Davidson’s Principles and Practice of Medicine (23rd Edition)

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Download Davidson’s Principles and Practice of Medicine (23rd Edition) written by Stuart H. Ralston, Ian D. Penman, Mark W J Strachan, Richard Hobson. in PDF format. This book is under the category Medicine and bearing the isbn/isbn13 number 702070289/9780702070280. You may reffer the table below for additional details of the book.

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Specifications

book-author

Stuart H. Ralston, Ian D. Penman, Mark W J Strachan, Richard Hobson.

publisher

Elsevier; 23rd edition

file-type

PDF

pages

1419 pages

language

English

asin

B079L6THPM

isbn10

702070289

isbn13

9780702070280


Book Description

More than 2 million doctors; medical students; and other health professionals around the world have owned a copy of Davidson’s Principles and Practice of Medicine 23rd edition (PDF) since it was first published. Now in its Twenty third Edition; this PDF etextbook describes the clinical features and pathophysiology of the most frequently encountered conditions in the major specialties of adult medicine and explains how to investigate; recognize; diagnose and manage them. Taking its origins from Sir S. Davidson’s much-admired lecture notes; Davidson’s has endured because it keeps pace with how modern medicine is taught and provides a wealth of information in a concise; easy-to-read; and beautifully illustrated format. This etextbook will serve medical students and readers everywhere as a core textbook that integrates medical science with clinical medicine; conveying practical advice and key knowledge in a highly accessible and readable format.

    • Clinical Examination overviews summarise the main elements for each system and now feature in the nutrition; biochemistry and dermatology chapters.
    • The opening section describes the fundamentals of immunology; genetics; infectious diseases and population health; and discusses the core principles of clinical decision-making and good prescribing.
    • A new second section on emergency and critical care medicine encompasses envenomation; poisoning; and environmental medicine; and introduces a new chapter on acute medicine and critical illness.
    • The third section covers the major medical specialties; each thoroughly revised and brought fully up to date. 2 new chapters on maternal and transition/adolescent medicine complement the one on disease and ageing.
    • A new chapter on medical ophthalmology has been included as a direct response to students’ requests.
    • Presenting Problems sections provide a clear pathway for the assessment of and approach to the most common complaints in each specialty.
    • Practice Point summaries detail the practical skills that college students and junior doctors must acquire.
    • Emergency boxes emphasize the core knowledge needed to manage acutely ill patients.

  • In Old Age; In Pregnancy and In Adolescence boxes highlight differences in the practice of medicine in these patient groups; and illustrate the interfaces between medical; obstetric and pediatric services.
  • The textbook is extensively illustrated; with over 1000 clinical photographs; diagrams; and radiology and pathology images.
  • A new internal text design for this 23rd Edition provides a simpler and clearer presentation of the various categories of text boxes.

The global perspective is enhanced by an International Advisory Board of experts from seventeen countries; and by expert authors from around the world.

Additional information

book-author

Stuart H. Ralston, Ian D. Penman, Mark W J Strachan, Richard Hobson.

publisher

Elsevier; 23rd edition

file-type

PDF

pages

1419 pages

language

English

asin

B079L6THPM

isbn10

702070289

isbn13

9780702070280

Table of contents


Table of contents :
Front Cover
Inside Front Cover
Half title page
Sir Stanley Davidson (1894–1981)
Davidson’s Principles and Practice of Medicine
Copyright Page
Table Of Contents
Preface
Contributors
International Advisory Board
Acknowledgements
Introduction
Clinical examination overviews
Presenting problems
Boxes
General Information
Practice Point
Emergency
In Old Age
In Pregnancy
In Adolescence
Terminology
Units of measurement
Finding what you are looking for
1 Fundamentals of Medicine
1 Clinical decision-making
Introduction
The problem of diagnostic error
Clinical reasoning: definitions
Clinical skills and decision-making
Use and interpretation of diagnostic tests
Normal values
Factors other than disease that influence test results
Operating characteristics
Sensitivity and specificity
Prevalence of disease
Dealing with uncertainty
Cognitive biases
Type 1 and type 2 thinking
Common cognitive biases in medicine
Human factors
Reducing errors in clinical decision-making
Cognitive debiasing strategies
History and physical examination
Problem lists and differential diagnosis
Mnemonics and checklists
Red flags and ROWS (‘rule out worst case scenario’)
Using clinical prediction rules and other decision aids
Effective team communication
Patient-centred evidence-based medicine and shared decision-making
Clinical decision-making: putting it all together
Evidence-based history and examination
Deciding pre-test probability
Interpreting test results
Treatment threshold
Post-test probability
Cognitive biases
Human factors
Reducing cognitive error
Person-centred EBM and information given to patient
Answers to problems
Harvard problem (p. 5)
Bat and ball problem (p. 6)
Further information
Books and journal articles
Websites
2 Clinical therapeutics and good prescribing
Principles of clinical pharmacology
Pharmacodynamics
Drug targets and mechanisms of action
Dose–response relationships
Therapeutic index
Desensitisation and withdrawal effects
Pharmacokinetics
Drug absorption and routes of administration
Enteral administration
Parenteral administration
Other routes of administration
Drug distribution
Volume of distribution
Drug elimination
Drug metabolism
Drug excretion
Elimination kinetics
Repeated dose regimens
Inter-individual variation in drug responses
Adverse outcomes of drug therapy
Adverse drug reactions
Prevalence of ADRs
Classification of ADRs
Detecting ADRs – pharmacovigilance
Drug interactions
Mechanisms of drug interactions
Avoiding drug interactions
Medication errors
Responding when an error is discovered
Drug regulation and management
Drug development and marketing
Licensing new medicines
Drug marketing
Managing the use of medicines
Evaluating evidence
Evaluating cost-effectiveness
Implementing recommendations
Prescribing in practice
Decision-making in prescribing
Making a diagnosis
Establishing the therapeutic goal
Choosing the therapeutic approach
Choosing a drug
Absorption
Distribution
Metabolism
Excretion
Efficacy
Avoiding adverse effects
Features of the disease
Severity of disease
Coexisting disease
Avoiding adverse drug interactions
Patient adherence to therapy
Cost
Genetic factors
Choosing a dosage regimen
Dose titration
Route
Frequency
Timing
Formulation
Duration
Involving the patient
Writing the prescription
Monitoring treatment effects
Stopping drug therapy
Prescribing in special circumstances
Prescribing for patients with renal disease
Prescribing for patients with hepatic disease
Prescribing for elderly patients
Prescribing for women who are pregnant or breastfeeding
Writing prescriptions
Prescribing in hospital
Hospital discharge (‘to take out’) medicines
Prescribing in primary care
Monitoring drug therapy
Clinical and surrogate endpoints
Plasma drug concentration
Timing of samples in relation to doses
Interpreting the result
Further information
Websites
3 Clinical genetics
The fundamental principles of genomics
The packaging of genes: DNA, chromatin and chromosomes
From DNA to protein
Transcription: DNA to messenger RNA
RNA splicing, editing and degradation
Translation and protein production
Non-coding RNA
Cell division, differentiation and migration
Cell death, apoptosis and senescence
Genomics, health and disease
Classes of genetic variant
Nucleotide substitutions
Insertions and deletions
Simple tandem repeat mutations
Copy number variations
Consequences of genomic variation
Normal genomic variation
Polymorphisms and common disease
Evolutionary selection
Constitutional genetic disease
Constructing a family tree
Patterns of disease inheritance
Autosomal dominant inheritance
Autosomal recessive inheritance
X-linked inheritance
Mitochondrial inheritance
Imprinting
Somatic genetic disease
Interrogating the genome: the changing landscape of genomic technologies
Looking at chromosomes
Looking at genes
Gene amplification: polymerase chain reaction
Gene sequencing
NGS capture
Challenges of NGS technologies
Uses of NGS
Third-generation sequencing
Genomics and clinical practice
Genomics and health care
Genomics in rare neurodevelopmental disorders
Genomics and common disease
Genomics and obstetrics
Genomics and oncology
Genomics in infectious disease
Treatment of genetic disease
Pharmacogenomics
Gene therapy and genome editing
Induced pluripotent stem cells and regenerative medicine
Pathway medicine
Ethics in a genomic age
Further information
Books and journal articles
Websites
4 Clinical immunology
Functional anatomy and physiology
The innate immune system
Physical barriers
Phagocytes
Neutrophils
Monocytes and macrophages
Dendritic cells
Cytokines
Integrins
Complement
Mast cells and basophils
Natural killer cells
The adaptive immune system
Lymphoid organs
The thymus
The spleen
Lymph nodes
Mucosa-associated lymphoid tissue
Lymphatics
Humoral immunity
Immunoglobulins
Cellular immunity
CD8+ T lymphocytes
CD4+ T lymphocytes
The inflammatory response
Acute inflammation
The acute phase response
Septic shock
Resolution of inflammation
Chronic inflammation
Laboratory features of inflammation
C-reactive protein
Erythrocyte sedimentation rate
Plasma viscosity
Presenting problems in immune disorders
Recurrent infections
Aetiology
Clinical assessment
Investigations
Management
Intermittent fever
Aetiology
Clinical assessment
Investigations
Management
Anaphylaxis
Aetiology
Clinical assessment
Investigations
Management
Immune deficiency
Primary phagocyte deficiencies
Chronic granulomatous disease
Leucocyte adhesion deficiencies
Defects in cytokines and cytokine receptors
Complement pathway deficiencies
Clinical features
Investigations
Management
Primary antibody deficiencies
X-linked agammaglobulinaemia
Selective IgA deficiency
Common variable immune deficiency
Functional IgG antibody deficiency
Investigations
Management
Primary T-lymphocyte deficiencies
DiGeorge syndrome
Bare lymphocyte syndromes
Severe combined immune deficiency
Investigations
Management
Autoimmune lymphoproliferative syndrome
Secondary immune deficiencies
Periodic fever syndromes
Familial Mediterranean fever
Mevalonic aciduria (mevalonate kinase deficiency)
TNF receptor-associated periodic syndrome
Amyloidosis
Pathophysiology
Clinical features
Investigations
Management
Autoimmune disease
Pathophysiology
Clinical features
Investigations
Autoantibodies
Complement
Cryoglobulins
Management
Allergy
Pathophysiology
Clinical features
Insect venom allergy
Peanut allergy
Birch oral allergy syndrome
Diagnosis
Investigations
Skin-prick tests
Specific IgE tests
Supervised exposure to allergen
Mast cell tryptase
Serum total IgE
Eosinophilia
Management
Avoidance of the allergen
Antihistamines
Glucocorticoids
Sodium cromoglicate
Antigen-specific immunotherapy
Omalizumab
Adrenaline (epinephrine)
Angioedema
Pathophysiology
Clinical features
Investigations
Management
Hereditary angioedema
Clinical features
Investigations
Management
Acquired C1 inhibitor deficiency
Transplantation and graft rejection
Transplant rejection
Investigations
Pre-transplantation testing
Post-transplant biopsy: C4d staining
Complications of transplant immunosuppression
Organ donation
Tumour immunology
Further information
5 Population health and epidemiology
Global burden of disease and underlying risk factors
Life expectancy
Global causes of death and disability
Risk factors underlying disease
Social determinants of health
The hierarchy of systems – from molecules to ecologies
The life course
Preventive medicine
Alcohol
Smoking
Obesity
Poverty and affluence
Atmospheric pollution
Climate change and global warming
Principles of screening
Epidemiology
Understanding causes and effect
Health data/informatics
Further information
Books and journal articles
Websites
6 Principles of infectious disease
Infectious agents
Viruses
Prokaryotes: bacteria (including mycobacteria and actinomycetes)
Eukaryotes: fungi, protozoa and helminths
Prions
Normal microbial flora
Host–pathogen interactions
Characteristics of successful pathogens
The host response
Pathogenesis of infectious disease
The febrile response
Investigation of infection
Direct detection of pathogens
Detection of whole organisms
Detection of components of organisms
Nucleic acid amplification tests
Culture
Blood culture
Indirect detection of pathogens
Antibody detection
Enzyme-linked immunosorbent assay
Immunoblot (Western blot)
Immunofluorescence assays
Complement fixation test
Agglutination tests
Other tests
Antibody-independent specific immunological tests
Antimicrobial susceptibility testing
Epidemiology of infection
Geographical and temporal patterns of infection
Endemic disease
Emerging and re-emerging disease
Reservoirs of infection
Human reservoirs
Animal reservoirs
Environmental reservoirs
Transmission of infection
Deliberate release
Infection prevention and control
Health care-associated infection
Outbreaks of infection
Immunisation
Vaccination
Types of vaccine
Use of vaccines
Antimicrobial stewardship
Treatment of infectious diseases
Principles of antimicrobial therapy
Antimicrobial action and spectrum
Empiric versus targeted therapy
Combination therapy
Antimicrobial resistance
Duration of therapy
Pharmacokinetics and pharmacodynamics
Therapeutic drug monitoring
Antimicrobial prophylaxis
Antibacterial agents
Beta-lactam antibiotics
Pharmacokinetics
Adverse effects
Drug interactions
Penicillins
Cephalosporins and cephamycins
Monobactams
Carbapenems
Macrolide and lincosamide antibiotics
Pharmacokinetics
Macrolides
Lincosamides (e.g. clindamycin)
Adverse effects
Aminoglycosides and spectinomycin
Pharmacokinetics
Gentamicin dosing
Adverse effects
Spectinomycin
Quinolones and fluoroquinolones
Pharmacokinetics
Adverse effects
Glycopeptides
Pharmacokinetics
Vancomycin
Teicoplanin
Adverse effects
Lipopeptides
Polymyxins
Folate antagonists
Pharmacokinetics
Adverse effects
Tetracyclines and glycylcyclines
Tetracyclines
Pharmacokinetics
Adverse effects
Glycylcyclines (tigecycline)
Nitroimidazoles
Pharmacokinetics
Adverse effects
Phenicols
Oxazolidinones
Other antibacterial agents
Fusidic acid
Nitrofurantoin
Fidaxomicin
Fosfomycin
Antimycobacterial agents
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Streptomycin
Other antituberculous agents
Clofazimine
Antifungal agents
Azole antifungals
Imidazoles
Triazoles
Echinocandins
Polyenes
Lipid formulations of amphotericin B
Other antifungal agents
Flucytosine
Griseofulvin
Terbinafine
Antiviral agents
Antiretroviral agents
Anti-herpesvirus agents
Aciclovir, valaciclovir, penciclovir and famciclovir
Ganciclovir
Cidofovir
Foscarnet
Anti-influenza agents
Zanamivir and oseltamivir
Amantadine and rimantadine
Other agents used to treat viruses
Ribavirin
Antiparasitic agents
Antimalarial agents
Artemisinin (qinghaosu) derivatives
Atovaquone
Folate synthesis inhibitors (proguanil, pyrimethamine–sulfadoxine)
Quinoline-containing compounds
Lumefantrine
Drugs used in trypanosomiasis
Benznidazole
Eflornithine
Melarsoprol
Nifurtimox
Pentamidine isetionate
Suramin
Other antiprotozoal agents
Pentavalent antimonials
Diloxanide furoate
Iodoquinol (di-iodohydroxyquinoline)
Nitazoxanide
Paromomycin
Drugs used against helminths
Benzimidazoles (albendazole, mebendazole)
Bithionol
Diethylcarbamazine
Ivermectin
Niclosamide
Piperazine
Praziquantel
Pyrantel pamoate
Thiabendazole
Further information
Websites
2 Emergency and Critical Care Medicine
7 Poisoning
Comprehensive evaluation of the poisoned patient
General approach to the poisoned patient
Triage and resuscitation
Clinical assessment and investigations
Psychiatric assessment
General management
Gastrointestinal decontamination
Activated charcoal
Gastric aspiration and lavage
Whole bowel irrigation
Urinary alkalinisation
Haemodialysis and haemoperfusion
Lipid emulsion therapy
Supportive care
Antidotes
Poisoning by specific pharmaceutical agents
Analgesics
Paracetamol
Management
Salicylates (aspirin)
Clinical features
Management
Non-steroidal anti-inflammatory drugs
Clinical features
Management
Antidepressants
Tricyclic antidepressants
Clinical features
Management
Selective serotonin and noradrenaline re-uptake inhibitors
Clinical features and management
Lithium
Clinical features
Management
Cardiovascular medications
Beta-blockers
Management
Calcium channel blockers
Clinical features
Management
Digoxin and oleander
Clinical features
Management
Iron
Clinical features
Management
Antipsychotic drugs
Clinical features
Management
Antidiabetic agents
Clinical features
Management
Pharmaceutical agents less commonly taken in poisoning
Drugs of misuse
Depressants
Benzodiazepines
Opioids
Gamma hydroxybutyrate
Stimulants and entactogens
Cocaine
Amphetamines and cathinones
Hallucinogens
Cannabis
Synthetic cannabinoid receptor agonists
Tryptamines
d-Lysergic acid diethylamide
Dissociative drugs
Volatile substances
Body packers and body stuffers
Chemicals and pesticides
Carbon monoxide
Clinical features
Management
Organophosphorus insecticides and nerve agents
Mechanism of toxicity
Clinical features and management
Acute cholinergic syndrome
Management
Intermediate syndrome
Organophosphate-induced delayed polyneuropathy
Carbamate insecticides
Paraquat
Methanol and ethylene glycol
Clinical features
Management
Corrosive substances
Aluminium and zinc phosphide
Copper sulphate
Chemicals less commonly taken in poisoning
Chemical warfare agents
Environmental poisoning
Arsenism
Fluorosis
Food-related poisoning
Paralytic shellfish poisoning
Ciguatera poisoning
Scombrotoxic fish poisoning
Plant poisoning
Further information
Books and journal articles
Websites
8 Envenomation
Comprehensive evaluation of the envenomed patient
Geographical distribution of venomous snakes
Bedside tests in the envenomed patient
Overview of envenomation
Venom
Venomous animals
Clinical effects
Local effects
General systemic effects
Specific systemic effects
General approach to the envenomed patient
First aid
Transporting patients
Assessment and management in hospital
Assessment and management of life-threatening problems
Assessment for evidence of envenoming
Laboratory investigations
Treatment
Antivenom
Non-antivenom treatments
Follow-up
Envenomation by specific animals
Venomous snakes
Clinical features and management
Scorpions
Clinical features and management
Spiders
Clinical features and management
Paralysis ticks
Venomous insects
Venomous lepidopterans
Venomous hymenopterans
Marine venomous and poisonous animals
Further information
Books and journal articles
Websites
9 Environmental medicine
Radiation exposure
Types of ionising radiation
Dosage and exposure
Effects of radiation exposure
Deterministic effects
Stochastic effects
Management of radiation exposure
Extremes of temperature
Thermoregulation
Hypothermia
Clinical features
Investigations
Management
Mild hypothermia
Severe hypothermia
Cold injury
Freezing cold injury (frostbite)
Non-freezing cold injury (trench or immersion foot)
Chilblains
Heat-related illness
Heat cramps
Heat syncope
Heat exhaustion
Heat stroke
High altitude
Physiological effects of high altitude
Illnesses at high altitude
Acute mountain sickness
High-altitude cerebral oedema
High-altitude pulmonary oedema
Chronic mountain sickness (Monge’s disease)
High-altitude retinal haemorrhage
Venous thrombosis
Refractory cough
Air travel
Advice for patients with respiratory disease
Advice for other patients
Deep venous thrombosis
Under water
Drowning and near-drowning
Clinical features
Management
Diving-related illness
Clinical features
Decompression illness
Barotrauma
Management
Humanitarian crisis
Recognition
Emergency response
Consolidation phase
Handover and withdrawal
Health-care priorities
Further information
Websites
Telephone numbers
10 Acute medicine and critical illness
Clinical examination in critical care
Monitoring
Acute medicine
The decision to admit to hospital
Ambulatory care
Presenting problems in acute medicine
Chest pain
Presentation
Site and radiation
Characteristics
Onset
Associated features
Clinical assessment
Initial investigations
Acute breathlessness
Presentation
Clinical assessment
Initial investigations
Syncope/presyncope
Presentation
Clinical assessment
Initial investigations
Delirium
Presentation
Clinical assessment
Investigations and management
Headache
Presentation
Clinical assessment
Initial investigations
Unilateral leg swelling
Presentation
Clinical assessment
Initial investigations
Identification and assessment of deterioration
Early warning scores and the role of the medical emergency team
Immediate assessment of the deteriorating patient
C – Control of obvious problem
A and B – Airway and breathing
C – Circulation
D – Disability
E – Exposure and evidence
Selecting the appropriate location for ongoing management
Common presentations of deterioration
Tachypnoea
Pathophysiology
Assessment and management
Hypoxaemia
Pathophysiology
Assessment and management
Tachycardia
Pathophysiology
Assessment and management
Hypotension
Pathophysiology
Assessment and management
Shock
Hypertension
Pathophysiology
Assessment and management
Decreased conscious level
Assessment
Management
Decreased urine output/deteriorating renal function
Assessment
Diagnosis and management
Abdominal compartment syndrome
Rhabdomyolysis
Disorders causing critical illness
Sepsis and the systemic inflammatory response
Aetiology and pathogenesis
Initiation of the inflammatory response
Propagation of the inflammatory response
Activation of the coagulation system
Organ damage from sepsis
Lactate physiology
The anti-inflammatory cascade
Management
Resuscitation in sepsis
Early source control
Noradrenaline (norepinephrine) for refractory hypotension
Other therapies for refractory hypotension
Septic cardiomyopathy
Review of the underlying pathology
Acute respiratory distress syndrome
Aetiology and pathogenesis
Diagnosis and management
Acute circulatory failure (cardiogenic shock)
Definition and aetiology
Myocardial infarction
Acute massive pulmonary embolism
Acute valvular pathology, aortic dissection and cardiac tamponade
Post cardiac arrest
Acute management
Prognosis
Other causes of multi-organ failure
Critical care medicine
Decisions around intensive care admission
Stabilisation and institution of organ support
Respiratory support
Non-invasive respiratory support
High-flow nasal cannulae
Continuous positive pressure ventilation
Non-invasive ventilation or bi-level ventilation
Intubation and intermittent positive pressure ventilation
Ventilator modes
Ventilator-induced lung injury
Advanced respiratory support
Airway pressure release ventilation
Prone positioning
Extracorporeal respiratory support
Venous–venous extracorporeal membrane oxygenation
Extracorporeal carbon dioxide removal
Cardiovascular support
Initial resuscitation
Fluid and vasopressor use
Advanced haemodynamic monitoring
Mechanical cardiovascular support
Intra-aortic balloon pump
Venous–arterial extracorporeal membrane oxygenation
Renal support
Neurological support
Daily clinical management in intensive care
Clinical review
Sedation and analgesia
Delirium in intensive care
Weaning from respiratory support
Spontaneous breathing trials
Progressive reduction in pressure support ventilation
Extubation
Tracheostomy
Nutrition
Other essential components of intensive care
Thromboprophylaxis
Glucose control
Blood transfusion
Peptic ulcer prophylaxis
Complications and outcomes of critical illness
Adverse neurological outcomes
Brain injury
ICU-acquired weakness
Critical illness polyneuropathy
Critical illness myopathy
Other long-term problems
The older patient
Withdrawal of active treatment and death in intensive care
Futility
Death
Organ donation
Donation after brain death
Donation after cardiac death
Postmortem examination or autopsy
Discharge from intensive care
Critical care scoring systems
Further information
Websites
3 Clinical Medicine
11 Infectious disease
Clinical examination of patients with infectious disease
Presenting problems in infectious diseases
Fever
Clinical assessment
Investigations
Management
Fever with localising symptoms or signs
Pyrexia of unknown origin
Clinical assessment
Investigations
Prognosis
Fever in the injection drug-user
Clinical assessment
Investigations
Management
Fever in the immunocompromised host
Clinical assessment
Investigations
Neutropenic fever
Post-transplantation fever
Positive blood culture
Clinical assessment
Investigations
Management
Central venous catheter infections
Investigations and management
Sepsis
Severe skin and soft tissue infections
Necrotising fasciitis
Gas gangrene
Other SSTIs
Acute diarrhoea and vomiting
Clinical assessment
Investigations
Management
Fluid replacement
Antimicrobial agents
Antidiarrhoeal, antimotility and antisecretory agents
Non-infectious causes of food poisoning
Antimicrobial-associated diarrhoea
Infections acquired in the tropics
Fever acquired in the tropics
Clinical assessment
Investigations and management
Diarrhoea acquired in the tropics
Eosinophilia acquired in the tropics
Clinical assessment
Investigations
Management
Skin conditions acquired in the tropics
Infections in adolescence
Infections in pregnancy
Viral infections
Systemic viral infections with exanthem
Measles
Clinical features
Management and prevention
Rubella (German measles)
Clinical features
Diagnosis
Prevention
Parvovirus B19
Clinical features
Diagnosis
Management
Human herpesvirus 6 and 7
Clinical features
Diagnosis and management
Chickenpox (varicella)
Clinical features
Diagnosis
Management and prevention
Shingles (herpes zoster)
Clinical features
Management
Enteroviral exanthems
Systemic viral infections without exanthem
Mumps
Clinical features
Diagnosis
Management and prevention
Influenza
Clinical features
Diagnosis
Management and prevention
Avian influenza
Swine influenza
Infectious mononucleosis and Epstein–Barr virus
Clinical features
Long-term complications of EBV infection
Investigations
Management
Cytomegalovirus
Clinical features
Investigations
Management
Dengue
Clinical features
Diagnosis
Management and prevention
Yellow fever
Clinical features
Diagnosis
Management and prevention
Viral haemorrhagic fevers
Clinical features
Investigations and management
Prevention
Ebola virus disease (EVD)
Clinical features
Investigations
Management
Prevention
Zika virus
Clinical features
Investigations
Prevention
Viral infections of the skin
Herpes simplex virus 1 and 2
Clinical features
Recurrence
Complications
Diagnosis
Management
Human herpesvirus 8
Enterovirus infections
Hand, foot and mouth disease
Herpangina
Poxviruses
Smallpox (variola)
Monkeypox
Cowpox
Vaccinia virus
Other poxviruses: orf and molluscum contagiosum
Gastrointestinal viral infections
Norovirus (Norwalk agent)
Astrovirus
Rotavirus
Hepatitis viruses (A–E)
Other viruses
Respiratory viral infections
Middle East respiratory syndrome coronavirus (MERS-CoV)
Clinical features
Diagnosis and management
Viral infections with neurological involvement
Japanese B encephalitis
Clinical features
Investigations, management and prevention
West Nile virus
Clinical features
Diagnosis and management
Enterovirus 71
Nipah virus encephalitis
Human T-cell lymphotropic virus type I
Viral infections with rheumatological involvement
Chikungunya virus
Prion diseases
Bacterial infections
Bacterial infections of the skin, soft tissues and bones
Staphylococcal infections
Skin infections
Wound infections
Cannula-related infection
Meticillin-resistant Staph. aureus
Staphylococcal toxic shock syndrome
Management
Streptococcal infections
Streptococcal scarlet fever
Streptococcal toxic shock syndrome
Treponematoses
Syphilis
Endemic treponematoses
Yaws
Pinta and bejel
Tropical ulcer
Buruli ulcer
Systemic bacterial infections
Brucellosis
Clinical features
Diagnosis
Management
Borrelia infections
Lyme disease
Clinical features
Diagnosis
Management
Prevention
Louse-borne relapsing fever
Clinical features
Investigations and management
Tick-borne relapsing fever
Leptospirosis
Microbiology and epidemiology
Clinical features
Bacteraemic leptospirosis
Aseptic meningitis
Icteric leptospirosis (Weil’s disease)
Pulmonary syndrome
Diagnosis
Management and prevention
Plague
Clinical features
Bubonic plague
Septicaemic plague
Pneumonic plague
Investigations
Management
Prevention and infection control
Listeriosis
Investigations and management
Typhoid and paratyphoid (enteric) fevers
Clinical features
Typhoid fever
Paratyphoid fever
Complications
Investigations
Management
Prevention
Tularaemia
Investigations and management
Melioidosis
Clinical features
Investigations and management
Actinomycete infections
Nocardiosis
Actinomyces spp.
Gastrointestinal bacterial infections
Staphylococcal food poisoning
Bacillus cereus food poisoning
Clostridium perfringens food poisoning
Campylobacter jejuni infection
Salmonella spp. infection
Escherichia coli infection
Enterotoxigenic E. coli
Entero-invasive E. coli
Enteropathogenic E. coli
Entero-aggregative E. coli
Enterohaemorrhagic E. coli
Clostridium difficile infection
Clinical features
Investigations
Management
Yersinia enterocolitica infection
Cholera
Clinical features
Diagnosis and management
Prevention
Vibrio parahaemolyticus infection
Bacillary dysentery (shigellosis)
Clinical features
Management and prevention
Respiratory bacterial infections
Diphtheria
Clinical features
Management
Prevention
Pneumococcal infection
Anthrax
Clinical features
Cutaneous anthrax
Gastrointestinal anthrax
Inhalational anthrax
Management
Bacterial infections with neurological involvement
Mycobacterial infections
Tuberculosis
Leprosy
Epidemiology and transmission
Pathogenesis
Clinical features
Leprosy reactions
Borderline cases
Investigations
Management
Patient education
Prognosis
Prevention and control
Rickettsial and related intracellular bacterial infections
Rickettsial fevers
Pathogenesis
Spotted fever group
Rocky Mountain spotted fever
Other spotted fevers
Typhus group
Scrub typhus fever
Epidemic (louse-borne) typhus
Endemic (flea-borne) typhus
Investigation of rickettsial infection
Management of rickettsial fevers
Q fever
Clinical features
Investigations and management
Bartonellosis
Investigations and management
Chlamydial infections
Trachoma
Pathology and clinical features
Investigations and management
Prevention
Protozoal infections
Systemic protozoal infections
Malaria
Pathogenesis
Life cycle of the malarial parasite
Pathology
Clinical features
P. falciparum infection
P. vivax and P. ovale infection
P. malariae and P. knowlesi infection
Investigations
Management
Mild P. falciparum malaria
Complicated P. falciparum malaria
Non-falciparum malaria
Prevention
Malaria control in endemic areas
Babesiosis
African trypanosomiasis (sleeping sickness)
Clinical features
Rhodesiense infections
Gambiense infections
Investigations
Management
Prevention
American trypanosomiasis (Chagas’ disease)
Pathology
Clinical features
Acute phase
Chronic phase
Investigations
Management and prevention
Toxoplasmosis
Clinical features
Congenital toxoplasmosis
Investigations
Management
Leishmaniasis
Epidemiology and transmission
Visceral leishmaniasis (kala-azar)
Clinical features
Investigations
Differential diagnosis
Management
Pentavalent antimonials
Amphotericin B
Other drugs
Response to treatment
HIV–visceral leishmaniasis co-infection
Post-kala-azar dermal leishmaniasis
Clinical features
Investigations and management
Prevention and control
Cutaneous and mucosal leishmaniasis
Cutaneous leishmaniasis
Pathogenesis
Clinical features
Mucosal leishmaniasis
Investigations in CL and ML
Management of CL and ML
Prevention of CL and ML
Gastrointestinal protozoal infections
Amoebiasis
Pathology
Clinical features
Intestinal amoebiasis – amoebic dysentery
Amoebic liver abscess
Investigations
Management
Prevention
Giardiasis
Clinical features and investigations
Management
Cryptosporidiosis
Cyclosporiasis
Infections caused by helminths
Intestinal human nematodes
Ancylostomiasis (hookworm)
Clinical features
Investigations
Management
Strongyloidiasis (threadworm)
Clinical features
Investigations
Management
Ascaris lumbricoides (roundworm)
Clinical features
Investigations
Management
Prevention
Enterobius vermicularis (threadworm)
Clinical features
Investigations
Management
Trichuris trichiura (whipworm)
Tissue-dwelling human nematodes
Lymphatic filariasis
Pathology
Clinical features
Investigations
Management
Chronic lymphatic pathology
Prevention
Loiasis
Clinical features
Investigations
Management
Prevention
Onchocerciasis (river blindness)
Pathology
Clinical features
Investigations
Management
Prevention
Dracunculiasis (Guinea worm)
Management and prevention
Other filariases
Mansonella perstans
Dirofilaria immitis
Zoonotic nematodes
Trichinosis (trichinellosis)
Clinical features
Investigations
Management
Anisakiasis (herring worm)
Cutaneous larva migrans
Angiostrongylus cantonensis
Gnathostomiasis
Trematodes (flukes)
Schistosomiasis
Pathology
Clinical features
Schistosoma haematobium
Schistosoma mansoni
Schistosoma japonicum, S. mekongi and S. intercalatum
Investigations
Management
Prevention
Liver flukes
Cestodes (tapeworms)
Intestinal tapeworm
Taenia solium
Taenia saginata
Taenia asiatica
Cysticercosis
Clinical features
Investigations
Management and prevention
Echinococcus granulosus (Taenia echinococcus) and hydatid disease
Clinical features
Investigations
Management and prevention
Other tapeworms
Ectoparasites
Jiggers (tungiasis)
Myiasis
Fungal infections
Superficial mycoses
Candidiasis (thrush)
Subcutaneous mycoses
Chromoblastomycosis
Mycetoma (eumycetoma and actinomycetoma)
Clinical features
Investigations
Management
Phaeohyphomycosis
Sporotrichosis
Investigations
Management
Systemic mycoses
Aspergillosis
Candidiasis
Syndromes of systemic candidiasis
Acute disseminated candidiasis
Chronic disseminated candidiasis (hepatosplenic candidiasis)
Other manifestations
Management
Cryptococcosis
Fusariosis
Mucormycosis
Talaromyces (formerly Penicillium) marneffei infection
Histoplasmosis
Pathology
Clinical features
Investigations
Management
Coccidioidomycosis
Investigations and management
Paracoccidioidomycosis
Blastomycosis
Further information
Websites
12 HIV infection and AIDS
Clinical examination in HIV disease
Epidemiology
Global and regional epidemics
Modes of transmission
Virology and immunology
Diagnosis and investigations
Diagnosing HIV infection
Viral load and CD4 counts
CD4 counts
Viral load
Clinical manifestations of HIV
Primary HIV infection
Asymptomatic infection
Minor HIV-associated disorders
Acquired immunodeficiency syndrome
Presenting problems in HIV infection
Lymphadenopathy
Weight loss
Fever
Mucocutaneous disease
Seborrhoeic dermatitis
Herpes simplex infections
Herpes zoster
Kaposi’s sarcoma
Bacillary angiomatosis
Papular pruritic eruption
Drug rashes
Oral conditions
Nail disorders
Gastrointestinal disease
Oesophageal diseases
Diarrhoea
Large-bowel diarrhoea
Small-bowel diarrhoea
Hepatobiliary disease
Chronic viral hepatitis
Hepatitis B
Hepatitis C
HIV cholangiopathy
Respiratory disease
Pneumocystis jirovecii pneumonia
Pulmonary tuberculosis
Bacterial pneumonia
Miscellaneous causes of pulmonary infiltrates
Nervous system and eye disease
Cognitive impairment
HIV-associated neurocognitive disorders
Progressive multifocal leucoencephalopathy
CMV encephalitis
Space-occupying lesions
Cerebral toxoplasmosis
Primary CNS lymphoma
Tuberculoma
Stroke
Meningitis
Cryptococcal meningitis
Tuberculous meningitis
Peripheral nerve disease
Myelopathy and radiculopathy
Psychiatric disease
Retinopathy
Rheumatological disease
Arthritis
Diffuse infiltrative lymphocytosis syndrome
Haematological abnormalities
Anaemia
Neutropenia
Thrombocytopenia
Renal disease
Cardiac disease
HIV-related cancers
Prevention of opportunistic infections
Preventing exposure
Safe water and food
Tuberculosis
Malaria vector control
Safer sex
Pets
Chemoprophylaxis
Co-trimoxazole primary prophylaxis
Tuberculosis preventive therapy
Mycobacterium avium complex prophylaxis
Preventing cryptococcosis
Immunisation
Antiretroviral therapy
Selecting antiretroviral regimens
Criteria for starting ART
Monitoring efficacy
Antiretroviral resistance
ART complications
Immune reconstitution inflammatory syndrome
Lipodystrophy
Hypersensitivity rashes
Other adverse effects
ART in special situations
Pregnancy
Prevention of HIV
Pre-exposure prophylaxis
Post-exposure prophylaxis
Further information
Websites with updated clinical guidelines
13 Sexually transmitted infections
Clinical examination in men
HIV testing
Clinical examination in women
Approach to patients with a suspected STI
STI during pregnancy
STI in children
Presenting problems in men
Urethral discharge
Investigations
Management
Genital itch and/or rash
Genital ulceration
Genital lumps
Proctitis in men who have sex with men
Presenting problems in women
Vaginal discharge
Lower abdominal pain
Genital ulceration
Genital lumps
Chronic vulval pain and/or itch
Prevention of STI
Case-finding
Changing behaviour
Sexually transmitted bacterial infections
Syphilis
Acquired syphilis
Early syphilis
Primary syphilis
Secondary syphilis
Latent syphilis
Late syphilis
Late latent syphilis
Benign tertiary syphilis
Cardiovascular syphilis
Neurosyphilis
Congenital syphilis
Investigations in adult cases
Investigations in suspected congenital syphilis
Management
Pregnancy
Treatment reactions
Gonorrhoea
Clinical features
Investigations
Management of adults
Chlamydial infection
Chlamydial infection in men
Chlamydial infection in women
Other sexually transmitted bacterial infections
Sexually transmitted viral infections
Genital herpes simplex
Clinical features
Diagnosis
Management
First episode
Recurrent genital herpes
Management in pregnancy
Human papillomavirus and anogenital warts
Clinical features
Management
Molluscum contagiosum
Viral hepatitis
Further information
Books and journal articles
Website
14 Clinical biochemistry and metabolic medicine
Clinical examination in biochemical and metabolic disorders
Biochemical investigations
Water and electrolyte homeostasis
Sodium homeostasis
Functional anatomy and physiology
Proximal renal tubule
Loop of Henle
Early distal renal tubule
Late distal renal tubule and collecting ducts
Regulation of sodium transport
Presenting problems in sodium and water balance
Hypovolaemia
Pathogenesis
Clinical features
Investigations
Management
Intravenous fluid therapy
Hypervolaemia
Pathogenesis
Clinical features
Investigations
Management
Diuretic therapy
Carbonic anhydrase inhibitors
Sodium-dependent glucose transporter inhibitors
Loop diuretics
Thiazide diuretics
Potassium-sparing diuretics
Osmotic diuretics
Clinical use of diuretics
Water homeostasis
Functional anatomy and physiology
Presenting problems in regulation of osmolality
Hyponatraemia
Pathophysiology
Hyponatraemia with hypovolaemia
Hyponatraemia with euvolaemia
Hyponatraemia with hypervolaemia
Clinical features
Investigations
Management
Hypernatraemia
Pathophysiology
Clinical features
Management
Potassium homeostasis
Functional anatomy and physiology
Presenting problems in potassium homeostasis
Hypokalaemia
Pathophysiology
Clinical features
Investigations
Management
Hyperkalaemia
Pathophysiology
Clinical features
Investigations
Management
Acid–base homeostasis
Functional anatomy and physiology
Renal control of acid–base balance
Presenting problems in acid–base balance
Metabolic acidosis
Pathophysiology
Clinical features
Investigations
Management
Metabolic alkalosis
Pathophysiology
Clinical features
Investigations
Management
Respiratory acidosis
Respiratory alkalosis
Mixed acid–base disorders
Calcium homeostasis
Magnesium homeostasis
Functional anatomy and physiology
Presenting problems in magnesium homeostasis
Hypomagnesaemia
Pathophysiology
Clinical features
Management
Hypermagnesaemia
Phosphate homeostasis
Functional anatomy and physiology
Presenting problems in phosphate homeostasis
Hypophosphataemia
Pathophysiology
Clinical features
Investigations
Management
Hyperphosphataemia
Pathophysiology
Clinical features
Management
Disorders of amino acid metabolism
Phenylketonuria
Homocystinuria
Disorders of carbohydrate metabolism
Galactosaemia
Glycogen storage diseases
Disorders of complex lipid metabolism
Lipids and lipoprotein metabolism
Functional anatomy and physiology
Processing of dietary lipid
Endogenous lipid synthesis
Cholesterol transport
Lipids and cardiovascular disease
Investigations
Presenting problems in lipid metabolism
Hypercholesterolaemia
Hypertriglyceridaemia
Mixed hyperlipidaemia
Rare dyslipidaemias
Principles of management
Non-pharmacological management
Pharmacological management
Hypercholesterolaemia
Statins
Ezetimibe
Bile acid-sequestering resins
PCSK9 inhibitors
Nicotinic acid
Combination therapy
Hypertriglyceridaemia
Fibrates
Highly polyunsaturated long-chain n-3 fatty acids
Mixed hyperlipidaemia
Monitoring of therapy
The porphyrias
Clinical features
Investigations
Management
Further information
Journal articles
Websites
15 Nephrology and urology
Clinical examination of the kidney and urinary tract
Functional anatomy and physiology
The kidneys
The nephron
The glomerulus
Renal tubules, loop of Henle and collecting ducts
The ureters and bladder
The prostate gland
The penis
Investigation of renal and urinary tract disease
Glomerular filtration rate
Urine investigations
Blood tests
Haematology
Biochemistry
Immunology
Imaging
Ultrasound
Computed tomography
Magnetic resonance imaging
Renal arteriography
Pyelography
Radionuclide studies
Renal biopsy
Presenting problems in renal and urinary tract disease
Oliguria/anuria
Haematuria
Nephritic syndrome
Proteinuria
Moderately elevated albuminuria (microalbuminuria)
Overt (dipstick-positive) proteinuria
Nephrotic syndrome
Oedema
Clinical assessment
Investigations
Management
Hypertension
Loin pain
Dysuria
Frequency
Polyuria
Nocturia
Urinary incontinence
Glomerular diseases
Glomerulonephritis
Diseases typically presenting with nephrotic syndrome
Minimal change nephropathy
Focal segmental glomerulosclerosis
Membranous nephropathy
Diseases typically presenting with mild nephritic syndrome
IgA nephropathy
Henoch–Schönlein purpura
Mesangiocapillary glomerulonephritis
Diseases typically presenting with rapidly progressive glomerulonephritis
Anti-glomerular basement membrane disease
Infection-related glomerulonephritis
Tubulo-interstitial diseases
Acute interstitial nephritis
Clinical features
Investigations
Management
Chronic interstitial nephritis
Pathophysiology
Clinical features
Management
Papillary necrosis
Genetic renal diseases
Inherited glomerular diseases
AIport’s syndrome
Thin glomerular basement membrane disease
Hereditary nephrotic syndrome
Inherited tubulo-interstitial diseases
Isolated defects of tubular function
Cystic diseases of the kidney
Adult polycystic kidney disease
Clinical features
Investigations
Management
Other cystic diseases
Renal vascular diseases
Renal artery stenosis
Pathophysiology
Clinical features
Investigations
Management
Acute renal infarction
Diseases of small intrarenal vessels
Thrombotic microangiopathies
Haemolytic uraemic syndrome
Thrombotic thrombocytopenic purpura
Cholesterol emboli
Small-vessel vasculitis
Renal involvement in systemic conditions
Diabetes mellitus
Multiple myeloma
Hepatic–renal disease
Sarcoidosis
Systemic vasculitis
Systemic sclerosis
Systemic lupus erythematosus
Sickle-cell nephropathy
Acute kidney injury
Pathophysiology
Clinical features
Pre-renal AKI
Renal AKI
Post-renal AKI
Management
Haemodynamic status
Hyperkalaemia and acidosis
Cardiopulmonary complications
Electrolyte disturbances
Dietary measures
Infection
Medications
Renal tract obstruction
Renal replacement therapy
Recovery from AKI
Chronic kidney disease
Epidemiology
Pathophysiology
Clinical features
Investigations
Management
Monitoring of renal function
Reduction of rate of progression
Antihypertensive therapy
Reduction of proteinuria
Treatment of complications
Maintenance of fluid and electrolyte balance
Acid–base balance
Renal bone disease
Anaemia
Treatment of risk factors for cardiovascular disease
Preparing for renal replacement therapy
Renal replacement therapy
Conservative treatment
Haemodialysis
Haemodialysis in AKI
Haemodialysis in CKD
Haemofiltration
Haemodiafiltration
Peritoneal dialysis
Renal transplantation
Renal disease in pregnancy
Renal disease in adolescence
Drugs and the kidney
Drug-induced renal disease
Non-steroidal anti-inflammatory drugs
ACE inhibitors
Prescribing in renal disease
Infections of the urinary tract
Urinary tract infection
Pathophysiology
Clinical features
Investigations
Management
Persistent or recurrent UTI
Asymptomatic bacteriuria
Catheter-related bacteriuria
Acute pyelonephritis
Tuberculosis
Reflux nephropathy
Pathophysiology
Clinical features
Investigations
Management
Urolithiasis
Pathophysiology
Clinical features
Investigations
Management
Diseases of the collecting system and ureters
Congenital abnormalities
Single kidneys
Medullary sponge kidney disease
Ureterocele
Ectopic ureters and duplex kidneys
Megaureter
Pelvi-ureteric junction obstruction
Retroperitoneal fibrosis
Tumours of the kidney and urinary tract
Renal cell cancer
Clinical features
Investigations
Management
Urothelial tumours
Pathophysiology
Clinical features
Investigations
Management
Inherited tumour syndromes affecting the renal tract
Urinary incontinence
Pathophysiology
Stress incontinence
Urge incontinence
Continual incontinence
Overflow incontinence
Post-micturition dribble
Clinical features
Investigations
Management
Prostate disease
Prostatitis
Benign prostatic enlargement
Pathophysiology
Clinical features
Investigations
Management
Prostate cancer
Pathophysiology
Clinical features
Investigations
Management
Testicular tumours
Clinical features and investigations
Management and prognosis
Erectile dysfunction
Investigations
Management
Further information
Websites
16 Cardiology
Clinical examination of the cardiovascular system
Functional anatomy and physiology
Anatomy
Coronary circulation
Conduction system
Nerve supply of the heart
Physiology
Myocardial contraction
Cardiac peptides
Circulation
Endothelium
Respiration
Investigation of cardiovascular disease
Electrocardiogram
The 12-lead ECG
Exercise ECG
Ambulatory ECG
Cardiac biomarkers
Brain natriuretic peptide
Cardiac troponins
Chest X-ray
Echocardiography
Transthoracic echocardiography
Doppler echocardiography
Transoesophageal echocardiography
Stress echocardiography
Computed tomography
Magnetic resonance imaging
Cardiac catheterisation
Electrophysiology
Radionuclide imaging
Blood pool imaging
Myocardial perfusion scanning
Presenting problems in cardiovascular disease
Chest pain on exertion
Clinical assessment
Investigations
Severe prolonged chest pain
Clinical assessment
Investigations
Management
Breathlessness
Syncope
Palpitation
Clinical assessment
Investigation
Management
Cardiac arrest
Pathogenesis
Clinical assessment and management
Basic life support
Advanced life support
The Chain of Survival
Survivors of cardiac arrest
Abnormal heart sounds
Clinical assessment
Is the sound cardiac?
Is the sound pathological?
What is the origin of the sound?
Systolic murmurs
Diastolic murmurs
Continuous murmurs
Investigations
Management
Heart failure
Left heart failure
Right heart failure
Biventricular heart failure
Epidemiology
Pathogenesis
Ventricular dysfunction
High-output failure
Valvular disease
Clinical assessment
Acute left heart failure
Chronic heart failure
Complications of heart failure
Investigations
Management of acute heart failure
Management of chronic heart failure
Education
Drug treatment
Diuretics
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Neprilysin inhibitors
Vasodilators
Beta-adrenoceptor blockers
Ivabradine
Digoxin
Amiodarone
Non-pharmacological treatments
Implantable cardiac defibrillators
Resynchronisation devices
Coronary revascularisation
Cardiac transplantation
Ventricular assist devices
Cardiac arrhythmias
Pathogenesis
Clinical features
Investigations
Management
Sinus arrhythmia
Sinus bradycardia
Sinus tachycardia
Sick sinus syndrome
Atrial ectopic beats
Atrial tachycardia
Atrial flutter
Management
Atrial fibrillation
Pathogenesis
Clinical features
Investigations
Management
Paroxysmal atrial fibrillation
Persistent atrial fibrillation
Rhythm control
Rate control
Thromboprophylaxis
Supraventricular tachycardia
Atrioventricular nodal re-entrant tachycardia
Management
Atrioventricular re-entrant tachycardia
Management
Ventricular premature beats
Management
Ventricular tachycardia
Management
Torsades de pointes
Management
Atrioventricular block
First-degree atrioventricular block
Second-degree atrioventricular block
Third-degree atrioventricular block
Clinical features
Management
Bundle branch block
Principles of management of cardiac arrhythmias
Anti-arrhythmic drugs
Class I drugs
Class Ia drugs
Disopyramide
Quinidine
Class Ib drugs
Lidocaine
Mexiletine
Class Ic drugs
Flecainide
Propafenone
Class II drugs
Non-selective β-blockers
Cardioselective β-blockers
Sotalol
Class III drugs
Amiodarone
Dronedarone
Class IV drugs
Verapamil
Diltiazem
Other anti-arrhythmic drugs
Atropine sulphate
Adenosine
Digoxin
Non-pharmacological treatments
Electrical cardioversion
Defibrillation
Temporary pacemakers
Permanent pacemakers
Implantable cardiac defibrillators
Cardiac resynchronisation therapy
Catheter ablation therapy
Coronary artery disease
Pathogenesis
Age and sex
Genetics
Smoking
Hypertension
Hypercholesterolaemia
Diabetes mellitus
Haemostatic factors
Physical activity
Obesity
Alcohol
Diet
Personality
Social deprivation
Management
Primary prevention
Secondary prevention
Angina pectoris
Pathogenesis
Coronary artery spasm
Syndrome X
Other causes
Clinical features
Investigations
Management
Anti-anginal drug therapy
Nitrates
Beta-blockers
Calcium channel antagonists
Potassium channel activators
If channel antagonist
Ranolazine
Non-pharmacological treatments
Percutaneous coronary intervention
Coronary artery bypass grafting
Prognosis
Acute coronary syndrome
Pathogenesis
Clinical features
Arrhythmias
Recurrent angina
Acute heart failure
Pericarditis
Dressler’s syndrome
Papillary muscle rupture
Ventricular septum rupture
Ventricular rupture
Embolism
Ventricular remodelling
Ventricular aneurysm
Investigations
Electrocardiogram
Cardiac biomarkers
Radiography
Echocardiography
Coronary angiography
Management
Analgesia
Reperfusion therapy
Thrombolytic therapy
Antithrombotic therapy
Anti-anginal therapy
Renin–angiotensin blockade
Mineralocorticoid receptor antagonists
Lipid-lowering therapy
Smoking cessation
Diet and exercise
Rehabilitation
Implantable defibrillators
Prognosis
Non-cardiac surgery in patients with heart disease
Peripheral arterial disease
Pathogenesis
Clinical features
Intermittent claudication
Critical limb ischaemia
Acute limb ischaemia
Atheroembolism
Subclavian steal
Investigations
Management
Buerger’s disease
Raynaud’s syndrome
Diseases of the aorta
Aortic aneurysm
Pathogenesis
Clinical features
Investigations
Management
Aortic dissection
Pathogenesis
Clinical features
Investigations
Management
Aortitis
Marfan’s syndrome
Clinical features
Investigations
Management
Coarctation of the aorta
Hypertension
Pathogenesis
Clinical features
Investigations
Blood pressure measurements
Ambulatory blood pressure measurements
Home blood pressure measurements
Other investigations
Management
Intervention thresholds
Treatment targets
Non-drug therapy
Drug therapy
Thiazides
ACE inhibitors
Angiotensin receptor blockers
Calcium channel antagonists
Beta-blockers
Combined β- and α-blockers
Other vasodilators
Aspirin
Statins
Choice of antihypertensive drug
Combination therapy
Refractory hypertension
Accelerated hypertension
Management
Diseases of the heart valves
Rheumatic heart disease
Acute rheumatic fever
Pathogenesis
Clinical features
Carditis
Arthritis
Skin lesions
Sydenham’s chorea
Other features
Investigations
Management
Bed rest
Treatment of cardiac failure
Antibiotics
Aspirin
Glucocorticoids
Chronic rheumatic heart disease
Pathogenesis
Mitral valve disease
Mitral stenosis
Pathogenesis
Clinical features
Investigations
Management
Medical management
Mitral balloon valvuloplasty and valve replacement
Mitral regurgitation
Pathogenesis
Mitral valve prolapse
Other causes of mitral regurgitation
Clinical features
Investigations
Management
Aortic valve disease
Aortic stenosis
Pathogenesis
Clinical features
Investigations
Management
Aortic regurgitation
Pathogenesis
Clinical features
Investigations
Management
Tricuspid valve disease
Tricuspid stenosis
Clinical features and investigations
Management
Tricuspid regurgitation
Clinical features
Management
Pulmonary valve disease
Pulmonary stenosis
Clinical features
Investigations
Management
Pulmonary regurgitation
Prosthetic valves
Transcatheter aortic valve implantation
Prosthetic valve dysfunction
Infective endocarditis
Epidemiology
Pathophysiology
Microbiology
Clinical features
Subacute endocarditis
Acute endocarditis
Post-operative endocarditis
Investigations
Management
Prevention
Congenital heart disease
Pathophysiology
Clinical features
Central cyanosis and digital clubbing
Growth retardation and learning difficulties
Syncope
Pulmonary hypertension
Eisenmenger’s syndrome
Congenital heart disease in pregnancy
Persistent ductus arteriosus
Pathophysiology
Clinical features
Investigations
Management
Coarctation of the aorta
Pathogenesis
Clinical features
Investigations
Management
Atrial septal defect
Pathogenesis
Clinical features
Investigations
Management
Ventricular septal defect
Pathogenesis
Clinical features
Investigations
Management
Tetralogy of Fallot
Pathogenesis
Clinical features
Investigations
Management
Other causes of cyanotic congenital heart disease
Adult congenital heart disease
Diseases of the myocardium
Myocarditis
Clinical features
Investigations
Management
Cardiomyopathy
Dilated cardiomyopathy
Pathogenesis
Clinical features
Investigations
Management
Hypertrophic cardiomyopathy
Pathogenesis
Clinical features
Investigations
Management
Arrhythmogenic ventricular cardiomyopathy
Restrictive cardiomyopathy
Obliterative cardiomyopathy
Takotsubo cardiomyopathy
Secondary causes of cardiomyopathy
Cardiac tumours
Atrial myxoma
Diseases of the pericardium
Acute pericarditis
Pathogenesis
Clinical features
Investigations
Management
Pericardial effusion
Clinical features
Investigations
Management
Tuberculous pericarditis
Chronic constrictive pericarditis
Clinical features
Investigations
Management
Cardiac tamponade
Clinical features
Investigations
Management
Further information
Websites
Journal articles
17 Respiratory medicine
Clinical examination of the respiratory system
Functional anatomy and physiology
Lung mechanics
Control of breathing
Ventilation/perfusion matching and the pulmonary circulation
Lung defences
Upper airway defences
Lower airway defences
Investigation of respiratory disease
Imaging
The ‘plain’ chest X-ray
Computed tomography
Positron emission tomography
Magnetic resonance imaging
Ultrasound
Endoscopic examination
Laryngoscopy
Bronchoscopy
Endobronchial ultrasound
Thoracoscopy
Immunological and serological tests
Microbiological investigations
Cytology and histopathology
Respiratory function testing
Measurement of airway obstruction
Lung volumes
Transfer factor
Arterial blood gases and oximetry
Exercise tests
Presenting problems in respiratory disease
Cough
Aetiology
Breathlessness
Pathophysiology
Differential diagnosis
Chronic exertional breathlessness
How is your breathing at rest and overnight?
How much can you do on a good day?
Did you have breathing problems in childhood or at school?
Do you have other symptoms along with your breathlessness?
Acute severe breathlessness
Chest pain
Finger clubbing
Haemoptysis
Management
The ‘incidental’ pulmonary nodule
Pleural effusion
Clinical assessment
Investigations
Radiological investigations
Pleural aspiration and biopsy
Management
Empyema
Clinical assessment
Investigations
Management
Respiratory failure
Pathophysiology
Management of acute respiratory failure
Chronic and ‘acute on chronic’ type II respiratory failure
Management
Home ventilation for chronic respiratory failure
Lung transplantation
Obstructive pulmonary diseases
Asthma
Pathophysiology
Clinical features
Diagnosis
Management
Setting goals
Avoidance of aggravating factors
The stepwise approach to the management of asthma
Step 1: Occasional use of inhaled short-acting β2-adrenoreceptor agonist bronchodilators
Step 2: Introduction of regular preventer therapy
Step 3: Add-on therapy
Step 4: Poor control on moderate dose of inhaled glucocorticoid and add-on therapy: addition of a fourth drug
Step 5: Continuous or frequent use of oral glucocorticoids
Step-down therapy
Exacerbations of asthma
Management of mild to moderate exacerbations
Management of acute severe asthma
Prognosis
Chronic obstructive pulmonary disease
Pathophysiology
Clinical features
Investigations
Assessment of severity
Management
Reducing exposure to noxious particles and gases
Bronchodilators
Combined inhaled glucocorticoids and bronchodilators
Oral glucocorticoids
Pulmonary rehabilitation
Oxygen therapy
Surgical intervention
Other measures
Palliative care
Prognosis
Acute exacerbations of COPD
Oxygen therapy
Bronchodilators
Glucocorticoids
Antibiotic therapy
Non-invasive ventilation
Additional therapy
Discharge
Bronchiectasis
Aetiology and pathology
Clinical features
Investigations
Management
Physiotherapy
Antibiotic therapy
Surgical treatment
Prognosis
Prevention
Cystic fibrosis
Genetics, pathogenesis and epidemiology
Clinical features
Management
Treatment of CF lung disease
Treatment of non-respiratory manifestations of CF
Novel therapies for cystic fibrosis
Infections of the respiratory system
Upper respiratory tract infection
Pneumonia
Community-acquired pneumonia
Clinical features
Investigations
Management
Oxygen
Fluid balance
Antibiotic treatment
Treatment of pleural pain
Physiotherapy
Prognosis
Discharge and follow-up
Prevention
Hospital-acquired pneumonia
Clinical features and investigation
Management
Prevention
Suppurative pneumonia, aspiration pneumonia and pulmonary abscess
Investigations
Management
Pneumonia in the immunocompromised patient
Clinical features
Investigations
Management
Tuberculosis
Epidemiology
Pathology and pathogenesis
Clinical features: pulmonary disease
Primary pulmonary TB
Miliary TB
Post-primary pulmonary TB
Clinical features: extrapulmonary disease
Lymphadenitis
Gastrointestinal tuberculosis
Pericardial disease
Central nervous system disease
Bone and joint disease
Genitourinary disease
Investigations
Drug sensitivity testing
Management
Chemotherapy
Control and prevention
Detection of latent TB
Directly observed therapy
TB and HIV/AIDS
Drug-resistant TB
Vaccines
Prognosis
Opportunistic mycobacterial infection
Respiratory diseases caused by fungi
Allergic bronchopulmonary aspergillosis
Clinical features
Management
Chronic pulmonary aspergillosis
Simple aspergilloma
Chronic cavitary pulmonary aspergillosis and chronic fibrosing pulmonary aspergillosis
Aspergillus nodule
Subacute invasive aspergillosis
Invasive pulmonary aspergillosis
Clinical features
Management and prevention
Other fungal infections
Tumours of the bronchus and lung
Primary tumours of the lung
Aetiology
Lung cancer
Pathology
Clinical features
Cough
Haemoptysis
Bronchial obstruction
Breathlessness
Pain and nerve entrapment
Mediastinal spread
Metastatic spread
Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA)
Non-metastatic extrapulmonary effects (Box 17.64)
Investigations
Imaging
Biopsy and histopathology
Staging to guide treatment
Management
Surgical treatment
Radiotherapy
Chemotherapy
Laser therapy and stenting
General aspects of management
Prognosis
Secondary tumours of the lung
Tumours of the mediastinum
Investigations
Management
Interstitial and infiltrative pulmonary diseases
Diffuse parenchymal lung disease
Idiopathic interstitial pneumonias
Idiopathic pulmonary fibrosis
Clinical features
Investigations
Management
Prognosis
Non-specific interstitial pneumonia
Sarcoidosis
Clinical features
Investigations
Management
Lung diseases due to systemic inflammatory disease
The acute respiratory distress syndrome
Respiratory involvement in connective tissue disorders
Rheumatoid disease
Systemic lupus erythematosus
Systemic sclerosis
Pulmonary eosinophilia and vasculitides
Acute eosinophilic pneumonia
Chronic eosinophilic pneumonia
Tropical pulmonary eosinophilia
Granulomatosis with polyangiitis
Goodpasture’s disease
Lung diseases due to irradiation and drugs
Radiotherapy
Drugs
Rare interstitial lung diseases
Occupational and environmental lung disease
Occupational airway disease
Occupational asthma
Reactive airways dysfunction syndrome
Chronic obstructive pulmonary disease
Byssinosis
Pneumoconiosis
Coal worker’s pneumoconiosis
Silicosis
Berylliosis
Less common pneumoconioses
Lung diseases due to organic dusts
Hypersensitivity pneumonitis
Clinical features
Investigations
Diagnosis
Management
Inhalation (‘humidifier’) fever
Asbestos-related lung and pleural diseases
Pleural plaques
Acute benign asbestos pleurisy
Diffuse pleural thickening
Asbestosis
Mesothelioma
Occupational lung cancer
Occupational pneumonia
Pulmonary vascular disease
Pulmonary embolism
Clinical features
Investigations
Management
General measures
Anticoagulation
Thrombolytic and surgical therapy
Caval filters
Prognosis
Pulmonary hypertension
Clinical features
Investigations
Management
Diseases of the upper airway
Diseases of the nasopharynx
Allergic rhinitis
Clinical features
Management
Sleep-disordered breathing
The sleep apnoea/hypopnoea syndrome
Aetiology
Clinical features
Investigations
Management
Laryngeal disorders
Chronic laryngitis
Laryngeal paralysis
Clinical features and management
Psychogenic hoarseness and aphonia
Laryngeal obstruction
Management
Tracheal disorders
Tracheal obstruction
Clinical features and management
Tracheo-oesophageal fistula
Pleural disease
Pneumothorax
Clinical features
Investigations
Management
Recurrent spontaneous pneumothorax
Diseases of the diaphragm and chest wall
Disorders of the diaphragm
Congenital disorders
Diaphragmatic hernias
Eventration of the diaphragm
Acquired disorders
Deformities of the chest wall
Thoracic kyphoscoliosis
Pectus excavatum
Pectus carinatum
Further information
Websites
18 Endocrinology
Clinical examination in endocrine disease
An overview of endocrinology
Functional anatomy and physiology
Endocrine pathology
Investigation of endocrine disease
Presenting problems in endocrine disease
The thyroid gland
Functional anatomy, physiology and investigations
Presenting problems in thyroid disease
Thyrotoxicosis
Clinical assessment
Investigations
Management
Atrial fibrillation in thyrotoxicosis
Thyrotoxic crisis (‘thyroid storm’)
Hypothyroidism
Clinical assessment
Investigations
Management
Levothyroxine replacement in ischaemic heart disease
Hypothyroidism in pregnancy
Myxoedema coma
Symptoms of hypothyroidism with normal thyroid function tests
Asymptomatic abnormal thyroid function tests
Subclinical thyrotoxicosis
Subclinical hypothyroidism
Non-thyroidal illness (‘sick euthyroidism’)
Thyroid lump or swelling
Clinical assessment and investigations
Thyroid scintigraphy
Thyroid ultrasound
Fine needle aspiration cytology
Management
Autoimmune thyroid disease
Graves’ disease
Graves’ thyrotoxicosis
Pathophysiology
Management
Antithyroid drugs
Thyroid surgery
Radioactive iodine
Thyrotoxicosis in pregnancy
Thyrotoxicosis in adolescence
Graves’ ophthalmopathy
Pretibial myxoedema
Hashimoto’s thyroiditis
Transient thyroiditis
Subacute (de Quervain’s) thyroiditis
Post-partum thyroiditis
Iodine-associated thyroid disease
Iodine deficiency
Iodine-induced thyroid dysfunction
Amiodarone
Simple and multinodular goitre
Simple diffuse goitre
Multinodular goitre
Clinical features and investigations
Management
Thyroid neoplasia
Toxic adenoma
Differentiated carcinoma
Papillary carcinoma
Follicular carcinoma
Management
Prognosis
Anaplastic carcinoma and lymphoma
Medullary carcinoma
Riedel’s thyroiditis
Congenital thyroid disease
Dyshormonogenesis
Thyroid hormone resistance
The reproductive system
Functional anatomy, physiology and investigations
The male
The female
Presenting problems in reproductive disease
Delayed puberty
Clinical assessment
Constitutional delay of puberty
Hypogonadotrophic hypogonadism
Hypergonadotrophic hypogonadism
Investigations
Management
Precocious puberty
Investigations
Management
Amenorrhoea
Clinical assessment
Investigations
Management
Male hypogonadism
Investigations
Management
Infertility
Clinical assessment
Investigations
Management
Gynaecomastia
Clinical assessment
Investigations
Management
Hirsutism
Clinical assessment
Investigations
Management
Polycystic ovarian syndrome
Management
Menstrual irregularity and infertility
Hirsutism
Turner’s syndrome
Clinical features
Diagnosis and management
Klinefelter’s syndrome
Clinical features
Diagnosis and management
The parathyroid glands
Functional anatomy, physiology and investigations
Presenting problems in parathyroid disease
Hypercalcaemia
Clinical assessment
Investigations
Management
Hypocalcaemia
Aetiology
Clinical assessment
Management
Primary hyperparathyroidism
Clinical and radiological features
Investigations
Management
Familial hypocalciuric hypercalcaemia
Hypoparathyroidism
Pseudohypoparathyroidism
Management of hypoparathyroidism
The adrenal glands
Functional anatomy and physiology
Glucocorticoids
Mineralocorticoids
Catecholamines
Adrenal androgens
Presenting problems in adrenal disease
Cushing’s syndrome
Aetiology
Clinical assessment
Investigations
Establishing the presence of Cushing’s syndrome
Determining the underlying cause
Management
Cushing’s disease
Adrenal tumours
Ectopic ACTH syndrome
Therapeutic use of glucocorticoids
Adverse effects of glucocorticoids
Management of glucocorticoid withdrawal
Adrenal insufficiency
Clinical assessment
Investigations
Assessment of glucocorticoids
Assessment of mineralocorticoids
Assessment of adrenal androgens
Other tests to establish the cause
Management
Glucocorticoid replacement
Mineralocorticoid replacement
Androgen replacement
Incidental adrenal mass
Clinical assessment and investigations
Management
Primary hyperaldosteronism
Clinical features
Investigations
Biochemical
Imaging and localisation
Management
Phaeochromocytoma and paraganglioma
Clinical features
Investigations
Localisation
Management
Congenital adrenal hyperplasia
Pathophysiology and clinical features
Investigations
Management
The endocrine pancreas and gastrointestinal tract
Presenting problems in endocrine pancreas disease
Spontaneous hypoglycaemia
Clinical assessment
Investigations
Does the patient have a hypoglycaemic disorder?
What is the cause of the hypoglycaemia?
Management
Gastroenteropancreatic neuro-endocrine tumours
Clinical features
Investigations
Management
The hypothalamus and the pituitary gland
Functional anatomy, physiology and investigations
Investigation of patients with pituitary disease
Presenting problems in hypothalamic and pituitary disease
Hypopituitarism
Clinical assessment
Investigations
Management
Cortisol replacement
Thyroid hormone replacement
Sex hormone replacement
Growth hormone replacement
Pituitary tumour
Clinical assessment
Investigations
Management
Hyperprolactinaemia/galactorrhoea
Clinical assessment
Investigations
Management
Prolactinoma
Management
Medical
Surgery and radiotherapy
Pregnancy
Acromegaly
Clinical features
Investigations
Management
Surgical
Radiotherapy
Medical
Craniopharyngioma
Diabetes insipidus
Clinical features
Investigations
Management
Disorders affecting multiple endocrine glands
Multiple endocrine neoplasia
Autoimmune polyendocrine syndromes
Late effects of childhood cancer therapy
Further information
Websites
19 Nutritional factors in disease
Clinical examination in nutritional disorders
Clinical assessment and investigation of nutritional status
Nutritional factors and disease
Physiology of nutrition
Energy balance
Regulation of energy balance
Responses to under- and over-nutrition
Macronutrients (energy-yielding nutrients)
Carbohydrates
Dietary fibre
Fats
Proteins
Dietary recommendations for macronutrients
Disorders of altered energy balance
Obesity
Complications
Body fat distribution
Aetiology
Susceptibility to obesity
Reversible causes of obesity and weight gain
Clinical features and investigations
Management
Lifestyle advice
Weight loss diets
Drugs
Surgery
Treatment of additional risk factors
Under-nutrition
Starvation and famine
Clinical features
Investigations
Management
Under-nutrition in hospital
Specific issues arising after intestinal surgery
Gastrectomy or partial gastrectomy
Proximal small bowel surgery
Pancreatic resection/Whipple’s operation
Ileal resection
Massive small bowel resection
An approach to assisted nutrition in hospital patients
Refeeding syndrome
Oral nutritional supplements
Enteral feeding
Complications
Route of access
Nasogastric tube feeding
Gastrostomy feeding
Post-pyloric feeding
Parenteral nutrition
Intestinal failure (‘short bowel syndrome’)
Management
Jejunum–colon patients
Jejunostomy patients
Small bowel and multivisceral transplantation
Further developments in treatment of intestinal failure
Artificial nutrition at the end of life
Nutrition and dementia
Micronutrients, minerals and their diseases
Vitamins
Fat-soluble vitamins
Vitamin A (retinol)
Vitamin D
Vitamin E
Vitamin K
Water-soluble vitamins
Thiamin (vitamin B1)
Deficiency – beri-beri
Riboflavin (vitamin B2)
Niacin (vitamin B3)
Deficiency – pellagra
Toxicity
Pyridoxine (vitamin B6)
Biotin
Folate (folic acid)
Hydroxycobalamin (vitamin B12)
Neurological consequences of vitamin B12 deficiency
Vitamin C (ascorbic acid)
Deficiency – scurvy
Other dietary organic compounds
Inorganic micronutrients
Calcium and phosphorus
Iron
Iodine
Zinc
Selenium
Fluoride
Sodium, potassium and magnesium
Other essential inorganic nutrients
Further information
Websites
20 Diabetes mellitus
Clinical examination of the patient with diabetes
Functional anatomy and physiology
Regulation of insulin secretion
Regulation of glucagon secretion
Blood glucose homeostasis
Fat metabolism
Investigations
Urine glucose
Blood glucose
Interstitial glucose
Urine and blood ketones
Glycated haemoglobin
Islet autoantibodies
C-peptide
Urine protein
Establishing the diagnosis of diabetes
Aetiology and pathogenesis of diabetes
Type 1 diabetes
Pathology
Genetic predisposition
Environmental predisposition
Metabolic disturbances in type 1 diabetes
Type 1 diabetes in adults
Type 2 diabetes
Pathology
Insulin resistance and the metabolic syndrome
Pancreatic β-cell failure
Genetic predisposition
Environmental and other risk factors
Diet and obesity
Age
Ethnicity
Metabolic disturbances in type 2 diabetes
Other forms of diabetes
Pancreatic disease
Monogenic diabetes
Presenting problems in diabetes mellitus
Hyperglycaemia
Presentation with the complications of diabetes
Diabetes emergencies
Diabetic ketoacidosis
Pathogenesis
Clinical assessment
Investigations
Assessment of severity
Management
Insulin
Fluid replacement
Potassium
Bicarbonate
Phosphate
Ongoing management
Hyperglycaemic hyperosmolar state
Hypoglycaemia
Clinical assessment
Circumstances of hypoglycaemia
Awareness of hypoglycaemia
Management
Acute treatment of hypoglycaemia
Prevention of hypoglycaemia
Management of diabetes
Self-assessment of glycaemic control
Therapeutic goals
Patient education, diet and lifestyle
Healthy eating
Carbohydrate
Fat
Salt
Weight management
Exercise
Alcohol
Driving
Ramadan
Drugs to reduce hyperglycaemia
Biguanides
Mechanism of action
Clinical use
Sulphonylureas
Mechanism of action
Clinical use
Alpha-glucosidase inhibitors
Thiazolidinediones
Mechanism of action
Clinical use
Incretin-based therapies: DPP-4 inhibitors and GLP-1 receptor agonists
SGLT2 inhibitors
Insulin therapy
Manufacture and formulation
Subcutaneous multiple dose insulin therapy
Insulin dosing regimens
Subcutaneous continuous insulin therapy
Closed loop insulin therapy
Transplantation
Management of diabetes in special situations
Diabetes in pregnancy
Children, adolescents and young adults with diabetes
Hyperglycaemia in acute medical illness
Surgery and diabetes
Pre-operative assessment
Perioperative management
Post-operative management
Complications of diabetes
Pathophysiology
Preventing diabetes complications
Glycaemic control
Control of other risk factors
Diabetic retinopathy
Diabetic nephropathy
Diagnosis and screening
Management
Diabetic neuropathy
Clinical features
Symmetrical sensory polyneuropathy
Asymmetrical motor diabetic neuropathy
Mononeuropathy
Autonomic neuropathy
Gastroparesis
Erectile dysfunction
Management
The diabetic foot
Aetiology
Management
Foot ulcer
Charcot neuroarthropathy
Further information
Books and journal articles
Websites
21 Gastroenterology
Clinical examination of the gastrointestinal tract
Functional anatomy and physiology
Oesophagus, stomach and duodenum
Gastric secretion
Gastrin, somatostatin and ghrelin
Protective factors
Small intestine
Digestion and absorption
Fat
Carbohydrates
Protein
Water and electrolytes
Vitamins and trace elements
Protective function of the small intestine
Physical defence mechanisms
Immunological defence mechanisms
Pancreas
Colon
Intestinal microbiota
Control of gastrointestinal function
The nervous system and gastrointestinal function
The enteric nervous system
Peristalsis
Migrating motor complexes
Gut hormones
Investigation of gastrointestinal disease
Imaging
Plain X-rays
Contrast studies
Ultrasound, computed tomography and magnetic resonance imaging
Endoscopy
Upper gastrointestinal endoscopy
Endoscopic ultrasound
Capsule endoscopy
Double balloon enteroscopy
Sigmoidoscopy and colonoscopy
Magnetic resonance cholangiopancreatography
Endoscopic retrograde cholangiopancreatography
Histology
Tests of infection
Bacterial cultures
Serology
Breath tests
Tests of function
Oesophageal motility
Gastric emptying
Colonic and anorectal motility
Radioisotope tests
Gut hormone testing
Presenting problems in gastrointestinal disease
Dysphagia
Investigations
Dyspepsia
Heartburn and regurgitation
Vomiting
Gastrointestinal bleeding
Acute upper gastrointestinal haemorrhage
Clinical assessment
Management
1. Intravenous access
2. Initial clinical assessment
3. Basic investigations
4. Resuscitation
5. Oxygen
6. Endoscopy
7. Monitoring
8. Surgery
9. Eradication
Lower gastrointestinal bleeding
Severe acute lower gastrointestinal bleeding
Subacute or chronic lower gastrointestinal bleeding
Major gastrointestinal bleeding of unknown cause
Chronic occult gastrointestinal bleeding
Diarrhoea
Acute diarrhoea
Chronic or relapsing diarrhoea
Malabsorption
Pathophysiology
Investigations
Weight loss
Physiological causes
Psychiatric illness
Systemic disease
Gastrointestinal disease
Metabolic disorders and miscellaneous causes
Investigations
Constipation
Clinical assessment and management
Initial visit
Next visit
Further investigation
Abdominal pain
The acute abdomen
Initial clinical assessment
Investigations
Management
Acute appendicitis
Acute cholecystitis
Acute diverticulitis
Small bowel obstruction
Large bowel obstruction
Perforated peptic ulcer
Chronic or recurrent abdominal pain
Constant abdominal pain
Diseases of the mouth and salivary glands
Aphthous ulceration
Oral cancer
Candidiasis
Parotitis
Diseases of the oesophagus
Gastro-oesophageal reflux disease
Pathophysiology
Abnormalities of the lower oesophageal sphincter
Hiatus hernia
Delayed oesophageal clearance
Gastric contents
Defective gastric emptying
Increased intra-abdominal pressure
Dietary and environmental factors
Patient factors
Clinical features
Complications
Oesophagitis
Barrett’s oesophagus
Diagnosis
Management
Anaemia
Benign oesophageal stricture
Gastric volvulus
Investigations
Management
Other causes of oesophagitis
Infection
Corrosives
Drugs
Eosinophilic oesophagitis
Motility disorders
Pharyngeal pouch
Achalasia of the oesophagus
Pathophysiology
Clinical features
Investigations
Management
Endoscopic
Surgical
Other oesophageal motility disorders
Secondary causes of oesophageal dysmotility
Benign oesophageal stricture
Tumours of the oesophagus
Benign tumours
Carcinoma of the oesophagus
Clinical features
Investigations
Management
Perforation of the oesophagus
Diseases of the stomach and duodenum
Gastritis
Acute gastritis
Chronic gastritis due to Helicobacter pylori infection
Autoimmune chronic gastritis
Ménétrier’s disease
Peptic ulcer disease
Gastric and duodenal ulcer
Pathophysiology
H. pylori
NSAIDs
Smoking
Clinical features
Investigations
Management
H. pylori eradication
General measures
Maintenance treatment
Surgical treatment
Complications of gastric resection or vagotomy
Dumping
Chemical (bile reflux) gastropathy
Diarrhoea and maldigestion
Weight loss
Anaemia
Metabolic bone disease
Gastric cancer
Complications of peptic ulcer disease
Perforation
Gastric outlet obstruction
Bleeding
Zollinger–Ellison syndrome
Pathophysiology
Clinical features
Investigations
Management
Functional disorders
Functional dyspepsia
Pathophysiology
Clinical features
Investigations
Management
Functional causes of vomiting
Gastroparesis
Tumours of the stomach
Gastric carcinoma
Pathophysiology
Clinical features
Investigations
Management
Surgery
Palliative treatment
Gastric lymphoma
Other tumours of the stomach
Diseases of the small intestine
Disorders causing malabsorption
Coeliac disease
Pathophysiology
Clinical features
Investigations
Duodenal biopsy
Antibodies
Haematology and biochemistry
Other investigations
Management
Complications
Dermatitis herpetiformis
Tropical sprue
Pathophysiology
Clinical features
Management
Small bowel bacterial overgrowth (‘blind loop syndrome’)
Pathophysiology
Clinical features
Investigations
Management
Whipple’s disease
Pathophysiology
Clinical features
Investigations
Management
Bile acid diarrhoea
Short bowel syndrome
Radiation enteritis and proctocolitis
Pathophysiology
Clinical features
Investigations
Management
Abetalipoproteinaemia
Motility disorders
Chronic intestinal pseudo-obstruction
Clinical features
Investigations
Management
Miscellaneous disorders of the small intestine
Protein-losing enteropathy
Intestinal lymphangiectasia
Ulceration of the small intestine
NSAID-associated small intestinal toxicity
Eosinophilic gastroenteritis
Clinical features
Investigations and management
Meckel’s diverticulum
Adverse food reactions
Lactose intolerance
Clinical features
Intolerance of other sugars
Food allergy
Infections of the small intestine
Travellers’ diarrhoea, giardiasis and amoebiasis
Abdominal tuberculosis
Investigations
Management
Cryptosporidiosis
Tumours of the small intestine
Benign tumours
Malignant tumours
Adenocarcinomas
Neuro-endocrine tumours
Lymphoma
Immunoproliferative small intestinal disease
Inflammatory bowel disease
Pathophysiology
Ulcerative colitis
Crohn’s disease
Clinical features
Ulcerative colitis
Crohn’s disease
Differential diagnosis
Complications
Life-threatening colonic inflammation
Haemorrhage
Fistulae
Cancer
Extra-intestinal complications
Investigations
Bacteriology
Endoscopy
Radiology
Management
Ulcerative colitis
Active proctitis
Active left-sided or extensive ulcerative colitis
Severe ulcerative colitis
Maintenance of remission
Crohn’s disease
Principles of treatment
Induction of remission
Maintenance therapy
Fistulae and perianal disease
Surgical treatment
Ulcerative colitis
Crohn’s disease
IBD in special circumstances
Childhood
Pregnancy
Metabolic bone disease
Refractory Crohn’s disease
Microscopic colitis
Irritable bowel syndrome
Pathophysiology
Behavioural and psychosocial factors
Physiological factors
Luminal factors
Clinical features
Investigations
Management
HIV/AIDS and the gastrointestinal tract
Ischaemic gut injury
Acute small bowel ischaemia
Acute colonic ischaemia
Chronic mesenteric ischaemia
Disorders of the colon and rectum
Tumours of the colon and rectum
Polyps and polyposis syndromes
Familial adenomatous polyposis
Peutz–Jeghers syndrome
Juvenile polyposis
Colorectal cancer
Pathophysiology
Clinical features
Investigations
Management
Surgery
Adjuvant therapy
Palliation of advanced disease
Prevention and screening
Diverticulosis
Pathophysiology
Clinical features
Investigations
Management
Constipation and disorders of defecation
Simple constipation
Severe idiopathic constipation
Faecal impaction
Melanosis coli and laxative misuse syndromes
Hirschsprung’s disease
Acquired megacolon
Acute colonic pseudo-obstruction
Anorectal disorders
Faecal incontinence
Management
Haemorrhoids
Pruritus ani
Solitary rectal ulcer syndrome
Anal fissure
Anorectal abscesses and fistulae
Diseases of the peritoneal cavity
Peritonitis
Tumours
Other disorders
Endometriosis
Pneumatosis cystoides intestinalis
Diseases of the pancreas
Acute pancreatitis
Pathophysiology
Clinical features
Investigations
Management
Chronic pancreatitis
Pathophysiology
Clinical features
Investigations
Management
Alcohol misuse
Pain relief
Malabsorption
Management of complications
Autoimmune pancreatitis
Congenital abnormalities affecting the pancreas
Pancreas divisum
Annular pancreas
Cystic fibrosis
Meconium ileus
Tumours of the pancreas
Adenocarcinoma of the pancreas
Clinical features
Investigations
Management
Incidental pancreatic mass
Further information
Books and journal articles
Websites
22 Hepatology
Clinical examination of the abdomen for liver and biliary disease
History and significance of abdominal signs
Functional anatomy and physiology
Applied anatomy
Normal liver structure and blood supply
Liver cells
Blood supply
Biliary system and gallbladder
Hepatic function
Carbohydrate, amino acid and lipid metabolism
Clotting factors
Bilirubin metabolism and bile
Storage of vitamins and minerals
Immune regulation
Investigation of liver and hepatobiliary disease
Liver blood biochemistry
Bilirubin and albumin
Alanine aminotransferase and aspartate aminotransferase
Alkaline phosphatase and γ-glutamyl transferase
Other biochemical tests
Haematological tests
Blood count
Coagulation tests
Immunological tests
Imaging
Ultrasound
Computed tomography and magnetic resonance imaging
Cholangiography
Endoscopic ultrasound
Histological examination
Non-invasive markers of hepatic fibrosis
Presenting problems in liver disease
Acute liver failure
Pathophysiology
Clinical assessment
Investigations
Management
Abnormal liver function tests
Jaundice
Pre-hepatic jaundice
Hepatocellular jaundice
Obstructive (cholestatic) jaundice
Hepatomegaly
Ascites
Pathophysiology
Investigations
Management
Sodium and water restriction
Diuretics
Paracentesis
Transjugular intrahepatic portosystemic stent shunt
Complications
Renal failure
Hepatorenal syndrome
Type 1 hepatorenal syndrome
Type 2 hepatorenal syndrome
Spontaneous bacterial peritonitis
Prognosis
Hepatic encephalopathy
Pathophysiology
Investigations
Management
Variceal bleeding
Cirrhosis
Pathophysiology
Clinical features
Management
Prognosis
Portal hypertension
Clinical features
Pathophysiology
Investigations
Management
Primary prevention of variceal bleeding
Management of acute variceal bleeding
Pharmacological reduction of portal venous pressure
Variceal ligation (‘banding’) and sclerotherapy
Balloon tamponade
TIPSS
Portosystemic shunt surgery
Oesophageal transection
Secondary prevention of variceal bleeding
Congestive ‘portal hypertensive’ gastropathy
Infections and the liver
Viral hepatitis
Clinical features of acute infection
Investigations
Management
Hepatitis A
Investigations
Management
Hepatitis B
Investigations
Serology
Hepatitis B surface antigen
Hepatitis B core antigen
Hepatitis B e antigen
Viral load and genotype
Management of acute hepatitis B
Management of chronic hepatitis B
Direct-acting nucleoside/nucleotide antiviral agents
Lamivudine
Entecavir and tenofovir
Interferon-alfa
Liver transplantation
Prevention
Co-infection with HIV
Hepatitis D (Delta virus)
Investigations
Management
Hepatitis C
Investigations
Serology and virology
Molecular analysis
Liver function tests
Liver histology
Management
Hepatitis E
Other forms of viral hepatitis
HIV infection and the liver
Liver abscess
Pyogenic liver abscess
Pathophysiology
Clinical features
Investigations
Management
Hydatid cysts and amoebic liver abscesses
Leptospirosis
Alcoholic liver disease
Pathophysiology
Clinical features
Alcoholic fatty liver disease
Alcoholic hepatitis
Alcoholic cirrhosis
Investigations
Management
Nutrition
Drug therapy
Liver transplantation
Non-alcoholic fatty liver disease
Pathophysiology
Clinical features
Investigations
Biochemical tests
Imaging
Liver biopsy
Management
Non-pharmacological treatment
Pharmacological treatment
Autoimmune liver and biliary disease
Autoimmune hepatitis
Pathophysiology
Clinical features
Investigations
Management
Primary biliary cholangitis
Epidemiology
Pathophysiology
Clinical features
Associated diseases
Diagnosis and investigations
Management
Pruritus
Fatigue
Malabsorption
Bone disease
Overlap syndromes
AMA-negative PBC (‘autoimmune cholangitis’)
PBC/autoimmune hepatitis overlap
Primary sclerosing cholangitis
Pathophysiology
Clinical features
Investigations
Management
Management of complications
Surgical treatment
IgG4-associated cholangitis
Liver tumours and other focal liver lesions
Primary malignant tumours
Hepatocellular carcinoma
Clinical features
Investigations
Serum markers
Imaging
Liver biopsy
Role of screening
Management
Hepatic resection
Liver transplantation
Percutaneous therapy
Trans-arterial chemo-embolisation
Chemotherapy
Fibrolamellar hepatocellular carcinoma
Other primary malignant tumours
Secondary malignant tumours
Clinical features
Investigations
Management
Benign tumours
Hepatic adenomas
Haemangiomas
Focal nodular hyperplasia
Cystic liver disease and liver abscess
Drugs and the liver
Drug-induced liver injury
Types of liver injury
Cholestasis
Hepatocyte necrosis
Steatosis
Vascular/sinusoidal lesions
Hepatic fibrosis
Inherited liver diseases
Haemochromatosis
Hereditary haemochromatosis
Pathophysiology
Clinical features
Investigations
Management
Secondary haemochromatosis
Wilson’s disease
Pathophysiology
Clinical features
Liver disease
Neurological disease
Kayser–Fleischer rings
Investigations
Management
Alpha1-antitrypsin deficiency
Gilbert’s syndrome
Clinical features
Investigations
Vascular liver disease
Hepatic arterial disease
Liver ischaemia
Liver arterial disease
Portal venous disease
Portal hypertension
Portal vein thrombosis
Hepatopulmonary syndrome
Portopulmonary hypertension
Hepatic venous disease
Budd–Chiari syndrome
Clinical features
Investigations
Management
Sinusoidal obstruction syndrome (veno-occlusive disease)
Cardiac disease
Nodular regenerative hyperplasia of the liver
Pregnancy and the liver
Intercurrent and pre-existing liver disease
Pregnancy-associated liver disease
Liver transplantation
Indications and contraindications
Complications
Early complications
Primary graft non-function
Technical complications
Rejection
Infections
Late complications
Prognosis
Cholestatic and biliary disease
Chemical cholestasis
Benign recurrent intrahepatic cholestasis
Intrahepatic biliary disease
Inflammatory and immune disease
Caroli’s disease
Congenital hepatic fibrosis
Cystic fibrosis
Extrahepatic biliary disease
Choledochal cysts
Secondary biliary cirrhosis
Gallstones
Pathophysiology
Cholesterol gallstones
Pigment stones
Biliary sludge
Clinical features
Investigations
Management
Cholecystitis
Acute cholecystitis
Pathophysiology
Clinical features
Investigations
Management
Medical
Surgical
Chronic cholecystitis
Acute cholangitis
Choledocholithiasis
Clinical features
Investigations
Management
Recurrent pyogenic cholangitis
Tumours of the gallbladder and bile duct
Carcinoma of the gallbladder
Cholangiocarcinoma
Carcinoma at the ampulla of Vater
Benign gallbladder tumours
Miscellaneous biliary disorders
Post-cholecystectomy syndrome
Functional biliary sphincter disorders (‘sphincter of Oddi dysfunction’)
Clinical features
Investigations
Management
Cholesterolosis of the gallbladder
Adenomyomatosis of the gallbladder
IgG4-associated cholangitis
Further information
Books and journal articles
Websites
23 Haematology and transfusion medicine
Clinical examination in blood disease
Anaemia
Bleeding
Functional anatomy and physiology
Haematopoiesis
Stem cells
Blood cells and their functions
Red cells
Haemoglobin
Destruction
White cells
Neutrophils
Eosinophils
Basophils
Monocytes
Lymphocytes
Haemostasis
Platelets
Clotting factors
Investigation of diseases of the blood
The full blood count
Blood film examination
Bone marrow examination
Investigation of coagulation
Bleeding disorders
Monitoring anticoagulant therapy
Thrombotic disorders
Presenting problems in blood disease
Anaemia
Clinical assessment
Investigations
High haemoglobin
Clinical assessment and investigations
Leucopenia (low white cell count)
Neutropenia
Lymphopenia
Leucocytosis (high white cell count)
Neutrophilia
Eosinophilia
Lymphocytosis
Lymphadenopathy
Splenomegaly
Bleeding
Clinical assessment
Investigations
Thrombocytopenia (low platelet count)
Thrombocytosis (high platelet count)
Pancytopenia
Infection
Principles of management of haematological disease
Blood products and transfusion
Blood products
Blood donation
Adverse effects of transfusion
Red cell incompatibility
ABO blood groups
ABO-incompatible red cell transfusion
The Rhesus D blood group and haemolytic disease of the newborn
Other immunological complications of transfusion
Transfusion-transmitted infection
Safe transfusion procedures
Pre-transfusion testing
Bedside procedures for safe transfusion
Transfusion in major haemorrhage
Chemotherapy
Haematopoietic stem cell transplantation
Allogeneic HSCT
Complications
Graft-versus-host disease
Autologous HSCT
Anticoagulant and antithrombotic therapy
Heparins
Heparin-induced thrombocytopenia
Clinical features
Investigations
Management
Coumarins
Direct oral anticoagulants
Anaemias
Iron deficiency anaemia
Blood loss
Malabsorption
Physiological demands
Investigations
Confirmation of iron deficiency
Investigation of the cause
Management
Anaemia of chronic disease
Pathogenesis
Diagnosis and management
Megaloblastic anaemia
Vitamin B12
Vitamin B12 absorption
Causes of vitamin B12 deficiency
Dietary deficiency
Gastric pathology
Pernicious anaemia
Small bowel pathology
Folate
Folate absorption
Folate deficiency
Management of megaloblastic anaemia
Vitamin B12 deficiency
Folate deficiency
Haemolytic anaemia
Extravascular haemolysis
Intravascular haemolysis
Causes of haemolytic anaemia
Red cell membrane defects
Hereditary spherocytosis
Investigations
Management
Hereditary elliptocytosis
Red cell enzymopathies
Glucose-6-phosphate dehydrogenase deficiency
Pyruvate kinase deficiency
Pyrimidine 5′ nucleotidase deficiency
Autoimmune haemolytic anaemia
Warm autoimmune haemolysis
Investigations
Management
Cold agglutinin disease
Chronic cold agglutinin disease
Other causes of cold agglutination
Alloimmune haemolytic anaemia
Non-immune haemolytic anaemia
Endothelial damage
Infection
Chemicals or drugs
Paroxysmal nocturnal haemoglobinuria
Haemoglobinopathies
Qualitative abnormalities – abnormal haemoglobins
Quantitative abnormalities – thalassaemias
Sickle-cell anaemia
Epidemiology
Pathogenesis
Clinical features
Investigations
Management
Prognosis
Other abnormal haemoglobins
Thalassaemias
Beta-thalassaemia
Management and prevention
Alpha-thalassaemia
Haematological malignancies
Leukaemias
Epidemiology and aetiology
Terminology and classification
Acute leukaemia
Investigations
Management
Specific therapy
Supportive therapy
Anaemia
Bleeding
Infection
Metabolic problems
Psychological problems
Haematopoietic stem cell transplantation
Prognosis
Chronic myeloid leukaemia
Natural history
Clinical features
Investigations
Management
Chronic phase
Accelerated phase and blast crisis
Chronic lymphocytic leukaemia
Clinical features
Investigations
Management
Prognosis
Prolymphocytic leukaemia
Hairy cell leukaemia
Myelodysplastic syndromes
Prognosis
Management
Lymphomas
Hodgkin lymphoma
Clinical features
Investigations
Management
Prognosis
Non-Hodgkin lymphoma
Clinical features
Investigations
Management
Low-grade NHL
High-grade NHL
Prognosis
Paraproteinaemias
Monoclonal gammopathy of uncertain significance
Clinical features and investigations
Prognosis
Waldenström macroglobulinaemia
Management
Multiple myeloma
Clinical features and investigations
Management
Immediate support
Chemotherapy with or without HSCT
Radiotherapy
Bisphosphonates
Prognosis
Aplastic anaemias
Primary idiopathic acquired aplastic anaemia
Clinical features and investigations
Management
Secondary aplastic anaemia
Myeloproliferative neoplasms
Myelofibrosis
Management and prognosis
Essential thrombocythaemia
Polycythaemia rubra vera
Management and prognosis
Bleeding disorders
Disorders of primary haemostasis
Vessel wall abnormalities
Hereditary haemorrhagic telangiectasia
Ehlers–Danlos disease
Scurvy
Platelet function disorders
Thrombocytopenia
Idiopathic thrombocytopenic purpura
Clinical features and investigations
Management
Coagulation disorders
Haemophilia A
Genetics
Clinical features
Management
Complications of coagulation factor therapy
Haemophilia B (Christmas disease)
Von Willebrand disease
Clinical features
Investigations
Management
Rare inherited bleeding disorders
Acquired bleeding disorders
Liver disease
Renal failure
Thrombotic disorders
Venous thromboembolic disease (venous thromboembolism)
Management of VTE
Prophylaxis of VTE
Inherited and acquired thrombophilia and prothrombotic states
Antithrombin deficiency
Protein C and S deficiencies
Factor V Leiden
Prothrombin G20210A
Antiphospholipid syndrome
Clinical features and management
Disseminated intravascular coagulation
Investigations
Management
Thrombotic thrombocytopenic purpura
Further information
Websites
24 Rheumatology and bone disease
Clinical examination of the musculoskeletal system
General Assessment of Locomotor System (GALS) and Schöber’s test
Functional anatomy and physiology
Bone
Bone matrix and mineral
Bone remodelling
Joints
Fibrous and fibrocartilaginous joints
Synovial joints
Articular cartilage
Synovial fluid
Intra-articular discs
Synovial membrane, joint capsule and bursae
Skeletal muscle
Investigation of musculoskeletal disease
Joint aspiration
Imaging
Plain X-rays
Bone scintigraphy
Magnetic resonance imaging
Ultrasonography
Computed tomography
Dual X-ray absorptiometry
Blood tests
Haematology
Biochemistry
Immunology
Rheumatoid factor
Anti-citrullinated peptide antibodies
Antinuclear antibodies
Antiphospholipid antibodies
Antineutrophil cytoplasmic antibodies
Complement
Tissue biopsy
Electromyography
Presenting problems in musculoskeletal disease
Acute monoarthritis
Clinical assessment
Investigations
Management
Polyarthritis
Clinical assessment
Investigations
Management
Fracture
Clinical assessment
Investigations
Management
Generalised musculoskeletal pain
Clinical assessment
Investigations
Management
Back pain
Clinical assessment
Investigations
Management
Regional musculoskeletal pain
Neck pain
Shoulder pain
Elbow pain
Hand and wrist pain
Hip pain
Knee pain
Ankle and foot pain
Muscle pain and weakness
Clinical assessment
Investigations
Management
Principles of management
Education and lifestyle interventions
Education
Exercise
Joint protection
Non-pharmacological interventions
Physical and occupational therapy
Self-help and coping strategies
Weight control
Surgery
Pharmacological treatment
Analgesics
Non-steroidal anti-inflammatory drugs
Topical agents
Disease-modifying antirheumatic drugs
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Azathioprine
Apremilast
Janus-activated kinase inhibitors
Cyclophosphamide
Mycophenolate mofetil
Other DMARDs
Glucocorticoids
Systemic glucocorticoids
Intra-articular and intramuscular glucocorticoids
Biologics
Anti-TNF therapy
Rituximab
Belimumab
Abatacept
Tocilizumab
Ustekinumab
Secukinumab
Anakinra
Canakinumab
Osteoarthritis
Epidemiology
Pathophysiology
Clinical features
Generalised nodal OA
Knee OA
Hip OA
Spine OA
Early-onset OA
Erosive OA
Investigations
Management
Education
Lifestyle advice
Non-pharmacological therapy
Pharmacological therapy
Intra-articular injections
Neutraceuticals
Surgery
Crystal-induced arthritis
Gout
Epidemiology
Pathophysiology
Clinical features
Investigations
Management
Acute gout
Prophylaxis
Calcium pyrophosphate dihydrate crystal deposition disease
Pathophysiology
Clinical features
Investigations
Management
Basic calcium phosphate deposition disease
Pathophysiology
Calcific periarthritis
Acute inflammatory arthritis
Milwaukee shoulder syndrome
Autoimmune connective tissue disease
Fibromyalgia
Pathophysiology
Clinical features
Investigations and management
Bone and joint infections
Septic arthritis
Pathogenesis
Clinical features
Investigations
Management
Viral arthritis
Osteomyelitis
Pathogenesis
Clinical features
Investigations
Management
Discitis
Tuberculosis
Rheumatoid arthritis
Pathophysiology
Clinical features
Systemic features
Nodules
Vasculitis
Ocular involvement
Serositis
Cardiac involvement
Pulmonary involvement
Peripheral neuropathy
Spinal cord compression
Other complications
Investigations
Management
Pharmacological therapy
Non-pharmacological therapy
Surgery
Juvenile idiopathic arthritis
Investigations
Management
Prognosis
Spondyloarthropathies
Axial spondyloarthropathy
Pathophysiology
Axial spondyloarthritis
Clinical features
Investigations
Management
Prognosis
Ankylosing spondylitis
Clinical features
Investigations
Management
Reactive arthritis
Clinical features
Investigations
Management
Psoriatic arthritis
Pathophysiology
Clinical features
Asymmetrical inflammatory mono-/oligoarthritis
Symmetrical polyarthritis
Distal interphalangeal joint arthritis
Psoriatic spondylitis
Arthritis mutilans
Enthesitis-predominant
Investigations
Management
Enteropathic (spondylo)arthritis
Autoimmune connective tissue diseases
Systemic lupus erythematosus
Pathophysiology
Clinical features
Arthritis
Raynaud’s phenomenon
Skin
Kidney
Cardiovascular
Lung
Neurological
Haematological
Gastrointestinal
Paediatric disease
Investigations
Management
Mild to moderate disease
Severe and life-threatening disease
Maintenance therapy
Systemic sclerosis
Pathophysiology
Clinical features
Skin
Raynaud’s phenomenon
Musculoskeletal features
Gastrointestinal involvement
Pulmonary involvement
Renal involvement
Investigations
Management
Mixed connective tissue disease
Primary Sjögren’s syndrome
Clinical features
Investigations
Management
Polymyositis and dermatomyositis
Clinical features
Investigations
Management
Juvenile dermatomyositis
Undifferentiated autoimmune connective tissue disease
Adult-onset Still’s disease
Vasculitis
Antineutrophil cytoplasmic antibody-associated vasculitis
Takayasu arteritis
Kawasaki disease
Polyarteritis nodosa
Giant cell arteritis and polymyalgia rheumatica
Clinical features
Investigations
Management
Eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome)
Henoch–Schönlein purpura
Cryoglobulinaemic vasculitis
Behçet’s disease
Relapsing polychondritis
Diseases of bone
Osteoporosis
Pathophysiology
Idiopathic osteoporosis
Secondary osteoporosis
Glucocorticoid-induced osteoporosis
Pregnancy-associated osteoporosis
Clinical features
Investigations
Management
Non-pharmacological interventions
Pharmacological interventions
Bisphosphonates
Denosumab
Calcium and vitamin D
Teriparatide
Abaloparatide
Hormone replacement therapy
Raloxifene
Tibolone
Other drugs
Surgery
Osteomalacia, rickets and vitamin D deficiency
Vitamin D deficiency
Pathogenesis
Clinical features
Investigations
Management
Osteomalacia and rickets
Pathogenesis
Clinical features
Investigations
Management
Vitamin D-resistant rickets
Pathogenesis
Clinical features
Investigations
Management
Hereditary hypophosphataemic rickets
Pathophysiology
Clinical features
Investigations
Management
Tumour-induced osteomalacia
Hypophosphatasia
Other causes of osteomalacia
Paget’s disease of bone
Pathophysiology
Clinical features
Investigations
Management
Other bone diseases
Complex regional pain syndrome type 1
Osteonecrosis
Scheuermann’s osteochondritis
Polyostotic fibrous dysplasia
Osteogenesis imperfecta
Osteopetrosis
Sclerosing bone dysplasias
Bone and joint tumours
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
Metastatic bone disease
Rheumatological involvement in other diseases
Malignant disease
Endocrine disease
Haematological disease
Neurological disease
Miscellaneous conditions
Anterior tibial compartment syndrome
Carpal tunnel syndrome
Diffuse idiopathic skeletal hyperostosis
Dupuytren’s contracture
Hypermobility syndromes
Inclusion body myositis
Periodic fever syndromes
Pigmented villonodular synovitis
Scoliosis
Spondylolysis
Synovitis–acne–pustulosis–hyperostosis–osteitis syndrome
Trigger finger
Further information
Journal articles
Websites
25 Neurology
Clinical examination of the nervous system
Functional anatomy and physiology
Cells of the nervous system
Generation and transmission of the nervous impulse
Functional anatomy of the nervous system
Cerebral hemispheres
The brainstem
The spinal cord
Sensory peripheral nervous system
Motor peripheral nervous system
The autonomic system
The motor system
Lower motor neurons
Upper motor neurons
The extrapyramidal system
The cerebellum
Vision
Speech
The somatosensory system
Pain
Sphincter control
Personality and mood
Sleep
Localising lesions in the central nervous system
Investigation of neurological disease
Neuroimaging
Head and orbit
Cervical, thoracic and lumbar spine
Blood vessels
Neurophysiological testing
Electroencephalography
Nerve conduction studies
Electromyography
Evoked potentials
Magnetic stimulation
Routine blood tests
Immunological tests
Genetic testing
Lumbar puncture
Biopsy
Presenting problems in neurological disease
Headache and facial pain
Ocular pain
Facial pain
Dizziness, blackouts and ‘funny turns’
Status epilepticus
Coma
Delirium
Amnesia
Transient global amnesia
Persistent amnesia
Weakness
Facial weakness
Facial nerve palsy (Bell’s palsy)
Sensory disturbance
Numbness and paraesthesia
Sensory loss in peripheral nerve lesions
Sensory loss in nerve root lesions
Sensory loss in spinal cord lesions
Sensory loss in brainstem lesions
Sensory loss in hemispheric lesions
Neuropathic pain
Abnormal movements
Tremor
Other hyperkinetic syndromes
Chorea
Athetosis
Ballism
Dystonia
Myoclonus
Tics
Abnormal perception
Altered balance and vertigo
Vertigo
Abnormal gait
Pyramidal gait
Foot drop
Myopathic gait
Ataxic gait
Apraxic gait
Marche à petits pas
Extrapyramidal gait
Abnormal speech and language
Dysphonia
Dysarthria
Dysphasia
Disturbance of smell
Visual disturbance and ocular abnormalities
Visual loss
Positive visual phenomena
Double vision
Nystagmus
Ptosis
Abnormal pupillary responses
Papilloedema
Optic atrophy
Hearing disturbance
Bulbar symptoms – dysphagia and dysarthria
Bladder, bowel and sexual disturbance
Bladder dysfunction
Rectal dysfunction
Erectile failure and ejaculatory failure
Personality change
Sleep disturbance
Psychiatric disorders
Functional symptoms
Headache syndromes
Tension-type headache
Pathophysiology
Clinical features
Management
Migraine
Pathophysiology
Clinical features
Management
Medication overuse headache
Cluster headache
Pathophysiology
Clinical features
Management
Trigeminal neuralgia
Pathophysiology
Clinical features
Management
Headaches associated with specific activities
Other headache syndromes
Epilepsy
Pathophysiology
Focal epilepsy
Generalised epilepsies
Clinical features
Seizure type and epilepsy type
Focal seizures
Generalised seizures
Tonic–clonic seizures
Absence seizures
Myoclonic seizures
Atonic seizures
Tonic seizures
Clonic seizures
Seizures of uncertain generalised or focal nature
Epileptic spasms
Epilepsy syndromes
Investigations
Single seizure
Epilepsy
Management
Immediate care
Lifestyle advice
Antiepileptic drugs
Monitoring therapy
Epilepsy surgery
Withdrawing antiepileptic therapy
Contraception
Pregnancy and reproduction
Prognosis
Status epilepticus
Non-epileptic attack disorder (‘dissociative attacks’)
Vestibular disorders
Acute vestibular failure
Benign paroxysmal positional vertigo
Ménière’s disease
Disorders of sleep
Excessive daytime sleepiness (hypersomnolence)
Narcolepsy
Parasomnias
Non-REM parasomnias
REM sleep behaviour disorder
Restless legs syndrome
Periodic limb movements in sleep
Neuro-inflammatory diseases
Multiple sclerosis
Pathophysiology
Clinical features
Investigations
Management
The acute episode
Disease-modifying treatment
Treatment of symptoms, complications and disability
Acute disseminated encephalomyelitis
Clinical features
Investigations
Management
Transverse myelitis
Neuromyelitis optica
Paraneoplastic neurological disorders
Clinical features
Investigations and management
Neurodegenerative diseases
Movement disorders
Idiopathic Parkinson’s disease
Pathophysiology
Clinical features
Non-motor symptoms
Investigations
Management
Drug therapy
Levodopa
Dopamine receptor agonists
MAOI-B inhibitors
COMT inhibitors
Amantadine
Anticholinergic drugs
Surgery
Physiotherapy, occupational therapy and speech therapy
Other parkinsonian syndromes
Multiple system atrophy
Progressive supranuclear palsy
Corticobasal degeneration
Wilson’s disease
Huntington’s disease
Clinical features
Investigations and management
Ataxias
Tremor disorders
Essential tremor
Dystonia
Hemifacial spasm
Motor neuron disease
Clinical features
Investigations
Management
Spinal muscular atrophy
Infections of the nervous system
Meningitis
Viral meningitis
Clinical features
Investigations
Management
Bacterial meningitis
Pathophysiology
Clinical features
Investigations
Management
Prevention of meningococcal infection
Tuberculous meningitis
Pathophysiology
Clinical features
Investigations
Management
Other forms of meningitis
Parenchymal viral infections
Viral encephalitis
Pathophysiology
Clinical features
Investigations
Management
Brainstem encephalitis
Rabies
Clinical features
Investigations
Management
Established disease
Pre-exposure prophylaxis
Post-exposure prophylaxis
Poliomyelitis
Pathophysiology
Clinical features
Investigations
Management
Established disease
Prophylaxis
Herpes zoster (shingles)
Subacute sclerosing panencephalitis
Progressive multifocal leucoencephalopathy
Parenchymal bacterial infections
Cerebral abscess
Clinical features
Investigations
Management and prognosis
Subdural empyema
Spinal epidural abscess
Lyme disease
Neurosyphilis
Clinical features
Investigations
Management
Diseases caused by bacterial toxins
Tetanus
Clinical features
Investigations
Management
Established disease
Prevention
Botulism
Prion diseases
Creutzfeldt–Jakob disease
Variant Creutzfeldt–Jakob disease
Intracranial mass lesions and raised intracranial pressure
Raised intracranial pressure
Clinical features
Management
Brain tumours
Clinical features
Investigations
Management
Surgical
Radiotherapy and chemotherapy
Prognosis
Acoustic neuroma
Clinical features
Investigations
Management
Neurofibromatosis
Von Hippel–Lindau disease
Paraneoplastic neurological disease
Hydrocephalus
Normal pressure hydrocephalus
Management
Idiopathic intracranial hypertension
Clinical features
Investigations
Management
Head injury
Disorders of cerebellar function
Disorders of the spine and spinal cord
Cervical spondylosis
Cervical radiculopathy
Clinical features
Investigations
Management
Cervical myelopathy
Clinical features
Investigations
Management
Prognosis
Lumbar spondylosis
Lumbar disc herniation
Pathophysiology
Clinical features
Investigations
Management
Lumbar canal stenosis
Pathophysiology
Clinical features
Investigations
Management
Spinal cord compression
Clinical features
Investigations
Management
Intrinsic diseases of the spinal cord
Diseases of peripheral nerves
Pathophysiology
Clinical features
Investigations
Entrapment neuropathy
Multifocal neuropathy
Polyneuropathy
Guillain–Barré syndrome
Clinical features
Investigations
Management
Chronic polyneuropathy
Hereditary neuropathy
Chronic demyelinating polyneuropathy
Brachial plexopathy
Lumbosacral plexopathy
Spinal root lesions
Diseases of the neuromuscular junction
Myasthenia gravis
Pathophysiology
Clinical features
Investigations
Management
Lambert–Eaton myasthenic syndrome
Diseases of muscle
Muscular dystrophies
Clinical features
Investigations
Management
Inherited metabolic myopathies
Mitochondrial disorders
Channelopathies
Acquired myopathies
Further information
Journal articles
Websites
26 Stroke medicine
Clinical examination in stroke disease
Functional anatomy and physiology
Investigations
Neuroimaging
Vascular imaging
Blood tests
Lumbar puncture
Cardiovascular investigations
Presenting problems
Weakness
Speech disturbance
Visual deficit
Visuo-spatial dysfunction
Ataxia
Headache
Seizure
Coma
Stroke
Pathophysiology
Cerebral infarction
Intracerebral haemorrhage
Clinical features
Investigations
Risk factor analysis
Neuroimaging
Vascular imaging
Cardiac investigations
Management
Supportive care
Reperfusion (thrombolysis and thrombectomy)
Aspirin
Heparin
Coagulation abnormalities
Management of risk factors
Carotid endarterectomy and angioplasty
Unusual causes
Subarachnoid haemorrhage
Clinical features
Investigations
Management
Cerebral venous disease
Clinical features
Investigations and management
Further information
Websites
27 Medical ophthalmology
Functional anatomy and physiology
Orbit
Eyelid/orbital septum/conjunctiva
Lacrimal gland/lacrimal drainage
Extraocular muscles
Eye
Sclera/cornea
Choroid, ciliary body and iris – the uveal tract
Retina
Lens
Vitreous
Blood supply of the orbit/eye
Investigation of visual disorders
Perimetry
Amsler chart
Tangent/Goldmann kinetic perimetry
Automated threshold perimetry
Imaging
Photography
Optical coherence tomography
Autofluorescence
Fundus angiography
Ocular ultrasound
Visual electrophysiology
Presenting problems in ophthalmic disease
Watery/dry eye
Pruritus
Pain/headache
Red eye
White eye
Photophobia/glare
Photopsia
Blurred vision
Loss of vision
Distortion of vision
Eyelid retraction
Optic disc swelling
Proptosis
Specialist ophthalmological conditions
Ocular inflammation
Sjögren’s syndrome
Peripheral ulcerative keratitis
Scleritis
Episcleritis
Uveitis
Infectious conditions
Conjunctivitis
Infectious keratitis/corneal ulceration
Endophthalmitis
Cataract
Diabetic eye disease
Diabetic retinopathy
Pathogenesis
Clinical features
Management of proliferative diabetic retinopathy
Management of diabetic macular oedema
Prevention
Screening
Other causes of visual loss in people with diabetes
Retinal vascular occlusion
Retinal vein occlusion (thrombosis)
Retinal artery occlusion
Age-related macular degeneration
Further information
Websites
28 Medical psychiatry
Clinical examination
The psychiatric interview
The mental state examination
General appearance and behaviour
Speech
Mood
Thoughts
Abnormal beliefs
Abnormal perceptions
Cognitive function
Patients’ own understanding of their symptoms
Investigations in medical psychiatry
Functional anatomy and physiology
Biological factors
Genetic
Brain structure and function
Psychological and behavioural factors
Early environment
Personality
Behaviour
Social and environmental factors
Social isolation
Stressors
Presenting problems in psychiatric illness
Delirium
Alcohol misuse
Clinical assessment
Investigations
Management
Substance misuse
Delusions and hallucinations
Delusions
Hallucinations
Clinical assessment
Investigations
Management
Low mood
Clinical assessment
Investigations
Management
Elevated mood
Investigations
Management
Anxiety
Investigations
Management
Psychological factors affecting medical conditions
Medically unexplained somatic symptoms
Self-harm
Clinical assessment
Management
Disturbed and aggressive behaviour
Clinical assessment
Investigations
Management
Principles of management of psychiatric disorders
Pharmacological treatments
Electroconvulsive therapy
Other forms of electromagnetic stimulation
Surgery
Psychological therapies
General psychotherapy
Cognitive therapy
Behaviour therapy
Cognitive behaviour therapy
Problem-solving therapy
Psychodynamic psychotherapy
Interpersonal psychotherapy
Social interventions
Psychiatric disorders
Dementia
Pathogenesis
Clinical features
Investigations
Management
Alzheimer’s disease
Pathogenesis
Clinical features
Investigations
Management
Fronto-temporal dementia
Lewy body dementia
Alcohol misuse and dependence
Pathogenesis
Clinical features
Social problems
Low mood
Anxiety
Alcohol withdrawal syndrome
Hallucinations
Wernicke–Korsakoff syndrome
Alcohol-related brain damage
Effects on other organs
Diagnosis
Management
Prognosis
Substance misuse disorder
Sedatives
Stimulants
Hallucinogens
Organic solvents
Pathogenesis
Diagnosis
Management
Schizophrenia
Pathogenesis
Clinical features
Diagnosis
Investigations
Management
Drug treatment
Neuroleptic malignant syndrome
Cardiac arrhythmias
Psychological treatment
Social treatment
Prognosis
Mood disorders
Depression
Pathogenesis
Diagnosis
Investigations
Management
Drug treatment
Tricyclic antidepressants
Selective serotonin re-uptake inhibitors
Noradrenaline (norepinephrine) re-uptake inhibitors
Monoamine oxidase inhibitors
Psychological treatment
Prognosis
Bipolar disorder
Pathogenesis
Diagnosis
Management
Prognosis
Anxiety disorders
Clinical features
Phobic anxiety disorder
Panic disorder
Generalised anxiety disorder
Diagnosis
Management
Psychological treatment
Drug treatment
Obsessive–compulsive disorder
Clinical features
Diagnosis
Management
Stress-related disorders
Acute stress reaction
Adjustment disorder
Clinical features
Diagnosis
Management
Post-traumatic stress disorder
Clinical features
Diagnosis
Management
Prognosis
Somatoform disorders
Pathogenesis
Clinical features
Somatoform autonomic dysfunction
Somatoform pain disorder
Chronic fatigue syndrome
Dissociative conversion disorders
Somatisation disorder
Hypochondriacal disorder
Body dysmorphic disorder
Management
Reassurance
Explanation
Advice
Drug treatment
Psychological treatment
Rehabilitation
Shared care
Eating disorders
Anorexia nervosa
Clinical features
Pathogenesis
Diagnosis
Management
Prognosis
Bulimia nervosa
Clinical features
Diagnosis
Investigations
Management
Prognosis
Personality disorders
Pathogenesis
Clinical features
Diagnosis
Management
Factitious disorder and malingering
Pathogenesis
Clinical features
Münchausen’s syndrome
Malingering
Management
Puerperal psychiatric disorders
Post-partum blues
Post-partum depression
Puerperal psychosis
Psychiatric disorders during pregnancy
Psychiatry and the law
Further information
Books and journal articles
Websites
29 Dermatology
Clinical examination in skin disease
Functional anatomy and physiology
Epidermis
Basement membrane
Dermis
Epidermal appendages
Hair follicles
Sebaceous glands
Sweat glands
Nails
Blood vessels and nerves
Functions of the skin
Investigation of skin disease
Magnifying glass
Wood’s light
Dermatoscopy and diascopy
Skin biopsy
Microbiology
Bacteriology
Virology
Mycology
Patch testing
Prick tests and specific immunoglobulin E testing
Phototesting
Blood tests
Imaging
Presenting problems in skin disease
Lumps and lesions
Clinical assessment
Is it a melanocytic naevus or a malignant melanoma?
Investigations and management
Rash
Clinical assessment
Investigations and management
Blisters
Clinical assessment
Investigations and management
Itch
Clinical assessment
Investigations and management
Photosensitivity
Clinical assessment
Investigations and management
Sunscreens
Leg ulcers
Clinical assessment
Leg ulceration due to venous disease
Leg ulceration due to arterial disease
Leg ulceration due to vasculitis
Leg ulceration due to neuropathy
Investigations
Management
Abnormal pigmentation
Hair and nail abnormalities
Acute skin failure
Clinical assessment
Investigations and management
Principles of management of skin disease
General measures
Topical treatments
Emollients
Topical glucocorticoids
Anti-infective agents
Calcineurin inhibitors
Immune response modifiers
Dressings
Phototherapy and photochemotherapy
Systemic therapies
Antibiotics
Antihistamines
Retinoids
Immunosuppressants
Biological therapies
Dermatological surgery
Excision biopsy
Curettage
Shave excision
Mohs’ micrographic surgery
Non-surgical treatments
Cryotherapy
Laser therapy
Photodynamic therapy
Radiotherapy and grenz (Bucky) ray therapy
Skin tumours
Pathogenesis
Malignant tumours
Basal cell carcinoma
Clinical features
Diagnosis and management
Squamous cell carcinoma
Clinical features
Management
Actinic keratosis
Management
Bowen’s disease
Clinical features
Diagnosis
Management
Cutaneous lymphomas
Melanoma
Pathophysiology
Clinical features
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous or palmoplantar melanoma
Subungual melanoma
Diagnosis and management
Prognosis
Benign skin lesions
Keratoacanthoma
Freckle
Lentigo
Haemangiomas
Basal cell papilloma
Melanocytic naevi
Clinical features
Diagnosis and management
Blue naevi
Dermatofibroma
Acrochordon
Lipoma
Common skin infections and infestations
Bacterial infections
Impetigo
Staphylococcal scalded skin syndrome
Toxic shock syndrome
Ecthyma
Folliculitis, furuncles and carbuncles
Superficial folliculitis
Deep folliculitis (furuncles and carbuncles)
Cellulitis and erysipelas
Mycobacterial infections
Leishmaniasis
Necrotising soft tissue infections and anthrax
Erythrasma
Pitted keratolysis
Other bacterial skin infections
Viral infections
Herpesvirus infections
Papillomaviruses and viral warts
Clinical features
Management
Molluscum contagiosum
Orf
Other viral exanthems
Fungal infections
Diagnosis
Management
Tinea corporis
Tinea cruris
Tinea pedis
Tinea capitis
Onychomycosis
Candidiasis
Pityriasis versicolor
Infestations
Scabies
Head lice
Body lice
Pubic (crab) lice
Acne and rosacea
Acne vulgaris
Pathogenesis
Clinical features
Investigations
Management
Mild to moderate disease
Moderate to severe disease
Other treatments and physical measures
Rosacea
Clinical features
Investigations
Management
Eczemas
Clinical features
Investigations
Management
Atopic eczema
Pathogenesis
Clinical features
Investigations
Management
Seborrhoeic eczema
Discoid eczema
Irritant eczema
Allergic contact eczema
Asteatotic eczema
Gravitational eczema
Lichen simplex
Pompholyx
Psoriasis and other erythematous scaly eruptions
Psoriasis
Pathogenesis
Clinical features
Plaque psoriasis
Guttate psoriasis
Erythrodermic psoriasis
Pustular psoriasis
Arthropathy
Investigations
Management
Pityriasis rosea
Pityriasis lichenoides chronica
Drug eruptions
Other causes
Lichenoid eruptions
Lichen planus
Pathogenesis
Clinical features
Investigations
Management
Drug-induced lichenoid eruptions
Graft-versus-host disease
Urticaria
Clinical features
Investigations
Management
Bullous diseases
Toxic epidermal necrolysis
Immunobullous diseases
Bullous pemphigoid
Pathogenesis
Clinical features
Investigations
Management
Pemphigus
Pathogenesis
Clinical features
Investigations
Management
Dermatitis herpetiformis
Linear IgA disease
Epidermolysis bullosa acquisita
Porphyria cutanea tarda and pseudoporphyria
Pigmentation disorders
Decreased pigmentation
Vitiligo
Clinical features
Management
Oculocutaneous albinism
Management
Increased pigmentation
Hair disorders
Alopecia
Pathogenesis
Clinical features
Alopecia areata
Androgenetic alopecia
Investigations
Management
Hypertrichosis
Hirsutism
Nail disorders
Normal variants
Nail trauma
Nail involvement in skin diseases
Nail involvement in systemic disease
Nail involvement in congenital disease
Skin disease in general medicine
Conditions involving cutaneous vasculature
Vasculitis
Pyoderma gangrenosum
Other neutrophilic dermatoses
Pressure sores
Connective tissue disease
Lupus erythematosus
Systemic sclerosis
Morphoea
Dermatomyositis
Granulomatous disease
Granuloma annulare
Necrobiosis lipoidica
Sarcoidosis
Cutaneous Crohn’s disease
Porphyrias
Cutaneous porphyrias: fragility and blisters
Cutaneous porphyria: pain on sun exposure
Abnormal deposition disorders
Xanthomas
Amyloidosis
Genetic disorders
Neurofibromatosis
Tuberous sclerosis
Reactive disorders
Erythema multiforme
Erythema nodosum
Acquired reactive perforating dermatosis
Annular erythemas
Acanthosis nigricans
Drug eruptions
Clinical features
Investigations and management
Further information
Websites
30 Maternal medicine
Clinical examination in pregnancy
Clinical evaluation in maternal medicine
Planning pregnancy in patients with medical conditions
Functional anatomy and physiology
Bone metabolism
Cardiovascular system
Endocrine system
Gastrointestinal system
Genitourinary system
Glucose metabolism
Haematological system
Respiratory system
Investigations
Imaging
Presenting problems in pregnancy
Breathlessness
Chest pain
Circulatory collapse
Headache
Nausea and vomiting
Oedema
Seizures
Medical disorders in pregnancy
Hypertension
Pre-existing hypertension
Gestational hypertension
Pre-eclampsia and eclampsia
Respiratory disease
Asthma
Respiratory infection
Bacterial infections
Viral infections
Tuberculosis
Gastrointestinal disease
Hyperemesis gravidarum
Inflammatory bowel disease
Diabetes
Gestational diabetes
Management
Pregnancy in women with established diabetes
Endocrine disease
Thyroid disease
Iodine deficiency
Hypothyroidism
Hyperthyroidism
Post-partum thyroiditis
Pituitary disease
Prolactinoma
Diabetes insipidus
Sheehan’s syndrome
Parathyroid disease
Primary hyperparathyroidism
Familial hypocalciuric hypercalcaemia
Adrenal disease
Human immunodeficiency virus infection
Inflammatory rheumatic disease
Rheumatoid arthritis
Systemic sclerosis
Systemic lupus erythematosus
Anti-phospholipid syndrome
Cardiac disease
Congenital heart disease
Valvular heart disease
Myocardial infarction
Aortic dissection
Peripartum cardiomyopathy
Dilated cardiomyopathy
Renal disease
Renal tract infection
Acute kidney injury
Glomerular disease
Chronic kidney disease
Renal replacement therapy
Renal transplant recipients
Liver disease
Acute fatty liver of pregnancy
HELLP syndrome
Obstetric cholestasis
Viral hepatitis
Neurological disease
Epilepsy
Idiopathic intracranial hypertension
Migraine
Stroke
Psychiatric disorders
Haematological disease
Anaemia
Rhesus disease
Thrombocytopenia
Venous thromboembolism
Further information
Websites
31 Adolescent and transition medicine
Transition from paediatric to adult health services
Effectiveness of transition planning
General principles of transition planning
Principles of prescribing during transition
A systematic approach to transition planning
When should transition happen?
Functional anatomy and physiology
Endocrine changes
Physical changes
Cognitive and behavioural changes
Investigations
Clinical assessment
Presenting problems in transition medicine
Problems with adherence
High-risk behaviour
Unplanned pregnancy
Clinical presentations
Neurological disease
Epilepsy
Cerebral palsy
Muscular dystrophy
Respiratory disease
Cystic fibrosis
Cardiovascular disease
Congenital heart disease
Hypertrophic obstructive cardiomyopathy
Oncology
Renal disease
Organ transplantation
Diabetes
Gastrointestinal disease
Inflammatory bowel disease
Rheumatology and bone disease
Juvenile idiopathic arthritis
Glucocorticoid-induced osteoporosis
Osteogenesis imperfecta
Hypophosphataemic rickets
Summary
Further information
Books and journal articles
Websites
32 Ageing and disease
Comprehensive Geriatric Assessment
Demography
Functional anatomy and physiology
Biology of ageing
Physiological changes of ageing
Frailty and multimorbidity
Investigations
Comprehensive Geriatric Assessment
Decisions about investigation and treatment
The views of the patient and family
The patient’s general health
Will the investigation alter management?
Will management benefit the patient?
Advance directives
Presenting problems in geriatric medicine
Characteristics of presenting problems in old age
Late presentation
Atypical presentation
Acute illness and changes in function
Multiple pathology
Approach to presenting problems in old age
Falls
Acute illness
Blackouts
Mechanical and recurrent falls
Prevention of falls and fractures
Dizziness
Delirium
Urinary incontinence
Prescribing and deprescribing
Appropriate prescribing and deprescribing
Other problems in old age
Rehabilitation
The rehabilitation process
Multidisciplinary team working
Rehabilitation outcomes
Further information
Websites
33 Oncology
Clinical examination of the cancer patient
The 10 hallmarks of cancer
1. Genome instability and mutation
2. Resisting cell death
Apoptosis
Autophagy
Necrosis
3. Sustaining proliferative signalling
The cell cycle
Cell cycle regulation
Stimulation of the cell cycle
4. Evading growth suppressors
5. Enabling replicative immortality
6. Inducing angiogenesis
7. Activating invasion and metastasis
8. Reprogramming energy metabolism
9. Tumour-promoting inflammation
10. Evading immune destruction
Environmental and genetic determinants of cancer
Environmental factors
Genetic factors
Investigations
Histology
Light microscopy
Immunohistochemistry
Electron microscopy
Cytogenetic analysis
Imaging
Ultrasound
Computed tomography
Magnetic resonance imaging
Positron emission tomography
Biochemical markers
Presenting problems in oncology
Palpable mass
Weight loss and fever
Thromboembolism
Ectopic hormone production
Neurological paraneoplastic syndromes
Cutaneous manifestations of cancer
Emergency complications of cancer
Spinal cord compression
Clinical features
Management
Superior vena cava obstruction
Clinical features
Investigations and management
Hypercalcaemia
Clinical features
Investigations and management
Neutropenic fever
Clinical features
Investigations and management
Tumour lysis syndrome
Clinical features
Investigations and management
Metastatic disease
Brain metastases
Clinical features
Investigations and management
Lung metastases
Liver metastases
Bone metastases
Clinical features
Investigations and management
Malignant pleural effusion
Investigations and management
Therapeutics in oncology
Surgical treatment
Biopsy
Excision
Palliation
Systemic chemotherapy
Combination therapy
Adverse effects
Radiation therapy
Adverse effects
Hormone therapy
Immunotherapy
Biological therapies
Gefitinib/erlotinib
Imatinib
Bevacizumab
Trastuzumab
Evaluation of treatment
Late toxicity of therapy
Specific cancers
Breast cancer
Pathogenesis
Clinical features
Investigations
Management
Ovarian cancer
Pathogenesis
Investigations
Management
Endometrial cancer
Pathogenesis
Investigations
Management
Cervical cancer
Pathogenesis
Investigations
Management
Head and neck tumours
Pathogenesis
Investigations
Management
Carcinoma of unknown origin
Investigations
Management
Multidisciplinary teams
Further information
Books and journal articles
Websites
34 Pain and palliative care
Pain
Functional anatomy and physiology
Peripheral nerves
Spinal cord
Central processing of pain
Sensitisation
Peripheral sensitisation
Central sensitisation
Genetic determinants of pain perception
Investigations
Magnetic resonance imaging
Blood tests
Quantitative sensory testing
Nerve conduction studies
Nerve blocks
Pain scoring systems
Principles of management
Clinical history
Biopsychosocial assessment
Examination
Interventions
Supported self-management
Physical therapies
Pharmacological therapies
Non-opioid analgesics
Paracetamol
Non-steroidal anti-inflammatory drugs
Topical analgesics
Adjuvant analgesics
Opioid analgesics
Psychological therapies
Stimulation therapies
Complementary and alternative therapies
Nerve blocks and nerve ablation
Chronic pain syndromes
Neuropathic pain
Complex regional pain syndrome
Phantom limb pain
Chronic widespread pain
Joint hypermobility syndrome
Palliative care
Presenting problems in palliative care
Pain
Clinical assessment
Management: pharmacological treatments
Opioids
Opioid-related adverse effects
Adjuvant analgesics
Management: non-pharmacological treatments
Neurodestructive interventions
Radiotherapy
Physiotherapy
Psychological techniques
Stimulation therapies
Complementary and alternative therapies
Breathlessness
Cough
Nausea and vomiting
Gastrointestinal obstruction
Weight loss
Anxiety and depression
Delirium and agitation
Dehydration
Death and dying
Planning for dying
Diagnosing dying
Management of dying
Ethical considerations
Capacity and advance directives
Euthanasia
Further information
Websites
Journal articles
35 Laboratory reference ranges
Notes on the international system of units (SI units)
Examples of basic SI units
Examples of decimal multiples and submultiples of SI units
Exceptions to the use of SI units
Laboratory reference ranges in adults
Laboratory reference ranges in childhood and adolescence
Laboratory reference ranges in pregnancy
Further information
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

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