Diagnosis A Symptom-based Approach in Internal Medicine

379 Pages·2011·5.05 MB·English

Diagnosis
A Symptom-based Approach
in Internal Medicine

Diagnosis
A Symptom-based Approach
in Internal Medicine
CS Madgaonkar MBBS FCGP
Consultant Family Physician
Hubli, Karnataka, India
Honorary National Professor
Indian Medical Association
College of General Practitioners
Chennai (HQ), Tamil Nadu, India
®
JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD
New Delhi • Panama City • London
Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
Phone: [phone], Fax: [phone]
Website: www.jaypeebrothers.com
Offices in India
• Ahmedabad, e-mail: [email protected]
• Bengaluru, e-mail: [email protected]
• Chennai, e-mail: [email protected]
• Delhi, e-mail: [email protected]
• Hyderabad, e-mail: [email protected]
• Kochi, e-mail: [email protected]
• Kolkata, e-mail: [email protected]
• Lucknow, e-mail: [email protected]
• Mumbai, e-mail: [email protected]
• Nagpur, e-mail: [email protected]
Overseas Offices
• Central America Office, Panama City, Panama, Ph: 001-507-317-0160,
e-mail: [email protected], Website: www.jphmedical.com
• Europe Office, UK, Ph: [phone], e-mail: [email protected]
Diagnosis: A Symptom-based Approach in Internal Medicine
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted
in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the
prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort
is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible
for any inadvertent error (s). In case of any dispute, all legal matters are to be settled under Delhi
jurisdiction only.
First Edition : 2011
ISBN 978-93-80704-75-3
Typeset at JPBMP typesetting unit
Printed in India
Dedicated to
The memory of my dear brothers
Ramakant and Vasant

PREFACE
The best physician is the one who is able to differentiate the possible and the impossible.
Herophilus of Alexandria
Diagnosis: A Symptom-based Approach in Internal Medicine was conceived during my practice in
general internal medicine. I wrote this book because I wished it had been written for me. Although
there are many textbooks and excellent manuals devoted to symptom-oriented diagnosis, I
personally felt the need for a book that provides the essential information necessary in a concise
and practical method, and thus relieve one from time and labor in searching through voluminous
medical textbooks on the diagnostic process of symptoms presented by patients in today’s arduous
ambulatory health care delivery system.
A symptom is commonly defined as,”Any affection which accompanies disease; a perceptible
change in the body or its functions, which indicates disease, or the kind or phases of disease”.
The importance of symptoms, therefore, cannot be overemphasized because symptoms are why
patients visit physicians; and based on their analysis, a physician attempts to make as accurate a
clinical diagnosis as possible.
Many symptoms encountered in everyday practice may suggest undifferentiated problems
and many may suggest problems that are self-limited, while many symptoms are characteristic
of early disease. New or serious symptoms often drive patients to overcrowded office or emergency
departments. However, physicians need medical resource that can deliver timely and effective
diagnostic information which, besides providing diagnosis on an established or common disease,
does not ignore other possibilities. Besides, relevant diagnostic investigations and clinical aspects
of related disorders are essential to support the diagnosis of any disease and treatment accordingly.
Thus, in a busy ambulatory care, diagnosis has to be made without it being unrecognized until
advance disease is present, treatment options are limited, and prognosis may be unfavorable.
It is in this context, I have made an attempt to first project common symptoms encountered in
internal medicine, especially as applicable to the epidemiological incidence to the adult patient
population, and then create a framework in which a physician can arrive at a tentative diagnosis.
The main features which remain constant for each symptom are:
• Synopsis: A symptom introduction in brief;
• Differential diagnosis of the symptom: Classified in three main groups, namely—common, occasional
and rare;
• Investigations: In two sections, namely—general and specific;
• Clinical notes: In short paragraphs, helpful in the diagnosis of most of the diseases;
• Red flags: Key points highlighted to alert serious disorders not to be missed;
• Tables: To simplify and comprehensively illustrate text, wherever needed;
• Selective glossary: Brief summary of assorted, common and uncommon diseases, denoted by the
sign “vide infra ↓↓”; and
• References: From various journals, textbooks, etc. where applicable.
viii
Thus, the contents of this book are focused on commonly encountered symptoms, with their
differential diagnosis in a concise form, which will lead to a working diagnosis and investigations.
The emphasis is on the axiom, ‘common diseases present commonly, and its converse, uncommon
diseases present uncommonly’. However, pointers to ‘red flags’, i.e. uncommon manifestations of
common diseases should alert the physician of serious diseases not to be missed. No attempt has
been made to discuss etiology or pathology of illness, or the complexities of practice management.
The frequency with which a disease is encountered by physician will depend upon its
prevalence in the region from which their patients are drawn and also their specialty; therefore,
regional variations in the incidence of diseases or methodology, or guidelines for investigations
and diagnosis are not discussed, which can be accessed from other relevant sources.
The book assumes much basic knowledge and the information it contains must be supplemented
by further reading. However, my endeavor has been to cover a spectrum of symptoms, with
emphasis on practical features of diagnosis, based on recent evidence-based guidelines. The contents
of the book are intended for medical students, internists, and house-officers during their daily
office or hospital practice, and also to physicians to boost their diagnostic skills during busy
practice day, and preparation for ‘rounds’ and clinical teaching. I also anticipate that physicians
of other specialties will also value this book as an easy-to-use ready-reference guide beyond their
everyday experience and in various practice settings.
There is no substitute for knowledge, and this book, I believe, will make symptom-based
diagnostic process more accessible to many physicians, and if it prompts others to delve further
and achieve sophistication in this clinical expertise, then this book has accomplished its purpose.
Finally, I would welcome feedback, which can be posted to me via my website: www.drcsm.com,
or email: [email protected], or to the publishers.
CS Madgaonkar
ACKNOWLEDGMENTS
My work in writing this book has been shared among many individuals.
First of all, I would like to appreciate the comments and advice of the following eminent
specialists who reviewed appropriate chapters of this book:
• Dr Vidya C Madgaonkar MD DA, Professor of Anesthesiology, Bangalore Medical College and
Research Institute, Bengaluru, Karnataka, India.
• Dr AS Guruprasad MS, Fellow Sankara Nethralaya, Head of Vitreoretinal Services, MM Joshi
Eye Institute, Hubli, Karnataka, India.
• Dr Shailesh E Gokavi MD, Infertility Consultant and Gynecological Endoscopic Surgeon, Hubli,
Karnataka, India.
• Dr Neminath R Patil MS DLO, Consulting ENT Surgeon, Shravan ENT Neuro-Otology Clinic,
Hearing Aid Center, Hubli, Karnataka, India.
I have received most generous assistance from the former Dean Dr YS Rai FRCS (Ed), SDM
College of Medical Sciences and Hospital, Manjushree Nagar, Sattur, Dharwad, Karnataka for
extending Central Library facilities, and also to the library staff, who took immense care and
pains to provide innumerable references in the compilation of this book.
I would also like to sincerely thank the library staff of my alma mater, Kasturba Medical
College, Manipal, Karnataka, India who have been a consistent resource.
My sincere thanks are extended to Shri Jitendar P Vij (Chairman and Managing Director), and
Mr Tarun Duneja, (Director-Publishing), M/s Jaypee Brothers Medical Publishers (P) Ltd, New
Delhi, India who have helped me throughout and displayed patience, understanding and
professionalism in publishing this book. I would also like to record my appreciation from Mr Venu
Gopal V, (Bengaluru branch) for extending his cooperation at every step.
I owe a debt of gratitude to my dear mother, Smt Sumitra S Madgaonkar, for her unstinted
support, encouragement, and forbearance. Thanks, as ever, also goes to my other family members
and friends, for their constant support, guidance and encouragement. The true kudos, however,
belong to my wife, Dr Vidya, and my son, Varun, for their eternal patience and incredible support
throughout, which ultimately made this book a realty.