BOOK
Essentials of Kumar and Clark's Clinical Medicine E-Book
Nicola Zammitt | Alastair O'Brien
(2017)
Additional Information
Book Details
Abstract
‘Baby Kumar & Clark’, best-selling portable revision reference, is now in its sixth edition.
Features
- Normal values
- Medical emergencies
- Useful websites
- Abbreviations
- Dictionary of terms
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- New author team: Nicola Zammitt and Alastair O’Brien
- Now comes with a free e-book on StudentConsult
- Fully updated and revised in line with the new edition of Kumar & Clark’s Clinical Medicine
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Essentials of Kumar & Clark’s Clinical Medicine | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Preface | vii | ||
| Contributors | ix | ||
| Medical emergencies | xi | ||
| Abbreviations | xv | ||
| Significant websites | xxix | ||
| General websites | xxix | ||
| Medical dictionaries | xxix | ||
| Guidelines and evidence-based medicine | xxix | ||
| Medical calculators | xxx | ||
| Healthcare journals and magazines | xxx | ||
| Medical societies and organizations | xxx | ||
| Others | xxx | ||
| Chapter-specific websites | xxx | ||
| 1. Ethics and communication | xxx | ||
| 2. Infectious diseases | xxxi | ||
| 3. Gastroenterology and nutrition | xxxi | ||
| Chapter 1: Ethics and communication | 1 | ||
| Legally valid consent | 1 | ||
| Capacity | 2 | ||
| Information disclosure | 2 | ||
| Obtaining consent | 3 | ||
| Special circumstances | 3 | ||
| Adults who lack capacity to consent | 3 | ||
| Advance decisions | 3 | ||
| Children | 4 | ||
| Teaching | 4 | ||
| Human immunodeficiency virus testing | 4 | ||
| End-of-life decisions including assisted dying | 4 | ||
| Cardiopulmonary resuscitation | 5 | ||
| Confidentiality | 5 | ||
| Communication | 5 | ||
| The medical interview | 6 | ||
| 1. Building a relationship | 6 | ||
| 2. Opening the discussion | 6 | ||
| 3. Gathering information | 6 | ||
| 4. Understanding the patient | 6 | ||
| 5. Sharing information | 7 | ||
| 6. Reaching agreement on management | 7 | ||
| 7. Providing closing | 7 | ||
| Breaking bad news | 7 | ||
| Communication in difficult circumstances | 8 | ||
| When things go wrong | 8 | ||
| Complaints | 9 | ||
| Culture and communication | 9 | ||
| Patients with impaired faculties for communication | 9 | ||
| Medical record keeping | 9 | ||
| Team communication | 10 | ||
| Chapter 2: Infectious diseases | 11 | ||
| Common investigations in infectious disease | 11 | ||
| Pyrexia of unknown origin | 12 | ||
| Investigations | 13 | ||
| Management | 14 | ||
| Septicaemia | 14 | ||
| Aetiology | 15 | ||
| Clinical features | 15 | ||
| Investigations | 15 | ||
| Management | 15 | ||
| Common viral infections | 16 | ||
| Measlesnd | 16 | ||
| Clinical features | 16 | ||
| Complications | 16 | ||
| Chapter 3: Gastroenterology and nutrition | 67 | ||
| Gastroenterology | 67 | ||
| Symptoms of gastrointestinal disease | 67 | ||
| Dyspepsia and indigestion | 67 | ||
| Dysphagia | 67 | ||
| Vomiting | 67 | ||
| Flatulence | 68 | ||
| Diarrhoea and constipation | 68 | ||
| Steatorrhoea | 68 | ||
| Abdominal pain | 69 | ||
| Investigation of gastrointestinal disease | 69 | ||
| Endoscopy | 70 | ||
| Oesophagogastroduodenoscopy (OGD, `gastroscopy) | 70 | ||
| Sigmoidoscopy | 70 | ||
| Colonoscopy | 70 | ||
| Endoscopic retrograde cannulation of biliary and pancreatic duct (ERCP) | 71 | ||
| Endoscopic ultrasound (EUS) | 71 | ||
| Endoanal and endorectal ultrasonography | 71 | ||
| Balloon enteroscopy, | 71 | ||
| Capsule endoscopy | 71 | ||
| Imaging | 71 | ||
| Plain X-rays | 71 | ||
| Ultrasound | 71 | ||
| Transabdominal ultrasound | 71 | ||
| Computed tomography (CT) scan | 71 | ||
| Magnetic resonance imaging (MRI) | 72 | ||
| Positron emission tomography (PET) | 73 | ||
| Contrast studies | 73 | ||
| Oesophageal physiology testing | 73 | ||
| The mouth | 73 | ||
| Mouth ulcers | 73 | ||
| Non-infective | 73 | ||
| Infective | 74 | ||
| Oral white patches | 74 | ||
| The tongue | 74 | ||
| Periodontal disorders | 74 | ||
| Salivary gland disorders | 75 | ||
| The oesophagus | 75 | ||
| Symptoms of oesophageal disorders | 75 | ||
| Gastro-oesophageal reflux disease (GORD) | 76 | ||
| Pathophysiology | 76 | ||
| Clinical features | 76 | ||
| Investigations | 76 | ||
| OGD | 76 | ||
| 24-Hour intraluminal pH monitoring or impedance | 76 | ||
| Management | 76 | ||
| Complications | 78 | ||
| Peptic stricture | 78 | ||
| Barrett's oesophagus | 78 | ||
| Achalasia | 79 | ||
| Clinical features | 79 | ||
| Investigations | 79 | ||
| Management | 79 | ||
| Complications | 79 | ||
| Systemic sclerosis | 80 | ||
| Other oesophageal dysmotility disorders | 80 | ||
| Hiatus hernia | 80 | ||
| Benign oesophageal strictures | 80 | ||
| Oesophageal perforation | 80 | ||
| Iatrogenic perforation | 80 | ||
| Traumatic or spontaneous oesophageal rupture | 81 | ||
| Malignant oesophageal tumours | 81 | ||
| Pathology | 81 | ||
| Epidemiology and aetiological factors | 81 | ||
| Squamous carcinoma | 81 | ||
| Adenocarcinoma | 81 | ||
| Clinical features | 81 | ||
| Investigations | 81 | ||
| Management | 82 | ||
| Prognosis | 82 | ||
| Benign oesophageal tumours | 82 | ||
| The stomach and duodenum | 82 | ||
| Helicobacter pylori infection | 82 | ||
| Chapter 4: Liver, biliary tract and pancreatic disease | 139 | ||
| Liver biochemistry and liver function tests | 139 | ||
| Approach to interpretation of abnormal liver biochemistry | 141 | ||
| Other investigations in liver and biliary disease | 141 | ||
| Hepatic stiffness (transient elastography) | 141 | ||
| Endoscopic ultrasound (EUS) | 143 | ||
| Computed tomography (CT) examination | 143 | ||
| Magnetic resonance imaging (MRI) | 143 | ||
| Magnetic resonance cholangiopancreatography (MRCP) | 143 | ||
| Upper gastrointestinal (GI) endoscopy | 143 | ||
| ERCP | 143 | ||
| Percutaneous transhepatic cholangiography (PTC) | 143 | ||
| Liver biopsy | 143 | ||
| Markers of liver fibrosis | 144 | ||
| Symptoms and signs of liver disease | 145 | ||
| Jaundice | 145 | ||
| Haemolytic jaundice | 145 | ||
| Congenital hyperbilirubinaemia | 147 | ||
| Cholestatic jaundice | 147 | ||
| Investigations | 148 | ||
| Hepatitis | 149 | ||
| Acute hepatitis | 149 | ||
| Chronic hepatitis | 150 | ||
| Viral hepatitis | 150 | ||
| Hepatitis A | 150 | ||
| Epidemiology | 150 | ||
| Clinical features | 151 | ||
| Investigations | 151 | ||
| Differential diagnosis | 153 | ||
| Management | 153 | ||
| Prophylaxis | 153 | ||
| Hepatitis B | 153 | ||
| Epidemiology | 153 | ||
| Viral structure | 153 | ||
| Acute HBV infection | 154 | ||
| Chronic HBV infection | 155 | ||
| Treatment of chronic infection: whom to treat | 156 | ||
| Antiviral agents | 157 | ||
| Hepatitis B and HIV co-infection | 157 | ||
| Prophylaxis | 157 | ||
| Hepatitis D (delta or δ agent) | 158 | ||
| Hepatitis C | 158 | ||
| Hepatitis C virus | 159 | ||
| Chronic hepatitis C infection | 159 | ||
| Hepatitis End | 160 | ||
| Acute hepatic failure | 160 | ||
| Alcohol use | 161 | ||
| Screening for problem drinking | 162 | ||
| Consequences of alcohol use and dependence | 162 | ||
| Physical complications | 162 | ||
| Alcohol withdrawal | 163 | ||
| Autoimmune hepatitis | 164 | ||
| Aetiology | 164 | ||
| Clinical features | 164 | ||
| Investigations | 164 | ||
| Treatment | 165 | ||
| Prognosis | 165 | ||
| Non-alcoholic fatty liver disease | 165 | ||
| Cirrhosis | 165 | ||
| Chapter 5: Haematological disease | 197 | ||
| Anaemia | 197 | ||
| Clinical features | 198 | ||
| Classification of anaemia (Table 5.2) | 198 | ||
| Microcytic anaemia | 199 | ||
| Iron deficiency | 199 | ||
| Causes of iron deficiency | 200 | ||
| Clinical features | 201 | ||
| Investigations | 201 | ||
| Differential diagnosis | 201 | ||
| Management | 201 | ||
| Sideroblastic anaemia | 202 | ||
| Anaemia of chronic disease | 202 | ||
| Macrocytic anaemia | 202 | ||
| Megaloblastic anaemia | 202 | ||
| Vitamin B12 deficiency | 203 | ||
| Pernicious anaemia | 203 | ||
| Epidemiology | 204 | ||
| Clinical features | 204 | ||
| Investigation of B12 deficiency | 204 | ||
| Differential diagnosis | 204 | ||
| Chapter 6: Malignant disease | 253 | ||
| Diagnosis of malignancy | 253 | ||
| Investigations | 254 | ||
| Cancer treatment | 255 | ||
| Chemotherapy | 255 | ||
| Radiotherapy | 255 | ||
| Endocrine therapy | 256 | ||
| Biological therapy | 256 | ||
| Myeloablative therapy and haemopoietic stem cell transplantation | 257 | ||
| Oncological emergencies | 257 | ||
| Neutropenic sepsis | 257 | ||
| Superior vena cava syndrome | 257 | ||
| Acute tumour lysis syndrome | 257 | ||
| The leukaemias | 258 | ||
| General classification | 258 | ||
| Aetiology | 258 | ||
| Acute leukaemia | 259 | ||
| Epidemiology | 259 | ||
| Clinical features | 259 | ||
| Investigations | 259 | ||
| Management | 260 | ||
| Supportive care | 260 | ||
| Treatment | 260 | ||
| Acute myeloid leukaemia | 260 | ||
| Low risk of treatment failure (based on the cytogenetic pattern) | 261 | ||
| Intermediate risk | 261 | ||
| High risk of treatment failure | 261 | ||
| Acute promyelocytic leukaemia | 261 | ||
| Prognosis | 261 | ||
| Acute lymphoblastic leukaemia | 261 | ||
| Chronic myeloid leukaemia | 262 | ||
| Chapter 7: Rheumatology | 273 | ||
| The normal joint | 273 | ||
| Musculoskeletal symptoms | 273 | ||
| Common investigations in musculoskeketal disease | 275 | ||
| Blood tests | 275 | ||
| Simple blood tests | 275 | ||
| Autoantibodies | 275 | ||
| Imaging | 275 | ||
| Plain X-rays | 275 | ||
| Bone scintigraphy (isotope bone scan) | 276 | ||
| Ultrasound | 276 | ||
| Magnetic resonance imaging (MRI) | 277 | ||
| DXA | 277 | ||
| Arthroscopy | 277 | ||
| Synovial fluid analysis | 277 | ||
| Investigation of suspected muscle disease | 277 | ||
| Common regional musculoskeletal problems | 277 | ||
| Pain in the neck and shoulder | 277 | ||
| Elbow pain | 278 | ||
| Hip problems | 278 | ||
| The knee | 278 | ||
| Back pain | 278 | ||
| Lumbar back pain | 278 | ||
| Investigations | 279 | ||
| Management | 280 | ||
| Intervertebral disc disease | 280 | ||
| Acute disc disease | 280 | ||
| Clinical features | 280 | ||
| Investigations | 281 | ||
| Management | 281 | ||
| Chronic disc disease | 281 | ||
| Mechanical problems | 282 | ||
| Spondylolisthesis | 282 | ||
| Spinal stenosis | 282 | ||
| Neck pain | 282 | ||
| Osteoarthritis | 282 | ||
| Epidemiology | 283 | ||
| Pathology and pathogenesis | 283 | ||
| Clinical features | 283 | ||
| Differential diagnosis | 284 | ||
| Investigations | 285 | ||
| Management | 285 | ||
| Inflammatory arthritis | 286 | ||
| Rheumatoid arthritis | 286 | ||
| Epidemiology | 286 | ||
| Aetiology and pathogenesis | 286 | ||
| Pathology | 286 | ||
| Clinical features | 287 | ||
| Non-articular manifestations | 288 | ||
| Investigations | 289 | ||
| Differential diagnosis | 289 | ||
| Management | 290 | ||
| NSAIDs and coxibs | 290 | ||
| Corticosteroids | 290 | ||
| Disease-modifying antirheumatic drugs | 290 | ||
| Biological DMARDs | 291 | ||
| Prognosis | 292 | ||
| The seronegative spondyloarthritis | 292 | ||
| Axial spondylarthritis | 292 | ||
| Clinical features | 293 | ||
| Investigations | 294 | ||
| Management | 295 | ||
| Psoriatic arthritis | 295 | ||
| Clinical features | 295 | ||
| Investigations | 295 | ||
| Treatment | 295 | ||
| Reactive arthritis | 296 | ||
| Clinical features | 296 | ||
| Investigations | 296 | ||
| Management | 296 | ||
| Enteropathic arthritis | 297 | ||
| Crystal arthritis | 297 | ||
| Gout and hyperuricaemia | 297 | ||
| Epidemiology | 297 | ||
| Pathogenesis | 297 | ||
| Clinical features | 297 | ||
| Investigations | 298 | ||
| Management | 299 | ||
| Pseudogout (pyrophosphate arthropathy) | 299 | ||
| Investigations | 300 | ||
| Chapter 8: Water, electrolytes and acid-base balance | 327 | ||
| Water and electrolyte requirements | 327 | ||
| Body fluid compartments | 327 | ||
| Osmotic pressure | 327 | ||
| Distribution of extracellular fluid | 328 | ||
| Intravenous fluids in clinical practice | 330 | ||
| Regulation of body fluid homeostasis | 331 | ||
| Regulation of extracellular volume | 332 | ||
| Abnormalities of extracellular volume | 332 | ||
| Increased extracellular volume | 332 | ||
| Clinical features | 332 | ||
| Chapter 9: Renal disease | 355 | ||
| Presenting features of renal disease | 355 | ||
| Dysuria | 357 | ||
| Polyuria and nocturia | 357 | ||
| Oliguria | 357 | ||
| Haematuria | 358 | ||
| Pain | 358 | ||
| Investigation of renal disease | 358 | ||
| Blood tests | 358 | ||
| Glomerular filtration rate | 358 | ||
| Calculation of creatinine clearance using the Cockroft–Gault equation: | 359 | ||
| Men | 359 | ||
| Women | 359 | ||
| Urine dipstick testing | 359 | ||
| Proteinuria | 359 | ||
| Haematuria | 360 | ||
| Glycosuria | 361 | ||
| Urine microscopy | 361 | ||
| White cells | 362 | ||
| Red cells | 362 | ||
| Casts | 362 | ||
| Bacteria | 363 | ||
| Imaging techniques | 363 | ||
| Plain X-ray | 363 | ||
| Ultrasonography | 363 | ||
| CT | 363 | ||
| Magnetic resonance imaging (MRI) | 363 | ||
| Excretion urography | 363 | ||
| Renal arteriography (angiography) | 363 | ||
| Anterograde pyelography | 364 | ||
| Retrograde pyelography | 364 | ||
| Renal scintigraphy | 364 | ||
| Transcutaneous renal biopsy | 364 | ||
| Glomerular diseases | 364 | ||
| Normal glomerular structure | 364 | ||
| Pathogenesis and terms in glomerular disease | 365 | ||
| Classification and presentation of glomerulopathies | 366 | ||
| Nephrotic syndrome | 367 | ||
| Aetiology | 367 | ||
| Nephrotic syndrome with 'bland' urine sediments | 367 | ||
| Nephrotic syndrome with 'active' urine sediments (mixed nephrotic/nephritic) | 368 | ||
| Clinical features | 368 | ||
| Differential diagnoses | 369 | ||
| Investigations | 369 | ||
| Management | 369 | ||
| General oedema | 369 | ||
| Specific treatment | 369 | ||
| Complications | 370 | ||
| Acute glomerulonephritis (acute nephritic syndrome) | 371 | ||
| Clinical features | 371 | ||
| Investigations | 372 | ||
| Management | 372 | ||
| Rapidly progressive glomerulonephritis | 372 | ||
| Urinary tract infection | 372 | ||
| Pathogenesis | 372 | ||
| Risk factors for UTI | 373 | ||
| Clinical features | 373 | ||
| Natural history | 374 | ||
| Uncomplicated versus complicated infection | 374 | ||
| Acute pyelonephritis | 374 | ||
| Reflux nephropathy | 374 | ||
| Recurrent UTI | 374 | ||
| Investigations | 374 | ||
| Diagnosis | 374 | ||
| Management | 375 | ||
| Treatment of single isolated attack | 375 | ||
| Recurrent infection | 376 | ||
| UTI in pregnancy | 376 | ||
| Abacteriuric frequency or dysuria ('urethral syndrome') | 376 | ||
| Bacterial prostatitis | 376 | ||
| Tuberculosis of the urinary tract | 377 | ||
| Tubulointerstitial nephritis | 377 | ||
| Acute tubulointerstitial nephritis | 377 | ||
| Chronic tubulointerstitial nephritis | 377 | ||
| Hypertension and the kidney | 378 | ||
| Essential hypertension | 378 | ||
| Renal hypertension | 378 | ||
| Bilateral renal disease | 378 | ||
| Renovascular disease | 378 | ||
| Options for renal artery imaging | 380 | ||
| Management | 380 | ||
| Renal calculi and nephrocalcinosis | 380 | ||
| Aetiology | 380 | ||
| Calcium stones | 380 | ||
| Hypercalciuria | 380 | ||
| Hyperoxaluria | 381 | ||
| Uric acid stones | 381 | ||
| Infection-induced stones | 381 | ||
| Cystine stones | 381 | ||
| Clinical features | 381 | ||
| Differential diagnosis | 382 | ||
| Investigations | 382 | ||
| Management | 382 | ||
| Initial treatment | 382 | ||
| Prevention of recurrence | 383 | ||
| Nephrocalcinosis | 384 | ||
| Urinary tract obstruction | 384 | ||
| Aetiology | 384 | ||
| Clinical features | 384 | ||
| Investigations | 385 | ||
| Management | 386 | ||
| Acute kidney injury | 386 | ||
| Epidemiology | 387 | ||
| Approaching AKI | 388 | ||
| 1. Prerenal AKI | 388 | ||
| 2. Postrenal AKI | 389 | ||
| 3. Renal parenchymal AKI | 389 | ||
| Clinical and biochemical features | 390 | ||
| Investigation of the uraemic emergency | 390 | ||
| Investigations | 391 | ||
| Management | 391 | ||
| Prognosis | 392 | ||
| Chronic kidney disease | 393 | ||
| Aetiology | 393 | ||
| Clinical features and investigations | 394 | ||
| Anaemia | 394 | ||
| Bone disease | 394 | ||
| Neurological complications | 395 | ||
| Cardiovascular disease | 396 | ||
| Other complications | 396 | ||
| Differentiating AKI from CKD | 397 | ||
| Management | 397 | ||
| Renoprotection | 397 | ||
| Reduce cardiovascular risk | 397 | ||
| Correction of complications | 397 | ||
| Hyperkalaemia | 397 | ||
| Calcium and phosphate | 397 | ||
| Anaemia | 398 | ||
| Acidosis | 398 | ||
| Infections | 398 | ||
| Referral to a nephrologist | 398 | ||
| Renal replacement therapy | 399 | ||
| Dialysis | 399 | ||
| Haemodialysis | 399 | ||
| Peritoneal dialysis | 399 | ||
| Haemofiltration | 400 | ||
| Complications of all long-term dialysis | 400 | ||
| Transplantation | 401 | ||
| Cystic renal disease | 401 | ||
| Solitary and multiple renal cysts | 401 | ||
| Autosomal-dominant polycystic kidney disease | 401 | ||
| Clinical features | 402 | ||
| Diagnosis | 402 | ||
| Management | 402 | ||
| Medullary sponge kidney | 402 | ||
| Tumours of the kidney and genitourinary tract | 403 | ||
| Renal cell carcinoma | 403 | ||
| Clinical features | 403 | ||
| Investigations | 403 | ||
| Management | 403 | ||
| Localized disease | 403 | ||
| Metastatic or locally advanced disease | 403 | ||
| Prognosis | 404 | ||
| Urothelial tumours | 404 | ||
| Clinical features | 404 | ||
| Investigations | 404 | ||
| Management | 404 | ||
| Diseases of the prostate gland | 404 | ||
| Benign enlargement of the prostate gland | 405 | ||
| Clinical features | 405 | ||
| Investigations | 405 | ||
| Management | 405 | ||
| Prostatic carcinoma | 405 | ||
| Chapter 10: Cardiovascular disease | 409 | ||
| Common presenting symptoms of heart disease | 409 | ||
| Chest pain | 409 | ||
| Dyspnoea | 409 | ||
| Palpitations | 409 | ||
| Syncope | 409 | ||
| Other symptoms | 411 | ||
| Investigations in cardiac disease | 411 | ||
| The chest X-ray | 411 | ||
| The electrocardiogram | 411 | ||
| ECG waveform and definitions (Fig. 10.5) | 412 | ||
| Heart rate | 412 | ||
| Exercise electrocardiography | 418 | ||
| 24-hour ambulatory taped electrocardiography | 418 | ||
| Tilt testing | 418 | ||
| Echocardiography | 419 | ||
| Cardiac nuclear imaging | 419 | ||
| Cardiac computed tomography | 421 | ||
| Cardiovascular magnetic resonance | 421 | ||
| Cardiac catheterization | 421 | ||
| Cardiac arrhythmias | 421 | ||
| General principles of management of arrhythmias | 422 | ||
| Sinus rhythms | 422 | ||
| Sinus arrhythmia | 422 | ||
| Bradycardia | 422 | ||
| Sinus bradycardia | 422 | ||
| Heart block | 423 | ||
| Atrioventricular block | 423 | ||
| First-degree AV block | 423 | ||
| Second-degree AV block | 423 | ||
| Third-degree AV block | 423 | ||
| Bundle branch block | 425 | ||
| Supraventricular tachycardias | 425 | ||
| Sinus tachycardia | 425 | ||
| Atrioventricular junctional tachycardias | 425 | ||
| Atrioventricular nodal re-entry tachycardia | 425 | ||
| Atrioventricular reciprocating tachycardia | 428 | ||
| Symptoms | 428 | ||
| Acute management | 428 | ||
| Long-term management | 429 | ||
| Atrial tachyarrhythmias | 429 | ||
| Atrial fibrillation | 430 | ||
| Management | 430 | ||
| Assessment for anticoagulation | 431 | ||
| Atrial flutter | 432 | ||
| Ventricular tachyarrhythmias | 432 | ||
| Ventricular ectopic premature beats (extrasystoles) | 432 | ||
| Sustained ventricular tachycardia | 432 | ||
| Non-sustained ventricular tachycardia | 433 | ||
| Ventricular fibrillation | 433 | ||
| Long QT syndrome | 433 | ||
| Cardiac arrest | 436 | ||
| Prognosis | 436 | ||
| Heart failure | 436 | ||
| Aetiology | 436 | ||
| Pathophysiology | 436 | ||
| Activation of the sympathetic nervous system | 437 | ||
| Renin–angiotensin system | 437 | ||
| Natriuretic peptides | 437 | ||
| Ventricular dilatation | 438 | ||
| Ventricular remodelling | 438 | ||
| Clinical features | 439 | ||
| Symptoms | 439 | ||
| Signs | 439 | ||
| Investigations | 440 | ||
| Treatment of chronic heart failure | 441 | ||
| Drug treatment | 441 | ||
| Vasodilator therapy | 441 | ||
| β-Blockers | 442 | ||
| Diuretics | 443 | ||
| Digoxin | 443 | ||
| Inotropes | 443 | ||
| Non-pharmacological treatment | 443 | ||
| Revascularization | 443 | ||
| Cardiac resynchronization therapy | 443 | ||
| Implantable cardioverter–defibrillator | 443 | ||
| Cardiac transplantation | 443 | ||
| Prognosis | 444 | ||
| Acute heart failure | 444 | ||
| Clinical features | 444 | ||
| Management | 444 | ||
| Ischaemic heart disease | 445 | ||
| Irreversible risk factors for coronary artery disease | 446 | ||
| Age | 446 | ||
| Gender | 446 | ||
| Family history | 446 | ||
| Potentially changeable risk factors | 446 | ||
| Hyperlipidaemia | 446 | ||
| Cigarette smoking | 446 | ||
| Hypertension | 446 | ||
| Metabolic factors | 446 | ||
| Diets | 446 | ||
| Other risk factors | 446 | ||
| Estimation of cardiovascular risk | 447 | ||
| Angina | 447 | ||
| Clinical features | 447 | ||
| Diagnosis | 447 | ||
| Investigations | 448 | ||
| Management | 448 | ||
| Secondary prevention | 448 | ||
| Symptomatic treatment | 448 | ||
| Percutaneous coronary intervention (PCI) | 449 | ||
| Coronary artery bypass grafting | 450 | ||
| Acute coronary syndromes | 450 | ||
| Clinical features | 450 | ||
| Treatment of NSTEMI and unstable angina | 451 | ||
| Risk stratification | 451 | ||
| ST segment elevation myocardial infarction (STEMI) | 453 | ||
| Clinical features | 453 | ||
| Investigations | 453 | ||
| The ECG | 454 | ||
| Cardiac markers | 455 | ||
| Other investigations | 455 | ||
| Management | 455 | ||
| Limitation of infarct size | 455 | ||
| Immediate primary angioplasty | 455 | ||
| Fibrinolytic agents | 455 | ||
| Subsequent management | 457 | ||
| Complications (Table 10.9) | 457 | ||
| Disturbances of rate, rhythm and conduction (p. 421) | 457 | ||
| Heart failure | 458 | ||
| Embolism | 458 | ||
| Pericarditis | 458 | ||
| Post-ACS drug therapy and assessment | 459 | ||
| Rheumatic fever | 459 | ||
| Epidemiology | 459 | ||
| Clinical features | 459 | ||
| Investigations | 460 | ||
| Blood count | 460 | ||
| Treatment | 460 | ||
| Chronic rheumatic heart disease | 460 | ||
| Valvular heart disease | 460 | ||
| Prosthetic heart valves | 460 | ||
| Mitral stenosis | 461 | ||
| Aetiology | 461 | ||
| Pathophysiology | 461 | ||
| Symptoms | 461 | ||
| Signs | 461 | ||
| Investigations | 462 | ||
| Chest X-ray | 462 | ||
| ECG | 462 | ||
| Echocardiography | 462 | ||
| Management | 462 | ||
| General | 462 | ||
| Specific | 462 | ||
| Mitral regurgitation | 462 | ||
| Aetiology | 462 | ||
| Pathophysiology | 463 | ||
| Symptoms | 463 | ||
| Signs | 463 | ||
| Investigations | 463 | ||
| Chapter 11: Respiratory disease | 505 | ||
| Basic structure of the respiratory system | 505 | ||
| Function of the respiratory system | 505 | ||
| Symptoms of respiratory disease | 506 | ||
| Cough | 506 | ||
| Sputum | 506 | ||
| Haemoptysis | 507 | ||
| Breathlessness | 507 | ||
| Wheezing | 507 | ||
| Chest pain (p. 409) | 508 | ||
| Investigation of respiratory disease | 508 | ||
| Sputum | 508 | ||
| Respiratory function tests | 508 | ||
| Peak expiratory flow rate | 508 | ||
| The spirometer | 509 | ||
| Arterial blood gas sampling | 509 | ||
| Walking distance | 509 | ||
| Imaging | 509 | ||
| Chest X-ray | 509 | ||
| Computed tomography (CT scan) | 509 | ||
| Magnetic resonance imaging (MRI) | 511 | ||
| Positron emission tomography (PET) | 511 | ||
| Scintigraphic imaging | 511 | ||
| Pleural aspiration and biopsy | 511 | ||
| Bronchoscopy | 512 | ||
| Mediastinoscopy | 512 | ||
| Video-assisted thoracoscopic (VATS) lung biopsy | 512 | ||
| Smoking | 512 | ||
| Diseases of the upper respiratory tract | 513 | ||
| The common cold (acute coryza) | 513 | ||
| Sinusitis (see p. 707) | 513 | ||
| Rhinitis | 513 | ||
| Seasonal rhinitis | 513 | ||
| Perennial rhinitis | 513 | ||
| Diagnosis | 513 | ||
| Management | 513 | ||
| Acute pharyngitis | 513 | ||
| Acute laryngotracheobronchitis (croup) | 514 | ||
| Influenza | 514 | ||
| Clinical features | 514 | ||
| Diagnosis | 514 | ||
| Management | 514 | ||
| Complications | 515 | ||
| Prophylaxis | 515 | ||
| Inhalation of foreign bodies | 515 | ||
| Diseases of the lower respiratory tract | 515 | ||
| Acute bronchitis | 515 | ||
| Chronic obstructive pulmonary disease (COPD) | 516 | ||
| Epidemiology and aetiology | 516 | ||
| Pathophysiology | 516 | ||
| Pathogenesis | 516 | ||
| Clinical features | 517 | ||
| Complications | 518 | ||
| Investigations | 518 | ||
| Management | 519 | ||
| Cessation of smoking | 520 | ||
| Bronchodilators | 520 | ||
| Phosphodiesterase type 4 inhibitors | 520 | ||
| Corticosteroids | 520 | ||
| Prevention of infection | 520 | ||
| Oxygen | 520 | ||
| Additional treatments | 520 | ||
| Acute exacerbation of COPD | 520 | ||
| Long term prognosis | 521 | ||
| Obstructive sleep apnoea (OSA) | 522 | ||
| Aetiology | 522 | ||
| Clinical features | 522 | ||
| Diagnosis | 522 | ||
| Management | 522 | ||
| Bronchiectasis | 523 | ||
| Aetiology | 523 | ||
| Clinical features | 523 | ||
| Investigations | 523 | ||
| Management | 523 | ||
| Complications | 524 | ||
| Cystic fibrosis | 524 | ||
| Clinical features | 525 | ||
| Investigations | 525 | ||
| Management | 525 | ||
| Prognosis | 526 | ||
| Asthma | 526 | ||
| Epidemiology | 526 | ||
| Classification | 526 | ||
| Aetiology | 527 | ||
| Pathogenesis | 527 | ||
| Inflammation | 527 | ||
| Remodelling | 527 | ||
| Precipitating factors | 528 | ||
| Clinical features | 528 | ||
| Investigations | 528 | ||
| Management | 529 | ||
| Avoidance of precipitating factors | 530 | ||
| Drug treatment | 530 | ||
| Acute severe asthma | 532 | ||
| Clinical features | 532 | ||
| Pneumonia | 532 | ||
| Clinical features | 534 | ||
| Investigations | 535 | ||
| Differential diagnosis | 536 | ||
| Management | 537 | ||
| Complications | 537 | ||
| Specific forms of pneumonia | 537 | ||
| Mycoplasma pneumoniae | 537 | ||
| Haemophilus influenzae | 537 | ||
| Chlamydia | 537 | ||
| Staphylococcus aureus | 539 | ||
| Legionella pneumophila | 539 | ||
| Pseudomonas aeruginosa | 539 | ||
| Pneumocystis jiroveci | 539 | ||
| Aspiration pneumonia | 539 | ||
| Complications of pneumonia: lung abscess and empyema | 539 | ||
| Clinical features | 540 | ||
| Investigations | 540 | ||
| Management | 540 | ||
| Tuberculosis | 540 | ||
| Epidemiology | 540 | ||
| Pathology | 541 | ||
| Clinical features | 541 | ||
| Investigations | 543 | ||
| Management | 543 | ||
| Prevention and chemoprophylaxis | 545 | ||
| Diffuse diseases of the lung parenchyma | 545 | ||
| Granulomatous lung disease | 546 | ||
| Sarcoidosis | 546 | ||
| Epidemiology | 546 | ||
| Immunopathology | 546 | ||
| Clinical features | 547 | ||
| Investigations | 548 | ||
| Differential diagnosis | 548 | ||
| Management | 548 | ||
| Prognosis | 549 | ||
| Granulomatous lung disease with vasculitis | 549 | ||
| Idiopathic interstitial pneumonias | 549 | ||
| Idiopathic pulmonary fibrosis (IPF) | 549 | ||
| Clinical features | 549 | ||
| Investigations | 550 | ||
| Differential diagnosis | 550 | ||
| Treatment | 550 | ||
| Prognosis | 550 | ||
| Hypersensensitivity pneumonitis | 550 | ||
| Clinical features | 551 | ||
| Investigations | 551 | ||
| Management | 552 | ||
| Other types of diffuse lung disease | 552 | ||
| Occupational lung disease | 552 | ||
| Coal worker's pneumoconiosis | 552 | ||
| Asbestosis | 553 | ||
| Carcinoma of the lung | 554 | ||
| Epidemiology | 554 | ||
| Aetiology | 554 | ||
| Pathology | 554 | ||
| Clinical features | 554 | ||
| Local effects of tumour within a bronchus | 554 | ||
| Spread within the chest | 554 | ||
| Metastatic disease | 554 | ||
| Non-metastatic manifestations | 555 | ||
| Investigations | 555 | ||
| Confirm the diagnosis | 555 | ||
| Determine the histology | 556 | ||
| Assess spread of the tumour | 556 | ||
| Determine patient suitability for major operation | 557 | ||
| Treatment | 557 | ||
| Non-small cell lung cancer | 557 | ||
| Small cell lung cancer | 557 | ||
| Symptomatic treatments | 557 | ||
| Differential diagnosis | 557 | ||
| Metastatic tumours in the lung | 557 | ||
| Diseases of the chest wall and pleura | 558 | ||
| Rib fractures | 558 | ||
| Kyphosis and scoliosis of the spine | 558 | ||
| Pleurisy | 558 | ||
| Pleural effusion | 558 | ||
| Aetiology | 558 | ||
| Investigations | 560 | ||
| Diagnostic pleural fluid aspiration | 560 | ||
| Contrast-enhanced thoracic CT scan | 560 | ||
| Pleural biopsy | 561 | ||
| Chapter 12: Intensive care medicine | 571 | ||
| ICUs | 571 | ||
| High-dependency units | 571 | ||
| Patient selection - withholding and withdrawing treatment | 571 | ||
| Critical care outreach and early warning systems | 572 | ||
| Acute disturbances of haemodynamic function (shock) | 572 | ||
| Pathophysiology | 572 | ||
| The sympathoadrenal response to shock | 572 | ||
| Neuroendocrine response | 574 | ||
| Release of mediators | 574 | ||
| Microcirculatory changes | 575 | ||
| Activation of the coagulation system | 575 | ||
| Progressive organ failure | 575 | ||
| Clinical features | 576 | ||
| Hypovolaemic shock | 577 | ||
| Cardiogenic shock | 577 | ||
| Mechanical shock | 577 | ||
| Anaphylactic shock | 577 | ||
| Sepsis | 577 | ||
| Management | 577 | ||
| Expansion of the circulating volume (preload) | 577 | ||
| Myocardial contractility and inotropic agents | 579 | ||
| Additional treatment | 579 | ||
| Specific treatment of the cause | 581 | ||
| Monitoring | 581 | ||
| Clinical | 581 | ||
| Invasive | 581 | ||
| Respiratory failure | 582 | ||
| Monitoring | 582 | ||
| Clinical | 582 | ||
| Pulse oximetry | 582 | ||
| Forced vital capacity (FVC) | 583 | ||
| Arterial blood gas analysis | 583 | ||
| Capnography | 584 | ||
| Management | 584 | ||
| Respiratory support | 584 | ||
| Acute respiratory distress syndrome (ARDS) | 586 | ||
| Definition and causes | 586 | ||
| Pathophysiology | 586 | ||
| Clinical features | 587 | ||
| Management | 587 | ||
| Prognosis | 587 | ||
| Chapter 13: Clinical pharmacology and toxicology | 589 | ||
| Drug prescribing | 589 | ||
| Concordance with medication | 589 | ||
| Adverse drug reactions | 589 | ||
| Writing a prescription | 590 | ||
| Best practice for drug prescribing | 590 | ||
| Specific drugs | 591 | ||
| Drug poisoning | 591 | ||
| The general approach to the poisoned patient | 592 | ||
| History | 592 | ||
| Investigations | 592 | ||
| Management | 592 | ||
| Emergency resuscitation (ABCDE, p. 742) | 592 | ||
| Prevention of further drug absorption | 594 | ||
| Increasing drug elimination | 594 | ||
| Antagonizing the effects of specific poisons | 595 | ||
| Psychiatric assessment | 595 | ||
| Specific drug problems | 595 | ||
| Aspirin | 595 | ||
| Clinical features | 595 | ||
| Investigations | 595 | ||
| Chapter 14: Endocrine disease | 607 | ||
| Common presenting symptoms in endocrine disease | 607 | ||
| The hypothalamus and pituitary | 609 | ||
| Control and feedback | 609 | ||
| Pituitary space-occupying lesions and tumours | 611 | ||
| Underproduction | 611 | ||
| Overproduction | 611 | ||
| Local effects | 612 | ||
| Investigation | 612 | ||
| Hypopituitarism | 613 | ||
| Aetiology | 613 | ||
| Clinical features | 613 | ||
| Investigation | 614 | ||
| Management | 615 | ||
| Pituitary hypersecretion syndromes | 615 | ||
| Hyperprolactinaemia | 615 | ||
| Aetiology | 616 | ||
| Clinical features | 616 | ||
| Investigations | 616 | ||
| Management | 616 | ||
| Acromegaly and gigantism | 617 | ||
| Clinical features | 617 | ||
| Investigations | 617 | ||
| Management | 618 | ||
| Transsphenoidal surgical resection | 618 | ||
| Medical therapy | 618 | ||
| External radiotherapy | 619 | ||
| Cushing's disease | 619 | ||
| Hypersecretion of other hormones | 619 | ||
| The thyroid axis | 619 | ||
| Assessment of thyroid function tests | 620 | ||
| Hypothyroidism | 620 | ||
| Aetiology | 620 | ||
| Autoimmune thyroiditis | 621 | ||
| Post-partum thyroiditis | 621 | ||
| Iatrogenic | 621 | ||
| Drug induced | 621 | ||
| Iodine deficiency | 621 | ||
| Congenital hypothyroidism | 621 | ||
| Clinical features | 621 | ||
| Investigations | 621 | ||
| Management | 621 | ||
| Borderline or subclinical hypothyroidism (compensated euthyroidism) | 622 | ||
| Myxoedema coma | 623 | ||
| Myxoedema madness | 623 | ||
| Hyperthyroidism | 624 | ||
| Graves' disease | 624 | ||
| Toxic multinodular goitre | 624 | ||
| Solitary toxic nodule/adenoma | 624 | ||
| de Quervain's thyroiditis | 624 | ||
| Post-partum thyroiditis | 624 | ||
| Clinical features | 624 | ||
| Investigations | 624 | ||
| Management | 626 | ||
| Antithyroid drugs | 626 | ||
| Radioactive iodine | 626 | ||
| Surgery | 626 | ||
| Thyroid crisis or `thyroid storm | 626 | ||
| Graves' orbitopathy (ophthalmopathy) | 627 | ||
| Aetiology | 627 | ||
| Clinical features | 627 | ||
| Investigations | 627 | ||
| Management | 627 | ||
| Goitre (thyroid enlargement) | 628 | ||
| Clinical features | 628 | ||
| Investigations | 628 | ||
| Management | 629 | ||
| Thyroid malignancy | 630 | ||
| Male reproduction and sex | 630 | ||
| Male hypogonadism | 631 | ||
| Klinefelters syndrome | 631 | ||
| Congenital deficiency of gonadotrophin-releasing hormone | 632 | ||
| Investigations | 632 | ||
| Management | 632 | ||
| Loss of libido and erectile dysfunction | 632 | ||
| Gynaecomastia | 633 | ||
| Female reproduction and sex | 634 | ||
| The menopause | 634 | ||
| Female hypogonadism and amenorrhoea | 635 | ||
| Aetiology | 635 | ||
| Investigations | 636 | ||
| Management | 636 | ||
| Hirsutism and polycystic ovary syndrome | 636 | ||
| Clinical features | 637 | ||
| Criteria for diagnosis | 637 | ||
| Investigations and differential diagnosis | 637 | ||
| Management | 637 | ||
| Local therapy for hirsutism | 637 | ||
| Systemic therapy for hirsutism | 637 | ||
| Treatment of menstrual disturbance | 638 | ||
| Treatment for infertility | 638 | ||
| The glucocorticoid axis | 638 | ||
| Synthetic steroids | 638 | ||
| Addison's disease: primary hypoadrenalism | 638 | ||
| Aetiology | 638 | ||
| Clinical features | 639 | ||
| Investigations | 639 | ||
| Management | 640 | ||
| Uses and problems of therapeutic steroid therapy | 641 | ||
| Secondary hypoadrenalism | 641 | ||
| Cushings syndrome | 642 | ||
| Clinical features | 643 | ||
| Investigations | 643 | ||
| Confirm raised cortisol | 643 | ||
| Establishing the cause of Cushing's syndrome | 644 | ||
| Management | 645 | ||
| Incidental adrenal tumours | 645 | ||
| Endocrinology of blood pressure control | 645 | ||
| The renin–angiotensin system | 646 | ||
| Aldosterone | 646 | ||
| Primary hyperaldosteronism | 646 | ||
| Clinical features | 646 | ||
| Chapter 15: Diabetes mellitus and other disorders of metabolism | 667 | ||
| Diabetes mellitus | 667 | ||
| Glucose metabolism | 667 | ||
| Classification of diabetes | 667 | ||
| Aetiology and pathogenesis | 668 | ||
| Type 1 diabetes mellitus | 668 | ||
| Type 2 diabetes mellitus | 668 | ||
| Clinical features | 669 | ||
| Investigations | 669 | ||
| Impaired glucose tolerance | 670 | ||
| Management | 670 | ||
| Principles of treatment | 671 | ||
| Diet | 671 | ||
| Tablet treatments for type 2 diabetes | 672 | ||
| Insulin treatment | 674 | ||
| Complications of insulin therapy | 675 | ||
| Hypoglycaemia | 675 | ||
| Whole pancreas and pancreatic islet transplantation | 676 | ||
| Measuring the metabolic control of diabetes | 676 | ||
| Home testing | 676 | ||
| Hospital (clinic) testing | 676 | ||
| Diabetic metabolic emergencies | 677 | ||
| Diabetic ketoacidosis | 677 | ||
| Pathogenesis | 677 | ||
| Clinical features | 677 | ||
| Investigations | 678 | ||
| Management | 678 | ||
| Hyperosmolar hyperglycaemic state | 680 | ||
| Clinical features | 680 | ||
| Management | 680 | ||
| Prognosis | 681 | ||
| Lactic acidosis | 681 | ||
| Complications of diabetes | 681 | ||
| Vascular | 681 | ||
| Macrovascular complications | 681 | ||
| Microvascular complications | 681 | ||
| Diabetic eye disease | 682 | ||
| Retinopathy | 682 | ||
| The diabetic kidney | 682 | ||
| Diabetic nephropathies | 683 | ||
| Ischaemic lesions | 684 | ||
| Infective lesions | 684 | ||
| Diabetic neuropathy | 684 | ||
| Symmetrical mainly sensory neuropathy | 685 | ||
| Acute painful neuropathy | 685 | ||
| Mononeuritis and mononeuritis multiplex (multiple mononeuropathy) | 685 | ||
| Diabetic amyotrophy | 686 | ||
| Autonomic neuropathy | 686 | ||
| The diabetic foot | 686 | ||
| Infections | 686 | ||
| The skin | 687 | ||
| Special situations | 687 | ||
| Surgery | 687 | ||
| Major surgery (i.e. having a general anaesthetic) | 687 | ||
| Minor surgery (e.g. endoscopy) | 688 | ||
| Insulin-treated patients | 688 | ||
| Tablet-controlled diabetes | 688 | ||
| Pregnancy and diabetes | 688 | ||
| Acutely ill hospital inpatients | 688 | ||
| Unstable diabetes | 689 | ||
| Hypoglycaemia in the non-diabetic | 689 | ||
| Insulinomas | 689 | ||
| Clinical features | 689 | ||
| Investigations | 689 | ||
| Treatment | 691 | ||
| Disorders of lipid metabolism | 691 | ||
| Measurement of plasma lipids | 692 | ||
| The primary hyperlipidaemias | 693 | ||
| Disorders of VLDL and chylomicrons - hypertriglyceridaemia alone | 693 | ||
| Disorders of LDL - hypercholesterolaemia alone | 693 | ||
| Combined hyperlipidaemia (hypercholesterolaemia and hyperlipidaemia) | 693 | ||
| Management of hyperlipidaemia | 694 | ||
| Guidelines to therapy | 694 | ||
| Lipid-lowering diet | 694 | ||
| Lipid-lowering drugs (Table15.12) | 694 | ||
| Whom to treat | 695 | ||
| Primary prevention for people at risk of cardiovascular disease | 695 | ||
| Secondary prevention | 695 | ||
| Aims of treatment | 695 | ||
| The porphyrias | 696 | ||
| Acute intermittent porphyria | 697 | ||
| Clinical features | 697 | ||
| Investigations | 697 | ||
| Management | 697 | ||
| Other porphyrias | 697 | ||
| Amyloidosis | 698 | ||
| Therapeutics | 698 | ||
| Oral antidiabetic drugs | 698 | ||
| Metformin | 698 | ||
| Mechanism of action | 698 | ||
| Chapter 16: The special senses | 703 | ||
| The ear | 703 | ||
| Hearing loss | 703 | ||
| Vertigo | 703 | ||
| Benign paroxysmal positional vertigo | 704 | ||
| Vestibular neuronitis | 704 | ||
| Ménières disease | 705 | ||
| Central causes | 705 | ||
| Ear infections | 705 | ||
| The nose and nasal cavity | 706 | ||
| Epistaxis (nose bleeds) | 706 | ||
| Sinusitis | 707 | ||
| The throat | 707 | ||
| Hoarseness (dysphonia) | 707 | ||
| Stridor | 707 | ||
| Sore throat | 708 | ||
| The eye | 708 | ||
| The red eye | 708 | ||
| Visual loss | 709 | ||
| Chapter 17: Neurology | 717 | ||
| Common neurological symptoms | 717 | ||
| Headache | 717 | ||
| Difficulty walking | 717 | ||
| Spasticity and hemiparesis | 717 | ||
| Parkinson's disease: shuffling gait | 718 | ||
| Cerebellar ataxia: broad-based gait | 718 | ||
| Sensory ataxia: stamping gait | 718 | ||
| Lower limb weakness: high-stepping and waddling gaits | 719 | ||
| Gait apraxia | 719 | ||
| Dizziness, faints and 'funny turns' | 719 | ||
| Dizziness and syncope | 719 | ||
| Investigation | 721 | ||
| Weakness | 721 | ||
| The corticospinal (or pyramidal) tracts | 721 | ||
| The upper motor neurone | 721 | ||
| The lower motor neurone | 723 | ||
| Numbness | 724 | ||
| The sensory system | 724 | ||
| Peripheral nerve lesions | 724 | ||
| Spinal root lesions | 724 | ||
| Spinal cord lesions | 724 | ||
| Pontine lesions | 724 | ||
| Thalamic lesions | 727 | ||
| Cortical lesions | 727 | ||
| Tremor | 727 | ||
| Coordination of movement | 727 | ||
| The cerebellum | 727 | ||
| The cranial nerves | 728 | ||
| The olfactory nerve (first cranial nerve) | 728 | ||
| The optic nerve (second cranial nerve) and the visual system | 728 | ||
| Visual field defects | 729 | ||
| Optic nerve lesions | 729 | ||
| Defects of the optic chiasm | 731 | ||
| Defects of the optic tract and radiation | 731 | ||
| Defects of the occipital cortex | 732 | ||
| Optic disc oedema (papilloedema) and optic atrophy | 732 | ||
| Papilloedema | 732 | ||
| Optic atrophy | 732 | ||
| The pupils | 732 | ||
| Cranial nerves III-XII | 733 | ||
| The ocular movements and the third, fourth and sixth cranial nerves | 733 | ||
| The trigeminal nerve (fifth cranial nerve) | 735 | ||
| Trigeminal neuralgia | 736 | ||
| Clinical features | 736 | ||
| Management | 736 | ||
| Differential diagnosis | 736 | ||
| The facial nerve (seventh cranial nerve) | 736 | ||
| Lower motor neurone lesions | 737 | ||
| Bell's palsy | 737 | ||
| Clinical features | 737 | ||
| Investigations | 737 | ||
| Management | 737 | ||
| Prognosis | 737 | ||
| Ramsay Hunt syndrome | 737 | ||
| Upper motor neurone lesions | 738 | ||
| The vestibulocochlear nerve (eighth cranial nerve) | 738 | ||
| Vertigo | 738 | ||
| Nystagmus | 738 | ||
| Pendular nystagmus | 738 | ||
| Jerk nystagmus | 738 | ||
| Glossopharyngeal, vagus, accessory and hypoglossal nerves (ninth to twelfth cranial nerves) | 739 | ||
| Common investigations in neurological disease | 739 | ||
| Blood tests | 739 | ||
| Imaging | 739 | ||
| Skull and spinal X-rays | 739 | ||
| Computed tomography | 739 | ||
| Magnetic resonance imaging | 739 | ||
| Positron emission tomography | 740 | ||
| Doppler studies | 740 | ||
| Electroencephalography | 740 | ||
| Lumbar puncture and cerebrospinal fluid examination | 740 | ||
| Electromyography | 740 | ||
| Investigation of suspected muscle disease | 740 | ||
| Unconsciousness and coma | 741 | ||
| Aetiology | 742 | ||
| Assessment | 742 | ||
| Immediate assessment | 742 | ||
| Further assessment | 742 | ||
| Investigations | 744 | ||
| Blood and urine tests | 744 | ||
| Radiology | 744 | ||
| CSF examination | 744 | ||
| Management | 744 | ||
| Prognosis | 745 | ||
| Brain death | 745 | ||
| Stroke and cerebrovascular disease | 745 | ||
| Definitions | 745 | ||
| Stroke | 745 | ||
| Stroke in evolution | 746 | ||
| A minor stroke | 746 | ||
| Transient ischaemic attack | 746 | ||
| Pathophysiology | 746 | ||
| Completed stroke | 746 | ||
| Transient ischaemic attacks | 746 | ||
| Risk factors | 746 | ||
| Transient ischaemic attacks | 747 | ||
| Investigations | 747 | ||
| Blood | 747 | ||
| Brain imaging | 747 | ||
| Carotid artery imaging | 748 | ||
| Other investigations | 748 | ||
| Treatment | 748 | ||
| Antithrombotic treatment | 748 | ||
| Other secondary prevention | 748 | ||
| Carotid endarterectomy | 748 | ||
| Cerebral infarction | 749 | ||
| Clinical features | 749 | ||
| Cerebral hemisphere infarcts | 749 | ||
| Brainstem infarction | 749 | ||
| Multi-infarct dementia | 749 | ||
| Management | 750 | ||
| Prognosis | 752 | ||
| Primary intracranial haemorrhage | 753 | ||
| Intracerebral haemorrhage | 753 | ||
| Subarachnoid haemorrhage | 753 | ||
| Incidence | 753 | ||
| Aetiology | 753 | ||
| Clinical features | 754 | ||
| Investigation | 754 | ||
| Management | 755 | ||
| Prognosis | 755 | ||
| Subdural haematoma | 755 | ||
| Extradural haemorrhage | 756 | ||
| Epilepsy and loss of consciousness | 756 | ||
| Epilepsy | 756 | ||
| Classification | 756 | ||
| Aetiology and precipitants | 757 | ||
| Evaluation and investigation | 758 | ||
| Management | 758 | ||
| Emergency measures | 758 | ||
| Status epilepticus | 758 | ||
| Antiepileptic drugs | 759 | ||
| Drug withdrawal | 760 | ||
| Neurosurgical treatment | 761 | ||
| Advice to patients | 761 | ||
| Movement disorders | 761 | ||
| Akinetic-rigid syndromes | 762 | ||
| Idiopathic Parkinsons disease | 762 | ||
| Aetiology | 762 | ||
| Clinical features | 762 | ||
| Investigations | 763 | ||
| Management | 763 | ||
| Levodopa | 763 | ||
| Dopamine agonists | 763 | ||
| Monoamine oxidase B inhibitors | 763 | ||
| Additional treatment | 764 | ||
| Other akinetic-rigid syndromes | 764 | ||
| Drug-induced parkinsonism | 764 | ||
| 'Parkinsonism plus' | 764 | ||
| Dyskinesias | 764 | ||
| Benign essential tremor | 764 | ||
| Chorea | 765 | ||
| Huntington's disease | 765 | ||
| Hemiballismus | 765 | ||
| Myoclonus | 765 | ||
| Tics | 766 | ||
| Dystonias | 766 | ||
| Multiple sclerosis | 766 | ||
| Epidemiology | 766 | ||
| Aetiology | 766 | ||
| Pathology | 767 | ||
| Clinical features | 767 | ||
| Optic neuropathy | 767 | ||
| Brainstem demyelination | 767 | ||
| Spinal cord lesions | 767 | ||
| Differential diagnosis | 768 | ||
| Investigations | 768 | ||
| Management | 768 | ||
| Nervous system infection and inflammation | 769 | ||
| Meningitis | 769 | ||
| Clinical features | 769 | ||
| Acute bacterial meningitis | 769 | ||
| Viral meningitis | 769 | ||
| Chronic meningitis | 769 | ||
| Differential diagnosis | 769 | ||
| Management | 770 | ||
| Notification | 770 | ||
| Meningococcal prophylaxis | 770 | ||
| Encephalitis | 771 | ||
| Acute viral encephalitis | 772 | ||
| Clinical features | 772 | ||
| Investigations | 772 | ||
| Treatment | 773 | ||
| Brain and spinal abscesses | 773 | ||
| Cerebral abscess | 773 | ||
| Clinical features | 773 | ||
| Investigations | 773 | ||
| Management | 773 | ||
| Spinal epidural abscess | 773 | ||
| Neurosyphilis | 773 | ||
| Management | 774 | ||
| Transmissible spongiform encephalopathy (Creutzfeldt-Jakob disease) | 774 | ||
| HIV and neurology | 775 | ||
| CNS and peripheral nerve disease in HIV | 775 | ||
| HIV seroconversion | 775 | ||
| Chronic meningitis | 775 | ||
| AIDS-dementia complex | 775 | ||
| Encephalitis and brain abscess | 775 | ||
| CNS lymphoma | 775 | ||
| Progressive multifocal leucoencephalopathy | 775 | ||
| Spinal vacuolar myelopathy | 775 | ||
| Peripheral nerve disease | 775 | ||
| Brain tumours | 775 | ||
| Clinical features | 775 | ||
| Neurological deficit | 776 | ||
| Raised intracranial pressure | 776 | ||
| Epilepsy | 776 | ||
| Differential diagnosis | 777 | ||
| Investigations | 777 | ||
| Management | 777 | ||
| Hydrocephalus | 777 | ||
| Aetiology | 778 | ||
| Clinical features | 778 | ||
| Management | 778 | ||
| Headache, migraine and facial pain | 778 | ||
| Tension headache | 779 | ||
| Migraine | 779 | ||
| Pathogenesis | 779 | ||
| Clinical features | 779 | ||
| Differential diagnosis | 780 | ||
| Management | 780 | ||
| General measures | 780 | ||
| Treatment of the acute attack | 780 | ||
| Prophylaxis | 780 | ||
| Facial pain | 781 | ||
| Trigeminal autonomic cephalgias | 781 | ||
| Cluster headaches (migrainous neuralgia) | 781 | ||
| Giant cell arteritis (cranial or temporal arteritis) | 781 | ||
| Clinical features | 781 | ||
| Investigations | 782 | ||
| Management | 782 | ||
| Spinal cord disease | 782 | ||
| Spinal cord compression | 782 | ||
| Clinical features | 782 | ||
| Aetiology | 784 | ||
| Investigations | 784 | ||
| Management | 784 | ||
| Differential diagnosis | 784 | ||
| Cauda equina lesion | 785 | ||
| Syringomyelia and syringobulbia | 785 | ||
| Aetiology | 785 | ||
| Clinical features | 785 | ||
| Investigation | 785 | ||
| Treatment | 785 | ||
| Friedreich's ataxia | 786 | ||
| Management of the paraplegic patient | 787 | ||
| Degenerative neuronal diseases | 787 | ||
| Motor neurone disease | 787 | ||
| Clinical features | 787 | ||
| Investigations | 788 | ||
| Differential diagnosis | 788 | ||
| Management | 788 | ||
| Spinal muscular atrophies | 788 | ||
| Dementia | 788 | ||
| Alzheimer's disease | 788 | ||
| Clinical features | 789 | ||
| Investigations | 789 | ||
| Management | 790 | ||
| Prognosis | 790 | ||
| Vascular (multi-infarct) dementia | 791 | ||
| Dementia with Lewy bodies | 791 | ||
| Diseases of the peripheral nerves | 791 | ||
| Mononeuropathies | 791 | ||
| Carpal tunnel syndrome | 791 | ||
| Aetiology | 791 | ||
| Clinical features | 792 | ||
| Management | 792 | ||
| Mononeuritis multiplex | 792 | ||
| Polyneuropathy | 792 | ||
| Guillain-Barré syndrome | 793 | ||
| Pathogenesis | 793 | ||
| Clinical features | 793 | ||
| Investigations | 794 | ||
| Differential diagnosis | 794 | ||
| Management | 794 | ||
| Vitamin deficiency neuropathies | 795 | ||
| Thiamin (vitamin B1) | 795 | ||
| Pyridoxine (vitamin B6) | 795 | ||
| Vitamin B12 | 795 | ||
| Hereditary sensorimotor neuropathy | 795 | ||
| Muscle diseases | 795 | ||
| Acquired muscle disease | 796 | ||
| Myasthenia gravis | 796 | ||
| Aetiology | 797 | ||
| Clinical features | 797 | ||
| Investigations | 797 | ||
| Differential diagnosis | 797 | ||
| Management | 798 | ||
| Anticholinesterases | 798 | ||
| Immunosuppressant drugs | 798 | ||
| Plasmapheresis and intravenous immunoglobulin | 798 | ||
| Thymectomy | 798 | ||
| Muscular dystrophies | 798 | ||
| Myotonias | 798 | ||
| Dystrophia myotonica | 799 | ||
| Myotonia congenita | 799 | ||
| Delirium | 799 | ||
| Delirium (toxic confusional state) | 799 | ||
| Management | 799 | ||
| Therapeutics | 800 | ||
| Hypnotics | 800 | ||
| Mechanism of action | 800 | ||
| Chapter 18: Dermatology | 807 | ||
| Introduction | 807 | ||
| Skin and soft tissue infections | 807 | ||
| Cellulitis and erysipelas | 807 | ||
| Clinical features | 808 | ||
| Diagnosis | 808 | ||
| Treatment | 808 | ||
| Necrotizing fasciitis | 809 | ||
| Gas gangrene | 809 | ||
| Fungal infections | 809 | ||
| Candida albicans | 810 | ||
| Common skin conditions | 810 | ||
| Acne vulgaris | 810 | ||
| Clinical features | 810 | ||
| Management | 811 | ||
| First-line therapy | 811 | ||
| Second-line therapy | 811 | ||
| Third-line therapy | 811 | ||
| Psoriasis | 811 | ||
| Aetiology | 811 | ||
| Clinical features | 812 | ||
| Associated features | 812 | ||
| Management | 813 | ||
| Topical treatment | 813 | ||
| Phototherapy | 813 | ||
| Systemic therapy | 813 | ||
| Urticaria/angio-oedema | 813 | ||
| Aetiology | 813 | ||
| Management | 814 | ||
| Eczema | 814 | ||
| Atopic eczema | 814 | ||
| Aetiology | 814 | ||
| Clinical features | 814 | ||
| Management | 815 | ||
| Exogenous eczema (contact dermatitis) | 815 | ||
| Clinical features | 815 | ||
| Normal values | 823 | ||
| Dictionary of terms | 827 | ||
| Index | 837 |