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Book Details
Abstract
Preparation is the key to success!
Now in its eighth edition, Examination Medicine: a guide to physician training, has prepared generations of physician trainees and medical students for their clinical examinations.
Instructive, informative and aligned with current practice, this new edition gives you an overview of what to expect, what is expected of you and how to develop a mature clinical approach to complex medical problems.
Talley and O’Connor share their valuable advice on how to prepare for the examinations, use your time to best effect and avoid common pitfalls to ensure you give your best possible performance in your examinations and beyond.
- Video tutorials of long and short cases included on ExpertConsult
- Clinical photographs of signs and conditions
- 50 long cases including history, examination, investigations, treatment and possible lines of questioning
- Sample long cases from the examiner’s perspective including discussion points and clinical traps
- 30 short cases including guidance for ‘spot diagnosis’ and ‘common stems’
- Hint boxes highlighting common pitfalls and useful tips
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Examination Medicine | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Foreword by Professor Geoffrey Metz | ix | ||
| Foreword by Professor John Kolbe | xi | ||
| Preface to the 8th edition | xiii | ||
| Authors’ statement | xiv | ||
| Acknowledgements | xv | ||
| Reviewers | xvi | ||
| Abbreviations | xvii | ||
| 1 Basic physician training | 1 | ||
| Historical note | 2 | ||
| Basic training | 2 | ||
| Fees | 4 | ||
| The written examination | 4 | ||
| The clinical examination | 4 | ||
| The short case | 4 | ||
| The long case | 5 | ||
| Passing the exam | 5 | ||
| Rationale for the FRACP exam | 6 | ||
| Basic training units | 7 | ||
| 2 The written examination | 9 | ||
| The examination format | 9 | ||
| Paper 1 | 9 | ||
| Paper 2 | 9 | ||
| Extended matching questions | 9 | ||
| Organisation | 10 | ||
| Examples of extended matching questions | 10 | ||
| Exam timing and make-up | 12 | ||
| Marking | 13 | ||
| Approaching multiple-choice questions | 13 | ||
| Preparation for the written examination | 13 | ||
| Reading | 13 | ||
| Practising exam questions | 14 | ||
| Trial examinations | 14 | ||
| Exam courses | 14 | ||
| Listening | 15 | ||
| General advice | 15 | ||
| 3 The clinical examination | 16 | ||
| The examination format | 16 | ||
| On the exam day | 17 | ||
| The long case | 18 | ||
| The short case (Fig 3.1) | 18 | ||
| The marking system | 19 | ||
| The mini-CEX | 21 | ||
| Preparation for the clinical examination | 21 | ||
| 4 The long case | 27 | ||
| The history-taking and physical examination | 28 | ||
| The presentation | 31 | ||
| The long-case rationale | 33 | ||
| Long-case marking | 36 | ||
| Types of long case | 37 | ||
| 5 The cardiovascular long case | 39 | ||
| Ischaemic heart disease | 39 | ||
| The history | 40 | ||
| The examination | 42 | ||
| Management | 42 | ||
| Investigations | 43 | ||
| Long-term treatment | 43 | ||
| Secondary prevention | 43 | ||
| Revascularisation | 44 | ||
| The history | 44 | ||
| The examination | 44 | ||
| Management | 44 | ||
| Surgery | 44 | ||
| Angioplasty | 45 | ||
| Frequent trial | 46 | ||
| Infective endocarditis | 46 | ||
| The history | 47 | ||
| The examination | 47 | ||
| Investigations | 49 | ||
| Notes | 49 | ||
| Organisms | 49 | ||
| Causes of culture-negative endocarditis | 51 | ||
| Post-valve surgery endocarditis | 51 | ||
| Diagnosis | 51 | ||
| Major criteria | 51 | ||
| Minor criteria | 51 | ||
| Treatment | 52 | ||
| Factors suggesting a poorer prognosis | 52 | ||
| Differential diagnosis | 52 | ||
| Prognosis | 52 | ||
| Prophylaxis | 52 | ||
| Congestive cardiac failure | 53 | ||
| The history | 53 | ||
| The examination | 55 | ||
| Investigations | 55 | ||
| Treatment | 58 | ||
| Diastolic heart failure (heart failure with preserved ejection fraction) | 61 | ||
| Hyperlipidaemia | 61 | ||
| The history | 62 | ||
| The examination | 63 | ||
| Investigations | 65 | ||
| Management | 65 | ||
| Hypertension | 67 | ||
| The history | 67 | ||
| The examination | 68 | ||
| Investigations | 68 | ||
| Treatment | 69 | ||
| Blood pressure reduction without drugs | 70 | ||
| Drug treatment | 70 | ||
| Uncontrolled hypertension | 72 | ||
| Renal artery denervation | 72 | ||
| Heart transplantation | 72 | ||
| The history | 73 | ||
| The examination | 75 | ||
| Investigations | 75 | ||
| Management | 76 | ||
| Cardiac arrhythmias | 77 | ||
| The history | 77 | ||
| The examination | 82 | ||
| Investigations | 82 | ||
| Management | 83 | ||
| The particular management problems of atrial fibrillation | 87 | ||
| The problem of AF and renal failure | 90 | ||
| 6 The respiratory long case | 91 | ||
| Bronchiectasis | 91 | ||
| The history | 91 | ||
| The examination | 92 | ||
| Investigations | 93 | ||
| Treatment | 94 | ||
| Lung carcinoma | 95 | ||
| The history | 96 | ||
| The examination | 97 | ||
| Investigations | 97 | ||
| Treatment | 100 | ||
| Small cell carcinomas | 100 | ||
| Non-small cell carcinomas | 101 | ||
| Chronic obstructive pulmonary disease | 101 | ||
| The history | 102 | ||
| The examination | 103 | ||
| Investigations | 103 | ||
| Differential diagnosis | 105 | ||
| Treatment | 106 | ||
| Sleep apnoea | 108 | ||
| The history | 108 | ||
| The examination | 109 | ||
| Investigations | 110 | ||
| Treatment | 110 | ||
| Interstitial lung disease, including idiopathic pulmonary fibrosis | 111 | ||
| The history | 111 | ||
| The examination | 114 | ||
| Investigations | 114 | ||
| Treatment | 116 | ||
| Pulmonary hypertension | 118 | ||
| The history | 118 | ||
| The examination | 120 | ||
| Investigations | 120 | ||
| Treatment | 123 | ||
| Idiopathic (primary) pulmonary hypertension | 124 | ||
| Sarcoidosis | 124 | ||
| The history | 125 | ||
| The examination | 126 | ||
| Investigations | 127 | ||
| Treatment | 128 | ||
| Cystic fibrosis | 129 | ||
| The history | 129 | ||
| The examination | 131 | ||
| Investigations | 132 | ||
| Management | 133 | ||
| Tuberculosis | 133 | ||
| The history | 134 | ||
| The examination | 135 | ||
| Investigations | 135 | ||
| Treatment | 136 | ||
| Lung transplantation | 139 | ||
| The history | 139 | ||
| The examination | 141 | ||
| Management | 141 | ||
| 7 The gastrointestinal long case | 142 | ||
| Irritable bowel syndrome (IBS) | 142 | ||
| The history | 142 | ||
| The diagnosis | 143 | ||
| The examination | 143 | ||
| Investigations | 143 | ||
| Management | 143 | ||
| Peptic ulceration | 144 | ||
| The history | 144 | ||
| The examination | 145 | ||
| Investigations | 145 | ||
| Treatment | 146 | ||
| Malabsorption and chronic diarrhoea | 147 | ||
| The history | 147 | ||
| The examination | 148 | ||
| Investigations (Table 7.2) | 149 | ||
| Treatment | 151 | ||
| Management of coeliac disease | 151 | ||
| Inflammatory bowel disease | 152 | ||
| The history | 152 | ||
| The examination | 155 | ||
| Investigations | 155 | ||
| Treatment | 156 | ||
| Ulcerative colitis | 156 | ||
| Crohn’s disease | 157 | ||
| Colon cancer | 159 | ||
| The history | 159 | ||
| The examination | 161 | ||
| Investigations | 162 | ||
| Treatment | 163 | ||
| Chronic liver disease (CLD) | 163 | ||
| The history | 163 | ||
| The examination | 164 | ||
| Investigations | 167 | ||
| Treatment | 169 | ||
| Hepatocellular failure | 170 | ||
| 8 The haematological long case | 181 | ||
| Haemolytic anaemia | 181 | ||
| The history | 181 | ||
| The examination | 183 | ||
| Investigations | 183 | ||
| Treatment | 187 | ||
| Thrombophilia | 188 | ||
| The history | 188 | ||
| The examination | 190 | ||
| Investigations | 190 | ||
| Management | 192 | ||
| Polycythaemia | 193 | ||
| The history | 193 | ||
| The examination | 195 | ||
| Investigations | 196 | ||
| Treatment | 196 | ||
| Idiopathic myelofibrosis | 197 | ||
| The examination | 198 | ||
| Investigations | 198 | ||
| Treatment | 198 | ||
| Essential thrombocythaemia | 199 | ||
| Investigations | 199 | ||
| Treatment | 199 | ||
| Notes on haematological malignancies | 199 | ||
| Chronic myeloid leukaemia (CML) | 200 | ||
| Investigations | 200 | ||
| Treatment | 200 | ||
| Lymphomas | 201 | ||
| The history | 203 | ||
| The examination | 204 | ||
| Investigations | 204 | ||
| Treatment | 205 | ||
| Hodgkin lymphoma (85% of patients are curable) | 205 | ||
| Salvage treatment | 206 | ||
| Prognosis | 206 | ||
| Complications of treatment | 206 | ||
| Non-hodgkin lymphoma | 207 | ||
| Treatment protocols: WHO classification | 208 | ||
| Bone marrow transplant | 210 | ||
| Multiple myeloma (myeloma) | 210 | ||
| The history | 210 | ||
| The examination | 211 | ||
| Investigations | 211 | ||
| Treatment | 213 | ||
| Differential diagnosis | 215 | ||
| Monoclonal gammopathy of undetermined significance | 215 | ||
| Waldenström’s macroglobulinaemia | 215 | ||
| Localised myeloma | 216 | ||
| POEMS syndrome | 216 | ||
| Bone marrow (haematopoietic cell) transplantation | 216 | ||
| The history | 217 | ||
| The examination | 218 | ||
| Management | 218 | ||
| 9 The rheumatological long case | 221 | ||
| Notes on the rheumatology long case | 221 | ||
| Ask: | 221 | ||
| Examine: | 221 | ||
| Rheumatoid arthritis (RA) | 222 | ||
| The history | 223 | ||
| The examination (Table 9.2) | 226 | ||
| Differential diagnosis | 227 | ||
| Investigations | 227 | ||
| Treatment | 228 | ||
| The TNF inhibitors | 232 | ||
| The non-TNF inhibitors | 233 | ||
| Pregnancy and rheumatoid arthritis | 234 | ||
| Osteoarthritis | 235 | ||
| The history | 236 | ||
| The examination | 236 | ||
| Management | 236 | ||
| Non-pharmacological | 236 | ||
| Drug treatment | 236 | ||
| Surgery | 237 | ||
| Complementary medicines | 237 | ||
| Ankylosing spondylitis (spondyloarthritis, SPA) | 237 | ||
| The history | 238 | ||
| Diagnosis | 239 | ||
| The examination | 239 | ||
| Management | 239 | ||
| Systemic lupus erythematosus | 240 | ||
| The history | 240 | ||
| The examination (Table 9.14) | 242 | ||
| Investigations | 244 | ||
| Treatment | 246 | ||
| Systemic vasculitis | 248 | ||
| The history | 248 | ||
| The examination | 249 | ||
| Investigations | 250 | ||
| Treatment | 252 | ||
| Antiphospholipid antibody syndrome | 253 | ||
| The history | 253 | ||
| The examination | 254 | ||
| Investigations (see also pp. 190–2) | 254 | ||
| Treatment | 254 | ||
| Systemic sclerosis (scleroderma) | 255 | ||
| Definitions | 255 | ||
| The history | 255 | ||
| The examination (see Table 9.19) | 256 | ||
| Investigations | 258 | ||
| Treatment | 259 | ||
| 10 The endocrine long case | 261 | ||
| Osteoporosis (and osteomalacia) | 261 | ||
| The history | 261 | ||
| The examination | 263 | ||
| Investigations | 264 | ||
| Treatment | 266 | ||
| Antiresorptive therapy | 266 | ||
| Bone formation therapy | 267 | ||
| Hypercalcaemia | 268 | ||
| The history | 268 | ||
| The examination | 269 | ||
| Investigations | 269 | ||
| Treatment | 270 | ||
| Paget’s disease of the bone (osteitis deformans) | 271 | ||
| The history | 271 | ||
| The examination (Table 10.7) | 272 | ||
| Investigations | 274 | ||
| Treatment | 275 | ||
| Acromegaly | 276 | ||
| The history | 276 | ||
| The examination | 277 | ||
| Investigations | 277 | ||
| Treatment | 277 | ||
| Surgery | 279 | ||
| Medical treatment – patients not cured by surgery | 279 | ||
| Radiotherapy | 279 | ||
| Screen for complications | 279 | ||
| Types 1 and 2 diabetes mellitus | 280 | ||
| The history | 281 | ||
| The examination | 283 | ||
| Management | 283 | ||
| The newly diagnosed patient with diabetes | 283 | ||
| Insulin therapy | 287 | ||
| Diabetes education | 289 | ||
| Management of chronic complications | 289 | ||
| The pregnant patient with diabetes | 291 | ||
| 11 The renal long case | 292 | ||
| Chronic kidney disease (chronic renal failure) | 292 | ||
| Fast facts on the eGFR | 292 | ||
| The history | 293 | ||
| Questions regarding symptoms, diagnosis and aetiology | 293 | ||
| Questions regarding management (Table 11.7) | 298 | ||
| Questions regarding complications | 300 | ||
| The examination (see Table 11.10) | 303 | ||
| Investigations | 304 | ||
| Treatment | 306 | ||
| Dialysis | 308 | ||
| Anticoagulation | 309 | ||
| Renal transplantation | 309 | ||
| The history | 310 | ||
| The examination | 310 | ||
| Investigations | 311 | ||
| Management | 311 | ||
| 12 The neurological long case | 314 | ||
| Multiple sclerosis | 314 | ||
| The history | 315 | ||
| The examination | 316 | ||
| Investigations | 316 | ||
| Treatment | 319 | ||
| Relapses | 321 | ||
| Myasthenia gravis | 321 | ||
| The history | 321 | ||
| The examination | 322 | ||
| Investigations | 322 | ||
| Differential diagnosis | 323 | ||
| Treatment | 323 | ||
| Symptomatic | 324 | ||
| Disease-suppressing | 324 | ||
| Guillain–Barré syndrome | 325 | ||
| The history | 325 | ||
| The examination | 325 | ||
| Investigations | 325 | ||
| Differential diagnosis | 326 | ||
| Treatment | 326 | ||
| Syncope, seizures and ‘funny turns’ | 327 | ||
| The history | 327 | ||
| The examination | 330 | ||
| Investigations | 330 | ||
| Management | 331 | ||
| TIA and stroke | 332 | ||
| The history | 332 | ||
| The examination | 333 | ||
| Investigations | 333 | ||
| Treatment | 336 | ||
| 13 Other important long cases | 338 | ||
| Pyrexia of unknown origin | 338 | ||
| The history | 338 | ||
| The examination | 340 | ||
| Investigations | 341 | ||
| Treatment | 342 | ||
| HIV / AIDS | 342 | ||
| The history | 342 | ||
| The examination | 347 | ||
| Investigations | 347 | ||
| Baseline | 348 | ||
| Monitoring | 350 | ||
| Treatment | 350 | ||
| Falls and the risk of falls | 352 | ||
| The history | 352 | ||
| The examination | 353 | ||
| Investigations | 353 | ||
| Management | 353 | ||
| The obese patient | 354 | ||
| The history | 354 | ||
| The examination | 355 | ||
| Management | 355 | ||
| The preoperative assessment | 356 | ||
| The history | 356 | ||
| Management | 357 | ||
| Carcinoma of the breast | 359 | ||
| The history | 359 | ||
| The examination | 360 | ||
| Treatment | 360 | ||
| 14 Think like a physician, think like an examiner – an approach with long-case examples | 364 | ||
| Long-case videos | 379 | ||
| First case | 379 | ||
| Examiners’ problem list | 380 | ||
| Second case | 380 | ||
| Examiners’ problem list | 381 | ||
| Third case | 381 | ||
| Examiner’s problem list | 382 | ||
| 15 The short case | 383 | ||
| The stem | 383 | ||
| Timing | 384 | ||
| Marking | 384 | ||
| Hand washing | 384 | ||
| Starting off | 384 | ||
| Approach to the patient | 385 | ||
| Blood pressure | 385 | ||
| Performance | 385 | ||
| Presentation | 386 | ||
| Understanding the role of the examiners | 387 | ||
| Investigations | 388 | ||
| Short-case selection | 388 | ||
| Understanding the examiners’ thinking | 388 | ||
| 16 Common short cases | 389 | ||
| The cardiovascular system | 390 | ||
| The cardiovascular examination | 390 | ||
| Method (Table 16.1) | 390 | ||
| Notes | 400 | ||
| Notes on valve diseases | 400 | ||
| Mitral stenosis | 401 | ||
| Causes | 401 | ||
| Clinical signs of severity | 401 | ||
| Results of investigations | 401 | ||
| Echocardiograph (M mode, two-dimensional (2D) Doppler and colour flow mapping) | 402 | ||
| Indications for surgery | 402 | ||
| Mitral regurgitation | 402 | ||
| Causes – chronic | 402 | ||
| Causes – acute | 402 | ||
| Clinical signs of severity | 403 | ||
| Results of investigations | 403 | ||
| Indications for surgery | 403 | ||
| Mitral valve prolapse (systolic click–murmur syndrome) | 403 | ||
| Dynamic auscultation | 405 | ||
| Echocardiography | 405 | ||
| Associations | 405 | ||
| Complications (more common for men with mitral valve prolapse) | 405 | ||
| Aortic regurgitation | 405 | ||
| Causes of chronic aortic regurgitation | 405 | ||
| Valvular | 405 | ||
| Aortic root (murmur may be maximal at the right sternal border) | 405 | ||
| Causes of acute aortic regurgitation | 405 | ||
| Clinical signs of severity in chronic aortic regurgitation | 405 | ||
| Results of investigations | 406 | ||
| Index | 553 | ||
| A | 553 | ||
| B | 555 | ||
| C | 555 | ||
| D | 558 | ||
| E | 558 | ||
| F | 559 | ||
| G | 560 | ||
| H | 560 | ||
| I | 562 | ||
| J | 563 | ||
| K | 563 | ||
| L | 563 | ||
| M | 564 | ||
| N | 566 | ||
| O | 567 | ||
| P | 567 | ||
| R | 569 | ||
| S | 570 | ||
| T | 572 | ||
| U | 573 | ||
| V | 573 | ||
| W | 573 | ||
| X | 574 | ||
| Z | 574 |