Differential Diagnosis of Common Complaints

506 Pages·2011·24.55 MB·English

by  Robert H. Seller

DIFFERENTIAL
DIAGNOSIS
OF COMMON
COMPLAINTS
Sixth Edition
ROBERT H. SELLER, MD
Emeritus Professor of Family Medicine and Medicine
Former Chairman, Department of Family Medicine
State University of New York at Buffalo
School of Medicine and Biomedical Science
Buffalo, New York
ANDREW B. SYMONS, MD, MS
Assistant Professor and Vice Chair for Medical Student Education
Department of Family Medicine
Course Director, Clinical Practice of Medicine
State University of New York at Buffalo
Medical Staff, Mercy Hospital of Buffalo
Buffalo, New York
Medical Staff, Millard Fillmore Suburban Hospital
Williamsville, New York
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
DIFFERENTIAL DIAGNOSIS OF COMMON COMPLAINTS ISBN: 978-1-4557-0772-0
Copyright © 2012, 2007, 2000, 1996, 1993, 1986 by Saunders, an imprint of Elsevier Inc.
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Notice
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
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Previous editions copyrighted 2007, 2000, 1996, 1993, 1986
Library of Congress Cataloging-in-Publication Data
Seller, Robert H., 1931-
Differential diagnosis of common complaints.—6th ed. / Robert H. Seller, Andrew B. Symons.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4557-0772-0 (pbk. : alk. paper) 1. Diagnosis, Differential. I. Symons, Andrew B. II. Title.
[DNLM: 1. Diagnosis, Differential. WB 141.5]
RC71.5.S45 2013
616.07’5—dc23 2011022111
Acquisitions Editor: James Merritt
Developmental Editor: Barbara Cicalese
Publishing Services Manager: Anne Altepeter
Project Manager: Deepthi Unni, Louise King
Designer: Steven Stave
Printed in China
Last digit is the print number 9 8 7 6 5 4 3 2 1
To my sons,
Michael, Adam, and Stuart
RHS
To my wife, Einav,
who supports me in all my endeavors
ABS
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Preface
The purpose of the sixth edition of Differential Diagnosis of Common Com-
plaints remains the same as the first—to help physicians accurately and effi-
ciently diagnose common complaints. This book emphasizes a clinical approach
to diagnosis rather than one that relies largely on diagnostic studies. Most medi-
cal school curricula, texts, and continuing education courses deal with diseases.
However, patients usually come to their physicians complaining of headache,
backache, or fatigue—not migraine, spinal stenosis, or depression. To address
this reality, this book is organized around common presenting complaints—
the patients’ symptoms rather than the disease. The 36 symptoms reviewed
account for more than 80% of the chief complaints with which physicians are
confronted. The physician who has mastered the differential diagnosis of these
symptoms will be able to diagnose accurately almost all the problems seen in a
typical medical practice.
Each chapter deals with different common complaints, which are presented
alphabetically. The chapters are organized to approximate the problem-solving
process that most physicians use to make a diagnosis. Initially, the presenting
symptom suggests several diagnostic possibilities. Then, this diagnostic list is
further refined and reduced by additional, more specific, historical findings; by
the patient’s physical findings; and then by the results of diagnostic studies. The
index lists all complaints, symptoms, and diagnoses noted in the text.
As with prior editions, this sixth edition has been revised to include sugges-
tions by colleagues and students who appreciate the book’s clinical orientation
and practical approach to differential diagnosis. Each chapter has been revised
to include new information, with an emphasis on the latest clinical and diagnos-
tic studies.
The text does not deal extensively with pathophysiology or therapy except in
situations in which this information is particularly useful in the diagnostic pro-
cess. The most useful and up-to-date diagnostic studies for differential diagnosis
are reviewed. When available, evidence-based information is included. The text
concentrates on the most likely diagnoses and common illnesses that include
many serious illnesses. It also notes when the physician must rule out extremely
serious diagnostic possibilities.
The format of each chapter has remained the same:
Introduction. Includes relevant definitions as well as a list of the most com-
mon causes of the symptoms.
v
vi Preface
Nature of patient. Identifies those conditions that are most prevalent within
a particular subgroup (e.g., children, the elderly, and premenopausal, diabetic,
hypertensive, and immunocompromised individuals).
Nature of symptoms. Further identifies conditions by amplifying additional
characteristics of the symptoms (how, when, where, radiation, acute/chronic,
and others).
Associated symptoms.
Precipitating and aggravating factors.
Ameliorating factors.
Physical findings.
Diagnostic studies.
Less common diagnostic considerations.
Differential diagnosis table. A concise table located at the end of each chapter
summarizes the salient differential diagnostic features of the most common clini-
cal entities that cause a particular complaint.
Selected references. Most articles represent an approach to the differential
diagnosis of problems rather than a review of a specific disease.
Clinicians and students may use this book for general information about the
many causes of common chief complaints. They can also use it as a reference
text when treating a patient who is complaining of a specific symptom (e.g.,
facial pain, shortness of breath, fever) when the diagnosis is not apparent.
Differential Diagnosis of Common Complaints was written to be useful. We
hope you find it so. Remember the adage: “If you don’t think about it, you will
never diagnose it.”
Robert H. Seller
Andrew B. Symons
Acknowledgments
Carolyn Doueck, CGF Health Sciences Libraries, provided invaluable assistance
with the literature reviews. We also wish to thank two editors: Lisette Bralow,
who, as the initial acquisitions editor, saw the potential of what became the first
edition of this book, and Jim Merritt, senior acquisitions editor at Elsevier, who
encouraged us to write this sixth edition.
RHS
ABS
vii
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