bluuebunny/crossref_metadata_2025 huggingface dataset:
Compound Muscle Action Potentials
Authors: Watson James C. , Daube Jasper R.
Published: May 2013

CMAPs are among the most helpful recordings in the electrophysiologic assessment of peripheral neuromuscular disease. Compound muscle action potentials are the recordings made for all motor conduction studies, both of the directly recorded M wave used for peripheral conduction and the F-wave late response used for testing proximal conduction. Reliable CMAP recordings require the use of standard stimulating and recording electrode types and locations and standard measurement criteria. 115 The sensitivity and specificity of motor conduction studies depend on comparing the results obtained in a patient with the normal values obtained by using exactly the same methods. The normal values of motor conduction studies vary with physiologic factors such as age and temperature, which must be controlled and adjusted.
Assessing The Neuromuscular Junction With Repetitive Stimulation Studies
Authors: Boon Andrea J.
Published: May 2013

The electrophysiologic technique of repetitive stimulation is an important component of the evaluation of patients with fatigue, weakness, ptosis, diplopia, dysphagia, or dysarthria. The technique requires a knowledge of the physiology and pathophysiology of neuromuscular transmission and the basic techniques of nerve conduction studies for proper application and interpretation. Errors in technique can produce falsely positive or negative results. The test must be individualized for each case, with the proper selection of nerve and muscle combinations, rates of stimulation, and types of exercise. The examiner must be aware of the varied abnormalities that occur with different disease entities.
Assessing the Motor Unit with Needle Electromyography
Authors: Rubin Devon I.
Published: May 2013

Virtually all primary neuromuscular diseases result in changes in the electric activity recorded from muscle fibers. These changes can best be depicted using fine needle electrodes inserted into the muscle to record spontaneous and voluntary EMG. Thus, EMG can be used to distinguish among lower motor neuron, peripheral nerve, neuromuscular junction, and muscle disease with great sensitivity and some specificity. The sensitivity is usually greater than clinical measures; specificity in identifying the cause of the disease often requires muscle biopsy or other clinical measures. Although EMG is somewhat uncomfortable for patients because needles need to be inserted into the muscles, it generally is well tolerated by patients and provides a rapid, efficient means of testing the motor unit.
Long Latency Reflexes and the Silent Period
Authors: Caviness John N.
Published: May 2013

LLRs and the silent period are EMG phenomena that reflect the complex interplay of spinal, brain stem, and cortical influences in motor control. These techniques have been applied to the study of disorders of motor control such as Parkinson’s disease, Huntington’s disease, and dystonia. Abnormalities of these reflexes may help to detect lesions of the central nervous system.
Vertigo and Balance
Authors: Zapala David A. , Brey Robert H.
Published: May 2013

This chapter has summarized five clinically available electrophysiologic measures for patients who complained of vertigo and imbalance. These measures will seldom provide a diagnosis. Careful history and physical examination, coupled with an understanding of vestibular anatomy, physiology, and pathophysiology, remain the bedrock for diagnosing problems of vertigo and imbalance. The electrophysiologic measures described in this chapter are merely extensions of the physical examination. Test data cannot be interpreted effectively without the same understanding of vestibular anatomy, physiology, and pathophysiology that underpins the initial history and physical examination.
Quantitative Sudomotor Axon Reflex and Related Tests
Authors: Low Phillip A.
Published: May 2013

The application of noninvasive, sensitive, quantitative, and dynamic tests of sudomotor function enhances significantly our ability to quantitate one aspect of the autonomic deficit. The QSART has an important role in clinical applications to better definition of the course of neuropathy, its response to treatment, and further exploration of sudomotor physiology.
Brain Stem and Cranial Nerve Monitoring
Authors: Crum Brian A.
Published: May 2013

Various modalities are available for monitoring the function of the cranial nerves and brain stem during intracranial or extracranial head and neck operations. After consideration of the surgical risks, a multimodality approach can be tailored to the needs of each patient. Close communication between the IOM team and the surgical team is vital in order to obtain appropriate electrophysiological information and provide useful feedback at a time when clinical detection of nerve injury is impossible. IOM has been shown to decrease the incidence of cranial nerve injury during posterior fossa surgery.
Spinal Cord Monitoring
Authors: Strommen Jeffrey A.
Published: May 2013

Continuous electrophysiologic monitoring of spinal cord or spinal nerve (or both) function intraoperatively can minimize potential damage that may occur during spine surgery. SEPs are easiest to use for monitoring function and have had the widest application. Unless spinal cord injury is caused by a vascular insult, with purely motor damage, SEP monitoring can identify the damage early enough to alert the surgeon. The addition of MEP monitoring further protects the motor pathways that may be at risk during some spinal procedure. Neurotonic discharges recorded from peripheral muscle are sensitive to nerve root irritation and, thus, can help surgeons recognize when and where damage may be occurring. These techniques appear reliable and with experience the neurophysiologist can acquire the skills to perform and correctly interpret these studies thus enhancing the neurologic and functional outcomes during the often complex procedures.
Nonarteritic Anterior Ischemic Optic Neuropathy
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Nonarteritic anterior ischemic optic neuropathy is the most frequent cause of optic neuropathy in older adults. Its pathogenesis remains uncertain, although it often occurs in patients with small, structurally congested optic discs. We summarize the symptoms, signs, possible precipitating factors, and management of this common optic neuropathy.
Hereditary Optic Neuropathy
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Monocular and binocular vision loss can occasionally be caused by hereditary optic neuropathy. While progressive painless binocular central vision loss is characteristic of dominant optic atrophy, acute painless monocular vision loss is characteristic of Leber’s hereditary optic neuropathy. We discuss the clinical features and evaluation of Leber’s hereditary optic neuropathy and briefly mention promising treatment options.
Chiasmal Syndromes
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Dysfunction of the optic chiasm typically produces bitemporal visual field defects. Chiasmal dysfunction most frequently results from compression by extrinsic lesions, such as pituitary macroadenomas and suprasellar meningiomas. We describe the clinical signs of chiasmal dysfunction in this chapter. We also discuss the evaluation and management of pituitary apoplexy.
Homonymous Hemianopia
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Homonymous hemianopia is caused by lesions involving the retrochiasmal visual pathways or primary visual cortex. The most common cause of homonymous hemianopia is stroke. We discuss the approach to the patient with homonymous hemianopia, with specific reference to prognosis, implications for driving, and rehabilitation.
Nonorganic Vision Loss
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Nonorganic vision loss is common, but can be challenging to diagnose and treat. We discuss the approach to the patient with suspected nonorganic vision loss in this chapter, and we describe the maneuvers that can be used to demonstrate intact visual function.
Third Nerve Palsy
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Acute painful pupil-involving third nerve palsy requires urgent investigation, because it can be due to third nerve compression by a rapidly enlarging aneurysm of the posterior communicating artery. We summarize the approach to the patient with a third nerve palsy in this chapter, with emphasis on the imaging evaluation of acute pupil-involving third nerve palsy.
Fourth Nerve Palsy
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Fourth nerve palsy is a common cause of binocular vertical diplopia but can be difficult to diagnose, because examination findings are often subtle. In this chapter, we review the symptoms, signs, causes, differential diagnosis, and evaluation of fourth nerve palsy.
Sixth Nerve Palsy
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Binocular horizontal diplopia is often due to sixth nerve palsy but can be caused by other conditions, such as restriction of the medial rectus muscle in thyroid eye disease. We review the approach to the patient with sixth nerve palsy in this chapter. We briefly discuss the role of imaging in patients with sixth nerve palsy, as this remains a controversial topic.
Gaze-Evoked Nystagmus
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Gaze-evoked nystagmus is the most common type of nystagmus encountered in clinical practice but is poorly localizing. It is often confused with “end-point” nystagmus, which is physiologic and of no concern. In this chapter, we discuss the approach to the patient with gaze-evoked nystagmus.
Acquired Pendular Nystagmus
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Acquired pendular nystagmus often occurs in the setting of multiple sclerosis but can also occur in the syndrome of oculopalatal tremor. Because it often causes disabling oscillopsia, many affected patients request treatment. In this chapter, we discuss the clinical features and treatment of acquired pendular nystagmus.
Infantile Nystagmus Syndrome
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Formerly known as congenital nystagmus, this form of nystagmus can occur in isolation or in association with other ophthalmic, neurologic, or endocrine abnormalities. While it does not usually cause oscillopsia, it can cause blurred vision. Consequently, affected patients sometimes request treatment. We review the clinical features of infantile nystagmus syndrome and present a contemporary approach to treatment.
Saccadic Intrusions and Dysmetria
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Saccadic intrusions and dysmetria are often encountered in association with certain cerebellar and neurodegenerative diseases. When severe, they can give rise to difficulty reading or oscillopsia. In this chapter, we review the approach to the patient with saccadic intrusions and dysmetria. We also briefly discuss proposed medical treatments.
Benign Essential Blepharospasm
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Blepharospasm is an involuntary closure of the eyes that is caused by spasm of the orbicularis oculi. It can be isolated or associated with certain ophthalmic and neurologic disorders. We review the approach to the patient with blepharospasm in this chapter, with emphasis on treatment strategies.
Pharmacologic Mydriasis
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

A dilated unreactive pupil is a dramatic clinical finding. While it can be seen in the setting of compressive third nerve palsy, it can also be due to pharmacologic mydriasis. We discuss the approach to the patient with suspected pharmacologic mydriasis, with an emphasis on the role of pharmacologic pupil testing.
Thyroid Eye Disease
Authors: Thurtell Matthew J. , Tomsak Robert L. , Daroff Robert B.
Published: May 2013

Thyroid eye disease is the most common cause of orbital disease encountered in clinical practice. It often occurs in patients with Graves’ disease, but it is not always associated with abnormal thyroid function. In this chapter, we review the clinical signs, investigation, and treatment of thyroid eye disease.
Ethics and research in psychiatry
Authors: Kessel Anthony S. , Silverton Francesca
Published: May 2013

Embracing the ethical issues that arise in healthcare research is part and parcel of designing and implementing research that is based on sound moral foundations. Researchers should avoid approaching ethical considerations as a hurdle to getting the research done, and should instead think of them in the same vein as making sure the scientific methodology is correct. Similarly, research ethics committees should not be thought of as an obstacle, but as bodies whose role is to facilitate ethically acceptable research.

Most of the issues that arise in research in psychiatry are generic to other areas of healthcare research, and this chapter has outlined the moral bases of these and provided a template through which they can be approached. However, because research in psychiatry inevitably may involve vulnerable participants, it is important to recognise that special attention needs to be paid to competence and ensuring consent is informed.

The research arena in psychiatry is changing, and researchers will need to keep abreast of future developments, which can take the form of new guidelines from relevant bodies and also changes to the law.
Ecological and cross-level studies
Authors: Neeleman Jan
Published: May 2013

Ecological studies differ from other study designs by having groups of individuals as their unit of analysis. Studying differences in risk factors between individuals cannot fully explain variations in the health of populations in different regions or over time, and ignores the fact that a population's health impacts on social functioning and collective economic performance (McMichael and Beaglehole 2000). Similarly, there is increasing interest on the impact of social capital, or those aspects of the social environment that promote cohesion and cooperation, which have been associated with improved health and other outcomes. For example, a recent study found higher rates of common mental disorder among British women living in areas of low social capital (McCulloch 2001).

Thus ecological associations can be analysed to gain insight into aetiological mechanisms at the level of individuals (cross-level inference), although there is ongoing debate about whether ecological analyses can add to insights obtained from studies of individual persons. Kasl (1979) stated that ‘ecological analyses lead to results which, in themselves, are opaque, unhelpful, potentially misleading’. Others emphasize that population health is more than the sum of the health of individual population members, and that therefore, ecological studies have a separate role alongside individual-level epidemiological research (Rose 1992).

This chapter summarizes the principles and the place of ecological studies in the history of epidemiology, and the distinguishing properties of ecological data. After a description of ecological study designs and their analysis, the chapter argues that ecological data have added value even if individual-level information is available on the associations of interest.
The case–control study
Authors: Hotopf Matthew
Published: May 2013

The case–control study, if well conducted, is able to give unbiased estimates of effect sizes between exposures and outcomes. They are a particularly efficient design—and this efficiency makes them a more viable approach in the study of rare disorders than cohort studies.
Statistical methods in psychiatric epidemiology 1: a statistician's perspective
Authors: Dewey Michael E.
Published: May 2013

In this chapter we shall look at methods of statistical analysis used in psychiatric epidemiology. We shall focus on the issues which arise in trying to make sense of a small real dataset. We assume that readers are already familiar with the concepts of confidence interval, means, correlations, and odds ratios.

What makes statistical analysis in psychiatric epidemiology different?

We have given more space to methods dealing with measures than would be usual in a general text on epidemiology. This is quite deliberate. What makes psychiatric epidemiology different is the emphasis on measurement. By contrast most outcomes in medical statistics were historically binary (usually dead vs. alive). This is beginning to change (note for instance the increased interest in measuring quality of life almost everywhere). Of course psychiatry as a branch of medicine has used the concept of diagnosis freely, and so naturally we also include methods for handling such binary outcomes.

We start by discussing methods for predicting an outcome, whether a measurement or a binary outcome. We then discuss a group of methods used for exploring the relationship between groups of variables where there is no single outcome.
Critical appraisal
Authors: Churchill Rachel
Published: May 2013

Critical appraisal skills are essential for interpreting studies and performing research. Each study design is susceptible to its own problems, and this chapter has summarized some of these areas of weakness, so that, for example, when reading a case–control study the immediate consideration should be whether there is recall or selection bias. However the essential characteristic of good research which has been well reported is that the reader is able to understand each stage of the process from setting out the aims of the study to reporting its conclusions.
Genetic epidemiology 2: molecular genetics
Authors: Collier David , Li Tao
Published: May 2013

The previous chapter has focused on methods for identifying familial clustering of disorders or traits, and on methods for distinguishing between shared genetic and environmental influences. The primary objective for this chapter is to outline techniques for identifying specific genes responsible for an observed phenotype. The theoretical basis of complex and quantitative traits was established many decades ago. However practical methods for the efficient molecular analysis of the human genome have only recently emerged. Alongside these developments, the molecular genetic analysis of human disorders has moved at a rapid pace. Molecular genetics has focused on single gene disorders with great success, whereas for complex psychiatric disorders, few genetic risk factors have been identified. However the tools used by the complex disorder geneticist have evolved rapidly in the last few years and better strategies and statistical methods continue to appear. This chapter outlines some established and novel approaches to the analysis of the genetics of complex human disorders. A basic understanding of genetical statistics will be useful.
Health economics for psychiatric epidemiology
Authors: Chisholm Daniel , McCrone Paul
Published: May 2013

This chapter examines the interface between psychiatric epidemiology and health economics, particularly in relation to mental health service evaluation. We discuss the issues inherent in conducting an economic evaluation and conclude with a summary of the applications of economic analyses.
Principles of imaging
Authors: Liaw Jonathan , Taylor Jane , Chambers Anthony , Sanghera Bal , Goh Vicky
Published: May 2013

Chapter 2 discusses how imaging is fundamentally important to the management of the cancer patient, how anatomical imaging is the mainstay for patient evaluation, and how functional and hybrid (combined functional–anatomical) imaging have acquired an increasing role. Additionally it offers guidance on obtaining the most accurate and reliable information possible with the most appropriate imaging modality and why the relative performance of the imaging test has to be defined.
Gastric tumours
Authors: Miller Ben , Geh Ian , Roy-Choudhury Shuvro
Published: May 2013

Chapter 7 discusses gastric tumours, and covers the majority of malignant stomach tumours, which are adenocarcinomas, the world’s second most common cancer, and the most common cancer in the Far East and South America. It is often difficult to distinguish the origin of tumours at the oesophagogastric junction (OGJ), and thus a new classification of OGJ tumours has been proposed dividing the OGJ into distal oesophageal (Siewert type I), cardia (Siewert type II), and subcardial gastric cancer (Siewert type III). This classification has important management implications regarding staging wherein Siewert type III are staged as stomach cancers.
Urological cancers
Authors: Wignall Oliver , Khoo Vincent , Aslam Sohaib S.
Published: May 2013

Chapter 13 covers urological cancers, including prostate cancer, bladder cancer, upper urinary tract urothelial tumours, testicular cancer, penile cancer, renal cell carcinoma, and urethral cancer.
Endocrine tumours
Authors: Du Yong , Bomanji Jamshed
Published: May 2013

Chapter 18 discusses endocrine tumours, and covers apudomas, carcinoid tumours, and adrenocortical tumours.
Paediatrics
Authors: Humphries Paul , Peters Francesca , Gaze Mark
Published: May 2013

Chapter 20 discusses the role of imaging in paediatric oncology, and covers CNS, renal, neuroblastoma, lymphoma, primary bone tumours (osteosarcoma and Ewing's sarcoma), and soft tissue sarcomas including rhabdomyosarcoma and other types.
Drugs in perspective
Authors: Plant Martin , Robertson Roy , Plant Moira , Miller Patrick
Published: May 2013

In a book about the nature and impact of drug taking it is important to spend some time discussing the range and nature of the drugs involved. This chapter provides what is hoped to be an accessible description of drug dependence or ‘addiction’ and the chemical and pharmacological effects of the main illicit substances that are used recreationally the UK. These substances include amphetamines, cannabis (including ‘skunk’), cocaine, crack, ecstasy (MDMA), LSD, heroin, opium, and morphine.
Upper limb
Authors: Harrison Dr Mark
Published: May 2013

1.1 Pectoral region, 4

1.2 Axilla, 5

1.3 Breast, 6

1.4 Shoulder, 7

1.5 The anterior arm, 8

1.6 The posterior arm, 10

1.7 The anterior forearm, 12

1.8 Posterior compartment of the forearm, 14

1.9 Wrist and hand, 16

1.10 The digital attachments of the long tendons, ...
Abdomen
Authors: Harrison Dr Mark
Published: May 2013

4.1 Abdominal wall, 56

4.2 Inguinal region, 58

4.3 Testis, epididymis, and spermatic cord, 59

4.4 Topography of the abdominal cavity, 61

4.5 Peritoneum, 62

4.6 Gastrointestinal tract, 63

4.7 Liver and biliary tract, 71

4.8 Pancreas, 75

4.9 Spleen, 76

4.10 Posterior abdominal wall, ...
Cranial nerve lesions
Authors: Harrison Dr Mark
Published: May 2013

7.1 Olfactory (I) nerve, 142

7.2 Optic (II) nerve, 142

7.3 Oculomotor (III) nerve, 144

7.4 Trochlear (IV) nerve, 144

7.5 Abducens (VI) nerve, 145

7.6 Trigeminal (V) nerve, 145

7.7 Facial (VII) nerve, 146

7.8 Vestibulocochlear (VIII) nerve, 147

7.9 Glossopharyngeal (IX) nerve, 147...
Natural and innate immunity
Authors: Harrison Dr Mark
Published: May 2013

1.1 Barriers to infection, 151

1.2 Normal bacterial flora, 152

1.3 Phagocytes and complement, 152

• Anatomical barrier physically preventing invasion of microorganisms.

• Chemical barrier providing unfavourable conditions for most organisms to survive due to:

▪ Free fatty acids produced by the sebaceous glands and skin flora...
Principles of immunization
Authors: Harrison Dr Mark
Published: May 2013

5.1 Normal childhood immunization schedule, 151

5.2 Additional immunization schedules, 161

5.3 Sources of information, 161

See Table B.A.5.1.

• Only given to immunosuppressed children who have been exposed.

• If they are asymptomatic they are given Varicella immunoglobulin.

• If they are symptomatic they receive full vaccination....
Gram negative gastrointestinal disease
Authors: Harrison Dr Mark
Published: May 2013

7.1 Helicobacter pylori, 184

7.2 Campylobacter, 185

• Gram negative curved/spiral rods

• Common worldwide.

• Transmission person to person.

• Can colonize the stomach, duodenum, and oesophagus.

• Causes noninvasive chronic infections if untreated.

• Survives in mucus layer that coats epithelium resulting in chronic inflammation of mucosa....
Cardiovascular system
Authors: Harrison Dr Mark
Published: May 2013

2.1 Cardiac glycosides (digoxin), 347

2.2 Diuretics, 348

2.3 Antiarrhythmics, 350

2.4 Beta-adrenoceptor blockers, 351

2.5 Hypertension and heart failure, 353

2.6 Nitrates and antianginal drugs, 356

2.7 Sympathomimetics, 358

2.8 Anticholinergics (antimuscarinics), 360

2.9 Anticoagulants, 361

2.10 Antiplatelet drugs, 363

2.11 Fibrinolytics (thrombolytics), 365...
Respiratory system
Authors: Harrison Dr Mark
Published: May 2013

3.1 Bronchodilators, 368

3.2 Corticosteroids, 370

3.3 Antihistamines, 371

3.4 Oxygen, 372

The curriculum assumes you know the BTS/SIGN Guidelines in relation to emergency clinical management of asthma.

• Act mainly at β‎2-receptors although effects β‎1-receptors at high doses...
Fluids and electrolytes
Authors: Harrison Dr Mark
Published: May 2013

7.1 Oral preparations, 409

7.2 Parenteral preparations, 409

7.3 Vitamin B, 411

• Oral potassium may be required in:

▪ Patients taking certain antiarrythmics (e.g. digoxin), where hypokalaemia may lead to arrhythmias

▪ Patients with secondary hyperaldosteronism

▪ Excessive potassium loss, e.g. chronic diarrhoea or malnutrition in elderly...
Musculoskeletal system
Authors: Harrison Dr Mark
Published: May 2013

8.1 Nonpharmacological measures, 412

8.2 Nonsteroidal anti-inflammatory drugs (NSAIDs), 412

8.3 Corticosteroids, 414

8.4 Drugs used in gout and hyperuricaemia, 414

• Management of musculoskeletal injuries and diseases involves more than just pharmacological intervention.

• Consideration of splinting, physiotherapy, and early mobilization can be the most effective way to ease pain and improve long-term outcome....
Haematological system
Authors: Harrison Dr Mark
Published: May 2013

5.1 Erythropoiesis, 483

5.2 Blood groups, 484

5.3 Coagulation, 485

5.4 Thrombolysis, 485

• Several precursor stages

• Occurs in the bone marrow

• Earliest recognizable cells are pronormoblasts

• Progressive decrease in cell content of RNA during differentiation

• Progressive increase in haemoglobin...
Wound healing
Authors: Harrison Dr Mark
Published: May 2013

4.1 General principles, 512

4.2 Specific tissues, 513

• 5 stages:

▪ Haemostasis

▪ Inflammation

▪ Reconstruction

▪ Epithelialization

▪ Maturation

• Primary haemostasis - local vascular contraction and platelet plug formation

• Activation of the clotting cascade

• Prepares the wound for healing...
Exam tips
Authors: Stacey Victoria
Published: May 2013

Structure of the exam - Marking system - Content - Curriculum - Glossary - Making the most of your knowledge - How to use this book
Surgery
Authors: Stacey Victoria
Published: May 2013

The acute abdomen - Biliary tract disorders - Acute pancreatitis - Appendicitis - Bowel obstruction - Bowel perforation - Bowel ischaemia/infarction - Abdominal aortic aneurysm - Aortic dissection - Acute limb ischaemia - Haematuria - Renal colic - Urinary tract infections - Testicular torsion - Priapism - Fournier’s gangrene - SAQs
Surgical sub-specialities
Authors: Stacey Victoria
Published: May 2013

Ear infections - Ear injuries - Epistaxis - Throat infections - Foreign bodies - Facial pain - Facial nerve palsy - Vertigo - Anatomy of the eye - Red eye - Conjunctivitis - Corneal trauma and infections - Acute angle-closure glaucoma - Anterior uveitis (iritis) - Scleritis/episcleritis - Cellulitis (orbital and peri-orbital) - Sudden visual loss - Facial trauma - Dental emergencies - Neck trauma - SAQs
Gastroenterology
Authors: Stacey Victoria
Published: May 2013

Acute gastrointestinal bleeding - Acute upper gastrointestinal bleeding - Acute lower gastrointestinal bleeding - Vomiting - Diarrhoea - Inflammatory bowel disease (IBD) - Liver failure - Alcoholic liver disease/withdrawal syndromes - SAQs
Dermatology
Authors: Stacey Victoria
Published: May 2013

Describing rashes - Life-threatening skin conditions - Rashes in multisystem diseases - Cellulitis, erysipelas, and impetigo - Eczema - SAQs
Paediatrics
Authors: Stacey Victoria
Published: May 2013

Introduction - Anaphylaxis - Apnoea, stridor, and airway obstruction - Cardiopulmonary arrest - Major trauma - The shocked child - The unconscious child - Abdominal pain - Accidental poisoning, poisoning, and self-harm - Apparent life-threatening events - Blood disorders - Breathing difficulties - Concerning presentations in children - Dehydration secondary to diarrhoea and vomiting - ENT - Fever in children - Floppy child - Gastrointestinal bleeding - Headache - Neonatal presentations - Ophthalmology - Pain in children - Painful limbs in children—atraumatic - Painful limbs in children—traumatic - Rashes in children - Sore throat - SAQs
Legal aspects of Emergency Medicine
Authors: Stacey Victoria
Published: May 2013

Consent - The Mental Capacity Act - The Mental Health Act - Confidentiality - Driving Vehicle Licensing Association (DVLA) - SAQs
The supply of new medicine—unlimited?
Authors: Barker Richard
Published: May 2013

Chapter 1 describes the supply of new medical technology which exploits the huge advances we are making in bioscience, the build-up a profound understanding of how the beautiful molecular machines of the living cell
actually work, and how they link together in the almost unimaginably complex system that is our body, and asks what fresh pharmaceutical innovations are on the horizon? Will gene and cell therapy reach the diseases that drugs cannot
reach? Is ‘Personalized medicine’ practical? What will converging technologies—therapeutics, diagnostics, informatics, nanotechnology—bring us?
Epilogue
Authors: Barker Richard
Published: May 2013

This short book cannot do more than scratch the surface of the debate we need to have on the future of medicine and healthcare. Therefore we have set up a website www.2030Healthfutures.com for readers to share their views on the challenges and proposals for healthcare in 2030....
Autoimmunity and the endocrine system
Authors: Spickett Gavin P
Published: May 2013

Classification of autoimmune thyroid disease

Graves’ disease

Hashimoto’s thyroiditis

Subacute thyroiditis syndromes

Primary hypothyroidism and sporadic goitre

Thyroid disease and other symptoms

Classification of diabetes mellitus

Type I diabetes (insulin-dependent)

Immunological complications of insulin therapy

Crow–Fukase syndrome (POEMS syndrome; Takatsuki syndrome)

Classification of adrenal insufficiency...
Autoimmunity in liver disease
Authors: Spickett Gavin P
Published: May 2013

Primary biliary cirrhosis (PBC)

Autoimmune hepatitis

Primary sclerosing cholangitis

• PBC is a disease of older women (90% of patients are female).

• Clinical features include initially:

• profound fatigue starting in the prodrome

• intense itch

• arthralgia.

• With disease progression:

• hepatosplenomegaly...
Autoimmune eye disease
Authors: Spickett Gavin P
Published: May 2013

Overview

Uveitis

Tubulointerstitial nephritis and uveitis (TINU)

Vogt–Koyanagi–Harada disease (VKH)

Cancer-associated retinopathy and uveitis

Birdshot retinopathy

Scleritis

Ocular cicatricial pemphigoid

Sympathetic ophthalmitis

Idiopathic orbital inflammation (orbital pseudo-tumour)

The eye has a number of interesting immunological properties which alter the propensity for immune-mediated disease, including the curious feature that antigen injected into the anterior chamber induces tolerance rather than immunity. In addition, the eye has no true lymphatics, relatively poor vascularity, and, as the retina is an extension of the CNS, there is a blood–retinal barrier which limits passage of molecules in either direction. Ocular involvement is a common feature of many connective tissue and vasculitic diseases....
Vasculitis
Authors: Spickett Gavin P
Published: May 2013

Causes of vasculitis

Diagnostic tests

Henoch–Schönlein purpura (HSP)

IgA nephropathy (Berger’s disease)

Buerger’s disease (thromboangiitis obliterans)

Hypersensitivity (‘allergic’) vasculitis

Microscopic polyarteritis (MPA)

Primary angiitis of the CNS (PACNS)

Behçet’s disease

Polyarteritis nodosa (PAN)

Churg–Strauss syndrome (CSS)

Cogan’s syndrome

Kawasaki syndrome (mucocutaneous lymph node syndrome)

Wegener’s granulomatosis 1...
Miscellaneous conditions
Authors: Spickett Gavin P
Published: May 2013

Sarcoidosis

Amyloidosis

AL amyloid

AA amyloid

Other acquired amyloidoses

Familial Mediterranean fever (FMF)

TNF-receptor-associated periodic syndrome (TRAPS, familial Hibernian fever)

Hyper-IgD syndrome

Muckle–Wells and related syndromes

Periodic fever with aphthous ulcers, pharyngitis, and cervical adenopathy (PFAPA)

Schnitzler’s syndrome

Blau syndrome

Deficiency of the IL-1 receptor antagonist (DIRA)...
Transplantation
Authors: Spickett Gavin P
Published: May 2013

Stem cell transplantation (HSCT) 1: clinical indications and types of HSCT

HSCT 2: conditioning and matching

HSCT 3: post-transplant monitoring

HSCT 4: immunological reconstitution

HSCT 5: immunization post-transplant and results

Gene therapy

Graft-versus-host disease (GvHD)

Acute GvHD (aGvHD)

Chronic GvHD (cGvHD)

Graft-versus-tumour (GvT) effect

Graft failure...
Immunochemistry
Authors: Spickett Gavin P
Published: May 2013

Techniques

α‎1-acid glycoprotein

α‎1-antichymotrypsin

α‎1-antitrypsin (α‎1-AT)

α‎1-antitrypsin (α‎1-AT) genotype (PI typing)

α‎2-macroglobulin

Acute-phase proteins (CRP, ESR, SAA)

Amyloid proteins

Avian precipitins

Bacterial and viral antibodies (specific antibodies; functional antibodies)...
Autoantibodies
Authors: Spickett Gavin P
Published: May 2013

Introduction

Techniques: overview

Particle agglutination assays

Immunoprecipitation assays

Indirect immunofluorescence

Direct immunofluorescence

Radio-immunoassay (RIA)

Enzyme-linked (EIA) and fluorescent immunoassays (FIA)

Immunoblotting

Acetylcholine-receptor antibodies (AChRAb)

Actin antibodies

Adrenal cortex autoantibodies

Amphiphysin antibodies

Anti-nuclear antibodies (ANA) and ANCA

Aquaporin antibodies

Auerbach’s plexus antibodies

β‎2-GPI antibodies

C1q antibodies...
A general framework for assessing fitness for work
Authors: Palmer Keith T. , Brown Ian
Published: May 2013

This introductory chapter deals mainly with the principles underlying medical assessment of fitness for work, contacts between medical practitioners and the workplace, and confidentiality of medical information. Medical fitness is relevant where illnesses or injuries reduce performance, or affect health and safety in the workplace. It may also be specifically relevant to certain onerous or hazardous tasks for which medical standards exist. Medical fitness should always be judged in relation to the work, and not simply the pension scheme. It has limited relevance in most employment situations: many medical conditions, and virtually all minor health problems, have minimal implications for work and should not debar from employment. Medical fitness for employment is not an end in itself. It must be maintained.
Support, rehabilitation, and interventions in restoring fitness for work
Authors: Aylward Mansel , Cohen Deborah A. , Sawney Philip E.
Published: May 2013

Prolonged absence from normal activities, including work, is often detrimental to a person’s mental, physical, and social well-being, whereas a timely return to appropriate work benefits the patient and his or her family by enhancing recovery and reducing disability. An approach to rehabilitation based upon a biopsychosocial model is necessary to identify and address the obstacles to recovery and barriers to return to work. It should also meet the needs of those with common health problems who do not recover in a timely fashion. Rehabilitation is dependent on labour market opportunities, and availability, as well as personal capabilities related to the physical and psychological demands of work. A patient’s return to function and work as soon as possible after an illness or injury should be encouraged and supported by employers, health professionals, fellow employees, and rehabilitation service providers. A safe and timely return to work also preserves a skilled and stable workforce and reduces demands on health and social services.
Neurological disorders
Authors: Hardie Richard J. , Poole Jon
Published: May 2013

This chapter deals mainly with common acute and chronic neurological problems, particularly as they affect employees and job applicants. The complications of occupational exposure to neurotoxins and putative neurotoxins will also be covered in so far as they relate to the fitness of an exposed employee to continue working. In addition to a few well-known and common conditions, many uncommon but distinct neurological disorders may present at work or affect work capacity. Fitness for work in these disorders will be determined by the person’s functional abilities, any comorbid illness, the efficacy or side effects of the treatment, and psychological and social factors, rather than by the precise diagnosis. This will also need to be put into the context of the job in question, as the basic requirements for a manual labouring job may be completely different from something more intellectually demanding. Indeed, even an apparently precise diagnostic label such as multiple sclerosis (MS) can encompass a complete spectrum of disability, from someone who is entirely asymptomatic to another who is totally incapacitated. Similarly, the job title ‘production operative’ may be applied to someone who is sedentary or who undertakes heavy manual handling. Furthermore, reports by general practitioners, neurologists, or neurosurgeons may describe the symptoms, signs, and investigations in detail, but without analysing functional abilities. These colleagues may also fail to appreciate the workplace hazards, the responsibilities of the employer, or what scope exists for adaptations to the job or workplace.
Mental health and psychiatric disorders
Authors: Heron Richard , Greenberg Neil
Published: May 2013

The aim of this chapter is to consider how work and mental health interrelate and how employers can ensure the mental health needs of their workforce are dealt with appropriately to maximize opportunities for productivity and minimize psychological morbidity. The chapter will follow a preventative medicine format by considering primary, secondary, and tertiary prevention of mental health disorders at work. Primary prevention equates to the prevention of mental ill health within a workforce and working environment; it is the responsibility of line managers and organizational policies and procedures. They may be advised by occupational health professionals who have a role to play in assuring the content of such policies and practices, and raising awareness about them. Secondary prevention refers to the early identification of the warning signs likely to indicate that mental health problems will develop. Early identification allows for either the prevention of progression of a disorder through management interventions or to ensure that personnel receive early treatment leading to a rapid return to occupational effectiveness which may involve healthcare professionals in some cases. Tertiary prevention refers to treatment and recovery which aims to prevent longer-term disability in those who have a diagnosed mental health disorder. Whilst is it beneficial for line managers to support tertiary prevention interventions, the responsibility for delivering them is likely to rest with healthcare professionals.
Vision and eye disorders
Authors: Pitts John , Mitchell Stuart J.
Published: May 2013

When considering the interaction of the visual system and the working environment, consideration should be given to the effect of vision on work and the effect of work on the eyes.This chapter is arranged in five sections. Part one introduces the main symptoms and functional effects of vision disorders. Part two reviews the main ocular diseases and uses a tabular approach to link the main symptoms of visual dysfunction to their effect on work—and the adjustments that have to be made as a result. Part three takes a brief look at visual ergonomics—including lighting, DSE, visual fatigue, and the employment of people with visual impairment. Part four reviews the commonest ocular hazards and toxins found in the workplace and eye protection. Part five is a brief introduction to ocular first aid in the workplace.
Hearing and vestibular disorders
Authors: Luxon Linda M. , Dick Finlay
Published: May 2013

Hearing and balance disorders are common in those of working age and become commoner with increasing age. Hearing impairment can adversely affect an individual’s education and employment prospects and there is limited evidence that it may compromise their safety. Similarly, vestibular disorders are common, can affect fitness for work, workplace performance, sickness absence, and fitness for safety critical work. While individuals with deafness or severe hearing impairment may be unable to work in safety critical roles, they are able to undertake many jobs subject to reasonable workplace adjustments being made (as required under the Equality Act 2010). Sadly, many people with hearing or balance impairment either do not seek, or do not receive, appropriate workplace adjustments and as a consequence continue to experience significant disadvantage in the employment market.
Rheumatological disorders
Authors: Ryder Steve , Walker-Bone Karen
Published: May 2013

Musculoskeletal pain affects up to 50 per cent of the population at any one time. Consequently, low back pain, neck pain, and upper limb disorders are important causes of sickness absence. Spinal disorders, including back pain, are covered in detail in Chapter 11, and will not be discussed further here. Instead this chapter will focus on the other common rheumatological disorders, including upper limb disorders (specific and non-specific), osteoarthritis (OA), inflammatory arthritis, connective tissue disorders, and widespread pain syndromes. Many rheumatological conditions are chronic and potentially disabling but there have been recent developments in medical therapies, especially in the inflammatory rheumatic conditions, which offer the prospect of controlling disease activity, reducing disability, improving quality of life, and enabling work.
Renal and urological disease
Authors: Hobson John , Brown Edwina A.
Published: May 2013

The kidney has the vital function of excretion, and controls acid–base, fluid, and electrolyte balance. It also acts as an endocrine organ. Renal failure, with severe impairment of these functions, results from a number of different processes, most of which are acquired, although some may be inherited. Glomerulonephritis, which presents with proteinuria, haematuria, or both, may be accompanied by hypertension and impaired renal function. Pyelonephritis with renal scarring is the end result of infective disorders. Diabetes is now the commonest cause of end-stage renal disease (ESRD) in the UK and other systemic disease such as hypertension and collagen disorders can also affect the kidney. Polycystic kidney disease is the commonest inherited disorder leading to renal failure. Chronic renal failure implies permanent renal damage, which is likely to be progressive and will eventually require renal replacement therapy. Treatment of ESRD using haemodialysis (HD) and peritoneal dialysis (PD) can significantly improve physical and metabolic well-being and function but the proportion of those who continue to work with ESRD remains very low despite advances in treatment. Kidney transplantation enables many patients to return to normal lives including work. Reintegration of patients into the workforce following transplantation or dialysis offers an exciting and rewarding challenge to the wider health team. Renal disease is not within the top ten of the most costly diseases for employers and accounts for less than 1 per cent of sickness absence and incapacity claims. Urinary incontinence affects significant proportions of the workforce particularly women. Better management of urinary infections and calculi, prostatic obstruction, incontinence, and other complications of urinary tract disease has significantly reduced time lost from work.
Women at work
Authors: Coomber Sally E. L. , Harris P. A.
Published: May 2013

Although nearly half the UK workforce is female, they differ from men in the jobs they do, the hours and patterns of work, and even their rates of pay. These factors impact on women’s health and fitness for work. This chapter considers fertility to conception, childbirth though to post-natal health, menstruation to the menopause and gynaecological surgery and ergonomics. When considering fitness to work of a female worker, there may be more to consider than the duties of the job and declared medical history. Some relevant clinical problems may not be raised without skilful, direct enquiry e.g. postnatal depression, stress incontinence. In addition to the role at work, women still tend to undertake the lion’s share of the childcare and family commitments: this should be considered when planning for a successful phased return to work.
Human immunodeficiency virus
Authors: Grime Paul , Conlon Christopher
Published: May 2013

Despite significant advances in the treatment of HIV infection and dramatic increases in disease-free survival, there has not been a corresponding increase in employment for those infected with HIV. It is likely that drug side effects, psychological barriers, and continuing (but lessening) prejudice among employers contribute. Occupational physicians working in healthcare require specialist knowledge of guidelines governing the management of HIV-infected healthcare workers. In nearly all other industries HIV-infected individuals can be managed in the same way as any other worker with a chronic, immunosuppressive disease. If the development of novel drugs outstrips viral resistance, and the disabling side effects of effective treatment reduce, the employment prospects for HIV-infected individuals, at least in developed countries, should continue to improve.
Medication and health in the workplace
Authors: Swales Caroline L. , Aronson Jeffrey K.
Published: May 2013

Medication allows many to pursue productive employment when they would otherwise be unable to work safely and effectively, particularly older workers who represent an increasing part of the workforce. Others require short courses of medicines which can occasionally cause harm. Although occupational health clinicians are generally not regular prescribers, they have a vital role in ensuring safe use of medications at work. Here we review the positive and negative effects of medication in the workplace and consider how occupational health can support employees taking medications.
Health screening
Authors: Aw Tar-Ching , Koh David S. Q.
Published: May 2013

Health screening is a useful tool in occupational health practice, but theoretical and practical issues bear consideration before beginning such screening for any group of workers. Legal requirements will vary from country to country and will influence what is provided. Proper communication with the workforce, employer, and occupational health and safety professionals is essential for implementing successful health screening programmes.