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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2683_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Series Editors’ foreword
- •Prefaces
- •Acknowledgements
- •Series Editors’ acknowledgements
- •History of the presenting complaint (HPC)
- •Past medical history (PMH)
- •Medications and allergies (DHX)
- •Family history (FHX)
- •Social history (SHX)
- •Systems review (SR)
- •General symptoms
- •Fatigue
- •Appetite
- •Weight change
- •Sweats
- •Pruritus (itching)
- •Sleep pattern
- •Cardiovascular symptoms
- •Chest pain
- •Shortness of breath (dyspnoea) and exercise tolerance
- •Loss of consciousness (syncope)
- •Palpitations
- •Ankle and calf swelling
- •Calf, thigh or buttock pain on exertion (claudication)
- •Respiratory symptoms
- •Dyspnoea
- •Cough
- •Sputum
- •Chest pain
- •Wheeze
- •Hoarse voice
- •Gastrointestinal disease
- •Abdominal pain
- •Dysphagia
- •Nausea and vomiting
- •Indigestion
- •Change in bowel habit or stools
- •Jaundice and itch
- •Abdominal swelling
- •Genitourinary symptoms
- •Dysuria
- •Change in urine appearance
- •Frequency and nocturia
- •Hesitancy
- •Contents
- •Loin pain
- •Incontinence
- •Menstruation
- •Discharge
- •Neurological symptoms
- •Headache
- •Dizziness and vertigo
- •Loss of consciousness
- •Visual disturbance
- •Altered hearing
- •General principles
- •Altered smell
- •Speech disturbance
- •Limb weakness, paraesthesiae and sensory loss
- •Metabolic and endocrine symptoms
- •Musculoskeletal symptoms
- •Pain
- •Weakness
- •Overview
- •The history
- •Presenting complaint (PC)
- •Visual survey
- •Position
- •Hands
- •Radial pulse
- •Blood pressure
- •Brachial and carotid artery
- •Jugular Venous Pressure
- •Face
- •Praecordium
- •Apex beat
- •Palpation
- •Auscultation
- •Summary
- •The respiratory system
- •Visual survey
- •Stiffness
- •Joint swelling
- •Disability
- •Skin symptoms
- •Rash
- •Pruritus
- •Precipitants
- •Haematological symptoms
- •Fatigue
- •Excessive bleeding or bruising
- •Recurrent infections
- •Glandular swelling
- •Conclusion of history taking
- •2 Clinical examination
- •ABCDE approach
- •Massive Blood Loss Protocol
- •General principles
- •Visual survey
- •Patient position, general behaviour and around the bed
- •Pallor
- •Cyanosis
- •Jaundice
- •Fluid status
- •Pigmentation
- •The face and body habitus
- •The hands
- •Hands
- •Nails
- •Tendons
- •Joints
- •Neuromuscular
- •Miscellaneous
- •The cardiovascular system
- •Position
- •Hands
- •Pulse
- •Blood pressure
- •Jugular venous pressure
- •Face and mouth
- •Trachea
- •Thorax
- •Inspection
- •Expansion
- •Tactile fremitus and vocal fremitus
- •Percussion
- •Auscultation
- •Summary
- •The abdomen
- •Visual survey
- •Position
- •Hands
- •Arms
- •Face and mouth
- •Neck
- •Trunk and back
- •Abdomen
- •Inspection
- •Palpation
- •Percussion
- •Auscultation
- •Concluding your examination
- •The nervous system
- •Visual survey
- •Cranial nerves
- •Cranial nerve I (olfactory nerve)
- •Cranial nerve II (optic nerve)
- •Cranial nerves III, IV and VI and eye movements
- •Cranial nerve III (oculomotor nerve)
- •Cranial nerve IV (trochlear nerve)
- •Cranial nerve VI (abducens nerve)
- •Cranial nerve V (trigeminal nerve)
- •Cranial nerve VII (facial nerve)
- •Cranial nerve VIII (vestibulocochlear nerve)
- •Cranial nerve IX (glossopharyngeal nerve)
- •Cranial nerve X (vagus nerve)
- •Cranial nerve XI (accessory nerve)
- •Cranial nerve XII (hypoglossal nerve)
- •Upper limb
- •Visual survey
- •Tone
- •Power
- •Coordination
- •Reflexes
- •Sensation
- •Lower limb
- •Visual survey
- •Tone
- •Power
- •Coordination
- •Reflexes
- •Sensation
- •Gait
- •Musculoskeletal examination
- •Visual survey
- •Look
- •Feel
- •Move
- •Assessment of disability
- •Hands
- •Skin and lymphadenopathy
- •Breast examination
- •Neck examination
- •3 Writing in the medical notes
- •General principles
- •Sample clerking
- •4 Chest pain
- •Introduction
- •History and examination findings
- •History
- •Type of chest pain
- •Onset and progression
- •Site and radiation
- •Nature of pain
- •Associated symptoms
- •Examination
- •Investigations
- •5 Shortness of breath
- •Introduction
- •History and examination findings
- •History
- •Onset
- •Severity
- •Precipitating and aggravating factors
- •Associated features
- •Other factors
- •Examination
- •Inspection
- •Palpation
- •Percussion
- •Auscultation
- •Investigations
- •Acute presentation
- •Chronic presentation
- •6 Cough and haemoptysis
- •Introduction
- •History and examination findings
- •History
- •Examination
- •Investigations
- •Bedside
- •Blood tests
- •Imaging
- •Further investigations
- •7 Palpitations
- •Introduction
- •History and examination findings
- •History
- •Causes and contributing factors
- •Examination
- •Investigations
- •8 Pyrexia of unknown origin
- •Introduction
- •History and examination findings
- •Investigations
- •Bedside investigations
- •Blood tests
- •Microbiology tests
- •Further investigations
- •Differential diagnosis
- •9 Abdominal pain
- •Introduction
- •History and examination findings
- •History
- •Examination
- •Ascertaining the underlying causes of abdomnal pain
- •Investigations
- •Bedside investigations
- •Blood tests
- •Imaging
- •Further investigations
- •10 Heartburn and indigestion
- •Introduction
- •History and examination findings
- •Investigations
- •Common investigations
- •Specialized investigations
- •11 Gastrointestinal bleed
- •Introduction
- •History and examination findings
- •History
- •Examination
- •Investigations
- •Bedside investigations
- •Blood tests
- •Further investigations
- •12 Change in bowel habit
- •Introduction
- •History and examination findings
- •History
- •Examination
- •Investigations
- •Bedside investigations
- •Blood tests
- •Imaging
- •Noninvasive
- •Invasive
- •Further investigations
- •13 Weight loss
- •Introduction
- •History and examination findings
- •History
- •Examination
- •Investigations
- •Blood tests
- •Imaging
- •14 Jaundice
- •Introduction
- •History and examination
- •History
- •Examination
- •Investigations
- •Haemolysis screen
- •Hepatocellular screen
- •Introduction
- •Micturition disturbances
- •History and examination findings
- •Examination
- •General appearance
- •Cardiovascular system
- •Abdominal examination
- •Neurological examination
- •Investigations
- •Urine tests
- •Blood tests
- •Imaging
- •Further investigations
- •Haematuria
- •History and examination findings
- •Initial tests
- •Imaging
- •Other investigations
- •Proteinuria
- •16 Headache and facial pain
- •Introduction
- •History and examination findings
- •History
- •Solitary acute episode
- •Progressive headache
- •Recurrent episodic headache and facial pain
- •Chronic headache and facial pain
- •Examination
- •Investigations
- •Blood tests
- •Imaging
- •Introduction
- •History and examination findings
- •Investigations
- •Imaging
- •Further investigations
- •Differential diagnosis
- •Thyroid disease
- •Hypothyroidism
- •Aetiology
- •Clinical features
- •Investigations
- •Blood tests
- •Other
- •Imaging
- •Hyperthyroidism
- •Aetiology
- •Primary hyperthyroidism
- •Clinical features
- •Investigations
- •Subacute (de Quervain) thyroiditis
- •Thyroid malignancy
- •Papillary thyroid carcinoma
- •Follicular thyroid carcinoma
- •Anaplastic carcinoma
- •Medullary thyroid carcinoma
- •Primary thyroid lymphoma
- •Further reading
- •18 Loss of consciousness
- •Introduction
- •History and examination findings
- •History
- •Before the event
- •The event itself
- •After the event
- •Risk factors
- •Examination
- •Comatose patient
- •Patient with blackouts
- •Investigations
- •19 Confusion and delirium
- •Introduction
- •History and examination findings
- •History
- •Pattern of confusion
- •Underlying causes
- •Examination
- •Investigations
- •Bedside investigations
- •Blood tests
- •Further tests
- •20 Stroke and TIA
- •Introduction
- •Causes and pathophysiology
- •History and examination findings
- •History
- •Examination
- •Investigations
- •Bedside investigations
- •Blood tests
- •Imaging
- •Further investigations
- •Management
- •Acute treatment
- •Prevention
- •21 Lumps
- •Introduction
- •History and examination findings
- •Investigations
- •Differential diagnosis
- •Localized lymphadenopathy
- •Generalized lymphadenopathy
- •Splenomegaly
- •22 Focal neurological deficits
- •Introduction
- •History and examination findings
- •History
- •Pattern of deficit
- •Onset
- •Precipitants
- •Progression
- •Evidence of cause
- •Examination
- •The anatomical site of the lesion
- •The underlying cause
- •The resultant disability
- •Investigations
- •Bedside investigations
- •Blood tests
- •Cerebrospinal fluid analysis
- •Imaging
- •Further investigations
- •23 Dizziness and vertigo
- •Introduction
- •History and examination findings
- •History
- •Onset and pattern of vertigo
- •Aural symptoms
- •Neurological symptoms
- •Examination
- •Investigations
- •24 Back pain and joint pain
- •Introduction
- •History and examination findings
- •History
- •Ask about associated features:
- •Other important points to consider include:
- •Examination
- •Investigations
- •Bedside investigations
- •Blood tests
- •Imaging
- •Differential diagnosis
- •Joint disease
- •Back pain
- •25 Skin lesions and rash
- •Introduction
- •History and examination
- •History
- •Examination
- •Investigations
- •Differential diagnosis
- •Pigmented lesions
- •Scaly lesions
- •Vesicular lesions
- •Weepy or pustular lesions
- •Figurate erythema
- •Bullous lesions
- •Papular and nodular lesions
- •Photodermatoses
- •Maculopapular lesions
- •Ulcerated lesions
- •Petechial and purpuric lesions
- •Miscellaneous lesions
- •Introduction
- •History and examination findings
- •Investigations
- •Differential diagnosis
- •Platelet abnormality
- •Thrombocytopenia
- •Platelet dysfunction
- •Coagulation abnormality
- •Vitamin K deficiency
- •Factor deficiency
- •Acquired factor inhibitors
- •Vessel wall abnormalities
- •Hereditary
- •Acquired
- •27 Cardiovascular system
- •Coronary heart disease
- •General overview
- •Risk factors
- •Nonmodifiable risk factors
- •Family history
- •Ethnicity
- •Modifiable risk factors
- •Smoking
- •Poor nutrition
- •Hyperlipidaemia
- •Hypertension
- •Diabetes mellitus
- •Obesity
- •Pathophysiology
- •Clinical features
- •Investigations
- •Electrocardiogram
- •Exercise tolerance test
- •Echocardiography
- •CT coronary angiography
- •Nuclear imaging
- •Coronary angiography
- •Treatment
- •Lifestyle changes
- •Drug agents
- •Antiplatelet drugs
- •Nitrates
- •β-Blockers
- •Calcium channel blockers
- •Potassium channel activators
- •Angiotensin-converting enzyme inhibitors
- •Lipid-lowering drugs
- •Revascularization
- •Acute coronary syndrome
- •ST elevation myocardial infarction
- •General overview
- •Clinical features
- •Investigations
- •Management
- •Acute management
- •Non-ST elevation myocardial infarction and unstable angina
- •General overview
- •Clinical features
- •Investigations
- •Risk scoring
- •Management
- •Acute management
- •Subsequent inpatient management of patients with acute coronary syndrome
- •Complications of myocardial infarction
- •Cardiac failure and cardiogenic shock
- •Cardiac rupture
- •Mitral regurgitation
- •Arrhythmias and conduction disturbances
- •Supraventricular arrhythmias
- •Arrhythmias
- •General overview
- •Investigations
- •Sinus tachycardia
- •Atrial fibrillation
- •Aetiology and pathophysiology
- •Complications
- •Management
- •Atrial flutter
- •Paroxysmal supraventricular tachycardia
- •Atrioventricular reentry tachycardia
- •Atrioventricular nodal reentry tachycardia
- •Management
- •Ventricular tachycardia
- •Torsades de pointes
- •Ventricular fibrillation
- •Bradycardias
- •Sinus bradycardia
- •Sick sinus syndrome
- •Heart block
- •Antiarrhythmic drugs
- •Supraventricular arrhythmias only
- •Supraventricular and ventricular arrhythmias
- •Ventricular arrhythmias
- •Heart failure
- •General overview
- •Aetiology
- •Clinical features
- •Left-sided heart failure
- •Right-sided heart failure
- •Congestive cardiac failure
- •Investigations
- •Blood tests
- •Imaging
- •Other
- •Management of acute heart failure
- •Management of chronic heart failure
- •Drug treatment
- •Angiotensin-converting enzyme inhibitors
- •β-Blockers
- •Diuretics
- •Aldosterone antagonists
- •Hydralazine in combination with a nitrate
- •Digoxin
- •Ivabradine
- •Nondrug therapy
- •Implantable cardioverter defibrillator and cardiac resynchronization therapy
- •Left ventricular assist devices
- •Transplantation
- •Hypertension
- •General overview
- •Clinical features
- •Investigations
- •Management
- •Drug treatment
- •Angiotensin-converting enzyme inhibitors
- •Angiotensin II receptor blockers
- •Calcium channel blockers
- •Thiazide diuretics
- •β-Blockers
- •α-Adrenergic receptor blockers
- •Central acting agents
- •Vasodilators
- •Management of hypertension in pregnancy
- •Malignant (accelerated) hypertension
- •Valvular heart disease
- •General overview
- •Mitral stenosis
- •Clinical features
- •Management
- •Mitral regurgitation
- •Clinical features
- •Management
- •Mitral valve prolapse
- •Aortic stenosis
- •Clinical features
- •Management
- •Aortic regurgitation
- •Clinical features
- •Management
- •Tricuspid regurgitation
- •Pulmonary valve lesions
- •Miscellaneous conditions
- •Pericarditis and pericardial effusion
- •Clinical features
- •Management
- •Constrictive pericarditis
- •Cardiomyopathy
- •Hypertrophic obstructive cardiomyopathy
- •Dilated cardiomyopathy
- •Restrictive/infiltrative cardiomyopathy
- •Arrhythmogenic right ventricular dysplasia
- •Infective endocarditis
- •Clinical features
- •Management
- •Rheumatic fever
- •Major Jones criteria
- •Carditis (40%–50%)
- •Polyarthritis (80%)
- •Sydenham chorea (10%)
- •Erythema marginatum (5%)
- •Subcutaneous nodules (rare)
- •Management
- •Atrial myxomata
- •Congenital heart disease in adults
- •Acyanotic conditions
- •Atrial septal defect
- •Ventricular septal defect
- •Patent ductus arteriosus
- •Aortic coarctation
- •Aortic and pulmonary stenosis
- •Cyanotic conditions
- •Tetralogy of Fallot
- •Further reading
- •28 Respiratory system
- •Respiratory failure
- •General overview
- •Type I respiratory failure
- •Causes
- •Management
- •Type II respiratory failure
- •Causes
- •Management
- •Asthma
- •General overview
- •Aetiology
- •Pathophysiology
- •Clinical features
- •Investigations
- •Management
- •Emergency management
- •Long-term management
- •Chronic obstructive pulmonary disease
- •General overview
- •Aetiology
- •Cigarette smoking
- •α1-Antitrypsin deficiency
- •Occupation
- •Pathophysiology
- •Clinical features
- •Investigations
- •Management
- •Short-term management
- •Long-term management
- •Bronchiectasis
- •General overview
- •Clinical features
- •Investigations
- •Management
- •Pneumonia
- •General overview
- •Aetiology
- •Community-acquired pneumonia
- •Atypical pneumonia
- •Hospital-acquired pneumonia (nosocomial)
- •Aspiration pneumonia
- •Opportunistic pneumonia
- •Clinical features
- •Typical
- •Atypical
- •Investigations
- •Bedside
- •Imaging
- •Other tests
- •CURB65 score
- •Management
- •Pulmonary embolism
- •Clinical features
- •Investigations
- •Management
- •Lung cancer
- •General overview
- •Aetiology
- •Pathology
- •Clinical features
- •Paraneoplastic syndrome
- •Investigations
- •Tumour, Node, Metastasis (TNM) staging
- •Management
- •Tuberculosis
- •General overview
- •Pathogenesis
- •Pulmonary tuberculosis
- •Extrapulmonary tuberculosis
- •Clinical features
- •Systemic
- •Pulmonary
- •Extrapulmonary
- •Investigations
- •Management
- •Pneumothorax
- •General overview
- •Clinical features
- •Management
- •Pleural effusion
- •General overview
- •Clinical features
- •Investigations
- •Management
- •Interstitial lung disease
- •General overview
- •Aetiology
- •Known cause:
- •Unknown cause:
- •Clinical features
- •Investigations
- •Management
- •Idiopathic pulmonary fibrosis
- •Sarcoidosis
- •Occupational lung disease
- •Aspergillus and the lung
- •Hypoventilation syndromes and sleep-related respiratory disorders
- •General overview
- •Obstructive sleep apnoea syndrome
- •Obesity hypoventilation syndrome
- •Congenital hypoventilation syndrome
- •Acute respiratory distress syndrome
- •General overview
- •Management
- •Cystic fibrosis
- •General overview
- •Clinical features
- •Management
- •Further Reading
- •Upper gastrointestinal tract
- •Oesophageal disorders
- •Gastro-oesophageal reflux disease
- •Clinical features
- •Investigations
- •Management
- •Complications
- •Hiatus hernia
- •Sliding hiatus hernia
- •Rolling (or paraoesophageal) hiatus hernia
- •Barrett oesophagus
- •Eosinophilic oesophagitis
- •Oesophageal motility disorders
- •Achalasia
- •Oesophageal cancer
- •Clinical features
- •Investigations
- •Management
- •Gastroduodenal disorders
- •Gastroduodenitis and peptic ulcer disease
- •Clinical features
- •Investigations
- •Management
- •Upper gastrointestinal tract haemorrhage
- •Management
- •Gastric cancer
- •Clinical features
- •Management
- •Gastrointestinal stromal tumour
- •Small bowel disorders
- •Malabsorption
- •Coeliac disease
- •Bacterial overgrowth
- •Tropical sprue
- •Whipple disease
- •Neuroendocrine tumours of the bowel
- •Carcinoid tumours
- •Gastrinoma
- •Insulinomas
- •VIPomas
- •Glucagonomas
- •Lower gastrointestinal tract
- •Colorectal disorders
- •Colorectal neoplasia
- •Benign disease
- •Colorectal cancer
- •Screening
- •Diverticular disease
- •Clinical features
- •Investigations
- •Management
- •Clostridium difficile and pseudomembranous colitis
- •Lower gastrointestinal tract bleeding
- •Ischaemic colitis
- •Microscopic colitis
- •Irritable bowel syndrome
- •Clinical features
- •Investigations
- •Management
- •Nonulcer dyspepsia
- •Inflammatory bowel disease
- •General overview
- •Ulcerative colitis
- •Crohn disease
- •Hepatobiliary system
- •Gallbladder disorders
- •Gallstones and biliary colic
- •Clinical features
- •Investigations
- •Management
- •Acute cholecystitis
- •Clinical features
- •Investigations
- •Management
- •Recurrent cholecystitis
- •Biliary tract cancer
- •Cholangiocarcinoma
- •Gallbladder cancer
- •Cancer of the ampulla of Vater
- •Pancreatic disorders
- •Acute pancreatitis
- •Clinical features
- •Investigations
- •Management
- •Chronic pancreatitis
- •Investigations
- •Management
- •Pancreatic cancer
- •Clinical features
- •Investigations
- •Management
- •Liver disorders
- •Chronic liver disease
- •Established chronic liver disease
- •Hepatitis
- •Acute hepatitis
- •Acute viral hepatitis
- •Hepatitis A
- •Epidemiology
- •Hepatitis B
- •Hepatitis C
- •Investigations
- •Management
- •Autoimmune hepatitis
- •Alcoholic liver disease
- •Pathology
- •Clinical features
- •Investigations
- •Prognosis
- •Nonalcoholic steatohepatitis
- •Haemochromatosis
- •Investigations
- •Management
- •Primary biliary cholangitis
- •Primary sclerosing cholangitis
- •Wilson disease (hepatocellular degeneration)
- •Clinical features
- •Investigations
- •Management
- •Hepatic tumours
- •Benign tumours
- •Malignant tumours
- •Miscellaneous conditions
- •α1-Antitrypsin deficiency
- •Liver abscess
- •Budd–Chiari syndrome
- •Further reading
- •Haematuria and proteinuria
- •Proteinuria
- •Benign proteinuria
- •Pathological proteinuria
- •Overflow proteinuria
- •Clinical Features
- •Investigations
- •Urine
- •Blood tests
- •Imaging
- •Histological diagnosis
- •Acute kidney injury
- •Aetiology
- •Clinical features
- •Investigations
- •Urine
- •Blood tests
- •Other tests
- •Management
- •Hyperkalaemia
- •Acidosis
- •Pulmonary oedema
- •Renal replacement therapies
- •Supportive management
- •Summary
- •Chronic kidney disease
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Prevention of decline in renal function
- •Prevention of complications
- •Cardiovascular
- •Renal osteodystrophy
- •Acidosis
- •Anaemia
- •Hyperkalaemia
- •End-stage renal failure
- •Glomerular disease
- •Clinical features
- •Nephritic syndrome
- •Nephrotic syndrome
- •History
- •Investigations
- •Urine
- •Blood tests
- •Imaging
- •Renal biopsy
- •Management
- •Important primary and secondary glomerular diseases
- •Rapidly progressive glomerulonephritis
- •Antiglomerular basement membrane disease
- •IgA nephropathy
- •Lupus nephritis
- •Minimal change nephropathy
- •Focal segmental glomerulosclerosis
- •Membranous glomerulonephritis
- •Membranoproliferative glomerulonephritis
- •Poststreptococcal glomerulonephritis
- •Urinary tract infections
- •Lower urinary tract infections
- •Upper urinary tract infections
- •Clinical features
- •Investigations
- •Management
- •Renal calculi
- •General overview
- •Clinical features
- •Management
- •Urinary tract malignancies
- •Renal cell carcinoma
- •Transitional cell carcinoma
- •Prostatic carcinoma
- •Testicular cancer
- •Miscellaneous conditions
- •Adult polycystic kidney disease
- •Hepatorenal syndrome
- •Thrombotic microangiopathies
- •Sexually transmitted diseases
- •Chlamydia
- •Gonorrhoea
- •Syphilis
- •Further reading
- •Sodium and water balance
- •Hyponatraemia
- •Investigations
- •Hypernatraemia
- •Focal onset seizures
- •Normal awareness
- •Impaired awareness
- •Focal evolving to bilateral convulsive seizures
- •Generalized onset seizures
- •Tonic–clonic (grand mal) seizures
- •Absence attacks (petit mal)
- •Myoclonic seizure
- •Atonic or akinetic epilepsy
- •Aetiology
- •Hypokalaemia
- •Investigations
- •Management
- •Hyperkalaemia
- •Investigations
- •Management
- •Calcium balance
- •Hypocalcaemia
- •Hypercalcaemia
- •Investigations
- •32 Nervous system
- •Cerebrovascular disease
- •Stroke and TIA
- •Intracerebral haemorrhage
- •Subarachnoid haemorrhage
- •Clinical features
- •Investigations
- •Management
- •Subdural haematoma
- •Extradural haematoma
- •Headache
- •Migraine
- •General overview
- •Clinical features
- •Management
- •Cluster headache
- •Tension-type headache
- •Idiopathic intracranial hypertension
- •Trigeminal neuralgia
- •Persistent idiopathic facial pain (atypical facial pain)
- •Dementia
- •Epilepsy
- •General overview
- •Classification
- •Investigations
- •Bedside
- •Imaging
- •Electroencephalogram
- •Management
- •Drug treatment
- •First-line drugs
- •Second-line drugs
- •Withdrawing drugs
- •Other treatment
- •Status epilepticus
- •Pregnancy and epilepsy
- •Driving and work and epilepsy
- •Sudden unexpected death in epilepsy
- •Intracranial tumours
- •General overview
- •Clinical features
- •Raised intracranial pressure
- •Investigations
- •Management
- •Movement disorders
- •Parkinsonism
- •Clinical features
- •Tremor
- •Rigidity
- •Bradykinesia
- •Other features
- •Management
- •Drug therapy
- •Other therapy
- •Tremor
- •Essential tremor
- •Cerebellar tremor
- •Huntington Disease
- •Sydenham chorea
- •Other movement disorders
- •Multiple sclerosis
- •General overview
- •Pathogenesis
- •Clinical features
- •Optic neuritis
- •Diplopia
- •Sensory symptoms
- •Motor weakness
- •Cerebellar signs
- •Other manifestations
- •Investigations
- •Management
- •Central nervous system infection
- •Meningitis
- •General overview
- •Causative organisms
- •Clinical features
- •Meningism
- •Sepsis
- •Raised intracranial pressure
- •Investigations
- •Management
- •Encephalitis
- •Central nervous system abscess
- •Spinal cord infection
- •Spinal cord disorders
- •Spinal cord compression
- •Subacute combined degeneration of the cord
- •Syringomyelia and syringobulbia
- •Peripheral nervous system disorders
- •Peripheral neuropathy
- •Guillain–Barré syndrome
- •Clinical features
- •Investigations
- •Management
- •Entrapment/compression neuropathies
- •Neuromuscular disorders
- •Muscle disorders
- •Myotonic dystrophy (myotonia dystrophica)
- •Muscular dystrophy
- •Duchenne and Becker muscular dystrophy (pseudohypertrophic)
- •Facioscapulohumeral dystrophy (Landouzy–Dejerine syndrome)
- •Limb girdle dystrophy
- •Neuromuscular junction disorders
- •Myasthenia gravis
- •Clinical features
- •Investigations
- •Management
- •Lambert–Eaton myasthenic syndrome
- •Miscellaneous disorders
- •Motor neurone disease
- •Management
- •Horner syndrome
- •Bulbar and pseudobulbar palsy
- •Bell palsy
- •Further reading
- •Diabetes mellitus
- •Aetiology and Pathophysiology
- •Clinical features
- •Macrovascular disease
- •Microvascular disease
- •Diabetic retinopathy
- •Diabetic nephropathy
- •Diabetic neuropathy
- •Diabetic feet
- •Skin
- •Infections
- •Management
- •Diet and lifestyle
- •Oral hypoglycaemic agents
- •Biguanides
- •Sulphonylureas
- •Meglitinides; rapid-acting insulin secretagogues
- •Thiazolidinediones
- •Dipeptidyl peptidase 4 inhibitors
- •Glucagon-like peptide 1 agonists
- •Acarbose
- •Insulin
- •Diabetes and surgery
- •Diabetic emergencies
- •Hypoglycaemia
- •Diabetic ketoacidosis
- •Hyperosmolar hyperglycaemic state
- •Obesity and metabolic syndrome
- •Lipid disorders
- •Aetiology and pathophysiology
- •Primary hyperlipidaemia
- •Secondary hyperlipidaemia
- •Investigations
- •Management
- •Primary prevention
- •Secondary prevention
- •Drugs
- •Thyroid disease
- •Hypothyroidism
- •Management
- •Hyperthyroidism
- •Management
- •Antithyroid drugs
- •Radioiodine
- •Subtotal thyroidectomy
- •Thyroid emergencies
- •Thyrotoxic crisis (‘thyroid storm’)
- •Myxoedema coma
- •Parathyroid disease
- •Hypoparathyroidism
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Hyperparathyroidism
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Pituitary disorders
- •Hypopituitarism
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Pituitary tumours
- •Clinical features
- •Investigations
- •Management
- •Acromegaly
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Surgery
- •Radiotherapy
- •Medical therapies
- •Prognosis
- •Prolactin disorders
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Diabetes insipidus
- •Cranial diabetes insipidus
- •Nephrogenic diabetes insipidus
- •Management
- •Adrenal disorders
- •Cushing syndrome
- •Clinical features
- •Investigations
- •Management
- •Cushing disease
- •Adrenocortical tumours
- •Ectopic adrenocorticotrophic hormone syndrome
- •Addison disease
- •Aetiology
- •Clinical features
- •Investigations
- •Management
- •Conn syndrome (primary hyperaldosteronism)
- •Clinical features
- •Investigations
- •Management
- •Phaeochromocytoma
- •Clinical features
- •Investigations
- •Management
- •Hypothalamus–pituitary–adrenal axis
- •Dynamic tests for cortisol excess
- •Tests for cortisol deficiency
- •Pituitary function tests
- •Miscellaneous endocrine conditions
- •Multiple endocrine neoplasia
- •Autoimmune polyendocrine syndrome
- •Congenital adrenal hyperplasia
- •Metabolic bone disease
- •Osteoporosis
- •Aetiology
- •Primary osteoporosis
- •Secondary osteoporosis
- •Clinical features
- •Investigations
- •Management
- •General principles
- •Drugs
- •Paget disease
- •Clinical features
- •Investigations
- •Management
- •Bisphosphonates
- •Calcitonin
- •Surgery
- •Osteomalacia
- •Aetiology
- •Clinical features
- •Investigations
- •Biochemistry
- •Imaging
- •Management
- •Renal osteodystrophy
- •Management
- •Further reading
- •34 Musculoskeletal system
- •Osteoarthritis
- •Pathology
- •Clinical features
- •Management
- •Rheumatoid arthritis
- •Pathology
- •Clinical features
- •Management
- •Spondyloarthropathies
- •Ankylosing spondylitis
- •Pathology
- •Clinical features
- •Management
- •Reactive arthritis
- •Pathology
- •Clinical features
- •Management
- •Psoriatic arthritis
- •Enteropathic arthropathies
- •Crystal arthropathy
- •Gout
- •Pathology
- •Clinical features
- •Management
- •Pseudogout
- •Connective tissue disorders
- •Systemic lupus erythematosus
- •Pathology
- •Clinical features
- •Treatment
- •Systemic sclerosis
- •Pathology
- •Clinical features
- •Management
- •Polymyositis and dermatomyositis
- •Pathology
- •Clinical features
- •Management
- •Sjögren syndrome
- •Vasculitis
- •General overview
- •Eosinophilic granulomatosis with polyangiitis
- •Granulomatosis with polyangiitis
- •Henoch–Schönlein purpura
- •Kawasaki disease
- •Microscopic polyangiitis
- •Polyarteritis nodosa
- •Behçet disease
- •Polymyalgia rheumatica and giant cell arteritis
- •Polymyalgia rheumatica
- •Giant cell arteritis
- •Antiphospholipid syndrome
- •35 Skin disease
- •Skin manifestations of systemic disease
- •Diabetes mellitus
- •Inflammatory bowel disease
- •Coeliac disease
- •Hyperthyroidism
- •Malignant disease
- •Sarcoidosis
- •Rheumatic fever
- •Neurofibromatosis
- •Lyme disease (borreliosis)
- •Hyperlipidaemia
- •Skin disease
- •Psoriasis
- •Clinical features
- •Management
- •Eczema/dermatitis
- •Clinical features
- •Management
- •Acne vulgaris
- •Actinic keratosis
- •Seborrhoeic keratosis
- •Herpes simplex
- •Herpes (varicella) zoster
- •Lichen planus
- •Erythema multiforme
- •Stevens–Johnson syndrome and toxic epidermal necrolysis
- •Pemphigus vulgaris and bullous pemphigoid
- •Erythema nodosum
- •Vitiligo
- •Pyoderma gangrenosum
- •Neoplastic disease
- •Basal cell carcinoma
- •Squamous cell carcinoma
- •Malignant melanoma
- •Infections
- •Impetigo
- •Cellulitis
- •Necrotizing fasciitis
- •36 Haematological disorders
- •Anaemia
- •Diagnosis
- •Management
- •Iron replacement
- •Vitamin B12 and folate replacement
- •Blood transfusion
- •Splenectomy
- •Erythropoietin
- •Causes of anaemia
- •Anaemia of chronic disease
- •Clinical features
- •Management
- •Haemolytic anaemia
- •Clinical features
- •Management
- •Sickle cell anaemia
- •Clinical features
- •Management
- •Thalassaemia
- •Clinical features
- •Management
- •Aplastic anaemia
- •Clinical features
- •Management
- •Leukaemia
- •Acute lymphoblastic leukaemia
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Acute myeloid leukaemia
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Chronic lymphocytic leukaemia
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Chronic myeloid leukaemia
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Multiple myeloma
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Lymphoma
- •Hodgkin disease
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Non-Hodgkin lymphoma
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Myelodysplastic syndromes
- •Classification
- •Clinical features
- •Management
- •Myeloproliferative disease
- •Polycythaemia vera
- •Essential thrombocythaemia
- •Primary myelofibrosis
- •Bleeding disorders
- •Haemophilia A
- •Haemophilia B (Christmas disease)
- •Von Willebrand disease
- •Immune thrombocytopenia
- •Disseminated intravascular coagulation
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Thrombotic disorders and thromboembolism
- •Aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Thrombotic thrombocytopenic purpura
- •Haemolytic uraemic syndrome
- •37 Infectious diseases
- •General overview
- •HIV and AIDS
- •Epidemiology and aetiology
- •Pathology
- •Clinical features
- •Primary HIV infection
- •Clinical stage 1
- •Clinical stage 2
- •Clinical stages 3 and 4
- •Treatment and prognosis
- •Prevention
- •Malaria
- •Epidemiology and aetiology
- •Pathology
- •Clinical features
- •Treatment and prognosis
- •Prevention
- •Diarrhoeal disease
- •Drug-resistant bacteria
- •Other resistant bacteria
- •38 Drug overdose and abuse
- •General overview
- •Common presentation, investigations and management
- •History
- •Examination
- •How ill is the patient?
- •Is there any evidence to suggest an underlying cause?
- •Have any complications occurred?
- •Investigations
- •Management
- •Supportive care
- •Preventing absorption
- •Increase elimination of drug
- •Specific antidotes
- •Psychiatric and social assessment
- •Paracetamol overdose
- •Illegal drugs
- •Alcohol misuse and withdrawal
- •Alcohol withdrawal
- •Wernicke encephalopathy/Korsakoff psychosis
- •Long-term treatment
- •Further reading
- •Self-Assessment
- •SBA answers
- •EMQ answers
- •Index
edition
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CRASH
Philip
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Chris
COURSE
Shreelata
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General
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ELSEVIER
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General Medicine
First, second and Third edition authors
Rachael Hough
Iftikhar Ul Haq
Robert Parker
Asheesh Sharma
Fourth edition authors
Oliver A. Leach
Gils I. van Boxel
5
th Edition
CRASH COURSE
SERIES EDITORS
Philip Xiu
MA MB BChir MRCP
GP Registrar
Yorkshire Deanery
Leeds, UK
Shreelata Datta
MD MRCOG LLM BSc (Hons) MBBS
Honorary Senior Lecturer
Imperial College London
Consultant Obstetrician and Gynaecologist
King’s College Hospital
London, UK
FACULTY ADVISOR
Chris Holland
MBBS BAO MMedEd FRCA FFICM FAcadMEd.
Consultant in Critical Care Medicine,
King’s College Hospital NHS Foundation Trust
London & Professorial Teaching Fellow
University of Surrey
Guildford, UK
General Medicine
Kathryn Watson
MBBS, BSc, MRCP, PGCert, FHEA
ST7 Renal and General Medicine
St George’s Hospital NHS Trust
London, UK
Inez Eiben
MBBS, BSc, MRCS
Clinical Fellow in Plastic Surgery
Guys & St Thomas NHS Foundation Trust
London, UK
Paola Eiben
MBBS, BSc, MRCP1
Clinical Fellow in Critical Care Medicine
King’s College Hospital NHS Foundation Trust
London, UK
For additional online content visit StudentConsult.com
Content Strategist: Jeremy Bowes
Content Development Specialist: Alexandra Mortimer
Project Manager: Andrew Riley
Design: Christian Bilbow
Illustration Manager: Karen Giacomucci
Illustrator: MPS North America LLC
Marketing Manager: Deborah Watkins
© 2019, Elsevier Limited. All rights reserved.
First edition 1999
Second edition 2005
Third edition 2008
Fourth edition 2013
Updated Fourth edition 2015
Fifth edition 2019
The right of Kathryn Watson, Inez Eiben and Paola Eiben to be identified as author of this work has been asserted by
them in accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on
how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as
the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted
herein).
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information,
methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent
verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier,
authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-7020-7372-4
eISBN: 978-0-7020-7373-1
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Series Editors’ foreword
The Crash Course series was conceived by Dr Dan Horton-Szar who as series
editor presided over it for more than 15years – from publication of the first
edition in 1997, until publication of the fourth edition in 2011. His inspiration,
knowledge and wisdom lives on in the pages of this book. As the new series
editors, we are delighted to be able to continue developing each book for the
twenty-first century undergraduate curriculum.
The flame of medicine never stands still, and keeping this all-new fifth series
relevant for today's students is an ongoing process. Each title within this new
fifth edition has been re-written to integrate basic medical science and clinical
practice, after extensive deliberation and debate. We aim to build on the success
of the previous titles by keeping the series up-to-date with current guidelines for
best practice, and recent developments in medical research and pharmacology.
We always listen to feedback from our readers, through focus groups and
student reviews of the Crash Course titles. For the fifth editions we have
reviewed and re-written our self-assessment material to reflect today's
‘single-best answer’ and ‘extended matching question’ formats. The artwork
and layout of the titles has also been largely re-worked and are now in colour,
to make it easier on the eye during long sessions of revision. The new on-line
materials supplement the learning process.
Despite fully revising the books with each edition, we hold fast to the principles
on which we first developed the series. Crash Course will always bring you all
the information you need to revise in compact, manageable volumes that still
maintain the balance between clarity and conciseness, and provide sufficient
depth for those aiming at distinction. The authors are junior doctors who have
recent experience of the exams you are now facing, and the accuracy of the
material is checked by a team of faculty editors from across the UK.
We wish you all the best for your future careers!
Philip Xiu and Shreelata Datta
v
Prefaces
Authors
Medicine is developing more rapidly than ever before, along with a plethora of
frequently updated clinical guidelines and a growing number of risk calculating
scoring systems. Our patient population is aging with an increasing number of
medical health and social problems. Furthermore, as doctors we are faced with
the challenges of treating more complex patients in an under resourced and
financially stretched healthcare system. However, despite this evolution and
challenges, a secure grasp and understanding of the basics of medicine remain
paramount. Taking a thorough history by putting the patient at ease, performing
a focussed clinical examination and communicating well with patients and other
healthcare members remains the corner stone of practicing good medicine.
This book serves as a comprehensive revision aid. We have highlighted key
information, red flags, common pitfalls, hints and tips, clinical notes, key ethical
considerations, communication pointers and quick read chapter summaries. There
is particular emphasis on self-assessment in this 5th edition, each chapter gives the
reader an opportunity to test their knowledge and understanding. The assessments
include case-based clinical scenarios, extended matched and multiple choice
questions, ideal preparation for those sitting final medical examinations or preparing
for membership. We have provided the most up-to-date clinical guidance in a quick
to read format, along with online material for further questions and images. This
book provides an interactive resource with knowledge at the finger tips, perfect as a
revision guide from the start of studies to the end.
Kathryn Watson, Inez Eiben and Paola Eiben
Faculty Advisor
The challenge of writing a textbook in the 21st Century is not to be
underestimated. As previous Crash Course Authors, Faculty Advisors and
Series Editors have noted, there is a tension between keeping up-to-date whilst
remaining concise enough to be useful. We have tried to present our readers
with a volume that contains necessary core knowledge, information about
contemporary clinical practice and the most up-to-date evidence and guidance
available at the time of writing. As this volume has been created, I have been
reminded of the excitement of being a medical student about to start clinical
practice and the amazement I felt at realising just how much I had learnt over
the course of my own undergraduate medical education. I hope that this volume
helps the next generations of medical practitioners prepare for a lifetime of
clinical practice and personal satisfaction.
Chris Holland
vi
Acknowledgements
Authors
First and foremost, we would like to thank Chris Holland, our faculty advisor,
with his infective passion for teaching. We would like to thank all the staff at
Elsevier in preparation for the manuscript, in particular Alex Mortimer and
Barbara Simmons. We are extremely grateful to our series editors for their expert
guidance, Philip Xiu and Shreelata Datta, and to be given the unique opportunity
to be part of the institution that is the Crash Course Series.
Kathryn Watson, Inez Eiben and Paola Eiben
Faculty Advisor
As well as echoing the thanks expressed above I would like to add my personal
thanks to the Authors themselves. They have kept to deadlines whilst working
fulltime in clinical practice and produced consistently high-quality work. They
have ensured that my task as faculty advisor has been enjoyable and refreshing.
Chris Holland
vii
Series Editors’ acknowledgements
We would like to thank the support of our colleagues who have helped in the
preparation of this edition, namely the junior doctor contributors who helped
write the manuscript as well as the faculty editors who check the veracity of the
information.
We are extremely grateful for the support of our publisher, Elsevier, whose staffs’
insight and persistence has maintained the quality that Dr Horton-Szar has setout since the first edition. Jeremy Bowes, our commissioning editor, has been a
constant support. Alex Mortimer and Barbara Simmons our development editors
have managed the day-to-day work on this edition with extreme patience and
unflaggable determination to meet the ever looming deadlines, and we are ever
grateful for Kim Benson’s contribution to the online editions and additional online
supplementary materials.
Philip Xiu and Shreelata Datta
ix
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