Training in paediatrics

492 Pages·2009·9.833 MB·English

by  Eisen, Sarah, Gardiner, R. Mark, Murphy, Catherine

Oxford Specialty Training:
Training in Paediatrics
The recent upheaval in training and education has left junior doctors
with much to contend with, including a new career structure, online
curricula, and workplace-based assessments. The need for
resources that refl ect these changes is great. Other books have
become outmoded and although the Internet offers access to
boundless medical material, little is tailored to the needs of spe-
cialty trainees. Fear not, change is coming; the Oxford Specialty
Training Series has arrived.
The series encompasses core specialty books as well as basic
science and revision texts that directly follow their respective
Royal College curriculum. Training in Paediatrics exemplifi es
their compact, but comprehensive style. It has self-contained
double-page spreads with a clear layout incorporating high qual-
ity illustrations. These features make information easy to access
and digest. In addition, the editorial team and contributing
authors are drawn from both trainees and senior clinicians to
ensure the content is both relevant and of a high standard.
The Oxford Specialty Training Series should see you through
the fi rst few years of specialty training whether on the ward, in
the clinic, or revising for specialty exams. I believe that regard-
less of your specialty, Oxford SpecialtyTraining gives you the
best possible chance of success in your chosen career.
Matthew D. Gardiner
Series Editor
Visit our website for details of forthcoming self-assessment
titles www.oup.com/uk/medicine/ost/
Oxford Specialty Training:
Training in Paediatrics
Edited by
Mark Gardiner
Professor of Paediatrics, University College London
Sarah Eisen
Academic Clinical Fellow, Institute of Child Health, University College London
Catherine Murphy
Paediatric SpR, University College London Hospitals NHS Foundation Trust
Foreword by
Andrew Wilkinson
Professor of Paediatrics, John Radcliffe Hospital, Oxford
Series Editor
Matthew D. Gardiner
Research Fellow in Plastic and Reconstructive Surgery, Kennedy Institute of Rheumatology,
Imperial College, London
1
1
Great Clarendon Street, Oxford OX2 6DP
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 in
Oxford New York
Auckland Cape Town Dar es Salaam Hong Kong Karachi
Kuala Lumpur Madrid Melbourne Mexico City Nairobi
New Delhi Shanghai Taipei Toronto
With offi ces in
Argentina Austria Brazil Chile Czech Republic France Greece
Guatemala Hungary Italy Japan Poland Portugal Singapore
South Korea Switzerland Thailand Turkey Ukraine Vietnam
Oxford is a registered trade mark of Oxford University Press
in the UK and in certain other countries
Published in the United States
by Oxford University Press Inc., New York
© Oxford University Press 2009
The moral rights of the author have been asserted
Database right Oxford University Press (maker)
Crown copyright material is reproduced under Class Licence
Number C01P0000148 with the permission of OPSI
and the Queen’s Printer for Scotland
First published 2009
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, 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 book in any other binding or cover
and you must impose the same condition on any acquirer
British Library Cataloguing in Publication Data
Data available
Library of Congress Cataloging in Publication Data
Data available
Typeset by Cepha Imaging Private Ltd, Bangalore, India
Printed in Italy
on acid-free paper by
LEGO SpA – Lavis, TN
ISBN 978-0-19-922773-0
1 3 5 7 9 10 8 6 4 2
Foreword
Here is a book specifi cally written for every trainee in Paediatrics and Child Health.
Paediatrics has always been a great challenge to new graduates because of the diversity of the speciality. Experience as a student may
ignite a genuine interest, but the time that most medical schools allocate to paediatrics is too short to give more than a glimpse of
this rewarding branch of medicine.
Advances in clinical science as well as social demands give the impression that the range of knowledge needed by a paediatrician is
vast. From neonatology to adolescent medicine; from genetics to child protection and all other branches of the discipline, the amount
to be understood can be daunting.
Recent developments in the structure of postgraduate training require a change in approach to learning. No longer is the Royal
College Membership examination (MRCPCH) dictated by the whims of the examiners. They now know, along with trainees, that
there is a well-defi ned curriculum. Following this requires attention to the details which have been carefully planned.
A wide range of activities is involved in training and assessment. In addition to clinical experience gained at the bedside, there are
practical skills and diagnostic procedures to be performed and observed. Resuscitation Council (UK) training courses give experi-
ence in team work at critical times. Special tutorials cover child protection issues, communication skills, and research methodology.
The objectives are clear. The aim is to make the content and the process transparent and fi t for the purpose of identifying compe-
tence in trainees.
A great deal must be achieved by self-directed learning, and there is no better way to approach this than to have an up-to-date,
v
comprehensive, and affordable book to read and re-read. Training in Paediatrics has been written specifi cally with your needs in mind.
The editors have chosen a style which emphasizes the essentials of every aspect of clinical paediatrics and clearly presents the knowl-
edge in a consistent format. Chapters end with examples of case-based discussions which illustrate and complement those needed
to fulfi l the work-based assessments during training.
This book should more than satisfy the needs of trainees preparing for the examinations. In addition to covering everything you might
expect to fi nd, there are chapters on pharmacology, statistics, and evidence-based medicine, all of which should be essential reading.
I predict that this will soon be regarded as the essential text for paediatric trainees, and no doubt their trainers will also fi nd it
invaluable.
Andrew R Wilkinson
Professor of Paediatrics
University of Oxford
John Radcliffe Hospital
Oxford
This page intentionally left blank
Preface
In current educational jargon reading a book can be described as an ‘informal learner directed strategy for delivering the knowledge
component of a competency based curriculum.’ The great physician and teacher Sir William Osler put it more succinctly:
‘He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all’
No book can provide the wise head and warm heart that comes only from clinical experience. Yet knowledge is generally preferable
to ignorance and, despite all the advances in information technology, is still found most easily between the covers of a book.
This book, written by a group of highly experienced clinicians at the forefront of their specialty will, we believe, provide a useful chart
for young paediatricians navigating the sea of paediatrics and child health. Its content has been informed by the paediatric curriculum
as defi ned by the Royal College of Paediatrics and Child Health (RCPCH) with particular emphasis on the requirements of those
undergoing Level 1 training leading up to the examination for Membership of the RCPCH.
Each chapter (where appropriate) opens with a brief review of some of the basic science relevant to clinical practice and closes with
case-based discussions. Topics are arranged in a uniform format and presented at a level which we hope is neither too brief nor too
detailed. Illustrations have been selected to enhance understanding and complement clinical experience.
We hope that you enjoy and benefi t from this book and welcome feedback on how it may be improved in the future. Comments or
suggestions should be emailed to [email protected].
vii
Mark Gardiner
Sarah Eisen
Catherine Murphy
Acknowledgements
We wish to thank all our contributors for their hard work and patience and for undertaking the signifi cant additional burden of
writing in addition to their normal and demanding clinical duties.
We would like to thank the team at Oxford University Press, including in particular Andrew Sandland, Fiona Goodgame, and Marionne
Cronin, who have given endless support and have been a pleasure to work with. Many anonymous reviewers have provided valuable
feedback and guidance and a number of friends and colleagues have kindly commented on the manuscript, including Janet Rennie, Tim
Chambers, Chris Verity, Nick Barnes, John Tripp, and Bob Dinwiddie.
Emma Laxton and Beth Dumonteil did a wonderful job of converting early drafts into perfectly organised word documents and in
creating order out of chaos with the image bank.The book would not have been possible without their unfailing hard work and good
humour.
Lastly we are grateful to the series editor, Matthew Gardiner, for the original conception and for his helpful advice and support along
the way and to our families for their unstinting support.
Mark Gardiner
Sarah Eisen
Catherine Murphy
viii
Contents
Detailed contents xi
List of contributors xv
Abbreviations and acronyms xvii
1 Neonatology 1
Kevin Ives and Topun Austin
2 Accidents and emergencies 29
Julian Sandell
3 Respiratory medicine 53
Eddie Chung
4 Cardiology 73 ix
Nick Archer and Nick Barnes
5 Gastroenterology and nutrition 93
Peter Sullivan
6 Nephrology and urology 119
Stephen Marks and Anja Lehnhardt
7 Neurology and neurodisability 143
Richard Newton and Rob Forsyth
8 Ophthalmology 175
Majeed Jawad
9 Dermatology 193
Edward Seaton
10 Endocrinology 209
Heather Mitchell
11 Metabolic medicine 233
John Walter and Simon Jones
12 Genetics 247
Frances Elmslie, Helen Hanson, and Emma Baple
13 Haematology 269
Owen Smith and Jonathan Bond