Essentials of internal medicine pdf is Building on established diagnostic techniques, presents a modern approach to internal medicine, equipping the reader with the skills to become an effective internist.

This textbook of Essentials of internal medicine pdf 4th edition presents practical approaches to diagnosis and up to date strategies for implementing evidence-based treatments for prevalent conditions.

Preface of Essentials of internal medicine pdf

‘The definition of a specialist as one who “knows more and more about less and less” is good and true. Its truth makes essential that the specialist, to do efficient work, must have some association with others who, taken altogether, represent the whole of which the specialty is only a part.’- Dr. Charlie Mayo

The American Board of Internal Medicine describes an internist as ‘a personal physician who provides long-term, comprehensive care in the office and in the hospital, managing both common and complex illnesses of adolescents, adults and the elderly’. Accurate diagnosis is the key to successful long-term management; the internist must be an expert diagnostician who applies their skill and knowledge like a detective to solve an often difficult problem, craft a sensible plan and make a positive difference. In order to practice safely and provide the best possible outcomes, the specialist physician must master multiple competencies that include a broad and deep knowledge of diseases in body systems and Disease prevention.

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The first edition of Essentials of internal medicine pdf: the essential facts were written by a single author (the senior editor) while a consultant at Mayo Clinic, as a guide to mastering the core knowledge and clinical facts in internal medicine. The popularity of the first edition with those sitting the American Board in Internal Medicine, Membership of the Royal College of, Fellowship of the Royal Australasian College of Physicians (Part One), and similar examinations led to a successful second edition by the three of us. This new third edition has been completely revised and updated. All chapters have been written by experts in the field, followed by careful editing to ensure that the material is set at the correct standard. Every chapter has then undergone detailed peer review and been subsequently revised and edited for consistency and clarity.

The new edition of Essentials of internal medicine pdf retains the most successful elements of previous editions, including an emphasis on the facts that all specialist physicians should know (or need to remember for their examinations).

Learn how to..

• Identify what is clinically important
• Understand and investigate disease
• Create an effective strategy for treatment
• Utilize technological diagnostic tools now available
• Color illustrations to enhance recognition and learning
• Clinical pearls
• Memory jog lists and tables
• Multiple-choice questions with answers and explanations

Content has been organized around themes of…

• Holistic approach to patient treatment
• The importance of diagnosis
• The physician’s role in public health
• The physician as scholar

Table of Contents of Essentials of internal medicine pdf

Chapter 1
INTERNAL MEDICINE IN THE 21st
CENTURY—BEST PRACTICE, BEST
OUTCOMES
Brad Frankum, David Currow, and Nicholas J Talley
General versus sub-specialty medicine
The importance of diagnosis
The physician’s role in public health
The physician as a scholar

Chapter 2

EVIDENCE-BASED MEDICINE AND
CRITICAL APPRAISAL OF THE
LITERATURE
Jane Young and David Currow
Chapter outline
Introduction
Assessing the evidence
Sources of error
Assessing potential biases in different study
designs
Critical appraisal of the literature
Interpreting a study’s findings
Interpreting statistical analysis
Interpreting test results
Screening
Conclusion
Acknowledgments
Self-assessment questions

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Chapter 3
ETHICS
Ian Kerridge and Michael Lowe
Chapter outline
Ethics in internal medicine
Ethical theories
Ethics and the law
Ethics, evidence, and decision-making
Prescribing
The prescribing checklist
Deprescribing
Adverse drug reactions
Drug interactions
Types of drug interaction
Therapeutic drug monitoring (TDM)
Drug regulation
Drug research

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Chapter 4

TOXICOLOGY
Epidemiology of poisoning
Sources of poisons information and advice
Clinical assessment of poisoned patients
Investigations
Risk assessment
Principles of management of poisoned patients
Common poisons and their management
Acetaminophen (paracetamol)
Non- steroidal anti-inflammatory drugs (NSAIDs)
Tricyclic antidepressants
Newer antidepressants
Newer antipsychotics
Benzodiazepines
Insulin and oral hypoglycemics
Drugs of abuse or misuse
Amphetamines
Cocaine and crack cocaine
Gamma hydroxybutyrate (GHB)
Opioids, such as heroin or morphine
Prescription drug abuse
Synthetic cathinones, e.g. ‘vanilla sky’, ‘ivory
wave’
Synthetic cannabinoids, e.g. ‘spice’, ‘K2’
Drink spiking
Chemicals
Acids and alkalis
Chlorine
Pesticides
Lead poisoning
Spider bites
Snake bites
Marine envenomation
Terrorism, and use of medical countermeasures
Chemical agents
Biological agents
Self-assessment questions

Chapter 5
GENETICS
John Attia
Chapter outline
Overview
The flow of genetic information
Transcription
Translation
Regulation
Genetic variation
Mendelian diseases
Calculating the risks of disease
Some examples
Genetic testing in medicine
Cytogenetic studies
Fluorescence in situ hybridization (FISH)
Sequencing
Polymerase chain reaction (PCR)
Common chromosomal genetic conditions
Down syndrome
Turner syndrome
Klinefelter syndrome
Acknowledgments
Self-assessment questions

Chapter 6
MEDICAL IMAGING FOR INTERNISTS
Lindsay Rowe
Chapter outline
1. CHEST RADIOGRAPHY
Principles of interpretation in chest X-rays
Patient demographics
Technical assessment
Lines, tubes and implants
Anatomical review
Review areas (‘hard to see areas’)
Summary

2. THORACIC COMPUTED TOMOGRAPHY
Techniques of examination
Principles of interpretation in chest CT
Patient demographics
Technical review
Initial image review
Key image review
Systematic review
Review areas
Summary

3. ABDOMINAL COMPUTED TOMOGRAPHY
Techniques of examination
Non-contrast CT abdomen
Non-contrast CT KUB
Arterial phase CT abdomen (CT angiogram, CTA)
Portal venous CT abdomen
Triple-phase CT abdomen
Delayed CT abdomen
Principles of interpretation in abdominal CT
Patient demographics
Technical review
Initial image review
Key image review
Systematic review
Review areas
Summary

4. ABDOMINAL ULTRASOUND
Background—ultrasound principles
Principles of ultrasound interpretation
Lower limb duplex ultrasound

5. HEAD COMPUTED TOMOGRAPHY
CT brain protocols
Contents
Non-contrast (NCCT)
Contrast-enhanced (CECT)
CT angiography (CTA)
Perfusion CT
Principles of interpretation in brain CT
Patient demographics
Technical review
Initial image review
Key image review
Systematic review
Review areas
Summary

6. HEAD MAGNETIC RESONANCE
MRI protocols
T1
T2
Inversion recovery (IR)
Diffusion-weighted imaging (DWI)
Gradient echo (GRE)
Gadolinium-enhanced (GAD)
Magnetic resonance angiography/venography
(MRA, MRV)
MR spectroscopy (MRS)
Magnetic resonance gated intracranial
cerebrospinal dynamics (MR-GILD, CSF
flow study)
Principles of interpretation in brain MR
Patient demographics
Technical review
Initial image review
Key image review
Systematic review
Review areas
Summary

7. POSITRON EMISSION TOMOGRAPHY (PET)
Chapter
PULMONOLOGY
David Arnold, Peter Wark, Michael Hensley and
Brad Frankum
Chapter outline
1. PULMONARY MEDICINE
Clinical presentations of respiratory disease
Important clinical clues 114
Dyspnea 114
Patterns of breathing 115
Chronic cough 116
Clubbing 116
Hemoptysis 116
Solitary pulmonary nodule (coin lesion) 117
Mediastinal masses 117
Wheeze 117
Chest pain 117
Stridor 118
Overview of the respiratory system and
pathophysiology 118
Functional anatomy and physiology 118
Hypoxemia 119
Hypercapnia 119
Oxygen–hemoglobin association–dissociation
curve 120
Acid–base disturbances from a pulmonary
perspective 120
Respiratory acidosis 120
Respiratory alkalosis 120
Measurement of lung function 120
Spirometry 120
Interpretation of lung volumes 122
Diffusing capacity for carbon monoxide
(DLCO test) 122
Flow–volume loops 122
Interpretation of pulmonary function tests 122
Control of breathing 122
Respiratory tract defenses 122
Mechanical defenses 122
Immune system 123
Genetics of lung disease 124
Pulmonary disorders 124
Respiratory failure 124
Hypoventilation 124
Diseases of the airways 124
Asthma 124
Allergic bronchopulmonary aspergillosis
(ABPA) 126
Bronchiectasis 126
Cystic fibrosis (CF) 127
Bronchiolitis 127
Chronic obstructive pulmonary disease
(COPD) 128
Interstitial lung disease (ILD) 129
Occupational lung disease 130
Granulomatous ILD 132
Eosinophilic pulmonary disorders 133
Acute eosinophilic pneumonia 133
Chronic eosinophilic pneumonia 133
Pulmonary hemorrhage 133
Pulmonary infections 134
Bacterial 134
Viral 134
Fungal 134
Mycobacterial 134
Other aspects 136
Pleural disease 136
Pleural effusion 136
Pneumothorax 138
Indications for a chest drain 138
Pulmonary vascular disease 138
Pulmonary hypertension (PH) 138
Pulmonary embolism (PE) 139
Diagnosis 140
Lung transplantation 140
Complications of lung transplantation 141
Pharmacology 141
Bronchodilators 141
Anti-inflammatory agents 141
Respiratory sleep medicine 142
Overview of sleep medicine 142
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Contents
Important clinical clues 142
Respiratory sleep disorders 142
2. CRITICAL CARE MEDICINE 144
Resuscitation 144
Cardiac arrest (CA) 144
Diagnosis and disease management 144
Shock 144
Acute respiratory distress syndrome (ARDS) 145
Mechanical ventilation of the lungs 147
Non-invasive positive-pressure ventilation
(NIV) 147
Invasive positive-pressure ventilation (IPPV) 148
Extracorporeal membrane oxygenation
(ECMO) 148
Self-assessment questions 150
Chapter 8
CARDIOLOGY 153
Peter Thompson
Chapter outline 153
Clinical evaluation of the patient 154
Taking the history—possible cardiac symptoms 154
Physical examination 156
Investigation of cardiac disease 160
Electrocardiography (EKG) 160
Chest X-ray (CXR) 163
Echocardiography 163
Radionuclide myocardial perfusion imaging 166
Coronary angiography and cardiac
catheterization 166
Coronary CT angiography (CTCA) and
calcium scoring 167
Magnetic resonance imaging (MRI) 168
Dyslipidemia 168
Cholesterol, lipoproteins, apoproteins 168
Dyslipidemia and cardiovascular disease (CVD) 170
Lipid-modifying treatments 171
Coronary artery disease (CAD) 172
Prevalence 172
Pathophysiology 172
Stable coronary artery disease 172
Investigation 172
Management to improve prognosis 174
Management of symptoms in the CHD patient 175
Management of refractory angina 176
Acute coronary syndromes 177
Terminology 177
Pathophysiology of acute coronary syndromes 178
Management of STEMI 179
Management of NSTEACS/NSTEMI 180
Pharmacological therapy in acute coronary
syndromes 181
Valvular heart disease 181
Mitral valve disease 182
Mitral stenosis (MS) 182
Mitral regurgitation (MR) 183
Mitral valve prolapse (MVP) syndrome 185
Aortic valve disease 185
Aortic stenosis (AS) 185
Aortic regurgitation (AR) 187
Tricuspid valve disease 188
Tricuspid stenosis (TS) 188
Tricuspid regurgitation (TR) 189
Pulmonary valve disease 189
Assessing the severity of valvular heart disease
and deciding on surgery 189
Cardiomyopathies 190
Dilated cardiomyopathy (DCM) 190
Hypertrophic cardiomyopathy (HCM) 191
Restrictive cardiomyopathy 192
Other cardiomyopathies 193
Cardiac arrhythmias 194
Sinus node disturbances 194
Sick sinus syndrome 195
Supraventricular premature complexes
(ectopics) 195
Supraventricular tachycardia (SVT) 195
Atrial flutter 196
Atrial fibrillation (AF) 197
Ventricular arrhythmias 200
Conduction defects 201
Bundle branch block (BBB) 201
Fascicular blocks (hemiblocks) 202
Atrioventricular (AV) blocks 203
Cardiac failure 203
Definition 203
Causes 204
Diagnosis of congestive heart failure 204
Treatment 205
Devices 207
Infective endocarditis 208
Microbiology 208
Diagnosis 209
Management 209
Prevention 210
Pericardial diseases 211
Acute pericarditis 211
Pericardial effusion and tamponade 212
Chronic pericardial disease 213
Self-assessment questions 214
Chapter 9
HYPERTENSION 217
Annemarie Hennessy
Chapter outline 217
Mechanisms of hypertension 217
Epidemiological evidence for hypertension and
its effects 218
Definitions of hypertension 220
Clinical presentations and investigations 221
Target-organ effects of hypertension 222
Blood vessels 222
Cardiac effects 222
Retinopathy 222

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Renal changes secondary to hypertension 223
Brain 224
Treatment and targets for hypertension control 224
Specific targets linked to comorbid conditions 224
x
Contents
Treatment for chronic primary hypertension 225
Normal adult 225
High-normal 225
Stage 1 hypertension 225
Higher stages of hypertension 226
Treatment in an acute setting 226
Self-assessment questions 228
Chapter 10
NEPHROLOGY 231
Annemarie Hennessy
Chapter outline 231
Inherited cystic kidney disease 232
Autosomal dominant polycystic kidney
disease (ADPCKD) 232
Medullary sponge kidney (MSK) 234
Medullary cystic disease and autosomal
recessive polycystic disease 234
Acquired kidney cystic disease 234
Simple renal cysts 234
Renal stones/kidney stones 235
Kidney and urinary tract infection 238
Mechanisms of disease 238
Clinical presentation, investigation and
diagnosis 238
Treatment and targets for urinary tract
infection 238
Inherited renal basement membrane disease 238
Thin basement membrane disease 238
Alport’s disease 239
Glomerulonephritis (GN) 239
Classification 239
Primary glomerular inflammatory disease 239
Secondary glomerular inflammatory disease 245
Sclerosing glomerular disease 248
Diabetes mellitus 248
Focal sclerosing glomerular nephropathy
(FSGN) 248
Vascular renal disease 251
Renal artery stenosis 251
Treatment of renovascular disease 251
Thrombotic thrombocytopenic purpura (TTP)/
Hemolytic uremic syndrome (HUS) 251
Malignant hypertension 252
Mechanisms of renal injury in hypertension 252
Clinical presentation, investigation and
diagnosis 252
Treatment and targets 252
Scleroderma kidney 252
Mechanisms of scleroderma kidney and
renal crisis 252
Clinical presentation, investigation and
diagnosis 252
Treatment and targets for scleroderma 253
Reflux nephropathy 253
Clinical presentation, investigation
and diagnosis 253
Treatment and targets 253
Chronic kidney disease (CKD) 253
Classification systems and definitions 253
Early stages of CKD 254
Clinical presentations of stage 3 CKD 254
Clinical presentations of stages 4 and 5 CKD 254
End-stage renal disease (ESRD) and renal
replacement therapy 255
Acute renal failure—acute kidney injury (AKI) 257
Tubulo-interstitial diseases 257
Acute interstitial nephritis (AIN) 258
Chronic tubulo-interstitial disease 258
Electrolyte disorders 258
Hypernatremia 258
Hyponatremia 259
Hyperkalemia 260
Hypokalemia 260
Inherited ‘channelopathies’ associated with
hyper tension or hyperkalemia 261
Hypokalemic alkalosis (with and without
hypertension) 261
Renal tubular acidosis 261
The kidneys in pregnancy and pregnancy-related
diseases 262
Normal adaptations to pregnancy 262
Underlying renal disease 263
Self-assessment questions 264
Chapter 11
ENDOCRINOLOGY 267
Mark McLean and Sue Lynn Lau
Chapter outline 267
System overview 268
Hormones, their transport and action 268
Feedback control of hormonal systems 268
Evaluating the function of hormonal systems 269
Pathogenic mechanisms of hormonal
disorders 269
Disorders of the pituitary and hypothalamus 270
Anatomy and physiology 270
Pituitary mass lesions 271
Hypopituitarism 272
Syndromes of hypersecretion 273
Surgery and radiotherapy for pituitary tumors 274
Inflammatory and infiltrative disorders 274
Diabetes insipidus (DI) 274
Thyroid disorders 275
Physiology and assessment of thyroid
function 275
Thyroid imaging 275
Thyroid autoimmunity 276
Hyperthyroidism 276
Hypothyroidism 278
Goiter and thyroid nodules 279
Thyroid cancer 280
Thyroid disease in pregnancy 280
Disorders of bone and mineral metabolism 281
Mineral homeostasis 281
Hypercalcemia 281
Hypocalcemia 283
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Contents
Osteoporosis 284
Osteomalacia and rickets 285
Paget’s disease (PD) 286
Adrenal disorders 287
Physiology and assessment of adrenal
function 287
Adrenal insufficiency 287
Cortisol excess (Cushing’s syndrome) 289
Primary hyperaldosteronism (Conn’s
syndrome) 290
Pheochromocytoma 291
Congenital adrenal hyperplasia (CAH) 292
Incidentally found adrenal masses
(‘incidentaloma’) 293
Growth and puberty 294
Causes of short stature 294
Onset of puberty—physiology 295
Male reproductive endocrinology 295
Testicular function 295
Male hypogonadism 297
Causes of erectile dysfunction 297
Gynecomastia 297
Androgen replacement therapy 298
Female reproductive endocrinology 298
Anatomy and physiology 298
Clinical and laboratory evaluation 298
Hirsutism and hyperandrogenism 299
Polycystic ovary syndrome (PCOS) 299
Female hypogonadism 300
Endocrinology of pregnancy 300
Neuroendocrine tumors (NETs) 300
Overview 300
Differential diagnosis of a hypoglycemic
disorder 302
Treatment of malignant NETS 302
Disorders of multiple endocrine systems 302
Multiple endocrine neoplasia (MEN) 302
Other multiple endocrine tumor syndromes 303
Polyglandular autoimmunity (PGA) syndromes 303
Diabetes and metabolism 303
Overview of energy metabolism 303
Carbohydrate metabolism and diabetes 304
Type 1 diabetes mellitus (T1DM) 306
Type 2 diabetes mellitus (T2DM) 307
Complications of diabetes 310
Hypoglycemia 311
Gestational diabetes (GDM) 312
Disorders of energy excess—overweight and
obesity 313
The metabolic syndrome 313
Self-assessment questions 315
Chapter 12
GASTROENTEROLOGY 319
Magnus Halland, Vimalan Ambikaipaker,
Kara De Felice and Nicholas J Talley
Chapter outline 319
Esophagus 320
Dysphagia 320
Motor disorders 320
Esophagitis due to causes other than acid reflux 322
Stomach 323
Physiology of acid secretion 323
Dyspepsia and its management 324
Gastritis and gastropathy 325
Peptic ulcer disease (PUD) 325
Tumors 326
Post-gastrectomy complications 326
Gastroparesis 327
Small bowel 327
Celiac disease 327
Diarrhea 328
Malabsorption 335
Microscopic colitis 336
Tropical sprue 336
Small intestinal bacterial overgrowth (SIBO) 336
Eosinophilic gastroenteritis (EGE) 337
Chronic idiopathic intestinal pseudoobstruction
(CIIP) 337
Short bowel syndrome 337
Nutritional deficiency 338
Clinical clues to malnutrition 338
Nutritional assessment in end-stage liver
disease 341
Enteral and parenteral nutrition 341
Large bowel 342
Irritable bowel syndrome (IBS) 342
Constipation 343
Diverticular disease 344
Inflammatory bowel disease (IBD) 344
Colon polyps 351
Bowel cancer screening 353
Recommendations for screening and
surveillance 353
Fecal occult blood testing (FOBT) 353
Malignant potential and surveillance 353
Gastrointestinal bleeding 355
Upper 355
Lower 356
Obscure GI bleeding 358
Management of iron-deficiency anemia 358
Pancreas 358
Acute pancreatitis 358
Chronic pancreatitis 361
Autoimmune pancreatitis (AIP) 362
Pancreatic cysts 363
Self-assessment questions 364
Chapter 13
HEPATOLOGY 371
Robert Gibson, Magnus Halland and
Nicholas J Talley
Chapter outline 371
Liver function tests and their abnormalities 372
Serum enzymes 372
Tests of synthetic function 372
Approach to the patient with liver disease 372
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Contents
Bilirubin metabolism and jaundice 374
Viral hepatitis 377
Hepatitis A (RNA virus) 377
Hepatitis B (DNA virus) 377
Hepatitis C (RNA virus) 381
Hepatitis D, E and G 382
Other viruses causing hepatitis 383
Cirrhosis 383
Useful investigations 383
Prognosis 383
Management 384
Ascites 385
Management 386
Hepatorenal syndrome (HRS) 387
Management 387
Hyponatremia 387
Spontaneous bacterial peritonitis (SBP) 388
Treatment 388
Portal hypertensive bleeding 388
Management 388
Portosystemic encephalopathy (PSE) 389
Precipitant-induced PSE 389
Persistent PSE 390
Minimal encephalopathy 390
Portopulmonary hypertension (POPH) 391
Hepatopulmonary syndrome (HPS) 391
Cirrhotic cardiomyopathy 392
Acute liver failure (ALF) 392
Liver transplantation 393
Drugs and the liver 394
Acetaminophen (paracetamol) and acute liver
disease 394
Alcohol and the liver 394
Specific liver diseases 396
Budd–Chiari syndrome (BCS) 396
Non-alcoholic fatty liver disease (NAFLD) and
non-alcoholic steatohepatitis (NASH) 396
Wilson’s disease (hepatolenticular
degeneration) 397
Alpha-1 anti-trypsin deficiency 397
Hemochromatosis 397
Autoimmune liver diseases 398
Autoimmune hepatitis (AIH) 398
Primary biliary cirrhosis (PBC) and primary
sclerosing cholangitis (PSC) 399
Systemic disease and the liver 400
Pregnancy and liver disease 400
Gallbladder and biliary tree 400
Gallstones 400
Acalculous cholecysitis 401
Porphyrias 401
Acute intermittent porphyria (AIP) 401
Porphyria cutanea tarda (PCT) 401
Self-assessment questions 402
Chapter 14
HEMATOLOGY 407
Harshal Nandurkar
Chapter outline 407
Hemostasis 408
Essential concepts 408
Components of the hemostatic system 408
Venous thrombosis 410
Predisposition to venous thrombosis 410
Diagnosis of venous thrombosis 411
Treatment of venous thromboembolism (VTE) 412
Post- thrombotic syndrome (PTS) 412
Antiphospholipid syndrome (APS) 412
Treatment 413
Thrombosis at unusual sites 413
Cerebral vein thrombosis (CVT) 413
Portal vein thrombosis (PVT) 413
Cancer and thrombosis 413
Bleeding disorders 414
Von Willebrand disease (vWD) 414
Hemophilia A 416
Hemophilia B 417
Bleeding disorders due to deficiencies of
other coagulation factors 417
Platelet disorders 417
Idiopathic thrombocytopenic purpura (ITP) 417
Thrombotic thrombocytopenic purpura and
hemolytic uremic syndrome 418
Disseminated intravascular coagulation (DIC) 419
Diagnosis 420
Treatment 420

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Coagulopathy in intensive care patients 421
Myeloproliferative disorders 421
Polycythemia rubra vera (PV) 421
Essential thrombocytosis (ET) 423
Primary myelofibrosis (PMF) 425
Leukemia 426
Acute myeloid leukemia (AML) 426
Acute promyelocytic leukemia (APML) 428
Acute lymphoblastic leukemia (ALL) 429
Myelodysplastic syndrome (MDS) 429
Chronic myeloid leukemia (CML) 430
Chronic lymphocytic leukemia and other
B- cell disorders 432
Non- Hodgkin lymphomas 434
Diagnosis 434
Staging 434
Diffuse large B- cell lymphoma (DLBCL) 434
‘Double hit’ (DH) lymphomas 435
Burkitt’s lymphoma 435
Follicular lymphoma (FL) 435
Mantle- cell lymphoma (MCL) 436
Cutaneous lymphomas 436
Hodgkin lymphoma (HL) 436
Histological subtypes and cell biology 437
Staging 437
Risk stratification 437
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Contents
Plasma cell disorders 438
Monoclonal gammopathy of uncertain
significance (MGUS) 438
Asymptomatic myeloma 438
Symptomatic myeloma 438
Prognostic markers in myeloma 439
Treatment of myeloma 439
Differential diagnosis 439
Anemia 440
Mechanisms of anemia 440
Common laboratory tests used for diagnostic
work- up 440
Approach to iron- deficiency anemia 440
Management of iron deficiency 442
Anemia of chronic disease 442
Thalassemias 442
Sideroblastic anemias 443
Macrocytic anemias 443
Hemolytic anemias 445
Drug- induced hemolysis 450
Non- immune acquired hemolytic anemias 450
Self- assessment questions 451
Chapter 15
ONCOLOGY 455
Christos S Karapetis
Chapter outline 455
What is cancer? 457
DNA and genes 457
Basic elements of cancer biology 457
Essential elements of cancer diagnosis and
treatment 457
Prevention 457
Diagnosis 458
Screening 458
Signs and symptoms 458
Diagnostic tests 458
Prognosis 459
Cancer factors 459
Patient factors 459
Prognostic vs predictive factors 459
Treatment principles 459
Defining treatment goals 459
Adjuvant therapy 460
Neoadjuvant therapy 460
Supportive management 460
Maintenance therapy 460
Principles of chemotherapy 460
Attitudes to chemotherapy 461
Toxicity of cytotoxic chemotherapy 461
Principles of radiotherapy 461
Fractionation 462
Radiation effects 462
Treatment responsiveness 462
Endocrine responsive 462
Potentially curable following chemotherapy
alone 462
Tumors very sensitive to chemotherapy 462
Potentially curable following radiotherapy 462
Personalized medicine 462
Molecular targeted therapy 462
Monoclonal antibodies (the ‘ABs’) 462
Tyrosine kinase inhibitors (the ‘IBs’) 463
Other 463
Familial cancers and cancer genetics 463
Oncological emergencies 463
Spinal cord compression 463
Febrile neutropenia 464
Cardiac tamponade 464
Addisonian crisis 465
Disseminated intravascular coagulation (DIC) 465
Hypercalcemia 465
Hyponatremia 465
Superior vena cava (SVC) obstruction 465
Raised intracranial pressure (ICP) 465
Tumor markers in serum 465
Paraneoplastic syndrome 466
Cancer with unknown primary (CUP) 466
Diagnosis 466
Potentially treatable subgroups of CUP 466
Recent research and future directions 467
Lung cancer 467
Clinical presentation 467
Risk factors 467
Epidemiology and pathology 467
Non-small-cell lung cancer (NSCLC) 467
Small cell lung cancer (SCLC) 468
Recent research and future directions 468
Renal cancer 469
Background 469
Diagnosis and staging 469
Treatment 469
Prognosis 469
Tumors of the pelvis, ureter and bladder 469
Epidemiology 469
Risk factors 470
Clinical presentation 470
Investigation and diagnosis 470
Treatment 470
Recent research and future directions 470
Prostate cancer 470
Epidemiology 470
Screening 470
Staging 470
Management 471
Recent research and future directions 471
Testis cancer 471
Epidemiology and risk 471
Pathology 471
Diagnosis 471
Prognostic factors in stage I NSGCT 472
Treatment 472
Post-chemotherapy residual masses 473
Relapsed disease 473
High-dose chemotherapy (HDCT) 473
Head and neck cancer 473
Early-stage disease 473
Advanced-stage disease 473
Human papillomavirus (HPV) infection 473
xiv

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Contents
Esophageal cancer 473
Pathology and epidemiology 473
Clinical presentation 474
Diagnosis and screening 474
Management 474
Gastric cancer 474
Epidemiology 474
Clinical presentation 474
Diagnosis 475
Treatment 475
Gastric MALT lymphoma 475
Colorectal cancer 475
Pathology and epidemiology 475
Diagnosis and staging 476
Management 476
Future directions 477
Pancreatic cancer 477
Key points 477
Epidemiology 477
Diagnosis 478
Management 478
Hepatocellular carcinoma (HCC) 478
Key points 478
Risk factors 478
Prognosis 478
Treatment 478
Brain tumors 479
Low-grade glioma (astrocytoma and
oligodendroglioma) 479
Glioblastoma multiforme (GBM) 480
Lymphoma—see Chapter 13 480
Melanoma 480
Pathology and epidemiology 480
Diagnosis and staging 480
Management 480
Future directions 481
Sarcoma 481
Clinical presentation 481
Diagnosis 481
Treatment 481
Breast cancer 482
Epidemiology 482
Risk factors 482
Pathology 482
Screening 482
Diagnosis and staging 482
Management 482
Recent research and future directions 484
Ovarian cancer 484
Key points 484
Pathology and epidemiology 484
Diagnosis 485
Management 485
Future directions 485
Endometrial cancer 486
Pathology and epidemiology 486
Diagnosis 486
Management 486
Self- assessment questions 487
Chapter 16
PALLIATIVE MEDICINE 489
Meera Agar and Katherine Clark
Chapter outline 489
Pain 490
Definition 490
Impact of the problem 490
Pathophysiological basis 490
Interventions to palliate the problem 490
Mucositis 492
Definition 492
Impact of the problem 492
Pathophysiological basis 492
Interventions 492
Fatigue 493
Definition 493
Impact of the problem 493
Pathophysiological basis 493
Interventions to palliate the problem 493
Nausea and vomiting 493
Definition 493
Impact of the problem 494
Pathophysiological basis 494
Interventions to palliate the problem 494
Cachexia and anorexia 496
Definition 496
Impact of the problems 496
Underlying pathophysiological basis 496
Interventions 497
Dyspnea 497
Definition 497
Impact of the problem 497
Pathophysiological basis 497
Interventions to palliate the problem 498
Constipation 498
Definition 498
Impact of the problem 498
Pathophysiological basis 498
Interventions to palliate the problem 498
Delirium 498
Definition 498
Impact of the problem 498
Pathophysiological basis 499
Interventions to palliate the problem 499
Insomnia 499
Definition 499
Impact of the problem 499
Pathophysiological basis 499
Interventions to palliate the problem 500
Self-assessment questions 501
Chapter 17
IMMUNOLOGY 503
Brad Frankum
Chapter outline 503
Key concepts in immunobiology 504
Innate and adaptive immunity 504
Specificity and diversity 505
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Contents
Immunological memory 506
Hypersensitivity, autoimmunity and
immunodeficiency 507
Immunity, inflammation and tissue repair 508
Understanding immunobiology 508
Manipulation of the immune system 508
Allergic disease 509
Anaphylaxis 509
Allergic rhinitis (AR) and allergic conjunctivitis
(AC) 510
Chronic rhinosinusitis 512
Atopic dermatitis (AD) 513
Food allergy 515
Urticaria and angioedema 516
Drug allergy 519
Insect venom allergy 520
Eosinophilia 521
Hypereosinophilic syndrome (HES) 521
Mast cell disorders 522
Cutaneous mastocytosis (CM) 522
Systemic mastocytosis (SM) 522
Systemic autoimmune disease 522
Systemic lupus erythematosus (SLE) 523
Sjögren’s syndrome (SS) 527
Inflammatory myopathies 529
Scleroderma and CREST syndrome 531
Mixed connective tissue disease (MCTD) 532
Antiphospholipid syndrome (APS) 533
IgG4-related disease 533
Primary vasculitis 534
Large-vessel vasculitis 534
Medium-vessel vasculitis 536
Small-vessel vasculitis 537
Single-organ vasculitis 539
Variable-vessel vasculitis 539
Autoinflammatory disorders 540
Familial Mediterranean fever (FMF) 540
TNF-receptor-associated periodic syndrome
(TRAPS) 541
Immunodeficiency 541
Primary immunodeficiency 541
Secondary (acquired) immunodeficiency 544
HIV/AIDS 544

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Epidemiology 545
Risk factors for HIV infection 545
Pathophysiology 545
Clinical features and diagnosis 546
Management 547
Prognosis 549
Self-assessment questions 551
Chapter 18
MUSCULOSKELETAL MEDICINE 557
Kevin Pile
Chapter outline 557
An approach to a patient with painful joints 558
History 558
Examination 559
Investigations 560
Rheumatoid arthritis (RA) 560
Genetics and environmental contribution
to RA 560
Pathology 561
Diagnosis 561
Clinical features and complications 561
Investigations 563
Treatment 563
Conclusions 565
Spondyloarthropathies 565
Ankylosing spondylitis (AS) 566
Psoriatic arthritis (PsA) 567
Reactive arthritis (ReA) 568
IBD- associated spondyloarthropathy 569
Adult- onset Still’s disease 569
Crystal arthropathies 569
Gout 569
Pseudogout 572
Relapsing polychondritis (RP) 574
Osteoarthritis (OA) 574
Types of osteoarthritis 574
Clinical features 575
Specific joint involvement 575
Investigations 576
Treatment 576
Genetic connective tissue disorders 578
Painful shoulders 578
Clinical assessment 578
Examination 579
Rotator cuff disease 579
Frozen shoulder/adhesive capsulitis 580
Tennis elbow and golfer’s elbow 581
Tennis elbow (lateral epicondylitis) 581
Golfer’s elbow (medial epicondylitis) 581
Plantar fasciitis 581
Fibromyalgia 582
Epidemiology and etiology 582
Investigations 582
Prognosis, differential diagnosis and
treatment 583
Septic arthritis 584
Investigations 585
Treatment 585
Acute low back pain 585
Specific pathology leading to acute low
back pain 586
Management 587
Outcome 587
Chronic low back pain 587
Clinical assessment 587
Conservative treatment 587
Invasive treatment 588
Self- assessment questions 589
xvi
Contents
Chapter 19
NEUROLOGY 593
Christopher Levi, Thomas Wellings and
Brad Frankum
Chapter outline 593
Disorders of consciousness 594
Definitions 594
Levels of consciousness 594
Causes of coma 594
Assessment of the patient with impaired
consciousness 595
Headache 596
Primary headache syndromes 596
Secondary headache 600
Stroke 602
Acute assessment and management 602
Thrombolysis 603
Neurosurgical intervention 604
General care measures 604
Early secondary prevention 605
Intracerebral hemorrhage 606
Medical treatment 606
Surgical management 606
Subarachnoid hemorrhage (SAH) 606
Natural history and outcome of an
aneurysmal SAH 606
Surgical versus endovascular management
of SAH 606
Transient ischemic attack (TIA) 606
Definition 607
Differential diagnosis of transient neurological
disturbances 607
Pathophysiology 607
Investigation 607
Recurrent event risk 607
Prevention of recurrent events 607
Dementia 607
Diagnosis 607
Major dementia syndromes 608
Diagnostic work-up of the dementia patient 609
Other dementia syndromes 609
Seizures and the epilepsies 611
Seizure types 611
Assessing a patient after a seizure 612
Investigation of a first seizure 613
The epilepsies 613
Important epilepsy syndromes 614
Choice of anticonvulsant therapy 616
Status epilepticus 616
Non-epileptic seizures 618
Balance, dizziness and vertigo 618
Hemodynamic dizziness or ‘lightheadedness’ 619
Vertigo 619
Central pathologies 621
Treatment of vertiginous patients 622
Other balance disorders 622
Movement disorders 623
Tremor 623
Parkinson’s disease (PD) 624

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Dementia with Lewy bodies (DLB) 627
Multisystem atrophy (MSA) 627
Progressive supranuclear palsy (PSP) 627
Corticobasal syndrome 627
Dystonia 627
Hyperkinetic movement disorders 628
NMDA encephalitis 629
Multiple sclerosis and CNS inflammation 630
Multiple sclerosis (MS) 630
Neuromyelitis optica (NMO; ‘Devic’s disease’) 634
Acute disseminated encephalomyelitis
(ADEM) and transverse myelitis (TM) 634
Neurological manifestations of sarcoidosis and
Behçet’s disease 635
Sarcoidosis 635
Behçet’s disease 635
Neuromuscular disease 635
Myopathy 636
Genetic disorders 638
Neuromuscular disorders 639
Myasthenia gravis (MG) 639
Disorders of peripheral nerves 641
Motor neuron disease (MND)/amyotrophic
lateral sclerosis 641
Demyelinating neuropathy and Guillain–Barré
syndrome (GBS) 643
Peripheral neuropathy 644
Self-assessment questions 646
Chapter 20
PSYCHIATRY FOR THE INTERNIST 651
Brian Kelly
Chapter outline 651
Depression 651
Anxiety disorders 652
Post-traumatic stress disorder (PTSD) 652
Somatization 653
Eating disorders 653
Anorexia and bulimia nervosa 654
Suicide and deliberate self-harm 654
Psychotropic agents 655
Lithium carbonate 655
Anticonvulsants 655
Antipsychotic agents 656
Antidepressants 656
Self-assessment questions 658
Chapter 21
CLINICAL INFECTIOUS DISEASES 659
Iain Gosbell
Chapter outline 659
Clinical approach to infectious diseases 660
Overview 660
History 660
Examination 660
Diagnostics in infectious diseases 661
Pre-analytical considerations 661
xvii
Contents
Analytical considerations 661
Post-analytical considerations 661
Selected common clinically important organisms 662
Selected bacteria 662
Selected viruses 664
Selected fungi 666
Selected parasites 668
Anti-infective treatment 668
Is infection likely? 669
What are the likely pathogen(s)? 669
Are anti-infective drugs required? 670
Choice of empirical and definitive antibiotics 670
What host factors need consideration? 670
What therapy other than antibiotics is
required? 670
Ongoing assessment and further results 670
What is the duration and endpoint of
treatment? 670
Anti-infective agents 671
Antibiotics 671
Antiviral agents 678
Antifungals 679
Specific syndromes 681
Acute fever 681
Pyrexia of unknown origin (PUO) 681
Skin and soft tissue infections 683
Drug fever 685
Infections in special hosts and populations 685
Infections in immunosuppressed patients 685
Sexually transmitted infections (STIs) 686
Systemic viral infections 692
HIV 692
Hepatitis viruses 692
Herpesviruses 692
Zoonoses 692
Infection prevention and control 696
Administrative support 696
Judicious use of antibiotics 697
MRO surveillance 697
Infection control precautions 697
Environmental measures 697
Decolonization 697
Self-assessment questions 698
Chapter 22
IMMUNIZATION 701
Rob Pickles
Chapter outline 701
General principles 701
Immunizing agents 702
Factors affecting immunogenicity 703
Chemical and physical properties of antigens
(vaccines) 703
Physiological attributes of individuals 704
Route of administration 704
Presence of adjuvants 704
Contraindications 704
False contraindications 704
Egg allergy 704
Booster doses 704
Immunization in specific populations 704
Pregnancy 704
Preconception 704
Breastfeeding 704
Immunocompromised hosts 704
Oncology patients 705
Solid-organ transplant patients 705
Hemopoetic stem-cell transplant (HSCT)
recipients 705
HIV/AIDS 706
Asplenia 706
Occupational exposure 706
Travel vaccines 706
Post-exposure prophylaxis (PEP) 707
Intramuscular immune globulin 707
Specific intramuscular immune globulin
preparations (hyperimmune globulins) 707
Specific immune globulins for intravenous
use 707
Routine immunization of adults 707
Self-assessment questions 711
Chapter 23
DERMATOLOGY FOR THE PHYSICIAN 715
Brad Frankum
Chapter outline 715
Acne 715
Autoimmune diseases of the skin 715
Psoriasis 716
Erythema nodosum (EN) 717
Bullous lesions 717
Dermatitis herpetiformis 718
Livedo reticularis 719
Skin problems associated with underlying
systemic disease 719
Acanthosis nigricans 719
Neutrophilic dermatoses 719
Pruritus 720
Pigmentation 721
Photosensitivity 721
Rash on the palms and soles 721
Red person syndrome (erythroderma or
exfoliative dermatitis) 721
Excessive sweating (hyperhydrosis) 722
Facial flushing 722
Genetic or congenital skin diseases 722
The phakomatoses 722
Skin disease associated with malignancy 723
Primary or secondary malignancy 723
Underlying malignancy 723
Self-assessment questions 725
Chapter 24
MEDICAL OPHTHALMOLOGY 727
Michael Hennessy and Brad Frankum
Chapter outline 727
Introduction 727
Ocular history 728
xviii
Contents
Ocular examination 728
General inspection findings 728
Visual acuity 728
Intraocular pressure 728
Field of vision 728
Pupils 729
Color vision 730
Ocular motility 730
Ophthalmoscopy 731
Auscultation 731
Pathological conditions 732
Retinal vascular disease 732
Hypertension 732
Retinal arterial occlusion 733
Retinal venous occlusion 733
Diabetic retinopathy (DR) 734
Non-arteritic anterior ischemic optic
neuropathy 734
Arteritis—arteritic acute anterior ischemic
optic neuropathy 735
Uveitis 735
Retinitis 736
Scleritis and sclero-uveitis 736
Thyroid-related orbitopathy 736
Dry eye 737
Neoplasia and the eye 737
Neuro-ophthalmology 738
Optic neuritis (ON) 738
Papilledema 738
Extraocular muscle paralysis 739
Phakomatoses 739
Ocular effects of systemic medication 739
Self-assessment questions 741
Chapter 25
WOMEN’S HEALTH FOR THE
PHYSICIAN 743
Andrew Korda
Chapter outline 743
Infertility 743
Age and infertility 744
Anovulatory infertility 744
Hyperprolactinemia 745
Infertility due to anatomical abnormalities of
the reproductive tract 745
Male factor infertility 745
Unexplained infertility 745
Contraception 745
Steroidal contraception 746
Non-steroidal contraception 748
Emergency contraception 748
Menopausal symptoms 748
Premenstrual syndrome 749
Abnormal uterine bleeding 749
Diagnosis 749
Management 750
Dysmenorrhea 750
Vulvar conditions 750
Management 751
Conditions with abnormalities on
examination 751
Sexually transmitted infections (STIs) 753
Chlamydia 753
Gonorrhea 754
Pelvic inflammatory disease (PID) 754
Clinical features 754
Treatment 755
Sexual problems 755
Treatment 756
Self-assessment questions 757
Chapter 26
OBSTETRIC MEDICINE 759
Annemarie Hennessy
Chapter outline 759
General principles of medical obstetric care 760
Diabetes in pregnancy 760
Gestational diabetes 761
Type 1 diabetes in pregnancy 762
Type 2 diabetes in pregnancy 762
Hypertension in pregnancy 763
Mechanisms of disease 763
Clinical presentation, investigation and
diagnosis 763
Treatment and targets 764
Prevention strategies for preeclampsia 764
Respiratory disease in pregnancy 764
Pneumonia 764
Asthma 765
Venous thromboembolism (VTE) in pregnancy 766
Thyroid disorders in pregnancy 766
Hypothyroidism 766
Hyperthyroidism 767
Common gastroenterological and liver disorders
in pregnancy 767
Gastroesophageal reflux disease (GERD) 767
Constipation and irritable bowel syndrome
(IBS) 767
Inflammatory bowel disease (IBD) 767
Cholestasis of pregnancy 768
Acute fatty liver of pregnancy (AFLP) 768
Budd–Chiari syndrome in pregnancy 769
Viral infection in pregnancy 769
Viral hepatitis 769
Immunological and hematological disease in
pregnancy 770
Systemic lupus erythematosus (SLE) 770
Antiphospholipid syndrome (APS) 770
Idiopathic thrombocytopenic purpura (ITP) 770
Iron-deficiency anemia (IDA) 771
Cardiac disease in pregnancy 771
Valvular heart disease 771
Arrhythmias and palpitations 772
Cardiomyopathy, including postpartum
cardiomyopathy 772
Other vascular conditions 772
xix
Contents
Obesity in pregnancy 773
Neurological conditions in pregnancy 773
Self-assessment questions 774
Chapter 27
GERIATRIC MEDICINE 777
Will Browne and Kichu Nair
Chapter outline 777
Introduction 777
Epidemiology of aging 778
Aging and disease 778
Degenerative disease 778
Theories of aging 778
Conditions associated with apparent
acceleration of aging 779
Physiology of aging 779
Cardiovascular changes 779
Cardiac changes 779
Renal changes 779
Musculoskeletal changes 780
Neurological changes 780
Skin changes 780
Metabolic and endocrine changes 780
Gastrointestinal changes 780
Atypical presentation of disease 780
Pathology: disease in older people 780
The giants of geriatrics 780
The six ‘I’s 781
The 6 ‘S’s 783
Elder abuse 786
Osteoporosis 786
Comprehensive geriatric assessment 786
Physical examination in the elderly 786
Functional assessment 786
Healthy aging 787
What is healthy aging? 787
Lifestyle issues in older people 787
Diet 787
Malnutrition in the elderly 787
Exercise 787
Alcohol use 787
Prescription drug use/misuse 788
Adapting to reduced function and
independence 788
Facing the inevitable with dignity 788
Palliative care in the older patient 788
Living wills and advance care planning 788
Self-assessment questions 789

Authors of Essentials of internal medicine pdf

Nicholas J. Talley

MD, PhD, FRACP, FAFPHM, FRCP (Lond.), FRCP (Edin.), FACP, FAHMS

Professor of Medicine, Faculty of Health and Medicine, University of Newcastle,

Australia; Adjunct Professor, Mayo Clinic, Rochester, MN, USA; Adjunct Professor,

University of North Carolina, Chapel Hill, NC, USA; Foreign Guest Professor,

Karolinska Institutet, Stockholm, Sweden

Brad Frankum

OAM, BMed (Hons), FRACP

Professor of Clinical Education, and Deputy Dean, University of Western Sydney

School of Medicine; Consultant Clinical Immunologist and Allergist, Campbelltown and Camden Hospitals, NSW, Australia

David Currow

BMed, MPH, PhD, FRACP

Professor, Discipline of Palliative and Supportive Services, Flinders University;

Flinders Centre for Clinical Change, Flinders University, SA, Australia

Product details

• ASIN: B08L6MPQXS
• Publisher: Elsevier; 4th edition (October 7, 2020)
• Publication date: October 7, 2020
• Language: English
• File size: 170331 KB
• Simultaneous device usage: Up to 4 simultaneous devices, per publisher limits
• Text-to-Speech: Enabled
• Enhanced typesetting: Enabled
• X-Ray: Not Enabled
• Word Wise: Not Enabled
• Print length: 2588 pages
• Lending: Not Enabled

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