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About the Oxford American Handbooks in Medicine The Oxford American Handbooks are flexi-covered pocket clinical books, providing practical guidance in quick reference, note form. Titles cover major medical specialties or cross-specialty topics and are aimed at students, residents, internists, family physicians, and practicing physicians within specific disciplines. Their reputation is built on including the best clinical information, complemented by hints, tips, and advice from the authors. Each one is carefully reviewed by senior subject experts, residents, and students to ensure that content reflects the reality of day-to-day medical practice. Key series features - Written in short chunks, each topic is covered in a two-page spread to enable readers to find information quickly. They are also perfect for test preparation and gaining a quick overview of a subject without scanning through unnecessary pages. - Content is evidence based and complemented by the expertise and judgment of experienced authors. - The Handbooks provide a humanistic approach to medicine—it’s more than just treatment by numbers. - A “friend in your pocket,” the Handbooks offer honest, reliable guidance about the difficulties of practicing medicine and provide coverage of both the practice and art of medicine. - For quick reference, useful “everyday” information is included on the inside covers. - Made with hard-wearing plastic covers, tough paper, and built-in ribbon bookmarks, the Handbooks stand up to heavy usage. This page intentionally left blank Oxford American Handbook of Clinical Diagnosis ii Published and forthcoming Oxford American Handbooks Oxford American Handbook of Clinical Medicine Oxford American Handbook of Anesthesiology Oxford American Handbook of Clinical Dentistry Oxford American Handbook of Clinical Diagnosis Oxford American Handbook of Critical Care Oxford American Handbook of Emergency Medicine Oxford American Handbook of Nephrology and Hypertension Oxford American Handbook of Obstetrics and Gynecology Oxford American Handbook of Oncology Oxford American Handbook of Otolaryngology Oxford American Handbook of Pediatrics Oxford American Handbook of Psychiatry Oxford American Handbook of Pulmonary Medicine Oxford American Handbook of Rheumatology Oxford American Handbook of Surgery iii Oxford American Handbook of Clinical Diagnosis Gregg Y. Lipschik Joan M. Von Feldt Lawrence Frame Scott Akers University of Pennsylvania School of Medicine Philadelphia, Pennsylvania Salvatore Mangione Thomas Jefferson School of Medicine Philadelphia, Pennsylvania Huw Llewelyn Kettering General Hospital Kettering, Northamptonshire England iv Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2009 by Huw Llewelyn Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Oxford American handbook of clinical diagnosis/Gregg Lipschik ... [et al.]. p. ; cm. —(Oxford American handbooks) Adapted from: Oxford ha