Emergency topics Arrests Adult resuscitation b p228 Obstetric resuscitation b p238 Neonatal resuscitation b p236 Pediatric resuscitation b p234 Trauma resuscitation b p232 Emergencies Abdominal pain b p288 Aggressive behavior b p364 Anaphylaxis b p470 Bradyarrhythmia b p256 Breathlessness b p270 Burns b p466 Chest pain b p240 Clotting abnormalities b p404 Coma b p338 Diabetic ke toacidosis (DKA) b p326 Disseminated intravascular coagulation (DIC) b p405 GI bleed b p298 Hepatic encephalopathy b p312 High INR b p404 Hyperglycaemia b p324 Hyperkalaemia b p385 H yperosmolar non-ketotic state (HONK) b p326 Hypertension b p262 Hypoglycaemia b p322 Hypoka laemia b p385 Hypotension b p472 Hypoxia b p270 Limb pain b p444 Liver failure b p312 Overd ose b p492 Pediatric seizure b p345 Psychosis b p365 Rash b p410 Red eye b p426 Reduced GCS b p338 Renal failure/kidney injury b p372 Shock b p476 Shortness of breath b p270 Stridor b p284 Stroke b p350 Tachyarrhythmia b p248 Seizures b p344 OHFP.indb B OHFP.indb B 30/05/2014 16:17 30/05/2014 16:17 Normal values Despite national eff orts to standardize laboratory testing and reporting,1 e xact ranges vary between hospitals, these fi gures serve as a guide. Hematology see b p566 4 \200\22311 x 109/l 2.0 \200\2237.5 x 109/l (40 \200\22375%) 1.3 \200\2233.5 x 109/l (20 \200\22345%) 0.04 \200\2230.44 x 109/l (1 \200\2236%) 197 \200\223866pg/ml 2 \200\22320micr ograms/l Hb \200\223men Hb \200\223women 130 \200\223180g/L 115 \200\223160g/L WBC \200 N \230 L \230 MCV 76 \200\22396fl E \230 150 \200\223400 x 109/l Plts Ferritin TIBC Clotting see b p567 12 \200\223200micrograms/l B12 42 \200\22380 mol/l Folate INR PT Fibrinogen 0.8 \200\2231.2 11 \200\22316s 1.5 \200\2234.0g/l APTTr APTT D \200\223dimer 0.8 \200\2231.2 35 \200\22345s <0.3mg/ml (<300ng/ml) U+Es see b p568 Na+ K+ Urea Creatinine Osmolality LFTs see b p569 Ca2+ (adjusted)2.2 \200\2232.6mmol/l 3 \200\223 0.8 \200\2231.5mmol/l PO4 Mg2+ 0.7 \200\223 1.0mmol/l 22 \200\22329mmol/l HCO3 95 \200\223108mmol/l 133 \200\223146mmol/l 3.5 \200\2235.3mmol/l 2.5 \200\2237.8mmol/l 70 \200\223150 mol/l 275 \200\223295mOsmol/kg Cl \200\223 \200\223 ALP ALT GGT 30 \200\223130units/l 3 \200\22335units/l 10 \200\22355units/l Bilirubin 3 \200\22321micrograms/l 35 \200\22350g/l Albumin Total protein 60 \200\22380g/l Other Amylase Fasting glucose Immunoglobulins 24 \200\22337g/l Cholesterol Triglycerides Blood ga sses see b p584 0 \200\223120units/l 3.5 \200\2236.0mmol/l CRP ESR CK LDH PSA <5mg/l <20mm/h 25 \200\223195units/l 70 \200\223250units/l 0 \200\2234ng/ml <6mmol/l 0.5 \200\2231.9mmol/l 10.6 \200\22313.3kPa 4.7 \200\2236.0kPa pH Base excess 7.35 \200\2237.45 2mmol/l PaO2 PaCO2 1 See (cid:27)www.pathologyharmony.co.uk _OHFP.indb C _OHFP.indb C 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank OXFORD MEDICAL PUBLICATIONS Oxford Handbook for the Foundation Program _OHFP.indb i _OHFP.indb i 30/05/2014 16:17 30/05/2014 16:17 Published and upcoming Oxford Handbooks Oxford Handbook for the Foundation Program 4e Oxfor d Handbook of Acute Medicine 3e Oxford Handbook of Anesthesia 3e Oxford Handbook of Applied Dental Sciences Oxford Handbook of 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Handbook of Pain Management Oxford Handbook of Palliative Care 2e Oxford Handbook of Pra ctical Drug Therapy 2e Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 3 e Oxford Handbook of Public Health Practice 3e Oxford Handbook of Reproductive Medicine & F amily Planning 2e Oxford Handbook of Respiratory Medicine 3e Oxford Handbook of Rheumatolog y 3e Oxford Handbook of Sport and Exercise Medicine 2e Handbook of Surgical Consent Oxford Handbook of Tropical Medicine 4e Oxford Handbook of Urology 3e OHFP.indb ii OHFP.indb ii 30/05/2014 16:17 30/05/2014 16:17 Oxford Handbook for the Foundation Program Fourth edition Tim Raine Clinical Fellow, Wellcome Trust Clinical Lecturer, Gastroenterology, University o f Cambridge, Honorary Registrar, Addenbrooke s Hospital, Cambridge James Dawson Consultant Anesthetist, Nottingham Stephan Sanders Assistant Specialist at University of California, San Francisco Simon Eccles Consultant in Emergency Medicine, St Thomas Hospital, London 1 _OHFP.indb iii _OHFP.indb iii 30/05/2014 16:17 30/05/2014 16:17 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Oxford University Press 2014 The moral rights of the authors have been asserted First edition published 2005 Second edition published 2008 Third edition published 2011 Fou rth edition published 2014 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license or under terms ag reed with the appropriate reprographics rights organization. Enquiries concerning reproduct ion outside the scope of the above should be sent to the Rights Department, Oxford Universi ty Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, Ne w York, NY 10016, United States of America British Library Cataloging in Publication Data Data available Library of Congress Control Number: 2014931114 ISBN 978 \200\2230 \200\22319 \200\223968381 \200\2239 Typeset by GreenGate Publishing Services, Tonbridge, UK Printed in Italy on acid-free paper by L.E.G.O. S.p.A. \200\224Lavis TN Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and c linical procedures with the most up-to-date published product information and data sheets p rovided by the manufacturers and the most recent codes of conduct and safety regulations. T he authors and the publishers do not accept responsibility or legal liability for any error s in the text or for the misuse or misapplication of material in this work. Except where ot herwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding. Links to third party websites are provided by Oxford in good faith and for information only . Oxford disclaims any responsibility for the materials contained in any third party websit e referenced in this work. HFP Prelims.indd iv OHFP Prelims.indd iv 30/07/2014 16:03 30/07/2014 16:03 v Contents Detailed contents Preface Acknowledgements Symbols and abbreviations Introduction 10 tips o n being a safe junior doctor 10 tips on being a happy doctor ix xvii xviii xix xxxiv xxxvi xxxvii 1 Being a doctor 2 Life on the wards 3 History and examination 4 Prescribing 5 Pharmacopeia 6 Resuscitation 7 Cardiovascular 8 Respiratory 9 Gastroenterology 1 65 123 167 181 223 239 269 287 321 337 371 391 409 433 509 565 599 10 Endocrinology 11 Neurology and psychiatry 12 Fluids and renal 13 Hematology 14 Skin and eyes 15 Emergency department 16 Procedures 17 Interpreting results 18 Appendices Index Common adult drug doses 615 646 _OHFP.indb v _OHFP.indb v 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank To every doctor who \200\231s ever stood there thinking: \200\230What on earth do I do now ? \200\231 _OHFP.indb vii _OHFP.indb vii 30/05/2014 16:17 30/05/2014 16:17 This page intentionally left blank ix Detailed contents Preface xvii Acknowledgements xviii Symbols and abbreviations xix Introduction xxxiv 10 tips on being a safe junior doctor xxxvi 10 tips on being a happy doctor xxxvii 1 Being a doctor 1 The Foundation Program 1 The Foundation Program 2 Applying to the Foundation Program 4 The FP curriculum and assessment 8 Starting as an F1 11 Before you start 11 Your fi rst day 12 Occupational health 13 What to carry 14 How to be an F1 15 Getting organized 17 Being effi cient 18 Communication 19 Patient-centered care 19 Communication and conduct 20 Breaking ba d news 22 Cross-cultural communication 23 Outside agencies 24 Quality and ethics 25 Clinica l governance/quality 25 Medical ethics 26 Patient confi dentiality 27 Capacity 28 Consent 2 9 When things go wrong 30 Medical errors 30 Complaints 31 Incident reporting 32 Colleagues and problems 33 Hating your job 34 Relaxation 35 Causes of stress 35 Boring but important s tuff 36 Pay and contracts 36 _OHFP.indb ix _OHFP.indb ix 30/05/2014 16:17 30/05/2014 16:17 x DETAILED CONTENTS Making more money 38 Money and debt 40 NHS entitlements 42 Your career 43 Specialty trainin g 43 Specialty training applications 44 Career structure 45 Specialty training options 46 S pecialty training competition 48 Choosing a job 50 Specialties in medicine 51 Your curricul um vitae 52 Post-Foundation Program CV 54 Interviews 56 Membership exams 57 Continuing your education 58 Audit 59 Presentations and teaching 60 Teaching medical students 63 Research and academia 64 2 Life on the wards 65 The medical team 66 The multidisciplinary team 68 Daily ward duties 69 Ward rounds 70 Being on-call 72 Night shifts 73 Writing in the notes 74 Common symbols i n the notes 76 Anatomical terms and planes 77 Forms 78 Discharge summaries (TTOs/TTAs) 78 F itness to work notes 80 Referrals 81 Referral letters 82 Investigation requests 84 Radiolog y 85 Common ward dilemmas 86 Pain 86 Thinking about death 90 Palliative care 91 The dying p atient 92 Death 94 Nutrition 102 Nutritional requirements 103 Diffi cult patients 104 Aggre ssion and violence 105 Needle-stick injuries 106 Surgery 107 OHFP.indb x OHFP.indb x 30/05/2014 16:17 30/05/2014 16:17 xi DETAILED CONTENTS Pre-op assessment 107 Bowel preparation 109 Surgical terminology 110 Preparing in-patients for surgery 111 Booking theater lists 112 Surgical instruments 113 The operating theater 11 4 Post-op care 116 Post-op problems 117 Wound management 118 Common elective operations 119 Stomas 121 3 History and examination 123 Basic history 124 Basic examination 126 Recording your clerking 127 Medicine 128 Cardiovasc ular 128 Respiratory 130 Gastrointestinal 131 Neurological 132 Endocrine 137 Skin 138 Oncol ogical/hematological 140 Surgery 141 Breast 141 Eyes 142 Head and neck 144 Musculoskeletal 146 Urological 154 Other specialties 156 Female reproductive system 156 Obstetric 158 Psych iatric 160 Neonatal examination 163 Pediatric 164 4 Prescribing 167 Prescribing \200\223 general considerations 168 How to prescribe \200\223 best practice 1 69 Drug interactions 171 Reporting adverse drug reactions 171 Special considerations 172 Co ntrolled drugs 173 Enzyme inducers and inhibitors 174 Endocarditis prophylaxis 175 Night se dation 176 Steroid therapy 177 Topical corticosteroids 178 Empirical antibiotic treatment 1 79 Clostridium diffi cile (C. diff ) 180 _OHFP.indb xi _OHFP.indb xi 30/05/2014 16:17 30/05/2014 16:17 xii DETAILED CONTENTS 5 Pharmacopeia 181 Pharmacopeia 182 6 Resuscitation 223 Early warning scores 224 Peri-arrest 226 In-hospital resuscitation 227 Advanced Life Suppor t (ALS) 228 Arrest equipment and tests 230 Advanced Trauma Life Support (ATLS) 232 Pediatri c Basic Life Support 234 Newborn Life Support (NLS) 236 Obstetric arrest 238 7 Cardiovascular 239 Chest pain emergency 240 Chest pain 241 Tachyarrhythmia emergency 248 Tachyarrhythmias 250 Bradyarrhythmia emergency 256 Bradyarrhythmias 258 Hypertension emergency 262 Hypertension 263 Heart failure 267 8 Respiratory 269 Breathlessness and low sats emergency 270 Breathlessness and low sats 271 Stridor in a cons cious adult patient 284 Cough 285 9 Gastroenterology 287 Abdominal pain emergency 288 Abdominal pain 289 GI bleeding emergency 298 Acute upper GI bl eeds 299 Acute lower GI bleeds 301 Nausea and vomiting 304 Diarrhea 306 Constipation 310 Li ver failure emergency 312 Liver failure 313 Jaundice 318 10 Endocrinology 321 Hypoglycaemia emergency 322 Hypoglycaemia 323 Hyperglycaemia emergency 324 Hyperglycaemia 3 25 Sliding scales 327 Diabetes mellitus 328 OHFP.indb xii OHFP.indb xii 30/05/2014 16:17 30/05/2014 16:17 xiii DETAILED CONTENTS Pituitary axis 331 Adrenal disease 332 Thyroid disease 334 11 Neurology and psychiatry 337 Coma and reduced GCS emergency 338 Coma and reduced GCS 340 Acute confusion 341 Dementia 34 2 Adult seizures emergency 344 Pediatric seizures emergency 345 Seizures 346 Neurodegenerat ive disorders 349 Stroke/CVA/TIA emergency 350 Stroke 351 Focal neurology 353 Back pain 356 Headache 358 Dizziness 362 Aggressive behavior emergency 364 Mood disturbance/psychosis 36 5 12 Fluids and renal 371 Acute kidney injury 372 Chronic renal failure 373 Haematuria 374 Pr oteinuria 375 Glomerular disease 376 Urological disorders 377 Low urine output 378 IV fl ui ds 380 Potassium emergencies 384 Electrolyte imbalance 385 13 Hematology 391 Anemia 392 Transfusion of blood products 398 Clotting emergencies 404 Bleeding 405 Anticoag ulation 406 14 Skin and eyes 409 Rash emergency 410 Rash 411 Bacterial infections causing a rash 412 Vi ral infections causing a rash 414 Fungal infections causing a rash 416 Infestations causing a rash 416 Chronic infl ammatory rashes 417 Other causes of rash 418 Skin lumps 420 _OHFP.indb xiii _OHFP.indb xiii 30/05/2014 16:17 30/05/2014 16:17 xiv DETAILED CONTENTS Skin cancers 422 Breast lumps 423 Leg ulcers 424 Acute red eye emergency 426 Sudden visual loss 429 Gradual visual loss 430 Other visual disturbances 431 15 Emergency department 433 Trauma 434 Head injury 438 Neck injury 440 Falls and collapse 442 Acutely painful limb emer gency 444 Acute limb pain 445 Chronic limb pain 448 Limb swelling 449 Joint pain 452 Neck l umps 458 ENT 460 Groin lumps 462 Burns emergency 466 Burns 468 Anaphylaxis in adults 470 Hy potension emergency 472 Hypotension 473 Shock 476 Pyrexia 482 Overdose emergency 492 Overdo se and deliberate self-harm 493 Vaginal bleeding 496 Gynecological causes of pain 500 Contr aception 501 Early pregnancy (1st trimester) 502 Later pregnancy (2nd/3rd trimester) 504 De livery 506 After delivery (post-partum) 507 16 Procedures 509 Practical procedures 510 Laboratories 511 Achievement of Core Foundation Skills 512 Blood a nd injections 514 Taking blood (venepuncture) 514 Femoral stab 516 Blood tubes 517 IV cannu lation 518 Taking blood in children 520 Arterial blood gas (ABG) 522 SC/IM injections 524 I V injections 526 OHFP.indb xiv OHFP.indb xiv 30/05/2014 16:17 30/05/2014 16:17 xv DETAILED CONTENTS Cardiology 528 ECGs and cardiac monitors 528 Exercise tolerance test 530 Chemical cardiover sion (adenosine) 531 Cardioversion and defi brillation 532 Central lines 534 Thrombolysis 5 36 Respiratory 538 Pleural tap 538 Chest drain (Seldinger method) 540 Endotracheal intubati on (adult) 542 Laryngeal mask airway (LMA) 544 Urology 546 Urethral catheterisation 546 Rep lacing a suprapubic catheter 548 Gastroenterology 548 Replacing a PEG feeding tube 548 Naso gastric (NG) tubes 549 Ascitic tap (abdominal paracentesis) 550 Neurology 552 Lumbar punctu re (LP) 552 Others 554 Normal vaginal delivery 554 Joint aspiration and injection 556 Local anesthetic (LA) 558 Suturing 560 Reduction of fractures and dislocations 562 17 Interpreting results 565 Blood tests 566 Full blood count (FBC) 566 Clotting 567 Cardiac markers 567 Infl ammatory r esponse 567 Urea and electrolytes (U+E) 568 Liver function tests (LFT) and amylase 569 Calc ium and phosphate 570 Endocrine tests 571 Cardiology 572 Electrocardiogram (ECG) 572 Respir atory 582 Chest X-ray (CXR) 582 Arterial blood gasses (ABGs) 584 Respiratory function tests 586 Gastrointestinal 588 Abdomen X-ray (AXR) 588 Urine tests 590 Neurological 592 CSF 592 Musculoskeletal 593 Autoantibodies and associated diseases 593 _OHFP.indb xv _OHFP.indb xv 30/05/2014 16:17 30/05/2014 16:17 xvi DETAILED CONTENTS Cervical spine radiographs 594 Skeletal radiographs 596 Appendices 599 Useful numbers and websites 600 Height conversion 602 Weight conversion 603 Body mass index (BMI) 604 Driving regulations 605 Interesting cases 606 Telephone numbers 1 608 Your fi rm \200\231s timetable 1 609 Telephone numbers 2 610 Your fi rm \200\231s timetable 2 611 Tel ephone numbers 3 612 Your fi rm \200\231s timetable 3 613 Index 615 OHFP.indb xvi OHFP.indb xvi 30/05/2014 16:17 30/05/2014 16:17 xvii Preface Since this book was fi rst written the training of doctors has altered dramatically. The Fo undation Program, Specialty Training and the rise and fall of MTAS have all aff ected the r ole, careers, and morale of junior doctors. This new edition emerges into a landscape of me dical training, which is set to be restructured yet again, creating yet more uncertainty fo r those starting out. And yet, through all of this turbulence, the fact remains that the le ap from being a fi nal year medical student to a junior doctor remains immense. No matter w hat elements may be introduced to fi nal year curriculums, or to Foundation Program inducti ons, the psy- chological and professional gear-shift is a change that many feel unpre- pare d for. Overnight the new doctor inherits huge responsibility, an incessantly active bleep, and an infl exible working rota. They also become a valued member of the medical team, someone who patients look to for help, someone with the capacity to off er the care that patients and their rela- tives need, and a new doctor with the potential and fl exibility to learn and s hape a career in just about any area of medicine they wish to pursue. While nothing can make this transition easy we hope that this book can act as a guide. Base d on feedback from foundation doctors we feel that this fourth edition builds on the streng ths of previous editions whilst improving on their weaknesses. The clinical chapters have b een com- pletely updated to refl ect all the latest developments, the prescribing pages giv en an overhaul to keep them current, and the front of the book reworked to refl ect the cha llenges and environment facing the foundation doctor for 2014 and beyond. Please continue to help us to improve this book by sending comments and suggestions to: ohf p.uk@oup.com. _OHFP.indb xvii _OHFP.indb xvii 30/05/2014 16:17 30/05/2014 16:17 xviii Acknowledgements The authors would like to say a huge \200\230thank you \200\231 to many people for their w isdom, knowledge and support: Tim thanks Dr Roger Lewis, who taught him much he once knew, and Prof. Arthur Kaser who has indulged his eff orts to try to retain it. And, as always, Lucy, the constant, and now Bea trice, the ever changing. James would like to thank, in no particular order: Simon Denning, Tobias Long, Will Tomlins on, John Gell, and my beautiful fellow authors. Stephan thanks Imogen Hart and Xanthe Sanders for making life won- derful. Simon would like to dedicate this to Amy and Arthur. To everyone who helped with the fi rst three editions: our job was so much easier for all y our hard work and we \200\231ve not forgotten you. In par- ticular, our ongoing thanks to N at Hurley, Shreelata Datta and Katherine McGinn. We would also like to thank all the staff at Oxford University Press for their help and for making our writing into a book. In particular, Liz Reeve and Hannah Lloyd for their terrif i c eff orts and support in making the OHFP4e such a pleasure to work on, along with the re st of the OUP team: \200 Michael Hawkes \200 Richard Martin \200 Mark Knowles \200 Kate Wilson \200 Catherine Barnes \200 Kelly Hewinson \200 Fiona Chippendale \200 A bigail Stanley \200 Anna Winstanley \200 Eloise Moir-Ford \200 Tracey Mills \200 Ja mie Hartmann-Boyce \200 David Gardner OHFP.indb xviii OHFP.indb xviii 30/05/2014 16:17 30/05/2014 16:17 xix Symbols and abbreviations b 3 (cid:27) i d l 9 > < 5 4 A+E AAA ABG ABPI ABx ACCS ACEi ACF ACS ACTH ADH ADL AED AF AFB AFP (AFP) AIDS AKI ALL ALP ALS ALT AML Cross-reference Don \200\231t dawdle Website Increased Decreased Leading to Plus/minus Grea ter than Less than Female Male Accident and emergency (now the emergency department) Abdomi nal aortic aneurysm Arterial blood gas Ankle brachial pressure index Antibiotics Acute care common stem Angiotensin-converting enzyme inhibitor Academic Clinical Fellowship Acute cor onary syndrome Adrenocorticotrophic hormone Antidiuretic hormone Activities of daily living Automated external defi brillator Atrial fi brillation Acid-fast bacilli A-fetoprotein Acq uired immunodefi ciency syndrome Acute kidney injury Acute lymphoblastic leukemia Alkaline phosphatase Advanced Life Support Alanine aminotransferase Acute myeloid leukemia _OHFP.indb xix _OHFP.indb xix 30/05/2014 16:17 30/05/2014 16:17 xx SYMBOLS AND ABBREVIATIONS AMPLE Allergies; Medications; Past medical history; Last meal; Events leading to presentation Ant inuclear antibody Antineutrophil cytoplasmic antibody Anteroposterior Antepartum hemorrhage Advanced Pediatric Life Support Activated partial thromboplastin time Activated partial th romboplastin time ratio Aortic regurgitation Angiotensin receptor blocker Acute respiratory distress syndrome Acute renal failure Aortic stenosis American Society of Anesthesiologist s As soon as possible Atrial septal defect Aspartate transaminase Advanced Trauma Life Supp ort Acute tubular necrosis Atrio-ventricular Aortic valve replacement Abdominal X-ray Bariu m Bronchoalveolar lavage Bacille Calmette \200\223Gu rin (TB vaccination) Bis die (twice d aily) Base excess Big friendly giant B-human chorionic gonadotrophin Benign intracranial hy pertension Biphasic positive airways pressure Below knee amputation Basic Life Support Boeh ringer Mannhein meter (capillary blood glucose) or Bone marrow British Medical Association Body mass index British National Formulary Blood pressure Benign prostatic hypertrophy ANA ANCA AP APH APLS APTT APTTr AR ARB ARDS ARF AS ASA ASAP ASD AST ATLS ATN AV AVR AXR Ba BAL BCG bd BE BFG B-hCG BIH BiPAP BKA BLS BM BMA BMI BNF BP BPH OHFP.indb xx OHFP.indb xx 30/05/2014 16:17 30/05/2014 16:17 xxi SYMBOLS AND ABBREVIATIONS BX C+S Ca2+ Ca CABG CAH CAPD CBD CBT CCF CCST CCT CCU CD CDT CEA CEPOD CEX cf CHD CI CJD CK CK-MB CLL CLO CML CMV CNS CO CO2 COAD COC COPD CPAP CPK CPN CPR CRB CRF Biopsy Culture and sensitivity Calcium Carcinoma Coronary artery bypass graft Congenital ad renal hyperplasia Continuous ambulatory peritoneal dialysis Case-based discussion/Common bi le duct Cognitive-behavioral therapy Congestive cardiac failure Certifi cate of Completion of Specialist Training Certifi cate of Completion of Training Coronary care unit Controlled drugs Clostridium diffi cile toxin Carcinoembryonic antigen Confi dential Enquiry into Per ioperative Deaths Clinical Evaluation Exercise Compared with Coronary heart disease Contrai ndication Creutzfeldt \200\223Jakob disease Creatine kinase Heart-specifi c creatine kinase (MB-isoenzyme) Chronic lymphocytic leukemia Campylobacter-like organism Chronic myeloid le ukemia Cytomegalovirus Central nervous system Carbon monoxide Carbon dioxide Chronic obstru ctive airway disease Combined oral contraceptive Chronic obstructive pulmonary disease Cont inuous positive airway pressure Creatine phosphokinase Community psychiatric nurse Cardiopu lmonary resuscitation Criminal Records Bureau Chronic renal failure _OHFP.indb xxi _OHFP.indb xxi 30/05/2014 16:17 30/05/2014 16:17 xxii SYMBOLS AND ABBREVIATIONS CRP CRT CSF CSU CT CTG CTPA CVA CVP CVS CXR d D+C D+V DEXA DH DH DHS DI DIB DIC DIPJ DKA DM DMARD DNA DNR DoB DOPS DRE DSM-5 C-reactive protein Capillary-refi ll time Cerebrospinal fl uid Catheter specimen of urine C omputer tomography/Core training Cardiotocograph CT pulmonary angiogram Cerebrovascular acc ident Central venous pressure Cardiovascular system Chest X-ray Day(s) Dilatation and curet tage Diarrhea and vomiting Dual-energy X-ray absorptiometry (DXA) Drug history Department o f Health Dynamic hip screw Diabetes insipidus Diffi culty in breathing Disseminated intrava scular coagulation Distal interphalangeal joint Diabetic ketoacidosis Diabetes mellitus Dis ease modifying anti-rheumatic drug Deoxyribonucleic acid/Did not attend Do not resuscitate Date of birth Direct Observation of Procedural Skills Digital rectal examination The Diagno stic and Statistical Manual of Mental Disorders 5th revision Diphtheria, tetanus and pertus sis Duodenal ulcer Driver and Vehicle Licensing Agency Deep vein thrombosis Discuss(ed) wit h Diagnosis Dual-energy X-Ray absorptiometry (DEXA) Evidence-based medicine Epstein \200 \223Barr virus DTP DU DVLA DVT d/w Dx DXA EBM EBV OHFP.indb xxii OHFP.indb xxii 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxiii ECG ECHO ECV ED EDD EEG EMD Electrocardiogram Echocardiogram External cephalic version Emergency department (formerly A +E) Expected due date (pregnancy) Electroencephalogram Electromechanical dissociation or pu lseless electrical activity (PEA) Electromyogram Emergency nurse practitioner Ear, nose, an d throat Eosinophil Erythropoietin Endoscopic retrograde cholangiopancreatography Evacuatio n of retained products of conception Ejection systolic murmur Erythrocyte sedimentation rat e End-stage renal failure Endotracheal Ethanol (alcohol) Endotracheal tube Examination unde r anesthetic Extra-ventricular drain European Working Time Directive Foundation year one/tw o Focused assessment with sonography in trauma Foreign body Full blood count Fibrin degrada tion product Forced expiratory volume in one second Fresh frozen plasma Family history/Feta l heart Fraction of inspired oxygen Fine needle aspiration Fecal occult blood Fall on outst retched hand Functional residual capacity Follicle stimulating hormone Fixed-term specialty training appointment Forced vital capacity Group and save EMG ENP ENT E \230 EPO ERCP ERPC ESM ESR ESRF ET EtOH ETT EUA EVD EWTD F1/F2 FAST FB FBC FD P FEV1 FFP FH FiO2 FNA FOB FOOSH FRC FSH FTSTA FVC G+S _OHFP.indb xxiii _OHFP.indb xxiii 30/05/2014 16:17 30/05/2014 16:17 xxiv SYMBOLS AND ABBREVIATIONS G6PD Glucose-6-phosphate dehydrogenase GA General anesthetic GB Gall bladder GBS Group B St reptococcus/Guillain \200\223Barr syndrome GCS Glasgow Coma Scale Glomerular fi ltration rate GFR GGT (GGT) G-glutamyl transpeptidase GH GI GMC GN GORD GP GTN GTT GU(M) h H@N HAART HAI HAV Hb HbA1c HBV HCA HCC hCG HCT HCV HDL HDU HELLP Growth hormone/Gynae history Gastrointestinal General Medical Council Glomerulonephritis Ga stro-oesophageal refl ux disease General practitioner Glyceryl trinitrate Glucose tolerance test Genitourinary (medicine) Hour(s) Hospital at night Highly active antiretroviral thera py Hospital acquired infection Hepatitis A virus Hemoglobin Glycosylated hemoglobin Hepatit is B virus Healthcare assistant Hepatocellular carcinoma Human chorionic gonadotrophin Haem atocrit Hepatitis C virus High-density lipoprotein High dependency unit Haemolysis, elevate d liver enzymes, low platelets (syndrome) Human immunodefi ciency virus Human leucocyte ant igen 4-hydroxy-3-methoxymandelic acid (phaeochromocytoma) Hypertrophic obstructive cardiomy opathy Hyperosmolar non-ketotic state Health Protection Agency Heart rate Human resources HIV HLA HMMA HOCM HONK HPA HR HR OHFP.indb xxiv OHFP.indb xxiv 30/05/2014 16:17 30/05/2014 16:17 xxv SYMBOLS AND ABBREVIATIONS HRT HSP HSV HTN HUS HVS I+D IBD IBS ICD-10 ICP ICU ID ID IDDM IE IFG Ig IGT IHD ILS IM Imp IN INH INR ITP ITU iu IUCD IUP IV IVDU IVI IVP IVU Ix JACCOL Hormone replacement therapy Henoch \200\223Sch nlein purpura Herpes simplex virus Hyperten sion Haemolytic uraemic syndrome High vaginal swab Incision and drainage Infl ammatory bowe l disease Irritable bowel syndrome International Classifi cation of Diseases 10th revision Intracranial pressure Intensive care unit Identifi cation Infectious diseases Insulin-depen dent diabetes mellitus (outdated term) Infective endocarditis Impaired fasting glucose Immu noglobulin Impaired glucose tolerance Ischaemic heart disease Immediate Life Support Intram uscular Impression (clinical) Intranasal By inhalation International normalized ratio Idiop athic thrombocytopenic purpura Intensive care unit International unit Intrauterine contrace ptive device Intrauterine pregnancy Intravenous Intravenous drug user Intravenous infusion Intravenous pyelogram Intravenous urogram Investigation(s) Jaundice, anemia, clubbing, cyan osis, oedema, lymphadenopathy Junior Doctors \200\231 Committee of BMA Jugular venous press ure JDC JVP _OHFP.indb xxv _OHFP.indb xxv 30/05/2014 16:17 30/05/2014 16:17 xxvi SYMBOLS AND ABBREVIATIONS K-nail kPa KUB K-wire l LA LACS LAD LBBB LDH LDL LFT LH LHRH LIF LMA LMN LMP LMWH LN LOC L \230 LP LSCS LTOT LUQ LVF LVH MAOI mane MAP M,C+S MCPJ MCV MDDUS MDR MDU ME MEWS mg MI K ntscher nail Kilopascal Kidneys, ureter, bladder (X-ray) Kirschner wire Liter(s) Local a nesthetic Lacunar circulation stroke Left axis deviation/Left anterior descending Left bund le branch block Lactate dehydrogenase Low-density lipoprotein Liver function test Luteinisi ng hormone Luteinising hormone releasing hormone Left iliac fossa Laryngeal mask airway Low er motor neuron Last menstrual period Low-molecular-weight heparin Lymph node Loss of consc iousness Lymphocyte Lumbar puncture Lower segment Cesarean section Long-term oxygen therapy Left upper quadrant Left ventricular failure Left ventricular hypertrophy Monoamine oxidas e inhibitor In the morning Mean arterial pressure Microscopy, culture, and sensitivity Meta carpal phalangeal joint Mean cell volume Medical and Dental Defense Union of Scotland Multi -drug resistant Medical Defense Union Myalgic encephalitis Modifi ed Early Warning Score Mi lligram(s) Myocardial infarction OHFP.indb xxvi OHFP.indb xxvi 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxvii min ml MMC mmH2O mmHg MMR MMSE MND MPS MR MRCP MRI MRSA MS MSF MSSA MST MSU MTPJ mth MVR N+ V NAD NAI NBM NEB NG NHS NICE NICU NIDDM NJ NNU N \230 nocte NPA NSAID NSTEMI NTN NVD NYHA Minute(s) Milliliter(s) Modernizing Medical Careers Millimeters of water Millimeters of mer cury Measles, mumps, and rubella Mini-mental State Examination Motor neuron disease Medical Protection Society Mitral regurgitation/modifi ed release Magnetic resonance cholangiopanc reatography Magnetic resonance imaging Meticillin-resistant Staphylococcus aureus Multiple sclerosis/Mitral stenosis Multisource feedback Meticillin-sensitive Staphylococcus aureus M orphine sulfate Mid-stream urine Metatarsal phalangeal joint Month(s) Mitral valve replacem ent Nausea and vomiting Nothing abnormal detected Non-accidental injury Nil by mouth By neb uliser Nasogastric National Health Service National Institute for Health and Care Excellenc e Neonatal intensive care unit Non-insulin dependent diabetes mellitus (outdated term) Naso jejunal Neonatal unit Neutrophil At night Nasopharyngeal aspirate Non-steroidal anti-infl a mmatory drug Non-ST-elevation myocardial infarction National training number Normal vaginal delivery New York Heart Association _OHFP.indb xxvii _OHFP.indb xxvii 30/05/2014 16:17 30/05/2014 16:17 xxviii SYMBOLS AND ABBREVIATIONS OA Obs OCD OCP od OD OGD OHA OHEM OHAM OHCC OHCLI OHCM OHCS OHFP OHGP OHOG om on ORIF OSCE OT P PA PaCO2 PACS Osteoarthritis Observations Obsessive-compulsive disorder Oral contraceptive pill/Ova, cyst s and parasites Omni die (once daily) Overdose Oesophagogastroduodenoscopy Oxford Handbook of Anesthesia Oxford Handbook of Emergency Medicine Oxford Handbook of Acute Medicine Oxfor d Handbook of Critical Care Oxford Handbook of Clinical and Laboratory Investigation Oxford Handbook of Clinical Medicine Oxford Handbook of Clinical Specialties Oxford Handbook for the Foundation Program Oxford Handbook of General Practice Oxford Handbook of Obstetrics an d Gynecology Omni mane (in the morning) Omni nocte (at night) Open reduction and internal f i xation Objective structured clinical examination Occupational therapy Pulse Posteroanteri or Partial pressure of arterial carbon dioxide Partial anterior circulation stroke/Picture archiving and communication systems Peripheral arterial disease Polyarteritis nodosa Partia l pressure of arterial oxygen Peer Assessment Tool Primary biliary cirrhosis Patient-contro lled analgesia Partial pressure of carbon dioxide Polycystic ovary syndrome Polymerase chai n reaction Primary care trust Packed cell volume Patent ductus arteriosus/Personal digital assistant Pulmonary embolism Pulseless electrical activity PAD PAN PaO2 PAT PBC PCA pCO2 PCOS PCR PCT PCV PDA PE PEA OHFP.indb xxviii OHFP.indb xxviii 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxix PEEP PEFR PERLA PET PICU PID PIP PIPJ PMETB PMH PMT PND PNS PO pO2 PoC POCS PONV POP PPH PP I PR PRHO Positive end expiratory pressure Peak expiratory fl ow rate Pupils equal and reactive to li ght and accommodation Positron emission tomography Pediatric intensive care unit Pelvic inf l ammatory disease Peak inspiratory pressure Proximal interphalangeal joint Postgraduate Me dical Education and Training Board Past medical history Pre-menstrual tension Paroxysmal no cturnal dyspnoea Peripheral nervous system Per os (by mouth) Partial pressure of oxygen Pro ducts of conception Posterior circulation stroke Post-operative nausea and vomiting Plaster of Paris/Progesterone only pill Postpartum hemorrhage Proton pump inhibitor Per rectum Pre -registration house offi cer (old training system but still widely used) Pro re nata (as re quired) Premature rupture of membranes (pregnancy) Polycythaemia rubra vera Prostate specif i c antigen Past surgical history Prothrombin time Parathyroid hormone Passed urine/Peptic ulcer Peptic ulcer disease Pyrexia of unknown origin Plasma viscosity/Per vagina Peripheral vascular disease Fourth die sumendus (four times daily) Rheumatoid arthritis Radioallergos orbant test Right bundle branch block Red blood cell PRN PROM PRV PSA PSH PT PTH PU PUD PUO PV PVD qds RA RAST RBBB RBC _OHFP.indb xxix _OHFP.indb xxix 30/05/2014 16:17 30/05/2014 16:17 xxx SYMBOLS AND ABBREVIATIONS RDW RF Rh RhF RIF ROM ROS RR RS RSI RTA RTI RUQ RVH Rx s SAH SALT SARS Sats SBE SBP SC SCBU SCC SE SH SHDU SHO Red cell distribution width Rheumatic fever Rhesus Rheumatoid factor Right iliac fossa Rang e of movement Review of systems Respiratory rate Respiratory system Rapid sequence inductio n Road traffi c accident Road traffi c incident Right upper quadrant Right ventricular hype rtrophy Prescription Second(s) Sub-arachnoid hemorrhage Speech and language therapy Severe acute respiratory syndrome O2 saturation Sub-acute bacterial endocarditis Systolic blood pr essure Subcutaneous Special care baby unit Squamous cell carcinoma Side eff ects Social his tory Surgical high dependency unit Senior house offi cer (old training system but still wid ely used) Syndrome of inappropriate antidiuretic hormone secretion Systemic infl ammatory r esponse syndrome Sublingual Systemic lupus erythematosus Swelling of ankles Short of breath Short of breath at rest Short of breath on exertion Space occupying lesion Oxygen saturati on in peripheral blood SIADH SIRS SL SLE SOA SOB SOBAR SOBOE SOL SpO2 OHFP.indb xxx OHFP.indb xxx 30/05/2014 16:17 30/05/2014 16:17 SYMBOLS AND ABBREVIATIONS xxxi SpR SR SSRI STAT ST STD STEMI STI STOP StR SVC SVR SVT Sx Temp T3 T4 TAB TACS TB TBG TCA td s Teds Temp TENS TFT THR TIA TIBC TIMI TIPS TKR TLC TMJ TNM TOE TPHA TPN TPR Specialist registrar (old training system but still widely used) Slow release/Sinus rhythm Selective serotonin re-uptake inhibitor Statim (immediately) Specialty Training/Trainee Sex ually transmitted disease ST-elevation myocardial infarction Sexually transmitted infection Surgical termination of pregnancy Specialty Training Registrar Superior vena cava Systemic vascular resistance Supraventricular tachycardia Symptoms Temperature Tri-iodothyronine Th yroxine Team Assessment of Behavior Total anterior circulation stroke Tuberculosis Thyroxin e-binding globulin Tricyclic antidepressant Ter die sumendus (three times daily) Thromboemb olism deterrent stockings Temperature Transcutaneous electrical nerve stimulation Thyroid f unction test Total hip replacement Transient ischaemic attack Total iron binding capacity T hrombolysis in myocardial infarction Transjugular intrahepatic porto-systemic shunting Tota l knee replacement Total lung capacity/Tender loving care Temporomandibular joint Tumor, no des, metastases \200\223 cancer staging Transoesophageal echocardiogram Treponema pallidum haemagglutination assay Total parenteral nutrition Total peripheral resistance _OHFP.indb xxxi _OHFP.indb xxxi 30/05/2014 16:17 30/05/2014 16:17 xxxii SYMBOLS AND ABBREVIATIONS TSH TTA TTO TTP TURP TWOC Tx u/U U+E UA UC UMN UO URTI US(S) UTI UV V/Q VA VC VDRL VE VF VM A VP shunt VSD VT VZV WB WBC WCC WHO wk WPW wt X-match yr ZN