Bedside Medicine Without Tears SN Chugh
INDEX
A
Abdominal X-rays 401
Abnormal heart shadow 398
Abnormalities of cardiac axis 419
left axis deviation 419
no axis deviation 419
right axis deviation 419
Abnormalities of intervals 425
P-P and R-R intervals 425
abnormalities 425
P-R interval 425
abnormalities 425
QTc interval 426
ST segment 426
abnormalities 426
Abnormalities of kidneys 405
Abnormalities of PQRST complex 420
absent P wave 420
inverted P wave 420
P mitrale 420
P pulmonale 420
Abnormalities of subdiaphragmatic region and the diaphragm 394
air under diphragm 394
elevation of hemidiaphragm 395
causes 395
Abnormalities of T and U wave 425
abnormalities of the T wave 425
flat or low voltage T waves 425
inverted in myocardial ischaemia 425
tall and peaked T waves 425
abnormalities of U wave 425
Abnormalities of voltage 418
high voltage of QRS 418
low voltage graph 419
Abnormalities on chest X-ray 380
Abnormally placed kidney 406
Abscess and pyopneumothorax 26
Acromegaly 185
causes 185
clinical diagnosis 185
clinical features 185
neurological manifestations 185
treatment 186
Acute nephritic syndrome 78
causes 78
complications 78
Acute severe asthma 43
Addison's disease 180, 226
causes 180
Adrenal crisis 180
Adrenal virilisation in female 197
Adult polycystic kidney disease 269
Advanced airflow obstruction 3
Alopecia 221
areata 221
totalis 221
universalis 221
Anaemia 85
causes 85
signs 85
symptoms 85
Anti-amoebic drugs 356
Antianginal drugs 292
Anti-arrhythmic drugs 285
Anticoagulants 297
Antidepressants 317
Anti-diabetic agents 328
Antihypertensives 292
Antimalarial drugs 358
Antiplatelet agents 296
Antiviral agents 361
Anxiolytics and hypnotics 319
Aortic regurgitation 130
causes 131
complications 133
differential diagnosis 132
Aortic stenosis 126
causes 127
complications 128
features 127
types 126
valvular aortic stenosis 126
congenital subvalvular AS 126
supravalvular AS 126
Asbestosis 33
Ascites 56
causes 56
differential diagnosis 56
Aspiration (paracentesis) 278
Atherosclerosis 159
Athetosis 208
B
Barium study 412
Behcet syndrome 224
Bell's palsy 198
Bell's phenomenon 198
Benign (innocent) murmurs 129
Bilateral ptosis 217
Black (hypertranslucent) lung fields 391
chronic obstructive pulmonary disease (COPD) 392
hypertranslucency 391
caution 391
pneumothorax (unilateral black lung) 393
radiological features 393
Bone marrow aspiration 276
complications 276
contraindications 276
indications 276
bone marrow infiltration 276
cytopenias 276
infections 276
myeloproliferative disorders 276
procedures 276
Borderline leprosy 230
Brachial plexus lesions 174
Bronchial asthma 3, 43
Bronchogenic carcinoma 13
Bullous emphysema 8
Bundle branch block 423
left bundle branch block 423
right bundle branch block 423
Busulphan lung 92
C
Calcinosis 239
Calculation of heart rate 419
1500 method 419
ten seconds method 419
Caplan's syndrome 33, 267
Cardiac tamponade 262
Cardiovascular drugs 285
Carpal tunnel syndrome 186
Causes of acute hepatitis 51
Causes of aplastic anaemia 86
Causes of bleeding gums 90
Causes of delayed or non-resolution of pneumonia 11
Causes of enlargement of left lobe 63
Causes of foot drop 173
Causes of haemolytic anaemia 86
Causes of hepatic bruit and rub 63
Causes of hypocalcaemia 182
Causes of lymphadenopathy 94
Causes of massive hepatomegaly 63
Causes of megaloblastic anaemia 86
Causes of painful tender lymph nodes 95
Causes of prolonged jaundice 51
Causes of recurrent pneumonia 11
Causes of refractory anaemia 87
Causes of short stature 187
Causes of sternal tenderness 91
Causes of tender hepatomegaly 63
Causes of wrist drop 173
Cavitation 34
causes 34
Cerebellar ataxia 209
Cerebral paraplegia 162
Characteristic of obstructive jaundice 51
Characteristics of various viral hepatitis 51
Characteristics of viral pneumonia 11
Chest X-ray in pulmonary disorders 380
Chorea 207
cardinal features 207
dinner-fork deformity 207
hypotonia and instability 208
pronator sign 207
waxing and waning of the grip 207
causes 207
Chronic bronchitis 3
Chronic complication of pulmonary tuberculosis 40
Chronic cor pulmonale 7
diseases of pulmonary vasculature 7
diseases of the lung 7
disorders of thoracic cage affecting lung function 7
Chronic hepatitis 54
causes 54
Chronic obstructive pulmonary disease 1
Chylous ascites 57
causes 57
Cirrhosis of the liver 67
clinical features 67
hepatic encephalopathy 67
signs of liver cell failure 67
signs of portal hypertension 67
Claw hand 220
Clinical features of post-primary pulmonary tuberculosis 39
Clinical features of primary tuberculosis 39
Clinical manifestations of scleroderma 235
cardiac 235
cutaneous 235
GI tract 235
musculoskeletal 235
pulmonary 235
renal 235
Coal miner's pneumoconiosis 33
Coal-worker's pneumoconiosis 33
Collapse of the lung 29
causes 29
complications 30
types 29
compression 29
obstructive 29
Complications of acute viral hepatitis 52
Complications of a lung abscess 37
Complications of Bell's palsy 199
Complications of bronchiectasis 48
Complications of cirrhosis 69
Complications of CML 91
Complications of COPD 3
Complications of myxedema 112
Complications of pleural effusion 18
acute pulmonary oedema 19
cachexia 19
empyema thoracis 19
hydropneumothorax 19
thickened pleura 18
Complications of pneumonia 11
Compression paraplegia 162
Conduction defects 437
complete (third degree AV block 441
causes 441
ECG characteristics 441
treatment 442
first degree AV block 439
causes 439
ECG characteristics 439
treatment 439
heart blocks (AV blocks) 437
second degree AV block 439
Mobitz type I 439
Mobitz type II AV block 439
types 439
Congenital lobar emphysema 7
Congestive heart failure 143
Conn's syndrome 178
Consolidation 10
causes 10
Consolidation of the lung 9
Cooing or ‘Sea guill’ murmur 143
Cor pulmonale 151
causes 151
clinical features 151
complications 152
Corticosteroids 340
Crocodile tears 199
Crohn's colitis 272
Cryptic tuberculosis 40
Cushing's syndrome 176
Cyanotic congenital heart disease 255
D
Delayed resolution and nonresolution 11
Dengue haemorrhagic fever 254
Diabetese mellitus 114
Diabetic foot 121
Diagnostic criteria for endocarditis 149
Differential diagnosis of polyneuropathy 171
arsenical neuropathy 172
chronic inflammatory demyelinating polyneuropathy 172
diabetic peripheral neuropathy 171
diphtheric neuropathy 172
Guillain-Barré syndrome 171
hereditary neuropathy 172
leprosy 172
neuropathies with HIV infection 172
prophyric neuropathy 172
triorthocresylphosphate (TOCP) neuropathy 173
Digitalis toxicity 144
Diuretics 301
Down's syndrome 188
Drug used in CNS and psychiatry 306
Drugs used in cardiology 285
Drugs used in gastroenterology 321
Drugs used in respiration diseases 372
Dry or wet bronchiectasis 47
Dwarfism 187
E
Eisenmenger's complex 256
Eisenmenger's syndrome 256
Electrical rotation of the heart 420
clockwise rotation 420
counterclockwise 420
Electrocardiography 417
Emphysema 3
Empyema thoracis 17
causes 17
blood-borne infection 17
diseases of the abdominal viscera 17
diseases of the lung 17
diseases of the mediastinum 17
iatrogenic infection 17
trauma with superadded infection 17
Empyema thoracis and pyopneumothorax 26
Endocarditis 147
complications 147
signs 147
symptoms 147
Endocrinal causes of obesity 178
Endotracheal intubation 279
complications 280
indications 279
Erythema nodosum 223
Eunuchoidism 191
F
Fallot's tetralogy 255
Farmer's lung 32
Fascicular blocks 424
left anterior fascicular block 424
left posterior fascicular block 425
Fasciculations 220
Features of homocystinuria 193
Features of pyopneumothorax 26
Felty's syndrome 267
Festinating gait of Parkinsonism 205
Fibrinolytic or thrombolytic agents 300
Flaccid paraplegia 162
Friedreich's ataxia 209
Functional murmurs 129
G
Glabellar sign 205
Glomerular proteinuria 82
Glucosylated haemoglobin 119
Gold criteria for severity of COPD 5
Gonadotrophins (FSH and LH) 338
Gouty tophi 238
Gower's sign 217
Graves’ disease 107
Gynaecomastia 194
causes 194
pseudogynaecomastia 194
H
Hamman-Rich syndrome 32
Hansen's bacillus 228
Hashimoto's thyroiditis 112
Hemic murmur 129
Hemichorea 208
Hemifacial spasm 199
Hemiplegia 154
causes 154
Hemisection of spinal cord 164
Hemolytic jaundice 50
Henoch-Schnölein purpura 253
Hepatic encephalopathy 68
Hepatocellular jaundice 51
Hepatomegaly 60
causes 61
differential diagnosis 61
congestive 61
hematological disorders 62
hepatomegaly due to diseases of liver 63
hepatomegaly due to parasitic infection/infestations 62
infiltrative 62
inflammatory 62
tumours of liver 62
Hepatosplenomegaly 102
Hess capillary test 254
Hilar enlargement (widening of hilum) 396
causes 396
bilateral 396
unilateral 396
differential features 396
left ventricular aneurysm 400
mediastinal shadow/enlargement 397
mitral valve disease 399
pericardial effusion 400
surgical emphysema 398
causes 398
radiological characteristics 398
Hirsutism 196
Hookworm infestation 87
Hydrocephalus 201
Hydrocephalus and raised intracranial pressure 201
Hydropneumothorax 25
causes 25
Hyperpigmentation 225
Hypersplenism 99
Hypoglycemia 124
Hypokalaemia 178
Hypoparathyroidism 183
Hypothyroidism 110
Hysterical hemiplegia 156
I
Ileocaecal mass 271
Infective endocarditis 146
Inflammatory bowel disorders 76
Interpretation of ECG 418
axis 418
P wave 418
position 418
PR interval 418
QRS complex 418
QRS duration 418
QT interval 418
rate 418
rhythm 418
rotation 418
ST segment 418
standardisation 418
T wave 418
voltage 418
Intravenous infusion set 283
Intravenous line access 283
Intravenous pyelography 413
J
Jaundice 49
causes 50
classification 50
Jones criteria 145
Juvenile mitral stenosis 138
K
Kala-azar 225
Kallmann's syndrome 191
Klinefelter's syndrome 192
L
Lactose intolerance 75
Large gut (colonic) obstruction 408
Latent tetany 183
Lathyrism 166
Lentigines 226
Lepromin test 230
Leprosy 228
classification 228
complications 229
systemic manifestations 228
Leukaemia 89
signs 90
symptoms 90
Limb girdle myopathy 216
Lumbar puncture 274
complications 275
brainstem herniation or cerebellar coning 275
introduction of infection 275
postspinal headache 275
contraindications 274
indications 274
diagnostic 274
other uses of LP needle 274
therapeutic 274
procedure 275
Lung volumes 6
Lutembacher's syndrome 138
Lymphadenopathy 93
M
Malignant consolidation 13
Marfan's syndrome 191
Massive pleural effusion 18
Membraneous glomerulonephritis 82
Microalbuminuria 121
Mimic facial nerve palsy 200
Mitral regurgitation 140
causes 141
Mitral stenosis 134
causes 135
clinical diagnosis 135
common features 135
complications 139
Mitral valve prolapse 142
Mononeuritis 173
Mononeuritis multiplex 173
Moon face 176
Movements of the chest wall 1
Mucinous ascites 57
Mucoid sputum 1
Muscle wasting 217
Myasthenia gravis 218
Myocardial infarction (ST elevation MI-stemi) 426
Myocardial ischaemia 427
Myoclonus 208
Myopathy 215
Myotonia 213
clinical significance 213
clinical characteristic 213
types 213
Myotonia congenita 213
N
Nasogastric intubation (Ryle's tube intubation) 280
Nasopharyngeal suction catheter 282
Nelson's syndrome 177
Nephrotic syndrome 81
causes 81
complication 83
differential diagnosis 81
etiopathogenesis 81
Neurofibromas 237
Neurofibromatosis 237
Noncirrhotic portal hypertension 66
Normal resolution 11
Nutrition 367
O
Obstructive sleep-apnoea syndrome 7
Obstructive ventilatory defect 6
Oculopharyngeal myopathy 217
Oral contraceptives 336
Oxygen delivery devices 281
P
Pachydermocele 238
Panniculitis 224
Paracentesis 59
complications 59
Paralytic ileus 408
Paraplegia 161
Parasympathomimetics 306
Parkinsonism 204
causes 204
clinical features 204
Pathogenesis of truncal obesity in Cushing's syndrome 178
Pendred's syndrome 112
Pericardial rub 261
Pericarditis 261
acute 261
causes 261
hypersensitivity or autoimmune 261
idiopathic or nonspecific 261
infections 261
non-infectious 261
chronic 261
classification 261
subacute 261
Peripheral neuropathy 168, 231
Persistent rhonchus/wheeze 44
Peutz-Jegher's syndrome 226
Phakomatoses 238
Phantom tumour 18
Philadelphia chromosome 92
Pityriasis versicolor (tinea versicolor) 245
Pleural effusion 16
causes 16
characteristics 16
Pleural effusion and emphyema thoracis 15
Pneumomediastinum 260
Pneumonia syndrome 13
atypical 13
typical 13
Pneumonias 10
classification 10
aetiological 11
anatomical 10
depending on the immunity and host resistance 10
empiricist 11
Pneumothorax 22
classification 22
clinical features 22
complications 22
Polyarthritis 265, 266
Polycystic ovarian disease 196
Portal hypertension 65
causes 66
classification 66
clinical diagnosis 66
Positions of the heart 420
horizontal heart position 420
intermediate heart position 420
vertical position 420
Protein-losing enteropathy 75
Pseudohypertrophy 215
Pseudointestinal obstruction 408
Pseudomembraneous colitis 74
Psoriasis 242
Pulmonary tuberculosis 38
Pure chorea 208
Purpura 251
causes 251
Q
QRS complex abnormalities 422
biventricular hypertrophy 423
left ventricular hypertrophy (LVH) 422
right ventricular hypertrophy 423
ventricular hypertrophies 422
R
Ramsay Hunt syndrome 198
Raynaud's phenomenon 233
Recombinant human erythropoietin 339
Recurrent spontaneous pneumothorax 22
Reidle lobe of the liver 64
Reiter's syndrome 266
Respiratory bronchiolitis 32
Respiratory rate and type of breathing 1
Rheumatoid factor 266
Rhythm disturbances 427
atrial flutter and atrial fibrillation 431
causes 431
treatment 431
paroxysmal supraventricular tachycardia 430
ECG characteristics 430
mechanisms 430
sinus arrhythmia 427
sinus bradycardia 427
sinus tachycardia 427
supraventricular arrhythmias 427
supraventricular ectopics 430
causes
ECG characteristics 430
ventricular arrhythmias 433
ventricular ectopics 433
ventricular fibrillation and ventricular asystole 437
ventricular tachycardia 433
Ringworm 245
Romberg's sign 211
S
Scabies 240
Scleroderma 234
Shy-Drager syndrome 206
Sideroblastic anaemia 85
Sigmoid volvulus 408
Silicosis 33
Small intestinal obstruction 408
Somatostatin (inhibitor of growth hormone release) 335
Somatotrophin (GH) 336
Spastic paraplegia 162
Splenomegaly 97
Spurious diarrhoea 74
Steroid therapy 176
Stevens-Johnson's syndrome 224
Stomach (gastric) lavage tube 284
Stroke 154
Subcutaneous emphysema 22
Subcutaneous swellings/masses 237
Subpulmonic effusion 18
Superior mediastinal compression 259
causes 259
aorta 259
enlarged lymph nodes 259
oesophageal lesions 259
thymus 259
tumours 259
signs 259
symptoms 259
Sympathomimetics 304
Systemic lupus erythematosus 247
T
Tall stature 191
Term bronchiectasis 47
causes 47
pathological types 47
Tetany 182
Thrombocytopenic purpura 251
Thyrotoxicosis 106
causes 107
differential diagnosis 107
signs 107
symptoms 107
Thyroxine replacement therapy 334
Tissue biopsy needle 277
Tracheostomy 279
complications 279
early 279
intermediate 279
late 279
indications 279
Traube's area 101
Traveller's diarrhoea 74
Treatment of alopecia areata 221
Tubular proteinuria 82
Turner's syndrome 189
U
Unilateral emphysema 8
Urinary catheterisation 281
V
Vaccines and antitoxins 363
Valsalva manoeuvre 143
Vasculitis 224
Vertiginous ataxia 211
W
Waddling gait 217
Wasting of small muscles of hand and claw hands 219
Wheeze 44
causes 44
types 44
Whiteness (opacification) of the lungs 381
a lobar homogeneous opacity 384
acute pulmonary oedema 381
cavitatory lung lesion 386
coin-shaped shadow 385
differential diagnosis of pulmonary oedema 383
homogeneous opacity 383
involving one hemithorax 383
miliary shadowing 388
pulmonary embolism 383
reticulonodular shadows 387
Winging of scapulae 217
Wrist drop 220
X
Xanthomas 238
causes 238
types 238
planus xanthomas 238
tuberous xanthomas 238
X-ray chest 379
bony cage 379
cardiac shadow 380
centralisation or centering 379
degree of inspiration 379
penetration/exposure 379
position of diaphragm 379
position of the trachea 379
sex 379
view 379
Z
Zollinger-Ellison's syndrome 74
×
Chapter Notes

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1BEDSIDE MEDICINE WITHOUT TEARS
2BEDSIDE MEDICINE WITHOUT TEARS
SN Chugh MD MNAMS FICP FICN FIACM FIMSA FISC Professor of Medicine and Head Endocrine and Metabolism PGIMS, Rohtak, Haryana, India
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672, Rel: 32558559
Fax: +91-11-23276490, +91-11-23245683
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Branches
Bedside Medicine Without Tears
© 2007, SN Chugh
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 : 2007
9788180619717
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd, Sector 60, Noida4
Dedicated to
My parents
Late Shri Chhabil Dass Chugh and Sanwari Devi and my wife Dr Kiran Chugh
and
My children
Daughter Dr Ashima Chugh
Son Dr Anshul Chugh
Daughter-in-law Dr Deepti Chugh and my teachers and students
5Preface
I have realised over the years that the students are not oriented well to practical examinations and face difficulty in the interpretation of clinical signs. They lack basic sense to analyse the symptoms and signs probably because either they do not attend the clinical classes or they lay more stress on theoretical discussion. In clinical case discussion, the questions are asked according to the interpretation of clinical symptoms and signs, and the students find difficulty in answering them because they are not ready to face practical examination immediately after the theory examination. The students prepare the subject for theory paper from the Textbook of Medicine but they do not have too many books on practical aspects of medicine. After the theory papers, the time given to the students is short to prepare for practical examination. They want to revise the subject as a whole for practical examinations because the examiners in practical examination do not limit themselves only to practical aspects but also can forward questions on theoretical aspects of medicine.
Today, the students want such a book which can orient them not only to clinical examination but also prepare them to face theoretical discussion about the case. Keeping in view the dire necessity of a book which can cater the needs of the students to their satisfaction and allow them to face the examination “without tears in their eyes”, I am bringing out the first edition of this book after consultations with students, residents and my teacher colleagues. I hope this book will not disappoint them at the hour of need.
The medicine being an ever-changing science, it is difficult to cope with the recent advances. I have attempted to include all the available informations in the literature, so as to present this book as updated. However, “to err is human”, and I am conscious of my deficiencies, therefore, I may be excused for any lapse or deficiency in this book as this is written by a single author.
I extend my sincere thanks to M/s Jaypee Brothers Medical Publishers (P) Ltd., for bringing the excellent first edition of the book. The publisher has taken special care to depict the clinical material provided to him clearly and carefully for which I am highly indebted. My special thanks to Mr Atul Jain of Jain Book Depot, Rohtak who had played vital role in the preparation of this book.
Mere words are not sufficient to express appreciation for my wife and children who have supported me during this period. I can say that it was impossible for me to bring out this book without their moral support.
At last, I request the readers to convey their suggestions or comments regarding this book to the publisher or author.
SN Chugh