kraft m approach to the patient with respiratory 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 ... spreading melanoma. This is the most common type of melanoma. Such lesions usually demonstrate asymmetry, border irregularity, color variegation (black, blue, brown, pink, and white), a diameter ... 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...

Ngày tải lên: 06/07/2014, 20:20

... formed from coalescing rings or incomplete rings. Pruritus: A sensation that elicits the desire to scratch. Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic ... 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 ... secondary to trauma or inflammation. Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character. Sites on hair-bearing areas may be characterized by destruction...

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... 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 rash limited ... lesions, the shape of individual lesions, and the arrangement of the lesions. An ideal skin examination includes evaluation of the skin, hair, and nails as well as the mucous membranes of the mouth, ... purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER...

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... 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...

Ngày tải lên: 06/07/2014, 20:20

... (Fig. 52-10) or primary irritant dermatitis. In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology. Figure 52-9 Erythema multiforme. This eruption ... by multiple erythematous plaques with a target or iris morphology. It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV). (Courtesy of the ... sulfonylamides) or infections (e.g., HSV). (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

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... appearance, but sometimes relatively simple diagnostic procedures can yield valuable information. In most instances, they can be performed at the bedside with a minimum of equipment. Skin Biopsy ... 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 ... (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 can be diagnosed...

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... Corynebacterium minutissimum) to show a characteristic coral pink color, and wounds colonized by Pseudomonas to appear pale blue. Tinea capitis caused by certain dermatophytes such as Microsporum canis ... 052. Approach to the Patient with a Skin Disorder (Part 8) Tzanck Smear A Tzanck smear is a cytologic technique most often used in the diagnosis of herpesvirus infections [herpes simplex ... Microsporum canis or M. audouini exhibits a yellow fluorescence. Pigmented lesions of the epidermis such as freckles are accentuated, while dermal pigment such as postinflammatory hyperpigmentation fades...

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... person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months). However, the patient with heart disease may remain functional and maintain ... 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 application ... Lympho ma 4 34,200 Lympho ma 4 28,990 Melano ma 4 33,910 Melanom a 4 26,030 Kidney 4 31,590 Thyroid 4 25,480 Leukemi a 3 24,800 Ovary 3 22,430 Chapter 077. Approach to the Patient...

Ngày tải lên: 07/07/2014, 01:20

... 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 medical ... 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 ... 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 or a paraneoplastic...

Ngày tải lên: 07/07/2014, 01:20

... Performance Status 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 ... although some tumors have more elaborate systems of nodal grading), and the presence of metastatic disease (M0 and M1 for the absence and presence, respectively, of metastases). The various permutations ... 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

... and myelosuppression (Chap. 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 ... hoc modifications 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 ... 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

... Hodgkin's disease, anaplastic large cell lymphoma — CD25 Hairy cell — Chapter 077. Approach to the Patient with Cancer (Part 6) Tumor markers may be useful in patient management in ... in certain tumors. Response to therapy may be difficult to gauge with certainty. However, some tumors produce or elicit the production of markers that can be measured in the serum or urine and, ... Table 77-5. Tumor markers are not 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...

Ngày tải lên: 07/07/2014, 01:20

... ideation. Patients with these symptoms should receive therapy. Medical therapy with a serotonin reuptake inhibitor such as fluoxetine (10–20 mg/d), sertraline (50–150 mg/d), or paroxetine (10–20 mg/d) ... breast cancer, melanoma, lung cancer, colon cancer, and lymphoma have all failed to support the notion that asymptomatic relapses are more readily cured by salvage therapy than symptomatic relapses. ... abnormality is biopsied. If disease persists, the multidisciplinary team discusses a new salvage treatment plan. If the patient has been rendered disease- free by the original treatment, the patient...

Ngày tải lên: 07/07/2014, 01:20

... 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 insult. Acute emesis, the most common variety, occurs within ... delayed vomiting. Like pain, emesis is easier to prevent than to alleviate. Delayed emesis may be related to bowel inflammation from the therapy and can be controlled with oral dexamethasone ... response to visual and olfactory stimuli previously associated with chemotherapy delivery. Acute emesis is the best understood form. Stimuli that activate signals in the chemoreceptor trigger...

Ngày tải lên: 07/07/2014, 01:20

... Chapter 077. Approach to the Patient with Cancer (Part 11) Effusions Fluid may accumulate abnormally in the pleural cavity, pericardium, or peritoneum. Asymptomatic malignant effusions may not ... treatment. Symptomatic effusions occurring in tumors responsive to systemic therapy usually do not require local treatment but respond to the treatment for the underlying tumor. Symptomatic ... relapse (the Damocles syndrome). Patients in whom therapy has been unsuccessful have other problems related to the end of life. therapy, peritoneovenous shunts may be inserted. Despite the fear...

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