Differential Diagnosis in Clinical Examination R Deenadayalan
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1Differential Diagnosis in Clinical Examination
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3Differential Diagnosis in Clinical Examination
R Deenadayalan MD (Gen Med) Formerly Professor of Medicine Stanley Medical College and Hospital Chennai, Tamil Nadu, India Meenakshi Medical College Hospital and Research Institute Enathur, Kancheepuram, Tamil Nadu, India ForewordsT Gunasagaran S Shiva Kumar L Pari
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© 2012, Jaypee Brothers Medical Publishers
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This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Differential Diagnosis in Clinical Examination
First Edition: 2012
9789350257685
Printed at
5Dedicated to
My Children and Grandson
Who are a Great
Source of Inspiration
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Dr T Gunasagaran
Meenakshi University
Vice Chancellor
Enathur, Kancheepuram 631 552
Foreword
Every book is meant to bring concept to those who care to read them. Books on medical subjects are vast in number and every author strives to fill a need that he himself has felt. Some authors achieve this objective, but others, their intentions though are genuine meander into a dreary desert of words.
Prof R Deenadayalan MD (Gen Med) has made a serious attempt in trying to help a hard pressed medical student by presenting him with a work based on two decades of experience superimposed on those of his teachers. Thus, a simple but a very useful glossary of differential diagnosis of clinical signs and entities has been created. Though this cannot replace a formal textbook, it will serve as a ready reckoner to the beleaguered medical student who labors under an ever increasing load of information and changing priorities.
The faculty of the Meenakshi University, I am sure, will find this contribution very useful and I am definite that they will recommend it to their students and colleagues. This book will be a bedside companion to students and staff alike.
Dr T Gunasagaran
Vice Chancellor
Meenakshi University
Enathur, Kancheepuram
Tamil Nadu, India
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Dr S Shiva Kumar MD
Res: 3362/O, AE, 8th Street,
Professor of Medicine (Retd.)
Anna Nagar, Chennai 600040
Stanley Medical College and Hospital
Phone: 26212522
Chennai-600 001
Mobile: 9840224019
Foreword
Dr R Deenadayalan has a reputation as an excellent teacher of clinical medicine to both undergraduate and postgraduate medical students. In this era, where modern diagnostic facilities are easily available, clinical medicine has unfortunately taken a back seat. But medicine is not an exact science, as even with all the modern diagnostic facilities, diagnosis can be difficult. In many rural areas diagnostic facilities are not available and clinician has to rely only on clinical methods for diagnosis. It is, therefore, apt that Dr R Deenadayalan has written this book on Differential Diagnosis in Clinical Examination which would be of immense benefit to undergraduates, postgraduates and clinicians to refer to a particular system and look for differential diagnosis. It should be remembered that clinical medicine is an art as well as science and one cannot replace clinical medicine even in this present era.
I congratulate Dr R Deenadayalan for the immense efforts to bring this book and wish him good luck in his endeavors.
Dr S Shiva Kumar
Professor of Medicine (Retd.)
Stanley Medical College and Hospital
Chennai, Tamil Nadu, India
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Dr L Pari MD
16, 1st Main Road,
Professor of Medicine
Srinivasa Nagar
Meenakshi Medical College
Chennai-600 099
Meenakshi General Hospital
Senior Civil Surgeon, Govt. General Hospital
Professor of Medicine, Madras Medical College (Formerly)
Authorised Medical Attendant
Reg. No. 20216
Foreword
It is with great pride and pleasure that I write the foreword to this book on clinical medicine by Prof Dr R Deenadayalan. He is sincere teacher, very popular among students. They had parental respect and great regard towards him.
I know Prof Dr R Deenadayalan for several years. He has put in a lot of efforts to bring out this concised book. The book is an expression of his teaching career and service to patients over a long period in various hospitals.
Medicine is both a science and an art, continuously changing and challenging. Obviously, it is too far vast a field to ever summarize in a textbook of any size. The tremendous developments in the field of medicine have increased the bulk of textbooks of medicine. A sincere attempt has been made to incorporate both the clinical methods and the critical aspects. Thus, this book is a handy one with adequate information. Despite the enormous information available in a number of textbooks or at the push of a key on computer, it is less frequently that the students or house officers are benefited by these. Hence, a ready reckoner like a book of this kind, will be of immense use to them.
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This book has been designed to provide a rapid and thoughtful initial approach to medical problems seen by students and internees with greater frequency. Questions that frequently come from faculty to the house staff on rounds, have been anticipitated and important ways of arriving at diagnosis are presented. This approach will facilitate the evidence-based medicine discussions that will follow the work up of the patient.
This well-conceived book should enhance the ability of every medical student to properly evaluate a patient in a precise timely fashion and to be stimulated to work the various possibilities in diagnosis.
I am sure that this book will prove to be a worthy addition to medical education, aiding in proper diagnosis and hence timely management. It will be useful throughout the arduous but incredibly rewarding journey of learning medicine for students.
Dr L Pari
Professor of Medicine
Meenakshi Medical College
Meenakshi General Hospital
Senior Civil Surgeon, Govt. General Hospital
Professor of Medicine, Madras Medical College (Formerly)
Authorised Medical Attendant
Chennai, Tamil Nadu, India
13Preface
Medicine is science. Practicing medicine is an art. When a doctor can make a proper history and physical examination, the correct diagnosis can be made. Because only after making a correct diagnosis, the physician can give a correct treatment. At time, patients may not bother about the diagnosis. The patients are mainly worried about relief of symptoms. To make a correct diagnosis, this book may be of some use.
In the book, the clinical usefulness is discussed. I have taken care, so that the book will be of some help for the undergraduates as well as postgraduates.
I have been teaching medicine nearly for two decades. So, I think that I can to some extent fulfill the needs of the students. There are so many books on clinical medicine, but, still this book also will fulfill the needs of a practicing doctor.
Suggestions to improve the book are welcome and it will be very much appreciated.
R Deenadayalan
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15Acknowledgments
In preparing this book, I have taken the help of my Assistant Professors and other colleagues.
Prof S Shiva Kumar had been helping me in preparation of this book. I must thank him for his advice in preparing this book.
I must thank the stenographer Mr S Thanthoney for preparing the book.