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1
Lipman, Bradford C. ECG assessment and interpretation. Philadelphia: F.A. Davis, 1994.
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2
Toni, Cascio, ed. ECG assessment and interpretation. Philadelphia, PA: F.A. Davis Co., 1994.
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3
Lippincott's need-to-know ECG facts. Philadelphia: Lippincott, 1997.
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4
Lippincott Williams & Wilkins., ed. Just the facts: ECG interpretation. Philadelphia: Lippincott Williams & Wilkins, 2005.
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5
Mark, Quigg, ed. EEG pearls. Philadelphia: Mosby Elsevier, 2006.
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6
Samanwoy, Ghosh-Dastidar, ed. Automated EEG-based diagnosis of neurological disorders: Inventing the future of neurology. Boca Raton: CRC Press/Taylor & Francis, 2010.
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7
Yamada, Tōru. Practical guide for clinical neurophysiologic testing: EEG. Philadelphia, PA: Lippincott Williams & Wilkins, 2010.
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8
Yamada, Tōru. Practical guide for clinical neurophysiologic testing: EEG. Philadelphia, PA: Lippincott Williams & Wilkins, 2010.
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9
Tyner, Fay S. Fundamentals of EEG technology. New York: Raven Press, 1989.
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10
Jr, Thomas S. Metkus. ECG Rounds. McGraw-Hill Education / Medical, 2013.
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11
Barold, S. Serge, Roland X. Stroobandt, and Alfons F. Sinnaeve. ECG from Basics to Essentials: Step by Step. Wiley & Sons, Incorporated, John, 2015.
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12
Barold, S. Serge, Roland X. Stroobandt, and Alfons F. Sinnaeve. ECG from Basics to Essentials: Step by Step. Wiley & Sons, Incorporated, John, 2015.
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13
Barold, S. Serge, Roland X. Stroobandt, and Alfons F. Sinnaeve. ECG from Basics to Essentials: Step by Step. Wiley & Sons, Limited, John, 2015.
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14
Malik, Aamir Saeed, and Kamel Nidal. Eeg/Erp Analysis. Taylor & Francis Group, 2014.
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15
Adeli, Hojjat, and Samanwoy Ghosh-Dastidar. Automated EEG-Based Diagnosis of Neurological Disorders: Inventing the Future of Neurology. Taylor & Francis Group, 2010.
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16
Adeli, Hojjat, and Samanwoy Ghosh-Dastidar. Automated EEG-Based Diagnosis of Neurological Disorders: Inventing the Future of Neurology. Taylor & Francis Group, 2010.
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17
Adeli, Hojjat. Automated Eeg-Based Diagnosis of Neurological Disorders: Inventing the Future of Neurology. Taylor & Francis Group, 2010.
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18
Adeli, Hojjat, and Samanwoy Ghosh-Dastidar. Automated EEG-Based Diagnosis of Neurological Disorders: Inventing the Future of Neurology. Taylor & Francis Group, 2017.
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19
EEG/ERP Analysis: Methods and Applications. Taylor & Francis Group, 2014.
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20
Malik, Aamir Saeed, and Kamel Nidal. EEG/ERP Analysis: Methods and Applications. Taylor & Francis Group, 2017.
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21
Malik, Aamir Saeed, and Kamel Nidal. EEG/ERP Analysis: Methods and Applications. Taylor & Francis Group, 2014.
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22
Malik, Aamir Saeed, and Kamel Nidal. EEG/ERP Analysis: Methods and Applications. Taylor & Francis Group, 2014.
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23
Practical Guide for Clinical Neurophysiologic Testing: EEG. LWW, 2017.
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24
Gill, Harminder S., and Jaswinder S. Gill. Causes, diagnosis, and therapeutic strategy in bradyarrhythmias. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0157.
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Bradyarrhythmias (defined as a heart rate <60 beat/min) occur frequently in the critical care setting. Most are related to underlying disease processes and the multidrug therapies administered. Because of the intense monitoring of these patients, recognition is generally easy. Examination of the ECG will allow diagnosis of the type of bradycardia based on the sinus node, atrioventricular node and the infra-Hissian conducting system. The extent of conduction system disease can be estimated and this has an influence on the prognosis. Bradycardias causing haemodynamic collapse require treatment of underlying causes, resuscitation, and administration of atropine and epinephrine. If there is no response to these then either transcutaneous pacing, or temporary transvenous pacing is necessary. This can be followed by implantation of a permanent pacing system. The outcome of correctly diagnosing and treating a bradyarrhythmia is excellent as long as the causative pathology can be stabilized.
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McKeon, Andrew, B. Mark Keegan, and W. Oliver Tobin. Mayo Clinic Cases in Neuroimmunology. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197583425.001.0001.
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In the past 2 decades, diagnostics and therapeutics in neuroimmunology have rapidly evolved and increased in complexity. Diagnosis is assisted by various laboratory and advanced imaging techniques. Randomized clinical trials in multiple sclerosis and neuromyelitis optica, and smaller studies for rarer autoimmune diseases, have led to distinct immune molecule–targeted and mechanism-specific therapies. The fields of cerebrovascular medicine, neurooncology, and neuroinfectious diseases have not remained static either. All of these gains present a challenge, however, in that early and accurate neurologic diagnosis is more important than ever. In our experience, some diagnostic pitfalls lie in the interpretation of test results and images without reference to the nuances of the clinical history and examination. Although some things change (eg, technology), other things never change (eg, clinical common sense). The 83 case-based chapters focus on key components of the history, examination and test findings, and differential diagnosis, although we also reference treatment approaches extensively throughout. To bring some form to this extensive repertoire of cases, the book is divided into 3 sections covering central nervous system demyelinating disease, autoimmune neurologic disorders, and others. Illustrations include imaging and, where relevant, pathologic images and video material. Board review–style questions are also provided.
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Koutroumanidis, Michalis, and Robin Howard. Encephalopathy, central nervous system infections, and coma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199688395.003.0032.
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This chapter provides an overview of the indications for and the diagnostic and prognostic value of acute video-electroencephalogram (EEG) and continuous video-EEG monitoring in patients with encephalopathies, encephalitides, and coma. Particular emphasis is placed on the detection of non-convulsive seizures and non-convulsive status epilepticus secondary to acute and sub-acute cerebral insults, including post-cardiac arrest hypoxic-ischaemic brain injury, and on the related pitfalls and uncertainties. It also discusses key technical aspects of the EEG recording, including artefact identification and limitation, timing and type of external stimulation and assessment of EEG reactivity, and highlights the main relevant pitfalls. Finally, it explores the role of evoked potentials (EPs) in outcome prediction and the value of Cognitive EPs and quantitative EEG in the assessment of chronic disorders of consciousness.
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Cuthbert, Bruce N. The Nimh Research Domain Criteria Project. Edited by Dennis S. Charney, Eric J. Nestler, Pamela Sklar, and Joseph D. Buxbaum. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190681425.003.0071.
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The Research Domain Criteria (RDoC) project grew from recognized deficiencies in currently used diagnostic schemes for mental illness, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the latter is based on a series of signs and symptoms of illnesses that can co-occur in groups of individuals, without consideration of underlying biological factors, RDoC is based on the increasing ability to relate normal as well as abnormal behavior to particular molecules and circuits in the brain across animal species and humans. Behavioral domains include negative valence systems (e.g., fear and anxiety), positive valence systems (e.g., reward and motivation), cognitive systems, social processes, and arousal and regulatory systems, several of which might be affected in a given DSM disease classification. RDoC is seen as a step toward a “precision psychiatry,” where increasing knowledge of the genetic, molecular, cellular, and circuit basis of mental illness will yield biologically based diagnoses that offer important pathophysiological, treatment, and prognostic implications.
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Rubin, Devon I., and Jasper R. Daube. Clinical Neurophysiology. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190259631.001.0001.
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Clinical neurophysiologic testing is an important component of evaluating patients with complaints that may be attributed to diseases of the central or peripheral nervous system. This classic volume in the Contemporary Neurology Series covers the basic concepts underlying each of the testing techniques and provides comprehensive descriptions of the methods and wide range of electrophysiologic testing available for patients with epilepsy, neuromuscular diseases, movement disorders, demyelinating diseases, sleep disorders, autonomic disorders and those undergoing orthopedic and neurosurgical procedures. This text details the role of each study, the interpretation of findings, and their application clinical problems. This text describes the multiple diagnostic procedures for diverse diseases of the neuromuscular system, including: electroencephalography (EEG); electromyography and nerve conduction studies; single fiber EMG; polysomnography; surface EMG patterns, blood pressure, pulse, sweat measures; vestibular function testing; deep brain stimulator physiology; and intraoperative monitoring. It is a practical textbook for neurologists, physiatrists and clinical neurophysiologists in clinical or research practice or in training. Key features of the new edition include fully updated chapters to reflect new research and techniques in clinical neurophysiology; updated images illustrating key elements of techniques and basic concepts; case examples for practical application.
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Tyner, Fay S., John R. Knott, and W. Brem Mayer. Fundamentals of EEG Technology: Vol. 2 Clinical Correlates. Lippincott Williams & Wilkins, 1989.
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30
Maegawa, Gustavo H. B. Lysosomal Storage Disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0068.
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The lysosomal storage disorders (LSDs) are a group of inborn organelle disorders, clinically heterogeneous, and biochemically characterized by accumulation of nondegraded macromolecules primarily in the lysosomal and other cellular compartments. Given the common and essential cellular function of the lysosomal system in different organs and systems, patients afflicted with these disorders present a broad range of clinical problems, including neurological problems, visceromegaly, and skeletal deformities. Onset of symptoms may range from fetal period to adulthood. The neurological problems include developmental delay, seizures, acroparesthesia, motor weakness, muscle wasting, behavioral/psychiatric disturbances, cerebrovascular ischemic events, and extrapyramidal signs. Patients may present with symptoms later that include psychiatric manifestations, are slowly progressive, and may precede other neurologic or systemic features. Most of LSDs are autosomal recessive; however, a few are X-linked with symptpmatic female carriers (e.g., Fabry disease). In most of them, the diagnosis is established by biochemical and/or molecular assays. In terms of management, disease-modifying therapies include enzyme replacement, hematopoietic stem cell transplantation, and substrate reduction therapy. Patients and their families require genetic counseling regarding reproductive risks, disease prognosis, and therapeutic options. Investigations of disease molecular mechanisms provide insights into potential targets for the development of therapeutic strategies. Supportive care has been the key and essential for most LSDs, resulting in substantial improvement in quality of life of patients and families.
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Pirelli, Gianni. Mental Health. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190630430.003.0003.
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In this chapter, the authors provide a broad overview of diagnosable psychiatric disorders, their symptoms, and examples of current theoretical and empirical thought underlying these conditions. In providing a primer concerning mental health, they first review the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), with respect to how psychopathology is defined and the nature of the diagnostic system. They then shift to definitions, key examples, and example theories for (i) clinical disorders (e.g., depressive and anxiety disorders), (ii) personality disorders (with an emphasis on borderline and antisocial personality disorders), and (iii) substance use disorders. While this chapter draws heavily from the DSM-5, such is done primarily for educational and illustrative purposes within the broader context of discussing key issues related to the behavioral science of firearms.
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Hagendorff, Andreas. Cardiac involvement in systemic diseases. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0020.
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Systemic diseases are generally an interdisciplinary challenge in clinical practice. Systemic diseases are able to induce tissue damage in different organs with ongoing duration of the illness. The heart and the circulation are important targets in systemic diseases. The cardiac involvement in systemic diseases normally introduces a chronic process of alterations in cardiac tissue, which causes cardiac failure in the end stage of the diseases or causes dangerous and life-threatening problems by induced acute cardiac events, such as myocardial infarction due to coronary thrombosis. Thus, diagnostic methods—especially imaging techniques—are required, which can be used for screening as well as for the detection of early stages of the diseases. Two-dimensional echocardiography is the predominant diagnostic technique in cardiology for the detection of injuries in cardiac tissue—e.g. the myocardium, endocardium, and the pericardium—due to the overall availability of the non-invasive procedure.The quality of the echocardiography and the success rate of detecting cardiac pathologies in patients with primary non-cardiac problems depend on the competence and expertise of the investigator. Especially in this scenario clinical knowledge about the influence of the systemic disease on cardiac anatomy and physiology is essential for central diagnostic problem. Therefore the primary echocardiography in these patients should be performed by an experienced clinician or investigator. It is possible to detect changes of cardiac morphology and function at different stages of systemic diseases as well as complications of the systemic diseases by echocardiography.The different parts of this chapter will show proposals for qualified transthoracic echocardiography focusing on cardiac structures which are mainly involved in different systemic diseases.
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Celesia, Gastone G., and Neal S. Peachey. Visual Evoked Potentials and Electroretinograms. Edited by Donald L. Schomer and Fernando H. Lopes da Silva. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228484.003.0041.
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Electrophysiological testing of vision permits the objective assessment of the function of the retina, visual pathways, and cortices. This chapter covers visual evoked potentials (VEPs) and electroretinography (ERG). Flash ERG is useful in evaluating the outer retinal function and specifically helping in the diagnosis of retinal degeneration, monitoring the progress of retinal diseases, monitoring the retinal toxicity of drugs, and understanding the pathophysiology of retinal disorders. VEPs to various stimuli are useful in evaluating macular disorders, diagnosing optic neuropathies, detecting silent pathologies in the absence of other clinical signs of visual impairment, and evaluating disturbances of visual processing in degenerative diseases of the central nervous system. Simultaneous recording of pattern ERG and pattern VEP permits the differentiation between maculopathies and optic neuropathy.
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Alchi, Bassam, and David Jayne. The patient with antiphospholipid syndrome with or without lupus. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0164.
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Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by recurrent arterial or venous thrombosis and/or pregnancy loss, accompanied by laboratory evidence of antiphospholipid antibodies (aPL), namely anticardiolipin antibodies (aCL), lupus anticoagulant (LA), and antibodies directed against beta-2 glycoprotein 1 (β2GP1). APS may occur as a ‘primary’ form, ‘antiphospholipid syndrome,’ without any known systemic disease or may occur in the context of systemic lupus erythematosus (SLE), ‘SLE-related APS’. APS may affect any organ system and displays a broad spectrum of thrombotic manifestations, ranging from isolated lower extremity deep vein thrombosis to the ‘thrombotic storm’ observed in catastrophic antiphospholipid syndrome. Less frequently, patients present with non-thrombotic manifestations (e.g. thrombocytopaenia, livedo reticularis, pulmonary hypertension, valvular heart disease, chorea, and recurrent fetal loss).The kidney is a major target organ in both primary and SLE-related APS. Renal involvement is typically caused by thrombosis occurring at any location within the renal vasculature, leading to diverse effects, depending on the size, type, and site of vessel involved. The renal manifestations of APS include renal artery stenosis and/or renovascular hypertension, renal infarction, APS nephropathy (APSN), renal vein thrombosis, allograft vasculopathy and vascular thrombosis, and thrombosis of dialysis access.Typical vascular lesions of APSN may be acute, the so-called thrombotic microangiopathy, and/or chronic, such as arteriosclerosis, fibrous intimal hyperplasia, tubular thyroidization, and focal cortical atrophy. The spectrum of renal lesions includes non-thrombotic conditions, such as glomerulonephritis. Furthermore, renal manifestations of APS may coexist with other pathologies, especially proliferative lupus nephritis.Early diagnosis of APS requires a high degree of clinical suspicion. The diagnosis requires one clinical (vascular thrombosis or pregnancy morbidity) and at least one laboratory (LA, aCL, and/or anti-β2GP1) criterion, positive on repeated testing.The aetiology of APS is not known. Although aPL are diagnostic of, and pathogenic in, APS, a ‘second hit’ (usually an inflammatory event) may trigger thrombosis in APS. The pathogenesis of the thrombotic tendency in APS remains to be elucidated, but may involve a combination of autoantibody-mediated dysregulation of coagulation, platelet activation, and endothelial injury.Treatment of APS remains centred on anticoagulation; however, it has also included the use of corticosteroids and other immunosuppressive therapy. The prognosis of patients with primary APS is variable and unpredictable. The presence of APS increases morbidity (renal and cerebral) and mortality of SLE patients.
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Wise, Matt, and Paul Frost. ICU treatment of respiratory failure. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0149.
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Respiratory failure is a syndrome characterized by defective gas exchange due to inadequate function of the respiratory system. There is a failure to oxygenate blood (hypoxaemia) and/or eliminate carbon dioxide (hypercapnoea). Respiratory failure can develop over years when it is due to conditions such as kyphoscoliosis or motor neuron disease, or minutes in the case of an acute asthma attack or pneumothorax. In this context, respiratory failure is often called acute (e.g. asthma), chronic (e.g. kyphoscoliosis), or acute on chronic (kyphoscoliosis complicated by pneumonia). Chronic respiratory failure is characterized by compensatory mechanisms which aim to adjust the pH of the blood back to the normal physiological range and involve the retention of bicarbonate by the kidney. This topic covers the etiology of respiratory failure as well as signs, symptoms, diagnosis, investigations, prognosis, and treatment.
36
Waldek, Stephen. Fabry disease. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0337.
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Fabry disease is a rare X-linked lysosomal storage disorder in which deficiency of alpha-galactosidase A leads to accumulation of substrate, mostly globotriaosylceramide, which causes a progressive, multiorgan disease affecting predominantly the kidneys, skin, heart, and nervous system. Painful peripheral (‘acral’) neuropathy is characteristic.Key clinical signs are angiokeratoma found by close examination of skin; characteristic eye lesions may be seen; lipid deposits may be seen in urine. Renal biopsy appearances are characteristic and this is commonly where the diagnosis is first made. Increasingly, cardiologists are suspecting the condition in adults with echocardiographic appearances of left ventricular hypertrophy. Diagnosis in men is usually made by measurement of alpha-galactosidase in either white cells or plasma (or using blood spots). Unfortunately, many female patients can have normal enzyme levels so that genetic testing is the only way to confirm a diagnosis. Non-selective screening strategies (e.g. males on renal replacement therapy with uncertain renal diagnoses) have had low yields.
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Kalanthroff, Eyal, Gideon E. Anholt, and Helen Blair Simpson. Research Domain Criteria and OCD. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0062.
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This chapter discusses the Research Domain Criteria (RDoC) project, an initiative of the National Institutes of Mental Health (NIMH) of the United States to develop for research purposes new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures, and explores how the hallmark symptoms of OCD (obsessions, compulsions, and anxiety) can be mapped onto RDoC domains. Unlike current categorical diagnostic systems (e.g., DSM), RDoC seeks to integrate many levels of information (from genomics to self-report) to validate dimensions defined by neurobiology and behavioral measures that cut across current disorder categories. The chapter explores, for heuristic reasons, how the RDoC matrix might be used to elucidate the neurobehavioral domains of dysfunction that lead to the characteristic symptoms of OCD. It then selectively reviews the OCD literature from the perspective of the RDoC domains, aiming to guide future transdiagnostic studies to examine specific neurobehavioral domains across disorders.
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Chadwick, David, Alastair Compston, Michael Donaghy, Nicholas Fletcher, Robert Grant, David Hilton-Jones, Martin Rossor, Peter Rothwell, and Neil Scolding. Investigations. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0100.
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This chapter describes the many methods that can be used to investigate neurological disorders. The application and suitability for specific disorder types are outlined, as are contraindications for use. Methods of imaging the central nervous system include computed tomography (CT) imaging, several magnetic resonance (MR) scanning methods, Single photon emission computed tomography (SPECT) and Positron Emission Tomography (PET). Invasive (angiography) and non-invasive methods of imaging the cerebral circulation are also outlined.The standard method of recording electrical activity of the brain is the electroencephalogram (EEG), which is heavily used in epilepsy to investigate regions of epileptogenesis.Other investigations described include evoked potentials, nerve conduction and electromyography studies, the examination of cerebrospinal fluid and the diagnostic use of neurological autoantibodies. Finally, neurogenetics, neuropsychological assessment and the assessment of treatments by randomized trials are discussed.
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Brugha, Traolach S. Obtaining an assessment. Edited by Traolach S. Brugha. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198796343.003.0005.
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This chapter on obtaining an assessment begins by considering why, when, and where to obtain an assessment. Sources of referrals can be from child services (transition referral), primary care, other specialist colleagues, and occasionally other agencies such as social care, education (e.g. higher and further education), and the criminal justice system. Assessment services may be limited to performing a basic diagnostic function or may have access to more sophisticated needs assessment methods. A reasoned case for referral needs to be considered and developed. Alternative ways of meeting needs such as short-term problem-solving should also be considered. Information required for a referral for an assessment, whether brief or lengthy, is important. Pre-assessment tests and their evaluation should be considered. Experiences and expectations of the process of referral are also covered.
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Sprigings, David. Coma. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0040.
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Coma is a pathological state of unconsciousness from which a patient cannot be roused to wakefulness by stimuli, and reflects dysfunction of the brainstem reticular system and its thalamic projections (the neuronal basis of wakefulness), or diffuse injury of both cerebral hemispheres. A unilateral lesion of a cerebral hemisphere (e.g. haemorrhagic stroke) will not cause coma unless there is secondary compression of the contralateral hemisphere or brainstem. Coma is a medical emergency, because a comatose patient is at high risk of permanent brain injury or death, caused either by the underlying disorder or the secondary effects of coma. Stabilization of the airway, breathing, and circulation, and exclusion of hypoglycaemia are the first priorities, before diagnosis is explored further. Clinical assessment together with neuroimaging will usually identify the likely cause or causes. The clinical approach to diagnosis and management of the comatose patient is described in this chapter.
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Morrison, Alan R., Joseph C. Wu, and Mehran M. Sadeghi. Cardiovascular Molecular Imaging. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199392094.003.0029.
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Cardiovascular molecular imaging is a relatively young but rapidly expanding discipline that consists of a biologically-targeted approach to the assessment of physiologic and pathologic processes in vivo. This novel approach to imaging involves the integration of multiple disciplines such as cell and molecular biology, chemistry, and imaging sciences. The ultimate goal is quantitative assessment of cardiovascular processes at the cellular and molecular level, moving beyond traditional diagnostic information, in order to guide individually tailored therapy. In fact, it is likely that specific approaches to molecular imaging will be developed in tandem with the development of novel therapeutic strategies. Recent advances in probe development and imaging systems have contributed to evolution of molecular imaging toward clinical translational. These include technological progress in traditional imaging platforms; along with the emergence of newer imaging modalities such as photoacoustic imaging. In addition, hybrid imaging (e.g. nuclear imaging with CT or MRI) has the potential for improved spatial localization, and more accurate quantification by coupling anatomic and biological information. In addition to potential clinical applications that address existing diagnostic gaps in cardiovascular medicine, molecular imaging allows for unique approaches to studying pathophysiology. This chapter is intended to provide an overview of the state of the art in cardiovascular molecular imaging, highlighting how it may improve the management of major cardiovascular diseases.
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Farne, Hugo, Edward Norris-Cervetto, and James Warbrick-Smith. Oxford Cases in Medicine and Surgery. Oxford University Press, 2015. http://dx.doi.org/10.1093/oso/9780198716228.001.0001.
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Oxford Cases in Medicine and Surgery, second edition, teaches students a logical step-by-step diagnostic approach to common patient presentations. This approach mirrors that used by successful clinicians on the wards, challenging students with questions at each stage of a case (history-taking, examination, investigation, management). In tackling these questions, students understand how to critically analyse information and learn to integrate their existing knowledge to a real-life scenario from start to finish. Each chapter focuses on a common presenting symptom (e.g. chest pain). By starting with a symptom, mirroring real life settings, students learn to draw on their knowledge of different physiological systems - for example, cardiology, respiratory, gastroenterology - at the same time. All the major presenting symptoms in general medicine and surgery are covered, together with a broad range of pathologies. This book is an essential resource for all medicine students, and provides a modern, well-rounded introduction to life on the wards. Ideal for those starting out in clinical medicine and an ideal refresher for those revising for OSCEs and finals.
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Johnson, Nicholas J., and Judd E. Hollander. Management of cocaine poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0324.
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Cocaine is powerful central nervous system (CNS) stimulant derived from the coca plant. It affects the body via a number of mechanisms including blockade of fast sodium channels, increased catecholamine release, inhibition of catecholamine reuptake, and increased concentration of excitatory amino acid concentrations in the CNS. It is rapidly absorbed via the aerodigestive, respiratory, gastrointestinal, and genitourinary mucosa, and also may be injected. When injected intravenously or inhaled, cocaine is rapidly distributed throughout the body and CNS, with peak effects in 3–5 minutes. With nasal insufflation, absorption peaks in 20 minutes. Its half-life is approximately 1 hour. Common clinical manifestations include agitation, euphoria, tachycardia, hyperthermia, and hypertension. Chest pain is a common presenting complaint among cocaine users; 6% of these patients will have myocardial infarction. Other life-threatening sequelae include stroke, intracranial haemorrhage, seizures, dysrhythmias, and rhabdomyolysis. Clinical signs and symptoms, as well as severity of intoxication, should dictate the diagnostic evaluation and treatment of cocaine intoxicated patients. If the patient has chest pain, an ECG, chest radiograph, and measurement of cardiac biomarkers should be performed. A brief observation period may be useful in these patients. Many manifestations of cocaine intoxication, including agitation, hypertension, and chest pain, are effectively treated with benzodiazepines. Beta-blockers should be avoided in patients with suspected cocaine intoxication. Special attention should be paid to pregnant patients and those who present after ingesting packets filled with cocaine, as they may exhibit severe toxicity if these packets rupture.
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McCarty, Richard. Stress and Mental Disorders: Insights from Animal Models. Oxford University Press, 2020. http://dx.doi.org/10.1093/med-psych/9780190697266.001.0001.
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Stress has now been recognized as an important factor in the development or recurrence of various mental disorders, from major depressive disorder to bipolar disorder to anxiety disorders. Stressful stimuli appear to exert their effects by acting upon individuals with susceptible genotypes. Over the past 50 years, animal models have been developed to study these dynamic interactions between stressful stimuli and genetically susceptible individuals during prenatal and postnatal development and into adulthood. This book begins with a discussion of the history of psychiatric diagnosis and the recent goal of moving toward precision psychiatry, followed by a review of clinical research on connections between stressful stimuli and the development of psychiatric disorders. Chapters are also included on neuroendocrine, immune, and brain systems involved in responses to stress. Additional chapters focus on the development of animal models in psychiatry and the susceptibility of the developing organism to stressful stimuli. Subsequent chapters are devoted to animal models of specific stress-sensitive psychiatric disorders, including schizophrenia, autism spectrum disorders, bipolar disorder, anxiety disorders, depression, and post-traumatic stress disorder. These chapters also focus on the identification of promising molecular targets for development of new drug therapies; a chapter examines animal models of resilience to stress-induced behavioral alterations as a newer approach to understand why some animals (e.g., inbred mice) are susceptible to stress and others are resilient, even if they are essentially genetically identical. The final chapter discusses how these basic laboratory animal models are providing promising leads for future breakthroughs in the diagnosis, treatment, and prevention of mental disorders.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
Full textAbstract:
The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.