Exam Preparatory Manual for Undergraduates MEDICINE
Exam Preparatory Manual for Undergraduates MEDICINE
Second Edition
Archith Boloor MBBS MD (Internal Medicine)
Associate Professor Department of Medicine Kasturba Medical College Manipal Academy of Higher Education Mangaluru, Karnataka, India archithb@gmail.com
Ramadas Nayak MBBS MD
Professor and Head Department of Pathology Yenepoya Medical College Yenepoya (Deemed to be University) Mangaluru, Karnataka, India Formerly Head, Department of Pathology Kasturba Medical College Manipal Academy of Higher Education Mangaluru, Karnataka, India askdr.nayak@gmail.com
Foreword
Chakrapani M
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Exam Preparatory Manual for Undergraduates—Medicine
First Edition: 2017
Second Edition: 2018
9789352704941
Printed at
All the wonderful students for inspiring us
and
All the kindred souls who believed in us
Internal medicine is expanding and evolving rapidly and there is a need for comprehensive yet simple textbook. Indian medical students have to be very competitive and up-to-date to excel in their fields. While a number of textbooks from foreign authors are available for the Indian students, they might not serve the purpose of preparing the students for the Indian examinations. A few Indian authors have accepted this challenge and have published textbooks oriented towards Indian medical examinations. Dr Archith Boloor realized this need many years ago and took up the challenge of publishing a textbook in internal medicine which was received well by the student community. Huge success of the first edition has prompted him to come out with the second edition of the book.
Dr Archith Boloor is an exceptionally gifted clinician and teacher. He has taken keen interest in medical education from his early days in the medical college and with more than a decade of experience in this field, he has been able to understand the needs of the students with regard to the medical examinations. He has received the Best Teacher Award at Kasturba Medical College, Mangaluru for many years.
The second edition of this compilation has seen qualitative improvements over the previous edition. While the contents of the book are comprehensive, presentation is simple. Clinical images, tables, boxes, algorithms and diagrams are simple and enhance the learning. This book will definitely be an essential learning tool for students of internal medicine.
Chakrapani M MD
Professor
Department of Medicine
Formerly, Head and Associate Dean
Kasturba Medical College
Manipal Academy of Higher Education
Mangaluru, Karnataka, India
Foreword to the First Edition
I am very proud to write a foreword to this book Exam Preparatory Manual for Undergraduates—Medicine written by Dr Archith Boloor, one of the outstanding students, trained in the Department of Medicine of our college of which I am faculty as Professor of Medicine. Coming from a rural background from outskirts of Mangaluru, Dr Boloor after getting a merit seat in Kasturba Medical College, Mangaluru for MBBS in 1998, completed his final MBBS with credit in the year 2003. He joined as a postgraduate student in the year 2005 and was the best outgoing PG student in the May 2008 examinations, a performance for which he was conferred gold medal. Soon after joining our department as a faculty, he had been committed teacher as proven by the Good Teacher Awards in the years 2013 and 2015 and Dr Patrick Pinto Memorial Best Teacher Award in 2014. The importance of these awards lies in that the selection is done by students which shows the efficacy of teaching. Not contented with this alone and trying to do better for the cause of students, I am pleased to know from him that he is writing a textbook on Exam Preparatory Manual for Undergraduates—Medicine which is meant for training the students for internal medicine especially to face the final MBBS examination. Having taken part in several scientific meetings, continuing medical educations (CMEs) and conferences in internal medicine, here as a speaker and panelist give him credentials to write the book. I hope that this book will be different from other books. It will be student-centric rather than author-centric.
M Venkatraya Prabhu MD
Dean and Professor
Department of Medicine
Kasturba Medical College
Manipal Academy of Higher Education
Mangaluru, Karnataka, India
Email: dean.kmcmlr@manipal.edu
Website: www.manipal.edu
Preface to the Second Edition
We have been extremely grateful for the positive response rendered towards the book, Exam Preparatory Manual for Undergraduates—Medicine and were thus, excited to undertake the challenge of developing a new edition. Surfing beyond plainly updating the literature, this second edition gifted us with the opportunity to further explore topics we ourselves have wrestled with as a student, teacher and teacher educator and also build an understanding of how we approach students and their texts.
In the year and a half following the release of the first edition of this book, we have received numerous feedbacks via e-mails and letters from readers who have given wonderful suggestions on how we could further upgrade the material. We had also built up a large file of ideas based on our own experiences in reading, writing and editing during this time. With the aid of all this information, we have completely revised the book.
In this second edition, the following changes and additions have been incorporated:
- Updated the literature, substantially reordered and updated the material according to the current guidelines in all chapters.
- Included clinical images for all commonly encountered medical conditions.
- Added X-rays, MRIs, CT scans and ECG images of common conditions with explanations.
- Treatment algorithms have been revised and updated.
- Topics regarding clinical trials and research methodology have been added.
- A full chapter on ‘common emergencies in medicine’ is included as a ready reckoner.
- With an eye to the book's potential use as an aid for entrance preparation, high yield points are highlighted in each section
- The bibliography has been updated. Many new editions of books are referenced and updated references have been added.
We must hereby acknowledge those who have helped us with this new edition. We are especially grateful for the ongoing encouragement from our university, Manipal Academy of Higher Education (MAHE) and Yenepoya Medical College (Deemed to be University), Mangaluru, Karnataka, India. We would like to express our gratitude to Dr Ramdas M Pai (Chancellor), Dr HS Ballal (Pro-Chancellor), Dr H Vinod Bhat (Vice-Chancellor), Dr V Surendra Shetty and Dr Poornima Baliga (Pro Vice-Chancellor) of MAHE, for their continued support.
We profusely thank Dr Chakrapani M, for his support and for writing the foreword for this edition.
We would also like to extend our warm thanks to our esteemed colleagues/friends Dr Sheetal Raj, Dr Saritha Aadhi, Dr Sachin Vemula, Dr Kaushiki Kirty, Dr B Thinakar Mani, Dr Sibithooran Karmegan, Dr Vishnu B Chandran, Dr Narendran Krishnamoorthy, Dr Pradeep Krishna Chowdary, Dr Madhurya Mallavarapu, Dr Deepti Ajjangadi, Dr Ashwini Kamath, Dr Holla Subraya Krishna, and Dr Thomas Kuncheria, for their contributions with the clinical images and proofreading.
We humbly place on record our heartfelt gratitude to our students Dr Mishaal Talish, Dr Sidharth Herur, Dr Raghu RV, Dr Sriraksha R Nayak, Dr M Harsha Sagar, Dr Nikhil Kenny Thomas, Dr Vivek K Koushik, Dr Navyashree HC, Dr Padakanti Anudeep Rao, Dr Laveena MariamJohn, Dr Ashwini MV, Dr Alister Joseph Thomas, and Dr Mohamed Faizan Thouseef, for their help in proofreading and correction.
We would further like to thank all our teachers, department colleagues, our current and former students and students from various colleges all over India, for their valuable suggestions and input.
Finally, we would like to acknowledge with gratitude, the support of our all family members, for their support and love, which has made us successful in our endeavors.
Students who have read the book before should find the revised edition more lucid and palatable, while those who have waited for scouts to carve the path will find the road paved and tested. Your suggestions are happily solicited for any improvements, if necessary.
Archith Boloor
Ramadas Nayak
Preface to the First Edition
The glory of medicine is that it keeps moving forward, that there is always more to learn.
We look for medicine to be an orderly field of knowledge and procedure but it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. The gap between what we know and what we aim for persists. And this book is an attempt in bridging the gap.
This book is a first of its kind with an amalgamation of clinical pathology and clinical medicine, resulting in an integrated comprehensive manual.
Every attempt has been made by us to present information in a simplified text augmented with the use of colored illustrations, flowcharts, algorithms which help the reader to understand the concepts, recollect and make use of and thus acquire knowledge in the examinations as well as in clinical practice.
It is designed for use as a companion book for exam preparation for undergraduates. The main characteristics of this book are:
- Reader-friendly pattern
- Color coded as in etiology, management, etc.
- Includes management algorithms
- Key points are highlighted
- Question-answer format
- Covers all the questions appeared in university examinations till April 2016
- Extensively covers all theory and most clinical scenarios
- Management practices have been updated till September 2016
- Recent advances, newer drugs and upcoming sections of Geriatrics, Immunology, Clinical Pharmacology have been included
- Exclusive coverage of high yielding points which are important for answering MCQs.
This book consists of 23 chapters and is organized into systemwise chapters which are further divided into subsections. Each chapter starts with basic introduction and proceeds to individual disease discussions. The etiology of the diseases have been separately included. Also, important management sections are in separate colored tables, so that selective reading can be done. Important clinical examination-oriented questions have also been included under each section. Diagnostic procedures have been discussed separately. Radiological investigations and their abnormalities have been emphasized especially X-ray findings of specific diseases. Basic reading of ECGs have been covered with the common abnormalities encountered. Clear ECG images have been included for better understanding. Also, many tables comparing clinical situations/abnormalities will aid in better understanding and also help in answering a lot of questions in the clinics as well as viva voce. All common clinical cases (long, semi-long, and short) that you would encounter in your practical examination have been covered extensively to give the readers an edge over.
After many years of teaching undergraduates, we found that undergraduate students find it difficult to understand, remember and answer the questions during examinations in a satisfying way. There are many textbooks, but students face difficulty to refresh their knowledge during examinations. This encouraged us to write a book to fill the niche, to provide basic information to them in a nutshell. Most students are fundamentally ‘visually-oriented’. As the saying goes ‘a picture is worth a thousand words’, it encouraged us to provide many illustrations.
We recommend this book to all students for understanding the basic knowledge and refresh their knowledge during examinations. One of the aims of the students after getting undergraduate degree is to fetch a good ranking in the postgraduate entrance examination. Most graduates cannot answer multiple choice questions in entrance examination by just reading the usual textbooks in medicine. Our book lays specific importance on this aspect and answers to most commonly asked MCQs. This book provides sufficient information which would help postgraduates and practicing clinicians in the knowledge and management of cases.
Archith Boloor
Ramadas Nayak
Acknowledgments
‘Writing this book has been an exercise in sustained knowledge gain, and for those who have played the larger role in our endeavor with constant encouragement and support; Well, you know who you are; Just a thanks would not suffice’.
After almost 6 years of working on it, we could not possibly come up with a full list of all the people who had helped, but we will try our best.
Dr Archith Boloor, thanks his family members namely his mother, Mrs Kumuda; sisters, Ms Arati, Ms Archana and Ms Aparna, his father and others. Dr Ramadas Nayak thanks Mrs Rekha Nayak and Dr Rakshatha Nayak who have patiently accepted his long preoccupation with this work.
We wish to express our gratitude to Dr Ramdas M Pai, Chancellor, Manipal University, Karnataka, India, for giving us an opportunity to be a part of this prestigious institution for nearly 20 years, to pursue our dreams and to grow to be the physician and teacher that we are today.
We are indebted to Dr HS Ballal (Pro-Chancellor), Dr H Vinod Bhat (Vice-Chancellor) and Dr V Surendra Shetty (Pro Vice-Chancellor) of Manipal University, Karnataka, India, for their support.
We are grateful to our beloved Dean, Dr M Venkatraya Prabhu, Kasturba Medical College, Mangaluru, Karnataka, India, for his constant support and encouragement and also for writing the foreword for the first edition.
We would like to express our gratitude to all colleagues in the Department of Medicine, Kasturba Medical College, Mangaluru, for their constant help at every juncture of our career. We would specially like to thank and acknowledge Dr Chakrapani M and Dr Damodar Shenoy, for mentoring Dr Archith to what he is today.
Dr Archith Boloor remains deeply indebted for his humble achievements, his passion for teaching and for instilling in him the tenacity to learn and achieve his goals to Dr Nagalakshmamma, Professor of Botany; Dr Ranjan Shetty and Dr Jayaraj Sindhur, his seniors, who are to him embodiments of the word ‘Teacher’. He humbly lays down his gratitude to them for inspiring him.
We would like to express our gratitude to our students (both undergraduate and postgraduate), friends and colleagues who helped us at different stages of preparing the manuscript; to all those who provided the support, talked things over, read, offered comments and assisted in the editing, proofreading and designing of this book. Our heartfelt thanks to Dr Hasmukh Jain, Dr Raghavendra BS, Dr Sheetal Raj, Dr Athulya Roopak, Dr Kaushiki Kirty, Dr Vishnu B Chandran, Dr Joseph Samuel, Dr Jimmy Joseph, Dr Kolla Gautham, Dr Anudeep Reddy, and Dr M Harsha Sagar, for their timely and continued support.
A word of thanks would hardly suffice for our pillars of strength and our support system Dr Suresh Shetty B, Dr Jagadish Rao PP, Dr Abul Fazil, Dr Abhishek Gupta, Dr Veena Jasmine Pinto, Dr Akshata Nayak, Dr Nishita Shetty, Dr Sandip Ganguly, Dr Ruchi Romya Das, Dr Mamta Gupta, Dr Sahil Popli, Dr Pradeep Krishna Chowdary, Dr Yogesh Rasal, Dr Sravan Thumati, Dr Amrutraj, Dr Satish AV, Dr Sachin Vemula, Dr Neil Dominic Fernandes, Dr Mishaal Talish, and Dr Apurva Mittal.
Also, we convey our sincere thanks to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Ms Ritu Sharma (Director–Content Strategy), and Ms Chetna Malhotra Vohra (Associate Director–Content Strategy) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for publishing the book in the same format as wanted, well in time.
We thank Ms Sunita Katla (Executive Assistant to Group Chairman and Publishing Manager), Ms Samina Khan (Executive Assistant to Director–Content Strategy), Mr Rajesh Sharma (Production Coordinator), Ms Seema Dogra (Cover Designer), Mr Laxmidhar Padhiary (Proofreader), Mr Rajesh Ghurkundi (Graphic Designer), and Mr Raj Kumar (DTP Operator) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
We thank especially Mr Venugopal V (Associate Director—South) and Mr Vasudev H (Mangaluru) of Jaypee Brothers Medical Publishers (P) Ltd, Bengaluru Branch, Karnataka, for taking this book to every corner of Karnataka.
This book has been written for our students who have inspired us to take up this project; it is their questions that made us read and learn and compile this book. This is a book for you and I do not think we can finish without thanking you.
Lastly, we thank God Almighty, for making us what we are, guiding us through our life, and helping us in bringing this book to you all.
There are many more people we could thank, but constraints of space compel us to stop here.