Syncope: An enigma for clinicians

Although most episodes of syncope are benign and the cause is not found in about half of all cases, it is important for the practitioner to differentiate between cardiac syncope, or other life-threatening aetiologies and the common faint. The differential diagnosis for syncope is extensive; but a careful history and physical examination, along with selected laboratory studies, can help rule out or confirm the causes of greatest potential concern

Chronic Diarrhea and weight loss

Chronic diarrhea and weight loss in adults pose a challenging diagnostic dilemma to the clinician. A thorough history, physical examination, and simple laboratory evaluation will yield a diagnosis in great majority of patients. For a substantial number, no diagnosis is reached after initial evaluation. Patients thus undergo an extensive clinical evaluation, and sometimes hospitalization, before a diagnosis is made. The goal of this case discussion is to present a stepwise evaluation and management plan of patients with chronic diarrhoea and weight loss

Evaluation of chronic cough in adults

Chronic cough has profound effect on the quality of life making it the fifth most common symptom seen in the outpatient clinic. The cause can be identified in 88-100 percent of the cases and treatment of the underlying cause has the success rate of 84-98 percent. The evaluation of a patient presenting with chronic cough starts with a thorough history and focused examination. This gives the clue in approximately 77 percent of the cases while in the remaining 23 percent of the cases it guides towards the relevant investigations. Patient with chronic cough should avoid exposure to environmental irritants and those who smoke should stop smoking. Any patient having cough for greater than three to six weeks requires a chest radiograph provided the patient is not taking ACE inhibitors and there is no irritant exposure. Postnasal drip syndrome, asthma, and gastroesophageal reflux disease are the most likely causes of chronic cough in adults having a normal chest radiograph. Trial of treatment-empiric therapy for the most likely cause may be preferable to extensive investigation because it may provide relief and diagnosis simultaneously