Long Cases in CLiniCaL MediCine Long Cases in CLiniCaL MediCine (Concerned with long cases, their presentation, related questions, answers and discussions) aBM abdullah mrcp (uk) frcp (edin) Dean, Faculty of Medicine Professor, Department of Medicine Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh Foreword Pran gopal datta ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD 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: “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” —sir William osler dedicated to My Parents, Wife and Children Foreword This is my pleasure and great honor to write a few words about Long Cases in Clinical Medicine. Professor Abdullah has written an excellent “made easy” book that will help both undergraduate and postgraduate students prepare themselves in a systematic manner. It is easy to understand, concise, and will help to learn many aspects of medicine. This will refect the diseases of the region. Medicine is a vast subject and ever-changing science, expanding and progressing day by day. New information is emerging all the time, making the textbooks bigger and harder to assimilate. Textbooks are a good source of knowledge, but many students, in spite of hours of tedious work, are often unable to acquire all the necessary information in a concise way. Dr Abdullah has admirably succeeded in fulflling this gap by preparing such a book in a concise and methodical way. This book is certainly the frst of its kind to fulfll the long demand of students and doctors. I have no doubt that this book will be of immense beneft for the students who are appearing in any postgraduate and undergraduate examination in clinical medicine. This book has an excellent outline regarding presentation of long cases, answers of relevant questions and a brief discussion. When I was a new student in clinical medicine, I found it diffcult while talking to the patient, taking the history, physical examination, coming to the diagnosis, etc. I think every new student in clinical medicine used to feel the same problem. There is no book or clinical methods that will fll these diffculties. In that respect, I strongly appreciate and feel that this book will really be a good guide, written in a concise and rational manner that will greatly help the undergraduate students to establish the foundation of clinical medicine with ease and confdence. I heartily appreciate and praise the author’s effort, hard work, sincere endeavor, enthusiasm and patience in bringing out this book in a beautifully designed way for the beneft of the learners in medicine. Pran gopal datta mcps acorl (Odessa) PhD (Kiev) MSc in Audiology (UK) FCPS FRCS (Glasgow) Vice-Chancellor Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh Preface By the good grace of Almighty, I have succeeded to bring out the frst edition of Long Cases in Clinical Medicine. Long cases are an integral part of any examination in medicine. The idea is to assess the candidate’s ability of gathering adequate information from thorough medical history and physical examination, interpreting them to come up with a probable diagnosis and formulating a management plan. A sound knowledge of medical science, optimum clinical skills, good interpersonal communication and adequate time management are all needed. A good preparation and adequate practice are vital for success. From my experience as a teacher and an examiner in medicine, I feel that many candidates, even brilliant ones, fail to succeed in long cases due to lack of adequate technique of taking history from the patient, analysis of symptoms, inapt presentation and inability to answer questions related to the case. In spite of good theoretical knowledge, many of them are unable to effectively communicate with the patient. This is because they do not prepare themselves in an examination- oriented manner. It is important to acquire knowledge from textbooks, but it is equally vital to know what to expect in examinations, how to face them and to practice with that in mind. Goal- based preparation, systematic practice and repeated exposure to different cases and rehearsal of presentation in front of others is the secret to success. With this in mind, I have written this book to help students prepare themselves in an examination-oriented manner. This book has been written to entertain a wide variety of readers from medical students to postgraduate examinees. It includes a complete outline of a comprehensive medical encounter including history taking and physical examination. It also gives valuable tips regarding interpretation of various clinical features to make a diagnosis. Successive chapters include long cases arranged according to body systems. In each case, the history and examination is presented frst followed by the clinical diagnosis and possible differentials. Then the relevant questions and answers are provided. The best way to get the most out of this book would be to practice a real case in the ward and then go through the relevant example given in the book. Students should notice how the case has been presented, the important clinical points that are mentioned and then familiarize themselves with the relevant questions and answers. They can make small groups where one will present a case in front of others and then answer questions asked by them. This will help them to be confdent and fuent during the real examination. In examination, a patient may have a single disease, or may be suffering from multiple diseases. For the purpose of preparation and simplicity, I have prepared this book using a prototype single case of a disease condition. x I do not claim that this book is enough for the whole clinical medicine and one should consult standard textbooks for learning. But for examination purpose, this book will be a valuable tool for optimum preparation. A candidate needs to prove that he is not only knowledgeable but also competent. I hope that this book will help to promote such an approach. I would like to invite constructive criticism from valued readers of this book, so that any error or omission may be corrected in future edition. aBM abdullah Long Cases in Clinical Medicine