clinical decision making approach to the patient
Chapter 052. Approach to the Patient with a Skin Disorder (Part 1) ppt
Ngày tải lên :
06/07/2014, 20:20
... 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 ... (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than would hemorrhagic papules, ... important to differentiate primary from secondary skin lesions If the examiner focuses on linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion...
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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
... incomplete 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 ... Lichenoid: Violaceous to purple, polygonal lesions that resemble those seen in lichen planus Milia: Small, firm, white papules filled with keratin Morbilliform: Generalized, small erythematous macules...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 4) doc
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 ... possible to assess the distribution of the eruption accurately The patient should first be viewed from a distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution ... 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...
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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
... A–D The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules...
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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
... Figure 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 ...
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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
... 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 with ... History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history ... 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...
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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
... is designed to document sensitivity to a specific antigen In this procedure, a battery of suspected allergens is applied to the patient' s back under occlusive dressings and allowed to remain in ... helpful in the evaluation of patients with chronic dermatitis FURTHER READINGS Dermatology Lexicon Project: www.futurehealth.rochester.edu/dlp2/ James WD et al: Andrews' Diseases of the Skin: Clinical ... allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of delayed hypersensitivity reactions (e.g., erythema, edema, or papulovesicles)...
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Chapter 077. Approach to the Patient with Cancer (Part 1) potx
Ngày tải lên :
07/07/2014, 01:20
... 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 ... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease ... of cancer cells is that the patient feels betrayed by his or her body The cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem No nationwide...
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Chapter 077. Approach to the Patient with Cancer (Part 3) pptx
Ngày tải lên :
07/07/2014, 01:20
... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease ... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past...
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Chapter 077. Approach to the Patient with Cancer (Part 4) pps
Ngày tải lên :
07/07/2014, 01:20
... Against Cancer and the American Joint Committee on Cancer (AJCC) The TNM classification is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor ... other prognostic factors have been identified (Chaps 104, 105, and 106) In addition to tumor burden, a second major determinant of treatment outcome is the physiologic reserve of the patient Patients ... 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...
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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 a ... follow other treatment approaches It is best for the treatment plan either to follow a standard protocol precisely or else to be part of an ongoing clinical research protocol evaluating new treatments ... 81) Tools are now available to minimize the acute toxicity of cancer treatment New symptoms developing in the course of cancer treatment should always be assumed to be reversible until proven otherwise...
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Chapter 077. Approach to the Patient with Cancer (Part 6) pdf
Ngày tải lên :
07/07/2014, 01:20
... Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific ... Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes Prostatic acid Prostate cancer...
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Chapter 077. Approach to the Patient with Cancer (Part 7) ppt
Ngày tải lên :
07/07/2014, 01:20
... cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms of cancer and its ... nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being ... in the course of their disease Unsound approaches are usually hawked on the basis of unsubstantiated anecdotes and not only cannot help the patient but may be harmful Physicians should strive to...
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Chapter 077. Approach to the Patient with Cancer (Part 8) potx
Ngày tải lên :
07/07/2014, 01:20
... on which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause ... signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in the medulla, the motor center ... caused by chemotherapy (Chap 81) Its severity can be predicted from the drugs used to treat the cancer Three forms of emesis are recognized on the basis of their timing with regard to the noxious...
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Chapter 077. Approach to the Patient with Cancer (Part 11) pot
Ngày tải lên :
07/07/2014, 01:20
... may provide more tools in the future as cytokine-mediated mechanisms are further elucidated Psychosocial Support The psychosocial needs of patients vary with their situation Patients undergoing ... another 24 h The tube is then disconnected from suction and allowed to drain by gravity If
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Chapter 077. Approach to the Patient with Cancer (Part 12) pot
Ngày tải lên :
07/07/2014, 01:20
... difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything that can be done to provide comfort ... hope Of course, patients not all progress through all the stages or proceed through them in the same order or at the same rate Nevertheless, developing an understanding of how the patient has been ... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions...
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Báo cáo y học: "Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetr" ppt
Ngày tải lên :
13/08/2014, 13:22
... was increased towards the formerly low crest side If the body remodels and adapts to the pelvic unleveling/torsion caused by anatomic LLI, then by putting a lift under the side of the "low" iliac ... in the muscles, ligaments, joints and bones to compensate for the imposed asymmetry Because these adaptive compensations to the LLI have become anatomic, they are not likely to change as the ... anatomic LLI and structurally compensatory pelvic torsion moves from a loaded (standing) to an unloaded (prone/supine) position, the torsion of the pelvis remains intact and the leg length at the...
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Báo cáo y học: "Computer says 2.5 litres - how best to incorporate intelligent software into clinical decision making in the intensive care unit" doc
Ngày tải lên :
13/08/2014, 11:23
... and so the model in fact predicts the decisions of the clinicians who looked after the patients in the first place Of course, the incorporation of expert clinician fluid assessment into the original ... pressure, and the response of these variables to fluid challenge not feature on the algorithm [8,9] The utility of clinical parameters such as peripheral oedema and capillary refill to improve the accuracy ... far-reaching implications of the incorporation of intelligence systems into clinical care Medicolegal challenges to nonadherence to the computer-derived protocol may be difficult to defend (and lawyers...
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Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 1) docx
Ngày tải lên :
07/07/2014, 04:20
... Approach to the Patient: Acute Febrile Illness A physician must have a consistent approach to acutely ill patients Even before the history is elicited and a physical ... infection, diabetes, malignancy, and chemotherapy all predispose to specific infections and frequently to increased severity The patient should be questioned about factors that might help identify a nidus ... Assessment of the patient' s general appearance and vital signs, skin and soft tissue examination, and the neurologic evaluation are of particular importance The patient may appear either anxious...
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Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 2) pptx
Ngày tải lên :
07/07/2014, 04:20
... (U.S.), Either: Atovaqu one and 01, 204 with fewer side or effects Treatmen Atovaquone t (750 mg q12h) plus with doxycycline c Azithromycin (100 mg bid ) (500-mg loading for potential dose, then 250 ... particularly in the setting of relative adrenal insufficiency c Tetracyclines can be antagonistic in action to β-lactam agents Adjust treatment as soon as the diagnosis is confirmed d The optimal ... discontinued Erythroder Group A Vancomycin If ma: toxic shock Streptococcus, (1 g q12h) plus penicillin- syndrome oxacillin- Staphylococcus a or 29, 130 toxigenic bacteria should be debrided; IV immunoglobuli...
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