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DIAGNOSIS AND
TREATMENT IN
INTERNAL MEDICINE

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DIAGNOSIS AND
TREATMENT
IN INTERNAL
MEDICINE

Edited by
Patrick Davey
Consultant Cardiologist, Northampton General Hospital NHS Trust,
Northampton, UK

David Sprigings
Formerly Consultant Physician, Northampton General Hospital NHS Trust,
Northampton, UK

1
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1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2018
The moral rights of the authors‌have been asserted
First Edition published in 2018
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2018941300
ISBN 978–​0–​19–​956874–​1
Printed and bound in China by
C&C Offset Printing Co., Ltd.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.

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Preface

Diagnosis and Treatment in Internal Medicine came about through our experience on
the acute medical take. Here, sick patients present in large numbers with a vast range
of problems. What all patients need, as the bedrock of management, is a differential
diagnosis, and the central aim of our book is to help doctors formulate this. We asked
experts in their field to provide succinct and authoritative guidance across the breadth
of internal medicine. The assessment of symptoms or presenting problems is a major
element of the book, but there is also comprehensive coverage of disorders of the
body systems, including psychological aspects and palliative care. Chapters are struc-
tured so that key information can rapidly be found. Doctors need a broad perspective
on health and its promotion, and there are sections addressing nutrition, lifestyle, and
prevention of disease.
This book approaches medicine from the patient’s perspective, through the stories
that patients tell us about their illness, and provides the knowledge that turns these
narratives into diagnoses, treatment, health, and longevity. Throughout, our focus has
been on meeting the needs of doctors in the clinic, in the emergency department, or
on the ward.
Our eternal thanks go out to our contributors. Some 200 outstanding doctors have
produced admirably compact and lucid chapters. Throughout the lengthy gestation of
the book, we have been ably supported by the staff at Oxford University Press, who
have encouraged us and orchestrated the project. All praise should be directed to the
authors, and any mistakes are ours. Please do let us have your suggestions for improve-
ments (you can contact us at david.sprigings@gmail.com and pftame@gmail.com).
Patrick Davey
David Sprigings

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Contents

Normal values xiii

Abbreviations xv
Contributors xxiii

PART 1 THE APPROACH TO THE PATIENT

1 Diagnostic reasoning 2 5 The psychological examination 18

2 Dealing with uncertainty 8 6 Confidentiality 22
3 Taking the history 12 7 Consent 24
4 The physical examination 15

PART 2 ASSESSMENT OF SYMPTOMS AND PRESENTING PROBLEMS

8 Palpitation 28 37 Anaemia 104

9 Acute chest pain 31 38 Bruising and bleeding 106
10 Chronic chest pain 37 39 Transient loss of consciousness 109
11 Hypotension 43 40 Coma 112
12 Acute breathlessness 47 41 Delirium (acute confusional state) 116
13 Chronic breathlessness 51 42 Seizures 120
14 Peripheral oedema 56 43 Difficulty speaking (including dysphasia and
15 Murmur 58 dysarthria) 123
16 Cough 61 44 Weakness 126
17 Wheeze 63 45 Tremor and other abnormal movements 131
18 Haemoptysis 65 46 Gait disorders 134
19 Pleural effusion 67 47 Sensory loss 137
20 Chylothorax 70 48 Headache 142
21 Difficulty swallowing 71 49 Loss of vision 146
22 Haematemesis 73 50 The red eye 150
23 Acute abdominal pain 75 51 Hearing loss 153
24 Chronic abdominal pain 78 52 Facial pain 155
25 Dyspepsia 81 53 Dizziness 157
26 Abdominal mass 83 54 Disorders of sleep 159
27 Constipation 85 55 Haematuria 161
28 Acute diarrhoea 87 56 Oliguria and anuria 163
29 Chronic diarrhoea 89 57 Polyuria 165
30 Rectal bleeding 91 58 Dysuria 167
31 Jaundice 93 59 Urinary incontinence 170
32 Ascites 95 60 Faecal incontinence 173
33 Chylous ascites 98 61 Vaginal discharge 175
34 Swelling in the neck 99 62 Joint pain 178
35 Splenomegaly and other disorders of the 63 Muscle pain 181
spleen 101 64 Low back pain 183
36 Lymphadenopathy 103 65 Painful leg 187

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 66 Leg ulcers 191 76 Fever 216
67 Limb ischaemia 193 77 Hyperthermia 218
68 Rashes 195 78 Hypothermia 221
69 Blistering rashes 197 79 Fatigue 224
70 Photosensitive rashes 200 80 Unintentional weight loss 226
71 Itching 203 81 Obesity: differential diagnosis 228
72 Lumps and bumps 205 82 Self-​harm 231
73 Falls 209 83 Alcohol intoxication 234
74 Immobility (‘Off legs’) 212 84 Intravenous drug use 239
75 Suspected anaphylaxis 214

PART 3 CARDIOVASCULAR DISORDERS

85 Normal function of the cardiovascular 105 Raynaud’s phenomenon 325

system 244 106 Heart muscle disease (cardiomyopathy) 327
86 Risk factors for cardiovascular disease 248 107 Tumours and the heart 332
87 Diagnosis and investigation in suspected heart 108 Cardiac infection 335
disease 252
109 Pericardial disease 340
88 Congenital heart disease in adults 263
110 Extrasystoles 342
89 Chronic stable angina 271
111 Sinus tachycardia 345
90 Acute coronary syndromes 275
112 Focal (ectopic) atrial tachycardia 348
91 Acute heart failure 280
113 Multifocal atrial tachycardia 351
Contents

92 Chronic heart failure 283

114 Atrioventricular nodal re-entrant
93 Aortic stenosis 287 tachycardia 354
94 Aortic regurgitation 290 115 Atrioventricular re-​entrant tachycardia 357
95 Mitral regurgitation 292 116 Atrial fibrillation 361
96 Miscellaneous valvar pathology: Mitral 117 Atrial flutter 366
stenosis, pulmonary stenosis, and tricuspid
regurgitation 295 118 Ventricular tachyarrhythmias: Ventricular
tachycardia and ventricular fibrillation 369
97 Percutaneous coronary intervention 299
119 Bradyarrhythmias 379
98 Heart surgery 302
120 Sudden cardiac death 384
99 Circulatory support therapy 306
121 Cardiac device therapy 395
100 Pulmonary hypertension 308
122 Drug-​induced cardiovascular disease 401
101 Venous thrombosis and pulmonary
embolism 312 123 Psychological management of coronary heart
disease 403
102 Aortic aneurysm 318
124 Treatment of terminal cardiovascular
103 Aortic dissection 320 disease 405
104 Peripheral arterial disease 322

PART 4 RESPIRATORY DISORDERS

125 Normal respiratory function 410 131 Pneumothorax 436

126 Diagnosis in suspected respiratory disease 412 132 Cystic fibrosis 439
127 Investigation in respiratory disease 415 133 Asthma 441
128 Upper respiratory tract infections, including 134 Chronic obstructive pulmonary disease 445
influenza 425 135 Respiratory failure 449
129 Pneumonia 427 136 Obstructive sleep apnoea 454
130 Tuberculosis 431 137 Bronchiectasis 456

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138 Sarcoidosis and other granulomatous lung
disease 458
139 Interstitial lung disease 460
140 Pulmonary vasculitis 464
141 Lung cancer (including management of an
isolated lung lesion) 467
142 Occupational lung disease 472
143 Pleural infection and malignancy 475
144 Drug-​induced lung disease 477
145 Psychology in respiratory disease, including
dysfunctional breathing 480
146 Terminal care in respiratory illness 482

PART 5 INTENSIVE CARE MEDICINE

147 Critical illness 486 151 ICU treatment of acute kidney injury 496
148 Role of the intensive care unit 488 152 ICU treatment of sepsis and septic shock 498
149 ICU treatment of respiratory failure 490 153 Terminal care in the intensive care unit 501
150 ICU treatment of cardiovascular failure 493 154 Brain death 503

PART 6 DISORDERS OF THE KIDNEY AND URINARY TRACT, AND ELECTROLYTE

AND METABOLIC DISORDERS

155 Normal renal function 506 169 Inherited renal diseases 556
156 Diagnosis in suspected renal disease 509 170 The kidney in systemic disease 558
157 Investigation in renal disease 512 171 Renal vascular disease 561
158 Urinary tract infection 518 172 Management of terminal care in renal
159 Glomerulonephritis 521 disease 563
160 Interstitial renal disease 527 173 Disorders of plasma potassium 565

Contents
161 Nephrotic syndrome 529 174 Disorders of plasma sodium 568
162 Acute kidney injury 533 175 Disorders of plasma calcium 570
163 Chronic kidney disease 536 176 Disorders of plasma phosphate 573
164 Diabetic renal disease 540 177 Disorders of plasma magnesium 575
165 Urinary tract obstruction 543 178 Disorders of acid–​base balance 577
166 Renal calculi 546 179 Porphyria 580
167 Renal and bladder cancer 549 180 Aminoacidopathies, urea cycle disorders, and
organic acidurias 582
168 Renal replacement therapy 552
181 Amyloidosis 584

PART 7 DIABETES MELLITUS AND ENDOCRINE DISORDERS

182 Normal function of the endocrine system 588 188 Adrenal disease 612
183 Diagnosis and investigation in endocrine 189 Cushing syndrome 617
disorders 593 190 Short stature 619
184 Diabetes mellitus 596 191 Infertility 621
185 Hypoglycaemia 601 192 Pituitary disorders: Prolactinomas, acromegaly,
186 Thyroid disease 603 and pituitary apoplexy 625
187 Primary hyperparathyroidism 610

PART 8 GASTROINTESTINAL DISORDERS

193 Normal gastrointestinal function 632 195 Investigation in gastrointestinal disease 637
194 Diagnosis in suspected gastrointestinal 196 Immunology and genetics in gastrointestinal and
disease 635 hepatic medicine 641

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 197 Gastrointestinal infections 644 202 Malabsorption 660
198 Benign oesophageal disease 648 203 Inflammatory bowel disease 663
199 Peptic ulcer disease 651 204 Gastrointestinal tumours 667
200 Gall bladder disease 653 205 Functional gastrointestinal diseases 674
201 Pancreatic disease 656 206 Psychiatry in gastrointestinal medicine 676

PART 9 DISORDERS OF THE LIVER

207 Normal hepatic function 680 213 Autoimmune hepatitis 709

208 Investigation in liver disease 686 214 Genetic liver disease 713
209 Acute liver failure 690 215 Drug-​induced liver disease 718
210 Chronic liver failure 693 216 Miscellaneous liver diseases 721
211 Alcoholic liver disease 697 217 The liver in systemic disease 726
212 Viral hepatitis 700 218 Liver cancer 731

PART 10 NEUROLOGICAL DISORDERS

219 Normal neurological function 736 232 Motor neuron disease 794
220 Diagnosis in suspected neurological disease 739 233 Spinal cord disease 796
221 Investigation in neurological disease 742 234 Neuropathy 800
222 Demographics of neurological disease 752 235 Myopathy 804
Contents

223 Neurogenetic disease 755 236 Vasculitis in neurology 807

224 Neurocutaneous syndromes 760 237 Neurological tumours 812
225 Congenital neurological disorders 762 238 Non-​metastatic neurological manifestations of
226 Epilepsy 764 malignancy 815
227 Stroke 767 239 Neurosurgery 817
228 Dementia 777 240 Drug-​induced neurological disease 821
229 Neurological infection 781 241 Functional and dissociative disorders in
neurology 825
230 Disorders of movement 787
242 Palliative care in neurological disease 828
231 Multiple sclerosis 791

PART 11 DISORDERS OF THE SKIN

243 Normal skin function 832 254 Nail disorders 863

244 Approach to diagnosing skin disease 836 255 Mucosal disease 865
245 Investigation in skin disease 839 256 Genital disease 868
246 Skin infection and infestation 842 257 Polymorphic light eruption and actinic
247 Cutaneous vasculitis 845 prurigo 870
248 Acne 847 258 Disorders of pigmentation 872
249 Psoriasis 850 259 Skin cancer 874
250 Eczema 853 260 Skin markers of internal medicine 882
251 Urticaria 855 261 Drug-​induced skin disease 886
252 Bullous disorders 857 262 Psychocutaneous medicine 889
253 Hair disorders 860

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PART 12 DISORDERS OF THE MUSCULOSKELETAL SYSTEM

263 Normal function of the musculoskeletal 269 Systemic lupus erythematosus 918
system 892 270 Crystal arthropathy 921
264 Diagnosis in suspected rheumatological 271 Infection of joints and bones 925
disease 894
272 Vasculitis 927
265 Investigation in rheumatological disease 900
273 Osteomalacia 932
266 Osteoarthritis 906
274 Paget’s disease of bone 933
267 Rheumatoid arthritis 910
275 Osteoporosis and fragility fracture 935
268 Seronegative spondyloarthropathy 914
276 Genetic bone and joint disease 938

PART 13 HAEMATOLOGICAL DISORDERS

277 Normal blood function 944 285 Prothrombotic conditions 984

278 Diagnosis and investigation in haematology 951 286 Acute leukaemia 989
279 Deficiency anaemias 955 287 Chronic leukaemia 992
280 Haemolytic anaemia 958 288 Myelodysplasia 995
281 Normal platelet function 967 289 Lymphoma 996
282 Platelet disorders 970 290 Multiple myeloma and related conditions 999
283 Normal haemostatic function 975 291 Myeloproliferative disorders 1002
284 Bleeding disorders 979 292 Terminal care in haematological disease 1005

Contents
PART 14 DISORDERS OF THE IMMUNE SYSTEM

293 Functions of the immune system 1008
294 Clinical features and diagnosis of immunological
disease 1013
295 Neutrophil abnormalities 1017
296 Human immunodeficiency virus infection 1020
297 Antibody deficiencies 1025
298 Combined T-​and B-​cell
immunodeficiencies 1028
299 Complement deficiencies 1031
300 Hypersensitivity diseases 1034
301 Immunological support 1038
302 Immunosuppressive therapy and therapeutic
monoclonal antibodies 1040

PART 15 INFECTIOUS DISEASES

303 Defences against infection 1044
304 Nature and demographics: Epidemiology of
infective organisms 1048
305 Diagnosis in suspected infective disease:
The history and examination 1051
306 Investigation in infection 1058
307 Treatment of infection 1061
308 Viral infection 1064
309 Sepsis 1068
310 Bacterial infection 1071
311 Mycobacterial infection other than
tuberculosis 1075
312 Spirochaetal infection (non-syphilis) 1079
313 Syphilis 1082
314 Rickettsial infection 1084
315 Fungal infection 1086
316 Protozoal infection: Gut organisms 1091
317 Protozoal infection: Malaria 1094
318 Worm infection (including hydatid
disease) 1098
319 Prion disease 1101
320 Sexually transmitted disease
(gonorrhoea) 1103

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 PART 16 CANCERS

321 Cancers related to infection 1106 326 Prostate cancer 1118

322 Principles of oncogenesis 1109 327 Breast cancer 1122
323 Presentations in suspected cancer 1111 328 Ovarian and testicular cancer 1126
324 Diagnosis and staging of cancer 1113 329 Symptom control in cancer 1128
325 Treatment of cancer 1115 330 Dying from cancer 1131

PART 17 DIETARY, LIFESTYLE, AND ENVIRONMENTAL FACTORS

AFFECTING HEALTH

331 Normal nutritional function 1134 337 Physical activity and its role in disease
332 Starvation and malnutrition 1136 prevention 1155
333 Vitamin deficiencies 1139 338 Smoking 1158
334 Nutritional support in the critically ill 1144 339 Alcohol 1160
335 Poor diets 1147 340 Environmental radiation 1164
336 Obesity: epidemiology, prevention and 341 Air pollution 1166
management 1150 342 Non-​prescription drugs 1168

PART 18 PREVENTION OF DISEASE

343 Prevention of cardiovascular disease 1172 347 Prevention of neurological disease 1183
Contents

344 Prevention of respiratory disease 1176 348 Prevention of cerebrovascular disease 1187
345 Prevention of kidney disease 1179 349 Prevention of infection 1189
346 Prevention of gastrointestinal disease 1181 350 Prevention of cancer 1192

PART 19 SCREENING FOR DISEASE

351 Screening for cardiovascular disease 1196 354 Screening for gastrointestinal disease 1206
352 Screening for respiratory disease 1202 355 Screening for neurological disease 1209
353 Screening for kidney disease 1205 356 Screening for cancer 1211

Index 1215

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Normal values

Common haematology values

Haemoglobin men: 130–​180 g/​l
women: 115–​160 g/​l
Mean cell volume, MCV 76–​96 fl
Platelets 150–​400 × 109/​l
White cells (total) 4–​11 × 109/​l
• neutrophils 40%–​75%
• lymphocytes 20%–​45%
• eosinophils 1%–​6%
Blood gases
pH 7.35–​7.45
PaO2 >10.6 kPa (75–​100 mm Hg)
PaCO2 4.7–​6 kPa (35–​45 mm Hg)
Base excess ±2 mmol/​l
U&ES (urea and electrolytes)
Sodium 135–​145 mmol/​l
Potassium 3.5–​5 mmol/​l
Creatinine 70–​120 μmol/​l
Urea 2.5–​6.7 mmol/​l
eGFR >90
LFTs (liver function tests)
Bilirubin 3–​17 μmol/​l
Alanine aminotransferase, ALT 5–​35 IU/​l
Aspartate transaminase, AST 5–​35 IU/​l
Alkaline phosphatase, ALP 30–​150 IU/​l (non-​pregnant adults)
Albumin 35–​50 g/​l
Protein (total) 60–​80 g/​l
Cardiac enzymes
Troponin T <0.1 μg/​l
Creatine kinase 25–​195 IU/​l
Lactate dehydrogenase, LDH 70–​250 IU/​l
Lipids and other biochemical values
Cholesterol <5 mmol/​l desired
Triglycerides 0.5–​1.9 mmol/​l
Amylase 0–​180 Somogyi U/​dl
C-​reactive protein, CRP <10 mg/​l
Calcium (total) 2.12–​2.65 mmol/​l
Glucose, fasting 3.5–​5.5 mmol/​l
Prostate-​specific antigen, PSA 0–​4 ng/​ml
T4 (total thyroxine) 70–​140 mmol/​l
Thyroid-​stimulating hormone, TSH 0.5–​5.7 mU/​l
Abbreviations: eGFR, estimated glomerular filtration rate; PaCO2, partial pressure of carbon dioxide in arterial blood; PaO2, partial pressure of oxygen in arterial blood.
Reproduced from M Longmore and IB Wilkinson et al., Oxford Handbook of Clinical Medicine, Ninth Edition, 2014, with permission from Oxford University Press

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Abbreviations

γGT gamma-​glutamyl transferase ALL acute lymphocytic leukaemia

5-​ASA 5-​aminosalicylic acid ALP alkaline phosphatase
6MP 6-​mercaptopurine ALS amyotrophic lateral sclerosis
AA AA protein-​related renal amyloidosis ALT alanine aminotransferase
AAA abdominal aortic aneurysm AMA anti-​mitochondrial antibody
AAFB acid-​and alcohol-​fast bacteria AMD age-​related macular degeneration
AASV antineutrophil cytoplasmic antibody-​associated AMI acute myocardial infarction
systemic vasculitis AML acute myeloid leukaemia
Ab antibody AMP adenosine monophosphate
ABC Airway, Breathing, and Circulation ANA antinuclear antibody
ABCDE Airway, Breathing, Circulation, Disability, and ANC absolute neutrophil count
Exposure ANCA antineutrophil cytoplasmic antibody
ABG arterial blood gas ANS alcohol nurse specialist
ABP arterial blood pressure anti-​dsDNA anti-​double-​stranded DNA antibody
ABPA allergic bronchopulmonary aspergillosis anti-​HBc antibody to the hepatitis B core antigen
ABPI ankle–​brachial pressure index anti-​HBe antibody to the hepatitis B e antigen
ABPM ambulatory blood-​pressure monitoring anti-​HBs antibody to the hepatitis B surface antigen
AC air conduction anti-​LKM anti-​liver kidney microsomal type 1 antibody
ACD anaemia of chronic disorders anti-​LPA anti-​liver–​pancreas antigen antibody
ACE angiotensin-​converting enzyme anti-​SLA anti-​soluble liver antigen antibody
ACE-​I angiotensin-​converting-​enzyme inhibitor anti-​SMA smooth muscle antibody
ACPA anti-​citrullinated protein/​peptide antibody anti-​TNF anti-​tumour necrosis factor
ACR albumin–​creatinine ratio ANZDATA Australia and New Zealand Dialysis and Transplant
ACS acute coronary syndrome Registry
ACT activated clotting time APACHE Acute Physiology and Chronic Health Evaluation
ACTH adrenocorticotropic hormone APC activated protein C
AD autosomal dominant APKD adult polycystic kidney disease
ADA adenosine deaminase APS antiphospholipid syndrome
ADC apparent diffusion coefficient APTT activated partial thromboplastin time
ADH antidiuretic hormone APTTr activated partial thromboplastin time ratio
ADP adenosine diphosphate AR autosomal recessive
ADT androgen deprivation therapy ARB angiotensin II receptor blocker
AEIPF acute exacerbation of idiopathic pulmonary fibrosis ARDS acute respiratory distress syndrome
AF atrial fibrillation ARF acute renal failure
AFB acid-​fast bacilli ARPKD autosomal recessive polycystic kidney disease
AH atrium–​His ARR aldosterone:renin activity ratio
AHF acute heart failure ARSAC Administration of Radioactive Substances Advisory
AHI apnoea hypopnoea index Committee
AI adrenal insufficiency ART antiretroviral therapy
AIDS acquired immune deficiency syndrome ARVC arrhythmogenic right ventricular cardiomyopathy
AIH autoimmune hepatitis ARVC/​D arrhythmogenic right ventricular cardiomyopathy/​
AIN anal intra-​epithelial neoplasia dysplasia
AION anterior ischaemic optic neuropathy AS ankylosing spondylitis
AIP autoimmune pancreatitis ASAS Assessment of SpondyloArthritis International
AIVR accelerated idioventricular rhythm Society
AJCC American Joint Committee on Cancer ASD atrial septal defect
AKI acute kidney injury AST aspartate aminotransferase
AL amyloid light chain AT antithrombin
ALA amoebic liver abscess ATG antithymocyte globulin
ALD alcoholic liver disease ATL adult T-​cell leukaemia
ALERT Acute Life-​threatening Events Recognition and ATN acute tubulointerstitial nephritis
Treatment ATP adenosine triphosphate
ALF acute liver failure AUDIT Alcohol Use Disorders Identification Test

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 AV atrioventricular CCF congestive cardiac failure
aVF augmented voltage unipolar left foot lead CCP cyclic citrullinated peptide
AVIR accelerated idioventricular rhythm CCS Canadian Cardiovascular Society
aVL augmented voltage unipolar left arm lead CD Crohn’s disease
AVN atrioventricular node CDC Centers for Disease Control
AVNRT atrioventricular nodal re-​entrant tachycardia CDI cranial diabetes insipidus
AVP arginine vasopressin CF counting fingers
AVPU Alert, Voice, Pain, or Unresponsive CGD chronic granulomatous disease
AVRT atrioventricular re-​entrant tachycardia CHD coronary heart disease
AVSD atrioventricular septal defect CHF congestive heart failure
AZA azathioprine CI confidence interval
BAE bronchial artery angiography and embolization CIDP chronic inflammatory demyelinating
BAL bronchoalveolar lavage polyradiculoneuropathy
BC bone conduction CIPO chronic idiopathic pseudo-​obstruction
BCC basal cell carcinoma CIS carcinoma in situ
BCLC Barcelona Clinic Liver Cancer CJD Creutzfeldt–​Jakob disease
BCNIE blood culture-​negative infective endocarditis CK creatine kinase
BCP basic calcium phosphates CKD chronic kidney disease
BCR B-​cell receptor CLL chronic lymphoid leukaemia
BCT broad-​complex tachycardia CMAP compound muscle action potential
BD brain death CMC carpometacarpal
BDD body dysmorphic disorder CML chronic myeloid leukaemia
BI bacterial index CMRI cardiac magnetic resonance imaging
BIMA bilateral internal mammary artery CMT Charcot–​Marie–​Tooth disease
BIPAP bi-​level positive airway pressure CMV cytomegalovirus
BIPSS bilateral inferior petrosal sinus sampling CNS central nervous system
BMD bone mineral density COCP combined oral contraceptive pill
Abbreviations

BMI body mass index COP cryptogenic organizing pneumonia

BMRC British Medical Research Council COPD chronic obstructive pulmonary disease
BMT bone marrow transplantation CPAP continuous positive airways pressure
BNP brain natriuretic peptide CPB cardiopulmonary bypass
BO Barrett’s oesophagus CPEX cardiopulmonary exercise testing
BP blood pressure CPP combined physical and psychological programme
BPH benign prostatic hypertrophy CPPD calcium pyrophosphate dihydrate deposition
bpm beats per minute CrAG cryptococcal antigen
BPPV benign paroxysmal positional vertigo CRAO central retinal artery occlusion
BRAO branch retinal artery occlusion CRF clinical risk factor for parental hip fracture
BRF bone risk factor CRH corticotrophin-​releasing hormone
BrS Brugada syndrome CRP C-​reactive protein
BRVO branch retinal vein occlusion CRT cardiac resynchronization therapy
BSA body surface area CRVO central retinal vein occlusion
BSD brainstem death CS corticosteroid
BSE bovine spongiform encephalopathy CSF cerebrospinal fluid
BSG British Society of Gastroenterology CSH carotid sinus hypersensitivity
BTS British Thoracic Society CSM carotid sinus massage
CABG coronary artery bypass graft surgery CT computed tomography
CAD coronary artery disease CTA computed tomography angiography
CADASIL cerebral autosomal dominant arteriopathy with CTD connective tissues disease
subcortical infarcts and leucoencephalopathy CTEPH chronic thromboembolic pulmonary hypertension
CAH congenital adrenal hyperplasia CTPA computed tomography pulmonary angiography
CAM Confusion Assessment Method CVA cerebral vascular accident
cANCA cytoplasmic antineutrophil cytoplasmic antibody CVD cardiovascular disease
CAP community-​acquired pneumonia CVID common variable immunodeficiency
CaSR calcium-​sensing receptor CVP central venous pressure
CBCD chronic bullous disease of childhood CVPT catecholaminergic polymorphic ventricular
CBD common bile duct tachycardia
CBG cortisol-​binding globulin CWS cotton-​wool spot
CBT cognitive behavioural therapy CXR chest X-​ray
CBZ carbimazole CYC cyclophosphamide
CCB calcium-​channel blocker DA dermatitis artefacta

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DADS distal acquired demyelinating symmetrical ET essential tremor
DAH diffuse alveolar haemorrhage EUA examination under anaesthesia
DAS Disease Activity Score EUS endoscopic ultrasound
DAT drug action team FAP familial amyloid polyneuropathy
DBS deep brain stimulation FAST Face Arm Speech Test
DCM dilated cardiomyopathy FBC full blood count
DEXA dual-​energy X-​ray absorptiometry FDA Food and Drug Administration
DF Maddrey discriminant function FDG fluorodeoxyglucose
DHEA dehydroepiandrosterone FDP fibrinogen degradation products
DHEAS dehydroepiandrosterone sulphate FEV1 forced expiratory volume in 1 second
DI diabetes incipidus FFA free fatty acid
DIC disseminated intravascular coagulopathy FFR fractional flow reserve
DILD drug-​induced lung disease FFS five-​factor score
DILS diffuse infiltrative lymphocytosis syndrome FHH familial hypocalciuric hypercalcaemia
DIP distal interphalangeal FI faecal incontinence
DIS dissemination in space FiO2 inspired fraction of oxygen
DIT dissemination in time; FISH fluorescent in situ hybridization
DLCO diffusing capacity of the lung for carbon monoxide FLAIR fluid attenuated inversion recovery
DLE discoid lupus erythematosus FLI fatty liver index
DM diabetes mellitus FNAC fine-​needle aspiration cytology
DMARD disease-​modifying anti-​rheumatic drug FOB faecal occult blood
DOT directly observed therapy FSGS focal segmental glomerulosclerosis
DPP-​4 dipeptidyl peptidase-​4 FSH follicle-​stimulating hormone
DRE digital rectal examination FTD frontotemporal dementia
dsDNA double-​stranded DNA FUO fever of unknown origin
DSE dobutamine stress echocardiography FVC forced vital capacity
DST dexamethasone suppression test FVL factor V Leiden

Abbreviations
DU duodenal ulcer FXTAS fragile X-​associated tremor/​ataxia syndrome
DVLA Driver and Vehicle Licensing Agency G1 Genotype 1
DVP diastolic blood pressure G2 Genotype 2
DVT deep-​vein thrombosis G3 Genotype 3
DWI diffusion-​weighted imaging G6PD glucose-​6-​phosphate dehydrogenase
EBUS-​TBNA endobronchial ultrasound-​guided transbronchial GA general anaesthesia
needle aspiration GABA gamma-​aminobutyric acid
EBV Epstein–​Barr virus GAD glutamic acid decarboxylase
ECG electrocardiogram GAD65 glutamic acid decarboxylase autoantibody
Echo echocardiography GALT gut-​associated lymphoid tissue
ECOG Eastern Cooperative Oncology Group GAS Group A streptococcus
EDTA ethylenediamine tetra-​acetic acid GBM glomerular basement membrane
EEG electroencephalogram GBS Guillain–​Barré syndrome
EGDT early goal-​directed therapy GCA giant cell arteritis
eGFR estimated glomerular function rate GCS Glasgow Coma Scale
EHEC enterohaemorrhagic Escherichia coli GFR glomerular filtration rate
EIA enzyme immunoassay GGO ground-​glass opacity
ELISA enzyme-​linked immunosorbent assay GH growth hormone
EMG electromyography GI gastrointestinal
ENA extractable nuclear antigen antibody GIST gastrointestinal stromal tumour
ENT ear, nose, and throat GMC General Medical Council
EOTR end-​of-​treatment response GN glomerulonephritis
EPAP expiratory positive airway pressure GnRH gonadotropin-​releasing hormone
EPO erythropoietin GOLD Global Initiative for Chronic Obstructive Lung
EPP erythropoietic protoporphyria Disease
ePPi extracellular pyrophosphate GORD gastro-​oesophageal reflux disease
EPR electronic patient record GOS Glasgow Outcome Score
EPS electrophysiological study GP general practitioner
ERCP endoscopic retrograde cholangiopancreatography GPA granulomatosis with polyangiitis
EROA effective regurgitant orifice area GPI glycosyl-​phosphatidylinositol
ESC European Society of Cardiology GRA glucocorticoid-​responsive aldosteronism
ESR erythrocyte sedimentation rate GU gastric ulcer
ESRD end-​stage renal disease GUM genito-​urinary medicine

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 GvHD graft-​vs-​host disease IBD inflammatory bowel disease
HAART highly active antiretroviral therapy IBS irritable bowel syndrome
HAP hospital-​acquired pneumonia IC intermittent claudication
HAS human albumin solution ICA islet cell autoantibody
HAV hepatitis A virus ICa,L L-​type calcium current
Hb A adult haemoglobin ICD implantable cardioverter defibrillator
Hb A1c haemoglobin A1c (glycosylated haemoglobin) ICH intracranial haemorrhage
Hb F fetal haemoglobin ICP intracranial pressure
Hb haemoglobin ICU intensive care unit
HBc hepatitis B core protein ID infectious disease
HBeAg hepatitis B e antigen IDL intermediate-​density lipoprotein
HBPM home blood-​pressure monitoring IDU intravenous drug users
HBsAg hepatitis B surface antigen IE infective endocarditis
HBV hepatitis B virus IFD invasive fungal disease
HCC hepatocellular carcinoma IFN interferon
HCM hypertrophic cardiomyopathy IFN-​alpha interferon alpha
HCV hepatitis C virus IgA immunoglobulin A
HD Huntington’s disease IgE immunoglobulin E
HDL high-​density lipoprotein IgG immunoglobulin G
HDU high-​dependency units IgM immunoglobulin M
HDV hepatitis D virus IGRA interferon gamma release assays
HER2 human epidermal growth factor receptor 2 IHD ischaemic heart disease
HEV hepatitis E virus IK1 inward rectifier potassium current
HF heart failure IKr rapidly activating component of the delayed rectifier
HFmrEF heart failure with mid-​range ejection fraction potassium current
HFpEF heart failure with preserved ejection fraction IKs slowly activating component of the delayed rectifier
HFrEF heart failure with reduced ejection fraction potassium channel
Abbreviations

HHT hereditary haemorrhagic telangiectasia IL interleukin

HHV6 human herpes virus 6 IL-​6 interleukin 6
HHV7 human herpes virus 7 ILD interstitial lung disease
HHV8 human herpes virus 8 IM intramuscular
HIFU high-​intensity focused ultrasound IMD inherited metabolic disease
HIGM hyperimmunoglobulin M IMIg intramuscular immunoglobulin
HIT heparin-​induced thrombocytopenia IMPACT Ill Medical Patients’ Acute Care and Treatment
HIV human immunodeficiency virus INa sodium current
HLA human leukocyte antigen INa,K sodium–​potassium pump current
HM hand movements INCX sodium-​calcium exchanger current
HMW high molecular weight INR international normalized ratio
HNPCC hereditary non-​polyposis colorectal cancer IPAP inspiratory positive airway pressure
HNPP hereditary neuropathy with liability to pressure palsies IPD idiopathic Parkinson’s disease
HPA hypothalamic–​pituitary–​adrenal IPF idiopathic pulmonary fibrosis
HPIV human parainfluenza virus IPG implantable pulse generator
HPV human papilloma virus IPI International Prognostic Index
HRA Human Rights Act 1998 IPJ interphalangeal joint
HRCT high-​resolution computed tomography IRIS immune reconstitution inflammatory syndrome
HRS hepatorenal syndrome IRRT intermittent renal replacement therapy
HS hereditary spherocytosis IRT immunoreactive trypsinogen
HSCT haemopoietic stem cell transplantation ISS International Staging System
HSP Henoch–​Schönlein purpura IST inappropriate sinus tachycardia
HSV herpes simplex virus ITP immune thrombocytopenia
HTLV1 human T-​lymphotrophic virus 1 ITT insulin tolerance test
HUS haemolytic–​uraemic syndrome ITU intensive therapy unit
HUV hypocomplementaemic urticarial vasculitis IUD intrauterine device
HV His–​ventricle IV intravenous
IA2 islet antigen 2 autoantibody IVC inferior vena cava
IAA insulin autoantibody IVDU intravenous drug use
IABP intra-​aortic balloon pump IVF in vitro fertilization
IAH intra-​abdominal hypertension IVIg intravenous immunoglobulin
IAP intra-​abdominal pressure IVUS intravascular ultrasound
IBA identification and brief advice JVP jugular venous pulse

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KCO carbon monoxide transfer coefficient MDS myelodysplasia
KDIGO Kidney Disease: Improving Global Outcomes MDT multidisciplinary team
KEEP Kidney Early Evaluation Program MELAS mitochondrial encephalomyopathy with lactic
KS Kaposi’s sarcoma acidosis and stroke-​like episodes
KSHV Kaposi’s sarcoma-​associated herpesvirus MELD Model for End-​Stage Liver Disease
LACS lacunar stroke MEN multiple endocrine neoplasia
LAD left anterior descending MERRF myoclonic epilepsy with ragged red fibres
LAE left atrial enlargement MG myasthenia gravis
LAVAT local anaesthetic video-​assisted thoracoscopy MGUS monoclonal gammopathy of unknown significance
LBBB left bundle branch block MHC major histocompatibility complex
LBC liquid-​based cytology MHRA Medicines and Healthcare Products
LBD Lewy body dementia Regulatory Agency
LBP low back pain MI myocardial infarction
LCIS lobular carcinoma in situ MIC minimum inhibitory concentration
LCSD left cervicothoracic sympathetic denervation MM malignant melanoma
LCX left circumflex artery MMA methylmalonic acidaemia
LDCT low-​dose computed tomography MMR measles, mumps, rubella
LDH lactate dehydrogenase MMSE Mini-​Mental State Examination
LDL low-​density lipoprotein MND motor neuron disease
LEMS Lambert–​Eaton myasthenia syndrome MOAI monoamine oxidase inhibitor
LET linear-​energy transfer MODY maturity-​onset diabetes of the young
LFT liver function test MOF multi-​organ failure
LH luteinizing hormone MPO myeloperoxidase
LIMA left internal mammary artery MPS myocardial perfusion scan
LMN lower motor neuron MR mitral regurgitation
LMWH low-​molecular-​weight heparin MRA magnetic resonance angiography
LN lymph node MRA magnetic resonance angiography

Abbreviations
LOS lower oesophageal sphincter MRC Medical Research Council
LP lumbar puncture MRCP magnetic resonance cholangiopancreatography
LPA Lasting Power of Attorney MRI magnetic resonance imaging
LPP lichen planopilaris MRSA meticillin-​resistant Staphylococcus aureus
LQTS long-​QT syndrome MRV magnetic resonance venography
LR likelihood ratio MS multiple sclerosis
LSMDT local skin cancer multidisciplinary team MSE mental state examination
LT leukotriene MSF Mediterranean spotted fever
LTBI latent infection with Mycobacterium tuberculosis MSM men who have sex with men
LTNP long-​term non-​progressor MSU monosodium urate
LV left ventricular MSUD maple syrup urine disease
LVAD left ventricular assist device MTP metatarsophalangeal
LVEF left ventricular ejection fraction MTX methotrexate
LVESD left ventricular end-​systolic diameter MUP minimum unit price
LVH left ventricular hypertrophy MuSK muscle-​specific kinase
LVNC left ventricular non-​compaction MUST Malnutrition Universal Screening Tool
LVOT left ventricular outflow tract NAAT nucleic acid amplification test
LVRS lung volume reduction surgery NAC N-​acetylcysteine
MAC Mycobacterium avium complex NAD nicotinamide adenine dinucleotide
MALT mucosa-​associated lymphoid tissue NADPH nicotinamide adenine dinucleotide phosphate
MAP mean arterial pressure NAFLD non-​alcoholic fatty liver disease
MAT multifocal atrial tachycardia NAPQI N-​acetyl-​p-​benzoquinone imine
MBL mannan-​binding-​lectin NASH non-​alcoholic steatohepatitis
MCA middle cerebral artery NCRN National Cancer Research Network
MCandS microscopy, culture, and sensitivities NCS nerve conduction study
MCBT mindfulness-​based cognitive therapy NEWS National Early Warning Score
MCH mean cell haemoglobin NFD nephrogenic fibrosing dermopathy
MCHC mean cell haemoglobin concentration NGT nasogastric tube
MCI mild cognitive impairment NHL non-​Hodgkin’s lymphoma
MCP metacarpophalangeal NICE National Institute for Health and Care Excellence
MCV mean corpuscular volume NIHL noise-​induced hearing loss
MDM multidisciplinary meeting NIHSS National Institutes of Health Stroke Scale
MDR multidrug-​resistant NIPPV nasal intermittent positive pressure ventilation

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Another random document with
no related content on Scribd:
 BIG BEAUTY
By W. J. Bowman

This giant may puzzle you in several ways. At the first

glance it looks as much like a maze as a cross word
puzzle. You’ll find it a cross word puzzle all right.
1 2 3 4 5 6 7 8 9 10 11 12 13
14 15 16 17 18 19
20 21 22 23 24 25 26 27 28
29 30 31 32 33 34 35
36 37 38 39 40 41 42 43
44 45 46 47 48 49 50
51 52 53 54 55 56
57 58 59 60 61 62 63 64
65 66 67 68 69 70 71 72
73 74 75 76 77 78 79
80 81 82 83 84 85
86 87 88 89
90 91 92 93 94 95 96
97 98 99 100 101 102 103 104 105
106 107 108 109 110 111 112
113 114 115 116 117 118 119
120 121 122 123 124 125 126
127 128 129 130 131 132
133 134 135 136 137 138 139 140 141
142 143 144 145 146 147 148 149
150 151 152 153 154 155 156
157 158 159 160 161 162
163 164 165
[64]

HORIZONTAL

Others 1 Edible
88 bivalve mollusk
Device 5 to carry a gun Nothing
89
Call 10
loudly Bend90
Bends14 Cad 92
Possessive
16 pronoun Sketched
94
Press17for payment Past96
Box 19 Negative
97
Abraham’s
20 birthplace Recesses
99 in walls
Small22davenport By 101
Sing24in a low undertone Inherent
103 power
Average
26 Mixed
105type
Sun 28
god Arid106
Female
29 rabbit Jogging
108 pace
Close31 Tramp
109
Shrub32 Genuine,
111 loyal
Change
34 direction Obtain
112
Automobile
35 Beseech
113
Deliver
36 By 115
Geometric
38 ratio Set116
free
Consumed
39 Unit118
of type
Touch40gently Stout
119
Pronoun
42 Native
120 of Arabia
Paper43containers Head122
Cut feloniously
44 Black
123
Den 46 Wharf
125
Spank48 Child
127
Finished
50 Vehicle
128
Curves
51 Help129
Affectedly
53 precise Catholic
131 sisters
Render
55 senseless Sinless
133
Note134of scale
 Something
56 granted for Snake-like
135 fish
temporary use Before
137
Evil 57 Part138
of verb “to be”
Neuter
58 pronoun Small
140secluded valley
Barren
60 One,142 indef.
Mother
62 Earth
143
Small63child Those
145 who color cloth
Comrade
65 Small
147nail
Slipped
66 River
149(Spanish)
Rock68 Thing
150
Printed
69 piece of paste- City151
in Mass.
board Part153
of head
Catch71(colloq.) A boisterous
154 preacher
For example
73 Preposition
156
Changes
74 Mold157
Prosecute
76 at law Plaything
158
Mean,77 vile Female
160 chicken
Exist79 Frozen
161 particles of
Distorted
80 vapor
Falling
81 water Marks
163
Units83of electrical Provoked
164
resistance Is full
165
Egg 84
of insect
Pastries
86
Ardor87

VERTICAL

Thumps
1 Portion
77
Upon 2 Dirty78
Wireless
3 signal for help Net 80
Paradise
4 The 82
head (slang)
To hasten
5 Aged83
Bone 6 Also85
Low district
7 Humor 91
Edition
8 (abbr.) Bullet92
Intoxicating
9 liquor Half 93
(prefix)
Whirled
10 rapidly Part 95
of “to be”
Cured11pork Time96
Else12 Eye 98
Lachrymose
13 Crustacean
100
exudations A long
101 staff
Small15distance To 102
rage
Fem.16pronoun Buttocks
104
Snare18 Fondle
105
Father
19 Annually
107
Egg 21
masses Snared
109
Appendage
23 Prevents
110
Color24tint Gather
112
Crazy25 A color
114
Unload
27 by tilting Attempt
116
Uncontrolled
28 anger Loose
117outer garment
Necessitate
30 A private
119 quarrel
Walks32with affected By 121
dignity Father
122
Fortress
33 Point
124of compass
Implement
35 of war Within
126
To mend
37 Skeletal
127 piece
Desires
39 To 128
incline
A color
41 Marsh
130
Water43conveyance Narrow
132 opening
Before
45 Christ Rodents
133
Like 47 Ultimate
134
Indef.
49article Caustic
136
Perform
50 Sin137
Alluvial
52 detritus Interweaves
139
Obtains
54 Aspects
141
Without
55 Diminution
143
Grease
56 for frying Small
144mark
Bend57 Not146
west
Row59 Prohibit
147
 Uproar
61 Depression
148
Spoils
62 To 151
obstruct
Tag 64 Negative
152 prefix
Binder
65 stones Color
154
Artfully
66 cunning Fish
155
eggs
Term67 used when Note
157of scale
hunting a criminal Pronoun
159
Criticism
69 Pronoun
160
Noise70 Us 162
Be of72service to
Malicious
74 firing of a
building
Places
75 to store grain

[67]
[Contents]
Puzzle No. 77
 TRY THEM OVER IN YOUR DAILY
CHAT
By Irvan Neckerman

There are several dozen words in this puzzle that

you can use and your best girl won’t know what you
are talking about. This is not misogyny. It merely
supposes that she does not follow cross word
puzzling. Or maybe that is misogyny.
1 2 3 4 5 6 7 8 9 10 11 12
13 14 15
16 17 18 19
20 21 22 23 24
25 26 27 28 29
30 31 32 33 34
35 36 37 38 39 40 41
42 43 44 45
46 47 48 49
50 51 52
53 54 55 56
57 58 59 60 61
62 63 64 65 66 67
68 69 70
71 72 73
[66]

HORIZONTAL

Discover
1 Observes
42
Ordinary
4 language Slacken
44
Story 9 Eighth
45 of a fathom
Knot13 Dressed
46 with
The 14
nobility, ornaments
collectively Heed48
Young15 fish Peruse
50 again
Character
16 in musical With52
less delay
notation Rested
53
Imbecile
18 Squalid
54 place
Agitation
19 Make56turbid
Exclamation
20 Sets58
back
Figurative
21 Adapts
62
Preposition
24 Elevate
64
Vending
25 Equable
65
Gain27superiority Beverage
68
Throw28 with violence Reduce
69
Piece31of ground Cool70
Small33aperture Merriment
71
Serpent
35 Milestone
72
Robbers
37 Boundary
73
Anger40

VERTICAL

Engrave
1 Guard
34
Pits for
2 storing fodder Dry 36
 Bill of3an anchor Color38
Loud 4sound Viscous
39 fluid
Make5over Stock41
Pristine
6 Weapons
43
Apartment
7 Married
45 person
Scene8 of Head 47
Wallenstein’s Any 49
assassination, 1634 Refresh
51
Repeated
10 Earthenware
54
Estuary
11 Pert.55
to one’s birth
Novice12 Brook57
Drop17 Dregs59
Recite19 metrically Head 60(Fr.)
Move 22swiftly School
61
Certain
23 days of Tire 62
months Elevation
63
Seems 26 Contend
66
Compensation
29 Born67
Article
30 of food
Jaded 32
Irritates
33

[69]

[Contents]
Puzzle No. 78
 POLYANGULAR AND POLYSYLLABIC
By Harold E. Vreeland

This constructor managed to fit together a well-joined

construction, central vertebrae and a neat outer shell.
Decorative and full of nice words.
1 2 3 4
5 6 7 8 9
10 11 12
13 14 15 16
17 18 19 20 21
22 23 24 25
26 27 28
29
30 31 32 33
34 35 36 37
38 39 40 41
42 43
44
45 46
47

[68]

HORIZONTAL
 Pale 1 Performing
29 a service
Insignificant
5 part An alloy
30
A circle
7 Wine32
Brag10 Places
34 of confinement
A river
13 in Italy Conjunction
35
Absconders
14 South
37American
A musical
15 note ruminant
A size
17of type A shield
38
To slip
19 Princes
39
Furnished
20 with a To goad
41
guard Seed42of North
Not the
22 same American plant
Refusal
24 Expressing
44 surprise
Do not
25 (Scotch) Brown
45
Divided
26 Decay
46
A richly
28 laden ship A president
47 of Orange
Free State

VERTICAL

A coral1 island Beckonings

20
A native
2 of Pacific The 21
star of dawn
islands Tears
23
A common
3 given Bore25
name (Prefix)
27 through
Saltpeter
4 A bow
28
A maiden
5 loved by Loiter
31
Jupiter Large
33birds
Poem6 A fabric
35 of asbestos
To talk8 nonsense Sad 36
A hypothetical
9 force A short
39 sword
American
10 explosive A counter-irritant
40
for shells Perform
42
 Sacrifice of principle to Spot43
11circumstances
Scientific
12 description
of races
Marrow
13
Compounds
16 of atoms
A Government
17
revenue
Collecting
18 wives

[71]

[Contents]
Puzzle No. 79
 WEDDING RING
By Mil-Wal

The contributors of this construction are husband and

wife. This fact is symbolized by the wedding ring you
see in the middle of the form. Cross-grained cross
worders may complain that the ring is not a solid
mass of words. Well, is a ring ever a solid mass?
1 2 3 4 5 6 7 8 9
10 11 12
13 14 15
16 17 18 19 20
21 22 23 24
25 26 27 28 29 30
31 32 33 34 35 36
37 38
39 40 41 42 43
44 45 46 47 48 49
50 51 52 53 54
55 56 57 58 59 60
61 62 63 64
65 66
67 68

[70]
HORIZONTAL

Slender
1 Indicate
38
Time 5 Heavenly
39 body
Small10boat Female
40 deer
Invades
11 Born42
Healing
13 medicine Consumed
44
Quicken
15 Exclamation
45 of pain
Termination
16 Exist47
Wrap17 Deer48
Beast18of burden Negative
50
To soak
19 in water One51 who dislikes
Preposition
21 Note54of scale
Taut22 Weight
55
Ourselves
24 To gain
57 success
Highest
25 point Tank58
Personal
27 pronoun Distant
60
Therefore
28 White,
61 translucent
Employ
30 Riddle
63
Garment
31 Withers
65
Stir 33 Basket
66
Vessel
35 Depressions
67
Classified
37 Polish
68

VERTICAL

Fat 1 Cry of
32sheep
Tavern2 Calculate
33
Work 3 Open34
Tri-formed
4 Greek Single
36 unit
goddess Crouches
39
Blots 6out Cereal
41
 Large7number Page43of a book
Hole 8 Insect
44
Poems 9 Conjunction
46
Religious
10 singer Part 47
Frozen
12 precipitates Rubbish
49
Anthropoid
14 Some 52
Possesses
15 Time53immediately
Consume
16 preceding
An equal
20 Require
56
Bow23 A small
57 bird
The 26
Ottoman court Periphery;
59 cover
Paris27subway Sign60
Believe
29 Part 62
of “to be”
Talk 30 A command
64 to draft
animals

[73]

[Contents]
Puzzle No. 80
 NOT SO DIFFICULT
By Robert S. Holzman

The beginner should have a good time with this neat

construction. There are no lurking terrors in the wood
here for the adventurous explorer of cross word
puzzledom. Try this one against time.
1 2 3 4 5 6 7 8 9 10 11
12 13 14 15 16
17 18 19 20 21
22 23 24 25
26 27 28 29 30
31 32 33 34
35 36 37 38 39
40 41
42 43 44 45 46 47 48 49
50 51 52 53
54 55 56 57
58 59 60 61 62 63
64 65 66 67 68
69 70 71 72 73
74 75 76

[72]

HORIZONTAL