RC SI.COM
SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
VOL UME 2
R C S I , U N I V E R S I T Y O F M E D I C I N E A N D H E A LT H S C I E N C E S
EDITORS IN CHIEF
Dr Síle Kelly and Dr Brian Creaner
1ST E D I T I O N
,
,SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
V OLUM E 2
,First published in Ireland in August 2020
by RCSI, University of Medicine and Health Sciences
123 St Stephen’s Green, Saint Peter’s, Dublin, D02 YN77, Ireland
© RCSI 2020
All rights reserved. No part of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including
photography, recording or any other information storage in a retrieval system
without prior permission from the publishers.
Produced and designed in Dublin, Ireland by RCSI
,SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
V OLU M E 2
EDITORS IN CHIEF
Dr Síle Kelly and Dr Brian Creaner
,CONTENTS
Introduction RHEUMATOLOGY 177
Osteoarthritis 179
GERONTOLOGY 01
Rheumatoid Arthritis 185
Comprehensive Geriatric
Crystal Arthropathies 199
Assessment 03
Seronegative Arthritidies 213
Frailty 09
Connective Tissue Disease 233
Osteoporosis and Bone Health 17
Scleroderma 247
Stoke/Transient Ischaemic Attack 25
Vasculitis 255
Delirium 45
Self-Assessment 265
Dementia 55
Answers to MCQs 273
Self-Assessment 69
Answers to MCQs 77
HAEMATOLOGY 277
NEUROLOGY 79 Anaemia 279
Epilepsy 81 Multiple Myeloma 289
Multiple sclerosis 93 Acute Leukaemia 297
Motor Neuron Disease 105 Chronic Leukaemia 307
Guillain-Barré Syndrome 115 Hodgkins Lymphoma 311
Neuro-Muscular Non-Hodgkins Lymphoma 319
Junction Disorders 125 Thrombophilia 331
Muscle Disorders 133 Coagulopathies: Hereditary
Parkinsonism 143 Disorders 339
Hyperkinetic Disorders 157 Disorders of Platelets 345
Self-Assessment 163 Febrile Neutropenia 353
Answers to MCQs 171 Disseminated Intravascular
Coagulation 359
Transfusion Reactions 365
Anticoagulation 373
Self-Assessment 383
Answers to MCQs 393
, SYMBOLS
INFECTIOUS DISEASE 397 These symbols will help you
Human Immunodeficiency Virus 399 to identify items of specific
Tuberculosis 411 interest to the related specialty
Malaria 423 and highlight other resources
for your consideration.
Fungal Infections 431
Dengue Fever 437
KEY
Self-Assessment 443 POINT
Answer to MCQs 449 Highlights some important points
and concepts to help consolidate
the information for you
DERMATOLOGY 451
Atopic Dermatitis / Eczema 453 TOP
TIP
Psoriasis 463
Points out helpful tips and trips
Herpes Zoster 475 to help your learning
Erythema Nodosum 481
COMMON
Erythema Multiforme 489 PITFALL
Pyoderma Gangrenosum 497 Watch out for these
commonly made errors
Bullous Disorders 505
Dermatomyositis 515 FURTHER
READING
Self-Assessment 523
Identifies chapters, books, journals,
Answers to MCQs 527 articles or websites picked out
for you to read around a topic if
MISCELLANEOUS 531 you’re interested. Majority are not
mandatory reading
Anaphylaxis 533
Drug Toxicity & Overdose 539 SCAN
HERE
Self-Assessment 547
QR codes that will bring you
Answers to MCQs 549 to a relevant learning resource
Acknowledgements PRACTICE
YOURSELF
Opportunity for you to practice
yourself or discuss a topic with
your peers
ONLINE
RESOURCE
Clicking the link will bring you to
a related online resource
,
,INTRODUCTION
Hippocrates of Kos (460 BC - 377 BC) is often referred to as the father
of Medicine. So great was his influence that even to the present
day most medical schools administer an oath similar to that first
envisioned by Hippocrates. His foundation principles of medicine still
ring true. The role of the physician is to
“Declare the past, diagnose the present, foretell the future.”
To put this in present day language: take a good history, examine the
patient and attempt a prognosis. You can see he is not too surefooted
on treatment. Probably because at that time there were very few
effective treatments, but in this regard he did say “As to diseases,
make a habit of two things — to help, or at least, to do no harm. We
hope this book will help you to declare, diagnose and foretell just
as Hippocrates advised. The book will inculcate basic principles of
putting the individual patient first, to do no harm and finally bearing
in mind that “There are in fact two things, science and opinion; the
former begets knowledge, the latter ignorance” we will teach you the
science and the art of medicine so that you will be able to meet the
enormous new challenges coming towards us in this field. To finish
with an Irish quotation, not by Hippocrates
Ní hé lá na báistí lá na bpáistí:
The wet day is not the day for children.
Medicine is not a vocation for the faint hearted. The Medicine course
is long and demanding and sometimes seems interminable. It is not
as clear-cut as Surgery, but if you know this book you will have the
knowledge required for final year Medicine, which, notwithstanding
the inevitable advances and changes over the years, will stand to you
throughout your medical career
Noel G. McElvaney
Professor of Medicine, RCSI
, x CONTENTS LIST CONTENTS LIST
R CS I Hand b o o k o f C lin i ca l Me d ic in e 1 st Ed it io n Vo l 2
SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
VOL UME 2
R C S I , U N I V E R S I T Y O F M E D I C I N E A N D H E A LT H S C I E N C E S
EDITORS IN CHIEF
Dr Síle Kelly and Dr Brian Creaner
1ST E D I T I O N
,
,SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
V OLUM E 2
,First published in Ireland in August 2020
by RCSI, University of Medicine and Health Sciences
123 St Stephen’s Green, Saint Peter’s, Dublin, D02 YN77, Ireland
© RCSI 2020
All rights reserved. No part of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including
photography, recording or any other information storage in a retrieval system
without prior permission from the publishers.
Produced and designed in Dublin, Ireland by RCSI
,SCHOOL OF MEDICINE
HANDBOOK
OF CLINICAL
MEDICINE
V OLU M E 2
EDITORS IN CHIEF
Dr Síle Kelly and Dr Brian Creaner
,CONTENTS
Introduction RHEUMATOLOGY 177
Osteoarthritis 179
GERONTOLOGY 01
Rheumatoid Arthritis 185
Comprehensive Geriatric
Crystal Arthropathies 199
Assessment 03
Seronegative Arthritidies 213
Frailty 09
Connective Tissue Disease 233
Osteoporosis and Bone Health 17
Scleroderma 247
Stoke/Transient Ischaemic Attack 25
Vasculitis 255
Delirium 45
Self-Assessment 265
Dementia 55
Answers to MCQs 273
Self-Assessment 69
Answers to MCQs 77
HAEMATOLOGY 277
NEUROLOGY 79 Anaemia 279
Epilepsy 81 Multiple Myeloma 289
Multiple sclerosis 93 Acute Leukaemia 297
Motor Neuron Disease 105 Chronic Leukaemia 307
Guillain-Barré Syndrome 115 Hodgkins Lymphoma 311
Neuro-Muscular Non-Hodgkins Lymphoma 319
Junction Disorders 125 Thrombophilia 331
Muscle Disorders 133 Coagulopathies: Hereditary
Parkinsonism 143 Disorders 339
Hyperkinetic Disorders 157 Disorders of Platelets 345
Self-Assessment 163 Febrile Neutropenia 353
Answers to MCQs 171 Disseminated Intravascular
Coagulation 359
Transfusion Reactions 365
Anticoagulation 373
Self-Assessment 383
Answers to MCQs 393
, SYMBOLS
INFECTIOUS DISEASE 397 These symbols will help you
Human Immunodeficiency Virus 399 to identify items of specific
Tuberculosis 411 interest to the related specialty
Malaria 423 and highlight other resources
for your consideration.
Fungal Infections 431
Dengue Fever 437
KEY
Self-Assessment 443 POINT
Answer to MCQs 449 Highlights some important points
and concepts to help consolidate
the information for you
DERMATOLOGY 451
Atopic Dermatitis / Eczema 453 TOP
TIP
Psoriasis 463
Points out helpful tips and trips
Herpes Zoster 475 to help your learning
Erythema Nodosum 481
COMMON
Erythema Multiforme 489 PITFALL
Pyoderma Gangrenosum 497 Watch out for these
commonly made errors
Bullous Disorders 505
Dermatomyositis 515 FURTHER
READING
Self-Assessment 523
Identifies chapters, books, journals,
Answers to MCQs 527 articles or websites picked out
for you to read around a topic if
MISCELLANEOUS 531 you’re interested. Majority are not
mandatory reading
Anaphylaxis 533
Drug Toxicity & Overdose 539 SCAN
HERE
Self-Assessment 547
QR codes that will bring you
Answers to MCQs 549 to a relevant learning resource
Acknowledgements PRACTICE
YOURSELF
Opportunity for you to practice
yourself or discuss a topic with
your peers
ONLINE
RESOURCE
Clicking the link will bring you to
a related online resource
,
,INTRODUCTION
Hippocrates of Kos (460 BC - 377 BC) is often referred to as the father
of Medicine. So great was his influence that even to the present
day most medical schools administer an oath similar to that first
envisioned by Hippocrates. His foundation principles of medicine still
ring true. The role of the physician is to
“Declare the past, diagnose the present, foretell the future.”
To put this in present day language: take a good history, examine the
patient and attempt a prognosis. You can see he is not too surefooted
on treatment. Probably because at that time there were very few
effective treatments, but in this regard he did say “As to diseases,
make a habit of two things — to help, or at least, to do no harm. We
hope this book will help you to declare, diagnose and foretell just
as Hippocrates advised. The book will inculcate basic principles of
putting the individual patient first, to do no harm and finally bearing
in mind that “There are in fact two things, science and opinion; the
former begets knowledge, the latter ignorance” we will teach you the
science and the art of medicine so that you will be able to meet the
enormous new challenges coming towards us in this field. To finish
with an Irish quotation, not by Hippocrates
Ní hé lá na báistí lá na bpáistí:
The wet day is not the day for children.
Medicine is not a vocation for the faint hearted. The Medicine course
is long and demanding and sometimes seems interminable. It is not
as clear-cut as Surgery, but if you know this book you will have the
knowledge required for final year Medicine, which, notwithstanding
the inevitable advances and changes over the years, will stand to you
throughout your medical career
Noel G. McElvaney
Professor of Medicine, RCSI
, x CONTENTS LIST CONTENTS LIST
R CS I Hand b o o k o f C lin i ca l Me d ic in e 1 st Ed it io n Vo l 2
