Davidson's Principles and Practice of Medicine E-Book

Brian R. Walker; Nicki R Colledge; Stuart H. Ralston; Ian Penman

BOOK

Davidson's Principles and Practice of Medicine E-Book

Brian R. Walker | Nicki R Colledge | Stuart H. Ralston | Ian Penman

(2013)

Additional Information

Book Details

ISBN: 978-0-7020-5103-6
Edition: 22
Language: English
Pages: 1392
Subjects: Clinical & internal medicine
Medical study & revision guides & reference material

Abstract

More than two million medical students, doctors and other health professionals from around the globe have owned a copy of Davidson’s Principles and Practice of Medicine since it was first published. Today’s readers rely on this beautifully illustrated text to provide up-to-date detail of contemporary medical practice, presented in a style that is concise and yet easy to read. Davidson’s provides the factual knowledge required to practise medicine, explaining it in the context of underlying principles, basic science and research evidence, and shows how to apply this knowledge to the management of patients who present with problems rather than specific diseases. The book has won numerous prizes including being highly commended in the British Medical Association book awards.

Davidson’s global perspective is enhanced by the input of an international team of authors and a distinguished International Advisory Board from 17 countries. Building on the foundations laid down by its original editor, Davidson’s remains one of the world’s leading and most respected textbooks of medicine.

The underlying principles of medicine are described concisely in the first part of the book, and the detailed practice of medicine within each sub-specialty is described in later system-based chapters.

Most chapters begin with a two-page overview of the important elements of the clinical examination, including a manikin to illustrate the key steps in the examination of the relevant system.

A practical, problem-based clinical approach is described in the ‘Presenting Problems’ sections, to complement the detailed descriptions of each disease.

The text is extensively illustrated, with over 1000 diagrams, clinical photographs, and radiology and pathology images.

1350 text boxes present information in a way suitable for revision, including 150 clinical evidence boxes summarising the results of systematic reviews and randomised controlled trials and 65 ’In Old Age’ boxes highlighting important aspects of medical practice in the older population.

A combined index and glossary of medical acronyms contains over 10 000 subject entries. The contents can also be searched comprehensively as part of the online access to the whole book on the StudentConsult platform.

Access over 500 self-testing questions with answers linked to the book’s content for further reading.

The text uses both SI and non-SI units to make it suitable for readers throughout the globe.

A new chapter specifically on Stroke Disease recognises the emergence of Stroke Medicine as a distinct clinical and academic discipline.

A rationalisation of the 1350 boxes used throughout the book gives a simpler and clearer presentation of the various categories.

New ‘In Adolescence’ boxes recognise the fact that many chronic disorders begin in childhood and become the responsibility of physicians practising adult medicine. These boxes acknowledge the overlap ‘transitional’ phase and highlight the key points of importance when looking after young people.

The regular introduction of new authors and editors maintains the freshness of each new edition. On this occasion Dr Ian Penman has joined the editorial team and 18 new authors bring new experience and ideas to the content and presentation of the textbook.

An expanded International Advisory Board of 38 members includes new members from several different countries.

Section Title	Page	Action	Price
Front cover	cover
Inside front cover	ifc1
Half title page	i
Sir Stanley Davidson (1894–1981)	ii
Davidson's Principles and Practice of Medicine, 22/e	iii
Copyright page	iv
Preface	v
Table of Contents	vi
List of presenting problems	viii
Abnormal investigation results	viii
Symptoms and signs	viii
Syndromes	ix
Contributors	x
International Advisory Board	xiv
Introduction	xvi
Clinical examination overviews	xvi
Presenting problems	xvi
Boxes	xvi
General Information	xvi
Evidence-based Medicine	xvi
Practice Point	xvi
Emergency	xvi
In Old Age	xvii
In Pregnancy	xvii
In Adolescence	xvii
Terminology	xvii
Units of measurement	xvii
Finding what you are looking for	xvii
Acknowledgements	xviii
Figure acknowledgements	xix
1 Principles of Medicine	1
1 Good medical practice	1
Medical practice	2
The doctor–patient relationship	2
Difficulties in the doctor–patient relationship	2
Communication and other clinical skills	4
Using investigations	4
The ‘normal’ (or reference) range	5
Sensitivity and specificity	5
Predictive value	6
Screening	6
Estimating and communicating risk	7
Clinical decision-making	7
Evidence-based medicine	8
Guidelines and protocols	8
Guidelines	8
Protocols	9
Cost-effectiveness	9
Quality-adjusted life years	9
Practising medicine in low-resource settings	9
Medical ethics	9
Principles of clinical ethics	10
Respect for persons and their autonomy	10
Truth-telling	10
Informed consent	10
Confidentiality	11
Beneficence	11
Non-maleficence	11
Justice	11
Types of ethical problem	11
A gap or block	11
Priority-setting	11
A moral dilemma	11
Resolving conflict	12
Ethical analysis	12
A clinical ethics scenario	13
On the one hand, considered mainly in teleological terms:	13
On the other hand, considered in deontological as well as teleological terms:	13
In practice:	13
Medical law	13
Personal and professional development	14
Clinical audit	15
Complementary and alternative medicine	15
Safety	16
Evidence	16
Regulation	16
Integrated health care	16
Further information and acknowledgements	16
Websites	16
Figure acknowledgements	16
2 Therapeutics and good prescribing	17
Principles of clinical pharmacology	18
Pharmacodynamics	18
Drug targets and mechanisms of action	18
Dose–response relationships	19
Therapeutic index	20
Desensitisation and withdrawal effects	20
Pharmacokinetics	21
Drug absorption and routes of administration	21
Enteral administration	21
Parenteral administration	21
Other routes of administration	21
Drug distribution	22
Volume of distribution	22
Drug elimination	22
Drug metabolism	22
Drug excretion	22
Elimination kinetics	22
Repeated dose regimens	23
Inter-individual variation in drug responses	23
Adverse outcomes of drug therapy	24
Adverse drug reactions	24
Prevalence of ADRs	24
Classification of ADRs	25
Detecting ADRs – pharmacovigilance	27
Drug interactions	28
Mechanisms of drug interactions	28
Avoiding drug interactions	29
Medication errors	29
Responding when an error is discovered	29
Drug regulation and management	30
Drug development and marketing	30
Licensing new medicines	31
Drug marketing	31
Managing the use of medicines	31
Evaluating evidence	32
Evaluating cost-effectiveness	32
Implementing recommendations	32
Prescribing in practice	33
Decision-making in prescribing	33
Making a diagnosis	33
Establishing the therapeutic goal	33
Choosing the therapeutic approach	33
Choosing a drug	33
Absorption.	33
Distribution.	33
Metabolism.	33
Excretion.	33
Efficacy.	33
Avoiding adverse effects.	33
Features of the disease.	33
Severity of disease.	33
Coexisting diseases	33
Avoiding adverse drug interactions.	33
Patient adherence to therapy.	33
Cost.	33
Genetic factors.	34
Choosing a dosage regimen	34
Dose titration.	34
Route.	34
Frequency.	34
Timing.	34
Formulation.	34
Duration.	34
Involving the patient	34
Writing the prescription	35
Monitoring treatment effects	36
Stopping drug therapy	36
Prescribing in special circumstances	36
Prescribing for patients with renal disease	36
Prescribing for patients with hepatic disease	36
Prescribing for elderly patients	36
Prescribing for women who are pregnant or breastfeeding	36
Writing prescriptions	37
Prescribing in hospital	37
Hospital discharge (‘to take out’) medicines	37
Prescribing in primary care	37
Monitoring drug therapy	39
Clinical and surrogate endpoints	39
Plasma drug concentration	39
Timing of samples in relation to doses	40
Interpreting the result	40
Further information	40
Websites	40
3 Molecular and genetic factors in disease	41
Functional anatomy and physiology	42
Cell and molecular biology	42
DNA, chromosomes and chromatin	42
Genes and transcription	42
RNA splicing, editing and degradation	43
Translation and protein production	44
Mitochondria and energy production	45
Protein degradation	46
The cell membrane and cytoskeleton	47
Receptors, cellular communication and intracellular signalling	48
Cell division, differentiation and migration	49
Cell death, apoptosis and senescence	50
Genetic disease and inheritance	50
Meiosis	50
Patterns of disease inheritance	51
Autosomal dominant inheritance	51
Autosomal recessive inheritance	53
X-linked inheritance	53
Mitochondrial inheritance	53
Epigenetic inheritance and imprinting	53
Classes of genetic variant	53
Nucleotide substitutions	53
Insertions and deletions	55
Simple tandem repeat mutation	55
Copy number variations	55
Polymorphic copy number variants	56
Consequences of genetic variation	57
Loss-of-function mutations	58
Gain-of-function and dominant negative mutations	58
Polymorphisms	58
Neutral variants	58
Evolutionary selection	58
Constitutional genetic disease	58
Allelic heterogeneity	59
Locus heterogeneity	59
De novo mutations	59
Somatic genetic disease	59
Investigation of genetic disease	60
General principles of diagnosis	60
Constructing a family tree	60
Polymerase chain reaction and DNA sequencing	60
Assessing DNA copy number	62
Non-DNA-based methods of assessment	62
Genetic testing in pregnancy and pre-implantation genetic testing	62
Genetic testing in children	63
Identifying a disease gene in families	63
Genetic investigation in populations	64
Predictive genetic testing	64
Presenting problems in genetic disease	64
Major categories of genetic disease	64
Inborn errors of metabolism	64
Intoxicating IEM	64
Mitochondrial disorders	65
Storage disorders	65
Neurological disorders	65
Huntington’s disease	65
Other triplet repeat disorders	65
Connective tissue disorders	65
Learning disability, dysmorphism and malformations	66
Chromosome disorders	66
Dysmorphic syndromes	66
X-linked mental handicap	66
De novo mutations	66
Familial cancer syndromes	66
Retinoblastoma	66
Familial adenomatous polyposis coli	67
Li–Fraumeni syndrome	67
Hereditary non-polyposis colorectal cancer	67
Familial breast cancer	67
Xeroderma pigmentosum	67
Genetic counselling	67
Genetics of common diseases	68
Measuring the genetic contribution to complex disease	68
Genetic testing in complex disease	69
Pharmacogenomics	69
Research frontiers in molecular medicine	69
Gene therapy	69
Induced pluripotent stem cells and regenerative medicine	69
Pathway medicine	70
Further information	70
Books and journal articles	70
Websites	70
4 Immunological factors in disease	71
Functional anatomy and physiology of the immune system	72
The innate immune system	72
Constitutive barriers to infection	72
Phagocytes	72
Neutrophils	72
Monocytes and macrophages	74
Dendritic cells	74
Cytokines	74
Complement	74
Mast cells and basophils	75
Natural killer cells	75
The adaptive immune system	76
Lymphoid organs	76
The thymus	76
The spleen	76
Lymph nodes and mucosa-associated lymphoid tissue	76
Lymphatics	77
Humoral immunity	77
B lymphocytes	77
Immunoglobulins	77
Cellular immunity	78
Immune deficiency	78
Presenting problems in immune deficiency	79
Recurrent infections	79
Primary phagocyte deficiencies	79
Leucocyte adhesion deficiencies	79
Chronic granulomatous disease	79
Defects in cytokines and cytokine receptors	79
Complement pathway deficiencies	79
Investigations and management	79
Primary deficiencies of the adaptive immune system	80
Primary T-lymphocyte deficiencies	80
DiGeorge syndrome	80
Bare lymphocyte syndromes	80
Autoimmune lymphoproliferative syndrome	80
Investigations and management	80
Combined B- and T-lymphocyte immune deficiencies	80
Primary antibody deficiencies	80
Investigations	81
Management	81
Secondary immune deficiencies	82
The inflammatory response	82
Physiology and pathology of inflammation	82
Acute inflammation	82
Acute phase proteins	82
Resolution of inflammation	82
Sepsis and septic shock	83
Chronic inflammation	83
Investigations in inflammation	83
C-reactive protein	84
Erythrocyte sedimentation rate	84
Plasma viscosity	85
Presenting problems in inflammation	85
Unexplained raised ESR	85
Clinical assessment	85
Investigations	85
Imaging	85
Periodic fever syndromes	85
Familial Mediterranean fever	85
Mevalonate kinase deficiency	85
TNF receptor-associated periodic syndrome	85
Amyloidosis	86
Diagnosis	86
Management	86
Autoimmune disease	86
Pathophysiology of autoimmunity	86
Immunological tolerance	86
Factors predisposing to autoimmune disease	87
Classification of autoimmune diseases	87
Investigations in autoimmunity	88
Autoantibodies	88
Measures of complement activation	88
Cryoglobulins	88
Allergy	89
Pathology of allergy	89
Susceptibility to allergic diseases	89
Presenting problems in allergy	90
A general approach to the allergic patient	90
Clinical assessment	90
Investigations	90
Skin prick tests	90
Specific IgE tests	90
Supervised exposure to allergen (challenge test)	90
Mast cell tryptase	90
Non-specific markers of atopic disease: total serum IgE and eosinophilia	90
Management	90
Anaphylaxis	91
Clinical assessment	91
Investigations	92
Management	92
Angioedema	93
Specific allergies	94
Insect venom allergy	94
Peanut allergy	94
Birch oral allergy syndrome	94
C1 inhibitor deficiency	94
Hereditary angioedema	94
Acquired C1 inhibitor deficiency	94
Transplantation Immunology	94
Transplant rejection	94
Investigations	95
Pre-transplantation testing	95
C4d staining	95
Complications of transplant immunosuppression	95
Organ donation	96
Further information and acknowledgements	96
Websites	96
Figure acknowledgements	96
5 Environmental and nutritional factors in disease	97
Principles and investigation of environmental factors in disease	98
Environmental effects on health	98
The hierarchy of systems – from molecules to ecologies	98
Interactions between people and their environment	98
The life course	98
Investigations in environmental health	99
Incidence and prevalence	99
Variability by time, person and place	99
Measuring risk	99
Establishing cause and effect	99
Preventive medicine	100
Environmental diseases	100
Alcohol	100
Smoking	100
Obesity	101
Poverty and affluence	101
Atmospheric pollution	102
Carbon dioxide and global warming	102
Radiation exposure	102
Types of ionising radiation	102
Dosage and exposure	103
Effects of radiation exposure	103
Deterministic effects	103
Stochastic effects	103
Management of radiation exposure	103
Extremes of temperature	103
Thermoregulation	103
Hypothermia	104
Clinical features	104
Investigations	104
Management	105
Mild hypothermia	105
Severe hypothermia	105
Cold injury	105
Freezing cold injury (frostbite)	105
Non-freezing cold injury (trench or immersion foot)	105
Chilblains	105
Heat-related illness	105
Heat cramps	106
Heat syncope	106
Heat exhaustion	106
Heat stroke	106
High altitude	106
Physiological effects of high altitude	107
Illnesses at high altitude	107
Acute mountain sickness	107
High-altitude cerebral oedema	107
High-altitude pulmonary oedema	107
Chronic mountain sickness (Monge’s disease)	107
High-altitude retinal haemorrhage	107
Venous thrombosis	107
Refractory cough	107
Air travel	107
Advice for patients with respiratory disease	108
Advice for other patients	108
Deep venous thrombosis	108
Under water	108
Drowning and near-drowning	108
Clinical features	108
Management	108
Diving-related illness	109
Clinical features	109
Decompression illness	109
Barotrauma	109
Management	110
Nutritional factors and disease	110
Physiology of nutrition	110
Energy balance	110
Regulation of energy balance	110
Responses to under- and over-nutrition	111
Macronutrients (energy-yielding nutrients)	112
Carbohydrates	112
Dietary fibre	113
Fats	113
Proteins	114
Dietary recommendations for macronutrients	114
Clinical assessment and investigation of nutritional status	114
Anthropometric measurements	114
Disorders of altered energy balance	115
Obesity	115
Complications of obesity	115
Body fat distribution	115
Aetiology	116
Susceptibility to obesity	116
Reversible causes of obesity and weight gain	117
Clinical assessment and investigations	117
Management	117
Lifestyle advice	118
Weight loss diets	118
Drugs	119
Surgery	119
Treatment of additional risk factors	120
Under-nutrition	120
Starvation and famine	120
Clinical assessment	121
Investigations	121
Management	121
Under-nutrition in hospital	122
Nutritional support of the hospital patient	122
Normal diet	122
Dietary supplements	123
Enteral tube feeding	123
Parenteral nutrition	123
Refeeding syndrome	124
Legal and ethical aspects of artificial nutritional support	124
Cachexia	124
Micronutrients, minerals and their diseases	124
Vitamins	124
Fat-soluble vitamins	126
Vitamin A (retinol)	126
Vitamin D	127
Vitamin E	127
Vitamin K	127
Water-soluble vitamins	127
Thiamin (vitamin B1)	127
Deficiency – beri-beri	128
Riboflavin (vitamin B2)	128
Niacin (vitamin B3)	128
Deficiency – pellagra	128
Toxicity	129
Pyridoxine (vitamin B6)	129
Biotin	129
Folate (folic acid)	129
Hydroxycobalamin (vitamin B12)	129
Neurological consequences of vitamin B12 deficiency	129
Vitamin C (ascorbic acid)	129
Deficiency – scurvy	129
Other dietary organic compounds	129
Inorganic micronutrients	130
Calcium and phosphorus	130
Iron	130
Iodine	131
Zinc	131
Selenium	132
Fluoride	132
Sodium, potassium and magnesium	132
Other essential inorganic nutrients	132
Further information and acknowledgements	132
Websites	132
Telephone numbers	132
Figure acknowledgements	132
6 Principles of infectious disease	133
Infectious agents	134
Prions	134
Viruses	134
Prokaryotes: bacteria (including mycobacteria and actinomycetes)	135
Eukaryotes: fungi, protozoa and helminths	135
Normal flora	136
Host–pathogen interactions	137
Characteristics of successful pathogens	137
The host response	138
Pathogenesis of infectious disease	138
The febrile response	138
Investigation of infection	138
Direct detection	139
Detection of whole organisms	139
Detection of components of organisms	139
Nucleic acid amplification tests (NAAT)	139
Culture	140
Blood culture	141
Specific immunological tests	141
Antibody detection	141
Enzyme-linked immunosorbent assay	141
Immunoblot (Western blot)	141
Immunofluorescence assays	142
Complement fixation test	142
Agglutination tests	142
Other tests	142
Antibody-independent specific immunological tests	142
Antimicrobial susceptibility testing	143
Epidemiology of infection	143
Geographic and temporal patterns of infection	143
Endemic disease	143
Emerging and re-emerging disease	143
Reservoirs of infection	143
Human reservoirs	143
Animal reservoirs	144
Environmental reservoirs	144
Transmission of infection	144
Deliberate release	145
Infection prevention and control	145
Health care-acquired infection	145
Outbreaks of infection	147
Principles of food hygiene	147
Immunisation	148
Vaccination	148
Types of vaccine	148
Use of vaccines	149
Treatment of infectious diseases	149
Principles of antimicrobial therapy	149
Antimicrobial action and spectrum	150
Empiric versus targeted therapy	150
Combination therapy	150
Antimicrobial resistance	151
Duration of therapy	152
Antimicrobial prophylaxis	152
Pharmacokinetics and pharmacodynamics	152
Therapeutic drug monitoring	154
Beta-lactam antibiotics	154
Pharmacokinetics	154
Adverse effects	154
Drug interactions	155
Penicillins	155
Cephalosporins and cephamycins	155
Monobactams	156
Carbapenems	156
Macrolide and lincosamide antibiotics	156
2 Practice of Medicine	179
8 Critical illness	179
Clinical examination of the critically ill patient	180
Physiology of critical illness	182
Oxygen transport	182
Cardiovascular component of oxygen delivery: flow	182
Preload	182
Afterload	183
Myocardial contractility	183
Oxygenation component of oxygen delivery: content	183
Oxygen consumption	184
Relationship between oxygen consumption and delivery	184
Pathophysiology of the inflammatory response	184
Local inflammation	184
Systemic inflammation	185
Monitoring	185
Monitoring the circulation	185
Electrocardiogram	185
Blood pressure	185
Central venous pressure	185
Pulmonary artery catheterisation and pulmonary artery ‘wedge’ pressure	185
Cardiac output	186
Echocardiography	187
Urine output	187
Peripheral skin temperature	187
Blood lactate, hydrogen ion and base excess/deficit	187
Monitoring respiratory function	187
Oxygen saturation	187
Arterial blood gases	187
Lung function	188
Capnography	188
Transcutaneous PCO2	188
Recognition of critical illness	188
Assessment and initial resuscitation of the critically ill patient	188
Airway and breathing	188
Circulation	189
Disability	189
Exposure, evidence and examination	189
Clinical decision-making and referral to critical care	189
Presenting problems/Management of major organ failure	190
Circulatory failure: ‘shock’	190
Low stroke volume	190
Vasodilatation	190
Clinical assessment and complications	190
Circulatory support	190
Therapeutic options to optimise cardiac function	191
Prognosis	191
Respiratory failure and acute respiratory distress syndrome	191
Acute lung injury and the acute respiratory distress syndrome	192
Respiratory support	193
Oxygen therapy	193
Non-invasive respiratory support	193
CPAP therapy	193
Non-invasive ventilation	194
Emergency endotracheal intubation and mechanical ventilation	194
General considerations in the management of the ventilated/intubated patient	194
Initial settings	195
Mandatory modes of ventilation	195
Volume-controlled modes.	195
Pressure-controlled modes.	195
Weaning or spontaneously breathing modes.	196
Mixed modes.	196
Advanced ventilation strategies	196
Prone ventilation.	196
High-frequency oscillatory ventilation (HFOV).	196
Nitric oxide.	196
Extracorporeal membrane oxygenation therapy (ECMO).	196
Corticosteroids.	196
Weaning from respiratory support	196
Spontaneous breathing trials (SBTs).	197
Progressive reduction in pressure support ventilation.	197
Weaning protocols.	197
Acute kidney injury	197
Renal support	197
Gastrointestinal and hepatic disturbance	198
Gastrointestinal and hepatic support	198
Neurological failure (coma)	198
Neurological support	199
Neurological complications in intensive care	199
Sepsis	200
Management	201
Corticosteroids	201
Disseminated intravascular coagulation	201
General principles of critical care management	201
Daily clinical management in the ICU	202
Sedation and analgesia	202
Muscle relaxants	202
Delirium	203
Discharge from intensive care	203
Withdrawal of intensive support	203
Brainstem death	203
Outcome of intensive care	204
Scoring systems	204
Further information	204
Websites	204
9 Poisoning	205
Comprehensive evaluation of the poisoned patient	206
Taking a history in poisoning	206
Evaluation of the envenomed patient	207
Taking a history in envenoming	207
General approach to the poisoned patient	208
Triage and resuscitation	208
Clinical assessment and investigations	209
Psychiatric assessment	210
General management	210
Gastrointestinal decontamination	210
Activated charcoal	210
Gastric aspiration and lavage	210
Whole bowel irrigation	210
Urinary alkalinisation	210
Haemodialysis and haemoperfusion	211
Lipid emulsion therapy	211
Supportive care	212
Antidotes	212
Poisoning by specific pharmaceutical agents	212
Analgesics	212
Paracetamol	212
Management	212
Salicylates (aspirin)	212
Clinical features	212
Index	1313
A	1313
B	1318
C	1321
D	1328
E	1331
F	1334
G	1335
H	1338
I	1342
J	1344
K	1344
L	1345
M	1347
N	1350
O	1352
P	1354
Q	1360
R	1360
S	1362
T	1366
U	1369
V	1370
W	1372
X	1372
Y	1372
Z	1372

Davidson's Principles and Practice of Medicine E-Book

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