Ebook Murtagh''s general practice (5th edition): Part 1

general practice

ctice

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To all our medical colleagues, past and present, who have
provided the vast reservoir of knowledge from which the
content of this book was made possible

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fifth edition

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general practice

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NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are
required. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is

complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in
medical sciences, neither the editors, nor the publisher, nor any other party who has been involved in the preparation or publication of this work warrants
that the information contained herein is in every respect accurate or complete. Readers are encouraged to confirm the information contained herein with
other sources. For example, and in particular, readers are advised to check the product information sheet included in the package of each drug they plan
to administer to be certain that the information contained in this book is accurate and that changes have not been made in the recommended dose or in
the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.
This fifth edition published 2011
First edition published 1994, Second edition published 1998, Third edition published 2003, Fourth edition published 2007
Text © 2011 John Murtagh
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National Library of Australia Cataloguing-in-Publication Data:
Author:
Murtagh, John, 1936Title:
General practice / John Murtagh.
Edition:
5th ed.

ISBN:
9780070285385 (hbk.)
Notes:
Includes index.
Bibliography.
Subjects:
Family medicine.
Physicians (General practice)
Dewey Number:
610
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McGraw-Hill Australia Pty Ltd
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987654321

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The authors

John Murtagh AM
MBBS, MD, BSc, BEd, FRACGP, DipObstRCOG
Emeritus Professor in General Practice, School of Primary Health, Monash University, Melbourne
Professorial Fellow, Department of General Practice, University of Melbourne
Adjunct Clinical Professor, Graduate School of Medicine, University of Notre Dame, Fremantle, Western Australia
Guest Professor, Peking University Health Science Centre, Beijing

J

ohn Murtagh was a science master teaching
chemistry, biology and physics in Victorian secondary
schools when he was admitted to the first intake
of the newly established Medical School at Monash
University, graduating in 1966. Following a comprehensive postgraduate training program, which included
surgical registrarship, he practised in partnership with
his medical wife, Dr Jill Rosenblatt, for 10 years in the
rural community of Neerim South, Victoria.
He was appointed Senior Lecturer (part-time) in
the Department of Community Medicine at Monash
University and eventually returned to Melbourne as
a full-time Senior Lecturer. He was appointed to a
professorial chair in Community Medicine at Box Hill
Hospital in 1988 and subsequently as chairman of

the extended department and Emeritus Professor of
General Practice in 1993 until retirement from this
position in 2000. He now holds teaching positions as
Professor in General Practice at Monash University,
Adjunct Clinical Professor, University of Notre Dame
and Professorial Fellow, University of Melbourne.
He combines these positions with part-time general
practice, including a special interest in musculoskeletal
medicine. He achieved the Doctor of Medicine degree
in 1988 for his thesis ‘The management of back pain
in general practice’.

He was appointed Associate Medical Editor of
Australian Family Physician in 1980 and Medical Editor
in 1986, a position held until 1995. In 1995 he was
awarded the Member of the Order of Australia for
services to medicine, particularly in the areas of medical
education, research and publishing.
One of his numerous publications, Practice Tips, was
named as the British Medical Association’s Best Primary
Care Book Award in 2005. In the same year he was
named as one of the most influential people in general
practice by the publication Australian Doctor. John
Murtagh was awarded the inaugural David de Kretser
medal from Monash University for his exceptional
contribution to the Faculty of Medicine, Nursing and
Health Sciences over a significant period of time.
Members of the Royal Australian College of General
Practitioners may know that he was bestowed the honour
of the namesake of the College library.

Today John Murtagh continues to enjoy active
participation with the diverse spectrum of general
practitioners—whether they are students or experienced
practitioners, rural- or urban-based, local or international
medical graduates, clinicians or researchers. His vast
experience with all of these groups has provided him
with tremendous insights into their needs, which is
reflected in the culminated experience and wisdom of
John Murtagh’s General Practice.

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vi

The authors

Dr Jill Rosenblatt
MBBS, FRACGP, DipObstRCOG, GradDipAppSci
General Practitioner, Ashwood Medical Group
Adjunct Senior Lecturer, School of Primary Health Care, Monash University, Melbourne

J

ill Rosenblatt graduated in medicine from the
University of Melbourne in 1968. Following terms

as a resident medical officer she entered rural
practice in Neerim South, Victoria, in partnership
with her husband John Murtagh. She was responsible
for inpatient hospital care in the Neerim District
Bush Nursing Hospital and in the West Gippsland
Base Hospital. Her special interests were obstetrics,
paediatrics and anaesthetics. Jill Rosenblatt also has a
special interest in Indigenous health since she lived at
Koonibba Mission in South Australia, where her father
was Superintendent.
After leaving rural life she came to Melbourne and
joined the Ashwood Medical Group, where she continues
to practice comprehensive general medicine and care
of the elderly in particular. She was appointed a Senior
Lecturer in the Department of General Practice at

Murtagh Prelims.indd vi

Monash University in 1980 and a teacher in the GP
registrar program.
She gained a Diploma of Sports Medicine (RACGP)
in 1985 and a Graduate Diploma of Applied Science
in Nutritional and Environmental Medicine from
Swinburne University of Technology in 2001.
Jill Rosenblatt brings a wealth of diverse experience
to the compilation of this textbook. This is based on 38
years of experience in rural and metropolitan general
practice. In addition she has served as clinical assistant
to the Shepherd Foundation, the Menopause Clinics at
Prince Henry’s Hospital and Box Hill Hospital and the

Department of Anaesthetics at Prince Henry’s Hospital.
Jill has served as an examiner for the RACGP for 34 years
and for the Australian Medical Council for 12 years. She
was awarded a life membership of the Royal Australian
College of General Practitioners in 2010.

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Foreword
I

n 1960 a young schoolmaster, then teaching biology
and chemistry in a secondary school in rural Victoria,
decided to become a country doctor. He was admitted
to the first intake of students into the Medical School
of the newly established Monash University and at the
end of the six-year undergraduate medical course and
subsequent intern and resident appointments his resolve
to practise community medicine remained firm.
During his years of undergraduate and early
postgraduate study Dr Murtagh continued to gather and
record data relating to the diagnostic and therapeutic
procedures and clinical skills he would require in solo
country practice. These records, subsequently greatly
expanded, were to provide at least the foundation of
this book. Happily, after graduation, he married Dr
Jill Rosenblatt, a young graduate from Melbourne
University, who shared his vocational interests.
Subsequently they also shared the fulfilment of family

life and the intellectual and emotional satisfaction of
serving as doctors in a rural setting.
In the meantime the Royal Australian College of
General Practitioners had established postgraduate
training programs that had a significant influence
on standards of professional practice. At the same
time Monash University established a Department of
Community Medicine at one of its suburban teaching
hospitals, under the Chairmanship of Professor
Neil Carson and staffed by practitioners in the local
community.
While in practice Dr Murtagh gained a Fellowship of
the College through examination. The College recognised
his unique clinical, educational and communication
skills and immediately commissioned him to prepare
educational programs, especially the CHECK programs.
His outstanding expertise as a primary care physician led
to his appointment as a senior lecturer in the University
Department of Community Medicine.
The success of the initial academic development
in Community Medicine at Monash University, and
its influence on the clinical skills of its graduates as
they relate to primary care, led to a University decision
to establish a further Department of Community
Medicine at another suburban teaching hospital in
Melbourne. It was considered by the University to be
entirely appropriate that Dr Murtagh be invited to accept
appointment as Professor and Head of that Department.
Four years later Professor Murtagh was appointed Head
of the extended Department and the first Professor of

General Practice at Monash University.
John Murtagh has now become a national and
international authority on the content and teaching of

primary care medicine. As Medical Editor of Australian
Family Physician from 1986 to 1995 he took that journal
to the stage where it was the most widely read medical
journal in Australia.
This textbook provides a distillate of the vast
experience gained by a once-upon-a-time rural doctor
whose career has embraced teaching from first to last,
whose interest is ensuring that disease, whether minor
or life-threatening, is recognised quickly, and whose
concern is that strategies to match each contingency
are well understood.
General Practice is the outcome of the vision of a
schoolteacher of great talent who made a firm decision
to become a country doctor; through this book his dream
has become a reality for all who are privileged to practise
medicine in a community setting. It is most appropriate
that Jill Rosenblatt, John’s partner in country practice
has joined him as co-author of this fifth edition.
The first edition of this book, published in 1994,
achieved remarkable success on both the national and
international scene. The second and third editions built
on this initial success and in an extraordinary way the
book became known as the ‘Bible of General Practice’ in
Australia. In addition to being widely used by practising
doctors, it has become a popular and standard textbook
in several medical schools and also in the teaching

institutions for alternative health practitioners, such as
chiropractic, naturopathy and osteopathy. In particular,
medical undergraduates and graduates struggling to learn
English have found the book relatively comprehensible.
The fourth edition was updated and expanded, and
retained the successful format of previous editions but
with a more attractive and user-friendly format including
clinical photographs and illustrations in colour.
John Murtagh’s works have been translated into
Italian by McGraw-Hill Libri Italia s.r.l., Portuguese by
McGraw-Hill Nova Iorque and Spanish by McGraw-Hill
Interamericana Mexico, and into Chinese, Greek, Polish
and Russian. In 2009 John Murtagh’s General Practice
was chosen by the Chinese Ministry of Health as the
textbook to aid the development of general practice in
China. Its translation was completed later that year.
GC SCHOFIELD
OBE, MD, ChB(NZ), DPhil(Oxon), FRACP,
FRACMA, FAMA
Professor of Anatomy,
Monash University, 1961–77
Dean of Medicine,
Monash University, 1977–88

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Contents
The authors
Foreword
Acknowledgments
Preface
Making the most of your book
Reviewers
Normal values: worth knowing by heart
Abbreviations

v
vii
xii
xiii
xiv
xviii
xxi
xxii

Part 1

The basis of general practice

1

1
2
3
4

5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

The nature and content of general practice
The family
Consulting skills
Communication skills
Counselling skills
Difficult, demanding and angry patients
Health promotion and patient education
The elderly patient
Prevention in general practice
Nutrition in healthand illness
Palliative care
Pain and its management
Research and evidence-based medicine
Travel medicine

Tropical medicine and the returned traveller
Laboratory investigations
Inspection as a clinical skill
A safe diagnostic strategy
Genetic conditions

2
7
14
21
29
39
43
48
62
72
81
90
103
112
125
136
145
150
158

Part 2

Diagnostic perspective in general practice

177

20
21
22
23
24
25
26
27
28

Depression
Diabetes mellitus: diagnosis
Drug problems
Anaemia
Thyroid and other endocrine disorders
Spinal dysfunction
Urinary tract infection
Malignant disease
HIV/AIDS—could it be HIV?

178
186
193
204
211
222
225
233

241

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Contents

Murtagh Prelims.indd ix

29
30
31
32
33
34

Baffling viral and protozoal infections
Baffling bacterial infections
Infections of the central nervous system
Chronic kidney failure
Connective tissue disease and the vasculitides
Neurological dilemmas

251
258
270

275
282
291

Part 3

Problem solving in general practice

307

35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54

55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

Abdominal pain
Arthritis
Anorectal disorders
Thoracic back pain
Low back pain
Bruising and bleeding
Chest pain
Constipation
Cough
Deafness and hearing loss

Diarrhoea
The disturbed patient
Dizziness/vertigo
Dyspepsia (indigestion)
Dysphagia
Dyspnoea
The painful ear
The red and tender eye
Pain in the face
Fever and chills
Faints, fits and funny turns
Haematemesis and melaena
Headache
Hoarseness
Jaundice
Nasal disorders
Nausea and vomiting
Neck lumps
Neck pain
Shoulder pain
Pain in the arm and hand
Hip, buttock and groin pain
Pain in the leg
The painful knee
Pain in the foot and ankle
Walking difficulty and leg swelling
Palpitations
Sleep disorders
Sore mouth and tongue

308
329
351
359
373
394
403
423
434
449
458
474
491
500
510
514
526
539
554
564
573
581
584
601
604
620
629
634
638
651

663
679
691
708
727
744
751
764
773

ix

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x

Contents

74
75
76
77
78
79
80

Sore throat
Tiredness/fatigue
The unconscious patient

Urinary disorders
Visual failure
Weight gain
Weight loss

783
791
798
806
817
829
837

Part 4

Child and adolescent health

843

81
82
83
84
85
86
87
88

An approach to the child
Specific problems of children

Surgical problems in children
Common childhood infectious diseases (including skin eruptions)
Behaviour disorders in children
Child abuse
Emergencies in children
Adolescent health

844
851
868
878
891
899
906
920

Part 5

Women’s health

925

89
90
91
92
93
94
95
96

97
98
99
100
101
102
103
104

Cervical cancer andPap smears
Family planning
Breast pain (mastalgia)
Lumps in the breast
Abnormal uterine bleeding
Lower abdominal and pelvic pain in women
Premenstrual syndrome
The menopause
Osteoporosis
Vaginal discharge
Vulvar disorders
Domestic violence and sexual assault
Basic antenatal care
Infections in pregnancy
High-risk pregnancy
Postnatal care

926
934
943
948

959
966
979
983
990
994
1002
1009
1013
1021
1026
1040

Part 6

Men’s health

1047

105
106
107
108
109

Men’s health: an overview
Scrotal pain
Inguinoscrotal lumps
Disorders of the penis
Disorders of the prostate

1048
1051
1056
1066
1072

Part 7

Sexually related problems

1079

110

The subfertile couple

1080

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Contents

Murtagh Prelims.indd xi

111
112

Sexual health
Sexually transmitted infections

Part 8

Problems of the skin

1111

113
114
115
116
117
118
119
120
121

A diagnostic and management approach to skin problems
Pruritus
Common skin problems
Acute skin eruptions
Skin ulcers
Common lumps and bumps
Pigmented skin lesions
Hair disorders
Nail disorders

1112
1122
1131
1152
1164
1172
1188
1197
1206

Part 9

Chronic disorders: continuing management

1215

122
123
124
125
126
127
128
129
130
131

Alcohol problems
Allergic disorders including hay fever
Anxiety disorders

Asthma
Chronic obstructive pulmonary disease
Epilepsy
Hypertension
Dyslipidaemia
Diabetes mellitus: management
Chronic heart failure

1216
1223
1230
1239
1251
1258
1266
1285
1289
1302

Part 10

Accident and emergency medicine

1309

132
133
134
135
136

137
138

Emergency care
The doctor’s bag and other emergency equipment
Stroke and transient ischaemic attacks
Thrombosis and thromboembolism
Common skin wounds and foreign bodies
Common fractures and dislocations
Common sporting injuries

1310
1324
1330
1336
1342
1355
1377

Part 11

Health of specific groups

1393

139
140
141

The health of Indigenous peoples

Refugee health
Catchy metaphors, similes and colloquial expressions in medicine

1394
1402
1407

Appendix
Index

1413
1421

xi

1087
1099

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Acknowledgments
The author would like to thank the Publication
Division of the Royal Australian College of General
Practitioners for supporting my past role as Medical
Editor of Australian Family Physician, which has
provided an excellent opportunity to gather material
for this book. Acknowledgment is also due to those
medical organisations that have given permission
to use selected information from their publications.

They include the Preventive and Community Medicine
committee of the RACGP (Guidelines for Preventive
Activities in General Practice), Therapeutic Guidelines
Limited (Therapeutic Guidelines series), the Hypertension
Guideline Committee: Research Unit RACGP (South
Australian Faculty), and the Medical Observer, publishers
of A Manual for Primary Health Care, for permitting
reproduction of Appendices I–IV.
Special thanks to Chris Sorrell, graphic designer, for
his art illustration, and to Nicki Cooper, Jenny Green

and Caroline Menara for their skill and patience in
typing the manuscript.
Figure 67.5 was provided by Dr Levent Efe.
Many of the quotations at the beginning of chapters
appear in either Robert Wilkins (ed), The Doctor’s
Quotation Book, Robert Hale Ltd, London, 1991 or
Maurice B. Strauss (ed), Familiar Medical Quotations,
Little, Brown & Co., New York, 1958.
Thanks are also due to Dr Bruce Mugford, Dr
Lucie Stanford, Dr Mohammad Shafeeq Lone, Dr
Brian Bedkobar and to Lesley Rowe, for reviewing the
manuscript, and to the publishing and production
team at McGraw-Hill Australia for their patience and
assistance in so many ways.
Finally, thanks to Dr Ndidi Victor Ikealumba for his
expert review of General Practice fourth edition and his
subsequent contribution.

Photo credits

Photographs appearing on the pages below are taken
from The Color Atlas of Family Medicine by Richard P
Usatine MD, McGraw-Hill US 2009, with the kind
permission of the following people:
Dr Richard Usatine: Fig 65.13, pg. 673; Fig 73.6,
pg. 781; Fig 82.4, pg. 862; Fig 82.5, pg. 862; Fig 82.6,
pg. 863; Fig 98.5, pg. 1000; Fig 112.5, pg. 1106;
Fig 118.20, pg. 1182; Fig 120.5, pg. 1202; Fig 120.6, pg.
1202; Fig 99.1, pg. 1004 and Fig 115.12, pg. 1143.
Dr Marc Solioz: Fig 17.1, pg. 146.
Dr Brad Neville: Fig 73.1, pg. 776.
Dr Edwin A Farnell: Fig 121.3a, pg. 1208.

McGraw-Hill USA: Fig 51.5, pg. 529; Fig 51.9, pg. 532;
Fig 58.1, pg. 603; Fig 91.2, pg. 947; Fig 92.2, pg. 950;
Fig 114.5, pg. 1126; Fig 121.2a, pg. 1208; Fig 140.1,
pg. 1404; Fig 15.6, pg. 134 and Fig 22.2, pg. 197.
Photographs from Infectious Diseases: Atlas, Cases, Text
by Robin Cooke, McGraw-Hill Australia 2008, with
the kind permission of Professor Robin Cooke and
Brian Stewart: Fig 15.2, pg. 129; Fig 15.3, pg. 130 and
Fig 31.2, pg. 271.

Journal of Family Practice, December 2007; 56(12):1025,
Dowden Health Media: Fig 86.4, pg. 903.

xii

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Preface
The discipline of general practice has become complex,
expansive and challenging, but nevertheless remains
manageable, fascinating and rewarding. John Murtagh’s
General Practice attempts to address the issue of the base
of knowledge and skills required in modern general
practice. Some of the basics of primary healthcare
remain the same. In fact, there is an everlasting identity
about many of the medical problems that affect human
beings, be it a splinter under a nail, a stye of the eyelid,
a terminal illness or simply stress-related anxiety. Many
of the treatments and approaches to caring management
are universal and timeless.
This text covers a mix of traditional and modern practice
with an emphasis on the importance of early diagnosis,
strategies for solving common presenting problems,
continuing care, holistic management and ‘tricks of the
trade’. One feature of our discipline is the patient who
presents with undifferentiated problems featuring an
overlap of organic and psychosocial components. There
is the constant challenge to make an early diagnosis and
identify the ever-lurking, life-threatening illness. Hence
the ‘must not be missed’ catch cry throughout the text.
To reinforce this awareness ‘red flag pointers’ to serious
disease have been added where appropriate. The general
practice diagnostic model, which pervades all the chapters
on problem solving, is based on the authors’ experience,

but readers can draw on their own experience to make
the model work effectively for themselves.
This fifth edition expands on the challenging initiative
of diagnostic triads (or tetrads) which act as a brief aide-

memoire to assist in identifying a disorder from three
(or four) key symptoms or signs. A particular challenge
in the preparation of the text was to identify as much
appropriate and credible evidence-based information as
possible. This material, which still has its limitations,
has been combined with considerable collective wisdom
from experts, especially from the Therapeutic Guideline
series. To provide updated accuracy and credibility the
authors have had the relevant chapters peer reviewed
by independent experts in the respective discipline.
These consultants are acknowledged in the reviewers
section. The revised edition also has the advantage of
co-authorship from an experienced general practitioner,
Dr Jill Rosenblatt, who in fact provided considerable
input into previous editions, especially regarding
women’s health.
Such a comprehensive book, which presents a basic
overview of primary medicine, cannot possibly cover
all the medical problems likely to be encountered. An
attempt has been made, however, to focus on those
problems that are common, significant, preventable
and treatable. Expanded material on genetic disorders,
infectious diseases and tropical medicine provides a
glimpse of relatively uncommon presenting problems
in first-world practice.

John Murtagh’s General Practice is written with the
recent graduate, the international medical graduate and
the medical student in mind. However, it is hoped that all
primary-care practitioners will gain useful information
from the book’s content.

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Making the most of
your book

Patient
presentation
Patient presentation provides the overall structure
of the book, mirroring clinical presentation in
practice. General Practice is renowned for this
unique and powerful learning feature which the
book introduced from its first edition.

The staff of
Asclepius
The staff of Asclepius icon is a new feature
highlighting diseases for when you are
specifically searching for information on a
particular disease.

1BSU



1SPCMFN
TPMWJOH
JO
HFOFSBM
QSBDUJDF


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35
36
37
38
39
40
41
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43
44
45
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48
49
50
51
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53
54
55
56
57

58
59
60
61
62
633
6

Abdominal pain
Arthritis
Anorectal disorders
Thoracic back pain
Low back pain
Bruising and bleeding
Chest pain
Constipation
Cough
Deafness and hearing loss
Diarrhoea
The disturbed patient
Dizziness
Dyspepsia (indigestion)
Dysphagia
Dyspnoea
The painful ear
The red and tender eye
Pain in the face
Fevers and chills
Faints, fits and funny turns
Haematemesis and melaena

Headache
Hoarseness
Jaundice
Nasal disorders
Nausea and vomiting
Neck lumps
Neck pain

x
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x
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Schistosomiasis (bilharzia)
The infestation is caused by parasite organisms
(schistosomes) whose eggs are passed in human
excreta, which contaminates watercourses (notably
stagnant water) and irrigation channels in Egypt,
other parts of Africa, South America, some parts of
South-East Asia and China. Freshwater snails are the
carriers (vectors).

Key facts and checkpoints

Key facts and
checkpoints
Key facts and checkpoints provide accurate
statistics and local and global contexts.

• The main diseases facing the international traveller
are traveller’s diarrhoea (relatively mild) and malaria,
especially the potentially lethal Plasmodium falciparum
malaria.
17/2/10 5:45:32 PM
• Most cases of traveller’s diarrhoea are caused by

enterotoxigenic Escherichia coli and Campylobacter
specus.
• Enteroinvasive E. coli (a different serotype) produces a
dysentery-like illness similar to Shigella.
• Traveller’s diarrhoea is contracted mainly from
contaminated water and ice used for beverages,
washing food or utensils or cleaning teeth.
• Poliomyelitis is endemic in at least 20 countries and
thus immunisation for polio is still important.

xiv

Murtagh Prelims.indd xiv

22/10/10 2:21:57 PM


Making the mostWhat
of your
is new?
book

xv

Yellow flag pointers

Red and yellow
flags
Red and yellow flags alert you to
potential dangers. The severity rates

red as the most urgent with yellow
requiring very careful consideration.

This term has been introduced to identify psychosocial
and occupational factors that may increase the risk of
chronicity in people presenting with acute back pain.
Consider psychological issues if:
• abnormal illness behaviour
• compensation issues
• unsatisfactory restoration of activities
Red flags for organic disease 12
• failure to return to work
• unsatisfactory response to treatment
• Older patient
• treatment refused
• atypical physical signs • Nocturnal pain or diarrhoea
• Progressive symptoms
• Rectal bleeding
• Fever
• Anaemia
• Weight loss
• Abdominal mass
• Faecal incontinence or urgency (recent onset)

Clinical features

Clinical framework
Clinical framework based on
major steps of clinical features,
investigations, diagnosis,

management and treatment reflects
the key activities in the daily tasks of
general practitioners.

• Peak incidence 50–70 years
• Risk factors:
— age
— obesity
— nulliparity
— late menopause
— diabetes mellitus

Symptoms
80% present with abnormal bleeding, especially
postmenopausal bleeding.

Examination
• Uterus usually feels normal, but may be bulky.

Investigations

xxx

• Smear (after pregnancy excluded)—detects some
cases. Endometrial cancer is not excluded by a normal
cervical smear
• Transvaginal ultrasound

Management
• Urgent gynaecological referral

Diagnostic triads
Key features that may discriminate
between one disease and another are
clearly presented.

xxx

DxT: febrile illness + vomiting + stupor =
Japanese B encephalitis

Murtagh - General Practice (5e) Part 3.indd 377

Q.

Seven masquerades checklist

A.

Depression



Diabetes

–

Drugs



Anaemia

–

Murtagh - General Practice (5e) Part 3.indd 327

Murtagh Prelims.indd xv

Thyroid disorder

–

Spinal dysfunction



UTI



Seven masquerades
checklist
Seven masquerades checklist is a unique
feature of the book that reminds you of
potential and hidden dangers underlying
patient presentations.

11/8/10 8:56:22 AM

22/10/10 2:21:59 PM


xvi

Part Onethe most of your book
Making

Evidence-based
research

13

Evidence-based research is recognised with a
full chapter on research in general practice and
evidence base, including more on qualitative
models. In addition, substantial references are
provided for every chapter.

Research and evidencebased medicine
Not the possession of truth, but the effort of struggling to attain it brings joy to the researcher.
G O F F H O L D L A S S I N G (1729–81)

Effective research is the trademark of the medical
developed in the context of Australian general practice
profession. When confronted with the great responsibility
and now beyond that. The focus of EBM has been
of understanding and treating human beings we need
to improve health care and health economics. Its
development has gone hand in hand with improved

as much scientific evidence as possible to render our
decision making valid, credible and justifiable.
information technology. EBM is inextricably linked
Research can be defined as ‘a systematic method
to research.
in which the truth of evidence is based on observing
The aim of this chapter is to present a brief overview
and testing the soundness of conclusions according to
of research and EBM and, in particular, to encourage
consistent rules’1 or, to put it more simply, ‘research
GPs, either singly or collectively, to undertake research—
is organised curiosity’,2 the end point being new and
simple or sophisticated—and also to publish their work.
improved knowledge.
The benefits of such are well outlined in John Howie’s
In the medical context the term ‘research’ tends to
classic text Research in General Practice.5
conjecture bench-type laboratory research. However, the
Why do research?
discipline of general practice provides a fertile research
The basic objective of research is to acquire new
area in which to evaluate the morbidity patterns and
knowledge and justification for decision making in
the nature of common problems in addition to the
medical practice. Research provides a basis for the
processes specific to primary health care.
acquisition of many skills, particularly those of critical
There has been an excellent tradition of research
thinking and scientific methodology. The discipline of
conducted by GPs. Tim Murrell in his paper ‘Nineteenth

general practice is special to us with its core content of
century masters of general practice’3 describes the
continuing, comprehensive, community-based primary
contributions of Edward Jenner, Caleb Parry, John
care, family care, domiciliary care, whole-person care
Snow, Robert Koch and James MacKenzie, and notes
and preventive care. To achieve credibility and parity
that ‘among the characteristics they shared was their
with our specialist colleagues we need to research this
capacity to observe and record natural phenomena,
area with appropriate methodology and to define the
breaking new frontiers of discovery in medicine using
discipline clearly. There is no area of medicine that
an ecological paradigm’.
involves such a diverse range and quantity
ity of decisions
This tradition was carried into the 20th century by
101 erefor
Pain and its management
each day as general practice, and therefore
patient
GPs such as William Pickles, the first president of the
management needs as much evidence-based
e-bas rigour
Royal College of General Practitioners, Keith Hodgkin
as possible.
and John Fry, all of whom meticulously recorded data
ural practice
p
Our own patch, be it an isolated rural

or
that helped to establish patterns for the nature of
For antiplatelet effects use low doses 2–5 mg/kg/
Hydromorphone
ts own
ow microan industrial suburban practice, has its
primary health care. In Australia the challenge was taken
day.
Usual dosage:
epidemiological fascination. Thus, it provides
ovides a unique
up by such people as Clifford Jungfer,
Alan Chancellor,
NSAIDs
opportunity to find answers to questions
ons aand make
Charles Bridges-Webb, Kevin•Cullen
and Trevor
0.04 mg/kg
(o) 4Beard
hourly
4
muni
observations about that particular community.
in the
and nowfor
the research activities of the new
NSAIDs have a proven safety and
effi1960s,
cacy in children

generation
GPs, academic-based
or practice-based,
There are also personal reasons to undertake
u
Methadone
mild to moderate pain and can
be used inofconjunction
research. The process assists professional
al development,
deve
havesuch
beenastaken
to a higher
with themg/kg
development
with paracetamol and opioids
codeine
and level
• 0.1–0.2
(o) 8–12 hourly
of evidence-based
encouraging clear and critical thinking,, improvement
imp
morphine. The advantage is their
opioid-sparingmedicine
effect. (EBM).
usedCollaboration
for opioid weaning
rotationand the satisfaction of developing

evelo
Based
on the work of the Often
Cochrane
of and
knowledge
new
Contraindications include known
hyper-sensitivity,
skills and opening horizons.
and the
initiatives
of Chris Silagy
in particular it has
severe asthma (especially if aspirin
sensitive),
bleeding
Fentanyl
diatheses, nasal polyposis and peptic ulcer disease.
Fentanyl citrate can be administered orally (transThose commonly used for analgesia are:
mucosal) as ‘lollipops’, transcutaneous as ‘patches’,

Extensive coverage
of paediatric and
geriatric care,
pregnancy, and
complementary
therapies

12

• ibuprofen: 5–10 mg/kg (o) 6–8 hourly (max.
40 mg/kg/day)
• naproxen: 5–10 mg/kg (o) 12–24 hourly (max. 1 g/day)
• indomethacin: 0.5–1 mg/kg (o) 8 hourly (max.
Murtagh - General Practice (5e) Part 1.indd 106-107
200 mg/day)
• diclofenac: 1 mg/kg (o) 8 hourly (max. 150 mg/day)
• celecoxib 1.5–3 mg/kg (o) bd

Extensive coverage of paediatric
and geriatric care, pregnancy,
and complementary therapies is
integrated throughout; as well as
devoted chapter content providing
more comprehensive information in
these areas.

The rectal dose is double the oral dose (e.g.
indomethacin 2 mg/kg) but only administered twice
a day.

Opioid analgesics
Oral opioids
These have relatively low bioavailability but can be
used for moderate to severe pain when weaning from
parenteral opioids, for ongoing severe pain (e.g. burns)
and where the IV route is unavailable.

• 0.3 mg/kg (o) 4 hourly prn

Sustained release:

Some general rules and tips2

• 0.6–0.9 mg/kg, 12 hourly

• Give analgesics at fixed times by the clock rather than
‘prn’ for ongoing pain.
• Regularly monitor your patient’s analgesic
requirements and modify according to needs and
adverse effects.
• Start with a dose towards the lower end of the dose
range and then titrate upwards depending on response.
• Provide ongoing interest and support. This will
magnify any placebo effect.
• Avoid using compound analgesics and prescribe
simple and opioid analgesics separately.
• Never cut suppositories in half with the intention of
halving the dose.

More effective if used combined with paracetamol
or ibuprofen.

Morphine
Immediate release:

• 1–2 mg/kg (o) 4 hourly (avoid with SSRIs)

numbness

Oxycodon
Oxycodone
Immediate release:
• 0.2–0.3 mg/kg
m
(o) 4 hourly (max. 10 mg)

pins and needles

intolerable pain

Sustained release:
Back

10

Front

• morphine: 0.2 mg/kg (max. 10–15 mg), 4 hourly prn
• pethidine: 2 mg/kg (max. 25–100 mg), 3 hourly prn

Older patients have the highest incidence of painful
disorders and also surgical procedures. As a general
rule, most elderly patients are more sensitive to
opioid analgesics and to aspirin and other NSAIDs
but there may be considerable individual differences
in tolerance between patients. Patients over 65 years
should receive lower initial doses of opioid analgesics
with subsequent doses being titrated according to the

patient’s needs.2

• 0.5–1 mg/kg (o), 4–6 hourly prn (max. 3 mg/kg/day)

Tramadol
Usual dosage:

pain

Parenteral opioids8
These are the most powerful parenteral analgesics for
children in severe pain and can be administered in
intermittent boluses (IM, IV or SC) or by continuous
infusion (IV or SC). Infants under 6 months are
more sensitive and need careful monitoring (e.g.
pulse oximetry). This management is invariably in the
hospital. Administration of parenteral opioid should
not be undertaken without the availability of oxygen,
resuscitation equipment and naloxone to reverse
overdose.
Maximum dosage of IM opioids:

Analgesics in the elderly

Codeine
Usual dosage:

Mark the areas on your body where you feel the various sensations

or intranasally via a mucosal atomiser device (for

painful procedures).

• 0.6 mg/
mg/kg (o) 12 hourly

9

8

Full colour
illustrations

Murtagh - General Practice (5e) Part 1.indd 100-101

7

6
moderate pain

5

4

3
Left

Right

Right

2

1

Left

17/2/10 5:45:20 PM

Full colour illustrations with over
600 diagrams retaining the clean
and simple style that has proved so
popular.

0
no pain
Mark your level of
pain on this scale

Figure 12.2 Assessing pain using a visual analogue scale and body chart: ideal for lumbosacral pain

Murtagh - General Practice (5e) Part 1.indd 96-97

Murtagh Prelims.indd xvi

17/2/10 5:45:17 PM

22/10/10 2:22:01 PM


Making the mostWhat

of your
is new?
book

xvii

Clinical photos
Clinical photos provide authentic and visual
examples of many conditions and serve as either a
valuable introduction or confirmation of diagnosis.

PRACTICE TIPS
• Morphine is the gold standard for pain.
• Consider prescribing antidepressants routinely for
patients in pain.
• Remember the ‘sit down rule’ whereby the home
visit is treated as a social visit—sitting down with
the patient and family, having a ‘cuppa’ and sharing
medical and social talk.3
• Early referral of terminal patients with difficult-tocontrol problems, especially pain, to a hospice or
multidisciplinary team can enhance the quality of
care. However, the patient’s family doctor must still
be the focus of the team.

Figure 15.4 Cutaneous leishmaniasis in a serviceman
after returning from the Middle East

Practice tips
Practice tips consists of key points of
use in the clinical setting.

Index

Significantly
enhanced index
Enhanced index has more subcategories with bold page numbers
indicating main treatment the topic,
enabling you to quickly pinpoint the
most relevant information.
Page numbers in italics refer to
figures and tables. Entries with
‘see also’ have cross-references to
related, but more specific information
on the topic.

25/8/10 2:31:13 PM

dental trauma 773, 776
dentition, and weight loss 842
denture therapy 776
dependent personality disorders 489
Depo-Provera 939, 962, 975
depression 178–85
in adolescents 795, 922–4
antidepressant medication 181–3
anxiety symptoms due to 1238
assessment of 485
back pain due to 373, 375–6, 392
cause of 181
in children 180, 486

classifications of 178
cognitive behaviour therapy 32
complementary therapies 183
constipation due to 425
contrasted with dementia 55, 55
counselling for 36–7
delirium due to 476
depression scales 180–1
diagnosis of 179, 180–1
drugs that may cause 179
due to alcohol abuse 1219
dyspepsia due to 500
ear pain due to 528
in the elderly 49, 55, 58, 180, 476
faints and fits due to 574
headache due to 587
major and minor depression 178–9
management of 181
masked depression 179–80
as a masquerade 154
‘missing chemical’ theory 37
non-pharmacological interventions 924
in patients with myocardial
infarction 420
perinatal depression 180
postnatal depressive disorders 1045–6
psychogenic pain 102
recurrent depression 184
as a side effect of oral contraceptives 938
tiredness due to 791, 792, 793

treatment of bipolar depression 485
weight loss due to 838, 842
see also suicide
depressive personality disorder 489
de Quervain tenosynovitis 663, 671, 673–4,
673–4, 678
de Quervain thyroiditis 215–16, 641
dermal skin lesions 1115, 1115
Derma Oil 734, 1134
Dermatec 1176
Dermatech Wart Treatment 866
dermatitis 1131–8
causes 1131
in children 864–5, 864–5
effect on nails 1116
irritant dermatitis 864–5, 1141
peri-oral dermatitis 1145, 1145–6

pruritus due to 1122, 1126
with umbilical discharge 863
vulvar dermatitis 1002–3, 1007
see also atopic dermatitis; eczema;
seborrhoeic dermatitis
dermatitis artefacta 1170
dermatitis herpetiformis 1114, 1122, 1125,
1125, 1129
dermato-conjunctivitis 543
dermatofibroma 1172, 1178–9, 1188, 1194
dermatomes 362, 363, 556
dermatomyositis 155, 234, 282–3, 287, 287–8,

330, 330, 343
dermatosis 1002, 1150
Dermeze 1133
dermoid cysts 636, 869
desensitisation 32
desferrioxamine 162, 207, 911
desipramine 1160
desloratadine 1227
desmoplastic melanoma 1193
desmopressin acetate 401, 860
desogestrel 935
desonide 1137
desvenlafaxine 182
detergent worker’s disorder 523
detrusor instability 813
developmental disability and delay 166–9,
850, 857–8
developmental dysplasia of the hip 679,
681, 684–5, 685, 690, 746, 874
developmental problems 846, 853–8
DEXA 991, 993
dexamethasone
for altitude sickness 123
for anorexia 87
for cerebral metastases 87
for croup 914
for meningitis 271, 912
for migraine 593
for nausea and vomiting 632
for pressure pain 84, 86

dexamphetamines 197, 579, 768
dexchlorpheniramine 447
dexedrine 199
dextrin 430
dextromethorphan 202, 203, 447
dextropropoxyphene 96, 910
dextrose 74, 916
DHA 75
DHEA 202
Dhobie itch 1126
diabetes insipidus 218
diabetes ketoacidosis 310, 328, 799
diabetes ketosis 476
diabetes mellitus
age of onset 48
air travel by diabetics 121
with arthropathy 329
association with facial nerve palsy 305

causes of secondary diabetes 187
in children 189–90
clinical features 187–8
complications of 190, 191, 192
deafness due to 455
delirium due to 476
diagnosis of 186–9
dietary control of 77
in the elderly 49, 190
erectile difficulties 1088
gestational diabetes 187, 189–90

hyperhidrosis due to 1149
kidney failure due to 275, 275
as a masquerade 154, 186
microvascular disease 190
neuropathy in 190, 192, 727, 729
painful diabetic neuropathy 101–2, 694
penile lesions due to 1070
peripheral neuropathy due to 302
prediabetes 189
in pregnancy 1030
preventing nephropathy 190
prevention of 192
retinopathy of 190, 817
as a risk factor for maternal
disorders 1028
role of exercise and diet 67
skin signs of 187
with skin ulcers 1164
susceptibility to infections 192
types 186, 186, 282
visual failure due to 818
weight loss due to 837–8, 840
diabetic ketoacidosis 192
diabetic lumbosacral r
adiculoplexopathy 190
diabetic maculopathy 828
diabetic proteinuria 813
diagnosis
application of the model 156–7
basic model of 150, 150–6

communication of to patients 18–19
components of 3–4
conditions often missed 152–3
defining the problem 17
diagnostic triads 150, 155, 306
of difficult and demanding patients 39
failure to make 18
hidden agendas of patients 154–6
history-taking in 15–17
inspection as a clinical skill 145–9
masquerades in 153–4, 154–5
mnemonics for 151–2
most common disorders 5–6
ordering further tests 17–18
psychosocial reasons for
malaise 154–6, 156
see also specific conditions and diseases
diagnostic triads 150, 155, 306
dialysis 280

1421

Patient education resources
Hand-out sheets from Murtagh’s Patient Education
5th edition:
• Attention Deficit Hyperactivity Disorder, page 14
• Autism, page 15
• Autism: Asperger’s Syndrome, page 16
• Bullying of Children, page 21
Murtagh - General Practice (5e) Part 1.indd 92-93

• Stuttering, page 57
• Tantrums, page 58

Murtagh Prelims.indd xvii

IndexSample.indd 1421

11/8/10 9:57:31 AM

Patient education resources
Where you can find relevant information
from Murtagh’s Patient Education 5th edition
to photocopy and hand out to patients.

22/10/10 2:22:03 PM


Reviewers
The fourth edition underwent a rigorous peer review process to ensure that General Practice remains
the gold standard reference for general practitioners around the world.
To that end, the author and the publishers extend their sincere gratitude to the following people who
generously gave their time, knowledge and expertise.

Content consultants
The author is indebted to the many consultants for their help and advice after reviewing various parts of the
manuscript that covered material in their particular area of expertise.

Dr Rob Baird

laboratory investigation

Dr Roy Beran

epilepsy; neurological dilemmas

Dr Peter Berger

a diagnostic and management approach to skin problems

Professor Geoff Bishop

basic antenatal care

Dr John Boxall

palpitations

Dr Jill Cargnello

hair disorders

Dr Paul Coughlin and
Professor Hatem Salem

bruising and bleeding; thrombosis and thromboembolism

Mr Rod Dalziel

shoulder pain

Dr David Dunn and
Dr Hung The Nguyen

the health of Indigenous peoples

Dr Robert Dunne

common skin wounds and foreign bodies

Professor John Emery

genetic disorders, malignant disease

Genetic Health Services, Victoria

genetic disorders

Dr Lindsay Grayson and
Associate Professor Joseph Torresi

travel medicine, the returned traveller and tropical medicine

Dr Michael Gribble

anaemia

Mr John Griffiths

pain in the hip and buttock

Professor Michael Grigg

pain in the leg

Dr Gary Grossbard

the painful knee

Dr Peter Hardy-Smith

the red and tender eye; visual failure

Professor David Healy

abnormal uterine bleeding

Assoc Professor Peter Holmes

cough; dyspnoea; asthma; COPD

Dr Ndidi Victor Ikealumba

refugee health

Professor Michael Kidd, Dr Ron McCoy human immunodeficiency virus infection
and Dr Alex Welborn
Professor Gab Kovacs

abnormal uterine bleeding; the infertile couple

Professor Even Laerum

research in general practice

xviii

Murtagh Prelims.indd xviii

22/10/10 2:22:05 PM


What
Reviewers
is new?

Dr Barry Lauritz

common skin problems; pigmented skin lesions

Mr Peter Lawson (deceased) and Dr
Sanjiva Wijesinha

disorders of the penis; prostatic disorders

Dr Peter Lowthian

arthritis

Mr Frank Lyons

common fractures and dislocations

Professor Barry McGrath

hypertension

Dr Joe McKendrick

malignant disease

Professor Robyn O’Hehir

allergic disorders, including hayfever

Dr Michael Oldmeadow

tiredness

Dr Frank Panetta

chest pain

Professor Roger Pepperell

high risk pregnancy

Dr Geoff Quail

pain in the face, sore mouth and tongue

Mr Ronald Quirk

pain in the foot and ankle

Dr Ian Rogers

emergency care

Dr Jill Rosenblatt

the menopause; cervical cancer and Pap smears

Professor Avni Sali

abdominal pain; lumps in the breast; jaundice; constipation;
dyspepsia; nutrition

Dr Hugo Standish

urinary tract infection; chronic kidney failure

Dr Richard Stark

neurological diagnostic triads

Dr Paul Tallman

stroke and transient ischaemic attacks

Dr Alison Walsh

breastfeeding, post-natal breast disorders

Professor Greg Whelan

alcohol problems, drug problems

Dr Sanjiva Wijesinha

men’s health, scrotal pain, inguinoscrotal lumps

Dr Alan Yung

fever and chills; sore throat

Dr Ronnie Yuen

diabetes mellitus; thyroid and other endocrine disorders

xix

A substantial number of people were involved in reviewing this book through surveys and their
invaluable contribution is acknowledged below. We also take the opportunity to thank the other
participants who preferred not to be named in this collective.

Survey respondents
Ashraf Aboud
Mehdi Alzaini
Anne Balcomb
Jill Benson

Ibrahim K Botros
Chris Briggs
Kathy Brotchie
Shane Brun

Murtagh Prelims.indd xix

Daniel Byrne
Paul Carroll
Louisa Case
Ercelle Celis
Peter Charlton
Tricia Charmer
Rudolph W M Chow
Patrick Clancy

Jennifer Cook-Foxwell
Barrie Coulson
Therese Cox
Roxane Craig
Gordana Cuk
Alice Cunningham
Fred De Looze
Rudi De Mulder

22/10/10 2:22:05 PM


xx

Part One
Reviewers

Gabrielle Dellit
Michael Desouza
Yock Seck Ding
Matthew Dwyer
Judith Ellis
Jon Emery
Say Poh Eng
Iain Esslemont
Marian Evans
Wes Fabb
N Fajardo
Cyril Fernandez
Danika Fietz
Clare Finnigan
Anthony Fok
Oliver Frank
Brett Garrett
Tarek Gergis
Ben Gerhardy
Elena Ghergori
Naomi Ginges
Jim Griffin
Ranjan Gupta
Hadia Haikal-Mukhtar
Pedita Hall
Nazih Hamzeh
Erfanul Haque

Abby Harwood
Mark Henschke
Edward C Herman
D Ho
David Holford
Sue Hookey
Elspeth Horn
Seyed Ebrahim Hosseini
Faline Howes
Brett Hunt
Rosalyn Hunt
Farhana Hussein
Robyn Hüttenmeister
Anwar Ikladios
John Inkwater

Daljit Janjua
Diosdado Javellana
Aravinda Jawali
Les Jenshel
Fiona Joske
Meredith Joslin
Gloria Jove
Mohammed Al Kamil
Inas Abdul Karim
Sophia Kennelly
George Kostalas
Jim Kourdoulos
Ivan S Lee
Mohammad Shafeeq Lone

Christine Lonergan
Dac Luu
Justin Madden
Hemant Mahagaonkar
Meredith Makeham
Shahid Malick
Muhammad Mannan
Luke Manestar
Linda Mann
Cameron Martin
Kohei Matsuda
Ronald Mccoy
Mark McGrath
Robert Meehan
Scott Milan
Kirsten Miles
Vahid Mohabbati
Megha Mulchandani
Patrick Mulhern
Brad Murphy
Charles Mutandwa
Keshwan Nadan
Ching-Luen Ng
Mark Nelson
Harry Nespolon
Brent O’Carrigan
Christopher Oh

George Pappas
Peter Parkes

W J Patterson
Anoula Pavli
Matthew Penn
Satish Prasad
Tereza Rada
Jason Rajakulendran
Muhammad Raza
Kate Roe
Daniel Rouhead
Fiona Runacres
Safwat Saba
Amin Sauddin
Kelly Seach
Leslie Segal
Isaac Seidl
Rubini Selvaratnam
Theja Seneviratne
Karina Severin
Pravesh Shah
Mitra Babazadeh Shahri
Jamie Sharples
G Sivasambu
Russell Shute
Sue Smith
Jane Smith
Lucie Stanford
Sean Stevens
S Sutharsamohan
Hui Tai Tan
Marlene Tham

Heinz Tilenius
Judy Toman
Khai Tran
Joseph V Turner
Susan Wearne
Anthony Wickins
Kristen Willson
Melanie Winter
Jeanita Wong
Belinda Woo
Belinda Wozencroft

John Padgett

Murtagh Prelims.indd xx

22/10/10 2:22:05 PM


Normal values:
worth knowing by heart
The following is a checklist that one can use as a template to memorise normal
quantitative values for basic medical conditions and management.
Vital signs (average)

< 6 months

6 months – 3 years

3 – 12 years

Adult

Pulse

120–140

110

80 – 100

60 – 100

Respiratory rate

45

30

20

14

BP (mmHg)

90/60

90/60

100/70

≤ 130/85

Children’s weight

1–10 years

Rule of thumb:

Wt = (age + 4) × 2 kg

Fever—temperature (morning)(a)
(a) There is considerable diurnal variation in temperature so that it
is higher in the evening (0.5–1°C). I would recommend the definition
given by Yung et al. in Infectious Diseases: a Clinical Approach: ‘Fever
can be defined as an early morning oral temperature > 37.2°C or a
temperature > 37.8°C at other times of the day’.

Oral

> 37.2°C

Rectal

> 37.7°C

Diabetes mellitus—blood sugar
Random
1 reading if symptomatic
2 readings if

asymptomatic

> 11.1 mmol/L

Fasting

> 7.0 mmol/L

or

the 2 values from an oral
GTT

< 3.5 mmol/L

Jaundice
Serum bilirubin

Serum potassium

> 19 µmol/L

> 5.0 mmol/L

Hypertension
BP

> 140/90 mmHg

Alcohol excessive drinking

Males

> 4 standard drinks/day

Females

> 2 standard drinks/day

Alcohol health guidelines
Males and females

Hypokalaemia
Serum potassium

Hyperkalaemia

≤ 2 standard drinks/day
< 4 standard drinks/occasion

Anaemia—haemoglobin
Males

< 130 g/L

Females

< 115 g/L

Body mass index

Wt (kg)/Ht (m2)

Normal

20–25

Overweight

> 25

Obesity

> 30

xxi

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Abbreviations
AAA
AAFP
ABC
ABCD
ABFP
ABI
ABO
AC

AC
ACAH
ACE
ACL
ACR
ACTH
AD
AD
ADHD
ADT
AFI
AFP
AI
AICD
AIDS
AIIRA
AKF
ALE
ALL
ALP
ALT
ALTE
AMI
AML
ANA
ANCI
ANF
a/n/v
AP
APF

APH
APTT
AR
ARC
ARR
ASD
ASIS
ASOT

abdominal aortic aneurysm
American Academy of Family Physicians
airway, breathing, circulation
airway, breathing, circulation, dextrose
American Board of Family Practice
ankle brachial index
A, B and O blood groups
air conduction
acromioclavicular
autoimmune chronic active hepatitis
angiotensin-converting enzyme
anterior cruciate ligament
albumin creatine ratio
adrenocorticotrophic hormone
aortic dissection
autosomal dominant
attention deficit hyperactivity disorder
adult diphtheria vaccine
amniotic fluid index
alpha-fetoprotein
aortic incompetence

automatic implantable cardiac defibrillator
acquired immunodeficiency syndrome
angiotension II(2) reuptake antagonist
acute kidney failure
average life expectancy
acute lymphocytic leukaemia
alkaline phosphatase
alanine aminotransferase
apparent life-threatening episode
acute myocardial infarction
acute myeloid leukaemia
antinuclear antibody
antineutrophil cytoplasmic antibody
antinuclear factor
anorexia/nausea/vomiting
anterior–posterior
Australian pharmaceutical formulary
ante-partum haemorrhage
activated partial thromboplastin time
autosomal recessive
AIDS-related complex
absolute risk reduction
atrial septal defect
anterior superior iliac spine
antistreptolysin 0 titre

AST
ATFL
AV
AVM

AZT

aspartate aminotransferase
anterior talofibular ligament
atrioventricular
arteriovenous malformation
azidothymidine

BC
BCC
BCG
bDMARDs

bone conduction
basal cell carcinoma
bacille Calmette-Guérin
biological disease modifying antirheumatic
drugs
bone mass density
body mass index
bladder outlet obstruction
blood pressure
benign prostatic hyperplasia
benign paroxysmal positional vertigo
breast self-examination

BMD
BMI
BOO
BP

BPH
BPPV
BSE
Ca
CABG
CAD
CAP
CBE
CBT
CCF
CCP
CCT
CCU
CD4
CD8
CDT
CEA
CFL
CFS
cfu
CHD
CHF
CI
CIN
CJD
CK
CK–MB
CKD
CKF

carcinoma
coronary artery bypass grafting
coronary artery disease
community acquired pneumonia
clinical breast examination
cognitive behaviour therapy
congestive cardiac failure
cyclic citrinullated peptide
controlled clinical trial
coronary care unit
T helper cell
T suppressor cell
combined diphtheria/tetanus vaccine
carcinoembryonic antigen
calcaneofibular ligament
chronic fatigue syndrome
colony forming unit
coronary heart disease
chronic heart failure
confidence interval
cervical intraepithelial neoplasia
Creutzfeldt-Jakob disease
creatinine kinase
creatinine kinase–myocardial bound
fraction
chronic kidney disease
chronic kidney failure

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Abbreviations
What is new?

CRF
CRFM
CRH
CR(K)F
CRP
CSF
CSFM
CSIs
CSU
CT
CTD
CTG
CTS
CVA
CVS
CXR

carpometacarpal
chronic myeloid leukaemia
cytomegalovirus
central nervous system
compound

chronic obstructive airways disease
combined oral contraceptive
combined oral contraceptive pill
catechol-O-methyl transferase
chronic obstructive pulmonary disease
cyclooxygenase
cardiopulmonary arrest
continuous positive airways pressure
creatine phosphokinase
calcium pyrophosphate dihydrate
cardiopulmonary resuscitation
complex partial seizures
controlled release
computerised reference database system
calcinosis cutis; Raynaud’s phenomenon;
oesophageal involvement; sclerodactyly;
telangiectasia
chronic renal failure
chloroquine-resistant falciparum malaria
corticotrophin-releasing hormone
chronic renal (kidney) failure
C-reactive protein
cerebrospinal fluid
chloroquine-sensitive falciparum malaria
COX-2 specific inhibitors
catheter specimen of urine
computerised tomography
connective tissue disorder
cardiotocograph
carpal tunnel syndrome

cerebrovascular accident
cardiovascular system
chest X-ray

DBP
DC
DDAVP
DDH
DDP
DEXA
DHA
DI
DIC
DIDA
DIMS

diastolic blood pressure
direct current
desmopressin acetate
developmental dysplasia of the hip
dipeptidyl peptidase
dual energy X-ray absorptiometry
docosahexaenoic acid
diabetes insipidus
disseminated intravascular coagulation
di-imino diacetic acid
disorders of initiating and maintaining sleep

CMC
CML

CMV
CNS
co
COAD
COC
COCP
COMT
COPD
COX
CPA
CPAP
CPK
CPPD
CPR
CPS
CR
CRD
CREST

Murtagh Prelims.indd xxiii

DIP
dL
DMARDs
DNA
DOM
DRE
DRABC
drug
dosage

ds
DS
DSM
DU
DUB
DVT
DxT

distal interphalangeal
decilitre
disease modifying antirheumatic drugs
deoxyribose-nucleic acid
direction of movement
digital rectal examination
defibrillation, resuscitation, airway,
breathing, circulation
bd—twice daily
tid, tds—three times dailyqid, qds—four
times daily
double strand
double strength
diagnostic and statistical manual (of mental
disorders)
duodenal ulcer
dysfunctional uterine bleeding
deep venous thrombosis
diagnostic triad

esp.
ESR

ET
ETT

expired air resuscitation
Epstein-Barr mononucleosis (glandular
fever)
Epstein-Barr nuclear antigen
Epstein-Barr virus
external chest compression
electrocardiogram
electroconvulsive therapy
emergency department
expected due date
electroencephalogram
enzyme linked immunosorbent assay
electromyogram
extractable nuclear antigen
ethinyloestradiol
eicosapentaenoic acid
extensor pollicis longus
expressed prostatic secretions
external rotation
end-stage renal failure
end stage renal (kidney) failure
endoscopic retrograde
cholangiopancreatography
especially
erythrocyte sedimentation rate
embryo transfer
endotracheal tube

FAD
FAP

familial Alzheimer disease
familial adenomatous polyposis

EAR
EBM
EBNA
EBV
ECC
ECG
ECT
ED
EDD
EEG
ELISA
EMG
ENA
EO
EPA
EPL
EPS
ER
ESRF
ESR(K)F
ERCP

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xxiv

Part One
Abbreviations

FTT
FUO
FVC
FXS

foreign body
full blood count
fetal death in utero
flexor digitorum longus
forced expiratory volume in 1 second
flexor hallucis longus
femto-litre (10–15)
functional residual capacity
follicle stimulating hormone
fluorescent treponemal antibody absorption
test
failure to thrive
fever of undetermined origin
forced vital capacity
fragile X syndrome

g
GA
GABHS
GBS
GCA
GESA
GFR
GGT
GI
GIFT
GIT
GLP
GnRH
GO
GORD
GP
G-6-PD
GSI
GU
GV

gram
general anaesthetic
group A beta-haemolytic streptococcus
Guillain-Barré syndrome
giant cell arteritis
Gastroenterological Society of Australia
glomerular filtration rate
gamma-glutamyl transferase
glycaemic index

gamete intrafallopian transfer
gastrointestinal tract
glucagon-like peptide
gonadotrophin-releasing hormone
gastro-oesophageal
gastro-oesophageal reflux
general practitioner
glucose-6-phosphate
genuine stress incontinence
gastric ulcer
growth velocity

HAV
anti-HAV
Hb
HbA
anti-HBc
HBeAg
anti-HBs
HBsAg
HBV
HCG
HCV
anti-HCV

hepatitis A virus
hepatitis A antibody
haemoglobin
haemoglobin A
hepatitis B core antibody

hepatitis Be antigen
hepatits B surface antibody
hepatitis B surface antigen
hepatitis B virus
human chorionic gonadotropin
hepatitis C virus
hepatitis C virus antibody

FB
FBE
FDIU
FDL
FEV1
FHL
fL
FRC
FSH
FTA–ABS

Murtagh Prelims.indd xxiv

HDL
HDV
HEV
HFA
HFM
HFV
HGV
HHC
HIDA

HIV
HLA-B27
HMGCoA
HNPCC
HPV
HRT
HSIL
HSV
H

high-density lipoprotein
hepatitis D (Delta) virus
hepatitis E virus
hydrofluoro alkane
hand, foot and mouth
hepatitis F virus
hepatitis G virus
hereditary haemochromatosis
hydroxy iminodiacetic acid
human immunodeficiency virus
human leucocyte antigen
hydroxymethylglutaryl CoA
hereditary nonpolyposis colorectal cancer
human papilloma virus
hormone replacement therapy
high grade squamous intraepithelial lesion
herpes simplex viral infection
hypertension

IBS

ICE
ICHPPC

irritable bowel syndrome
ice, compression, elevation
International Classification of Health
Problems in Primary Care
inhaled corticosteroid
intercondylar separation
intracytoplasmic sperm injection
immunochromatographic test
insulin dependent diabetes mellitus
injecting drug user
immunoglobulin E
immunoglobulin G
immunoglobulin M
interferon gamma release assay
ischaemic heart disease
International Headache Society
intramuscular injection
intermalleolar separation
including
international normalised ratio
International Olympic Committee
intraocular foreign body
interphalangeal
intermittent positive pressure variation
internal rotation
idiopathic (or immune) thrombocytopenia
purpura

intrauterine contraceptive device
intrauterine growth retardation
intravenous

ICS
ICS
ICSI
ICT
IDDM
IDU
IgE
IgG
IgM
IGRA
IHD
IHS
IM, IMI
IMS
inc.
INR
IOC
IOFB
IP
IPPV
IR
ITP
IUCD
IUGR
IV

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