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Essential Notes for Medical
and Surgical Finals
KAJI SRITHARAN MBBS, BSc, MRCS (Eng)
Specialist Registrar in General Surgery
North West Thames, London
Honorary Research Fellow, SORA, Imperial College London
JONATHAN ROHRER
Clinical Research Fellow
Institute of Neurology
ALEXANDRA C RANKIN MBBS, BSc, MRCP
Clinical Research Fellow
King’s College London
SACHI SIVANANTHAN
Foundation Year Doctor
Conquest Hospital, East Sussex
Boca Raton London New York
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
MA (Cantab), MRCP
and
MBBS, BSc (Hons)
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin and Sachi Sivananthan have asserted
their right under the Copyright, Designs and Patents Act 1998 to be identified as the authors
of this work.
First published 2008 by Radcliffe Publishing
Published 2021 by CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2008 Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin and Sachi Sivananthan
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
ISBN-13: 978-1-84619-169-5 (pbk)
This book contains information obtained from authentic and highly regarded sources. While all
reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the
publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The
publishers wish to make clear that any views or opinions expressed in this book by individual editors,
authors or contributors are personal to them and do not necessarily reflect the views/opinions of the
publishers. The information or guidance contained in this book is intended for use by medical, scientific
or health-care professionals and is provided strictly as a supplement to the medical or other professional’s
own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and
the appropriate best practice guidelines. Because of the rapid advances in medical science, any
information or advice on dosages, procedures or diagnoses should be independently verified. The reader is
strongly urged to consult the relevant national drug formulary and the drug companies’ and device or
material manufacturers’ printed instructions, and their websites, before administering or utilizing any of
the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular
treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the
medical professional to make his or her own professional judgements, so as to advise and treat patients
appropriately. The authors and publishers have also attempted to trace the copyright holders of all
material reproduced in this publication and apologize to copyright holders if permission to publish in this
form has not been obtained. If any copyright material has not been acknowledged please write and let us
know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced,
transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying, microfilming, and recording, or in any information storage
or retrieval system, without written permission from the publishers.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Typeset by Pindar NZ (Egan Reid), Auckland, New Zealand
Contents
Preface iv
About the authors v
Acknowledgements vi
Medicine 1
1
Neurology 3
2 Cardiology 27
3 Respiratory disease 39
4 Gastroenterology 53
5 Renal disease 67
6 Endocrinology and metabolism 76
7 Rheumatology 88
8 Dermatology 97
9 Infectious disease 103
10 Haematology 120
11 Oncology 130
12 Toxicology 132
Surgery 135
13
General surgery 137
14 Vascular surgery 157
15 Urology 168
16 Orthopaedics 176
17 Ophthalmology 189
18 Ear, nose and throat 192
19 Breast disease 195
20 Peri-operative care 199
21 Critical care 206
Glossary 210
Index 215
Preface
Covering both Medicine and Surgery, this is an essential revision companion for
medical students and will prove to be a valuable resource for junior doctors at all
stages of their training.
Examinations for undergraduate medical students and at postgraduate level
can take a number of forms, including Multiple Choice and Extended Matching
Questions, Single Best Answers, Short Notes, Vivas and OSCEs. This book provides
the necessary information to tackle all of these exam formats successfully, and gives
guidance on how to manage each topic competently in clinical practice.
The medical and surgical curricula are divided into over twenty key sections, each
of which concisely cover the relevant information including defi nitions, aetiology,
key clinical features, investigations, and management.
Comprehensive, compact and user-friendly, this book is ideal for the early stages
of revision, for last minute cramming, and for use on the wards.
Kaji Sritharan
Jonathan Rohrer
Alexandra C Rankin
Sachi Sivananthan
June 2008
iv
About the authors
Kaji Sritharan MBBS, BSc, MRCS (Eng)
Kaji trained in medicine at St Mary’s Hospital Medical School and University
College London, and completed her Basic Surgical Training in London. She has
recently completed an MD in the field of Vascular Surgery and is currently a
Specialist Registrar in General Surgery on the North West Thames Rotation. Kaji has
considerable experience in teaching having held posts as an Anatomy Demonstrator
and Tutor in Anatomy and Embryology at Christ Church College, University of
Oxford, and as a PBL-tutor at Imperial College London, where she was also involved
in organising the final MBBS Examinations.
Jonathan Rohrer
Jonathan trained at Oxford and Royal Free and University College Medical School.
He has taken an active interest in medical education and teaching since qualifi cation,
including being Chairman of the Young Fellows Committee of the Royal Society
of Medicine, lecturing in Neurology for fi nals and MRCP, and running a number
of courses including Teaching Skills for junior doctors. He is currently a Clinical
Research Fellow at the Institute of Neurology undertaking a PhD.
Alexandra C Rankin
Alex trained in medicine at St Mary’s Hospital Medical School, Imperial College
London. After graduating from university in 2001, with triple honours and a fi rst
class honours BSc, she rotated through a variety of general medical positions,
obtaining her MRCP in 2004. She commenced her training as a specialist registrar in
renal medicine in January 2005. Alex takes an active interest in both undergraduate
and postgraduate education. She is currently working as a Clinical Research Fellow
at King’s College London.
MA(Cantab), MRCP
MBBS, BSc, MRCP
Sachi Sivananthan
Sachi trained in medicine as a graduate entry medical student at Guy’s, King’s and
St Thomas’ (GKT) Medical School, and is currently a Foundation Year doctor at
Conquest Hospital, East Sussex. She has a keen interest in teaching and was involved
in trialling the peer-teaching of Anatomy at GKT medical school. She was a member
on the Working Group for the International Campaign for Revitalising Academic
Medicine (ICRAM) and was chairperson of the Students’ group. In addition, she sits
on the Council of the Clinical Section and Students’ section of the Royal Society of
Medicine, and has organised a number of Finals OSCE Revision Meetings.
MBBS, BSc (Hons)
v
Acknowledgements
This book would not have been possible without support and advice from the
following individuals:
Dr Catherine Bagot
Dr Rupa Bessant
Mr Imad Bourghli
Dr Richard Board
Dr Kate Childs
Mr Peter Dawson
Mr Ian Franklin
Dr Clare Hooper
Dr Tricia Khoo
Dr Aliki Manoras
Dr Mark Norman
Dr Satish Jayawardene
Dr Frank Post
Dr Nadeem Rahman
Dr Gajan Rajeswaran
Mr TGV Sritharan
Mr Abbad Toma
Mr Andrew Wan
Dr Jason Warren
Dr Mark Westbrook
vi
Medicine
Neurology
1.1. Neurological examination
1.2. Epilepsy
1.3. Dementia
1.4. Acute confusional state (delirium)
1.5. The unconscious patient
1.6. Head injury
1.7. Brain tumours
1.8. Cerebrovascular disease
1.9. Headache
1.10. Meningitis and encephalitis
1.11. Movement disorders
1.12. Speech disorders
1.13. Multiple sclerosis
1.14. Cerebellar disease
1.15. Dizziness
1.16. Cranial nerve disorders
1.17. Disorders of the spine
1.18. Anterior horn cell, nerve root and plexus disease
1.19. Peripheral neuropathies (polyneuropathies)
1.20. Single nerve lesions (mononeuropathies)
1.21. Neuromuscular junction disorders
1.22. Muscle disorders
1.23. Investigations
1
1.1. Neurological examination
The key to neurological diagnosis is pattern recognition, and there are a limited
number of patterns that you need to know. Neurological exami na tion and diagnosis
is sometimes seen as difficult because emphasis is placed on lots of different
individual diseases rather than patterns of disease.
Patients with weakness will fall into one (rarely two) of four syndromes represent ing the stages in the motor pathway from the cortex to the muscle: upper
motor neurone (UMN), lower motor neurone (LMN), neuromuscular junction
(NMJ), and muscle. You should be aware of the classical features for each of these
syndromes.
3