bluuebunny/crossref_metadata_2025 huggingface dataset:
Miscellaneous Pharmacology
Authors: Naidu Ramana K.
Published: March 2017

This chapter discusses the unique and miscellaneous drugs that play a role in chronic pain management. The therapies can be used for analgesia, to address comorbidities associated with chronic pain, and to manage side effects associated with commonly used analgesics. Essentially, this chapter provides a diverse group of pharmacological questions that are important for the armamentarium of the pain physician. Topics range from neuroleptics to antispasticity drugs and sympatholytic drugs. Knowledge of these sometimes rarely used drugs can be highly useful in challenging situations.
Neuromodulation
Authors: Covert Bryan , Huntoon Marc A.
Published: March 2017

This chapter addresses the indications for and complications related to surgical, pharmacologic, and adjunctive neuromodulation therapy. Many forms of neuromodulation therapy find their inspiration from the landmark work by Melzack and Wall in 1965 that described the gate theory of pain. Fifty years later, technological and pharmaceutical progress leads the charge on this exciting field within pain medicine. As understanding of the generation, transmission, and interpretation of pain signaling expands, the options for interventional and medical therapy will surely follow suit. These advancements are a welcome addition as the aging population meets a medical community seeking to curb chronic opioid therapy. The questions in this chapter serve as a guide to the salient neuromodulation techniques, but an emphasis should be placed on the suggested readings in this chapter to develop a more thorough understanding of the topic and variety of techniques and pharmacotherapy not covered.
Physical Medicine and Rehabilitation and Electrodiagnosis
Authors: Yang Aaron Jay
Published: March 2017

This chapter focuses on the principles of physical modalities, exercise therapy, mobilization, massage, traction, spinal orthoses, and electrodiagnosis. The questions are formulated to focus on the most relevant and timely topics that may be tested within this section, and most answers are highlighted by important key facts that are associated with the tested questions. This chapter is by no means a comprehensive review of the field of physical medicine and rehabilitation. Rather, it is a guide to some of the main principles that may fall under this field in regard to the examination. For a more comprehensive overview on a certain topic, the reader should consult the Further Reading sections that follow the answers.
Acute Pain Management and Tissue Pain
Authors: Badiola Ignacio
Published: March 2017

This chapter on acute pain medicine examines the themes represented on the American Board of Anesthesiology’s pain medicine certification exam. It covers Part 6 (tissue pain), Section 1 (acute pain). In detail, the epidemiology of acute pain, current inadequacy of acute pain therapies, the physiology of acute pain, and both pharmacologic and nonpharmacologic aspects of acute pain treatment are discussed. Tools for assessing acute pain are reviewed, as well as the roles of both patient and family as they relate to adults and children in acute pain.
Chronic Pelvic Pain
Authors: Smith Martha J.
Published: March 2017

Nonmalignant chronic pelvic pain is defined as nonmenstrual pain below the level of the umbilicus that has continued for at least 6 months and is severe enough to seek medical or surgical treatment. In chronic pelvic pain, the pain and disability may often appear out of proportion to physical abnormalities, and this pain is often refractory to medical and surgical therapies. Significant psychiatric comorbidities and many medical comorbidities often accompany pelvic pain. Although most pelvic pain patients are female, several conditions can cause chronic pelvic pain in males. When evaluating and diagnosing various pelvic pain conditions, it is imperative to rule out malignancy and other organic causes. Pelvic floor dysfunction, sacroiliac joint instability, and other mechanical issues are often partially involved in the process of chronic pelvic pain. As a clinician, all of these variables must be taken into consideration when evaluating and treating chronic pelvic pain patient.
Obstetric Pain
Authors: Sviggum Hans P. , Jacob Adam K.
Published: March 2017

This chapter on obstetric pain reviews the complex pathophysiologic processes of pain transmission and perception experienced by women throughout pregnancy, management of pain in the peripartum period, and how preexisting chronic pain or opioid use affects the care of parturients. It discusses mechanisms of pain; common pain pathways; and factors influencing the perception of pain during pregnancy, labor, and delivery. It compares the benefits and adverse effects of current strategies for managing maternal pain during labor and after delivery. Finally, it reviews maternal and fetal effects of peripartum pain management in opiate- and non-opiate-dependent mothers.
Neuropathic Pain
Authors: Fowler Ian M. , Hackworth Robert J. , Voogd Erik P.
Published: March 2017

Neuropathic pain encompasses a vast number of clinical conditions that share the common characteristic of pain resulting from nerve injury or damage. Upon injury, pathophysiologic changes in the peripheral nervous system occur, including hyperexcitability and the spontaneous generation of impulses (ectopia). As a result of these peripheral changes, alterations in signal processing and intrinsic changes within the central nervous system occur. All of these changes contribute to the generation of neuropathic pain. This chapter attempts to capture the essence of the objectives and goals set forth by the International Association for the Study of Pain’s Core Curriculum for Professional Education in Pain for the topic of neuropathic pain. The questions cover topics including definitions, common clinical conditions, uncommon clinical conditions, therapeutic interventions, pathophysiological mechanisms, and current investigations.
Geriatric Pain
Authors: Huntoon Elizabeth
Published: March 2017

Advances in health care have provided improved longevity and daily functioning in many elderly individuals; however, the increase in longevity contributes to the complexity of caring for elderly pain patients. Many elderly pain patients are undertreated as a result of inadequate pain assessment, cognitive limitations, or physiologic processes. Therefore, it is imperative to have an awareness and understanding of how the aging process affects the body. The treatment of pain in the elderly includes a variety of pain medications that are commonly used in other age groups but must be approached with caution in older patients due to the differences caused by age-related physiologic changes as well as psychological and socioeconomic differences. The International Association for the Study of Pain has published a comprehensive review of issues related to pain in the elderly.
Pain Relief in Areas of Deprivation and Conflict
Authors: Corey John , McQueen Kelly
Published: March 2017

This chapter addresses pain relief in areas of deprivation and conflict. There is variability in the causes of pain worldwide, including HIV/AIDS, torture-related pain and suffering, and war-related injuries. There is also great variability in the availability of adequate pain treatment worldwide due to limitations of education, training, knowledge of pain and its treatment, beliefs and communication about pain, and the inadequacy of access to drugs and palliative care in many countries. Research reflects the importance of extending pain care worldwide and addressing ethical and political issues surrounding pain care.
Treatment of Psychiatric Disorders
Authors: Gupta Neha
Published: March 2017

In this chapter, essential aspects of the treatment of psychiatric disorders are reviewed including pharmacokinetics, pharmacodynamics, drug interactions, psychogenomics and the use of antidepressants, mood stabilizers, antianxiety agents, antipsychotics, psychostimulants, hypnotics and sedatives, ECT and psychotherapy
Treatment of Neuropsychiatric Disorders
Authors: Maksimowski Michael , Tampi Rajesh
Published: March 2017

In this chapter different issues associated with the treatment of neuropsychiatric disorders will be reviewed including neuropharmacokinetics, neuropharmacodynamics, drug interactions, antiparkinsonians, nootropics, treatment of tardive dyskinesia, treatment of neuroleptic malignant syndrome, neurosurgical approaches and pain management
Childhood-Onset Disorders
Authors: Rizvi Waqar
Published: March 2017

This chapter provides a review of disorders first diagnosed in infancy, childhood, and adolescence including intellectual disability, learning disorders, motor skills disorders, communication disorders, attention deficit and disruptive behavior disorders, tic disorders, elimination disorders, kleptomania, and pyromania
Psychiatric Presentations Due to Medical Conditions
Authors: Singh Harvinder , Diaz Nery
Published: March 2017

This chapter will mental disorders associated with medical conditions including hyperthyroidsm, hypothyroidism, hyperparathyroidism, Cushing’s disease, Addison’s disease, Wilson’s disease and COPD among others
Dissociative Disorders
Authors: Matuskey David
Published: March 2017

In this chapter topics related to dissociative disorders are reviewed including dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder and derealization disorder
Eating Disorders
Authors: Singh Harvinder
Published: March 2017

This chapter reviews topics related to eating disorder including anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder
Adjustment Disorders
Authors: Bachu Anil
Published: March 2017

In this chapter the topic of adjustment disorders is reviewed in detail including epidemiology, diagnosis, treatment plan and prognosis
Personality Disorders
Authors: Rizvi Waqar
Published: March 2017

In this chapter essential aspects of personality disorder will be reviewed including paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, Avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder and antisocial personality disorder
Epidemiology, Biostatistics, and Research Design
Authors: Oldham Mark
Published: March 2017

This chapter reviews topics on epidemiology, biostatistics and research designs
Clinical Vignette
Authors: Akinsanya Adefolake
Published: March 2017

This chapter includes a clinical vignette on Autism Spectrum Disorder, with accompanying questions.
Clinical Vignette
Authors: Michna Isabella
Published: March 2017

This chapter includes a clinical vignette on Competence to Stand Trial, with accompanying questions.
Clinical Vignette
Authors: Wasser Tobias
Published: March 2017

This chapter includes a clinical vignette on Capacity Evaluation, with accompanying questions.
HIV Cure Strategies
Authors: Juelg Boris , Gandhi Rajesh
Published: March 2017

Although current antiretroviral therapy (ART) is highly effective at controlling HIV-1 replication, it does not eradicate or cure the infection. HIV-1 persists quiescently in cellular reservoirs, not detected by the immune system due to the lack of active viral replication; these reservoirs represent the major obstacle for cure approaches. Reversal of HIV-1 latency and induction of virus expression by a variety of interventions may render infected cells susceptible to immune recognition and active clearance. Strategies to boost immune responses via vaccination, immunomodulation, or gene therapy are being evaluated with the aim of achieving HIV-1 control without antiretroviral therapy, if not viral eradication.
Initial Laboratory Evaluation and Risk Stratification of the HIV-Infected Patient
Authors: Martagon-Villamil Jose , Skiest Daniel J.
Published: March 2017

To adequately understand the HIV-infected individual’s stage of disease, risk profile, and management needs, a series of laboratory tests must be performed. Essential tests include CD4+ count, HIV viral load, HIV resistance assay, and serologic evaluation for certain opportunistic infections. The availability and indication for many of these may be influenced by cost considerations, especially in resource-limited settings. Baseline laboratory evaluation of all patients with HIV newly engaged in care must be done. In stable patients with suppressed viral load, CD4 count monitoring is only required at 6- to 12-month intervals. In stable patients with virologic suppression for 2 years or more, viral load monitoring can be decreased to every 6 months.
Health Maintenance
Authors: Edun Babatunde , Haas Michelle K. , Brendemuhl Christopher , Baker Jason V. , Speights Anthony C.
Published: March 2017

The introduction of highly potent antiretroviral agents has transformed HIV from a disease with a once dismal prognosis to a manageable chronic medical condition. The primary care provider as well as the HIV care provider must focus on aspects of preventive medicine that improve the quality of life and life expectancy of the HIV-infected person. Accurate record-keeping is essential, and examples of HIV primary care flow sheets are presented in this chapter. In addition, tuberculosis screening indications and methods are reviewed. Regular preventative dental and gynecological care should be given. Reviewing the treatment of traditional cardiovascular risk factors with patients will be helpful in educating them and reducing the risk of cardiovascular disease.
Care Coordination
Authors: Kang Joy H. , Selwyn Peter A.
Published: March 2017

Patients infected with HIV are now living longer, and there is a growing prevalence of HIV-related and/or non-HIV-related comorbidities, often with an increasing need for chronic disease management beyond the treatment of HIV infection. The barriers to each of the steps in the HIV continuum of care need to be identified, anticipated, and addressed. Comprehensive HIV care requires the coordination of many providers. Successful management of referrals, communication between team members, and the challenges of an aging HIV-infected population are reviewed. The interdisciplinary team approach is essential to effective coordination of care for patients with multiple health and service needs.
HIV Virology
Authors: Livingston Schuyler , Young Benjamin , Markowitz Martin , Mathur Poonam , Gilliam Bruce L.
Published: March 2017

HIV is a member of the lentivirus subfamily of retroviruses. Two distinct groups of viruses are pathogenic in humans: HIV-1 and HIV-2. Both are transmitted sexually and known to cause immunodeficiency disease. HIV enters the cell through use of the CD4 receptor and chemokine co-receptors, primarily CCR5 and CXCR4. The viral genome is transcribed from RNA to DNA by reverse transcriptase and integrated into the host genome by integrase. The HIV genome encodes 15 proteins, comprising three categories: structural, regulatory, and accessory. After budding from the host cell, the virus matures into its infectious form through cleavage of viral precursor proteins by protease.
Classes of Antiretrovirals
Authors: Young Benjamin
Published: March 2017

Results of the randomized, international INSIGHT START clinical trial provide definitive proof of the benefit of antiretroviral therapy initiation in asymptomatic individuals with CD4+ counts greater than 500 cells/mm3. There are six different classes of antiretroviral agents: two types of reverse transcriptase inhibitors, two types of entry inhibitors, one class of inhibitors of HIV protease, and one class of inhibitors of HIV integrase. Combination antiretroviral therapy is recommended for all people living with HIV. The primary goal of combination antiretroviral therapy is to achieve viral suppression. Each antiretroviral class targets a unique step in the replication cycle of HIV-1.
Initiation of Antiretroviral Therapy
Authors: Ajmal Saira , Temesgen Zelalem
Published: March 2017

The primary goal of therapy is to prevent HIV-associated morbidity and mortality. In addition to the dramatic decline in HIV-related illness and death that has been observed as a result of the introduction and expansion of combination antiretroviral therapy, evidence is emerging that uncontrolled HIV replication also has a deleterious impact on conditions that are not conventionally associated with immune deficiency. These conditions include cardiovascular disease, kidney disease, liver disease, neurologic complications, and malignancy. Studies have found an independent association between cumulative exposure to replicating virus over time and mortality. Emerging data also increasingly support the earlier use of ART.
Future Antiretrovirals, Immune-Based Strategies, and Therapeutic Vaccines
Authors: Majid Adrian , Gilliam Bruce L.
Published: March 2017

Highly active antiretroviral therapy remains the mainstay of treatment for patients chronically infected with HIV. Novel drugs, both within existing classes and new ones, are in various stages of development and testing. New medications within existing classes of antiretroviral agents are in clinical trials and will likely offer activity against resistant HIV-1 strains and provide alternatives for combination pill therapy. Novel therapeutics including oral attachment inhibitors and monoclonal antibody treatments continue to show efficacy against HIV-1 and progress in clinical trials. Tenofovir alafenamide is a prodrug that produces higher intracellular levels of tenofovir diphosphate with likely less renal and bone toxicity. Among traditional classes of HIV treatment, both doravirine (a non-nucleoside reverse transcriptase inhibitor) and cabotegravir (an integrase strand inhibitor) are newer agents with activity against resistant virus. Maturation inhibitors are a new class of treatment that block protease cleavage, leading to the release of an immature virion.
Understanding and Managing Antineoplastic and Antiretroviral Therapy
Authors: Schafer Jason J. , Sherman Elizabeth M. , Gill Taylor K. , Birney Jatandra
Published: March 2017

The use of combination antiretroviral therapy in patients with malignancies is associated with improved HIV and cancer-related outcomes. Combining antiretroviral and antineoplastic therapy is often complicated by significant drug-drug interactions, drug-disease state monitoring interactions and overlapping toxicities. Definitive pharmacokinetic studies evaluating drug interactions between antineoplastics and antiretrovirals are uncommon and clinical judgment must often be used to determine the potential for significant interactions. Adjusting antiretroviral therapy in response to significant drug interactions or overlapping toxicities is often more feasible than modifying antineoplastic protocols.
Substance Abuse in HIV Populations
Authors: David Elizabeth , Casas John P.
Published: March 2017

Mental illness and substance abuse are separate and additive risk factors for HIV infection. A comprehensive approach in the treatment of those with the dual diagnosis of mental illness and substance abuse is very important because these patients are inherently at a higher risk of contracting or transmitting sexually transmitted diseases, including HIV. Problems with adherence to medical treatment seem to be additive in this group. In addition, substance abuse is associated with a host of medical sequelae (liver disease, infection, diabetes, cardiovascular disease, and neurocognitive changes), complicating treatment of the virus in a population already at risk for these problems and leading to increased disease progression.
Opportunistic Infections
Authors: Barnett Ben J. , Armitige Lisa , Vigil Karen J.
Published: March 2017

The question of when to initiate antiretroviral therapy (ART) in the setting of an acute or ongoing opportunistic infection (OI) has been controversial. The immediate initiation of ART in the presence of an OI may provide better clinical outcomes as the immune system improves. However, rapidly decreasing HIV viral load has been associated with the immune reconstitution inflammatory syndrome, which may lead to further complications in the setting of an OI. There are also questions of increasing pill burden, potential drug–drug interactions, additive toxicity and adverse events, and the more practical problem of continuity of care if ART is started in a hospital setting for a newly diagnosed patient with HIV without established outpatient care already in place. This problem could be particularly troublesome for patients who do not have health insurance or otherwise do not have affordable access to ART in the outpatient setting.
Non-opportunistic Infections
Authors: Vigil Karen J.
Published: March 2017

Lymphocytic interstitial pneumonitis is a common respiratory complication of HIV infection in children but a rare complication in HIV-infected adults. The diagnosis requires histologic confirmation by biopsy. Antiretroviral therapy has been used with success for treatment. Nonspecific interstitial pneumonitis (NSIP) presents with dyspnea, nonproductive cough, and fever in patients with CD4+ T cell counts >200 cells/mm3. The diagnosis of NSIP requires histologic confirmation by biopsy. The optimum treatment remains unclear. The prevalence of pulmonary arterial hypertension (PAH) is higher in HIV-infected patients compared to the general population. Potential therapies for HIV-associated PAH include HIV antiretroviral therapy as well as supportive therapy, including oxygen, diuretics, and anticoagulation.
Ocular Complications
Authors: Dunn James P.
Published: March 2017

Before the era of antiretroviral therapy (ART), cytomegalovirus (CMV) retinitis was the most common ocular opportunistic infection in patients with AIDS, occurring in up to 30% of patients. The incidence of CMV retinitis, its natural history, and the indications for and response to therapy depend in part on whether at-risk patients are taking ART. Symptoms of CMV retinitis are nonspecific and include floaters, light flashes, peripheral visual field loss, and blurred central vision. Patients taking ART, especially those with immune recovery, are at lower risk of CMV retinitis than are patients who remain profoundly immunosuppressed; thus, patients taking ART do not need to be screened as often.
Musculoskeletal Complications of HIV
Authors: Bell Tanvir K.
Published: March 2017

Vitamin D levels have been observed to be low in HIV-infected patients. If replacement of low vitamin D is warranted, supplementation is done with vitamin D2 or D3. HIV-infected patients may be at higher risk for osteopenia, osteoporosis, and fragility fractures. Tenofovir alafenamide has been shown to produce less bone loss compared to tenofovir disoproxil fumarate. Muscle disorders can be debilitating in HIV-infected patients. Myopathies can have a range of presentation from myalgias to rhabdomyolysis. HIV myopathy is a rare proximal muscle disorder that can occur in HIV-infected patients. Antiretroviral drugs, including zidovudine and raltegravir, can cause myopathy and elevated creatine kinase.
HIV and Bone Health
Authors: Battalora Linda A. , Young Benjamin
Published: March 2017

With improved long-term survival among populations of people living with HIV, it has been suggested that HIV/AIDS may hasten the aging process. There is increasing evidence that cardiovascular, renal, and bone disease and neurocognitive deficits may be more common among long-term survivors of HIV infection. Findings from cohort and prospective randomized studies suggest that people living with HIV are at increased risk of metabolic bone disease and related fractures. There are limited HIV-specific evidence-based recommendations regarding screening for bone disease. Several organizations recommend using dual-energy X-ray absorptiometry and/or the Fracture Risk Assessment Tool for screening of HIV-infected persons at risk of fractures.
Types of Laboratories and Business Relationships
Authors: Keiles Steven , Lilley Margaret , MacLeod Heather
Published: March 2017

Laboratory genetic counselors work in many different laboratory settings that can represent a variety of clinical specialties. This chapter explores the various types of laboratories and their resulting business relationships. Genetic counselors working in a laboratory will build important relationships with colleagues from within their own company as well as competitors, clients, and others they work with externally. The laboratory’s specialty and its setting will determine who their clients are and is also directly related to their business model. CPT codes and billing and reimbursement issues are also reviewed in this chapter. The size and success of different billing and reimbursement strategies will ultimately affect the services a laboratory offers as well as how the counselor’s roles will develop in that setting.
Laboratory Infrastructure
Authors: LaGrave Danielle , Redman Joy B.
Published: March 2017

In a genetics laboratory, genetic counselors work as part of the larger team of laboratory professionals. This chapter provides details about the many different personnel who work in a genetics laboratory. It discusses their different roles and educational backgrounds. It provides information about credentialing and certification. The focus throughout the chapter is on how the genetic counselor would interact with each of these laboratory personnel.
Molecular Technologies and Test Issues
Authors: Kotzer Katrina E. , Kerr Sarah E.
Published: March 2017

Molecular genetic testing has been around since the discovery and offering of clinical testing for the first gene sequenced. However, in recent years the methods and scope of molecular genetic testing have evolved significantly to encompass next-generation sequencing, multigene panels, and whole exome and genome testing. With this evolution in molecular methods, the nomenclature and variant evaluation and annotation processes are crucial for the systematic and standard interpretation of molecular test results. This chapter will provide the laboratory genetic counselor with information about the common sample types analyzed by molecular techniques for the purposes of genetic testing and the various methodologies available and their limitations. Guidelines are given for the standard approach to molecular variant reporting with respect to nomenclature and variant classification.
Prenatal Screening Technologies and Test Issues
Authors: LaGrave Danielle , Devers Winters Patricia L. , Lambert-Messerlian Geralyn
Published: March 2017

Maternal serum screening began with the measurement of serum alpha fetal protein to detect open neural tube defects, which led to the implementation of routine serum-based prenatal screening in the second trimester for Down syndrome. Advances via combined and integrated screening allowed for the first-trimester detection of both Down syndrome and trisomy 18. Next-generation sequencing has enabled the identification of aneuploidies in circulating cell-free fetal DNA from the plasma fraction of maternal whole blood. This breakthrough in molecular genetic testing, commonly referred to as noninvasive prenatal testing, has revolutionized prenatal screening and testing for genetic disorders without posing additional risk to the pregnancy. This chapter reviews the history of maternal serum screening, the disorders it can detect, the methods of calculating patient-specific risk, and reasons for recalculation or adjustment of risk. This chapter also reviews of cell-free DNA-based testing for fetal aneuploidies, including its limitations and potential.
Genetic Counselor Role in Laboratory Case Management
Authors: Balcom Jessica R. , Bandholz Anne M. , Swanson Amy L.
Published: March 2017

The laboratory genetic counselor plays an important role in case management. This chapter describes the various aspects of this role, such as improving patient care by preventing inappropriate testing, contributing to laboratory and clinical interpretation of test results, and communicating complex or unexpected results. The laboratory genetic counselor serves as a liaison between ordering providers and laboratory staff. Good communication is vital in this role to ensure understanding and appropriate patient care. The communication skills that the laboratory genetic counselor needs are detailed throughout the chapter.
Genetic Counselor Role in Hospital Test Utilization
Authors: Conta Jessie , Hess Cheryl , Riley Jacquelyn
Published: March 2017

Recently, hospital laboratories have significantly improved patient care by intercepting genetic tests that have been ordered in error or inappropriately. Such tests can be flagged before they are sent out to referral laboratories for testing. This is commonly performed by genetic counselors acting in support of test utilization management. This chapter details the role of the test utilization counselor. Multiple methods are described for developing and implementing a hospital-based test utilization management program for genetic testing.
The Laboratory Genetic Counselor as an Educator
Authors: Rosenthal Eric , Studinski Jones April L.
Published: March 2017

The laboratory genetic counselor is commonly called upon to serve as an educational resource within the genetic testing laboratory. This chapter outlines this unique genetic counseling role. Laboratory genetic counselors provide education about genetic testing and genetic concepts within the laboratory to existing laboratory staff, new laboratory genetic counselor colleagues, formal educational program participants (genetic counselor interns, graduate students, medical students and residents, and laboratory fellows), and laboratory colleagues. They also use their skills and knowledge to educate client laboratories and clinicians. They may also participate in public and community forums.
Thorax
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the thorax as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the surface markings, blood supply, nerve supply, and muscles of the thoracic body wall, diaphragm, thoracic inlet, trachea, thymus, heart and pericardium, oesophagus, and pleura and lungs. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Head and neck
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the head and neck as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of fascial layers, tissue spaces, muscles, boundaries, relations, blood supply, nerves, and arteries of the neck, thyroid, trachea, oesophagus, face, scalp, nose, mouth, larynx, orbit and eye, ear, temporomandibular joint, and vertebral column. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Central nervous system
Authors: Harrison Mark
Published: March 2017

This chapter describes the anatomy of the central nervous system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the structure, anatomy, and arteries of the cerebral hemispheres, blood supply and venous drainage, brainstem, cerebrospinal fluid, cerebellum, spinal cord, and core blood supply. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Mechanisms of disease
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of mechanisms of disease as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the basic terminology and mechanisms of attachment, invasions, and persistence. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Controlling infection
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of controlling infection as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of endogenous and exogenous infection sources, how infection spreads, hospital-acquired infection, and control of hospital-acquired infection. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Streptococci and staphylococci
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of streptococci and staphylococci as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the methods of spread and clinical features of Streptococcus pneumoniae, Streptococcus pyogenes, alpha-haemolytic streptococci, Staphylococcus aureus, MRSA, and Staphylococcus epidermidis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Tuberculosis
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of tuberculosis as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the clinical features, laboratory identification, management, and immunosuppression regarding the transmission and establishment of tuberculosis in the host. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Pertussis
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of pertussis as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of epidemiology, basis of infection, clinical features, basis of diagnoses, and medical management of pertussis. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Legionella
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of Legionella as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the background to infection, clinical features, basis of diagnosis, medical management, and principles of prevention and public health of Legionella. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Hepatitis
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of hepatitis as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, clinical features, basis of diagnosis, medical management, and prevention of hepatitis A, B, and C. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Respiratory viruses
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of respiratory viruses as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, clinical features, basis of immunity, and management and treatment of rhinovirus, influenza, parainfluenza and respiratory syncytial virus. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Yeasts and fungi
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of yeasts and fungi as they apply to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the transmission, clinical features, and diagnosis and management of Candida, Cryptococcus, and dermatophytes. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Malaria
Authors: Harrison Mark
Published: March 2017

This chapter describes the microbiology of malaria as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the epidemiology, clinical features, basis of diagnosis, and therapy of malaria, including falciparum malaria and benign malaria. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Respiratory physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes respiratory physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of lung volumes and pressures, lung epithelium, lung compliance, surfactant, airway resistance, gas transfer, gas transport within circulation, control of respiration, and ventilation–perfusion relationship. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Gastrointestinal physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes gastrointestinal physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the functional anatomy of the gastrointestinal tract, saliva, swallowing, stomach, small intestine, pancreas, liver, gallbladder, and large intestine. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Renal physiology
Authors: Harrison Mark
Published: March 2017

This chapter describes renal physiology as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the kidneys, mechanism of filtration, acid–base balance, potassium balance, and calcium balance. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Cardiovascular system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the cardiovascular system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of cardiac glycosides, diuretics, antiarrhythmics, beta-adrenoceptor blockers, hypertension and heart failure, nitrates and antianginal drugs, sympathomimetics, anticholinergics, anticoagulants, antiplatelet drugs, fibrinolytics, and lipid-regulating drugs. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Central nervous system
Authors: Harrison Mark
Published: March 2017

This chapter describes the pharmacology of the central nervous system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of hypnotics and anxiolytics, antipsychotics, antimania drugs, tricyclic antidepressants, nausea and vomiting, analgesics, non-opioid analgesics, opioid analgesics, antiepileptics, and status epilepticus. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Renal
Authors: Harrison Mark
Published: March 2017

This chapter describes the pathophysiology of the renal system as it applies to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of uraemia, the glomerular filtration rate, tubular function, endocrine function, water balance, extracellular volume, disorders of sodium, potassium and calcium, and control of micturition. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Bias
Authors: Harrison Mark
Published: March 2017

This chapter describes bias as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details and categories of bias, including reporting, publication, selection, performance, observation, and attrition. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Risks
Authors: Harrison Mark
Published: March 2017

This chapter describes the measurement of risks as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of the 2 × 2 contingency table, and measures of risks. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Errors
Authors: Harrison Mark
Published: March 2017

This chapter describes types of errors as applied to Emergency Medicine, and in particular the Primary FRCEM examination. The chapter outlines the key details of type 1 errors and type 2 errors. This chapter is laid out exactly following the RCEM syllabus, to allow easy reference and consolidation of learning.
Cardiac Disease in Pediatric Intensive Care
Authors: Yarlagadda Vamsi V. , Thiagarajan Ravi R.
Published: March 2017

This chapter on cardiac disease in pediatric intensive care provides essential information on cardiovascular physiology, how to assess cardiovascular and hemodynamic status, and principles of treatment of congenital and acquired cardiac disease in children. The review of physiology includes definitions of preload, afterload, oxygen content, cardiac output, vascular resistance, blood pressure, and cardiopulmonary interactions. Formulas to calculate key parameters are provided. The authors also summarize the presentation and care of most common cyanotic and acyanotic congenital heart defects, including treatment of low cardiac output syndrome, clinical sequelae of cardiopulmonary bypass, and the key aspects of treating pre- and postoperative patients with single-ventricle lesions (e.g., hypoplastic left heart syndrome). All three stages of single-ventricle palliation are discussed, with management summaries of children undergoing the Norwood, bidirectional Glenn, and Fontan operations. Finally, the chapter includes a discussion of the clinical presentation and management of viral myocarditis and cardiomyopathy.
Parkinson Disease
Authors: Soileau Michael J. , Chou Kelvin L.
Published: March 2017

Parkinson disease is a neurodegenerative disorder characterized clinically by tremor, rigidity, bradykinesia, and postural instability and pathologically by loss of nigrostriatal neurons and deposition of alpha-synuclein in neuronal cell bodies and neuritis. Non-motor symptoms such as psychiatric disorders, cognitive abnormalities, sleep dysfunction, autonomic dysfunction, and sensory manifestations are also common. This chapter gives a broad overview of this disorder. Sections cover pathophysiology, genetics, clinical manifestations, and disease course. The chapter also briefly discusses how to make the diagnosis, and alternative conditions that should be considered.
Parkinson Disease
Authors: Thien Lim Thien , Fernandez Hubert H.
Published: March 2017

Levodopa is the most efficacious medication to reduce motor impairment in Parkinson disease (PD). The effect of levodopa can wear off after time, which is treated by increasing the dose or shortening the inter-dose interval. Dyskinesias can be treated by a change in levodopa dosing or route of administration, such as by constant administration of levodopa as a gel through a jejunostomy tube or a change to dopamine agonists or amantadine. Non-motor signs including depression can be treated with several antidepressants. Surgical treatments including pallidotomy, thalamotomy, and deep brain stimulation (DBS) have emerged as effective therapies in selected patients with PD refractory to drug treatment.
Multiple System Atrophy
Authors: Kong Melvin W. , Shamim Ejaz A.
Published: March 2017

Multiple system atrophy is a group of diseases characterized by parkinsonism, ataxia, and dysautonomia. Although the etiology remains unclear, the molecular pathology has been somewhat clarified. The diagnosis is largely clinical but certain tests may help with confirming diagnosis. Treatment largely remains symptomatic.
Huntington Disease
Authors: Albin Roger L. , Paulson Henry L.
Published: March 2017

A member of the expanded polyglutamine (polyQ) repeat family of neurodegenerative disorders, Huntington disease (HD) is a rare, autosomal, dominantly inherited neuropsychiatric disorder. Characterized by midlife onset, HD exhibits progressive motor, behavioral, and cognitive changes. There is no effective treatment and death usually ensues 15 to 20 years after diagnosis. The expanded polyglutamine repeat causes multiple cellular dysfunctions to induce neurodegeneration. Many brain regions are affected in HD though striatal degeneration is particularly prominent. Widespread availability of specific genetic testing facilitates diagnosis. Management is largely supportive care.
Huntington Disease
Authors: Venuto Charles S. , Kieburtz Karl
Published: March 2017

The clinical management of Huntington’s disease entails pharmacologic interventions and nonpharmacologic supportive therapy. There are no treatments that can halt or alter the progression of disease, therefore the goal is to maximize function and optimize quality of life. Tetrabenazine is the only pharmacologic agent with regulatory approval for Huntington’s disease chorea; however, off-label use of antidopaminergic agents is common. Treatment of behavioral disturbances can be tailored to the specific symptoms by using antidepressant, antipsychotic, and anxiolytic agents. Clinical trials testing therapeutic strategies for motor, behavioral, and cognitive aspects of disease and delaying progression are ongoing.
The Neurobiology of Dystonia
Authors: Jinnah H. A. , Prudente Cecilia N. , Rose Samuel J. , Hess Ellen J.
Published: March 2017

The dystonias are a large group of disorders characterized by excessive muscle activity leading to abnormal movements. They are clinically diverse, affecting different parts of the body at all ages in both humans and other animals. They also are etiologically diverse, with causes that are either inherited due to specific dystonia-causing genes, or acquired because of nervous system injury or exposure to certain drugs or chemicals. Despite the clinical and etiological heterogeneity, there is an increasing appreciation that certain subgroups of dystonias share some biological abnormalities at the molecular, cellular, anatomical, or physiological levels.
Dystonia
Authors: Williams Jeri Yvonne , Standaert David G
Published: March 2017

Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions. Classification of dystonia is based on age of onset, distribution of body parts affected, and underlying etiology. A large number of different genetic forms of dystonia have been discovered in recent years. Although these syndromes are important to recognize, the majority of dystonias encountered in clinical practice are of unknown cause. Therapy of dystonia includes medications, particularly anticholinergic drugs, use of botulinum toxins, and deep brain stimulation.
Alzheimer’s Disease
Authors: Jicha Gregory A. , Schmitt Frederick A.
Published: March 2017

Advances in the current management and treatment of Alzheimer’s disease have grown directly from our increased understanding of the neurobiology underlying this disease. Currently available pharmacologic and nonpharmacologic treatment strategies remain focused on symptomatic management of disease rather than disease modification. Despite a wealth of evidence supporting the clinical benefits of existing therapies in the management of symptomatic progression, there is limited evidence that these available therapies modify disease progression over the course of dementia progression. More recent research discoveries in the areas of genetics, molecular and cell biology, and environmental risk factors have become the focal point for an explosive growth in experimental disease-modifying strategies designed to prevent, slow, or potentially halt the progression of Alzheimer’s disease.