Additional Information
Book Details
Abstract
Mini Kumar & Clark goes into its fifth edition! New to this best-selling, portable, quick reference to clinical medicine:
- Fully updated in line with the latest edition of Kumar & Clark’s Clinical Medicine
- New chapter on malignant disease
- Practical procedures and therapeutics taken into individual chapters as appropriate.
From reviews of the previous edition:
‘This really is an excellent medical textbook … Easily covers undergraduate medicine.’
‘Pocket Essentials is a great little book to review the night before you start on a rotation. It is small enough that you can easily read over the chapter and then appear on the ward with a good idea of what is going on.’
‘In short this book is concise, succinct and gets straight to the point.’
‘This book summarises everything you need to know: causes, diagnoses and treatments.’
‘I am finding this book very helpful and more importantly very concise. It has most things you need to know about common clinical pathologies.’
‘… I turned to Pocket Essentials of Clinical Medicine as my clinical medicine reference guide – and what a guide! An excellent book, which gives you the clinical features, investigations and management for a whole variety of different illnesses. The book is clearly laid out, and even has normal blood chemistry values at the end. Do yourself a favour and buy this book!’
‘This mini paperback is a must for anyone studying medicine. It gives all the information one would need and all without the pain of carrying around a large book.’
‘I liked this book … it was useful having a smaller reference book … to carry around on wards etc. – it's more digestible and easier to follow than big K&C, and gives a little more background than the Oxford Handbook – and I know people who use it to revise for finals.’
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Medical emergencies | ifc_2 | ||
| Symptom based | ifc_2 | ||
| System based | ifc_2 | ||
| Infectious diseases and tropical medicine | ifc_2 | ||
| Gastroenterology and nutrition | ifc_2 | ||
| Liver, biliary tract and pancreatic disease | ifc_2 | ||
| Diseases of the blood and haematological malignancies | ifc_2 | ||
| Malignant disease | ifc_2 | ||
| Rheumatology | ifc_2 | ||
| Water and electrolytes | ifc_2 | ||
| Renal disease | ifc_2 | ||
| Cardiovascular disease | ifc_2 | ||
| Respiratory disease | ifc_2 | ||
| Intensive care medicine | ifc_2 | ||
| Poisoning, drug and alcohol abuse | ifc_2 | ||
| Endocrinology | ifc_2 | ||
| Diabetes mellitus and other disorders of metabolism | ifc_2 | ||
| The special senses | ifc_2 | ||
| Neurology | ifc_2 | ||
| Dermatology | ifc_2 | ||
| Half title page | i | ||
| series page | ii | ||
| Essentials of Kumar and Clark's Clinical Medicine, 5/e | iii | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Series Preface | vii | ||
| Preface | ix | ||
| Abbreviations | xi | ||
| Significant websites | xv | ||
| General Websites | xv | ||
| Medical dictionaries | xv | ||
| Guidelines and evidence based medicine | xv | ||
| Medical calculators | xvi | ||
| Healthcare journals and magazines | xvi | ||
| Medical societies and organizations | xvi | ||
| Others | xvi | ||
| Chapter-Specific Websites | xvi | ||
| 1 Ethics and communication | xvi | ||
| 2 Infectious diseases | xvii | ||
| 3 Gastroenterology and nutrition | xvii | ||
| 1 Ethics and communication | 1 | ||
| Legally valid consent | 2 | ||
| Obtaining consent | 2 | ||
| Special circumstances | 3 | ||
| Emergencies | 3 | ||
| Adults who lack capacity to consent | 3 | ||
| Children | 3 | ||
| Research procedures | 3 | ||
| Teaching | 4 | ||
| Human immunodeficiency virus (HIV) testing | 4 | ||
| Advance directives | 4 | ||
| Communication | 4 | ||
| The medical interview | 5 | ||
| 1. Building a relationship | 5 | ||
| 2. Opening the discussion | 5 | ||
| 3. Gathering information | 5 | ||
| 4. Understanding the patient | 6 | ||
| 5. Sharing information | 6 | ||
| 6. Reaching agreement on management | 6 | ||
| 7. Providing closing | 6 | ||
| Breaking bad news | 6 | ||
| Complaints and lawsuits | 8 | ||
| Culture and communication | 8 | ||
| Patients with impaired faculties for communication | 8 | ||
| Medical record keeping | 9 | ||
| 2 Infectious diseases | 11 | ||
| Common investigations in infectious disease | 12 | ||
| Pyrexia of unknown origin | 13 | ||
| Investigations | 13 | ||
| Management | 14 | ||
| Septicaemia | 15 | ||
| Aetiology | 15 | ||
| Clinical features | 15 | ||
| Investigations | 16 | ||
| Management | 16 | ||
| Common viral infections | 16 | ||
| Measlesnd | 16 | ||
| Clinical features | 16 | ||
| The pre-eruptive and catarrhal stage | 16 | ||
| Eruptive or exanthematous stage | 17 | ||
| Complications | 17 | ||
| 3 Gastroenterology and nutrition | 65 | ||
| Gastroenterology | 65 | ||
| Symptoms of gastrointestinal disease | 65 | ||
| Dyspepsia and indigestion | 65 | ||
| Dysphagia | 65 | ||
| Vomiting | 65 | ||
| Flatulence | 66 | ||
| Diarrhoea and constipation | 66 | ||
| Steatorrhoea | 67 | ||
| Abdominal pain | 67 | ||
| Investigation of gastrointestinal disease | 67 | ||
| Endoscopy | 67 | ||
| Oesophagogastroduodenoscopy (OGD, ‘gastroscopy’) | 67 | ||
| Sigmoidoscopy | 68 | ||
| Colonoscopy | 68 | ||
| Small bowel examination | 69 | ||
| Imaging | 69 | ||
| Plain X-rays | 69 | ||
| Ultrasound | 69 | ||
| Transabdominal ultrasound | 69 | ||
| Endoscopic ultrasound (EUS) | 69 | ||
| Endoanal and endorectal ultrasonography | 69 | ||
| Computed tomography (CT) scan | 70 | ||
| Magnetic resonance imaging (MRI) | 71 | ||
| Positron emission tomography (PET) scanning | 71 | ||
| Contrast studies | 71 | ||
| Oesophageal physiology testing | 71 | ||
| The mouth | 71 | ||
| Mouth ulcers | 72 | ||
| Non-infective | 72 | ||
| Infective | 72 | ||
| Oral white patches | 72 | ||
| Atrophic glossitis | 72 | ||
| Geographical tongue | 72 | ||
| Periodontal disorders | 73 | ||
| Salivary gland disorders | 73 | ||
| The oesophagus | 73 | ||
| Gastro-oesophageal reflux disease (GORD) | 74 | ||
| Pathophysiology | 74 | ||
| Clinical features | 74 | ||
| Investigations | 74 | ||
| OGD | 74 | ||
| 24-hour intraluminal pH monitoring or impedance | 74 | ||
| Management | 74 | ||
| Complications | 75 | ||
| Oesophageal stricture formation | 75 | ||
| Barrett’s oesophagus, | 75 | ||
| Achalasia | 76 | ||
| Pathology | 76 | ||
| Clinical features | 76 | ||
| Investigations | 76 | ||
| Management | 76 | ||
| Complications | 77 | ||
| Systemic sclerosis | 77 | ||
| Other oesophageal dysmotility disorders | 77 | ||
| Hiatus hernia | 77 | ||
| Benign oesophageal strictures | 77 | ||
| Oesophageal perforation | 78 | ||
| Iatrogenic perforation | 78 | ||
| Traumatic or spontaneous oesophageal rupture | 78 | ||
| Malignant oesophageal tumours | 78 | ||
| Pathology | 78 | ||
| Epidemiology and aetiological factors | 78 | ||
| Squamous carcinoma | 78 | ||
| Adenocarcinoma | 78 | ||
| Clinical features | 78 | ||
| Investigations | 79 | ||
| Management | 79 | ||
| Prognosis | 79 | ||
| Benign oesophageal tumours | 79 | ||
| The stomach and duodenum | 79 | ||
| Helicobacter pylori infection | 80 | ||
| Epidemiology | 80 | ||
| Clinicopathological features | 80 | ||
| Diagnosis of infection | 80 | ||
| Management | 80 | ||
| Peptic ulcer disease | 81 | ||
| Epidemiology | 81 | ||
| Aetiology | 81 | ||
| Clinical features | 82 | ||
| Investigations | 82 | ||
| Management | 82 | ||
| Ulcers associated with H. pylori | 82 | ||
| H. pylori-negative peptic ulcers | 83 | ||
| Surgery | 83 | ||
| Complications | 83 | ||
| Perforation | 83 | ||
| Gastric outlet obstruction | 83 | ||
| Haemorrhage | 83 | ||
| Management of dyspepsia | 83 | ||
| Gastropathy and gastritis | 83 | ||
| Gastropathy | 84 | ||
| Gastritis | 85 | ||
| Gastric cancer | 85 | ||
| Epidemiology | 85 | ||
| Aetiology | 85 | ||
| Pathology | 85 | ||
| Clinical features | 86 | ||
| Investigations | 86 | ||
| Management | 86 | ||
| Prognosis | 86 | ||
| Other gastric tumours | 86 | ||
| GISTs | 86 | ||
| Gastric lymphoma | 86 | ||
| Gastric polyps | 86 | ||
| Gastrointestinal bleeding | 87 | ||
| Acute upper gastrointestinal bleeding | 87 | ||
| Aetiology | 87 | ||
| Management | 87 | ||
| Immediate management | 87 | ||
| Risk assessment | 87 | ||
| Resuscitate | 87 | ||
| Pre-endoscopy drug therapy | 87 | ||
| Determine site of bleeding | 88 | ||
| Specific management | 89 | ||
| Post-endoscopy | 90 | ||
| Lower gastrointestinal bleeding | 91 | ||
| Management | 91 | ||
| Specific management | 91 | ||
| Chronic gastrointestinal bleeding | 91 | ||
| Investigations | 92 | ||
| Management | 92 | ||
| The small intestine | 92 | ||
| Coeliac disease (gluten-sensitive enteropathy) | 93 | ||
| Aetiopathogenesis | 93 | ||
| Clinical features | 93 | ||
| Investigations | 94 | ||
| Serum antibodies | 94 | ||
| Distal duodenal biopsies | 94 | ||
| Blood count | 94 | ||
| Small bowel radiology or capsule endoscopy | 94 | ||
| Bone densitometry | 94 | ||
| Management | 94 | ||
| Complications | 95 | ||
| Dermatitis herpetiformis | 95 | ||
| Tropical sprue | 95 | ||
| Bacterial overgrowth | 95 | ||
| Clinical features | 95 | ||
| Diagnosis | 96 | ||
| Management | 96 | ||
| Intestinal resection | 96 | ||
| Whipple’s disease | 96 | ||
| Tuberculosis | 97 | ||
| Clinical features | 97 | ||
| Diagnosis | 97 | ||
| Imaging | 97 | ||
| Histology | 97 | ||
| Management | 97 | ||
| Protein-losing enteropathy | 97 | ||
| Meckel’s diverticulum | 97 | ||
| Intestinal ischaemia | 98 | ||
| Tumours of the small intestine | 98 | ||
| Malignant tumours | 98 | ||
| Benign small bowel tumours | 98 | ||
| Carcinoid tumours | 98 | ||
| Pathology | 98 | ||
| Clinical features | 99 | ||
| Investigations | 99 | ||
| Management | 99 | ||
| Inflammatory bowel disease | 99 | ||
| Epidemiology | 99 | ||
| Aetiology | 99 | ||
| Genetic susceptibility | 99 | ||
| Environment | 100 | ||
| Host immune response | 100 | ||
| Pathology | 100 | ||
| Clinical features | 100 | ||
| Crohn’s disease | 100 | ||
| Ulcerative colitis | 100 | ||
| Investigations | 100 | ||
| Blood tests | 101 | ||
| Radiology and imaging | 101 | ||
| Rigid or flexible sigmoidoscopy | 101 | ||
| Colonoscopy | 102 | ||
| Small bowel imaging | 102 | ||
| Perianal CD | 102 | ||
| Ultrasonography | 102 | ||
| Plain abdominal X-ray | 102 | ||
| Radiolabelled white cell scanning | 102 | ||
| Differential diagnosis | 102 | ||
| Management | 103 | ||
| Medical | 103 | ||
| Surgery | 104 | ||
| Cancer in inflammatory bowel disease | 106 | ||
| Prognosis | 106 | ||
| Microscopic colitis | 106 | ||
| The colon and rectum | 106 | ||
| Constipation | 107 | ||
| Investigation | 107 | ||
| Management | 108 | ||
| Faecal incontinence | 108 | ||
| Diverticular disease | 108 | ||
| Aetiology | 109 | ||
| Clinical features | 109 | ||
| Management | 109 | ||
| Miscellaneous conditions | 109 | ||
| Megacolon | 109 | ||
| Ischaemic colitis | 109 | ||
| Colon polyps and the polyposis syndromes | 110 | ||
| Adenomatous polyps | 110 | ||
| Colorectal cancer | 110 | ||
| Epidemiology | 110 | ||
| Inheritance | 112 | ||
| Pathology | 112 | ||
| Clinical features | 112 | ||
| Investigation | 113 | ||
| Colonic examination | 113 | ||
| Blood tests | 113 | ||
| Radiology | 113 | ||
| Faecal occult blood tests | 113 | ||
| Management | 113 | ||
| Prognosis | 113 | ||
| Screening | 113 | ||
| Diarrhoea | 114 | ||
| Acute diarrhoea | 114 | ||
| Chronic diarrhoea | 114 | ||
| Mechanisms of diarrhoea | 114 | ||
| Osmotic diarrhoea | 114 | ||
| Secretory diarrhoea | 114 | ||
| Inflammatory diarrhoea (mucosal destruction) | 114 | ||
| Motility related | 115 | ||
| Approach to the patient with diarrhoea | 115 | ||
| Step 1: | 115 | ||
| Step 2: | 115 | ||
| Step 3: | 115 | ||
| Investigation | 115 | ||
| Chronic diarrhoea | 115 | ||
| Functional bowel disorders | 115 | ||
| The acute abdomen | 118 | ||
| History | 118 | ||
| Examination | 119 | ||
| 4 Liver, biliary tract and pancreatic disease | 139 | ||
| Liver biochemistry and liver function tests | 140 | ||
| Approach to interpretation of abnormal liver biochemistry | 141 | ||
| Other investigations in liver and biliary disease | 141 | ||
| Magnetic resonance imaging (MRI) | 141 | ||
| Endoscopic retrograde cholangiopancreatography (ERCP) | 141 | ||
| Percutaneous transhepatic cholangiopancreatography (PTC) | 143 | ||
| Liver biopsy | 143 | ||
| Assessment of liver fibrosis and cirrhosis | 143 | ||
| Symptoms and signs of liver disease | 143 | ||
| Jaundice | 145 | ||
| Haemolytic jaundice | 145 | ||
| Congenital hyperbilirubinaemia | 145 | ||
| Cholestatic jaundice | 146 | ||
| Investigations | 147 | ||
| Hepatitis | 148 | ||
| Acute hepatitis | 148 | ||
| Chronic hepatitis | 149 | ||
| Viral hepatitisnd | 149 | ||
| Hepatitis And | 149 | ||
| Epidemiology | 149 | ||
| Clinical features | 150 | ||
| Investigations | 150 | ||
| Differential diagnosis | 152 | ||
| Management | 152 | ||
| Prophylaxis | 152 | ||
| Hepatitis Bnd | 152 | ||
| Epidemiology | 152 | ||
| Viral structure | 152 | ||
| Acute HBV infection | 153 | ||
| Chronic HBV infection | 154 | ||
| Treatment of chronic infection: whom to treat | 155 | ||
| Antiviral agents | 156 | ||
| Hepatitis B and HIV co-infection | 156 | ||
| Prophylaxis | 156 | ||
| Hepatitis D (delta or δ agent)nd | 157 | ||
| Hepatitis Cnd | 157 | ||
| Epidemiology | 157 | ||
| Clinical features | 157 | ||
| Diagnosis | 157 | ||
| Management | 158 | ||
| Hepatitis End | 158 | ||
| Fulminant hepatic failure | 158 | ||
| Autoimmune hepatitis | 158 | ||
| Aetiology | 159 | ||
| Clinical features | 159 | ||
| Investigations | 159 | ||
| Treatment | 160 | ||
| Prognosis | 160 | ||
| Non-alcoholic fatty liver disease (NAFLD) | 160 | ||
| Clinical features | 160 | ||
| Investigations | 160 | ||
| Management | 160 | ||
| Cirrhosis | 161 | ||
| Aetiology | 161 | ||
| Pathology | 161 | ||
| Clinical features | 161 | ||
| Investigations | 161 | ||
| Severity | 161 | ||
| Aetiology | 162 | ||
| Further investigations | 162 | ||
| Management | 162 | ||
| Prognosis | 162 | ||
| Portal hypertension | 162 | ||
| Aetiology | 163 | ||
| Clinical features | 164 | ||
| Variceal haemorrhage | 164 | ||
| Management | 164 | ||
| Active bleeding | 164 | ||
| Prevention of recurrent variceal bleeding | 165 | ||
| Ascites | 166 | ||
| Aetiology | 166 | ||
| Clinical features | 166 | ||
| Investigations | 166 | ||
| Management | 167 | ||
| Diuretics | 167 | ||
| Paracentesis | 167 | ||
| Transjugular intrahepatic portosystemic shunt | 167 | ||
| Complications | 167 | ||
| Portosystemic encephalopathy | 168 | ||
| Pathophysiology | 168 | ||
| Clinical features | 168 | ||
| Differential diagnosis | 168 | ||
| Investigations | 169 | ||
| Management | 169 | ||
| Prognosis | 169 | ||
| Hepatorenal syndrome | 169 | ||
| Hepatopulmonary syndrome | 169 | ||
| Liver transplantation | 170 | ||
| Types of chronic liver disease and cirrhosis | 170 | ||
| Alcoholic cirrhosis | 170 | ||
| Primary biliary cirrhosis | 170 | ||
| Epidemiology | 170 | ||
| Aetiology | 170 | ||
| Clinical features | 171 | ||
| Investigations | 171 | ||
| Management | 171 | ||
| Prognosis | 172 | ||
| Secondary biliary cirrhosis | 172 | ||
| Hereditary haemochromatosis | 172 | ||
| Aetiology | 172 | ||
| Clinical features | 172 | ||
| Investigations | 173 | ||
| Management | 173 | ||
| Prognosis | 174 | ||
| Wilson’s disease (hepatolenticular degeneration) | 174 | ||
| α1-antitrypsin deficiency | 174 | ||
| Alcohol and the liver | 174 | ||
| Fatty change | 175 | ||
| Alcoholic hepatitis | 175 | ||
| Clinical features | 175 | ||
| Investigations | 175 | ||
| Management | 176 | ||
| Alcoholic cirrhosis | 176 | ||
| Primary sclerosing cholangitis | 176 | ||
| Budd–chiari syndrome | 177 | ||
| Aetiology | 177 | ||
| Clinical features | 177 | ||
| Investigations | 177 | ||
| Treatment | 177 | ||
| Liver abscess | 178 | ||
| Aetiology | 178 | ||
| Clinical features | 178 | ||
| Investigations | 178 | ||
| Management | 178 | ||
| Amoebic liver abscess | 178 | ||
| Pyogenic abscess | 179 | ||
| Liver disease in pregnancy | 179 | ||
| Liver tumours | 179 | ||
| Hepatocellular carcinoma (hepatoma) | 179 | ||
| Aetiology | 179 | ||
| Clinical features | 179 | ||
| Investigations | 180 | ||
| Management | 180 | ||
| Prognosis | 180 | ||
| Benign liver tumours | 180 | ||
| Gallstones | 180 | ||
| Pathophysiology | 180 | ||
| Clinical presentation | 181 | ||
| Biliary pain | 181 | ||
| Clinical features | 181 | ||
| Investigations | 182 | ||
| Management | 182 | ||
| Acute cholecystitis | 182 | ||
| Clinical features | 182 | ||
| Investigations | 183 | ||
| Management | 183 | ||
| Chronic cholecystitis | 183 | ||
| Acute cholangitis | 183 | ||
| Clinical features | 183 | ||
| Investigations | 184 | ||
| Management | 184 | ||
| Common bile duct stones (choledocholithiasis) | 184 | ||
| The pancreas | 185 | ||
| Pancreatitis | 185 | ||
| Acute pancreatitis | 185 | ||
| Pathogenesis | 185 | ||
| Clinical features | 185 | ||
| Investigation | 186 | ||
| Management | 187 | ||
| General supportive care | 187 | ||
| Therapies to reduce the severity or frequency of complications | 188 | ||
| Complications | 188 | ||
| Chronic pancreatitis | 189 | ||
| Clinical features | 189 | ||
| Investigations | 189 | ||
| Treatment | 190 | ||
| Carcinoma of the pancreas | 190 | ||
| Epidemiology | 190 | ||
| Aetiology | 190 | ||
| Clinical features | 190 | ||
| Investigations | 190 | ||
| Management | 191 | ||
| Prognosis | 192 | ||
| Cancer of the bile ducts | 192 | ||
| Neuroendocrine tumours of the pancreas | 192 | ||
| 5 Haematological disease | 193 | ||
| Anaemia | 193 | ||
| Clinical features | 194 | ||
| Classification of anaemia (Table 5.2) | 195 | ||
| Microcytic anaemia | 195 | ||
| Iron deficiency | 196 | ||
| Causes of iron deficiency | 197 | ||
| Clinical features | 197 | ||
| Investigations | 197 | ||
| Differential diagnosis | 198 | ||
| Management | 198 | ||
| Anaemia of chronic disease | 198 | ||
| Sideroblastic anaemia | 198 | ||
| Macrocytic anaemia | 198 | ||
| Megaloblastic anaemia | 199 | ||
| Vitamin B12 deficiency | 199 | ||
| Pernicious anaemia | 199 | ||
| Epidemiology | 199 | ||
| Clinical features | 200 | ||
| Investigation of B12 deficiency | 200 | ||
| Differential diagnosis | 201 | ||
| Management | 201 | ||
| Folate deficiency | 201 | ||
| Clinical features | 201 | ||
| Investigations | 202 | ||
| Management | 202 | ||
| Prevention of neural tube defects with folic acid | 202 | ||
| Differential diagnosis | 202 | ||
| Anaemia caused by marrow failure (aplastic anaemia) | 203 | ||
| Aetiology | 203 | ||
| Clinical features | 203 | ||
| Investigations | 204 | ||
| Differential diagnosis | 204 | ||
| Management | 204 | ||
| Haemolytic anaemia | 205 | ||
| Inherited haemolytic anaemias | 206 | ||
| Membrane defects | 206 | ||
| Hereditary spherocytosis | 206 | ||
| Clinical features | 207 | ||
| Investigations | 208 | ||
| Management | 208 | ||
| Hereditary elliptocytosis | 208 | ||
| Haemoglobin abnormalities | 208 | ||
| Thalassaemia | 208 | ||
| β-Thalassaemia | 209 | ||
| Investigations | 210 | ||
| Management | 210 | ||
| α-Thalassaemia | 210 | ||
| Antenatal diagnosis of haemoglobin abnormalities | 210 | ||
| Sickle syndromes | 210 | ||
| Clinical features | 211 | ||
| Vaso-occlusion | 211 | ||
| Anaemia | 211 | ||
| Long-term problems | 212 | ||
| Investigations | 212 | ||
| Management | 212 | ||
| Sickle cell trait | 213 | ||
| Metabolic red cell disorders | 213 | ||
| Glucose-6-phosphate dehydrogenase deficiency | 213 | ||
| Acquired haemolytic anaemia | 214 | ||
| Autoimmune haemolytic anaemia | 214 | ||
| Clinical features | 215 | ||
| Investigation | 215 | ||
| Management | 215 | ||
| Clinical features | 216 | ||
| Investigation | 216 | ||
| Management | 216 | ||
| Drug-induced haemolysis | 216 | ||
| Non-immune haemolytic anaemia | 216 | ||
| Paroxysmal nocturnal haemoglobinuria | 216 | ||
| Mechanical haemolytic anaemia | 217 | ||
| Myeloproliferative disorders | 217 | ||
| Polycythaemia | 217 | ||
| Polycythaemia vera | 218 | ||
| Clinical features | 218 | ||
| Investigations | 219 | ||
| Management | 219 | ||
| Secondary polycythaemia | 219 | ||
| Essential thrombocythaemia | 219 | ||
| Myelofibrosis (myelosclerosis) | 220 | ||
| Clinical features | 220 | ||
| Investigations | 220 | ||
| Management | 221 | ||
| Myelodysplasia | 221 | ||
| The spleen | 221 | ||
| Hypersplenism | 221 | ||
| Splenectomy | 222 | ||
| Blood transfusion | 222 | ||
| Whole blood | 223 | ||
| Red cell concentrates | 223 | ||
| Platelet concentrates | 223 | ||
| Fresh frozen plasma | 223 | ||
| Cryoprecipitate | 223 | ||
| Factor VIII and IX concentrates | 223 | ||
| Albumin | 223 | ||
| Immunoglobulins | 223 | ||
| Blood groups | 224 | ||
| Procedure for blood transfusion | 224 | ||
| Complications of transfusing red blood cells | 225 | ||
| The white cell | 226 | ||
| Neutrophils | 227 | ||
| Neutrophil leucocytosis | 227 | ||
| Neutropenia | 227 | ||
| Monocytes | 227 | ||
| Eosinophils | 227 | ||
| Lymphocytes | 227 | ||
| Haemostasis and thrombosis | 228 | ||
| Haemostasis | 228 | ||
| Investigation of bleeding disorders | 230 | ||
| Platelet disorders | 231 | ||
| Immune thrombocytopenic purpura (ITP) | 232 | ||
| Investigation | 232 | ||
| Management | 233 | ||
| First-line therapy | 233 | ||
| Second-line therapy | 233 | ||
| Thrombotic thrombocytopenic purpura (TTP) | 233 | ||
| Inherited coagulation disorders | 233 | ||
| Haemophilia A | 233 | ||
| Clinical features | 233 | ||
| Investigations | 234 | ||
| Management | 234 | ||
| Complications | 234 | ||
| Haemophilia B (Christmas disease) | 234 | ||
| von Willebrand’s disease | 234 | ||
| 6 Malignant disease | 251 | ||
| Diagnosis of malignancy | 251 | ||
| Investigations | 252 | ||
| Cancer treatment | 253 | ||
| Chemotherapy | 253 | ||
| Radiotherapy | 253 | ||
| Endocrine therapy | 254 | ||
| Biological therapy | 254 | ||
| Myeloablative therapy and haemopoietic stem cell transplantation | 255 | ||
| Oncological emergencies | 255 | ||
| Superior vena cava syndrome | 255 | ||
| Acute tumour lysis syndrome | 255 | ||
| The leukaemias | 256 | ||
| General classification | 256 | ||
| Aetiology | 256 | ||
| Genetic factors | 256 | ||
| Environmental factors | 257 | ||
| Acute leukaemia | 257 | ||
| Epidemiology | 257 | ||
| Clinical features | 257 | ||
| Investigations | 257 | ||
| Management | 258 | ||
| Supportive care | 258 | ||
| Treatment | 258 | ||
| Acute myeloid leukaemia | 258 | ||
| Acute promyelocytic leukaemia | 259 | ||
| Prognosis | 259 | ||
| Acute lymphoblastic leukaemia | 259 | ||
| Chronic myeloid leukaemia | 260 | ||
| 7 Rheumatology | 271 | ||
| The normal joint | 271 | ||
| Musculoskeletal symptoms | 271 | ||
| Common investigations in musculoskeletal disease | 273 | ||
| Blood tests | 273 | ||
| Simple blood tests | 273 | ||
| Autoantibodies | 273 | ||
| Imaging | 273 | ||
| Plain X-rays | 273 | ||
| Bone scintigraphy (isotope bone scan) | 274 | ||
| Ultrasound | 274 | ||
| MRI | 274 | ||
| DXA | 274 | ||
| Arthroscopy | 274 | ||
| Synovial fluid analysis | 274 | ||
| Investigation of suspected muscle disease | 274 | ||
| Common regional musculoskeletal problems | 274 | ||
| Pain in the neck and shoulder | 274 | ||
| Elbow pain | 275 | ||
| Hip problems | 275 | ||
| The knee | 275 | ||
| Back pain | 276 | ||
| Lumbar back pain | 276 | ||
| Investigations | 277 | ||
| Management | 277 | ||
| Intervertebral disc disease | 277 | ||
| Acute disc disease | 277 | ||
| Clinical features | 278 | ||
| Investigations | 278 | ||
| Management | 278 | ||
| Chronic disc disease | 279 | ||
| Mechanical problems | 279 | ||
| Spondylolisthesis | 279 | ||
| Spinal stenosis | 279 | ||
| Neck pain | 279 | ||
| Osteoarthritis | 280 | ||
| Epidemiology | 280 | ||
| Pathology and pathogenesis | 280 | ||
| Clinical features | 280 | ||
| Differential diagnosis | 281 | ||
| Investigations | 282 | ||
| Management | 282 | ||
| Inflammatory arthritis | 282 | ||
| Rheumatoid arthritis | 283 | ||
| Epidemiology | 283 | ||
| Aetiology and pathogenesis | 283 | ||
| Pathology | 283 | ||
| Clinical features | 284 | ||
| Non-articular manifestations | 284 | ||
| Investigations | 285 | ||
| Differential diagnosis | 285 | ||
| Management | 285 | ||
| NSAIDs and coxibs | 287 | ||
| Corticosteroids | 287 | ||
| Disease-modifying anti-rheumatic drugs | 287 | ||
| Biological DMARDs | 287 | ||
| Prognosis | 288 | ||
| The seronegative spondyloarthropathies | 289 | ||
| Ankylosing spondylitis | 289 | ||
| Clinical features | 289 | ||
| Investigations | 290 | ||
| Management | 291 | ||
| Psoriatic arthritis | 292 | ||
| 8 Water, electrolytes and acid–base balance | 323 | ||
| Water and electrolyte requirements | 323 | ||
| Body fluid compartments | 323 | ||
| Osmotic pressure | 324 | ||
| Distribution of extracellular fluid | 324 | ||
| Intravenous fluids in clinical practice | 325 | ||
| Regulation of body fluid homeostasis | 328 | ||
| Regulation of extracellular volume | 328 | ||
| Abnormalities of extracellular volume | 329 | ||
| Increased extracellular volume | 329 | ||
| Clinical features | 329 | ||
| Aetiology | 329 | ||
| Management | 330 | ||
| Decreased extracellular volume | 330 | ||
| Aetiology | 330 | ||
| Clinical features | 330 | ||
| Investigations | 331 | ||
| Management | 331 | ||
| Plasma osmolality and disorders of sodium regulation | 332 | ||
| Regulation of body water content | 333 | ||
| Hyponatraemia | 333 | ||
| Hyponatraemia resulting from salt loss (hypovolaemic hyponatraemia) | 333 | ||
| Clinical features | 334 | ||
| Management | 335 | ||
| Hyponatraemia resulting from water excess (dilutional hyponatraemia) | 335 | ||
| Aetiology | 335 | ||
| Clinical features | 335 | ||
| Investigation | 335 | ||
| Management | 336 | ||
| Central pontine myelinolysis | 336 | ||
| Hypernatraemia | 337 | ||
| Aetiology | 337 | ||
| Clinical features | 337 | ||
| Investigations | 337 | ||
| Management | 337 | ||
| Disorders of potassium regulation | 338 | ||
| Hypokalaemia | 338 | ||
| Aetiology | 338 | ||
| Clinical features | 338 | ||
| Management | 338 | ||
| Hyperkalaemia | 340 | ||
| Aetiology | 340 | ||
| Clinical features | 340 | ||
| Management | 341 | ||
| Disorders of magnesium regulation | 341 | ||
| Hypomagnesaemia | 342 | ||
| Aetiology | 342 | ||
| Clinical features | 342 | ||
| Management | 343 | ||
| Hypermagnesaemia | 343 | ||
| Disorders of acid–base balance | 343 | ||
| Respiratory acidosis | 344 | ||
| Respiratory alkalosis | 344 | ||
| Metabolic acidosis | 345 | ||
| Clinical features | 345 | ||
| Differential diagnosis (the anion gap) | 345 | ||
| Lactic acidosis | 346 | ||
| Diabetic ketoacidosis | 346 | ||
| Renal tubular acidosis | 346 | ||
| Uraemic acidosis | 347 | ||
| Metabolic alkalosis | 347 | ||
| Clinical features | 348 | ||
| Management | 348 | ||
| Therapeutics | 348 | ||
| Diuretics (Table 8.4) | 348 | ||
| Mechanism of action | 348 | ||
| Indications | 348 | ||
| Preparations and dose | 348 | ||
| Side-effects | 348 | ||
| 9 Renal disease | 353 | ||
| Presenting features of renal disease | 353 | ||
| Dysuria | 355 | ||
| Polyuria and nocturia | 355 | ||
| Oliguria | 355 | ||
| Haematuria | 356 | ||
| Pain | 356 | ||
| Investigation of renal disease | 356 | ||
| Blood tests | 356 | ||
| Glomerular filtration rate | 357 | ||
| Calculation of creatinine clearance using the Cockroft–Gault equation | 357 | ||
| Men | 357 | ||
| Women | 357 | ||
| Urine dipstick testing | 357 | ||
| Proteinuria | 357 | ||
| Haematuria | 358 | ||
| Glycosuria | 360 | ||
| Urine microscopy | 360 | ||
| White cells | 360 | ||
| Red cells | 361 | ||
| Casts | 361 | ||
| Bacteria | 361 | ||
| Imaging techniques | 361 | ||
| Plain X-ray | 361 | ||
| Ultrasonography | 361 | ||
| CT | 361 | ||
| Magnetic resonance imaging (MRI) | 362 | ||
| Excretion urography | 362 | ||
| Renal arteriography (angiography) | 362 | ||
| Antegrade pyelography | 362 | ||
| Retrograde pyelography | 362 | ||
| Renal scintigraphy | 362 | ||
| Transcutaneous renal biopsy | 362 | ||
| Glomerular diseases | 363 | ||
| Normal glomerular structure | 363 | ||
| Pathogenesis and terms in glomerular disease | 363 | ||
| Classification and presentation of glomerulopathies | 364 | ||
| Nephrotic syndrome | 365 | ||
| Aetiology | 365 | ||
| Nephrotic syndrome with ‘bland’ urine sediments | 365 | ||
| Nephrotic syndrome with ‘active’ urine sediments (mixed nephrotic/nephritic) | 366 | ||
| Clinical features | 367 | ||
| Differential diagnoses | 367 | ||
| Investigations | 367 | ||
| Management | 367 | ||
| General oedema | 367 | ||
| Specific treatment | 367 | ||
| Complications | 369 | ||
| Acute glomerulonephritis (acute nephritic syndrome) | 369 | ||
| Clinical features | 369 | ||
| Investigations | 370 | ||
| Management | 370 | ||
| Rapidly progressive glomerulonephritis | 370 | ||
| Urinary tract infection | 370 | ||
| Pathogenesis | 370 | ||
| Clinical features | 371 | ||
| Natural history | 371 | ||
| Uncomplicated versus complicated infection | 371 | ||
| Acute pyelonephritis | 372 | ||
| Reflux nephropathy | 372 | ||
| Recurrent UTI | 372 | ||
| Investigations | 372 | ||
| Management | 373 | ||
| Antibiotics | 373 | ||
| A high fluid intake | 373 | ||
| Recurrent infection | 373 | ||
| UTI in pregnancy | 373 | ||
| Abacteriuric frequency or dysuria (‘urethral syndrome’) | 373 | ||
| Tuberculosis of the urinary tract | 373 | ||
| Tubulointerstitial nephritis | 374 | ||
| Acute tubulointerstitial nephritis (TIN) | 374 | ||
| Chronic tubulointerstitial nephritis | 374 | ||
| Hypertension and the kidney | 374 | ||
| Essential hypertension | 375 | ||
| Renal hypertension | 375 | ||
| Bilateral renal disease | 375 | ||
| Renovascular disease | 375 | ||
| Options for renal artery imaging | 376 | ||
| Management | 377 | ||
| Renal calculi and nephrocalcinosis | 377 | ||
| Aetiology | 377 | ||
| Calcium stones | 377 | ||
| Hypercalciuria | 377 | ||
| Hyperoxaluria | 377 | ||
| Uric acid stones | 378 | ||
| Infection-induced stones | 378 | ||
| Cystine stones | 378 | ||
| Clinical features | 378 | ||
| Differential diagnosis | 379 | ||
| Investigations | 379 | ||
| Management | 379 | ||
| Initial treatment | 379 | ||
| Prevention of recurrence | 380 | ||
| Nephrocalcinosis | 381 | ||
| Urinary tract obstruction | 381 | ||
| Aetiology | 381 | ||
| Clinical features | 381 | ||
| Investigations | 382 | ||
| Management | 383 | ||
| Acute renal failure/acute kidney injury | 383 | ||
| Definition | 383 | ||
| Classification | 383 | ||
| Prerenal failure | 384 | ||
| Management | 385 | ||
| Postrenal uraemia | 385 | ||
| Acute uraemia due to renal parenchymal disease | 386 | ||
| Clinical and biochemical features | 386 | ||
| Investigation of the uraemic emergency | 387 | ||
| Investigations | 387 | ||
| Management | 388 | ||
| Prognosis | 388 | ||
| Chronic kidney disease | 388 | ||
| Aetiology | 389 | ||
| Clinical features and investigations | 390 | ||
| Anaemia | 390 | ||
| Bone disease | 390 | ||
| Neurological | 391 | ||
| Cardiovascular disease | 391 | ||
| Other complications | 392 | ||
| Differentiating AKI from CKD | 392 | ||
| Management | 393 | ||
| Renoprotection | 394 | ||
| Reduce cardiovascular risk | 394 | ||
| Correction of complications | 394 | ||
| Hyperkalaemia | 394 | ||
| Calcium and phosphate | 394 | ||
| Anaemia | 394 | ||
| Acidosis | 395 | ||
| Infections | 395 | ||
| Referral to a nephrologist | 395 | ||
| Renal replacement therapy | 395 | ||
| Dialysis | 395 | ||
| Haemodialysis | 396 | ||
| Peritoneal dialysis | 396 | ||
| Haemofiltration | 397 | ||
| Complications of all long-term dialysis | 397 | ||
| Transplantation | 397 | ||
| Cystic renal disease | 398 | ||
| Solitary and multiple renal cysts | 398 | ||
| Autosomal-dominant polycystic kidney disease | 398 | ||
| Clinical features | 398 | ||
| Diagnosis | 399 | ||
| Management | 399 | ||
| Medullary sponge kidney | 399 | ||
| Tumours of the kidney and genitourinary tract | 399 | ||
| Renal cell carcinoma | 399 | ||
| Clinical features | 399 | ||
| Investigations | 400 | ||
| Management | 400 | ||
| Localized disease | 400 | ||
| Metastatic or locally advanced disease | 400 | ||
| Prognosis | 400 | ||
| Urothelial tumours | 400 | ||
| 10 Cardiovascular disease | 407 | ||
| Common presenting symptoms of heart disease | 407 | ||
| Chest pain | 407 | ||
| Dyspnoea | 407 | ||
| Palpitations | 407 | ||
| Syncope | 407 | ||
| Other symptoms | 409 | ||
| Investigations in cardiac disease | 409 | ||
| The chest X-ray | 409 | ||
| The electrocardiogram | 409 | ||
| ECG waveform and definitions (Fig. 10.5) | 411 | ||
| Heart rate | 411 | ||
| Exercise electrocardiography | 415 | ||
| 24-Hour ambulatory taped electrocardiography | 417 | ||
| Tilt testing | 417 | ||
| Echocardiography | 417 | ||
| Cardiac nuclear imaging | 419 | ||
| Cardiac computed tomography (CT) | 419 | ||
| Cardiovascular magnetic resonance (CMR) | 419 | ||
| Cardiac catheterization | 420 | ||
| Cardiac arrhythmias | 420 | ||
| General principles of management of arrhythmias | 420 | ||
| Sinus rhythms | 421 | ||
| Sinus arrhythmia | 421 | ||
| Bradycardia | 421 | ||
| Sinus bradycardia | 421 | ||
| Heart block | 422 | ||
| Atrioventricular block | 422 | ||
| First-degree AV block | 422 | ||
| Second-degree AV block | 422 | ||
| Third-degree AV block | 422 | ||
| Bundle branch block | 423 | ||
| Supraventricular tachycardias | 425 | ||
| Sinus tachycardia | 425 | ||
| Atrioventricular junctional tachycardias | 425 | ||
| Atrioventricular nodal re-entry tachycardia | 425 | ||
| Atrioventricular reciprocating tachycardia | 427 | ||
| Symptoms | 427 | ||
| Acute management | 427 | ||
| Long-term management | 428 | ||
| Atrial tachyarrhythmias | 428 | ||
| Atrial fibrillation (AF) | 429 | ||
| Management | 429 | ||
| Assessment for anticoagulation | 430 | ||
| Atrial flutter | 430 | ||
| Atrial ectopic beats | 430 | ||
| Ventricular tachyarrhythmias | 431 | ||
| Ventricular ectopic premature beats (extrasystoles) | 431 | ||
| Sustained ventricular tachycardia | 431 | ||
| Non-sustained ventricular tachycardia | 431 | ||
| Ventricular fibrillation (VF) | 432 | ||
| Long QT syndrome | 432 | ||
| Cardiac arrest | 432 | ||
| Prognosis | 433 | ||
| Heart failure | 433 | ||
| Aetiology | 433 | ||
| Pathophysiology | 433 | ||
| Activation of the sympathetic nervous system | 433 | ||
| Renin–angiotensin system | 433 | ||
| Natriuretic peptides | 437 | ||
| Ventricular dilatation | 437 | ||
| Ventricular remodelling | 437 | ||
| Clinical features | 437 | ||
| Symptoms | 438 | ||
| Signs | 438 | ||
| Investigations | 438 | ||
| Treatment of chronic heart failure | 440 | ||
| Drug treatment | 440 | ||
| Vasodilator therapy | 440 | ||
| β-blockers | 440 | ||
| Diuretics | 441 | ||
| Digoxin | 442 | ||
| Inotropes | 442 | ||
| Non-pharmacological treatment | 442 | ||
| Revascularization | 442 | ||
| Cardiac resynchronization therapy | 442 | ||
| Implantable cardioverter–defibrillator (ICD) | 442 | ||
| Cardiac transplantation | 442 | ||
| Prognosis | 443 | ||
| Acute heart failure | 443 | ||
| Clinical features | 443 | ||
| Management | 443 | ||
| Ischaemic heart disease | 444 | ||
| Irreversible risk factors for coronary artery disease | 445 | ||
| Age | 445 | ||
| Gender | 445 | ||
| Family history | 445 | ||
| Potentially changeable risk factors | 445 | ||
| Hyperlipidaemia | 445 | ||
| Cigarette smoking | 445 | ||
| Hypertension | 445 | ||
| Metabolic factors | 445 | ||
| Diets | 445 | ||
| Other risk factors | 445 | ||
| Estimation of cardiovascular risk | 446 | ||
| Angina | 446 | ||
| Clinical features | 446 | ||
| Diagnosis | 446 | ||
| Investigations | 447 | ||
| Management | 447 | ||
| Secondary prevention | 447 | ||
| Symptomatic treatment | 448 | ||
| Percutaneous coronary intervention (PCI) | 448 | ||
| Coronary artery bypass grafting | 449 | ||
| Acute coronary syndromes | 449 | ||
| Clinical features | 449 | ||
| Treatment | 450 | ||
| Risk stratification | 450 | ||
| ST segment elevation myocardial infarction (STEMI) | 452 | ||
| Clinical features | 452 | ||
| Investigations | 452 | ||
| The ECG | 453 | ||
| Cardiac markers | 454 | ||
| Other investigations | 454 | ||
| Management | 454 | ||
| Limitation of infarct size | 454 | ||
| Immediate primary angioplasty | 454 | ||
| Fibrinolytic agents | 455 | ||
| Subsequent management | 456 | ||
| Complications (Table 10.9) | 456 | ||
| Disturbances of rate, rhythm and conduction (p. 420) | 456 | ||
| Heart failure | 457 | ||
| Embolism | 457 | ||
| Pericarditis | 458 | ||
| Prognosis | 458 | ||
| Rheumatic fever | 458 | ||
| Epidemiology | 458 | ||
| Clinical features | 458 | ||
| Investigations | 459 | ||
| Blood count | 459 | ||
| Treatment | 459 | ||
| Chronic rheumatic heart disease | 459 | ||
| Valvular heart disease | 459 | ||
| Prosthetic heart valves | 459 | ||
| Mitral stenosis | 460 | ||
| Aetiology | 460 | ||
| Pathophysiology | 460 | ||
| Symptoms | 460 | ||
| Signs | 460 | ||
| Investigations | 461 | ||
| Chest X-ray | 461 | ||
| ECG | 461 | ||
| Echocardiography | 461 | ||
| Management | 461 | ||
| General | 461 | ||
| Specific | 461 | ||
| Mitral regurgitation | 461 | ||
| Aetiology | 461 | ||
| Pathophysiology | 462 | ||
| Symptoms | 462 | ||
| Signs | 462 | ||
| Investigations | 462 | ||
| 11 Respiratory disease | 505 | ||
| Basic structure of the respiratory system | 505 | ||
| Function of the respiratory system | 505 | ||
| Symptoms of respiratory disease | 506 | ||
| Cough | 506 | ||
| Breathlessness | 507 | ||
| Wheezing | 508 | ||
| Haemoptysis | 508 | ||
| Chest pain (p. 407) | 508 | ||
| Investigation of respiratory disease | 508 | ||
| Sputum | 508 | ||
| Respiratory function tests | 508 | ||
| Peak expiratory flow rate (PEFR) | 509 | ||
| The spirometer | 509 | ||
| Arterial blood gas sampling | 509 | ||
| Walking distance | 509 | ||
| Imaging | 509 | ||
| Chest X-ray | 509 | ||
| Computed tomography (CT scan, p. 822) | 510 | ||
| Magnetic resonance imaging (MRI, p. 826) | 511 | ||
| Positron emission tomography (PET, p. 828) | 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 | ||
| Rhinitis | 513 | ||
| Seasonal rhinitis | 513 | ||
| Perennial rhinitis | 513 | ||
| Diagnosis | 513 | ||
| Management | 514 | ||
| Acute pharyngitis | 514 | ||
| Acute laryngotracheobronchitis (croup) | 514 | ||
| Influenza | 514 | ||
| Clinical features | 514 | ||
| Diagnosis | 515 | ||
| Management | 515 | ||
| Complications | 515 | ||
| Prophylaxis | 515 | ||
| Inhalation of foreign bodies | 515 | ||
| Diseases of the lower respiratory tract | 516 | ||
| Acute bronchitis | 516 | ||
| Chronic obstructive pulmonary disease (COPD) | 516 | ||
| Epidemiology and aetiology | 516 | ||
| Pathophysiology | 516 | ||
| Pathogenesis | 517 | ||
| Clinical features | 517 | ||
| Complications | 518 | ||
| Investigations | 519 | ||
| Management | 520 | ||
| Cessation of smoking | 520 | ||
| Bronchodilators | 520 | ||
| Corticosteroids | 520 | ||
| Prevention of infection | 520 | ||
| Oxygen | 520 | ||
| Additional treatments | 520 | ||
| Acute exacerbation of COPD | 521 | ||
| Long term prognosis | 522 | ||
| Obstructive sleep apnoea (OSA) | 522 | ||
| Aetiology | 522 | ||
| Clinical features | 522 | ||
| Diagnosis | 523 | ||
| Management | 523 | ||
| Bronchiectasis | 523 | ||
| Aetiology | 523 | ||
| Clinical features | 523 | ||
| Investigations | 524 | ||
| Management | 524 | ||
| Complications | 524 | ||
| Cystic fibrosis | 525 | ||
| Clinical features | 525 | ||
| Investigations | 525 | ||
| Management | 526 | ||
| Prognosis | 526 | ||
| Asthma | 526 | ||
| Epidemiology | 526 | ||
| Classification | 527 | ||
| Aetiology | 527 | ||
| Pathogenesis | 527 | ||
| Inflammation | 527 | ||
| Remodelling | 528 | ||
| Precipitating factors | 528 | ||
| Clinical features | 528 | ||
| Investigations | 529 | ||
| Management | 530 | ||
| Avoidance of precipitating factors | 530 | ||
| Drug treatment | 530 | ||
| Acute severe asthma | 532 | ||
| Clinical features | 532 | ||
| Pneumonia | 532 | ||
| Clinical features | 534 | ||
| Investigations | 535 | ||
| Differential diagnosis | 537 | ||
| 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 | 540 | ||
| Aspiration pneumonia | 540 | ||
| Complications of pneumonia: lung abscess and empyema | 540 | ||
| Clinical features | 540 | ||
| Investigations | 540 | ||
| Management | 540 | ||
| Tuberculosisnd | 541 | ||
| Epidemiology | 541 | ||
| Pathology | 541 | ||
| Clinical features | 541 | ||
| Investigations | 543 | ||
| Management | 544 | ||
| Prevention and chemoprophylaxis | 545 | ||
| Diffuse diseases of the lung parenchyma | 546 | ||
| Granulomatous lung disease | 546 | ||
| Sarcoidosis | 547 | ||
| Epidemiology | 547 | ||
| Immunopathology | 547 | ||
| Clinical features | 547 | ||
| Investigations | 547 | ||
| Differential diagnosis | 548 | ||
| Management | 549 | ||
| Prognosis | 549 | ||
| Granulomatous lung disease with vasculitis | 549 | ||
| Idiopathic interstitial pneumonias | 550 | ||
| Idiopathic pulmonary fibrosis (IFP) | 550 | ||
| Clinical features | 550 | ||
| Investigations | 550 | ||
| Differential diagnosis | 550 | ||
| Treatment | 551 | ||
| Prognosis | 551 | ||
| Hypersensensitivity pneumonitis | 551 | ||
| 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 | 553 | ||
| Epidemiology | 553 | ||
| Aetiology | 553 | ||
| Pathology | 554 | ||
| Clinical features | 554 | ||
| Local effects of tumour within a bronchus | 554 | ||
| Spread within the chest | 555 | ||
| Metastatic disease | 555 | ||
| Non-metastatic manifestations | 555 | ||
| Investigations | 556 | ||
| Confirm the diagnosis | 556 | ||
| Determine the histology | 556 | ||
| Assess spread of the tumour | 557 | ||
| 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 | 558 | ||
| Metastatic tumours in the lung | 558 | ||
| Diseases of the chest wall and pleura | 558 | ||
| Rib fractures | 558 | ||
| Kyphosis and scoliosis of the spine | 558 | ||
| Pleurisy | 558 | ||
| Pleural effusion | 559 | ||
| Aetiology | 560 | ||
| Investigations | 560 | ||
| Diagnostic pleural fluid aspiration | 560 | ||
| Contrast-enhanced thoracic CT scan | 561 | ||
| Pleural biopsy | 561 | ||
| Management | 561 | ||
| Pneumothorax | 561 | ||
| Aetiology | 561 | ||
| Clinical features | 562 | ||
| Investigations | 562 | ||
| Management | 562 | ||
| Disorders of the diaphragm | 563 | ||
| Therapeutics | 564 | ||
| Bronchodilators | 564 | ||
| 12 Intensive care medicine | 571 | ||
| Patient selection – withholding and withdrawing treatment | 571 | ||
| Critical care outreach and early warning systems | 572 | ||
| Acute disturbances of haemodynamic function (shock) | 572 | ||
| Pathophysiology | 574 | ||
| Sympathoadrenal | 574 | ||
| Neuroendocrine response | 574 | ||
| Release of mediators | 574 | ||
| Microcirculatory changes | 575 | ||
| Activation of the coagulation system | 575 | ||
| Progressive organ failure | 575 | ||
| Clinical features | 575 | ||
| Hypovolaemic shock | 576 | ||
| Cardiogenic shock | 577 | ||
| Mechanical shock | 577 | ||
| Anaphylactic shock | 577 | ||
| Sepsis | 577 | ||
| Management | 578 | ||
| Expansion of the circulating volume (preload) | 578 | ||
| 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 | 583 | ||
| Forced vital capacity (FVC) | 583 | ||
| Arterial blood gas analysis | 583 | ||
| Capnography | 584 | ||
| Management | 584 | ||
| Respiratory support | 584 | ||
| Acute lung injury/acute respiratory distress syndrome | 586 | ||
| Aetiology | 586 | ||
| Pathophysiology | 586 | ||
| Clinical features | 587 | ||
| Management | 587 | ||
| Prognosis | 587 | ||
| 13 Drug therapy, poisoning, and alcohol misuse | 589 | ||
| Drug prescribing | 589 | ||
| Concordance with medication | 589 | ||
| Adverse drug reactions | 590 | ||
| Writing a prescription | 590 | ||
| Best practice for drug prescribing | 591 | ||
| Specific drugs | 591 | ||
| Drug poisoning | 591 | ||
| Clinical features | 592 | ||
| Investigations | 592 | ||
| Management | 594 | ||
| Emergency resuscitation (ABCDE, p. 740) | 594 | ||
| Prevention of further drug absorption | 594 | ||
| Antagonizing the effects of poisons | 595 | ||
| Psychiatric assessment | 595 | ||
| Specific drug problems | 595 | ||
| Aspirin | 595 | ||
| Clinical features | 596 | ||
| Investigations | 597 | ||
| Management | 597 | ||
| Paracetamol (acetaminophen) | 597 | ||
| Clinical features | 597 | ||
| Management | 598 | ||
| Other drugs | 600 | ||
| Carbon monoxide | 601 | ||
| Alcohol | 601 | ||
| Drug use | 601 | ||
| Opioids | 601 | ||
| Cannabis | 602 | ||
| Lysergide | 602 | ||
| Cocaine | 602 | ||
| Amfetamines | 602 | ||
| Solvents | 603 | ||
| Management of body packers | 603 | ||
| Alcohol use | 603 | ||
| Screening for problem drinking | 604 | ||
| Consequences of alcohol use and dependence | 604 | ||
| Physical complications | 604 | ||
| Alcohol withdrawal | 605 | ||
| 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 | 614 | ||
| Investigation | 614 | ||
| Management | 614 | ||
| Pituitary hypersecretion syndromes | 615 | ||
| Acromegaly and gigantism | 615 | ||
| Clinical features | 615 | ||
| Investigations | 615 | ||
| Management | 616 | ||
| Transsphenoidal surgical resection | 617 | ||
| Medical therapy | 617 | ||
| External radiotherapy | 617 | ||
| Hyperprolactinaemia | 617 | ||
| Aetiology | 617 | ||
| Clinical features | 617 | ||
| Investigations | 618 | ||
| Management | 618 | ||
| The thyroid axis | 618 | ||
| Assessment of thyroid function tests | 619 | ||
| Hypothyroidism | 619 | ||
| Aetiology | 619 | ||
| Autoimmune thyroiditis | 620 | ||
| Iatrogenic | 620 | ||
| Drug induced | 620 | ||
| Iodine deficiency | 620 | ||
| Congenital hypothyroidism | 620 | ||
| Clinical features | 620 | ||
| Investigations | 620 | ||
| Management | 620 | ||
| Borderline or subclinical hypothyroidism (compensated euthyroidism) | 621 | ||
| Myxoedema coma | 622 | ||
| Myxoedema madness | 622 | ||
| Hyperthyroidism | 623 | ||
| Graves’ disease | 623 | ||
| Toxic multinodular goitre | 623 | ||
| Solitary toxic nodule/adenoma | 623 | ||
| de Quervain’s thyroiditis | 623 | ||
| Postpartum thyroiditis | 623 | ||
| Clinical features | 623 | ||
| Investigations | 623 | ||
| Management | 625 | ||
| Antithyroid drugs | 625 | ||
| Radioactive iodine | 625 | ||
| Surgery | 625 | ||
| Thyroid crisis or ‘thyroid storm’ | 626 | ||
| Ophthalmic Graves’ disease | 626 | ||
| Aetiology | 626 | ||
| Clinical features | 626 | ||
| Investigations | 626 | ||
| Management | 627 | ||
| Goitre (thyroid enlargement) | 627 | ||
| Clinical features | 627 | ||
| Investigations | 628 | ||
| Management | 629 | ||
| Thyroid malignancy | 629 | ||
| Male reproduction and sex | 629 | ||
| Male hypogonadism | 630 | ||
| Klinefelter’s syndrome | 630 | ||
| Congenital deficiency of gonadotrophin-releasing hormone (GnRH) | 631 | ||
| Investigations | 631 | ||
| Management | 631 | ||
| Loss of libido and erectile dysfunction | 631 | ||
| Gynaecomastia | 632 | ||
| Female reproduction and sex | 632 | ||
| The menopause | 632 | ||
| Female hypogonadism and amenorrhoea | 634 | ||
| Aetiology | 634 | ||
| Investigations | 635 | ||
| Management | 635 | ||
| Hirsutism and polycystic ovary syndrome (PCOS) | 635 | ||
| Clinical features | 636 | ||
| Criteria for diagnosis | 636 | ||
| Investigations and differential diagnosis | 636 | ||
| Management | 636 | ||
| Local therapy for hirsutism | 636 | ||
| Systemic therapy for hirsutism | 637 | ||
| Treatment of menstrual disturbance | 637 | ||
| Treatment for infertility | 637 | ||
| The glucocorticoid axis | 637 | ||
| Addison’s disease: primary hypoadrenalism | 637 | ||
| Aetiology | 638 | ||
| Clinical features | 638 | ||
| Investigations | 638 | ||
| Management | 639 | ||
| Uses and problems of therapeutic steroid therapy | 640 | ||
| Secondary hypoadrenalism | 641 | ||
| Cushing’s syndrome | 641 | ||
| Clinical features | 641 | ||
| Investigations | 643 | ||
| Confirm raised cortisol | 644 | ||
| Establishing the cause of Cushing’s syndrome | 644 | ||
| Management | 644 | ||
| Incidental adrenal tumours | 645 | ||
| The thirst axis | 645 | ||
| Diabetes insipidus | 645 | ||
| Aetiology | 645 | ||
| Clinical features | 646 | ||
| Investigations | 646 | ||
| Management | 646 | ||
| Syndrome of inappropriate ADH secretion (SIADH) | 647 | ||
| Aetiology | 647 | ||
| Clinical features | 647 | ||
| Investigations | 647 | ||
| Management | 648 | ||
| Disorders of calcium metabolism | 648 | ||
| Hypercalcaemia | 648 | ||
| Aetiology | 648 | ||
| Primary hyperparathyroidism | 649 | ||
| Secondary hyperparathyroidism | 649 | ||
| Tertiary hyperparathyroidism | 649 | ||
| Clinical features | 650 | ||
| Investigations | 650 | ||
| Management | 650 | ||
| Treatment of primary hyperparathyroidism | 651 | ||
| Hypocalcaemia and hypoparathyroidism | 651 | ||
| Aetiology | 651 | ||
| Clinical features | 651 | ||
| Investigations | 652 | ||
| Management | 653 | ||
| Acute | 653 | ||
| Persistent hypocalcaemia | 653 | ||
| Disorders of phosphate concentration | 653 | ||
| Hypophosphataemia | 654 | ||
| Aetiology | 654 | ||
| Clinical features | 654 | ||
| Treatment | 654 | ||
| Oral phosphate supplements | 654 | ||
| Intravenous phosphate | 655 | ||
| Endocrinology of blood pressure control | 655 | ||
| The renin–angiotensin system | 655 | ||
| Aldosterone | 657 | ||
| Primary hyperaldosteronism | 657 | ||
| Clinical features | 657 | ||
| Investigations | 657 | ||
| Management | 657 | ||
| Phaeochromocytoma | 657 | ||
| Clinical features | 658 | ||
| Investigations | 658 | ||
| Management | 658 | ||
| Multiple endocrine neoplasia | 658 | ||
| Disorders of temperature regulation | 659 | ||
| Hypothermia | 659 | ||
| Aetiology | 660 | ||
| Clinical features | 660 | ||
| Diagnosis | 660 | ||
| Management | 660 | ||
| Hyperthermia (hyperpyrexia) | 661 | ||
| Therapeutics | 662 | ||
| Thyroid hormones | 662 | ||
| 15 Diabetes mellitus and other disorders of metabolism | 667 | ||
| Diabetes mellitus | 667 | ||
| Glucose metabolism | 667 | ||
| Classification of diabetes | 667 | ||
| Aetiology and pathogenesis | 669 | ||
| Type 1 diabetes mellitus | 669 | ||
| Type 2 diabetes mellitus | 669 | ||
| 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 during insulin treatment | 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 | 677 | ||
| Management | 678 | ||
| Hyperosmolar hyperglycaemic state | 678 | ||
| Clinical features | 680 | ||
| Management | 680 | ||
| Prognosis | 680 | ||
| Lactic acidosis | 681 | ||
| Complications of diabetes | 681 | ||
| Vascular | 681 | ||
| Macrovascular complications | 681 | ||
| Microvascular complications | 681 | ||
| Diabetic eye disease | 681 | ||
| Retinopathy | 682 | ||
| The diabetic kidney | 684 | ||
| Diabetic nephropathies | 684 | ||
| 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 | 685 | ||
| Autonomic neuropathy | 686 | ||
| The diabetic foot | 686 | ||
| Infections | 686 | ||
| The skin | 686 | ||
| Special situations | 687 | ||
| Surgery | 687 | ||
| Major surgery (i.e. having a general anaesthesic): | 687 | ||
| Minor surgery (e.g. endoscopy): | 687 | ||
| Insulin-treated patients | 687 | ||
| Tablet-controlled diabetes | 688 | ||
| Pregnancy and diabetes | 688 | ||
| Acutely ill hospital inpatients | 688 | ||
| Unstable diabetes | 688 | ||
| Hypoglycaemia in the non-diabetic | 688 | ||
| Insulinomas | 688 | ||
| Clinical features | 690 | ||
| Investigations | 690 | ||
| Treatment | 690 | ||
| Disorders of lipid metabolism | 690 | ||
| Measurement of plasma lipids | 691 | ||
| The primary hyperlipidaemias | 692 | ||
| Disorders of VLDL and chylomicrons – hypertriglyceridaemia alone | 692 | ||
| Disorders of LDL – hypercholesterolaemia alone | 692 | ||
| Combined hyperlipidaemia (hypercholesterolaemia and hyperlipidaemia) | 693 | ||
| Management of hyperlipidaemia | 693 | ||
| Guidelines to therapy | 693 | ||
| Lipid-lowering diet | 693 | ||
| Lipid-lowering drugs (Table 15.12) | 693 | ||
| Whom to treat | 694 | ||
| Primary prevention for people at risk of cardiovascular disease | 694 | ||
| Secondary prevention | 695 | ||
| Aims of treatment | 695 | ||
| The porphyrias | 695 | ||
| Acute intermittent porphyria | 695 | ||
| Clinical features | 695 | ||
| Investigations | 696 | ||
| Management | 697 | ||
| Other porphyrias | 697 | ||
| Amyloidosis | 697 | ||
| Therapeutics | 697 | ||
| Oral antidiabetic drugs | 697 | ||
| Mechanism of action | 697 | ||
| Indications | 698 | ||
| Preparations and dose | 698 | ||
| Metformin | 698 | ||
| Side-effects | 698 | ||
| 16 The special senses | 703 | ||
| The ear | 703 | ||
| Hearing loss | 703 | ||
| Vertigo | 704 | ||
| Benign paroxysmal positional vertigo | 704 | ||
| Vestibular neuronitis | 705 | ||
| Ménière’s disease | 705 | ||
| Central causes | 705 | ||
| Ear infections | 705 | ||
| The nose and nasal cavity | 706 | ||
| Epistaxis (nose bleeds) | 707 | ||
| Sinusitis | 707 | ||
| The throat | 707 | ||
| Hoarseness (dysphonia) | 707 | ||
| Stridor | 708 | ||
| Sore throat | 708 | ||
| The eye | 708 | ||
| The red eye | 708 | ||
| Visual loss | 709 | ||
| 17 Neurology | 715 | ||
| Common neurological symptoms | 715 | ||
| Headache | 715 | ||
| Dizziness, faints and ‘funny turns’ | 715 | ||
| Dizziness and syncope | 717 | ||
| Investigation | 718 | ||
| Weakness | 718 | ||
| The corticospinal tracts | 718 | ||
| The upper motor neurone | 718 | ||
| The lower motor neurone | 720 | ||
| Numbness | 721 | ||
| The sensory system | 721 | ||
| Peripheral nerve lesions | 721 | ||
| Spinal root lesions | 721 | ||
| Spinal cord lesions | 721 | ||
| Pontine lesions | 724 | ||
| Thalamic lesions | 724 | ||
| Cortical lesions | 724 | ||
| Tremor | 724 | ||
| Coordination of movement | 724 | ||
| The cerebellum | 724 | ||
| The cranial nerves | 725 | ||
| The olfactory nerve (first cranial nerve) | 725 | ||
| The optic nerve (second cranial nerve) and the visual system | 726 | ||
| Visual field defects | 726 | ||
| Optic nerve lesions | 728 | ||
| Defects of the optic chiasm | 729 | ||
| Defects of the optic tract and radiation | 729 | ||
| Defects of the occipital cortex | 729 | ||
| Optic disc oedema (papilloedema) and optic atrophy | 729 | ||
| Papilloedema | 729 | ||
| Optic atrophy | 729 | ||
| The pupils | 729 | ||
| Cranial nerves III–XII | 730 | ||
| The ocular movements and the third, fourth and sixth cranial nerves | 731 | ||
| The trigeminal nerve (fifth cranial nerve) | 732 | ||
| Trigeminal neuralgia | 733 | ||
| Clinical features | 733 | ||
| Management | 733 | ||
| Differential diagnosis | 734 | ||
| The facial nerve (seventh cranial nerve) | 734 | ||
| Lower motor neurone (LMN) lesions | 734 | ||
| Bell’s palsy | 734 | ||
| Clinical features | 734 | ||
| Investigations | 734 | ||
| Management | 735 | ||
| Prognosis | 735 | ||
| Ramsay Hunt syndrome | 735 | ||
| Upper motor neurone (UMN) lesions | 735 | ||
| The vestibulocochlear nerve (eighth cranial nerve) | 735 | ||
| Vertigo | 736 | ||
| Nystagmus | 736 | ||
| Pendular nystagmus | 736 | ||
| Jerk nystagmus | 736 | ||
| Glossopharyngeal, vagus, accessory and hypoglossal nerves (ninth to twelfth cranial nerves) | 736 | ||
| Common investigations in neurological disease | 737 | ||
| Blood tests | 737 | ||
| Imaging | 737 | ||
| Skull and spinal X-rays | 737 | ||
| Computed tomography (CT) | 737 | ||
| Magnetic resonance imaging (MRI) | 737 | ||
| Positron emission tomography (PET) | 737 | ||
| Doppler studies | 737 | ||
| Electroencephalography (EEG) | 737 | ||
| Lumbar puncture and cerebrospinal fluid (CSF) examination | 737 | ||
| Electromyography (EMG) | 738 | ||
| Investigation of suspected muscle disease | 738 | ||
| Unconsciousness and coma | 738 | ||
| Aetiology | 739 | ||
| Assessment | 740 | ||
| Immediate assessment | 740 | ||
| Further assessment | 741 | ||
| Investigations | 741 | ||
| Blood and urine tests | 742 | ||
| Radiology | 742 | ||
| CSF examination | 742 | ||
| Management | 742 | ||
| Prognosis | 742 | ||
| Brain death | 742 | ||
| Stroke and cerebrovascular disease | 743 | ||
| Definitions | 743 | ||
| Stroke | 743 | ||
| Stroke in evolution | 743 | ||
| A minor stroke | 743 | ||
| Transient ischaemic attack | 743 | ||
| Pathophysiology | 743 | ||
| Completed stroke | 743 | ||
| Transient ischaemic attacks | 744 | ||
| Risk factors | 744 | ||
| Transient ischaemic attacks (TIAs) | 744 | ||
| Investigations | 745 | ||
| Blood | 745 | ||
| Brain imaging | 745 | ||
| Carotid artery imaging | 745 | ||
| Treatment | 745 | ||
| Antithrombotic treatment | 745 | ||
| Other secondary prevention | 746 | ||
| Carotid endarterectomy | 746 | ||
| Cerebral infarction | 746 | ||
| Clinical features | 746 | ||
| Cerebral hemisphere infarcts | 746 | ||
| Brainstem infarction | 746 | ||
| Multi-infarct dementia | 748 | ||
| Management | 748 | ||
| Prognosis | 750 | ||
| Primary intracranial haemorrhage | 750 | ||
| Intracerebral haemorrhage | 750 | ||
| Subarachnoid haemorrhage (SAH) | 750 | ||
| Incidence | 750 | ||
| Aetiology | 750 | ||
| Clinical features | 751 | ||
| Investigation | 752 | ||
| Management | 752 | ||
| Prognosis | 752 | ||
| Subdural haematoma (SDH) | 752 | ||
| Extradural haemorrhage | 753 | ||
| Epilepsy and loss of consciousness | 753 | ||
| Epilepsy | 753 | ||
| Classification | 753 | ||
| Aetiology and precipitants | 754 | ||
| Evaluation and investigation | 755 | ||
| Management | 755 | ||
| Emergency measures | 755 | ||
| Status epilepticus | 755 | ||
| Antiepileptic drugs (AEDs) | 756 | ||
| Drug withdrawal | 757 | ||
| Neurosurgical treatment | 757 | ||
| Advice to patients | 758 | ||
| Movement disorders | 758 | ||
| Akinetic–rigid syndromes | 759 | ||
| Idiopathic Parkinson’s disease | 759 | ||
| Aetiology | 759 | ||
| Clinical features | 759 | ||
| Investigations | 760 | ||
| Management | 760 | ||
| Levodopa | 760 | ||
| Dopamine agonists | 760 | ||
| Monoamine oxidase B inhibitor | 760 | ||
| Additional treatment | 760 | ||
| Other akinetic-rigid syndromes | 761 | ||
| Drug-induced parkinsonism | 761 | ||
| ‘Parkinsonism plus’ | 761 | ||
| Dyskinesias | 761 | ||
| Benign essential tremor | 761 | ||
| Chorea | 761 | ||
| Huntington’s disease | 761 | ||
| Hemiballismus | 762 | ||
| Myoclonus | 762 | ||
| Tics | 762 | ||
| Dystonias | 762 | ||
| Multiple sclerosis (MS) | 763 | ||
| Epidemiology | 763 | ||
| Aetiology | 763 | ||
| Pathology | 763 | ||
| Clinical features | 763 | ||
| Optic neuropathy | 764 | ||
| Brainstem demyelination | 764 | ||
| Spinal cord lesions | 764 | ||
| Differential diagnosis | 764 | ||
| Investigations | 764 | ||
| Management | 765 | ||
| Nervous system infection and inflammation | 765 | ||
| Meningitisnd | 765 | ||
| Clinical features | 765 | ||
| Acute bacterial meningitis | 765 | ||
| Viral meningitis | 766 | ||
| Chronic meningitis | 766 | ||
| Differential diagnosis | 766 | ||
| Management | 767 | ||
| Notification | 767 | ||
| Meningococcal prophylaxis | 768 | ||
| Encephalitis | 768 | ||
| Acute viral encephalitis | 768 | ||
| 18 Dermatology | 803 | ||
| Introduction | 803 | ||
| Skin and soft tissue infections | 803 | ||
| Cellulitis and erysipelas | 803 | ||
| Clinical features | 804 | ||
| Diagnosis | 804 | ||
| Treatment | 804 | ||
| Necrotizing fasciitis | 805 | ||
| Gas gangrene | 805 | ||
| Fungal infections | 805 | ||
| Candida albicans | 806 | ||
| Common skin conditions | 806 | ||
| Acne vulgaris | 806 | ||
| Clinical features | 807 | ||
| Management | 807 | ||
| First-line therapy | 807 | ||
| Second-line therapy | 807 | ||
| Third-line therapy | 807 | ||
| Psoriasis | 807 | ||
| Aetiology | 808 | ||
| Clinical features | 808 | ||
| Associated features | 809 | ||
| Management | 809 | ||
| Topical treatment | 809 | ||
| Phototherapy | 809 | ||
| Systemic therapy | 809 | ||
| Urticaria/angio-oedema | 809 | ||
| Dictionary of terms | 819 | ||
| Index | 831 | ||
| A | 831 | ||
| B | 834 | ||
| C | 836 | ||
| D | 840 | ||
| E | 842 | ||
| F | 843 | ||
| G | 844 | ||
| H | 845 | ||
| I | 848 | ||
| J | 850 | ||
| K | 850 | ||
| L | 850 | ||
| M | 852 | ||
| N | 854 | ||
| O | 856 | ||
| P | 856 | ||
| Q | 860 | ||
| R | 860 | ||
| S | 861 | ||
| T | 864 | ||
| U | 866 | ||
| V | 867 | ||
| W | 868 | ||
| X | 868 | ||
| Y | 869 | ||
| Z | 869 | ||
| Normal values | ibc_4 |