Kumar and Clark's Clinical Medicine, 7th Edition (MRCP Study Guides)

1360 Pages·2009·110.33 MB·English

Kumar & Clark’s
Clinical
Medicine
Seventh Edition
For Elsevier
Commissioning Editor: Pauline Graham
Development Editors: Janice Urquhart, Ruth Swan
Project Manager: Frances Affleck
Designer: Stewart Larking, Sarah Russell
Illustration Manager: Gillian Richards
Illustrators: Richard Morris, Ethan Danielson
Kumar & Clark’s
Clinical
Medicine
Seventh Edition
Edited by
Professor Parveen Kumar
CBE BSc MD DM(hc) FRCP FRCP (Edin)
Professor of Medicine and Education,
Barts and The London School of Medicine and Dentistry,
Queen Mary University of London,
and Honorary Consultant Physician and Gastroenterologist,
Barts and the London NHS Trust and Homerton University
Hospital NHS Foundation Trust, London, UK
Dr Michael Clark
MD FRCP
Honorary Senior Lecturer,
Barts and The London
School of Medicine and Dentistry,
Queen Mary University of London, London, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2009
© 2009, Elsevier Limited. All rights reserved
No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage
and retrieval system, without permission in writing from the publisher. Permissions may be
sought directly from Elsevier’s Rights Department: phone: [phone] (US) or
([phone] (UK); fax: [phone]; e-mail:
Contents
Online contents vii
Contributors ix
International Advisory Panel xi
Preface to the Seventh Edition xiii
Acknowledgements xv
  1.  Ethics   1
L Doyal
Communication    8
A Cushing and C Mallinson
  2.  Molecular cell biology and genetic disorders  19
RK Iles
  3.  The immune system and disease   53
M Peakman
  4.  Infectious diseases, tropical medicine and sexually  
transmitted infection  79
RG Finch, WL Irving, P Moss and J Anderson
  5.  Nutrition  207
M Elia
  6.  Gastrointestinal disease  241
PD Fairclough and DBA Silk
  7.  Liver, biliary tract and pancreatic disease  319
AK Burroughs and D Westaby
  8.  Haematological disease  387
MF Murphy, J Wainscoat and KJ Pasi
  9.  Malignant disease  449
CJ Gallagher, TA Lister, MJ Johnson and A Davies
10.  Rheumatology and bone disease  499
M Shipley, A Rahman, D O’Gradaigh and JE Compston
11.  Renal disease  571
MM Yaqoob
vi Contents
12. Water, electrolytes and acid–base balance 649
MM Yaqoob
13. Cardiovascular disease 681
AJ Camm and N Bunce
14. Respiratory disease 811
AJ Frew and ST Holgate
15. Intensive care medicine 889
CJ Hinds and D Watson
16. Drug therapy and poisoning 923
M Rawlins and JA Vale
17. Environmental medicine 953
ML Clark, CRA Clarke and A Geddes
18. Endocrine disease 963
TA Howlett and MJ Levy
19. Diabetes mellitus and other disorders
of metabolism 1029
EAM Gale and JV Anderson
20. The special senses 1077
M Harries, F Vaz and S Verma
21. Neurological disease 1095
CRA Clarke
22. Psychological medicine 1185
PD White and AW Clare
23. Skin disease 1225
DG Paige
Index 1273
Online Contents
w w w. s t u d e n t c o n s u l t . c om
The seventh edition of Kumar & Clark’s Clinical Medicine has N Vitamin B12 and folic acid deficiency Professor V J Louw
an online version that can be accessed via www.studentcon- N IgA nephropathy Professor K N Lai
sult.com. The online version consists of the full text and N Arsenic poisoning Dr A K Kundu
illustrations for the seventh edition as well as other additional N Drug-drug and drug-food interactions Professor S G
features, some of which are unique to Kumar & Clark. To Carruthers
access the online version, readers should follow the instruc- N Poisoning – a Sri Lankan perspective Professor J de Silva
tions on the book’s inside front cover. The list below provides N Snake bite Professor Dr CA Gnanathasan and R Sheriff
a guide to some of the online features, and you can also find N Pyogenic meningitis Dr S Shafqat and Dr A Zaidi
them listed online in the ‘extras’ folder. N Tropical neurology Dr U K Ranawaka
ONLINE APPENDIX INTERACTIVE SURFACE ANATOMY
edited by Professor Janaka de Silva from Drake et al: Gray’s Anatomy for Students
This appendix, which will be updated regularly, provides This programme relates anatomy to the skills of clinical
supplementary information on diseases and problems that examination. Over 40 interactive animations take the student
are more prevalent in certain parts of the world, up to date through the seven body regions, demonstrating major ana-
for the seventh edition. The need for this material – which tomical features, surface landmarks and other palpable
enlarges on what can be found in the print version – became structures. By working through each module students see
plain to the Editors from their travels to various parts of the their role when performing a general physical examination,
world. We are grateful to members of the Kumar & Clark listening for heart sounds, examining movements of the eye,
International Advisory Panel and other colleagues for their and many others. We are grateful to the authors of Gray’s
contributions to this unique resource. Anatomy for Students for the opportunity to provide Kumar
& Clark readers with the benefits of this unique interactive
N Brucellosis Professor S S Fedail learning tool and to introduce them to this outstanding
N Dengue fever Dr R Sood anatomy textbook.
N Diarrhoeas including amoebiasis Professor S A Azer
N Human avian influenza infection Professor M Ellis Back
N HIV in resource-limited settings Dr M Mendelson and
Professor G Maartens N How to identify specific vertebral spinous processes
N Infections caused by Rickettsiae, Orientiae and Coxiella N Visualizing the inferior ends of the spinal cord and
Dr R Premaratna subarachnoid space
N Leprosy Dr S A Kamath Thorax
N Malaria Dr S A Kamath N How to count ribs
N Rabies Professor K N Viswanathan N Surface anatomy of the breast in women
N Rheumatic fever Professor K N Viswanathan N Visualizing structures at the T4/5 vertebral level
N Rift Valley fever Professor O. Khalafallah, Dr A A K N Visualizing structures in the superior mediastinum
Jebriel, Dr M El Sadig, Dr M Mirghani, Professor S S N Visualizing the margins of the heart
Fedail N Where to listen for heart sounds
N Severe acute respiratory syndrome (SARS) Professor N How to visualize the pleural cavities and lungs
K N Lai N Where to listen to right lung sounds
N Soil-transmitted helminths Professor N de Silva N Where to listen to left lung sounds
N Vaccination for adults Dr R Dewan
N Fluorosis Professor F S Hough Pelvis and perineum
N Tropical sprue Professor S A Azer N Identification of structures in the urogenital triangle of
N Liver transplantation Dr J T Wells, Professor M R Lucey women
N Thrombotic thrombocytopenic purpura (TTP) associated N Identification of structures in the urogenital triangle of
with HIV Professor V J Louw men
viii Online Contents
Abdomen the animations build on the descriptions given in the ‘practi-
■ How to find the superficial inguinal ring cal boxes’ in Kumar & Clark.
■ How to determine lumbar vertebral levels
■ Arterial cannulation
■ Visualizing structures at the LI vertebral level
■ Arterial puncture
■ Visualizing the position of major blood vessels
■ Bladder catheterization: female
■ Using abdominal quadrants to locate major viscera
■ Bladder catheterization: male
■ Defining surface regions to which pain from the gut is
■ Central venous catheterization (CVC): jugular vein
referred
■ Central venous catheterization (CVC): subclavian vein
■ Where to find the kidneys and spleen
■ Joint aspiration
■ Lumbar puncture
lower limb ■ Venepuncture
■ Avoiding the sciatic nerve
■ Finding the femoral artery in the femoral triangle
HeArt And lung SOundS
■ Identifying structures around the knee
by Dr Salvatore Mangione
■ Visualizing the contents of the popliteal fossa
This feature provides readers with the opportunity to improve
■ Finding the tarsal tunnel
their clinical skills by listening to 10 pulmonary and 12 cardiac
■ Identifying tendons around the ankle and in the foot
sounds. The sounds can be heard on their own or accompa-
■ Finding the dorsalis pedis artery
nied by an instructive narrative. This workshop has been pre-
■ Identifying major superficial veins
pared by Dr Salvatore Mangione, and we are grateful for the
■ Where to take peripheral arterial pulses in the lower
opportunity to make it available to readers of Kumar & Clark.
limb
■ CARDIAC AUSCULTATION:
upper limb Opening snap
■ Visualizing the axilla, its contents and related structures Aortic regurgitation and systolic flow murmur
■ Locating the brachial artery in the arm Pericardial friction rub
■ Locating the triceps brachii tendon and the position of S3 gallop
the radial nerve Mid-systolic click
■ Identifying the cubital fossa and its contents Patent ductus arteriosus
■ Identifying tendons and locating major vessels and Early-systolic ejection sound
nerves in the distal forearm Aortic stenosis
■ Identifying the position of the flexor retinaculum and the S4 gallop
recurrent branch of the median nerve Mitral regurgitation
■ Visualizing the positions of the superficial and deep Aortic regurgitation
palmar arches Mitral stenosis and opening snap
■ Where to take peripheral arterial pulses in the upper
■ PULMONARY AUSCULTATION:
limb
Bronchial breath sounds
Crackles
Head and neck
Wheezes
■ Visualizing structures at the CIII/CIV and CVI vertebral
Vesicular breath sounds
levels
Rhonchi
■ How to outline the anterior and posterior triangles of the
Pleural friction rub
neck
Bronchial breath sounds and late-inspiratory crackles
■ How to locate the cricothyroid ligament (membrane)
Late-inspiratory squeak
■ How to find the thyroid gland
Amphoric breath sounds
■ Where to take peripheral arterial pulses in the head and
Whispered pectoriloquy
neck
■ Testing eye movements – demonstration illustrating the
muscle involved in each activity. ASk tHe AutHOrS
This popular feature continues on into the seventh edition of
AnimAtiOnS Of prActicAl prOcedureS Kumar & Clark. It gives readers the opportunity to submit
This feature brings to life a selection of key practical proce- questions to the editors and to read the answers online.
dures in a way not usually possible outside the clinic or skills Readers can view the most recent questions, or can access
laboratory. Once again, the existence of the online version the complete list of questions and answers that have been
has made it possible to provide this unique feature, where logged on the site.
Contributors
Jane Anderson BSc PhD MB BS Charles Richard Astley Clarke Anthony J Frew MA MD FRCP
FRCP MA MB FRCP Professor of Allergy and Respiratory
Consultant Physician, The Centre for Honorary Consultant Neurologist, Medicine, Brighton and Sussex Medical
the Study of Sexual Health and HIV, National Hospital for Neurology and School, Brighton, UK
Homerton University Hospital NHS Neurosurgery, London, UK Respiratory disease
F
oof uCnedll aatniodn MTroulesct;u Plarro Sfecsiseonrc,e T, hBea Irnts titute ENnevuironlomgiecnatla dl imseeadsiceine EPrdowfesinso Ar Mof DGiaablet icM MBe FdiRcinCeP, University
and The London School of Medicine Juliet Compston MD FRCPath of Bristol, Bristol, UK
and Dentistry, Queen Mary University of FRCP FMedSci Diabetes mellitus and other disorders of
London, London, UK Professor of Bone Medicine, Department metabolism
sInefexucatiolyu str adnisemaisttesd, itnrofepcictioaln medicine and oSfc Mhoeodl icoifn Ce,l inUicnaivl eMrseitdyi coinf eC,a Cmabmribdrgideg, e; C
PhDris FtoRpChPer J Gallagher MBChB
John V Anderson MD MA MBBS Honorary Consultant Physician, Consultant Medical Oncologist, St
FRCP Addenbrookes’ NHS Trust, Cambridge, Bartholomew’s Hospital, Barts and The
Consultant Physician, Homerton UK London NHS Trust, London, UK
University Hospital NHS Foundation Bone disease Malignant disease
DaTL
mTanorieaudntbsa d tTDeb ;ot aheoeHnnenls,iosd t Limnm soBotenrnaryladlri,tr ousQynsn auS ,Sa neUndcenKdhn iTo o oMhro teLhla eorLycrfo tMdUnuidrnseoidvrrn eidca rNeitsn rBiHesty aSo ro tf sf ARUIB(MnEaensnenaritdvntidtgseiuic ere)tais rne Bn ieC tindoyD a ufCo TnSHsfhld i ehnLe( aioDH icLnlntaeohgdln n nCo StdPisnsocot,h)imr enLyDn m,oS c QncuFedhunsDoe icEnSoead,nlRt uoUi oMcCfKn a StSriyo k nil,s , AMEDoF
EnfmRil sBavBeCirsiCaroimdPstnhueamainsBsit eg,rPh nh FSrM taocFRamfhlaF eCmo,scP oPsBeIHlon d iro(rimt Lc fFo iMoinfMns enIgehnehdf eadGi cc&mSietni ,ocedE Uu,id dsUKe insi)v eCrsBitEy
Nicholas Harry Bunce BSc MBBS Communication
C
H
CMoeaDrandlstiohuvcltasrnect uNClaHar rSd isoTelrouagsiets, tL, oSnt dGoeno, rUgeK’s ASHeonndiorrea Lrwye c CDtuoarnevsriu einltsa M nMte, dRCicaCanlP cOe Pnr chSoeDlrovgicye asn d TMChoenu rsnseutpydlet aHcynidoatls d Eps NeiHtnaTasl ,Se rBsruirreigseh otFonnR, ,R CUoSKya Ml SSucssex
Division, Southampton General Hospital,
Andrew Kenneth Burroughs Southampton, UK Charles Hinds FRCP FRCA
MBChB (Hons) FRCP Malignant disease Professor of Intensive Care Medicine,
P
F
LCHDirveoeoepsnefrpeas, Susritbtsahlmtiloalei,ae rnilLr anytoo tPfS tn roHhahdfyc eoSstprn liuoca, rinctUagodkneKl o rLpaygianv,y nedR, cr To HrCheyeaeptl n iRacFtrt oreodey,lieo asa elg naisdst e, LMUEBmaenerindvetseir ci Drtaisunnoisetdy y P a aoTrnfohld LfeB eoD sLAnesod nonMotrdi nsoSot,fr n cLyM ,oS eQncdhuiocenaoe;lnl EoP Mtfr hoaifcreyss ,s or aWaLTInnortuiedlnlsin datTDsm,o hievLn enHo, tLnaciasodnartvnrdroeyed n, By o,mQ aRnUeru etKSdessice ceahniano reMdco hlaT orhIynfe sMU Ltinetouidvnteiedcr,ois nBniet ya N rotHsf S
of Healthcare Ethics, University of East
A John Camm MD FRCP Anglia, Norwich, UK Stephen T Holgate BSc MB BS
Professor of Clinical Cardiology, St Ethics MD DSc FRCP FRCP (Edin) FRC
G
U
CKaerodrigoeva’ss,c Uulnairv edriseitay soef London, London, FPMrRoaCfreisPnsoosr oEf lCialin BicSalc N (uHtroitinons )a MndD PMI
MmaeRmdtChuic n CiFnoleiIpnB,hi cUiaaonrlm liP vFaeroMcrsfoeitelsoyds gooSyfr , cS oSiofc uhtohoaml opf ton,
Anthony W Clare MD FRCP Metabolism, University of Southampton, Southampton, UK
FRCPI FRCPsych MPhil Southampton, UK Respiratory disease
(deceased) Nutrition
P
IFP
Proeslyryamcnhedoiraloytr gyiAsi,cts ,Das Slou mtcb Pileainadt etiUcr iPicnrkievo’esfer sHsistoyos;r p Coitofa nl,s Duultabnlint , BLGHPoaoaenrsntdtesoro rani nnrD,ty deU sCFTKtoiahnneiars l Lcudolitosnaedunaotgs nGeh aN MsHtrSDo e TFnrutResrCto, Plogist, ETCI
ELnenrofidedrcnmoevscusaortrlritreinyna r,eAno N Utldo HnPigsihSvieosey atwTsr,ss ireLcluiteiysait tcnHt, e LaoMsensteidpDcr ie t RasFltosRey roCa, flU PK
LMD
EHTonheoivennci drtoLohiosronatnnrmre,yyd ,eLl o SnQoLntenua nSdCle iomcoelnhanre ,o Lrd MkUoeiclac K iMorntyufe rDMUer ne,Fi dvBReicarCirsntiPesty a onfd PDFoRfrRio voMiCgfseoioesPlensraco oFutrhf li oanI nrfF c fIMenFhcfePe tFdicMoiRtcuioasCul DsPS icD sFieeisRanescCaeessPse,, s S(F,E cahdcouinoltyl) PASRPsrchaoshDyfooemco sCisla ootBenrf iHodDofe el K BaMlinrtohu,Im BRsaenieodds ilIec lSaFeaorlRs ccS hSiBca, iCleS aSnccd iee Msn,cS ecs ,
of Medicine and Health Sciences, The Middlesex University, Hendon, UK
University of Nottingham, Nottingham, Molecular cell biology and genetic
UK disorders
Infectious diseases, tropical medicine and
sexually transmitted infection