He has provided a systematic approach to the common symptoms with differential diagnosis and relevant investigations to arrive at the final diagnosis. I am sure that this book would be of immense value to the undergraduate and postgraduate students and practitioners of medicine.

I am practically impressed with the flowcharts which not only depict the common causes of the symptoms but also the salient features regarding pathological and clinical aspects of the diseases. It makes fluent, interesting, and absorbing reading going through various chapters due to a systemic approach in dealing with a clinical situation. I strongly feel and suggest that this book should be possessed by every undergraduate and postgraduate student of medicine as well as practitioners to find readymade solutions to the various clinical problems they encounter in their daily practice.

I feel very happy to write the foreword for this fourth edition that is well compiled and comprehensive, and profound knowledge of medicine by my esteemed teacher Dr P Siva Rama Krishna Rao.

The demand placed on the medical profession is ever-increasing for a variety of reasons: the complexity of medical practice steadily increases as more and more diagnostic and therapeutic possibilities become available, and as populations age, so the incidents of disease increase. Added to these are, on the one hand, ever-increasing consumer demand, while, on the other, governments’ attempt to hold down healthcare costs. All this means that doctors simply have to raise their game. This requires a process of continuing professional development to keep up-to-date and to ensure that professional performance is kept to an acceptable level. Included in this process is continuing medical education that nowadays can be derived from a variety of modalities, including distance learning. However, despite electronic means of communication and the visual display unit (VDU), most people find the printed word still the best way of assimilating new information and Dr P Siva Rama Krishna Rao's book is an excellent example of this.

My hope is that it will be valuable to all who have to deal with the clinical differential diagnosis that he has identified. It should be of particular use to general practitioners, accident and emergency physicians and indeed all those who encounter this aspect of medicine. It is the sort of book that should be presented not only on the shelves at home and in libraries, but also at all the sites where emergency medicine is practised.

A symptom-oriented approach book containing 45 day-to-day problems (40 symptom chapters and 5 appendices along with 103 illustrations), enriched with assiduous knowledge, covering the whole gamut of medicine with an easy flow for easy uptake, followed by 40 algorithms encompassing the salient features of the detailed information, furnished in the text. Indeed it is a fantastic stratification of essential information.

Three additional topics of absorbing interest are included in the 4th edition, i.e. (1) Abnormal Involuntary Movements; (2) Incontinence; and (3) Sleep Disorders. The quantity of information provided is qualitative with essential fast facts.

Understanding medicine in depth cannot be realized in toto even after years of study, as it is ever changing, extensive, and fathom deep. Nevertheless persisting lacunae existing are addressed wherever possible.

The complexity of clinical medicine is simplified with lucid exquisite exposition, maintaining a uniform problem-based unique approach, backed up by basic considerations of the various symptom complexes.

This treatise with comprehensive assimilable information can as well be entertained, as an alternative textbook for students preparing for examinations and particularly for those crossing the bridge from graduation to internship (foundation period).

Further it will be a boon for those seeking solutions for solving problems faced day in and day out, with exhilarating confidence accrued, therein, for diagnosing correctly and then designing appropriate strategy for effective treatment, with guides to management provided therein.

As such this book will be invaluable as a constant companion to students (both under- and postgraduates) as well as for practitioners to equip with practical knowledge and to accomplish Clear medical insight, enabling one to deal with cases on hand successfully, and cheer the chuffed outcome.

This edition is thoroughly revised and every chapter is updated. Therapeutics have been revisited with vigour and efforts persisted to disseminate knowledge effectively.

Indeed this manual is a clinical treasure house for the common problems faced by one and all.

This manual is a practical clinical guide to diagnosis and principles of treatment of some of the age-old medical problems. The overall emphasis is on clinical access to these problems and the importance of fundamental clinical skills of history-taking and systemic problem-oriented physical examination in search of a correct diagnosis is highlighted. In addition, a sensible order of investigations to be adopted during the diagnostic work-up is detailed, instead of indulging in the endless array of investigations.

The pattern followed for each symptom runs through basic fundamental concepts, appended causes, essentials of diseases therein, clinical approach with illustrations wherever necessary and diagnostic flow charts followed by symptomatic as well as specific treatment. The student burdened with his ever-crowded curriculum or the practitioner anxious to keep abreast of the times may find it useful as it is easily readable and assimilable. The guiding principle throughout this endeavour is to inculcate knowledgeable medical practice enabling the growth of the Doctor's clinical acumen and competence to establish an early diagnosis confidently, after which an effective treatment can be instituted.

This is not a textbook of description of diseases to bestow theoretical knowledge, but an attempt to bridge the gap between theory and practice of medicine and reinforce the ability to apply the knowledge coherently to various clinical situations. As a matter of fact, any book is likely to become out-of-date within a few years as theory-cum-practice of medicine is ever-changing and advancing. In such a live science and art of medicine, new concepts and technical innovations demand voluminous output of information and explanation. Such information has been freely drawn from many related books and, for that matter, my own colleagues in various specialities.

The idea of writing such a symptom-oriented-approach book is a real challenge to one who has spent most of his life in the practice of medicine facing ever so many specific problem areas. I hope all the thirty-six symptoms, specially identified in relation to day-to-day practice of general medicine, some of which even poorly understood, are presented with lucidity, in a practical and clinically useful manner, for medical personnel at any stage ranging from an examination performing student to a practitioner, or even a mature physician for that matter.

Solid 2,500 hours or so are bestowed to bring out this treatise, fulfilling the desired aim of this book. Suggestions offered to further improve the style and pattern of presentation in subsequent editions will be gracefully acknowledged.

King George Hospital and Andhra Medical College, Visakhapatnam, Andhra Pradesh, India—Department of Cardiology, Department of Endocrinology and Diabetology, Department of Gastroenterology, Department of Nephrology and Department of Neurology.

Visakhapatnam Port Trust Golden Jubilee Hospital—Dr B Satyanarayana (Chief Medical Officer) and Dr ML Kasturi (General Physician), who particularly assisted in the collection of some of the illustrations; Dr A Ranga Rao (General Surgeon), Dr PV Rao (Orthopaedic Surgeon) and Dr PK Bhaskara Rao (Dermatologist).

Bharat Heavy Plates and Vessels Hospital, Visakhapatnam—Dr PS Krupakar (Chief Medical Officer), Dr S Subba Rao (Deputy Chief Medical Officer), Dr BK Arunabala (Gynaecologist), Dr BK Satyanarayana and Dr K Subrahmanyam (Medical Officers).

Visakhapatnam Steel Plant Hospital—Dr C Harendra (Consultant ENT Surgeon).

Apollo Hospital, Hyderabad, Telangana, India—Dr K Saratchandra (Cardiologist).

St Andrews Healthcare, Northampton, United Kingdom—Dr (Mrs) Sunitha Rani Bonthala, for her timely suggestions.

University College Hospital, London, United Kingdom—Dr Latha Bonthala, for her line diagrams.

Dr Apuroopa Routhu, for assisting the updating of fourth edition.

Though most of the illustrative material of clinical photographs, radiology and imaging, ECGs, ECHOs, colour Doppler, isotope scanning, endoscopic pictures, etc. are all personal collections from the patients’ records and other sources, I must particularly thank Dr G Saigopal, Professor of Cardiology, and Cardiologist and Dr E Pedaveera Raju, Professor of Gastroenterology and Gastroenterologist, Andhra Medical College, Visakhapatnam and Dr Vaheesan, VITA Diagnostics Ltd, MR and CT Imaging Centre, Visakhapatnam, who have readily lent some of the illustrations.

I also wish to thank Professor DV Krishna Rao, Department of Physics, Andhra University and Professor A Appa Rao, Department of Computer Sciences, Andhra University for rendering photographic services, for offering computer services in the preparation of flow charts and Dr (Mrs) CH Suguna for assisting drawing of line diagrams.

I am particularly grateful to V Sree Rama Murty for secretarial work throughout the preparation of the primer, without whose help probably this gigantic attempt would not have been possible. Returi Vijaya Kumar for secretarial help for incorporating the corrections including additions in the fourth addition.

I must specially thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Dr Richa Saxena and Dr Nidhi Sood of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for having recognised the merits of the presented material and to have come forward enthusiastically for publishing and for cooperating patiently throughout this period in bringing out this edition.