Rheumatology: Clinical Scenarios

145 Pages·2011·6.745 MB·English

by  Efim Benenson (auth.)

Rheumatology

Efim Benenson
Rheumatology
Clinical Scenarios
Syndrome or disease?
Author
Efim Benenson, MD
Professor of Medicine
Department of Internal Medicine
University of Cologne
Cologne
Germany
The work was first published as a part of a work published in 2009 by Shaker Media in
German language with the following title:
Rheumatologie: Syndrome und Algorithmen
Translation: Beverley Taylor
ISBN 978-0-85729-239-1 e-ISBN 978-0-85729-240-7
DOI 10.1007/978-0-85729-240-7
Springer London Dordrecht Heidelberg New York
A catalogue record for this book is available from the British Library
Mathematics Subject Classification (2000): insert codes if applicable
© Springer-Verlag London Limited 2011
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as per-
mitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced,
stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers,
or in the case of reprographic reproduction in accordance with the terms of licenses issued by the
Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to
the publishers.
The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of
a specific statement, that such names are exempt from the relevant laws and regulations and therefore
free for general use.
Product liability: The publisher can give no guarantee for information about drug dosage and application
thereof contained in this book. In every individual case the respective user must check its accuracy by
consulting other pharmaceutical literature.
Cover design: eStudioCalamar, Figueres/Berlin
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
I dedicate this book to my wife, Irina, for her
patience and support, our children, Anna
and Vladimir, and to our grandchildren,
Patrick, Paulina, and Wlada.

Preface
“Clinical Scenarios” is directed toward trainees of rheumatology. Active learning by case
studies on the way toward an established diagnosis based on a structured clinical knowl-
edge and thinking – such is the concept of this training. It has arisen from the experience
of practical clinical teaching.
How can I find a diagnosis for the pictures on the front matter page? Which two com-
monly confused diseases do the two hands represent? Which syndromes can be seen here:
arthritis, osteoarthritis, or both? How can I find the correct diagnosis for diseases I am
seeing for the very first time? How to get the ability to apply my knowledge about diseases
from the basic books to a real patient?
The 73 clinical situations and 156 illustrations provide a realistic simulation of every-
day medical practice – not as an illustration of the topic, but as a problem to be solved
when seeking a diagnosis. Furthermore the case reports and pictures complete most part of
the specific area of rheumatology and present the important basis of what every doctor
should be able to identify and interpret correctly. Syndrome or disease? This lately impor-
tant of questions is the key both to diagnosis and clinical training. During the training with
this book you can reach a diagnosis for the first time on your own, using the morphological
structured signs or syndromes (terminated as a stable combination of symptoms from the
Greek syn. together, dromos passage) which, unlike the symptoms, clearly depict the simi-
larities and distinctions of the individual diseases. The solutions to the images and associ-
ated clinical situations are offered not as a process of perception or visual diagnosis, but
rather as a flow of thoughts (the Greek term for flow, rheuma, happens to fit perfectly here)
and respectively the outcome of integrated morphological and pathophysiological
reasoning.
The clinical situations and figures enclose the relatively comprehensive collection of
rheumatologic leading symptoms and syndromes (Chap. 1). Certain clinical situations –
also emergencies – are presented as “typical,” “unusual,” or “memorable.” They are
labeled with the combinations of symptoms and syndromes, documented in the images by
means of various radiological and morphological methods; also included are the tradi-
tional and new therapeutic options (immunosuppressive, biologics, laser therapy, surger-
ies) partly with therapy outcomes in figures. The syndromes, especially on the images,
should be recognized by the reader in the context of the clinical situation and then linked
with the correct diagnosis. The exemplary solutions are presented, even in the case when
comparing the classical nosological and here favorite syndromes principle (Chap. 1.2).
vii
viii Preface
The reader is encouraged to enter his/her preliminary diagnosis of all figures and clini-
cal situations in Chap. 3 as self-check and then compare his/her opinion with the diagnosis
given in the Appendix. This table also serves as an index for all figures and clinical situa-
tions for a quick diagnosis. A critical review of each figure and clinical situation is pre-
sented and discussed in terms of specifics of the cases and its boundaries in the overall
context with the individual treatment options (Chap. 2).
In Clinical Scenarios with the images and clinical cases is also presented the deductive
key for their clearing. The standardized diagnostic program (diagnostic skills) achieves a
solid structuring of the findings based on morphology and pathophysiology as well as the
causal investigation and wide-ranging clinical examination. The Rheumatology Trees 1
and 2 (Tables 1 and 2) offer compact information as basics at a glance and as “shortcut” for
the already experienced colleagues who want to fresh up their proficiency. All images were
structured as syndrome-specific, non-disease-specific, or disease specific. Rheumatology:
Symptoms and Syndromes, E. Benenson, Springer 2011, is a reference work for this book.
Thus the clinical routine – from patient to information and back – is in the active learning
completely modulated. The idea, how to get a diagnosis, can be applied to other areas of
clinical medicine.
Training in rheumatology with these clinical cases could vary according to the indi-
vidual objectives: as self-assessment (quiz) or study program (case-based learning) with
the book as a well-structured guide to differential diagnosis (diagnostic Index of all syn-
dromes and diseases in the Appendix), or package of individual therapeutic options with
clear outcomes.
I wish my readers both enjoyment and success and to myself a broad discussion in the
future about clinical training ([email protected]).
Cologne, Germany Efim Benenson, MD
Acknowledgements
Sincere thanks to my colleagues Professor of Medicine Michael Hallek, Director of
Department I of Internal Medicine, University of Cologne for his advice and support, and
my former boss, Professor of Medicine Volker Diehl, for welcoming me kindly to this
Clinic in 1994, and especially Ursula Voigt-Pfeil for her active support in realizing this
project.
ix