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OXFORD CLINICAL GUIDELINES
Newly Qualified Doctor
OXFORD CLINICAL GUIDELINES

Newly Qualified
Doctor

EDITED BY
David Fisher
Specialist in Internal Medicine, Clalit Healthcare
Services, Israel
Liora Wittner
Resident in Family Medicine, Clalit Healthcare
Services, Israel

WITH CONSULTANT EDITOR

Deborah Gill
Vice-President (Education & Student Experience),
University of Southampton, Southampton, UK
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 2023
The moral rights of the authors have been asserted
First Edition published in 2023
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: 2021947301
ISBN 978–0–19–883450–2
eISBN 978–0–19–257143–4
DOI: 10.1093/med/9780198834502.001.0001
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.
 Preface

Evidence-based guidelines have played an increasing

role in medical practice in recent years. Healthcare
professionals use guidelines to contend with the
overwhelming wealth of available information and to
translate scientific advances and new knowledge into
safe clinical care.
The popularity of clinical guidelines has led to an
exponential rise in guidelines being created since the
1980s and modern healthcare professionals are
expected to be familiar with them. The General
Medical Council’s (GMC) Good Medical Practice
guidance, which records what is expected of every
GMC-registered doctor, states: ‘You must be familiar
with guidelines … that affect your work’. Such a
directive is challenging to uphold. First, the range of
available guidelines in every speciality is vast and
constantly expanding. Furthermore, individual
guidelines can be dense and lengthy, and are
therefore impractical to comb through for a
professional wishing to acquaint themselves quickly
with current clinical approaches.
This publication seeks to address that challenge.
Written by junior doctors, each chapter summarizes
the key clinical evidence-based guidelines which
shape UK practice and presents the information in an
accessible and concise format. Where relevant,
chapters provide brief additional contextual points in
order to explain the guideline for those less familiar
with the field. Junior doctors, in particular foundation
doctors, will find this resource useful to rapidly
familiarize themselves with the latest clinical
guidelines for the commonest conditions that they
encounter in both primary and secondary care.
Students will find this book useful as a quick
reference guide to better understand the patient
journey. They can also use it as a revision aid, as
knowledge of guidelines is increasingly tested in
medical school examinations.
Reading and learning every clinical guideline that is
relevant to junior doctors is an arduous and almost
impossible task. We hope that this book helps to
bridge the gap and makes clinical guidelines more
accessible to junior doctors, both for their benefit
and also for the benefit of the patients that they
treat.
 Introduction: how to use this book

This book contains 123 chapters, covering a wide

range of topics within internal medicine, surgery,
emergency medicine, paediatrics, obstetrics and
gynaecology, and psychiatry. The book is designed to
cover the breadth of knowledge expected of a
foundation doctor and it is pitched at this level.
However, we would expect it to also be useful for
medical students, specialist nurses, and junior
specialist trainees (ST/CT 1–3 level).
This book is intended to be concise. Content which
is relevant to multiple chapters will usually be noted
once and other chapters will signpost to the primary
mention.
Multiple guidelines exist for some topics and
occasionally they conflict with each other in terms of
their conclusions. It can be challenging for non-
specialists to know which guideline they should
follow. Each specialty section in this book has been
overseen by at least one senior specialist consultant
who has provided direction in identifying the most
relevant and widely used guideline (or guidelines) to
base each chapter upon. Readers should be aware
that institutions often have their own local protocols
which supersede the guidelines used in this
publication.
The information in each chapter refers to adult
patients only, except for chapters in the Resuscitation
section (Part 17) where paediatric content is
highlighted and chapters in the Paediatric section
(Part 10). Where a drug is suggested as a treatment
option, any dosages mentioned assume an otherwise
healthy, non-pregnant adult with normal hepatic and
renal function, and of average height and weight.
Exceptions include chapters dealing with obstetrics,
paediatrics, elderly medicine, hepatology, and
nephrology. In all cases, the most recent British
National Formulary or local protocols should be
consulted to verify the drug choice, dosage, and any
contraindications.
This book includes some investigation and
management options that should only be considered
under the guidance of a senior or specialist clinician,
and they are highlighted as such. It is vital that
junior professionals should be aware of their own
limitations and not do anything that they are not
competent to do.
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 Finally, please note that the information contained
within these pages is for educational purposes only
and should not be solely relied upon to direct the
management of patients. The full guidelines are
referenced at the start of each chapter and can be
accessed online.
 Acknowledgements

First and foremost, this book would not have been

possible without the hard work of each chapter
contributor. We are also grateful for the dedication of
the Senior Editorial Board and for all of the reviews
and advice that they provided.
We are appreciative of Professor Deborah Gill for
her thoughtful oversight and helpful suggestions over
the course of writing this book.
We are of course indebted to the wonderful team
at Oxford University Press. We are grateful to each of
the project managers that we have been fortunate to
work with including Sam Callard, Mark Knowles,
Fiona Sutherland, and most recently Sylvia Warren.
Most of all we would like to thank our
commissioning editors Elizabeth Reeve and Geraldine
Jeffers, who have provided us with their wealth of
expert experience and have guided every step of this
project to fruition. They have been a pleasure to
work with and we are grateful for their support. As a
brand-new concept which took time to perfect, this
book has been a long time in the making, so finally,
we would like to acknowledge all the ‘OCG babies’
born to the team since the start of this process,
Tessa, Aurora, and Gidon!
Contents

A-Z of all conditions

Index of emergency topics
Section editors
Contributors
Symbols and abbreviations

Part 1 Cardiology

1 Acute coronary syndromes

2 Acute heart failure

3 Aortic stenosis and mitral regurgitation

4 Atrial fibrillation

5 Chronic heart failure

6 Hypertension
7 Pericardial diseases

8 Stable angina

9 Transient loss of consciousness

Part 2 Care of the elderly

10 Delirium

11 Dementia

12 Falls

13 Hip fractures

Part 3 Endocrinology

14 Adrenal insufficiency

15 Diabetic ketoacidosis

16 Hypercalcaemia

17 Hyperglycaemia

18 Hyperglycaemic hyperosmolar syndrome

19 Hyperthyroidism

20 Hypocalcaemia
21 Hypoglycaemia

22 Hyponatraemia

23 Hypothyroidism

24 Osteoporosis

25 Type 1 diabetes mellitus

26 Type 2 diabetes mellitus and diabetic foot

problems

Part 4 Gastrointestinal

27 Acute upper gastrointestinal bleeding and

variceal bleeding

28 Coeliac disease

29 Crohn’s disease

30 Gastro-oesophageal reflux disease and

dyspepsia

31 Irritable bowel syndrome

32 Ulcerative colitis

Part 5 Hepatobiliary
33 Acute liver failure

34 Alcohol-related liver disease

35 Alcohol use disorders

36 Liver cirrhosis

Part 6 Mental health

37 Bipolar disorder

38 Depression

39 Eating disorders

40 Generalized anxiety disorder

41 Panic disorder

42 Post-traumatic stress disorder

43 Psychosis and schizophrenia

44 Self-harm

45 Violence and aggression

Part 7 Nephrology

46 Acute kidney injury

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References 1: Practical applications and examples

Learning Objective 1: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 2: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Learning Objective 3: Interdisciplinary approaches
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Learning Objective 4: Theoretical framework and methodology
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 5: Case studies and real-world applications
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 5: Diagram/Chart/Graph]
Definition: Theoretical framework and methodology
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 6: Comparative analysis and synthesis
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 7: Key terms and definitions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 8: Comparative analysis and synthesis
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 9: Experimental procedures and results
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
References 2: Practical applications and examples
Note: Study tips and learning strategies
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Learning outcomes and objectives
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 12: Diagram/Chart/Graph]
Remember: Study tips and learning strategies
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Study tips and learning strategies
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Experimental procedures and results
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Definition: Ethical considerations and implications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Problem-solving strategies and techniques
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Statistical analysis and interpretation
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 19: Diagram/Chart/Graph]
Note: Critical analysis and evaluation
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 20: Diagram/Chart/Graph]
Test 3: Fundamental concepts and principles
Key Concept: Comparative analysis and synthesis
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 21: Problem-solving strategies and techniques
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 22: Problem-solving strategies and techniques
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Historical development and evolution
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 24: Interdisciplinary approaches
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 25: Diagram/Chart/Graph]
Note: Literature review and discussion
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Theoretical framework and methodology
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Critical analysis and evaluation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 28: Diagram/Chart/Graph]
Key Concept: Statistical analysis and interpretation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Section 4: Best practices and recommendations
Note: Interdisciplinary approaches
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 31: Fundamental concepts and principles
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Key terms and definitions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 34: Fundamental concepts and principles
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 35: Diagram/Chart/Graph]
Note: Comparative analysis and synthesis
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Practical applications and examples
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 37: Diagram/Chart/Graph]
Remember: Interdisciplinary approaches
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 38: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 39: Study tips and learning strategies
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Conclusion 5: Fundamental concepts and principles
Key Concept: Experimental procedures and results
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 42: Diagram/Chart/Graph]
Remember: Critical analysis and evaluation
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Fundamental concepts and principles
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 44: Diagram/Chart/Graph]
Key Concept: Problem-solving strategies and techniques
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Case studies and real-world applications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 46: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 47: Diagram/Chart/Graph]
Key Concept: Literature review and discussion
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Literature review and discussion
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Results 6: Current trends and future directions
Practice Problem 50: Historical development and evolution
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 52: Diagram/Chart/Graph]
Remember: Theoretical framework and methodology
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 53: Diagram/Chart/Graph]
Example 53: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 54: Diagram/Chart/Graph]
Practice Problem 54: Fundamental concepts and principles
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Literature review and discussion
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 56: Diagram/Chart/Graph]
Example 56: Practical applications and examples
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 57: Study tips and learning strategies
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Current trends and future directions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 59: Interdisciplinary approaches
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
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