Oxford Assess and Progress: Clinical Specialties [4 ed.] 0198862555, 9780198862550

Table of contents :
Cover
Series
OXFORD ASSESS AND PROGRESS
Copyright
Contents
About the editors
Contributors
Normal and average values
Abbreviations
How to use this book
1 Obstetrics
2 Gynaecology and genitourinary medicine
3 Paediatrics 
4 Ophthalmology
5 ENT
6 Dermatology
7 Orthopaedics
8 Trauma
9 Emergency medicine
10 Pre-​hospital emergency medicine
11 Anaesthesia and intensive care
12 Psychiatry
13 General practice
14 Eponymous syndromes
Index

Citation preview

OXFORD ASSESS AND PROGRESS Series Editors

Katharine Boursicot

Director, Health Professional Assessment Consultancy (HPAC) Honorary Reader in Medical Education St George’s, University of London

David Sales

Consultant in Medical Assessment

OXFORD ASSESS AND PROGRESS your prescription for exam success Written by clinicians and educational experts, these unique guides present complete coverage for your exam revision, with illustrative material and tips to help you succeed in your medical exams. Also available and forthcoming titles in the Oxford Assess and Progress series Clinical Dentistry Nicholas Longridge, Pete Clarke, Raheel Aftab, and Tariq Ali Clinical Medicine, Third Edition Dan Furmedge and Rudy Sinharay Clinical Surgery Neil Borley, Frank Smith, Paul McGovern, Bernadette Pereira, and Oliver Old Emergency Medicine Pawan Gupta Medical Sciences Jade Chow and John Patterson Psychiatry Gil Myers and Melissa Gardner Situational Judgement Test, Third Edition David Metcalfe and Harveer Dev

OXFORD ASSESS AND PROGRESS

Clinical Specialties Fourth Edition

EDITED BY Luci Etheridge Consultant Paediatrician and Honorary Senior Lecturer in Clinical Education, St George’s University Hospitals NHS Foundation Trust and St George’s, University of  London

Henry Collier Specialty Trainee in Anaesthesia, Lancashire Teaching Hospitals NHS Foundation Trust and Clinical Fellow, Health Education England

CONSULTANT EDITOR Alex Bonner Consultant Anaesthetist, Lancashire Teaching Hospitals NHS Foundation Trust

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1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2021 The moral rights of the authors have been asserted First Edition published in 2010 Second Edition published in 2013 Third Edition published in 2018 Fourth Edition published in 2021 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, 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 licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University 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, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2020950909 ISBN 978–​0–​19–​886255–​0 DOI: 10.1093/oso/9780198862550.001.0001 Printed in Great Britain by Ashford Colour Press Ltd, Gosport, Hampshire 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 clinical procedures with the most up-​to-​date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise 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 website referenced in this work.

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Series editor preface The Oxford Assess and Progress series is a groundbreaking development in the extensive area of self-​assessment texts available for medical students. The questions were specifically commissioned for the series, written by practising clinicians, extensively peer-​reviewed by students and their teachers, and quality-​assured to ensure that the material is up-​to-​date, accurate, and in line with modern testing formats. The series has a number of unique features and is designed to be as much a formative learning resource as a self-​assessment one. The questions are constructed to test the same clinical problem-​solving skills that we use as practising clinicians, rather than only to test theoretical knowledge. These skills include: ● gathering and using data required for clinical judgement ● choosing the appropriate examination and investigations, and interpretation of the findings ● applying knowledge ● demonstrating diagnostic skills ● ability to evaluate undifferentiated material ● ability to prioritize ● making decisions and demonstrating a structured approach to decision-​making. Each question is bedded in reality and is typically presented as a clinical scenario, the content of which has been chosen to reflect the common and important conditions that most doctors are likely to encounter both during their training and in exams! The aim of the series is to build the reader’s confidence in recognizing important symptoms and signs and suggesting the most appropriate investigations and management, and in so doing to aid the development of a clear approach to patient management which can be transferred to the wards. The content of the series has deliberately been pinned to the relevant Oxford Handbook but, in addition, has been guided by a blueprint which reflects the themes identified in Tomorrow’s Doctors and Good Medical Practice to include novel areas such as history taking, recognition of signs (including red flags), and professionalism. Particular attention has been paid to giving learning points and constructive feedback on each question, using clear fact-​or evidence-​ based explanations as to why the correct response is right and why the incorrect responses are less appropriate. The question editorials are clearly referenced to the relevant sections of the accompanying Oxford Handbook and/​or more widely to medical literature or guidelines. They are designed to guide and motivate the reader, being multi-​purpose in nature and covering, for example, exam technique, approaches to difficult subjects, and links between subjects.

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Series editor preface

Another unique aspect of the series is the element of competency progression from being a relatively inexperienced student to being a more experienced junior doctor. We have suggested the following four degrees of difficulty to reflect the level of training, so that the reader can monitor their own progress over time: ● ● ● ●

graduate should know ★ graduate nice to know ★★ foundation doctor should know ★★★ foundation doctor nice to know ★★★★

We advise the reader to attempt the questions in blocks as a way of testing their knowledge in a clinical context. The series can be treated as a dress rehearsal for life on the ward by using the material to hone clinical acumen and build confidence by encouraging a clear, consistent, and rational approach, proficiency in recognizing and evaluating symptoms and signs, making a rational differential diagnosis, and suggesting appropriate investigations and management. Adopting such an approach can aid not only success in examinations, which really are designed to confirm learning, but also—​more importantly—​being a good doctor. In this way, we can deliver high-​ quality and safe patient care by recognizing, understanding, and treating common problems, but at the same time remaining alert to the possibility of less likely, but potentially catastrophic, conditions. David Sales and Kathy Boursicot Series Editors

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A note on single best answer questions Single best answer questions are currently the format of choice being widely used by most undergraduate and postgraduate knowledge tests, and therefore all the assessment questions in this book follow this format. Single best answer questions have many advantages over other machine-​ markable formats, such as extended matching questions (EMQs), notably the breadth of sampling or content coverage that they afford. Briefly, the single best answer or ‘best of five’ question presents a problem, usually a clinical scenario, before presenting the question itself and a list of five options. These consist of one correct answer and four incorrect options or ‘distractors’, from which the reader has to choose a response. All of the questions in this book, which are typically based on an evaluation of symptoms, signs, or results of investigations, either as single entities or in combination, are designed to test reasoning skills, rather than straightforward recall of facts, and utilize cognitive processes similar to those used in clinical practice. The peer-​reviewed questions are written and edited in accordance with contemporary best assessment practice, and their content has been guided by a blueprint pinned to all areas of Good Medical Practice, which ensures comprehensive coverage. The answers and their rationales are evidence-​based and have been reviewed to ensure that they are absolutely correct. Incorrect options are selected as being plausible, and indeed they may appear correct to the less knowledgeable reader. When answering questions, the reader may wish to use the ‘cover’ test in which they read the scenario and the question but cover the options. Kathy Boursicot and David Sales Series Editors

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Editor preface to the fourth edition During the journey through medical school as a student, you experience medicine in a range of settings, from the rural general practice to the inner-​city teaching hospital. You encounter doctors working in a wide range of specialties, many of which will be appealing future career choices and many of which will seem daunting. Specialty attachments may be the first time that you encounter people with mental illness, or children, or pregnant women. Trying to absorb all these new experiences while also continuing to work towards final examinations can seem like a roller-​coaster ride to some! In partnership with the well-​established Oxford Handbook of Clinical Specialties, the Oxford Assess and Progress:  Clinical Specialties volume seeks to tie together the clinical specialties and to provide a grounding in knowledge that may get pushed to the back burner when medicine and surgery have to be revised. This fourth edition has been produced in line with the new edition of the Oxford Handbook of Clinical Specialties and builds on the success of the first three books, bringing you questions on the latest hot topics, current issues, and core material. As in the third edition, there are chapters ranging from primary care and pre-​hospital care through to medical and surgical specialties, anaesthesia and intensive care, and eponymous syndromes. This ensures the full spectrum of specialty practice is considered and covered. The questions in each chapter have been written by experienced doctors working within the specialty, who are familiar with the common presentations, pathologies, and dilemmas that are encountered. Their knowledge of teaching medical students about their specialty, often within the confines of very short attachments, has been transferred to these pages. All the questions map on to medical school curricula and are rooted in real-​life clinical encounters. The grading system allows you to judge for yourself which knowledge is core and which might require some further reading. We have added many new guidelines and key websites to guide this reading, and we hope that you will find these useful. The strong focus on clinical experiences also allows you to look forward to, and prepare for, your time as a foundation doctor. We hope that, as a result of working through these questions, your interest in, and appreciation and understanding of, the different clinical specialties will grow, and you will have a useful tool for judging your own learning needs. Luci Etheridge and Henry Collier

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Acknowledgements The editors would like to thank all the contributors from all editions for their hard work in combining their specialist knowledge with clinical experience to provide this resource of stimulating, realistic questions with considered explanations. Sadly, one of our much valued contributors Dr Gill McGauley passed away in 2016. Gill was a well-​known and respected psychiatrist and educationalist, and we are grateful to her for being one of the original contributors to this Series. Thank you also to all of the reviewers—​students and specialists—​for your much valued feedback. We hope that we have managed to address your suggestions in this new edition. Finally, Luci would like to thank her ever patient children, who are a constant source of inspiration and joy. Henry would like to thank his parents for their support and encouragement throughout his training, Dr Alex Bonner for his support in starting in an editorial role, and his two cats Lyro and Rosie for their attempts to interfere with the editorial process whenever possible.

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Contents About the editors  xv Contributors  xvii Normal and average values  xix Abbreviations  xxix How to use this book  xxxv

1 Obstetrics 2 Gynaecology and genitourinary medicine 3 Paediatrics  4 Ophthalmology 5 ENT 6 Dermatology 7 Orthopaedics 8 Trauma 9 Emergency medicine 10 Pre-​hospital emergency medicine 11 Anaesthesia and intensive care 12 Psychiatry 13 General practice 14 Eponymous syndromes Index  255

1 17 35 63 75 93 113 127 139 161 173 197 223 245

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About the editors Volume editors Luci Etheridge is a Consultant Paediatrician and Honorary Senior Lecturer in Clinical Education at St George’s University Hospitals NHS Foundation Trust in London. She previously worked for four years with UCL Medical School and was involved with the development of Fitness to Practise assessments for the General Medical Council and item writing for the Professional and Linguistics Assessments Board Part  1 and the Royal College of Paediatrics and Child Health. She has a doctorate in education from the Institute of Education, University of London, and plays an active role in undergraduate and postgraduate education, regionally and nationally, in the UK. Henry Collier is a Speciality Trainee in Anaesthesia in the North West Deanery. He studied medicine at the Royal Free and University College Medical School from 2006 to 2012 (now UCL Medical School) and has returned to work in the North West. Following successful completion of the FRCA examinations, he has become more involved with NHS improvement and activity redesign with the Clinically Led Workforce and Activity Redesign Programme (CLEAR). He has also begun work as a Cochrane Clinical Dissemination Fellow, and begun working towards a Postgraduate Certificate in Medical Education. Throughout his training, he has been actively involved in teaching and training of medical students, foundation doctors, and junior anaesthetic trainees. Alex Bonner is a Consultant Anaesthetist at Lancashire Teaching Hospitals NHS Foundation Trust, with subspecialty interests in vascular anaesthesia and medical education. He is regularly involved in the teaching of medical students, foundation doctors, and anaesthetic trainees who are preparing for their FRCA examinations. He is an instructor for Adult and Paediatric Advanced Life Support courses and has experience of practising anaesthesia and teaching in sub-​Saharan Africa. He has also contributed to the development of Fitness to Practise assessments for the General Medical Council.

Series editors Katharine Boursicot BSc MBBS MRCOG MAHPE NTF SFHEA FRSM is a consultant in health professions education, with special expertise in assessment. Previously, she was Head of Assessment at St George’s, University of London, Barts and The London School of Medicine and Dentistry, and Associate Dean for Assessment at Cambridge University

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About the editors

School of Clinical Medicine. She is a consultant on assessment to several UK medical schools, medical Royal Colleges, and international institutions, as well as an assessment advisor to the General Medical Council. David Sales is a general practitioner by training who has been involved in medical assessment for over 20  years, having previously been convenor of the MRCGP knowledge test. He has run item-​writing workshops for a number of undergraduate medical schools and medical Royal Colleges, and internationally. He has chaired the Professional and Linguistic Assessments Board Part 1 panel for the General Medical Council and is their consultant on Fitness to Practise knowledge testing.

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Contributors Erica Allason-​Jones

NHS Consultant in Genitourinary Medicine, Mortimer Market Centre (Camden PCT), London, UK

Dinesh Bhugra

Professor of Mental Health and Cultural Diversity, Institute of Psychiatry, King’s College, London, and Honorary Consultant, Maudsley Hospital, London, UK

Jennifer Birch

Consultant in Neonatal Medicine, Luton and Dunstable NHS Foundation Hospital Trust, Luton, UK

Alex Bonner

Consultant Anaesthetist, Lancashire Teaching Hospitals NHS Foundation Trust

Ruth Brown

Consultant in Emergency Medicine, St Mary’s Hospital, Imperial College NHS Trust, and Honorary Senior Lecturer, Imperial College London, UK

Will Coppola

Clinical Lecturer and Sub-​Dean E-​learning, UCL Medical School, London, UK, and salaried General Practitioner

Jonathan Darling

Senior Lecturer in Paediatrics and Child Health, University of Leeds, and Honorary Consultant Paediatrician, Leeds Teaching Hospitals NHS Trust, Leeds, UK

Nev Davies

Consultant in Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, UK

James Dawson

Registrar in Anaesthesia and Intensive Care, Trent Region, UK

Philippa Edwards

Salaried General Practitioner, Portsmouth, UK

Luci Etheridge

Consultant Paediatrician, St George’s University Hospital, London, UK

Oliver Harrison

Consultant Anaesthetist, Department of Anaesthesia, Royal Preston Hospital and North West Air Ambulance

Kamila Hawthorne

General Practice Principal in Cardiff, and Sub Dean for Assessment, School of Medicine, Cardiff University, Cardiff, UK

Kevin Hayes

Senior Lecturer and Consultant in Obstetrics and Gynaecology, St George’s University Hospital, London, UK

Virginia Hubbard

Consultant Dermatologist, Homerton University Hospital, and Clinical Senior Lecturer, Barts and The London School of Medicine and Dentistry, UK

Vikram Jha

Senior Lecturer in Medical Education, Leeds Institute of Medical Education, University of Leeds, and Honorary Consultant Obstetrician, Bradford Teaching Hospitals NHS Trust, UK

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Contributors

Matthew Mathai

Consultant Paediatrician, Bradford Royal Infirmary, and Honorary Lecturer in Paediatrics and Child Health, University of Leeds, UK

Gill McGauley

Reader in Forensic Psychotherapy, St George’s University of London, and Consultant in Forensic Psychotherapy, Broadmoor Hospital, West London Mental Health NHS Trust, UK

Isabel McMullen

Consultant Liaison Psychiatrist, Department of Psychological Medicine, South London and Maudsley NHS Foundation Trust, King’s College Hospital, UK

Catherine Roberts

Consultant in Emergency Medicine, Emergency Medicine Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, UK

Zeryab Setna

Consultant Obstetrician, Lady Dufferin Hospital, Karachi, Pakistan

Gemma Simcox

Salaried General Practitioner with Special Interest in Dermatology, West Yorkshire, UK

Venki Sundaram

Consultant Ophthalmologist, Department of Ophthalmology, Luton and Dunstable NHS University Hospital, UK

Philippa Tostevin

Senior Lecturer in Surgical Education, St George’s University of London, and Honorary Consultant Otolaryngologist, St George’s Hospital, London, UK

Anuhya Vusirikala

Core Surgical Trainee, Oxford Deanery, UK

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Normal and average values Biochemistry: reference intervals All laboratory discourse is probabilistic. Drugs may interfere with any chemical method; as these effects may be method-​dependent, it is difficult for us to be aware of all of the possibilities. If in doubt, discuss the issue with the laboratory. Substance

Specimen

Normal value

Adrenocorticotrophic hormone

P