Part I:The Patient Presents With 1
History in the patient with chest pain 3
Preface 3
1.Chest Pain 3
Introduction 3
Differential diagnosis of chest pain 3
Investigating the patient with chest pain 4
Examining the patient with chest pain 4
Acknowledgements 4
2.Shortness of Breath 9
Introduction 9
History in the patient with breathlessness 9
Dedication 10
Examining the patient with breathlessness 10
Investigating the patient with breathlessness 12
History 15
Differential diagnosis by description of the rhythm 15
Introduction 15
3.Palpitations 15
Consequences of palpitations 16
Examining the patient with palpitations 16
Investigating the patient with palpitations 17
4.Heart Murmurs 19
Introduction 19
Differential diagnosis of heart murmurs 19
History in the patient with heart murmurs 20
Examining the patient with heart murmurs 20
5.Cough and Haemoptysis 25
Introduction 25
Differential diagnosis of cough and haemoptysis 25
History in the patient with cough and haemoptysis 25
Examining the patient with cough and haemoptysis 26
Investigating the patient with cough and haemoptysis 27
Examing the patient with PUO 29
History in the patient with PUO 29
Investigating the patient with PUO 29
Introduction 29
6.Pyrexia of Unknown Origin 29
Causes 29
7.Haematemesis and Melaena 33
Introduction 33
Differential diagnosis of haematemesis and melaena 33
History in the patient with haematemesis and melaena 33
Examining the patient with haematemesis and melaena 34
Investigating the patient with haematemesis and melaena 35
8.Change in Bowel Habit 37
Introduction 37
Differential diagnosis of a change in bowel habit 37
History in the patient with a change in bowel habit 38
Examining the patient with a change in bowel habit 38
Investigating the patient with a change in bowel habit 38
Introduction 41
Differential diagnosis of weight loss 41
9.Weight Loss 41
History in the patient with weight loss 42
Examining the patient with weight loss 42
Investigating the patient with weight loss 43
10.Jaundice 45
Introduction 45
Differential diagnosis of jaundice 45
History in the patient with jaundice 45
Examining the patient with jaundice 47
Investigating the patient with jaundice 48
11.Abdominal Pain 51
Introduction 51
Differential diagnosis of abdominal pain 51
History in the patient with abdominal pain 52
Examining the patient with abdominal pain 52
Investigating the patient with abdominal pain 53
Differential diagnosis of polyuria 55
12.Polyuria and Polydipsia 55
Introduction 55
History in the patient with polyuria or polydipsia 56
Examining the patient with polyuria or polydipsia 57
Investigatig the patient with polyuria and polydipsia 58
13.Haematuria and Proteinuria 61
Introduction 61
Differential diagnosis of haematuria and proteinuria 61
History in the patient with haematuria and proteinuria 62
Investigating the patient with haematuria and proteinuria 63
Examining the patient with haematuria and proteinuria 63
14.Hypertension 67
Introduction 67
Differential diagnosis of hypertension 67
History in the patient with hypertension 67
Examining the patient with hypertension 68
Investigating the patient with hypertension 69
History in the patient with headache or facial pain 71
Differential diagnosis of headache and facial pain 71
15.Headache and Facial Pain 71
Introduction 71
Examining the patient with headache or facial pain 73
Investigating the patient with headache or facial pain 73
16.Joint Disease 77
Differential diagnosis of jointdisease 77
History in the patient with joint disease 77
Examining the patient with joint disease 78
Investigating the patient with joint disease 79
17.Skin Rashes 81
Differential diagnosis by appearance 81
History in the patient with skin rashes 83
Examining the patient with skin rashes 83
Investigating the patient with skin rashes 85
History in the patient with loss of consciousness 87
Differential diagnosis of loss of consciousness 87
Introduction 87
18.Loss of Consciousness 87
Examining the patient with loss of consciousness 88
Investigating the patient with loss of consciousness 89
19.Confusional States 93
Introduction 93
Differential diagnosis of confusion 93
History in the confused patient 93
Examining the confused patient 94
Investigating the confused patient 95
20.Acute Neurological Deficit 97
Introduction 97
Differential diagnosis of stroke 97
History in the stroke patient 98
Examining the stroke patient 98
Investigating the stroke patient 99
History in the patient with lymphadenopathy or splenomegaly 103
Differential diagnosis of lymphadenopathy and splenomegaly 103
Introduction 103
21.Lymphadenopathy and Splenomegaly 103
Examining the patient with lymphadenopathy and splenomegaly 104
Investigating the patient with lymphadenopathy and splenomegaly 106
22.Sensory and Motor Neurological Deficits 109
Introduction 109
Differential diagnosis of sensory and/or motor neurological deficits 109
History in the patient with sensory and/or motor neurological deficits 110
Examining the patient with sensory and/or motor neurological deficits 111
Investigating the patient with sensory and/or motor neurological deficits 113
23.Bruising and Bleeding 115
Introduction 115
Differential diagnosis of bleeding or bruising 115
History in the patient with bleeding and bruising 115
Examining the patient with bleeding and bruising 116
Investigating the patient with bleeding and bruising 117
History in the patient with vertigo 121
Differential diagnosis in the patient with vertigo or dizziness 121
24.Vertigo and Dizziness 121
Introduction 121
Examining the patient with vertigo 123
Investigating the patient with vertigo 123
25.Anaemia 125
Introduction 125
Differential diagnosis of anaemia 125
History in the anaemic patient 125
Examining the anaemic patient 127
Investigating the anaemic patient 127
Part II:History, Examination, and Common Investigations 131
26.Taking a History 133
General principles--the bedside manner 133
The history 133
Presenting complaint 133
History of presenting complaint 133
Systems review 134
Previous medical history 134
Drug history 138
Family history 139
Social history 140
27.Examination of the Patient 143
Introduction 143
First things first 143
General inspection 143
The face and body habitus 144
The neck 145
The hands 146
The cardiovascular system 148
The respiratory system 151
The abdomen 154
The nervous system 157
The joints 167
The skin 167
Medical sample clerking 169
28.The Clerking 169
Introduction 169
29.Common Investigations 173
Introduction 173
The cardiovascular system 173
The respiratory system 177
The gastrointestinal system 181
The urinary system 183
The nervous system 184
Metabolic and endocrine disorders 184
Musculoskeletal and skin disease 189
Haematological disorders 189
Part III:Diseases and Disorders 193
30.Cardiovascular System 195
Ischaemic heart disease 195
Myocardial infarction 200
Arrhythmias 206
Heart failure 211
Hypertension 215
Valvular heart disease 220
Miscellaneous cardiovascular conditions 222
31.Respiratory Disease 231
Asthma 231
Chronic bronchitis and emphysema 235
Tuberculosis 237
Lung cancer 240
Pneumonia 244
Respiratory failure 246
Miscellaneous respiratory conditions 248
32.Gastrointestinal and Liver Disease 253
Peptic ulcer disease 253
Gastrointestinal haemorrhage 254
Inflammatory bowel disease 256
Crohn s disease 259
Gastrointestinal tumours 260
Malabsorption 262
Diseases of the gallbladder 264
Diseases of the pancreas 265
Acute viral hepatitis 267
Chronic liver disease 269
Miscellaneous gastrointestinal disorders 273
33.Genitourinary System 275
Glomerular disease 275
Acute renal failure 278
Chronic renal failure 280
Urinary tract infection 283
Fluid and electrolyte balance 284
Miscellaneous genitourinary conditions 287
34.Central Nervous System 289
Cerebrovascular disease 289
Management of conditions causing headache 293
Parkinsonism 296
Multiple sclerosis 299
Meningitis 301
Epilepsy 303
Infracranial tumours 306
Miscellaneous neurological disorders 307
35.Metabolic and Endocrine Disorders 311
Diabetes 311
Lipid disorders 317
Metabolic bone disease 319
Hyperparathyroidism 324
Hypoparathyroidism 325
Crystal arthropathy 325
Hypercalcaemia 327
Pituitary disorders 327
Thyroid disorders 331
Disorders of the adrenal glands 336
Miscellaneous endocrine conditions 339
36.Musculoskeletal and Skin Disorders 341
Arthritis 341
Osteoarthritis 343
Systemic lupus erythematosus 346
Polymyalgia rheumatica 348
Other connective tissue disorders 349
Primary skin diseases 353
Skin manifestations of systemic disease 355
Malignant skin tumours 357
37.Haematological Disorders 359
Anaemia 359
Leukaemias 367
Multiple myeloma 370
Malignant lymphomas 371
Bleeding disorders 374
Disseminated intravascular coagulation 375
Thrombotic disorders 376
Introduction 379
HIV and AIDS 379
38.Infectious Diseases 379
Malaria 382
39.Drug Overdose 387
Epidemiology 387
Aetiology 387
Presentation 387
Management 388
Investigations 388
Part IV:Self-assessment 391
Multiple-choice questions 393
Short-answer questions 399
Case-based questions 400
MCQ answers 401
SAQ answers 402
Index 405