Second Edition
SN Chugh MD MNAMS FICP FICN FIACM FIMSA FISC FICA Senior Professor and Pro-Vice Chancellor Pt BD Sharma University of Health Sciences Rohtak, Haryana, India
Eshan Gupta MD DM (Cardiology Student) Govind Ballabh Pant Hospital New Delhi, India
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Clinical Methods in Medicine: Clinical Skills and Practices
First Edition: 2008
Second Edition: 2015
9789350250396
Printed at
5Dedicated to
My parents
Late Shri Chhabil Dass Chugh and Sanwari Devi Chugh
and my wife Dr Kiran Chugh
and
My children
Dr Anshul Chugh (Son)
Dr Ashima Chugh (Daughter)
and my all students and teachers
SN Chugh
7Preface to the Second Edition
After the success of first edition of this book, I am delighted to introduce the revised second edition on the request of my students. I am fully aware that in the present era, the clinical medicine has got back seat. The driving seat in medicine is occupied by highly sophisticated investigations which are marred with false-negative and false-positive results.
The student in medicine, who has to make up his career, must be acquainted with the skills and interpretation of clinical signs. What you see or elicit is more reliable than what you do not see? Student has to appear in the examination with proper skills and interpretations of the clinical signs.
I being a clinician is of the opinion that a student must learn the history taking and master the technique of interpreting and eliciting the clinical signs. The history and clinical signs prepare road map to the clinical and differential diagnoses.
A large number of books in clinical medicine written by Indian as well as Foreign authors are available, but no book is perfect, i.e. some are deficient in substance while others are deficient in elaboration of signs. Keeping these deficiencies in mind, I have prepared the second edition of this book.
Clinical Methods in Medicine: Clinical Skills and Practices consists of two sections—: History Taking and Physical Examination (Chapters 1 to 10) concentrates on History Taking and Review of System (Unit I) and Physical Examination (Unit II). I have written this as separate section because in examinations, short cases/spot cases are kept only for general physical examination. : Systemic Examination (Chapters 11 to 20) and Appendices is written on Systemic Examination (Unit III), which is comprehensive and gives explanation of each abnormal finding and Unit IV on Appendices.
This book is written for students of medicine, both for undergraduates and postgraduates. Even the clinicians will find it useful in their day-to-day practice. I have attempted to include all the available information in the literature to update this book. However, if there is an error in interpretation of a clinical sign or there is under- or over-interpretation, I may be informed personally. I shall be obliged for this gesture.
I am thankful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who have made first edition successful and now has taken sincere effort to bring the colourful edition of the book.
Any suggestion from my students and teachers will be appreciated with open heart.
SN Chugh
9Preface to the First Edition
Medicine is a fast-changing subject, is nowadays dominated by investigations instead of clinical skills in making the clinical diagnosis. There is no doubt that with fast development of science and availability of new techniques for investigations, the diagnosis can be made accurately but at exuberant cost. In the present era, the practice of medicine is changing; clinical skills have been pushed to back seat. I must say that clinical skills make up the clinical sense of the students/physicians thus cut short the demand of unnecessary investigations. The human mind is a computer, can see and interpret the clinical signs on the bedside and can give provisional diagnosis instantaneously. A good bedside examination can narrow down the differential diagnosis and provide you a concise approach for investigations and thus curtail the cost of investigations. The developing countries cannot afford such costly investigations just for pretty ailments/diseases, for example CT scan for just headache.
I being a clinician, is of the opinion that a student must learn the technique of history taking and master the interpretation of clinical signs so as to become a good physician. If you cannot see and interpret clinical sign, your mind will not think of the diagnosis and differential diagnosis. If you cannot make a provisional diagnosis, you cannot order the appropriate investigations; hence, history taking, clinical skills and methods and investigations are interlinked. Keeping this concept in mind, I am delighted to bring the first edition of this book.
A large number of books are available on clinical examination in the market, but none of them is complete. Most of them are written by foreign authors from the developed countries, lay more emphasis on the investigations than the physical signs. Our students by reading such books are not able to interpret the clinical signs and are becoming investigations-oriented which is not accepted by our society. Our patients are poor, cannot afford so much on investigations, require cheap diagnosis which can be provided by the accurate and better interpretations of clinical signs and symptoms.
This book on Clinical Methods in Medicine will provide the students an opportunity to get acquainted with the secrets of history taking and clinical examination and then take the help of appropriate bedside investigations so as to plan the management. The basic aim of the book is to describe the various skills in taking a history and step by step clinical examination including general physical and systemic examination. Unit I is devoted to history taking and analysis of the symptoms pertaining to various systems. Unit II concentrates on the clinical examination, includes first ten chapters on detailed general physical examination while next ten chapters of Unit III deals with the proper systemic examination. The approach of this book is basic, i.e. to start with the history taking and then proceed to analyse the symptoms and discuss their significance and then find all what is normal or what is abnormal on physical examination. The examination sequence is detailed, abnormal findings to be noted on inspection or palpation also detailed and relevance of abnormal findings discussed simultaneously. Throughout the book, the “key points” are highlighted in the boxes.
The book is primarily intended for the undergraduate students but the postgraduate students and even the physicians will also find it useful in day today clinical practice. The postgraduate students who are preparing for the examination and especially those who are planning to pursue higher study will also be benefitted. I have attempted to include all the available information in the literature so as to make the book presentable both for undergraduates and postgraduates. However, if there is an error in interpretation of a clinical sign or under- or over-interpretation, I may be informed personally. I will like suggestions from my teacher colleagues on this book so that I can improve on my deficiencies.
I extend my sincere thanks to M/s Jaypee Brothers Medical Publishers (P) Ltd, who have taken sincere and dedicated efforts to bring the first colourful edition of this book. I must say that best look and face to the book is provided by the publisher.
I am grateful to my family who have supported me in this endeavour.
At last, I request the readers to forward any suggestion or comment on this book to the publisher or to me.
SN Chugh