, Graber and Wilbur’s
FAMILY MEDICINE
EXAMINATION
& BOARD REVIEW
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, Graber and Wilbur’s
FAMILY MEDICINE
EXAMINATION
& BOARD REVIEW
FIFTH EDITION
Editors
Mark A. Graber, MD, MSHCE, FACEP
Clinical Professor
Departments of Family Medicine and Emergency Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
Brigit E. Ray, MD, MME
Clinical Assistant Professor
Department of Family Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
Jason K. Wilbur, MD, FAAFP
Clinical Professor
Department of Family Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
New York/Chicago/San Francisco/Athens/London/Madrid/Mexico City/
New Delhi/Milan/Singapore/Sydney/Toronto
FM.indd 3 29-11-2019 18:41:5
,Copyright © 2020 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976,
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system,
without the prior written permission of the publisher.
ISBN: 978-1-26-044108-6
MHID: 1-26-044108-3
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-044107-9,
MHID: 1-26-044107-5.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO
IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and
its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will
be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy,
error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility
for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors
be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use
the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or
cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, To the people who make Family Medicine happen. Jogjakarta:
Dr. Mora Claramita, Dr. Adi Heru Husodo, Dr. Wahyudi Istiono,
and Dr. Fitriana Murriya. Moscow: Professor Dr. Gregorii Efimovich
Roitberg, Dr. Olga Sharkun, Dr. Irina Slastnikova, Dr. Janna Dorosh,
and Professor Timothy O’Connor. Haiphong: Dr. Hùng Nguyễn Văn,
Dr. Linh Nguyễn, and Dr. Nguyễn Thuý Hiếu.
—MAG
To my parents, Bill and Bonnie Ray, for always loving, supporting, and
encouraging me to follow my dreams to become a family physician.
To all of my Family Medicine and education mentors including: Drs.
George Bergus, Rick Dobyns, Jason Wilbur, Bob Tallitsch, Jeff Pettit,
and Marcy Rosenbaum. Your guidance and support along this journey
have shaped me into the family physician educator I have become!
—BER
To my many mentors in Family Medicine, including Drs. John Ely,
Mark Graber, Paul James, Gerald Jogerst, and Barcey Levy; and to Dr.
Kate Thoma and all the Family Medicine program directors and faculty
members who work tirelessly (and mostly thanklessly) to develop the
next generation of excellent family doctors. Keep teaching; keep leading!
—JKW
FM.indd 5 29-11-2019 18:41:5
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, Contents
Contributors..............................................................................................ix 16 Men’s Health............................................................................... 501
Preface..................................................................................................... xiii 17 Dermatology.............................................................................. 525
A Few Words on Studying and Taking the Board Examination...... xv
18 Neurology.................................................................................... 551
1 Emergency Medicine................................................................... 1 19 Ophthalmology......................................................................... 585
2 Cardiology......................................................................................43 20 Otolaryngology......................................................................... 607
3 Pulmonology.............................................................................. 105 21 Care of the Older Patient........................................................ 631
4 Allergy and Immunology....................................................... 141 22 Care of the Surgical Patient................................................... 662
5 Nephrology................................................................................. 150 23 Psychiatry.................................................................................... 693
6 Hematology and Oncology................................................... 183 24 Nutrition and Herbal Medicine............................................ 729
7 Gastroenterology...................................................................... 211 25 Substance Use Disorders....................................................... 742
8 Infectious Diseases................................................................... 253 26 Ethics............................................................................................. 763
9 HIV/AIDS...................................................................................... 281 27 End-of-Life Care......................................................................... 774
10 Endocrinology........................................................................... 296 28 Evidence-Based Medicine..................................................... 788
11 Rheumatology........................................................................... 330 29 Patient-Centered Care............................................................. 800
12 Orthopedics and Sports Medicine..................................... 364 30 Final Examination..................................................................... 813
13 Pediatrics..................................................................................... 395
14 Adolescent Medicine............................................................... 437
Index........................................................................................................841
15 Obstetrics and Women’s Health.......................................... 451
vii
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, Contributors
Emad Abou-Arab, MD, CME Guru V. Bhoojhawon, MBBS, MD, FAAP
Clinical Assistant Professor Clinical Associate Professor
Department of Family Medicine Department of Pediatrics
Roy J. and Lucille A. Carver College of Medicine Roy J. and Lucille A. Carver College of Medicine
University of Iowa University of Iowa
Iowa City, Iowa Iowa City, Iowa
10. Endocrinology 13. Pediatrics
Daniel M. Anderson, DO
Nicholas R. Butler, MD, MBA
Senior Associate Consultant
Clinical Associate Professor
Department of Neurology
Department of Family Medicine
Mayo Clinic Health System Franciscan Healthcare
Roy J. and Lucille A. Carver College of Medicine
La Crosse, Wisconsin
University of Iowa
18. Neurology
Iowa City, Iowa
A. Ben Appenheimer, MD 21. Care of the Older Patient
Clinical Assistant Professor
Department of Internal Medicine Rachel R. Butler, MD
Division of Infectious Diseases Clinical Assistant Professor
Roy J. and Lucille A. Carver College of Medicine Department of Internal Medicine
University of Iowa Division of Pulmonary, Critical Care, and Occupational
Iowa City, Iowa Medicine
8. Infectious Diseases Roy J. and Lucille A. Carver College of Medicine
9. HIV/AIDS University of Iowa
Iowa City, IA
Stacey Appenheimer, MD 3. Pulmonology
Clinical Assistant Professor
Department of Family Medicine
Meghan Connett, MD
Roy J. and Lucille A. Carver College of Medicine
Clinical Assistant Professor
University of Iowa
Department of Family Medicine
Iowa City, Iowa
Roy J. and Lucille A. Carver College of Medicine
14. Adolescent Medicine
University of Iowa
Iowa City, Iowa
Olivia E. Bailey, MD
15. Obstetrics and Women’s Health
Clinical Associate Professor
Department of Emergency Medicine
Roy J. and Lucille A. Carver College of Medicine Dustin Z. DeYoung, MD
University of Iowa Psychiatrist
Iowa City, Iowa Behavioral Health Associates
1. Emergency Medicine University of California, Los Angeles
Los Angeles, California
Maresi Berry-Stoelzle, MD
Department of Family Medicine Austin R. Fox, MD
Roy J. and Lucille A. Carver College of Medicine Department of Ophthalmology and Visual Sciences
University of Iowa University of Iowa
Iowa City, Iowa Iowa City, Iowa
6. Hematology and Oncology 19. Ophthalmology
ix
FM.indd 9 29-11-2019 18:41:5
FAMILY MEDICINE
EXAMINATION
& BOARD REVIEW
FM.indd 1 29-11-2019 18:41:4
, This page intentionally left blank
FM.indd 6 29-11-2019 18:41:5
, Graber and Wilbur’s
FAMILY MEDICINE
EXAMINATION
& BOARD REVIEW
FIFTH EDITION
Editors
Mark A. Graber, MD, MSHCE, FACEP
Clinical Professor
Departments of Family Medicine and Emergency Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
Brigit E. Ray, MD, MME
Clinical Assistant Professor
Department of Family Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
Jason K. Wilbur, MD, FAAFP
Clinical Professor
Department of Family Medicine
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
Iowa City, Iowa
New York/Chicago/San Francisco/Athens/London/Madrid/Mexico City/
New Delhi/Milan/Singapore/Sydney/Toronto
FM.indd 3 29-11-2019 18:41:5
,Copyright © 2020 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976,
no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system,
without the prior written permission of the publisher.
ISBN: 978-1-26-044108-6
MHID: 1-26-044108-3
The material in this eBook also appears in the print version of this title: ISBN: 978-1-26-044107-9,
MHID: 1-26-044107-5.
eBook conversion by codeMantra
Version 1.0
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions or for use in corpo-
rate training programs. To contact a representative, please visit the Contact Us page at www.mhprofessional.com.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug
therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to
provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been
involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or com-
plete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in
this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers
are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the
information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications
for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education and its licensors reserve all rights in and to the work. Use of this work is subject
to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may
not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate,
sell, publish or sublicense the work or any part of it without McGraw-Hill Education’s prior consent. You may use the work for your
own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if
you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WAR-
RANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING
THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR
OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO
IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill Education and
its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will
be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy,
error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility
for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors
be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use
the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or
cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
, To the people who make Family Medicine happen. Jogjakarta:
Dr. Mora Claramita, Dr. Adi Heru Husodo, Dr. Wahyudi Istiono,
and Dr. Fitriana Murriya. Moscow: Professor Dr. Gregorii Efimovich
Roitberg, Dr. Olga Sharkun, Dr. Irina Slastnikova, Dr. Janna Dorosh,
and Professor Timothy O’Connor. Haiphong: Dr. Hùng Nguyễn Văn,
Dr. Linh Nguyễn, and Dr. Nguyễn Thuý Hiếu.
—MAG
To my parents, Bill and Bonnie Ray, for always loving, supporting, and
encouraging me to follow my dreams to become a family physician.
To all of my Family Medicine and education mentors including: Drs.
George Bergus, Rick Dobyns, Jason Wilbur, Bob Tallitsch, Jeff Pettit,
and Marcy Rosenbaum. Your guidance and support along this journey
have shaped me into the family physician educator I have become!
—BER
To my many mentors in Family Medicine, including Drs. John Ely,
Mark Graber, Paul James, Gerald Jogerst, and Barcey Levy; and to Dr.
Kate Thoma and all the Family Medicine program directors and faculty
members who work tirelessly (and mostly thanklessly) to develop the
next generation of excellent family doctors. Keep teaching; keep leading!
—JKW
FM.indd 5 29-11-2019 18:41:5
, This page intentionally left blank
FM.indd 6 29-11-2019 18:41:5
, Contents
Contributors..............................................................................................ix 16 Men’s Health............................................................................... 501
Preface..................................................................................................... xiii 17 Dermatology.............................................................................. 525
A Few Words on Studying and Taking the Board Examination...... xv
18 Neurology.................................................................................... 551
1 Emergency Medicine................................................................... 1 19 Ophthalmology......................................................................... 585
2 Cardiology......................................................................................43 20 Otolaryngology......................................................................... 607
3 Pulmonology.............................................................................. 105 21 Care of the Older Patient........................................................ 631
4 Allergy and Immunology....................................................... 141 22 Care of the Surgical Patient................................................... 662
5 Nephrology................................................................................. 150 23 Psychiatry.................................................................................... 693
6 Hematology and Oncology................................................... 183 24 Nutrition and Herbal Medicine............................................ 729
7 Gastroenterology...................................................................... 211 25 Substance Use Disorders....................................................... 742
8 Infectious Diseases................................................................... 253 26 Ethics............................................................................................. 763
9 HIV/AIDS...................................................................................... 281 27 End-of-Life Care......................................................................... 774
10 Endocrinology........................................................................... 296 28 Evidence-Based Medicine..................................................... 788
11 Rheumatology........................................................................... 330 29 Patient-Centered Care............................................................. 800
12 Orthopedics and Sports Medicine..................................... 364 30 Final Examination..................................................................... 813
13 Pediatrics..................................................................................... 395
14 Adolescent Medicine............................................................... 437
Index........................................................................................................841
15 Obstetrics and Women’s Health.......................................... 451
vii
FM.indd 7 29-11-2019 18:41:5
, This page intentionally left blank
FM.indd 6 29-11-2019 18:41:5
, Contributors
Emad Abou-Arab, MD, CME Guru V. Bhoojhawon, MBBS, MD, FAAP
Clinical Assistant Professor Clinical Associate Professor
Department of Family Medicine Department of Pediatrics
Roy J. and Lucille A. Carver College of Medicine Roy J. and Lucille A. Carver College of Medicine
University of Iowa University of Iowa
Iowa City, Iowa Iowa City, Iowa
10. Endocrinology 13. Pediatrics
Daniel M. Anderson, DO
Nicholas R. Butler, MD, MBA
Senior Associate Consultant
Clinical Associate Professor
Department of Neurology
Department of Family Medicine
Mayo Clinic Health System Franciscan Healthcare
Roy J. and Lucille A. Carver College of Medicine
La Crosse, Wisconsin
University of Iowa
18. Neurology
Iowa City, Iowa
A. Ben Appenheimer, MD 21. Care of the Older Patient
Clinical Assistant Professor
Department of Internal Medicine Rachel R. Butler, MD
Division of Infectious Diseases Clinical Assistant Professor
Roy J. and Lucille A. Carver College of Medicine Department of Internal Medicine
University of Iowa Division of Pulmonary, Critical Care, and Occupational
Iowa City, Iowa Medicine
8. Infectious Diseases Roy J. and Lucille A. Carver College of Medicine
9. HIV/AIDS University of Iowa
Iowa City, IA
Stacey Appenheimer, MD 3. Pulmonology
Clinical Assistant Professor
Department of Family Medicine
Meghan Connett, MD
Roy J. and Lucille A. Carver College of Medicine
Clinical Assistant Professor
University of Iowa
Department of Family Medicine
Iowa City, Iowa
Roy J. and Lucille A. Carver College of Medicine
14. Adolescent Medicine
University of Iowa
Iowa City, Iowa
Olivia E. Bailey, MD
15. Obstetrics and Women’s Health
Clinical Associate Professor
Department of Emergency Medicine
Roy J. and Lucille A. Carver College of Medicine Dustin Z. DeYoung, MD
University of Iowa Psychiatrist
Iowa City, Iowa Behavioral Health Associates
1. Emergency Medicine University of California, Los Angeles
Los Angeles, California
Maresi Berry-Stoelzle, MD
Department of Family Medicine Austin R. Fox, MD
Roy J. and Lucille A. Carver College of Medicine Department of Ophthalmology and Visual Sciences
University of Iowa University of Iowa
Iowa City, Iowa Iowa City, Iowa
6. Hematology and Oncology 19. Ophthalmology
ix
FM.indd 9 29-11-2019 18:41:5
