general principles in the approach to the patient with an acute emergency
Chapter 052. Approach to the Patient with a Skin Disorder (Part 1) ppt
... 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 a different ... linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation ... of skin or systemic disease For instance, the sometimes minor differences in color and shape that distinguish a melanoma (Fig 52-1) from a benign nevomelanocytic nevus (Fig 52-2) can be difficult...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 2) potx
... 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 dermatitis, ... 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 areas may ... scratching Atrophy: An acquired loss of substance In the skin, this may appear as a depression with intact epidermis (i.e., loss of dermal or subcutaneous tissue) or as sites of shiny, delicate, wrinkled...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 4) doc
... 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 findings can be integrated ... 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, ... nasopharynx, and anogenital region In the initial examination it is important that the patient be disrobed as completely as possible This will minimize chances of missing important individual skin lesions...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 5) pptx
... 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 and plaques with ... papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale Figure 52-8 ...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 6) pdf
... irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous ... 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 Yale Resident's ... (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
... selected areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel ... dermatophyte infections, pseudohyphae and budding yeast in Candida infections (see Fig 196-1), and "spaghetti and meatballs" yeast forms in tinea versicolor The same sampling technique can be used to obtain ... biopsy In the latter technique, a punch is pressed against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then...
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Chapter 052. Approach to the Patient with a Skin Disorder (Part 8) pptx
... allergens is applied to the patient' s back under occlusive dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of ... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled Urticaria (Fig 52-11) will blanch with ... Granulomas often have an opaque to transparent, brown-pink "apple jelly" appearance on diascopy Figure 52-11 Urticaria Discrete and confluent, edematous, erythematous papules and plaques are characteristic...
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Chapter 077. Approach to the Patient with Cancer (Part 1) potx
... 40 and 59, in 12 men and in 11 women will develop cancer; and for the interval between ages 60 and 79, in men and in women will develop cancer Overall, men have a 45% risk of developing cancer ... desperate significance Cancer is an exception to the coordinated interaction among cells and organs In general, the cells of a multicellular organism are programmed for collaboration Many diseases ... decline in 1997 (Fig 77-2) The five leading causes of cancer deaths are shown for various populations in Table 77-2 Along with the decrease in incidence has come an increase in survival for cancer patients...
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Chapter 077. Approach to the Patient with Cancer (Part 3) pptx
... 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 ... cancer 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 ... on 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...
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Chapter 077. Approach to the Patient with Cancer (Part 4) pps
... examination, radiographs, isotopic scans, CT scans, and other imaging procedures; pathologic staging takes into account information obtained during a surgical procedure, which might include intraoperative ... and/or tissue adjacent to the tumor, and inspection and biopsy of organs commonly involved in disease spread Pathologic staging includes histologic examination of all tissues removed during the ... obtained from staging is used to define the extent of disease either as localized, as exhibiting spread outside of the organ of origin to regional but not distant sites, or as metastatic to distant...
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Chapter 077. Approach to the Patient with Cancer (Part 5) doc
... is important to remember the comfort that is provided by holding the patient' s hand, continuing regular examinations, and taking time to talk 2 The National Cancer Institute maintains a database ... skilled 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 ... defined as the appearance of any new lesion or an increase of >25% in the sum of the products of the perpendicular diameters of all measurable lesions (or an increase of 20% in the sums of the...
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Chapter 077. Approach to the Patient with Cancer (Part 6) pdf
... Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the ... Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate cancer Prostatitis, antigen prostatic ... Myeloma Infection, MGUSa immunoglobulin CA-125 Ovarian cancer, some lymphomas Menstruation, peritonitis, pregnancy CA 19-9 Colon, pancreatic, breast cancer CD30 ulcerative colitis Hodgkin's disease,...
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Chapter 077. Approach to the Patient with Cancer (Part 7) ppt
... 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 taken.3 Information about unsound ... visits, during which the history and physical examination are the major investigations performed As time passes, the likelihood of recurrence of the primary cancer diminishes For many types of cancer, ... consequence of the disease and some as a consequence of the treatment An understanding of these disease- and treatment-related problems may help in their detection and management Despite these concerns,...
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Chapter 077. Approach to the Patient with Cancer (Part 8) potx
... process, including dopamine, serotonin, histamine, opioid, and acetylcholine receptors The serotonin receptor antagonists ondansetron and granisetron are the most effective drugs against highly emetogenic ... delivery Acute 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 ... 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 in the...
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Chapter 077. Approach to the Patient with Cancer (Part 11) pot
... bleomycin or g of doxycycline is infused into the chest tube in 50 mL of 5% dextrose in water; the tube is clamped; the patient is rotated on four sides, spending 15 in each position; and, after ... in which protein catabolism, glucose intolerance, and lipolysis cannot be reversed by the provision of calories It remains controversial how to assess nutritional status and when and how to intervene ... volumes of fluid If the underlying malignancy is unresponsive to systemic therapy, peritoneovenous shunts may be inserted Despite the fear of disseminating tumor cells into the circulation, widespread...
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Chapter 077. Approach to the Patient with Cancer (Part 12) pot
... 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 ... acknowledgment of an incurable disease, and the goal of palliative therapy is embraced in the hope of being able to live with disease; finally, at the disclosure of imminent death, another adjustment in outlook ... discussions can be 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...
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báo cáo khoa học: " Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study" potx
... testing in the primary setting and less ‘over-testing’ of the patient could occur in the primary care setting, compared to the hospital setting The most serious patient safety incidents in our ... been conducted in hospital settings [12] The aim of the present study was to determine the prevalence and types of patient safety incidents occurring in general practice in the Netherlands Page of ... cause the patient harm 110 (52.1) An error occurred that reached the patient and required monitoring to confirm that it resulted in no harm to the patient and/or required intervention to preclude...
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Báo cáo khoa học: H2O2, but not menadione, provokes a decrease in the ATP and an increase in the inosine levels in Saccharomyces cerevisiae An experimental and theoretical approach pot
... accompanied by an increase in the rate of synthesis of Ino, without any need to modify the kinetic parameters or activities of the enzymes involved in the pathway from ATP to Ino Being aware of the simplications ... in ATP and the increase in inosine, promoted by H2O2, cannot be explained solely by a change in the level of the enzymes more directly involved in the nucleotide pathway from ATP to inosine (Fig ... 50%, with concomitant appearance of inosine (Fig 1A) Incubation times longer than 30 in the presence of H2O2 did not greatly change the ratio SATP + ADP + AMP/Ino Similar changes in ATP and inosine...
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coats & schauberger - nature as teacher - new principles in the working of nature (1998)
... meanings as: - pertaining to the first age of the world, or of anything ancient; - pertaining to or existing from the earliest beginnings;- constituting the earliest beginning or starting point;- ... the culmination point before swinging downwards once more In the same instant the child returned to the seat and allowed the swing to move without influencing it further, until with shorter and ... by avalanches, branches and all, freed themselves from being stuck in the sand and began to perform a spiral dance, which swept them faster and faster towards the centre of the lake There they...
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Chapter 3 - General Principles of the IMS Architecture pot
... domain, replacing the I-CSCF as the original first entry point The IBCF can also be the last node in the signaling path prior to the forwarding of the SIP request to an external domain The main functionality ... purposes and for calculating the integrity and cipher keys used between the terminal and the network The IMS terminal uses the integrity key to integrity-protect the SIP signaling that the IMS terminal ... users to easily move their user subscriptions (including the phonebook) from one terminal to another The user simply removes the smart card from a terminal and inserts it into another terminal...
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