1000 Questions and Answers from Kumar & Clark's Clinical Medicine

322 Pages·2011·9.86 MB·english

by  Parveen Kumar

1000 Questions
& Answers
from
clinical medicine
For Elsevier
Commissioning Editor: Ellen Green/Pauline Graham
Development Editor: Clive Hewat
Project Manager: Kerrie-Anne Jarvis
Designer: George Ajayi
Illustration Manager: Merlyn Harvey
1000 Questions
& Answers

from
Clinical Medicine
SECOND EDITION
Professor Parveen J Kumar
CBE BSc MD 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 the Homerton
Hospital NHS Foundation Trust, London, UK
Dr Michael L Clark
MD FRCP
Honorary Senior Lecturer, Barts and the London School of Medicine and
Dentistry, Queen Mary University of London, UK
Consultant Physician and Gastroenterologist, Princess Grace Hospital, London
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2011
© 2011, Elsevier Limited. All rights reserved.
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First published 2008
Second edition published 2011
ISBN: 978-0-7020-4436-6
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notice
Knowledge and best practice in this field are constantly changing. As new
research and experience broaden our knowledge, changes in practice, treatment and
drug therapy may become necessary or appropriate. Readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose
or formula, the method and duration of administration, and contraindications. It is
the responsibility of the practitioner, relying on their own experience and knowledge
of the patient, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions. To the fullest extent
of the law, neither the Publisher nor the Authors assumes any liability for any injury
and/or damage to persons or property arising out or related to any use of the material
contained in this book.
The Publisher
The
Publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in China
Contents
Acknowledgements vi
Preface vii
1 Ethics and communication 1
2 Molecular cell biology and genetic disorders 5
3 Clinical immunology 9
4 I nfectious diseases, tropical medicine and sexually
transmitted infection 13
5 Nutrition 27
6 Gastrointestinal disease 33
7 Liver, biliary tract and pancreatic disease 48
8 Haematological disease 65
9 Malignant disease 79
10 Rheumatology and bone disease 85
11 Renal disease 102
12 Water, electrolytes and acid-base balance 114
13 Cardiovascular disease 120
14 Respiratory disease 156
15 Intensive care medicine 173
16 Drug therapy and poisoning 177
17 Environmental medicine 185
18 Endocrine disease 187
19 Diabetes mellitus and other disorders of metabolism 198
20 The special senses 216
21 Neurological disease 221
22 Psychological medicine 273
23 Skin disease 286
v
Index 293
Acknowledgements
We would like to thank everyone who has helped in the preparation
of this book – especially Ellen Green, who originally commissioned the
book from the source questions and answers on the Clinical Medicine
website, and other Elsevier staff – Pauline Graham, Clive Hewat, Kerrie-
Anne Jarvis, George Ajayi, and Caroline Cockrell. We are also grateful to
Ms Jillian Linton, and Sue Beasley who helped prepare the manuscript,
and to the copy-editor Eleanor Flood.
vi
Preface
This book is a compilation of questions, which you, the readers of Clinical
Medicine, have sent to us. In this second edition we have replaced some
of the older questions with more relevant and up-to-date ones. We have
also increased the number of questions in each chapter. We have tried
to keep the book as authentic as possible by inserting questions as you
have phrased them. It is therefore not a complete coverage of all that is
in Clinical Medicine. A number of your questions were quite penetrating
and raised issues that were quite unusual. These were quite a challenge
to answer! We are told that readers have found the book useful in
answering the many intriguing questions that are presented to us by
patients every day.
We would like to thank all the authors of Clinical Medicine who, with
their hard work in producing coherent chapters, made this book possible.
The answers to your questions were mainly gleaned from these chapters
in Clinical Medicine. We would also like to thank all of you who have sent
in questions; these are always extremely helpful in making changes to
new editions of Clinical Medicine.
Please continue to send in your questions and also your interesting
comments to us. We find them all extremely valuable. We hope you find
this book helpful and of interest.
PJK
MLC
vii
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1
Ethics and communication
QUESTIONS
Question 1
Regarding medical ethics, if a man is discovered to be hepatitis B or C
positive, is it advisable for the physician to inform the wife or sexual
contact of the patient?
Question 2
Is it unlawful in most countries to limit medical care, particularly
by rationing the usage of drugs? Surely rationing must be against
the oath we took as doctors to provide the best care available.
Question 3
What is meant by QALYs? Is there a difference between quality and
quantity of life?
Question 4
Are ‘Do not resuscitate’ orders illegal in most countries?
Question 5
What is a living will?
Question 6
I’ve heard of the Bolam principle but when I mentioned it to my lecturer
I was told it was out of date. Could you explain please?
Question 7
Why is counselling required before an HIV test can be done on a patient?
We don’t counsel patients when we look for a tumour marker to
diagnose cancer, which is often more serious for a patient. 1