approach to the patient with neurologic disease

... 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...

Ngày tải lên: 06/07/2014, 20:20

... 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 ... advisable to assess the patient before taking an extensive history. This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated with relevant historic...

Ngày tải lên: 06/07/2014, 20:20

... papulosquamous skin 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...

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

... 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 ... history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10. Social, sexual, or travel history as relevant to the patient DIAGNOSTIC TECHNIQUES Many skin diseases ... 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 ... 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 cancer cell to maintain...

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 ... Increasing evidence links the expression of certain genes with the prognosis and response to therapy (Chaps. 79, 80). Occasionally a patient will present with a metastatic disease process that is...

Ngày tải lên: 07/07/2014, 01:20

... Functional Capability of the Patient 100 Normal; no complaints; no evidence of disease 90 Able to carry on normal activity; minor signs or symptoms of disease 80 Normal activity with effort; some ... 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 ... complications 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 ... 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),...

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. ... trophoblastic disease, gonadal germ cell tumor Pregnancy Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular ... 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...

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 ... 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 disease...

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...

Ngày tải lên: 07/07/2014, 01:20

Ngày tải lên: 07/07/2014, 01:20

Ngày tải lên: 07/07/2014, 01:20

... retinal disease for possible prophylactic laser treatment just posterior to the leading margin of the lesion. 3. Patient Education The optometrist should educate the patient about the symptoms ... independent travel aids, and other devices geared to improve the patient& apos;s quality of life and ability to function in their own households. The optometrist should provide the patient written documentation ... Prognosis and Followup The prognosis for the patient with a retinal break and the need for followup by the optometrist depend on the type and severity of the break. The frequency and composition...

Ngày tải lên: 22/03/2014, 09:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20