,
,AL Graw any
,
, a LANGE medical book
2025
CURRENT
Medical Diagnosis
& Treatment
SIXT Y-FOURTH EDITION
Edited by
Maxine A. Papadakis, MD Michael W. Rabow, MD
Professor of Medicine, Emeritus Professor of Medicine and Urology
Department of Medicine Division of Palliative Medicine
University of California, San Francisco Department of Medicine
University of California, San Francisco
Kenneth R. McQuaid, MD
Professor of Medicine
Department of Medicine
University of California, San Francisco
Associate Editor
Monica Gandhi, MD, MPH
Professor of Medicine
Division of HIV, ID, and Global Medicine
San Francisco General Hospital
University of California, San Francisco
With Contributing Authors
AL Graw any
,Current Medical Diagnosis & Treatment 2025, Sixty-Fourth Edition
Copyright © 2025 by McGraw Hill. All rights reserved. Printed in the United States of America. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any
means, or stored in a database or retrieval system, without prior written permission of the publisher.
Previous editions copyright 2000 through 2024 by McGraw Hill Education; copyright © 1987 through 1999 by Appleton &
Lange; copyright 1962 through 1986 by Lange Medical Publications.
1 2 3 4 5 6 7 8 9 0 LWI 28 27 26 25 24 23
ISBN 978-1-2662-6623-2
MHID 1-2662-6623-2
ISSN 0092-8682
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 complete,
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
medication 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 medications.
This book was set in Minion Pro by KnowledgeWorks Global Ltd.
The editors were Kay Conerly, Jennifer Bernstein, and Sylvia Choi.
The production supervisor was Jeffrey Herzich.
Project management was provided by Tasneem Kauser at KnowledgeWorks Global Ltd.
The copyeditors were Greg Feldman, Kathryn Whitley, and Kim McAllister.
The index was prepared by Susan Hunter.
This book is printed on acid-free paper.
McGraw Hill books are available at special quantity discounts to use as premiums and sales promotions, or for use in
corporate training programs. To contact a representative, please visit the Contact Us pages at www.mhprofessional.com.
, Contents
Commonly Used Acronyms & Abbreviations 11. Heart Failure & Cardiomyopathy 390
Authors vii
Preface xv Christopher B. Granger, MD
Dedication xvii
12. Disorders of Cardiac Rhythm 410
YEAR IN REVIEW:
KEY CLINICAL UPDATES IN CMDT 2025 Kevin P. Jackson, MD
1. Disease Prevention & Health Promotion 1 13. Systemic Hypertension 431
Michael Pignone, MD, MPH Michael Sutters, MD, MRCP (UK)
2. Common Symptoms 15 14. Blood Vessel & Lymphatic Disorders 460
Paul L. Nadler, MD, & Warren J. Gasper, MD, James C. Iannuzzi, MD, MPH,
Ralph Gonzales, MD, MSPH & Meshell D. Johnson, MD
3. Preoperative Evaluation & Perioperative 15. Blood Disorders 488
Management 42
Lloyd E. Damon, MD, &
Hugo Q. Cheng, MD Charalambos Babis Andreadis, MD, MSCE
4. Geriatric Disorders 52 16. Disorders of Hemostasis, Thrombosis, &
Leah J. Witt, MD, Rossana Lau-Ng, MD, & Antithrombotic Therapy 534
G. Michael Harper, MD Andrew D. Leavitt, MD, &
Erika Leemann Price, MD, MPH
5. Palliative Care & Pain Management 69
Michael W. Rabow, MD, Kara E. Bischoff, MD, 17. Gastrointestinal Disorders 568
Ann Cai Shah, MD, Lawrence Poree, MD, MPH, PhD,
Kenneth R. McQuaid, MD
& Karin Sinavsky, MD, MS
6. Dermatologic Disorders 101 18. Liver, Biliary Tract, & Pancreas
Disorders 665
Nathan W. Rojek, MD, Scott Worswick, MD,
Kanade Shinkai, MD, PhD, & Lindy P. Fox, MD Lawrence S. Friedman, MD
7. Disorders of the Eyes & Lids 166 19. Breast Disorders 726
Jacque L. Duncan, MD, Neeti B. Parikh, MD, & Armando E. Giuliano, MD, FACS, FRCSEd, &
Gerami D. Seitzman, MD Sara A. Hurvitz, MD, FACP
8. Otolaryngology Disorders 200 20. Gynecologic Disorders 752
Elliott D. Kozin, MD, Rosh Sethi, MD, & Jill Brown, MD, MPH, MHS, FACOG, &
Lawrence R. Lustig, MD Katerina Shvartsman, MD, FACOG
9. Pulmonary Disorders 242 21. Obstetrics & Obstetric Disorders 783
Rime Abbas, MD, Mazen El Ali, MD, Vanessa L. Rogers, MD, & Scott W. Roberts, MD
Meghan E. Fitzpatrick, MD, &
Belinda Rivera-Lebron, MD, MS, FCCP 22. Rheumatologic, Immunologic, &
Allergic Disorders 809
10. Coronary Artery Disease, Valvular Disease,
& Other Key Topics in Cardiology 316 Rebecca L. Manno, MD, MHS,
Jinoos Yazdany, MD, MPH,
Todd Kiefer, MD Teresa K. Tarrant, MD, & Mildred Kwan, MD, PhD
iii
AL Graw any
, iv CMDT 2025 CONTENTS
23. Electrolyte & Acid-Base Disorders 864 35. Bacterial & Chlamydial Infections 1429
Nayan Arora, MD, & J. Ashley Jefferson, MD, FRCP Kelly A. Johnson, MD, MPH, &
Emma D. Bainbridge, MD, MPH
24. Kidney Disease 893
36. Spirochetal Infections 1470
Tonja C. Dirkx, MD, & Tyler B. Woodell, MD, MCR
Susan S. Philip, MD, MPH
25. Urologic Disorders 931
37. Protozoal & Helminthic Infections 1487
Mathew Sorensen, MD, MS, FACS,
Marah C. Hehemann, MD, & Philip J. Rosenthal, MD
Maahum A. Haider, MD, MPH
38. Mycotic Infections 1523
26. Nervous System Disorders 958
Stacey R. Rose, MD, FACP, FIDSA, &
Vanja C. Douglas, MD, & Richard J. Hamill, MD, FACP, FIDSA
Michael J. Aminoff, MD, DSc, FRCP
39. Disorders Related to Environmental
27. Psychiatric Disorders 1035 Emergencies 1537
Kristin S. Raj, MD, Nolan R. Williams, MD, Jacqueline A. Nemer, MD, FACEP, &
Charles DeBattista, DMH, MD, & Marianne A. Juarez, MD
Meshell D. Johnson, MD
40. Poisoning 1553
28. Endocrine Disorders 1085
Craig Smollin, MD
Paul A. Fitzgerald, MD
41. Cancer 1583
29. Diabetes Mellitus & Hypoglycemia 1179
Sunny Wang, MD, Tiffany O. Dea, PharmD, BCOP,
Umesh Masharani, MB, BS Lawrence S. Friedman, MD, Carling Ursem, MD,
Kenneth R. McQuaid, MD, & Marc A. Dall’Era, MD
30. Lipid Disorders 1223
Michael J. Blaha, MD, MPH
42. Genetic & Genomic Disorders 1647
Reed E. Pyeritz, MD, PhD
31. Nutrition, Nutritional Disorders, &
Obesity 1235 43. Orthopedic Disorders &
Katherine H. Saunders, MD,
Sports Medicine 1657
Leon I. Igel, MD, FACP, FTOS, & Anthony Luke, MD, MPH, & C. Benjamin Ma, MD
Sarah Fink, RD, CDN, CNSC
44. Sexual & Gender Minority Health 1693
32. Common Problems in Infectious
Patricia A. Robertson, MD, Nicole Rosendale, MD,
Diseases & Antimicrobial Therapy 1255
Kevin L. Ard, MD, MPH, Kenneth H. Mayer, MD,
Monica Fung, MD, MPH, Katherine Gruenberg, & Mitzi Hawkins, MD, MAS
PharmD, MAEd, & Peter V. Chin-Hong, MD
45. Substance Use Disorders 1715
33. HIV Infection & AIDS 1297
J. Janet Ho, MD, MPH, FASAM,
Monica Gandhi, MD, MPH, & Julian A. Mitton, MD, MPH, & Jessica Ristau, MD
Matthew A. Spinelli, MD, MAS
34. Viral & Rickettsial Infections 1338
Eva H. Clark, MD, PhD, Patrycja Ashley, MD, &
Wayne X. Shandera, MD
, CONTENTS CMDT 2025 v
The following chapters are available online e4. Podiatric Disorders
without subscription at Monara Dini, DPM, & Charles B. Parks, DPM
www.accessmedicine.com/CMDT
e1. Anti-infective Treatment: Antibiotic, e5. Women’s Health Issues
Antifungal, and Antiviral Agents Brigid M. Dolan, MD, MEd, &
Judith Walsh, MD, MPH
Katherine Gruenberg, PharmD, MAEd, &
Emily Kaip, PharmD
e6. Appendix: Therapeutic Drug
e2. Diagnostic Testing & Medical Monitoring, Laboratory Reference
Decision-Making Intervals, & Commonly Used Blood
Specimen Collection Tubes
Chuanyi Mark Lu, MD
Chuanyi Mark Lu, MD
e3. Information Technology in Index 1729
Patient Care
Russ Cucina, MD, MS
AL Graw any
, This page intentionally left blank
,AL Graw any
,
, a LANGE medical book
2025
CURRENT
Medical Diagnosis
& Treatment
SIXT Y-FOURTH EDITION
Edited by
Maxine A. Papadakis, MD Michael W. Rabow, MD
Professor of Medicine, Emeritus Professor of Medicine and Urology
Department of Medicine Division of Palliative Medicine
University of California, San Francisco Department of Medicine
University of California, San Francisco
Kenneth R. McQuaid, MD
Professor of Medicine
Department of Medicine
University of California, San Francisco
Associate Editor
Monica Gandhi, MD, MPH
Professor of Medicine
Division of HIV, ID, and Global Medicine
San Francisco General Hospital
University of California, San Francisco
With Contributing Authors
AL Graw any
,Current Medical Diagnosis & Treatment 2025, Sixty-Fourth Edition
Copyright © 2025 by McGraw Hill. All rights reserved. Printed in the United States of America. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any
means, or stored in a database or retrieval system, without prior written permission of the publisher.
Previous editions copyright 2000 through 2024 by McGraw Hill Education; copyright © 1987 through 1999 by Appleton &
Lange; copyright 1962 through 1986 by Lange Medical Publications.
1 2 3 4 5 6 7 8 9 0 LWI 28 27 26 25 24 23
ISBN 978-1-2662-6623-2
MHID 1-2662-6623-2
ISSN 0092-8682
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 complete,
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
medication 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 medications.
This book was set in Minion Pro by KnowledgeWorks Global Ltd.
The editors were Kay Conerly, Jennifer Bernstein, and Sylvia Choi.
The production supervisor was Jeffrey Herzich.
Project management was provided by Tasneem Kauser at KnowledgeWorks Global Ltd.
The copyeditors were Greg Feldman, Kathryn Whitley, and Kim McAllister.
The index was prepared by Susan Hunter.
This book is printed on acid-free paper.
McGraw Hill books are available at special quantity discounts to use as premiums and sales promotions, or for use in
corporate training programs. To contact a representative, please visit the Contact Us pages at www.mhprofessional.com.
, Contents
Commonly Used Acronyms & Abbreviations 11. Heart Failure & Cardiomyopathy 390
Authors vii
Preface xv Christopher B. Granger, MD
Dedication xvii
12. Disorders of Cardiac Rhythm 410
YEAR IN REVIEW:
KEY CLINICAL UPDATES IN CMDT 2025 Kevin P. Jackson, MD
1. Disease Prevention & Health Promotion 1 13. Systemic Hypertension 431
Michael Pignone, MD, MPH Michael Sutters, MD, MRCP (UK)
2. Common Symptoms 15 14. Blood Vessel & Lymphatic Disorders 460
Paul L. Nadler, MD, & Warren J. Gasper, MD, James C. Iannuzzi, MD, MPH,
Ralph Gonzales, MD, MSPH & Meshell D. Johnson, MD
3. Preoperative Evaluation & Perioperative 15. Blood Disorders 488
Management 42
Lloyd E. Damon, MD, &
Hugo Q. Cheng, MD Charalambos Babis Andreadis, MD, MSCE
4. Geriatric Disorders 52 16. Disorders of Hemostasis, Thrombosis, &
Leah J. Witt, MD, Rossana Lau-Ng, MD, & Antithrombotic Therapy 534
G. Michael Harper, MD Andrew D. Leavitt, MD, &
Erika Leemann Price, MD, MPH
5. Palliative Care & Pain Management 69
Michael W. Rabow, MD, Kara E. Bischoff, MD, 17. Gastrointestinal Disorders 568
Ann Cai Shah, MD, Lawrence Poree, MD, MPH, PhD,
Kenneth R. McQuaid, MD
& Karin Sinavsky, MD, MS
6. Dermatologic Disorders 101 18. Liver, Biliary Tract, & Pancreas
Disorders 665
Nathan W. Rojek, MD, Scott Worswick, MD,
Kanade Shinkai, MD, PhD, & Lindy P. Fox, MD Lawrence S. Friedman, MD
7. Disorders of the Eyes & Lids 166 19. Breast Disorders 726
Jacque L. Duncan, MD, Neeti B. Parikh, MD, & Armando E. Giuliano, MD, FACS, FRCSEd, &
Gerami D. Seitzman, MD Sara A. Hurvitz, MD, FACP
8. Otolaryngology Disorders 200 20. Gynecologic Disorders 752
Elliott D. Kozin, MD, Rosh Sethi, MD, & Jill Brown, MD, MPH, MHS, FACOG, &
Lawrence R. Lustig, MD Katerina Shvartsman, MD, FACOG
9. Pulmonary Disorders 242 21. Obstetrics & Obstetric Disorders 783
Rime Abbas, MD, Mazen El Ali, MD, Vanessa L. Rogers, MD, & Scott W. Roberts, MD
Meghan E. Fitzpatrick, MD, &
Belinda Rivera-Lebron, MD, MS, FCCP 22. Rheumatologic, Immunologic, &
Allergic Disorders 809
10. Coronary Artery Disease, Valvular Disease,
& Other Key Topics in Cardiology 316 Rebecca L. Manno, MD, MHS,
Jinoos Yazdany, MD, MPH,
Todd Kiefer, MD Teresa K. Tarrant, MD, & Mildred Kwan, MD, PhD
iii
AL Graw any
, iv CMDT 2025 CONTENTS
23. Electrolyte & Acid-Base Disorders 864 35. Bacterial & Chlamydial Infections 1429
Nayan Arora, MD, & J. Ashley Jefferson, MD, FRCP Kelly A. Johnson, MD, MPH, &
Emma D. Bainbridge, MD, MPH
24. Kidney Disease 893
36. Spirochetal Infections 1470
Tonja C. Dirkx, MD, & Tyler B. Woodell, MD, MCR
Susan S. Philip, MD, MPH
25. Urologic Disorders 931
37. Protozoal & Helminthic Infections 1487
Mathew Sorensen, MD, MS, FACS,
Marah C. Hehemann, MD, & Philip J. Rosenthal, MD
Maahum A. Haider, MD, MPH
38. Mycotic Infections 1523
26. Nervous System Disorders 958
Stacey R. Rose, MD, FACP, FIDSA, &
Vanja C. Douglas, MD, & Richard J. Hamill, MD, FACP, FIDSA
Michael J. Aminoff, MD, DSc, FRCP
39. Disorders Related to Environmental
27. Psychiatric Disorders 1035 Emergencies 1537
Kristin S. Raj, MD, Nolan R. Williams, MD, Jacqueline A. Nemer, MD, FACEP, &
Charles DeBattista, DMH, MD, & Marianne A. Juarez, MD
Meshell D. Johnson, MD
40. Poisoning 1553
28. Endocrine Disorders 1085
Craig Smollin, MD
Paul A. Fitzgerald, MD
41. Cancer 1583
29. Diabetes Mellitus & Hypoglycemia 1179
Sunny Wang, MD, Tiffany O. Dea, PharmD, BCOP,
Umesh Masharani, MB, BS Lawrence S. Friedman, MD, Carling Ursem, MD,
Kenneth R. McQuaid, MD, & Marc A. Dall’Era, MD
30. Lipid Disorders 1223
Michael J. Blaha, MD, MPH
42. Genetic & Genomic Disorders 1647
Reed E. Pyeritz, MD, PhD
31. Nutrition, Nutritional Disorders, &
Obesity 1235 43. Orthopedic Disorders &
Katherine H. Saunders, MD,
Sports Medicine 1657
Leon I. Igel, MD, FACP, FTOS, & Anthony Luke, MD, MPH, & C. Benjamin Ma, MD
Sarah Fink, RD, CDN, CNSC
44. Sexual & Gender Minority Health 1693
32. Common Problems in Infectious
Patricia A. Robertson, MD, Nicole Rosendale, MD,
Diseases & Antimicrobial Therapy 1255
Kevin L. Ard, MD, MPH, Kenneth H. Mayer, MD,
Monica Fung, MD, MPH, Katherine Gruenberg, & Mitzi Hawkins, MD, MAS
PharmD, MAEd, & Peter V. Chin-Hong, MD
45. Substance Use Disorders 1715
33. HIV Infection & AIDS 1297
J. Janet Ho, MD, MPH, FASAM,
Monica Gandhi, MD, MPH, & Julian A. Mitton, MD, MPH, & Jessica Ristau, MD
Matthew A. Spinelli, MD, MAS
34. Viral & Rickettsial Infections 1338
Eva H. Clark, MD, PhD, Patrycja Ashley, MD, &
Wayne X. Shandera, MD
, CONTENTS CMDT 2025 v
The following chapters are available online e4. Podiatric Disorders
without subscription at Monara Dini, DPM, & Charles B. Parks, DPM
www.accessmedicine.com/CMDT
e1. Anti-infective Treatment: Antibiotic, e5. Women’s Health Issues
Antifungal, and Antiviral Agents Brigid M. Dolan, MD, MEd, &
Judith Walsh, MD, MPH
Katherine Gruenberg, PharmD, MAEd, &
Emily Kaip, PharmD
e6. Appendix: Therapeutic Drug
e2. Diagnostic Testing & Medical Monitoring, Laboratory Reference
Decision-Making Intervals, & Commonly Used Blood
Specimen Collection Tubes
Chuanyi Mark Lu, MD
Chuanyi Mark Lu, MD
e3. Information Technology in Index 1729
Patient Care
Russ Cucina, MD, MS
AL Graw any
, This page intentionally left blank
