Книга_2683_Библиотеки_им_академика_М_И_Перельмана

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Index

Gottron papules, 343 gout, 147t

clinical features, 340 management, 340

pathology, 340 gouty tophi, 14 granulomatosis with polyangiitis, 344 Graves disease, 109 Grey Turner sign, 67 Guillain-Barre´ syndrome

clinical features, 299

investigations, 299

management, 299 guttate psoriasis, 348, 348f

HAART therapy, 376–378 haemarthrosis, 147, 160 haematemesis, 66

differential diagnosis, 75t

examination, 76, 76f

history, 75–76

investigations, 76–79, 77f

Rockall score, 78t haematological disorders

anaemia, 76, 357–362

bleeding disorders, 370–371

clinical features, 8

disseminated intravascular coagulation,

371–372

haemolytic uraemic syndrome, 374 leukaemia, 362–365 lymphoma, 366–369 multiple myeloma, 365–366 myelodysplastic syndromes, 369 myeloproliferative disease, 369–370 thromboembolic disorders, 372–374,

373t

thrombotic thrombocytopenic purpura,

374

haematuria, 96–99

causes, 97t examination, 97–99 history, 97–99 investigation, 98f, 254, 255f

haemochromatosis

classification, 249 investigations, 249–250 management, 250 prevalence, 249

haemoglobin synthesis, 360, 360t haemolysis screen, 92 haemolytic anaemia, 359

autoimmune, 359 clinical features, 359 immune, 359 management, 359 nonimmune, 359

haemolytic uraemic syndrome (HUS),

271, 374

haemophilia A, 370–371

haemophilia B (Christmas disease),

371

haemoptysis, 47

differential diagnosis, 53b examination, 54, 55f history, 53–54 investigations, 54–56

haemorrhage

splinter, 14

subarachnoid, 101, 283 haemostasis, 160 hands, 13–14, 20

clubbing of fingers (see clubbing) HAV. See hepatitis A virus HBV. See hepatitis B virus HCV. See hepatitis C virus HDV. See hepatitis D virus headache, 6, 284–285

atypical facial pain, 285

chronic headache, 102–103

cluster headache, 285

differential diagnosis, 101, 101t

examination, 103–104, 103f

history, 101–103

idiopathic intracranial hypertension,

285

migraine, 102 migraine, 284–285 progressive, 102, 102b recurrent episodic, 102 tension-type headache, 285 trigeminal neuralgia, 285

head impulse test, 143 Heaf test, 218 hearing, altered, 6 heart. See cardiac; cardiovascular heart block, 175, 178 heartburn

causes, 71b examination, 71 history, 71 investigations, 72–73, 72f

heart failure, 180–183

acute, 182 aetiology, 180–181 chronic, 182–183 clinical features, 181 investigations, 181 left-sided, 181 management of, 182–183 right-sided, 181

heart murmurs, 191–192, 194 heart transplantation, 183 heat rash, 154 heaving, 17 Heberden nodes, 14 Helicobacter pylori, 73 hemiplegia, 138t Henoch-Schönlein purpura, 344–345 heparin, 162, 386t

overdose, 385, 386t

hepatic encephalopathy, 245

hepatitis

acute, 246–248 autoimmune, 248

viral, 246–248 hepatitis A virus, 246 hepatitis B virus, 246 hepatitis C virus, 246–247 hepatitis D virus, 247 hepatitis E, 247 hepatobiliary system

biliary tract cancer

cancer of ampulla of vater, 243 cholangiocarcinoma, 242 gallbladder cancer, 242

gallbladder disorders

acute cholecystitis, 242 gallstones and biliary colic, 241–242

liver disorders

abscess, 251 alcoholic liver disease, 248–249

α1-antitrypsin deficiency, 251

Budd–Chiari syndrome, 251–252 chronic liver disease, 244–245 haemochromatosis, 249–250 hepatic tumours, 251 hepatitis, 246–248 nonalcoholic steatohepatitis, 249 primary biliary cholangitis, 250 primary sclerosing cholangitis, 250 Wilson disease, 250–251

pancreatic disorders

acute pancreatitis, 243–244 chronic pancreatitis, 244

pancreatic cancer, 244 hepatocellular screen, 92 hepatomegaly, 22t hepatorenal syndrome (HRS), 271

chronic liver disease, 245 hereditary haemorrhagic telangiectasia, 163 hereditary nonpolyposis colon cancer, 235 hernia, 67 heroin, 385, 387t herpes simplex, 154, 352

and HIV/AIDS, 378, 379t herpes zoster, 154, 155f, 352

and HIV/AIDS, 378, 379t hiatus hernia, 229–230 high-density lipoprotein (LDL), 168 high-dose dexamethasone suppression

test, 328

history taking. See also specific conditions

bedside manner, 1

family history, 2

medical history, 2

medications and allergies, 2

presenting complaint, 1–2

social history, 3, 3f

systems review, 3–8 HIV/AIDS, 375–379

clinical features, 376, 376t

epidemiology and aetiology, 375, 375t

opportunistic infections, 378, 379t

448

Index

HIV/AIDS (Continued)

pathology, 375, 375t prevention, 379 primary HIV infection, 376, 377–378t treatment and prognosis, 376–379, 378f,

379t

hoarseness, 5 Hodgkin disease

aetiology, 367 clinical features, 367, 367f pathology, 367, 367t

treatment and prognosis, 367–368 Holter monitoring, 175 Horner syndrome, 24, 302 hospital acquired (nosocomial)

pneumonia, 210, 212t Huntington disease, 293–294 hydralazine, for heart failure, 182 hydrocephalus, 102 hypercalcaemia, 281

causes of, 281, 281t investigations, 281

treatment of, 281 hyperextensibility, 159 hyperhaemolytic anaemia, 360 hyperkalaemia, 258–259, 262, 278–279

causes of, 278, 278t

EKG changes in, 279, 279f

investigations, 279

management, 279 hyperkeratotic lesions, 156 hyperlipidaemia

and ischaemic heart disease, 168

primary, 314

skin manifestations, 347–348 (see lipid

disorders)

hypernatraemia, 277–278

causes of, 277, 277t hyperosmolar hyperglycaemic state, 313 hyperparathyroidism

aetiology, 318

clinical features, 318

investigations, 318–319

management, 319 hyperprolactinaemia, 322, 322t hypertension, 183–187

clinical features, 184

control in pregnancy, 187

idiopathic intracranial, 167

investigations, 184–185

and ischaemic heart disease, 168

malignant, 187

management, 185–187 hyperthyroidism, 109–110, 316. See also

thyrotoxicosis aetiology, 109 clinical features, 109 investigations, 110 primary, 109 skin manifestations, 347

hypertrophic obstructive cardiomyopathy,

193–194

hypoalbuminaemia, 14t hypocalcaemia, 280–281

causes of, 280, 280t hypoglossal nerve, 28 hypoglycaemia, 311–312 hypokalaemia, 278

causes of, 278, 278t

investigations, 278

management, 278 hyponatraemia, 275–277

diagnostic algorithm, 275, 276f

investigations, 276–277 hypoparathyroidism

aetiology, 317, 318t

clinical features, 317

investigations, 318

management, 318 hypopituitarism

aetiology, 319

clinical features, 319

investigations, 319–320

management, 320 hypothyroidism, 108–109, 316

aetiology, 108

clinical features, 108

investigations, 109

palpitations, 58 hypoventilation syndromes, 224 hypovolaemia, 76

iatrogenic hypothyroidism, 108 iatrogenic pneumothorax, 219 IBD. See inflammatory bowel disease

(IBD) IBS. See irritable bowel syndrome (IBS) icterus. See jaundice idiopathic atrophic thyroiditis, 108 idiopathic pulmonary fibrosis (IPF), 223 IgA nephropathy, 265–266 ileus, 22b illegal drugs, 385, 387t, 388 imaging. See also chest X-ray

abdominal pain, 68 back pain, 147–148 bowel habits, 82–83 cough/haemoptysis, 55 focal neurological deficits, 138–139 glomerular disease, 264 goitre, 108 headache/facial pain, 104 heart failure, 181 hypothyroidism, 109 joint pain, 147–148, 147t pneumonia, 211 proteinuria, 255 stroke, 126 thyroid, 110 urinary symptoms, 96 vertigo, 144 weight loss, 87

immune thrombocytopaenia (ITP), 371 impalpable, 17 impetigo, 155, 355 implantable cardioverter defibrillator, 183 incontinence

urge, 94 urinary, 6

indigestion, 5

causes, 71b examination, 71 history, 71

investigations, 72–73, 72f indurated lesions, 152t infections

cellulitis, 356, 356f

central nervous system

meningitis, 101 impetigo, 355, 355f necrotizing fasciitis, 356 signs of, 119

infectious diseases, 263, 375. See also

specific diseases

HIV/AIDS, 375–379

infective endocarditis, 194–196

clinical features, 194–195 management, 195–196

inflammatory bowel disease (IBD), 340.

See also specific conditions cause, 238 Crohn disease, 240–241 skin manifestations, 347 ulcerative colitis, 239–240

inflammatory markers, 61 infliximab, 240, 337, 338t, 349, 349t insulin, 310, 311f insulinomas, 234 intention tremor, 14 international normalized ratio

(INR), 160

interstitial lung disease (ILD)

aetiology, 222 Aspergillus, 223–224 causes, 222 clinical features, 222 idiopathic pulmonary fibrosis, 223 investigations, 222, 222t management, 222 occupational, 223, 223t sarcoidosis, 223

intertrigo, 154 intraaortic balloon counterpulsation, 182 intracerebral haemorrhage, 283–284 intracranial pressure, raised, 102–103b

intracranial tumours, 290 meningitis, 296

intracranial tumours

clinical features, 290 investigations, 290 management, 290 origins, 289–290, 290t primary brain, 289–290 secondary brain, 289–290

449

Index

intraepidermal squamous cell carcinoma,

154

intrinsic liver disease, 159 iodine-deficient hypothyroidism, 108 iron-deficiency anaemia. See anaemia iron replacement, 357 irritable bowel syndrome (IBS), 237 ischaemic colitis, 237 ischaemic heart disease (IHD), 167–168.

See also cardiovascular disease

(CVD) itching. See pruritus itching, skin lesions, 151 ITP. See immune thrombocytopaenia

(ITP) ivabradine, for heart failure, 183

janeway lesions, 15 jaundice, 5, 13, 16, 67, 76

biochemical abnormalities in, 92t causes, 89–90 differential diagnosis, 90t examination, 90–91, 90f history, 89 investigations, 91–92, 91f

joint(s)

aspiration, 147 examination, 14 joint position sense, 298 swelling, 8

joint disease. See also musculoskeletal

disorders

differential diagnosis, 148, 148f examination, 146–147, 146t history, 145–146 investigations, 147–148

jugular venous pressure (JVP),

15–16, 58

vs carotid pulsation, 16t

jugular venous waveform, abnormalities

of, 16f

Kallmann syndrome, 23 Kartagener syndrome, 224 Kawasaki disease, 345 keratoacanthoma, 354 Kernig sign, 104, 296, 296f ketamine, 385, 387t ketoacidosis, 312–313 kidney

loop of Henle, 93

palpable, 22t, 185f Kimmelstiel–Wilson lesion, 307 Köbner phenomenon, 152t, 353 koilonychia, 13 Kussmaul respiration, 49 kyphoscoliosis, 48

lactate dehydrogenase (LDH), 172, 221 Lambert-Eaton myasthenic syndrome, 301 Landouzy-Dejerine syndrome. See

Facioscapulohumeral dystrophy large cell (anaplastic) carcinoma, 213 lateral sclerosis, primary, 301 lead pipe rigidity, 28, 291 left ventricular assist devices, 183 legs. See lower limb lentigines, 153 leuconychia, 13 leucopoenia, 61 leukaemia

acute lymphoblastic, 362–363, 363t acute myeloid, 363–364, 363–364t chronic lymphocytic, 364–365 chronic myeloid, 365

multiple myeloma, 365–366 levodopa (L-DOPA), 292 Lhermitte sign, 294 lichenification, 152t lichen simplex chronicus, 153 Lichtheim disease, 298 lidocaine, 180 limb girdle dystrophy, 300 limbs

lower (see lower limbs)

upper (see upper limbs) lipid disorders. See also individual drugs

aetiology and pathophysiology, 314

investigations, 314

management, 314–315

skin manifestations, 347–348 lipid-lowering drugs, 170 lipid-regulating drugs, 315 lipoatrophy, 308 lip pursing, 49 lisinopril, 182 liver abscess, 251 liver disease, 159, 162

prothrombin time, 78 liver disorders

abscess, 251

alcoholic liver disease, 248–249

α1-antitrypsin deficiency, 251

Budd–Chiari syndrome, 251–252

chronic liver disease, 244–245

haemochromatosis, 249–250

hepatic tumours, 251

hepatitis, 246–248

nonalcoholic steatohepatitis, 249

primary biliary cholangitis, 250

primary sclerosing cholangitis, 250

Wilson disease, 250–251 liver function tests, 160

focal neurological deficits, 138

PUO, 61 liver tumours, 251 localized lymphadenopathy, 130 loin pain, 6

long synacthen test, 328 loss of consciousness, 4

differential diagnosis, 111t examination, 112–114, 113f history, 111–112 investigations, 114–115

risk factors, 112 low-density lipoprotein (LDL), 168 lower gastrointestinal tract

bleeding, 236–237

Clostridium difficile, 236

colorectal disorders, 234–236

inflammatory bowel disease, 238–241

irritable bowel syndrome, 237

ischaemic colitis, 237

microscopic colitis, 237

nonulcer dyspepsia, 237–238

pseudomembranous colitis, 236 lower limbs

coordination, 31

oedema, 23t

power, 31

reflexes, 31

sensation, 31–32

tone, 30

visual survey, 30 lower urinary tract infections, 267 low-molecular-weight heparin (LMWH),

213

lumbar plexus, 133–135t lumbar puncture, 104 lumps

anatomical distribution and causes, 130t differential diagnosis, 130–131 examination, 129–130 history, 129–130 investigations, 130

lung cancer

aetiology, 214, 214t clinical features, 214–215 five-year survival rates, 214t investigations, 215 management, 215–216, 216t paraneoplastic syndrome, 215, 215t pathology, 214 TNM staging, 215, 216t treatment strategies for, 216t

types, 213 lung disease, 194 lupus nephritis, 266 Lyme disease, 347 lymphadenopathy, 33–34, 76

abdominal pain, 67 lymph node sites, 34f lymphocytosis, 61 lymphoma, 366–369

Hodgkin disease, 367–368, 367t

myeloma and immunoproliferative

disorder, 366–368, 367t

non-Hodgkin, 367f, 368–369, 368t Lynch syndrome. See hereditary

nonpolyposis colon cancer

450

Index

macrophages, 168 macrovascular disease, 307 macule, 152t maculopapular lesions, 156–157 magnesium sulphate, 180 magnetic resonance imaging (MRI), 108,

139, 215

Major Jones criteria, 196 malabsorption, 162, 232–234, 233t malar flush, 16 malaria

clinical features, 380–381, 380t diarrhoeal disease, 381–382,

381–382t

epidemiology and aetiology, 379–380,

380t

pathology, 380, 380f, 380t prevention, 381

treatment and prognosis, 381 malaria transmission cycle, 380, 380f malignancy, 160 malignant disease, 347 malignant melanoma, 354–355, 355f malignant tumours, 251 Mallory-Weiss tear, 75t massive blood loss protocol, 12 MDMA, 385, 387t MDS. See myelodysplastic syndromes

(MDS) medical documentation, 37t medical history, 2 medications, 2. See also specific drugs medullary thyroid carcinoma, 110 mefloquine, 381 meglitinides, 310 melaena, 5

differential diagnosis, 75t examination, 76, 76f history, 75–76 investigations, 76–79, 77f

Rockall score, 78t melanocytic naevus (mole), 153 melanoma, 153, 354–355 melasma, 153 membranoproliferative

glomerulonephritis, 266–267 membranous glomerulonephritis, 266 Ménière disease, 142t meningism, 104b, 296 meningitis, 101

causative organisms, 296 cerebrospinal fluid, 297, 297t clinical features, 296 cryptococcal, 378, 379t investigations, 297

management, 297 menstruation, 6 mephedrone, 385, 387t meralgia paraesthetica, 300 mesalazine, 239–240

metabolic/endocrine disorders, 7

andenal disorders, 323–328 autoimmune polyendocrine syndrome,

329

bone disease, 329–334 congenital adrenal hyperplasia, 329 diabetes mellitus (see diabetes mellitus) lipid disorders, 314–315 metabolic syndrome, 313–314 multiple endocrine neoplasia,

328–329

obesity, 313–314 pituitary disorders, 319–323 thyroid disease, 315–319

methicillin-resistant Staphylococcus aureus

(MRSA), 382

metoprolol, 170 microbiology tests, 62 micropsia, 284 microscopic colitis, 237 microscopic polyangiitis, 345 microvascular disease

diabetic nephropathy, 307–308 diabetic neuropathy, 308 diabetic retinopathy, 307

migraine, 102. See also headache

syndromes clinical features, 284 general overview, 284 management, 284

miliaria, 154 milrinone, 182 minimal change nephropathy, 266 minoxidil, 187 mitral regurgitation, 175, 189–190

clinical features, 189 management, 190

mitral stenosis, 188–189

clinical features, 188 management, 189

mitral valve prolapse, 190 mitral valvotomy scar, 17 monoamine oxidase B inhibitors, 293 monocytosis, 61 mononeuritis, 308 motor neurone disease, 301 motor weakness, 294 mouth, 16 movement disorders

Huntington disease, 293–294 other movement disorders, 294 parkinsonism, 291–293 Sydenham chorea, 294 tremor (see tremor)

MRSA. See Methicillin-resistant

Staphylococcus aureus (MRSA)

multiple endocrine neoplasia, 328–329 multiple myeloma, 365–366

aetiology, 365–366 clinical features, 366 pathology, 366 treatment and prognosis, 366

multiple sclerosis

clinical features, 294–295 diagnosis, 295, 295b investigations, 295 management, 295–296 pathogenesis, 294

muscle disorders

muscular dystrophy, 300 myasthenia gravis, 300–301

myotonic dystrophy, 300 musculoskeletal disease, 138t musculoskeletal disorders, 7–8. See also

specific conditions

musculoskeletal examination

assessment of disability, 33

feel, 33

look, 33

move, 33

visual survey, 33 musculoskeletal system

antiphospholipid syndrome, 346

connective tissue disorders, 341–344

crystal arthropathy, 340–341

giant cell arteritis, 346

osteoarthritis, 335–336

polymyalgia rheumatica, 345–346

rheumatoid arthritis, 336–338

spondyloarthropathies, 336–338

vasculitis, 344–345

Mycobacterium

M. avium complex, 378, 379t

M. tuberculosis, 216–218

myelodysplastic syndromes (MDS), 162,

369

classification, 369, 369t clinical features, 369 management, 369

myelofibrosis, 370

primary, 370

myeloproliferative disease, 162, 369–370

essential thrombocythaemia, 370 polycythaemia vera, 369–370 primary myelofibrosis, 370

myocardial infarction, 169t, 171b myocardial muscle creatine kinase (CK-

MB), 172

myoclonic seizure, 287–288 myotonia, 14 myotonic dystrophy/myotonia

dystrophica, 300

myotonic pupil, 24 myxoedema coma, 317

naevus, 153 nails, 13–14 NASH. See nonalcoholic steatohepatitis

(NASH)

natalizumab, 295–296 National Institute for Health and Care

Excellence (NICE), 170b, 182

451

Index

nausea, 5 nebivolol, 182 neck clinical examinations, 34 necrotizing fasciitis, 356 neoplastic disease, 353–355

basal cell carcinoma, 353–354, 354f, 354t malignant melanoma, 354–355, 355f

squamous cell carcinoma, 354, 354f nephritic syndrome, 263 nephrogenic diabetes insipidus, 323, 323t nephrotic syndrome, 253t, 263 nervous system

clinical signs, 23

cranial nerves, 23–28

symptoms, 6

visual survey, 23–28 neurodegenerative disorder, 287 neuroendocrine tumours. See specific types neurofibromatosis, 347 neuroimaging, 288 neuromuscular examination, 14 neuromuscular junction disorders

clinical features, 300–301

investigations, 301

management, 301 neuropathic ulcers, 157 neutrophilia, 61 NHL. See non-Hodgkin lymphoma (NHL) nicorandil, 170 nifedipine, 170 nitrates, 170 nocturia, 6, 93 nodular lesions, 156 nodule, 152t ‘no known drug allergies’ (NKDA), 2 nonalcoholic steatohepatitis, 249 non-Hodgkin lymphoma (NHL)

aetiology, 368

clinical features, 368

multifactorial cause, 368

pathology, 368, 368t

treatment and prognosis, 368–369 non-nucleoside reverse transcriptase

inhibitors, 378, 378f

non ST elevation myocardial infarction

(NSTEMI), 172–175

nonsteroidal antiinflammatories

(NSAIDs), 337–338 nonulcer dyspepsia, 237–238 non-vitamin K antagonist oral

anticoagulants, 213 Noonan syndrome, 191, 198 NSAIDs. See nonsteroidal

antiinflammatories (NSAIDs) NSTEMI. See non ST elevation myocardial

infarction (NSTEMI) N-terminal pro-B-type natriuretic peptide,

181

nuclear imaging, 169 nucleoside reverse transcriptase inhibitors,

378, 378f

nystagmus, 143

452

OA. See osteoarthritis (OA) obesity, 313–314

and hypertension, 183–187 hypoventilation syndrome, 224 and ischaemic heart disease, 168

obstructive sleep apnoea (OSA)

syndrome, 224 occipital lobe, 290 occupational lung disease, 223, 223t oculomotor nerve, 25–26 oedema, 4. See also swelling

lower limbs, 23, 23t oesophageal cancer, 230 oesophageal disorders

achalasia, 230

Barrett oesophagus, 230

eosinophilic oesophagitis, 230

gastro-oesophageal reflux

disease, 229 hiatus hernia, 229–230 oesophageal cancer, 230 oesophageal motility disorders, 230

oesophageal motility disorders, 230 oesophageal varices, 75t oesophagitis, 75t olfactory nerve, 23 oliguria, 93 omeprazole, 229 Ondine curse, 224 onycholysis, 14 ophthalmoscopy, 24 opiate overdose, 385, 386t opiates, 386t opportunistic infections, 378, 379t opportunistic pneumonia, 210 optic atrophy, 24t optic nerve, 23–25 optic neuritis, 294 oral anticoagulants

treatment, 213 types of, 213

oral hypoglycaemic agents

acarbose, 310 biguanides, 309 dipeptidyl peptidase 4 inhibitors, 310 glucagon-like peptide

1agonists, 310 meglitinides, 310 sulphonylureas, 309–310 thiazolidinediones, 310

oral mucolitics, 209 orthopnoea, 4 orthostatic proteinuria, 253 Osler nodes, 15 Osler-Weber-Rendu disease, 76 osmotic diuresis, 94t osteoarthritis (OA), 147t

clinical features, 335 management, 335–336 pathology, 335, 335f

osteomalacia

aetiology, 332 biochemistry, 332 clinical features, 332 imaging, 332–333

management, 333 osteopenia, 330–331 osteoporosis

aetiology, 330

clinical features, 330

drugs, 330–331

investigations, 330

primary, 330

principles, 330 overflow proteinuria, 254 overnight dexamethasone suppression

test, 328 overriding aorta, 198 oxygen therapy, 204, 204–205t, 208

PA. See psoriatic arthritis (PA) Paco2, 201 Paget disease, 331–332

clinical features, 331–332 features, 331, 331f investigations, 332 management, 332

pain

abdominal, 5 bone, 8t chest, 4 epigastric, 122 loin, 6 musc ula r, 7 sensory testing, 30, 31t

thigh, 4 pallor, 12 palmar erythema, 14t palpation, 17

dyspnoea, 50 palpitations, 4, 178

causes, 57–58

consequences of, 58b

differential diagnosis, 57, 57f

examination, 58, 59f

history, 57

investigations, 58–59 PAN. See polyarteritis nodosa (PAN) Pancoast symptoms, 18 pancreatic cancer, 244 pancreatic disorders

acute pancreatitis, 243–244

chronic pancreatitis, 244

pancreatic cancer, 244 papillary thyroid carcinoma, 110 papilloedema, 24t papular lesions, 156 papule, 152t paracetamol overdose, 385, 386t, 388 paraneoplastic syndrome, 215, 215t

Index

parathyroid disease

hyperparathyroidism, 318–319

hypoparathyroidism, 317–318 parietal lobe, 290 parkinsonism, 138t

clinical features, 291–292

differential diagnosis, 291, 291t

management, 292–293

typical posture in, 291, 292f Parkinson disease, 291 paroxysmal nocturnal dyspnoea, 4 paroxysmal nocturnal haemoglobinuria,

372, 373t

paroxysmal supraventricular tachycardia,

177

past medical history, 2 patch, 152t patent ductus arteriosus (PDA), 197 patients, visual assessment, 12–13 PBC. See primary biliary cholangitis (PBC) peak expiratory flow rate (PEFR), 203 pemphigus, 156 pemphigus vulgaris, 353 penile discharge, 6 peptic ulcer disease, 75t percussion, 50 percutaneous coronary intervention (PCI),

46, 170

pericardial effusion, 192–193 pericarditis, 192–193

clinical features, 192–193 constrictive, 193 management, 193

myocardial infarction and, 175 perilymphatic fistula, 142, 142t perindopril, 182 peripheral nervous system disorder

entrapment/compression neuropathies,

299–300

Guillain-Barré syndrome, 299 peripheral neuropathy, 299–300

peripheral neuropathy, 299 peritonism, 66, 67t pernicious anaemia, 357 persistent idiopathic facial pain. See

atypical facial pain

petechiae, 152t petechial lesions, 157 Peutz–Jeghers syndrome, 76, 235 phaeochromocytoma

clinical features, 327 cortisol deficiency, 328 cortisol excess tests, 328 hypothalamus-pituitary- andrenal axis,

324f, 327–328

investigations, 327 management, 327 pituitary function tests, 328

pharyngoscopy, 55 Philadelphia chromosome, 365 photodermatoses, 156 Pickwickian syndrome, 224

pigmentation, 13 pigmented lesions, 153 pioglitazone, 310 pituitary apoplexy, 319 pituitary disorders

acromegaly, 320–322 diabetes insipidus, 94t, 323 hypopituitarism, 319–320 prolactin disorders, 322–323

tumours, 320 pituitary function tests, 328 pituitary tumours

clinical features, 320

investigations, 320

management, 320

pityriasis versicolor, 154, 154f plaque, 152t plaque psoriasis, 348, 348f plasma viscosity, 366 Plasmodium spp., 380–381, 380–381t platelet

abnormalities, 159, 162

count, 162

dysfunction, 162

function tests, 161 platelet function analyser (PFA), 161 pleural effusion, 221–222

aetiology, 221

clinical features, 221

investigations, 221–222

management, 222 pleural fluid aspiration, 221–222 pleural tap, 211 pleuritic chest pain, 43 PMR. See polymyalgia rheumatica (PMR) Pneumocystis jirovecii, 378, 379t pneumonia, 209–211

aetiology, 210

aspiration, 210

atypical, 210

clinical features, 210

community-acquired (CAP), 210

hospital acquired (nosocomial), 210

investigations, 210–211

management, 211, 212t

opportunistic, 210

severity, 211

typical, 210 pneumothorax

catamenial, 219

clinical features, 219

iatrogenic, 219

management, 219–221, 220f

primary spontaneous, 219

secondary spontaneous, 219

spontaneous, 219

tension, 219

traumatic, 219 polyarteritis nodosa, 345 polyarthritis, 196 polycythaemia vera, 369–370

polydipsia, 93, 95

investigations, 96, 96b psychogenic, 94t

polymyalgia rheumatica

(PMR), 345–346

polymyositis

clinical features, 343 management, 343 pathology, 343

polyuria, 93, 95

differential diagnosis, 94t

investigations, 96 pompholyx, 154 porphyria cutanea tarda, 156 positive tuberculin testing, 218 postherpetic neuralgia, 102 poststreptococcal glomerulonephritis, 267 potassium channel activators, 170 praecordium, 17 prasugrel, 173 pregnancy

and epilepsy, 289

hypertension control, 187 presenting complaint, 1–2 pretibial myxoedema, 109 primary biliary cholangitis, 250 primary hyperaldosteronism. See Conn

syndrome primary hyperlipidaemia, 314 primary hyperthyroidism, 109 primary lateral sclerosis, 301 primary myelofibrosis, 370 primary osteoporosis, 330 primary sclerosing cholangitis, 250 primary spontaneous pneumothorax, 219 primary thyroid lymphoma, 110 procyclidine, 293 progressive bulbar palsy, 301 progressive muscular atrophy, 301 prolactin disorders

aetiology, 322, 322t clinical features, 322–323 investigations, 323

management, 323 propranolol, 317 prostate-specific antigen (PSA), 270 prostatic carcinoma, 270 protein-to-creatinine ratio (PCR), 253–254 proteinuria, 99

benign, 253

blood tests, 254–255

clinical features, 254

definition, 253

differential diagnosis, 254

histological diagnosis, 255–256

investigations, 254–256, 255f

levels, 253, 253t

overflow, 254

pathological, 253–254, 253t

protein-to-creatinine ratio/albumin-to-

creatinine ratio, 254

urine, 254

453

Index

prothrombin time (PT), 160

liver disease, 78 proximal myopathy, 138t pruritus, 3, 4t, 8 pseudobulbar palsy, 302 pseudogout, 341 pseudomembranous colitis, 236

Pseudomonas spp., 382

P. aeruginosa, 210

pseudoxanthoma elasticum, 159 psoriasis, 153, 348–349

clinical features, 348

management, 349, 349t psoriatic arthritis (PA), 339–340 psychiatric abnormalities, 295 pulmonary embolism, 46b, 212–213

clinical features, 212, 212t

investigations, 212–213

management, 213

risk factors, 212 pulmonary fibrosis, 18, 19t

clinical findings, 48, 48t pulmonary oedema, 259 pulmonary rehabilitation, 208 pulmonary stenosis, 198 pulmonary tuberculosis, 217 pulmonary valve lesions, 191–192 pulse, 18

abdominal pain, 66, 67f pulse pressure, 15 pulsus paradoxus, 15 PUO. See pyrexia of unknown origin

(PUO) purpura, 152t purpuric lesions, 157 pustular lesions, 155 pustule, 152t, 155 pyoderma gangrenosum, 347 pyrazinamide, 218 pyrexia, 67 pyrexia of unknown origin (PUO)

causes, 63t definition, 61 differential diagnosis, 62 examination, 61, 62f history, 61 investigations, 61–62

pyuria, 94

‘question mark’ posture, 338 Quincke sign, 14–15, 191

RA. See rheumatoid arthritis (RA) rachitic rosary, 332 radial nerve palsy, 300 radial pulse, 15 radical prostatectomy, 270 radioiodine, 317

radionuclide imaging, 108 radiotherapy, 368

acromegaly, 322 colorectal cancer, 235–236 intracerebral tumours, 290 lung cancer, 215–216 oesophageal cancer, 230

testicular cancer, 270 raloxifene, 330 ramipril, 182 ranitidine, 229 rapidly progressive glomerulonephritis, 265 rasagiline, 293 rashes, 8, 151. See also skin lesions

intertrigo, 154

miliaria, 154

red and scaly, 153f Raynaud phenomenon, 342 reactive arthritis

clinical features, 339

management, 339

pathology, 339 rectal bleeding, 5, 5b, 66 recurrent cholecystitis, 242 reflexes, 30, 30f Refsum disease, 24 relative afferent pupillary defect (RAPD),

renal biopsy

acute kidney injury, 258

glomerular disease, 264 renal calculi

clinical features, 268–269

factors, 268

management, 269 renal cell carcinoma, 269 renal Doppler scan, 258 renal osteodystrophy, 261, 333–334 renal replacement therapies, 259 renal ultrasound, 264 reperfusion, 175 resistant gram-negative bacteria,

382

respiratory disease, 4–5 respiratory failure

type I, 201–202 type II, 202–203

respiratory system

acute respiratory distress syndrome,

224–225

Aspergillus spp., 223–224 asthma, 203 auscultation, 20 blood pressure, 18 bronchiectasis, 209 clinical examination, 17–20 COPD, 206–209 cystic fibrosis, 225–226 expansion, 18–20 face and mouth, 18 hands, 18 hypoventilation syndromes, 224

respiratory system (Continued)

inspection, 18 interstitial lung disease, 222–224 jugular venous pressure, 18 lung cancer, 213–216 occupational lung disease, 223, 223t percussion, 20 pleural effusion, 221–222 pneumonia, 209–211 pneumothorax, 219–221 position, 18 pulmonary embolism, 212–213 pulse, 18 sarcoidosis, 223 sleep-related disorders, 224 tactile fremitus, 20 thorax, 18–20 trachea, 18, 18t tuberculosis, 216–218 visual survey, 17–18

vocal fremitus, 20 resting tremor, 14 restrictive/infiltrative cardiomyopathy, 194 retinopathy, 24, 25t, 307–308 revascularization, 170–171 rheumatic fever, 196

Major Jones criteria, 196

management, 196

skin manifestations, 347 rheumatoid arthritis (RA), 147t

clinical features, 336–337, 336f, 337t

anaemia, 337t extraarticular features, 337t

finger and hand abnormalities, 336f investigations, 336 management, 337–338, 338t

DMARDs, 337–338, 338t

NSAIDs, 337–338

steroids, 337–338

surgery, 337–338 pathology, 336

rickets, 332 rifampicin, 218 riluzole, 301 risedronate, 332 rivaroxaban, 173 Rockall score, 78, 78t Romberg test, 143

salbutamol, 204, 204–205t sarcoidosis, 222t, 223, 347

skin manifestations, 347

scabies, 155, 155f scale, 152t scaly lesions, 153–154 sc ar, 152t sclerodactyly, 14 sclerosing cholangitis, primary, 250 seborrhoeic dermatitis, 153, 153f, 350f, 350t seborrhoeic keratosis, 153, 153f, 352

454

Index

secondary hyperlipidaemia, 314 secondary hyperthyroidism, 109 secondary osteoporosis, 330 secondary spontaneous pneumothorax, 219 second-degree heart block, 178 seizures. See epilepsy; and specific

conditions selegiline, 293 sensory symptoms, 294 sepsis, 225, 296 serology. See also specific conditions

PUO, 61 sex, and ischaemic heart disease, 167 sexually transmitted infections (STIs), 272

Chlamydia trachomatis, 272

gonorrhoea, 272

syphilis, 272–273 shingles, 154. See also herpes zoster short synacthen test, 328 SIADH. See syndrome of inappropriate

secretion of antidiuretic hormone (SIADH)

sickle cell anaemia, 359–360

clinical features, 359–360

management, 360 sick sinus syndrome, 178 sideroblastic anaemia, 369, 369t sigmoidoscopy, 82 simvastatin, 315 sinus bradycardia, 58b, 175, 178 sinus tachycardia, 58b, 175 Sjögren syndrome, 343–344 skeletal deformities, 17 skin diseases, 8, 151b

bullous pemphigoid, 353

eczema/dermatitis, 349–351

erythema multiforme, 353

erythema nodosum, 353

herpes simplex, 352

psoriasis, 348–349

pyoderma gangrenosum, 353

Stevens-Johnson syndrome, 353

systemic disease-related, 347–348

toxic epidermal necrolysis, 353

vitiligo, 353 skin lesions

bullous, 156

candidiasis, 157

cellulitis, 157

erysipelas, 157

examination, 151–152

figurate erythema, 155–156

history, 151

investigations, 152–153

maculopapular, 156–157

papular and nodular, 156

petechial and purpuric, 157

photodermatoses, 156

pigmented, 153

sc aly, 153–154

staphylococcal scalded skin syndrome, 157

Stevens-Johnson syndrome, 157

skin lesions (Continued)

toxic epidermal necrolysis, 157 ulcerated, 157 vesicular, 154–155 weepy/pustular, 155

SLE. See systemic lupus erythematosus

(SLE) sleep pattern, 3 sleep-related disorders, 224 small bowel disorders

bacterial overgrowth, 233 coeliac disease, 233 malabsorption, 232–234, 233t neuroendocrine tumours of

bowel, 234

tropical sprue, 233

Whipple disease, 234 small cell (oat cell) carcinoma, 213 smell, altered, 6 smoking

and COPD, 206, 208

and ischaemic heart disease, 168

lung cancer, 214, 214t social history, 3, 3f SOCRATES mnemonic, 66 sodium homeostasis, 275 somatic neuropathies, 308 spastic paraplegia, 138t speech disturbance, 6, 7t spherocytosis, hereditary, 359 spinal cord disorders

compression, 298, 298t

infections, 298

nerve root lesions, 298

subacute combined degeneration,

298–299

syringomyelia/syringobulbia, 299 splenectomy, 358 splenomegaly, 131 splinter haemorrhages, 14–15 spondyloarthropathies

ankylosing spondylitis, 338–339

enteropathic arthritis, 340

psoriatic arthritis, 339–340

reactive arthritis, 339 spontaneous pneumothorax, 219

primary, 219 spot diagnoses, 13, 13t sputum, 4, 47, 50b

cytology, 215 squamous cell carcinoma, 154, 213, 354 stable angina, 170b staphylococcal scalded skin syndrome, 157 Staphylococcus aureus, methicillin-

resistant, 382 statins, 170, 173–174, 315 status epilepticus, 289 ST elevation myocardial infarction

(STEMI), 171–172 STEMI. See ST-elevation myocardial

infarction (STEMI) sternotomy scar, 17

steroids

asthma, 204–206t COPD, 209 psoriasis, 349

rheumatoid arthritis, 337–338 Stevens-Johnson syndrome, 157, 353 stiffness, 8 Stokes-Adams attacks, 58, 112 stools, appearance of, 5 streptococcal infection, 196 Streptococcus pneumoniae, 296 stress incontinence, 94 stridor, 47–48 stroke, 283

Bamford classification, 124–125t

blood pressure control, 127b

causes and pathophysiology, 122

complications, 125t

differential diagnosis, 122b

examination, 123–125, 124f

history, 122–123

incidence, 121

investigations, 125–126

management, 126–127

prevention, 127

risk factors, 121b

symptoms and signs, 123f

types, 121t strontium ranelate, 330 subacute thyroiditis, 110 subarachnoid haemorrhage, 101, 283 subcutaneous nodules, 152, 196 subdural haematoma, 102, 283–284, 284f subtotal thyroidectomy, 317 sudden unexpected death in epilepsy

(SUDEP), 289 suicide risk, 385, 385b sulphonylureas, 309–310 supraventricular arrhythmias, 175

antiarrhythmic drugs, 179–180

surgery

diabetic patients, 310–311 Paget disease, 332 rheumatoid arthritis, 337–338

splenectomy, 358 sweats, 3 swelling

abdominal, 6

ankle, 4

calf, 4

glandular, 8

joints, 8 Sydenham chorea, 196, 294 syncope, 4, 112. See also loss of consciousness

causes, 111t syndrome of inappropriate secretion of

antidiuretic hormone (SIADH),

275, 276f, 277

causes of, 276–277, 276t syphilis, 157, 272–273 syringobulbia. See syringomyelia syringomyelia, 299

455

Index

systemic disease-related. See specific

conditions

systemic lupus erythematosus (SLE),

341–342

clinical features, 341, 341t investigations, 341 pathology, 341, 341t treatment, 341–342

systemic sclerosis

clinical features, 342, 342f, 343t management, 342 pathology, 342

systems review, 3–8

cardiovascular symptoms, 4 gastrointestinal disease, 5–6 general symptoms, 3 genitourinary systems, 6 haematological symptoms, 8 metabolic and endocrine symptoms, 7 musculoskeletal symptoms, 7–8 neurological symptoms, 6 respiratory symptoms, 4–5 skin symptoms, 8

tapping, 17 tazarotene, 349, 349t teichopsias, 284 temperature, sensory testing, 30, 31t temporal arteritis, 102, 104b temporal lobe, 290 tendons, 14 tenesmus, 5 tension pneumothorax, 219 tension-type headache, 102–103, 285 testicular cancer, 270 tetralogy of Fallot, 198–199 thalassaemia, 360–362

characteristics of, 360, 361t clinical features, 360, 361t management, 362 normal haemoglobin synthesis, 360,

360t

theophylline, 205, 206t thiazide diuretics, 186–187 thiazolidinediones, 310 thigh pain, 4 thiopurine methyltransferase (TPMT),

239–240

third-degree heart block, 178 thrombin time (TT), 160 thrombocytopenia, 157, 162 thromboembolic disorders

aetiology, 372, 373t clinical features, 372–373, 373t haemolytic uraemic syndrome, 374 pathology, 372 risk factors, 372, 373t thrombotic thrombocytopenic purpura,

374

treatment and prognosis, 373–374

456

thrombolysis, 127 thrombotic microangiopathies, 271–272 thrombotic thrombocytopenic purpura,

374

thrusting, 17 thyroid

enlargement, 34t malignancy, 110 status, 35t

thyroid disease, 108–110

emergencies, 317

myxoedema coma, 317

thyrotoxic crisis, 317 hormone production control, 315, 316f hyperthyroidism, 316 hypothyroidism, 316 management, 316–317

antithyroid drugs, 316–317

radioiodine, 317

subtotal thyroidectomy, 317 parathyroid disease, 317–319

thyroid lymphoma, primary, 110 thyroid storm. See thyrotoxic crisis thyrotoxic crisis, 317 thyrotoxicosis, 109, 316. See also

hyperthyroidism

palpitations, 58

ticagrelor, 173 tinea, 153–154, 154f tinnitus, 6 TNM classification, lung

cancer, 215, 216t Todd paresis, 287 tonic-clonic seizures, 287 torsades de pointes, 177–178 total afferent pupillary defect, 24 toxic epidermal necrolysis, 157, 353 toxoplasmosis, 378, 379t transient ischaemic attacks. See stroke transient ischaemic attacks (TIAs), 283.