410, 413 relaxation techniques, 431 renal arteriography, 255 renal artery stenosis, 710 renal biopsy , 256t renal calculi, 258 \200\2239, 260t, 150 \200\223201 255, 706 \200\2237 pulmonary nodules, 692 pulmonary regurgitation, radionuclide ventriculography, 706 277 140 radiotherapy, 435 \200\2236 raised intracranial pressure, renal cell carcinoma, 710 renal computed pulmonary stenosis, 45, 140, 146t pulmonary vascular congestion, 272 pulsatile tinnitus, 357 pulse, assessment, 48, 49f, 778, 779t raloxifene, 307t raltegravir, 574 raltegravir + tenofovir/ emtricitabine, 572 tomography, 710 renal disease, 133, 368 renal Doppler, 710 renal dysfunction post- transplantation, 256t 49t, 50f pulse pressure, 44 pulsus alternans, 48, 49f, Ramsay Hunt syndrome, 65t, 356, 390t randomized controlled trials (RCTs), 27, 32 renal failure, 281, 388t renal hyperperfusion, 282 renal hypoperfusion, 268 renal infarctio n, 251 renal insufficiency, 452 renal medicine, 250 \200\22383 renal nuclear scans, 710 ren al phakomatoses, 281 renal replacement therapy, 50f, 129 pulsus bisferiens, 48 pulsus paradoxus, 48 pulsus parvus et tardus, 48 pupillary a bnormalities, rapidly progressing glomerulonephritis (RPGN), 265 rasburicase, 430 rashes, 399, 412t, 413, 515, 81 \200\2232 purulent cellulitis, 537t pyelonephritis, 252, 257, 698 pyrazinamide, 216t, 556t pyruvate k inase deficiency, 575 \200\2236 274 \200\2235 renal scan, 707 renal stones, 192, 283, 381 renal transplantation, 258, 275t \200\223276t, 412t renal tubular acidosis type Raynaud phenomenon, 43t, 203, 399, 412 reactive arthritis, 398, 399 reactive hypoglycemia, 297 reactive lymphadenopathy, 617 Q Q fever, 519t, 589 Quality Adjusted Life Year (QALY), 14 \200\22315 2, 280 79 renal tubular disease, 76, rebound abdominal pain, 82 280 \200\2231 questions asked of patients, renal ultrasound, 710 renal vein metastases, 244 renal vein thrombosis, rebound headache, 346t, 5 \200\2236 quinidine, 550 quinidine gluconate, 551t quinine sulfate, 551t quinolones, 257, 533, 533t, 349 rectal bleeding, 82 rectal cancer, 80 rectal prolapse 267, 710 renin-secreting tumor, 664t (procidentia), 75, 214t, 490, 598 recurrent HSV, 559 recurrent pneumonia, 173 recurrent pol yserositis, 542 red kidney bean poisoning, 556t, 582 renovascular disease, 279 renovascular HTN, 664t respiratory acidosis, 663 respiratory alka losis, 663 respiratory bronchiolitis, R rabies, 523t, 525, 578 \200\2239 radial nerve, 339f radiation enteritis, 248 radiation ex posure, 686 radiation-induced lung fibrosis, 630 radiation nephritis, 277 radiation procedu res, 185 543t respiratory failure, 165, Reed-Sternberg cell, 560 reflexes, 63t reflex tachycardia, 135 reflux esophagitis, 206 refr actory anemia, 610 Refsum \200\231s syndrome, 388t 186 \200\2237 respiratory quinolones, 824 537t, 538t respiratory system, examination, 54 \200\2237 222 \200\2234 risk-ratio, 28 risk ratio, in epidemiology, screening for cancer, respiratory tract- 426, 427 scrub typhus, 590 scurvy, 245 secondary amyloidosis, 282, 283, 636 secondary heada che, 345 secondary predominant infections, 519t resting tremor, 335 restless leg syndrome, 610 restrictive car diomyopathy, 28 risperidone, 323 ritonavir-boosted atazanavir + tenofovir/ emtricitabine, 572 145, 145t, 146t reticulocytes, 612 retinal degeneration, 281 retinitis pigmentosa, 281 retinoblastoma, 425t retrograde pyelography, ritonavir-boosted hemochromatosis, 231 darunavir + tenofovir/ emtricitabine, 572 secondary rituximab, 406t, 412 Rockall risk score, 217, 218t Rocky Mountain spotted hyperaldosteronism, 664t 255 secondary hyperlipidemias, retroperitoneal fibrosis, 261 retroviruses, 522t reversible cerebral fever, 590 rosiglitazone, 290t rotaviruses, 523t, 524, 544t Rotor \200\231s syndrome, 215 R ouleaux formation, 612 Roux-en-Y choledochoje- junostomy, 486 109 secondary hyperoxaluria, 281 vasoconstriction (RCVS), 364 secondary hypertension, 133, 278 review of systems (ROS), in patients, 38, 40 \200\2231 secondary liver tumors, 237t second degree Reye \200\231s syndrome, 452 rhabdomyolysis, 278t, 680 rheumatic fever, 137, 140, rubella, 523t rufinamide, 381 ruptured aortic aneurysm, arteriovenous (AV) block, 732 seizures, 62, 680 seizures (epilepsy), 378 \200\22380 selecti ve estrogen receptor 146t, 636 74 rheumatic mitral stenosis, 138 rheumatoid arthritis (RA), 43t, 183, 190, 198t, 282, 305, 390, 398, 404 \200\2235, 406t \200\223407t, 542, 636, 637 S saccular aneurysm, 364 salicylate poisoning, 791 salmeterol, 177, 178t, 182t salmon calci tonin, 307t Salmonella spp., 519t, 520t, modulator (SERM), 307t selective -opioid receptor antagonists, 213 selective serotonin rheumatoid nodules, 146t rheumatological diseases, reuptake inhibitors (SSRIs), 648 sensory deficits, 333 sensory neuropathy, 387 sentinel hea dache, 365 S. epidermidis, 520t sepsis, 186t, 268, 295, 539t, 524, 546t salpingitis, 578 salt-losing nephropathy, 282 rheumatology, 398 \200\223419 rhinoviruses, 522t Rickettsial infections, 261 saquinavir, 573 sarcoidosis, 55, 77, 146t, 183, 189, 192, 198t, 276, 277, 283, 376, 399 589 \200\22390 rifabutin, 556t rifampin, 216t, 276, 535t, 745, 747t septic arthritis, 400 septicemia, 166, 282, 637 septicemic shock, 449 septic jugu lar vein 556t, 639 Rift Valley virus, 523t right-heart valve disease, saxagliptin, 290t scabies, 78, 575 \200\2236 scarring-renovascular disease, 272 schistocyte s, 612 schistosomiasis, 193t, 252, 140 thrombosis, 368 sequestration/hepatic crises, 618 right iliac fossa masses, 70 right iliac fossa pain, 82 right upper quadrant pain, 264, 282, 601 sciatic nerves, 341f sclerodactyly, 203 scleroderma renal crisis, 279 scolios is, 71 scombrotoxin ingestion, SERM (selective estrogen 82, 235, 618 right ventricular failure (RVF), 116 \200\22317, 128 right ventricular infarct ion, receptor modulator), 307t seronegative arthritis, 636 750 rigors, 76, 82 rilpivirine, 574 risedronate, 307t, 308 825 serotonergic agonists, 352 Serratia marcescens 543t screening, in epidemiology, Shigella spp, 520t 34 \200\2235 small bowel follow- serum creatine, 250 serum free light chains, 679 serum glutamic-oxaloacetic transaminase, 6 79 serum glutamic-pyruvic transaminase, 679 17-hydroxyprogesterone, splenectomy, 637 splenic infarction, 618 splenic vein thrombosis, 244 splenomegaly, 59, 70, 82, 192, 312, 634 splinter hemorrhages (of nails), 43t through, 223 small bowel resection, 248 small cell carcinoma, 173 small cell lung carcinoma, 310, 388t small intestinal disease, 258 smallpox, 519t smoke inhalation, 795t smooth muscle antibodie s 317t spondyloarthritis, 399, 402 \200\2233 spondylolisthesis, 401 spontaneous bacterial severe acute respiratory syndrome-associated coronavirus (SARS- COV), 519t (SMA), 414t sodium control, 667, 668 \200\2239. See also hypernatremia; hyponatremia peritonitis, 228 spontaneous intracranial hypotension (SIH), 346t severe pulmonary edema, 754 sporotrichosis, 594 sputum, 54 squamous cell carcinoma, sexually transmitted sodium polystyrene infections, 519t, 574 \200\2237 sulfonate, 270 shagreen patch, 281 Shigatoxin-associated HUS, 279 soft tissues, evaluation, 698 solifenacin, 647 somatostatin analogs, 173 stable angina, 117 Staphylococci spp., 141, 143t, 164, 282, 461, 579 Shigatoxin-producing E. 246, 325 somatropin, 348 sotalol, 116 space-occupying lesions, in the brain, 393, 394t coli, 519t statin myopathy, 414 statins, 109, 111, 216t, Shigella spp., 524, 544t, 546t shunt nephritis, 264 sibutramine, 206f sickle-cell anemia, 6 17 \200\22319 sickle-cell disease, 77, 280 sick sinus syndrome, 119 sideroblastic anemia, 6 09 sigmoidoscopy, 426 sigmoid sinus thrombosis, 289, 680 status epilepticus, 354t, 382, 774, 775t spastic dysarthria, 66 speckled pancreatic stavudine, 573 stem-cell transplantation, calcification, 249 speech, higher mental 630 function, 65 \200\2236, 67f, 67t Stenotrophomonas spherocytes, 612 spider telangiectasia, 58 SPIKES mnemonic, for maltophilia, 520t 367 sildenafil, 294 silicosis, 193t, 196, 198t silodosin, 647 simvastatin, 109 single-stran ded DNA virus, stents, 101, 235, 261 Stephens-Johnson breaking bad news, 21 syndrome, 380 spinal cord sterile pyuria, 258 steroids, 178t, 240 steroids, topical, 239 still \200\231s disease, 542 St. Louis encephalitis, 519t stoma, 440t, 463t stool softeners, 213 strangulated bowel, 46 8 streptococcal infections, 137, 160, 162t, 162t, 163t, 163t, 358 streptokinase, 622f, 749 \200\22350 streptomycin, 556t, 582 stress echocardiography, 104 stridor, 82 stroke, 113 anatomy, 329, 336, 339 cauda equina tumors, 522t 401 sinoatrial disease, 732 sinus bradycardia, 116 sinusitis, 346, 347 sinus tachycardia, 760 s itagliptin, 290t 6-mercaptopurine, 232 Sj gren \200\231s syndrome, 184, compression, 429 evaluation, 63t, 75t infarct, 376 infection, 401 injury, 335, 358 lesions, 331, 332t, 333 myelopathies, 376, 392 tumor, 376 249, 276, 280, 376, 399, 410, 413 spine, bone analysis, 698 spine CT, 716 spine MRI, 712 spine radiography, 716 spirochetes, 144, 521t, skeletal radiography, 716 skin discoloration, 82 skin lesions, 547 skin tags, 324, 493 slee ping sickness, 592 \200\2233 slowly resolving ischemic stroke, 359 \200\22362 MCA territory stroke, 587 \200\2238 826 spirometry, 155, 157f, 176, 331t pneumonia, 173 182t, 196 transient ischemic attack, 71, 363 \200\2234 S. lugdunensis, 520t small bowel enema, 223 spironolactone, 314, 318 acute abdomen, 466 \200\2238 acute appendicitis, glucose management, Strongyloides stercoralis, 598 struma ovarii, 298 ST-segment elevation, 113 \200\22315, 750 , 753t diabetic patients, 455 \200\2236 478 \200\22380 gynecology, 515 \200\22317 hemorrhoids, 491, 492t hepatic failure, 464 hernias, 482 \200 \2234, 485f ileostomies, 463 informed consent, 447 intestinal ischemia, 468 \200\2239 intes tinal obstruction, adjuvant treatments, 452 airway dif \201 culties, 443 anal \201 ssure, 492 \200\2233 ant icoagulants/steroids, subacute bacterial endocarditis, 637 subacute dyspnea, 74 subacute sclerosing panencephalitis (SSPE), 377 464 aortic aneurysm, dissection, 474 \200\2236 back pain, 401 \200\2232 bariatric surgery, 289 biliary tract, benign 489 \200\22390 subacute thyroiditis, 300 subarachnoid hemorrhage, 345, 346t, 364 \200\2236 subclavian cent ral venous pressure (CVP), 189 subclinical hypothyroidism, limb ischemia, 476 \200\2238 liver transplantation, 226t, 228, 233, 234 diseases, 485 \200\2236, 487f bladder tumors, 514 \200\22315 blood transfusion, blood lower-extremity amputations, 295 nutritional support, 458 \200\2239 obesity, 496 \200\2237 pain control, 45 2, 453t pancreatic cancer, 502, products, 456 \200\2238, 457t \200\223458t 297t, 302 subcutaneous calcinosis, bowel preparation, 445 breast lumps, cancer, 281 subcutaneous emphysema, 497 \200\2239 503t 82 bronchial adenoma, 174 cancer, 433 cardiac risk assessment, pancreatitis, 487 parenteral (IV) nutrition, subdural hematoma, 345, 369 suberosis, 194 subfalcine (cingulate) 460 \200\2231 443 \200\2235 pituitary adenomas, 323 postoperative care, cardiac surgery, 94, 102, 117, 118, 125, 127, 138 \200\2239, 140, 141t herniation, 778 464 \200\2236 subfulminant hepatic failure, 224, 225 subthalamotomy, 384 sucralfate, 208 sudden-onset hyp ertension, preoperative evaluation, colorectal 440 \200\2231 adenocarcinoma, 500, 501t, 502t complication preoperative medical assessment, 442 \200\2233 preoperative tests, 279 management, 463t corpus callosotomies, 441t \200\223442t suicidal ideation, 68, 347 sulfasalazine, 198t, 239, 240, prophylactic antibiotics, 381 \200\2232 445 403t, 406t cutaneous neoplasms, pulmonary medicine, 158 rectal prolapse, 490 renal transplant, 258 renal transplantation, sulfonamides, 276, 278t, 411 sulfonylureas, 290 sumatriptan, 347 superficial gluteal nerve, 507 \200\2238 deep vein thrombosis, swollen legs, 453 \200\2235, 454t 258, 275t \200\223276t 341f diverticular disease, 480 \200\2231 drains, 461 \200\2232 esophageal cancer, 505 fecal inco ntinence, 490 \200\2231 \202 uid/electrolyte risk factors/prophylaxis, superficial mycoses, 594 superior vena cava 447t stomas, 462 terminology, 439t \200\223440t thyroid disease, 301t, obstruction, with airway compromise, 429 management, perioperative, 448 \200\2239, 450t, 451t 463, 504 \200\2235 trauma, 472 \200\2234 urinary incontinence, 513 urinary tract superior vena cava syndrome, 173 suppositories, 213, 432t suppositories, glycerol, 213 supr aventricular gastric cancer, 506 gastric/duodenal ulcer malignancies, 511 \200\22312 urological disorders, tachycardia, 90, 91, 112, 116, 119, 146t, 732, 757, 760 disease, 493 \200\2236 508 \200\22311 gastroesophageal re \202 ux 827 VTE disease risk factors, disease, 496 446t surgery gastrointestinal bleeding, wounds, 462 acromegaly, 325 470 \200\2231 tagged white blood cell thoracoscopy, 158 thoracostomy, 461 \200\2232 thrombin inhibitors, 624 \200\2235 thrombocyt openia, 232 thrombocytosis, essential, Susac \200\231s syndrome, 357 suturing, 389, 718 \200\22319 swollen legs, and DVT, scan, 707 Tai Chi, 408 Takayasu \200\231s arteritis, 193t, 453 \200\2234 279 tamsulosin, 647 tardive dyskinesia, 210, 359 target cells, 612 T-cell modulators, 407t TED stockings, 189 teeth, 203 temporal lobe functions, Sydenham \200\231s chorea, 72, 633 137, 358 thromboembolism, 267 thrombolysis, 749 thrombophilia, 188, 638 \200\2239 thrombophlebitis m igrans, symptomatic bradycardia, 732 synchronized cardioversion, 759f 244 syncope, 91, 113 synovial fluid analysis, thrombosis-in-situ, 359 thrombotic 333 400t synovitis, 282 synpharyngitic hematuria, ten commandments of prescribing drugs, 12 \200\22313 tenecteplase, 750 tenesmus, 83 tenofov ir, 572, 573 tenofovir, emtricitabine, microangiopathy, 279 thrombotic thrombocytopenic purpura, 279 thymic hyperplasia, 390 thymic hyperthyroidism, 263 syphilis, 65t, 146t, 193t, 203, 362, 519t serology types, 576 treatment, 577t syphilitic aortitis, 139 systemic arthritis, 407t syste mic disease, renal 390 572 thyroid tension pneumothorax, 190 terazosin, 647 teriparatide, 307t terminal dribbling, 83. see als o prostatism antibodies, 415t eye disease, 300t function tests, 297 \200\2238 hormone replacement manifestations, 282 \200\2233 systemic embolism, 117, therapy, 302 140 systemic lupus Terry \200\231s nails, 43t testicular atrophy, 59 testicular ultrasound, 710 testosterone, 317t testosterone replacement review of symptoms, 41 scan, 707 surgery, 301t, 463 thyroid stimulating erythematosus (SLE), 72, 146t, 170, 183, 184, 190, 198t, 264, 370, 379, 390, 399, 410, 411, 412t, 468, 542, 632 systemic mycoses, 594 systemic sclerosis, 133, hormone (TSH), 285, 297t \200\223298t therapy, 322 tetanus, 519t, 525, 584 \200\2235 tetracycline, 165, 348, 588 thalamic deep br ain surgery, 384 thalamotomy, 384 thalamus thyroid storm, 301t, 463, 468, 783t thyrotoxicosis, 72, 74, 146t, 211, 298, 305, 463 thyrotropin releasing 198t, 203, 412 \200\22313 systolic blood pressure, 44 systolic-ejection murmur hormone (TRH), 297 (SEM), 53 anatomy, 335 lesions, 333 tick-born bacterial infections, 519t, 588 T tachyarrhythmias, 116 tachycardias, 99f, 121, 122t, 125, 126t, 129, 135, 146t, 185, 199 t achyphylaxis, 307t tachypnea, 129, 176, 179, 185 tacrolimus, 232, 275 tacrolimus/cyclospori ne, 275 tactile fremitus, 56 tactile vocal fremitus, tick typhus, 590 tics, 358 Tietze \200\231s syndrome, 71 tinidazole, 577 tinnitus, 326, 355 , 357 tipranavir, 573 T-lymphocytes, 613 TMP/SMX, 535t, 536t, 546t, thalassemia, 609, 619 \200\22320 theophylline, 177 thiazide diuretics, 134, 281, 293, 327, 362f thiazolidinediones, 290 thin basement membrane nephropathy, 256t, 265 thioamides, 301t thoracentesis, 153, 461, 582, 586 TNF antagonists, 407t TNM staging, for lung 724 \200\2235 thoracic outlet 56, 86 neoplasms, 175t tobramycin, 143t, 167t, 582 tocilizumab, 407t Todd \200\231s palsy, 378 tadalafil, 294 Taenia solium, 600 tagged red blood cell scans, 707 828 compression, 386t thoracic radiology, 711 \200\22312 thoracic sarcoidosis, 192 trigeminal neuralgia, 65t, ultrasound-guided tofacitinib, 407t tolterodine, 647 tonsillar lymphoid 347 trimethoprim/ percutaneous liver biopsy, 222 ultrasound (US) of the chest, 152 \200\2233 uncal herniation , 778 undifferentiated connective sulfamethoxazole, 257 hyperplasia, 312 topiramate, 352, 381, 384 Torsade de pointes triptans, 352 tropical enteropathy, 210t tropical sprue, 248 tropical traveler evaluation, tachycardia, 126t, 758 tissue disease (UCTD), 413 toxic adenoma, 298, 299 toxic multinodal goiter, 546 \200\2238 trospium, 647 Trousseau \200\231s sign, 83 Trousseau \200\231s syndrome, Uniform Determination of 298, 299 toxic occupational exposure, 197 Toxocara canis, 598 toxoplasmosis, 542, 563 \200 \2234, Death Act, 19 unstable angina, 111, 83, 174 113, 117 true allergic reactions, to upper GI bleeding, 217 \200\22319, drugs, 12 219 \200\22320 570t tramadol, 294 transbronchial biopsy, 158 transcutaneous electrical trypanosomiasis, 592 \200\2233 TSH-secreting pituitary adenoma, 298, 320t upper motor neuron (UMN) dysfunction, 329, 332t urate crystals, 408 urate nephropathy, 277 uremia, 84, 379 ure teral stent, 261 urethritis, 252, 399 urinary changes, 83 urinary frequency, 76 urinary inc ontinence, 646 \200\2237 urinary proteins, 678 urinary tract tuberculosis, 76, 189, 193t, 216t, 252, 399, 571t diagnosis/treatment, 554 \200\2235, 555t \200\223557t tuberous sclerosis, 281, 379 tubulointerstitial disease, nerve stimulation (TENS), 75, 452 transesophageal echocardiography (TEE), 104 transient ischemic attack (TIA), 71, 363 \200\2234 transitional cell carcinoma 280 tularemia, 583 \200\2234 tumor lysis syndrome, 186t, (TCC), 514 430, 665 \200\2236 transjugular liver biopsy, tumor markers, 680, 681t tumor necrosis factor empiric treatment, 536t imaging, 254 \200\2235 infection, 257 \200\2238, 269, 282 obstructi on, 257, 268, 222 transverse myelitis, 376 traumatic hemoptysis, 76 traumatic herpes (herpes gladiatorum), 55 8 (TNF)- agents, 283, 403t Turner \200\231s syndrome, 140, 146t 24 hour urine, 252253 two-dimensional 710 urine, 252 \200\2233 urine dipstick, 252, 261, travel advice, 524 \200\2236 tropical traveler echocardiography, 104 292, 543, 575, 656 evaluation, 546 \200\2238 traveler \200\231s diarrhea, 524 treatment-induced type II respiratory failure, urine glucose, 657 urine microscopy, 254f urobilinogen, 657 urokinase, 622f urothelial mali gnancy, 252 ursodeoxycholic acid, 232 ursodeoxycholic acid 186 \200\2237 type I respiratory failure, 186 type V hyperlipo- hypoglycemia, 294, 295 trematodes (flukes), 601 \200\2232 tremor, 83, 335, 358, 384 trench fever, 590 Treponema pa llidum, 520t triamterene, 258 Trichinella spiralis, 598 trichinellosis, 519t trichomonas va ginalis, 577 Trichomonas vaginalis, 516 Trichophyton spp., 524 Trichuris trichiura, 598 tri cuspid regurgitation, proteinemia, 110t typhoid fever, 519t, 525, 547, 585, 590 (UDCA), 232, 234 uterine disorders, 516 uterine masses, 710 uveitis, 192, 403t U ulcerated tongue, 203 ulcerative colitis (UC), 210t, 232, 238 \200\22340, 368, 398 V vaccines ulnar mononeuropathies, hepatitis infections, 386t ulnar nerve, 340f ultrasonography 140, 199 540t, 564 829 tricuspid stenosis, 140 tricyclic antidepressants, HPV2/HPV4, 539t in \202 uenza vaccine, 161, (ultrasound), 254 \200\2235, 702, 703f 209, 214t 539t ventral septal defect (VSD), voice and disturbances of speech, 64, 84 vomiting, 84, 84t, 113, 207, vaccines (Cont.) 113, 117 measles, mumps, rubella, ventricular arrhythmia, 757 ventricular conduction disorders, 95 \200\2236 540t 355, 547 von Hippel-Lindau meningococcal, 540t pneumococcal vaccine, ventricular ectopy, 27 ventricular extrasystoles, syndrome, 281, 315, 316, 425t 161, 540t tetanus, diphtheria (Td), 758 von Willebrand \200\231s disease, 161, 539t ventricular hypertrophy, 96 ventricular septal defect, 621 tetanus, diphtheria, acellular pertussis (Tdap), 539t voriconazole, 170 vulva disorders, 515 \200\22316 148 \200\2239 ventricular tachycardia, traveling suggestions, 732, 757 verapamil, 639 vertiginous epilepsy, 356t vertigo, 355 \200\2236, 360 vestibular m igraine, 356 vestibular nerve, 355 \200\2236 vestibular neuronitis, 356 vestibular schwanno mas, 526 W walking difficulty, 84 \200\2235 warfarin, 188 \200\2239, 267, 464, varicella, 539t zoster, 539t vaccinia virus, 522t vaginal disorders, 516, 623 \200\2235 water brash, 85 water deprivation test, 326t 577, 578 valganciclovir, 561t valproate, 381 valproic acid, 216t valve disorders, 128 valve replacement surgery, water hammer pulses, 48 Wegener \200\231s granulomatosis, 356 Vibrio cholera, 544t, 585 \200\2236 Vibrio parahaemolyticus, 170, 193t, 388t weight loss, 85 \200\2236 Wernicke \200\231s (receptive) aphasia, 66 544t, 546t 140 valvotomy, 140 valvuloplasty, 140 vancomycin, 445, 536t, vibriosis, 519t video-assisted- Wernicke \200\231s encephalopathy, thoracoscopy (VAT), 158 65t 538t, 539t vardenafil, 294 variant (Prinzmetal \200\231s) angina, 117 West Nile virus, 372, 519t wheeze, 56, 150, 176 Whipple procedure, 247t Whipple \200\231s d isease, 248, Vincent \200\231s angina, 203 viral hemorrhagic fevers, 519t, 588 \200\2239 viral hepatitis infections, 224, 519t, 564 \200\2236 viral pneumonia, 165 virilization, 318 virtual bronchoscopy, 153 viruses, 521t visceral leishmaniasis, 593 \200\2234 visual loss, 83 vitamin A variceal hemorrhage, 220, 542, 610 229t whispered pectoriloquy, varicella zoster virus, 356, 86 521t, 557 white cell count differential, variegate porphyria, 682 variola virus, 522t vascular calcification, 698 vascular hemoptysi s, 76 vascular malformation, 612 \200\22313 whooping cough, 583 wide complex tachycardia, 116, 125, 126f, 126t, 757 \200\2238, 759t widened mediastinum, 252 de \201 ciency, 245 therapy, 234, 348 vitamin B12 deficiency, vasculitis, 76, 252, 416 vasodilators, 131 vasogenic intracranial pressure, 778 vaso-occlus ive crisis, 618 vasospastic intestinal ischemia, 468 692 William \200\231s syndrome, 140, 610, 613 146t vitamin B deficiencies, Wilson and Jungner 203, 610 criteria, in screening, 34 vitamin C deficiency, 203 vitamin D Wilson \200\231s disease, 215, 216, venipuncture problems, 431 venlafaxine, 352 veno-occlusive disease, analogs, 305 intoxication, 277 therapy, 234, 306, 309 224, 233 Wolff-Parkinson-White-like syndrome, 128t Wolff-Parkinson-White 220, 224 vitamin K 830 venous angiomas, 367 venous thromboembolism, de \201 ciency, 621 therapy, 234 syndrome, 124f, 138, 757, 760 \200\2231 239, 307t, 446t vitiligo, 302 wood worker \200\231s lung, 194 Zenker diverticulum, World Trade Center attack, 197 Y yeast infection, vaginal, 577 207 zidovudine, 572 \200\2233 zoledronic acid, 307t, Yellow fever, 523t, 525, 588 X xanthelasma palpebra, 86 xanthomata, 86, 109 xerophthalmia, 245 X-linked 308, 430 Zollinger-Ellison Yersinia spp., 544t, 582, 583 syndrome, 208 zonisamide, 380 Zygomycetes Z zafirlukast, 178 zanamivir, 161 hypophosphatemic rickets (XLH), 309 (mucormycosis), 524 831 This page intentionally left blank Plate 1. A few milliliters of gas in the peritoneal cavity can be difficult to see. The bes t way is with a CXR after remaining erect for 10 min. This may be a small pneumoperitoneum at the right cardiophrenic angle. Check with another view or a CT if necessary. If you stro ngly suspected a perforated ulcer and the CXR and AXR showed no signs of pneumoperitoneum, could you exclude the diagnosis? No. Only 75% of perforations have evidence of pneumoperito neum. The authors and publishers would like to thank Peter Scally for permission to use these pla tes taken from Scally, P. (1999) Medical imaging: an Oxford core text. Oxford University Pr ess, Oxford Plate 2. (a) (b) Two radiographs, 4 days apart. Lungs: The major abnor- mality in the initi al movie is in the lungs; perihilar opacities that are poorly defined. This is consolidatio n. But what is the cause? Pulmonary oedema, infection, or blood? The lungs are filled with fluid and unable to expand fully. Pleura: The hemidiaphragms are not visible because of ple ural effu- sions, seen curving up the side walls. Mediastinum: The heart is enlarged. Hila, bones, soft tissues: normal. These are the changes of severe left heart failure. The pulmo nary venous pressure has been so high that fluid has flowed from the capillaries, into the interstitium, and then into the alveoli. Look at how the lungs have expanded and the heart borders and hemidi- aphragms have sharpened up after treatment. Plate 3. Erect. The fluid levels are immediately obvious in the erect movie, but let \200 \231s approach it in a systematic way. Gas can be seen in the colon from the rectum back to the caecum. The stomach bubble is barely visible. That leaves several loops with fluid lev els to be explained. They must be small intestine, being centrally placed and with a few va lvulae conniventes. The loops are dilated, 3 cm wide, and are probably ileum as the valvula e con- niventes are less pronounced here than in the jejunum. By comparison, if the large b owel was obstructed it would show as a few peripheral loops, often over 5 cm in diameter, c ontaining feces and showing a haustral (scal- loped) pattern. Folds in the mucosa of the co lon do not extend completely across the lumen. No sign of calcification in the biliary tree or urinary tract. The bones and soft tissues are normal. We would be looking for evidence of a cause of small bowel obstruction: a hernia, surgical clips, or any other signs of surg ery. Plate 4. Lungs: These are of normal volume. Fewer markings are seen in the left lung except at the base. Pleura: Following the pleura reveals loss of the clarity of the left hemidiap hragm. Mediastinum: In the mediastinum the left main bronchus is pulled down and there is a triangular opacity behind the heart on the left. This is a collapsed left lower lobe. It a lso depresses the left hilum. Bones: Check the bones for metastatic disease because the lef t lower lobe bronchus may be obstructed by a neoplasm. Soft tissues: appear unremarkable. Plate 5. (a) (b) Lungs: Normal lung volumes. A poorly defined opacity in the left lung obli terates the left heart border and therefore is in the upper lobe. The air-bronchogram indic ates consolidation. Pleura: The pleura in the right hemithorax seem normal. Mediastinum: Th is is central but the oblique fissure on the lateral movie is bowed inferiorly because of a slight increase in volume. Hila: The left hilum is not visible. Bones, soft tissues: norma l. Left upper lobe pneumonia (lobar pneumonia). Pneumonia is an infection of the lung, clas si- fied as lobar, broncho, and atypical. Usually the pathology progresses through four sta ges: congestion, red hepatization, gray hepatization, and resolution. This would be one of the stages of hepatization. Plate 6. This is a great educational movie from the intensive care unit. The inexperienced doctor could be distracted by the poor quality, badly centered movie. The technicians do th e best they can under difficult conditions. To ask for another in this instance would be a mistake. There is adequate informa- tion to make a life-saving decision. After checking the name of the patient, see that the tubes and lines are well positioned \200\224the endotrac heal and naso- gastric tubes and the right subclavian central venous line. Lungs: The left lung shows consolidation. The right hemithorax is too black and hyper- expanded. Right hemi diaphragm is depressed. Pleura: The pleural recess is seen at the right base. Mediastinum: This is shifted to the left, obstructing venous return and decreasing cardiac output, a thr eat to life. Is it being pushed or pulled? Hila, bones, and soft tissues: Check these struc tures. Is the endotracheal tube down the right main bronchus, inflating the right lung and collapsing the left? No. Is the right lung collapsed? Yes. Right tension pneumothorax. Bewa re of the half-toning of the hemidiaphragm in a supine movie. In the supine position, a pne umothorax will be anterior and the lung will fall posteriorly. A chest tube is needed immed iately. The consolidation in the left lung could be a result of any of the causes of the ac ute respiratory distress syndrome (ARDS). Consolidation/collapse often occurs in intubated patients at the left base. Suction catheters to clear the lungs pass down the ETT and prefe rentially into the right main bronchus. Plate 7. Lungs: The lung volumes are normal but the parenchyma shows increased markings tha t extend out to the chest wall. Normally vessels (arteries and veins) are only seen for 80% of the distance from hilum to pleura. The bronchi should barely be visible. Pleura: Follow ing the pleura demonstrates that the heart borders are poorly defined, reflecting intersti- tial disease in the lung adjacent to the heart. Mediastinum: The mediastinal structures th emselves are normal. Hila: The hila are difficult to interpret. So what? It is not unusual to be missing a piece of information when making a clinical decision. No need for wringing of hands and gnashing of teeth. Either go ahead without it or, if it is essential, find it. In this case, further information is available by comparison with old films or by requesti ng a CT. Bone and soft tissues: No abnormality. This is interstitial lung disease. It has a similar appearance to the interstitial oedema of moderate left heart failure but without a big heart. Check the previous movie to see if it is acute. It was not. The diagnosis in th is example is fibrosing alveolitis. Plate 8. (a) (b) Lungs: An opacity can be seen at the base of the right lung. Pleura: The s ilhouette of the pleura over the right hemidiaphragm is lost because of adjacent lung disea se. The right heart border is also unclear. Mediastinum, hila, bones, soft tissues: normal. The middle lobe has two seg- ments. The consolidation of lobar pneumonia here involves pri ncipally the lateral segment. The medial segment is affected to a lesser extent, shown by t he loss of clarity of the right heart border. Also well seen on the lateral projection, but the PA view has adequate information. Plate 9. Beau \200\231s lines. Plate 10. Pectus excavatum. The medical term for funnel or sunken chest. Associations: scol iosis; restrictive spirometry; Marfan \200\231s syndrome; Ehlers \200\223 Danlos syndrome ( plate 24). Plate 11. Xanthelasma. Xanthos is Greek for yellow, and elasma means plate. Xanthelasma are lipid-laden yellow plaques congregating around the lids. They are typically a few mm wide, and signify hyperlipidaemia. Plate 12. Spider naevi. These consist of a central arteriole, from which numerous vessels r adiate (like the legs of a spider). These fill from the cen- tre. They occur most commonly in skin drained by the superior vena cava. Up to 5 are said to be normal (they are common i n young females). Causes include liver failure, contraceptive steroids, and pregnancy (ie c hanges in estrogen metabolism). Plate 13. Diabetes, background retinopathy. There are scattered blot hae- morrhages and spa rse hard exudates but vision is normal. Plate 14. Nodular goiter. Plate 15. Cushing \200\231s disease. Signs of Cushings include purple abdominal striae and wasting, eg in the thighs. Plate 16. Tophaceous gout. Plate 17. Erythema multiforme. Target lesions eg caused by drugs, herpes or mycoplasma. Plate 18. Erythema nodosum. Causes include sarcoidosis, drugs, streps, TB, and UC/Crohn \200\231s disease. Plate 19. Shingles (herpes zoster) involving the ophthalmic (Vi) division of the trigeminal nerve. Plate 20. Rheumatoid arthritis. Note ulnar deviation of fingers. Plate 21. Drug reaction. Plate 22. Vascultic skin rash from Behcet \200\231s disease. Plate 23. Dupuytren \200\231s contracture. Plate 24. Ehlers \200\223Danlos syndrome. Note the hyperelasticity of the skin. Association s: aneurysms; GI bleeds/perforations; hypermobile joints; flat feet. It is a disorder of co llagen.