Index

Index Page numbers set in italics refer to illustrative materials. abdominal distension, 83-84, 87 acid regurgitation, 77-78 acne, 44, 46, 244 acneiform eruption, 348, 349 acrocyanosis, 221 acromegaly, 34, 41-43, 55, 208, 222,378 ACTH, 44-47, 204, 378 acupuncture, 77 adrenal tumours, 45-46 agranulocytosis, 64, 170 air bronchogram, 269 air pollutants, 183, 196 airway obstruction, 196-97, 285, 286, 352; chronic obstructive, 299, 309 alcohol, 8, 78-79, 85, 88, 95, 145, 2067, 224-26; safety limits for, 98 alcoholism, 26, 68-70, 72, 97-100, 188, 210, 225, 248 allergens, 44, 196, 350 allergic reactions, 44, 181, 197, 199, 330, 331, 335, 350-52 allopurinol, 113, 123, 176, 226, 331,339 alopecia, 101, 170; areata, 346, 347 alpha-1 antitrypsin deficiency, 183 alpha fetoprotein, 70, 85-86, 88-90 alveolitis, 244 Alzheimer’s disease, 157 amaurosis fugax, 369 amenorrhoea, 58-60 amnesia, 169 amyloidosis, 26, 114-15, 233, 244 amyotrophic lateral sclerosis (ALS), 150-52 anaemia, 26-27, 53, 101, 1034, 107, 109, 129-30, 244, aplastic, 112; chronic renal disease and, 129; haemolytic, 98, 105-6, 112-13; iron deficiency, 112; macrocytic, 115; multiple myeloma and, 114-16; normochromic normocytic, 115, 128, 243 aneurysms, 3, 14, 299, 354, 359, 371,372 angioedema, 350, 357, 352 anorexia, 115, 170 antacids, 75, 76, 79

anti-coagulation, 8, 10, 166, 217, 356 anti-convulsants, 145, 168-71, 331 antidepressants, 76, 151 anti-inflammatories, 200, 225, 232,238-39, 242, 245 anti-malarials, 137, 230 anti-rheumatic drugs, 245 anti-rheumatics, 228, 243 anti-thyroids, 64-65 anti-tumour necrosis factor (anti- TNF), 82, 239, 245 aortic dissection, 3, 18, 35 aortic regurgitation, 2-4, 14, 17, 18 aortic sclerosis, 5 aortic stenosis, 2-5, 10, 13, 18,29 aphasia, 157, 165-67 arrhythmias, 7, 13, 29-30, 222, 235,301, 314, 315. See also particular arrhythmias arterial blood gases, 54, 182, 184, 216, 288 arterial dissection, 148-49, 360-61 arterial thomboembolism, 148, 370 arteriolosclerosis, 357 arteriovenous malformation, 22, 354,359 arteritis, 49, 119, 156, 176 arthritis: acute monoarthritis, 224-25; enteropathic, 219; erosive, 234; foot, 246; gonococcal, 219-20; gouty, 107; Jaccoud’s, 236; oligoarthritis, 82, 229; polyarthritis, 227-29, 240; psoriatic, 228-30, 236, 384, 385; rheumatoid, 181, Index 411 192, 212, 219-20, 227-29, 233-34, 236, 243-46, 384, 385, 387-89, 388; septic, 219, 225, 226, 244, seronega- tive, 3; spondyloarthritis, 219, 228, 238; traumatic, 225 arthropathy, 3, 42, 44, 204, 227-28 asbestosis, 214 ascites, 15-16, 68-72, 83-87, 93-94, 96, 98, 107-8, 193 aspergillosis, allergic bronchopul- monary (ABPA), 181, 197, 199 assisted suicide, 257-58 asthma, 43, 78, 181, 183-85, 195-97, 200-201, 205-6, 286 ataxia, 53, 145-46, 148, 360 atherosclerosis, 51, 231, 319 atopy, 4344 atrial fibrillation, 2, 7-9, 11-12, 15, 19, 26, 30, 50, 164-67, 301, 303, 304, 305 atrial flutter, 8, 302, 303 atrial myxoma, 11 atrial septal defect, 5-7, 15 atrioventricular dissociation, 307, 311 Austin Flint murmur, 3, 11 autoimmune disorders, 27, 50-51, 94, 105-6, 11213, 189, 192, 197, 212, 347. See also particular disorders avascular necrosis, 46, 244 azathioprine, 113, 123,214 Babinski’s sign, 152, 158, 162 back pain, 219, 237-38, 382 barrel chest, 183, 185 Bechet’s syndrome, 48, 341

412 Index Bell’s palsy, 163 beta-2 agonists, 195-96, 200 beta-blockers, 23, 26, 30, 35, 38-39, 132, 196 biliary disorders, 69, 74 biologic agents, 82, 242, 245 bisphosphonates, 116, 380 bone disease, 62-63, 114-16, 242. See also particular diseases bone marrow transplantation, 104, 110-11, 116, 332 bone mineral density (BMD), 62-63 bone pain, 62, 114, 116, 202, 204, 210 Bouchard’s nodes, 227 bradycardia, 306, 307, 314, 315 bradykinesia, 145, 154 brain haemorrhage, 148, 157, 160, 166, 354, 358, 359 brain imaging, 353-73; CT scans, 353, 355, 358, 364, 366; digital subtraction angiog- raphy, 369, 371; magnetic resonance angiography, 360; MRI scans, 362 brain infarctions, 35, 145, 160, 175, 356-57, 360 brain lesions, 145, 157, 170, 353, 354, 355,356, 358, 368 brainstem, 148-49, 158-59, 371-72 breast cancer, 146, 222, 368 breast-feeding, 59 breath sounds, 180, 183, 186-87, 190-91, 193, 208 bronchial breathing, 187, 190-91 bronchial cancer, 201 bronchiectasis, 180-82, 184, 192, 197-201, 272, 273, 284 bronchiolitis: diffuse panbronchi- olitis (DPB), 197; obliterans, 197; obliterans with organiz- ing pneumonia (BOOP), 214 bronchitis, 181 bronchodilators, 285-86 bruising, 44, 46, 48, 109, 111-13, 341 Buerger’s disease, 231 buffalo hump, 45, 111, 243-44 bundle branch block: antidromic, 311; left, 298, 299, 311; right, 6, 300, 301, 306, 307, 309, 311, 374, 315 bursitis, 236 cachexia, 179, 180, 193 café-au-lait complexion, 127 calcinosis, 221, 230, 235 calcium channel blockers, 30, 35, 132 caput medusae, 107 carcinoid heart disease, 16 carcinoid tumours, 197 cardiac arrest, 391-98 cardiac resynchronization therapy (CRT), 27 cardiac transplantation, 27 cardioembolism, 148, 165, 244, 357 cardiomegaly, 3, 33, 184 cardiomyopathy, 5, 13, 20, 24-30, 299-300 carotid artery stenosis, 369, 370 carotid endarterectomy, 369-70 carpal tunnel syndrome, 42 cataracts, 46, 112, 244 cellulitis, 336, 337 cerebellar signs, 145, 149, 152 cerebellar syndrome, 145

cerebral amyloid angiopathy, 354, 358-59 cerebral oedema, 34, 203, 356, 367 cerebral small vessel disease, 154 cerebrospinal fluid, 145, 147, 157, 175, 364-65 cerebrovascular disease, 129-30, 210 cervical myelopathy, 150, 373, 374, 389-90 Chagas’ disease, 27 Charcot-Marie-Tooth disease, 147 cheilitis, granulomatous, 352 chemotherapy, 88, 109-11, 114, 203, 217; anti-tuberculous, 176, 186, 366 chest pain, 5, 13, 21, 29, 77-78, 240 chest X-rays (CXRs), 215, 269, 271,272,274, 275,276,277, 278,279,281, 282, 283 Cheyne-Stokes breathing, 290 Chlamydia psittacci, 27172 cholangitis, sclerosing, 69, 82 cholecystitis, 140 choriocarcinoma, 368 chronic inflammatory demyelinat- ing polyneuropathy (CIDP), 146-48 chronic obstructive pulmonary disease (COPD), 181, 183-85, 197, 201, 208, 214 Churg-Strauss Syndrome (eosinophilic granulomatous pulmonary angiitis), 119-20, 197 chylothorax, 188 cirrhosis, 66, 71, 188, 210; alcoholic, 72, 97-100; biliary, Index 413 69, 93-95; cardiac, 16, 69; hepatitis B, 83-87 CKD-EPI formula, 128-29 clonus, 144, 162 Clostridium difficile, 81 clubbing, 6-7, 14, 66, 83, 145, 179-81, 193, 198, 215 coarctation, 14, 34, 52 Cockeroft-Gault formula, 128-29 colitis, 3, 81 collagen vascular disease, 212 colon cancer, 42, 368 colorectal cancer, 82 coma, 58, 93, 95, 115, 249-50 confusion, acute, 56, 58, 174-75 congestive heart failure, 290 conjunctivitis, 220-21, 234, 239, 244 connective tissue diseases, 13, 147, 209, 219-22, 232, 288, 335. See also particular diseases Conn’s syndrome, 34, 52 constipation, 95 coronary artery disease, 10-11, 13,29 cor pulmonale, 180, 184-85, 194, 208, 214, 309 Corrigan’s sign, 2 corticosteroids: for angioedema, 352; for asthma, 197; for cer- ebral oedema, 203, 367; for CIDP, 147; Cushing’s and, 44-45; for dermatomyositis, 223; for Graves’ ophthalmop- athy, 51; hypertension and, 34, 52; inhaled, 195, 200; for IPF, 214; for ITP, 111-13; pleural effusion and, 188; for polymyositis, 156-57; for

414 Index renal disease, 120, 137; for systemic lupus erythemato- sus, 240, 242; topical, 332, 350; for ulcerative colitis, 82-83 cortisol, 4547, 203 cough, 78, 181, 184, 195, 198-99, 201, 208-9, 211 CPAP (Continuous Positive Airway Pressure), 194, 206 CPR (cardiopulmonary resuscita- tion), 249-50, 391-98 crackles, 180, 181, 183-84, 187, 191-92, 198, 211 cranial nerves, 143-44, 148, 158-59, 161, 163, 171, 173, 176 crepitations, 180, 220, 227 Crohn’s disease, 81, 82 cultural issues, 252, 391-98 Cushing’s syndrome, 34, 44-47, 52,111,378 cyanosis, 1, 6-7, 14, 179, 183, 194,221,232 cyclosporine, 123 cystic fibrosis, 182 cytomegalovirus (CMV), 81 dabigatran, 218 dactylitis, 219, 229 deep tendon reflexes, 154 dehydration, 56, 58, 95-96, 114-15, 117 dementia, 154, 157 de Musset’s sign, 2 demyelination, 146, 149, 152-53 depression, 46, 151 dermatitis: atopic, 346-47, 350, 352; contact, 44; contact allergic, 349, 350, 352; exfoliative, 330, 331; irritant, 350; seborrhoeic, 44, 350 dermatomyositis, 155-56, 204, 221-23, 231, 350 dermatophytosis, 44 dexamethasone, 115, 176, 203 dexamethasone suppression test, 45-47 diabetes mellitus, 42, 56-58, 112, 138-41, 160, 188, 244, 315; nephropathy and, 125, 131-33, 138, 210; neuropa- thy and, 133, 147. See also retinopathy dialysis, 117-18, 124, 130, 138-40 diarrhoea, 80, 83, 95-96 digital subtraction angiography, 369, 370, 371, 372 digoxin toxicity, 305, 307 diplopia, 158, 171-73 directly observed therapy (DOT), 191 disseminated intravascular coagu- lation (DIC), 112, 335 diuretics, 16, 26, 35, 71, 86, 132, 224-26 diverticulitis, 140 DNAR (do not attempt resuscita- tion), 249-50, 391-98 driving regulations, 170, 207, 250-51 drooling, 153, 160, 163 drug abuse, 87, 167, 169-71, 248, 354,357 drug compliance, 36, 60, 75, 124, 166, 168-70, 195-96 drug reactions, 44, 131, 147, 212,214, 224, 292, 315, 335; allopurinol, 226;

anti-convulsants, 145; cel- lulitis and, 337; cyclophos- phamide, 137; cyclosporine, 123; digoxin, 8; erythema nodosum and, 341-42; erythroderma and, 330, 331-32; gefitinib, 347-48; ITP and, 113; penicillin, 32; toxic epidermal necrolysis and, 338, 339-40 drug screening, 26 drug trials, 253-55 Dupuytren’s contracture, 66 Duroziez murmur, 3 dysarthria, 144, 145, 150, 354 dysdiadochokinesia, 145, 152 dyslipidaemia, 46, 129 dyspepsia, 73-77, 170 dysphagia, 148 dysphasia, 157-58 dyspnoea, 19, 24,27, 181, 193, 195, 197, 208-9, 211, 215 Eaton-Lambert syndrome, 172-73 ecchymosis, 101, 117 eczema, 331, 337; asteatotic, 348-49; atopic, 4344 Ehlers-Danlos syndrome, 361 Eisenmenget’s syndrome, 6-7, 14-15,17 electrocardiograms (ECGs), 295-316, 296, 298, 300, 302, 304, 306, 308, 310, 312, 314 empyema, 188 encephalitis, 157, 362, 363 encephalopathy, 34-35, 93-96, 100, 130, 148, 169 endocarditis, 1-3, 7, 9, 12, 15, 20, 31-32, 166, 307 Index 415 eosinophilic granulomatous pulmonary angiitis (EGPA; Churg-Strauss Syndrome), 119-20, 197 epigastric pain, 73-74 epilepsy, 167-71, 250-51, 363, 367-68 episcleritis, 220 epistaxis, 53 erythema, 350; induratum, 49; multiforme, 339, 343; nodosum, 48-49, 80-82, 340, 341 erythrocytosis, 184 erythroderma, 330, 331-32 ethambutol, 176 ethical issues, 247-58, 392-95, 398 euthanasia, 258 Evans syndrome, 112 fasciculations, 150-52 fasciitis, necrotizing, 337 febuxostat, 226 fever, 31, 83, 109, 119, 139, 174, 240, 331 fibrinolytic therapy, 22-23 flexion contractures, 231 fluid retention, 46, 84, 112 fluorescence in-situ hybridization (FISH), 103 Friedreich’s ataxia, 53 fundi, 317-27, 317, 318, 319, 320, 321,322, 323,324, 325, 326 gag reflex, 144, 148 gait, 144, 145, 154 galactorrhoea, 58-59 gall-bladder disorders, 74, 76, 82 gastric cancer, 74, 76

416 Index gastritis, 112, 244 gastroenteritis, 81 gastrointestinal bleeding, 53, 95, 97-98, 378 gastro-oesophageal reflux, 74, 77-80, 181, 196, 200, 214 gefitinib, 347-48 glaucoma, 46, 53, 244 glomerular filtration rate, 128-30, 136-37 glomerulonephritis, 120, 135 glomerulosclerosis, 125, 132 glucose-6-phosphate dehydroge- nase deficiency, 106 glycosuria, 41, 45 goitre, 42, 49, 55, 64 Gottron’s patches, 221 gout, 176, 219-20, 224-26, 236 Graves’ disease, 49-51, 55, 63-65 Guillain-Barre syndrome, 147 gum bleeding, 36, 101, 109-10, 111 H,-receptor antagonists, 75-76, 79 haemachromatosis, 69 haematemesis, 97 haematological malignancies, 102. See also particular diseases haematuria, 32, 34, 133-35 haemochromatosis, 26, 27 haemodialysis, 117-18, 124, 130, 140 haemoglobinuria, paroxysmal nocturnal, 106 Haemophilus influenzae, 185, 199, 337 haemoptysis, 197, 200-201, 283-84 haemothorax, 188 hallux valgus, 243 Hashimoto’s thyroiditis, 55 headache, 34, 149, 321, 323, 361, 364, 366, 371-72; migraine, 357 head injury, 23, 57 heart block, complete, 307 heartburn, 77-78 heart disease: congenital, 11, 14, 16-18; degenerative, 3-4, 9, 13, 18; ischaemic, 8-9, 20, 26, 306, 313; rheumatic, 3, 4,9, 11, 15, 18-20, 36-39, 164-67; thyroid, 8; valvular, 3-5,8-13, 15-20, 26-27, 36-39, 164-67, 357. See also particular diseases heart failure, 1-2, 8, 23, 50, 115, 197, 290; cardiomyopathy and, 26-27; hypertension and, 33-35, 52; pleural effusion and, 188, 193; right, 7, 100, 183, 194; valvular disease and, 5, 9, 19-20, 29, 166 Helicobacter pylori, 73-76 hemianopia, 41, 53, 59, 174, 177, 372,377 hemiparesis, 157, 174, 354, 356, 358, 363 hemiplegia, 354, 356, 358 Hemophilus influenza, 271 Henoch-Schonlein purpura, 135, 335 heparin, 38, 217 hepatic encephalopathy, 93-96, 100 hepatic hydrothorax, 188, 193 hepatic osteodystrophy, 94 hepatitis, 71, 72, 83-87, 88, 176; alcoholic, 68-69, 98-99

hepatocellular carcinoma, 66, 68-70, 72, 84-87, 87-92 hepatoma, 69, 85-86 hepatomegaly, 6669, 97-98, 103-6, 108, 121-22, 126, 204 hepatotoxicity, 170, 245 Herberden’s nodes, 227 hernias, 70 herpes: simplex, 102, 157, 363; zoster, 60, 102, 137, 332, 333 hirsutism, 44, 46, 170, 244 HIV (human immunodeficiency virus), 26, 28, 189, 275, 333 hoarseness, 148, 204 Horner’s syndrome, 148, 158-59, 161, 173, 178, 191, 360-61 hydrocephalus, 154, 176, 364, 365 hydronephrosis, 118 hydropneumothorax, 282 hydrothorax, hepatic, 188, 193 hyperacusis, 163 hyperaemia, 232 hyperaldosteronism, 86 hypercalcaemia, 61-63, 114-16, 118, 202, 305-6, 378 hypercalciuria, 62 hypercarbia, 208 hyper-gammaglobulinaemia, 234 hyperglycaemia, 57-58, 140 hyperkalaemia, 129, 130, 132, 307 hyperkeratosis, 229 hyperlipidaemia, 137, 160 hyperparathyroidism, 61-63 hyperphosphataemia, 128, 129 hyperprolactinaemia, 59-61 hypersplenism, 16, 71, 86, 98, 112 hypertension, 8, 26, 42, 52, 112, 148, 160, 244, 353-54; Cushing’s and, 45-46; malignant, 33-36, 321, 322; Index 417 portal, 84-85, 94, 100, 102, 107; pulmonary, 6, 9-10, 15, 20, 165-66, 184, 235, 309; renal disease and, 34-36, 121, 128-29, 132, 137-38; sleep apnoea and, 206, 208 hyperthyroidism, 42, 55, 62, 222 hyperuricaemia, 129, 226 hyperventilation, 58, 169 hyperviscosity syndrome, 114-16 hypoalbuminaemia, 332 hypocalcaemia, 62, 128, 129, 315 hypogammglobulinaemia, 181 hypoglycaemia, 58, 133, 14041, 378 hypoglycaemic agents, oral, 133, 141 hypokalaemia, 46, 112, 204, 234, 305-6, 315 hypomagnesaemia, 305-6, 315 hyponatremia, 202-3 hypophosphataemia, 62 hypopituitarism, 41-42, 60-61 hypopnoea, 206, 294 hypotension, 210 hypothalamic-pituitary region tumours, 46, 53, 59-60 hypothyroidism, 59, 208, 222, 315 hypoxaemia, 184, 211, 213, 280, 288 hypoxia, 216, 392, 394 iatrogenic complications, 45-46, 146, 282 idiopathic thrombocytopenic purpura (ITP), 111-14, 221 immunodeficiency, 182, 199-200 immunoglobulin therapy, 113, 147, 157, 340, 343

418 Index immunomodulators, 64, 82, 115, 153,349 immunophenotypic analysis, 103, 108, 110 immunosuppression, 46, 210, 232, 275, 333, 336; for alopecia areata, 347; for CIDP, 147 for Graves’ ophthalmopathy, 51; for kidney transplant, 123-24; for myocarditis, 27, for pemphigus vulgaris, 343-44; for polymyositis, 157; for renal disease, 121, 137-38; for theumatoid arthritis, 244; for systemic lupus erythematosus, 242 inappropriate anti-diuretic hormone syndrome, 202-3, 367-68 incontinence, 114, 116 indigestion, 24 infertility, 174 inflammatory bowel disease (IBD), 48, 81, 229, 341 INR (International Normalized Ratio), 36-38, 96, 217 insulin, 57-58, 141 interferon, 87, 90-91, 153 interstitial lung disease (ILD), 211-14, 223, 276, 277, 288 intracranial pressure, 54, 367-68, 372 . IPF. See pulmonary fibrosis ritis, 220, 239 iron deficiency, 292 irritability, 46 irritable bowel syndrome, 74 isoniazid, 176, 366 jaundice, 66, 72, 83, 93, 97, 101, 105, 154 Jendrassik manoeuvre, 144 jugular venous pressure, 2, 5-7, 9, 11, 15-17, 25, 131 Kartagener’s syndrome, 181-82, 198 keratoconjunctivitis, 221, 234, 244 ketoacidosis, 56, 58 kidney transplantation, 66, 117-18, 122-24, 125, 130 Kimmelstiel-Wilson nodules, 132 kyphoscoliosis, 158 labetalol, 35 lactic acidosis, 133 lamotrigine, 170 laryngeal stenosis, 196 laryngitis, 78 laser photocoagulation, 48, 320, 321 lateral medullary syndrome, 14849 legal issues, 170, 207, 250-51, 255-58 Legionella pneumophila, 271-72 lethargy, 115, 176, 365 leukaemia: acute, 112; acute Iymphoblastic, 111; acute monocytic, 110; acute myeloid, 109-11, 330; acute promyelocytic, 110-11; chronic lymphocytic, 103, 108; chronic myeloid, 102, 104-5, 107, 109-10 leukoencephalopathy, 148 Lewy bodies, 154-55 listeriosis, 174-75

liver disease: alcoholic, 69-70, 97-100; chronic, 66, 69, 84. See also particular diseases liver function, 16, 70-71, 85, 89, 92-93, 98, 166, 202, 216 liver transplantation, 91, 93-97, 100 liver tumours, 88-92 lung cancer, 146, 162, 184, 186, 192-93, 2014, 209-10, 215-18, 222, 367-68 lung collapse, 185-87, 277, 278 lung entrapment syndrome, 282 lung function, 184, 198-99, 212, 231,235, 285, 286-88, 287 lung lesions, 188-89, 191, 202, 274, 281 lung transplantation, 200, 214 lupus, 117, 124, 188-89; cer- ebral, 137; nephritis and, 125, 136-38, 240. See also systemic lupus erythematosus Lyme disease, 27, 307 lymphadenopathy, 1014, 107-8, 145,156, 193, 210, 233-34, 244; cervical, 179, 187; mediastinal, 186, 188; supraclavicular, 179 lymphangitis, 337 Iymphocytic pleocytosis, 365 lymphoedema, 337-38 lymphomas, 102-3, 107-8, 116, 233-34, 331, 352; gastric, 76; Hodgkin’s, 108, 222; non-Hodgkin’s, 156 lymphopenia, 275 lymphoproliferative diseases, 104-8, 116, 224, 333. See also particular diseases Index 419 maculopathy, 48, 321 Maladie de Roger, 18 malar flush, 1, 10 Mallory Weiss syndrome, 98 mania, 24 Marfan syndrome, 2, 3, 12, 361 MDRD (Modification of Diet in Renal Disease) formula, 128-29 measles, 180 melaena, 36, 97 melanoma, malignant, 368 melioidosis, 210 memory, 142-43 meningitis, 363; tuberculous, 174-76, 365 menorrhagia, 111 mental function examination, 142-43 mesothelioma, 188, 204 mestinon, 172 metabolic acidosis, 129-30 metastatic disease, 91-92, 145, 204, 210; adrenal, 203; bone, 162, 202, 215; brain, 202-3, 366, 367-68; liver, 202; lung, 202, 274; lymph node, 203 mitral valve disease, 8, 164—67; prolapse, 9, 12-13, 20; regurgitation, 5, 9-10, 13, 16, 17, 20, 23, 166; stenosis, 2, 3, 10-12, 19, 36-39, 166 Model for End-Stage Liver Disease (MELD) score, 96-97 monoclonal gammopathy, 116 mononeuritis, 244, 389 Moraxella catarrhalis, 185,271 Moyamoya disease, 354, 357, 359

420 Index MRI scans: lumbar spine, 383; pituitary, 378; sacroiliac joints, 383 mTOR inhibitors, 123 multiple endocrine neoplasia, 377-78 multiple myeloma, 114-16 multiple sclerosis, 53, 145, 148, 152-53 muscular atrophy, 150-51 muscular dystrophy, 150, 156 myasthenia gravis, 156, 161, 171-73 Mycobacterium tuberculosis, 175, 273 mycophenolic acid, 123 Mycoplasma pneumoniae, 27172 myelodysplastic syndrome, 109-10, 112 myelofibrosis, 102, 104, 106-7 myeloproliferative diseases, 109-10. See also particular diseases myocardial infarction, 1, 17-18, 21-24, 26, 33-36, 295-301, 296, 298, 307, 309; throm- botic agents and, 200-201 myocarditis, 26 myopathies, 112-13, 222 myositis, 222, 232, 235 myxoedema, 49 nail changes, 66, 83, 130, 220-21, 228-30, 239-40, 346, 385 nasopharyngeal cancer, 222 nephritic syndrome, acute, 136 nephritis, lupus, 125, 136-38, 240 nephropathy: diabetic, 125, 131-33, 138, 210; IgA, 52, 133-35 nephrosclerosis, 35, 125 nephrotoxicity, 123, 131, 245 neuromyelitis optica (NMO), 152 neuropathy: associated with connective tissue diseases, 147; CIDP, 146-48; diabetic, 133, 147; entrapment, 118, 244; hereditary motor sensory, 147; HIV- or CMV- associated, 147; ischaemic optic, 53; motor predominant, 150; paraneoplastic, 147; paraproteinemic, 147; peripheral, 103, 118, 176, 210; vasculitic, 389 neutropenia, 110, 113, 115 nintedanib, 213 nucleoside analogues, 87 nutritional status, 98, 101, 117, 129 nystagmus, 145, 148-49, 158-59 obesity, 44, 46, 78, 179, 194, 206-8, 244 obesity hypoventilation syndrome, 194, 207 occupational exposure, 183, 188, 192, 196, 204, 211-12 occupational therapy, 159, 245 ocular diseases, 82. See also particular diseases odontoid process, 389 oedema: angioedema, 350, 351, 352; ankle, 9, 10, 15, 66, 83,97-98, 117, 127, 131, 136, 179, 183, 194, 334-35; cerebral, 34, 203, 356, 367, cytotoxic, 367; limb, 179, 221; lymphoedema, 337-38; myxoedema, 49; periorbital,

117, 221; pulmonary, 130, 205; sacral, 9, 10, 15, 117; vasogenic, 367. See also papilloedema oesophageal cancer, 74 oesophageal dysmotility, 222, 231, 235 oesophageal rupture, 188 oesophagitis: erosive, 78; reflux, 231-32,235 ophthalmic zoster, 334 ophthalmopathy, 49-51 ophthalmoplegia, 152 optic atrophy, 52-53, 59, 324, 325 optic nerve tumours, 53 optic neuritis, 152, 176 optic neuropathy, 53 oral candidiasis, 102, 233 organ harvesting, 391-98 Osler-Weber-Rendu syndrome, 53 osteitis condensa, 382-83 osteoarthritis, 41, 227-28, 236, 380, 387 osteoarthropathy, hypertrophic pulmonary, 204 osteodystrophy, hepatic, 94 osteogenesis imperfecta, 12, 361 osteopenia, 62-63, 379, 380, 384, 385, 389 osteophytosis, 379, 380, 386, 387 osteoporosis, 46, 63, 112, 229, 244, 380 osteosclerosis, 381, 382, 386, 387 otitis media, 163 oxygen supplementation, 178, 185,191, 194, 213, 216 Paget’s disease, 42 palliative care, 131, 151, 252, 258, 367,393, 398 Index 421 pallor, 66, 109, 136, 179 palmar erythema, 49, 66, 83, 88, 97 palpitations, 164-65, 300, 302, 304,312 palsy: Bell’s, 163; progressive bulbar, 151; progressive supranuclear, 154 Pancoast tumour, 191, 204 pancreatic disease, 74, 76, 170, 378 panic attacks, 169, 205 panniculitis, 49, 340, 341 papillary muscle dysfunction, 9-10, 15, 18, 20, 23 papillitis, 54 papilloedema, 34, 47, 53, 54, 317, 318, 323, 324 paraesthesia, 170, 333 paraneoplastic syndrome, 145 paraparesis, 152, 162 paraplegia, 114, 116 paraproteinaemia, 116 parathyroid adenoma, 62, 378 parathyroid carcinoma, 62 Parkinson’s disease, 153-55 parotid swelling, 69, 233-34 patent ductus arteriosus, 6-7, 14-15 patients: autonomy of, 248, 250, 252,258, 391-98; care of, 265-67, 395; communica- tion with, 248, 262, 391-94, 396-97; confidentiality and, 248, 257, 262-63, 267; consent of, 253-56; counselling of, 151, 239, 252; education of, 23, 57, 76, 239, 244, family of, 252, 26263, 391-98; mental competence

422 Index of, 396-97; prognosis of, 249, 396-97; rights of, 392-93 pemphigoid, bullous, 343 pemphigus vulgaris, 342, 343 penicillin, 32 peptic ulcers, 74, 76 pericarditis, 118, 130, 244, 297 periodic limb movements (PLM), 292 peripheral vascular disease, 118 peritoneal dialysis, 117-18, 124, 138 peritonitis, 71, 95-96, 138-40 pertussis, 180 pes cavus, 148 pes planus, 243, 246 petechiae, 101, 109, 111 phaeochromocytoma, 34, 52 phenytoin, 170 physicians: beneficence of, 248-49, 394; code of conduct of, 247, 392-93; conflicts of interest of, 265-66; core values of, 259-60; docu- mentation by, 251, 262, 264, 391-92, 398; honesty of, 252,262, 266, 267; non- malfeasance and, 24849, 394; professionalism of, 259-67; self-prescription by, 266-67; social contract of, 260; whistle-blowing by, 248, 262-63, 267 physiotherapy, 159, 239, 242, 244 pigmentation, 4344, 49, 66, 83, 101, 230 pirfenidone, 213 pituitary lesions, 41, 45-46, 53, 59-60, 377, 378 plantar fasciitis, 238 plantar response, 145, 146, 150, 174-75 plasmapheresis, 116, 120-21, 147, 172 pleural effusion, 108, 118, 187-89, 193,204, 208-10, 244 pleurisy, 188, 209 pneumatosis coli, 96 Pneumocystis jeroveci (Pneumocystis carinii), 275 pneumonia, 180, 182, 202, 209; aspiration, 151, 222, 235; atypical, 271-72; commu- nity-acquired, 270, 271; cryptogenic organizing, 214; eosinophilic, 214; obstruc- tive, 192; usual interstitial, 212-14 pneumonitis, 214 pneumothorax, 184 poliomyelitis, 150 polyangiitis, microscopic, 119-20 polyarteritis nodosa, 49, 119 polyarthralgia, 335 polycystic diseases, 105, 107; kidney, 117-18, 121-22, 126, 361; liver, 118, 122, 126 polycythaemia, 7 polydipsia, 115, 131 polymyalgia rheumatica, 156 polymyositis, 150, 155-57, 222, 231 polysomnograms (sleep studies), 206-7, 289-94, 289, 291, 293 polyuria, 115 portal vein thrombosis, 89, 91-92 prednisolone, 123 pre-eclampsia, 35-36

pregnancy, 36-39, 59, 61, 137, 292 probenecid, 226 prolactinoma, 58-61, 378 prostate cancer, 222 proteinuria, 34, 47, 52, 119, 132-33, 135, 136, 138 proton pump inhibitors, 75-76, 79-80, 232 pruritis, 93-95, 117, 129-30, 352 Pseudomonas aeruginosa, 199 psoriasis, 44, 220, 224, 229-30, 239-40, 328, 329 psychosis, 24, 46, 112-13 ptosis, 171-73, 174, 178 pulmonary angiogram, CT, 216 pulmonary embolism, 189, 215-18, 241, 299-300, 309 pulmonary fibrosis (IPF), 178, 181-82, 190-92, 222-23, 231-32, 235, 288, 389; idiopathic, 191-92, 211-14; interstitial, 276, 277 pulmonary haemorrhage, 120-21 pulmonary oedema, 130, 205 pupillary reflexes, 161 pyoderma gangrenosum, 82 pyrazinamide, 176 pyridoxine, 176 quality of life, 78, 200, 239-40, 249, 355, 391, 395-97 Quincke’s pulse, 2 radiation pneumonitis, 181 radiotherapy, 42, 60, 109, 114, 116, 190, 203, 367 Ramsay-Hunt syndrome, 163 Raynaud’s phenomenon, 221, 230, 232,233, 235,244 Index 423 rectal bleeding, 80, 83 recurrent laryngeal nerve, 204 reflexes, 51, 143-44, 146, 148, 150, 152, 154, 158, 160-62, 173 Reiter’s syndrome, 3, 220, 239 renal artery stenosis, 34, 52, 118, 123,132 renal carcinoma, 368 renal disease, 66, 188; chronic, 117,121, 127-31; colic, 377-78; end-stage, 124, 130, 132, 134, 138, 141, 292; hepatomegaly and, 121-22, 126; hypertension and, 34-36, 121, 128-29, 132, 137-38; systemic lupus erythematosus and, 242; tumours, 118. See also particular diseases renal failure, 114-15, 121, 124, 125, 130; chronic, 52, 60, 62-63, 210 renal function, 33-34, 62, 86, 120, 122-23, 128-34, 166, 216, 225 respiratory distress, 179, 180, 185, 280 respiratory distress syndrome, acute (ARDS), 279, 280 respiratory failure, 151, 194, 216, 279-80, 288 respiratory system, tuberculosis and, 180-82, 188, 209-10 respiratory tract infections, upper, 163, 335 restless leg syndrome (RLS), 292 retinal artery occlusion, 318, 319 retinal detachment, 48, 326, 327 retinal vascular disease, 82

424 Index retinal vein occlusion, central, 320, 321 retinopathy: diabetic, 4748, 52, 131, 133, 138-39, 210, 321, 322, 323, 325, 326; hyperten- sive, 47, 51-52, 127 rhabdomyolysis, 222 rheumatic fever, 32 rheumatoid factor, 32, 228, 234, 245 rhinitis, 196, 205-6 rhonchi, 180, 181, 183-85 rifampicin, 176 riluzole, 151 rivaroxaban, 218 rosacea, 350 sacroiliac joints, 381, 382, 383 sacroiliitis, 228-29, 383 salpingitis, 175 sarcoidosis, 27, 48-49, 62, 352 scaling, 329, 331, 344-45, 350 Schirmer’s test, 233 sciatica, 238 sclerodactyly, 230, 234 scleroderma, 230-33 sclerosis: periarticular, 238; primary lateral, 151; systemic, 53, 181, 231-32, 234-35 seizures, 167-71, 250, 363, 367-68 selective serotonin reuptake inhibitors, 76 sensory deficits, 14546, 150, 152, 162, 175, 354 serositis, 221, 241 sinusitis, 182, 196-97 Sjogren’s syndrome, 233-34 skin conditions, 82, 328-52, 328, 330, 332, 334, 336, 338, 340, 342, 344, 346, 348, 349, 351. See also particular conditions skin rashes, 76, 82, 135, 170, 179, 221,223, 240, 389 sleep apnoea, 34, 42, 194, 204-8, 214,290, 294 sleep disorders, 78, 169 sleep studies (polysomnograms), 2067, 289-94, 289, 291, 293 smell, sense of, 143 smoking, 23, 78, 82, 88, 148, 160, 183, 188, 196, 213 snoring, 294 social media, 262-63 sodium valproate, 170 spherocytosis, 105-6 spinal cord compression, 103, 114, 116, 159 spinal cord tumours, 149, 159, 162 spirometry, 182, 183-84, 212, 285, 286 spironolactone, 86 splenomegaly, 66, 68-71, 84-85, 97-98, 102-5, 107-9, 113, 244 spondylitis, 228-29; ankylos- ing, 82, 190, 219-20, 229, 237-40, 383 spondyloarthritis, 219, 383 spondylosis, 375, 380 sputum, 179-86, 188, 190, 192, 197-201, 272-73, 275, 281, 283-84 Staphylococcus, 32, 44; aureus, 271,332,337 steatorrhoea, 94-95 Stevens-Johnson syndrome, 170, 339

Streptococcus, 44, 48, 337, 341; bovis, 32; pneumoniae, 185, 271; viridans, 32 stroke, 8, 12, 36, 56-58, 148, 160, 164-67, 174-717, 315, 360-61; brain haemorrhages and, 157, 354, 358, 359; ischaemic, 23, 149, 157, 356-57, 369-70; thrombotic agents and, 200201 subarachnoid haemorrhage, 122, 315, 359, 371, 372-73 suicide, physician-assisted, 257-58 sulphasalazine, 82 superior vena cava obstruction, 179, 204 swan neck deformity, 236, 243 syncope, 5, 24, 28-30, 169, 215, 306 synovitis, 221, 233, 236 syphilis, 3 syringomyelia (syringobulbia), 158-59 systemic lupus erythematosus, 113, 156, 181, 212, 219, 221-22, 232, 236, 240-42, 350 TACE (transcatheter arterial chem- oembolization), 92 tachycardia: atrial, 8, 305, 313-14; atrioventricular re-entry, 313-14; junctional, 305; parrow complex, 302, 303, 312, 313; par- oxysmal supraventricular, 301; sinus, 50, 308, 309; supraventricular, 303, 311, Index 425 313; ventricular, 311; wide complex, 310, 311 tachypnea, 179, 183, 185, 187, 191, 193, 211 tacrolimus, 123-24, 347 taste, 96, 143, 163 telangiectasias, 53, 66, 230 temporal arteritis, 156 tendonitis, 229, 238 tendon rupture, 24445 testicles, 102 thalassaemia, 102, 105-6 thoracocentesis, 188, 209-10 thorax, CT, 270, 273, 276, 280, 284 thrombocytopenia, 99, 109, 112, 115,138 thrombophlebitis, 341 thrombopoietin receptor agonists, 114 thrombotic microangiopathy, 112 thrombotic thrombocytopenic purpura, 112,221 thymoma, 17273 thyroid adenoma, 50, 64 thyroid function, 8, 25, 50, 65 thyroiditis, 50, 64 thyrotoxicosis, 7, 26-27, 50, 151, 171-73, 196 tinea corporis, 344, 345 tinzaparin, 218 tonsils, 102, 103, 108 tophus deposition, 117, 220, 224-26, 236 topiramate, 170 torsades de pointes, 316 toxic epidermal necrolysis, 338, 339 toxic megacolon, 83

426 Index tracheal deviation, 185-86, 187, 189, 190-91 transient ischaemic attacks, 169, 361, 370 Traube sign, 3 trauma, 16, 23, 60, 148, 159, 225-26, 244,315 travel history, 80, 208, 210 tremor, 170; action, 49; benign essential, 154; fine hand, 171; intention, 145; pill-rolling, 154-55; resting, 64, 154 tricuspid regurgitation, 7, 9, 13, 15-17 tuberculoma, 176, 365 tuberculosis, 48-49, 62, 81, 112-13, 341; endobronchial, 186-87; pulmonary, 187, 190-91, 202, 283, 284; res- piratory system and, 180-82, 188, 209-10 tyrosine kinase inhibitors (TKIs), 104, 348-49 ulcerative colitis, 73, 80-83 ulcers, cutaneous, 119-21, 158, 230,235 ulnar deviation, 236 upper endoscopy, 74-75, 78-79, 100 upper respiratory tract infections, 197 uraemia, 117-19, 121, 126, 128, 130, 224 uric acid, 224-26 urinalysis, 119 urinary tract infection, 118 urinary tract obstruction, 118, 122-23 urinoma, 123 uropathy, 226 ursodeoxycholic acid, 94 urticaria, 352 uveitis, 229 vaccinations, 213 variceal bleeding, 86, 94, 96, 97-100 vasculitis, 49, 176, 240, 242, 341, 354,357, 359, 389; allergic, 334, 335; coronary, 27; digital, 221; leukocytoclastic, 135, 334, 335; renal, 119-21; septic, 335; skin, 117, 119-21 vena cava obstruction, 179, 204 venous thrombosis: central retinal vein, 47, 319, 320; deep vein, 138, 215-18, 337 portal vein, 89, 91-92; renal vein, 138 ventricular fibrillation, 301 ventricular hypertrophy: left, 4-5, 8-9,29, 33-34, 42, 52, 304, 305; right, 7, 15, 301, 309 ventricular septal defect, 7, 9, 14, 16,17-18, 23 Venturi effect, 29 vertebral artery, 148-49 vertebral body fractures, 379, 380 vertigo, 149, 240 vestibular neuronitis, acute, 149 vitamins: A, 94-95; B12, 53, 147, D, 61, 63, 94-95; K, 94; K1, 37-38 vitreous haemorrhage, 326, 327 vocal cord dysfunction, 148, 196-97 vocal resonance, 180, 183, 187, 193

i [ O77 Wallenberg’s syndrome, 360 warfarin, 36-38, 217-18 Wegener’s granulomatosis, 119-20 weight loss, 63, 170, 193, 201-2 Wernicke’s aphasia, 157, 165, 167 wheeze, 180, 181, 184-85, 205-6 Wilson’s disease, 69, 72, 154 Wolff-Parkinson-White syndrome, 299, 301 xanthelasma, 148 xanthochromia; 372-73 78 Index 427 xanthomata, 224 xerosis, 348-49 X-ray images: cervical spine, 388; foot, 384; hand, 384, 386; lumbar spine, 379, 381, 382; pelvis, 381; skull, 376. See also chest X-rays Zieve’s syndrome, 98 Z-thumb, 236

IWARAARIEE X65289920

PROBLEM-BASED MEDICAL CASE MANAGEMENT SECOND EDITION Medicine is an ever-changing science. Since this book was first published in 2006, there have been major advances in many aspects of medicine. In this second edition, medical cases, diagnostic approaches and treatment modalities have been brought up to date, in keeping with advances in medical science. Chapters on respiratory medicine have been thoroughly revised and strengthened to reflect the most current information in the field. New topics in medical case management, such as emerging controversies in medical ethics and issues of professional conduct are covered. Problem-Based ~ Medical Case Management primarily provides a compact and essential aid for medical students preparing for their examinations in general medicine. Practising doctors will also find this book useful in their day-to-day practice and when preparing for case presentation. “In this book the authors, all physicians with considerable knowledge and experience, clearly describe a problem-based approach to the management of common diseases. This has been expertly and success- fully achieved. There are illustrative long and short cases preceded by an overview of the relevant subspecialty; the questions being posed and the pitfalls that are mentioned are very useful. The inclusion of images and clinical laboratory results is an additional asset.” —Professor Sir David Todd Kathryn Tan (MD Wales; FRCP Edin & Lond; FHKCP; FHKAM [Medicine]) is Sir David Todd Professor in Medicine in the Department of Medicine, the University of Hong Kong. Medicine ISBN 978-988-8390-79-3 T 898881390793 FHEKXNZHKRR Honc KoNG UN1vERSITY PRESS Printed and bound in Hong Kong, China