, OXFORD HANDBOOK OF
CLINICAL
MEDICINE
TENTH EDITION
Ian B. Wilkinson
Tim Raine
Kate Wiles
Anna Goodhart
Catriona Hall
Harriet O’Neill
3
.indb i 02/05/2017 19:06
, He moved N. 48
all the brightest gems N. 24
faster and faster towards the N. 18
ever-growing bucket of lost hopes; N. 14
had there been just one more year
of peace the battalion would have made N. 12
a floating system of perpetual drainage.
A silent fall of immense snow came near oily
N. 10
remains of the recently eaten supper on the table.
We drove on in our old sunless walnut. Presently
classical eggs ticked in the new afternoon shadows. N. 8
We were instructed by my cousin Jasper not to exercise by country
house visiting unless accompanied by thirteen geese or gangsters. N. 6
The modern American did not prevail over the pair of redundant bronze puppies.
The worn-out principle is a bad omen which I am never glad to ransom in August. N. 5
Reading tests Hold this chart (well-illuminated) 30cm away, and record the smallest
type read (eg N12 left eye, N6 right eye, spectacles worn) or object named accurately.
.indb d 02/05/2017 19:06
, Oxford University Press, Great Clarendon Street, Oxford OX2 6DP
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education by
publishing worldwide. Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries.
Published in the United States by Oxford University Press Inc., New York
© Oxford University Press, 2017
The moral rights of the authors have been asserted
Database right Oxford University Press (maker)
First published 1985 Fifth edition 2001 Tenth edition 2017
(RA Hope & JM Longmore) (JM Longmore & IB Wilkinson) (IB Wilkinson, T Raine & K Wiles)
Second edition 1989 Sixth edition 2004
Third edition 1993 Seventh edition 2007
Fourth edition 1998 Eighth edition 2010
Ninth edition 2014
Translations:
Chinese French Hungarian Polish Russian
Czech German Indonesian Portuguese Spanish
Estonian Greek Italian Romanian
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, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
or under terms agreed with the appropriate reprographics rights organization.
Enquiries concerning reproduction outside the scope of the above should be sent
to the Rights Department, Oxford University Press, at the address above.
You must not circulate this book in any other binding or cover
and you must impose the same condition on any acquirer.
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2017939060
Typeset by GreenGate Publishing Services, Tonbridge, UK; printed in China by
C&C Offset Printing Co. Ltd.
ISBN 978-0-19-968990-3
Drugs
Except where otherwise stated, recommendations are for the non-pregnant adult
who is not breastfeeding and who has reasonable renal and hepatic function.
We have made every effort to check this text, but it is still possible that drug or
other errors have been missed. OUP makes no representation, express or implied,
that doses are correct. Readers are urged to check with the most up to date prod-
uct information, codes of conduct, and safety regulations. The authors and the
publishers do not accept responsibility or legal liability for any errors in the text,
or for the misuse or misapplication of material in this work.
For updates/corrections, see http://www.oup.co.uk/academic/series/oxhmed/updates/
.indb ii 02/05/2017 19:06
, Common haematology values
Haemoglobin men: 130–180g/L p324
women: 115–160g/L p324
Mean cell volume, MCV 76–96fL p326; p332
Platelets 150–400 ≈ 109/L p364
White cells (total) 4–11 ≈ 109/L p330
neutrophils 2.0–7.5 ≈ 109/L p330
lymphocytes 1.0–4.5 ≈ 109/L p330
eosinophils 0.04–0.4 ≈ 109/L p330
Blood gases
pH 7.35–7.45 p670
PaO2 >10.6kPa p670
PaCO2 4.7–6kPa p670
Base excess ± 2mmol/L p670
U&E S (urea and electrolytes)
Sodium 135–145mmol/L p672
Potassium 3.5–5.3mmol/L p674
Creatinine 70–100μmol/L p298–301
Urea 2.5–6.7mmol/L p298–301
eGFR >60 p669
LFTS (liver function tests)
Bilirubin 3–17μmol/L p272, p274
Alanine aminotransferase, ALT 5–35IU/L p272, p274
Aspartate transaminase, AST 5–35IU/L p272, p274
Alkaline phosphatase, ALP 30–130IU/L p272, p274
(non-pregnant adults)
Albumin 35–50g/L p686
Cardiac enzymes
Troponin T <99th percentile of p119
upper reference limit:
value depends on local
assay
Other biochemical values
Cholesterol <5mmol/L p690
Triglycerides Fasting: 0.5–2.3mmol/L p690
Amylase 0–180 IU/dL p636
C-reactive protein, CRP <10mg/L p686
Corrected calcium 2.12–2.60mmol/L p676
Glucose, fasting 3.5–5.5mmol/L p206
Thyroid stimulating hormone, TSH 0.5–4.2mU/L p216
For all other reference intervals, see p750–7
.indb c 02/05/2017 19:06
, Index to emergency topics
‘Don’t go so fast: we’re in a hurry!’—Talleyrand to his coachman.
Acute abdomen 606 Malignant hypertension 140
Acute kidney injury 298 Meningitis 822
Addisonian crisis 836 Meningococcaemia 822
Anaphylaxis 794 Myocardial infarction 796
Aneurysm, abdominal aortic 654 Needle pericardiocentesis 773
intracranial/extradural 78, 482 Neutropenic sepsis 352
gastrointestinal 256, 820 Obstructive uropathy 641
rectal 629
variceal 257, 820 Oncological emergencies 528
Antidotes, poisoning 842 Opioid poisoning 842
Arrhythmias, broad complex 128, 804 Overdose 838–44
narrow complex, SVT 126, 806 Pacemaker, temporary 776
Asthma 810 Pericardiocentesis 773
Asystole 895 Phaeochromocytoma 837
Atrial flutter/fibrillation Pneumonia 816
Bacterial shock 790 Pneumothorax 814
Blast injury 851 Poisoning 838–44
Bradycardia 124 Potassium, hyperkalaemia 674
hypokalaemia 674
Burns 846
Pulmonary embolism 818
Cardiac arrest 894 (Fig A3)
Respiratory arrest 894 (Fig A3)
Cardiogenic tamponade 802
Respiratory failure 188
Cardioversion, DC 770
Resuscitation 894 (Fig A3)
Central line insertion (CVP line) 774
Rheumatological emergencies 538
Cerebral oedema 830
Shock 790
Chest drain 766
Smoke inhalation 847
Coma 786
Sodium, hypernatraemia 672
Cricothyrotomy 772
hyponatraemia 672
Cyanosis 186–9
Spinal cord compression 466, 543
Cut-down 761
Status asthmaticus 810
Defibrillation 770, 894 (Fig A3)
Status epilepticus 826
Diabetes emergencies 832–4
Stroke 470
Disseminated intravascular coagulopathy
(DIC) 352 Superior vena cava obstruction 528
Disaster, major 850 Supraventricular tachycardia (SVT) 806
Encephalitis 824 Testicular torsion 652
Epilepsy, status 826 Thrombotic thrombocytopenic purpura
(TTP) 315
Extradural haemorrhage 482
Thyroid storm 834
Fluids, IV 666, 790
Transfusion reaction 349
Haematemesis 256–7
Varices, bleeding 257, 820
Haemorrhage 790
Vasculitis, acute systemic 556
Hyperthermia 790, 838
Venous thromboembolism, leg 656
Hypoglycaemia 214, 834
pulmonary 818
Hypothermia 848
Ventricular arrhythmias 128, 804
Intracranial pressure, raised 830
Ventricular failure, left 800
Ischaemic limb 656
Ventricular fibrillation 894 (Fig A3)
Malaria 416
Ventricular tachycardia 128, 804
Malignant hyperpyrexia 572
.indb b 02/05/2017 19:06
, Contents
Each chapter’s contents are detailed on its first page
Prefaces to the first and tenth editions iv
Acknowledgements v
Symbols and abbreviations vi
1 Thinking about medicine 0
2 History and examination 24
3 Cardiovascular medicine 92
4 Chest medicine 160
5 Endocrinology 202
6 Gastroenterology 242
7 Renal medicine 292
8 Haematology 322
9 Infectious diseases 378
10 Neurology 444
11 Oncology and palliative care 518
12 Rheumatology 538
13 Surgery 564
14 Clinical chemistry 662
15 Eponymous syndromes 694
16 Radiology 718
17 Reference intervals, etc. 750
18 Practical procedures 758
19 Emergencies 778
20 References 852
Index 868
Early warning score 892
Cardiac arrest 894
.indb iii 02/05/2017 19:06
, Preface to the tenth edition
This is the first edition of the book without either of the original authors—Tony Hope
and Murray Longmore. Both have now moved on to do other things, and enjoy a
well-earned rest from authorship. In this book, I am joined by a Nephrologist, Gas-
troenterologist, and trainees destined for careers in Cardiology, Dermatology, and
General Practice. Five physicians, each with very different interests and approaches,
yet bringing their own knowledge, expertise, and styles. When combined with that
of our specialist and junior readers, I hope this creates a book that is greater than
the sum of its parts, yet true to the original concept and ethos of the original authors.
Life and medicine have moved on in the 30 years since the first edition was published,
but medicine and science are largely iterative; true novel ‘ground-breaking’ or ‘prac-
tice-changing’ discoveries are rare, to quote Isaac Newton: ‘If I have seen further, it
is by standing on the shoulders of giants’. Therefore, when we set about writing this
edition we drew inspiration from the original book and its authors; updating, adding,
and clarifying, but trying to retain the unique feel and perspective that the OHCM has
provided to generations of trainees and clinicians.
IBW, 2017
Preface to the first edition
We wrote this book not because we know so much, but because we know we
remember so little…the problem is not simply the quantity of information, but the
diversity of places from which it is dispensed. Trailing eagerly behind the surgeon,
the student is admonished never to forget alcohol withdrawal as a cause of post-
operative confusion. The scrap of paper on which this is written spends a month
in the pocket before being lost for ever in the laundry. At different times, and in
inconvenient places, a number of other causes may be presented to the student.
Not only are these causes and aphorisms never brought together, but when, as a
surgical house officer, the former student faces a confused patient, none is to hand.
We aim to encourage the doctor to enjoy his patients: in doing so we believe he
will prosper in the practice of medicine. For a long time now, house officers have
been encouraged to adopt monstrous proportions in order to straddle the diverse
pinnacles of clinical science and clinical experience. We hope that this book will
make this endeavour a little easier by moving a cumulative memory burden from
the mind into the pocket, and by removing some of the fears that are naturally felt
when starting a career in medicine, thereby freely allowing the doctor’s clinical
acumen to grow by the slow accretion of many, many days and nights.
RA Hope and JM Longmore, 1985
.indb iv 02/05/2017 19:06
, Acknowledgements
Heart-felt thanks to our advisers on specific sections—each is acknowledged on
the chapter’s first page. Thanks also to our junior readers, Charles Badu-Boateng,
Clare Coggins, and Luke Walls. We especially thank all our mentors and teach-
ers, and patients who provide our inspiration and remind us that one never stops
learning. We acknowledge the Department of Radiology at both the Leeds Teach-
ing Hospitals NHS Trust and the Norfolk and Norwich University Hospital for their
kind help in providing many images, particularly Dr Edmund Godfrey, whose tire-
less hunt for perfect images has improved so many chapters.
Readers’ comments These have formed a vital part of our endeavour to provide
an accurate, comprehensive, and up-to-date text. We sincerely thank the many stu-
dents, doctors, and other health professionals who have found the time and the
generosity to write to us on our Reader’s Comments Cards, in editions past, or, in
more recent times, via the web. These have now become so numerous for past edi-
tions that they cannot all be listed. See http://www.oup.com/uk/academic/series/
oxhmed/links for a full list, and our very heart-felt tokens of thanks.
3rd-party web addresses We disclaim any responsibility for 3rd-party content.
.indb v 02/05/2017 19:06
, Symbols and abbreviations
..........this fact or idea is important DU ........duodenal ulcer
.......don’t dawdle!—prompt action saves lives D&V .....diarrhoea and vomiting
1 ...........reference DVT ......deep venous thrombosis
:......male-to-female ratio. :=2:1 means twice as DXT ......deep radiotherapy
common in males EBV ......Epstein–Barr virus
.........therefore ECG ......electrocardiogram
~ ..........approximately Echo ...echocardiogram
–ve ......negative (+ve is positive) EDTA ....ethylene diamine tetra-acetic acid (anticoagulant
........increased or decreased coating, eg in FBC bottles)
.......normal (eg serum level) EEG ......electroencephalogram
1° ........primary eGFR ....estimated glomerular filtration rate (in mL/
2° ........secondary min/1.73m2)
..........diagnosis ELISA ...enzyme-linked immunosorbent assay
........differential diagnosis EM .......electron microscope
A:CR ......albumin to creatinine ratio (mg/mmol) EMG .....electromyogram
A2 .........aortic component of the 2nd heart sound ENT ......ear, nose, and throat
Ab ......antibody ERCP ....endoscopic retrograde cholangiopancreatography
ABC ......airway, breathing, and circulation ESR ......erythrocyte sedimentation rate
ABG .....arterial blood gas: PaO2, PaCO2, pH, HCO3 ESRF ....end-stage renal failure
ABPA ....allergic bronchopulmonary aspergillosis EUA ......examination under anaesthesia
ACE-i .....angiotensin-converting enzyme inhibitor FBC ......full blood count
ACS .......acute coronary syndrome FDP ......fibrin degradation products
ACTH ....adrenocorticotrophic hormone FEV1 .....forced expiratory volume in 1st sec
ADH .....antidiuretic hormone FiO2 ....partial pressure of O2 in inspired air
AF ........atrial fibrillation FFP ......fresh frozen plasma
AFB ......acid-fast bacillus FSH ......follicle-stimulating hormone
Ag .......antigen FVC ......forced vital capacity
AIDS ....acquired immunodeficiency syndrome g ..........gram
AKI ........acute kidney injury G6PD ....glucose-6-phosphate dehydrogenase
ALL ......acute lymphoblastic leukaemia GA .......general anaesthetic
ALP ......alkaline phosphatase GCS ......Glasgow Coma Scale
AMA ....antimitochondrial antibody GFR ......glomerular filtration rate
AMP .....adenosine monophosphate GGT ......gamma-glutamyl transferase
ANA .....antinuclear antibody GH ........growth hormone
ANCA ...antineutrophil cytoplasmic antibody GI ........gastrointestinal
APTT ....activated partial thromboplastin time GN ........glomerulonephritis
AR ........aortic regurgitation GP ........general practitioner
ARB .....angiotensin II receptor ‘blocker’ (antagonist) GPA ......granulomatosis with polyangiitis (formerly
ARDS ...acute respiratory distress syndrome Wegener’s granulomatosis)
ART ......antiretroviral therapy GTN ......glyceryl trinitrate
AS ........aortic stenosis GTT ......glucose tolerance test
ASD .....atrial septal defect GU(M) ..genitourinary (medicine)
AST ......aspartate transaminase h ..........hour
ATN ......acute tubular necrosis HAV .....hepatitis A virus
ATP ......adenosine triphosphate Hb .......haemoglobin
AV ........atrioventricular HbA1c .glycated haemoglobin
AVM .....arteriovenous malformation(s) HBSAg ..hepatitis B surface antigen
AXR .....abdominal X-ray (plain) HBV .....hepatitis B virus
Ba ........barium HCC ......hepatocellular cancer
BAL ......bronchoalveolar lavage HCM .....hypertrophic obstructive cardiomyopathy
bd .......bis die (Latin for twice a day) Hct ......haematocrit
BKA .....below-knee amputation HCV ......hepatitis C virus
BNF ......British National Formulary HDV .....hepatitis D virus
BNP ......brain natriuretic peptide HDL ......high-density lipoprotein
BP ........blood pressure HHT ......hereditary haemorrhagic telangiectasia
BPH ......benign prostatic hyperplasia HIV ......human immunodeficiency virus
bpm ....beats per minute HLA ......human leucocyte antigen
ca ........cancer HONK ...hyperosmolar non-ketotic (coma)
CABG ...coronary artery bypass graft HPV ......human papillomavirus
cAMP ...cyclic adenosine monophosphate (AMP) HRT ......hormone replacement therapy
CAPD ...continuous ambulatory peritoneal dialysis HSP ......Henoch–Schönlein purpura
CCF ......congestive cardiac failure (ie left and right heart HSV ......herpes simplex virus
failure) HUS ......haemolytic uraemic syndrome
CCU ......coronary care unit IBD ......inflammatory bowel disease
CDT ......Clostridium difficile toxin IBW .....ideal body weight
CHB ......complete heart block ICD ......implantable cardiac defibrillator
CHD ......coronary heart disease ICP .......intracranial pressure
CI .........contraindications IC(T)U ..intensive care unit
CK ........creatine (phospho)kinase IDDM ...insulin-dependent diabetes mellitus
CKD ......chronic kidney disease IFN- ..interferon alpha
CLL ......chronic lymphocytic leukaemia IE .........infective endocarditis
CML .....chronic myeloid leukaemia Ig ........immunoglobulin
CMV .....cytomegalovirus IHD ......ischaemic heart disease
CNS ......central nervous system IM ........intramuscular
COC ......combined oral contraceptive pill INR ......international normalized ratio
COPD ....chronic obstructive pulmonary disease IP .........interphalangeal
CPAP ....continuous positive airway pressure IPPV ....intermittent positive pressure ventilation
CPR ......cardiopulmonary resuscitation ITP .......idiopathic thrombocytopenic purpura
CRP ......c-reactive protein IU ........international unit
CSF ......cerebrospinal fluid IVC ......inferior vena cava
CT ........computed tomography IV(I) ....intravenous (infusion)
CVA ......cerebrovascular accident IVU ......intravenous urography
CVP ......central venous pressure JVP ......jugular venous pressure
CVS ......cardiovascular system K ..........potassium
CXR ......chest x-ray kg .......kilogram
d ..........day(s); also expressed as /7; months are /12 KPa ......kiloPascal
DC ........direct current L ..........litre
DIC ......disseminated intravascular coagulation LAD ........left axis deviation on the ECG
DIP ......distal interphalangeal LBBB ....left bundle branch block
dL .......decilitre LDH ......lactate dehydrogenase
DM .......diabetes mellitus LDL ......low-density lipoprotein
DOAC ...direct oral anticoagulant LFT ......liver function test
.indb vi 02/05/2017 19:06
CLINICAL
MEDICINE
TENTH EDITION
Ian B. Wilkinson
Tim Raine
Kate Wiles
Anna Goodhart
Catriona Hall
Harriet O’Neill
3
.indb i 02/05/2017 19:06
, He moved N. 48
all the brightest gems N. 24
faster and faster towards the N. 18
ever-growing bucket of lost hopes; N. 14
had there been just one more year
of peace the battalion would have made N. 12
a floating system of perpetual drainage.
A silent fall of immense snow came near oily
N. 10
remains of the recently eaten supper on the table.
We drove on in our old sunless walnut. Presently
classical eggs ticked in the new afternoon shadows. N. 8
We were instructed by my cousin Jasper not to exercise by country
house visiting unless accompanied by thirteen geese or gangsters. N. 6
The modern American did not prevail over the pair of redundant bronze puppies.
The worn-out principle is a bad omen which I am never glad to ransom in August. N. 5
Reading tests Hold this chart (well-illuminated) 30cm away, and record the smallest
type read (eg N12 left eye, N6 right eye, spectacles worn) or object named accurately.
.indb d 02/05/2017 19:06
, Oxford University Press, Great Clarendon Street, Oxford OX2 6DP
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education by
publishing worldwide. Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries.
Published in the United States by Oxford University Press Inc., New York
© Oxford University Press, 2017
The moral rights of the authors have been asserted
Database right Oxford University Press (maker)
First published 1985 Fifth edition 2001 Tenth edition 2017
(RA Hope & JM Longmore) (JM Longmore & IB Wilkinson) (IB Wilkinson, T Raine & K Wiles)
Second edition 1989 Sixth edition 2004
Third edition 1993 Seventh edition 2007
Fourth edition 1998 Eighth edition 2010
Ninth edition 2014
Translations:
Chinese French Hungarian Polish Russian
Czech German Indonesian Portuguese Spanish
Estonian Greek Italian Romanian
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, without the prior
permission in writing of Oxford University Press, or as expressly permitted by law,
or under terms agreed with the appropriate reprographics rights organization.
Enquiries concerning reproduction outside the scope of the above should be sent
to the Rights Department, Oxford University Press, at the address above.
You must not circulate this book in any other binding or cover
and you must impose the same condition on any acquirer.
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2017939060
Typeset by GreenGate Publishing Services, Tonbridge, UK; printed in China by
C&C Offset Printing Co. Ltd.
ISBN 978-0-19-968990-3
Drugs
Except where otherwise stated, recommendations are for the non-pregnant adult
who is not breastfeeding and who has reasonable renal and hepatic function.
We have made every effort to check this text, but it is still possible that drug or
other errors have been missed. OUP makes no representation, express or implied,
that doses are correct. Readers are urged to check with the most up to date prod-
uct information, codes of conduct, and safety regulations. The authors and the
publishers do not accept responsibility or legal liability for any errors in the text,
or for the misuse or misapplication of material in this work.
For updates/corrections, see http://www.oup.co.uk/academic/series/oxhmed/updates/
.indb ii 02/05/2017 19:06
, Common haematology values
Haemoglobin men: 130–180g/L p324
women: 115–160g/L p324
Mean cell volume, MCV 76–96fL p326; p332
Platelets 150–400 ≈ 109/L p364
White cells (total) 4–11 ≈ 109/L p330
neutrophils 2.0–7.5 ≈ 109/L p330
lymphocytes 1.0–4.5 ≈ 109/L p330
eosinophils 0.04–0.4 ≈ 109/L p330
Blood gases
pH 7.35–7.45 p670
PaO2 >10.6kPa p670
PaCO2 4.7–6kPa p670
Base excess ± 2mmol/L p670
U&E S (urea and electrolytes)
Sodium 135–145mmol/L p672
Potassium 3.5–5.3mmol/L p674
Creatinine 70–100μmol/L p298–301
Urea 2.5–6.7mmol/L p298–301
eGFR >60 p669
LFTS (liver function tests)
Bilirubin 3–17μmol/L p272, p274
Alanine aminotransferase, ALT 5–35IU/L p272, p274
Aspartate transaminase, AST 5–35IU/L p272, p274
Alkaline phosphatase, ALP 30–130IU/L p272, p274
(non-pregnant adults)
Albumin 35–50g/L p686
Cardiac enzymes
Troponin T <99th percentile of p119
upper reference limit:
value depends on local
assay
Other biochemical values
Cholesterol <5mmol/L p690
Triglycerides Fasting: 0.5–2.3mmol/L p690
Amylase 0–180 IU/dL p636
C-reactive protein, CRP <10mg/L p686
Corrected calcium 2.12–2.60mmol/L p676
Glucose, fasting 3.5–5.5mmol/L p206
Thyroid stimulating hormone, TSH 0.5–4.2mU/L p216
For all other reference intervals, see p750–7
.indb c 02/05/2017 19:06
, Index to emergency topics
‘Don’t go so fast: we’re in a hurry!’—Talleyrand to his coachman.
Acute abdomen 606 Malignant hypertension 140
Acute kidney injury 298 Meningitis 822
Addisonian crisis 836 Meningococcaemia 822
Anaphylaxis 794 Myocardial infarction 796
Aneurysm, abdominal aortic 654 Needle pericardiocentesis 773
intracranial/extradural 78, 482 Neutropenic sepsis 352
gastrointestinal 256, 820 Obstructive uropathy 641
rectal 629
variceal 257, 820 Oncological emergencies 528
Antidotes, poisoning 842 Opioid poisoning 842
Arrhythmias, broad complex 128, 804 Overdose 838–44
narrow complex, SVT 126, 806 Pacemaker, temporary 776
Asthma 810 Pericardiocentesis 773
Asystole 895 Phaeochromocytoma 837
Atrial flutter/fibrillation Pneumonia 816
Bacterial shock 790 Pneumothorax 814
Blast injury 851 Poisoning 838–44
Bradycardia 124 Potassium, hyperkalaemia 674
hypokalaemia 674
Burns 846
Pulmonary embolism 818
Cardiac arrest 894 (Fig A3)
Respiratory arrest 894 (Fig A3)
Cardiogenic tamponade 802
Respiratory failure 188
Cardioversion, DC 770
Resuscitation 894 (Fig A3)
Central line insertion (CVP line) 774
Rheumatological emergencies 538
Cerebral oedema 830
Shock 790
Chest drain 766
Smoke inhalation 847
Coma 786
Sodium, hypernatraemia 672
Cricothyrotomy 772
hyponatraemia 672
Cyanosis 186–9
Spinal cord compression 466, 543
Cut-down 761
Status asthmaticus 810
Defibrillation 770, 894 (Fig A3)
Status epilepticus 826
Diabetes emergencies 832–4
Stroke 470
Disseminated intravascular coagulopathy
(DIC) 352 Superior vena cava obstruction 528
Disaster, major 850 Supraventricular tachycardia (SVT) 806
Encephalitis 824 Testicular torsion 652
Epilepsy, status 826 Thrombotic thrombocytopenic purpura
(TTP) 315
Extradural haemorrhage 482
Thyroid storm 834
Fluids, IV 666, 790
Transfusion reaction 349
Haematemesis 256–7
Varices, bleeding 257, 820
Haemorrhage 790
Vasculitis, acute systemic 556
Hyperthermia 790, 838
Venous thromboembolism, leg 656
Hypoglycaemia 214, 834
pulmonary 818
Hypothermia 848
Ventricular arrhythmias 128, 804
Intracranial pressure, raised 830
Ventricular failure, left 800
Ischaemic limb 656
Ventricular fibrillation 894 (Fig A3)
Malaria 416
Ventricular tachycardia 128, 804
Malignant hyperpyrexia 572
.indb b 02/05/2017 19:06
, Contents
Each chapter’s contents are detailed on its first page
Prefaces to the first and tenth editions iv
Acknowledgements v
Symbols and abbreviations vi
1 Thinking about medicine 0
2 History and examination 24
3 Cardiovascular medicine 92
4 Chest medicine 160
5 Endocrinology 202
6 Gastroenterology 242
7 Renal medicine 292
8 Haematology 322
9 Infectious diseases 378
10 Neurology 444
11 Oncology and palliative care 518
12 Rheumatology 538
13 Surgery 564
14 Clinical chemistry 662
15 Eponymous syndromes 694
16 Radiology 718
17 Reference intervals, etc. 750
18 Practical procedures 758
19 Emergencies 778
20 References 852
Index 868
Early warning score 892
Cardiac arrest 894
.indb iii 02/05/2017 19:06
, Preface to the tenth edition
This is the first edition of the book without either of the original authors—Tony Hope
and Murray Longmore. Both have now moved on to do other things, and enjoy a
well-earned rest from authorship. In this book, I am joined by a Nephrologist, Gas-
troenterologist, and trainees destined for careers in Cardiology, Dermatology, and
General Practice. Five physicians, each with very different interests and approaches,
yet bringing their own knowledge, expertise, and styles. When combined with that
of our specialist and junior readers, I hope this creates a book that is greater than
the sum of its parts, yet true to the original concept and ethos of the original authors.
Life and medicine have moved on in the 30 years since the first edition was published,
but medicine and science are largely iterative; true novel ‘ground-breaking’ or ‘prac-
tice-changing’ discoveries are rare, to quote Isaac Newton: ‘If I have seen further, it
is by standing on the shoulders of giants’. Therefore, when we set about writing this
edition we drew inspiration from the original book and its authors; updating, adding,
and clarifying, but trying to retain the unique feel and perspective that the OHCM has
provided to generations of trainees and clinicians.
IBW, 2017
Preface to the first edition
We wrote this book not because we know so much, but because we know we
remember so little…the problem is not simply the quantity of information, but the
diversity of places from which it is dispensed. Trailing eagerly behind the surgeon,
the student is admonished never to forget alcohol withdrawal as a cause of post-
operative confusion. The scrap of paper on which this is written spends a month
in the pocket before being lost for ever in the laundry. At different times, and in
inconvenient places, a number of other causes may be presented to the student.
Not only are these causes and aphorisms never brought together, but when, as a
surgical house officer, the former student faces a confused patient, none is to hand.
We aim to encourage the doctor to enjoy his patients: in doing so we believe he
will prosper in the practice of medicine. For a long time now, house officers have
been encouraged to adopt monstrous proportions in order to straddle the diverse
pinnacles of clinical science and clinical experience. We hope that this book will
make this endeavour a little easier by moving a cumulative memory burden from
the mind into the pocket, and by removing some of the fears that are naturally felt
when starting a career in medicine, thereby freely allowing the doctor’s clinical
acumen to grow by the slow accretion of many, many days and nights.
RA Hope and JM Longmore, 1985
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, Acknowledgements
Heart-felt thanks to our advisers on specific sections—each is acknowledged on
the chapter’s first page. Thanks also to our junior readers, Charles Badu-Boateng,
Clare Coggins, and Luke Walls. We especially thank all our mentors and teach-
ers, and patients who provide our inspiration and remind us that one never stops
learning. We acknowledge the Department of Radiology at both the Leeds Teach-
ing Hospitals NHS Trust and the Norfolk and Norwich University Hospital for their
kind help in providing many images, particularly Dr Edmund Godfrey, whose tire-
less hunt for perfect images has improved so many chapters.
Readers’ comments These have formed a vital part of our endeavour to provide
an accurate, comprehensive, and up-to-date text. We sincerely thank the many stu-
dents, doctors, and other health professionals who have found the time and the
generosity to write to us on our Reader’s Comments Cards, in editions past, or, in
more recent times, via the web. These have now become so numerous for past edi-
tions that they cannot all be listed. See http://www.oup.com/uk/academic/series/
oxhmed/links for a full list, and our very heart-felt tokens of thanks.
3rd-party web addresses We disclaim any responsibility for 3rd-party content.
.indb v 02/05/2017 19:06
, Symbols and abbreviations
..........this fact or idea is important DU ........duodenal ulcer
.......don’t dawdle!—prompt action saves lives D&V .....diarrhoea and vomiting
1 ...........reference DVT ......deep venous thrombosis
:......male-to-female ratio. :=2:1 means twice as DXT ......deep radiotherapy
common in males EBV ......Epstein–Barr virus
.........therefore ECG ......electrocardiogram
~ ..........approximately Echo ...echocardiogram
–ve ......negative (+ve is positive) EDTA ....ethylene diamine tetra-acetic acid (anticoagulant
........increased or decreased coating, eg in FBC bottles)
.......normal (eg serum level) EEG ......electroencephalogram
1° ........primary eGFR ....estimated glomerular filtration rate (in mL/
2° ........secondary min/1.73m2)
..........diagnosis ELISA ...enzyme-linked immunosorbent assay
........differential diagnosis EM .......electron microscope
A:CR ......albumin to creatinine ratio (mg/mmol) EMG .....electromyogram
A2 .........aortic component of the 2nd heart sound ENT ......ear, nose, and throat
Ab ......antibody ERCP ....endoscopic retrograde cholangiopancreatography
ABC ......airway, breathing, and circulation ESR ......erythrocyte sedimentation rate
ABG .....arterial blood gas: PaO2, PaCO2, pH, HCO3 ESRF ....end-stage renal failure
ABPA ....allergic bronchopulmonary aspergillosis EUA ......examination under anaesthesia
ACE-i .....angiotensin-converting enzyme inhibitor FBC ......full blood count
ACS .......acute coronary syndrome FDP ......fibrin degradation products
ACTH ....adrenocorticotrophic hormone FEV1 .....forced expiratory volume in 1st sec
ADH .....antidiuretic hormone FiO2 ....partial pressure of O2 in inspired air
AF ........atrial fibrillation FFP ......fresh frozen plasma
AFB ......acid-fast bacillus FSH ......follicle-stimulating hormone
Ag .......antigen FVC ......forced vital capacity
AIDS ....acquired immunodeficiency syndrome g ..........gram
AKI ........acute kidney injury G6PD ....glucose-6-phosphate dehydrogenase
ALL ......acute lymphoblastic leukaemia GA .......general anaesthetic
ALP ......alkaline phosphatase GCS ......Glasgow Coma Scale
AMA ....antimitochondrial antibody GFR ......glomerular filtration rate
AMP .....adenosine monophosphate GGT ......gamma-glutamyl transferase
ANA .....antinuclear antibody GH ........growth hormone
ANCA ...antineutrophil cytoplasmic antibody GI ........gastrointestinal
APTT ....activated partial thromboplastin time GN ........glomerulonephritis
AR ........aortic regurgitation GP ........general practitioner
ARB .....angiotensin II receptor ‘blocker’ (antagonist) GPA ......granulomatosis with polyangiitis (formerly
ARDS ...acute respiratory distress syndrome Wegener’s granulomatosis)
ART ......antiretroviral therapy GTN ......glyceryl trinitrate
AS ........aortic stenosis GTT ......glucose tolerance test
ASD .....atrial septal defect GU(M) ..genitourinary (medicine)
AST ......aspartate transaminase h ..........hour
ATN ......acute tubular necrosis HAV .....hepatitis A virus
ATP ......adenosine triphosphate Hb .......haemoglobin
AV ........atrioventricular HbA1c .glycated haemoglobin
AVM .....arteriovenous malformation(s) HBSAg ..hepatitis B surface antigen
AXR .....abdominal X-ray (plain) HBV .....hepatitis B virus
Ba ........barium HCC ......hepatocellular cancer
BAL ......bronchoalveolar lavage HCM .....hypertrophic obstructive cardiomyopathy
bd .......bis die (Latin for twice a day) Hct ......haematocrit
BKA .....below-knee amputation HCV ......hepatitis C virus
BNF ......British National Formulary HDV .....hepatitis D virus
BNP ......brain natriuretic peptide HDL ......high-density lipoprotein
BP ........blood pressure HHT ......hereditary haemorrhagic telangiectasia
BPH ......benign prostatic hyperplasia HIV ......human immunodeficiency virus
bpm ....beats per minute HLA ......human leucocyte antigen
ca ........cancer HONK ...hyperosmolar non-ketotic (coma)
CABG ...coronary artery bypass graft HPV ......human papillomavirus
cAMP ...cyclic adenosine monophosphate (AMP) HRT ......hormone replacement therapy
CAPD ...continuous ambulatory peritoneal dialysis HSP ......Henoch–Schönlein purpura
CCF ......congestive cardiac failure (ie left and right heart HSV ......herpes simplex virus
failure) HUS ......haemolytic uraemic syndrome
CCU ......coronary care unit IBD ......inflammatory bowel disease
CDT ......Clostridium difficile toxin IBW .....ideal body weight
CHB ......complete heart block ICD ......implantable cardiac defibrillator
CHD ......coronary heart disease ICP .......intracranial pressure
CI .........contraindications IC(T)U ..intensive care unit
CK ........creatine (phospho)kinase IDDM ...insulin-dependent diabetes mellitus
CKD ......chronic kidney disease IFN- ..interferon alpha
CLL ......chronic lymphocytic leukaemia IE .........infective endocarditis
CML .....chronic myeloid leukaemia Ig ........immunoglobulin
CMV .....cytomegalovirus IHD ......ischaemic heart disease
CNS ......central nervous system IM ........intramuscular
COC ......combined oral contraceptive pill INR ......international normalized ratio
COPD ....chronic obstructive pulmonary disease IP .........interphalangeal
CPAP ....continuous positive airway pressure IPPV ....intermittent positive pressure ventilation
CPR ......cardiopulmonary resuscitation ITP .......idiopathic thrombocytopenic purpura
CRP ......c-reactive protein IU ........international unit
CSF ......cerebrospinal fluid IVC ......inferior vena cava
CT ........computed tomography IV(I) ....intravenous (infusion)
CVA ......cerebrovascular accident IVU ......intravenous urography
CVP ......central venous pressure JVP ......jugular venous pressure
CVS ......cardiovascular system K ..........potassium
CXR ......chest x-ray kg .......kilogram
d ..........day(s); also expressed as /7; months are /12 KPa ......kiloPascal
DC ........direct current L ..........litre
DIC ......disseminated intravascular coagulation LAD ........left axis deviation on the ECG
DIP ......distal interphalangeal LBBB ....left bundle branch block
dL .......decilitre LDH ......lactate dehydrogenase
DM .......diabetes mellitus LDL ......low-density lipoprotein
DOAC ...direct oral anticoagulant LFT ......liver function test
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