Problem Solving in Clinical Medicine

Paul Cutler, MD, FACP

The clinical reasoning process is explained in terms of formation of an initial concept, formation of hypotheses, the further expansion of inquiry tactics, and application of appropriate clinical skills. Over 80 carefully selected cases are featured where pieces of data are interspersed with corresponding pieces of logic. The most common clinical presentations seen in medical practice are covered, and readers get an extensive body of medical knowledge.

"The data and logic sections are just right for building thinking skills while still keeping you on track....I find the author's personal comments at the end of each clinical case to be as if an attending were taking a few moments to share their best insights with you...the best part has been that from the clinical cases I've read so far, I've already been able to contribute while on rounds." -Joseph Sky, M3, Loma Linda University School of Medicine (1/98)

Table of Contents

SECTION I THE PROBLEM SOLVING PROCESS
Chapter 1: Dissection of a Symptom
Chapter 2: Data Collection, Data Processing, Problem Lists
Chapter 3: Problem-Solving Methods
Chapter 4: Clues: The Building Blocks
Chapter 5: Data Resolution Skills
Chapter 6: More Clinical Tools
Chapter 7: Digits, Decimals, and Doctors
Chapter 8: How to Use Tests
Chapter 9: The Impact of New Technology
Chapter 10: Into the Problem Solver's Mind
Chapter 11: From Patient to Paper

SECTION II PROBLEM SOLVING IN ACTION
Introduction
Chapter 12: Hematologic Problems
Introduction
Case 1: Weakness and Joint pain
Case 2: Mild Asymptomatic Anemia
Case 3: Bleeding Gums and Bruising
Case 4: Lethargy and Confusion
Case 5: A Family Affair
Case 6: Cough, Fever, then Fatigue
Case 7: Neck Lumps
Case 8: Elevated Hematocrit
Case 9: Backache, Weakness, Nosebleeds
Case 10: Jaundice, Weakness, Pallor
Case 11: Leg Pain

Chapter 13: Endocrine Problems
Introduction
Case 12: A Thyroid Nodule
Case 13: Glycosuria
Case 14: Weakness, Anxiety, Sweating
Case 15: Obesity and Hirsutism
Case 16: Nervousness and Weight Loss
Case 17: Polyria and Polydipsia
Case 18: Hypercalcemia
Case 19: Compounded Confusion
Case 20: Galactorrhea and Amenorrhea
Case 21: Weak and Shaky Spells
Case 22: A Fat Problem

Chapter 14: Cardiovascular Problems
Introduction
Case 23: Abnormal ECG
Case 24: Sever Substernal Tightness
Case 25: Systolic Murmur
Case 26: High Blood Pressure
Case 27: Dyspnea on Exertion
Case 28: Coma and T-Wave Inversion
Case 29: Sharp Chest Pain
Case 30: Swollen Legs
Case 31: Palpitations
Case 32: Somnolence and Swollen Legs

Chapter 15: Pulmonary Problems
Introduction
Case 33: X-Ray Abnormality
Case 34: Wheeze and Dyspnea
Case 35: Coughing of Blood
Case 36: Cough, Fever, Chill
Case 37: Sudden Shortness of Breath
Case 38: Chest Pain and Shortness of Breath
Case 39: Chronic Cough and Expectoration
Case 40: Worsening Shortness of Breath
Case 41: Wheeze, Cough, Fever, Dyspnea

Chapter 16: Gastrointestinal Problems
Introduction
Case 42: Dysphagia
Case 43: Indigestion
Case 44: Diarrhea and Weight Loss
Case 45: Sudden Abdominal Pain
Case 46: Painless Jaundice
Case 47: Jaundice and Pain
Case 48: Lower Abdominal Pain
Case 49: Swelling of the Abdomen
Case 50: Black Stools
Case 51: Vomiting of Blood and Dyspnea
Case 52: Cramps and Nausea
Case 53: Fever, Confusion, Alcohol
Case 54: Diarrhea and Fever

Chapter 17: Renal and Electrolyte Problems
Introduction
Renal
Case 55: Bloody Urine
Case 56: Frequent and Painful Urination
Case 57: Sharp Flank Pain
Case 58: Swelling of Face and Legs
Case 59: Coma and Oliguria
Case 60: Nausea, Weakness, Confusion
Introduction
Electrolyte
Case 61: Fatigue and Abnormal ECG
Case 62: Weakness and Disorientation

Chapter 18: Gynecologic Problems
Introduction
Case 63: Missed Menstrual Period
Case 64: Acute Pelvic Pain
Case 65: Abnormal Vaginal Bleeding
Case 66: Breast Lump

Chapter 19: Musculoskeletal Problems
Introduction
Case 67: Painful Swollen Joint
Case 68: Shoulder Pain
Case 69: Painful Stiff Joints
Case 70: Backache

Chapter 20: Neurologic Problems
Introduction
Case 71: Headache
Case 72: Dizziness
Case 73: Convulsions
Case 74: Paralysis

Chapter 21: Geriatric Problems
Introduction
Case 75: Incontinence
Case 76: Nocturia and Frequency
Case 77: Demented or Depressed
Case 78: Erectile Dysfunction
Case 79: Falls

Chapter 22: Multisystem Problems
Introduction
Case 80: Fatigue
Case 81: The Great Imitator
Case 82: Fainting Spells
Case 83: Strange Behavior
Case 84: Weakness, Weight Loss, Anorexia
Case 85: Coma
Case 86: Prolonged Fever