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BECOME
THE
DOCTOR
YOU
WANTTOBE
INTERNATIONAL
OXFORD
EDITION
HANDBOOK
CLINICAL
MEDICINE
Wilkinson
lan
B
Peter
.
Hateley
Tim
Raine
Dearbhla
Kelly
Kate
lain
OF
Wiles
McGurgan
sale
EU
Americas
.
Canada
Not
in
China
.
for
UK
.
.
.
ALGrawany
OXFORD HANDBOOK OF
CLINICAL
MEDICINE
ELEVENTH EDITION
Ian B. Wilkinson
Tim Raine
Kate Wiles
Peter Hateley
Dearbhla Kelly
Iain McGurgan
Oxford University Press, Great Clarendon Street, Oxford
OX2 6DP
Oxford University Press is a department of the University of Oxford. It furthers the
University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in
the UK and in certain other countries.
Published in the United States by Oxford University Press Inc., New York
© Oxford University Press,
2024
The moral rights of the authors have been asserted
Database right Oxford University Press (maker)
First published
(RA Hope & JM Longmore) (JM Longmore & IB Wilkinson) (IB Wilkinson, T Raine & K Wiles)
Second edition
Third edition
Fourth edition
Ninth edition
1985
Fifth edition
1989
Sixth edition
1993
Seventh edition
1998
Eighth edition
2001
Tenth edition
2004
Eleventh edition
2007
2010
2014
2017
2024
Translations:
Chinese French Hungarian Polish Russian
Czech German Indonesian Portuguese Spanish
Estonian Greek Italian Romanian
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
or under terms agreed with the appropriate reprographics rights organization.
Enquiries concerning reproduction outside the scope of the above should be sent
to the Rights Department, Oxford University Press, at the address above.
You must not circulate this book in any other binding or cover
and you must impose the same condition on any acquirer.
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number:
ISBN
978–0–19–884401–3
2023944066
Printed in Italy by L.E.G.O. S.p.A. Lavis (TN)
Gender
Where guidelines apply to pregnancy and childbirth, the word ‘women’ should
be assumed to cover all people who can get pregnant and would need access to
healthcare services in this capacity. Their gender identity should be respected
at the point of care.
Drugs
Except where otherwise stated, recommendations are for the non-pregnant adult
who is not breastfeeding and who has reasonable renal and hepatic function.
We have made every eort to check this text, but it is still possible that drug or
other errors have been missed.
OUP
makes no representation, express or implied,
that doses are correct. Readers are urged to check with the most up to date product information, codes of conduct, and safety regulations. The authors and the
publishers do not accept responsibility or legal liability for any errors in the text,
or for the misuse or misapplication of material in this work.
For updates/corrections, see http://www.oup.co.uk/academic/series/oxhmed/updates/
Contents
ALGrawany
Each chapter’s contents are detailed on its first page
Prefaces to the eleventh and first editions iv
Acknowledgements v
Symbols and abbreviations vi
1 Thinking about medicine
2 History and examination
3 Cardiovascular medicine
4 Chest medicine
5 Endocrinology
6 Gastroenterology
7 Kidney medicine
8 Haematology
9 Infectious diseases
10 Neurology
11 Oncology and palliative care
12 Rheumatology
13 Surgery
14 Clinical chemistry
15 Eponymous syndromes
16 Radiology
17 Reference intervals, etc.
18 Practical procedures
19 Emergencies
20 References
Index
849
Early warning score
Cardiac arrest
876
878
0
24
84
152
196
236
288
318
374
440
514
534
562
654
686
702
734
742
762
834
Preface to the eleventh edition
https://t.me/med1917
I must sincerely apologize for the delay in publishing the eleventh edition of the
handbook, but to quote Harold MacMillan: ‘Events, dear boy, events.’ COVID hit
midway through our programme of work on this edition, and we all devoted our
time and eort to clinical duties, bringing work on the book to a complete halt.
COVID has had a profound eect on all of us, both personally and professionally—
who would have thought that we would be conducting consultations remotely, all
know so much about a new virus, or have received our first mRNA vaccination.
Pandemic over, we regrouped, doubled our eorts, and completed the book, aided
in no small part by the endless patience and assistance of Kate and Elizabeth
at OUP.
The formula is the same unique blend of fact, explanation, context- setting, and
guidance that generations of medical students have enjoyed, but brought right upto- date— including SARS viruses! We have tried to provide a greater emphasis on
what really matters, whilst retaining a very personal perspective and creating a
little more white space. Tim, Kate, and I have been joined by three new authors for
this edition, providing a broad range of expertise including Clinical Pharmacology,
Hepatology, Nephrology, Neurology, and General Practice as well as new ideas. As
always, we greatly value the feedback from our junior and senior readers, and long
may it continue.
I do hope that you will enjoy this edition of the OHCM as much as previous editions
and that the twelfth edition is not as long in gestation as this one was.
IBW,
2024
Preface to the first edition
We wrote this book not because we know so much, but because we know we remember so little . . . the problem is not simply the quantity of information, but the
diversity of places from which it is dispensed. Trailing eagerly behind the surgeon,
the student is admonished never to forget alcohol withdrawal as a cause of postoperative confusion. The scrap of paper on which this is written spends a month in
the pocket before being lost for ever in the laundry. At dierent times, and in inconvenient places, a number of other causes may be presented to the student. Not
only are these causes and aphorisms never brought together, but when, as a surgical house ocer, the former student faces a confused patient, none is to hand.
We aim to encourage the doctor to enjoy his patients: in doing so we believe he
will prosper in the practice of medicine. For a long time now, house ocers have
been encouraged to adopt monstrous proportions in order to straddle the diverse
pinnacles of clinical science and clinical experience. We hope that this book will
make this endeavour a little easier by moving a cumulative memory burden from
the mind into the pocket, and by removing some of the fears that are naturally felt
when starting a career in medicine, thereby freely allowing the doctor’s clinical
acumen to grow by the slow accretion of many, many days and nights.
RA Hope and JM Longmore,
1985
ALGrawany
https://t.me/med1917
Acknowledgements
Heart- felt thanks to our advisers on specific sections— each is acknowledged on the
chapter’s first page. Our thanks to our junior readers, Emma Flint, Adam Komorowski,
Oliver Mowforth, Gemma Smith, Christina Taylor, and Tom Weatherby. We especially thank all our mentors and teachers, and patients who provide our inspiration
and remind us that one never stops learning. We acknowledge the Department of
Radiology at both the Leeds Teaching Hospitals NHS Trust and the Norfolk and
Norwich University Hospital for their kind help in providing many images, particularly
Dr Edmund Godfrey, whose tireless hunt for perfect images has improved so many
chapters.
Readers’ comments These have formed a vital part of our endeavour to provide
an accurate, comprehensive, and up- to- date text. We sincerely thank the many students, doctors, and other health professionals who have found the time and the
generosity to write to us on our Reader’s Comments Cards, in editions past, or, in
more recent times, via the web. These have now become so numerous for past editions that they cannot all be listed. See http:// www.oup.com/ uk/ acade mic/ ser ies/
oxh med/ links for a full list, and our very heart- felt tokens of thanks.
3rd- party web addresses We disclaim any responsibility for 3rd- party content.
BNF
Symbols and abbreviations
https://t.me/med1917
.............. this fact or idea is important
. . . . . . . . . . . don’t dawdle!— prompt action saves lives
. . . . . . . . . . . . warning
1
................ reference
: . . . . . . . . . . male- to- female ratio. := 2:1 means twice
as common in males
. . . . . . . . . . . . . . therefore
. . . . . . . . . . . . . . because of
~ . . . . . . . . . . . . . . approximately
≈
. . . . . . . . . . . . . . approximately equal to
– ve
. . . . . . . . . . . . negative
+ ve
. . . . . . . . . . . positive
>
.. ... .. .. ... .. greater than
<
.. ... .. .. ... .. less than
. . . . . . . . . . . . increased or decreased
. . . . . . . . . . . . . leading to
. . . . . . . . . . . normal (eg serum level)
1
° . . . . . . . . . . . . primary
2
° .. .. .. .. ... secondary
. . . . . . . . . . . . . diagnosis
. . . . . . . . . . . . dierential diagnosis
A
. . . . . . . . . . . . aortic component of the 2nd heart sound
2
Ab .. .. .. ... . antibody
ABC
. . . . . . . . . airway, breathing, and circulation
ABG
. . . . . . . . . arterial blood gas: PaO2, PaCO2, pH, HCO
ABPA
. . . . . . . allergic bronchopulmonary aspergillosis
ACE-
i . . . . . . . angiotensin- converting enzyme inhibitor
ACR
. . . . . . . . . albumin to creatinine ratio (mg/ mmol)
ACS
. . . . . . . . . acute coronary syndrome
ACTH
. . . . . . . adrenocorticotropic hormone
ADH
. . . . . . . . . antidiuretic hormone
AF
. . . . . . . . . . . atrial fibrillation
AFB
. . . . . . . . . acid- fast bacillus
Ag . . . . . . . . . . antigen
AIDS
.. .. .. . acquired immunodeficiency syndrome
AKI
.......... acute kidney injury
ALL
.. .. .. .. . acute lymphoblastic leukaemia
ALP
. . . . . . . . . alkaline phosphatase
AMA
. . . . . . . . antimitochondrial antibody
AMP
. . . . . . . . adenosine monophosphate
ANA
.. .. .. .. antinuclear antibody
ANCA
.. .. . . antineutrophil cytoplasmic antibody
APTT
. . . . . . . activated partial thromboplastin time
AR
. . . . . . . . . . . aortic regurgitation
ARA
. . . . . . . . . angiotensin receptor antagonist (blocker)
ARDS
. . . . . . . acute respiratory distress syndrome
ART
. . . . . . . . . antiretroviral therapy
AS
. . . . . . . . . . . aortic stenosis
ASD
. . . . . . . . . atrial septal defect
AST
. . . . . . . . . aspartate transaminase
ATN
. . . . . . . . . acute tubular necrosis
ATP
.. . . . . .. . adenosine triphosphate
AV
. . . . . . . . . . . atrioventricular
AVM
. . . . . . . . arteriovenous malformation(s)
AXR
. . . . . . . . . abdominal x- ray (plain)
BAL
. . . . . . . . . bronchoalveolar lavage
BD
. . . . . . . . . . . bis die (Latin for twice a day)
.. . . . . . . . British National Formulary
BNP
. . . . . . . . . brain natriuretic peptide
BP
.. . . . . . . . . . blood pressure
BPH
. . . . . . . . . benign prostatic hyperplasia
bpm . . . . . . . beats per minute
ca . . . . . . . . . . . cancer
2+
Ca
. . . . . . . . calcium
CABG
. . . . . . . coronary artery bypass graft
c
AMP
. . . . . . cyclic adenosine monophosphate (
CAPD
. . . . . . . continuous ambulatory peritoneal dialysis
CCF
.. .. .. .. . congestive cardiac failure (ie left and right
heart failure)
CCU
. . . . . . . . . coronary care unit
CDT
.. . .. . . .. Clostridium difficile toxin
CHD
. . . . . . . . . coronary heart disease
CI
. . . . . . . . . . . . contraindication(s)
CK
.. . . . . . . . . . creatine (phospho)kinase
CKD
. . . . . . . . . chronic kidney disease
CLL
. . . . . . . . . . chronic lymphocytic leukaemia
CML
......... chronic myeloid leukaemia
CMV
. . . . . . . . cytomegalovirus
CNS
. . . . . . . . . central nervous system
COPD
. . . . . . . chronic obstructive pulmonary disease
CoV
.. .. . .. .. coronavirus
COVID- 19
. . . coronavirus disease
CPAP
. . . . . . . continuous positive airway pressure
CPR
. . . . . . . . . cardiopulmonary resuscitation
CRP
. . . . . . . . . c- reactive protein
CSF
.. ... .. .. cerebrospinal fluid
CT
.. .. . .. .. .. computed tomography
CV
. . . . . . . . . . . cardiovascular
CVA
. . . . . . . . . cerebrovascular accident
CVD
. . . . . . . . . cardiovascular disease
CVP
. . . . . . . . . central venous pressure
2019
CVS
. . . . . . . . . cardiovascular system
CXR
. . . . . . . . . chest x- ray
d . . . . . . . . . . . . . . day(s); also expressed as / 7; months are /
DC
. . . . . . . . . . . direct current
DIC
. . . . . . . . . . disseminated intravascular coagulation
DIP
. . . . . . . . . . distal interphalangeal
dL . . . . . . . . . . . decilitre
DM
.. . . . . . . . . diabetes mellitus
DOAC
. . . . . . . direct oral anticoagulant
DU
. . . . . . . . . . . duodenal ulcer
D&V
. . . . . . . . . diarrhoea and vomiting
DVT
. . . . . . . . . deep venous thrombosis
EBV
. . . . . . . . . Epstein– Barr virus
ECG
.. . . . . .. . electrocardiogram
Echo
.. .. . .. . echocardiogram
EDTA
.. . .. . . ethylene diamine tetra- acetic acid
(anticoagulant coating, eg in
EEG
.. .. . .. .. electroencephalogram
e
GFR
. . . . . . . estimated glomerular filtration rate (in
mL/ min/ 1.73m2)
ELISA
. . . . . . enzyme- linked immunosorbent assay
EM
.. ... .. .. . electron microscope
EMG
.. . . . . .. electromyogram
ENT
. . . . . . . . . ear, nose, and throat
ERCP
.. . . . . . endoscopic retrograde
AMP
3
)
cholangiopancreatography
ESR
.. . . .. . . . erythrocyte sedimentation rate
ESRF
.. .. .. . end- stage renal failure
EUA
. . . . . . . . . examination under anaesthesia
FBC
.. . .. . . .. full blood count
FDP
.. . .. . . .. fibrin degradation products
FEV
.. .. .. .. forced expiratory volume in 1st second
1
FiO
.......... partial pressure of O2 in inspired air
2
FFP
. . . . . . . . . . fresh frozen plasma
FSH
.. . . .. . .. follicle- stimulating hormone
FVC
.. . .. . .. . forced vital capacity
g .. . . . . . . . . . . . . gram
G6PD
. . . . . . . glucose- 6- phosphate dehydrogenase
GA
. . . . . . . . . . . general anaesthetic
GCS
. . . . . . . . . Glasgow Coma Scale
GFR
.. . . . . . . . glomerular filtration rate
GGT
. . . . . . . . . gamma- glutamyl transferase
GH
. . . . . . . . . . . growth hormone
GI
. . . . . . . . . . . . gastrointestinal
GN
. . . . . . . . . . . glomerulonephritis
GP
. . . . . . . . . . . general practitioner
GPA
. . . . . . . . . granulomatosis with polyangiitis
(formerly Wegener’s granulomatosis)
GTN
. . . . . . . . . glyceryl trinitrate
GTT
.. . .. . .. . glucose tolerance test
GU(M)
. . . . . . genitourinary (medicine)
h . . . . . . . . . . . . . hour(s)
HAV
. . . . . . . . . hepatitis A virus
Hb . . . . . . . . . . . haemoglobin
Hb
A1c
..... glycated haemoglobin
HBsA
g .. . . hepatitis B surface antigen
HBV
. . . . . . . . . hepatitis B virus
HCC
. . . . . . . . . hepatocellular cancer
HCM
. . . . . . . . hypertrophic obstructive cardiomyopathy
Hct
.. . . . . .. . . haematocrit
HCV
. . . . . . . . . hepatitis C virus
HDV
. . . . . . . . . hepatitis D virus
HDL
. . . . . . . . . high- density lipoprotein
HHT
. . . . . . . . . hereditary haemorrhagic telangiectasia
HIV
.......... human immunodeficiency virus
HLA
. . . . . . . . . human leucocyte antigen
HONK
....... hyperosmolar non- ketotic (coma)
HPV
. . . . . . . . . human papillomavirus
HR
. . . . . . . . . . . heart rate
HRT
. . . . . . . . . hormone replacement therapy
HSP
. . . . . . . . . Henoch– Schönlein purpura
HSV
. . . . . . . . . herpes simplex virus
HUS
. . . . . . . . . haemolytic uraemic syndrome
IBD
. . . . . . . . . . inflammatory bowel disease
IBW
......... ideal body weight
ICD
. . . . . . . . . . implantable cardioverter defibrillator
ICP
. . . . . . . . . . intracranial pressure
ICU
. . . . . . . . . . intensive care unit
IE
. . . . . . . . . . . . infective endocarditis
I
g . . . . . . . . . . . . immunoglobulin
IHD
.......... ischaemic heart disease
IM
. . . . . . . . . . . intramuscular
INR
. . . . . . . . . . international normalized ratio
IP
. . . . . . . . . . . . interphalangeal
IPPV
. . . . . . . . intermittent positive pressure ventilation
ITP
. . . . . . . . . . idiopathic thrombocytopenic purpura
ITU
. . . . . . . . . . intensive therapy unit
IU
. . . . . . . . . . . . international unit
IV
. . . . . . . . . . . . intravenous
IVC
. . . . . . . . . . inferior vena cava
IVI
.. .. . .. .. . intravenous (infusion)
FBC
12
bottles)
IVU
OHCS
TSH
https://t.me/med1917
. . . . . . . . . . intravenous urography
JVP
.. .. .. .. . jugular venous pressure
+
K
.. . .. . . .. . . potassium
kg . . . . . . . . . . . kilogram
kPa .. . . . . . . kiloPascal
L . . . . . . . . . . . . . litre
LAD
. . . . . . . . . left axis deviation on the
LBBB
. . . . . . . left bundle branch block
LDH
. . . . . . . . . lactate dehydrogenase
LDL
.......... low- density lipoprotein
LFT
. . . . . . . . . . liver function test
LH
.. .. . .. .. . . luteinizing hormone
LIF
.. . .. . .. . . left iliac fossa
LMN
.. . .. . .. lower motor neuron
LMWH
. . . . . low- molecular- weight heparin
LOC
.. ... .. .. loss of consciousness
LP
............ lumbar puncture
LUQ
. . . . . . . . . left upper quadrant
LV
. . . . . . . . . . . . left ventricle of the heart
LVF
. . . . . . . . . . left ventricular failure
LVH
.. .. .. .. . left ventricular hypertrophy
MALT
. . . . . . . mucosa- associated lymphoid tissue
MAOI
. . . . . . . monoamine oxidase inhibitor
MAP
. . . . . . . . mean arterial pressure
MC&S
. . . . . . microscopy, culture, and sensitivity
mcg .. . . . . . microgram(s)
MCP
.. . .. . .. metacarpophalangeal
MCV
. . . . . . . . mean cell volume
MDMA
. . . . .3,4- methylenedioxymethamphetamine
ME
.. ... .. .. . myalgic encephalomyelitis
mg .. . .. . .. . milligram(s)
2+
Mg
....... magnesium
MI
. . . . . . . . . . . myocardial infarction
min .. .. . .. . minute(s)
mL . . . . . . . . . . millilitre(s)
mmHg . . . millimetres of mercury
MND
. . . . . . . . motor neuron disease
MR
.. . . .. . .. . modified release or mitral regurgitation
MRA
. . . . . . . . magnetic resonance angiography
MRCP
.. . . . . magnetic resonance
cholangiopancreatography
MRI
. . . . . . . . . magnetic resonance imaging
MRSA
. . . . . . meticillin- resistant Staphylococcus aureus
MS
.. .. .. .. .. multiple sclerosis
MSM
.. .. .. . men who have sex with men
MSU
.. . . . . . . midstream urine
mth(s) . . . month(s)
N&V
. . . . . . . . . nausea and/ or vomiting
+
Na
. . . . . . . . . sodium
NBM
. . . . . . . . nil by mouth
NEWS
. . . . . . National Early Warning Score
ng . . . . . . . . . . . nanogram(s)
NG
. . . . . . . . . . . nasogastric
NHS
. . . . . . . . . National Health Service (UK)
NICE
. . . . . . . . National Institute for Health and Care
Excellence, http:// www.nice.org.uk
NMDA
. . . . . .N- methyl- D- aspartate
NNT
. . . . . . . . . number needed to treat
nocte . . . . . at night
NR
. . . . . . . . . . . normal range (= reference interval)
NSAID
.. . . . non- steroidal anti- inflammatory drug
OCP
. . . . . . . . . oral contraceptive pill
OD
. . . . . . . . . . . omni die (Latin for once daily)
OGD
. . . . . . . . . oesophagogastroduodenoscopy
OGTT
. . . . . . . oral glucose tolerance test
. . . . . . . Oxford Handbook of Clinical Specialties
OT
.. . .. . . .. . . occupational therapist
P
. . . . . . . . . . . . pulmonary component of 2nd heart sound
2
PaCO
....... partial pressure of CO2 in arterial blood
2
PAN
. . . . . . . . . polyarteritis nodosa
PaO
. . . . . . . . . partial pressure of O2 in arterial blood
2
PBC
. . . . . . . . . primary biliary cirrhosis
PCR
. . . . . . . . . polymerase chain reaction or protein to
creatinine ratio (mg/ mmol)
PCV
. . . . . . . . . packed cell volume
PE
.. .. .. .. .. . pulmonary embolism
PEEP
.. .. .. . positive end- expiratory pressure
PEF(R)
. . . . . peak expiratory flow (rate)
PET
.. .. .. .. . positron emission tomography
PID
. . . . . . . . . . pelvic inflammatory disease
PIP
. . . . . . . . . . proximal interphalangeal (joint)
PND
. . . . . . . . . paroxysmal nocturnal dyspnoea
PO
. . . . . . . . . . . per os (by mouth)
ALGrawany
PPI
. . . . . . . . . . proton pump inhibitor, eg omeprazole
PR
.. . . . . . . .. . per rectum (by the rectum)
PRL
.. .. .. ... prolactin
PRN
. . . . . . . . . pro re nata (Latin for as required)
PRV
. . . . . . . . . polycythaemia rubra vera
PSA
ECG
. . . . . . . . . prostate- specific antigen
PTH
.. . . . . . .. parathyroid hormone
PTT
.. ... .. .. prothrombin time
PUO
. . . . . . . . . pyrexia of unknown origin
PVD
. . . . . . . . . peripheral vascular disease
QDS
. . . . . . . . . quater die sumendus; take 4 times daily
R
.. . . . .. . . . .. . right
RA
. . . . . . . . . . . rheumatoid arthritis
RAD
. . . . . . . . . right axis deviation on the
RBBB
. . . . . . . right bundle branch block
RBC
. . . . . . . . . red blood cell
RCT
.. . . . . .. . randomized controlled trial
RDW
. . . . . . . . red cell distribution width
RFT
.......... respiratory function tests
Rh .. . . . .. . . . Rhesus status
RIF
. . . . . . . . . . right iliac fossa
RR
. . . . . . . . . . . respiratory rate
RRT
.. . . . . . . . renal replacement therapy
RUQ
. . . . . . . . . right upper quadrant
RV
. . . . . . . . . . . right ventricle of heart
RVF
.. . . . . .. . right ventricular failure
RVH
. . . . . . . . . right ventricular hypertrophy
. . . . . . . . . . . . . recipe (Latin for treat with)
s .............. second(s)
S1, S
. . . . . . . . first and second heart sounds
2
SARS
. . . . . . . . severe acute respiratory syndrome
SBE
.. . . . . . .. subacute bacterial endocarditis
SBP
. . . . . . . . . systolic blood pressure
SC
.. . .. . . .. . . subcutaneous
SD
. . . . . . . . . . . standard deviation
SE
.. .. .. .. .. . side eect(s)
SIADH
.. . . . syndrome of inappropriate antidiuretic
hormone secretion
SL
............ sublingual
SLE
. . . . . . . . . . systemic lupus erythematosus
SOB
. . . . . . . . . short of breath
SPO
. . . . . . . . peripheral oxygen saturation (%)
2
SR
.. . . . . . .. . . slow- release
Stat
. . . . . . . . . statim (immediately; as initial dose)
STD/ I
. . . . . . . sexually transmitted disease/ infection
SVC
. . . . . . . . . superior vena cava
SVT
.. . . .. . . . supraventricular tachycardia
T
° ............ temperature
t½ .. . . . . . . . . . biological half- life
T
.. . . . . . . .. . . tri- iodothyronine
3
T
. . . . . . . . . . . . thyroxine
4
TB
.. . . . . . . . . . tuberculosis
TDS
. . . . . . . . . ter die sumendus (take 3 times a day)
TFT
. . . . . . . . . . thyroid function test (eg
TIA
. . . . . . . . . . transient ischaemic attack
TIBC
. . . . . . . . total iron- binding capacity
TPN
. . . . . . . . . total parenteral nutrition
TRH
. . . . . . . . . thyrotropin- releasing hormone
TSH
.. . . . . . . . thyroid- stimulating hormone
TTP
.. .. . .. .. thrombotic thrombocytopenic purpura
U
. . . . . . . . . . . . . unit(s)
UC
. . . . . . . . . . . ulcerative colitis
U&E
. . . . . . . . . urea and electrolytes (and creatinine)
UMN
. . . . . . . . upper motor neuron
URT(I)
.. .. . upper respiratory tract (infection)
US(S)
. . . . . . . ultrasound (scan)
UTI
. . . . . . . . . . urinary tract infection
VDRL
. . . . . . . Venereal Diseases Research Laboratory
VE
.. . . . . . . . . . ventricular extrasystole
VF
.. . .. . .. . .. ventricular fibrillation
VHF
. . . . . . . . . viral haemorrhagic fever
V/ Q
. . . . . . . . . . ventilation/ perfusion scan
VRE
. . . . . . . . . vancomycin- resistant enterococci
VSD
. . . . . . . . . ventricular septal defect
VT
.. . . . . . .. . . ventricular tachycardia
VTE
.. . . .. . . . venous thromboembolism
WBC
. . . . . . . . white blood cell
WCC
. . . . . . . . white blood cell count
WHO
. . . . . . . . World Health Organization
WPW
. . . . . . . Wol– Parkinson– White
wk(s) . . . . . week(s)
yr(s) ....... year(s)
ZN
. . . . . . . . . . . Ziehl– Neelsen stain, eg for mycobacteria
ECG
)
‘He who studies medicine without books sails an uncharted sea, but he who studies
https://t.me/med1917
Rather pause and do your metaphorical cap, oering due respect to those
medicine without patients does not go to sea at all’
The word ‘patient’ occurs frequently throughout this book.
who by the opening up of their lives to you, become your true teachers.
Without your patients, you are a technician with a useless skill.
William Osler 1849– 1919
Do not skim over it lightly.
With them, you are a doctor.
ALGrawany
https://t.me/med1917
1
Thinking about medicine
Contents
The Hippocratic oath 1
The human right to health
Surviving life on the wards
Bedside manner and
communication
The diagnostic puzzle
Duty of candour
Prescribing
Medicine and...
Race
Sleep
Sex and gender
The environment
Compassion
Death
Medical ethics
Mental health
Medicalization
Epidemiology
Medical mathematics
Evidence- based medicine (
Special populations
The older person
Pregnancy
8
10
10
10
11
12
14
15
16
17
23
1
2
4
6
7
11
11
18
EBM
22
22
Fig 1.
was witty and aable, with the wisdom to reject
) 20
her father’s chosen match and marry the British
ambassador to Turkey. There she witnessed older
women attending parties, bringing with them ’a
nut- shell full of the matter of the best sort of smallpox’ to be injected into oered veins. Having had
and been scarred by smallpox, she oered her son’s
vein, making him the first English person to receive inoculation against disease. She was ‘patriot
enough to take pains to bring this useful invention
into fashion in England’, inoculating her daughter
before an audience at the court of George I. No
harm occurred and her daughter would go on to
marry the prime minister. But history respects
the man who convinced the world, not the women
who did it first. Inoculation became vaccination
with Jenner’s comparable use of cow- (vacca) pox
more than
one of our most powerful life- saving interventions
and yet controversy has persisted since Montagu
and Jenner.
The severe acute respiratory syndrome coronavirus
omies, education, politics, sport, and the arts, as
well as medicine and our capacity to care for the
sick. Change and uncertainty bred misinformation.
Enforced lockdowns engendered revolt against
establishment diktats. The disconnect between
infection and serious illness for the majority distorted risk perception. Populism and non- scientific
models of disease became the lifeblood of vaccine
dissent.
Honesty, understanding, and communication
have never been more important. The success of
vaccination programmes is a test of community
and cooperation. This remains our biggest challenge and one we cannot aord to fail.
1
Lady Mary Wortley Montagu (
70
years after Montagu. Vaccination is
2
(
SARS- CoV- 2
) pandemic changed lives, econ-
Artwork by Gillian Turner.
1689– 1762
)
We thank Josephine Fielding, our Specialist Reader for this chapter.
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