Essential Med Notes 2019 – Toronto Notes for Medical Students is proud to present the 35th Edition of the highly successful Toronto Notes textbook series. This 2019 edition features brand new content to reflect the most recent updates to the MCCQE objectives, along with a new layout across all 31 chapters for enhanced readability.

Content updates across the main text, figures, graphics, and evidence-based medicine sections further enhance preparation for the Canadian and American medical licensing exams. A number of landmark trials have been included to reflect the most current evidence across all medical specialties.

As a not-for-profit organization, all our proceeds from book sales have been donated to support medical student activities, charity events, and community outreach programs over the past years.

### Features

• Brand new content reflective of new MCCQE objectives
• A concise textbook with in-depth coverage of 31 medical specialties
• Up-to-date DSM-5 criteria and Evidence-Based Medicine highlights
• Our website features online resources, including a Colour Atlas, ECGs Made Simple tutorial, Heart Sounds tutorial, Essentials of Medical Imaging, over 50 Practice OSCE stations, and much more!
• A Clinical Handbook highlighting common clinical management scenarios and helpful tips on clerkship basics – perfect size to carry on the wards. This has also been updated to be reflective of the latest evidence and MCCQE objectives!
• Stat Notes: The ultimate guide to managing on-call issues, this pocketbook features a step-by-step approach for 30 common ward scenarios

## Preface – Essential Med Notes 2019

Dear Readers, As the Editors-in-Chief of Toronto Notes 2018, we are proud to present the 34th Edition! Toronto Notes began humbly in 1985 from a set of student notes circulated among medical students at the University of Toronto. Over time, Toronto Notes has grown into one of the premier study resources for generations of medical trainees in Canada and abroad. This rich history solidified our commitment to publish a comprehensive study resource for medical students engaged in clinical rotations and studying for both the Canadian MCCQE Part 1 and USMLE Step 2. For the past 33 years we have remained committed to our original vision. Essential Med Notes 2019

The 2018 edition of Toronto Notes contains significant improvements and new editions including: 1. A brand new Medical Genetics chapter with evidence based medicine highlights. 2. Updated versions of the Clinical Handbook and STAT Notes that are more concise, with new figures and additions. 3. An updated website featuring a colour atlas, ECG and heart sound tutorials, essentials of medical imaging, and over 50 OSCE practice questions and scenarios. 4. A significantly improved interactive eBook with many new high-quality colour images. 5. An updated Toronto Notes Quiz App, which is available for free on iTunes and Google Play. This app contains hundreds of questions allowing users to test themselves on the content contained within Toronto Notes. Essential Med Notes 2019

Toronto Notes 2018 is produced by Toronto Notes for Medical Students Inc., which is a non-for-profit organization supporting various charity organizations and medical student initiatives in the city of Toronto and across the globe. This year, sponsored organizations included Community Affairs, the Ontario Medical Student Weekend (OMSW), the University of Toronto Class Councils, Save A Child’s Heart, Earth Tones, Medical Student Research Day (MRSD), The Medical Student Education Research Grant (MSERG), Daffydil, the Conference of the Australian Medical School Association, among others. We would like to thank you for supporting these initiatives through your purchase of Toronto Notes 2018. We would like to highlight the exceptional work of our team, composed of over 150 medical students, medical illustrators, and faculty members at the University of Toronto Faculty of Medicine. Without the tireless effort expended by these individuals, the production of Toronto Notes 2018 would not have been possible. Essential Med Notes 2019

In particular, we would like to highlight the work of the executive team, all of whom made personal sacrifices in balancing their clinical and academic duties with the responsibilities asked of them: our production managers, Ilya Mukovozov and Kirill Zaslavsky, our associate editors, Graham Mazereeuw, Samik Doshi, Mark Shafarenko, Sangwoo Leem, Tara Tofighi, Sheliza Halani, and our EBM editors, Alexander Sapa, Keeth Krishnan, Shubham Shan, Jin Kyu Kim, Sukhmani Sodhi, Arnav Agarwal. We also want to highlight the work of Rajkumari Chatterjee from University of Toronto Bookstore, who has contributed to the production of Toronto Notes for the past ten years, and has been instrumental in the annual launch of the Toronto Notes Ebook. Lastly, we would like to thank our partners at Type & Graphics Inc., particularly Enrica Aguilera, for their assistance during the production of Toronto Notes 2018 We would like to continue to encourage feedback – this year’s edition saw many improvements thanks to suggestions from our readers. We hope that Toronto Notes 2018 enhances your medical knowledge and allows you to perform better on both your clinical rotations and licensing exams. On behalf of the Toronto Notes 2018 team, we wish you success in your studies and academic endeavours

## Content – Essential Med Notes 2019

1. Common Unit Conversions
2. Commonly Measured Laboratory Values
3. Ethical, Legal, and Organizational Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ELOM
4. Anesthesia and Perioperative Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A
5. Cardiology and Cardiac Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C
6. Clinical Pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CP
7. Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D
8. Emergency Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ER
9. Endocrinology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E
10. Family Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FM
11. Gastroenterology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G
12. General Surgery and Thoracic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GS
13. Geriatric Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GM
14. Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GY
15. Hematology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H
16. Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ID
17. Medical Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MG
18. Medical Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MI
19. Nephrology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NP
20. Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N
21. Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NS
22. Obstetrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OB
23. Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OP
24. Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OR
25. Otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OT
26. Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P
27. Plastic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PL
28. Population Health and Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PH
29. Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PS
30. Respirology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . R
31. Rheumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . RH
32. Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U
33. Vascular Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VS

Audience: Senior medical students engaged in clinical rotations and preparing licensing exams (United States Medical Licensing Examination II and Medical Council of Canada Qualifying Examination), junior general and emergency medicine practitioners, residents, and other interested physicians.

Purpose: The book provides an overview of the basic knowledge in all fields of clinical medicine, including anatomy, physiology, pathology, diagnostics, clinical presentation, and therapy. The content is presented through text, pictures, tables, graphs, and explanatory text paragraphs. The wealth of information makes this book a useful source for all interested readers.

Content: Each field of clinical medicine is represented by one of the thirty three alphabetically organized chapters. Each chapter consists of a basic anatomy and physiology review, diagnostics, pathology, and clinical presentation of the diseases, differential diagnosis and therapy, followed by a list of references.

The first two chapters consist of tables containing Common Unit Conversions and Commonly Measured Laboratory Values, and the third chapter Ethical, Legal and Organizational Medicine discusses ethical and legal issues in medicine, such as confidentiality, consent, capacity, end-of-life care, etc.

The chapters focused on internal medicine and related subspecialist fields (Cardiology, Endocrinology, Gastroenterology, Hematology, Nephrology, Respirology, Rheumatology) all begin with the basic anatomical overview of the particular organ system, differential diagnosis of common clinical presentations, and routine diagnostic tests and medications. Further on, each chapter focuses on the specific diseases under separate sections, for example, cardiac arrhythmias, ischemic heart disease, heart failure, disorders of glucose metabolism, pituitary gland disorders, anemias, hematologic and lymphoid malignancies, diseases of the gastrointestinal and hepatobiliary systems, acute and chronic kidney injuries, pulmonary vascular diseases, respiratory failure, septic arthritis, osteoarthritis, etc.

Ten chapters related to surgical disciplines and anesthesia (Anesthesia and Perioperative Medicine, Cardiac Surgery, General Surgery, Thoracic Surgery, Ophthalmology, Orthopedics, Otolaryngology, Plastic Surgery, Urology, Vascular Surgery) also begin with an introductory section. For anesthesia, the types of anesthesia and preoperative assessment are first reviewed. In the chapters related to surgical disciplines, introduction contains the basic review of the anatomy of the respective system, differential diagnosis of common presentations, preoperative preparations, general procedures, common surgical complications, emergencies, and routinely used medications. Specific diseases are discussed in separate sections, such as cardiac transplantation, bowel obstruction, appendix surgery, breast surgery, fractures, facial nerve paralysis, brachial plexus conditions and surgical treatment, craniofacial injury, urinary trauma, peripheral venous diseases, carotid stenosis. Pediatric surgery is described in a special section of each chapter. Essential Med Notes 2019

Three chapters related to the nervous system, NeurologyNeurosurgery and Psychiatry, also include an introductory section containing basic anatomical review, differential diagnosis, neurological and psychiatric assessment, routinely used medications, diagnostic tests, imaging methods, and different neurosurgical approaches. Specific diseases, such as seizure disorders and epilepsy, behavioral neurology, mild traumatic brain injury, neurooncology, movement and cerebellar disorders, tumors, abscesses, cerebrovascular diseases, vascular malformations, back pain, extradural lesions, neurotrauma, pediatric and functional neurosurgery, as well as psychotic disorders, mood disorders and anxiety, trauma and stress related disorders, are thoroughly discussed in separate sections. Essential Med Notes 2019

Gynecology and Obstetrics chapters, after a basic overview, focus on disorders of menstruation, endometriosis, pregnancy, infertility, oncology, multi-fetal gestation and malpresentations, hypertension, labor and delivery, and puerperal care. Chapter Pediatrics merges together all clinical fields (internal medicine, surgical disciplines, infectious diseases, and neonatology).

Emergency Medicine, Family Medicine, and Geriatric Medicine are three separate chapters describing specific patient assessment in each field, and focus on major principles, common clinical presentations, and therapeutic management related to each of these disciplines.

The chapters Infectious Diseases and Dermatology after introductory general review describe specific conditions, such as gastrointestinal infections, travelers’ disease, infections of the heart and CNS, systemic infections, tuberculosis, HIV, fever of unknown origin, heritable disorders, and malignant skin conditions.

The chapter Medical Imaging contains description of specific imaging modalities for each organ system, whereas chapter Medical Genetics starts with the introduction to genetics, and then focuses on specific genetic syndromes and diseases. Chapter Clinical Pharmacology reviews general principles of pharmacokinetics, pharmacodynamics, drug reactions, therapeutic responses, and interactions.

The chapter Public Health and Preventive Medicine describes the methodological tools for determining and measuring the population health, epidemiology, study designs, methods of data analysis, research methods, epidemiology of infectious diseases, and environmental and occupational health.

Highlights: The book contains all essential information and provides an excellent overview of the various clinical conditions. Lateral page border contains concluding remarks, which help the reader to repeat and summarize the provided information. The comprehensive index at the end of the book enables quick orientation and selective reading. The text is accompanied by numerous schematic presentations, radiological images, and photographs, which make learning both easy and exciting. Additional materials, Clinical Handbook, Essential Medical Notes, and Handouts (approach to ECG containing examples, cardiac condition algorithms, and ophthalmology test materials), are useful tools for everyday clinical work.

Related reading: A number of other comprehensive medical references either in book or pocket-size handbook format are available: Oxford Medical Handbook, Oxford University Press, 10th Edition, 2017 (for emergency medicine, anesthesia, internal medicine, clinical and health care research, clinical and laboratory research, clinical pharmacology and pathology, surgery etc.); Harrison’s Principles of Internal Medicine, McGraw-Hill Education, 20th Edition, 2018; Principles and Practice of Surgery, Elsevier, 6th Edition, 2012; Clinical Cases and OSCEs in Surgery, Elsevier, 3rd Edition, 2017; USMLE Step 2 CK Lecture Notes, Kaplan Medical, 1st Edition, 2019: 5-book set; First Aid for the USMLE Step 2 CK, McGraw-Hill Education, 10th Edition, 2019.