Additional Information
Book Details
Abstract
For over half a century Davidson’s Principles and Practice of Medicine has informed and educated students, doctors and other health professionals all over the world, providing a comprehensive account of the practice of medicine. Davidson’s Essentials of Medicine provides the core content of the main textbook in a condensed format which will be invaluable whenever you are on the move – whether commuting, travelling between training sites, or on electives.
- This book provides a distillation of the core information required for clinical studies in medicine. While retaining the acclaimed readability of the main textbook it presents the key information in a format more appropriate for practical clinical work.
- The contents have been carefully selected by a team of junior doctors, emphasising only the topics that will be essential for clinical studies.
- The book includes additional chapters of content to aid clinical practice including a practically-focussed chapter on therapeutics and a useful guide to interpreting major clinical investigations.
- The text draws directly on the depth and breadth of experience of the Davidson’s authors and its International Advisory Board.
- Updated to include key changes and new illustrations included in Davidson’s Principles and Practice of Medicine.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Davidson's Essentials of Medicine | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Sir Stanley Davidson (1894–1981) | vi | ||
| Preface | vii | ||
| Acknowledgements | viii | ||
| Contributors to Davidson’s Principles and Practice of Medicine, 22nd Edition | ix | ||
| List of abbreviations | xiv | ||
| Picture credits | xvi | ||
| Chapter 2 | xvi | ||
| Chapter 5 | xvi | ||
| Chapter 6 | xvi | ||
| Chapter 8 | xvi | ||
| Chapter 9 | xvi | ||
| Chapter 10 | xvii | ||
| Chapter 12 | xvii | ||
| Chapter 13 | xvii | ||
| Chapter 14 | xvii | ||
| Chapter 16 | xvii | ||
| Chapter 17 | xvii | ||
| 1 Good medical practice | 1 | ||
| The doctor–patient relationship | 1 | ||
| Communication and other clinical skills | 2 | ||
| Investigations | 3 | ||
| The ‘normal’ (or reference) range | 3 | ||
| Sensitivity and specificity | 4 | ||
| Predictive value | 5 | ||
| Screening | 5 | ||
| Estimating and communicating risk | 5 | ||
| Clinical ethics | 6 | ||
| Respect for persons and their autonomy | 6 | ||
| Truth-telling | 6 | ||
| Informed consent | 6 | ||
| Confidentiality | 7 | ||
| Beneficence | 7 | ||
| Non-maleficence | 7 | ||
| Justice | 7 | ||
| Personal and professional development | 7 | ||
| Complementary and alternative medicine | 8 | ||
| Evidence | 8 | ||
| Regulation | 8 | ||
| 2 Ageing and disease | 9 | ||
| Comprehensive geriatric assessment | 10 | ||
| Investigation in the elderly | 9 | ||
| Presenting problems in geriatric medicine | 9 | ||
| Falls | 11 | ||
| Acute illness | 11 | ||
| Blackouts | 12 | ||
| Mechanical and recurrent falls | 12 | ||
| Dizziness | 13 | ||
| Delirium | 13 | ||
| Urinary incontinence | 14 | ||
| Adverse drug reactions | 14 | ||
| Hypothermia | 15 | ||
| Clinical assessment | 15 | ||
| Investigations | 15 | ||
| Management | 16 | ||
| Rehabilitation | 16 | ||
| The process | 16 | ||
| 3 Critical care and emergency medicine | 19 | ||
| Clinical examination of the critically ill patient | 20 | ||
| Recognising the critically ill patient | 19 | ||
| Monitoring | 19 | ||
| Monitoring the circulation | 19 | ||
| Monitoring respiratory function | 22 | ||
| General principles of critical care management | 22 | ||
| Assessment and initial resuscitation | 22 | ||
| Daily clinical management in the ICU | 23 | ||
| Specific presenting problems in the ICU | 23 | ||
| Circulatory failure: ‘shock’ | 23 | ||
| Low stroke volume | 23 | ||
| Vasodilatation | 24 | ||
| Management | 24 | ||
| Respiratory failure, including ARDS | 24 | ||
| Acute respiratory distress syndrome | 25 | ||
| Management | 26 | ||
| Anaphylaxis | 27 | ||
| Investigations | 28 | ||
| Management | 28 | ||
| Acute kidney injury | 28 | ||
| Gastrointestinal and hepatic disturbance | 29 | ||
| Neurological problems in intensive care | 29 | ||
| Management | 29 | ||
| Sepsis | 30 | ||
| Management | 30 | ||
| Disseminated intravascular coagulation | 31 | ||
| Discharge from intensive care | 31 | ||
| Withdrawal of care | 31 | ||
| Outcomes of intensive care | 31 | ||
| 4 Poisoning | 33 | ||
| Clinical examination of the poisoned patient | 34 | ||
| General approach to the poisoned patient | 33 | ||
| Triage | 33 | ||
| History | 33 | ||
| Clinical examination (p. 34) | 35 | ||
| Investigations | 35 | ||
| Psychiatric assessment | 35 | ||
| Management of the poisoned patient | 35 | ||
| Poisoning by specific pharmaceutical agents | 36 | ||
| Paracetamol | 36 | ||
| Salicylates (aspirin) | 38 | ||
| Non-steroidal anti-inflammatory drugs | 38 | ||
| Antidepressants | 38 | ||
| Cardiovascular medications | 38 | ||
| Antimalarials | 39 | ||
| Antidiabetic agents | 39 | ||
| Drugs of misuse | 39 | ||
| Cannabis | 39 | ||
| Benzodiazepines | 39 | ||
| Cocaine | 40 | ||
| Amphetamines | 40 | ||
| Gamma hydroxybutyrate and gamma butyrolactone | 40 | ||
| d-Lysergic acid diethylamide | 41 | ||
| Opioids | 41 | ||
| Body packers and stuffers | 41 | ||
| Alcohol misuse and dependence | 42 | ||
| Consequences of alcohol misuse | 42 | ||
| Management and prognosis | 43 | ||
| Chemicals and pesticides | 44 | ||
| Carbon monoxide | 44 | ||
| Clinical features | 44 | ||
| Management | 44 | ||
| Organophosphorus insecticides and nerve agents | 44 | ||
| Methanol and ethylene glycol | 45 | ||
| Drinking water contamination | 45 | ||
| Envenoming | 46 | ||
| Management | 46 | ||
| 5 Infectious disease | 47 | ||
| Clinical examination of patients with infectious disease | 48 | ||
| Principles of infectious disease | 47 | ||
| Detection of infection | 47 | ||
| Reservoirs of infection | 49 | ||
| Transmission of infection | 49 | ||
| Health care-acquired infection | 49 | ||
| Prevention of infection | 49 | ||
| Outbreak control | 50 | ||
| Immunisation | 50 | ||
| Presenting problems in infectious diseases | 50 | ||
| Fever | 50 | ||
| Pyrexia of unknown origin | 50 | ||
| Investigations and management | 52 | ||
| Prognosis | 52 | ||
| Fever in the injection drug-user | 52 | ||
| Clinical assessment | 53 | ||
| Management | 53 | ||
| Fever in the immunocompromised host | 53 | ||
| Severe skin and soft tissue infections | 54 | ||
| Necrotising fasciitis | 54 | ||
| Clostridial soft tissue infections | 54 | ||
| Gas gangrene or myonecrosis | 54 | ||
| Acute diarrhoea and vomiting | 55 | ||
| Clinical assessment | 55 | ||
| Investigations | 56 | ||
| Management of acute diarrhoea | 56 | ||
| Non-infectious food poisoning | 57 | ||
| Infections acquired in the tropics | 57 | ||
| Fever in travellers recently returned from the tropics | 57 | ||
| Clinical assessment | 57 | ||
| Investigations | 57 | ||
| Diarrhoea acquired in the tropics | 59 | ||
| Eosinophilia acquired in the tropics | 59 | ||
| Clinical assessment | 59 | ||
| Investigations | 59 | ||
| Skin conditions acquired in the tropics | 60 | ||
| Infection issues in adolescence | 60 | ||
| Infection issues in pregnancy | 60 | ||
| Viral infections | 60 | ||
| Systemic viral infections with exanthem | 60 | ||
| Measles | 60 | ||
| Clinical features | 62 | ||
| Management | 64 | ||
| Rubella (German measles) | 64 | ||
| Parvovirus B19 | 64 | ||
| Human herpesvirus 6 and 7 | 64 | ||
| Chickenpox | 66 | ||
| Shingles (herpes zoster) | 66 | ||
| Complications | 67 | ||
| Dengue | 67 | ||
| Investigations | 68 | ||
| Management and prevention | 68 | ||
| Systemic viral infections without exanthem | 68 | ||
| Mumps | 68 | ||
| Complications | 68 | ||
| Management | 68 | ||
| Influenza | 68 | ||
| Clinical features | 68 | ||
| Infectious mononucleosis | 69 | ||
| Clinical features | 69 | ||
| Complications | 69 | ||
| Investigations | 69 | ||
| 6 Clinical biochemistry and metabolism | 139 | ||
| Water and electrolyte distribution | 139 | ||
| Investigation of water and electrolytes | 140 | ||
| Disorders of sodium balance | 140 | ||
| Sodium depletion | 141 | ||
| Clinical features | 141 | ||
| Management of sodium and water depletion | 142 | ||
| Sodium excess | 142 | ||
| Management | 142 | ||
| Disorders of water balance | 142 | ||
| Hyponatraemia | 143 | ||
| Investigations | 143 | ||
| Management | 144 | ||
| Hypernatraemia | 144 | ||
| Management | 145 | ||
| Disorders of potassium balance | 145 | ||
| Hypokalaemia | 145 | ||
| Investigations | 146 | ||
| Management | 146 | ||
| Hyperkalaemia | 147 | ||
| Investigations | 147 | ||
| Management | 147 | ||
| Disorders of acid–base balance | 148 | ||
| Metabolic acidosis | 148 | ||
| Management | 149 | ||
| Metabolic alkalosis | 150 | ||
| Management | 150 | ||
| Respiratory acidosis | 150 | ||
| Respiratory alkalosis | 150 | ||
| Mixed acid–base disorders | 151 | ||
| Disorders of divalent ion metabolism | 151 | ||
| Hypomagnesaemia | 151 | ||
| Clinical features | 151 | ||
| Management | 151 | ||
| Hypermagnesaemia | 152 | ||
| 7 Kidney and urinary tract disease | 159 | ||
| Clinical examination of the kidney and urinary tract | 160 | ||
| Measurement of renal function | 159 | ||
| Presenting problems in renal and urinary tract disease | 159 | ||
| Dysuria | 159 | ||
| Loin pain | 159 | ||
| Oliguria/anuria | 161 | ||
| Polyuria | 161 | ||
| Nocturia | 161 | ||
| Frequency | 161 | ||
| Urinary incontinence | 161 | ||
| Incontinence syndromes | 162 | ||
| Clinical assessment and investigations | 162 | ||
| Erectile dysfunction | 163 | ||
| Haematuria | 163 | ||
| Proteinuria and nephrotic syndrome | 163 | ||
| Clinical assessment | 165 | ||
| Oedema | 165 | ||
| Investigations | 165 | ||
| Management | 165 | ||
| Hypertension | 166 | ||
| Acute kidney injury | 167 | ||
| Clinical features | 167 | ||
| Investigations | 168 | ||
| Management | 168 | ||
| Chronic kidney disease | 170 | ||
| Clinical features | 172 | ||
| Investigations | 174 | ||
| Management | 175 | ||
| Renal replacement therapy | 176 | ||
| Preparation for renal replacement therapy | 176 | ||
| Conservative treatment | 178 | ||
| Haemodialysis | 178 | ||
| Haemofiltration | 178 | ||
| Peritoneal dialysis | 178 | ||
| Renal transplantation | 178 | ||
| Management after transplantation | 180 | ||
| Renal vascular diseases | 180 | ||
| Renal artery stenosis | 180 | ||
| Clinical features | 180 | ||
| Investigations | 181 | ||
| Management | 181 | ||
| Acute renal infarction | 181 | ||
| Diseases of small intrarenal vessels | 182 | ||
| Glomerular diseases | 182 | ||
| Glomerulonephritis | 182 | ||
| Minimal change nephropathy | 183 | ||
| Focal segmental glomerulosclerosis | 184 | ||
| Membranous nephropathy | 184 | ||
| IgA nephropathy and Henoch–Schönlein purpura | 184 | ||
| Mesangiocapillary glomerulonephritis | 185 | ||
| Glomerulonephritis associated with infection | 185 | ||
| Rapidly progressive glomerulonephritis | 185 | ||
| Inherited glomerular diseases | 186 | ||
| Tubulo-interstitial diseases | 186 | ||
| Acute interstitial nephritis | 186 | ||
| Investigations | 186 | ||
| Management | 186 | ||
| Chronic interstitial nephritis | 186 | ||
| Clinical features, investigations and management | 186 | ||
| Reflux nephropathy (chronic pyelonephritis) | 187 | ||
| Clinical features | 187 | ||
| Investigations | 187 | ||
| Management and prognosis | 187 | ||
| Sickle-cell nephropathy | 187 | ||
| 8 Cardiovascular disease | 201 | ||
| Clinical examination of the cardiovascular system | 202 | ||
| Presenting problems in cardiovascular disease | 201 | ||
| Chest pain | 201 | ||
| Characteristics of cardiac pain | 201 | ||
| Differential diagnosis of chest pain | 203 | ||
| Initial evaluation of suspected cardiac pain | 204 | ||
| Breathlessness (dyspnoea) | 204 | ||
| Acute circulatory failure (cardiogenic shock) | 205 | ||
| Heart failure | 205 | ||
| Types of heart failure | 207 | ||
| Clinical features | 207 | ||
| Acute left heart failure | 207 | ||
| Chronic heart failure | 208 | ||
| Investigations | 208 | ||
| Management of acute pulmonary oedema | 208 | ||
| Management of chronic heart failure | 210 | ||
| General measures | 210 | ||
| Drug therapy | 210 | ||
| Non-drug therapies | 211 | ||
| Syncope and presyncope | 212 | ||
| Cardiac syncope | 212 | ||
| Neurocardiogenic syncope | 212 | ||
| Postural hypotension | 213 | ||
| Palpitation | 213 | ||
| Cardiac arrest | 214 | ||
| Ventricular fibrillation and pulseless ventricular tachycardia | 214 | ||
| Asystole | 214 | ||
| Pulseless electrical activity (PEA) | 214 | ||
| Management of cardiac arrest | 214 | ||
| Abnormal heart sounds and murmurs | 216 | ||
| Disorders of heart rate, rhythm and conduction | 217 | ||
| Sinoatrial nodal rhythms | 217 | ||
| Sinoatrial disease (sick sinus syndrome) | 217 | ||
| Tachyarrhythmias | 217 | ||
| Atrial tachyarrhythmias | 218 | ||
| Atrial fibrillation | 218 | ||
| Management | 220 | ||
| ‘Supraventricular’ tachycardias | 220 | ||
| AV nodal re-entry tachycardia | 220 | ||
| Wolff–Parkinson–White syndrome and atrioventricular re-entrant tachycardia | 221 | ||
| Ventricular tachyarrhythmias | 222 | ||
| Ventricular ectopic beats (extrasystoles, premature beats) | 222 | ||
| Ventricular tachycardia | 223 | ||
| Torsades de pointes | 223 | ||
| Atrioventricular block | 224 | ||
| First-degree AV block | 224 | ||
| Second-degree AV block | 224 | ||
| Third-degree (complete) AV block | 224 | ||
| Stokes–Adams attacks | 225 | ||
| Management | 225 | ||
| Bundle branch block | 225 | ||
| Anti-arrhythmic drugs | 226 | ||
| Therapeutic procedures | 226 | ||
| External defibrillation and cardioversion | 226 | ||
| Catheter ablation | 228 | ||
| Temporary and permanent pacemakers | 228 | ||
| Temporary pacemakers | 228 | ||
| Permanent pacemakers | 228 | ||
| Implantable cardiac defibrillators | 229 | ||
| Cardiac resynchronisation therapy | 229 | ||
| Coronary artery disease | 230 | ||
| Stable angina | 230 | ||
| Clinical features | 231 | ||
| Investigations | 231 | ||
| Management | 232 | ||
| Acute coronary syndrome | 233 | ||
| Clinical features | 233 | ||
| Investigations | 234 | ||
| Risk stratification | 235 | ||
| Immediate management: the first 12 hrs | 236 | ||
| Antithrombotic therapy | 237 | ||
| Anti-anginal therapy | 237 | ||
| Reperfusion therapy in non-ST elevation MI | 237 | ||
| Reperfusion therapy in ST elevation acute coronary syndrome | 237 | ||
| Complications of acute coronary syndrome | 238 | ||
| Arrhythmias | 238 | ||
| Ischaemia | 238 | ||
| Acute circulatory failure | 238 | ||
| Pericarditis | 239 | ||
| Mechanical complications | 239 | ||
| Other recognised peri-infarct complications | 239 | ||
| Late management | 239 | ||
| Risk stratification and further investigation | 239 | ||
| Lifestyle and risk factor modification | 239 | ||
| Mobilisation and rehabilitation | 240 | ||
| Secondary prevention and drug therapy | 240 | ||
| Prognosis | 240 | ||
| Vascular disease | 241 | ||
| Peripheral arterial disease | 241 | ||
| Intermittent claudication | 241 | ||
| Critical limb ischaemia | 242 | ||
| Diabetic vascular disease | 242 | ||
| Buerger’s disease | 242 | ||
| Acute limb ischaemia | 242 | ||
| Diseases of the aorta | 243 | ||
| Abdominal aortic aneurysms | 243 | ||
| Thoracic aortic aneurysm | 243 | ||
| Aortic dissection | 243 | ||
| Hypertension | 244 | ||
| Approach to newly diagnosed hypertension | 244 | ||
| Target organ damage | 245 | ||
| ‘Malignant’ or ‘accelerated’ phase hypertension | 246 | ||
| Investigations | 246 | ||
| Management | 246 | ||
| Diseases of the heart valves | 248 | ||
| Acute rheumatic fever | 249 | ||
| Clinical features | 249 | ||
| Investigations | 250 | ||
| Management | 250 | ||
| Chronic rheumatic heart disease | 251 | ||
| Mitral stenosis | 251 | ||
| Clinical features | 251 | ||
| Investigations | 251 | ||
| Management | 252 | ||
| Mitral regurgitation | 252 | ||
| Clinical features | 252 | ||
| 9 Respiratory disease | 265 | ||
| Clinical examination of the respiratory system | 266 | ||
| Presenting problems in respiratory disease | 265 | ||
| Cough | 265 | ||
| Breathlessness (dyspnoea) | 265 | ||
| Chronic exertional breathlessness | 267 | ||
| How is your breathing at rest and overnight? | 267 | ||
| How much can you do on a good day? | 267 | ||
| Did you have breathing problems in childhood or at school? | 267 | ||
| Do you have other symptoms with your breathlessness? | 267 | ||
| Acute severe dyspnoea | 268 | ||
| Investigations and management | 268 | ||
| Chest pain | 268 | ||
| Haemoptysis | 270 | ||
| Investigations and management | 270 | ||
| The incidental pulmonary nodule | 270 | ||
| Pleural effusion | 271 | ||
| Investigations | 272 | ||
| Management | 273 | ||
| Empyema | 273 | ||
| Clinical features | 273 | ||
| Investigations | 274 | ||
| 10 Endocrine disease | 327 | ||
| Clinical examination in endocrine disease | 328 | ||
| Major endocrine functions and anatomy | 327 | ||
| Presenting problems in endocrine disease | 330 | ||
| The thyroid gland | 330 | ||
| Presenting problems in thyroid disease | 331 | ||
| Thyrotoxicosis | 331 | ||
| Clinical assessment | 331 | ||
| Investigations | 331 | ||
| Management | 332 | ||
| Hypothyroidism | 334 | ||
| Clinical assessment | 335 | ||
| Investigations | 335 | ||
| Management | 337 | ||
| Asymptomatic abnormal thyroid function tests | 338 | ||
| Thyroid lump or swelling | 338 | ||
| Clinical assessment and investigations | 338 | ||
| 11 Diabetes mellitus | 381 | ||
| Clinical examination of the patient with diabetes | 382 | ||
| Functional anatomy, physiology and investigations | 381 | ||
| Normal glucose and fat metabolism | 381 | ||
| Aetiology and pathogenesis of diabetes | 383 | ||
| Type 1 diabetes | 383 | ||
| Genetic predisposition | 383 | ||
| Environmental factors | 383 | ||
| Metabolic disturbances in type 1 diabetes | 384 | ||
| Type 2 diabetes | 384 | ||
| Genetic predisposition | 385 | ||
| Environmental and other risk factors | 385 | ||
| Metabolic disturbances in type 2 diabetes | 385 | ||
| Other forms of diabetes | 386 | ||
| Investigations | 386 | ||
| Urine testing | 386 | ||
| Glucose | 386 | ||
| Ketones | 386 | ||
| Protein | 386 | ||
| Blood testing | 387 | ||
| Glucose | 387 | ||
| Ketones | 387 | ||
| Glycated haemoglobin | 387 | ||
| Presenting problems in diabetes | 387 | ||
| Newly discovered hyperglycaemia | 387 | ||
| Establishing the diagnosis of diabetes | 387 | ||
| Clinical assessment | 388 | ||
| Management | 389 | ||
| Long-term supervision of diabetes | 390 | ||
| Therapeutic goals | 390 | ||
| Diabetic ketoacidosis | 391 | ||
| Clinical assessment | 391 | ||
| Investigations | 391 | ||
| Management | 392 | ||
| Hyperglycaemic hyperosmolar state | 393 | ||
| Hypoglycaemia | 394 | ||
| Clinical assessment | 394 | ||
| Management | 395 | ||
| Prevention of hypoglycaemia | 396 | ||
| Diabetes in pregnancy | 396 | ||
| Gestational diabetes | 396 | ||
| Management of gestational diabetes | 396 | ||
| Pregnancy in women with established diabetes | 397 | ||
| Surgery and diabetes | 397 | ||
| Pre-operative assessment | 397 | ||
| Peri-operative management | 398 | ||
| Diabetes presenting through complications | 399 | ||
| Management of diabetes | 399 | ||
| Diet and lifestyle | 399 | ||
| Healthy eating | 399 | ||
| Carbohydrate | 400 | ||
| Fat | 400 | ||
| Salt | 400 | ||
| Weight management | 400 | ||
| Exercise | 400 | ||
| Alcohol | 401 | ||
| Drugs to reduce hyperglycaemia | 401 | ||
| Biguanides | 401 | ||
| Sulphonylureas | 401 | ||
| Alpha-glucosidase inhibitors | 402 | ||
| Thiazolidinediones | 402 | ||
| Incretin-based therapies: DPP-4 inhibitors and GLP-1 analogues | 402 | ||
| Insulin | 403 | ||
| Subcutaneous multiple dose insulin therapy | 403 | ||
| Insulin dosing regimens | 404 | ||
| Transplantation | 404 | ||
| Complications of diabetes | 404 | ||
| Preventing diabetes complications | 405 | ||
| Diabetic retinopathy | 405 | ||
| Clinical features | 406 | ||
| Prevention | 408 | ||
| Management | 408 | ||
| Other causes of visual loss in diabetes | 408 | ||
| Diabetic nephropathy | 408 | ||
| Diagnosis and screening | 409 | ||
| Management | 409 | ||
| Diabetic neuropathy | 409 | ||
| Clinical features | 409 | ||
| Management | 410 | ||
| The diabetic foot | 410 | ||
| Management | 411 | ||
| 12 Gastrointestinal and nutritional disorders | 413 | ||
| Clinical examination of the gastrointestinal tract | 414 | ||
| Presenting problems in gastrointestinal disease | 413 | ||
| Dysphagia | 413 | ||
| Dyspepsia | 413 | ||
| Vomiting | 415 | ||
| GI bleeding | 416 | ||
| Acute upper GI haemorrhage | 416 | ||
| Management | 416 | ||
| Lower GI bleeding | 417 | ||
| Severe acute lower GI bleeding | 417 | ||
| Subacute or chronic lower GI bleeding | 417 | ||
| Obscure major GI bleeding | 417 | ||
| Occult GI bleeding | 418 | ||
| Diarrhoea | 418 | ||
| Acute diarrhoea | 418 | ||
| Chronic or relapsing diarrhoea | 418 | ||
| Malabsorption | 418 | ||
| Weight loss | 418 | ||
| History and examination | 419 | ||
| Investigations | 420 | ||
| Constipation | 420 | ||
| Abdominal pain | 421 | ||
| The acute abdomen | 421 | ||
| Management | 421 | ||
| Chronic or recurrent abdominal pain | 422 | ||
| Constant abdominal pain | 422 | ||
| Disorders of nutrition | 423 | ||
| Obesity | 423 | ||
| Complications of obesity | 423 | ||
| Clinical features and investigations | 423 | ||
| Management | 424 | ||
| Under-nutrition | 425 | ||
| Starvation and famine | 425 | ||
| Clinical features | 425 | ||
| Investigations | 425 | ||
| Management | 426 | ||
| Under-nutrition in hospital | 426 | ||
| Nutritional support of the hospital patient | 426 | ||
| Refeeding syndrome | 427 | ||
| Ethical aspects | 427 | ||
| Vitamin deficiency | 427 | ||
| Anorexia nervosa | 427 | ||
| Management and prognosis | 429 | ||
| Diseases of the mouth and salivary glands | 429 | ||
| Diseases of the oesophagus | 430 | ||
| Gastro-oesophageal reflux disease | 430 | ||
| Clinical features | 430 | ||
| Complications | 430 | ||
| Investigations | 431 | ||
| Management | 432 | ||
| Other causes of oesophagitis | 432 | ||
| Motility disorders | 432 | ||
| Pharyngeal pouch | 432 | ||
| Achalasia of the oesophagus | 432 | ||
| Clinical features and investigations | 433 | ||
| Management | 433 | ||
| Other oesophageal motility disorders | 434 | ||
| Tumours of the oesophagus | 434 | ||
| Carcinoma of the oesophagus | 434 | ||
| Clinical features and investigations | 434 | ||
| Management and prognosis | 435 | ||
| Perforation of the oesophagus | 435 | ||
| Diseases of the stomach and duodenum | 435 | ||
| Gastritis | 435 | ||
| Peptic ulcer disease | 436 | ||
| Gastric and duodenal ulcer | 436 | ||
| Clinical features and investigations | 437 | ||
| Management | 437 | ||
| Complications of gastric resection or vagotomy | 438 | ||
| Complications of peptic ulcer | 439 | ||
| Zollinger–Ellison syndrome | 440 | ||
| Functional disorders | 440 | ||
| Functional dyspepsia | 440 | ||
| Clinical features and investigations | 441 | ||
| Management | 441 | ||
| Functional vomiting | 441 | ||
| Gastroparesis | 441 | ||
| Tumours of the stomach | 442 | ||
| Gastric carcinoma | 442 | ||
| Clinical features | 442 | ||
| Investigations | 443 | ||
| Management and prognosis | 443 | ||
| Gastric lymphoma | 443 | ||
| Diseases of the small intestine | 443 | ||
| Disorders causing malabsorption | 443 | ||
| Coeliac disease | 443 | ||
| Clinical features | 444 | ||
| Investigations | 444 | ||
| Management | 445 | ||
| Complications | 446 | ||
| Dermatitis herpetiformis | 446 | ||
| Tropical sprue | 446 | ||
| Small bowel bacterial overgrowth (‘blind loop syndrome’) | 446 | ||
| Whipple’s disease | 447 | ||
| Ileal resection | 448 | ||
| Short bowel syndrome | 448 | ||
| Radiation enteritis and proctocolitis | 448 | ||
| Miscellaneous disorders of the small intestine | 449 | ||
| Protein-losing enteropathy | 449 | ||
| Meckel’s diverticulum | 449 | ||
| Infections of the small intestine | 449 | ||
| Travellers’ diarrhoea, giardiasis and amoebiasis | 449 | ||
| Abdominal tuberculosis | 450 | ||
| Tumours of the small intestine | 450 | ||
| Benign tumours | 450 | ||
| Malignant tumours | 450 | ||
| Carcinoid tumours | 450 | ||
| Lymphoma | 451 | ||
| Diseases of the pancreas | 451 | ||
| Acute pancreatitis | 451 | ||
| Clinical features and complications | 452 | ||
| Investigations | 452 | ||
| Management and prognosis | 453 | ||
| Chronic pancreatitis | 454 | ||
| Clinical features and complications | 455 | ||
| Investigations | 455 | ||
| Management | 455 | ||
| Congenital abnormalities of the pancreas | 456 | ||
| Annular pancreas | 456 | ||
| Cystic fibrosis | 456 | ||
| Tumours of the pancreas | 456 | ||
| Clinical features | 457 | ||
| Investigations | 457 | ||
| Management | 457 | ||
| Pancreatic neuro-endocrine tumours | 457 | ||
| Inflammatory bowel disease | 458 | ||
| Clinical features of ulcerative colitis | 459 | ||
| Clinical features of Crohn’s disease | 459 | ||
| Complications | 460 | ||
| Investigations | 460 | ||
| General management | 462 | ||
| Medical management of ulcerative colitis | 462 | ||
| Medical management of Crohn’s disease | 463 | ||
| Surgical treatment of ulcerative colitis | 463 | ||
| Surgical treatment of Crohn’s disease | 463 | ||
| Prognosis | 464 | ||
| Irritable bowel syndrome | 464 | ||
| Clinical features and investigations | 464 | ||
| 13 Liver and biliary tract disease | 475 | ||
| Clinical examination of the abdomen for liver and biliary disease | 476 | ||
| Presenting Problems in Liver Disease | 475 | ||
| Acute liver failure | 475 | ||
| Clinical assessment | 475 | ||
| Investigations | 478 | ||
| Management | 478 | ||
| Abnormal liver function tests | 479 | ||
| Jaundice | 479 | ||
| Bilirubin metabolism | 479 | ||
| Pre-hepatic jaundice | 479 | ||
| Hepatocellular jaundice | 481 | ||
| Obstructive (cholestatic) jaundice | 482 | ||
| 14 Blood disease | 519 | ||
| Clinical examination in blood disease | 520 | ||
| Presenting problems in blood disease | 519 | ||
| Anaemia | 519 | ||
| Clinical assessment | 519 | ||
| Investigations | 521 | ||
| High haemoglobin | 521 | ||
| Clinical assessment and investigations | 521 | ||
| Leucopenia (low white count) | 522 | ||
| Leucocytosis (high white count) | 523 | ||
| Lymphadenopathy | 523 | ||
| Splenomegaly | 523 | ||
| Bleeding | 524 | ||
| Normal haemostasis | 524 | ||
| Clinical assessment | 525 | ||
| Investigations | 526 | ||
| Thrombocytopenia (low platelets) | 526 | ||
| Thrombocytosis (high platelets) | 526 | ||
| Venous thrombosis | 527 | ||
| Management | 528 | ||
| Blood products and transfusion | 529 | ||
| Blood products | 529 | ||
| Adverse effects of transfusion | 530 | ||
| Red cell incompatibility | 530 | ||
| Transfusion reactions | 530 | ||
| Safe transfusion procedures | 531 | ||
| Haematopoietic stem cell transplantation | 531 | ||
| Allogeneic HSCT | 531 | ||
| Graft-versus-host disease | 532 | ||
| Autologous HSCT | 532 | ||
| Anticoagulant and antithrombotic therapy | 532 | ||
| Heparin | 532 | ||
| Heparin-induced thrombocytopenia | 533 | ||
| Warfarin | 533 | ||
| Prevention of venous thrombosis | 534 | ||
| Anaemias | 534 | ||
| Iron deficiency anaemia | 534 | ||
| Investigations | 535 | ||
| Management | 535 | ||
| Anaemia of chronic disease | 535 | ||
| Megaloblastic anaemia | 535 | ||
| Vitamin B12 | 535 | ||
| Causes of vitamin B12 deficiency | 536 | ||
| Folate | 536 | ||
| Management of megaloblastic anaemia | 537 | ||
| Haemolytic anaemia | 537 | ||
| Red cell membrane defects | 537 | ||
| Hereditary spherocytosis | 537 | ||
| Hereditary elliptocytosis | 538 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 538 | ||
| Acquired haemolytic anaemia | 538 | ||
| Autoimmune haemolytic anaemia | 538 | ||
| Warm autoimmune haemolysis | 540 | ||
| Cold agglutinin disease | 540 | ||
| Non-immune haemolytic anaemia | 540 | ||
| Physical trauma | 540 | ||
| Infection | 541 | ||
| Haemoglobinopathies | 541 | ||
| Sickle-cell anaemia | 541 | ||
| Clinical features | 541 | ||
| Investigations | 542 | ||
| Management and prognosis | 542 | ||
| The thalassaemias | 542 | ||
| Beta-thalassaemia | 542 | ||
| Alpha-thalassaemia | 543 | ||
| Haematological malignancies | 543 | ||
| Leukaemias | 543 | ||
| Acute leukaemia | 544 | ||
| Investigations | 544 | ||
| Management | 544 | ||
| Specific therapy | 544 | ||
| Supportive therapy | 545 | ||
| Haematopoietic stem cell transplantation | 545 | ||
| Prognosis | 546 | ||
| Chronic myeloid leukaemia | 546 | ||
| Clinical features | 546 | ||
| Investigations | 546 | ||
| Management | 546 | ||
| Chronic lymphocytic leukaemia | 547 | ||
| Clinical features | 547 | ||
| Investigations | 547 | ||
| Management and prognosis | 547 | ||
| Myelodysplastic syndrome | 548 | ||
| Lymphomas | 548 | ||
| Hodgkin lymphoma | 548 | ||
| Clinical features | 548 | ||
| Investigations | 548 | ||
| Management and prognosis | 549 | ||
| Non-Hodgkin lymphoma | 549 | ||
| Clinical features | 549 | ||
| Investigations | 549 | ||
| Management | 549 | ||
| Prognosis | 550 | ||
| Paraproteinaemias | 550 | ||
| Monoclonal gammopathy of uncertain significance | 550 | ||
| Waldenström macroglobulinaemia | 551 | ||
| Multiple myeloma | 551 | ||
| Clinical features and investigations | 551 | ||
| 15 Rheumatology and bone disease | 561 | ||
| Clinical examination of the musculoskeletal system | 562 | ||
| Presenting problems in musculoskeletal disease | 561 | ||
| Acute monoarthritis | 561 | ||
| Polyarthritis | 561 | ||
| Generalised musculoskeletal pain | 563 | ||
| Regional musculoskeletal pain | 563 | ||
| Back pain | 563 | ||
| Clinical assessment | 563 | ||
| Investigations | 565 | ||
| Management | 565 | ||
| Neck pain | 566 | ||
| Shoulder pain | 566 | ||
| Elbow pain | 566 | ||
| Hand and wrist pain | 566 | ||
| Lower limb pain | 567 | ||
| Muscle pain and weakness | 568 | ||
| Principles of management of musculoskeletal disorders | 568 | ||
| Education and lifestyle interventions | 568 | ||
| Pharmacological treatment | 569 | ||
| Analgesia | 569 | ||
| Non-steroidal anti-inflammatory drugs | 569 | ||
| Topical agents | 569 | ||
| Non-pharmacological interventions | 569 | ||
| Surgery | 570 | ||
| Osteoarthritis | 571 | ||
| Clinical features | 572 | ||
| Generalised nodal OA | 573 | ||
| Knee OA | 573 | ||
| Hip OA | 574 | ||
| Spine OA | 574 | ||
| Investigations | 574 | ||
| Management | 574 | ||
| Crystal-induced arthritis | 574 | ||
| Gout | 574 | ||
| Clinical features | 575 | ||
| Investigations | 576 | ||
| Management | 576 | ||
| Calcium pyrophosphate dihydrate crystal deposition | 577 | ||
| Clinical features | 577 | ||
| Investigations | 577 | ||
| Management | 577 | ||
| Fibromyalgia | 577 | ||
| Clinical features and investigations | 578 | ||
| Management | 578 | ||
| Bone and joint infection | 578 | ||
| Septic arthritis | 578 | ||
| Clinical features | 578 | ||
| Investigations | 579 | ||
| 16 Neurological disease | 605 | ||
| Clinical examination of the nervous system | 606 | ||
| Presenting problems in neurological disease | 605 | ||
| Headache and facial pain | 605 | ||
| Ocular pain | 607 | ||
| Facial pain | 607 | ||
| Dizziness, blackouts and ‘funny turns’ | 607 | ||
| Loss of consciousness | 607 | ||
| Syncope | 609 | ||
| Seizures | 609 | ||
| Non-epileptic attack disorder, psychogenic seizures, pseudoseizures, psychogenic non-epileptic seizures | 609 | ||
| Status epilepticus | 610 | ||
| Coma | 610 | ||
| Brain death | 611 | ||
| Delirium and acute confusion | 611 | ||
| Diagnosis | 612 | ||
| Management | 612 | ||
| Amnesia | 612 | ||
| Transient global amnesia | 612 | ||
| Permanent amnesia | 614 | ||
| Weakness | 614 | ||
| The motor system | 614 | ||
| Clinical assessment of weakness | 615 | ||
| Facial nerve palsy (Bell’s palsy) | 616 | ||
| Sensory disturbance | 617 | ||
| A diagnostic approach to sensory symptoms | 618 | ||
| Patterns of sensory disturbance | 618 | ||
| Sensory loss in peripheral nerve lesions | 618 | ||
| Sensory loss in nerve root lesions | 618 | ||
| Sensory loss in spinal cord lesions | 618 | ||
| Sensory loss in brainstem lesions | 620 | ||
| Sensory loss in hemispheric lesions | 620 | ||
| Neuropathic pain | 621 | ||
| Abnormal movements | 621 | ||
| Tremor | 621 | ||
| Other hyperkinetic syndromes | 621 | ||
| Abnormal perception | 622 | ||
| Altered balance and vertigo | 622 | ||
| Gait disorders | 622 | ||
| Abnormal speech and language | 623 | ||
| Dysphonia and dysarthria | 623 | ||
| Dysphasia | 624 | ||
| Disturbance of smell | 624 | ||
| Visual disturbance and ocular abnormalities | 624 | ||
| Visual loss | 624 | ||
| Eye movement disorders | 624 | ||
| Diplopia (‘double vision’) | 624 | ||
| Nystagmus | 627 | ||
| Ptosis | 627 | ||
| Abnormal pupillary responses | 627 | ||
| Optic disc disorders | 627 | ||
| Hearing disturbance | 629 | ||
| Bulbar symptoms – dysphagia and dysarthria | 630 | ||
| Bladder, bowel and sexual disturbance | 630 | ||
| Bladder | 630 | ||
| Rectum | 630 | ||
| Erectile failure and ejaculation failure | 631 | ||
| Changes in personality and behaviour | 631 | ||
| Stroke disease | 631 | ||
| Acute stroke | 631 | ||
| Cerebral infarction | 632 | ||
| Intracerebral haemorrhage | 632 | ||
| Clinical features | 632 | ||
| Investigations | 633 | ||
| Neuroimaging | 633 | ||
| Vascular imaging | 636 | ||
| Cardiac investigations | 636 | ||
| Management | 636 | ||
| The deteriorating stroke patient | 636 | ||
| Thrombolysis | 638 | ||
| Aspirin | 638 | ||
| Coagulation abnormalities | 639 | ||
| Management of risk factors | 639 | ||
| Carotid endarterectomy and angioplasty | 639 | ||
| Subarachnoid haemorrhage | 639 | ||
| Clinical features | 639 | ||
| Investigations | 639 | ||
| Management | 640 | ||
| Cerebral venous disease | 640 | ||
| Cortical vein thrombosis | 640 | ||
| Cerebral venous sinus thrombosis | 640 | ||
| Headache syndromes | 640 | ||
| Tension-type headache | 640 | ||
| Clinical features | 640 | ||
| 17 Skin disease | 687 | ||
| Clinical examination in skin disease | 688 | ||
| Presenting problems in skin disease | 687 | ||
| Lumps – new or changing lesions | 687 | ||
| Melanocytic naevus or malignant melanoma? | 689 | ||
| Rashes – papulosquamous eruptions | 690 | ||
| History | 690 | ||
| Blisters | 691 | ||
| Itch (pruritus) | 692 | ||
| Management | 693 | ||
| Photosensitivity | 693 | ||
| Clinical assessment | 693 | ||
| Investigations and management | 693 | ||
| Leg ulcers | 694 | ||
| 18 Therapeutics and prescribing | 731 | ||
| Writing a drug prescription | 732 | ||
| Altering dosages in renal impairment | 732 | ||
| Altering dosages in hepatic failure | 732 | ||
| Altering dosages in older people | 736 | ||
| Drugs commonly used in clinical practice | 739 | ||
| GI diseases | 739 | ||
| Drugs used for dyspepsia and peptic ulcer disease | 739 | ||
| Drugs used for irritable bowel syndrome | 740 | ||
| Drugs used for diarrhoea | 741 | ||
| Drugs used for constipation | 742 | ||
| Drugs used in inflammatory bowel disease | 743 | ||
| Drugs used in diverticular disease | 744 | ||
| Other drugs | 744 | ||
| Cardiovascular diseases | 744 | ||
| Drugs for hypertension | 744 | ||
| Drugs for heart failure | 748 | ||
| Drugs for angina | 749 | ||
| Anti-arrhythmic drugs | 750 | ||
| Antiplatelet drugs | 752 | ||
| Anticoagulants and fibrinolytics | 753 | ||
| Lipid-lowering drugs | 754 | ||
| Respiratory diseases | 755 | ||
| Bronchodilators | 755 | ||
| Corticosteroids | 756 | ||
| Other drugs used for asthma and COPD | 757 | ||
| Antihistamines | 758 | ||
| Drugs used in anaphylaxis | 758 | ||
| Oxygen | 758 | ||
| Neurological diseases | 758 | ||
| Analgesic drugs | 758 | ||
| Anti-migraine drugs | 760 | ||
| Anti-epileptic drugs | 760 | ||
| Drugs for nausea and vertigo | 763 | ||
| Drugs for Parkinson’s disease | 765 | ||
| Drugs for dementia | 766 | ||
| Other drugs | 767 | ||
| Psychiatric diseases | 767 | ||
| Hypnotic and anxiolytic drugs | 767 | ||
| Antidepressant drugs | 768 | ||
| Antipsychotic drugs | 770 | ||
| Infectious diseases | 772 | ||
| Antibacterial drugs | 772 | ||
| Antifungal drugs | 779 | ||
| Antiviral drugs | 780 | ||
| Other drugs | 781 | ||
| Endocrine diseases | 781 | ||
| Insulin | 781 | ||
| Drugs for type 2 diabetes | 782 | ||
| Drugs for thyroid disease | 783 | ||
| Corticosteroids | 784 | ||
| Other endocrine drugs | 786 | ||
| Bone diseases | 786 | ||
| Drugs for osteoporosis | 786 | ||
| Diseases affecting women | 788 | ||
| Drugs used for the menopause | 788 | ||
| Musculoskeletal diseases | 788 | ||
| Drugs used for rheumatic diseases | 788 | ||
| Drugs used for immunosuppression | 790 | ||
| Drugs used for gout | 791 | ||
| Diseases of the urinary tract | 792 | ||
| Drugs used in benign prostate hypertrophy | 792 | ||
| Drugs used for bladder instability | 793 | ||
| 19 Interpreting key investigations | 795 | ||
| Electrocardiography | 795 | ||
| Systematic approach to ECG interpretation | 795 | ||
| Patient details and ECG calibration | 795 | ||
| The normal ECG | 795 | ||
| P wave | 797 | ||
| PR interval | 797 | ||
| QRS complex | 797 | ||
| ST segment | 798 | ||
| T wave | 798 | ||
| QT interval | 798 | ||
| U wave | 798 | ||
| Rate | 799 | ||
| Rhythm | 799 | ||
| Cardiac axis | 799 | ||
| Quick method | 799 | ||
| Chest X-ray | 799 | ||
| The normal chest X-ray | 799 | ||
| Systematic approach to CXR interpretation | 800 | ||
| Patient details and date | 800 | ||
| Technical quality | 800 | ||
| Trachea | 801 | ||
| Heart and mediastinal contours | 802 | ||
| Lung fields and pleura | 802 | ||
| Diaphragm | 802 | ||
| Soft tissues and bones | 802 | ||
| Review areas | 803 | ||
| Respiratory function tests | 803 | ||
| Peak expiratory flow | 804 | ||
| Spirometry | 804 | ||
| Flow-volume loops | 804 | ||
| Lung volumes | 804 | ||
| Gas transfer | 805 | ||
| Inflammatory markers | 805 | ||
| C-reactive protein | 805 | ||
| Erythrocyte sedimentation rate | 805 | ||
| CRP versus ESR | 805 | ||
| Unexplained raised ESR | 806 | ||
| 20 Laboratory reference ranges | 809 | ||
| Units | 809 | ||
| Exceptions to the use of SI units | 809 | ||
| Index | 817 | ||
| A | 817 | ||
| B | 821 | ||
| C | 823 | ||
| D | 827 | ||
| E | 829 | ||
| F | 831 | ||
| G | 832 | ||
| H | 833 | ||
| I | 837 | ||
| J | 838 | ||
| K | 839 | ||
| L | 839 | ||
| M | 841 | ||
| N | 843 | ||
| O | 845 | ||
| P | 846 | ||
| Q | 850 | ||
| R | 850 | ||
| S | 852 | ||
| T | 855 | ||
| U | 858 | ||
| V | 859 | ||
| W | 860 | ||
| X | 860 | ||
| Y | 860 | ||
| Z | 860 |