دانلود کتاب Davidson's Principles and Practice of Medicine

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Front Cover
Davidson’s Principles and Practice of Medicine
Copyright Page
Contents
Preface
Contributors
International Advisory Board
Acknowledgements
Introduction
Clinical examination overviews
Presenting problems
Boxes
Terminology
Units of measurement
Finding what you are looking for
1 FUNDAMENTALS OF MEDICINE
1 Clinical decision-making
Introduction
The problem of diagnostic error
Clinical reasoning: definitions
History and physical examination
Use and interpretation of diagnostic tests
Normal values
Factors other than disease that influence test results
Operating characteristics
Sensitivity and specificity
Prevalence of disease
Dealing with uncertainty
Problem representation
Cognitive biases
Type 1 and type 2 thinking
Common cognitive biases in medicine
Thinking about thinking
Human factors
Shared decision-making
Patient-centred evidence-based medicine
Effective team communication
Using clinical prediction rules and other decision aids
Reducing errors in clinical decision-making
Deliberate practice
Cognitive debiasing strategies
History and physical examination
Problem representation/list and differential diagnosis
Mnemonics and checklists
Red flags and ROWS (‘rule out worst-case scenario’)
Evidence-based history and examination
Deciding pre-test probability
Interpreting test results
Treatment threshold
Post-test probability
Cognitive biases
Human factors
Shared decision-making
Harvard problem (p. 5)
Bat and ball problem (p. 6)
Clinical decision-making: putting it all together
Answers to problems
Further information
2 Clinical therapeutics and good 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 administration
Parenteral administration
Other routes of administration
Drug distribution
Volume of distribution
Drug elimination
Drug metabolism
Drug excretion
Elimination kinetics
Repeated dose regimens
Prevalence of ADRs
Classification of ADRs
Inter-individual variation in drug responses
Adverse outcomes of drug therapy
Adverse drug reactions
Detecting ADRs – pharmacovigilance
Drug interactions
Mechanisms of drug interactions
Avoiding drug interactions
Medication errors
Responding when an error is discovered
New therapeutic agents
Manufacturers
Health services
Prescribers
Absorption
Distribution
Metabolism
Excretion
Efficacy
Avoiding adverse effects
Features of the disease
Severity of disease
Coexisting disease
Avoiding adverse drug interactions
Patient adherence to therapy
Cost
Genetic factors
Dose titration
Route
Frequency
Timing
Formulation
Duration
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
Writing the prescription
Monitoring treatment effects
Stopping drug therapy
Prescribing in special circumstances
Prescribing for patients with renal disease
Prescribing for patients with hepatic disease
Prescribing for older 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
Timing of samples in relation to doses
Interpreting the result
Multiple Choice Questions
Further information
3 Clinical genetics
The fundamental principles of genomics
The packaging of genes: DNA, chromatin and chromosomes
From DNA to protein
Transcription: DNA to messenger RNA
RNA splicing, editing and degradation
Translation and protein production
Non-coding RNA
Cell division, differentiation and migration
Cell death, apoptosis and senescence
Genomics, health and disease
Classes of genetic variant
Nucleotide substitutions
Insertions and deletions
Simple tandem repeat variants
Copy number variations
Consequences of genomic variation
Normal genomic variation
Polymorphisms and common disease
Evolutionary selection
Constitutional genetic disease
Constructing a family tree
Patterns of disease inheritance
Autosomal dominant inheritance
Autosomal recessive inheritance
X-linked inheritance
Mitochondrial inheritance
Imprinting
Somatic genetic disease
Interrogating the genome: the changing landscape of genomic technologies
Looking at chromosomes
Looking at genes
Gene amplification: polymerase chain reaction
Gene sequencing
NGS capture
Challenges of NGS technologies
Uses of NGS
Third-generation sequencing
Genomics and clinical practice
Genomics and health care
Genomics in rare neurodevelopmental disorders
Genomics and common disease
Genomics and obstetrics
Genomics and oncology
Genomics in infectious disease
Treatment of genetic disease
Pharmacogenomics
Gene therapy and genome editing
Induced pluripotent stem cells and regenerative medicine
Pathway medicine
Ethics in a genomic age
Multiple Choice Questions
Further information
4 Clinical immunology
Functional anatomy and physiology
The innate immune system
Physical barriers
Phagocytes
Neutrophils
Monocytes and macrophages
Dendritic cells
Cytokines
Integrins
Complement
Mast cells and basophils
Natural killer cells
The adaptive immune system
Lymphoid organs
The thymus
The spleen
Lymph nodes
Mucosa-associated lymphoid tissue
Lymphatics
Humoral immunity
Immunoglobulins
Cellular immunity
CD8+ T lymphocytes
CD4+ T lymphocytes
The inflammatory response
Acute inflammation
The acute phase response
Septic shock
Resolution of inflammation
Chronic inflammation
Laboratory features of inflammation
C-reactive protein
Erythrocyte sedimentation rate
Plasma viscosity
Aetiology
Clinical assessment
Investigations
Management
Aetiology
Clinical assessment
Investigations
Management
Chronic granulomatous disease
Leucocyte adhesion deficiencies
Defects in cytokines and cytokine receptors
Clinical features
Investigations
Management
X-linked agammaglobulinaemia
Selective IgA deficiency
Common variable immune deficiency
Specific antibody deficiency
Investigations
Management
DiGeorge syndrome
Bare lymphocyte syndromes
Severe combined immune deficiency
Presenting problems in immune disorders
Recurrent infections
Intermittent fever
Anaphylaxis
Immune deficiency
Primary phagocyte deficiencies
Complement pathway deficiencies
Primary antibody deficiencies
Primary T-lymphocyte deficiencies
Investigations
Management
Autoimmune lymphoproliferative syndrome
Secondary immune deficiencies
Familial Mediterranean fever
Mevalonate kinase deficiency
TNF receptor-associated periodic syndrome
Cryopyrin-associated periodic syndrome (CAPS)
Pathophysiology
Clinical features
Investigations
Management
Pathophysiology
Clinical features
Investigations
Autoantibodies
Complement
Cryoglobulins
Management
Pathophysiology
Clinical features
Insect venom allergy
Peanut allergy
Birch oral allergy syndrome
Diagnosis
Investigations
Skin-prick tests
Specific IgE tests
Supervised exposure to allergen
Mast cell tryptase
Serum total IgE
Eosinophilia
Management
Avoidance of the allergen
Antihistamines
Glucocorticoids
Sodium cromoglicate
Antigen-specific immunotherapy
Omalizumab
Adrenaline (epinephrine)
Pathophysiology
Clinical features
Investigations
Management
Hereditary angioedema
Clinical features
Investigations
Management
Acquired C1 inhibitor deficiency
Investigations
Pre-transplantation testing
Post-transplant biopsy: C4d staining
Periodic fever syndromes
Amyloidosis
Autoimmune disease
Allergy
Angioedema
Pregnancy and the immune system
Transplantation and graft rejection
Transplant rejection
Complications of transplant immunosuppression
Organ donation
Tumour immunology
Further information
Multiple Choice Questions
5 Population health and epidemiology
Global burden of disease and underlying risk factors
Life expectancy
Global causes of death and disability
Risk factors underlying disease
Social determinants of health
The hierarchy of systems – from molecules to ecologies
The life course
Preventive medicine
Alcohol
Smoking
Obesity
Poverty and affluence
Atmospheric pollution
Carbon dioxide and global warming
Principles of screening and immunisation
Screening
Immunisation
Epidemiology
Understanding causes and effect
Mendelian randomisation
Health data/informatics
Management of epidemics
Multiple Choice Questions
Further information
6 Principles of infectious disease
Agents causing infection
3 CLINICAL MEDICINE
17 Respiratory medicine
Presenting problems in respiratory disease
Respiratory failure
Chronic and ‘acute on chronic’ type II respiratory failure
Genetics, pathogenesis and epidemiology
1 FUNDAMENTALS OF MEDICINE
6 Principles of infectious disease
Normal microbial flora
1 FUNDAMENTALS OF MEDICINE
6 Principles of infectious disease
Host–pathogen interactions
Investigation of infection
Direct detection of pathogens
Detection of whole organisms
Detection of components of organisms
Nucleic acid amplification tests
Culture
Blood culture
Indirect detection of pathogens
Antibody detection
Enzyme-linked immunosorbent assay
Immunoblot (Western blot)
Immunofluorescence assays
Complement fixation test (CFT)
Agglutination tests
Immunodiffusion
Lateral flow immunochromatography
Antibody-independent specific immunological tests
Antimicrobial susceptibility testing
Geographical and temporal patterns of infection
Endemic disease
Emerging and re-emerging disease
Reservoirs of infection
Human reservoirs
Animal reservoirs
Environmental reservoirs
Transmission of infection
Deliberate release
Epidemiology of infection
Infection prevention and control
Health care-associated infection
Outbreaks of infection
Immunisation
Vaccination
Types of vaccine
Use of vaccines
Antimicrobial stewardship
Treatment of infectious diseases
Principles of antimicrobial therapy
Antimicrobial action and spectrum
Empiric versus targeted therapy
Combination therapy
Antimicrobial resistance
Duration of therapy
Pharmacokinetics and pharmacodynamics
Therapeutic drug monitoring
Pharmacokinetics
Adverse effects
Drug interactions
Antimicrobial prophylaxis
Antibacterial agents
ß-lactam antibiotics
Penicillins
Cephalosporins and cephamycins
Monobactams
Carbapenems
Macrolide and lincosamide antibiotics
Pharmacokinetics
Macrolides
Lincosamides (e.g. clindamycin)
Adverse effects
Pharmacokinetics
Gentamicin dosing
Adverse effects
Aminoglycosides and spectinomycin
Spectinomycin
Pharmacokinetics
Adverse effects
Pharmacokinetics
Adverse effects
Pharmacokinetics
Adverse effects
Quinolones and fluoroquinolones
Glycopeptides
Lipopeptides
Polymyxins
Folate antagonists
Tetracyclines and glycylcyclines
Tetracyclines
Pharmacokinetics
Adverse effects
Glycylcyclines (tigecycline)
Nitroimidazoles
Phenicols (chloramphenicol)
Oxazolidinones
Other antibacterial agents
Fusidic acid
Nitrofurantoin
Fidaxomicin
Fosfomycin
Lefamulin
Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Streptomycin
Other antituberculous agents
Clofazimine
Antimycobacterial agents
Antifungal agents
Azole antifungals
Imidazoles
Triazoles
Lipid formulations of amphotericin B
Echinocandins
Polyenes
Other antifungal agents
Flucytosine
Griseofulvin
Terbinafine
Antiviral agents
Antiretroviral agents
Anti-herpesvirus agents
Aciclovir, valaciclovir, penciclovir and famciclovir
Ganciclovir
Cidofovir
Foscarnet
Letermovir
Anti-influenza agents
Zanamivir and oseltamivir
Other anti-influenza agents
Other agents used to treat viruses
Remdesivir
Ribavirin
Antiparasitic agents
Antimalarial agents
Artemisinin (qinghaosu) derivatives
Atovaquone
Folate synthesis inhibitors (proguanil, pyrimethamine–sulfadoxine)
Quinoline-containing compounds
Lumefantrine
Drugs used in trypanosomiasis
Other antiprotozoal agents
Pentavalent antimonials
Diloxanide furoate
Iodoquinol (di-iodohydroxyquinoline)
Nitazoxanide
Paromomycin
Drugs used against helminths
Benzimidazoles (albendazole, mebendazole)
Bithionol
Diethylcarbamazine
Ivermectin
Niclosamide
Piperazine
Praziquantel
Pyrantel pamoate
Thiabendazole
Further information
Multiple Choice Questions
7 Oncology
Clinical examination of the cancer patient
Clinical examination of the patient on cancer treatment
The 10 hallmarks of cancer
1 . Genome instability and mutation
2 . Resisting cell death
Apoptosis
Autophagy
Necrosis
3 . Sustaining proliferative signalling
The cell cycle
Stimulation of the cell cycle
4 . Evading growth suppressors
5 . Enabling replicative immortality
6 . Inducing angiogenesis
7 . Activating invasion and metastasis
8 . Deregulating cellular energetics
9 . Tumour-promoting inflammation
10 . Evading immune destruction
Environmental factors
Genetic factors
Environmental and genetic determinants of cancer
Investigations
Determining the extent of disease (staging)
Computed tomography
Ultrasound
Magnetic resonance imaging
Positron emission tomography
Biochemical markers
Establishing the type of cancer
Histopathology
Light microscopy
Immunohistochemistry
Molecular pathology
Cytogenetic analysis
Assessing fitness
Multidisciplinary teams
Acute oncology
Acute presentation of new cancer
Cancer of unknown primary (CUP)
Metastatic malignant disease of undefined primary origin (MUO)
Oncological emergencies
Malignant spinal cord compression
Clinical features
Management
Superior vena cava obstruction
Clinical features
Investigations and management
Neutropenic fever
Clinical features
Investigations and management
Hypercalcaemia of malignancy
Clinical features
Investigations and management
Immune-related adverse events
Clinical features
Investigations and management
Tumour lysis syndrome
Clinical features
Investigations and management
Other acute presentations in oncology
Venous thromboembolism
Ectopic hormone production
Neurological paraneoplastic syndromes
Cutaneous manifestations of cancer
Symptoms from locally advanced cancer or metastatic sites
Brain metastases
Clinical features
Investigations and management
Lung metastases
Liver metastases
Bone metastases
Clinical features
Investigations and management
Malignant pleural effusion
Investigations and management
Other common symptoms
Treatment-related toxicities
Therapeutics in oncology
Surgical treatment
Radiotherapy
Systemic anti-cancer therapy
Cytotoxic chemotherapy
Hormone therapy
Targeted therapies
Immunotherapy
Pathogenesis
Clinical features
Investigations
Management
Pathogenesis
Investigations
Management
Pathogenesis
Investigations
Management
Pathogenesis
Investigations
Management
Pathogenesis
Investigations
Management
Evaluation of treatment
Late toxicity of therapy
Cancer clinical trials
Specific cancers
Breast cancer
Ovarian cancer
Endometrial cancer
Cervical cancer
Head and neck tumours
Survivorship
Further information
8 Pain and palliative care
Clinical examination in pain and palliative care
Clinical evaluation and management in a patient with chronic pain or in the palliative care setting
Pain
Functional anatomy and physiology
Peripheral nerves
Spinal cord
Central processing of pain
Sensitisation
Peripheral sensitisation
Central sensitisation
Genetic determinants of pain perception
Investigations
Magnetic resonance imaging
Blood tests
Quantitative sensory testing
Nerve conduction studies
Nerve blocks
Pain scoring systems
Principles of management
Clinical history
Biopsychosocial assessment
Examination
Interventions
Supported self-management
Physical therapies
Pharmacological therapies
Non-opioid analgesics
Paracetamol
Non-steroidal anti-inflammatory drugs
Topical analgesics
Anti-neuropathic agents
Opioid analgesics
Psychological therapies
Stimulation therapies
Complementary and alternative therapies
Nerve blocks and nerve ablation
Chronic pain syndromes
Neuropathic pain
Complex regional pain syndrome
Phantom limb pain
Chronic widespread pain
Joint hypermobility syndrome
Palliative care
Presenting problems in palliative care
Pain
Clinical assessment
Management: pharmacological treatments
Opioids
Opioid-related adverse effects
Adjuvant analgesics
Management: non-pharmacological treatments
Neurodestructive interventions
Radiotherapy
Physiotherapy
Psychological techniques
Stimulation therapies
Complementary and alternative therapies
Breathlessness
Cough
Nausea and vomiting
Gastrointestinal obstruction
Weight loss
Anxiety and depression
Delirium and agitation
Dehydration
Planning for dying
Diagnosing dying
Management of dying
Ethical considerations
Capacity and advance directives
Euthanasia
Death and dying
Multiple Choice Questions
Further information
2 EMERGENCY AND CRITICAL CARE MEDICINE
9 Acute medicine and critical illness
Clinical examination in critical care
Monitoring
Acute medicine
The decision to admit to hospital
Ambulatory care
Presenting problems in acute medicine
Chest pain
Acute breathlessness
Anaphylaxis
Syncope/presyncope
Headache
Unilateral leg swelling
Acute abdomen
Identification and assessment of deterioration
Early warning scores and the role of the medical emergency team
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
Pathophysiology
Assessment and management
Pathophysiology
Assessment and management
Pathophysiology
Assessment and management
Pathophysiology
Assessment and management
Shock
Pathophysiology
Assessment and management
Assessment
Management
Assessment
Diagnosis and management
Abdominal compartment syndrome
Rhabdomyolysis
Aetiology and pathogenesis
Initiation of the inflammatory response
Propagation of the inflammatory response
Activation of the coagulation system
Organ damage from sepsis
Lactate physiology
The anti-inflammatory cascade
Management
Resuscitation in sepsis
Early source control
Noradrenaline (norepinephrine) for refractory hypotension
Other therapies for refractory hypotension
Septic cardiomyopathy
Review of the underlying pathology
Aetiology and pathogenesis
Diagnosis and management
Definition and aetiology
Myocardial infarction
Acute massive pulmonary embolism
Acute valvular pathology, aortic dissection and cardiac tamponade
Selecting the appropriate location for ongoing management and anticipatory care planning
Common presentations of deterioration
Tachypnoea
Hypoxaemia
Tachycardia
Hypotension
Hypertension
Decreased conscious level
Decreased urine output/deteriorating renal function
Disorders causing critical illness
Sepsis and the systemic inflammatory response
Acute respiratory distress syndrome
Acute circulatory failure (cardiogenic shock)
Cardiac arrest
Out-of-hospital cardiac arrest (OHCA)
Pathogenesis
Survivors of OHCA
In-hospital cardiac arrest (IHCA)
Pathogenesis
Clinical assessment and management
Basic life support
Advanced life support
Acute management
Prognosis
Post cardiac arrest
Other causes of multi-organ failure
Critical care medicine
Decisions around intensive care admission
Stabilisation and institution of organ support
Respiratory support
Non-invasive respiratory support
High-flow nasal cannulae
Continuous positive pressure ventilation
Non-invasive ventilation or bi-level ventilation
Intubation and intermittent positive pressure ventilation
Ventilator modes
Ventilator-induced lung injury
Advanced respiratory support
Airway pressure release ventilation
Prone positioning
Extracorporeal respiratory support
Venous–venous extracorporeal membrane oxygenation
Extracorporeal carbon dioxide removal
Cardiovascular support
Initial resuscitation
Fluid and vasopressor use
Advanced haemodynamic monitoring
Mechanical cardiovascular support
Intra-aortic balloon pump
Venous–arterial extracorporeal membrane oxygenation
Critical illness polyneuropathy
Critical illness myopathy
Renal support
Neurological support
Daily clinical management in intensive care
Clinical review
Infection surveillance
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-acquired weakness
Airway complications
Micro- and macrovascular complications
Other complications
The older patient
Withdrawal of active treatment and death in intensive care
Futility
Death
Organ donation
Donation after brain death
Donation after cardiac death
Post-mortem examination or autopsy
Discharge from intensive care
Critical care scoring systems
Multiple Choice Questions
Further information
10 Poisoning
Comprehensive evaluation of the poisoned patient
General approach to the poisoned patient
Triage and resuscitation
Clinical assessment and investigations
Psychiatric assessment
General management
Gastrointestinal decontamination
Activated charcoal
Gastric aspiration and lavage
Whole bowel irrigation
Urinary alkalinisation
Haemodialysis and haemoperfusion
Lipid emulsion therapy
Supportive care
Antidotes
Poisoning by specific pharmaceutical agents
Analgesics
Paracetamol
Management
Salicylates (aspirin)
Clinical features
Management
Non-steroidal anti-inflammatory drugs
Clinical features
Management
Antidepressants
Tricyclic antidepressants
Clinical features
Management
Selective serotonin and noradrenaline re-uptake inhibitors
Clinical features and management
Lithium
Clinical features
Management
Cardiovascular medications
Beta-blockers
Management
Calcium channel blockers
Clinical features
Management
Digoxin and oleander
Clinical features
Management
Clinical features
Management
Clinical features
Management
Clinical features
Management
Iron
Antipsychotic drugs
Antidiabetic agents
Pharmaceutical agents less commonly taken in poisoning
Drugs of misuse
Depressants
Benzodiazepines
Opioids
Gamma hydroxybutyrate
Stimulants and entactogens
Cocaine
Amphetamines and cathinones
Hallucinogens
Cannabis
Synthetic cannabinoid receptor agonists
Tryptamines
d-Lysergic acid diethylamide
Dissociative drugs
Volatile substances
Body packers and body stuffers
Chemicals and pesticides
Carbon monoxide
Clinical features
Management
Organophosphorus insecticides and nerve agents
Mechanism of toxicity
Clinical features and management
Acute cholinergic syndrome
Management
Intermediate syndrome
Organophosphate-induced delayed polyneuropathy
Carbamate insecticides
Paraquat
Alcohols and glycols
Corrosive substances
Aluminium and zinc phosphide
Copper sulphate
Chemicals less commonly taken in poisoning
Chemical warfare agents
Arsenism
Fluorosis
Paralytic shellfish poisoning
Ciguatera poisoning
Scombrotoxic fish poisoning
Tetrodotoxin poisoning
Environmental poisoning
Food-related poisoning
Plant poisoning
Multiple Choice Questions
Further information
11 Envenomation
Comprehensive evaluation of the envenomed patient
Geographical distribution of venomous snakes
Bedside tests in the envenomed patient
Overview of envenomation
Venom
Venomous animals
Clinical effects
Local effects
General systemic effects
Specific systemic effects
General approach to the envenomed patient
First aid
Transporting patients
Assessment and management in hospital
Assessment and management of life-threatening problems
Assessment for evidence of envenoming
Laboratory investigations
Treatment
Antivenom
Non-antivenom treatments
Clinical features and management
Clinical features and management
Clinical features and management
Follow-up
Prevention
Envenomation by specific animals
Venomous snakes
Scorpions
Spiders
Paralysis ticks
Venomous insects
Venomous lepidopterans
Venomous hymenopterans
Marine venomous and poisonous animals
Multiple Choice Questions
Further information
12 Medicine in austere environments
Extremes of temperature
The cold environment
Hypothermia
Management
Mild hypothermia
Severe hypothermia
Cardiac arrest
Cold injury
Freezing cold injury (‘frostbite’)
Management
Non-freezing cold injury
Pathophysiology of heat stroke
Management
Prevention
Respiratory
Haematological
Cardiovascular
Heat-related illness
Physiological effects of high altitude
Acute high altitude illness
Illness at high altitude
Acute mountain sickness
Management
High altitude cerebral oedema
Management
High altitude pulmonary oedema
Management
Drowning
Cold shock
Autonomic conflict
Pre-hospital management
In-hospital management
CPR modifications
Decompression illness
Decompression sickness
Arterial gas embolism
Management
Immersion pulmonary oedema
Shallow-water blackout
Subaquatic medicine
Multiple Choice Questions
Further information
3 CLINICAL MEDICINE
13 Infectious disease
Clinical examination of patients with infectious disease
Presenting problems in infectious diseases
Fever
Fever with localising symptoms or signs
Pyrexia of unknown origin
Clinical assessment
Investigations
Prognosis
Fever in the injection drug-user
Clinical assessment
Investigations
Management
Fever in the immunocompromised host
Clinical assessment
Investigations
Neutropenic fever
Post-transplantation fever
Clinical assessment
Investigations
Management
Positive blood culture
Central venous catheter infections
Investigations and management
Sepsis
Severe skin and soft tissue infections
Necrotising fasciitis
Gas gangrene
Other SSTIs
Clinical assessment
Investigations
Management
Fluid replacement
Antimicrobial agents
Antidiarrhoeal, antimotility and antisecretory agents
Acute diarrhoea and vomiting
Non-infectious causes of food poisoning
Antimicrobial-associated diarrhoea
Infections acquired in the tropics
Fever acquired in tropical regions
Clinical assessment
Investigations and management
Diarrhoea acquired in the tropics
Eosinophilia acquired in the tropics
Clinical assessment
Investigations
Management
Skin conditions acquired in the tropics
Infections in adolescence
Infections in pregnancy
Viral infections
Systemic viral infections with exanthem
Measles
Clinical features
Diagnosis
Management and prevention
Rubella (German measles)
Clinical features
Diagnosis
Prevention
Parvovirus B19
Clinical features
Diagnosis
Management
Human herpesvirus 6 and 7
Clinical features
Diagnosis and management
Chickenpox (varicella)
Clinical features
Diagnosis
Management and prevention
Shingles (herpes zoster)
Clinical features
Management
Enteroviral exanthems
Systemic viral infections without exanthem
Mumps
Clinical features
Diagnosis
Management and prevention
Influenza
Clinical features
Diagnosis
Management and prevention
Avian influenza
Infectious mononucleosis and Epstein–Barr virus
Clinical features
Long-term complications of EBV infection
Investigations
Management
Cytomegalovirus
Clinical features
Investigations
Management
Dengue
Clinical features
Diagnosis
Management and prevention
Yellow fever
Clinical features
Diagnosis
Management and prevention
Viral haemorrhagic fevers
Clinical features
Investigations and management
Prevention
Ebola virus disease (EVD)
Clinical features
Investigations
Management
Prevention
Zika virus
Clinical features
Investigations
Prevention
Viral infections of the skin
Herpes simplex virus 1 and 2
Clinical features
Recurrence
Complications
Diagnosis
Management
Human herpesvirus 8
Enterovirus infections
Hand, foot and mouth disease
Herpangina
Poxviruses
Smallpox (variola)
Monkeypox
Cowpox
Vaccinia virus
Other poxviruses: orf and molluscum contagiosum
Pathogenesis
Gastrointestinal viral infections
Norovirus
Astrovirus
Rotavirus
Hepatitis viruses (A–E)
Other viruses
Respiratory viral infections
Coronaviruses
SARS coronavirus (SARS-CoV)
Middle East respiratory syndrome coronavirus (MERS-CoV)
Clinical features
Diagnosis and management
SARS-CoV-2
Responses to control the pandemic
Infection prevention and control in health-care settings
Public health measures
Clinical features
Investigations
Management
Vaccination
Other considerations
Viral infections with neurological involvement
Japanese encephalitis virus (JEV)
Clinical features
Investigations, management and prevention
Tick-borne encephalitis virus
West Nile virus
Clinical features
Diagnosis and management
Nipah virus encephalitis
Human T-cell lymphotropic virus type I
Viral infections with rheumatological involvement
Chikungunya virus
Prion diseases
Bacterial infections
Bacterial infections of the skin, soft tissues and bones
Staphylococcal infections
Skin infections
Wound infections
Cannula-related infection
Meticillin-resistant Staphylococcus aureus
Staphylococcal toxic shock syndrome
Management
Streptococcal infections
Streptococcal scarlet fever
Streptococcal toxic shock syndrome
Treponematoses
Syphilis
Endemic treponematoses
Yaws
Pinta and bejel
Tropical ulcer
Buruli ulcer
Systemic bacterial infections
Brucellosis
Clinical features
Diagnosis
Management
Borrelia infections
Lyme disease
Clinical features
Diagnosis
Management
Prevention
Louse-borne relapsing fever
Clinical features
Investigations and management
Tick-borne relapsing fever
Leptospirosis
Microbiology and epidemiology
Clinical features
Bacteraemic leptospirosis
Aseptic meningitis
Icteric leptospirosis (Weil’s disease)
Pulmonary syndrome
Diagnosis
Management and prevention
Plague
Clinical features
Bubonic plague
Septicaemic plague
Pneumonic plague
Investigations
Management
Prevention and infection control
Listeriosis
Investigations and management
Enteric fevers (typhoid and paratyphoid)
Clinical features
Typhoid fever
Paratyphoid fever
Complications
Investigations
Management
Prevention
Tularaemia
Investigations and management
Melioidosis
Clinical features
Investigations and management
Actinomycete infections
Nocardiosis
Actinomyces spp.
Enterotoxigenic E. coli
Entero-invasive E. coli
Enteropathogenic E. coli
Entero-aggregative E. coli
Enterohaemorrhagic E. coli
Gastrointestinal bacterial infections
Staphylococcal food poisoning
Bacillus cereus food poisoning
Clostridium perfringens food poisoning
Campylobacter infection
Salmonella spp. infection
Escherichia coli infection
Clostridioides difficile infection
Clinical features
Investigations
Management
Yersiniosis
Cholera
Clinical features
Diagnosis and management
Prevention
Vibrio parahaemolyticus infection
Bacillary dysentery (shigellosis)
Clinical features
Management and prevention
Respiratory bacterial infections
Diphtheria
Clinical features
Management
Prevention
Pneumococcal infection
Anthrax
Clinical features
Cutaneous anthrax
Gastrointestinal anthrax
Inhalational anthrax
Management
Bacterial infections with neurological involvement
Mycobacterial infections
Tuberculosis
Leprosy
Epidemiology and transmission
Pathogenesis
Clinical features
Leprosy reactions
Borderline cases
Investigations
Management
Patient education
Prognosis
Prevention and control
Rickettsial and related intracellular bacterial infections
Rickettsial fevers
Pathogenesis
Spotted fever group
Rocky Mountain spotted fever
Other spotted fevers
Typhus group
Scrub typhus fever
Epidemic (louse-borne) typhus
Endemic (flea-borne) typhus
Investigation of rickettsial infection
Management of rickettsial fevers
Q fever
Clinical features
Investigations and management
Bartonellosis
Investigations and management
Chlamydial infections
Trachoma
Pathology and clinical features
Investigations and management
Prevention
Protozoal infections
Systemic protozoal infections
Malaria
Pathogenesis
Life cycle of the malarial parasite
Pathology
Clinical features
P. falciparum infection
P. vivax and P. ovale infection
P. malariae and P. knowlesi infection
Investigations
Management
Mild P. falciparum malaria
Complicated P. falciparum malaria
Non-falciparum malaria
Prevention
Malaria control in endemic areas
Babesiosis
African trypanosomiasis (sleeping sickness)
Clinical features
Rhodesiense infections
Gambiense infections
Investigations
Management
Prevention
American trypanosomiasis (Chagas’ disease)
Pathology
Clinical features
Acute phase
Chronic phase
Investigations
Management and prevention
Toxoplasmosis
Clinical features
Congenital toxoplasmosis
Investigations
Management
Epidemiology and transmission
Leishmaniasis
Visceral leishmaniasis (kala-azar)
Clinical features
Investigations
Differential diagnosis
Management
Pentavalent antimonials
Amphotericin B
Other drugs
Response to treatment
HIV–visceral leishmaniasis co-infection
Post-kala-azar dermal leishmaniasis
Clinical features
Investigations and management
Prevention and control
Cutaneous and mucosal leishmaniasis
Cutaneous leishmaniasis
Pathogenesis
Clinical features
Mucosal leishmaniasis
Investigations in CL and ML
Management of CL and ML
Prevention of CL and ML
Gastrointestinal protozoal infections
Amoebiasis
Pathology
Clinical features
Intestinal amoebiasis – amoebic dysentery
Amoebic liver abscess
Investigations
Management
Prevention
Giardiasis
Clinical features and investigations
Management
Cryptosporidiosis
Cyclosporiasis
Infections caused by helminths
Intestinal human nematodes
Ancylostomiasis (hookworm)
Clinical features
Investigations
Management
Strongyloidiasis
Clinical features
Investigations
Management
Ascaris lumbricoides (roundworm)
Clinical features
Investigations
Management
Prevention
Enterobius vermicularis (threadworm, pinworm)
Clinical features
Investigations
Management
Trichuris trichiura (whipworm)
Tissue-dwelling human nematodes
Lymphatic filariasis
Pathology
Clinical features
Investigations
Management
Co-infections
Chronic lymphatic pathology
Prevention
Loiasis
Clinical features
Investigations
Management
Prevention
Onchocerciasis (river blindness)
Pathology
Clinical features
Investigations
Management
Prevention
Dracunculiasis (Guinea worm)
Management and prevention
Other filariases
Mansonella perstans
Dirofilaria immitis
Zoonotic nematodes
Trichinosis (trichinellosis)
Clinical features
Investigations
Management
Anisakiasis (herring worm)
Cutaneous larva migrans
Angiostrongylus cantonensis
Gnathostomiasis
Trematodes (flukes)
Schistosomiasis
Pathology
Clinical features
Schistosoma haematobium
Schistosoma mansoni
Schistosoma japonicum, S. mekongi and S. intercalatum
Investigations
Management
Prevention
Liver flukes
Cestodes (tapeworms)
Intestinal tapeworm
Taenia solium
Taenia saginata
Taenia asiatica
Cysticercosis
Clinical features
Investigations
Management and prevention
Echinococcus granulosus (Taenia echinococcus) and hydatid disease
Clinical features
Investigations
Management and prevention
Other tapeworms
Jiggers (tungiasis)
Myiasis
Ectoparasites
Fungal infections
Superficial mycoses
Candidiasis (thrush)
Subcutaneous mycoses
Chromoblastomycosis
Mycetoma (eumycetoma and actinomycetoma)
Clinical features
Investigations
Management
Phaeohyphomycosis
Sporotrichosis
Investigations
Management
Systemic mycoses
Aspergillosis
Candidiasis
Syndromes of systemic candidiasis
Acute disseminated candidiasis
Chronic disseminated candidiasis (hepatosplenic candidiasis)
Other manifestations
Management
Cryptococcosis
Fusariosis
Mucormycosis
Talaromyces marneffei infection
Histoplasmosis
Pathology
Clinical features
Investigations
Management
Coccidioidomycosis
Investigations and management
Paracoccidioidomycosis
Blastomycosis
Further information
14 HIV infection and AIDS
Clinical examination in HIV disease
Epidemiology
Global and regional epidemics
Modes of transmission
Virology and immunology
Diagnosis and investigations
Diagnosing HIV infection
Viral load and CD4 counts
Clinical manifestations of HIV
Presenting problems in HIV infection
Lymphadenopathy
Weight loss
Fever
Mucocutaneous disease
Seborrhoeic dermatitis
Herpes simplex infections
Herpes zoster
Kaposi’s sarcoma
Bacillary angiomatosis
Papular pruritic eruption
Drug rashes
Oral conditions
Nail disorders
Gastrointestinal disease
Oesophageal diseases
Diarrhoea
Large bowel diarrhoea
Small bowel diarrhoea
Hepatobiliary disease
Chronic viral hepatitis
Hepatitis B
Hepatitis C
HIV cholangiopathy
Respiratory disease
Pneumocystis jirovecii pneumonia (Pneumocystis pneumonia, PCP)
Pulmonary tuberculosis
Bacterial pneumonia
Miscellaneous causes of pulmonary infiltrates
Nervous system and eye disease
Cognitive impairment
HIV-associated neurocognitive disorders
Progressive multifocal leucoencephalopathy
CMV encephalitis
Space-occupying lesions
Cerebral toxoplasmosis
Primary CNS lymphoma
Tuberculoma
Stroke
Meningitis
Cryptococcal meningitis
Tuberculous meningitis
Peripheral nerve disease
Myelopathy and radiculopathy
Psychiatric disease
Retinopathy
Rheumatological disease
Arthritis
Diffuse infiltrative lymphocytosis syndrome
Haematological abnormalities
Anaemia
Neutropenia
Thrombocytopenia
Renal disease
Cardiac disease
HIV-related cancers
Prevention of opportunistic infections
Preventing exposure
Safe water and food
Tuberculosis
Malaria vector control
Safer sex
Pets
Chemoprophylaxis
Co-trimoxazole primary prophylaxis
Tuberculosis preventive therapy
Mycobacterium avium complex prophylaxis
Preventing cryptococcosis
Immunisation
Selecting antiretroviral regimens
Starting ART
Monitoring efficacy
Antiretroviral resistance
Antiretroviral therapy
ART complications
Immune reconstitution inflammatory syndrome
Antiretroviral adverse drug reactions
ART in special situations
Pregnancy
Old age
Prevention of HIV
Pre-exposure prophylaxis
Post-exposure prophylaxis
Further information
15 Sexually transmitted infections
Clinical examination in sexually transmitted infection
Aetiology
Clinical assessment
Presenting problems
Urethral discharge
Genital itch, rash and discomfort
Vaginal discharge
Genital ulceration
Genital lumps
Proctitis
Lower abdominal pain
Epidemiology
Prevention
Sexually transmitted bacterial infections
Syphilis
Acquired syphilis
Early syphilis
Primary syphilis
Secondary syphilis
Latent syphilis
Late syphilis
Late latent syphilis
Cardiovascular syphilis
Benign tertiary syphilis
Neurosyphilis
Congenital syphilis
Investigations in adult cases
Investigations in suspected congenital syphilis
Management
Pregnancy
Treatment reactions
Clinical features
Investigations
Management of adults
Clinical features
Diagnosis
Management
First episode
Recurrent genital herpes
Management in pregnancy
Clinical features
Management
Gonorrhoea
Chlamydial infection
Mycoplasma genitalium
Other sexually transmitted bacterial infections
Sexually transmitted viral infections
Genital herpes simplex
Human papillomavirus and anogenital warts
Molluscum contagiosum
Viral hepatitis
Further information
16 Cardiology
Clinical examination of the cardiovascular system
Functional anatomy and physiology
Anatomy
Coronary circulation
Conduction system
Nerve supply of the heart
Physiology
Myocardial contraction
Cardiac peptides
Circulation
Endothelium
Respiration
Investigation of cardiovascular disease
Electrocardiogram
The 12-lead ECG
Exercise ECG
Ambulatory ECG
Cardiac biomarkers
Brain natriuretic peptide
Cardiac troponins
Chest X-ray
Echocardiography
Transthoracic echocardiography
Doppler echocardiography
Transoesophageal echocardiography
Stress echocardiography
Computed tomography
Magnetic resonance imaging
Cardiac catheterisation
Electrophysiology
Radionuclide imaging
Blood pool imaging
Myocardial perfusion scanning
Clinical assessment
Investigations
Clinical assessment
Investigations
Management
Clinical assessment
Investigation
Management
Clinical assessment
Is the sound cardiac?
Is the sound pathological?
What is the origin of the sound?
Systolic murmurs
Diastolic murmurs
Continuous murmurs
Investigations
Management
Left heart failure
Right heart failure
Biventricular heart failure
Epidemiology
Pathogenesis
Ventricular dysfunction
High-output failure
Valvular disease
Clinical assessment
Acute left heart failure
Chronic heart failure
Complications of heart failure
Investigations
Management of acute heart failure
Management of chronic heart failure
Education
Drug treatment
Diuretics
Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
Neprilysin inhibitors
Vasodilators
Beta-adrenoceptor antagonists (β-blockers)
Ivabradine
Digoxin
Amiodarone
Non-pharmacological treatments
Implantable cardiac defibrillators
Cardiac resynchronisation therapy devices
Coronary revascularisation
Cardiac transplantation
Ventricular assist devices
Pathogenesis
Clinical features
Investigations
Management
First-degree atrioventricular block
Second-degree atrioventricular block
Third-degree atrioventricular block
Presenting problems in cardiovascular disease
Chest pain on exertion
Severe prolonged chest pain
Breathlessness
Syncope
Palpitation
Cardiac arrest
Abnormal heart sounds
Heart failure
Sinus arrhythmia
Sinus bradycardia
Sinus tachycardia
Sinoatrial disease
Atrioventricular block
Clinical features
Management
Bundle branch block
Atrial ectopic beats
Atrial tachycardia
Atrial flutter
Management
Atrial fibrillation
Pathogenesis
Clinical features
Investigations
Management
Paroxysmal atrial fibrillation
Persistent atrial fibrillation
Rhythm control
Rate control
Prevention of thromboembolism and stroke
Supraventricular tachycardia
Atrioventricular nodal re-entrant tachycardia
Management
Atrioventricular re-entrant tachycardia
Management
Ventricular premature beats
Management
Ventricular tachycardia
Management
Torsades de pointes
Management
Cardiac arrhythmias
Principles of management of cardiac arrhythmias
Anti-arrhythmic drugs
Class I drugs
Class Ia drugs
Disopyramide
Quinidine
Class Ib drugs
Lidocaine
Mexiletine
Class Ic drugs
Flecainide
Propafenone
Non-selective β-blockers
Cardioselective β-blockers
Sotalol
Amiodarone
Dronedarone
Verapamil
Diltiazem
Atropine sulphate
Adenosine
Digoxin
Class II drugs
Class III drugs
Class IV drugs
Other anti-arrhythmic drugs
Non-pharmacological treatments
Electrical cardioversion
Defibrillation
Temporary pacemakers
Permanent pacemakers
Implantable cardiac defibrillators
Cardiac resynchronisation therapy
Catheter ablation therapy
Pathogenesis
Age and sex
Genetics
Smoking
Hypertension
Hypercholesterolaemia
Diabetes mellitus
Haemostatic factors
Physical activity
Obesity
Alcohol
Diet
Personality
Social deprivation
Management
Primary prevention
Secondary prevention
Pathogenesis
Coronary artery spasm
Syndrome X and microvascular angina
Other causes
Clinical features
Investigations
Management
Anti-anginal drug therapy
Nitrates
Beta-blockers
Calcium channel antagonists
Potassium channel activators
If channel antagonist
Ranolazine
Non-pharmacological treatments
Percutaneous coronary intervention
Coronary artery bypass grafting
Prognosis
Pathogenesis
Anchor 207
Coronary artery disease
Angina pectoris
Acute coronary syndrome
17 Respiratory medicine
Clinical examination of the respiratory system
Functional anatomy and physiology
Investigation of respiratory disease
Imaging
The ‘plain’ chest X-ray
Computed tomography
Positron emission tomography
Magnetic resonance imaging
Ultrasound
Endoscopic examination
Laryngoscopy
Bronchoscopy
Endobronchial ultrasound
Thoracoscopy
Microbiological investigations
Immunological and serological tests
Cytology and histopathology
Respiratory function testing
Measurement of airway obstruction
Lung volumes
Transfer factor
Arterial blood gases and oximetry
Exercise tests
Aetiology
Pathophysiology
Differential diagnosis
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 along with your breathlessness?
Presenting problems in respiratory disease
Cough
Breathlessness
Chronic exertional breathlessness
Acute severe breathlessness
Management
Clinical assessment
Investigations
Radiological investigations
Pleural aspiration and biopsy
Management
Chest pain
Finger clubbing
Haemoptysis
‘Incidental’ pulmonary nodule
Pleural effusion
Empyema
Clinical assessment
Investigations
Management
Pathophysiology
Management of acute respiratory failure
Respiratory failure
Chronic and ‘acute on chronic’ type II respiratory failure
Management
Home ventilation for chronic respiratory failure
Lung transplantation
Pathophysiology
Clinical features
Diagnosis
Management
Setting goals
Self-management
Avoidance of aggravating factors
The stepwise approach to the management of asthma
Step 1: Regular preventer
Step 2: Initial add-on therapy
Step 3: Additional add-on therapies
Step 4: High-dose therapies
Step 5: Continuous or frequent use of oral glucocorticoids
Exacerbations of asthma
Management of mild to moderate exacerbations
Management of acute severe asthma
Prognosis
Pathophysiology
Clinical features
Investigations
Assessment of severity
Management
Reducing exposure to noxious particles and gases
Pulmonary rehabilitation
Bronchodilators
Combined inhaled glucocorticoids and bronchodilators
Oral anti-inflammatories
Other maintenance measures
Oxygen therapy and home ventilation
Surgical intervention
Palliative care
Prognosis
Acute exacerbations of COPD
Oxygen therapy
Bronchodilators
Glucocorticoids
Antibiotic therapy
Non-invasive ventilation
Additional therapy
Discharge
Aetiology and pathology
Clinical features
Investigations
Management
Physiotherapy
Antibiotic therapy
Surgical treatment
Prognosis
Prevention
Clinical features
Management
Treatment of CF lung disease
Treatment of non-respiratory manifestations of CF
CFTR modulator therapies
Community-acquired pneumonia
Clinical features
Investigations
Management
Oxygen
Fluid balance
Antibiotic treatment
Treatment of pleural pain
Physiotherapy
Prognosis
Discharge and follow-up
Prevention
Hospital-acquired pneumonia
Clinical features and investigation
Management
Prevention
Suppurative pneumonia, aspiration pneumonia and pulmonary abscess
Investigations
Management
Pneumonia in the immunocompromised patient
Clinical features
Investigations
Management
Epidemiology
Pathology and pathogenesis
Clinical features: pulmonary disease
Primary pulmonary TB
Miliary TB
Post-primary pulmonary TB
Clinical features: extrapulmonary disease
Lymphadenitis
Pleural tuberculosis
Gastrointestinal tuberculosis
Pericardial disease
Central nervous system disease
Bone and joint disease
Genitourinary disease
Investigations
Drug sensitivity testing
Management
Chemotherapy
Control and prevention
Latent TB infection (LTBI)
Directly observed therapy
TB and HIV/AIDS
Drug-resistant TB
Vaccines
Cough
Haemoptysis
Bronchial obstruction
Breathlessness
Pain and nerve entrapment
Mediastinal spread
Metastatic spread
Finger clubbing
Hypertrophic pulmonary osteoarthropathy (HPOA)
Non-metastatic extrapulmonary effects (Box 17.64)
Prognosis
Obstructive pulmonary diseases
Asthma
Chronic obstructive pulmonary disease
Bronchiectasis
Cystic fibrosis
Infections of the respiratory system
Upper respiratory tract infection
Pneumonia
Tuberculosis
Non-tuberculous mycobacterial infection
Respiratory diseases caused by fungi
Allergic bronchopulmonary aspergillosis
Clinical features
Management
Chronic pulmonary aspergillosis
Simple aspergilloma
Chronic cavitary pulmonary aspergillosis and chronic fibrosing pulmonary aspergillosis
Aspergillus nodule
Subacute invasive aspergillosis
Invasive pulmonary aspergillosis
Clinical features
Management and prevention
Other fungal infections
Aetiology
Tumours of the bronchus and lung
Primary tumours of the lung
Lung cancer
Pathology
Clinical features
Investigations
Imaging
Biopsy and histopathology
Staging to guide treatment
Management
Surgical treatment
Radiotherapy
Chemotherapy
Laser therapy and stenting
General aspects of management
Prognosis
Investigations
Management
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
Prognosis
Non-specific interstitial pneumonia
Sarcoidosis
Clinical features
Investigations
Management
Lung diseases due to systemic inflammatory disease
The acute respiratory distress syndrome
Respiratory involvement in connective tissue disorders
Rheumatoid disease
Systemic lupus erythematosus
Systemic sclerosis
Pulmonary eosinophilia and vasculitides
Acute eosinophilic pneumonia
Chronic eosinophilic pneumonia
Tropical pulmonary eosinophilia
Granulomatosis with polyangiitis
Goodpasture’s disease
Lung diseases due to irradiation and drugs
Radiotherapy
Drugs
Rare interstitial lung diseases
Occupational and environmental lung disease
Occupational airway disease
Occupational asthma
Irritant-induced asthma
Chronic obstructive pulmonary disease
Byssinosis
Pneumoconiosis
Coal worker’s pneumoconiosis
Silicosis
Berylliosis
Less common pneumoconioses
Lung diseases due to organic dusts
Hypersensitivity pneumonitis
Clinical features
Investigations
Diagnosis
Management
Inhalation (‘humidifier’) fever
Asbestos-related lung and pleural diseases
Pleural plaques
Acute benign asbestos pleurisy
Benign asbestos-related pleural effusion
Diffuse pleural thickening
Asbestosis
Mesothelioma
Occupational lung cancer
Occupational pneumonia
Clinical features
Investigations
Management
General measures
Anticoagulation
Thrombolytic and surgical therapy
Caval filters
Further investigations
Prognosis
Clinical features
Investigations
Management
Pulmonary vascular disease
Pulmonary embolism
Pulmonary hypertension
Diseases of the upper airway
Diseases of the nasopharynx
Allergic rhinitis
Clinical features
Management
Sleep-disordered breathing
The obstructive sleep apnoea/hypopnoea syndrome
Aetiology
Clinical features
Investigations
Management
Central sleep apnoea and nocturnal hypoventilation
Aetiology
Clinical features
Investigations
Management
Laryngeal disorders
Chronic laryngitis
Laryngeal paralysis
Clinical features and management
Psychogenic hoarseness and aphonia
Laryngeal obstruction
Management
Tracheal disorders
Tracheal obstruction
Clinical features and management
Tracheo-oesophageal fistula
Pneumothorax
Clinical features
Investigations
Management
Recurrent spontaneous pneumothorax
Pleural disease
Diseases of the diaphragm and chest wall
Disorders of the diaphragm
Congenital disorders
Diaphragmatic hernias
Eventration of the diaphragm
Acquired disorders
Deformities of the chest wall
Thoracic kyphoscoliosis
Pectus
Further information
18 Nephrology and urology
Clinical examination of the kidney and urinary tract
Functional anatomy and physiology
Investigation of renal and urinary tract disease
Glomerular filtration rate
Urine investigations
Blood tests
Haematology
Biochemistry
Immunology
Imaging
Ultrasound
Computed tomography
Magnetic resonance imaging
Renal arteriography
Pyelography
Radionuclide studies
Clinical assessment
Investigations
Management
Renal biopsy
Presenting problems in renal and urinary tract disease
Oliguria/anuria
Polyuria
Frequency
Nocturia
Urinary incontinence
Abdominal pain
Dysuria
Oedema
Hypertension
Haematuria
Nephritic syndrome
Proteinuria
Moderately elevated albuminuria (microalbuminuria)
Overt (dipstick-positive) proteinuria
Nephrotic syndrome
Glomerular diseases
Glomerulonephritis
Diseases typically presenting with nephrotic syndrome
Minimal change nephropathy
Focal segmental glomerulosclerosis
Membranous nephropathy
Diseases typically presenting with mild nephritic syndrome
IgA nephropathy
Henoch–Schönlein purpura
Mesangiocapillary glomerulonephritis
Diseases typically presenting with rapidly progressive glomerulonephritis
Anti-glomerular basement membrane disease
Infection-related glomerulonephritis
Acute interstitial nephritis
Clinical features
Investigations
Management
Chronic interstitial nephritis
Pathophysiology
Clinical features
Management
Papillary necrosis
Tubulo-interstitial diseases
Genetic renal diseases
Inherited glomerular diseases
Alport syndrome
Thin glomerular basement membrane disease
Hereditary nephrotic syndrome
Inherited tubulo-interstitial diseases
Isolated defects of tubular function
Cystic diseases of the kidney
Autosomal dominant polycystic kidney disease
Clinical features
Investigations
Management
Other cystic diseases
Pathophysiology
Clinical features
Investigations
Management
Renal vascular diseases
Renal artery stenosis
Acute renal infarction
Diseases of small intrarenal vessels
Thrombotic microangiopathies
Haemolytic uraemic syndrome
Thrombotic thrombocytopenic purpura
Cholesterol emboli
Small-vessel vasculitis
Diabetes mellitus
Multiple myeloma
Hepatic–renal disease
Sarcoidosis
Systemic vasculitis
Systemic sclerosis
Systemic lupus erythematosus
Sickle-cell nephropathy
Pathophysiology
Clinical features
Pre-renal AKI
Renal AKI
Post-renal AKI
Management
Optimisation of volume status
Treatment of underlying cause
Electrolyte and acid–base disturbances
Dietary measures
Infection
Medications
Renal replacement therapy (RRT)
Recovery from AKI
Epidemiology
Pathophysiology
Clinical features
Investigations
Management
Monitoring of renal function
Reduction of rate of progression
Antihypertensive therapy
Reduction of proteinuria
Treatment of complications
Maintenance of fluid and electrolyte balance
Acid–base balance
Renal bone disease
Anaemia
Treatment of risk factors for cardiovascular disease
Preparing for renal replacement therapy
Renal involvement in systemic conditions
Acute kidney injury
Chronic kidney disease
Renal replacement therapy
Conservative treatment
Haemodialysis
Haemodialysis in AKI
Haemodialysis in ESRD
Haemofiltration
Peritoneal dialysis
Renal transplantation
Renal disease in pregnancy
Renal disease in adolescence
Drugs and the kidney
Drug-induced renal disease
Non-steroidal anti-inflammatory drugs
ACE inhibitors
Prescribing in renal disease
Urinary tract infection
Pathophysiology
Clinical features
Investigations
Management
Persistent or recurrent UTI
Asymptomatic bacteriuria
Catheter-related bacteriuria
Acute pyelonephritis
Tuberculosis
Pathophysiology
Clinical features
Investigations
Management
Infections of the urinary tract
Urolithiasis
Diseases of the collecting system and ureters
Congenital abnormalities
Single kidneys
Medullary sponge kidney disease
Ureterocele
Ectopic ureters and duplex kidneys
Megaureter
Pelvi-ureteric junction obstruction
Reflux nephropathy
Pathophysiology
Clinical features
Investigations
Management
Retroperitoneal fibrosis
Renal cell cancer
Clinical features
Investigations
Management
Urothelial tumours
Pathophysiology
Clinical features
Investigations
Management
Pathophysiology
Stress incontinence
Urge incontinence
Continual incontinence
Overflow incontinence
Post-micturition dribble
Clinical assessment
Investigations
Management
Prostatitis
Benign prostatic enlargement
Pathophysiology
Clinical features
Investigations
Management
Prostate cancer
Pathophysiology
Clinical features
Investigations
Management
Clinical features and investigations
Management and prognosis
Investigations
Management
Tumours of the kidney and urinary tract
Urinary incontinence
Prostate disease
Testicular tumours
Erectile dysfunction
Further information
19 Clinical biochemistry and metabolic medicine
Clinical examination in biochemical and metabolic disorders
Biochemical investigations
Water and electrolyte homeostasis
Sodium homeostasis
Functional anatomy and physiology
Proximal renal tubule
Loop of Henle
Early distal renal tubule
Late distal renal tubule and collecting ducts
Regulation of sodium transport
Presenting problems in sodium balance
Hypovolaemia
Pathogenesis
Clinical features
Investigations
Management
Intravenous fluid therapy
Hypervolaemia
Pathogenesis
Clinical features
Investigations
Management
Diuretic therapy
Carbonic anhydrase inhibitors
Sodium-dependent glucose transporter inhibitors
Loop diuretics
Thiazide diuretics
Potassium-sparing diuretics
Osmotic diuretics
Clinical use of diuretics
Water homeostasis
Functional anatomy and physiology
Presenting problems in regulation of osmolality
Hyponatraemia
Pathophysiology
Hyponatraemia with hypovolaemia
Hyponatraemia with euvolaemia
Hyponatraemia with hypervolaemia
Clinical features
Investigations
Management
Hypernatraemia
Pathophysiology
Clinical features
Management
Potassium homeostasis
Functional anatomy and physiology
Presenting problems in potassium homeostasis
Hypokalaemia
Pathophysiology
Clinical features
Investigations
Management
Hyperkalaemia
Pathophysiology
Clinical features
Investigations
Management
Acid–base homeostasis
Functional anatomy and physiology
Renal control of acid–base balance
Presenting problems in acid–base balance
Metabolic acidosis
Pathophysiology
Clinical features
Investigations
Management
Metabolic alkalosis
Pathophysiology
Clinical features
Investigations
Management
Respiratory acidosis
Respiratory alkalosis
Mixed acid–base disorders
Calcium homeostasis
Magnesium homeostasis
Functional anatomy and physiology
Presenting problems in magnesium homeostasis
Hypomagnesaemia
Pathophysiology
Clinical features
Management
Hypermagnesaemia
Phosphate homeostasis
Functional anatomy and physiology
Presenting problems in phosphate homeostasis
Hypophosphataemia
Pathophysiology
Clinical features
Investigations
Management
Hyperphosphataemia
Pathophysiology
Clinical features
Management
Lipids and lipoprotein metabolism
Functional anatomy and physiology
Processing of dietary lipid
Endogenous lipid synthesis
Cholesterol transport
Lipids and cardiovascular disease
Investigations
Presenting problems in lipid metabolism
Hypercholesterolaemia
Hypertriglyceridaemia
Mixed hyperlipidaemia
Rare dyslipidaemias
Principles of management
Non-pharmacological management
Pharmacological management
Hypercholesterolaemia
Statins
PCSK9 inhibitors
Ezetimibe
Bile acid-sequestering resins
Combination therapy
Hypertriglyceridaemia
Fibrates
Highly polyunsaturated long-chain n-3 fatty acids
Mixed hyperlipidaemia
Monitoring of therapy
Inherited metabolic disorders
Disorders of amino acid metabolism
Phenylketonuria
Homocystinuria
Disorders of the urea cycle
Ornithine tricarboxylase deficiency
Disorders of carbohydrate metabolism
Galactosaemia
Glycogen storage diseases
Disorders of mitochondrial energy metabolism
Lysosomal storage disorders
The porphyrias
Cutaneous porphyrias
Further information
20 Endocrinology
Clinical examination in endocrine disease
An overview of endocrinology
Functional anatomy and physiology
Endocrine pathology
Investigation of endocrine disease
Presenting problems in endocrine disease
The thyroid gland
Functional anatomy, physiology and investigations
Presenting problems in thyroid disease
Thyrotoxicosis
Clinical assessment
Investigations
Management
Atrial fibrillation in thyrotoxicosis
Thyrotoxic crisis (‘thyroid storm’)
Hyperthyroidism in old age
Hypothyroidism
Clinical assessment
Investigations
Management
Levothyroxine replacement in ischaemic heart disease
Hypothyroidism in old age
Hypothyroidism in pregnancy
Myxoedema coma
Symptoms of hypothyroidism with normal thyroid function tests
Asymptomatic abnormal thyroid function tests
Subclinical thyrotoxicosis
Subclinical hypothyroidism
Non-thyroidal illness (‘sick euthyroidism’)
Thyroid lump or swelling
Clinical assessment and investigations
Thyroid scintigraphy
Thyroid ultrasound
Fine needle aspiration cytology
Management
Autoimmune thyroid disease
Graves’ disease
Graves’ thyrotoxicosis
Pathophysiology
Management
Antithyroid drugs
Thyroid surgery
Radioactive iodine
Thyrotoxicosis in pregnancy
Thyrotoxicosis in adolescence
Graves’ ophthalmopathy
Pretibial myxoedema
Hashimoto’s thyroiditis
Transient thyroiditis
Subacute (de Quervain’s) thyroiditis
Post-partum thyroiditis
Iodine-associated thyroid disease
Iodine deficiency
Iodine-induced thyroid dysfunction
Amiodarone
Simple and multinodular goitre
Simple diffuse goitre
Multinodular goitre
Clinical features and investigations
Management
Papillary carcinoma
Follicular carcinoma
Thyroid neoplasia
Toxic adenoma
Differentiated carcinoma
Management
Prognosis
Anaplastic carcinoma and lymphoma
Medullary carcinoma
Riedel’s thyroiditis
Congenital thyroid disease
Dyshormonogenesis
Thyroid hormone resistance
The male
The female
The reproductive system
Functional anatomy, physiology and investigations
Presenting problems in reproductive disease
Delayed puberty
Clinical assessment
Constitutional delay of puberty
Hypogonadotrophic hypogonadism
Hypergonadotrophic hypogonadism
Investigations
Management
Amenorrhoea
Clinical assessment
Investigations
Management
Male hypogonadism
Investigations
Management
Infertility
Clinical assessment
Investigations
Management
Gynaecomastia
Clinical assessment
Investigations
Management
Hirsutism
Clinical assessment
Investigations
Management
Management
Menstrual irregularity and infertility
Hirsutism
Clinical features
Diagnosis and management
Clinical features
Diagnosis and management
Polycystic ovary syndrome
Turner syndrome
Klinefelter syndrome
The parathyroid glands
Functional anatomy, physiology and investigations
Presenting problems in parathyroid disease
Hypercalcaemia
Clinical assessment
Investigations
Management
Hypocalcaemia
Aetiology
Clinical assessment
Management
Clinical and radiological features
Investigations
Management
Pseudohypoparathyroidism
Management of hypoparathyroidism
Glucocorticoids
Mineralocorticoids
Catecholamines
Adrenal androgens
Primary hyperparathyroidism
Familial hypocalciuric hypercalcaemia
Hypoparathyroidism
The adrenal glands
Functional anatomy and physiology
Presenting problems in adrenal disease
Cushing’s syndrome
Aetiology
Clinical assessment
Investigations
Establishing the presence of Cushing’s syndrome
Determining the underlying cause
Management
Cushing’s disease
Adrenal tumours
Ectopic ACTH syndrome
Therapeutic use of glucocorticoids
Adverse effects of glucocorticoids
Management of glucocorticoid withdrawal
Adrenal insufficiency
Clinical assessment
Investigations
Assessment of glucocorticoids
Assessment of mineralocorticoids
Assessment of adrenal androgens
Other tests to establish the cause
Management
Glucocorticoid replacement
Mineralocorticoid replacement
Androgen replacement
Incidental adrenal mass
Clinical assessment and investigations
Management
Clinical features
Investigations
Biochemical
Imaging and localisation
Management
Clinical features
Investigations
Localisation
Management
Pathophysiology and clinical features
Investigations
Management
Primary hyperaldosteronism
Phaeochromocytoma and paraganglioma
Congenital adrenal hyperplasia
The endocrine pancreas and gastrointestinal tract
Presenting problems in endocrine pancreas disease
Spontaneous hypoglycaemia
Clinical assessment
Investigations
Does the patient have a hypoglycaemic disorder?
What is the cause of the hypoglycaemia?
Management
Clinical features
Investigations
Management
Investigation of patients with pituitary disease
Gastroenteropancreatic neuro-endocrine tumours
The hypothalamus and the pituitary gland
Functional anatomy, physiology and investigations
Presenting problems in hypothalamic and pituitary disease
Hypopituitarism
Clinical assessment
Investigations
Management
Cortisol replacement
Thyroid hormone replacement
Sex hormone replacement
Growth hormone replacement
Pituitary tumour
Clinical assessment
Investigations
Management
Hyperprolactinaemia/galactorrhoea
Clinical assessment
Investigations
Management
Management
Medical
Surgery and radiotherapy
Pregnancy
Clinical features
Investigations
Management
Surgical
Medical
Radiotherapy
Clinical features
Investigations
Management
Prolactinoma
Acromegaly
Craniopharyngioma
Diabetes insipidus
Disorders affecting multiple endocrine glands
Multiple endocrine neoplasia
Autoimmune polyendocrine syndromes
Endocrine effects of cancer immunotherapy
Late effects of childhood cancer therapy
Opioid-induced endocrine dysfunction
Multiple Choice Questions
Further information
21 Diabetes mellitus
Clinical examination of people with diabetes
Functional anatomy and physiology
Anchor 4
Insulin
Regulation of insulin secretion
Actions of insulin
Glucagon
Blood glucose homeostasis
Fat metabolism
Investigations
Anchor 12
Urine glucose
Blood glucose
Interstitial glucose
Urine and blood ketones
Glycated haemoglobin
Islet autoantibodies
C-peptide
Urine albumin (‘microalbuminuria’)
Establishing the diagnosis of diabetes
Aetiology and pathogenesis of diabetes
Anchor 23
Pathogenesis of diabetes
Insulin resistance and the metabolic syndrome
β-cell dysfunction
Type 1 diabetes
Pathogenesis
Genetic predisposition
Environmental predisposition
Metabolic disturbances in type 1 diabetes
Clinical course of type 1 diabetes
Type 1 diabetes presenting in adults
Type 2 diabetes
Pathogenesis
Risk factors for type 2 diabetes
Genetic predisposition
Lifestyle factors and obesity
Age
Ethnicity
Interaction of risk factors for type 2 diabetes
Clinical course and metabolic disturbances in type 2 diabetes
Other forms of diabetes
Pancreatic diabetes
Monogenic diabetes
Presenting problems in diabetes
Anchor 47
Hyperglycaemia
Diabetic ketoacidosis
Pathogenesis
Clinical assessment
Investigations
Assessment of severity
Management
Fluid replacement
Insulin replacement
Potassium replacement
Intravenous bicarbonate and phosphate
Ongoing management
Hyperglycaemic hyperosmolar state
Hypoglycaemia
Clinical assessment
Awareness of hypoglycaemia
Risk factors and causes of hypoglycaemia
Management
Reversing hypoglycaemia
Reducing future risk of hypoglycaemia
Type 2 diabetes
Type 1 diabetes
Type 2 diabetes
Type 1 diabetes
Type 1 diabetes
Type 2 diabetes
Type 2 diabetes
Type 1 diabetes
Type 1 diabetes
Type 2 diabetes
Management of diabetes
Anchor 69
Self-assessment of glycaemic control
Therapeutic goals
HbA1c targets
Control of other risk factors
Education, diet and lifestyle
Principles of healthy eating
Weight management
Exercise
Alcohol and smoking
Driving
Ramadan
Glucose-lowering agents
Biguanides
Mechanism of action
Clinical use
Sulphonylureas
Mechanism of action
Clinical use
Thiazolidinediones
Mechanism of action
Clinical use
DPP-4 inhibitors
Mechanism of action
Clinical use
GLP-1 receptor agonists
Mechanism of action
Clinical use
SGLT2 inhibitors
Mechanism of action
Clinical use
Manufacture and formulations
Intermittent subcutaneous insulin injection therapy
Intermittent subcutaneous insulin injection regimens
Continuous subcutaneous insulin infusion therapy (insulin pump)
Sensor-augmented CSII therapy
Intravenous insulin therapy
Insulin therapy
Transplantation
Management of diabetes in special situations
Diabetes in pregnancy
Children, adolescents and young adults with diabetes
Diabetes in hospital
Hyperglycaemia in acute admissions to hospital
Surgery and diabetes
Pre-operative assessment
Perioperative management
Postoperative management
Diabetes footcare in hospital
Complications of diabetes
Life expectancy/mortality
Infections and diabetes
Urogenital, skin and soft tissue infections
Bone and joint infection
COVID-19
Diagnosis and screening
Management
Clinical features
Symmetrical sensory polyneuropathy
Asymmetrical motor diabetic neuropathy (diabetic amyotrophy)
Mononeuropathy
Autonomic neuropathy
Gastroparesis
Sexual dysfunction
Management
Diabetic eye disease
Diabetic kidney disease
Diabetic neuropathy
Diabetic foot disease
Aetiology
Management
Foot ulceration
Charcot neuroarthropathy
Skin and rheumatological complications of diabetes
Multiple Choice Questions
22 Nutritional factors in disease
Clinical examination in nutritional disorders
Clinical assessment and investigation of nutritional status
Nutritional factors and disease
Physiology of nutrition
Energy balance
Regulation of energy balance
Responses to under- and over-nutrition
Macronutrients (energy-yielding nutrients)
Carbohydrates
Dietary fibre
Fats
Proteins
Dietary recommendations for macronutrients
Complications
Body fat distribution
Aetiology
Susceptibility to obesity
Clinical features and investigations
Management
Lifestyle advice
Weight loss diets
Drugs
Surgery
Treatment of additional risk factors
Disorders of altered energy balance
Obesity
Under-nutrition
Starvation and famine
Clinical features
Investigations
Management
Under-nutrition in hospital
An approach to assisted nutrition in hospital patients
Oral nutritional supplements
Enteral feeding
Nasogastric tube feeding
Gastrostomy feeding
Post-pyloric feeding
Parenteral nutrition
Intestinal failure (‘short bowel syndrome’)
Management
Jejunum–colon patients
Jejunostomy patients
Small bowel and multivisceral transplantation
Further developments in treatment of intestinal failure
Artificial nutrition at the end of life
Nutrition and dementia
Micronutrients, minerals and their diseases
Vitamins
Fat-soluble vitamins
Vitamin A (retinol)
Vitamin D
Vitamin E
Vitamin K
Water-soluble vitamins
Thiamin (vitamin B1)
Deficiency – beri-beri
Riboflavin (vitamin B2 )
Niacin (vitamin B3 )
Deficiency – pellagra
Toxicity
Pyridoxine (vitamin B6 )
Biotin
Folate (folic acid)
Hydroxycobalamin (vitamin B12)
Vitamin C (ascorbic acid)
Deficiency – scurvy
Other bioactive dietary compounds
Inorganic micronutrients
Calcium and phosphorus
Iron
Iodine
Zinc
Selenium
Fluoride
Sodium, potassium and magnesium
Other essential inorganic nutrients
Further information
23 Gastroenterology
Clinical examination of the gastrointestinal tract
Functional anatomy and physiology
Oesophagus, stomach and duodenum
Gastric secretion
Gastrin, somatostatin and ghrelin
Protective factors
Small intestine
Digestion and absorption
Fat
Carbohydrates
Protein
Water and electrolytes
Vitamins and trace elements
Protective function of the small intestine
Physical defence mechanisms
Immunological defence mechanisms
Pancreas
Colon
Intestinal microbiota
Control of gastrointestinal function
The nervous system and gastrointestinal function
The enteric nervous system
Peristalsis
Migrating motor complexes
Gut hormones
Investigation of gastrointestinal disease
Imaging
Plain X-rays
Contrast studies
Ultrasound, computed tomography and magnetic resonance imaging
Endoanal ultrasound and anorectal manometry
Endoscopy
Upper gastrointestinal endoscopy
Endoscopic ultrasound
Capsule endoscopy
Enteroscopy – push enteroscopy/double balloon enteroscopy
Sigmoidoscopy and colonoscopy
Magnetic resonance cholangiopancreatography
Endoscopic retrograde cholangiopancreatography
Histology
Tests of infection
Bacterial cultures
Serology
Breath tests
Tests of function
Oesophageal motility
Gastric emptying
Colonic and anorectal motility
Investigations
Radioisotope tests
Gut hormone testing
Presenting problems in gastrointestinal disease
Dysphagia
Dyspepsia
Heartburn and regurgitation
Vomiting
Gastrointestinal bleeding
Acute upper gastrointestinal bleeding
Clinical assessment
Management
Intravenous access
Initial clinical assessment
Basic investigations
Resuscitation
Oxygen
Antithrombotic drugs
Proton pump inhibitor (PPI) therapy
Endoscopy
Monitoring
Radiology and surgery
Eradication
Lower gastrointestinal bleeding
Severe acute lower gastrointestinal bleeding
Subacute or chronic lower gastrointestinal bleeding
Major gastrointestinal bleeding of unknown cause
Chronic occult gastrointestinal bleeding
Diarrhoea
Acute diarrhoea
Chronic or relapsing diarrhoea
Pathophysiology
Investigations
Physiological causes
Psychiatric illness
Systemic disease
Gastrointestinal disease
Metabolic disorders and miscellaneous causes
Investigations
Clinical assessment and management
Initial investigations
Further investigations
Malabsorption
Weight loss
Constipation
Abdominal pain
Chronic or recurrent abdominal pain
Constant abdominal pain
Aphthous ulceration
Oral cancer
Candidiasis
Parotitis
Pathophysiology
Abnormalities of the lower oesophageal sphincter
Hiatus hernia
Delayed oesophageal clearance
Gastric contents
Defective gastric emptying
Increased intra-abdominal pressure
Dietary and environmental factors
Patient factors
Clinical features
Complications
Oesophagitis
Barrett’s oesophagus
Diagnosis
Management
Anaemia
Benign oesophageal stricture
Gastric volvulus
Investigations
Management
Infection
Corrosives
Drugs
Eosinophilic oesophagitis
Disorders of the mouth and salivary glands
Disorders of the oesophagus
Gastro-oesophageal reflux disease
Other causes of oesophagitis
Benign oesophageal stricture
Tumours of the oesophagus
Benign tumours
Carcinoma of the oesophagus
Clinical features
Investigations
Management
Perforation of the oesophagus
Oesophageal motility disorders
Pharyngeal pouch
Achalasia of the oesophagus
Pathophysiology
Clinical features
Investigations
Management
Endoscopic
Surgical
Other oesophageal motility disorders
Secondary causes of oesophageal dysmotility
Disorders of the stomach and duodenum
Gastritis
Acute gastritis
Chronic gastritis due to Helicobacter pylori infection
Autoimmune chronic gastritis
Ménétrier’s disease
Peptic ulcer disease
Gastric and duodenal ulcer
Pathophysiology
Helicobacter pylori
NSAIDs
Smoking
Clinical features
Investigations
Management
H. pylori eradication
General measures
Maintenance treatment
Surgical treatment
Complications of gastric resection or vagotomy
Dumping
Chemical (bile reflux) gastropathy
Diarrhoea and maldigestion
Weight loss
Anaemia
Metabolic bone disease
Gastric cancer
Complications of peptic ulcer disease
Perforation
Gastric outlet obstruction
Bleeding
Zollinger–Ellison syndrome
Pathophysiology
Clinical features
Investigations
Management
Tumours of the stomach
Gastric carcinoma
Pathophysiology
Clinical features
Investigations
Management
Surgery
Palliative treatment
Gastric lymphoma
Other tumours of the stomach
Gastric motility disorders
Gastroparesis
Disorders of the small intestine
Disorders causing malabsorption
Coeliac disease
Pathophysiology
Clinical features
Investigations
Duodenal biopsy
Antibodies
Haematology and biochemistry
Other investigations
Management
Complications
Dermatitis herpetiformis
Tropical sprue
Pathophysiology
Clinical features
Management
Small intestinal bacterial overgrowth
Pathophysiology
Clinical features
Investigations
Management
Whipple’s disease
Pathophysiology
Clinical features
Investigations
Management
Bile acid diarrhoea
Short bowel syndrome
Radiation enteropathy
Pathophysiology
Clinical features
Investigations
Management
Abetalipoproteinaemia
Miscellaneous disorders of the small intestine
Protein-losing enteropathy
Intestinal lymphangiectasia
Ulceration of the small intestine
NSAID-associated small intestinal toxicity
Eosinophilic gastroenteritis
Clinical features
Investigations and management
Meckel’s diverticulum
Adverse food reactions
Lactose intolerance
Clinical features
Infections of the small intestine
Tumours of the small intestine
Benign tumours
Malignant tumours
Adenocarcinomas
Neuro-endocrine tumours
Lymphoma
Immunoproliferative small intestinal disease
Small intestine motility disorders
Chronic small intestine pseudo-obstruction
Clinical features
Investigations
Management
Disorders of the colon and rectum
Colorectal polyps
Types of colorectal polyps
Assessment and treatment of colorectal polyps
Pathophysiology
Genetics
Environment
Clinical features
Investigations
Management
Endoscopy
Surgery
Adjuvant therapy
Palliation of advanced disease
Prevention and screening
Colorectal cancer
Hereditary syndromes predisposing to colorectal cancer
Non-polyposis syndromes
Polyposis syndromes
Familial adenomatous polyposis
Peutz–Jeghers syndrome
Juvenile polyposis
Pathophysiology
Clinical features
Investigations
Management
Diverticulosis
Colonic motility disorders
Simple constipation
Severe idiopathic constipation
Faecal impaction
Melanosis coli and laxative misuse syndromes
Hirschsprung’s disease
Acquired megacolon
Acute colonic pseudo-obstruction
Anorectal disorders
Haemorrhoids
Pruritus ani
Solitary rectal ulcer syndrome
Anal fissure
Anorectal abscesses and fistulae
Faecal incontinence
Management
Pathophysiology
Ulcerative colitis
Crohn’s disease
Clinical features
Ulcerative colitis
Crohn’s disease
Differential diagnosis
Complications
Life-threatening colonic inflammation
Haemorrhage
Fistulae
Cancer
Extra-intestinal complications
Investigations
Bacteriology
Endoscopy
Radiology
Management
Medical therapy
Non-biologic therapies
Aminosalicylates (5-ASA)
Glucocorticoids
Thiopurines
Methotrexate
Ciclosporin
Antibiotics
Biologic agents
Anti-TNF antibodies
Anti-α4β7 integrin
Janus kinase inhibitor
Anti-p40 antibodies
Therapeutic drug monitoring
Ulcerative colitis
Active ulcerative colitis
Severe ulcerative colitis
Maintenance of remission
Crohn’s disease
Principles of management
Induction of remission in mild to moderate disease
Induction of remission in severe disease
Maintenance therapy
Fistulae and perianal disease
Surgical management
Ulcerative colitis
Crohn’s disease
IBD in special circumstances
Childhood
Pregnancy
Metabolic bone disease
Microscopic colitis
Pathophysiology
Clinical features
Investigations
Management
Pathophysiology
Behavioural and psychosocial factors
Physiological factors
Luminal factors
Clinical features
Investigations
Management
Inflammatory bowel disease
Functional bowel disorders
Functional dyspepsia
Functional causes of vomiting
Irritable bowel syndrome
Acute small bowel ischaemia
Acute colonic ischaemia
Chronic mesenteric ischaemia
Pathophysiology
Clinical features
Investigations
Management
Pathophysiology
Clinical features
Investigations
Alcohol misuse
Pain relief
Malabsorption
Management of complications
Ischaemic gut injury
Diseases of the pancreas
Acute pancreatitis
Chronic pancreatitis
Management
Autoimmune pancreatitis
Congenital abnormalities affecting the pancreas
Pancreas divisum
Annular pancreas
Cystic fibrosis
Meconium ileus
Tumours of the pancreas
Adenocarcinoma of the pancreas
Clinical features
Investigations
Management
Incidental pancreatic mass
Diseases of the peritoneal cavity
Peritonitis
Tumours
Endometriosis
Pneumatosis cystoides intestinalis
HIV/AIDS and the gastrointestinal tract
Other disorders
Multiple Choice Questions
24 Hepatology
Clinical examination of the abdomen for liver and biliary disease
Functional anatomy and physiology
Applied anatomy
Normal liver structure and blood supply
Liver cells
Blood supply
Biliary system and gallbladder
Hepatic function
Carbohydrate, amino acid and lipid metabolism
Clotting factors
Bilirubin metabolism and bile
Storage of vitamins and minerals
Immune regulation
Investigation of liver and hepatobiliary disease
Liver blood biochemistry
Bilirubin
Albumin
Alanine aminotransferase and aspartate aminotransferase
Alkaline phosphatase and γ-glutamyl transferase
Other biochemical tests
Haematological tests
Blood count
Coagulation tests
Immunological tests
Imaging
Ultrasound
Computed tomography and magnetic resonance imaging
Cholangiography
Endoscopic ultrasound
Non-invasive markers of hepatic fibrosis
Histological examination
Presenting problems in liver disease
Abnormal liver function tests
Jaundice
Pre-hepatic jaundice
Hepatic jaundice
Post-hepatic jaundice
Pathophysiology
Clinical assessment
Investigations
Management
Pathophysiology
Investigations
Management
Sodium restriction
Diuretics
Paracentesis
Transjugular intrahepatic portosystemic stent shunt
Complications
Renal failure
Hepatorenal syndrome
Spontaneous bacterial peritonitis
Prognosis
Pathophysiology
Investigations
Management
Pathophysiology
Clinical features
Management
Nutrition in cirrhosis
Screening for complications
Prognosis
Clinical features
Pathophysiology
Investigations
Management
Primary prevention of variceal bleeding
Management of acute variceal bleeding
Pharmacological reduction of portal venous pressure
Variceal ligation (‘banding’)
Balloon tamponade
TIPSS
Portosystemic shunt surgery
Oesophageal transection
Secondary prevention of variceal bleeding
Acute liver failure
Hepatomegaly
Ascites
Hepatic encephalopathy
Variceal bleeding
Congestive ‘portal hypertensive’ gastropathy
Clinical features of acute infection
Investigations
Management
Cirrhosis
Acute on chronic liver failure
Portal hypertension
Infections and the liver
Viral hepatitis
Hepatitis A
Investigations
Management
Hepatitis B
Investigations
Serology
Hepatitis B surface antigen
Hepatitis B core antigen
Hepatitis B e antigen
Viral load and genotype
Management of acute hepatitis B
Management of chronic hepatitis B
Direct-acting nucleoside/nucleotide antiviral agents
Lamivudine
Entecavir and tenofovir
Pegylated interferon-alfa
Liver transplantation
Hepatocellular carcinoma risk
Prevention
Co-infection with HIV
Hepatitis D (Delta virus)
Investigations
Management
Hepatitis C
Investigations
Serology and virology
Molecular analysis
Liver function tests
Fibrosis assessment
Management
Hepatitis E
Other forms of viral hepatitis
HIV infection and the liver
Liver abscess
Pyogenic liver abscess
Pathophysiology
Clinical features
Investigations
Management
Hydatid cysts and amoebic liver abscesses
Leptospirosis
Pathophysiology
Clinical features
Alcohol-related fatty liver disease
Alcoholic hepatitis
Alcoholic cirrhosis
Investigations
Management
Nutrition
Drug therapy
Liver transplantation
Pathophysiology
Clinical features
Investigations
Biochemical tests
Imaging
Transient elastography
Liver biopsy
Management
Non-pharmacological treatment
Pharmacological treatment
Pathophysiology
Clinical features
Investigations
Management
Epidemiology
Pathophysiology
Clinical features
Associated diseases
Diagnosis and investigations
Management
Pruritus
Fatigue
Malabsorption
Bone disease
AMA-negative PBC (‘autoimmune cholangitis’)
PBC/autoimmune hepatitis overlap
Alcohol-related liver disease
Non-alcoholic fatty liver disease
Autoimmune liver and biliary disease
Autoimmune hepatitis
Primary biliary cholangitis
Overlap syndromes
Pathophysiology
Clinical features
Investigations
Management
Cancer screening
Management of complications
Surgical treatment
Primary sclerosing cholangitis
IgG4-associated cholangitis
Liver tumours and other focal liver lesions
Primary malignant tumours
Hepatocellular carcinoma
Clinical features
Investigations
Serum markers
Imaging
Liver biopsy
Role of screening
Management
Hepatic resection
Liver transplantation
Ablative therapy
Transarterial chemoembolisation
Systemic therapy
Fibrolamellar hepatocellular carcinoma
Other primary malignant tumours
Clinical features
Investigations
Management
Secondary malignant tumours
Benign tumours
Hepatic adenomas
Haemangiomas
Focal nodular hyperplasia
Cystic liver disease and liver abscess
Drugs and the liver
Drug-induced liver injury
Types of liver injury
Cholestasis
Hepatocyte necrosis
Steatosis
Vascular/sinusoidal lesions
Hepatic fibrosis
Autoimmune hepatitis-like
Inherited liver diseases
Haemochromatosis
Genetic haemochromatosis
Pathophysiology
Clinical features
Investigations
Management
Secondary haemochromatosis
Pathophysiology
Clinical features
Liver disease
Neurological disease
Kayser–Fleischer rings
Investigations
Management
Clinical features
Investigations
Wilson’s disease
Alpha-1-antitrypsin deficiency
Gilbert syndrome
Vascular liver disease
Hepatic arterial disease
Liver ischaemia
Liver arterial disease
Portal venous disease
Portal hypertension
Portal vein thrombosis
Hepatopulmonary syndrome
Portopulmonary hypertension
Hepatic venous disease
Budd–Chiari syndrome
Clinical features
Investigations
Management
Sinusoidal obstruction syndrome (veno-occlusive disease)
Cardiac disease
Nodular regenerative hyperplasia of the liver
Pregnancy and the liver
Intercurrent and pre-existing liver disease
Pregnancy-associated liver disease
Liver transplantation
Indications and contraindications
Complications
Early complications
Primary graft non-function
Technical complications
Rejection
Infections
Late complications
Prognosis
Cholestatic and biliary disease
Chemical cholestasis
Benign recurrent intrahepatic cholestasis
Intrahepatic biliary disease
Inflammatory and immune disease
Caroli’s disease
Congenital hepatic fibrosis
Cystic fibrosis
Extrahepatic biliary disease
Choledochal cysts
Pathophysiology
Cholesterol gallstones
Pigment stones
Biliary sludge
Clinical features
Investigations
Management
Secondary biliary cirrhosis
Gallstones
Cholecystitis
Acute cholecystitis
Pathophysiology
Clinical features
Investigations
Management
Medical
Surgical
Chronic cholecystitis
Acute cholangitis
Clinical features
Investigations
Management
Choledocholithiasis
Recurrent pyogenic cholangitis
Tumours of the gallbladder and bile duct
Carcinoma of the gallbladder
Cholangiocarcinoma
Carcinoma at the ampulla of Vater
Benign gallbladder tumours
Miscellaneous biliary disorders
Functional gallbladder disorder
Post-cholecystectomy syndrome
Functional biliary sphincter disorders (‘sphincter of Oddi dysfunction’)
Clinical features
Investigations
Management
Cholesterolosis of the gallbladder
Adenomyomatosis of the gallbladder
IgG4-associated cholangitis
Further information
25 Haematology and transfusion medicine
Clinical examination in blood disease
Functional anatomy and physiology
Haematopoiesis
Stem cells
Blood cells and their functions
Red cells
Haemoglobin
Destruction
White cells
Neutrophils
Eosinophils
Basophils
Monocytes
Lymphocytes
Haemostasis
Platelets
Clotting factors
Investigation of diseases of the blood
The full blood count
Blood film examination
Bone marrow examination
Investigation of coagulation
Bleeding disorders
Monitoring anticoagulant therapy
Thrombotic disorders
Clinical assessment
Investigations
Clinical assessment and investigations
Presenting problems in blood disease
Anaemia
High haemoglobin
Leucopenia (low white cell count)
Neutropenia
Lymphopenia
Leucocytosis (high white cell count)
Neutrophilia
Eosinophilia
Lymphocytosis
Clinical assessment
Investigations
Lymphadenopathy
Splenomegaly
Bleeding
Thrombocytopenia (low platelet count)
Thrombocytosis (high platelet count)
Pancytopenia
Infection
Principles of management of haematological disease
Blood components and transfusion
Blood components
Blood donation
Adverse effects of transfusion
Red cell incompatibility
ABO blood groups
ABO-incompatible red cell transfusion
The Rhesus D blood group and haemolytic disease of the newborn
Other immunological complications of transfusion
Transfusion-transmitted infection
Safe transfusion procedures
Pre-transfusion testing
Bedside procedures for safe transfusion
Transfusion in major haemorrhage
Anti-cancer drugs
Cytotoxic chemotherapy
Monocolonal antibodies
Small molecule targeted therapies
Immunotherapy
Haematopoietic stem cell transplantation
Allogeneic HSCT
Complications
Graft-versus-host disease
Autologous HSCT
Alternative cellular therapies
Anticoagulant and antithrombotic therapy
Heparins
Heparin-induced thrombocytopenia
Clinical features
Investigations
Management
Blood loss
Malabsorption
Physiological demands
Coumarins
Direct oral anticoagulants
Investigations
Confirmation of iron deficiency
Investigation of the cause
Management
Pathogenesis
Diagnosis and management
Anaemias
Iron deficiency anaemia
Anaemia of chronic disease
Megaloblastic anaemia
Vitamin B12
Vitamin B12 absorption
Causes of vitamin B12 deficiency
Dietary deficiency
Gastric pathology
Pernicious anaemia
Small bowel pathology
Folate
Folate absorption
Folate deficiency
Management of megaloblastic anaemia
Vitamin B12 deficiency
Folate deficiency
Extravascular haemolysis
Intravascular haemolysis
Causes of haemolytic anaemia
Haemolytic anaemia
Red cell membrane defects
Hereditary spherocytosis
Investigations
Management
Hereditary elliptocytosis
Red cell enzymopathies
Glucose-6-phosphate dehydrogenase deficiency
Pyruvate kinase deficiency
Pyrimidine 5′ nucleotidase deficiency
Autoimmune haemolytic anaemia
Warm autoimmune haemolysis
Investigations
Management
Cold agglutinin disease
Chronic cold agglutinin disease
Other causes of cold agglutination
Alloimmune haemolytic anaemia
Non-immune haemolytic anaemia
Endothelial damage
Infection
Chemicals or drugs
Paroxysmal nocturnal haemoglobinuria
Qualitative abnormalities – abnormal haemoglobins
Quantitative abnormalities – thalassaemias
Epidemiology
Pathogenesis
Clinical features
Investigations
Management
Prognosis
Haemoglobinopathies
Sickle-cell anaemia
Other abnormal haemoglobins
Thalassaemias
Beta-thalassaemia
Management and prevention
Alpha-thalassaemia
Terminology and classification
Epidemiology and aetiology
Haematological malignancies
Leukaemias
Acute leukaemia
Investigations
Management
Specific therapy
Acute myeloid leukaemia (AML)
Acute promyelocytic leukaemia (APML)
Acute lymphoblastic leukaemia (ALL)
Supportive therapy
Anaemia
Bleeding
Infection
Metabolic problems
Psychological problems
Haematopoietic stem cell transplantation (HSCT)
Prognosis
Chronic myeloid leukaemia
Natural history
Clinical features
Investigations
Management
Chronic phase
Accelerated phase and blast crisis
Chronic lymphocytic leukaemia
Clinical features
Investigations
Management
Prognosis
Prolymphocytic leukaemia
Hairy cell leukaemia
Myelodysplastic syndromes
Prognosis
Management
Lymphomas
Hodgkin lymphoma
Clinical features
Investigations
Management
Prognosis
Non-Hodgkin lymphoma
Clinical features
Investigations
Management
Low-grade NHL
High-grade NHL
Prognosis
Paraproteinaemias
Monoclonal gammopathy of uncertain significance
Clinical features and investigations
Prognosis
Waldenström macroglobulinaemia
Management
Multiple myeloma
Clinical features and investigations
Management
Immediate support
Chemotherapy with or without HSCT
Radiotherapy
Bisphosphonates
Prognosis
Solitary plasmacytomas
Histiocytic disorders
Primary idiopathic acquired aplastic anaemia
Clinical features and investigations
Management
Secondary aplastic anaemia
Myelofibrosis
Management and prognosis
Essential thrombocythaemia
Polycythaemia rubra vera
Management and prognosis
Aplastic anaemia
Myeloproliferative neoplasms
Bleeding disorders
Disorders of primary haemostasis
Vessel wall abnormalities
Hereditary haemorrhagic telangiectasia
Ehlers–Danlos disease
Scurvy
Platelet function disorders
Thrombocytopenia
Idiopathic thrombocytopenic purpura
Clinical features and investigations
Management
Coagulation disorders
Haemophilia A
Genetics
Clinical features
Management
Complications of coagulation factor therapy
Haemophilia B (Christmas disease)
Von Willebrand disease
Clinical features
Investigations
Management
Rare inherited bleeding disorders
Acquired bleeding disorders
Liver disease
Renal failure
Management of VTE
Prophylaxis of VTE
Antithrombin deficiency
Protein C and S deficiencies
Factor V Leiden
Prothrombin G20210A
Thrombotic disorders
Venous thromboembolic disease (venous thromboembolism)
Inherited and acquired thrombophilia and prothrombotic states
Antiphospholipid syndrome
Clinical features and management
Disseminated intravascular coagulation
Investigations
Management
Thrombotic thrombocytopenic purpura
Multiple Choice Questions
Further information
26 Rheumatology and bone disease
Clinical examination of the musculoskeletal system
Functional anatomy and physiology
Bone
Bone matrix and mineral
Bone remodelling
Joints
Fibrous and fibrocartilaginous joints
Synovial joints
Articular cartilage
Synovial fluid
Intra-articular discs
Synovial membrane, joint capsule and bursae
Skeletal muscle
Investigation of musculoskeletal disease
Joint aspiration
Imaging
Plain X-rays
Radionuclide bone scintigraphy
Magnetic resonance imaging
Ultrasonography
Computed tomography
Dual X-ray absorptiometry
Blood tests
Haematology
Biochemistry
Immunology
Rheumatoid factor
Anti-citrullinated peptide antibodies
Antinuclear antibodies
Antiphospholipid antibodies
Antineutrophil cytoplasmic antibodies
Complement and complement component antibodies
Approach to autoantibody testing and interpretation
Clinical assessment
Investigations
Management
Clinical assessment
Investigations
Management
Clinical assessment
Investigations
Management
Clinical assessment
Investigations
Management
Clinical assessment
Investigations
Management
Tissue biopsy
Electromyography
Presenting problems in musculoskeletal disease
Monoarthritis
Polyarthritis
Fracture
Generalised musculoskeletal pain
Muscle weakness
Regional musculoskeletal pain
Back pain
Clinical assessment
Investigations
Management
Neck pain
Shoulder pain
Elbow pain
Hand and wrist pain
Hip pain
Knee pain
Ankle and foot pain
Principles of management
Education and lifestyle interventions
Education
Exercise
Joint protection
Non-pharmacological interventions
Physical and occupational therapy
Self-help and coping strategies
Weight control
Surgery
Pharmacological treatment
Analgesics
Non-steroidal anti-inflammatory drugs (NSAIDs)
Topical agents
Disease-modifying anti-rheumatic drugs
Classical DMARDs (cDMARDs)
Targeted synthetic DMARDs (tsDMARDs)
Biologic DMARDs
Epidemiology
Pathophysiology
Clinical features
Generalised nodal OA
Knee OA
Hip OA
Spine OA
Early-onset OA
Erosive OA
Investigations
Management
Education
Lifestyle advice
Non-pharmacological therapy
Pharmacological therapy
Intra-articular injections
Neutraceuticals
Surgery
Gout
Epidemiology
Pathophysiology
Clinical features
Investigations
Management
Acute gout
Prophylaxis
Calcium pyrophosphate deposition (CPPD) disease
Pathophysiology
Clinical features
Investigations
Management
Pathophysiology
Basic calcium phosphate deposition disease
Calcific periarthritis
Acute inflammatory arthritis
Milwaukee shoulder syndrome
Autoimmune connective tissue disease
Pathophysiology
Clinical features
Investigations and management
Septic arthritis
Pathogenesis
Clinical features
Investigations
Management
Viral arthritis
Osteomyelitis
Pathogenesis
Clinical features
Investigations
Management
Discitis
Tuberculosis
Pathophysiology
Clinical features
Systemic features
Nodules
Vasculitis
Ocular involvement
Serositis
Cardiac involvement
Pulmonary involvement
Peripheral neuropathy
Spinal cord compression
Other complications
Investigations
Management
Pharmacological therapy
Non-pharmacological therapy
Surgery
Investigations
Management
Prognosis
Pathophysiology
Clinical features
Investigations
Management
Prognosis
Clinical features
Investigations
Management
Pathophysiology
Clinical features
Asymmetrical inflammatory mono-/oligoarthritis
Symmetrical polyarthritis
Distal interphalangeal joint arthritis
Psoriatic spondylitis
Arthritis mutilans
Enthesitis-predominant
Nail changes
Investigations
Management
Osteoarthritis
Crystal-induced arthritis
Fibromyalgia
Bone and joint infections
Rheumatoid arthritis
Juvenile idiopathic arthritis
Spondyloarthritides
Axial spondyloarthritis
Reactive arthritis
Psoriatic arthritis
Enteropathic (spondylo)arthritis
Systemic lupus erythematosus
Pathophysiology
Clinical features
Arthritis
Raynaud’s phenomenon
Skin
Kidney
Cardiovascular
Lung
Neurological
Haematological
Gastrointestinal
Paediatric disease
Investigations
Management
Mild to moderate disease
Severe and life-threatening disease
Maintenance therapy
Systemic sclerosis
Pathophysiology
Clinical features
Skin
Raynaud’s phenomenon
Musculoskeletal features
Gastrointestinal involvement
Pulmonary involvement
Renal involvement
Investigations
Management
Mixed connective tissue disease
Sjögren syndrome
Clinical features
Investigations
Management
Polymyositis and dermatomyositis
Clinical features
Investigations
Management
Microscopic polyangiitis
Granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Juvenile dermatomyositis
Undifferentiated autoimmune connective tissue disease
Adult-onset Still’s disease
Antineutrophil cytoplasmic antibody-associated vasculitis
Investigation of AAV
Management
Takayasu arteritis
Kawasaki disease
Polyarteritis nodosa
Giant cell arteritis and polymyalgia rheumatica
Clinical features
Investigations
Management
Henoch–Schönlein purpura
Cryoglobulinaemic vasculitis
Behçet’s disease
Relapsing polychondritis
IgG4 disease
Pathophysiology
Idiopathic osteoporosis
Glucocorticoid-induced osteoporosis
Pregnancy-associated osteoporosis
Autoimmune connective tissue diseases
Vasculitis
Diseases of bone
Osteoporosis
Secondary osteoporosis
Clinical features
Investigations
Management
Non-pharmacological interventions
Pharmacological interventions
Bisphosphonates
Denosumab
Calcium and vitamin D
Teriparatide
Abaloparatide
Romosozumab
Hormone replacement therapy
Raloxifene
Surgery
Tibolone
Osteomalacia, rickets and vitamin D deficiency
Vitamin D deficiency
Pathogenesis
Clinical features
Investigations
Management
Osteomalacia and rickets
Pathogenesis
Clinical features
Investigations
Management
Vitamin D-resistant rickets
Pathogenesis
Clinical features
Investigations
Management
Hereditary hypophosphataemic rickets
Pathophysiology
Clinical features
Investigations
Management
Tumour-induced osteomalacia
Hypophosphatasia
Other causes of osteomalacia
Pathophysiology
Clinical features
Investigations
Management
Paget’s disease of bone
Other bone diseases
Complex regional pain syndrome type 1
Osteonecrosis
Scheuermann’s osteochondritis
Fibrous dysplasia
Osteogenesis imperfecta
Osteopetrosis
Sclerosing bone dysplasias
Osteosarcoma
Chondrosarcoma
Ewing’s sarcoma
Metastatic bone disease
Malignant disease
Endocrine disease
Haematological disease
Neurological disease
Anterior tibial compartment syndrome
Carpal tunnel syndrome
Diffuse idiopathic skeletal hyperostosis
Dupuytren’s contracture
Joint hypermobility
Inclusion body myositis
Pigmented villonodular synovitis
Scoliosis
Spondylolysis
Synovitis–acne–pustulosis–hyperostosis–osteitis syndrome
Trigger finger
Bone and joint tumours
Rheumatological involvement in other diseases
Miscellaneous conditions
Further information
27 Dermatology
Clinical examination in skin disease
Functional anatomy and physiology
Epidermis
Basement membrane
Dermis
Epidermal appendages
Hair follicles
Sebaceous glands
Sweat glands
Nails
Blood vessels and nerves
Functions of the skin
Magnifying glass
Wood’s light
Dermatoscopy and diascopy
Skin biopsy
Microbiology
Bacteriology
Virology
Mycology
Patch testing
Prick tests and specific immunoglobulin E testing
Phototesting
Blood tests
Imaging
Clinical assessment
Is it a melanocytic naevus or a malignant melanoma?
Investigations and management
Clinical assessment
Investigations and management
Clinical assessment
Investigations and management
Clinical assessment
Investigations and management
Clinical assessment
Investigations and management
Sunscreens
Clinical assessment
Leg ulceration due to venous disease
Leg ulceration due to arterial disease
Leg ulceration due to vasculitis
Leg ulceration due to neuropathy
Investigations
Management
Clinical assessment
Investigations and management
Investigation of skin disease
Presenting problems in skin disease
Lumps and lesions
Rash
Blisters
Itch
Photosensitivity
Leg ulcers
Abnormal pigmentation
Hair and nail abnormalities
Acute skin failure
Principles of management of skin disease
General measures
Topical treatments
Emollients
Topical glucocorticoids
Anti-infective agents
Calcineurin inhibitors
Immune response modifiers
Dressings
Phototherapy and photochemotherapy
Systemic therapies
Antibiotics
Antihistamines
Retinoids
Immunosuppressants
Biologic and other advanced therapies
Dermatological surgery
Excision biopsy
Curettage
Shave excision
Mohs’ micrographic surgery
Non-surgical treatments
Cryotherapy
Laser therapy
Photodynamic therapy
Radiotherapy and grenz (Bucky) ray therapy
Pathogenesis
Skin tumours
Malignant tumours
Basal cell carcinoma
Clinical features
Diagnosis and management
Squamous cell carcinoma
Clinical features
Management
Actinic keratosis
Management
Bowen’s disease
Clinical features
Diagnosis
Management
Cutaneous lymphomas
Melanoma
Pathophysiology
Clinical features
Superficial spreading melanoma
Nodular melanoma
Lentigo maligna melanoma
Acral lentiginous or palmoplantar melanoma
Subungual melanoma
Diagnosis and management
Prognosis
Benign skin lesions
Keratoacanthoma
Freckle
Lentigo
Haemangiomas
Basal cell papilloma
Melanocytic naevi
Clinical features
Diagnosis and management
Blue naevi
Dermatofibroma
Acrochordon
Lipoma
Common skin infections and infestations
Bacterial infections
Impetigo
Staphylococcal scalded skin syndrome
Toxic shock syndrome
Ecthyma
Folliculitis, furuncles and carbuncles
Superficial folliculitis
Deep folliculitis (furuncles and carbuncles)
Cellulitis and erysipelas
Mycobacterial infections
Leishmaniasis
Necrotising soft tissue infections and anthrax
Erythrasma
Pitted keratolysis
Other bacterial skin infections
Viral infections
Herpesvirus infections
Papillomaviruses and viral warts
Clinical features
Management
Molluscum contagiosum
Orf
Other viral exanthems
Diagnosis
Management
Fungal infections
Tinea corporis
Tinea cruris
Tinea pedis
Tinea capitis
Onychomycosis
Candidiasis
Pityriasis versicolor
Infestations
Scabies
Head lice
Body lice
Pubic (crab) lice
Acne vulgaris
Pathogenesis
Clinical features
Investigations
Management
Mild to moderate disease
Moderate to severe disease
Other treatments and physical measures
Rosacea
Clinical features
Investigations
Management
Clinical features
Investigations
Management
Atopic eczema
Pathogenesis
Clinical features
Investigations
Management
Seborrhoeic eczema
Discoid eczema
Irritant eczema
Allergic contact eczema
Asteatotic eczema
Gravitational eczema
Lichen simplex
Pompholyx
Psoriasis
Pathogenesis
Clinical features
Plaque psoriasis
Guttate psoriasis
Erythrodermic psoriasis
Pustular psoriasis
Arthropathy
Investigations
Management
Pityriasis rosea
Pityriasis lichenoides chronica
Drug eruptions
Other causes
Lichen planus
Pathogenesis
Clinical features
Investigations
Management
Drug-induced lichenoid eruptions
Graft-versus-host disease
Clinical features
Investigations
Management
Acne and rosacea
Eczemas
Psoriasis and other erythematous scaly eruptions
Lichenoid eruptions
Urticaria
Bullous diseases
Toxic epidermal necrolysis
Immunobullous diseases
Bullous pemphigoid
Pathogenesis
Clinical features
Investigations
Management
Pemphigus
Pathogenesis
Clinical features
Investigations
Management
Dermatitis herpetiformis
Linear IgA disease
Epidermolysis bullosa acquisita
Porphyria cutanea tarda and pseudoporphyria
Pigmentation disorders
Decreased pigmentation
Vitiligo
Clinical features
Management
Oculocutaneous albinism
Management
Increased pigmentation
Alopecia
Pathogenesis
Clinical features
Alopecia areata
Androgenetic alopecia
Investigations
Management
Hypertrichosis
Hirsutism
Normal variants
Nail trauma
Nail involvement in skin diseases
Nail involvement in systemic disease
Nail involvement in congenital disease
Hair disorders
Nail disorders
Skin disease in general medicine
Conditions involving cutaneous vasculature
Vasculitis
Pyoderma gangrenosum
Other neutrophilic dermatoses
Pressure sores
Lupus erythematosus
Systemic sclerosis
Morphoea
Dermatomyositis
Connective tissue disease
Granulomatous disease
Granuloma annulare
Necrobiosis lipoidica
Sarcoidosis
Cutaneous Crohn’s disease
Porphyrias
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
Acquired reactive perforating dermatosis
Annular erythemas
Acanthosis nigricans
Clinical features
Investigations and management
Drug eruptions
Multiple Choice Questions
Further information
28 Neurology
Clinical examination of the nervous system
Functional anatomy and physiology
Cells of the nervous system
Generation and transmission of the nervous impulse
Functional anatomy of the nervous system
Cerebral hemispheres
The brainstem
The spinal cord
Sensory peripheral nervous system
Motor peripheral nervous system
The autonomic system
The motor system
Lower motor neurons
Upper motor neurons
The extrapyramidal system
The cerebellum
Vision
Speech
The somatosensory system
Pain
Sphincter control
Personality and mood
Sleep
Localising lesions in the central nervous system
Investigation of neurological disease
Neuroimaging
Head and orbit
Cervical, thoracic and lumbar spine
Blood vessels
Neurophysiological testing
Electroencephalography
Nerve conduction studies
Electromyography
Evoked potentials
Magnetic stimulation
Routine blood tests
Immunological tests
Genetic testing
Lumbar puncture
Biopsy
Presenting problems in neurological disease
Headache and facial pain
Ocular pain
Facial pain
Dizziness, blackouts and ‘funny turns’
Status epilepticus
Coma
Delirium
Amnesia
Transient global amnesia
Persistent amnesia
Weakness
Facial 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
Chorea
Athetosis
Ballism
Dystonia
Myoclonus
Tics
Abnormal perception
Altered balance and vertigo
Vertigo
Pyramidal gait
Foot drop
Myopathic gait
Ataxic gait
Apraxic gait
Marche à petits pas
Extrapyramidal gait
Abnormal gait
Abnormal speech and language
Dysphonia
Dysarthria
Dysphasia
Disturbance of smell
Visual disturbance and ocular abnormalities
Visual loss
Positive visual phenomena
Double vision
Nystagmus
Ptosis
Abnormal pupillary responses
Papilloedema
Optic atrophy
Hearing disturbance
Bulbar symptoms – dysphagia and dysarthria
Bladder, bowel and sexual disturbance
Bladder dysfunction
Rectal dysfunction
Erectile failure and ejaculatory failure
Personality change
Sleep disturbance
Psychiatric disorders
Tension-type headache
Pathophysiology
Clinical features
Management
Migraine
Pathophysiology
Clinical features
Management
Medication overuse headache
Cluster headache
Pathophysiology
Clinical features
Management
Trigeminal neuralgia
Pathophysiology
Clinical features
Management
Headaches associated with specific activities
Other headache syndromes
Pathophysiology
Focal epilepsy
Generalised epilepsies
Clinical features
Seizure type and epilepsy type
Focal seizures
Generalised seizures
Tonic–clonic seizures
Absence seizures
Myoclonic seizures
Atonic seizures
Tonic seizures
Clonic seizures
Seizures of uncertain generalised or focal nature
Epileptic spasms
Epilepsy syndromes
Investigations
Single seizure
Epilepsy
Management
Immediate care
Lifestyle advice
Antiepileptic drugs
Monitoring therapy
Epilepsy surgery
Withdrawing antiepileptic therapy
Contraception
Pregnancy and reproduction
Prognosis
Status epilepticus
Non-epileptic attack disorder (‘dissociative attacks’)
Acute vestibular failure
Benign paroxysmal positional vertigo
Ménière disease
Headache syndromes
Functional neurological disorder
Epilepsy
Vestibular disorders
Disorders of sleep
Excessive daytime sleepiness (hypersomnolence)
Narcolepsy
Parasomnias
Non-REM parasomnias
REM sleep behaviour disorder
Restless legs syndrome
Periodic limb movements in sleep
Multiple sclerosis
Pathophysiology
Clinical features
Investigations
Management
Disease-modifying treatment (DMT)
The acute relapse
Treatment of symptoms, complications and disability
Acute disseminated encephalomyelitis
Clinical features
Investigations
Management
Transverse myelitis
Neuromyelitis optica
Autoimmune encephalitis
Clinical features
Investigations and management
Neuro-inflammatory diseases
Paraneoplastic neurological disorders
Neurodegenerative diseases
Movement disorders
Idiopathic Parkinson’s disease
Pathophysiology
Clinical features
Non-motor symptoms
Investigations
Management
Drug therapy
Levodopa
Dopamine receptor agonists
MAOI-B inhibitors
COMT inhibitors
Amantadine
Anticholinergic drugs
Surgery
Physiotherapy, occupational therapy and speech therapy
Other Parkinsonian syndromes
Multiple system atrophy
Progressive supranuclear palsy
Corticobasal degeneration
Wilson’s disease
Huntington’s disease
Clinical features
Investigations and management
Ataxias
Tremor disorders
Essential tremor
Clinical features
Investigations
Management
Dystonia
Hemifacial spasm
Motor neuron disease
Spinal muscular atrophy
Infections of the nervous system
Meningitis
Viral meningitis
Clinical features
Investigations
Management
Bacterial meningitis
Pathophysiology
Clinical features
Investigations
Management
Prevention of meningococcal infection
Tuberculous meningitis
Pathophysiology
Clinical features
Investigations
Management
Fungal meningitis
Other meningitides
Subdural empyema
Spinal epidural abscess
Parenchymal viral infections
Viral encephalitis
Pathophysiology
Clinical features
Investigations
Management
Brainstem encephalitis
Rabies
Clinical features
Investigations
Management
Established disease
Pre-exposure prophylaxis
Post-exposure prophylaxis
Human immunodeficiency virus (HIV) infection
Poliomyelitis
Herpes zoster (shingles)
Subacute sclerosing panencephalitis
Progressive multifocal leucoencephalopathy
Parenchymal bacterial infections
Cerebral abscess
Clinical features
Investigations
Management and prognosis
Lyme disease
Neurosyphilis
Clinical features
Investigations
Management
Parenchymal parasitic infections
Neurocysticercosis
Cerebral malaria
Neuroschistosomiasis
Parenchymal fungal infections
Diseases caused by bacterial toxins
Tetanus
Clinical features
Investigations
Management
Established disease
Prevention
Botulism
Prion diseases
Creutzfeldt–Jakob disease
Variant Creutzfeldt–Jakob disease
Clinical features
Management
Clinical features
Investigations
Management
Surgical
Radiotherapy and chemotherapy
Prognosis
Intracranial mass lesions and raised intracranial pressure
Raised intracranial pressure
Brain tumours
Acoustic neuroma
Clinical features
Investigations
Management
Neurofibromatosis
Von Hippel–Lindau disease
Paraneoplastic neurological disease
Hydrocephalus
Normal pressure hydrocephalus
Management
Clinical features
Investigations
Management
Idiopathic intracranial hypertension
Head injury
Disorders of cerebellar function
Disorders of the spine and spinal cord
Cervical spondylosis
Cervical radiculopathy
Clinical features
Investigations
Management
Cervical myelopathy
Clinical features
Investigations
Management
Prognosis
Lumbar spondylosis
Lumbar disc herniation
Pathophysiology
Clinical features
Investigations
Management
Lumbar canal stenosis
Pathophysiology
Clinical features
Investigations
Management
Clinical features
Investigations
Management
Pathophysiology
Clinical features
Investigations
Spinal cord compression
Intrinsic diseases of the spinal cord
Diseases of peripheral nerves
Entrapment neuropathy
Multifocal neuropathy
Polyneuropathy
Guillain–Barré syndrome
Clinical features
Investigations
Management
Chronic polyneuropathy
Hereditary neuropathy
Chronic demyelinating polyneuropathy
Pathophysiology
Clinical features
Investigations
Management
Clinical features
Investigations
Management
Brachial plexopathy
Lumbosacral plexopathy
Spinal root lesions
Diseases of the neuromuscular junction
Myasthenia gravis
Lambert–Eaton myasthenic syndrome
Diseases of muscle
Muscular dystrophies
Inherited metabolic myopathies
Mitochondrial disorders
Channelopathies
Acquired myopathies
Multiple Choice Questions
Further information
29 Stroke medicine
Clinical examination in stroke
Functional anatomy and physiology
Investigations
Presenting problems
Weakness
Speech disturbance
Visual deficit
Visuo-spatial dysfunction
Ataxia
Headache
Seizure
Coma
Stroke
Pathophysiology
Cerebral infarction
Intracerebral haemorrhage
Clinical features
Investigations
Neuroimaging
Vascular imaging
Cardiac investigations
Blood tests
Management
Reperfusion (thrombolysis and thrombectomy)
Supportive care
Antiplatelet agents
Coagulation abnormalities
Blood pressure
Management of risk factors
Carotid endarterectomy and arterial angioplasty
Rehabilitation
Causes of ischaemic stroke
Causes of intracerebral haemorrhage
Subarachnoid haemorrhage
Clinical features
Investigations
Management
Rehabilitation
Cerebral venous disease
Clinical features
Investigations and management
Multiple Choice Questions
Further information
30 Medical ophthalmology
Functional anatomy and physiology
Investigation of visual disorders
Perimetry
Amsler chart
Tangent/Goldmann kinetic perimetry
Automated threshold perimetry
Imaging
Photography
Optical coherence tomography (OCT)
Autofluorescence
Fundus angiography
Ocular ultrasound
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 and papilloedema
Proptosis
Optic atrophy
Specialist ophthalmological conditions
Ocular inflammation
Sjögren 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-related macular degeneration
Multiple Choice Questions
Further information
31 Medical psychiatry
Clinical examination
The psychiatric interview
The mental state examination
Investigations in medical psychiatry
Functional anatomy and physiology
Biological factors
Psychological and behavioural factors
Social and environmental factors
Presenting problems in psychiatric illness
Delirium
Alcohol misuse
Substance misuse
Delusions and hallucinations
Low mood
Elevated mood
Anxiety
Psychological factors affecting medical conditions
Medically unexplained somatic symptoms
Self-harm
Disturbed and aggressive behaviour
Principles of management
Pharmacological treatments
Electroconvulsive therapy
Other forms of electromagnetic stimulation
Surgery
Psychological therapies
General supportive psychotherapy
Cognitive therapy
Behaviour therapy
Cognitive behaviour therapy
Problem-solving therapy
Psychodynamic psychotherapy
Interpersonal psychotherapy
Pathogenesis
Clinical features
Investigations
Management
Social interventions
Psychiatric disorders
Dementia
Alzheimer’s disease
Pathogenesis
Clinical features
Investigations
Management
Fronto-temporal dementia
Lewy body dementia
Pathogenesis
Clinical features
Social problems
Low mood
Anxiety
Alcohol withdrawal syndrome
Hallucinations
Wernicke–Korsakoff syndrome
Alcohol-related brain damage
Effects on other organs
Diagnosis
Management
Prognosis
Sedatives
Stimulants
Hallucinogens
Organic solvents
Pathogenesis
Diagnosis
Management
Pathogenesis
Clinical features
Diagnosis
Investigations
Management
Drug treatment
Neuroleptic malignant syndrome
Cardiac arrhythmias
Psychological treatment
Social treatment
Prognosis
Alcohol misuse and dependence
Substance misuse disorder
Schizophrenia
Mood disorders
Depression
Pathogenesis
Diagnosis
Investigations
Management
Drug treatment
Tricyclic antidepressants
Selective serotonin re-uptake inhibitors
Noradrenaline (norepinephrine) re-uptake inhibitors
Monoamine oxidase inhibitors
Esketamine
ECT and related treatments
Psychological treatment
Prognosis
Bipolar disorder
Pathogenesis
Diagnosis
Management
Prognosis
Clinical features
Phobic anxiety disorder
Panic disorder
Generalised anxiety disorder
Diagnosis
Management
Psychological treatment
Drug treatment
Clinical features
Diagnosis
Management
Anxiety disorders
Obsessive–compulsive disorder
Stress-related disorders
Acute stress reaction
Adjustment disorder
Clinical features
Diagnosis
Management
Post-traumatic stress disorder
Clinical features
Diagnosis
Management
Prognosis
Pathogenesis
Clinical features
Somatoform autonomic dysfunction
Somatoform pain disorder
Chronic fatigue syndrome
Dissociative conversion disorders
Somatisation disorder
Hypochondriacal disorder
Body dysmorphic disorder
Management
Reassurance
Explanation
Advice
Drug treatment
Psychological treatment
Rehabilitation
Shared care
Somatoform disorders
Eating disorders
Anorexia nervosa
Clinical features
Pathogenesis
Diagnosis
Management
Prognosis
Bulimia nervosa
Clinical features
Diagnosis
Investigations
Management
Prognosis
Pathogenesis
Clinical features
Diagnosis
Management
Pathogenesis
Clinical features
Münchausen syndrome
Malingering
Management
Personality disorders
Factitious disorder and malingering
Puerperal psychiatric disorders
Post-partum blues
Post-partum depression
Puerperal psychosis
Psychiatric disorders during pregnancy
Psychiatry and the law
Multiple Choice Questions
Further information
32 Maternal medicine
Clinical examination in pregnancy
Clinical evaluation in maternal medicine
Planning pregnancy in patients with medical conditions
Functional anatomy and physiology
Investigations
Imaging
Presenting problems in pregnancy
Breathlessness
Chest pain
Circulatory collapse
Headache
Nausea and vomiting
Oedema
Seizures
Medical disorders in pregnancy
Hypertension
Pre-existing hypertension
Gestational hypertension
Pre-eclampsia and eclampsia
Respiratory disease
Asthma
Respiratory infection
Bacterial infections
Viral infections
Tuberculosis
COVID-19
Gastrointestinal disease
Hyperemesis gravidarum
Inflammatory bowel disease
Diabetes
Gestational diabetes
Management
Pregnancy in women with established diabetes
Endocrine disease
Thyroid disease
Iodine deficiency
Hypothyroidism
Hyperthyroidism
Post-partum thyroiditis
Pituitary disease
Prolactinoma
Diabetes insipidus
Sheehan syndrome
Parathyroid disease
Primary hyperparathyroidism
Familial hypocalciuric hypercalcaemia
Adrenal disease
Human immunodeficiency virus infection
Inflammatory rheumatic disease
Rheumatoid arthritis
Systemic sclerosis
Systemic lupus erythematosus
Antiphospholipid syndrome
Bone disease
Cardiac disease
Congenital heart disease
Valvular heart disease
Myocardial infarction
Aortic dissection
Peripartum cardiomyopathy
Dilated cardiomyopathy
Renal disease
Renal tract infection
Acute kidney injury
Glomerular disease
Chronic kidney disease
Renal replacement therapy
Renal transplant recipients
Liver disease
Acute fatty liver of pregnancy
HELLP syndrome
Obstetric cholestasis
Viral hepatitis
Neurological disease
Epilepsy
Idiopathic intracranial hypertension
Migraine
Stroke
Psychiatric disorders
Haematological disease
Anaemia
Rhesus disease
Thrombocytopenia
Venous thromboembolism
Further information
33 Adolescent and transition medicine
Transition from paediatric to adult health services
Functional anatomy and physiology
Endocrine changes
Physical changes
Cognitive and behavioural changes
Investigations
Clinical assessment
Presenting problems
Adherence
High-risk behaviour
Unplanned pregnancy
Clinical presentations
Neurological disease
Epilepsy
Cerebral palsy
Muscular dystrophy
Respiratory disease
Cystic fibrosis
Cardiovascular disease
Congenital heart disease
Hypertrophic obstructive cardiomyopathy
Oncology
Renal disease
Organ transplantation
Diabetes
Gastrointestinal disease
Inflammatory bowel disease
Rheumatology and bone disease
Juvenile idiopathic arthritis
Glucocorticoid-induced osteoporosis
Osteogenesis imperfecta
Hypophosphataemic rickets
Summary
Multiple Choice Questions
Further information
34 Ageing and disease
Assessment of the older adult
Demography
Functional anatomy and physiology
Biology of ageing
Physiological changes of ageing
Core concepts in older adults
Frailty, disability and multimorbidity
Frailty
Disability
Multimorbidity
The rehabilitation process
Multidisciplinary team working
Rehabilitation outcomes
Does the patient want this investigation?
Will the investigation be feasible?
Will the investigation alter management?
Will management benefit the patient?
Rehabilitation
Investigation and management
Comprehensive Geriatric Assessment
Decisions about investigation and treatment
Characteristics of presenting problems in old age
Late presentation
Atypical presentation
Acute illness and changes in function
Multiple pathology
Approach to presenting problems in old age
Mechanism
Risk factors
Management
Presentation
Clinical assessment
Management
Presenting problems in geriatric medicine
Falls and collapse
Dizziness
Confusion (dementia and delirium)
Dementia
Delirium
Bladder health
Bowel health
Ageing and the immune system
Assessment
Management
Adverse drug reactions
Appropriate prescribing and deprescribing
Continence
Infection in the older adult
Prescribing and deprescribing
Other problems in old age
Multiple Choice Questions
Further information
35 Laboratory reference ranges
Notes on the international system of units (SI units)
Laboratory reference ranges in adults
Laboratory reference ranges in childhood and adolescence
Laboratory reference ranges in pregnancy
Further information
Index