Ebook Murtagh''s general practice (5th edition): Part 2

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Ebook Murtagh''s general practice (5th edition): Part 2

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(BQ) Part 2 book Murtagh''s general practice presents the following contents: Women''s health, men’s health, sexually related problems, problems of the skin, chronic disorders - continuing management, accident and emergency medicine, health of specific groups.

Part Murtagh - General Practice (5e) Part 5.indd 925 Women's health 22/10/10 2:45:13 PM 89 Cervical cancer and Pap smears If all women have regular Pap smears, one every two years, we can prevent 90% of all cervical cancers D R G A B R I E L E M E D L E Y , T I M E , 24 A P R I L 199 Facts and figures Cervical cancer Cervical cancer is a common malignancy in women worldwide, especially in the developing countries; it is the sixth most common in Australia1 and seventh in the US.2 The incidence of invasive cervical cancer rises steadily from age 20 to 50 and then remains relatively steady The most common form of cervical cancer is squamous cell carcinoma (SCC) 85–90%, with adenocarcinoma representing 10–15%.2 A striking epidemiological feature about cervical cancer is that it is a disorder related to sexual activity It is almost non-existent in virgins but has an increased incidence in women with multiple partners and those who began sexual activity at an early age Thus, epidemiological studies indicate that cervical cancer is a sexually transmitted disorder (see Table 89.1) Table 89.1 Cervical cancer and risk factors Age Increased After 55 Sexuality Increased With multiple and/ or promiscuous sex partners Early age for first intercourse Early age first pregnancy Viruses Increased After herpes II or wart virus infection (probable) Occupation Increased In prostitutes (decreased in nuns) Parity Increased Multiparity Socioeconomic status Increased With low socioeconomic status • Invasive cervical cancer is almost unknown in women under the age of 20, and very rare before age 25 • There are two small peaks of incidence, in the late 30s and late 60s.1 • The lifetime probability of an Australian woman developing cancer is in 90.3 • On average, cervical cancer takes at least a decade to develop from a focus of a cervical squamous intraepithelial lesion.4 • SCC of the cervix occurs almost exclusively in women who have had coitus • The earlier the age of first intercourse, the greater the chance of developing cervical cancer • Invasive cervical cancer is a disease for which definite curable premalignant lesions can be identified using a Papanicolaou (Pap) smear as a screening test • The incidence of cervical cancer has been decreased significantly through the screening procedures of the Pap smear, colposcopy and colposcopically directed cervical biopsy • Poor Pap smear technique is a common cause of a false negative result • The GP needs to achieve the best possible cervical cell sample and forward it to the best possible cytology laboratory • Despite the availability of liquid-based smears, a well-taken conventional Pap smear is still a very good screening test • New methods of laboratory examination of the smear include PAPNET, which involves computer scanning of the smear, and ThinPrep, whereby a liquid-based sample is prepared Basic pathology The focus of attention is the transformation zone (see Fig 89.1) where columnar cells lining the endocervical canal undergo metaplasia to squamous cells—in the region of the squamocolumnar junction It is important clinically to realise that this transformation zone 926 Murtagh - General Practice (5e) Part 5.indd 926 22/10/10 2:45:13 PM Cervical cancer and Pap smears can extend with progressive metaplasia of columnar epithelium and so the squamocolumnar junction may recede into the endocervical canal This is a 927 feature in postmenopausal women (see Fig 89.2) As squamous cell carcinoma almost always arises in the transformation zone, it is vital that cells are taken from it when performing a Pap smear Cervical intraepithelial neoplasia Cellular changes can occur in the transformation zone for a variety of reasons, including invasion with human papillomavirus (HPV) One such important change is cervical dysplasia, previously known as cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesion in the now adopted modified Bethesda System.5, These dysplasias have the potential to become invasive cervical cancer Natural history of cervical dysplasia Figure 89.1 The transformation zone: it is vital that cells are taken from this zone with Pap smears Dysplasia may return to normal, persist or eventually progress to invasive cervical cancer The reported progression times to cervical cancer range from to 30 years On average it takes at least 10 years, so it is considered that 2-yearly Pap smears are a reasonable safety margin However, women with histologically confirmed moderate to severe dysplasia require a colposcopic assessment 89 "QQFBSBODF PGDFSWJY SFQSPEVDUJWFBHF NFOPQBVTBM QFSJBOEQPTU FOEPDFSWJDBM DBOBM USBOTGPSNBUJPO [POF TRVBNPDPMVNOBS KVODUJPO FYUFSOBMPT $FSWFYTBNQMFSCSPPNPS *OTUSVNFOUT GPS1"1 $FSWFY#SVTI$PNCJPSTQBUVMB CMVOUFOE TNFBS FOEPDFSWJDBMCSVTI WBHJOB $FSWFY#SVTI$PNCJPSTQBUVMB QPJOUFEFOE PS $FSWFYTBNQMFSCSPPN FOEPDFSWJDBMCSVTI Figure 89.2 Changing position of the transformation zone with age, and a selection of sampling instruments according to its position Murtagh - General Practice (5e) Part 5.indd 927 22/10/10 2:45:13 PM 928 Part Five Women's health $*/4ZTUFN $*/ $*/ $*/ NJME NPEFSBUF CBTFNFOU NFNCSBOF OPSNBM TRVBNPVT FQJUIFMJVN 5IF#FUIFTEB 4ZTUFN 5#4 TFWFSF -4*- DBSDJOPNB JOTJUV JOWBTJWF DBSDJOPNB )4*- Figure 89.3 Illustration of the various grades of squamous intraepithelial lesions and CIN (comparison of nomenclature) Figure 89.3 and Table 89.2 illustrate the disease spectrum of cervical neoplasia Table 89.2 Squamous cell abnormalities and the different nomenclatures5, Clinical presentation Many patients with cervical cancer are asymptomatic and when early symptoms arise they are often dismissed as of little consequence Symptoms, if present, may be: • vaginal bleeding, especially postcoital bleeding • vaginal discharge • symptoms of advanced disease (e.g vaginal urine or flatus, weakness) Screening recommendations Routine Pap smears • Perform every years for women 18–70 years of age with no clinical evidence of cervical pathology and who have ever had sex • Perform from beginning of sexual activity up to 70 years • Begin Pap smears at 18–20 years or 1–2 years after first sexual intercourse (whichever is later) • Cease at 70 years in those who have had two normal Pap smears within the last years • Perform a Pap smear on women over 70 years if they request it or if they have never had a smear or if they have symptoms • Ideally, practices should have a reminder or a recall system Murtagh - General Practice (5e) Part 5.indd 928 Australian modified Bethesda system Description CIN grade Normal Normal Within normal limits Atypia ASCUS HPV LSIL Mild dysplasia CIN LSIL Moderate dysplasia CIN HSIL Severe dysplasia CIN HSIL CIS HSIL Invasive carcinoma Invasive carcinoma Atypia: reactive or neoplastic HPV Carcinoma in situ Invasive carcinoma ASCUS = Atypical squamous cells of undetermined significance CIN = Cervical intraepithelial neoplasia CIS = Carcinoma in situ HSIL = High-grade squamous intraepithelial lesion LSIL = Low-grade squamous intraepithelial lesion 22/10/10 2:45:14 PM Cervical cancer and Pap smears Women who have never engaged in coitus not need Pap smears However lesbian women require Pap testing even if they have never had a male sexual partner.7 Six-monthly or 12-monthly screening on young, asymptomatic women provides only minimal benefit compared with 2-year intervals Hysterectomy Smears are needed if the cervix was not completely removed However, vaginal vault smears are needed if there is a history of gynaecological dysplasia or malignancy, exposure to diethylstilboestrol in utero and in immunosuppressed women Taking a Pap smear1, The importance of a good specimen The optimal Pap smear contains: • sufficient mature and metaplastic squamous cells to indicate adequate sampling from the whole of the transformation zone • sufficient endocervical cells to indicate that the upper limit of the transformation zone was sampled; and to provide a sample for screening of adenocarcinoma and its precursors Optimal timing of specimens • The best time is any time after the cessation of the period • Avoid smear-taking during menstruation • Avoid in the presence of obvious vaginal infection • Avoid within 48 hours of use of vaginal creams or pessaries or douching • Avoid within 24 hours of intercourse • Avoid lubrication or cleaning of cervix with preliminary pelvic examination Communicating with the pathologist Good communication with the pathologist is essential It is important to provide basic details about the reason for the Pap smear and the clinical history on the pathology form sent to the laboratory Include patient age, LMP, hormone intake, previous treatment and clinical findings The method Education and explanation Take time to explain the reason for taking the Pap smear, especially if it is the first Emphasise that it is mainly a preventive measure to detect and treat early cell changes that could develop into cancer Anatomical models, sample instructions or charts are useful in describing the procedure Explain that it does not hurt and doesn’t take long, that it may be uncomfortable but slow deep breathing will help relaxation and make it easier It is preferable to talk to Murtagh - General Practice (5e) Part 5.indd 929 the patient during the examination with appropriate explanation It is advisable for a male doctor to have a chaperone present Equipment Prepare the following equipment: • adequate light source • speculum (preferably bivalve) warmed under lukewarm water • glass slide labelled in pencil with the woman’s name and date of birth • spray fixative • plastic gloves for both hands • smear-taking instruments; choose from: — Ayer’s spatula, wooden or plastic — Cervex sampler broom — Cervex-Brush Combi — endocervical brush Refer Figure 89.2 for recommended choice Special notes: • pregnancy—avoid use of the endocervical brush and the Cervex-Brush Combi • eversion—take care to sample the squamocolumnar junction Positioning The supine position is usually best (see Fig 89.4) The left lateral position can be used if smears are difficult to obtain (e.g older women with lax anterior vaginal walls, older women with poor hip mobility and the very embarrassed patient) The Sims exaggerated left lateral position (see Fig 89.5) provides better exposure of the vulva but requires more manipulation of the patient Better visualisation of the cervix is obtained if the patient elevates her buttocks with her hands (best as fists) Inserting the speculum6 Avoid using lubricating jelly on the speculum blades Warming the speculum with water should provide adequate lubrication Gently spread the labia with a gloved hand and introduce the speculum with the blades vertical or at 45° from the vertical Gently advance the blades with slow firm pressure towards the rectum as far as possible Rotate the blades during the process until they are horizontal and exerting gentle pressure against the posterior wall of the vagina Remember that the cervix is situated in the upper sixth of the anterior vaginal wall (not in the apex of the vagina) Visualising the cervix Good lighting and exposure of the cervix is essential Note any significant features or abnormalities of the cervix Reassure the woman if the cervix looks normal with a comment such as ‘Your tissues look very healthy’ A cervical ectropion is normal in most premenopausal women and was formerly incorrectly called an erosion Taking the smear Choose the sampling instrument that best suits the shape of the cervix and os Place Ayer’s spatula firmly 929 89 22/10/10 2:45:14 PM 930 Part Five Women's health on the os and rotate it through 360°, ensuring that the whole transformation zone is sampled (see Fig 89.6a) If the squamocolumnar junction is not visible (lying within the endocervical canal), use both spatula (first) and the cytobrush (see Fig 89.6b) The cytobrush (tends to cause bleeding) should be advanced until only the lower bristles are still visible, then rotated for a quarter of a rotation The cytobrush should be avoided in pregnant women After removing the speculum, perform a bimanual pelvic examination if appropriate Preparing the slide Transfer the cervical cell sample on to a glass slide with an even spreading motion (see Fig 89.6c, d) Fix immediately (within seconds from a distance of 20 cm to prevent air drying, which distorts cellular features) with an aerosol or pump-action alcohol spray (see Fig 89.6e) The HPV and chlamydia sample If appropriate after the smear, place the brush and spatula in the tube with the transport medium (do not use a wooden spatula for a liquid-based sample) Swirl it around vigorously to release material The specimen tube can be forwarded with the slide to the laboratory with a request to test for HPV and chlamydia Follow-up Discuss mutually suitable arrangements to ensure that the woman obtains the result of the smear whether it is positive or negative Inform her when her next smear is likely to be due (special cards are available) and have a system in place to send a reminder note The explanation of the results, especially if there is an abnormality present (a variety of abnormal smear), should be crystal clear to the patient Figure 89.4 The supine or dorsal position is the best position for the speculum examination and subsequent bimanual palpation (patient should be appropriately clothed and/or draped) Abnormal cervical cytology Confirmation of the Pap smear result is by colposcopy and/or by a biopsy and appropriate referral should be arranged without delay Inaccurate results can be caused by:9 • using dirty glass slides • using lubricants or doing pelvic examinations before taking the smear • insufficient material • endocervical cells not being taken in the smear (i.e taken from the wrong site) • a thick film with an inadequate spread of material • air-drying before fixing • smear not being fixed for long enough or the solution of alcohol being too weak • the slide not being dry before being placed in the cardboard container (this encourages fungal overgrowth) Murtagh - General Practice (5e) Part 5.indd 930 Figure 89.5 The Sims exaggerated left lateral position 22/10/10 2:45:14 PM Cervical cancer and Pap smears 931 Abnormal Pap smears B Follow the guidelines in Table 89.3 and Figure 89.7 for the abnormal smear result Table 89.3 Guidelines for abnormal Pap smears7 Pap smear report Investigation and management No endocervical cells Repeat in years Negative smear— inflammatory cells Repeat smear in years Unsatisfactory smear Repeat smear in 6–12 weeks (allows regeneration of cells) C Low-grade epithelial lesion Possible LSIL and Definite LSIL D Repeat Pap smear at 12 months If the woman is 30+ years, and has no negative cytology in previous 2–3 years, refer for colposcopy or repeat the test in months 89 High-grade epithelial lesion E Possible HSIL Definite HSIL Refer for colposcopy Glandular abnormalities including adenocarcinoma in situ Refer to a gynaecologist Invasive squamous cell carcinoma or adenocarcinoma Refer to appropriate specialist gynaecologist or unit Inconclusive—raising possibility of high-grade disease Refer for colposcopy and possible biopsy Post-treatment assessment of HSIL F A woman treated for HSIL should have a colposcopy and cervical cytology at 4–6 months after treatment Cervical cytology and HPV typing should be done at 12 months and then annually until the woman has tested negative by both tests on two consecutive occasions Return to usual 2-yearly screening when all four tests are negative Prevention of cervical cancer ‘In other words, chastity and fidelity are recommended for those who can, and condoms for those who cannot’.10 This statement is a succinct recommendation for prevention and includes the following: Figure 89.6 Method of smear taking and preparing the slide Murtagh - General Practice (5e) Part 5.indd 931 • Ideally, people should have intercourse with only one partner 22/10/10 2:45:14 PM 932 Part Five Women's health -PXHSBEF -4*- EFGJOJUFPSQPTTJCMF *GXPNBOJT Index Normacol 430 Normacol Plus 430, 430 normal transit constipation 429 normethadone 447 Normison 120 normocytic anaemia 209 normograms 610 norpethidine 96 Norspan 96 nor-testosterone 934 nortriptyline 101, 182, 196, 1046 Norwalk virus 113 Norwegian scabies 1124, 1129 nose disorders see nasal disorders nose injuries, in sport 1378 NovoMix 30 1291 NovoRapid 1291 Nozoil 626 NPH 1291, 1291 NPPV 1257 NRTIs 247 NSAIDs see non-steroidal antiinflammatory drugs NSU 119, 807, 1100, 1101, 1108 nucleic acid amplification tests 1099, 1102 nucleic acids 136 nucleotide reverse transcriptase inhibitors 247 Nuelin 1244 Nu-Lax 430 number needed to treat (NNT) 109–10 nummular eczema 1133, 1148 nursemaid’s arm 1409 nurses see practice nurses Nutraplus 734, 1134, 1148 nutrition 72–80 for adolescents 78–9 anaemia and iron intake 77 bulking agents 429, 429 coeliac disease 78 daily recommendations 73 deficits causing delirium 476 for diabetics 67, 77, 1292, 1294 diet for iron deficiency 207 dietary advice for weight loss 834–5 dietary fibre 47, 74, 76, 78, 423, 428, 429, 429, 473 dietary guidelines 78–9 dietary measures for dyslipidaemia 1286 during pregnancy 1016 educating patients about 45, 46, 47 failure to thrive 854 food pyramids 72, 73, 79, 80 Index.indd 1479 foods associated with migraine 78 iodine deficiency 78 lactose-free diet 501 lacto-vegetarian diets 1275 Lyon Heart Study 75–6 meals at school 832 nutritional assessment 72 Ornish program 76 osteoporosis due to poor diet 993 for premenstrual syndrome 980–1 prevention of cardiovascular disease 67 principles of optimal nutrition 72–5, 73 recurrent urinary calculi 78 reducing sodium in the diet 1275, 1281 relation of diet to cancers 65–6 relation of diet to constipation 78, 429 safe consumption of alcohol 77 smell disorders due to deficiency 621 sources of calcium 992 treatment of diarrhoea 469 vitamin deficiency disorders 77 see also malnutrition; parental nutrition NuvaRing 940 nystagmus 491, 492 nystatin for balanitis 1067 for Candida albicans 865, 1142 categorisation of drug risk 1039 for chronic vulvovaginal candidiasis 1005 for oral candidiasis 776 for seborrhoeic dermatitis 1137 with triamcinolone acetonide 1120 for vaginal candidiasis 998, 999 for vaginitis 1101 nystatin mouthwash 778, 782 O obesity 829–36 in adults 68 age of onset 48, 829 causes and incidence of 829 in children 856 classification of 831 clinical investigations 832–3 diagnosis of 829–30, 830 dyspnoea due to 514, 515, 516 effect on facial features 147 factors predisposing towards 832 increased cancer risk 65 management of 832–4, 833 1479 in pregnancy 1019 pseudogynaecomastia 871 relation to mortality 832, 833 as risk factor for DVT 121 see also weight gain oblique lie 1037 obsessions 475 obsessive-compulsive disorder 474, 486, 489, 1201, 1235, 1237 obstructive airways disorders 523 obstructive bronchitis 515 obstructive jaundice 604, 610 obstructive pulmonary disease see chronic obstructive pulmonary disease obstructive sleep apnoea 627, 764, 766, 767, 768, 791, 919 obturator hernias 1056, 1058 occipital headache 599 occipital neuralgia 595 occlusion method, wart removal 741, 741 occlusive agents 1119, 1120 occlusive arterial disease 700 occlusive vascular disease 702–3 occult organic pain 102 occupational health hazards cancer 234 cough 436 extrinsic alveolitis 523 for farmers 67, 436, 523, 1408 headache 152 hepatitis B 613 infections from animals 266 milker’s nodules 1177, 1177 for miners 67, 436, 523–4, 524 pox virus lumps 1176–7 septal perforation 625 specific examples by occupation 67 working with cadmium and silica 1251 OCD 474, 486, 489, 1201, 1235, 1237 OCP see combined oral contraceptives ocular albinism 1050 ocular cytomegalovirus infection 823 ocular disease 148 odds ratio 110 odour disorders 1149–50 odynophagia 512 oedema 701, 748–9, 749, 835, 1303 oesophageal atresia 630, 630, 849, 877 oesophageal cancer 361, 512, 512, 513, 581 oesophageal candiasis 512 oesophageal diverticulae 157 oesophageal dysfunction, as a cause of back pain 360 22/10/10 2:54:56 PM 1480 Index oesophageal dysphagia 510 oesophageal manometry 407 oesophageal motility disorder 500, 512 oesophageal pain 411, 411 oesophageal reflux see gastrooesophageal reflux oesophageal rupture 361 oesophageal spasm 361, 361, 403–4, 404, 411, 411, 421, 422, 512 oesophagitis 361, 403, 411, 411, 501–2, 508, 511, 581 oestradiol 143, 986 oestradiol valerate 986, 1287 oestriol 986 oestrogen cream 1007, 1098 oestrogens cholestasis of pregnancy 1032 in contraception 934, 936–7, 938 to decrease sebaceous gland activity 1143 for deep venous thrombosis 121 for dyslipidaemia 1287 effect on lactation 1042 effect on sexual function 1089 effect on warfarin activity 1341 generalised oedema due to 835 gynaecomastia due to 1050 in hormone replacement therapy 985–9, 986–7 jaundice due to 607 for menorrhagia 962, 963 secondary diabetes due to 187 Ogen 986, 986 Ogilvie syndrome 321 oil acne 1143 oil injection injuries 1351, 1351 Oilatum 1120 Oilatum Plus 889 oily hair 1205 ointments 1119, 1120, 1121 olanzapine 58, 299, 479–80, 482, 484–5, 753 olecranon bursitis 663, 669 olecranon, fractures of 1366 oligoarticular arthritis 336 oligohydramnios 1036 oligomenorrhoea 965 omalizumab 1245, 1246 omega-3 fatty acids 75, 76, 94, 1078 omeprazole 279, 505, 506, 507 onchoerciasis 134 oncofetal antigens 234 oncogenes 159 ondansetron 87, 632, 632 onychogryphosis 732, 1212, 1212 Index.indd 1480 onycholtillomania 1206 onycholysis 1206, 1206–7, 1209 onychomycosis 1206, 1210 oophorectomy 983 oophoritis 887 open-ended questions 16 ophthalmia neonatorum 541 ophthalmic preparations, for rhinitis 1228–9 opioid respiratory depression 1313, 1328 opioids adverse effects 193, 476, 477, 523, 598, 632 as analgesics 95, 425, 1038, 1316 antidote for 911 banning of in sport 203 for cancer pain 83–7 for children 97, 98 in cough suppressants 447 dosages 95–6 for nociceptive pain 94 overdose and loss of consciousness 798, 799, 805 as poison 909 poor response to 101 rotation of 85 safe storage of 1325 withdrawal from dependence on 200, 476 opiophobia 85 opisthotonos 271 oppositional behaviour 891 optic atrophy 818 optic gliomas 829 optic neuritis 823, 827, 828 Optifast 835 Orabase 774, 778 oral allergy syndrome 1223 oral anticoagulant 395, 395 oral cancer 69, 773, 775, 776, 779–80 oral candidiasis 776, 789 oral cavity 869 oral contraceptives see combined oral contraceptives; progesterone-only contraceptive pill oral corticosteroids 203 oral dermatoses 777–8 oral dysaesthesia 779 oral gold 94 oral hygiene 69 oral hypoglycaemics 937 oral mucosa disorders 773 oral opioids 98 oral steroids 914 oral thrush 786 oral ulcers 773, 773–5, 774, 782 oral use, of thermometers 565 orbital cellulitis 539, 541, 547, 549, 549–50, 556 orchidectomy 1050, 1062, 1078 orchidopexy 1064, 1064 orchitis 886, 887, 1050, 1052, 1054, 1054 Ordine 85 orf 1172, 1177 organ failure, vomiting due to 630 organic failure to thrive 854–5 organophosphates 911 orgasm difficulties 1087, 1091 orlistat 460, 834 Ornish nutritional program 76 oromandibular dystonia 304 oropharyngeal disorders 554, 560 oropharyngeal dysphagia 510 Orosed 852 orphenadrine 297, 909, 1076 orthopaedic surgery 84 orthopnoea 514 orthostatic intolerance 579, 799, 802 orthostatic proteinuria 812–13 Ortolani test 684 OSA 627, 764, 766, 767, 768, 791, 919 OSD 708, 716, 716–17, 850, 1391 oseltamivir 442 Osgood-Schlatter disorder 708, 716, 716–17, 850, 1391 Osler–Weber–Rendu syndrome 395, 581 osteitis pubis 687, 1381 osteoarthritis 337–9 arm pain due to 663 diagnosis of 329, 330, 337–8, 349 in the elderly 49 foot pain due to 727, 734 of the glenohumeral joint 661, 662 hand pain due to 338, 338, 664, 677 hip pain due to 681, 686, 687, 690, 707 incidence of 329 joints involved 337, 338 knee pain due to 709, 717, 724 leg pain due to 693, 696 limp due to 746 lower back pain due to 381 management of 94, 338, 348 neck pain due to 639, 639 as a non-inflammatory joint disorder 282 in overweight patients 836 synonymity with spondylosis 373 X-ray of 335 22/10/10 2:54:56 PM Index osteoarthrosis 384 osteochondral fractures 712, 712, 1388 osteochondritis 676, 729, 731 osteochondritis dissecans 710, 712, 716, 717, 717–18 osteochondritis of the femoral condyle 716 osteogenesis 451 osteogenesis imperfecta 174 osteogenic cancer 238, 696 osteoid osteoma 361, 382, 696, 726, 727, 728–9 osteomalacia 77 osteomas 626 osteomyelitis acute osteomyelitis 137, 375 fever due to 570 hand pain due to 677 hip pain due to 681, 684, 690 in Indigenous children 1397 in infants 847 leg pain due to 691, 696 neck pain due to 639, 640 shoulder pain due to 652 thoracic back pain due to 360, 360 walking difficulty due to 747 osteonecrosis 717, 717, 726 osteoporosis 990–3 causes 991 chest pain due to 421 in children 993 clinical investigations 990–1 loss of bone mass 990, 990 in men 1049 in menopause 983 natural remedies 993 preventive medicine 67, 988 risk factors 991 thoracic back pain due to 360, 360, 363, 371 treatment 991–3 Oswestry low-back pain questionnaire 94 otalgia 526, 529 OTC 96–7 otic barotrauma 451, 526–7, 528–9, 537, 537, 538 otitis externa 451, 526–7, 526–7, 529, 534–6, 538, 1398 otitis media acute otitis media 526, 526, 531–3, 1398 in children 453, 529, 530–2, 532 chronic otitis media 526, 531, 533–4, 534 Index.indd 1481 chronic suppurative otitis media 492, 1395, 1396, 1397, 1398 delirium caused by 476 ear pain due to 526–30, 530–4 in Indigenous Australians 1399 ‘unsafe’ and ‘safe’ ears 527, 527, 533–4, 534 when to refer 537 otosclerosis 451, 455 ototoxic drugs 451, 455 Otovent assisted nasal inflation 531 Ottawa rules 710–11, 716, 1386–7 out-toeing 874 ovarian cancer 155, 171–2, 235, 235–6, 423, 459, 973 ovarian cysts 308, 966, 968, 971, 972, 972, 978 ovarian tumours 971–3, 1203 overactive bladder 813 overflow incontinence 813 overlap syndrome 155, 283, 283 over-the-counter preparations 96–7 overuse syndromes 669–70, 721–4, 722, 1380, 1382–3, 1383–4 ‘overwear syndrome’ 540, 552 overweight children, tiredness in 794 overwork 792, 793 Ovestin 986 Ovestin Ovula 986 OvPlex™ serum test 236 ovulation disorders 1080, 1082 ovulation pain 309 ovulatory cycle 1081 oxalate 78 oxandrolone 202 oxazepam 58, 480, 1234, 1237 oxcarbazepine 1260 oxolamine 447 oxprenolol 1029 oxycodone 84, 85, 86, 95, 98 Oxycontin 86, 95 oxygen for acute cardiogenic pulmonary oedema 1312 for altitude sickness 123 for anaphylaxis 917, 1311 as an antidote to carbon monoxide 911 for asthma 1248, 1312 for cluster headache 594, 1329 for dyspnoea 87 in emergency care 1311 for febrile convulsions 911 for jellyfish sting 1316 for myocardial infarction 1313 1481 for seizures 1313 in treatment of poisoning 909 oxygen therapy 1254, 1256 oxygen transfer, enhancement of 202 oxymetazoline 559 OxyNorm 86, 95 oxytocics 1034 oxytocin 1034, 1041 P P value 110 pacemakers 121, 1307 pacing 28 paediatric advanced life support 909 Paget disease with arthropathy 329 diagnosis of 153 facies of 147 groin pain due to 687 headache due to 585, 590 hearing loss due to 451 hip pain due to 681 hypercalcaemia due to 220 leg pain due to 696 neck pain due to 639 of the nipple 950, 950 walking difficulty due to 747–8, 748 pain acute and chronic pain 92 assessing and measuring 92–4, 93–4, 97 changes in threshold to 49 components of 92, 92 delirium due to 476 with IUCDs 940 origins of 91 patterns for mastalgia 943 patterns for menstrual cycle related pain 968 types of 90–1 see also neuropathic pain; nociceptive pain; pain management; psychogenic pain Pain Disability Index 94 pain management 90–102 in cancer 82–7, 83–6 in children 97–8 counselling for chronic pain 37 defined 90 drugs allowed in sport 203 for the elderly 98–9 golden rules 90 holistic approach 94 neuropathic pain 101–2 painful diabetic neuropathy 101–2 22/10/10 2:54:57 PM 1482 Index prescribing NSAIDs 99–100, 99–100 somatoform pain disorder 102 painful arc syndrome 656, 656 paint gun injuries 1351, 1351 paints (skin preparations) 1119 palilalia 894 palliative care 81–9 in children 88 common symptom control 87–8 Golden Standards Framework 82 pain control in cancer 82–7, 83–6 principles of 81 role of family doctor 81 support for patients and carers 81–2 symptom control 82, 82–3 palliative surgery 84 palmar hyperhidrosis 1149 palpitations 751–63 in children 755 clinical investigations 752–3, 754–5 diagnosis of 751–2, 752 in the elderly 755, 757 as a masquerade 752, 752 specific conditions 757–63 Paludrine 116 2-PAM 911 pamidronate disodium 748 pamphlets, for patients 46, 46 Pancoast syndrome 636, 652, 664 pancreatic cancer 66, 155, 235, 236, 604, 616–17, 837 pancreatic disorders 187, 360 pancreatic tumours 464 pancreatitis abdominal pain due to 308, 310–11 acute 325–6, 326, 328, 630 chronic 187, 311, 326, 464, 464 as a complication of mumps 887 dyspepsia due to 500 gastroparesis due to 631 jaundice due to 604 malabsorption due to 464, 464 secondary diabetes due to 187 vomiting due to 630 panda eyes 1411 panic attacks 1233–4, 1237 panic disorder 474, 1234, 1234 pantoprazole 505, 507 Pap smears 47, 69, 926, 927, 928–31, 930–1, 1395 papaverine 1093 papaya 1341 papillary carcinomas 953 papilloedema 597, 828 papillomas 602, 626, 1112, 1172, 1175–6 Index.indd 1482 papular urticaria 865 papules 1112, 1112 Para check V test 127 paracetamol for acute otitis media 531 for adhesive capsulitis 659 for analgesia in mastitis 1044 as an analgesic 94–5 antidote for 911 for arthritis 94, 101 for cancer pain 83 categorisation of drug risk 1038 for children 97 classification of 99 in combined analgesics 96 in cough mixtures 447 for cracked nipples 1043 for dental pain 557 dosage 95, 97 for dysmenorrhoea 973 for EBM 254 effect on warfarin activity 1341 for engorged breasts 1042 for erythema infectiosum 884 for febrile convulsions 912 for fever 916 for fever in chickenpox 879 for hangover headache 1222 for headache 590, 592, 598 for Henoch-Schönlein purpura 866 for herpes zoster 1159 for influenza 442 jaundice due to 607 for lower back pain 391 for neck pain 645, 646 for neuropathic pain 101 for nociceptive pain 94 for pain 947 for postherpetic neuralgia 1160 for pseudogout 346 rebound headache due to 598 for restless legs 770 for rhinitis 853 for rubella 883 for snuffling infants 627 in sport 203 for teething infants 852 for travellers 124 paracetamol prophylaxis 70 paradoxical embolus 1334 paradoxical straight leg raising test 387–8 paraesthesia 91, 743 paraesthesia of extremities 1236 paraffin cream 1006, 1133 paraffin oil 428 paragonimiasis 125 parainsomnias 771–2 paraldehyde 916 paralytic ileus 630 paramyxovirus 886 paranasal sinus disorders 554, 557 paraneoplastic syndromes 233–4, 234, 235 paranoid personality disorder 489 paranoid psychoses 58, 481 paraphimosis 873, 1066–7, 1066–7 paraphrasing 28 paraphrenia 58 paraplegia 87 parasitic infections 131–5, 464, 842, 1397 parasomnias 765 parasuicide 184, 487, 923, 923 paratyphoid 459, 460, 470, 570 para-umbilical hernia 873, 876 parecoxib 100 parental nutrition 88 parental opioids 98 parenterally transmitted hepatitis 612 parent-held health record 849 parenting 854, 903–4, 922 Parkinson disease 294–9 anti-Parkinson drugs 60, 179, 297–8, 425, 477, 1076, 1200 checklist of symptoms 296 clinical features 295 cognitive impairment 299 constipation with 428 diagnosis of 291, 306 in diagnosis of depression 179 differential diagnosis 298 drop attacks caused by 802 drug-induced 294 dysphagia due to 511 genetic profile 165 hyperhidrosis due to 1149 management of 295–8, 299 management of motor problems 298 as a masquerade 49, 155 motor problems 298, 298 practice tips 299 reduced sense of smell due to 621 as a risk factor for dementia 57 spontaneous motor Parkinsonism 55 symptoms and signs 294–5, 296 tremor in 293 when to refer 298–9 Parkinsonism 294, 483 Parkinson-type gait 745 paromomycin 131 22/10/10 2:54:57 PM Index paronychia 742, 1206, 1209, 1210–11 parosmia 621 parotid gland 554, 555 parotitis 526, 887 paroxetine 182, 988, 1046, 1095, 1233–5 paroxysmal nocturnal dyspnoea 514 paroxysmal supraventricular tachycardia 751, 755, 757, 760, 763 pars interarticularis fractures 1380 partial seizures 1259, 1259 participation observation 107 party drugs 197 parvovirus 881 parvovirus B19 139, 333, 883, 1023, 1025 passive immunisation 1353 passive-aggressive personality disorder 489 pastes (skin preparations) 1119 Pasteurella multocida 1348 Patau sydnrome 167 patches 1112, 1112 patella dislocation or subluxation of 712, 715, 1372, 1372–3 fractures of 1373, 1374 patella apprehension test 714 patellar tendonitis 722 patellar tendonopathy 709, 714, 715, 722–3, 723, 1382 patellofemoral pain syndrome 709, 714, 715, 716, 721–2, 722, 726, 1382 patent ductus arteriosus 872 patent foramen ovale 1330 pathological bereavement 34, 34–5 pathological bradyarrhythmias 758 pathological jaundice 610 pathological tachyarrhythmias 758 patient registers patient-centred counselling 31 patient-centred diagnosis 3–4 patients bereaved patients 34–5 breaking of bad news to 33, 35, 35–6 complaints from 40 consent of 17 difficult patients 25–6, 39–42 doctor-patient relationship 20, 23, 41, 1395–6, 1400 education of 4, 18–19, 43–7, 46, 63 factors affecting communication by 25–6, 26 helping distressed patients 33–4 involvement in decision-making 18, 19 management plans for 18–20 rapport with 15, 15, 27–8, 41 Index.indd 1483 reassurance of 17, 23 taking history of 15–17, 51, 67 touching of 17, 42 see also children; consultations; elderly patients; Indigenous Australians; refugee health Patrick test 688, 688 pauciarticular arthritis 336 Paul-Bunnell test 253 pawpaw 1118 Paxinos sign 661 PCI 415, 415 PCO2 144 PCOS 187, 964, 1080, 1082, 1084–5, 1203, 1297 PCR 136 PCR Chlamydia urine test 1102 PCU 87 PCV 144 PDDNOS 895, 896–8 PDDs 895 PDE inhibitors 415, 587, 1094, 1094 pea soup stools 1408 peak expiratory flow rate 519, 1240, 1241, 1242, 1243, 1247–9 peanut allergy 1223, 1225 pearly papules 1410 pearly penile papules 1070, 1070 pectin 464 pectoralis major 872, 944 pediculosis 1114–16, 1122, 1126 pediculosis pubis 1100 Pediculus humanus capitis 889 PEEP 1318 PEFR 519, 1240, 1241, 1242, 1243, 1247–9 Peggy bloomers 1410 pegylated interferon alpha 613, 615 Pel-Ebstein fever 567 pellagra 77 Pellegrini–Stieda syndrome 721 pelvic abscess 459, 681 pelvic adhesions 966, 968, 974, 978 pelvic congestion syndrome 966–7, 968, 969 pelvic floor exercises 815, 816 pelvic floor muscles 814 pelvic fractures 1371, 1374 pelvic inflammatory disease acute 975, 975 causative organism 1100, 1103 chronic 975 clinical investigations 975–7, 976 compared with endometriosis 969 diagnosis of 975, 975 fever due to 567 1483 hip and groin pain from 681 in Indigenous Australians 1400, 1401 infertility due to 1082 lower abdominal pain due to 966, 968, 975–6, 975–7 occuring with IUCD 940 pathogenesis of 976 specimen collection 1103 treatment 1103 uterine bleeding due to 960 pelvic pain see lower abdominal and pelvic pain in women pelvic peritonitis 968 pemphigus vulgaris 777 penciclovir 1161 penetrance factor 159, 161 penetrating eye injuries 552, 1398 penetrating hand injuries 1370 penicillamine 516, 744, 1154, 1200 penicillin adverse effects 193, 253, 279, 564, 607, 1156–7, 1156–7 for bites 1347, 1348 categorisation of drug risk 1039 for erysipeloid 677 for glomerulonephritis 1399 for haematoma of nasal septum 626 for pneumonia 444 penicillinase 1102 penicillin-resistant gonococci 1102 penile cancer 1070 penile disorders 1066–71, 1069, 1097, 1097, 1176 penile lesions 1070, 1070 penile prostheses 1094, 1095 penile ulcers 1070 penile warts 1069, 1069, 1176 penis, compared with clitoris 1091, 1092 pentamidine 250, 803 pentazocine 96, 202 Penthrox Inhaler 97 PEP 247 peptic strictures 511, 511–12 peptic ulcers abdominal pain due to 309, 311, 314 bleeding 506 chest pain due to 403, 411 clinical features 327 dyspepsia due to 500, 501, 506–7 perforation of 310, 317, 322, 322 percutaneous intervention 415, 415 percutaneous transluminal angioplasty 415, 415, 1334 perforated septum 625 perforated tympanic membrane 451 22/10/10 2:54:57 PM 1484 Index perforated ulcers 308, 309–10, 317, 322, 322, 328, 360 perforated viscus 310 perforation of uterus 940 pergolide 297 perhexiline 415, 607 perianal abscess 353 perianal erythema 903 perianal haematomas 353, 424 perianal warts 354 periapical abscess 555 periareolar inflammation 950 periarthritis 652 pericardial disease 1303 pericarditis 361, 403–4, 404, 409, 409– 10, 419, 639 perichondritis 526, 528, 529, 536 peridontal disease 776 periductal mastitis 956 perilymphatic fistula 451 perinatal depression 180 perinatal mortality 1026–7 perindopril 1277, 1278, 1305 periodic limb movements 769 periodic oedema 835 periodontal diseases 554 periodontitis 557, 777, 777 peri-oral dermatitis 1145, 1145–6 peri-oral paraesthesia 1236 peri-orbital cellulitis 549, 1398 peripheral meniscal tears 712 peripheral nerve entrapment syndromes 664 peripheral nerve pain 91 peripheral neuropathy 302, 743 peripheral oedema 749 peripheral vasodilators 575 peripheral visual loss 817 peritendonitis 733 peritendonopathy 1380 peritoneal cancer 459 peritonitis 310, 327, 1082 peritonsillar abscess 529 periungal warts 1176, 1212 permethrin 115, 865, 889, 1100, 1107, 1124, 1399 pernicious anaemia 77, 208, 282 pernicous anaemia of pregnancy 208 perniosis 676, 1150, 1150–1 peroneal muscle atrophy 302 peroneal nerve entrapment 699 peroneal tendon dislocation 737, 743 peroneal tendonitis 737 personal health records 4, 849 personality disorders 474, 487–90, 489, 574 Index.indd 1484 Perthes’ disease 679, 681, 684, 684, 685, 690, 746 pertussis 256, 435, 881, 887–8, 1013, 1397, 1405 pervasive development disorders 895 pes cavus 736 pes plano valgus 874, 875, 876 pes planus 727, 736 pessaries 816 petechiae 394, 1112 pethidine 85, 96, 98, 202, 592, 600, 1325 pethidine addicts 811 petit mal seizures 578, 1259, 1259, 1264 petrol sniffing 1318, 1401 petrostitis 531 Peutz-Jegher disease 147 Peyronie disorder 1071 PFO 1330 PH 143 phaeochromocytoma 187, 220, 752, 1149 phalangeal fractures 1363, 1369–70, 1370, 1374, 1378 phalanges 1370 Phalen test 671 phantom pain 91, 101 pharyngeal cancer 787, 790 pharyngeal disorders 526 pharyngeal pouch 636 pharyngitis 253, 571, 643, 783 pharyngolaryngitis 602 pharyngotonsillitis 511, 1399 Phazyme 500 phenelzine 182, 593, 1235 Phenergan 121, 123, 124 phenindione 1338 pheniramine 122, 447 phenobarbital 910 phenobarbitone adverse effects 193, 208, 494, 1261 for barbiturate dependence 486 for complex partial seizures 578 for epilepsy 1260–1, 1264 macrocytosis caused by 208 for seizures 1313 for terminal distress 87 phenol 1118, 1119, 1170 phenolphthalein 433, 564, 1156, 1157 phenomenology 107 phenothiazines adverse effects 60, 194, 294, 494, 511, 611, 818, 1076, 1148, 1156, 1157 antidote for 911 categorisation of drug risk 1038 contraindications 298 increased pigmentation due to 149 for movement disorders 483 for nausea 87 Parkinsonism induced by 294 prescription without revision 60 for travel sickness 121, 122 for vestibular disturbances 632 phenotypes 159 phenoxybenzamine 575, 675, 814 phenoxymethyl penicillin 562, 677, 706, 777, 787, 813, 889, 1005 phentermine 834 phentolamine 1316 phenylalanine 74, 170 phenylbutazone 99, 348 phenylephedrine 447 phenylephrine 544, 1228 phenylketonuria 170, 174 phenylpropanolamine 202, 203, 447 phenytoin adverse effects 60, 193, 208, 311, 494, 499, 564, 607, 1049, 1143, 1156–7, 1200, 1204, 1260, 1261–2, 1262–3 for complex partial seizures 578 effect of active charcoal on 910 effect on warfarin activity 1341 for epilepsy 1260, 1260–1, 1264 laboratory reference values 143 macrocytosis caused by 208 malabsorption due to 208 for night terrors 577 relation to birth defects 1032 for seizures 1313 for status epilepticus 917 for trigeminal neuralgia 561 Philadelphia chromosome 234, 1410 philosophical commitment phimosis 807, 873, 1066 phlegmasia dolens 705 phobias 32, 474, 574, 1234–5, 1235 pholcodine 202, 203, 447 phonaesthenia 601 ‘phony’ colic 323 phosphate 143 phosphodiesterase inhibitors 415, 487, 1094, 1094 photo-ageing 1149 photochemicals 65 photochemotherapy 149 photodynamic therapy 1180 photophobia 540 photosensitive epilepsy 1263 photosensitivity 147, 1116, 1148, 1156, 1156–7 PHRs 4, 849 Phthirus pubis 1100, 1107 22/10/10 2:54:57 PM Index Phyllodes tumour 956 phylloquinone 77 physical abuse 899, 900–1, 901 physical activity for diabetics 1294 effect on blood pressure 1275 for the elderly 48 for epileptics 1262, 1262 exercise-induced asthma 1245 haematuria due to 809 in pregnancy 1019 prevention of cardiovascular disease 67 promotion of by GPs 45, 46, 47 for restless legs syndrome 770 physical disability 857–8 physical examinations of the elderly 51–2 guidelines for 17 periodic health examinations 66–7 reassuring patients through 20 of refugees 1402–3, 1403 requests for full STI check-up 1108 screening of children 67–8 physical therapy 390, 390 physiognomy 145 physiological jaundice 610 physiotherapy 1253 phytochemicals 76 phytoestrogens 988 phytosterols 75 pianist’s cramp 304, 1411 Pick disease 55 Pickwickian syndrome 1410 picornavirus 273 PID see pelvic inflammatory disease Pierre–Robin syndrome 877 pigeon toes 874, 1410 pigmented skin lesions 1188, 1188–95 pilar cysts 1174 piles 353–5, 355, 433, 1018 pill-rolling tremor 1410, 1411 pilocarpine 822 pilonidal sinus 353–4, 354, 355 pimecrolimus 1133 pindolol 1277 Pinetarsol 865, 884, 1139 pinguecula 549–50 pinhole test 821 pink eyes 1408 pinna, haematoma of 1343, 1343 pinworms 125, 132–3, 133, 1006 pioglitazone 1293 pipe smoker’s tongue 1411 piperazine oestrone sulphate 986 Index.indd 1485 piperonyl butoxide 865, 1107 piperonyl foam 889 piroxicam 1157 pitcher’s elbow 663 pitted dark teeth 852 pitted keratolysis 1150 pituitary dependent hyperadrenalism 832 pituitary disorders 218, 218–19, 585, 1082 pituitary hormones 211 pituitary neoplasms 829 pityriasis alba 864, 1133–4, 1148 pityriasis capitis 1204 pityriasis rosea 1114, 1115, 1152–4, 1153 pityriasis versicolor 1114, 1147–8, 1147–8 Pityrosporum orbiculare 1162 pivot shift test 720, 720 pizotifen 498, 593, 594 PJP 242, 244, 246, 434 PKU 170, 174 placenta praevia 1028, 1033 placental abruption 1033 plagiocephaly 868, 868 plague 117, 118–19, 125, 129, 256 plane warts 866, 1175–6, 1175–6 plant sterols 75, 1288 plantar fasciitis 282, 727, 732, 733–4, 734 plantar skin conditions 727 plantar warts 739–41, 740–1, 743, 866, 1175, 1175–6 plaque psoriasis 1139 plaques 1112 plasma 1340 plasma alkaline phosphatase 141 plasma bilirubin 141 plasma cell mastitits 956 plasma D-dimer 1337 plasma expanders 202 plasma thromboplastin component 400 plasma tranferases 141 plasma volume, decrease or increase in 835, 835 Plasmodium falciparum 112, 115, 127 Plasmodium knowlesi 115 Plasmodium malariae 115, 127, 567 Plasmodium ovale 115, 127 Plasmodium vivax 115, 127, 567 plaster casts 121, 1355, 1375, 1375 plaster of Paris 1375 platelet disorders 395, 395, 397–400, 402 platelets 144 pleomorphic adenoma 781 pleural effusion 516, 520 pleural plaques 524 1485 pleural taps 87 pleurisy 360, 361, 404, 404, 435 pleuritis 403, 409 PLISSIT model, of counselling 30, 1090–1, 1096, 1098 Plummer–Vinson syndrome 511 PMDD 979, 980 PMS 979–82, 980, 987 pneumatic otoscopy 454 pneumococcal pneumonia 564 pneumococcal vaccination 532, 1254, 1395, 1405 pneumococcus 70, 70, 117, 401 pneumoconiosis 67, 435, 436, 523, 524, 524 pneumonia 442–4 abdominal pain due to 310 atypical 269, 443 chest pain due to 403, 404, 404 in children 444, 849, 907 as a complication of herpes simplex 1161 as a complication of influenza 441 cough due to 435, 439, 440 deaths from 256 dyspnoea due to 516 fever due to 571 in Indigenous children 1395 in infants 847 initial presentation of 269 P jiroveci pneumonia 242, 244, 246, 434 in returned travellers 126 thoracic back pain due to 361 pneumonic plague 129 pneumonitis 436 pneumothorax chest pain due to 403–4, 404, 409, 409–10, 420–1 dyspnoea due to 516, 525 thoracic back pain due to 360, 361 PO2 143 podalgia 727, 735, 735–6, 736 podophyllin 1069, 1177 podophyllotoxin 1069, 1100, 1106, 1176 poeterior vitreous detachment 817 Point of Care laboratory equipment 1401 poisoning 906, 908, 909–10, 910–11 Poland syndrome 872 policeman’s heel 733, 1409 policosanol 1288 poliomyelitis 273–4 dyspnoea due to 516 immunisation against 69, 70, 112, 116, 117, 119, 1405 22/10/10 2:54:57 PM 1486 Index in Indigenous Australians 1397 neck pain due to 639 in returned travellers 125 vaccination in pregnancy 119 worldwide fight against 256 poliovirus 270 pollens 1223, 1227 Pollyanna effect 531, 1410 poloxamer drops 428, 430 polyangiitis 283 polyarteritis nodosa 155, 282, 283, 288–9, 331, 570 polyarthritis 286, 329, 330, 333, 350 polycystic kidney disease 275, 275 polycystic kidneys 809 polycystic ovary syndrome 187, 964, 1080, 1082, 1084–5, 1203, 1297 polycythaemia 234, 455, 1122 polycythaemia vera 238 polyethylene glycol 910 polyhydraminos 1028, 1036 polymerase chain reaction 136 polymorphism 159 polymyalgia 282, 570 polymyalgia rheumatica 289–90 arm pain due to 664 classification of 282, 283 diagnosis of 331, 349 in the elderly 49 hip pain due to 681, 686 laboratory investigations 137 leg pain due to 696 as a masquerade 155 neck pain due to 639, 640 shoulder pain due to 660, 661, 662 sites of pain and stiffness 289 polymyalgia syndrome 360 polymyositis 282–4, 287–8, 330, 343 polymyxin B sulphate 544 polyneuropathy 302 polyols 74 polypharmacy 1263–4 polyposis coli 1174 polyps 601, 602, 620, 622–3, 623, 965 Polytar 1139 polyunsaturated fats 75 pompholyx 1134, 1134 POP 934, 935, 938, 939, 963, 1041 Popeye syndrome 1410 popliteal artery 700, 701 popliteal entrapment syndrome 702 popliteus tendonopathy 723, 1382 porphobilinogen deaminase 170 porphyria 102, 149, 170–1, 174, 302, 425, 809 Index.indd 1486 porphyria cutanea tarda 170 port wine stain 862, 871, 1410 positional dyspareunia 978 positive end expiratory pressure 1318 positive jerk test 720 posseting 503 post coronary procedure angina 408 post infarction angina 408, 422 post-AMI syndrome 419 postauricular lymphadenopathy 529 postcoital contraception 934 post-concussion syndrome 803 posterior chest pain 421 posterior cruciate ligament rupture 720–1, 1382 posterior dislocation of the elbow 1365, 1365–6 posterior dislocation of the hip 1372 posterior dislocation of the shoulder 661, 662, 1362, 1362, 1363, 1363 posterior impingement syndrome 1388 posterior talofibular ligament 1385, 1385 posterior tibial artery 701, 701 posterior tibial tendon rupture 1388 posterior vitreous detachment 827 post-exposure prophylaxis 247 post-gastrectomy 464, 464, 803 postherpetic neuralgia 101, 562, 1160, 1160 Postinor-2 939 post-lumbar-puncture headache 598–9 postnasal drip 434, 435, 435 postnatal adjustment disorder 1045 postnatal blues 1045 postnatal care 1040–6 after-pains 1041 contraception 1040–1 guidelines for the lying-in ward 1040 postnatal consultations 1040, 1041 postnatal depression 1045–6 postnatal depressive disorders 1045–6 postoperative jaundice 618–19 postoperative vomiting 632 postpartum haemorrhage 1033–4, 1044–5 postpartum hypothyroidism 1046 postpartum psychiatric illness 474, 1046 postpartum thyroiditis 1046 post-primary pulmonary TB 259 post-procedural headache 585, 585 post-streptococcal glomerulonephritis 1398, 1399 post-traumatic chronic wrist pain 674 post-traumatic headaches 585, 585, 590, 598 post-traumatic stress disorder 474, 904, 1236, 1237, 1403 post-traumatic synovotis 1388 post-tussive syncope 447 postural competence 58–9, 59 postural hypotension 491, 493, 496, 574, 798, 1297 postural orthostatic tachycardia syndrome 574, 579, 801 postural talipes 874 postural talipes equinovarus 874 postural tremors 293 postviral syndrome 795 potassium 464, 909, 911 potassium clavulanate for acute bacterial sinusitis 559 for acute diverticulitis 327 for bacterial prostatitis 1073 for bites 1347, 1348 for cystitis 230, 231, 1021 for epididymo-orchitis 1053 for epiglottitis 914 for frontal sinusitis 597 for Group B Streptococcus infection 1022 for orbital cellulitis 549 for otitis media 531, 533 for PID 977 for pneumonia 443 for secondary postpartum haemorrhage 1045 potassium iodide 1255 potassium ions 142, 143 potassium supplements 502 POTS 574, 579, 801 Pott disease 274 Pott fracture 1374 povidone-iodine 889, 1161, 1162, 1177, 1397, 1399 pox virus 1100 pox virus lumps 1172, 1176–7, 1177 PPNG 1102 PPROM 1035 PQRST approach, pain measurement 93 practice nurses 51–2 Prader–Willi syndrome 167–8, 174, 829, 831, 850 pralidoxime 911 pramipexole 297, 298, 770 pravastatin 1286, 1287 prawn workers 523 praziquantel 132 prazosin 60, 575, 814, 1075, 1277, 1278, 1282 pre-auricular sinus 869 22/10/10 2:54:57 PM Index prebyopia 821 precocious puberty 856 preconception care 1013–14 precordial catch 412–13 predeparture screening, for refugees 1402 prediabetes 189 predictive values, in research 105, 105, 106 prednisolone for ACAH 617 for acute vertigo 496 for adhesive capsulitis 659 for alopecia 1199 for anaphylaxis 1312 for asthma 1244, 1244, 1246, 1248, 1250, 1313 banning of in sport 202 for chronic ITP 400 for cluster headache 594 for COPD 1256 for croup 914, 1328 for erythema nodosum 1158 for extrinsic allergic alveolitis 523 for facial nerve palsy 305 gastrointestinal haemorrhage due to 582 for gout 345 for infantile spasms 576 for lichen planus 1211 for mouth ulcers 775 for nasal polyps 623 for nephrotic sydrome 813 for nerve function impairment 1399 for neurological pressure pain 86 for rheumatoid arthritis 343 for sarcoidosis 522 for systemic lupus erythematosus 285, 1031 for temporal arteritis 595 for ‘tropical ear’ 535 pre-eclampsia 812, 1026–7, 1028, 1029, 1032, 1280, 1282 pregabalin 101, 370, 1160, 1260 pregnancy alcohol and drugs during 77, 1016–17 amenorrhoea 964 antenatal screening 1014–15, 1016 back pain 1018–19 basic antenatal care 1013–19 breathlessness 1019 calendar to determine due date 1015 carpal tunnel syndrome 1019 cramps 1018 dental hygiene 1018 Index.indd 1487 detection of early pregnancy 153 dyslipdaemia in 1288 for epileptics 1263 exercise during 1019 first-visit examination 1014 generalised itching 1019 haemorrhoids 1018 heartburn 1018 hypertension 1027, 1029, 1282 hypotension 1019 infections in 1020–5 mastalgia 944 mineral supplements 1019 nutrition during 1016 obesity during 1019 obesity following 829 occuring with IUCD 940 pernicous anaemia of pregnancy 208 prenatal screening 159, 173–4 proteinuria in 1016 rubella in 882, 883 screening for gestational diabetes 190 sex in 1017 sickness during 1018 skin pigmentation 149 smoking in 1016 tiredness due to 793 travelling when pregnant 119, 1017 urinary tract infections 231 uterine bleeding 959 vaginal bleeding 1017–18 varicose veins 1018 vomiting during 630, 633, 1018 see also ectopic pregnancy; high-risk pregnancies; infertility; postnatal care; termination of pregnancy Prehn sign 1052 preleukaemia 208 Premarin 986, 986 premature adrenarche 857 premature (ectopic) complexes 751, 757, 758, 758–9, 762, 763 premature ejaculation 1087, 1094–5 premature infants 1026–7 premature ovarian failure 965 premature rupture of membranes 1035–6 premature thelarche 857 premenstrual dysphoric disorder 979, 980 premenstrual mastalgia 943 premenstrual syndrome 979–82, 980, 987 prenatal screening 159, 173–4 1487 prepatellar bursitis 709, 723–4 preperitoneal inguinal hernias 1056 presbyacusis 451 presbyphonia 601, 602 prescription drugs, adverse reactions to 192–3 prescriptions see drugs presenile dementia 480 presenting symptoms see symptoms pressure changes see barotrauma pressure gun injuries 1342, 1351, 1351 pressure pain 84, 86 pressure sores 1164, 1169–70 preterm labour 1035 preterm PROM 1035 pretibial haematomas 1343 prevalence (research) 105 prevalence studies 108 prevascular femoral hernias 1056 preventive medicine 62–71 advice in consultations 19 definitions 62–3 in general practice 64 global strategy for 64–5 immunisation 69–71 malignant disease 64, 65–6 masquerades in 67 mortality and morbidity patterns 64, 64 periodic health examinations 66–7 phases of 63 proactive professional behaviour 43–4, 44 recall lists respiratory diseases 66 screening for adults 68–9 screening for children 67–8 taking a patient’s history 67 types of 62, 63 vascular disease 64, 65 what is preventable 63 priapism 1070 prickly heat 1150 prilocaine 1095, 1349 prima donna personality 1410 primaquine 127 primary absence seizure 574 primary amenorrhoea 964 primary biliary cirrhosis 606, 606 primary care 2–3, 14 primary dysmenorrhoea 973, 974 primary haemostatic disorders 395 primary herpes simplex infection 544, 545 primary herpetic gingivostomatitis 775 22/10/10 2:54:58 PM 1488 Index primary HIV infection 1154, 1155 primary hyperaldosteronism 220 primary hyperparathyroidism 221 primary osteoarthritis 282 primary osteoporosis 990 primary postpartum haemorrhage 1033–4 primary prevention 62, 63, 64 primary research 107 primary sclerosing cholangitis 606, 606, 617 primary septicaemia 572 primary syphilis 262, 262 primary testicular disease 1094 primary tuberculosis 258 primidone 208, 294, 1260 Primolut N 986 Primoteston Depot 1094 Prinzmetal angina 413 prion transmitted diseases 273 proactive professional behaviour 43–4, 44 probability 106 probability diagnosis 151 probanthine aluminium chloride 1149 probe method, removing foreign bodies 529, 530 probenecid 202, 345, 346, 1398, 1399, 1400 problem gambling, counselling for 37–8 problem-solving, in counselling 30 probucol 1287, 1287 procainamide 564, 759 procaine 700 procaine penicillin 443, 677, 777, 787, 1106, 1347–8, 1398–9 Prochaska and Di Clemente model, of change 37 prochlorperazine for acute vertigo 496, 1329 as an anti-emetic 632 for diarrhoea 469 for the doctor’s bag 1326 for migraine 592, 1329 for nausea and vomiting 87, 631, 1329 for sea sickness 122 for travel sickness 121, 123 for vestibular disturbances 632 proctalgia fugax 352 procyclidine 1076 professional development 103 progesterone-only contraceptive pill 938 progesterones 955, 981, 985, 993 progestogen-only contraceptive pills 934, 935, 938, 939, 963, 1041 Index.indd 1488 progestogens in contraception 934, 937, 938 in the differential diagnosis of depression 179 for endometriosis 975 in hormone replacement therapy 986, 986–7, 987, 987–9 for menorrhagia 962, 963 for premenstrual syndrome 981 progressive primary tuberculosis 258 progressive supranuclear palsy 295 proguanil 116, 119, 127 Progynova 986, 986 Proladone 86, 95 prolapsed disc 359, 373, 382, 392, 411, 746 prolonged pregnancy 1036 PROM 1035–6 promethazine for acute vertigo 496, 1329 for anaphylaxis 1312 for angio-oedema 1312, 1328 as an anti-emetic 632 in cough mixtures 447 for the doctor’s bag 1325, 1327 for insect bites 1316 for motion sickness 87, 123 photosensitivity due to 1157 in a traveller’s medical kit 124 promethazine hydrochloride 121, 122 promethazine theoclate 121, 122, 632 propantheline 293, 1076 prophylactic colectomy 69 propranolol 216, 294, 498, 593–4, 770, 1233, 1235, 1277 propylene glycol 1119 propylthiouracil 216 prospective studies 108 prostaglandin analogue 507 prostaglandin E 945 prostaglandin E1 1093 prostaglandin F2- 1034 prostaglandin inhibitors 963, 973 prostaglandins 460, 1036 prostamegaly 1071 prostate cancer 65, 66, 69, 235, 1049, 1076–8, 1077 prostate disorders 49, 1072, 1072–8 prostate examination 427, 427 prostatectomy 1075–6, 1077 prostate-specific antigen 235 prostatic tumours 1071 prostatic varices 809 prostatitis 231, 807, 809, 1071, 1072–3, 1072–3, 1102 prostatodynia 1072, 1072, 1073 protamine 1291 protamine IV 911 protamine sulfate 1340 protaphane 1291 protease inhibitors 247 protein C deficiency 1336 protein, in the diet 74, 80 protein S deficiency 1336 protein-energy malnutrition 74 proteinuria 812, 812–13, 1016 Proteus sp 228, 534, 1072 prothrombin 144, 400 prothrombin gene mutation 1336 proton-pump inhibitors 505, 506, 583, 1038, 1341 protozoal infections 125, 251–7, 458, 837 Provera 986 proximal muscle weakness 745 proximal nail folds, swelling of 1209 proximal obstruction, in the leg 702 prune belly 1410 pruritus 1122–30 asteatotic eczema 1128, 1128 brachioradialis pruritus 1128 candida intertrigo 1127 causes of 1123 clinical investigations 1123–4 dermatis hepertiformis 1122, 1125, 1125 diagnosis of 1123 erythrasma 1003, 1127, 1127 generalised pruritus 1122–3 of the genitals 1107 ‘golfer’s vasculitis’ 1128 localised pruritus 1122 physiology 1122 pruritus ani 357, 357–8, 1126 pruritus capitis 1126 pruritus gravidarum 1019 pruritus vulvae 1005–6 from scabies and lice 1109 skin disorders causing 1122 tinea cruris 1126–7, 1126–7 treatment 1124 see also Grover disease; insect bites; lichen planus; lichen simplex; scabies PSA 143 pseudo ‘neutropenia’ 1406 pseudoaneurysm 1172, 1183 pseudobulbar palsy 306, 511 pseudo-Cushing syndrome 145 pseudocyst of lateral meniscus 713, 713 pseudodementia 55, 55, 476, 480 pseudoephedrine 202, 203, 447, 753, 1228 22/10/10 2:54:58 PM Index pseudofolliculitis 1162 pseudogout 337, 346, 349, 708, 717, 717 pseudogynaecomastia 871 pseudohaematuria 809, 810–11 pseudomembranous colitis 459, 460–1 Pseudomonas aeroginosa 542, 1162 Pseudomonas pyocyanea 1209 Pseudomonas sp 228, 526, 534, 544, 1072, 1153 pseudopelade 1199 pseudoseizures 577, 1263 pseudosquint 870, 870 pseudotumour cerebri 599 pseudovertigo 491 PSGN 1398, 1399 psittacosis 266, 268, 269, 436, 567, 570 psoas abscess 687, 1056 psoralens 149, 1157, 1199 psoriasis 1138–41 with arthropathy 329 chronic stable plaque psoriasis 1139 diagnosis of 1114, 1115, 1116, 1138–9 dry skin due to 1148 intertrigo due to 1003 intralesional corticosteroid injections 1139, 1141, 1141 knee pain due to 708 of nails 1206, 1210 neck pain due to 639 penile lesions due to 1070 on the penis 1116 pruritus due to 1126 psoriatic nappy rash 1142 raised plaques on skin 1138 on the scalp 1116 skin distribution 1139 treatment 865, 1139, 1140 types of 1138 typical skin distribution 1139 vulvar discomfort due to 1002, 1004 psoriatic arthritis 347, 375, 384, 386, 735 PSVT 751, 755, 757, 760, 763 psychiatric disorders 474–90 of childhood and adolescence 486 classification of 474 clinical investigations 477 diagnosis of 475, 475–7 faints and fits due to 580 genetics of 165, 165 managing acutely disturbed patients 478 as masquerades 475, 476 psychosis with Alzheimer disease 58 specific conditions 478–90 terminology 475 Index.indd 1489 tiredness due to 791, 792, 793 weight loss due to 838 see also bipolar disorder; delirium; depression; personality disorders; psychotic disorders; schizophrenia psychoactive substance abuse disorders 485–6 psychogenic pain abdominal pain 311, 317 aggravation of by arthritis 331 amnesic episodes 579–80 arm and hand pain 665 blackouts 804 chest pain 405, 412, 412 constipation 426 cough 436, 440 defined 91 delirium 477 diarrhoea 461 dizziness 494 dysphagia 513 dyspnoea 516–17 facial pain 556 faints and fits due to 573, 574, 577 features of 102 headache 586, 590 hip pain 682 jaundice 607 knee pain 711 leg pain 694 loss of consciousness 799 lower back pain 376–7, 386–7 neck pain 639, 641 palpitations 752 therapeutic agents 94 thoracic back pain 362 tiredness 793 vaginal discharge 995 weight gain 830 weight loss 838 psychological disorders 38, 42, 920, 965 see also depression psychological distress 791, 794–5, 1403 psychopathic personality disorder 489 psychoses 574, 920, 1046 psychosexual ejaculatory failure 1082 psychosocial health 67 see also depression psychosocial health promotion 45–6 psychosocial reasons, for malaise 154–6, 156 psychosomatic illness 8, psychotherapeutic drugs 1089 1489 psychotherapy 31–2, 181, 482, 488, 841, 1235 psychotic disorders 32, 479, 480–1, 481 psychotropics 59, 86 psyllium 429 psyllium mucilloid 430 pterygium 549–50 ptosis 303, 303, 595 PTSD 474, 904, 1236, 1237, 1403 pubertal gynaecomastia 857 puberty 856, 920, 945, 964 pubic lice 1107, 1108, 1109 puerperal fever 1045 puerperal infection 1021–2 puffers (asthma) 1246–7, 1247 puffiness 835 pulled elbow 666, 667 Pulmicort 1244 pulmonary crackles 518–19 pulmonary disease 523–4 pulmonary embolism abdominal pain due to 310 as a cause of sudden death 1310 chest pain due to 403–4, 403–4, 408–9, 409, 410, 420, 422 dyspnoea due to 516, 525 haemoptysis due to 439 maternal death due to 1026 thoracic back pain due to 361 treatment 1338 pulmonary fibrosis 520–1, 523 pulmonary function tests 519 pulmonary hypertension 1031 pulmonary infarction 360, 361, 403–4, 439 pulmonary nodules 445 pulmonary rehabilitation 1255, 1257 pulmonary stenosis 148 pulmonary tuberculosis 157 pulse oximetry 519 pulseless disease 289, 1410 pump bumps 1390, 1410 punch biopsy 1185, 1186 punctate keratopathy 551 PUO 569 purgatives 937 purple toes syndrome 1341 purpura 394–6, 394–400, 398–9, 1112, 1153 purpura simplex 395 pustules 1112 pyaemia 572 pyelonephritis 137, 226, 229, 1021, 1021, 1268 pygeum Africanum 1078 22/10/10 2:54:58 PM 1490 Index pyloric stenosis 630, 631, 842, 849, 877, 918 pyogenic arthritis 330 pyogenic granuloma 780, 1188, 1188–9, 1189 pyogenic infection 564, 570 pyomyositis 1397 pyosalpinx 681 pyrantel 133 pyrantel embonate 1400, 1401 pyrazalones 1156 pyrazinamide 262 pyrethrin 865, 889, 1107 pyrexia of unknown origin 569 pyridoxine 77, 262, 911, 945, 981, 982, 1018 pyridoxine hydrochloride 632 pyrimethamine 208 pyruvate kinase 209 pyuria 228 Q Q fever 267 causative organism 1410 fever due to 567, 570 immunisation against 71 jaundice due to 611 overview 266 skin lesions due to 126 tests for 139 quadriceps exercises 725, 725 quadriceps tendonopathy 1382 quadriplegia 222 qualitative research 107 quantitative research 107, 108 quartan fever 567, 1408 Queensland tick typhus 131 questions, in patient interviews 16 quetiapine 57, 299, 482, 485 Quinaband 1168 quinalones 279 quinapril 1278, 1305 quinidine adverse effects 194, 460, 494, 564, 1156, 1157, 1305 for arrhythmias 759 effect on lactation 1042 effect on warfarin activity 1341 as poison 909 quinine adverse effects 494, 803, 817, 1143, 1156, 1157 categorisation of drug risk 1039 effect on warfarin activity 1341 for malaria 127 Index.indd 1490 as poison 909 in pregnancy 119 for restless legs 770 toxicity to the ear 451 quinine dihydrochloride 127 quinine sulphate 127, 706 quinolones 343, 1102 quinsy 157, 529, 783, 788, 788 quotidian fever 567, 1408 QV 1133, 1148 QV Bath Oil 1154 QVAR 1244 R rabbit fever 1410 rabbit pellets stools 1408 rabeprazole 505 rabid dog bites 1348 rabies 117, 118, 125, 129–30, 1348 Rachitic rosary 1410 radial head, fractures of 1366, 1366–7, 1374 radial styloid fractures 1368 radiation cystitis 809 radiculopathy 190, 224, 384, 392, 639, 648–9 radioactive iodine therapy 216 radiology 313, 313, 1052 radionucleide transit studies 407 radiotherapy after masectomy 954 for basal cell carcinoma 1180 diarrhoea due to 459 dysphagia due to 511 dyspnoea due to 516 nausea caused by 87 pain control in cancer 84 for prostate cancer 1077 to the scalp 1200 vomiting due to 630 radius, fractures of 1367–8, 1374 raggedy Ann syndrome 1410 raised intracranial pressure 597, 597 RAL 247 raloxifene 992 raltegravir 247 ramipril 190, 1277, 1278, 1305 Ramsay-Hunt syndrome 146, 305, 526, 528, 532 ranibizumab 826 ranitidine 505, 587, 1042, 1341 ranula 780, 780 RAP 316–17, 327 rapport, with patients 15, 15, 27–8, 41, 49–50 rashes see facial rashes; skin problems rat handler’s lung 523 Raynaud phenomenon 283, 288, 350, 674–5, 675, 1043 Raynaud syndrome 283 reactivated pulmonar TB 259 reactive arthritis 347, 347, 349, 375, 639, 708, 735, 807, 1070 reactive professional behaviour 43–4, 44 reactive spondyloarthropathies 384 reagin tests 263 reassurance, of patients 17, 20, 23 rebelliousness 921 reboxetine 183 recall lists recessive genes 159 records see medical records; personal health records rectal bleeding 356, 356–7 rectal disorders 351, 351–8 rectal examinations 426–7, 426–7 rectal prolapse 354, 355 rectal suppositories 87 rectal use, of thermometers 565–6, 566 Rectinol 624 Rectogesic 352 rectus femoris, injuries to 1381, 1381 recurrent abdominal pain 316–17, 327 recurrent anterior dislocation of the shoulder 1362 recurrent aphthous ulceration 773–5 recurrent depression 184 recurrent subluxation 661, 662, 1363 recurrent tonsillitis 787, 789 recurrent urinary calculi 78, 323 red cell enzymes 209 red cell isoimmunisation 1034 red cherry spot 1410 red currant jelly stools 1408 red eyes 1408 red flags, in diagnosis 152, 298 red man syndrome 1410 red patches (mouth) 775 red urine 1411 red-nucleus lesion 293 reductions, of fractures and dislocations 1355–75, 1357, 1366, 1369, 1371 re-entry tachycardia 757, 758 referrals 18, 20, 231 referred pain from the cervical spine 223, 648, 648 to the ear 527 from the hip joint 679, 691, 708–9, 709 22/10/10 2:54:58 PM Index to the knee 679, 708–9, 709 to the leg 695, 696–7 from the lumbosacral spinal 224, 224, 679–80, 680, 691, 708–9, 966 to the scrotum 1052, 1054 from the thoracic spine 224, 362, 363–4 reflex anorexic seizures 892 reflex sympathetic dystrophy 101, 721, 727 reflex sympathic dystrophy 676 reflex syncope 579, 798, 801, 802 reflux see gastro-oesophageal reflux reflux nephropathy 275, 275 refractive errors 819, 820–1, 828, 828 refractory anaemia 208 refractory arrhythmias 422 refractory hypertension 1266, 1280, 1283 refugee health 1402–6 regional pain syndrome 676, 677, 1388 regurgitation 629 rehabilitation 63, 1405–6 rehydration 113, 124, 464, 470 Reinke oedema 602 relationships 67, 155, 159, 174 relative risk 110 relative risk reduction 110 relaxation, drugs for inducing 1375 relaxation exercises 1232–3, 1275 Relenza 442 reliability, of research 105 Reminyl 57 remittent fever 567 renin 1279 renin-angiotensin-aldosterone system 1279 renovascular disease 1268 repaglinide 1293, 1293, 1294 Repellem 115 Replens 988 representative samples 107 rescue breathing 1320, 1321, 1322 research-based medicine 103–10 critical appraisal of published research 110 evidence-based medicine 108–10 reasons for doing research 103–4 research by GPs 103 research, defined 103 research design 107 research methods 106–7, 108 subjects of 104–5 types of research 107–8 understanding terminology 105–6 who should research 104 Index.indd 1491 reserpine 294, 587 resins 1295 resisted movements, in determining shoulder pain 655–6, 655–6, 657 resorcinol 1118 respiratory diseases 66, 256, 516, 521, 854 respiratory emergencies 906 respiratory failure 476 respiratory infection, headache due to 584, 585, 588 respiratory syncope 801 respiratory tract infections chronic 1396 common infections 440–2, 441 cough due to 434, 435 in Indigenous Australians 1396, 1397 lower respiratory tract infections 434, 435, 476 in returned travellers 126 upper respiratory tract infections 434, 435, 439, 440–2, 441, 601, 602, 783 rest angina 408 rest pain, in the foot 701, 702 resting tremors 293 restless legs syndrome 769–70, 770, 1410 resuscitation 583 resuscitation kit 1327–8 Resuscitubes 1320, 1325 retained vaginal tampon 1000–1 retarded ejaculation 1087 retching 629 retention cysts 780 retention dressings 1350 reteplase 418, 1338 reticulocytes 144 reticulocytosis 209 Retin-A 1149 retinal artery occlusion 817, 823, 825–6, 828 retinal degeneration 822–3 retinal detachment 817, 820, 823, 824, 827, 828, 828 retinal haemorrhage 823 retinal migraine 827 retinal vein thromboisis 823, 826 retinitis 243 retinitis pigmentosa 817, 822–3, 828, 1050 retinoblastinoma 820 retinoic acid 1143 retinoids 587, 1157, 1176, 1200 retinol 77 retinopathy 190, 817, 819 1491 retractile testis 1063 retrobulbar neuritis 827 retrograde ejaculation 1082 retropatellar fragment 712 retroperitoneal haematomas 681 retroperitoneal haemorrhage 707 retropharyngeal abscess 640 retrospective studies 108 Rett syndrome 896 reverse Colles fracture 1368 Revia 1220 Reye syndrome 97, 605–6, 849, 878 Rh negative mothers 1034 rhabdomyolysis 279 rhabdomyosarcoma 233 rhesus immunoprophylaxis 1034 rheumatic disease 329 rheumatic fever 337 arthropathy with 329, 330 as a cause of FUO 570 in children 849, 1397 ESR levels 137 hip pain due to 681 in Indigenous Australians 1397, 1401 knee pain due to 708 rheumatic heart disease 752 ‘rheumatism’ 680 rheumatoid arthritis 340–3 arm pain due to 663 autoantibodies 284 as an autoimmune disease 282 diagnosis of 329, 330, 340–1, 341, 349 ESR readings 137 explosive RA 337 fever due to 570 foot pain due to 727, 735, 743 in the hand 677 hip pain due to 681 incidence of 329 joints involved 340, 340 knee pain due to 708, 724 management of 341–3, 343, 348 neck pain due to 350, 639, 640, 643, 649–50 non-articular manifestations of 342 pain in 94, 282 signs of chronic rheumatoid arthritis 340–1 with skin ulcers 1164 typical joint distribution 340 X-ray of 335 rheumatological pain 282 rhinitis 439, 620–1, 621–2, 853, 1226, 1226–9, 1228–9 Rhinocort 1228 22/10/10 2:54:58 PM 1492 Index rhinophyma 624, 1145 rhinoplasty 625, 869 rhinorrhoea 626 rhinosinusitis 620, 622 rhythm method 934, 935, 941 Riamet 116, 117, 127 rib fractures 371, 404, 404, 421, 1359, 1359, 1374 ribavirin 615 riboflavin 77 RICE treatment 1342, 1372, 1385, 1387, 1388 rice water stools 1408 rickets 77, 1404 Rickettsiae australis 131 Rickettsiae sp 125, 272 Rickettsiae tsutsugamushi 130 Rid 115 rifampicin 262, 269, 443, 912, 937, 1341 Rift Valley fever 112, 126 rigors 564–5 riluzole 293 rimantadine 442 ring pessaries 816 ringworm 1146, 1398, 1399 Rinne test 452, 452 risendronate 748, 992 risk, defined 110 risk factors, for illness 45 risk-taking, in adolescence 920 risperidone 58, 480, 482 risus sardonicus 1410 Ritalin 768 ritonavir 247 rituximab 343 rivaroxaban 1338 rivastigmine 57–8 river blindness 134 rizatriptan 593 RLS 769–70, 770, 1410 RNA 136 Roaccutane 1144, 1200 rofecoxib 100 roller injuries, to legs 706, 1342 Roman breast plate 1410 Rome II diagnostic criteria, for IBS 472 rooster legs 1409 root canal infection 557 ropinirole 770 rosacea 147, 148, 1116, 1144, 1144–5 roseola infantum 272, 881, 884–5, 885, 1152, 1153 rosiglitazone 1292, 1293 Ross River fever 126, 140, 155, 251, 255–6, 272, 1153, 1401 Index.indd 1492 rosuvastatin 1286, 1287 Rotahaler 1247 rotator cuff tears 657, 658–9 rotator cuff tendonopathy 652, 653–5, 654–5, 657–9, 662, 1378 rotavirus 70, 71, 113, 256, 466, 1397 rotigotine 297, 298 Rotor syndrome 606 roundworms 125, 132, 133, 1400 Roux-en-Y bypass 835 roxithromycin for boils 1162 categorisation of drug risk 1039 for Donovanosis 1400 for gonorrhoea 1103 for impetigo 1399 for Mycoplasma pneumoniae 269 for PID 977 for pitted keratolysis 1150 for pneumonia 443, 444 for trachoma 1398 Royal Australian College of General Practitioners 2, 45, 49, 66, 104 Royal College of General Practitioners (UK) 64 Royal Free disease 795 RR 110 RRR 110 RTV 247 rubber catheter suction method 529, 530 rubella with arthralgia 333 audiological assessment 457 in children 882–3, 883 clinical features 882, 883 complications of 883 exclusion from school 881 immunisation against 69, 70, 71, 1013 incubation period 881 jaundice due to 611 lymph node infections due to 636 as a masquerade 251 in pregnancy 883, 1017, 1022, 1025 skin eruptions due to 1152, 1153 tests for 139, 140 rubella encephalopathy 895 rubeola 880 rubia 863 rule of nines 1120, 1120 rules of 52, 52 rum, for chilblains 1151 rumination 629 ‘runner’s anaemia’ 1377 runner’s knee 721, 1382, 1409 running nose 626 ruptured abdominal aortic aneurysm 308, 309, 310–11, 317, 318, 318–19, 328 ruptured ectopic pregnancy 308, 309– 10, 310, 966, 968, 969–71, 970 ruptured liver 308 ruptured ovarian cyst 308, 966, 968, 971, 972 ruptured ovarian follicle 966, 971, 971 ruptured papillary muscle 422 ruptured septum 422 ruptured spleen 308 Rynacom 1228 S SAβΑ 1242, 1243, 1245, 1250 sacroiliac joint dysfunction 679, 687–8, 688, 691, 697 sacroiliitis 330, 347, 348, 697 sacrum, fracture of 1359 SAD 184 SAD PERSONS Index 184 saddle nose 1410 safe sex 47, 249, 250, 932 safety in the home 849 SAH 306, 584, 585, 585, 590, 598, 598, 600, 799 Saint Vitus dance 1410 salbutamol for anaphylaxis 1312, 1328 as an antidote for potassium 911 for asthma 440, 915, 916, 1244, 1245, 1248, 1312, 1328 for bronchial spasm 917 for collapse 909 for COPD 1253, 1256 for the doctor’s bag 1325, 1327 LUTS due to 1076 palpitations due to 753 for proctalgia fugax 352 in sport 202, 203 Salia Orthana 781 salicylates adverse effects 193, 460, 494, 564, 607, 632, 803, 1156, 1157, 1200 for black tongue 779 in cough mixtures 447 effect of active charcoal on 910 effect on warfarin activity 1341 intolerance to 1225 as poison 909 sensitivity to 1249 toxicity to the ear 451 salicylic acid for acne 1143 22/10/10 2:54:58 PM Index for cracked hands 677 for dandruff 1205 as a keratolytic 1119 for prickly heat 1150 for psoriasis 1139, 1141 for seborrhoeic dermatitis 864, 1136, 1137, 1138 uses of 1118 for warts 739–41, 866, 1176 saline chlorhexidine 889 saline laxatives 430 salivary gland 555 sallow skin 1409 salmeterol 202, 203, 1244, 1245, 1253 salmon patch 861–2, 862, 1411 Salmonella sp diarrhoea due to 113, 125, 459, 461, 464, 466, 1397 fever in returned travellers 140 infection by 1399 recurrent Salmonella septicaemia 244 Salmonella enteritis 468, 470 thoracic back pain due to 360 salpingitis 308, 310, 310, 976 salt intake 1275 sample size 107 samples, in research 107 ‘sandbox’ vaginitis 1006 sandfly bites 1317 Sandrena 986 saphenous varix 1056 saquinavir 247 sarcoidosis arthropathy with 329, 331 association with pulmonary infiltration 516 cough caused by 435 diagnosis of 153, 154 erythema nodosum due to 1158 fever due to 570 hypercalcaemia due to 220 knee pain due to 709 as a pitfall in diagnosis 153, 153 pleural effusion due to 521 sarcoma 239, 361 Sarcoptes scabei 1100, 1107, 1124 SARS 255 sartorius, injuries to 1381, 1381 satellite lesions 1141 saturated fats 75 sausage digits 1410 sausage workers 523 saw palmetto 1078 SBE 329 scabies Index.indd 1493 in children 865 distribution of rash 1125 in Indigenous Australians 1397, 1398, 1399 lesions of 1115, 1115 on the penis 1116 pruritus due to 1107, 1122, 1124, 1124–5 skin eruptions due to 1153 topical antipruritics for 1109 treatment 865, 1107 when to refer 1108 scabs 1112 scalded skin syndrome 1410 scales 1112 scalp biopsy 1203 scalp disorders 1204–5 scalp lacerations, in children 1348 scalp psoriasis 1141 scaphoid fractures 1363, 1368, 1368, 1374 scapholunate dislocation 1363 scapholunate dissociation 1368–9 scapula, fractures of 1360, 1374 scapulocostal syndrome 369 scapulothoracic joint disorders 368–9 scarlet fever 778, 881, 885, 1399 scarring alopecia 1198, 1199 scars 1113 SCC see squamous cell carcinomas SCFE see slipped capital femoral epiphysis Scheuermann disease 359, 364, 366, 382, 850, 1391 Schistosoma sp 274 schistosomes 131 schistosomiasis 112–13, 125–6, 126, 131–2, 1402, 1404 schizoaffective disorder 481 schizoid personality disorder 489 schizophrenia 481–3 in adolescents 486, 920 in children 486 compared with dementia 480 constipation due to 426 in differential diagnosis of depression 178, 179 drug-resistant schizophrenia 483 feelings of unreality 580 genetic component 165, 165 paraphrenia as a form of 58 psychosis due to 481 violent and dangerous conduct 486 schizotypal personality disorder 489 school exclusion periods, for infectious diseases 881 1493 school sores 888–889 sciatica 224, 373, 391, 691, 697, 746 scleritis 539, 540, 543, 546 scleroderma 282–4, 283, 286–7, 286–7, 330, 330, 343, 349, 508, 1206 sclerosants 705 sclerosing haemangioma 1178 sclerosis 1113 scoliosis 68, 359, 363, 364, 365, 366–7, 367 scombrotoxin 462 Scop 123 scorpion bites 1316 ‘screamer’s nodules’ 601 screening, in preventive medicine 63, 66–9, 188 screening, of refugees 1406 scrotal lumps 1058–62, 1059–60 scrotal pain 1051–5, 1052–4 scrub typhus 126, 130–1 scurvy 72, 77, 157, 395, 696, 776 sea sickness 121, 122, 123 sea wasp 1316 seasonal affective disorder 184 seasonal allergic rhinoconjunctivitis 1227–9, 1227–9 sea-urchins 1316 sebaceous cysts 636, 1054, 1172, 1174, 1174 sebaceous hyperplasia 862, 863, 1174, 1180, 1184 Sebi Rinse 1205 Sebitar 1205 seborrhoeic dermatitis 1135–8 in adults 1136, 1137, 1137–8 areas affected 1116 in children 864, 865, 1136–7, 1136–7 contrasted with atopic dermatitis 1136 dandruff caused by 1204 groin rash caused by 1126 intertrigo caused by 1003 nappy rash as 1119, 1141 skin rash 147, 1114, 1115 treatment 1136, 1142 vulvar dermatitis caused by 1002 seborrhoeic keratoses 1172, 1177–8, 1178, 1184, 1188, 1188, 1194 seborrhoeic warts 1177 secondary amenorrhoea 964–5 secondary dyslipidaemia 1285 secondary dysmenorrhoea 974, 974 secondary haemostatic disorders 395 secondary hypertension 1267–8, 1268, 1281, 1283 secondary osteoporosis 990, 993 22/10/10 2:54:59 PM ... and preparing the slide Murtagh - General Practice (5e) Part 5.indd 931 • Ideally, people should have intercourse with only one partner 22 /10/10 2: 45:14 PM 9 32 Part Five Women's health -PXHSBEF -4*-... CMPPETUBJOFEOJQQMFEJTDIBSHF 92 QFBVE±PSBOHF FD[FNBPGOJQQMF 1BHFUEJTFBTF Figure 92. 1 Important ‘tell-tale’ symptoms of breast cancer Murtagh - General Practice (5e) Part 5.indd 949 22 /10/10 2: 45:17 PM 950 Part Five... is important clinically to realise that this transformation zone 926 Murtagh - General Practice (5e) Part 5.indd 926 22 /10/10 2: 45:13 PM Cervical cancer and Pap smears can extend with progressive

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  • Contents

  • Part 1 The basis of general practice

  • Part 2 Diagnostic perspective in general practice

  • Part 3 Problem solving in general practice

  • Part 4 Child and adolescent health

  • Part 5 Women's health

  • Part 6 Men's health

  • Part 7 Sexually related problems

  • Part 8 Problems of the skin

  • Part 9 Chronic disorders: continuing management

  • Part 10 Accident and emergency medicine

  • Part 11 Health of specifi c groups

  • Appendixes

  • Index

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