Davidson's Essentials of Medicine, 3rd Edition

Front Cover
IFC
Davidson’s Essentials of Medicine
Davidson’s Essentials of Medicine
Copyright
Contents
Sir Stanley Davidson (1894–1981)
Preface
Acknowledgements
Contributors to Davidson’s Principles and Practice of Medicine, 23rd Edition
List of abbreviations
Picture credits
1 - Clinical decision making
The problem of diagnostic error
Clinical reasoning
Clinical skills and decision making
Use and interpretation of diagnostic tests
Normal values
Factors other than disease that influence results
Operating characteristics
Sensitivity and specificity
Prevalence of disease
Dealing with uncertainty
Cognitive biases
Type 1 and type 2 thinking
Common cognitive biases in medicine
Human factors
Reducing errors in clinical decision making
Cognitive debiasing strategies
History and physical examination
Problem lists and differential diagnosis
Mnemonics and checklists
Red flags and ROWS (rule out worst case scenario)
Using clinical prediction rules and other decision aids
Patient-
2 - Clinical therapeutics and prescribing
Principles of clinical pharmacology
Pharmacodynamics
Drug targets and mechanisms of action
Dose–response relationships
Therapeutic index
Desensitisation and withdrawal effects
Pharmacokinetics
Drug absorption and routes of administration
Enteral (gastrointestinal) administration
Parenteral administration
Other routes of administration
Drug distribution
Volume of distribution, Vd
Drug excretion
Elimination kinetics
Repeated dose regimens
Inter-
Adverse outcomes of drug therapy
Adverse drug reactions (ADRs)
Prevalence of ADRs
Classification of ADRs
Detecting ADRs—pharmacovigilance
Drug interactions
Mechanisms of drug interactions
Avoiding drug interactions
Medication errors
Responding to an error
Drug regulation and management
Drug development and marketing
Licensing new medicines
Drug marketing
Managing the use of medicines
Evaluating evidence
Evaluating cost effectiveness
Implementing recommendations
Prescribing in practice
Decision making in prescribing
Making a diagnosis
Establishing the therapeutic goal
Choosing the therapeutic approach
Choosing a drug
Choosing a dosage regimen
Involving the patient
Stopping drug therapy
Prescribing in special circumstances
Prescribing for patients with renal disease
Prescribing for patients with hepatic disease
Prescribing for elderly patients
Prescribing for women who are pregnant or breastfeeding
Writing prescriptions
Prescribing in hospital
Hospital discharge (‘to take out’) medicines
Prescribing in primary care
Monitoring drug therapy
Clinical and surrogate endpoints
Plasma drug concentration measurement
Timing of samples in relation to doses
Interpreting the results
3 - Poisoning
General approach to the poisoned patient
Triage
History
Clinical examination of the poisoned patient
Clinical examination
Investigations
Psychiatric assessment
Management of the poisoned patient
Poisoning by specific pharmaceutical agents
Paracetamol
Salicylates (aspirin)
Nonsteroidal antiinflammatory drugs
Antidepressant overdose
Cardiovascular medications
Antidiabetic agents
Drugs of misuse
Benzodiazepines
Opioids
Gamma hydroxybutyrate
Cocaine
Amphetamines
Cannabis
Synthetic cannabinoid receptor agonists
d-Lysergic acid diethylamide (LSD)
Volatile substances
Body packers and stuffers
Alcohol misuse and dependence
Consequences of alcohol misuse
Diagnosis
Management
Chemicals and pesticides
Carbon monoxide
Clinical features
Management
Organophosphorus insecticides and nerve agents
Paraquat
Methanol and ethylene glycol
Food-
Drinking water contamination
Envenoming
4 - Acute medicine and critical illness
Acute medicine
The decision to admit to hospital
Ambulatory care
Presenting problems in acute medicine
Chest pain
Presentation
Clinical assessment
Initial investigations
Acute breathlessness
Presentation
Clinical assessment
Initial investigations
Syncope/Presyncope
Presentation
Clinical assessment
Initial investigations
Delirium
Presentation
Clinical assessment
Investigations and management
Headache
Presentation
Clinical assessment
Initial investigations
Unilateral leg swelling
Presentation
Clinical assessment
Investigations and management
Identification and assessment of deterioration
Immediate assessment of the deteriorating patient
C—Control of obvious problem
A and B—airway and breathing
C—circulation
D—disability
E—exposure and evidence
Deciding where to manage the patient
Common presentations of deterioration
Tachypnoea
Pathophysiology
Assessment and management
Hypoxaemia
Pathophysiology
Assessment and management
Tachycardia
Pathophysiology
Assessment and management
Hypotension
Pathophysiology
Assessment and management
Hypertension
Pathophysiology
Assessment and management
Decreased conscious level
Assessment
Management
Oliguria/deteriorating renal function
Assessment
Diagnosis and management
Disorders causing critical illness
Sepsis and the systemic inflammatory response
Acute respiratory distress syndrome
Aetiology and pathogenesis
Diagnosis and management
Acute circulatory failure (cardiogenic shock)
Postcardiac arrest
Acute management
Prognosis
Other causes of multiorgan failure
Critical care medicine
Decisions around intensive care admission
Stabilisation and institution of organ support
Respiratory support
Noninvasive respiratory support
High-
Continuous positive airway pressure (CPAP)
Noninvasive (bi-
Intubation and intermittent positive pressure ventilation (IPPV)
Ventilator modes
Ventilator-
Extracorporeal respiratory support
Venous-venous ECMO
Venous-arterial ECMO
Extracorporeal carbon dioxide removal
Cardiovascular support
Initial resuscitation
Fluid and vasopressor use
Advanced haemodynamic monitoring
Mechanical cardiovascular support
Intraaortic balloon pump
Renal support
Neurological support
Daily clinical management in intensive care
Clinical review
Sedation and analgesia
Delirium in intensive care
Weaning from respiratory support
Spontaneous breathing trials
Progressive reduction in pressure support ventilation
Extubation
Tracheostomy
Nutrition
Other essential components of intensive care
Thromboprophylaxis
Glucose control
Blood transfusion
Peptic ulcer prophylaxis
Complications and outcomes of critical illness
Adverse neurological outcomes
Brain injury
ICU-
Other long-
The older patient
Withdrawal of active treatment and death in intensive care
Futility
Death
Donation after cardiac death
Postmortem examination
Discharge from intensive care
Critical care scoring systems
5 - Infectious disease
Principles of infectious disease
Clinical examination of patients with infectious disease
Detection of infection
Reservoirs of infection
Transmission of infection
Healthcare associated infections
Prevention of infection
Outbreak control
Immunisation
Presenting problems in infectious diseases
Fever
Pyrexia of unknown origin
Investigations and management
Prognosis
Fever in the injection drug user
Clinical assessment
Management
Fever in the immunocompromised host
Severe skin and soft tissue infections
Necrotising fasciitis
Gas gangrene
Acute diarrhoea and vomiting
Clinical assessment
Investigations
Management of acute diarrhoea
Infections acquired in the tropics
Fever acquired in the tropics
Clinical assessment
Investigations
Diarrhoea acquired in the tropics
Eosinophilia acquired in the tropics
Clinical assessment
Investigations
Skin conditions acquired in the tropics
Infection issues in adolescence
Infection issues in pregnancy
Viral infections
Systemic viral infections with exanthem
Measles
Clinical features
Management
Rubella (German measles)
Parvovirus B19
Human herpesvirus 6 and 7
Chickenpox
Shingles (herpes zoster)
Complications
Systemic viral infections without exanthem
Mumps
Complications
Management and prevention
Influenza
Clinical features
Infectious mononucleosis and Epstein-
Clinical features
Complications
Investigations
Management
Cytomegalovirus
Dengue
Investigations
Management and prevention
Yellow fever
Management
Viral haemorrhagic fevers
Zika virus
Viral infections of the skin
Herpes Simplex Virus 1 and 2
Complications
Management
Human herpesvirus 8
Enterovirus infections
Poxvirus infections
Gastrointestinal viral infections
Norovirus (Norwalk agent)
Rotavirus
Other viruses
MERS-
Covid-19
Prion diseases
Bacterial infections
Bacterial infections of the skin, soft tissues and bones
Staphylococcal infections
MRSA
Staphylococcal TSS
Streptococcal infections
Streptococcal scarlet fever
Streptococcal TSS
Cellulitis, erysipelas and impetigo
Systemic bacterial infections
Brucellosis
Clinical features
Investigations
Management
Clinical features
Investigations
Management
Louse-
Tick-
Leptospirosis
Clinical features
Investigations
Management and prevention
Plague
Investigations
Management
Listeriosis
Typhoid and paratyphoid (enteric) fevers
Clinical features
Complications
Investigations
Management
Tularaemia
Melioidosis
Gastrointestinal bacterial infections
Food Poisoning
Staphylococcal food poisoning
Bacillus cereus
Ingestion of the preformed enterotoxins of B. cereus leads to rapid onset of vomiting and some diarrhoea within hours of food co...
Clostridium perfringens
Campylobacter jejuni
Salmonella spp
Escherichia coli
Clostridium difficile infection
Yersinia enterocolitica
Cholera
Clinical features
Investigations and management
Vibrio parahaemolyticus
Bacillary dysentery (shigellosis)
Respiratory bacterial infections
Diphtheria
Clinical features
Management
Prevention
Pneumococcal infection
Anthrax
Management
Bacterial infections with neurological involvement
Mycobacterial infections
Tuberculosis
Leprosy
Clinical features
Borderline cases
Leprosy reactions
Investigations
Management
Prognosis
Prevention and control
Rickettsial and related intracellular bacterial infections
Spotted fever group
Typhus group
Investigation of rickettsial infection
Management of the rickettsial diseases
Q Fever
Clinical features
Investigations
Management
Bartonellosis
Investigations
Management
Chlamydial infections
Trachoma
Clinical features
Investigations and management
Protozoal infections
Systemic protozoal infections
Malaria
Life cycle
Clinical features
Investigations
Management
Prevention
Babesiosis
African trypanosomiasis (sleeping sickness)
Clinical features
Investigations
Management
American trypanosomiasis (Chagas’ disease)
Clinical features
Investigations
Management
Toxoplasmosis
Clinical features
Investigations
Management
Leishmaniasis
Life cycle
Visceral leishmaniasis (Kala-
Clinical features
Investigations
Differential diagnosis
Management
Response to treatment
HIV–visceral leishmaniasis co-
Post-kala-azar dermal leishmaniasis
Prevention and control
Mucosal leishmaniasis
Investigations in CL and ML
Management of CL and ML
Prevention of CL and ML
Gastrointestinal protozoal infections
Amoebiasis
Clinical Features
Investigations
Management
Giardiasis
Cryptosporidiosis
Intestinal nematodes
Ancylostomiasis (hookworm)
Clinical features
Investigations
Management
Strongyloidiasis (threadworm)
Clinical features
Investigations
Management
Ascaris lumbricoides (roundworm)
Clinical features
Investigations
Management
Enterobius vermicularis (threadworm)
Clinical features
Investigations
Management
Trichuris trichiura (whipworm)
Tissue-
Lymphatic filariasis
Clinical features
Investigations
Management
Loiasis
Clinical features
Investigations
Management
Onchocerciasis (river blindness)
Clinical features
Investigations
Management
Dracunculiasis (Guinea worm)
Zoonotic nematodes
Trichinosis (trichinellosis)
Clinical features
Investigations
Management
Cutaneous larva migrans
Trematodes (flukes)
Schistosomiasis
Clinical features
Investigations
Management
Liver flukes
Cestodes (tapeworms)
Intestinal tapeworm
Cysticercosis
Clinical features
Investigations
Management and prevention
Echinococcus granulosus (Taenia echinococcus) and hydatid disease
Clinical features
Investigations
Management and prevention
Fungal infections
Subcutaneous mycoses
Chromoblastomycosis
Investigations
Management
Mycetoma (eumycetoma and actinomycetoma)
Clinical features
Investigations
Management
Sporotrichosis
Investigations
Management
Systemic mycoses
Aspergillosis
Candidiasis
Management
Cryptococcosis
Histoplasmosis
Clinical features
Investigations
Management
Coccidioidomycosis
Paracoccidioidomycosis
Blastomycosis
Sexually transmitted bacterial infections
Syphilis
Gonorrhoea
Chlamydial infection
Sexually transmitted viral infections
Herpes simplex
Human papilloma virus and anogenital warts
HIV infection
Global epidemic and regional patterns
Virology and immunology
Diagnosis and initial testing
Clinical manifestations of HIV
Primary HIV infection
Asymptomatic infection
Minor HIV-
AIDS
Presenting problems in HIV infection
Lymphadenopathy
Weight loss
Fever
Mucocutaneous disease
Gastrointestinal disease
Hepatobiliary disease
Respiratory disease
Pneumocystis jirovecii pneumonia
Pulmonary tuberculosis
Nervous system and eye disease
Rheumatological problems
Haematological problems
Renal disease
Cardiac disease
Management of HIV
Prevention of opportunistic infections
Antiretroviral therapy
Pregnancy, HIV and ART
Pre-exposure prophylaxis
Post-exposure prophylaxis
6 - Clinical biochemistry and metabolic medicine
Biochemical investigations
Water and electrolyte homeostasis
Presenting problems in sodium and water balance
Hypovolaemia
Clinical features
Investigations
Management
Hypervolaemia
Management
Water homeostasis
Hyponatraemia
Investigations
Management
Hypernatraemia
Management
Potassium homeostasis
Hypokalaemia
Clinical features
Investigations
Management
Hyperkalaemia
Clinical features
Investigations
Management
Acid-base homeostasis
Metabolic acidosis
Metabolic alkalosis
Management
Respiratory acidosis
Respiratory alkalosis
Mixed acid-base disorders
Calcium homeostasis
Magnesium homeostasis
Hypomagnesaemia
Clinical features
Management
Hypermagnesaemia
Clinical features
Management
Phosphate homeostasis
Hypophosphataemia
Clinical features
Management
Hyperphosphataemia
Clinical features
Management
Disorders of amino acid metabolism
Phenylketonuria
Homocystinuria
Disorders of carbohydrate metabolism
Lipids and lipoprotein metabolism
Hypercholesterolaemia
Hypertriglyceridaemia
Mixed hyperlipidaemia
Management of dyslipidaemia
Nonpharmacological management
Pharmacological management
Other biochemical disorders
Amyloidosis
Investigations
Management
The porphyrias
Clinical features
Investigations
Management
7 - Nephrology and urology
Presenting problems in renal and urinary tract disease
Oliguria/anuria
Clinical examination of the kidney and urinary tract
Anchor 571
Haematuria
Nephritic syndrome
Proteinuria
Oedema
Investigations
Management
Hypertension
Loin pain
Dysuria
Frequency
Polyuria
Nocturia
Urinary incontinence
Glomerular diseases
Glomerulonephritis
Diseases presenting with nephrotic syndrome
Focal segmental glomerulosclerosis
Membranous nephropathy
Diseases presenting with mild nephritic syndrome
Mesangiocapillary glomerulonephritis
Diseases presenting with rapidly progressive glomerulonephritis
Antiglomerular basement membrane disease
Infection-
Tubulo-
Acute interstitial nephritis
Investigations
Management
Chronic interstitial nephritis
Papillary necrosis
Genetic renal diseases
Isolated defects of tubular function
Cystic kidney diseases
Adult polycystic kidney disease
Clinical features
Investigations and screening
Management
Other cystic diseases
Renal vascular diseases
Renal artery stenosis
Clinical features
Investigations
Management
Acute renal infarction
Diseases of small intrarenal vessels
Renal involvement in systemic disorders
Diabetes mellitus
Multiple myeloma
Hepatic–renal disease
Sarcoidosis
Systemic vasculitis
Small-
Systemic sclerosis
Systemic lupus erythematosus
Sickle-
Acute kidney injury
Clinical features
Management
Recovery from AKI
Chronic kidney disease
Clinical features
Investigations
Management
Treatment of complications
Renal replacement therapy
Conservative treatment
Haemodialysis
Haemofiltration
Peritoneal dialysis
Renal transplantation
Drugs and the kidney
Urinary tract infection
Clinical features
Investigations
Management
Persistent or recurrent UTI
Asymptomatic bacteriuria
Acute pyelonephritis
Clinical features
Investigations and management
Tuberculosis
Clinical features
Investigations and management
Reflux nephropathy
Clinical features
Investigations
Management and prognosis
Urolithiasis
Clinical features
Investigations
Management
Diseases of the collecting system and ureters
Congenital abnormalities
Retroperitoneal fibrosis
Tumours of the kidney and urinary tract
Renal cell cancer
Clinical features
Investigations
Management and prognosis
Urothelial tumours
Clinical features and investigations
Management and prognosis
Urinary incontinence
Urge incontinence
Continual incontinence
Overflow incontinence
Postmicturition dribble
Clinical assessment and investigations
Prostatic disease
Benign prostatic enlargement
Clinical features
Investigations
Management
Prostate cancer
Clinical features
Investigations
Management and prognosis
Testicular tumours
Erectile dysfunction
8 - Cardiology
Chest pain on exertion
Severe prolonged chest pain
Clinical assessment
Investigations
Breathlessness
Syncope
Palpitation
Clinical assessment
Investigation and management
Cardiac arrest
Abnormal heart sounds and murmurs
Heart failure
Epidemiology
Pathophysiology
Investigations
Management of acute pulmonary oedema
Drug treatment
Nondrug therapies
Cardiac arrhythmias
Clinical features
Investigations
Management
Sick sinus syndrome
Atrial arrhythmias
Atrial fibrillation
Clinical features
Investigation and management
Thromboprophylaxis
Supraventricular tachycardia
Atrioventricular nodal re-entrant tachycardia
Management
Atrioventricular re-entrant tachycardia
Management
Ventricular premature beats
Ventricular tachycardia
Management
Torsades de pointes
Management
Atrioventricular block
First-
Second-
Third-
Clinical features
Management
Bundle branch block
Antiarrhythmic drugs
Nonpharmacological treatment of arrhythmias
Electrical cardioversion
Defibrillation
Temporary pacemakers
Permanent pacemakers
Implantable cardiac defibrillators
Cardiac resynchronisation therapy
Catheter ablation therapy
Coronary artery disease
Angina pectoris
Clinical features
Investigations
Management
Antianginal drug therapy
Nonpharmacological treatments
Acute coronary syndrome
Clinical features
Other recognised peri-
Management
Rehabilitation
Prognosis
Peripheral arterial disease
Clinical features
Investigations
Management
Buerger’s disease–thrombangitis obliterans
Raynauld’s syndrome
Diseases of the aorta
Aortic aneurysms
Clinical features
Investigation
Management
Aortic dissection
Clinical features
Investigation
Management
Marfan’s syndrome
Clinical features
Investigations
Management
Hypertension
Clinical features
Investigations
Management
Accelerated hypertension
Diseases of the heart valves
Acute rheumatic fever
Clinical features
Investigations
Management
Chronic rheumatic heart disease
Mitral stenosis
Clinical features
Investigations
Management
Mitral regurgitation
Clinical features
Investigations
Management
Aortic stenosis
Clinical features
Investigations
Management
Aortic regurgitation
Clinical features
Investigations
Management
Tricuspid stenosis
Tricuspid regurgitation
Pulmonary stenosis
Pulmonary regurgitation
Prosthetic valves
Infective endocarditis
Microbiology
Clinical features
Investigations
Management
Prevention
Congenital heart disease
Persistent ductus arteriosus
Coarctation of the aorta
Atrial septal defect
Ventricular septal defect
Eisenmenger’s syndrome
Tetralogy of Fallot
Adult congenital heart disease
Diseases of the myocardium
Myocarditis
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Cardiac tumours
Diseases of the pericardium
Acute pericarditis
Clinical features
Investigations
Management
Pericardial effusion
Chronic constrictive pericarditis
Management
9 - Respiratory medicine
PRESENTING PROBLEMS IN RESPIRATORY DISEASE
Cough
Breathlessness (dyspnoea)
CLINICAL EXAMINATION OF THE RESPIRATORY SYSTEM
Chronic exertional breathlessness
How is your breathing at rest and overnight?
How much can you do on a good day?
Did you have breathing problems in childhood or at school?
Do you have other symptoms with your breathlessness?
Acute severe breathlessness
Chest pain
Finger clubbing
Haemoptysis
The ‘incidental’ pulmonary nodule
Pleural effusion
Management
Empyema
Clinical features
Investigations
Management
Respiratory failure
Chronic and ‘acute on chronic’ type II respiratory failure
Home ventilation for chronic respiratory failure
Lung transplantation
Obstructive pulmonary diseases
Asthma
Clinical features
Investigations
Management
Pharmacological treatment
Exacerbations of asthma
Management of mild to moderate exacerbations
Management of acute severe asthma
Chronic obstructive pulmonary disease
Clinical features
Investigations
Management
Acute exacerbations of COPD
Bronchiectasis
Clinical features
Investigations
Management and prognosis
Cystic fibrosis
Clinical features
Management and prognosis
Infections of the respiratory system
Upper respiratory tract infections
Pneumonia
Community-acquired pneumonia
Clinical features
Investigations
Management
Complications
Follow-
Hospital-acquired pneumonia
Management and prognosis
Suppurative and aspiration pneumonia (including pulmonary abscess)
Pneumonia in the immunocompromised patient
Clinical features and investigations
Management
Tuberculosis
Clinical features
Investigations
Chemotherapy
Control and prevention
TB and HIV/AIDS
Drug-
Vaccines
Prognosis
Opportunistic mycobacterial infection
Respiratory diseases caused by fungi
Allergic bronchopulmonary aspergillosis
Investigations
Management
Chronic pulmonary aspergillosis
Simple aspergilloma
Invasive pulmonary aspergillosis
Tumours of the bronchus and lung
Lung cancer
Clinical features
Investigations
Management and prognosis
Secondary tumours of the lung
Tumours of the mediastinum
Interstitial and infiltrative pulmonary diseases
Diffuse parenchymal lung disease
Idiopathic interstitial pneumonias
Idiopathic pulmonary fibrosis
Clinical features
Investigations
Management
Non-specific interstitial pneumonia
Sarcoidosis
Clinical features
Investigations
Management
Lung diseases attributed to systemic inflammatory disease
Acute respiratory distress syndrome
Respiratory involvement in connective tissue disorders
Pulmonary eosinophilia and vasculitides
Lung diseases attributed to irradiation and drugs
Occupational and environmental lung disease
Occupational airway disease
Pneumoconiosis
Lung diseases attributed to organic dusts
Hypersensitivity pneumonitis
Clinical features
Investigations
Management
Asbestos-
Pulmonary vascular disease
Venous thromboembolism
Clinical features
Investigations
Management
Prognosis
Pulmonary hypertension
Diseases of the upper airway
Diseases of the nasopharynx
Allergic rhinitis
Management
Sleep-
The sleep apnoea/hypopnoea syndrome
Clinical features
Investigations
Differential diagnosis
Management
Laryngeal disorders
Laryngeal paralysis
Laryngeal obstruction
Management
Tracheal disorders
Tracheal obstruction
Clinical features
Management
Tracheo-
Management
Pleural disease
Pneumothorax
Clinical features
Investigations
Management (Fig. 9.15)
Diseases of the diaphragm
Deformities of the chest wall
10 - Endocrinology
Clinical examination in endocrine disease
Presenting problems in endocrine disease
The thyroid gland
Presenting problems in thyroid disease
Thyrotoxicosis
Clinical assessment
Investigations
Management
Hypothyroidism
Clinical assessment
Investigations
Management
Symptoms of hypothyroidism with normal thyroid function tests
Asymptomatic abnormal thyroid function tests
Thyroid lump or swelling
Clinical assessment and investigations
Management
Autoimmune thyroid disease
Graves’ disease
Graves’ thyrotoxicosis
Management
Thyrotoxicosis in pregnancy
Graves’ ophthalmopathy
Pretibial myxoedema
Hashimoto’s thyroiditis
Transient thyroiditis
Subacute (de Quervain’s) thyroiditis
Postpartum thyroiditis
Iodine-
Iodine deficiency
Iodine-
Amiodarone
Simple and multinodular goitre
Simple diffuse goitre
Multinodular goitre
Clinical features and investigations
Management
Thyroid neoplasia
Toxic adenoma
Differentiated carcinoma
Management
Anaplastic carcinoma and lymphoma
Medullary carcinoma
Riedel’s thyroiditis
The reproductive system
Presenting problems in reproductive disease
Delayed puberty
Investigations
Management
Precocious puberty
Amenorrhoea
Clinical assessment
Investigations
Management
Male hypogonadism
Investigations
Management
Infertility
Clinical assessment
Investigations
Management
Gynaecomastia
Hirsutism
Polycystic ovarian syndrome
Clinical features
Management
Turner’s syndrome
Klinefelter’s syndrome
The parathyroid glands
Presenting problems in parathyroid disease
Hypercalcaemia
Clinical assessment
Investigations
Management
Hypocalcaemia
Clinical assessment
Management
Primary hyperparathyroidism
Management
Hypoparathyroidism
Pseudohypoparathyroidism
The adrenal glands
Presenting problems in adrenal disease
Cushing’s syndrome
Clinical assessment
Investigations
Management
Therapeutic use of glucocorticoids
Adverse effects of glucocorticoids
Management of glucocorticoid withdrawal
Adrenal insufficiency
Clinical assessment
Investigations
Management
Incidental adrenal mass
Primary hyperaldosteronism
Clinical assessment
Investigations
Management
Phaeochromocytoma and paraganglioma
Clinical features
Investigations
Management
Congenital adrenal hyperplasia
Investigations
Management
The endocrine pancreas and GI tract
Presenting problems in endocrine pancreas disease
Spontaneous hypoglycaemia
Clinical assessment
Investigations
Management
Gastroenteropancreatic neuro-endocrine tumours
Investigations
Management
The hypothalamus and the pituitary gland
Presenting problems in hypothalamic and pituitary disease
Hypopituitarism
Clinical assessment
Investigations
Management
Pituitary tumour
Clinical assessment
Investigations
Management
Hyperprolactinaemia/galactorrhoea
Clinical assessment
Investigations
Management
Prolactinoma
Management
Pregnancy
Acromegaly
Clinical features
Investigations
Management
Craniopharyngioma
Diabetes insipidus
Investigations
Management
Diseases affecting multiple endocrine glands
Multiple endocrine neoplasia
Autimmune polyendocrine syndromes
11 - Diabetes mellitus
Functional anatomy and physiology
Regulation of insulin secretion
Regulation of glucagon secretion
Blood glucose homeostasis
Clinical examination of the patient with diabetes
Investigations
Urine glucose
Blood glucose
Interstitial glucose
Urine and blood ketones
Glycated Hb
Islet autoantibodies
C-
Urine protein
Establishing the diagnosis of diabetes
Aetiology and pathogenesis of diabetes
Type 1 diabetes
Genetic predisposition
Environmental predisposition
Metabolic disturbances in type 1 diabetes
Type 2 diabetes
Insulin resistance and the metabolic syndrome
Pancreatic β cell failure
Genetic predisposition
Environmental and other risk factors
Metabolic disturbances in type 2 diabetes
Other forms of diabetes
Presenting problems in diabetes mellitus
Hyperglycaemia
Diabetes presenting through complications
Diabetes emergencies
Diabetic ketoacidosis
Clinical assessment
Investigations
Management
Hyperglycaemic hyperosmolar state
Hypoglycaemia
Clinical assessment
Management
Prevention of hypoglycaemia
Management of diabetes
Patient education, diet and lifestyle
Healthy eating
Carbohydrate
Fat
Salt
Weight management
Exercise
Alcohol
Driving
Ramadan
Drugs to reduce hyperglycaemia
Biguanides
Sulphonylureas
α-­Glucosidase inhibitors
Thiazolidinediones
Incretin-
Sodium and glucose transporter 2 inhibitors
Insulin
Subcutaneous multiple dose insulin therapy
Insulin dosing regimens
Transplantation
Management of diabetes in special situations
Diabetes in pregnancy
Gestational diabetes
Management of gestational diabetes
Pregnancy in women with established diabetes
Surgery and diabetes
Preoperative assessment
Perioperative management
Complications of diabetes
Diabetic eye disease
Diabetic nephropathy
Diagnosis and screening
Management
Diabetic neuropathy
Clinical features
Management
The diabetic foot
12 - Gastroenterology
Presenting problems in gastrointestinal disease
Dysphagia
Dyspepsia
Clinical examination of the gastrointestinal tract
Heartburn and regurgitation
Vomiting
GI bleeding
Acute upper GI haemorrhage
Management
Lower GI bleeding
Severe acute lower GI bleeding
Subacute or chronic lower GI bleeding
Major GI bleeding of unknown cause
Occult GI bleeding
Diarrhoea
Acute diarrhoea
Chronic or relapsing diarrhoea
Malabsorption
Weight loss
History and examination
Investigations
Constipation
Abdominal pain
The acute abdomen
Management
Chronic or recurrent abdominal pain
Constant abdominal pain
Disorders of nutrition
Obesity
Aetiology
Complications
Clinical features and investigations
Management
Under-
Starvation and famine
Clinical features
Investigations
Management
Under-
Nutritional support of the hospital patient
Refeeding syndrome
Ethical aspects
Intestinal failure (‘short bowel syndrome’)
Management
Vitamin deficiency
Diseases of the mouth and salivary glands
Diseases of the oesophagus
Gastro-oesophageal reflux disease
Clinical features
Complications
Investigations
Management
Other causes of oesophagitis
Motility disorders
Pharyngeal pouch
Achalasia of the oesophagus
Clinical features and investigations
Management
Other oesophageal motility disorders
Tumours of the oesophagus
Carcinoma of the oesophagus
Clinical features and investigations
Management and prognosis
Perforation of the oesophagus
Diseases of the stomach and duodenum
Gastritis
Peptic ulcer disease
Gastric and duodenal ulcer
Pathophysiology
Clinical features and investigations
Management
Complications of gastric resection or vagotomy
Complications of peptic ulcer
Zollinger–Ellison syndrome
Functional disorders
Functional dyspepsia
Clinical features and investigations
Management
Functional vomiting
Gastroparesis
Tumours of the stomach
Gastric carcinoma
Clinical features
Investigations
Management and prognosis
Gastric lymphoma
Diseases of the small intestine
Disorders causing malabsorption
Coeliac disease
Clinical features
Investigations
Management
Complications
Dermatitis herpetiformis
Tropical sprue
Small bowel bacterial overgrowth (‘blind loop syndrome’)
Whipple’s disease
Bile acid diarrhoea
Short bowel syndrome
Radiation enteritis and proctocolitis
Management
Miscellaneous disorders of the small intestine
Protein-
Meckel’s diverticulum
Infections of the small intestine
Travellers’ diarrhoea, giardiasis and amoebiasis
Abdominal tuberculosis
Investigations and management
Tumours of the small intestine
Benign tumours
Malignant tumours
Adenocarcinomas
Neuro
Lymphoma
Inflammatory bowel disease
Crohn’s disease
Complications
Investigations
Management
Ulcerative colitis
Crohn’s disease
Crohn’s disease
Microscopic colitis
Irritable bowel syndrome
Clinical features and investigations
Ischaemic gut injury
Acute small bowel ischaemia
Acute colonic ischaemia
Chronic mesenteric ischaemia
Disorders of the colon and rectum
Tumours of the colon and rectum
Polyps and polyposis syndromes
Colorectal cancer
Clinical features
Investigations and management
Diverticulosis
Clinical features
Investigations and management
Constipation and disorders of defecation
Anorectal disorders
Faecal incontinence
Haemorrhoids (‘piles’)
Pruritus ani
Solitary rectal ulcer syndrome
Anal fissure
Anorectal abscesses and fistulae
Diseases of the peritoneal cavity
Peritonitis
Tumours
Endometriosis
Diseases of the pancreas
Acute pancreatitis
Clinical features and complications
Investigations
Management and prognosis
Chronic pancreatitis
Clinical features and complications
Investigations
Management
Congenital abnormalities of the pancreas
Annular pancreas
Cystic fibrosis
Tumours of the pancreas
Clinical features
Investigations
Management
Pancreatic neuro
13 - Hepatology
CLINICAL EXAMINATION OF THE ABDOMEN FOR LIVER AND BILIARY DISEASE
Acute liver failure
Clinical assessment
Investigations
Management
Abnormal liver function tests
Jaundice
Prehepatic jaundice
Hepatocellular jaundice
Obstructive (cholestatic) jaundice
Clinical assessment
Hepatomegaly
Ascites
Pathophysiology
Clinical assessment
Investigations
Management
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Hepatic encephalopathy
Clinical assessment
Management
Cirrhosis
Clinical features
Portal hypertension
Clinical features
Management
Primary prevention of variceal bleeding
Management of acute variceal bleeding
Secondary prevention of variceal bleeding
Congestive ‘portal hypertensive’ gastropathy
Infections and the liver
Viral hepatitis
Clinical features of acute infection
Investigations
Management
Hepatitis A
Investigations
Management
Hepatitis B
Investigations
Management
Prevention
Co-
Hepatitis D (delta virus)
Hepatitis C
Investigations
Management
Hepatitis E
Other forms of viral hepatitis
HIV infection and the liver
Liver abscesses
Pyogenic liver abscess
Clinical features
Investigations
Management and prognosis
Hydatid cysts and amoebic liver abscesses
Alcoholic liver disease
Clinical features
Investigations
Management
Non-alcoholic fatty liver disease
Clinical features
Investigations
Management and prognosis
Autoimmune liver and biliary disease
Autoimmune hepatitis
Clinical features
Investigations
Management
Primary biliary cholangitis
Clinical features
Diagnosis and investigations
Management
Primary sclerosing cholangitis
Clinical features
Investigations
Management and prognosis
Liver tumours
Primary malignant tumours
Hepatocellular carcinoma
Clinical features
Investigations
Management
Fibrolamellar hepatocellular carcinoma
Secondary malignant tumours
Haemangiomas
Cystic liver disease
Drugs and the liver
Types of liver injury
Inherited liver diseases
Haemochromatosis
Hereditary haemochromatosis
Clinical features
Investigations
Management and prognosis
Secondary haemochromatosis
Wilson’s disease
Clinical features
Investigations
Management
Alpha1-antitrypsin deficiency
Gilbert’s syndrome
Cystic fibrosis
Vascular liver diseases
Hepatic arterial disease
Portal venous disease
Hepatopulmonary syndrome
Portopulmonary hypertension
Hepatic venous disease
Budd–Chiari syndrome
Clinical features
Investigations
Management
Sinusoidal obstruction syndrome (veno-
Cardiac disease
Nodular regenerative hyperplasia of the liver
Pregnancy and the liver
Obstetric cholestasis
Acute fatty liver of pregnancy
Toxaemia of pregnancy and HELLP
Liver transplantation
Cholestatic and biliary disease
Cholestasis
Chemical cholestasis
Benign recurrent intrahepatic cholestasis
Intrahepatic biliary disease
Inflammatory and immune disease
Congenital hepatic fibrosis
Cystic fibrosis
Extrahepatic biliary disease
Choledochal cysts
Secondary biliary cirrhosis
Gallstones
Clinical features
Investigations
Management
Cholecystitis
Acute cholecystitis
Clinical features
Investigations
Management
Chronic cholecystitis
Acute cholangitis
Choledocholithiasis
Clinical features
Investigations
Management
Tumours of the gallbladder and bile duct
Carcinoma of the gallbladder
Cholangiocarcinoma
Carcinoma at the ampulla of vater
Miscellaneous biliary disorders
Postcholecystectomy syndrome
Functional biliary sphincter disorders
14 - Haematology and transfusion medicine
Presenting problems in blood disease
Anaemia
Clinical assessment
Investigations
High haemoglobin
Leucopenia (low white count)
Leucocytosis (high white count)
Lymphadenopathy
Splenomegaly
Bleeding
Normal haemostasis
Clinical assessment
Investigations
Thrombocytopenia (low platelets)
Thrombocytosis (high platelets)
Blood products and transfusion
Blood products
Adverse effects of transfusion
Red cell incompatibility
Transfusion reactions
Safe transfusion procedures
Transfusion in major haemorrhage
Chemotherapy
Haematopoietic stem cell transplantation
Allogeneic HSCT
Graft-versus-host disease
Autologous HSCT
Anticoagulant and antithrombotic therapy
Heparin
Heparin-
Coumarins
Direct oral anticoagulants
Anaemias
Iron deficiency anaemia
Investigations
Management
Anaemia of chronic disease
Megaloblastic anaemia
Vitamin B12
Causes of vitamin B12 deficiency
Folate
Management of megaloblastic anaemia
Haemolytic anaemia
Red cell enzymopathies
Autoimmune haemolytic anaemia
Warm autoimmune haemolysis
Cold agglutinin disease
Alloimmune haemolytic anaemia
Infection
Haemoglobinopathies
Sickle-
Clinical features
Investigations
Management and prognosis
Thalassaemias
Beta-
Alpha-
Haematological malignancies
Leukaemias
Acute leukaemia
Investigations
Management
Specific therapy
Supportive therapy
Haematopoietic stem cell transplantation
Prognosis
Chronic myeloid leukaemia
Clinical features
Investigations
Management
Chronic lymphocytic leukaemia
Clinical features
Investigations
Management and prognosis
Myelodysplastic syndromes
Lymphomas
Hodgkin’s lymphoma
Clinical features
Investigations
Management and prognosis
Non-Hodgkin lymphoma
Clinical features
Investigations
Management
Prognosis
Paraproteinaemias
Monoclonal gammopathy of uncertain significance
Waldenström’s macroglobulinaemia
Multiple myeloma
Clinical features and investigations
Management
Prognosis
Aplastic anaemias
Primary idiopathic acquired aplastic anaemia
Clinical features and investigations
Management
Secondary aplastic anaemia
Myeloproliferative neoplasms
Myelofibrosis
Clinical features
Investigations
Management
Essential thrombocythaemia
Polycythaemia rubra vera
Clinical features
Investigations
Management and prognosis
Bleeding disorders
Disorders of primary haemostasis
Thrombocytopenia
Idiopathic thrombocytopenic purpura
Management
Coagulation disorders
Congenital bleeding disorders
Haemophilia A
Clinical features and investigations
Management
Complications of therapy
Haemophilia B (Christmas disease)
Von Willebrand’s disease
Clinical features
Investigations
Management
Acquired bleeding disorders
Disseminated intravascular coagulation
Liver disease
Renal disease
Thrombotic disorders
Venous thromboembolism
Management of VTE
Prevention of venous thrombosis
Disseminated intravascular coagulation
Investigations
Management
Thrombotic thrombocytopenic purpura
15 - Rheumatology and bone disease
Presenting problems in musculoskeletal disease
Acute monoarthritis
Polyarthritis
Clinical examination of the musculoskeletal system
Fracture
Clinical Assessment
Investigations
Management
Generalised musculoskeletal pain
Regional musculoskeletal pain
Back pain
Clinical assessment
Investigations
Management
Neck pain
Shoulder pain
Elbow pain
Hand and wrist pain
Lower limb pain
MUSCLE PAIN AND WEAKNESS
Principles of management of rheumatological disorders
Non-pharmacological interventions
Pharmacological treatment
Analgesia
Non-steroidal anti-inflammatory drugs
Disease-modifying antirheumatic drugs
Glucocorticoids
Biologics
Anti-
Rituximab
Topical agents
Osteoarthritis
Clinical features
Generalised nodal OA
Knee OA
Hip OA
Spine OA
Investigations
Management
Crystal-
Gout
Clinical Features
Investigations
Management
Calcium pyrophosphate dihydrate crystal deposition
Clinical features
Investigations
Management
Fibromyalgia
Clinical features and investigations
Bone and joint infections
Septic arthritis
Clinical features
Investigations
Management
Viral arthritis
Osteomyelitis
Clinical features and investigations
Management
Discitis
Tuberculosis
Rheumatoid arthritis
Clinical features
Systemic features
Investigations
Management
Juvenile idiopathic arthritis
Spondyloarthropathies
Axial spondyloarthropathy
Clinical features
Investigations
Management and prognosis
Reactive arthritis
Clinical features
Investigations
Management
Psoriatic arthropathy
Clinical features
Investigations
Management and prognosis
Enteropathic (spondylo)arthritis
Autoimmune connective tissue disease
Systemic lupus erythematosus
Clinical features
Investigations
Management
Systemic sclerosis
Clinical features
Investigations
Management and prognosis
Mixed connective tissue disease
Primary Sjögren’s syndrome
Clinical features
Investigations
Management
Polymyositis and dermatomyositis
Clinical features
Investigations
Management
Vasculitis
Antineutrophil cytoplasmic antibody-associated vasculitis
Takayasu arteritis
Kawasaki’s disease
Polyarteritis nodosa
Giant cell arteritis and polymyalgia rheumatica
Clinical features
Investigations
Management
Eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome)
Henoch–Schönlein purpura
Cryoglobulinaemic vasculitis
Behçet’s disease
Diseases of bone
Osteoporosis
Clinical features
Investigations
Nonpharmacological interventions
Pharmacological interventions
Osteomalacia, rickets and vitamin D deficiency
Clinical features
Investigations
Management
Paget’s disease of bone
Clinical features
Investigations
Management
Scheuermann’s osteochondritis
Osteogenesis imperfecta
Primary bone tumours
16 - Neurology
Presenting problems in neurological disease
Headache and facial pain
Ocular pain
Facial pain
Clinical examination of the nervous system
Dizziness, blackouts and ‘funny turns’
Status epilepticus
Coma
Delirium
Amnesia
Transient global amnesia
Persistent amnesia
Weakness
The motor system
Clinical assessment of weakness
Facial nerve palsy (Bell’s palsy)
Sensory disturbance
Numbness and paraesthesia
Sensory loss in peripheral nerve lesions
Sensory loss in nerve root lesions
Sensory loss in spinal cord lesions
Sensory loss in brainstem lesions
Sensory loss in hemispheric lesions
Neuropathic pain
Abnormal movements
Tremor
Other hyperkinetic syndromes
Abnormal perception
Altered balance and vertigo
Abnormal gait
Abnormal speech and language
Dysphonia
Dysarthria
Dysphasia
Disturbance of smell
Visual disturbance and ocular abnormalities
Visual disturbance
Eye movement disorders
Double vision
Nystagmus
Ptosis
Abnormal pupillary responses
Optic disc swelling
Optic atrophy
Hearing disturbance
Bulbar symptoms–dysphagia and dysarthria
Bladder, bowel and sexual disturbance
Bladder
Rectum
Erectile failure and ejaculation failure
Personality change
Functional symptoms
Stroke
Acute stroke
Pathophysiology
Cerebral infarction
Intracerebral haemorrhage
Clinical features
Investigations
Neuroimaging
Vascular imaging
Cardiac investigations
Management
Reperfusion (thrombolysis and thrombectomy)
Aspirin and heparin
Coagulation abnormalities
Management of risk factors
Carotid endarterectomy and angioplasty
Subarachnoid haemorrhage
Clinical features
Investigations
Management
Cerebral venous disease
Cortical vein thrombosis
Cerebral venous sinus thrombosis
Headache syndromes
Tension-
Clinical features
Management
Migraine
Clinical features
Management
Medication overuse headache
Management
Management
Epilepsy
Clinical features
Focal seizures
Generalised seizures
Investigations
Single seizure
Epilepsy
Management
Prognosis
Nonepileptic attack disorder (‘dissociative attacks’)
Vestibular disorders
Sleep disorders
Hypersomnolence
Parasomnias
Neuro-
Multiple sclerosis
Clinical features
Investigations
Management
Acute disseminated encephalomyelitis
Clinical features
Investigations
Management
Transverse myelitis
Paraneoplastic neurological disease
Clinical features
Investigations
Management
Neurodegenerative diseases
Degenerative causes of dementia
Alzheimer’s disease
Clinical features
Investigations and management
Fronto-
Lewy body dementia
Wernicke–Korsakoff syndrome
Movement disorders
Idiopathic Parkinson’s disease
Clinical features
Investigations
Management: drug therapy
Management: nonpharmacological
Other parkinsonian syndromes
Multiple systems atrophy
Progressive supranuclear palsy
Wilson’s disease
Huntington’s disease
Ataxias
Motor neuron disease
Clinical features
Investigations
Management and prognosis
Infections of the nervous system
Meningitis
Viral meningitis
Clinical features
Investigations
Management
Bacterial meningitis
Clinical features
Investigations
Management
Tuberculous meningitis
Clinical features
Investigations
Management and prognosis
Parenchymal viral infections
Viral encephalitis
Clinical features
Investigations
Management
Brainstem encephalitis
Rabies
Clinical features
Investigations
Management
Prevention
Poliomyelitis
Clinical features
Investigations
Management
Subacute sclerosing panencephalitis
Progressive multifocal leucoencephalopathy
Parenchymal bacterial infections
Cerebral abscess
Clinical features
Investigations
Management and prognosis
Spinal epidural abscess
Neurosyphilis
Clinical features
Investigations
Management
Diseases caused by bacterial toxins
Tetanus
Clinical features
Investigations and management
Prevention
Botulism
Prion diseases
Creutzfeldt–Jakob disease
Variant CJD
Intracranial mass lesions and raised intracranial pressure
Raised intracranial pressure
Brain tumours
Primary and secondary brain tumours
Clinical features
Investigations
Management
Prognosis
Acoustic neuroma
Clinical features
Investigations and management
Neurofibromatosis
Von Hippel–Lindau disease
Hydrocephalus
Normal pressure hydrocephalus
Idiopathic intracranial hypertension
Clinical features
Investigations
Management
Disorders of the spine and spinal cord
Cervical spondylosis
Cervical radiculopathy
Clinical features
Investigations
Management
Cervical myelopathy
Clinical features
Investigations
Management and prognosis
Lumbar spondylosis
Lumbar disc herniation
Clinical features
Investigations
Management
Lumbar canal stenosis
Spinal cord compression
Clinical features
Investigations
Management
Intrinsic diseases of the spinal cord
Diseases of peripheral nerves
Entrapment neuropathy
Multifocal neuropathy (mononeuritis multiplex)
Polyneuropathy
Guillain–Barré syndrome
Clinical features
Investigations
Management and prognosis
Chronic polyneuropathy
Hereditary neuropathy
Chronic demyelinating polyneuropathy
Brachial plexopathy
Lumbosacral plexopathy
Spinal root lesions
Disorders of the neuromuscular junction
Myasthenia gravis
Clinical features
Investigations
Management
Lambert–Eaton myasthenic syndrome
Diseases of muscle
Muscular dystrophies
Clinical features
Investigations
Management
Inherited metabolic myopathies
Acquired myopathies
17 - Medical ophthalmology
Investigation of visual disorders
Perimetry
Imaging
Visual electrophysiology
Presenting problems in ophthalmic disease
Watery/dry eye
Pruritus
Pain/headache
Red eye
White eye
Photophobia/glare
Photopsia
Blurred vision
Loss of vision
Distortion of vision
Eyelid retraction
Optic disc swelling
Proptosis
Specialist ophthalmological conditions
Ocular inflammation
Sjögren’s syndrome
Peripheral ulcerative keratitis
Scleritis
Episcleritis
Uveitis
Infectious conditions
Conjunctivitis
Infectious keratitis/corneal ulceration
Endophthalmitis
Cataract
Diabetic eye disease
Diabetic retinopathy
Pathogenesis
Clinical features
Management of proliferative diabetic retinopathy
Management of diabetic macular oedema
Prevention
Screening
Other causes of visual loss in people with diabetes
Retinal vascular occlusion
Retinal vein occlusion (thrombosis)
Retinal artery occlusion
Age-
18 - Dermatology
Clinical examination in skin disease
Rashes
Blisters
Itch
Photosensitivity
Clinical assessment
Investigations and management
Leg ulcers
Leg ulceration as a result of arterial disease
Leg ulceration as a result of vasculitis
Leg ulceration as a result of neuropathy
Investigations
Management
Abnormal pigmentation
Hair and nail abnormalities
Acute skin failure
Skin tumours
Malignant tumours
Basal cell carcinoma
Management
Squamous cell carcinoma
Management
Actinic keratosis
Bowen’s disease
Cutaneous lymphoma
Melanoma
Clinical features
Diagnosis
Management
Benign skin lesions
Keratoacanthoma
Freckles
Lentigines
Basal cell papilloma
Melanocytic naevi
Clinical features
Management
Common skin infections and infestations
Bacterial infections
Impetigo
Staphylococcal scalded skin syndrome
Toxic shock syndrome
Folliculitis, furuncles and carbuncles
Cellulitis and erysipelas
Mycobacterial infections
Erythrasma
Viral infections
Herpes virus infections
Papillomaviruses and viral warts
Clinical features
Management
Molluscum contagiosum
Orf
Fungal infections
Infestations
Scabies
Head lice
Acne and rosacea
Acne vulgaris
Rosacea
Eczema
Atopic eczema
Seborrhoeic eczema
Discoid eczema
Irritant eczema and allergic contact eczema
Asteatotic eczema
Gravitational eczema
Lichen simplex
Pompholyx
Psoriasis and other erythematous scaly eruptions
Psoriasis
Pityriasis rosea
Lichenoid eruptions
Lichen planus
Urticaria
Clinical features
Investigations
Management
Bullous diseases
Toxic epidermal necrolysis
Immunobullous diseases
Bullous pemphigoid
Clinical features and diagnosis
Management
Pemphigus
Clinical features and diagnosis
Management
Dermatitis herpetiformis
Pigmentation disorders
Decreased pigmentation
Vitiligo
Clinical features
Management
Oculocutaneous albinism
Increased pigmentation
Hair disorders
Alopecia
Investigations
Management
Hypertrichosis
Hirsutism
Nail disorders
Normal variants
Nail trauma
Nail involvement in systemic disease
Skin disease in general medicine
Conditions involving cutaneous vasculature
Vasculitis
Pyoderma gangrenosum
Pressure sores
Connective tissue disease
Lupus erythematosus
Systemic sclerosis
Morphoea
Dermatomyositis
Granulomatous disease
Granuloma annulare
Necrobiosis lipoidica
Sarcoidosis
Porphyria
Cutaneous porphyrias: fragility and blisters
Cutaneous porphyria: pain on sun exposure
Abnormal deposition disorders
Xanthomas
Amyloidosis
Genetic disorders
Neurofibromatosis
Tuberous sclerosis
Reactive disorders
Erythema multiforme
Erythema nodosum
Acanthosis nigricans
Drug eruptions
19 - Ageing and disease
Comprehensive geriatric assessment
Comprehensive geriatric assessment
Presenting problems in geriatric medicine
Falls
Acute illness
Blackouts
Mechanical and recurrent falls
Dizziness
Delirium
Urinary incontinence
Prescribing and deprescribing
Hypothermia
Clinical assessment
Investigations
Management
Rehabilitation
The process
20 - Oncology
The 10 hallmarks of cancer
1. Genome instability and mutation
Clinical examination of the cancer patient
Anchor 407
2. Resistance to cell death
3. Sustained proliferative signalling
4. Evasion of growth suppressors
5. Replicative immortality
6. Induction of angiogenesis
7. Activation of invasion and metastasis
8. Reprogramming of energy metabolism
9. Tumour-
10. Evasion of immune destruction
Environmental and genetic determinants of cancer
Environmental factors
Genetic factors
Assessing and investigating a cancer patient
Clinical assessment
Immunohistochemistry of biopsies
Imaging
Biochemical markers
Presenting problems in oncology
Palpable mass
Weight loss and fever
Thromboembolism
Ectopic hormone production
Neurological paraneoplastic syndromes
Cutaneous manifestations of cancer
Emergency complications of cancer
Spinal cord compression
Clinical features
Management
Superior vena cava obstruction
Clinical features
Investigations and management
Hypercalcaemia
Clinical features
Investigations and management
Neutropenic fever
Clinical features
Investigations and management
Tumour lysis syndrome
Clinical features
Investigations and management
Metastatic disease
Brain metastases
Clinical features
Investigations and management
Lung metastases
Liver metastases
Bone metastases
Clinical features
Investigations and management
Malignant pleural effusion and ascites
Therapeutics in oncology
Surgery in cancer
Biopsy
Excision
Palliation
Systemic chemotherapy
Combination therapy
Adverse effects
Radiation therapy
Adverse effects
Hormone therapy
Immunotherapy
Biological therapies
Gefitinib/Erlotinib
Imatinib
Bevacizumab
Trastuzumab
Evaluation of treatment
Late toxicity of therapy
Specific cancers
Breast cancer
Pathogenesis
Clinical features
Investigations
Management
Ovarian cancer
Pathogenesis
Investigations
Management
Endometrial cancer
Pathogenesis
Investigations
Management
Cervical cancer
Pathogenesis
Investigations
Management
Head and neck tumours
Pathogenesis
Investigations
Management
Carcinoma of unknown origin
Investigations
Management
Multidisciplinary teams
21 - Laboratory reference ranges
Units
Laboratory reference ranges in adults
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z