approach to the patient

... Chapter 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 ... assume 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 ... 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

... rings. Pruritus: A sensation that elicits the desire to scratch. Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); ... 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 ... follicles. 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...

Ngày tải lên: 06/07/2014, 20:20

... hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to the sun-exposed portions of the face. Once the distribution ... important 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 ... SKIN DISORDER In examining the skin it is usually advisable to assess the patient before taking an extensive history. This way, the entire cutaneous surface is sure to be evaluated, and objective...

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)...

Ngày tải lên: 06/07/2014, 20:20

... 52-9 Erythema multiforme. This eruption is characterized by multiple erythematous plaques with a target or iris morphology. It usually represents a hypersensitivity reaction to drugs (e.g., ... 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 cut ... 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 ... of the slide accelerates dissolution of keratin. When the preparation is viewed under the microscope, the refractile hyphae will be seen more easily when the light intensity is reduced and the...

Ngày tải lên: 06/07/2014, 20:20

... 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 ... al (eds): Fitzpatrick's Dermatology in General Medicine, 7th ed. New York, McGraw-Hill, 2008 Urticaria. Discrete and confluent, edematous, erythematous papules and plaques are characteristic...

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 ... obtaining adequate tissue to permit careful evaluation of the histology of the tumor, its grade, and its invasiveness and to yield further molecular diagnostic information, such as the expression of...

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 ... 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 ... of the organ of origin to regional but not distant sites, or as metastatic to distant sites. The most widely used system of staging is the TNM (tumor, node, metastasis) system codified by the...

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 ... 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 ... of standard protocols are likely to compromise treatment results. The choice of treatment approaches was formerly dominated by the local culture in both the university and the practice settings....

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

... 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 ... 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 ... should strive to keep communications open and nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing. The appearance of unexpected toxicity may...

Ngày tải lên: 07/07/2014, 01:20

... 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 ... stimulation of the vomiting center in the medulla, the motor center responsible for coordinating the secretory and muscle contraction activity that leads to emesis. Diverse receptor types participate ... serotonin receptors at high dosages. The best strategy for preventing anticipatory emesis is to control emesis in the early cycles of therapy to prevent the conditioning from taking place. If...

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Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20