Diagnosis and Treatment in Internal Medicine (Oct 16, 2018)_(019956874X)_(Oxford University Press)

Cover
Half title
Diagnosis and Treatment in Internal Medicine
Copyright
Preface
Contents
Normal values
Abbreviations
Contributors
Plates
Part 1 The Approach to the Patient
	1 Diagnostic reasoning
	2 Dealing with uncertainty
	3 Taking the history
	4 The physical examination
	5 The psychological examination
	6 Confidentiality
	7 Consent
Part 2 Assessment of Symptoms and Presenting Problems
	8 Palpitation
	9 Acute chest pain
	10 Chronic chest pain
		Differential diagnosis
		Table 10.1 Differential diagnosis of chronic chest pain
	11 Hypotension
	12 Acute breathlessness
	13 Chronic breathlessness
	14 Peripheral oedema
	15 Murmur
	16 Cough
	17 Wheeze
	18 Haemoptysis
	19 Pleural effusion
	20 Chylothorax
	21 Difficulty swallowing
	22 Haematemesis
	23 Acute abdominal pain
	24 Chronic abdominal pain
	25 Dyspepsia
	26 Abdominal mass
	27 Constipation
	28 Acute diarrhoea
	29 Chronic diarrhoea
	30 Rectal bleeding
	31 Jaundice
	32 Ascites
	33 Chylous ascites
	34 Swelling in the neck
	35 Splenomegaly and other disorders of the spleen
	36 Lymphadenopathy
	37 Anaemia
	38 Bruising and bleeding
	39 Transient loss of consciousness
	40 Coma
	41 Delirium (acute confusional state)
	42 Seizures
	43 Difficulty speaking (including dysphasia and dysarthria)
	44 Weakness
	45 Tremor and other abnormal movements
	46 Gait disorders
	47 Sensory loss
	48 Headache
	49 Loss of vision
	50 The red eye
	51 Hearing loss
	52 Facial pain
	53 Dizziness
	54 Disorders of sleep
	55 Haematuria
	56 Oliguria and anuria
	57 Polyuria
	58 Dysuria
	59 Urinary incontinence
	60 Faecal incontinence
	61 Vaginal discharge
	62 Joint pain
		Definition of the symptom
		Differential diagnosis
		Context
		Approach to diagnosis
		Table 62.1 Causes of acute arthralgia in primary andsecondary care
		Key factors in the history
			Demographics:
			previoushistory of similar attacks
			A history of current or recent infection: This is important, as it mayindicate
			The time course of symptom onset:
				develop over a matter of hours
			The number of joints involved and the pattern of involvement:
				Determiningthe number of joints involved
				the pattern of involvement
				some conditionshave a predilection for certain joints (e.g. gout and
				Patients withrheumatoid arthritis will often have pain involving
				Thosewith ankylosing spondylitis may report
			Morning stiffness
			The presence of systemic upset:
				Other risk factors for infectionshould also be screened for, notably
			Systemic enquiry:
				This should include asking about
			Past medical history:
				A history ofhaemophilia, von Willebrand’s disease, or anticoagulation raisesthe possibility of
				a pasthistory of TB should prompt consideration of
		Key features on examination
			Involvement of other joints:
			Involvement of other systems:
		Specific clues to the diagnosis
		Key diagnostic tests
		Table 62.2 Specific clues to the diagnosis of acute joint pain
		Table 62.3 Investigations ordered for the diagnosis of acute jointpain, with their justifications
		Introduction to therapy
		Prognosis
	63 Muscle pain
	64 Low back pain
	65 Painful leg
	66 Leg ulcers
	67 Limb ischaemia
	68 Rashes
	69 Blistering rashes
	70 Photosensitive rashes
	71 Itching
	72 Lumps and bumps
	73 Falls
	74 Immobility (‘Off legs’)
	75 Suspected anaphylaxis
	76 Fever
	77 Hyperthermia
	78 Hypothermia
	79 Fatigue
	80 Unintentional weight loss
	81 Obesity: differential diagnosis
	82 Self-​harm
	83 Alcohol intoxication
	84 Intravenous drug use
Part 3 Cardiovascular disorders
	85 Normal function of the cardiovascular system
	86 Risk factors for cardiovascular disease
	87 Diagnosis and investigation in suspected heart disease
	88 Congenital heart disease in adults
	89 Chronic stable angina
	90 Acute coronary syndromes
	91 Acute heart failure
	92 Chronic heart failure
	93 Aortic stenosis
	94 Aortic regurgitation
	95 Mitral regurgitation
	96 Miscellaneous valvar pathology: Mitral stenosis, pulmonary stenosis, and tricuspid regurgitation
	97 Percutaneous coronary intervention
	98 Heart surgery
	99 Circulatory support therapy
	100 Pulmonary hypertension
	101 Venous thrombosis and pulmonary embolism
	102 Aortic aneurysm
	103 Aortic dissection
	104 Peripheral arterial disease
	105 Raynaud’s phenomenon
	106 Heart muscle disease (cardiomyopathy)
	107 Tumours and the heart
	108 Cardiac infection
	109 Pericardial disease
	110 Extrasystoles
	111 Sinus tachycardia
	112 Focal (ectopic) atrial tachycardia
	113 Multifocal atrial tachycardia
	114 Atrioventricular nodal re-entrant tachycardia
	115 Atrioventricular re-​entrant tachycardia
	116 Atrial fibrillation
	117 Atrial flutter
	118 Ventricular tachyarrhythmias: Ventricular tachycardia and ventricular fibrillation
	119 Bradyarrhythmias
	120 Sudden cardiac death
	121 Cardiac device therapy
	122 Drug-​induced cardiovascular disease
	123 Psychological management of coronary heart disease
	124 Treatment of terminal cardiovascular disease
Part 4 Respiratory disorders
	125 Normal respiratory function
	126 Diagnosis in suspected respiratory disease
	127 Investigation in respiratory disease
		Introduction
			Figure 127.1 The anatomic sites that different respiratory tests evaluate.
		Arterial blood gases and respiratory failure
		Investigations of pulmonary function
		Table 127.1 Suggested investigations to further evaluate respiratory symptoms
		Table 127.2 Simple lung function tests in respiratory disease
		Figure 127.2 (A1) Volume– time curve; (A2) lung volumes in respiratory disease; (B) flow– volume loop; FEV1, forced expiratory volume in 1 second;FRC, functional residual capacity; IC, inspiratory capacity; RV, residual volume; TLC, total lung capacity; VC, vital capacity; VT, tidal volume; V̇E max,maximum airflow on expiration; V̇I max, maximum airflow on inhalation.
		Figure 127.3 (A) An algorithm for interpreting spirometry; (B) an algorithm for interpreting static lung volume measurements; EP, extra- pulmonary;FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; RV, residual volume; TLC, total lung capacity.
	128 Upper respiratory tract infections, including influenza
	129 Pneumonia
		Definition of the disease
		Aetiology of the disease
			Immunocompromised patients are also susceptible to
			The pathogens that cause HAP are
			within 5 days of admission.In that instance, the most commonly isolated organisms are
			As the length of inpatient stay increases,
				become more prominent
			Inlate- onset HAP (after 5 days of admission)
				shouldbe considered
			Less common causes of HAP include
			VAP is mostfrequently caused by
		Typical symptoms of the disease,and less common symptoms
			onset
			will vary depending upon
			The constitutional symptoms include
			Respiratory symptoms include
			In some cases,where lower lobe pneumonia is present, the patient may describe
			Historically, CAP was divided into
			Extra- pulmonary manifestations are
			Elderly patients more frequently present with
			Immunocompromised patients are susceptible to
				presentationwill depend on
				Pneumocystisjirovecii pneumonia
					onset
					Haemoptysis andextra- pulmonary manifestations, such as lymphadenopathy, are
			VAP
				tends to occur in
				Such patients maydevelop
		Demographics of the disease
		Approach to diagnosing the disease
			play an important role in determining the diagnosisand differential diagnosis
			will help differentiate CAP from HAP
			Table 129.1 Clinical features that may provide clues to theunderlying causative pathogen in different types of pneumonia
			In the case of immunosuppressed individuals
				may make it easier to ascertainthe likely cause
				HIV- positive patients are at risk of
				In thetransplant setting
					gives a clue to the likely pathogen
					may also be relevant
			For HAPs
				the likelypathogens isolated depend upon
				In earlyonset HAP (between
					the pathogenisolated is
				as the inpatient stay lengthens
		Other diagnoses that should be considered
			These include
			Other infections such as
			can mimic theclinical presentation of pneumonia and must be considered in thedifferential diagnosis
		‘Gold- standard’ diagnostic test
			pneumonia is defined as
			the gold- standard diagnostic test for pneumonia is
	130 Tuberculosis
	131 Pneumothorax
		Aetiology of the disease
		Typical symptoms of the disease, andless common symptoms
		‘Gold- standard’ diagnostic test
		Acceptable diagnostic alternatives tothe gold standard
		Prognosis and how to estimate it
		Treatment and its effectiveness
			Figure 131.1 Management of spontaneous pneumothorax; BTS, British Thoracic Society; CXR, chest X- ray; OPD, outpatient department.Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65(Suppl 2):ii18- ii31. Available online at: http:// www.brit- thoracic.org.uk/ clinical- information/ pleural- disease.aspx
		Management
			Observation alone
			Supplemental oxygen
			Simple aspiration
			Intercostal chest tube drainage
			Chemical pleurodesis
			Indications for surgical intervention
		Further Reading
	132 Cystic fibrosis
	133 Asthma
		Demographics of the disease
		Natural history and complications ofthe disease
		‘Gold- standard’ diagnostic test
		Table 133.1 The A to E of airway disease
		Acceptable diagnostic alternativesto the gold standard
		Other relevant investigations
		Prognosis and how to estimate it
		Treatment and its effectiveness
			Non- pharmacological treatmentof chronic asthma
			Pharmacological treatmentof chronic asthma
			Stepwise incremental management
			Single- inhaler therapy
			Small airways targeted treatment
			Anti- IgE therapy
			Antifungal therapy
			Treatment of premenstrual/ menstrual asthma
		Pharmacological treatmentof chronic asthma
	134 Chronic obstructive pulmonary disease
	135 Respiratory failure
	136 Obstructive sleep apnoea
	137 Bronchiectasis
	138 Sarcoidosis and other granulomatous lung disease
	139 Interstitial lung disease
	140 Pulmonary vasculitis
	141 Lung cancer (including management of an isolated lung lesion)
	142 Occupational lung disease
	143 Pleural infection and malignancy
	144 Drug-​induced lung disease
	145 Psychology in respiratory disease, including dysfunctional breathing
	146 Terminal care in respiratory illness
Part 5 Intensive care medicine
	147 Critical illness
	148 Role of the intensive care unit
	149 ICU treatment of respiratory failure
	150 ICU treatment of cardiovascular failure
	151 ICU treatment of
	152 ICU treatment of sepsis and septic shock
	153 Terminal care in the intensive care unit
	154 Brain death
Part 6 Disorders of the kidney and urinary tract, and electrolyte and metabolic disorders
	155 Normal renal function
	156 Diagnosis in suspected renal disease
	157 Investigation in renal disease
	158 Urinary tract infection
	159 Glomerulonephritis
	160 Interstitial renal disease
	161 Nephrotic syndrome
	162 Acute
	163 Chronic kidney disease
	164 Diabetic renal disease
	165 Urinary tract obstruction
	166 Renal calculi
	167 Renal and bladder cancer
	168 Renal replacement therapy
	169 Inherited renal diseases
	170 The kidney in systemic disease
	171 Renal vascular disease
	172 Management of terminal care in renal disease
	173 Disorders of plasma potassium
	174 Disorders of plasma sodium
	175 Disorders of plasma calcium
	176 Disorders of plasma phosphate
	177 Disorders of plasma magnesium
	178 Disorders of acid–​base balance
	179 Porphyria
	180 Aminoacidopathies, urea cycle disorders, and organic acidurias
	181 Amyloidosis
Part 7 Diabetes mellitus and endocrine disorders
	182 Normal function of the endocrine system
	183 Diagnosis and investigation in endocrine disorders
	184 Diabetes mellitus
	185 Hypoglycaemia
	186 Thyroid disease
	187 Primary hyperparathyroidism
	188 Adrenal disease
	189 Cushing syndrome
	190 Short stature
	191 Infertility
	192 Pituitary disorders: Prolactinomas, acromegaly, and pituitary apoplexy
Part 8 Gastrointestinal disorders
	193 Normal gastrointestinal function
	194 Diagnosis in suspected gastrointestinal disease
	195 Investigation in gastrointestinal disease
	196 Immunology and genetics in gastrointestinal and hepatic medicine
	197 Gastrointestinal infections
		Typical symptoms of the disease, andless common symptoms
		Demographics of the disease
		Natural history and complications ofthe disease
		Approach to diagnosing the disease
		Other relevant investigations
		Prognosis and how to estimate it
		Treatment and its effectiveness
	198 Benign oesophageal disease
		Definition of the disease
		Aetiology of the disease
		Typical symptoms of the disease, andless common symptoms
		Natural history and complications ofthe disease
		Approach to diagnosing the disease
		Other diagnoses that should be considered
	199 Peptic ulcer disease
		Definition of the disease
		Aetiology of the disease
		Typical symptoms of the disease, andless common symptoms
		Demographics of the disease
		Natural history and complications ofthe disease
		Approach to diagnosing the disease
		Prognosis and how to estimate it
		Treatment and its effectiveness
	200 Gall bladder disease
	201 Pancreatic disease
	202 Malabsorption
	203 Inflammatory bowel disease
	204 Gastrointestinal tumours
	205 Functional gastrointestinal diseases
	206 Psychiatry in gastrointestinal medicine
Part 9 Disorders of the liver
	207 Normal hepatic function
	208 Investigation in liver disease
	209 Acute liver failure
	210 Chronic liver failure
	211 Alcoholic liver disease
	212 Viral hepatitis
	213 Autoimmune hepatitis
	214 Genetic liver disease
	215 Drug-​induced liver disease
	216 Miscellaneous liver diseases
	217 The liver in systemic disease
	218 Liver cancer
Part 10 Neurological disorders
	219 Normal neurological function
	220 Diagnosis in suspected neurological disease
	221 Investigation in neurological disease
	222 Demographics of neurological disease
	223 Neurogenetic disease
	224 Neurocutaneous syndromes
	225 Congenital neurological disorders
	226 Epilepsy
	227 Stroke
		Definition of stroke
		Demographics of stroke
		Ischaemic stroke
			Box 227.2 Connective tissue disorders associatedwith carotid artery dissection
			Hereditary disorders
			Table 227.1 Cerebral vasculitides
			Signs and symptoms of anterior circulation strokes
			Box 227.4 Ischaemic stroke risk factors
			Signs and symptoms of posterior circulation strokes
			Haemorrhagic strokes
			Secondary prevention
			Anticoagulants
			Box 227.5 Typical stroke presentations
		Prevention and management of complications
	228 Dementia
	229 Neurological infection
	230 Disorders of movement
	231 Multiple sclerosis
	232 Motor neuron disease
	233 Spinal cord disease
	234 Neuropathy
	235 Myopathy
	236 Vasculitis in neurology
	237 Neurological tumours
	238 Non-​metastatic neurological manifestations of malignancy
	239 Neurosurgery
	240 Drug-​induced neurological disease
	241 Functional and dissociative disorders in neurology
	242 Palliative care in neurological disease
Part 11 Disorders of the skin
	243 Normal skin function
	244 Approach to diagnosing skin disease
	245 Investigation in skin disease
	246 Skin infection and infestation
	247 Cutaneous vasculitis
	248 Acne
	249 Psoriasis
	250 Eczema
	251 Urticaria
	252 Bullous disorders
	253 Hair disorders
	254 Nail disorders
	255 Mucosal disease
	256 Genital disease
	257 Polymorphic light eruption and actinic prurigo
	258 Disorders of pigmentation
	259 Skin cancer
	260 Skin markers of internal medicine
	261 Drug-​induced skin disease
	262 Psychocutaneous medicine
Part 12 Disorders of the musculoskeletal system
	263 Normal function of the musculoskeletal system
	264 Diagnosis in suspected rheumatological disease
	265 Investigation in rheumatological disease
	266 Osteoarthritis
	267 Rheumatoid arthritis
	268 Seronegative spondyloarthropathy
	269 Systemic lupus erythematosus
	270 Crystal arthropathy
	271 Infection of joints and bones
	272 Vasculitis
	273 Osteomalacia
	274 Paget’s disease of bone
	275 Osteoporosis and fragility fracture
	276 Genetic bone and joint disease
Part 13 Haematological disorders
	277 Normal blood function
	278 Diagnosis and investigation in haematology
	279 Deficiency anaemias
	280 Haemolytic anaemia
	281 Normal platelet function
	282 Platelet disorders
	283 Normal haemostatic function
	284 Bleeding disorders
	285 Prothrombotic conditions
	286 Acute leukaemia
	287 Chronic leukaemia
	288 Myelodysplasia
	289 Lymphoma
	290 Multiple myeloma and related conditions
	291 Myeloproliferative disorders
	292 Terminal care in haematological disease
Part 14 Disorders of the immune system
	293 Functions of the immune system
	294 Clinical features and diagnosis of immunological disease
	295 Neutrophil abnormalities
	296 Human immunodeficiency virus infection
		Table 296.1 Principal complications of untreated HIV infection
		Box 296.1 Clinical indicator diseases for adult HIVinfection; patients with the following specific indicatorconditions should be routinely offered an HIV test
		Principles of treatment
		Immune reconstitution inflammatory syndrome
	297 Antibody deficiencies
	298 Combined T-​ and B-​cell immunodeficiencies
	299 Complement deficiencies
	300 Hypersensitivity diseases
	301 Immunological support
	302 Immunosuppressive therapy and therapeutic monoclonal antibodies
Part 15 Infectious diseases
	303 Defences against infection
	304 Nature and demographics: Epidemiology of infective organisms
	305 Diagnosis in suspected infective disease: The history and examination
	306 Investigation in infection
	307 Treatment of infection
	308 Viral infection
	309 Sepsis
	310 Bacterial infection
	311 Mycobacterial infection other than tuberculosis
	312 Spirochaetal infection (non-syphilis)
	313 Syphilis
	314 Rickettsial infection
	315 Fungal infection
	316 Protozoal infection: Gut organisms
	317 Protozoal infection: Malaria
	318 Worm infection (including hydatid disease)
	319 Prion disease
	320 Sexually transmitted disease (gonorrhoea)
Part 16 Cancers
	321 Cancers related to infection
	322 Principles of oncogenesis
	323 Presentations in suspected cancer
	324 Diagnosis and staging of cancer
	325 Treatment of cancer
	326 Prostate cancer
	327 Breast cancer
	328 Ovarian and testicular cancer
	329 Symptom control in cancer
	330 Dying from cancer
Part 17 Dietary, lifestyle, and environmental factors affecting health
	331 Normal nutritional function
	332 Starvation and malnutrition
	333 Vitamin deficiencies
	334 Nutritional support in the critically ill
	335 Poor diets
	336 Obesity: epidemiology, prevention and management
	337 Physical activity and its role in disease prevention
	338 Smoking
	339 Alcohol
	340 Environmental radiation
	341 Air pollution
	342 Non-​prescription drugs
Part 18 Prevention of disease
	343 Prevention of cardiovascular disease
	344 Prevention of respiratory disease
	345 Prevention of kidney disease
	346 Prevention of gastrointestinal disease
	347 Prevention of neurological disease
	348 Prevention of cerebrovascular disease
	349 Prevention of infection
	350 Prevention of cancer
Part 19 Screening for disease
	351 Screening for cardiovascular disease
	352 Screening for respiratory disease
	353 Screening for kidney disease
	354 Screening for gastrointestinal disease
	355 Screening for neurological disease
	356 Screening for cancer
Index