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Differential Diagnosis and Medical Therapeutics: A Treatise on Clinical Medicine
P Siva Rama Krishna Rao
CHAPTER 1:
Acute Abdominal Pain
CAUSES OF ACUTE ABDOMINAL PAIN
Intra-abdominal
Inflammations
Mechanical
Mesentery
Vascular
Abdominal
Extra-abdominal
Cardiopulmonary
Neurological
Genital
Alcohol, Drugs and Metals
Psychogenic
CLINICAL APPROACH
Analysis of Pain
Location
Intensity
Duration
Radiation
Aggravating Factors
Relieving Factors
Associated Symptoms
Clues from History
Physical Examination
Examination of the Abdomen
Special Signs
Investigations
Urine
Motion
Blood
Peritoneal Fluid
Radiology
ECG
Special Investigations
TREATMENT OF ACUTE ABDOMINAL PAIN
Immediate Management
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Intra-abdominal
Inflammations
Biliary Tract
Intestinal
Acute Pancreatitis
Pyelonephritis
Pelvic Inflammatory Disease
Acute Mesenteric Lymphadenitis
Mechanical (Colics—Obstruction and Acute Distension)
Vascular
Mesenteric Angina and Infarction
Abdominal
Bornholm Disease
Nerve Entrapment
Haematoma of Rectus Sheath
Abdominal Hernias
Referred Pain
Extra-abdominal
Cardiopulmonary
Neurological
Genital Torsion of the Testicle
Metabolic
Alcohol and Metals
Hip Joint Disease
Psychogenic
CHAPTER 2:
Bleeding Disorder
NORMAL HAEMOSTASIS
Coagulation System
Extrinsic Pathway
Intrinsic Pathway
Coagulation Inhibitory System
Fibrinolytic System (Dissolution of Fibrin as well as Prevention of Excessive Fibrin Formation)
CLASSIFICATION OF HAEMORRHAGIC DISORDERS
I. Coagulation Defects
Congenital
Acquired
II. Platelet Defects
Causes of Thrombocytopenia (Quantitative)
Congenital
Acquired
1. Bone Marrow Defect
Causes of Thrombocytosis and Thrombocythaemia (Quantitative)
Causes of Thrombocytopathy/ Thrombasthenia (Qualitative)
III. Capilliary Endothelium Defects
Congenital
Acquired
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
INVESTIGATIONS
Blood Examination (Table 2.3)
Capillary Resistance Test (Hess Test)
Bone Marrow Examination
Further Investigations
TREATMENT OF BLEEDING DISORDERS
SYMPTOMATIC TREATMENT
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
1. Coagulation Defects
Congenital
Acquired
Primary Fibrinolysis
2. Platelet Defects
Thrombocytopenia
BONE MARROW DEFECTS (DECREASEDPRODUCTION)
(a) Bone Marrow Infiltrations
Congenital
Acquired
(b) Bone Marrow Depression
Congenital
Acquired
(c) Maturation Defect
Congenital
Acquired
Splenic Defect (Sequestration)
Decreased Survival of Platelets (Increased Destruction/Consumption)
3. Capillary Endothelial Defects
Vascular Defects (Vascular Purpuras)
Acquired
CHAPTER 3:
Chest Pain
CAUSES OF CHEST PAIN
CHEST
Cardiac
Myocardial Ischaemia
Pericarditis and Pericardial Effusion
Tachyarrhythmias
Mitral Valve Prolapse
Hypertrophic Obstructive Cardiomyopathy
Aortitis
Aneurysms
Chronic Pulmonary Hypertension
PULMONARY
Pulmonary Embolism (Acute Cor Pulmonale)
Pleurisy
Pneumonia
Bronchogenic Carcinoma
Spontaneous Pneumothorax
MEDIASTINAL (CHEST)
New Growths
Mediastinal Emphysema
OESOPHAGEAL (CHEST)
MUSCULOSKELETAL
Costochondritis (Tietze’s Syndrome)
Xiphoidalgia
Spondylitis
Pleurodynia
Myofibrositis
Subacromial Bursitis and Periarthritis of Left Shoulder Joint
Trauma
NEUROVASCULAR (CHEST)
Herpes Zoster
Thoracic Outlet Compression Syndrome
Hyperabduction Syndrome
Mondor Disease
ABDOMEN (ALIMENTARY AFFECTIONS)
Acute Indigestion
Gastric or Colonic Distension
Oesophageal
Perforated Peptic Ulcer (Fig. 3.5)
Acute Pancreatitis
Cholelithiasis and Cholecystitis (Biliary Colic)
ENDOCRINAL
PSYCHOGENIC
CLINICAL APPROACH
History
Physical Examination
Investigations
ECG
X-ray
Haematology
Enzyme Study
Lipid Profile: Increased LDL and LP(a) Levels increase risk for CAD
Special Tests
Therapeutic Trial
TREATMENT OF CHEST PAIN
Symptomatic Relief
SPECIFIC TREATMENT FOR SPECIFIC CAUSES
Chest
CARDIAC CAUSES
PULMONARY CAUSES
MEDIASTINAL CAUSES
OESOPHAGEAL CAUSES
MUSCULOSKELETAL CAUSES
NEUROVASCULAR CAUSES
ABDOMINAL
ENDOCRINAL
PSYCHOGENIC
1. Acute Anxiety
2. Chronic Anxiety (Da Costa’s Syndrome)
CHAPTER 4:
Chronic Diarrhoea
PHYSIOLOGY
PATHOPHYSIOLOGY
AETIOLOGY (CAUSES)
1. Inflammatory Diarrhoea
Specific
Non-specific
2. Malabsorption Syndrome and Protein Losing Enteropathy
Malabsorption Syndrome
Protein Losing Enteropathy
3. Neoplasms
Carcinoid Tumour
Colonic Carcinoma
Zollinger-Ellison Syndrome (Gastrinoma)
Lymphomas
4. Deficiency States
Pellagra
Globulin Deficiency
Achlorhydria
5. Endocrinal and Metabolic
Hyperthyroidism
Diabetes Mellitus
Chronic Uraemia
Endometriosis
Amyloidosis
Pancreatic Cholera (VIP—Vasoactive Intestinal Polypeptide)
6. Post-gastrointestinal Surgery
7. Drugs
8. Functional Colonopathies
Irritable Bowel Syndrome
Nervous Diarrhoea
9. Genetic
Abetalipoproteinaemia
Chloridorrhoea
Hartnup Disease
Hypogammaglobulinaemia
Disaccharidase Deficiency
10. Allergic
11. Paradoxical (Spurious diarrhoea)
12. Factitious
CLINICAL APPROACH
History (Listening to Patient)
Physical Examination (looking at patient)
General Examination
Systemic Examination
Investigations
Additional Investigations
TREATMENT OF CHRONIC DIARRHOEA
Symptomatic Therapy
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
1. Inflammatory
(A) Specific
(B) Nonspecific
(C) Postradiation: Symptomatic
2. Malabsorption Syndrome and Protein Losing Enteropathy (Diarrhoeal/Steatorrhoeal)
Protein Losing Enteropathy
3. Neoplasms
4. Deficiency States
5. Endocrinal and Metabolic
6. Post-gastrointestinal (GI) Surgery
7. Drugs
8. Functional Colonopathies
9. Genetic
10. Allergic
11. Paradoxical
12. Factitious
CHAPTER 5:
Coma
PATHOPHYSIOLOGY
Structural
Metabolic
GRADING OF COMA
Drowsiness (Somnolence)
Stupor
Coma
PERSISTENT VEGETATIVE STATE
BRAIN DEATH
CAUSES OF COMA
1. Neurological Causes
Cerebrovascular Lesions
Meningitis and Encephalitis
Space Occupying Lesions
Head Injury
Epilepsy
2. Metabolic Causes
Diabetic acidosis
Hyperosmolar Nonketoacidotic Diabetic Coma
Lactic Acidosis
Hypoglycaemia
Uraemia
Hepatocellular Failure
Porphyria
Electrolyte Disorders
3. Endocrinal Causes
Hypothyroidism
Hypopituitarism
Suprarenal Cortical Failure
4. Tropical
Parasitic Infections
Heat Hyperpyrexia
Wernicke’s Encephalopathy
5. Toxicological Causes
Sedatives and Tranquillisers
Narcotics (Morphine and Opium)
Aspirin and Salicylates
Alcohol
Carbon Monoxide
Metals
6. Haematological Causes
Hyperviscosity Syndrome
Bleeding Disorder
7. Psychiatric Causes
Depressive Psychiatric States
Hysteria
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF COMA
Specific Measures for Specific Causes
Neurological
Metabolic
Endocrinal
Hypothyroidism—Myxoedema Coma
Hypopituitarism (Hypothermia)
Suprarenal Cortical Failure
Tropical
Toxicological
Haematological
Psychiatric
CHAPTER 6:
Cyanosis
CENTRAL CYANOSIS
PERIPHERAL CYANOSIS
OTHER CLINICAL TYPES OF CYANOSIS
Mixed Cyanosis
Differential Cyanosis
Acrocyanosis
Erythrocyanosis
MECHANISM OF CYANOSIS
Central Cyanosis
Hypoxia
Haemoglobin Abnormalities
Peripheral Cyanosis
Vasoconstriction
Vascular Obstruction of Arteries or Veins
CAUSES OF CYANOSIS
Central Cyanosis
1. Congenital Heart Diseases
Atresias
Transposition
2. Pulmonary Causes
3. Haemoglobin Abnormalities
4. Polycythaemia
Peripheral Cyanosis
1. Decreased Cardiac Output
Heart Failure
2. Obstructions
3. Raynaud’s Phenomenon
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Bedside Manoeuvres
Investigations
Radiography
ECG
Echocardiography (2D or colour)
Circulation Time
Doppler Test
Spirometry
Measurement of Blood Gas Tensions
Haematology
Spectroscopic
Electrophoresis
Second Level Studies (If necessary)
TREATMENT OF CYANOSIS
Oxygen Therapy
Respiratory Failure
Treatment of Acute Type-I Respiratory Failure
Treatment of Acute Type-II Respiratory Failure
Treatment of Chronic Type-I Respiratory Failure
Treatment of Chronic Type-II Respiratory Failure
Treatment of Acute on Chronic Respiratory Failure
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Pulmonary Causes
Obstruction of the Airways
Hypoxaemic Spells (Congenital Heart Disease)
Methaemoglobinaemia
Polycythaemia
Circulatory Failure (Decreased cardiac output)
Vascular Obstructions
Raynaud’s Phenomenon (Local cyanosis)
CHAPTER 7:
Dementia
ANATOMICAL AND PHYSIOLOGICAL BASIS OF DEMENTA
Cognitive Aspects
Memory Aspects
CLASSIFICATION OF DEMENTIA
Demented Patient
CAUSES OF DEMENTIA
Primary Degenerative Dementias—Neural
Mild Cognitive Impairment (MCI)
Alzheimer’s Disease (AD)
Lewy Body Dementia (LBD)
Frontotemporal Dementia/Pick’s Disease (FTD)
PARKINSON’S DISEASE: (Paralysis Agitans) PD
Huntington’s Disease (HD)
Prion Diseases
PRIMARY DEGENRATION DEMENTIA—VASCULAR
Vascular Dementia (VD)
Secondary Dementias (Secondary causes are listed above)
CLINICAL APPROACH
History
Physical Examination
Investigations
TREATMENT OF DEMENTIA
Symptomatic Treatment
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Mild Cognitive Impairment
Alzheimer’s Disease
Prevention of Alzheimer’s Disease
Lewy Body Dementia
Frontotemporal Dementia
Parkinson’s Disease
Medical
Surgical
HUNTINGTON’S DISEASE
PRION DISEASE
VASCULAR DEMENTIAS
SECONDARY DEMENTIAS
CHAPTER 8:
Dyspepsia
CLASSIFICATION
ACUTE DYSPEPSIA
CHRONIC DYSPEPSIA
Causes of Chronic Dyspepsia
Alimentary
Oesophagus
Gastric
Duodenum
Instestinal
Appendix
Hepatobiliary
Pancreatic
Food Intolerance
Extra-alimentary
Nonorganic
Non-ulcer Dyspepsia (Functional or Nervous Dyspepsia or Non-organic)
Moynihan Disease
Irritable Bowel Syndrome
CLINICAL APPROACH
History
Physical Examination
General Survey
Investigations
Treatment of Dyspepsia
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Alimentary
Oesophageal
Gastric
Adjunct Therapy
Indications for Surgery
Surgical Treatment
Duodenum
Intestinal
Hepatobiliary
Pancreatic
Food Intolerance
Extra-alimentary (Consequent to Systemic Diseases)
Nonorganic
Nonulcer Dyspepsia (Functional or Nervous Dyspepsia)
Irritable Bowel Syndrome
CHAPTER 9:
Dysphagia
ANATOMICAL AND PHYSIOLOGICAL CONSIDERATIONS
CAUSES OF DYSPHAGIA
Stage One
Stomatitis
Carcinomatous Ulcer
Sjögren’s Syndrome
Acute Pharyngitis
Acute Tonsillitis or Quinsy (Peritonsillar Abscess)
Retropharyngeal Abscess
Pharyngeal Pouch or Zemker’s Diverticulum
Cervical Spondylitis with Anterior Oesteophytes
Stage Two
Plummer-Vinson Syndrome (Sideropenic Dysphagia)
Neuromuscular Disorders
Parkinson’s Disease
Myasthenia Gravis
Dermatomyositis
Globus Hystericus
Stage Three
Mechanical Obstruction of Oesophagus
Extrinsic Causes
Intrinsic Causes
Stage Four
Hiatus Hernia
Carcinoma of the Fundus of the Stomach
Chronic Volvulus of Stomach
CLINICAL APPROACH
History
Physical Examination
General Examination
Local Examination
Systemic Examination
Investigations
Special Investigations
TREATMENT OF DYSPHAGIA
Symptomatic Treatment
Specific Treatment for Specific Disease
Stage One: Disorders of Voluntary Propulsion (Oral/Oropharyngeal)
Stage Two
Stage Three
Stage Four
CHAPTER 10:
Dyspnoea
MECHANISMS OF DYSPNOEA
CAUSES OF DYSPNOEA (TABLE 10.1)
I. Cardiovascular
Acute
Chronic
II. Pulmonary
Acute
Bronchial Asthma
Chronic
3. Restrictive Lung Disease
Acute Restrictive Lung Disease
4. Infections
5. Vascular Occlusion
6. Chest Wall
7. High Altitudes
III. Alimentary Affections
IV. Neurological
V. Metabolic
VI. Psychogenic
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Cardiovascular System
Abdomen
Neurological Examination
Investigations
TREATMENT OF DYSPNOEA
Symptomatic Treatment
Specific Treatment for Specific Diseases
I. Cardiovascular
Acute
Chronic
II. Pulmonary
(a) Obstruction in the Upper Airways
(b) Obstruction to Lower Airways
Acute Severe Attack—(Status Asthmaticus)
Chronic Asthma
(C) Restrictive Lung Disease
(d) Infections
(e) Vascular Occlusion
(f) Chest Wall
(g) High Altitude
III Alimentary Affections
Acute
Chronic
IV Neurological
Acute
Chronic
Metabolic
V. Metabolic Acidosis
VI. Psychogenic
Acute
Chronic
CHAPTER 11:
Epileptic Seizures
AETIOLOGICAL CLASSIFICATION OF EPILEPTIC SEIZURES
Idiopathic
Psychogenic
Symptomatic
Local Causes
General Causes
CLINICAL PRESENTATION
Partial Seizures (Focal, Local)
Simple Partial Seizures
Complex Partial Seizures
Partial Seizures Evolving to Secondarily Generalised Seizures
Generalised Seizures (Convulsive and Nonconvulsive)
Nonconvulsive
Convulsive
Unclassified Epileptic Seizures
Status Epilepticus
Generalised (Major Motor Status) (Convulsive and Nonconvulsive)
Partial (Jacksonian-Minor Motor Status)
Complex Partial Status
CLINICAL APPROACH
History
Drug History and other Chemicals
Psychosocial History
Family History
Past History
Age of Onset
Physical Examination
General Examination
Neuropsychiatric Examination
Chest Examination
Differential Diagnosis
Determining the Type of Seizure
Deciphering the Cause
Investigations
TREATMENT OF EPILEPTIC SEIZURES
Treatment During the Attack
Treatment Between the Attacks to Control Seizures
Anticonvulsant Drug Therapy
Treatment of Epileptic Seizures in Pregnancy
Ketogenic Diet
Surgical Therapy
Underlying Cause
Adjunctive Therapy
Psychotherapy or Behavioural Therapies
Treatment of Status Epilepticus (Continuously for > 5 minutes)
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Symptomatic
Local Causes
General Causes
Idiopathic
Psychogenic
CHAPTER 12:
Erectile Dysfunction
ANATOMICAL AND PHYSIOLOGICAL BASIS OF MALE SEXUAL DYSFUNCTION
CAUSES OF ERECTILE DYSFUNCTION
Physiological
Pharmacological
Antihypertensive Drugs
Antipsychotic Drugs
Anticholinergic Drugs
Antihistamines
Other Drugs
Psychological (Functional)
Pathological (Organic)
Vascular
Neurological
Systemic Diseases
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF ERECTILE DYSFUNCTION
Symptomatic Treatment
Specific Treatment
Psychogenic or Situational Factors
Organic Causes
CHAPTER 13:
Fatigue
MECHANISM OF FATIGUE
CAUSES OF FATIGUE
I Haematological
A. Anaemia
B. Polycythaemia
C. Methaemoglobinaemia
II. Metabolic and Endocrinal
Diabetes Mellitus
Fluid and Electrolyte Disturbances
Hyper or Hypothyroidism
Aldosterone Deficiency
Addison’s Disease
Simmond’s Disease
III. Malnutrition
IV. Infections and Inflammatory Disorders
Occult Infections
Tuberculosis
Connective Tissue Disorders
V. Neoplasia
Lymphomas
Carcinomas
VI. Cardiovascular Disorders
Peripheral Circulatory Failure (Rapidly Setting)
Central Cardiac Failure
VII. Respiratory Disease
Chronic Obstructive Pulmonary Disease
VIII. Gastrointestinal Disorders
Chronic Dyspepsia or Diarrhoea
Chronic Hepatitis
IX. Neurological Diseases
Myasthenia Gravis
Parkinsonian Syndrome
Insomnia
X. Psychogenic
Affective Psychosis (Mood and Emotion: Depression)
Neurosis: Anxiety Neurosis
XI. Asthenic Syndromes
Tropical Neurasthenia
Neurocirculatory Asthenia
Chronic Fatigue Syndrome
XII. Drugs/Chemicals and Alcohol
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Psychiatric Examination
Investigations
2. Biochemical Tests
3. Stool
4. Urine
5. Radiology
6. ECG
7. Special Tests
TREATMENT OF FATIGUE
Symptomatic Treatment
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Haematological
Anaemia
Due to Intraerythrocytic Defects (Intracorpuscular Defects)
Haemolytic Anaemias due to Extra-erythrocytic Causes (Extracorpus–cular Defects)
Metabolic and Endocrinal
Diabetes Mellitus
Fluids and Electrolyte Disturbances
Hyper or Hypothyroidism
Aldosterone Deficiency
Addison’s Disease
Simmond’s Disease (Hypopituitarism in Adults)
Malnutrition
Infections and Inflammatory Disorders
Neoplasia
Cardiovascular Disorders
Respiratory Diseases
Gastrointestinal Disorders
Neurological Diseases
Psychogenic
Depression
Anxiety
Asthenic Syndromes
Tropical Neurasthenia
Neurocirculatory Asthenia (Da Costa’s Syndrome)
Chronic Fatigue Syndrome
Drugs and Alcohol (Refer Causes of Fatigue Table)
Chronic Alcoholism
Chronic Carbon Monoxide Poisoning
CHAPTER 14:
Goitre
THYROID FUNCTION
Synthesis and Storage
Secretion
Regulatory Mechanism
CAUSES OF GOITRE
Nontoxic Goitre (Euthyroid or Hypothyroid)
Simple Goitre
Goitrogens
Hereditary Biosynthetic Defects (Dyshormonogenesis)
Toxic Goitre (Hyperthyroidism)
Diffuse Toxic Goitre or Primary Thyrotoxicosis or Grave’s Disease
Toxic Nodular Goitre or Secondary Thyrotoxicosis or Plummer’s Disease
Thyroiditis
Hypothyroidism
Benign Neoplastic Nodules
Malignant Neoplastic Nodules (Malignant Goitre)
Carcinoma
Lymphoma
Problems of Thyroid Nodules
CLINICAL APPROACH
History
Physical Examination
Local Examination
General Examination
Systemic Examination
Investigations
Basic Thyroid Function Tests (Secretion and uptake Studies)
Dynamic Tests for Thyroid/Hypothalaemic Hypophyseal Function
Special Tests (For Elucidating Cause)
Other Routine Tests
Diagnostic Strategy at A Glance
TREATMENT OF GOITRE
Treatment of Nontoxic Goitre
Simple Goitre (Nonendemic or Sporadic; and Endemic)
Goitrogens
Dyshormonogenesis
Treatment of Toxic Goitre (Hyperthyroidism)
Diffuse Toxic Goitre (Grave’s Disease or Primary Thyrotoxicosis)
Toxic Nodular Goitre (Secondary Thyrotoxicosis)
Other Forms of Hyperthyroidism
Thyroiditis
Solitary Thyroid Nodule
Thyroid Neoplasia
Malignant Neoplastic Nodules
Follow-up
CHAPTER 15:
Gynaecomastia
PATHOPHYSIOLOGY
CAUSES OF GYNAECOMASTIA
Physiological Gynaecomastia
Newborn or Neonatal Gynaecomastia
Adolescent Gynaecomastia
Climacteric (Senescent) Gynaecomastia
PATHOLOGICAL GYNAECOMASTIA
Pharmacological (Drugs)
Oestrogenic
Antiandrogenic Drugs
Gonadotrophins
Prolactinogenic
Androgenic
Unknown Mechanism
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF GYNAECOMASTIA
Symptomatic Treatment
Reassurance
Medical
Surgical
Specific Treatment for Specific Causes
Physiological Gynaecomastia
Pathological Entities
Pharmacological Causes
CHAPTER 16:
Haematemesis and Melaena
CAUSES OF HAEMATEMESIS AND MELAENA
Causes of Haematemesis
Oesophageal Causes
Gastroduodenal Causes
Haemobilia
Vascular Causes
Nongastrointestinal Causes
Causes of Melaena
Upper Gastrointestinal Lesions and Other Causes of Haematemesis
Between the Duodental Bulb and Caecum
Lower Gastrointestinal Lesions
Clinical Approach
History
Interpreting Symptoms
Physical Examination
Bedside Manoeuvres
Investigations
TREATMENT OF HAEMATEMESIS AND MELAENA
Symptomatic Treatment
SPECIFIC TREATMENT FOR SPECIFIC DISEASES
Haematemesis
Oesophageal Causes
Gastroduodenal Causes
Haemobilia
Vascular
Melaena
Upper Gastrointestinal Lesions and Other Causes of Haematemesis (Vide Supra)
Lower Gastrointestinal Lesions
CHAPTER 17:
Haematuria
PATHOPHYSIOLOGY
CAUSES OF HAEMATURIA
Beginning of Micturition
Local Urinary Tract Diseases
Urethral Causes
End of Micturition
Vesical Causes
Intimately Mixed Throughout Micturition
Renal Causes
Ureteric lesions
General (Systemic) Diseases
Infections
Malignant Hypertension
Diabetes Mellitus
Collagen Diseases
Scurvy
Drugs
Neighbouring Visceral Disease Involving Urinary Tract
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Other Systems
Investigations
Urine Examination
Blood Tests
Haematological
Radiological Investigations
Instrumental Investigations (Invasive)
TREATMENT OF HAEMATURIA
Symptomatic Relief
Specific Treatment for Specific Diseases
Initial Haematuria (Urethral and Prostate)
Terminal Haematuria (Vesical Lesions)
Total (Throughout) Haematuria (Renal Lesions)
Acute Pyelonephritis
Glomerulopathies
Ureteric Lesions
Treatment of Haematuria due to General (Systemic) Diseases
CHAPTER 18:
Haemoptysis
PATHOGENESIS OF HAEMOPTYSIS
CAUSES OF HAEMOPTYSIS
Respiratory
Infections
Malignancy
Traumatic
Cardiac
Mitral Stenosis
Systemic Hypertension
Pulmonary Hypertension
Left Heart Failure
Vascular
Vasculitides (Uncommon causes)
Good Pasture’s Syndrome
Pulmonary Haemosiderosis
Aneurysm of the Ascending Aorta or Arch of Aorta (Uncommon)
Bleeding Diathesis
CLINICAL APPROACH
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF HAEMOPTYSIS
Respiratory
Infections
Treatment of Tuberculosis
Traumatic
Cardiac
Mitral Stenosis
Systemic Hypertension
Pulmonary Hypertension
Left Heart Failure
Vascular
Bleeding Diathesis
Idiopathic
CHAPTER 19:
Headache
MECHANISM OF HEADACHE
Main Factors Responsible for the Headache
CAUSES OF HEADACHE
Vascular Headache
Cluster Headache (Migrainous Neuralgia or Horton’s Syndrome)
Hypertension
Toxic-Infective
Giant Cell Arteritis
Carcinoid Syndrome
Hyperviscosity Syndrome
Musculoskeletal
Tension Headache
Cervical Fibrositis
Cervical Spondylosis
Osteitis of the Cranial Bones
Neuritides
Neuritis and Neuralgia
Meningeal
Meningitis
Subarachnoid Haemorrhage
Space Occupying Lesions
Intracranial Tumour
Cerebral Abscess
Subdural Haematoma
Altered CSF Flow
Hydrocephalus
Post-lumbar Puncture
Pseudotumour Cerebri
Trauma (Head Injury)
Referred Pain (Reflex Headache)
Anoxaemia and Hypercapnia
Anoxaemia
Hypercapnia (Rise in arterial PaCO2)
Psychogenic Headache
CLINICAL APPROACH
History
Location and Direction of Spread
Character
Intensity
Periodicity
Age and Sex
Aggravating and Relieving Factors
Associated Symptoms
Family History
Scheme of Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF HEADACHE
Symptomatic Treatment (Before Establishing Clinical Diagnosis)
Specific Treatment of Specific Diseases
Vascular Headache
Hypertension
Musculoskeletal
Neuritides (Neuritis and Neuralgia)
Meningeal
Space Occupying Lesions
Altered CSF Flow
Trauma (Head Injury)
Referred Pain
Anoxaemia and Hypercapnia
Psychogenic
CHAPTER 20:
Jaundice
METABOLISM OF BILIRUBIN
Formation of Bilirubin from Breakdown of Haemoglobin (In Reticuloendothelial System)
Formation of Albumin-Bilirubin Complex (ABC)
Uptake and Transport Phase (Liver)
Conjugation Phase
Excretory (Alimentary) Phase
Excretory (Renal) Phase
Pathophysiological Mechanisms
CLASSIFICATION AND CAUSES OF JAUNDICE
1. Haemolytic Jaundice (Pre-hepatic)
Intracorpuscular Defects (Congenital and Acquired)
Extracorpuscular Defects (Acquired)
2. Hepatocellular Jaundice (Hepatic)
Impaired Hepatic Uptake and Transport or Conjugation of Bilirubin
Cell Damage and impaired excretion (Acquired)
3. Obstructive Jaundice (Post-hepatic): May be Acute or Chronic
Intrahepatic Obstructive Jaundice or Intrahepatic Cholestasis (Impaired Excretion)
Extrahepatic Obstructive Jaundice
In the Wall of the Duct (Luminal)
Pancreatitis and Pancreatic Malignancy
CLINICAL APPROACH
History
Physical Examination
General Survey
Systemic Examination (Abdominal)
Investigations
Stool
Blood
Immunological Tests
Immunoglobulins
Bromsulphalein Excretion
Other Tests
Radiology
Imaging Procedures
Liver Biopsy
Endoscopy
TREATMENT OF JAUNDICE
Supportive/Symptomatic Treatment
Treatment of Specific Types of Jaundice
Haemolytic Jaundice
Hepatocellular Jaundice
Obstructive Jaundice
Prevention
CHAPTER 21:
Low Backache
CAUSES OF BACKACHE
Spinal Cord and Roots
Spinal Tumours
Cauda Equina Lesions
Lesions of the Vertebral Column
Degenerations
Infections
Metabolic Causes
Nutritional Causes
Autoimmune Diseases
Neoplastic Lesions
Congenital
Traumatic
Osteochondritis
Soft Tissues and Joints
Soft Tissues
Joints
Referred Pain
Psychogenic
CLINICAL APPROACH
History
Analysis of Pain
Additional Factors
Examination
Physical Examination
Neurologic Examination
General Examination
Investigations
TREATMENT OF LOW BACKACHE
Preventive Steps
Symptomatic Relief
Specific Therapy for Specific Diseases
Spinal Cord and Roots
Lesions of the Vertebral Column
Autoimmune Diseases
Neoplastic
Congenital
Traumatic
Osteochondritis
Soft Tissues and Joints
Referred Pain
Psychogenic Pain
CHAPTER 22:
Obesity
Chemical Composition of Body Compartments
PATHOPHYSIOLOGY
Methods to Estimate Body Fat
Direct Methods
Indirect Methods (Anthropometric Measurements)
Types of Obesity
Clinical Types
Morphological Types
Degree of Obesity
Risks Related to Obesity
CAUSES OF OBESITY
1. Simple obesity (Primary)
Constitutional obesity
Alimentary obesity
2. Endocrinal obesity (Secondary)
Hypothalamic Pituitary Disorders
Thyroid (Hypothyroidism)
Parathyroid (Pseudohypoparathyroidism)
Adernal Cortex (Cushing’s Syndrome)
Pancreas (lslet Cell Adenoma)
Gonads
3. Genetic Defects: (Vide Supra)
4. Congenital Disorders
5. Disorders of Adipose Tissue (Lipodystrophies)
Multiple Lipomata
Dercum’s Disease (Adiposis Dolorosa)
Partial Lipodystrophy
6. Pickwickian Syndrome
7. Drugs
COMPLICATIONS OF OBESITY
Syndrome X (Reaven’s Syndrome/Insulin Resistance Syndrome/Metabolic Syndrome)
CLINICAL APPROACH
History
Physical Examination
General Survey
Systemic Examination
Investigations
TREATMENT OF OBESITY
Symptomatic Treatment
Therapeutic Lifestyle Changes
Nonpharmacological
PHARMACOTHERAPY
Bariatric Surgery
Treatment of Insulin Resistance Syndrome (IRS)
SPECIFIC TREATMENT FOR SPECIFIC UNDERLYING CAUSE
Simple obesity Symptomatic Treatment (Vide supra). Endocrinal obesity.
Congenital Disorders
Disorders of Adipose Tissue
Drugs
CHAPTER 23:
Oedema
PATHOPHYSIOLOGY
CAUSES OF OEDEMA
Pathological Oedema
Generalised
Immunological
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF OEDEMA
Symptomatic Relief
Specific Treatment for Specific Diseases
Generalised Oedema
Severe Anaemia
Endocrinal and Metabolic
Idiopathic Cyclic Oedema
Localised Oedema
CHAPTER 24:
Oliguria
RENAL FUNCTIONS
PATHOPHYSIOLOGY
ACUTE RENAL FAILURE (ARF)
Subdivision
Prerenal Failure
Renal (Intrarenal) Failure
Postrenal Failure
Acute-on-Chronic Renal failure
CAUSES OF OLIGURIA
Clinical Essence
Clinical Discussion
Prerenal Failure
Renal Failure
Postrenal Failure
Acute-on-Chronic Renal Failure
CLINICAL APPROACH
History
Physical Examination
Investigations
Urinalysis
Blood Tests
Dye Reduction Spot Test or Dye Reduction Test
Radiology
Ultrasonography
Cystoscopy
ECG
Renal Biopsy
Further Investigations
Blood
Imaging Techniques
TREATMENT OF OLIGURIA
Prerenal Failure
Intrinsic Renal Failure
Postrenal Failure
Ureters
CHAPTER 25:
Pain in the Extremities
CAUSES OF PAIN (TABLE 25.1)
Pain in the Upper Extremities
Pain in the Lower Extremities
Mechanism of Pain
1. Cutaneous
Cellulitis
2. Locomotor
Muscles
Tendon Sheaths and Bursae
Bones
Joints
3. Lymphovascular
Lymphangitis, Thrombophlebitis and Deep Venous Thrombosis
Acute or Chronic Arterial Occlusion
Raynaud’s Disease
Erythromelalgia
4. Neurologial
Peripheral Nerves
Plexus, Spinal Nerves Roots
Meninges
Cord
5. Referred Pain (From Viscera)
Angina Pectoris
Malignant Disease in the Pelvis
6. Psychogenic
CLINICAL APPROACH
History
Analysis of Pain
Associated features
Physical Examination
General Examination
Local Examination
Systemic Examination
Investigations
Blood
CSF
Radiology
ECG
Special Tests
Treatment of Pain in the Extremities
Cutaneous
Cellulitis
Locomotor
Myalgias (Muscle Pains)
Myositis
Cramps
Tendons and Bursae (Vide infra)
Bone Pains
Joint Pains
Lymphovascular Causes
Lymphangitis
Thrombophlebitis
Deep Venous Thrombosis
Acute Arterial Occlusion
Chronic Arterial Occlusion
Raynaud’s Phenomenon
Erythromelalgia
Neurological Causes (Neuralgias)
Plexus, Spinal Nerves Roots
Meninges
Cord
Reffered Pain
Psychogenic
CHAPTER 26:
Palpitations
CAUSES OF PALPITATIONS
PATHOLOGICAL
Cardiac
Cardiac Arrhythmias
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
Blood Tests
Motion Examination
Radiological Tests
Surface ECG
Exercise Test (Treadmill Stress Test)
Oesophageal Electrocardiography
His Bundle Electrocardiograms
Echocardiogram
Electrophysiological Testing
TREATMENT OF PALPITATIONS
Cardiac Origin
Cardiac Arrhythmias
Sick Sinus Syndrome
Hypertension
Valvular Lesions
Congenital Heart Disease
Acute Myocardial Infarction
Arrhythmogenic Right Ventricular Dysplasia
Noncardiac Origin
CHAPTER 27:
Paraplegia
CAUSES OF PARAPLEGIA
SPASTIC PARAPLEGIAS
Spinal
Cerebral
Functional
Spastic Paraplegias of Gradual Onset
Extramedullary Extradural Lesions
Extramedullary Intradural Lesions
Intramedullary Lesions
Cerebral
FLACCID PARAPLEGIAS OF ACUTE ONSET
Faccid Paraplegia of Gradual Onset
Hereditary
Motor Neurone Disease
Cauda Equina Lesions
Peripheral Neuropathies
Myasthenia Gravis (Neuromuscular Transmission Disorders)
Botulism (Neuromuscular Transmission Disorder)
Myopathies
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Methodical Examination of CNS
Motor System
Sensory System
Reflexes
Special Signs
Gait
Investigations
TREATMENT OF PARAPLEGIA
General Measures
Specific Treatment for Specific Disease
Spastic Paraplegias of Acute Onset
Flaccid Paraplegias of Acute Onset
Spastic Paraplegias of Gradual Onset
Nutritional Neuropathies
Cerebral
Flaccid Paraplegias of Gradual Onset
CHAPTER 28:
Polyarthritis
MECHANISM OF ARTHRITIC PAIN
PATHOGENESIS OF SWOLLEN JOINTS
CAUSES OF OLIGO AND POLYARTHRITIS
1. Inflammatory Arthritis (Infectious or Immunological or Reactive)
Infectious Arthritis (Microbial)
Chlamydia
Spirochaetal
Mycotic
Postinfectious Arthritis
Reactive Arthritis
Immunological (Connective Tissue Disorders)
Seronegative Spondyloarthropathies (Seronegative RA excluded)
Idiopathic
2. Degenerative (Mechanical)
Osteoarthritis
Neuropathic joint Disease (Charcot’s joint)
3. Metabolic
Gout
Pseudogout (Chondrocalcinosis Articularis)
Ochronosis (Alkaptonuria)
Hyperlipidaemia
Amyloidosis
Haemochromatosis
Dialysis Arthropathy
Less Common Arthritides
1. Hereditary (Congenital Arthropathies)
2. Endocrinal
3. Haematological
4. Neoplastic
5. Traumatic Arthritis
6. Iatrogenic
CLINICAL APPROACH
History
Physical Examination
Systemic Examination (For systemic features particularly)
Investigations
TREATMENT OF POLYARTHRITIS
Symptomatic Treatment
Specific Treatment for Specific Diseases
Inflammatory
Reactive/Postinfectious Arthritis
Systemic Lupus Erythematous (SLE)
Reiter’s Syndrome and Reactive Arthritis (Vide supra)
Degenerative
Metabolic
Less Common Arthrides
Hereditary Arthropathies
Endocrinal
Haematological
Neoplastic
Traumatic Arthritis
Iatrogenic
CHAPTER 29:
Polyuria
PHYSIOLOGY OF URINE FORMATION
MECHANISM OF POLYURIA
CAUSES OF POLYURIA
Diabetes Mellitus (DM)
Primary
Secondary (Specific Types)
Endocrinopathies
Diabetogenic Drugs
Genetic Syndromes
Gestational Diabetes Mellitus (GDM)
Clinical Features
Mechanism of Polyuria
Diagnostic Criteria of DM
COMPLICATIONS
Hypercalcaemia and Hypercalciuria (Calcium Diabetes)
Increased Solute Load (Hypertonic Intravenous Infusions)
Renal Dysfunction
Acute Renal Failure
Chronic Renal Failure
Natriuretic Syndrome (Salt losing nephropathy)
Diabetes Insipidus (DI)
Neurogenic or Central Diabetes Insipidus (Vasopressin Deficiency)
Nephrogenic Diabetes Insipidus (Vasopressin Insensitivity)
Primary Polydipsia
Hypokalaemia
CLINICAL APPROACH
History
Physical Examination
General Survey
Systemic Examination
Investigations
Measurement of Fluid Intake and Output
Examination of the Urine
Blood
Kidney Function Tests
Radiology
Ultrasound
ECG
CT Scan of Brain
Kveim Test
TREATMENT OF POLYURIA
Symptomatic Relief
Fluid and Electrolyte Imbalance
Drugs
Specific Treatment for Specific Diseases
Diabetes Mellitus
Calcium Diabetes
Renal dysfunction
Chronic Renal Failure
Natriuretic Syndrome
Hypokalaemia
CHAPTER 30:
Pruritus
PATHOPHYSIOLOGY OF PRURITUS
CLINICAL PERSPECTIVE
CAUSES OF PRURITUS (TABLE 30.1)
Itching Dermatosis with Obvious Skin Lesions (Climatic Effects)
1. Physical
2. Infestations (Parasitosis and Arthropoda)
3. Urticaria (HIVES)
Papular Urticaria (Lichen Urticaria)
4. Infections
5. Dermatitis and Eczema
6. Lichenoid Dermatosis
7. Psoriasis
8. Pityriasis Rosea
9. Mycosis Fungoides
Itching Dermatoses (Without Obvious Skin Lesions—Generalised)
1. Physiological: Pregnancy
2. Systemic and other Disorders
3. Dry Skin (Xerosis or Asteatosis)
4. Senile Pruritus
5. Food and Drug Sensitivity (Allergic Reactions)
6. Vasospastic Disorders: Erythromelalgia
7. Psychogenic
CLINICAL APPROACH
History
Physical Examination
Local Examination
General Examination
Systemic Examination
Psychological Assessment
Investigations
Treatment of Pruritus
Symptomatic Relief
Specific Treatment
Infestations
Urticaria
Infections
Dermatitis
Psoriasis
Pityriasis Rosea
Mycosis Fungoides
Pruritus without Dermatologic Affections Per Se
Physiological: Pregnancy
Systemic and other Disorders
Internal Malignancy
Localised Pruritus
CHAPTER 31:
Pyrexia of Unknown Origin
PATHOGENESIS OF FEVER
Causes of Pyrexia of Unknown Origin
Infections (may be Systemic or Localised)
Bacterial
Chlamydial
Viral
Parasitic
Rickettisial (Refer to Chapter titled ‘Rashes’)
Spirochaetal
Mycotic
Neoplastic (Malignant or Benign)
Connective Tissue Disorders
Vascular Diseases
Granulomas
Granulomatous Hepatitis
Liver Cirrhosis
Hypersensitivity to Drugs
Haematological
CLINICAL APPROACH
Physical Examination
Investigations
First Stage
Second Stage
Third Stage
Fourth Stage
Treatment of Pyrexia of Unknown Origin (PUO)
Symptomatic/Supportive Treatment
Specific Treatment for Specific Diseases
Infections
Viral Infections
Parasitic Infections (Antiprotozoval Drugs)
Rikettsial Diasease
Spirochaetal
Mycotic Infections
Neoplasms (Malignant or Benign)
Connective Tissue Disorders
Vascular Diseases
Granulomas
Liver
Drug Fever
Haematological
Agranulocytosis
Febrile Neutropenia
Other Causes
Inherited
CHAPTER 32:
Rashes
TERMINOLOGY
Macule or Spot
Haemorrhages
Papule
Maculopapular
Weal
Vesicle
Bullae
Cyst
Pustule
Desquamation
Pigmentation
Ulcer
Scar
Atrophy
Mechanical
PATHOGENESIS
Causes of Rashes (Generalised Eruptions) (Table 32.1)
Infections
Viral
Others
Bacterial
Chlamydial: Psittacosis
Spirochaetal
Rickettsial
Fungal
Parasitic
Other Parasites
Immunologic
Hypersensitivity (Cell Mediated Immunity)
HLA Related Diseases
Tumours
Drug Eruptions
Idiopathic Causes
CLINICAL APPROACH
History
Physical Examination
Dermatological Examination
General Examination
Systemic Examination
Investigations
Special Investigations
TREATMENT OF RASHES
Symptomatic Treatment
Specific Treatment for Specific Diseases
Infections
Immunologic
HLA Related Diseases (Genetic Components Involved in Autoimmunity)
Systemic Lupus Erythematosus
Pemphigus Vulgaris
Tumours
Drug Eruptions
Idiopathic
CHAPTER 33:
Shock
PATHOPHYSIOLOGY OF SHOCK
CLASSIFICATION AND CAUSES
CLINICAL FEATURES OF SHOCK
SPECIFIC TYPES OF SHOCK
Hypovolaemic Shock
2. Distributive Type (Vasodilatation)
Neurogenic Shock (Vasodilatory Shock/Vasoplegia Syndrome)
Vasogenic (Septic) Shock: (Bacteraemic/Septicaemic)/Systemic Inflammatory Response Syndrome (SIRS)
Anaphylactic Shock
3. Cardiogenic Shock (Pump Failure with Intact Intravascular Volume)
4. Obstructive
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
Urine
Blood
Radiology
ECG
TREATMENT OF SHOCK
General Measures
Specific Measures
Adequate Ventilation (Respiratory Support)
Optimum Fluid and Electrolyte Replacement/Inotropic Agents (Haemodynamic Support)
Effective Circulation
Drug Therapy
CIRCULATORY DEVICES
DESIRED TARGETS
Treatment of Complications of Shock
Renal Failure
Cardiac Failure
Respiratory Failure
Gastrointestinal Complications
Disseminated Intravascular Coagulation (Refer to Chapter titled ‘Bleeding Disorders’)
Infections
Multiorgan Dysfunction Syndrome (MODS)
Treatment of Different Types of Shock
Hypovolaemic Shock
Distributive
Neurogenic Shock
Septic (Bacteraemic) Shock
Toxic Shock Syndrome
Anaphylactic Shock
Cardiogenic Shock
Ischaemic Causes
Nonischaemic Causes
CHAPTER 34:
Syncope
AETIOPATHOGENESIS
TYPES OF SYNCOPE
1. Neurocardiogenic Syncope
2. Postural Syncope or Orthostatic Hypotension
3. Cardiac Syncope (Arrhythmias and mechanical)
Cardiac Arrhythmias (Refer to Chapter titled‘Palpitations’)
Obstruction to Outflow Tracts
Cyanotic Heart Disease
Ischaemic Heart Disease
Pericardial Tamponade
Intracardiac Masses
Pulmonary Embolism
Arrhythmogenic Right Ventricle Dysplasia (Arvd)
4. Cerebral Syncope (Neurologic)
5. Metabolic Origin
6. Anoxic Syncope
7. Psychogenic
CLINICAL APPROACH
Investigations
Haematology
Biochemical Evaluation
Other Investigations
Evaluation of Autonomic Function
Reproducing Attacks of Syncope
Further Investigations
TREATMENT OF SYNCOPE
Symptomatic Relief
Specific Treatment for Specific Causes
1. Inadequate Venous Return and Cardiac Filling
2. Inadequate Cardiac Output (Cardiac Syncope)
Cardiopulmonary Resuscitation (CPR)
3. Vascular Insufficiency of Outgoing Vessels to the Brain
4. Vascular Insufficiency of Cerebral Vessels
5. Metabolic Disturbances
6. Anoxic Syncope
7. Psychogenic
CHAPTER 35:
Vertigo and Dizziness
CLINICAL APPROACH
Physical Examination
General Examination
Systemic Examination
Cardiovascular Examination
Investigations
Special Investigations
Treatment of Vertigo and Dizziness
Therapeutic Options
Pharmacotherapy
Counselling
Surgery
Specific Treatment for Specific Diseases
Otologial (Peripheral)
Neurological (Central)
Cerebellar
Ocular
Cervical
Psychogenic
Treatment of General Medical Disorders Causing Dizziness
Cardiovascular
Adverse Reactions of Drugs
CHAPTER 36:
Vomiting
PATHOPHYSIOLOGY
CAUSES OF VOMITING
Central Causes
1. Toxic
2. Neurological
3. Psychogenic (Hysterical Vomiting)
Reflex Causes
1. Visceral
2. Otological
CLINICAL APPROACH
History
Physical Examination
Vital Data
Examination of the body Components
Investigations
Urine
Blood
Stool
CSF
Radiology
Imaging Procedures (If indicated)
Eighth Nerve
TREATMENT OF VOMITING
Symptomatic treatment
Anti-emetic Drugs
Replacement of Fluid and Electrolytes
Diet
Specific Treatment for Specific Diseases
Central Causes
Reflex Causes
CHAPTER 37:
Weight Loss
BASIC PRINCIPLES
1. Gastrointestinal
Deficient Intake of Food
Impaired Absorption or Utilisation
2. Endocrine and Metabolic
3. Cardiopulmonary
4. Renal
5. Infections/Immunological
6. Malignant Neoplasms
Tumourigenesis
Tumour Markers
7. Substance (Drugs and Alcohol) Abuse
Drug Abuse
Alcoholism
Tobacco Smoking
Psychogenic
Anorexia Nervosa
Depressive Illness
Schizophrenia
CLINICAL APPROACH
History
Physical Examination
General Examination
Systemic Examination
Investigations
TREATMENT OF WEIGHT LOSS
Symptomatic Measures
Specific Treatment of Underlying Causes
1. Facilitate Increased Calorie Intake
2. Prevent the Calorie Loss
3. Correct the Increased Metabolic Rate
4. Deal Psychological Factors
5. Prevent cachexia
Drugs of Choice for Malignancies Listed Under Cause
APPENDIX I:
Appendices: Essentials of Electrocardiography
INTRODUCTION
ELECTROPHYSIOLOGIC BASIS OF ECG
ELECTROCARDIOGRAPH AND ITS LEAD SYSTEM
ECG PAPER
PREREQUISiTES FOR A GOOD ECG TRACING
COMPONENETS OF NORMAL ECG AND ITS GENESIS (Fig. APP I)
INTERPRETATION OF ECG
ABNORMAL ECG PATTERNS
APPENDIX II:
HIV/AIDS
BASIC CONSIDERATIONS
Clinical Spectrum
Acute Infection (Acute Retroviral Syndrome) Acute Seroconversion
Latent Infection (Asymptomatic stage) Second Stage
Chronic Infection: (Early Stage and Advanced Stage-Symptomatic and Complicated Stages)
Diagnosis of HIV infection and AIDS
Management
When to Initiate ART
How to Initiate Treatment?
How Long to Give Treatment
Monitoring of Treatment
Complications of Art in General
When to Stop ART
Immune Reconstitution Inflammatory Syndrome (IRIS)
Treatment of Complications of HIV infections
Prophylaxis of Opportunistic Infections
Fungal
Treatment of AIDS in Pregnancy
Prevention and Control
Primary Prevention
Secondary Prevention
APPENDIX III:
Toxicology (Specific Poisons/Overdoses)
APPENDIX IV:
Laboratory Reference Values
APPENDIX V:
Function Tests of Diverse Organs
Suggested Reading
INDEX
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