Table Of Contentgeneral practice
COMPANION HANDBOOK
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd ii 2244//99//1100 33::1144::5555 PPMM
NOTICE
Medicine is an ever-changing science. As new research and clinical
experience broaden our knowledge, changes in treatment and drug therapy
are required. The editors and the publisher of this work have checked with
sources believed to be reliable in their efforts to provide information that
is complete and generally in accord with the standards accepted at the
time of publication. However, in view of the possibility of human error or
changes in medical sciences, neither the editors, nor the publisher, nor any
other party who has been involved in the preparation or publication of this
work warrants that the information contained herein is in every respect
accurate or complete. Readers are encouraged to confi rm the information
contained herein with other sources. For example, and in particular, readers
are advised to check the product information sheet included in the package
of each drug they plan to administer to be certain that the information
contained in this book is accurate and that changes have not been made
in the recommended dose or in the contraindications for administration.
This recommendation is of particular importance in connection with new
or infrequently used drugs.
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd iiii 2244//99//1100 33::1144::5555 PPMM
general practice
fi fth edition
COMPANION HANDBOOK
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd iiiiii 2244//99//1100 33::1144::5555 PPMM
This fi fth edition published 2011
First edition published 1996 Second edition published 1999
Third edition published 2003 Fourth edition published 2007
Text © 2011 Author John E Murtagh
Illustrations and design © 2011 McGraw-Hill Australia Pty Ltd
Additional owners of copyright are acknowledged on the acknowledgments page.
Every effort has been made to trace and acknowledge copyrighted material. The authors
and publishers tender their apologies should any infringement have occurred.
Reproduction and communication for educational purposes
The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or
10% of the pages of this work, whichever is the greater, to be reproduced and/or
communicated by any educational institution for its educational purposes provided that
the institution (or the body that administers it) has sent a Statutory Educational notice
to Copyright Agency Limited (CAL) and been granted a licence. For details of statutory
educational and other copyright licences contact: Copyright Agency Limited, Level 15,
233 Castlereagh Street, Sydney NSW 2000. Telephone: (02) 9394 7600. Website: www.
copyright.com.au
Reproduction and communication for other purposes
Apart from any fair dealing for the purposes of study, research, criticism or review, as
permitted under the Act, no part of this publication may be reproduced, distributed or
transmitted in any form or by any means, or stored in a database or retrieval system,
without the written permission of McGraw-Hill Australia including, but not limited to,
any network or other electronic storage.
Enquiries should be made to the publisher via www.mcgraw-hill.com.au or marked
for the attention of the permissions editor at the address below.
National Library of Australia Cataloguing-in-Publication Data
Author: Murtagh, John
Title: John Murtagh’s general practice companion handbook / John Murtagh.
Edition: 5th ed.
ISBN: 9780070285569 (hbk.)
ISBN: 9780071014649 (Special edition)
Subjects: Family medicine. Physicians (General practice)
Dewey Number: 610
Published in Australia by
McGraw-Hill Australia Pty Ltd
Level 2, 82 Waterloo Road, North Ryde NSW 2113
Publisher: Elizabeth Walton
Associate editor: Fiona Richardson
Art director: Astred Hicks
Cover and internal design: Astred Hicks
Production editor: Michael McGrath
Illustrator: Alan Laver, Shelly Communications
Proofreader: Laura Davies
Typeset in Scala 8/10 pt by Midland Typesetters, Australia
Printed in China on 80gsm matt art by iBook Printing Ltd.
1 2 3 4 5 6 7 8 9 10
Muurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd iivv 2277//1100//1100 1100::0033::5511 AAMM
Contents
Preface xxv
About the authors xxvii
Laboratory reference values xxix
Normal values: diagnostic guidelines xxxiii
Abbreviations xxxv
A
ABC of general practice 1
A diagnostic perspective 2
Abdominal pain 5
Abdominal pain in children 8
Infantile colic 8
Intussusception 8
Drugs 9
Mesenteric adenitis 9
Recurrent abdominal pain 9
Specifi c causes of acute abdominal pain 9
Abdominal aortic aneurysm (AAA) 9
Mesenteric artery occlusion 9
Acute retention of urine 10
Acute appendicitis 11
Small bowel obstruction 12
Large bowel obstruction 12
Perforated peptic ulcer 12
Ureteric colic 14
Biliary pain 14
Acute pancreatitis 15
Chronic pancreatitis 16
Acute diverticulitis 16
Lower abdominal pain in women 17
Ectopic pregnancy 17
Ruptured ovarian (Graafi an) follicle (Mittelschmerz) 17
Ruptured ovarian cyst 18
Acute torsion of ovarian cyst 19
Pelvic adhesions 19
v
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd vv 2244//99//1100 33::1144::5566 PPMM
CONTENTS
Acne 19
Some topical treatment regimens 19
Oral antibiotics 20
Other therapies 20
Facial scars 20
Acute allergic reactions 21
Anaphylaxis and anaphylactic reactions 21
Angioedema and acute urticaria 22
Addison disease 22
Adolescent health 22
Depression, parasuicide and suicide 23
Alcohol problems 23
Alopecia areata (patchy hair loss) 26
Androgenetic alopecia (male pattern baldness) 26
Amnesia (loss of memory) 27
Transient global amnesia 27
Classifi cation of anaemia 28
Microcytic anaemia—MCV ≤ 80 fL 28
Iron-defi ciency anaemia 28
Thalassaemia 29
Macrocytic anaemia—MCV > 98 fL 29
Vitamin B12 defi ciency (pernicious anaemia) 29
Folic acid defi ciency 29
Angina pectoris 29
Anorectal disorders 31
Anorectal pain 31
Anal fi ssure 31
Proctalgia fugax 31
Perianal haematoma 32
Strangulated haemorrhoids 32
Perianal abscess 32
Anorectal lumps 32
Skin tags 32
Perianal warts 33
Internal haemorrhoids 33
Anal (faecal) incontinence 33
Antibiotic prescribing 33
Antibiotic resistance 36
General guidelines for antibiotic prescribing 37
Anxiety disorders 37
Generalised anxiety disorder 38
Panic disorder 39
Phobic disorders 39
Obsessive–compulsive disorder 40
Acute stress disorder 40
Post-traumatic stress disorder 40
Aphthous ulcers (canker sores) 40
vi
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd vvii 2244//99//1100 33::1144::5566 PPMM
CONTENTS
Arm and hand pain 41
Pulled elbow 41
Tennis elbow 41
Olecranon bursitis 42
Trigger fi nger/thumb 42
Raynaud’s phenomenon and disorder 42
Chilblains 43
Carpal tunnel syndrome 43
Arthritis 43
Osteoarthritis 43
Rheumatoid arthritis 44
Connective tissue disorders 45
Crystal arthritis 46
The spondyloarthropathies 46
Lyme disease 48
The vasculitides 48
Asthma 48
Pharmacological agents to treat asthma 49
Maintenance plan for persistent asthma—adult (example) 51
Asthma action plan (example) 51
The acute asthma attack 51
Asthma First Aid Action Plan 52
Asthma in children 52
B
Back pain 55
Low back pain (LBP) 55
Vertebral dysfunction with non-radicular pain (non-specifi c LBP) 56
Chronic LBP (pain > 3 mths) 57
Vertebral dysfunction with radiculopathy (sciatica) 58
Lumbar spondylosis 58
Spondylolisthesis 59
The spondyloarthropathies 60
Thoracic back pain 60
Scheuermann’s disorder 61
Idiopathic adolescent scoliosis 61
Kyphosis 62
Dysfunction of the thoracic spine 62
Bad news (breaking bad news)—guidelines 62
Bereavement and coping with loss 63
Balanitis (balanoposthitis) 64
Bed sores (pressure sores) 65
Belching (aerophagia) 65
Bell’s (facial nerve) palsy 66
Benzodiazepine problems 66
Benzodiazepine withdrawal syndrome 66
Biological terrorism 67
Inhalation anthrax 67
Botulism 68
vii
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd vviiii 2244//99//1100 33::1144::5566 PPMM
CONTENTS
Pneumonic plague 68
Ricin 68
Smallpox 68
Bites and stings 69
Bite wounds 69
Snake bites 69
Spider bites 70
Human bites and clenched fi st injuries 70
Dog bites (non-rabid) 71
Cat bites 71
Bed bug bites 71
Sandfl y bites 71
Mollusc bite (blue-ringed octopus, cone shell) 72
Stings 72
Bee stings 72
Centipede and scorpion bites/stings 72
Box jellyfi sh or sea wasp (Chironex fl eckeri) 72
Irukandji syndrome 73
Stinging fi sh 73
Other bites and stings 73
Bladder dysfunction (in women during night) 73
Blepharitis 74
Body odour 74
Boils (recurrent) 74
Breast lumps 75
Carcinoma of the breast 76
Mammary dysplasia 77
Breast cyst 77
Lactation cysts (galactoceles) 77
Fibroadenoma 77
Fat necrosis 78
Mammary duct ectasia 78
Phyllodes tumour 78
Breast pain (mastalgia) 78
Cyclical mastalgia 79
Non-cyclical mastalgia 79
Costochondritis (Tietze’s syndrome) 80
Mastitis 80
Infl ammatory breast cancer (mastitis carcinomatosa) 80
Breast abscess 80
Breath-holding attacks 81
Bronchiolitis 81
Bronchitis 82
Acute bronchitis 82
Chronic bronchitis 82
Bruising and bleeding 82
Vascular disorders 83
Platelet disorders 84
Coagulation disorders 84
viii
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd vviiiiii 2244//99//1100 33::1144::5566 PPMM
CONTENTS
Bruxism (teeth grinding) 85
Burning feet syndrome 85
Burns 85
Burns to hands 86
C
Cancer 87
Diagnostic triads for specifi c cancers 87
Metastat tumours 89
Cannabis (marijuana) 89
Cardiopulmonary resuscitation (CPR) 90
‘Cellulite’ 90
Cellulitis 91
Central nervous system infections (incl. meningitis,
encephalitis, abcess) 91
Bacterial meningitis 91
Viral meningitis 93
Encephalitis 93
Brain abscess 93
Spinal subdural or epidural abscess 94
Prion transmitted diseases 94
Poliomyelitis 95
Cervical cancer and Pap smears 95
Chest pain 97
Site, radiation and features of chest pain syndromes 97
Acute coronary syndromes (ACS) 97
Aortic dissection 98
Pulmonary embolism 100
Acute pericarditis 101
Spontaneous pneumothorax 101
Psychogenic pain 101
Chilblains 101
Children: normal developmental milestones 102
Children: developmental disorders 103
Growth and puberty problems 103
Short stature 103
Tall stature 103
Growing pains (benign nocturnal limb pain) 103
Delayed puberty 104
Precocious puberty 104
Premature thelarche 104
Premature adrenarche 104
Pubertal breast hyperplasia 104
Intellectual disability 104
Cerebral palsy 105
Down syndrome 105
Fragile X syndrome (FXS) 106
Prader–Willi syndrome 106
Williams syndrome 106
ix
MMuurrttaagghh--GGPPHHBB44--pprreellNNEEWW..iinndddd iixx 2244//99//1100 33::1144::5577 PPMM
