approach to the patient with altered mental status
Chapter 052. Approach to the Patient with a Skin Disorder (Part 1) ppt
Ngày tải lên :
06/07/2014, 20:20
... 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 ... that the 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 ... 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...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 2) potx
Ngày tải lên :
06/07/2014, 20:20
... elicits the desire to scratch. Pruritus is often the
predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis,
allergic contact dermatitis); it is also commonly associated with ...
Table 52-3 Common Dermatologic Terms
A schematic representation of several common primary skin lesions
(see Table 52-1).
Chapter 052. Approach to the Patient
with a Skin Disorder
(Part ... epidermal atrophy).
Scar: A change in the skin secondary to trauma or inflammation. Sites may
be erythematous, hypopigmented, or hyperpigmented depending on their age or
character. Sites on hair-bearing...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 4) doc
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06/07/2014, 20:20
... 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 ... correlates 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 ... individual skin lesions
and make it possible to assess the distribution of the eruption accurately. The
Chapter 052. Approach to the Patient
with a Skin Disorder
(Part 4)
Figure 52-5
...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 5) pptx
Ngày tải lên :
06/07/2014, 20:20
... 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
(Part 5)
Figure...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 6) pdf
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
...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 7) ppt
Ngày tải lên :
06/07/2014, 20:20
... 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 cut with
iris ... of systems
9. Family history (particularly relevant for patients with melanoma,
atopy, psoriasis, or acne)
10. Social, sexual, or travel history as relevant to the patient
DIAGNOSTIC TECHNIQUES ... 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,...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 8) pptx
Ngày tải lên :
06/07/2014, 20:20
... 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 stain. Multinucleated epithelial ...
noting the amount of blanching that occurs. Granulomas often have an opaque to
transparent, brown-pink "apple jelly" appearance on diascopy.
Figure 52-11
Chapter 052. Approach to the ... may also aid in the demonstration of tinea versicolor and
in recognition of ash leaf spots in patients with tuberous sclerosis.
Figure 52-12
Diascopy is designed to assess whether a skin lesion...
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Chapter 077. Approach to the Patient with Cancer (Part 1) potx
Ngày tải lên :
07/07/2014, 01:20
... 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 ...
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
cancer cell to maintain its specialized...
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Chapter 077. Approach to the Patient with Cancer (Part 3) pptx
Ngày tải lên :
07/07/2014, 01:20
... 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 presence of ... 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 ...
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...
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Chapter 077. Approach to the Patient with Cancer (Part 4) pps
Ngày tải lên :
07/07/2014, 01:20
... the tumor on the basis of the size of the primary tumor lesion (T1–4, where a
higher number indicates a tumor of larger size), the presence of nodal involvement
(usually N0 and N1 for the ... histologic grade G) are then broken into stages,
usually designated by the roman numerals I through IV. Tumor burden increases
and curability decreases with increasing stage. Other anatomic staging systems ... of the patient. Patients who are bedridden
before developing cancer are likely to fare worse, stage for stage, than fully active
patients. Physiologic reserve is a determinant of how a patient...
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Chapter 077. Approach to the Patient with Cancer (Part 5) doc
Ngày tải lên :
07/07/2014, 01:20
... 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 pressure of ... both the disease and its treatment as well as
the complex psychosocial problems associated with cancer. In the short term
during a course of curative therapy, the patient& apos;s functional status ... 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 (see below),...
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Chapter 077. Approach to the Patient with Cancer (Part 6) pdf
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...
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Chapter 077. Approach to the Patient with Cancer (Part 7) ppt
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 ... cannot help the patient but may be harmful. Physicians should strive
to keep communications open and nonjudgmental, so that patients are more likely
to discuss with the physician what they are ...
Chapter 077. Approach to the
Patient with Cancer
(Part 7)
The recognition and treatment of depression are important components of
management. The incidence of depression in cancer patients...
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Chapter 077. Approach to the Patient with Cancer (Part 8) potx
Ngày tải lên :
07/07/2014, 01:20
... Chapter 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, ... 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 receptors at ... emesis is the best understood form. Stimuli that activate signals in
the chemoreceptor trigger zone in the medulla, the cerebral cortex, and
peripherally in the intestinal tract lead to stimulation...
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