Exam Preparatory Manual For Undergraduates Medicine

Exam Preparatory Manual for UndergraduatesMedicineSecond EditionArchith BoloorMBBS MD (Internal Medicine)Associate ProfessorDepartment of MedicineKasturba Medical CollegeManipal Academy of Higher EducationMangaluru, Karnataka, Indiaarchithb@gmail.comRamadas Nayak MBBS MDProfessor and HeadDepartment of PathologyYenepoya Medical CollegeYenepoya (Deemed to be University)Mangaluru, Karnataka, IndiaFormerlyHead, Department of PathologyKasturba Medical CollegeManipal Academy of Higher EducationMangaluru, Karnataka, Indiaaskdr.nayak@gmail.comForewordChakrapani MThe Health Sciences PublisherNew Delhi London Panama

Foreword to the Second EditionInternal medicine is expanding and evolving rapidly and there is a need for comprehensive yetsimple textbook. Indian medical students have to be very competitive and up-to-date to excelin their fields. While a number of textbooks from foreign authors are available for the Indianstudents, 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 towardsIndian medical examinations. Dr Archith Boloor realized this need many years ago and took upthe challenge of publishing a textbook in internal medicine which was received well by the studentcommunity. Huge success of the first edition has prompted him to come out with the secondedition of the book.Dr Archith Boloor is an exceptionally gifted clinician and teacher. He has taken keen interestin medical education from his early days in the medical college and with more than a decade ofexperience 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 contentsof the book are comprehensive, presentation is simple. Clinical images, tables, boxes, algorithms and diagrams are simpleand enhance the learning. This book will definitely be an essential learning tool for students of internal medicine.Chakrapani M MDProfessorDepartment of MedicineFormerly, Head and Associate DeanKasturba Medical CollegeManipal Academy of Higher EducationMangaluru, Karnataka, Indiachakrapani.m@manipal.edu

Preface to the Second EditionWe have been extremely grateful for the positive response rendered towards the book, Exam Preparatory Manual forUndergraduates—Medicine and were thus, excited to undertake the challenge of developing a new edition. Surfing beyondplainly updating the literature, this second edition gifted us with the opportunity to further explore topics we ourselves havewrestled with as a student, teacher and teacher educator and also build an understanding of how we approach students andtheir texts.In the year and a half following the release of the first edition of this book, we have received numerous feedbacks viae-mails and letters from readers who have given wonderful suggestions on how we could further upgrade the material. Wehad also built up a large file of ideas based on our own experiences in reading, writing and editing during this time. With theaid 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 ongoingencouragement from our university, Manipal Academy of Higher Education (MAHE) and Yenepoya Medical College (Deemedto 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 ViceChancellor) 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 NarendranKrishnamoorthy, 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 PadakantiAnudeep Rao, Dr Laveena MariamJohn, Dr Ashwini MV, Dr Alister Joseph Thomas, and Dr Mohamed Faizan Thouseef, fortheir help in proofreading and correction.We would further like to thank all our teachers, department colleagues, our current and former students and studentsfrom 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 whohave waited for scouts to carve the path will find the road paved and tested. Your suggestions are happily solicited for anyimprovements, if necessary.Archith BoloorRamadas Nayak

Contents1. Nutrition and Environmental Medicine1Vitamin A 1Vitamin B Complex 3Vitamin C 6Vitamin D 7Trace Elements 11Fluorosis 12Enteral and Parenteral Nutrition Support 12Protein-Energy Malnutrition 14Obesity 15Environmental Diseases 21Radiation Exposure 21Illness at high altitude 22Heatstroke 23Drowning (Submersion Injuries) 272. EndocrinologyDisorders of Pituitary and HypothalamusAcromegaly 34Diabetes Insipidus 37Thyroid Disorders 39Thyrotoxicosis 41Hypothyroidism 46Thyroiditis 50Parathyroid Disorders 53Hypercalcemia 57Adrenal Gland Disorders 60Pheochromocytoma 70Gonadal Disorders 7229293. Diabetes Mellitus76Definition and Classification 76Pathogenesis 78Clinical Features of Diabetes Mellitus 81Diagnosis of Diabetes Mellitus 83Management of Diabetes Mellitus 85Oral Hypoglycemic (Glucose-Lowering) Drugs 86Insulin Therapy 90Diabetic Ketoacidosis 96Hyperglycemic Hyperosmolar State 99Hypoglycemia 101Chronic Complications of Diabetes 104Metabolic Syndrome 1114. Infectious DiseasesPyrexia (Fever) of Unknown Origin 113Strepococcal Infections 118Pneumococcal Infections 120Tetanus 122113

xiv Exam Preparatory Manual for Undergraduates—MedicineEnteric fever 128Food poisoning 130Amebiasis 133Cholera 136Leprosy 137Leptospirosis 142Rickettsial Diseases 145Viral Infections 146Herpes Virus Infections 150Dengue 156Rabies 164Fungal Infections 168Opportunistic Mycoses 171Malaria 173Leishmaniasis 183Cestodes (Tapeworms) 187Filariasis 194Ectoparasites 196Gonorrhea 199Chlamydial Infections 202Granuloma Inguinale (Donovanosis) 202Syphilis 203Nosocomial Infections (Hospital Infections)Sepsis 211Anti-infective Therapy 2152075. HIV Infection and AIDSEtiology 220Pathogenesis of Hiv Infection and Aids 222Natural History of Hiv Infection 224Important Infections and Presenting Problems in AidsCancers in Hiv 233Diagnosis of Hiv Infection or Aids 233Management of a Patient with Hiv Infection 234Postexposure Care of a Healthcare Worker 2412202266. Respiratory SystemIntroduction, Basic Approach, Symptomatology and Investigations 244Bronchial Asthma 252Chronic Obstructive Pulmonary Disease 267Pulmonary Tuberculosis 280Antituberculous Drugs 289Extrapulmonary Tuberculosis 296Bronchiectasis 301Lung Abscess 308Pleural Effusion 312Pneumothorax 321Pneumonia 326Diffuse Parenchymal Lung Disease/Interstitial Lung Disease 343Occupational Lung Diseases 346Lung Cancer (Bronchial Carcinoma) 349Mediastinum 358Respiratory Failure 360Sleep Apnea/Hypopnea Syndrome 363Acute Respiratory Distress Syndrome 367Sarcoidosis 370Hemoptysis 376Dyspnea 379Pulmonary Eosinophilic Syndromes 380244

Contents7. Cardiology384Introduction and Symptomatology 384Arterial Pulse 388Jugular Venous Pressure 391Apical Impulse 395Heart Sounds 396Murmurs 400Conduction System of the Heart 404Electrocardiogram 404Ischemic Heart Disease 412Acute Coronary Syndrome 420Hypertension 433Rheumatic Heart Disease 443Mitral Stenosis 450Mitral Regurgitation 458Aortic Stenosis 463Aortic Regurgitation 466Infective Endocarditis 474Heart Failure 482Cardiac Arrhythmias 493Diseases of the Myocardium 505Congenital Heart Diseases 510Diseases of the Pericardium 518Pulmonary Hypertension 523Sudden Cardiac Death 524Cardiac Arrest 525Cor Pulmonale 528Diseases of Vessels 530Raynaud’s Phenomenon and Raynaud’s Disease 532Circulatory Failure: Shock 533Pulmonary Embolism and Venous Thrombosis 537Disorders of Blood Lipids and Lipoproteins 542Valsalva Maneuver 5488. HematologyAnemia 553Iron Deficiency Anemia 557Macrocytic Anemia 562Hemolytic Anemias 570Sickle Cell Disease 572Hereditary Spherocytosis 577Thalassemia Syndrome 577Glucose-6-Phosphate Dehydrogenase Deficiency 580Miscellaneous Anemias 581Non-neoplastic Disorders of Wbc 589Acute Leukemias 592Chronic Myeloid Leukemia 600Chronic Lymphocytic Leukemia 604Myeloproliferative Neoplasms 606Plasma Cell Neoplasms 614Hodgkin Lymphoma 620Non-Hodgkin Lymphoma 622Immune Thrombocytopenic Purpura 635Thrombocytosis 638Hemophilia 638von Willebrand’s Disease 641Microangiopathic Hemolytic States and Thrombocytopenias 642Disseminated Intravascular Coagulation 644Transfusion Medicine 646550xv

xvi Exam Preparatory Manual for Undergraduates—MedicineHematopoietic Stem Cell Transplantation 652Drugs Used in Hematological Diseases 656Spleen 662Disorders of Heme Synthesis: The Porphyrias 6649. Rheumatology and Connective Tissue Disorders667Rheumatoid Arthritis 671Systemic Lupus Erythematosus 678Spondyloarthropathies (Spondyloarthritides) 684Vasculitis 690Osteoarthritis 697Systemic Sclerosis (Scleroderma) 699Sjögren’s Syndrome 702Crystal Arthropathies 704Osteoporosis 708Antiphospholipid Antibody Syndrome 711Inflammatory Muscle Diseases 71310. Gastroenterology716Symptomatology and Evaluation of Gastrointestinal DiseaseGastrointestinal Bleeding 722Approach to Diarrhea 727Diseases of the Esophagus 731Gastroesophageal Reflux Disease 733Diseases of the Stomach and Duodenum 738Peptic Ulcer Disease 738Malabsorption Syndrome 746Irritable Bowel Syndrome 756Inflammatory Bowel Disease 762Probiotics and Prebiotics 77311. Hepatobiliary System716777Liver Function Tests 777Diagnostic Procedures 781Jaundice 783Congenital Nonhemolytic Hyperbilirubinemias 786Viral Hepatitis 788Chronic Hepatitis 796Acute Liver Failure 801Fatty Liver 803Non-alcoholic Fatty Liver Disease 803Alcoholic Liver Disease 805Cirrhosis 806Portal Hypertension 813Hepatic Encephalopathy 820Ascites 825Drug and Toxin-induced Hepatitis 834Hepatic Venous Outflow Tract Obstruction 834Hepatocellular Carcinoma 836Liver Transplantation 838Liver Abscess 839Metabolic Liver Disease 841Biliary Cirrhosis 845Noncirrhotic Portal Fibrosis 84712. PancreasAcute Pancreatitis 850Chronic Pancreatitis 856Pancreatic Cancer 859Endocrine Tumors of Pancreas850861