25-35 Laboratory reference ranges

35 Laboratory reference ranges

Laboratory reference ranges SJ Jenks Notes on the international system of units (SI units) 1358 Laboratory reference ranges in adults 1358 Urea and electrolytes in venous blood 1358 Analytes in arterial blood 1358 Hormones in venous blood 1359 Other common analytes in venous blood 1360 Common analytes in urine 1361 Analytes in cerebrospinal ﬂuid 1361 Analytes in faeces 1361 Haematological values 1362 Laboratory reference ranges in childhood and adolescence 1363 Laboratory reference ranges in pregnancy 1364

1358 • LABORATORY REFERENCE RANGES Laboratory reference ranges in adults Reference ranges are largely those used in the Departments of Clinical Biochemistry and Haematology, Lothian Health University Hospitals Division, Edinburgh, UK. Values are shown in both SI units and, where appropriate, non-SI units. Many reference ranges vary between laboratories, depending on the assay method used and on other factors; this is especially the case for enzyme assays. The origin of reference ranges and the interpretation of ‘abnormal’ results are discussed on page 3. No details are given here of the collection requirements, which may be critical to obtaining a meaningful result. Unless otherwise stated, reference ranges shown apply to adults; values in children may be different. Many analytes can be measured in either serum (the supernatant of clotted blood) or plasma (the supernatant of anticoagulated blood). A speciﬁc requirement for one or the other may depend on a kit manufacturer’s recommendations. In other instances, the distinction is critical. An example is ﬁbrinogen, where plasma is required, since ﬁbrinogen is largely absent from serum. In contrast, serum is required for electrophoresis to detect paraproteins because ﬁbrinogen migrates as a discrete band in the zone of interest. 35.2 Analytes in arterial blood Analysis Reference range SI units Non-SI units Bicarbonate 21–29 mmol/L 21–29 mEq/L Hydrogen ion 37–45 nmol/L pH 7.35–7.43 PaCO2 4.5–6.0 kPa 34–45 mmHg PaO2 12–15 kPa 90–113 mmHg Oxygen saturation

97% 35.1 Urea and electrolytes in venous blood Analysis Reference range SI units Non-SI units Sodium 135–145 mmol/L 135–145 mEq/L Potassium* 3.6–5.0 mmol/L 3.6–5.0 mEq/L Chloride 95–107 mmol/L 95–107 mEq/L Urea 2.5–6.6 mmol/L 15–40 mg/dL Creatinine Male 64–111 μmol/L 0.72–1.26 mg/dL Female 50–98 μmol/L 0.57–1.11 mg/dL *Serum values are, on average, 0.3 mmol/L higher than plasma values. Notes on the international system of units (SI units) Système International (SI) units are a speciﬁc subset of the metre–kilogram–second system of units and were agreed on as the everyday currency for commercial and scientiﬁc work in 1960, following a series of international conferences organised by the International Bureau of Weights and Measures. SI units have been adopted widely in clinical laboratories but non-SI units are still used in many countries. For that reason, values in both units are given for common measurements throughout this textbook and commonly used non-SI units are shown in this chapter. The SI unit system is, however, recommended. Examples of basic SI units Length metre (m) Mass kilogram (kg) Amount of substance mole (mol) Energy joule (J) Pressure pascal (Pa) Volume The basic SI unit of volume is the cubic metre (1000 litres). For convenience, however, the litre (L) is used as the unit of volume in laboratory work. Examples of decimal multiples and submultiples of SI units Factor Name Preﬁx

megaM

kilok 10−1 decid 10−2 centic 10−3 millim 10−6 microμ 10−9 nanon 10−12 picop 10−15 femtof Exceptions to the use of SI units By convention, blood pressure is excluded from the SI unit system and is measured in mmHg (millimetres of mercury) rather than pascals. Mass concentrations such as g/L and μg/L are used in preference to molar concentrations for all protein measurements and for substances that do not have a sufﬁciently well-deﬁned composition. Some enzymes and hormones are measured by ‘bioassay’, in which the activity in the sample is compared with the activity (rather than the mass) of a standard sample that is provided from a central source. For these assays, results are given in standardised ‘units’ (U/L), or ‘international units’ (IU/L), which depend on the activity in the standard sample and may not be readily converted to mass units.

Laboratory reference ranges in adults • 1359

35.3 Hormones in venous blood Hormone Reference range SI units Non-SI units Adrenocorticotrophic hormone (ACTH) (plasma) 1.5–13.9 pmol/L (0700–1000 hrs) 63 ng/L Aldosterone Supine (at least 30 mins) 30–440 pmol/L 1.09–15.9 ng/dL Erect (at least 1 hr) 110–860 pmol/L 3.97–31.0 ng/dL Cortisol Dynamic tests are required – see Box 18.53, p. 680 Follicle-stimulating hormone (FSH) Male 1.0–10.0 IU/L – Female 3.0–10.0 IU/L (early follicular) –

30 IU/L (post-menopausal) – Gastrin (plasma, fasting) < 40 pmol/L < 83 pg/mL Growth hormone (GH) Dynamic tests are usually required – see Box 18.55, p. 682 < 0.5 μg/L excludes acromegaly (if insulin-like growth factor 1 (IGF-1) in reference range) < 2 mIU/L 6 μg/L excludes GH deﬁciency 18 mIU/L Insulin Highly variable and interpretable only in relation to plasma glucose and body habitus Luteinising hormone (LH) Male 1.0–9.0 IU/L – Female 2.0–9.0 IU/L (early follicular) – 20 IU/L (post-menopausal) – 17β-Oestradiol Male < 160 pmol/L < 43 pg/mL Female: early follicular 75–140 pmol/L 20–38 pg/mL post-menopausal < 150 pmol/L < 41 pg/mL Parathyroid hormone (PTH) 1.6–6.9 pmol/L 16–69 pg/mL Progesterone (in luteal phase in women) Consistent with ovulation 30 nmol/L 9.3 ng/mL Probable ovulatory cycle 15–30 nmol/L 4.7–9.3 ng/mL Anovulatory cycle < 10 nmol/L < 3 ng/mL Prolactin (PRL) 60–500 mIU/L 2.8–23.5 ng/mL Renin concentration Supine (at least 30 mins) 5–40 mIU/L – Sitting (at least 15 mins) 5–45 mIU/L – Erect (at least 1 hr) 16–63 mIU/L – Testosterone Male 10–38 nmol/L 290–1090 ng/dL Female 0.3–1.9 nmol/L 10–90 ng/dL Thyroid-stimulating hormone (TSH) 0.2–4.5 mIU/L – Thyroxine (free), (free T4) 9–21 pmol/L 0.7–1.63 ng/dL Triiodothyronine (free), (free T3) 2.6–6.2 pmol/L 0.16–0.4 ng/dL Notes

A number of hormones are unstable and collection details are critical to obtaining a meaningful result. Refer to local laboratory handbook.
Values in the table are only a guideline; hormone levels can often be meaningfully understood only in relation to factors such as gender, age, time of day, pubertal status, stage of the menstrual cycle, pregnancy and menopausal status.
Reference ranges are usually dependent on the method used for analysis and frequently differ between laboratories. Non-SI units also differ; those shown here are amongst those most widely used. Readers are encouraged to consult their local laboratory for non-SI units for individual analytes and their respective reference ranges.

1360 • LABORATORY REFERENCE RANGES Analyte Reference range SI units Non-SI units α1-antitrypsin 1.1–2.1 g/L 110–210 mg/dL Alanine aminotransferase (ALT) 10–50 U/L – Albumin 35–50 g/L 3.5–5.0 g/dL Alkaline phosphatase (ALP) 40–125 U/L – Amylase < 100 U/L – Aspartate aminotransferase (AST) 10–45 U/L – Bile acids (fasting) < 14 μmol/L – Bilirubin (total) 3–16 μmol/L 0.18–0.94 mg/dL Calcium (total) 2.1–2.6 mmol/L 4.2–5.2 mEq/L or 8.5–10.5 mg/dL Carboxyhaemoglobin 0.1–3.0% Levels of up to 8% may be found in heavy smokers – Caeruloplasmin 0.16–0.47 g/L 16–47 mg/dL Cholesterol (total) Ideal level varies according to cardiovascular risk (see cardiovascular risk chart, p. 511) HDL-cholesterol Ideal level varies according to cardiovascular risk, so reference ranges can be misleading. According to the National Cholesterol Education Programme Adult Treatment Panel III (ATPIII), a low HDL-cholesterol is < 1.0 mmol/L (< 40 mg/dL) Complement C3 0.81–1.57 g/L – C4 0.13–1.39 g/L – Total haemolytic complement 0.086–0.410 g/L – Copper 10–22 μmol/L 64–140 μg/dL C-reactive protein (CRP) < 5 mg/L Highly sensitive CRP assays also exist that measure lower values and may be useful in estimating cardiovascular risk Creatine kinase (CK; total) Male 55–170 U/L – Female 30–135 U/L – Creatine kinase MB isoenzyme < 6% of total CK – Ethanol Not normally detectable Marked intoxication 65–87 mmol/L 300–400 mg/dL Stupor 87–109 mmol/L 400–500 mg/dL Coma

109 mmol/L 500 mg/dL Analyte Reference range SI units Non-SI units γ-glutamyl transferase (GGT) Male 10–55 U/L Female 5–35 U/L – Glucose (fasting) 3.6–5.8 mmol/L 65–104 mg/dL See page 722 for deﬁnitions of impaired glucose tolerance and diabetes mellitus, and page 738 for deﬁnition of hypoglycaemia Glycated haemoglobin (HbA1c) 4.0–6.0% 20–42 mmol/mol Hb – See page 722 for diagnosis of diabetes mellitus Immunoglobulins (Ig) IgA 0.8–4.5 g/L – IgE 0–250 kU/L – IgG 6.0–15.0 g/L – IgM 0.35–2.90 g/L – Lactate 0.6–2.4 mmol/L 5.4–21.6 mg/dL Lactate dehydrogenase (LDH; total) 125–220 U/L – Lead < 0.5 μmol/L < 10 μg/dL Magnesium 0.75–1.0 mmol/L 1.5–2.0 mEq/L or 1.82–2.43 mg/dL Osmolality 280–296 mOsmol/kg – Osmolarity 280–296 mOsmol/L – Phosphate (fasting) 0.8–1.4 mmol/L 2.48–4.34 mg/dL Protein (total) 60–80 g/L 6–8 g/dL Triglycerides (fasting) 0.6–1.7 mmol/L 53–150 mg/dL Troponins Values consistent with myocardial infarction are crucially dependent on which troponin is measured (I or T) and on the method employed. Interpret in context of clinical presentation. See page 450 Tryptase 0–135 mg/L – Urate Male 0.12–0.42 mmol/L 2.0–7.0 mg/dL Female 0.12–0.36 mmol/L 2.0–6.0 mg/dL Vitamin D (25(OH)D) Normal 50 nmol/L 20 ng/mL Insufﬁciency 25–50 nmol/L 10–20 ng/ml Deﬁciency < 25 nmol/L < 10 ng/mL Zinc 10–18 μmol/L 65–118 μg/dL 35.4 Other common analytes in venous blood

Laboratory reference ranges in adults • 1361

35.5 Common analytes in urine Analyte Reference range SI units Non-SI units Albumin Deﬁnitions of microalbuminuria are given on page 394 Proteinuria is deﬁned below Calcium (normal diet) Up to 7.5 mmol/24 hrs Up to 15 mEq/24 hrs or 300 mg/24 hrs Copper < 0.6 μmol/24 hrs < 38 μg/24 hrs Cortisol 20–180 nmol/24 hrs 7.2–65 μg/24 hrs Creatinine Male 6.3–23 mmol/24 hrs 712–2600 mg/24 hrs Female 4.1–15 mmol/24 hrs 463–1695 mg/24 hrs 5-Hydroxyindole-3-acetic acid (5-HIAA) 10–42 μmol/24 hrs 1.9–8.1 mg/24 hrs Metadrenalines Normetadrenaline 0.4–3.4 μmol/24 hrs 73–620 μg/24 hrs Metadrenaline 0.3–1.7 μmol/24 hrs 59–335 μg/24 hrs Oxalate 0.04–0.49 mmol/24 hrs 3.6–44 mg/24 hrs Phosphate 15–50 mmol/24 hrs 465–1548 mg/24 hrs Potassium* 25–100 mmol/24 hrs 25–100 mEq/24 hrs Protein < 0.3 g/L < 0.03 g/dL Sodium* 100–200 mmol/24 hrs 100–200 mEq/24 hrs Urate 1.2–3.0 mmol/24 hrs 202–504 mg/24 hrs Urea 170–600 mmol/24 hrs 10.2–36.0 g/24 hrs Zinc 3–21 μmol/24 hrs 195–1365 μg/24 hrs *The urinary output of electrolytes such as sodium and potassium is normally a reﬂection of dietary intake. This can vary widely. The values quoted are appropriate to a ‘Western’ diet. 35.7 Analytes in faeces Analyte Reference range SI units Non-SI units Calprotectin < 50 μg/g – Elastase

200 μg/g – 35.6 Analytes in cerebrospinal ﬂuid Analysis Reference range SI units Non–SI units Cells < 5 × 106 cells/L (all mononuclear) < 5 cells/mm3 Glucose1 2.3–4.5 mmol/L 41–81 mg/dL IgG index2 < 0.65 – Total protein 0.14–0.45 g/L 0.014–0.045 g/dL 1Interpret in relation to plasma glucose. Values in CSF are typically approximately two-thirds of plasma levels. 2A crude index of increase in IgG attributable to intrathecal synthesis.

1362 • LABORATORY REFERENCE RANGES 35.8 Haematological values Analysis Reference range SI units Non-SI units Bleeding time (Ivy) < 8 mins – Blood volume Male 65–85 mL/kg – Female 60–80 mL/kg – Coagulation screen Prothrombin time (PT) 10.5–13.5 secs – Activated partial thromboplastin time (APTT) 26–36 secs – D-dimers Interpret in relation to clinical presentation < 200 ng/mL – Erythrocyte sedimentation rate (ESR) Higher values in older patients are not necessarily abnormal Adult male 0–10 mm/hr – Adult female 3–15 mm/hr – Ferritin Male (and post-menopausal female) 20–300 μg/L 20–300 ng/mL Female (pre-menopausal) 15–200 μg/L 15–200 ng/mL Fibrinogen 1.5–4.0 g/L 0.15–0.4 g/dL Folate Serum 2.8–20 μg/L 2.8–20 ng/mL Red cell 120–500 μg/L 120–500 ng/mL Haemoglobin Male 130–180 g/L 13–18 g/dL Female 115–165 g/L 11.5–16.5 g/dL Haptoglobin 0.4–2.4 g/L 0.04–0.24 g/dL Iron Male 14–32 μmol/L 78–178 μg/dL Female 10–28 μmol/L 56–157 μg/dL Leucocytes (adults) 4.0–11.0 × 109/L 4.0–11.0 × 103/mm3 Differential white cell count Neutrophil granulocytes 2.0–7.5 × 109/L 2.0–7.5 × 103/mm3 Lymphocytes 1.5–4.0 × 109/L 1.5–4.0 × 103/mm3 Monocytes 0.2–0.8 × 109/L 0.2–0.8 × 103/mm3 Eosinophil granulocytes 0.04–0.4 × 109/L 0.04–0.4 × 103/mm3 Basophil granulocytes 0.01–0.1 × 109/L 0.01–0.1 × 103/mm3 Mean cell haemoglobin (MCH) 27–32 pg – Mean cell volume (MCV) 78–98 ﬂ – Packed cell volume (PCV) or haematocrit Male 0.40–0.54 – Female 0.37–0.47 – Platelets 150–350 × 109/L 150–350 × 103/mm3 Red cell count Male 4.5–6.5 × 1012/L 4.5–6.5 × 106/mm3 Female 3.8–5.8 × 1012/L 3.8–5.8 × 106/mm3 Red cell lifespan Mean 120 days – Half-life (51Cr) 25–35 days – Reticulocytes (adults) 25–85 × 109/L 25–85 × 103/mm3 Transferrin 2.0–4.0 g/L 0.2–0.4 g/dL Transferrin saturation Male 25–50% – Female 14–50% – Vitamin B12 Normal

210 ng/L – Intermediate 180–200 ng/L – Low < 180 ng/L –

Laboratory reference ranges in childhood and adolescence • 1363

Laboratory reference ranges in childhood and adolescence The levels of many analytes in blood vary due to the physiological changes that occur during growth and adolescence. Hospital laboratories may provide reference ranges that are ageadjusted or based on pubertal stage but this is not always the case. It is therefore important for the doctor requesting these tests to understand the impact of age and puberty on interpretation of the results. For example, a creatinine of 70 μmol/L (0.79 mg/dL) is perfectly normal for the majority of adults but may indicate signiﬁcant renal impairment in a child. Reference ranges for hormone results are described according to the Tanner stages of puberty (p. 1290). Analyte Age/Pubertal stage Gender Reference range Alkaline phosphatase (ALP) < 1 year M, F 80–580 U/L 1–16 years M, F 100–400 U/L 16–20 years M 50–250 U/L F 40–200 U/L Creatinine < 1 year M, F 12–39 μmol/L (0.14–0.44 mg/dL) 1–4 years M, F 13–42 μmol/L (0.15–0.48 mg/dL) 4–12 years M, F 20–57 μmol/L (0.23–0.64 mg/dL) 12–15 years M, F 31–67 μmol/L (0.35–0.76 mg/dL) 15–18 years M 39–92 μmol/L (0.44–1.04 mg/dL) F 34–72 μmol/L (0.38–0.81 mg/dL) Folliclestimulating hormone (FSH) Prepubertal M < 3.0 IU/L (< 0.6 μg/L) F < 3.2 IU/L (< 0.64 μg/L) Pubertal stage 2 M < 6.6 IU/L (< 1.32 μg/L) F < 4.1 IU/L (< 0.82 μg/L) Pubertal stage 3 M 0.7–5.0 IU/L (0.14–1 μg/L) Pubertal stages 4–5 M 1.5–6.0 IU/L (0.3–1.2 μg/L) Pubertal stages 3–5 F 2.5–13.5 IU/L (0.5–2.7 μg/L) Insulin-like growth factor 1 < 7 years M 15–349 μg/L F 17–272 μg/L 8–16 years M 67–510 μg/L F 59–502 μg/L Analyte Age/Pubertal stage Gender Reference range Luteinising hormone (LH) Prepubertal M < 1.0 IU/L (< 0.1 μg/L) Pubertal stage 2 M < 3.0 IU/L (< 0.3 μg/L) Prepubertal and pubertal stage 2 F < 1.0 IU/L (< 0.1 μg/L) Pubertal stage 3 M 1.0–4.0 IU/L (0.1–0.4 μg/L) Pubertal stages 4–5 M 1.0–5.0 IU/L (0.1–0.6 μg/L) Pubertal stages 3–5 F 1.0–8.0 IU/L (0.1–0.9 μg/L) 17β-Oestradiol Prepubertal and pubertal stages 2–3 M < 75 pmol/L (< 20 pg/mL) Prepubertal and pubertal stage 2 F < 100 pmol/L (< 27 pg/mL) Pubertal stages 4–5 M < 130 pmol/L (< 35 pg/mL) Pubertal stages 3–5 F < 150 pmol/L (< 41 pg/mL) Testosterone Prepubertal M < 0.5 nmol/L (< 10 ng/dL) F < 0.6 nmol/L (< 20 ng/dL) Pubertal stage 2 M < 10.6 nmol/L (< 310 ng/dL) F < 1.4 nmol/L (< 40 ng/dL) Pubertal stage 3 M 0.4–30 nmol/L (10–870 ng/dL) Pubertal stage 4 M 5.6–30 nmol/L (160–870 ng/dL) Pubertal stage 5 M 10–30 nmol/L (290–870 ng/dL) Pubertal stages 3–5 F 0.4–1.9 nmol/L (10–50 ng/dL) Non-SI equivalents are given in brackets where appropriate. 35.9 Analytes that may be signiﬁcantly affected by growth and puberty

1364 • LABORATORY REFERENCE RANGES Laboratory reference ranges in pregnancy and it is important for the clinician reviewing the results to be aware of this to enable appropriate interpretation and patient management. The levels of many analytes in blood vary during pregnancy, when many hormonal and metabolic changes occur. The standard adult reference ranges may therefore not be appropriate Further information Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol 2009; 114:1326–1331. Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976; 51:170–179. Non-SI equivalents are given in brackets where appropriate. 35.10 Analytes that may be signiﬁcantly affected by pregnancy Analyte Reference range First trimester Second trimester Third trimester Alkaline phosphatase (ALP) 17–88 U/L 25–126 U/L 38–229 U/L Packed cell volume (PCV) or haematocrit 0.31–0.41 0.30–0.39 0.28–0.40 Haemoglobin 116–139 g/L 97–148 g/L 95–150 g/L Human chorionic gonadotrophin 4 weeks: 16–156 IU/L 4–9 weeks: 101–233 000 IU/L 9–13 weeks: 20 900–291 000 IU/L 4270–103 000 IU/L 2700–78 300 IU/L 17β-Oestradiol 690–9166 pmol/L (188–2497 pg/mL) 4691–26 401 pmol/L (1278–7192 pg/mL) 12 701–22 528 pmol/L (3460–6137 pg/mL) Progesterone 25–153 nmol/L (8–48 ng/mL) Not available 314–1088 nmol/L (99–342 ng/mL) Prolactin 765–4532 mIU/L (36–213 ng/mL) 2340–7021 mIU/L (110–330 ng/mL) 2914–7914 mIU/L (137–372 ng/mL) Thyroid-stimulating hormone (TSH) 0.60–3.40 mIU/L 0.37–3.60 mIU/L 0.38–4.04 mIU/L Thyroxine (free), (free T4) 10–18 pmol/L 0.77–1.40 ng/dL 9–16 pmol/L 0.70–1.24 ng/dL 8–14 pmol/L 0.62–1.09 ng/dL

Index A AAAs see Abdominal aortic aneurysms Abacavir, 324b for HIV/AIDS, 324–325, 324b hypersensitivity reaction of, 326 pharmacodynamics of, 180b Abaloparatide, for osteoporosis, 1048b,

Abatacept, for musculoskeletal disease, 1007, 1007b Abciximab, platelet inhibition, 500,

Abdomen examination of blood disease, 912f cancer, 1315b cardiovascular disease, 442f gastrointestinal disease, 764f liver and biliary disease, 846–847 renal and urinary tract disease, 382f–383f palpation of, 765b percussion of, 765b swelling of see Ascites Abdominal aortic aneurysms (AAAs), 505, 505b Abdominal compartment syndrome, diagnosis and management of,

Abdominal examination, 765b Abdominal pain, 787–789 acute, 787–789, 787b assessment of, 787, 788f chronic or recurrent, 789, 789b constant, 789 diabetic ketoacidosis and, 736, 736b investigations of, 787 irritable bowel syndrome and, 824 large bowel obstruction of, 789 liver abscess and, 880 in lower abdomen, 336 management of, 787–789 in old age, 788b pancreatitis acute, 837–839, 837b chronic, 839–841 peptic ulcer, perforated, 789 Abdominal tuberculosis, 812–813 Abducens (6th cranial) nerve, tests of, 1063b Abetalipoproteinaemia, 810 Abnormal movements, 1084–1086, 1085b Abnormal perceptions, 1086, 1181 ABO blood groups, 931–932, 933b ABO-incompatible red cell transfusion, 932–933 ABPA see Allergic bronchopulmonary aspergillosis ABPI see Ankle-brachial pressure index Abscess anorectal, 836 cerebral, 1124, 1124b, 1124f ‘collar-stud’, 590 infective endocarditis and, 527 intra-abdominal, 787b liver, 879–880, 893 amoebic, 880 in old age, 901b pyogenic, 879–880, 880b lung, 219f, 251f pancreatic, 219f perinephric, 430 pulmonary, 586–587 spinal epidural, 1125 Absence seizures, 1099 Absidia, 303 Absolute erythrocytosis, 925, 925b Absorption, 17–18 gastrointestinal tract, 17 interactions, 23 parenteral, 17 topical, 17–18 see also Malabsorption ABVD regimen, for Hodgkin lymphoma,

Acamprosate, 1195 Acanthosis, 1244 Acanthosis nigricans, 1265, 1325b,

Acarbose, 745–746 Accelerated hypertension, 514 Accessory (11th cranial) nerve, tests of, 1063b Acclimatisation to heat, 167 to high altitude, 168 Accommodation, 1198 ACCORD (Action to Control Cardiovascular Risk in Diabetes),

ACD see Anaemia(s), of chronic disease ACE (angiotensin-converting enzyme), 351–352 ACE inhibitors for acute coronary syndrome prevention, 498b adverse reactions of, 22b, 1310b angioedema, 1266b cough, 556 hyperkalemia, 363 for chronic kidney disease, 417 contraindication to, cirrhosis, 894b effect on renal function, 426, 427b for heart failure, 466, 466f dosages, 466b sites of action, 466f for hypertension, 513 for mitral regurgitation, 521 for myocardial infarction, 500–501 during pregnancy, 32b Acetaldehyde metabolism, 881 Page numbers followed by ‘f’ indicate ﬁgures, and ‘b’ indicate boxes. Acetazolamide, 354 for altitude illness, 168 for epilepsy, 1102b for idiopathic intracranial hypertension, 1133 Acetyl-CoA, 881 Acetylcholine, 767 Acetylcholinesterase (AChE), 1142f Acetylcysteine, 138 Achalasia of oesophagus, 794–795 AChE see Acetylcholinesterase Achilles tendinitis, 999 Achlorhydria, 803f, 808b, 941 Aciclovir for herpes virus infection, 126, 127b bone marrow transplant patients, 937b chickenpox/shingles, 239b genital, 342 HIV/AIDS, 315 viral encephalitis, 1122 nephrotoxicity, 427b in pregnancy, 120b Acid-base balance chronic kidney disease and, 418 disorders mixed, 367 presenting problems of, 364–367 homeostasis, 363–367 principal patterns of disturbances, 365b renal control of, 364 Acidosis lactic, 365 diabetic, 746 poisoning, 149b metabolic, 364–366 acute kidney injury and, 413 chronic kidney disease, 415 critically ill patients and, 180–181 diabetic ketoacidosis, 735 differential diagnosis, 558b hypothermia and, 166 malaria, 276b near-drowning, 170 poisoning and, 135b renal tubular, 365b respiratory, 367 Acids, poisoning, 136b Acinus, 548–549, 549f, 848, 848f Acitretin for atopic eczema, 1246 for psoriasis, 1227 Acne, 1241–1244, 1242f in adolescence, 1241b conglobata, 1242 cystic, 1242f excoriée, 1242 fulminans, 1242 secondary, 1242 vulgaris, 1241–1243 Acneiform eruptions, 1266b Acoustic neuroma, 1131 Acquired C1 inhibitor deﬁciency, 88 Acrochordon, 1235 Acrocyanosis, 84b, 950 Acrodermatitis chronica atrophicans,

Acrodermatitis enteropathica, 717 Acromegaly, 630f, 685–687, 686f musculoskeletal manifestations of,

ACTH see Adrenocorticotrophic hormone Actinic dermatitis, chronic, 1221b, 1222f Actinic keratosis, 1230b, 1231, 1231f Actinic prurigo, 1221b Actinomadura spp., 301 Actinomyces israelii, 261–262 Actinomyces spp., 103f Actinomycete infections, 261–262 Actinomycetes, 100–101 Actinomycetoma, 301 Action potential, 1065 Activated partial thromboplastin time (APTT), 920–921 reference range of, 1362b Active proctitis, 820 Activities of daily living (ADL), 1303b Barthel Index, 1311, 1312b Acupuncture, for pain management, 1347, 1347f Acute abdomen, 787–789, 787b, 788f Acute benign asbestos pleurisy, 618 Acute cholinergic syndrome, 146, 146b Acute circulatory failure, 199–200 Acute colonic ischaemia, 827 Acute colonic pseudo-obstruction, 835, 835b ‘Acute confusional states,’ in older people, 1080 Acute coronary syndrome, 493–501, 493b–494b, 494f–495f chest pain and, 455 clinical features of, 494–496, 495b complications of, 494–495 management of, 498–501, 498b, 499f see also Myocardial infarction Acute disseminated encephalomyelitis,

Acute eosinophilic pneumonia, 611 Acute fatty liver of pregnancy, 1283, 1283b Acute inﬂammation, 70–71, 71f acute phase response in, 70 resolution of, 71 septic shock and, 70–71 Acute inﬂammatory arthritis, 1017 Acute intermittent porphyria, 379b Acute interstitial nephritis (AIN), 402, 402b Acute interstitial pneumonia (AIP), 606b

1366 • INDEX Acute kidney injury (AKI), 411–415 causes of, 411f clinical features of, 411–413 dialysis for, indications for, 422b haemodialysis in, 422 interstitial, 402, 402b investigations of, 412b malaria, 276b management of, 413–414, 413b non-oliguric, 402 in old age, 414b pathophysiology of, 411 post-renal, 412b, 413 pre-renal, 411–412, 412b pregnancy and, 1282, 1283b recovery from, 414–415, 414f renal, 412–413, 412b renal replacement therapy, 414 Acute leukaemia, 955–958 investigations of, 955–956, 956f management of, 956–958 haematopoietic stem cell transplantation, 958 speciﬁc therapy, 956–957, 956b–957b supportive therapy, 957–958 outcome of, 958b prognosis of, 958 WHO classiﬁcation of, 955b Acute limb ischaemia, 503, 503b, 503f Acute liver failure, 856–859 adverse prognostic criteria in, 858b causes of, 856f–857f classiﬁcation of, 857b clinical assessment of, 857–858 complications of, 858b hepatic encephalopathy and, 857b hepatitis A and, 873 investigations for, 858, 858b management of, 858–859, 858b pathophysiology of, 857 Acute lung injury, 170 Acute lymphoblastic leukaemia (ALL), 955, 956f Acute medicine, 173–214 ambulatory care, 176, 176b decision to admit to hospital, 176 problems in, 176–187 Acute mountain sickness (AMS), 168 Acute myeloid leukaemia (AML), 955, 956f, 958b ‘Acute on chronic’ type II respiratory failure, 566–567, 566b Acute pancreatitis, 837–839, 837b causes of, 838b complications of, 838b management of, 839 pathophysiology of, 837, 838f Acute pericarditis, 542, 542b, 542f Acute phase proteins, 72 Acute phase response, 105 ferritin levels in, 941 musculoskeletal disease, 1017–1018 retroperitoneal ﬁbrosis, 434 rheumatic disease, 1012 Acute Physiology Assessment and Chronic Health Evaluation (APACHE II), 214, 214b Acute renal failure see Acute kidney injury Acute respiratory distress syndrome (ARDS), 198 aetiology of, 198, 198b Berlin deﬁnition of, 198b diagnosis of, 198, 199f drug-induced, 612b management of, 198 mechanical ventilation in, 198 near-drowning victims and, 170 pathogenesis of, 198 severity of, 199b Acute rheumatic fever, 515–517, 516f investigations in, 517b Jones criteria for, 516b Acute severe breathlessness, 558 Acute skin failure, 1224–1225 Acute small bowel ischaemia, 827 Acute transmural anterior myocardial infarction, 497f Acute transmural inferolateral myocardial infarction, 498f Acute tubular necrosis (ATN), 402f drug-induced, 427b Adalimumab for inﬂammatory bowel disease, 820, 821b for inﬂammatory rheumatic disease, 1007b for psoriasis, 1250–1251 Adapalene, 1242–1243 Adaptive immune system, 67–70 ADCC see Antibody-dependent cellular cytotoxicity Addenbrooke’s Cognitive Examination- 3rd edition (ACE-III), 1181–1183 Addison’s disease, 671b Adductor tendinitis, 999b Adenine, 38, 39f Adenocarcinoma, 813 ampullary/periampullary, 842–844 of oesophagus, 796f–797f of pancreas, 842–844 of prostate, 438–439 of small intestine, 813 of unknown primary, 1336 Adenoma adrenal, 667b Conn’s syndrome, 675f Cushing’s syndrome, 667b, 669–670 bronchial gland, 603b colorectal, 776b, 827 familial adenomatous polyposis, 828–829, 829f hepatic, 893 parathyroid, 663 periampullary, 813 sebaceum, 1264 small intestine, 813 toxic, 638f, 649 Adenomyomatosis, of gallbladder, 909 Adenosine, 480b, 482, 482b Adenosine diphosphate see ADP Adenosine triphosphate see ATP Adenosquamous carcinoma of lung, 603b Adenoviruses, diarrhoea, 249 ADH see Antidiuretic hormone Adherence factors affecting, 1294b SIMPLE strategies for, 1294b Adhesion molecules, 77 ADHR see Autosomal dominant hypophosphataemic rickets Adipocytes, 725 Adipokines, 731 Adiponectin, 699 Adjustment disorders, 1187, 1201 prevalence of, 1180b ADL see Activities of daily living Adolescents, 1290 allergy in, 76b congenital heart disease in, 537b cystic ﬁbrosis in, 581b diabetes mellitus in, 753–754, 753b–754b epilepsy in, 1103b haematological malignancy in, 955b infections in, 234, 235b inﬂammatory bowel disease in, 823b juvenile idiopathic arthritis in, 1027b laboratory reference range of, 1363 medical ophthalmology in, 1175b renal impairment in, 1298b ADP (adenosine diphosphate), 446f Adrenal crisis, 673b Adrenal disease, 1280 Adrenal glands, 665–676 disease classiﬁcation of, 665b presenting problems of, 666–674 functional anatomy and physiology of, 665–666, 666f–667f incidental adrenal mass, 673–674 older people, 673b Adrenal hyperplasia, congenital, 676 Adrenal insufﬁciency, 671–673, 671b–673b Adrenal tumours Cushing’s syndrome, 669–670 see also Phaeochromocytoma Adrenalectomy, 675 for Cushing’s disease, 669 Adrenaline for allergy, 86 anaphylaxis, 75, 76b circulatory effects of, 206b self-injectable, prescription of, 76b for urticaria, 1254 Adrenarche, 666 β-Adrenoceptor antagonist, 1190b for thyrotoxicosis, in pregnancy,

for variceal bleeding, 869, 871 Adrenocorticotrophic hormone (ACTH) Cushing’s syndrome and, 667b ectopic, 667b, 1325b ectopic ACTH syndrome, 670 ectopic hormone production, 1325b excess, 672b hypopituitarism, 672b reference range of, venous blood, 1359b stimulation test, 672b Adrenoleukodystrophy, 1116b Adriamycin see Doxorubicin Adult-onset Still’s disease, 1040 Adult polycystic kidney disease (PKD), 405–406, 405b Advance directives, 1307 Advanced life support (ALS), 457 Adverse drug reactions (ADRs), 21–23 classiﬁcation of, 22–23, 22b interactions, 23–24 in older people, 1310, 1310b pharmacovigilance, 23 prevalence of, 21–22, 21b–22b risk factors for, 21b TREND analysis of, 23b see also individual drugs Aedes aegypti Chikungunya virus, 250 dengue, 243 yellow fever, 244 AEDs (antiepilepsy drugs) see Anticonvulsants AF see Atrial ﬁbrillation Affective mood disorders bipolar, 1198 organic, 1185b Afﬁnity, 14 Afﬂuence, health consequences of, 94 AFP (alpha-fetoprotein) hepatocellular carcinoma and, 890–891 as tumour markers, 1322, 1324b African tick bite fever, 270, 271b African trypanosomiasis (sleeping sickness), 278–279, 278f Afterload heart failure, 461 reduction, 465 Age/ageing, 1301–1312 biological, 1304 biology of, 1304–1305 chronological, 1304 physiological changes of, 1305, 1305f syndrome of premature ageing see Werner’s syndrome type 2 diabetes and, 732, 732b see also Older people Age-related macular degeneration,

Agglutination, cold, 950 Agglutination test, 108 for leishmaniasis, 283 for leptospirosis, 258 microscopic, 258 for sporotrichosis, 301 trypanosomiasis, 279 for tularaemia, 261 Aggrecan, 987 Aggregatibacter aphrophilusAggregatibacter actinomycetemcomitans, 528 Aggressive behaviour, 1188–1189, 1189f Agitation, in palliative care, 1354 Agnosia, 1086 Agonists, 14 Agoraphobia, 1200 Agranulocytosis, 644 AHR see Airway hyper-reactivity AIDS see HIV infection/AIDS Aids and appliances, for musculoskeletal disease, 1001 AIN see Acute interstitial nephritis AIP see Acute interstitial pneumonia Air embolism, during dialysis, 424b Air travel, 169 Airﬂow obstruction, 554f assessment in COPD, 575 Airway hyper-reactivity (AHR), 568, 568f Airway pressure release ventilation (APRV), 204 Airways, 548, 548f assessment of, in deteriorating patient, 188 in asthma, 568f defences, 550, 550f of envenomed patient, 152f obstruction of, 555, 1324b reactive dysfunction syndrome, 614 in sleep apnoea, 622 of stroke patients, 1159b upper airway diseases, 622–625 Akathisia, 1105–1106, 1197 AKI see Acute kidney injury Akinesia, 1113b ALA dehydratase deﬁciency, 379b Alanine aminotransferase (ALT), 852, 1360b Albendazole for cysticercosis, 298 for helminthic infections, 129 ﬁlariasis, 291 for hydatid cysts, 299 Albers-Schönberg disease, 1056 Albinism inheritance, 1258 oculocutaneous, 1258 Albright’s hereditary osteodystrophy, 51b, 664, 1017b Albumin in AKI, 416b liver blood biochemistry, 852 plasma, liver function test, 858 reference range of urine, 1361b venous blood, 1360b urinary, 1361b see also Hypoalbuminaemia Albumin solutions, for ascites, 864 Albuminuria, moderately elevated, 394 Alcohol, 94 abstinence from, 1194b amount in average drink, 880b coronary artery disease and, 486 dependence, 1194–1195, 1194b diabetes and, 744–745 drug interactions, 24b energy provided by, 694 liver disease and, 880–882 pharmacokinetics, 20b poisoning, 134b thiamin deﬁciency and, 714 see also Ethanol Alcohol misuse, 1184, 1194–1195 chronic, presentation and consequences of, 1194b clinical assessment of, 1184 clinical features of, 1194–1195 diagnosis of, 1195 effects of, 1194b, 1195 investigations of, 1184 liver disease see Alcoholic liver disease management of, 1195 maternal, 1194b in pancreatitis, 841 pathogenesis of, 1194 prevalence of, 1180b prognosis of, 1195

INDEX • 1367 Alcohol withdrawal syndrome, 1194, 1194b management of, 1195 Alcoholic fatty liver disease (AFLD),

Alcoholic liver disease, 880–882 clinical features of, 881–882, 881b liver function test (LFT) abnormality in, 854b in old age, 901b pathophysiology of, 881, 881b risk factors for, 880 Aldosterone, 666 deﬁciency, 363 plasma potassium and, 360 reference range of, 1359b resistance, 363 see also Hyperaldosteronism Alendronate for osteoporosis, 1048b timing of, 31b Alfacalcidol (1,25- dihydroxycholecalciferol), 665 Alfentanil, 209b Alginates, 793 sodium content of, 864b Alkaline phosphatase (ALP) liver function tests and, 852 placental, 1322, 1324b reference values of, venous blood, 1360b sclerosing cholangitis, 889 serum Paget’s disease, 1054 rickets/osteomalacia, 1052 in skeletal disease, 990b Alkalinisation, urinary, 136 Alkalis, poisoning, 136b Alkalosis hypokalaemic, Cushing’s syndrome,

metabolic, 366–367, 367f respiratory, 367 Alkylating agents, 936b Allele, 47 Allergen, 84 asthma, 568f avoidance of, 86 contact eczema, 1247 supervised exposure to, 86 Allergic alveolitis, extrinsic see Hypersensitivity pneumonitis Allergic bronchopulmonary aspergillosis (ABPA), 596, 596b, 596f Allergic contact eczema, 1247, 1247b, 1247f Allergic rhinitis, 622 Allergy, 84–86 in adolescence, 76b clinical features of, 85 clinical manifestations of, 85b diagnosis of, 85 food, 812 hygiene hypothesis, 84–85 to insect venom, 85 investigations of, 86 challenge tests, 86 eosinophilia, 86 mast cell tryptase, 86 patch tests, 1215, 1244 serum total IgE, 86 skin-prick tests, 86 speciﬁc IgE tests, 86 management of, 86 pathophysiology of, 84–85, 85f to peanut, 85 in pregnancy, 88b Allodynia, 1084 Allogeneic haematopoietic stem cell transplantation, 937 complications of, 937, 937b indications for, 936b Alloimmune haemolytic anaemia, 950 Allopurinol for acute leukaemia patients, 956b, 957–958 drug interactions of, 24b for gout, 1015–1016 hepatotoxicity, 32b, 894 pharmacodynamics, 20b renal stone prevention, 432–433, 433b for toxic epidermal necrolysis, 1254–1255 Alopecia, 1258–1259, 1259b androgenetic, 1259 scarring inﬂammatory, 1262f Alopecia areata hair in, 1258–1259, 1259f nails in, 1261 Alpha-fetoprotein (AFP) hepatocellular carcinoma and, 890–891 as tumour markers, 1322, 1324b Alpha-glucosidase inhibitors, for hyperglycaemia, 747 Alpha heavy chain disease, 813 Alpha particles, 164, 164f Alpha-thalassaemia, 954 Alpha1-antitrypsin deﬁciency, 48b, 897, 897f inheritance, 47b Alport’s syndrome, 403–404, 404f ALS see Advanced life support ALT see Alanine aminotransferase Alternaria, 572 Alternative therapies for cancer pain, 1353 for pain, 1348 Altitude, illnesses, 168–169 Aluminium osteomalacia and, 1053 poisoning from, 148 Aluminium hydroxide for diarrhoea, 809 phosphorus deﬁciency and, 716 for renal bone disease, 419 Alveolar macrophages, 303, 615 Alveolar microlithiasis, 613b Alveolar proteinosis, 613b Alveolitis extrinsic see Hypersensitivity pneumonitis ﬁbrosing, 558b, 1024b non-eosinophilic, drug-induced, 612b Alzheimer’s disease, 1191b, 1192–1193, 1193f familial, 1192 see also Dementia Amanita phalloides poisoning, 150b Amantadine, 127, 127b for multiple sclerosis, 1110b for Parkinson’s disease, 1114 Amastigotes, leishmaniasis, 282f Amaurosis fugax, 1152 AmBisome, 283 Amelanotic melanoma, 1322 Amenorrhoea, 654–655, 654b American trypanosomiasis (Chagas’ disease), 279–280 Amikacin for actinomycetoma, 301 for nocardiosis, 261 Amiloride, 360, 864 for diabetes insipidus, 688 mineralocorticoid excess, 675 Amino acids, 697, 697b essential, 697b metabolism, 850 disorders of, 369–370 Aminoglycosides, 116b, 122 adverse effects of, 122 for brucellosis, 254 dosing of, 122f mechanism of action, 116b nephrotoxicity, 32b pharmacokinetics of, 122 in pregnancy, 120b Aminopenicillins, 120, 120b Aminophylline for asthma, 573, 573f for COPD, 578 Aminosalicylates, for inﬂammatory bowel disease, 821b Aminotransferases acute liver failure and, 858 elevated, common causes of, 859b hypothermia, 166 liver function tests, 852 non-alcoholic fatty liver disease and,

reference range of, 1360b viral hepatitis, 874f Amiodarone adverse reactions pigmentation, 1258b pulmonary ﬁbrosis, 612 for arrhythmias, 479b–480b, 481 atrial ﬁbrillation, 471–472 atrial ﬂutter, 470 tachycardia, 475 causing thyroid dysfunction, 636b, 638f, 647–648, 647f for heart failure, 467 hepatotoxicity of, 894b structure of, 647f thyrotoxicosis, 639, 647–648 Amitriptyline, 1199b for ﬁbromyalgia, 1018–1019 for functional dyspepsia, 802–803 for headache, 1095 for herpes zoster, 240 for irritable bowel syndrome, 825 for migraine prevention, 1096 multiple sclerosis, 1110b for musculoskeletal pain, 995 for neuropathic pain, 1350b, 1352b for pain management, 1350b for post-herpetic neuralgia, 240 for psychiatric disorder, 1199b Amlodipine for angina, 491b unstable, 500 for hypertension, 513 Ammonia, 384 hepatic encephalopathy and, 865 Ammonium chloride, 366 Amnesia, 1080–1081 persistent, 1081 post-ictal, 1081 transient global, 1081 Amniocentesis, 56 Amniotic ﬂuid embolism (AFE), pregnancy and, 1275 Amodiaquine, for malaria, 277 Amoebiasis, 286–287, 286f incubation period of, 111b Amoebic dysentery, 287 Amoebic liver abscess, 287, 880 Amoeboma, 286–287, 286f Amoxicillin, 117b for diphtheria, 266 for Helicobacter pylori eradication,

for listeriosis, 260 for Lyme disease, 256 for pneumonia, 585b for skin reactions, infectious mononucleosis, 242 for urinary tract infection, 428 Amphetamines, misuse of, 143 Amphotericin/amphotericin B, 125b,

for aspergillosis, 598 for blastomycosis, 304 for candidiasis, 302 for coccidioidomycosis, 304 for cryptococcal meningitis, HIV-related, 321 for fusariosis, 302–303 for histoplasmosis, 304 for leishmaniasis, 283 lipid formulations of, 126 for mucormycosis, 303 for mycetoma, 301 nephrotoxicity, 365b, 427b for neutropenic fever, 1327–1328 for Penicillium (Talaromyces) marneffei infection, 303 for sporotrichosis, 301 Ampicillin, 117b, 120b for cerebral abscess, 1124b drug interactions of, 121 for listeriosis, 260 for liver abscess, 880 for meningitis, 1120b for paratyphoid fever, 260–261 skin reactions, 1266b infectious mononucleosis, 242, 242f Ampulla of Vater, carcinoma of, 907–908 AMS see Acute mountain sickness Amsacrine, for acute leukemia, 957b Amsler chart, 1168, 1168f Amygdala, 1066 Amylase, 768, 770b pancreatic, 695–697 reference range of, venous blood, 1360b salivary, 62–63 serum hypothermia, 166 pancreatitis, 563b, 839 Amyloid A, serum, 70 Amyloid angiopathy, 1155b, 1191b Amyloid deposition, type 2 diabetes,

Amyloid in plaques, in Alzheimer’s disease, 1192, 1193f Amyloidosis, 81, 1264 causes of, 82b heart disease, 541 multiple myeloma, 410b rheumatoid arthritis, 1024–1025 Amylose, 695–697 ANA see Antinuclear antibody Anaemia(s), 717, 913, 913b, 923–925, 940–951, 941f after peptic ulcer surgery, 801 aplastic, 968–969 autoimmune haemolytic, 949–950 causes of, 923b of chronic disease (ACD), 942b, 942f,

chronic kidney disease and, 419, 419b clinical assessment of, 923 haemolytic, 923, 945–951 alloimmune, 950 autoimmune, 949–950 causes of, 946f, 947 microangiopathic, 950 non-immune, 950 HIV-related, 322 investigations of, 923–925, 924f iron deﬁciency, 940–943 alimentary tract disorders, 793 blood loss in, 940–941 conﬁrmation of, 941–942, 942b investigations in, 941–942 malabsorption in, 941, 942f management of, 943 physiological demands in, 941, 941b pregnancy and, 1284 megaloblastic, 940, 943–945 clinical features of, 943b investigations in, 944b management of, 945 microangiopathic haemolytic, 408,

microcytic, 925 in rheumatoid arthritis, 1024–1025 normochromic normocytic, 853 in old age, 954b pernicious, 944 pregnancy and, 1284, 1285b primary idiopathic acquired aplastic, 968–969, 968b secondary aplastic, 969, 969b sickle-cell, 923, 951–953 clinical features of, 952–953, 952f epidemiology of, 951, 951f investigations of, 953 management of, 953 pathogenesis of, 951–952 in pregnancy, 953b prognosis of, 953 Anagrelide, 970 Anakinra, for musculoskeletal disease,

Anal canal, 771f Anal ﬁssure, 836

1368 • INDEX Analgesia for acute coronary syndrome, 498 for back pain, 997 cholecystitis, 905 in intensive care, 209, 209b for low back pain, 997 for musculoskeletal disease, 1002 myocardial infarction, 498 for osteoarthritis, 1012 for palliative care, 1350 for pancreatic cancer, 842–844 for pancreatitis, 839 for pleural pain, 584 for post-herpetic neuralgia, 240 for psoriatic arthritis, 1033–1034 for reactive arthritis, 1032 for renal colic, 432 Analgesic ladder (WHO), 1351f Analgesics adjuvant for cancer pain, 1352, 1352b for pain, 1345–1346 poisoning from, 137–138 see also speciﬁc drugs Anaphase, 40 Anaphylactic shock, 204, 206b Anaphylactoid reactions, 75, 75b Anaphylaxis, 75–76, 339 causes of, 75b clinical assessment of, 75–76 clinical manifestations of, 75f differential diagnosis of, 76b gastrointestinal, 812 management of, 76, 76b Anaplastic carcinoma, 650 ANCAs (antineutrophil cytoplasmic antibodies), 992 Ancylostoma caninum, 294 Ancylostoma duodenale, 288, 288f Ancylostomiasis (hookworm), 288–289, 288f Andersen disease, 370b Andersen-Tawil syndrome, 1145b Androgen receptor antagonism, 659b Androgen replacement therapy for adrenal insufﬁciency, 673 options for, 656b Androgens adrenal, 666 in older women, 660b Anergy, 82 Aneuploidy, 51 Aneurysm aortic, 505–506 abdominal, 505b saccular, 508 ventricular, 496 see also Microaneurysms Angelman’s syndrome, 44b, 51b Angina, 487–493, 487b–488b clinical features of, 488, 488b investigations for, 488, 489f–490f management of, 488–489 drug therapy, 489–491, 490b non-pharmacological treatments, 491–493, 491f–492f, 493b in old age, 493b prognosis of, 493 recurrent, in acute coronary syndrome, 495 stable advice to patients with, 489b risk stratiﬁcation in, 488b Angina equivalent, 180 Angiodysplasia, 782–783 Angioedema, 87–88, 87f drug-induced, 1266b hereditary, 88 types of, 87b Angiogenesis, 1318, 1319f Angiography coronary, 143 CT, 452, 452f hepatic, 854 magnetic resonance, 869 mesenteric, 783, 813 of nervous system, 1072 visceral, 782–783 Angiomatosis, bacillary, 272 Angioplasty for renal artery stenosis, 407–408 for stoke, 1160 Angiosarcoma, 1320b Angiostrongylus cantonensis, 294 Angiotensin-converting enzyme see ACE Angiotensin-converting enzyme inhibitors see ACE inhibitors Angiotensin II, 666 Angiotensin II receptor blockers effect on renal function, 407b microalbuminuria in diabetes, 758 renal failure, 417 Angiotensin receptor blockers for heart failure, 466, 466b for hypertension, 513 Angular cheilitis, HIV/AIDS, 316 Angular stomatitis, 714, 764f, 817 Anhedonia, 1181 Anion gap acidosis, 365 poisoning, 135b Anisakiasis, 294 Anismus, 834 Ankle-brachial pressure index (ABPI),

Ankle pain, 999 Ankylosing spondylitis (AS), 1028b, 1030–1031 clinical features of, 1030, 1030b investigations of, 1030–1031, 1030f–1031f management of, 1031 Annular erythemas, 1265 Annulus ﬁbrosus, 444 Anogenital warts, 342–343 Anorectal abscesses, 836 Anorectal disorders, 835–836 Anorectal motility test, 778 Anorexia in cancer patients, 1325b in rheumatoid arthritis, 1023 Anorexia nervosa, 1203–1204, 1204b features of, 785 in osteoporosis, 1047–1048 Anosmia, 653 Anosognosia, 1192–1193 ANP see Atrial natriuretic peptide Anserine bursitis, 999b Antacids for bile reﬂux, 801 drug interactions of, 23 sodium content of, 864b Antagonists, 14 Antalgic gait, 1086, 1309b Anterior pituitary hormone deﬁciency, 681b Anterior tibial compartment syndrome,

Anthracyclines, 936b Anthrax, 266–267 bioterrorism, 111 clinical features of, 267 cutaneous, 267 gastrointestinal, 267 immunisation for, 115b incubation period of, 111b inhalational, 267 management of, 267 skin, 1238 Anthropometry, 693b Anti-α4β7 integrin, for inﬂammatory bowel disease, 821b Anti-androgen therapy, for polycystic ovarian syndrome, 659b Anti-anginal therapy, for acute coronary syndrome, 500 Anti-anxiety drugs, 1190b Anti-arrhythmic drugs, 479–482 adverse reactions of, 926b classiﬁcation of, 479b by site of action, 479f dosages of, 480b principal uses of, 480b–481b side-effects of, 480b see also individual drugs Anti-cancer therapy see Chemotherapy Anti-CCP antibodies, 563b, 607 Anti-CD20 monoclonal antibody rituximab, for chronic lymphocytic leukaemia, 960 Anti-centromere antibody, 992b Anti-citrullinated peptide antibodies (ACPAs), 991 Anti-D, 933 Anti-DNA antibodies, 991 Anti-glomerular basement membrane disease, 398b–399b, 401 Anti-herpesvirus agents, 126–127, 127b Anti-histone antibody, 992b Anti-infective agents, 1226 Anti-inﬂammatory cascade, 196 Anti-inﬂammatory therapy for asthma, 571 for osteoarthritis, 1011b see also individual drugs Anti-inﬂuenza agents, 127 Anti-Jo-1 (anti-histidyl-tRNA synthase), 992b Anti-La antibody (anti-SS-B), 992b Anti-liver-kidney microsomal (LKM) antibodies, 886 Anti-oestrogen, 1332 Anti-phospholipid syndrome, 1281 Anti-ribonucleoprotein antibody (anti-RNP), 992b Anti-RNA polymerase, 992b Anti-RO antibody (anti-SS-A), 992b Anti-Scl-70 (anti-topoisomerase I antibody), 992b Anti-Smith antibody, 992b Anti-smooth muscle antibodies, 886, 886b Anti-thymocyte globulin (ATG), 89b Anti-TNF therapy for ankylosing spondylitis, 1031 for inﬂammatory bowel disease, 821b–822b, 822 for rheumatoid arthritis, 1006 Anti-topoisomerase I antibody, 992b Antibacterial agents, 120–124 aminoglycosides, 116b beta-lactam, 116b, 120–121 folate antagonists, 123 glycopeptides, 123 lincosamides, 122 macrolide, 116b, 121–122 nitroimidazoles, 124 quinolones, 122–123, 123b target and mechanism of action of, 116b therapeutic drug monitoring, 119 Antibiotic therapy for acne, 1242–1243 for acute leukaemia, 957 adverse reactions of, 22b, 926b for bronchiectasis, 579 for cerebral abscess, 1124 for cholecystitis, 905 for choledocholithiasis, 906 for community-acquired pneumonia, 584, 585b for cystic ﬁbrosis, 580 for diabetic foot ulcers, 761–762 diarrhoea associated with, 104b for gastroenteritis/acute diarrhoea,

for Helicobacter pylori eradication,

hepatotoxicity and, 864b for infective endocarditis, 529b, 530 for inﬂammatory bowel disease, 821b for meningitis, 1118 for osteomyelitis, 1021 for pneumonia community-acquired, 583 hospital-acquired, 586 suppurative/aspirational, 587 prophylactic for pancreatitis, 839 for spontaneous bacterial peritonitis, 864 for variceal bleeding, 869 for respiratory tract infections bronchiectasis, 790 COPD, 578 cystic ﬁbrosis, 580 pneumonia see Pneumonia, above for rheumatic fever, 517 for sepsis, 197, 197b for septic arthritis, 1020, 1020b for skin disease, 1227 sodium content of, 864b for staphylococcal infections see individual infections for urinary tract infection, 428 Antibody/antibodies classes and properties of, 68b in coeliac disease, 806–807 deﬁciency in, 73b primary, 78–79, 78f, 79b detection of, 106–108, 109f see also Autoantibodies Antibody-dependent cellular cytotoxicity (ADCC), 67–69 Anticardiolipin antibodies, 1157b Anticholinergics adverse reactions of, 1310b for bladder dysfunction, 1094b for COPD, 577 for Parkinson’s disease, 1114 poisoning, 150b Anticholinesterases for Alzheimer’s disease, 1193 for myasthenia gravis, 1142 non-antivenom, 159 α1-Antichymotrypsin, 70 Anticoagulants/anticoagulation, 938–940 adverse reactions of, 22b for atrial ﬁbrillation, stroke prevention, 472b coagulation screening, 1362b direct oral, 940 drug interactions, 940 indications for, 938b modes of action of, 938b monitoring, 922 for obliterative cardiomyopathy, 541 in old age, 1160b poisoning, 148b in pregnancy, 941b prosthetic heart valves and, 527b for pulmonary embolism, 621 risk assessment of, 940b rodenticides, 148b for stroke patients, 1157b for venous thromboembolism, 975–976 see also speciﬁc anticoagulants Anticodon, 40 Anticonvulsants for epilepsy, 1101–1102, 1102b choice of drug, 1102b withdrawing, 1102–1103 for pain management, 1352b poisoning, 141b skin reactions, 1266b use in pregnancy, 1284 Antidepressants, 1190b, 1199b, 1200 adverse reactions of, 926b, 1310b for alcohol withdrawal, 1195 for anxiety disorders, 1201 in older people, 1310b poisoning from, 138–139 tricyclic, 1199, 1199b poisoning from, 138–139, 139b, 139f Antidiabetic agents, poisoning from, 141 Antidiarrhoeal agents, 230 for inﬂammatory bowel disease, 821b for irritable bowel syndrome, 826f Antidiuretic hormone (ADH), 350–351 ectopic hormone production, 1325b inappropriate secretion, 357b cancer patients, 1325b Antiemetic drugs, receptor site activity of, 1353b Antiepilepsy drugs (AEDs) see Anticonvulsants Antifreeze poisoning, 147 Antifungal agents, 125–126, 125b Antigen processing and presentation,

Antiglobulin (Coombs) test, 948f

INDEX • 1369 Antihistamines for allergy, 86 for eczema, 1244 for food allergy, 812 for pruritus, 1220 for skin disease, 1227 for urticaria, 1254 Antihypertensive drugs, 513, 514b, 515f adverse reactions of, 926b for chronic kidney disease, 416–417 for gout, 1016 Antimalarials, 128, 1252 adverse reactions of, 926b poisoning, 141b prophylactic, 119b see also individual drugs Antimetabolites, 936b, 1317f Antimicrobial agents combination therapy, 116 for infective gastroenteritis, 230 pharmacokinetics and pharmacodynamics of, 118–119, 119f in pregnancy, 120b resistance to, 116–118, 118f selection, 117b susceptibility testing, 109, 109f target and mechanism of action of, 116b therapeutic drug monitoring, 119 see also Antibiotic therapy Antimicrobial stewardship, 115, 115f Antimicrobial therapy, 117b action and spectrum, 116, 117b duration of, 118, 119b empiric versus targeted therapy, 116, 117f in old age, 120b principles of, 116–120 prophylactic, 119–120, 119b see also Antibiotic therapy Antimitochondrial antibodies, 886b,

Antimonials, for leishmaniasis, 128, 283 Antimotility agents, 230 Antimycobacterial agents, 125 Antineutrophil cytoplasmic antibodies (ANCAs), 389 Antineutrophil cytoplasmic antibodyassociated vasculitis (AAV), 1041, 1041f Antinuclear antibody (ANA) in autoimmune hepatitis, 886b in musculoskeletal disease, 991, 991b Antioxidants, 550 Antiparasitic agents, 128–129 Antiphospholipid antibodies, 991–992 Antiphospholipid syndrome (APS), 977–978, 978b Antiplatelet drugs, 938b for angina, 489 for myocardial infarction, 498b for obliterative cardiomyopathy, 541 for stroke prevention, 1161f Antiproteinases, 550 Antipsychotic drugs, 1190b adverse reactions of, 22b, 1198b for agitation, 1354 poisoning from, 141 for schizophrenia, 1198b Antiretroviral therapy, 127b, 324–327, 324b complications of, 325–326 criteria for, 325 monitoring efﬁcacy of, 325 in pregnancy, 326–327 resistance to, 325 selection of, 324–325 see also individual drugs Antirheumatic drugs during pregnancy and breastfeeding, 1281b slow-acting (DMARDs) see Disease-modifying antirheumatic drugs Antisecretory agents, 230 Antiseptics, 586, 1226 Antithrombin deﬁciency, 977 Antithrombotic therapy, 938–940, 938b for acute coronary syndrome, 500 prophylaxis, for venous thromboembolism, 976–977, 977b Antithyroid drugs adverse reactions of, 926b for Graves’ thyrotoxicosis, 644, 644b in pregnancy, 1279 α1-Antitrypsin faecal clearance of, 811 liver disease, 854b liver histology in, 897f reference range of, venous blood, 1360b Antivenom, 159, 159b, 160f Antiviral agents, 126–128, 127b see also Antiretroviral therapy Anuria, 391, 391b Anxiety/anxiety disorders, 1186, 1200–1201 alcohol and, 1194 classiﬁcation of, 1200b clinical features of, 1200 diagnosis of, 1200 differential diagnosis of, 1186b generalised, 1200 investigations of, 1186 management of, 1186, 1200–1201 in palliative care, 1354 panic disorder, 1200 phobic, 1200 prevalence of, 1180b in stroke patients, 1159f symptoms of, 1186b Aorta ascending dilatation of, 451f syphilis and, 338 coarctation of, 508, 534, 534f diseases of, 505–514 Aortic aneurysm, 505–506 abdominal, 505b Aortic dissection, 506–508, 506f–508f, 507b pregnancy and, 1282 Aortic regurgitation, 443b, 524–525, 524b clinical features of, 524–525, 524b, 525f investigations of, 525, 525b chest X-ray for, 451f Aortic stenosis, 443b, 521–524, 522b, 522f causes of, 521b Doppler echocardiography for, 451f investigations of, 522–524, 523b, 523f in old age, 524b Aortic valve, disease, 521–525 Aortitis, 508 APACHE II, 214 APD see Automated peritoneal dialysis Aphonia, psychogenic, 624 Aphthous ulceration, 790, 790b Apixaban, 938b Aplastic anaemias, 968–969 Aplastic crisis, 947, 952–953 Apo A1 deﬁciency, 375, 375b Apo A1 Milano, 375, 375b Apocrine sweat glands, 1213–1214 Apolipoproteins, 371 Apoptosis, 41, 1316 Apoptotic bodies, 41 Appearance, in psychiatric interview,

Appendicitis, acute, 788 Apraxia, 1086 gait, 1087, 1309b Apremilast, for musculoskeletal disease, 1004b, 1005 Apronectomy, 704 APTT see Activated partial thromboplastin time Arachnoiditis, 996–997 Arboviruses, 1121–1122 ARDS see Acute respiratory distress syndrome Arginine, 697b Arms, assessment of, 983f Aromatase inhibitors for cancer treatment, 1334 osteoporosis and, 1046b Arrhythmias, 468–479, 468f in acute coronary syndrome, 495, 495b during dialysis, 424b electrophysiology of, 454 hypothermia and, 166f management of, 479–484 drugs, 479–482, 479b–482b, 479f non-pharmacological treatments, 482–484 see also speciﬁc arrhythmias Arrhythmogenic ventricular cardiomyopathy, 540 Arsenic, poisoning, 149, 149b Arsenism, 149, 149b Artemisinin (qinghaosu) derivatives,

Arterial blood analysis of, 1358b critically ill patients, 179 respiratory failure, 199b Arterial disease hepatic, 898 leg ulcers due to, 1223–1224 Arterial gas embolism (AGE), 170 Arterial pressure waveform, 206 Arterial pulse, examination of, 443b Arterialisation, 422–423 Arteriography, renal, 389 Artesunate, for malaria, 277 Arthritis acute inﬂammatory, 1017 crystal-induced, 1012–1018 HIV-related, 321 juvenile idiopathic, 1026–1027 in adolescence, 1027b clinical features of, 1027b oligoarticular, 1300 transition medicine and, 1300 monoarthritis acute, 992–993, 993b chronic inﬂammatory, 992 mutilans, 1033 osteoarthritis, 1007–1012 polyarthritis see Polyarthritis psoriatic, 1032–1034 CASPAR criteria for, 1032b clinical features of, 1032–1033, 1033f investigations for, 1033 management for, 1033–1034 pathophysiology of, 1032 reactive, 1031–1032 rheumatoid, 1021–1026 algorithm for, 1026f biologic therapy for, 1026 cardiac involvement in, 1024 clinical features of, 1023–1025, 1023f criteria for diagnosis of, 1023b DMARD therapy for, 1025–1026 extra-articular, 1024b investigations in, 1025, 1025b, 1026f management of, 1025–1026 nodules in, 1023–1024, 1024f non-pharmacological therapy for,

ocular involvement in, 1024 pathophysiology of, 1022–1023, 1022f peripheral neuropathy in, 1024 in pregnancy, 1026b, 1280 pregnancy and, 1280 pulmonary involvement in, 1024 serositis in, 1024 spinal cord compression in, 1024, 1025f surgery for, 1026 systemic, 1023 vasculitis in, 1024 septic, 1019–1020 systemic lupus erythematosus and,

viral, 1020–1021 Arthrodesis, 1002b Arthropathy in parvovirus B19 infection, 237b psoriasis and, 1249 reactive, sexually acquired, 340 rheumatological manifestations of,

Arthroplasty, 1002b Asacol, for inﬂammatory bowel disease, 821b Asbestos-related lung and pleural diseases, 617–618 Asbestosis, 618 Ascariasis, 233b Ascaris lumbricoides (roundworm), 289–290, 906 Ascending and descending pain pathways, 1339f Ascites, 847b, 862–864, 1324b appearance and analysis of, 863b Budd-Chiari syndrome and, 899 causes of, 862b cirrhosis and, 867 hepatorenal syndrome and, 864 management of, 863–864 oedema, 395–396 pancreatic, 839 pathogenesis of, 863f pathology of, 862–863 portal hypertension and, 869 prognosis of, 864 renal failure and, 864 serum- ascites albumin gradient (SAAG) and, 863 spontaneous bacterial peritonitis and,

Ascorbic acid see Vitamin C Aspartate, 697b Aspartate aminotransferase (AST),

Aspergillosis, 301 bronchopulmonary classiﬁcation of, 596b Aspergillus clavatus, 616b Aspergillus ﬂavus, 1320b Aspergillus nodule, 597 Aspergillus spp., in immunocompromised patients,

Asphyxia/asphyxiation laryngeal obstruction, 624–625 self-harm, 1187 Aspiration, pleural, 563–564 Aspiration pneumonia, 586–587 Aspirin for acute coronary syndrome prevention, 498b adverse reactions of, 22b for angina, 489 asthma association, 568 atrial ﬁbrillation, stroke prevention,

coronary artery bypass grafting, 491–492 drug interactions, 24b for hypertension, 513 for myocardial infarction, 500 poisoning, 138 for rheumatic fever, 517 for stroke patients, 1160 timing of, 31b AST see Aspartate aminotransferase Asteatotic eczema, 1247 Asterixis, 864–865 Asthma, 567–573, 567f clinical features of, 568–569 control, levels of, 570b diagnosis of, 569, 569b, 569f–570f exacerbations of, 572–573, 572b–573b, 573f and gastro-oesophageal reﬂux disease, 791–792 management of, 569–570, 571f occupational, 613–614, 614b, 614f pathophysiology of, 568, 568f in pregnancy, 570b, 1277 prognosis of, 573 Astrocytes, 1064–1065 Astrocytoma, 1075f

1370 • INDEX Astrovirus, 249 Asymmetrical inﬂammatory mono-/ oligoarthritis, 1032 Asymptomatic bacteriuria, 429 Ataxia(s), 1115 acquired, 1115b cerebellar, 1325 inherited, 1116b stroke and, 1153 Ataxia telangiectasia, 1321b genes, 1321 Ataxic gait, 1087, 1309b Atazanavir, 324b Atenolol for angina, 500 drug interactions of, 24b for hypertension, 513 Atheroembolism, 390b, 503–504, 504b Atherosclerosis in old age, 505b renal artery stenosis and, 406 six stages of, 485f Athetosis, 1086 Athlete’s foot, 1240 Atmospheric pollution, 94 ATN see Acute tubular necrosis Atomic absorption (AA), 348b Atonic seizures, 1100 Atopic eczema, 1245–1246 clinical features of, 1245, 1246f complications of, 1246b investigations of, 1245, 1246b management of, 1246 pathogenesis of, 1245 rash in, 1217b, 1246b Atopy, 84, 86 see also Allergy Atorvastatin, 501 Atovaquone, for malaria, 128 ATP (adenosine triphosphate), myocardial contraction and,

ATP synthase, 49b Atria, 444, 444f Atrial ectopic beats, 469–470, 470f Atrial ﬁbrillation (AF), 470–473, 471f causes of, 471b management of, 471–473 mechanisms of, 471f in old age, 472b paroxysmal, 471–472 persistent, 472–473 stroke risk in, 473b Atrial ﬂutter, 470, 470f Atrial myxoma, 541–542 Atrial natriuretic peptide (ANP), 351 Atrial septal defect, 534–535, 535f Atrial tachycardia, 470 Atrioventricular (AV) block, 477–478, 477f–478f, 478b Atrioventricular (AV) node, 445, 445f re-entrant tachycardia, 473, 474f Atrophy, deﬁnition of, 1226, 1226f Atropine for acute cholinergic syndrome, 146 for AV block, 478 for carbamate poisoning, 147 cardiotoxic drug poisoning, 140 for organophosphorus poisoning,

for sinus bradycardia, 469 Auerbach’s plexus, 771–772 Auscultation examination of, respiratory system, 546f of heart, 443b malignant pleural effusions, 1315b Austin Flint murmur, 524 Australian tick typhus, 271b Autoantibodies autoimmune disease and, 83, 83f autoimmune hepatitis and, 886b and musculoskeletal disease, 991 primary biliary cholangitis and, 887–888 thyroid, 637b Autoﬂuorescence, of visual disorders,

Autoimmune connective tissue disease, 1018, 1034–1040 Autoimmune disease, 81–84 clinical features of, 83 gene polymorphisms associated with, 82b investigations of, 83–84 autoantibodies in, 83, 83f complement in, 84 cryoglobulins in, 84, 84b of liver, 885–890 management of, 84 pathophysiology of, 82–83 Autoimmune haemolytic anaemia, 949–950 Autoimmune hepatitis, 886–887 conditions associated with, 886b liver function test (LFT) abnormality in, 854b primary biliary cholangitis and, 888 Autoimmune lymphoproliferative syndrome, 80 Autoimmune pancreatitis, 841 Autoimmune polyendocrine syndromes, 689, 689b Autoimmune thyroid disease, 639b, 643–646 Autologous haematopoietic stem cell transplantation, 936–938 Automated peritoneal dialysis (APD),

Automated threshold perimetry, 1168 Autonomic dysfunction, somatoform,

Autonomic nervous system, 1068 Autonomic neuropathy, diabetic, 760, 760b ‘Autonomic storm’, 155 Autonomy, patients, 1288–1289 Autophagy, 1316 Autopsy, 213 Autosomal dominant hypophosphataemic rickets (ADHR), 1050b Autosomal dominant inheritance, 46–47, 47b Autosomal recessive inheritance, 47b,

Autosomes, 38 AV see Atrioventricular Avascular cornea, 1166 Avid sodium retention, nephrotic syndrome and, 395b Axial spondyloarthritis, 1028b, 1029–1030, 1029f Axial spondyloarthropathy, 1028–1031, 1029f Axons, peripheral nerve, 1064–1065 Azathioprine adverse reactions of, 22 for autoimmune haemolysis, 950 for autoimmune hepatitis, 886–887 drug interactions of, 24b for eczema, 1246 hepatotoxicity, 894b for inﬂammatory bowel disease, 821b,

liver transplantation and, 901 for musculoskeletal disease, 1004b,

systemic lupus erythematosus,

for myasthenia gravis, 1142b for primary biliary cholangitis, 888 for rheumatoid arthritis, 1026b transplant patients, 89b, 425–426 Azelaic acid, 1242–1244 Azithromycin, 117b for bacillary angiomatosis, HIV/AIDS patients, 315–316 for cystic ﬁbrosis, 581b for Mycobacterium avium complex, 315b for STIs chlamydial infection, 341b syphilis, 339 for trachoma, 273 Azole antifungals, 126 Aztreonam, 117b, 120b, 121 B B-cell receptor, 68, 68f B lymphocytes (B cells), 68, 68f, 917 Babesia microti, 226b Babesiosis, 278 Bacillary angiomatosis, 272 HIV-related, 315–316 Bacillary dysentery, 265 Bacille Calmette-Guérin see BCG Bacillus anthracis, 266 Bacillus cereus, food poisoning, 262, 262f Bacillus spp., 102f Back, examination of, cardiology, 442f Back pain, 995–997 red ﬂags for, 996b triage assessment of, 996f see also Low back pain Background radiation, 164 Baclofen, for multiple sclerosis, 1110b Bacteraemia, 106 Staphylococcus aureus, 225 Bacteraemic leptospirosis, 257 Bacteria, 100–101, 101b, 102f endogenous commensal, 63 exotoxin, disease caused by, 104b identiﬁcation of, 102f Bacterial cultures, for gastrointestinal infection, 777 Bacterial infections, 250–273 after HSCT, 937b and cancer, 1320b chlamydial, 272–273, 272b gastrointestinal, 262–265 with neurological involvement, 267 respiratory, 265–267 rickettsial, 270–272, 271b of skin, 1235–1238 soft tissues and bones, 250–254 systemic, 254–262 see also speciﬁc infections Bacterial keratitis, 1173 Bacterial meningitis, 1118–1120 causes of, 1119b cerebrospinal ﬂuid in, 1119 clinical features of, 1119, 1119b headache and, 185, 185b investigations of, 1119–1120, 1119f, 1120b management of, 1120, 1120b pathophysiology of, 1119 Bacterial swab, for leg ulcers, 1224 Bacteriology, skin, 1215 Bacteriophage, 100 Bacteriuria asymptomatic, 429 catheter-related, 429–430 Bacteroides fragilis, 586 Bacteroides spp., 103f, 117b Bad news, 1185 Baker’s (popliteal) cyst, 999b, 1023 rupture, 1023 Balance altered, 1086 see also Dizziness; Vertigo Balanitis, 333 anaerobic, 334b circinate, 334b plasma cell (of Zoon), 334b Balanoposthitis, 333 Balkan nephropathy, 403 Ballism, 1086 Balloon dilatation, 434 Balloon tamponade, for variceal bleeding, 870–871, 870f Balloon valvuloplasty for aortic valve, 524 for mitral valve, 519, 519b, 519f Balsalazide, 821b Balsam of Peru, 1247b ‘Bamboo’ spine, 1030–1031, 1031f Band ligation, 870 Bandages, for leg ulcers, 1223 Banding, for variceal bleeding, 869 Barbiturates, 142b misuse of, 1195 skin reactions of, 1266b withdrawal effects of, 16b Bardet-Biedl syndrome, 404b Bare lymphocyte syndromes, 79 Bariatric surgery, for obesity, 702f–703f, 703–704, 703b Baricitinib, for musculoskeletal disease, 1004b Baritosis, 614–615 Barium enema for constipation, 787 for diverticulosis, 833 for gastrointestinal tuberculosis, 590 for inﬂammatory bowel disease, 819–820 for oesophageal diseases, 778 for pharyngeal pouch, 794 Barotrauma, 171 Barrett’s (columnar lined) oesophagus, 792–793, 793f carcinoma and, 796 Barthel Index of Activities of Daily Living, 1311, 1312b Bartonella henselae, 272, 315–316 Bartonella quintana, 272, 315–316 Bartonellosis, 272, 272b Bartter’s syndrome, 361 Basal cell carcinoma, 1229–1230, 1229f, 1230b Basal cell papilloma, 1234, 1234f Basal ganglia, 1066–1067 Basal metabolic rate (BMR), 694, 695f in over-nutrition, 694 Basement membrane, 1212, 1213f Basic calcium phosphate (BCP) deposition disease, 1017–1018, 1017b Basic life support (BLS), 456–457 Basophil granulocytes, 1362b Basophilia, 926b Basophilic stippling, 921f Basophils, 66–67, 917, 926b, 926f count, 1362b Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), 1029 Bath Ankylosing Spondylitis Functional Index (BASFI), 1029 Battery acid poisoning, 794 Bayes’ theorem, 5 BCG (bacille Calmette-Guérin) for leprosy, 270 for tuberculosis, 594 BCP see Basic calcium phosphate BCR see Breakpoint cluster region Beau’s lines, 1261, 1261f Becker muscular dystrophy, 48b Becker’s disease, 1145b Beckwith-Wiedemann syndrome, 51b Beclometasone, 17–18 Bedside procedures, for safe transfusion, 934, 934f–935f Behaviour assessment of, in psychiatric interview, 1181 disturbed and aggressive, 1188–1189, 1189f in old age, 1189b high-risk, transition medicine and,

history-taking in, 1295b personality and, 1295 protective factors in, 1295 theories in, 1295 psychiatric disorders and, 1183 Behaviour therapy, 1190 Behavioural rating scales, for pain,

Behçet’s disease, 1043–1044, 1043f, 1044b Beighton score, modiﬁed, 1059 Bejel, 254, 254b Beliefs, abnormal, 1181 Belimumab, for musculoskeletal disease, 1006–1007, 1007b Bell’s palsy, 1082–1083 Bence Jones protein, 394–395 Bence Jones proteinuria, 966–967 Bendroﬂumethiazide, 22b Benign oesophageal stricture, 793, 795–796, 796b Benign paroxysmal positional vertigo, 1104, 1104f

INDEX • 1371 Benign prostatic enlargement (BPE), 437–438 treatment for, 438b Benign prostatic hyperplasia (BPH), 437 Benserazide, 1113 Benzamides, substituted, 1198b Benzathine benzylpenicillin, for syphilis,

Benzbromarone, 1016 Benzene, 1320b Benzimidazoles, for helminthic infections, 129 Benzisoxazole, 1198b Benznidazole, for trypanosomiasis, 128 Benzocaine, allergy, 1247b Benzodiazepines, 1190b adverse reactions of, 22b, 1310b alcohol withdrawal, 1195 for anxiety disorders, 1190b, 1201 delirium, 1310b misuse of, 142 overdose, 142 respiratory depression and, 1188–1189 stress reactions, 1201 withdrawal, 1186b Benzoyl peroxide, 1242–1243 Benzylpenicillin, 120b for cerebral abscess, 1124b for meningitis, 1120b for neurosyphilis, 1125 procaine see Procaine penicillin Bereavement, 1184 Beri-beri, 714 Bernoulli equation, modiﬁed, 451–452 Berylliosis, 616 Beta-adrenoceptor blockers, for heart failure, 467 Beta-blockers adverse reactions of, 22b, 1310b for anxiety disorder, 1201 for essential tremor, 1115 for hypertension, 513 poisoning from, 140 for thyrotoxicosis, 637–638 Beta-chain haemoglobinopathy, 953 Beta-lactam antibiotics, 116b, 120–121 adverse reactions of, 120–121 drug interactions of, 121 mechanism of action, 116b pharmacokinetics of, 120 Beta particles, 164, 164f Beta-thalassaemia, 953–954 diagnostic features of, 954b management and prevention of, 953–954, 954b Beta-2-microglobulin, as tumour markers, 1324b Bevacizumab, 1332 Bi-level ventilation, 202 Bicarbonate, 349b arterial blood of, 1358b in diabetic ketoacidosis, 738 see also Sodium bicarbonate Bicarbonate system, 364, 364f Biguanides, for hyperglycaemia, 746 Bilateral diaphragmatic weakness, 627 Bile, 850–851 reﬂux, 801 Bile acid diarrhoea, 809 Bile acid-sequestering resins, 376–377 Bile duct, tumours of, 907–908 Bile salts, 768f Bilharziasis see Schistosomiasis Biliary colic, 904 Biliary disease, 902–909 autoimmune, 885–890 clinical examination of, 846f extrahepatic, 902–903 intrahepatic, 902 inﬂammatory and immune disease and, 902 investigation of, 852–855, 852b see also Liver disease Biliary obstruction, pregnancy and, 900 Biliary sludge, 904 Biliary sphincterotomy, 906 Biliary system, functional anatomy of, 849–850 Bilirubin alcoholic hepatitis and, 882 excretion of, 851f Gilbert’s syndrome and, 897 liver blood biochemistry and, 852 metabolism of, 850–851 plasma acute liver failure and, 858 jaundice and, 860 viral hepatitis, 872 reference range of, venous blood, 1360b see also Hyperbilirubinaemia Bioavailability, 17 Biochemical disorders, clinical examination of, 346–348, 346f Biochemical investigations, 348–349, 348b Biochemical markers, cancer, 1323, 1324b Biochemical tests, for liver disease, 852–853 Biochemistry, 388–389 of bone disease, 990–991 of coeliac disease, 807 Biological therapies for cancer, 1332 for musculoskeletal disease, 1006–1007, 1006f for psychiatric disorders, 1190 for skin disease, 1228 Biopsy, 776 bone, 992 brain, 1078 cancer diagnosis, 1330 liver, 855, 855b, 884 for hepatocellular carcinoma, 891 for lung cancer, 601 muscle, 992, 1078 for neurological disease, 1078 pleural, 563–564 renal, 391, 391b skin, 1214–1215 synovial, 992 temporal artery, 992 tissue, in musculoskeletal disease,

Bioterrorism, 111 Biotin, 715 deﬁciency, 715 dietary sources of, 711b reference nutrient intake of, 711b 2,3-Biphosphoglycerate (2,3-BPG), 915–916 Bipolar disorder, 1199–1200 prevalence of, 1180b Birch oral allergy syndrome, 85 Bird fancier’s lung, 616b Bisacodyl, 834b Bismuth, 230, 800 Bisoprolol, 466b for angina, 490 for arrhythmias, 481 for hypertension, 513 Bisphosphonates adverse effects of, 1048b for bone metastases, 1329 for giant cell arteritis, 1043b for multiple myeloma, 968 osteomalacia and, 1053 for osteoporosis, 1047–1048, 1047f, 1048b for Paget’s disease, 1054 Bites snake, 158b spider, 161 Bithionol, 129 Bitot’s spots, 713 Blackheads see Comedone Blackouts, 1080 alcoholic, 1195 in older people, 1308 Bladder, 386 disturbance, 1093–1094 dysfunction, 1093–1094, 1094b ﬂaccid, 1093 multiple sclerosis and, 1109–1110 ultrasound of, 389 Bladder neck, obstruction, 437 Blastomyces dermatitidis, 304 Blastomycosis, 304 Blatchford score, 780 Bleeding, 913–914, 913b, 927–929 clinical assessment of, 928–929 gastrointestinal, 780–783 in haemophilia A, 972 investigation of, 929 supportive therapy for, 957 variceal see Variceal bleeding see also Haemorrhage Bleeding disorders, 920–922, 970–975 acquired, 974–975 rare inherited, 974 Bleeding time, 921, 1362b Bleomycin Hodgkin lymphoma, 963 pigmentation from, 1258b for viral warts, 1239 ‘Blind loop syndrome’, 808–809 Blindness, night, 713 Blisters, 1211f, 1218–1219 acquired, 1218b clinical assessment of, 1218f, 1219 deﬁnition of, 1218 investigations and management of,

α-Blockers for benign prostatic enlargement, 438 for hypertension, 513, 514b for phaeochromocytoma, 675–676 Blood arterial, analytes in, 1358b components of, 931b culture, 106, 107f–108f, 225–226, 225b functional anatomy and physiology of, 914–919 oxygenation in, 190 Blood-brain barrier, 1064–1065 Blood cells, 915–917 see also Platelets; Red cells Blood count for acute kidney injury, 416b for gastrointestinal bleeding, 777–778 for hepatobiliary disease, 853 for musculoskeletal disease, 990 see also Platelets; Red cells Blood diseases clinical examination of, 912–914, 912f investigation of, 919–923 ophthalmic features of, 1164b pregnancy and, 1284–1285 anaemia as, 1284, 1285b Rhesus disease as, 1285 thrombocytopenia as, 1285, 1285b venous thromboembolism as, 1285 presenting problems in, 923–930 principles of management of, 930–940 pruritus and, 1219b rheumatological manifestations of,

in systemic lupus erythematosus, 1035–1036 see also individual disorders Blood donation, 930–931, 932f Blood ﬁlm examination, 920, 921b, 921f Blood ﬂow Doppler echocardiography for, 451–452, 451f respiration and, 447–448 through heart, 444f resistance to, 447 Blood glucose, of stroke patients, 1159b Blood loss, 940–941 Blood pool imaging, for cardiovascular system, 454 Blood pressure effects of respiration on, 447b in endocrine disease, 630f examination of, respiratory system, 546f optimal target, 513b of stroke patients, 1159b see also Hypertension Blood products, 930–931, 931b Blood-stream infection, 225, 225b see also Bacteraemia Blood supply, to liver, 848–849, 848f Blood tests for abdominal pain, 787 for cerebrovascular disease, 1151–1152 for diabetes mellitus, 726 for gastrointestinal bleeding, 777 for hepatobiliary disease, 853 for inﬂammatory bowel disease, 818 for malabsorption, 785f for musculoskeletal disease, 990–992 for neurological disease, 1077 older people, 923b for pain, 1342, 1342b for pneumonia, 584b for renal disease, 388–389 for skin disease, 1215–1216 for stroke, 1151–1152 see also Haematological values Blood transfusion, 930–936 adverse effects of, 931–933 exchange for malaria, 277 for megaloblastic anaemia, 945 for sickle-cell disease, 953 in intensive care, 211 in major haemorrhage, 934–936 other immunological complications of,

safe transfusion procedures in, 934 for sickle-cell anaemia, 953 Blood vessels imaging of, 1074 see also Vascular Blood volume, reference range of, 1362b Bloom’s syndrome, 1321b BLS see Basic life support Blue naevi, 1235 Blurred vision, of ophthalmic disease,

BMD see Bone mineral density BMI see Body mass index BMR see Basal metabolic rate BNP see Brain natriuretic peptide Body composition, measures of, 693b Body dysmorphic disorder, 1202 Body fat, in endocrine disease, 630f Body lice, 1241 Body mass index (BMI) cardiovascular disease risk and, 699f clinical assessment of, 693b diabetes risk and, 699f obesity and, 700, 700b of older people, 1302f pancreatitis and, 837b Body packers/stuffers, 144, 144f ‘Boerhaave’s syndrome’, 797 Bohr effect, 190 Bone anatomy of, 984–985 biopsy, 992 cortical, 984f in endocrine disease, 630f fractures see Fractures infection, 1019–1021 in old age, 1020b matrix, 985 metabolism, pregnancy and, 1272 mineral, 985 mineralisation, 985 pain, 1324b remodelling, 985, 985f–986f, 986b resorption, 985, 985f trabecular, 984f tumours, 1056–1057 metastatic, 1329 woven, 985 Bone disease, 1044–1056 biochemical abnormalities in, 990b metabolic after gastric resection, 801 chronic kidney disease and, 418–419 metastatic, 1057 in bone scintigraphy, 988–989 in tuberculosis, 591 see also individual disorders

1372 • INDEX Bone lining cells, 985 Bone marrow, 914, 914f examination of, 920, 922f Bone marrow stromal cells, 985 Bone marrow transplantation (BMT), for severe combined immune deﬁciency, 80 Bone mineral density (BMD), 989–990 Borrelia burgdorferi, 255 Borrelia infections, 255–257, 256b Botﬂy, 235f Botulinum toxin, 104b, 1126, 1126b for achalasia, 795 for dystonia, 1116 for hemifacial spasm, 1116 Bouchard nodes, 982f, 1009 Bouginage, 775f, 793 Boutonneuse fever, 271b Bovine serum albumin (BSA), 729 Bovine spongiform encephalopathy (BSE), 1127 Bowel disturbance, 1093–1094 whole bowel irrigation, 136 see also Colon; Small intestine Bowen’s disease, 1230b, 1232, 1232f BPH see Benign prostatic hyperplasia Brachial plexopathy, 1141 Brachial plexus lesions, 1141b Brachytherapy, 1331 Bradykinesia, 1069 Brain alcohol-related damage, 1195 arterial circulation of, 1150f biopsy, 1078 cerebral hemispheres, 1066–1067, 1066b, 1067f damage due to alcohol, 1195 lesions, 1071–1072, 1072b schizophrenia, 1196 structure and function of, psychiatric disorders and, 1183 tumours, 1129–1132, 1129b, 1129f clinical features of, 1129 investigations of, 1130, 1130f management of, 1130–1131 metastatic, 1328, 1328b prognosis of, 1131 venous circulation of, 1151f see also speciﬁc regions, and entries under cerebral Brain death classiﬁcation of, 212b organ donation after, 213 UK criteria for diagnosis of, 211b Brain injury, from critical illness, 211, 211b–212b Brain natriuretic peptide (BNP), 351,

Brainstem, 1067, 1067f death, 211 encephalitis, 1122 lesions, 1083–1084 Breakpoint cluster region (BCR) abl oncogene, 958 Philadelphia chromosome, 958 Breast cancer, 1333–1334 clinical features of, 1333–1334 investigations of, 1334 management of, 1334 in older people, 1325b pathogenesis of, 1333 screening, 1325b staging, 1333b survival rates for, 1333, 1333b Breastfeeding HIV infection/AIDS and, 326–327 safety of antirheumatic drugs during, 1281b Breasts, in endocrine disease, 630f Breath tests, gastroenterology, 777 Breathing assessment of, in deteriorating patient, 188 control of, 549 in divers, 170 Kussmaul, 415 of stroke patients, 1159b see also Respiration Breathlessness, 557–558 acute, 179–181, 558b clinical assessment of, 179–180 clinical features in, 180b investigations of, 180–181 presentation of, 179, 179f severe, 558 chronic exertional, 557–558, 558b in COPD, 575 differential diagnosis of, 557, 558b in lung cancer, 600 in palliative care, 1353 pathophysiology of, 557, 557f in pregnancy, 1274–1275, 1275b psychogenic, 558b Briquet’s syndrome, 1202 Bristol stool chart, 229, 229f British National Formulary, 28 Broca’s area, 1070 Bromocriptine for brain tumours, 1130 for neuroleptic malignant syndrome, 1197–1198 for Parkinson’s disease, 1114b for prolactinoma, 685, 685b Bronchial artery, 549f angiography, 560f embolisation, 597 Bronchial gland adenoma, 603b Bronchial gland carcinoma, 603b Bronchial obstruction in lung cancer, 600, 600b, 600f radiological features of, 551, 552f Bronchiectasis, 578–579, 578b–579b, 579f Bronchoalveolar carcinoma, 603b Bronchodilators for acute exacerbations of COPD,

for chronic obstructive pulmonary disease (COPD), 576 Bronchopulmonary aspergillosis, classiﬁcation of, 596b Bronchopulmonary segments, 548f Bronchoscopy, 553 in haemoptysis, 560 in lung cancer, 601, 601f in mediastinal tumours, 604 Bronchus, tumours of, 598–605 Brown-Séquard syndrome, 1083, 1136 Bruce Protocol, for exercise ECG, 449–450 Brucella abortus, 254 Brucella canis, 254 Brucella melitensis, 254 Brucella suis, 254 Brucellosis, 254 clinical features of, 254, 255f diagnosis of, 254 incubation period of, 111b management of, 254, 255b in pregnancy, 235b Brudzinski’s sign, 1118 Brugada syndrome, 477 Brugia malayi infection, 233b, 291, 291f BSA see Bovine serum albumin BSE see Bovine spongiform encephalopathy BTK gene, X-linked agammaglobulinaemia and, 78 Bubonic plague, 259 Buccal administration, 17 Budd-Chiari syndrome, 898–899 acute liver failure and, 857–858 Budesonide (BUD), 821b Buerger’s disease, 504 Bulbar palsy, 1093, 1093b Bulimia nervosa, 1204, 1204b Bullae, in lungs, 552b, 575 Bullous disease, 1254–1257 Bullous eruptions, drug-induced, 1266b Bullous impetigo, 1218b Bullous lupus erythematosus, 1255b Bullous pemphigoid, 1255–1256, 1255b, 1256f Bumetanide for hypertension, 513 for oedema, 396 Bundle branch block, 478–479, 478b, 478f Bundle of His, 445 Bupropion, 139b Burch-Wartofsky scoring system, for thyrotoxic crisis, 639b Burkholderia pseudomallei, 261 Burkitt’s lymphoma, 1320b Burns haemolysis and, 950 sunburn, 1221f Burrow, deﬁnition of, 1241 Bursae, 987 Bursitis anserine, 998b deep infrapatellar, 998b ischiogluteal, 999b olecranon, 998b pre-patellar, 998b superﬁcial, 998b trochanteric, 998, 999b, 999f Buruli ulcer, 254 Buschke-Löwenstein tumour, 343 Buspirone, 139b Busulfan drug-induced pigmentation, 1258b hepatotoxicity of, 894b Butterﬂy rash, 982f Button hole deformity of ﬁngers,

Butyrophenones, 1190b for schizophrenia, 1198b Byssinosis, 614, 616b C C-peptide, 724, 724f, 727 C-reactive protein (CRP), 63 abnormal, conditions associated with, 72b in acute phase response, 70 inﬂammation and, 71–72 reference range of, venous blood, 1360b C1 inhibitor deﬁciency (hereditary angioedema), 87 acquired, 88 C4d staining, 89 CA-19.9, as tumour markers, 1324b Cabergoline for brain tumours, 1130 nephrotoxicity, 427b for Parkinson’s disease, 1114b for prolactinoma, 685b CABG see Coronary artery bypass grafting Cabozantinib, for medullary carcinoma,

Cachexia, cancer, 693f CADASIL, 1095 Cadherin-1 (CDH1), 1319 Cadmium, lung cancer, 618 Caecum, cancer, 831 Caeruloplasmin, 1360b Wilson’s disease, 896 Café au lait spot, 1131f Caffeine, 716 cagA see Cytotoxin-associated gene Calabar swelling, 292 Calciﬁc periarthritis, 1017, 1017f Calciﬁcation artery, 452 metastatic, 369 in musculoskeletal disease, 988 Calcimimetic agents, 419 Calcineurin inhibitors, 1226 Calcinosis crystal-associated arthritis and deposition in connective tissue, 1013b nephrocalcinosis, 427b, 431 Calcipotriol, 1250 Calcitonin for Paget’s disease, 1054b as tumor markers, 1324b Calcitonin gene-related peptide (CGRP), 771–772 Calcitriol (1,25-dihydroxycholecalciferol), for hypoparathyroidism, 665 Calcium, 716 absorption, 716 acute kidney injury and, 416b deﬁciency, 716 dietary sources of, 717b excess, 716 homeostasis, 367 in myocardial contraction, 446 for osteoporosis, 1048, 1048b pregnancy and, 1272 reference nutrient intake of, 717b reference range of urine, 1361b venous blood, 1360b in skeletal disease, 990b stone, prevention of, 433b see also Hypercalcaemia; Hypocalcaemia Calcium and vitamin D supplements,

Calcium antagonists (channel blockers) adverse reactions of, 22b for angina, 491b for arrhythmias, 472 for hypertension, 513 for hypertrophic cardiomyopathy, 540 for mitral stenosis, 519 poisoning from, 140 for pulmonary hypertension, 622 for Raynaud’s phenomenon, 1038 Calcium carbonate, 419 Calcium gluconate, 368 cardiotoxic drug poisoning, 140 drug interactions, 24b for hypermagnesaemia, 368 Calcium oxalate crystal, 147 stones, 431b Calcium phosphate, stones, 431b Calcium pyrophosphate crystals, 663 Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, 1016–1017 Calcium therapy for hypoparathyroidism, 665 for osteoporosis, 1047 for rickets/osteomalacia, 1052 tetany, 663 Calculi (stones) gallbladder see Gallstones renal, 431, 431b staghorn, 431, 432f urinary, 431 see also Gallstones Calicivirus, 872b Calprotectin, faecal, 777b, 1361b ‘Cameron lesions’, 793 Campbell de Morgan spots, 1234, 1234f Campylobacter jejuni Guillain-Barré syndrome, 1140 infection, 262 Camurati-Engelmann disease, 1056 Canakinumab for gout, 1015 for musculoskeletal disease, 1007, 1007b Canalicular system, 918 Cancer, 1316, 1316f, 1333b aetiology, environmental, 1320b biochemical markers, 1323 breast, 1333–1334 clinical features of, 1333–1334 investigations of, 1334 management of, 1334 pathogenesis of, 1333 staging, 1333b survival rates for, 1333, 1333b cervical, 1335 investigations in, 1335 management of, 1335 pathogenesis of, 1335 childhood, 1298 clinical examination of, 1314, 1314f colorectal, 830–833 clinical features of, 831 dietary risk factors for, 830b familial adenomatous polyposis, 828–829, 829b, 829f

INDEX • 1373 investigations of, 832, 833f management of, 832 modiﬁed Dukes classiﬁcation and survival of, 832f non-dietary risk factors for, 830b pathogenesis of, 830f pathophysiology of, 830–831, 831f prevention and screening of, 832–833 determinants of, 1320–1321 environmental, 1320–1321, 1320b genetic, 1321, 1321b ectopic hormone production, 1325, 1325b emergency complications of, 1326–1328 endometrial, 1334–1335 investigations of, 1334 management of, 1335 pathogenesis of, 1334 of gallbladder, 904 hallmarks of, 1316–1320 activating invasion and metastasis,

angiogenesis, 1318, 1319f enabling replicative immortality,

evading growth suppressors, 1318 evading immune destruction, 1320 genome instability/mutation, 1316 reprogramming energy metabolism,

resisting cell death, 1316–1317 sustaining proliferative signalling,

tumour-promoting inﬂammation, 1319–1320 histology of, 1322 cytogenetic analysis, 1322 electron microscopy, 1322 immunohistochemistry, 1322 light microscopy, 1322 HIV-related, 322, 323b imaging for, 1323 inheritance, 1321b investigations of, 1321–1323, 1322b local features of, 1324b lung, 599–603, 599f burden of, 598b cell types in, 599b clinical features of, 599–601 investigations of, 601–602 management of, 602–603 non-metastatic extrapulmonary manifestations of, 601b occupational, 618 pathology of, 599, 599f prognosis for, 603, 603b metastatic disease, 1328–1329 neurological paraneoplastic syndromes, 1325–1326 obesity and, 698f in older people, 1325b oral, 790, 790b ovarian, 1334 investigations of, 1334 management of, 1334 pathogenesis of, 1334 predisposition syndromes, 1321b presenting problems of, 1323–1326, 1324b–1325b renal cell, 434–435, 435f screening, breast cancer, 1325b staging, TNM classiﬁcation, 1322b therapeutics for, 1329–1333 adjuvant, 1329 biological, 1332 chemoprevention, 1330 chemotherapy, 1330 hormonal, 1332 immunotherapy, 1332 neoadjuvant, 1330 palliative, 1329 radiation therapy, 1331–1332 surgical, 1330 of unknown origin, 1336, 1336b see also Chemotherapy; speciﬁc cancers Cancer antigen 19.9 (CA-19.9), 1324b Cancer antigen 125 (CA-125), 1324b Cancer cachexia, 693f Candesartan for heart failure, 466b for myocardial infarction, 500–501 Candida albicans, 300 Candida dubliniensis, 302 Candida glabrata, 302 Candida krusei, 302 Candida parapsilosis, 302 Candida spp., 100, 103f endocarditis, 528 Candida tropicalis, 302 Candidiasis, 334b, 336b acute disseminated, 302 chronic disseminated, 302 genital, 735b oesophageal, 794 oral, 790 skin, 1240 superﬁcial, 300 systemic, 302 Cannabis, 143 CAPD see Continuous ambulatory peritoneal dialysis Capecitabine, 832 Caplan’s syndrome, 610–611 Capnocytophaga canimorsus, 226b Capnography, 175f Capsaicin for herpes zoster, 240 for osteoarthritis, 1003–1004 topical, 315 Capsule endoscopy, 774–776, 775f wireless, 775f, 776b Capsulitis (frozen shoulder), 997–998 Caput medusae, 868 Carbamate insecticides, 146–147 Carbamazepine for epilepsy, 1102b hyponatraemia, 1103b multiple sclerosis, 1110b pharmacodynamics, 20b poisoning, 141b for status epilepticus, 1081b for trigeminal neuralgia, 1097 Carbapenems, 120b, 121 Carbaryl, 1241 Carbenoxolone, 361 sodium content of, 864b Carbidopa, 1113 Carbimazole for Graves’ thyrotoxicosis, 644 for thyrotoxicosis, in pregnancy,

Carbohydrates, 695–697 in diabetic diet, 743–744 dietary, 696b energy provided by, 694 recommended intake, 698b digestion of, 768 metabolism, 850 disorders of, 370 see also Diabetes mellitus effects of insulin in, 723b Carbon dioxide arterial blood (PaCO2), 204, 1358b removal of, extracorporeal, 204 Carbon monoxide poisoning, 134b, 144–145 Carbonic acid/bicarbonate buffer system, 363–364 Carbonic anhydrase, 717 Carbonic anhydrase inhibitors, for hypervolaemia, 354 Carboplatin, 1334 Carboxyhaemoglobin, reference range of, 1360b Carboxypenicillins, 121 Carbuncles, 1237, 1237f Carcinoembryonic antigen (CEA), 1322, 1324b Carcinoid syndrome pellagra, 714 valvular heart disease, 526 Carcinoid tumours gastric, 805 lung, 603b Carcinoma at ampulla of Vater, 907–908 anaplastic, 650 basal cell, 1229–1230, 1229f, 1230b, 1324b bronchial gland, 603b bronchoalveolar, 603b ﬁbrolamellar hepatocellular, 892 follicular, 649 of gallbladder, 907 gastric, 803–804, 804f hepatocellular, 890–892, 891f chemotherapy for, 892 cirrhosis and, 890 ﬁbrolamellar, 892 hepatic resection for, 891 hepatitis B and, 873 liver biopsy for, 891 liver transplantation for, 891 management of, 892f in old age, 901b percutaneous therapy for, 891 screening for, 890–891 trans-arterial chemo-embolisation for, 892 medullary, 650 of oesophagus, 796–797 of pancreas, 843f papillary, 649 squamous, 796b skin, 1230–1231, 1231f of unknown origin, 1336, 1336b see also sites of carcinoma Carcinoma in situ, 1230b Card agglutination trypanosomiasis test (CATT), 279 Cardiac arrest, 456–457, 456b, 456f chain of survival in, 457, 458f clinical assessment and management of, 456–457, 457f–458f post, 200–201 acute management of, 201, 201b prognosis of, 201, 201b Cardiac arrhythmias, 1198 Cardiac biomarkers, 450 for acute coronary syndrome, 497, 498f Cardiac catheterisation, 453–454, 453f aortic regurgitation, 525b aortic stenosis, 523b mitral valve disease, 519, 521b Cardiac death, organ donation after,

Cardiac disease, 899 HIV-related, 322 in pregnancy, 1282 aortic dissection, 1282 congenital, 1282 dilated cardiomyopathy, 1282 myocardial infarction, 1282 peripartum cardiomyopathy, 1282 valvular, 1282 Cardiac glycosides see Digoxin Cardiac output, 447–448 heart failure, 461 Cardiac pacemakers code, 483b permanent, 469, 483, 483b rate-responsive, 483 temporary, 482–483, 483f Cardiac peptides, 446–447 Cardiac resynchronisation therapy, for arrhythmias, 484 Cardiac tamponade, 447–448, 544, 544b see also Heart Cardiac transplantation, 467–468 Cardiac tumours, 541–542 Cardiobacterium hominis, 528 Cardiogenic shock, 199–200, 206b causes of, 200f downward spiral of, 199, 200f Cardiology, 441–544 Cardiomegaly, 450 Cardiomyopathy, 538–541, 539f, 541b arrhythmogenic ventricular, 540 dilated, 1282 HIV-associated, 322 hypertrophic obstructive, 1297–1298 obliterative, 541 peripartum, pregnancy and, 1282 restrictive, 540 septic, 198 types of, 539f Cardiopulmonary resuscitation (CPR), 213b see also Basic life support Cardiothoracic ratio, 450 Cardiotoxicity, venom and, 155 Cardiovascular disease chronic kidney disease and, 420 congenital, 531–538 hypertension see Hypertension investigation of, 448–454 New Heart Association (NYHA) functional classiﬁcation of, 454, 454b ophthalmic features of, 1165b presenting problems in, 454–468 in rheumatoid arthritis, 1024 risk of, obesity, 699f syphilis, 338 in systemic lupus erythematosus,

transition medicine and, 1297–1298 congenital heart disease, 1297 hypertrophic obstructive cardiomyopathy, 1297–1298 Cardiovascular medications, poisoning from, 140 Cardiovascular risk prediction chart, 511f Cardiovascular support, in intensive care, 204–208 advanced haemodynamic monitoring, 206, 207b, 207f ﬂuid and vasopressor use, 206, 206b initial resuscitation, 204–206, 206b mechanical, 206–208 Cardiovascular system clinical examination of, 442–444, 442f pregnancy and, 1272 Cardioversion, 482 atrial ﬁbrillation, 470–471 direct current (DC), 470 ventricular tachycardia, 475 Carditis, 515–516 Care see Health care Carey Coombs murmur, 515–516 Carnitine-palmitoyl transferase (CPT) deﬁciency, 1144b Caroli’s disease, 902 Carotenes, 712–713 Carotid endarterectomy, 1160 Carotid pulse, 166, 189 Carpal tunnel syndrome, 1058 diabetes, 760 rheumatoid arthritis, 1024 Carrion’s disease, 272 Cartilage articular, 987, 987f calciﬁcation of, 988 osteoarthritis in, 1010 Carvedilol, 869 for arrhythmias, 481 for hypertension, 513 Casal’s necklace, 714, 715f Caspases, 41 Caspofungin, 125b, 126 for acute leukaemia patients, 957 for aspergillosis, 598 Cassava, 839–840 Castleman’s disease, 220b, 248 Cat scratch disease, 272 Cataplexy, 1105 Cataract diabetics, 756b in ophthalmological conditions, 1174 ‘snowﬂake’, 1177 Catatonia, 1196–1197 Catechol-O-methyl-transferase (COMT) inhibitors, for Parkinson’s disease, 1114 Catecholamines, 666 drug interactions, 24b Catephen, for anogenital warts, 343 Cathepsin K, 985

1374 • INDEX Catheter ablation therapy, 484, 484f for arrhythmias, 470 Catheters/catheterisation bacteriuria, 429–430 bladder dysfunction, 1094b cardiac, 453–454, 453f aortic regurgitation, 525b aortic stenosis, 523b mitral valve disease, 519, 521b pulmonary artery, critically ill patients, 206, 207f Cathinones, 143 CATT see Card agglutination trypanosomiasis test Cauda equina syndrome, 997b Caudal regression syndrome, 1278–1279 Caval ﬁlters, for pulmonary embolism,

Cawthorne-Cooksey exercises, 1104 CBT see Cognitive behaviour therapy CCK see Cholecystokinin CD4 cells, in HIV infection/AIDS, 309–310 CD4+ T lymphocytes, 70 CD8+ T lymphocytes, 70 CDKs see Cyclin-dependent kinases CEA see Carcinoembryonic antigen Cefaclor, 121b Cefalexin, 121b for urinary tract infection, 428 Cefazolin, 121b Cefepime, 117b, 121b Ceﬁxime, 121b for gonorrhoea, 340b Cefotaxime, 117b, 121b for cerebral abscess, 1124b for meningitis, 1120b for spontaneous bacterial peritonitis,

Cefoxitin, 121b Cefradine, 121b Ceftaroline, 121b Ceftazidime, 117b, 121b for bronchiectasis, 579 for melioidosis, 261 Ceftobiprole, 121b Ceftriaxone, 117b, 121b for leptospirosis, 258–259 for meningitis, 1120b for nocardiosis, 261 for pneumonia, 319 for pyogenic meningitis, 1120b for STIs congenital syphilis, 339 gonorrhoea, 340b for Whipple’s disease, 809 Cefuroxime, 117b, 121b for cerebral abscess, 1124b for cholecystitis, 905 for empyema, 565 for meningitis, 1120b for pneumonia, 585b, 586 prophylactic, 119b Cefuroxime axetil, 256 Celecoxib, 1003b Cell adhesion molecules, 1318f Cell body, 1338 Cell cycle, 1317, 1317f regulation, 1317 stimulation, 1317 Cell differentiation, 40–41 Cell migration, 40–41 Cell surface antigens, 917 Cells cerebrospinal ﬂuid analysis of, 1077, 1078b, 1361b death of, 41, 1316–1317 programmed (apoptosis), 1316 division of, 40–41 of nervous system, 1064–1065, 1064f senescence of, 41 Cellular immunity, 69–70, 69f Cellulitis, 1237, 1237f anaerobic, 227 clinical assessment of, 187 investigation of, 187 Central core disease, 1145b Central nervous system (CNS) HIV infection/AIDS, 309–310 tuberculosis, 591 Central sensitisation, 1340, 1341f Central termination, 1338 Central venous catheter infections, 225–226 Central venous pressure, monitoring of, 175f, 190b Cephalosporin, 117b, 121, 121b for cholecystitis, 905 for pneumonia, 586 in pregnancy, 120b renal or hepatic disease, 32b for septic arthritis, 1020 for variceal bleeding, 869, 869b Cephamycins, 121 Cerebellar ataxia, 1325 Cerebellar degeneration, cancer-related, 1325, 1325b Cerebellar dysfunction, 1134 Cerebellum, 1069 Cerebral abscess, 1124, 1124b, 1124f Cerebral cortex anatomy of, 1067f lobar functions of, 1066b effects of damage, 1066b Cerebral hemispheres, 1066–1067, 1066b, 1067f lesions, 1084 Cerebral infarction, 1153–1154, 1153f–1154f Cerebral ischaemia, 967f Cerebral oedema acute liver failure and, 857 high-altitude, 168 hypoglycaemia, 740 stroke patients, 1154–1155 Cerebral palsy, transition medicine and,

Cerebral perfusion pressure (CPP), 208 Cerebral toxoplasmosis, HIV-related, 315b, 320, 320f Cerebral tumours see Brain, tumours Cerebral venous disease, 1162 causes of, 1162b clinical features of, 1162, 1162b investigations and management of,

Cerebrospinal ﬂuid (CSF), 1067 analysis, 1077, 1078b, 1361b circulation, 1128b encephalomyelitis, 1110 Guillain-Barré syndrome, 1140 meningitis, 1118, 1121 multiple sclerosis, 1108 result of, interpretation of, 1077, 1078b in subacute sclerosing panencephalitis, 1123 syphilis and, 339 in viral encephalitis, 1122 see also Lumbar puncture Cerebrotendinous xanthomatosis, 375b Cerebrovascular disease see speciﬁc conditions Certolizumab, for musculoskeletal disease, 1007b Cervical cancer, 1335 HIV-related, 322 investigations of, 1335 management of, 1335 pathogenesis of, 1335 Cervical cord compression, 1134f in cervical spondylosis, 1134f in rheumatoid arthritis, 1024b Cervical spine myelopathy, 1134–1135 radiculopathy, 1134, 1134f spondylosis, 1134–1135, 1134f subluxation of, 1024, 1025f Cervicitis, gonococcal, 335 Cestode infections, 233b, 297–299 Cetirizine, 1227 Cetuximab, 832, 1335–1336 CF see Cystic ﬁbrosis CFTR see Cystic ﬁbrosis transmembrane conductor regulator (CFTR) protein CFU-E (colony-forming unit erythroid), 914–915 CFU-GM (colony-forming unitgranulocyte, monocyte), 914 CFU-Meg (colony-forming unitmegakaryocyte), 914, 918 CGRP (calcitonin gene-related peptide), 771–772 Chagas’ disease, 279–280 transfusion-transmitted, 930–931 Chain of infection, 100f Chain of survival, in cardiac arrest, 457, 458f Chancre, 333–334 trypanosomal, 278 Chancroid, 341b Channelopathies, 1144, 1145b Charcoal, activated, 136, 136b antidiabetic overdose, 141 digoxin/oleander poisoning, 140 NSAID overdose, 138 salicylate poisoning, 138 tricyclic antidepressant poisoning,

Charcot joints, 1057, 1058f Charcot-Marie-Tooth disease (CMT),

Charcot neuroarthropathy, 762 Charcot’s triad, 861–862 acute cholangitis and, 905 Charles Bonnet’s syndrome, 1088 Cheese worker’s lung, 616b Cheiroarthropathy, 1057 Chelating agents, 165 Chemical cholestasis, 902 Chemical poisoning, 144–149 Chemical warfare agents, poisoning from, 149, 149b Chemicals, in haemolysis, 950 Chemo-embolisation, hepatocellular carcinoma, 892 Chemokine receptor inhibitor, 324b Chemoprevention, 1330 Chemoprophylaxis, 112b for malaria, 277, 278b Chemotherapy, 936, 936b, 1330 adjuvant, 1329 breast cancer, 1334 adverse effects, 1330, 1331f for brain tumours, 1130–1131 combination therapy, 1330 for hepatocellular carcinoma, 892 for high-grade NHL, 966 for Hodgkin lymphoma, 963 leukaemia acute, 956b chronic lymphocytic, 960 chronic myeloid, 959 for low-grade NHL, 965 for lung cancer, 602–603 for multiple myeloma, 968 neoadjuvant, 1330 palliative, 1329 platinum-based, 602–603 for prostate cancer, 439 for tuberculosis, 592–594 Chernobyl, 164 Chest infection, in stroke patients, 1159f Chest pain, 176–179, 454–455 associated features of, 177–178, 178f cardiac disease, aortic dissection,

characteristics of, 177 clinical assessment of, 178 differential diagnosis of, 177b investigations of, 178–179, 179b ischaemic, 454f onset of, 177 pregnancy and, 1275 in respiratory disease, 558 site and radiation of, 177 Chest radiography/X-ray, 450 for bronchiectasis, 579 cardiovascular disorders for aortic regurgitation, 451f for chronic constrictive pericarditis, 544f for heart failure, 464, 464f for mitral valve, 451f for myocardial infarction, 497–498 of cardiovascular system, 450 for COPD, 575 for empyema, 564f of pacemaker/deﬁbrillator, 467f for pleural effusion, 563 pregnancy and, 1274 for respiratory disease abnormalities, 552b ARDS, 199f aspergillosis, 597f asthma, 569 bronchial obstruction/lung collapse, 600f bronchiectasis, 579 COPD, 575 empyema, 564f haemoptysis, 560 HIV-related pulmonary disease, 318b, 318f–319f interpretation, 551b interstitial, 605f lobar collapse, 552f mediastinal tumours, 604f pleural effusion, 563 pleural plaques, 617f Pneumocystis jirovecii pneumonia, 318f pneumonia, 585 pneumothorax, 626 pulmonary embolism, 619b, 619f pulmonary hypertension, 622f sarcoidosis, 609b silicosis, 615f tuberculosis, 590f, 592f Chest wall deformities, 628 Chickenpox, 238–239 clinical features of, 238–239, 238f diagnosis of, 239 incubation period of, 111b management and prevention of, 239, 239b periods of infectivity, 111b rash, 238 varicella zoster immunoglobulin, 240b Chiclero ulcers, 285 Chief cells, 661 Chikungunya virus, 250 Chilblains, 167 Child-bearing potential, cystic ﬁbrosis and, 1297 Child-Pugh classiﬁcation, cirrhosis prognosis and, 867b Childbirth, associated psychiatric disorders, 1206 Childhood absence epilepsy, 1100b Childhood cancer therapy, late effects of, 689 Children diabetes mellitus in, 753–754, 754b important long-term conditions of, adult health affected by, 1288b inﬂammatory bowel disease and, 823,

laboratory reference range of, 1363 osteomyelitis in, 1021 renal impairment in, causes of, 1298b STI in, 332–333 Chiropractic, 826b Chlamydia pneumoniae, 272b Chlamydia psittaci, 272b Chlamydia spp., 272 Chlamydia trachomatis, 100–101, 117b,

in pregnancy, 235b, 332b Chlamydial infection, 340–341 in men, 340 in reactive arthritis, 1031 treatment of, 341b urethritis, 333 in women, 340–341 Chloasma, 1258 Chlorambucil for chronic lymphocytic leukaemia,

for non-Hodgkin’s lymphoma, 965 for Waldenström macroglobulinaemia,

INDEX • 1375 Chloramphenicol, 117b, 124 contraindication to, in pregnancy, 120b mechanism of action, 116b for meningitis, 1120b for plague, 259 in pregnancy, 120b for pyogenic meningitis, 1120b in renal/hepatic disease, 32b for rickettsial fevers, 271–272 Chloride, 349b, 718 channelopathies, 1145b reference range of, venous blood, 1358b Chloroquine adverse reactions of, 22 pigmentation, 1258b leprosy reactions, 270 for malaria, 128, 278b myopathy, 1057b poisoning, 141b resistance to, 273, 277 Chlorphenamine, 33b anaphylaxis, 76b diphtheria, 625 pruritus, 935f Chlorpromazine for acute diarrhoea, 230 for alcohol withdrawal, 1195 for cholestatic hepatitis, 894 hepatotoxicity, 894b long QT syndrome, 476b poisoning, 141 for rabies, 1122 for schizophrenia, 1197 Chlorpropamide, neutropenia, 926b Cholangiocarcinoma, 892, 907, 907f primary sclerosing cholangitis and,

Cholangiography, 906 for hepatobiliary disease, 854–855 percutaneous transhepatic (PTC), 854–855 for sclerosing cholangitis, 888 Cholangiopancreatography endoscopic retrograde see ERCP magnetic resonance see MRCP Cholangiopathy, HIV-related, 318 Cholangitis acute, 905 liver ﬂukes, 297, 297b primary biliary, 887–888 IgG4-associated, 890, 909 primary sclerosing, 888–890 recurrent pyogenic, 906–907 Cholecalciferol see Vitamin D Cholecystectomy in old age, 909b for pancreatitis, 839 post-cholecystectomy syndrome, 908b Cholecystitis, 905 acalculous, 905 acute, 788, 905 in old age, 909b chronic, 905 gallstones and, 904 pregnancy and, 900 Cholecystography, oral, 909 Cholecystokinin (CCK), 768, 768f, 772b Cholecystolithiasis, 904 Choledochal cysts, 903, 903f Choledochojejunostomy, 842–844 Choledocholithiasis, 904, 906–907 endoscopic retrograde cholangiopancreatography for, 906f endoscopic ultrasound for, 906f Choledochoscopy, 906 Cholera, 104b, 264–265 clinical features of, 265 diagnosis and management of,

ﬂuid loss, 265 incubation period of, 111b prevention of, 265 ‘Cholera sicca’, 265 Cholestasis, 894 benign recurrent intrahepatic, 902 biliary cirrhosis, 903 chemical, 902 obstetric (of pregnancy), 1220b, 1284 pruritus, 1220b pure, 894 sclerosing cholangitis, 889 Cholestatic jaundice, 860b–862b, 861–862 Cholesterol, 370 absorption of, 697 atheroembolism, 390b dietary, 698b gallstones, 903, 903b low-density lipoproteins, 371–372 metabolism of, 81 reference range of, venous blood, 1360b transport of, 372–373 see also Hypercholesterolaemia Cholesterol absorption inhibitors, 371 Cholesterol emboli, 409, 409f Cholesterol ester transfer protein (CETP), 373 Cholesterol gallstones, 903, 903b Cholesterolosis of gallbladder, 909 Choline salicylate, 790 Cholinergic syndrome, organophosphate poisoning, 146, 146b Chondrocalcinosis, 1016, 1016b, 1016f Chondrocytes in osteoarthritis, 1008 tumours, 1056b Chondroitin sulphate, 987 for osteoarthritis, 1012 Chondroma, 1056b Chondrosarcoma, 1056b, 1057 CHOP regimen, for non-Hodgkin lymphoma, 966 Chorea, 1085 causes of, 1085b in Huntington’s disease, 1085 Chorionic villus sampling, 56 Choroid, of eye, 1167 Choroid plexus, 1132f Christmas disease, 973–974 Chromatin, 38, 38f Chromatography, 348b Chromium, 718 deﬁciency, 718 Chromoblastomycosis, 300–301 Chromosomal disorders, 44b, 45f see also speciﬁc conditions Chromosomes, 38, 38f, 51–52, 52f abnormalities see Mutation(s) analysis of, 45f leukaemia, 955–956 myelodysplastic syndromes, 960–961 deletions, 52 duplication, 44, 45f sex, 38 see also X chromosome; Y chromosome translocations of, 805 Chronic allograft failure, 89 Chronic bronchitis, 555b, 573–574 Chronic cavitary pulmonary aspergillosis, 597, 597f Chronic cold agglutinin disease, 950 Chronic constrictive pericarditis, 543–544, 543b, 544f Chronic demyelinating polyneuropathy, 1139b, 1141 Chronic eosinophilic pneumonia, 611–612 Chronic exertional breathlessness, 557–558, 558b Chronic fatigue syndrome, 1202 Chronic ﬁbrosing pulmonary aspergillosis, 597 Chronic graft-versus-host disease, 937 Chronic granulomatous disease, 77 Chronic inﬂammation, 71 Chronic interstitial nephritis, 402–403, 403b Chronic intestinal pseudo-obstruction, 810–811, 811b Chronic kidney disease, 415–420, 417b causes of, 415b haemodialysis in, 422–423 indications for dialysis for, 422b osteodystrophy and, 419f physical signs of, 416f pregnancy and, 1282, 1283f staging of, in children over 2 years of age, 1298b transition medicine and, 1298–1299 Chronic laryngitis, 624, 624b Chronic liver failure causes of, 856f, 867b cirrhosis and, 867 Chronic lymphocytic leukaemia (CLL), 959–960 clinical features of, 959 investigations of, 959–960 management of, 960 prognosis of, 960 staging of, 960b Chronic meningococcaemia, 1119 Chronic mesenteric ischaemia, 827 Chronic myeloid leukaemia (CML), 958–959 characteristics of, 958 clinical features of, 958 investigations of, 959 management of, 959 accelerated phase, 959 blast crisis, 959 chronic phase, 959, 959b natural history of, 958 Chronic obstructive pulmonary disease see COPD Chronic pain syndrome, 1348–1349 Chronic pancreatitis, 839–841, 840b complications of, 840b investigations of, 840, 841b, 841f management of complications of, 841 pathophysiology of, 840f Chronic pulmonary aspergillosis (CPA), 596–597 Chronic pulmonary tuberculosis, complications of, 590b Chronic renal failure see Renal failure, chronic Chronic respiratory failure, 566–567 management of, 566–567, 566b Chronic rheumatic heart disease, 517 Chronic venous insufﬁciency, 187 Chronic widespread pain, 1349 CHRPE see Congenital hypertrophy of the retinal pigment epithelium Chrysops, loiasis, 292 Churg-Strauss syndrome, 1043 Chvostek’s sign, 367 Chylomicrons, 697 Chylothorax, 562–563 Chyluria, lymphatic ﬁlariasis, 291 Chymotrypsinogen, 770b Ciclesonide, 571 Ciclosporin adverse reactions of chronic interstitial nephritis, 427b musculoskeletal, 1057b proximal myopathy, 1145f for aplastic anaemias, 969 asthma, 572 drug interactions, 24b eczema, 1246 heart transplant patients, 467 HSCT, 937 immunosuppression, 89b for inﬂammatory bowel disease, 821b for lichen planus, 1252 liver transplant patients, 901 lung transplant patients, 567 for primary biliary cholangitis, 888 for psoriasis, 1250 for pyoderma gangrenosum, 1261–1262 for skin disease, 1227–1228 Ciclosporin A, for musculoskeletal disease, 1004b, 1005 Cidofovir as antiviral agents, 127b CMV, 243 for herpesvirus infection, 126, 127b Cigarette smoke, in lower airway defences, 550 Ciguatera poisoning, 149–150 Cilia, 62–63 Ciliary body, of eye, 1167 Ciliary dysfunction syndromes, 578b,

Ciliary dysmotility syndrome, 550 Cilostazol, 504 Cimetidine drug interactions of, 24 neutropenia, 926b for urticaria, 1254 Cinacalcet, for primary hyperparathyroidism, 664 Ciproﬂoxacin, 117b, 123b for anthrax, 267 for bacillary dysentery, 265 for bronchiectasis, 579 for brucellosis, 255b for cholera, 265 drug interactions of, 23 for inﬂammatory bowel disease, 823 for intestinal bacterial overgrowth, 808–809 for meningococcal infection, 1120 for plague, 259 for primary sclerosing cholangitis, 890 prophylactic, 119b for Q fever, 272 for spontaneous bacterial peritonitis,

for STIs chancroid, 341b gonorrhoea, 340b for urinary tract infection, 429b for variceal bleeding, 869 Circinate balanitis, 334b, 1031 Circulation assessment of, in deteriorating patient, 189 coronary, 444–445 enterohepatic, 19 portal, 384, 385f of stroke patients, 1159b Circulatory collapse, pregnancy and,

Circulatory failure (shock), 193 acute, 199–200 Circumduction, 1086 Circumﬂex artery (CX) in coronary circulation, 444–445, 445f with stenosis, 453f Cirrhosis, 866–867 alcoholic, 881–882, 881b ascites and, 867 biliary, secondary, 903 causes of, 866b–867b Child-Pugh classiﬁcation of, 867b cryptogenic, 884 drugs to be avoided in, 894b haemochromatosis, 866–867 hepatic encephalopathy and, 865 hepatic ﬁbrosis and, 866, 866f hepatitis B and, 873, 876 hepatitis C and, 877 hepatocellular carcinoma and, 890 macronodular, 866 management of, 867 micronodular, 866 non-alcoholic fatty liver disease and, 882–883, 883f portal hypertension and, 869 survival in, 868b, 868f Cisplatin for head and neck tumours, 1335–1336 hypomagnesaemia and, 368b nephrotoxicity, 427b polyneuropathy, 1139b Citalopram, 1199b Citric acid (Krebs) cycle, 49, 714 Citrobacter freundii, 225 Citrobacter spp., 117b CJD see Creutzfeldt-Jakob disease CK see Creatine kinase Clarithromycin drug interactions, 24b H. pylori eradication, 800

1376 • INDEX for leprosy, 269 for Mycobacterium avium complex, 315b for pneumonia, 585b in pregnancy, 120b Clasp-knife phenomenon, 1068–1069 Classical syndromes, 633 Claude syndrome, 1072b Clearance, 19 CLI (critical limb ischaemia), 502–503 Climate change, 94 Clindamycin, 117b for acne vulgaris, 1242–1243 for babesiosis, 278 for gas gangrene, 227 for malaria, 277b for MRSA, 252 for necrotising fasciitis, 227 in pregnancy, 120b for septic arthritis, 1020b Clinical biochemistry, 345–380 Clinical decision-making, 10–12 in cognitive biases, 11 dealing with uncertainty during, 5–6 in deciding pre-test probability, 11 in evidence-based history and examination, 11 heuristic, 7b in human factors, 11 in interpreting results, 11 in person-centred EBM and patient information, 12 in post-test probability, 11 in reducing cognitive error, 11 reducing errors in, 9–10 cognitive debiasing strategies, 8f, 9–10 effective team communication, 10, 10b using clinical prediction rules and other decision aids, 10 in treatment threshold, 11 Clinical endpoints, 35–36 Clinical genetics, 37–59 Clinical immunology, 61–90 functional anatomy and physiology in, 62–70, 62f Clinical pharmacology, 14–19 Clinical reasoning, 2, 2f Clinical skills, 3, 3f Clinical therapeutics, 13–36 Clinical trials, 27–28, 28f Clobazam, 1102b Clobetasol, 334b, 336b, 1226b Clobetasone butyrate, 1226b for eczema, 1244 Clock drawing test, 1149f Clofazimine for leprosy, 269 pigmentation from, 1258b for tuberculosis, 125 Clomethiazole, effect of old age, 32b Clomifene, for infertility, 656–657 Clomipramine, 1199b for narcolepsy, 1105 Clonal expansion, 68, 68f Clonazepam for epilepsy, 1102b for periodic limb movement syndrome, 1106 for sleep disorders, 1105 Clonic seizures, 1100 Clonidine diarrhoea, 761b opiate withdrawal, 1196 Clonorchiasis, 297b Clonorchis sinensis, choledocholithiasis and, 906 Clonorchis spp., 129 Clopidogrel for angina, 489 for myocardial infarction, 498b,

for peripheral arterial disease, 504b pharmacokinetics, 20b platelet inhibition, 918 for stroke prevention, 1161f Clostridium botulinum, 104b, 1126 Clostridium difﬁcile, 103f, 104b, 117b, 264, 264f Clostridium novyi, in injecting drug-user, 222–223 Clostridium perfringens anaerobic cellulitis from, 227 food poisoning, 262 Clostridium perfringens sepsis, 950 Clostridium spp., 102f–103f Clostridium tetani, 104b Clotrimazole, 125b for erythrasma, 1238 Clotting see Coagulation Clotting factors, 850, 918–919 Clozapine drug interactions, 24b schizophrenia, 1198b Clubbing, 1261, 1261f ﬁnger, 546f, 559, 559b, 559f asbestosis, 618 in lung cancer, 600 Cluster headache, 1096 CMV (cytomegalovirus) see Cytomegalovirus (CMV) infection CNS see Central nervous system Co-amoxiclav, 117b cholestatic hepatitis and, 894 for empyema, 565 hepatotoxicity of, 894b prophylactic, 119b for respiratory tract infection, pneumonia, 585b, 586 for urinary tract infection, 428 Co-artemether, 277 Co-phenoxylate, for inﬂammatory bowel disease, 821b Co-trimoxazole, 117b, 123 for brucellosis, 255b for cyclosporiasis, 287–288 for HIV infection/AIDS, 323–324, 323b for melioidosis, 261 for meningitis, 1120b for mycetoma, 301 for nocardiosis, 261 for Pneumocystis jirovecii pneumonia,

haematopoietic stem cell transplantation, 937b leukaemia patients, 957 prophylactic, 119b toxoplasmosis, HIV/AIDS patients,

for Whipple’s disease, 809 Coagulation, disseminated intravascular,

Coagulation disorders, 971–975 Coagulation factors, 850, 930 complications of therapy, in haemophilia A, 973 Coagulation screen, 922b, 1362b in disseminated intravascular coagulation, 921–922 Coagulation system, 918–919 activation of, 196 investigation of, 920–923 Coagulation tests, for hepatobiliary disease, 853 Coagulopathy, causes of, 972b Coal tar, 1250 Coal worker’s pneumoconiosis (CWP),

Cobalt, 718 Cocaine, misuse of, 143 Coccidioidomycosis, 304 Codeine cirrhosis and, 894b diarrhoea, 801 irritable bowel syndrome, 826f headache, 1096 pharmacokinetics, 20b Codons, 40 Coeliac disease, 805–807 clinical features of, 806 disease associations of, 806b investigations of, 806–807 liver function test (LFT) abnormality in, 854b pathophysiology of, 805, 806f Coeliac plexus neurolysis, 842–844 Coexisting disease, in choosing drugs,

Coffee, 716 type 1 diabetes and, 729 Cognitive behaviour therapy (CBT),

for eating disorders, 1204 for obsessive-compulsive disorder,

for schizophrenia, 1198 for somatoform disorder, 1203 Cognitive biases, 6–9, 11 in human factors, 9, 9f, 11 in medicine, 7–9, 8f in type 1 and type 2 thinking, 7, 7b, 7f Cognitive debiasing strategies, 8f, 9–10 history and physical examination in, 9 mnemonics and checklists in, 9 problem lists and differential diagnosis in, 9 red ﬂags and ROWS (‘rule out worst case scenario’) in, 9–10 Cognitive function, assessment of, 1181–1183, 1182f Cognitive impairment, 1181 chemotherapy and, 1298 HIV-associated, 319–320 Cognitive therapy, 1190 Colchicine for Behçet’s disease, 1044 for CPPD crystal deposition disease,

for familial Mediterranean fever, 81 for gout, 1015 Cold agglutinin disease, 950 Cold antibodies, 949 Cold injury, 166–167 Colesevelam, 376–377 Colestipol, 376–377 Colestyramine, 376–377 for irritable bowel syndrome, 826f for post-cholecystectomy syndrome,

pruritus, 888, 1220b for radiation enteritis, 810 Colic biliary, 904 renal, 396 Colipase, 770b Colistin, 117b Colitis collagenous, 824 microscopic, 824 pseudomembranous, 104b ulcerative see Ulcerative colitis Collagen, 1213f in osteoarthritis, 1008 Collagenase, 64, 71 Colon, 770, 771f acute colonic pseudo-obstruction,

disorders of, 827–836 tumours of, 827–833 Colon cancer, hereditary non-polyposis, 831b Colonoscopy, 776, 776b for abdominal pain, 789 for colorectal cancer, 832 for gastrointestinal haemorrhage, 782–783 Colony-forming unit-granulocyte, monocyte (CFU-GM), 914 Colorectal cancer, 830–833 clinical features of, 831 dietary risk factors for, 830b familial adenomatous polyposis, 828–829, 829b, 829f, 1321b investigations of, 832, 833f management of, 832 modiﬁed Dukes classiﬁcation and survival of, 832f non-dietary risk factors for, 830b pathogenesis of, 830f pathophysiology of, 830–831, 831f prevention and screening of, 832–833 Colorimetric chemical reaction, 348b Columnar lined (Barrett’s) oesophagus (CLO), 792 Coma, 1080 causes of, 194b deﬁnition of, 194 poisoning, 137b stroke patients in, 1153 Combination therapy, for hypertension,

Combined inhaled glucocorticoids and bronchodilators, for chronic obstructive pulmonary disease (COPD), 576 Comedone, deﬁnition of, 1242 Common variable immune deﬁciency,

Community-acquired pneumonia, 582–585, 582f clinical features of, 582–583 discharge and follow-up of, 585 investigations of, 583, 584b management of, 583–584 organisms causing, 582b prognosis for, 585 Comorbidities, in older people, 1307 Compartment syndrome abdominal, 195 identiﬁcation of, 187b in injecting drug-user, 222–223 Competitive antagonist, 14 Complement, 66, 66f alternate pathway for, 66 autoimmune disease and, 84 classical pathway for, 66 deﬁciency in, 73b lectin pathway for, 66 pathway deﬁciencies in, 78 total haemolytic, 1360b Complement ﬁxation test (CFT), 107–108 Complementary therapies for cancer pain, 1353 for pain, 1348 Complex regional pain syndrome (CRPS), 1348–1349, 1349b type 1, 1055, 1055f Compressed air, physics of breathing, 170b Concentration, 1181 Concordance, 1294 Condyloma, 343 Condylomata lata, 337 Confrontation, for visual ﬁelds, 631b Confusion/confusional states, 1196 cerebral oedema, 168 Congenital abnormalities, in pancreas, 842–844 Congenital adrenal hyperplasia, 676 hirsutism and, 658b Congenital heart disease, 531–538, 531b, 532f in adolescent, 537b adult, 537–538 cyanotic, 537b pregnancy and, 1282 transition medicine and, 1297 Congenital hypertrophy of the retinal pigment epithelium (CHRPE),

Congenital thyroid disease, 650–651 Congestive ‘portal hypertensive’ gastropathy, 871 Coning, 1077 Conjunctiva, 1164 Conjunctivitis, 1173 gonococcal, 339 Connective tissue disease, 1262–1263 respiratory involvement in, 610–611, 610b Conn’s syndrome, 361 Consanguinity, 48 Conscious level, decreased, 194–195 assessment of, 186f, 194–195, 194b management of, 195 Consent, artiﬁcial nutritional support, 710b Conservative treatment, for chronic kidney disease, 421 Clarithromycin (Continued)

INDEX • 1377 Constipation, 786–787 causes of, 786b clinical assessment of, 786–787 disorders of, 834–835 diverticulosis and, 833 in old age, 834b simple, 834 in stroke patients, 1159b Constitutional delay, of puberty, 653 Contact inhibition, 1318 Continence, faecal, 770 Continuous ambulatory peritoneal dialysis (CAPD), 424, 425b Continuous murmurs, 461 Continuous positive airway pressure (CPAP), 199b, 202 for drowning victims, 170 Continuous positive pressure ventilation,

Continuous venovenous haemoﬁltration (CVVH), 423 Contraception cystic ﬁbrosis and, 1297 in epilepsy, 1103 Contrast media, nephrotoxicity and, 390b Contrast radiology, 773f Conversion (dissociative) disorder, 1202, 1202b COPD, 547f, 573–578 BODE index in, 577b classiﬁcation of, 576b clinical features of, 575, 575b chronic exertional breathlessness, 575, 575b exacerbations of, 572–573 acute, 577–578 investigations of, 575–576 management of, 576–577, 576f, 577b occupational, 614 in old age, 578b pathophysiology of, 574–575, 574f prognosis of, 577 risk factors for, 574b Copper, 718 deﬁciency, 703b dietary sources of, 717b excessive, Wilson’s disease, 896 refeeding diet, 705b reference nutrient intake of, 717b reference range of urine, 1361b venous blood, 1360b Copper sulphate, poisoning from, 148 Copy number variations (CNV), 44, 44b, 45f Cor pulmonale, 550 Cornea, of eye, 1166–1167 Coronary angiography, for acute coronary syndrome, 498 Coronary artery, 444–445, 445f angiography of, 452f calciﬁcation, 452 with stenosis, 453f Coronary artery bypass grafting (CABG) for angina, 488, 491–493, 492f vs. PCI, 493b Coronary artery disease, 484–502, 487b clinical manifestations of, 485b Coronary artery dissection, pregnancy and, 1282 Coronary circulation, 444–445, 445f Coronary heart disease, obesity and, 698–699, 699f Coronary revascularisation, 467 Coronavirus, 111b Corrosives oesophagitis, 794 poisoning from, 147–148 Cortical (volitional) inﬂuences, in control of breathing, 549 Corticobasal degeneration, 1115 Corticosteroids biosynthetic enzyme defects, 671b for congenital adrenal hyperplasia,

see also Cortisol; Glucocorticoids; Hydrocortisone; Mineralocorticoids; Prednisolone Corticotrophin-releasing hormone (CRH), 633f Cortisol, 665 deﬁciency, hypopituitarism, 682 reference range of urine, 1361b venous blood, 1359b see also Hydrocortisone Corynebacterium diphtheriae, 104b Corynebacterium minutissimum, 1238 Corynebacterium spp., 103f Cough, 556, 556b aetiology of, 556 in asthma, 568 bovine, 600, 624 in COPD, 575 headache and, 1097b at high altitude, 168–169 in laryngeal nerve, paralysing, 553 in lung cancer, 599 in palliative care, 1353 in pneumonia, 582–583 refractory, 169 and upper airway defences, 550 in upper respiratory tract infection, 581–582 Cough reﬂex, 556 Coumarins, 938b, 939–940 Counselling, dietary for coeliac disease, 807 for hyperlipidaemia, 375–376 Coupled enzymatic reaction, 348b Courvoisier’s Law, 861–862 Cowden’s syndrome, 1321b Cowpox, 249 Coxiella burnetii, 100–101, 272 Coxsackie virus infections, 240 ‘Crack’ cocaine, 143 Cramps, heat, 167 Cranial nerves damage to, 1089b of envenomed patient, 152f examination of, 1063b nuclei, 1067 see also speciﬁc nerves by name Craniopharyngioma, 687, 687f Creams, 1225b Creatine kinase (CK) in hypothermia, 166 in muscular dystrophies, 1143–1144 reference range of, venous blood, 1360b Creatinine, 349b in acute kidney injury, 416b in hepatorenal syndrome, 864 reference range of urine, 1361b venous blood and, 1358b Creatinine phosphokinase (CPK) elevated serum, causes of, 991b in myopathy, 990–991 in myositis, 990–991 Cretinism, 717 Creutzfeldt-Jakob disease (CJD), 1127, 1127b variant, 933 Crigler-Najjar syndrome, 860b Critical care/critical illness, 173–214 admission requirement, 176 clinical examination in, 174, 174f in context of congenital conditions, 201, 202b disorders causing, 196–201 acute circulatory failure as, 199–200 acute respiratory distress syndrome as, 198 post cardiac arrest as, 200–201 sepsis and systemic inﬂammatory response as, 196–198 monitoring in, 175–176, 175b, 175f nutrition, 210 outcomes of, 211–214 adverse neurological, 211–212 discharge from intensive care as,

in older patient, 212 withdrawal of active treatment and death in intensive care as, 213 oxygen therapy in, 191, 191b referral, 212 renal support, 208 respiratory support, 202–204 scoring systems in, 213–214, 214b withdrawal of care, 213 Critical care medicine, decisions around intensive care admission in, 201, 202b Critical illness polyneuropathy, 211 Critical limb ischaemia, 502–503 Crohn’s colitis, primary sclerosing cholangitis and, 888 Crohn’s disease clinical features of, 816–817 cutaneous, 1263 ileal, 816f–817f management of, 820–823 pathophysiology of, 816, 816f refractory, 824 small bowel, differential diagnosis of, 817b treatment strategy for, 1300b Cross-infection, 103 see also Health care-associated infection Crust, skin, deﬁnition of, 1216 Cruveilhier-Baumgarten syndrome,

Cryoglobulinaemic vasculitis, 1043 Cryoglobulins, 1043 autoimmune disease and, 84 classiﬁcation of, 84b Cryoprecipitate, 931b Cryotherapy for anogenital warts, 343 for basal cell papilloma, 1234 for granuloma annulare, 1263 for molluscum contagiosum, 343 for sarcoidosis, 1263 for skin disease, 1228 for warts, 343 Cryptic tuberculosis, 589b Cryptococcal meningitis, HIV-related,

Cryptococcosis, 302, 302f HIV-related, 315b prevention of, 324 Cryptogenic cirrhosis, 884 Cryptorchidism, in hypogonadism, 653 Cryptosporidia/cryptosporidiosis, 287,

Cyclo-oxygenase, 1002–1003, 1003f Cyclophosphamide, 1320b for Churg-Strauss syndrome, 1043 glomerulonephritis, 400 for juvenile dermatomyositis, 1040 for leukaemias, 960, 963 for musculoskeletal disease, 1004b,

for neuromyelitis optica, 1110 for non-Hodgkin lymphoma, 965 for pemphigus, 1256 for rheumatic disease, 1004b for SLE, 1036 for vasculitis, 1041 for warm autoimmune haemolysis,

Cyclospora cayetanensis, 287–288 Cyclosporiasis, 287–288 Cypermethrin, 148b Cyproterone acetate, 659b for acne, 1243 for alopecia, 1259 for prostate cancer, 439 Cystathionine β-synthase deﬁciency,

Cysteine, 697b Cystic ﬁbrosis (CF), 580–581, 580f, 581b, 842, 902 contraception and, 1297 fertility and child-bearing potential in,

transition medicine and, 1297 Cystic ﬁbrosis transmembrane conductor regulator (CFTR) protein, 1297 Cysticercosis, 297f–298f, 298 Cystinuria, 405 Cystoisospora belli diarrhoea, HIV-related, 315b Cystoisosporiasis, HIV-related, 317b Cysts Baker’s (popliteal), 999b, 1023 rupture, 1023 choledochal, 903, 903f hydatid, liver and, 880 Cytarabine for acute leukaemia, 957b for chronic myeloid leukaemia, 959 Cytochrome P450, 18 Cytogenetic analysis, 1322 Cytokeratin, as tumour markers, 1322, 1324b Cytokines, 64–66, 65b, 65f asthma, 568 cancer, 1319 defects in, 78 immune response regulation, 65b pro-inﬂammatory, 70, 1005 Cytology, in respiratory disease, 554

1378 • INDEX Cytomegalovirus (CMV) infection, 238b, 242–243 after HSCT, 937b clinical features of, 242–243 encephalitis, 320 investigations of, 243 liver transplantation and, 901 management of, 243 polyradiculitis, 321 in pregnancy, 235b viral hepatitis and, 878 Cytopathic hypoxia, 197f Cytosine, 38 Cytotoxic oedema, 1153–1154 Cytotoxic therapy, for myeloﬁbrosis, 969 Cytotoxin-associated gene (cagA), 798f D D-dimers pulmonary embolism, 620 reference range of, 1362b venous thromboembolism, 976 Dabigatran etexilate, indications for, 938b Dacarbazine, for Hodgkin lymphoma,

Dactylitis, 1032, 1034f Danaparoid, for heparin-induced thrombocytopenia, 939 Dandruff, 1246 Dane particle, 873 Dantrolene, 1197–1198 Dantron, 834b Dapsone, 123, 1227–1228 adverse effects of, 123 for dermatitis herpetiformis, 807 for erythema nodosum, 1265 haemolysis from, 950 for leprosy, 269 for linear IgA disease, 1256–1257 neutropenia and, 926b for Pneumocystis jirovecii pneumonia, 323–324 poisoning, 136b prophylactic, 119b for pyoderma gangrenosum, 1261–1262 ‘Dapsone syndrome’, 123 Daptomycin, 117b, 123 mechanism of action, 116b Darunavir, 324b Daunorubicin, for acute leukaemia, 957b DCCT (Diabetes Control and Complications Trial), 756–757 DDAVP see Desmopressin DDT, 148b de Musset’s sign, 524b De novo mutation, 47 De Quervain’s tenosynovitis, 998 de Quervain’s thyroiditis, 646–647 ‘Dead-in-bed syndrome’, 739–740 Deafness Alport’s syndrome, 403 Lassa fever, 245b Paget’s disease, 1054 Pendred’s syndrome, 640f quinine toxicity, 141b rubella, 237b salicylate overdose, 138 Death and dying, 1354–1356, 1355b advance directives, 1307 brainstem, 211 diagnosis of, 1355 ethical considerations in, 1355 intensive care and, 213 management of, 1355 see also Brain death; Palliative care; Sudden death Death certiﬁcate, completed, 98f Debrisoquine, 58 DEC see Diethylcarbamazine Decision-making see Clinical decision-making Decompression, for musculoskeletal disease, 999 Decompression illness in aviators, 168 in divers, 170–171, 170b–171b Decontamination, 133f Deep infrapatellar bursitis, 999b Deep vein thrombosis (DVT) air travel and, 169 investigation of, 187, 187f pre-test probability of, 187b pregnancy and, 1285 magnetic resonance imaging for,

presentation of, 186 in stroke patients, 1159f warfarin for, 939 see also Venous thromboembolism/ thrombosis DEET (diethyltoluamide), malaria prevention, 277 Defecation disorders of see Constipation obstructed, 778 Defensins, 62–63, 769 Deﬁbrillation, 457 for arrhythmias, 482 implantable cardiac deﬁbrillators, 467, 483–484, 483b heart failure, 467, 467f public access, 457 Dehydration cerebral, hypernatraemia and, 359–360 cholera, 265 diabetics, 729–730 gastric outlet obstruction, 801–802 heat exhaustion and, 167 in palliative care, 1354 in type 1 diabetes, 729–730 see also Water, depletion Dehydroepiandrosterone sulfate (DHEAS), 672 Déjerine-Klumpke paralysis, 1141b Delayed oesophageal clearance, 791 Delayed puberty, 653–654, 653b, 1290 Deletions, 42, 45f Delirium, 183–184, 1080, 1184 clinical assessment of, 184 diagnosis of, 183b hepatic encephalopathy and, 864–865 in intensive care, 209 investigations of, 184, 184f in older people, 1309, 1310b in palliative care, 1354 presentation of, 183–184 prevalence of, 1180b risk factors for, 183b Delirium tremens, 1194 Delta antigen, 877 Delta virus see Hepatitis D virus Delusional disorders, 1197, 1197b Delusional parasitosis, 1202 Delusional perception, 1196–1197 Delusions, 1181, 1184 differential diagnosis, 1197b schizophrenia, 1197b Demeclocycline, 687b Dementia, 1191–1194 alcoholic, 1195 fronto-temporal, 1193–1194, 1193f HIV-associated, 319 investigations of, 1192, 1192b Lewy body, 1194 management of, 1192 nutrition and, 711, 711f pathogenesis of, 1192 pellagra and, 714 subtypes and causes of, 1191b vascular, 1191b see also Alzheimer’s disease Demography, in older people, 1304, 1304f Demyelination acute disseminated encephalomyelitis and, 1110 multiple sclerosis and, 1106–1110 transverse myelitis and, 1110 from vitamin B12 deﬁciency, 715 Dendritic cells, 64 Dengue, 243–244 clinical features of, 243–244, 243b–244b diagnosis of, 244 endemic zones of, 243f management and prevention of, 244 in pregnancy, 235b Dengue haemorrhagic fever, incubation period of, 111b Denosumab for bone metastases, 1329 for osteoporosis, 1048, 1048b Dental caries, ﬂuoride and, 718 11-Deoxycorticosterone-secreting adrenal tumour, 674b Depolarisation, cardiac conduction system, 445f Deposition disorders, 1264 Depressants, misuse of, 141–143 Depression, 1198–1199 alcohol and, 1195 diagnosis of, 1199 investigations of, 1199 low mood due to, 1185 management of, 1199 manic, 1200 and medical illness, 1199b negative cognitive triad associated with, 1190b in old age, 1189b in palliative care, 1354 pathogenesis of, 1198–1199 post-partum, 1206 prevalence of, 1180b prognosis of, 1199 in stroke patients, 1159f symptoms of, 1185b unipolar, 1198 Dermatitis chronic actinic, 1221b exfoliative, 1266b herpetiformis, 807, 1255b, 1256,

pellagra and, 714, 715f seborrhoeic, HIV-related, 314 see also Eczema Dermatobia hominis, 300 Dermatoﬁbroma, 1235 Dermatology, 1209–1267 Dermatomyositis/polymyositis, 1039–1040, 1039f, 1260f,

in cancer patients, 1325b, 1326 Dermatophyte infections, 1239, 1240f Dermatoscopy, 1214, 1217f Dermatoses, 334b, 336b Dermis, 1212 Dermoscopy, 1214 Des-amino-des-aspartate-arginine vasopressin, for diabetes insipidus, 688 Desensitisation, 16 Desmopressin (DDAVP), in haemophilia A, 973 Desmosomes, 1212 Deterioration early warning scores for, 188, 188f–189f immediate assessment of, 188–189 management for, location for, 189–190, 190b medical emergency team and, 188, 189b presentations of, 190–195 decreased conscious level as, 194–195 decreased urine output/ deteriorating renal function as,

hypertension as, 193–194 hypotension as, 193 hypoxaemia as, 190–191 tachycardia as, 191–193 tachypnoea as, 190 Detrusor muscle, 386 failure of, 437 over-activity, 436b Detrusor-sphincter dyssynergia, 1093 Developing countries epilepsy in, 1097 tetanus in, 1125–1126 Devic’s disease, 1110 Dexamethasone adjunctive, for bacterial meningitis, 1120b for altitude illness, 168 for brain tumours, 1130 for Cushing’s syndrome, 668 for gastrointestinal obstruction, 1354 for high-altitude cerebral oedema, 168 for meningitis, 1120b for pain management, 1352b for spinal cord compression, 1326b for thyrotoxicosis, 639 Dexamethasone suppression test (DST), for Cushing’s syndrome, 700 Dexamfetamine, 1105 Dextran, 1266b Dextropropoxyphene, 142b poisoning, 142b Dextrose, 353b hypoglycaemia, 141 DFMO see Eﬂornithine DHA see Docosahexaenoic acid Di George syndrome, genetics, 44b Diabetes Control and Complications Trial (DCCT), 756–757 Diabetes insipidus, 687–688, 687b pregnancy and, 1280 Diabetes mellitus, 409, 719–762 adherence and concordance in, 1299 in adolescents, 753–754, 753b–754b aetiology and pathogenesis of, 728–734 air travel and, 169 bronzed, 895 causes of visual loss in people with,

in children, 753–754, 754b classiﬁcation of, 733b clinical examination of patient with, 720–721, 720f, 721b complications of, 755–762, 756b pathophysiology of, 756 prevention of, 756–757 diagnosis of, 726b, 727–728 functional anatomy and physiology and, 723–725 gestational, 1278, 1278b diagnosis of, 1278 management of, 1278 screening for, 1278 glomerular ﬁltration rate and, 417f impact of transition planning on, 1299b investigations of, 725–728 management of, 741–755, 755f alcohol in, 744–745 dietary, 743–744, 744b driving and, 745, 745b drugs to reduce hyperglycaemia in, 745–748 exercise in, 744 insulin therapy in, 748–751 Ramadan and, 745, 745b review in, 743b therapeutic goals in, 742–743, 743f transplantation in, 752, 753f weight management in, 744 monogenic, 733–734, 733b mortality in, 755, 756b in old age, 757b ophthalmic features of, 1165b pre-operative assessment of, 754b pregnancy and, 752–753, 1278–1279 presenting problems of, 734–741 prevalence of, 722, 722f rheumatological manifestations of,

risk of, 698–699, 699f, 700b transition medicine and, 1299 type 1, 728–730 in adults, 730 classical features of, 735b environmental predisposition in,

genetic predisposition of, 728–729 metabolic disturbances in, 729–730, 730f pathology of, 728, 729f risk of, 729b

INDEX • 1379 type 2, 730–732 classical features of, 735b drugs in treatment of, 746b environmental factors of, 732 genetic predisposition of, 731–732 hereditary haemochromatosis and,

insulin resistance in, 730–731 management of, 742f metabolic disturbances in, 732 pancreatic β-cell failure in, 731 pathology of, 730–731, 731f risk of, 731b sibling risk of, 731b in young adults, 753–754 Diabetic amyotrophy, 759 Diabetic eye disease, in ophthalmological conditions, 1174–1177 Diabetic foot, 759f, 761–762 aetiology of, 761 clinical features of, 761b management of, 761–762, 762b, 762f Diabetic glomerulosclerosis, nodular, 757, 758f Diabetic ketoacidosis, 729–730, 735–738 in adolescence, 753b clinical features of, 736, 736b investigations of, 736 management of, 736–738, 737b bicarbonate in, 738 ﬂuid replacement in, 737 insulin in, 737 ongoing, 738 phosphate in, 738 potassium in, 738 pathogenesis of, 735–736, 736b severe, indications of, 736b Diabetic macular oedema, management of, 1176–1177 Diabetic microangiopathy, 756 Diabetic nephropathy, 757–758 diagnosis and screening for, 757 management of, 757–758 natural history of, 757, 758f Diabetic neuropathy, 758–761 classiﬁcation of, 759b clinical features of, 758–761 management of, 761, 761b risk factors for, 757b Diabetic osteopathy, rheumatological manifestations of, 1057 Diabetic retinopathy, 757, 1174–1177, 1176f clinical features of, 1175–1176 management of proliferative, 1176 pathogenesis of, 1175 prevention of, 1177 screening of, 1177 Diagnosis, 29 Diagnostic error, problem of, 2, 2b Diagnostic tests, use and interpretation of, 3–5 factors other than disease, 4, 4b normal values, 3, 4f operating characteristics, 4 prevalence of disease, 5, 6f sensitivity and speciﬁcity, 4–5, 5b, 5f Dialyser hypersensitivity, 424b Dialysis amyloidosis associated with, 82b gastrointestinal, 136 hyperkalaemia, 363 peritoneal, 424 poisoning, 136 renal AKI, 413–414, 422b CKD, 419 in old age, 422b SLE, 410–411 see also Haemodialysis 3,4-Diaminopyridine, for Lambert-Eaton myasthenic syndrome, 1143 Diamorphine for myocardial infarction, 498 for palliative care, 1351, 1355 Diaphragm disorders of, 627 eventration of, 627 Diaphragmatic hernias, 627 Diarrhoea, 783 acute, 227–230, 228b, 783 clinical assessment of, 228–229 differential diagnosis of, 228b investigations of, 229 management of, 229–230 after peptic ulcer surgery, 801 amoebic dysentery, 287 antibiotic-associated, 104b antimicrobial-associated, 230 bloody, 816 cholera, 264–265 chronic or relapsing, 233, 233b, 783, 784b diabetic, 761b enteral feeding and, 707b faecal incontinence, 835, 835b,

Dibenzodiazepines, 1198b Dibenzothiazepines, 1198b DIC see Disseminated intravascular coagulation Diclofenac, 1003b for actinic keratosis, 1231 for hepatocyte necrosis, 894 for renal colic, 432 Didanosine, 321 Dieldrin, 148b Diet(s) acute coronary syndrome and, 501 cancer and, 1320b gallstones and, 903 in gastro-oesophageal reﬂux disease,

gluten-free, 807 high protein, obesity, 701b low carbohydrate, 701b low fat, 701b modiﬁcation of, for gestational diabetes, 1278 refeeding, 705b for renal failure, acute kidney injury,

starvation, 702 type 2 diabetes and, 732 vegan, 697 very-low-calorie, 702 weight loss, 701–702, 701b Diet history elements of, 693b obesity and, 700 Dietary deﬁciency, 944 Dietary supplements, 712 Diethylcarbamazine (DEC), 129 Dietl’s crisis, 396 Differentiated carcinoma, in thyroid disease, 649–650 Diffuse idiopathic skeletal hyperostosis (DISH), 1058–1059, 1058f Diffuse inﬁltrative lymphocytosis syndrome, HIV-related, 321–322, 322f Diffuse parenchymal lung disease (DPLD), 605–610, 605b, 606f, 607b Diffuse pleural thickening (DPT), 618, 618f DiGeorge syndrome, 79 Digestion, 767 Digital photography, 1168 Digoxin adverse reactions of, 22b for arrhythmias, 469b atrial ﬁbrillation, 471–472 atrial ﬂutter, 470 drug interactions of, 24b effect of old age, 32b for heart failure, 467 for mitral valve disease, 519, 521b plasma concentration, 36b for pulmonary hypertension, 621–622 toxicity/poisoning, 137b, 140 Digoxin-speciﬁc antibody fragments,

Dihydrocodeine for musculoskeletal disease, 1002 poisoning, 142b Dihydropyridines for angina, 490–491 for hypertension, 513, 514b overdose, 140 see also individual drugs 1,25-Dihydroxycholecalciferol (calcitriol) for hypoparathyroidism, 665 for osteoporosis, 1049 pseudohypoparathyroidism, 665 1,25-Dihydroxyvitamin D, 384–386 Diiodotyrosine (DIT), 635f Dilated cardiomyopathy, 539 pregnancy and, 1282 Diloxanide furoate, 129 Diltiazem for angina, 490–491 for aortic dissection, 508 for arrhythmias, 472, 479f for atrial ﬁbrillation, 472 drug eruptions, 1266b for hypertension, 513 Diltiazem cream, for anal ﬁssure, 836 Dilute Russell viper venom time (DRVVT), 978 Diphencyprone, 1239 Diphenoxylate, 230, 808–809 Diphenylbutylpiperidines, 1198b Diphtheria, 104b, 265–266, 266b clinical features of, 266 incubation period of, 111b management of, 266 prevention of, 266 prophylaxis for, 119b Diplopia, 1088–1089 in Graves’ disease, 631b, 645f intracranial hypertension and, 1133 Dipyridamole, platelet inhibition, 918 Direct-acting nucleoside/nucleotide antiviral agents for hepatitis B, 876 for hepatitis C, 878, 878b, 879f Direct antiglobulin tests, 948f Direct Coombs test, in warm autoimmune haemolysis, 949 Direct oral anticoagulants (DOACs),

Directly observed therapy, for tuberculosis, 594–595 Diroﬁlaria immitis, 293 Disability in deteriorating patient, 189 International Classiﬁcation of Functioning, Disability and Health, 1311 in older people, 1306 Discharge, from intensive care, 213, 214b Discitis, 1021 Discoid eczema, 1246 Discriminant function (DF), 882 Disease, choosing drugs for features of, 29 severity of, 29 Disease Activity Score 28 (DAS28), in rheumatoid arthritis, 1025, 1026f Disease-modifying antirheumatic drugs (DMARDs), for musculoskeletal disease, 1004–1005, 1004b psoriatic arthritis, 1033–1034 reactive arthritis, 1032 rheumatoid arthritis, 1025–1026 Disopyramide for arrhythmias, 476b, 479–480, 479b for cardiomyopathy, 540 Disseminated intravascular coagulation (DIC), 196, 978–979, 978b Dissociative conversion disorders, 1202, 1202b Dissociative drugs, poisoning from, 144 Distal interphalangeal joint arthritis, 1032, 1034f Distribution drug, 18, 29 volume of, 18, 18f interactions, 23 Disturbed behaviour, 1188–1189, 1189f Disulﬁram, 1195 DIT see Diiodotyrosine Dithranol, 1250 Diuretics adverse reactions of, 22b, 355, 1310b for ascites, 864 clinical use of, 355 drug eruptions, 1266b drug interactions of, 24b for heart failure, 465, 465f for hypertension, 513, 514b for hypervolaemia, 354–355 loop-acting, 355b for mitral regurgitation, 521b for obliterative cardiomyopathy, 541 for oedema, 396 osmotic, 355 potassium-sparing, 355 in pregnancy, 1276 resistance to, 355 timing of, 31b see also Thiazides Diverticulitis, acute, 788 Diverticulosis, 833–834 human colon in, 833f jejunal, 773f Diving-related illness, 170–171 Dizziness, 1080 in older people, 181b, 1309 DMARDs see Disease-modifying antirheumatic drugs DNA, 38, 38f analysis, for neurological disease,

mitochondrial, 49, 1305 nuclear chromosomal, 1304 proviral, 309–310 repair of, 41 transcription, 38–40 Dobutamine, 206b Docosahexaenoic acid (DHA), 377 Dominant negative mutations, 45 Domperidone, 1096 Donath-Landsteiner antibody, 950 Donepezil, 1193 Donor lymphocyte infusion (DLI), 937 Donor-recipient cross-matching, 89 Donovanosis, 341b Dopamine, low-dose, AKI, 413 Dopamine agonists for acromegaly, 686–687 for Parkinson’s disease, 1114, 1114b pregnancy, 685 for prolactinoma, 685, 685b and renal dysfunction, 427b for restless legs syndrome, 1105–1106 Dopamine antagonists for gastroparesis, 761b and prolactin concentrations, 684 Dopamine dysregulation syndrome,

1380 • INDEX Doppler echocardiography, 451–452, 451f for aortic dissection, 507–508, 508f for atrial septal defect, 535f colour-ﬂow Doppler, 452f three-dimensional, 452 for valvular regurgitation, 451–452 Doppler ultrasound for haemorrhoids, 835–836 for hepatobiliary disease, 853–854 for leg ulcers, 1224 for venous thromboembolism, 187 Doripenem, 120b Dose-response curves, 14–16, 15f Dosulepin, 1199b Down’s syndrome (trisomy 21), 44b acute hepatitis B and, 875 Doxapram, 567 Doxazosin, 513, 675–676 Doxorubicin cardiotoxicity, 541b hepatocellular cancers, 892 liposomal, for ovarian cancer, 1334 myocarditis and, 538 for non-Hodgkin’s lymphoma, 965 Doxycycline, 117b for anthrax, 267 for bacillary angiomatosis, HIV/AIDS patients, 315–316 for brucellosis, 255b for cholera, 265 drug eruption, 1267f for ﬁlariasis, 291 for leptospirosis, 258–259 for louse-borne relapsing fever, 257 for Lyme disease, 256 for malaria, 278b for melioidosis, 261 for onchocerciasis, 293 for plague, 259 for Q fever, 272 for reactive arthritis, 1032 for relapsing fever, 257 for rickettsial fevers, 271–272 skin infections, 1238 for STIs chlamydial infection, 341b granuloma inguinale, 341b lymphogranuloma venereum, 341b syphilis, 339 for Whipple’s disease, 809 DPLD see Diffuse parenchymal lung disease DPP-4 inhibitors, for hyperglycaemia, 747–748 Dracunculiasis, 293 Dracunculus medinensis, 293 DRESS, 1266b Dressings, 1226–1227, 1227b Dressler’s syndrome, in acute coronary syndrome, 496 Dribble, post-micturition, 437 Drinking, 1184, 1194 Driving diabetes mellitus and, 745, 745b restrictions in, epilepsy and, 1296 Dronedarone, 471–472, 479b–480b,

Drowning/near-drowning, 169–170, 169b Drug eruptions, 1251, 1265–1267 clinical features of, 1266b, 1267 exanthematous, 1266b ﬁxed, 1266b investigations and management of, 1267, 1267b phototoxicity, 1221b rash in, 1217b types of, 1265b, 1267f Drug history, 21b Drug misuse, 93, 1184, 1184b causing stroke, 1157b polydrug misuse, 1196 psychosis, 1195–1196 tetanus and, 1125 Drug rashes, HIV-related, 316 Drug-related disorders eosinophilia, 123 neutropenia, 926b obesity and, 700b phototoxicity, 1221b psychosis, 1197b renal, 426, 427b Drug resistance, 16 Drug-resistant TB, 595, 595b Drug sensitivity testing, for tuberculosis,

Drug therapy adverse outcomes of, 21–26 duration of, 30 monitoring of, 34–36 patient adherence to, 29 stopping, 31 Drugs absorption, 17–18, 17f, 29 abuse, 21 adverse reactions of, 21–23, 22b classiﬁcation of, 22–23, 22b dose-related, 16 inter-individual variation in, 19, 20b in older people, 1310, 1310b pharmacovigilance, 23 prevalence of, 21–22, 21b–22b risk factors for, 21b TREND analysis of, 23b clinical and surrogate endpoints in, 35–36 controlled, 26, 33–34 cost of, 29 development, 26–27, 26b–27b distribution, 18, 29 dosage regimens of, 29–30 frequency of, 30 repeated, 19 timing of, 30, 31b dose-response curves of, 14–16, 15f dose titration of, 30 efﬁcacy, 16, 29 elimination, 18–19 excretion, 17f, 18–19, 29 formulation of, 30 hospital discharge, 33 interactions, 23–24 avoiding, 24, 29 mechanisms of, 23–24 pharmaceutical, 24b pharmacodynamic, 24b pharmacokinetic, 24b licensing, 26–27 lung disease due to, 612–613, 612b management, 26–28 cost-effectiveness evaluation, 28, 28b evidence evaluation, 27–28 implementing recommendations,

use of, 27–28 marketing, 26–27 metabolism, 18, 29 interactions, 24 of misuse, 141–144 for oesophagitis, 794 plasma concentrations of, 36, 36b potency of, 16 regulation of, 26–28 route of administration of, 17f, 30, 30b topical administration of, 17–18 toxicity, 21 DRVVT see Dilute Russell viper venom time Dry drowning, 169 Dubin-Johnson syndrome, 860b Duchenne muscular dystrophy (DMD), 48b transition medicine and, 1297 Ductopenia, 894 Duloxetine, for pain management, 1350b Duodenal biopsy, 806 Duodenal switch, 703b Duodenal ulcers, 782, 799f Duodenogastro-oesophageal reﬂux,

Duodenum, functional anatomy of, 766–767, 766f Duplex kidneys, 434 Duplication, 44, 45f Dupuytren’s contracture, 1059 cirrhosis and, 867 Dusts, lung disease and, 616–617, 616b Dwarﬁsm, zinc deﬁciency, 717 DXA (dual x-ray absorptiometry) in bone mineral density, 989–990 for fractures, 1308 indications for, 1046b for musculoskeletal disease, 990f Dysarthria, 1087–1088, 1093 causes of, 1087b Dysbetalipoproteinaemia, 375 Dysdiadochokinesis, 1069 Dysentery, bacillary, 111b Dysexecutive syndrome, 1094 Dysgraphia, 1086 Dyshormonogenesis, 650 Dyslexia, 1086 Dyslipidaemia, in pregnancy, 377b Dysmetria, 1069 Dyspepsia, 779 alarm features in, 779b causes of, 779b functional, 802–803 gallstone, 904 investigations of, 780f, 802 Dysphagia, 778, 1093 investigations of, 778, 779f oesophagus, 1324b in stroke patients, 1158 Dysphasia, 1088 Dysphonia, 1087 Dysthymia, 1198 Dystonia, 1086, 1116 poisoning, 137b Dystrophia myotonica, 1191b Dysuria, 396 E E-cadherin (CDH1) gene, 803 E-selectin, 447 Early-onset osteoarthritis, 1011, 1011b Ears freezing injuries and, 166 squamous cell carcinoma, 1231 Eastern Cooperative Oncology Group (ECOG) performance scale, 1322, 1322b Eating disorders, 1203–1204, 1204b Ebola virus disease, 246–247 Eccrine sweat glands, 1213–1214 ECF see Extracellular ﬂuid ECF (epirubicin, cisplatin and 5-ﬂuorouracil), 804 ECG (electrocardiogram), 448–450, 448f 12-lead, 448–449, 448b, 449f for acute coronary syndrome, 496–497, 497f AKI, 422b ambulatory, 450 angina, 487 for aortic dissection, 507–508 for aortic regurgitation, 525b for aortic stenosis, 523f for atrial ectopic beats, 470f for atrial ﬁbrillation, 471f for atrial ﬂutter, 470f for AV block, 477f–478f for AV nodal re-entrant tachycardia, 473f cardiac cycle, 460f for cardiac tamponade, 544 for chest pain, 178–179 for critically ill patients, 178 for endocarditis, 530 exercise, 449–450, 450b for hyperkalemia, 363 for hypokalaemia, 361 for left ventricular hypertrophy, 523f for mitral stenosis, 519 for myocardial infarction, 448 for myocardial ischaemia, 448 for pericarditis, 542, 542f for pulmonary embolism, 619b, 620 reading, 448b for sinoatrial disease, 469f for supraventricular tachycardia, 473f for syncope/presyncope, 183 for torsades de pointes, 476f in tricyclic antidepressant poisoning, 139f for ventricular ectopic beats, 475f for ventricular ﬁbrillation, 475 for ventricular tachycardia, 475f for Wolff-Parkinson-White syndrome, 474f Echinocandins, 125b, 126 Echinococcus granulosus, 298–299, 299f Echocardiography, 451–452 for acute coronary syndrome, 498 for angina, 488 for aortic dissection, 508f for aortic stenosis, 523f for atrial septal defect, 535f for cardiac tamponade, 544 for critically ill patients, 206 Doppler, 451–452, 451f–452f ventricular septal defect, 536 for endocarditis, 530 for ‘four-chamber’ view, 452f for heart failure, 464 for hypertrophic cardiomyopathy, 540 indications for, 451b for left ventricular hypertrophy, 540 for mitral regurgitation, 520f for myocarditis, 538 for papillary muscle rupture, 496 for pericardial effusion, 543f for pulmonary embolism, 620 stress, 452 for tetralogy of Fallot, 537 three-dimensional, 452 transoesophageal, 179, 452 transthoracic, 451 two-dimensional, 452 valvular disease aortic, 522–524 mitral, 519 tricuspid, 526 for ventricular aneurysm, 496 Echovirus infections, 240 Eclampsia, hypertension and, 1276–1277 ECOG (Eastern Cooperative Oncology Group) performance scale, 1322, 1322b Econazole, 125b, 335b Ecstasy (drug), 143 Ecthyma, 1236 Ectoparasites, 299–300 Ectopia lentis, 370 Ectopic ACTH syndrome, management of, 670 Ectopic pregnancy, 336 Ectopic ureters, 434 Eculizumab, 66 Eczema, 1244–1247 allergic contact, 1247, 1247b, 1247f asteatotic, 1247 atopic, 1245–1246 rash in, 1217b classiﬁcation of, 1244b clinical features of, 1244 clinical morphology of, 1244b discoid, 1246 gravitational, 1247 investigations of, 1244 irritant, 1247 management of, 1244–1245, 1245f in nails, 1261 pruritus, 1219b seborrhoeic, 1246 Edoxaban, 938b Edrophonium bromide, for myasthenia gravis diagnosis, 1142 EDTA (ethylenediamine-tetra-acetic acid), 386b Education food allergy and, 812 infection control, 112b in musculoskeletal disease, 1000–1001 ﬁbromyalgia, 1018 mechanical back pain, 997 osteoarthritis, 1011–1012

INDEX • 1381 Edwards’ syndrome (trisomy 18), 44b EEG (electroencephalography), 1074–1076 for dementia, 1192 for epilepsy, 1075f, 1076 for hepatic encephalopathy, 865 for sleep disorders, 1071 for viral encephalitis, 1122 Efavirenz, 324b, 325 Efﬁcacy, 16, 29 Eﬂornithine (DFMO), for trypanosomiasis,

Eﬂornithine cream, 659 Ehlers-Danlos disease, 970 Eicosapentaenoic acid (EPA), 377 Eisenmenger’s syndrome, congenital heart disease and, 533 Ejaculatory failure, 1094 Elastase, 71 faecal, 1361b Elbow pain, 998, 998b Elderly Mobility Scale, 1311 Electrical cardioversion, for arrhythmias,

Electroclinical epilepsy syndromes, 1100b Electroconvulsive therapy, 1190 Electroencephalography see EEG Electrofulguration, 343 Electrolyte balance, 353b assessment, in hospitalised patients, 353b in renal failure, chronic, 418 Electrolyte disturbances, acute kidney injury and, 414 Electrolytes absorption and secretion of, 769, 769f acute kidney injury and, 416b basic daily requirements, 353b distribution of, 349, 349f homeostasis, 349 interpretation of, 349b loss of, in diabetic ketoacidosis, 736b reference range of, venous blood, 1358b Electromagnetic spectrum, 1222f Electromyography see EMG Electron microscopy (EM), 105, 1322 for sexually transmitted infections,

Electrophoresis, 348b Electrophysiology, 454 Elevated mood, 1186 Elimination of drugs, 18–19 kinetics, 18f, 19 ELISA, 106–107, 109f for Clostridium difﬁcile, 264 for dengue, 244 for hydatid cyst, 299 for leishmaniasis, 283 for leptospirosis, 258 for Lyme disease, 256 for lymphatic ﬁlariasis, 291 for schistosomiasis, 296 for strongyloidiasis, 289 Elliptocyte, 915 Elliptocytosis, hereditary, 947–948 Embolism in acute coronary syndrome, 496 in acute limb ischaemia, 503, 504b arterial gas, 170 pulmonary, 619–621 acute massive, 200 clinical features of, 619, 619b investigations of, 619–620, 619f–620f management of, 620–621 in pregnancy, 620b prognosis for, 621 in stroke patients, 1159f EMG (electromyography), 1076 for motor neuron disease, 1117 in musculoskeletal disease, 992 Emollients, 1225 for eczema, 1247 for pruritus, 1220 in pregnancy, 1220b for psoriasis, 1250 for skin disease, 1226 Emphysema, 549 computed tomography of, 552, 576f lung transplantation for, 567, 567b pathology of, 575f in respiratory function abnormalities, 555b Employment, 1198 epilepsy and, 1296 Empyema, 564–565, 564b, 564f–565f subdural, 1125 Emtricitabine, 119b, 324b Enalapril for heart failure, 466b for hypertension, 513 for myocardial infarction, 500–501 Encapsulated bacteria infection, after HSCT, 937b Encephalitis brainstem, 1122 viral, 1121–1123 West Nile, 1121–1122 Encephalomyelitis acute disseminated, 1110 cancer-related, 1325 Encephalopathy hepatic, 847b, 864–865 acute liver failure and, 856–857 clinical grade of, assessment for, 857b differential diagnosis of, 865b factors precipitating, 865b Wernicke’s, 714 Endemic typhus, 271, 271b Endobronchial ultrasound (EBUS),

Endocarditis, 1035 gonococcal, 340 infective, 527–531, 528b, 531b acute, 529 antimicrobial treatment of, 530b in old age, 527b post-operative, 529 prevention of, 531 subacute, 528–529, 529b, 529f Endocrine axes, 633f Endocrine disease classiﬁcation of, 632b clinical examination in, 630–632, 630f, 631b investigation of, 633, 633b ophthalmic features of, 1165b pathology of, 632–633 pregnancy and, 1279–1280 presenting problems of, 633, 634b pruritus and, 1219b rheumatological manifestations of,

Endocrine glands, functional anatomy and physiology of, 632, 632f–633f Endocrine pancreas disease classiﬁcation of, 677b presenting problems in, 676–678 Endocrine system, pregnancy and,

Endocrine treatment, for prostate cancer, 439 Endocrinology, 629–689 of adrenal glands, 665–676 endocrine glands, disorders affecting, 688–689 of endocrine pancreas and gastrointestinal tract, 676–679 of hypothalamus and pituitary gland, 679–688 reproductive system, 651–661 of thyroid gland, 634–651 Endometrial cancer, 1334–1335 investigations of, 1334 management of, 1335 pathogenesis of, 1334 Endometriosis, 837 Endomitotic reduplication, 918 Endophthalmitis, 1173–1174, 1174f Endoplasmic reticulum (ER), 40 Endoscopic examination, of respiratory system, 553 Endoscopic retrograde cholangiopancreatography see ERCP Endoscopic ultrasound, 774 for choledocholithiasis, 906f for hepatobiliary disease, 855 Endoscopy, 774–776, 775f for abdominal pain, 789 for achalasia, 795 capsule, 774–776, 775f wireless, 775f, 776b for corrosive oesophagitis, 794 double balloon, 776, 776b for dysphagia, 778, 779f for gastric outlet obstruction, 801–802 gastrointestinal haemorrhage, 782, 782f for gastrointestinal haemorrhage, 782, 782f for inﬂammatory bowel disease, 818–819 for obscure bleeding, 783f for oesophageal cancer, 796–797, 796f for oesophageal candidiasis, 317f for oesophageal varices, 865f in old age, 776b for peptic ulcer, 799 for pharyngeal pouch, 794 for portal hypertension, 869 of respiratory system, 553 upper gastrointestinal, 774, 775b wireless capsule, 775f, 776b Endosulfan, 148b Endothelial cells, of liver, 848 Endothelial damage, 950 Endothelin 1 (ET1), 447, 849f Endothelium, 447 Endotoxin, 104 Endotracheal intubation, critically ill patients, 190b, 208 Energy expenditure, 694, 695f increased, 704b intake, 695f, 701 decreased, 704b requirements, 698b Energy balance, 694–695, 695f altered, disorders of, 698–711 determinants of, 694, 695f in old age, 710b regulation of, 694–695, 696f and reproduction, 696f Energy-yielding nutrients, 695–697 WHO recommendations, 698b Engerix, for hepatitis B, 876 Enhanced Liver Fibrosis (ELF) serological assay, 855 Entacapone, for Parkinson’s disease,

Entactogens, 143 Entamoeba histolytica, 286 life cycle of, 286f liver abscess from, 286 see also Amoebiasis Entecavir, 876 Enteral administration, 17 Enteral feeding, 707, 707b Enteric nervous system, 771–772 Enteritis, radiation, 809–810, 810b Enterobacter spp., 103f, 117b Enterobacteriaceae, 103f Enterobius vermicularis (threadworm), 290, 290f Enterococcus faecalis, 103f, 117b Enterococcus faecium, 103f, 117b Enterocytes, 371 Enterohaemorrhagic Escherichia coli (EHEC), 227–228 Enterohepatic circulation, 19 Enterokinase, 768 Enteropathic (spondylo)arthritis, 1034 Enteropathy, protein-losing, 811, 811b Enteroscopy, double balloon, 776, 776b Enterovirus 71, 250 Enthesis, 987–988 Enthesitis, 1033 Enthesitis-related arthritis (ERA), 1027 Enthesopathy, patella ligament, 999b Entrapment neuropathy, 1139–1140, 1139b Envenomation, 151–162 diagnosis of, 159 envenomed patient bedside test in, 153, 153f evaluation of, 152, 152f general approach to, 156–160 treatment, 159–160 follow-up, 160 hospital assessment and management for, 158–159 evidence of, 158–159 laboratory investigations, 159 life-threatening problems, 158 local effects, 155, 155b overview of, 154 by speciﬁc animals, 160–162 systemic effects, 155, 155b venom, 154 venomous animals, 154–155, 154b, 156b–158b Environment, early, psychiatric disorders and, 1183 Environmental factors in disease, cancer, 1320–1321, 1320b of gastro-oesophageal reﬂux disease,

of inﬂammatory bowel disease, 830 Environmental medicine, 163–172 extremes of temperature and, 165–168 high altitude and, 168–169 humanitarian crisis and, 171–172 radiation exposure and, 164–165 under water and, 169–171 Environmental poisoning, 149, 149b Enzymes drugs acting on, 15b pancreatic, chronic pancreatitis,

Eosinophil granulocytes, 1362b Eosinophilia, 233–234, 233b–234b, 926b, 927 allergy and, 86 tropical, 233–234, 233b–234b Eosinophilic gastroenteritis, 811–812 Eosinophilic granulomatosis with polyangiitis, 1043 Eosinophilic oesophagitis, 794 Eosinophils, 917, 926b, 926f count, 1362b EPA see Eicosapentaenoic acid Ependymal cells, 1064–1065 Epidemic typhus, 271, 271b Epidemiology, 95–97, 95b understanding causes and effect, 95–97, 95b, 97b, 97f Epidermal growth factor receptor,

Epidermal necrolysis, toxic, 1254–1255, 1254b, 1254f, 1266b Epidermis, 1212, 1213f Epidermolysis bullosa acquisita, 1255b, 1257 classiﬁcation of, 1254b dystrophic, 1229, 1254b Epididymo-orchitis, 240 Epilepsy, 1097–1104 in adolescence, 1103b classiﬁcation of, 1098b clinical features of, 1098–1100 contraception in, 1103 focal, 1098, 1098f generalised, 1098, 1098f investigations of, 1100–1101, 1101b brain imaging, 1101b EEG, 1075f, 1076 single seizure, 1100 management of, 1101–1103 antiepileptic drugs for, 1101–1102, 1102b immediate care, 1101, 1101b lifestyle advice, 1101, 1102b monitoring, 1102 surgery, 1102 in old age, 1103b

1382 • INDEX outcome after 20 years, 1101b pathophysiology of, 1097–1098 pregnancy and, 1284 in pregnancy and reproduction, 1103, 1103b prognosis of, 1103 seizure types, 1098–1100, 1098b absence, 1099 atonic, 1100 clonic, 1100 focal, 1099, 1099b generalised, 1099–1100 myoclonic, 1099–1100 tonic, 1100 tonic-clonic, 1099, 1099b temporal lobe, 1185, 1197, 1197b transition medicine and, 1296 Epilepsy syndromes, 1100, 1100b Epileptic spasms, 1100 Epimysium, 987–988 Epinephrine for allergy, 86 self-injectable, prescription of, 76b Epiphysis, 984 femoral, 1007–1008 Epirubicin, 804 Episcleritis, 1172 Epistaxis cirrhosis, 867b dengue, 244 granulomatosis with polyangiitis,

leptospirosis, 258 systemic vasculitis, 1041b Epithelial membrane antigen (EMA), as tumour markers, 1322, 1324b Eplerenone for heart failure, 465 for mineralocorticoid excess, 675 for myocardial infarction, 501 Epley manoeuvre, 1104 Epo see Erythropoietin Epoprostenol see Prostacyclin EPs see Evoked potentials Epstein-Barr virus (EBV) cancer and, 1320b hepatitis and, 871–872 post-transplant lymphoproliferative disorders and, 1299 viral hepatitis and, 878 Epstein-Barr virus infection, 238b, 241–242 clinical features of, 241–242 complications of, 241–242, 242b investigations of, 242 management of, 242 Eptiﬁbatide, platelet inhibition, 918 Eradication, for gastrointestinal haemorrhage, 782 ERCP (endoscopic retrograde cholangiopancreatography), 776, 777b, 854–855 for cholangiocarcinoma, 907f for cholangitis, 905 for choledocholithiasis, 906f for pancreatic cancer, 842 for pancreatitis, acute, 839 Erectile dysfunction, 440, 440b in diabetes mellitus, 760–761 Erectile failure, 1094 Ergocalciferol, 713 Ergotamine, 1096 Erlotinib, 1332 Erosions in rheumatoid arthritis, 988 skin, deﬁnition of, 1218 Erosive osteoarthritis, 1011 Ertapenem, 117b, 120b Erysipelas, 1237, 1237f Erythema, palmar, 635–636, 866–867, 1194b Erythema ab igne, 840 Erythema infectiosum, 237b Erythema multiforme, 1221b, 1264, 1264b, 1265f, 1266b Erythema nodosum, 1265, 1265b–1266b Erythrasma, 1238 Erythrocyte sedimentation rate (ESR) abnormal, conditions associated with, 72b inﬂammation and, 72 reference range of, 1362b Erythrocytosis, 925 classiﬁcation and causes of, 925b Erythroderma, 1224 Erythromycin, 119b for acne, 1242–1243 for diphtheria, 266 for erythrasma, 1238 for Lyme disease, 256 for pneumonia, 585b in pregnancy, 120b prophylactic, 119b for relapsing fever, 257 for rheumatic fever, 517 for rosacea, 1244 for STIs chancroid, 341b chlamydial infection, 341b granuloma inguinale, 341b lymphogranuloma venereum, 341b syphilis, 339 for tetanus, 1126 Erythropoiesis, impaired, 237b Erythropoietic porphyria, congenital, 379b Erythropoietic protoporphyria (EPP), 379b, 1264 Erythropoietin (Epo), 915 chronic renal failure and, 419 ectopic hormone production, 1325b Escherichia coli, 100, 103f, 104b, 263–264 entero-aggregative, 263–264 entero-invasive, 263 enterohaemorrhagic, 263–264 enteropathogenic, 263 spontaneous bacterial peritonitis and,

verocytotoxigenic, 263f Escitalopram, 1199b ESR see Erythrocyte sedimentation rate Essential fatty acids, 697, 697f Essential thrombocythaemia, 969–970 Essential tremor, 1115 Etanercept, for musculoskeletal disease, 1007b Ethambutol, 125 Mycobacterium avium complex, 315b polyneuropathy, 1139b for tuberculosis, 593, 593b Ethanol pharmacokinetics of, 20b poisoning, 135b reference range of, 1360b see also Alcohol Ethics in artiﬁcial nutritional support, 710b in genomic age, 59 Ethnicity, type 2 diabetes and, 732 Ethosuximide, 1100b Ethylene glycol poisoning, 135b, 147, 147f Ethylenediamine-tetra-acetic acid (EDTA), 386b Etidronate, for Paget’s disease, 1054b Etoposide for acute leukaemia, 957b for testicular tumours, 440 Etoricoxib, 1003b Euchromatin, 38–39 Eukaryotes, 101–102 Eumycetoma, 301 Euphoria, 1196 Euthanasia, 1356 Euvolaemia with hypernatraemia, 359b with hyponatraemia, 357 Evidence-based medicine, 10 Evoked potentials (EPs), 1076–1077, 1077f Evolutionary selection, 45–46 Ewing’s sarcoma, 1057 Exanthem, enteroviral, 240 Exanthem subitum, 238 Excessive daytime sleepiness, 1105 Exchange transfusion for malaria, 277 for megaloblastic anaemia, 945 for sickle-cell disease, 953 Excision, for cancer, 1330 Excision arthroplasty, 1002b Excision biopsy, for skin disease, 1228 Excitatory neurotoxins, 155 Excoriation, deﬁnition of, 1241 Excretion of drugs, 17f, 18–19, 29 interactions, 24 Exemplar medicine sick-day card, 418b Exenatide, 747 Exercise(s) acute coronary syndrome and, 501 arrhythmias and, 450b asthma, 568, 570f chest pain and, 455 COPD, 574 diabetes and, 744 heart disease and, 537b hypoglycaemia and, 740 insulin levels and, 740 for musculoskeletal disease, 1001 ankylosing spondylitis, 1031 ﬁbromyalgia, 1018–1019 osteoarthritis, 1012 Exercise ECG, 449–450, 450b Exercise testing for angina, 488 for COPD, 575 for myocardial infarction, 450b for respiratory function testing, 556 Exertion headache, 1097 Exfoliative dermatitis, drug-induced, 1266b Exogenous androgen administration, hirsutism and, 658b Exons, 39f Exophthalmos, in Graves’ disease, 631b Expiration, of lungs, 548 Explanation, for somatoform disorders,

Extracellular ﬂuid (ECF), 349 Extracorporeal membrane oxygenation (ECMO) principles of, 205f venous-arterial, 207–208 venous-venous, 204 Extracorporeal shock wave lithotripsy (ESWL), 906 Extractable nuclear antigens (ENAs), antibodies to, 991 Extrahepatic portal vein obstruction, portal hypertension and, 868 Extraocular muscles, 1164 of right eye, 1165f Extrapyramidal gait, 1087 Extrapyramidal system, 1069 Extravascular haemolysis, 946–947 Extubation, in intensive care, 210 Eye disease, HIV-related, 319–321, 319f Eye movement desensitisation and reprocessing (EMDR), 1201–1202 Eyelid, 1164 retraction, of ophthalmic disease,

Eyes, 1164–1168 blood supply of, 1168 of envenomed patient, 152f examination of diabetes mellitus, 721b respiratory system, 546f inﬂammatory arthritis in, 994b main structure of, 1167f rheumatoid arthritis in, 1024 Ezetimibe, 376 F F-ﬂuorodeoxyglucose (FDG), 553 Fabry’s disease, 371b Face angioedema, 87f examination of musculoskeletal system, 982f respiratory system, 546f frostbite, 166 hemifacial spasm in, 1116 numbness of, 1080 skin disease see individual conditions superior vena cava obstruction, 1326 Facial (7th cranial) nerve palsy, 1082–1083 tests of, 1063b Facial pain, 1080 Facial warts, 1238 Facial weakness, 1082–1083 Facioscapulohumeral dystrophy, 1143b Factitious disorder, 1205–1206 Factitious fever, 220b Factor II, 972b Factor V, 919 Leiden, 923b, 972b, 977 stroke, 1157b Factor VII, 919 deﬁciency, 928, 974 Factor VIII concentrate, 972–973 haemophilia A, 971 inhibitor bypass activity (FEIBA), 973 Factor IX, 972 concentrate, 973–974 deﬁciency, 973–974 haemophilia B, 973–974 Factor XI deﬁciency, 974 Faecal antigen test, for Helicobacter pylori infection, 782 Faecal continence, 770 Faecal impaction, 834 Faecal incontinence, 835, 835b, 1094 Faeces analytes, 1361b Faints see Syncope Falciparum malaria, 231 Falls older people, 1308–1309, 1308b–1309b, 1308f prevention, 1308–1309 Famciclovir, for herpes virus infection, 126, 127b genital, 342 Familial adenomatous polyposis, 828–829, 829f, 1321b Familial hypercholesterolaemia, 374, 374b Familial hypocalciuric hypercalcaemia,

pregnancy and, 1280 Familial Mediterranean fever (FMF), 81 Family behaviour therapy (FBT), for eating disorders, 1203–1204 Family history, 56 of allergic disease, 85 genetic disease, 46 of melanoma, 1232 ovarian cancer and, 1334 of psoriasis, 1247–1248 psychiatric disorders and, 1181b of vitiligo, 1257 Family tree see Pedigree Famine, 704–705 Fanconi anaemia, 1321b Fanconi’s syndrome, 366, 405 multiple myeloma and, 410b Farmer’s lung, 616b Fasciculations, 146b, 148b, 158b, 1063b Fasciculi, 987–988 Fasciola hepatica, choledocholithiasis and, 906 Fascioliasis, 297b Fat-pad syndrome, 999b Fatal familial insomnia, 1127b Fatigue in cancer patients, 1325b chronic fatigue syndrome, 1202 ﬁbromyalgia, 1018 multiple sclerosis, 1110b primary biliary cholangitis and, 888 rheumatoid arthritis, 1023 Fats, 697, 697f body, distribution of, 699 see also Obesity in diabetic diet, 744 digestion and absorption of, 768 distribution of, clinical assessment for, 693b Epilepsy (Continued)

INDEX • 1383 energy provided by, 694 malabsorption, small bowel disease and, 809 normal metabolism of, 725 recommended intake, 698b Fatty acids essential, 697, 697f free, 697 n-3, 376 polyunsaturated, 697f trans, 697 Fatty liver alcoholic, 881, 881b non-alcoholic, 882–885, 883f Febrile response, 104 Febuxostat, for gout, 1016 Feeding enteral (tube), 707, 707b, 839 for famine management, 705 gastrostomy, 707, 707b, 708f parenteral, 707–708 post-pyloric, 707 Felty’s syndrome, 1024–1025, 1025b Female, reproductive system of, 652, 652f Femoral neck fractures, 994 Femoral stretch test, 996–997 Ferritin in acute phase response, 70 adult-onset Still’s disease, 1040 anaemia of chronic disease, 943 haemochromatosis and, 895 iron deﬁciency anaemia, 941, 942b megaloblastic anaemia, 944b in old age, 954b reference range of, 1362b Ferrous gluconate, 943 Ferrous sulphate, 943 Fertility cystic ﬁbrosis and, 1297 renal replacement therapy and, 1282–1283 Festination, 1087, 1309b Fetor hepaticus, 857–858 portal hypertension and, 868 Fever(s), 217b, 218–225 accompanying features of, 217b acute rheumatic, 515–517, 516f investigations in, 517b Jones criteria for, 516b African tick bite, 270, 271b boutonneuse, 271b in cancer patients, 1323 clinical assessment of, 218, 218b factitious, 220b febrile response, 104 HIV-related, 313–314, 313f–314f in immunocompromised host, 223–224 inhalation (‘humidiﬁer’), 617 in injection drug-user, 222–223, 222f–223f intermittent, 74 investigations of, 218 with localising symptoms or signs, 218, 219f louse-borne relapsing, 256b, 257, 257f management of, 218 neutropenic, 224 in cancer patients, 1327–1328 post-transplantation, 224–225, 224b recurrent, 217b rickettsial, 270–272 Rocky mountain spotted, 270, 271b scrub typhus, 270–271, 271b streptococcal scarlet, 252, 253f tick-borne relapsing, 256b, 257 trench, 272 tropical, 230–232 causes of, 231b clinical assessment of, 230–232, 232b history taking in, 231b investigations of, 232, 232b management of, 231f, 232 typhoid, 260, 260b of unknown origin see Pyrexia of unknown origin viral haemorrhagic, 245–247, 245b yellow, 243f, 244–245 incubation period of, 245b Fexofenadine, 1227 FGF see Fibroblast growth factor Fibrates, 377 hyperlipidaemia management, 377–378 muscle pain, 1000b Fibre, dietary, 697 Fibrin, 1319f Fibrinogen in acute phase response, 70 concentration of, 922b reference range of, 1362b Fibroblast growth factor (FGF), 1325b Fibroblast growth factor 23 (FGF23), in skeletal disease, 990b Fibrolamellar hepatocellular carcinoma,

Fibromuscular dysplasia, renal artery stenosis and, 406 Fibromyalgia (FM), 1018–1019, 1018f–1019f investigations of, 1019b spectrum of symptoms in, 1018b Fibrosis cystic, 580–581, 580f, 581b, 842,

contraception and, 1297 fertility and child-bearing potential in, 1297 transition medicine and, 1297 hepatic, 894 cirrhosis and, 866, 866f congenital, 868f, 902 non-invasive markers of, 855 pathogenic mechanisms in, 849f idiopathic pulmonary, 605–608, 607f of liver, 894 cirrhosis and, 866, 866f congenital, 868f, 902 non-invasive markers of, 855 pathogenic mechanisms in, 849f nephrogenic sclerosing, 390b pulmonary, 547f in dermatomyositis, 610b idiopathic, 605–608, 607f in respiratory function abnormalities, 555b in rheumatoid arthritis, 610b, 1024 in sarcoidosis, 609b in sclerosis, 610b in systemic lupus erythematosus, 610b retroperitoneal, 434 drug-induced, 427b Fibrous and ﬁbrocartilaginous joints, 986 Fidaxomicin, 124 Fifth disease, 237b ‘Fight or ﬂight’ response, 1213–1214 Filaggrin, 1212 Filariases, 233b Finasteride, 659b for alopecia, 1259 Fine needle aspiration cytology, 643 Fingers clubbing, 546f, 559, 559b, 559f asbestosis, 618 in lung cancer, 600 trigger, 1060 Finkelstein’s sign, 998 First aid, for envenomed patient, 156–157 First-pass metabolism, 17 Fish minerals in, 717b venom, 154b vitamins in, 711b Fish eye disease, 375, 375b Fish oils, 697, 711b Fissure anal, 836 skin, deﬁnition of, 1244b Fistulae, 836 inﬂammatory bowel disease and, 823 tracheo-oesophageal, 625 see also different types Fitz-Hugh-Curtis syndrome, 836 Flapping tremor, hepatic encephalopathy and, 864–865 Flares, of gout, 1015 Flavonoids, 716 Fleas, 231b bartonellosis, 272b plague, 259 typhus, 271, 271b Flecainide, 470–473, 476b Flora, normal microbial, 102–103, 103f Flow cytometry, 105 Flucloxacillin, 117b, 120b cerebral abscess, 1124b hepatotoxicity, 894 for impetigo, 1236 for infective endocarditis, 223 for pneumonia, 585b for septic arthritis, 1020, 1020b for staphylococcal infections, 251 for staphylococcal scalded skin syndrome, 1236 Fluconazole, 125b, 126 acute leukaemia patients, 957 candidiasis, 336 HIV/AIDS patients, 316 cryptococcal meningitis, HIV-related, 315b, 321 for cutaneous leishmaniasis, 286 for paracoccidioidomycosis, 304 in pregnancy, 120b prophylaxis, 315b for skin disease, 1239–1240 Flucytosine, as antifungal agents, 126 Fludarabine for chronic lymphocytic leukaemia,

for Waldenström macroglobulinaemia,

Fludrocortisone for adrenal insufﬁciency, 673, 673b postural hypotension, 1308–1309 Fluid, loss of, in diabetic ketoacidosis, 736, 736b Fluid balance for community-acquired pneumonia,

for heat exhaustion, 167 for renal failure, chronic kidney disease, 418 Fluid overload, in hypertension, 193 Fluid replacement for acute diarrhoea, 229–230, 229b for cholera, 265 for decompression illness, 171 for diabetic ketoacidosis, 737 for diving-related illness, 171 for food poisoning, 150 for heat exhaustion, 167 intensive care unit, 208 intravenous, for decompression illness, 171 Fluid therapy assessment, in hospitalised patients, 353b intravenous, for hypovolaemia, 353 for shocked patients, 206 Fluke, liver, 1320b Flumazenil, 142 Fluocinolone acetonide, 1226b Fluorescent in situ hybridisation (FISH) techniques, 1322 Fluoride, 718 dietary sources of, 717b and osteomalacia, 1053 poisoning, 718 reference nutrient intake of, 717b Fluorimetry, 348b 5-Fluorocytosine, 125b, 126 Fluoroquinolones, 122–123, 123b for leprosy, 269 for plague, 259 skin reactions, 1173b tuberculosis, 593 Fluorosis, 149 5-Fluorouracil (5-FU), 804 for basal cell carcinoma, 1230, 1230b for colorectal cancer, 832 for gastric cancer, 804 Fluoxetine, 1199b for bulimia nervosa, 1204 for ﬁbromyalgia, 1018–1019 Flupentixol, 1198b Flutamide, 659b Fluvoxamine, 139 FMF see Familial Mediterranean fever Foamy macrophages, 430, 809 Focal hypermelanosis, 1258 Focal nodular hyperplasia, 893 Focal segmental glomerulosclerosis (FSGS), 400 Focal seizures, 1099, 1099b Folate (folic acid), 715, 945 absorption, 945 biochemical assessment of status, 712b deﬁciency, 715, 945 causes of, 945b investigation of, 945b management of, 945 dietary sources of, 711b for neural tube defects, 712b, 715 reference nutrient intake of, 711b reference range of, 1362b supplements, 715 Folate antagonists, 123 Folate synthesis inhibitors, 128 Folinic acid for colorectal cancer, 832 for toxoplasmosis, 281 Follicle-stimulating hormone (FSH) puberty and, 1290 reference range of, 1359b Follicular carcinoma, 636b, 649 Folliculitis, 1236–1237 deep, 1237f pruritic, 1220b superﬁcial, 1236–1237 Fomepizole, 147 Fondaparinux, 938–939, 938b Fonsecaea compacta, 300–301 Fonsecaea pedrosoi, 300–301 Food allergy, 812 Food hygiene, 323 Food intolerance, 812 irritable bowel syndrome of, 825 Food poisoning Bacillus cereus, 262, 262f Clostridium perfringens, 262 non-infectious causes of, 230 staphylococcal, 262 Food-related poisoning, 149–150 Foot drop, 1087, 1309b Foot/feet diabetic, 759f, 761–762 aetiology of, 761 clinical features of, 761b management of, 761–762, 762b, 762f examination of diabetes mellitus, 721b musculoskeletal system, 982f non-freezing cold injury (trench or immersion foot), 167 Foot pain, 999 Foot ulcer, 761–762 Forced expiratory volume (FEV1), 554f in COPD, 574b in old age, 550b Forced vital capacity (FVC), 550b Foreign body, inhaled, 179, 179f Fortiﬁcation spectra, 1088 Foscarnet for CMV infection, 243 for herpesvirus infection, 127, 127b Fosfomycin, 124 Fournier’s gangrene, 227 Fractures, 994–995 associated with osteoporosis, 1044, 1045f bone mineral density and, 1046f fragility, 995b high-energy, 995b hip, 1308, 1308f investigation of, 994–995, 995b osteoporotic, 1308 pathological, 995b

1384 • INDEX prevention of, 1308–1309, 1309b repair, 1002b stress, 995b vertebral, 995b Fragile site mental retardation 2 (FRAXE), 43b Fragility fracture, 995b Frailty, 1306, 1306b Frameshift mutation, 42 Francisella tularensis, 261 FRAXE see Fragile site mental retardation 2 FRC see Functional residual capacity Freckle, 1234 Free fatty acids, 697 Free intravascular haemoglobin, 917 Free radicals, 713, 881 Freezing cold injury, 166–167 Frequency of micturition, 396 Fresh frozen plasma, 931b Fried Frailty score, 1306b Froin’s syndrome, 1136–1137 Frontal lobes, 1066 functions of, 1066b effects of damage, 1066b Fronto-temporal dementia, 1193–1194, 1193f Frontostriatal reward circuits, high-risk behaviour and, 1295 Frostbite, 166–167, 167f Frozen shoulder, 997–998 Fructose, 695–697, 696b FSH see Follicle-stimulating hormone 5-FU see 5-Fluorouracil Full blood count (FBC), 919–920 see also Blood count Fulminant liver failure, hepatitis B and,

Functional disorders, 802–803, 1094–1095, 1095b ‘Functional’ gonadotrophin deﬁciency,

Functional IgG antibody deﬁciency, 79 Functional residual capacity (FRC),

Functional somatic syndromes, 1187, 1187b Fundus angiography, of visual disorders,

Fungal infections, 300–304, 300f after HSCT, 937b antifungal agents, 125–126, 125b, 1239–1240 skin, 1239–1240, 1240f subcutaneous, 300–301 superﬁcial, 300 systemic, 301–304 Fungal keratitis, 1173 Fungal meningitis, 1121 Fungi, 101–102 respiratory diseases caused by, 596–598, 596b ‘Funny turns’, 1080 Furosemide adverse reactions of, 22b ascites and, 864 for heart failure, 465 for hyperkalaemia, 363b for hypertension, 513 for oedema, 396 route of administration, 30b for skin disease, 1221b Furuncles, 1237 Fusariosis, 302–303, 303f Fusidic acid, 124 for impetigo, 1236 Fusobacterium necrophorum, 586 Fusobacterium spp., 103f, 117b Fusobacterium ulcerans, 234b Futility, 213 FVC see Forced vital capacity G G-CSF see Granulocyte-colonystimulating factor G6PD see Glucose-6-phosphate dehydrogenase (G6PD) deﬁciency GABA hepatic encephalopathy and, 865 role in epilepsy, 1097–1098 Gabapentin for abdominal pain, 789 adjuvant analgesics, 1352b for chronic pain, 1345b for epilepsy, 1102b for ﬁbromyalgia, 1018–1019 multiple sclerosis, 1110b for neuropathic pain, 1084, 1350b for post-herpetic neuralgia, 240 for somatoform pain disorder, 1202 GAD see Glutamic acid decarboxylase Gain-of-function mutations, 45 Gait abnormal, 1086–1087 assessment of, 983f examination of, 1063b in older people, 1309b stamping, 1087 waddling, 1063b Galactorrhoea, 684 Galactosaemia, 370 Galactose, 370, 768 Galactose-1-phosphate uridyl transferase gene (GALT), 370 Gallbladder, 849–850 adenomyomatosis of, 909 cancer of, 904 in old age, 909b carcinoma of, 907 cholesterolosis of, 909 disease of, in old age, 909b strawberry, 909 tumours of, 907–908 benign, 908 Gallstone dyspepsia, 904 Gallstones, 903–905, 904f biliary sludge and, 904 cholesterol, 903, 903b clinical features of, 904, 904b in old age, 909b pigment stones and, 903–904, 903b pregnancy and, 900 treatment of, 905b ultrasound for, 853–854, 854f GALT, 370 Gambiense infections, 279 Gametogenesis, 41f Gamma-glutamyl transferase (GGT), liver blood biochemistry test and, 852, 853b Gamma hydroxybutyrate, misuse of,

Gamma ray-emitting radiopharmaceuticals, 390 Gamma rays, 164, 164f Gammopathy, 966 Ganciclovir for CMV infection, 224 HIV-related, 322 transplant patients, 89, 937b for herpesvirus infection, 126, 127b ‘Gas-bloat syndrome’, 794 Gas exchange, in lungs, 549–550, 549f Gas gangrene, 227 prophylaxis for, 119b Gastrectomy sleeve, 703b under-nutrition and, 706 Gastric acid, 791 Gastric aspiration, 136 Gastric banding, 703b Gastric bypass, 703b Gastric carcinogenesis, 803f risk factors for, 804b Gastric emptying, defective, 791 Gastric emptying study, 778b Gastric inhibitory polypeptide (GIP), 723–724, 772b Gastric lavage, 136, 136b Gastric outlet obstruction, 801–802, 801b Gastric secretion, 767, 767f Gastric varices, 865–866, 865f Gastric volvulus, 793 Gastrin, 767, 772b reference range of, 1359b Gastritis, 797–798 acute, 797 causes of, 798b chronic autoimmune, 797 due to Helicobacter pylori infection, 797, 798f Gastro-oesophageal reﬂux disease, 791–794, 791f, 794f asthma and, 791–792 in old age, 794b Gastroenteritis eosinophilic, 811–812 infective causes of, 228b foods associated with, 228b in old age, 228b Gastroenterology, 763–844 functional anatomy of, 766–772 histology of, 776, 777b Gastroenteropancreatic neuro-endocrine tumours, 678–679, 678b, 679f Gastroenteropathy, allergic, 812 Gastroenterostomy, 801–802 Gastrointestinal bleeding, 780–783 acute upper gastrointestinal haemorrhage in, 780–782 management of, 781–782 endoscopic therapy, 780 lower gastrointestinal tract, 782–783, 782b severe, 782–783 subacute or chronic, 783 occult, 783 of unknown cause, 783, 783f upper, risk stratiﬁcation in, 781b Gastrointestinal decontamination, in poisoning, 135–136, 136b Gastrointestinal disease, 785 contrast radiology in, 773b HIV-related, 316–317 ophthalmic features of, 1166b during pregnancy, 1277–1278 transition medicine and, 1299–1300 inﬂammatory bowel disease in, 1299–1300 Gastrointestinal haemorrhage, upper, causes of, 781f Gastrointestinal obstruction, in palliative care, 1354 Gastrointestinal polyposis syndromes, 828b Gastrointestinal stromal cell tumours (GISTs), 805 Gastrointestinal system, pregnancy and,

Gastrointestinal tract absorption from, 17 clinical examination of, 764–766, 764f, 765b diseases/disorders classiﬁcation of, 677b functional, 802–803 gut hormones, 772 investigation of, 772–778 presenting problems in, 778–789 function, control of, 771–772 HIV/AIDS and, 826 obstruction, 788 Gastrointestinal tuberculosis, 590, 591f Gastroparesis, 760, 803 Gastropathy, congestive, ‘portal hypertensive’, 871 Gastrostomy feeding, 707, 707b, 708f Gaucher’s disease, 371b GCA see Giant cell arteritis GCS see Glasgow Coma Scale Geﬁtinib, 1332 Gegenhalten, 1094 Gels, 1225b Gemcitabine, for pancreatic cancer, 842–844 Gender, alcoholic liver disease and, 880 Gene panels, 54b Gene promoter, 39, 39f Gene sequencing, 52–56, 54f–55f challenges of NGS technologies in, 53–54 methods for, 55b NGS capture in, 53 third-generation, 56 uses of, 54–56 Gene therapy, for genetic disease, 58 General anaesthetics, 14 General assessment of locomotor system (GALS), 983, 983f General sales list (GSL), 27 Generalised anxiety disorder, 1200 Generalised lymphadenopathy, 927 Generalised pain, causes of, 995b Generalised seizures, 1099–1100 Generic virus life cycle, 101f Genes ampliﬁcation of, 52, 53f packaging of, 38, 38f Genetic disease(s) constitutional, 46–50 inheritance patterns of, 46–50 renal, 403–406 skin, 1264 somatic, 50–51 treatment of, 58 Genetic factors adverse drug reactions and, 29 of ageing, 1304–1305 alcoholic liver disease and, 880, 881f of cancer, 1316 of inﬂammatory bowel disease,

of osteoarthritis, 1007–1008 of osteoporosis, 1044 of Parkinson’s disease, 1112 psychiatric disorders and, 1183 Genetic testing, 1077 for Peutz-Jeghers syndrome, 829 Genetic variant classes of, 42–44, 42b consequences of, 44–45 in evolutionary selection, 45–46 normal, 45–46 Genital herpes, 334b, 336b Genital itch/rash, 333, 334b Genital lumps in men, 334 in women, 336 Genital ulcers in Behçet’s disease, 1043–1044 in men, 333–334, 334f in women, 336 Genital warts, 1238 Genitalia, in endocrine disease, 630f Genitourinary disease, in tuberculosis,

Genitourinary system, pregnancy and,

Genome editing, for genetic disease,

Genome-wide association studies (GWAS), 45 Genomics clinical practice and, 56–59 common disease and, 56 ethics and, 59 fundamental principles of, 38–41 health and disease, 42–51 health care and, 56–58 in infectious disease, 58 obstetrics and, 56 oncology and, 56–58 in rare neurodevelopmental disorders,

technologies for, 51–56 Gentamicin, 429 for brucellosis, 255b for cerebral abscess, 1124b dosing of, 122, 122f drug concentration, 36b for infective endocarditis, 223 for liver abscess, 880 for meningitis, 1120b for neutropenic sepsis, 957 for plague, 259 prophylactic, 119b renal or hepatic disease, 32b for septic arthritis, 1020 for tularemia, 261 for urinary tract infection, 429b Fractures (Continued)

INDEX • 1385 Geriatric medicine assessment, 1306 presenting problems in, 1307–1311 see also Age/ageing; Older people Gerstmann-Sträussler-Scheinker syndrome, 1127b Gestational diabetes, 1278, 1278b diagnosis of, 1278 management of, 1278 screening for, 1278 Get up and go test, 1303b GFR see Glomerular ﬁltration rate GGT see γ-Glutamyl transferase GH see Growth hormone Ghrelin, 767, 772b Giant cell arteritis (GCA), 1042–1043,

emergency management of, 1043b Giardia lamblia, 287 Giardiasis, 287 clinical features and investigations of,

management of, 287 Gilbert’s syndrome, 860, 860b, 897 Gingivitis, 316 GIP see Gastric inhibitory polypeptide GISTs see Gastrointestinal stromal cell tumours Gitelman’s syndrome, 361 Glanzmann’s thrombasthenia, 971 Glasgow Coma Scale (GCS), 134, 185, 186f, 194, 194b Glasgow criteria, for prognosis in acute pancreatitis, 837b Glasgow score, for alcoholic liver disease, 882, 882b Glatiramer acetate, 1109, 1109b Glioblastoma multiforme, 1129 Gliomas, 1130–1131 Glitazones, for non-alcoholic fatty liver,

Global burden of disease (GBD) causes of death and disability, 92–93, 92b underlying risk factors of, 93b Global warming, 94 Glomerular diseases, 397–401, 397b histopathology of, 399f inherited, 403–404 pregnancy and, 1282 Glomerular ﬁltration rate (GFR), 386–387, 387f diabetes mellitus and, 417f estimation of, 386b limitations of, 387b pregnancy and, 1272 renal failure, chronic, 415 renal haemodynamics and, 413f Glomerulonephritis, 397–401 antibody production, associated with, 397f categorised, 398b–399b causes of, 401b drug-induced, 427b infection-related, 398b–399b, 401 mesangiocapillary, 398b–399b, 401 nephrotic syndrome, 392b, 395, 395b rapidly progressive, 397 in systemic lupus erythematosus,

terminology used in, 400b Glomerulosclerosis, nodular, diabetic, 757, 758f Glomerulus, 384 Glossitis, atrophic, 764f Glossopharyngeal (9th cranial), tests of, 1063b Gloves and socks syndrome, 237b Glucagon famine, 704–705 secretion, regulation, 724 Glucagon-like peptide-1 (GLP-1), 723–724, 772b Glucagon-like peptide-1 (GLP-1) receptor agonists, for hyperglycaemia, 747–748 Glucocorticoid-induced osteoporosis,

Glucocorticoids, 665 for acute exacerbations of COPD,

for adrenal insufﬁciency, 672–673 adverse effects of, 670–671 advice to patients on, 671b for alcoholic hepatitis, 882 for allergy, 86 anabolic, cholestatic hepatitis and,

for ankylosing spondylitis, 1031 for antineutrophil cytoplasmic antibody-associated vasculitis,

for autoimmune hepatitis, 886–887 in bone remodelling, 986b for Duchenne muscular dystrophy,

for Graves’ ophthalmopathy, 646 growth retardation and, 1290, 1299 for inﬂammatory bowel disease, 821b,

for musculoskeletal disease, 1005–1006 in old age, 673b osteoporosis induced by, transition medicine, 1300 for polymyositis and dermatomyositis,

for primary biliary cholangitis, 888 pruritus, 1220b for psoriatic arthritis, 1033–1034 for reactive arthritis, 1032 for rheumatic fever, 517 sodium content of, 864b therapeutic use of, 670–671, 670b topical, 1226, 1226b, 1226f for tuberculosis, 593 for ulcerative colitis, 1299–1300 for warm autoimmune haemolysis,

weight gain, 700b withdrawal of, management of, 671, 671b see also Corticosteroids; Cortisol; Hydrocortisone; Mineralocorticoids; Prednisolone Gluconeogenesis, 850 Glucosamine sulphate, for osteoarthritis,

Glucose acute kidney injury and, 416b blood diabetes and, 724–726 impaired fasting glucose, 726b,

normal metabolism of, 724, 725f cerebrospinal ﬂuid, 1361b control of, in intensive care, 210–211 ﬁltration and reabsorption by nephron, 748f impaired tolerance, 374, 1360b interstitial, diabetes and, 726 intravenous, porphyria, 379 metabolism of, pregnancy and, 1272–1273 reference range of, venous blood, 1360b urine, diabetes and, 725 values of, in gestational diabetes,

Glucose-6-phosphate dehydrogenase (G6PD) deﬁciency, 948–949, 949b Glucose tolerance, impaired, 726b,

Glucose tolerance test, oral, 726b Glue snifﬁng, 1196 Glutamate, 698b Glutamic acid decarboxylase (GAD), 1111b Glutaminase, 364 γ-Glutamyl transferase (GGT) in alcohol misuse, 1184 reference range of, venous blood, 1360b Glutathione, 712b Gluten-free diet, 807 Gluteus medius enthesitis, 999b Glycaemic control, in diabetes, 756–757, 756f in adolescence, 753b in old age, 757b self-assessment of, 742 ‘Glycaemic index,’ of foods, 695–697 Glycated haemoglobin (HbA1C), 726–727, 727b, 1360b Glycation, 726–727 Glyceryl trinitrate (GTN) for anal ﬁssure, 836 angina, 489, 490b duration of action, 490b intravenous, accelerated hypertension, 514 for pulmonary oedema, 465b route of administration, 30b sublingual, 489, 500 Glycine, 698b Glycogen, 694 Glycogen storage diseases (GSDs), 370, 370b Glycopeptide-resistant enterococci (GRE), 117b Glycopeptides, 123 mechanism of action, 116b in pregnancy, 120b Glycoprotein intrinsic factor, 767 Glycosidases, 987 Glycosuria, 725, 729–730 diabetes mellitus, 409, 729–730 Fanconi’s syndrome, 410b hypernatraemia and, 359b ‘lag storage’, 638b leg ulcers and, 1224 in old people, 732b pregnancy and, 1272 renal, 405, 725 Glycosylphosphatidylinositol (GPI), 950–951 Glycylcyclines, 120b, 124 GM2-gangliosidosis, 371b Gnathostomiasis, 294 Goitre endemic, 717 multinodular, 648–649, 648f simple diffuse, 648, 648f thyrotoxicosis, 635–636, 636b Gold (myocrisin) adverse effects on kidney, 427b adverse reactions of, 926b for musculoskeletal disease, 1004b,

Golfer’s elbow, 998 Golgi apparatus, 40 Golimumab, for musculoskeletal disease, 1007b Gonadotrophin-releasing hormone (GnRH), 633f for infertility, 656–657 puberty and, 1290 Gonadotrophin-releasing hormone analogues, 379 Gonococcal infection, disseminated (DGI), 340 Gonococcal ophthalmia neonatorum, 340f Gonococcal urethritis, 333, 333f Gonorrhoea, 339–340 arthritis, 340 complications of delayed therapy in, 340b incubation period, 111b, 339 pharyngeal, 340 treatment of uncomplicated, 340b urethritis, 333 Goodpasture’s disease, 612 Gorlin’s syndrome, 57b Goserelin, 1332 Got transition, 1290 Gottron’s papules, 1039 Gout, 1012–1016 causes of, 1013b clinical features of, 1014, 1014f–1015f epidemiology of, 1012–1013 investigations for, 1014–1015 management of, 1015–1016 in old age, 1014b pathophysiology of, 1013–1014, 1013f tophaceous, 1014–1015, 1015f Graft-versus-host disease (GVHD), 937,

Graham Steell murmur, 526 Granulocyte-colony-stimulating factor (G-CSF), 1327–1328 Granulocytes, 917 count, 1362b Granuloma annulare, 1263 Granuloma inguinale, 341b Granulomas, 71 Granulomatosis with polyangiitis, 612,

Granulomatous disease, 1263 Granzymes, 67 Graves’ disease, 643–646 ophthalmopathy, 631b, 645–646, 645f thyrotoxicosis and, 635–636, 636b, 643–646, 643f management of, 644–645, 644b Graves’ thyrotoxicosis, 643–645, 643f Gravitational eczema, 1247 Grays (Gy), 164 Grenz (Bucky) ray therapy, for skin disease, 1228–1229 ‘Grey baby’ syndrome, 120b Grey Turner’s sign, 837–838 Grief reactions, 1201 Griseofulvin, as antifungal agents, 126 Group A streptococci (GAS), 252 Group B streptococcal infection, in pregnancy, 235b Growth, analytes affected by, 1363b Growth factors, 914, 915f asthma, 568 cancer, 1317, 1317f haematopoiesis, 914 Growth failure, 823 Growth hormone (GH), 632, 633f reference range of, 1359b Growth hormone-releasing hormone (GHRH), 633f Growth hormone replacement, for Hypopituitarism, 682 Growth hormone secretion, tests of, 682b Growth retardation congenital heart disease and, 533 eating disorders, 1204b GSDs see Glycogen storage diseases GTN see Glyceryl trinitrate Guanine, 38 Guillain-Barré syndrome, 1140 Guinea worm (dracunculiasis), 293 Gumma, 338 Gums, 696b Kaposi’s sarcoma, 316f scurvy, 716b Gut hormones, 772, 772b testing, 778 GVHD see Graft-versus-host disease Gynaecomastia, 657, 657b, 867 in hypogonadism, 653 H HACE see High-altitude cerebral oedema HACEK group bacteria, endocarditis, 528, 528b HAE see Hereditary angioedema Haem, biosynthetic pathway, 378f Haemagglutination testing, 261 Haemagogus spp., yellow fever and,

Haemangioblastomas, 1132 Haemangiomas, 1234 liver, 893, 893f Haemarthrosis, 992–993 Haematemesis, 780 Haematocrit (Hct), 919–920, 1362b Haematological abnormalities, HIV-related, 322 Haematological disorders see Blood diseases Haematological investigations, in older people, 923b

1386 • INDEX Haematological malignancies, 954–968, 955b chemotherapy in, 936 in old age, 968b Haematological practice, treatments for emergencies in, 939b Haematological system, pregnancy and,

Haematological tests, for hepatobiliary disease, 853 Haematological values, 1362b Haematology, 388 in coeliac disease, 807 in musculoskeletal disease, 990 transfusion medicine and, 911–979 Haematoma extradural, 1133 intracerebral, 1133 muscle, haemophilia, 973f in stroke patients, 1157–1158, 1158b subdural, 1133 subungual, 1260, 1260f Haematopoiesis, 914–915, 914f Haematopoietic stem cell transplantation (HSCT), 936–938 for acute leukaemia, 958 allogeneic, 936–937, 936b–937b for aplastic anaemia, 969 autologous, 936–938 for beta-thalassaemia, 954b for chronic myeloid leukaemia, 959 fever after, 224–225 for high-grade NHL, 966 infections during recovery from, 937b for myeloﬁbrosis, 969 for myeloma, 968 Haematuria, 391–392, 392f investigation of, 393f loin pain, 396 non-visible, 392b Haemochromatosis, 717, 895–896, 896f causes of, 895b hereditary, 895–896 liver function test (LFT) abnormality in, 854b rheumatological manifestations of,

secondary, 896 Haemoconcentration, hypothermia and,

Haemodiaﬁltration, 423 Haemodialysis, 136, 421–423 access, 423f in acute kidney injury, 422 in CKD, 422–423 peritoneal dialysis vs., 420b problems with, 424b Haemoﬁltration, 423 continuous venovenous, 423 Haemoglobin, 915–916, 917f abnormal, 951 glycated, 726–727, 727b, 1360b mean cell (MCH), 1362b pregnancy and, 1273 reference range of, 1362b Haemoglobin A, 915–916 Haemoglobin C, 951–952 Haemoglobin C (HbC) disease, 953 Haemoglobin F, 915–916 Haemoglobin H, 954 Haemoglobin-oxygen dissociation curve, 190, 191f Haemoglobin S, 951–952 Haemoglobin SC disease, 953 Haemoglobinopathies, 951–954, 951f Haemoglobinuria, 338, 392b march, 950 paroxysmal cold, 950 paroxysmal nocturnal, 950–951 Haemolysis, 945 active, investigation results indicating, 946b causes and classiﬁcation of, 946f extravascular, 946–947 intravascular, 946b, 947 Haemolytic anaemias, 923, 945–951 alloimmune, 950 autoimmune, 949–950 causes of, 946f, 947 microangiopathic, 950 non-immune, 950 Haemolytic crisis, 947 Haemolytic disease of newborn (HDN), 933, 933b Haemolytic uraemic syndrome (HUS), 104b, 388, 408–409 pregnancy and, 1285 Haemophilia, rheumatological manifestations of, 1058 Haemophilia A, 971–973 clinical features of, 972, 972b, 973f coagulation factor therapy for, complications of, 973 genetics in, 971–972 management of, 972–973 Haemophilia B, 973–974 Haemophilus ducreyi, 341b Haemophilus inﬂuenzae, 117b bacterial meningitis, 1119b–1120b immunisation for, 115b pneumonia, 319, 583 Haemophilus spp., 103f Haemoptysis in lung cancer, 599–600 in respiratory disease, 559–560, 559b, 560f Haemorrhage during dialysis, 424b intracerebral, 1154–1155, 1155f causes of, 1155b major, transfusion in, 931b, 934–936, 936b obstetric, circulatory collapse and,

retinal, 169 splinter, 994b, 1260 subarachnoid, 1160–1162 clinical features of, 1161, 1162f investigations of, 1161 management of, 1162 see also stroke Haemorrhagic fevers, viral, 245–247, 245b Haemorrhagic toxins, 155–156 Haemorrhoids, 835–836 Haemosiderin, 851 Haemosiderosis, 716 idiopathic pulmonary, 613b Haemostasis, 917–919, 918f–919f in old age, 978b Haemostasis system toxins, 155, 156f Hair abnormalities, 1224 disorders, 1258–1260 follicles, 1212–1213 loss, 1266b Hairy cell leukaemia, 960 Hairy leucoplakia, 316 Hallpike manoeuvre, 1104, 1104f Hallucinations, 1181, 1184 in alcohol misuse, 1194 hypnagogic, 1184 hypnopompic, 1184 in schizophrenia, 1196–1197 Hallucinogens, misuse of, 143–144,

Hallucinosis, alcoholic, 1194 Hallux valgus, 999 Haloperidol adverse reactions of, 22b agitation, 1354 for delirium, 209 for disturbed behaviour, 1188–1189 poisoning, 141 schizophrenia, 1198b Halothane, 82–83, 857f Hamartoma, 603b small intestine and, 813 Hands in endocrine disease, 630f examination of blood disease, 912f cancer, 1314f cardiology, 442f diabetes mellitus, 721b endocrine disease, 630f gastrointestinal disease, 764f liver and biliary disease, 846f musculoskeletal system, 982f renal/urinary tract disease, 382f respiratory system, 546f skin disease, 1210f foot and mouth disease, 248 gastrointestinal disease, 764f hygiene, infection control, 112–113, 113f liver and biliary disease and, 846f osteoarthritis, 1009f pain, 998 rheumatoid arthritis in, 1023f washing, 113f Hantavirus infection, 258 Haploinsufﬁciency, 659 Haptoglobin, 947, 1362b in acute phase response, 70 Hard metal disease, 616 Hartmann’s procedure, 788 Hartmann’s solution, 353b Hartnup’s disease, 714 Hasenclever index, in Hodgkin lymphoma, 964, 964b Hashimoto’s thyroiditis, 646 Haversian system, 984f Hay fever, 85, 622 Hayﬂick limit, 41 Head and neck examination of diabetes mellitus, 720f endocrine disease, 630f gastrointestinal disease, 764f imaging of, 1073–1074, 1074f injury, 1133 tumours in, 1335–1336, 1335b investigations of, 1335 management of, 1335–1336 pathogenesis of, 1335 Head lice, 1241 Head-up tilt-table testing, 183 Headache, 185–186, 1080, 1095–1097 analgesic for, 1096 associated with speciﬁc activities,

benign paroxysmal, 1097, 1097b brain tumours causing, 1129 clinical assessment of, 185, 186f cluster, 1096 exertion, 1097 fever and, 217b heat stroke and, 167 investigations of, 185–186 medication overuse, 1096 migraine and, 1095–1096 morning, 558 pregnancy and, 1275 presentation of, 185, 185b raised ICP, 1128b ‘red ﬂag’ symptoms in, 185b sexual activity and, 1097 stroke and, 1153 subarachnoid haemorrhage and,

tension-type, 1095 Health, social determinants of, 93–94 Health care, genomics and, 56–58 Health care-associated infection, 111–113, 112f–113f MRSA, 100 predisposing factors, 112f Health data/informatics, 97–98 Hearing disturbance, 1093 Heart anatomy of, 444–446, 444f–445f auscultation of, 443b blood ﬂow through, 444f catheterisation, 453–454, 453f chamber, 445f dilation of, 450 conduction system, 445, 445f coronary circulation in, 444–445 endothelium and, 447 inﬂammatory arthritis in, 994b nerve supply of, 445–446 physiology of, 446–448 Starling’s law, 461, 461f Heart beats ectopic atrial, 469–470, 470f ventricular, 474–475, 475f see also Palpitation Heart block atrioventricular, 477–478, 477f–478f, 478b bifascicular, 478–479 bundle branch, 478–479, 478b, 478f hemiblock, 478–479 Heart disease congenital, 531–538, 531b, 532f HIV-related, 322 pregnancy, 1282 rheumatic, 515–517 rheumatoid arthritis and, 1024 Heart failure, 461–468 in acute coronary syndrome, 496 acute left, 463 biventricular, 461 chronic, 463–464, 463b, 463f clinical assessment for, 463–464, 463b complications of, 464 congestive, in old age, 466b high-output, 463 investigations for, 464, 464f left, 461 management of, 464–468, 465b drug treatment for, 465–467, 466f mechanisms of, 462b, 462f right, 461 Heart murmur, 459b Heart rate effects of respiration on, 447b pregnancy and, 1272 Heart sounds, 460f abnormal, 457–461, 459b normal, 459b Heart valves, diseases of, 514–531, 515b Heartburn, 779 Heat cramps, 167 Heat exhaustion, 167 Heat-related illness, 167–168 Heat stroke, 167–168 Heat syncope, 167 Heberden’s nodes, 1009f Height, in endocrine disease, 630f Heinz bodies, 950 Helicobacter pylori eradication therapy, 800, 800b gastric lymphoma, 805 peptic ulcer and, 798–799, 799f, 800b Helium dilution technique, 575 Heller’s operation, 795 HELLP syndrome, pregnancy and,

Helminthiases, soil-transmitted, 233b Helminths, 101–102 drugs used against, 129 Hemicellulose, 696b Hemicrania, chronic paroxysmal, 1097b Hemidiaphragm, elevation of, 627, 627b Hemifacial spasm, 1116 Hemiparesis, 1083, 1123 Hemiplegic gait, 1309b Henderson-Hasselbalch equation, 364 Henoch-Schönlein purpura, 398b–399b, 401, 1043 Heparin, 938–939 for acute limb ischaemia, 503 for angina, 491 indications for, 938b low-molecular-weight, in thrombosis,

monitoring, 922 for stroke, 1160 Heparin-induced thrombocytopenia (HIT), 939 Hepatic acinus, 848, 848f Hepatic adenomas, 893 Hepatic artery aneurysms, 898 Hepatic decompensation, 867 Hepatic disease, prescribing for patients with, 32, 32b

INDEX • 1387 Hepatic encephalopathy, 847b, 864–865 acute liver failure and, 856–857 clinical grade of, assessment for, 857b differential diagnosis of, 865b factors precipitating, 865b Hepatic ﬁbrosis, 894 cirrhosis and, 866, 866f congenital, 868f, 902 non-invasive markers of, 855 pathogenic mechanisms in, 849f Hepatic hydrothorax, 863 Hepatic Iron Index (HII), 895 Hepatic-renal disease, 409–410 Hepatic venous disease, 898 Hepatic venous pressure, 868 Hepatitis acute kidney injury and, 416b alcoholic, 881 autoimmune, 886–887 conditions associated with, 886b liver function test (LFT) abnormality in, 854b interface, 886 viral, 343–344, 871–878 causes of, 871b chronic, HIV-related, 317–318 features of, 872b investigations for, 872 management of, 872 non-A, non-B, non-C (NANBNC),

pregnancy and, 1284 sexual, 343–344 Wilson’s disease and, 896 Hepatitis A virus (HAV), 872–873, 872b acute liver failure and, 873 antigen for, 872 immunisation, 115b incubation period of, 111b in old age, 901b pregnancy and, 900 transmission, sexual, 343 Hepatitis B core antigen (HBcAg), 873–874 Hepatitis B core IgM antibody, screening for, in acute liver failure, 858 Hepatitis B e antigen (HBeAg), 874–875 Hepatitis B surface antigen (HBsAg),

recombinant hepatitis B vaccine with,

Hepatitis B virus (HBV), 872b, 873–877 acute, management of, 875 chronic HBeAg-negative, 875 liver function test (LFT) abnormality in, 854b management of, 875–876 natural history of, 874f phases of, 874b risk of, 873b source of, 873b cirrhosis and, 876 co-infection with HIV, 876–877 HIV-related, 317–318 incubation period of, 111b investigations of, 873–875 in pregnancy, 235b, 900 prevention of, 876, 876b schematic diagram of, 873f serology for, 873–875, 875b, 875f transmission, sexual, 343 vertical transmission of, 873 viral load and, 875, 875f Hepatitis C virus (HCV), 872b, 877–878 antigens for, 877 chronic, risk factors for, 877b cirrhosis and, 877 HIV-related, 318 liver function test for, 877 abnormality in, 854b liver histology for, 878 molecular analysis for, 877 pregnancy and, 900 transmission, sexual, 343 Hepatitis D virus, 872b, 877 Delta antigen for, 877 vertical transmission of, 877 Hepatitis E, 872b, 878 in pregnancy, 235b pregnancy and, 900 Hepatitis viruses, 249 Hepatobiliary disease, HIV-related, 317–318 Hepatocellular carcinoma, 890–892, 891f chemotherapy for, 892 cirrhosis and, 890 ﬁbrolamellar, 892 hepatic resection for, 891 hepatitis B and, 873 liver biopsy for, 891 liver transplantation for, 891 management of, 892f in old age, 901b percutaneous therapy for, 891 screening for, 890–891 trans-arterial chemo-embolisation for,

Hepatocellular jaundice, 860–861 Hepatocytes, 848, 849f necrosis of, 894 Hepatology, 845–909 Hepatomegaly, 862 acute liver failure and, 857–858 Budd-Chiari syndrome and, 899 cirrhosis and, 866–867 Hepatopulmonary syndrome, 898 Hepatorenal syndrome ascites and, 864 type 1, 864 type 2, 864 Hepatosplenic candidiasis, 302 Hepcidin, 716–717, 943 HER2 receptor, as tumour markers, 1322, 1324b Herbal medicines, for pain, 1348 Herd immunity, 115 Hereditary angioedema (HAE), 88 Hereditary coproporphyria (HCP), 379b Hereditary elliptocytosis, 947–948 Hereditary haemorrhagic telangiectasia (HHT), 970 Hereditary hypophosphataemic rickets, 405, 1052–1053 Hereditary nephrotic syndrome, 404 Hereditary neuropathy, 1140 Hereditary spherocytosis, 947 investigations of, 947, 948f management of, 947, 948b Hernia diaphragmatic, 627 hiatus, 791, 791b, 792f lumbar disc, 1135, 1135f Heroin, misuse, 142 Herpangina, 248 Herpes simplex keratitis, 1173 Herpes simplex virus (HSV), 238b after HSCT, 937b genital, 341–342 HIV-related, 314f, 315, 315b HSV-1, 247–248, 247f HSV-2, 247–248, 247f in pregnancy, 235b, 332b viral hepatitis and, 878 Herpes zoster, 239–240, 1123 clinical features of, 239 facial pain from, 1080 HIV-related, 315 management of, 240 Herpesvirus infections, skin, 1238 Herring worm, 294 Heterochromatin, 38–39 Hiatus hernia, 627, 791, 791b, 792f ‘Hibernating’ myocardium, 452 Hibernian fever, 81 Hierarchy of systems, 93, 93b, 93f High altitude, 168–169 illnesses at, 168–169 cerebral oedema (HACE), 168 pulmonary oedema (HAPE), 168–169 physiological effects of, 168, 168f High-altitude cerebral oedema (HACE),

High-density lipoproteins (HDL), 1360b High-energy fracture, 995b High-ﬂow nasal cannulae (HFNCs), 202 High-grade tumours, 961 High haemoglobin, 925, 925b High-risk behaviour, transition medicine and, 1295 history-taking in, 1295b personality and, 1295 protective factors in, 1295 theories in, 1295 Highly polyunsaturated long-chain n-3 fatty acids, 377 Hip osteoarthritis, 1010, 1010f pain, 998, 999b, 999f Hippocampus, 1066 Hirschsprung’s disease, 834–835 Hirsutism, 657–658, 658b, 1259–1260 His bundle, 445 Histamine, 767 Histidine, 698b Histones, 38 Histopathology, in respiratory disease,

Histoplasma capsulatum, 303 Histoplasmosis, 303–304 in HIV infection/AIDS, 314f HIV infection/AIDS, 312 antiretroviral therapy for, 324–327, 324b asymptomatic, 312, 312f CD4 counts in, 311 chemoprophylaxis for, 323–324 clinical examination of, 306f clinical manifestations of, 311–312 counselling for, 311b diagnosis of, 310–311, 310b epidemiology of, 308 global and regional epidemics of, 308, 308b hepatitis B and acute, 875 co-infection with, 876–877 immunisation for, 324 immunology of, 309–310 investigations of, 310–311, 311b life cycle of, 309f liver and, 879 liver blood tests in, abnormal, 879b modes of transmission of, 308, 308b–309b musculoskeletal manifestations of, 1021b in old age, 326b pregnancy and, 1280 presenting problems of, 312–322, 313b cancers, 322, 323b cardiac disease, 322 fever, 313–314, 313f–314f gastrointestinal disease, 316–317 haematological abnormalities, 322 hepatobiliary disease, 317–318 lymphadenopathy, 313 mucocutaneous disease, 314–316, 314b nervous system and eye disease, 319–321, 319f renal diseases, 322 respiratory disease, 318–319, 318b rheumatological diseases, 321–322 weight loss, 313, 313f prevention of, 323–324, 327b primary, 311–312, 312b prophylaxis for, 119b pruritus and, 1219b staging classiﬁcations of, 307b testing of, 330 tuberculosis and, 595 viral load in, 311 virology of, 309–310 HIV serology, acute kidney injury and, 416b Hives, 1252 HLA antigen, transplant rejection, 88–89 HNF1-beta mutations, 406 Hoarseness, psychogenic, 624 Hodgkin lymphoma (HL), 961–964, 962f classiﬁcation of, 962b clinical features of, 962 epidemiology of, 961, 962b investigations of, 962, 963f management of, 962–964 prognosis of, 964, 964b stages of, 962b Holmes-Adie syndrome, 1092b Home ventilation, for chronic respiratory failure, 567 Homocystinuria, 369–370 Honeycomb lung, 608f Hookworm ancylostomiasis, 288–289, 288f dog, 294 Hookworm infestation, 233b Hoover’s sign, 1081–1082 Hormone replacement therapy amenorrhoea, 655 cancer, 1332 for osteoporosis, 1048b, 1049 Hormones gastrointestinal tract, 772 production, ectopic, 1325b in venous blood, 1359b Horner’s syndrome, 1091b–1092b, 1091f Hospital, under-nutrition in, 693f, 705–708, 706b Host-pathogen interactions, 104 House dust mite, 570 Howell-Jolly bodies, 921f Human albumin, 930 Human albumin solution (HAS), ascites and, 864 Human chorionic gonadotrophin (hCG) secretion of, pregnancy and, 1272 as tumour markers, 1322, 1324b Human herpesvirus 6 (HHV-6), 238, 238b Human herpesvirus 7 (HHV-7), 238, 238b Human herpesvirus 8 (HHV-8), 238b,

Human leucocyte antigen (HLA) molecules, 67 antigen processing and presentation and, 70 Human papillomavirus (HPV), 342–343 in pregnancy, 332b vaccines, 115 Human parvovirus arthropathy, 1020–1021 Human T-cell lymphotrophic virus type 1, 250 Humanitarian crisis, 171–172, 172b Humidiﬁer fever, 616b, 617 Humoral immunity, 68 Hunter’s syndrome, 371b Huntington’s disease, 1115 genetic testing of, 1077 Hurler’s syndrome, 371b Hutchinson’s sign, 1233 Hyaluronic acid, intra-articular injections of, 1012 Hydatid cyst, liver and, 880 Hydatid disease, 298–299, 299f Hydralazine, 467 lupus syndrome, 1057b malignant hypertension, 514 pharmacokinetic, 20b skin reactions, 1266b Hydration for stroke patients, 1159b see also Fluid replacement Hydroa vacciniforme, 1221b Hydrocephalus, 1132–1133, 1132f causes of, 1132b, 1133f dementia and, 1191b management of, 1133 normal pressure, 1132–1133 obstructive, 1092b, 1121 Hydrocortisone ACTH deﬁciency, 682 adrenal insufﬁciency, 673 anaphylaxis, 76b asthma, 573

1388 • INDEX eczema, 1244 equivalent dose, 670b for inﬂammatory bowel disease, 820, 821b laryngeal obstruction, 625 potency and strength, 1226b topical, 1226b see also Cortisol Hydrocortisone sodium succinate, 625 Hydrogen ions acid-base balance, 364 in arterial blood, 565b, 1358b Hydromorphone, 1352 Hydronephrosis, 413 Hydrophobia, 1122 Hydrops fetalis, 237b Hydrotherapy, for musculoskeletal disease, 1001 Hydrothorax, hepatic, 863 Hydroxyapatite crystals, 985 Hydroxycarbamide essential thrombocythaemia, 970 leukaemia, 959 for myeloﬁbrosis, 969 sickle-cell disease, 953 for skin disease, 1227–1228 Hydroxychloroquine (HCQ) for musculoskeletal disease, 1004b,

for rheumatoid arthritis, 1026b for Sjögren’s syndrome, 1039 skin reactions, 1266b for systemic lupus erythematosus,

for Whipple’s disease, 809 1α-Hydroxycholecalciferol (alfacalcidol), for hypoparathyroidism, 665 Hydroxycobalamin see Vitamin B12 5-Hydroxyindole-3-acetic acid (5-HIAA), 1361b 11-Hydroxylase deﬁciency, 509b 17α-Hydroxylase deﬁciency, 509b 21-Hydroxylase deﬁciency, 676 11β-Hydroxysteroid dehydrogenase, 665, 665b deﬁciency, 509b 25-Hydroxyvitamin D (25(OH)D), for skeletal disease, 990b Hyfrecation, 343 Hygiene, hand-washing, 113f Hygiene hypothesis, 84–85 Hyoscine butylbromide, 1350b, 1354 Hyper IgD syndrome (HIDS), 81 Hyperacusis, 1083 Hyperacute rejection, 89 Hyperaesthesia dengue fever, 243b diabetic neuropathy, 758–759 herpes simplex, 247 Hyperaldosteronism glucocorticoid suppressible, 509b,

primary, 674–675, 674b secondary, 674b in type 1 diabetes, 729–730 Hyperalgesia, ﬁbromyalgia, 1018 Hyperalphalipoproteinaemia, 374 Hyperbilirubinaemia non-haemolytic, 860, 860b see also Jaundice Hypercalcaemia, 661–662 cancer and, 1327, 1327b causes of, 662, 662b clinical assessment of, 662 familial hypocalciuric, 662, 664 hypoparathyroidism, 664–665 investigations of, 662 malignant, 662 management of, 662 multiple myeloma and, 410b, 967f sarcoidosis, 609–610 Hypercapnia, ventilator-induced lung injury and, 204 Hypercarotenosis, 713 Hypercholesterolaemia, 373–374, 376–377 atherosclerosis risk, 486 familial, 374, 374b management of, 376–377 nephrotic syndrome and, 395b polygenic, 373–374 primary biliary cholangitis and, 887–888 secondary, 373b Hypercoagulability, nephrotic syndrome and, 395b Hypercortisolism, 667b Hyperemesis gravidarum, pregnancy and, 1277–1278, 1278b Hyperglycaemia in acute medical illness, 754 in diabetes, 734–735, 734f clinical assessment of, 734–735 drugs to reduce, 745–748 symptoms of, 735, 735b type 1, 729–730 type 2, 732 diabetic ketoacidosis, 735 maternal, diabetes and, 1278–1279 pancreatitis, 838b stress, 728 Hyperglycaemic hyperosmolar state (HHS), 738, 739b Hypergonadotrophic hypogonadism, 653b, 654 Hyperinsulinaemia, 740 Hyperkalaemia, 362–363, 464 acute kidney injury and, 413 causes of, 362b chronic kidney disease, 417 heart failure, 464 periodic paralysis, 1145b treatment of, 363b Hyperkeratosis, subungual, 1031 Hyperketonaemia, 725 Hyperlactataemia, 196, 197f Hyperlipidaemia check for signs of, 347f classiﬁcation of, 374b drug treatment of, 376f familial combined, 374, 374b mixed, 375, 377–378 in old age, 377b rare forms of, 375b remnant, 375 secondary, 373b treatment of, 376f Hypermagnesaemia, 368 Hypermelanosis, focal, 1258 Hypermobile Ehlers-Danlos syndrome (hEDS), 1059 Hypermobility syndromes, 1059 Hypernatraemia, 358–360 causes of, 359b in old age, 360b Hyperostosis, diffuse idiopathic skeletal, 1058–1059, 1058f Hyperparasitaemia, malaria, 276b Hyperparathyroidism chronic kidney disease and, 418–419 in old age, 665b pain, 663 primary, pregnancy and, 1280 Hyperphosphataemia, chronic kidney disease and, 419 Hyperpigmentation, photo-exposed site,

Hyperprolactinaemia, 684, 684b disconnection, 667 Hyperpyrexia, 276b Hypersensitive carotid sinus syndrome,

Hypersensitivity, 71 allergic rhinitis, 622 drug response, 20b Gell and Coombs classiﬁcation of, 83, 83b patch tests, 1215 prick tests, 1215 type I, 83–84, 85f type II, 83 type III, 83 type IV, 83 Hypersensitivity pneumonitis, 616–617, 617b, 617f Hypersensitivity rashes, 326 Hypersensitivity reaction, deﬁnition of,

Hypersomnolence, 1105, 1105b Hypersplenism leucopenia and, 853 portal hypertension, 868b and thrombocytopenia, 869 Hypertension, 193–194, 396, 508–514, 509b–511b, 509f, 511f–512f accelerated, 514 assessment and management of, 193–194 cocaine, 143 deﬁnition, 509b essential, 509 gestational, 1276, 1276b history, 510 idiopathic intracranial, 1133 investigations, 510 management antihypertensive drugs, 513 British Hypertension Society guidelines, 512f intervention thresholds, 511–512 non-drug therapy, 513 treatment targets, 512–513, 513b in old age, 512b pathogenesis, 509 pathophysiology of, 193 portal, 868–871, 898 ascites and, 869 cirrhosis and, 868 classiﬁcation of, 868f clinical features of, 868–869 complications of, 868b extrahepatic portal vein obstruction,

investigations for, 869 management of, 869–871 pathophysiology of, 869 portopulmonary, 898 pre-eclampsia, 1276–1277 during pregnancy, 1276–1277 classiﬁcation of, 1276b pre-eclampsia and eclampsia in, 1276–1277, 1276b, 1277f pre-existing, 1276 pulmonary, 550, 621–622, 621b, 622f congenital heart disease and, 533 systemic sclerosis and, 1038 renal artery stenosis and, 406 renal disease, 396 AKI, 411–412 chronic, 415 polycystic, 405 reﬂux nephropathy, 430 secondary, 509b in systemic sclerosis, 1038 target organ damage, 510 venous, 1223 white coat, 510, 1276b Hypertensive renal crisis, systemic sclerosis and, 1038 Hyperthermia, malignant, 1145b Hyperthyroidism, pregnancy and, 1279 Hypertrichosis, 1259 drug-induced, 1266b Hypertriglyceridaemia, 374 familial, 374, 374b management of, 377–378 secondary, 373b Hypertrophic cardiomyopathy, 539–540, 540b Hypertrophic obstructive cardiomyopathy, transition medicine and, 1297–1298 Hypertrophic pulmonary osteoarthropathy (HPOA), in lung cancer, 600–601 Hyperuricaemia, 1012–1013 causes of, 1013b chronic, 1014 gout, 1013b Hyperventilation in panic disorder, 1200 psychogenic, 1202 and respiratory alkalosis, 367 Hyperviscosity syndrome, 966 Hypervolaemia, 353–355 clinical features of, 352b hypernatraemia with, 359b hyponatraemia with, 357 Hypnic jerks, 1086 Hypnotics dosage regimens of, 31b in old age, 32b Hypoadrenalism, tuberculosis, 595 Hypoalbuminaemia, nephrotic syndrome and, 395b Hypobetalipoproteinaemia, 375 Hypocalcaemia, 662–663 aetiology of, 662–663 clinical assessment of, 663 differential diagnosis of, 662b ethylene glycol poisoning, 147 hypomagnesaemia and, 368 kidney failure and acute, 414 chronic, 418–419 kidney injury acute, 414 chronic, 418–419 management of, 663, 663b pancreatitis, 838b Hypochlorhydria, 798–799, 944 Hypochlorous acid, 64 Hypochondriacal disorder, 1202 Hypoﬁbrinogenaemia, 922b, 972b Hypogammaglobulinaemia, in vitamin B12 deﬁciency, 944 Hypoglossal (12th cranial) nerve, tests of, 1063b Hypoglycaemia, 738–741 acute treatment of, 740 awareness of, 740 causes of, 740b diabetes, 738–741 drug-induced, 747 emergency treatment of, 741b exercise-induced, 740 malaria, 276b nocturnal, 740 prevention of, 740–741, 741b risk factors for, 740b spontaneous, 676–678, 677f, 738 in old age, 678b symptoms of, 739, 739b Hypogonadism hypergonadotrophic, 653b, 654 hypogonadotrophic, 653, 653b male, 655, 656b, 660b Hypogonadotrophic hypogonadism, 653, 653b Hypokalaemia, 361–362, 464 causes of, 361b chloroquine poisoning, 141b heart failure, 464 hyperaldosteronism, 674 mineralocorticoid excess, 675 periodic paralysis, 1145b Hypomagnesaemia, 368 causes of, 368b management, 368 Hypomania, 1199–1200 Hypomimia, 1113b Hyponatraemia, 357–358, 464, 852–853 adrenal insufﬁciency, 671–672 algorithm for diagnosis of, 359f brain and, 358f causes of, 357b depletional, 672b dilutional, 414 ecstasy/amphetamine misuse, 143 with euvolaemia, 357 heart failure, 464 with hypervolaemia, 357 hypopituitarism, 681–682 with hypovolaemia, 357 in old age, 360b symptoms and severity of, 358b Hypoparathyroidism, 664–665 Hypophosphataemia, 368–369, 369b Hypophosphataemic rickets biochemical abnormalities in, 990b transition medicine and, 1300 Hypophosphatasia, 1053 Hydrocortisone (Continued)

INDEX • 1389 Hypopigmentation, 1257–1258 Hypopituitarism, 681–682, 681b–682b, 681f clinical assessment, 681–682, 681f investigations, 682, 682b management, 682 Hyposmia, 1088 Hypotension, 193 assessment and management of, 193, 193b during dialysis, 424b pathophysiology of, 193, 193b poisoning, 137b postural, 181, 1308–1309 glucocorticoid insufﬁciency, 672b in old age, 32b renal disease, 411–412 shock, 196b treatment of, 1308–1309 Hypothalamus, 679–688, 1066–1067 disease classiﬁcation of, 680b presenting problems in, 681–684 functional anatomy, physiology and investigations of, 679f in old age, 688b therapeutic modalities, 683b thermoregulation and, 165 tumours, 1066–1067 Hypothermia, 165–166, 165f–166f cold water immersion, 166 in old age, 166b Hypothyroidism, 639–642 autoimmune, 637b, 639b causes, 639b clinical assessment of, 639–640, 640f clinical features of, 637b congenital, 639b, 650 iatrogenic, 639b investigations of, 640 laboratory abnormalities, 638b management of, 640–641, 641b with normal thyroid function tests, 641–642 obesity, 654–655 in old age, 650b in pregnancy, 641, 651b, 1279 radiotherapy and, 1298 rheumatological manifestations of,

secondary, 639b spontaneous atrophic, 639b subclinical, 642 transient, 640 transient thyroiditis, 639b Hypoventilation, alveolar, 567, 621b Hypovolaemia, 352–353 causes of, 352b clinical features of, 352b hypernatraemia with, 359b hyponatraemia with, 357 Hypovolaemic shock, description of, 206b Hypoxaemia, 168f acute mountain sickness and, 168 assessment and management of, 191, 191b causes of, 192b cirrhosis, 866–867 high-altitude pulmonary oedema, 168–169 mechanisms of, 192f near drowning accidents and, 169–170 pathophysiology of, 190–191, 191f pulmonary hypertension, 621b Hypoxia altitude illness and, 168 cytopathic, 197f, 198 pancreatitis, 838b respiratory failure, 565b Hypromellose, 1039 Hysterectomy, cancer treatment, 1335 Hysteria, 1126 I Ibandronate, for osteoporosis, 1048b Ibuprofen, 1003b adverse reactions of, 22b Ice cream headache, 1097b Ice pick headache, 1097b Ichthyosis, 1212 Idarucizumab, 940 Idiopathic interstitial pneumonias, 605–608, 606b Idiopathic intracranial hypertension, pregnancy and, 1284 Idiopathic osteoporosis, 1044 Idiopathic Parkinson’s disease, 1112–1114 causes of, 1112b clinical features of, 1112–1113, 1113b non-motor symptoms of, 1112–1113 investigations of, 1113, 1113f management of, 1113–1114 drug therapy, 1113–1114 surgery, 1114 pathophysiology of, 1112, 1112f Idiopathic pulmonary ﬁbrosis, 605–608, 607f Idiopathic pulmonary haemosiderosis, 613b Idiopathic thrombocytopenic purpura (ITP), 971 pregnancy and, 1285 If channel antagonists, angina, 491 Ifosfamide, 365b Ileal resection, 810f under-nutrition and, 706 Ileus meconium, 842 paralytic, 837–838 Illusions, 1181 Iloprost, 622 Imaging for epilepsy, 1101b in gastroenterology, 774b, 774f of gastrointestinal tract, 772–776 for hepatobiliary disease, 853–855 for lung cancer, 601, 601f for musculoskeletal disease, 988–990 neuroimaging, 1151, 1151f, 1157–1158 of renal tract, 389–390 of respiratory system, 551–553 vascular, 1151, 1152f Imatinib, 1332 acute leukaemia, 957b chronic myeloid leukaemia, 958 for GIST, 805 Imidazoles, 125b, 126 Imipenem, 120b nocardiosis, 261 Imipramine, 611b irritable bowel syndrome, 825 neurogenic bladder, 1094b Imiprothrin, 148b Imiquimod for lentigo maligna, 1233 for molluscum contagiosum,

for skin cancer, 1230, 1230b for viral warts, 1239 Imiquimod cream, for anogenital warts,

Immersion foot, 167 Immotile cilia syndrome, 578b Immune deﬁciency, 77–81 autoimmune lymphoproliferative syndrome and, 80 common variable, 79 complement pathway deﬁciencies in,

consequences of, 77 investigations of initial, 74b specialist, 74b primary, warning signs of, 73b primary antibody deﬁciencies in, 78–79, 78f, 79b primary phagocyte deﬁciencies in, 77–78, 77f primary T-lymphocyte deﬁciencies and, 79–80, 80f secondary, 80–81, 80b Immune disorders anaphylaxis and, 75–76 common causes of, 75b intermittent fever and, 74 presenting problems of, 73–76 recurrent infections and, 73 Immune reconstitution inﬂammatory syndrome (IRIS), 104, 325–326 Immune response modiﬁers, 1226 Immune responses, in lower airway defences, 550 Immune senescence, 80–81, 81b Immune serum globulin, for hepatitis A, 872–873 Immune system adaptive, 67–70 cellular immunity and, 69–70, 69f immunoglobulins and, 68–69, 68b, 68f lymphoid organs and, 67 innate, 62–67 complement and, 66 cytokines and, 64–66, 65b, 65f dendritic cells in, 64 integrins and, 66 mast cells and basophils, 66–67 natural killer cells and, 67 phagocytes in, 63–64, 63f physical barriers in, 62–67 regulation of, 851 Immunisation, 114–115, 115b for chickenpox, 239 for cholera, 265 for diphtheria, 266 Haemophilus inﬂuenzae, 115b for hepatitis A, 872–873 for hepatitis B, 876, 876b for HIV infection/AIDS, 324 for human papillomavirus, 343 for inﬂuenza, 241 for meningococcal infection, 1120 for mumps, 240 for plague, 259 for pneumococcal infection, 266 for poliomyelitis, 1123 primary antibody deﬁciencies and,

for rabies, 1122 for rubella, 266 for tetanus, 1126 for tuberculosis, 595 for typhoid fever, 261 for whooping cough, 582 whooping cough (pertussis), 115b for yellow fever, 245 see also Vaccines/vaccination Immunity adaptive humoral immunity and, 67–68 cellular, 67, 69–70, 69f humoral, 67–68 Immunoblot (Western blot), 107 innate, 769 Immunoblot (Western blot), 107 Immunobullous disease, drug-induced, 1266b Immunochromatographic rapid diagnostic tests (RDTs), 276 Immunochromatographic tests, 108 Immunocompromised host, fever in, 223–224 Immunocompromised patient, pneumonia in, 587 Immunodiffusion, 108 Immunoﬂuorescence assays, 107 anti-endomysial antibodies of, 807 Immunoglobulin(s), 68–69, 68b, 68f,

for idiopathic thrombocytopenic purpura, 971 intravenous Guillain-Barré syndrome, 1140 myasthenia gravis, 1142b myositis, 1040 thrombocytopenia, 971 toxic shock syndrome, 252 prophylactic, 115b reference range of, venous blood, 1360b Immunoglobulin A (IgA), 68b deﬁciency, selective, 78–79 linear IgA disease, 1255b, 1256–1257 nephropathy, 398b–399b, 400 reference range of, venous blood, 1360b Immunoglobulin D (IgD), 68b hyper-IgD syndrome, 81 Immunoglobulin E (IgE), 68b, 1215 reference range of, venous blood, 1360b serum total, for allergy, 86 speciﬁc tests, for allergy, 86 Immunoglobulin G (IgG), 68b anti-HBc, 875b antibody, functional deﬁciency in, 79 cerebrospinal ﬂuid, 1361b reference range of, 1360b rubella-speciﬁc, 236 Immunoglobulin M (IgM), 68b anti-HBc, 875b cold agglutinin disease, 950 reference range of, venous blood, 1360b Immunoglobulin replacement therapy, for primary antibody deﬁciencies,

Immunohistochemistry, tumour identiﬁcation, 1322 Immunological memory, 69 Immunological tests, 1077 antibody-independent speciﬁc, 109 for hepatobiliary disease, 853 for respiratory disease, 554 Immunoproliferative small intestinal disease (IPSID), 813 Immunosuppressants for skin disease, 1227–1228 for systemic lupus erythematosus,

Immunosuppression liver transplantation and, 901 myasthenia gravis, 1142b in transplant complications of, 89–90 drugs used in, 89b Immunosuppressive agent, for autoimmune hepatitis, 886 Immunotherapy antigen-speciﬁc, for allergy, 86 cancer, 1332 myasthenia gravis, 1142b Impaired glucose tolerance, 374, 1360b Impetigo, 1235–1236 non-bullous, 1235f Implantable cardiac deﬁbrillators, 467, 483–484, 483b for acute coronary syndrome, 501 Impotence see Erectile dysfunction Imprinting, 49–50, 51b Incidence of disease, microbiological sampling, 105b Incident pain, 1350b Incidental adrenal mass, 673–674 Incidental pancreatic mass, 844 ‘Incidentalomas’, 633b Inclusion body myositis, 1059 Incontinence continual, 437 faecal, 1094 overﬂow, 437, 1093 stress, 436 of stroke patients, 1159b urge, 436–437, 1093 urinary, 397, 436–437 older people, 436b, 1309–1310, 1310f Increased intra-abdominal pressure, 791 Incremental cost-effectiveness ratio (ICER), 28 ‘Incretin’ effect, 723–724, 724f Indirect antiglobulin tests, 948f Indocyanine angiography, of visual disorders, 1169 Indometacin, 1003b for paroxysmal headache prevention,

for pericarditis, 542 for persistent ductus arteriosus, 534

1390 • INDEX Inductively coupled plasma/mass spectroscopy, 348b Infection(s), 215–304, 930 in adolescence, 234, 235b agents of, 100–102, 100b bacterial, 250–273 after HSCT, 937b chlamydial, 272–273, 272b gastrointestinal, 262–265 with neurological involvement, 267 respiratory, 265–267 rickettsial, 270–272, 271b of skin, 1235–1238 soft tissues and bones, 250–254 systemic, 254–262 caused by helminths, 288–299, 288b central venous catheter, 225–226 chain of, 100f chlamydial, 340–341 in men, 340 in reactive arthritis, 1031 treatment of, 341b urethritis, 333 in women, 340–341 clinical examination of, 216–218, 216f, 217b common infecting organisms, 117b constitutive barriers to, 63 control, 111–115, 112b cytomegalovirus, 238b, 242–243 after HSCT, 937b clinical features of, 242–243 encephalitis, 320 investigations of, 243 liver transplantation and, 901 management of, 243 polyradiculitis, 321 in pregnancy, 235b viral hepatitis and, 878 deﬁnition of, 100 deliberate release, 111 emerging and re-emerging disease, 110, 110f endemic disease, 110 epidemiology of, 110–111 Epstein-Barr virus, 238b, 241–242 clinical features of, 241–242 complications of, 241–242, 242b investigations of, 242 management of, 242 Escherichia coli, 263–264 entero-aggregative, 263–264 entero-invasive, 263 enterohaemorrhagic, 263–264 enteropathogenic, 263 verocytotoxigenic, 263f fungal, 300–304, 300f after HSCT, 937b skin, 1239–1240, 1240f subcutaneous, 300–301 superﬁcial, 300 systemic, 301–304 gastrointestinal tract function of, 777–778, 777b oral cancer, 790 test of, 777 geographical and temporal patterns of, 110 history-taking in, 217b HIV/AIDS, 305–327 antiretroviral therapy for, 324–327, 324b asymptomatic, 312, 312f CD4 counts in, 311 chemoprophylaxis for, 323–324 clinical examination of, 306f clinical manifestations of, 311–312 counselling for, 311b diagnosis of, 310–311, 310b epidemiology of, 308 global and regional epidemics of, 308, 308b immunisation for, 324 immunology of, 309–310 investigations of, 310–311, 311b life cycle of, 309f liver and, 879 liver blood tests in, abnormal, 879b modes of transmission of, 308, 308b–309b musculoskeletal manifestations of, 1021b in old age, 326b pregnancy and, 1280 presenting problems of, 312–322, 313b prevention of, 323–324, 327b primary, 311–312, 312b pruritus and, 1219b staging classiﬁcations of, 307b testing of, 330 tuberculosis and, 595 viral load in, 311 virology of, 309–310 host-pathogen interaction of, 104 incubation periods of, 111b investigation of, 105–109, 105b culture, 106 direct detection of pathogens, 105–106 joints, 1019–1021 in old age, 1020b of liver, 871–880 liver transplantation and, 901 microbiological sampling, 105b mycobacterial, 267–270 nematode, 233b intestinal, 288–290 tissue-dwelling, 290–293, 290b zoonotic, 293–294 in non-immune haemolytic anaemia,

normal microbial ﬂora, 102–103, 103f of oesophagitis, 794 outbreaks of, 114 reporting, 114b terminology, 114b parvovirus B19, 237 clinical features of, 237, 237b, 237f diagnosis of, 237 management of, 237 in pregnancy, 235b periods of infectivity, 111b in pregnancy, 234, 235b presenting problems in, 218–234 prevention, 111–115, 112b protozoal, 273–288 gastrointestinal, 286–288 leishmaniasis, 281–286 systemic, 273–281 recurrent, 73 reservoirs of, 110 animal, 110 environmental, 110 human, 110 respiratory, 581–598 in old age, 586b pneumonia, 582–587 pregnancy and, 1277 tuberculosis (TB), 588–595 upper respiratory tract infection, 581–587 rubella clinical features of, 236 congenital malformation and, 237b diagnosis of, 236 in pregnancy, 235b prevention of, 236–237 sexually transmitted, 329–344 approach to patients, 332–333, 332b in children, 332–333 contact tracing for, 333 HIV testing for, 330 management goals of, 331b in men, 330, 330b, 330f men who have sex with men, 330b, 334–335 during pregnancy, 332 presenting problems of, men, 333–336, 333f–334f prevention of, 336–337 those at particular risk, 331b viral, 341–344 in women, 331, 331b, 331f skin, 1235–1241 bacterial, 1235–1238 fungal, 1239–1240, 1240f mycobacterial, 1237–1238 tropical, 234, 234b, 235f viral, 1238–1239 of small intestine, 812–813 soft tissue, 226–227 necrotising, 227b staphylococcal, 250–252, 251f cannula-related, 251–252, 251b methicillin-resistant Staphylococcus aureus, 252 skin, 251 staphylococcal toxic shock syndrome, 252, 252f wound, 251, 251f starvation-associated, 705b supportive therapy for, 957 transmission of, 100f, 111 tropical, 230–234, 230b urinary tract, 426–431 antibiotic regimens for, 429b investigation of, 428b in old age, 428b persistent or recurrent, 429, 429b risk factors for, 428b in stroke patients, 1159f viral, 236–250 gastrointestinal, 249 with neurological involvement, 249–250 respiratory, 249 with rheumatological involvement,

sexually transmitted, 341–344 of skin, 247–249, 1238–1239 Infection-related glomerulonephritis, 398b–399b, 401 Infectious conditions, in ophthalmological conditions, 1173–1174 Infectious disease genomics in, 58 pathogenesis of, 104, 108f periods of infectivity in, 111b principles of, 99–129 treatment of, 116–129, 119b Infectious keratitis/corneal ulceration, 1173, 1174f common causes of, 1173b Infectious mononucleosis, 241–242 causes of, 241b clinical features of, 241–242, 242f investigations of, 242 management of, 242 Infective endocarditis, 527–531, 528b, 531b acute, 529 antimicrobial treatment of, 530b in old age, 527b post-operative, 529 prevention of, 531 subacute, 528–529, 529b, 529f Inferior petrosal sinus sampling, bilateral, 670f Inferior vena cava, 384, 444f Infertility, 656–657, 656b cytotoxic medications and, 1298 in polycystic ovarian syndrome, 659 Infestations, skin, 1241 Inﬂammation acute, 70–71, 71f cancer, 1319–1320 chronic, 71 laboratory features of, 71–72 resolution, 71 systemic, 196–198 Inﬂammatory bowel disease (IBD), 813–824 childhood, 823 clinical features of, 816–817 complications of, 818, 818f differential diagnosis of, 817, 817b disease distribution in, 815f investigations of, 818–820, 819f management of, 820–823 metabolic bone disease and, 824 microscopic colitis and, 824 monitoring of, 822b pathogenesis of, 815f pathophysiology of, 814–816, 814b in pregnancy, 823–824, 824b, 1278 systemic complications of, 819f transition medicine and, 1299–1300 treatment of, 821b Inﬂammatory molecules, 64 Inﬂammatory myopathy, 1042b Inﬂammatory response, 70–72 acute inﬂammation and, 70–71, 71f acute phase response in, 70 resolution of, 71 septic shock and, 70–71 chronic inﬂammation and, 71 laboratory features of, 71–72 C-reactive protein as, 72 erythrocyte sedimentation rate and,

plasma viscosity as, 72 Inﬂammatory rheumatic diseases biologics for, 1006, 1006f, 1007b in pregnancy, 1280–1281 anti-phospholipid syndrome as,

rheumatoid arthritis as, 1280 systemic lupus erythematosus as, 1281, 1281b systemic sclerosis as, 1280–1281, 1281b Inﬂiximab for inﬂammatory bowel disease, 821b,

for musculoskeletal disease, 1007b in pregnancy, 1278 Inﬂuenza, 240–241 avian, 241 clinical features of, 241 diagnosis of, 241 epidemic, 104 immunisation for, 115b incubation period of, 111b management and prevention of, 241 prophylaxis for, 119b swine, 241 Infraorbital artery, 1168 Infrapatellar bursitis, 999b Inhalation (‘humidiﬁer’) fever, 616b,

Inhalational administration, 17–18 Inheritance autosomal dominant, 46–47 autosomal recessive, 48 mitochondrial, 49 pedigrees, 46f X-linked, 48–49 Inherited cancer predisposition syndromes, 56–57, 57b Inherited metabolic myopathies, 1144, 1144b Inherited thrombophilia, 977–979 Inherited tubulo-interstitial diseases, 404, 404b Inhibin, 633f Inhibitor of kappa B kinase (IKK), 64–66 Innate immune system, 62–67 complement and, 66 cytokines and, 64–66, 65b, 65f dendritic cells in, 64 integrins and, 66 mast cells and basophils, 66–67 natural killer cells and, 67 phagocytes in, 63–64, 63f physical barriers in, 62–67 Inorganic micronutrients, 716–718 Insect bites, 230 Insect stings, allergic reactions, 75b Insect venom allergy, 85 Insecticides carbamate, 146–147 organophosphorus, 145–146, 145b, 145f pyrethroid, 148b Insertions, 42 Insight, lack of, 1183 Insomnia fatal familial, 1127b sporadic fatal, 1127b

INDEX • 1391 Inspiration, of lungs, 548 Insulin adverse reactions of, 22b amino acid structure of, 748–749, 749f manufacture and formulation of, 748–749 metabolic actions of, 723b puberty and, 1290 reference range of, 1359b resistance to, pregnancy and, 1272–1273 secretion of, 724f regulation of, 723–724 synthesis of, 724, 724f Insulin-like growth factor (IGF), 633f, 849f Insulin-like growth factor binding protein (IGF-BP3), 633f Insulin pump, 751, 751f Insulin resistance polycystic ovarian syndrome, 658b in type 2 diabetes, 730–731 Insulin therapy closed loop, 751, 752f for diabetes mellitus, 748–751 dosing regimens in, 750, 750f, 751b subcutaneous, 749–750, 749b for diabetic ketoacidosis, 737 injection sites of, 721b preparations for, duration of action of, 748–749, 749b side-effects of, 750b Insulin tolerance test, for Hypopituitarism, 682b Insulitis, 728, 729f Integrade inhibitors, 324b Integrase, 309–310 Integrins, 66 Intensive care clinical management in, 208–211 blood transfusion in, 211 clinical review in, 208–209 delirium in, 209 extubation in, 210 glucose control in, 210–211 nutrition in, 210 peptic ulcer prophylaxis in, 211 sedation and analgesia in, 209, 209b thromboprophylaxis in, 210 tracheostomy in, 210, 210b weaning from respiratory support in, 209–210 discharge from, 213, 214b withdrawal of active treatment and death in, 213 Intention tremor, 1069 Intercellular adhesion molecule type 1(ICAM-1), 447 Intercostal tube drainage, 626–627, 627f Interferon pegylated, 877 warts, 1239 Interferon-α, 65b Interferon-alfa for hepatitis B, 876 pegylated, for hepatitis C, 878 polycythaemia rubra vera, 970 Interferon-gamma (IFN-γ), 65b in coeliac disease, 806f Interferon-gamma release assays (IGRAs), 594, 594f Interleukin, immune response, 65b Intermediate-density lipoproteins, 371–372 Intermediate syndrome, from OP poisoning, 146 Intermittent claudication, 502 Intermittent positive pressure ventilation, 203–204 International Autoimmune Hepatitis Group (IAIHG) criteria, 886 International normalised ratio (INR), 850,

International Prostate Symptom Score (IPSS), 438b International staging system (ISS), for multiple myeloma, 968 International system of units (SI units),

Interpersonal psychotherapy, 1191 Interphalangeal joints, osteoarthritis in, 1009f Interstitial and inﬁltrative pulmonary diseases, 605–613 diffuse parenchymal lung disease (DPLD), 605–610, 605b, 606f, 607b due to irradiation and drugs, 612–613 due to systemic inﬂammatory disease, 610–611 in old age, 613b pulmonary eosinophilia and vasculitides, 611–612, 611b rare interstitial lung diseases, 613b Interstitial cells of Cajal, 772 Interstitial lung disease, systemic sclerosis and, 1038 Interstitial nephritis acute, 402, 402b, 402f chronic, 402–403, 403b drug-induced, 427b Interstitial pneumonia acute, 606b desquamative, 606b lymphocytic, 606b usual, 608f Interstitial pneumonitis lymphoid, 319 usual, 608f Intertrigo, 300, 1240 Intervertebral disc, 986 prolapse of, 996–997 Intervertebral discs intra-articular, 987 Intestinal defence mechanisms, 770f Intestinal failure (IF), 708–710 causes of, 708–709 classiﬁcation of, 708–709 management of, 709–710, 709b in jejunostomy patients, 709 in jejunum-colon patients, 709 in small bowel and multivisceral transplantation, 710, 710b Intestinal microbiota, 771 Intestinal tapeworm, 298 Intra-aortic balloon pump, 207 Intra-articular discs, 987 Intra-articular glucocorticoids, for musculoskeletal disease, 1005–1006 Intra-articular injections, for osteoarthritis, 1012 Intracellular ﬂuid (ICF), 349 Intracerebral haemorrhage, 1154–1155, 1155f causes of, 1155b Intracranial hypertension, idiopathic,

Intracranial mass lesions, 1127–1133 Intracranial pressure (ICP) measurement of, 208 raised, 1127–1129, 1128b, 1128f Intramuscular administration, 17 Intramuscular androgen replacement therapy, 656b Intramuscular glucocorticoids, for musculoskeletal disease, 1005–1006 Intranasal administration, 17 Intraretinal microvascular abnormalities (IRMAs), 1175 Intravascular haemolysis, 946b, 947 Intravenous administration, 17 Intravenous ﬂuid therapy, 353 Intravenous urography (IVU), 389 for retroperitoneal ﬁbrosis, 434 Intrinsic factor, glycoprotein, 767 Introns, 39f Intubation, 203–204 endotracheal, critically ill patients, 190b, 208 nasogastric, 805b safety during, 203b ventilator modes in, 203, 203f Invasive pulmonary aspergillosis (IPA), 597–598, 598b Involuntary movements, 1069 Iodide, 634 Iodine, 647, 717 deﬁciency, 639b, 647, 717 pregnancy and, 651b, 1279 dietary sources of, 717b radioactive for fetal hypothyroidism, 1279 for Graves’ thyrotoxicosis, 644b,

reference nutrient intake of, 717b for thyroid neoplasia, 649 Iodine-associated thyroid disease, 647–648 Iodine-induced thyroid dysfunction, 647 Iodine therapy, for differentiated carcinoma, 649–650 Iodoquinol, 129 Ion channels, drugs acting on, 15b Ion-selective electrodes, 348b Ionising radiation, 164, 164f Ipratropium bromide, asthma, 572 Irbesartan, 513 Irinotecan, 832, 842–844 Iris, of eye, 1167 Iron, 716–717 absorption/uptake, 716–717 deﬁciency, 717 dietary sources of, 717b overload, 717 haemochromatosis, 717 poisoning from, 140 reference nutrient intake of, 717b reference range of, 1362b supplements congestive gastropathy, 871 constipation and, 786b in pregnancy, 941b Iron deﬁciency anaemia, 923, 940–943 alimentary tract disorders, 793 blood loss in, 940–941 conﬁrmation of, 941–942, 942b investigations in, 941–942 of cause, 942 malabsorption in, 941, 942f management of, 943 physiological demands in, 941, 941b pregnancy and, 1284 Iron oxide, 615b Irritable bowel syndrome (IBS), 824–826 clinical features of, 825, 825b complementary and alternative therapies for, 826b investigations of, 825, 825b management of, 825–826, 826f dietary, 825b pathophysiology of, 824–825 behavioural and psychosocial factors, 824 luminal factors, 825 physiological factors, 824 Irritant eczema, 1247 Ischaemia cerebral, 967f critical limb, 502–503 liver, 898 lower limb, 504b Ischaemic gut injury, 827 Ischaemic heart disease hierarchy of systems applied to, 93b levothyroxine replacement in, 641 Ischaemic nephropathy, 406–407 Ischaemic pain, 1350b Ischaemic penumbra, 1154 Ischiogluteal bursitis, 999b Islet autoantibodies, 727 Islet cell antibodies, in type 1 diabetes, 728 transplantation of, 752, 753f Isocyanates, 614b Isolated gonadotrophin deﬁciency, 653 Isolation precaution, types of, 113b Isoleucine, 698b Isoniazid as antimycobacterial agents, 125 hepatotoxicity, 120b, 894b poisoning, 141b polyneuropathy and, 1139b prophylactic, 119b and pyridoxine deﬁciency, 715 resistance, 118 skin reactions, 1266b tuberculosis HIV/AIDS patients, 324, 324b treatment, 592–593, 593b Isoprenaline, 476–477 AV block, 478 Isosorbide dinitrate, 490b Isosorbide mononitrate, 490b Isotretinoin, 1227 Ispaghula husk, 834 Itch, 1219–1220 ITGB2 gene, loss-of-function mutations in, leucocyte adhesion deﬁciencies and, 77 Itraconazole, 125b, 126 acute leukaemia patients, 957 allergic bronchopulmonary aspergillosis, 596 chromoblastomycosis, 301 cutaneous leishmaniasis, 286 fungal skin infections, 1239–1240 histoplasmosis, 304 mycetoma, 301 P. marneffei infection, 303 prophylactic, 119b sporotrichosis, 301 ITU, referral to, in community-acquired pneumonia, 584b Ivabradine angina, 491 for heart failure, 467 Ivermectin for helminthic infections, 129 ﬁlariasis, 291 for scabies, 1241 for strongyloidiasis, 289 J Jaccoud’s arthropathy, 1035 JAK proteins, 64–66 Janus-activated kinase (JAK) inhibitors, for musculoskeletal disease,

Japanese B encephalitis, 249–250 Jarisch-Herxheimer reaction, 339 Jaundice, 860–862, 860b acute liver failure and, 857–858 alcoholic hepatitis and, 881, 881b cholecystitis and, 905 cholestatic, 860b–862b, 861–862 cirrhosis and, 866–867 hepatocellular, 860–861 investigation of, 861f obstructive, 861–862 pre-hepatic, 860 primary biliary cholangitis and, 887 JC virus, 319–320 Jejunal mucosa, 807f Jejunostomy patients, intestinal failure and, 709 Jejunum coeliac disease see Coeliac disease hormones, 772b short bowel syndrome, 709b Jejunum-colon patients, intestinal failure and, 709 Jellyﬁsh, 154b Jiggers, 299–300 Jod-Basedow effect, 647 Joint capsule, 987 Joint disease crystal-associated, 1012–1018, 1013b, 1013f in tuberculosis, 591 Joint hypermobility syndrome, 1349 Joints, 986–987 aspiration, 988, 988f, 1015, 1017,

ﬁbrous and ﬁbrocartilaginous, 986 haemophilia, 1058 hypermobility, 1059b infection, 1019–1021 neuropathic (Charcot), 1057, 1058f in old age, 1020b protection, 1001

1392 • INDEX replacement arthroplasty, 1002b for osteoarthritis, 1012 synovial, 987, 987f tumours, 1056–1057 types of, 986b Jugular venous pressure, effects of respiration on, 447b Jugular venous pulse examination of, 443b respiratory system, 546f tricuspid regurgitation, 526 Junin and Machupo viruses, 245b Juvenile absence epilepsy, 1100b Juvenile dermatomyositis (JDM), 1040 Juvenile idiopathic arthritis (JIA), 1026–1027 in adolescence, 1027b clinical features of, 1027b oligoarticular, 1300 transition medicine and, 1300 Juvenile myoclonic epilepsy, 1100b Juvenile polyposis, 829 K Kala-azar (visceral leishmaniasis), 282–284, 282f clinical features of, 282 differential diagnosis of, 283 HIV co-infection, 283–284 investigations of, 282–283, 282f management of, 283 post-kala-azar, dermal leishmaniasis, 284, 284f Kallmann’s syndrome, 653 Kaposi’s sarcoma, HIV-related, 315, 316f Kartagener’s syndrome, 550 Karyotype, 38f Kashin-Beck disease, 1011 Katayama syndrome, 295 Kawasaki disease, 1041–1042 Kayser-Fleischer rings, 896–897 in Wilson’s disease, 1174f Kco (transfer coefﬁcient for carbon monoxide), 555b Kearns-Sayre syndrome, 1144b Keloid scar, deﬁnition of, 1226 Kennedy’s disease, 1093b Keratan sulphate, 987 Keratin, 1212 Keratinocytes, 1212 Keratoacanthoma, 1234, 1234f Keratoconjunctivitis sicca rheumatoid arthritis, 1024 Sjögren’s syndrome and, 1038 Keratoderma blennorrhagica, 1031 Keratolysis, pitted, 1238 Keratomalacia, 713 Keratosis, actinic, 1230b Kerion, 1240 Kernig’s sign, 1118 Kerosene, poisoning, 148b Keshan’s disease, 718 Ketamine, 1345b Ketoacidosis, diabetic, 729–730, 735–738 in adolescence, 753b clinical features of, 736, 736b investigations of, 736 management of, 736–738, 737b bicarbonate in, 738 ﬂuid replacement in, 737 insulin in, 737 ongoing, 738 phosphate in, 738 potassium in, 738 pathogenesis of, 735–736, 736b severe, indications of, 736b Ketoconazole, 125b, 126 Cushing’s syndrome, 669 cutaneous leishmaniasis, 286 fungal skin infections, 1239–1240 mycetoma, 301 paracoccidioidomycosis, 304 shampoos, 1240 Ketogenesis, 725f Ketone bodies, 725, 725f Ketones blood, 726, 726b urine, 726 Ketonuria, 726 Ketoprofen, 1003b Kidney acid-base balance control, 364 clinical examination of, 382–384, 382f–383f cystic diseases of, 405–406 drugs and, 426 duplex, 434 functional anatomy and physiology of, 384–386, 385f imaging of, 389–390, 389f MRI images of, 406f single, 433 sodium handling, 349 stones, 431b systemic lupus erythematosus in,

transplantation, 424 tumours of, 434–436 Kidney disease in adolescence, 426b chronic, 415–420, 417b causes of, 415b haemodialysis in, 422–423 indications for dialysis for, 422b osteodystrophy and, 419f physical signs of, 416f pregnancy and, 1282, 1283f pruritus, 415 stages of, 388b staging of, in children over 2 years of age, 1298b transition medicine and, 1298–1299 medullary sponge, 433 Kidney injury, acute, 411–415 causes of, 411f clinical features of, 411–413 dialysis for, indications for, 422b haemodialysis in, 422 investigations of, 412b management of, 413–414, 413b in old age, 414b pathophysiology of, 411 post-renal, 412b, 413 pre-renal, 411–412, 412b pregnancy and, 1282, 1283b recovery from, 414–415, 414f renal, 412–413, 412b renal replacement therapy, 414 Kimmelstiel-Wilson nodule, 758f Kinase inhibitors, for low-grade NHL,

Kinases, cyclin-dependent, 1317 Klebsiella granulomatis, 341b Klebsiella oxytoca, 230 Klebsiella pneumoniae, 116 Klebsiella spp., 103f Klinefelter’s syndrome, 44b, 660–661 Knee osteoarthritis, 1009–1010, 1010f pain, 998–999, 999b rheumatoid arthritis, 1023 Knee height, measurement of, 693b Knudson hypothesis, 56–57 Köbner phenomenon, 1252 Koch’s postulates, 100b Koilonychia, 1261, 1261f Koplik’s spots, 236, 236f Korsakoff’s psychosis, 714 Korsakoff’s syndrome, 1081 Krebs (citric acid) cycle, 49, 714 Krukenberg tumour, 804 Kupffer cells, 64, 848, 850f Kuru, 1127b Kussmaul breathing, 415 Kussmaul’s sign, 544b Kwashiorkor, 704 Kyasanur fever, 245b Kyphoplasty, 1002b for osteoporosis, 1049 Kyphoscoliosis, 546f thoracic, 628 Kyphosis, 591f, 1302f ankylosing spondylitis, 1030 L L-dopa see Levodopa Labetalol aortic dissection, 508 hypertension, 513 accelerated, 514 Laboratory investigations, biochemical, 348–349, 348b Laboratory reference ranges, 1357–1364 of adolescence, 1363 of adults, 1358 of childhood, 1363 in pregnancy, 1364 Labyrinthitis, 1104 Lacrimal gland/lacrimal drainage, 1164 Lactase deﬁciency, 812 Lactate reference range of, venous blood, 1360b sepsis and, 196, 197f Lactate dehydrogenase (LDH) acute kidney injury, 412b empyema, 564 megaloblastic anaemia, 943, 944b pancreatitis and, 837b pleural effusion, 610 reference range of, venous blood, 1360b Lactation, nutrition in, 712b Lactic acidosis, 365 Lactitol, 834b Lactobacillus spp., 103f Lactoferrin, 62–63, 992 in acute phase response, 70 Lactose, refeeding diet, 705b Lactose hydrogen breath test, 812 Lactose intolerance, 812 Lactulose for hepatic encephalopathy, 865 for variceal bleeding, 869b Lacunar infarctions, 1153 Lacunar syndrome (LACS), 1156f Lambert-Eaton myasthenic syndrome (LEMS), 1142f, 1143, 1325–1326 Lamina densa, 1212 Lamina lucida, 1212 Laminin, 1212 Lamivudine, 324b for hepatitis B, 876 co-infection with HIV, 877 resistance, 325 Lamotrigine, 1102b–1103b Langerhans cell histiocytosis (histiocytosis X), 613b Langerhans’ cells, 1212 Language disorders, 1089b spoken, 1070f Lanreotide, 686–687 Laparoscopy for ascites, 863 for infertility, 656 for lower abdominal pain, 336 for pyrexia of unknown origin, 219–222 Large-bowel diarrhoea, HIV-related, 317 Large rectal adenomatous polyp, 828f Laron dwarﬁsm, 680b Larva currens, 289 Larva migrans cutaneous, 294, 294f visceral, 233–234 Laryngeal disorders, 624–625 Laryngeal obstruction, 624–625, 624b Laryngeal paralysis, 624 Laryngoscopy, 553 Lasègue’s sign, 1135 Laser therapy for bleeding control, 775f for colorectal cancer, 832 for hereditary haemorrhagic telangiectasia, 970 for hypertrichosis, 1259 for lung cancer, 603 for oesophageal carcinoma, 797 for proliferative diabetic retinopathy,

for rosacea, 1244 for skin disease, 1228 Lassa fever, 245b incubation period of, 111b Latent autoimmune diabetes of adulthood (LADA), 730 Latent tuberculosis, 1172 detection of, 594, 594f Lateral ﬁlm, of chest X-ray, 551 Lateral humeral epicondylitis, 998b Latex agglutination test, 301 Lavage bronchoalveolar, 609–610 gastric, 136, 136b Law, psychiatry and, 1207 Lawrence-Moon-Biedl syndromes, 700 Laxative misuse syndromes, 834 Laxatives, 834b Lead poisoning, 148b reference range of, venous blood, 1360b Lead pipe rigidity, 1069 Leão, spreading depression of, 1095 Learning difﬁculties, congenital heart disease and, 533 Leber’s hereditary optic neuropathy, 1089b Lecithin cholesterol acyl transferase (LCAT), 375 deﬁciency, 375, 375b Lectin mannose-binding deﬁciency, 78 Lectin pathway, for complement, 66 Leﬂunomide, for musculoskeletal disease, 1004b, 1005 Left anterior descending artery (LAD) and coronary arteries with a stenosis, 453f in coronary circulation, 444–445, 445f Left atrial dilatation, 450 Left bundle branch block, 478–479, 479f Left main coronary artery, 444–445, 445f occlusion, 445 Left ventricular dilatation, 450 Left ventricular hypertrophy, 523f Legal considerations, in artiﬁcial nutritional support, 710b Legionella pneumophila infection, 106, 117b Legionella spp., 114b, 119b Legs examination of, 982f–983f cardiology, 442f diabetes mellitus, 720f endocrine disease, 630f febrile injecting drug user, 222f HIV/AIDS, 306f liver and biliary disease, 846f liver and biliary disease and, 846f oedema and, 395–396 examination of, respiratory system, 546f ulcers, 1223–1224 causes of, 1223b, 1223f clinical assessment of, 1223–1224 due to arterial disease, 1223–1224 due to neuropathy, 1224 due to vasculitis, 1224 due to venous disease, 1223, 1223f investigations in, 1224 management of, 1224 Leigh’s syndrome, 49 Leishman-Donovan body (amastigotes), 282f Leishmania, 281 life cycle of, 281–282, 282f Viannia subgenus, 285 Leishmania aethiopica, 284 Leishmania amazonensis, 285 Leishmania brasiliensis, 285 Leishmania chagasi, 282, 282f Leishmania donovani, 282, 282f Leishmania guyanensis, 285 Leishmania infantum, 282, 282f Joints (Continued)

INDEX • 1393 Leishmania major, 284 Leishmania mexicana, 285 Leishmania tropica, 284 Leishmaniasis, 281–286, 1238 cutaneous, 284–285, 285b, 285f incubation period of, 111b dermal, post-kala-azar, 284, 284f epidemiology and transmission of, 281–282, 281f–282f mucosal, 285 prevention and control of, 284 visceral, 282–284, 282f clinical features of, 282 differential diagnosis of, 283 HIV co-infection, 283–284 incubation period of, 111b investigations of, 282–283, 282f management of, 283 Lemierre’s syndrome, 586–587 Lenalidomide, for multiple myeloma,

Lens, of eye, 1168 Lentigo, 1234 Leprosy, 267–270, 267f borderline cases of, 269 clinical features of, 268–269, 268b, 269f epidemiology and transmission of,

granulomas in, 71 incubation period of, 111b investigations of, 269 management of, 269–270, 269b–270b pathogenesis of, 267–268 patient education of, 270 prevention and control of, 270 prognosis of, 270 reactions, 268–269, 268b tuberculoid, 267–268 Leptin, 694 Leptosphaera senegalensis, 301 Leptospira interrogans, 257 Leptospirosis, 257–259, 880 aseptic meningitis, 257 bacteraemic, 257 clinical features of, 257–258, 258f diagnosis of, 258 icteric, 258 management and prevention of, 258–259 microbiology and epidemiology of,

Lesch-Nyhan syndrome, 1014 Leucine, 698b Leucocyte adhesion deﬁciencies, 77 Leucocytes, 917 Leucocytosis, 926–927 cholecystitis and, 905 choledocholithiasis and, 906 hepatobiliary disease and, 853 in inﬂammation, 71–72 pyogenic liver abscess and, 880 Leucoencephalopathy, progressive multifocal, 1123 HIV-associated, 319–320, 320f Leucoerythroblastic anaemia, 969 Leuconychia, striate, 1260 Leucopenia, 925–926 hepatobiliary disease and, 853 Leukaemias, 954–961 acute, 955–958 haematopoietic stem cell transplantation for, 958 investigations of, 955–956, 956f management of, 956–958 outcome of, 958b prognosis of, 958 speciﬁc therapy for, 956–957, 956b–957b supportive therapy for, 957–958 WHO classiﬁcation of, 955b in children, 1298 chronic lymphocytic, 959–960 clinical features of, 959 investigations of, 959–960 management of, 960 prognosis of, 960 staging of, 960b chronic myeloid, 958–959 accelerated phase, management of, 959 blast crisis, management of, 959 characteristics of, 958 chronic phase, management of, 959, 959b clinical features of, 958 investigations of, 959 management of, 959 natural history of, 958 epidemiology and aetiology of, 954–955 hairy cell, 960 prolymphocytic, 960 risk factors for, 955b terminology and classiﬁcation of, 955, 955b Leukoplakia, hairy, 316 Leukotriene receptor antagonists, asthma, 571f, 572 Leukotrienes, 66–67 Levator palpebrae superioris, 1164 Levetiracetam, 1100b in pregnancy, 1103b Levodopa adverse reactions, chorea, 1085 for Parkinson’s disease, 1113–1114 Levoﬂoxacin, 117b, 123b plague, 259 Levothyroxine hypothyroidism management, 640–641, 641b in ischaemic heart disease, 641 Lewy body dementia, 1194 Leydig cell tumours, 439 LH see Luteinising hormone Li-Fraumeni syndrome, 1321b Libman-Sacks endocarditis, 1035 Lice body, 1241 head, 1241 pubic (crab), 1241 relapsing fever, 256b, 257, 257f Lichen planus, 1252 clinical features of, 1252, 1252f investigations of, 1252 management of, 1252 in nails, 1261 pathogenesis of, 1252 rash, 334b rash in, 1217b vulval pain/itch, 336b Lichen sclerosus, 334b, 336b Lichen simplex, 1247 Lichenoid eruptions, drug-induced, 1252, 1266b Liddle’s syndrome, 361 Lidocaine arrhythmias, 480, 480b effect in old age, 32b in renal/hepatic disease, 32b Life course, 93 Life expectancy, 92, 1304, 1304b Life support advanced, 457, 458f basic, 456–457, 457f Lifestyle advice, for obesity, 701 Lifestyle changes for chronic kidney disease, 420 for dyslipidaemia, 375 Lifestyle factors ageing, 1305 cancer, 1316 diabetes mellitus, 743–745 weight management, 744 Lifestyle interventions, for musculoskeletal disease, 1000–1001 in gout, 1016 in osteoarthritis, 1012 Ligaments, 987 Ligand assay, 348b Likelihood ratios (LR), 3, 3f Limb girdle dystrophy, 1143b Limbic encephalitis, 1111b Limbic (emotional) inﬂuences, in control of breathing, 549 Limbic system, 1066 Limbs lower see Legs upper see Arms Linagliptin, 747 Lincomycin, 29 Lincosamides, 122 antibiotics, 121–122 mechanism of action, 116b Lindane, 148b Linear accelerators, 1331 Linear IgA disease, 1255b, 1256–1257 Linezolid, 117b, 124 in pneumonia, 587 in pregnancy, 120b Linitis plastica, 804 Linoleic acid, 697 Linolenic acid, 697 Lipase, 770b Lipid emulsion therapy, 136–137 Lipid-lowering therapy for acute coronary syndrome, 501 chronic kidney disease, 420 for dyslipidaemia, 375 Lipid peroxidation, 1305 Lipids, 370–378 acute kidney injury and, 416b cardiovascular disease and, 373 dietary, 371 endogenous, 372f measurement, 373 metabolism, 370–378, 850 disorders of, 370 effects of insulin in, 723b presenting problems in, 373–375 transport, 372f see also Fats Lipodermatosclerosis, 1223 Lipodystrophy, 326, 326f Lipohypertrophy, 721b Lipolysis, 694 Lipomas skin, 1235 small intestine and, 813 Lipopeptides, 123 Lipoprotein lipase, 371–372 deﬁciency, 374b Lipoproteins high-density (HDL), 1360b intermediate-density, 371–372 low-density, 371–372 metabolism, 370–378 structure of, 371f very low-density, 371–372 Liquorice, excessive intake of, 361 Liraglutide, for obesity, 702–703, 702f Lisch nodule, 1132b Lisinopril heart failure, 466b hypertension, 513 Listeria monocytogenes bacterial meningitis from, 1119 listeriosis from, 259 Listeriosis, 259–260 in pregnancy, 235b Lisuride, for Parkinson’s disease, 1114b Lithium for cluster headache, 1096 drug interactions of, 24, 24b hypothyroidism and, 639b nephrotoxicity, 427b plasma interactions of, 36b poisoning from, 139 prescribing, 32b skin reactions, 1266b teratogenesis, 1200 Lithium carbonate, for bipolar disorder,

Livedo reticularis, 1035, 1036f Liver abscess, 879–880, 893 amoebic, 880 in old age, 901b pyogenic, 879–880, 880b biopsy of, 855, 855b for hepatocellular carcinoma, 891 for non-alcoholic fatty liver, 884 blood supply to, 848–849, 848f cells see Hepatocytes drugs and, 893–895 fatty alcoholic, 881, 881b non-alcoholic, 882–885, 883f, 885f ﬁbrosis of, 894 cirrhosis and, 866, 866f congenital, 868f, 902 non-invasive markers of, 855 pathogenic mechanisms in, 849f function of, 850–851, 850f functional anatomy and physiology of, 848–851 HIV infection and, 879 infections of, 871–880 injury to drug-induced, 894–895, 894b types of, 894–895 ischaemia, 898 nodular regenerative hyperplasia of,

size of assessment for, 847b change in, causes of, 862b structure of, 848–849, 848f transplantation of, 900–901 for acute liver failure, 858–859 for alcoholic liver disease, 882 for Budd-Chiari syndrome, 899 for cirrhosis, 867 complications of, 901 for hepatic encephalopathy, 865 for hepatitis B, 876 for hepatitis C, 878 for hepatocellular carcinoma, 891 indications and contraindications for, 900–901, 900b, 901f living donor, 901 orthotopic, 890 for primary biliary cholangitis, 888 for primary sclerosing cholangitis,

prognosis for, 901 split liver, 901 for Wilson’s disease, 897 tumours, metastatic, 1328–1329 Liver capsule pain, 1350b Liver disease abdominal signs in, history and signiﬁcance of, 847 alcoholic, 880–882 fatty, 881 liver function test (LFT) abnormality in, 854b in old age, 901b risk factors for, 880 autoimmune, 885–890 bleeding, 975 chronic, 853b hepatitis B and, 873 cirrhosis see Cirrhosis clinical examination for, 846f clinical features of, 847b cystic, 893, 893f decompensated, 867 drug-induced, liver function test (LFT) abnormality in, 854b HIV-related, 317–318 hydatid cyst and, 880 inherited, 895–897 haemochromatosis as, 895–896 investigation of, 852–855, 852b in old age, 901b pregnancy and, 899–900, 1283–1284 acute fatty liver as, 1283, 1283b obstetric cholestasis as, 1284 viral hepatitis as, 1284 prescribing in, 32, 32b presentation of, 856b presenting problems of, 855–866, 856f pruritus and, 1219b silent presentation of, 847b tumours as, 890–893 benign, 893 primary malignant, 890–892 secondary malignant, 892–893, 893f vascular, 898–899 Wilson’s disease and, 896

1394 • INDEX Liver failure acute, 856–859 adverse prognostic criteria in, 858b causes of, 856f–857f classiﬁcation of, 857b clinical assessment of, 857–858 complications of, 858b hepatic encephalopathy and, 857b hepatitis A and, 873 investigations for, 858, 858b management of, 858–859, 858b pathophysiology of, 857 chronic causes of, 856f, 867b cirrhosis and, 867 fulminant, hepatitis B and, 875 hepatic encephalopathy, 856–857 Liver ﬂukes, 233b, 297, 297b Liver function tests, 852 abnormal, 859–860, 859b asymptomatic, 859f HIV infection and, 879b identifying the cause of, 854b in pregnancy, 900b cholestatic/obstructive, 853b for gastrointestinal bleeding, 781 hepatitic, 853b for hepatitis C, 877 Loa loa, 233b, 290b, 292 Loading dose, 19 Local glucocorticoid injections, for ankylosing spondylitis, 1031 Localised lymphadenopathy, 927 ‘Locked-in’ syndrome, 211 Lockjaw, 1126 Lofexidine, 1196 Löfgren’s syndrome, 608–609 Loiasis, 233b, 292 Loin pain, 396 Long QT syndrome, 476 Long-term domiciliary oxygen therapy (LTOT), for chronic obstructive pulmonary disease (COPD), 577 Loop diuretics, for hypervolaemia, 354–355 Loop of Henle, 350, 384–386 Looser’s zones, 1052 Loperamide for faecal incontinence, 835 for inﬂammatory bowel disease, 821b intussusception and, 230 for irritable bowel syndrome, 826f for radiation enteritis, 810 for short bowel syndrome, 808–809 for small bowel bacterial overgrowth, 808–809 Lopinavir, 324b Loratadine, 622, 1254 Lorazepam disturbed behaviour, 1189f palliative care, 1353 status epilepticus, 1081b Loricrin, 1212 Losartan, 58 Loss-of-function mutations, 44 Loss of vision, of ophthalmic disease, 1170–1171, 1170b Lotions, 1225b Louse-borne relapsing fever, 256b, 257, 257f Low back pain assessment of, 988–989 causes of, 996b mechanical, features of, 996b radicular, 997b Low birth weight, and disease susceptibility, 93 Low-density lipoproteins, 371–372 Low-dose dexamethasone suppression test (LDDST), in Cushing’s syndrome, 668 Low-grade tumours, 961 Low-molecular-weight heparins (LMWHs), 922, 938–939, 938b for venous thromboembolism, 975 Low mood, 1185–1186 alcohol misuse and, 1194 Lower airway defences, 550 Lower limbs examination, diabetes mellitus, 721b ischaemia, 504b see also Foot/feet; Legs Lower oesophageal sphincter, abnormalities of, 791 Lubiprostone, 825 Lumbar canal stenosis, 1135–1136 Lumbar disc herniation, 1135, 1135f Lumbar nerve root compression, 1135f Lumbar puncture, 1077–1078 for meningitis, 1118 for stroke, 1152 for viral encephalitis, 1118 Lumbar spondylosis, 1135–1136 Lumbosacral plexopathy, 1141 Lumefantrine, for malaria, 128 Lumps, skin, 1216 Lung(s) abscess, 170f, 219f, 251f biopsy in interstitial pneumonias, 607 pleural effusion, 563–564 cavitation of, 551b collapse by bronchial obstruction, 552f upper lobe, 547f consolidation of, 551b defences, 550, 550f ﬁbrosis see Pulmonary ﬁbrosis functional anatomy and physiology of, 548–550, 548f–549f gas exchange in, 549–550, 549f inﬂammatory arthritis in, 994b innate response of, 550 irradiation and, 612–613 mechanics, 549 near drowning accidents and, 169 near-drowning victims, 169 shrinking, 610b, 611 systemic lupus erythematosus in,

transplantation, 567, 567b tumours of, 598–605 metastatic, 1328 primary, 599–603 secondary, 603 volumes, 555 Lung cancer, 599–603, 599f burden of, 598b cell types in, 599b clinical features of, 599–601 investigations of, 601–602 management of, 602–603 non-metastatic extrapulmonary manifestations of, 601b occupational, 618 pathology of, 599, 599f prognosis for, 603, 603b Lung disease alveolar microlithiasis, 613b proteinosis, 613b diffuse parenchymal, 605–610 drug-induced, 612–613, 612b due to organic dusts, 616–617, 616b due to systemic inﬂammatory disease, 610–611 dust exposure and, 614–615, 615b HIV-related, 318–319, 318b infection, 581–598 interstitial, 605–613 investigation of, 550–556 obstructive, 573–578 in old age, 578b occupational, 613–619 presenting problems of, 556–567 radiotherapy-induced, 612 rheumatoid arthritis, 1024 tumours, 598–605 secondary, 603 vascular, 619–622 Lung ﬂukes, 233b Lung injury, ventilator-induced, 204 Lupus anticoagulant, 920–921 Lupus erythematosus, 1221b, 1262 bullous, 1255b drug-induced, 1266b systemic, 410–411, 1034–1037 classiﬁcation of, criteria for, 1036b clinical features of, 1035–1036 investigations of, 1036 management of, 1036–1037 pathophysiology of, 1034 pregnancy and, 1281, 1281b respiratory involvement in, 611 Lupus nephritis, 392b Lupus pernio, 609f, 610 Luteinising hormone (LH) deﬁciency, 680b puberty and, 1290 reference range of, 1359b Lyme disease, 255–256, 256b, 256f,

myopericarditis, 538 Lymecycline, 1243 Lymph node biopsy, in Hodgkin lymphoma, 962, 963f Lymph nodes, 67 diphtheria, 266 of envenomed patient, 152f examination of, cancer, 1314, 1315b normal architecture of, 961, 961f trypanosomiasis, 279 tuberculosis and, 590 Lymphadenitis, 590 Lymphadenopathy, 913b, 927, 927b HIV-related, 313 persistent generalised, 313 rheumatoid arthritis, 1024–1025 Lymphangiectasia, intestinal, 811 Lymphangioleiomyomatosis, 613b Lymphangitic carcinomatosis, 603 Lymphatic ﬁlariasis, 290–292 Lymphatics, 67 Lymphocytes, 917, 926b, 926f count, 1362b older people, 923b see also B lymphocytes; T lymphocytes Lymphocytic interstitial pneumonia, 606b Lymphocytosis, 926b, 927 infectious mononucleosis, 241 Lymphogranuloma venereum (LGV), 341b Lymphoid interstitial pneumonitis, 319 Lymphoid organs, 67 Lymphoid tissue gastrointestinal mucosa-associated, 769–770 mucosa-associated, 67 Lymphomas, 650, 961–966, 961f B-cell, 805 cutaneous, 1232 gastric, 805 gastrointestinal tract and, 813 Hodgkin, 961–964, 962f classiﬁcation of, 962b clinical features of, 962 epidemiology of, 961, 962b investigations of, 962, 963f management of, 962–964 prognosis of, 964, 964b stages of, 962b MALT, 769–770 non-Hodgkin, 964–966, 965f clinical features of, 964, 965f epidemiology of, 964, 964b high-grade management of, 966 investigations of, 964–965 low-grade management of, 965 management of, 965–966 prognosis of, 966 primary CNS, 320, 320f T-cell cutaneous, 1224 enteropathy-associated, 813 thyroid, 646 Lymphopenia, 925–926, 926b HIV infection, 311–312 sarcoidosis and, 609–610 Lymphoproliferative syndrome, autoimmune, 80 Lynch’s syndrome, 46 d-Lysergic acid diethylamide, 144, 144f Lysine, 698b Lysolecithin, 905 Lysosomal storage diseases, 370, 371b Lysosomes, 370 Lysozyme, 62–63 M Machado-Joseph disease, genetics, 43b Machupo virus, 245b Macrocytic anaemia, 925 Macrocytosis, 853, 921f, 941f Macroglobulinaemia, Waldenström, 966 Macrolides, 117b, 121–122 mechanism of action, 116b Macronutrients (energy-yielding nutrients), 695–697 dietary recommendations for, 697, 698b Macrophage colony stimulating factor (M-CSF), 1022–1023, 1022f Macrophages, 64, 550 alveolar, 303, 615 foamy, 430, 809 functions of, 64b in gastrointestinal tract, 769–770 Macroprolactin, 684 Macroprolactinaemia, 684, 684b Macroprolactinomas, pregnancy and,

Macules café au lait, 1131f deﬁnition of, 1211f Maculopathy, diabetic, 721 Maddrey score, 882 Madopar, 1113 Madura foot, 301 Madurella grisea, 301 Madurella mycetomatis, 301 Magic (hallucinogenic) mushrooms, 143,

Magnesium, 718 dietary sources of, 717b homeostasis, 367–368 intravenous acute severe asthma, 573 arrhythmias, 140 tetany, 663b torsades de pointes, 476–477 metabolism, disorders of, 367–368 refeeding diet, 705b reference nutrient intake of, 717b reference range of, venous blood, 1360b Magnesium ammonium phosphate stones, 431b Magnesium chloride, 368 Magnesium salts, 368 Magnesium sulphate asthma, 573f hypomagnesaemia, 368 pre-eclampsia, 1276 ventricular tachycardia, 137b Magnetic resonance angiography (MRA) in nervous system, 1072 renal artery stenosis, 407, 407f stroke, 1157b urinary tract disease, 389 Magnetic stimulation, 1077 Magnifying glass, 1214 Main d’accoucheur, 663 Main en lorgnette, 1033 Major haemorrhage, transfusion in, 931b Major histocompatibility complex (MHC), 851, 1028–1029, 1248 Malabsorption, 783–785, 784f, 785b, 942f after gastric resection, 783–785 after ileal resection, 706 biliary cirrhosis, 888 of chronic pancreatitis, 841 cystic ﬁbrosis, 581 disorders causing, 805–810 investigations of, 785, 785b, 785f iron deﬁciency anaemia, 941, 942f in old age, 808b pathophysiology of, 784–785 primary biliary cholangitis and, 888 Maladie de Roger, 535–536

INDEX • 1395 Malar ﬂush, 442f Malar rash, of systemic lupus erythematosus, 1035f Malaria, 273–277 algid, 276b cerebral, 276b chemoprophylaxis of, 277, 278b clinical features of, 274b, 275–276, 275f complicated, 277 control in endemic areas, 277 distribution of, 273f exchange transfusion, 277 haemolysis, 274–275 incubation period, 111b, 274b investigations of, 276 management of, 277, 277b mild, 277 non-falciparum, 277 pathogenesis of, 273–275 pathology of, 274–275 in pregnancy, 235b prevention of, 277 sickle-cell anaemia, 951 treatment of, 128 vector control, 323 Malarial parasite, life cycle of, 273–274, 274f Malarone, 278b Malassezia, 103f, 1240 Malassezia furfur, 1240 Malathion louse infestation, 1241 scabies, 1241 Male hypogonadism in, 655, 656b, 660b reproductive system of, 651, 651f Malignancy, pruritus and, 1219b Malignant disease, rheumatological manifestations of, 1057, 1057b Malignant hyperpyrexia, 195 Malignant plasma cells, 967 Malingering, 1206 Mallory-Denk bodies, 884 Mallory-Weiss syndrome, 177b Mallory-Weiss tears, 781f Mallory’s hyaline, 884 Malnutrition in dementia, 711, 711f risk of, screening for, 693f see also Under-nutrition MALT (mucosa-associated lymphoid tissue), 769–770 MALT lymphomas, 964 Malt worker’s lung, 616b Mammary artery grafts, 491–492 Mammography, 1333 Manganese, 718 Mania, 1186 Mannitol, 355 Mannose-binding lectin deﬁciency, 78 Mansonella perstans infection, 233b,

Mansonella streptocerca, 290b Mantle cell lymphoma, 964 MAOI-B inhibitors, for Parkinson’s disease, 1114 Maple bark stripper’s lung, 616b Marasmus, 704 Maraviroc, 324b Marburg fever, 230, 245b March haemoglobinuria, 950 Marche à petits pas, 1087 Marcus Gunn pupil, 1092b Marfan’s syndrome, 508 cardiovascular system aortic aneurysm, 505, 506f aortic dissection, 506, 507b mitral valve prolapse, 520 congenital defects, 531–532 mutation, 508 Marine poisonous animals, envenomation of, 162 Marine venomous animals, envenomation of, 162 Marjolin’s ulcer, 1021, 1223 Mass spectroscopy (MS), 348b inductively coupled, 348b Massive small bowel resection, under-nutrition and, 706 Mast cell tryptase, 86 Mast cells, 66–67 degranulation of, clinical features of, 75b Mastectomy, 1334 Maternal medicine, 1269–1285 adrenal disease in, 1280 cardiac disease in, 1282 clinical evaluation in, 1271, 1271f clinical examination in, 1270, 1270f–1271f diabetes in, 1278–1279 gestational, 1278, 1278b endocrine disease in, 1279–1280 functional anatomy and physiology in, 1272–1273 bone metabolism and, 1272 cardiovascular system and, 1272 endocrine system and, 1272 gastrointestinal system and, 1272 genitourinary system and, 1272 glucose metabolism in, 1272–1273 haematological system and, 1273 respiratory system and, 1273 gastrointestinal disease in, 1277–1278 haematological disease in, 1284–1285 human immunodeﬁciency virus infection in, 1280 hypertension in, 1276–1277 imaging and, 1274 inﬂammatory rheumatic disease in, 1280–1281 investigations in, 1274, 1274b liver disease and, 1283–1284 medical disorders in pregnancy and, 1276–1285 neurological disease in, 1284 parathyroid disease in, 1280 pituitary disease in, 1280 planning pregnancy in, for patients with medical conditions, 1272 presenting problems in pregnancy and, 1274–1276 breathlessness as, 1274–1275 chest pain as, 1275 circulatory collapse as, 1275 headache as, 1275 nausea and vomiting as, 1275, 1275b oedema as, 1275 seizures as, 1275–1276, 1276b psychiatric disorders in, 1284 renal disease in, 1282–1283 respiratory disease in, 1277 thyroid disease in, 1279 Matrix metalloproteinases, 485–486 Mayaro viruses, 250, 1020–1021 McArdle’s disease, 1144b McCune-Albright syndrome, 50–51, 1055, 1056f Meal bolus calculation, 751b Mean arterial pressure (MAP), calculation of, 193b Mean cell haemoglobin (MCH), 919–920, 1362b Mean cell volume (MCV), 853, 919–920 in alcohol misuse, 1184 in anaemias, 940 reference range of, 1362b Measles, 236 clinical features of, 236, 236f management of, 236 in pregnancy, 235b prevention of, 236 rash, 236f subacute sclerosing panencephalitis,

Mebendazole, for helminthic infections,

Mechanical heart valves, 950 pregnancy and, 1282 Meckel’s diverticulum, 778, 812 bleeding from, 782b Meckel’s scan, 778b Meconium ileus, 842 Medial collateral ligament lesions, 998b–999b Medial ﬁbroplasia, 407 Medial humeral epicondylitis, 998b Medial longitudinal fasciculus (MLF), 1069–1070 Median nerve entrapment, 1139b palsy, 760 Mediastinal spread, in lung cancer, 600 Mediastinoscopy, 604 Mediastinum divisions of, 604f tumours of, 603–605, 603b–604b, 604f Medical emergency team, deterioration and, 188, 189b Medical interview, 231b Medical ophthalmology, 1163–1178 functional anatomy and physiology of, 1164–1168 ophthalmic disease, presenting problems in, 1169–1171 specialist ophthalmological conditions in, 1171–1178 visual disorders, investigation of, 1168–1169 Medical psychiatry, 1179–1207 Medically unexplained somatic symptoms, 1187, 1187b, 1205f general management principles for, 1202, 1203b in old age, 1189b Medication, of stroke patients, 1159b Medication errors, 24–26 causes of, 25, 25b, 25f response to, 26 types of, 25b Medication overuse headache, 1096 migraine and, 1095 Medicines management, 26 Medroxyprogesterone, 655 Medullary carcinoma, 650 Medullary cystic kidney disease, 404 Medullary sponge kidney disease, 433 Medulloblastoma, 1129 Mefenamic acid, overdose, 138 Meﬂoquine, for malaria, 278b Megacolon acquired, 835 toxic, 818 Megakaryoblasts, 915f, 918 Megakaryocytes, 918 Megaloblastic anaemia, 940, 943–945 clinical features of, 943b investigations in, 944b management of, 945 Megaloblastic crisis, 947 Megaureter, 434 Megestrol, 1332 Meglitinides, 746b, 747 Meglumine antimoniate, 128 Meiosis, 40–41, 41f Meissner’s plexus, 771–772 Melaena, 780 Melanocortin-4 receptor (MC4R) mutations, 700 Melanocytes, 1212 Melanocytic naevi, 1216, 1234–1235, 1235f Melanoma, 1232–1234 ABCDE rule of, 1216, 1216b acral lentiginous, 1233 amelanotic, 1322 clinical features of, 1232–1233 cutaneous, 1232b diagnosis and management of, 1233 lentigo maligna, 1233 malignant, 1216 nodular, 1233, 1233f pathophysiology of, 1232 prognosis of, 1233–1234 subungual, 1233 superﬁcial spreading, 1232–1233, 1233f Melanoptysis, 615 Melanosis coli, 834 Melarsoprol, for trypanosomiasis, 128 MELAS, 1116b, 1144b Melasma, 1258 MELD score, for liver transplantation, 900–901 Meleney’s gangrene, 227b Melioidosis, 261 Melphalan, 968, 1320b Memantine, 1193 Membrane attack complex (MAC), 66 Membranoproliferative glomerulonephritis, 401 Membranous nephropathy, 398b–399b, 401, 427b Memory, 1066 Alzheimer’s disease, 1192–1193 disorders of, 1066b long-term, 1065, 1192–1193 loss, 1081 short-term, 1081, 1192–1193 Memory cells, 68 Ménétrier’s disease, 797–798 Ménière’s disease, 1104–1105 MENIN, 688 Meningioma, 1130–1131 Meningism, 1118 Meningitis, 1118–1121 aseptic, 257 bacterial, 1118–1120 cerebrospinal ﬂuid in, 1119 headache and, 185, 185b management of, 1120, 1120b causes of, 1118b Coccidioides, 304 cryptococcal, HIV-related, 321 fungal, 1121 HIV-related, 321 malignant, 1121 in mumps, 240 protozoa, 1121 recurrent aseptic, 1121 tuberculous, 1120–1121, 1121b viral, 1118 cerebrospinal ﬂuid in, 1118 Meningococcaemia, chronic, 1119 Meningococcal infection chemoprophylaxis following, 1121b meningitis, 1118–1119, 1119b prevention of, 1120 rash, 1120 Meningococcal sepsis, 1119b Meningoencephalitis, 279 Menopause, 652 male, 660b premature, 654 Menorrhagia, 923 Menstrual cycle, normal, 652f Menstrual irregularity, in polycystic ovarian syndrome, 659 Menstruation, 1290, 1291f Mental state examination, 1181–1183 Mental test, older people, 184 Menthol, topical, 1220 Mepacrine, hyperpigmentation from, 1258b Meptazinol, 1002 Meralgia paraesthetica, 1139b Mercaptopurine for acute leukaemia, 957b for inﬂammatory bowel disease, 821b Mercury poisoning, 365b Merkel cells, 1212 Meropenem, 117b, 120b melioidosis, 261 neutropenic fever, 1327–1328 nocardiosis, 261 pneumonia, 586 in pregnancy, 120b MERRF (myoclonic epilepsy with ragged red ﬁbres), 1116b, 1144b Mesalazine, for inﬂammatory bowel disease, 818, 820, 821b Mesangiocapillary glomerulonephritis (MCGN), 398b–399b, 401 Mesenteric ischaemia, chronic, 827 Mesna, 1036 Mesothelioma, 618 Meta-iodobenzyl guanidine (MIBG) scintigraphy, 675

1396 • INDEX Metabolic acidosis, 364–366 acute mountain sickness, 168 causes of, 365b diabetic ketoacidosis, 735 hypothermia and, 166 kidney failure/renal failure acute, 413 chronic, 415 malaria, 276b near-drowning, 170 poisoning, 139b, 141b starvation, 704–705 Metabolic alkalosis, 366–367, 367f Metabolic disorders, 785 clinical examination of, 346–348, 346f supportive therapy for, 957–958 Metabolic medicine, 345–380 Metabolic myopathies, 1144 Metabolic syndrome, 730–731 liver transplantation and, 901 Metabolism ﬁrst-pass, 17 interactions, 24 phase I, 18 phase II, 18 Metadrenalines, 1361b Metalloproteinases, 485–486 Metamyelocytes, 917 Metaphase, 40 Metapneumovirus, 249 Metastatic bone disease, 1057 Metastatic spread, in lung cancer, 600 Metatarsophalangeal joints, polyarthritis in, 994f Metavir system, for hepatitis C, 878 Metered-dose inhaler, for asthma, 571f Metformin, 746, 746b acidosis, 135b, 141 for hyperglycaemia, 746 mechanism of action, 746 overdose, 135b, 141 polycystic ovarian syndrome, 659 in pregnancy, 1278 renal/hepatic disease, 32b Methadone misuse, 142, 142b withdrawal, 16b Methaemoglobin, 277, 947 Methaemoglobinaemia, 120b, 135f, 1227–1228 Methanol, poisoning from, 147, 147f Methicillin-resistant Staphylococcus aureus (MRSA), 252 Methimazole, 644 Methionine, 138 Methotrexate (MTX) acute leukaemia, 957, 957b drug interaction, 24b eczema, 1227–1228 hepatic ﬁbrosis and, 895–897 hepatotoxicity of, 894b for inﬂammatory bowel disease, 821b, 822, 1299 for musculoskeletal disease, 1004, 1004b antineutrophil cytoplasmic antibody-associated vasculitis,

juvenile dermatomyositis, 1040 juvenile idiopathic arthritis, 1027 polymyositis and dermatomyositis,

psoriatic arthritis, 1033–1034 systemic lupus erythematosus,

pregnancy and, 1226b, 1278 psoriasis, 1227–1228, 1250 renal disease, 32b and respiratory disease, 612b sarcoidosis, 610 Methyl-phenyl-tetrahydropyridine (MPTP), 1112b Methylbenzethonium chloride, 286 Methylcellulose, 646, 834b Methyldopa, for pre-existing hypertension, pregnancy and,

Methylphenidate, 1105 Methylprednisolone for acute disseminated encephalomyelitis, 1110 antineutrophil cytoplasmic antibody-associated vasculitis (AAV), 1041 Grave’s ophthalmopathy, 646 histoplasmosis, 304 for inﬂammatory bowel disease, 820 for juvenile dermatomyositis, 1040 liver transplant patients, 901 for polymyositis and dermatomyositis,

rheumatic disease, 1005–1006 for systemic lupus erythematosus,

for transverse myelitis, 1110 Methysergide, and respiratory disease, 612b Meticillin, 120b Metoclopramide chronic intestinal pseudo-obstruction,

and hyperprolactinaemia, 684b nausea and vomiting, 803, 1351b poisoning, 137b sodium content of, 864b Metoprolol, 466b, 480b angina, 500 arrhythmias, 481 hypertension, 513 Metronidazole, 117b for amoebiasis, 287 for balanitis, 334b for cerebral abscess, 1124b for cholecystitis, 905 for choledocholithiasis, 906 for Clostridium difﬁcile infection, 264 for gas gangrene, 227 for giardiasis, 287 for Helicobacter pylori eradication,

for inﬂammatory bowel disease, 823 for liver abscess, 880 for neutropenic fever, 1327–1328 for PID, 336 for pneumonia, 587 polyneuropathy and, 1139b in pregnancy, 120b prophylactic, 119b for rosacea, 1244 for small bowel bacterial overgrowth, 808–809 for tetanus, 1126b for tropical ulcer, 254 Metyrapone, 669, 671b Mevalonate kinase deﬁciency, 81 Mexiletine, 480, 480b Mezavant, for inﬂammatory bowel disease, 821b Micafungin, 125b Micelles, mixed, 768 Miconazole, 125b, 1239–1240 erythrasma, 1238 Microalbuminuria, 394 in diabetic nephropathy, 757, 758b in diabetic neuropathy, 727 Microaneurysms, 509–510 Microangiopathic haemolytic anaemia (MAHA), 408, 950 Microangiopathy, diabetic, 756 Microarrays, 51 Microbial ﬂora, normal, 102–103, 103f Microbiological investigations, for respiratory disease, 554 Microbiome, 63, 103 Microcytic anaemia, 925 in rheumatoid arthritis, 1024–1025 Microcytosis, 921f, 941f Microdeletion syndromes, 44 Microglia, 1106 Microlithiasis, alveolar, 613b Micronutrients, 711–718 Microorganisms culture, 106 detection of components, 106 detection of whole organisms, 105 host response, 105–109 MicroRNA (miRNA), 40 Microsatellite repeats, 43 Microscopy bright ﬁeld, 105 dark ﬁeld, 105 electron, 105 epiluminescence, 1214 Microsomal ethanol-oxidising system (MEOS) pathway, 881 Microsporidiosis, HIV-related, 317b Microsporum audouinii, 1240 Microsporum canis, 1240, 1240f Micturating cystourethrography, reﬂux nephropathy, 431f Micturition cycle, 386 disorders of, benign prostatic hyperplasia, 437 frequency of, 396 Mid-axillary line, 626–627 Midazolam, 1189f Middle East respiratory syndrome coronavirus (MERS-CoV), 249 Midges, ﬁlariases, 293 Miglitol, 747 Migraine, 1095–1096 pregnancy and, 1284 stroke risk in, 1095 in visual disturbance, 1088 Migrainous neuralgia, 1096 Migrating motor complexes (MMC), 772 Miliary tuberculosis (TB), 588–589 Milk, cow’s, type 1 diabetes and, 729 Milk alkali syndrome, 716 Milk intolerance, 812 Millard-Gubler syndrome, 1072b Miller Fisher syndrome, 1140 Miltefosine, 283 Milwaukee shoulder syndrome, 1017–1018 Mineralocorticoid receptor, 355 Mineralocorticoid receptor antagonists for acute coronary syndrome, 501 for primary hyperaldosteronism, 675 Mineralocorticoid replacement, for adrenal insufﬁciency, 673 Mineralocorticoids, 666, 666f in adrenal insufﬁciency, 672 excess in, causes of, 674b Minerals, storage of, liver and, 851 Mini-Mental State Examination (MMSE), 1181–1183 Minimal change nephropathy, 398–400, 398b–399b Minimally conscious state, 211, 212b Minimum bactericidal concentration (MBC), 109 Minimum inhibitory concentration (MIC),

Minocycline for acne, 1243 hyperpigmentation from, 1243, 1258b for leprosy, 269 skin reactions, 1266b Minoxidil alopecia, 1259 hypertension, 513 skin reactions, 1266b Mirizzi’s syndrome, 904–905 Misoprostol, 1003 Missense mutation, 42, 42f Mites house dust, 568, 570, 1215, 1245 typhus, 270 Mitochondria, 49, 50f Mitochondrial disorders, 49, 1144 Mitochondrial DNA, 1305 Mitochondrial inheritance, 49, 49b Mitochondrial syndromes, 1144b Mitomycin C, 436, 612b Mitosis, phases of, 40 Mitotane, 669–670 Mitotic spindle poisons, 1317f Mitoxantrone, 936b acute leukaemia, 957b Mitral regurgitation, 519–521, 519b, 520f clinical features of, 521b, 521f investigation of, 521b management of, 521 Mitral stenosis, 517–519, 518b, 518f investigations in, 518f, 519b chest X-ray for, 451f pregnancy and, 1282 Mitral valve balloon valvuloplasty, 519, 519b, 519f disease of, 517–521 endocarditis, 200f prolapse, 520 pain, 177 repair, 521 replacement, 526–527 Mixed connective tissue disease (MCTD), 1038 Mixed venous oxygen saturation, 198b Mobilisation, of stroke patients, 1159b Mobitz type I second-degree AV block, 477, 477f Mobitz type II second-degree AV block, 477, 477f Moclobemide, 1199b Modaﬁnil, 1105, 1110b Modiﬁed Beighton score, for joint hypermobility, 1059, 1059b Modiﬁed Dukes classiﬁcation, survival in colorectal cancer and, 832f Mohs’ micrographic surgery, 1228 Molecular adsorbent recirculating system (MARS), for pruritus, primary biliary cholangitis and,

Molecular diagnostics, 348b Molecular mimicry, 82 Moles, 1234–1235, 1235f Mollaret’s syndrome, 1121 Molluscum contagiosum, 248f, 343, 343f, 1239, 1239f HIV disease and, 306f, 314b Mometasone, 1226b Monday fever, 614 Monge’s disease, 169 Monitoring in critical care/critical illness, 175–176, 175b, 175f Monitoring drug therapy, 34–36 Monkeypox, 248–249 Monoamine oxidase inhibitors, 1199, 1199b drug interactions, 24b Monoarthritis acute, 992–993, 993b chronic inﬂammatory, 992 Monobactams, 120b, 121 Monoclonal antibody therapy for allergy, 86 for asthma, 572 for haemolytic uraemic syndrome,

for high-grade NHL, 966 for low-grade NHL, 965 for osteoporosis, 1048 Monoclonal gammopathy of uncertain signiﬁcance (MGUS), 966 Monoclonal immunoglobulin deposition disease, multiple myeloma and, 410b Monocytes, 64, 917, 926b, 926f count, 1362b Monocytosis, 926b Monoﬁlament testing, 721b Monoiodotyrosine (MIT), 635f Mononeuritis multiplex, 1140 Mononeuropathy diabetic, 760 multifocal, 1140b Monosodium urate monohydrate crystals, 988f, 1015 Monospot test, 242 Montelukast, asthma, 572 Montreal Cognitive Assessment (MoCA), 1181–1183, 1182f Mood, 1071 assessment of, in psychiatric interview, 1181 Mood disorders, 1198–1200 bipolar, 1199–1200 organic, 1185b Mood-stabilising drugs, 1190b Moraxella catarrhalis, 103f

INDEX • 1397 Morphine adverse reactions of, 22b COPD, 577 intensive care, 209b misuse, 142b palliative care, 1351 pharmacogenetics, 20b renal colic, 432 renal or hepatic disease, 32b rout of administration, 30b Morphoea, 1262–1263 Morquio’s syndrome, 371b Mortality ratios, standardised (SMRs),

Morton’s neuroma, 999 Mosaic warts, 1238 Mosquitoes, 231b ﬁlariasis, 290 malaria, 273–274 virus transmission of, 111 Motilin, 772b Motility disorders, in vitamin B12 deﬁciency, 944 Motor cortex, 1063f Motor neuron disease, 1111b, 1116–1117, 1117b, 1117f Motor neurons lower, 1068 upper, 1068–1069 Motor neuropathy, 503b Motor system, 1068–1069, 1068f Mountain sickness acute, 168 chronic, 169 Mouth disease of, 790 of envenomed patient, 152f examination of cardiology, 442f respiratory system, 546f oral allergy syndrome, 812 ulcers in Behçet’s disease, 1043–1044, 1043f Mouth ulcers, for systemic lupus erythematosus, 1036 Movement disorders, 1112–1115 involuntary movements, 1069 see also names of speciﬁc disorders Moxiﬂoxacin, 123b meningitis, 1120b MRCP (magnetic resonance cholangiopancreatography), 776, 854–855 for cholangiocarcinoma, 855f for choledocholithiasis, 906 for gallstones, 904–905, 904f MRI (magnetic resonance imaging) of aldosterone-producing adenoma,

for cancer, 1323 for cardiovascular system, 452–453, 453f of gastrointestinal tract, 774 for haemangiomas, 893f for hepatobiliary disease, 854 for hepatocellular carcinoma, 891 for musculoskeletal disease, 989, 989b, 989f for neurological disease, 1072, 1073b epilepsy, 1101b stroke, 1151, 1157–1158, 1158b viral encephalitis, 1122 of osteonecrosis, 1055 for pain, 1342 pregnancy and, 1274 for renal disease, 389 for respiratory disease, 553 for sacroiliitis, 1029–1030, 1029f MRSA (meticillin-resistant Staphylococcus aureus), 117b Mucociliary escalator, 550f Mucocutaneous disease, HIV-related, 314–316, 314b Mucopolysaccharidosis, 371b Mucor spp., 303 Mucormycosis, 303, 598 Mucosa-associated lymphoid tissue (MALT), 67 Mucosal leishmaniasis, 285 Mucous membranes inﬂammatory arthritis in, 994b as physical barrier, 62–63 Mucous patches, syphilis, 337 Multi-organ failure, causes of, 201 Multidisciplinary team, 1303b, 1311,

Multifocal encephalomyelitis, 1111b Multifocal neuropathy, 1140, 1140b Multimorbidity, 1306 Multinodular goitre, 648–649, 648f Multiple endocrine neoplasia (MEN), 688–689, 689b Multiple myeloma, 409, 410b, 966–968 classiﬁcation of, 967b clinical features and investigations of, 967, 967f management of, 967–968 bisphosphonates for, 968 chemotherapy for, 968 immediate support for, 967–968 radiotherapy for, 968 prognosis of, 968 Multiple organ failure, 411 Multiple sclerosis, 1106–1110 cerebrospinal ﬂuid in, 1108 clinical features of, 1106–1108, 1108b investigation of, 1108, 1108f–1109f Macdonald criteria for, 1107b management of, 1109–1110 acute episode, 1109 disease-modifying treatments, 1109, 1109b symptoms, complications and disability, 1109–1110, 1110b pathophysiology of, 1106, 1107f–1108f in pregnancy, 1110b Multiple systems atrophy (MSA), 1114 Multivisceral transplantation, 710 complications of, 710b Mumps, 240 clinical features of, 240, 240f diagnosis of, 240 incubation period, 111b, 232b, 240 management and prevention of, 240 periods of infectivity, 111b testicular swelling, 216f Münchausen’s syndrome, 1206 Murmur aortic regurgitation, 524, 524b, 525f aortic stenosis, 522, 522b, 522f atrial septal defect, 535, 535f ausculatory evaluation, 443b Austin Flint, 524 benign, 459, 459b–460b cardiac, 459b, 460f carditis, 515–516 Carey Coombs, 515–516 coarctation of aorta, 534 continuous, 461 diastolic, 460 Graham Steell, 526 mitral regurgitation, 520, 520f, 521b mitral stenosis, 518–519, 518f persistent ductus arteriosus, 533 pulmonary regurgitation, 526 pulmonary stenosis, 526 systolic, 459–460, 460b tetralogy of Fallot, 537 timing and pattern, 460f tricuspid stenosis, 526 ventricular septal defect, 460b, 535–536 Murphy’s sign, cholecystitis and, 905 Muscle biopsy, 992 in polymyositis and dermatomyositis, 1039, 1040f contraction, 1068 of envenomed patient, 152f pain, 1000, 1000b skeletal, 987–988 Muscle disease, 1143–1144 acquired, 1144, 1145f Muscle ﬁbre, 446f Muscle haematomas, in haemophilia A,

Muscle spindles, in control of breathing,

Muscle weakness/wasting, 1000, 1000b diabetes, 759 osteoarthritis, 1010 systemic sclerosis and, 1037 Muscular atrophy, spinal, 1117 Muscular dystrophies, 1143–1144, 1143b inheritance, 1143 transition medicine and, 1297 Musculoskeletal disease anatomy and physiology of, 984–988, 984f investigation of, 988–992 management of, 1000–1007, 1001b X-rays for, 988, 988b bony metastases, 662 Charcot’s joint, 1058f chondrocalcinosis, 1016f CPPD crystal deposition disease,

fracture, 994–995 osteoarthritis, 1009f–1011f osteomalacia, 1052, 1052f osteonecrosis, 1055 osteosarcoma, 1056–1057 reactive arthritis, 1032 rheumatoid arthritis, 1025 supraspinatus tendon calciﬁcation, 1017f Musculoskeletal system anatomy and physiology of, 984–988, 984f clinical examination of, 982–983, 982f drug-induced effects on, 1057b presenting problems in, 992–1000 primary tumours of, 1056b Mushrooms magic (hallucinogenic), 143, 1196 poisoning, 857 Mutation(s) de novo, 47 domain negative, 45 frameshift, 42 gain-of-function, 45 loss-of-function, 44 missense, 42 nonsense, 42, 42f point, 42 simple tandem repeat, 43, 43b splice site, 43f tandem repeat, 43, 43b Myalgia drug-induced, 1057b fever and, 217b infections, 223 Myasthenia gravis, 1111b, 1141–1143, 1142b, 1142f diplopia, 1141 drug-induced, 1057b weakness, 1093 Myasthenic crisis, 1142–1143 Mycetoma, 301 intracavitary, 559 Mycobacteria, 100–101 opportunistic infection, 595, 595b Mycobacterial infections, skin, 1237–1238 Mycobacterium abscessus, 580–581 Mycobacterium avium complex, HIV-related disseminated, 315b prophylaxis for, 324 Mycobacterium chelonei, 595b Mycobacterium fortuitum, 595b Mycobacterium genavense, 595b Mycobacterium haemophilum, 595b Mycobacterium kansaii, 595, 595b Mycobacterium leprae, 100, 106, 595b Mycobacterium malmoense, 595, 595b Mycobacterium marinum, 595b Mycobacterium tuberculosis (MTB), 106, 588 Mycobacterium ulcerans, 254, 595b Mycobacterium xenopi, 595, 595b Mycology, 1215 Mycophenolate mofetil (MMF) for autoimmune hepatitis, 886–887 liver transplantation and, 901 for musculoskeletal disease, 1004b,

for polymyositis and dermatomyositis,

for systemic lupus erythematosus,

Mycoplasma pneumoniae, 583 cold agglutination, 950 Mycoplasma spp., 121 Mycoses, superﬁcial, 300 Mycosis fungoides (cutaneous T-cell lymphoma), 1232 Myelin sheaths, 358, 1106 Myelinolysis, 358 Myelitis, transverse, 1110 Myeloablative conditioning, 937 Myelocytes, 917 Myelodysplasia, 124 Myelodysplastic syndromes (MDSs), 960–961, 961b Myeloﬁbrosis, 969 Myelography, spine, 996–997 Myeloma AKI, 412b multiple, 409, 410b, 966–968 Myelopathy, 1111b cervical, 1134–1135 HIV-related, 321 vacuolar, 321 Myeloperoxidase, 64 Myeloproliferative neoplasms, 969–970 Myelosuppression, drug-induced, 1330 Myiasis, 300 Myocardial contraction, 446, 446f Myocardial infarction, 199–200, 199b acute, 493b diagnosis of, 493 electrocardiogram (ECG) for, 448 investigation of, 496 ECG, 496–497 management of late, 498, 498b in old age, 500b pregnancy and, 1282 rehabilitation, 501 time course, 495f Myocardial ischaemia electrocardiogram (ECG) for, 448 myocardial infarction, 498 Myocardial stunning, 199–200 Myocarditis, 538, 538b acute, 538 chronic, 538 fulminant, 538 Myocardium disease of, 538–542 hibernating, 452 Myoclonic seizures, 1099–1100 Myoclonus, 1086 Myocytes, 446, 446f Myoﬁbrils, 987 Myoglobinuria, 392b Myonecrosis, clostridial, 227 Myopathic gait, 1087 Myopathy, critical illness, 212 Myophosphorylase deﬁciency (McArdle’s disease), 1144b Myosin, 446, 987 Myositis drug-induced, 1057b inclusion body, 1059 systemic sclerosis, 1037 Myotonia, potassium-aggravated, 1145b Myotonia congenita, 1145b Myotonic dystrophy, 1143b genetics/inheritance, 43b Myotoxicity, 155 Myxoedema, Graves’ disease, 643 Myxoedema coma, 641 Myxoma, atrial, 541–542 N N-Acetylcysteine therapy, for acute liver failure, 858–859 NADH dehydrogenase, 49b

1398 • INDEX Nadolol arrhythmias, 481 thyrotoxicosis, 637–638 variceal bleeding, 869 Naevi blue, 1235 melanocytic, 1216, 1234–1235, 1235f spider, 846f autoimmune hepatitis and, 886 Nafcillin, 120b Nails, 1214 abnormalities, 1224 in congenital disease, 1261 disorders, 1260–1261 HIV-related, 316 inﬂammatory arthritis in, 994b involvement in skin diseases, 1260–1261 normal variants of, 1260 plate and bed, 1260f in systemic disease, 1261, 1261f trauma, 1260 Na,K-activated adenosine triphosphatase (ATPase), 349 Nalidixic acid, 123b skin reactions, 1266b Naloxone adverse reactions of, 23 drug interactions of, 24b Naltrexone, for pruritus, primary biliary cholangitis and, 888 Naproxen, 1003b Narcolepsy, 1105, 1105b Narcotics, cirrhosis and, 894b Nasal cannulae, high-ﬂow, 202 Nasogastric tube, 805b Nasogastric tube feeding, 707, 707b Nasopharynx, disease of, 622 Natalizumab, 66, 1109b Nateglinide, 747 National Institute for Health and Clinical Excellence (NICE), 11 Natural killer cells, 67 Nausea and vomiting palliative care and, 1353–1354, 1353f pregnancy and, 1275, 1275b Near-drowning, 169–170, 170f Necator americanus, 288 Neck Casal’s necklace, 714, 715f examination of endocrine disease, 630f neurological disease, 1062f stiffness, 321 Neck pain, 997, 997b Necrobiosis lipoidica, 1263, 1263f Necrosis, 41, 1316–1317 Necrotising enteritis, 262 Necrotising fasciitis, 226–227, 227f Necrotising pancreatitis, 839 Necrotising scleritis, 1172 Necrotising soft tissue infections, 227b skin, 1238 Nefopam, 1002 Negative visual phenomena, 1171 Neisseria gonorrhoeae, 117b, 339 in pregnancy, 235b, 332b Neisseria spp., 103f Nelson’s syndrome, 669 Nematode infections, 233b intestinal, 288–290 tissue-dwelling, 290–293, 290b zoonotic, 293–294 Neoadjuvant chemotherapy, 1330 Neomycin allergy, 1247b for vitamin B12 deﬁciency, 715 Neostigmine, 835 Nephelometry, 348b Nephrectomy, 431, 435 Nephritic syndrome, 392, 392b, 393f Nephritis crescentic, 398b–399b, 410 drug-induced, 427b interstitial acute, 402, 402b chronic, 402–403, 403b drug-induced, 427b lupus, 392b post-streptococcal, 401 Nephrocalcinosis, drug-induced, 427b,

Nephrogenic sclerosing ﬁbrosis, 390b Nephrology, 381–440 Nephron, 349–350, 350f, 384 segments of, 351f Nephronophthis, 404 Nephropathy analgesic, 426 Balkan, 403 diabetic, 757–758 diagnosis and screening for, 757 management of, 757–758 natural history of, 757, 758f HIV-associated, 322 IgA, 398b–399b, 400 ischaemic, 406–407 membranous, 398b–399b, 401 minimal change, 398–400, 398b–399b multiple myeloma and, 410b pregnancy and, 1279 reﬂux, 430–431 salt-losing, 403 sickle-cell, 411 Nephrotic syndrome, 392b, 395, 395b diseases typically presenting with, 398–400 Neprilysin inhibitors, for heart failure, 466–467 Nerve, disorder of, 1089b Nerve agents, organophosphorus insecticides and, 145–146 Nerve biopsy, 1078 Nerve blocks and nerve ablation, for pain, 1348 for pain, 1342–1343 Nerve conduction studies, 1076, 1076f for pain, 1342 Nerve entrapment, in lung cancer, 600 Nerve ﬁbre, 1338 types of, 1338b Nerve root decompression, 1002b Nerve root lesions, 1083 Nerve root pain, 997b Nervous impulse, 1065, 1065f Nervous system anatomy and physiology of, 1064–1072 functional, 1065–1071, 1065f cells of, 1064–1065, 1064f clinical examination of, 1062–1064, 1062f in old age, 1079b in gastrointestinal function, 771–772 Nervous system disease cerebrovascular disease see speciﬁc conditions clinical examination of, 1062–1064, 1062f cranial nerves, 1063b emergencies, 1064b HIV-related, 319–321, 319f infections, 1117–1127, 1118b intracranial mass lesions/raised intracranial pressure, 1127–1133, 1128b investigation of, 1072–1078 lesion localisation in, 1071–1072 neuromuscular junction, 1141–1143 paraneoplastic, 1110–1111, 1111b,

paraneoplastic syndromes, 1325–1326 peripheral nerves, 1138–1141, 1139b presenting problems in, 1078–1094, 1079b–1080b spine/spinal cord, 1134–1137 Neural tube defects, prevention with folic acid, 712b, 945 Neuralgia migrainous, 1096 post-herpetic, 239, 1080 trigeminal, 1080, 1096–1097 Neuralgic amyotrophy, 1141 Neuro-endocrine tumours (NETs), 603b, 678–679, 678b, 679f, 813 Neuro-inﬂammatory diseases, 1106–1110 Neuroacanthocytosis, 1085b Neurocognitive disorders, HIVassociated, 319 Neurodegenerative diseases, 1111–1117 Neurodestructive interventions, for cancer pain, 1352 Neurodevelopmental disorders, rare, genomics in, 56 Neuroﬁbroma, 1129b, 1137f Neuroﬁbromatosis, 613b, 1131–1132, 1131f, 1132b, 1264 and cancer predisposition, 1321b inheritance, 1131–1132 Neurogenic shock, description of, 206b Neuroglycopenia, 739 Neuroimaging, 1072–1074, 1073b, 1151, 1151f, 1157–1158 Neuroleptic malignant syndrome, 1197–1198 Neurological disease in pregnancy, 1284 epilepsy as, 1284 idiopathic intracranial hypertension as, 1284 migraine as, 1284 stroke as, 1284 rheumatological manifestations of, 1058, 1058f in systemic lupus erythematosus,

transition medicine and, 1296–1297 cerebral palsy in, 1296 epilepsy in, 1296 muscular dystrophy in, 1297 Neurological support, in intensive care,

Neurology, 1061–1146 Neuroma acoustic, 1131 Morton’s, 999 Neuromuscular junction, diseases of, 1141–1143 Neuromyelitis optica, 1110 Neuromyotonia, 1111b Neuronectomy, multiple sclerosis, 1110b Neuropathic pain, 1084, 1348, 1348b, 1348f Neuropathy ataxia and retinitis pigmentosa (NARP), 1144b autonomic, 760, 760b critical illness, 211 diabetic, 758–761 classiﬁcation of, 759b clinical features of, 758–761 management of, 761, 761b risk factors for, 757b entrapment, 1139–1140, 1139b hereditary, 1140 leg ulcers due to, 1224 motor, 503b, 1111b multifocal, 1140, 1140b peripheral, 1325 cancer-related, 1325 diabetic, 755, 756b drug-induced, 321 HIV-related, 321 leprosy, 268 in rheumatoid arthritis, 1024 sensorimotor, 321 peripheral, cancer-related, 1325 sensory, 503b, 1111b Neuropeptides, 1338–1339, 1340b Neurosensory retina, 1167 Neurosyphilis, 338, 1125, 1125b Neurotoxic ﬂaccid paralysis, 155 Neurotoxins, hepatic encephalopathy and, 865 Neurotransmission/neurotransmitters, 1065f in pain processing, 1340b Neutral variants, 44 Neutrons, 164, 164f Neutropenia, 925 drug-induced, 926b fever in, 224, 1327–1328 HIV-related, 322 Neutropenic fever, cancer and, 1327–1328 Neutrophil chemotactic factor, 75b Neutrophil extracellular trap (NET) formation, 64 Neutrophil granulocytes, 1362b Neutrophilia, 926, 926b asthma, 568–569 Neutrophilic dermatoses, 1262 Neutrophils, 64, 917, 926b, 926f asthma, 568–569 count, 1362b toxic granulation, 64 Nevirapine, in pregnancy, 326–327 Newborn, haemolytic disease of, 933, 933b Next-generation sequencing (NGS), 52–53 capture, 53 challenges of, 53–54 methods of, 55b uses of, 54–56 Niacin (vitamin B3), 714–715 biochemical assessment of, 712b deﬁciency, 714, 715f dietary sources of, 711b reference nutrient intake of, 711b toxicity, 715 Nicardipine, angina, 491b Nickel hypersensitivity, 83b, 1247b Niclosamide, 129 Nicorandil, 790b Nicotinamide, for pellagra, 714 Nicotinamide adenine dinucleotide (NAD), 881 Nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase enzyme complex, 64 Nicotine replacement therapy, 4 Nicotinic acid, 377 Niemann-Pick disease, 371b Nifedipine altitude illness, 169 angina, 490–491, 491b unstable, 500 for high-altitude pulmonary oedema,

hypertension, 513 and neutropenia, 926b for oesophageal disorders, 795 older people, 32b Raynaud’s syndrome, 504–505 sphincter of Oddi dysfunction, 909 Nifurtimox, for trypanosomiasis, 128 Night blindness, 713 Night sweats, 217b Night terrors, 1094 Nightmares, 1094 Nikolsky sign, 1254–1255 Nimodipine, for subarachnoid haemorrhage, 1162 Nipah virus encephalitis, 250 Nitazoxanide, 129 Nitrates angina, 489–490 duration of action, 490b heart failure, 467 for oesophageal disorders, 795 Nitric oxide (NO), 386, 447 anal ﬁssure, 836 hepatopulmonary syndrome and, 898 Nitrites, 428 Nitrofurantoin, 124 and pulmonary eosinophilia, 611b–612b urinary tract infection, 428, 429b Nitrogen narcosis, 170 Nitroimidazoles, 124 mechanism of action, 116b Nitroprusside reaction, 726 Nitrosamines, type 1 diabetes and, 729 ‘Nits’, 1241 Nocardia, 587 pneumonia, 319 Nocardiosis, 261

INDEX • 1399 Nociceptive pain, 1084 Nocturia, 397 Nodal osteoarthritis, generalised, 1009, 1009b, 1009f Nodular lymphocyte-predominant HL, 961–962 Nodular regenerative hyperplasia, of the liver, 899 Nodules deﬁnition of, 1211f pulmonary, 560–562, 560b–561b, 560f–562f cryptococcosis, 302 lung metastases, 1328 rheumatoid, 1023–1024, 1024f skin, deﬁnition, 1211f thyroid, 630f, 635 Non-alcoholic fatty liver disease (NAFLD), 850, 882–885, 883f, 885f biochemical tests for, 884, 884b clinical features of, 884 imaging for, 884 investigations for, 884 liver biopsy for, 884 liver function test (LFT) abnormality in, 854b management of, 884–885 pathophysiology of, 883 Non-alcoholic steatohepatitis (NASH), 882–883, 883f Non-antivenom treatments, 159–160 Non-cardiac surgery, with heart disease, 501–502, 501b Non-compliance, 30–31 Non-disjunction, 44 Non-epileptic attack disorder (‘dissociative attacks’), 1103–1104 Non-freezing cold injury, 167 Non-Hodgkin lymphoma, 964–966, 965f clinical features of, 964, 965f epidemiology of, 964, 964b investigations of, 964–965 management of, 965–966 high-grade, 966 low-grade, 965 prognosis of, 966 Non-immune haemolytic anaemia, 950 Non-invasive prenatal diagnosis (NIPD),

Non-invasive prenatal testing (NIPT), 56 Non-invasive ventilation, for acute exacerbations of COPD, 578 Non-metastatic extrapulmonary effects, of lung cancer, 601 Non-necrotising scleritis, 1172 Non-nucleoside reverse transcriptase inhibitors (NNRTIs), 324b Non-opioid analgesics, for pain, 1345–1346 Non-speciﬁc interstitial pneumonia, 608 Non-speciﬁc urethritis (NSU), 333 Non-starch polysaccharides (NSPs; dietary ﬁbre), 697 Non-steroidal anti-inﬂammatory drugs see NSAIDs Non-thrombocytopenic purpura, 928b Non-thyroidal illness, 642 Nonsense mutation, 42, 42f Noradrenaline (norepinephrine), for refractory hypotension, 198, 198b Noradrenaline (norepinephrine) re-uptake inhibitors, 1199, 1199b poisoning from, 139 Norﬂoxacin for spontaneous bacterial peritonitis,

urinary tract infection, 428 Normal distribution/range, 3, 4f Normetadrenaline, 1361b Normoblasts, 915, 916f Normocytic anaemia, 925 Norovirus, 249 Nortriptyline, pharmacokinetics, 20b Norwalk agent, 249 Nosocomial (health care-acquired) infections Clostridium difﬁcile, 211 MRSA, 111–112 pneumonia, 585 Notiﬁcation food poisoning, 262 partner, STIs, 333, 339 Novel therapies, for cystic ﬁbrosis, 581 NSAIDs adverse reactions of, 22b associated with small intestinal toxicity, 811 for back pain, 997 in blood loss, 940–941 for cholecystitis, 905 cirrhosis and, 894b for CPPD crystal deposition disease,

for gout, 1015 hepatotoxicity of, 894b for intermittent fever, 74 mechanism of action of, 1003f for musculoskeletal disease, 1002–1003 in old age, 1004b for osteoarthritis, 1012 for pain, 1345 for pancreatitis, 841 for peptic ulcer, 799 poisoning from, 138 for psoriatic arthritis, 1033–1034 for reactive arthritis, 1032 recommendations for the use, 1003b renal disease and, 426 risk of, in gastrointestinal bleeding and perforation, 1003b for systemic lupus erythematosus,

topical, 1003–1004 ulcers induced by, risk factors for, 1003b Nuclear antigens, extractable, antibodies to, 389 Nuclear factor kappa B (NFκB) pathway, 64–66 Nucleic acid ampliﬁcation test (NAAT), 106, 333 Nucleoside reverse transcriptase inhibitors (NRTIs), 324b Nucleosome, 38 Nucleotide substitutions, 42, 42f Numbness, 1083–1084 ‘Nutcracker’ oesophagus, 795 Nutraceuticals, for osteoarthritis, 1012 Nutrients, energy-yielding (macronutrients), 694–697 Nutrition, 694, 694f for alcoholic liver disease, 882 alcoholic liver disease and, 880–881 artiﬁcial, 710–711 dementia and, 711, 711f in hospital patients, 706 in intensive care, 210 in lactation, 712b parenteral, 707–708, 708b physiology of, 694–697 in pregnancy, 712b of stroke patients, 1159b under-nutrition and, 704–711 Nutritional disorders, clinical examination in, 692, 692f Nutritional factors, in disease, 691–718 Nutritional status, clinical assessment and investigation of, 693b, 693f Nutritional supplements, oral, 706 Nutritional support, artiﬁcial, ethical and legal considerations in management of, 710–711, 710b Nystagmus, 1069, 1090 balance disorders and, 1104f gaze-evoked, 1090 Nystatin, 125b candidiasis, 126, 790 O Obesity, 94, 698–704 aetiology of, 699–700, 699b body fat distribution in, 699 clinical assessment for, 693b clinical features of, 700, 700b complications of, 698–699, 698f investigations of, 700 management of, 700–704, 701f drugs in, 702–703, 702f lifestyle advice in, 701 surgery in, 702f–703f, 703–704, 703b weight loss diets in, 701–702, 701b in musculoskeletal disease, 1001–1002 non-alcoholic fatty liver disease and, 882–883 reversible causes of, 700 susceptibility to, 699–700 type 2 diabetes and, 732 Obesogenic environment, 699b Obeticholic acid (OCA), for primary biliary cholangitis, 888 Obidoxime, 146 Obinutuzumab, for chronic lymphocytic leukaemia, 960 Obliterative cardiomyopathy, 541 Obsessive-compulsive disorder (OCD),

Obstetric cholestasis, pregnancy and,

Obstetric haemorrhage, circulatory collapse and, 1275 Obstetrics, genomics and, 56 Obstructive pulmonary diseases, 567–581 asthma, 567–573 bronchiectasis, 578–579 chronic, 573–578 cystic ﬁbrosis, 580–581 Obstructive shock, description of, 206b Occipital lobes, 1066 disorders of, 1089b functions of, 1066b effects of damage, 1066b Occupational airway disease, 613–614 Occupational and environmental lung disease, 613–619 asbestos-related, 617–618 due to organic dusts, 616–617, 616b occupational airway disease, 613–614 pneumoconiosis, 614–616, 615b Occupational asthma, 613–614, 614b, 614f Occupational lung cancer, 618 Occupational pneumonia, 618–619 Occupational therapist, 1303b Occupational therapy for musculoskeletal disease, 1001 rheumatoid arthritis, 1026 for Parkinson’s disease, 1114 Ochrobactrum spp., 617 Octopus, blue-ringed, 154b Octreotide acromegaly, 686–687 gastrointestinal obstruction, 1354 scintigraphy, 679f short bowel syndrome, 709b for Zollinger-Ellison syndrome, 802 Ocular abnormalities, 1088–1093 Ocular dysmetria, 1090 Ocular imaging, 1169f Ocular inﬂammation, 1171–1173 Ocular pain, 1080 Ocular ultrasound, for visual disorders,

Oculomotor (3rd cranial) nerve palsies, 1121b, 1144b tests of, 1063b Oculopharyngeal dystrophy, 1143b Odds ratio, drug therapy, 28f Odynophagia, 316, 1324b Oedema, 395–396 ascites, 395–396 causes of, 396b cerebral see Cerebral oedema famine, 704 generalised, 282 legs, 395–396 mechanisms of, 186b nephrotic syndrome, 395–396, 395b peripheral differential diagnosis, 463b heart failure, 463b hypervolaemia, 354 pitting, 395 pregnancy and, 1275 pulmonary see Pulmonary oedema Oesophageal candidiasis, in HIV/AIDS patients, 316, 317f Oesophageal diseases, HIV-related, 315b, 316, 317f Oesophageal dysmotility, secondary causes of, 795 Oesophageal motility, 778 Oesophageal transection, for variceal bleeding, 871 Oesophageal variceal bleeding, 869 management of, 870f Oesophageal varices, 865–866, 865f management of, 870f Oesophagitis, 792 eosinophilic, 794 herpes simplex, in HIV infection/AIDS,

reﬂux, 792, 792f systemic sclerosis, 1037–1038 Oesophagus Barrett’s, 792–793, 793f carcinoma and, 796 carcinoma of, 796–797 diseases of, 791–797 achalasia of, 794–795, 795f motility disorders, 794–796 reﬂux, 791–794 functional anatomy of, 766–767, 766f lower, adenocarcinoma of, 796f ‘nutcracker’, 795 perforation of, 797 tumours of, 796–797 benign, 796 17β−Oestradiol, 1359b Oestradiol, pregnancy and, 1272 Oestrogen in bone remodelling, 986b for delayed puberty, 654 hepatotoxicity, 894b Oestrogen deﬁciency, 654b Oestrogen receptors, as tumour markers, 1322, 1324b Oestrogen replacement therapy delayed puberty, 655 Turner’s syndrome, 660 Oﬂoxacin leprosy, 270b for PID, 336 for STIs, chlamydial infection, 341b Ogilvie’s syndrome, 835 Ointments, 1225b Older people acute illness, 1308, 1308b acute kidney injury in, 414b adrenal glands, 673b antimicrobial therapy in, 120b blackouts, 1308 cancer in, 1325b comorbidities in, 1307 critical illness in, 212, 213b delirium, 1309 demography of, 1304, 1304f deprescribing in, 1310–1311 diabetes mellitus in, 732b management of, 757b dizziness, 1309 endoscopy in, 776b energy balance in, 710b epilepsy in, 1103b examination, 1303b falls, 1308–1309, 1308b, 1308f frailty, 1306, 1306b gait and balance, 1303b gastrointestinal disorders, acute abdominal pain in, 788b geriatric assessment, 1302, 1302f gout in, 1014b haematological investigations in, 923b history, 1303b hypernatraemia in, 360b hyponatraemia in, 360b

1400 • INDEX incontinence, 436b, 1309–1310, 1310f investigation, 1306–1307 Comprehensive Geriatric Assessment, 1306 decisions on, 1306–1307 medical psychiatry in, 1189b neurological examination in, 1079b NSAIDs in, 1004b ophthalmological ﬁndings of, 1175b oral health in, 791b osteoarthritis in, 1011b osteoporosis in, 1049b polypharmacy in, 1310b prescribing in, 1310–1311 presenting problems in, 1307–1311, 1311b rehabilitation, 1311–1312 renal replacement therapy in, 422b respiratory disease in infection, 586b interstitial lung disease, 613b obstructive pulmonary disease, 578b pleural disease, 626b respiratory function in, 550b urinary tract infection in, 428b vitamin deﬁciency in, 712b Oleander, poisoning from, 140 Olecranon bursitis, 998b, 1024f Olfactory loss, 1088 Olfactory (1st cranial) nerve, tests of, 1063b Oligoarthritis, 1027 asymmetrical inﬂammatory, 1032 Oligoclonal bands, 1077 Oligodendrocytes, 1064–1065 Oligodendroglioma, 1129b Oligopeptides, 768 Oliguria, 391 critically ill patients, 195 Olsalazine, for inﬂammatory bowel disease, 821b Omalizumab, for allergy, 86 Omeprazole drug interactions of, 24b for H. pylori eradication, 800 Onchocerca volvulus, 292, 292f Onchocerciasis, 233b, 292–293 Oncogenes, 51 Oncogenesis, 1318f Oncology, 1313–1336 genomics and, 56–58 transition medicine and, 1298 Onychogryphosis, 1260 Onychomycosis, 1240 Oophoritis, mumps, 240 Open reading frame (ORF), 40 Ophthalmia neonatorum, 341 Ophthalmic disease, presenting problems of, 1169–1171 Ophthalmology, 1164 medical, 1163–1178 Ophthalmopathy, Graves’, 645–646, 645f examination of, 631b Opiates/opioids adverse reactions of, 22b for cholecystitis, 905 misuse of, 142, 142b, 1195 for osteoarthritis, 1012 for pain, 1346–1347, 1346b–1347b adverse effects of, 1351–1352, 1351b Opisthorchiasis, 297b Opisthotonus, 1126 Opportunistic mycobacterial infection, 595, 595b Opsoclonus-myoclonus, 1111b Opsonins, 63 complement fragments as, 66 Opsonisation, 63, 63f Optic atrophy, 1091–1093, 1092f Optic chiasm, disorder of, 1089b Optic disc disorders, 1089b Optic disc swelling, of ophthalmic disease, 1171 Optic (2nd cranial) nerve, tests of, 1063b Optic neuritis, 1089b, 1111b multiple sclerosis, 1108b onchocerciasis, 293 swelling, 1092b and transverse myelitis (neuromyelitis optica), 1110 Optic neuropathy, Leber hereditary,

Optic tract, disorders of, 1089b Optical coherence tomography, 1169 OptiMAL®, 276 Oral administration, 17 Oral allergy syndrome, 812 Oral androgen replacement therapy, 656b Oral cancer, 790, 790b Oral cavity, organisms in, 103f Oral contraception/contraceptives acne treatment, 1243 migraine and, 1095 skin reactions, 1266b venous thtombosis and, 975b, 1162b Oral contraceptive pill (OCP) cystic ﬁbrosis and, 1297 epilepsy and, 1296 porphyria and, 379 Oral diseases, HIV-related, 316 Oral glucocorticoids, for chronic obstructive pulmonary disease (COPD), 576–577 Oral glucose tolerance test (OGTT), 726b Oral hairy leukoplakia, 316 Oral health, in old age, 791b Oral rehydration solution (ORS), 229b Oral ulcers, in Behçet’s disease, 1043–1044, 1043f Orbit, 1164 blood supply of, 1168 imaging of, 1073–1074, 1074f Orbital septum, 1164 Orchitis, mumps, 240 Orf, 1239 Organ donation, 90 after brain death, 213 after cardiac death, 213 altruistic living, 90 cadaveric, 90 Organelles, intracellular, 1154f Organic solvents, misuse of, 1196 Organisms detection of components of, 106 whole, detection of, 105 Organophosphate-induced delayed polyneuropathy, 146 Organophosphorus compound, 145–146, 145b, 145f Oriental spotted fever, 271b Orientation, assessment, 1181 Orlistat, for obesity, 702, 702f Ornidazole, 287 Oropharynx, examination HIV disease, 306f infectious disease, 216f Oroya fever, 272 Orphenadrine, for Parkinson’s disease,

Orthopnoea, 557, 611 Orthoses, for musculoskeletal disease,

Oscillopsia, 1090 Oseltamivir, 119b, 127 Osgood-Schlatter disease, 999b Osmolality, 1360b presenting problems of, 356–360 Osmolarity, 1360b Osmotic agents, 14 Osmotic diuretics, for hypervolaemia,

Osteitis ﬁbrosa cystica, 418–419 Osteoarthritis (OA), 1007–1012 clinical features of, 1008–1011, 1009b early-onset, 1011, 1011b epidemiology of, 1007 erosive, 1011 generalised nodal, 1009, 1009b, 1009f hip, 1010, 1010f investigations for, 1011 knee, 1009–1010, 1010f management of, 1011–1012 in older people, 1011b pathophysiology of, 1007–1008, 1008f risk factors for, 1008b spine, 1011, 1011f Osteoarthropathy, hypertrophic pulmonary, 600–601 Osteoblasts, 984 in bone remodelling, 985f Osteochondritis dissecans, 998–999 of patella ligament, 998b Osteoclasts, 984 in bone remodelling, 985f Osteocytes, 985 Osteogenesis imperfecta (OI), 1055–1056 transition medicine and, 1300 Osteoid, 985f Osteoid osteoma, 1056b Osteomalacia, 1051–1052 causes of, 1050b chronic kidney disease and, 418–419 clinical features of, 1052 investigations in, 1052, 1052f management of, 1052 pathogenesis of, 1051–1052 tumour-induced, 1053 vitamin D-deﬁcient, biochemical abnormalities in, 990b Osteomyelitis, 1021 Osteonecrosis, 1055 drug-induced, 1057b pain, 1055 Osteopenia biliary cirrhosis, 888 fracture and, 994 hyperparathyroidism, 663 radiographic, 989–990 Osteopetrosis, 1056 Osteophytes, 988, 1134 Osteoporosis, 1044–1049 biochemical abnormalities in, 990b clinical features of, 1045 coeliac disease and, 807 fractures associated with, 1044, 1045f bone mineral density and, 1046f glucocorticoid-induced, 1045 transition medicine and, 1300 idiopathic, 1044 investigations of, 1046, 1047b, 1047f management of, 1046–1049 non-pharmacological interventions for,

in old age, 1049b pathophysiology of, 1044–1045, 1045f pharmacological interventions for, 1047–1049, 1048b pregnancy-associated, 1045 risk factors for, 1046b secondary, 1044–1045 surgery for, 1049 treatment of, 1309 Osteoprotegerin, in bone remodelling, 986b Osteosarcoma, 1056–1057 Osteosclerosis osteoarthritis and, 1007, 1011f Paget’s disease and, 1054 Osteotomy, 1002b, 1012 Ostium primum defects, 534 Otitis media, 236, 253b, 266, 1119 Ovarian cancer, 1334 investigations of, 1334 management of, 1334 pathogenesis of, 1334 Ovarian failure, chemotherapy-induced,

Ovaries, polycystic, 658–659, 659f Over-nutrition, responses to, 694–695 Overﬂow incontinence, 437, 1093 in older people, 1310 Overnight dexamethasone suppression test (ONDST), in Cushing’s syndrome, 668 Ovulation, 656–657 Oxacillin, 120b Oxalate, 1361b Oxazolidinones, 124 Oxcarbazepine, 1102b Oxidative killing, 64 Oxidative stress, 881f, 883 Oximes, 146 Oximetry, 555–556 asthma, 573 Oxygen arterial blood (PaO2), 1358b content and delivery of, in shock, 193, 193b for gastrointestinal haemorrhage, 782 Oxygen dissociation curve, in haemoglobin, 915–916, 917f Oxygen saturation, 1358b Oxygen therapy for acute exacerbations of COPD,

for air passengers, 169 for chronic obstructive pulmonary disease (COPD), 577, 577b for community-acquired pneumonia,

for critical illness, 191, 191b for diving-related illness, 171 for high-altitude pulmonary oedema,

Oxyhaemoglobin dissociation curve, 190, 191f Oxytetracycline, acne, 1243 P P gene, 1258 Pabrinex, 1195 Pachyonychia congenita, 1261 Pacing AV block, 482, 483f dual-chamber, 714 tachyarrhythmias, 469 transcutaneous, 482–483 Packed cell volume (PCV), 1362b Paclitaxel, 1334 Paediatric disease, in systemic lupus erythematosus, 1036 Paediatric health services, transition to adult health services from, 1288–1290 Paget’s disease biochemical abnormalities in, 990b of bone, 1053–1054 clinical features of, 1054 investigations in, 1054, 1054f management of, 1054, 1054b pathophysiology of, 1053–1054 Pain, 1070, 1338–1349 abdominal, 787–789 acute, 787–789, 787b acute pancreatitis, 837–839, 837b assessment of, 787, 788f chronic or recurrent, 789, 789b chronic pancreatitis, 839–841 constant, 789 diabetic ketoacidosis and, 736, 736b investigations of, 787 irritable bowel syndrome and, 824 large bowel obstruction of, 789 liver abscess and, 880 in lower abdomen, 336 management of, 787–789 in old age, 788b peptic ulcer, perforated, 789 ankle, 999 back, 995–997 red ﬂags for, 996b triage assessment of, 996f biliary, gallstones and, 904 biopsychosocial model of, 1338f in cancer, 1350, 1350b central processing of, 1339–1340 challenges in, 1344b Older people (Continued)

INDEX • 1401 chest, 176–179, 454–455 associated features of, 177–178, 178f characteristics of, 177 clinical assessment of, 178 differential diagnosis of, 177b investigations of, 178–179, 179b ischaemic, 454f onset of, 177 pregnancy and, 1275 in respiratory disease, 558 site and radiation of, 177 elbow, 998, 998b facial, 1080 foot, 999 functional anatomy and physiology of, 1338–1341 hand, 998 in headache, 1080 hip, 998, 999b, 999f osteoarthritis and, 1010 instruments for assessment of, 1343b interventions for, 1344–1348 complementary and alternative therapies for, 1348 nerve blocks and nerve ablation in,

pharmacological therapies in, 1344–1347, 1345b–1347b physical therapies in, 1344, 1344b psychological therapies in, 1347 stimulation therapies in, 1347, 1347f supported self-management in,

investigations of, 1342–1343 knee, 998–999, 999b loin, 396 low back assessment of, 988–989 causes of, 996b mechanical, features of, 996b radicular, 997b muscle, 1000, 1000b musculoskeletal, regional, 997–999 neck, 997, 997b neuropathic, 1084, 1348, 1348b, 1348f ocular, 1080 of ophthalmic disease, 1170 osteoarthritis and, 1007–1008 hip, 1010 knee, 1009–1010 palliative care for, 1349–1354, 1349f perception of, 1338f principles of management of, 1343 radicular, 997b shoulder, 997–998, 998b, 998f somatoform disorder, 1202 wrist, 998 Pain relief, for pancreatitis, 841 Pain scoring system, 1343 Painful vaso-occlusive crisis, 952 Palliation, for cancer, 1330 Palliative care, 1349–1354, 1349f for chronic obstructive pulmonary disease (COPD), 577 presenting problems of, 1350–1354 anxiety and depression in, 1354 cough in, 1353 dehydration in, 1354 delirium and agitation in, 1354 gastrointestinal obstruction in,

nausea and vomiting in, 1353–1354, 1353f weight loss in, 1354 Palliative chemotherapy, 1329 Palmar erythema, 630f, 635–636, 846f, 866–867 Palmoplantar pustulosis, 1249 Palpable mass, cancer and, 1323 Palpable purpura, 1042, 1042f Palpation of abdomen, 765b of precordium, 443b in respiratory system, examination of, 546f Palpitation, 455–456, 455b, 456f Pamidronate bone metastases, 1329 hypercalcaemia, 1329 for Paget’s disease, 1054, 1054b Pancoast’s syndrome, 600 Pancolitis, 815–816 Pancreas, 770, 770f annular, 842 artiﬁcial, 751, 751f carcinoma of, 843f congenital abnormalities affecting,

diseases of, 837–844 divisum, 842 endocrine, 676–679 pre-diabetic, 728 structure and endocrine function of, 723f tumours of, 842–844 Pancreatic cancer, 843f Pancreatic β-cell failure, in type 2 diabetes, 731 Pancreatic disease, 733 Pancreatic enzymes, 770b Pancreatic necrosis, 839f Pancreatic pseudocyst, 838f ‘Pancreatic rests’, 805 Pancreatitis acute, 837–839, 837b causes of, 838b complications of, 838b management of, 839 pathophysiology of, 837, 838f autoimmune, 841 chronic, 839–841, 840b complications of, 840b investigations of, 840, 841b, 841f management of complications of,

pathophysiology of, 840f hereditary, 840b, 842 necrotising, 839 Pancreolauryl test, 777b Pancytopenia, 930, 930b Panic disorder, 1200 Pannus, 1022–1023 Panton-Valentine leukocidin, 586, 1237 Papilla of Vater, 861 Papillary carcinoma, 649 Papillary muscle rupture, in acute coronary syndrome, 496 Papillary necrosis, 403 Papillary renal cell cancer syndrome, 1321b Papilloedema, 1090–1091, 1092b, 1092f haemorrhagic, 1062f Papilloma, basal cell, 1234, 1234f Papillomaviruses, 1238–1239 Papular pruritic eruption, HIV-related,

Papule, deﬁnition of, 1211f Papulosquamous eruptions, 1251 Para-aminosalicylic acid (PAS), skin reactions, 1266b Parabens, 1247b Paracentesis, for ascites, 863–864 Paracetamol adverse reactions, 22b for chronic pain, 1345b for fever, 218 for headache, 1096 hepatoxicity of, 857, 857f for musculoskeletal disease, 1002 osteoarthritis, 1012 for pain, 1345 poisoning, 134b poisoning from, 137–138, 138f acute liver disease and, 857–858, 858b Paracoccidioides brasiliensis, 304 Paracoccidioidomycosis, 304 Paraesthesia, 1083–1084 Paraganglioma, 675–676 Paragonimiasis, 233–234 Paragonimus spp., 129 Paragonimus westermani, 233b Parainﬂuenza viruses, 249 Paraldehyde disturbed behaviour, 1189f poisoning, 135b Paralysis, ventilator-induced lung injury and, 204 Paralysis ticks, envenomation of, 161 Paralytic ileus, 837–838 Paralytic shellﬁsh poisoning, 149 Paramyotonia congenita, 1145b Paraneoplastic disease, neurological, 1110–1111, 1111b Paraneoplastic syndromes, neurological, 1325–1326 Paraparesis, 1086–1087 Paraphasia, 1088 Paraphenylenediamine, 1247b Paraplegia, hereditary spastic, 1138b Parapneumonic effusion, 564 Paraproteinaemias, 966–968 Paraproteins, 965–966 Paraquat, poisoning from, 147 Parasitic infections and cancer, 1320b eosinophilia, 233b Parasitosis, delusional, 1202 Parasomnias, 1105–1106 non-REM, 1105 Parathyroid disease, pregnancy in,

familial hypocalciuric hypercalcaemia as, 1280 primary hyperparathyroidism as, 1280 Parathyroid glands, 661–665 disease of classiﬁcation of, 661b presenting problems in, 661–663 familial hypocalciuric hypercalcaemia and, 664 functional anatomy, physiology and investigations of, 661 hypoparathyroidism and, 664–665 in old age, 665b primary hyperparathyroidism and, 663–664, 663b, 664f Parathyroid hormone (PTH), 661 acute kidney injury and, 416b in bone remodelling, 986b osteomalacia and rickets, 1051–1052 osteoporosis, 1047b reference range of, 1359b in skeletal disease, 990b Parathyroid hormone-related protein (PTHrP), ectopic production, 1325b Parathyroidectomy, 419 Paratyphoid fever, 260 Parenchymal bacterial infections, 1124–1125 Parenchymal viral infections, 1121–1123 Parenteral administration, 17 Parenteral nutrition, 707–708, 708b Parietal lobes, 1066 disorders of, 1089b functions of, 1066b effects of damage, 1066b Parinaud syndrome, 1072b Parkinsonian syndromes, 1114–1115 Parkinsonism, 1084–1085, 1085b, 1112 drug-induced, 1112b Parkinson’s disease, idiopathic, 1112–1114 causes of, 1112b clinical features of, 1112–1113, 1113b non-motor symptoms of, 1112–1113 investigations of, 1113, 1113f management of, 1113–1114 drug therapy, 1113–1114 surgery, 1114 pathophysiology of, 1112, 1112f Paromomycin, 129 for leishmaniasis, 283 Parotitis, 790, 790b Paroxysmal atrial ﬁbrillation, 471–472 Paroxysmal cold haemoglobinuria, 950 Paroxysmal nocturnal haemoglobinuria (PNH), 950–951 Partial agonists, 14 Partial anterior circulation syndrome (PACS), 1156f Partial thromboplastin time with kaolin (PTTK), 920–921 Parvovirus B19 infection, 237 clinical features of, 237, 237b, 237f diagnosis of, 237 management of, 237 in pregnancy, 235b Past-pointing, 1069 Pastes, 1225b Pastia’s sign, 252, 253f Patau’s syndrome (trisomy 13), 44b Patch testing, for skin disease, 1215 Patella ligament enthesopathy, 999b Paterson-Kelly syndrome, 795–796 Pathergy test, 1044 Pathogen-associated molecular patterns (PAMPs), 63 ‘Pathogenicity,’ in host-pathogen interactions, 104 Pathogens direct detection of, 105–106 host-pathogen interactions, 104 indirect detection of, 106–109 successful, 104 Pathological fracture, 995b Pathway medicine, for genetic disease,

Patient-centred evidence-based medicine, 10, 11f, 12 Patient factors, of gastro-oesophageal reﬂux disease, 791 Patients, autonomy, 1288–1289 Pattern recognition receptors (PRRs),

Paul-Bunnell test, 242 PCSK9 inhibitors, 377 Peak expiratory ﬂow (PEF) asthma, 569f, 573f home monitoring, 555 morning dipping, 569f Peak ﬂow meters, 555, 569 Peanut allergy, 85 PECAM-1, 447 Pectins, 696b Pectus carinatum, 628 Pectus excavatum, 628 Pediculus humanus, 257 Pediculus humanus capitis, 1241 Pedigree, construction of, 46, 46f Pegloticase, for gout, 1016 Pegvisomant, 686–687 Pellagra, 714, 715f, 1221b Pelvi-ureteric junction obstruction (PUJO), 434 Pelvic ﬂoor exercises, faecal incontinence, 835 Pelvic inﬂammatory disease (PID), 336 Pemphigoid, bullous, 1255–1256, 1255b, 1256f Pemphigoid gestationis, 1220b, 1255b Pemphigus, 1256, 1326 Pemphigus foliaceus, 1255b Pemphigus vulgaris, 1255b Penciclovir, as anti-herpesvirus agent, 126, 127b Pendred’s syndrome, 635f, 650 Pendrin, 635f Penetrance, genetic, 47 Penicillamine for musculoskeletal disease, 1004b,

nephrotoxicity, 427b for oral ulceration, 790b for primary biliary cholangitis, 888 for pyridoxine deﬁciency, 715 for Wilson’s disease, 897 Penicillin(s), 117b, 121 adverse reactions, 21, 22b allergy, 75b anthrax, 267 diphtheria, 266 endocarditis, 528 leptospirosis, 258–259 listeriosis, 260 meningitis, 1120 nephrotoxicity, 427b

1402 • INDEX for neurosyphilis, 1125 penicillinase-resistant, 121 in pregnancy, 120b prophylactic, 78, 119b resistance, 116 rheumatic fever, 517 syphilis, 337 for syphilis, 339 tetanus, 1126b tropical ulcer, 254 urinary tract infection, 428 Penicillium marneffei infection, 303 Penile erection, 440 Penis, 386 Pentamidine, prophylactic, 119b Pentamidine isethionate for leishmaniasis, 283 for Pneumocystis jirovecii pneumonia,

Pentasa, for inﬂammatory bowel disease, 821b Pentavalent antimonials, 128, 283 Pentoxifylline for alcoholic hepatitis, 882 for frostbite, 166–167 Pepsinogen, 767 Peptic ulcer complications of, 801–802 indications for, 800b in old age, 801b perforation, 789, 801 prophylaxis for, in intensive care,

Zollinger-Ellison syndrome, 802 Peptic ulcer disease, 798–802 Peptide YY, 772b Peptides, antimicrobial, 62–63 Peptostreptococcus spp., 253b Perceptions abnormal, 1086, 1181 delusional, 1196–1197 Percussion abdomen, 765b in respiratory system, examination of, 546f Percutaneous coronary intervention (PCI) angina, 491–493, 491f–492f myocardial infarction, 493b vs. CABG, 493b Percutaneous endoscopic gastrostomy (PEG), 707, 708f Percutaneous therapy, for hepatocellular carcinoma, 891 Percutaneous transhepatic cholangiography (PTC), 854–855 Perforating dermatosis, acquired reactive, 1265 Perforin, 67 Perfusion, in respiratory system, 549–550 Perianal disease, inﬂammatory bowel disease and, 823 Pericardial disease, in tuberculosis (TB),

Pericardial effusion, 542b, 543, 543f, 1315b Pericarditis acute, 542, 542b, 542f in acute coronary syndrome, 496 chronic constrictive, 543–544, 543b, 544f tuberculous, 543 Pericardium, diseases of, 542–544 Perimetry, 1168 Perimysium, 987–988 Periodic fever syndromes, 81, 1059 Periodic limb movements, and sleep,

Periodic paralysis hyperkalaemic, 1145b hypokalaemic, 1145b Periostitis, 337, 600–601 Peripartum cardiomyopathy, pregnancy and, 1282 Peripheral arterial disease, 502–505, 502b Peripheral nerves, 1338 disease of, 1138–1141, 1139b HIV-related, 321 endings, 1338 lesions, 1083 Peripheral nervous system motor, 1068 sensory, 1068 Peripheral neuropathy, 1325 cancer-related, 1325 diabetic, 755, 756b drug-induced, 321 HIV-related, 321 leprosy, 268 in rheumatoid arthritis, 1024 sensorimotor, 321 Peripheral sensitisation, 1340, 1341f Peripheral ulcerative keratitis, 1171–1172 Peripheral vascular disease, in diabetes, 503b Perisinusoidal ﬁbrosis, 884 Peristalsis, 772 Peritoneal cavity, disease of, 836–837 Peritoneal dialysis, 424 automated, 424 continuous ambulatory, 424 haemodialysis vs., 420b problems with, 425b Peritonitis, 836 spontaneous bacterial, 864 Permanent pacemakers, for arrhythmias, 483, 483b Pernicious anaemia, 944 Persistent atrial ﬁbrillation, 472–473 Persistent ductus arteriosus, 532f–533f, 533–534 Personality, 1071 change, 1094 high-risk behaviour and, 1295 psychiatric disorders and, 1183 Personality disorders, 1204–1205 prevalence of, 1180b Pes cavus, 1140 Pesticides, 144–149 Petechiae, deﬁnition of, 1211f Petechial purpura, 928–929, 928f Petit mal, 1097 Pets allergic rhinitis and, 622 asthma and, 568 HIV infection/AIDS and, 323 Peutz-Jeghers syndrome, 829, 829f Peyer’s patches, 67, 769–770 Phaeochromocytoma, 675–676, 675b, 676f Phaeohyphomycoses, 301 Phagocytes, 63–64, 63f deﬁciency in, 73b primary, 77–78, 77f Phagocytosis, 63, 63f Phagolysosome, 64 Phantom limb pain, 1349 Pharmacist, 21b Pharmacodynamics, 14–16, 14f dose-response relationship in, 14–16, 15f drug targets in, 14, 15b mechanisms of action of, 14 Pharmacogenomics, for genetic disease, 58 Pharmacokinetics, 17–19, 17f absorption in, 17–18 distribution in, 18 elimination in, 18–19 patient-speciﬁc factors in, 20b repeated dose regimens in, 19 Pharmacological therapies, for pain, 1344–1347, 1345b Pharmacovigilance, 23, 23b Pharmacy, 27 Pharyngeal pouch, 794 Phenelzine, 1199b Phenobarbital epilepsy, 1102b in old age, 32b poisoning, 136b status epilepticus, 1081b Phenothiazines, for schizophrenia, 1198b Phenoxymethylpenicillin, 120b prophylactic, 119b Phentermine, for obesity, 702–703 Phenylketonuria, 369 Phenytoin ataxia, 1115b drug interactions, 24b epilepsy, 1102b multiple sclerosis, 1110b pharmacokinetics of, 19 plasma concentration, 36b poisoning, 141b renal or hepatic disease, 32b sodium content of, 864b status epilepticus, 1081b Phobia, 1200 Phobic anxiety disorder, 1200 Phosphate acute kidney injury and, 416b in diabetic ketoacidosis, 738 enema, 869b homeostasis, 368–369 reference range of urine, 1361b venous blood, 1360b in skeletal disease, 990b Phosphenes, 1088 Phosphodiesterase type 5 inhibitors, erectile dysfunction, 440 Phospholipids, 126, 370 Phosphorus, 716 deﬁciency, 716 dietary sources of, 717b excess, 716 reference nutrient intake of, 717b Photo-exposed site hyperpigmentation,

Photoallergy, 1221b Photochemotherapy, 1227 Photodynamic therapy (PDT) for oral cancer, 790 for skin disease, 1228 Photophobia/glare, of ophthalmic disease, 1170 Photopsia, of ophthalmic disease, 1170 Photosensitivity, 1220–1223, 1221b clinical assessment of, 1221 drug-induced, 1266b investigations and management of, 1221–1223 Phototesting, for skin disease, 1215 Phototherapy, 1227 Phototoxicity, 1221b Physical activity, energy expenditure and, 694, 695f Physical therapies for musculoskeletal disease, 1001 rheumatoid arthritis, 1026 for pain, 1344, 1344b Physiological anaemia of pregnancy,

Physiological breathlessness, of pregnancy, 1274–1275 Physiotherapy for bronchiectasis, 579 for cancer pain, 1352 for cervical spondylosis, 1134 for community-acquired pneumonia,

for fracture, 995 for Parkinson’s disease, 1114 for stroke, 1159f Phytoestrogens, 716 Pick’s disease, 1193–1194 Pigment stones, 903–904, 903b Pigmentation drug-induced, 1258, 1258b, 1266b endocrine, 1258 Pigmented villonodular synovitis, 1059 Pinta, 254, 254b Piperacillin, 120b for spontaneous bacterial peritonitis,

for variceal bleeding, 869 Piperacillin-tazobactam, 117b for necrotising fasciitis, 227 for neutropenic fever, 224 Piperazine, 129 Piroxicam, 1003b Pitted keratolysis, 1238 Pituitary disease investigation of patients with, 680, 680b pregnancy and, 1280 diabetes insipidus as, 1280 prolactinoma as, 1280 Sheehan’s syndrome as, 1280 Pituitary hormones, 632 Pituitary tumours, 683–684, 1129 Pityriasis lichenoides chronica, 1251 Pityriasis rosea, 1217b, 1251 Pityriasis versicolor, 1240 rash in, 1217b Placental alkaline phosphatase (PLAP), as tumour markers, 1322, 1324b Plague, 259, 259f Plain chest X-ray for gastrointestinal disease, 772, 773f contrast studies of, 773 normal, 551f for respiratory disease, 551, 551b, 551f abnormalities, 552b aspergillosis, 597f asthma, 569 bronchiectasis, 579 COPD, 575 empyema, 564f haemoptysis, 560 interstitial, 605, 605f lobar collapse, 552f lung cancer, 599, 599f mediastinal tumours, 604, 604f pleural effusion, 563 pleural plaques, 617f pneumonia, 585 pneumothorax, 626 pulmonary embolism, 619–620, 619b, 619f pulmonary hypertension, 622f sarcoidosis, 609b silicosis, 615f tuberculosis, 590f Plane warts, 1238 Plant poisoning, 150, 150b Plantar warts, 1238 Plaques amyloid in, 1192 deﬁnition of, 1211f Plasma derivatives, 930 Plasma exchange (PE) for Guillain-Barré syndrome, 1140 pre-renal transplant, 424 Plasma iron, 942 Plasma viscosity, inﬂammation and, 72 Plasmapheresis, for pruritus, primary biliary cholangitis and, 888 Plasmodium falciparum infection, 274f, 275, 276b Plasmodium falciparum malaria, 950 Plasmodium knowlesi infection, 276 Plasmodium malariae infection, 276 Plasmodium ovale infection, 275 Plasmodium vivax infection, 275 Platelet-derived growth factor (PDGF),

Platelet-endothelial cell adhesion molecule type 1 (PECAM-1), 447 Platelet function disorders, 970–971 Platelets, 918, 920f concentrate, 931b count in coagulation screening tests, 922b high, 929–930 low, 929 function, assessing, 921 reference range of, 1362b Plethysmography (SpO2), 175b Pleural disease, 625–627 Pleural effusion, 562–565, 1329, 1329b cardiac failure in, 563b causes of, 563b clinical assessment of, 563 investigations of, 563–564 large right, 547f Penicillin(s) (Continued)

INDEX • 1403 malignant, 563b management of, 564 obstruction of thoracic duct in, 563b oedema, 395–396 pancreatitis in, 563b pulmonary infarction in, 563b rheumatoid disease in, 563b, 610–611 in systemic lupus erythematosus,

systemic lupus erythematosus in, 563b tuberculosis in, 563b, 589f–590f Pleural pain in community-acquired pneumonia, treatment of, 584 in lung cancer, 600 Pleural plaques, 617–618, 617f Pleural rub, 457–459 Plexopathy, 1138 brachial, 1141 lumbosacral, 1141 Plumboporphyria, 379b Plummer-Vinson syndrome, 795–796 Pluripotent stem cells, induced, for genetic disease, 58 Pneumatosis cystoides intestinalis, 837 Pneumococcal infection, 266 Pneumoconiosis, 614–616, 615b Pneumocystis jirovecii infection, after HSCT, 937b Pneumocystis jirovecii pneumonia, HIV-related, 315b, 318, 318b, 318f Pneumocytes, 548–549 Pneumonia, 582–587 bacterial, HIV-related, 319f community-acquired, 582–585, 582f clinical features of, 582–583 discharge and follow-up of, 585 investigations of, 583, 584b management of, 583–584 organisms causing, 582b prognosis for, 585 complications of, 585b differential diagnosis of, 583b factors predispose to, 582b hospital-acquired, 585–586, 585b in immunocompromised patient, 587 necrotising, 104b occupational, 618–619 pregnancy and, 1277 causes of, 1277b viral, 1277 right middle lobe, 547f, 584f suppurative pneumonia, aspiration pneumonia and pulmonary abscess, 586–587 Pneumonic plague, 259 Pneumothorax, 547f, 625–627, 625f age distribution of, 625f air travel after, 169 classiﬁcation of, 625b clinical features of, 626 investigations of, 626 management of, 626–627, 627f spontaneous recurrent, 627 types of, 626f tension, 566 Podocytes, 384 Podophyllotoxin, 343 Point mutations, 42 Point-of-care testing (POCT), 348 Poiseuille’s Law, 447 Poisoning, 131–150 acute, 134 assessment and investigation for, 134–135, 135b from chemicals and pesticides, 144–149 chemicals less commonly taken in, 148, 148b clinical signs of, 133f decontamination and enhanced elimination for, 133f drugs of misuse and, 141–144 environmental, 149 evaluation for, 132–134, 132b, 132f food-related, 149–150 management of, 135–137 antidotes for, 137, 137b gastrointestinal decontamination for, 135–136, 136b haemodialysis and haemoperfusion for, 136, 136b lipid emulsion therapy for, 136–137 supportive care for, 137, 137b urinary alkalinisation for, 136 in old age, 134b by pharmaceutical agents, 137–141 less commonly taken in, 141, 141b plant, 150, 150b poisoned patient, general approach to, 134–137 psychiatric assessment for, 135 substances involved in, 134b substances of very low toxicity and, 134b triage and resuscitation, 134 Poliomyelitis, 1123, 1123f immunisation for, 1123 incubation period of, 1123 Pollution, atmospheric, 94 PolyA tail, 39f, 40 Polyadenylation signal, 38 Polyarteritis nodosa, 1042 Polyarthritis, 993–994, 993b, 1020–1021 inﬂammatory arthritis and, extra-articular features of, 994b joint involvement in, 994f symmetrical, 1032 Polycystic ovarian syndrome, 658–659, 659f features of, 658b hirsutism and, 658b, 659 Polycythaemia, 384–386, 925 Polycythaemia rubra vera (PRV), 925,

Polydipsia, 357, 634b Polyenes, 126 Polyethylene glycol, 842 Polymerase chain reaction (PCR), 106 for genetic diseases, 52, 53f for hepatitis B, 873 for herpes simplex virus, 333, 1077 for Whipple’s disease, 809 Polymorphic eruption of pregnancy, 1220b Polymorphic light eruption, 1221b Polymorphisms, 45 single nucleotide, 45 Polymorphonuclear cells, 1122 Polymorphonuclear leucocytes, 64 Polymyalgia rheumatica (PMR), 1042–1043 mimic, 1042b Polymyositis (PM) see Dermatomyositis/ polymyositis Polymyxins, 123 Polyneuropathy, 1139b chronic, 1140–1141 critical illness, 211–212 Polyostotic ﬁbrous dysplasia, 1055 Polypeptides, 768 Polyposis syndromes, 827–829, 827b juvenile, 829 Polyps, 827–829, 827b Polyuria, 396–397, 396b, 634b Pompe’s disease, 1144b Pompholyx, 1247 Popliteal cyst, 998b–999b Population health, 91–98 Porphyria cutanea tarda (PCT), 379b, 1257, 1263–1264, 1264f Porphyrias, 378–380, 1221b, 1263–1264 acute intermittent, 379b congenital erythropoietic, 379b cutaneous, 1263–1264 erythropoietic protoporphyria, 379b hepatic, exacerbation of, 1266b hereditary coproporphyria, 379b plumboporphyria, 379b variegate, 379b ‘Portal’ circulation, 384, 385f Portal hypertension, 868–871, 898 ascites and, 869 cirrhosis and, 868 classiﬁcation of, 868f clinical features of, 868–869 complications of, 868b extrahepatic portal vein obstruction,

investigations for, 869 management of, 869–871 pathophysiology of, 869 Portal vein thrombosis, 898 Portal venous disease, 898 Portal venous pressure, pharmacological reduction of,

Portopulmonary hypertension, 898 Portosystemic shunt fetor hepaticus from, 868 portal hypertension and, 869 for variceal bleeding, 871 Posaconazole, 126 Positron emission tomography (PET) for cancer, 1323, 1323f of gastrointestinal tract, 778b for Hodgkin lymphoma, 962, 963f of nervous system, 1072 for oesophageal carcinoma, 796f for respiratory disease, 553, 553f Post-cholecystectomy syndrome, 908, 908b Post-exposure prophylaxis, for HIV infection/AIDS, 327 Post-micturition dribble, 437 Post-partum blues, 1206 Post-partum haemorrhage primary, 1275 secondary, 1275 Post-partum thyroiditis, 647, 651b in pregnancy, 651b, 1279 Post-pyloric feeding, 707 Post-transplant lymphoproliferative disorders (PTLDs), 1299 Post-traumatic stress disorder, 1201–1202 Posterior circulation stroke (POCS), 1156f Posterior descending artery, 444 Posterior scleritis, 1170 Posterior uveitis, 1172 Posteroanterior (PA) ﬁlm, of chest X-ray,

Postmortem examination, 213 Postural hypotension, renal dysfunction, 395–396 Posture, examination of, 1063b Potassium, 349b, 718 and diabetic ketoacidosis, 738 dietary sources of, 717b foods high in, 418b homeostasis, 360–363 presenting problems in, 361–363 intake, chronic renal failure, 418 plasma concentration control and, 360f reference nutrient intake of, 717b reference range of urine, 1361b venous blood, 1358b renal handling, 360, 360f ROMK channel, 360 supplements, 367 Potassium chloride, hypokalaemia, 362 Potassium phosphate, 369 Potassium-sparing diuretics, for hypervolaemia, 355 Potency, 16 Poverty, health consequences of, 94 Poxviruses, 248–249 Practolol, nephrotoxicity, 427b Praziquantel, 129 Pre-eclampsia, hypertension and, 1276–1277, 1276b, 1277f Pre-exposure prophylaxis, for HIV infection/AIDS, 327 Pre-implantation genetic diagnosis (PGD), 56 Pre-patellar bursitis, 999b Pre-symptomatic/predictive testing, 59 Pre-test probability, in clinical decision-making, 11 Pre-transfusion testing, 934 Precocious puberty (PP), 654 Prednisolone for alcoholic hepatitis, 882 for autoimmune hepatitis, 886–887 for eosinophilic gastroenteritis, 811–812 for gout, 1015 for inﬂammatory bowel disease, 821b liver transplantation and, 901 for respiratory disease aspergillosis, 596 asthma, 572 chronic eosinophilic pneumonia, 611–612 COPD, 578 hypersensitivity pneumonitis, 617 rheumatoid disease, 610 sarcoidosis, 610 for syphilis, 339 for systemic lupus erythematosus,

for type II thyrotoxicosis, 648 for warm autoimmune haemolysis,

Prefrontal cortex (PFC), high-risk behaviour and, 1295 Pregabalin, 1102b Pregnancy abnormal liver function tests in, 900b adolescent, rates of, 1296b adrenal disease in, 1280 air travel and, 169 analytes affected by, 1364b antimicrobial agents in, 120b biliary obstruction and, 900 cardiac disease in, 1282 cholecystitis and, 900 congenital heart disease in, 533, 533b diabetes in, 1278–1279 diabetes mellitus in, 752–753 dyslipidaemia in, 377b ectopic, 336 endocrine disease in, 1279–1280 functional anatomy and physiology in, 1272–1273 bone metabolism and, 1272 cardiovascular system and, 1272 endocrine system and, 1272 gastrointestinal system and, 1272 genitourinary system and, 1272 glucose metabolism in, 1272–1273 haematological system and, 1273 respiratory system and, 1273 gallstones and, 900 gastrointestinal disease in, 1277–1278 haematological disease in, 1284–1285 anaemia as, 1284, 1285b Rhesus disease as, 1285 thrombocytopenia as, 1285, 1285b venous thromboembolism as,

haematological physiology in, 941b hepatitis A and, 900 hepatitis B and, 900 hepatitis C and, 900 hepatitis E and, 900 hormonal changes in, 1273f human immunodeﬁciency virus infection in, 1280 hypertension in, 1276–1277 hypothyroidism in, 641, 651b immunological diseases during, 88b inﬂammatory bowel disease in, 823–824, 824b inﬂammatory rheumatic disease in, 1280–1281 iodine deﬁciency in, 651b ketoacidosis and, 1279 laboratory reference range in, 1364 liver disease and, 899–900, 1283–1284 medical disorders in, 1276–1285

1404 • INDEX neurological disease during epilepsy, 1103, 1103b multiple sclerosis, 1110b neurological disease in, 1284 neutrophilia during, 926 nutrition in, 712b osteoporosis in, 1045 parathyroid disease in, 1280 physiological anaemia of, 1273 pituitary disease in, 1280 diabetes insipidus as, 1280 prolactinoma as, 1280 Sheehan’s syndrome as, 1280 planning of, in patients with medical conditions, 1272 post-partum thyroiditis in, 651b prescribing in, 32–33, 32b presenting problems of, 1274–1276 breathlessness as, 1274–1275 chest pain as, 1275 circulatory collapse as, 1275 headache as, 1275 nausea and vomiting as, 1275, 1275b oedema as, 1275 seizures as, 1275–1276, 1276b prolactinoma in, 685 psychiatric disorders during, 1206–1207, 1206b, 1284 renal disease in, 426, 426b, 1282–1283 respiratory disease in, 1277 Rhesus D blood groups in, 933b rheumatoid arthritis in, 1026b safety of antirheumatic drugs during, 1281b sickle-cell disease in, 953, 953b STI during, 332, 332b swollen legs in, 187, 188b syphilis in, 339 thyroid disease in, 651b, 1279 thyrotoxicosis in, 645, 651b unplanned, transition medicine and, 1295–1296 visual disorders and, 1175b Prenatal genetic testing, 56, 59 Prescribing, 13–36, 14b choice of drug, 29 decision-making in, 28–31 for elderly patients, 32, 32b high-risk moments, 33b in hospitals, 33 monitoring treatment effects, 31 patient involvement, 30–31, 31b for patients with hepatic disease, 32, 32b for patients with renal disease, 31–32 in practice, 28–36 for pregnancy and breastfeeding, 32–33, 32b in primary care, 33–34 principles of, during transition, 1289, 1289b repeat, 34 in special circumstances, 31–33 steps in, 14b writing, 31, 33–34, 34f–35f Prescription-only medicine (PoM), 27 Pressure areas, of stroke patients, 1159b Pressure sores, 1262 in stroke patients, 1159f Presyncope, 181–183, 455 clinical assessment of, 182–183 congenital heart disease and, 533 differential diagnosis of, 182f features of, 181b gastrointestinal haemorrhage, 780 heat, 167 investigations of, 183 in older people, 1308 presentation of, 181–182 seizures versus, 182b Pretibial myxoedema, 646 Prevalence, of disease, 95 Preventive medicine, 93–94 alcohol, 94 atmospheric pollution, 94 obesity, 94 poverty and afﬂuence, 94 smoking, 94 Prevotella spp., 103f Prick tests, 1215 Primary afferent neurons, 1338 Primary biliary cholangitis, 887–888 AMA-negative, 888 associated diseases with, 887 autoimmune hepatitis and, 888 bone disease and, 888 clinical features of, 887 diagnosis and investigations for, 887–888 epidemiology of, 887 fatigue and, 888 liver function test (LFT) abnormality in, 854b management of, 888 natural history of, 887f in old age, 901b overlap syndromes, 888 pathophysiology of, 887 primary sclerosing cholangitis and, 902b pruritus and, 888 Primary CNS lymphoma, 320, 320f Primary disease, in endocrinology, 632–633 Primary eosinophilias, 927 Primary granules, 64 Primary haemostasis, disorders of, 970–971 Primary headache syndromes, 185b Primary hyperaldosteronism, 674–675, 674b, 675f Primary hyperparathyroidism, 663–664, 663b, 664f biochemical abnormalities in, 990b pregnancy and, 1280 Primary idiopathic acquired aplastic anaemia, 968–969, 968b Primary immune deﬁciency, warning signs of, 73b Primary sclerosing cholangitis, 888–890, 889f diagnostic criteria for, 888 diseases associated with, 889b liver function test (LFT) abnormality in, 854b magnetic resonance cholangiopancreatogram of, 889, 889f primary biliary cholangitis and, 902b Primary Sjögren’s syndrome (PSS), 1038–1039 Primidone, 1102b Prion diseases, 250, 1126–1127, 1127b, 1191b Prions, 102 Pro-carboxypeptidases, 770b Pro-elastase, 770b Probenecid, for neurosyphilis, 1125 Problem-solving therapy, 1191, 1191b Procaine penicillin for neurosyphilis, 1125 for syphilis, 339 Procaine reaction, 339 Procarboxypeptidases, 768 Prochlorperazine, 803, 1104 Proctocolitis, radiation, 809–810, 810b Proctoscopy, 339 Procyclidine, 1188–1189 Progeric syndromes, 41 Progesterone pregnancy and, 1272 reference range of, 1359b Progesterone receptors, as tumour markers, 1322, 1324b Progestogens, in cancer treatment,

Progressive multifocal leucoencephalopathy, 1123 Progressive pulmonary hypertension, in systemic sclerosis, 1038 Progressive supranuclear palsy, 1114–1115 Proguanil, 128 for malaria, 278b Prokaryotes, 100–101 Prolactin (PRL), reference range of, 1359b Prolactinoma, 684–685, 685b, 685f pregnancy and, 1280 Prolymphocytic leukaemia (PLL), 960 Prone positioning, as advanced respiratory support, 204 Propantheline, 1142–1143 Prophase, 40 Prophylactic gonadectomy, for Turner’s syndrome, 660 Propionibacterium spp., 103f Propranolol for anxiety disorder, 1201 for congestive ‘portal hypertensive’ gastropathy, 871 for variceal bleeding, 869 Proptosis, of ophthalmic disease, 1171 Propylthiouracil (PTU) for Graves’ thyrotoxicosis, 644 for thyrotoxicosis, in pregnancy, 1279 Prosody, 1070 Prostacyclin, 447 for acute kidney injury, 422 Prostaglandin E1, erectile dysfunction,

Prostaglandin E2, febrile response, 104 Prostate benign hyperplasia, 437 cancer, 438–439 Prostate gland, 386 Prostate-speciﬁc antigen (PSA), 439b as tumour markers, 1322, 1324b Prostatic acid phosphatase (PAP), as tumour markers, 1322, 1324b Prostatitis, 437 Prosthetic valve dysfunction, 527 Prosthetic valves, 526–527 Protease inhibitors (PIs), 324b Proteases, 768 Protein C deﬁciency, 977 Protein-losing enteropathy, 811b Protein S deﬁciency, 977 Proteins, 697, 697b, 1305 Bence Jones, 394–395 biliary transport, 851f cerebrospinal ﬂuid, 1361b cholesterol ester, 373 digestion of, 768, 769f IGF-BP3, 633f metabolism of, effects of insulin in, 723b plasma, 850 production of, 39f, 40 reference range of urine, 1361b venous blood, 1360b restriction in, for hepatic encephalopathy, 865 Tamm-Horsfall, 392 urine, 727 Proteinuria, 392–395, 394b in diabetic neuropathy, 727 investigation of, 394f orthostatic, 394 overt (dipstick-positive, 394–395 pregnancy and, 1282 reduction of, 417 tubular, 394 Proteoglycans, 987 Proteosome inhibitor, for multiple myeloma, 968 Proteus spp., 103f Prothrombin G20210A, 977 Prothrombin time (PT), 920–921 in coagulation screening tests, 922b for gastrointestinal bleeding, 781 for liver disease, 850, 853 acute liver failure and, 858 alcoholic hepatitis and, 882 reference range of, 1362b Prothrombotic states, 977–979 Proto-oncogenes, 56–57 ‘Proton pump’, 767 Proton pump inhibitor, for variceal bleeding, 869b Protozoa, 101–102 Protozoal infections, 273–288 gastrointestinal, 286–288 leishmaniasis, 281–286 systemic, 273–281 Prozone phenomenon, 338–339 Prurigo gestationis, 1220b Pruritic folliculitis, 1220b Pruritus, 1219–1220, 1326 clinical assessment of, 1219–1220 investigations and management of, 1220, 1220f of ophthalmic disease, 1170 in pregnancy, 1220b primary biliary cholangitis and, 887 treatment for, 888 primary causes of, 1219b secondary causes of, 1219b Pruritus ani, 836, 836b Pseudo-hallucinations, 1184 Pseudo precocious puberty, 654 Pseudocyst, pancreatic, 838f Pseudohypoparathyroidism, 664–665 Pseudomonas aeruginosa, 117b Pseudomonas ﬂuorescens, 225 Pseudoporphyria, 1221b, 1257, 1266b Psoralens, for skin disease, 1227 Psoriasiform, drug-induced, 1266b Psoriasis, 1247–1251 arthropathy and, 1249 clinical features of, 1249, 1249f erythrodermic, 1249 guttate, 1249 investigations of, 1250 management of, 1250–1251, 1250f–1251f pathogenesis of, 1248, 1248b, 1248f plaque, 1249 pustular, 1249 rash in, 1217b Psoriatic arthritis (PsA), 1032–1034 CASPAR criteria for, 1032b clinical features of, 1032–1033, 1033f investigations for, 1033 management for, 1033–1034 pathophysiology of, 1032 Psoriatic spondylitis, 1032 Psychiatric assessment, poisoning and,

Psychiatric disorders, 1094, 1191–1207 classiﬁcation of risk factors for, 1183, 1183b clinical examination of, 1180–1183 mental state examination, 1181–1183 psychiatric interview, 1181, 1181b emergencies for, 1189b functional anatomy and physiology in, 1183–1184 biological factors, 1183 psychological and behavioural factors, 1183 social and environmental factors,

INDEX • 1405 Psychological factors affecting medical conditions, 1186–1187, 1186b of migraine, 1095 Psychological therapies/psychotherapy, 1190–1191 for alcohol misuse, 1195 general, 1190 interpersonal, 1191 for pain, 1347 psychodynamic, 1191 Psychosis affective, 1200 organic, 1197 puerperal, 1206 toxic, 1195–1196 Psychotropic drugs, 1190b Pthirus pubis, 334b Ptosis causes of, 1091b unilateral, 1091f Puberty analytes affected by, 1363b delayed, 653–654, 653b, 1290 hormonal events of, 1291f initiation of, 1290 onset of, 1290 Pubic (crab) lice, 1241 Pubic symphysitis, 999b Puerperal psychiatric disorders, 1206–1207 Pulmonary abscess, 586–587 Pulmonary artery catheter, 206, 207f Pulmonary artery wedge pressure, portopulmonary hypertension and, 898 Pulmonary circulation, 549–550 Pulmonary embolism, 619–621 acute massive, 200 clinical features of, 619, 619b investigations of, 619–620, 619f–620f management of, 620–621 in pregnancy, 620b prognosis for, 621 in stroke patients, 1159f Pulmonary eosinophilia and vasculitides, 611–612, 611b Pulmonary ﬁbrosis, 547f in dermatomyositis, 610b idiopathic, 605–608, 607f in respiratory function abnormalities, 555b in rheumatoid arthritis, 610b, 1024 in sarcoidosis, 609b in sclerosis, 610b in systemic lupus erythematosus, 610b Pulmonary hypertension, 550, 621–622, 621b, 622f congenital heart disease and, 533 systemic sclerosis and, 1038 Pulmonary nodules cryptococcosis, 302 lung metastases, 1328 in respiratory disease, 560–562, 560b–561b, 560f–562f Pulmonary oedema, 413–414, 413f high-altitude, 168–169 renal artery stenosis, 407 sputum in, 546f Pulmonary regurgitation, 526, 527b Pulmonary rehabilitation, for chronic obstructive pulmonary disease (COPD), 577 Pulmonary stenosis, 526 Pulmonary syndrome, 258 Pulmonary tuberculosis clinical presentations of, 590b HIV-related, 318–319, 319f major manifestations and differential diagnosis of, 590f post-primary, 589 primary, 588, 589b, 589f Pulmonary tuberous sclerosis, 613b Pulmonary valve disease, 526 Pulmonary vascular disease, 619–622 pulmonary embolism, 619–621 pulmonary hypertension, 621–622, 621b, 622f Pulse, in endocrine disease, 630f Pulsus paradoxus, 447–448 Pupillary abnormalities, 1090, 1091f, 1092b Purkinje ﬁbres, 445 Purpura deﬁnition of, 1226 drug-induced, 1266b Henoch-Schönlein, 398b–399b, 401,

idiopathic thrombocytopenic, 971 non-thrombocytopenic, 928b petechial, 928–929, 928f pinch, 1264 senile, 978b thrombotic thrombocytopenic, 388, 409, 979 Pustule, deﬁnition of, 1211f Pustuloderma, drug-induced, 1266b Pustulosis acute generalised exanthematous, 1266b palmoplantar, 1249 PUVA, 1215, 1227 atopic eczema, 1246 granuloma annulare, 1263 lichen planus, 1252 necrobiosis lipoidica, 1263 psoriasis, 1250 vitiligo, 1257–1258 Pyelography, 390 retrograde, 390f Pyelonephritis acute, 402f, 430 chronic, 430 emphysematous, 430 pregnancy and, 1282 Pyeloplasty, 434 Pyloroplasty, 782 Pyoderma gangrenosum, 1261–1262, 1262f Pyonephrosis, 432 Pyopneumothorax, 564 Pyramidal gait, 1086–1087 Pyrantel pamoate, 129 Pyrazinamide as antimycobacterial agents, 125 for tuberculous meningitis, 1121 Pyrexia of unknown origin, 218–222 aetiology of, 220b clinical assessment of, 218–219 investigations of, 219–222, 221b prognosis of, 222 Pyridostigmine, 1142–1143 Pyridoxal, 715 Pyridoxamine, 715 Pyridoxine (vitamin B6), 715 biochemical assessment of, 712b deﬁciency, 715 dietary sources of, 711b reference nutrient intake of, 711b supplements, 715 Pyrimethamine malaria, 273 toxoplasmosis, 281 HIV-related, 320 Pyrimidine 5’ nucleotidase deﬁciency,

Pyrin, 81 Pyrophosphate arthritis, 993b Pyruvate kinase deﬁciency, 949 Pyuria, sterile, 430 Q Q fever, 231b, 272 endocarditis, 272, 528 Qualitative abnormalities, 951 Quality-adjusted life years (QALYs), 28, 28b Quality of life, 202b Quantitative abnormalities, 951 Quantitative sensory testing, for pain, 1342, 1342f Questions, medical interview, 231b Quetiapine bipolar disorder, 1200 delirium, 209 Quinagolide, prolactinoma, 685 Quincke’s sign, 524b Quinidine arrhythmias, 480 malaria, 277b and neutropenia, 926b poisoning, 137b Quinine babesiosis, 278 lichenoid eruptions, 1252 for malaria, 128 poisoning, 141b Quinolones, 122–123, 123b adverse effects of, 123 drug eruptions, 1266b mechanism of action, 116b in old age, 120b pharmacokinetics of, 122 in pregnancy, 120b prophylactic, spontaneous bacterial peritonitis, 864 for spontaneous bacterial peritonitis,

see also Fluoroquinolones R R protein, 944 RA see Rheumatoid arthritis Rabies, 1122–1123 incubation period, 111b, 232b prophylaxis for post-exposure, 1122–1123 pre-exposure, 1122 vaccination, 115b, 1122–1123 Radial nerve, entrapment, 1139b Radial pulse, 534 examination of, in respiratory system, 546f Radiation(s), 164–165 dosage and exposure of, 164 effects of exposure to, 164–165 enteritis and proctocolitis, 809–810, 810b infrared, 1222f ionising, 164, 164f management of exposure to, 165 mutagenic effects, 1320b natural background, 164 non-ionising, 164 pneumonitis, 612 proctocolitis, 809–810, 810b ultraviolet see Ultraviolet radiation Radicular pain, 997b, 998f Radiculography, 1073b Radiculopathy, 256, 1138, 1141 cervical, 1134, 1134f HIV-related, 321 Radio-femoral delay, 442f Radio-iodine therapy, for thyrotoxicosis, 637–638, 645b Radioactive iodine, for Graves’ thyrotoxicosis, 644b, 645 Radioallergosorbent test (RAST), 86 Radiofrequency ablation arrhythmias, 481b, 484f cardiovascular disease, 484 GORD, 792–793 for hepatocellular carcinoma, 891 liver metastases, 1328–1329 renal cell cancer, 435 Radiography see X-rays Radioiodine multinodular goitre, 649 thyrotoxicosis, 637, 644b Radioisotope imaging see Radionuclide (radioisotope) imaging Radioisotope tests, gastroenterology,

Radioisotopes cancer treatment, 1331 exposure to, 165 intravenous injection of, 1331 Radiology see CT; MRI; X-rays Radionuclide (radioisotope) imaging of bone, 988–989 of cardiovascular system, 454 of nervous system, 1073b Paget’s disease, 1054f renal disease, 390, 390f Radionuclide studies, renal disease, 390, 390f Radionuclide ventilation/perfusion (Vࡆ/Qࡆ) scanning, pregnancy and, 1274 Radiotherapy, 1331–1332 for acromegaly, 686 adverse effects, 1331f, 1332 blood disorders chronic lymphocytic leukaemia, 960 Hodgkin lymphoma, 962 multiple myeloma, 968 non-Hodgkin lymphoma, 965 for brain tumours, 1130–1131 breast cancer, 1334 for cancer pain, 1352 colorectal cancer, 832 conformal, 1331 fractionation, 1331 for high-grade NHL, 966 hypothyroidism and, 1298 late effects, 689, 955b for low-grade NHL, 965 lung cancer, 602 for lung cancer, 602 lung damage, 612 lung disease due to, 612 mesothelioma, 618 for multiple myeloma, 968 oesophageal cancer, 797 for oral cancer, 790 pain management, 1344 palliative, 1352 pituitary tumours, 683–684 for prolactinoma, 685 prostate cancer, 439 for skin disease, 1228–1229 Radon, lung cancer and, 561b Raloxifene, for osteoporosis, 1048b,

Raltegravir, 119b Ramadan, diabetes during, 745, 745b Ramipril heart failure, 466b hypertension, 513 myocardial infarction, 500–501 Ramsay Hunt syndrome, 239 Randomised controlled clinical trials, 27–28, 28f Ranitidine and neutropenia, 926b urticaria, 1254 RANK (receptor activator of nuclear κB),

RANKL (Receptor activator of nuclear factor kappa B ligand), in bone remodelling, 986b Rapid diagnostic tests (RDTs), immunochromatographic, 276 Rapid immunochromatographic tests,

Rapid plasma reagin (RPR), 338–339 Rapidly progressive glomerulonephritis,

diseases typically presenting with,

Rare inherited bleeding disorders, 974 Rare interstitial lung diseases, 613b Rasagiline, for Parkinson’s disease,

Rashes, 1216–1218, 1217b atopic eczema, 1217b, 1246b butterﬂy (malar), 982f in chickenpox, 238 clinical features, 1217b dengue, 243–244 dermatitis herpetiformis, 807 dermatomyositis, 1039 distribution, 1217b drug eruption, 316, 1217b, 1267f erythema migrans, 256f erythematous, 1255 in fever, 218 genital, 333, 334b haemorrhagic, 271b hand, foot and mouth disease, 248 herpes simplex, 247f HIV-related, 316 infectious mononucleosis, 242f lichen planus, 334b, 1217b Lyme borreliosis (disease), 256f macular/maculopapular, 271b

1406 • INDEX morbiliform, 271b parvovirus B19, 237f petechiae, 928–929, 928f photosensitivity, 1221f pityriasis rosea, 1217b pityriasis versicolor, 1217b post-kala-azar dermal leishmaniasis, 284f psoriasiform, 1266b psoriasis, 1217b purpura see Purpura rheumatic fever, 515 in rubella infection, 234b scaly, 1217b scarlet fever, 253f shingles, 238f syphillis, 1217b of systemic lupus erythematosus, 1035f tinea corporis, 1217b toxic shock syndrome, 1236 tropical diseases, 234b typhoid, 260 typhus, 271 urticarial, 1253f vesicular, 315 RAST (radioallergosorbent test), 86 Rat bite fever, 235f Raynaud’s phenomenon in systemic lupus erythematosus, 1035, 1035f in systemic sclerosis, 1037–1038 Raynaud’s syndrome, 504–505 RB-ILD see Respiratory bronchiolitisinterstitial lung disease RBBB see Right bundle branch block RCA see Right coronary artery Re-entry, 468 Reactive airways dysfunction syndrome,

Reactive arthritis, 1031–1032 Reactive disorders, 1264–1265 ‘Ready Steady Go’ programme,

Reassurance, somatoform disorders and, 1203 Receiver operating characteristic (ROC) curve, 5f Receptor activator of nuclear factor kappa B ligand (RANKL), in bone remodelling, 986b Receptor activator of nuclear factor κB ligand see RANKL Receptor activator of nuclear κB see RANK Receptors B-cell, 68, 68f drugs acting on, 15b in pain processing, 1340b Recombinant human DNAase (rhDNAase), cystic ﬁbrosis, 581b Recombinant human erythropoietin, chronic renal failure, 419 Recombinant tissue plasminogen activator (rt-PA), stroke, 1158f, 1159–1160 Recombination, 41 Recompression, for diving-related illness, 171 Rectal administration, 17 Rectal examination, 765b gastrointestinal disease, 787 prostate, 427, 437–438 Rectal varices, portal hypertension and,

Rectum, 771f disorders of, 827–836 dysfunction of, 1094 tumours of, 827–833 see also Colorectal cancer Recurrent occult upper gastrointestinal bleeding, systemic sclerosis and, 1037–1038 Red cell enzymopathies, 948–949 Red cell membrane defect, 947–948 structure, 915, 916f Red cells, 915–917, 916f agglutination, cold, 950 anaemia, 941f aplasia, 947 appearance of, 921b, 921f blood ﬁlm examination, 921f concentrate, 931b count, 1362b destruction of, 917 effects of malaria, 273–274 enzymopathies, 948–949 formation, 915, 916f fragments, 921f haemoglobin and, 915–916, 917f haemolytic anaemia, 945, 946b, 946f incompatibility, in blood transfusion, 931–933 lifespan, 1362b membrane defects, 947–948 nucleated, 921f sickled see Sickle-cell anaemia/ disease structure and functions, 915–917, 916f transfusion, (in)compatibility, 932–933 Red eye, 1170 Red hepatisation, 583 ‘Red man’ reaction, 123 Reduced-intensity conditioning, 937 5α-Reductase inhibitors, 438 Reduviid bugs, 280 Reed-Sternberg cells, 961 Refeeding diets, WHO recommended, 705, 705b Refeeding syndrome, 706 Reference nutrient intake (RNI), 711–712 of minerals, 717b of vitamins, 711b Reference range, 3, 4f Reﬂex(es) cough, 556 diabetes, 759 stretch, 1068 tendon, root values of, 1063b Reﬂex sympathetic dystrophy (RSD), 1348–1349 Reﬂux bile, 801 duodenogastro-oesophageal, 792 gastro-oesophageal, 791–794, 791f Reﬂux nephropathy, 430–431 Refractory cough, 169 Refractory hypertension, 514 Regenerative medicine, for genetic disease, 58 Regurgitation, 779 aortic, 443b, 524–525, 524b, 525f causes, 524b chest X-ray for, 451f clinical features, 524–525, 524b clinical features of, 524–525, 524b, 525f investigations, 525, 525b investigations of, 525, 525b mitral, 519–521, 519b, 520f clinical features of, 521b, 521f investigation of, 521b management of, 521 pulmonary, 526, 527b tricuspid, 526, 526b Rehabilitation for acute coronary syndrome, 501 myocardial infarction, 501 in older people, 1311–1312 schizophrenia, 1198 for somatoform disorders, 1203 stroke, 1158 Rehydration see Fluid replacement Reiter’s disease/syndrome see Reactive arthritis Relapsing fevers louse-borne, 256b, 257, 257f tick-borne, 256b, 257 Relapsing polychondritis, 1044 Relative erythrocytosis, 925, 925b REM sleep behaviour disorder, 1105 Remission consolidation, in acute leukaemia, 956 Remission induction, in acute leukaemia, 956 Remission maintenance, in acute leukaemia, 956 Renal see Kidney Renal allograft dysfunction, common causes of, 425b Renal arteriography/venography, 389 Renal artery stenosis, 406–408, 407b, 407f Renal biopsy, 391, 391b Renal cell cancer, 434–435, 435f Renal colic, 396 Renal dialysis see Dialysis, renal Renal disease in adolescence, 426, 426b atheroembolic, 390b, 410 chronic, 415–420 pruritus, 415 stages, 388b in connective tissue disease Henoch-Schönlein purpura, 1043 SLE, 1036 systemic sclerosis, 1038 cystic, 405–406 adult polycystic kidney, 405–406 medullary, 404 diabetics see Diabetic nephropathy drug-induced, 426, 427b genetic, 403–406 glomerular, 397–401 HIV-related, 322 infections, 426–431 investigation of, 386–391 in pregnancy, 426, 426b, 1282–1283 acute kidney injury as, 1282, 1283b chronic kidney disease as, 1282, 1283f glomerular disease and, 1282 renal replacement therapy for, 1282–1283 renal tract infection as, 1282 for prescribing patients with, 31–32,

presenting problems in, 391–397 signs, 416f transition medicine and, 1298–1299 tuberculosis, 591 tubulo-interstitial, 401–403 tumours/cancer, 1316f vascular, 406–409 see also Nephropathy Renal failure acute see Acute kidney injury ascites, 864 bleeding, 975 chronic, 415–420, 417b causes of, 415b haemodialysis in, 422–423 indications for dialysis for, 422b osteodystrophy and, 419f physical signs of, 416f pregnancy and, 1282, 1283f staging of, in children over 2 years of age, 1298b transition medicine and, 1298–1299 cystic disease see Renal disease, cystic diabetics, 757 end-stage, 415b heart failure, 464 heart failure causing, 464 pruritus and, 1219b pyelonephritis see Pyelonephritis Renal function tests, 962 Renal impairment, causes of, in childhood and adolescence, 1298b Renal infarction, acute, 408 Renal lesion, systemic lupus erythematosus and, 1035 Renal osteodystrophy, biochemical abnormalities in, 990b Renal pelvis, 386 obstruction, 389f pyelonephritis, 430 stone in, 431 tumours, 435 Renal replacement therapy (RRT), 208, 420–426, 421f for acute kidney injury, 414 for chronic kidney disease, 414 continuous, 424b in old age, 422b percentage survival in, 422f pregnancy and, 1282–1283 preparing for, 420 Renal stones, 431 composition of, 431b investigations for, 432b Renal support, in intensive care, 208 Renal tract infection, pregnancy and,

Renal tract obstruction, acute kidney injury and, 414 Renal transplantation in diabetic nephropathy, 758 recipients of, pregnancy and, 1283 Renal tubular acidosis, 365, 365b, 405 Renal tubules, 384–386 collecting ducts, 350–351, 384–386 distal, 350 loop of Henle, 350, 384–386 proximal, 350 Renal ultrasound, acute kidney injury and, 416b Renin, 351–352 Renin activity, 666 Renin-angiotensin-aldosterone system,

hypertension, 509 hypokalaemia, 362 Renin-angiotensin blockade, for acute coronary syndrome, 500–501 Renin concentration, reference range of, 1359b Repaglinide, 747 Repeat prescriptions, 34 Repeated dose regimens, 19 Reperfusion therapy, for acute coronary syndrome, 499–500 Replacement therapy, for amenorrhoea,

Replicative immortality, 1318 Reproductive disease classiﬁcation of, 652b presenting problems in, 653–658 Reproductive system, 651–661 classiﬁcation of diseases of, 652b female, 652, 652f functional anatomy, physiology and investigations of, 651–652, 651f–652f Klinefelter’s syndrome in, 660–661 male, 651, 651f polycystic ovarian syndrome in, 658–659, 659f Turner’s syndrome in, 659–660, 660f Resection hepatic, for hepatocellular carcinoma,

ileal, under-nutrition and, 706 massive small bowel, under-nutrition and, 706 pancreatic, under-nutrition and, 706 Residual volume (RV), 555b Resin bile acid-sequestering, 376–377 ion-exchange, 363, 363b Resistin, 699 Respiration haemodynamic effects of, 447–448, 447b Kussmaul, 415 see also Breathing Respiratory acidosis, 367 Respiratory alkalosis, 367 Respiratory bronchiolitis-interstitial lung disease (RB-ILD), 606b Respiratory burst, 64 Respiratory chain complexes, 49b Respiratory disease, 556–567 air travel and, 169 breathlessness in, 557–558, 557f, 558b Rashes (Continued)

INDEX • 1407 caused by fungi, 596–598, 596b chest pain in, 558 cough in, 556, 556b drug-induced, 612–613, 612b ﬁnger clubbing in, 559, 559b, 559f haemoptysis in, 559–560, 559b, 560f HIV-related, 318–319, 318b investigation of, 550–556 ophthalmic features of, 1165b pleural effusion in, 562–565, 563b–564b pregnancy and, 1277 pulmonary nodule in, 560–562, 560b–561b, 560f–562f respiratory failure in, 565–567, 565b transition medicine and, 1297 cystic ﬁbrosis in, 1297 tumours, 598–605 Respiratory distress syndrome, acute see Acute respiratory distress syndrome Respiratory failure, 565–567 acute, management of, 565–566 chronic and ‘acute on chronic’ type II, 566–567 management of, 566–567, 566b pathophysiology of, 565, 565b Respiratory function in old age, 550b testing, 554–556, 554f airway obstruction, measurement of, 555 arterial blood gases and oximetry, 555–556, 555f in asthma, 555b in chronic bronchitis, 555b in emphysema, 555b exercise tests, 556 lung volumes, 555 in pulmonary ﬁbrosis, 555b transfer factor, 555 Respiratory infections, 581–598 cystic ﬁbrosis, 580–581 fungal, 596–598 in old age, 586b pneumonia, 582–587 pregnancy and, 1277 bacterial, 1277 viral, 1277 tuberculosis (TB), 588–595 upper respiratory tract infection, 581–587 Respiratory medicine, 545–628 Respiratory support, in intensive care, 202–204 advanced, 204 extracorporeal, 204 intubation and intermittent positive pressure ventilation, 203–204 non-invasive, 202 weaning from, 209–210 Respiratory syncytial virus (RSV), 249 Respiratory system clinical examination of, 546–548, 546f–547f functional anatomy and physiology of, 548–550, 548f–549f infections see Respiratory infections in old age, 550b pregnancy and, 1273 tumours, 598–605 Response evaluation criteria in solid tumours (RECIST), 1333b Restless legs syndrome, 1105–1106, 1106b Restraint, for aggressive behaviour, 1188–1189 Restrictive cardiomyopathy, 540 Resuscitation drowning and, 170 for gastrointestinal haemorrhage, 782 hypothermia and, 166 initial, 204–206, 206b for poisoning, 134 in sepsis, 196–197, 197b Resynchronisation devices, 467, 467f Resynchronisation therapy, cardiac, 467f, 484 Reteplase, 500 Reticular formation, brainstem, 1067f Reticulocytes, 915 reference range of, 1362b Retina detachment, 1088 of eye, 1167 visual ﬁeld loss in, 1089b Retinal artery occlusion, in ophthalmological conditions, 1178, 1178f Retinal haemorrhage high-altitude, 169 see also Diabetic retinopathy Retinal pigment epithelium, congenital hypertrophy, 829 Retinal vascular occlusion, in ophthalmological conditions, 1177–1178 Retinal vein occlusion (thrombosis), 1177–1178, 1177f Retinitis cytomegalovirus, 216f HIV-related, 321 Retinitis pigmentosa, 810 Retinoblastoma, 1321b Retinochoroiditis, due to toxoplasmosis, 280, 281f Retinoic acid, 713 all-trans-Retinoic acid, 958 Retinoids, 713 hyperlipidaemia, 373b hypertriglyceridaemia, 374 phototherapy and photochemotherapy, 1227 for skin disease, 1227 squamous cell carcinoma, 1231 warts, 1239 Retinol (vitamin A), 712–713 deﬁciency, 713, 713f dietary sources of, 711b reference nutrient intake of, 711b Retinopathy, 1325 HIV-related, 321 hypertensive, 509–510, 510b pregnancy and, 1279 Retroperitoneal ﬁbrosis, 434 drug-induced, 427b Retroviruses, 100 Return of spontaneous circulation (ROSC), in post cardiac arrest, 200–201, 201b Reverse transcriptase, 309–310 Reverse transcriptase inhibitors non-nucleoside, 316, 324b nucleoside, 324b Reversibility test, 569f Revised International Prognostic Scoring System (IPSS-R), in myelodysplasia, 961, 961b Reye’s syndrome, acute liver failure and, 857–858 Rhabdomyolysis, 363 diagnosis and management of, 195 Rhesus D blood group, 933, 933b Rhesus disease, pregnancy and, 1285 Rheumatic fever, 515–517, 516f investigations in, 517b Jones criteria for, 516b prophylactic, 119b Rheumatic heart disease, 515–517 chronic, 517 Rheumatoid arthritis (RA), 1021–1026 clinical features of, 1023–1025, 1023f cardiac involvement in, 1024 extra-articular, 1024b nodules in, 1023–1024, 1024f ocular involvement in, 1024 peripheral neuropathy in, 1024 pulmonary involvement in, 1024 serositis in, 1024 spinal cord compression in, 1024, 1025f systemic, 1023 vasculitis in, 1024 criteria for diagnosis of, 1023b investigations in, 1025, 1025b, 1026f management of, 1025–1026 algorithm for, 1026f biologic therapy for, 1026 DMARD therapy for, 1025–1026 non-pharmacological therapy for,

surgery for, 1026 pathophysiology of, 1022–1023, 1022f in pregnancy, 1026b, 1280 Rheumatoid disease pleural effusion, 563b, 610–611 respiratory involvement in, 610–611, 611f Rheumatoid factor (RF), in musculoskeletal disease, 991, 991b Rheumatoid nodules, 1023–1024, 1024f Rheumatological/musculoskeletal disease HIV-related, 321–322 ophthalmic features of, 1166b Rheumatology, 981–1060 see also Musculoskeletal disease Rheumatology and bone disease, transition medicine and, 1300 glucocorticoid-induced osteoporosis in, 1300 hypophosphataemic rickets in, 1300 juvenile idiopathic arthritis in, 1300 osteogenesis imperfecta in, 1300 Rhinitis, allergic, 622 Rhinocladiella mackenziei, 301 Rhinosinusitis, 582 Rhinoviruses, 249 Rhizomucor spp., 303 Rhizopus spp., 303 Rhodesiense infections, 278 Rhodesiense trypanosomiasis, 278–279 Rhodococcus equi, 319 Rib fracture, 626b Ribavirin, 128 for hepatitis C, 878 viral haemorrhagic fevers, 246 Riboﬂavin (vitamin B2), 714 biochemical assessment of, 712b deﬁciency, 714 dietary sources of, 711b reference nutrient intake of, 711b Ribonucleic acid (RNA) degradation of, 40 editing of, 40 messenger ribonucleic acid (mRNA),

microRNA (miRNA), 40 non-coding, 40 ribosomal RNA (rRNA), 40 splicing of, 40 synthesis of, 39f transfer RNA (tRNA), 40 Ribosomes, 39f Ribozymes, 40 Richmond Agitation Sedation Scale (RASS), 209, 209b Richter’s transformation, 960 Rickets, 1051–1052 causes of, 1050b hypophosphataemic, 990b hereditary, 1052–1053 hypophosphataemic, transition medicine and, 1300 vitamin D-resistant, 1052 Rickettsial fevers, 270–272, 271b Rickety rosary, 1052 Riedel’s thyroiditis, 650 Rifampicin, 117b as antimycobacterial agents, 125 drug interactions of, 24 hepatotoxicity of, 894b infective endocarditis, 530b for leprosy, 269 meningitis, 1120b pneumonia, 585b prophylactic, 119b for pruritus, primary biliary cholangitis and, 888 Q fever, 272 for tuberculosis, 593 Rifamycin, mechanism of action, 116b Rifaximin, for hepatic encephalopathy,

RIFLE criteria, 411 Rift Valley fever, 245b Right atrial pressure, in critically ill patients, 207f Right bundle branch block (RBBB), 478f Right coronary artery (RCA), 444, 445f Right ventricle, 444f Right ventricular cardiomyopathy, arrhythmogenic, 453, 539f Right ventricular dilatation, 450 Rigidity cogwheel, 1069 lead pipe, 1069 Parkinson’s disease, 1084–1085, 1113b tetanus, 1126 tetanus and, 1126 Rigors, 217b Riluzole, amyotrophic lateral sclerosis,

Rimantadine, 127 Rimonabant, 702 Ringer-lactate, 265 Ringworm, 1239 Risedronate for osteoporosis, 1048b for Paget’s disease, 1054, 1054b Risk attributable, 95b global burden of disease and underlying factors, 92–93 relative, 95b Risperidone bipolar disorder, 1200 schizophrenia, 1198b Risus sardonicus, 1126 Rituximab, for musculoskeletal disease, 1006, 1007b polymyositis and dermatomyositis,

systemic lupus erythematosus, 1037 Rivaroxaban, for venous thromboembolism, 975 Rivastigmine, for Parkinson’s disease,

River blindness, 292–293 RNA degradation of, 40 editing of, 40 messenger (mRNA), 38 messenger ribonucleic acid (mRNA),

microRNA (miRNA), 40 non-coding, 40 ribosomal RNA (rRNA), 40 splicing, editing and degradation, 40 splicing of, 40 synthesis, 39f synthesis of, 39f transfer, 40 transfer RNA (tRNA), 40 RNA polymerase, 38 RNI see Reference nutrient intake Robertsonian translocation, 45f Rocky Mountain spotted fever, 270, 271b Rodent ulcer, 1229 Rodenticide poisoning, 148 Rokitansky-Aschoff sinuses, 909 Romaña’s sign, 279 Romberg’s test, 1062f Romosozumab, for osteoporosis, 1049 Ropinirole, Parkinson’s disease, 1114b Rosacea, 1221b, 1243–1244, 1243f Roseola infantum, 238 Rosiglitazone, 747 Ross River virus, 250, 1020–1021 Rotator cuff lesions, 997–998, 998b Rotavirus, 249 Rotigotine, Parkinson’s disease, 1114b Rotor’s syndrome, 860b Roundworm (Ascaris lumbricoides), 289–290, 906 Roux-en-Y gastric bypass, 703b RPGN see Rapidly progressive glomerulonephritis RSV see Respiratory syncytial virus RT see Reverse transcriptase rt-PA see Recombinant tissue plasminogen activator

1408 • INDEX RTA see Renal tubular acidosis Rubber allergy, 1247b Rubella infection clinical features of, 236 congenital malformation and, 237b diagnosis of, 236 in pregnancy, 235b prevention of, 236–237 Russell’s sign, 1204 Ruxolitinib, for myeloﬁbrosis, 969 RV see Residual volume Ryanodine receptor channelopathies, 1145b S SA node see Sinoatrial (SA) node Sabin-Feldman dye test, 281 Saccades, 1090 Sacroiliitis, 1029f and ankylosing spondylitis, 1030 and axial spondyloarthropathies, 1028, 1028b and brucellosis, 255f and inﬂammatory bowel disease, 819f polyarthritis and, 994f and Whipple’s disease, 809b Salbutamol asthma, 572 drug interactions, 24b scombrotoxic ﬁsh poisoning, 150 Salicylates (aspirin) overdose, 138 poisoning from, 136, 138 Salicylic acid actinic keratosis, 1230b molluscum contagiosum, 1239 warts, 1239 Saline, 353b abdominal compartment syndrome,

genital itch/rash, 333 heat cramps, 167 hyperkalaemia, 363 hyponatraemia, 358 hypophosphataemia, 369 hypovolaemia, 353 metabolic alkalosis, 367 Salivary glands disease of, 790 enlargement, 1039b Salmonella food poisoning/gastroenteritis, 263 HIV/AIDS patients, 323 Salmonella enteritidis, 262–263 Salmonella paratyphi, 227–228 Salmonella spp. infection, 262–263 Salmonella typhi, 117b Salmonella typhimurium, 262–263 Salmonellosis, 231b Salofalk, for inﬂammatory bowel disease, 821b Salt in diabetic diet, 744 see also Sodium Salt-losing nephropathy, 403 Salt-wasting disease, 418 Sand ﬂea, 299–300 Sandﬂies, 282 bartonellosis, 272 leishmaniasis, 282 Sandhoff’s disease, 371b Sanﬁlippo’s syndrome, 371b Sanger, Fred, 52–53 Sanger sequencing, 52–53, 54f Saphenous vein grafts, 492f SARA see Sexually acquired reactive arthritis Sarcoidosis, 410, 608–610, 608f,

clinical features of, 608–609, 609b, 609f investigations of, 609–610, 609b management of, 610 Sarcoma Ewing’s, 1057 osteogenic, 1056–1057 see also Kaposi’s sarcoma Sarcomere, cardiac, 446 Sarcoptes scabiei, 1241 SARS see Severe acute respiratory syndrome Sausage digit, 1032 Saxagliptin, 747 Saxophone player’s lung, 616b SBAR system, of communication, 10, 10b SBP see Spontaneous bacterial peritonitis Scabies, 1241, 1241f ecthyma, 1236 HIV/AIDS, 330f–331f Norwegian, 1241 pruritus, 1219b Scaling, 1216 Scalp fungal infections, 300–304 head lice, 1241 psoriasis, 1247–1251 tinea capitis, 1240, 1240f Scapula, winging, 1062f Scarlet fever incubation period, 111b period of infectivity, 111b streptococcal, 252, 253f Scars, deﬁnition, 1226 Scedosporium apiospermum, 301 SCF see Stem cell factor ‘Schatzki ring’, 795–796 Scheuermann’s osteochondritis, 1055 Schilling test, 944 Schirmer tear test, 1038–1039 Schistosoma, life cycle of, 294, 295f Schistosoma haematobium, 295–296, 296f Schistosoma intercalatum, 296 Schistosoma japonicum, 296 Schistosoma mansoni, 296, 296f Schistosoma mekongi, 296 Schistosomiasis, 233b, 294–297 clinical features of, 295–296, 295b investigations of, 296 management of, 296 pathology of, 294 prevention of, 296–297 Schizoaffective disorder, 1200 Schizophrenia, 1196–1198 acute, 1196–1197 clinical features of, 1196–1197 diagnosis of, 1197 differential diagnosis of, 1197b investigations of, 1197 management of, 1197–1198 pathogenesis of, 1196 prevalence of, 1180b prognosis of, 1198 symptoms of, 1197b auditory hallucinations as, 1185 thought disorder as, 1181 Schmidt’s syndrome, 689 Schöber’s test, 983, 983f Schumm’s test, 947 Schwann cells, 1064–1065 Sciatica, 1135 Scintigraphy bone, in musculoskeletal disease, 988–989, 989b meta-iodobenzyl guanidine, 675 octreotide, 679f of thyroid gland, 638f, 642 see also Radionuclide (radioisotope) imaging SCLE see Subacute cutaneous lupus erythematosus Sclera, of eye, 1166–1167 Scleritis, 1172 posterior, 1170 Sclerodactyly, 1037 Scleroderma see Systemic sclerosis Scleromalacia, rheumatoid arthritis,

Sclerosing bone dysplasias, 1056 Sclerosing cholangitis primary, 888–890, 889f diagnostic criteria for, 888 diseases associated with, 889b liver function test (LFT) abnormality in, 854b magnetic resonance cholangiopancreatogram of, 889, 889f primary biliary cholangitis and, 902b secondary, 888, 889b Sclerosis, systemic see Systemic sclerosis Sclerostin, in bone remodelling, 986b Sclerotherapy, for variceal bleeding, 870 Sclerotic bodies, 301 Scoliosis, 1059 Scombrotoxic ﬁsh poisoning, 150 Scorpions, envenomation of, 161 Scotoma, 1095–1096 Screening aortic aneurysm, 505 breast cancer, 1325b for chronic liver disease, 853b ciliary dysfunction syndromes, 579 coagulation, 922b colorectal cancer, 832–833 cystic ﬁbrosis, 580 diabetes mellitus, 1278 diabetic nephropathy, 757 genetic, 58 gestational diabetes, 1278 hepatitis B core IgM antibody, 858 hepatocellular carcinoma, 890–891 for hepatocellular carcinoma, 890–891 malnutrition, 693f microalbuminuria, 394 principles of, 94–95 Scrub typhus fever, 270–271, 271b Scurvy, 715–716, 716b, 716f, 970 Sebaceous glands, 1213 Sebocytes, 1213 Seborrhoeic dermatitis, HIV-related,

Seborrhoeic eczema, 1246 Seborrhoeic warts, 1234 Sebum, 1213 acne vulgaris, 1242 Secondary aplastic anaemia, 969, 969b Secondary disease, in endocrinology, 632–633 Secondary granules, 64 Secondary headache syndromes, 185b Secondary osteoporosis, 1044–1045 Secretin, 772b Secukinumab, for musculoskeletal disease, 1007, 1007b Sedation for aggressive behaviour, 1188–1189 in intensive care, 209, 209b Sedatives, misuse of, 1195 75SeHCAT test, 777b 75SeHCAT test, 777b Seizures brain tumour and, 1129 pregnancy and, 1275–1276, 1276b in stroke patients, 1153, 1159f syncope versus, 182b types of, 1098–1100, 1098b absence, 1099 atonic, 1100 clonic, 1100 focal, 1099, 1099b generalised, 1099–1100 myoclonic, 1099–1100 tonic, 1100 tonic-clonic, 1099, 1099b Selective noradrenaline reuptake inhibitors (SNRIs), poisoning, 139 Selective serotonin re-uptake inhibitors (SSRIs), 1199, 1199b poisoning from, 139 Selectivity, 14 Selegiline, for Parkinson’s disease, 1114 Selenium, 634, 718 deﬁciency, 718 dietary sources of, 717b excess, 718 for Graves’ ophthalmopathy, 646 reference nutrient intake of, 717b Selenium sulphide shampoo, 314 Selenosis, 716 Self-harm in old age, 1189b patient assessment of, 1187b, 1188f Self-help and coping strategies, for musculoskeletal disease, 1001, 1001b Seminoma, 439 Senescence immune, 80–81, 81b see also Age/ageing; Older people Sengstaken-Blakemore tube, for variceal bleeding, 870, 870f Senna, 761b, 834b Sensitisation, 1340 Sensorimotor polyneuropathy, 1111b Sensory ataxia, 1125b Sensory cortex, 1063f Sensory disturbances, 1083–1084 diabetes see Diabetic neuropathy Sensory loss, pattern of, 1084f Sensory neurons, 1338 Sensory neuropathy, 1111b Sensory system examination, 1062f Sentinel lymph node biopsy, 1233 Sentinel pile, 836 Sepsis, 196–198, 226–227, 226b acute kidney injury and, 411–412 cardiomyopathy and, 198 coagulation system and, activation of,

deﬁnition of, 196b during dialysis, 424b lactate and, 196 meningococcal, 1119b mimics of, 198b organ damage from, 196, 197f resuscitation in, 196–197, 197b skin and soft tissue infections causing, 226–227 Sepsis syndrome, 550 Septic arthritis, 1019–1020 emergency management of, 1020b synovial ﬂuid in, 1020 Septic shock, 70–71, 196b, 206b Septicaemic plague, 259 Sequestration crisis, 952 ‘Seroconversion’, 106 Serological tests, for respiratory disease,

Serology for gastrointestinal infection, 777 for Helicobacter pylori infection, 777 for hepatitis B, 873–875, 875b for hepatitis C, 877 Seronegative spondyloarthropathies, 1166b Serositis, in rheumatoid arthritis, 1024 Serotonin (5-hydroxytryptamine, 5-HT), 1345b, 1353f excess in irritable bowel syndrome,

Serotonin agonists, irritable bowel syndrome, 824 Serotonin-noradrenaline reuptake inhibitors (SNRIs), 139 Serotonin selective (speciﬁc) re-uptake inhibitors (SSRIs), 1199, 1199b Serotonin syndrome, 1199 Serratia spp., 102f Sertraline, 1199b Serum- ascites albumin gradient (SAAG), 863 Serum ferritin, 941 Serum sickness antivenom, 159 diphtheria antitoxin, 266 schistosomiasis, 295b Severe acute respiratory syndrome (SARS), 249 Severe combined immune deﬁciency, 79–80 X-linked, 79–80 Severe idiopathic constipation, 834 Sex, HIV infection/AIDS and, 323 Sex chromosomes, 38 see also X chromosome; Y chromosome

INDEX • 1409 Sex hormone replacement therapy for hypopituitarism, 682 see also Hormone replacement therapy Sex hormones see individual hormones Sexual activity, headache and, 1097 Sexual disturbance, 1093–1094 Sexual dysfunction, 1109–1110 see also Erectile dysfunction Sexually acquired reactive arthritis (SARA), 1031 Sexually acquired reactive arthropathy,

Sexually transmitted infections (STIs), 329–344 approach to patients, 332–333, 332b in children, 332–333 clinical examination of in men, 330, 330f in women, 331, 331f contact tracing for, 333 HIV testing for, 330 investigations of in men, 330b in women, 331b management goals of, 331b men who have sex with men, 330b, 334–335 during pregnancy, 332 presenting problems of, men, 333–336, 333f–334f prevention of, 336–337 those at particular risk, 331b viral, 341–344 Sézary’s syndrome, 1224, 1232 SGLT2 inhibitors, for hyperglycaemia, 748, 748f SH (self-harm) see Self-harm Shagreen patches, 1264 Shampoo ketoconazole, 1240, 1246 selenium sulphide, 314 Shared decision-making, 10, 11f, 12 Shave excision, for skin disease,

Sheehan’s syndrome, pregnancy and,

Shellﬁsh poisoning, paralytic, 149 Sheltered employment, 1198 Shiga-like toxin, 408–409 Shigella diarrhoea, 227–228, 232 dysentery/shigellosis, 265 reactive arthritis, 1031 Shigellosis, 265 Shingles see Herpes zoster Shivering, 165b, 165f Shock anaphylactic, 204, 206b cardiogenic, 199–200, 206b causes of, 200f downward spiral of, 199, 200f clinical features of, 180b hypotension and, 193, 193b hypovolaemic, 206b neurogenic, 206b obstructive, 206b septic, 70–71, 196b, 206b Short bowel syndrome, 708–710 Short stature in Turner’s syndrome, 659 see also Dwarﬁsm; Growth retardation Shoulder frozen, 997–998 pain, 997–998, 998b, 998f painful, in stroke patients, 1159f Shrinking lungs, 610b, 611 Shufﬂing gait, 1087b Shunts Blalock-Taussig, 537 intracardiac, 454, 459 left-to-right, 450 persistent ductus arteriosus, 533 portosystemic fetor hepaticus from, 868 portal hypertension and, 869 for variceal bleeding, 871 TIPSS for ascites, 864 for variceal bleeding, 871, 871f transjugular intrahepatic portosystemic stent for ascites, 864 for variceal bleeding, 871, 871f SI units, 1358 SIADH see Syndrome of inappropriate secretion of ADH Siberian tick typhus, 271b Sibutramine, 702 Sick euthyroidism, 642 Sick sinus syndrome, 469, 469b, 469f Sickle-cell anaemia/disease, 923, 951–953 clinical features of, 952–953, 952f epidemiology of, 951, 951f investigations of, 953 management of, 953 pathogenesis of, 951–952 in pregnancy, 953b prognosis of, 953 rheumatological manifestations of,

Sickle-cell nephropathy, 411 Sickle-cell trait, 951 Sickle chest syndrome, 952 Side-effect, deﬁnition of, 21 Siderosis, 614–616, 615b Sieverts (Sv), 164 Sigmoidoscopy, 776 amoebiasis, 287 Clostridium difﬁcile infection, 264 constipation, 787 familial adenomatous polyposis, 829 inﬂammatory bowel disease, 824b for inﬂammatory bowel disease, 817b radiation enteritis and proctocolitis,

schistosomiasis, 296 ulcerative colitis, 817b Sildenaﬁl, 440 Silicosis, 615–616, 615f Silicotuberculosis, 615–616 Simple aspergilloma, 596–597, 597f Simple diffuse goitre, 648, 648f Simple tandem repeat mutations, 43, 43b Simulium spp., onchocerciasis, 292 Simvastatin for stroke prevention, 1161f timing, 31b Sinemet, 1113 Single-layered retinal pigment epithelium, 1167 Single nucleotide polymorphisms (SNPs; snips), 42 Single photon emission tomography (SPECT), 1072 Sinoatrial disease, 469b, 469f, 471b Sinoatrial (SA) node, 445, 445f Sinus arrhythmia, 469 Sinus bradycardia, 469 Sinus tachycardia, 469, 469b Sinusitis see Rhinosinusitis Sinusoidal obstruction syndrome, 899 Sipple’s syndrome, 689b SIRS (systemic inﬂammatory response syndrome), pancreatitis, 838b Sister Joseph’s nodule, 804 Sitagliptin, 747 Sitosterolaemia, 375, 375b Sixth disease, 238 Sjögren’s syndrome, 1038–1039, 1039b, 1171 Skeletal muscle, 987–988 Skin blood vessels and nerves in, 1214 changes in old age, 1215b of envenomed patient, 152f epidermal appendages of, 1212–1214 examination of cancer, 1315b endocrine disease, 630f gastrointestinal disease, 764f function of, 1214, 1214b functional anatomy and physiology of, 1212–1214 imaging, 1216 immunobullous disease of, 1255–1257, 1255b infestations, 1235–1241 inﬂammatory arthritis in, 994b lichenoid eruptions in, 1252 microbiology of, 1215 as physical barrier, 62–63 systemic lupus erythematosus in, 1035f systemic sclerosis in, 1037, 1037f Skin cancer, 1229 non-melanoma, 1228, 1230b pathogenesis, 1229 see also names of speciﬁc tumours Skin disease abnormal pigmentations in, 1224 acute skin failure in, 1224–1225 clinical examination in, 1210, 1210f in general medicine, 1261–1267, 1261b investigation of, 1214–1216 management of, 1225–1229 nail involvement in, 1260–1261 ophthalmic features of, 1166b phototherapy and photochemotherapy for, 1227 pigmentation disorders as, 1257–1258 presenting problems in, 1216–1225 terminology in, 1211f treatment of non-surgical, 1228–1229 surgery for, 1228 systemic, 1227–1228 topical, 1225–1227, 1225b Skin grafts, vitiligo, 1257–1258 Skin infections, 1235–1241 bacterial, 1235–1238 fungal, 1239–1240, 1240f mycobacterial, 1237–1238 tropical, 234, 234b, 235f viral, 1238–1239 Skin lesions, benign, 1234–1235 Skin-prick tests, for allergy, 86 Skin snips, 234b Skin tags See Acrochordon Skin test asthma, 613–614 patch tests, 1215 prick tests, 86, 1215 tuberculin, 594, 594f Skin tumours, 1229–1235 malignant, 1229–1234 pathogenesis of, 1229 Skinfold thickness, 693f Slapped cheek syndrome, 237, 237f SLE see Systemic lupus erythematosus Sleep, 1071 Sleep apnoea/hypopnoea syndrome, 622–624 aetiology of, 623 clinical features of, 623 investigations of, 623, 623b–624b, 623f management of, 623–624 Sleep-disordered breathing, 622–624 Sleep disorders, 1105–1106 Sleep disturbance, 1094 Sleep paralysis, 1094 Sleepiness Epworth scale, 623b, 1105 persistent, differential diagnosis, 624b see also Hypersomnolence Sleeping sickness, 278–279, 278f Sleeve gastrectomy, 703b Small bowel bacterial overgrowth, causes of, 808b Small-bowel diarrhoea, HIV-related, 317, 317b, 317f Small bowel surgery, proximal, under-nutrition and, 706 Small bowel transplantation, 710 complications of, 710b indications for, 710b Small interfering RNA (siRNA), 27b Small intestine bacterial overgrowth, 808–809 diseases/disorders of, 805–813 functional anatomy of, 767–770, 767f infections of, 812–813 miscellaneous disorders of, 811–812 motility disorders, 810–811 protective function of, 769–770 tumours of, 813 ulceration of, 811, 811b Small-vessel vasculitis, 409 Smallpox (variola), 248 Smell, disturbance of, 1088 Smith-Magenis syndrome, genetics, 44b Smoking and autoimmune disease, 82–83 cannabis, 143 and cardiovascular risk, 420 cocaine, 143 effects on health, 94 familial hypercholesterolaemia, 374b freezing cold injury, 166 heart failure and, 465b lung cancer and, 1320–1321 in older people, 1305 peptic ulcer and, 799 urinary incontinence, 436 Smoking cessation acute coronary syndrome and, 501 in Graves’ ophthalmopathy, 646 Smooth muscle atrophy, systemic sclerosis and, 1037–1038 Snail track ulcers, 337 Snake bites, 134 Snakes, geographical distribution of,

Snakeskin gastropathy, 871 Snoring, 623 SNPs see Single nucleotide polymorphisms Social isolation, psychiatric disorders and, 1184 Social worker, 1303b Sodium, 349b, 718 depletion, 349 dietary sources of, 717b excess, 354b, 354f homeostasis, 349–355 intake, chronic renal failure, 418 presenting problems of, 352–355 in primary hyperaldosteronism, 674 reabsorption, 384 reference nutrient intake of, 717b reference range of urine, 1361b venous blood, 1358b restriction of, for ascites, 863 retention of, 395, 864b transport, 351–352, 352f see also Hypernatraemia; Hyponatraemia Sodium aurothiomalate (gold), 1005 Sodium bicarbonate chronic kidney disease, 418 drug interactions, 24b salicylate poisoning, 138 in urinary alkalinisation, 136 Sodium calcium edetate, 137b Sodium chloride dietary, 718 see also Saline Sodium cromoglicate for allergy, 86 for food allergy, 812 Sodium-dependent glucose transporter inhibitors, for hypervolaemia, 354 Sodium ipodate, 639 Sodium nitroprusside aortic dissection, 508 hypertension, 514 phaeochromocytoma, 676 Sodium phosphate, 368 Sodium-potassium pump, 349 Sodium stibogluconate, 128 Sodium valproate bipolar disorder, 1200 cluster headache, 1096 epilepsy, 1102b, 1284 pregnancy, 1103, 1103b

1410 • INDEX for epilepsy, 1100b neutropenia, 926b poisoning, 141b sodium retention and, 864b status epilepticus, 1081b steatosis, 894 SOFA score, 214b Soft tissue infections, 226–227 necrotising, 227b Soft tissue release, 1002b Solar urticaria, 1221b Solitary rectal ulcer syndrome, 836 Solvent inhalation, 1196 Somatic hypermutation, 68, 68f Somatic mutations, 50–51 Somatic symptoms, medically unexplained, 1187, 1187b, 1189b, 1203b, 1205f Somatic syndromes, functional, 1187b Somatisation disorder, 1202 Somatoform autonomic dysfunction,

Somatoform disorders, 1202–1203 advice for, 1203 prevalence of, 1180b Somatoform pain disorder, 1202 Somatosensory system, 1070–1071, 1071f–1072f Somatostatin, 767, 772b Somatostatin analogues, for neuro-endocrine tumours (NETs),

Somatostatin receptor scintigraphy (SRS), 778b Somatostatinoma, 678b Somnolence daytime, 1105–1106 idiopathic hypersomnolence, 623 Sorafenib, for hepatocellular carcinoma,

Sorbitol, 812 Sotalol, 140 South American botﬂy, 300 Space-occupying lesions, HIV-related, 320–321 Space of Disse, 849 cirrhosis and, 866 Sparganosis, 299 Spastic catch, 1068–1069 Spastic paraplegia, hereditary, 1138b Spasticity, 1068–1069 Specialised receptors, 1338 Specialist nurse, 1109–1110 Spectinomycin, 117b, 122 Spectrophotometry, 348b Spectroscopy (ICP-MS), 348b Speech disturbance, stroke and,

Speech/speech disorders, 1070, 1070f, 1087–1088, 1088f assessment of, in psychiatric interview, 1181 Speech therapy, for Parkinson’s disease, 1114 Spermatogenesis, 651f Spherocytes, 915, 921b, 921f Spherocytosis, hereditary, 947 investigations of, 947, 948f management of, 947, 948b Sphincter anal, 437 bladder, 386 control, 1070–1071 urethral, 103, 436 Sphincter of Oddi, 849–850 dysfunction of, 908–909 classiﬁcation of, 908b pancreatic, criteria for, 908b Sphincterotomy biliary, 906 endoscopic, in old age, 909b Sphygmomanometry, 510 Spider bites, 161 Spider naevi, 846f autoimmune hepatitis and, 886 Spider telangiectasia, 866–867 Spiders, envenomation of, 161 Spina biﬁda, 715, 1138b Spinal cord, 1067, 1338–1339 compression, 1136–1137, 1136b, 1137f cancer and, 1326, 1326b in rheumatoid arthritis, 1024, 1025f disorders of, 1134–1137 intrinsic diseases of, 1137, 1137f, 1138b lesions, sensory loss, 1083 Spinal cord syndrome, 1136b Spinal epidural abscess, 1125 Spinal muscular atrophy, 1117 Spinal root lesions, 1141 Spinal stenosis, 1135–1136 Spine assessment of, 983f bamboo, 1030–1031, 1031f cervical imaging of, 1074, 1075f myelopathy, 1134–1135 radiculopathy, 1134, 1134f spondylosis, 1134–1135, 1134f subluxation of, 1024, 1025f disorders of, 1134–1137 lumbar, imaging of, 1074, 1075f osteoarthritis, 1011, 1011f thoracic, imaging of, 1074, 1075f Spinobulbar muscular atrophy, 43b Spinocerebellar ataxia, 43b, 1116b Spiramycin, 281 Spirillum minus, 234b Spirometry asthma, 569 COPD, 575 Spironolactone ascites, 864 ascites and, 864 gynaecomastia, 657b heart failure, 465 Splanchnic vasodilatation, for ascites, 862–863 Spleen, 67 enlarged see Splenomegaly examination of, 913b Splenectomy for chronic lymphocytic leukaemia,

for idiopathic thrombocytopenic purpura, 971 for myeloﬁbrosis, 969 Splenomegaly, 927, 928b cirrhosis and, 867 portal hypertension and, 868 Splice site mutations, 43f Splicing, 40 Splinter haemorrhages, 994b, 1260 Splints, for musculoskeletal disease,

Spondylitis, psoriatic, 1032 Spondyloarthritis, axial, 1028b, 1029–1030, 1029f Spondyloarthropathies (SPAs), 1027–1034, 1028b seronegative, 1166b Spondylolisthesis, 996–997, 1059–1060 Spondylolysis, 1059–1060 Spondylosis cervical, 1134–1135, 1134f lumbar, 1135–1136 Spondylotic myelopathy, cervical, 1082b Spongiosis, 1244 Spontaneous bacterial peritonitis, 864 Spontaneous breathing trials, respiratory support and, 210 Spontaneous hypoglycaemia, 676–678 cause of, 677–678 clinical assessment of, 677 differential diagnosis of, 677f investigations of, 677–678 management of, 678 in old age, 678b Sporadic fatal insomnia, 1127b Sporothrix schenckii, 301 Sporotrichosis, 301 Sporozoites, malaria, 273–274 Spreading depression of Leão, 1095 Sprue, tropical, 233 Spurious full blood count results, from autoanalysers, 919–920, 920b Sputum, 546f cough, 556 cytology, 554 haemoptysis, 559 investigations, 554 Pneumocystis jirovecii pneumonia,

in pulmonary oedema, 546f pulmonary tuberculosis, 318 Squamous carcinoma, 796b Squamous cell carcinoma, skin, 1230–1231, 1230b, 1231f SRS see Somatostatin receptor scintigraphy SSPE see Subacute sclerosing panencephalitis SSSS see Staphylococcal scalded skin syndrome St John’s wort, drug interactions, 24b St Vitus dance, 516 Stable angina advice to patients with, 489b risk stratiﬁcation in, 488b Staging, in lung cancer, 602, 602f Stamping gait, 1087 Stannosis, 614–615 Staphylococcal food poisoning, 262 Staphylococcal infections, 250–252, 251f cannula-related, 251–252, 251b methicillin-resistant Staphylococcus aureus, 252 skin, 251 staphylococcal toxic shock syndrome, 252, 252f wound, 251, 251f Staphylococcal scalded skin syndrome, 1236, 1236f Staphylococcal toxic shock syndrome, 252, 252f Staphylococcus aureus, 104b, 117b,

acute leukaemia, 957 atopic eczema, 1246b bacteraemia, 225 blood-stream infection, 225b bronchiectasis, 579 cerebral venous sinus thrombosis,

chronic granulomatous disease, 77 fever, 223, 223f folliculitis from, 1236–1237 impetigo from, 1235–1236 infections caused by, 251f infectious keratitis, 1173b infective endocarditis, 527 meningitis, 1119b pneumonia bacterial, 319 community-acquired, 582b, 584b in septic arthritis, 1020 skin infections, 251f vancomycin-resistant, 252 Staphylococcus epidermis, 251 Staphylococcus intermedius, 251 Staphylococcus saprophyticus, 251 Starches dietary, 695–697 hydrolysis, 768 polysaccharides, 696b resistant, 265 Starling’s law, 461, 461f Starvation, 704–705 infections associated with, 705b STAT proteins, 64–66 Statins, 376 for acute coronary syndrome prevention, 498b hepatotoxicity of, 894b for hypertension, 513 for non-alcoholic fatty liver disease,

for stroke prevention, 1161f Statistics, 10 Status epilepticus, 1080, 1081b,

Steady state, 19 Steatohepatitis, non-alcoholic, 882–883, 883f Steatorrhoea bile acid diarrhoea, 809 cystic ﬁbrosis, 842 malabsorption, 783–784, 784b small bowel disorders, 808 Steatorrhoea, pancreatitis, 840 Steatosis, 882–883, 894 Stellate cells, 772 Stem cell factor, 914 Stem-cell plasticity, 914–915 Stem cells, 914–915, 915f plasticity, 914–915 pluripotent, 954 Stenosis aortic, 443b, 521–524, 522b, 522f causes of, 521b Doppler echocardiography for, 451f investigations of, 522–524, 523b, 523f in old age, 524b lumbar canal, 1135–1136 mitral, 517–519, 518b, 518f chest X-ray for, 451f investigations in, 518f, 519b pregnancy and, 1282 pulmonary, 526 renal artery, 406–408, 407b, 407f spinal, 1135–1136 tricuspid, 525–526 Stents/stenting aortic dissection, 508 carotid, 1160 cholecystitis, 905 colonic, 833f coronary, 491, 491f graft, 507f liver arterial disease, 898 for lung cancer, 603 myocardial infarction, 1282 pregnancy and, 1282 renal artery, 389 superior vena cava obstruction, 1327 thrombosis, 493b ureteric, 414 Stercobilin, 851 Stercobilinogen, 851 Sterile pyuria, 430 Steroid hormones, pathways of synthesis of, 667f Steroids anabolic, 88 synthesis, 667f see also Corticosteroids Stevens-Johnson syndrome, 316, 1224, 1254–1255 Stiff person syndrome, 1111b Still’s disease adult, 895, 1040 see also Juvenile idiopathic arthritis Stimulant, misuse of, 1195–1196 Stimulation therapies for cancer pain, 1353 for pain, 1347, 1347f Stings insect, 75b scorpion, 159 see also Envenomation Stockings, compression, 396 ‘Stokes-Adams’ attacks, 477–478 Stomach emptying, 778 erosions, 781f functional anatomy of, 766–767, 766f outlet obstruction, 801–802, 801b tumours of, 803–805 ulcer, 798–802 Stomatitis angular, 764f, 817 herpetic, 247f Stones see Calculi (stones) Stool cultures, 777 Stop codons, 40 Storage disorders, 929b Stratum corneum, 1212 Strawberry gallbladder, 909 Strawberry tongue, 252, 253f Streptococcal infections, 252–253, 253b acute rheumatic fever, 515, 517b bone and joint, 1020 Sodium valproate (Continued)

INDEX • 1411 in pregnancy, 235b tics, 1086 Streptococcal toxic shock syndrome, 217f, 253 Streptococci, 102f alpha-haemolytic, 102f beta-haemolytic, 102f group A, 252 group B, 252 Streptococcus anginosus, 103f Streptococcus constellatus, 103f Streptococcus intermedius, 103f Streptococcus mitis, 528 Streptococcus pneumoniae, 67, 73b, 117b, 266, 1277b in community-acquired pneumonia, 582, 582f meningitis, 1119b–1120b peritonitis, 836 sepsis, 226b Streptococcus pyogenes, 103f, 117b Streptococcus suis, 1119 bacterial meningitis, 1120b Streptococcus viridans endocarditis,

Streptokinase, Budd-Chiari syndrome and, 899 Streptomyces, 1238 Streptomycin adverse reactions, 593b as antimycobacterial agents, 125 mycetoma, 301 plague, 259 tuberculosis, 97f for tuberculosis, 593 Stress acute reaction, 1201 oxidative, 881f, 883 post-traumatic stress disorder, 1201–1202 Stress echocardiography, 452 Stress electrocardiography, 449–450 Stress fracture, 995b Stress incontinence, 436 in older people, 1309–1310 Stress-related disorders, 1201–1202 Stressors, psychiatric disorders and,

Stretch reﬂex, 1068 Striae, deﬁnition of, 1226f Strictures, endoscopic techniques for management see Endoscopy Stridor aortic aneurysm, 505 bronchial obstruction, 600 connective tissue disorders, 610b hypocalcaemia, 663 inspiratory, 566 laryngeal disorders, 624 tracheal disorders, 625 String test, 287 Stroke, 952, 1153–1160 anatomy and physiology of, 1150–1151, 1150f classiﬁcation of, 1150f clinical examination of, 1148, 1148f clinical features of, 1150f, 1155–1157, 1155b, 1156f completed, 1157 complications of, 1159f differential diagnosis of, 1155b general examination of, 1149b heat, 167–168 HIV-related, 321 investigations of, 1151–1152, 1157–1158, 1157b blood tests, 1151–1152 cardiac, 1158 cardiovascular, 1152 lumbar puncture, 1152 neuroimaging, 1151, 1151f, 1157–1158 vascular imaging, 1151, 1152f,

management of, 1158–1160, 1158f aspirin, 1160 carotid endarterectomy and angioplasty, 1160 coagulation abnormalities, 1160 heparin, 1160 reperfusion (thrombolysis and thrombectomy), 1159–1160 supportive care, 1158–1159, 1159b unusual causes, 1160 medicine for, 1147–1162 migraine and, 1095 pathophysiology of, 1153–1155 cerebral infarction, 1153–1154, 1153f–1154f intracerebral haemorrhage, 1154–1155, 1155b, 1155f pregnancy and, 1284 presenting problems of, 1152–1153 ataxia, 1153 coma, 1153 headache, 1153 seizure, 1153 speech disturbance, 1152 visual deﬁcit, 1152 visuo-spatial dysfunction, 1152 progressive (in evolution), 1157 rapid assessment of, 1149b risk factors for, 1153b analysis, 1157, 1157b management, 1160 secondary prevention of, 1161f Stroke mimics, 1155b Stroke units, 1158 Stroke volume, 446 pregnancy and, 1272 Strongyloides hyperinfection syndrome, 226b, 289 Strongyloides stercoralis, 231b, 233b, 289, 612 Strongyloidiasis, 233b, 289, 289b Subacute cutaneous lupus erythematosus (SCLE), 1262 Subacute invasive aspergillosis (SIA),

Subacute sclerosing panencephalitis (SSPE), 236, 1123 Subacute (de Quervain’s) thyroiditis, 646–647 Subarachnoid haemorrhage, 1160–1162 clinical features of, 1161, 1162f investigations of, 1161 management of, 1162 see also stroke Subclavian steal, 504 Subclinical hypothyroidism, 642 Subclinical thyrotoxicosis, 636b, 638,

Subclinical urethritis, 334b Subcutaneous administration, 17 Subcutaneous androgen replacement therapy, 656b Subdural empyema, 1125 Subdural haematoma, 864–865 Sublingual administration, 17 Substance misuse, 1184, 1184b prevalence of, 1180b Substance misuse disorder, 1195–1196 Substance P, 1003–1004 Subtotal thyroidectomy, for Graves’ thyrotoxicosis, 644b, 645 Subtotal villous atrophy, important causes of, 806b Subungual haematoma, in nails, 1260f Succinate dehydrogenase, 49b Sucralfate, 801 Sudden death due to heart failure, 464 in raised ICP, 1128 Sugars dietary, 696b recommended intake, 698b Suicide anorexia nervosa, 1204 attempted, 1187 bipolar disorder, 1200 depression, 1198 low mood, 1185 old age, 1189b risk factors for, 1187b schizophrenia, 1198 see also Self-harm Sulfadiazine prophylactic, 119b rheumatic fever, 517 toxoplasmosis, 281, 320 Sulfadoxine, and neutropenia, 926b Sulfamethoxazole, melioidosis, 261 Sulfasalazine (SSZ) in haemolysis, 950 for inﬂammatory bowel disease, 821b for musculoskeletal disease, 1004–1005, 1004b prophylactic, 119b Sulﬁnpyrazone, gout, 1016 Sulindac, 829 Sulphonamides mechanism of action, 116b in pregnancy, 120b Sulphonylureas effect of hepatic impairment, 32b effect of renal insufﬁciency, 32b for hyperglycaemia, 746–747 weight gain and, 700b Sulphur, 718 Sulpiride, 1115 Sumatriptan, for migraine, 1096 Sunbed exposure, cancer and, 1229 Sunburn, 1221f SUNCT, 1097, 1097b Sunﬂower cataract, in Wilson’s disease, 1174f Sunitinib, 435 Sunlight melanoma and, 1232 sensitivity to, 1036b Sunscreens, 1222–1223 albinism and, 1258 melanoma and, 1233 photosensitivity, 1221b protection levels, 1222–1223 vitiligo and, 1257–1258 Superﬁcial bursitis, 999b Superior vena cava, 444f Superior vena cava obstruction (SVCO), 1314f, 1315b cancer and, 1326–1327, 1327b Superior vena cava syndrome, 505 Superoxide dismutase, 1116 Supported self-management, for pain,

Suppurative pneumonia, 586–587, 587b Supranuclear palsy, progressive, 1114–1115 Supraventricular tachycardia, 473, 473f Suramin, for trypanosomiasis, 128 Surfactant, 548–549 Surgery for acromegaly, 686 bariatric, 702f–703f, 703–704, 703b for brain tumours, 1130 for cholecystitis, 905 for chronic obstructive pulmonary disease (COPD), 577 for epilepsy, 1102 gastrointestinal achalasia, 795 haemorrhage, 782 prophylactic, 119b for lung cancer, 602 for musculoskeletal disease, 1002, 1002b osteoarthritis, 1012 osteoporosis, 1049 rheumatoid arthritis, 1026 for obesity, 702f–703f, 703–704, 703b for Parkinson’s disease, 1114 for primary hyperparathyroidism, 664 for prolactinoma, 685 for psychiatric disorders, 1190 Surrogate endpoints, 35–36 Sustained virological response (SVR),

Suxamethonium allergy, 75b pharmacokinetics, 20b Swallowing, difﬁculty in see Dysphagia Swan-Ganz catheter, 206, 207f Swan neck deformity of ﬁngers, 1023, 1023f Sweat glands, 1213–1214 Sweating, excessive, 217b Sydenham’s chorea, 516 Symmetrical polyarthritis, 1032 Symmetrical sensory polyneuropathy, diabetic, 758–759 Sympathetic nervous system, sodium transport regulation in, 352 Synaptic transmission, 1065 Syncope, 181–183, 455 clinical assessment of, 182–183 congenital heart disease and, 533 differential diagnosis of, 182f features of, 181b gastrointestinal haemorrhage, 780 heat, 167 investigations of, 183 in older people, 1308 presentation of, 181–182 seizures versus, 182b Syndesmophytes, 988 Syndrome of inappropriate secretion of ADH (SIADH), 357b Synergistic gangrene, 227, 227b Synovectomy, 1002b for rheumatoid arthritis, 1026 Synovial biopsy, 992 Synovial ﬂuid, 987, 988f in septic arthritis, 1020 Synovial joints, 987 structure of, 987f Synovial membrane, 987 Synoviocytes, 987 Synovitis, pigmented villonodular, 1059 Synovitis-acne-pustulosis-hyperostosisosteitis (SAPHO) syndrome,

Synovium, 987 loose bodies within, 988 needle trauma to, 988 in osteoarthritis, 1008 Synthetic cannabinoid receptor agonist, misuse of, 143 Syphilis, 253, 337–339 acquired, 337–338 benign tertiary, 338 cardiovascular, 338 classiﬁcation of, 337b congenital, 338–339, 338b dementia and, 339 early, 337–338 investigations of, 338–339 late, 338 latent, 337–338 management of, 339 neurosyphilis, 338, 1125, 1125b in pregnancy, 235b, 339 primary, 337, 337f secondary, 337 rash in, 1217b serological tests for, 339b treatment reactions of, 339 Syringomyelia, 1083 Systemic disease, 785 Systemic glucocorticoids, for musculoskeletal disease, 1005 Systemic inﬂammatory response, 196–198 initiation of, 196 propagation of, 196 see also Sepsis Systemic juvenile idiopathic arthritis,

Systemic lupus erythematosus (SLE), 410–411, 1034–1037 classiﬁcation of, criteria for, 1036b clinical features of, 1035–1036 investigations of, 1036 management of, 1036–1037 pathophysiology of, 1034 pregnancy and, 1281, 1281b respiratory involvement in, 611 Systemic sclerosis (SScl), 410, 1037–1038, 1037f, 1262 pregnancy and, 1280–1281, 1281b respiratory involvement in, 611 Systemic vasculitis, 410 Systolic dysfunction, 450 Systolic murmurs, 459–460, 460b

1412 • INDEX T T-helper lymphocytes, HIV infection/ AIDS and, 310 T lymphocytes (T cells), 69–70, 69f, 917 CD4+, 70 CD8+, 70 deﬁciency in, 73b primary, 79–80, 80f liver and, 849f lymphoma cutaneous, 1224 enteropathy-associated, 813 multiple sclerosis, 1106 skin, 1212 psoriasis, 1248f T-regulatory cells (T regs), 70 Tabes dorsalis, 1125b Tachycardia, 191–193 assessment and management of, 192–193 pathophysiology of, 191–192 sinus, 469, 469b supraventricular, 473, 473f ventricular, 475–476, 475b, 475f–476f poisoning, 137b pulseless, 457 Tachyphylaxis, 16 Tachypnoea, 190, 191f assessment and management of, 190, 191f pathophysiology of, 190 Tacrolimus, 1281b liver transplantation and, 901 nephrotoxicity, 427b thrombocytopenia, 971 vitiligo, 1257–1258 Tactoids, 951–952 Taenia asiatica, 298 Taenia echinococcus, 298–299 Taenia saginata, 298 Taenia solium, 297f, 298 Takayasu arteritis, 1041 Takotsubo cardiomyopathy, 541, 541f Tamm-Horsfall protein, 392 Tamoxifen breast cancer, 1334 desmoid tumours, 829 gynaecomastia, 657 Tamponade balloon, for variceal bleeding, 870–871, 870f cardiac, 447–448 Tamsulosin, 438 Tandem repeat mutations, 43, 43b Tangent/Goldmann kinetic perimetry,

Tangier disease, 375, 375b Tanner staging, 1290, 1292f Tapeworms, 297–299 Tarsal tunnel syndrome, 1024 Tarui disease, 370b Tay-Sachs disease, 371b Tazobactam for spontaneous bacterial peritonitis,

for variceal bleeding, 869 TB see Tuberculosis TBG see Thyroxine-binding globulin TBW see Total body water 99mTc-sestamibi scintigraphy, for primary hyperparathyroidism, 663–664, 664f TCAs see Tricyclic antidepressants Team communication, effective, for clinical decision-making, 10, 10b Teardrop poikilocytes, 969 Teduglutide, for intestinal failure, 710 Teenagers, adherence in, 1294–1295 Teichopsia, 1088 Teicoplanin, 117b, 123 adverse effects of, 123 Telangiectasia deﬁnition of, 1226 hereditary haemorrhagic, 970 spider, liver disease and, 866–867 Telaprevir, 878b Teletherapy, 1331 Telomerase, 1318 Telomeres, 1304–1305 Telophase, 40 Temperature, 94 abnormal, 165f body, 165 cold injury and, 166–167 elevated body, 167b extremes of, 165–168 heat-related illness and, 167–168 hypothermia and, 165–166, 165f–166f of stroke patients, 1159b thermoregulation and, 165, 165b Temporal artery biopsy, 992 Temporal coning, 1128, 1128f Temporal lobes, 1066 disorders of, 1089b functions of, 1066b effects of damage, 1066b Temporary pacemakers, for arrhythmias, 482–483, 483f Tendinitis adductor, 999b bicipital, 998b, 998f Tendon, xanthomas, 375 Tendon reﬂexes, root values of, 1063b Tendon repairs and transfers, 1002b Tenecteplase (TNK), 500 Tennis elbow, 998b Tenofovir, 119b, 324b for hepatitis B, 876 Tenosynovectomy, 1002 Tenosynovitis, 998 Tension-type headache, 1095 Teratogen, 22–23 Terbinaﬁne, 125b, 126 chromoblastomycosis, 301 fungal infections, 1239–1240 sporotrichosis, 301 Terbutaline, asthma, 571 Teriparatide, for osteoporosis, 1048–1049, 1048b Terlipressin, 864 for variceal bleeding, 869b, 870 Terminal illness see Palliative care Terrorism see Bioterrorism Testicular tumours, 439–440 Testis epididymo-orchitis, 240 undescended, 653 Testosterone for delayed puberty, 654 puberty and, 1290 reference range of, 1359b Tetanus, 104b, 1125–1126 prevention of, 1126 treatment of, 1126b Tetany, 663 Tetrabenazine, 1115 Tetracycline(s), 117b, 124 acne, 1243 adverse effects of, 124 bartonellosis, 272 brucellosis, 254 bullous pemphigoid, 1256 cholera, 265 drug interactions, 24b mechanism of action, 116b pharmacokinetics of, 124 plague, 259 in pregnancy, 120b pyoderma gangrenosum, 1261–1262 relapsing fever, 257 rickettsial fevers, 271–272 rosacea, 1244 steatosis, 894 timing, 31b trachoma, 273 tropical sprue, 808 Tetralogy of Fallot, 536–537, 536f Th1 (T helper) cells, 70 Th2 cells, 70 Th17 cells, 70 Thalamus, 1066–1067 Thalassaemias, 951, 953–954 alpha, 954 beta, 953–954 rheumatological manifestations of,

Thalidomide for Behçet’s disease, 1044 for multiple myeloma, 968 sarcoidosis, 610 Theophylline asthma, 1277 plasma concentration, 36b poisoning, 137b, 141b tremor, 1116b Therapeutic approach, 29, 29b Therapeutic drug monitoring, 119 Therapeutic efﬁcacy, 16 Therapeutic goal, 29 Therapeutic index, 15f, 16 Thermal injury, 950 Thermodilution, for measurement, of cardiac output, 454 Thermogenesis, diet-induced, 694, 695f Thermoregulation, 165, 165b in old age, 166b Thiabendazole, 129 Thiamin (vitamin B1), 714 biochemical assessment of, 712b deﬁciency, 714 dietary sources of, 711b reference nutrient intake of, 711b Thiamin pyrophosphate (TPP), 714 Thiazides adverse effects, 355b for hypertension, 513 for hypervolaemia, 355, 355b and hyponatraemia, 357b Thiazolidinediones, for hyperglycaemia,

Thienobenzodiazepines, 1198b Thin glomerular basement membrane disease, 404 Thiopurines, for inﬂammatory bowel disease, 821b Thioxanthenes, 1198b Thirst diabetes insipidus, 687 water homeostasis, 356 Thomsen’s disease, 1145b Thoracic kyphoscoliosis, 628 Thoracic outlet syndrome, 1141b Thoracoscopy, 553 Thorax, examination of, in respiratory system, 546f Thought assessment of, 1181 passivity of, 1196–1197 Thought, passivity of, 1196–1197 Threadworm (Enterobius vermicularis),

Threonine, 697b Thrombasthenia, Glanzmann’s, 970–971 Thrombin, 918f–919f Thromboangiitis obliterans, 504 Thrombocythaemia, essential, 969–970 Thrombocytopenia, 929, 929b, 971 hepatobiliary disease and, 853 HIV-related, 322 pregnancy and, 1285, 1285b Thrombocytopenic purpura (TTP), pregnancy and, 1285 Thrombocytosis, 929–930, 929b Thromboembolism in cancer patients, 1324–1325 Heart failure causing, 464 venous, 975–977 causes and consequences of, 975, 976f factors predisposing to, 975b management of, 975–976 pregnancy and, 1285 prophylaxis of, 976–977, 977b Thrombolytic therapy for acute coronary syndrome, 500, 500b for pulmonary embolism, 621 Thrombophilia, 977–979 acquired, 977–979 investigation of, 922–923, 923b testing in, indications for, 922–923, 923b Thrombopoietin receptor agonists (TPO-RA), for idiopathic thrombocytopenic purpura, 971 Thromboprophylaxis, 472–473, 473b in intensive care, 210 Thrombosed prolapsed haemorrhoids, 836f Thrombosis deep vein air travel and, 169 investigation of, 187, 187f pre-test probability of, 187b pregnancy and, 1285 presentation of, 186 in stroke patients, 1159f warfarin for, 939 hepatic artery, 898 in old age, 978b Thrombospondin (TSP)-1, 1318 Thrombotic disorders, 922–923, 923b, 975–979 Thrombotic microangiopathies, 408–409, 408b Thrombotic thrombocytopenic purpura (TTP), 388, 409, 979 Thrush, 300 oral, 790 Thumb, Z deformity, 1023 Thymectomy, myasthenia gravis, 1142b Thymine, 38 Thymus, 67 Thyroglobulin (Tg), 634, 635f as tumour markers, 1324b Thyroid autoantibodies, 637b Thyroid disease autoimmune, 639b, 643–646 classiﬁcation of, 634b clinical features of, 637b congenital, 650–651 investigations of, 634–635 iodine-associated, 647–648 during pregnancy, 651b, 1279 hyperthyroidism as, 1279 hypothyroidism as, 1279 iodine deﬁciency as, 1279 post-partum thyroiditis as, 1279 presenting problems of, 635–643 Thyroid function tests asymptomatic abnormal, 642 hypothyroidism, 636b interpretation of, 636b for obesity, 700 thyrotoxicosis, 636b Thyroid gland, 634–651 enlargement of, 642–643, 642b examination of, 631b functional anatomy, physiology and investigations of, 634–635, 635f, 636b in old age, 650b scintigraphy, 638f, 642 ultrasound, 643 Thyroid hormone, 634, 635f in bone remodelling, 986b replacement, for hypopituitarism, 682 resistance, 651 Thyroid lump or swelling, 642–643, 642b Thyroid neoplasia, 649–650, 649b Thyroid nodule, solitary, 642 Thyroid peroxidase antibodies, 640 Thyroid-stimulating hormone (TSH; thyrotrophin), 632, 634 and free T4, relationship of, 634, 635f receptor antibodies (TRAb), 643 reference range of, 1359b Thyroid-stimulating immunoglobulins,

Thyroid storm, 639 Thyroiditis Hashimoto’s, 646 post-partum, pregnancy and, 1279 Riedel’s, 650 subacute (de Quervain’s), 646–647 transient, 646–647, 646f Thyrotoxic crisis, 639 Thyrotoxicosis, 635–639 in adolescence, 645, 645b amiodarone and, 636b, 638f, 647–648 atrial ﬁbrillation in, 638 causes of, 636b

INDEX • 1413 clinical assessment of, 635–636, 637b differential diagnosis of, 638f factitious, 637 goitre and, 635–636, 636b Graves’ disease and, 635–636, 636b, 643–646, 643f management of, 644–645, 644b investigations of, 636–637, 637b–638b iodide-induced, 636b laboratory abnormalities, 638b low-uptake, 637 management of, 637–639 in pregnancy, 645, 651b subclinical, 636b, 638, 642 T4 : T3 ratio in, 637 toxic adenoma in, 638f, 649 type I, 647–648 type II, 648 Thyrotrophin-releasing hormone (TRH), 633f, 634 Thyroxine (T4), 633f, 634, 635f reference range of, 1359b thyroid-stimulating hormone (TSH) and, relationship of, 634, 635f Thyroxine-binding globulin (TBG), 634 Tiagabine, 1102b Tibial compartment syndrome, anterior,

Tibolone, for osteoporosis, 1048b, 1049 Tic douloureux, 1096–1097 Ticarcillin, 120b Tick-borne diseases, 256b babesiosis, 278 Lyme disease, 255 rickettsial fevers, 270 tularaemia, 261 viral haemorrhagic fevers, 246 Tick-borne relapsing fever, 256b, 257 Tics, 1086 Tidal volume (TV), pregnancy and, 1273 Tietze’s syndrome, 177b Tigecycline, 117b, 124 Tiludronate, for Paget’s disease, 1054b Tin oxide, 615b Tinea capitis, 1240, 1240f Tinea corporis, 1240 rash in, 1217b Tinea cruris, 1240, 1240f Tinea incognito, 1240 Tinea pedis, 1240 Tinidazole, 287, 808–809 Tiroﬁban, 500, 918 Tissue biopsy, in musculoskeletal disease, 992 Tissue factor pathway, assessing, 920–921 Tissue plasminogen activator, 447 Tizanidine, 1110b TNF inhibitors, pregnancy and, 1278,

TNF receptor-associated periodic syndrome, 81 TNF receptor-associated proteins (TRAPs), 64–66 TNFRSF1A gene, TNF receptorassociated periodic syndrome and, 81 TNM classiﬁcation, 1322b Tobramycin cystic ﬁbrosis, 581b dosing interval, 122f Tocilizumab, 1027 for musculoskeletal disease, 1007, 1007b α-Tocopherol see Vitamin E Toe cock-up deformities, 1023 ingrowing toenails, 1260 Tofacitinib, for musculoskeletal disease, 1004b Tolcapone, for Parkinson’s disease,

Tolerance, 16 Toll-like receptors, 63 Tolterodine, 1094b, 1310f Tongue biting, 1102b strawberry, 252, 253f Tonic-clonic seizures, 1099, 1099b Tonic seizures, 1100 Tonsillar coning, 1128, 1129f Tonsillitis, 242–243 membranous, 266b streptococcal, 252, 253b Tonsils, 67, 912f Tophi, 1014, 1015f Topical administration, 17–18 Topical agents, for musculoskeletal disease, 1003–1004 Topical analgesics, for pain, 1345 Topiramate, for obesity, 702–703 Topoisomerase II inhibitors, 936b Topotecan, ovarian cancer, 1334 Torsades de pointes, 476–477, 476b, 476f Torticollis, 997b, 1116 Total anterior circulation syndrome (TACS), 1156f Total body water (TBW), 349 Total iron binding capacity (TIBC), 942 Total lung capacity, 555b Total parenteral nutrition candidiasis, 302 gastroparesis, 803 Total thyroidectomy, for medullary carcinoma, 650 Tourette’s syndrome, 1086 Toxic adenoma, 638f, 649 Toxic epidermal necrolysis, 1254–1255, 1254b, 1254f, 1266b Toxic megacolon, 818 Toxic pustuloderma, drug-induced, 1266b Toxic shock syndrome (TSS), 1236 staphylococcal, 252, 252f streptococcal, 217f, 253 Toxins bacterial, 1125–1126 food-related poisoning, 149–150 ciguatera poisoning, 149–150 paralytic shellﬁsh poisoning, 149 scombrotoxic ﬁsh poisoning, 150 gastrointestinal decontamination for, 135–136 plant, 150, 150b venom, 154, 154b Toxocara canis, 233b Toxocariasis, 233b Toxoplasma gondii, 280 life cycle of, 280f Toxoplasmosis, 280–281 clinical features of, 280, 281f congenital, 280 investigations of, 281 management of, 281 in pregnancy, 235b Trace elements, absorption, 769 Tracheal disorders, 625 Tracheal obstruction, 625 Tracheo-oesophageal ﬁstula, 625 Tracheostomy, in intensive care, 210, 210b Trachoma, 273, 273f Trachyonychia, 1261 Tramadol, 1002 Tranexamic acid, 560, 597 Tranquillisers, effect of old age, 32b Trans-arterial chemo-embolisation, for hepatocellular carcinoma, 892 Transcatheter aortic valve implantation, 527, 527f Transcobalamin II, 943–944 Transcription, of DNA, 38–40 Transcription factors, 39 Transcutaneous electrical nerve stimulation (TENS), 1012 for osteoarthritis, 1012 Transdermal administration, 17 Transdermal androgen replacement therapy, 656b Transference, 1191 Transferrin, 1362b saturation of, 1362b Transforming growth factor beta (TGF-β1), 849f Transfusion-associated graft-versushost disease (TA GVHD), 933 Transfusion medicine haematology and, 911–979 key points in, 936b Transfusion-transmitted infection, 933 Transient ischaemic attack (TIA), 1156–1157 causing sensory loss, 1083 causing visual loss, 1088 Transient ocular ischaemia, 1171 Transient thyroiditis, 646–647, 646f Transition medicine, adolescent and, 1287–1300 clinical assessment in, 1293 features of, 1293b clinical presentations in, 1296–1300 diabetes and, 1299 functional anatomy and physiology in, 1290–1292 cognitive and behavioural changes in, 1292 endocrine changes in, 1290, 1291f physical changes in, 1290 gastrointestinal disease and, 1299–1300 inﬂammatory bowel disease and, 1299–1300 investigations in, 1293, 1293b neurological disease and, 1296–1297 cerebral palsy in, 1296 epilepsy in, 1296 muscular dystrophy in, 1297 oncology and, 1298 organ transplantation and, 1299 presenting problems in, 1294–1296 adherence as, 1294–1295 high-risk behaviour as, 1295 unplanned pregnancy as, 1295–1296 renal disease and, 1298–1299 respiratory disease and, 1297 cystic ﬁbrosis in, 1297 rheumatology and bone disease and,

glucocorticoid-induced osteoporosis in, 1300 hypophosphataemic rickets in,

juvenile idiopathic arthritis in, 1300 osteogenesis imperfecta in, 1300 transition from paediatric to adult health services in, 1288–1290 principles of prescribing during, 1289, 1289b readiness for, key features in, 1289b timing of, 1290, 1290f transition planning in effectiveness of, 1288 general principles of, 1288–1289, 1288f reasons to consider, 1288f systematic approach to, 1289–1290 transition referral letter in, 1293 Transition planning effectiveness of, 1288 general principles of, 1288–1289, 1288f impact of, on outcome in diabetes, 1299b reasons to consider, 1288f systematic approach to, 1289–1290 Transjugular intrahepatic portosystemic stent shunt (TIPSS) for ascites, 864 for variceal bleeding, 871, 871f Translation, 39f, 40 Transoesophageal echocardiography (TOE), 452 Transplantation cardiac, 467–468 in diabetes mellitus, 752 graft rejection and, 88–90 investigations in, 89 haematopoietic stem cell, 936–938 for acute leukaemia, 958 allogeneic, 936–937, 936b–937b autologous, 936–938 fever after, 224–225 for high-grade NHL, 966 infections during recovery from, 937b immunosuppression in complications of, 89–90 drugs used in, 89b of islet cell, 752, 753f of kidney, 424 of liver, 900–901 for acute liver failure, 858–859 for alcoholic liver disease, 882 complications of, 901 for hepatic encephalopathy, 865 for hepatitis B, 876 for hepatitis C, 878 for hepatocellular carcinoma, 891 indications and contraindications for, 900–901, 900b, 901f living donor, 901 for primary biliary cholangitis, 888 prognosis for, 901 split liver, 901 for Wilson’s disease, 897 for low-grade NHL, 965 lungs, 567, 567b multivisceral, 710 complications of, 710b organ donation and, 90 pre-implantation testing in, 89 renal, 424–426 in diabetic nephropathy, 758 recipients of, pregnancy and, 1283 small bowel, 710 complications of, 710b indications for, 710b transition medicine and, 1299 transplant rejection and, 88–89 classiﬁcation of, 88b Transportation, for envenomed patient,

Transposition of great arteries, 531b Transrectal ultrasound scan (TRUS) of prostate, 437–438 Transverse myelitis, 1110 Tranylcypromine, 1199b TRAPS see TNF receptor-associated periodic syndrome Trastuzumab, 1332 Trauma head, 1133 nails, 1260 Travellers eosinophilia, 233 fever in, 231b, 231f health needs, 230b incubation times and illnesses, 232b rash, 234b Traveller’s diarrhoea, 232b Treadmill, for exercise electrocardiography, 449–450 Trefoil factor family (TFF) peptides, 767 Trematodes, 294–297 Tremor, 1085, 1115 causes and characteristics of, 1085b drug-induced, 1116b dystonic, 1085b essential, 1085b, 1115 ﬂapping, hepatic encephalopathy and, 864–865 functional, 1085b intention, 1069 Parkinson’s disease causing, 1085b resting, 1081 Trench fever, 272 Trench foot, 167 Trephine biopsy, 920, 922f Treponema pallidum, 117b, 333, 336 in pregnancy, 332b Treponema pertenue, 253 Treponema vincentii, 254 Treponemal (speciﬁc) antibody tests,

Treponematoses, 253–254 endemic, 253–254 see also Syphilis Triamcinolone, 790 Triamterene, 355 Triazoles, 125b, 126 Tricarboxylic acid (Krebs) cycle, 714

1414 • INDEX Triceps skinfold thickness, 693b Trichiasis, 273 Trichinella spiralis, 293 Trichinellosis, 293–294 Trichinosis, 293–294 Trichloroacetic acid, 1239 Trichomonas vaginalis, 333 Trichomoniasis, genital, 335 Trichophyton rubrum, 1240 Trichophyton verrucosum, 1240 Trichuris trichiura (whipworm), 290 Triclabendazole, 297b Tricuspid regurgitation, 526, 526b Tricuspid stenosis, 525–526 Tricuspid valve, disease of, 525–526 Tricyclic antidepressants, 1199, 1199b poisoning from, 138–139, 139b, 139f Trientine dihydrochloride, Wilson’s disease, 897 Trigeminal (5th cranial) nerve, tests of, 1063b Trigeminal neuralgia, 1080, 1096–1097 Trigger ﬁnger, 1060 Triglycerides measurement, 373 reference range of, venous blood, 1360b Trihexyphenidyl, for Parkinson’s disease,

Triiodothyronine (T3), 633f, 635f reference range of, 1359b Trimethoprim acne vulgaris, 1243 brucellosis, 255b listeriosis, 260 mechanism of action, 116b melioidosis, 261 in pregnancy, 120b urinary tract infection, 428 Triple X syndrome, 44b Triptans, 17, 1096 Trismus, 1126 Trisomy 13 (Patau’s syndrome), 44b Trisomy 18 (Edwards’ syndrome), 44b Trisomy 21 (Down’s syndrome), genetics, 44b Trochanteric bursitis, 999b Trochlear (4th cranial) nerve, tests of, 1063b Troisier’s sign, 804 Tropheryma whipplei, 100, 106, 809 Tropical diseases diarrhoea, 232–233 eosinophilia, 233–234 fever, 230–232 skin, 234 Tropical fever, 230–232 causes of, 231b clinical assessment of, 230–232, 232b history taking in, 231b investigations of, 232, 232b management of, 231f, 232 Tropical pulmonary eosinophilia, 612 Tropical sprue, 233, 807–808 Tropical ulcer, 254, 254b Tropomyosin, 446 Troponins cardiac, 450 reference range of, venous blood, 1360b Trousseau’s sign, 367 ‘True’ polycythaemia, 925 Truncus arteriosus, 531–532 Trunk, examination of, in musculoskeletal system, 982f Trypanosoma brucei gambiense infection, incubation period of, 111b Trypanosoma cruzi, 794–795 Trypanosomiasis African (sleeping sickness), 278–279, 278f American (Chagas’ disease), 279–280 drugs for, 128 Trypsin, 768 Trypsinogen, 770b Tryptamines, misuse of, 143 Tryptase, 1360b Tryptophan, 697b Tube drainage, intercostal, 626–627 Tube feeding, nasogastric, 707, 707b Tuberculin skin test, 594, 594f Tuberculoma, 320–321 Tuberculosis (TB), 267, 430, 588–595,

abdominal, 812–813 bone and joint disease in, 591 central nervous system disease in,

chronic pulmonary, complications of, 590b control and prevention of, 594–595 cryptic, 589b diagnosis of, 592b epidemiology of, 588, 588f gastrointestinal, 590, 591f genitourinary disease in, 591 granulomas in, 71 HIV-related prevention of, 323 therapy for, 324, 324b investigations of, 591–592, 592f lymphadenitis and, 590 management of, 592–594, 593b miliary, 588–589 pathology and pathogenesis of, 588, 588f pericardial disease in, 590 pregnancy and, 1277 prognosis for, 595 pulmonary clinical presentations of, 590b major manifestations and differential diagnosis of, 590f post-primary, 589 primary, 588, 589b, 589f risk of, factors increasing, 589b Tuberculous granuloma, 588f Tuberculous meningitis, 1120–1121, 1121b HIV-related, 321 Tuberculous pericarditis, 543 Tuberous sclerosis, 1264 Tubular obstruction, drug-induced, 427b Tubulo-interstitial diseases, 401–403 inherited, 404, 404b Tularaemia, 261 Tumbu ﬂy, African, 300 Tumour-induced osteomalacia, 1053 Tumour lysis syndrome, 369 cancer and, 1328 Tumour markers, 1322, 1324b Tumour necrosis factor (TNF), 64–66 Tumour suppressor genes, 51 Tumours, 836–837 adrenal, management of, 669–670 bone, 1056–1057 metastatic, 1329 brain, 1129–1132, 1129b, 1129f clinical features of, 1129 investigations of, 1130, 1130f management of, 1130–1131 metastatic, 1328, 1328b prognosis of, 1131 of bronchus, 598–605 of gallbladder and bile duct, 907–908 benign, 908 gastroenteropancreatic neuroendocrine, 678–679, 678b, 679f gastrointestinal stromal cell, 805 head and neck, 1335–1336, 1335b investigations of, 1335 management of, 1335–1336 pathogenesis of, 1335 immunology of, 90 of liver, 890–893 benign, 893 primary malignant, 890–892 secondary malignant, 892–893, 893f of lungs, 598–605 metastatic, 1328 primary, 599–603 secondary, 603 vascular, 619–622 of mediastinum, 603–605, 603b–604b, 604f neuro-endocrine, 603b, 678–679, 678b, 679f, 813 of oesophagus, 796–797 benign, 796 of pancreas, 842–844 pituitary, 683–684, 1129 of rectum, 827–833 of respiratory system, 598–605 skin, 1229–1235 malignant, 1229–1234 pathogenesis of, 1229 of small intestine, 813 of stomach, 803–805 of urinary tract, 434–436 urothelial, 435–436 Tunga penetrans, 299–300 Tungiasis, 299–300 Turbidimetry, 348b Turcot’s syndrome, 829 Turner’s syndrome, 659–660, 660f genetics of, 44b Type A (‘augmented’) ADRs, 22 Type B (‘bizarre’) ADRs, 22 Type C (‘chronic/continuous’) ADRs, 22 Type D (‘delayed’) ADRs, 22 Type E (‘end-of-treatment’), 22 Typhoid fever, 260, 260b Typhus fever endemic, 271, 271b epidemic, 271, 271b scrub typhus, 270–271 Tyrosine, 635f Tyrosine kinase inhibitors, 959 in chronic myeloid leukaemia, 959b TZD drugs see Thiazolidinediones U UDCA see Ursodeoxycholic acid UIP see Usual interstitial pneumonia UK Faculty of Public Health, 92 UK NHS Pregnancy and Newborn Screening Programmes, 96f UK Prospective Diabetes Study, 746 Ulceration aphthous, 790, 790b of small intestine, 811, 811b Ulcerative colitis active left-sided or extensive, 820 cancer, 1320b childhood, 823 clinical features of, 816, 817b comparison with Crohn’s disease, 814b complications, 818 differential diagnosis, 817b histology of, 816f investigations, 818–820 management of, 820, 1299–1300 medical, 822b surgical, 823, 823b pathophysiology of, 815–816 pregnancy, 823–824 primary sclerosing cholangitis and,

pseudopolyposis in, 815f severe, 820 treatment of, medical, 820 Ulcers amoebic, 287 Buruli, 254 Chiclero, 285 dendritic, 248 digital, 1038 foot, 761–762 genital in men, 333–334, 334f in women, 336 legs, 1223–1224 causes of, 1223b, 1223f clinical assessment of, 1223–1224 due to arterial disease, 1223–1224 due to neuropathy, 1224 due to vasculitis, 1224 due to venous disease, 1223, 1223f investigations in, 1224 management of, 1224 leishmaniasis, 285f leprosy, 268 Marjolin’s, 1021 mouth, 1036 neuropathic, 759f, 1224 oesophageal, 794 oral, 1043–1044, 1043f peptic complications of, 801–802 indications for, 800b in old age, 801b perforation, 789, 801 prophylaxis for, in intensive care,

rodent, 1229 skin, deﬁnition, 1216 small intestine, 811, 811b solitary rectal ulcer syndrome, 836 tropical, 254 Ulnar nerve entrapment, 1002b palsy, 760 Ultraﬁltration, 349–350, 384 failure, 425b Ultrasound for ascites, 863 for cancer, 1323 Doppler see Doppler ultrasound echocardiography see Echocardiography endocrine disease polycystic ovary, 659f thyroid, 643 endoscopic, 774 for choledocholithiasis, 906f for hepatobiliary disease, 855 of gastrointestinal tract, 774 oesophageal cancer, 797f pancreatitis, 839 for hepatobiliary disease, 853–854 gallstones and, 853–854, 854f for hepatocellular carcinoma, 891 for musculoskeletal disease, 989 rheumatoid arthritis, 1025 synovitis, 989f for nervous system, 1073b for non-alcoholic fatty liver disease,

for portal hypertension, 869 renal, 389, 389f for renal artery stenosis, 407 for respiratory disease, 553 for splenomegaly, 927 for tachypnoea, 190, 191f of thyroid gland, 643 Ultraviolet radiation, 1229 photosensitivity, 1220–1223 psoriasis, 1250f skin cancer, 1320b ultraviolet A, 1227 ultraviolet B, 1227 Wood’s light, 1214 Under-nutrition, 704–711 causes of, 704b classiﬁcation of, 704b clinical assessment for, 693 clinical features of, 704, 704b in hospital, 705–708, 706b responses to, 694–695 Under water, 169–171 Undifferentiated autoimmune connective tissue disease, 1040 Unfractionated heparin (UFH), 938–939 Unilateral leg swelling, 186–187, 186b clinical assessment of, 186–187 investigations of, 187, 187b–188b, 187f presentation of, 186, 187b United Kingdom End-stage Liver Disease (UKELD) score, for liver transplantation, 900–901 Upper airway defences, 550 disease of, 622–625 Upper respiratory tract infection, 581–587 Uracil, 39 Uraemia haemolytic uraemic syndrome, 388 see also Renal failure

INDEX • 1415 Urate, reference range of urine, 1361b venous blood, 1360b Urate-lowering drugs, indications for, 1015b Urea, 349b acute kidney injury and, 416b reference range of urine, 1361b venous blood, 1358b Urea breath test, 778b Ureidopenicillins, 121 Ureterocele, 434 Ureteropyelogram, retrograde, 436 Ureterovaginal ﬁstula, 437 Ureters, 386 colic, 431–432 diseases of, 433–434 ectopic, 434 megaureter, 434 obstruction, 434 Urethral discharge, 333 Urethral syndrome, 427–428 Urethritis chlamydial, 333 gonococcal, 333, 333f non-speciﬁc, 333 subclinical, 334b Urge incontinence, 436–437, 1093 in older people, 1309 Uric acid crystals, 431b in gout, 1013–1014 lowering, 1015 metabolism of, 1013f pool, 1013f reference values, urine, 1361b Uricosuric drugs, for gout, 1016 Urinalysis acute kidney injury, 412b reference range, 1361b Urinary diversion, 436 Urinary incontinence, 397, 436–437 older people, 436b, 1309–1310, 1310f Urinary tract, 383f calculi, 431 clinical examination of, 382–384, 382f–383f collecting system diseases of, 433–434 imaging, 389f congenital abnormalities of, 433–434, 434f stones, removal of, 433b, 433f tumours of, 434–436 Urinary tract disease investigation of, 386–391 presenting problems in, 391–397 Urinary tract infection, 426–431 antibiotic regimens for, 429b clinical features, 427–428 investigation of, 428b management, 428–429 in old age, 428b pathophysiology, 427 persistent or recurrent, 429, 429b prophylaxis, 429b risk factors for, 428b in stroke patients, 1159f vesico-ureteric reﬂux, 428b Urine alkalinisation, 136 black, 947 investigation of, 387–388 microscopy, 387, 388f retention acute, 437–438 benign prostatic hyperplasia, 437–438 chronic, 438 volume, 391 see also Anuria; Oliguria Urine output, decreased, 195 assessment of, 195 diagnosis and management of, 195 Urine testing diabetes, 725 glycaemic control, 742 Urobilin, 851 Urobilinogen, 851 Urography, intravenous see Intravenous urography Urokinase, 1319f Urolithiasis, 431–433 Urology, 381–440 Urothelial tumours, 435–436 Ursodeoxycholic acid (UDCA) gallstones, 905b for primary biliary cholangitis, 888 Urticaria, 1252–1254 causes of, 1253b clinical features of, 1252–1253, 1253f drug-induced, 1266b investigations of, 1253–1254 management of, 1254 papular, 292 pathogenesis of, 1253f solar, 1221b Ustekinumab for Crohn’s disease, 822 for inﬂammatory rheumatic disease, 1007, 1007b for psoriatic arthritis, 1033–1034 Usual interstitial pneumonia, 608f Uterine tumours, 1316f UTI see Urinary tract infection Uveal tract, of eye, 1167 Uveitis, 1031, 1172–1173 acute anterior, ankylosing spondylitis,

aetiology of, 1172b brucellosis, 255f HTLV-1, 250 immune recovery, 321 treatment, 258–259 Weil’s disease, 258 UVR see Ultraviolet radiation V Vaccines/vaccination, 114–115, 115b anthrax, 115b BCG, 595 chickenpox, 239 cholera, 115b diphtheria, 266 guidelines for, 115b Haemophilus inﬂuenzae type B, 115b for hepatitis B, 876b HIV, 327 for human papillomavirus, 343 inﬂuenza, 241 Japanese B encephalitis, 250 leprosy, 270 malaria, 277 meningococcal infection, 1120 MMR, 240 mumps, 240 plague, 259 pneumococcal pneumonia, 266 for poliomyelitis, 1123 primary antibody deﬁciencies and, 79 for rabies, 1122 rotavirus, 249 rubella, 236–237 tetanus, 1126 tick-borne encephalitis, 230b for tuberculosis, 595 types of, 114–115 typhoid, 261 use of, 115, 115b varicella zoster virus (VZV), 115b, 239, 240b whooping cough, 115b yellow fever, 245 see also Immunisation Vaccinia virus, 249 Vacuolating cytotoxin (vacA), 798f VAD see Ventricular assist devices Vagina, discharge, 335, 335b, 335f Vaginosis, bacterial, 335, 335b, 335f Vagotomy, complication of, in peptic ulcer, 801 Vagus (10th cranial) nerve, tests of, 1063b Valaciclovir as anti-herpesvirus agent, 126, 127b for herpes virus infection, genital, 342 Valganciclovir for CMV infection, 224 herpesvirus infection, 127b Valine, 697b Valproate see Sodium valproate Valsartan heart failure, 466b hypertension, 513 myocardial infarction, 500–501 Valves of Heister, 850 Valvular heart disease causes of, 515b infective endocarditis, 527–531 prevention, 531 pregnancy and, 1282 rheumatic, 515–517 risks of non-cardiac surgery, 501b,

valve replacement, 526–527 Valvuloplasty aortic, 524 mitral, 519 Van Buchem’s disease, 1056 Vancomycin, 117b, 123 acute leukaemia, 957 adverse effects, 123 Clostridium difﬁcile infection, 264 drug eruptions, 1266b for infective endocarditis, 223 meningitis, 1120b pharmacokinetics, 123 respiratory disease, 586 for septic arthritis, 1020 therapeutic monitoring, 36b toxic shock syndrome, 252 Vancomycin-resistant Staphylococcus aureus (VRSA), 252 Vandetanib, for medullary carcinoma,

Vanishing bile duct syndrome, 889, 902 Variant Creutzfeldt-Jakob disease (vCJD), 933, 1127, 1127f Variceal band ligation, 869b Variceal bleeding, 865–866, 865f cirrhosis, 866–867 management of, 869–871, 869b, 870f–871f portal hypertension and, 869 prevention of primary, 869 secondary, 871 Variceal ligation, 775f for variceal bleeding, 870 Varicella, pneumonia, 582b Varicella zoster virus (VZV), 238b after HSCT, 937b HIV infection, 321 immunisation, 115b, 240b infection from, pregnancy and, 1277 management and prevention of, 239, 239b in pneumonia, 582b in pregnancy, 235b, 1277 stem cell transplantation, 937b Varicella zoster virus immunoglobulin (VZIG), 239, 240b Varices gastric, 865–866, 865f oesophageal, 865–866, 865f rectal, portal hypertension and, 868 Varicose veins, 1223 Variegate porphyria, 379b Variola, 248 Vascular dementia, 1191b Vascular disease atherosclerotic see Atherosclerosis diabetes, 503b, 756 diffuse, 1191 liver, 898–899 peripheral, 502–505 pulmonary, 619–622 pulmonary embolism, 619–621 pulmonary hypertension, 621–622, 621b, 622f renal, 406–409 Vascular endothelial growth factor, 1318 Vascular imaging, 1151, 1152f, 1158 Vascular malformations, jejunal bleeding, 775f Vascular resistance portal hypertension, 869 pulmonary, 461, 467, 532f systemic, 447 Vasculitides, 611–612 Vasculitis, 1040–1044, 1040f, 1261 antineutrophil cytoplasmic antibody, 1041, 1041f cerebral, 1093b, 1108 cryoglobulinaemic, 1043 cutaneous, 581b drug-induced, 1266b leg ulcers due to, 1224 renal artery stenosis, 407 in rheumatoid arthritis, 1024 small-vessel, 409 systemic, 410, 1041b, 1042f urticarial, 1253b Vaso-occlusive crisis, 952 Vasoactive agents, actions of, 206b Vasoactive intestinal peptide (VIP), 772b Vasodilatation, 206b splanchnic, for ascites, 862–863 Vasodilators angina, 487 for heart failure, 467 for hypertension, 513 myocardial infarction, 199b valvular heart disease, 521 Vasomotor rhinitis, 622 Vasopressin for refractory hypotension, 198 see also Antidiuretic hormone Vasopressin receptor agonist desmopressin, in haemophilia A,

Vasopressinase, pregnancy and, 1280 Vasopressors, 206 for variceal bleeding, 869b VDRL see Venereal Diseases Research Laboratory (VDRL) test VDRR see Vitamin D-resistant rickets Vedolizumab, for inﬂammatory bowel disease, 821b Vegan, 697 vitamin B12 deﬁciency, 944 Velocardiofacial syndrome, 44b Venae cavae, 444, 444f see also Inferior vena cava; Superior vena cava Venereal Diseases Research Laboratory (VDRL) test, 338–339 Venesection haemochromatosis, 895–896 for polycythaemia rubra vera, 970 Venlafaxine, 1199b Veno-occlusive disease, 899 Venography cerebral, 1162 hepatic portal, 854, 899 venous thrombosis, 1162 Venom, 154, 154b of animals, 156b–158b clinical effects of, 155–156 insect, allergy to, 85 local effects of, 155, 155b scorpions, 156b–157b snakes, 154b, 156b–157b spiders, 157b Venomous animals, 154–155 Venomous hymenopterans, envenomation of, 161–162 Venomous insects, envenomation of, 161–162 Venomous lepidopterans, envenomation of, 161 Venomous snakes envenomation of, 160–161 geographical distribution of, 153, 153f Venous disease cerebral, 1162 causes of, 1162b clinical features of, 1162, 1162b investigations and management of,

leg ulcers due to, 1223, 1223f Venous hypertension, 1223

1416 • INDEX Venous pulse distinguishing arterial and, 443b jugular, 443b Venous thromboembolism/thrombosis, 169, 975–977 air travellers, 169 causes and consequences of, 975, 976f clinical features, 619, 619b factors predisposing to, 975b at high altitude, 169 investigations of, 619–620, 619f–620f management of, 975–976 anticoagulants, 621 caval ﬁlters, 621 thrombolytic therapy, 621 pregnancy and, 620b, 1285 prognosis, 621 prophylaxis of, 976–977, 977b retinal vein, 509f stroke, 1151f Wells score, 187b Ventilation airway pressure release, 204 continuous positive pressure, 202 intermittent positive pressure, 203–204 mechanical ARDS, 198 asthma, 573b COPD, 578 critically ill patients, 202 envenomation, 160 setting, 203, 203f non-invasive, 202, 578 ‘open lung’, 204 pressure support, progressive reduction in, 210 respiratory failure, 567 in respiratory system, 549–550 Ventilation-perfusion matching, 549–550 hypoxaemia and, 192 in old age, 550b Ventricles, of heart, 449f Ventricular aneurysm, in acute coronary syndrome, 496, 496f Ventricular assist devices, 468 Ventricular contractility, reduced, 462b Ventricular ectopic beats, 474, 475f Ventricular ﬁbrillation, 456f cardiac arrest, 456 myocardial infarction, 495 Ventricular inﬂow obstruction, 462b Ventricular outﬂow obstruction, 462b Ventricular premature beats, 474–475, 475f Ventricular remodelling, in acute coronary syndrome, 496, 496f Ventricular rupture, in acute coronary syndrome, 496 Ventricular septal defect, 535–536, 536f heart murmur, 460b incidence, 531b tetralogy of Fallot, 536–537 Ventricular septum rupture, in acute coronary syndrome, 496 Ventricular tachyarrhythmias, 480b, 483 Ventricular tachycardia, 475–476, 475b, 475f–476f poisoning, 137b pulseless, 457 Ventricular volume overload, 462b Ventriculitis, 1122 Ventriculography, left, 453–454 Verapamil angina, 490–491, 491b, 500 aortic dissection, 508 arrhythmias, 471–472, 480b, 481 for cluster headache, 1096 hypertension, 513 tachyarrhythmias atrial ﬁbrillation, 471–472 atrial ﬂutter, 470 Verocytotoxigenic Escherichia coli, 263, 263f Verotoxin, 408–409 Verrucae, 1238 Verruga peruana, 272, 272b Vertebral fracture, 995b Vertebroplasty, 1002b for osteoporosis, 1049 Vertical gaze palsy, 1072b Vertigo, 1086 benign paroxysmal positional, 1104, 1104f in older people, 1309 Very low-density lipoproteins, 371–372 Vesicle, deﬁnition of, 1211f Vesico-ureteric reﬂux, 430–431, 431f Vesicovaginal ﬁstula, 437 Vessel wall abnormalities, 970 Vestibular disorders, 1104–1105 Vestibular failure, acute, 1104 Vestibular neuronitis, 780f, 1104 Vestibulitis, 336b Vestibulocochlear (8th cranial) nerve, tests of, 1063b Vibration-controlled transient elastography (Fibroscan), 855 Vibrio cholerae, 104b, 264–265 Vibrio parahaemolyticus, 265 Vibrio vulniﬁcus, 227 Vildagliptin, 747 Villous atrophy, 806 Vinblastine, Hodgkin lymphoma, 963 Vinca alkaloids, 936b Vincristine bronchial carcinoma, 602 leukaemia, 957b non-Hodgkin lymphoma, 966 polyneuropathy, 1139b VIP see Vasoactive intestinal peptide VIPoma, 678b Viral arthritis, 1020–1021 Viral encephalitis, 1121–1123 Viral haemorrhagic fevers, 231f, 245–247, 245b Viral hepatitis, 871–878 acute clinical features of, 871–872 complications of, 872b causes of, 871b chronic, HIV-related, 317–318 features of, 872b icteric, 878 immunisation, 876b investigations for, 872 management of, 872 non-A, non-B, 877 non-A, non-B, non-C (NANBNC), 878 pregnancy and, 1284 sexual, 343–344 transmission, 873b blood donation, 930–931 sexual, 343–344 treatment, 126–127, 127b see also under individual hepatitis viruses Viral infections, 236–250 antiviral agents, 126–128, 127b,

arthritis, 1020–1021 cancer and, 1320b diabetes type 1, 729 gastrointestinal, 249 haemorrhagic fevers, 245–247, 245b immune deﬁciencies and, 73b nervous system encephalitis, 1121–1123 meningitis, 1118 with neurological involvement, 249–250 respiratory tract, 249 pneumonia, 241, 605b upper, 581–587 with rheumatological involvement, 250 sexually transmitted, 341–344 of skin, 247–249, 1238–1239 HIV/AIDS, 1238–1239 systemic with exanthem, 236–240 without exanthem, 240–247 TSEs, 250, 1126–1127 see also speciﬁc infections/infectious diseases Viral load hepatitis B, 875, 875f HIV, 875 Viral meningitis, 1118 Viral warts, 1238–1239, 1239f Virchow’s gland, 764f Virilisation, 657, 1242 Virions, HIV, 309–310 Virology of hepatitis C, 877 skin, 1215 Viruses, 100 bioterrorism, 111 incubation period, 232b life cycle, 101f oncogenic HPV, 343 Visceral leishmaniasis, 282–284, 282f clinical features of, 282 differential diagnosis of, 283 HIV co-infection, 283–284 investigations of, 282–283, 282f management of, 283 Vision, 1069, 1070f double (diplopia), 1088–1090, 1090f loss diabetes, 757 leprosy, 268 older people, 1302f Vision distortion, of ophthalmic disease,

Visual analogue scale, 1343b Visual deﬁcit, 1152 Visual disorders, 1088–1093 antineutrophil cytoplasmic antibody-associated vasculitis, 1041f giant cell arteritis, 1042 Graves’ disease, 631b, 645–646, 645f investigation of, 1168–1169 electrophysiology, 1169 imaging, 1168–1169 perimetry, 1168 positive visual phenomena, 1088 pregnancy and, 1175b stroke, 1152 Visual disturbance, 1088–1093 Visual electrophysiology, 1169 Visual evoked potential (VEP) recording, 1077f Visual ﬁelds confrontation for, 631b loss, 1089b Visual Infusion Phlebitis (VIP) score, 251b Visual loss, 1088 Visual pathways, 1069, 1069f Visual phenomena, 1088 Visuo-spatial dysfunction, 1152 Vital capacity (VC), 554f forced, 550b, 554f, 555 Vitamin A (retinol), 712–713 biochemical assessment of, 712b deﬁciency, 713, 713f dietary sources of, 711b excess, 713 reference nutrient intake of, 711b supplements, 713 toxicity, 713 Vitamin B1 see Thiamin Vitamin B2 see Riboﬂavin Vitamin B3 see Niacin Vitamin B6 see Pyridoxine Vitamin B12, 715, 943–944 absorption, 943–944 biochemical assessment of, 712b deﬁciency, 943, 1138b causes of, 944 management of, 945 neurological consequences of, 715, 944b, 1139b neurological ﬁndings in, 944b older people, 712b pregnancy, 941b small bowel disease, 944 dietary sources of, 711b reference nutrient intake of, 711b reference range of, 1362b Vitamin C (ascorbic acid), 715–716 biochemical assessment of, 712b deﬁciency, 715–716, 716b, 716f,

dietary sources of, 711b reference nutrient intake of, 711b Vitamin D, 713 biochemical assessment of, 712b concentrations, seasonal changes in, 1050f deﬁciency, 713, 1049–1051 older people, 712b, 1049–1051 reference range of, venous blood, 1360b rickets/osteomalacia management,

dietary sources of, 711b excess, 713 metabolism of, 1051f for osteoporosis, 1048, 1048b reference nutrient intake of, 711b reference range of, venous blood, 1360b Vitamin D analogues, hypoparathyroidism, 665 Vitamin D and calcium supplements, osteoporosis prophylaxis, 1049b Vitamin D-deﬁcient osteomalacia, biochemical abnormalities in, 990b Vitamin D-resistant rickets (VDRR),

Vitamin E, 713–714 biochemical assessment of, 712b deﬁciency, 714 dietary sources of, 711b for non-alcoholic fatty liver, 885 reference nutrient intake of, 711b Vitamin K, 714 antagonists, 938b anticoagulant poisoning, 714 biochemical assessment of, 712b blood coagulation, 714 deﬁciency, 714 dietary sources of, 711b reference nutrient intake of, 711b supplements, epilepsy in pregnancy, 1103b Vitamins, 711–716, 711b absorption of, 769 biochemical assessment of, 712b deﬁciency, 712 in old age, 712b dietary sources, 711b excess, 712 fat-soluble, 711b, 712–714 malabsorption of, gastrointestinal disorders associated with, 712b reference nutrient intake, 711b storage of, liver and, 851 water-soluble, 711b, 714–716 see also speciﬁc vitamins Vitiligo, 1257–1258, 1257f, 1326 Vitrectomy, 1174 Vitreous gel, in eye, 1168 VLDL see Very low-density lipoproteins Voiding see Micturition Volatile substance, poisoning from, 144 Volume of distribution (Vd), 18, 18f Vomiting, 227–230, 780 causes of, 777b, 780f cyclical vomiting syndrome, 803 functional causes of, 803 palliative care, 1353–1354, 1353f peptic ulcer, 801–802 psychogenic, 803 Von Gierke disease, 370b von Hippel-Lindau disease, 1132, 1321b von Willebrand disease (vWD), 974, 974b von Willebrand factor, 974 Voriconazole, 125b, 126 acute leukemia and, 957 aspergillosis, 598 candidiasis, 302 fusariosis, 302–303 mycetoma, 301 paracoccidioidomycosis, 304 VT see Ventricular tachycardia Vulva chronic pain of, 336, 336b herpetic ulceration of, 342f

INDEX • 1417 pruritus, 336, 336b schistosomal papilloma, 295–296 Vulvodynia, 336b VUR see Vesico-ureteric reﬂux W Waddling gait, 1063b Waist circumference, 693b Waldenström macroglobulinaemia, 966 Wallenberg syndrome, 1072b Warfarin, 939 adverse reactions of, 22b for antiphospholipid syndrome, 978 for atrial ﬁbrillation, 472 bleeding in, 940 drug interaction of, 24b indications for, 938b monitoring, 922 for older people, 32b, 472b pharmacodynamic, 24b pharmacokinetic, 24b poisoning, 148b in pregnancy, 620b, 1282 problems with, 939 pulmonary embolism, 620b for stroke prevention, 1161f for systemic lupus erythematosus,

venous thromboembolism, 620b Warfarin-like rodenticides, 148b Warm antibodies, 949 Warm autoimmune haemolysis, 949 Warts anogenital, 342–343 seborrhoeic, 1234 viral, 1238–1239, 1239f Water absorption and secretion of, 769, 769f basic daily requirements of, 353b depletion, 353 see also Dehydration distribution of, 349, 349f excess, 354b homeostasis, 349, 355–360 inhalation, 169–170 investigations, 357–358 presenting problems in, 352–355 reabsorption, 350 renal handling, 356f restriction of, for ascites, 863 safe, for HIV-related exposure, 323 total body (TBW), 349 Water deprivation test, for diabetes insipidus, 688b ‘Waterbrash’, 791–792 Waterhouse-Friderichsen syndrome, 671b Watermelon stomach, 1037–1038 Watery/dry eye, of ophthalmic disease,

Wax baths, 1001 Weakness, 1081–1083, 1082b, 1082f facial, 1082–1083 ICU-acquired, 211–212 muscle, 1000, 1000b stroke and, 1152 Weal, deﬁnition of, 1252–1253 Weaning, from respiratory support, 209–210 Weber syndrome, 1072, 1072b Wegener’s granulomatosis, 1171 Weight, and endocrine disease, 630f Weight control, for musculoskeletal disease, 1001–1002 osteoarthritis, 1012 Weight gain history of, 700 reversible causes of, 700, 700b see also Obesity Weight loss, 785–786 after gastric resection, 801 anorexia nervosa and, 1203 cancer patients, 1323 causes of, 786f diabetes and, 729–730, 732 diets, 701–702, 701b HIV-related, 313, 313f investigations, 786 musculoskeletal disease, 1001–1002 obesity, 701 in palliative care, 1354 pancreatitis and, 840 physiological causes of, 785 rheumatoid arthritis, 1023 Weight management, for diabetes,

Weil-Felix test, 108 Weil’s disease, 258 Wells score, 187b Wenckebach phenomenon, 477f Werner’s syndrome, 41, 689b Wernicke-Korsakoff syndrome, 1195 prevention of, 1195 Wernicke’s aphasia, 1088f Wernicke’s area, 1066 Wernicke’s encephalopathy, 714 West Nile encephalitis, 250, 1121–1122 West Nile virus, 250 Western blot, 107 WG see Wegener’s granulomatosis Wheezing, asthma, 568 Whipple’s disease, 809, 809b Whipple’s operation, under-nutrition and, 706 Whipple’s triad, 676–677, 677f Whipworm (Trichuris trichiura), 290 White blood cells, 917 appearance of, 926f count acute fever without localising signs, 232b differential, 1362b high, 926–927 low, 925–926 viral hepatitis and, 872 formation, 917 polymorphonuclear see Neutrophils reference values, 1362b results of, interpreting, 926b White eye, 1170 White spirit, poisoning, 148b Whiteheads, 1242 Whitlow, herpetic, 247f WHO see World Health Organization Whole bowel irrigation, 136 Whole-exome sequencing, 54b Whole-genome sequencing, 54b Whooping cough, 582 antimicrobial prophylaxis, 119b immunisation, 115b incubation period, 111b periods of infectivity, 111b Wickham’s striae, 1252 Williams’ syndrome, 44b Wills, living, 1307 Wilm’s tumour, 1321b Wilson’s disease, 718, 896–897 investigations, 897 Kayser-ﬂeischer rings and, 896–897 liver disease and, 896 liver function test (LFT) abnormality in, 854b neurological aspects of, 1115 Windkessel effect, 447 Winterbottom’s sign, 279 Withdrawal effects, 16, 16b Wnt, in bone remodelling, 986b Wolbachia spp., 291 Wolff-Parkinson-White (WPW) syndrome, 473–474, 474f Wood’s light, 1214 World Health Organization (WHO) analgesic ladder, 1350, 1351f classiﬁcation of psychiatric disorders, 1180, 1180b ICD-10, 1180 macronutrient recommendations, 698b refeeding diet, 705b Wound dressing, 1226–1227, 1227b Wound infections staphylococcal, 251, 251f tetanus, 1126 WPW syndrome see Wolff-ParkinsonWhite (WPW) syndrome Wrist fracture, 1045f pain, 998 Writer’s cramp, 1086 Wuchereria bancrofti infection, 233b, 290, 291f X X chromosome, 38 abnormalities see individual conditions inactivation, 48–49 see also X-linked X-linked agammaglobulinaemia, 78 X-linked hypophosphataemic rickets (XLH), 1052 X-linked inheritance, 47b, 48–49 X-rays, 164, 164f for acute respiratory distress syndrome, 198, 199f for ankylosing spondylitis, 1030f of body packers, 144f cardiovascular system see Chest radiography/X-ray for Charcot foot, 759f chest see Chest radiography/X-ray for chest pain, 178 for gastrointestinal disease, 772, 773b, 773f achalasia, 795f contrast studies, 773 inﬂammatory bowel disease, 818f, 819–820 hepatobiliary disease, 164 hyperparathyroidism, 663 for musculoskeletal disease, 988, 988b bone fractures, 994–995, 1045f bony metastases, 662 Charcot joint, 1058f chondrocalcinosis, 1016f complex regional pain syndrome (CRPS) type 1, 1055f CPPD crystal deposition disease,

fracture, 994–995 osteoarthritis, 1009f–1011f osteomalacia, 1052, 1052f osteonecrosis, 1055 osteoporosis, 1045f osteosarcoma, 1056–1057 Paget’s disease, 1054f reactive arthritis, 1032 rheumatoid arthritis, 1025 supraspinatus tendon calciﬁcation, 1017f of nervous system, 1073b properties of, 164f respiratory system see Chest radiography/X-ray of skull, 1073 of spine, 1075f Xa inhibitors, 472–473 Xanthelasma cholestatic jaundice and, 861b hyperlipidaemia and, 346f Xanthomas, 1264 biliary cholangitis, 887 cholestatic jaundice and, 861b hyperlipidaemia and, 346f tendon, 375 Xanthomatosis, cerebrotendinous, 375b Xeroderma pigmentosum, 1221b, 1321b Xerophthalmia, 713 Xerostomia, 1038 XLH see X-linked hypophosphataemic rickets Y Y chromosome, 38 microdeletions of, 656 Yaws, 253–254, 254b Yellow Card scheme, 23 Yellow fever, 243f, 244–245, 245b incubation period of, 245b vaccination, 245 Yersinia enterocolitica, 264 in Graves’ thyrotoxicosis, 644 Yersinia pestis, 259 Young adults, diabetes mellitus in, 753–754 Young’s syndrome, 550 Z Zanamivir, 127, 127b, 241 Zero-order kinetics, 19 Zidovudine (ZVD), 324b adverse reactions of anaemia, 322 lipodystrophy, 326f neutropenia, 322, 926b for HIV/AIDS, 324–325, 324b muscle pain/weakness from, 1000b for onychomycosis, 316 Zika virus infection, 247 in pregnancy, 235b Zinc, 717 deﬁciency, 717 dietary sources of, 717b refeeding diet, 705b reference nutrient intake of, 717b reference range of urine, 1361b venous blood, 1360b supplements, 717 for Wilson’s disease, 897 Zinc phosphide poisoning, 148 Zinc therapy, for Wilson’s disease, 897 Zoledronic acid bone metastases, 1329 for osteoporosis, 1048b for Paget’s disease, 1054, 1054b Zollinger-Ellison syndrome, 802 Zoonoses transmission of, 110 viral haemorrhagic fevers, 245–246 Zoster sine herpete, 239

7KLVSDJHLQWHQWLRQDOO\OHIWEODQN

01-1 Clinical decision-making

02-2 Clinical therapeutics and good prescribing

03-3 Clinical genetics

04-4 Clinical immunology

05-5 Population health and epidemiology

06-6 Principles of infectious disease

01-7 Poisoning

02-8 Envenomation

03-9 Environmental medicine

04-10 Acute medicine and critical illness

01-11 Infectious disease

02-12 HIV infection and AIDS

03-13 Sexually transmitted infections

04-14 Clinical biochemistry and metabolic medicine

05-15 Nephrology and urology

06-16 Cardiology

07-17 Respiratory medicine

08-18 Endocrinology

09-19 Nutritional factors in disease

10-20 Diabetes mellitus

11-21 Gastroenterology

12-22 Hepatology

13-23 Haematology and transfusion medicine

14-24 Rheumatology and bone disease

15-25 Neurology

16-26 Stroke medicine

17-27 Medical ophthalmology

18-28 Medical psychiatry

19-29 Dermatology

20-30 Maternal medicine

21-31 Adolescent and transition medicine

22-32 Ageing and disease

23-33 Oncology

24-34 Pain and palliative care

25-35 Laboratory reference ranges

25-35 Laboratory reference ranges

35 Laboratory reference ranges