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Davidson's Principles and Practice of Medicine E-Book

Davidson's Principles and Practice of Medicine E-Book

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

(2013)

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Book Details

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.

Table of Contents

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