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FOR

FOUNDATION

THE

FINAL

YEAR

DOCTOR

MEDICAL

AND

STUDENT

TRAINEE

OXFORD

CLINICAL

NEWLY

QUALIFIED

DOCTOR

EDITED

David

AND

Fisher

CONSULTANT

Liora

EDITOR

Wittner

GUIDELINES

Deborah

Gill

Summarizes

medical

Brings

Gives

together

practical

the

students

clinical

and

over

answers

guidelines

newly

115

qualified

guidelines

the

required

for

question

doctors

core

what

final

conditions

year

now

OXFORDCLINICALGUIDELINES

NewlyQualifiedDoctor

OXFORDCLINICALGUIDELINES

NewlyQualified Doctor

EDITEDBY

DavidFisher

SpecialistinInternalMedicine,ClalitHealthcareServices,Israel

LioraWittner

ResidentinFamilyMedicine,ClalitHealthcareServices,Israel

WITHCONSULTANTEDITOR

DeborahGill

Vice-President (Education & Student Experience), University of Southampton, Southampton,UK

GreatClarendonStreet,Oxford,OX26DP, UnitedKingdom

OxfordUniversityPressisadepartmentoftheUniversityofOxford. ItfurtherstheUniversity’sobjectiveofexcellenceinresearch,scholarship,andeducationbypublishing worldwide.OxfordisaregisteredtrademarkofOxfordUniversityPressintheUKandincertainother countries

©OxfordUniversityPress2023

Themoralrightsoftheauthorshavebeenasserted

FirstEditionpublishedin2023

Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or transmitted,inanyformorbyanymeans,withoutthepriorpermissioninwritingofOxfordUniversity Press,orasexpresslypermittedbylaw,bylicenceorundertermsagreedwiththeappropriate reprographicsrightsorganization.Enquiriesconcerningreproductionoutsidethescopeoftheabove shouldbesenttotheRightsDepartment,OxfordUniversityPress,attheaddressabove

Youmustnotcirculatethisworkinanyotherform andyoumustimposethissameconditiononanyacquirer

PublishedintheUnitedStatesofAmericabyOxfordUniversityPress 198MadisonAvenue,NewYork,NY10016,UnitedStatesofAmerica

BritishLibraryCataloguinginPublicationData

Dataavailable

LibraryofCongressControlNumber:2021947301

ISBN978–0–19–883450–2 eISBN978–0–19–257143–4

DOI:10.1093/med/9780198834502.001.0001

OxfordUniversityPressmakesnorepresentation,expressorimplied,thatthedrugdosagesinthisbook arecorrect.Readersmustthereforealwayschecktheproductinformationandclinicalprocedureswith themostup-to-datepublishedproductinformationanddatasheetsprovidedbythemanufacturersandthe mostrecentcodesofconductandsafetyregulations.Theauthorsandthepublishersdonotaccept responsibilityorlegalliabilityforanyerrorsinthetextorforthemisuseormisapplicationofmaterialin thiswork.Exceptwhereotherwisestated,drugdosagesandrecommendationsareforthenon-pregnant adultwhoisnotbreast-feeding

LinkstothirdpartywebsitesareprovidedbyOxfordingoodfaithandforinformationonly.Oxford disclaimsanyresponsibilityforthematerialscontainedinanythirdpartywebsitereferencedinthiswork.

Preface

Evidence-based guidelines have played an increasing role in medical practice in recent years.Healthcareprofessionalsuse guidelinestocontend with theoverwhelmingwealth ofavailableinformationandtotranslatescientificadvancesandnewknowledgeintosafe clinicalcare.

Thepopularityofclinicalguidelineshasledtoanexponentialriseinguidelinesbeing createdsince the 1980s andmodernhealthcareprofessionalsareexpectedtobe familiar with them. The General Medical Council’s (GMC) Good Medical Practice guidance, which records what is expected of every GMC-registered doctor, states: ‘You must be familiar with guidelines … that affect your work’. Such a directive is challenging to uphold.First,therangeofavailableguidelines ineveryspeciality is vast and constantly expanding. Furthermore, individual guidelines can be dense and lengthy, and are thereforeimpracticaltocombthroughfor aprofessionalwishingtoacquaintthemselves quicklywithcurrentclinicalapproaches.

This publication seeks to address that challenge. Written by junior doctors, each chapter summarizes thekeyclinicalevidence-basedguidelines whichshape UKpractice and presents the information in an accessible and concise format. Where relevant, chapters provide brief additional contextualpointsin order to explain the guideline for those less familiar with the field. Junior doctors, in particular foundation doctors, will find this resource useful to rapidly familiarize themselves with the latest clinical guidelines for the commonest conditions that they encounter in both primary and secondarycare.Studentswillfindthisbook useful as a quick referenceguideto better understand the patientjourney. Theycan also useitas a revision aid, as knowledge of guidelinesisincreasinglytestedinmedicalschoolexaminations.

Reading and learning every clinical guideline that is relevant to junior doctors is an arduousandalmostimpossibletask.Wehopethatthisbookhelpstobridgethegapand makesclinicalguidelinesmoreaccessibletojuniordoctors,bothfortheirbenefitandalso forthebenefitofthepatientsthattheytreat.

https://t.me/med1917

Introduction:howtousethisbook

This book contains 123 chapters, covering a wide range of topics within internal medicine, surgery, emergency medicine, paediatrics, obstetrics and gynaecology, and psychiatry. The book is designed to cover the breadth of knowledge expected of a foundation doctoranditispitchedatthislevel.However,wewould expectitto alsobe useful for medical students, specialist nurses, and junior specialist trainees (ST/CT 1–3 level).

Thisbookisintendedtobeconcise.Contentwhichisrelevanttomultiplechapterswill usuallybenotedonceandotherchapterswillsignposttotheprimarymention.

Multipleguidelinesexistforsometopicsandoccasionallytheyconflictwitheachother in terms of their conclusions. It can be challenging for non-specialists to know which guidelinetheyshouldfollow.Eachspecialtysectioninthisbookhasbeenoverseenbyat leastonesenior specialistconsultantwhohasprovided direction inidentifyingthemost relevant and widely used guideline (or guidelines) to base each chapter upon. Readers should be aware thatinstitutions often have their own localprotocols which supersede theguidelinesusedinthispublication.

Theinformationineachchapterreferstoadultpatientsonly,exceptforchaptersinthe Resuscitationsection(Part17)wherepaediatriccontentishighlightedandchaptersinthe Paediatricsection(Part10).Whereadrugissuggestedasatreatmentoption,anydosages mentioned assume an otherwise healthy, non-pregnant adult with normal hepatic and renal function, and of average height and weight. Exceptions include chapters dealing withobstetrics,paediatrics,elderlymedicine,hepatology,andnephrology.Inallcases,the mostrecentBritishNational Formularyorlocalprotocolsshouldbeconsultedtoverify thedrugchoice,dosage,andanycontraindications.

This book includes some investigation and management options that should onlybe consideredundertheguidanceofaseniororspecialistclinician,andtheyarehighlighted assuch.Itisvitalthatjuniorprofessionalsshouldbeawareoftheirownlimitationsand notdoanythingthattheyarenotcompetenttodo.

Finally,pleasenotethattheinformationcontainedwithinthesepagesisforeducational purposesonlyandshouldnotbesolelyreliedupontodirectthemanagementofpatients. Thefullguidelinesarereferencedatthestartofeachchapterandcanbeaccessedonline.

https://t.me/med1917

Acknowledgements

First and foremost, this book would not have been possible without the hard work of each chapter contributor.We are also grateful for thededicationof the Senior Editorial Boardandforallofthereviewsandadvicethattheyprovided.

WeareappreciativeofProfessorDeborahGillforherthoughtfuloversightandhelpful suggestionsoverthecourseofwritingthisbook.

Weare of courseindebtedtothewonderfulteam atOxfordUniversityPress. Weare grateful to each of the project managers that we have been fortunate to work with including Sam Callard, Mark Knowles, Fiona Sutherland, and most recently Sylvia Warren.

Most of all we would like to thank our commissioning editors Elizabeth Reeve and GeraldineJeffers,whohaveprovideduswiththeirwealthofexpertexperienceandhave guidedeverystepofthisprojecttofruition.Theyhavebeenapleasuretoworkwithand wearegratefulfortheirsupport.Asabrand-newconceptwhichtooktimetoperfect,this bookhasbeenalongtimeinthemaking,sofinally,wewouldliketoacknowledgeallthe ‘OCGbabies’borntotheteamsincethestartofthisprocess,Tessa,Aurora,andGidon!

https://t.me/med1917

Contents

A-Zofallconditions

Indexofemergencytopics

Sectioneditors

Contributors

Symbolsandabbreviations

Part1Cardiology

Acutecoronarysyndromes

Acuteheartfailure

Aorticstenosisandmitralregurgitation

Atrialfibrillation

Chronicheartfailure

Hypertension

Pericardialdiseases

Stableangina

Transientlossofconsciousness

Part2Careoftheelderly

Delirium

Dementia

Falls

Hipfractures

https://t.me/med1917

Part3Endocrinology

Adrenalinsufficiency

Diabeticketoacidosis

Hypercalcaemia

Hyperglycaemia

Hyperglycaemichyperosmolarsyndrome

Hyperthyroidism

Hypocalcaemia

Hypoglycaemia

Hyponatraemia

Hypothyroidism

Osteoporosis

Type1diabetesmellitus

Type2diabetesmellitusanddiabeticfootproblems

Part4Gastrointestinal

Acuteuppergastrointestinalbleedingandvaricealbleeding

Coeliacdisease

Crohn’sdisease

Gastro-oesophagealrefluxdiseaseanddyspepsia

Irritablebowelsyndrome

Ulcerativecolitis

Part5Hepatobiliary

Acuteliverfailure

https://t.me/med1917

Alcohol-relatedliverdisease

Alcoholusedisorders

Livercirrhosis

Part6Mentalhealth

Bipolardisorder

Depression

Eatingdisorders

Generalizedanxietydisorder

Panicdisorder

Post-traumaticstressdisorder

Psychosisandschizophrenia

Self-harm

Violenceandaggression

Part7Nephrology

Acutekidneyinjury

Chronickidneydisease

Hyperkalaemia

Part8Neurology

Acuteencephalitis

Epilepsy

Headache

Meningitis

Metastaticspinalcordcompression

https://t.me/med1917

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