 64 cases per 100,000 population. BPPV is by far the mos... Predominant Sex and Age: Female (2:1 to 3:1 ratio); peak onset: 50 to 60 yr Genetics: Unknown Risk Factors: Head trauma, inner ear surgery, viral labyrinthitis, Ménière disease, migraine. The majority are idiopathic Dix-Hallpike Maneuver: With head turned to one side at an angle of 45 degrees, patient is moved rapidly from sitting to supine p... Head Roll Test for the Right Horizontal Semicircular Canal (Inducing Geotropic Nystagmus): Patient is moved from sitting to supi... Supine Head Roll Test for the Right Horizontal Semicircular Canal (Inducing Apogeotropic Nystagmus): Patient is moved from sitti... ?Diagnosis ?Treatment Suggested Reading Benign Prostatic Hyperplasia ?Pearls & Considerations Suggested Readings Biceps Tendonitis ?Treatment ?Pearls & Considerations Suggested Readings Bicuspid Aortic Valve Prevalence Predominant Sex & Age: Predominant in males with 2:1 male-to-female ratio Risk Factors: BAV can be sporadic (more common) and familial. No clear risk factors have been defined. However, multiple clinica... ?Treatment Related Content Suggested Readings Binge Eating Disorder (BED) Incidence: To our knowledge, no incidence studies on BED yet exist Prevalence (In U.S.): Approximately 2% lifetime prevalence in adult community samples was found (women 3.5%; men 2.0%). BED was ... Predominant Age (In U.S.): Higher prevalence rates in females (1.75:1) were found among adults Genetics Risk Factors ?Pearls & Considerations Suggested Readings Bipolar Disorder Incidence: 0.016% to 0.021% Prevalence (In U.S.): 0.4% to 1.6% (lifetime); bipolar spectrum disorders: 2.8%; approximately 25% attempt suicide, and suicide ... Predominant Sex: Equal distribution among male and female Predominant Age: Lifelong condition with age of onset 14 to 30 yr Peak Incidence: Onset in 20s Genetics Key Diagnostic Criteria Distinguishing Bipolar I Disorder from Bipolar II Disorder 1Manic episode (Bipolar I Disorder) ?Pearls & Considerations Related Content Suggested Readings Bite Wounds Related Content Suggested Reading Bites and Stings, Arachnids Suggested Readings Author: Gail M. O’Brien, MD Suggested Readings Bites and Stings, Insect Prevalence (Of Bee Stings and Insect Bites) Suggested Readings Bites, Snake Crotalinae (Pit Vipers): Local signs and symptoms Elapidae (Coral Snakes): Local signs and symptoms In the Field In the Hospital Crotalid (Rattlesnake, Copperhead, Cottonmouth) Envenomations Elapid (Coral Snake) Envenomations Nonnative or Exotic Snake Envenomations: Contact the Poison Control Center or your local zoo, as zoos with exotic snakes are re... Follow-up ?Pearls & Considerations Suggested Readings Suggested Readings Bladder Cancer Predominant Sex: It is 3 to 4 times more common in men than in women; lifetime risks are 1 in 26 for men and 1 in 88 for women Risk Factors Smoking Peak Incidence: Incidence increases with age: Higher after age 60 yr, uncommon in those younger than 40 yr Genetics: It is thought to be multifactorial in etiology, involving both genetic and environmental interactions. Overall, approx... Distribution: In North America, transitional cell carcinomas (TCC) account for 93%, squamous cell carcinomas account for 6%, and... Pathogenesis: Two pathways exist for bladder cancer (TCC) Molecular Epidemiology: TCC is usually a field change disease with tumors arising at different times and sites in the urothelium... ?Diagnosis Bladder Preservation Approaches: After cystectomy for muscle-invasive disease, 50% or more of the patients will develop metastas... Indications for Partial Cystectomy Contraindications Indications for Intravesical Chemotherapy Indications for Cystectomy Systemic Therapy Radiotherapy: Conflicting reports suggest that superficial bladder cancer is more sensitive to radiotherapy. Only 20% to 30% of ... Follow-up Recommendations for Superficial Bladder Cancer ?Pearls & Considerations Suggested Readings Bladder Pain Syndrome Incidence: 21 cases per 100,000 women and four cases per 100,000 men annually Prevalence Predominant Sex And Age ?Treatment ?Pearls & Considerations Suggested Readings Blastomycosis Incidence & Prevalence Risk Factors Pulmonary Manifestations: Symptoms and signs of chronic pneumonia: Productive cough, hemoptysis, pleuritic chest pain, weight lo... Extrapulmonary Manifestations Pulmonary Infection Cutaneous Infection ?Treatment Suggested Readings Blepharitis Suggested Readings Blepharospasm Incidence: Not applicable Peak Incidence: Not applicable Prevalence: Prevalence is between 20 and 133 cases per million depending on geographic area Predominant Sex and Age: Female preference, peak age at onset between the fifth and seventh decade Genetics: Predominantly a sporadic disorder, however 25% of patients have one or more family members affected by dystonia. No sp... Risk Factors: Risk of primary BSP increases with diseases of the anterior segment of the eye and preceding head trauma. Risk of ... Suggested Readings Body Dysmorphic Disorder ?Diagnosis Suggested Readings Bone Tumor, Primary Malignant Fibrosarcoma and Liposarcoma: They are extremely rare and similar to tumors arising in soft tissue Osteosarcoma: A rare primary malignant tumor of bone characterized by malignant tumor cells that produce osteoid or bone. Severa... Chondrosarcoma: A malignant cartilage tumor that may develop primarily or secondarily from transformation of a benign osteocarti... Ewing Sarcoma: A malignant tumor of the bone or soft tissues characterized by the presence of small, round, blue cells on immuno... Multiple Myeloma: A neoplastic proliferation of plasma cells in the bone marrow Multiple Myeloma Osteogenic Sarcoma Chondrosarcoma Ewing Sarcoma: Age at onset: 10 to 15 yr Multiple Myeloma Osteosarcoma Chondrosarcoma Ewing Sarcoma ?Treatment Borderline Personality Disorder Prevalence: Affects approximately 1% to 3% of the general population and up to 10% of psychiatric outpatients Predominant Sex: Female (3:1) historically, although recent studies indicate fewer gender disparities Predominant Age: 20s Genetics: BPD is five times as likely if disorder is present in a first-degree relative. Increased prevalence of mood disorders ... Risk Factors: Association with childhood physical, sexual, or emotional abuse and/or neglect Suggested Readings ?Pearls & Considerations Botulism ?Pearls & Considerations Suggested Readings Brain Abscess Incidence: Uncommon (reported incidence 0.4 to 0.9 cases per 100,000 population; occurs about 2% as commonly as brain tumors) Peak Incidence: Preadolescence and middle age (and depends on predisposing condition); increased rates in the immunocompromised ... Predominant Age: Occurs at any age Predominant Sex: Men affected more than women (ratio 2:1 to 3:1) ?Pearls & Considerations Related Content Suggested Readings Brain Metastases Incidence ?Treatment ?Pearls & Considerations Brain Neoplasm, Benign and Low Grade Incidence: U.S. incidence rate of a new brain tumor is approximately 6.4/100,000 persons per yr for all primary brain tumors (Ta... Peak Incidence: Depends on histology, though highest peak at ∼age 50 yr Predominant Sex and Age: Slight male predominance of malignant brain tumors (8.0 vs. 5.5/100,000 person/yr). Men account for sli... Genetics: Most primary CNS neoplasms are sporadic; 5% are associated with hereditary syndromes that predispose to neoplasia. The... Risk Factors: Exposure to ionizing radiation has been implicated in meningiomas, gliomas, and nerve sheath tumors. No convincing... ?Diagnosis ?Treatment Suggested Readings Brain Neoplasm, Glioblastoma Predominant Sex and Age: GBM is primarily diagnosed at older ages, with the median age of diagnosis at 64 yr. It is uncommon in ... Risk Factors: Many genetic and environmental factors have been studied in GBM, but no risk factor that accounts for a large prop... ?Treatment Author: Jigisha P. Thakkar, MD Brain Neoplasm, Glioblastoma Suggested Readings Breast Abscess Related Content Breast Cancer ?Pearls & Considerations Breech Birth Incidence: Gestational age dependent: 3% to 4% overall, 14% at 29 to 32 wk, 33% at 21 to 24 wk ?Pearls & Considerations Related Content Suggested Readings Bronchiectasis ?Treatment Suggested Readings Brucellosis Incidence (In U.S.): About 100 to 200 cases/yr (may be underreported) (Fig. E1), predominantly B. melitensis. The number of case... Predominant Sex: Male Predominant Age: Adult Congenital Infection: Recent evidence suggests a high rate of spontaneous abortions in untreated pregnant women during the first... Neonatal Infection: Can occur if mother is infected during pregnancy ?Pearls & Considerations Suggested Readings Brugada Syndrome Incidence: The incidence ranges from 1 to 5:10,000 people in Europe and 12:10,000 in Southeast Asia Prevalence: It comprises 4% of SCD and 20% of SCD in structurally normal hearts. Although found in every population, the prevale... Predominant Sex and Age: BRS is more common in males (58% to 80% of patients). Mean age at presentation is 40 to 45 Genetics: The disease is autosomal dominant with variable expression (Table 1) Risk Factors: First-degree relatives with sudden death or known BRS ?Diagnosis ?Pearls & Considerations Author: John Wylie, MD, FACC Suggested Readings Bruxism Budd-Chiari Syndrome Incidence: Males: 2.0/1 million persons per yr Predominant Sex Predominant Age Suggested Readings Bulimia Nervosa Incidence/Prevalence: Affects 1% to 3% of female adolescents and young adults Predominant Sex: Female:male ratio of 10:1 Predominant Age: Adolescence to young adulthood; mean age of onset 17 yr ?Pearls & Considerations Bullous Pemphigoid History ?Diagnosis ?Treatment ?Pearls & Considerations Authors: Sara Moradi Tuchayi, MD, and Kachiu C. Lee, MD, MPH Suggested Readings Bundle Branch Block Incidence: The cumulative incidence of any type of bundle branch block increases with age (1.5% at age 50, 18% at age 80) Peak Incidence: Cumulative incidence of 18% at age 80 for any type of bundle branch block Prevalence: The estimated prevalence in the general population for any type of bundle branch block ranges between 0.2% and 3.4% ... Predominant Sex and Age: More common in men, incidence increases with age Genetics: Most cases of bundle branch block are not hereditary. The Brugada syndrome is an autosomal dominant genetic disorder w... Risk Factors: Male gender, elder age, structural heart disease, cardiomyopathy, hypertension ?Treatment ?Pearls & Considerations Suggested Readings Burning Mouth Syndrome ?Pearls & Considerations Suggested Readings Burns Prevalence (In U.S.) Predominant Age & Sex: Children ages 2 to 4 yr have the greatest frequency of burns (most commonly scald burns), with male adole... Minor Burns (First-Degree Burns and Second/Third-Degree Burns of Limited TBSA) Moderate and Major Burns (Second/Third-Degree Burns of Extensive TBSA) General ?Pearls & Considerations Suggested Readings Bursitis Suggested Readings Calcium Pyrophosphate Deposition Disease (Pseudogout) Prevalence ?Treatment ?Pearls & Considerations Suggested Readings Calcium-Alkali Syndrome ?Pearls & Considerations Cancer of Unknown Primary ?Treatment Suggested Readings Candidiasis, Cutaneous Incidence: Estimated to be 50 cases per 100,000 persons Prevalence: Colonizes more than 50% of U.S. population Predominant Sex and Age Risk Factors: Risk factors that allow Candida infection include Suggested Reading Candidiasis, Invasive Incidence: Invasive candidiasis is the most common fungal disease among hospitalized patients in the developed world. It is an i... Prevalence: No data available Predominant Sex and Age: Equal between males and females; all ages are susceptible Risk Factors: Prolonged hospitalization and ICU stay, use of broad-spectrum antibiotics, prolonged indwelling of catheters (espe... ?Treatment Candidemia: General principles Disseminated Candidiasis: Fluconazole is the drug of choice Disseminated Candidiasis with End-Organ Infection Osteomyelitis or Septic Arthritis Endocarditis Myocarditis Esophagitis Pericarditis: Lipid-based amphotericin B 3 to 5 mg/kg daily Surgical Care: Includes ?Pearls & Considerations Author: Daniel K. Asiedu, MD, PhD, FACP Suggested Readings Carbon Monoxide Poisoning Suggested Readings Carcinoid Syndrome Incidence ?Diagnosis Anchor 85 ?Treatment Anchor 87 Anchor 88 Cardiac Tamponade ?Diagnosis Suggested Readings Cardiomyopathy, Chemical-Induced Predominant Sex and Age: The prevalence of ACM appears to be similar among alcoholic men and women, with women developing left v... Risk Factors Genetics Authors: Vrinda Trivedi, MBBS, and Aravind Rao Kokkirala, MD, FACC Suggested Readings Cardiomyopathy, Dilated INCIDENCE: DCM is the most common form of cardiomyopathy, comprising approximately 60% of all cases PREVALENCE: The estimated age-adjusted prevalence of DCM in the U.S. in general is approximately 36 per 100,000 or 1:2500. The i... PREDOMINANT AGE: Although DCM can occur at any age, the incidence is greatest in the third and fourth decades of life in men GENETICS: African Americans have a three-fold increased risk for developing DCM, irrespective of comorbidities or socioeconomic ... ?Diagnosis ?Pearls & Considerations Suggested Readings Cardiomyopathy, Hypertrophic ?Pearles & Considerations Suggested Readings Cardiomyopathy, Restrictive ?Diagnosis Suggested Readings Cardiorenal Syndrome ?Diagnosis Suggested Readings Carotid Artery Stenosis Incidence: 2.2 to 8/1000 persons per yr Prevalence: 11 to 77/100,000 persons; it is estimated that 5/1000 persons aged 50 to 60 yr and 100/1000 persons >80 yr have caro... Predominant Sex and Age: Male:female ratio of 2:1; more common in whites than African Americans and Asians Peak Incidence: Peak incidence is between 50 and 60 yr Genetics: Multifactorial; twin studies (monozygotic versus dizygotic) suggest a familial influence Risk Factors: Hypertension, dyslipidemia, diabetes mellitus, and smoking are the four major risk factors Suggested Readings Carotid Sinus Syndrome ?Diagnosis Carpal Tunnel Syndrome Incidence: 3.8% of the general population (the most common entrapment neuropathy) Prevalent Age: 30 to 60 yr Prevalent Sex: Females are affected two to five times as often as males Related Content Suggested Readings Cataracts Incidence (In U.S.): Most common cause of treatable blindness; cataract removal is one of the most frequent surgical procedure i... Peak Incidence Predominant Age: Elderly; some stage of cataract development is present in >50% of persons 65 to 74 yr and in 65% of those >75 y... Genetics: Hereditary with syndromes such as galactosemia, homocystinuria, diabetes ?Treatment Catatonia Incidence: The incidence of catatonia has been studied primarily in acutely ill psychiatric inpatients and is present in approxi... Prevalence: Catatonia has a 9% to 17% prevalence rate in patients with acute psychiatric disorders, with stuporous catatonia the... Genetics: Familial clustering of catatonia suggests a genetic component that lacks classic Mendelian inheritance. Studies of per... Risk Factors: See Table 1 for a list of risk factors ?Diagnosis Suggested Readings Cat-Scratch Disease Prevalence: Unknown Incidence (In U.S.) Peak Incidence: August through January Suggested Readings Related Content Suggested Readings Cavernous Sinus Thrombosis ?Diagnosis ?Pearls & Considerations Suggested Readings Celiac Disease ?Diagnosis ?Pearls & Considerations Suggested Readings Cellulitis Erysipelas Staphylococcal cellulitis H. influenzae cellulitis Vibrio vulnificus E. rhusiopathiae A. hydrophila Related Content Suggested Readings Cerebral Palsy Incidence (In U.S.): 2 to 2.5 persons per 1000 live births Predominant Sex: Males and females affected equally Predominant Age: Diagnosis typically made at 3 to 5 yr of age ?Diagnosis Suggested Reading Cerebral Vasculitis Incidence: 2.4 cases per 1,000,000 person-yr for PACNS Peak Incidence: Fourth decade of life for PACNS Predominant Sex: Males are affected twice as often as females by PACNS. For secondary vasculitis of the CNS, sex predominance va... Predominant Age: Usual age of presentation of PACNS is in the third and fourth decades of life, but it can present in age rangin... Genetics: Multifactorial Risk Factors: Infections, connective tissue disorders, systemic vasculitis, and substance abuse are the prominent risk factors f... Classification ?Treatment ?Pearls & Considerations Suggested Readings Cervical Artery Dissection Incidence: The average annual incidence rate for CAD is reported at 2.6 per 100,000 population; however, the true incidence is l... Prevalence: Prevalence may reach 15% in the young adult stroke population Predominant Sex and Age: Carotid artery dissections are most commonly found in young adults. The mean age for extracranial inter... Genetics: Marfan syndrome, type IV Ehlers-Danlos syndrome, cystic medial necrosis, and the 677TT genotype of the 5,10-methylenet... Risk Factors ?Diagnosis ?Treatment Suggested Readings Author: Thomas M. Triplett, MD Suggested Readings Cervical Cancer Incidence: According to the World Health Organization, cervical cancer is the fourth most common malignancy in women. It is repo... Predominance: Higher incidence rates occur in developing countries. Among the U.S. population, Hispanics have a higher incidence... Risk Factors: Infection with high-risk human papillomavirus (HPV; types 16 and 18 are the most oncogenic with 31, 33, 35, 45, 52... Suggested Readings Cervical Disc Syndromes Incidence: The incidence of cervical radiculopathy can be up to 107.3 and 64.5 per 100,000 men and women, respectively, in the U... Prevalence: Up to 67% of all adults experience neck and arm pain at some point in their life Predominant Sex and Age: Males and females are affected equally between the ages of 30 and 60. Most commonly, cervical myelopath... Risk Factors: Risk factors include aging, repetitive microtrauma to the neck, and, potentially, genetic factors, although resear... Genetics: No definitive genetic associations have been identified, though family history likely plays a role Suggested Readings Cervical Dysplasia Updated Screening Protocol Bethesda 2001 Updated Classification: The Bethesda 2001 System was the result of a year-long iterative process held to update th... Key Points Predominant Age Peak Incidence ?Pearls & Considerations Suggested Readings Cervical Insufficiency Incidence: 1 in 1000 among general obstetrical population Suggested Reading Cervical Polyps ?Pearls & Considerations Cervicitis ?Diagnosis ?Pearls & Considerations Related Content Suggested Reading Chagas Disease Incidence (In U.S.) Prevalence (In U.S.): Based on regional seroprevalence studies in Hispanic blood donors, it is estimated that between 300,000 an... Predominant Sex: Male = female Predominant Age Peak Incidence: Unknown Genetics ?Pearls & Considerations Author: Patricia Cristofaro, MD Suggested Readings Chalazion Incidence: Common condition, exact incidence not documented Peak Incidence: Most common in adults age 30 to 50 Prevalence: Unknown Predominant Sex and Age: Affects males and females equally, more common in adults 30 to 50 yr old Genetics: Not applicable ?Treatment ?Pearls & Considerations Suggested Readings Chancroid ?Pearls & Considerations Suggested Reading Charcot Joint ?Diagnosis Suggested Readings Charcot-Marie-Tooth Disease Prevalence: Estimated prevalence is 1:2500, making CMT the most common inherited peripheral neuropathy and the most common inher... Suggested Readings Chemotherapy-Induced Nausea and Vomiting Incidence: The highest incidence of CINV is before or during the first cycle of chemotherapy Genetics: Some rapid metabolizers of certain 5-HT3 receptor antagonists and polymorphisms in the 5-HT3 receptor confer greater r... Risk Factors ?Treatment ?Pearls & Considerations Author: Byung Kim, MD Suggested Readings Child Abuse and Neglect Incidence (In U.S.): The incidence of child maltreatment is universally underestimated due to children not disclosing abuse and ... Predominant Sex: There is a slight predominance of girls identified as victims. However, rates vary by age. Boys 5 and under hav... Predominant Age: Youngest children (0 to 3 yr old) have the highest rates of victimization, with 27% being younger than the age ... Genetics: No known genetic factors Risk Factors ?Diagnosis Bruising Burns Intracranial Hemorrhage Fractures Sexual Abuse ?Pearls & Considerations Suggested Readings Chlamydia Genital Infections Follow-Up Suggested Readings Cholangiocarcinoma Incidence Predominant Sex and Age Risk factors ?TREATMENT Suggested Readings Cholangitis Incidence (In U.S.): Complicates approximately 1% of cases of cholelithiasis Peak Incidence: Seventh decade Prevalence (In U.S.): 2 cases/1000 hospital admissions Predominant Sex Predominant Age: Seventh decade and older; unusual <50 yr of age Suggested Reading Cholecystitis ?Pearls & Considerations Suggested Readings Choledocholithiasis Suggested Readings Cholelithiasis Related Content Suggested Readings Cholera Incidence (In U.S.) Predominant Sex: None Predominant Age: In nonendemic areas, attack rates are equal in all age groups. In epidemic areas, children older than the age o... Peak Incidence ?Pearls & Considerations Suggested Readings Chorea Incidence: No published data exist on the incidence of chorea in the U.S Predominant Sex and Age: Can affect any age and sex depending on the cause Risk Factors: The most important risk factors are a family history of Huntington disease, exposure to rheumatic fever as a child... ?Treatment ?Pearls & Considerations Suggested Readings Chronic Fatigue Syndrome Prevalence In U.S.: Prevalence rates of CFS in the U.S. range from 0.3% to 2.5%. It is estimated that 800,000 to 2.5 million Ame... Predominant Age: Young adulthood and middle age Predominant Sex: Females affected more often than males Economics: The estimated annual cost of lost productivity is estimated to be between $17 billion and $24 billion annually Suggested Readings Chronic Inflammatory Demyelinating Polyneuropathy Prevalence: 0.5/100,000 children; 1 to 2/100,000 adults Predominant Sex and Age: Slightly higher in males Risk Factors: It is associated with certain systemic medical conditions (see under “Differential Diagnosis”), but the associatio... ?Diagnosis ?Treatment Chronic Kidney Disease ?Diagnosis ?Treatment Chronic Lymphocytic Leukemia ?Diagnosis ?Treatment Related Content Suggested Readings Chronic Myeloid Leukemia ?Treatment Related Content Suggested Readings Chronic Obstructive Pulmonary Disease ?Diagnosis ?Pearls & Considerations Suggested Readings Chronic Pancreatitis ?Treatment Chronic Rhinosinusitis Incidence: CRS occurs in children and adults but is most frequently diagnosed in young and middle-aged adults Prevalence: In the U.S. it varies from 1% to 5% Predominant Sex and Age: Some studies suggest women are more affected. In adults, the mean age of diagnosis was 39 yr Genetics: Patients with cystic fibrosis or primary ciliary dyskinesia are more likely to develop CRS Risk Factors ?Treatment Surgery: Endoscopic surgery is appropriate if medical therapy fails. It can provide ventilation and drainage of the paranasal si... Herbal medicines, homeopathy, acupuncture, reflexology, and yoga are used but have not been studied in clinical trials Author: Glenn G. Fort, MD, MPH SUGGESTED READINGS Chronic Traumatic Encephalopathy (CTE) Peak Incidence & Prevalence: The incidence and prevalence of CTE are currently unknown. Among 202 deceased former football playe... Predominant Sex And Age: CTE may present early (20s to 30s) or later (50s to 60s) in adulthood. The relationship with gender is ... Genetics: Currently there are no known genetic risk factors that predispose to the development of CTE Risk Factors: Repetitive head injuries leading to concussions are the strongest risk factor for the development of CTE. Athletes... ?Pearls & Considerations Suggested Readings Chronic Urticaria Incidence: 1.4% per yr Prevalence: Lifetime prevalence is 1.8%. The period prevalence in the last 12 mo is 0.6% to 0.8%. CU occurs in 0.1% to 0.3% of c... Predominant Age and Sex: There is a 2:1 female to male predominance. The mean age is 40 yr Risk Factors: None Genetics: Patients with demonstrable histamine-releasing autoantibodies have a very strong association with HLA-DR4 and the asso... First-Line Treatment Third-Line Treatment: Choice of agent depending on histologic infiltrate (e.g., neutrophilic), patient’s comorbidities, and pref... Fourth-Line Treatment ?Pearls & Considerations Suggested Readings Cirrhosis General: Fever (spontaneous bacterial peritonitis) Skin: Jaundice, palmar erythema, spider angiomata, ecchymosis (thrombocytopenia or coagulation factor deficiency), increased pig... Eyes: Kayser-Fleischer rings (corneal copper deposition seen in Wilson disease; best diagnosed with slit lamp examination), scle... Breath: Fetor hepaticus (breath has a sweet musty odor found in cirrhosis with hepatic failure) Chest: Possible gynecomastia in men Abdomen: Tender or nontender hepatomegaly (congestive hepatomegaly), small, nodular liver (cirrhosis), palpable, nontender gallb... Rectal Examination: Hemorrhoids (portal hypertension), guaiac-positive stools (alcoholic gastritis, bleeding esophageal varices,... Genitalia: Testicular atrophy in males (chronic liver disease, hemochromatosis) Extremities: Pedal edema (hypoalbuminemia, anasarca), arthropathy (hemochromatosis), Dupuytren contractures Neurologic: Asterixis (hepatic encephalopathy), choreoathetosis, dysarthria (Wilson disease) Suggested Readings Cirrhotic Cardiomyopathy Incidence and Prevalence ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Claudication Suggested Readings Clostridium difficile Infection ?Diagnosis Suggested Readings Cluster Headache Incidence: Estimated to occur in 0.05% to 1% of the population Predominant Sex: Occurs in males at least five times more commonly than in females Predominant Age: Peak age of onset between 20 and 40 yr Genetics: May be inherited in up to 20% of cases, although uncertainty exists over the mode or modes of inheritance ?Diagnosis ?Pearls & Considerations Suggested Readings Cocaine Overdose Phase I Phase II Phase III ?Treatment Inhalation: Wash nasal passages Agitation Hyperthermia Rhabdomyolysis Seizure Management (Status Epilepticus) Hypertension: Cocaine-induced hypertension usually responds to benzodiazepines. If this fails Chest pain Ventricular Arrhythmias (Considerations) Suggested Readings Coccidioidomycosis Incidence (In U.S.): Estimated annual infection rate is 150,000 persons, predominantly in the southwest U.S., and appears to be ... Prevalence: 28.65 cases per 1 million population in the southwest U.S. based on patients requiring hospital admission Predominant Sex ?Pearls & Considerations Suggested Readings Cogan Syndrome Incidence: No population studies are available for incidence calculation. Approximately 250 cases have been described in the lit... Prevalence: No population studies are available for prevalence analysis. The classic form of Cogan syndrome tends to affect Cauc... Predominant Sex: No gender preference. Affects men and women equally in case reports Predominant Age: Median age of onset is 22 yr, with range 5 to 63 yr. Cases reported in children and older adults Risk Factors: Cogan syndrome may have increased prevalence in patients with inflammatory bowel disease. In many case reports, in... Genetics: Unknown Suggested Readings Colorado Tick Fever ?Diagnosis ?Treatment Colorectal Cancer ?Treatment ?Pearls & Considerations Suggested readings Compartment Syndrome ?Diagnosis ?Treatment Suggested Readings Complex Regional Pain Syndrome Incidence: CRPS is rare (population prevalence less than 1 in 2000). One study in the Netherlands found an overall incidence of ... Peak Incidence: Sixth decade, highest in postmenopausal women Risk Factors: Common situations in which CRPS is seen include extremity trauma, burns, stroke, and orthopedic and podiatric proc... ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Suggested Readings Concussion Incidence: 3.8 million sports- and recreation-related concussions occur each yr in the U.S. It is estimated that as many as 50% ... Prevalence: Each yr, U.S. emergency departments treat an estimated 135,000 sports- and recreation-related TBIs, including concus... Predominant Sex and Age Risk Factors ?Pearls & Considerations Suggested Readings Conduct Disorder Incidence: 1% (12 mo span, National Comorbidity Survey-Replication [NCS-R]) Prevalence: Approximately 2% to 10%; NCS-R: 9%. Disruptive behavior disorders are considered the most common reason for referral... Predominant Sex: More common in males (4:1 preadolescence and 2:1 postadolescence). It is unclear if CD females are underreprese... Predominant Age: Most common onset in early adolescence. Median age of onset is 11 yr Genetics: Risk increased if parent or sibling with disorder Risk Factors: There are various temperamental (including lower-than-average intelligence, especially verbal), family-level (incl... ?Treatment Suggested Readings Condyloma Acuminatum Suggested Reading Congenital Adrenal Hyperplasia ?Pearls & Considerations Suggested Readings Conjunctivitis Incidence (In U.S.): 1.6% to 12% in newborns Prevalence (In U.S.) Predominant Age: Occurs at any age. Most cases in adults are due to viral infection. Children are more prone to develop bacteria... Peak Incidence: More common in the spring and fall, when viral infections and pollens increase ?Pearls & Considerations Connective Tissue Disease1397059140Associated Vasculitis General ?Treatment ?Pearls & Considerations Suggested Readings Constipation ?Treatment Suggested Readings Contact Dermatitis Irritant Contact Dermatitis Suggested Readings ?Pearls & Considerations Contraception Suggested Readings Contrast-Associated Acute Kidney Injury (CA-AKI) Nomenclature: The term contrast-induced acute kidney injury (CI-AKI), formerly called contrast-induced nephropathy (CIN), implie... Incidence: The overall incidence of CA-AKI has been reported to be approximately 7%, and 11% of acquired AKI cases during hospit... Peak Incidence: Incidence rates of CA-AKI vary widely in the literature—a result of discrepancies in type and dose of contrast m... Sex and Age: Current controversies surrounding the true incidence of CA-AKI call into question the relationship of age to CA-AKI... Risk Factors: Patient-related factors include chronic kidney disease (CKD) with estimated GFR <30 ml/min per 1.73 m2 (CKD stage ... ?Treatment Suggested Readings Conversion Disorder (Functional Neurologic Symptom Disorder) ?Diagnosis ?Pearls & Considerations Suggested Readings Cor Pulmonale ?Treatment Suggested Readings Corneal Abrasion Incidence (In U.S.): A universal problem. Corneal abrasions comprise 8% of all eye presentations in primary care Peak Incidence: Childhood through active adulthood and older and debilitated patients Predominant Age: Any age Suggested Reading ?Pearls & Considerations Corneal Ulceration Incidence (In U.S.): Four to six cases per month seen by an average general ophthalmologist Prevalence (In U.S.): Common Predominant Sex: Either Predominant Age: All ages Coronary Artery Disease Incidence: For persons who are 40 yr old, the lifetime risk of developing CAD is 49% in men and 32% in women. The risk increases... Prevalence: The 2017 Heart Disease and Stroke Statistics update from the American Heart Association estimated that 16.5 million ... Risk Factors: The most prevalent risk factors include age, male sex, hypertension, hyperlipidemia, diabetes mellitus, obesity, t... Lifestyle Modification Therapeutic Interventions: Coronary angiography with PCI or CABG for patients on optimal medical therapy with persistent symptom... Related Content Suggested Readings Costochondritis 1398042195 Prevalence: Comprises approximately 28% of undifferentiated noncardiac chest pain patients Predominant Sex: Women Predominant Age: >40 yr of age Symptoms Signs Suggested Readings Craniopharyngioma Peak Incidence: Occurs at all ages; peak during the first two decades of life, with a second small peak occurring in the sixth d... Creutzfeldt-Jakob Disease ?Diagnosis Suggested Readings ?Pearls & Considerations Crohn Disease 1398042195 ?Treatment Suggested Readings Croup (Laryngotracheobronchitis) ?Diagnosis Suggested Readings ?Treatment ?Pearls & Considerations Cryoglobulinemia Prevalence Predominant Sex and Age: Female-to-male ratio of 3:1 Predominant Age: Mean age reported is 42 to 52 yr Risk Factors ?Treatment Suggested Readings Cryptococcosis Incidence (In U.S.) Peak Incidence: 20 to 40 yr (parallel to HIV/AIDS epidemic) Predominant Sex: Equal sex distribution when adjusted for HIV status Predominant Age: Less than 2 yr of age; 20 to 40 yr of age Neonatal Infection: Very uncommon Suggested Readings Cryptogenic Organizing Pneumonia Incidence: Estimated incidence is six to seven cases per 100,000 per yr Peak Incidence: Typically, age of onset is 50 to 60 yr old Prevalence: Unknown Predominant Sex and Age: No sex predominance Genetics: Unknown Risk Factors: Unknown Cryptorchidism ?Treatment Suggested Readings Cryptosporidium Infection Incidence Prevalence: Worldwide, especially third-world countries; associated with poor hygiene as a waterborne pathogen Predominant Sex: Male = female Transmission ?Diagnosis ?Treatment Suggested Reading Cubital Tunnel Syndrome ?Diagnosis ?Treatment Suggested Readings Cushing Disease and Syndrome ?Pearls & Considerations Suggested Reading Cutaneous Larva Migrans ?Diagnosis ?Treatment Cyanosis Incidence: Unknown Peak Incidence: Unknown Prevalence: Unknown Predominant Sex and Age: Unknown Genetics: None Risk Factors: Congenital heart disease, high altitude, hypercoagulable state, cardiopulmonary disease, cirrhosis, exposure to an... Cyclic Vomiting Syndrome Incidence & Prevalence ?Treatment ?Pearls & Considerations Suggested Readings Cystic Fibrosis ?Treatment ?Pearls & Considerations Suggested Readings Suggested Readings Cysticercosis Suggested Readings Cytomegalovirus Infection Children: Congenital—25% of infected children with symptoms if congenital Healthy adults: Common Immunosuppressed patients Suggested Readings Deep Vein Thrombosis ?Pearls & Considerations Suggested Readings Delayed Puberty Prevalence: The actual prevalence and incidence for children presenting with delayed puberty is unknown. Delayed puberty is more... ?Treatment ?Pearls & Considerations Suggested Readings Delirium ?Pearls & Considerations Suggested Readings Delirium Tremens Incidence (In U.S.): Up to 500,000 cases annually, 3% to 5% of patients who are hospitalized for alcohol withdrawal meet the cri... Peak Incidence: 30 yr and older Predominant Sex: Male Peak Age: Teenage yrs and older Genetics: More common with patients who have relatives who are alcoholics Acute General Rx Suggested Reading Delusional Parasitosis Incidence: Unknown Peak Incidence: Occurs more often later in life Prevalence: The disorder is rare. It has a prevalence estimated at 80 cases per million and appears to have a bimodal distributi... Predominant Sex and Age: For patients less than age 50, the male/female ratio is 1:1; for patients older than 50, females predom... Genetics: Unknown Risk Factors: From 5% to 15% of individuals close to patients with delusional parasitosis will be at risk for developing shared ... ?Treatment Suggested Reading Dementia with Lewy Bodies Incidence: Accounts for 10% to 15% of all dementias. DLB is the second most common neurodegenerative cause of dementia after Alz... Peak Incidence: Affects individuals in their sixth decade or older Prevalence: Estimated 0.7% of individuals older than age 65 Predominant Sex and Age Genetics Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Dengue Fever Incidence and Prevalence: The incidence of dengue is underestimated. Recent estimates indicate 390 million dengue infections per... ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Dependent Personality Disorder Prevalence: 0.5% in general population. Dependent traits, as opposed to the disorder itself, are among the most frequently repor... Suggested Readings Depression, Major Lifetime Risk (In U.S.): 10% of men, 20% of women Prevalence (In U.S.): Point prevalence in a community sample is 3% of men, 4.5% to 9.3% of women, and 1% of children. Prevalence... Predominant Sex: Female/male ratio 2:1 Predominant Age: 25 to 44 yr; 5% of adolescents Peak Incidence: 30 to 40 yr; 13% of postpartum women Genetics ?Pearls & considerations Related Content Suggested Reading De Quervain Tenosynovitis ?Diagnosis Suggested Readings Dermatitis Herpetiformis Prevalence (In U.S.): 11 cases per 100,000 persons per yr; prevalence for CD is one in 133 adults Predominant Sex: Male predominance (2:1); however, female predominance in children Predominant Age: Fourth decade of life, but can occur at any age Predominant Race: Most common in Caucasians of Northern European ancestry Genetics: Both CD and DH have a strong genetic component. 10% to 15% of patients with DH have a first-degree relative with eithe... ?Diagnosis ?Treatment Suggested Readings Diabetes Insipidus ?Pearls & Considerations Suggested Reading Diabetes Mellitus Idiopathic Diabetes: Type 1 DM: Results from autoimmune beta-cell destruction, usually leading to absolute insulin deficiency ?Treatment ?Pearls & Considerations Suggested Readings Diabetic Foot Incidence: DFIs are the most common cause of hospitalizations for diabetic patients. They account for 20% of all hospital admiss... Peak Incidence: More common in Hispanics, African Americans, and Native Americans due to increased rates of diabetes in those po... Prevalence: 25 million people in the U.S. have diabetes, of which 19% to 34% will develop a foot ulcer in their lifetime and mor... Predominant Sex And Age: Females greater than males Risk Factors ?Treatment Wound Management Antibiotic Management Suggested Readings Diabetic Gastroparesis ?Treatment ?Pearls & Considerations Related Content Suggested Readings Diabetic Ketoacidosis Fluid Replacement: Fluid therapy is initiated to expand volume and restore renal perfusion for a typical total body water defici... Insulin Administration: Administer initial bolus of IV regular insulin 0.1 units/kg followed by 0.1 units/kg per hour infusion o... Potassium Replacement: Insulin therapy shifts potassium intracellularly, frequently causing hypokalemia. If the serum potassium ... Bicarbonate Replacement: The administration of bicarbonate in DKA is generally not recommended. Bicarbonate does not improve tim... Phosphate Replacement: Phosphate replacement is not routinely recommended, although phosphorus concentrations decrease with ins... Transition to Subcutaneous Insulin: Resolution of DKA occurs when blood glucose is <200 mg/dl and two of the following occur: Ve... Disposition: In general, patients with DKA should be admitted to an intensive care unit with an insulin infusion. Alert patients... ?Pearls & Considerations Diabetic Nephropathy Incidence: Diabetes is present in 10% of the U.S. population. DN occurs in approximately 40% of patients who have diabetes for m... Prevalence: DN develops in approximately 30% of patients with type 1 diabetes mellitus (T1DM) and 40% of patients with type 2 di... Predominant Sex and Age: Male patients and older age Genetics: Polygenetic. Patients with first-degree relative with DN are at increase risk Risk Factors Related CONTENT Suggested Readings Diabetic Polyneuropathy Prevalence: The prevalence of diabetic polyneuropathy varies from 10% to 100% in patients with diabetes mellitus in population-b... ?Pearls & Considerations Suggested Readings Diabetic Retinopathy Incidence (In U.S.) Prevalence (In U.S.) Predominant Sex: Males and females affected equally Predominant Age: ≥30 yr Genetics ?Pearls & Considerations Suggested Readings Diarrhea, Persistent Prevalence ?Treatment ?Pearls & Considerations Suggested Readings Diffuse Idiopathic Skeletal Hyperostosis Prevalence: The prevalence of DISH varies in different populations. Factors such as age, ethnicity, geography, and clinical sett... Predominant Sex and Age Genetics: Association with COL6A1 gene in some populations, causing ossification of the posterior longitudinal ligament, a condi... Risk factors ?Diagnosis ?Treatment Suggested Readings Suggested Reading Digoxin Overdose Bioavailability: Approximately 80% tablets; 100% capsules or IV Volume of Distribution: 5 to 7 L/kg, highly tissue bound Half-Life: 36 to 48 hr Excretion: Predominantly renal Therapeutic Level: 0.5 to 2 ng/ml (0.5 to 0.9 ng/ml suggested in heart failure and <1.2 for atrial fibrillation); check level 1 ... Cardiac: Initial presentation often due to proarrhythmic effects; can present with almost any dysrhythmia or conduction block ex... Gastrointestinal: Anorexia, nausea, vomiting, diarrhea, abdominal pain Central Nervous System ?Diagnosis ?Treatment Decrease Toxicity Complications: These recommendations are temporizing measures until digoxin-specific Fab fragments can be given Suggested Readings Diphtheria Incidence (In U.S.): Since 1980, the incidence in the U.S. has been about 0.001 cases per 100,000 population because of widespre... Predominant Age: Adult yr (in the U.S.) Respiratory Diphtheria Cutaneous Diphtheria ?Pearls & Considerations Suggested Readings Diplopia Genetics: Some diseases have a genetic basis, such as Marfan syndrome (dislocation of lens), or to a lesser degree, autoimmune c... ?Treatment Suggested Readings Suggested Readings Discoid Lupus ?Diagnosis Suggested Readings Disseminated Intravascular Coagulation ?Pearls & Considerations Suggested Readings Dissociative Disorders Incidence: Limited research documents the incidence of DDs, and estimates vary based on the assessment utilized and the sample s... Peak incidence: Age of peak incidence varies by the type of DD Prevalence: The prevalence of DDs using various screening instruments is estimated to be 10%, with higher rates evidenced in stu... Predominant sex and age: Females are diagnosed with DDs more frequently than males. Diagnoses may be made among individuals of a... Genetics: There is some evidence that biologic differences may play a role the likelihood of dissociation following the experien... Risk factors: DDs have been linked to experiencing chronic stress, especially during adolescence, as well as experiencing or wit... ?Treatment Suggested Readings Diverticular Disease (Diverticulosis, Diverticulitis, Diverticular Hemorrhage) Procedures: Colonoscopy should be avoided during acute diverticulitis due to the risk of perforation. It can generally be perfor... Treatment of Diverticulitis Diverticular Hemorrhage Suggested Readings Down Syndrome Incidence (In U.S.): 1 in 733 births Peak Incidence: Newborn Prevalence (In U.S.): 300,000 persons Predominant Sex: Male:female ratio of 1.3:1.0 Predominant Age: Newborn to early adulthood Genetics: Nondisjunction causing trisomy 21 ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Drowning ?Basic Information Incidence Peak Incidence Predominant Sex & Age Risk Factors ?Treatment Suggested Readings Drug-Induced Liver Injury Incidence: Estimated annual incidence between 10 and 15 per 10,000 to 100,000 has been reported Peak Incidence: N/A Prevalence: N/A Predominant Sex and Age: Incidence increases with age and is more common in females Risk Factors ?Pearls & Considerations Suggested Readings Drug-Induced Parenchymal Lung Disease (DILD) Incidence: Global incidence is not known but likely accounts for 2.5% to 3% of interstitial lung disease (ILD) cases. More than ... Prevalence: Not reported Predominant Age And Sex: Extreme ends of ages are prone to develop severe drug-induced side effects. Some studies have shown sev... Genetics: Limited studies have shown that there may be a racial difference in the incidence of DILD Risk Factors: Age, sex, ethnicity, drug dose, oxygen, drug interaction, radiation, presence of underlying lung disease ?Treatment Suggested Reading Drug Use Disorder Incidence (In U.S.): Alcohol or drug dependence: 5% to 10% of population Prevalence (In U.S.): Approximately 15% of patients in primary care practice have an at-risk pattern of drug and/or alcohol use;... Predominant Sex: Males > females Predominant Age Peak Incidence: For most substances: Age 15 to 30 yr Duration of Condition Genetics: There is evidence of nonspecific genetic factors. Addiction may result in part from underlying, inherited abnormalitie... Methamphetamine: Even small amounts of methamphetamine can result in many of the same health effects as those of other stimulant... Suggested Readings Dumping Syndrome ?Diagnosis ?Pearls & Considerations Authors: Samantha Ni, MD, and Mark F. Brady, MD, MPH, MMSc Suggested Readings Dupuytren Contracture ?Basic Information Incidence: Varies by ethnicity but estimated at 3 per 10,000 men in the U.S Prevalence: Varies depending on ethnicity and age. In the U.S., the overall prevalence is estimated to be about 7% but can be as... Prevalent Sex: Male:female ratio of 5.9:1. Approaches a 1:1 ratio after age 80 Prevalent Age: Increases significantly after age 40 Genetics: No specific gene has been identified that is responsible for Dupuytren contracture, although abnormalities in the Wnt ... Risk Factors: Age older than 40 yr, male sex, northern European descent, positive family history, diabetes mellitus, alcoholism,... ?Treatment Suggested Readings ?Pearls & Considerations Dysmenorrhea Dyspareunia Prevalence (in U.S.): Affects 10% to 20% of women Predominant Sex: Female At-Risk Population: No consistent findings regarding Risk Factors: Dyspareunia can lower Historical Factors—Assessment Suggested Reading Dyspepsia, Nonulcerative ?Pearls & Considerations Suggested Readings Dysphagia ?Diagnosis ?Treatment Suggested Reading Dystonia Prevalence: Estimated at 1 in 3000 persons Predominant Sex: Cervical dystonia has a 3:2 female preponderance Predominant Age Genetics: Autosomal-dominant, autosomal-recessive, and X-linked forms of dystonia have been identified. Metabolic conditions in ... ?Pearls & Considerations Suggested Reading Early Repolarization Syndrome Incidence: The clinical entity “early repolarization pattern” is commonly asymptomatic; therefore, the true incidence of the pat... Predominant Sex: J point elevation >1 mm was documented significantly higher in males vs. females Genetics: The mode of transmission and the genetic basis of the syndrome are unclear. An autosomal dominant pattern of inheritan... Risk Factors: Male sex, younger age, lower systolic blood pressure, higher Sokolow-Lyon index, and lower Cornell voltage have be... Suggested Readings ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Echinococcosis Incidence (In U.S.): Seen primarily in foreign-born patients, but local transmission of CE can occur in southwestern U.S., Calif... Peak Incidence: Presumed to be acquired in childhood or early adulthood in most cases, although prevalence increases with age Prevalence (In U.S.): Prevalence in the U.S. is unknown Predominant Sex: Globally, women are more often affected by cystic echinococcosis than men. This higher prevalence in women is f... Predominant Age: 0 to 50 yr of age ?Pearls & Considerations Suggested Readings Eclampsia Incidence: One case per 1500 to 3000 pregnancies; 2% to 4% of those with preeclampsia; one large Australian series found 8.6 cas... Genetics: Increased incidence with a first-degree relative (sister or mother) having had eclampsia Risk Factors: Multifetal gestation (3.6% in twin gestation), molar pregnancy, nonimmune hydrops fetalis, uncontrolled hypertensi... Suggested Readings Ectopic Pregnancy Prevalence (In U.S.): Accounts for up to 18% of women presenting to the emergency room with vaginal bleeding or abdominal pain. ... Risk Factors: Previous EP, previous pelvic infection (pelvic inflammatory disease, tubo-ovarian abscess, salpingitis), previous ... Physical Findings & Clinical Presentation Related Content Suggested Readings Ehlers-Danlos Syndrome ?Diagnosis ?Treatment Suggested Readings Ehrlichiosis and Anaplasmosis Incidence (In U.S.): Highest overall incidence in Rhode Island (36.5 per 1 million), New York, New Jersey, Connecticut, Wisconsi... Predominant Sex: Males outnumber females by 2 to 1 Predominant Age: Most severe disease 50 to 70 yr Peak Incidence: Occurs throughout the yr, with peak incidence between May and July and again in September Suggested Readings Ejaculation and Orgasm Disorders Incidence: Not well understood, due to variability in definitions and reporting Peak Incidence: Not well understood. Ejaculatory and orgasmic disorders may be primary (lifelong) if the condition has always be... Prevalence: Premature ejaculation is the most prevalent male sexual complaint, affecting up to 30% of men. Delayed ejaculation i... Predominant Sex and Age: These disorders have been reported among men aged 18 to 70 yr Genetics: No known genetic predisposition Risk Factors: Men with ejaculatory dysfunction of any type usually indicate higher levels of relationship stress, sexual dissati... ?Pearls And Considerations Suggested Readings Elder Abuse ?Basic Information Incidence: As many as 5,000,000 elders are abused annually in the U.S Peak Incidence: >75 yr; more recent studies now suggest <75 yr Prevalence Risk Factors (Victim) Risk Factors (Perpetrator) ?Pearls & Considerations Suggested Readings Electrical and Lightning Injury ?Pearls & Considerations Emergency Contraception Empyema ?Pearls & Considerations Suggested Readings Encephalitis, Acute Viral Incidence (In U.S.): About 20,000 cases/yr are reported to the CDC. In 2016, there were 2149 cases of West Nile virus with 106 d... Peak Incidence: Any age, but children and older adults are more likely to have significant morbidity Prevalence (In U.S.) Predominant Sex: Male = female Predominant Age: Any age Genetics: No specific genetic or congenital predisposition Suggested Readings Suggested Readings Encephalopathy Point Prevalence: 1.1% of adults in the general population >55 yr, 10% to 40% of hospitalized elderly, and 60% of nursing home p... ?Treatment Suggested Readings Encopresis Peak Incidence: Preschool age (though also occurs during school age and adolescence) Prevalence (In U.S.): 1.5% to 7.5% of children 4 to 12 yr old Predominant Sex: More often in males (estimates range from 1.9:1 to 9:1) Suggested Readings Endocarditis, Infective Acute Endocarditis: Usually caused by Staphylococcus aureus, Streptococcus pyogenes, S. pneumoniae, and Neisseria organisms; cla... Subacute Endocarditis: Usually caused by viridans streptococci in the presence of valvular pathology; less toxic, often indolent... Endocarditis in Injection Drug Users: Often involving S. aureus or Pseudomonas aeruginosa with variation that may be geographica... Prosthetic Valve Endocarditis (Early): Usually caused by S. aureus (leading cause of PVE) within 2 mo of valve replacement; othe... Prosthetic Valve Endocarditis (Late): Typically develops >60 days after valvular replacement; involved organisms similar to earl... Nosocomial Endocarditis: Secondary to intravenous catheters, TPN lines, pacemakers; coagulase-negative staphylococci, S. aureus,... Incidence (In U.S.): Yearly incidence is 15 cases/100,000 persons and is increasing due to medical interventions in the elderly ... Peak Incidence: Females: Often <35 yr old; males: 45 to 65 yr old Nosocomial Endocarditis: 14% to 28% of cases Prevalence (In U.S.): 0.3 to 3 cases/1000 hospital admissions. 40,000 to 50,000 new cases a yr in the U.S Predominant Sex: Male < female Predominant Age: 45 to 65 yr Acute Endocarditis Subacute Endocarditis Endocarditis in Injection Drug Users Prosthetic Valve Endocarditis (Early) Prosthetic Valve Endocarditis (Late) Nosocomial Endocarditis Hacek Organisms ?Treatment Suggested Readings Endometrial Cancer Incidence: In 2015, 53,911 new cases of uterine cancer were diagnosed. This corresponds to an incidence of 27 cases per 100,000 ... Predominance: Median age at diagnosis: 62 yr; only 5% occur in women <40 yr; 5-yr survival >80% Risk Factors: Obesity, diabetes, nulliparity, early menarche and late menopause, unopposed estrogen therapy, tamoxifen use, olig... ?treatment Suggested Readings Endometriosis prevalence Most Common Age at Diagnosis: 25 to 29 yr Genetics Pharmacologic Management Estrogen-progesterone Surgical Management Conservative Management Of Endometriosis-Associated Infertility Conservative surgery Suggested Readings Endometritis End-Stage Kidney Disease Incidence: According to the U.S. Renal Data System (USRDS), there were 124,675 incident cases of ESKD in the U.S. in 2016 Prevalence: According to the USRDS, there were 726,331 prevalent cases of ESKD in 2016. The number of prevalent cases has increa... Predominant Sex and Age: The incidence and prevalence of ESKD increases with age, but individuals can experience ESKD at any age... Genetics: Genome-wide association studies (GWAS) have shown several genes that are associated with the development of CKD and pr... Risk Factors: Risk factors for the development of ESKD include proteinuria, higher body mass index, diabetes mellitus, high bloo... ?Treatment Suggested Readings Enteropathic Arthritis Predominant Sex and Age: Males and females equally affected. Inflammatory back pain usually presents before the age of 45 yr. On... Risk Factors Genetics: The presence of HLA-B27 is the strongest association with SpA. Recent genome-wide association studies demonstrated a g... ?Treatment Suggested Readings Enuresis Peak Incidence: Ages 5 to 10 yr. 5 to 7 million children in the U.S. have enuresis Prevalence (In U.S.) Predominant Sex: Twice as many males as females at all ages Predominant Age: Highest prevalence at age 5 with a steady decrease thereafter at a rate of approximately 12% to 15% per yr Genetics Risk Factors suggested Readings Eosinophilic Esophagitis (EoE) Incidence (in U.S.): One to 20 new cases per 100,000 inhabitants per yr, increased from last year Prevalence: Between 13 and 49 cases per 100,000 inhabitants Predominant Sex: Male predominance (ratio ∼3:1) Predominant Age: Peak of disease activity at age 35 to 39 Peak Incidence: Older children; in adults, ages 30 to 50 Genetics Risk Factors/Etiology: Genetic, host immune, and environmental ?Pearls & Considerations Suggested Readings Eosinophilic Fasciitis ?Pearls & Considerations Suggested Readings Eosinophilic Granulomatosis with Polyangiitis ?Diagnosis ?Pearls & Considerations Suggested Readings Eosinophilic Pneumonias Simple Pulmonary Eosinophilia (Löffler Syndrome) Idiopathic Acute EP Idiopathic Chronic EP Allergic Bronchopulmonary Asper-gillosis (ABPA) Tropical Pulmonary Eosinophilia Eosinophilic Granulomatosis with Polyangiitis (EGPA) Hypereosinophilic Syndrome Drug- or Toxin-Induced Eosinophilic Pneumonia ?Diagnosis ?Treatment Suggested Readings Epicondylitis PREVALENCE SUGGESTED READINGS ?TREATMENT Epidermolysis Bullosa Prevalence and Incidence: The estimated overall prevalence and incidence of EB in the U.S. are 11.1 per 1 million population and... Genetics: The most common forms of EB simplex (EBS) are transmitted in an autosomal dominant manner. Table E3 summarizes the var... EB is marked by development of painful blisters on the hands, feet (Fig. E1), elbows, and knees after mild trauma. Extensive bli... ?Pearls & Considerations Suggested Reading Epididymitis Incidence (In U.S.): Cause of >600,000 visits to physicians per yr Peak Incidence: Sexually active yrs Predominant Sex: Exclusive to males Predominant Age: All ages affected but usually in sexually active men or older males Congenital: Congenital urologic structural disorders possibly predisposing to infections Epidural Abscess Incidence: Spinal epidural abscess: 2 to 25 patients per 100,000 admissions; spinal epidural abscess is 9 times more common than... Peak Incidence: Median age at onset of spinal epidural abscess: 50 yr old Prevalence: Greatest between 50 and 70 yr of age Predominant Sex: More common in men Risk Factors: Bacteremia, secondary to distant infection; epidural catheter placement (0.5% to 3% risk), paraspinal injections o... ?Pearls & Considerations Epidural Hematoma Incidence: Exact incidence is unknown; however, it is found in 1% to 4% of traumatic head injury cases and 5% to 15% of autopsy ... Predominant Sex and Age: Male > female Peak Incidence: Peak incidence is among adolescents and young adults. It is rarely found in patients older than 50 to 60 yr old Genetics: There is a role for genetics in spontaneous (nontraumatic) EDH caused by coagulopathies and vascular malformations Risk Factors: Head trauma, especially in cases involving skull fracture ?Treatment Epiglottitis 1398042195 Incidence (In U.S.): Due to vaccination against Haemophilus influenzae type B, this is a rare infection in children estimated at... Peak Incidence: Now highest in children ages 6 to 12 Predominant Sex: Males Suggested Reading Epiploic Appendagitis Incidence: Reported in 2% to 7% of patients suspected of diverticulitis and 0.3% to 1% of patients suspected of appendicitis Peak Incidence: Reported age range of 12 to 82 yr with a peak incidence in the fifth decade of life Predominant Sex and Age: Four times higher in men than women Risk Factors: Obesity and strenuous exercise Episcleritis 1398042195 Incidence (In U.S.): Relatively rare in an ophthalmologic practice Peak Incidence: Most common in middle and old age Predominant Sex: None Predominant Age: 40s ?Pearls & Considerations Epistaxis ?Diagnosis ?Pearls & Considerations Epstein-Barr Virus Infection Incidence (In U.S.): 5 cases/100,000 persons per yr of IM Predominant Sex: Neither, although peak incidence occurs about 2 yr earlier in women Predominant Age Suggested Readings Erectile Dysfunction Prevalence (In U.S.) Predominant Sex: By definition, only in males Predominant Age: Increases with age Risk Factors: Age, coronary artery disease, peripheral vascular disease, hypertension, hypogonadism, diabetes mellitus, hypercho... Related Content Suggested Readings Erysipelas Predominant Age: Occurs most often in the young or old Risk Factors: Patients with impaired lymphatic or venous drainage (mastectomy, saphenous vein harvesting) and immunocompromised ... Recurrence Rate: Relatively common Erythema Elevatum Diutinum Erythema Multiforme Predominant Age: 20 to 40 yr ?Pearls & Considerations Erythema Nodosum Incidence: It is the most common form of panniculitis. Two to three cases/100,000 persons per yr Predominant Sex: Female:male ratio of 3 to 4:1 Predominant Age: 25 to 40 yr Infections ?Treatment Esophageal Tumors Incidence: It is the eighth most common cancer worldwide and the seventh leading cause of cancer deaths. Rates are increasing ev... Prevalence: In the U.S., there was an estimated 16,000 new cases and 15,000 deaths are reported yearly, making it the seventh le... Race, Age, & Sex Predominance: In the U.S., squamous cell esophageal cancer is more common among those of African descent than w... Genetics: Increasing evidence shows that genetics may play a role by increasing susceptibility to esophageal cancer. One well-id... Etiologic Agents: Squamous cell carcinoma Adenocarcinoma: The incidence of adenocarcinoma is continually rising, whereas that of squamous cell carcinoma is unchanged Combination Therapy: Chemoradiotherapy Followed by Surgical Resection: Induction chemotherapy that occurs before chemoradiation ... Surgical Resection Radiation Therapy Suggested Readings Esophageal Varices Incidence Prevalence: Approximately 50% of patients with cirrhosis have varices at the time of diagnosis Risk Factors: Cirrhosis, low platelet count and advanced Child-Pugh class, hepatitis C with advanced fibrosis ?Treatment Essential Tremor1398042195 Predominant Age: Can begin at any age, but incidence increases after age 40 yr. Prevalence is 6% to 9% for those >60 yr of age ?Treatment Suggested Readings Exocrine Pancreatic Insufficiency Prevalence: Approximately 40% in patients with CP and 90% in patients with CF Predominant Sex & Age: More common in males than females Risk Factors ?DIAGNOSIS ?TREATMENT SUGGESTED READINGS Factitious Disorder (Including Munchausen Syndrome) Incidence (In U.S.): Unknown Prevalence (In U.S.): Likely underdiagnosed because of the role of deception, but estimates range between 0.5% and 2% Predominant Sex: Variable. With psychological subtype M > F; with predominant physical symptoms F > M by a ratio of 3:1. Munchau... Predominant Age: 30 to 40 yr of age Peak Incidence: Approximately 30 to 40 yrs of age Genetics: No genetic predisposition known ?Diagnosis Suggested Readings Failure to Thrive (Pediatric) Incidence: FTT is a common problem, though its incidence in the community is unclear. A total of 1% to 5% of inpatient pediatric... Predominant Sex and Age: FTT most commonly occurs among children ages 6 to 12 mo, with 80% presenting before 18 mo of age. Most ... Risk Factors: Poverty is the single greatest risk factor. Nonmedical: Poverty, food insecurity, social isolation, neglect, and p... Suggested Readings ?Treatment ?Pearls & Considerations Fallopian Tube Cancer Incidence: Primary fallopian tube tumors make up 0.3% to 1.1% of all gynecologic cancers ?Treatment Falls in the Elderly Incidence Health Care Cost: In 2006, patients ≥65 had over 2.1 million visits to the ED for injurious falls, which was 10.5% of all ED vis... Predominant Sex & Age Risk Factors: Four groups of risk factors for falls have been identified (Table 1) Suggested Readings Familial Adenomatous Polyposis and Gardner Syndrome ?Diagnosis Genetic Testing: note: Genetic counseling should be performed, and written informed consent obtained before testing. Refer to a ... Sigmoidoscopy Chrpe: Lesions occur in up to 80% of families and are a reliable indicator of affected status in these families ?Treatment Suggested Readings Familial Mediterranean Fever (FMF) Prevalence: Varies depending on the ethnic background of the population. FMF affects primarily eastern Mediterranean populations... Predominant Sex and Age: Male:female ratio is 1.5 to 2:1. Disease onset is typically before age 20, with the vast majority of in... Genetics: Pattern of inheritance is primarily autosomal recessive. Mutations in the MEFV gene, which encodes the pyrin protein, ... Risk Factors: Affected first-degree relatives, consider offering genetic testing ?Treatment ?Pearls & Considerations Suggested Readings Fatty Liver of Pregnancy, Acute Incidence Average Gestational Age: 37 wk (range 28 to 42 wk) Risk Factors Genetics: Some with a familial deficiency of long-chain 3-hydroxyacyl-coenzyme A dehydrogenase (LCHAD) Suggested Readings Febrile Seizures Incidence: Febrile seizures are the most common seizures of childhood. 2% to 5% of children will have a febrile seizure by age 6... Prevalence: Represents up to 18% of all pediatric epilepsy syndromes Predominant Sex and Age: Slightly more common in boys than girls Peak Incidence: 6 to 60 mo ?Treatment ?Pearls & Considerations Suggested Readings Felty Syndrome ?Pearls & Considerations Suggested Readings Fertility Preservation in Women Prevalence: Given the emergence and novelty of fertility preservation techniques, the epidemiology has not been well established... ?TREATMENT ?PEARLS & CONSIDERATIONS SUGGESTED READINGS Fetal Alcohol Spectrum Disorder ?Diagnosis ?Treatment Suggested Readings Fever in the Returning Traveler Incidence: Fever was the chief complaint in 28% of travelers who reported to a travel clinic. Mortality is between 0.2% and 0.5%... Peak Incidence: Location and timing of travel influences the incidence of fever Risk Factors: Morbidity and mortality increased among elderly and young travelers ?Treatment ?Pearls & Considerations Authors: Samantha Ni, MD, and Ana Castaneda-Guarderas, MD Suggested Readings Fever of Undetermined Origin ?Treatment Suggested Readings Fibrocystic Breast Disease Related Content Suggested Readings Fibromyalgia Fifth Disease (Parvovirus B19 Infection) Incidence: Between 1% and 9% of pregnancies are affected by B19 infection. During B19 epidemics, approximately 20% of susceptibl... Peak Incidence: In the U.S., B19 infection occurs more frequently between late winter and early summer, often in cycles of local... Prevalence: The percentage of people with protective IgG antibodies to parvovirus B19 increases with age. Approximately 15% of s... Predominant Age: 5 to 18 yr old Risk Factors ?Treatment Suggested Readings Filariasis Incidence (In U.S.): In the U.S., the last locale with endemic lymphatic filariasis was Charleston, South Carolina, with no infe... Incidence (Global): Thanks to mass drug administration campaigns targeted at stopping transmission of infection, prevalence is s... Predominant Sex: Male Predominant Age: For both males and females, risk is greatest between the ages of 15 and 35 yr Suggested Readings Focal Seizures Incidence: 30 to 50 cases per 100,000 person per yr Prevalence: 5 to 8 cases per 1000 persons Predominant Sex and Age: No gender preference ?Treatment ?Pearls & Considerations Suggested Readings Folliculitis1398042195 Prevalence: Staphylococcal folliculitis is the most common form of infectious folliculitis; it occurs most commonly in persons w... ?Pearls & Considerations Food Allergies Incidence: Food allergies have a cumulative incidence of 6% to 8% for the first 3 yr of life Prevalence Genetics: Children with parents or close relatives with allergies may have a tendency to become allergic to foods ?Diagnosis Suggested Readings Food Poisoning, Bacterial Incidence (In U.S.) Peak Incidence: Varies with specific organism Predominant Age: Varies with specific agent Neonatal Infection: Rare but severe with Shigella and Salmonella spp ?Pearls & Considerations Suggested Readings Friedreich Ataxia Incidence (In U.S.): Estimated at 1 in 30,000 Caucasians Peak Incidence: 8 to 15 yr Prevalence (In U.S.): 2 to 4 per 100,000. Carrier rate 1:120 to 1:160; lower prevalence in people of Asian or African descent Predominant Sex: Males and females affected equally Genetics: Autosomal recessive; 96% of affected patients are homozygous and 4% are compound heterozygous (two different mutations... Related Content Frontotemporal Dementia Incidence: The estimated annual incidence is 2.7 to 4.1 per 100,000 persons Prevalence: The estimated point prevalence is 15 to 22 per 100,000 persons Predominant Sex and Age: There is a nearly equal distribution by sex, and the average age of presentation is 58 yr Genetics: Approximately 40% of FTD cases have a positive family history, and several genes (Table 1) have been associated with t... ?Diagnosis ?Treatment Suggested Readings Frostbite ?Treatment (3 PHASES) Suggested Readings Functional Gallbladder Disorder Incidence: Biliary dyspepsia has an incidence rate of 1% to 6% Prevalence: Ten percent to 45% of total population report dyspepsia Predominant Sex and Age: There is a 3:1 female-to-male predominance Risk Factors: There is no consistent relationship to meals or fatty meal intake ?Treatment ?Pearls & Considerations Galactorrhea ?Treatment Suggested Reading Gallbladder Cancer ?Treatment Authors: Sonali Harchandani, MD, and Patan Gultawatvichai, MD Suggested Readings Ganglia ?Diagnosis ?Treatment Suggested Readings Gastric Cancer ?Treatment ?Pearls & Considerations Suggested Readings Gastrinoma ?Treatment Related Content Suggested Readings Gastritis Gastroenteritis PREDOMINANT Sex PREDOMINANT Age Rehydration Treatment of Symptoms ?Pearls and Considerations Suggested Readings Gastroesophageal Reflux Disease (GERD) ?Diagnosis Suggested Readings Gender Dysphoria and Gender Nonconformity Development & Background: Gender development begins as early as 18 mo. By age 2 to 4 yr, children understand gender differences ... Predominant Age: Incidence may be heavily associated with cultural expectations. It is generally less acceptable to be a feminiz... Prevalence: Overall, it is estimated that 0.6% of people identify as transgender, or approximately 1.4 million U.S. citizens per... Genetics: There is no known single or specific genetic basis for TGD identity or gender dysphoria. There appear to be no specifi... Risk Factors: Most children and adults benefit from medical care and social systems that do not pathologize their innate sense a... ?Diagnosis ?Treatment Partially Reversible Transition Irreversible Transition: The U.S. Department of Health and Human Services Departmental Appeals Board ruled Medicare’s categorica... Additional Therapies: Antiandrogens such as spironolactone or finasteride prevent male-pattern hair growth, while laser treatmen... Suggested Readings Genitopelvic Pain/Penetration Syndrome Incidence: Estimated at 11.7% to 42% of women presenting to sexual dysfunction clinics Prevalence: Affects 14% to 34% of younger women and 6.5% to 45% of older women Predominant Sex: Affects people with vulvas Risk Factors: Any previous sexual trauma, including incest or rape ?Treatment Suggested Reading Genitourinary Syndrome of Menopause Incidence: GSM can occur at any time in a woman’s life; however, it is more common during the postmenopausal phase, affecting >5... Prevalence: According to a cross-sectional population-based study, GSM and its features affect 57% of sexually active women in t... Risk Factors Systemic hormone therapy: Use of estrogen only or estrogen plus progestogen for the management of vulvovaginal symptoms. Systemi... Local estrogen treatment: Local vaginal estrogen treatment is suggested as the main treatment for GSM, combined with nonhormonal... Selective estrogen receptor modulators (SERMs): Certain SERMs with estrogen agonistic effect have shown improvement in VMI, vagi... Bazedoxifene (BZA) and conjugated estrogens (CEs): BZA (20 mg) combined with CE (0.45 or 0.625 mg) has shown significant improve... Nonhormonal treatment: Vulvovaginal symptoms can be improved by use of nonhormonal lubricants during intercourse and regular use... Fractional CO2 laser treatment Fractional CO2 laser treatment has been reported in an Australian study to be significantly effective in improving sexual functi... ?Pearls & Considerations Suggested Readings Gestational Diabetes Mellitus (GDM) Incidence: Approximately 5% of pregnant women in the U.S. will be diagnosed with GDM using the two-step approach and 18% using t... Predominant Sex and Age: Women of childbearing age; increased risk is observed in women over the age of 35 yr Genetics: Higher rate in women with a family history of GDM or type 2 diabetes in a first-degree relative; specific HLA alleles ... Suggested Readings Giant Cell Arteritis Incidence: Approximately 20 new cases per 100,000 persons >50 yr; peak incidence is in patients ages 60 to 80 yr ?Diagnosis Suggested Readings Giant Cell Myocarditis Incidence: Overall, the incidence of GCM is low. Autopsy series report an incidence of GCM ranging from 0.007% to 0.051% Predominant Sex and Age: In a large multicenter registry of GCM cases (n = 63) patients ranged in age from 16 to 69 yr at the ti... Genetics: Gene expression analysis of GCM shows that altered expression of T-cell activation genes (immune response genes), such... Risk Factors: Approximately 20% of patients who develop GCM have a history of an autoimmune disorder, including ulcerative colit... ?Treatment Suggested Readings Giardiasis Incidence (In U.S.) Prevalence (In U.S.): 4% Predominant Sex: Male = female Predominant Age Peak Incidence Genetics: Familial disposition: Patients with common variable immunodeficiency or X-linked agammaglobulinemia are at increased r... ?Pearls & Considerations Suggested Readings Gilbert Syndrome Incidence (In U.S.): Probable autosomal-dominant disease affecting >5% of the U.S. population Predominant Sex: Male:female ratio of 3:1 Genetics: Most common hereditary hyperbilirubinemia (genotypic prevalence 12%) ?Pearls & Considerations Gingivitis ?Pearls & Considerations Suggested Readings Gingivitis, Necrotizing Ulcerative (NUG) ?Diagnosis ?Treatment ?Pearls & Considerations Glaucoma, Open-Angle ?Basic Information Incidence (In U.S.): Third most common cause of vision loss (75% to 95% of all forms of glaucoma are open angle) Peak Incidence Prevalence (In U.S.) Predominant Age ?Pearls & Considerations Suggested Readings Glaucoma, Primary Angle-Closure Incidence (In U.S.) Peak Incidence: Greater >50 yr; high association with hyperopia, cataracts, and eye trauma Predominant Sex: Females are affected more often than males Predominant Age: 50 to 60 yr Genetics: Family history is not particularly helpful; far-sighted (hyperopes) individuals with thickening lenses (i.e., cataract... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Glenohumeral Dislocation ?Treatment ?Pearls & Considerations Suggested Readings Glossitis ?PEARLS & CONSIDERATIONS Gonorrhea Suggested Readings Goodpasture Disease Suggested Readings Gout Prevalence: Self-reported prevalence in the U.S. is estimated at 3.9% of adults Predominant Sex: Male:female ratio ∼4:1 Predominant Age: 30 to 50 yr in men; older than 60 yr in women Acute Gout Chronic Tophaceous Gout (Fig. E2) ?Diagnosis ?Treatment Allopurinol: Allopurinol is very effective and safe when used properly. Correct dosing and patient compliance are essential elem... Febuxostat: Febuxostat is a xanthine oxidase inhibitor that has been shown to be more potent than allopurinol 300 mg daily for r... Probenecid: Uricosuric agents may be used in patients with good renal function and urinary uric acid less than 600 mg in a 24-h ... Lesinurad: Lesinurad is a URAT1 and OAT4 inhibitor approved by the FDA in 2015 for gout-associated hyperuricemia unresponsive to... Pegloticase: Intravenous PEGylated uricase is FDA approved for treatment of severe refractory tophaceous gout. It is a PEGylated... Suggested Readings Graft-versus-Host Disease Incidence: The incidence of acute GVHD is 25% to 35% in recipients of fully matched sibling donor grafts and 40% to 50% in recip... Predominant Age And Sex: Older age and female donor-to-male recipient transplant are risk factors for GVHD Genetics: Degree of HLA mismatch is a risk factor for GVHD Risk Factors ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Granuloma Annulare Granuloma Inguinale Incidence: Rare in the U.S. (<100 cases reported annually) and other developed countries Prevalence: Endemic in some tropical and developing areas, including India, Papua New Guinea, the Caribbean, Central Australia, ... Predominant Sex: Can affect both males and females ?Pearls & Considerations Suggested Reading Granulomatosis with Polyangiitis Incidence: 3/100,000 in recent U.S. epidemiologic studies, equal in men and women, more common in whites ?Treatment Suggested Readings ?Pearls & Considerations Granulomatous Arthritis Peak Incidence: No seasonal predilection Prevalence (In U.S.): Unknown Predominant Sex: Male = female Predominant Age: Rare in childhood Suggested Reading Graves Disease Incidence/Prevalence: Graves disease is the most common cause of hyperthyroidism. It affects 3% of women and 0.5% of men during ... Predominant Age: Peak incidence is between 30 and 60 yr Genetics: Patients often report a family history of Hashimoto thyroiditis, Graves disease, or other autoimmune conditions. Incre... ?Treatment Suggested Readings Grief, Complicated or Prolonged Incidence: Studies indicate that of bereaved individuals, around 10% experience bereavement symptoms that grow or persist with t... ?Diagnosis ?Treatment Suggested Readings Guillain-Barré Syndrome Incidence: 0.6 to 1.9 cases/100,000 persons annually without geographic variation. Incidence increases with age. A slight peak i... Suggested Readings Gynecomastia ?Diagnosis ?Treatment Suggested Reading Hairy Cell Leukemia ?Diagnosis ?Treatment Related Content Suggested Readings Hallucinogenic Overdose Incidence: Used by people of all ages. The drugs commonly are used in group settings such as raves, parties, and college events Peak Incidence: Most commonly between the ages of 17 and 25 yr old Prevalence Suggested Readings ?Treatment ?Pearls & Considerations Hand-Foot-Mouth Disease Suggested Readings Related Content Hantavirus Pulmonary Syndrome Suggested Readings ?Treatment ?Pearls & Considerations Head and Neck Squamous Cell Carcinoma Incidence Peak Incidence: Sixth decade of life Predominant Sex and Age: Male:female ratio is about 3:1. Risk increases significantly over the age of 40 Genetics: Research is ongoing in genetic factors that lead to the development and progression of HNSCC. Tumor suppressor genes i... Risk Factors: The two most strongly implicated risk factors associated with HNSCC are tobacco and alcohol use. These carcinogens... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Health Care–Associated Infections (HAIs) Incidence (In U.S.) Prevalence (In U.S.): Estimated 648,000 patients with at least one HAI/yr in 2011 Predominant Sex Predominant Age: Newborns and elderly patients (>60 yr) at highest risk Peak Incidence: Varies widely with infection site Risk Factors: Patients with the following conditions can develop HAIs at any age Sources and Modes of Transmission Risks Amplified Prevention Strategies: Handwashing and hand hygiene between all patient contacts is the single most important method of decreasi... Methicillin-Resistant Staphylococcus aureus Vancomycin-Resistant Enterococcus Faecium (VREF) Clostridium difficile Norovirus Most Common Health Care–Associated Infections Health Care–Associated UTIs Health Care–Associated Bloodstream Infections Health Care–Associated Pneumonias Surgical and Health Care–Associated Soft Tissue Infections ?Pearls & Considerations Suggested Readings Heart Block, Complete ?Pearls & Considerations Heart Block, Second-Degree ?Pearls & Considerations Heart Failure Classification: The American College of Cardiology/American Heart Association (ACC/AHA) describes the following four stages of H... Terminology: Although HF has traditionally been classified as systolic vs. diastolic, this was dependent on the imaging modality... Left Ventricular Failure: The dichotomy of whether HF occurs in the setting of preserved or reduced LV systolic function plays a... Right Ventricular Failure Acute Pharmacologic Treatments Chronic Treatment of HFrEF: The goals of HF therapy are clinical improvement followed by stabilizing, slowing, or even reversing... Chronic Treatment of HFpEF Suggested Readings Heat Exhaustion and Heat Stroke Incidence (In U.S.): Incidence of heat stroke is approximately 20 cases/100,000 population ?Diagnosis ?Treatment Suggested Readings Heavy Menstrual Bleeding (Menorrhagia) Incidence: 10% to 15% of reproductive-aged women; 30% of outpatient office visits; 70% of all gynecologic consults Peak Incidence: Reproductive-aged women, ages 13 to 50 Prevalence: 9% to 14% of all women Predominant Sex and Age: Female; peak in adolescence and perimenopausal periods Genetics: Hereditary coagulopathy (most commonly von Willebrand disease, platelet dysfunction disorders) in 20% of women with he... Risk factors: Genetic predisposition, anticoagulation treatment, obesity, endocrinopathies, autoimmune disease, liver disease, r... Suggested Readings Helicobacter pylori Infection SUGGESTED READINGS HELLP Syndrome Risk Factors: Women >35 yr, white, multiparity, heritable genetics ?Treatment Suggested Readings Hemochromatosis Incidence: In whites, approximately 1 in 385 persons Predominant Sex and Age: Generally diagnosed in males in their fifth decade. Diagnosis in females is generally not made until 10... Genetics: Most common genetic disorder in North European ancestry. Homozygosity for the C282Y mutation is now found in approxima... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Hemolytic-Uremic Syndrome ?Diagnosis Suggested Readings ?Treatment Hemophilia Incidence/Prevalence (In U.S.): Hemophilia A: 100 cases per 1 million males; it is the most common severe inherited bleeding dis... Genetic: Both hemophilias have an X-linked recessive pattern of inheritance with only males affected Hemophilia A Suggested Readings Hemoptysis Incidence: Unknown, varies based on underlying pathology ?Treatment Suggested Reading Hemorrhoids Prevalence ?Pearls & Considerations Suggested Readings Heparin-Induced Thrombocytopenia Incidence: Occurs in 0.2% to 5% of patients exposed to heparin in various clinical settings. Initially, there was an overwhelmin... Predominant Sex and Age: Females are at slightly higher risk than males. More common in adults, but may also occur in children Risk Factors: Heparin type (unfractionated heparin has up to 10 times greater risk than low–molecular-weight heparin), dose (the... ?Treatment Suggested Readings Hepatic Encephalopathy ?Pearls & Considerations Suggested Readings Hepatitis A Incidence Prevalence Predominant Sex: None, except higher infection rates seen in men who have sex with men who engage in oral–anal contact Predominant Age/Peak Incidence Incubation Period: Averages 30 days (15 to 50) ?Treatment Related Content Suggested Readings Hepatitis B Incidence Prevalence Predominant Sex Predominant Age: 20 to 45 yr Peak Incidence: 30 to 45 yr of age, at rates of 5% to 20% Genetics: Neonatal infection ?Pearls & Considerations Suggested Readings Related Content Suggested Readings Hepatitis C Incidence: HCV infects more than 185 million individuals worldwide. Approximately 20% of patients chronically infected with HCV ... Prevalence (In U.S.) Predominant Sex: Slight male predominance Predominant Age: Highest prevalence in 30- to 49-yr age group (65%) Peak Incidence Genetics: Neonatal infection is rare; increased risk with maternal HIV-1 coinfection Suggested Readings Hepatitis D Incidence Peak Incidence: Peak incidence was in the 1980s Prevalence Predominant Sex and Age Genetics ?Pearls & Considerations Hepatitis E Incidence Peak Incidence Prevalence Predominant Sex and Age ?Treatment ?Pearls & Considerations Suggested Readings Hepatocellular Carcinoma Biopsy: Percutaneous biopsy under ultrasound or CT scan is obtained in the event that imaging studies are nondiagnostic or atypi... Screening: Screening high-risk patients with US every 6 mo is currently recommended to identify early-stage HCC. The use of AFP ... Staging: The commonly used Barcelona Clinic Liver Cancer (BCLC) staging system includes patient performance status, cancer sympt... ?Treatment ?Pearls & Considerations Suggested Readings Hepatopulmonary Syndrome Prevalence:Between 4% and 47% of patients with cirrhosis; the wide range is due to lack of diagnostic criteria Predominant sex and age:No data on age or gender prevalence Genetics:New data suggest that polymorphisms in genes involved in the regulation of angiogenesis are associated with increased H... Risk factors:HPS occurs with any degree or etiology of liver disease but is more prevalent in patients with established cirrhosi... ?Treatment ?Pearls & Considerations Hepatorenal Syndrome ?Diagnosis Suggested Readings Hereditary Breast and Ovarian Cancer Incidence: Overall, an estimated 6% to 10% of gynecologic cancers are heritable. Approximately 7% to 10% of the estimated 235,00... Predominant sex and age: Although females are predominantly affected, males who carry deleterious mutations in BRCA 1, 2 are at ... Genetics: The transmission pattern is autosomal dominant. A child whose father or mother has a BRCA mutation has a 50% chance of... Risk factors: BRCA1 and BRCA2 mutations can generate a greater risk of breast cancer than other such well-established factors as... Related Content Suggested Readings Hereditary Hemorrhagic Telengiectasia Incidence: 1 in 8,000 to 16,500 Prevalence: Approximately 1.2 million people worldwide Predominant Sex and Age Genetics: Inherited dominant mutation. Mutations in the endoglin gene, a cell surface component of the transforming growth facto... Suggested Readings Herpangina Predominant Sex: Male = female ?Treatment ?Pearls & Considerations Herpes Simplex Primary Infection ?Treatment ?Pearls & Considerations Herpes Simplex Keratitis Incidence: 5/100,000 to 15/100,000 per yr Peak incidence: After an episode of ocular HSV, there is a 30% chance of a recurrence within a 1-yr period Prevalence: 149/100,000 people Predominant sex & age: Equal, although some studies report a slight male predominance. There are no known patterns of age of pre... Genetics: There are no known patterns of genetic inheritance Risk factors: Risk factors include close physical contact with an HSV disease carrier and primary or latent infection with HSV-1... ?Treatment ?Pearls & Considerations Suggested Reading Related Content Herpes Zoster Hiatal Hernia ?Diagnosis ?Pearls & Considerations Suggested Readings Hidradenitis Suppurativa Prevalence: Overall prevalence in the United States is ∼1% to 2% Predominant Sex: Female: male ratio is 3:1 Predominant Age: HS most often manifests after puberty, usually in the second or third decade of life. It is rare in the elderly... Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings High-Altitude Sickness ?Diagnosis ?Pearls & Considerations Related Content Suggested Readings Hip Fracture Prevalence: Lifetime risk in women ∼16% Incidence: 350,000 hip fractures annually in the U.S Epidemiology Mortality: 20% to 25% mortality within the first yr following the fracture ?Treatment ?Pearls & Considerations Related Content Suggested Readings Hirsutism ?Pearls & Considerations Suggested Readings Histocytosis X (Langerhans Cell Histocytosis) ?Diagnosis ?Treatment Suggested Readings Histoplasmosis Suggested Readings Histrionic Personality Disorder Prevalence (In U.S.) Predominant Sex: Female. Cultural factors (e.g., attention-seeking behavior not as acceptable in men) may lead to more common di... Predominant Age: Generally begins in early adulthood Genetics: Limited research using interview and self-report methods suggests that histrionic personality disorder has a moderate ... Suggested Readings HIV-Associated Cardiomyopathy ?Treatment Suggested Readings HIV-Associated Cognitive Dysfunction ?Basic Information Suggested Readings ?Treatment Hoarding Disorder Suggested Readings Hodgkin Lymphoma ?Pearls & Considerations Related Content Suggested Readings Hookworm Incidence (in u.s.) Prevalence (in u.s.): Varies from 10% to 90% in regions where it is found Predominant age: Schoolchildren ?Pearls & Considerations Suggested Readings Horner Syndrome ?Treatment Suggested Readings Suggested Readings Hot Flashes Suggested Readings Human Immunodeficiency Virus Predominant Risk Groups Racial Data Genetics ?Treatment ?Pearls & Considerations Suggested Readings Suggested Readings Huntington Disease Peak Incidence: Late 30s and 40s, with onsets from ages 2 to 70 yr Prevalence (In U.S.): 4.1 to 8.4 cases/100,000 persons. Most common neurodegenerative cause of generalized chorea Predominant Sex: Female = male Predominant Age: Adulthood Genetics: Autosomal dominant Suggested Readings Hydrocele ?Treatment Hydrocephalus, Normal Pressure Incidence: The exact incidence is not known. In one study the incidence was found to be 5.5 per 100,000, but it may account for ... Predominant Sex: Males = females Predominant Age: NPH is more common with increasing age. In one study of 1238 patients who had undergone a head CT and neuropsyc... ?Treatment Suggested Readings Hydronephrosis History ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Hypercholesterolemia ?Pearls & Considerations Suggested Readings Hypercoagulable State Incidence, Prevalence, Predominant Sex, and Age: See Table 2. Significant variations in the prevalence rates and thrombotic risk... Genetics Risk Factors: Family history of thrombosis, increasing age, tobacco use, immobility, surgery, prior history of deep vein thrombo... Inherited: Factor V Leiden (FVL) mutation Acquired: Antiphospholipid antibody syndrome (APS) Timing of Workup ?Pearls & Considerations Suggested Readings Suggested Readings Hyperemesis Gravidarum Incidence: 0.5% to 2% of pregnancies Genetics: A genetic predisposition may exist; hyperemesis gravidarum is more common among first-degree relatives of those diagno... Risk Factors: Women with increased placental mass, including molar pregnancy or multiple gestation, family history or personal h... ?Pearls & Considerations Hypereosinophilic Syndrome ?Basic Information Predominant Sex: Occurs in men more often than women (9:1) Predominant Age: Usually occurs between the ages of 20 and 50 yr ?Diagnosis ?Treatment Hyperglycemic Hyperosmolar Syndrome Aggressive Intravenous Fluid Replacement: Due to trivial ketonemia and the insulin sensitivity of most HHS patients, initial tre... Insulin: Once glucose is no longer significantly improving with fluids alone, reassess patient’s fluid status and initiate intra... Potassium replacement: Insulin therapy shifts potassium intracellularly, frequently causing hypokalemia. If serum potassium at p... Phosphorus and magnesium replacement Transition to subcutaneous insulin: Normalization of serum osmolality and mental status indicates resolution of HHS. At this poi... Chronic therapy: Most patients will need insulin at discharge, at least short term. Patients whose diabetes was previously well ... ?Pearls & Considerations Hyperhidrosis ?Basic Information Peak Incidence: The average age of onset is 25 yr Prevalence: The condition is most common among people aged 25 to 64 yr Predominant Sex and Age: Equal proportions male and female Genetics: Unknown Risk Factors: None known for primary, but secondary has numerous causes (see Table 1) ?Diagnosis ?Treatment Suggested Readings Hyperkalemia Incidence & Prevalence Predominant Sex & Age Genetics: Other syndromes that may be associated with hyperkalemia include Risk Factors: Primary risk factor is CKD, especially if eGFR is <45 ml/min/1.73m2 more commonly associated with diabetes mellitu... ?Treatment ?Pearls & Considerations Suggested Readings Hyperlipoproteinemia, Primary Incidence: The most common types are lipoprotein A excess, hypertriglyceridemia, and combined hyperlipidemia ?Pearls & Considerations Suggested Readings Hypernatremia ?Treatment ?Pearls & Considerations Suggested Readings Hyperparathyroidism Incidence: Four cases per 100,000 persons per yr. Although malignancy is the most common cause of hypercalcemia in hospitalized ... Prevalence: Varies by country and race with approximately nine cases/1000 persons in the United States Predominant Sex and Age: Higher prevalence in women (female:male ratio 3 to 4:1) and older age (peaks in the seventh decade of l... ?Treatment Suggested Readings Hypersensitivity Pneumonitis ?Diagnosis Suggested Readings Hypersplenism Suggested Readings Hypertension ?Basic Information Treatment of renovascular hypertension: The therapeutic approach varies with the cause of the renovascular hypertension (RVH) (r... HTN During Pregnancy Malignant HTN, Hypertensive Emergencies, and Hypertensive Urgencies: Definitions ?Pearls & Considerations Hyperthyroidism Incidence/Prevalence Antithyroid drugs (thionamides): Propylthiouracil (PTU) and methimazole inhibit thyroid hormone synthesis by blocking production... Radioiodine therapy (radioactive iodine [rai; 131i]) Surgical therapy (subtotal thyroidectomy) Adjunctive therapy: Propranolol alleviates the beta-adrenergic symptoms of hyperthyroidism; initial dose is 20 to 40 mg PO q6h; ... ?Pearls & Considerations Suggested Readings Hypertrophic Osteoarthropathy ?Diagnosis ?Treatment Author: Daphne Scaramangas-Plumley, MD Suggested Readings Hyperuricemia ?Treatment Suggested Readings Hypoactive Sexual Desire Disorder (HSDD) Peak Incidence: Prevalence of low sexual desire increases with age. Middle-aged women (45 to 65 yr old) and men over 60 appear a... Prevalence Predominant Sex & Age: HSDD appears to be more prevalent in women; however, men are more likely to be underdiagnosed or misdiagn... Genetics: There appears to be a strong influence of genetics in the vulnerability of women to sexual dysfunction. Specifically, ... Risk Factors: Temperamental and environmental risk factors for HSDD include mood and anxiety symptoms, negative cognitions about... Suggested Readings Hypoaldosteronism ?Pearls & Considerations Hypochondriasis (Illness Anxiety Disorder) Prevalence: 1% to 5% (based on estimates of DSM-III and DSM-IV disorder hypochondriasis) but may be higher (3% to 10%) in primar... Predominant Sex: Equal frequency in men and women Predominant Age: Onset at any age, but most commonly between ages 20 and 30 yr Suggested Readings Hypocomplementemic Urticarial Vasculitis incidence Peak Incidence: The peak reported incidence is in the fourth decade of life Prevalence: The prevalence of UV in patients with chronic urticaria varies from 5% to 20% predominant Age And Sex Genetics: A study including two families with autosomal-recessive HUVS found that mutations in DNASE1L3 were associated with a f... Risk Factors The most common abnormal laboratory results associated with urticarial vasculitis (UV) include Suggested Reading Hypoglycemia Fasting: If symptoms witnessed when fasting, with verified low blood glucose levels, draw the following labs: Plasma glucose, β-... Postprandial 72-Hr Fast Suggested Readings Hypogonadism Incidence: Hypogonadism is the most common clinical disorder of the testis. Incidence is unclear due to the many possible underl... Prevalence: Prevalence of hypogonadism increases with aging, obesity, diabetes mellitus, and other comorbidities. The average de... Genetics: Genetic abnormalities underlie a number of hypogonadal disorders including Klinefelter syndrome, Noonan syndrome, hemo... Risk Factors: These are many and include genetic abnormalities; the aging process; pituitary and testicular lesions and disorder... ?Treatment ?Pearls & Considerations Suggested Readings Hypokalemic Periodic Paralysis ?Diagnosis Suggested Reading Suggested Reading Hypomagnesemia ?treatment ?Pearls & Considerations Suggested Readings Suggested Readings Hyponatremia Prevalence: The prevalence of hyponatremia varies widely according to setting and population age. In the general U.S. population... Predominant Sex and Age: Prevalence of hyponatremia was significantly higher in women in the NHANES dataset (2.09%; P=0.004) and... Genetics: The hyponatremic disorder, nephrogenic syndrome of inappropriate antidiuresis (NSIAD), is caused by rare familial gain... Risk Factors: In NHANES, hyponatremia was more common in subjects with hypertension, diabetes, coronary artery disease, stroke, ... ?Pearls & Considerations Prevention: Well-meaning family members, friends, news media, and health care providers often encourage patients with chronic ki... Syndrome of Inappropriate Antidiuresis (Related Key Topic) Suggested Readings Hypoparathyroidism ?Treatment Suggested Readings Hypopituitarism ?Diagnosis ?Treatment Hypospadias Prevalence Penile Curvature (Chordee): Three theories Classification Based on Meatal Position Special Considerations Hormonal Manipulation Complications of Repair: Hematoma, meatal stenosis, fistula, urethral stricture, urethral diverticulum, wound infection, impaire... Suggested Reading Hypothermia ?Diagnosis Suggested Reading Suggested Reading Hypothyroidism ?Basic Information Incidence & Prevalence: 1.5% to 2% of women and 0.2% of men. Overall, about 1 in 300 persons in the U.S. has hypothyroidism Predominant Age: Incidence of hypothyroidism increases with age; among persons older than 60 yr, 6% of women and 2.5% of men hav... Suggested Readings Suggested Readings ID Reaction ?Diagnosis ?Treatment Idiopathic Intracranial Hypertension Incidence Risk Factors Symptoms Signs Modified Dandy Criteria For Diagnosis Of Iih Suggested Readings Idiopathic Pulmonary Fibrosis ?Treatment Suggested Readings IgA Nephropathy Incidence: IgA nephropathy (IgAN) is the most common primary glomerulopathy worldwide. The annual incidence of IgAN in the U.S. ... Prevalence: Prevalence data ranges from 1.3% to 16% in the general population based on autopsy studies that demonstrate renal Ig... PREDOMINANT Sex and Age: IgAN is most prevalent in the second and third decades of life with a male:female ratio of 2:1 in the U... Genetics and Pathogenesis: The primary defect is systemic aberrant glycosylation resulting in galactose-deficient IgA1 (Gd-IgA1)... Risk Factors: There are greater associations in Asians, whites, and Native Americans, but IgAN is relatively rare in African Ame... ?Treatment ?Pearls & Considerations Suggested Readings Authors: Dhruti P. Chen, MD, and Koyal Jain, MD Suggested Readings IgA Vasculitis IgA vasculitis (IgAV, formerly known as Henoch-Schönlein purpura [HSP]) is a systemic, small-vessel, IgA immune complex–mediated... Incidence: Annual incidence of 3 to 27 cases/100,000 population in children. Approximately 1/100,000 in adults Prevalence: Most common vasculitis seen in children and younger age groups; seen in white and Asian populations (primarily from ... Predominant Sex and Age: Approximately 2:1 male:female ratio. Seen mostly from ages 3 to 12 with peak incidence between 4 and 6 ... Peak Incidence: Late autumn to early spring, rarely in summer. Seasonal variation is not seen in adults Genetics: Recent studies have identified genetic susceptibility factors, but familial recurrence is very rare. There appears to ... Risk Factors: There are no formally identified risk factors; however, viral precipitants have been theorized to trigger onset of... ?Diagnosis Suggested Readings IgG4-Related Disease Incidence and Prevalence: Exact incidence and prevalence are unknown. Most epidemiologic information comes from Japanese studies... Predominant Sex/Age: Among two study cohorts of 765 patients, mean age of symptom onset was 57.7 and 59.5 yr. There may be a sli... Risk Factors: Tobacco, asbestos exposure, atopy, history of malignancy ?Treatment Suggested Reading Suggested Readings Immune Thrombocytopenic Purpura Incidence: Primary ITP occurs in 10 in 100,000 adults and 5 in 100,000 children Prevalence: Five to 10 cases per 100,000 persons Predominant Sex: 72% of patients >10 yr are female; among children, males are more commonly affected Predominant Age: Children ages 1 to 6 yr and young women (70% are <40 yr). New onset of ITP after age 60 yr is uncommon; compreh... Suggested Readings Impetigo ?Pearls & Considerations Suggested Readings Inclusion Body Myositis Incidence: 0.22 to 0.79 cases/100,000 persons; uncommon in Asians and African Americans Prevalence: 0.5 to 7.1 cases/100,000 persons Predominant Sex: Male:female ratio: 1.3:1 Predominant Age: 87% older than 50 yr; mean age of 60 yr Peak Incidence: Seventh decade Risk Factors: None known Genetics: Less than 10% of cases familial Suggested Reading Incontinence, Bowel, Elderly Patient Incidence: Affects 0.5% to 1.5% of the population younger than age 65, but >10% older than 65. More common in institutionalized ... Prevalence: Varies widely depending on definition used and population studied; often underreported. In community-based studies, ... Predominant Sex and Age: Slightly more common in females than males and those of advanced age (older than 65 yr) Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Incontinence, Urinary ?Diagnosis ?Treatment ?Pearls & Considerations Infantile Hypotonia ?Treatment Infertility Prevalence: One in eight reproductive age couples experience infertility. This prevalence is consistent in all developed countri... Predominant Sex And Age: By definition this is a diagnosis of reproductive age couples. Infertility increases with aging in both... Peak Incidence: The incidence of infertility increases with age. Subtle decreases in female fertility start as early as age 30. ... Risk Factors: Aging is among the most common risk factors, predominantly among females, although there is evidence that aging af... ?Treatment ?Pearls & Considerations Author: Emelia Argyropoulos Bachman, MD Suggested Readings Inflammatory Myopathies ?Diagnosis ?Treatment Suggested Readings Influenza Peak Incidence: Winter outbreaks lasting 5 to 6 wk Predominant Sex: Male = female Predominant Age: Attack rates are usually higher among children than adults, although children are less prone to pulmonary compl... Incidence (In U.S.): Annual incidence of influenza-related deaths is between 12,000 and 51,000 deaths/yr ?Pearls & Considerations Related Content Suggested Readings Influenza, Avian Predominant Sex and Age: Children and young adults ?Treatment ?Pearls & Considerations Suggested Readings Inguinal Hernia Incidence: Incidence is unknown Prevalence: Approximately 5% of the population experiences an abdominal hernia, and 75% of these are inguinal hernias. Two third... Predominant Sex and Age: Male gender and increasing age are associated with increased incidence of inguinal hernias Peak Incidence: Increases with age Risk Factors: History of hernia repair, older age, male sex, Caucasian race, family history, smoking ?Treatment Suggested Readings Insomnia Incidence (In U.S.): 20% to 30% of adults experience occasional bouts of acute insomnia Prevalence (In U.S.): The prevalence of chronic insomnia disorder ranges from 6% to 10% Predominant Sex: More common in women Predominant Age: Transient insomnia can occur at any age; persistent insomnia can also occur at any age but is more common after... Genetics: Can run in families and may be genetically influenced. Circadian rhythm disorders and narcolepsy have been traced to s... ?Diagnosis ?Pearls & Considerations Suggested Readings Insulinoma Incidence: One case per 250,000 persons annually. 90% of insulinomas are benign ?Treatment Suggested Reading Anchor 76 Intermittent Explosive Disorder (IED) Incidence: Unknown Peak Incidence: Occurs earlier in life Prevalence: Lifetime prevalence of 6% to 7% Predominant Sex and Age: Occurs more so in males and in people under the age of 50 Genetics: Patients with intermittent explosive disorder (IED) are more likely to have first-degree relatives with the disorder. ... Risk Factors: Prior history of violence, exposure to trauma, comorbid depression, anxiety, substance abuse or dependence, or clu... ?Treatment (Table E1) ?Pearls & Considerations Suggested Readings Interstitial Lung Disease Incidence And Prevalence: Varies widely with type of ILD. The most common ILDs are sarcoidosis, cryptogenic organizing pneumonia... Predominant Sex & Age: Some ILDs are more common in women, such as those resulting from connective tissue disorders. Lymphangiom... Risk Factors: Although many ILDs are categorized as idiopathic, the most common identifiable risk factors include environmental ... ?Pearls & Considerations Suggested Readings Interstitial Nephritis Prevalence Demographics Risk Factors Signs and Symptoms Acute Interstitial Nephritis Chronic Interstitial Nephritis Overlap of Acute and Chronic Interstitial Nephritis: Some metabolic processes and autoimmune disorders can present either as acu... ?Treatment ?Pearls & Considerations Suggested Readings Intraventricular Conduction Delay (IVCD) ?Diagnosis ?Treatment Suggested Readings Irritable Bowel Syndrome ?Pearls & Considerations Suggested Readings Ischemic Colitis Incidence: It is the most common type of intestinal ischemia with an annual incidence of 15.6 to 17.7 per 100,000 Peak Incidence: Unknown Prevalence: Unknown Predominant Sex and Age Risk Factors General ?Treatment ?Pearls & Considerations Suggested Readings Ischemic Hepatitis Incidence Peak Incidence: Highest in the cardiac care units Prevalence Predominant Age and Sex Genetics: No genetic predisposition Risk Factors ?Diagnosis ?Pearls & Considerations Ischemic Optic Neuropathy Incidence PREDOMINANT Age, Race, and Sex Risk Factors ?Treatment Authors: Paul D. Chamberlain, MD, and Joseph S. Kass, MD, JD, FAAN Suggested Readings Jaundice in the Adult Patient ?Treatment Suggested Readings Junctional Rhythm Incidence: Junctional rhythm occurs more commonly in children due to higher vagal tone (13% of 10- to 13-yr-old boys, 45% of 7- ... Prevalence: Junctional tachycardia is a rare cause of supraventricular tachycardia. It is rare in the pediatric population and e... Genetics: There is no known hereditary component Risk Factors: Conduction system disease, heart block, digitalis intoxication, heart surgery, endocarditis Essential History Symptoms Physical examination ?Treatment ?Pearls & Considerations Suggested Reading Juvenile Idiopathic Arthritis ?Pearls & Considerations Related Content Suggested Readings Kaposi Sarcoma ?Pearls & Considerations Suggested Readings Kawasaki Disease ?Diagnosis ?Treatment Suggested Readings ?Pearls & Considerations Keloid Risk Factors ?Diagnosis ?Treatment Klinefelter Syndrome Incidence: 1 in 500 men (most common sex chromosome disorder) ?Diagnosis ?Treatment ?Pearls & Considerations Korsakoff Psychosis ?Pearls & Considerations Suggested Reading Labyrinthitis Incidence (In U.S.): Most common cause of prolonged spontaneous vertigo associated with nausea at any age Predominant Age: Any Clinical Presentation ?Pearls & Considerations Lactic Acidosis ?Pearls & Considerations Suggested Readings Lactose Intolerance ?Pearls & Considerations Suggested Readings Lambert-Eaton Myasthenic Syndrome Incidence: Uncertain; estimated at five cases per 1 million persons annually (in U.S.) Peak Incidence: Sixth decade Prevalence: Uncertain; estimated at one per 100,000 (in U.S.). Up to 3% of small cell lung cancer (SCLC) patients are estimated ... Predominant Sex: Male:female ratio of 2:1 ?Treatment Patient Information Suggested Readings Large Bowel Obstruction Peak Incidence: 73 yr of age, higher in the elderly due to increased rates of colorectal cancer Prevalence: 25% of intestinal obstructions Predominant Sex And Age: Affects males and females equally, more common in the elderly Risk Factors: Colorectal cancer, prior abdominal surgery, prior colorectal resection, chronic constipation, radiation, diverticu... ?Treatment Suggested Readings Laryngeal Carcinoma Suggested Readings Laryngitis Acute Laryngitis Chronic Laryngitis: Characterized by hoarseness or dysphonia persisting for longer than 2 wk Acute Laryngitis Chronic Laryngitis Suggested Reading Lead Poisoning ?Pearls & Considerations Legg-Calvé-Perthes Disease Incidence: Four to thirty-two cases per 100,000 children. Varies by country. More common in Caucasians, lower socioeconomic stat... Predominant Sex: Male:female ratio of 5:1 Predominant Age: 4 to 8 yr old Suggested Readings Legionnaires Disease Prevalence: Rough estimates of 18 to 36 cases per 100,000, mostly sporadic cases, occasional community outbreaks due to contamin... Predominant Sex and Age: Male gender with twofold increased risk, age >50 Risk Factors: Chronic heart disease, smoking, end-stage renal disease, immunosuppression, cancer. No person-to-person transmissi... ?Treatment ?Pearls & Considerations Suggested Readings Leishmaniasis Incidence: ∼2 million total new cases and 500,000 visceral cases occur each yr with almost 400 million people at risk for the di... Specific Antileishmanial Therapy: Visceral leishmaniasis Extraintestinal leishmaniasis Cutaneous leishmaniasis (mild disease) Cutaneous leishmaniasis (moderate disease) ?Pearls & Considerations Suggested Readings Lemierre Syndrome Incidence: 0.6 to 3.6 cases per million overall but increases to 14.4 cases per million in ages 15 to 24 yr, and cases seem to b... Peak Incidence: In one study of 114 patients with Lemierre syndrome, the median age was 22 yr Risk Factors: Cases appear to be more common in the 15 to 24 yr age group due to involution of tonsillar tissue predisposing thi... ?Treatment ?Pearls & Considerations Suggested Readings Leprosy ?Diagnosis ?Pearls & Considerations Suggested Readings Leptospirosis Incidence (In U.S.) Peak Incidence: Summer months, into the fall Predominant Sex: Male (4:1) Predominant Age: Teenagers and young adults Genetics: Neonatal infection can occur Anicteric Form Icteric Leptospirosis (Weil Syndrome) Suggested Readings Levator Ani Syndrome Incidence: Unknown Prevalence: 6.6%, by survey Predominant Sex And Age: Unknown Peak Incidence: Unknown Risk Factors: Middle age (30 to 60), Women Genetics: Unknown ?Pearls & Considerations Suggested Readings Lichen Planus Incidence: One in every 100 new patients seen in dermatology clinics in the United States is diagnosed with LP Prevalence: 440 cases/100,000 persons Predominant Sex: Found equally between males and females (1:1) Predominant Age: Usually found in people between the ages of 30 and 60 yr Predisposing Factors ?Diagnosis For cutaneous LP For oral LP ?Pearls & Considerations Suggested Readings Lichen Sclerosus ?Pearls & Considerations Suggested Reading Lichen Simplex Chronicus Peak Incidence: Between 35 and 50 yr old Prevalence: Increased in patients with underlying anxiety disorders Predominant Sex and Age Risk Factors: Anxiety disorders, dry skin, insect bites Listeriosis Incidence (In U.S.) Predominant Sex: Pregnant women are more susceptible to Listeria bacteremia, accounting for up to one third of reported cases Predominant Age Genetics: Congenital infection ?Treatment ?Pearls & Considerations Suggested Readings Liver Abscess Incidence: Incidence of pyogenic liver abscess is 2.3 cases per 100,000 population Prevalence (Worldwide): Amebic liver abscess is more common than pyogenic liver abscess Prevalence (In U.S.): Pyogenic liver abscess is more common than amebic liver abscess Predominant Sex and Age: More common in men than women; male/female ratio of 2:1; most common in fourth to sixth decades of life... ?Diagnosis ?Treatment ?Pearls and Considerations Liver Transplantation Incidence: Number of patients on liver transplant list exceeds 15,000 Prevalence: 6000 liver transplants are performed annually in the U.S Genetics: Genetic factors that may induce end-stage liver failure include hemachromatosis, Wilson disease, alpha-1 antitrypsin d... ?Treatment ?Pearls & Considerations Suggested Readings Long QT Syndrome ?Pearls & Considerations Suggested Readings Lumbar Disk Syndrome Prevalence Predominant Sex: Male:female ratio is roughly 2:1 Predominant Age: Herniation: 30 to 50 yr Risk Factors: Smoking, obesity, weight-bearing sports (weightlifting, hammer throw), male, family history, and certain work acti... Suggested Readings Lung Abscess Incidence: Has decreased over the last 30 yr as a result of antibiotic therapy ?Diagnosis ?Pearls & Considerations Suggested ReadingS Lung Neoplasms, Primary Adenocarcinoma: Represents 35% to 40% of lung carcinomas; frequently located in mid-lung and periphery; initial metastases are t... Squamous Cell: Represents 20% to 30% of lung cancers; central location; metastasis by local invasion; frequent cavitation and ob... Small Cell: Represents 15% of lung carcinomas; central location; metastasis through lymphatics; associated with lesion of the sh... Large Cell: Represents 10% to 15% of lung carcinomas; frequently located in the periphery; metastasis to central nervous system ... Lepidic-Predominant Pattern (Bronchoalveolar): Represents 5% of lung carcinomas; frequently located in the periphery; may be bi... ?Diagnosis Non–Small Cell Carcinoma Small Cell Lung Cancer Related Content Suggested Readings Lyme Disease Incidence (In U.S.): In the U.S., 4.4 cases/100,000 persons; it is the most common vector-borne infection in the U.S., with more... Peak Incidence: May to November Predominant Sex: Male = female Predominant Age: Median age of 28 yr ?Diagnosis ?Treatment Suggested Readings Lymphangitis Incidence (In U.S.): Several hundred cases/yr of sporotrichoid lymphangitis, which is a fungal infection; bacterial lymphangitis... Acute Lymphangitis Sporotrichoid or Nodular Lymphangitis ?Pearls & Considerations Suggested Readings Lymphedema Primary Lymphedema Secondary Lymphedema: See specific etiology in the following Stage 0: Latency Stage I: Reversible Stage II: Spontaneously Irreversible Stage III: Elephantiasis Etiology: Lymphedema is caused by a reduction in lymphatic system transport and is classified into primary and secondary forms Primary Lymphedema Secondary Lymphedema ?Diagnosis Lymphogranuloma Venereum Incidence (In U.S.): Rare; <300 cases/yr Prevalence: Endemic in Africa, India, parts of Southeast Asia, South America, and the Caribbean Predominant Sex: Male:female ratio is 5:1 ?Pearls & Considerations Suggested Reading Lynch Syndrome Risk Factors: Family history of colon cancer or other hereditary nonpolyposis colorectal cancer (HNPCC)-related cancers such as ... ?Treatment Suggested Readings Macular Degeneration Incidence (In U.S.) Peak incidence Prevalence (In U.S.) Predominant Sex: Males and females are affected equally (15% of white women >80 yr have severe AMD) Predominant Age: >50 yr Risk factors ?Pearls & Considerations Suggested Readings Malabsorption Predominant Sex and Age: More common in females, with a mean age of 40 Genetics: HLA-DQ2 present in 95% of celiac disease Risk Factors ?Diagnosis ?Treatment ?Pearls & Considerations Malaria Common Errors in Reading Malarial Smears Molecular Diagnosis of Malaria Antimosquito Measures Uncomplicated Chloroquine-Sensitive Plasmodium vivax, Plasmodium ovale, or Plasmodium malariae (Non-Falciparum Malaria) Uncomplicated Falciparum Malaria or Species Not Identified Alternatives Severe Falciparum Malaria Multidrug-Resistant Malaria Risk Factors for Fatal Malaria Complications of Malaria ?Pearls & Considerations Prevention of Malaria: Medications are available for the prophylaxis of malaria and will vary depending on level of chloroquine ... Special Considerations Prevention of Relapse2 Vaccination Malaria Information Suggested Readings Malignant Hyperthermia Prevalence: In the general population, between 1:2000 to 1:3000 are thought to carry a defective gene for the ryanodine receptor... Predominant Sex and Age: MH male to female ratio is 2:1. Children account for up to half of cases Peak Incidence: Among patients undergoing general anesthesia, the incidence is approximately 1:100,000. It is widely believed th... Risk Factors Etiology: Approximately 50% of cases of MH susceptibility (MHS) are inherited (primarily MH1 and MH5); the remainder are presume... Susceptibility Testing ?Pearls & Considerations Suggested Readings Suggested Readings Mallory-Weiss Tear Suggested Readings Marfan Syndrome ?Treatment Mastitis Prevalence: Lactational mastitis occurs in up to 33% of mothers Predominant Sex: Females Risk Factors ?Pearls & Considerations Suggested Readings Mastocytosis Author: Ritesh Rathore, MD Suggested Readings Mastodynia Mastoiditis Incidence (in U.S.): Since the introduction of antibiotic therapy and use of broad-spectrum antibiotics, there has been a marked... Predominant Sex: More common in males Predominant Age: 2 mo to 18 yr Peak incidence: Early childhood Suggested Readings Measles (Rubeola) ?Treatment Suggested Reading Meckel Diverticulum ?Treatment Mediastinitis Incidence: Incidence of postoperative mediastinitis ranges from 0.4% to 5% ?Treatment Suggested Readings Medical Marijuana Related Content Suggested Readings Medication-Related Osteonecrosis of the Jaw Incidence Peak Incidence Prevalence Predominant Sex and Age Genetics Risk Factors ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Meigs Syndrome Authors: Nima R. Patel, MD, MS, and Terri Q. Huynh, MD, MSCR Suggested ReadingS Melanoma ?Treatment Suggested Readings Related Content Suggested Readings Ménière Disease Incidence (in U.S.): Approximately 190/100,000 persons Predominant Sex: Female:male ratio of 1.3:1 Peak Incidence: Fourth to sixth decade of life ?Diagnosis Suggested Readings Related Content Suggested Readings Meningioma Incidence: 7.92/100,000 persons/yr, but increases with age. Most common primary type of central nervous system tumor, and most c... Predominant Sex and Age: Female:male ratio of almost 3:1 (in ages 35 to 54) in the brain and up to 6:1 in the spinal cord; 1:1 i... Peak Incidence: Males: Sixth decade, females: Seventh decade, incidence increases with age, dramatic increase in incidence after... Risk factors: Ionizing radiation results in increased incidence and a shorter latency period. Neurofibromatosis type 2 (NF2) is ... Genetics: Meningiomas may be isolated or found in association with other genetic diseases, such as NF2 and familial meningioma. ... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Meningitis, Bacterial Incidence (In U.S.): 1.3 to 2.0 cases/100,000 persons; 1.2 million cases per yr in the world; 135,000 deaths annually worldwide.... Predominant Sex: Male = female Predominant Age: All ages, neonate to geriatric ?Diagnosis ?Treatment ?Pearls & Considerations suggested Readings Meningitis, Fungal Incidence: Overall attack rate is calculated at 4.4 cases per 100 persons potentially exposed Predominant Age and Sex Peak Incidence: Occurs within 6 wk of receiving an epidural or paraspinal injection of methylprednisolone contaminated with the ... Risk Factors: The source of this outbreak was traced to a single compounding pharmacy (New England Compounding Center). E. rostr... ?Treatment ?Pearls & Considerations Suggested Readings Meningitis, Viral Incidence (In U.S.): 11 cases/100,000 persons; leads to 26,000 to 42,000 hospitalizations per yr Predominant Sex: Male = female Genetics: Those with abnormal humoral immunity and agammaglobulinemia have associated difficulty with viral clearance ?Diagnosis ?Treatment Suggested Readings Meningomyelocele Incidence (In U.S.): 4.6/10,000 births Predominant Sex: Male = female Peak Incidence: Newborn Genetics: Environmental and genetic factors have a joint role ?Diagnosis ?Treatment Suggested Readings Meniscal Tear Incidence Peak Incidence Prevalence (In U.S.) Predominant Age and Sex Risk Factors: Trauma, age ?Treatment ?Pearls & Considerations Menopause ?Pearls & Considerations Suggested Readings Meralgia Paresthetica Incidence: The incidence rate for males and females is similar, and it is one of the most common mononeuropathies of the lower l... Peak Incidence: The mean age at diagnosis is 50 yr old Risk Factors: Obesity, diabetes mellitus, and older age are the most commonly associated conditions. Other risk factors include ... ?Diagnosis Suggested Readings Mesenteric Adenitis ?Diagnosis Mesenteric Venous Thrombosis Acute MVT Subacute MVT Chronic MVT Hypercoagulable States Portal Hypertension Inflammation Postoperative State or Trauma ?Treatment Mesothelioma, Malignant ?Treatment Related Content Suggested Readings Metabolic Syndrome Suggested Readings ?Pearls & Considerations Metatarsalgia ?Treatment Suggested Readings Methanol and Ethylene Glycol Poisoning ?Diagnosis ?Treatment Suggested Readings Methicillin-Resistant Staphylococcus aureus (MRSA) Incidence: 1:3000 Peak Incidence: Occurs yr-round; may peak during summer and fall mos for CA-MRSA Prevalence: The national rate of MRSA colonization or infection is 46.3 per 10,000 inpatients. Hospital prevalence rate of MRSA ... Predominant Age and Sex: All ages and both sexes Risk Factors ?Treatment Suggested Readings Microangiopathic Hemolytic Anemia ?Diagnosis ?Treatment Suggested Reading Microscopic Colitis (Lymphocytic Colitis) Incidence: Incidence of microscopic colitis is 24 to 103 in 100,000 person-yr Peak Incidence: Most cases of microscopic colitis are diagnosed in patients 60 to 70 yr of age Prevalence: Approximately 7.5% of patients who undergo workup for chronic watery diarrhea are diagnosed with MC Predominant Age and Sex: Microscopic colitis, more specifically the collagenous variant, is often diagnosed later in life (>65 y... Genetics: It is unclear how important specific genetic polymorphisms are in the pathophysiology of MC. However, a recent study d... Risk Factors ?Treatment ?Pearls & Considerations Related Content Suggested Readings Microscopic Polyangiitis Suggested Readings Microsporidiosis Prevalence: Prevalence in immunocompetent persons is unclear, with rates varying from 5% to 45% in recent studies of stool from ... ?Pearls & Considerations Suggested Readings Middle East Respiratory Syndrome (MERS) Incidence: In one study in Saudi Arabia of more than 10,000 people, the positive serology rate was only 0.15%, was higher in men... ?Pearls & Considerations Suggested Readings Migraine Headache Incidence: Increases from infancy, peaks during the third decade of life, then decreases Prevalence (In U.S.): Migraine is very common, affecting 1 in 6 people in the U.S. It is the fourth or fifth most common reason ... Age: Peak prevalence between ages of 18 and 49 Predominant Sex: Female:male ratio of 3:1 Genetics: Familial predisposition: More than 50% of migraine sufferers have an affected family member ?Diagnosis ?Treatment Suggested Readings Mild Cognitive Impairment Incidence Peak Incidence: In the elderly Prevalence: 15% to 25% in those older than age 70 Predominant Sex and Age: Male, age ≥75 Genetics: APOE4 genotype Risk Factors: Male sex, age, lower socioeconomic status, lower educational level ?Treatment Mitral Regurgitation ?Pearls & Considerations Suggested Readings Mitral Stenosis Suggested Reading Mitral Valve Prolapse ?Pearls & Considerations Suggested Reading Mixed Connective Tissue Disease Prevalence: Rare, with little data. From a 2011 Norwegian study, 3.8 per 100,000 adults Predominant Sex: Female predominant, ranging from 3:1 to 15:1 Predominant Age: Average age at onset is 37 yr, with range between 40 and 80 yr ?Treatment Suggested Readings Molar Pregnancy Incidence: 1/1500 pregnancies in the U.S Predominant Sex & Age: Females of reproductive age, highest rates at extremes of reproductive ages Risk Factors ?Diagnosis ?Treatment Suggested Readings Molluscum Contagiosum ?Diagnosis ?Pearls & Considerations Monoclonal Gammopathy of Renal Significance ?Diagnosis ?Treatment Suggested Readings Monoclonal Gammopathy of Undetermined Significance (MGUS) Incidence: In the U.S., the estimated age-adjusted incidence of MGUS is higher in men than in women. The annual incidence of MGU... Prevalence: MGUS is associated with increasing age; approximately 1.5% of persons older than 50 yr and 3.0% of persons older tha... Predominant Sex & Age: The median age at diagnosis is about 70 yr. Prevalence is higher in men than in women at any given age Risk Factors: Race (African American), older age, male sex, or exposure to pesticides. Environmental and/or genetic defects play... ?Treatment Authors: Jorge J. Castillo, MD, and Irene M. Ghobrial, MD Suggested Readings Mononucleosis Incidence (In U.S.): 500 cases/100,000 persons/yr; worldwide, approximately 90% lifetime prevalence by age 30 yr Predominant Sex: Incidence is the same, but occurs earlier in females Predominant Age: Symptomatic infection most common between the ages of 15 and 24 yr. The age at which primary EBV infection is a... ?Pearls & Considerations suggested Readings Morton Neuroma ?Pearls & Considerations Suggested Readings Motion Sickness Incidence (In U.S.): Common Prevalence (In U.S.): Common Predominant Sex: Male = female Predominant Age: Any age Peak Incidence: Any age Genetics: Not known to be genetic ?Pearls & Considerations Mucormycosis ?Diagnosis ?Treatment Suggested Readings Multidrug-Resistant Gram-Negative Rods (MDR-GNRs) Incidence: There is an increasing incidence of these bacteria in hospitals and long-term care facilities in the U.S. and around ... Predominant Sex & Age: These bacteria can be seen in any age group. They may be more frequent in women due to increased risk of ... Risk factors: In general, these bacteria are more common in hospitals and long-term care facilities, but they are spread nosocom... ?Treatment Suggested Readings Multifocal Atrial Tachycardia ?Treatment Suggested Readings Multiple Endocrine Neoplasia Incidence Prevalence Genetics Risk Factors: Family history of MEN syndrome, although it can also occur sporadically ?Treatment ?Pearls & Considerations Suggested Readings Multiple Myeloma Annual Incidence Suggested Readings Multiple Sclerosis Peak Incidence: 20 to 40 yr in two thirds of patients; it is the most common permanently disabling disorder of the central nervo... Prevalence: More common in people raised in northern latitudes and in certain genetic clusters. Prevalence per 10,000 varies fro... Predominant Sex & Age: Female/male ratio is 2 to 3:1 Genetics: Frequency of MS in dizygotic twins and siblings is 3% to 5%, and 20% to 40% in monozygotic twins. Most common associat... ?Diagnosis ?Treatment Suggested Readings Multiple System Atrophy Incidence: Estimated mean incidence is 0.6 to 0.7 cases per 100,000 persons per yr, with a range of 0.1 to 2.4 cases Prevalance Predominant Sex & Age Risk Factors: People with MSA perform some activities more often than the general population, such as drinking alcohol and tea, ... Genetics: A large, genome-wide association study found no significant loci, including no association with the SNCA and COQ2 gene... ?Treatment Suggested Readings Mumps Incidence (In U.S.) Predominant Sex: Males = females Predominant Age: 75% of disease in teenage years Peak Incidence: Late winter and early spring months Genetics Suggested Readings ?Pearls & Considerations Muscular Dystrophy Incidence Mushroom Poisoning ?Treatment Suggested Reading Myasthenia Gravis Incidence (In U.S.): 8 to 10 cases annually per 1 million persons. It is the most common disorder of neuromuscular junction tran... Prevalance (In U.S.): 150 to 250 cases per 1 million Predominant Sex: Females are affected more often than males (3:2) in adults; they are equally affected in the elderly Peak Incidence: Female, second to third decades; male, sixth to eighth decades Genetics: Increased frequency of HLA-B8, DR3 Suggested Readings Mycosis Fungoides ?Diagnosis ?Treatment Suggested Readings Myelodysplastic Syndrome Incidence (In U.S.): Approximately five new cases/100,000 persons per yr. An estimated 30,000 new cases are diagnosed annually i... ?Treatment ?Pearls & Considerations Related Content Suggested Readings Myocardial Infarction ?Pearls & Considerations Myocarditis ?Diagnosis (Table 1) ?Treatment Myoclonus Incidence: 1.3/100,000 persons Prevalence: 8.6/100,000 persons Predominant Sex & Age: No gender preference; age at onset varies by the etiology of the myoclonus Genetics: Varies by etiology, can be hereditary or sporadic ?Pearls & Considerations Suggested Reading Myofascial Pain Syndrome ?Diagnosis ?Treatment Suggested Readings Myotonia ?Treatment Myxedema Coma Narcissistic Personality Disorder Prevalence: Less than 1% of the general population; estimates range from 2% to 6% in the clinical population Predominant Sex: More commonly diagnosed in males (up to 3:1) Predominant Age: 20s and 30s ?Pearls & Considerations Suggested Readings Narcolepsy Incidence: 0.74/100,000 persons/yr Prevalence: 1 in 2000 people Predominant Sex: Males and females equally affected Age of Onset: Peak 15 to 30 yr (range, 10 to 55 yr) Genetics Risk Factors: Anesthesia, head injury, history of meningitis or encephalitis, family history of narcolepsy, tumor, vascular malf... Hypocretin/Orexin Secondary Etiologies ?Treatment Suggested Readings Nasal Polyps Prevalence Predominant Sex & Age Peak Incidence: Mean age of onset is 42 yr Genetics: Some literature suggests there is a genetic component to the disease with an association between HLA-A74 and nasal pol... Risk Factors Classification: Box E1 describes a classification of nasal polyps Physical Findings & Clinical Presentation ?Pearls & Considerations Suggested Readings Nasopharyngeal Carcinoma ?Treatment Related Topic Suggested Readings Necrotizing Autoimmune Myopathy (NAM) Incidence: Incidence of IIM in a homogenous population is 2.2 to 7.7 per million, and NAM, which is a rare disorder, accounts fo... Predominant Sex & Age: Primarily affects adults >18 yr, with mean age at onset around 50 to 60 yr, while younger ages of 47 to 4... Genetics: HLADRB1*11:01 is associated with an increased risk of developing anti-HMGCR NAM in whites and African Americans when e... Risk Factors ?Treatment Suggested Readings Necrotizing Fasciitis Predominant Sex: Male > female Predominant Age: 6 to 50 yr; less common in children INCIDENCE: Invasive group A Streptococcus infection occurs at a rate of 3.5 cases per 100,000 persons, with a case fatality rate... Clinical Types of Necrotizing Fasciitis Examples of Necrotizing Fasciitis ?Treatment Suggested Readings Nephroblastoma ?Treatment Author: Bharti Rathore, MD Suggested Readings Nephrogenic Systemic Fibrosis Incidence: Annually, the incidence is 0.0043 cases per dialysis-dependent patient. In one retrospective study of patients referr... Predominant sex and age: The male:female ratio is 1:1. Ages have ranged from 8 to 87 yrs. Nationally, reported cases are U.S. > ... Risk factors ?Treatment ?Pearls & Considerations Suggested Readings Nephrotic Syndrome Suggested Readings Neuroblastoma Incidence (IN U.S.): 8% to 10% of all solid tumors of childhood (third most common childhood cancer, after leukemia and brain tu... Predominant Sex: Male/female ratio of 1:1.3 Peak Age: Early childhood. Mean age of onset is 18 mo; 33% onset by 1 yr; 75% onset by 5 yr; 97% by 10 yr. In rare cases, neurob... Genetics: Although the majority of neuroblastomas are sporadic, in 1% to 2% of cases, there are exceptions associated with famil... ?Treatment Suggested Readings Neurocognitive Disorders ?Treatment Suggested Readings Neurofibromatosis ?Diagnosis ?Treatment Suggested Readings Neuroleptic Malignant Syndrome Incidence (in U.S.): 0.02% to 0.2% annual incidence in psychiatric population Predominant Sex: More than two thirds of patients are male Predominant Age: Young and middle-aged adults Predisposing Factors: History of intake of dopamine antagonists, e.g., antipsychotics Authors: Chloe Mander Nunneley, MD, Joseph S. Kass, MD, JD, FAAN, and Fariha Jamal, MD Suggested Reading Neuropathic Pain Suggested Readings Neuropathy, Hereditary ?Treatment New Onset Seizures Incidence: 29 to 39 per 100,000 per yr for acute symptomatic seizures. 23 to 61 per 100,000 person-yr for unprovoked seizures. A... Prevalence: 5 to 8.4 cases per 1000 persons Predominant sex and age: Males younger than 12 mo and older than 65 yr Risk Factors ?Treatment Suggested Readings Nocardiosis ?Diagnosis Nonalcoholic Fatty Liver Disease ?Treatment Suggested Readings Nonallergic Rhinitis Related Content Suggested Readings Non-Celiac Gluten Sensitivity ?Pearls and Considerations Suggested Readings Non-Hodgkin Lymphoma ?Basic Information Staging: The Ann Arbor staging system that was initially developed for Hodgkin lymphoma (HL) was revised as the Lugano criteria ... Indolent NHL Aggressive NHL: The most common aggressive NHL is DLBCL. The addition of rituximab against CD20 B-cell lymphoma to the CHOP regi... Highly aggressive NHL: The most common high-grade NHL subtype is Burkitt lymphoma (BL). BL affects younger patients than DLBCL a... Suggested Readings Obesity ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Obesity-Hypoventilation Syndrome Prevalence: The worldwide prevalence of obesity more than doubled in the last 30 yr and has become a global epidemic. In 2014, t... Predominant Sex & Age: Male gender and 50 to 60 yr of age Risk Factors ?Diagnosis ?Treatment Suggested Reading Obsessive-Compulsive Disorder (OCD) Peak Incidence: Mean age at onset is 19.5 yr 12-Mo Prevalence: 1.2% of adults in the U.S., international prevalence estimates are similar (1.1% to 1.8%) Predominant Sex: Slightly more common among females than males in adulthood, although males are more commonly affected in childh... Predominant Age Disease Course Genetics Suggested Readings Ocular Foreign Body Incidence (In U.S.): Universal, with a predominance in active people. Common with industrial jobs and activities such as metal w... Predominant Sex: Perhaps slightly more common in men Predominant Age: Childhood through active adult yrs Peak Incidence: Childhood through active adult yrs ?Pearls & Considerations Opioid Overdose Incidence: Drug overdose deaths and opioid-involved deaths continue to increase in the U.S. The majority of drug overdose deaths... Prevalence: From 1999 to 2017 more than 700,000 U.S. residents died from drug overdoses. From 2013 to 2017, the number of opioid... Predominant Sex and Age: The “typical” heroin death involves experienced users in their 20s to 30s using coingestants, with a ma... Risk Factors: The majority of drug-overdose deaths are unintentional or accidental (74%). The following increase risk for opioid... ?Treatment Suggested Readings Opioid Use Disorder Incidence: It is estimated that more than 2.5 million Americans have an opioid use disorder Prevalence Predominant Sex: Males abuse opioids more commonly than females, with a male:female ratio of 3:1 for heroin and 1.5:1 for prescr... Peak Incidence: The majority of new abusers of opiates are <26 yr Risk factors Genetics ?Pearls & Considerations Suggested Readings Oppositional Defiant Disorder (ODD) Peak Incidence: Usually diagnosed in school-aged children (roughly ages 6-12) Prevalence: Ranges from 1% to 16% based on source (community prevalence) Predominant Sex and Age Genetics: Some evidence for genetic factors, but studies are not usually specific to ODD (e.g., studies also include conduct dis... Risk factors ?Treatment ?Pearls & Considerations Suggested Readings Optic Atrophy Predominant Sex: Depends on etiology Predominant Age: Variable Peak Incidence: Varies depending on cause ?Pearls & Considerations Optic Neuritis Incidence (In U.S.): 1 to 5/100,000 person(s) per yr; rates vary according to incidence of multiple sclerosis (MS). Optic neurit... Prevalence (In U.S.): Common in patients with MS Predominant Sex: Female:male ratio: 1.8:1 Peak Incidence: 20 to 49 yr, mean 30 Genetics: Unknown. If due to MS, it is more common in patients with certain human lymphocyte antigen (HLA) blood types and in mo... ?Diagnosis ?Treatment Oral Cancer Incidence & Prevalence: OSCC comprise the sixth most common cancer in the world. An estimated 530,000 cases are diagnosed annual... Predominant Sex & Age: The ratio of oral cancer in males: females is 2.5:1 in the U.S. Black males have a higher early incidence... Genetics: The genes that are critically altered in OSCC include TP53, the retinoblastoma family, p16 and cyclin D1. The TP53, CC... Risk Factors (Fig. 1): The following factors are implicated in the development of oral cancer ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Oral Hairy Leukoplakia Incidence and Prevalence: Epstein-Barr virus (EBV) is implicated in the etiology of OHL, and the incidence of EBV seroprevalence... Orchitis Predominant Sex: Male ?Diagnosis ?Treatment suggested Readings Orthostatic Hypotension ?Pearls & Considerations Suggested Readings Osgood-Schlatter Disease Prevalence: 4 cases/100 adolescents Predominant Sex: Male:female ratio of 3:1 Predominant Age: Males: Ages 13 to 15 yr, females: Ages 11 to 13 yr ?Treatment ?Pearls & Considerations Suggested Readings Osteoarthritis ?Basic Information Prevalence: Affects more than 30 million individuals in the U.S. Approximately 10% of men and 18% of women over the age of 60 yr... Predominant Sex: Prior to age 50, there is almost no gender discrepancy. After age 50, there is increased incidence of OA in fem... Predominant Age: Occurs more frequently after 50 yr of age, but it is increasingly being recognized that OA may occur as early a... Genetics: 39% to 65% heritability rate in twin studies of women who have generalized OA, concordance rate of 0.64 in monozygotic... Risk Factors: Osteoarthritis is considered predominantly a mechanical noninflammatory form of arthritis (Fig. 1). OA is thought ... ?Treatment Hand OA Hip And Knee OA ?Pearls & Considerations Related Content Suggested Readings Osteochondritis Dissecans Peak Incidence: Adolescent Age Group Prevalence: 15 to 29/100,000 persons Predominant Sex: Male/female ratio of 2-4:1 Predominant Age: Typically between 10 and 20 years of age Genetics: While there is emerging evidence that OCD has a genetic component, the genetic basis is still largely unknown Risk Factors: Repetitive microtrauma, young athletes ?Treatment Suggested Readings ?Pearls & Considerations Osteomalacia and Rickets Suggested Readings ?Treatment Osteomyelitis Predominant Sex: Male > female Predominant Age: All ages Hematogenous Osteomyelitis Vertebral Osteomyelitis Contiguous Osteomyelitis Chronic Osteomyelitis ?Treatment Suggested Readings Osteonecrosis Osteoporosis Primary Osteoporosis: Primary osteoporosis is the loss of bone mass due to aging and decreased gonadal function, not to any othe... Secondary Osteoporosis: Secondary osteoporosis is bone loss due to another chronic condition such as thyroxine excess, hyperpara... Prevalence (In U.S.) Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Otitis Externa Incidence (In U.S.) Prevalence (In U.S.) Predominant Sex: None Predominant Age Suggested Readings Otitis Media Incidence (In U.S.) Peak Incidence Risk Factors ?Pearls & Considerations Suggested Readings Otosclerosis (Otospongiosis) Incidence (In U.S.): Most common cause of hearing loss in young adults Peak Incidence: Onset of hearing impairment usually occurs between third and fifth decade of life Prevalence (In U.S.) Predominant Sex: Female:male ratio of 2:1 Predominant Age: Symptoms start between ages 20 and 40 yr, with slowly progressive conductive hearing loss Genetics: Autosomal dominant inheritance with incomplete penetrance in about 40% to 45% of patients ?Pearls & Considerations Ovarian Cancer Incidence: 12.9 to 15.1 cases/100,000 persons; ∼25,000 new cases annually. Lifetime risk for developing ovarian cancer is 1.3%. ... Prevalence: It is most commonly diagnosed in those 55 to 64 yr of age Risk factors Genetics: The greatest risk factors of ovarian cancer are a family history and associated genetic syndromes. More than 90% of in... ?Treatment Suggested Readings Ovarian Neoplasm, Benign Suggested Reading Over-the-Counter Medication in Pregnancy Incidence: More than 90% of women take some form of OTC medications in pregnancy ?Pearls and Considerations Suggested Reading Paget Disease of Bone ?Basic Information Predominant Sex: Variable preponderance of males Predominant Age: Middle or advanced yr Familial Incidence: Common, family history positive in up to 40% of cases ?Diagnosis ?Treatment Suggested Readings Paget Disease of the Breast Pain Management in Chronic Pain ?Treatment Suggested Readings Pancreas Transplantation Incidence: Despite an increasing prevalence of DM, the number of PTX in the United States decreased from 2006 through 2012 but r... Prevalence: There are 24,557 functional SPK and 8,885 solitary PTX (i.e., PKA and PTA), respectively, in the United States. Ther... Predominant Sex and Age: The typical SPK candidate has T1DM (80%), is 35 to 49 yr old, 55.4% are male, and 40% have a BMI of 18.... Risk Factors: The risk factors for PTX loss are similar to other transplanted organs: African American race, recipients of two o... Available at ExpertConsult.com Author: Milagros Samaniego-Picota, MD Suggested readings Pancreatic Cancer (Exocrine) Incidence: In the U.S., it is estimated that there were 56,770 new cases and 45,750 deaths in 2019. It is the fourth leading cau... Predominant Sex: Male:female ratio of 2:1 Predominant Age: Median age at diagnosis is 71 yr Primary tumor (T) Lymph nodes (N) Distant metastases (M) Staging Groups ?Treatment ?Pearls & Considerations Related Content Suggested Readings Pancreatitis, Acute General Measures Suggested Readings Panic Disorder, with or without Agoraphobia Incidence (In U.S.): 1% 1-mo incidence of panic attacks Prevalence (In U.S.) Peak Incidence Predominant Sex Predominant Age Genetics Suggested Readings Panniculitis ?Treatment Related Content Suggested Readings Paralytic Shellfish Poisoning Incidence: Toxin-containing shellfish are generally found in the cold-water regions of the coast of northwestern and northeaster... Peak Incidence: PSP has been associated with algal blooms known as “red tides,” but cases can occur even without red tides. Case... Risk Factors: Shellfish including mussels; scallops; clams; and, at times, crustaceans (Dungeness crabs, shrimp, or lobsters), g... ?Treatment Related Content Suggested Reading Paraneoplastic Syndromes ?Basic Information ?Pearls & Considerations Authors: Hetal D. Mistry, MD, and John L. Reagan, MD Suggested Readings Paranoid Personality Disorder Prevalence: Epidemiologic studies report a prevalence of 2.3% to 4.4% in the general U.S. population Predominant Sex: More commonly diagnosed in males in clinical samples Genetics: Increased prevalence of PPD in relatives of patients with schizophrenia and delusional disorder, paranoid type ?Pearls & Considerations Suggested Readings Paraphilic Disorders Incidence: Unknown due to: (1) the secretive nature of the behavior; (2) changes in criterion over time; and (3) differences bet... Peak Incidence: Although prepubescent individuals can be diagnosed with a paraphilic disorder, diagnosis is usually made postpub... Prevalence: Prevalence rates for paraphilia and paraphilic disorders are extremely difficult to report with any certainty. While... Predominant Sex and Age Genetics: Although the literature points to some possible genetic influences on sexual interest in males and females, it is inco... Risk Factors: Possible risk factors associated with paraphilia and paraphilic disorders include ?Treatment Suggested Readings Parkinson Disease ?Diagnosis Suggested Readings Paronychia ?Diagnosis ?Pearls & Considerations Suggested Readings Paroxysmal Cold Hemoglobinuria Incidence: Estimated at 0.4 cases per 100,000 people Prevalence: Accounts for up to 5% of all adult hemolytic anemias and 30% to 40% of childhood cases Predominant Sex and Age: Mild male sex predilection with reported male-to-female ratio of 2:1 to 5:1. PCH affects both young chi... Genetics: None Risk Factors: Age (most common in young population), infections, and neoplasms have been associated with the development of Dona... ?Pearls & Considerations Suggested Readings Paroxysmal Nocturnal Hemoglobinuria ?Diagnosis ?Treatment Author: Bharti Rathore, MD Suggested Readings Patellofemoral Pain Syndrome Prevalence: Estimated >20% of adolescents. Patellofemoral pain syndrome (PFPS) is the most common diagnosis in outpatients prese... Predominant Sex And Age: Nearly 2:1 female predominance; disproportionately affects active adolescents and adults in the second ... Risk Factors: Increase in physical activity intensity or duration, overuse, joint overload, trauma, anatomic abnormalities, mala... ?Treatment ?Pearls & Considerations Suggested Readings Patent Ductus Arteriosus ?Diagnosis Suggested Readings Patent Foramen Ovale ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Pediatric Medication Errors Incidence Peak Incidence: Among outpatient prescriptions, medication errors occur more frequently in children <4 yr compared with older ch... Prevalence: Not applicable Predominant Sex and Age: Children <4 yr Genetics: Not applicable Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Pediculosis ?Pearls & Considerations Suggested Readings Pedophilic Disorder Prevalence: Unknown, with likely maximum of 5% in the male population and much smaller in the female population Onset: Around the time of puberty, as adolescents begin to develop sexual interest Predominant Sex: The significant majority of pedophiles are men (females commit roughly 1%-6% of child sexual assault) Suggested Readings Pelvic Abscess Incidence ?Treatment ?Pearls & Considerations Suggested Reading Pelvic Congestion Syndrome ?Treatment ?Pearls & Considerations Suggested Readings Pelvic Inflammatory Disease Incidence/Prevalence: Pelvic inflammatory disease is most often diagnosed in young, sexually active women. The incidence of PID ... ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Pelvic Organ Prolapse Incidence and Prevalence: Exact prevalence estimates are difficult to determine due to varying definitions of POP and various di... Genetics: Data suggest a heritable component to POP; however, no specific genes or genetic factors outside of specific connectiv... Risk Factors: POP has a long latency and is multifactorial. Multiple risk factors have been identified. Some are modifiable, sug... POP Treatment Options Suggested Readings Pemphigus Vulgaris ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Peptic Ulcer Disease ?Pearls & Considerations Pericarditis Treatment of Underlying Cause Suggested Readings Periodic Limb Movement Disorder Incidence: Unknown Peak Incidence: None Prevalence: 5% to 8% Predominant Sex and Age: Prevalence is higher in females and increases with age Genetics: Unknown, but may share autosomal dominant inheritance pattern if concurrent with restless leg syndrome Risk Factors ?Treatment ?Pearls & Considerations Prevention: As mentioned in “Nonpharmacologic Therapy.” Patient information on PLMD and other sleep disorders can be found at the National Sleep Foundation website: www.sleepfoundation... Peripheral Artery Disease ?Treatment Lowering cardiovascular risk factors, morbidity, and mortality Treatment of Claudication ?Pearls & Considerations Suggested Readings Perirectal Abscess Incidence (In U.S.): Commonly encountered Predominant Sex: Male > female Predominant Age: All ages Peak Incidence: Not seasonal; common Genetics: None known ?Diagnosis Outpatient—oral Inpatient—intravenous Suggested Readings Peritonitis, Secondary Peritonsillar Abscess Incidence (In U.S.): 30:100,000/yr for ages 5 to 59. For adolescents, the incidence is 40:100,000/yr. It is the most common deep... Prevalence: 45,000 cases/yr in the U.S Predominant Sex: Male > female Predominant Age: Highest incidence is adults aged 20 to 40 yr Peak Incidence: Bimodal frequency during the yr, with highest occurrence from November to December and April to May Risk Factors: Smoking, periodontal disease, oropharyngeal or dental infection, male gender ?Pearls & Considerations Authors: Peter J. Sell, DO, Amity Rubeor, DO, CAQSM, and Glenn G. Fort, MD, MPH Suggested Readings Pertussis Incidence (In U.S.): Case reports from 2016 were 15,737, including seven deaths. This represents a decrease in the number of cas... Peak Incidence Predominant Age Suggested Readings Peutz-Jeghers Syndrome and Other Polyposis Syndromes Peutz-Jeghers Syndrome Juvenile Polyposis Syndrome Cowden Disease Bannayan-Ruvalcaba-Riley Syndrome Cronkhite-Canada Syndrome ?Diagnosis Peyronie Disease ?Diagnosis ?Pearls & Considerations Pharyngitis/Tonsillitis Peak Incidence: Late winter/early spring (GAS infections) Predominant Sex: Females = males Predominant Age Suggested Readings Pheochromocytoma ?Treatment ?Pearls & Considerations Suggested Readings Phobias Peak incidence: The majority of cases of specific phobia tend to onset prior to age 10; median onset is from ages 7 to 10 Prevalence (In U.S.) Predominant sex and age Genetics: Specific phobia is more common in first-degree relatives Suggested Readings Pilonidal Disease Incidence: 26 cases per 100,000 persons Predominant Sex: Males are more commonly affected than females (2.2:1) Average Age of Presentation: 21 yr Risk Factors ?Pearls & Considerations Pinworms ?Treatment Piriformis Syndrome Clinical Presentation: Patients with piriformis syndrome may present the following symptoms Suggested Reading ?Treatment ?Pearls & Considerations Pituitary Adenoma Classification (by Hormone Secreted) Prevalence/Incidence Prolactinomas GH-Secreting Pituitary Adenoma: Acromegaly Corticotropin-Secreting Pituitary Adenoma: Cushing Disease Thyrotropin-secreting pituitary adenoma Nonsecretory pituitary adenomas (endocrine inactive pituitary adenoma) Prolactinoma Acromegaly: Ectopic production of GH-releasing hormone from a carcinoid or other neuroendocrine tumor Cushing disease Thyrotropin-Secreting Pituitary Adenomas: Primary hypothyroidism Nonsecretory Pituitary Adenoma: Nonneoplastic mass lesions of various etiologies (e.g., infectious, granulomatous) Prolactinoma: First step: Measurement of basal PRL levels (practitioners should be aware of discriminatory values in their own i... Acromegaly Cushing disease Thyrotropin-secreting pituitary adenoma Nonsecretory pituitary adenoma Surgery Radiotherapy Prolactinoma Acromegaly Cushing disease Thyrotropin-secreting pituitary adenoma Nonsecretory pituitary adenoma Suggested Readings Pityriasis Rosea Suggested Reading Placenta Previa Incidence: The pooled prevalence of major placenta previa was 4.3 cases per 1000 pregnancies. Prevalence was highest among Asian... Suggested Readings Plantar Fasciitis Incidence: Plantar fasciitis is the most common cause of plantar heel pain and occurs bilaterally in up to 30% of cases. In the ... Predominant Sex: Predominance of plantar fasciitis varies according to studies Predominant Age: Peak incidence ranges from ages 40 to 60 yr old but can occur at any age Risk Factors: Rapid increase in activity, weight gain, obesity, pes cavus or pes planus foot type, prolonged standing, excessive... ?Treatment ?Pearls & Considerations Suggested Readings Pleural Effusion ?Treatment Suggested Readings Pleurisy ?Treatment Pneumonia, Bacterial ?Pearls & Considerations Suggested Readings Pneumonia, Mycoplasma Incidence (In U.S.) Prevalence (In U.S.) Peak Incidence Predominant Sex: Equal distribution Predominant Age Genetics: Familial disposition ?Pearls & Considerations Suggested Readings Pneumonia, Pneumocystis jiroveci (carinii) Incidence (In U.S.) Predominant Sex: Equal incidence when adjusted for HIV status Predominant Age: 20 to 40 yr Peak Incidence: Age 20 to 40 yr (parallel to AIDS epidemic) Genetics: Neonatal infection ?Diagnosis ?Pearls & Considerations Pneumonia, Viral Incidence (in u.s.) Prevalence (in u.s.) Predominant Sex Predominant Age Peak incidence Genetics: Familial disposition Pneumothorax, Spontaneous ?Diagnosis Suggested Readings Poison Ivy Dermatitis Incidence: Affects 10 million to 40 million Americans annually Prevalence: From 50% to 75% of the adult population is clinically sensitive to these plants. Sensitivity rates are lower in urba... Predominant Sex and Age: Sensitization occurs most commonly between ages 8 and 14 yr. Sensitivity wanes with age, especially in ... Peak Incidence: More frequent in mos when outdoor activity is more common Genetics: There is thought to be a genetic susceptibility to sensitivity; however, the rash occurs in all ethnicities and skin t... Risk Factors: Firefighters, forestry workers, farmers, and outdoor workers in general, as well as those who participate in outdo... ?Treatment ?Pearls & Considerations Suggested Reading Poliomyelitis Incidence (In U.S.) Predominant Age: Almost always infants or young children Neonatal Infection: Most cases occur in otherwise healthy infants who receive OPV, or their contacts ?Pearls & Considerations Suggested Readings Polyarteritis Nodosa Polycystic Ovary Syndrome ?Diagnosis ?Treatment Suggested Readings Polycythemia Vera ?Treatment Related Content Suggested Readings Polymyalgia Rheumatica Incidence/Prevalence: In the U.S., incidence is 52.5 cases per 100,000; increases with advancing age. Prevalence is 0.5% to 0.7%... Predominant Sex: Female:male ratio of 2:1 Predominant Age: Almost exclusively occurs above age 50, with peak incidence between seventh and eighth decades ?Treatment Suggested Readings Polypharmacy Peak Incidence: Incidence increases with age and disease burden Prevalence: One in five Americans receives potentially inappropriate drug therapy, although prevalence may be substantially high... Predominant Sex, Age, and Race Risk Factors ?Pearls & Considerations Suggested Readings Porphyrias Incidence: 0.13 cases/million/yr (Europe) with a peak incidence in Sweden (0.51 cases/million/yr) Prevalence: 1:75,000 population in Europe (1:1000 population in Sweden) Predominant Sex and Age: Equal female-to-male ratio, except for AIP (female predominance). Pubertal onset is common Genetics: Acute intermittent porphyria is more prevalent in northern Sweden (1:1,000); variegate porphyria is more common in des... Risk Factors: No risk factors are identified ?Pearls & Considerations Portal Hypertension ?Diagnosis ?Treatment Suggested Reading Portal Vein Thrombosis ?Treatment Suggested Reading Postconcussion Syndrome ?Diagnosis ?Treatment Suggested Readings Postherpetic Neuralgia Incidence: PHN occurs in approximately 9% to 34% of HZ patients. It is the most frequent chronic complication of herpes zoster a... Peak Incidence: Unknown Predominant Sex and Age Genetics: Family history of HZ is considered a risk factor for HZ, with higher risk if multiple family members have had HZ Risk Factors Topical Treatments Oral Treatments: First line Suggested Reading Postpartum Depression Incidence: Approximately 800,000 women who deliver in the U.S. or 20% of all live births are affected by postpartum depression a... Prevalence: Perinatal depression affects approximately 10% to 15% of women Risk Factors: Risk factors include depression or anxiety during pregnancy, traumatic birth experiences, stressful life events du... Genetics: A family history of mood disorders is a risk factor for postpartum depression Suggested Readings Postpartum Hemorrhage Incidence: Depending on definitions used and scope considered, anywhere from 1% to 6% of obstetric patients will experience post... Predominant Sex and Age: Female of reproductive age Risk Factors: Antepartum factors: History of PPH, primiparity or high parity, macrosomic infant, multiple gestation, polyhydramn... ?Treatment ?Pearls & Considerations Suggested Readings Postpoliomyelitis Syndrome Incidence: Estimates vary from 22% to 85% of individuals who survive acute poliomyelitis Peak Incidence: About 30 to 36 yr following acute poliomyelitis, although cases have been reported between 8 and 71 yr Risk Factors ?Treatment Suggested Readings Postthrombotic Syndrome Incidence: 23% to 60% of people with DVT will experience postthrombotic syndrome, often within 2 yr of onset of DVT Prevalence: Unknown Predominant Sex: Slightly female predominance Risk Factors: Symptomatic DVT, postoperative DVT, recurrent DVT, underlying primary venous insufficiency, younger age, obesity, ... ?Treatment ?Pearls & Considerations Suggested Readings Posttraumatic Stress Disorder Incidence: Fewer than 10% of individuals who have experienced a traumatic event will develop PTSD; however, there is considerabl... Prevalence (In U.S.) Predominant Age and Sex Genetics: Several studies, including twin studies, have demonstrated genetic factors associated with increased risk of developin... ?Diagnosis ?Treatment Suggested Readings Postural Orthostatic Tachycardia Syndrome (POTS) Incidence: Unknown Prevalence: Most prevalent form of orthostatic intolerance—estimated to be 5 to 10 times more common than orthostatic hypotensio... Predominant Sex and Age: Female:male ratio of 5:1. Mean age is 30 yr old (most commonly between 15 to 50 yr old) Genetics: POTS is a heterogeneous entity, and thus, no single mutation is responsible for the syndrome. Mutations in a norepinep... Risk factors ?Treatment ?Pearls & Considerations Suggested Readings Precocious Puberty Incidence: Estimated to be between 1 in 5000 to 1 in 10,000 Predominant Sex: Females are affected five times more often than males for the idiopathic variant; for other causes, it is depen... Genetics: The genetics for some of the etiologies of precocious puberty is known. The most common genetic cause of central preco... Suggested Readings Preeclampsia Incidence: 2% to 7% in primigravidas, up to more than 50% in multigravidas with risk factors Risk Factors: See Table 2 Genetics: Positive correlation with maternal and paternal family history ?Pearls & Considerations Suggested Readings Premature Rupture of Membranes Incidence: Affects approximately 8% of all pregnancies ?Pearls & Considerations Suggested Readings Premenstrual Dysphoric Disorder Suggested Readings Premenstrual Syndrome Author: Adrienne B. Neithardt, MD Suggested Readings Pressure Injury ?Pearls & Considerations Suggested Readings Preterm Labor Incidence: The incidence of preterm births in the U.S. increased from 9.5% in 1981 to 12.7% in 2006 before falling gradually to ... Predominant Age and racial differences: Pregnant women at the extremes of reproductive age (<17 yr and >35 yr) are at greatest r... Genetics: A genetic component has been suggested. Women with sisters who have had preterm births and women with grandparents who... Risk Factors: Risk factors for premature labor include a prior preterm delivery, intrauterine infection, systemic or genital tra... ?Treatment Related Content Suggested Readings Priapism ?Treatment Primary Angiitis of the Central Nervous System Incidence: PACNS is a rare disease. A retrospective analysis of 101 patients with PACNS reported an annual incidence rate of 2.4... Predominant Sex: There is a 2:1 male predominance among reported cases Predominant Age: The median age at diagnosis is 50 yr, although PACNS can occur at almost every age ?Diagnosis ?Treatment Suggested Readings Primary Biliary Cholangitis Incidence Prevalence: Prevalence is greatest in North America and Northern Europe and varies tremendously by time and geographic areas, ra... Predominant Sex: Female:male ratio of 9:1 Predominant Age: Onset typically occurs between the ages of 30 and 65 yr and is uncommon before age 25 yr Predominant Race: Most often described in Caucasians but PBC affects all races Genetics ?Diagnosis ?Treatment Suggested Readings Primary Chest Wall Tumors ?Treatment Suggested Readings Primary Immunodeficiency Disease ?Diagnosis ?Treatment Suggested Readings Primary Myelofibrosis Incidence (U.S.): ∼1.9 per 100,000, age >75 yr; 0.7 per 100,000, age 50 to 74 yr; 0.1 per 100,000, age 35 to 49 yr Predominant Sex and Age Common Symptoms ?Treatment Suggested Readings Author: Ritesh Rathore, MD Suggested Readings Primary Ovarian Insufficiency Incidence: Affects 1% to 4% of the female population in the U.S ?Pearls & Considerations Primary Sclerosing Cholangitis ?Diagnosis ?Treatment Related Content Suggested Readings Progressive Multifocal Leukoencephalopathy (PML) Risk Factors: Typically seen in patients with profound immunosuppression and impaired cell-mediated immunity. These include pati... Incidence and Prevalence Predominant Sex and Age: Males and females are equally affected. There is no specific age distribution Genetics: Unknown ?Treatment Suggested Readings Progressive Supranuclear Palsy Incidence: 1.1 per 100,000 (5.3 per 100,000 over age 50) Prevalence: 4.9 per 100,000 (6.4 per 100,000 age-adjusted) Predominant Sex and Age: Slight male predominance; mean age onset 65 yr, very uncommon for onset <50 yr Genetics: Familial cases have been reported only rarely. The vast majority of cases are sporadic ?Pearls & Considerations Suggested Readings Prolactinoma Incidence: Most common pituitary tumor; nearly 30% of all pituitary adenomas secrete enough prolactin to cause hyperprolactinemi... ?Pearls & Considerations Suggested Reading Pronator Syndrome Incidence: Rare (comprises <1% of median nerve entrapment disorders); most common in dominant arm ?Treatment ?Pearls & Considerations Suggested Readings Prostate Cancer ?Treatment Suggested Readings Prostatitis ?Treatment Suggested Readings Pruritus Ani Suggested Readings Pruritus Vulvae Psittacosis Incidence (In U.S.) Peak incidence: Age 30 to 60 yr Prevalence (In U.S.) Predominant Sex: Equal sex distribution Predominant Age: More common in adults ?Pearls & Considerations Author: Glenn G. Fort, MD, MPH Suggested Reading Psoriasis ?Pearls & Considerations Psoriatic Arthritis Incidence: 6 per 100,000 per yr Prevalence: One to two per 1000 in the general population. Variable estimates of 4% to 30% of patients with underlying psoriasis... Predominant Sex: Equal male-to-female distribution Predominant Age: Symptom onset generally between age 30 to 55 Suggested Readings Psychosis Pulmonary Edema ?Pearls & Considerations Suggested Readings Pulmonary Embolism ?Treatment ?Pearls & Considerations Suggested Readings Pulmonary Hypertension ?Diagnosis ?Treatment (FIG. 3) General Measures and Treatment Treatment of Secondary Pah, Apah Suggested Readings Pulseless Electrical Activity Primary PEA Secondary PEA: As in primary PEA and may also have Primary PEA: Myocardial electromechanical uncoupling secondary to advanced heart muscle disease Secondary PEA: Related to changes in the loading conditions of the heart, ischemia, and/or myocardial depressants. Current guide... ?Treatment Suggested Readings Pure Red Cell Aplasia Predominant Sex and Age: The male:female ratio is 2:1 for PRCA with thymoma. However, immune-mediated cases are seen more common... ?Pearls & Considerations Suggested Readings Pyelonephritis Consists of two groups Incidence: Pyelonephritis is extremely common in the U.S. (450,000 cases per yr), with the highest incidence in the summer. Pyel... Predominant Sex: Women are 5 times more likely to be hospitalized than men until age 65 yr. In males beyond age 65 yr, the diffe... Predominant Age: Trimodal distribution described in females Bimodal distribution in males Genetics: Congenital urologic structural disorders associated with vesicoureteral reflux predispose to infections at an early ag... Uncomplicated Acute Pyelonephritis: Close outpatient follow-up is possible with minimal gastrointestinal symptoms and the abilit... Complicated Acute Pyelonephritis: Hospitalization is indicated for the following reasons Pyoderma Gangrenosum Incidence: 10 cases per million people per yr Predominant Age: Most common in young and middle-aged adults, with an average age of onset between 40 and 60 yr. Children can be... Predominant Sex: Women are more frequently affected Genetics: Familial cases of PG have been reported. PAPA syndrome is an autosomal dominant disorder linked to a mutation on chrom... Risk Factors: Autoimmune diseases, particularly ulcerative colitis, Crohn disease, and rheumatoid arthritis ?Treatment ?Pearls & Considerations Suggested Readings Pyogenic Granuloma ?Pearls & Considerations Suggested Readings Q Fever ?Pearls & Considerations Suggested Readings Quadrilateral Space Syndrome Incidence: Rare in general population, more common in participants in sports that involve abduction and external rotation of upp... Dominant Sex: 7:1 male:female ratio, most likely due to traditional sex distribution in overhead or “throwing” athletics Risk Factors: Professional athletes, window cleaners Suggested Readings Rabies Incidence (In U.S.): Approximately two U.S. cases annually; 83 human cases or rabies in the U.S. from 1980 to 2015. Of these, 25... ?Pearls & Considerations Suggested Readings Radial Tunnel Syndrome Incidence: Rare, annual incidence is <0.03% Peak Incidence: Unknown Predominant Sex & Age: Peak between age 30 and 50, likely slight female predominance, studies range from a female:male ratio of ... Genetics: Unknown Risk Factors: Trauma and heavy manual labor, especially those who perform forearm extensions in pronation or supination ?Pearls & Considerations Radiation Exposure Acute Radiation Syndrome Chronic Low-Dose Exposure: Excess cancer not detected below 100 mSv Acute Radiation Syndrome Chronic Low-Dose Exposure Acute Radiation Syndrome: Usually nuclear disaster Chronic Low-Dose Exposure: The average annual dose to residents of the U.S. is approximately 3.6 mSv ?Treatment ?Pearls & Considerations Suggested Readings Ramsay Hunt Syndrome Predominant Sex: Equal sex distribution ?Diagnosis Raynaud Phenomenon ?Diagnosis Suggested Readings Suggested Readings Reactive Arthritis (Reiter Syndrome) Incidence (In U.S.): 0.0035% annually of men ≤50 yr Peak Incidence: Most common in the third decade Predominant Sex: Male Predominant Age: 20 to 40 yr Genetics: Familial disposition: Strongly associated with HLA-B27 (63% to 96%) ?Pearls & Considerations Rectal Prolapse Incidence: Unknown in general population. In children with cystic fibrosis it approaches 20% Peak Incidence: Women after the fifth decade represent between 80% and 90% of patients with rectal prolapse. Incidence increases... Prevalence: N/A Predominant Sex and Age: Rectal prolapse occurs at the extremes of age, with an equal sex distribution in children. In adults, f... Genetics: N/A Risk Factors: Cystic fibrosis, hemorrhoids, laxity of the pelvic fascia/muscles due to prior pelvic surgery or obstetric trauma,... ?Treatment ?Pearls & Considerations Relapsing Polychondritis Incidence: 3.5 cases per million. There is similar frequency of cases in both sexes. RP is associated with human leukocyte antig... Predominant Sex: Males and females are affected equally Predominant Age: Peak onset is between 40 and 60 yr, although RP has been described in children Suggested Readings Renal Abscess Incidence: Ranges from 1 to 10 per 10,000 hospital admissions Predominant Sex and Age: In one study median age was 59.8 yr Risk Factors: Diabetes and renal stones ?Treatment ?Pearls & Considerations Renal Artery Stenosis Renal Doppler Ultrasound Magnetic Resonance Angiography Computed Tomography Angiography Direct Angiography Nuclear Renography (Without Captopril): A noninvasive test conducted when renal atrophy is present to document differential kidn... Renal Cell Carcinoma Incidence: In 2019, there were an estimated 73,820 new cases and 14,770 deaths in the U.S. Two percent of cases of renal cancer ... Predominant Sex: Male:female ratio is approximately 2:1 Predominant Age: Peak incidence is at age 50 to 70 yr Laboratory Tests ?Treatment Suggested Readings Renal Tubular Acidosis Suggested Readings Renal Vein Thrombosis ?Treatment Respiratory Syncytial Virus Incidence: Humans are the only source of infection. There are 64 million infections worldwide annually, resulting in 160,000 dea... Prevalence: Nearly everyone is infected by age 2, with reinfections occurring at all ages Predominant Sex and Age: Male sex may predispose to more severe respiratory disease in RSV infection. Age predominance in infanc... Peak Incidence: In nontropical areas of the Northern Hemisphere, seasonal outbreaks usually occur November to April, with a peak... Risk Factors: For children, risk factors include attending daycare or school and inpatient hospitalization. Severe disease is se... Genetics: Severe disease is associated with polymorphisms in various interleukins and CCR5 ?Pearls & Considerations Suggested Readings Restless Legs Syndrome Prevalence: Average prevalence rate is 1% to 29%. Prevalence estimates in Europe are around 10%, and 0.1% to 12% in East Asian p... Peak Prevalence: 10% in persons aged 30 to 79 and 19% in persons aged 80 or above Predominant Sex: Early-onset RLS is more common in females, with 2:1 female/male ratio Predominant Age: Prevalence of RLS increases with age, and it is more commonly seen in the elderly population Genetics: Genetic basis of RLS has been reported, particularly in early-onset RLS Risk Factors Suggested Readings Retinal Detachment Incidence (In U.S.) of rhegmatogenous retinal detachment Peak Incidence: Incidence increases with increasing age or increasing myopia Prevalence (In U.S.): Busy ophthalmologists may see one or two acute retinal detachments per month Predominant Age Risk Factors Retinal Hemorrhage Incidence (In U.S.): Busy ophthalmologists see one or two cases a mo Predominant Age: Usually vascular disease in older patients Peak Incidence Physical Findings & Clinical Presentation ?Pearls & Considerations Suggested Reading Retinitis Pigmentosa Prevalence (In U.S.) Predominant Sex: X-linked presents only in males, but there is no gender predilection with the other genetic varieties Predominant Age: Onset usually in young adulthood but can present at any time from infancy up to 30s to 50s, depending on mode o... Peak Incidence Genetics ?Pearls & Considerations Suggested Readings Retinoblastoma Incidence: Retinoblastoma affects 1 in 15,000 children, with approximately 300 children newly diagnosed each yr in the U.S. The ... Peak Incidence Predominant Age: 8 mo Genetics ?Treatment ?Pearls & Considerations Suggested Readings Retroperitoneal Fibrosis Suggested Readings Retropharyngeal Abscess ?Treatment ?Pearls & Considerations Suggested Reading Reye Syndrome ?Treatment Rh Incompatibility Incidence Genetics: Five major loci determine Rh status: C, D, E, c, e. The presence of the D antigen results in an Rh+ individual, while ... Risk Factors Suggested Readings Rhabdomyolysis Predominant Age: Incidence of 1 in 10,000 in the U.S Mortality Rate: 5% to 8%. Prognosis is better in the absence of AKI Onset: Evidence is limited regarding the onset of physical exertion-induced rhabdomyolysis. Exercise levels exceeding usual exer... ?Pearls & Considerations Suggested Readings Rheumatic Fever Incidence (In U.S.): Has declined in the last 4 to 6 decades Incidence (World): ARF remains one of the most important causes of cardiovascular morbidity and mortality among socially and eco... Predominant Age (In U.S.) Peak Incidence (In U.S.): School-age children Suggested Readings Rheumatoid Arthritis Incidence: Annual incidence in northern Europe and the U.S. 0.15 to 0.60 per 1000 Typical age at diagnosis: Usually between age 30 and 60. Steadily increases with age until the mid-70s Prevalence: 0.5% to 1.0% of the worldwide population, with different rates in different ethnic groups Predominant Sex: Females > males (2 to 3:1) Risk Factors ?Diagnosis ?Treatment Suggested Readings Rocky Mountain Spotted Fever Incidence: 0.18 to 0.32 cases per 100,000 person/yr. Infections have been reported throughout the U.S Prevalence: Most prevalent in the Southeast, followed by the South Central states, but seen nywhere (Fig. E1). The RMSF main ter... Predominant Sex: Affects both genders equally Predominant Age: Occurs at any age, but more likely in children ages 5 to 14 yr ?Diagnosis ?Treatment Rosacea ?Diagnosis ?Pearls & Considerations Suggested Readings Roseola ?Diagnosis Suggested Readings Rotator Cuff Disease Prevalence: 5% to 10% of the population. Can be prevalent in up to 39% of asymptomatic individuals with up to 64% prevalence in ... Predominant Sex: Both sexes have been quoted as being equally predisposed to the development of rotator cuff pathology Predominant Age: >40 yr. Advancing age has been consistently held accountable as a major risk factor for development of cuff tea... Risk Factors: Advanced age, genetics, obesity, smoking and alcohol consumption, diabetes mellitus, repetitive overhead activity,... ?Treatment ?Pearls & Considerations Suggested Readings Rubella ?Treatment Salivary Gland Neoplasms Incidence: One to two cases per 100,000 person-yr (1% of all head and neck tumors) Risk Factors Distribution Etiology and Pathogenesis History Stage (TNM) ?Treatment Suggested Readings Salmonellosis Incidence (In U.S.) Predominant Age Peak Incidence: Summer and fall Genetics ?Pearls & Considerations Related Content Suggested Readings Sarcoidosis ?Basic Information Incidence (In U.S.): Incidence is 11 in 100,000 in whites and 35 in 100,000 in blacks; presents most commonly in the winter and ... Predominant Sex: Increased incidence in females Predominant Age: 20 to 40 yr Genetics: Familial clustering has been described. Having a first-degree relative with sarcoidosis increases the risk for disease... Immunopathogenesis of Sarcoidosis: Numerous chemokines and cytokines have been implicated in the development and/or resolution o... ?Pearls & Considerations Suggested Readings Sarcoma ?Treatment Suggested Readings Scabies ?Pearls & Considerations Suggested Readings Scarlet Fever ?Treatment ?Pearls & Considerations Schistosomiasis Incidence Prevalence: The greatest cercarial exposure usually occurs in boys ages 5 to 10 yr Distribution Acute symptoms Chronic Symptoms Complications Comorbidities ?Treatment ?Pearls & Considerations Suggested Readings Schizophrenia Incidence: 0.2 per 1000 Prevalence: 0.5%; lifetime prevalence risk, 0.4% Predominant Sex: Males have a more severe illness with earlier onset. Prevalence in males approximately 1.4 times higher Predominant Age Peak Incidence: Between ages of 16 and 30 yr Genetics Suggested Readings Sciatica Incidence: Very few studies have determined the incidence of sciatica. However, 5% to 10% of patients with low back pain have sc... Peak Incidence: Age 30 to 64 yr Prevalence: Annual prevalence of disc-related sciatica in the general population is estimated at 2.2% Risk Factors History Taking Physical Examination: Neurological testing Lumbar mobility assessment: Neural tension tests (preferable seated position) ?Treatment ?Pearls & Considerations Suggested Readings Scleritis Peak Incidence: Increases with increasing age Incidence (In U.S.): Busy ophthalmologists may see one or two cases/yr Prevalence (In U.S.): Relatively rare Predominant Sex: 61% women Predominant Age: 52 yr ?Pearls & Considerations Suggested Reading Scleroderma (Systemic Sclerosis) Incidence: There are an estimated 19 cases per 1 million persons/yr, but many mild cases go unrecognized Prevalence: 276 cases per 1 million persons per yr Predominant Sex: Female/male ratio of 4:1 Predominant Age: 30 to 50 yr Distribution: Worldwide Physical Findings ?Diagnosis Dermatologic Systemic ?Treatment ?Pearls & Considerations Suggested Readings Scoliosis Predominant Sex: The incidence of AIS is similar in males and females; however, females have up to a tenfold greater risk of cur... Prevalence: 1.5% to 3% of adolescents Predominant Age ?Pearls & Considerations Suggested Readings Scombroid Poisoning Incidence: According to the CDC’s Foodborne Disease Outbreak surveillance system, data collected from U.S and Puerto Rico show t... Peak Incidence: Summer Risk Factors: Improperly stored fish at temperatures >4° C or >40° F ?Treatment Suggested Readings Seasonal Affective Disorder ?Diagnosis Suggested Readings Seborrheic Dermatitis (SD) Prevalence: Affects 3% to 5% of otherwise healthy adults; increases to 34% to 83% in immunocompromised patients Predominant Sex and Age: Can occur from infancy through old age, with peak incidence in adolescents and young adults and increas... Risk Factors: More common in patients with HIV/AIDS, Parkinson disease, other neurologic disorders, mood disorders, chronic alco... Suggested Readings Seizures, Generalized Tonic Clonic Incidence: Thirty to fifty cases per 100,000 person-yr (epilepsy incidence) Peak Incidence: Not applicable Prevalence: Five to eight cases/1,000 persons (epilepsy incidence) Predominant Sex and Age: No gender preference ?Treatment ?Pearls & Considerations Sepsis Incidence (In U.S.) Predominant Sex: Males are slightly more commonly affected than females Predominant Age Genetics Authors: Glenn G. Fort, MD, MPH, and Fred F. Ferri, MD Suggested Readings Septic Arthritis Incidence (In U.S.): Between 2 and 6 cases per 100,000 people per yr Prevalence (In U.S.): Unknown Predominant Sex: Gonococcal arthritis in females Predominant Age: Gonococcal arthritis in sexually active adults Peak Incidence ?Diagnosis Suggested Readings Serotonin Syndrome ?Diagnosis ?Treatment Suggested Readings Sexual Assault Incidence: 19% of women, 3% of men Peak Incidence: As high as 25% Prevalence (In U.S.): 23 million women, 2.8 million men Predominant Sex and Age: Female, ages 12 to 34 Risk Factors: Alcohol/drug consumption, prior history of being sexually/physically abused, multiple sexual partners, involvement... Suggested Readings Suggested Readings Sexual Dysfunction in Women Incidence: According to the National Health and Social Life Survey, in 1999, ∼20% to 50% of women reported some form of sexual d... Prevalence (Table E1): A more recent survey of women 18 yr of age and older found an age-adjusted prevalence of any sexual probl... Predominant Age: Sexually related personal distress was more common in middle-aged women (aged 45 to 64) than in younger or olde... Risk Factors Related Content Suggested Readings Shaken Baby Syndrome Incidence: Most common cause of death or serious neurologic injury resulting from child abuse. It is specific to infancy, when c... Peak Incidence: Shaken babies are typically younger than 1 yr; with median age of 4 mo Prevalence: ∼25% of clinically diagnosed babies with shaken baby syndrome die, and ∼80% of the remaining suffer lifelong neurolo... Predominant Sex: About 60% of identified victims of shaking injury are male. Children of families who live at or below the pover... Risk Factors: History of abuse, history of domestic violence, low socioeconomic status, perinatal illness, incessant crying, and... ?Treatment ?Pearls & Considerations Sheehan Syndrome Incidence: Approximately 1 case in 10,000 deliveries. Actual frequency is not known but is thought to be higher in developing co... Predominant Sex: Affects only females Risk Factors Onset of Symptoms: Symptoms may be acute or chronic. The severity of the disease depends on the extent of the damage to particul... Suggested Readings Shift Work Disorder Incidence: Not known Peak Incidence: Not known Prevalence Predominant Sex and Age: More prevalent in shift workers aged above 50 yr and worsens with passage of time if the work hours per... Genetics: No known genetic contribution to SWD Risk Factors: SWD is more likely in shift workers who have a morning-type disposition, sleep need greater than 8 hours, or stron... ?Diagnosis ?Treatment ?Pearls & Considerations Shigellosis Incidence (In U.S.): 6.59 cases per 100,000 population with approximately 450,000 cases/yr Predominant Sex: Male homosexuals are at increased risk Predominant Age: Shigellosis predominantly affects children (Box E1), with 28 cases per 100,000 population in children <4 yr old... Peak Incidence: Summer Genetics: Neonatal infection: Rare but severe ?Pearls & Considerations Suggested Readings Short Bowel Syndrome ?Diagnosis ?Treatment Short QT Syndrome ?Diagnosis ?Treatment Suggested Readings Sialadenitis Incidence ?Treatment ?Pearls & Considerations Suggested Readings Sialolithiasis ?Treatment Suggested Readings Sick Sinus Syndrome ?Treatment Suggested Readings Sickle Cell Disease ?Treatment ?Pearls & Considerations Suggested Readings Silicosis ?Treatment Sinusitis Incidence (In U.S.): Seems to correlate with the incidence of upper respiratory tract infections and higher in women than men; 3... Suggested Readings Sjögren Syndrome Incidence: 4 per 100,000; of these cases, 70% had primary SS Prevalence: Prevalence is 0.2% to 2.7% of population; secondary SS is also common and can affect up to 19% of patients with syst... Predominant Sex: Female:male ratio is approximately 10:1 Predominant Age: Peak incidence is the fourth and fifth decade, but can occur in all ages. Rarely reported in children Risk Factor: Seen in all races/ethnicities, but more common in Caucasians Secondary ?Pearls & Considerations Suggested Readings Sleep Apnea ?Treatment Suggested Readings Slipped Capital Femoral Epiphysis (SCFE) Incidence: The incidence is 10 cases per 100,000, with a 1.4:2.0 female:male ratio. Left hip is more commonly affected than righ... Peak Incidence: Average age at diagnosis is 12 yr, with range of 10 to 16 yr Prevalence: 10.8 cases per 100,000 children Genetics: Greater incidence in blacks, Hispanics, and Pacific Islanders Risk Factors ?Treatment Suggested Reading Small Bowel Bacterial Overgrowth (SIBO) Prevalence: The prevalence of SIBO is varied based on the population studied and the diagnostic tests used. It has shown to be p... Predominant Sex and Age: SIBO affects predominantly the elderly population or those with recent UGI surgery, including bariatric... Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Small Bowel Obstruction Predominant Sex and Age: None Physical Findings: These may include Clinical Presentation: There are four key symptoms: abdominal pain, vomiting, distention, and constipation Smallpox Social Anxiety Disorder Incidence (In U.S.): Ranges from 4 to 5 to 9/1000 person-yr; cumulative incidence of 11.0% in first 3 decades of life Peak Incidence: Highest standardized incidence rates per person-yr between 10 and 19 yr of age Prevalence (In U.S.): Lifetime prevalence of 12% in epidemiologic samples, and 12-mo prevalence of 7%; point prevalence of up to... Predominant Sex: More common in women than in men (odds ratio of 1.5 to 2.2) in epidemiologic samples, but men are more likely t... Predominant Age: Mean age at onset ∼16 yr of age; median age at onset, 13 yr of age; onset rarely occurs after age 25, with 75% ... Genetics Suggested Readings Somatic Cough Syndrome and Tic Cough Incidence: Unknown Peak Incidence: Somatic cough disorder incidence peaks at age 8 to 14 yr Prevalence: Unknown Predominant Sex and Age: There is no gender difference in children. In adults, there may be a female predominance, although limi... Genetics: None known ?Treatment ?Pearls & Considerations Suggested Readings Suggested Readings Somatic Symptom Disorder Incidence: Not known Peak Incidence: Not known Prevalence: Estimated to be around 5% to 7% Predominant Sex and Age: Females tend to report more somatic symptoms Genetics: Not known, but thought to contribute along with other factors Risk Factors: Tendency to experience negative affect (neuroticism), limited education, lower socioeconomic status, recent stress... Suggested Readings Suggested Readings Southern Tick-Associated Rash Illness (STARI) Incidence: Unknown as not a reportable disease in the U.S Peak Incidence: As it is temporally associated with tick bites, occurs more often in spring and summer Risk Factors: Activities that lead humans to enter wooded areas where the ticks reside, such as hiking, lawn care, hunting, and ... ?Treatment Suggested Readings Spasticity Incidence: Spasticity affects between 47% and 70% of people with multiple sclerosis, 32% to 36% of those with spinal cord injury... Predominant Sex and Age: Spasticity is not affected by sex, race, or age group, nor is it more prevalent in any of those groups Risk Factors: Central nervous system diseases, including multiple sclerosis, stroke, spinal cord injury, cerebral palsy, trauma... ?Treatment Spina Bifida Incidence Predominant Sex: Females are affected more frequently than males Risk Factors Genetics ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Spinal Cord Compression Incidence: 12,400 new cases/yr in 2010 in the U.S Prevalence: 250,000 persons in 2005 in the U.S Cost (In U.S.): >$5 billion/yr Risk factors: Underlying spinal disease can predispose to SCI ?Treatment Suggested Readings Spinal Epidural Abscess Incidence (In U.S.) Suggested Readings Spinal Stenosis, Cervical Spine Peak Incidence: In acquired cases, >50 yr Prevalence: 1:1000 persons >65 yr old and 5:1000 persons >50 yr old Predominant Sex and Age: Males and females affected equally; age depends on etiology (congenital vs. acquired); in acquired case... Genetics: Genetic factors play a role in degenerative disease of the vertebrae and disc desiccation, but no one associated gene ... Risk Factors: Systemic diseases, rheumatoid arthritis, osteoarthritis; degenerative disc disease, repetitive microtrauma (spear ... ?Treatment Suggested Readings Spinal Stenosis, Lumbar ?Pearls & Considerations Suggested Readings Suggested Readings Spinocerebellar Ataxia Prevalence: The prevalence of the condition is approximately 3 persons per 100,000. The most common SCAs are 1, 2, 3, 6, and 7 Predominant Sex: SCA demonstrates no gender preference Predominant Age: The age of onset is often during the 30s or 40s. However, this can be highly variable, even within family group... Genetics: All SCAs are inherited in an autosomal dominant fashion; however, reduced penetrance can be present Suggested Readings Spondyloarthropathies Prevalence: Worldwide prevalence of SpA is 0.2% to 1.6%, with over 1% of the U.S. population affected. Varies regionally with pr... Predominant Sex and Age: Males younger than age 45 yr are predominantly affected. Previously, male:female ratio was thought to b... Genetics: Association with the HLA-B27 allele is the strongest known genetic risk factor Risk Factors: HLA-B27 allele*, male sex*, smoking*, ethnic background, family history of SpA, and certain infections (*Associate... ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Spontaneous Abortion Incidence: 10% to 20% of clinically recognized pregnancies; 80% of miscarriages occur in the first trimester. Recurrent miscarri... Genetics Maternal Causes Risk Factors Suggested Readings Spontaneous Bacterial Peritonitis Prevalence: The prevalence of SBP in cirrhotic patients admitted to the hospital has been estimated at 10% to 30% ?Diagnosis ?Pearls & Considerations Suggested Readings Sporotrichosis Predominant Sex: The most common form, lymphocutaneous sporotrichosis, occurs equally in both sexes. Males predominate in both p... Predominant Age: Generally, lymphocutaneous sporotrichosis occurs in people 35 yr of age or younger, usually through occupation ... Genetics: Neonatal infection: At least one case of transmission from the cheek lesions of the mother to the skin of the infant h... Cutaneous and Lymphocutaneous Sporotrichosis Deep-Seated Mycoses (Osteoarticular, Noncavitary Pulmonary Disease) Suggested Readings Squamous Cell Carcinoma ?Pearls & Considerations Statin-Induced Muscle Syndromes Incidence: Risk of statin-induced rhabdomyolysis is 1.2 per 10,000 persons/yr. Rhabdomyolysis risk of death is 0.15 deaths per 1... Peak Incidence: Patients on high-dose statins have a 0.9% incidence of statin-induced rhabdomyolysis Prevalence: The prevalence of statin-induced myalgias is about 1% to 5%, similar to placebo in clinical trials, although observa... Predominant Sex and Age: The mean age of hospitalized patients with statin-induced myopathy or rhabdomyolysis was 64 yr old and ... Genetics: Interpatient variability exists in the activity of the CYP3A4 gene for the metabolism of simvastatin, atorvastatin, an... Risk Factors: Small body frame; age over 80 yr; women, particularly frail elderly women; patients taking multiple drugs, especia... ?Pearls & Considerations Suggested Readings Status Epilepticus Incidence: 40 to 100 cases per 100,000 persons Peak Incidence: It is most common among children younger than 1 yr and adults older than 60 yr Predominant Sex and Age: No gender preference ?Treatment ?Pearls & Considerations Stevens-Johnson Syndrome Suggested Reading Suggested Reading Stomatitis/Mucositis White Lesions Red Lesions Dark Lesions (Brown, Blue, Black) Raised Lesions Blisters ?Treatment Strabismus Incidence (In U.S.): 2% of the population Peak Incidence: Childhood Predominant Sex: None Predominant Age: Variable depending on type, but more common in childhood Genetics: Most childhood forms suggest polygenic inheritance patterns with variable penetrance, although certain types (i.e., ac... Stroke, Acute Ischemic Incidence Prevalence: There are ∼4.5 million stroke survivors in the U.S Risk Factors: Hypertension, dyslipidemia, diabetes mellitus, and smoking are the four major modifiable risk factors. Other risk ... Genetics: Multifactorial General considerations Intravenous thrombolysis Hypertension: Elevated blood pressure is common during acute stroke, and it often subsides without specific therapy. In general,... Hypotension: The presence of systemic hypotension in acute ischemic stroke portends a poor outcome. The cause should be sought, ... Hypoglycemia: Hypoglycemia can mimic stroke. Prompt assessment of serum glucose level and replacement as necessary are important... Hyperglycemia: Hyperglycemia should be treated with sliding scale insulin, taking into consideration the patient’s oral intake. ... Fever: Fever is harmful during acute stroke. Ascertaining and addressing the cause while lowering an elevated temperature is str... Antiplatelet Therapy: Oral, rectal, or feeding tube administration of aspirin (325 mg/day) within 48 hours of stroke onset is ad... ?Pearls & Considerations Stroke, Hemorrhagic Incidence: There are approximately 795,000 new or recurrent strokes per yr in the U.S., of which approximately 10% are hemorrhag... Risk Factors Genetics: Multifactorial Hypertension (Box 2): Blood pressure should be quickly lowered by 15% and then gradually and safely brought to the individual pa... Correction Of Coagulopathy Elevated Intracranial Pressure: This condition should be treated with a graded approach, which may include the elevation of the ... Seizures: If seizures occur, they should be treated aggressively, including with intravenous medications, if needed. Although wi... Supportive Treatment Suggested Readings Stroke, Secondary Prevention Risk Factors: Age is the most important non-modifiable risk factor. Modifiable risk factors include hypertension, hyperlipidemia... ?Treatment Suggested Readings Sturge-Weber Syndrome Cutaneous Manifestations Leptomeningeal Angioma Ocular Manifestations Neurologic Features Seizures ?Treatment ?Pearls & Considerations Stuttering Incidence: Approximately 2% of adults stutter and 5% of children exhibit stuttering. The prevalence of stuttering in the teenage... Predominant Sex and Age: During childhood, twice as many boys stutter as girls. More girls than boys recover from stuttering, ap... Genetics: Studies show higher rates of stuttering within families of those who stutter and a higher concordance for stuttering i... Risk Factors: Presence of other speech or language disorders, family history of stuttering, onset after 3.5 yr of age, male sex,... Suggested Readings Stye (Hordeolum) Incidence (In U.S.): Unknown Prevalence (In U.S.): Unknown Predominant Sex: No gender predilection Predominant Age: May occur at any age Neonatal Infection: Rare in the neonatal period Peak Incidence: May occur at any age ?Pearls & Considerations Suggested Readings Suggested Readings Subarachnoid Hemorrhage Incidence: Nontraumatic: 6 to 8 cases/100,000 persons per yr Predominant Sex: Women aged >55 yr were found to have a 25% greater risk of developing SAH compared with men of the same age Predominant Age: The mean age at onset is 55 yr Peak Incidence: Most aneurysmal SAH occurs in people who are between the ages of 55 and 60 yr Genetics Risk Factors: Although genetics seem to play a factor in SAH, lifestyle factors are more important for determining overall risk.... Imaging Studies ?Pearls & Considerations Suggested Readings Subclavian Steal Syndrome ?Diagnosis ?Treatment Subclinical Brain Infarction Incidence: Annual incidence 2% to 4% per year over the age of 50 with incidence rates increasing with age Peak Incidence: Peak incidence occurs in the aging population and those with prior history of a stroke or a transient ischemic a... Prevalence: The overall prevalence of SBIs ranges from 8% to 62% depending on the population being studied. It increases with ag... Genetics: Genetic polymorphisms of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF), methylen... Risk Factors: Age, hypertension, metabolic syndrome, carotid artery disease, chronic kidney disease, coronary artery disease, he... ?Treatment ?Pearls & Considerations Suggested readings Suggested Readings Subdural Hematoma Incidence Prevalence: Unknown Predominant Age and Sex Risk Factors ?Treatment ?Pearls & Considerations Subphrenic Abscess Incidence: Not well known but intraabdominal abscess occurs in 1% to 2% of all cases of abdominal surgery. It increases to 10% t... ?Treatment ?Pearls & Considerations Suggested Readings Substance Use Disorder Incidence: Peak period of both alcohol and illicit drug use disorders occurs in late adolescence and early adulthood, with a sub... Prevalence: The lifetime prevalence of alcohol use disorders is approximately 8%, and prevalence of illicit drug use disorders i... Predominant Sex And Age: Substance abuse in general is more common among males than among females (1.3 times more) Genetics: Multiple biological mechanisms are involved in tolerance, craving, anxiety, dysphoria, executive cognitive function, a... Risk Factors: Offspring of substance abusers were at twofold increased risk for any substance use disorder and a threefold risk ... ?Treatment ?Pearls & Considerations Suggested Readings Suicide Data and Statistics: Firearm suicides (CDC 2014) Age-Related Data Gender Differences Environmental Factors Marital Status: Suicide rates are highest among the divorced, separated, and widowed and lowest among the married Substance Use: CDC data from 16 National Violent Death Reporting System states in 2010: 33.4% of suicide decedents tested positi... Financial Impact of Suicides Survivors (CDC) Risk Factors (CDC) (Table E1) Protective Factors (CDC) Suicidal Behavior Evaluation Acute Interventions Acute Psychopharmacologic Interventions Therapy Suggested Readings Superior Vena Cava Syndrome ?Diagnosis ?Treatment Supraventricular Tachycardia Suggested Readings Syncope ?Pearls & Considerations Suggested Readings Suggested Readings Syndrome of Inappropriate Antidiuresis Incidence: Hyponatremia occurs in nearly 14% of hospitalized patients and represents an acquired disorder in the majority of cas... Suggested Readings Synthetic Cannabinoids ?Diagnosis ?Treatment Suggested Readings Syphilis Primary Syphilis Secondary Syphilis Latent Syphilis—Early vs. Late Latent Tertiary Syphilis Suggested Readings Syringomyelia Incidence Prevalence Predominant sex and age Risk Factors ?Treatment Suggested Readings Systemic Lupus Erythematosus Incidence: Varies across gender, race/ethnic groups, and geography from 20 to 70 cases per 100,000 persons. Prevalence higher am... Predominant Sex: Female:male ratio is 9:1. The ratio is highest in reproductive age group, and about half of that in patients yo... Predominant Age: Mean age at diagnosis is 31 Suggested Readings Tabes Dorsalis Incidence (In U.S.): Rare, but increasing with HIV/AIDS Peak Incidence: 15 to 20 yr after initial infection Prevalence (In U.S.): Rare; more common with HIV/AIDS epidemic. Ten percent of untreated patients with syphilis develop neurosyp... Predominant Sex: Male ?Pearls & Considerations Suggested Readings Takayasu Arteritis ?Diagnosis ?Treatment Suggested Readings Takotsubo Cardiomyopathy Incidence: An estimated 15 to 30 new cases per 100,000 per yr Prevalence: About 1% to 2% of patients presenting with troponin-positive acute coronary syndrome (ACS) have SC Predominant Sex and Age: On presentation, 90% are females, and 80% are females >50 yr of age. Mean age of presentation is 68.8 y... Risk Factors: SC can be triggered by severe medical illness, intense emotional psychosocial stress or physical stress (death of ... ?Diagnosis ?Treatment Suggested Readings Tapeworm Infestation Incidence (In U.S.) Prevalence (In U.S.) Predominant Sex: Equal sex distribution Predominant Age Tapeworm Cysticercosis ?Pearls & Considerations Suggested Readings Tardive Dyskinesia Suggested Readings Tarsal Tunnel Syndrome Prevalence: Rare entrapment neuropathy, but the most common entrapment neuropathy in the foot/ankle Suggested Readings Temporomandibular Joint Syndrome ?Diagnosis suggested Reading Tension-Type Headache ?Basic Information ?Diagnosis ?Treatment Suggested Readings Testicular Cancer Incidence: There were an estimated 9560 new cases and 410 deaths associated with testicular cancer in the U.S. in 2019. The inci... ?Treatment Testicular Torsion Incidence: Affects 1 in 4000 males <25 yr ?Diagnosis ?Treatment Tetanus Incidence (In U.S.): 264 cases between 2009 and 2017. Overall case fatality was 13.2%, but 31.3% for people over 65. More than 6... Incidence (Worldwide): About 1 million cases of tetanus are reported worldwide annually, suggesting a global incidence of about ... Predominant Age: >60 yr of age Genetics: Neonatal infection ?Diagnosis Suggested Readings ?Pearls & Considerations Tetralogy of Fallot Incidence Predominant Sex: Slightly higher incidence in males than females Genetics: Genetic influence is suspected (22q11 deletion) ?Diagnosis Suggested Readings Thalassemias ?Treatment Suggested Readings Suggested Readings Thoracic Outlet Syndrome Prevalence: TOS is an uncommon disorder. Varies from source to source; presence of cervical ribs in 0.5% to 1% of population (50... Predominant Sex: Females affected more often than males (ratio of 3.5:1) Predominant Age: Rare in those aged <20 yr ?Treatment ?Pearls & Considerations Thromboangiitis Obliterans Prevalence: Although TAO has been observed worldwide, it is most prevalent in the Mediterranean, Asia, the Middle East, and East... Predominant Sex and Age: TAO affects predominantly males (70% to 91%), typically between the ages of 25 and 45, with one report ... Risk Factors Pathology: Although not necessary, biopsy helps confirm diagnosis and is useful in atypical presentations Outcomes Suggested Readings Suggested Readings Thrombocytosis Incidence: 1.2 to 3.0 per 100,000 population/yr Prevalence: Estimated as 24 cases/100,000 population Predominant Sex and Age: The median age at diagnosis is 58 yr. Female:male ratio is 2:1 ?Treatment ?Pearls & Consideration Thrombophlebitis, Superficial Venous ?Pearls & Considerations Suggested Readings Thrombotic Thrombocytopenic Purpura ?Treatment ?Pearls & Considerations Suggested Readings Thyroid Carcinoma ?Diagnosis ?Pearls & Considerations Suggested Readings Thyroid Nodule ?Pearls & Considerations Suggested Readings Thyroiditis Thyrotoxic Storm ?Diagnosis ?Pearls & Considerations Suggested Reading Tinea Capitis ?Treatment Suggested Reading Tinea Corporis Tinea Cruris Tinea Pedis ?Diagnosis Tinea Unguium ?Diagnosis ?Pearls & Considerations Tinea Versicolor Tinnitus Prevalence Predominant Sex And Age: Persons most affected are male, Caucasian, elderly, persons with hearing impairment, persons living in ... Risk Factors: Any condition causing hearing loss or damage to the auditory system can produce tinnitus. Cochlear damage from exp... Torsade de Pointes Incidence: The precise incidence of TdP is unclear but accounts for fewer than 5% of all sudden cardiac arrests. In congenital l... Predominant Sex and Age: Because testosterone shortens the QT interval, women have a longer baseline QT interval, which is belie... Genetics: Of the congenital LQTS channelopathies, long QT syndromes 1, 2, and 3 account for >70% of all cases. In general, the r... Risk Factors: TdP in patients with congenital LQTS is often initiated by an external trigger (Table 1). Triggers can include exe... Pathophysiology ?Treatment ?Pearls & Considerations Torticollis Suggested Readings ?Treatment Tourette Syndrome Prevalence (In U.S.): Unknown; estimates range from 0.3% to 0.9% in children Predominant Sex: Approximate male:female ratio of 4:1 Predominant Age: Typical age of onset is between 2 and 15 yr (mean 5 to 7 yr) Tics ADHD: Stimulants are useful for symptoms of ADHD but may exacerbate tics in 25% of patients. These medications should be used if... OCD: Selective serotonin reuptake inhibitors, such as fluoxetine, are the most effective treatment for OCD Suggested Readings Toxic Epidermal Necrolysis Incidence: Annual incidence is two to seven cases per million per year Predominant Sex and Age: Women:men ratio 1.5:1 Genetics: Some ethnic groups are more susceptible to developing TEN to certain medications when having specific human leukocyte ... Risk Factors: Slow acetylator genotypes, immunosuppression, and concomitant administrations of radiotherapy and anticonvulsants ... ?Treatment ?Pearls & Considerations Suggested Readings Toxic Megacolon Incidence: Varies depending on etiology. Incidence in patients with ulcerative colitis (UC) is approximately 10% and nearly 5% i... Peak Incidence: N/A Prevalence: N/A Predominant Sex and Age: With increasing rates of Clostridium difficile (C. diff) infections, patients ages 65 and older are at ... Genetics: There are no known genetic factors that predispose patients to developing toxic megacolon associated with an inflammat... Risk Factors: Major risk factors include inflammatory, infectious, and ischemic conditions of the colon, especially in individua... ?Treatment ?Pearls & Considerations Suggested Readings Toxic Shock Syndrome ?Pearls & Considerations Suggested Readings Toxoplasmosis Incidence (In U.S.) Predominant Sex: Equal gender distribution Predominant Age Peak Incidence: Seroprevalence is much higher in Latin America, Africa, and other temperate climates than in the U.S Genetics: Congenital infection ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Tracheitis Incidence (In U.S.) Peak Incidence: Three fourths of cases reported in winter Predominant Sex: Boys > girls in one series Predominant Age Genetics Direct laryngoscopy ?Pearls & Considerations Suggested Readings Transfusion Reaction, Hemolytic ?Pearls & Considerations Suggested Readings Transient Global Amnesia Incidence (In U.S.): 3.4 to 10.4 per 100,000 people Peak Incidence: Most between ages 50 to 70 and equally common in men and women. In population older than 50 the incidence increa... Recurrence Rate: 2.9% to 23.8% Suggested Readings Transient Ischemic Attack Incidence: 70 to 101 cases per 100,000 persons annually Peak Incidence: After age 60 yr Prevalence: 200,000 to 500,000 persons in the United States. The annual risk of stroke after either a TIA or minor stroke is app... Predominant Sex and Race: Males > females; African American > Caucasian Risk Factors: Same as for ischemic stroke Suggested Readings Transverse Myelitis Incidence: Annual incidence ranges from 1.3 to 8 cases per million. The incidence increases to 24.6 cases per million annually i... Prevalence: Unknown Predominant Sex: None, but female preponderance seen in cases associated with multiple sclerosis and neuromyelitis optica spectr... Genetics: No genetic predisposition has been shown Peak Incidence: Can occur at any age. Bimodal peak in the incidence between 10 to 19 yr and 30 to 39 yr. 20% of cases occur in c... Risk Factors: Infection, vaccination ?Treatment Suggested Readings Traumatic Brain Injury (TBI) Incidence: Globally, more than 10 million people suffer TBI resulting in mortality or requiring hospitalization each yr. By 2020... Prevalence: The prevalence of TBI in the United States has been estimated at approximately 5.3 million. In the European Union wi... Peak Incidence: Approximate incidence in the US per CDC data is 103/100,000 population. In the European Union, this is estimated... Predominant Sex and Age: TBI occurs more frequently in young adults, particularly males 15 to 25 yr of age, and has a high cost ... Genetics: TBI and Apo E ε4 synergistically are also associated with a tenfold increased risk for Alzheimer disease as well as la... Risk Factors: N/A High risk Low risk ?Treatment Related Content Suggested Readings Traveler Diarrhea Incidence: High risk (>20%): South and Southeast Asia, Africa (except South Africa), South and Central America, and Mexico Peak Incidence Prevalence: Acute and chronic diarrhea account for a third of medical visits by returned travelers as per the GeoSentinel databa... Predominant Sex and Age Genetics: Travelers with the O blood group are at higher risk for diarrhea caused by Norovirus and Shigella Risk Factors Suggested Readings Trichinellosis Incidence (In U.S.) ?Pearls & Considerations Suggested Readings Tricuspid Regurgitation ?Diagnosis ?Treatment Suggested Reading Tricuspid Stenosis Suggested Readings Tricyclic Antidepressant Overdose Trigeminal Neuralgia Incidence: 4 per 100,000 Peak Incidence: Incidence increases with age and peaks at 67 yr of age; onset in 90% of patients is after age 40 Prevalence: 155 in 1 million Predominant Sex and Age: Male:female ratio is 1:1.5 Risk Factors: Most cases are idiopathic; age and multiple sclerosis are risk factors Suggested Reading Trigger Finger Predominant Sex and Age: Female:male ratio of 4:1. Trigger finger can be found in all age groups but is most commonly found in p... ?Diagnosis ?Treatment Suggested Readings Trochanteric Pain Syndrome (Trochanteric Bursitis) ?Treatment Suggested Readings Tropical Sprue Tuberculosis, Miliary Incidence (In U.S.): More than 38% of AIDS patients with TB have disseminated disease, often with concurrent pulmonary and extra... Prevalence (In U.S.) Predominant Sex Predominant Age: Predominantly among 24 to 45 yr Peak Incidence: HIV-positive patients, regardless of age ?Pearls & Considerations Suggested Readings Tuberculosis, Pulmonary Incidence (Worldwide) Incidence (In U.S.) Predominant Sex Predominant Age Peak Incidence Genetics ?Pearls & Considerations Suggested Readings Tuberous Sclerosis Incidence: TS has an estimated incidence of 1 case per 6000 live births. Thus, it is the second most common neurocutaneous syndr... Prevalence: The disorder affects about 1 in 10,000 persons in the general population Predominant Sex: TS has no predilection for gender or race Genetics ?Treatment ?Pearls & Considerations Suggested Readings Tularemia Incidence (In U.S.): Overall incidence in the U.S. had been about 120 cases/yr with the highest reported incidence found in Sout... Predominant Sex: Male Predominant Age: Occurs at any age but is most common in 5- to 9-yr-old children and in men >55 yr of age Peak Incidence: June through August and in December Suggested Readings Tumor Lysis Syndrome Incidence: The frequency of TLS is unknown, but it is the most common disease-related emergency encountered by physicians who tr... Prevalence: Variable Predominant Sex and Age Genetics: No racial predilection Risk Factors Clinical Presentation: Patients may present with a number of symptoms either before starting chemotherapy or commonly within 3 d... Physical Findings Suggested Readings Turner Syndrome ?Treatment Suggested Reading Typhoid Fever ?Pearls & Considerations Suggested Readings Ulcerative Colitis Incidence: The incidence of UC is 9 to 12 cases per 100,000 persons per yr in the U.S.; worldwide, the estimated incidence range... Prevalence: The prevalence of UC is 7.6 to 246.0 cases per 100,000 per yr. Higher prevalence in Ashkenazi Jewish descendants Geographic Distribution: The highest incidence and prevalence of IBD are seen in northern Europe and North America, and the lowe... Genetics ?Treatment Suggested Readings Unruptured Intracranial Aneurysms (UIAs) Peak incidence: The incidence of UIAs is currently unknown Prevalence: The prevalence of UIAs is approximately 3% in a population without comorbidity and with a mean age of 50 yr Predominant sex & age: UIAs are 3× more common in women and are more likely to occur in those aged 60 and older. In the pediatri... Genetics: No specific genetic mutations have been shown to cause UIAs. However, more than 19 single nucleotide polymorphisms (SN... Risk Factors: Risk factors include female gender, older age, family history, genetic factors, cigarette smoking, and hypertensio... Suggested Readings Upper Extremity Deep Vein Thrombosis ?Treatment Suggested Reading Urethritis, Gonococcal Suggested Readings Urethritis, Nongonococcal ?Treatment Suggested Readings Urinary Tract Infection ?Diagnosis (Fig. 1) ?Pearls & Considerations Suggested Readings Urolithiasis (Nephrolithiasis) ?Treatment ?Pearls & Considerations Related Content Suggested Readings Urticaria ?Diagnosis Suggested Readings Uterine Fibroids ?Treatment Suggested Readings Uterine Malignancy Incidence: Incidence of uterine cancer (including endometrial) is 27 per 100,000 women per yr, with 5 deaths per 100,000 women a... Prevalence: Uterine sarcoma accounts for approximately 8% of all cancers of the uterine corpus and is associated with poor progn... Mean Age at Diagnosis: 60 yr Risk Factors: Box 1 describes risk factors for uterine sarcoma ?Diagnosis Related Content Suggested Readings Uveitis Incidence (In U.S.): Common; busy ophthalmologist will see two or more cases per wk Peak Incidence: Middle age or older Prevalence (In U.S.): 17 cases per 100,000 persons Predominant Sex: None Predominant Age: 38 yr. Although uveitis is less common in children than adults, it is believed to be more severe with an increa... Suggested Reading Vaginal Bleeding During Pregnancy Suggested Readings Vaginal Cancer Incidence: There were an estimated 5170 new cases in 2018 and an estimated 910 deaths Prevalence: Vaginal cancer is the second rarest gynecologic cancer. It comprises 3% of malignancies of the female genital tract.... Mean Age at Diagnosis: This is predominantly a disease of menopause. The mean age at diagnosis is 65.7 +/-14.3 yr ?Treatment Suggested Readings Vaginal Fistulas Incidence: After benign hysterectomy: <1% (0.08% to 0.26%); after radical hysterectomy: 1% to 4%. Incidence is difficult to esti... Prevalence: Rare in the developed world from obstetric complications, but in developing countries, the best estimate of prevalen... Risk Factors: In developing countries ?Treatment (Fig. E5) ?Pearls & Considerations Suggested Readings Vaginitis, Estrogen-Deficient Suggested Readings Vaginitis, Fungal Suggested Readings ?Pearls & Considerations Vaginitis, Prepubescent Related Content Suggested Readings Vaginitis, Trichomonas Suggested Readings Vaginosis, Bacterial Suggested Readings Vancomycin-Resistant Enterococcus (VRE) Incidence: VRE may be associated with the use of specific classes of antibiotics Peak Incidence: VRE was first reported in Europe in 1986, and there has been a steady rise in the incidence of enterococcal stra... Prevalence: Eighty percent of E. faecium are VRE; 69% of E. faecalis are VRE Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Varicella ?Pearls & Considerations Varicocele Prevalence: A varicocele is present in up to 20% of all males. It occurs in approximately 40% of infertile men. However, only 10... ?Treatment Suggested Reading Varicose Veins Prevalence: One large U.S. cohort study found the biannual incidence of varicose veins was 3% in women and 2% in men Risk Factors Conservative Therapy Sclerotherapy Ambulatory Phlebectomy Endovenous Ablation Suggested Readings Vasculitis, Systemic ?Treatment Suggested Readings Venous Insufficiency, Chronic ?Diagnosis ?Pearls & Considerations Suggested Readings Venous Ulcers Suggested Readings Ventricular Fibrillation Incidence: A peak incidence of VF occurs in the first 48 hrs after an acute myocardial infarction (MI). The true incidence of VF... ?Pearls & Considerations Suggested Reading Ventricular Septal Defect ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Ventricular Tachycardia Incidence: The actual incidence and prevalence of VT in the general population is unknown. VT, especially NSVT, can be seen in b... Suggested Readings Vertebral Compression Fractures Author: Fred F. Ferri, MD Suggested Readings Vestibular Neuronitis ?Pearls & Considerations Suggested Readings Viral Bronchiolitis Incidence: Approximately 20% of infants will need care for bronchiolitis in the first yr of life, and 2% to 3% of those younger ... Peak Incidence: Bronchiolitis can occur throughout the yr but is most prevalent from December to March Predominant Age & Sex Risk Factors ?Treatment ?Pearls & Considerations Suggested Readings Vitamin D Deficiency ?Basic Information Incidence Peak Incidence: In the U.S., 40% to 100% of the elderly are vitamin D deficient. Sixty percent of nursing home residents may be ... Prevalence: Forty-two percent of African American girls and women 15 to 49 yr old have 25(OH)D levels <20 ng/dl Predominant Sex and Age Risk Factors Screening: Routine screening for low-risk adults is not recommended. Screening is recommended only for individuals at high risk ... Suggested Readings Vitamin Deficiency (Hypovitaminosis) ?Treatment Suggested Reading Vitiligo Prevalence: Vitiligo affects 0.5% to 1% of the population; it is the most common depigmenting disorder Predominant Age: Vitiligo can begin at any age, but the age at onset is <20 yr for half of patients. Peak onset is between ages ... Genetics: A positive family history is present in 25% to 30% of patients, and both sexes are equally affected. There are no diff... ?Treatment Suggested Readings Von Hippel-Lindau Disease Suggested Readings Von Willebrand Disease ?Diagnosis Screening Laboratory Tests Specific Laboratory Tests Suggested Readings Vulvar Cancer Incidence: In 2019, it is estimated that there will be approximately 6070 new cases of vulvar cancer and that approximately 1280... Prevalence: Vulvar cancer is uncommon. It comprises 3% to 5% of malignancies of the female genital tract and approximately 1% of... Mean Age at Diagnosis: Predominantly a disease of menopause, the mean age at diagnosis is 65 yr. However, the incidence shows a ... Waldenström Macroglobulinemia ?Diagnosis ?Treatment ?Pearls & Considerations Suggested Readings Warts ?Pearls & Considerations Suggested Readings Wernicke Syndrome Predominant Sex and Age Genetics Risk Factors ?Pearls & Considerations West Nile Virus Infection Suggested Readings Whiplash Suggested Readings Whipple Disease Physical Findings ?Treatment Wilson Disease Prevalence: One case in 30,000 Predominant Sex: Affects men and women equally (autosomal recessive gene) Onset of Symptoms: Ages 3 to 40 yr Physical Findings ?Pearls & Considerations Wolff-Parkinson-White Syndrome ?Diagnosis ?Treatment Suggested Readings Yellow Fever Geographic Distribution Incidence: Approximate attack rates of 3% in Africa and Amazon Prevalence: Endemic areas: 20% of population Predominant Sex: In Africa and the Amazon, male agricultural workers Pathogenesis & Pathology ?Pearls & Considerations Suggested Readings Zenker Diverticulum ?Diagnosis Suggested Readings Zika Virus Incidence Peak Incidence: As a mosquito-borne disease, it is more common in warmer mos of the yr Prevalence: In an outbreak in Yap islands, 70% of the population was infected in a 13-wk period of time. Although transmission o... Risk Factors: The virus can be transmitted in different ways Suggested Readings A B C D E F G H I J K L M N O P Q R S T U V W X Y B C D E F G H I J L M N O P R S T U V W A B C D E F G H I L M N O P R S T U V IMMUNIZATIONS AND CHEMOPROPHYLAXIS Childhood and Adolescent Immunizations General Recommendations on Immunization VACCINE ADMINISTRATION* INFECTION CONTROL AND STERILE TECHNIQUE INFANTS (AGED <12 MONTHS) TODDLERS AND OLDER CHILDREN (AGED 12 MONTHS TO 10 YEARS) ADOLESCENTS AND ADULTS (AGED >11 YEARS) SUBCUTANEOUS INJECTIONS Immunizations for Adults RECOMMENDED IMMUNIZATION SCHEDULE FOR ADULTS AGED 19 YEARS OR OLDER, UNITED STATES, 2020 Vaccinations for International Travel Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practi... Hepatitis A Prophylaxis Influenza Treatment and Prophylaxis INDICATIONS FOR USE OF ANTIVIRALS RECOMMENDATIONS FOR HIV TESTING OF ADULTS, ADOLESCENTS, AND PREGNANT WOMEN Recommendations for Meningococcal Vaccination Ia - Definitions of Complementary and Alternative Medicine Terms Ib - Relaxation Techniques Ic - Overview of Selected Natural Products Id - Natural Products and Drug Interactions Ie - Commonly Ingested Plants with Significant Toxic Potential If - Herbs Associated with Toxicity Ig - Websites Providing Data on Herbal Therapy Hazards Ih - Common Herbs in Integrated Medicine Ii - Herbal Activities Against Pain and Chronic Diseases IIa - Dietary Supplements: What Every Primary Care Provider Should Know IIb - Vitamins and Their Functions IIc - Nutritional Trace Elements and Their Clinical Implications IId - Summary of Vitamin and Mineral Deficiencies IIIa - Selected Historical and Physical Findings in Poisoning IIIb - Toxidromes IIIc - Antidotes and Indications for Use IIId - Management of Acute Poisoning IIIe - Pathophysiology, Clinical Effects, and Management of Specific Drugs and Toxicants IIIf - Accidental Poisoning by Exposure to Other Drugs Acting on the Autonomic Nervous System IV - Impairment and Disability Issues V - Protection of Travelers VI - Physician Quality Reporting System (PQRS) Measures VIII - Palliative Care IX - Preoperative Evaluation Preoperative Evaluation SUGGESTED READINGS IBC
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