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دانلود کتاب Davidson's Principles and Practice of Medicine
دانلود کتاب اصول و عملکرد پزشکی دیویدسون
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Davidson's Principles and Practice of Medicine
ویرایش: [23 ed.] نویسندگان: Ian D Penman, BSc(Hons) MD FRCPE, Stuart H. Ralston, MD FRCP FMedSci FRSE FFPM(Hon), Mark W J Strachan, BSc(Hons), MD, FRCPE and Richard Hobson, LLM, PhD, MRCP(UK), FRCPath سری: ISBN (شابک) : 9780702070280, 9780702070273 ناشر: Elsevier سال نشر: 2018 تعداد صفحات: 1440 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 128 Mb
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Front Cover Inside Front Cover Half title page Sir Stanley Davidson (1894–1981) Davidson\'s Principles and Practice of Medicine Copyright Page Table Of Contents Preface Contributors International Advisory Board Acknowledgements Introduction Clinical examination overviews Presenting problems Boxes General Information Practice Point Emergency In Old Age In Pregnancy In Adolescence Terminology Units of measurement Finding what you are looking for 1 Fundamentals of Medicine 1 Clinical decision-making Introduction The problem of diagnostic error Clinical reasoning: definitions Clinical skills and decision-making Use and interpretation of diagnostic tests Normal values Factors other than disease that influence test results Operating characteristics Sensitivity and specificity Prevalence of disease Dealing with uncertainty Cognitive biases Type 1 and type 2 thinking Common cognitive biases in medicine Human factors Reducing errors in clinical decision-making Cognitive debiasing strategies History and physical examination Problem lists and differential diagnosis Mnemonics and checklists Red flags and ROWS (‘rule out worst case scenario’) Using clinical prediction rules and other decision aids Effective team communication Patient-centred evidence-based medicine and shared decision-making Clinical decision-making: putting it all together Evidence-based history and examination Deciding pre-test probability Interpreting test results Treatment threshold Post-test probability Cognitive biases Human factors Reducing cognitive error Person-centred EBM and information given to patient Answers to problems Harvard problem (p. 5) Bat and ball problem (p. 6) Further information Books and journal articles Websites 2 Clinical therapeutics and good prescribing Principles of clinical pharmacology Pharmacodynamics Drug targets and mechanisms of action Dose–response relationships Therapeutic index Desensitisation and withdrawal effects Pharmacokinetics Drug absorption and routes of administration Enteral administration Parenteral administration Other routes of administration Drug distribution Volume of distribution Drug elimination Drug metabolism Drug excretion Elimination kinetics Repeated dose regimens Inter-individual variation in drug responses Adverse outcomes of drug therapy Adverse drug reactions Prevalence of ADRs Classification of ADRs Detecting ADRs – pharmacovigilance Drug interactions Mechanisms of drug interactions Avoiding drug interactions Medication errors Responding when an error is discovered Drug regulation and management Drug development and marketing Licensing new medicines Drug marketing Managing the use of medicines Evaluating evidence Evaluating cost-effectiveness Implementing recommendations Prescribing in practice Decision-making in prescribing Making a diagnosis Establishing the therapeutic goal Choosing the therapeutic approach Choosing a drug Absorption Distribution Metabolism Excretion Efficacy Avoiding adverse effects Features of the disease Severity of disease Coexisting disease Avoiding adverse drug interactions Patient adherence to therapy Cost Genetic factors Choosing a dosage regimen Dose titration Route Frequency Timing Formulation Duration Involving the patient Writing the prescription Monitoring treatment effects Stopping drug therapy Prescribing in special circumstances Prescribing for patients with renal disease Prescribing for patients with hepatic disease Prescribing for elderly patients Prescribing for women who are pregnant or breastfeeding Writing prescriptions Prescribing in hospital Hospital discharge (‘to take out’) medicines Prescribing in primary care Monitoring drug therapy Clinical and surrogate endpoints Plasma drug concentration Timing of samples in relation to doses Interpreting the result Further information Websites 3 Clinical genetics The fundamental principles of genomics The packaging of genes: DNA, chromatin and chromosomes From DNA to protein Transcription: DNA to messenger RNA RNA splicing, editing and degradation Translation and protein production Non-coding RNA Cell division, differentiation and migration Cell death, apoptosis and senescence Genomics, health and disease Classes of genetic variant Nucleotide substitutions Insertions and deletions Simple tandem repeat mutations Copy number variations Consequences of genomic variation Normal genomic variation Polymorphisms and common disease Evolutionary selection Constitutional genetic disease Constructing a family tree Patterns of disease inheritance Autosomal dominant inheritance Autosomal recessive inheritance X-linked inheritance Mitochondrial inheritance Imprinting Somatic genetic disease Interrogating the genome: the changing landscape of genomic technologies Looking at chromosomes Looking at genes Gene amplification: polymerase chain reaction Gene sequencing NGS capture Challenges of NGS technologies Uses of NGS Third-generation sequencing Genomics and clinical practice Genomics and health care Genomics in rare neurodevelopmental disorders Genomics and common disease Genomics and obstetrics Genomics and oncology Genomics in infectious disease Treatment of genetic disease Pharmacogenomics Gene therapy and genome editing Induced pluripotent stem cells and regenerative medicine Pathway medicine Ethics in a genomic age Further information Books and journal articles Websites 4 Clinical immunology Functional anatomy and physiology The innate immune system Physical barriers Phagocytes Neutrophils Monocytes and macrophages Dendritic cells Cytokines Integrins Complement Mast cells and basophils Natural killer cells The adaptive immune system Lymphoid organs The thymus The spleen Lymph nodes Mucosa-associated lymphoid tissue Lymphatics Humoral immunity Immunoglobulins Cellular immunity CD8+ T lymphocytes CD4+ T lymphocytes The inflammatory response Acute inflammation The acute phase response Septic shock Resolution of inflammation Chronic inflammation Laboratory features of inflammation C-reactive protein Erythrocyte sedimentation rate Plasma viscosity Presenting problems in immune disorders Recurrent infections Aetiology Clinical assessment Investigations Management Intermittent fever Aetiology Clinical assessment Investigations Management Anaphylaxis Aetiology Clinical assessment Investigations Management Immune deficiency Primary phagocyte deficiencies Chronic granulomatous disease Leucocyte adhesion deficiencies Defects in cytokines and cytokine receptors Complement pathway deficiencies Clinical features Investigations Management Primary antibody deficiencies X-linked agammaglobulinaemia Selective IgA deficiency Common variable immune deficiency Functional IgG antibody deficiency Investigations Management Primary T-lymphocyte deficiencies DiGeorge syndrome Bare lymphocyte syndromes Severe combined immune deficiency Investigations Management Autoimmune lymphoproliferative syndrome Secondary immune deficiencies Periodic fever syndromes Familial Mediterranean fever Mevalonic aciduria (mevalonate kinase deficiency) TNF receptor-associated periodic syndrome Amyloidosis Pathophysiology Clinical features Investigations Management Autoimmune disease Pathophysiology Clinical features Investigations Autoantibodies Complement Cryoglobulins Management Allergy Pathophysiology Clinical features Insect venom allergy Peanut allergy Birch oral allergy syndrome Diagnosis Investigations Skin-prick tests Specific IgE tests Supervised exposure to allergen Mast cell tryptase Serum total IgE Eosinophilia Management Avoidance of the allergen Antihistamines Glucocorticoids Sodium cromoglicate Antigen-specific immunotherapy Omalizumab Adrenaline (epinephrine) Angioedema Pathophysiology Clinical features Investigations Management Hereditary angioedema Clinical features Investigations Management Acquired C1 inhibitor deficiency Transplantation and graft rejection Transplant rejection Investigations Pre-transplantation testing Post-transplant biopsy: C4d staining Complications of transplant immunosuppression Organ donation Tumour immunology Further information 5 Population health and epidemiology Global burden of disease and underlying risk factors Life expectancy Global causes of death and disability Risk factors underlying disease Social determinants of health The hierarchy of systems – from molecules to ecologies The life course Preventive medicine Alcohol Smoking Obesity Poverty and affluence Atmospheric pollution Climate change and global warming Principles of screening Epidemiology Understanding causes and effect Health data/informatics Further information Books and journal articles Websites 6 Principles of infectious disease Infectious agents Viruses Prokaryotes: bacteria (including mycobacteria and actinomycetes) Eukaryotes: fungi, protozoa and helminths Prions Normal microbial flora Host–pathogen interactions Characteristics of successful pathogens The host response Pathogenesis of infectious disease The febrile response Investigation of infection Direct detection of pathogens Detection of whole organisms Detection of components of organisms Nucleic acid amplification tests Culture Blood culture Indirect detection of pathogens Antibody detection Enzyme-linked immunosorbent assay Immunoblot (Western blot) Immunofluorescence assays Complement fixation test Agglutination tests Other tests Antibody-independent specific immunological tests Antimicrobial susceptibility testing Epidemiology of infection Geographical and temporal patterns of infection Endemic disease Emerging and re-emerging disease Reservoirs of infection Human reservoirs Animal reservoirs Environmental reservoirs Transmission of infection Deliberate release Infection prevention and control Health care-associated infection Outbreaks of infection Immunisation Vaccination Types of vaccine Use of vaccines Antimicrobial stewardship Treatment of infectious diseases Principles of antimicrobial therapy Antimicrobial action and spectrum Empiric versus targeted therapy Combination therapy Antimicrobial resistance Duration of therapy Pharmacokinetics and pharmacodynamics Therapeutic drug monitoring Antimicrobial prophylaxis Antibacterial agents Beta-lactam antibiotics Pharmacokinetics Adverse effects Drug interactions Penicillins Cephalosporins and cephamycins Monobactams Carbapenems Macrolide and lincosamide antibiotics Pharmacokinetics Macrolides Lincosamides (e.g. clindamycin) Adverse effects Aminoglycosides and spectinomycin Pharmacokinetics Gentamicin dosing Adverse effects Spectinomycin Quinolones and fluoroquinolones Pharmacokinetics Adverse effects Glycopeptides Pharmacokinetics Vancomycin Teicoplanin Adverse effects Lipopeptides Polymyxins Folate antagonists Pharmacokinetics Adverse effects Tetracyclines and glycylcyclines Tetracyclines Pharmacokinetics Adverse effects Glycylcyclines (tigecycline) Nitroimidazoles Pharmacokinetics Adverse effects Phenicols Oxazolidinones Other antibacterial agents Fusidic acid Nitrofurantoin Fidaxomicin Fosfomycin Antimycobacterial agents Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin Other antituberculous agents Clofazimine Antifungal agents Azole antifungals Imidazoles Triazoles Echinocandins Polyenes Lipid formulations of amphotericin B Other antifungal agents Flucytosine Griseofulvin Terbinafine Antiviral agents Antiretroviral agents Anti-herpesvirus agents Aciclovir, valaciclovir, penciclovir and famciclovir Ganciclovir Cidofovir Foscarnet Anti-influenza agents Zanamivir and oseltamivir Amantadine and rimantadine Other agents used to treat viruses Ribavirin Antiparasitic agents Antimalarial agents Artemisinin (qinghaosu) derivatives Atovaquone Folate synthesis inhibitors (proguanil, pyrimethamine–sulfadoxine) Quinoline-containing compounds Lumefantrine Drugs used in trypanosomiasis Benznidazole Eflornithine Melarsoprol Nifurtimox Pentamidine isetionate Suramin Other antiprotozoal agents Pentavalent antimonials Diloxanide furoate Iodoquinol (di-iodohydroxyquinoline) Nitazoxanide Paromomycin Drugs used against helminths Benzimidazoles (albendazole, mebendazole) Bithionol Diethylcarbamazine Ivermectin Niclosamide Piperazine Praziquantel Pyrantel pamoate Thiabendazole Further information Websites 2 Emergency and Critical Care Medicine 7 Poisoning Comprehensive evaluation of the poisoned patient General approach to the poisoned patient Triage and resuscitation Clinical assessment and investigations Psychiatric assessment General management Gastrointestinal decontamination Activated charcoal Gastric aspiration and lavage Whole bowel irrigation Urinary alkalinisation Haemodialysis and haemoperfusion Lipid emulsion therapy Supportive care Antidotes Poisoning by specific pharmaceutical agents Analgesics Paracetamol Management Salicylates (aspirin) Clinical features Management Non-steroidal anti-inflammatory drugs Clinical features Management Antidepressants Tricyclic antidepressants Clinical features Management Selective serotonin and noradrenaline re-uptake inhibitors Clinical features and management Lithium Clinical features Management Cardiovascular medications Beta-blockers Management Calcium channel blockers Clinical features Management Digoxin and oleander Clinical features Management Iron Clinical features Management Antipsychotic drugs Clinical features Management Antidiabetic agents Clinical features Management Pharmaceutical agents less commonly taken in poisoning Drugs of misuse Depressants Benzodiazepines Opioids Gamma hydroxybutyrate Stimulants and entactogens Cocaine Amphetamines and cathinones Hallucinogens Cannabis Synthetic cannabinoid receptor agonists Tryptamines d-Lysergic acid diethylamide Dissociative drugs Volatile substances Body packers and body stuffers Chemicals and pesticides Carbon monoxide Clinical features Management Organophosphorus insecticides and nerve agents Mechanism of toxicity Clinical features and management Acute cholinergic syndrome Management Intermediate syndrome Organophosphate-induced delayed polyneuropathy Carbamate insecticides Paraquat Methanol and ethylene glycol Clinical features Management Corrosive substances Aluminium and zinc phosphide Copper sulphate Chemicals less commonly taken in poisoning Chemical warfare agents Environmental poisoning Arsenism Fluorosis Food-related poisoning Paralytic shellfish poisoning Ciguatera poisoning Scombrotoxic fish poisoning Plant poisoning Further information Books and journal articles Websites 8 Envenomation Comprehensive evaluation of the envenomed patient Geographical distribution of venomous snakes Bedside tests in the envenomed patient Overview of envenomation Venom Venomous animals Clinical effects Local effects General systemic effects Specific systemic effects General approach to the envenomed patient First aid Transporting patients Assessment and management in hospital Assessment and management of life-threatening problems Assessment for evidence of envenoming Laboratory investigations Treatment Antivenom Non-antivenom treatments Follow-up Envenomation by specific animals Venomous snakes Clinical features and management Scorpions Clinical features and management Spiders Clinical features and management Paralysis ticks Venomous insects Venomous lepidopterans Venomous hymenopterans Marine venomous and poisonous animals Further information Books and journal articles Websites 9 Environmental medicine Radiation exposure Types of ionising radiation Dosage and exposure Effects of radiation exposure Deterministic effects Stochastic effects Management of radiation exposure Extremes of temperature Thermoregulation Hypothermia Clinical features Investigations Management Mild hypothermia Severe hypothermia Cold injury Freezing cold injury (frostbite) Non-freezing cold injury (trench or immersion foot) Chilblains Heat-related illness Heat cramps Heat syncope Heat exhaustion Heat stroke High altitude Physiological effects of high altitude Illnesses at high altitude Acute mountain sickness High-altitude cerebral oedema High-altitude pulmonary oedema Chronic mountain sickness (Monge’s disease) High-altitude retinal haemorrhage Venous thrombosis Refractory cough Air travel Advice for patients with respiratory disease Advice for other patients Deep venous thrombosis Under water Drowning and near-drowning Clinical features Management Diving-related illness Clinical features Decompression illness Barotrauma Management Humanitarian crisis Recognition Emergency response Consolidation phase Handover and withdrawal Health-care priorities Further information Websites Telephone numbers 10 Acute medicine and critical illness Clinical examination in critical care Monitoring Acute medicine The decision to admit to hospital Ambulatory care Presenting problems in acute medicine Chest pain Presentation Site and radiation Characteristics Onset Associated features Clinical assessment Initial investigations Acute breathlessness Presentation Clinical assessment Initial investigations Syncope/presyncope Presentation Clinical assessment Initial investigations Delirium Presentation Clinical assessment Investigations and management Headache Presentation Clinical assessment Initial investigations Unilateral leg swelling Presentation Clinical assessment Initial investigations Identification and assessment of deterioration Early warning scores and the role of the medical emergency team Immediate assessment of the deteriorating patient C – Control of obvious problem A and B – Airway and breathing C – Circulation D – Disability E – Exposure and evidence Selecting the appropriate location for ongoing management Common presentations of deterioration Tachypnoea Pathophysiology Assessment and management Hypoxaemia Pathophysiology Assessment and management Tachycardia Pathophysiology Assessment and management Hypotension Pathophysiology Assessment and management Shock Hypertension Pathophysiology Assessment and management Decreased conscious level Assessment Management Decreased urine output/deteriorating renal function Assessment Diagnosis and management Abdominal compartment syndrome Rhabdomyolysis Disorders causing critical illness Sepsis and the systemic inflammatory response Aetiology and pathogenesis Initiation of the inflammatory response Propagation of the inflammatory response Activation of the coagulation system Organ damage from sepsis Lactate physiology The anti-inflammatory cascade Management Resuscitation in sepsis Early source control Noradrenaline (norepinephrine) for refractory hypotension Other therapies for refractory hypotension Septic cardiomyopathy Review of the underlying pathology Acute respiratory distress syndrome Aetiology and pathogenesis Diagnosis and management Acute circulatory failure (cardiogenic shock) Definition and aetiology Myocardial infarction Acute massive pulmonary embolism Acute valvular pathology, aortic dissection and cardiac tamponade Post cardiac arrest Acute management Prognosis Other causes of multi-organ failure Critical care medicine Decisions around intensive care admission Stabilisation and institution of organ support Respiratory support Non-invasive respiratory support High-flow nasal cannulae Continuous positive pressure ventilation Non-invasive ventilation or bi-level ventilation Intubation and intermittent positive pressure ventilation Ventilator modes Ventilator-induced lung injury Advanced respiratory support Airway pressure release ventilation Prone positioning Extracorporeal respiratory support Venous–venous extracorporeal membrane oxygenation Extracorporeal carbon dioxide removal Cardiovascular support Initial resuscitation Fluid and vasopressor use Advanced haemodynamic monitoring Mechanical cardiovascular support Intra-aortic balloon pump Venous–arterial extracorporeal membrane oxygenation Renal support Neurological support Daily clinical management in intensive care Clinical review Sedation and analgesia Delirium in intensive care Weaning from respiratory support Spontaneous breathing trials Progressive reduction in pressure support ventilation Extubation Tracheostomy Nutrition Other essential components of intensive care Thromboprophylaxis Glucose control Blood transfusion Peptic ulcer prophylaxis Complications and outcomes of critical illness Adverse neurological outcomes Brain injury ICU-acquired weakness Critical illness polyneuropathy Critical illness myopathy Other long-term problems The older patient Withdrawal of active treatment and death in intensive care Futility Death Organ donation Donation after brain death Donation after cardiac death Postmortem examination or autopsy Discharge from intensive care Critical care scoring systems Further information Websites 3 Clinical Medicine 11 Infectious disease Clinical examination of patients with infectious disease Presenting problems in infectious diseases Fever Clinical assessment Investigations Management Fever with localising symptoms or signs Pyrexia of unknown origin Clinical assessment Investigations Prognosis Fever in the injection drug-user Clinical assessment Investigations Management Fever in the immunocompromised host Clinical assessment Investigations Neutropenic fever Post-transplantation fever Positive blood culture Clinical assessment Investigations Management Central venous catheter infections Investigations and management Sepsis Severe skin and soft tissue infections Necrotising fasciitis Gas gangrene Other SSTIs Acute diarrhoea and vomiting Clinical assessment Investigations Management Fluid replacement Antimicrobial agents Antidiarrhoeal, antimotility and antisecretory agents Non-infectious causes of food poisoning Antimicrobial-associated diarrhoea Infections acquired in the tropics Fever acquired in the tropics Clinical assessment Investigations and management Diarrhoea acquired in the tropics Eosinophilia acquired in the tropics Clinical assessment Investigations Management Skin conditions acquired in the tropics Infections in adolescence Infections in pregnancy Viral infections Systemic viral infections with exanthem Measles Clinical features Management and prevention Rubella (German measles) Clinical features Diagnosis Prevention Parvovirus B19 Clinical features Diagnosis Management Human herpesvirus 6 and 7 Clinical features Diagnosis and management Chickenpox (varicella) Clinical features Diagnosis Management and prevention Shingles (herpes zoster) Clinical features Management Enteroviral exanthems Systemic viral infections without exanthem Mumps Clinical features Diagnosis Management and prevention Influenza Clinical features Diagnosis Management and prevention Avian influenza Swine influenza Infectious mononucleosis and Epstein–Barr virus Clinical features Long-term complications of EBV infection Investigations Management Cytomegalovirus Clinical features Investigations Management Dengue Clinical features Diagnosis Management and prevention Yellow fever Clinical features Diagnosis Management and prevention Viral haemorrhagic fevers Clinical features Investigations and management Prevention Ebola virus disease (EVD) Clinical features Investigations Management Prevention Zika virus Clinical features Investigations Prevention Viral infections of the skin Herpes simplex virus 1 and 2 Clinical features Recurrence Complications Diagnosis Management Human herpesvirus 8 Enterovirus infections Hand, foot and mouth disease Herpangina Poxviruses Smallpox (variola) Monkeypox Cowpox Vaccinia virus Other poxviruses: orf and molluscum contagiosum Gastrointestinal viral infections Norovirus (Norwalk agent) Astrovirus Rotavirus Hepatitis viruses (A–E) Other viruses Respiratory viral infections Middle East respiratory syndrome coronavirus (MERS-CoV) Clinical features Diagnosis and management Viral infections with neurological involvement Japanese B encephalitis Clinical features Investigations, management and prevention West Nile virus Clinical features Diagnosis and management Enterovirus 71 Nipah virus encephalitis Human T-cell lymphotropic virus type I Viral infections with rheumatological involvement Chikungunya virus Prion diseases Bacterial infections Bacterial infections of the skin, soft tissues and bones Staphylococcal infections Skin infections Wound infections Cannula-related infection Meticillin-resistant Staph. aureus Staphylococcal toxic shock syndrome Management Streptococcal infections Streptococcal scarlet fever Streptococcal toxic shock syndrome Treponematoses Syphilis Endemic treponematoses Yaws Pinta and bejel Tropical ulcer Buruli ulcer Systemic bacterial infections Brucellosis Clinical features Diagnosis Management Borrelia infections Lyme disease Clinical features Diagnosis Management Prevention Louse-borne relapsing fever Clinical features Investigations and management Tick-borne relapsing fever Leptospirosis Microbiology and epidemiology Clinical features Bacteraemic leptospirosis Aseptic meningitis Icteric leptospirosis (Weil’s disease) Pulmonary syndrome Diagnosis Management and prevention Plague Clinical features Bubonic plague Septicaemic plague Pneumonic plague Investigations Management Prevention and infection control Listeriosis Investigations and management Typhoid and paratyphoid (enteric) fevers Clinical features Typhoid fever Paratyphoid fever Complications Investigations Management Prevention Tularaemia Investigations and management Melioidosis Clinical features Investigations and management Actinomycete infections Nocardiosis Actinomyces spp. Gastrointestinal bacterial infections Staphylococcal food poisoning Bacillus cereus food poisoning Clostridium perfringens food poisoning Campylobacter jejuni infection Salmonella spp. infection Escherichia coli infection Enterotoxigenic E. coli Entero-invasive E. coli Enteropathogenic E. coli Entero-aggregative E. coli Enterohaemorrhagic E. coli Clostridium difficile infection Clinical features Investigations Management Yersinia enterocolitica infection Cholera Clinical features Diagnosis and management Prevention Vibrio parahaemolyticus infection Bacillary dysentery (shigellosis) Clinical features Management and prevention Respiratory bacterial infections Diphtheria Clinical features Management Prevention Pneumococcal infection Anthrax Clinical features Cutaneous anthrax Gastrointestinal anthrax Inhalational anthrax Management Bacterial infections with neurological involvement Mycobacterial infections Tuberculosis Leprosy Epidemiology and transmission Pathogenesis Clinical features Leprosy reactions Borderline cases Investigations Management Patient education Prognosis Prevention and control Rickettsial and related intracellular bacterial infections Rickettsial fevers Pathogenesis Spotted fever group Rocky Mountain spotted fever Other spotted fevers Typhus group Scrub typhus fever Epidemic (louse-borne) typhus Endemic (flea-borne) typhus Investigation of rickettsial infection Management of rickettsial fevers Q fever Clinical features Investigations and management Bartonellosis Investigations and management Chlamydial infections Trachoma Pathology and clinical features Investigations and management Prevention Protozoal infections Systemic protozoal infections Malaria Pathogenesis Life cycle of the malarial parasite Pathology Clinical features P. falciparum infection P. vivax and P. ovale infection P. malariae and P. knowlesi infection Investigations Management Mild P. falciparum malaria Complicated P. falciparum malaria Non-falciparum malaria Prevention Malaria control in endemic areas Babesiosis African trypanosomiasis (sleeping sickness) Clinical features Rhodesiense infections Gambiense infections Investigations Management Prevention American trypanosomiasis (Chagas’ disease) Pathology Clinical features Acute phase Chronic phase Investigations Management and prevention Toxoplasmosis Clinical features Congenital toxoplasmosis Investigations Management Leishmaniasis Epidemiology and transmission Visceral leishmaniasis (kala-azar) Clinical features Investigations Differential diagnosis Management Pentavalent antimonials Amphotericin B Other drugs Response to treatment HIV–visceral leishmaniasis co-infection Post-kala-azar dermal leishmaniasis Clinical features Investigations and management Prevention and control Cutaneous and mucosal leishmaniasis Cutaneous leishmaniasis Pathogenesis Clinical features Mucosal leishmaniasis Investigations in CL and ML Management of CL and ML Prevention of CL and ML Gastrointestinal protozoal infections Amoebiasis Pathology Clinical features Intestinal amoebiasis – amoebic dysentery Amoebic liver abscess Investigations Management Prevention Giardiasis Clinical features and investigations Management Cryptosporidiosis Cyclosporiasis Infections caused by helminths Intestinal human nematodes Ancylostomiasis (hookworm) Clinical features Investigations Management Strongyloidiasis (threadworm) Clinical features Investigations Management Ascaris lumbricoides (roundworm) Clinical features Investigations Management Prevention Enterobius vermicularis (threadworm) Clinical features Investigations Management Trichuris trichiura (whipworm) Tissue-dwelling human nematodes Lymphatic filariasis Pathology Clinical features Investigations Management Chronic lymphatic pathology Prevention Loiasis Clinical features Investigations Management Prevention Onchocerciasis (river blindness) Pathology Clinical features Investigations Management Prevention Dracunculiasis (Guinea worm) Management and prevention Other filariases Mansonella perstans Dirofilaria immitis Zoonotic nematodes Trichinosis (trichinellosis) Clinical features Investigations Management Anisakiasis (herring worm) Cutaneous larva migrans Angiostrongylus cantonensis Gnathostomiasis Trematodes (flukes) Schistosomiasis Pathology Clinical features Schistosoma haematobium Schistosoma mansoni Schistosoma japonicum, S. mekongi and S. intercalatum Investigations Management Prevention Liver flukes Cestodes (tapeworms) Intestinal tapeworm Taenia solium Taenia saginata Taenia asiatica Cysticercosis Clinical features Investigations Management and prevention Echinococcus granulosus (Taenia echinococcus) and hydatid disease Clinical features Investigations Management and prevention Other tapeworms Ectoparasites Jiggers (tungiasis) Myiasis Fungal infections Superficial mycoses Candidiasis (thrush) Subcutaneous mycoses Chromoblastomycosis Mycetoma (eumycetoma and actinomycetoma) Clinical features Investigations Management Phaeohyphomycosis Sporotrichosis Investigations Management Systemic mycoses Aspergillosis Candidiasis Syndromes of systemic candidiasis Acute disseminated candidiasis Chronic disseminated candidiasis (hepatosplenic candidiasis) Other manifestations Management Cryptococcosis Fusariosis Mucormycosis Talaromyces (formerly Penicillium) marneffei infection Histoplasmosis Pathology Clinical features Investigations Management Coccidioidomycosis Investigations and management Paracoccidioidomycosis Blastomycosis Further information Websites 12 HIV infection and AIDS Clinical examination in HIV disease Epidemiology Global and regional epidemics Modes of transmission Virology and immunology Diagnosis and investigations Diagnosing HIV infection Viral load and CD4 counts CD4 counts Viral load Clinical manifestations of HIV Primary HIV infection Asymptomatic infection Minor HIV-associated disorders Acquired immunodeficiency syndrome Presenting problems in HIV infection Lymphadenopathy Weight loss Fever Mucocutaneous disease Seborrhoeic dermatitis Herpes simplex infections Herpes zoster Kaposi’s sarcoma Bacillary angiomatosis Papular pruritic eruption Drug rashes Oral conditions Nail disorders Gastrointestinal disease Oesophageal diseases Diarrhoea Large-bowel diarrhoea Small-bowel diarrhoea Hepatobiliary disease Chronic viral hepatitis Hepatitis B Hepatitis C HIV cholangiopathy Respiratory disease Pneumocystis jirovecii pneumonia Pulmonary tuberculosis Bacterial pneumonia Miscellaneous causes of pulmonary infiltrates Nervous system and eye disease Cognitive impairment HIV-associated neurocognitive disorders Progressive multifocal leucoencephalopathy CMV encephalitis Space-occupying lesions Cerebral toxoplasmosis Primary CNS lymphoma Tuberculoma Stroke Meningitis Cryptococcal meningitis Tuberculous meningitis Peripheral nerve disease Myelopathy and radiculopathy Psychiatric disease Retinopathy Rheumatological disease Arthritis Diffuse infiltrative lymphocytosis syndrome Haematological abnormalities Anaemia Neutropenia Thrombocytopenia Renal disease Cardiac disease HIV-related cancers Prevention of opportunistic infections Preventing exposure Safe water and food Tuberculosis Malaria vector control Safer sex Pets Chemoprophylaxis Co-trimoxazole primary prophylaxis Tuberculosis preventive therapy Mycobacterium avium complex prophylaxis Preventing cryptococcosis Immunisation Antiretroviral therapy Selecting antiretroviral regimens Criteria for starting ART Monitoring efficacy Antiretroviral resistance ART complications Immune reconstitution inflammatory syndrome Lipodystrophy Hypersensitivity rashes Other adverse effects ART in special situations Pregnancy Prevention of HIV Pre-exposure prophylaxis Post-exposure prophylaxis Further information Websites with updated clinical guidelines 13 Sexually transmitted infections Clinical examination in men HIV testing Clinical examination in women Approach to patients with a suspected STI STI during pregnancy STI in children Presenting problems in men Urethral discharge Investigations Management Genital itch and/or rash Genital ulceration Genital lumps Proctitis in men who have sex with men Presenting problems in women Vaginal discharge Lower abdominal pain Genital ulceration Genital lumps Chronic vulval pain and/or itch Prevention of STI Case-finding Changing behaviour Sexually transmitted bacterial infections Syphilis Acquired syphilis Early syphilis Primary syphilis Secondary syphilis Latent syphilis Late syphilis Late latent syphilis Benign tertiary syphilis Cardiovascular syphilis Neurosyphilis Congenital syphilis Investigations in adult cases Investigations in suspected congenital syphilis Management Pregnancy Treatment reactions Gonorrhoea Clinical features Investigations Management of adults Chlamydial infection Chlamydial infection in men Chlamydial infection in women Other sexually transmitted bacterial infections Sexually transmitted viral infections Genital herpes simplex Clinical features Diagnosis Management First episode Recurrent genital herpes Management in pregnancy Human papillomavirus and anogenital warts Clinical features Management Molluscum contagiosum Viral hepatitis Further information Books and journal articles Website 14 Clinical biochemistry and metabolic medicine Clinical examination in biochemical and metabolic disorders Biochemical investigations Water and electrolyte homeostasis Sodium homeostasis Functional anatomy and physiology Proximal renal tubule Loop of Henle Early distal renal tubule Late distal renal tubule and collecting ducts Regulation of sodium transport Presenting problems in sodium and water balance Hypovolaemia Pathogenesis Clinical features Investigations Management Intravenous fluid therapy Hypervolaemia Pathogenesis Clinical features Investigations Management Diuretic therapy Carbonic anhydrase inhibitors Sodium-dependent glucose transporter inhibitors Loop diuretics Thiazide diuretics Potassium-sparing diuretics Osmotic diuretics Clinical use of diuretics Water homeostasis Functional anatomy and physiology Presenting problems in regulation of osmolality Hyponatraemia Pathophysiology Hyponatraemia with hypovolaemia Hyponatraemia with euvolaemia Hyponatraemia with hypervolaemia Clinical features Investigations Management Hypernatraemia Pathophysiology Clinical features Management Potassium homeostasis Functional anatomy and physiology Presenting problems in potassium homeostasis Hypokalaemia Pathophysiology Clinical features Investigations Management Hyperkalaemia Pathophysiology Clinical features Investigations Management Acid–base homeostasis Functional anatomy and physiology Renal control of acid–base balance Presenting problems in acid–base balance Metabolic acidosis Pathophysiology Clinical features Investigations Management Metabolic alkalosis Pathophysiology Clinical features Investigations Management Respiratory acidosis Respiratory alkalosis Mixed acid–base disorders Calcium homeostasis Magnesium homeostasis Functional anatomy and physiology Presenting problems in magnesium homeostasis Hypomagnesaemia Pathophysiology Clinical features Management Hypermagnesaemia Phosphate homeostasis Functional anatomy and physiology Presenting problems in phosphate homeostasis Hypophosphataemia Pathophysiology Clinical features Investigations Management Hyperphosphataemia Pathophysiology Clinical features Management Disorders of amino acid metabolism Phenylketonuria Homocystinuria Disorders of carbohydrate metabolism Galactosaemia Glycogen storage diseases Disorders of complex lipid metabolism Lipids and lipoprotein metabolism Functional anatomy and physiology Processing of dietary lipid Endogenous lipid synthesis Cholesterol transport Lipids and cardiovascular disease Investigations Presenting problems in lipid metabolism Hypercholesterolaemia Hypertriglyceridaemia Mixed hyperlipidaemia Rare dyslipidaemias Principles of management Non-pharmacological management Pharmacological management Hypercholesterolaemia Statins Ezetimibe Bile acid-sequestering resins PCSK9 inhibitors Nicotinic acid Combination therapy Hypertriglyceridaemia Fibrates Highly polyunsaturated long-chain n-3 fatty acids Mixed hyperlipidaemia Monitoring of therapy The porphyrias Clinical features Investigations Management Further information Journal articles Websites 15 Nephrology and urology Clinical examination of the kidney and urinary tract Functional anatomy and physiology The kidneys The nephron The glomerulus Renal tubules, loop of Henle and collecting ducts The ureters and bladder The prostate gland The penis Investigation of renal and urinary tract disease Glomerular filtration rate Urine investigations Blood tests Haematology Biochemistry Immunology Imaging Ultrasound Computed tomography Magnetic resonance imaging Renal arteriography Pyelography Radionuclide studies Renal biopsy Presenting problems in renal and urinary tract disease Oliguria/anuria Haematuria Nephritic syndrome Proteinuria Moderately elevated albuminuria (microalbuminuria) Overt (dipstick-positive) proteinuria Nephrotic syndrome Oedema Clinical assessment Investigations Management Hypertension Loin pain Dysuria Frequency Polyuria Nocturia Urinary incontinence Glomerular diseases Glomerulonephritis Diseases typically presenting with nephrotic syndrome Minimal change nephropathy Focal segmental glomerulosclerosis Membranous nephropathy Diseases typically presenting with mild nephritic syndrome IgA nephropathy Henoch–Schönlein purpura Mesangiocapillary glomerulonephritis Diseases typically presenting with rapidly progressive glomerulonephritis Anti-glomerular basement membrane disease Infection-related glomerulonephritis Tubulo-interstitial diseases Acute interstitial nephritis Clinical features Investigations Management Chronic interstitial nephritis Pathophysiology Clinical features Management Papillary necrosis Genetic renal diseases Inherited glomerular diseases AIport’s syndrome Thin glomerular basement membrane disease Hereditary nephrotic syndrome Inherited tubulo-interstitial diseases Isolated defects of tubular function Cystic diseases of the kidney Adult polycystic kidney disease Clinical features Investigations Management Other cystic diseases Renal vascular diseases Renal artery stenosis Pathophysiology Clinical features Investigations Management Acute renal infarction Diseases of small intrarenal vessels Thrombotic microangiopathies Haemolytic uraemic syndrome Thrombotic thrombocytopenic purpura Cholesterol emboli Small-vessel vasculitis Renal involvement in systemic conditions Diabetes mellitus Multiple myeloma Hepatic–renal disease Sarcoidosis Systemic vasculitis Systemic sclerosis Systemic lupus erythematosus Sickle-cell nephropathy Acute kidney injury Pathophysiology Clinical features Pre-renal AKI Renal AKI Post-renal AKI Management Haemodynamic status Hyperkalaemia and acidosis Cardiopulmonary complications Electrolyte disturbances Dietary measures Infection Medications Renal tract obstruction Renal replacement therapy Recovery from AKI Chronic kidney disease Epidemiology Pathophysiology Clinical features Investigations Management Monitoring of renal function Reduction of rate of progression Antihypertensive therapy Reduction of proteinuria Treatment of complications Maintenance of fluid and electrolyte balance Acid–base balance Renal bone disease Anaemia Treatment of risk factors for cardiovascular disease Preparing for renal replacement therapy Renal replacement therapy Conservative treatment Haemodialysis Haemodialysis in AKI Haemodialysis in CKD Haemofiltration Haemodiafiltration Peritoneal dialysis Renal transplantation Renal disease in pregnancy Renal disease in adolescence Drugs and the kidney Drug-induced renal disease Non-steroidal anti-inflammatory drugs ACE inhibitors Prescribing in renal disease Infections of the urinary tract Urinary tract infection Pathophysiology Clinical features Investigations Management Persistent or recurrent UTI Asymptomatic bacteriuria Catheter-related bacteriuria Acute pyelonephritis Tuberculosis Reflux nephropathy Pathophysiology Clinical features Investigations Management Urolithiasis Pathophysiology Clinical features Investigations Management Diseases of the collecting system and ureters Congenital abnormalities Single kidneys Medullary sponge kidney disease Ureterocele Ectopic ureters and duplex kidneys Megaureter Pelvi-ureteric junction obstruction Retroperitoneal fibrosis Tumours of the kidney and urinary tract Renal cell cancer Clinical features Investigations Management Urothelial tumours Pathophysiology Clinical features Investigations Management Inherited tumour syndromes affecting the renal tract Urinary incontinence Pathophysiology Stress incontinence Urge incontinence Continual incontinence Overflow incontinence Post-micturition dribble Clinical features Investigations Management Prostate disease Prostatitis Benign prostatic enlargement Pathophysiology Clinical features Investigations Management Prostate cancer Pathophysiology Clinical features Investigations Management Testicular tumours Clinical features and investigations Management and prognosis Erectile dysfunction Investigations Management Further information Websites 16 Cardiology Clinical examination of the cardiovascular system Functional anatomy and physiology Anatomy Coronary circulation Conduction system Nerve supply of the heart Physiology Myocardial contraction Cardiac peptides Circulation Endothelium Respiration Investigation of cardiovascular disease Electrocardiogram The 12-lead ECG Exercise ECG Ambulatory ECG Cardiac biomarkers Brain natriuretic peptide Cardiac troponins Chest X-ray Echocardiography Transthoracic echocardiography Doppler echocardiography Transoesophageal echocardiography Stress echocardiography Computed tomography Magnetic resonance imaging Cardiac catheterisation Electrophysiology Radionuclide imaging Blood pool imaging Myocardial perfusion scanning Presenting problems in cardiovascular disease Chest pain on exertion Clinical assessment Investigations Severe prolonged chest pain Clinical assessment Investigations Management Breathlessness Syncope Palpitation Clinical assessment Investigation Management Cardiac arrest Pathogenesis Clinical assessment and management Basic life support Advanced life support The Chain of Survival Survivors of cardiac arrest Abnormal heart sounds Clinical assessment Is the sound cardiac? Is the sound pathological? What is the origin of the sound? Systolic murmurs Diastolic murmurs Continuous murmurs Investigations Management Heart failure Left heart failure Right heart failure Biventricular heart failure Epidemiology Pathogenesis Ventricular dysfunction High-output failure Valvular disease Clinical assessment Acute left heart failure Chronic heart failure Complications of heart failure Investigations Management of acute heart failure Management of chronic heart failure Education Drug treatment Diuretics Angiotensin-converting enzyme inhibitors Angiotensin receptor blockers Neprilysin inhibitors Vasodilators Beta-adrenoceptor blockers Ivabradine Digoxin Amiodarone Non-pharmacological treatments Implantable cardiac defibrillators Resynchronisation devices Coronary revascularisation Cardiac transplantation Ventricular assist devices Cardiac arrhythmias Pathogenesis Clinical features Investigations Management Sinus arrhythmia Sinus bradycardia Sinus tachycardia Sick sinus syndrome Atrial ectopic beats Atrial tachycardia Atrial flutter Management Atrial fibrillation Pathogenesis Clinical features Investigations Management Paroxysmal atrial fibrillation Persistent atrial fibrillation Rhythm control Rate control Thromboprophylaxis Supraventricular tachycardia Atrioventricular nodal re-entrant tachycardia Management Atrioventricular re-entrant tachycardia Management Ventricular premature beats Management Ventricular tachycardia Management Torsades de pointes Management Atrioventricular block First-degree atrioventricular block Second-degree atrioventricular block Third-degree atrioventricular block Clinical features Management Bundle branch block Principles of management of cardiac arrhythmias Anti-arrhythmic drugs Class I drugs Class Ia drugs Disopyramide Quinidine Class Ib drugs Lidocaine Mexiletine Class Ic drugs Flecainide Propafenone Class II drugs Non-selective β-blockers Cardioselective β-blockers Sotalol Class III drugs Amiodarone Dronedarone Class IV drugs Verapamil Diltiazem Other anti-arrhythmic drugs Atropine sulphate Adenosine Digoxin Non-pharmacological treatments Electrical cardioversion Defibrillation Temporary pacemakers Permanent pacemakers Implantable cardiac defibrillators Cardiac resynchronisation therapy Catheter ablation therapy Coronary artery disease Pathogenesis Age and sex Genetics Smoking Hypertension Hypercholesterolaemia Diabetes mellitus Haemostatic factors Physical activity Obesity Alcohol Diet Personality Social deprivation Management Primary prevention Secondary prevention Angina pectoris Pathogenesis Coronary artery spasm Syndrome X Other causes Clinical features Investigations Management Anti-anginal drug therapy Nitrates Beta-blockers Calcium channel antagonists Potassium channel activators If channel antagonist Ranolazine Non-pharmacological treatments Percutaneous coronary intervention Coronary artery bypass grafting Prognosis Acute coronary syndrome Pathogenesis Clinical features Arrhythmias Recurrent angina Acute heart failure Pericarditis Dressler’s syndrome Papillary muscle rupture Ventricular septum rupture Ventricular rupture Embolism Ventricular remodelling Ventricular aneurysm Investigations Electrocardiogram Cardiac biomarkers Radiography Echocardiography Coronary angiography Management Analgesia Reperfusion therapy Thrombolytic therapy Antithrombotic therapy Anti-anginal therapy Renin–angiotensin blockade Mineralocorticoid receptor antagonists Lipid-lowering therapy Smoking cessation Diet and exercise Rehabilitation Implantable defibrillators Prognosis Non-cardiac surgery in patients with heart disease Peripheral arterial disease Pathogenesis Clinical features Intermittent claudication Critical limb ischaemia Acute limb ischaemia Atheroembolism Subclavian steal Investigations Management Buerger’s disease Raynaud’s syndrome Diseases of the aorta Aortic aneurysm Pathogenesis Clinical features Investigations Management Aortic dissection Pathogenesis Clinical features Investigations Management Aortitis Marfan’s syndrome Clinical features Investigations Management Coarctation of the aorta Hypertension Pathogenesis Clinical features Investigations Blood pressure measurements Ambulatory blood pressure measurements Home blood pressure measurements Other investigations Management Intervention thresholds Treatment targets Non-drug therapy Drug therapy Thiazides ACE inhibitors Angiotensin receptor blockers Calcium channel antagonists Beta-blockers Combined β- and α-blockers Other vasodilators Aspirin Statins Choice of antihypertensive drug Combination therapy Refractory hypertension Accelerated hypertension Management Diseases of the heart valves Rheumatic heart disease Acute rheumatic fever Pathogenesis Clinical features Carditis Arthritis Skin lesions Sydenham’s chorea Other features Investigations Management Bed rest Treatment of cardiac failure Antibiotics Aspirin Glucocorticoids Chronic rheumatic heart disease Pathogenesis Mitral valve disease Mitral stenosis Pathogenesis Clinical features Investigations Management Medical management Mitral balloon valvuloplasty and valve replacement Mitral regurgitation Pathogenesis Mitral valve prolapse Other causes of mitral regurgitation Clinical features Investigations Management Aortic valve disease Aortic stenosis Pathogenesis Clinical features Investigations Management Aortic regurgitation Pathogenesis Clinical features Investigations Management Tricuspid valve disease Tricuspid stenosis Clinical features and investigations Management Tricuspid regurgitation Clinical features Management Pulmonary valve disease Pulmonary stenosis Clinical features Investigations Management Pulmonary regurgitation Prosthetic valves Transcatheter aortic valve implantation Prosthetic valve dysfunction Infective endocarditis Epidemiology Pathophysiology Microbiology Clinical features Subacute endocarditis Acute endocarditis Post-operative endocarditis Investigations Management Prevention Congenital heart disease Pathophysiology Clinical features Central cyanosis and digital clubbing Growth retardation and learning difficulties Syncope Pulmonary hypertension Eisenmenger’s syndrome Congenital heart disease in pregnancy Persistent ductus arteriosus Pathophysiology Clinical features Investigations Management Coarctation of the aorta Pathogenesis Clinical features Investigations Management Atrial septal defect Pathogenesis Clinical features Investigations Management Ventricular septal defect Pathogenesis Clinical features Investigations Management Tetralogy of Fallot Pathogenesis Clinical features Investigations Management Other causes of cyanotic congenital heart disease Adult congenital heart disease Diseases of the myocardium Myocarditis Clinical features Investigations Management Cardiomyopathy Dilated cardiomyopathy Pathogenesis Clinical features Investigations Management Hypertrophic cardiomyopathy Pathogenesis Clinical features Investigations Management Arrhythmogenic ventricular cardiomyopathy Restrictive cardiomyopathy Obliterative cardiomyopathy Takotsubo cardiomyopathy Secondary causes of cardiomyopathy Cardiac tumours Atrial myxoma Diseases of the pericardium Acute pericarditis Pathogenesis Clinical features Investigations Management Pericardial effusion Clinical features Investigations Management Tuberculous pericarditis Chronic constrictive pericarditis Clinical features Investigations Management Cardiac tamponade Clinical features Investigations Management Further information Websites Journal articles 17 Respiratory medicine Clinical examination of the respiratory system Functional anatomy and physiology Lung mechanics Control of breathing Ventilation/perfusion matching and the pulmonary circulation Lung defences Upper airway defences Lower airway defences Investigation of respiratory disease Imaging The ‘plain’ chest X-ray Computed tomography Positron emission tomography Magnetic resonance imaging Ultrasound Endoscopic examination Laryngoscopy Bronchoscopy Endobronchial ultrasound Thoracoscopy Immunological and serological tests Microbiological investigations Cytology and histopathology Respiratory function testing Measurement of airway obstruction Lung volumes Transfer factor Arterial blood gases and oximetry Exercise tests Presenting problems in respiratory disease Cough Aetiology Breathlessness Pathophysiology Differential diagnosis Chronic exertional breathlessness How is your breathing at rest and overnight? How much can you do on a good day? Did you have breathing problems in childhood or at school? Do you have other symptoms along with your breathlessness? Acute severe breathlessness Chest pain Finger clubbing Haemoptysis Management The ‘incidental’ pulmonary nodule Pleural effusion Clinical assessment Investigations Radiological investigations Pleural aspiration and biopsy Management Empyema Clinical assessment Investigations Management Respiratory failure Pathophysiology Management of acute respiratory failure Chronic and ‘acute on chronic’ type II respiratory failure Management Home ventilation for chronic respiratory failure Lung transplantation Obstructive pulmonary diseases Asthma Pathophysiology Clinical features Diagnosis Management Setting goals Avoidance of aggravating factors The stepwise approach to the management of asthma Step 1: Occasional use of inhaled short-acting β2-adrenoreceptor agonist bronchodilators Step 2: Introduction of regular preventer therapy Step 3: Add-on therapy Step 4: Poor control on moderate dose of inhaled glucocorticoid and add-on therapy: addition of a fourth drug Step 5: Continuous or frequent use of oral glucocorticoids Step-down therapy Exacerbations of asthma Management of mild to moderate exacerbations Management of acute severe asthma Prognosis Chronic obstructive pulmonary disease Pathophysiology Clinical features Investigations Assessment of severity Management Reducing exposure to noxious particles and gases Bronchodilators Combined inhaled glucocorticoids and bronchodilators Oral glucocorticoids Pulmonary rehabilitation Oxygen therapy Surgical intervention Other measures Palliative care Prognosis Acute exacerbations of COPD Oxygen therapy Bronchodilators Glucocorticoids Antibiotic therapy Non-invasive ventilation Additional therapy Discharge Bronchiectasis Aetiology and pathology Clinical features Investigations Management Physiotherapy Antibiotic therapy Surgical treatment Prognosis Prevention Cystic fibrosis Genetics, pathogenesis and epidemiology Clinical features Management Treatment of CF lung disease Treatment of non-respiratory manifestations of CF Novel therapies for cystic fibrosis Infections of the respiratory system Upper respiratory tract infection Pneumonia Community-acquired pneumonia Clinical features Investigations Management Oxygen Fluid balance Antibiotic treatment Treatment of pleural pain Physiotherapy Prognosis Discharge and follow-up Prevention Hospital-acquired pneumonia Clinical features and investigation Management Prevention Suppurative pneumonia, aspiration pneumonia and pulmonary abscess Investigations Management Pneumonia in the immunocompromised patient Clinical features Investigations Management Tuberculosis Epidemiology Pathology and pathogenesis Clinical features: pulmonary disease Primary pulmonary TB Miliary TB Post-primary pulmonary TB Clinical features: extrapulmonary disease Lymphadenitis Gastrointestinal tuberculosis Pericardial disease Central nervous system disease Bone and joint disease Genitourinary disease Investigations Drug sensitivity testing Management Chemotherapy Control and prevention Detection of latent TB Directly observed therapy TB and HIV/AIDS Drug-resistant TB Vaccines Prognosis Opportunistic mycobacterial infection Respiratory diseases caused by fungi Allergic bronchopulmonary aspergillosis Clinical features Management Chronic pulmonary aspergillosis Simple aspergilloma Chronic cavitary pulmonary aspergillosis and chronic fibrosing pulmonary aspergillosis Aspergillus nodule Subacute invasive aspergillosis Invasive pulmonary aspergillosis Clinical features Management and prevention Other fungal infections Tumours of the bronchus and lung Primary tumours of the lung Aetiology Lung cancer Pathology Clinical features Cough Haemoptysis Bronchial obstruction Breathlessness Pain and nerve entrapment Mediastinal spread Metastatic spread Finger clubbing Hypertrophic pulmonary osteoarthropathy (HPOA) Non-metastatic extrapulmonary effects (Box 17.64) Investigations Imaging Biopsy and histopathology Staging to guide treatment Management Surgical treatment Radiotherapy Chemotherapy Laser therapy and stenting General aspects of management Prognosis Secondary tumours of the lung Tumours of the mediastinum Investigations Management Interstitial and infiltrative pulmonary diseases Diffuse parenchymal lung disease Idiopathic interstitial pneumonias Idiopathic pulmonary fibrosis Clinical features Investigations Management Prognosis Non-specific interstitial pneumonia Sarcoidosis Clinical features Investigations Management Lung diseases due to systemic inflammatory disease The acute respiratory distress syndrome Respiratory involvement in connective tissue disorders Rheumatoid disease Systemic lupus erythematosus Systemic sclerosis Pulmonary eosinophilia and vasculitides Acute eosinophilic pneumonia Chronic eosinophilic pneumonia Tropical pulmonary eosinophilia Granulomatosis with polyangiitis Goodpasture’s disease Lung diseases due to irradiation and drugs Radiotherapy Drugs Rare interstitial lung diseases Occupational and environmental lung disease Occupational airway disease Occupational asthma Reactive airways dysfunction syndrome Chronic obstructive pulmonary disease Byssinosis Pneumoconiosis Coal worker’s pneumoconiosis Silicosis Berylliosis Less common pneumoconioses Lung diseases due to organic dusts Hypersensitivity pneumonitis Clinical features Investigations Diagnosis Management Inhalation (‘humidifier’) fever Asbestos-related lung and pleural diseases Pleural plaques Acute benign asbestos pleurisy Diffuse pleural thickening Asbestosis Mesothelioma Occupational lung cancer Occupational pneumonia Pulmonary vascular disease Pulmonary embolism Clinical features Investigations Management General measures Anticoagulation Thrombolytic and surgical therapy Caval filters Prognosis Pulmonary hypertension Clinical features Investigations Management Diseases of the upper airway Diseases of the nasopharynx Allergic rhinitis Clinical features Management Sleep-disordered breathing The sleep apnoea/hypopnoea syndrome Aetiology Clinical features Investigations Management Laryngeal disorders Chronic laryngitis Laryngeal paralysis Clinical features and management Psychogenic hoarseness and aphonia Laryngeal obstruction Management Tracheal disorders Tracheal obstruction Clinical features and management Tracheo-oesophageal fistula Pleural disease Pneumothorax Clinical features Investigations Management Recurrent spontaneous pneumothorax Diseases of the diaphragm and chest wall Disorders of the diaphragm Congenital disorders Diaphragmatic hernias Eventration of the diaphragm Acquired disorders Deformities of the chest wall Thoracic kyphoscoliosis Pectus excavatum Pectus carinatum Further information Websites 18 Endocrinology Clinical examination in endocrine disease An overview of endocrinology Functional anatomy and physiology Endocrine pathology Investigation of endocrine disease Presenting problems in endocrine disease The thyroid gland Functional anatomy, physiology and investigations Presenting problems in thyroid disease Thyrotoxicosis Clinical assessment Investigations Management Atrial fibrillation in thyrotoxicosis Thyrotoxic crisis (‘thyroid storm’) Hypothyroidism Clinical assessment Investigations Management Levothyroxine replacement in ischaemic heart disease Hypothyroidism in pregnancy Myxoedema coma Symptoms of hypothyroidism with normal thyroid function tests Asymptomatic abnormal thyroid function tests Subclinical thyrotoxicosis Subclinical hypothyroidism Non-thyroidal illness (‘sick euthyroidism’) Thyroid lump or swelling Clinical assessment and investigations Thyroid scintigraphy Thyroid ultrasound Fine needle aspiration cytology Management Autoimmune thyroid disease Graves’ disease Graves’ thyrotoxicosis Pathophysiology Management Antithyroid drugs Thyroid surgery Radioactive iodine Thyrotoxicosis in pregnancy Thyrotoxicosis in adolescence Graves’ ophthalmopathy Pretibial myxoedema Hashimoto’s thyroiditis Transient thyroiditis Subacute (de Quervain’s) thyroiditis Post-partum thyroiditis Iodine-associated thyroid disease Iodine deficiency Iodine-induced thyroid dysfunction Amiodarone Simple and multinodular goitre Simple diffuse goitre Multinodular goitre Clinical features and investigations Management Thyroid neoplasia Toxic adenoma Differentiated carcinoma Papillary carcinoma Follicular carcinoma Management Prognosis Anaplastic carcinoma and lymphoma Medullary carcinoma Riedel’s thyroiditis Congenital thyroid disease Dyshormonogenesis Thyroid hormone resistance The reproductive system Functional anatomy, physiology and investigations The male The female Presenting problems in reproductive disease Delayed puberty Clinical assessment Constitutional delay of puberty Hypogonadotrophic hypogonadism Hypergonadotrophic hypogonadism Investigations Management Precocious puberty Investigations Management Amenorrhoea Clinical assessment Investigations Management Male hypogonadism Investigations Management Infertility Clinical assessment Investigations Management Gynaecomastia Clinical assessment Investigations Management Hirsutism Clinical assessment Investigations Management Polycystic ovarian syndrome Management Menstrual irregularity and infertility Hirsutism Turner’s syndrome Clinical features Diagnosis and management Klinefelter’s syndrome Clinical features Diagnosis and management The parathyroid glands Functional anatomy, physiology and investigations Presenting problems in parathyroid disease Hypercalcaemia Clinical assessment Investigations Management Hypocalcaemia Aetiology Clinical assessment Management Primary hyperparathyroidism Clinical and radiological features Investigations Management Familial hypocalciuric hypercalcaemia Hypoparathyroidism Pseudohypoparathyroidism Management of hypoparathyroidism The adrenal glands Functional anatomy and physiology Glucocorticoids Mineralocorticoids Catecholamines Adrenal androgens Presenting problems in adrenal disease Cushing’s syndrome Aetiology Clinical assessment Investigations Establishing the presence of Cushing’s syndrome Determining the underlying cause Management Cushing’s disease Adrenal tumours Ectopic ACTH syndrome Therapeutic use of glucocorticoids Adverse effects of glucocorticoids Management of glucocorticoid withdrawal Adrenal insufficiency Clinical assessment Investigations Assessment of glucocorticoids Assessment of mineralocorticoids Assessment of adrenal androgens Other tests to establish the cause Management Glucocorticoid replacement Mineralocorticoid replacement Androgen replacement Incidental adrenal mass Clinical assessment and investigations Management Primary hyperaldosteronism Clinical features Investigations Biochemical Imaging and localisation Management Phaeochromocytoma and paraganglioma Clinical features Investigations Localisation Management Congenital adrenal hyperplasia Pathophysiology and clinical features Investigations Management The endocrine pancreas and gastrointestinal tract Presenting problems in endocrine pancreas disease Spontaneous hypoglycaemia Clinical assessment Investigations Does the patient have a hypoglycaemic disorder? What is the cause of the hypoglycaemia? Management Gastroenteropancreatic neuro-endocrine tumours Clinical features Investigations Management The hypothalamus and the pituitary gland Functional anatomy, physiology and investigations Investigation of patients with pituitary disease Presenting problems in hypothalamic and pituitary disease Hypopituitarism Clinical assessment Investigations Management Cortisol replacement Thyroid hormone replacement Sex hormone replacement Growth hormone replacement Pituitary tumour Clinical assessment Investigations Management Hyperprolactinaemia/galactorrhoea Clinical assessment Investigations Management Prolactinoma Management Medical Surgery and radiotherapy Pregnancy Acromegaly Clinical features Investigations Management Surgical Radiotherapy Medical Craniopharyngioma Diabetes insipidus Clinical features Investigations Management Disorders affecting multiple endocrine glands Multiple endocrine neoplasia Autoimmune polyendocrine syndromes Late effects of childhood cancer therapy Further information Websites 19 Nutritional factors in disease Clinical examination in nutritional disorders Clinical assessment and investigation of nutritional status Nutritional factors and disease Physiology of nutrition Energy balance Regulation of energy balance Responses to under- and over-nutrition Macronutrients (energy-yielding nutrients) Carbohydrates Dietary fibre Fats Proteins Dietary recommendations for macronutrients Disorders of altered energy balance Obesity Complications Body fat distribution Aetiology Susceptibility to obesity Reversible causes of obesity and weight gain Clinical features and investigations Management Lifestyle advice Weight loss diets Drugs Surgery Treatment of additional risk factors Under-nutrition Starvation and famine Clinical features Investigations Management Under-nutrition in hospital Specific issues arising after intestinal surgery Gastrectomy or partial gastrectomy Proximal small bowel surgery Pancreatic resection/Whipple’s operation Ileal resection Massive small bowel resection An approach to assisted nutrition in hospital patients Refeeding syndrome Oral nutritional supplements Enteral feeding Complications Route of access Nasogastric tube feeding Gastrostomy feeding Post-pyloric feeding Parenteral nutrition Intestinal failure (‘short bowel syndrome’) Management Jejunum–colon patients Jejunostomy patients Small bowel and multivisceral transplantation Further developments in treatment of intestinal failure Artificial nutrition at the end of life Nutrition and dementia Micronutrients, minerals and their diseases Vitamins Fat-soluble vitamins Vitamin A (retinol) Vitamin D Vitamin E Vitamin K Water-soluble vitamins Thiamin (vitamin B1) Deficiency – beri-beri Riboflavin (vitamin B2) Niacin (vitamin B3) Deficiency – pellagra Toxicity Pyridoxine (vitamin B6) Biotin Folate (folic acid) Hydroxycobalamin (vitamin B12) Neurological consequences of vitamin B12 deficiency Vitamin C (ascorbic acid) Deficiency – scurvy Other dietary organic compounds Inorganic micronutrients Calcium and phosphorus Iron Iodine Zinc Selenium Fluoride Sodium, potassium and magnesium Other essential inorganic nutrients Further information Websites 20 Diabetes mellitus Clinical examination of the patient with diabetes Functional anatomy and physiology Regulation of insulin secretion Regulation of glucagon secretion Blood glucose homeostasis Fat metabolism Investigations Urine glucose Blood glucose Interstitial glucose Urine and blood ketones Glycated haemoglobin Islet autoantibodies C-peptide Urine protein Establishing the diagnosis of diabetes Aetiology and pathogenesis of diabetes Type 1 diabetes Pathology Genetic predisposition Environmental predisposition Metabolic disturbances in type 1 diabetes Type 1 diabetes in adults Type 2 diabetes Pathology Insulin resistance and the metabolic syndrome Pancreatic β-cell failure Genetic predisposition Environmental and other risk factors Diet and obesity Age Ethnicity Metabolic disturbances in type 2 diabetes Other forms of diabetes Pancreatic disease Monogenic diabetes Presenting problems in diabetes mellitus Hyperglycaemia Presentation with the complications of diabetes Diabetes emergencies Diabetic ketoacidosis Pathogenesis Clinical assessment Investigations Assessment of severity Management Insulin Fluid replacement Potassium Bicarbonate Phosphate Ongoing management Hyperglycaemic hyperosmolar state Hypoglycaemia Clinical assessment Circumstances of hypoglycaemia Awareness of hypoglycaemia Management Acute treatment of hypoglycaemia Prevention of hypoglycaemia Management of diabetes Self-assessment of glycaemic control Therapeutic goals Patient education, diet and lifestyle Healthy eating Carbohydrate Fat Salt Weight management Exercise Alcohol Driving Ramadan Drugs to reduce hyperglycaemia Biguanides Mechanism of action Clinical use Sulphonylureas Mechanism of action Clinical use Alpha-glucosidase inhibitors Thiazolidinediones Mechanism of action Clinical use Incretin-based therapies: DPP-4 inhibitors and GLP-1 receptor agonists SGLT2 inhibitors Insulin therapy Manufacture and formulation Subcutaneous multiple dose insulin therapy Insulin dosing regimens Subcutaneous continuous insulin therapy Closed loop insulin therapy Transplantation Management of diabetes in special situations Diabetes in pregnancy Children, adolescents and young adults with diabetes Hyperglycaemia in acute medical illness Surgery and diabetes Pre-operative assessment Perioperative management Post-operative management Complications of diabetes Pathophysiology Preventing diabetes complications Glycaemic control Control of other risk factors Diabetic retinopathy Diabetic nephropathy Diagnosis and screening Management Diabetic neuropathy Clinical features Symmetrical sensory polyneuropathy Asymmetrical motor diabetic neuropathy Mononeuropathy Autonomic neuropathy Gastroparesis Erectile dysfunction Management The diabetic foot Aetiology Management Foot ulcer Charcot neuroarthropathy Further information Books and journal articles Websites 21 Gastroenterology Clinical examination of the gastrointestinal tract Functional anatomy and physiology Oesophagus, stomach and duodenum Gastric secretion Gastrin, somatostatin and ghrelin Protective factors Small intestine Digestion and absorption Fat Carbohydrates Protein Water and electrolytes Vitamins and trace elements Protective function of the small intestine Physical defence mechanisms Immunological defence mechanisms Pancreas Colon Intestinal microbiota Control of gastrointestinal function The nervous system and gastrointestinal function The enteric nervous system Peristalsis Migrating motor complexes Gut hormones Investigation of gastrointestinal disease Imaging Plain X-rays Contrast studies Ultrasound, computed tomography and magnetic resonance imaging Endoscopy Upper gastrointestinal endoscopy Endoscopic ultrasound Capsule endoscopy Double balloon enteroscopy Sigmoidoscopy and colonoscopy Magnetic resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography Histology Tests of infection Bacterial cultures Serology Breath tests Tests of function Oesophageal motility Gastric emptying Colonic and anorectal motility Radioisotope tests Gut hormone testing Presenting problems in gastrointestinal disease Dysphagia Investigations Dyspepsia Heartburn and regurgitation Vomiting Gastrointestinal bleeding Acute upper gastrointestinal haemorrhage Clinical assessment Management 1. Intravenous access 2. Initial clinical assessment 3. Basic investigations 4. Resuscitation 5. Oxygen 6. Endoscopy 7. Monitoring 8. Surgery 9. Eradication Lower gastrointestinal bleeding Severe acute lower gastrointestinal bleeding Subacute or chronic lower gastrointestinal bleeding Major gastrointestinal bleeding of unknown cause Chronic occult gastrointestinal bleeding Diarrhoea Acute diarrhoea Chronic or relapsing diarrhoea Malabsorption Pathophysiology Investigations Weight loss Physiological causes Psychiatric illness Systemic disease Gastrointestinal disease Metabolic disorders and miscellaneous causes Investigations Constipation Clinical assessment and management Initial visit Next visit Further investigation Abdominal pain The acute abdomen Initial clinical assessment Investigations Management Acute appendicitis Acute cholecystitis Acute diverticulitis Small bowel obstruction Large bowel obstruction Perforated peptic ulcer Chronic or recurrent abdominal pain Constant abdominal pain Diseases of the mouth and salivary glands Aphthous ulceration Oral cancer Candidiasis Parotitis Diseases of the oesophagus Gastro-oesophageal reflux disease Pathophysiology Abnormalities of the lower oesophageal sphincter Hiatus hernia Delayed oesophageal clearance Gastric contents Defective gastric emptying Increased intra-abdominal pressure Dietary and environmental factors Patient factors Clinical features Complications Oesophagitis Barrett’s oesophagus Diagnosis Management Anaemia Benign oesophageal stricture Gastric volvulus Investigations Management Other causes of oesophagitis Infection Corrosives Drugs Eosinophilic oesophagitis Motility disorders Pharyngeal pouch Achalasia of the oesophagus Pathophysiology Clinical features Investigations Management Endoscopic Surgical Other oesophageal motility disorders Secondary causes of oesophageal dysmotility Benign oesophageal stricture Tumours of the oesophagus Benign tumours Carcinoma of the oesophagus Clinical features Investigations Management Perforation of the oesophagus Diseases of the stomach and duodenum Gastritis Acute gastritis Chronic gastritis due to Helicobacter pylori infection Autoimmune chronic gastritis Ménétrier’s disease Peptic ulcer disease Gastric and duodenal ulcer Pathophysiology H. pylori NSAIDs Smoking Clinical features Investigations Management H. pylori eradication General measures Maintenance treatment Surgical treatment Complications of gastric resection or vagotomy Dumping Chemical (bile reflux) gastropathy Diarrhoea and maldigestion Weight loss Anaemia Metabolic bone disease Gastric cancer Complications of peptic ulcer disease Perforation Gastric outlet obstruction Bleeding Zollinger–Ellison syndrome Pathophysiology Clinical features Investigations Management Functional disorders Functional dyspepsia Pathophysiology Clinical features Investigations Management Functional causes of vomiting Gastroparesis Tumours of the stomach Gastric carcinoma Pathophysiology Clinical features Investigations Management Surgery Palliative treatment Gastric lymphoma Other tumours of the stomach Diseases of the small intestine Disorders causing malabsorption Coeliac disease Pathophysiology Clinical features Investigations Duodenal biopsy Antibodies Haematology and biochemistry Other investigations Management Complications Dermatitis herpetiformis Tropical sprue Pathophysiology Clinical features Management Small bowel bacterial overgrowth (‘blind loop syndrome’) Pathophysiology Clinical features Investigations Management Whipple’s disease Pathophysiology Clinical features Investigations Management Bile acid diarrhoea Short bowel syndrome Radiation enteritis and proctocolitis Pathophysiology Clinical features Investigations Management Abetalipoproteinaemia Motility disorders Chronic intestinal pseudo-obstruction Clinical features Investigations Management Miscellaneous disorders of the small intestine Protein-losing enteropathy Intestinal lymphangiectasia Ulceration of the small intestine NSAID-associated small intestinal toxicity Eosinophilic gastroenteritis Clinical features Investigations and management Meckel’s diverticulum Adverse food reactions Lactose intolerance Clinical features Intolerance of other sugars Food allergy Infections of the small intestine Travellers’ diarrhoea, giardiasis and amoebiasis Abdominal tuberculosis Investigations Management Cryptosporidiosis Tumours of the small intestine Benign tumours Malignant tumours Adenocarcinomas Neuro-endocrine tumours Lymphoma Immunoproliferative small intestinal disease Inflammatory bowel disease Pathophysiology Ulcerative colitis Crohn’s disease Clinical features Ulcerative colitis Crohn’s disease Differential diagnosis Complications Life-threatening colonic inflammation Haemorrhage Fistulae Cancer Extra-intestinal complications Investigations Bacteriology Endoscopy Radiology Management Ulcerative colitis Active proctitis Active left-sided or extensive ulcerative colitis Severe ulcerative colitis Maintenance of remission Crohn’s disease Principles of treatment Induction of remission Maintenance therapy Fistulae and perianal disease Surgical treatment Ulcerative colitis Crohn’s disease IBD in special circumstances Childhood Pregnancy Metabolic bone disease Refractory Crohn’s disease Microscopic colitis Irritable bowel syndrome Pathophysiology Behavioural and psychosocial factors Physiological factors Luminal factors Clinical features Investigations Management HIV/AIDS and the gastrointestinal tract Ischaemic gut injury Acute small bowel ischaemia Acute colonic ischaemia Chronic mesenteric ischaemia Disorders of the colon and rectum Tumours of the colon and rectum Polyps and polyposis syndromes Familial adenomatous polyposis Peutz–Jeghers syndrome Juvenile polyposis Colorectal cancer Pathophysiology Clinical features Investigations Management Surgery Adjuvant therapy Palliation of advanced disease Prevention and screening Diverticulosis Pathophysiology Clinical features Investigations Management Constipation and disorders of defecation Simple constipation Severe idiopathic constipation Faecal impaction Melanosis coli and laxative misuse syndromes Hirschsprung’s disease Acquired megacolon Acute colonic pseudo-obstruction Anorectal disorders Faecal incontinence Management Haemorrhoids Pruritus ani Solitary rectal ulcer syndrome Anal fissure Anorectal abscesses and fistulae Diseases of the peritoneal cavity Peritonitis Tumours Other disorders Endometriosis Pneumatosis cystoides intestinalis Diseases of the pancreas Acute pancreatitis Pathophysiology Clinical features Investigations Management Chronic pancreatitis Pathophysiology Clinical features Investigations Management Alcohol misuse Pain relief Malabsorption Management of complications Autoimmune pancreatitis Congenital abnormalities affecting the pancreas Pancreas divisum Annular pancreas Cystic fibrosis Meconium ileus Tumours of the pancreas Adenocarcinoma of the pancreas Clinical features Investigations Management Incidental pancreatic mass Further information Books and journal articles Websites 22 Hepatology Clinical examination of the abdomen for liver and biliary disease History and significance of abdominal signs Functional anatomy and physiology Applied anatomy Normal liver structure and blood supply Liver cells Blood supply Biliary system and gallbladder Hepatic function Carbohydrate, amino acid and lipid metabolism Clotting factors Bilirubin metabolism and bile Storage of vitamins and minerals Immune regulation Investigation of liver and hepatobiliary disease Liver blood biochemistry Bilirubin and albumin Alanine aminotransferase and aspartate aminotransferase Alkaline phosphatase and γ-glutamyl transferase Other biochemical tests Haematological tests Blood count Coagulation tests Immunological tests Imaging Ultrasound Computed tomography and magnetic resonance imaging Cholangiography Endoscopic ultrasound Histological examination Non-invasive markers of hepatic fibrosis Presenting problems in liver disease Acute liver failure Pathophysiology Clinical assessment Investigations Management Abnormal liver function tests Jaundice Pre-hepatic jaundice Hepatocellular jaundice Obstructive (cholestatic) jaundice Hepatomegaly Ascites Pathophysiology Investigations Management Sodium and water restriction Diuretics Paracentesis Transjugular intrahepatic portosystemic stent shunt Complications Renal failure Hepatorenal syndrome Type 1 hepatorenal syndrome Type 2 hepatorenal syndrome Spontaneous bacterial peritonitis Prognosis Hepatic encephalopathy Pathophysiology Investigations Management Variceal bleeding Cirrhosis Pathophysiology Clinical features Management Prognosis Portal hypertension Clinical features Pathophysiology Investigations Management Primary prevention of variceal bleeding Management of acute variceal bleeding Pharmacological reduction of portal venous pressure Variceal ligation (‘banding’) and sclerotherapy Balloon tamponade TIPSS Portosystemic shunt surgery Oesophageal transection Secondary prevention of variceal bleeding Congestive ‘portal hypertensive’ gastropathy Infections and the liver Viral hepatitis Clinical features of acute infection Investigations Management Hepatitis A Investigations Management Hepatitis B Investigations Serology Hepatitis B surface antigen Hepatitis B core antigen Hepatitis B e antigen Viral load and genotype Management of acute hepatitis B Management of chronic hepatitis B Direct-acting nucleoside/nucleotide antiviral agents Lamivudine Entecavir and tenofovir Interferon-alfa Liver transplantation Prevention Co-infection with HIV Hepatitis D (Delta virus) Investigations Management Hepatitis C Investigations Serology and virology Molecular analysis Liver function tests Liver histology Management Hepatitis E Other forms of viral hepatitis HIV infection and the liver Liver abscess Pyogenic liver abscess Pathophysiology Clinical features Investigations Management Hydatid cysts and amoebic liver abscesses Leptospirosis Alcoholic liver disease Pathophysiology Clinical features Alcoholic fatty liver disease Alcoholic hepatitis Alcoholic cirrhosis Investigations Management Nutrition Drug therapy Liver transplantation Non-alcoholic fatty liver disease Pathophysiology Clinical features Investigations Biochemical tests Imaging Liver biopsy Management Non-pharmacological treatment Pharmacological treatment Autoimmune liver and biliary disease Autoimmune hepatitis Pathophysiology Clinical features Investigations Management Primary biliary cholangitis Epidemiology Pathophysiology Clinical features Associated diseases Diagnosis and investigations Management Pruritus Fatigue Malabsorption Bone disease Overlap syndromes AMA-negative PBC (‘autoimmune cholangitis’) PBC/autoimmune hepatitis overlap Primary sclerosing cholangitis Pathophysiology Clinical features Investigations Management Management of complications Surgical treatment IgG4-associated cholangitis Liver tumours and other focal liver lesions Primary malignant tumours Hepatocellular carcinoma Clinical features Investigations Serum markers Imaging Liver biopsy Role of screening Management Hepatic resection Liver transplantation Percutaneous therapy Trans-arterial chemo-embolisation Chemotherapy Fibrolamellar hepatocellular carcinoma Other primary malignant tumours Secondary malignant tumours Clinical features Investigations Management Benign tumours Hepatic adenomas Haemangiomas Focal nodular hyperplasia Cystic liver disease and liver abscess Drugs and the liver Drug-induced liver injury Types of liver injury Cholestasis Hepatocyte necrosis Steatosis Vascular/sinusoidal lesions Hepatic fibrosis Inherited liver diseases Haemochromatosis Hereditary haemochromatosis Pathophysiology Clinical features Investigations Management Secondary haemochromatosis Wilson’s disease Pathophysiology Clinical features Liver disease Neurological disease Kayser–Fleischer rings Investigations Management Alpha1-antitrypsin deficiency Gilbert’s syndrome Clinical features Investigations Vascular liver disease Hepatic arterial disease Liver ischaemia Liver arterial disease Portal venous disease Portal hypertension Portal vein thrombosis Hepatopulmonary syndrome Portopulmonary hypertension Hepatic venous disease Budd–Chiari syndrome Clinical features Investigations Management Sinusoidal obstruction syndrome (veno-occlusive disease) Cardiac disease Nodular regenerative hyperplasia of the liver Pregnancy and the liver Intercurrent and pre-existing liver disease Pregnancy-associated liver disease Liver transplantation Indications and contraindications Complications Early complications Primary graft non-function Technical complications Rejection Infections Late complications Prognosis Cholestatic and biliary disease Chemical cholestasis Benign recurrent intrahepatic cholestasis Intrahepatic biliary disease Inflammatory and immune disease Caroli’s disease Congenital hepatic fibrosis Cystic fibrosis Extrahepatic biliary disease Choledochal cysts Secondary biliary cirrhosis Gallstones Pathophysiology Cholesterol gallstones Pigment stones Biliary sludge Clinical features Investigations Management Cholecystitis Acute cholecystitis Pathophysiology Clinical features Investigations Management Medical Surgical Chronic cholecystitis Acute cholangitis Choledocholithiasis Clinical features Investigations Management Recurrent pyogenic cholangitis Tumours of the gallbladder and bile duct Carcinoma of the gallbladder Cholangiocarcinoma Carcinoma at the ampulla of Vater Benign gallbladder tumours Miscellaneous biliary disorders Post-cholecystectomy syndrome Functional biliary sphincter disorders (‘sphincter of Oddi dysfunction’) Clinical features Investigations Management Cholesterolosis of the gallbladder Adenomyomatosis of the gallbladder IgG4-associated cholangitis Further information Books and journal articles Websites 23 Haematology and transfusion medicine Clinical examination in blood disease Anaemia Bleeding Functional anatomy and physiology Haematopoiesis Stem cells Blood cells and their functions Red cells Haemoglobin Destruction White cells Neutrophils Eosinophils Basophils Monocytes Lymphocytes Haemostasis Platelets Clotting factors Investigation of diseases of the blood The full blood count Blood film examination Bone marrow examination Investigation of coagulation Bleeding disorders Monitoring anticoagulant therapy Thrombotic disorders Presenting problems in blood disease Anaemia Clinical assessment Investigations High haemoglobin Clinical assessment and investigations Leucopenia (low white cell count) Neutropenia Lymphopenia Leucocytosis (high white cell count) Neutrophilia Eosinophilia Lymphocytosis Lymphadenopathy Splenomegaly Bleeding Clinical assessment Investigations Thrombocytopenia (low platelet count) Thrombocytosis (high platelet count) Pancytopenia Infection Principles of management of haematological disease Blood products and transfusion Blood products Blood donation Adverse effects of transfusion Red cell incompatibility ABO blood groups ABO-incompatible red cell transfusion The Rhesus D blood group and haemolytic disease of the newborn Other immunological complications of transfusion Transfusion-transmitted infection Safe transfusion procedures Pre-transfusion testing Bedside procedures for safe transfusion Transfusion in major haemorrhage Chemotherapy Haematopoietic stem cell transplantation Allogeneic HSCT Complications Graft-versus-host disease Autologous HSCT Anticoagulant and antithrombotic therapy Heparins Heparin-induced thrombocytopenia Clinical features Investigations Management Coumarins Direct oral anticoagulants Anaemias Iron deficiency anaemia Blood loss Malabsorption Physiological demands Investigations Confirmation of iron deficiency Investigation of the cause Management Anaemia of chronic disease Pathogenesis Diagnosis and management Megaloblastic anaemia Vitamin B12 Vitamin B12 absorption Causes of vitamin B12 deficiency Dietary deficiency Gastric pathology Pernicious anaemia Small bowel pathology Folate Folate absorption Folate deficiency Management of megaloblastic anaemia Vitamin B12 deficiency Folate deficiency Haemolytic anaemia Extravascular haemolysis Intravascular haemolysis Causes of haemolytic anaemia Red cell membrane defects Hereditary spherocytosis Investigations Management Hereditary elliptocytosis Red cell enzymopathies Glucose-6-phosphate dehydrogenase deficiency Pyruvate kinase deficiency Pyrimidine 5′ nucleotidase deficiency Autoimmune haemolytic anaemia Warm autoimmune haemolysis Investigations Management Cold agglutinin disease Chronic cold agglutinin disease Other causes of cold agglutination Alloimmune haemolytic anaemia Non-immune haemolytic anaemia Endothelial damage Infection Chemicals or drugs Paroxysmal nocturnal haemoglobinuria Haemoglobinopathies Qualitative abnormalities – abnormal haemoglobins Quantitative abnormalities – thalassaemias Sickle-cell anaemia Epidemiology Pathogenesis Clinical features Investigations Management Prognosis Other abnormal haemoglobins Thalassaemias Beta-thalassaemia Management and prevention Alpha-thalassaemia Haematological malignancies Leukaemias Epidemiology and aetiology Terminology and classification Acute leukaemia Investigations Management Specific therapy Supportive therapy Anaemia Bleeding Infection Metabolic problems Psychological problems Haematopoietic stem cell transplantation Prognosis Chronic myeloid leukaemia Natural history Clinical features Investigations Management Chronic phase Accelerated phase and blast crisis Chronic lymphocytic leukaemia Clinical features Investigations Management Prognosis Prolymphocytic leukaemia Hairy cell leukaemia Myelodysplastic syndromes Prognosis Management Lymphomas Hodgkin lymphoma Clinical features Investigations Management Prognosis Non-Hodgkin lymphoma Clinical features Investigations Management Low-grade NHL High-grade NHL Prognosis Paraproteinaemias Monoclonal gammopathy of uncertain significance Clinical features and investigations Prognosis Waldenström macroglobulinaemia Management Multiple myeloma Clinical features and investigations Management Immediate support Chemotherapy with or without HSCT Radiotherapy Bisphosphonates Prognosis Aplastic anaemias Primary idiopathic acquired aplastic anaemia Clinical features and investigations Management Secondary aplastic anaemia Myeloproliferative neoplasms Myelofibrosis Management and prognosis Essential thrombocythaemia Polycythaemia rubra vera Management and prognosis Bleeding disorders Disorders of primary haemostasis Vessel wall abnormalities Hereditary haemorrhagic telangiectasia Ehlers–Danlos disease Scurvy Platelet function disorders Thrombocytopenia Idiopathic thrombocytopenic purpura Clinical features and investigations Management Coagulation disorders Haemophilia A Genetics Clinical features Management Complications of coagulation factor therapy Haemophilia B (Christmas disease) Von Willebrand disease Clinical features Investigations Management Rare inherited bleeding disorders Acquired bleeding disorders Liver disease Renal failure Thrombotic disorders Venous thromboembolic disease (venous thromboembolism) Management of VTE Prophylaxis of VTE Inherited and acquired thrombophilia and prothrombotic states Antithrombin deficiency Protein C and S deficiencies Factor V Leiden Prothrombin G20210A Antiphospholipid syndrome Clinical features and management Disseminated intravascular coagulation Investigations Management Thrombotic thrombocytopenic purpura Further information Websites 24 Rheumatology and bone disease Clinical examination of the musculoskeletal system General Assessment of Locomotor System (GALS) and Schöber’s test Functional anatomy and physiology Bone Bone matrix and mineral Bone remodelling Joints Fibrous and fibrocartilaginous joints Synovial joints Articular cartilage Synovial fluid Intra-articular discs Synovial membrane, joint capsule and bursae Skeletal muscle Investigation of musculoskeletal disease Joint aspiration Imaging Plain X-rays Bone scintigraphy Magnetic resonance imaging Ultrasonography Computed tomography Dual X-ray absorptiometry Blood tests Haematology Biochemistry Immunology Rheumatoid factor Anti-citrullinated peptide antibodies Antinuclear antibodies Antiphospholipid antibodies Antineutrophil cytoplasmic antibodies Complement Tissue biopsy Electromyography Presenting problems in musculoskeletal disease Acute monoarthritis Clinical assessment Investigations Management Polyarthritis Clinical assessment Investigations Management Fracture Clinical assessment Investigations Management Generalised musculoskeletal pain Clinical assessment Investigations Management Back pain Clinical assessment Investigations Management Regional musculoskeletal pain Neck pain Shoulder pain Elbow pain Hand and wrist pain Hip pain Knee pain Ankle and foot pain Muscle pain and weakness Clinical assessment Investigations Management Principles of management Education and lifestyle interventions Education Exercise Joint protection Non-pharmacological interventions Physical and occupational therapy Self-help and coping strategies Weight control Surgery Pharmacological treatment Analgesics Non-steroidal anti-inflammatory drugs Topical agents Disease-modifying antirheumatic drugs Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Azathioprine Apremilast Janus-activated kinase inhibitors Cyclophosphamide Mycophenolate mofetil Other DMARDs Glucocorticoids Systemic glucocorticoids Intra-articular and intramuscular glucocorticoids Biologics Anti-TNF therapy Rituximab Belimumab Abatacept Tocilizumab Ustekinumab Secukinumab Anakinra Canakinumab Osteoarthritis Epidemiology Pathophysiology Clinical features Generalised nodal OA Knee OA Hip OA Spine OA Early-onset OA Erosive OA Investigations Management Education Lifestyle advice Non-pharmacological therapy Pharmacological therapy Intra-articular injections Neutraceuticals Surgery Crystal-induced arthritis Gout Epidemiology Pathophysiology Clinical features Investigations Management Acute gout Prophylaxis Calcium pyrophosphate dihydrate crystal deposition disease Pathophysiology Clinical features Investigations Management Basic calcium phosphate deposition disease Pathophysiology Calcific periarthritis Acute inflammatory arthritis Milwaukee shoulder syndrome Autoimmune connective tissue disease Fibromyalgia Pathophysiology Clinical features Investigations and management Bone and joint infections Septic arthritis Pathogenesis Clinical features Investigations Management Viral arthritis Osteomyelitis Pathogenesis Clinical features Investigations Management Discitis Tuberculosis Rheumatoid arthritis Pathophysiology Clinical features Systemic features Nodules Vasculitis Ocular involvement Serositis Cardiac involvement Pulmonary involvement Peripheral neuropathy Spinal cord compression Other complications Investigations Management Pharmacological therapy Non-pharmacological therapy Surgery Juvenile idiopathic arthritis Investigations Management Prognosis Spondyloarthropathies Axial spondyloarthropathy Pathophysiology Axial spondyloarthritis Clinical features Investigations Management Prognosis Ankylosing spondylitis Clinical features Investigations Management Reactive arthritis Clinical features Investigations Management Psoriatic arthritis Pathophysiology Clinical features Asymmetrical inflammatory mono-/oligoarthritis Symmetrical polyarthritis Distal interphalangeal joint arthritis Psoriatic spondylitis Arthritis mutilans Enthesitis-predominant Investigations Management Enteropathic (spondylo)arthritis Autoimmune connective tissue diseases Systemic lupus erythematosus Pathophysiology Clinical features Arthritis Raynaud’s phenomenon Skin Kidney Cardiovascular Lung Neurological Haematological Gastrointestinal Paediatric disease Investigations Management Mild to moderate disease Severe and life-threatening disease Maintenance therapy Systemic sclerosis Pathophysiology Clinical features Skin Raynaud’s phenomenon Musculoskeletal features Gastrointestinal involvement Pulmonary involvement Renal involvement Investigations Management Mixed connective tissue disease Primary Sjögren’s syndrome Clinical features Investigations Management Polymyositis and dermatomyositis Clinical features Investigations Management Juvenile dermatomyositis Undifferentiated autoimmune connective tissue disease Adult-onset Still’s disease Vasculitis Antineutrophil cytoplasmic antibody-associated vasculitis Takayasu arteritis Kawasaki disease Polyarteritis nodosa Giant cell arteritis and polymyalgia rheumatica Clinical features Investigations Management Eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome) Henoch–Schönlein purpura Cryoglobulinaemic vasculitis Behçet’s disease Relapsing polychondritis Diseases of bone Osteoporosis Pathophysiology Idiopathic osteoporosis Secondary osteoporosis Glucocorticoid-induced osteoporosis Pregnancy-associated osteoporosis Clinical features Investigations Management Non-pharmacological interventions Pharmacological interventions Bisphosphonates Denosumab Calcium and vitamin D Teriparatide Abaloparatide Hormone replacement therapy Raloxifene Tibolone Other drugs Surgery Osteomalacia, rickets and vitamin D deficiency Vitamin D deficiency Pathogenesis Clinical features Investigations Management Osteomalacia and rickets Pathogenesis Clinical features Investigations Management Vitamin D-resistant rickets Pathogenesis Clinical features Investigations Management Hereditary hypophosphataemic rickets Pathophysiology Clinical features Investigations Management Tumour-induced osteomalacia Hypophosphatasia Other causes of osteomalacia Paget’s disease of bone Pathophysiology Clinical features Investigations Management Other bone diseases Complex regional pain syndrome type 1 Osteonecrosis Scheuermann’s osteochondritis Polyostotic fibrous dysplasia Osteogenesis imperfecta Osteopetrosis Sclerosing bone dysplasias Bone and joint tumours Osteosarcoma Chondrosarcoma Ewing’s sarcoma Metastatic bone disease Rheumatological involvement in other diseases Malignant disease Endocrine disease Haematological disease Neurological disease Miscellaneous conditions Anterior tibial compartment syndrome Carpal tunnel syndrome Diffuse idiopathic skeletal hyperostosis Dupuytren’s contracture Hypermobility syndromes Inclusion body myositis Periodic fever syndromes Pigmented villonodular synovitis Scoliosis Spondylolysis Synovitis–acne–pustulosis–hyperostosis–osteitis syndrome Trigger finger Further information Journal articles Websites 25 Neurology Clinical examination of the nervous system Functional anatomy and physiology Cells of the nervous system Generation and transmission of the nervous impulse Functional anatomy of the nervous system Cerebral hemispheres The brainstem The spinal cord Sensory peripheral nervous system Motor peripheral nervous system The autonomic system The motor system Lower motor neurons Upper motor neurons The extrapyramidal system The cerebellum Vision Speech The somatosensory system Pain Sphincter control Personality and mood Sleep Localising lesions in the central nervous system Investigation of neurological disease Neuroimaging Head and orbit Cervical, thoracic and lumbar spine Blood vessels Neurophysiological testing Electroencephalography Nerve conduction studies Electromyography Evoked potentials Magnetic stimulation Routine blood tests Immunological tests Genetic testing Lumbar puncture Biopsy Presenting problems in neurological disease Headache and facial pain Ocular pain Facial pain Dizziness, blackouts and ‘funny turns’ Status epilepticus Coma Delirium Amnesia Transient global amnesia Persistent amnesia Weakness Facial weakness Facial nerve palsy (Bell’s palsy) Sensory disturbance Numbness and paraesthesia Sensory loss in peripheral nerve lesions Sensory loss in nerve root lesions Sensory loss in spinal cord lesions Sensory loss in brainstem lesions Sensory loss in hemispheric lesions Neuropathic pain Abnormal movements Tremor Other hyperkinetic syndromes Chorea Athetosis Ballism Dystonia Myoclonus Tics Abnormal perception Altered balance and vertigo Vertigo Abnormal gait Pyramidal gait Foot drop Myopathic gait Ataxic gait Apraxic gait Marche à petits pas Extrapyramidal gait Abnormal speech and language Dysphonia Dysarthria Dysphasia Disturbance of smell Visual disturbance and ocular abnormalities Visual loss Positive visual phenomena Double vision Nystagmus Ptosis Abnormal pupillary responses Papilloedema Optic atrophy Hearing disturbance Bulbar symptoms – dysphagia and dysarthria Bladder, bowel and sexual disturbance Bladder dysfunction Rectal dysfunction Erectile failure and ejaculatory failure Personality change Sleep disturbance Psychiatric disorders Functional symptoms Headache syndromes Tension-type headache Pathophysiology Clinical features Management Migraine Pathophysiology Clinical features Management Medication overuse headache Cluster headache Pathophysiology Clinical features Management Trigeminal neuralgia Pathophysiology Clinical features Management Headaches associated with specific activities Other headache syndromes Epilepsy Pathophysiology Focal epilepsy Generalised epilepsies Clinical features Seizure type and epilepsy type Focal seizures Generalised seizures Tonic–clonic seizures Absence seizures Myoclonic seizures Atonic seizures Tonic seizures Clonic seizures Seizures of uncertain generalised or focal nature Epileptic spasms Epilepsy syndromes Investigations Single seizure Epilepsy Management Immediate care Lifestyle advice Antiepileptic drugs Monitoring therapy Epilepsy surgery Withdrawing antiepileptic therapy Contraception Pregnancy and reproduction Prognosis Status epilepticus Non-epileptic attack disorder (‘dissociative attacks’) Vestibular disorders Acute vestibular failure Benign paroxysmal positional vertigo Ménière’s disease Disorders of sleep Excessive daytime sleepiness (hypersomnolence) Narcolepsy Parasomnias Non-REM parasomnias REM sleep behaviour disorder Restless legs syndrome Periodic limb movements in sleep Neuro-inflammatory diseases Multiple sclerosis Pathophysiology Clinical features Investigations Management The acute episode Disease-modifying treatment Treatment of symptoms, complications and disability Acute disseminated encephalomyelitis Clinical features Investigations Management Transverse myelitis Neuromyelitis optica Paraneoplastic neurological disorders Clinical features Investigations and management Neurodegenerative diseases Movement disorders Idiopathic Parkinson’s disease Pathophysiology Clinical features Non-motor symptoms Investigations Management Drug therapy Levodopa Dopamine receptor agonists MAOI-B inhibitors COMT inhibitors Amantadine Anticholinergic drugs Surgery Physiotherapy, occupational therapy and speech therapy Other parkinsonian syndromes Multiple system atrophy Progressive supranuclear palsy Corticobasal degeneration Wilson’s disease Huntington’s disease Clinical features Investigations and management Ataxias Tremor disorders Essential tremor Dystonia Hemifacial spasm Motor neuron disease Clinical features Investigations Management Spinal muscular atrophy Infections of the nervous system Meningitis Viral meningitis Clinical features Investigations Management Bacterial meningitis Pathophysiology Clinical features Investigations Management Prevention of meningococcal infection Tuberculous meningitis Pathophysiology Clinical features Investigations Management Other forms of meningitis Parenchymal viral infections Viral encephalitis Pathophysiology Clinical features Investigations Management Brainstem encephalitis Rabies Clinical features Investigations Management Established disease Pre-exposure prophylaxis Post-exposure prophylaxis Poliomyelitis Pathophysiology Clinical features Investigations Management Established disease Prophylaxis Herpes zoster (shingles) Subacute sclerosing panencephalitis Progressive multifocal leucoencephalopathy Parenchymal bacterial infections Cerebral abscess Clinical features Investigations Management and prognosis Subdural empyema Spinal epidural abscess Lyme disease Neurosyphilis Clinical features Investigations Management Diseases caused by bacterial toxins Tetanus Clinical features Investigations Management Established disease Prevention Botulism Prion diseases Creutzfeldt–Jakob disease Variant Creutzfeldt–Jakob disease Intracranial mass lesions and raised intracranial pressure Raised intracranial pressure Clinical features Management Brain tumours Clinical features Investigations Management Surgical Radiotherapy and chemotherapy Prognosis Acoustic neuroma Clinical features Investigations Management Neurofibromatosis Von Hippel–Lindau disease Paraneoplastic neurological disease Hydrocephalus Normal pressure hydrocephalus Management Idiopathic intracranial hypertension Clinical features Investigations Management Head injury Disorders of cerebellar function Disorders of the spine and spinal cord Cervical spondylosis Cervical radiculopathy Clinical features Investigations Management Cervical myelopathy Clinical features Investigations Management Prognosis Lumbar spondylosis Lumbar disc herniation Pathophysiology Clinical features Investigations Management Lumbar canal stenosis Pathophysiology Clinical features Investigations Management Spinal cord compression Clinical features Investigations Management Intrinsic diseases of the spinal cord Diseases of peripheral nerves Pathophysiology Clinical features Investigations Entrapment neuropathy Multifocal neuropathy Polyneuropathy Guillain–Barré syndrome Clinical features Investigations Management Chronic polyneuropathy Hereditary neuropathy Chronic demyelinating polyneuropathy Brachial plexopathy Lumbosacral plexopathy Spinal root lesions Diseases of the neuromuscular junction Myasthenia gravis Pathophysiology Clinical features Investigations Management Lambert–Eaton myasthenic syndrome Diseases of muscle Muscular dystrophies Clinical features Investigations Management Inherited metabolic myopathies Mitochondrial disorders Channelopathies Acquired myopathies Further information Journal articles Websites 26 Stroke medicine Clinical examination in stroke disease Functional anatomy and physiology Investigations Neuroimaging Vascular imaging Blood tests Lumbar puncture Cardiovascular investigations Presenting problems Weakness Speech disturbance Visual deficit Visuo-spatial dysfunction Ataxia Headache Seizure Coma Stroke Pathophysiology Cerebral infarction Intracerebral haemorrhage Clinical features Investigations Risk factor analysis Neuroimaging Vascular imaging Cardiac investigations Management Supportive care Reperfusion (thrombolysis and thrombectomy) Aspirin Heparin Coagulation abnormalities Management of risk factors Carotid endarterectomy and angioplasty Unusual causes Subarachnoid haemorrhage Clinical features Investigations Management Cerebral venous disease Clinical features Investigations and management Further information Websites 27 Medical ophthalmology Functional anatomy and physiology Orbit Eyelid/orbital septum/conjunctiva Lacrimal gland/lacrimal drainage Extraocular muscles Eye Sclera/cornea Choroid, ciliary body and iris – the uveal tract Retina Lens Vitreous Blood supply of the orbit/eye Investigation of visual disorders Perimetry Amsler chart Tangent/Goldmann kinetic perimetry Automated threshold perimetry Imaging Photography Optical coherence tomography Autofluorescence Fundus angiography Ocular ultrasound Visual electrophysiology Presenting problems in ophthalmic disease Watery/dry eye Pruritus Pain/headache Red eye White eye Photophobia/glare Photopsia Blurred vision Loss of vision Distortion of vision Eyelid retraction Optic disc swelling Proptosis Specialist ophthalmological conditions Ocular inflammation Sjögren’s syndrome Peripheral ulcerative keratitis Scleritis Episcleritis Uveitis Infectious conditions Conjunctivitis Infectious keratitis/corneal ulceration Endophthalmitis Cataract Diabetic eye disease Diabetic retinopathy Pathogenesis Clinical features Management of proliferative diabetic retinopathy Management of diabetic macular oedema Prevention Screening Other causes of visual loss in people with diabetes Retinal vascular occlusion Retinal vein occlusion (thrombosis) Retinal artery occlusion Age-related macular degeneration Further information Websites 28 Medical psychiatry Clinical examination The psychiatric interview The mental state examination General appearance and behaviour Speech Mood Thoughts Abnormal beliefs Abnormal perceptions Cognitive function Patients’ own understanding of their symptoms Investigations in medical psychiatry Functional anatomy and physiology Biological factors Genetic Brain structure and function Psychological and behavioural factors Early environment Personality Behaviour Social and environmental factors Social isolation Stressors Presenting problems in psychiatric illness Delirium Alcohol misuse Clinical assessment Investigations Management Substance misuse Delusions and hallucinations Delusions Hallucinations Clinical assessment Investigations Management Low mood Clinical assessment Investigations Management Elevated mood Investigations Management Anxiety Investigations Management Psychological factors affecting medical conditions Medically unexplained somatic symptoms Self-harm Clinical assessment Management Disturbed and aggressive behaviour Clinical assessment Investigations Management Principles of management of psychiatric disorders Pharmacological treatments Electroconvulsive therapy Other forms of electromagnetic stimulation Surgery Psychological therapies General psychotherapy Cognitive therapy Behaviour therapy Cognitive behaviour therapy Problem-solving therapy Psychodynamic psychotherapy Interpersonal psychotherapy Social interventions Psychiatric disorders Dementia Pathogenesis Clinical features Investigations Management Alzheimer’s disease Pathogenesis Clinical features Investigations Management Fronto-temporal dementia Lewy body dementia Alcohol misuse and dependence Pathogenesis Clinical features Social problems Low mood Anxiety Alcohol withdrawal syndrome Hallucinations Wernicke–Korsakoff syndrome Alcohol-related brain damage Effects on other organs Diagnosis Management Prognosis Substance misuse disorder Sedatives Stimulants Hallucinogens Organic solvents Pathogenesis Diagnosis Management Schizophrenia Pathogenesis Clinical features Diagnosis Investigations Management Drug treatment Neuroleptic malignant syndrome Cardiac arrhythmias Psychological treatment Social treatment Prognosis Mood disorders Depression Pathogenesis Diagnosis Investigations Management Drug treatment Tricyclic antidepressants Selective serotonin re-uptake inhibitors Noradrenaline (norepinephrine) re-uptake inhibitors Monoamine oxidase inhibitors Psychological treatment Prognosis Bipolar disorder Pathogenesis Diagnosis Management Prognosis Anxiety disorders Clinical features Phobic anxiety disorder Panic disorder Generalised anxiety disorder Diagnosis Management Psychological treatment Drug treatment Obsessive–compulsive disorder Clinical features Diagnosis Management Stress-related disorders Acute stress reaction Adjustment disorder Clinical features Diagnosis Management Post-traumatic stress disorder Clinical features Diagnosis Management Prognosis Somatoform disorders Pathogenesis Clinical features Somatoform autonomic dysfunction Somatoform pain disorder Chronic fatigue syndrome Dissociative conversion disorders Somatisation disorder Hypochondriacal disorder Body dysmorphic disorder Management Reassurance Explanation Advice Drug treatment Psychological treatment Rehabilitation Shared care Eating disorders Anorexia nervosa Clinical features Pathogenesis Diagnosis Management Prognosis Bulimia nervosa Clinical features Diagnosis Investigations Management Prognosis Personality disorders Pathogenesis Clinical features Diagnosis Management Factitious disorder and malingering Pathogenesis Clinical features Münchausen’s syndrome Malingering Management Puerperal psychiatric disorders Post-partum blues Post-partum depression Puerperal psychosis Psychiatric disorders during pregnancy Psychiatry and the law Further information Books and journal articles Websites 29 Dermatology Clinical examination in skin disease Functional anatomy and physiology Epidermis Basement membrane Dermis Epidermal appendages Hair follicles Sebaceous glands Sweat glands Nails Blood vessels and nerves Functions of the skin Investigation of skin disease Magnifying glass Wood’s light Dermatoscopy and diascopy Skin biopsy Microbiology Bacteriology Virology Mycology Patch testing Prick tests and specific immunoglobulin E testing Phototesting Blood tests Imaging Presenting problems in skin disease Lumps and lesions Clinical assessment Is it a melanocytic naevus or a malignant melanoma? Investigations and management Rash Clinical assessment Investigations and management Blisters Clinical assessment Investigations and management Itch Clinical assessment Investigations and management Photosensitivity Clinical assessment Investigations and management Sunscreens Leg ulcers Clinical assessment Leg ulceration due to venous disease Leg ulceration due to arterial disease Leg ulceration due to vasculitis Leg ulceration due to neuropathy Investigations Management Abnormal pigmentation Hair and nail abnormalities Acute skin failure Clinical assessment Investigations and management Principles of management of skin disease General measures Topical treatments Emollients Topical glucocorticoids Anti-infective agents Calcineurin inhibitors Immune response modifiers Dressings Phototherapy and photochemotherapy Systemic therapies Antibiotics Antihistamines Retinoids Immunosuppressants Biological therapies Dermatological surgery Excision biopsy Curettage Shave excision Mohs’ micrographic surgery Non-surgical treatments Cryotherapy Laser therapy Photodynamic therapy Radiotherapy and grenz (Bucky) ray therapy Skin tumours Pathogenesis Malignant tumours Basal cell carcinoma Clinical features Diagnosis and management Squamous cell carcinoma Clinical features Management Actinic keratosis Management Bowen’s disease Clinical features Diagnosis Management Cutaneous lymphomas Melanoma Pathophysiology Clinical features Superficial spreading melanoma Nodular melanoma Lentigo maligna melanoma Acral lentiginous or palmoplantar melanoma Subungual melanoma Diagnosis and management Prognosis Benign skin lesions Keratoacanthoma Freckle Lentigo Haemangiomas Basal cell papilloma Melanocytic naevi Clinical features Diagnosis and management Blue naevi Dermatofibroma Acrochordon Lipoma Common skin infections and infestations Bacterial infections Impetigo Staphylococcal scalded skin syndrome Toxic shock syndrome Ecthyma Folliculitis, furuncles and carbuncles Superficial folliculitis Deep folliculitis (furuncles and carbuncles) Cellulitis and erysipelas Mycobacterial infections Leishmaniasis Necrotising soft tissue infections and anthrax Erythrasma Pitted keratolysis Other bacterial skin infections Viral infections Herpesvirus infections Papillomaviruses and viral warts Clinical features Management Molluscum contagiosum Orf Other viral exanthems Fungal infections Diagnosis Management Tinea corporis Tinea cruris Tinea pedis Tinea capitis Onychomycosis Candidiasis Pityriasis versicolor Infestations Scabies Head lice Body lice Pubic (crab) lice Acne and rosacea Acne vulgaris Pathogenesis Clinical features Investigations Management Mild to moderate disease Moderate to severe disease Other treatments and physical measures Rosacea Clinical features Investigations Management Eczemas Clinical features Investigations Management Atopic eczema Pathogenesis Clinical features Investigations Management Seborrhoeic eczema Discoid eczema Irritant eczema Allergic contact eczema Asteatotic eczema Gravitational eczema Lichen simplex Pompholyx Psoriasis and other erythematous scaly eruptions Psoriasis Pathogenesis Clinical features Plaque psoriasis Guttate psoriasis Erythrodermic psoriasis Pustular psoriasis Arthropathy Investigations Management Pityriasis rosea Pityriasis lichenoides chronica Drug eruptions Other causes Lichenoid eruptions Lichen planus Pathogenesis Clinical features Investigations Management Drug-induced lichenoid eruptions Graft-versus-host disease Urticaria Clinical features Investigations Management Bullous diseases Toxic epidermal necrolysis Immunobullous diseases Bullous pemphigoid Pathogenesis Clinical features Investigations Management Pemphigus Pathogenesis Clinical features Investigations Management Dermatitis herpetiformis Linear IgA disease Epidermolysis bullosa acquisita Porphyria cutanea tarda and pseudoporphyria Pigmentation disorders Decreased pigmentation Vitiligo Clinical features Management Oculocutaneous albinism Management Increased pigmentation Hair disorders Alopecia Pathogenesis Clinical features Alopecia areata Androgenetic alopecia Investigations Management Hypertrichosis Hirsutism Nail disorders Normal variants Nail trauma Nail involvement in skin diseases Nail involvement in systemic disease Nail involvement in congenital disease Skin disease in general medicine Conditions involving cutaneous vasculature Vasculitis Pyoderma gangrenosum Other neutrophilic dermatoses Pressure sores Connective tissue disease Lupus erythematosus Systemic sclerosis Morphoea Dermatomyositis Granulomatous disease Granuloma annulare Necrobiosis lipoidica Sarcoidosis Cutaneous Crohn’s disease Porphyrias Cutaneous porphyrias: fragility and blisters Cutaneous porphyria: pain on sun exposure Abnormal deposition disorders Xanthomas Amyloidosis Genetic disorders Neurofibromatosis Tuberous sclerosis Reactive disorders Erythema multiforme Erythema nodosum Acquired reactive perforating dermatosis Annular erythemas Acanthosis nigricans Drug eruptions Clinical features Investigations and management Further information Websites 30 Maternal medicine Clinical examination in pregnancy Clinical evaluation in maternal medicine Planning pregnancy in patients with medical conditions Functional anatomy and physiology Bone metabolism Cardiovascular system Endocrine system Gastrointestinal system Genitourinary system Glucose metabolism Haematological system Respiratory system Investigations Imaging Presenting problems in pregnancy Breathlessness Chest pain Circulatory collapse Headache Nausea and vomiting Oedema Seizures Medical disorders in pregnancy Hypertension Pre-existing hypertension Gestational hypertension Pre-eclampsia and eclampsia Respiratory disease Asthma Respiratory infection Bacterial infections Viral infections Tuberculosis Gastrointestinal disease Hyperemesis gravidarum Inflammatory bowel disease Diabetes Gestational diabetes Management Pregnancy in women with established diabetes Endocrine disease Thyroid disease Iodine deficiency Hypothyroidism Hyperthyroidism Post-partum thyroiditis Pituitary disease Prolactinoma Diabetes insipidus Sheehan’s syndrome Parathyroid disease Primary hyperparathyroidism Familial hypocalciuric hypercalcaemia Adrenal disease Human immunodeficiency virus infection Inflammatory rheumatic disease Rheumatoid arthritis Systemic sclerosis Systemic lupus erythematosus Anti-phospholipid syndrome Cardiac disease Congenital heart disease Valvular heart disease Myocardial infarction Aortic dissection Peripartum cardiomyopathy Dilated cardiomyopathy Renal disease Renal tract infection Acute kidney injury Glomerular disease Chronic kidney disease Renal replacement therapy Renal transplant recipients Liver disease Acute fatty liver of pregnancy HELLP syndrome Obstetric cholestasis Viral hepatitis Neurological disease Epilepsy Idiopathic intracranial hypertension Migraine Stroke Psychiatric disorders Haematological disease Anaemia Rhesus disease Thrombocytopenia Venous thromboembolism Further information Websites 31 Adolescent and transition medicine Transition from paediatric to adult health services Effectiveness of transition planning General principles of transition planning Principles of prescribing during transition A systematic approach to transition planning When should transition happen? Functional anatomy and physiology Endocrine changes Physical changes Cognitive and behavioural changes Investigations Clinical assessment Presenting problems in transition medicine Problems with adherence High-risk behaviour Unplanned pregnancy Clinical presentations Neurological disease Epilepsy Cerebral palsy Muscular dystrophy Respiratory disease Cystic fibrosis Cardiovascular disease Congenital heart disease Hypertrophic obstructive cardiomyopathy Oncology Renal disease Organ transplantation Diabetes Gastrointestinal disease Inflammatory bowel disease Rheumatology and bone disease Juvenile idiopathic arthritis Glucocorticoid-induced osteoporosis Osteogenesis imperfecta Hypophosphataemic rickets Summary Further information Books and journal articles Websites 32 Ageing and disease Comprehensive Geriatric Assessment Demography Functional anatomy and physiology Biology of ageing Physiological changes of ageing Frailty and multimorbidity Investigations Comprehensive Geriatric Assessment Decisions about investigation and treatment The views of the patient and family The patient’s general health Will the investigation alter management? Will management benefit the patient? Advance directives Presenting problems in geriatric medicine Characteristics of presenting problems in old age Late presentation Atypical presentation Acute illness and changes in function Multiple pathology Approach to presenting problems in old age Falls Acute illness Blackouts Mechanical and recurrent falls Prevention of falls and fractures Dizziness Delirium Urinary incontinence Prescribing and deprescribing Appropriate prescribing and deprescribing Other problems in old age Rehabilitation The rehabilitation process Multidisciplinary team working Rehabilitation outcomes Further information Websites 33 Oncology Clinical examination of the cancer patient The 10 hallmarks of cancer 1. Genome instability and mutation 2. Resisting cell death Apoptosis Autophagy Necrosis 3. Sustaining proliferative signalling The cell cycle Cell cycle regulation Stimulation of the cell cycle 4. Evading growth suppressors 5. Enabling replicative immortality 6. Inducing angiogenesis 7. Activating invasion and metastasis 8. Reprogramming energy metabolism 9. Tumour-promoting inflammation 10. Evading immune destruction Environmental and genetic determinants of cancer Environmental factors Genetic factors Investigations Histology Light microscopy Immunohistochemistry Electron microscopy Cytogenetic analysis Imaging Ultrasound Computed tomography Magnetic resonance imaging Positron emission tomography Biochemical markers Presenting problems in oncology Palpable mass Weight loss and fever Thromboembolism Ectopic hormone production Neurological paraneoplastic syndromes Cutaneous manifestations of cancer Emergency complications of cancer Spinal cord compression Clinical features Management Superior vena cava obstruction Clinical features Investigations and management Hypercalcaemia Clinical features Investigations and management Neutropenic fever Clinical features Investigations and management Tumour lysis syndrome Clinical features Investigations and management Metastatic disease Brain metastases Clinical features Investigations and management Lung metastases Liver metastases Bone metastases Clinical features Investigations and management Malignant pleural effusion Investigations and management Therapeutics in oncology Surgical treatment Biopsy Excision Palliation Systemic chemotherapy Combination therapy Adverse effects Radiation therapy Adverse effects Hormone therapy Immunotherapy Biological therapies Gefitinib/erlotinib Imatinib Bevacizumab Trastuzumab Evaluation of treatment Late toxicity of therapy Specific cancers Breast cancer Pathogenesis Clinical features Investigations Management Ovarian cancer Pathogenesis Investigations Management Endometrial cancer Pathogenesis Investigations Management Cervical cancer Pathogenesis Investigations Management Head and neck tumours Pathogenesis Investigations Management Carcinoma of unknown origin Investigations Management Multidisciplinary teams Further information Books and journal articles Websites 34 Pain and palliative care Pain Functional anatomy and physiology Peripheral nerves Spinal cord Central processing of pain Sensitisation Peripheral sensitisation Central sensitisation Genetic determinants of pain perception Investigations Magnetic resonance imaging Blood tests Quantitative sensory testing Nerve conduction studies Nerve blocks Pain scoring systems Principles of management Clinical history Biopsychosocial assessment Examination Interventions Supported self-management Physical therapies Pharmacological therapies Non-opioid analgesics Paracetamol Non-steroidal anti-inflammatory drugs Topical analgesics Adjuvant analgesics Opioid analgesics Psychological therapies Stimulation therapies Complementary and alternative therapies Nerve blocks and nerve ablation Chronic pain syndromes Neuropathic pain Complex regional pain syndrome Phantom limb pain Chronic widespread pain Joint hypermobility syndrome Palliative care Presenting problems in palliative care Pain Clinical assessment Management: pharmacological treatments Opioids Opioid-related adverse effects Adjuvant analgesics Management: non-pharmacological treatments Neurodestructive interventions Radiotherapy Physiotherapy Psychological techniques Stimulation therapies Complementary and alternative therapies Breathlessness Cough Nausea and vomiting Gastrointestinal obstruction Weight loss Anxiety and depression Delirium and agitation Dehydration Death and dying Planning for dying Diagnosing dying Management of dying Ethical considerations Capacity and advance directives Euthanasia Further information Websites Journal articles 35 Laboratory reference ranges Notes on the international system of units (SI units) Examples of basic SI units Examples of decimal multiples and submultiples of SI units Exceptions to the use of SI units Laboratory reference ranges in adults Laboratory reference ranges in childhood and adolescence Laboratory reference ranges in pregnancy Further information Index A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
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