Alagappan's clinical medicine for dental students.

Priya Verma Gupta Aims, Objectives and Case History Aims and Objectives Doctor-Patient Interrelationship Case History General Examination Pulse Respiration Blood Pressure Temperature Fever Febrile Convulsions Patterns of Fever Continuous Fever Remittent Fever Intermittent Fever Relapsing Fever Hyperpyrexia Causes of Hyperpyrexia Treatment Hyperthermia Causes Pyrexia of Unknown Origin Investigations Clinical Examination Inspection Palpation Percussion Ф п Auscultation Examination of Skin Prerequisites for Skin Examination Accessibility Adequate Illumination Inspection of Skin Examination of Hair Shape Colour Growth Examination of Face Type of Facies Eyes Anthropometric Classification Stature State of Nutrition Obesity Types of Obesity Waist-hip Ratio Oedema Types Clinical Features Characteristic Features Examination of Mouth and Pharynx Examination of Neck Lymph Nodes Lymphadenopathy Examination of Hands and Fingers Examination of Nails Differential Diagnosis Investigations Diagnosis Provisional Diagnosis Confirmed Diagnosis Treatment Prognosis Follow-up Protocol for Recording Case History/Sample Format for Case History Assessment and Examination Regions of Abdomen Measurements Surface Marking of Organs Stomach Liver Spleen Kidneys Gall Bladder Inspection Position Shape Umbilicus Movements Visible Pulsations Visible Gastric Peristalsis Visible Intestinal Peristalsis Skin or Surface Palpation Palpation of Liver Alternate Method Palpation of Gall Bladder Courvoisier’s Law Murphy’s Sign Palpation of Spleen Palpation of Kidneys Palpation of Urinary Bladder Palpation of Groins, Para-aortic Nodes and Vessels Tenderness Percussion Defining Boundaries Liver Spleen Newer Methods of Percussion of Spleen Bladder Detecting Fluid Shifting Dullness Fluid Thrill Puddle’s Sign Percussion of Cyst (Hydatid Thrill) Auscultation Bowel Sounds Succussion Splash Bruit Venous Hum Friction Rub Investigation Abdominal X-rays Abdominal Ultrasonography Endoscopy Indications Contraindications Computed Tomography Magnetic Resonance Imaging Magnetic Resonance Cholangiopancreatography Endoscopic Retrograde Cholangiopancreatography Percutaneous Transhepatic Cholangiography Oral Cholecystogram (Graham-Cole Test) Laboratory Investigation Liver Function Tests Serum Enzymes Tests of Biosynthetic Function Tests of Cholestasis Serum Bilirubin Urine Analysis Methods of Collection of Urine Specimens Microscopic Dipstick Testing Renal (Kidney) Function Test Diseases of Oral Cavity Introduction Dental Caries Clinical Features Prophylaxis Treatment Pulpitis Periodontitis Aetiopathogenesis Clinical Features Treatment Acute Necrotising Ulcerative Gingivitis Aetiology Clinical Features Diagnosis Treatment Sialolithiasis Ranula Aphthous Ulcer Aetiology Clinical Features Treatment Important Questions Diseases of Oesophagus Chapter Outline Introduction Dysphagia Definition Aetiology □ Luminal causes Extrinsic compression □ Disorders of pharyngeal and oesophageal striated muscle Clinical Features Investigations Diagnosis Treatment Plummer-Vinson Syndrome Gastroesophageal Reflux Disease Introduction Aetiology Clinical Features Investigations Treatment Indications for Surgical Treatment Complications Important Questions Diseases of Stomach Chapter Outline Gastritis Classification Acute Erosive Gastritis (Haemorrhagic) Aetiology Pathogenesis Clinical Features Management Acute H. pylori Gastritis Diagnosis of H. pylori Invasive Non Invasive Management Triple Drug Therapy Consequences of H. pylori Infection Acute Phlegmonous Gastritis Chronic Atrophic Gastritis Types Type A Type B Histological Stages of Chronic Gastritis Diagnosis Management Miscellaneous Corrosive Agents Induced Gastritis Treatment Infectious Gastritis Granulomatous Gastritis Eosinophilic Gastritis Gastritis Following Gastric Surgery (Alkaline or Bile Reflux Gastritis) Menetrier’s Disease (Hypertrophic Gastritis) Peptic Ulcer Pathogenesis Helicobacter pylori and Peptic Ulcer Disease Pathogenesis of Ulcer Production Treatment Nonsteroidal Anti-inflammatory Drug and Peptic Ulcer Mechanism of Action Upper Gastrointestinal Radiography (Barium Meal Series) Complications Stress Ulcer Pathogenesis Clinical Conditions Producing Stress Ulcer Treatment Important Questions Diseases of Intestine Chapter Outline DIARRHOEA Definition Types Acute Diarrhoea Definition Aetiology Pathogenesis Clinical Features Investigations Examination of Stool Gross Examination Microscopic Examination Stool Culture Sigmoidoscopy Complications Treatment Chronic Diarrhoea Definition Classification Investigations Treatment Traveller’s Diarrhoea Aetiology Clinical Features Treatment Prophylaxis DYSENTERY Introduction Types Bacillary Dysentery Pathogenesis Clinical Features Investigations Management Prevention AMOEBIASIS Life Cycle Pathogenesis Clinical Features Intestinal Amoebiasis Hepatic Amoebiasis Investigations Management Amoebic Liver Abscess Aspiration of Liver Abscess Indications MALABSORPTION Luminal Phase Transport Phase Important Questions Diseases of Liver Chapter Outline JAUNDICE Metabolism of Bilirubin Types Haemolytic Jaundice Hepatocellular Jaundice Clinical Features Laboratory Investigations Management Obstructive Jaundice Clinical Features Laboratory Investigations Management Congenital Jaundice Crigler-Najjar Syndrome (Type I) Treatment Crigler-Najjar Syndrome (Type II) Treatment Gilbert’s Syndrome Treatment Dubin-Johnson Syndrome Rotor Syndrome HEPATITIS Introduction Hepatitis A Transmission Signs and Symptoms Pathogenesis Diagnosis Treatment Hepatitis B Pathogenesis Signs and Symptoms Acute Chronic Diagnosis Treatment Liver Transplant Prevention Hepatitis C Signs and Symptoms Acute Chronic Oral Manifestation Diagnosis Treatment Prevention Hepatitis D Hepatitis E HEPATOMEGALY CIRRHOSIS OF LIVER Management Introduction Aetiology Classification Alcoholic Cirrhosis Clinical Features Sequelae Investigations Treatment Post-viral Cirrhosis Aetiology Pathogenesis Biliary Cirrhosis Primary Biliary Cirrhosis Secondary Biliary Cirrhosis Clinical Features Investigations Treatment Cardiac Cirrhosis Aetiology Pathogenesis Clinical Features Investigations Treatment ASCITES Ascites Causes of Ascites Causes of Transudate Ascitic Fluid Causes of Exudate Ascitic Fluid Pathogenesis Analysis of Ascitic Fluid Spontaneous Bacterial Peritonitis Organisms Clinical Features Criteria for Diagnosis Management Chylous Ascites Causes Mucinous Ascites Investigations Management Refractory Ascites Treatment Important Questions Glomerulonephritis Chapter Outline Introduction Acute Glomerulonephritis Aetiology Infectious Disease Multisystem Disease Primary Glomerular Disease Pathogenesis Clinical Features Diagnosis Management Complications Acute Post-streptococcal Glomerulonephritis Diagnosis Treatment Post-infectious Glomerulonephritis Important Questions Nephrotic Syndrome Introduction Pathogenesis Aetiology Clinical Features Minimal Change Glomerulonephritis Causes Treatment Membranous Glomerulonephritis Mesangial Proliferative Glomerulonephritis Diabetic Nephropathy Manifestations of Diabetic Nephropathy Focal and Segmental Glomerulosclerosis Complications Management Difference Between Nephrotic and Nephritic Syndrome Acute Nephritic Syndrome Nephrotic Syndrome Important Questions Renal Failure Chapter Outline ACUTE RENAL FAILURE Introduction Aetiology Pre-renal Failure Intra-renal Failure Post-renal Failure Clinical Features Investigations Management Complications CHRONIC KIDNEY DISEASE Chronic Kidney Disease—risk Factors CHRONIC RENAL FAILURE Introduction Aetiology Clinical Features Symptoms Signs Consequences Investigations Management Important Questions Assessment and Examination General Examination Inspection Visible Pulsations Chest Wall Defects Golden Rules Palpation Apical Impulse Parasternal Impulse Types of Apical Impulse Thrills Carotid Thrill (Carotid Shudder) Pulmonary Thrills Left Lower Parasternal Thrills Arterial Pulse Pulse Rate Causes of Sinus Bradycardia Causes of Sinus Tachycardia Pulse Deficit (Apex-Pulse Deficit) Pulse Rhythm Regularly Irregular Rhythm Irregularly Irregular Rhythm Pulse Volume Pulse Character Hypokinetic Pulse Anacrotic Pulse (Parvus et Tardus) Hyperkinetic Pulse Collapsing Pulse (Water-Hammer Pulse, Corrigans Pulse) Pulsus Bisferiens Pulsus Dicroticus Pulsus Alternans Pulsus Bigeminus Pulsus Paradoxus Reverse Pulsus Paradoxus Radio-femoral Delay Percussion Auscultation Auscultatory Areas Areas of Auscultation Over Precordium Blood Pressure Auscultatory Gap Blood Pressure in the Basal Condition Postural or Orthostatic Hypotension Causes Normal Blood Pressure Common Causes of Hypertension Isolated Systolic Hypertension Accelerated Hypertension Malignant Hypertension Hypertensive Urgency Hypertensive Emergency White Coat Hypertension Pseudohypertension Transient Hypertension Episodic or Paroxysmal Hypertension Labile Hypertension Paradoxical Hypertension Examples Hypertensive States Pulsus Paradoxus Pulsus Alternans Heart Sounds First Heart Sound (S1) Second Heart Sound (S2) Third Heart Sound (S3) Causes of Pathological S3 Fourth Heart Sound (S4) Gallops Triple Rhythm with Tachycardia Quadruple Rhythm Summation Gallop Opening Snap Causes of Opening Snap Ejection Clicks (Vascular/Valvular) Valvular Clicks Vascular Clicks Pericardial Knock Pericardial Rub Prosthetic Sounds Heart Murmurs Levine and Freeman’s Grading of Murmurs Systolic Murmur Diastolic Murmur Dynamic Auscultation 1. Respiration Deep Expiration 2. Valsalva Manoeuvre 3. Standing to Squatting Squatting to Standing 4. Isometric Exercise Investigations Chest X-ray Electrocardiography Cardiac Stress Test Echocardiography Cardiac Computed Tomography Cardiac Magnetic Resonance Imaging Cardiac Catheterization Important Symptoms and Signs Dyspnoea New York Heart Association Grading for dyspnoea, palpitation, fatigue and angina in patients with cardiovascular disease. Causes Cardiac Orthopnoea Mechanism Causes Paroxysmal Nocturnal Dyspnoea Mechanism Causes Trepopnoea Causes Palpitation Causes Syncope Causes Cerebrovascular disorders: Disorders resembling syncope: Cyanosis Types Causes In Case of Central Cyanosis In Case of Peripheral Cyanosis Congenital Heart Diseases Introduction Classification Gross Anomalies Lesions without Shunts Left Heart Malformations Right Heart Malformations Shunt Lesions—Left to Right (Acyanotic) Atrial Level Shunt Ventricular Level Shunt Aortic Root to Right Heart Shunt Aortopulmonary Level Shunt Multiple Level Shunts Shunt Lesions—Right to Left (Cyanotic) Cardiac Malposition Levocardia Dextrocardia Mesocardia Situs Inversus Totalis Isolated Dextrocardia Atrial Septal Defect Clinical Features Investigations Electrocardiography Chest X-ray Treatment Ventricular Septal Defect Classification Mechanism of Closure of Defect Clinical Features Investigations Electrocardiography Treatment Patent Ductus Arteriosus Clinical Features Investigations Electrocardiography Chest X-ray Treatment Medical Surgical Conditions Where Patent Ductus Arteriosus is Essential for Survival Eisenmenger Syndrome Clinical Features Ф Death is Caused By Tetralogy of Fallot Embryology Cyanotic Fallot Acyanotic Fallot Clinical Features Investigations Electrocardiography Chest X-ray Complications Treatment Medical Surgical Blalock-Taussig Procedure Waterston Procedure Pott’s Procedure Important Questions Rheumatic Fever 13 Chapter Outline Introduction Pathophysiology Valve Involvement in Rheumatic Heart Disease Diagnosis Essential Criteria Major Criteria Carditis Arthritis Subcutaneous Nodules Erythema Marginatum Chorea (Sydenham’s Chorea) Minor Criteria Clinical Laboratory Management Duration of Management Prevention Primary Secondary Important Questions Valvular Heart Disease 14 MITRAL VALVE DISEASE Mitral Stenosis Aetiology Clinical Features Symptoms Signs Severity According to A2-OS Interval According to the Gradient Across Stenotic Mitral Valve Complications Haemoptysis Atrial Fibrillation Pulmonary Oedema Infective Endocarditis Chest Pain Pressure Symptoms Investigations Electrocardiogram Chest X-ray Echocardiogram Management Medical Surgical Closed Mitral Valvotomy/Commissurotomy Open Mitral Valvotomy/Commissurotomy Percutaneous Balloon Valvuloplasty Valve Replacement Mechanical Prosthesis Bioprosthesis Mitral Regurgitation Aetiology Acute Mitral Regurgitation Chronic Mitral Regurgitation Clinical Features Symptoms Signs Severity Complications Investigations Electrocardiogram Chest X-ray Echocardiogram Management Medical Surgical Indication for Surgery Procedure Mitral Valve Prolapse Syndrome Aetiology and Associations Clinical Features Symptoms Signs Complications Investigations Electrocardiogram Management Medical Surgical AORTIC VALVE DISEASE Aortic Stenosis Aetiology Clinical Features Symptoms Signs Severity Complications Investigations Electrocardiogram Chest X-ray Echocardiogram Cardiac Catheterisation Coronary Angiogram Management Medical Surgical Aortic Regurgitation Aetiology Acute Aortic Regurgitation Combined Aortic Stenosis and Aortic Regurgitation Chronic Aortic Regurgitation Aortic Valve Involvement Aortic Wall Involvement Clinical Features Symptoms Signs of Wide Pulse Pressure Other Signs Severity Investigations Electrocardiogram Chest X-ray Echocardiogram Cardiac Catheterization Management Medical Surgical TRICUSPID VALVE DISEASE Tricuspid Stenosis\ Aetiology Symptoms and Signs Investigations Electrocardiogram Echocardiogram Management Tricuspid Regurgitation Aetiology Primary or Organic Secondary or Functional Symptoms and Signs Investigations Chest X-ray Echocardiography Management Important Questions Coronary Artery Disease 15 Acute Coronary Syndromes Pathogenesis Investigations Coronary Angiography Management Risk Stratification of Acute Coronary Syndrome Low Risk Patients Intermediate and High Risk Patients Antiplatelet Therapy Anticoagulant Therapy Dalteparin Enoxaparin Heparin Percutaneous Coronary Intervention Angina Pectoris Canadian Heart Association Grading of Angina Characteristics of Anginal Pain Levine Test Anginal Equivalent Prinzmetal Angina Nocturnal Angina Unstable Angina Second Wind Angina Causes of Angina Pectoris Myocardial Infarction Incidence Risk Factors Category I Category II Category III Category IV Clinical Features Symptoms Signs Investigations Electrocardiogram Chest X-ray Cardiac Enzymes Creatine Phosphokinase-MB Aspartate Transaminase Lactate Dehydrogenase Troponin T Management Thrombolytic Agents Complications Cardiogenic Shock Arrhythmias Post-infarct Angina Pericarditis Treatment Mechanical Complications Thromboembolism Treatment Ventricular Aneurysm Cardiopulmonary Resuscitation (Basic Life Support) Procedure Cardioversion (Direct Current Shock) Contraindications to Cardioversion Cardiac Transplantation Contraindications Important Questions Infective Endocarditis 16 Introduction Types Acute Infective Endocarditis Sub-acute Infective Endocarditis Endocarditis Occurring in Intravenous Drug Abusers Prosthetic Valve Endocarditis Predisposing Factors Clinical Manifestations Symptoms Signs Clinical Consequences Investigations Laboratory Diagnosis Blood Culture Negative Blood Culture in Infective Endocarditis Imaging 2 D ECHO Management Medical Surgical Indications Procedure Prevention Non-infective Endocarditis Important Questions Arrhythmias Chapter Outline Introduction Atria Origin Arrhythmias Atrial Fibrillation Electrocardiogram Management Atrial Flutter Management Wolff-Parkinson-White Syndrome Management Premature Atrial Beats Sick Sinus Syndromes Management Sinus Arrhythmia Sinus Tachycardia Ventricle Origin Arrhythmias Premature Ventricular Contraction Ventricular Fibrillation Management Ventricular Tachycardia Characteristics Suggestive of Ventricular Tachycardia Sustained Monomorphic Ventricular Tachycardia Polymorphic Ventricular Flutter Management of Broad Complex Tachycardia Haemodynamically Stable Ventricular Tachycardia If the above drugs fail or the patient haemodynamically unstable: Resistant Ventricular Tachycardia Torsades De Pointes Associated with Long QT Syndrome Prevention of Recurrent Ventricular Tachycardia Indications for Implantable Cardioverter Defibrillators Important Questions Cardiac Failure 18 Chapter Outline Introduction Classification High Output and Low Output Failure High Output Failure Low Output Failure Right, Left and Biventricular Heart Failure Right Sided Heart Failure Left Sided Heart Failure Congestive Cardiac Failure Forward and Backward Heart Failure Forward Heart Failure Backward Heart Failure Systolic and Diastolic Failure Systolic Failure Diastolic Failure Aetiology Investigations Chest X-ray Electrocardiogram Echocardiography Framingham Criteria for Diagnosis of Congestive Heart Failure Major Criteria Minor Criteria 0 : Management Nonpharmacologic Measures Physical Rest Mental Rest Oxygen Diet Sodium Restriction Water Restriction Dialysis and Ultrafiltration Pharmacologic Therapy Oral Vasodilators Parenteral Vasodilators Digitalis Management of Digitoxicity Dose Mechanical Circulatory Support Important Questions Hypertension Chapter Outline Introduction Aetiology Causes of Isolated Systolic Hypertension Clinical Features Diagnosis When to Suspect Secondary Hypertension Evidence of Underlying Secondary Cause Factors Influencing Prognosis Risk Factors Target Organ Damage Associated Clinical Conditions Nervous Diseases Heart Disease Renal Disease Vascular Disease Advanced Hypertensive Retinopathy Management General Principles Non-drug Therapy Diet Exercise and Relaxation Smoking Drug Therapy Diuretics в—Blockers Non-cardioselective b-blockers Cardioselective b-blockers b-blockers with Added Alpha-blocking Activities Ultra Short-acting b-blockers Route of Elimination of b-blockers is as Follows The Following are Indications for b-blockers b-blockers with ISA can be used in Hypertensives The Following are Contraindications for b-blockers Doses of Commonly used b-blockers Other Indications for b-blockers Centrally-acting Adrenergic Inhibitors The Drugs Belonging to this Category The Following are the Indications for Using these Drugs Peripherally-acting Adrenergic Inhibitors The Drugs Belonging to this Category Alpha-adrenergic Inhibitors The Drugs Belonging to this Category Indications for Using these Drugs Calcium-channel Blockers The Drugs Belonging to this Category Indications Angiotensin-converting-enzyme Inhibitors The Drugs Belonging to this Category The Advantages Angiotensin-converting-enzyme Inhibitors can be Used in the Following Situations Angiotention II Receptor Blocker Directly-acting Vasodilators The Drugs Used in this Category Special Considerations in Anti-hypertensive Therapy Pregnancy Elderly Anaesthesia Renal Failure Ischaemic Heart Disease Diabetes Mellitus Arrhythmias Chronic Obstructive Pulmonary Disease Peripheral Vascular Disease Sub-arachnoid Haemorrhage Aortic Dissection Hyperlipoproteinaemia Left Ventricular Hypertrophy Complications of Hypertension Central Nervous System Retina Cardiovascular System Kidneys Important Questions Assessment and Examination General Examination Surface Markings Bronchopulmonary Segments Borders of the Lung The Pleura Pleural Border Inspection Inspection of Upper Respiratory Tract Inspection of Lower Respiratory Tract Position Position of Trachea Position of Apex Beat Chest Shape Chest Deformities Spinal Deformity Movement of the Chest Rate Rhythm Breathing Patterns Regular Abnormal Breathing Patterns Irregular Abnormal Breathing Patterns Palpation Tracheal Tug—Oliver’s Sign Inspiratory Tracheal Descent Measurement of Chest Expansion Assessment of Anterior Thoracic Movement Assessment of Posterior Thoracic Movement Tenderness Detection of Subcutaneous Emphysema Sounds Tactile Fremitus Friction Fremitus Vocal Fremitus Percussion Position Objectives Cardinal Rules Areas of Percussion Anterior Chest Wall Lateral Chest Wall Posterior Chest Wall Percussion of Right Side Tidal Percussion Percussion of Left Side Traube’s Space Types of Percussion Percussion Tenderness Straight Line Dullness Shifting Dullness ‘S’ Shaped Curve of Ellis Auscultation General Principles Auscultatory Areas Technique Importance Breath Sounds Vesicular Breath Sound Bronchial Breath Sound Types Tubular Cavernous Amphoric Bronchovesicular Breath Sound Absent Breath Sounds Added Sounds Wheeze Rhonchi Crackles Voice Sounds Vocal Resonance Types Miscellaneous Sounds Stridor Hamman’s Mediastinal Crunch Investigations Sputum Examination Pulmonary Function Tests Bedside Lung Function Tests Spirometry Spirometry Measurements Forced Vital Capacity Forced Expiratory Volume1 Maximal Expiratory Flow Rate Peak Expiratory Flow Rate Obstructive Abnormality Restrictive Abnormality Lung Volume Estimation Peak Expiratory Flow Rate Chest X-Ray Computed Tomography Scan Ultrasound Scan Magnetic Resonance Imaging Scan Gas Diffusion Capacity Arterial Blood Gas Analysis Ventilation-Perfusion Imaging Pulmonary Angiography Bronchoscopy Uses of Bronchoscope Rigid Bronchoscope Fibreoptic Bronchoscope Pleural Aspiration and Percutaneous Pleural Biopsy Important Signs and Symptoms Symptoms Cough Mechanism of Cough Sputum Haemoptysis Bronchial Asthma Introduction Aetiology and Types Extrinsic Asthma Intrinsic Asthma Gastric Asthma Pathophysiology Clinical Features Investigations Chest X-ray Pulmonary Function Tests Peak Expiratory Flow Haematological Examination Management Drugs Used in Asthma A. Drugs Used for Prevention of Asthma B. Drugs Used to Reverse Bronchospasm D. Leukotriene Antagonists E. Lipoxygenase Inhibitor Status Asthmaticus Management Important Questions Chronic Obstructive Pulmonary Disease Chapter Outline Introduction Chronic Bronchitis Emphysema Types of Emphysema Predisposing Factors for Chronic Obstructive Pulmonary Disease Pathogenesis Clinical Features Diagnosis Investigations Chest X-ray Pulmonary Function Test Management Important Questions Pneumonia Introduction Classification Primary or Community-acquired Pneumonia Secondary Pneumonia Predisposing Factors Pathological Stages Clinical Features Primary Pneumonia Pneumococcal Pneumonia Staphylococcal Pneumonia Klebsiella Pneumonia Legionella Pneumonia Viral Pneumonia (Atypical Pneumonia) Actinomycosis Mycoplasma Pneumonia Pneumonia due to Chlamydia Pneumonia in Immunocompromised Host Pneumocystis Carinii Pneumonia Physical Findings Investigations Secondary Pneumonia Acute Bronchopneumonia Clinical Findings Aspiration Pneumonia Hospital-acquired Pneumonia Pneumonia in Immunocompromised Patients Management Complications Important Questions Pulmonary Tuberculosis 24 Introduction Causative Organism Mode of Infection Primary Tuberculosis Lesions Clinical Features Symptoms Signs Miliary Tuberculosis Clinical Features Post Primary Pulmonary Tuberculosis Extrapulmonary Tuberculosis Endobronchial and Laryngeal Tuberculosis Tuberculosis Meningitis Genitourinary Tuberculosis Bone and Joint Tuberculosis Investigations Chest X-ray Laboratory Diagnosis of Tuberculosis Tuberculin Test Interpretation Causes BCG Vaccination (Bacillus Calmette-Guerin) Management Important Questions Pleural Effusion Introduction Pathogenesis Clinical Features Physical Examination Investigations Chest X-ray Ultrasonography Pleural Fluid Analysis □ Differential cell count Parapneumonic Effusion Empyema Thoracis Causes of Empyema Organisms Predisposing Factors Clinical Features Investigations Treatment Malignant Effusions Haemothorax Causes Chylothorax Bilateral Pleural Effusion Causes of Bilateral Effusion Management Important Questions Pneumothorax Introduction Spontaneous Pneumothorax Traumatic Pneumothorax Types Clinical Features Catamenial Pneumothorax Investigations Management Management According to the Aetiology Complications Important Questions Pulmonary Suppuration 27 Chapter Outline LUNG ABSCESS Investigations Management BRONCHIECTASIS Predisposing Factors Types Clinical Features Investigations Assessment of Ciliary Function Sputum Examination Chest X-ray Computed Tomography Scan Pulmonary Function Test Bronchography Management Complications Important Questions Lung Cancers Chapter Outline Introduction Aetiology and Risk Factors Classification Staging/TNM Classification Primary Tumour (T) Regional Lymph Nodes (N) Distant Metastasis (M) Clinical Features Investigations Management Important Questions Disorders of Red Blood Cells Chapter Outline Anaemia Aetiology Classification Etiological Classification Reticulocyte Index 2.5: Clinical Features Iron Deficiency Anaemia Iron Metabolism Aetiology Physiological Causes In Children In Adults (Menstruating Women) In Postmenopausal Women and Adult Men At All Ages Stages in Iron Deficiency Anaemia Clinical Features Oral Manifestations Investigations Differential Diagnosis Management Alternative parenteral Fe preparations: Iron Dextran-Intravenous (In Intramuscular Intolerance) Megaloblastic Anaemia Aetiology Causes of Macrocytosis Clinical Features Oral Manifestation Megaloblastic Anaemia Folic Acid Deficiency Investigations Management Addisonian Pernicious Anaemia Aetiology Clinical Features Laboratory Findings Management Maintenance Haemolytic Anaemia Aetiology Congenital Acquired Clinical Features Investigations Management General Measures Intravenous Immunoglobulin Haemolytic Disease of Newborn Aetiology Rh Incompatibility Clinical Presentation Investigation Suspected Case of Rh Isoimmunisation Postnatal Diagnosis Management Prenatal Management Postnatal Management Other Forms of Therapy Prevention ABO Haemolytic Disease Acquired Haemolytic Anaemias Clinical Features Treatment Red Cell Enzymopathy Glucose-6-phosphate Dehydrogenase Deficiency Clinical Features Laboratory Findings 6 Treatment Sickle Cell Anaemia Clinical Features Oral Manifestations Diagnosis Management Prophylactic Measures Thalassaemias Beta-Thalassaemia Major (Cooley’s Anaemia) Clinical Features Oral Manifestations Diagnosis Management Aplastic Anaemia Aetiology Primary Secondary Clinical Features Oral Manifestations Diagnosis Management Polycythaemia Rubra Vera (Osler’s Disease) Clinical Features Diagnosis Management Important Questions Disorders of White Blood Cells Chapter Outline Introduction Acute Myeloid Leukaemia Aetiology Classification Clinical Features Oral Manifestations Investigations Bone Marrow Examination Biochemical Investigations Molecular Studies Imaging for Mass Lesions Management Induction Complete Remission Peripheral Smear Bone Marrow Postremission Management Bone Marrow Transplantation Complications Relapse Acute Lymphoblastic Leukaemia Classification Clinical Features Investigations Complete Blood Count Management Symptomatic Bone Marrow Transplant Chronic Myeloid Leukaemia Clinical Features Investigations Bone Marrow Picture Molecular Studies Chemotherapy Imatinib Mesylate Alpha Interferon Allogeneic or Syngeneic Bone Marrow Transplant Leukapheresis and Splenectomy Treatment of Accelerated Phase and Blast Crisis Management Prognosis Special Clinical Problems in Chronic Myeloid Leukaemia False Platelet Counts Pseudohyperkalaemia Pseudohypoglycaemia Pseudohypoxaemia Chronic Lymphocytic Leukaemia Clinical Stage Clinical Features Investigations Management Important Questions Haemostasis Disorders 31 Introduction Ф PLATELET DISORDERS Quantitative Platelet Disorders Qualitative Platelet Disorders Congenital Acquired Thrombocytopaenia Causes Idiopathic Thrombocytopaenic Purpura Clinical Features In children In adults Oral Manifestations Investigations Differential Diagnosis Management In children Adults DISORDERS DUE TO DEFICIENCY OF CLOTTING FACTORS Haemophilia A © : Clinical Features Investigation Management Complications Haemophilia B (Christmas Disease) Treatment von Willebrand’s Disease Clinical Features Diagnosis Management Oral Manifestations of Haemophilia and von Willebrand Disease Vitamin K Deficiency Disseminated Intravascular Coagulation Associated Diseases Clinical Features Investigations Management Indications for Heparin Important Questions Disorders of Lymph Nodes and Spleen 32 Chapter Outline Introduction Lymph Nodes Normal Immune Response Lymphadenopathy Assessments Anatomical Site Aetiology Infectious Diseases Viral Infections Bacterial Infections Fungal Infections Chlamydial Infections Important Questions Assessment and Examination General Examination Glasgow Coma Scale Abbreviated Coma Scale Inspection Examination Orientation Emotional State Memory Handedness General Intelligence Perception Visuospatial Functions Apraxia Agnosia Sleep Examination of Speech and Language Cognitive Scales Coordination Methods of Testing Coordination Testing Coordination in the Upper Limbs Testing Coordination in the Lower Limbs Involuntary Movements Common Involuntary Movements Chorea (caudate nucleus) Signs Elicitable in Chorea Athetosis (Putamen) Hemiballismus (Subthalamic Nucleus) Dystonias (putamen) Tremors Myoclonus Tics Fasciculation Fibrillation Myokymia Titubation Abdominal Reflexes Abnormal Responses The Plantar Reflex Abnormal Responses Equivocal Babinski Sign Pseudo-Babinski Sign Babinski Sign in Absence of Pyramidal Tract Lesion Minimal Plantar Response Deep Tendon Reflexes Other Allied Reflexes Abnormalities of Tendon Reflexes Diminished or Absent Tendon Reflexes Exaggerated Tendon Reflexes Inverted Knee Reflex Primitive Reflexes (Released Reflexes) Grasp Reflex Groping Reflex Avoiding Reflex Palmo-mental Reflex Sucking Reflex Snout Reflex Glabellar Reflex Cerebellum Nuclei of the Cerebellum □ Archicerebellum (phylogenetically oldest part of cerebellum)—Vestibular: It is made up of the Clinical Manifestations of Cerebellar Dysfunction Localisation of Cerebellar Lesions Causes of Cerebellar Lesions Acute Onset Gradual Onset Treatable Cerebellar Lesions Tone Power Sensory Dermatomes Clues Rule of 3 Method of Examination Preliminary Screening Touch Pain Deep Pain Sensory Levels Remember to test for sacral sparing Examination over the Trunk Proprioceptive Sensations Position Sense Sense of Passive La medicina clínica de Alagappan para estudiantes de odontología es la última edición de este completo recurso para estudiantes. Los datos epidemiológicos actualizados y los nuevos diagramas de flujo e ilustraciones actualizan el libro. Dividida en 55 capítulos en nueve secciones, la primera sección cubre la evaluación médica general, proporcionando un cuadro de evaluación de muestra al final de la sección. Otras secciones cubren partes y sistemas específicos del cuerpo, incluyendo abdomen, sistema cardiovascular, sistema respiratorio, hematología y endocrinología. Las últimas dos secciones cubren nutrición y enfermedades infecciosas. Las manifestaciones orales de las condiciones médicas se definen claramente para los estudiantes de medicina, bajo encabezados separados cuando es necesario, y se incluyen cuadros de texto para resaltar la información clave. Esta nueva edición presenta las últimas definiciones y directrices sobre medicina clínica en odontología. Con información altamente relevante y actualizada mejorada por 264 imágenes e ilustraciones a todo color, la Medicina Clínica para Estudiantes de Odontología de Alagappan es un libro de referencia ideal y un recurso de revisión para estudiantes de odontología de pregrado. Puntos clave Nueva edición de esta guía completa de medicina clínica para estudiantes de odontología Alagappan’s Clinical Medicine for Dental Students is the latest edition of this comprehensive student resource. Updated epidemiological data and new flowcharts and illustrations bring the book firmly up to date. Divided into 55 chapters across nine sections, the first section covers general medical assessment, providing a sample assessment chart at the end of the section. Further sections cover specific parts and systems of the body, including abdomen, cardiovascular system, respiratory system, haematology and endocrinology. The final two sections cover nutrition and infectious diseases. Oral manifestations of medical conditions are defined clearly for medical students, under separate headings where necessary, and text boxes are included to highlight key information. This new edition features the latest definitions and guidelines on clinical medicine in dentistry. With highly relevant and up to date information enhanced by 264 full colour images and illustrations, Alagappan’s Clinical Medicine for Dental Students is an ideal reference book and revision resource for undergraduate dental students. Key Points New edition of this comprehensive guide to clinical medicine for dental students Previous edition published 2009 (9788184485288) 264 full colour images and illustrations