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OX FO RD SP ECIA LTY T RAINING

Medicine for MRCP

OX F ORD S P E CI A LTY TRA I N I N G

Medicine for MRCP

SENIOR EDITOR

Rupa Bessant MBChB MSc (Dist) FRCP

Course Director, PassPACES, UK
www.passpaces.co.uk
(Formerly Consultant Rheumatologist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK)

EDITORS

Jonathan Birns BSc MBBS PhD FRCP

Consultant in Stroke Medicine, Geriatrics and General Medicine, Guy’s and St Thomas’ NHS
Foundation Trust, London, UK
Honorary Senior Lecturer, King’s College London, UK
Deputy Head of School of Medicine, Health Education England, London, UK

Charlotte Ford BSc MBChB MRCP

Consultant Gastroenterologist, Western Sussex Hospitals NHS Foundation Trust, UK

1
1
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First Edition published in 2020
Impression: 
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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
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otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
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contained in any third party website referenced in this work.
 For my daughters, Olivia and Serena,
who continue to inspire me each and every day,
and my parents, Ramola and Amiya,
for whose love and guidance I will always be grateful.
Rupa Bessant

For my sons Cassius, Jonah and Otto who

are my answers to everything.
Charlotte Ford

v
Foreword

Acquisition of the diploma of Membership of the Royal Colleges of Physicians is a crucial step in a
physician’s working life that enables them to pursue a career in one of the thirty medical specialties and
two subspecialties that are recognised by the General Medical Council (GMC). The work and training that
is required to pass the three parts of the examination should not be underestimated by anyone. Trying to
learn the enormous extent of medicine so that the trainee has enough confidence to answer the questions
that are posed is daunting and there are many theories about the best way to prepare. The changes that are
occurring both in medical training and indeed the MRCP does not obviate the fact that studying medicine
will require a sound grounding in knowledge. It is anticipated, however, that the provision of better training
will aid in the acquisition of knowledge.
The main changes that are occurring in medical training in the UK have been driven by the Shape of
Training report which recommended that all new curricula must better serve the patient need, have more
generic skills to support the acute unselected take, provide continuity of care, improve care in the com-
munity, support credentialing and provide a more flexible approach to training. Furthermore, the GMC
mandated that all postgraduate curricula must be based on higher level learning outcomes and incorporate
the GMC defined Generic Professional Capabilities (GPCs). In response to this, stage  of The Joint Royal
Colleges of Physicians Training Board ( JRCPTB) designed Internal Medicine Training (IMT) programme
was implemented in August 209. This is an indicative three-year programme designed to better prepare
doctors to become a medical registrar and provide them with the skills needed to manage patients pre-
senting with a wide range of general medical symptoms and conditions. Experience in critical care medicine,
geriatric medicine and outpatients is mandated and trainees will receive simulation training throughout the
programme.
The use of all sources of information can only be assisted if there is an adequacy of time and the intro-
duction by JRCPTB of quality standards for registrars in general internal medicine is now being augmented
to cover the whole of internal medicine training.
The MRCP clinical examination is also changing and 2021 should see the introduction of the updated
PACES exam to ensure it remains fair, relevant and fit for purpose. This has been the subject of a great
deal of scrutiny, consultation and deliberation reflecting not only the place of the examination, but also the
importance of the role of excellent clinical skills. Knowing how a disease presents and how and when to
investigate such presentations is at the heart of what physicians do.
The editors for this book have enrolled an extensive field of authors who are experts in their fields to
provide facts which may be assimilated rapidly and that will be helpful both in revising for the MRCP exam-
inations and also in day to day practice. The consistency of editorship means that individual conditions are
listed according to clinical features, diagnosis and management - a system that will serve anyone well at
the bedside, whether in a clinical or exam setting. It covers aspects of medicine that have been ignored by
the statutory definition of specialty but are enormously important in everyday presentations to the acute
hospital, including obstetric medicine. The inclusion of critical care as a specific aspect for consideration
complements well the ambition within the internal medicine training programme of generating doctors
who are more able to manage the acutely ill patient. The editors have also ensured that there are chapters
covering topics that traditionally are ‘Cinderella areas’ and yet are defined as being important in the new
curriculum – these include Statistics and Medical Law and Ethics.
In summary, this work will help you in studying for the MRCP diploma but if used well will stand the
reader in good stead for their future career.

Michael Jones
Medical Director, Training and Development
Joint Royal Colleges of Physicians Training Board
Federation of Royal Colleges of Physicians of the United Kingdom
Consultant Acute Physician
GIRFT National Clinical Lead for Acute and General Medicine

vii
Preface

Medicine for MRCP aims to be a comprehensive guide to the MRCP Part  and Part 2 written examinations,
and to provide the requisite theoretical knowledge in a user-​friendly format. Each chapter has been written
by highly experienced MRCP lecturers. The most relevant clinical information for the MRCP (UK) examin-
ations is covered, incorporating the appropriate protocols, guidelines and treatment algorithms from NICE,
UK, and European and American Colleges. An emphasis has been placed on a UK clinical setting. Latest
developments and clinical treatments (e.g. biologic therapy) have been included throughout the text. Can-
didates who wish to read in greater depth are directed to relevant publications at the end of each section.
Furthermore, the inclusion of links to carefully selected relevant websites (e.g. DVLA guidelines and cur-
rent mental health legislation) are intended to provide up-​to-​date information to benefit doctors within
their clinical setting and daily practice.
A well-​structured and comprehensive approach to clinical medicine has been used to ensure that the
text is an invaluable resource for candidates preparing for the MRCP Part  and Part 2, and PACES exam-
inations, as well as the MRCPI, USMLE and PLAB examinations. Undergraduate students will also find this
book beneficial and we believe that it will remain a valuable reference for trainees in acute medicine, acci-
dent and emergency medicine, anaesthetics, critical care and general practice.
Each chapter integrates the basic science required for the Part  written, with more clinically based in-
formation, concentrating on subjects that need to be covered for the Part 2 written and providing a solid
foundation for candidates as they progress to the PACES examination. Where possible, the clinical impli-
cations of the theoretical knowledge covered in Part  are emphasised within the clinical context, thereby
making this information easier to remember.
The text utilises a combination of flowcharts, tables and mnemonics to assist candidates in retaining and
recalling the key relevant facts in both an examination setting and clinical practice. Multiple choice ques-
tions (MCQs) relevant to Part  and Part 2 written papers have been included at the end of each chapter,
enabling candidates to build their confidence. The answers to these questions will help to consolidate the
medical knowledge relevant to all three parts of the MRCP examination.
The editors and chapter authors have combined their extensive clinical knowledge and practical teaching
experience to create a book that we believe will help to optimise the chances of examination success. We
hope that candidates will both enjoy and benefit from this book during their revision and clinical practice.
Good luck to you all! 

 Rupa Bessant

ix
Acknowledgements

Firstly, I wish to thank the whole editorial team at Oxford University Press for accepting the proposal for
Medicine for MRCP and for giving me the privilege of editing this book. My particular thanks go to Geraldine
Jeffers (Senior Commissioning Editor), Fiona Sutherland (Senior Assistant Commissioning Editor), Karen
Moore (Senior Production Editor) and Susan Finlay (Copy Editor), for their ongoing support from commis-
sion to completion.
Secondly, I am grateful to all the contributors to this manuscript for their combined wisdom, and espe-
cially my co-editors, Jonathan Birns and Charlotte Ford, and to each of our families who have supported
us all throughout this project.
I would especially like to thank my husband, David, whose continued patience and support, whilst editing
these 27 chapters has, as always, been invaluable.
Finally, I wish to thank all my students whose intriguing questions continue to challenge me and to inspire
my interest in medical education.

Rupa Bessant

x
Contents

Contributors xiii
Abbreviations 
xix

 Metabolic Medicine  1
2 Molecular Medicine and Genetics  37
3 Clinical Pharmacology and Toxicology  57
4 Drug Development and Clinical Trials Translational Medicine  97
5 Radiological Investigations and Applications  111
6 Immunology 147
7 Genitourinary Medicine and HIV 
187
8 Infectious Diseases and Tropical Medicine  227
9 Haematology 271
0 Principles of Oncology and Palliative Care  315
 Respiratory Medicine  345
2 Critical Care  391
3 Cardiology 409
4 Gastroenterology 491
5 Hepatology 519
6 Nephrology 549
7 Neurology 597
8 Ophthalmology 645
9 Diabetes and Endocrinology  671
20 Rheumatology 705
2 Dermatology 755
22 Psychiatry 777
23 Obstetric Medicine  799
24 Environmental Medicine  819
25 Epidemiology and Public Health  839
26 Statistics 857
27 Medical Law and Ethics  881

Index 
895

xi
Contributors

Please note that the start of each chapter lists the authors who have contributed to that chapter. Junior
authors are listed before senior authors. Where there are more than one junior or senior author, they are
listed in an order reflecting their contribution to the chapter; if two authors have contributed equally this is
denoted with asterisks and a relevant footnote to this effect.

Robert Adam MA MBBS MRCP PhD FRACP

Consultant Neurologist, Department of Neurology,

The Royal Brisbane and Women’s Hospital, Brisbane, Australia

Christine O. Ademokun MBBS BSc MRCP

Specialist Registrar, Haematology Department, Hammersmith Hospital,

Imperial College NHS Trust, London, UK

Behdad Afzali BSc MBBS PhD MRCP PGDip FHEA MAcadMEd

Earl Stadtman Investigator and Consultant Nephrologist, Immunoregulation Section,

Kidney Diseases Branch, NIDDK, NIH Bethesda, MD, USA

John Archer
Consultant Physician and Clinical Toxicologist, Department of Clinical Toxicology,
Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Stephen R. Atkinson PhD MRCP

Specialist Registrar in Gastroenterology and Hepatology,

Chelsea and Westminster NHS Foundation Trust;
Honorary Clinical Lecturer, Imperial College London, UK

Chitrabhanu Ballav
Consultant Physician and Endocrinologist, Diabetes and Endocrinology,
Buckinghamshire Healthcare NHS Trust, Aylesbury, UK

David Bessant BSc MBChB MD FRCOphth

Consultant Ophthalmologist, Clinical Director Moorfields Northwest,

Moorfields Eye Hospital, London, UK

Rupa Bessant MBChB MSc (Dist) FRCP

Course Director, PassPACES, UK (Formerly Consultant Rheumatologist,

Guy’s and St Thomas’ NHS Foundation Trust, London, UK)

Jonathan Birns BSc MBBS PhD FRCP

Consultant in Stroke Medicine, Geriatrics and General Medicine,

Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Anthony C. Brooms BSc MSc PhD FHEA

Lecturer in Statistics, Department of Economics, Mathematics and Statistics,

Birkbeck, University of London, UK

xiii
Contributors

Anupam Chatterjee MBChB FRCSE Cert LRS (RCOphth)

Ophthalmologist, Brent Community Ophthalmology Service, Sudbury,

Primary Care Centre, Wembley, London, UK

Danny Cheriyan MBBCh MD FRCPI

Consultant Gastroenterologist, Beaumont Hospital, Dublin, Ireland

Coziana Ciurtin MSc PhD FRCP

Consultant Rheumatologist, Associate Professor, Department of Rheumatology,

University College London, UK

Rosemary E.J. Clarke MChem MBBS MSc PhD MRCP FRCPath

Consultant Medical Biochemist, NHS Highlands, UK

Sophie A. Clarke MBBS BSc PhD MRCP

Clinical Lecturer, Department of Endocrinology and Investigative Medicine,

Imperial College London, UK

Cordelia E.M. Coltart MBBS BSc DTM&H MPH PhD MRCP FRCPath

Academic Clinical Lecturer, Institute for Global Health, University College London; Specialist
Registrar in Infectious Diseases, University College London Hospitals NHS Foundation Trust,
London, UK

Jennifer Crawley MBChB BSc MRCP

Consultant Dermatologist, Department of Dermatology, University College London

Hospitals, London, UK

David Cunningham OBE MD FRCP FMedSci

Director of Clinical Research, Director of The Royal Marsden/Institute of Cancer Research

NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust, London, UK

Ameet Dhar PhD FRCP

Consultant Hepatologist and Honorary Senior Lecturer,

Imperial College Healthcare NHS Trust, London, UK

Simon Edwards
Medical Director and Consultant Physician, Diggory Division, CNWL; Trustwide Quality
Improvement Clinical Lead, CNWL; Honorary Associate Professor,
University College London, UK

Michael Fertleman FRCP FFLM FHEA Barrister (NP)

Consultant Physician, St Mary’s Hospital London; Visiting Professor, Department of

Bioengineering, Imperial College, London, UK

Douglas Fink MRCP SCE(ID)

Registrar Infectious Diseases, Hospital for Tropical Diseases,

University College London Hospitals NHS Foundation Trust, London, UK

xiv
 Contributors

Elisa Fontana
Medical Oncologist, The Institute of Cancer Research and The Royal Marsden Hospital,
London, UK

Charlotte Ford BSc MBChB MRCP

Consultant Gastroenterologist, Western Sussex Hospitals NHS Foundation Trust, UK

Matthew C. Frise BM BCh DPhil MRCP FFICM

Consultant in Acute Medicine and Intensive Care, Royal Berkshire Hospital, Reading, UK

Nicholas Gall
Consultant Cardiologist, Department of Cardiology, King’s College Hospital;
Honorary Senior Lecturer, King’s College London, UK

Benjamin Glickstein BSc MBBS MRCP

Consultant Geriatrician, Miramichi Regional Hospital, New Brunswick, Canada

Refik Gökmen MA PhD FRCP FHEA

Consultant Nephrologist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Chris J. Harvey BSc MBBS MRCP FRCR

Consultant Radiologist, Hammersmith Hospital, London, UK

David Holdsworth MA, DPhil

Consultant Cardiologist, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK

Philip Howard MA GDipLaw LLM MA MD FRCP

Consultant Physician and Gastroenterologist, Department of Medicine, Epsom and St Helier

University Hospitals NHS Trust; Honorary Senior Lecturer in Medicine, St George’s Hospital
Medical School, London, UK

Dev Kevat BMedSci MBBS LLB MSc FRACP

Consultant Endocrinologist, Western Health and Monash Health, Melbourne; Consultant

Obstetric Physician, Royal Brisbane & Women’s Hospital, Brisbane, Australia

Lucy Lamb PhD MRCP DTMH

Defence Senior Lecturer in Medicine, Honorary Clinical Associate Professor in the Division of
Infection and Immunity UCL and Honorary Clinical Fellow, Imperial College, London, UK

Richard Lee MA MBBS MRCP PhD

Consultant Respiratory Physician with an Interest in Early Cancer Diagnosis,

Royal Marsden Hospital, London, UK

Lucy Mackillop BMBCh MA FRCP

Consultant Obstetric Physician, Women’s Centre, Oxford University Hospitals

NHS Foundation Trust, Oxford, UK

Tim Mant
Visiting Professor, Clinical Pharmacology, King’s College London, UK

xv
Contributors

Charles Marshall
Clinical Lecturer in Neurology, Preventive Neurology Unit, Wolfson Institute of Preventive
Medicine, Queen Mary University of London, UK

Alan Maryon-​Davis MBBChir MSc FFPH FRCP FFSEM FRCGP

Honorary Professor of Public Health, School of Public Health and Environmental Sciences,
Kings College London, UK

Claire L. Meek MBChB PhD MRCP FRCPath

Senior Clinical Research Associate, Institute of Metabolic Science, University of Cambridge,

UK; Consultant Chemical Pathologist and Metabolic Physician,
Department of Chemistry, Peterborough City Hospital, Peterborough, UK

Nasir Saeed Mirza MBBS BSc MRCP FHEA

Senior Clinical Lecturer and Honorary Consultant Neurologist, Department of Molecular and
Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, UK

Elena Nikiphorou MBBS BSc MD FRCP PGCME FHEA

Consultant Rheumatologist, Department of Rheumatology, King’s College Hospital;

Senior Clinical Research Fellow, Department of Inflammation Biology,
King’s College London, UK

Kingsley Norton MA MD FRCPsych

Medical Psychotherapist, DocHealth, BMA House, Tavistock Square, London, UK

Anna Nuttall BA MBBS MD MRCP MRCP

Rheumatology Consultant, Whittington Hospital, London, UK

Declan P. O’Regan FRCP FRCR PhD

Consultant Radiologist, Imperial College Healthcare NHS Trust, London, UK; Reader in
Imaging Sciences, London Institute of Medical Sciences, Imperial College, London, UK

Donal O’Kane MBBCh BAO MRCP PhD

Consultant Dermatologist, Department of Dermatology, Royal Victoria Hospital,

Belfast, UK

William L.G. Oldfield MSc PhD FRCP

Executive Medical Director, University Hospitals Bristol NHS Foundation Trust,

Bristol, UK

Stephen Patchett
Consultant Gastroenterologist, Beaumont Hospital, Dublin; Clinical Associate Professor,
Royal College of Surgeons of Ireland, Ireland

Munir Pirmohamed PhD FRCP FMedSci

David Weatherall Chair of Medicine, Department of Molecular and Clinical Pharmacology,

The University of Liverpool, UK

xvi
 Contributors

Nita Prasannan MBBS MRCP FRCPath

Consultant Haematologist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Deepti H. Radia BSc MSc (Med Ed) MRCPI FRCPath

Consultant Haematologist, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Brintha Selvarajah MA MBBS MRCP

Clinical Research Fellow, UCL Respiratory, University College London, UK

Gulshan Sethi MSc FRCP FHEA

Consultant Physician in Sexual Health and HIV, Guy’s and St Thomas’ NHS Foundation
Trust; Honorary Senior Clinical Lecturer, King’s College London, UK

Penelope Smith
Consultant Physician Acute Medicine and Infectious Diseases, Royal Free London NHS
Foundation Trust, London, UK

Elizabeth Smyth MD

Consultant Medical Oncologist, Addenbrooke’s Hospital, Cambridge, UK

Mike Stacey MD MRCP DTMH

Defence Senior Lecturer in Military Medicine and Consultant Physician, Chelsea &
Westminster Hospital, London, UK

Rob Tandy MBBS MRCPsych

Consultant Psychiatrist, Tavistock Centre, London, UK

John Wass
Professor of Endocrinology, Department of Endocrinology, Churchill Hospital, Oxford, UK

Andrew Webb FRCP PhD

Senior Lecturer, King’s College London; Guy’s and St Thomas’ NHS Foundation Trust,
London, UK

Ingeborg Welters
Reader, University of Liverpool; Honorary Consultant in Intensive Care, Royal Liverpool
University Hospital, Liverpool, UK; Professor of Anaesthesia,
Justus-​Liebig-​Universität Gießen, Gießen, Germany

John Whitaker BMBCh PhD MRCP

Specialty Registrar in Cardiology, Guy’s and St Thomas’ NHS Foundation Trust;

Clinical Research Fellow, King’s College London, UK

Anthony S. Wierzbicki DM DPhil FRCPath

Professor and Consultant in Metabolic Medicine/​Chemical Pathology, Department of
Chemical Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Rupert P. Williams MBBS BSc PhD MRCP

Consultant Cardiologist, Kingston Hospital NHS Foundation Trust, Surrey, UK

xvii
Contributors

Tom Wingfield MBChB PhD MRCP DTMH DipHIV PGCMedE

Senior Clinical Lecturer, Liverpool School of Tropical Medicine, Liverpool, UK and Karolinska
Institutet, Stockholm, Sweden; Honorary Consultant Physician, Royal Liverpool and
Broadgreen University Hospitals NHS Trust, Liverpool, UK

David R. Woods MD FRCP L/​RAMC

Defence Professor of Military Medicine; Professor of Sport and Exercise Endocrinology,

Carnegie Research Institute, Leeds Beckett University, Leeds, UK

Patrick Yong MBChB MSc PhD MRCP FRCPath

Consultant Immunologist, Department of Immunology, Frimley Park Hospital, Frimley, UK

xviii
Abbreviations

FDG
8
8-​fluorodeoxy-​D-​glucose AIT amiodarone-​induced thyrotoxicosis
2OH 2, hydroxylase AJCC American Joint Committee on Cancer
2,3-DPG 2,3- diphosphoglycerate AKI acute kidney injury
3-​HMG CoA 3-​hydroxy-​3-​methyl-​glutaryl-​CoA ALA aminolaevulinic acid
5HIAA 5-​hydroxyindoleacetic acid ALARA as low as reasonably achievable
5HT 5-​hydroxytryptamine ALD alcoholic liver disease
6MWD 6-​minute walk distance ALF acute liver failure
αFP alpha fetoprotein ALL acute lymphoblastic leukaemia
βHCG beta-​human chorionic gonadotropin ALP alkaline phosphatase
ALS amyotrophic lateral sclerosis
A adenine ALT alanine aminotransferase
AA aplastic anaemia AML acute myeloid leukaemia;
AAFB acid and alcohol-​fast bacilli angiomyolipoma
AAV ANCA-​associated vasculitis AMPA α-​amino-​3-​hydroxy-​5-​methyl-​4-​
ABC ATP-​binding cassette transporter isoxazolepropionic acid
ABG arterial blood gas AMS acute mountain sickness
ABPA allergic bronchopulmonary aspergillosis ANA antinuclear antibodies
AC activated charcoal; alternating current ANCA antineutrophil cytoplasmic antibody
ACA anterior cerebral artery ANOVA analysis of variance
ACE angiotensin-​converting enzyme AP accessory pathway
ACE-​i angiotensin-​converting enzyme inhibitor APB atrial premature beat
AChR acetylcholine receptor APC antigen-​presenting cell
ACLE acute cutaneous lupus erythematosus APD automated peritoneal dialysis
ACR albumin creatinine ratio APECED autoimmune polyendocrinopathy,
ACS acute coronary syndrome candidiasis, ectodermal dysplasia
ACTH adrenocorticotrophic hormone APLA antiphospholipid antibodies
AD Alzheimer’s disease; autosomal dominant APLS antiphospholipid syndrome
ADA adenosine deaminase APML acute promyelocytic leukaemia
ADCA autosomal dominant cerebellar ataxia APO apolipoprotein
ADCC antibody-​dependent cellular cytotoxicity APQ Alcohol Problems Questionnaire
ADH antidiuretic hormone APTT activated partial thromboplastin
ADP adenosine diphosphate time
ADPKD autosomal dominant polycystic kidney APUD amine precursor uptake and
disease decarboxylation
ADR adverse drug reaction AR autosomal recessive; aortic regurgitation
ADT androgen-​deprivation therapy ARB angiotensin receptor blocker
AE adverse event; atopic eczema ARDS acute respiratory distress syndrome
AE anion exchanger ARF acute rheumatic fever
AF atrial fibrillation ARMD age-​related macular degeneration
AFB acid-​fast bacilli ARPKD autosomal recessive polycystic kidney
AFLP acute fatty liver of pregnancy disease
AFP alpha-​fetoprotein ART antiretroviral therapy
AG anion gap ARVC arrhythmogenic right ventricular
AGEP acute generalised exanthematous cardiomyopathy
pustulosis ARVD arrhythmogenic right ventricular dysplasia
aHUS atypical haemolytic uraemic syndrome AS Angelman syndrome; aortic stenosis;
AIDS acquired immune deficiency syndrome ankylosing spondylitis
AIH amiodarone-​induced hypothyroidism ASD atrial septal defect
AIHA autoimmune haemolytic anaemia AST aspartate transaminase
AIMSS aromatase inhibitor-​associated AT atrial tachycardia
musculoskeletal syndrome ATG anti-​thymocyte globulin
AIN acute interstitial nephritis ATLL adult T cell leukaemia
AIP acute intermittent porphyria ATN acute tubular necrosis
AIRE autoimmune regulator ATP adenosine triphosphate

xix
Abbreviations

ATRA all-trans-retinoic acid CFH complement factor H

AUC area under the curve CFTR cystic fibrosis transmembrane
AUDIT Alcohol Use Disorders Identification Test conductance regulator
AV atrioventricular; arterio-venous CHART continuous hyperfractionated accelerated
AVM arterio-​venous malformation radiotherapy
AVN avascular necrosis CHB complete heart block
AVNRT atrioventricular node re-​entry CHM Commission on Human Medicines
tachycardia CI cardiac index
AVRT atrioventricular re-entry tachycardia CIDP chronic inflammatory demyelinating
BAV bicuspid aortic valve polyneuropathy
BBB blood-brain barrier; bundle branch block CK creatine kinase
BC blood culture CKD chronic kidney disease
BCG Bacillus Calmette–​Guérin CLE cutaneous lupus erythematosus
BCSP bowel cancer screening programme CLL chronic lymphocytic leukaemia
BD twice daily CM chylomicron
BG blood glucose CMC carpometacarpal
B-​hCG B-​human chorionic gonadotrophin CML chronic myeloid leukaemia
BHIVA British HIV Association CMML chronic myelomonocytic leukaemia
BHR bronchial hyper-​responsiveness CMR cardiac magnetic resonance
BMD bone mineral density CMT Charcot–​Marie–​Tooth
BMI body mass index CMV cytomegalovirus
BMT bone marrow transplant CN cranial nerve
BNP brain natriuretic peptide CNS central nervous system
BO Barrett’s oesophagus CO carbon monoxide; cardiac output
BP blood pressure; bullous pemphigoid COMT catechol-​o-​methyl transferase
BRAF B-​rapidly accelerated fibrosarcoma COPD chronic obstructive pulmonary disease
BRAO branch retinal artery occlusion COREC Central Office for Research Ethics
BRVO branch retinal vein occlusion Committees
BSA body surface area COX cyclo-​oxygenase
BSR British Society of Rheumatology CPAP continuous positive airway pressure
BTS British Thoracic Society CPEO chronic progressive external
C cytosine ophthalmoplegia
CA cancer antigen CPP cerebral perfusion pressure
CABG coronary artery bypass grafting CPPD calcium pyrophosphate dehydrate
CAD coronary artery disease CPR cardiopulmonary resuscitation
CADSIL cerebral autosomal dominant CPVT catecholaminergic polymorphic
arteriopathy with subcortical infarcts and ventricular tachycardia
leukoencephalopathy CRAO central retinal artery occlusion
CAH congenital adrenal hyperplasia CRC colorectal cancer
cAMP cyclic adenosine monophosphate CRH corticotropin-​releasing hormone
CAP community acquired pneumonia CRP C-​reactive protein
CAPD continuous ambulatory peritoneal dialysis CRT cardiac resynchronisation therapy
CBD common bile duct CRT-​D cardiac resynchronisation therapy
CBT cognitive behavioural therapy defibrillator
CCB calcium channel blocker CRT-​P cardiac resynchronisation therapy pacemaker
CCHF Crimean–​Congo haemorrhagic fever CRVO central retinal vein occlusion
CCK cholecystokinin CSC cancer stem cells
CCP cyclic citrullinated peptide csDMARDs conventional synthetic DMARDs
CD Crohn’s disease; cluster of differentiation CSF cerebrospinal fluid; colony stimulating
CDA congenital dyserythropoietic anaemia factor
CDAD Clostridium difficile-​associated diarrhoea CT computed tomography
CDI Clostridium difficile infection CTA clinical trial authorisation
CDK cyclin-​dependent kinase CTD connective tissue disease
CDT Clostridium difficile toxin CTEPH chronic thromboembolic pulmonary
CEA carcinoembryonic antigen hypertension
CETP cholesterol ester transfer protein CTI cavo-​tricuspid isthmus
CF cystic fibrosis CTIMP clinical trials of investigational medicinal
cffDNA cell-​free fetal DNA products

xx
 Abbreviations

CTLA cytotoxic T-​lymphocyte-​associated EBV Epstein–​Barr virus

CT-NCAP CT neck, chest, abdomen, pelvis ECG electrocardiogram
CTPA computed tomography pulmonary ECHO echocardiogram
angiography ECMO extracorporeal membrane oxygenation
CTX cross-​linked C-​telopeptide ECOG Eastern Cooperative Oncology Group
CV cardiovascular; crystal violet ECT electro-​convulsive therapy
CVA cerebrovascular accident EDS Ehlers–​Danlos syndrome
CVC central venous catheter EDV end diastolic volume
CVD cardiovascular disease EEG electroencephalogram
CVP central venous pressure EGDT early goal-​directed therapy
CVVH continuous venovenous haemofiltration EGFR epidermal growth factor receptor
CVVHD continuous venovenous haemodialysis eGFR estimated glomerular filtration rate
CVVHDF continuous venovenous haemodiafiltration EGFR epidermal growth factor receptor
CXR chest X-​ray EGPA eosinophilic granulomatosis with
CYP450 cytochrome P450 polyangiitis
DAH diffuse alveolar haemorrhage EIA enzyme-​linked immunoassay
DAS disease activity score EL elevated liver
DAT direct antiglobulin test ELISA enzyme-​linked immunosorbent assay
DBA Diamond Blackfan anaemia EMA European Medicines Agency
DBD donation after brain death EMG electromyogram
DBS deep brain stimulation EMR endoscopic mucosal resection
DC direct current; dyskeratosis congenita EMT epithelial-​mesenchymal transition
DCCV DC cardioversion EN erythema nodosum
DCD donation after circulatory death ENA extractable nuclear antigens
DCM dilated cardiomyopathy ENaC epithelial sodium channel
DCT distal convoluted tubule ENT ear, nose, and throat
DEXA dual energy X-​ray absorptiometry EoE eosinophilic oesophagitis
DHEA dehydroepiandrosterone EP electrophysiology
DHFR dihydrofolate reductase EPAP expiratory positive airway pressure
DI diabetes insipidus EPP exposure prone procedure
DIC disseminated intravascular coagulation EPSP excitatory post-​synaptic potential
DILI drug-​induced liver injury ER endoplasmic reticulum
DIP distal interphalangeal ERCP endoscopic retrograde
DISH diffuse idiopathic skeletal hyperostosis cholangiopancreatogram
DKA diabetic ketoacidosis ESC European Society of Cardiology
DLB dementia with Lewy bodies ESKD end-​stage kidney disease
DLBCL diffuse large cell B-​cell lymphoma ESQ Environmental Symptom Questionnaire
DLCO diffusion capacity ESR erythrocyte sedimentation rate
DLE discoid lupus erythematosus ET essential tremor; essential thrombocythaemia
DLQI Dermatology Life Quality Index ETC electron transport chain
DM diabetes mellitus EU European Union
DMARD disease-​modifying anti-​rheumatic drug EUS endoscopic ultrasound
DMD Duchenne muscular dystrophy FAB French-​American-​British
DMPK dystrophia myotonica protein kinase FAERS FDA Adverse Event Reporting System
DNA deoxyribonucleic acid; double-​stranded FasL Fas ligand
antibodies FASP fetal anomaly screening programme
DNACPR do not attempt cardiopulmonary FBC full blood count
resuscitation FDA Food and Drug Administration
DNAR do not attempt resuscitation FDG fluorodeoxyglucose
DRESS drug reaction with eosinophilia and FDP fibrin degradation product
systemic symptoms FE fractional excretion [value]
DSM Diagnostic and Statistical Manual of FEV forced expiratory volume
Mental Disorders FFP fresh frozen plasma
DUSR Development Update Safety Report FFR fractional flow reserve
DVT deep vein thrombosis FGF fibroblast growth factor
DWI diffusion weighted imaging FIA fluorescent immunoassay
EASI Eczema Area and Severity Index FIGO International Federation of Gynaecology
EBUS endobronchial ultrasound and Obstetrics

xxi
Abbreviations

FISH fluorescence in-​situ hybridisation Hb haemoglobin

FMD fibromuscular dysplasia HbAc glycosylated haemoglobin
FMF familial Mediterranean fever HBV hepatitis B virus
FNA fine needle aspiration HCAI health care-​associated infection
FP fetoprotein HCC hepatocellular carcinoma
FRAX fracture risk assessment tool hCG human chorionic gonadotrophin
FRAXA fragile X type A syndrome HCHWA-​D hereditary cerebral haemorrhage with
FRC functional residual capacity amyloidosis
FRDA Friedreich ataxia HCM hypertrophic cardiomyopathy
FSGS focal segmental glomerulosclerosis HCV hepatitis C virus
FSH follicle-​stimulating hormone HD haemodialysis; Huntington disease
FTD frontotemporal dementia HDL high-​density lipoprotein
FUS fused in sarcoma HDU high dependency unit
FVC forced vital capacity HE hepatic encephalopathy
FVL factor V Leiden mutation HELLP haemolysis, elevated liver enzymes and
G guanine low platelets
G6PD glucose-​6-​phosphate dehydrogenase HER human epidermal growth factor receptor
GABA gamma-​aminobutyric acid HERNS hereditary endotheliopathy with
GAD glutamic acid decarboxylase retinopathy, nephropathy and stroke
GAS Group A Strep. HF haemofiltration; heart failure
Gaβ-​HS Group A (beta haemolytic) Streptococcus HFpEF heart failure with preserved ejection
GBM glomerular basement membrane fraction
GBS Group B Strep. HFrEF heart failure with reduced ejection
GCA giant cell arteritis fraction
GCP good clinical practice HG hyperemesis gravidarum
GCS Glasgow Coma Score HGPRT hypoxanthine guanine
GCSF granulocyte-​colony stimulating factor phosphoribosyltransferase
GDH glutamate dehydrogenase HHS hyperglycaemic hyperosmolar state
GDM gestational diabetes mellitus HHT hereditary haemorrhagic telangiectasia
GFR glomerular filtration rate HHV human herpes virus
GGT gamma-​glutamyl transferase HIT heparin-​induced thrombocytopenia
GH gestational hypertension; growth HIV human immunodeficiency virus
hormone HIVAN HIV-​associated nephropathy
GHRH growth hormone-​releasing hormone HL Hodgkin’s lymphoma
GI gastrointestinal HLA human leukocyte antigen
GIST gastrointestinal stromal tumour HMN hereditary motor neuropathy
GMC General Medical Council HNPCC hereditary non-​polyposis colon cancer
GN glomerulonephritis HNPP hereditary neuropathy with liability to
GnRH gonadotrophin-​releasing hormone pressure palsies
GOJ gastro-​oesophageal junction HOA hypertrophic osteoarthropathy
GORD gastroesophageal reflux disease HP Helicobacter pylori; hypersensitivity
Gp glycoprotein pneumonitis
GPA granulomatosis with polyangiitis HPV human papillomavirus
GPCR G-​protein coupled receptor HR heart rate
GPi globus pallidus interna HRA Health Research Authority
GSD glycogen storage disease HRCT high-​resolution CT
GTN glyceryl trinitrate HRS hepatorenal syndrome
GTP guanosine triphosphate HRT hormone replacement therapy
GU genitourinary HSAN hereditary sensory-​autonomic
GUM genitourinary medicine neuropathy
GVHD graft-​versus-​host disease HSC haematopoietic stem cell
GWAS genome-​wide association study HSE Health and Safety Executive
H haemolysis HSIDU high-​security infectious disease unit
H histamine HSN hereditary sensory neuropathy
HACE high altitude cerebral oedema HSV herpes simplex virus
HAP hospital-​acquired pneumonia HT hydroxytryptamine
HAPE high altitude pulmonary oedema HTLV human T-​cell lymphotropic virus
HAS human albumin solution HU Hounsfield unit

xxii
 Abbreviations

HUS haemolytic uraemic syndrome IVDU intravenous drug use

HUV hypocomplementaemic urticarial IVIG intravenous immunoglobulin
vasculitis JAK Janus kinase
IASLC International Association for the Study of JIA juvenile idiopathic arthritis
Lung Cancer JME juvenile myoclonic epilepsy
IBA identification and brief advice JVP jugular venous pulse
IBD inflammatory bowel disease KCO transfer factor
IBS irritable bowel syndrome LA left atrial; lupus anticoagulant
ICD implantable cardioverter defibrillator; LABA long-​acting inhaled β2 agonist
International Classification of Diseases LAD left anterior descending
ICD-​O International Classification of Diseases LAM lymphangioleiomyomatosis
for Oncology LAP left atrial pressure
ICP intracranial pressure LBBB left bundle branch block
ICS Intensive Care Society LCHAD long chain 3-​hydroxyacetyl coenzyme-​A
ICU intensive care unit dehydrogenase
ID imprinting disorder LDH lactate dehydrogenase
IDL intermediate-​density lipoprotein LDL low-​density lipoprotein
IDDM insulin-dependent diabetes mellitus LFT liver function test
IE infective endocarditis LGMD limb girdle muscular dystrophy
IFALD intestinal failure-​related liver disease LGV lymphogranuloma venereum
IFG impaired fasting glucose LH luteinising hormone
IFRT involved field radiation therapy LHC left heart catheterisation
Ig immunoglobulin LMF lipid maturation factor
IGF insulin-​like growth factor LMS left main stem
IGRA interferon gamma release assay LMWH low molecular weight heparin
IGT impaired glucose tolerance LOS lower oesophageal sphincter
IHD ischaemic heart disease LP lichen planus; lumbar puncture
IIP idiopathic interstitial pneumonia LPA Lasting Power of Attorney
IL interleukin LPL lipoprotein lipase
ILD interstitial lung disease LPS lipopolysaccharide
IM intramuscular LRP lipoprotein-related receptor
IMCA independent mental capacity advocate LRRK leucine-​rich repeat kinase
IMD inherited metabolic disorder LTBI latent tuberculosis infection
IMP investigational medicinal product LTOT long-​term oxygen therapy
IMRT intensity modulated radiotherapy LV left ventricle
IMt intestinal metaplasia LVEDP left ventricular end-​diastolic pressure
INF interferon LVEF left ventricular ejection fraction
INR international normalised ratio LVOT left ventricular outflow tract
IOL intraocular lens LVH left ventricular hypertrophy
IPAF interstitial pneumonia with autoimmune MABP mean arterial blood pressure
features MAC Mycobacterium avium complex
IPAH idiopathic pulmonary arterial MACE major adverse cardiac events
hypertension MAGE melanoma-associated antigen
IPAP inspiratory positive airway pressure MALToma mucosa-associated lymphoid tissue
IPEX immune dysfunction, MAO monoamine oxidase
polyendocrinopathy, and enteropathy, MAOI monoamine oxidase inhibitor
X-​linked MAP mean arterial pressure
IPF idiopathic pulmonary fibrosis MAPK mitogen-​activated protein kinase
IPSP inhibitory post-​synaptic potential MAPT microtubule-​associated protein tau
IPSS International Prognostic Scoring System MAS macrophage activation syndrome
IR(ME)R Ionising Radiation (Medical Exposure) MAU medical admissions unit
Regulations MC&S microscopy, culture and sensitivity
IRMA intra-​retinal microvascular abnormality MCA Mental Capacity Ac; middle
ITP immune thrombocytopenic purpura cerebral artery
ITT insulin tolerance test MCD minimal change disease
IUGR intrauterine growth restriction MCGN mesangiocapillary glomerulonephritis
IV intravenous MCP metacarpophalangeal
IVC inferior vena cava MCR melanocortin receptor

xxiii
Abbreviations

MCTD mixed connective tissue disease MTCD mixed connective tissue disease
MD myotonic dystrophy MTP metatarsophalangeal
mDF Maddrey’s discriminant function MusK muscle specific kinase
MDMA 3,4-​methylenedioxymethamphetamine MVR mitral valve replacement
MDR multidrug resistance MZ monozygote
MDS myelodysplasia NA noradrenaline
MDT multidisciplinary team NAAT nucleic acid amplification technique
MELAS mitochondrial encephalomyopathy with NAC N-​acetylcysteine
lactic acidosis and stroke-​like episodes NAD nicotinamine adenine dinucleotide
MEN multiple endocrine neoplasia NAFLD non-​alcoholic fatty liver disease
MEP maximal expiratory pressure NAP neutrophil alkaline phosphatase
MEPE matrix extracellular phosphoglycoprotein NAPQI N-acetyl-p-benzoquinone imine
MERRF myoclonus epilepsy with ragged NASH non-​alcoholic steatohepatitis
red fibres NBTE non-​bacterial thrombotic endocarditis
MERS Middle East respiratory syndrome NCB sodium bicarbonate co-​transporter
MG Mycoplasma genitalium NCCT sodium chloride co-​transporter
MGUS monoclonal gammopathy of unknown NCS nerve conduction studies
significance NDI nephrogenic diabetes insipidus
MHA Mental Health Act NER nucleotide excision repair
MHC major histocompatibility complex NET neuroendocrine tumour
MHRA Medicines and Healthcare products NF neurofibromatosis; nuclear factor
Regulatory Agency NFCI non-​freezing cold injury
MI myocardial infarction NG nasogastric
MIBG meta iodobenzylguanidine NGT nasogastric tube
MIP maximal inspiratory pressure NGU non-​gonococcal urethritis
MLF medial longitudinal fasciculus NHL non-​Hodgkin’s lymphoma
MMF mycophenolate mofetil NHS National Health Service
MMP matrix metalloproteinase NICE National Institute for Health and Care
MMR mismatch repair Excellence
MMSE mini-​mental state examination NIPHS non-​insulinoma pancreatogenous
MN membranous nephropathy hypoglycaemia syndrome
MND motor neurone disease NIV non-​invasive ventilation
MoCA Montreal Cognitive Assessment NJ nasojejunal
MODY maturity onset diabetes of the young NK natural killer (cell)
MOG myelin oligodendrocyte glycoprotein NMDA N-​methyl-​D-​aspartate
MPA microscopic polyangiitis NMJ neuromuscular junction
mPAP mean pulmonary arterial pressure NMO neuromyelitis optica
MPL myeloproliferative leukaemia NNRTI non-​nucleoside reverse transciptase
MPO myeloperoxidase inhibitor
MPS myocardial perfusion scintigraphy NNT number needed to treat
MR mitral regurgitation NO nitric oxide
MRA magnetic resonance angiography NOAC novel oral anticoagulant
MRCP magnetic resonance NOVAC novel anticoagulant
cholangiopancreatogram NP nasopharyngeal
MRE magnetic resonance enterography NPH neutral protamine Hagedorn
MRI magnetic resonance imaging NPS new psychoactive substance
mRNA messenger RNA NPSA National Patient Safety Agency
MRSA meticillin-​resistant Staphylococcus aureus NPV negative predictive value
MS mitral stenosis; multiple sclerosis NRT nicotine replacement therapy
MSA multiple system atrophy NRTI nucleoside reverse transcriptase inhibitor
MSCC metastatic spinal cord compression NSAID non-​steroidal anti-​inflammatory drug
MSI microsatellite instability NSC National Screening Committee
MSM men who have sex with men NSCLC non-​small cell lung cancer
MSSA meticillin-​sensitive Staphylococcus aureus NSIP non-specific interstitial pneumonia
MSU mid-​stream urine NSR normal sinus rhythm
mSv milliSievert NSTEMI non-​ST-​segment elevation myocardial
MTB mycobacterium tuberculosis infarction
MTC medullary thyroid cancer NSVT non-​sustained ventricular tachycardia

xxiv
 Abbreviations

NT nuchal translucency PE pulmonary embolus

nt-​BNP N-​terminal brain natriuretic peptide PEEP positive-​end-​expiratory pressure
NTM non-​tuberculous mycobacteria PEFR peak expiratory flow rate
NTX cross-​linked N-​telopeptide PEG percutaneous endoscopic gastrostomy
NUV normocomplementaemic urticarial PEM protein-​energy malnutrition
vasculitis PEP post-​exposure prophylaxis
NVP nausea and vomiting of pregnancy PERC Pulmonary Embolism Rule out Criteria
NYHA New York Heart Association PET positron emission tomography;
OA osteoarthritis pre-​eclamptic toxaemia
OAT organic anion transporter PEU protein energy undernutrition
OC obstetric cholestasis PFA platelet function assay
OCT organic cation transporter PFT pulmonary function test
OD once daily PG pyoderma gangrenosum
OGD oesophagogastroduodenoscopy PGL primary generalised lymphadenopathy
OGTT oral glucose tolerance test PH pulmonary hypertension
OH occupational health PI protease inhibitor
OHS obesity hypoventilation syndrome PICA posterior inferior cerebellar artery
OI opportunistic infection PICC peripherally inserted central catheter
OMT optimal medical therapy PiCCO Pulse Contour Cardiac Output
ONJ osteonecrosis of the jaw PID pelvic inflammatory disease; primary
OPAT outpatient parenteral antibiotic therapy immunodeficiency
OPG osteoprotegenerin PIH pregnancy-​induced hypertension
OR Odds ratio PINK phosphatase and tensin-holding
OSA obstructive sleep apnoea homologue- induced putative kinase
OSAHS obstructive sleep apnoea/​hypoapnoea PIP proximal interphalangeal
syndrome PKC protein kinase C
OTC ornithine transcarbamylase PlGF placental growth factor
PA postero-anterior PLS primary lateral sclerosis
PAC pulmonary artery catheter PMA progressive muscular atrophy
PAH pulmonary arterial hypertension PMF probability mass function
PAI plasminogen activator inhibitor PMN polymorphonuclear
PALS Patient Advice and Liaison Service PMNL polymorphonuclear leukocytes
PAMP pathogen associated molecular pattern PO by mouth
PAOP pulmonary artery occlusion pressure PO2 partial pressure of oxygen
PAP pulmonary artery pressure POEM Patient-​Orientated Eczema Measure;
PAPP-​A pregnancy-​associated plasma protein-​A per-​oral endoscopic myotomy
PARP poly-​ADP ribose polymerase PON paraoxonase 
PASI Psoriasis Area and Severity Index POTS postural orthostatic tachycardia
PAVM pulmonary arteriovenous malformation syndrome
PBC primary biliary cirrhosis PPAR peroxisome proliferator activated
PBF peripheral blood film receptor
PBG porphobilinogen PPCI primary percutaneous coronary
PBP progressive bulbar palsy intervention
PCA posterior cerebral artery PPCM peri-​partum cardiomyopathy
PCI percutaneous coronary intervention PPI proton pump inhibitor
PCOS polycystic ovarian syndrome PPM permanent pacemaker
PCP Pneumocystis jirovecii pneumonia PPMS primary progressive multiple sclerosis
(formerly Pneumocystis carinii pneumonia) PPRF paramedian pontine reticular formation
PCR polymerase chain reaction PPV positive predictive value
PCSK proprotein convertase subtilisin/​kexin PR3 proteinase 3
PCT porphyria cutanea tarda; proximal PRCA pure red cell aplasia
convoluted tubule PrEP pre-​exposure prophylaxis
PCWP pulmonary capillary wedge pressure PROMM proximal myotonic myopathy
PD peritoneal dialysis; personality disorder; PRPP 5-​phospho-​alpha-​d-​ribosyl
programmed death pyrophosphate
PDA patent ductus arteriosus PRV polycythaemia rubra vera
PDE phosphodiesterase PS performance status
PDF probability density function PSA prostate-​specific antigen

xxv
Abbreviations

PsA psoriatic arthritis RV right ventricle

PSC primary sclerosing cholangitis RVD right ventricle dysfunction
PSP progressive supranuclear palsy RVEDP right ventricular end-​diastolic pressure
PT prothrombin time RVH right ventricular hypertrophy
PTC percutaneous transabdominal RVO retinal vein occlusion
cholangiography SA sinoatrial
PTH parathyroid hormone SAAG serum albumin ascites gradient
PTHrp parathyroid-​related peptide SADQ Severity of Alcohol Dependence
PTLD post-​transplant lymphoproliferative Questionnaire
disorder SAE serious adverse event
PTU propylthiouracil SAH subarachnoid haemorrhage
PUD peptic ulcer disease SARA sexually acquired reactive arthritis
PUVA psoralen plus ultraviolet A SARS severe adult respiratory syndrome
PV pemphigus vulgaris SASSAD six area six sign atopic dermatitis
PVE prosthetic valve infective endocarditis SBP spontaneous bacterial peritonitis
PWS Prader–​Willi syndrome SBRT stereotactic body radiotherapy
QDS four times a day SC subcutaneous
QFT-​GIT QuantiFERON-​TB Gold In-​Tube SCA spinocerebellar ataxia
QoL quality of life SCD sickle cell disease; sudden cardiac death
QPPV qualified person for pharmacovigilance SCF stem cell factor
R&D research and development SCID severe combined immunodeficiency
RA rheumatoid arthritis; right atrium SCLC small cell lung carcinoma
RAI radioactive iodine therapy SCRA synthetic cannabinoid receptor agonist
RAPD relative afferent pupillary defect SCUF slow continuous ultrafiltration
RAS renal artery stenosis; ScvO2 central venous oxygen saturation
renin-​angiotensin system SD standard deviation
RAST radioallergosorbent assay SEGA subependymal giant cell astrocytoma
RB retinoblastoma SEN subependymal nodule
RBBB right bundle branch block SERM selective oestrogen receptor modulator
RBC red blood cell SF synovial fluid
RCAD renal cysts and diabetes syndrome sFlt fms-​like tyrosine kinase 
RCOG Royal College of Obstetricians and SHGB sex hormone-​binding globulin
Gynaecologists SHO senior house officer
RCT randomised controlled trial SHOT serious hazards of transfusion
RDT rapid diagnostic test SIADH syndrome of inappropriate anti-​diuretic
ReA reactive arthritis hormone
REC Research Ethics Committee SIBO small intestinal bacterial overgrowth
REM-​BD rapid eye movement (sleep) behavioural SIJ sacroiliac joint
disorder SIRS systemic inflammatory response
RET re-​arranged during transfection syndrome
RF rheumatoid factor SJS Stevens–​Johnson syndrome
RFA radiofrequency ablation SLC solute carrier
RFCA radiofrequency catheter ablation SLE systemic lupus erythematosus
RHC right heart catheterisation SLED slow low-​efficiency dialysis
RIF resistance to rifampicin SNMG seronegative myasthenia gravis
RIG radiologically inserted gastrostomy SNRI serotonin noradrenaline reuptake
RNA ribonucleic acid inhibitor
ROC receiver-operator characteristic SOB shortness of breath
RP relapsing polychrondritis; retinitis SOD superoxide dismutase
pigmentosa SOFA Sequential Organ Failure Score
RPF renal plasma flow SpA spondyloarthropathy
RPR rapid plasma regain SPECT single-​photon emission computed
RR respiratory rate tomography
RRMS relapsing-​remitting multiple sclerosis SPMS secondary progressive multiple sclerosis
rRNA ribosomal RNA SpO2 peripheral capillary oxygen saturation
RRT renal replacement therapy SR scavenger receptor
RSV respiratory syncytial virus SSc systemic sclerosis
RTA renal tubular acidosis SSRI selective serotonin reuptake inhibitor
RUQ right upper quadrant SSTI skin and soft tissue infection

xxvi
 Abbreviations

STEMI ST-​segment elevation myocardial infarction tRNA transfer RNA

STI sexually transmitted disease TSA tumour-​specific antigen
STIR short tau inversion recovery TSC tuberous sclerosis complex
SUDEP sudden unexpected death in epilepsy tsDMARDs targeted synthetic DMARDs
SUSAR suspected unexpected serious adverse TSH thyroid-​stimulating hormone
reaction TSP thrombospondin
SV stroke volume TST tuberculin skin test
SVC superior vena cava TTE transthoarcic echocardiogram
SVCO superior vena cava obstruction tTG anti-​tissue transglutaminase
SVD structural valve deterioration TTKG trans-​tubular potassium gradient
SVR systemic vascular resistance TTP thrombotic thrombocytopenic purpura
SVT supraventricular tachycardia TV Trichomonas vaginalis
T thymine U uracil
T3 tri-​iodothyronine U&E urea & electrolytes
T4 thyroxine UC ulcerative colitis
TA Takayasu arteritis UFH unfractionated heparin
TAA tumour-​associated antigen UGI upper gastrointestinal
TACE transarterial chemoembolisation UICC Union for International Cancer Control
of tumour UIP usual interstitial pneumonitis
TAL thick ascending loop of Henle ULN upper limit of normal
TAVI transcatheter aortic valve implantation UN United Nations
TB tuberculosis UPDRS unified PD rating scale
TBG thyroid-​binding globulin US ultrasound
Tc core temperature UTI urinary tract infection
TC total cholesterol UV ultraviolet
TCA tricyclic antidepressant VA alveolar volume
TCR T cell receptor VAD ventricular assist device
TDS three times daily VATS video-​assisted thoracoscopic surgery
TED thromboembolic disease; dysthryoid eye VCE video capsule endoscopy
disease VEGF vascular endothelial growth factor
TEN toxic epidermal necrolysis VEP visual-​evoked potential
TENS transcutaneous electrical nerve stimulation VER visual-​evoked response
TFPI tissue factor pathway inhibitor VF ventricular fibrillation
TFT thyroid function test VFA vertebral fracture analysis
TG triglyceride VFR visiting friends and relatives
TGF tumour growth factor VGKC voltage-​gated potassium channel
THC ∆9-​tetrahydrocannabinol VHD valvular heart disease
TIA transient ischaemic attack VHF viral haemorrhagic fever
TIN tubulointerstitial nephritis VL viral load
TINU tubulointerstitial nephritis and uveitis VLDL very low density lipoprotein
TIPSS trans-​jugular intrahepatic V/Q ventilation/perfusion
portosystemic shunt VRE vancomycin-​resistant Enterococci
TJ trans-​jugular VRet venous return
TKI tyrosine kinase inhibitor VSD ventricular septal defect
TLC total lung capacity VT ventricular tachycardia
TLCO transfer factor for carbon monoxide VTE venous thromboembolism
T-​LOC transient loss of consciousness vWF von Willebrand factor
TLR toll-​like receptor VZIG varicella zoster immunoglobulin
TLS tumour lysis syndrome VZV varicella zoster virus
TNF tumour necrosis factor WBCT whole-​blood clotting test
TNM tumour, node, metastases WCC white cell count
TOE transoesophageal echocardiogram WHO World Health Organization
tPA tissue plasminogen activator WPW Wolff–​Parkinson–​White
TPN total parenteral nutrition XDR extensively drug resistant
TPO thyroid peroxidase XLD X-​linked dominant
TPPA Treponema pallidum particle XP xeroderma pigmentosum
agglutination assay ZES Zollinger–​Ellison syndrome
TPR total peripheral resistance ZN Ziehl–​Neelsen
TRH thyrotropin-​releasing hormone

xxvii
Another random document with
no related content on Scribd:
 CHAPTER XXIV
IN THE SWIRL OF THE RAPIDS

The warning to Bomba came too late.

The tree had been undermined by the current, swelled by the recent
rain. It had probably been tottering to its fall when Bomba climbed it,
and his weight and his movements among the branches determined
its fate.
Bomba was too high to jump. From such a distance he would surely
have broken a limb and possibly his neck. He could only cling tightly
to the bough on which he found himself and trust to chance.
Slowly the tree toppled, and then, with a tremendous splash, fell into
the river. Its momentum carried it for a moment beneath the surface.
Then it came up again with Bomba, drenched and sputtering, still
holding tightly to the bough.
Fortunately he had been on the landward side of the tree, so that he
was on the upper side as the tree swirled in the current.
Now, as his eyes cleared, he found that he was not alone. Ashati
and Neram had been standing at the foot of the tree, and as its great
roots tore loose from the ground they caught the two ex-slaves and
flung them with the force of a catapult far out into the stream.
They had made for the tree as the nearest haven of safety, and now
climbed up into the branches and drew as near as they could to
Bomba.
The lad’s first impulse, when he found himself afloat, was to plunge
into the river and swim for the bank, two hundred feet away. But
even as the thought came into his mind he caught sight of the scaly
body and horrid head of an alligator between him and the shore. The
brute would have had him before he had gone twenty feet.
By this time the tree had been caught in the rapids, those terrible
rapids of the River of Death whose power Bomba had already
tested.
Had it been merely the trunk of a tree on which they found
themselves, they would have been tossed off in a moment. But the
great spreading branches kept it from turning over. Even at that, it
was tossed about like a chip, and great waves broke over it,
threatening at any moment to dislodge Bomba and his two
companions, who had to hold on with all their might to prevent being
swept away.
The horror of their position was intensified by the presence of a
swarm of alligators, whose eyes had detected them and looked upon
them as certain prey. The monsters swam about the tree on every
side, at times dashing up from underneath with wide open jaws, in
the hope of reaching them and pulling them down.
Ashati and Neram thought that their last hour had come, and Bomba
was inclined to agree with them. The tree might stay there, buffeted
back and forth, for days. They could not guide it. They dared not
leave it.
From the contemplation of his own plight, his thoughts turned to
those on shore. He was thankful that they were safe for the moment.
Hondura was there to lead them, and the wily chief knew all the lore
and craft of the jungle. With the start he had over his enemies and
the probability that he would soon fall in with his own warriors
coming to his rescue, Hondura would probably win through.
And Bomba knew that the old chief and his people would take good
care of Casson. Good old Casson! Would he ever see the old man
again, the lad wondered.
But a different and more welcome turn was given to his thoughts
when Bomba discovered that the fierce tossing had ceased. The tree
had been thrown from the rapids into smoother water, and was now
drifting in the grip of a strong current in the same direction that
Bomba’s canoe had taken two days before.
In a little while the point of land resembling a finger had been
reached and passed, at so little distance that it would have been
easy to swim to it, had it not been for the monster caymen that still
kept pace with them.
Ashati and Neram had recovered their spirits, now that they had
escaped the grip of the rapids.
“The Spirit of the Jungle is good!” exclaimed Ashati.
“It will not be long before we touch land somewhere,” prophesied
Neram, hopefully.
“Yes,” said Bomba, as his eyes caught sight of Sobrinini’s domain
looming up before them, “and the land will be Snake Island.”
At this name of ominous import a shudder ran through Bomba’s
companions.
“The island of the witch woman!” exclaimed Ashati, making cabalistic
signs to ward off evil.
“The woman with the evil eye which brings death to everyone on
whom it falls!” said Neram with a shiver.
“Listen!” said Bomba. “You talk like foolish men. Is Bomba dead? Yet
Sobrinini’s look fell upon Bomba. She is a wise woman. Did she not
say that I would come back to Snake Island? And is Bomba not
going back? I do not like her snakes. But she has done no evil to
Bomba, and she will do no hurt to Bomba’s friends. And Ashati and
Neram are my friends.”
The boy’s words brought some reassurance to his companions, but
not enough to banish their fears wholly, and it was with great
trepidation that they viewed the dreaded island as the tree drew ever
nearer.
As for Bomba himself, he was almost glad at the accident which had
at the time seemed so disastrous. He would not of his own accord
have taken the time just now to visit Sobrinini again, eager as he
was to renew his questioning. She had been on the very point of
telling him what he wanted to know when Nascanora and his braves
had broken in upon them. Perhaps this time he would be more
fortunate.
He was immersed in these thoughts when to their ears came a
wailing cry, so weird, so uncanny, so long drawn out, that it chilled
their blood.
It came from the direction of the island, but, strain their eyes as they
might, they could detect no human figure from whom the cry might
have issued.
The sound was the signal for another outbreak of fear on the part of
the ex-slaves. They were brave enough when facing human or
animal foes, as they had shown in their combat with the jaguars, but
when brought in contact with what they regarded as supernatural,
their hearts melted within them.
They whimpered and cowered and glanced at the water, as though
they were almost willing to take their chances with the alligators
rather than approach the island they deemed accursed.
But they had drawn nearer now and they could detect an agitated,
tumultuous group of figures on the shore.
The wailing cry came again, so near this time that Ashati and Neram
nearly lost their grip on the boughs.
Then from out the fringe of trees that lined the shore shot a small
canoe, paddled with frantic energy by a withered old woman, her
straggling locks streaming behind her head, her face convulsed with
fear.
“Sobrinini!” cried Bomba.
 CHAPTER XXV
THE RESCUE OF SOBRININI

With Bomba, to think was to act.

In a moment he had made his way out on the bough to a point where
the foliage thinned out and there was a chance of his being seen.
“Sobrinini! Sobrinini!” he shouted at the top of his voice.
At the call, the old crone ceased paddling for a moment and turned
her haggard face in the direction of the tree.
“Who calls?” she cried shrilly. “Who is it that calls Sobrinini?”
“It is Bomba!” shouted the lad, at the same time shaking the bough
of the tree violently to attract her attention.
She caught the movement of the foliage, and, peering closely, saw
the outline of Bomba’s face and form.
“Bartow!” she cried. “Or is it Bartow’s ghost? You have come to see
Sobrinini die.”
“No!” replied Bomba. “I have come to help Sobrinini live. Come
quickly!”
This last admonition was prompted by the sight of another boat
containing several natives of the island putting out from the shore.
He sensed at once that their errand was hostile.
Sobrinini saw them too, and with a few strokes of her paddle brought
the canoe directly beneath the jungle boy.
Bomba dropped lightly into the canoe, and then held it steady until
Ashati and Neram had time to follow his example.
The other boat was coming on rapidly now, and time was pressing.
Bomba took the paddle from Sobrinini’s hands and pressed her
gently to the bottom of the boat.
But before he dipped the paddle into the water he drew his knife and
shook it menacingly at the approaching natives.
“Go back or you will die!” he shouted. “This is the knife that
frightened Nascanora. It made his heart like that of a woman. Who
are you to stand before it when even the chief of the headhunters
was afraid?”
It was a wholesome reminder, and it had an immediate effect. They
recognized Bomba now as the jungle boy whose challenge
Nascanora had been afraid to accept. That scene had made an
indelible impression upon their minds. They stopped paddling, and
excited jabbering ensued.
Bomba faced them for a full minute. Then with a disdainful gesture
he replaced the knife in his belt, as though they were foes too
insignificant to bother with any further, took up the paddle, and
without once looking behind him made for the opposite shore.
His evident fearlessness and contempt decided the issue. The
pursuing party, after a little irresolution, gave up the chase and
turned the prow of their boat in the direction of Snake Island.
Sobrinini had said nothing coherent since her rescue, but sat
crouched on the bottom of the boat mumbling to herself, her long,
disheveled hair shielding her face. Bomba regarded her curiously
from time to time, half expecting to see one or more snakes make
their appearance. But it soon became apparent that all her horrid
“pets” had been left behind in her hurried flight.
Ashati and Neram kept as far away from her as they could, crowding
against each other to avoid contact with the “witch” whose name
spread terror through all that region.
Why had she fled from the island where she had so long held sway?
Why had her formerly submissive slaves turned against her? Bomba
longed to question her, but had to defer that to another time. He
wished that she had brought with her that picture, the picture of that
sweet, beautiful woman, whose eyes had looked so fondly into his.
After a long siege of paddling, the boat touched the farther shore.
Bomba jumped out and pulled the canoe far up on the shelving bank.
Then he helped Sobrinini out, while Ashati and Neram leaped ashore
quickly, glad to be freed from their enforced proximity to the witch.
At Bomba’s command, the men scattered to gather a little food from
the forest, and soon returned with nuts and berries that partially
satisfied their hunger.
Bidding them stay where they were, Bomba penetrated some
distance into the jungle to see if he could pick up the trail of Hondura
and his party.
He had not gone far before he began to sniff. He smelled smoke. His
eyes followed the indications of his nostrils, and he finally caught
sight of a shred of smoke rising above trees not far distant.
He was about to drop on his hands and knees and creep through the
brush to reconnoiter, when he heard a sound that made his heart
leap with delight.
It came to him faintly, and yet was unmistakable. Somebody was
playing a harmonica!
Reassured now, but still not abandoning his habitual caution, he
moved forward until from the shelter of a bush he could see
encamped in a clearing, while they prepared their midday meal, a
large party of natives, evidently on the warpath, as they were armed
to the teeth.
He knew them at once. They were the Araos coming to the rescue of
their chief. There was Lodo, evidently in command, a little apart from
the rest. And there was Grico, squatting on his haunches and
bringing weird sounds from Bomba’s harmonica for the delectation of
his mates.
Bomba stepped from the shelter of the bush, his hands upraised with
palms outward in sign of friendship.
There was a chorus of ejaculations, a hurried grasping of weapons,
and then shouts of pleasure as they recognized the newcomer.
They crowded about him with every manifestation of delight,
overwhelming him with questions. And cries of joy went up as
Bomba, in as few words as possible, told them what had happened
and that Hondura with the ex-captives must be close at hand and
coming to meet them.
Instantly their meal was forgotten as they gathered up their weapons
and supplies and prepared to go forward to greet their chief, their
women, and their children.
Grico, the man with the one eye and the split nose, had listened to
Bomba’s story with such absorbed interest that he still held the
harmonica loosely in his hand. Bomba reached out coolly and took it
from him.
Grico looked astonished and sheepish. And he was still more
abashed when Bomba, noting a protuberance in Grico’s pouch,
reached in and drew out the precious revolver.
“It was good of Grico to keep these for Bomba till he should come
back again,” said the boy in the friendliest of tones, as he stowed
away the treasures in his pouch.
His look was so kindly, so innocent, that Grico did not know what to
do or say. Ordinarily this would have meant a fight. But Grico knew
that Bomba was a bad opponent to pick for a fight, and, besides, at
this moment, the boy was high in the favor of the tribe.
And Bomba’s eyes were very compelling, despite their friendliness.
Grico had never heard of an iron hand in a velvet glove, but he felt
that something of that kind was very close by.
So he swallowed hard for a moment, and then took advantage of the
opening that Bomba had given him.
“Y—yes,” he stammered. “Grico found them in the jungle and kept
them for Bomba.”
“Grico did well, and Bomba will not forget,” said the lad gravely.
It was arranged hastily that Bomba should go back and get his
companions and then join the war party as they went forward to
meet their chief.
Ashati and Neram greeted Bomba’s news with cries of delight.
Sobrinini showed no emotion whatever. It was doubtful whether she
understood. She was sunk in a state of apathy, the natural reaction
from her exciting experiences.
It was difficult to get her to her feet at all, but the need was urgent
and Bomba put his strong arm under hers, and with Ashati and
Neram made as good time as possible in the direction of the line of
march.
Luckily, their journey was not prolonged, for before an hour had
passed a joyous hubbub not far ahead told them that the two parties
had joined forces. Hondura and the ex-prisoners were once more
with their own people.
Bomba was welcomed with wild acclaim when he came into view.
Casson and Pipina especially greeted him with tears and embraces
that testified how deeply they were moved.
There was a great feast to celebrate the reunion, followed by a long
powwow between Hondura, Grico and Lodo. Bomba was invited to
join the conference, but declined, as he felt this was a matter that
concerned them chiefly and he did not want to take any responsibility
for the future movements of the tribe.
The result of the powwow was that the natives formed themselves
into two bands. One, consisting of picked warriors under the
leadership of Lodo, with Grico as his lieutenant, proceeded toward
the Giant Cataract to give battle to the headhunters and remove
forever, if possible, that menace to the peaceful tribes of the region.
Others, under the guidance of the aged chief, Hondura, convoyed
the rescued women and children in the direction of their maloca,
which they planned to rebuild.
The grateful Hondura detailed eight of his men to make two litters on
which they bore Casson and Sobrinini, who had reached the limit of
their strength, to the cabin of Pipina.
When their paths at last diverged, Hondura and Bomba clasped
each other by the shoulders and vowed eternal friendship. Pirah
wept bitterly at the separation, and could only be comforted by
Bomba’s promise to come to see her before long.
Bomba had cherished a vague hope that something dramatic would
take place when Casson and Sobrinini were brought face to face. He
hoped the meeting would unlock the floodgates of memories which
they shared in common.
But to his bitter disappointment nothing of the kind occurred. Age
had changed each so utterly that neither recognized the other. They
looked at each other indifferently, and then their eyes turned away.
He had not named either one to the other as yet, and both were so
apathetic that they showed no curiosity. But though disheartened,
Bomba did not wholly despair. When they should get to the cabin of
Pipina he would try again.
Ashati and Neram had begged to be allowed to go along with
Bomba, and he had willingly agreed. The faithful fellows were
devoted to him heart and soul, and they might be of great service to
him whenever he should be compelled to absent himself from the
cabin.
Shred by shred, in monosyllables and muttered exclamations,
Bomba gathered, as he walked beside Sobrinini’s litter, the reason
for her flight from the island. He had already guessed it pretty
accurately.
Her harsh rule had for a long time galled the natives, who sought an
excuse for rebellion. That excuse had been found in the visit of
Nascanora. They had expected that she would annihilate him on the
spot. Was she not a witch? But when, on the contrary, Nascanora
had triumphed and taken her guest from under her protection, their
belief in her supernatural powers failed, their long-smothered
resentment broke forth, and she had been compelled to flee for her
life.
The little party reached the cabin of Pipina without any untoward
happening, the braves departed for their maloca, and the little
household, now increased by three, was reëstablished.
Bomba waited till several days had elapsed and his aged charges
had become rested and strengthened after their exhausting
experiences before he broached the subject that was nearest his
heart.
Then, one evening after supper, he turned to them as they were
sitting dreamily in the large room of the little cabin.
“Casson!” he said. “Sobrinini! Look upon each other and tell me what
you see.”
They started at his sharp command, and gazed bewilderedly at him,
then at each other.
At first there was no recognition, but as they gazed fixedly a dawning
wonderment came into their eyes.
Casson was the first to speak.
“Sobrinini!” he cried. “No, that is not Sobrinini. Sobrinini was
beautiful. Sobrinini could sing. And yet—and yet——”
“Casson!” exclaimed Sobrinini in her turn. “It cannot be Casson. He
was young and strong, and his hair was like that of the raven. But I
am Sobrinini. I can sing. Listen!”
She sprang to her feet and sang in her cracked voice the song that
Bomba had heard in the language he did not understand. As she
sang, Casson began to beat his withered palms together in
applause, and finally got to his feet and started to dance about the
room.
It was weird and uncanny, and Bomba looked on, fascinated yet
horrified, until the song ended, the dance stopped, and the aged
participants sank trembling in their chairs.
“You do know each other!” cried Bomba. “And you know about my
father and my mother. Tell me, oh, tell me who they were, where they
are! Tell me!”
They looked at him, trying to gather their poor scattered wits. Casson
rubbed his forehead with his hand.
“Ask Jojasta,” he muttered. “I cannot remember. The door is closed.
But Jojasta knows. Ask him.”
“But Jojasta is dead!” exclaimed Bomba.
“Oh, yes,” replied Casson. “You told me he was dead. Then ask
Sobrinini. Nini will know.”
In desperation, Bomba turned to the woman.
“You tell me,” he begged. “You were going to tell me when
Nascanora came. Tell me now!”
“I forget—I forget,” murmured Sobrinini. “I cannot tell you, Bartow.”
“I am not Bartow,” said Bomba.
“Then you are his ghost,” muttered the crone.
“No, no!” cried Bomba. “Look at me. Try to remember.”
She stared at him long and hard.
“If you are not Bartow nor Bartow’s ghost, you are his son,” she
declared. “Andrew Bartow and Laura—yes, her name was Laura—
had a son who was named Bonny. She used to sing to him like this
—” and again she crooned the tender cradle song that had stirred
Bomba so strangely.
She relapsed into meditation, still humming that haunting song.
“Yes,” prompted Bomba eagerly. “Where are Bartow and Laura now?
And Bonny——”
“Bonny!” she repeated. “Oh, yes, Bonny was stolen. He was stolen
from home by—by—Japazy! That was his name—a half-breed.
Japazy hated Bartow and hated Casson, too. I do not know why he
hated them. And then—and then—oh, I cannot remember! But ask
Japazy—he will know. Look for Japazy on Jaguar Island above the
cataract.”
Her voice died away in disjointed mutterings, and from neither her
nor Casson could he get anything clearer that evening nor in the
days that followed.
The boy was desperate. It seemed that the half-demented man and
woman could get no further. Bomba had got merely a clue.
But that in itself was something. How Bomba followed it up and what
exciting perils and adventures he met in fulfilling his task will be told
in the next volume of this series, entitled: “Bomba the Jungle Boy on
Jaguar Island; or, Adrift on the River of Mystery.”
From the pain and disappointment in his heart Bomba sought relief
with his wild friends of the forest. They could always sympathize with
his mood and in some degree understand it. To them he talked, and
they chattered in reply. And his sore heart was eased in their
companionship.
One day, when he had been playing his harmonica and Doto, the
monkey, and Kiki and Woowoo, the parrots, and others of their
mates were gathered around him, there was a crashing in the
bushes, and faithful Polulu, the giant puma, bounded into the
clearing.
The others scattered like magic as the formidable beast came up to
Bomba, purring and rubbing his head against him.
“Good old Polulu!” exclaimed Bomba, as he caressed the great head
affectionately. “He is one of Bomba’s best friends. Bomba is glad to
see him. But Bomba cannot stay with Polulu long. He is going on a
long journey. For Bomba’s place is not here. He is not a native of the
jungle. He has a soul. He is white. Yes, Bomba is white. And
Bomba’s soul cannot be at rest until he dwells among the white
people.”
THE END
 THE BOMBA BOOKS
By ROY ROCKWOOD
12mo. Cloth. Illustrated. With Colored jacket.
Price 50 cents per volume. Postage 10 cents additional.
Bomba lived far back in the jungles of the Amazon with a
half-demented naturalist who told the lad nothing of his
past. The jungle boy was a lover of birds, and hunted
animals with a bow and arrow and his trusty machete. He
had only a primitive education, and his daring adventures
will be followed with breathless interest by thousands.

1. BOMBA THE JUNGLE BOY

2. BOMBA THE JUNGLE BOY AT
THE MOVING MOUNTAIN
3. BOMBA THE JUNGLE BOY AT
THE GIANT CATARACT
4. BOMBA THE JUNGLE BOY ON
JAGUAR ISLAND
5. BOMBA THE JUNGLE BOY IN
THE ABANDONED CITY
6. BOMBA THE JUNGLE BOY ON
TERROR TRAIL
7. BOMBA THE JUNGLE BOY IN
THE SWAMP OF DEATH
8. BOMBA THE JUNGLE BOY
AMONG THE SLAVES
9. BOMBA THE JUNGLE BOY ON
THE UNDERGROUND RIVER
10. BOMBA THE JUNGLE BOY AND
THE LOST EXPLORERS
 11. BOMBA THE JUNGLE BOY IN A
STRANGE LAND
12. BOMBA THE JUNGLE BOY
AMONG THE PYGMIES
13. BOMBA THE JUNGLE BOY AND
THE CANNIBALS
14. BOMBA THE JUNGLE BOY AND
THE PAINTED HUNTERS
15. BOMBA THE JUNGLE BOY AND
THE RIVER DEMONS
16. BOMBA THE JUNGLE BOY AND
THE HOSTILE CHIEFTAIN
17. BOMBA THE JUNGLE BOY
TRAPPED BY THE CYCLONE
18. BOMBA THE JUNGLE BOY IN
THE LAND OF BURNING LAVA

These books may be purchased wherever books are sold

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CUPPLES & LEON COMPANY, Publishers

New York
 THE BASEBALL JOE SERIES
By LESTER CHADWICK
12mo. Illustrated. Price 50 cents per volume. Postage 10
cents additional.

1. BASEBALL JOE OF THE SILVER

STARS
or The Rivals of Riverside
2. BASEBALL JOE ON THE SCHOOL
NINE
or Pitching for the Blue Banner
3. BASEBALL JOE AT YALE
or Pitching for the College
Championship
4. BASEBALL JOE IN THE CENTRAL
LEAGUE
or Making Good as a Professional
Pitcher
5. BASEBALL JOE IN THE BIG LEAGUE
or A Young Pitcher’s Hardest
Struggles
6. BASEBALL JOE ON THE GIANTS
or Making Good as a Twirler in the
Metropolis
7. BASEBALL JOE IN THE WORLD
SERIES
or Pitching for the Championship
8. BASEBALL JOE AROUND THE
WORLD
or Pitching on a Grand Tour
9. BASEBALL JOE: HOME RUN KING
or The Greatest Pitcher and Batter on
 Record
10. BASEBALL JOE SAVING THE
LEAGUE
or Breaking Up a Great Conspiracy
11. BASEBALL JOE CAPTAIN OF THE
TEAM
or Bitter Struggles on the Diamond
12. BASEBALL JOE CHAMPION OF THE
LEAGUE
or The Record that was Worth While
13. BASEBALL JOE CLUB OWNER
or Putting the Home Town on the Map
14. BASEBALL JOE PITCHING WIZARD
or Triumphs Off and On the Diamond

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New York
 THE GREAT ACE SERIES
By NOËL SAINSBURY, JR.
Author of The Champion Sport Stories
12mo. Cloth. Illustrated. Jacket in
colors. Price 50 cents per volume.
Postage 10 cents additional.
Here is a series of rattling good flying
stories told by an expert. A boy-
aviator’s adventures in the wilds of
New Guinea, Arabia, South America
and other strange lands. Billy Smith,
son of an eminent explorer, learns to
pilot a seaplane aboard a Naval Air
Station, and immediately fares forth
upon a series of the most exciting cruises and mysterious
quests by air, by land and by sea that have ever fallen to
the lot of man. The author, a traveller and ex-naval aviator,
brings many of his own adventures into these tales. Every
boy with a drop of red blood in his veins will want to join
Billy Smith in his thrilling quests.

1. BILLY SMITH—EXPLORING ACE

or By Airplane to New Guinea
The story of a fourteen-year-old lad, taught to pilot a
seaplane by his uncle, Lieut.-Commander on a Naval Air
Station. Together they are forced down at sea, and Lieut.-
Com. Smith is so impressed with the lad’s courage in this
trying situation that he takes Billy with him to New Guinea
to help search for Billy’s father.
2. BILLY SMITH—SECRET SERVICE ACE
or Airplane Adventures in Arabia
Billy Smith again proves his mettle in a series of
adventures that take him to Port Sudan on the Red Sea
 and the Holy City of Hejaz.
3. BILLY SMITH—MYSTERY ACE
or Airplane Discoveries in South America
Doctor Stanton, bird man of the Natural History Museum
disappeared in the Amazon Jungles. The Smiths, father
and son are ordered to find him, and the trail leads to an
outpost rubber plantation, where Billy is lost in the jungle
and captured by the cannibal Mangeroma Indians.
4. BILLY SMITH—TRAIL EATER ACE
or Into the Wilds of Northern Alaska
Another exciting story. Billy Smith and his pal, Nuky, with
the aid of Billy’s father set a trap to catch desperate
gangsters which they succeed in doing after many thrilling
adventures.
5. BILLY SMITH—SHANGHAIED ACE
or Malay Pirates and Solomon Island Cannibals
Billy shanghaied while on a search for a missing steamer
and one passenger in particular, escapes in time to be of
vast help, after all, and bring off a famous rescue in the
South Sea Islands.

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New York
MYSTERY AND ADVENTURE BOOKS FOR
BOYS
12mo. Cloth. Illustrated. Colored
jackets.
Price 50 cents per volume.
Postage 10 cents additional.
SOUTH FROM HUDSON BAY, by E.
C. Brill
A thrilling tale of the coming of settlers
from France and Switzerland to the
wilderness of the Prairie country of
the Red River district.
THE SECRET CACHE, by E. C. Brill
The father of two boys, a fur hunter, has been seriously
injured by an Indian. Before he dies he succeeds in telling
the younger son about a secret cache of valuable furs,
who starts off to find the cache, and after many
adventures succeeds.
THE ISLAND OF YELLOW SANDS, by E. C. Brill
An exciting story of Adventure in Colonial Days in the
primitive country around Lake Superior, when the forest
and waters were the hunting ground of Indians, hunters
and trappers.
LOST CITY OF THE AZTECS, by J. A. Lath
Four chums find a secret code stuck inside the binding of
an old book written many years ago by a famous
geologist. The boys finally solve the code, learn of the
existence of the remnant of a civilized Aztec tribe inside
an extinct crater in Arizona. Their many stirring adventures
makes a story of tremendous present-day scientific
interest that every boy will enjoy.