Oxford Handbook of Clinical Specialties

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Contents
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1 Obstetrics 0
Obstetric history 2
Antenatal care and screening 4
Abdominal examination 4
Physiological changes 6
Pre-pregnancy counselling 7
The placenta 8
Plasma chemistry 9
Antenatal care 10
Structural abnormalities and us 12
Ultrasound images 14
Screening and diagnosis of aneuploidy 16
Medical conditions in pregnancy 18
Minor symptoms 18
Hyperemesis gravidarum 19
Sickle-cell disease 20
Cardiac disease 21
Drugs used in psychiatry and epilepsy 22
Anaemia 23
HIV 24
Diabetes mellitus 26
Thyroid disease 28
Jaundice 29
Malaria 30
Renal disease 31
Epilepsy 32
Respiratory disease 33
Connective tissue diseases 34
Hypertension 35
Thromboprophylaxis 36
Thrombophilia 36
Venous thromboembolism 37
Antenatal problems 38
Ante/perinatal infection 38
Group B Streptococcus 41
Abdominal pain 42
Pelvis and head 44
Fetal monitoring 46
Terms used to describe the CTG 47
Pre-eclampsia 50
Prematurity 52
Small for gestational age 54
Postmaturity (prolonged pregnancy) 56
Labour and delivery 57
Prelabour rupture of membranes at term 57
Normal labour 58
Induction of labour 60
Management of delay in labour 62
Home birth 63
Pain relief in labour 64
Multiple pregnancy 66
Breech presentation 68
Other malpresentations / malpositions 69
Meconium-stained liquor 70
Reduced fetal movements 70
Retained placenta 71
Operative vaginal delivery 72
Caesarean section 76
Stillbirth (intrauterine fetal death, IUD) 78
Placenta praevia, accreta, and increta 80
Postnatal care 82
Birth injuries 82
Episiotomy and tears 84
The puerperium 86
Obstetric emergencies 88
**Sepsis 88
**Eclampsia and HELLP 90
**Maternal collapse 91
**Antepartum hemorrhage 92
**Cord prolapse 93
**Shoulder dystocia 94
**Uterine rupture 95
**Mendelson syndrome 95
**Postpartum haemorrhage 96
**Uterine inversion 98
**DIC and coagulation defects 990
**Amniotic fluid embolism 1001
Maternal mortality 1023
Perinatal mortality 1034
2 Gynaecology 104
History and examination 106
Sexual health and dysfunction 107
Gynaecological anatomy 108
Genital abnormalities 110
Female genital mutilation 111
Normal menstruation 112
Defining menstrual abnormalities 114
Onset of menstruation: menarche & amenorrhoea 115
Polycystic ovarian syndrome 116
Menorrhagia 117
Premenstrual syndrome 118
The menopause and HRT 120
Termination of pregnancy 122
Miscarriage 124
Ectopic pregnancy 126
Pregnancy of unknown location 127
Gestational trophoblastic disease 128
The vulva 130
Vaginal discharge 132
Pelvic inflammatory disease 134
The uterus 136
Chronic pelvic pain 137
Dyspareunia 137
Fibroids (uterine leiomyomata) 138
Endometriosis 140
Subfertility: causes and tests 142
Subfertility: management 144
Male subfertility 145
Ovarian hyperstimulation syndrome 146
Contraception 148
The intrauterine contraceptive device 150
Emergency contraception 151
Combined hormonal contraceptives 152
Progestogen-only contraceptives 156
Sterilization 157
Urinary incontinence 158
Prolapse 160
Vulval lumps, ulcers, and carcinoma 162
The cervix and cervical screening 164
Management of CIN 166
Cervical cancer 167
Vaginal cancer 168
Endometrial cancer 170
Endometrial sampling in outpatients 171
Benign ovarian tumours 172
Ovarian cancer 174
Gynaecological surgery 176
3 Paediatrics 178
**European paediatric BLS 180
**APLS 181
**Intraosseous transfusion 182
**Anaphylaxis 183
**Newborn life support 184
Eliciting the history 188
Physical examination 190
**The ill and feverish child 192
Signposting common problems 194
Non-accidental injury 196
Encephalitis 198
**Meningitis 198
Assessing consciousness in children 200
**Raised intracranial pressure 200
**Meningococcal disease 201
Meningitis: the organisms 202
Measles, rubella, mumps, and erythroviruses 204
Varicella (herpes) zoster virus (vzv) 206
HIV infection 207
Stridor and upper respiratory infection 208
Lower respiratory infection 210
**Asthma in children >2yrs old 212
Cystic fibrosis 214
Abdominal pain 216
Abdominal distension 216
Coeliac disease 217
Diarrhoea 218
Malnutrition 218
Some acute surgical problems 220
GI malformations 222
Urinary tract infection 224
Nephrotic syndrome and acute glomerulonephritis 226
Genitourinary diseases 228
Acute kidney injury and renal disease 230
Epilepsy & febrile convulsions 232
Epilepsy: management 234
Headache 236
CNS tumours 237
Congenital heart disease (CHD) 238
Murmurs and heart sounds in children 239
Anaemia 240
Acute lymphoblastic leukaemia 242
Primary immunodeficiencies 244
Diabetes mellitus 246
Diabetic ketoacidosis 248
Hypothyroidism 250
Hyperthyroidism 251
Inherited metabolic diseases 252
Puberty 254
Screening and child health promotion 256
Speech delay 258
Developmental milestones & screening 260
Motor delay and cerebral palsy 262
Faltering growth and short stature 264
Ethnospecific growth charts 265
Childhood obesity 266
Hypertension in children 267
Problems with feeding and toileting 268
Impairment and disability 270
Genetic testing 272
Trisomy 21 273
Genetic diseases and counselling 274
**Poisoning: general points 276
Iron poisoning 277
Paracetamol (acetaminophen) poisoning 278
Salicylate poisoning 279
Neonatology 280
**The sick neonate 280
Routine examination of the newborn 282
Minor neonatal problems 283
Other neonatal problems 284
Enteral and parenteral nutrition 286
Daily water and electrolyte requirements 287
Learning to breastfeed 288
Breastfeeding and social/biological influences 290
Bottle feeding and weaning 291
Common symptoms in infancy 292
Neonatal jaundice 294
Haemolytic disease of the fetus and newborn 296
Preterm and small-for-dates babies 298
Orofacial clefts (cleft lip and palate) 300
Other head & neck malformations 300
Disorders of sex development 302
Respiratory distress syndrome 304
The neonatal intensive care unit 306
Respiratory support for neonates 308
Sudden unexplained infant death 310
Fluid regimens and dehydration 312
Paediatric reference intervals 314
UK/WHO growth charts 318
4 Ophthalmology 320
Understanding the eye 321
Ophthalmic glossary 322
Assessing the eyes-history 323
Assessing the eyes-function 324
Assessing the eyes-examination 326
Some key things to remember 328
Iris abnormalities 329
The red eye: an approach 330
The red eye: acute glaucoma 331
The red eye: acute anterior uveitis 332
The red eye: episcleritis and scleritis 333
The red eye: corneal ulcers and others 334
Ophthalmic shingles 335
The red eye: conjunctivitis 336
Allergic eye disease 337
Eyelids and around the eye 338
Tears and lacrimation 340
Blepharospasm and hemifacial spasm 341
Orbital swelling 342
Retinoblastoma 343
Sudden loss of vision 344
Gradual loss of vision 348
Primary open-angle glaucoma 348
Cataract 350
Macular degeneration 352
Other retinal disorders 354
Retinal detachment and others 356
Optic disc swelling and other disc abnormalities 358
Is the optic disc swollen? 360
Visual field defects 362
Eye movements and squint 364
Pupil problems 366
The eye in systemic disease 368
Ocular disease in pregnancy 369
The eye in diabetes mellitus 370
Drugs and the eye 372
Tropical eye disease 374
Refraction 376
Contact lenses 378
Refractive procedures 379
Blindness and partial sight 380
Looking into the future 382
5 Ear, nose, and throat 384
ENT examination 386
The ear 388
Hearing tests and audiology 390
Painful ears (otalgia) 392
Discharging ears and otitis media 394
Fluid in the middle ear 396
Childhood deafness 398
Deafness in adults 400
Tinnitus 402
Acoustic neuroma 403
Noise-induced hearing loss 403
Vertigo and associated disorders 404
The paranasal sinuses 406
Nasal injury & foreign bodies 410
**Nosebleed (epistaxis): the chief ENT emergency 412
Sore throats, the tonsils, and beyond 414
**Stridor 416
Hoarseness (dysphonia) 418
Dysphagia 420
Head & neck squamous cell carcinomas 422
Facial palsy 424
Lumps in the neck 426
The salivary glands 428
Dentistry for doctors 430
6 Dermatology 432
Dermatology basics 434
Describing a lesion 435
Patterns of skin disease 436
Skin signs of systemic disease 438
Common skin cancers & premalignant tumours 440
Other malignancies & skin 440
Malignant melanoma 442
Psoriasis 444
Eczema (dermatitis) 446
Skin infections 448
Acne vulgaris 450
Rosacea 450
Drug eruptions 451
Miscellaneous skin disorders 452
Photosensitivity 453
Urticaria 453
Venous ulcers 454
Pressure ulcers 454
HIV and skin disorders 456
Infestations 458
The skin, identity, and psychodermatoses 460
Skin type 461
7 Orthopaedics 462
Orthopaedic-related mnemonics 463
Principles of history and examination 464
The neck 466
Other neck pathologies 468
The shoulder 470
The painful shoulder 472
The elbow 474
The wrist and hand 476
Examination of the back 478
Kyphosis and scoliosis 480
More causes of back pain 482
Simple lower back pain 484
Specific and sometimes sinister back pain 486
Hip history and examination 488
Painful hips in children 490
Developmental dysplasia of the hip 492
Club foot 492
Knee history and examination 494
Pain in the knee 496
Knees that swell 498
Feet 500
Osteomyelitis 502
Bone tumours: malignant 504
Bone tumours: benign 505
Congenital disorders of bone and cartilage 506
Osteochondroses 508
Joint replacement (arthroplasty) 510
Joint aspiration and injections 512
Joint injections 514
Tendon rupture and injury 516
Soft tissue and sports injuries 518
8 Trauma 520
Describing an x-ray 521
Does he need an x-ray? 522
Does he need a cT? 523
Fractures 524
Management of fractures 526
Complications from fractures 528
Complex regional pain syndromes 529
Trauma to the arm and shoulder 530
Trauma to the elbow and forearm 532
Distal radial and ulnar fractures 534
Hand fractures 536
Injuries to the hand 538
Proximal femoral fractures 540
Hip fractures in the elderly 542
Injuries to the knee 543
Ankle and foot strains, and fractures 544
**Injuries to the face and neck 546
Eye trauma 548
Testing peripheral nerve motor functions 550
Dermatomes and peripheral nerves 552
**Injury to peripheral nerves 554
Nerve compression and syndromes 555
Injuries to the brachia! plexus 556
**Spinal cord injury-the first day 558
Cord pathology and anatomy 560
Cord injury-function and functional anatomy 562
Living with spinal cord injury 564
Cord injury-OT, physio, and nursing aspects 566
9 Emergency medicine 568
Working as an emergency doctor 569
Introduction to emergency medicine 569
Teams in the ED 570
The ED 571
Triage 572
Crowding and exit block 572
Clinical decision-making 574
Meeting patient expectations 574
Patient assessment in ED 576
Advanced life support (adult) 576
11+Advanced life support fundamentals 578
Pain 580
Procedural sedation 581
Shock 582
The unwell child 584
Major trauma: overview 586
Receiving the major trauma patient 586
The lethal triad 588
Traumatic brain injury 590
Thoracic trauma 592
Abdominal trauma 594
Pelvic trauma 596
Major burns 598
Environmental emergencies 600
Emergency toxicology 601
Sepsis 602
Transient loss of consciousness 603
Stroke in the ED 604
Acute severe headache 605
Chest pain 606
Acute shortness of breath 608
Abdominal pain 610
Atraumatic back pain 612
Extremity problems in the ED 613
Common upper limb injuries 614
Common lower limb injuries 616
Bites and stings 618
Foreign body ingestion 620
Wound care 621
Other 'minor' problems 622
Tying it all together 623
10 Pre-hospital emergency medicine 624
Introduction to pre-hospital emergency medicine 625
Activation of the emergency services 626
Major trauma networks in the UK 627
Assessment on arrival at the scene 628
Hazards to consider 629
Triage 630
Initial patient assessment 632
Shock 634
The entrapped patient 636
Pre-hospital analgesia 638
Splintage and manipulation 640
Head injuries 641
Spinal injuries 642
Chest injuries 644
Pre-hospital care of special interest groups 646
Pre-hospital emergency anaesthesia 648
Traumatic cardiac arrest 650
**The major incident 652
On the importance of public health 654
The last word-towards lasting resilience 655
11 Anaesthesia 656
Introduction 656
Preoperative assessment 658
Sedation 661
The drugs used to induce anaesthesia 662
Inhalational anaesthetic agents 662
Commonly used IV anaesthetic agents 663
Muscle relaxants: neuromuscular blockers 664
Practical conduct of anaesthesia 666
Maintaining and monitoring 668
Difficult Airway Society guidelines 669
RSI 670
Intubation technique 671
Some complications of anaesthesia 672
End of anaesthesia and recovery 674
Pain 676
Postoperative nausea and vomiting 674
Regional anaesthesia: peripheral nerve blocks 678
Regional anaesthesia: neuraxial anaesthesia 680
Other relevant pages 656
Pain relief in labour 64
resuscitation after delivery 91
neonatal ITU 306
ventilating neonates 308
12 Psychiatry 682
Psychiatric history skills 684
First principles 684
Skills introduction 686
Psychiatric history 688
Mental state exam 690
Risk assessment 692
Confidentiality 693
Physical examination 694
Assessment of psychiatric symptoms 696
Descriptive psychopathology 696
Classification of disorders 701
Community psychiatry 702
Community care 702
Schizophrenia 704
Depression 706
Mania and bipolar affective disorder 716
Anxiety (and OCD, PTSD) 718
Withdrawing medication 724
Gender identity 725
Emergency department psychiatry 726
Suicide and suicidal ideation 726
Deliberate self-harm 728
Crisis intervention 729
Urgent psychiatric situations 730
Liaison psychiatry and organi illness 732
Delirium 732
Dementia 734
Child and adolescent psychiatry 736
Depression 736
Psychosis 737
Behavioural difficulties 738
Sleep disorders 739
Autism spectrum disorders 740
Attention deficit hyperactivity disorder 741
Psychiatric subspecialties 742
Intellectual disability 742
Personality disorders 744
Eating disorders 746
Psychosexual disorders 748
Talking about sex 749
Perinatal psychiatry 750
Psychological treatment and psychotherapy 752
The psychotherapies 752
Cognitive therapy 754
Comparing therapies 756
Behavioural therapy 756
Dynamic psychotherapy 758
Systemic/family therapy 760
Counselling and supportive psychotherapies 762
Group psychotherapy 764
Play therapy 766
Art therapy 767
Mental health and the law 768
Compulsory treatment 768
Compulsory hospitalization 770
Mental Health Act law and consent 772
Capacity 773
13 General practice 774
General practice 775
An introduction to general practice 775
Common reasons for seeing a GP 776
General practice in the UK 780
Differences between GPs and specialists 780
Pressures of primary care 781
Primary care models 782
Primary care teams 784
Consulting and certifying 786
The consultation & patient centredness 786
Consultation models 788
Consultations and decision-making 790
Continuity of care 792
Risk management 793
Prescribing: compliance and concordance 794
Protocols, targets, and guidelines 796
Referral statistics 797
Telephone consulting 798
Home visits 799
Chronic disease 781
Approaching minor illness 802
Medically unexplained symptoms 803
Time off work 804
Certifying fitness to work (UK) 805
Fitness to drive 806
Fitness to fly 808
UK benefits 810
UK benefits for disability and illness 811
Confirmation and certification of death (uK) 812
Health and healthy living 814
Health 814
The inverse care law and distributive justice 815
Social class and inequalities in health 815
Social, psychological, & physical elements of health 816
Prevention of disease 818
Barriers to prevention 819
Screening 820
Health education: what's the point? 822
cvo risk assessment 824
Smoking cessation 825
Managing alcohol misuse 826
Assessing and managing drug misuse 828
Obesity 830
Managing sleep problems 831
Exercise 832
Healthy eating 832
Alternative/holistic medicine 833
Domestic/intimate partner violence: the GP's role 834
Practice management 836
GPs as managers 836
Commissioning 837
New ways of extending primary care 838
Patient groups 840
Expert patients 841
14 Eponymous syndromes 842
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15 Doctors' health & perfonnance 860
How to look after your own mental health 861
Managing stress 862
Resilience 864
Trainees in difficulty 866
Manipulative patients and boundary setting 868
Being a good doctor 870
Appraisal and revalidation 872
Clinical governance 874
Managing uncertainty and risk 876
Organizations that can help 878
Useful apps 879
Useful apps 879
Index 880
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