CLINICAL MEDICINE Bradley, Gurnell & Wood Lecture Notes 7th Edition Reviews of the previous edition ‘.this book tackles the vast subject that is clinical medicine in a matter of fact, easy to learn way. It does exactly what it says on the tin: a no-nonsense overview of clinical medicine, perfect in the run up to finals.’ Oxford Medical School Gazette ‘This book more than lives up to the other popular books in the same Lecture Notes series with its clear, CLINICAL MEDICINE concise, no-nonsense format [.] ideal for revision.’ North Wing, Sheffield Medics Magazine Lecture Notes Clinical Medicine Lecture Notes provides a comprehensive, accessible introduction to the Lecture Notes management and treatment of medical conditions. A short manual of techniques on communication and physical examination in Part 1 is supported by the core knowledge required on diseases specific to each body system in Part 2. Combining readability with high quality illustrations, this seventh edition€has been thoroughly revised to reflect up-to-date practice in examination and clinical investigation, and advances in the evidence base supporting modern day clinical practice.
Numerous figures and tables help distil the information for revision purposes, and there are new chapters on the medical interview and assessment. LN Whether you need to develop your knowledge for clinical practice, or refresh that knowledge in CLINICAL MEDICINE the run up to examinations, Clinical Medicine Lecture Notes will help foster a systematic approach to the clinical situation for all medical students and hospital doctors. John Bradley For information on all the titles in the Lecture Notes series, please visit: Mark Gurnell www.com Diana Wood Titles of related interest All content reviewed 7th Edition by students for students Medicine at a Glance, Third Edition Patrick Davey 2010 Wiley-Blackwell Medical Education books 9781405186162 are designed exactly for their intended Medicine at a Glance: Core Cases audience. All of our books are developed in Patrick Davey 2010 collaboration with students.
This means that 9781444335118 our books are always published with you, the student, in mind. The Hands-on Guide for Junior Doctors, Fourth Edition Anna Donald, Mike Stein and Ciaran Hill 2011 If you would like to be one 7th Edition 9781444334661 of our student reviewers, go to www.com For more information on the complete range of Wiley-Blackwell to find out more. medical student and junior doctor publishing, please visit: www.com To receive automatic updates on Wiley-Blackwell books and journals, join our email list. Sign up today at www.com/email ISBN 978-1-4051-5714-8 www.com/go/medicine 9 781405 157148 Clinical Medicine Lecture Notes John Bradley MA, DM, FRCP Consultant Physician Addenbrooke’s Hospital Cambridge Mark Gurnell MA(MedEd), PhD, FRCP Associate Clinical Dean, University Lecturer and Honorary Consultant Physician University of Cambridge School of Clinical Medicine Addenbrooke’s Hospital Cambridge Diana Wood MA, MD, FRCP Director of Medical Education, Clinical Dean and Honorary Consultant Physician University of Cambridge School of Clinical Medicine Addenbrooke’s Hospital Cambridge Seventh Edition This edition first published 2012, Ó 2012 by John Bradley, Mark Gurnell, Diana Wood, David Rubenstein and David Wayne Previous editions: 1976, 1980, 1985, 1991, 1997, 2003 Blackwell Publishing was acquired by John Wiley & Sons in February 2007.
Blackwell’s publishing programme has been merged with Wiley’s global Scientific, Technical and Medical business to form Wiley-Blackwell. Registered office: John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.com/wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
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Library of Congress Cataloging-in-Publication Data Bradley, John, MRCP. Clinical medicine / John Bradley, Mark Gurnell, Diana Wood. Clinical medicine Rev. of: Lecture notes on clinical medicine / David Rubenstein, David Wayne, John Bradley.
Lecture notes on clinical medicine. Title: Clinical medicine. Clinical Medicine–Handbooks. WB 39] 616–dc23 2011042644 A catalogue record for this book is available from the British Library.
Cover image: Dana Neely/Corbis Cover design: Grounded Design Set in 8/10pt Utopia by Thomson Digital, Noida, India 1 2012 Contents Preface to the Seventh Edition iv Preface to the First Edition v Part 2 Clinical Medicine 10 Cardiovascular disease 73 11 Respiratory disease 110 Part 1 Clinical Examination 12 Gastroenterology 128 1 The medical interview 1 13 Liver disease 144 2 General examination 7 14 Renal disease 153 3 Cardiovascular system 10 15 Neurology 171 4 Respiratory system 19 16 Endocrine disorders 208 5 The abdomen 28 17 Metabolic disorders 229 6 Neurological system 39 18 Rheumatology 269 7 Endocrinology and metabolism 57 19 Dermatology 297 8 Musculoskeletal system 62 20 Haematology 321 9 Assessment 66 21 Infectious diseases 336 22 Toxicology 351 SI Units conversion table 361 Index 362 The plate section can be found facing page 314 Preface to the Seventh Edition History-taking and examination remain the essential practice of clinical medicine. Please continue to let us tools of clinical medicine. However, the environment have your views. in which medicine is practised has changed since the first edition of Lecture Notes in Clinical Medicine in John Bradley 1975.
The seventh edition follows the format of Mark Gurnell previous editions of this book with two sections: Diana Wood Clinical Examination and Clinical Medicine. Each section has been updated to reflect the increased evidence upon which clinical practice is based and Acknowledgements the more objective methods of assessment that are We would like to thank Dr Ellie Gurnell, Dr Mark now used. Lillicrap and Dr Narayanan Kandasamy for their con- It is rewarding to discover how many readers have tributions, help and advice during the preparation of found the text useful for study, for revision and for the the manuscript. Preface to the First Edition This book is intended primarily for the junior hospital working knowledge in a clinical situation.
It should doctor in the period between qualification and the not be forgotten that some rare diseases are of great examination for Membership of the Royal Colleges importance in practice because they are treatable or of Physicians. We think that it will also be helpful to preventable, e. infective endocarditis, hepatolenti- final-year medical students and to clinicians reading cular degeneration, attacks of acute porphyria. Some for higher specialist qualifications in surgery and conditions are important to examination candidates anaesthetics.
because patients are ambulant and appear commonly The hospital doctor must not only acquire a large in examinations, e. neurosyphilis, syringomyelia, amount of factual information but also use it effect- atrial and ventricular septal defects. ively in the clinical situation. The experienced phy- We have not attempted to cover the whole of sician has acquired some clinical perspective through medicine, but by cross-referencing between the two practice: we hope that this book imparts some of this sections of the book and giving information in sum- to the relatively inexperienced.
The format and con- mary form we have completely omitted few subjects. tents are designed for the examination candidate but Some highly specialised fields such as the treatment of the same approach to problems should help the hos- leukaemia were thought unsuitable for inclusion. pital doctor in his everyday work. A short account of psychiatry is given in the section The book as a whole is not suitable as a first reader on neurology since many patients with mental illness for the undergraduate because it assumes much basic attend general clinics and it is hoped that readers may be knowledge and considerable detailed information has warned of gaps in their knowledge of this important had to be omitted.
It is not intended to be a complete field. The section on dermatology is incomplete but textbook of medicine and the information it contains should serve for quick revision of common skin must be supplemented by further reading. The con- disorders. tents are intended only as lecture notes and the mar- Wherever possible we have tried to indicate the gins of the pages are intentionally large so that the relative frequency with which various conditions are reader may easily add additional material of his own.
likely to be seen in hospital practice in this country and The book is divided into two parts: the clinical have selected those clinical features which in our view approach and essential background information. In are most commonly seen and where possible have the first part we have considered the situation which a listed them in order of importance. The frequency candidate meets in the clinical part of an examination with which a disease is encountered by any individual or a physician in the clinic. This part of the book thus physician will depend upon its prevalence in the resembles a manual on techniques of physical exam- district from which his cases are drawn and also on ination, though it is more specifically intended to help his known special interests.
Nevertheless, rare condi- the candidate carry out an examiner’s request to tions are rarely seen; at least in the clinic. Examin- perform a specific examination. It has been our ex- ations, however, are a ‘special case’. perience in listening to candidates’ performances in We have used many generally accepted abbrevi- examinations and hearing the examiner’s subsequent ations, e.
ECG, ESR, and have included them in the assessment that it is the failure of a candidate to index instead of supplying a glossary. examine cases systematically and his failure to behave Despite our best efforts, some errors of fact may as if he were used to doing this every day of his clinical have been included. As with every book and authority, life that leads to adverse comments. question and check everything – and please write to us In the second part of the book a summary of basic if you wish.
clinical facts is given in the conventional way. We have We should like to thank all those who helped included most common diseases but not all, and we us with producing this book and, in particular, have tried to emphasise points which are under- Sir Edward Wayne and Sir Graham Bull who have stressed in many textbooks. Accounts are given of kindly allowed us to benefit from their extensive many conditions which are relatively rare. It is neces- experience both in medicine and in examining for sary for the clinician to know about these and to be on the Colleges of Physicians.
the lookout for them both in the clinic and in exam- inations.