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Differential Diagnosis and Medical Therapeutics a Treatise on Clinical Medicine DIFFERENTIAL DIAGNOSIS AND MEDICAL THERAPEUTICS A Treatise on Clinical Medicine Third Edition P Siva Rama Krishna Rao BSc MBBS (Madra) MD (Andhr) FRCP (Glasg) FRSM (London) FICA (NY) FCCP (USA) FIMSA (India) FIAMS (India) FICP (India) Formerly Professor and Head Department of Medicine Andhra Medical College First Physician King George Hospital Visakhapatnam, Andhra Pradesh, India Additional Director in the office ofBrothers Directorate of Medical Education Government of Andhra Pradesh Forewords IV Rao David R London Jaypee The Health Sciences Publisher New Delhi | London | Philadelphia | Panama Jaypee Brothers Medical Publishers (P) Ltd Headquarters Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc Jaypee Medical Inc 83, Victoria Street, London City of Knowledge, Bld. 237, Clayton 325 Chestnut Street SW1H 0HW (UK) Panama City, Panama Suite 412, Philadelphia, PA 19106, USA Phone: +44 20 3170 8910 Phone: +1 507-301-0496 Phone: +1 267-519-9789 Fax: +02 03 0086180 Fax: +1 507-301-0499 Email: [email protected] Email: [email protected] Email: [email protected] Jaypee Brothers Medical Publishers (P) Ltd Jaypee Brothers Medical Publishers (P) Ltd 17/1-B Babar Road, Block-B, Shaymali Bhotahity, Kathmandu Mohammadpur, Dhaka-1207 Nepal Bangladesh Phone: +977-9741283608 Mobile: +08801912003485 Email: [email protected] Email: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com Brothers © 2015, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject mat- ter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the servicesJaypee of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected] Differential Diagnosis and Medical Therapeutics—A Treatise on Clinical Medicine First Edition: 2000 Second Edition: 2010 Third Edition: 2015 ISBN 978-93-5152-310-9 Printed at Foreword to the Third Edition Dr P Siva Rama Krishna Rao is a popular physician, reputed teacher and a physician with a vast experience. I am privileged to be his student when I was pursuing my Postgraduate Course in General Medicine. He has put in an enormous hard work in bringing out the textbook Differential Diagnosis and Medical Therapeutics—A Treatise on Clinical Medicine and presently updated it as the 3rd edition with inclusion of topics like dementia and essentials of electrocardiography. He has provided a systematic approach to the common symptoms with the flowcharts to arrive at the final diagnosis. I am sure that this book would be of immense value to the undergraduate and postgraduate students and practitioners of medicine. I am particularly impressed by the flowcharts which depict not only the various causes of the symptom but also the salient features regarding the pathological and clinical aspects of the disease. It makes fluent, interesting and absorbing reading going through the various chapters with slick narration. I immensely suggest that this textbook should be possessed by all the students of medicine both undergraduate and postgraduate as well as practitioners, who find readymade solutions to the various clinical problems they encounter in their daily practice. I feel very happy to write the foreword to this book that is well compiled with a comprehensive and profound knowledge of medicine by my teacher, philosopher and guideBrothers Dr P Siva Rama Krishna Rao. IV Rao MD (General Medicine) Vice Chancellor Dr NTR University of Health Sciences Vijayawada, Andhra Pradesh, India Jaypee Foreword to the First Edition It gives me great pleasure to write a foreword to Common Clinical Challenges—A Treatise on Maladies and Remedies. The approach adopted by the author should be of great help to those who are facing difficulty in the management of medical emergencies. The idea of taking symptom complexes and then describing the diagnostic possibilities with guides to the management both of the disease itself and of the symptoms, that it occasions, will be valuable to all who have to deal with problems of this sort. The demand placed on the medical profession is ever-increasing for a variety of reasons: the complexity of medical practice steadily increases as more and more diagnostic and therapeutic possibilities become available, and as populations age, so the incidents of disease increase. Added to these are, on the one hand, ever-increasing consumer demand, while, on the other, governments’ attempt to hold down healthcare costs. All this means that doctors simply have to raise their game. This requires a process of continuing professional development to keep up-to-date and to ensure that professional performance is kept to an acceptable level. Included in this process is continuing medical education that nowadays can be derived from a variety of modalities, including distance learning. However, despite electronic means of communication and the visual display unit (VDU), most people find the printed word still the best way of assimilating new information and Dr P Siva Rama Krishna Rao’s book is an excellent example of this. My hope is that it will be valuable to all who have to deal with the clinical differential diagnosis that he has identified. It should be of particular use to general practitioners, accident and emergency physicians and indeed all those who encounter this aspect of medicine. It is the sort of book that should be presented not only on the shelves at home and in libraries, but also at all the sites whereBrothers emergency medicine is practised. David R London Registrar Royal College of Physicians of London United Kingdom Jaypee Preface to the Third Edition Differential Diagnosis and Medical Therapeutics—A Treatise on Clinical Medicine is updated and throughly revised by reviewing every chapter and appendix with exquisite exposition. Therapeutics has been revisited with vigor. Flowcharts continue to highlight the salient features. Efforts persisted to dispense the knowledge effectively, facilitating one to arrive at a diagnosis with ease. Two additional subjects are added: one on “Essentials of Electrocardiography” and another on “Dementia”, making a total of 37 chapters and 5 appendices. The former is made easy for any doctor to opine with confidence and the latter is full of expansive expression. Tremendous effort involving countless hours is behind this endeavour of lucid narration, which will serve as a clinical treasure-house. Understanding Medicine in depth cannot be realised in toto, even after years of study, as it is fathom deep and extensive. That is the reason why no book on medicine is complete, with obvious persisting lacunae existing. These are addressed to wherever possible. Hence, this treatise with abundant assimilable information, arranged in an orderly manner can be entertained, as an alternative textbook and a constant companion for students. Also, it will be a guiding force, for those practicing medicine, who intensely desire to enrich themselves, for gaining exhilarating confidence to deal with any case, towards correct diagnosis and then design the successful strategy, for effective treatment. It is no exaggeration if it is stated that this will be a valuable accompaniment at every stage of professionalism, particularly while crossing the bridge from graduation to internship (Foundation period) enabling the doctors’ clinical acumen to grow freely. Brothers As many as thirty outstanding review comments including four from abroad are incorporated. The book, indeed, will be a boon particularly for the problem-based learners and also for those, who desire to equip with practical knowledge. P Siva Rama Krishna Rao Jaypee Preface to the First Edition
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