Clinical Methods—A Key to Diagnosis in Paediatrics Dilip Mukherjee, Indraneel Banerjee
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1Clinical Methods: A Key to Diagnosis in Paediatrics
2Clinical Methods: A Key to Diagnosis in Paediatrics
Dilip Mukherjee MD (Paed), DCH, PhD, FIAP, FAMS Professor of Paediatrics Ex-Dean, Vivekananda Institute of Medical Sciences Ramakrishna Mission Seva Pratishthan Kolkata-700 026, India Indraneel Banerjee MD (Paed), MRCPCh (UK) Consultant Paediatric Endocrinologist Department of Paediatric Endocrinology Royal Manchester Children's Hospital (UK)
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Clinical Methods—A Key to Diagnosis in Paediatrics
© 2008, Dilip Mukherjee
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 authors and the publisher.
First Edition: 2008
9788184481938
Typeset at JPBMP typesetting unit
Printed at Replica
4This book is dedicated to all who are involved in the care of the children and specially the residents and the postgraduate students in paediatrics
5Foreword
Standard textbooks serve as reference material but are no substitutes for books that deal with practical aspects of clinical paediatrics. There are few books that focus on clinical approach to childhood diseases but this book titled “Clinical Methods – A Key to Diagnosis in Paediatrics” is unique in many ways.
Opening chapter emphasizes systematic approach to detailed history taking that nearly offers clue to probable diagnosis. Importance of each point in the history is analysed with probable interpretations. Physical examination follows in the next chapter that is aimed at sharpening clinical skills. Subsequent chapters deal with individual systems. Appropriate stress on anatomy is a special feature in the chapter on Neurology. Endocrinological and metabolic system is a welcome addition that universally lacks in most of the publications. Special mention must be made for inclusion of child behaviour and psychology that is often neglected though extremely relevant. Each chapter includes many tables that provide useful information.
Another unique feature of this book is the Appendices that include growth charts, body surface area chart, ECGs and radiological images. This adds significantly to the academic value of the book. The book also includes many clinical photographs that offer visual impressions of various conditions.
This book is authored by two experienced paediatricians — Dr. Dilip Mukherjee and Dr. Indraneel Banerjee who have very thoughtfully presented their ideas on clinical methods.
Never before such a complete book was published on clinical methods and I strongly recommend it to all the students and practitioners alike.
YK Amdekar md, dch
Former Professor of Paediatrics
Grant Medical College and J.J. Group of Hospitals
Mumbai
President of Indian Academy of Paediatrics 1995
Consultant Paediatrician Jaslok Hospital and Breach Candy Hospital
Mumbai
6Preface
Clinical Paediatrics is a very challenging and interesting subject. Clinical medicine in adults has been more or less standardised but in children there are wide variations across ages and individuals which make it more complex. Further, we faced everyday with new knowledge of disease states and better understanding of pathology. We therefore need to constantly refine our clinical methods to account for this recent acquisition of information.
Our humble endeavour in this regard has been chiefly aimed at the postgraduate students and all those involved in the care of the child. It shall be our greatest reward if this book can be of any service to them.
A word of caution–clinical paediatrics is an eminently practical subject. The many cases you see, the variety you come across, the better will be your insight to diagnose and treat. However quality can never be compromised for quantity. Examine each case thoroughly, searching for all possibilities with an observant eye and trained ear. Do not take things for granted – your meticulous approach will be handsomely rewarded. This book is not meant to be armchair reading, rather it is for practice, discussion, comparison and criticism.
It is important to follow-up a case and see through the natural progression. Examine the same case periodically for differences of symptoms and sign, no matter how subtle. Do not be disheartened if your provisional diagnosis does not always tally with the actual diagnosis made after performing investigations. Remember to make a clinical diagnosis as would be expected of a clinician. In most cases the clinical diagnosis would fit in with the real diagnosis, but not always. In such situations be satisfied that your approach and rationality are justified in the formulation of a working diagnosis.
Develop a sense of regard for the child or newborn baby. Never take a patient as a mere name or a diagnosis. Cultivate a rapport with the patient and the guardian and you will positively find your history taking and examinations less bumpy and more satisfying. Happy reading!
Dilip Mukherjee
Indraneel Banerjee
7Acknowledgements
We express our great sense of gratitude to Dr Prachi, Clinical Psychologist and Stress Counsellor, UN Department of Safety and Security (UNDSS), New Delhi for kindly contributing as guest author for chapter on Psychological Assessment of Children. We are really indebted to her for her contribution which as added a new dimension to this book. We are grateful to Prof YK Amdekar, Ex-Prof of JJ Hospital, Mumbai and renowned consultant paediatrician and a versatile genius in the field of paediatrics for kindly agreeing to write the foreword for this book. We express our gratitude to him for his generosity.
We are also grateful to Prof AK Dutta the Director Professor of the Department of Paediatrics of Lady Hardinge Medical College, New Delhi for kindly going through the manuscript and encouraging us very much.
Dr Debjani Das and Dr Sutapa Halder the postgraduate students of the department of paediatrics of Ramakrishna Mission Seva Pratisthan, Vivekananda Institute of Medical Sciences have kindly drawn all the sketches for this book. Dr Anindya Saha, Dr Arpan Agarwal and Dr Suparna Guha (MD, Paed) of our department who has taken all the photographs for this book. Dr Surajit Santra has taken the arduous trouble to incorporate and edit the photos and the sketches in the CD for the book. Dr Taraknath Ghosh, MD (Paed) and Ex-registrar of our department, and Dr Soumitra Masani our PGT have gone through the entire book and did the primary editing job for us. We are grateful to all of them and also to other residents and the senior colleagues of our department for their suggestions and comments.
We are really grateful to Parimal Kar for doing the composing and typing of this manuscript.
We are also grateful to M/s. Jaypee Brothers Medical Publishers (P) Ltd for their cooperation and help to publish this book.