Preface to the 6th Edition ................................ vii
Acknowledgements ......................................... ix
Section A: Short Cases
CHAPTER 1 General Examination ...... 3
Introduction ...................................................... 3
Jaundice .......................................................... 12
Cyanosis ......................................................... 16
Clubbing ......................................................... 18
Koilonychia .................................................... 23
Examination of Hands .................................... 30
Generalized Oedema ...................................... 34
Cervical Lymphadenopathy ........................... 36
Generalized Lymphadenopathy ..................... 40
Pigmentation .................................................. 43
Erythema Ab Igne .......................................... 47
Gynaecomastia ............................................... 49
Erythema Nodosum ....................................... 53
Leprosy (Hansen’s Disease) ........................... 57
Superior Vena Caval Obstruction
(Superior Vena Caval Syndrome) ............... 61
Inferior Vena Caval Obstruction .................... 64
Hirsutism ........................................................ 66
Polycystic Ovarian Syndrome ........................ 71
Leg Ulcer ....................................................... 74
Pyoderma Gangrenosum ................................ 77
Diabetic Foot .................................................. 80
Diabetic Ulcer ................................................ 82
Diabetic Amyotrophy ..................................... 85
Lipodystrophy of Thigh ................................. 87
Necrobiosis Lipoidica Diabeticorum ............. 88
Unilateral or Bilateral Leg Swelling .............. 90
Angioedema ................................................... 95
Deep Venous Thrombosis (DVT) ................... 97
Cellulitis ...................................................... 102
Erysipelas .................................................... 104
Peripheral Vascular Disease ........................ 106
Buerger’s Disease (Thromboangiitis
Obliterans) ............................................... 108
Bardet–Biedl Syndrome .............................. 109
Tongue ......................................................... 110
Hairy Leukoplakia ...................................... 114
Dupuytren’s Contracture ............................. 116
Paget’s Disease ............................................ 118
Lupus Pernio ............................................... 121
CHAPTE 2 Cardiovascular System ........................................ 127
Introduction ................................................. 127
Mitral Stenosis ............................................ 140
Mitral Regurgitation .................................... 147
Mitral Valve Prolapse (Barlow’s
Syndrome or Floppy Mitral Valve) ......... 150
Mitral Stenosis with Mitral Regurgitation
(Mixed Mitral Valve Disease) ................. 152
Aortic Stenosis ............................................ 154
Aortic Regurgitation ................................... 159
Aortic Stenosis with Aortic Regurgitation
(Mixed Aortic Valve Disease) ................. 165
Tricuspid Regurgitation (TR) ...................... 167
Tricuspid Stenosis (TS) ............................... 169
Pulmonary Stenosis (PS) ............................ 170
Pulmonary regurgitation (PR) ..................... 173
Prosthetic Heart Valves ............................... 175
Congenital Heart Disease ............................ 179
Tetralogy of Fallot (TOF) ........................... 181
Ventricular Septal Defect (VSD) ................ 185
Eisenmenger’s Syndrome ............................ 188
Atrial Septal Defect (ASD) ......................... 191
Patent Ductus Arteriosus (PDA) ................. 194
Coarctation of Aorta .................................... 197
Marfan’s Syndrome ..................................... 201
Dextrocardia ................................................ 205
Examination of Pulse .................................. 206
Atrial Fibrillation (Irregular Pulse) ............. 208
Slow Pulse Rate (Complete Heart Block) ..... 213
Absent Pulse (Takayasu’s Disease) ............... 216
Pericardial Effusion ...................................... 219
Chronic Constrictive Pericarditis .................. 222
Acute Pericarditis .......................................... 225
Rheumatic Fever ........................................... 228
Hypertrophic Cardiomyopathy ..................... 233
CHAPTER 3 Respiratory system .....239
Introduction ................................................... 239
Pleural Rub or Crepitations ........................... 253
Pleural Effusion ............................................ 255
Pneumothorax ............................................... 265
Bronchiectasis ............................................... 272
Bronchiectasis with Cystic Fibrosis .............. 277
Dpld (Previously Called Fibrosing
Alveolitis or ILD) ..................................... 280
Consolidation ................................................ 284
Collapse of Lung ........................................... 293
Fibrosis of Lung ............................................ 296
Lung Abscess ................................................ 298
Chronic Obstructive Pulmonary
Disease (COPD) ........................................ 302
Chronic Bronchitis ........................................ 309
Emphysema ................................................... 312
Mass Lesion in Lung (Bronchial
Carcinoma) ................................................ 317
Lobectomy and Pneumonectomy .................. 325
Rheumatoid Lung .......................................... 327
CHAPTER 4 Abdomen ...................331
Introduction ................................................... 331
Splenomegaly (Not Hepatomegaly) .............. 340
Splenomegaly (Tropical Splenomegaly
Syndrome) ................................................. 344
Hepatosplenomegaly ..................................... 346
Hepatosplenomegaly (Discussion
About Malaria) ...........................................350
Hepatosplenomegaly (Discussion
About Kala-Azar) ...................................... 357
Post-Kala-Azar Dermal Leishmaniasis
(PKDL) ..................................................... 362
Hepatomegaly (Isolated) ............................... 364
Hepatomegaly (Discussion About
Hepatoma) ................................................. 368
Hepatomegaly (Enlarged Tender
Liver, Viral Hepatitis) ................................ 372
Tender Hepatomegaly (Discussion
About Liver Abscess) ................................ 378
Hepatomegaly (Discussion About
Hydatid Cyst) ............................................ 382
Ascites ........................................................... 385
Ascites (Discussion About
Tuberculous Peritonitis) ............................ 391
Chronic Liver Disease or Cirrhosis
of Liver ...................................................... 393
Porto-Systemic Encephalopathy
(Discussion About PSE or Hepatic
Precoma) ....................................................406
Hepatomegaly (Discussion about
Primary Biliary Cirrhosis) ..........................410
Hepatomegaly (Discussion about
Haemochromatosis) ...................................415
Abdominal Mass ............................................419
Mass in Different Sites of Abdomen ..............421
Mass in the Epigastrium (Discussion
About Carcinoma of Stomach) ..................429
Mass in the Epigastrium (Discussion
About Carcinoma of Head of Pancreas) ....433
Mass in the Epigastrium (Discussion
About Pancreatic Pseudocyst) ....................436
Mass in the Epigastrium (Discussion
About Aneurysm of Aorta) .........................438
Mass in Right Iliac Fossa (Discussion
About Ileo-Caecal Tuberculosis) ...............442
Mass in Right Iliac Fossa (Discussion
About Crohn’s Disease) .............................445
Carcinoma of Colon .......................................451
CHAPTER 5 Haematology ..............457
Introduction ................................................... 457
Generalized Lymphadenopathy
(Hodgkin’s Lymphoma) ............................ 459
Generalized Lymphadenopathy
(Chronic Lymphatic Leukaemia) .............. 468
Splenomegaly (Chronic Myeloid
Leukaemia) ............................................... 471
Purpura .......................................................... 475
Purpura (Discussion About Idiopathic
Thrombocytopenic Purpura) ..................... 480
Purpura (Discussion About
Henoch–Schönlein Purpura) ..................... 483
Splenomegaly (Hereditary Haemolytic
Anaemia) ................................................... 486
Anaemia (Iron Deficiency Anaemia) ............ 491
Splenomegaly (Discussion About
Polycythaemia Rubra Vera) ....................... 498
Splenomegaly (Myelofibrosis) ...................... 501
CHAPTER 6 Endocrinology ............505
Examination of Thyroid Gland ..................... 507
Face in Thyroid Disease (by Looking
at the Face) ................................................ 510
Thyrotoxicosis (Hyperthyroidism) ................ 512
Thyroid disorders in pregnancy .................... 518
Hypothyroidism ............................................ 521
Hypothyroidism in Pregnancy ...................... 528
Graves’ disease .............................................. 531
Goitre ............................................................ 536
Thyroid Malignancy ...................................... 545
Acromegaly ................................................... 548
Cushing’s Syndrome ..................................... 555
Addison’s Disease ......................................... 562
Tall Stature .................................................... 568
Klinefelter’s Syndrome ................................. 569
Short Stature .................................................. 572
Diabetes Mellitus .......................................... 575
CHAPTER 7 Nephrology ................587
Mass in Flank (Renal) ................................... 589
Bilateral Renal Mass (Polycystic
Kidney Disease) ........................................ 591
Unilateral Mass (Renal Cell
Carcinoma) ................................................ 594
Mass in Left or Right Iliac
Fossa (Transplanted Kidney) .................... 597
Nephrotic Syndrome .................................. 601
CHAPTER 8 Neurology ..................613
Introduction ................................................... 613
Neurological Examination of
Lower Limb .............................................. 615
Spastic Paraplegia (Spinal Cord
Compression) ............................................ 621
Multiple Sclerosis (Presenting as Spastic
Paraplegia) ................................................ 628
Multiple Sclerosis (Presenting in
other Forms) .............................................. 633
Transverse Myelitis (Presenting
as Spastic Paraplegia) ................................ 635
Flaccid Paraplegia ......................................... 638
Guillain–Barré Syndrome (Presenting
as Flaccid Paraplegia) ............................... 640
Monoplegia (Brown–Séquard
Syndrome) ................................................. 644
Old Poliomyelitis (Presenting
as Monoplegia) .......................................... 646
Polyneuropathy ............................................. 648
Subacute Combined Degeneration
(Presenting as Polyneuropathy) ................ 653
Motor Neuron Disease (MND) ..................... 657
Friedreich’s Ataxia ........................................ 664
Cerebellar Lesion .......................................... 668
Parkinson’s Disease ...................................... 672
Chorea ........................................................... 681
Tremor ........................................................... 685
Speech ........................................................... 688
Dysphasia ...................................................... 691
Dysarthria ...................................................... 694
Examination of Hands (Wasting
of Small Muscles of Hands) ...................... 697
Syringomyelia ............................................... 700
Myotonic Dystrophy ..................................... 703
Myopathy (Muscular Dystrophy) ................. 706
Carpal Tunnel Syndrome (Median
Nerve Palsy) .............................................. 712
Ulnar Nerve Palsy ......................................... 715
Radial Nerve Palsy ........................................ 717
Cranial Nerves .............................................. 719
Facial (VIIth) Nerve Palsy ............................ 723
VIth Nerve Palsy ........................................... 728
Multiple Cranial Nerve Palsy ........................ 729
CVD with Hemiplegia .................................. 732
Gait Abnormality .......................................... 739
Orofacial Dyskinesia ..................................... 741
Foot Drop (Common Peroneal
Nerve Palsy) .............................................. 743
Charcot–Marie–Tooth Disease
(Peroneal Muscle Atrophy) ....................... 745
Cervical Myelopathy ..................................... 748
Cerebello-Pontine (CP) Angle Lesion .......... 751
CHAPTER 9 Rheumatology ............755
Introduction ................................................... 755
Systemic Sclerosis ........................................ 757
Raynaud’s Phenomenon or Disease .............. 764
Rheumatoid Hand ......................................... 767
Knee Joint Arthritis (Examination
of Knee Joint) ............................................ 780
Juvenile Idiopathic Arthritis (JIA/JCA) ........ 784
Septic Arthritis .............................................. 789
Haemophilic Arthritis .................................... 792
Reiter’s Syndrome (or, Reactive
Arthritis) .................................................... 798
Psoriatic Arthropathy .................................... 801
Ankylosing Spondylitis ................................. 805
Dermatomyositis or Polymyositis ................. 811
Proximal Myopathy ...................................... 817
Gout ............................................................... 820
Systemic Lupus Erythematosus (SLE) ......... 825
Vasculitis ....................................................... 838
Osteoarthrosis ............................................... 842
Charcot’s Joint .............................................. 845
CHAPTER 10 Examination of the Eye .....................................849
Introduction ................................................... 849
Optic Atrophy ................................................ 851
Papilloedema (Pure) ...................................... 854
Retinal Vein Occlusion (Central and
Branch Retinal Vein Occlusion) ................ 858
Hypertensive Retinopathy ............................. 860
Retinal Haemorrhage .................................... 862
Diabetic Retinopathy .................................... 864
Retinitis Pigmentosa ..................................... 869
Ptosis ............................................................. 871
Horner’s Syndrome ....................................... 875
Argyll Robertson Pupil (AR Pupil) ............... 877
Holmes–Adie Pupil (Myotonic pupil) .......... 878
Brief Discussion about Different
Types of Pupil ........................................... 879
Exophthalmos ............................................... 881
Nystagmus ..................................................... 884
Subhyaloid Haemorrhage .............................. 888
Choroido-Retinitis ........................................ 890
Retinal Detachment ....................................... 892
Drusen ........................................................... 893
Retinal Artery Occlusion ............................... 895
Miscellaneous Ocular Abnormality .............. 897
CHAPTER 11 Dermatology.....................................903
Introduction ................................................... 903
Psoriasis ........................................................ 905
Erythema Multiforme and Stevens–
Johnson Syndrome .................................... 910
Dermatitis Herpetiformis .............................. 913
Herpes Zoster (Shingles) ............................... 916
Acanthosis Nigricans .................................... 920
Ichthyosis ...................................................... 922
Pemphigus Vulgaris ...................................... 924
Pemphigoid (Bullous) ................................... 927
Arsenicosis (Chronic Arsenic Toxicity) ........ 930
Scabies .......................................................... 933
Lupus Vulgaris .............................................. 936
Lichen Planus ................................................ 939
Exfoliative Dermatitis ................................... 943
Alopecia ........................................................ 947
Vitiligo .......................................................... 950
Neurofibroma ................................................ 952
Mycosis Fungoides ....................................... 955
Tuberous Sclerosis ........................................ 957
Kaposi’s Sarcoma .......................................... 959
Pityriasis Versicolor (Tinea Versicolor) ........ 961
CHAPTER 12 Miscellaneous .........965
Face in Different Diseases ............................ 965
Wegener’s Granulomatosis ........................... 968
Butterfly Rash ............................................... 969
Turner’s Syndrome ........................................ 971
Down’s Syndrome ......................................... 974
Bilateral Parotid Enlargement ....................... 976
Xanthelasma .................................................. 978
Sturge–Weber’s Syndrome ............................ 980
Hereditary Haemorrhagic Telangiectasia ...... 981
Yellow Nail Syndrome .................................. 983
Skin Cancers ................................................. 984
Normal Case .................................................. 986
Bibliography ..................................................987
Index ..............................................................989
Section B: Common Interpretations in Medicine
(Available Online)
CHAPTER 13 Data Interpretation
CHAPTER 14 X-Ray, CT and MRI
CHAPTER 15 E CG
CHAPTER 16 Pictures
CHAPTER 17 Instruments
