Index to Davidson Principles and Practice of Medicine - 4

1149 Nervous system anatomy and physiology 1148-1153 cells I 148 clinical examination I 146-1 148 older people 1149 enteric 858 see also Autonomic nervous system: Peripheral nervous ystem Nervous system diseases cerebrovascular disease 1200-1212 cranial nerves 1248- 1249 degenerative 1216-1224 HIY-related 391-395 infections 1224-1234 inflammatory 1212-1216 injecting drug users 292 intracranial/raised intracranial pressure 1234-1241 investigations 1153-1160 muscle 1254, 1256 neuromuscular junction 1252-1253 paraneoplastic 1238-1239 peripheral nervous system 1246-1252 hereditary diseases 1251 presenting problems 1160-1200 spine/spinal cord 1241-1246 see also Neuropathy Netilmicin 151 ettlerash 1270-1271 for detailed entry see Urticaria Neural tube defects (NTD), prevention, folic acid 125 Neuralgia 1163 migrainous 1163 post-herpetic 306, 1164, 1186 trigeminal 1164, 1248 Neuralgic amyotrophy 125 I Neurasthenia 250 Neuro-endocrine tumours (NETs) 791-792 pancreatic 791 NEURODI/~2 815 eurofibroma 1236 eurofibromatosis 725, 1237-1238, 1307 gene test 52 inheritance 52 Neurofibromin 49 Neuroglycopenia 823, 824 Neuroleptic malignant syndrome 244 Neuroleptics see Antipsychotics Neurological disease see Nervous system diseases Neurological failure 189 Neuroma acoustic 1237, 1238 Morton's 1082 Neuromuscular diseases, genetic 52 Neuromuscular junction 115 I disorders 1252-1253 Neuromyelitis optica 1216 Neuronectomy, multiple sclerosis 1216 Neurons I 148, 1149 motor 1152, 1178 lesions 1178-1179, ll80, I 18 I europathy autonomic 844, 845 axonal 1246-1247, 1249, 1250-1251 chronic renal failure 490 critical illness 199 demyelinating 1246, 1247, 1249, 1250 diabetic 837, 843-844 entrapment 1104, 1246, 1247, 1248 focal (mononeuropathy) 1246, 1247-1248 generalised (polyneuropathy) 1249 leg ulceration 1278 motor and sensory, hereditary 45, 46,52 multi focal 1249 multi focal motor 1250 optic 42, 52 peripheral 1246-1252 leprosy 334, 337 rheumatoid arthritis 1104 sensorimotor peripheral 1239 sensory 1239 HIY-related 394 subacute motor 1239 see also Mononeuropathy; Polyneuropathy Neuropeptides 1150 gut 858 Neuropeptide Y 858 europhysiology, clinical 1153-1155 eurosyphilis 412, 413, 1233-1234 eurotensin 859 Neurotransmissionl Neurotransmitters 1149, 1150 psychiatric disorders 229 eutrons 99 Neutropenia 1014 acute leukaemia 1042 causes 1006 drug-induced 1014 fever in 293 Neutrophil chemotactic factor 84 Neutrophilia 78, 1015 asthma 673 causes 1006 Neutrophils 65--66, 1003-1004, 1004,1005, 1006 asthma 671, 672 function and dysfunction 72 older people 1010 evirapine 397,398,399,400-401 HL (non-Hodgkin's lymphoma) see Linder Lymphoma Niacin (nicotinic acid; vitamin B3 121, 124 deficiency 121, 124 dietary sources 121, 124 hyperlipidaemia 450, 45 I Nicardipine, angina 585 Niclosamide 370, 371 Nicorandil 585 Nicotinamide 124 - Nicotinamide adenine dinucleotide phosphate (NADPINADPH) 124, 1005 icotine replacement therapy 98 Nicotinic acid see Niacin Niemann-Pick disease 444 Nifedipine altitude illness 104 angina 585 unstable 590 aortic regurgitation 628 hypertension 613 oesophageal disorders 882 older people 28 Raynaud's disease 604 sphincter of Oddi dysfunction 997 ifurtimox 356 Night blindness 122 ight sweats 285 Night terrors 1177 ightrnares 1177 Nipah virus 312 NIPPy (non-invasive positive pressure ventilation) 193, 194 Nitrates angina 584-585 post-infarct 598 unstable 590 long-acting, prescription 26 myocardial infarction 597 oesophageal disorders 882 Nitric oxide (NO) 186,858, 1150 anal fissure 933 inhaled 196 itrites 208 Nitroblue tetrazolium reduction test (NBT) 71 Nitrofurantoin 154 urinary tract infection 469 Nitrogen mustard, prostate cancer 512 Nitrogen narcosis 106 Nitroglycerin, myocardial infarction 597 Nitroimidazoles 153-154 Nitroprusside, circulatory effects 192 Nitrosamines, diabetogenic effect 812 'Nits' 1298 Nizatidine 889 K (natural killer) cells 68 NMDA (N-methyl-D-aspartate), Alzheimer's disease I 189 NRTls see on-nucleoside reverse transcriptase inhibitors NNT B (number needed to treat for benefit) 19-20 NNT H (number needed to treat for harm to occur) 19-20 NO see Nitric oxide Nocardia brasiliensis 373 Nocturia 473 Node of Ranvier 1148 Nodules hepatic 983, 986 skin, definition 1259 Non-adrenergic non-cholinergic (NANC) nerves 672 Non-alcoholic steatohepatitis ( ASH) 971, 972 Non-epileptic attack disorder (pseudoseizures) 1168, 1176 Non-Hodgkin's lymphoma see Lymphoma, non-Hodgkin's Non-invasive positive pressure ventilation (NlPPY) 193, 194 Non-maleficence 12 Non-nucleoside reverse transcriptase inhibitors (NNRTIs) 397, 399 resistance 40 I side-effects 398, 399 Non-specific interstitial pneumonia (NSIP)) 717 Non-specific urethritis (NSU) 406-407,415 Non-starch polysaccharides ( SPs; dietary fibre) 109-110,873 recommended intake III Non-steroidal anti-inflammatory drugs ( SAlDs) asthma association 671 cancer cachexia 280 contraindication, renal insufficiency 27 diabetes insipidUS 797 effect of hepatic impairment 27 effect on renal function 505, 506, 517 hepatotoxicity 973, 974 low back pain 1084 musculoskeletal disorder 1090-1091 ankylosing spondylitis 1108 gout 1114 osteoarthritis 1100 Non-steroidal anti -inflanunatory drugs (NSAlDs) (cont'd) musculoskeletal disorders (conl 'd) psoriatic arthritis I 110 reactive arthritis 1109 rheumatoid arthritis 1104, 1105 systemic lupus erythematosus 1134 pain management 276, 278 pancreatitis 908 and peptic ulcer 887- 888 platelet inhibition 1056 poisoning 209-210 recommendations for use 1091 sarcoidosis 716 side-effects 1090-1091 topical 1092 use in older people 1092 Noradrenaline 779, 858, 1150 circulatory effects 192 sepsis 199 Noradrenergic re-uptake inhibitors 238,241 Norepinephrine see Noradrenaline Norfloxacin 151 prophylactic 147 spontaneous bacterial peritonitis 950 urinary tract infection 469 Normal range, investigations 6-7 Normetadrenaline 1321 Normoblasts 1003, 1004, 1010 Norovirus 311 Nortriptyline, effect of hepatic impairment 27 Norwalk agent 31 I Nosocomial (health care-acquired) infections 134, 189, 190 Clostridiulll difficile 931- 932 control 138, 140 MRSA 313 pneumonia 639-640 Nosocomially acquired multidrugresistant tuberculosis (MORTB) 391 Notification cholera 330 diphtheria 332 food poisoning 326 Novice-expert shift 6 NRTIs see Nucleoside reverse transcriptase inhibitors NSAI0s see Non-steroidal anti-inflammatory drugs NSIP (non-specific interstitial pneumonia) 717 NSPs see Non-starch polysaccharides NSU (non-specific urethritis) 406-407,415 Nuclear antigens, extractable, antibodies to 82 Nucleo-cytoplasmic asynchrony 1027 Nucleoside reverse transcriptase inhibitors (NRTls) 394, 397-398 HTY-related tuberculosis 391 resistance to 398 side-effects 398 Nucleosomes 38, 39 Number needed to treat for harm to occur(~TH) 19- 20 Number needed to treat (NNT B), drug benefit assessment 19-20 Numbness 1183 Nutcracker oesophagus 882 Nutrients energy-yielding (macronutrients) 108- 110 recommended intakes III inorganic 125-126 Nutripharmaceuticals, musculoskeletal disorders 1092 utrition critical illness 197 cystic fibrosis 909 enteral/parenteral see LInder Feeding functional anatomy and physiology 108- 1 I I health and 109- 11 I overnutrition 109 undernutrition 109, 117- 118 Nutritional support ruti ficial I 19- 120 acute pancreatitis 906 Crohn's disease 918, 919 legal and ethical aspects 120-121 hospital patients 119-120 see also Feeding, enteral and parenteral Nutritional therapy, inflammatory bowel disease 918 Nystagmus 1196-1197 ataxic I 196 balance disorders 1166, 1193 Nystatin 154, 155 candidiasis 877 o OA see Osteoarthritis Obesity 111-117 abdominal 113 aetiology 112- 113 assessment 113 asthma and 671 atherosclerotic vascular disease and 580 complications 111-112 diabetes 818 management 831 type 2 813, 814 management 113- 117 dietary 657 musculoskeletal disease 1089 non-alcoholic fatty liver disease 971 Obidoxime 208, 218, 220 Obsessive-compulsive disorder (OCD) 240 Occipital lobes 1151 functions I 151, I 152 effects of damage 1152 Occupational diseases/disorders crrunps 1183 HIV infection/AIDS 401 immunisations 139 malignant 255, 705 respiratory asthma 671, 672, 673- 675, 720,721 dust-related 718-722 lung cancer 705 Occupational therapy, musculoskeletal disorders 1089 • OCO (obsessive-compulsive disorder) 240 Ochratoxin 505, 517 Octacalcium phosphate 1116 Octopus, blue-ringed 225 Octreotide 280,891,897,899,903 acromegaly 802 sulphonylurea overdose 211 variceal bleeding 960 Oculomotor (3rd cranial) nerve 1195, 1197 palsies 1195, 1196, 1197, 1198 tests 1147 Odds ratio, drug therapy 20 Odynophagia 864, 877, 879 Oedema 480-481 cerebral see Cerebral oedema cytotoxic 1202 famine 117 generalised 480-481 legs, respiratory disease 648 nephrotic syndrome 479 peripheral 426 differential diagnosis 545 heart failure 545 pulmonary see Pulmonary oedema OER (oxygen extraction ratio) 184 Oesophageal candidiasis, HlY/AIDS patients 386 Oesophageal cytomegalovirus infection, HIV / AIDS patients 386-387 Oesophageal variceal bleeding 958, 959-961 Oesophagi tis 867, 881 reflux 878, 879, 880 systemic sclerosis 1135 Oesophagus Barrell's (columnar lined) 879-880 carci noma and 879-880, 883 diseases 877-884 benign stricture 880, 883 high-grade dysplasia 879-880 motility disorders 881-883 reflux 877-881, 882-883 tumours 867, 879-880, 881, 883-884 functional anatomy 852 motility, tests 863 nutcracker 882 pain 536, 537 perforation 884 transection, varices 960 Oestradiol 763, 1319 Oestrogen 763 anti-androgen therapy 769 deficiency 765, 766 hepatotoxicity 973 as tumour marker 258, 261 Oestrogen replacement therapy delayed puberty 765 secondary amenorrhoea 766 Turner's syndrome 771 Ofloxacin 151, 512 gonorrhoea 414 leprosy 337 non-speci fic urethritis/chlamydial infection 415 Ogilvie's syndrome 931 OGTT (oral glucose tolerance test) 816,817 01 (osteogenesis imperfecta) 44, 52, 1068, 1141 Ointments 1312, 1313 Olanzapine 243, 244 Older people 160-171 antibiotic therapy 152 blood disorders anaemia 1030 haemostasis and thrombosis 1061 malignancies 1047 cardiovascular disease angina 591 aortic stenosis 626 atherosclerosis 603 atrial fibrillation 563 congestive heart failure 551 infective endocarditis 630 myocardial infarction 600 clinical assessment 160-161 comorbidities 165 critically ill 190 demography 162 diabetes mellitus 814 management 838 dizziness 168, I 165 drug therapy 26-28 endocrine pancreas disorders 792 endocrine system adrenal glands 785 parathyroid glands 776 pituitary and hypothalamus 802 reproductive medicine 769 thyroid gland 762 energy balance 118 environmental factors in disease 96 fever 289 frailty in 162, 164 gallbladder disease 997 gastrointestinal disorders acute abdominal pain 875 constipation 930 endoscopy 862 gastro-oesophageal reflux disease 880 infectious diarrhoea 326 malabsorption 898 peptic ulcer 890 genetic disease and counselling 58 haematological function 1010 hyperlipidaemia management 451 hypematraemia 431 hypertension 612 hyponatraemia 431 immune deficiency 75 incontinence 475 investigation 164-165 Comprehensive Geriatric Assessment 164 liver disease 986 micronutrient deficiency 122 musculoskeletal disorders bone infection 1118 goutll14 osteoarthritis I 100, 1102 osteomalacia 1128 osteoporosis 1126 Paget's disease I 130 rheumatoid arthritis 1106 neurological disease/disorders acute confusional state 1188 dizziness 1165 epi lepsy I 176 examination 1149 headache I 161 Parkinson's disease 1221 stroke 1206 visual loss 1195 NSAlD use 1092 oncology 256 oral health 877 poisoning/drug overdose 205 presenting problems 165-168 psychiatric disorders 235 rehabilitation 169-170 renal failure, acute 485 renal replacement therapy 495 respiratory disease infections 693 influenza vaccine 693 interstitial lung disease 720 lung cancer 711 obstructive pulmonary disease 684 pleural disease 736 thromboembolic disease 728 respiratory function 652 skin changes 1263 skin diseases 1260 eczema 1287 inflammatory 1293 tumours 1307 Older people (collt'd) social assessment 161 thermoregulation 100 urinary tract infection 470 Olecranon bursitis 1080, I 104 Olfactory (I st cranial) nerve, tests I 147 Oligoarthritis 1077-1078 associated extra-articular features 1078 asymmetrical inflammatory 1108, 1109 Oligoclonal bands 1214 Oligodendrocytes I 148 Oligodendroglioma 1236, 1237 Oligopeptides 855 Oliguria 189,475-476 acute renal failure 483 critically ill patients 197 Olsalazine 917 Omalizumab 86 Omeprazole 889, 890-891, 1091 Onchocerca volvuLus 363, 365 Onchocerciasis (river blindness) 297,298,365-366 Onchocercomas 366 Oncogenes 48-49 Oncogenesis 43, 48-50 Oncology 254-271 older people 256 Onychogryphosis 1283 Onycholysis 1283 psoriasis 1288, 1289 Oophoritis, mumps 302-303 OPG (osteoprotegerin) 1069, J070 Ophthalmia neonatorum chlamydial 415 gonococcal 413,414 Ophthalmopathy, Graves' disease 746,747, 756-757 Ophthalmoplegia chronic progressive 1255 internuclear 1195, I 196 Opiates diarrhoea 295 misuse 246 management 247 myocardial infarction 595, 598 pancreatitis 908 prescription 26 use in respiratory failure 667 withdrawal syndrome 246 Opioid peptides 1150 Opioids effect of renal insufficiency 27 gut 858 myths about 276 osteoarthritis 1100 pain management 275 cancer 276-277 poisoning 208, 214-215 side-effects 277 spider bites 223, 224 toxicity 277, 280 Opisthorchiasis/Opisthorchis felineus 370 Opisthotonus 1232 Opsoclonus 1239 Opsonins/Opsonisation 65, 66, 67, 69 Opthalmia neonatorum 141 Optic disc disorders 1198-1199 Optic fundal haemorrhage 1000, 10 17 Optic fundi, febrile patient 284, 291 Optic (2nd cranial) nerve, tests 1147 Optic neuritis acute transverse myelitis 1216 multiple sclerosis 1214 Optic neuropathy, Leber's hereditary 42, 52 OPV (oral polio vacci ne) 139 Oral allergy syndrome 902 Oral cancer 876-877 Oral cavity, common infecting organisms 133 Oral contraception/contraceptives acne treatment 1300 drug interactions 31 epilepsy and I 173, 1176 migraine and I 162, 1163 Oral disease, HIV-related 378, 384, 386 Oral glucose tolerance test (OGTI) 816, 817 Oral rehydration solution (ORS) 294-295, 330 Orchitis, mumps 302 Orf 1297 Organ donation 200 Organelles, intracellular 41, 42 Organochlorines 220 Organophosphate-induced delayed polyneuropathy (OPION) 218,220 Organophosphorus insecticides 208, 216-220 Organophosphorus nerve agents 216-217 Oriental sore 298, 352-354 Orientation, assessment 231 Orlistat 115,116 Orofaciodigital syndrome type I 53 Oropharynx examination, febrile patient 284, 285 Orphenadrine 1221 ORS (oral rehydration solution) 294-295,330 Orthomyxoviruses 299 Orthopnoea 539, 659, 660 Orthoses 1089 Oscillopsia I 196 Oseltamivir 156, 157 Osgood-Schlatter's disease 1081 Osler's nodes 630 Osmolality 428-429, 1320 hyponatraemia 429 430 Osmolarity 1320 Osteitis, periarticular 1106 Osteitis fibrosa 775-776 chronic renal failure 489 Osteoarthritis (OA; osteoarthrosis) 1077,1096-1100 aetiology/pathogenesi s 1097-1098 BCP crystal deposition II 17 clinical features 1098-1100 epidemiology 1096-1097 erosive 1098 investigations I 100 management 1100 nodal generalised 1098- 1099 older people 1100, I 102 prevalence 1068 radiology 1073 young-onset J 099-1 100 see also specific sites Osteoarthropathy, hypertrophic 1143 pulmonary 707, 709 Osteoblasts 1068, 1069 bone remodelling 1069, 1070 Osteochon~ritis, Scheuermann's 1085 Osteoclasts 1068, 1069 bone remodelling 1069, 1070 osteopetrosis I 131-1132 Paget's disease 1129 Osteocytes 1068, 1069 Osteodystrophy hepatic 978 renal 490, 1076 Osteogenesis imperfecta (01) 44, 52, 1068, 1141 Osteoid 1069, 1070 Osteolysis, famiJjal expansile 1129 Osteomalacia 1126-1129 after gastric resection 889 bone biopsy 1076 chronic renal failure 489 drug-induced 1142 malignancy and 1033 older people I 128 pain J087 vitamin O-deficient 1076 Osteomyelitis 318, 11 18, 1119 Osteonecrosis I I 18, I 119 drug-induced I 142 pain 1087 Osteopathy see Bone diseases Osteopenia 979, 1072, 1073, 1123, 1124 inflammatory bowel disease 919 s 1131-1132 and renal tubular acidosis 1132 Osteophytes 1072, 1073 Osteoporosis 40, 1121-1126 after gastric resection 889 biochemical abnormalities 1076 bone mineral density measurement 1123, 1124, 1126 chronic renal failure 489 drug-induced 1123, 1142 corticosteroids 676, 785, 1I22, 1123,1125 fractures 1086 inflammatory bowel disease 919 juvenile 1123 management 1124-1 126 men 1122, 1125 older people 1 126 post-menopausal 769, 1121-1122 pregnancy-associated I 123 prevalence 1068 prevention/prophylaxis 167 in prolonged glucorticoid therapy 785 rheumatoid arthritis 1103 secondary 1122-1123 Osteoporosis-pseudoglioma syndrome 1123 Osteoprotegerin (OPG) 1069, 1070 Osteosarcomas 271 Paget's disease 1130, 1131 Osteosclerosis 1072, 1132 chronic renal failure 489 malignancy and 1033 Osteotomy 1096 Otitis media 687, 688 Ovarian ablation, cancer treatment 267 Ovarian cancer familial 50 treatment 270 Ovaries failure 766 polycystic 766, 768, 769-770 Ovulation 763 Oxalate 1321 Oxazolidinones 154 Oxcarbazepine !l72, 1174 Oxidative stress 163 Oximes 218, 220 Oximetry 657 asthma 678 Oxybutynin, bladder dysfunction 1199, 1200 Oxycodone 277 Oxygen arterial blood 1318 cascade 183 consumption 184 oxygen delivery and 184-185 delivery global 182, 183 regional di tribution 182, 183 transport 182-183 Oxygen dissociation curve 1005 Oxygen extraction ratio (OER) 184 Oxygen saturation (Sp02) 182 at altitude 103, 104 Oxygen therapy 668-669 air passengers 104 altitude illness 104 asthma 677-678 carbon monoxide poisoning 216 chronic obstructive pulmonary disease 681, 682, 683 critically ill patient 193 decompression illness 107 gastrointestinal haemorrhage 867 hyperbaric carbon monoxide poisoning 216 spider bites 224 long-term, chronic obstructive pulmonary disease 682 organophosphorus poisoning 219 pneumonia 691 pulmonary embolism 727-728 respiratory failure 668, 669 spider bites 224 toxic effects 668 Oxyhaemoglobin dissociation curve 183, 184 at altitude 103 Oxytetracycline acne 1300 rosacea 130 I p p53 gene 49 Pabrinex 246, 1218 Pacemaker syndrome 577 Pacemakers, artificial 576-577 AV block in myocardial infarction 571 permanent 533, 577 sinoatrial disease 569 rate-responsive 577 sinoatrial disease 569 temporary 576-577 Pachyonychia congenita 1282 Pacing, cardiac 576-577 tachyarrhythmias 563, 568 Packed cell volume (PCY) 1322 Paclitaxel 266, 267, 389, 390, 396, 587 PAD (peripheral arterial disease) 601--608 Paget's disease 1129-1130 biochemical abnormalities 1076 extra mammary 1281 older people 1 130 pain 1087 radionuclide bone scan 1074 PAl (plasminogen activator inhibitor) 1009 Pain abdominal 275,873-876 for detailed entry see Abdominal pain acute, management 275, 276 assessment 274-275 bone 275, 1086-1087 bronchial carcinoma 707, 710 chest see Angina; Chest pain chronic, psychological aspects 274,275 classification 274 components 275 definition 274 facial 1160, 1164 fibromyalgia 1120 abnormal processing 1119-1120 headache 275, 1160-1164 Pain (cont'd) hepatobiliary disease cholecystitis 993 choledocholithiasis 994 gallst0!1es 992 incident 275, 276 ischaemic 275, 276 joints 1076---1079 regional periarticular pain 1079-1083 see also names of specific joints liver capsule 275 loin 470-471 low back 1083-1085, 1242 measurement 274-275 mechanisms 274 muscle 1087-1088 musculoskeletal 1067 management 1089 neck 1085-1086 neuropathic 274, 275, 276, 278, 1185-1186 nociceptive 274 osteoarthritis 1098, 1099 hip 1099 pancreatic cancer 910 perception 274, I 185 peripheral vascular disease 602 pleural 692, 732 bronchial carcinoma 707 psychological causes 876 renal colic 471 somatoform disorder 250 stress, wrist 1067 types 275 Pain management/treatment 274, 275- 278 acute pain 275, 276 cancer 275-278 see also Analgesia; Analgesics Pain pathway 274 PAL (physical activity level) 107, 114 Palivizumab 157 prophylactic 147 Palliative care 262, 263, 264, 274-282 chronic obstructive pulmonary disease 681 chronic renal failure 494 dying phase 280-281 non-malignant conditions 282 Palmar erythema 936 Palmarpustular pustulosis 1290 Palmitate 122-123 Palpation abdomen 937 respiratory disease 648, 649 Palpitation 554 Pamidronate bone metastases I 143 osteogenesis imperfecta I 131 Paget's disease 1033, I 130 polyostotic fibrous dysplasia 1132 PAN (polyarteritis nodosa) 1140 Pancoast's syndrome 707 Pancolitis 912, 920 Pancreas annular 908 congenital abnormalities 908-909 diabetes mellitus type 1811 type 2 813 divisum 908 endocrine 743 diseases 789-792 older people 792 function, tests 863, 871, 876 structure and function 810, 856---857 transplantation 91, 843, 846 tumours 909-910 endocrine 910 neuroendocrine 791 Pancreatic enzymes 854, 855, 856-857 cystic fibrosis management 909 Pancreatic pol ypeptide 810, 859 Pancreatic pseudocyst 904-905, 906,907,908 Pancreatic rests 894 Pancreaticoduodenectomy 996 Pancreatitis acute 774, 904-906 complications 904-905, 906 management 905-906 nutritional support 906 pleural effusion 665 prognosis 906 chronic 906-908 hereditary 52 necrotising 905, 906 risk, hyperLipidaemia and 447 Pancreolauryl test 863 Pancytopenia 1018, 10 19 Panic-breathlessness cycles 279 Panic disorder 240, 240 Pannus 1101 Pantoprazole 889 Papilla of Vater, carcinoma 995-996 Papillary carcinoma, thyroid 760-761 Papilloedema 1198, 1240-1241 haemorrhagic I 146 Papilloma basal cell 1302 definition 1259 Papillomaviruses 1295-1296 see also Human papillomavirus Papovaviruses 299 Papule. definition 1259 Papulosquamous eruptions l267-1269 Paracentesis, ascites 948, 949 Paracetamol effect of hepatic impairment 27 hepatotoxicity 973, 974 migraine 1162 musculoskeletal disorders 1090, 1092 osteoarthritis I 100 pain management 276 poisoning 204, 208-209, 517 acute liver failure and 952, 953 antidotes 208 upper respiratory tract infection 688 Paracoccidiodomycosis 375 Paraesthesia I 183, 1184 diabetic neuropathy 843, 845 peripheral neuropathies 1248, 1250 Parainfluenza viruses 689 Paraldehyde 233 epilepsy 1174 Paralytic ileus 904, 906 Paralytic shellfish toxin 331 Paramomycin 351, 354, 389 Paramyotonia congenita 1256 ParamyxoviMes 299 Paraneoplastic disease, neurological 1189, l238-1239 Paraparesis 1179-1180, I 181 Paraphasia 1191 Paraplegia, hereditary spastic 52, 1245 Parapneumonic effusion 732 Paraproteinaemias 1051-1054 Paraproteins 1051-1052 Paraquat 220 Parasellar tumours 797, 798, 799 Parasitic infections eosinophilia 297 HTV / AIDS patients 385 nervous system 1225 Parasitosis, delusional 249 Parasomnias 1177 Parasympathetic nervous system 1153 Parathormone-related peptide 260 Parathyroid glands 743 diseases 772-776 classification 773 functional anatomy and physiology 772 investigations 772 older people 776 Parathyroid hOnl10ne (PTH) 771,772 hyperparathyroidism 775 osteoporosis 1126 reference values in venous blood 1319 rickets/osteomalacia 1127, 1129 serum, bone disease 1076 Parathyroidectomy, primary hyperparathyroidism 776 Paratyphoid fever 141, 342-345 Parenteral nutrition 119-120 total 197, 899 Parietal lobe 1151 functions 1149,1151,1152, 1190, I 192 effects of damage 1152, I 191 Parinaud's syndrome 1192 Parkinsonism 1221-1222 drug-induced 1221 Parkinson's disease 1218-l221 management 1219-1221 movement disorders 1180, 1181 older people 1221 pain 1082-1083 Paronychia 1282 Parotitis 877 Paroxetine 241 Parthenogenesis 47 Partial thromboplastin time with kaolin (PTTK) 10 I 0 Parvovirus B 19 see Erythrovirus 19 Past-pointing 1179 Pastes 1312, 1313 Pastia's sign 314, 315 Patau's syndrome (trisomy 13) 47 Patch tests, hypersensitivity 1264, 1286 Paterson-Kelly syndrome 883 Pathergy reaction 1142 Patients autonomy 11-12 decision making 9 relationship with doctor 4-5 ethical issues 11-12 Pauciarticular disease see Oligoarthritis Paul-Bunnell test 307 PAVMs (pulmonary arteriovenou malformations) 1056 PAWP (pulmonary artery wedge pressure) 180, 187,541 monitoring 534 PCI (percutaneous coronary intervention) 586-587, 588-589,596 PCNSL (primary CNS lymphoma) 392-393 PCOS see Polycystic ovarian syndrome PCP see Pneulllocystis carinii PCR see Polymerase chain reaction PCT (porphyria cutanea tarda) 451, 452, 453, 1308 PCV (packed cell volume) 1322 PCV (pressure controlled ventilation) 193 POB see Paget's disease PDT see Photodynamic therapy PE see Plasma exchange Peak expiratory flow (PEF) 656 asthma 671, 673, 675, 676, 677, 678 morning dipping 673 Peak flow meters 656, 673 Peanut allergy 88 Pectins 110 Pectus carinatum (pigeon chest) 737 Pectus excavatum (funnel chest) 737 Pediculus humanus capitis 1298 Pedigree, genetic information 53-54 PEEP (positive end-expiratory pressure) 193, 195 PEF see Peak expiratory flow PEG (percutaneous endoscopic gastrostomy) 119, 120 Peginterferon 157 Pegvisomant 802 Pellagra 124, 1272 Pel vi-ureteric junction obstruction 466,508 Pelvic floor exercises, faecal incontinence 932-933 Pelvic inflammatory disease (PID) 410,414,415 PEM (protein-energy malnutrition) 117 zinc deficiency 127 Pemphigoid, bullous 1275 Pemphigoid gestationis 1267, 1275 Pemphigus 1275-1276 paraneoplastic 1275 Pemphigus vulgaris 1275 Penciclovir 156 Pendred's syndrome 745,751,762 Pendrin 745, 762 Penetrance 52 age-related 58 Penicillamine adverse effects on kidney 517 rheumatic disease 1093 side-effects 1093 stone disease 472 Wilson's disease 976 Penicillin(s) 147,148 adverse reactions 29, 148 anthrax 332 contraindications 22 diphtheria 332 effect of renal insufficiency 27 leptospirosis 322 listeriosis 324 nephrotoxicity 517 neurosyphilis 1233 penicillinase-resistant 147 platelet inhibition 1056 prophylactic 147 sickle-cell disease 1037 soft tissue infections 316 streptococcal infections 314 rheumatic fever 617, 618 syphilis 386, 413 tetanus 1233 tropical ulcer 299 see also Benzylpenicillin; Procaine penicillin Penile erection 1200 see also Erectile dysfunction Pentamidine 351, 354 Pneumocystis carinii pneumonia 389,390 trypanosomiasis 355 Pentoxifylline 971 Pepsin 855, 887 Pepsinogen 853 Peptic ulcer 885-891 bleeding from 867 complications 889-890 management 887-889 adjunctive drug therap) 68 surgery 868 Peptic ulcer (cont'd) NSAlD-induced L090, L091 older people 889 perforation 889 management 875 Zollinger-Ellison syndrome 890 Peptides 855 antimicrobial 65 Peptide YY 859 Peptostreptococcus spp. 315 Perception(s) abnormal 231, 232- 233 delusional 243 disorders 1191- 1192 Percussion, respiratory disease 648, 649 Percutaneous coronary intervention (PCl) 586-587, 588- 589 myocardial infarction 596 Percutaneous endoscopic gastrostomy (PEG) I 19, 120 Percutaneous transhepatic cholangiography (PTC) 941-942 Perfloxacin 337 Perforin 68, 70 Pergolide Parkinson's disease 1221 prolactinomas 800 Pericardial effusion 644, 645 tuberculous 698, 699, 702 Pericardial friction rub 644 Pericardial (cardiac) tamponade 526,540,542,598,645 Pericarditis 617 acute 644--645 chronic renal failure 489 constrictive 983 chronic 645-646 myocardial infarction 598 pain 537 rheumatoid arthritis 1104 tubercu lous 645, 698, 699, 702 Pericardium, aspiration 645 Perimysium 1071 Perinephric abscess 470 Perineum examination, gastrointestinal disease 850 Periodic fever syndromes 78-79 Periodic paralysis hyperkalaemic 1256 hypokalaemic 1256 Periostitis 1106 Peripheral arterial disease (PAD) 601~8 Peripheral nerves 1I52- 1 153 diseases 1246-1252 lesions 1183, I 184 Peripheral nervous system 1152-1153 Peripheral neuropathy 1246-1252 diabetic 843- 844, 845 hereditary 1251 HIV-related 394 leprosy 334, 337 rheumatoid arthritis 1104 Peripheral oedema 426 Peristalsis 852, 853, 857-858 Peritoneal cavity, tumours 934 Peritonitis 874, 889, 934 CAPO 495 chemoprophylaxis 147 spontaneous bacterial 147,950 tuberculous 699 Permelhrin 347, 348, 386 louse infestation 1298 scabies 1297-1298 Pernicious anaemia 1012, 1028-1029 Peroneal nerve palsy 1248 Peroxisol11es 42 Persistent generalised lymphadenopathy (PGL) 383 Personal and professional development (PPO) 6 Personality atherosclerotic vascular disease and 580 changes in 1190 and psychiatric disorders 229 Personality disorder(s) 247-248 prevalence 228 Pertussis see Whooping cough Pes cavus 1082 Pes planus 1082 Pesticides 216-220 PET see Positron emission tomography Petechiae, definition 1259 Pethidine cholecystitis 993 effect of hepatic impairment 27 misuse 214-215 pain management 277 renal colic 472 Petit mal I 168 Petroleum distillates, poisoning 219 Pets, and asthma 671, 675 Peutz- Jeghers syndrome 50, 903, 924, 925, 1281 Peyer's patches 69, 856 PGL (persistent generalised lymphadenopathy) 383 pH monitoring, gastro-oesophageal reflux 880 Phaeochromocytoma 513, 787-789 Phagocyte deficiencies 71-72 Phagocytes 65-66 Phagocytosis 65- 66, 68 Phagolysosome 65, 66 Pharmacogenomics 38, 59-{i0 Pharyngeal pouch 881 Pharyngi tis rheumatic fever 616 role of antibiotics 137 Phenaceti n 506 Phenelzine 241 Phenobarbital effect of hepatic impairment 27 epilepsy 1172, 1173, 1174 Phenothiazines 238, 243 hyperpigmentation from 1281 Phenoxybenzamine 788 Phenoxymethylpenicillin 147, 148 anthrax 332 cellulitis 1295 prophylactic 147 rheumatic fever 618 Phentolamine, phaeochromocytoma 788 Phenylalanine 110,442 Phenylbutazone, platelet inhibition 1056 Phenylketonuria 442, 1280 inheritance 52 Phenytoin drug interactions 31 effect of hepatic impairment 27 epi lepsy 1172-1173, I 175 muitipleosclerosis 1216 plasma concentrations 34 trigeminal neuralgia 1164 Phialophora verrucosa 373 Philadelphia (Ph) chromosome 47, 48, 1044 Phobias 239-240 Pholcodine 688 Phosphate 421, 437 deficiency 126, I 128-1129 intake, chronic renal failure 490 metabolism 441 disorders of 421, 441 442 regulation 1128 reference values urine 1321 venous blood 1320 serum, bone disease 1076 supplements 442 rickets 1129 see also Hyperphosphataemia; Hypophosphataemia Phosphenes 1195 Phosphodiesterase inhibitors, erectile dysfunction 477 Phosphofructinose deficiency 1255 Phospholipase A 136 Phospholipids 854 Phosphorus diet 126 radioactive, myeloproliferative disorders L055 Photochemotherapy, psoriatic arthritis 1110 Photocoagulation laser 841 retinal 841 Photodynamic therapy (PDT) 862, 1314 Barrett's oesophagus 879 oral cancer 877 skin cancer 1303, 1304 Photosensitivity 1271-1273 drug-induced 1311 porphyria 453 Phototesting, skin disease 1264 Phototherapy pruritus 1267,1268 psoriasis 1289 vitiligo 1280 Phrenic nerve paralysis 707, 712 Phrygian cap 997 Physical activity level (PAL) 107, 114 Physiotherapy aspergillosis 704 bronchiectasis 685 cancer patients 278 cystic fibrosis 686 headache I 162 leprosy 338 low back pain 1084 multiple sclerosis 1216 osteoarthritis 1100 Parkinson's disease 1221 pneumonia 692, 694 PIs see Protease inhibitors Pick's disease 1189, 1218 Picornaviruses 299 PID (pelvic inflammatory disease) 4LO, 414, 415 Pigeon chest 737 Pigmentation disorders of 1279- 1280 drug-induced 1281, 1311 Pi les (haemorrhoids) 850, 869, 933 Pimecrolimus 1287 Pi mozide 243 Pineal tumours 1236, 1237 'Pink puffers' 680 Pinta 317, 413 Pioglitazone 833 Piperacillin 147,148 neutropenic sepsis 293 Piperazine 362, 363 Piracetam epilepsy 1172, 1175 myoclonus 1183 Piroxicam 1091 Pituitary apoplexy 798 Pituitary gland diseases 792-796 anterior pituitary hormone deficiency 794-796 classification 793 investigation 793- 794, 795 older people 802 tumours see Pituitary tumours functional anatomy and physiology 792- 794 Pituitary hormones 742 Pituitary tumours 793, 794, 797-799, 1236, 1237 Cushing's syndrome 779, 782 identification 793- 794, 795 treatment 799 TSH-oma 744 visual field defect 797- 798, 799 Pi tyri as i s rosea inverse 1268 rash 1267-1268, 1269 Pityriasis rubra pilaris 1269 Pityriasis versicolor 1264 rash 1268, 1269 Pityrosporum orbiculare 1264 Pityrosporum ovale 1285 Pizotifen, migraine prevention 1163 PKO (polycystic kidney disease) 506-507 Plague 141, 322-323 immunisation 138 Plant toxins 331, 517 Plantar fasciitis 1082 Plantar warts 1296 Plaques atheromatous 578, 579 skin definition 1259 erythematous 1259 Plasma fresh frozen 1021 virus-inactivated 1021 viscosity 77 Plasma derivatives LO 19 Plasma exchange (PE) myasthenia gravis 1253 peripheral neuropathies 1250 thrombotic thrombocytopenic purpura L057 Plasma membrane see Cell membrane Plasmapharesis 979, 1216 Plasmin 1009 Plasminogen 1009 Plasminogen activator inhibitor (PAl) 1009 Plasmodium spp., life cycle 343, 344 Plasmodium jalciparum infection 342,343,344,345 chloroquine resistance 343, 346 clinical features 344 345 diagnosis 346 management 346-347 Plasmodiulll malariae infection 342,343,344,345,347 Plasmodium ovale infection 342, 343,344,345,347 Plasmodium vivax infection 342, 343, 344, 345, 347 Platelet-activating factor, allergy 84 Platelets 1002, 1007-1008 concentrate 1019, L021 contamination L023 count 1009, LOtO, lOll high 1017,1055 low 1017 disorders LO II functional 1056-1057 formation 1004 function assessment 1011 drugs inhibiting 1056 reference values 1322 transfusions acute leukaemia 1041, 1042 platelet functional disorders 1056 Platinum-based chemotherapy 710 Plethysmography 680 Pleura, bronchial carcinoma 707 Pleural aspiration 655, 665 Pleural biopsy 655, 665 • bronchial carcinoma 709 Pleural disease 732-736 asbestos-related 721, 735- 736 drug-induced 724 older people 736 Pleural effusion 664 666 asci tes 947-948 benign 735 bronchial carcinoma 706, 707, 709 causes 664, 665 connective tissue disorders 722-723 diffuse 735 febrile injecting drug user 290, 291 oedema 480 pneumonia 732 signs 649 tuberculosis 696, 698 Pleural pain 692, 732 bronchial carcinoma 707 Pleural rub 732 febrile injecting drug user 290, 291 Pleurisy 732 connective tissue disorders 722 tuberculous 696 Pleurodesis, pneumothorax 735, 736 Plexopatby 1246, 1251 Plumboporphyria 451, 452 Plummer-Vinson syndrome 883 PMFL (progressive multi focal leucoencephalopathy) 393 PMNs (polymorphonuclear cells) 185-186 PMR see Polymyalgia rheumatica Pneumatosis cystoides intestinal is 932 Pneumococcus see Streptococcus • pneulllomae Pneumoconiosis 720, 721 Pneumocystis carinii (jiroveci) (PCP) infection 389-390, 401 acute leukaemia J 042 bone marrow transplants 1044 immunocompromised patients 695 Pneumocytes 651 Pneumonia 689--{j95 aspirational 694, 722 malaria 345 assessment of severity 691, 692 bronchial carcinoma 706, 707 clinical features 689, 693, 694-695 community-acquired 689--{j93 antibiotic therapy 691-ti92 microbiological investigations 690,691 complications 692 connective tissue disorders 722 cryptogenic organising (bronchiolitis obliterans) 717 differential diagnosis 661, 690 eosinophilic 723-724 HIV/AlDS patients 389- 390, 391 hospital-acquired (nosocomial) 693-ti94 hypostatic 693 in immunocompromised patient 694-695 interstitial 717-718 investigations 689-ti91 lobar 690, 691 management 691-ti92, 693-ti94, 695 middle lobe, signs 649 pleural effusion 732 Pneumocystis carinii see Pneumocystis carinii infection prevention after measles 301 suppurative 694 tuberculous 697 viral 689, 690, 691 immunocompromised patients 695 Pneumonitis hypersensitivity 714, 715, 718-720 interstitial, bone marrow transplants 1044 radiation 724 Pneumothorax connective tissue disorders 722 pain 535 signs 649 spontaneous 733-735 older people 736 recurrent 735 tension 734, 735 POCT (point-of-care testing) 420 Podagra 1112, I I 13 Podiatry, diabetics 845 Podocytes 458, 459 Podophyllin 386, 1297 Podophyllotoxin cream 418 Poikilocytes, teardrop 1055 Point-of-care testing (POCT) 420 Poisoning, acute 204-226 antidotes 208 chemicals and pesticides 216-221 clinical features 204, 205 contact numbers 226 drugs 204-215 of misuse 212-215 envenomation 221-226 environmental 226 general management 206-208 history taking 204 laboratory screening 204-205 marine animals and 225-226 in old age 205 prevention 206 psychiatric assessment 205- 206 substances involved 204 websites 226 see aLso Food poisoning; Venoms Poliomyelitis 1230 immunisation 138, 139, 1230 incubation period 135 Pollens 729 Polyangiitis, microscopic 515, 1141 Polyarteritis nodosa (PAN) 1140 Polyarthritis 1077-1079 associated extra-articular features 1078 symmetrical I 109 Polychromasia 1003, 10 10 Polycystic hepatorenal disease 988 Polycystic kidney disease (PKD) 506-507 autosomal t10minant 45, 46 inheritance 52 Polycystic ovarian syndrome (PCOS) 766, 768, 769-770 acne 1300 Polycythaemia 1014 Polycythaemia rubra vera (PRV) 1054, 1055 Polydipsia 430, 472 diabetes insipidus 797 Polyenes 154--155 Polyethylene glycol 208 Polymerase chain reaction (PCR) 142 genetic diseases 51, 52 leishmaniasis 350, 351, 354 leptospirosis 322 Lyme disease 320 meningitis 1227 tularaemia 325 viral hepatitis 965, 966 Polymorphisms 39, 44, 59 restriction fragment length 51 single-nucleotide 44, 59 Polymorphonuclear cells (PMNs) 185- 186 Polymyalgia rheumatica (PMR) 1083, 1087, 1139 management, DMARDs 1093 prevalence 1068 Polymyositis 82, 1078, 1083, 1136-1137, 1239 respiratory complications 722 Polyneuropathy 1249 acute inflammatory demyelinating see Guillain-Barre syndrome chronic 1250-125 I critical illness 199 demyelinating 1250 organophosphate-induced delayed 218, 220 symmetrical sensory, diabetics 843 Polyostotic fibrous dysplasia 1132, 1307 Polypectomy 862 colonoscopic, colonic polyps 923 Polypeptides 859 Polypharmacy, older people 167-168 Polyposis, juvenile 924 Polyposis syndromes 923-924 see aLso Familial adenomatous polyposis Polyps colonic 923-925 gastric 894 Polysaccharides non-starch (dietary fibre) 109-110, 111,873 starch 109 Polyuria 472-473 diabetes insipidus 797 . Pompe disease 443 Pompholyx 1286 Popliteal cysts see Baker's cysts Popliteal nerve palsy 844 Porpbyria cutanea tarda (PCT) 451, 452, 453, 1308 Porpbyrias 451-453, 1272 acute intermittent 52, 451,452 congenital erythropoietic 451, 452 skin lesions 1308 variegate 451, 452, 1308 Porphyrins 451 Portal circulation 458 Portal hypertension 957-962 Portal venography, bepatic 942 Portal venous pressure measurement 957-958 reduction 960 Portal venous thrombosis 982 Portasystemic encephalopathy see Hepatic encephalopathy Portasysternic shunts 949, 950, 958, 960,961,962,983 Portopulmonary bypertension 949, 962 Posaconazole 155 Positive end-expiratory pressure (PEEP) 193, 195 Positron emission tomography (PET) myocardial 534 nervous system 1156 respiratory disease 654 Post-cholecystectomy syndrome 996 Post-myocardial infarction syndrome 598 Post-partum 'blues' 251 Post-traumatic stress disorder (PTSD) 239 Posterior descending artery 522, 523- 524 Postural drainage, bronchiectasis 685 Postural hypotension 167,482,554, 844,845 hypopituitarism 795 management 167 multiple systems atrophy 1221-1222 Posture examination 1147 Parkinson's disease 1218, 1219, 1221 Potassium 421 daily requirements 425 depletion, diabetic ketoacidosis 821 disorders of balance 421, 431-436 intake acute renal failure 485 chronic renal failure 489 reference values urine 1321 venous blood 1318 renal handling 432 replacement 434 ROMK channel 422,423,432 supplements 434, 678, 1042 see also Hyperkalaemia; Hypokalaemia Potassium channel activators, angina 585 Potassium chloride, diabetes 211, 822 Potassium iodide 100, 373 Graves' disease 755 Potassium perchlorate 759 Potassium phosphate 442 Pott's disease 699 Poverty, health consequences 97 Poxvirus infections 306 Pox viruses 299 PPAR-aJy agonists see Thiazolidi nediones PPD (personal rofessional development) Practolol, nephrotoxicity 5 Prader- Willi syndrome 47,54, 113 Praecordium, palpation 521 Pralidoxirne 208, 220 Pramipexole 1221 Prayer sign 807 Praziquantel cysticercosis 370, 371 hydatid disease 372 liver flukes 370 schistosomiasis 369-370 Prazosin 225, 613 Prednisolone autoimmune hepatitis 978 blood disorders acute leukaemia 1042 autoimmune haemolysis 1034 Hodgkin's disease 1049 idiopathic thrombocytopenic purpura 1056, 1057 non-Hodgkin's lymphoma 1051 cysticercosis 371 eosinophilic gastroenteritis 901 - • Prednisolone (conI 'd) facial nerve palsy 1249 fi lariases 366 histoplasmosis 374 inflammatory bowel diseasc 917, 918 leprosy reactions 338 liver transplant patients 990 musculoskeletal disorders juvenile idiopathic arthritis 1023 myositis 1136-1137 rheumatic disease 1095 rheumatoid arthritis 1105 systemic lupus erythematosus 1134 vasculitis 1139, 1140, 1141, 1142 orchitis 303 renal disease glomerulonephritis 500 tubulo-interstitial 505 renal transplantation patients 495 respiratory diseases aspergi lIosis 704 asthma 676, 677, 678 chronic obstructive pulmonary disease 683 cryptogenic eosinophilic pneumonia 724 interstitial lung disease 718, 720 pleural effusions 723 rheumatic fever 618 syphilis 413 thyroiditis 757 tuberculous pericarditis 645 Pre-eclampsia 516 Pregnancy air travel 104 congenital heart disease and 636 cytomegalovirus infection 308 diabetes and 813, 814, 815, 818, 826-827 dopamine agonist therapy 800-801 ectopic 409 epilepsy and 1173, I 176 folate deficiency/supplements 1028, 1029 glycosuria 815 hypothyroidism 752 inflammatory bowel disease 919 iron deficiency 1026 kidneys in 515-516 listeriosis 323 liver disease ~d 987-988 malaria management 346 prophylaxis 347 Marfan's syndrome 606 osteoporosis 1123 pre-eclampsia 516 pruritus 1267 rhesus D negative women 1022 rubella in 30 I sexually transmitted infections anogenital warts 417 genital herpes 417 syphilis 412, 413 testing for genetic disease 56, 57 thyrotoxicosis 750, 756 toxaemia 988 toxoplasmosis 357, 358 Preload 191, 525, 543 heart failure 543 increasing 193 Premature beats 561,566-567 Prepatellar bursitis 1081 Presbyopia 1195 Prescription see Drugs, prescription Pre sure controlled ventilation (PCV) 193 Pressure sores 1298-1299 stroke patients 1207 Pressure support ventilation (PSV) 193,194,196 Presyncope 1165, I 167 cardiac 551- 554 differential diagnosis 551 - 554 investigations 553 Prevalence of disease 95, 96 Preventive medicine 96 Prick tests, hypersensitivity 1264, 1286 Prickly heat 298 Primaquine 347,390 Primary CNS lymphoma (PCNSL) 392-393 Primidone 1172, 1175 Prion diseases 341, 1224,1234 Prions 130 Priority-setting 12-13 Probenecid gonorrhoea 414 gout II 15 Lyme disease 320 neurosyphilis 1233 Probiotics 671, 921, 1284 Problem-solving therapy 238 Procainamide, effect of hepatic impairnlent 27 Procaine penicillin reaction to 413 relapsing fever 321 syphilis 413, 1234 Procarbazine 266, 1049 Procarboxypeptidases 855, 856 Procblorperazine 891 Proctitis 912, 913 management 917 men who have sex with men 408, 414 Proctocolitis 899-900 Proctography, defecating 863, 873 Proctoscopy 860, 869 Proctosigmoiditis 912, 913 Procyclidine 233 Proelastase 855, 856 Progeria see Werner's syndrome Progestagens, cancer treatment 267 Progesterone 763 170H- 789 reference values in venous blood 1319 Progestogen, secondary amenorrhoea 766 Proglitazone 973 Progres ive multi focal leucoencephalopathy (PMFL) 393 Proguanil 296, 346, 347, 348 Pro-insulin 810 Prolactin 793, 799 plasma/serum levels 800 reference values in venous blood 1319 Prolactinoma 793, 798, 799, 800-801 Proline 110 Prolymphocytic leukaemia 1046-1047 Promastigotes 348, 349 Promyelocytes 1004, 1015 Propafenone 573, 574 atrial fibrillation 563 tachyarrhythmias 562, 566 Propantheline 1253 Propranolol 573 anx iety disorder 240 effect of hepatic impairment 27 endocrine disease thyroiditis 757 thyrotoxic crisis 749 essential tremor 1182 headache/migraine prevention 1163,1164 variceal bleeding 961, 962 Propriol1obaCleriul1I acnes 1299 Proptosis 1197 Graves' disease 756 Wegener's granulomatosis 1141 Propylthiouracil 755, 756 Prostacyclin (epoprostenol) 186, 1136 anticoagulation, haemodialysis 491 circulatory effects 192 pulmonary hypertension 729 Prostaglandins allergy 84 pulmonary hypertension 729 Prostaglandin EI, erectile dysfunction 477 Prostaglandin E2 136 Prostaglandin analogues, peptic ulcer 889 Prostaglandin synthetase inhibitors, persistent ductus arteriosus 636 Prostate benign hyperplasia 466, 510-511 incontinence and 475 biopsy 51 I function 460 International Prostate Symptom Score 5 10, 5 I I obstruction 474 Prostate cancer 511-512 hormonal treatment 267 screening 255 staging 259 Prostate-specific antigen (PSA) 255, 259,511,512 Prostatitis 512 bacterial, antibiotic therapy 469 Protamine, intravenous 1063 Protease 382 Protease inhibitors (PIs) 397, 398-399 drug interactions 398 side-effects 398-399 Proteases 854 Protein acute phase 65, 76 cell membrane 40 cerebrospinal fluid 1324 metabolism, effects of insulin 809 modification by glycation 163 monoclonal 1051, 1052 plasma 421 liver function test 941 reference values urine 1321 venous blood 1320 synthesis 38 urinary 816 Protein, dietary 110 absorption, tests 863 diabetics 830 digestion 855 recommended intake III restriction acute renal failure 485 chronic renal failure 488 hepatic encephalopathy 951 Protein C 1008 activated sepsis 199 septic shock 318 deficiency 1062 Protein kinasc C inhibitors 846 Protein S 1008 deficiency 1062 Protein-energy malnutrition (PEM) 117 zinc deficiency 127 • Protein-losing enteropathy 900-901 Proteinase inhibitors 651 Proteinosis, alveolar 715, 725 Proteinuria 478-479 Bence Jones 479, 1084 diabetic nephropathy 842 orthostatic 478 pregnancy 515- 5 16 tubular 479 Proteoglycans 1068, 1070-1071 Pro/ells spp., urinary tract infection 467 Prothrombin G20210A 1062 Prothrombin time (PT) 1010, 10 II, 1018, 1322 acute liver failure 953 alcoholic liver disease 970 liver disease 940 viral hepatitis 963 Proto-oncogenes 48 49 Proton pump 853 Proton pump inhibitors cystic fibrosis 909 gastrointestinal reflux 880, 882 oesophageal dysmotility 882 peptic ulcer/dyspepsia 887, 888, 889, 890 bleeding peptic ulcers 868 short bowel syndrome 899 Protoporphyria, erythropoietic 451, 452, 1308 Protozoal infections 342-360 blood and tissue parasites 342- 358 gastrointestinal 358-360 ilfUllune deficiency and 71 nervous system 1224, 1228 Prozone phcnomenon 413 Prurigo gestationis 1267 Pruritus 1266-1267, 1268 genital 407-408, 410,1281 pregnancy 1267 primary biliary cirrhosis 978, 979 sclerosing cholangitis 981 Pruritus ani 933 Pruritus vulvae 410,1281 PRV (polycytbaemia rubra vera) 1054, 1055 PSA (prostale-specific antigen) 255, 259,511,512 Pscudobulbar palsy I 192, 1193 Pseudo-Cushing's syndrome 779 Pseudocyst, pancreatic 904-905, 906,907,908 Pseudodementia 1188 Pseudofractures 1130 Pseudogenes 39 Pseudogout 1076, 1077,1099, 1115-1116 Pseudohallucinations 232 Pseudohypoparathyroidism 774-775 Pseudomonas spp. bone infection 1118 respiratory infection bronchiectasis 685 cystic fibrosis 686 pneumonia 693 urinary tract infection 467 Pseudomonas aerllgillosa 686, 687, 694 Pseudomonas pseudomallei 325 Pseudoporphyrias 1308 Pseudo-pseudohypoparathyroidism 775 Pseudo-puberty, precocious 789 Pseudoseizures 1168, 1176 Psilocybill 246 Psittacosis, incubation period 135 Psoralens 1291 hyperpigmentation from 1281 see also PUVA Psoriasis 1287-1292 aetiology 1287-1288 clinical features 1288- 1290 erythrodermic 1289 guttate .1268, 1269, 1289 histology 1289 inheritance 1288 investigations 1290 management/treatment 1290-1292 DMARDs 1093 nails in 1283, 1288, 1289 pustular 1290 rash 1268, 1269 stable plaque 1288 vulva 1281 Psoriatic arthritis 1076, 1077, 1079, 1109- 1110, 1258 erosions 1073 foot, target sites 1072 PSV (pressure support ventilation) 193,194,196 Psychiatric disorders 228--252 aetiology 229 classification 228 diagnosis 229- 230 epidemiology 228 HIV-related 394-395 law and 251- 252 older people 235 organic 235 patient's understanding ('insight') 231 physical illness and 230, 232, 241 presenting problems 231-237 puerperal 228, 251 self-poisoning 'and 205-206 stress-related 239 treatments 237-239 Psychogenic attacks (pseudoseizures) 1168, 1176 Psychogenic weakness 1179 Psychological factors fibromyalgia 1119, 1120 irritable bowel syndrome 920, 921 low back pain 1083 in medical illness 236 non-ulcer dyspepsia 891 osteoarthritis 1098 pain 876 psychiatric disorders 229 Psychological treatment/ Psychotherapy alcohol misuse 246 depression 239 eating disorders 249 erectile dysfunction 477 general (supportive) 238 alcohol misuse 246 medically unexplained somatic symptoms 250 pain management 278 psychodynamic (interpretative) 238-239 supportive, acute leukaemia patients 1042 Psychopathic (antisocial) personality disorder 247 Psychosis affective 242 puerperal 25 I Psychotherapy see Psychological treatmentlPsychotherapy P ychotropic drugs 237, 238 dementia 247 PT see Prothrombin time PTC (percutaneous transhepatic cholangiography) 941-942 PTH see Parathyroid honnone Pthirus pubis 407 Ptosis 1195, 1197 PTSD (post-traumatic stress disorder) 239 PlTK (partial thromboplastin time with kaolin) 10 10 Puberty, delayed 763--765 Pubic lice 1298 Public health, ethics 14 Puerperal psychiatric disorders 251 prevalence 228 Pulmonary abscess 694 Pulmonary angiography 654 CT 653, 654, 727 Pulmonary arteriovenous malformations (PAVMs) 1056 Pulmonary artery 522, 523 cannulationlcatheterisation 180, 181 critically ill patients 180 risks 180 Pulmonary artery pressure, assessment 534 Pulmonary artery wedge pressure (PAWl?) 180,541 critically ill patients 180 monitoring 534 shock 187 Pulmonary embolism! thromboembolism 660, 661, 724 728 acute 540, 541 anticoagulation therapy 1063 categorisation 725 circulatory measurements 186 clinical features 725-726 heart failure 546 investigation 653, 654, 726-727 management 727-728 older people 729 pain 535-536 stroke patients 1207 Pulmonary eosinophilia 723--724 drug-induced 724 tropical 363, 364 Pulmonary fibrosis drug-induced 724 idiopathic 713, 714, 715, 717-718 respiratory function abnormalities 657 sarcoidosis 715, 717 Pulmonary function tests asthma 673-675 chronic obstructive pulmonary disease 680-681 interstitial disease 714, 719 Pulmonary hypertension 651, 728--729 classification 728 congenital heart disease 636, 638 mi tral stenosis 619, 620 primary 729 pulmonary regurgitation 629 systemic sclerosis 1135 Pulmonary infarction, pleural effusion 665 Pulmonary lesions (nodules) rheumatoid 722, 723 solitary radiographic 663-664 Pulmona.r1oedema 661, 662 acute 539, 540 management 547-548 myocardial infarction 598 acute renal failure 484 chest X-ray 547 dust-related 721 heart failure 545, 546 high altitude 104 left heart failure 545, 546 malaria 345 management 547-548 non-cardiogenic 724 renal artery stenosis 496 Pulmonary plethora 530 Pulmonary regurgitation 629 Pulmonary-renal syndrome 514 Pulmonary stenosis 629 incidence 634 Pulmonary syndrome, leptospirosis 322 Pulmonary valve 522, 523 atresia 640 Pulseless electrical activity 555, 556 Pulses, cardiovascular disease 520, 521 Pulsus paradoxus 526, 699 Punch-drunk syndrome 1189 PUO (pyrexia of unknown origin) 286-288 older people 289 Pupillary disorders 1197-1198 neurosyphilis 1233 Purines I 150 Purkinje network 527 Purpura definition 1259 drug-induced 13J I Henoch- Schonlein 503, 515, 1141 idiopathic thrombocytopenic (ITP) 1056--1057 non-thrombocytopenic 1055 pinch 1308 senile 1061 thrombotic thrombocytopenic 498, 1057 Pustule, definition 1259 Pustulosis, palmarpustular 1290 PUVA bath 1291 pruritus 1267 psoriasis 1291 psoriatic arthritis II 10 vitiligo 1280 Pyelography 463--464 an tegrade 485 Pyelonephritis acute 470, 505 antibiotic therapy 469 chronic 509-510 pregnancy 515 Pyeloplasty 508 Pyknodysostosis 1131 Py 10ropiasL y 889 Pyoderma gangrenosum 850, 1309 Pyonephrosis 472 Pyopneumothorax 732 Pyrazinamide adverse effects 702 tuberculosis 70 I HIV/AIDS patients 390 tuberculous meningitis 1228 Pyrethroid insecticides 220 Pyrexia see Fever Pyridostigmine 1253 Pyridoxal 124 Pyridoxamine 124 Pyridoxine (vitamin 8 6) 121, 124 125,212 deficiency 121, 124-125 dietary sources 121, 124 excess 121 supplements 124, 442 tuberculosis 70 I Pyrimethamine 152, 153 malaria 345 toxoplasmosis 358 HIV-related 393 Pyrimethamine/sulfadoxine see Fandisar Pyrimidine 5' nucleotidase deficiency 1033 Pyrizinamide 903 Pyrogens, exogenous 136 Pyronaridine 348 Pyrophosphate arthritis 1115 Pyruvate kinase deficiency 1033 Pyuria, sterile 515 Q Q fever 340, 690 endocarditis 630 Quality-adjusted life years (QALY) 10 Quantitative measurements, normal range 6-7 Questions, medical interview 5 Quinagolide 800, 1237 Quinidine 347, 572 effect of hepatic impairment 27 Quinine babesiosis 343 malaria 346, 347 poisoning 211 Quinolones 144,151-152 adverse reactions 152 contraindications 22 prophylactic, spontaneous bacterial peritonitis 950 soft tissue infections 316 see also Fluoroquinolones Quinupristinldalfopristin combination 154 R R protein 1027 RA see Rheumatoid arthritis Rabeprazole 889 Rabies 141,1229-1230 immunisation 138, 139, 1229-1230 incubation period 135 prophylaxis 137 Radial nerve palsy 1248 Radial pulse, respiratory disease 648 Radiation(s) effects of exposure 99-100 infrared 99 ionising 44, 99-100 mutagenic effects 44 natural background 99 non-ionising 44 pneumonitis 724 ultraviolet see Ultraviolet radiation Radicular pain 1084, 1085, 1086 Radiculography 1156 Radiculopathy 1183, 1184, 1246, 1251-1252 HIV-related 393, 394 truncal 843 Radioallergosorbent test (RAST) 85, 1264 Radiocolloid, intra-articular injection 1095 Radiofemoral delay 634 Radiofrequency ablation, cardiovascular disease 533 arrhythmias 561, 562, 563, 576 Radioiodine contamination 100 multinodular goitre 760 thyroid cancer 760-761 thyrotoxicosis 755, 756 Radioisotope imaging see Radionuclide imaging Radioisotope tests, gastroenterology 863-864 Radioisotopes cancer treatment 264, 270 exposure to 100 Radiology biliary diseases 993, 994 Radiology (cont'd) cardiovascular system 529- 530 heart failure 547 cerebral tumours 1236-1237 chest see Chest radiology/X-ray gastrointestinal tract 858-859 contrast studies 859, 860 inflammatory bowel disease 916 hepatobiliary disease 941 hyperparathyroidism 776 musculoskeletal disorders 1072-1074 ankylosing spondylitis 1107, 1108 bone fractures 1086 gout 1114 low back pain 1084, 1085 osteoarthritis 11 00 Paget's disease I 130 reactive arthritis 1109 nervous system 1155- 1 158 prostate cancer 51 I renal 463~64 complications 462 respiratory disease 653-654 aspergillosis 703, 704 asthma 675 bronchial carcinoma 706, 709 bronchial obstruction!lung collapse 707, 708 bronchiectasis 685 chronic obstructive pulmonary disease 680, 681 interstitial 714, 715, 716, 717, 718,719 mediastinal tumours 712, 713 pleural 732- 733, 734 pneumonia 690, 691, 692-693, 694 pulmonary embolism 725, 726 solitary pulmonary lesion 663-664 tuberculosis 696-697, 698 spine 1241, 1242, 1244 Radionuclide (radioisotope) • • Imagmg bone 1073-1074, 1087, 1130 fractures 1086 metastatic disease 1143 cardiac 534, 584 angina 582-583, 584 inflammatory bowel disease 916 nervous system 1156 renal artery stenosis 497 renal disease 464, 509 Radiotherapy 264 blood disorders chronic lymphocytic leukaemia 1046 Hodgkin's disease 1049 multiple myeloma 1053 non-Hodgkin's lymphoma 1050, 1051 brain tumours 262, 1237 bronchial carcinoma 710 conformal 264 continuous hyperfractionated accelerated (CHART) 710 fractionation 264 intestinal complications 899-900 Kaposi's sarcoma 386 lung damage 724 mesothelioma 736 oesophageal cancer 884 oral cancer 877 pain management 278 palliative 264 pituitary tumours 799, 800, 802 prophylactic 263 prostate cancer 512 rectal cancer 928 side-effects 264-265 skin cancer 1304-1305 solid tumours 269, 271 spinal cord compression 260 superior vena cava obstruction 261 Radon, lung cancer and 705 Raloxifene 1125-1126 Ramipril heart failure 550 hypertension 613 myocardial infarction 600 Ramsay Hunt syndrome 305 Randomised clinical trials (RCTs) 20-21 Ranitidine 197-198 peptic ulcer 889 urticaria 1271 RANK (receptor activator of nuclear kappa B) 1069, 1070 RANKL (receptor activator of nuclear kappa B ligand) 1070 RAP (right atrial pressure), critically ill patients 180 Rapamycin 495 Rapid immunochromatographic tests 142, 322 Rapid plasma reagin (RPR) test 413 Rapidly progressive glomerulonephritis (RPGN) 483,503 Rashes butterfly (malar) 1133 chickenpox 305 dengue 309 dermatitis herpetiformis 896 d~rmatomyositis 1136 distribution 1258 erythematous 285, 289 erythrovirus 19 30 I, 302 fever and 289 genital 407~08 with haemorrhage 289 hand, foot and mouth disease 306 helminthic infections 297 HIV infection! AIDS 384, 385 identification 285 infection and 285 macular/maculo-papular 289 measles 300 meningococcal infection 177, 284 nodular 285 photosensitivity 1272 post-kala-azar leishmaniasis 352 purpuric/petechial 285 rheumatic fever 617 rubella 30 I scaly 1267-1269 scarlet fever 314, 315 shingles 305 syphilis 411 congenital 412 systemic lupus erythematosus 1133 toxic shock syndrome 314-315 tropical diseases 289 typhoid 325 typhus 339, 340 urticarial 289 vesicular/pustular 285, 289 RAST (radioallergosorbcnt test) 85, 1264 Rat poisons 220-221 Raynaud's phenomenon!disease/ syndrome 82, 604, 1132-1133, 1134-1135 RB-ILD (respiratory bronchiolitisinterstitial lung disease) 717 RBBB see Right bundle branch block RCA (right coronary artery) 522, 523,524 occlusion 524 Reaven's syndrome see Insulin resistance syndrome Reboxetine 241 Receptor activator of nuclear kappa B (RANK) 1069, 1070 Receptor activator of nuclear kappa B ligand (RANKL) 1070 Receptors, cell membrane 41, 42 Recombinant human DNAase • (rhDNAase), cystic fibrosis 687 Recombinant human erythropoietin, chronic renal failure 489 Recombinant tissue plasminogen activator (rt-PA) 1207, 1208 Rectal examination febrile patient 284 gastrointestinal disease 850, 851 Rectum 857 neurological disease 1199-1200 solitary ulcer syndrome 933 tumours 923-929 see also Colorectal cancer see also Anorectal ... Red cell enzymopathies 1032-1033 Red cell membrane defects 1031- 1032 structure 1004-1005 Red cells 1002 agglutination, cold 1034 anaemia 1023, 1025 aplasia 302 blood film examination 1009, 1010 components 1021 concentrate 1021 count 1009, 1010, 1322 destruction 1005 effects of malaria 343 formation 1003, 1004 haemolytic anaemia 1030-1031 lifespan 1322 nucleated 1010 radiolabelled, gastrointestinal investigations 864 sickled 1036 structure and functions 1004-1005 transfusion 191, 1019 (in)compatibility 1020-1022, 1024 Red man syndrome 30 5a-Reductase inhibitors 511, 769 Reed-Sternberg cells 1048 Re-entry 560 Refeeding syndrome 120 Reflex(es) Bezold- larisch 553 cough 657 diabetes 807 motor system I 178-1179 tendon, root values 1147 Reflex sympathetic dystrophy 1131 Reflux bile 888 duodenogastro-oesophageal 879 gastro-oesophageal 877-881, 882-883 Reflux nephropathy 509- 510 Refsum's disease 1251 Regurgitation 879 Rehabilitation geriatric medicine 169-170 hip fractures 1086 leprosy 338 myocardial infarction 599-600 schizophrenia 244 stroke 1207 Rehydration see Fluid replacement Reidel's thyroiditis 761 Reiter's cells 1109 Reiter's disease/syndrome 331, 1106, 1108 Relapsing fevers 141 louse-borne 320-321 tick-borne 321 Renal arteriography/venography 464,497 Renal artery stenosis 49~97 Renal biopsy 465 Renal colic 471 Renal dialysis see Dialysis, renal Renal disease atheroembolic 499 chronic, pruritus 1268 in connective tissue disease Henoch-Schonlein purpura 1141 systemic lupus erythematosus 1133, 1134 systemic sclerosis 1136 cystic 506-507 autosomal dominant polycystic disease 45, 46 inheritance 52 diabetics 841-843 drug-induced 482, 483, 504-506, 516-517 genetic 52 glomerular 465,467, 499-504 gout and 1113-1114 HIV-related 395 hypertension and 611 infections 47~71 investigation 46~65 pregnancy 515-516 presenting problems 465~91 symptoms 457 tuberculo is 699 tubulo-interstitial 504-508 tumours/cancer 512-513 vascular 49~99 see also Nephropathy Renal fai lure 466 acute 434, 481~85 causes 481 ~82 established 482~85 interstitial 505, 506 malaria 345, 346 non-oliguric 483 older people 485 renal replacement 491 reversible pre-renal 481, 482 screening tests 484 bleeding 1061 chronic 434 435, 485~91, 774 causes 485~86 interstitial 506 management 488~91 osteomalacia 1128 screening tests 487 stages 486 critically ill patients 189 management 197 cystic disease 507 diabetics 841 end-stage 485 heart fail ure 546 hepatic cirrhosis 949 pregnancy 516 pyelonephritis 470 systemic lupus erythematosus 515 Renal function 458 tests 46~62 Renal infarction, acute 496 Renal insufficiency, effect on drug dosages 26, 27 Renal osteodystrophy 489~90, 1076 Renal papillary necrosis 506, 517 pyelonephritis and 470 • Renal pelvis (collt 'd) stone in 473 tumours 513- 514 Renal replacement therapy 491-496 acute renal failure 491 chronic 'renal failure 485, 491. 493-496 critically ill patients 197 older people 495 Renal tract. common infecting organism ' 133 Renal transplantation 91. 492. 494 496 cystic disease 507 diabetics 842- 843 systemic lupus erythematosus 515 Renal tubular acidosis (RTA) 434. 435. 438. 439.506,508 inheritance 52 osteopetrosis and I 132 Renal tubules 458. 459. 460 acute necrosis see Acute tubular . necrOSIS distal 423, 432 function isolated defects 507- 508 testing 461-462 proximal 422 Rcnal... see also Kidneys Renin 424, 458 hyperaldosteronism 786 hypokalaemia 434 secretion 779 Ren i n- angi otensi n- aldoste rone system 424. 433. 779 in heart failure 543- 544 hyperkalaemia 435 Repaglinide 833 Reperfusion therapy. myocardial infarction 595- 596 Reproductive diseases 763- 771 classification 764 Reproductive system female 763 male 762-763 older people 769 Research. ethics 14-15 Residual volume (RV) 656. 657 Resins bile acid sequestering 450 ion-exchange 436 Resistance. vascular 192. 525- 526 Resistin 833 Respect for persons and autonomy I I Respiration Cheyne- Stokes 540 haemodynamic effects 526 Kussmaul 437. 487. 806 see also Breathing Respiratory acidosis 437. 440. 657. 668,669 Respiratory alkalosis 437. 440. 657. 660, 774 Respiratory burst 65 Respiratory disease 648-737 air travel and 104 chest pain 535, 536. 537 drug-induced 722 genetic 52 HIV-related 389- 391 investigations 652-657 physical signs 649 presenting problems 657-670 rheumatoid arthritis 722. 1103 tumours 705-713 Respiratory distress syndrome, acute see Acute respiratory distress syndrome Respiratory failure 667-670 critically ill patients 187-188 management 667- 670 type 1188.651.667.668 type II 188.651,667.668. 669 Respiratory function monitoring. critically ill patients 182 tests 655-657 Respiratory infections 687-705 asthma and 671, 676 bacterial 331 - 333 common organisms 133 cystic fibrosis 686-687 fungal 375. 703-705 H IV-related 389- 391 older people 693 pneumonia 43-49 rheumatoid disease 722 SARS 341-342, 695 stroke patients 1207 upper respiratory tract 687, 688-689 antibiotic therapy 688 viral 312. 687. 689. 695 Respiratory support critically ill patients 193- 196 non-invasive support 193- 194 weaning from 196 Respiratory syncytial virus (RSV) 137,689,690 chemoprophylaxis 147 Respiratory system clinical examination 648- 649 common infecting organisms 133 older people 652 Respiratory tract applied anatomy and physiology 650-651 infections see Respiratory infections tumours 705-713 Restless leg syndrome 490. 1177 Restraint. disturbed patients 234 Restriction fragment length polymorph isms (RFPLs) 51 Resuscitation acute renal failure 484 cardiopulmonary 556. 557 critically ill patient 176 drowning 105 Ouid 1019 gastrointestinal haemorrhage 867 hypothermia 101 - 102 older people 190 Resynchronisation therapy, cardiac 577-578 RET proto-oncogene 803 Reteplase (rPA) 595. 597 Reticular formation, brainstem I 152, I 153 Reticulocytes 1003, 1004 reference values 1322 Reticulocytosis 1003 Retinal degeneration 1239 Retinal detachment 839, 840 Retinal haemorrhage 838-839, 840 high-altitude 104 Retinal pigment epithelium. congenital hypertrophy 925 Retinitis • cytomegalovirus 393. 395 HIV-related 378, 393, 395 Retinitis pigmentosa 52 Retirtitis proliferans 840 Retinoblastoma 49, 50 Retinochoroiditis. toxoplasmosis 357.358 13-eis-retinoic acid (isotretinoin) 1300 Retinoids acne vulgaris 1300 psoriasis 1292 and skin cancer 1303 warts 1296 Retinol see Vitamin A Retinopathy diabetic 807. 808. 838-841, 846 pregnancy and 827 hypertensive 610-611 Retroperitoneal fibrosis 466, 509 drug-induced 517 Retroviral oncogenes 48 Retroviruses 299 leukaemia 1039 see also H IV infection Reverse transcriptase (RT) 381 Reverse transcriptase inhibitors non-nucleoside 397, 398. 399. 401 nucleoside 397-398 RF see Rheumatoid factor RFPLs (restriction fragment length polymorph isms) 51 Rhabdomyolysis 434 Rhabdoviruses 299 Rheoviruses 299 Rhesus D blood group L021-1022 Rheumatic fever 616-618 chemoprophylaxis 147 Jones criteria 617 respiratory complicalions 722 Rheumatic heart disease 616-618 valvular disease 618 Rheumatoid arthritis (RA) 1078, 1079, 1101-1106 aetiology I 101 clinical features 110 I- I 104 eXlra-articular ll03- II04 connective tissue disorders 722 erosions 1073 foot, target sites 1.072 HLA associations 80 investigation. I 105 management 1105 DMARDs 1093 older people I 106 pathology 1101. 1102 polymyalgia I 139 prevalence 1068 progression and prognosis 1105- 1106 Rheumatoid disease pleural elfusion 665 respiratory involvement 722- 723 Rheumatoid factor (RF) 81. 1074-1075. I 101. 1I OS, 1138 Rheumatoid nodules. subcutaneous 1101.1103.1104 Rhinitis, allergic (vasomotor) 729-730 Rhinoviruses 689 Rhodesiense trypanosomiasis 354, 355 incubation period 135 Rhodopsin 42 Rib fractures 1086 Ribavirin 156, 157, 31 I hepatitis C 968 vasculitis 1141 viral hepatitis. HIV/AlDS patients 388. 389 RiboOavin (vitamin B~) 121, 124 deficiency 121. 124 dietary sources 121.124 Ribonuclear protein. antibodies to 1075 Ribonucleic acid see RNA Ribs, fracture 736 Richter's lransformation 1046 Rickets 1126-1129 hypophosphataerrtic 441, 1076. 1128-1129 vitamin D-resistant 508, 1127 Rickeusial fevers 338-340 Rickety rosary I 127 Riedel's thyroiditis 761 Rifabutin 389. 390 Rifampicin 903 adverse effects 702 brucellosis 319 drug interactions 23 hepatotoxicity 973 infective endocarditis 632 leprosy 337 meningitis 1227 pneumonia 692 primary biliary cirrhosis 979 prophylactic 137 rickeusial fevers 340 staphylococcal endocardilis, injecting drug user 293 tuberculosis 70 I, 702 HIV/AIDS patients 390, 391, 401 Right atrial pressure (RAP), critically ill patients 180 Right bundle branch 527 Right bundle branch block (RBBB) 527.571,572 atrial septal defect 638 Right coronary artery (RCA) 522. 523. 524 occlusion 524 Right ventricle 522. 523 Right venuicular dilalation. chest X-ray 530 Right ventricular dysplasia. arrhythmogenic 643 Rigidity 1179, 1180 Parkinson's disease 1218.1219, 1220. 1221 tetanus 1232 Rigors 136, 285 Riluzole 1223 Rimantadine 157 prophylactic 147 Rimonabant 115, 846 Ringer-Lactate 330 Ringworm 298. 1263. 1297 Risedronate biliary cirrhosis 979 osteoporosis I 125 Pagel's disease 1033. 1130 Risk attributable 96 empiric 58 estimation and communication 9 relative 96 Risk calculation descriplive epidemiology 96 genetic diseases 58 polygenic diseases 58- 59 Risk ratio. drug therapy 20 Risperidone 243. 244 Risus sardonicus 1232 Ritonavir 397,398,401 prophylactic 147 Rituximab 268, 397 idiopalhic thrombocytopenic purpura 1057 non-Hodgkin's lymphoma 1050-1051 Rivastigmine 1189,1217 River blindness 297. 298. 365-366 RNA 39 messenger (mRNA) 39. 40 lransfer (tRNA) 39 Rocky Mountain spotted fever 339 Rodent ulcer 1304 Rofecoxib 22. 1092 Rokilansky- Aschoff sinuses 997 Romaiia's sign 356 Romberg test 1147 Ropinirole 1221 Rosacea 1300-1301 Roseola infantum 303 Rosiglitazone 833 Rotator cuff lesions 1079, 1080 Rotavirus 311 Rotor's syndrome 945 Roundworm (Ascaris lumbricoides) 360,362 rPA (reteplase) 595, 597 RPGN (rapidly progressive glomerulonephritis) 483, 503 RPR (rapid plasma reagin) test 413 RSY see Respiratory syncytial virus RT (reverse transcriptase) 381 rt-PA (recombinant tissue plasminogen activator) 1207, 1208 RTA see Renal tubular acidosis Rubella (German measles) 141,301 arthritis 1078 congenital malfonnations and 30 I immunisation 138, 1078 incubation period 135 maternal infection 634 period of infectivity 135 vaccination 139 Rubeosis iridis 840, 841 'Rum fits' 245 RY (residual volume) 656, 657 5 SA (sinoatrial) node 522, 523, 524, 526,527 depolarisation 526 Sabin- Feldman dye test 357-358 Saccades 1196 Sacroiliac pain 1080 Sacroiliitis inflammatory bowel disease and 1110 inflammatory joint disease 1107, 1108,1110 pain 1084 St Yitus dance 617 Salbutamol 677, 678 hyperkalaemia 436 Salicylate plasma concentration 209 poisoning 209 Salicylic acid molluscum contagiosum 1296--1297 warts 1296 Saline hyperkalaemia 436 hyponatraemia 431 hypovolaemia 425 Salivary glands, enlargement 877 Salmeterol 676 prescription 26 Salmonella food poisoning/gastroenteritis 294,328 HIY / AIDS patients 388 Salmonella el1leritidis 328 Salmonella paratyphi 324 Salmonella typhi 324 vaccine 137 Salmonella typhimurium 328 Salt see Sodium Salt-wasting disease 489 Sand fleas 299 Sandnies, leishmaniasis 348-349 Sandhoff's disease 40, 56, 444 Sanfilippo's syndrome 444 Saphenous vein grafts 587, 588 SAPS (Simplified Acute Physiology Score) 200 Saquinavir 397,398,399,401 SARA (sexually acquired reactive arthropathy) 415 Sarcoidosis 713, 714, 715-717 dementia 1189 management 716--717 musculoskeletal manifestations 1078, 1144 skin lesions 1308 Sarcoma definition 254 treatment 271 see also Kaposi's sarcoma Sarcomere 525 cardiac 524, 525 Sarcopenia, rheumatoid arthritis 1103 Sarcoptes scabiei 1297 SARS (severe acute respiratory syndrome) 341-342, 695 Sausage digit 1109, litO SSP (spontaneous bacterial peritonitis) 147,950 Scabies 298, 1297-1298 HTY/AIDS 385, 386 Norwegian 385, 1298 pruritus 1266, 1267 Scale, skin, definition 1259 Scaling, drug-induced 131 I Scalp examination 1258 febrile patient 284 fungal infections 1278 psoriasis 1288 ringworm 1263 Scapula, winging 1146 Scarlet fever 141, 314, 315 incubation period 135 period of infectivity 135 Scars definition 1259 treatment 1314 SCF (stem cell factor) 1003 Schatzki ring 883 Scheuermann's osteochondritis 1085 Schilling test 1028 Schirmer tear test 1138 Schistosoma spp. 367- 368 Schistosoma haematobium 367, 368,369,370 Schistosoma intercalatum 369, 370 Schistosoma japonicum 368-369, 370 Schistosoma mansoni 368, 369, 370 Schistosoma mekongi 369 Schistosomiasis 297, 367-370 incubation period 135 Schizoaffective disorder 242, 243 Schizophrenia 230, 232, 242- 244 acute 242, 243, 244 chronic 243, 244 management 243-244 sibling risk 58 Schmidt's syndrome 803-804 Schumm's test 1030 Schwann cells 1148 Sciatica 1242 Scintigraphy meta-iodobenzyl guanidine 788 musculoskeletal disease tO~-1074 Scl-70 (anti-topoisomerase) 1075 SCLE (subacute cutaneous lupus erythematosus) 1133 Scleritis, rheumatoid arthritis I 104 Sclerodactyly 1134, 1135 Scleroderma see Systemic sclerosis Scleromalacia, rheumatoid arthritis 1104 Sclerosing bone dysplasia 1132 Sclerosing cholangitis 980-982 Sclerosis, systemic see Systemic sclerosis Sclerosteosis 1132 Sclerotherapy 862 variceal bleeding 959, 960 Scombrotoxic fish poisoning 331 Scorpion stings 224--225 Scotoma I 194 Screening 9 cancer 255-256 colorectal cancer 928 cost-effectiveness 9 cystic fibrosis 685 cystic kidney disease 507 diabetes 846 diabetic retinopathy 840-841 genetic 55, 57 hepatocellular carcinoma 984 melanoma 1265 microalbuminuria 842 prostate cancer 511 tuberculosis contacts 700 Scrub typhus 339, 340 Scurvy 121, 125 Sea anemone 225 Sebaceous glands 1263 Seborrhoeic eczema/dermatitis 1285, 1287 HIY/AlDS 384, 386 Seborrhoeic warts 1302 Sebum 1263 acne vulgaris 1299 Secretin 857, 859 Sedation aggressive behaviour 233, 234 older people 167 Sedative misuse 246,247 SeHCAT test 863, 871 Seizures 553, 1167-1169 alcohol withdrawal 245 cerebral tumour 1236 cocaine-induced 213 distinction from faints I 167 epilepsy 1168-1176 malaria 345 poisoning 207, 212 stroke patients 1207 Selectins 186 Selective oestrogen receptor modulators (SERMs) 1125 Selectron 270 Selegiline 1220, 1221 Selenium 127 deficiency 127 Self-harm (SH) 234--235 older people 235 see also Drugs, overdose/ . . pOlsomng Sellar tumours 797, 798 Seminoma 771 Senescence see Ageing Sensory ataxia 1181 Sensory disturbances 1183--1186 diabetes 807, 843 Sensory system examination 1146 Sentinel lymph node biopsy 1306 Sentinel pile 933 Sepsis 76--77, 185,189- 190,434 acute renal fai lure 197, 482 chemoprophy laxis 147 hyperdynamic 192 management 199-200 meningococcal 177 musculoskeletal disease 1088 neutropenic 293 cancer patients 260 renal failure 189 Sepsis syndrome 317-318 Septic arthritis 1077,1117-1118 radiography 1073 synovial fluid analysis 1071 Septic shock 76--77, 185, 186, 187, 189,318 circulatory measurements 186 treatment/management 184, 199- 200 Septicaemia cancer patients 260 meningococcal 1226 Sequestration, sickle-cell disease 1036 SERMs (selective oestrogen receptor modulators) 1125 Serology gastrointestinal infection 862 Helicobacter pylori infection 886 pyrexia of unknown origin 287 viral hepatitis 965, 968 Serotonin see 5-HT Serotonin selective (specific) re-uptake inhibitors (SSRls) 238,241 toxicity 210 Sertral i ne 241 Serum sickness 332 antivenins 222, 225 Severe acute respiratory syndrome (SARS) 341-342, 695 Severe combined immune deficiency 72, 73, 74 Sex chromosomes 38 abnormalities 47 Sex hormone replacement therapy see Hormone replacement therapy Sex hormones 762-763 Sexual dysfunction chronic renal failure 490 diabetics 844, 845 Sexually acquired reactive arthropathy (SARA) 415 Sexually transmitted infections (STIs) 404-428 bacterial 41 1-415 contact tracing (partner notification) 407 examination/approach to patient 404 405,406 investigations 406 men 404 women 405 management goals 405 men who have sex with men