Foreword ix
Preface x
Acknowledgements xii
Abbreviations xiii
Advice xx
Respiratory 1
Clinical mark sheet 1
Respiratory exam – general advice 2
Pulmonary fibrosis 4
Bronchiectasis 5
Old tuberculosis 6
Surgical respiratory cases 7
Chronic obstructive airways disease 8
Pleural effusion 10
Lung cancer 12
Cystic fibrosis 14
Pneumonia 15
Pulmonary hypertension 17
Cardiology 19
Clinical mark sheet 19
Cardiology exam – general advice 20
Aortic stenosis 22
Aortic incompetence 25
Mitral stenosis 27
Mitral incompetence 29
Tricuspid incompetence 31
Pulmonary stenosis 32
Prosthetic valves: aortic and mitral 33
Implantable devices 35
Constrictive pericarditis 36
Common Congenital Defects 38
Atrial septal defect 38
Ventricular septal defect 39
Associations with Congenital VSD 40
1. Fallot’s tetralogy 40
2. Coarctation 40
3. Patent ductus arteriosus (PDA) 40
Hypertrophic (obstructive) cardiomyopathy 42
Heart failure 44
Neurology 46
Clinical mark sheet 46
Neurology exam – general advice 47
Dystrophia myotonica 51
Cerebellar syndrome 53
Multiple sclerosis 54
Stroke 56
Spastic legs (i.e. spinal cord lesion) 59
Syringomyelia 61
Motor neurone disease 63
Parkinson’s disease 64
Hereditary motor sensory neuropathy aka Charcot–Marie–Tooth 66
Friedreich’s ataxia 67
Facial weakness 68
Myasthenia gravis 70
Tuberous sclerosis 71
Neurofibromatosis 72
Abnormal pupils 73
Horner’s pupil 73
Holmes–Adie (myotonic) pupil 73
Argyll Robertson pupil 74
Oculomotor (III) nerve palsy 74
Optic atrophy 75
Retinal Pathology 77
Age-related macular degeneration 77
Retinitis pigmentosa 78
Retinal artery occlusion 79
Retinal vein occlusion 79
Abdominal 80
Clinical mark sheet 80
Abdominal exam – general advice 81
Chronic liver disease and hepatomegaly 83
Haemochromatosis 86
Splenomegaly 88
Renal enlargement 90
The liver transplant patient 92
The renal patient 93
Communication 95
Clinical mark sheet 95
Communication station – general advice 96
Ethics and Law in Medicine 97
Contents vii
Principles of medical ethics 97
Competency and consent 98
Legal aspects 98
Confidentiality 101
End-of-life decisions 102
Types of Communication 104
Information delivery 104
Breaking bad news 105
Dealing with a difficult patient 106
Worked Examples 108
Duty of candour/medical mistake 108
Advanced care planning 108
Needlestick injury 110
Epilepsy 111
Huntington’s chorea 111
Paracetamol overdose 112
Brain-stem death and organ donation 113
Non-compliant diabetic 115
Vaccination compliance 116
Shared decision making 117
Sample questions for self-directed learning 119
Consultations 120
Clinical mark sheet 120
Consultation – general advice 121
Chest pain 122
Pericarditis with effusion 124
Atrial fibrillation 125
Hypertension 127
Eisenmenger’s syndrome 130
Ataxia 131
Headache 132
Altered conscious state 135
Syncope 137
Worsening mobility 139
Fall and a fragility fracture 141
Dyspnoea – asthma 142
Dyspnoea – acute pulmonary embolus 144
Haemoptysis 146
Persistent fever 148
Anaemia 151
Sickle cell disease 153
Glandular fever 155
Nephrotic syndrome 157
Jaundice 159
Inflammatory bowel disease 161
Infectious (traveller’s) diarrhoea 164
Swollen calf 166
Leg ulcers 168
Red rashes 170
Skin malignancy 174
Skin and hyperextensible joints 176
Rheumatoid arthritis 178
Systemic lupus erythematosus 181
Systemic sclerosis 183
Ankylosing spondylitis 185
Marfan’s syndrome 186
Paget’s disease 188
Other joint problems 189
Hypercalcaemia 191
Diabetes and complications 192
General diabetes questions 192
Diabetes and the skin 192
Diabetic retinopathy 194
Hyperthyroidism and Graves’ disease 197
Hypothyroidism 199
Amenorrhoea 201
Acromegaly 203
Cushing’s syndrome 205
Addison’s disease 208
Index 210
