Oxford Handbook Of Clinical and Laboratory Investigation.pdf

ix
Preface
With the increasing complexity of modern medicine, we now have literally
thousands of possible investigative techniques at our disposal. We are able
to examine our patient’s serum and every other body fluid down to the
level of individual nucleotides, as well as being able to perform precise
imaging through CT, MRI and other imaging technologies. The problem we
have all faced, especially as senior medical students or junior doctors is:
which test should we use in a given setting? What hazards are associated
with the tests? Are there any situations where specific tests should not be
used or are likely to produce erroneous results? As medical complexity
increases so too does cost; many assays available today are highly expensive
and wherever possible we would ideally like to use a test which is
cheap, reliable, reproducible and right for a given situation.
Such knowledge takes many years to acquire and it is a fact of life that
senior doctors (who have attained such knowledge) are not usually those
who request the investigations. In this small volume, we have attempted
to distil all that is known about modern tests, from blood, urine and other
body fluids, along with imaging and molecular tests. The book is divided
into two principal parts: the first deals with symptoms and signs in The
patient section, because that is how patients present. We have tried to
cover as many topics as possible, discussing these in some detail and have
provided differential diagnoses where possible. We also try to suggest
tests that might be of value in determining the cause of the patient’s
symptom or sign. The second part of the book, Investigations, is specialty-
specific, and is more relevant once you know roughly what type of
disease the patient might have. For example, if the symptom section suggests
a likely respiratory cause for the patient’s symptoms, then the reader
should look to the Respiratory investigations chapter in order to determine
which tests to carry out, or how to interpret the results.
The entire book is written by active clinicians, rather than scientists, since
we wanted to provide a strong clinical approach to investigation. We have
tried, wherever possible, to cross-refer to the Oxford Handbook of Clinical
Medicine, 5th edition, Oxford University Press, which provides the clinical
detail omitted from this handbook. The symbol .. is used to highlight a
cross-reference to OHCM, in addition to cross-referencing within this book.
We would value feedback from readers since there will doubtless be
tests omitted, errors in the text and many other improvements we could,
and will, make in future editions. All contributors will be acknowledged
individually in the next edition. We would suggest you e-mail us directly:
a.provan@virgin.net.
Drew Provan
Andrew Krentz
2002
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