Table Of ContentDavidson's
e
Self-assessment in
Medicine
Edited by
Deborah Wake
CD
MB ChB (Hans), BSc, PhD, Diploma Clin Ed, MRCPE
Clinical Reader, University of Edinburgh; Honorary Consultant
Physician, NHS Lothian, Edinburgh, UK
Patricia Cantley
MB ChB, FRCP, BSc Hans (Med Sci)
Consultant Physician, Midlothian Enhanced Rapid Response and
Intervention Team, Midlothian Health and Social Care Partnership
and also Royal Infirmary of Edinburgh and Midlothian Community
Hospital, Edinburgh, UK
II
::s
CD
Edinburgh London New York Oxford Philadelphia
ELSEVIER
St Louis Sydney 2018
ELSEVIER
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Contents
Preface vii
Introduction ix
Contributors xi
Abbreviations XV
1. Clinical decision-making 1
2. Clinical therapeutics and good prescribing 6
3. Clinical genetics 14
4. Clinical immunology 22
5. Population health and epidemiology 28
6. Principles of infectious disease 32
7. Poisoning 37
8. Envenomation 46
9. Environmental medicine 151
10. Acute medicine and critical illness 54
11. Infectious disease 73
12. HIV infection and AIDS 96
13. Sexually transmitted infections 103
14. Clinical biochemistry and metabolic medicine 107
15. Nephrology and urology 115
16. Cardiology 132
17. Respiratory medicine 154
18. Endocrinology 185
19. Nutritional factors in disease 203
20. Diabetes mellit.us 212
21. Gastroenterology 225
/
Preface
This is the first edition of Davidson's Self-assessment in Medicine, designed as an accompanying
volume to the internationally renowned textbook Davidson's Principles and Practice of Medicine.
Since the original Davidson's was first published in 1952, it has acquired a large following of medical
students, doctors and health professionals. Alongside the success of the main textbook, a demand
has emerged for a complementary self-assessment book covering a broad range of general medicine
topics. Our new book uses typical clinical scenarios to test the reader. Each chapter is written by a
specialty expert and the contents follow the style and chapter layout of Davidson's. This book can
be used either independently or in conjunction with the main book.
This book has been built around modern educational principles and utilises a contemporary assess
ment style, in line with current undergraduate and postgraduate teaching. It is designed to help and
support students in their final undergraduate years and in the early years after qualification. The style
is compatible with that used in modern postgraduate examinations across the world.
The clinical scenarios have been chosen to be suitable for clinicians at any stage in their career,
supporting ongoing professional development. Clinical reasoning and judgement are encouraged,
with questions mirroring the situations and presentations that clinicians will meet in their everyday
practice. The content is applicable to a global audience and is based on current evidence-based best
practice.
The modern physician needs not only a sound knowledge base but also the ability to apply that
understanding appropriately to individual patients. The vision of the editors is to create a resource
that stimulates readers to build and apply their clinical knowledge to real-life scenarios, resulting in
excellent patient -centred care. 1
Deborah Wake and Patricia Cantley
Edinburgh, 2018
Introduction
This book offers a broad education through formative self-assessment in general internal medicine.
The majority of the questions have been designed around clinical scenarios, with a number of optional
answers offered to the question posed. In general, the 'best fit' answer is sought unless otherwise
stated. Full explanations are given as appropriate to assist the reader in their learning.
The questions aim to cover a wide range of topics, divided into specialist chapters in line with
Davidson's Principles and Practice of Medicine. The questions have in general been based on UK
clinical practice and pharmacology, but where appropriate generic drug names are used and the
underlying principles are applicable internationally. Whilst the answers given are in line with best evidence
based clinical practice, patient choice and cultural factors should always be considered when applying
the learning in individual patients and situations.
How to use this book
This self-assessment book can be used either independently or in conjunction with Davidson's.!
Readers may find it useful to read the relevant section of the main textbook in advance of tacklin~
the self-assessment; or they can use it subsequently to explore the topic in greater detail.
The questions, followed by their corresponding answers, have been arranged in the same chapter
order as Davidson's. The chapters are free-standing and can be read independently in any order.
Some of the questions are based on accompanying clinical images and radiology. Where it is
appropriate to see the image in colour, it has also been reproduced in a colour photographic SE;ction
at the back of the book.
Normal Reference Ranges for tests have not been used within the questions or explanations, but
can be found in the laboratory reference range chapter, at the end of the book.
Standard abbreviations are found within the text and are generally explained at first use. A full list
of abbreviations can be found at the front of the book.
r
i
Contributors
Anna Anderson MBChB, MRCP, PhD Harry Campbell MD, FRCPE, FFPH, FRSE
Specialist Registrar Diabetes and Endocrinology, Professor of Genetic Epidemiology and Public
Western General Hospital, Edinburgh, UK Health, Centre for Global Health Research, Usher
Institute of Population Health Sciences
Brian J Angus BSc (Hons), DTM&H, FRCP, and Informatics, University of Edinburgh,
MD, FFTM(Gias) Edinburgh, UK
Associate Professor, Nuffield Department of
Medicine, University of Oxford, UK C Fiona Clegg BSc (MedSci), MBChB,
MRCP (UK)
Quentin M Anstee BSc (Hons), MBBS, PhD, Clinical Lecturer in Gastroenterology, School of
MRCP, FRCP Medicine, Medical Sciences and Nutrition,
Professor of Experimental Hepatology, Institute University of Aberdeen, Aberdeen, UK
of Cellular Medicine, Newcastle University,
Newcastle upon Tyne, UK; Honorary Consultant Gavin Clunie BSc, MBBS, MD, FRCP
Hepatologist, Freeman Hospital, Newcastle upon Consultant Rheumatologist and Metabolic Bone I
1
Tyne NHS Hospitals Foundation Trust, Newcastle Physician, Cambridge University Hospitals NHS
upon T yne, UK Foundation Trust, Addenbrooke's Hospital,
Cambridge, UK
Jennifer Bain MBChB, MRCP, FRCA, FFICM
Fellow in Vascular Anaesthesia, Scottish Lesley A Colvin MBChB, BSc, FRCA, PhD,
Thoraco-abdorninal & Aortic Aneurysm Service, FRCP (Edin), FFPMRCA
Royal Infirmary of Edinburgh, Edinburgh, UK ConsultanVHonorary Professor in Anaesthesia
and Pain Medicine, Department of Anaesthesia,
Leslie Burnett MBBS, PhD, FRCPA . Critical Care and Pain Medicine, University
Chief Medical Officer, Genome.One, of Edinburgh, Western General Hospital,
Garvan Institute of Medical Research, Edinburgh, UK
Darlinghurst, Sydney; Honorary Professor,
University of Sydney, Sydney Medical School, Bryan Conway MB, MRCP, PhD
Sydney; Conjoint Professor, UNSW, St Senior Lecturer, Centre for Cardiovascular
Vincent's Medical School, Darlinghurst, Science, University of Edinburgh; Honorary
Sydney, Australia Consultant Nephrologist, Royal Infirmary
Edinburgh, Edinburgh, UK
Mark Byers OBE, FRCGP, FFSEM, FIMC,
MRCEM Nicola Cooper MBChB, FAcadMEd, FRCPE,
Consultant in Pre-Hospital Emergeney Medicine, FRACP
Institute of Pre-Hospital Care, London, UK Consultant Physician, Derby Teaching Hospitals
NHS Foundation Trust; Honorary Clinical
Associate Professor, Nottingham University,
Division of Medical Sciences and Graduate Entry
Medicine, Nottingham, UK
---,
xii • CONTRIBUTORS I
i
i
Dominic J Culligan BSc, MBBS, MD, FRCP, Sally H Ibbotson BSc (Hons), MBChB (Hons),
FRCPath MD, FRCP (Edin)
Consultant Haematologist and Honorary Professor of Photodermatology, Photobiology
Senior Lecturer, Aberdeen Royal Infirmary, Unit, Dermatology Department, University of
Aberdeen, UK Dundee, Dundee, UK
Ruth Darbyshire MB BChir, MA(Cantab) Sara J Jenks Bsc (Hons), MRCP, FRCPath
Specialty Trainee in Ophthalmology, Yorkshire Consultant in Metabolic Medicine, Department of
and Humber Deanery, Yorkshire, UK Clinical Biochemistry, Royal Infirmary of
Edinburgh, UK
Graham Dark MBBS, FRCP, FHEA
Senior Lecturer in Medical Oncology and Cancer Sarah Louise Johnston MB ChB, FCRP,
Education, Newcastle University, Newcastle upon FRCPath
Tyne, UK Consultant in Immunology & HIV Medicine,
Department of Immunology and Immunogenetics,
Richard J Davenport DM, FRCP (Edin), North Bristol NHS Trust, Bristol, UK
BM BS, BMedSci
Consultant Neurologist and Honorary Senior David E J Jones MA, BM BCh, PhD, FRCP
Lecturer, University of Edinburgh, Edinburgh, UK Professor of Uver Immunology, Institute of Cellular
Medicine, Newcastle University; Consultant
David Dockrell MD, FRCPI, FRCP (Gias), Hepatologist, Freeman Hospital, Newcastle upon
FACP Tyne, UK
Professor of Infection Medicine, MAC/University of
Edinburgh Centre for Inflammation Research, Peter Langhorne MBChB, PhD, FRCP (Gias),
University of Edinburgh, Edinburgh, UK Hon FRCPI
Professor of Stroke Care, Institute of
Emad EI-Omar BSc (Hons), MBChB, Cardiovascular and Medical Sciences, University
MD (Hons), FRCP (Edin), FRSE of Glasgow, Glasgow, UK
Professor of Medicine, St George and Sutherland
Clinical School, University of New South Wales, Stephen Lawrie MD (Hons), FRCPsych,
Sydney, Australia Hon FRCP (Edin)
Professor of Psychiatry, University of Edinburgh,
Sarah Fadden BA, MB BChir, FRCA Edinburgh, UK
Senior Registrar in Anaesthesia, Royal Infirmary of
Edinburgh, Edinburgh, UK John Paul Leach MD, FRCP
Consultant Neurologist, Institute of Neurological
Catriona M Farrell MBChB, MRCP (UK) Sciences, Glasgow; Head of Undergraduate
Specialist Registrar Endocrinology and Diabetes, Medicine, University of Glasgow, Glasgow, UK
Ninewells Hospital, Dundee, UK
Andrew Leitch MBChB, BSc (Hons), PhD,
Amy Frost MA (Cantab), MBBS, MRCP MSc (Ciin Ed), FRCPE (Respiratory)
Clinical Genomics Educator, Affiliated to St Consultant Respiratory Physician, Western
George's University NHS Foundation Trust, General Hospital; Honorary Senior Lecturer,
London, UK University of Edinburgh, Edinburgh, UK
Neil Grubb MD, FRCP Gary Maartens MBChB, FCP(SA), MMed
Cardiology Consultant, Royal Infirmary of Professor of Medicine, University of Cape Town,
Edinburgh; Honorary Senior Lecturer, Cape Town, South Africa
Cardiovascular Sciences, University of Edinburgh,
Edinburgh, UK Lucy Mackillop BM BCh, MA (Oxon), FRCP
Consultant Obstetric Physician, Oxford University
Jyoti Hansi Hospitals NHS Found01tion Trust; Honorary Senior
Department of Gastroenterology, Royal Infirmary Clinical Lecturer, Nuffield Departmentof
of Edinburgh, Edinburgh, UK Obstetrics and Gynaecology, University of Oxford,
Oxford, UK
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