Fourth Edition
R Alagappan MD FICP
Formerly Director Professor and Head Institute of Internal Medicine Madras Medical College and Government General Hospital
Chennai, Tamil Nadu, India
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Manual of Practical Medicine
© 2011, Jaypee Brothers Medical Publishers
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: 1998
Reprint: 1998, 1999, 2000, 2001
Second Edition: 2002
Reprint: 2005
Third Edition: 2007
Reprint: 2009
Fourth Edition: 2011
9789380704807
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
5Preface to the Fourth Edition
The Manual of Practical Medicine provides the basic principles of clinical examination in addition to detailed history taking. The firm foundation in clinical methods will help the physicians in arriving at a provisional diagnosis and for planning relevant necessary investigations to confirm the diagnosis. The common and important clinical disorders are described in detail along with relevant investigations and updated management. New diagrams, tables and radiological images have been added in all the chapters.
The fourth edition is dedicated to the community of medical students whose thirst for knowledge make the teachers learn. Learning helps in the proper management of patients.
I profusely thank the postgraduate students Dr A Prabhakar and Dr S Karthikeyan for helping me in updating the fourth edition. I fully appreciate their hard work.
I offer my heartfelt thanks to Dr KG Srinivasan of KGS advanced MRI scan in providing me the necessary images and also in updating the chapter on Imaging Modalities in Internal Medicine.
I thank Mr P Ilango for doing the photoshop work for this edition.
I am deeply indebted to Shri Jitendar P Vij, Chairman and Managing Director, M/s Jaypee Brothers Medical Publishers (P) Ltd for his constant best wishes.
I also thank Mr Tarun Duneja, Director-Publishing, M/s Jaypee Brothers Medical Publishers (P) Ltd for his tremendous efforts in bringing out the fourth edition.
I do hope and wish that the updated edition with more number of diagrams and tables will be a good guide for both medical students and physicians.
R Alagappan
6Preface to the First Edition
Medicine is an everchanging science. The vast clinical experience, the technological advancement in the field of investigatory modalities, tremendous explosion in the invention and addition of newer drugs in the field of pharmacology, and a wide variety of interventional therapeutic advancements have contributed to the voluminous growth of medical literature.
Human brain cannot remember all the facts. It is impossible to learn, register, remember and to recall all the medical facts in the course of time bound undergraduate and postgraduate medical education. It is the realization of these difficulties that prompted me to write this manual. Hence, an earnest attempt has been made to merge the clinical methods and the principles of internal medicine and to present both in a condensed form. To keep the size of the volume compact and small, only certain important clinical topics are included in this manual. Even references are not included since high-tech reference system is available in all the good libraries.
The manual will be of practical value to the medical students and practising physicians with an emphasis not only on clinical methods, clinical features, various essential investigations, but also on the management of various important clinical disorders.
I am deeply indebted to three of my postgraduate students Dr K Narayanasamy MD, Dr Rajesh Bajaj MD, and Dr S Sujatha MD who have helped me in preparation of the manuscript, computer and laser printing and upto the stage of submission to the publishers. But for their untiring efforts and hardwork, the timely publication of this manual would not have been possible.
I wish to acknowledge the contribution of my associates and colleagues in securing the clinical photographs, echocardiograms, X-rays, CT films, nuclear imaging photographs and computer line diagrams for this manual: C Lakshmikanthan, R Alagesan, P Thirumalai, K Kannan (Madurai), CU Velmurugendran, SG Krishnamoorthy, S Sethuraman, P Raja Sambandam, MA Muthusethupathy, P Soundarrajan, AS Natrajan, D Sivagnanasundaram, C Panchapakesa Rajendran, KR Suresh Bapu, Thirumoorthy and Hari Ramesh.
I wish to thank my postgraduate students who did the proofreading of the entire manual.
Last, but by no means the least, I wish to acknowledge the help and encouragement provided by the editorial department and the editorial staff of the Jaypee Brothers Medical Publishers for their kind cooperation in bringing out this manual.
I do wish that this manual will be a good guide and primer to the internal medicine students and practising physicians.
R Alagappan