... 052. ApproachtothePatient with a Skin Disorder (Part 1) Harrison's Internal Medicine > Chapter 52. ApproachtothePatientwith a Skin Disorder APPROACH TOTHEPATIENTWITH ... that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that thepatient 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 thepatient in...
... characterized by small and large erythematous papules and plaques with overlying adherent silvery scale. Figure 52-8 Chapter 052. ApproachtothePatient with a Skin Disorder (Part 5) Figure...
... against the surface of the skin and rotated with downward pressure until it penetrates tothe 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 tothepatient 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,...
... 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. Approachtothe ... 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...
... 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 tothe 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...
... 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. ApproachtothePatient 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...
... MD; with permission.)[newpage] APPROACH TOTHE PATIENT: SKIN DISORDER In examining the skin it is usually advisable to assess thepatient before taking an extensive history. This way, the ... correlates highly with diagnosis (Fig. 52-6). For example, a hospitalized patientwith a generalized erythematous exanthem is more likely to have a drug eruption than is a patientwith a similar ... individual skin lesions and make it possible to assess the distribution of the eruption accurately. The Chapter 052. ApproachtothePatient with a Skin Disorder (Part 4) Figure 52-5...
... 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 ...
... Approachtothe Patient with Cancer (Part 1) Harrison's Internal Medicine > Chapter 77. ApproachtothePatientwith Cancer Approach tothePatientwith 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...
... 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...
... C(·) is the complexity operator for singleinput (Ta bl e 1), Dxi(·) is the distortion operatorfor the single input xi(9), Lkis the approximationindex list associated withthe C-D pair ... Dxi(Ti) is the distortion due to the approximationTifor the ith element of the input set (i.e.,xi), and d(·) is the distortion measure. In this paper, d(·)is the standard Euclidean ... norm.Definition 2. The complexity distortion region is the closure of the set of achievable complexity distortion pairs (C, D). Thisdefinition is similar tothe definition of the rate distortionregion...