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Toronto Notes
Comprehensive medical reference and preparation for licensing exams.
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Comprehensive medical reference and exam prep adapted for our US & International readers.
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Study aid highlighting the most high yield pharmacology information using full colour figures and descriptive adverse drug reaction icons.
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Toronto Notes is a concise and comprehensive medical review revised annually by the University of Toronto student contributors under the guidance of the Faculty of Medicine. This reference text started as a compilation of notes written by and shared among University of Toronto students to study for their medical licensing exams. After 37 years, it has become the most reputable study guide used by medical students across Canada and around the world.
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Toronto Notes 2022 Contributors
Editors-in-Chief
Yuliya Lytvyn
Maleeha A. Qazi
Clinical Handbook Editors
Benjamin Baker
Cathy Huilin Lu
Chunyi Christie Tan
Clinical Handbook Copy Editors
Leah Bennett
David Buchan
Marc Manzo
Adanna Odunze
Sushmitha Srinivasan
Punithan Thiagalingam
Communications Managers
Michelle Lim
Grace Xiaoxi Zhou
Online Content Managers
Alex Beomju Bak
Jeffrey Lam Shin Cheung
Huaqi Li
Rayoun Ramendra
Copyright Managers
Wei Fang Dai
Saba Manzoor
Eric Plitman
BMC Production Editors
Ariadna Pomada Villalbi
Aimy Wang
BMC Illustrators
Sherry An
Jennifer Barolet
Jennifer Gu
Mimi Guo
Cassie Hillock-Watling
Alexandra Ho
Min Jee Kim
Abeeshan Selvabaskaran
Willow Yang
Amy Zhang
PRIMARY
Associate Editors
Ming Li
Jacqui van Warmerdam
EBM Editors
Sarah House
Vrati Mehra
MEDICINE
Associate Editors
Thomas Chang
Andreea Damian
EBM Editors
Peter Nakhla
Kyle Seigel
SURGERY
Associate Editors
Winston W. Li
Ashmita Singh
EBM Editors
Isra Hussein
Lisa Vi
Chapter Editors
Ethical, Legal, and Organizational Medicine
Happy Inibhunu
Andrew Lagrotteria
Joseph Kates Rose
Anesthesia
Carlos Khalil
Isabelle Laksono
Evan Tang
Clinical Pharmacology
Mark Khoury
Sahar Zarabi
Dermatology
Cindy Na-Young Kang
Maria Leis
Sara Mirali
Emergency Medicine
Yousuf Ahmed
Danny Ma
Jackie Tsang
Kenneth Williams
Family Medicine
Anson Cheung
Cathy Huilin Lu
Amanda Poxon
Emily Tam
Medical Genetics
Yaanu Jeyakumar
Nicholas Light
Medical Imaging
Jeffrey Lam Shin Cheung
Sabrina Fitzgerald
Paediatrics
Melanie El Hafid
Anna Jiang
Shakiba Khalkhali Ardestani
Benjamin Martinez
Palliative Medicine
Brian Hyung
Jack Su
Psychiatry
Ava Abraham
Jeanette Hui
Fiona Moloney
Public Health and Preventive Medicine
Glen Katsnelson
Caleb Tackey
Cardiology and Cardiac Surgery
Ahmed Abdelaal
Nitish K. Dhingra
Lina Elfaki
Abdullah Malik
Dustin Tanaka
Endocrinology
Lindsey Hatcher
Kyung Young (Peter) Kim
Alicia Serrano
Gastroenterology
Tedi Hoxha
Rohit Jogendran
Jocelyn Price
Geriatric Medicine
Jim TC Chen
Maggie Li
Dorothy Qian
Hematology
Vanessa Arciero
Justin Brunet
Reid Gallant
Nathalie Loeb
Infectious Diseases
Rawaan Elsawi
Arjuna Maharaj
Yici (Andrea) Liu
Nephrology
Anshika Jain
Tiange Li
Neurology
Juweiriya Ahmed
Moriam Ahmed
Keshav Narang
Respirology
Kevin Jia Qi Chen
Jenny Sue Hyun Cho
Jenny Liao
Rheumatology
Sabrina Campbell
Dario Ferri
General Surgery and Thoracic Surgery
Noor Bakir
Justin Lu
Raumil Patel
Audrey Shakespeare
Jessica Trac
Gynaecology
Zainab Doleeb
Michelle Lee
Matthew Tersigni
Melissa Tigert
Neurosurgery
Dan Budiansky
Zaid Salaheen
Raza Syed
Obstetrics
Ye Rin (Yenah) Seo
Katie Wilkins
Wei (Sheila) Yu
Ophthalmology
Yuri V. Chaban
Anubhav (Avi) Garg
Bryan Wong
Orthopaedics
Anser Daud
Robert Koucheki
Geoffrey Schemitsch
Otolaryngology
Emily YiQin Cheng
Christopher End
Plastic Surgery
Shaishav Datta
Max Solish
Mithila Somasundaram
Urology
Edem (Andy) Afenu
Adree Khondker
Smruthi Ramesh
Vascular Surgery
Monish Ahluwalia
Lyon Qiao
Copy Editors
Ethical, Legal, and Organizational Medicine
Sahibjot Grewal
Zuhal Mohmand
Anesthesia
Matthew McGarr
Adanna Odunze
Clinical Pharmacology
Brian Hyung
Robert Lao
Dermatology
Emma Price
Adrian Witol
Emergency Medicine
Maria Leis
Mitchell Segal
Family Medicine
Leah Bennett
Tsz Ying So
Medical Genetics
Brian Hyung
Robert Lao
Medical Imaging
Raza Syed
Brian Tsang
Paediatrics
Zachary Blatman
Noel Kim
Palliative Medicine
Khizar Abid
Kaylee Sohng
Psychiatry
Jude Sanon
Brian Serapio
Public Health and Preventive Medicine
Zuhal Mohmand
Max Solish
Matthaeus Ware
Cardiology and Cardiac Surgery
Harsukh Benipal
Erika Opingari
Endocrinology
Roslyn Mainland
Christine Wu
Gastroenterology
Miski Dahir
Rachel Goldfarb
Geriatric Medicine
Sahibjot Grewal
Shamara Nadarajah
Hematology
Manu Sharma
Cimon Song
Infectious Diseases
Daniel Teitelbaum
Rachel Tran
Nephrology
David Buchan
Anna Lee
Neurology
Armin Farahvash
Yajur Iyengar
Golsa Shafa
Respirology
Orli Silverberg
Rajiv Tanwani
Rheumatology
Xinran Liu
Eden Meisels
General Surgery and Thoracic Surgery
Alyssa Li
Saba Manzoor
Gynaecology
Sonia Igboanugo
Claire Sethuram
Neurosurgery
Alyssa Li
Rachel Tran
Matthaeus Ware
Obstetrics
Sallie Han
Julianah Oguntala
Ophthalmology
Arjan Dhoot
Glen Katsnelson
Orthopaedics
Marc Anthony Manzo
Zarian Shahzad
Otolaryngology
Isabella Janusonis
Kathak Vachhani
Plastic Surgery
Khizar Abid
Irina Sverdlichenko
Urology
Wei Fang Dai
Tiffany Ni
Vascular Surgery
Catherine Meng
Sandra Sabongui
All of the following contributors have been appointed at the University of Toronto.
PRIMARY
Ethical, Legal, and Organizational Medicine
Andria Bianchi, PhD
Bioethicist, University Health Network
Assistant Professor, Dalla Lana School of Public Health, University of Toronto
Affiliate Scientist, KITE Research Institute, Toronto Rehab
Education Investigator 2, TIER (The Institute for Education Research)
Chase Everett McMurren, BA, BEd, MD, CCFP
Department of Family and Community Medicine
University of Toronto
Anesthesia
Ahtsham Niazi, MBBS, FCARCSI, FRCPC
Department of Anesthesia and Pain Management
University Health Network
Diana Tamir, MD, FRCPC
Staff Anesthesiologist, Toronto General Hospital
Clinical Director of the Acute Pain Service
Postgrad Anesthesia Site Assistant Coordinator
Department of Anesthesia and Pain Management
Toronto General Hospital
Clinical Pharmacology
David Juurlink, BPhm, MD, PhD, FRCPC
Division of Clinical Pharmacology and Toxicology, Departments of Medicine and Paediatrics
Sunnybrook Health Sciences Centre
Cindy Woodland, PhD
Associate Professor, Teaching Stream
Director, Collaborative Specialization in Biomedical Toxicology
Director, Applied Clinical Pharmacology Program
Dermatology
Patrick Fleming, BSc(Nutrition), MSc(Community Health), MD, FRCPC, FCDA
Assistant Professor of Medicine, Department of Medicine, University of Toronto
Dermatologist. York Dermatology & Research Centre
Consultant Dermatologist, University Health Network
Marissa Joseph, MD, MScCH, FRCPC, FRCPC
Division of Dermatology, Department of Medicine
Women's College Hospital and The Hospital for Sick Children
Jensen Yeung, MD, FRCPC
Division of Dermatology, Department of Medicine
Women's College Hospital
Emergency Medicine
Mark Freedman, BSc, MD, FRCPC
Department of Emergency Medicine
Sunnybrook Health Sciences Centre
Adam Kaufman, MD, CCFP(EM)
Emergency Physician, Michael Garron Hospital, Toronto East Health Network
Assistant Professor, Department of Family and Community Medicine, University of Toronto
Jo Jo Leung, MD, CCFP(EM), MScCH(HPTE)
Emergency Physician, University Health Network and Trillium Health Partners
Assistant Professor, Department of Family and Community Medicine, University of Toronto
Kaif Pardhan, BSc, MD, MMEd, FRCPC
Emergency Physician
Sunnybrook Health Sciences Centre & McMaster Children's Hospital
David Rosenstein, BSc Arch, MD, CCFP(EM)
Emergency Physician, Michael Garron Hospital, Toronto East Health Network
Family Medicine
Ruby Alvi, MD, CCFP, MHSc FCFP
Department of Family and Community Medicine
University of Toronto
Chung Kit (Jacky) Lai, MD, CCFP
Department of Family and Community Medicine
Royal Victoria Regional Health Centre
University of Toronto
Chase Everett McMurren, BA, BEd, MD, CCFP
Department of Family and Community Medicine
University of Toronto
Rachel Walsh, MD, MSc, CCFP
Department of Family and Community Medicine
Sunnybrook Health Sciences Centre
University of Toronto
Medical Genetics
Hanna Faghfoury, MDCM, FRCPC, FCCMG
The Fred A Litwin Family Centre in Genetic Medicine, Department of Medicine
Mount Sinai Hospital and University Health Network
Graeme AM Nimmo, MBBS, MSc, FRCPC, FCCMG
The Fred A Litwin Family Centre in Genetic Medicine, Department of Medicine
Mount Sinai Hospital and University Health Network
Medical Imaging
Angela Atinga, MB, BChir, BA, MA (Cantab), FRCR
Sunnybrook Health Sciences Centre, Department of Medical Imaging, Division of Musculoskeletal Imaging
Assistant Professor, Department of Medical Imaging,
University of Toronto
Nasir Jaffer, MD, FRCPC
Division of Abdominal Imaging, Department of Medical Imaging
Mount Sinai Hospital and University Health Network
Joint Department of Medical Imaging
University of Toronto
Kieran Murphy, MB, FRCPC, FSIR
Interventional Neuroradiology,
Professor of Medical Imaging
Ciara O'Brien, MB BCh, BAO (MD), FFR RCSI
Staff Radiologist, Abdominal Division
Joint Department of Medical Imaging
University Health Network, Mt. Sinai Hospital, Women's College Hospital
Assistant Professor, Department of Medical Imaging,
University of Toronto
Paediatrics
Julie Johnstone, MD (FRCPC), MScCH
Division of Paediatric Medicine, Department of Paediatrics
The Hospital for Sick Children
Giuseppe (Joey) Latino, MD, FRCPC
Department of Paediatrics
Division of Genetics, Department of Medicine
North York General Hospital
Laila Premji, MD, FRCPC
Division of Paediatric Medicine, Department of Paediatrics
The Hospital for Sick Children
Angela Punnett, MD, FRCPC
Division of Haematology/Oncology, Department of Paediatrics
The Hospital for Sick Children
Palliative Medicine
Risa Bordman, MD, CCFP(PC), FCFP
Associate Professor
Faculty Development Program Lead, Office of Education Scholarship
Department of Family & Community Medicine
Adam Rapoport, MD, FRCPC, MHSc
Departments of Paediatrics and Family & Community Medicine
University of Toronto
Paediatric Advanced Care Team, SickKids
Emily's House Children's Hospice
Donna Spaner, MD, CCFP(PC), FCFP, MScCH
Division of Palliative Care, Department of Family and Community Medicine
Toronto Grace Health Centre
Psychiatry
Saulo Castel, MD, PhD, FRCPC
Director, Inpatient Services
Sunnybrook Health Sciences Centre
Assistant Professor, Department of Psychiatry
Tamara Milovic, MD, MBA, FRCPC
Psychiatrist, Centre for Addiction and Mental Health
Lecturer, Department of Psychiatry, University of Toronto
Jerome Perera, MD, FRCPC
Psychiatrist, North York General Hospital
Clinician Teacher, Department of Psychiatry, University of Toronto
Ilana Shawn, MD FRCPC
Department of Psychiatry, St. Michael's Hospital
Assistant Professor, Department of Psychiatry
Public Health and Preventive Medicine
Onye Nnorom, MDCM, CCFP, MPH, FRCPC
Dalla Lana School of Public Health, University of Toronto
Department of Family and Community Medicine, University of Toronto
Jason J Pennington, MD, MSc, FRCSC
Division of General Surgery, Department of Surgery, Scarborough Health Network
Assistant Professor, Department of Surgery, University of Toronto
Lisa Richardson, MD, MA, FRCPC
Division of General Internal Medicine
Department of Medicine
University Health Network
MEDICINE
Cardiology and Cardiac Surgery
Paul Dorian, MD, MSc, FRCPC
Division of Cardiology
St. Michael's Hospital
Douglas J. Ing, MD, FRCPC, FACC
Division of Cardiology
Toronto General Hospital
Rebecca Noad, MB BCh, BAO, PhD, MRCP (UK), DipMedED
Division of Cardiology
Toronto General Hospital
Jacob A. Udell, MD, MPH, FRCPC
Division of Cardiology, Department of Medicine
Women's College Hospital and Toronto General Hospital
University of Toronto
Endocrinology
Angela Assal, MD, MHSc, FRCPC
Division of Endocrinology and Metabolism, Department of Medicine
Sunnybrook Health Sciences Centre
University of Toronto
Jeremy Gilbert, MD, FRCPC
Division of Endocrinology and Metabolism
Sunnybrook Health Sciences Centre
Adrian Lau, MD, MScCH, FRCPC
Division of Endocrinology and Metabolism
Department of Medicine
Women's College Hospital
University of Toronto
Maria Wolfs, MD, MHSc, FRCPC
Division of Endocrinology and Metabolism
St. Michael's Hospital
Gastroenterology
Maria Cino, BSc(Hon), Hon BSc, MSc, MD, FRCPC, CAGF
Division of Gastroenterology, Department of Medicine
University Health Network - Toronto Western Site
Associate Professor, University of Toronto
Flavio Habal, MD, PhD, FRCP, FAGA
Division of Gastroenterology
University Health Network, Toronto Western Division
Associate Professor, University of Toronto
Piero Tartaro, MD, MScCH, FRCPC
Division of Gastroenterology, Department of Medicine
Sunnybrook Health Sciences Centre
Geriatric Medicine
Vicky Chau, MD, MScCH, FRCPC
Division of Geriatric Medicine, Department of Medicine
Sinai Health System & University Health Network
Karen A. Ng, MD, FRCPC
Division of Geriatric Medicine, Department of Medicine
Sinai Health System
Thiru Yogaparan, MD, FRCPC
Division of Geriatric Medicine, Department of Medicine,
Associate Professor, University of Toronto
Baycrest Health Sciences
Hematology
Matthew Cheung, MD, FRCPC
Division of Medical Oncology and Hematology, Department of Medicine
Sunnybrook Health Sciences Centre
Lisa Chodirker, MD, FRCPC
Division of Medical Oncology and Hematology, Department of Medicine
Sunnybrook Health Sciences Centre
Helena Dhamko, MD, FRCPC, MScCH
Division of Hematology, Department of Medicine
University Health Network
Zachary Liederman, MD, FRCPC, MScCH
Division of Hematology, Department of Medicine
University Health Network
Martina Trinkaus, MD, FRCPC
Division of Hematology, Department of Medicine
St. Michael's Hospital
Infectious Diseases
Andrea K. Boggild, BSc, MSc, MD, DTMH, FRCPC
Tropical Disease Unit, Toronto General Hospital
Division of Infectious Diseases, University Health Network
Department of Medicine, University of Toronto
Institute of Medical Science, University of Toronto
Paul E. Bunce, BSc, MA, MD, FRCPC
Division of Infectious Diseases, Department of Medicine
University Health Network
Susan M. Poutanen, MD, MPH, FRCPC
Department of Microbiology,
University Health Network & Sinai Health
Division of Infectious Diseases, Department of Medicine
University Health Network & Mount Sinai Hospital
Nephrology
Damien Noone, MB BCh BAO, MSc
Division of Paediatric Nephrology, Department of Paediatrics
The Hospital for Sick Children
Gemini Tanna, MD, FRCPC
Division of Nephrology, Department of Medicine
Sunnybrook Health Sciences Centre
Alireza Zahirieh, MD, FRCPC
Division of Nephrology, Department of Medicine
Sunnybrook Health Sciences Centre
Neurology
Charles D. Kassardjian, MD, MSc, FRCPC
Division of Neurology, Department of Medicine
St. Michael's Hospital
Mary Jane Lim-Fat, MD, MSc, FRCPC
Division of Neurology, Department of Medicine
Sunnybrook Health Sciences Centre
Alexandra Muccilli, MD, MEd, FRCPC
Division of Neurology, Department of Medicine
St. Michael's Hospital
Respirology
Samir Gupta, MD, FRCPC
Division of Respirology, Department of Medicine
Unity Health Toronto
Ambrose Lau, MD, MEd, FRCPC
Division of Respirology, Department of Medicine
University Health Network and Unity Health Toronto
Assistant Professor, University of Toronto
Christopher Li, MD, FRCPC, DABSM
Division of Respirology, Department of Medicine
Unity Health Toronto - St. Michael's
Rheumatology
Arthur Bookman, MD, FRCPC
Division of Rheumatology, Department of Medicine
University Health Network
Shirley Lake, MD, FRCPC, MSc (QIPS)
Division of Rheumatology, Department of Medicine
Sunnybrook Health Sciences Centre
SURGERY
General Surgery and Thoracic Surgery
Mary-Anne Aarts, MD, FRCSC
Department of Surgery, Michael Garron Hospital
Department of Surgery, University Health Network
Department of Surgery, St. Joseph's Hospital
Abdollah Behzadi, MD, MBA, FRCSC, FACS
Division of Thoracic Surgery, Department of Surgery
Trillium Health Partners, University of Toronto
Laura Donahoe, MD, MSc, FRCSC
Division of Thoracic Surgery, Department of Surgery
Toronto General Hospital, University Health Network
Jesse Pasternak, MD, MPH, FRCSC
Section of Endocrine Surgery
Division of General Surgery, Department of Surgery
University Health Network
Gynaecology
Karthika Devarajan, MD, FRCSC
Division of General Obstetrics and Gynaecology
Department of Obstetrics and Gynaecology
North York General Hospital
Colleen McDermott, MSc, MD, FRCSC
Division of Female Pelvic Medicine & Reconstructive Surgery
Department of Obstetrics & Gynaecology
Mount Sinai Hospital
Evan Tannenbaum, MSc, MD, FRCSC
Division of General Obstetrics & Gynaecology
Department of Obstetrics & Gynaecology
Mount Sinai Hospital
Cici Zhu, MD, FRCSC
Department of Obstetrics and Gynecology, North York General Hospital
Neurosurgery
Sunit Das, MD, PhD
Division of Neurosurgery
St. Michael's Hospital
Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery, Department of Surgery, University of Toronto
Vice Chair Research, Department of Surgery, University of Toronto
Senior Scientist, Krembil Brain Institute, University Health Network
Staff Neurosurgeon, University Health Network
Co-Director, University of Toronto Spine Program
Nader Hejrati, MD, FMH
Division of Genetics and Development
Krembil Brain Institute, University Health Network
Division of Neurosurgery and Spine Program, Department of Surgery
University Health Network
Eric M. Massicotte, MD, MSc, MBA, FRCSC
Associate Professor University of Toronto
Staff Neurosurgeon, University Health Network
Medical Director, Back & Neck Program Altum Health
Obstetrics
Richard Pittini, MD, MEd, FRCSC, FACOG
Department of Obstetrics and Gynecology, University of Toronto
Sunnybrook Health Sciences Centre
Mara Sobel, MD, MSc, FRCSC
Department of Obstetrics and Gynecology, University of Toronto
Mount Sinai Hospital
University Health Network, Toronto General Hospital
Women's College Hospital
Melissa Walker, MD, MSc, FRCSC
Staff Obstetrician Gynecologist, Department of Obstetrics & Gynecology, Mount Sinai Hospital
Assistant Professor, Department of Obstetrics & Gynecology, University of Toronto
Ophthalmology
Asim Ali, MD, FRCSC
Professor of Ophthalmology, University of Toronto
Ophthalmologist-in-Chief, The Hospital for Sick Children
Wai-Ching Lam, MD, FRCSC
Department of Ophthalmology and Vision Science
University Health Network, Toronto Western Hospital
The Hospital for Sick Children
Jonathan Micieli, MD, FRCSC
Department of Ophthalmology and Vision Sciences; Division of Neurology, Department of Medicine; Kensington Vision and Research Centre, St. Michael's Hospital, University of Toronto
Orthopaedics
Paul Kuzyk, MD, MASc, FRCSC
Assistant Professor
Lower Extremity Reconstruction Surgery
Division of Orthopaedic Surgery
Jesse Wolfstadt, MD, MSc, FRCSC
Granovsky Gluskin Division of Orthopaedic Surgery, Department of Surgery
Sinai Health System
Otolaryngology
Yvonne Chan, MD, MSc, FRCSC
Otolaryngologist-in-chief, St. Michael's Hospital, Unity Health
Associate Professor and Continuing Professional Development Director
Department of Otolaryngology - Head & Neck Surgery
Antoine Eskander, MD, ScM, FRCSC
Assistant Professor
Department of Otolaryngology - Head & Neck Surgery
Sunnybrook Health Sciences Centre, Odette Cancer Centre
Michael Garron Hospital
Jonathan Irish, MD, MSc, FRCSC
Department of Otolaryngology, Head and Neck Surgery
University Health Network
Plastic Surgery
Siba Haykal, MD, PhD, FRCSC, FACS
Division of Plastic and Reconstructive Surgery, Department of Surgery
University Health Network
Melinda Musgrave, MD, PhD, FRCSC
Division of Plastic and Reconstructive Surgery, Department of Surgery
St. Michael's Hospital
Urology
Yonah Krakowsky, MD, FRCSC
Division of Urology
Women's College & Mount Sinai Hospital
Jason Lee, MD, MHPE, FRCSC
Division of Urology, Department of Surgery
University Health Network, Toronto General Hospital
Michael Ordon, MD, MSc, FRCSC
Division of Urology, Department of Surgery
St. Michael's Hospital
Vascular Surgery
Elisa Greco, BSc, MEd, MD, RPVI, FRCSC
Vascular Surgeon, St Michael's Hospital
George Oreopoulos, MD, MSc, FRCSC
Division of Vascular Surgery, Department of Surgery
University Health Network