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100 Case Histories in Medicine
© 2004, Farrukh Iqbal
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.
First Edition: 2001
Second Edition: 2004
9788180613074
Typeset at JPBMP typesetting unit
Printed at
7Foreword
I was privileged to be asked to write a foreword to this book published by a very practical and excellent clinical educator. It was a source of pride for me as he was my talented pupil with most distinguished college record and later on a very successful physician. It was a great pleasure to read the book as it deals with the practical problems faced in general wards of hospitals in Pakistan.
A manual to be carried in the pocket of every medical student. Being myself a life-long teaching physician in a clinical setting, I find this book a good contribution to the subject of clinical medicine giving a good coverage to different sections of internal medicine. The presentation is simple, readable, accurate and with a sound scientific foundation. One feels pleasure and satisfaction after going through it. This book is an extra help to those doctors who are preparing for FCPS (Medicine), MRCP (UK) and MD (Medicine) examinations.
I have no doubt that this book work will receive respect, admiration and success it rightly deserves from undergraduate, postgraduate medical students and family practitioners.
Prof M Akhtar Khan
Retired Professor of Medicine
and
Principal, King Edward Medical College
Lahore, Pakistan
9Preface
Medical science is a very vast field and is expanding every day. It is extremely difficult to keep abreast the knowledge, as lots of advancements have been made in this field every moment and the concepts keep on changing perpetually. However, a medical doctor should at least be aware of common medical problems which he could face in his professional career. These problems may present individually or as multisystem disorders. Basic working knowledge and clinical skills are required to analyze these problems methodically and reach to a diagnosis and then plan appropriate management.
This book is an effort to pick up the “brains” by exercising problem solving. The set up is very simple. A brief history and important clues on clinical examination along with investigations are provided. Few important investigations are intentionally omitted and are asked in questions. In a few histories, the ECG or X-ray is shown and the reader is expected to interpret those to reach a diagnosis. In this book SI units have been used.
The lay out is in the form of chapters which are named system-wise and the diagnosis of case histories are labelled as such. If a reader is interested to read the cases related to, for example, cardiology, then the reader can go through that chapter and so on. An attempt has been made to improve important questions related to the text and current concepts are also discussed. This book will not only help problem solving in day-to-day life of medical doctors but will also serve as a purpose for preparing them for their postgraduate examination in medicine, e.g. FCPS, MRCP and others.
All these cases were actually recorded and collected by the author over the last three years and a lot of effort was put in to formulate in the form of a book. However, in such a small book the information contained cannot be comprehensive and it may not be a substitute for a textbook either. Therefore, the candidates should consult one of the standard textbooks in internal medicine to expand their knowledge.
The size of this book is such that it can be kept in the pocket so that the reader, whenever gets time should sit, have a cup of tea, 10relax and go through it. I also firmly believe that the clinical skills of history taking and examination make the main pillar of good medical practice and most of the cases depend upon clinical presentation and examination. Although every effort has been made to write this book in a simple way, but if there are any suggestions for improvement, I would be more than happy to welcome them.
I would like to thank my colleagues for encouraging me to write this book. I am highly indebted to Dr Asif Kamal FRCP (Lond), FRCP (Edin), and Dr Avinash Mithal FRCP (Lond), FRCP (Edin), both Consultant Physicians at Lincoln County Hospitals, UK, for encouraging me, to write this book and for useful suggestions and allowing me to follow their footsteps in academics all the time during my stay in the United Kingdom and even to date. I am grateful to my wife, Shahina Farrukh, my daughters Saliha and Zunaira and my son Aizad who extended their full support in writing this book.
The second edition is completely revised after the sale of one thousand copies in less than one year. In this edition, current informations on various topics have been included. A conversion table along with normal values is added in the end of this book.
Lastly I shall welcome constructive and healthy criticisms and suggestions to improve this book, so that they should be included in the future editions.
Farrukh Iqbal
11Acknowledgements
I am personally thankful to Prof Anwar A Khan (Gastroenterology), Chairman and Dean of Shaikh Zayed Postgraduate Medical Institute Prof Abdul Hayee (Haematology), Prof Muhammad Asim Khan from the USA (Rheumatology), Prof Saulat Siddique (Cardiology), Dr Nazim H Bokhari (Pulmonology) and Dr Nadir Zafar Khan (Neurology) all from Shaikh Zayed Postgraduate Medical Institute, Lahore for reading the relative chapters of the script and giving their valuable suggestions. I am also grateful to Prof Tahir Shafi, Professor of Nephrology and Ex-Chairman and Dean of Shaikh Zayed Postgraduate Medical Institute for being very kind and affectionate and of course to Prof Zafar Iqbal, Professor of Medicine for his encouragement and co-operation in writing this book. It would not be fair if I do not mention about a number of my students who actually made this book practically possible by continuously hammering me to get it published. I am indebted to Mr M Shahzad Mughal from the Institute of Education and Research, University of the Punjab for composing the manuscript. I am also thankful to all my other colleagues who have helped me in all ways.