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DeGowin’s
Diagnostic Examination
NOTICE
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ELEVENTH EDITION
DeGowin’s
Diagnostic Examination
Manish Suneja, MD, FACP, FASN
Professor of Internal Medicine
The University of Iowa Carver College of Medicine
Iowa City, Iowa
Joseph F. Szot, MD, FACP
Professor of Internal Medicine
The University of Iowa Carver College of Medicine
Iowa City, Iowa
Richard F. LeBlond, MD, MACP
Professor Emeritus of Internal Medicine
The University of Iowa Carver College of Medicine
Iowa City, Iowa
Donald D. Brown, MD, FACP
Professor of Internal Medicine
The University of Iowa Carver College of Medicine
Iowa City, Iowa
Illustrated by
Elmer DeGowin, MD, Jim Abel, and Shawn Roach
New York Chicago San Francisco Athens London Madrid Mexico City
New Delhi Milan Singapore Sydney Toronto
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the reader should form an outline of it from the description.
—H
“
On JOints”
[Studies] perfect nature, and are perfected by experience: for natural abilities
are like natural plants, that need pruning, by study; and studies themselves,
do give forth directions too much at large, except they be bounded in by
experience. Crafty men contemn studies, simple men admire them, and wise
men use them; for they teach not their own use; but that is a wisdom without
them, and above them, won by observation. Read not to contradict and confute;
nor to believe and take for granted; nor to nd talk and discourse; but to weigh
and consider.
—F B
“
Of studies”
A little observation and much reasoning lead to error; many observations and a
little reasoning to truth.
—D. A C
It is only by persistent intelligent study of disease upon a methodical plan of
examination that a man gradually learns to correlate his daily lessons with the
facts of his previous experience and that of his fellows, and so acquires clinical
wisdom.
— S W O
Sources for Quotations:
Brecht quotation from: Bertolt Brecht. Poems, 1913–1956. London, Methuen London Ltd.,
1979.
Eliot quotation from: T.S. Eliot. The Complete Poems and Plays, 1909–1950. New York,
Harcourt, Brace & World, Inc., 1971.
Frazer quotation from: Sir James George Frazer. The Golden Bough, A Study in Magic and
Religion, abridged edition. New York, MacMillan Publishing Company, 1922.
Hippocrates quotation from: Jacques Jouanna (M.B. DeBevoise translator). Hippocrates.
Baltimore, The Johns Hopkins University Press, 1999.
Osler quotation from: Sir William Osler. Aequanimitas, with other Addresses to Medical Students,
Nurses and Practictioners of Medicine. Philadelphia, P. Blakiston’s Son and Co., 1928.
Roethke quotations from: Theodore Roethke. On Poetry and Craft. Port Townsend,
Washington Copper Canyon Press, 2001.
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CONTENTS
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Preface xxiii
Common Abbreviations
Introduction and User’s Guide
1. DIAGNOSIS 2
1. Accurate Diagnosis Is Imperative 2
2. Diagnostic Process 2
3. Diseases and Syndromes 2
A. The Diagnostic Process 3
1. Stories 3
2. Gathering and Processing Information 4
3. Differential Diagnosis 5
4. Anatomic and Pathophysiologic Diagnostic Hypotheses 6
5. Cognitive Tests of Diagnostic Hypotheses 10
6. Selecting Diagnostic Tests 11
7. Rare Diseases 11
8. Certainty and Diagnosis 11
9. Prognostic Uncertainty 12
10. Summary of the Diagnostic Process 12
11. Caveat 13
12. An Example of the Diagnostic Process 13
2. HISTORY TAKING AND THE MEDICAL RECORD 14
A. Outline of the Medical Record 14
1. Scope of the History 15
2. How to Take a History 15
3. Do Not Make Assumptions 16
B. Completion of the Medical Record 17
1. Identication 17
2. The Informant 17
3. Chief Complaints 18
4. Past Medical and Surgical History 20
5. Family History 20
6. Social History 21
7. Military History 21
8. Review of Systems 22
9. Gynecologic History 23
10. Male History 23
11. Venereal Disease History 23
12. Medications 24
xxvii
xxix
PART 1
THE DIAGNOSTIC FRAMEWORK
ix
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