(ee) NTN PERSPECTIVES. CHAPTER I : LONG CASES 3-252 CARDIOVASCULAR SYSTEM 654 SCHEME OF EXAMINATION. Mitral stenosis... Mitral incompetence. Aortic teN05'S.sunssnsnnnnee Aortic incompetence. Mitral stenosis and mitral incompetence. Aortic stenosis and aortic incompetence. Infective endocarditis RESPIRATORY SYSTEM 54-106 SCHEME OF EXAMINATION. Hydropneumothorax. Consolidation of the lung. Bronchial asthma... GASTROINTESTINAL SYSTEM 106-134 ‘SCHEME OF EXAMINATION. Pyloric stenosis... Acute viral hepatitis. Cirrhosis of liver. NERVOUS SYSTEM 134-187 SCHEME OF EXAMINATION... Hemiplegia. Paraplegia. Peripheral neuropathy... Parkinsonist GENITOURINARY SYSTEM 187-200 SCHEME OF EXAMINATION. wsmsssnessunennnnnniin ‘Acute glomerulonephritis. Nephrotic syndrome.. LOCOMOTOR SYSTEM 201 - 207 ‘SCHEME OF EXAMINATION. ml 7 201 Polyarthritis. 202 LYMPHORETICULAR SYSTEM 208-234 ‘SCHEME OF EXAMINATION. Thalassaemia..... Chronic myeloid leukaemia. Lymphoma. MISCELLANEOUS 234-252 Chronic kala-azar... Diabetes mellitus. CHAPTER II : SHORT CASES 253-299 Cyanotic congenital heart disease, i Fibrosis or collapse of the 1ung....nsenesn Superior mediastinal syndrome.. CHAPTER III : SPOT CASES 300-489 Dwarf ism (cretinism).. Tall stature. : Emaciation. Examination of neck veins. Spider naevi Palmar erythema.. Examination of the hands... Wasting of the small muscles of hands... Claw hand. Gynaecomastia.. Hypo- or hyperpigmentation.. Scabies, Psoriasis. Pityriasis versicolor. Haemorrhagic spot Leprosy, Neurofibromatosts. Scleroderma. . ‘Systemic lupus erythematosus (SLE). Erythema nodosum... Subcutaneous nodules.. Down's syndrome (mongolism)... Hydrocephalus... Rickets.. Myxoedema. Hyperthyroidism. Exophthalmos, Cushing's syndrome. ‘Acromegaly. Palpation of base of the heart Percussion of the sternum or base of the Neatt...snmmnmnmnnsinennnnii Auscultation of different areas of heart... Pericardial rub. Shape of the chest... ‘Auscultation of the chest. Pleural rub.. Examination of the tongue. Visible peristalsis Prominent veins with venous urn, Kayser Fleischer (K-F) ring, 437 440 Plantar response (reflex). ‘Trophic change: Charcot joint. ‘Abnormal gait. 487 APPENDIX 490-503 YOUR EXAMINATION HALL AND PATH OF SUCCESS. .490 INSTRUMENTS TO CARRY IN THE EXAMINATION HALLiwssustiensinnsennnnsnnnsnnn 90 ‘THE HISTORY SHEET AND DISTRIBUTION OF MARKS. ven ALP. J. MEHTA’S PRACTICAL MEDICINE SP Mehta = SR Joshi * Nihar P Mehta 20, @ NATIONAL CONTENTS PART I - CLINICAL CASES 1. HISTORY TAKING AND SYMPTOMATOLOGY Weightloss Weight gain 1 24. Heart burns 2. 3, Anorexia 4 25. Vomiting 26. Hematemesis Fever 27. Constipation 5. Chest pain 28. Flatulence 6 Dyspnea 29. Diarthea 7. Cough 30. Bleeding per rectum 8, Hemoptysis, 9. Palpitations 31. Jaundice 32. Epistaxis 10. Syncope 33. Bleeding Gums 11. Polyuria 34. Hoarse Voice 12, Pyuria - Itching 13, Frequency of Micturition and Nocturia 36. Hirsutism 14, Hesitancy and Precipitancy of Urine 37. Gynecomastia 38. Backache 39. Hiccough 40. Headache 41. Tinnitus 15, Retention of urine 16, Hematuria 17, Anuria 18, Pain in the Loin 19, Abdominal Pain 42. Tingling and Numbness 20. Dysphagia 21. Water brash 43. Cramps 44, Intermittent Claudication 22, Indigestion 23. Enuctation 45. Vertigo 2. GENERAL EXAMINATION 1. Built 1011. Skin and its Appendages 7 2. Body Proportions 1412. Vertebral Column 31 3. Nutrition 1413, Thickened nerves 2 4 Decubitus 1514, Joints 32 5. Clubbing 15 15. Temperature 36 6 Cyanosis 16 16. Pulse 39 2. Jaundice 19 17. Jugular Venous Pulse (JVP) a 8. Pallor 22 18. Blood pressure 6 9. lymphadenopathy 23°19, Hypertension 48 10. Edema 25 20, Hypotension 53 3. ABDOMEN 1. Proforma 55 10. Alcoholic Liver Disease 7 2. Examination 5611. Malaria 90 3. Hepatomegaly 65 (12. Kala Azar 95 4. Splenomegaly 67 13. Typhoid 98 5. Ascites 7 14, Leukemia 102 6 Abdominal Lump 72 15. Malignant lymphoma 106 7. Acute Viral Hepatitis 77 16. Human Immunodeficiency Virus (HIV) Cee a2 Disease Acquired Immune Deficiency ‘Syndrome (AIDS) 109 9. Portal Hypertension 84 4. RESPIRATORY SYSTEM L 122 10. Chronic Obstructive Pulmonary Disease a en (COPD) (Emphysema and Chronic Bronchitis) 168 3. Pleural Effusion 135 > 11, Pneumonia 172 4. Collapse / Atelectasis of Lung 1 ea in 5. Pulmonary Fibrosis Se a Interstitial Lung Diseases 145 Ce pean: 149 14 Solitary Pulmonary Nodule (SPN) 180 7 ulnar) cay 15415. Obstructive Sleep Apnoea 182 8, Bronchogenic Carcinoma 155.1 16. Hepstopamonsry Syadrome 1 9. Pulmonary Tuberculosis iss ae Alles Bronchopulmonary Apeigiloss a 5. CARDIOVASCULAR SYSTEM 1. Proforma 188 12. Cyanotic Congenital Heart Disease 243 2. Examination 189 13, Patent Ductus Arteriosis (PDA) 250 3. Rheumatic fever 203 14, Ventricular Septal Defect (VSD) 252 4. Infective Endocarditis 205 15. Atrial Septal Defect (ASD) 253 5. Ischemic Heart Disease 208 16. Coarctation of Aorta 255 6. Cardiac Failure 22017. Aneurysm of Aorta 287 7. Mitral Stenosis (MS) 225 18. Pericardial Effusion 259 8. Mitral Regurgitation (MR) 232 19. Cardiomyopathy 260 9. Mitral Valve Prolapse (MVP) 236 20. Fitness for surgery 10. Aortic Regurgitation (AR) BS (Pre-operative Evaluation) 263 11. Aortic Stenosis (AS) 2a 6. CENTRAL NERVOUS SYSTEM 1. Proforma 264 8 Myasthenia Gravis 340 2. Examination 266 9. Cerebellum 341 3, Cranial Nerves 298 10. Tuberculosis of Nervous System 344 4. Bulbar Palsy 321 11. Cerebrovascular Diseases 349 5. Hemiplegia 32212, Parkinsonism 357 6. Paraplegia 326 13. Coma 365 7. Quadriplegia 336 14. Syphilis of Nervous System 370 ART II - TABLE-WORK 7. MEDICAL EMERGENCIES 1, Cardiac Arrest 374 28. Acute Retention of Urine 395 2, Cardiac Failure 377 29. Acute Renal Failure (ARF) 395 3, Ischemic Heart Disease 377 30. Diabetic Ketoacidosis 396 4. Stokes Adams Syndrome 377 31. Hypoglycemia 397 5. Hypertensive Crisis 377 32. Respiratory Acidosis 398 6. Hypertensive Encephalopathy 378 33. Metabolic Acidosis 399 7. Shock 379 34. Respiratory Alkalosis 399 8. Anaphylactic Shock 380 35. Metabolic Alkalosis 399 9. Pulmonary Embolism and 36. Dehydration 400 Deep Vein Thrombosis 380 37, Hypernatremia ane 10, Hemoptysis 38238, Hyponatremia 400 11. Bronchial Asthma 38359, Hyperkalemia ai 12. Respiratory Failure 38540, Hypokalemia ‘aol 13, Tension Pneumothorax 386 41. Acute Hypercalcemia 401 1h Honatenes 38742. Amebic Dysentery 401 15, Acute Gastroenteritis / Food poisoning 38843, Bacilary Dysentery Aa 16. Acute Pancreatitis Sag oe tor 17. Hepatic Coma 38945, Typhoid 03 18. Coma 39046, Dengue aa 19. Meningitis 390 47. Leptospirosis 404 20. Cerebrovascular Diseases 39143, Diphtheria aoe 21. Subarachnoid Hemorrhage aON eas ees lia 22. Epilepsy 39150. Rabies 406 23. Sickle Cell Crisis 393 51. Cerebral Malaria i 24. Acute Hemolytic Crisis 39352, Acute Poisonings 406 25. Aplastic Anemia 39453, Organophosphorous Compound 26. Hemophilia 394 Poisoning 407 27. Renal Colic 394 54. Acute Alcoholic Intoxication 408 55. Barbiturate Poisoning 408 59. Snake Bite 410 56. Acute Salicylate Poisoning 409 60. Scorpion Bite an 57, Carbon Monoxide Poisoning 409 61. Hyperpyrexia 413 58. Carbon Dioxide Narcosis 410 62. Drowning 413 8. ELECTROCARDIOGRAPHY 1. Introduction 415 6, Rhythm Disturbances 42 2. Normal ECG 415 7, Conduction Defects Atrioventricular 3. Waves and Complexes 416 Block (AV Block) 429 4. Myocardial Infarction 421 8. Effect of Drugs and Electrolytes 430 5. Ventricular Enlargement au 9. RADIOLOGY 1. X-ray chest 4325. Barium studies 443 2. X-ray Chest - Heart 437 6. X-rayof Bones 447 3. Plain X-ray Abdomen 4387. X-ray Skull 452 4. Urogenital System 440 10. INSTRUMENTS 1, Endotracheal Tube 455 20, Urosac Bag 465 2. Tracheostomy Tube 456 21. Stomach Tube 466 3. Laryngoscope 457 22. Ryle's Tube (RT) or Nasogastric Tube 466 4. Oxygen Mask and Oxygen Cannula 23, Sengstaken Blakemore Tube (S.B. Tube) 467 (Nasal Prongs) 458 24. Infant Feeding Tube 468 5. Nebulizer Chamber 458 95, Record Syringe and Needle 469 6. “Metered Dose Inhaler 458 26. B.D. Syringe and Needle 469 7. Spacehaler 459 97, Tuberculin Syringe 470 8 Rotahaler 459 28, Insulin Syringe 470 9. Nekion’ Inhaler 459 29. Lumbar Puncture Needle 471 10. Ambu Bag (Self-inflating Ventillation Bag) 46039, sternal Puncture Needle a M. Airway 460 31. Vim-Silverman’ Needle 47. 12, Mouth Gag 461 32, Menghin?s Needle and Syringe an 13. Tongue Depremor 462 33, Bone Marrow Aspiration Needle a7 14. Trocar and Cannula 462 34, Pleural Biopsy Needle an 15, Asepto Syringe and Bulb Meee ee = 16, Simple Rubber Catheter 462 36, southeys Tube and Needle eB 17. Foley's Self-retaining Catheter 463 37. Tourniquet an 18. Malecot's Catheter 465 32, Venesection Needle FER 19. Condom Catheter 465 39. scalp Vein Needle as 40. Pleural or Ascitic Aspiration Needle 47344, Clinical Thermometer 475 41, Intravenous Cannulas 45, Flatus Tube 476 (Venflow or Angiocath) 47346, Proctoscope 476 42. Three Way 47447. Stethoscope an 43. LV. Set. 474 48. Central Venous Catheter 477 11. PROCEDURES 1. Transvenous Pacing 47911. Ascitic Tapping 490 2. Cardioversion 47912. Gastric Analysis 491 3. Lumbar Puncture 480 13. Glucose Tolerance Test (G:T.T) 492 4. Cisternal Puncture 484 14. Intravenous Therapy 493 5. Liver Biopsy 484 15. Subcutaneous Infusions 495 6. Kidney Biopsy 486 16. Tracheostomy 495 7. Bone-marrow Aspiration 487 17. Oxygen Therapy 496 8. Pleural Fluid Aspiration 488 18, Enema 497 9. Aspiration of Pneumothorax Cavity 489 19. Parenteral Hyperalimentation 499 10. Pericardial Aspiration 490 12. HEMATOLOGY 1. Blood Collection 501 11. Electronic Cell Counters si4 2. Preparation of Blood 502 12, Red Cell Indices si4 3. Hemoglobin Estimation 505 13. Red Cell Morphology 515 4. Packed Cell Volume (PCV) 507 14. Anemias 517 5. Erythrocyte Sedimentation Rate(ES.R.) $07 15. Differential Leucocyte Count 522 6. Reticulocyte Count 509 16, Leukemias 525 7. Osmotic Fragility of RBCs 510 17. Parasitesin Blood 525 8, Total Red Cell Count 510 18. Multiple Myeloma 526 9 Total White Cell Count 511 19. Coagulation studies 526 10. Platelet Count 513 20. Normal Hematological Values 613 13. CLINICAL PATHOLOGY 1. Urine Examination 533 3. Feces Examination 539 2. Sputum 539 4, Helminthic Infections S41 14, PATHOLOGY SPECIMENS 1. Central Nervous System 546 5. Large Intestines 553 2. Cardiovascular System 5476. Liver 553 3. Lung 3497. Kidney 555 4, Small Intestine 552 15. DRUGS 1. Cardiovascular Drugs 557 5. Antibacterial Agents 585 a) Inotropic Drugs 557 a) Sulfonamides 585 b) _Anti-arrhythmic Drugs 558 b) Quinolones 586 ©) Anti-anginal Agents 560 ©) Beta-lactams 586 4) Anti-hypertensive Agents 561 @) Macrolides 588 ©) Anti-thrombotic Agents 566 ©) Aminoglycosides 589 ) Heparins/Aprotinin 566 f) Tetracyclines 589 f) Diuretics 567 8) Chloramphenicol 390 2. Autonomic Nervous System 568 6, Anti-tuberculous Drugs 590 a) Catecholamines 5687. Antisleprosy Drugs cE b) Cholinergic and Anti-cholinergic Agents 569 . 8. Anti-amoebic Drugs 592 3 Drugs in Respiratory Diseases oe eee a a) Anti-asthma Agents 370 b) Agents for Cough and Expectoration 572._-~—=«10.Anti-malarial Drugs 593, ©) Anti-allergic Drugs 57211. Antichelminthic Agents 594 4d) Serotoninergic Agents 57312, Anti-fungal Agents 597 4. Drugs in Central Nervous System 13. Antiviral Agents Diseases, 373 a) Opioids 57314 Anti-retroviral Agents for HIV Infection 599 b) Analgesics and Anti-inflammatory Drugs 57415. Alcohol 601 ©) Drugs in Migraine 576 16, Anti-malignancy Agents 601 4) Drugs in Goutand Arthritis 576 s ae 17. Hemopoietic Drugs 603 €) Anti-epileptic Drugs 377 f) Muscles Relaxants 579 18. Chelating Agents 604 g) Anti-psychotic Drugs 579 19. Drugs in Endocrine Disorders 605 h)_ Sedatives/ Hypnotics 580 90, Drugs for Diabetes oe i) Anti-depressants 582 ie : ees 21. Lipid Lowering Agents 608 j) Anti-parkinsonism Drugs 583 k) Drugs in Stroke 5gq 22 Gastro-intestinal Drugs 609 }) Drugs in Degenerative Brain Disorders 584 23. Electrolytes ou 25. Plasma Expanders 612 List of Contributors for the 20" Edition Dr. HardikShah Dr. Sunitalyer Dr. Nikesh Jain Dr. Rajiv Shah|. Introduction to Internal Medicine Nutrition: . Cardiovascular System |. Respiratory System Abdomen Haematology Nephrology . Nervous System Endocrine and Metabolic Disorders . Connective Tissue Disorders . Oncology Geriatric Medicine }. Substance Abuse Imaging Modalities in Internal Medicine Procedures Laboratory Reference Values Index