Davidson's 100 clinical cases

391 Pages·2012·42.93 MB·English

by  Stanley Davidson, Sir, Mark W J Strachan, S K Sharma, John A A Hunter

A Davidson’s
Davidson
Title Clinical
100Cases
Commissioning Editor: Laurence Hunter
Development Editor: Carole McMurray
Project Manager: Frances Affleck
Designer: Stewart Larking
Illustration Manager: Bruce Hogarth
A
Davidson
Title
Davidson’s
The Editors
Mark W.J. Strachan 100
BSc(Hons) MD FRCP Edin
Consultant in Diabetes and
Endocrinology Metabolic Unit,
Western General Hospital, Edinburgh;
Part-time Reader, University of Edinburgh, UK
Surendra K. Sharma
MD PhD
Chief, Division of Pulmonary,
Critical Care and Sleep Medicine;
Professor and Head, Department of Medicine,
All India Institute of Medical Sciences,
New Delhi, India
John A. A. Hunter
OBE BA MD FRCP Edin
Professor Emeritus of Dermatology,
University of Edinburgh, UK
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012
Clinical Cases
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This book and the individual contributions contained in it are protected under
copyright by the Publisher (other than as may be noted herein).
First edition 2008
Second edition 2012
ISBN 9780702044595
International ISBN 9780702044601
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this feld are constantly changing. As new
research and experience broaden our understanding, changes in research methods,
professional practices or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds, or
experiments described herein. In using such information or methods they should
be mindful of their own safety and the safety of others, including parties for
whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identifed, readers are
advised to check the most current information provided (i) on procedures featured
or (ii) by the manufacturer of each product to be administered, to verify the
recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make diagnoses, to determine
dosages and the best treatment for each individual patient, and to take all
appropriate safety precautions.
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or editors assume any liability for any injury and/or damage to persons or
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Contents
Preface vii 27 Acute breathlessness 94
Acknowledgements viii 28 Progressive breathlessness
Contributors ix and cough 97
Abbreviations xv 29 Pleuritic chest pain 101
30 Haemoptysis 104
1 Genital ulceration 1 31 A solitary radiographic
2 Urethral discharge 4 pulmonary lesion 107
3 Proctitis in a man who has sex 32 Pleural effusion 112
with men 7 33 Day-time sleepiness 116
4 Vaginal discharge 10 34 Chronic wheeze 120
5 Fever in an individual with human 35 Hyponatraemia 123
immunodefciency virus infection 13
36 Hypokalaemia 126
6 Adverse drug interaction 18
37 Metabolic acidosis 129
7 Pyrexia of unknown origin 21
38 Hypomagnesaemia 133
8 Fever with jaundice and a
39 Haematuria 136
purpuric rash 25
40 Nephrotic syndrome 139
9 Short duration high-grade fever 29
41 Acute kidney injury 143
10 Weight loss 33
42 Chronic renal failure 147
11 Acute diarrhoea 37
43 Thyrotoxicosis 151
12 Eosinophilia 41
44 Solitary thyroid nodule 154
13 Snake bite 45
45 Secondary amenorrhoea 157
14 Unknown sting 49
46 Hypercalcaemia 160
15 Organophosphorus poisoning 52
47 Hypocalcaemia 163
16 Paracetamol (acetaminophen)
overdose 55 48 Cushing’s syndrome 166
17 Aluminium phosphide poisoning 58 49 Adrenal insuffciency 170
18 Disseminated malignancy 61 50 Spontaneous hypoglycaemia 174
19 Spinal cord compression 65 51 Newly discovered
hyperglycaemia 177
20 Central chest pain 68
52 Diabetic ketoacidosis 181
21 Breathlessness and peripheral
oedema 72 53 Diabetic foot ulcer 185
22 Hypertension in a young adult 75 54 Dysphagia 189
23 Syncope 79 55 Haematemesis 192
24 Palpitation 83 56 Chronic diarrhoea 195
25 Infective endocarditis 86 57 Constipation 199
26 Rheumatic fever 90 58 Chronic abdominal pain 203
v
59 Jaundice during pregnancy 207 83 Peripheral neuropathy 290
60 Acute hepatitis 210 84 Acute coma 293
61 Chronic liver disease 214 85 First ft 298
62 Liver abscess 218 86 Progressive uniocular visual loss 301
63 Malnutrition 221 87 Stroke 304
64 Falls in the elderly 225 88 Tremor 308
65 Delirium 229 89 Subacute confusion and amnesia 311
66 Dizziness 233 90 Functional weakness 315
67 Macrocytic anaemia 236 91 Anaphylaxis 318
68 Polycythaemia 239 92 The changing mole 321
69 Leucopenia 242 93 Pruritus 325
70 Cervical lymphadenopathy 245 94 Widespread scaly rash 329
71 Massive splenomegaly 248 95 Palpable purpura 332
72 Bleeding disorder 252 96 Dermatomyositis 335
73 Thrombocytopenia 256 97 A non-healing leg ulcer 340
74 Thrombocytosis 260 98 Blistering disorder 343
75 Blood transfusion reaction 264 99 Multiple hypopigmented lesions 346
76 Unilateral swollen leg 267 100 Bilateral swollen, red legs 350
77 Acute monoarthritis 271
78 Polyarthropathy 274
Appendix: 353
79 Osteoporosis 277
Biochemical and
80 Antiphospholipid antibody haematological values 353
syndrome 280
Cardiovascular risk
81 Acute headache 283 prediction charts 359
82 Chronic headache 287 Index 361
vi
Preface
We were pleased with the favourable reception given to the first edition of our
book and proud when it won first prize in the Medicine category of the 2009
British Medical Association Medical Book Competition. Indeed we feel that
there has been more than enough support for our conviction that this text should
be a welcome addition to the member of the Davidson family of books. Our
original aim; that it should encourage and help students to approach clinical
problems in a way similar to the contributors, all chosen because of their
considerable clinical and teaching experience, appears to have been met. But
medicine does not stand still and there have been ample advances and changes
in the diagnosis and management of diseases to warrant an extensive update and
revision of the text. We have dropped a few cases and added a number more to
complete the century; hence the not so subtle change in the title of this edition!
Davidson’s Principles and Practice of Medicine, now in its 21st edition,
has stood the test of time because it continues to reflect Sir Stanley Davidson’s
determination to produce a book that was readable without ambiguity, uncertainty
or wordiness. It attempts to provide an international perspective on disease, to
reflect the huge success that the book has had in many parts of the world,
especially in the Indian subcontinent.
In Davidson’s 100 Clinical Cases we re-emphasise the value of interpreting
available clinical and investigative information in a logical way before considering
a definitive diagnosis. We asked our contributors to take the reader through their
cases in a personal way and to avoid regurgitating long and all-embracing lists
from larger textbooks! Our selection of cases continues to be based on the
‘Presenting Problems’ of the (21st) edition of Davidson’s Principles and Practice
of Medicine and illnesses that reflect an international outlook. We have remained
strict in our editing in an effort to ensure uniformity in the layout and style of the
many contributions.
We hope that our readers will continue to find that knowledge imparted in this
manner is not only easy and painless to digest but useful in practice. Welcome to
the second edition of Davidson’s 100 Clinical Cases!
M.W.J.S., S.K.S. and J.A.A.H.
Edinburgh and New Delhi, 2011
vii
Acknowledgements
Case 64: M Y Rao acknowledges assistance from Robert Rao MBBS, Nuffield
Department of Surgery, John Radcliffe Hospital, University of Oxford, UK.
Case 96: TAzhar acknowledges assistance from Suhaimi Ayoub MD MMED,
International Islamic University of Malaysia, Pahang Darul Makmur, Malaysia.
Case 4: Fig 24.1 supplied courtesy of A McMillan and G Scott, 2000, Colour
Guide to Sexually Transmitted Infections, Churchill Livingstone, Edinburgh.
Case 43: T Das acknowledges assistance from Dr Satinath Mukherjee,
Department of Endocrinology, IPGMER, Kolkata, India. Case 50: The figure
was reproduced with the kind permission of Dr lan Penman, Department of
Gastroenterology, Western General Hospital, Edinburgh. Case 60: The figure
was provided courtesy of Dr Philip P. C. Ip, Department of Pathology and
Clinical Biochemistry, Queen Mary Hospital, Hong Kong. Case 85: The figure
was kindly provided by Prosessor Selim Benbadis, University of South Florida.
Case 87: The figure was provided courtesy of Dr A. J. Farrell, SINAPSE
Collaboration, University of Edinburgh. Case 98: The figure was reproduced
from Hunter J H, Savin J A and Dahl M V, Clinical Dermatology, 3rd edn, 2002.
With permission from Blackwell Publishing.
viii
Contributors
T. Ahmed J. I. O. Craig
MBBS FCPS (Bangladesh) FCPS (Pak) MRCP MB ChB MD FRCP Edin FRCPath
FRCP Edin Glas Ire FACP FCCP Consultant Haematologist, Department
Professor of Medicine, Gono of Haematology, Addenbrooke’s
Biswalidyalaya, Savar, Dhaka and Hospital, Cambridge, UK
Ex Dean of Postgraduate Medicine,
Dhaka University, Bangladesh A. Cumming
MBChB MD FRCP
I. D.-R. Arnott Professor of Medical Education and
BSc MBChB MD FRCP Edin Consultant in Renal Medicine,
Consultant Gastroenterologist and Department of Renal Medicine,
Honorary Senior Lecturer, University of Edinburgh, UK
Gastrointestinal Unit, Western
General Hospital, Edinburgh, UK M. K. Daga
MD MNAMS
T. Azhar Director Professor of Medicine and Head
MBBS FRCP FFRRCS(I) of Medical ITU, Department of Medicine,
Deputy Rector, Academic and Planning, Maulana Azad Medical College,
International Islamic University Malaysia, New Delhi, India
Kuala Lumper, Malaysia
D. Dalus
S. Banerjee MD FRCP PhD
MD Professor & Head, Department of
Professor, Department of Medicine, Internal Medicine, Medical College
Vivekananda Institute of Medical Hospital, Trivandrum, India
Sciences, Kolkata, India
T. Das
H. S. Bawaskar MD
Bawaskar Hospital and Research Professor and Head, Department of
Centre, Raigad Maharastra, India Medicine, Institute of Post-graduate
Medical Education and Research and
P. Bloomfeld S.S.K.M. Hospital, Kolkata, India
MD FRCP FACC
Consultant Cardiologist, Department of R. J. Davenport
Cardiology, Royal Infrmary of DM FRCP Edin BMBS BMedSci
Edinburgh, UK Consultant Neurologist and Honorary
Senior Lecturer, Department of Clinical
J. D. Bos Neurosciences, Western General
MD PhD FRCP
Hospital, Edinburgh, UK
Professor and Chairman, Department
of Dermatology, Academic Medical J. M. Davies
Centre, University of Amsterdam, MA MD FRCP FRCPath
the Netherlands Consultant Haematologist and Honorary
Senior Lecturer, Department of
J. Collier Haematology, Western General Hospital,
MD FRCP
Edinburgh, UK
Consultant Hepatologist, Department of
Gastroenterology and Hepatology, John
Radcliffe Hospital, Oxford, UK
ix