approach to the ed patient with lowrisk chest pain

... 052. Approach to the Patient with a Skin Disorder (Part 1) Harrison's Internal Medicine > Chapter 52. Approach to the Patient with a Skin Disorder APPROACH TO THE PATIENT WITH ... erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused by scratching. ... Fig. 52-3) and to formulate a differential diagnosis (Table 52-4). For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in...

Ngày tải lên: 06/07/2014, 20:20

... formed from coalescing rings or incomplete rings. Pruritus: A sensation that elicits the desire to scratch. Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic ... delicate, wrinkled lesions (i.e., epidermal atrophy). Scar: A change in the skin secondary to trauma or inflammation. Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age ... associated with xerosis and aged skin. Systemic conditions that can be associated with pruritus include chronic renal disease, cholestasis, pregnancy, malignancy, thyroid disease, polycythemia...

Ngày tải lên: 06/07/2014, 20:20

... highly with diagnosis (Fig. 52-6). For example, a hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited ... limited to the sun-exposed portions of the face. Once the distribution of the lesions has been established, the nature of the primary lesion must be determined. Thus, when lesions are distributed ... MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is usually advisable to assess the patient before taking an extensive history. This way, the...

Ngày tải lên: 06/07/2014, 20:20

... disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale. Figure 52-8 Chapter 052. Approach to the Patient with a Skin Disorder...

Ngày tải lên: 06/07/2014, 20:20

... lesions with a generalized arrangement are common and suggest a systemic etiology. Figure 52-9 Erythema multiforme. This eruption is characterized by multiple erythematous plaques with ... represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV). (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... pressed against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue. The circular biopsy is then lifted with forceps, and the bottom is ... infection is suspected. The edge of such a lesion is scraped gently with a no. 15 scalpel blade, and the removed scale is collected on a glass microscope slide then treated with 1 to 2 drops of a ... skin is anesthetized with 1% lidocaine with or without epinephrine. The skin lesion in question can be excised or saucerized with a scalpel or removed by punch biopsy. In the latter technique,...

Ngày tải lên: 06/07/2014, 20:20

... a pustule or crusted lesion, is unroofed, and the base of the lesion is scraped gently with a scalpel blade. The material is placed on a glass slide, air-dried, and stained with Giemsa or Wright's ... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled. Urticaria (Fig. 52-11) will blanch with ... 2006 Wolff K et al (eds): Fitzpatrick's Dermatology in General Medicine, 7th ed. New York, McGraw-Hill, 2008 Urticaria. Discrete and confluent, edematous, erythematous papules and plaques...

Ngày tải lên: 06/07/2014, 20:20

... Approach to the Patient with Cancer (Part 1) Harrison's Internal Medicine > Chapter 77. Approach to the Patient with Cancer Approach to the Patient with Cancer: Introduction The ... (surgery, radiation therapy, chemotherapy, and biological therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of ... programmed for collaboration. Many diseases occur because the specialized cells fail to perform their assigned task. Cancer takes this malfunction one step further. Not only is there a failure of the...

Ngày tải lên: 07/07/2014, 01:20

... obtained from every portion of the routine history and physical examination. The duration of symptoms may reveal the chronicity of disease. The past medical history may alert the physician to the ... influence the course of disease and its treatment. The family history may suggest an underlying familial cancer predisposition and point out the need to begin surveillance or other preventive therapy ... diagnostic procedure, the diagnosis generally depends on obtaining adequate tissue to permit careful evaluation of the histology of the tumor, its grade, and its invasiveness and to yield further molecular...

Ngày tải lên: 07/07/2014, 01:20

... Knowledge of the predilection of particular tumors for spread to adjacent or distant organs helps direct the staging evaluation. Information obtained from staging is used to define the extent ... response to therapy and prognosis. The presence of selected cytogenetic abnormalities may influence survival. Tumors with higher growth fractions, as assessed by expression of proliferation-related ... features of the tumor are being related to prognosis. The expression of particular oncogenes, drug-resistance genes, apoptosis-related genes, and genes involved in metastasis are being found to influence...

Ngày tải lên: 07/07/2014, 01:20

... results. Sometimes the chemotherapy and radiation therapy need to be delivered sequentially, and other times concurrently. Surgical procedures may precede or follow other treatment approaches. It ... schedule greatly limit the time a physician spends with a patient who is receiving only palliative care. Resist these forces. In addition to the medicines administered to alleviate symptoms ... skilled physician also has much to offer the patient for whom curative therapy is no longer an option. Often a combination of guilt and frustration over the inability to cure the patient and the...

Ngày tải lên: 07/07/2014, 01:20

... Chapter 077. Approach to the Patient with Cancer (Part 6) Tumor markers may be useful in patient management in certain tumors. Response to therapy may be difficult to gauge with certainty. ... in themselves specific enough to permit a diagnosis of malignancy to be made, but once a malignancy has been diagnosed and shown to be associated with elevated levels of a tumor marker, the ... produce or elicit the production of markers that can be measured in the serum or urine and, in a particular patient, rising and falling levels of the marker are usually associated with increasing...

Ngày tải lên: 07/07/2014, 01:20

... inability to concentrate, and suicidal ideation. Patients with these symptoms should receive therapy. Medical therapy with a serotonin reuptake inhibitor such as fluoxetine (10–20 mg/d), sertraline ... nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing. The appearance of unexpected toxicity may be an indication that a supplemental therapy is being ... disease persists, the multidisciplinary team discusses a new salvage treatment plan. If the patient has been rendered disease-free by the original treatment, the patient is followed regularly for...

Ngày tải lên: 07/07/2014, 01:20

... 077. Approach to the Patient with Cancer (Part 8) Pain Pain occurs with variable frequency in the cancer patient: 25–50% of patients present with pain at diagnosis, 33% have pain associated ... Emesis in the cancer patient is usually caused by chemotherapy (Chap. 81). Its severity can be predicted from the drugs used to treat the cancer. Three forms of emesis are recognized on the basis ... Delayed emesis may be related to bowel inflammation from the therapy and can be controlled with oral dexamethasone and oral metoclopramide, a dopamine receptor antagonist that also blocks serotonin...

Ngày tải lên: 07/07/2014, 01:20

Ngày tải lên: 07/07/2014, 01:20

Ngày tải lên: 07/07/2014, 01:20

... transform. The speedup is just the ratio of the number of operations needed for the exact 2D DCT (544 operations) to the number of operations needed for the approximation. Increasing the pruning ... we remove the calculations in the exact transform that are only related to the output coefficients with small energy (close to zero). The pruning operator P is an M × M diagonal matrix defined as follows: P = ... C( ·) is the complexity operator for single input (Ta bl e 1), D x i (·) is the distortion operator for the single input x i (9), L k is the approximation index list associated with the C-D pair...

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Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20