Oxford case histories in geriatric medicine PDF
Preview Oxford case histories in geriatric medicine
Oxford Case Histories in Geriatric Medicine Oxford Case Histories in Geriatric Medicine Dr Sanja Thompson Consultant geriatrician, Departments of acute general medicine and geratology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK Dr Nicola Lovett Specialist registrar in general (internal) medicine and geratology, Oxford University Hospitals NHS Foundation Trust, and Clinical Research Fellow, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, UK Professor John Grimley Evans Professor Emeritus, Nuffield Department of Clinical Medicine and Clinical Geratology, University of Oxford, Oxford, UK Professor Sarah Pendlebury Associate Professor in Medicine and Old Age Neuroscience, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford and Consultant Physician, Departments of acute general medicine and geratology, Oxford University Hospitals NHS Foundation Trust and the Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK 1 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2016 The moral rights of the authors have been asserted First Edition published in 2016 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2015938317 ISBN 978–0–19–969926–1 Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. To Mark, Noel and George Thompson –Sanja Thompson To Lynn Lovett –Nicola Lovett To Edward Harry Jarvis –John Grimley Evans To [my father] John Michael Pendlebury –Sarah Pendlebury A note from the series editors Case histories have always had an important role in medical education, but most published material has been directed at undergraduates or residents. The Oxford Case Histories series aims to provide more complex case-based learning for clinicians in specialist training and consultants, and is now well-established in aiding preparation for entry and exit-level specialty examinations and revali- dation. Each case book follows the same format with approximately 50 cases, each comprising a brief clinical history and investigations, followed by ques- tions on differential diagnosis and management, and detailed answers with dis- cussion. At the end of each book, cases are listed by mode of presentation, aetiology, and diagnosis. We are grateful to our colleagues in the various medical specialties for their enthusiasm and hard work in making the series possible. Sarah Pendlebury and Peter Rothwell From reviews of other books in the series: Neurological Case Histories “ . . . contains 51 cases that cover the spectrum of acute neurology and the neur- ology of general medicine—this breadth makes the volume unique and pro- vides a formidable challenge . . . it is a heavy-duty diagnostic series of cases, and readers have to work hard, to recognise the diagnosis and answer the questions that are posed for each case . . . I recommend this excellent volume highly.” Lancet Neurology “This short and well-written text is. . . . designed to enhance the reader’s diag- nostic ability and clinical understanding. . . . A well documented and practical book.” European Journal of Neurology Oxford Case Histories in Gastroenterology and Hepatology “ . . . a fascinating insight into clinical gastroenterology, an excellent and enjoy- able read and an education for all levels of gastroenterologist from ST1 to consultant.” Gut A NOTE FROM THE SERIES EDITORS vii Oxford Case Histories in Respiratory Medicine “The Oxford Case Histories series presents cases in a most refreshing manner, using the Aristotelian concept of practical knowledge learned through experi- ence and conveyed to those in search of knowledge. We heartily endorse this approach. These cases . . . are real-world cases with good teaching potential. Oxford Case Histories in Respiratory Medicine has 44 short cases that cover many interesting topics in pulmonary and sleep medicine. It is not a cookbook or heavily referenced text, but it encompasses a wide breadth of topics. It is nei- ther too superficial nor too deep, and it is both a delight and a challenge to read.” Respiratory Care Foreword The authors of this book have compiled a comprehensive set of 48 case studies in Geriatric Medicine. They are to be congratulated in producing a well researched piece of work, which will benefit trainees of all grades, as well as consultants seeking to update their knowledge. Undergraduates will also find the cases a useful addition to their resources during their placements involving older patients. The material covered matches well to existing postgraduate curricula in Geri- atric Medicine and will help prepare candidates for their Specialty Certificate Examinations (Knowledge Based Assessments). The cases also map well to the British Geriatric Society’s, European, and other international undergraduate curricula in Geriatric Medicine. The cases cover not only the common presenting syndromes in older patients (the so-called ‘Geriatric Giants’) but also the less common yet important presen- tations where the diagnosis should not be missed. The cases include discussion on possible differential diagnoses, as well as the evidence base that underpins their management. Professor Tahir Masud NHS Trust Professor of Geriatric Medicine, Nottingham University Hospitals Vice President for Education and Training, British Geriatrics Society President of the European Union of Medical Specialists (UEMS)— Geriatric Medicine Section Preface The world’s population is ageing rapidly with estimates that in the first five dec- ades of the 21st century, the proportion of the world’s population over 60 years of age will double from 11% to 22% and the absolute number of older adults will triple from 605 million to 2 billion. Delivery of optimal healthcare services for older people—both in hospital and in the community—is therefore imperative. Recent reports from the Royal College of Physicians highlight the need for staff skill mix and training to reflect the rising numbers of frail older people in the general hospital. The demand for generalists expert in the care of complex older patients is thus likely to continue to rise over the coming decades. The cases in this volume have been selected to illustrate the wide spectrum of acute medicine in older patients who often present with atypical or non-specific presentations on a background of complex co-morbidity, and the attendant management and ethical dilemmas. The format follows that of other books in the series: case descriptions with questions followed by answers including detailed discussion of the diagnosis, treatment, management, and ethical and holistic aspects of care. This structure was chosen as it is very difficult to illus- trate the practical process of clinical management through a conventional text- book format and we believe it is more interesting and educational to consider real cases and one’s own management plan than to read a text that does not require the same interactive effort on the part of the reader.
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