approach to the patient with 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 ... 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...

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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... 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 ...

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...

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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... 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,...

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...

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 ... 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...

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...

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...

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 ... 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), ... important to remember the comfort that is provided by holding the patient& apos;s hand, continuing regular examinations, and taking time to talk. increase of >25% in the sum of the products of 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 ... 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 ... 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...

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, 33% have pain associated ... 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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