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Contributors
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Brian J Angus MD, FRCP, DTM&H
Associate Professor, Nufeld Department of Medicine,
Oxford University, Oxford, UK
Adam C Baker BM, BMedSci(Hons), MSc ExMed
Pre-Hospital Emergency Medicine Fellow, Honorary Senior Clinical
Research Fellow, Department of Emergency Medicine,
University Hospitals Plymouth NHS Trust, Devon Air Ambulance,
University of Exeter, Devon, UK
James G Boyle MBChB, MD, MSc, FRCP
Consultant Diabetologist, Department of Diabetes, Endocrinology and
Clinical Pharmacology, Glasgow Royal Inrmary; Honorary Associate
Clinical Professor, School of Medicine, Dentistry and Nursing,
University of Glasgow, Glasgow, UK
Harry Campbell MBChB, MD, FRCPE, FFPH, FRSE, FMedSci
Professor of Genetic Epidemiology and Public Health,
Centre for Global Health, Usher Institute, University of Edinburgh,
Edinburgh, UK
Thean Soon Chew MBChB, MRCP, PhD
Consultant Gastroenterologist and Honorary Senior Lecturer in
Gastroenterology, Academic Unit of Gastroenterology,
University of Shefeld, Shefeld, UK
Ian J Clifton MD, FRCP
Consultant Respiratory Physician and Honorary Senior Lecturer,
Department of Respiratory Medicine, St James’s University Hospital,
Leeds, UK
Sally Clive BMedSci(Hons), MBChB, MD, FRCPE
Consultant Medical Oncologist, Edinburgh Cancer Centre, Western
General Hospital, Edinburgh, UK
Gavin PR Clunie MD, FRCP
Consultant Rheumatologist and Metabolic Bone Physician,
Department of Rheumatology, Cambridge University Hospital NHS
Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
Daniel J Clutterbuck BSc(Hons), FRCP
Consultant in Genitourinary and HIV Medicine, NHS Lothian;
Chalmers Sexual Health Centre, Edinburgh, UK
Myles D Connor MBBCh, FCP(SA), FCNeurol(SA), PhD, FRCPE
Consultant Neurologist, Department of Neurology, NHS Borders,
Melrose, UK; Honorary Senior Lecturer, Centre for Clinical Brain
Sciences, University of Edinburgh, Edinburgh, UK; Honorary Senior
Researcher, School of Public Health,
University of the Witwatersrand, Johannesburg, South Africa
Bryan Conway MB, MRCP, PhD
Senior Lecturer and Honorary Consultant Nephrologist, Department of
Renal Medicine, University of Edinburgh and Edinburgh Royal Inrmary,
Edinburgh, UK
Nicola Cooper MBChB, MMedSci, FRCPE, FRACP, FAcadMEd,
SFHEA
Consultant Physician and Clinical Associate Professor in Medical
Education, Department for Acute Internal Medicine, University Hospitals
of Derby & Burton NHS Foundation Trust, Derby, UK
Alison L Cracknell MBChB, FRCP
Consultant in Medicine for Older People, Department of Medicine for
Older People, Leeds Teaching Hospitals NHS Trust; Honorary Clinical
Associate Professor, University of Leeds, Leeds, UK
Dominic J Culligan BSc, MD, FRCP, FRCPath
Consultant Haematologist and Honorary Senior Lecturer,
Department of Haematology, Aberdeen Royal Inrmary,
Aberdeen, UK
David H Dockrell MD, FRCPI, FRCPG, FACP
Chair of Infection Medicine, Centre for Inammation Research,
University of Edinburgh; Professor of Infection Medicine,
UoE Centre for Inammation Research, University of Edinburgh,
Edinburgh, UK
Deborah AB Ellames BSc(Hons), MBChB
Consultant Physician in Respiratory Medicine, Department of
Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
Marie Fallon MBChB, MD, FRCPG, FRCPE, DCH, DRCOG,
MRCGP
St Columba’s Hospice Chair of Palliative Medicine, Edinburgh Cancer
Research Centre, Institute for Genetics and Cancer, University of
Edinburgh, Edinburgh, UK
Lesley A Colvin MBChB, PhD, FRCA, FFPMRCA, FRCPE
Professor of Pain Medicine, Division of Population Health
and Genomics, University of Dundee School of Medicine,
Dundee, UK
Fraser W Gibb MBChB, BSc(Hons), FRCP, PhD
Consultant Physician/Honorary Clinical Reader, Edinburgh Centre for
Endocrinology and Diabetes, Royal Inrmary of Edinburgh/
University of Edinburgh, Edinburgh, UK
xii CONT RIB UTOR S
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Timothy T Gordon-Walker MBChB, PhD, MRCP
Consultant Hepatologist, Department of Gastroenterology and
Scottish Liver Transplant Unit, The Royal Inrmary of Edinburgh,
Edinburgh, UK
Neil R Grubb MD, FRCP
Consultant in Cardiology and Cardiac Electrophysiology,
Department of Cardiology, Royal Inrmary of Edinburgh, Edinburgh, UK
David PJ Hunt MB BChir, PhD, FRCP
Wellcome Senior Clinical Fellow, Department of Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK
Sally H Ibbotson BSc(Hons), MD, FRCPE
Professor of Photodermatology, University of Dundee; Honorary
Consultant Dermatologist and Head of Photobiology Unit,
Ninewells Hospital and Medical School, Dundee, UK
Sara J Jenks MBChB, MRCP, FRCPath
Consultant in Metabolic Medicine, Department of Clinical Biochemistry,
Royal Inrmary of Edinburgh, Edinburgh, UK
Sarah L Johnston FRCP, FRCPath
Consultant Immunologist, Department of Immunology and
Immunogenetics, North Bristol NHS Trust, Bristol, UK
Stephen M Lawrie MD(Hons), FRCPsych, Hon FRCPE, FRSE
Professor of Psychiatry and Neuroimaging, Division of Psychiatry,
Centre for Clinical Brain Sciences, University of Edinburgh,
Edinburgh, UK
David A McAllister MBChB, MPH, MD, MRCP, MFPH
Wellcome Trust Intermediate Clinical Fellow and Beit Fellow and
Honorary Consultant in Public Health Medicine, Institute of Health and
Wellbeing, University of Glasgow, Glasgow, UK
Eve Miller-Hodges MBChB, PhD
Senior Clinical Lecturer and Honorary Consultant in Inherited Metabolic
Disorders and Renal Medicine, Centre for Cardiovascular Science &
Scottish IMD Service, University of Edinburgh, Edinburgh, UK
Francesca EM Neuberger MBChB, FRCP
Consultant Physician in Acute and Obstetric Medicine, Medical Division,
North Bristol NHS Trust, Bristol, UK
David E Newby BA BSc(Hons), PhD, BM DM DSc, FRSE, FESC,
FACC, FMedSci
British Heart Foundation Duke of Edinburgh Chair of Cardiology, Centre
for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
John DC Newell-Price MA, PhD, FRCP
Professor of Endocrinology, Department of Oncology and Metabolism,
University of Shefeld, Shefeld, UK
John A Olson MD, FRCPE, FRCOphth
Consultant Ophthalmic Physician, Aberdeen Royal Inrmary; Honorary
Reader, University of Aberdeen, Aberdeen, UK
John R Petrie BSc, MBChB, PhD, FRCPE, FRCPG
Professor of Diabetic Medicine, Institute of Cardiovascular and Medical
Sciences, University of Glasgow, Glasgow, UK
Michael EJ Lean MA, MB, BChir, MD, FRCP, FRSE
Professor of Human Nutrition, Human Nutrition, University of Glasgow,
Glasgow, UK
Gary Maartens MBChB, MMed, FCP(SA)
Chair of Clinical Pharmacology, Department of Medicine,
University of Cape Town, Cape Town, South Africa
Lucy H Mackillop BM BCh, MA(Oxon), FRCP
Consultant Obstetric Physician, Oxford University Hospitals,
NHS Foundation Trust; Honorary Senior Clinical Lecturer,
Nufeld Department of Women’s and Reproductive Health,
University of Oxford, Oxford, UK
Michael J MacMahon FRCA, EDIC
Consultant Intensivist, Department of Anaesthesia and Intensive Care,
Victoria Hospital, Kirkcaldy, UK
Rebecca J Mann BMedSci, BMBS, MRCP, FRCPCh
Consultant Paediatrician, Department of Paediatrics, Taunton and
Somerset NHS Foundation Trust, Taunton, UK
Lynn M Manson MBChB, MD
Consultant Haematologist, Department of Transfusion Medicine,
Royal Inrmary of Edinburgh, Edinburgh, UK
Amanda Mather MBBS, FRACP, PhD
Renal Staff Specialist, Department of Renal Medicine, Royal North
Shore Hospital; Conjoint Senior Lecturer, Faculty of Medicine,
University of Sydney, Sydney, NSW, Australia
Paul J Phelan MD, FRCPE
Consultant Nephrologist and Renal Transplant Physician,
Department of Nephrology, Royal Inrmary of Edinburgh, Edinburgh, UK
Terence J Quinn FRCP, MD, MBChB, BSc
Senior Clinical Lecturer and Honorary Consultant in Geriatric Medicine,
Institute of Cardiovascular and Medical Sciences, University of
Glasgow, Glasgow, UK
Stuart H Ralston MBChB, MD, FRCP, FFPM(Hon), FMedSci, FRSE
Professor of Rheumatology, Centre for Genomic and Experimental
Medicine, Institute of Genetics and Cancer, University of Edinburgh,
Western General Hospital, Edinburgh, UK
Anupam Rej MBChB, BMedSci(Hons), MRCP(UK)
Clinical Research Fellow, Academic Unit of Gastroenterology,
Royal Hallamshire Hospital, Shefeld, UK
David S Sanders MBChB, MD, FACG
Professor of Gastroenterology, Academic Unit of Gastroenterology,
Royal Hallamshire Hospital and University of Shefeld, Shefeld, UK
Jonathan AT Sandoe FRCPath, PhD
Associate Clinical Professor, Consultant Microbiologist,
Department of Microbiology, University of Leeds and
Leeds Teaching Hospitals NHS Trust, Leeds, UK
Alan G Shand MD, FRCPE
Consultant Gastroenterologist, Gastrointestinal Unit,
Western General Hospital, Edinburgh, UK
Simon RJ Maxwell MD, PhD, FRCP, FRCPE, FBPhS
Professor of Student Learning (Clinical Pharmacology and Prescribing),
Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, UK
Mark Stares MBBS, MD(Res), MRes, BSc, MRCP
Medical Oncologist, Edinburgh Cancer Centre, Western General
Hospital, NHS Lothian, Edinburgh, UK
CO NTR IBU T ORS xiii
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Robby M Steel MA, MD, FRCPsych
Consultant Liaison Psychiatrist and Honorary (Clinical) Senior Lecturer
in Psychiatry, Department of Psychological Medicine, Royal Inrmary of
Edinburgh, Edinburgh, UK
Grant D Stewart BSc, MBChB, PhD Edin, MA Cantab,
FRCSE (Urol)
Professor of Surgical Oncology, Department of Surgery,
University of Cambridge, Cambridge, and Honorary Consultant
Urological Surgeon, Addenbrooke’s Hospital, Cambridge, UK
David R Sullivan MBBS, FRACP, FRCPA, FCSANZ
Head of Department, Department of Chemical Pathology,
NSW Health Pathology, Sydney, NSW, Australia
Shyam Sundar MD, FRCP, FAMS, FASc, FNA
Distinguished Professor, Department of Medicine, Institute of Medical
Sciences, Banaras Hindu University, Varanasi, India
Victoria R Tallentire MBChB, MD, FRCP
Consultant Acute Physician and Associate Postgraduate Dean,
Medical Directorate, NHS Education for Scotland, Edinburgh, UK
Katrina Tatton-Brown BM BCh, BA, MD
Professor of Clinical Genetics and Genomic Education and Consultant
in Clinical Genetics, South West Thames Regional Genetics Service,
St George’s University Hospitals NHS Foundation Trust, London, UK
Simon HL Thomas BSc, MD, FRCP, FRCPE, FEAPCCT, FACCT
Professor of Clinical Pharmacology and Therapeutics,
Translational and Clinical Research Institute, Newcastle University,
Newcastle-upon-Tyne, UK
Henry G Watson MD, FRCP, FRCPath
Consultant Haematologist and Honorary Professor of Medicine,
Department of Haematology, Aberdeen Royal Inrmary, Aberdeen, UK
Julian White MD, FACTM
Clinical Toxinologist and Head of Toxinology, Toxinology Department
and University of Adelaide Department of Paediatrics,
Women’s & Children’s Hospital, North Adelaide, SA, Australia
William Whiteley BA, BM BCh, MSc, PhD, FRCP
Reader in Neurology, Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK;
Senior Research Fellow, Nufeld Department of Population Health,
University of Oxford, Oxford, UK
Michael J Williams BM BCh, PhD
Consultant Hepatologist, Scottish Liver Transplant Unit, Royal Inrmary
of Edinburgh, Edinburgh, UK
Rebecca Woodeld MA, MB BChir, MRCP, PhD
Consultant Geriatrician and Stroke Physician, Department of Medicine
for the Elderly, Western General Hospital, Edinburgh, UK
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International Advisory Board
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ABM Abdullah MRCP(UK), FRCPE
UGC Professor, Department of Medicine, Bangabandhu Sheikh Mujib
Medical University, Dhaka, Bangladesh
Amitesh Aggarwal MD, FRCPE, FACP(USA), FRCPG, FICP,
FIACM, FIMSA, FISE, FIAMS, FUPDA, FGSI, FISH, FRSSDI
Professor, Department of Medicine, University College of Medical
Sciences (University of Delhi) and GTB Hospital, Delhi, India
Matthew A Brown MBBS, MD, FRACP, FAHMS, FAA
Director, Guy’s and St Thomas’ NHS Foundation Trust and King’s
College London NIHR Biomedical Research Centre, King’s College
London, London, UK
Arnold N Cohen MD, FACP, FACG, AGAF
Professor of Medicine, Department of Medical Education and Science,
Elson S. Floyd College of Medicine of Washington State University;
Associate Clinical Professor of Medicine Emeritus, University of
Washington School of Medicine, Spokane, Washington, USA
Mradul Kumar Daga MD, FRCP, FCCP
Professor of Medicine and In-Charge Medical ICU, Department of
Internal Medicine, Maulana Azad Medical College, New Delhi, India
D Dalus MD, PhD, FRCP, FRCPE, FRCPG
Professor of Medicine and Senior Consultant, Department of Internal
Medicine, Cosmopolitan Hospitals, Trivandrum, Kerala, India
Sydney C Dsouza MD
Professor and Head, Department of Internal Medicine, Yenepoya
Medical College, Mangaluru, Karnataka, India
Tarun K Dutta MBBS, MD
Emeritus Professor, Department of General Medicine, Mahatma Gandhi
Medical College and Research Institute, Puducherry, India
M Abul Faiz MBBS, FCPS, PhD
Professor of Medicine (Retired), Department of Medicine, Sir Salimullah
Medical College and Dev Care Foundation, Dhaka, Bangladesh
Albert G Frauman MD, FRACP, FACP, FACCP, FBPhS
Professor of Clinical Pharmacology and Therapeutics, The University
of Melbourne; Director, Department of Clinical Pharmacology and
Therapeutics, Austin Health, Victoria, Australia
Hadi Goubran MBBCh, MSc, MD, FACP, FRCPE
Professor, Division of Hematology and Oncology, Saskatoon Cancer
Centre and College of Medicine, University of Saskatchewan,
Saskatoon, Saskatchewan, Canada
Rajiva Gupta MD, MRCP, FRCP
Vice Chairman and Head, Department of Rheumatology and Clinical
Immunology, Medanta The Medicity, Gurgaon, India
Quazi T Islam FCPS, FRCP, FRCPE, MACP
Professor of Medicine, Department of Medicine, Popular Medical
College, Dhaka, Bangladesh
Saroj Jayasinghe MBBS, MD, MRCP(UK), PhD, FRCP, FCCP,
FNASSL
Consultant Physician and former Chair Professor of Medicine,
Department of Clinical Medicine, University of Colombo, Colombo,
Sri Lanka
AL Kakrani MD, FICP
Professor of Clinical Eminence and Director of Academic
Collaborations, Department of Medicine, Dr. D.Y. Patil Medical College,
Hospital and Research Centre, Pune, Maharashtra, India
Vasantha Kamath MD, FICP
Senior Professor in Internal Medicine, Department of Internal Medicine,
MVJ Medical College and Research Hospital, Hoskote, Bangalore,
Karnataka, India
Ammar F Mubaidin MD, FRCPE, FRCPG
Professor of Clinical Neurology, Department of Neurology, Al Khalidi
Medical Centre, Amman, Jordan
Milind Y Nadkar MD, FICP, FACP
Additional Dean (Academic) and Professor and Head, Department of
Medicine and Rheumatology Services, Seth G S Medical College and
KEM Hospital, Mumbai, Maharashtra, India
Viswanathan Neelakantan MBBS, DNB, FRCPG, FRCP,
FACP, AB
Senior Professor of Medicine and Consultant in Tropical Medicine,
Department of Internal Medicine, Sri Manakula Vinayagar Medical
College Hospital, Puducherry, India
Sujoy Ghosh MD, DM, FRCP, FRCPE, FRCPG, FACE
Professor, Department of Endocrinology, Institute of Post Graduate
Medical Education and Research, Kolkata, West Bengal, India
Matthew Ng FRCP, FRCPE
Honorary Clinical Professor, Department of Medicine, University of Hong
Kong, Pok Fu Lam, Hong Kong
xvi INTE RNAT ION AL A DVI SORY B OAR D
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Ami Prakashvir Parikh MD
Professor and Head, Department of Medicine, Smt. NHL Municipal
Medical College and SVP Hospital, Ahmedabad, Gujarat, India
Medha Y Rao MBBS, MD, PGDHHM
Senior Professor of Internal Medicine and Principal and Dean,
Department of General Medicine, M.S. Ramaiah Medical College,
Bangalore, Karnataka, India
NR Rau MD, FICP
Consultant Physician, Anugraha Medical Center, Udupi, Karnataka, India;
Consultant Physician and Head, Department of Internal Medicine,
Adarsh Hospital, Udupi, Karnataka, India; Former Professor and
Head, Department of Medicine, Kasturba Medical College,
Manipal, India
Jacek Rozanski MD, PhD
Professor of Medicine, Department of Nephrology, Transplantology, and
Internal Medicine, Pomeranian Medical University, Szczecin, Poland
Sarkar Nirmalendu MD
Honorary Professor, Department of General Medicine, Ramakrishna
Mission Sevapratishthan and Vivekananda Institute of Medical
Sciences, Kolkata, West Bengal, India
Surendra K Sharma MD (Internal Medicine), PhD
Adjunct Professor, Department of Molecular Medicine, Jamia Hamdard
Institute of Molecular Medicine, Hamdard University, Hamdard Nagar,
Delhi, India
Arvind K Vaish MD, FICP
Professor and Head, Department of Medicine, Hind Institute of Medical
Sciences; Former Professor and Head of Medicine, King George’s
Medical University, Lucknow, India
Josanne Vassallo MD, PhD, FRCP, FACP, FACE
Professor and Consultant Endocrinologist, Department of Medicine,
Division of Endocrinology, University of Malta Medical School, Msida,
Malta
Special Content Advisor for the Indian
National Medical Commission undergraduate
curriculum
Professor Dilip R Karnad MD, FRCPG, FACP
Senior Consultant in Critical Care, Jupiter Hospital, Thane, India
Acknowledgements
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The editors would like to acknowledge and offer grateful thanks for the
input of all previous editions’ contributors, without whom this new edition
would not have been possible.
In particular we are indebted to those former authors who step down
with the arrival of this new edition. They include Quentin M Anstee,
Leslie Burnett, Mark Byers, Graham G Dark, Richard J Davenport, Emad
El-Omar, David R FitzPatrick, J Alastair Innes, David EJ Jones, Peter
Langhorne, John Paul Leach, Sara E Marshall, Rory J McCrimmon,
Mairi H McLean, Ewan R Pearson, Peter T Reid, Gordon R Scott, Peter
Stewart, John PH Wilding and Miles D Witham.
We are grateful to members of the International Advisory Board, all
of whom provided detailed suggestions that have improved the book.
Several members have now retired from the Board and we are grateful for their support during the preparation of previous editions. They
include Ragavendra Bhat, Khalid I Bzeizi, Piotr Kuna, Pravin Manga,
Moffat Nyirenda, Tommy Olsson, KR Sethuraman, Ibrahim Sherif, Ian J
Simpson, SG Siva Chidambaram and Josanne Vassallo. We are equally
grateful to new members of our International Advisory Board, who have
given us valuable advice as we prepared this new edition, including ABM
Abdullah, Quazi T Islam, Viswanathan Neelakantan and Jacek Rozanski.
We would like to extend special thanks to Professor Dilip Karnad,
Jupiter Hospital, Thane, India, who thoroughly reviewed all chapters of
this 24th edition in draft form, to help ensure the coverage of this edition
is more relevant than ever to our large readership in India, Pakistan and
Bangladesh. He provided invaluable advice to the editorial team during preparation of the 24th edition and exhaustive feedback on how the
content aligns with competencies in the current Indian National Medical
Commission undergraduate curriculum. Readers of the International
Edition of this book can now access a comprehensive Competency
Mapping Guide with full page references for the rst time as a result of
this thorough review.
Detailed chapter reviews were commissioned to help plan this new
edition and we are grateful to all those who assisted, including Professor
Rustam Al-Shahi, Dr Daniel Beckett, Dr Helen Cohen, Dr Ian Edmond,
Dr David Enoch, Professor Tonks Fawcett, Dr Colin Forfar, Professor
Richard Gilson, Dr Helena Gleeson, Dr Peter Hall, Dr Greg Heath,
Dr Richard Herriot, Dr Robert Lindsay, Dr Catherine Nelson-Piercy and
Dr Alex Rowe.
The Editors and Publisher would like to thank all those who have provided valuable feedback on this textbook and whose comments have
helped shape this new edition. We would particularly like to extend
our thanks to the many readers who contact us with suggestions for
improvements. This input has been invaluable and is much appreciated;
we regret the names are too numerous to mention individually.
The authors of Chapter 20 would like to thank Dr Drew Henderson,
who reviewed the ‘Diabetic nephropathy’ section, and we are indebted
to Dr Ruth Darbyshire for assistance with the Ophthalmology multiple
choice questions to accompany Chapter 30.
Two short sections in Chapter 3 on array comparative genomic
hybridisation and single-molecule sequencing are adapted from Dr K
Tatton-Brown’s Massive Open Online Course for FutureLearn. We would
like to thank the Open University and St George’s, University of London,
for permission to use this material.
We are especially grateful to Laurence Hunter and Wendy Lee from
Elsevier for their endless support and expertise in the shaping, collation
and publication of Davidson’s over many years and who have now retired.
We have thoroughly enjoyed working with a new team including Jeremy
Bowes, Siân Jarman and Anne Collett who have seamlessly taken over
the reins. We are delighted that Robert Britton continues to work on the
book and illustrate it beautifully. We are proud of this new edition and are
condent it will remain an essential and invaluable resource for readers
the world over.
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Introduction
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The opening chapters of the book, making up Part 1 on ‘Fundamentals
of Medicine’, provide an account of the principles of genetics, immunology, infectious diseases and population health, oncology and pain management, along with a discussion of the core principles behind clinical
decision-making and good prescribing. Subsequent chapters in Part 2,
‘Emergency and Critical Care Medicine’, discuss medical emergencies
in poisoning, envenomation and medicine in austere environments, while
Chapter 9 explores common presentations in acute medicine, as well
as the recognition and management of the critically ill. The third part,
‘Clinical Medicine’, is devoted to the major medical specialties. Each
chapter has been written by experts in the eld to provide the level of
detail expected of trainees in their discipline. To maintain the book’s virtue
of being concise, care has been taken to avoid unnecessary duplication
between chapters.
The system-based chapters in Part 3 follow a standard format, beginning with an overview of the relevant aspects of clinical examination,
followed by an account of functional anatomy, physiology and investigations, then the common presentations of disease, and details of the
individual diseases and treatments relevant to that system. In chapters
that describe the immunological, cellular and molecular basis of disease,
this problem-based approach brings the close links between modern
medical science and clinical practice into sharp focus.
The methods used to present information are described below.
Clinical examination overviews
The value of good clinical skills is highlighted by a two-page overview
of the important elements of the clinical examination at the beginning
of most chapters. The left-hand page includes a mannikin to illustrate
key steps in examination of the relevant system, beginning with simple
observations and progressing in a logical sequence around the body.
The right-hand page expands on selected themes and includes tips on
examination technique and interpretation of physical signs. These overviews are intended to act as an aide-mémoire and not as a replacement
for a detailed text on clinical examination, as provided in our sister title,
Macleod’s Clinical Examination
Presenting problems
Medical students and junior doctors must not only assimilate a great many
facts about various disorders, but also develop an analytical approach to
formulating a differential diagnosis and a plan of investigation for patients
who present with particular symptoms or signs. In Davidson’s this is
addressed by incorporating a ‘Presenting Problems’ section into all relevant chapters. Nearly 250 presentations are included, which represent
the most common reasons for referral to each medical specialty.
Boxes
Boxes are a popular way of presenting information and are particularly
useful for revision. They are classied by the type of information they
contain, using specic symbols.
General Information
These include causes, clinical features, investigations, treatments and
other useful information.
Practice Point
There are many practical skills that students and doctors must master.
These vary from inserting a nasogastric tube to reading an ECG or X-ray,
or interpreting investigations such as arterial blood gases or thyroid function tests. ‘Practice Point’ boxes provide straightforward guidance on
how these and many other skills can be acquired and applied.
Emergency
These boxes describe the management of many of the most common
emergencies in medicine.
In Old Age
Life expectancy is increasing in many countries and older people are
the chief users of health care. While they contract the same diseases
as those who are younger, there are often important differences in the
way they present and how they are best managed. Chapter 34, ‘Ageing
and disease’, concentrates on the principles of managing the frailest
group, who suffer from multiple comorbidity and disability, and who tend
to present with non-specic problems such as falls or delirium. Many
older people, though, also suffer from specic single-organ pathology. ‘In
Old Age’ boxes are thus included in each chapter and describe common
presentations, implications of physiological changes of ageing, effects of
age on investigations, problems of treatment in old age, and the benets
and risks of intervention in older people.
In Pregnancy
Many conditions are different in the context of pregnancy, while some
arise only during or shortly after pregnancy. Particular care must be taken
with investigations (for example, to avoid radiation exposure to the fetus)
and treatment (to avoid the use of drugs that harm the fetus). These
issues are highlighted by ‘In Pregnancy’ boxes distributed throughout the
book, which complement Chapter 32, ‘Maternal medicine’.
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