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دانلود کتاب Davidson's Principles and Practice of Medicine
دانلود کتاب اصول و عملکرد پزشکی دیویدسون
مشخصات کتاب
Davidson's Principles and Practice of Medicine
ویرایش: [24 ed.] نویسندگان: Ian D Penman BSc(Hons) MD FRCPE (editor), Stuart H. Ralston MD FRCP FMedSci FRSE FFPM(Hon) (editor), Mark W J Strachan BSc(Hons) MD FRCPE (editor), Richard Hobson LLM PhD MRCP(UK) FRCPath (editor) سری: ISBN (شابک) : 070208347X, 9780702083471 ناشر: Elsevier سال نشر: 2022 تعداد صفحات: 1378 [1440] زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 128 Mb
قیمت کتاب (تومان) : 45,000
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توجه داشته باشید کتاب اصول و عملکرد پزشکی دیویدسون نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب اصول و عملکرد پزشکی دیویدسون
بیش از دو میلیون دانشجوی پزشکی، پزشک و سایر متخصصان بهداشت در سراسر جهان دارای نسخه‌ای از اصول و شیوه‌های پزشکی دیویدسون بوده‌اند. بیش از 70 سال پیش منتشر شده است. اکنون در نسخه بیست و چهارم خود، این کتاب درسی کاملاً به‌روز شده، پاتوفیزیولوژی و ویژگی‌های بالینی شایع‌ترین بیماری‌هایی را که در تخصص‌های اصلی پزشکی بزرگسالان با آن مواجه می‌شوند، توصیف می‌کند و نحوه تشخیص، بررسی، تشخیص و مدیریت آنها را توضیح می‌دهد. دیویدسون که سرچشمه آن را از یادداشت های سخنرانی بسیار تحسین برانگیز سر استنلی دیویدسون گرفته است، ماندگار بوده است زیرا با نحوه آموزش پزشکی مدرن همگام است و اطلاعات قابل اعتماد فراوانی را به صورت آسان ارائه می کند. -قالب خواندن، مختصر و به زیبایی مصور.
ویژگی های کلیدی:
- بخش 1 "مبانی پزشکی" - شرحی از اصول ژنتیک، ایمونولوژی، بیماری های عفونی، سلامت جمعیت، انکولوژی و مدیریت درد، همراه با بحث در مورد اصول اصلی پشت تصمیم گیری بالینی و تجویز خوب ارائه می دهد. span>
- قسمت 2 "پزشکی اورژانس و مراقبت های ویژه" - فوریت های پزشکی در مسمومیت، مسمومیت و دارو در محیط های سخت و همچنین ارائه های رایج در پزشکی حاد و شناخت و مدیریت بیماران بدحال را پوشش می دهد.
- بخش 3 "پزشکی بالینی" - تخصص های اصلی پزشکی را به طور کامل پوشش می دهد. بازنگری شده و کاملاً به روز شده است. بخش جدیدی در مورد COVID-19 اضافه شده است و تأثیر این عفونت در سراسر کتاب توضیح داده شده است.
-
نمایش های کلی معاینه بالینی - برای خلاصه کردن عناصر
اصلی برای هر سیستم، گسترش یافته و به روز شده است.
- بخش های ارائه مشکلات - یک مسیر روشن برای ارزیابی و رویکرد به رایج ترین شکایات در هر تخصص.
- خلاصه نکات تمرینی - جزئیات عملی مهارت هایی که دانشجویان پزشکی و پزشکان جوان باید کسب کنند.
- جعبه های اورژانس - تاکید بر دانش اصلی مورد نیاز برای مدیریت بیماران مبتلا به بیماری حاد است. و در جعبه‌های نوجوانی - تفاوت‌ها را در عملکرد پزشکی در این گروه‌های بیمار برجسته کنید و رابط بین خدمات پزشکی، زایمان و اطفال را نشان دهید.
- متن به‌طور گسترده نشان داده شده است - با بیش از 1000 نمودار، عکس بالینی، و تصاویر رادیولوژی و پاتولوژی.
- چشم انداز جهانی توسط هیئت مشورتی بین المللی متشکل از کارشناسان از 11 کشور و توسط پیشرو تقویت شده است. نویسندگانی از سراسر جهان
نسخه کامل و قابل دانلود کتاب الکترونیکی همراه با خرید شما (نسخه چاپی) موجود است - برای دسترسی آسان در دستگاه قابل حمل شما، در هر زمان و هر مکان< /span>! اکنون با بهبود یافته است:
- < span>مواد خودارزیابی تعاملی جدید -بیش از 150سوال و پاسخ درک شما از نکات کلیدی فصل را آزمایش می‌کند و به آمادگی کارآمد برای امتحان کمک می‌کند </ li>
دیویدسون به عنوان یک متن اصلی که علم پزشکی را با پزشکی بالینی ادغام می‌کند و دانش کلیدی و توصیه‌های عملی را در قالبی بسیار قابل دسترس و خواندنی منتقل می‌کند، به خوانندگان در همه جا خدمت خواهد کرد.
بررسی‌ها
به زیبایی با وضوح فوق‌العاده طراحی شده است - دیویدسون همچنان برای دانشجویان، پزشکان و سایر متخصصان بهداشت ارائه می‌کند. پایه ای مناسب برای تمرین پزشکی
جوایز کتاب پزشکی انجمن سلطنتی پزشکی و جامعه نویسندگان
این کتاب از جایی به دست می‌آید که دیگران شکست می‌خورند: یک کتاب درسی عالی ، خواندنی آسان و ارزش عالی.
مجله پزشکی بریتانیا
توضیحاتی درمورد کتاب به خارجی
Well over two million medical students, doctors and other health professionals around the globe have owned a copy of Davidson's Principles and Practice of Medicine since it was first published over 70 years ago. Now in its 24th Edition, this thoroughly updated textbook describes the pathophysiology and clinical features of the most frequently encountered conditions in the major specialties of adult medicine, and explains how to recognise, investigate, diagnose and manage them. Taking its origins from Sir Stanley 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 trusted information in an easy-to-read, concise and beautifully illustrated format.
Key features:
- Part 1 'Fundamentals of Medicine' - provides an account of the principles of genetics, immunology, infectious diseases, population health, oncology and pain management, along with a discussion of the core principles behind clinical decision-making and good prescribing.
- Part 2 'Emergency and Critical Care Medicine' - covers medical emergencies in poisoning, envenomation and medicine in austere environments, as well as common presentations in acute medicine and the recognition and management of the critically ill.
- Part 3 'Clinical Medicine'- covers the major medical specialties, each thoroughly revised and brought fully up to date. A new section on COVID-19 has been added and the impact of this infection is described throughout the book.
- Clinical Examination overviews - extended and updated to summarise the main elements for each system.
- 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 medical students and junior doctors must acquire.
- Emergency boxes - emphasise 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 paediatric services.
- The text is extensively illustrated - with over 1000 diagrams, clinical photographs, and radiology and pathology images.
- The global perspective is enhanced by an International Advisory Board of experts from 11 countries and by leading authors from around the world.
The complete, downloadable eBook version is included with your (print copy) purchase - for easy access on your portable device, anytime, anywhere! Now enhanced with:
- NEW interactive self-assessment material -over 150Questions and Answers test your understanding of chapter key points and aid efficient exam preparation
Davidson's will serve readers everywhere as a core text that integrates medical science with clinical medicine, conveying key knowledge and practical advice in a highly accessible and readable format.
REVIEWS
Beautifully constructed with superb clarity of style - Davidson's continues to provide for students, doctors and other health professionals a sound basis for the practice of medicine.
Royal Society of Medicine and Society of Authors Medical Book Awards
This book comes through where others fail: an excellent textbook, easy to read and superb value.
British Medical Journal
فهرست مطالب
Front Cover Davidson’s Principles and Practice of Medicine Copyright Page Contents Preface Contributors International Advisory Board Acknowledgements Introduction Clinical examination overviews Presenting problems Boxes 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 History and physical examination 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 Problem representation Cognitive biases Type 1 and type 2 thinking Common cognitive biases in medicine Thinking about thinking Human factors Shared decision-making Patient-centred evidence-based medicine Effective team communication Using clinical prediction rules and other decision aids Reducing errors in clinical decision-making Deliberate practice Cognitive debiasing strategies History and physical examination Problem representation/list and differential diagnosis Mnemonics and checklists Red flags and ROWS (‘rule out worst-case scenario’) Evidence-based history and examination Deciding pre-test probability Interpreting test results Treatment threshold Post-test probability Cognitive biases Human factors Shared decision-making Harvard problem (p. 5) Bat and ball problem (p. 6) Clinical decision-making: putting it all together Answers to problems Further information 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 Prevalence of ADRs Classification of ADRs Inter-individual variation in drug responses Adverse outcomes of drug therapy Adverse drug reactions Detecting ADRs – pharmacovigilance Drug interactions Mechanisms of drug interactions Avoiding drug interactions Medication errors Responding when an error is discovered New therapeutic agents Manufacturers Health services Prescribers 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 Dose titration Route Frequency Timing Formulation Duration 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 Choosing a dosage regimen 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 older 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 Multiple Choice Questions Further information 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 variants 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 Multiple Choice Questions Further information 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 Aetiology Clinical assessment Investigations Management Aetiology Clinical assessment Investigations Management Chronic granulomatous disease Leucocyte adhesion deficiencies Defects in cytokines and cytokine receptors Clinical features Investigations Management X-linked agammaglobulinaemia Selective IgA deficiency Common variable immune deficiency Specific antibody deficiency Investigations Management DiGeorge syndrome Bare lymphocyte syndromes Severe combined immune deficiency Presenting problems in immune disorders Recurrent infections Intermittent fever Anaphylaxis Immune deficiency Primary phagocyte deficiencies Complement pathway deficiencies Primary antibody deficiencies Primary T-lymphocyte deficiencies Investigations Management Autoimmune lymphoproliferative syndrome Secondary immune deficiencies Familial Mediterranean fever Mevalonate kinase deficiency TNF receptor-associated periodic syndrome Cryopyrin-associated periodic syndrome (CAPS) Pathophysiology Clinical features Investigations Management Pathophysiology Clinical features Investigations Autoantibodies Complement Cryoglobulins Management 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) Pathophysiology Clinical features Investigations Management Hereditary angioedema Clinical features Investigations Management Acquired C1 inhibitor deficiency Investigations Pre-transplantation testing Post-transplant biopsy: C4d staining Periodic fever syndromes Amyloidosis Autoimmune disease Allergy Angioedema Pregnancy and the immune system Transplantation and graft rejection Transplant rejection Complications of transplant immunosuppression Organ donation Tumour immunology Further information Multiple Choice Questions 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 Carbon dioxide and global warming Principles of screening and immunisation Screening Immunisation Epidemiology Understanding causes and effect Mendelian randomisation Health data/informatics Management of epidemics Multiple Choice Questions Further information 6 Principles of infectious disease Agents causing infection 3 CLINICAL MEDICINE 17 Respiratory medicine Presenting problems in respiratory disease Respiratory failure Chronic and ‘acute on chronic’ type II respiratory failure Genetics, pathogenesis and epidemiology 1 FUNDAMENTALS OF MEDICINE 6 Principles of infectious disease Normal microbial flora 1 FUNDAMENTALS OF MEDICINE 6 Principles of infectious disease Host–pathogen interactions 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 (CFT) Agglutination tests Immunodiffusion Lateral flow immunochromatography Antibody-independent specific immunological tests Antimicrobial susceptibility testing 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 Epidemiology of infection 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 Pharmacokinetics Adverse effects Drug interactions Antimicrobial prophylaxis Antibacterial agents ß-lactam antibiotics Penicillins Cephalosporins and cephamycins Monobactams Carbapenems Macrolide and lincosamide antibiotics Pharmacokinetics Macrolides Lincosamides (e.g. clindamycin) Adverse effects Pharmacokinetics Gentamicin dosing Adverse effects Aminoglycosides and spectinomycin Spectinomycin Pharmacokinetics Adverse effects Pharmacokinetics Adverse effects Pharmacokinetics Adverse effects Quinolones and fluoroquinolones Glycopeptides Lipopeptides Polymyxins Folate antagonists Tetracyclines and glycylcyclines Tetracyclines Pharmacokinetics Adverse effects Glycylcyclines (tigecycline) Nitroimidazoles Phenicols (chloramphenicol) Oxazolidinones Other antibacterial agents Fusidic acid Nitrofurantoin Fidaxomicin Fosfomycin Lefamulin Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin Other antituberculous agents Clofazimine Antimycobacterial agents Antifungal agents Azole antifungals Imidazoles Triazoles Lipid formulations of amphotericin B Echinocandins Polyenes Other antifungal agents Flucytosine Griseofulvin Terbinafine Antiviral agents Antiretroviral agents Anti-herpesvirus agents Aciclovir, valaciclovir, penciclovir and famciclovir Ganciclovir Cidofovir Foscarnet Letermovir Anti-influenza agents Zanamivir and oseltamivir Other anti-influenza agents Other agents used to treat viruses Remdesivir Ribavirin Antiparasitic agents Antimalarial agents Artemisinin (qinghaosu) derivatives Atovaquone Folate synthesis inhibitors (proguanil, pyrimethamine–sulfadoxine) Quinoline-containing compounds Lumefantrine Drugs used in trypanosomiasis 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 Multiple Choice Questions 7 Oncology Clinical examination of the cancer patient Clinical examination of the patient on cancer treatment The 10 hallmarks of cancer 1 . Genome instability and mutation 2 . Resisting cell death Apoptosis Autophagy Necrosis 3 . Sustaining proliferative signalling The cell cycle Stimulation of the cell cycle 4 . Evading growth suppressors 5 . Enabling replicative immortality 6 . Inducing angiogenesis 7 . Activating invasion and metastasis 8 . Deregulating cellular energetics 9 . Tumour-promoting inflammation 10 . Evading immune destruction Environmental factors Genetic factors Environmental and genetic determinants of cancer Investigations Determining the extent of disease (staging) Computed tomography Ultrasound Magnetic resonance imaging Positron emission tomography Biochemical markers Establishing the type of cancer Histopathology Light microscopy Immunohistochemistry Molecular pathology Cytogenetic analysis Assessing fitness Multidisciplinary teams Acute oncology Acute presentation of new cancer Cancer of unknown primary (CUP) Metastatic malignant disease of undefined primary origin (MUO) Oncological emergencies Malignant spinal cord compression Clinical features Management Superior vena cava obstruction Clinical features Investigations and management Neutropenic fever Clinical features Investigations and management Hypercalcaemia of malignancy Clinical features Investigations and management Immune-related adverse events Clinical features Investigations and management Tumour lysis syndrome Clinical features Investigations and management Other acute presentations in oncology Venous thromboembolism Ectopic hormone production Neurological paraneoplastic syndromes Cutaneous manifestations of cancer Symptoms from locally advanced cancer or metastatic sites Brain metastases Clinical features Investigations and management Lung metastases Liver metastases Bone metastases Clinical features Investigations and management Malignant pleural effusion Investigations and management Other common symptoms Treatment-related toxicities Therapeutics in oncology Surgical treatment Radiotherapy Systemic anti-cancer therapy Cytotoxic chemotherapy Hormone therapy Targeted therapies Immunotherapy Pathogenesis Clinical features Investigations Management Pathogenesis Investigations Management Pathogenesis Investigations Management Pathogenesis Investigations Management Pathogenesis Investigations Management Evaluation of treatment Late toxicity of therapy Cancer clinical trials Specific cancers Breast cancer Ovarian cancer Endometrial cancer Cervical cancer Head and neck tumours Survivorship Further information 8 Pain and palliative care Clinical examination in pain and palliative care Clinical evaluation and management in a patient with chronic pain or in the palliative care setting 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 Anti-neuropathic agents 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 Planning for dying Diagnosing dying Management of dying Ethical considerations Capacity and advance directives Euthanasia Death and dying Multiple Choice Questions Further information 2 EMERGENCY AND CRITICAL CARE MEDICINE 9 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 Acute breathlessness Anaphylaxis Syncope/presyncope Headache Unilateral leg swelling Acute abdomen 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 Pathophysiology Assessment and management Pathophysiology Assessment and management Pathophysiology Assessment and management Pathophysiology Assessment and management Shock Pathophysiology Assessment and management Assessment Management Assessment Diagnosis and management Abdominal compartment syndrome Rhabdomyolysis 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 Aetiology and pathogenesis Diagnosis and management Definition and aetiology Myocardial infarction Acute massive pulmonary embolism Acute valvular pathology, aortic dissection and cardiac tamponade Selecting the appropriate location for ongoing management and anticipatory care planning Common presentations of deterioration Tachypnoea Hypoxaemia Tachycardia Hypotension Hypertension Decreased conscious level Decreased urine output/deteriorating renal function Disorders causing critical illness Sepsis and the systemic inflammatory response Acute respiratory distress syndrome Acute circulatory failure (cardiogenic shock) Cardiac arrest Out-of-hospital cardiac arrest (OHCA) Pathogenesis Survivors of OHCA In-hospital cardiac arrest (IHCA) Pathogenesis Clinical assessment and management Basic life support Advanced life support Acute management Prognosis Post cardiac arrest 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 Critical illness polyneuropathy Critical illness myopathy Renal support Neurological support Daily clinical management in intensive care Clinical review Infection surveillance 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 Airway complications Micro- and macrovascular complications Other complications The older patient Withdrawal of active treatment and death in intensive care Futility Death Organ donation Donation after brain death Donation after cardiac death Post-mortem examination or autopsy Discharge from intensive care Critical care scoring systems Multiple Choice Questions Further information 10 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 Clinical features Management Clinical features Management Clinical features Management Iron Antipsychotic drugs Antidiabetic agents 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 Alcohols and glycols Corrosive substances Aluminium and zinc phosphide Copper sulphate Chemicals less commonly taken in poisoning Chemical warfare agents Arsenism Fluorosis Paralytic shellfish poisoning Ciguatera poisoning Scombrotoxic fish poisoning Tetrodotoxin poisoning Environmental poisoning Food-related poisoning Plant poisoning Multiple Choice Questions Further information 11 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 Clinical features and management Clinical features and management Clinical features and management Follow-up Prevention Envenomation by specific animals Venomous snakes Scorpions Spiders Paralysis ticks Venomous insects Venomous lepidopterans Venomous hymenopterans Marine venomous and poisonous animals Multiple Choice Questions Further information 12 Medicine in austere environments Extremes of temperature The cold environment Hypothermia Management Mild hypothermia Severe hypothermia Cardiac arrest Cold injury Freezing cold injury (‘frostbite’) Management Non-freezing cold injury Pathophysiology of heat stroke Management Prevention Respiratory Haematological Cardiovascular Heat-related illness Physiological effects of high altitude Acute high altitude illness Illness at high altitude Acute mountain sickness Management High altitude cerebral oedema Management High altitude pulmonary oedema Management Drowning Cold shock Autonomic conflict Pre-hospital management In-hospital management CPR modifications Decompression illness Decompression sickness Arterial gas embolism Management Immersion pulmonary oedema Shallow-water blackout Subaquatic medicine Multiple Choice Questions Further information 3 CLINICAL MEDICINE 13 Infectious disease Clinical examination of patients with infectious disease Presenting problems in infectious diseases Fever 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 Clinical assessment Investigations Management Positive blood culture Central venous catheter infections Investigations and management Sepsis Severe skin and soft tissue infections Necrotising fasciitis Gas gangrene Other SSTIs Clinical assessment Investigations Management Fluid replacement Antimicrobial agents Antidiarrhoeal, antimotility and antisecretory agents Acute diarrhoea and vomiting Non-infectious causes of food poisoning Antimicrobial-associated diarrhoea Infections acquired in the tropics Fever acquired in tropical regions 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 Diagnosis 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 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 Pathogenesis Gastrointestinal viral infections Norovirus Astrovirus Rotavirus Hepatitis viruses (A–E) Other viruses Respiratory viral infections Coronaviruses SARS coronavirus (SARS-CoV) Middle East respiratory syndrome coronavirus (MERS-CoV) Clinical features Diagnosis and management SARS-CoV-2 Responses to control the pandemic Infection prevention and control in health-care settings Public health measures Clinical features Investigations Management Vaccination Other considerations Viral infections with neurological involvement Japanese encephalitis virus (JEV) Clinical features Investigations, management and prevention Tick-borne encephalitis virus West Nile virus Clinical features Diagnosis and management 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 Staphylococcus 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 Enteric fevers (typhoid and paratyphoid) 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. Enterotoxigenic E. coli Entero-invasive E. coli Enteropathogenic E. coli Entero-aggregative E. coli Enterohaemorrhagic E. coli Gastrointestinal bacterial infections Staphylococcal food poisoning Bacillus cereus food poisoning Clostridium perfringens food poisoning Campylobacter infection Salmonella spp. infection Escherichia coli infection Clostridioides difficile infection Clinical features Investigations Management Yersiniosis 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 Epidemiology and transmission Leishmaniasis 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 Clinical features Investigations Management Ascaris lumbricoides (roundworm) Clinical features Investigations Management Prevention Enterobius vermicularis (threadworm, pinworm) Clinical features Investigations Management Trichuris trichiura (whipworm) Tissue-dwelling human nematodes Lymphatic filariasis Pathology Clinical features Investigations Management Co-infections 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 Jiggers (tungiasis) Myiasis Ectoparasites 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 marneffei infection Histoplasmosis Pathology Clinical features Investigations Management Coccidioidomycosis Investigations and management Paracoccidioidomycosis Blastomycosis Further information 14 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 Clinical manifestations of HIV 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 (Pneumocystis pneumonia, PCP) 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 Selecting antiretroviral regimens Starting ART Monitoring efficacy Antiretroviral resistance Antiretroviral therapy ART complications Immune reconstitution inflammatory syndrome Antiretroviral adverse drug reactions ART in special situations Pregnancy Old age Prevention of HIV Pre-exposure prophylaxis Post-exposure prophylaxis Further information 15 Sexually transmitted infections Clinical examination in sexually transmitted infection Aetiology Clinical assessment Presenting problems Urethral discharge Genital itch, rash and discomfort Vaginal discharge Genital ulceration Genital lumps Proctitis Lower abdominal pain Epidemiology Prevention Sexually transmitted bacterial infections Syphilis Acquired syphilis Early syphilis Primary syphilis Secondary syphilis Latent syphilis Late syphilis Late latent syphilis Cardiovascular syphilis Benign tertiary syphilis Neurosyphilis Congenital syphilis Investigations in adult cases Investigations in suspected congenital syphilis Management Pregnancy Treatment reactions Clinical features Investigations Management of adults Clinical features Diagnosis Management First episode Recurrent genital herpes Management in pregnancy Clinical features Management Gonorrhoea Chlamydial infection Mycoplasma genitalium Other sexually transmitted bacterial infections Sexually transmitted viral infections Genital herpes simplex Human papillomavirus and anogenital warts Molluscum contagiosum Viral hepatitis Further information 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 Clinical assessment Investigations Clinical assessment Investigations Management Clinical assessment Investigation Management 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 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 antagonists (β-blockers) Ivabradine Digoxin Amiodarone Non-pharmacological treatments Implantable cardiac defibrillators Cardiac resynchronisation therapy devices Coronary revascularisation Cardiac transplantation Ventricular assist devices Pathogenesis Clinical features Investigations Management First-degree atrioventricular block Second-degree atrioventricular block Third-degree atrioventricular block Presenting problems in cardiovascular disease Chest pain on exertion Severe prolonged chest pain Breathlessness Syncope Palpitation Cardiac arrest Abnormal heart sounds Heart failure Sinus arrhythmia Sinus bradycardia Sinus tachycardia Sinoatrial disease Atrioventricular block Clinical features Management Bundle branch block 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 Prevention of thromboembolism and stroke Supraventricular tachycardia Atrioventricular nodal re-entrant tachycardia Management Atrioventricular re-entrant tachycardia Management Ventricular premature beats Management Ventricular tachycardia Management Torsades de pointes Management Cardiac arrhythmias 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 Non-selective β-blockers Cardioselective β-blockers Sotalol Amiodarone Dronedarone Verapamil Diltiazem Atropine sulphate Adenosine Digoxin Class II drugs Class III drugs Class IV drugs Other anti-arrhythmic drugs Non-pharmacological treatments Electrical cardioversion Defibrillation Temporary pacemakers Permanent pacemakers Implantable cardiac defibrillators Cardiac resynchronisation therapy Catheter ablation therapy 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 Pathogenesis Coronary artery spasm Syndrome X and microvascular angina 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 Pathogenesis Anchor 207 Coronary artery disease Angina pectoris Acute coronary syndrome 17 Respiratory medicine Clinical examination of the respiratory system Functional anatomy and physiology 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 Microbiological investigations Immunological and serological tests Cytology and histopathology Respiratory function testing Measurement of airway obstruction Lung volumes Transfer factor Arterial blood gases and oximetry Exercise tests Aetiology Pathophysiology Differential diagnosis 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? Presenting problems in respiratory disease Cough Breathlessness Chronic exertional breathlessness Acute severe breathlessness Management Clinical assessment Investigations Radiological investigations Pleural aspiration and biopsy Management Chest pain Finger clubbing Haemoptysis ‘Incidental’ pulmonary nodule Pleural effusion Empyema Clinical assessment Investigations Management Pathophysiology Management of acute respiratory failure Respiratory failure Chronic and ‘acute on chronic’ type II respiratory failure Management Home ventilation for chronic respiratory failure Lung transplantation Pathophysiology Clinical features Diagnosis Management Setting goals Self-management Avoidance of aggravating factors The stepwise approach to the management of asthma Step 1: Regular preventer Step 2: Initial add-on therapy Step 3: Additional add-on therapies Step 4: High-dose therapies Step 5: Continuous or frequent use of oral glucocorticoids Exacerbations of asthma Management of mild to moderate exacerbations Management of acute severe asthma Prognosis Pathophysiology Clinical features Investigations Assessment of severity Management Reducing exposure to noxious particles and gases Pulmonary rehabilitation Bronchodilators Combined inhaled glucocorticoids and bronchodilators Oral anti-inflammatories Other maintenance measures Oxygen therapy and home ventilation Surgical intervention Palliative care Prognosis Acute exacerbations of COPD Oxygen therapy Bronchodilators Glucocorticoids Antibiotic therapy Non-invasive ventilation Additional therapy Discharge Aetiology and pathology Clinical features Investigations Management Physiotherapy Antibiotic therapy Surgical treatment Prognosis Prevention Clinical features Management Treatment of CF lung disease Treatment of non-respiratory manifestations of CF CFTR modulator therapies 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 Epidemiology Pathology and pathogenesis Clinical features: pulmonary disease Primary pulmonary TB Miliary TB Post-primary pulmonary TB Clinical features: extrapulmonary disease Lymphadenitis Pleural tuberculosis Gastrointestinal tuberculosis Pericardial disease Central nervous system disease Bone and joint disease Genitourinary disease Investigations Drug sensitivity testing Management Chemotherapy Control and prevention Latent TB infection (LTBI) Directly observed therapy TB and HIV/AIDS Drug-resistant TB Vaccines 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) Prognosis Obstructive pulmonary diseases Asthma Chronic obstructive pulmonary disease Bronchiectasis Cystic fibrosis Infections of the respiratory system Upper respiratory tract infection Pneumonia Tuberculosis Non-tuberculous 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 Aetiology Tumours of the bronchus and lung Primary tumours of the lung Lung cancer Pathology Clinical features Investigations Imaging Biopsy and histopathology Staging to guide treatment Management Surgical treatment Radiotherapy Chemotherapy Laser therapy and stenting General aspects of management Prognosis Investigations Management Secondary tumours of the lung Tumours of the mediastinum 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 Irritant-induced asthma 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 Benign asbestos-related pleural effusion Diffuse pleural thickening Asbestosis Mesothelioma Occupational lung cancer Occupational pneumonia Clinical features Investigations Management General measures Anticoagulation Thrombolytic and surgical therapy Caval filters Further investigations Prognosis Clinical features Investigations Management Pulmonary vascular disease Pulmonary embolism Pulmonary hypertension Diseases of the upper airway Diseases of the nasopharynx Allergic rhinitis Clinical features Management Sleep-disordered breathing The obstructive sleep apnoea/hypopnoea syndrome Aetiology Clinical features Investigations Management Central sleep apnoea and nocturnal hypoventilation 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 Pneumothorax Clinical features Investigations Management Recurrent spontaneous pneumothorax Pleural disease 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 Further information 18 Nephrology and urology Clinical examination of the kidney and urinary tract Functional anatomy and physiology 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 Clinical assessment Investigations Management Renal biopsy Presenting problems in renal and urinary tract disease Oliguria/anuria Polyuria Frequency Nocturia Urinary incontinence Abdominal pain Dysuria Oedema Hypertension Haematuria Nephritic syndrome Proteinuria Moderately elevated albuminuria (microalbuminuria) Overt (dipstick-positive) proteinuria Nephrotic syndrome 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 Acute interstitial nephritis Clinical features Investigations Management Chronic interstitial nephritis Pathophysiology Clinical features Management Papillary necrosis Tubulo-interstitial diseases Genetic renal diseases Inherited glomerular diseases Alport syndrome Thin glomerular basement membrane disease Hereditary nephrotic syndrome Inherited tubulo-interstitial diseases Isolated defects of tubular function Cystic diseases of the kidney Autosomal dominant polycystic kidney disease Clinical features Investigations Management Other cystic diseases Pathophysiology Clinical features Investigations Management Renal vascular diseases Renal artery stenosis Acute renal infarction Diseases of small intrarenal vessels Thrombotic microangiopathies Haemolytic uraemic syndrome Thrombotic thrombocytopenic purpura Cholesterol emboli Small-vessel vasculitis Diabetes mellitus Multiple myeloma Hepatic–renal disease Sarcoidosis Systemic vasculitis Systemic sclerosis Systemic lupus erythematosus Sickle-cell nephropathy Pathophysiology Clinical features Pre-renal AKI Renal AKI Post-renal AKI Management Optimisation of volume status Treatment of underlying cause Electrolyte and acid–base disturbances Dietary measures Infection Medications Renal replacement therapy (RRT) Recovery from AKI 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 involvement in systemic conditions Acute kidney injury Chronic kidney disease Renal replacement therapy Conservative treatment Haemodialysis Haemodialysis in AKI Haemodialysis in ESRD Haemofiltration 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 Urinary tract infection Pathophysiology Clinical features Investigations Management Persistent or recurrent UTI Asymptomatic bacteriuria Catheter-related bacteriuria Acute pyelonephritis Tuberculosis Pathophysiology Clinical features Investigations Management Infections of the urinary tract Urolithiasis 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 Reflux nephropathy Pathophysiology Clinical features Investigations Management Retroperitoneal fibrosis Renal cell cancer Clinical features Investigations Management Urothelial tumours Pathophysiology Clinical features Investigations Management Pathophysiology Stress incontinence Urge incontinence Continual incontinence Overflow incontinence Post-micturition dribble Clinical assessment Investigations Management Prostatitis Benign prostatic enlargement Pathophysiology Clinical features Investigations Management Prostate cancer Pathophysiology Clinical features Investigations Management Clinical features and investigations Management and prognosis Investigations Management Tumours of the kidney and urinary tract Urinary incontinence Prostate disease Testicular tumours Erectile dysfunction Further information 19 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 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 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 PCSK9 inhibitors Ezetimibe Bile acid-sequestering resins Combination therapy Hypertriglyceridaemia Fibrates Highly polyunsaturated long-chain n-3 fatty acids Mixed hyperlipidaemia Monitoring of therapy Inherited metabolic disorders Disorders of amino acid metabolism Phenylketonuria Homocystinuria Disorders of the urea cycle Ornithine tricarboxylase deficiency Disorders of carbohydrate metabolism Galactosaemia Glycogen storage diseases Disorders of mitochondrial energy metabolism Lysosomal storage disorders The porphyrias Cutaneous porphyrias Further information 20 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’) Hyperthyroidism in old age Hypothyroidism Clinical assessment Investigations Management Levothyroxine replacement in ischaemic heart disease Hypothyroidism in old age 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 Papillary carcinoma Follicular carcinoma Thyroid neoplasia Toxic adenoma Differentiated carcinoma Management Prognosis Anaplastic carcinoma and lymphoma Medullary carcinoma Riedel’s thyroiditis Congenital thyroid disease Dyshormonogenesis Thyroid hormone resistance The male The female The reproductive system Functional anatomy, physiology and investigations Presenting problems in reproductive disease Delayed puberty Clinical assessment Constitutional delay of puberty Hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism 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 Management Menstrual irregularity and infertility Hirsutism Clinical features Diagnosis and management Clinical features Diagnosis and management Polycystic ovary syndrome Turner syndrome Klinefelter syndrome The parathyroid glands Functional anatomy, physiology and investigations Presenting problems in parathyroid disease Hypercalcaemia Clinical assessment Investigations Management Hypocalcaemia Aetiology Clinical assessment Management Clinical and radiological features Investigations Management Pseudohypoparathyroidism Management of hypoparathyroidism Glucocorticoids Mineralocorticoids Catecholamines Adrenal androgens Primary hyperparathyroidism Familial hypocalciuric hypercalcaemia Hypoparathyroidism The adrenal glands Functional anatomy and physiology 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 Clinical features Investigations Biochemical Imaging and localisation Management Clinical features Investigations Localisation Management Pathophysiology and clinical features Investigations Management Primary hyperaldosteronism Phaeochromocytoma and paraganglioma Congenital adrenal hyperplasia 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 Clinical features Investigations Management Investigation of patients with pituitary disease Gastroenteropancreatic neuro-endocrine tumours The hypothalamus and the pituitary gland Functional anatomy, physiology and investigations 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 Management Medical Surgery and radiotherapy Pregnancy Clinical features Investigations Management Surgical Medical Radiotherapy Clinical features Investigations Management Prolactinoma Acromegaly Craniopharyngioma Diabetes insipidus Disorders affecting multiple endocrine glands Multiple endocrine neoplasia Autoimmune polyendocrine syndromes Endocrine effects of cancer immunotherapy Late effects of childhood cancer therapy Opioid-induced endocrine dysfunction Multiple Choice Questions Further information 21 Diabetes mellitus Clinical examination of people with diabetes Functional anatomy and physiology Anchor 4 Insulin Regulation of insulin secretion Actions of insulin Glucagon Blood glucose homeostasis Fat metabolism Investigations Anchor 12 Urine glucose Blood glucose Interstitial glucose Urine and blood ketones Glycated haemoglobin Islet autoantibodies C-peptide Urine albumin (‘microalbuminuria’) Establishing the diagnosis of diabetes Aetiology and pathogenesis of diabetes Anchor 23 Pathogenesis of diabetes Insulin resistance and the metabolic syndrome β-cell dysfunction Type 1 diabetes Pathogenesis Genetic predisposition Environmental predisposition Metabolic disturbances in type 1 diabetes Clinical course of type 1 diabetes Type 1 diabetes presenting in adults Type 2 diabetes Pathogenesis Risk factors for type 2 diabetes Genetic predisposition Lifestyle factors and obesity Age Ethnicity Interaction of risk factors for type 2 diabetes Clinical course and metabolic disturbances in type 2 diabetes Other forms of diabetes Pancreatic diabetes Monogenic diabetes Presenting problems in diabetes Anchor 47 Hyperglycaemia Diabetic ketoacidosis Pathogenesis Clinical assessment Investigations Assessment of severity Management Fluid replacement Insulin replacement Potassium replacement Intravenous bicarbonate and phosphate Ongoing management Hyperglycaemic hyperosmolar state Hypoglycaemia Clinical assessment Awareness of hypoglycaemia Risk factors and causes of hypoglycaemia Management Reversing hypoglycaemia Reducing future risk of hypoglycaemia Type 2 diabetes Type 1 diabetes Type 2 diabetes Type 1 diabetes Type 1 diabetes Type 2 diabetes Type 2 diabetes Type 1 diabetes Type 1 diabetes Type 2 diabetes Management of diabetes Anchor 69 Self-assessment of glycaemic control Therapeutic goals HbA1c targets Control of other risk factors Education, diet and lifestyle Principles of healthy eating Weight management Exercise Alcohol and smoking Driving Ramadan Glucose-lowering agents Biguanides Mechanism of action Clinical use Sulphonylureas Mechanism of action Clinical use Thiazolidinediones Mechanism of action Clinical use DPP-4 inhibitors Mechanism of action Clinical use GLP-1 receptor agonists Mechanism of action Clinical use SGLT2 inhibitors Mechanism of action Clinical use Manufacture and formulations Intermittent subcutaneous insulin injection therapy Intermittent subcutaneous insulin injection regimens Continuous subcutaneous insulin infusion therapy (insulin pump) Sensor-augmented CSII therapy Intravenous insulin therapy Insulin therapy Transplantation Management of diabetes in special situations Diabetes in pregnancy Children, adolescents and young adults with diabetes Diabetes in hospital Hyperglycaemia in acute admissions to hospital Surgery and diabetes Pre-operative assessment Perioperative management Postoperative management Diabetes footcare in hospital Complications of diabetes Life expectancy/mortality Infections and diabetes Urogenital, skin and soft tissue infections Bone and joint infection COVID-19 Diagnosis and screening Management Clinical features Symmetrical sensory polyneuropathy Asymmetrical motor diabetic neuropathy (diabetic amyotrophy) Mononeuropathy Autonomic neuropathy Gastroparesis Sexual dysfunction Management Diabetic eye disease Diabetic kidney disease Diabetic neuropathy Diabetic foot disease Aetiology Management Foot ulceration Charcot neuroarthropathy Skin and rheumatological complications of diabetes Multiple Choice Questions 22 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 Complications Body fat distribution Aetiology Susceptibility to obesity Clinical features and investigations Management Lifestyle advice Weight loss diets Drugs Surgery Treatment of additional risk factors Disorders of altered energy balance Obesity Under-nutrition Starvation and famine Clinical features Investigations Management Under-nutrition in hospital An approach to assisted nutrition in hospital patients Oral nutritional supplements Enteral feeding 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) Vitamin C (ascorbic acid) Deficiency – scurvy Other bioactive dietary compounds Inorganic micronutrients Calcium and phosphorus Iron Iodine Zinc Selenium Fluoride Sodium, potassium and magnesium Other essential inorganic nutrients Further information 23 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 Endoanal ultrasound and anorectal manometry Endoscopy Upper gastrointestinal endoscopy Endoscopic ultrasound Capsule endoscopy Enteroscopy – push enteroscopy/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 Investigations Radioisotope tests Gut hormone testing Presenting problems in gastrointestinal disease Dysphagia Dyspepsia Heartburn and regurgitation Vomiting Gastrointestinal bleeding Acute upper gastrointestinal bleeding Clinical assessment Management Intravenous access Initial clinical assessment Basic investigations Resuscitation Oxygen Antithrombotic drugs Proton pump inhibitor (PPI) therapy Endoscopy Monitoring Radiology and surgery 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 Pathophysiology Investigations Physiological causes Psychiatric illness Systemic disease Gastrointestinal disease Metabolic disorders and miscellaneous causes Investigations Clinical assessment and management Initial investigations Further investigations Malabsorption Weight loss Constipation Abdominal pain Chronic or recurrent abdominal pain Constant abdominal pain Aphthous ulceration Oral cancer Candidiasis Parotitis 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 Infection Corrosives Drugs Eosinophilic oesophagitis Disorders of the mouth and salivary glands Disorders of the oesophagus Gastro-oesophageal reflux disease Other causes of oesophagitis Benign oesophageal stricture Tumours of the oesophagus Benign tumours Carcinoma of the oesophagus Clinical features Investigations Management Perforation of the oesophagus Oesophageal motility disorders Pharyngeal pouch Achalasia of the oesophagus Pathophysiology Clinical features Investigations Management Endoscopic Surgical Other oesophageal motility disorders Secondary causes of oesophageal dysmotility Disorders 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 Helicobacter 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 Tumours of the stomach Gastric carcinoma Pathophysiology Clinical features Investigations Management Surgery Palliative treatment Gastric lymphoma Other tumours of the stomach Gastric motility disorders Gastroparesis Disorders 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 intestinal bacterial overgrowth Pathophysiology Clinical features Investigations Management Whipple’s disease Pathophysiology Clinical features Investigations Management Bile acid diarrhoea Short bowel syndrome Radiation enteropathy Pathophysiology Clinical features Investigations Management Abetalipoproteinaemia 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 Infections of the small intestine Tumours of the small intestine Benign tumours Malignant tumours Adenocarcinomas Neuro-endocrine tumours Lymphoma Immunoproliferative small intestinal disease Small intestine motility disorders Chronic small intestine pseudo-obstruction Clinical features Investigations Management Disorders of the colon and rectum Colorectal polyps Types of colorectal polyps Assessment and treatment of colorectal polyps Pathophysiology Genetics Environment Clinical features Investigations Management Endoscopy Surgery Adjuvant therapy Palliation of advanced disease Prevention and screening Colorectal cancer Hereditary syndromes predisposing to colorectal cancer Non-polyposis syndromes Polyposis syndromes Familial adenomatous polyposis Peutz–Jeghers syndrome Juvenile polyposis Pathophysiology Clinical features Investigations Management Diverticulosis Colonic motility disorders Simple constipation Severe idiopathic constipation Faecal impaction Melanosis coli and laxative misuse syndromes Hirschsprung’s disease Acquired megacolon Acute colonic pseudo-obstruction Anorectal disorders Haemorrhoids Pruritus ani Solitary rectal ulcer syndrome Anal fissure Anorectal abscesses and fistulae Faecal incontinence Management 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 Medical therapy Non-biologic therapies Aminosalicylates (5-ASA) Glucocorticoids Thiopurines Methotrexate Ciclosporin Antibiotics Biologic agents Anti-TNF antibodies Anti-α4β7 integrin Janus kinase inhibitor Anti-p40 antibodies Therapeutic drug monitoring Ulcerative colitis Active ulcerative colitis Severe ulcerative colitis Maintenance of remission Crohn’s disease Principles of management Induction of remission in mild to moderate disease Induction of remission in severe disease Maintenance therapy Fistulae and perianal disease Surgical management Ulcerative colitis Crohn’s disease IBD in special circumstances Childhood Pregnancy Metabolic bone disease Microscopic colitis Pathophysiology Clinical features Investigations Management Pathophysiology Behavioural and psychosocial factors Physiological factors Luminal factors Clinical features Investigations Management Inflammatory bowel disease Functional bowel disorders Functional dyspepsia Functional causes of vomiting Irritable bowel syndrome Acute small bowel ischaemia Acute colonic ischaemia Chronic mesenteric ischaemia Pathophysiology Clinical features Investigations Management Pathophysiology Clinical features Investigations Alcohol misuse Pain relief Malabsorption Management of complications Ischaemic gut injury Diseases of the pancreas Acute pancreatitis Chronic pancreatitis Management 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 Diseases of the peritoneal cavity Peritonitis Tumours Endometriosis Pneumatosis cystoides intestinalis HIV/AIDS and the gastrointestinal tract Other disorders Multiple Choice Questions 24 Hepatology Clinical examination of the abdomen for liver and biliary disease 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 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 Non-invasive markers of hepatic fibrosis Histological examination Presenting problems in liver disease Abnormal liver function tests Jaundice Pre-hepatic jaundice Hepatic jaundice Post-hepatic jaundice Pathophysiology Clinical assessment Investigations Management Pathophysiology Investigations Management Sodium restriction Diuretics Paracentesis Transjugular intrahepatic portosystemic stent shunt Complications Renal failure Hepatorenal syndrome Spontaneous bacterial peritonitis Prognosis Pathophysiology Investigations Management Pathophysiology Clinical features Management Nutrition in cirrhosis Screening for complications Prognosis Clinical features Pathophysiology Investigations Management Primary prevention of variceal bleeding Management of acute variceal bleeding Pharmacological reduction of portal venous pressure Variceal ligation (‘banding’) Balloon tamponade TIPSS Portosystemic shunt surgery Oesophageal transection Secondary prevention of variceal bleeding Acute liver failure Hepatomegaly Ascites Hepatic encephalopathy Variceal bleeding Congestive ‘portal hypertensive’ gastropathy Clinical features of acute infection Investigations Management Cirrhosis Acute on chronic liver failure Portal hypertension Infections and the liver Viral hepatitis 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 Pegylated interferon-alfa Liver transplantation Hepatocellular carcinoma risk Prevention Co-infection with HIV Hepatitis D (Delta virus) Investigations Management Hepatitis C Investigations Serology and virology Molecular analysis Liver function tests Fibrosis assessment 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 Pathophysiology Clinical features Alcohol-related fatty liver disease Alcoholic hepatitis Alcoholic cirrhosis Investigations Management Nutrition Drug therapy Liver transplantation Pathophysiology Clinical features Investigations Biochemical tests Imaging Transient elastography Liver biopsy Management Non-pharmacological treatment Pharmacological treatment Pathophysiology Clinical features Investigations Management Epidemiology Pathophysiology Clinical features Associated diseases Diagnosis and investigations Management Pruritus Fatigue Malabsorption Bone disease AMA-negative PBC (‘autoimmune cholangitis’) PBC/autoimmune hepatitis overlap Alcohol-related liver disease Non-alcoholic fatty liver disease Autoimmune liver and biliary disease Autoimmune hepatitis Primary biliary cholangitis Overlap syndromes Pathophysiology Clinical features Investigations Management Cancer screening Management of complications Surgical treatment Primary sclerosing cholangitis 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 Ablative therapy Transarterial chemoembolisation Systemic therapy Fibrolamellar hepatocellular carcinoma Other primary malignant tumours Clinical features Investigations Management Secondary malignant tumours 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 Autoimmune hepatitis-like Inherited liver diseases Haemochromatosis Genetic haemochromatosis Pathophysiology Clinical features Investigations Management Secondary haemochromatosis Pathophysiology Clinical features Liver disease Neurological disease Kayser–Fleischer rings Investigations Management Clinical features Investigations Wilson’s disease Alpha-1-antitrypsin deficiency Gilbert syndrome 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 Pathophysiology Cholesterol gallstones Pigment stones Biliary sludge Clinical features Investigations Management Secondary biliary cirrhosis Gallstones Cholecystitis Acute cholecystitis Pathophysiology Clinical features Investigations Management Medical Surgical Chronic cholecystitis Acute cholangitis Clinical features Investigations Management Choledocholithiasis 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 Functional gallbladder disorder 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 25 Haematology and transfusion medicine Clinical examination in blood disease 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 Clinical assessment Investigations Clinical assessment and investigations Presenting problems in blood disease Anaemia High haemoglobin Leucopenia (low white cell count) Neutropenia Lymphopenia Leucocytosis (high white cell count) Neutrophilia Eosinophilia Lymphocytosis Clinical assessment Investigations Lymphadenopathy Splenomegaly Bleeding Thrombocytopenia (low platelet count) Thrombocytosis (high platelet count) Pancytopenia Infection Principles of management of haematological disease Blood components and transfusion Blood components 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 Anti-cancer drugs Cytotoxic chemotherapy Monocolonal antibodies Small molecule targeted therapies Immunotherapy Haematopoietic stem cell transplantation Allogeneic HSCT Complications Graft-versus-host disease Autologous HSCT Alternative cellular therapies Anticoagulant and antithrombotic therapy Heparins Heparin-induced thrombocytopenia Clinical features Investigations Management Blood loss Malabsorption Physiological demands Coumarins Direct oral anticoagulants Investigations Confirmation of iron deficiency Investigation of the cause Management Pathogenesis Diagnosis and management Anaemias Iron deficiency anaemia Anaemia of chronic disease 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 Extravascular haemolysis Intravascular haemolysis Causes of haemolytic anaemia 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 Qualitative abnormalities – abnormal haemoglobins Quantitative abnormalities – thalassaemias Epidemiology Pathogenesis Clinical features Investigations Management Prognosis Haemoglobinopathies Sickle-cell anaemia Other abnormal haemoglobins Thalassaemias Beta-thalassaemia Management and prevention Alpha-thalassaemia Terminology and classification Epidemiology and aetiology Haematological malignancies Leukaemias Acute leukaemia Investigations Management Specific therapy Acute myeloid leukaemia (AML) Acute promyelocytic leukaemia (APML) Acute lymphoblastic leukaemia (ALL) Supportive therapy Anaemia Bleeding Infection Metabolic problems Psychological problems Haematopoietic stem cell transplantation (HSCT) 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 Solitary plasmacytomas Histiocytic disorders Primary idiopathic acquired aplastic anaemia Clinical features and investigations Management Secondary aplastic anaemia Myelofibrosis Management and prognosis Essential thrombocythaemia Polycythaemia rubra vera Management and prognosis Aplastic anaemia Myeloproliferative neoplasms 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 Management of VTE Prophylaxis of VTE Antithrombin deficiency Protein C and S deficiencies Factor V Leiden Prothrombin G20210A Thrombotic disorders Venous thromboembolic disease (venous thromboembolism) Inherited and acquired thrombophilia and prothrombotic states Antiphospholipid syndrome Clinical features and management Disseminated intravascular coagulation Investigations Management Thrombotic thrombocytopenic purpura Multiple Choice Questions Further information 26 Rheumatology and bone disease Clinical examination of the musculoskeletal system 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 Radionuclide 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 and complement component antibodies Approach to autoantibody testing and interpretation Clinical assessment Investigations Management Clinical assessment Investigations Management Clinical assessment Investigations Management Clinical assessment Investigations Management Clinical assessment Investigations Management Tissue biopsy Electromyography Presenting problems in musculoskeletal disease Monoarthritis Polyarthritis Fracture Generalised musculoskeletal pain Muscle weakness Regional musculoskeletal pain Back pain Clinical assessment Investigations Management Neck pain Shoulder pain Elbow pain Hand and wrist pain Hip pain Knee pain Ankle and foot pain 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 (NSAIDs) Topical agents Disease-modifying anti-rheumatic drugs Classical DMARDs (cDMARDs) Targeted synthetic DMARDs (tsDMARDs) Biologic DMARDs 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 Gout Epidemiology Pathophysiology Clinical features Investigations Management Acute gout Prophylaxis Calcium pyrophosphate deposition (CPPD) disease Pathophysiology Clinical features Investigations Management Pathophysiology Basic calcium phosphate deposition disease Calcific periarthritis Acute inflammatory arthritis Milwaukee shoulder syndrome Autoimmune connective tissue disease Pathophysiology Clinical features Investigations and management Septic arthritis Pathogenesis Clinical features Investigations Management Viral arthritis Osteomyelitis Pathogenesis Clinical features Investigations Management Discitis Tuberculosis 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 Investigations Management Prognosis Pathophysiology Clinical features Investigations Management Prognosis Clinical features Investigations Management Pathophysiology Clinical features Asymmetrical inflammatory mono-/oligoarthritis Symmetrical polyarthritis Distal interphalangeal joint arthritis Psoriatic spondylitis Arthritis mutilans Enthesitis-predominant Nail changes Investigations Management Osteoarthritis Crystal-induced arthritis Fibromyalgia Bone and joint infections Rheumatoid arthritis Juvenile idiopathic arthritis Spondyloarthritides Axial spondyloarthritis Reactive arthritis Psoriatic arthritis Enteropathic (spondylo)arthritis 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 Sjögren syndrome Clinical features Investigations Management Polymyositis and dermatomyositis Clinical features Investigations Management Microscopic polyangiitis Granulomatosis with polyangiitis Eosinophilic granulomatosis with polyangiitis Juvenile dermatomyositis Undifferentiated autoimmune connective tissue disease Adult-onset Still’s disease Antineutrophil cytoplasmic antibody-associated vasculitis Investigation of AAV Management Takayasu arteritis Kawasaki disease Polyarteritis nodosa Giant cell arteritis and polymyalgia rheumatica Clinical features Investigations Management Henoch–Schönlein purpura Cryoglobulinaemic vasculitis Behçet’s disease Relapsing polychondritis IgG4 disease Pathophysiology Idiopathic osteoporosis Glucocorticoid-induced osteoporosis Pregnancy-associated osteoporosis Autoimmune connective tissue diseases Vasculitis Diseases of bone Osteoporosis Secondary osteoporosis Clinical features Investigations Management Non-pharmacological interventions Pharmacological interventions Bisphosphonates Denosumab Calcium and vitamin D Teriparatide Abaloparatide Romosozumab Hormone replacement therapy Raloxifene Surgery Tibolone 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 Pathophysiology Clinical features Investigations Management Paget’s disease of bone Other bone diseases Complex regional pain syndrome type 1 Osteonecrosis Scheuermann’s osteochondritis Fibrous dysplasia Osteogenesis imperfecta Osteopetrosis Sclerosing bone dysplasias Osteosarcoma Chondrosarcoma Ewing’s sarcoma Metastatic bone disease Malignant disease Endocrine disease Haematological disease Neurological disease Anterior tibial compartment syndrome Carpal tunnel syndrome Diffuse idiopathic skeletal hyperostosis Dupuytren’s contracture Joint hypermobility Inclusion body myositis Pigmented villonodular synovitis Scoliosis Spondylolysis Synovitis–acne–pustulosis–hyperostosis–osteitis syndrome Trigger finger Bone and joint tumours Rheumatological involvement in other diseases Miscellaneous conditions Further information 27 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 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 Clinical assessment Is it a melanocytic naevus or a malignant melanoma? Investigations and management Clinical assessment Investigations and management Clinical assessment Investigations and management Clinical assessment Investigations and management Clinical assessment Investigations and management Sunscreens 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 Clinical assessment Investigations and management Investigation of skin disease Presenting problems in skin disease Lumps and lesions Rash Blisters Itch Photosensitivity Leg ulcers Abnormal pigmentation Hair and nail abnormalities Acute skin failure 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 Biologic and other advanced 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 Pathogenesis Skin tumours 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 Diagnosis Management Fungal infections Tinea corporis Tinea cruris Tinea pedis Tinea capitis Onychomycosis Candidiasis Pityriasis versicolor Infestations Scabies Head lice Body lice Pubic (crab) lice 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 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 Pathogenesis Clinical features Plaque psoriasis Guttate psoriasis Erythrodermic psoriasis Pustular psoriasis Arthropathy Investigations Management Pityriasis rosea Pityriasis lichenoides chronica Drug eruptions Other causes Lichen planus Pathogenesis Clinical features Investigations Management Drug-induced lichenoid eruptions Graft-versus-host disease Clinical features Investigations Management Acne and rosacea Eczemas Psoriasis and other erythematous scaly eruptions Lichenoid eruptions Urticaria 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 Alopecia Pathogenesis Clinical features Alopecia areata Androgenetic alopecia Investigations Management Hypertrichosis Hirsutism Normal variants Nail trauma Nail involvement in skin diseases Nail involvement in systemic disease Nail involvement in congenital disease Hair disorders Nail disorders Skin disease in general medicine Conditions involving cutaneous vasculature Vasculitis Pyoderma gangrenosum Other neutrophilic dermatoses Pressure sores Lupus erythematosus Systemic sclerosis Morphoea Dermatomyositis Connective tissue disease 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 Clinical features Investigations and management Drug eruptions Multiple Choice Questions Further information 28 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 Pyramidal gait Foot drop Myopathic gait Ataxic gait Apraxic gait Marche à petits pas Extrapyramidal gait Abnormal 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 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 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’) Acute vestibular failure Benign paroxysmal positional vertigo Ménière disease Headache syndromes Functional neurological disorder Epilepsy Vestibular disorders Disorders of sleep Excessive daytime sleepiness (hypersomnolence) Narcolepsy Parasomnias Non-REM parasomnias REM sleep behaviour disorder Restless legs syndrome Periodic limb movements in sleep Multiple sclerosis Pathophysiology Clinical features Investigations Management Disease-modifying treatment (DMT) The acute relapse Treatment of symptoms, complications and disability Acute disseminated encephalomyelitis Clinical features Investigations Management Transverse myelitis Neuromyelitis optica Autoimmune encephalitis Clinical features Investigations and management Neuro-inflammatory diseases Paraneoplastic neurological disorders 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 Clinical features Investigations Management Dystonia Hemifacial spasm Motor neuron disease 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 Fungal meningitis Other meningitides Subdural empyema Spinal epidural abscess 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 Human immunodeficiency virus (HIV) infection Poliomyelitis Herpes zoster (shingles) Subacute sclerosing panencephalitis Progressive multifocal leucoencephalopathy Parenchymal bacterial infections Cerebral abscess Clinical features Investigations Management and prognosis Lyme disease Neurosyphilis Clinical features Investigations Management Parenchymal parasitic infections Neurocysticercosis Cerebral malaria Neuroschistosomiasis Parenchymal fungal infections Diseases caused by bacterial toxins Tetanus Clinical features Investigations Management Established disease Prevention Botulism Prion diseases Creutzfeldt–Jakob disease Variant Creutzfeldt–Jakob disease Clinical features Management Clinical features Investigations Management Surgical Radiotherapy and chemotherapy Prognosis Intracranial mass lesions and raised intracranial pressure Raised intracranial pressure Brain tumours Acoustic neuroma Clinical features Investigations Management Neurofibromatosis Von Hippel–Lindau disease Paraneoplastic neurological disease Hydrocephalus Normal pressure hydrocephalus Management Clinical features Investigations Management Idiopathic intracranial hypertension 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 Clinical features Investigations Management Pathophysiology Clinical features Investigations Spinal cord compression Intrinsic diseases of the spinal cord Diseases of peripheral nerves Entrapment neuropathy Multifocal neuropathy Polyneuropathy Guillain–Barré syndrome Clinical features Investigations Management Chronic polyneuropathy Hereditary neuropathy Chronic demyelinating polyneuropathy Pathophysiology Clinical features Investigations Management Clinical features Investigations Management Brachial plexopathy Lumbosacral plexopathy Spinal root lesions Diseases of the neuromuscular junction Myasthenia gravis Lambert–Eaton myasthenic syndrome Diseases of muscle Muscular dystrophies Inherited metabolic myopathies Mitochondrial disorders Channelopathies Acquired myopathies Multiple Choice Questions Further information 29 Stroke medicine Clinical examination in stroke Functional anatomy and physiology Investigations Presenting problems Weakness Speech disturbance Visual deficit Visuo-spatial dysfunction Ataxia Headache Seizure Coma Stroke Pathophysiology Cerebral infarction Intracerebral haemorrhage Clinical features Investigations Neuroimaging Vascular imaging Cardiac investigations Blood tests Management Reperfusion (thrombolysis and thrombectomy) Supportive care Antiplatelet agents Coagulation abnormalities Blood pressure Management of risk factors Carotid endarterectomy and arterial angioplasty Rehabilitation Causes of ischaemic stroke Causes of intracerebral haemorrhage Subarachnoid haemorrhage Clinical features Investigations Management Rehabilitation Cerebral venous disease Clinical features Investigations and management Multiple Choice Questions Further information 30 Medical ophthalmology Functional anatomy and physiology Investigation of visual disorders Perimetry Amsler chart Tangent/Goldmann kinetic perimetry Automated threshold perimetry Imaging Photography Optical coherence tomography (OCT) 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 and papilloedema Proptosis Optic atrophy Specialist ophthalmological conditions Ocular inflammation Sjögren 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 Multiple Choice Questions Further information 31 Medical psychiatry Clinical examination The psychiatric interview The mental state examination Investigations in medical psychiatry Functional anatomy and physiology Biological factors Psychological and behavioural factors Social and environmental factors Presenting problems in psychiatric illness Delirium Alcohol misuse Substance misuse Delusions and hallucinations Low mood Elevated mood Anxiety Psychological factors affecting medical conditions Medically unexplained somatic symptoms Self-harm Disturbed and aggressive behaviour Principles of management Pharmacological treatments Electroconvulsive therapy Other forms of electromagnetic stimulation Surgery Psychological therapies General supportive psychotherapy Cognitive therapy Behaviour therapy Cognitive behaviour therapy Problem-solving therapy Psychodynamic psychotherapy Interpersonal psychotherapy Pathogenesis Clinical features Investigations Management Social interventions Psychiatric disorders Dementia Alzheimer’s disease Pathogenesis Clinical features Investigations Management Fronto-temporal dementia Lewy body dementia 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 Sedatives Stimulants Hallucinogens Organic solvents Pathogenesis Diagnosis Management Pathogenesis Clinical features Diagnosis Investigations Management Drug treatment Neuroleptic malignant syndrome Cardiac arrhythmias Psychological treatment Social treatment Prognosis Alcohol misuse and dependence Substance misuse disorder Schizophrenia Mood disorders Depression Pathogenesis Diagnosis Investigations Management Drug treatment Tricyclic antidepressants Selective serotonin re-uptake inhibitors Noradrenaline (norepinephrine) re-uptake inhibitors Monoamine oxidase inhibitors Esketamine ECT and related treatments Psychological treatment Prognosis Bipolar disorder Pathogenesis Diagnosis Management Prognosis Clinical features Phobic anxiety disorder Panic disorder Generalised anxiety disorder Diagnosis Management Psychological treatment Drug treatment Clinical features Diagnosis Management Anxiety disorders Obsessive–compulsive disorder Stress-related disorders Acute stress reaction Adjustment disorder Clinical features Diagnosis Management Post-traumatic stress disorder Clinical features Diagnosis Management Prognosis 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 Somatoform disorders Eating disorders Anorexia nervosa Clinical features Pathogenesis Diagnosis Management Prognosis Bulimia nervosa Clinical features Diagnosis Investigations Management Prognosis Pathogenesis Clinical features Diagnosis Management Pathogenesis Clinical features Münchausen syndrome Malingering Management Personality disorders Factitious disorder and malingering Puerperal psychiatric disorders Post-partum blues Post-partum depression Puerperal psychosis Psychiatric disorders during pregnancy Psychiatry and the law Multiple Choice Questions Further information 32 Maternal medicine Clinical examination in pregnancy Clinical evaluation in maternal medicine Planning pregnancy in patients with medical conditions Functional anatomy and physiology 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 COVID-19 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 syndrome Parathyroid disease Primary hyperparathyroidism Familial hypocalciuric hypercalcaemia Adrenal disease Human immunodeficiency virus infection Inflammatory rheumatic disease Rheumatoid arthritis Systemic sclerosis Systemic lupus erythematosus Antiphospholipid syndrome Bone disease 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 33 Adolescent and transition medicine Transition from paediatric to adult health services Functional anatomy and physiology Endocrine changes Physical changes Cognitive and behavioural changes Investigations Clinical assessment Presenting problems 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 Multiple Choice Questions Further information 34 Ageing and disease Assessment of the older adult Demography Functional anatomy and physiology Biology of ageing Physiological changes of ageing Core concepts in older adults Frailty, disability and multimorbidity Frailty Disability Multimorbidity The rehabilitation process Multidisciplinary team working Rehabilitation outcomes Does the patient want this investigation? Will the investigation be feasible? Will the investigation alter management? Will management benefit the patient? Rehabilitation Investigation and management Comprehensive Geriatric Assessment Decisions about investigation and treatment 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 Mechanism Risk factors Management Presentation Clinical assessment Management Presenting problems in geriatric medicine Falls and collapse Dizziness Confusion (dementia and delirium) Dementia Delirium Bladder health Bowel health Ageing and the immune system Assessment Management Adverse drug reactions Appropriate prescribing and deprescribing Continence Infection in the older adult Prescribing and deprescribing Other problems in old age Multiple Choice Questions Further information 35 Laboratory reference ranges Notes on the international system of units (SI units) Laboratory reference ranges in adults Laboratory reference ranges in childhood and adolescence Laboratory reference ranges in pregnancy Further information Index
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