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OXFORD MEDICAL PUBLICATIONS

Oxford Handbook for

Medical School
ii
Published and forthcoming Oxford Handbooks
Oxford Handbook for the Foundation
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Oxford Handbook for Medical School
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Hypertension 2e
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Oxford Handbook of Obstetrics and
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Oxford Handbook for
Medical School
Editor-in-Chief
Kapil Sugand
Trauma and Orthopaedics Specialist Trainee
and Surgical Research Fellow,
Imperial College London, UK

Edited by
Miriam Berry
Consultant Nephrologist, University Hospitals
Birmingham, Birmingham, UK
Imran Yusuf
Ophthalmology Specialist Trainee and
MRC Research Fellow, Oxford University, UK
Aisha Janjua
Obstetrics and Gynaecology Specialist Trainee
and NIHR Clinical Lecturer,
Warwick University, UK
Chris Bird
Consultant in Paediatric Emergency Medicine,
Oxford, UK

Consultant Editors
David Metcalfe
Clinical Research Fellow in Musculoskeletal Trauma,
Oxford University, UK
Harveer Dev
Urology Specialist Trainee and Wellcome Trust PhD
Fellow, Cambridge University, UK
Sri Thrumurthy
General Surgical Specialist Trainee,
University College London Hospitals, UK

1
iv

1
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 v

Dedication

We would like to wholeheartedly thank the following people for their con-
stant support, efforts, and faith in us, in helping to realize this handbook
after 7 years.
Sincere and heartfelt thanks to the following:
• The publishing team from Oxford University Press, especially Mr
Michael Hawkes (Senior Assistant Commissioning Editor for Medical
Books) for his patience, negotiation, and expertise. You have been there
every step of the way and your efforts are very much appreciated.
• All members of the editorial team and the consultant reviewers for
giving up so much of their personal time to assist the contributors and
ensuring quality control of the content. Thank you for working so well
as a team and bringing such superb ideas to the table.
• Our plethora of devoted contributors and educators from every field
of medicine and surgery. Thank you for submitting work of such high
calibre, your insights, and expert advice.
• Our colleague publishing houses for offering permission to use their
images.
• Our internal reviewers for taking the time out to review, critique, and
appraise our entire book and offering your constructive criticisms to
improve the content.
• Our families for their love, encouragement, and motivation. Thank you
for compromising and sacrificing quality time with us, once again, so that
we could write this handbook for every medical student everywhere.
Needless to say, we will be striving to make up for the lost time.
• Our international audience for wanting a book like this and supporting
the project from the very beginning. This handbook has been written
for you. We all hope that it will serve as a useful companion throughout
your exciting time at medical school that will ultimately lay the strong
foundations for a lifetime of clinical practice.
vi

vi

Foreword

This superb guide to the neophyte doctor ranges from one’s first approach
to medical school and how to cope with such a complex process right
through to a doctor’s decision on which specialty career to follow eventu-
ally. As always this Oxford Handbook covers a vast range of useful, relevant
material, and this particular one will be of great value to anyone seriously
considering medical school for their future career choice.
The contributors are a talented group of doctors whose expertise and
interests span many different clinical specialties as well as having, between
them, a vast experience in clinical academic research as well as a huge com-
mitment in the modern complex process of medical education.
I am sure this book, where the nuts and bolts of virtually every specialty
are most clearly laid out, will be a most useful guide worldwide for those
not only considering a career in the medical profession but even those
midway through their medical careers.
Peter Abrahams MBBS FRCS(ED) FRCR DO(Hon) FHEA
Prof. Emeritus of Clinical Anatomy
Warwick Medical School, Gibbet Hill
National Teaching fellow 2011–14
Life fellow, Girton college, Cambridge
Visiting Professor LKC School of Medicine NTU Singapore
 vii

Preface

Medicine is a huge undertaking, both to study as an undergraduate and sub-

sequently to practise as a doctor. During your preclinical studies, you are
expected to learn anatomy, physiology, and biochemistry but also genetics,
pharmacology, pathology, microbiology, the history of medicine, psych-
ology, sociology, law, ethics, epidemiology, and statistics. The list is never-​
ending! These are vast disciplines in their own right and medical students
often struggle to understand what exactly they are expected to learn. The
course objectives are frequently vague: ‘students should be able to iden-
tify the important anatomical structures of the pelvis and lower limbs’. You
are also bound to see a course handbook state: ‘students may be assessed
on any material from the lectures, group work, recommended reading,
and anything else that the examiners feel students should know at this stage’.
A common complaint of all medical students is that the material tested in
exams feels disconnected from the topics taught. This is very different from
the situation at secondary school in which core knowledge is tightly defined
by a course syllabus. You would not be alone in becoming frustrated by the
seemingly unpredictable, if not unlimited bounds of knowledge that appear
to be expected by examiners.
Furthermore, the clinical years bring their own particular challenges. You
are thrust into unfamiliar environments in which busy and overworked staff
are trying to manage complex tasks with little time set aside to teach stu-
dents, due to constant understaffing and lack of resources. The material
that you painstakingly learned during the preclinical years somehow seems
irrelevant to—​or at least wholly insufficient to understand—​what is going
on in a practical and clinical setting. There are hierarchies, conflicts, and
unwritten rules that you will navigate with varying degrees of success. You
will never quite overcome the feeling of always being ‘in the way’. The
overwhelming burden of boundless learning returns as you wrangle with
over 60 different branches of medicine and surgery, from anaesthetics to
urology. The knowledge expected of you by a cardiologist in a heart failure
clinic will differ wildly to that expected by a skull base neurosurgeon in the
operating theatre.
Hence, this handbook was conceived as a partial solution to the com-
plexities of learning medicine in the twenty-​first century. Sir William Osler
famously wrote, ‘he who studies medicine without books sails an uncharted
sea’. This handbook should serve as your map through the countless obs-
tacles that you must overcome on your journey to qualifying as a doctor.
First, it will help define the core knowledge that is expected of all med-
ical students, which is often distinct from the niche interests of individual
teachers. Second, it will identify ‘high-​yield’ information and suggest what
you should know (and so are likely to be asked) in any given clinical setting.
Besides serving as a quick reference guide, this handbook introduces core
topics to help guide you with further reading in your own time. It will also
help you to prepare for some of the unfamiliar settings (such as etiquette
vii

viii PREFACE

and conduct in the operating theatre, on wards, and in the emergency de-
partment) where you are likely to find yourself over the next few years
until retirement.
The Oxford Handbook for Medical School will provide you with succinct,
precise, and accurate facts about medicine and surgery that are bound to
come up on a daily basis whether in or out of your time in hospital. The
core motivation was to bequeath all the important lessons about the med-
ical course and subject matter to the next generation of NHS leaders, pi-
oneers, and consultants as well as to reflect on what we would like to have
known back when we were medical students. Whether you are in the cardi-
ology clinic, on the surgical wards, in theatre, or witnessing emergency care,
this handbook includes carefully selected clinical scenarios that will explain
the logic behind the management plans as well as improve your confidence
in explaining it to your examiners. With aide-​memoires, mnemonics, pic-
tures, and seminal research accompanied by concise text you will be able
to easily deconstruct abstract principles into digestible and memorable in-
formation. Since medical school is not only about clinical attachment as it
encroaches into your personal life too, there is plenty of useful information
on managing finances, health issues, planning electives, and career guidance
to improve your chances of professional success from an early stage. Not
many other books, at least known to us, can say the same. We have also
ensured that the handbook does not preach or lecture but communicates
with its audience on an informal and conversational level.
Needless to say, writing this compendium has been one of the biggest
professional challenges to the editorial team but if it means that we manage
to improve the quality of medical education globally, uplift the competence
of medical students in all corners of the world, and give you another reason
to fall in love with this vocation, then all the personal sacrifices, comprom-
ises, and struggles will have been all the more worthwhile. Medicine is
obviously voluminous and it is sometimes discouraging when the sudden
realization dawns on you that there is much work to be done in order to
carry out the responsibilities for your vulnerable patients. Hopefully the
Oxford Handbook for Medical School will serve as a friendly companion to
ease your stress throughout your studies as well as introduce you to other
speciality-​specific Oxford Handbooks for further information with our
cross-​referencing style.
The Oxford Handbook for Medical School is the result of efforts from eight
doctors from a range of specialities to offer a one-​stop survival guide for
every medical student to make the most of their course from the very first
day to the very last. There was a vision and intention to pose the com-
monest clinical scenarios, how to excel at medical school, and improve
career potential early on. There are clearly many textbooks available on
the market with too little or too much information, written formally as if
you were being lectured, and with dense data that risk losing your attention.
This survival guide synthesizes advice from over 100 doctors. It has been
said that ‘you should learn from the mistakes of others as you do not have
time to make them all yourself ’. The time you spend reading this handbook
could well be one of the best investments you make at medical school.
 PREFACE ix

Finally, on behalf of the editorial team, we would like to take this op-
portunity to wholeheartedly thank everyone involved in the success of this
handbook. We welcome your feedback to constantly improve the con-
tent of this handbook in subsequent editions and we hope that the Oxford
Handbook for Medical School will serve you well.
David Metcalfe and Kapil Sugand
Members of the Editorial Team
Oxford Handbook for Medical School
May 2018
x
 xi

Contents

Contributors xiv
Symbols and abbreviations xxi

Part 1 Preclinical
1 Starting as a medical student    3
2 Studying at medical school   23
3 Preclinical medicine   41
4 Preparing for preclinical exams   71
5 Intercalated degrees and special study modules   85

Part 2 Clinical medicine

6 Going clinical  113
7 Anaesthetics  165
8 Cardiology  177
9 Critical care  199
10 Dermatology  213
11 Elderly care  231
12 Emergency medicine  253
13 Endocrinology and diabetes  285
14 Gastroenterology  307
15 General practice  335
16 Genetics  341
17 Genitourinary medicine  349
18 Haematology  369
19 Immunology and allergies  395
20 Infectious diseases and tropical medicine  399
21 Nephrology  413
xii

xii CONTENTS

22 Neurology  437
23 Obstetrics and gynaecology  461
24 Oncology  485
25 Ophthalmology  499
26 Paediatrics  521
27 Palliative medicine  547
28 Pathology  557
29 Psychiatry  567
30 Respiratory medicine  589
31 Rheumatology  609

Part 3 Clinical surgery

32 Breast surgery  623
33 Cardiothoracic surgery  635
34 Colorectal surgery  647
35 Ear, nose, and throat surgery  685
36 Neurosurgery  701
37 Oral and maxillofacial surgery  715
38 Paediatric surgery  725
39 Plastic surgery  733
40 Trauma and orthopaedic surgery  747
41 Vascular surgery  765
42 Upper gastrointestinal and
hepatopancreatobiliary surgery  779
43 Urology  797

Part 4 Clinical skills

44 Radiology  811
45 Practical procedures  821
46 Basic investigations  839
47 Ethics and law  859
 CONTENTS xiii

Part 5 Assessments and examinations

48 Clinical assessments  867
49 Preparing for clinical examinations  873
50 Clinical examinations  895
51 Written exams  969
52 Other assessments  983

Part 6 Career planning

53 Making decisions  997
54 Getting ahead  1009
55 Electives  1047
56 Career planning  1057

Index 1067
xvi
xiv
Contributors
John R. Apps
(Chapter 54: Getting ahead)
Paediatric Specialist Oncology
Trainee, Birmingham Women’s
and Children’s NHS Foundation
Trust. Birmingham, UK,
Honorary Research Associate,
UCL Great Ormond Street
Institute of Child Health,
University College London,
London, UK
Bilal Azhar
(Chapter 42: Upper gastrointes-
tinal and hepatopancreatobiliary
surgery)
Vascular Surgery Specialist
Registrar, London Deanery,
London Postgraduate School of
Surgery, UK
James R. Bentham
(Chapter 26: Paediatrics)
Assistant Professor and
Consultant Paediatric and Adult
Interventional Cardiologist,
Department of Paediatric
Cardiology, Leeds General
Infirmary, UK
Miriam Berry
(Chapter 3: Preclinical medi-
cine; Chapter 5: Intercalated
degrees and special study mod-
ules; Chapter 21: Nephrology;
Chapter 48: Clinical assessments;
Chapter 50: Clinical examinations;
Chapter 54: Getting ahead)
Consultant Nephrologist,
University Hospitals Birmingham,
Birmingham, UK
Chris Bird
(Chapter 3: Preclinical medi-
cine; Chapter 6: Going clin-
ical; Chapter 26: Paediatrics;
Chapter 45: Practical procedures;
Chapter 46: Basic investigations)
Consultant in Emergency
Paediatric Medicine, Birmingham
Children’s Hospital, UK
Lesley Black
(Chapter 17: Genitourinary
medicine)
GP Specialist Registrar, Severn
Deanery, Bristol, UK
Deborah Bowman
(Chapter 47: Ethics and law)
Professor of Bioethics, Clinical
Ethics and Medical Law at
St George’s, University of
London, UK
Lois Brand
(Chapter 53: Making decisions)
Consultant in Emergency
Medicine, John Radcliffe
Hospital, Oxford, UK
Elsa Butrous
(Chapter 54: Getting ahead)
GP Specialist Registrar,
Oxford Deanery, UK
James Butterworth
(Chapter 34: Colorectal surgery)
Surgical Specialist Registrar,
Clinical Research Fellow,
Department of Cancer and
Surgery, Imperial College
London, London, UK

William Butterworth
(Chapter 34: Colorectal surgery)
Core Surgical Trainee, General
Surgery, Princess Royal
University Hospital, London, UK
Nandini Datta
(Chapter 6: Going clinical)
Senior Resident Medical Officer,
Emergency Department,
Gosford Hospital, Central Coast
Local Health District, Australia
Fungai Dengu
(Chapter 42: Upper gastrointestinal
and hepatopancreatobiliary surgery)
ST5 General Surgery Registrar
Oxford Deanery, Clinical Research
Fellow in Transplant Surgery,
Nuffield Department of Surgical
Sciences, University of Oxford.
Harveer Dev
(Chapter 3: Preclinical medi-
cine; Chapter 8: Cardiology;
Chapter 41: Vascular surgery;
Chapter 43: Urology)
Urology Specialist Trainee and
Wellcome Trust PhD Fellow,
Cambridge University Hospitals
NHS Trust, UK
Kate Drysdale
(Chapter 14: Gastroenterology)
Hepatology Clinical Research
Fellow, Queen Mary University
of London, London, UK
Tegwen Ecclestone
(Chapter 56: Career planning)
Core Trainee, Northern
Deanery, UK
Daniel Fitzgerald
(Chapter 56: Career planning)
Medical Doctor,
Médecins Sans Frontières,
Operational Centre Paris, France
CONTRIBUTORS xv
Neil Gupta
(Chapter 44: Radiology)
Consultant Interventional
Radiologist, Joint College
Tutor for Clinical Radiology,
Radiology Fellowship Program
Director, University Hospital
Coventry & Warwickshire,
Coventry, UK
Ruofan Connie Han
(Chapter 49: Preparing for clinical
examinations)
Specialist Registrar in
Ophthalmology, Oxford
Eye Hospital, John Radcliffe
Hospital, UK
Adam Handel
(Chapter 50: Clinical
examinations)
Clinical Lecturer in Neurology,
Nuffield Department of Clinical
Neurosciences, University
of Oxford
Ayad Harb
(Chapter 39: Plastic surgery)
Consultant Plastic Surgeon,
University Hospital North
Midlands NHS Trust, UK
Amy Hawkins
(Chapter 55: Electives)
Specialist Registrar in Palliative
Medicine, London, UK
Fiona Hayes
(Chapter 31: Rheumatology)
Consultant in Rheumatology
and Acute Medicine Southend
University Hospital NHS Trust, UK
Catherine Hearnshaw
(Chapter 50: Clinical
examinations)
Specialist Registrar Paediatrics,
Royal Derby Hospital, UK
xvi
xvi CONTRIBUTORS
Alexander J Hills
(Chapter 37: Oral and maxillo-
facial surgery)
Specialist Registrar, Oral and
Maxillofacial Surgery, Queen
Victoria Hospital, East Grinstead,
Sussex, UK
Thiagarajan Jaiganesh
(Chapter 12: Emergency medicine)
Consultant in Adult and
Paediatric Emergency Medicine,
Emergency Department,
St George’s, University of
London, UK
Aisha Janjua
(Chapter 23: Obstetrics &
Gynaecology
Chapter 50: Clinical examinations;
Chapter 51: Written exams)
Obstetrics and Gynaecology
Specialist Registrar and NIHR
Clinical Lecturer, Warwick
University, UK
Mhairi Jhugursing
(Chapter 9: Critical care)
Consultant Anaesthetist, West
Middlesex Hospital, London, UK
Irfan Jumabhoy
(Chapter 2: Studying at medical
school; Chapter 54: Getting ahead)
Core Surgical Trainee, Plastic
and Reconstructive Surgery,
Nottingham University Hospital
NHS Trust, Nottingham, UK
Raghunath Kadiyala
(Chapter 13: Endocrinology and
diabetes)
Consultant in Diabetes and
Endocrinology, Stoke Mandeville
Hospital, Buckinghamshire
Healthcare NHS Trust,
Aylesbury, UK
Sheirin Khalil
(Chapter 52: Other assessments)
GP Specialist Registrar, James
Paget University Hospital, Great
Yarmouth, UK
Harry Krishnan
(Chapter 50: Clinical examinations)
Specialist Trainee, Trauma and
Orthopaedics, Northwest
Thames Rotation, UK
Kar-​Hung Kuet
(Chapter 10: Dermatology)
Specialist Registrar, Dermatology,
Royal Hallamshire Hospital,
Sheffield, UK
Mong -​Loon Kuet
(Chapter 35: Ear, nose, and
throat surgery)
Specialist Registrar, Ipswich
Hospital NHS Trust, Ipswich, UK
Suhas S. Kumar
(Chapter 7: Anaesthetics)
Consultant, Department of
Anaesthesia and Critical Care,
Norfolk and Norwich University
Hospital, Norwich, UK
Lily XLi
(Chapter 40: Trauma and
orthopaedic surgery)
Orthopaedic Specialist Registrar,
North West London rotation, UK
Firas Maghrabi
(Chapter 20: Infectious diseases
and tropical medicine)
Clinical Research Fellow in
Infectious Diseases, The
National Aspergillosis Centre,
Manchester University
NHS Foundation Trust,
Wythenshawe Hospital,
Manchester, UK

David Metcalfe
(Chapter 8: Cardiology;
Chapter 30: Respiratory medicine;
Chapter 41: Vascular surgery)
Clinical Research Fellow in
Musculoskeletal Trauma,
University of Oxford, UK
Yasmeen Mulla
(Chapter 4: Preparing for
preclinical exams)
GP Specialty Trainee, Thames
Valley Deanery, Buckinghamshire
Healthcare Trust, UK
Biplab Nandi
(Chapter 38: Paediatric surgery)
Lecturer in Paediatric Surgery,
College of Medicine, University
of Malawi; Consultant Paediatric
Surgeon, Kamuzu Central
Hospital, Lilongwe, Malawi
Fiona Napier
(Chapter 3: Preclinical medi-
cine; Chapter 7: Anaesthetics;
Chapter 13: Endocrinology and dia-
betes; Chapter 14: Gastroenterology;
Chapter 21: Nephrology;
Chapter 22: Neurology)
Consultant, Emergency
Department, Derriford Hospital,
Plymouth, UK
Arjun Odedra
(Chapter 5: Intercalated de-
grees and special study modules;
Chapter 54: Getting ahead)
GP Specialist Registrar, Royal
Surrey County Hospital,
Guildford, UK
Nicola Okeahialam
(Chapter 6: Going clinical)
Specialist Registrar, Obstetrics
and Gynaecology, Chelsea
& Westminster Hospital,
London, UK
CONTRIBUTORS xvii
Vishal Patel
(Chapter 32: Breast surgery)
Breast and General
Surgery Specialist Registrar,
North West London
Deanery, UK
Nikhil Pawa
(Chapter 34: Colorectal surgery)
Consultant General &
Colorectal Surgeon, West
Middlesex University Hospital
Middlesex, UK
Benjamin Pinkey
(Chapter 6: Going clinical)
Consultant Paediatric
Radiologist, Department
of Radiology, Birmingham
Children’s Hospital,
Birmingham Women’s and
Children’s NHS Foundation
Trust, UK
Emma Prower
(Chapter 11: Elderly care)
Intensive Care Specialist
Registrar, Kings College Hospital,
London, UK
Tasneem Rahman
(Chapter 19: Immunology and
allergies)
Specialist Registrar
in Immunology and
Allergy, Department of
Immunopathology,
Royal London Hospital,
London, UK
Fatimah Ravat
(Chapter 2: Studying at medical
school)
Postgraduate MSc Student,
Deanery of Biomedical Sciences,
University of Edinburgh,
Edinburgh, UK
xvii
xviii CONTRIBUTORS
Imran Raza
(Chapter 34: Colorectal surgery)
Specialist Registrar in
Colorectal and general surgery,
University College Hospital,
London, UK
Isabel Rodriguez-Goncer
(Chapter 20: Infectious diseases
and tropical medicine)
Senior Clinical Fellow in
Infectious Diseases, The National
Aspergillosis Centre, Manchester
University NHS Foundation
Trust, Wythenshawe hospital,
Manchester, UK
Shahbaz Roshanzamir
(Chapter 11: Elderly care)
Consultant Geriatrician and
General Physician, Department
of Ageing and Health, Guy’s & St
Thomas’ Hospital, London, UK
Hazim Sadideen
(Chapter 39: Plastic surgery)
Department of Surgery and
Cancer, Imperial College
London, London, UK
Ahmed-Ramadan Sadek
(Chapter 36: Neurosurgery)
Senior Neurosurgical
Registrar, Jason Brice Fellow
in Neurosurgical Research,
Department of Neurosurgery,
Wessex Neurological
Centre, University Hospital
Southampton, UK
Ashraf Sanduka
(Chapter 28: Pathology)
Consultant, Department of
Histopathology, West Suffolk
Hospital, Bury St Edmunds,
Suffolk, UK
Guy Schofield
(Chapter 27: Palliative medicine)
Specialist Registrar in Palliative
Medicine, Wellcome Trust
Society and Ethics Fellow,
Centre for Ethics in Medicine,
University of Bristol, UK
Katherine Schon
(Chapter 16: Genetics)
Specialist Registrar and
Academic Clinical Fellow,
Department of Clinical
Genetics, East Anglian
Medical Genetics Service,
Addenbrooke’s Hospital,
Cambridge, UK
Eshan Senanayake
(Chapter 33: Cardiothoracic
surgery)
Specialist Registrar,
Department of Cardiothoracic
Surgery, University
Hospitals Birmingham
NHS Foundation Trust,
Birmingham, UK
Stephanie Slater
(Chapter 51: Written exams)
Senior House Officer,
Acute Medicine, Croydon
University Hospital, UK
Carmel Stober
(Chapter 31: Rheumatology)
Locum Consultant in
Rheumatology, Department
of Rheumatology, Cambridge
University Hospitals
NHS Foundation Trust,
Addenbrooke’s Hospital,
Cambridge, UK

Amit Sud
(Chapter 18: Haematology)
Clinical Research Fellow, The
Institute of Cancer Research/
The Royal Marsden NHS
Foundation Trust, London, UK
Kapil Sugand
(Chapter 1: Starting as a medical
student; Chapter 3: Preclinical
medicine; Chapter 5: Intercalated
degrees and special study mod-
ules; Chapter 8: Cardiology;
Chapter 12: Emergency medicine;
Chapter 15: General practice;
Chapter 30: Respiratory medi-
cine; Chapter 34: Colorectal
surgery; Chapter 40: Trauma
and Orthopaedics;
Chapter 41: Vascular sur-
gery; Chapter 43: Urology;
Chapter 49: Preparing
for clinical examinations;
Chapter 50: Clinical examinations;
Chapter 53: Making decisions;
Chapter 54: Getting ahead)
Editor-in-Chief for OHMS,
Trauma and Orthopaedics
Specialist Registrar and Surgical
Research Fellow, Imperial
College London, UK,
Quen Tang
(Chapter 40: Trauma and ortho-
paedic surgery)
Specialist Registrar in Trauma
and Orthopaedics, North West
Thames Rotation, Department
of Trauma and Orthopaedics,
Chelsea and Westminster
Hospital, London, UK
Hannah Tharmalingam
(Chapter 24: Oncology)
Oncology Registrar,
Department of Oncology,
Mount Vernon Cancer Centre,
Northwood, UK
CONTRIBUTORS xix
Jemma Theivendran
(Chapter 29: Psychiatry)
Specialist Registrar in Child
and Adolescent Psychiatry,
South West London and St
George’s Mental Health Trust;
Honorary Clinical Lecturer,
St George’s, University of
London, UK
Sri Thrumurthy
(Chapter 8: Cardiology;
Chapter 30: Respiratory medicine;
Chapter 41: Vascular surgery)
General Surgical Specialist
Trainee, University College
London Hospitals NHS
Trusts, UK
Alex Tsui
(Chapter 22: Neurology)
Specialist Registrar, Clinical
Research Fellow, MRC Unit
for Lifelong Health and Ageing,
University College London, UK
Aravinthan Varatharaj
(Chapter 22: Neurology)
MRC Clinical Research
Training Fellow, University of
Southampton, and Honorary
Specialist Registrar in Neurology,
Wessex Neurological Centre, UK
Laura Watson
(Chapter 15: General practice)
GP, Emergency Department,
John Radcliffe Hospital, Oxford
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 Ant. Contract, curtail, condense, restrict, attenuate.
Expanse. Extent, stretch, expansion; firmament, sky, canopy,
vault, welkin; vast, void, space, breadth.
Ant. Limit, enclosure, confine, bound.
Expatiate. Rove, range; dilate, enlarge, descant, be copious, launch
out, amplify.
Ant. Contract, summarize, condense, epitomize.
Expect. Await, look for; anticipate, rely upon, count upon, reckon
or calculate upon, look forward to; look for, forecast, forebode,
foresee.
Ant. Welcome, greet, hail, recognize; realize.
Expectation. Anticipation, expectance, prospect, expectancy;
reliance, confidence, assurance, presumption; trust, hope.
Ant. Recollection, remembrance, retrospect; distrust, despair,
discouragement.
Expediency. Fitness, propriety, suitableness, desirableness,
advisability; advantage, utility, profit, usefulness; profitableness,
advantageousness; interest.
Ant. Disadvantage, detriment, inutility, inexpediency.
Expedition. Haste, speed, celerity, despatch, alertness,
promptness, alacrity, quickness; enterprise, undertaking; march,
voyage.
Ant. Delay, tardiness, procrastination.
Expend. Disburse, spend, lay out; use, exert, consume, employ;
waste, exhaust, spread, scatter, dissipate.
Ant. Save, economize, husband.
Expense. Expenditure, outgo, cost, outlay; price, charge, payment.
Ant. Income, gain, proceeds, return, profit, product, receipts.
Expensive. Dear, costly, high-priced; lavish, wasteful, extravagant;
valuable, rich.
Ant. Cheap, worthless, poor; economical.
Experience, n. Actual observation, feeling, or presentation;
practice, experimental knowledge; experiment, trial, proof, test,
knowledge, habit.
Ant. Anticipation, expectation.
Experience, v. Feel, undergo, prove by trial, endure, suffer, be
subject to; try, encounter.
Ant. Evade, escape, lose, miss.
Experienced. Practiced, versed, accomplished, able, qualified,
instructed, thoroughbred; familiar, skilled, accustomed,
conversant.
Ant. Inexperienced, strange, unpracticed.
Experiment. Trial, test, assay, examination, proof, touchstone,
ordeal; observation, investigation, experimentation; illustration,
exemplification.
Ant. Hypothesis, conjecture, assumption.
Explain. Elucidate, expound, interpret, unfold, clear up, make
plain; account for, make intelligible, give the reasons for, solve,
warrant, trace to causes, justify; teach, decipher.
Ant. Mystify, bewilder, obscure, darken, misinterpret.
Explanation. Elucidation, interpretation, exposition, illustration,
description, explication; solution, warrant, justification, account,
key; mutual understanding; sense.
Ant. Confusion, misinterpretation, mystification, obscuration.
Explicit. Express, clear, plain, definite, positive, unambiguous,
unreserved, categorical, determinate; detailed, declaratory,
unobscure, stated.
Ant. Ambiguous, doubtful, indefinite, uncertain, vague,
implied, implicit, indeterminate; hinted, suggestive, obscure.
Exponent. Index, indication, example, type, representative,
illustration, specimen; advocate, interpreter, propounder.
Ant. System, creed, principle, opinion.
Export, v. Send out, carry out, send abroad, ship, produce.
Ant. Import; consume.
Exposed. Unprotected, defenseless, unguarded, endangered.
Ant. Guarded, defended, protected.
Expostulate. Object, dissuade, remonstrate.
Ant. Abet, coincide, agree, confirm.
Express, v. Squeeze out; utter, declare, assert, speak; represent,
indicate, show, signify, exhibit, denote, intimate; send by express.
Ant. Suppress, repress, conceal.
Express, a. Explicit, clear, definite, plain, determinate, positive,
categorical; exact, accurate, faithful, true, close, precise; special,
particular; swift, rapid, fast; specific, pointed, direct.
Ant. General; vague; leisurely; inaccurate, inexact,
approximate.
Expression. Squeezing out; assertion, statement, utterance,
declaration; phrase, mode of speech, term; general tone, pervading
effect, look, cast of countenance; lively representation; modulation,
feeling, execution; indication.
Ant. Suppression, restraint, repression; face, features,
lineament; falsification, misstatement, solecism, enigma.
Expunge. Erase, efface, obliterate, cancel, blot out, delete.
Ant. Mark, write, trace, delineate.
Exquisite. Nice, accurate, delicate, discriminating, exact, refined;
precious, valuable, select, choice, rare, excellent; perfect, complete,
matchless, consummate; keen, poignant, acute, intense; delicious.
Ant. Common, coarse, ordinary; unrefined.
Extemporaneous. Improvised, unpremeditated, extempore,
impromptu, extemporary, offhand.
Ant. Prepared, studied, premeditated, read, written,
elaborated; rehearsed, recited.
Extend. Stretch, reach; prolong, continue, lengthen, protract;
expand, dilate, enlarge, widen, augment, increase; diffuse; impart,
give, offer, yield; amplify, avail, apply.
Ant. Contract, restrict, curtail, limit, narrow, reduce, condense;
miss, fail.
Extent. Expanse, amplitude, extension; volume, bulk, magnitude,
size; stretch, reach, compass, length; degree, distance, quantity.
Ant. Limitation, diminution, restriction.
Extenuate. Lessen, diminish, reduce; palliate, mitigate, excuse,
qualify, apologize for.
Ant. Enhance, aggravate, heighten.
Exterior, a. Outward, external, outer, outside, superficial; foreign,
extrinsic, from without.
Ant. Inner, internal, domestic, inward.
Exterminate. Eradicate, overthrow, uproot, expel, extirpate,
annihilate, banish, destroy, remove, root out, wipe out.
Ant. Augment, breed, cherish, develop, increase, populate,
replenish, settle, plant, foster, propagate, colonize, build up,
beget.
Extermination. Extirpation, annihilation, eradication, abolition,
destruction, extinction, excision, elimination.
Ant. Settlement, replenishment, augmentation, colonization,
population, propagation, increase.
External. Outward, outer, exterior, outside, superficial; foreign,
extrinsic; visible, apparent; manifest, palpable.
Ant. Inner, internal, intestine, inmost, hidden, non-apparent.
Extinction. Destruction, annihilation, extirpation, extermination,
abolition; extinguishment; stifling, death, suffocation, cessation,
obsolescence.
Ant. Inception, origination, birth, course, life, operation, action,
exercise, continuance, prosperity, survival.
Extinguish. Quench; destroy, suppress, put down; extirpate,
abolish, eradicate, kill, annihilate, put out.
Ant. Replenish, replant, implant, cherish, propagate, promote,
invigorate, establish, confirm, secure.
Extort. Exact, wrest, wrench, wring out, force; despoil, express,
fleece, squeeze out, extract.
Ant. Coax, cheat, wheedle, cajole.
Extortionate. Oppressive, exacting, severe, hard, harsh;
exorbitant, close-fisted, rigorous, monstrous, preposterous.
Ant. Liberal, bountiful, indulgent, fair, moderate, reasonable.
Extract, n. Selection, excerpt, passage, citation, quotation.
Extract, v. Draw, pull, take out; derive, select, quote, cite;
determine, find; educe, elicit, gather, collect, extort.
Ant. Insert, replace, incorporate, restore, reinsert, impose.
Extraneous. Foreign, extrinsic; non-pertinent, not germane,
unessential, superfluous; unconnected, alien, unrelated,
adventitious, ascititious.
Ant. Intrinsic, vital, internal, connected, essential.
Extraordinary. Unusual, remarkable, uncommon, singular,
signal, egregious, rare, extra; unwonted, peculiar, wonderful,
unprecedented, marvelous, prodigious, monstrous, preposterous,
strange.
Ant. Common, usual, frequent, wonted, unremarkable,
unimportant, ordinary.
Extravagance. Excess, exorbitance, enormity, unreasonableness,
preposterousness; wildness, folly, absurdity, irregularity;
prodigality, lavish expenditure, profusion, waste.
Ant. Carefulness, economy, frugality, saving, provision,
prudence, foresight.
Extravagant. Excessive, inordinate, unreasonable, preposterous,
exorbitant; wild, foolish, absurd, irregular; lavish, profuse,
wasteful, spendthrift, prodigal.
Ant. Sound, sober, consistent, fair, rational, economical, frugal,
careful, regular, usual.
Extreme. Utmost, farthest, uttermost, outermost; greatest,
highest; last, final, ultimate; extravagant, immoderate, excessive,
unreasonable; remote, terminal, distant, most violent.
Ant. Initial, primal, judicious, moderate.
Extremity. End, verge, termination, edge, border, extreme, utmost
point; close, conclusion.
Ant. Beginning, commencement, opening, center, origin, bulk,
body.
Exudation. Ooze, drip, percolation, excretion, secretion.
Ant. Absorption, parching, aridity.
Exultant. Exulting, jubilant, triumphant, elated, joyous,
transported.
Ant. Mournful, dispirited, depressed.
Exultation. Elation, joy, triumph, delight, transport, ecstasy.
Ant. Mourning, depression.
 F

Fable. Story, myth, legend, allegory, apologue; plot, action, series

of events; fiction, falsehood, lie, untruth, fabrication, forgery,
invention, figment; romance, parable, novel.
Ant. History, fact, narrative.
Fabric. Building, structure, edifice, pile; texture, make,
workmanship, conformation; manufactured cloth, woven stuff;
work, construction, tissue, web.
Ant. Destruction, dismantlement, demolition, fragment, wreck,
tatters, ruin, shreds, rags.
Fabricate. Build, frame, construct; make, manufacture; forge,
invent, coin, feign; form, falsify, produce, devise, misrepresent.
Ant. Demolish, tear, spoil, dismember, destroy, narrate,
lacerate, copy, represent, repeat, portray.
Fabulous. Invented, fabricated, feigned, unreal, coined, fictitious;
incredible, pretended, imaginary, false, monstrous.
Ant. Real, actual, historic, authentic, fair, true, reasonable.
Facetious. Witty, jocose, jocular, humorous, waggish, funny,
comical, pleasant, droll; gay, merry, sportive, lively, entertaining,
sprightly; playful.
Ant. Matter-of-fact, heavy, dull, grave, serious, saturnine,
somber, lugubrious.
Facile. Docile, easy, mild, courteous, affable, complaisant,
approachable; pliant, pliable, ductile, flexible, yielding, tractable,
manageable, compliant; ready, dexterous; indulgent, weak,
irresolute, characterless.
Ant. Resolute, sturdy, obstinate, determined, inflexible, crusty,
self-willed, self-reliant, independent.
Facility. Easiness, ease; readiness, dexterity, expertness, ability,
knack; condescension, urbanity, affability, civility, complaisance,
politeness; pliancy, flexibility, ductility; appliance, convenience,
means, advantage, resource; quickness, adroitness.
Ant. Effort, awkwardness, labor, difficulty.
Fact. Occurrence, event, deed, incident, act, performance,
circumstance; reality, actuality, certainty, truth.
Ant. Fiction, supposition, unreality, falsehood, chimera, lie,
delusion, invention, hallucination, romance.
Factious. Turbulent, refractory, seditious, rebellious, recalcitrant,
litigious, adversative, malcontent.
Ant. Genial, complaisant, agreeable, loyal, harmonious, public-
spirited, sympathetic, cooperative, auxiliary.
Factitious. Artificial; euphuistic, affected, finical, cramped,
conventional, spurious.
Ant. Natural, genial, unaffected, pure, genuine, truthful.
Fade. Vanish, evanesce, disappear, pass away; decline, languish,
droop, decay, wither; lose color, grow dim, blanch, bleach, fall,
sink, dwindle, pale, change, set, etiolate, fail.
Ant. Rise, increase, bloom, grow, flourish, endure, abide, last,
stand.
Fag. Droop, sink, grow weary, flag; drudge, toil; do menial service,
tire, fatigue, jade, exhaust; work, slave.
Ant. Idle, lounge, dawdle; strike; bask.
Fail. Fall short, be insufficient, be deficient; decline, sink, decay,
wane, fade, break, give out; cease, disappear, become extinct; miss,
miscarry, be unsuccessful, miss fire, be frustrated; omit, neglect;
break, become insolvent, suspend payment; trip, lose.
Ant. Succeed, exceed, surpass, achieve, abound, yield, excel.
Faint. Weak, exhausted, worn, listless, languid, wearied, dim,
feeble, fatigued, faint-hearted, faded, faltering, half-hearted,
irresolute, purposeless, timid, ill-defined, indistinct; unenergetic;
obscure, inconspicuous.
Ant. Prominent, marked, glaring; resolute, sturdy, vigorous,
strong, fresh, hearty, daring, energetic; clear, brilliant, bright,
 conspicuous.
Fair. Spotless, unspotted, unblemished, unstained, untarnished;
white, light, blond; handsome, comely, beautiful; pleasant, clear,
cloudless, unclouded; favorable, prosperous; promising, hopeful;
open, distinct, plain, unobstructed, unencumbered; frank, honest,
ingenuous, candid, noble, honorable, upright, impartial;
reasonable, proper, equitable, just; passable, tolerable, above
mediocrity; serene.
Ant. Lowering, dull, foul, ugly, disfigured, fraudulent, unfair,
dishonorable.
Faith. Creed, doctrine, assurance, belief, confidence, assent,
credence, opinion, trust, credit, reliance.
Ant. Distrust, disbelief, dissent, doubt, incredulity, infidelity,
misgiving, skepticism, unbelief, suspicion, rejection.
Faithful. Firm, loyal, devoted, stanch, sure, true, trustworthy,
trusty, unwavering, incorruptible; attached; accurate, close,
consistent, correspondent, exact, equivalent.
Ant. Inaccurate, inexact; faithless, false, fickle, untrue,
wavering, untrustworthy, capricious.
Fall. Drop, descend, sink; lapse, droop, gravitate; fall down, be
prostrated; be lowered, be depressed; decrease, decline, be
diminished, die away, sin, err, transgress, trip, trespass; die,
perish; empty, be discharged, flow; happen, befall, come; become,
get; pass, be transferred; be dropped, be uttered carelessly.
Ant. Rise, soar, mount, recover, climb, ascend.
Fallacy. Illusion, deception, deceit, delusion, mistake,
misapprehension, error, misconception; sophism, sophistry,
paralogism, deceitful argument.
Ant. Truth, logic, proof, postulate, argument, verity, fact,
axiom, soundness.
Fallible. Erring, uncertain, ignorant, weak, frail, imperfect.
Ant. Certain, infallible, unerring, omniscient.
Fallow. Pale red or pale yellow; untilled, unsowed, neglected;
inert, inactive, dormant; quiescent, idle, uncultivated,
unproductive.
 Ant. Cultivated, tilled, productive, worked, sown, prolific,
operative, fruitful.
False. Untrue, mendacious, unveracious, lying; dishonest,
perfidious, treacherous, faithless, disloyal, dishonorable,
disingenuous, double-tongued, false-hearted, double-faced, two-
faced; untrustworthy, untruthful, unreliable, truthless; spurious,
counterfeit, forged, not genuine, feigned, sham, hypocritical, make-
believe; incorrect, improper, erroneous, unfounded, wrong;
fallacious, deceptive, deceiving, deceitful, delusive, misleading,
disappointing; sophistical, mock, bogus, fabricated, unfaithful.
Ant. True, sound, correct, authentic, real, genuine, candid,
conclusive, honorable, faithful.
Falsehood. Falsity, lie, fabrication, untruth, fiction, fib; imposture,
counterfeit, cheat; fallacy, error, sophistry, forgery, deception.
Ant. Truth, verity, correctness, fact, genuineness, honesty,
honor, reality, authenticity.
Falsify. Misrepresent, counterfeit, belie, misstate, garble; disprove,
show unsound; violate; mistake, misinterpret, betray.
Ant. Verify, rectify, correct, check, certify, justify, expose,
declare, exhibit, publish.
Falter. Hesitate, stutter, stammer; fail, quiver, tremble, totter;
waver, be undecided, show weakness; halt, slip, dubitate, demur,
flinch, vacillate.
Ant. Proceed, speed, flow, run, discourse, determine, persevere,
resolve.
Fame. Celebrity, honor, laurels, distinction, notoriety, renown,
reputation, repute, glory, eminence, credit; report, tidings, rumor,
bruit, news.
Ant. Silence, suppression, hush; dishonor, discredit,
humiliation, infamy, shame, obscurity, contempt, contumely,
disgrace, disrepute, ignominy, oblivion.
Familiar. Conversant, well-acquainted, well-versed; intimate,
close, near, friendly, fraternal, cordial, amicable; social, accessible,
sociable, affable, kindly, courteous, civil, companionable,
conversible; unceremonious, unconstrained, free, easy, informal;
well-known; household, frank, everyday, accustomed.
 Ant. Uncommon, rare, extraordinary, strange, unaccustomed,
unacquainted, new, unfamiliar, inconversant.
Famous. Celebrated, renowned, distinguished, remarkable, far-
famed, eminent, noted, illustrious, glorious.
Ant. Unknown, unsung, inglorious, obscure, forgotten.
Fanatic. Enthusiast, zealot, visionary, bigot.
Ant. Skeptic, unbeliever, cynic.
Fanaticism. Intolerance, superstition, bigotry, credulity;
enthusiasm, frenzy.
Ant. Skepticism, cynicism, indifference, freethinking,
latitudinarianism; disbelief, profanity; disregard, coldness.
Fanciful. Fantastic, grotesque, visionary, imaginative, chimerical;
unreal, eccentric, quaint, imaginary, freakish, erroneous,
humorsome, capricious, fitful, erratic, whimsical, absurd.
Ant. Ordinary, usual, regular, commonplace, real, accurate,
literal, prosaic, reasonable, sensible, solid, sure, true, sound,
calculable, calculated; natural, sober, truthful, correct.
Fancy. Imagination, whim, vagary, caprice, belief, conceit,
conception, desire, humor, idea, image, inclination, mood, liking,
predilection, supposition; thought, notion.
Ant. Certainty, fact, reality, truth, verity, actuality; object,
subject, thought, law, order; aversion, horror.
Farcical. Droll, absurd, ridiculous, ludicrous; comic, funny,
nonsensical, pantomimic.
Ant. Grave, serious, tragic, solemn, dismal, ghastly, funereal.
Fare. Go, travel, journey, pass; prosper, be treated, prove, happen,
turn out, be situated; be entertained, feed; live, speed, do.
Ant. Toil, fast, fail, droop, sink, faint, drop, falter, halt.
Farewell. Adieu, good-by, valedictory, leave-taking, congé,
departure, parting.
Ant. Salutation, welcome, greeting.
Fashion. Form, shape, figure, cut, make, model, cast, mold,
pattern, appearance, configuration, conformation; way, manner,
sort, method; usage, custom, style, mode, conventionality;
gentility; guise, character, practice, ceremony.
 Ant. Person, work, speech, dress; derangement, formlessness,
shapelessness; outlandishness, strangeness, eccentricity.
Fast, a. Fixed, fastened, close, tight; firm, immovable; steadfast,
constant, stanch; fortified, strong, impregnable; profound, sound,
deep; swift, quick, fleet, rapid; wild, reckless, thriftless, dissipated,
thoughtless, extravagant; secure, stable, unyielding, unswerving;
accelerated; gay.
Ant. Insecure, loose, slow, tardy, steady, sober, virtuous.
Fasten. Secure, bind, tie, attach; join, unite, connect, hold
together; hold compact, affix, annex, grapple, fix.
Ant. Undo, loose, sever, relax, remove, unfasten, detach.
Fastidious. Dainty, squeamish, difficult, overnice, overdelicate,
queasy, critical; overrefined, censorious, particular, punctilious.
Ant. Indulgent, uncritical, easy; coarse; omnivorous.
Fat. Unctuous, greasy, fatty, oily; plump, fleshy, obese, corpulent,
portly, pursy; coarse, heavy, dull, sluggish, stupid; rich, profitable,
lucrative; productive, fertile, fruitful; luxuriant, brawny; stout;
oleaginous.
Ant. Lean, slender, attenuated, emaciated, barren, poor, scant;
marrowless; anatomical.
Fatal. Deadly, mortal, lethal; destructive, calamitous, baleful,
ruinous, mischievous, baneful, pernicious; fateful.
Ant. Beneficial, wholesome, vitalizing, restorative, salubrious,
nutritious, slight, superficial, harmless.
Fate. Destiny, destination, inevitable necessity, fatality; lot, doom,
predetermined event; destruction, death; final event, ultimate
destruction; fortune, end.
Ant. Will, choice, decision, independence, freedom.
Fathom, v. Sound; divine, penetrate, reach, comprehend,
understand; gage, pierce, measure, probe.
Ant. Survey, glance, scan, miss, skin, graze, overlook.
Fathomless. Bottomless, profound, abysmal.
Ant. Superficial, shallow, skin-deep.
Fatigue, n. Weariness, exhaustion, lassitude; labor, hardship, toil;
languor, enervation.
 Ant. Freshness, vigor, indefatigability, activity.
Fatigue, v. Harass, weary, tire, jade, exhaust, fag.
Ant. Inspirit, refresh, enliven, animate.
Fatuity. Foolishness, imbecility, idiocy; folly, madness, absurdity,
infatuation.
Ant. Wisdom, sense, soundness, sobriety, discernment.
Fault. Defect, blemish, imperfection, flaw, weakness, failing,
frailty; misdeed, misdemeanor, offense, trespass, wrong,
transgression, delinquency, indiscretion; slip, error, lapse; failure,
omission, want, drawback.
Ant. Perfection, sufficiency, correctness, completeness.
Faultless. Without blemish, perfect; innocent, guileless, blameless,
sinless, spotless, immaculate, guiltless, stainless; complete, correct,
accurate.
Ant. Incomplete, imperfect, incorrect, defective, inaccurate,
corrupt, faulty, erroneous.
Faulty. Bad, defective, imperfect; blamable, blameworthy,
culpable, reprehensible.
Ant. Correct, complete, perfect, accurate; irreproachable,
blameless, unassailable.
Favor, n. Kindness, grace, countenance, friendliness, good will;
benefit, good deed, friendly turn; patronage, championship,
support; letter, communication, epistle; gift, present; decoration,
knot, rosette; permission, leave, pardon; advantage, preference,
boon; concession, predilection, civility, regard, condescension.
Ant. Refusal, denial, prohibition, disfavor, withholding,
withdrawal, frown, disapproval, injury, discountenance.
Favor, v. Befriend, countenance, patronize, encourage; approve,
regard with favor; facilitate, be propitious to; support, help, aid,
assist; humor, indulge, extenuate, palliate, ease, spare; resemble,
look like.
Ant. Refuse, deny, disapprove, withdraw, withhold, prohibit,
discountenance, injure, harm.
Favorable. Kind, friendly, propitious, willing, auspicious;
conducive, contributing; beneficial, advantageous, convenient,
 suitable, fit; permissive, indulgent, concessive, partial, fond,
liberal.
Ant. Reluctant, unpropitious, unfavorable, impartial.
Favorite. Dear, beloved, pet, darling.
Favoritism. Partiality, invidiousness.
Ant. Odium, prejudice; impartiality.
Fawn upon. Flatter, wheedle, cajole, cringe, palaver, slaver.
Ant. Insult, deride, defy, censure, dare, satirize, rebuke,
reprimand.
Fealty. Homage, loyalty, allegiance; fidelity, faithfulness, honor,
good faith, devotion.
Ant. Disloyalty, treachery, infidelity, disaffection, shame,
dishonor.
Fear. Dismay, alarm, horror, awe, apprehension, dread, terror,
fright, panic, tremor, timidity, trepidation, trembling, affright,
consternation, disquietude, misgiving, anxiety, solicitude, concern;
veneration, reverence.
Ant. Courage, confidence, assurance, fearlessness; trust,
boldness; fortitude.
Fearful. Afraid, apprehensive; timid, nervous, timorous, faint-
hearted, cowardly; dreadful, terrible, frightful, dire; awful;
shocking, terrific, horrible; hesitating.
Ant. Venturesome, audacious, bold, confident, consolatory,
inspiriting, assuring; attractive, alluring, hopeful, inviting.
Feasible. Manageable, possible, permissible, practicable,
contrivable.
Ant. Impossible, unallowable, impracticable.
Feast. Treat, banquet, regalement, entertainment, carousal;
festival, holiday; delight, enjoyment.
Ant. Starvation, scarcity, want, lack, bareness, scantiness.
Featly. Neatly, cleverly, dexterously, adroitly.
Ant. Clumsily, bunglingly, hardly.
Feature. Lineament, cast of the face; fashion, make, aspect,
appearance, conformation; prominent part, outline; characteristic,
 trait, point, mark, item, component, element, indication, portion,
sign.
Ant. Whole, system, countenance; arrangement, case;
misindication, misinformation, falsification; blind, mask,
disguise; excrescence.
Federation. Uniting, federating, confederation, union, league,
allying, alliance, coalition, federal compact, confederacy,
combination.
Ant. Secession, disunion, sedition, mutiny, disruption.
Fee. Pay, reward, recompense, compensation, remuneration; feud,
fief, fee-simple, unconditional tenure.
Feeble. Weak, not strong, enervated, debilitated, infirm, languid,
sickly, languishing, declining, frail, drooping; faint, imperfect, dim;
without vigor, lacking intensity; wretched, poor, dull, forceless,
puny, enfeebled, nerveless; incomplete, vain, fruitless; scanty,
pitiable.
Ant. Strong, robust, active, successful, effective; abundant;
powerful, muscular; forcible, cogent, telling; violent, vehement,
ardent; lusty, hale, vigorous, hearty.
Feed. Give food to, supply, contribute to, provide for; nourish,
cherish, sustain; eat, take food, take nourishment; sustain life,
subsist.
Ant. Starve, refuse, deny, withhold, take away; impoverish,
steal from; diet, abstain, refrain.
Feel. Perceive, have feeling; be perceived; be moved, be excited, be
stirred, be wrought up, be impressed; touch, handle; experience,
suffer, or enjoy; be affected by, be moved by; prove, sound, try, put
to the test.
Ant. Be hard or callous, insensate, apathetic, dull, numb,
imperceivable, indifferent, unsusceptible, or stoical.
Feeling. Sense of touch; sensation, perception by touch;
sensibility, emotion, sentiment, affection, passion, impression;
tenderness, susceptibility; contact; pathos; consciousness,
sensitiveness.
Ant. Callousness, insensibility, imperturbability, inexcitability,
coldness, insensateness.
Feign. Invent, imagine, devise, forge, fabricate; counterfeit, affect,
assume, simulate, pretend to.
Ant. Detect, test, unmask, refute, verify, substantiate.
Felicitous. Fit, appropriate, apt, pertinent, seasonable, opportune,
well-timed, happy, skilful, ingenious; prosperous, successful,
fortunate, lucky, auspicious, propitious; timely, joyous.
Ant. Unhappy, unfortunate, inauspicious, untimely,
inopportune, disastrous, sad.
Felicity. Bliss, blessedness, happiness; aptness, aptitude, fitness,
propriety, felicitousness, suitableness; success, luck, fortune.
Ant. Ill luck, bad fortune, sorrow, unhappiness, disaster,
misfortune; sadness, mourning, melancholy.
Fell, a. Inhuman, cruel, barbarous, relentless, ruthless, implacable,
unrelenting, pitiless, malignant, malicious, malign, savage,
ferocious, bloody, blood-thirsty; direful, merciless, remorseless,
fierce, truculent.
Ant. Generous, chivalrous, lenient, humane, propitious.
Fell, v. Prostrate, level, bring to the ground, hurl down, knock
down; cut down, hew down, lay low; hem; demolish, subvert,
waste, bare.
Ant. Plant, erect, support; stock, upraise, rear, propagate.
Fellow. Associate, companion, comrade; equal, peer, compeer;
mate, match, counterpart; adherent, colleague, member;
correlative, tally; partner, friend.
Ant. Foe, opponent, antagonist, stranger, mismatch, opposite.
Fellowship. Companionship, familiarity, intimacy, brotherhood,
acquaintance; participation, partnership, joint interest; converse,
intercourse, communion; sociability, affability, kindliness;
association, company; membership, society.
Ant. Severance, disconnection, dismemberment; non-
intercourse.
Felonious. Malignant, malign, malicious, nefarious, infamous,
heinous, atrocious, cruel, felon; perfidious, traitorous, disloyal,
base.
 Ant. Legal, constitutional, rightful, regular; legitimate,
legalized; permissible, allowable; just, proper.
Feminine. Female, womanish, womanly, effeminate; delicate,
tender, modest, soft.
Ant. Robust, manly; indelicate, unfeminine; rough, rude;
masculine.
Fen. Marsh, swamp, bog, moor, morass, quagmire.
Fence, v. Enclose, guard, fortify, defend, circumscribe, protect;
elude, parry, stave.
Ant. Open, disenclose; receive, catch, suffer.
Ferment, n. Yeast, leaven, fermentation; agitation, commotion,
tumult; fever, heat, glow.
Ferment, v. Set in fermentation; excite, agitate, heat; seethe,
concoct, brew; warm, chafe; effervesce, rankle, fester.
Ant. Damp, cool; dissipate; subside, evaporate, disperse; heal.
Fertile. Prolific, fecund, breeding, bearing; fruitful, productive,
rich, plenteous, luxuriant, exuberant, teeming; causative,
conducive; pregnant; fraught, ingenious, inventive.
Ant. Poor, sterile, barren, unproductive, ineffective,
inconducive, fruitless, inoperative, uninventive, unimaginative.
Festive. Convivial, jovial, joyous, gay, merry, mirthful, festival.
Ant. Solitary, deserted, ascetic, gloomy.
Fetid. Stinking, offensive, rank, rancid, malodorous, mephitic,
noisome, foul, strong-smelling, corrupt.
Ant. Inodorous, fresh, perfumed, scented, balmy.
Fetter, n. Chains, bondage, custody, durance, duress, manacles,
irons, shackles, imprisonment, handcuffs, gyves, bonds.
Fetter, v. Shackle, clog, hamper, trammel; chain, bind, tie, confine,
restrain, encumber; manacle, hinder, impede.
Ant. Free, liberate, accelerate, expedite.
Feud. Contest, controversy, dispute, enmity, hostility, quarrel,
strife, dissension, affray, animosity, bitterness, broil, contention,
brawl, fray; antipathy.
 Ant. Friendliness, congeniality, sympathy, clanship,
pacification, reconciliation, sociality, neighborliness.
Fever. Heat, flush, excitement, agitation, ferment; ardor, fervor,
broil, passion.
Ant. Coolness, iciness, frigidity; composure, indifference.
Few. Not many, small in number, hardly any, scarcely any; scant,
rare, lacking.
Ant. Many, abundant, numerous.
Fiber. Strength, sinews, thews, toughness; thread, staple, pile,
filament.
Ant. Laxity, debility, flabbiness.
Fickle. Wavering, unsteady, unstable, inconstant, variable,
vacillating, volatile, mercurial, fitful, changeable, irresolute,
unsettled, capricious, fanciful, unreliable, mutable; veering,
restless, shifting.
Ant. Sober, orderly, reliable, calculable, well-regulated,
uniform, steady, trustworthy.
Fiction. Fable, falsehood, myth, invention, novel, romance,
figment, story, fabrication, legend, allegory, apologue; creation.
Ant. History, fact, literalness, reality, truth, verity, certainty.
Fictitious. Feigned, imaginary, invented, unreal, purely ideal,
fanciful; false, counterfeit, spurious, supposititious.
Ant. Real, true, historical, genuine, authentic, veritable.
Fidelity. Faithfulness, devotedness, devotion, truth, loyalty, true-
heartedness, fealty, adherence to duty; accuracy, closeness,
exactness, truthfulness, precision, attachment, honesty, allegiance,
integrity.
Ant. Disloyalty, treachery, untruthfulness, disaffection,
inaccuracy, infidelity, inexactness.
Field. Tract of land; battle-field, scene of war; surface, expanse,
range, scope; province, department, region, realm, domain;
ground, arena; room, opportunity.
Ant. Circumscription, constraint; interdiction, exclusion,
debarment.
Fierce. Ravenous, infuriate, barbarous, fell; vehement, turbulent,
passionate, uncurbed, untamed, raging; furious, savage, ferocious,
fiery, violent, wild, impetuous; uncultivated, untrained.
Ant. Gentle, harmless, kind, patient, submissive, sweet, tender,
docile, affectionate, mild, peaceful, tame; calm.
Fiery. Hot, ardent, heated, fervid, flaming, glowing; impetuous,
vehement, fierce, passionate, impassioned; irascible, choleric,
excited, enkindled, hot-blooded, irritable.
Ant. Cold, icy, frigid, chilly; indifferent, phlegmatic,
passionless, unimpassioned, mild, tame; extinguished, quenched.
Fight, n. Combat, conflict, contest, battle, struggle, engagement,
encounter, action, affair, fray, affray, brush; broil, riot; spirit,
fighting temper; resistance, disposition to struggle, contention.
Ant. Pacification, reconciliation.
Figurative. Typical, representative, emblematical; metaphorical,
tropical; flowery, florid, ornate; poetical, rhetorical, symbolical.
Ant. Literal, prosaic, unpoetical, unmetaphorical.
Figure, n. Form, shape, configuration, conformation, outline;
image, likeness, representation, effigy; appearance; pattern,
design; metaphor, trope; diagram, drawing; price; symbol, type,
emblem; digit, number, numeral, character; aspect, delineation,
condition, illustration.
Ant. Misrepresentation, deformity, disfigurement.
Figure, v. Adorn, variegate, diversify; represent, signify, typify,
symbolize; imagine, image, conceive, picture, represent; calculate,
compute, cipher; appear, act, perform; show off, cut a dash.
Ant. Disfigure, harm, destroy; miscalculate, mistake.
File. Rasp, smooth, finish; place on file; polish; perfect, refine,
improve.
Ant. Roughen, jag, acuminate, denticulate, barb, notch, cusp.
Fill. Make full, fill up; pervade, occupy; dilate, expand, stretch,
distend; store, supply, furnish, replenish, stock; satisfy, content,
sate, satiate, cloy, pall; occupy, hold, fulfil, perform; become full,
be filled; gorge, appoint, glut; stuff; rise; swell, grow, increase.
 Ant. Exhaust, drain, dissatisfy, deprive, stint, vacate;
misappoint; subside, ebb, evaporate, shrink, diminish.
Filter. Strain, ooze, percolate, exude, transude; refine, distil, leak;
purify, cleanse, depurate, defecate, clarify.
Ant. Muddle, disturb, befoul, thicken.
Filthy. Dirty, nasty, foul, defiled, unclean, squalid; impure, corrupt,
gross; dingy, unsanitary, unwholesome.
Ant. Pure, sweet, healthy, clean, sanitary, wholesome.
Final. Latest, last, eventual, ultimate; decisive, conclusive,
definitive; terminal; definite, developed.
Ant. Initiative, open, progressive, continuous, incipient,
current, unconcluded, inchoate, inaugural, nascent, rudimental.
Find. Discover, fall upon, light upon, meet; obtain, get, procure,
gain, arrive at, attain to; observe, remark, perceive, notice,
discover; detect, catch; supply, furnish, provide, contribute;
determine judicially, declare by verdict; confront, ascertain,
experience, invent.
Ant. Withdraw; miss, lose, elude, withhold, overlook,
miscontrive.
Fine, n. Forfeit, penalty, forfeiture, mulct, amercement.
Fine, a. Minute, small, comminuted, little; slender, capillary,
delicate; thin, tenuous, subtile, attenuated; light, keen, sharp;
exquisite, nice, refined; excellent, superior, very good; brilliant,
accomplished; beautiful, handsome, splendid, elegant; clear, pure,
unadulterated; gay, showy, garish, flashy, filmy, artistic, choice,
finished, high, grand, noble, generous, honorable, pretentious,
pretty, ostentatious; presumptuous, casuistical.
Ant. Rough, mean, petty, unfinished; illiberal, unimposing,
paltry; modest, unaffected, affable; plain-spoken, categorical;
unanalytical, unreflective; coarse, great, heavy, huge, immense,
large, rude, stout, thick, blunt, big, clumsy.
Finery. Gewgaws, trinkets, ornaments, trimmings, tawdriness,
decorations, trappings, bedizenment, tinsel, trash, dressiness.
Ant. Ornament, dress, decoration, adornment; chasteness,
sobriety, simplicity.
Finical. Fastidious, dainty, overparticular, squeamish, overnice,
affected, elegant; dandyish, foppish, spruce.
Ant. Effective, unaffected, practical, energetic, real, genuine,
natural; outspoken, blunt, coarse, rude.
Finish, v. Accomplish, execute, complete, perform, achieve, do, get
done; perfect, polish, elaborate; end, terminate, close, conclude,
put an end to; shape.
Ant. Start, commence, begin; fail, undertake; miscontrive,
botch, mar, mismanage.
Finished. Perfect, artistic, refined, high.
Ant. Inartistic, incomplete, poor, rude, coarse, unfinished.
Finite. Bounded, limited, conditioned, contracted, restricted,
terminated.
Ant. Infinite, unlimited, unbounded.
Fire. Blaze, burning, conflagration, flame, combustion; discharge;
heat, ardor, fervor, violence, force, passion, impetuosity, fervency,
intensity, animation, vigor, spirit, enthusiasm; light, luster,
radiance, splendor; vivacity, inspiration, imagination; torture,
affliction, trouble, bitter trial, persecution.
First. Foremost, leading; chief, highest, principal, capital;
elementary, primary, rudimentary; earliest; primitive, primeval,
pristine; in the first place, at the outset, in the beginning, first and
foremost; original, onmost.
Ant. Subsequent, secondary, subordinate, subservient, lowest,
unimportant, last, hindmost.
Fit, a. Competent, fitted, qualified; suitable, appropriate, apt,
apposite, meet, seemly, becoming, befitting, proper, good, decent,
convenient, fitting, decorous, adapted, congruous, peculiar,
particular, prepared, adequate, calculated, ripe, right, contrived,
expedient.
Ant. Awkward, misfitting, ungainly, ill-suited, inappropriate,
unseemly, unprepared, unsuitable, inadequate, miscalculated,
miscontrived, improper, unfit, inexpedient.
Fitful. Variable, irregular, impulsive, spasmodic, unstable, fickle,
whimsical, fanciful, capricious, fantastic, humorsome, odd;