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21. Acute Rhinosinusitis in Adults

and the nasal cavity lasting no longer than 4 weeks. It can range from acute viral rhinitis (the common cold) to acute bacterial rhinosinusitis. Fewer than 5 in 1,000 colds are followed by bacterial rhinosinusitis. Diagnosis. Estimate the probability of acute bacterial rhinosinusitis based on history, clinical presentation, and physical examination. Best predictors include maxillary toothache, poor response to decongestants, patient report of colored nasal discharge, and purulent secretions by exam (...) ? No Continue treatment as needed Limited sinus CT while symptomatic (Order “Sinus CT Stealth”) Positive for inflammatory disease? (see Table 6) Stop sinusitis treatment and reassess diagnosis (see Table 7) Otolaryngologyic consultation (endoscopic exam) Yes No Figure 2: Antibiotic Treatment for Suspected Acute Bacterial Rhinosinusitis High High Low Low Symptomatic treatment (Antibiotics only if symptoms are worsening) Symptom treatment only Antibiotic & symptom treatment Moderate Probability of Acute

2013 University of Michigan Health System

22. Allergic Rhinitis

effect Atrophic rhinitis Common medications causing rhinitis symptoms include calcium channel blockers, beta blockers, ACE inhibitors and alpha blockers Also called “ozena”, caused by over-resection of nasal turbinate tissue or poor mucus production, resulting in nasal dryness and crusting. Foul odor may be present. Gastroesophageal reflux Non-allergic rhinitis Under-recognized cause of post-nasal drip, cough, and globus sensation; hoarseness or frequent throat clearing may also be present Post-nasal (...) flooring. Homes should be dusted and vacuumed frequently and bedding should be washed in hot water on a weekly basis. It is best to eliminate stuffed animals from the affected child’s room. Chemical treatments include using 3% tannic acid solution (e.g., Allersearch® ADS Anti-Allergen Dust Spray) to denature dust mites in upholstered furniture and treating carpeting with a compound containing benzyl benzoate (e.g., Arcarosan?). The effectiveness of chemical treatments depends upon their repeated

2013 University of Michigan Health System

23. Is a Cure for Hepatitis B Coming? Experts Say Yes

recommend treatment if you experience any liver damage. This is indicated by an ultrasound exam and a blood test for the liver enzyme ALT/SGPT. Your doctor has probably decided that you require treatment, and tenofovir is an excellent antiviral that is very effective in lowering viral load and reducing your risk of liver damage. Experts predict a cure will be found in the next few years, we remain optimistic! Good luck. says: I’ve been on Viread for 4yrs. I moved last year and the new doctor took me off (...) unless he has signs of liver damage. Good luck. Please make medicine to cure hbv I’m waiting Hello sir I’m hapitise b viruse patient last one year I used tenvir medicine one year again report is coming positive what should I do I have no sygtom my hapitise is normal so his there any​ medicine to cure my hapitise b Hello: Medical guidelines do not recommend treatment with tenofovir unless you had signs of liver damage — indicated by elevated liver enzymes or an ultrasound exam of the liver that found

2016 hepbblog

24. Volatile Inhalant

Bagging Substance poured into a bag and inhaled Most dangerous method of Inhalant Abuse due to combination with anoxia and hypercarbia V. Symptoms Mood swings or VI. Findings: Signs and Symptoms See ral observation Staining of clothes Chemical inhalant odor to breath Room with multiple inhalant cans (e.g. air fresheners) Mouth and nose changes Perioral lesions, discoloration, erythema or "de-fatting" (with chronic use) Dominant hand changes Staining of s or skin De-fatting of dominant hand (...) Inhalant , Inhalation Drug Use , Inhalant Abuse , Volatile Inhalant Abuse , Sudden Sniffing Death Syndrome , Huffing From Related Chapters II. Epidemiology Common abuse in 10-14 years old (easy access to household inhalants) III. Forms Organic Nitrates (" ") Also found in aerosol bottles (see below) Gasoline, Propane, or other Hydrocarbons Butane (lighter fluid, hair spray, deodorants) Propane (Gas grill fuel, room freshener, spray paint) Fluorocarbons ( or spray, Freon gas) Chlorinated hydrocarbons

2018 FP Notebook

25. Your vagina doesn’t need a herbal cleanse. Here’s why.

backyard) could be damaging to your lactobacilli (the good bacteria) or be directly irritating to the vagina mucosa (the lining), and both of these outcomes will increase your risk of infection. Leaving a bag of anything in your vagina for three days is dangerous and smelly. What happens when you leave something in a vagina for three days is that anaerobic (not good) bacteria grow. I have removed many retained tampons over my career, and the smell is so bad we typically have to close the exam room (...) . Your uterus and vagina want you to leave them alone. Your uterus isn’t tired or depressed or dirty, and your vagina has not misplaced its chakra. They want no real help from you unless there is something wrong and they will tell you there is something wrong by bleeding profusely or itching or cramping badly or producing an odor. Don’t blame malaise, or fatigue on your uterus or vagina (unless you are anemic from bleeding, but then you would have had the warning sign). Actually, none of your organs

2016 KevinMD blog

26. Nutrition in Cancer Care (PDQ®): Health Professional Version

sections comprising 17 data points evaluating weight/weight history, food intake, symptoms, and activities/function. The remainder of the PG-SGA is completed by a health care practitioner, accounting for information about disease and metabolic demand and the completion of a physical exam. The abPG-SGA and PG-SGAsf use only the section completed by the patient. Responses are then scored and, on the basis of the score, patients are stratified into four nutrition triage categories:[ , ] No intervention (...) . Education by registered dietitian or other clinician. Intervention by registered dietitian. Critical need for improved symptom management. The drawback is that the PG-SGA takes more time to administer and requires a trained health care practitioner to complete the physical assessment portion. With validation of the short form, the need for physical exam is eliminated, and the practitioner’s administration time is reduced. The benefit of the PG-SGA (PG-SGAsf) is that it collects clinical information

2015 PDQ - NCI's Comprehensive Cancer Database

28. A primary care success story: Sometimes our words hit the mark

a few brochures, gave her a few numbers, and scheduled up a follow-up appointment. I made her promise that she would get help. As it turns out, she never came back to my office for the follow-up. But that morning she began a long successful journey toward sobriety. Now, a decade later, she was thanking me for saying the words that launched that journey. Years into the practice of medicine, I have spoken millions of words in the exam room and forgotten the majority of them. I humbly hope that some (...) at my watch and prepared to enter my son’s classroom when she stopped me, and asked the question that I assume had been hanging on her lips the whole time. You don’t remember, do you? She had come to my office nearly ten years prior for a routine physical. It was a mid-morning appointment, and as I listened to her heart I recognized the faint odor of alcohol poorly covered by breath mints. I waited patiently till the end of the appointment, and then gently discussed with her my suspicions. She

2015 KevinMD blog

29. Patient Modesty: Volume 64

I had a doctors appointment for the first time since they relocated to a newly built building. I got led to the exam room, and the first thing I notice in the room... a frigging CAMERA built into the ceiling. One of those black domed cameras you see in stores. It wasn't hidden, but I know a lot of people don't look around that much. (especially if they're worried about a medical issue) I asked the nurse why there was a camera, and she said for patient and doctor safety... I looked at the door (...) of the exam room and the reception / registration area on the way out and there was no notice that you'd be putting on a strip tease for whatever rent-a-cop happened to be working that day. ( I can only assume they're being watched in live time, otherwise if I snapped and attacked the doctor / nurse, the cameras wouldn't be much good for their safety... and yes... the patient table thing had the gyno stirrups, so I can only imagine the minimum wage security guards personal collection of "local girl

2014 Bioethics Discussion Blog

30. Nutrition in Cancer Care

and outpatient oncology settings.[ , ] It is an in-depth tool, and most of the items are completed by the patient. There are four sections comprising 17 data points evaluating weight/weight history, food intake, symptoms, and activities/function. The remainder of the PG-SGA is completed by a health care practitioner, accounting for information about disease and metabolic demand and the completion of a physical exam. The abPG-SGA and PG-SGAsf use only the section completed by the patient. Responses (...) are then scored and, on the basis of the score, patients are stratified into four nutrition triage categories:[ , ] No intervention. Education by registered dietitian or other clinician. Intervention by registered dietitian. Critical need for improved symptom management. The drawback is that the PG-SGA takes more time to administer and requires a trained health care practitioner to complete the physical assessment portion. With validation of the short form, the need for physical exam is eliminated

2012 PDQ - NCI's Comprehensive Cancer Database

31. Volatile Inhalant

Bagging Substance poured into a bag and inhaled Most dangerous method of Inhalant Abuse due to combination with anoxia and hypercarbia V. Symptoms Mood swings or VI. Findings: Signs and Symptoms See ral observation Staining of clothes Chemical inhalant odor to breath Room with multiple inhalant cans (e.g. air fresheners) Mouth and nose changes Perioral lesions, discoloration, erythema or "de-fatting" (with chronic use) Dominant hand changes Staining of s or skin De-fatting of dominant hand (...) Inhalant , Inhalation Drug Use , Inhalant Abuse , Volatile Inhalant Abuse , Sudden Sniffing Death Syndrome , Huffing From Related Chapters II. Epidemiology Common abuse in 10-14 years old (easy access to household inhalants) III. Forms Organic Nitrates (" ") Also found in aerosol bottles (see below) Gasoline, Propane, or other Hydrocarbons Butane (lighter fluid, hair spray, deodorants) Propane (Gas grill fuel, room freshener, spray paint) Fluorocarbons ( or spray, Freon gas) Chlorinated hydrocarbons

2015 FP Notebook

32. Glycopyrrolate oral solution

) Baseline (Day -8 to 0) Day +1 Week 2 (Day 14) Week 4 (Day 28) Week 6 (Day 42) Week 8 (Day 56) Dropout Informed Consent X Inclusion/ Exclusion X Demographics X Medical History X Physical Exam X X X Randomization X Study Medication X X X X X X Caregiver Training X X X X Blood Chemistry X X X CBC X X X Urinalysis X X X 12-Lead ECG X X X Pregnancy Test X X X mTDS Caregiver Dispense Diary X X X X X Global Assessments X X mBMRS Instruct Caregiver, Dispense Diary X X X X X X Caregiver Diary (c) Instruct

2010 FDA - Drug Approval Package

33. Ceftaroline fosamil for injection (Teflaro)

. The constituted solution should be used within 6 hours when stored at room temperature or within 24 hours when refrigerated at 2 to 8 degrees centigrade. , ceftaroline fosamil is available as an acetate monohydrate 21 Reference ID: 2857265 (b) (4) (b) (4) (b) (4) (b) (4)Clinical Review Ariel Ramirez Porcalla, MD, MPH Neil Rellosa, MD NDA 200327: Teflaro (ceftaroline fosamil) which is a stable solvate. Manufactured by ACS Dobfar under Drug Master File (DMF) 23167, ceftaroline fosamil has related impurities

2010 FDA - Drug Approval Package

34. Overview of Coma and Impaired Consciousness

the American... 3D Model Herniated Nucleus Pulposus Video How to do a 4-Minute Neurologic Exam SOCIAL MEDIA Add to Any Platform Loading , MD, National Heart, Lung, and Blood Institute Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Coma is unresponsiveness from which the patient cannot be aroused. Impaired consciousness refers to similar, less severe disturbances of consciousness; these disturbances are not considered coma. The mechanism for coma (...) . Findings may suggest a cause: Hypothermia: Environmental exposure, near-drowning, sedative overdose, Wernicke encephalopathy, or, in the elderly, sepsis Hyperthermia: Heatstroke Fever, petechial or purpuric rash, hypotension, or severe extremity infections (eg, gangrene of one or more toes): Sepsis or CNS infection Needle marks: Drug overdose (eg, of opioids or insulin) A bitten tongue: Seizure Breath odor: Alcohol, other drug intoxication, or diabetic ketoacidosis Neurologic examination The determines

2013 Merck Manual (19th Edition)

35. Evaluation of the Elderly Patient

be counseled to stop and, if they continue, not to smoke in bed because the elderly are more likely to fall asleep while doing so. Patients should be checked for signs of , which are underdiagnosed in the elderly. Such signs include confusion, anger, hostility, alcohol odor on the breath, impaired balance and gait, tremors, peripheral neuropathy, and nutritional deficiencies. Screening questionnaires (eg, AUDIT—see Table: and see Table: ) and questions about quantity and frequency of alcohol consumption (...) can gain insight about nutrition from the refrigerator’s contents and about multiple ADLs from the bathroom’s condition. The number of rooms, number and type of phones, presence of smoke and carbon monoxide detectors, and condition of plumbing and heating system are determined, as is the availability of elevators, stairs, and air conditioning. Home safety evaluations can identify home features that can lead to falls (eg, poor lighting, slippery bathtubs, unanchored rugs), and solutions can

2013 Merck Manual (19th Edition)

36. Pap test

appropriate precautions and discuss the process ahead of time with their providers, in writing if necessary. A smaller speculum, gel, and warming the instruments and lubricant ahead of time, along with extra time in the exam room and gentle technique, can all contribute to reducing the risk to manageable levels. These are reasonable accommodations to ask for and are aligned with good practice. Many people experience spotting or mild diarrhea afterward. The spotting is usually from the scrape on the cervix (...) and the diarrhea may be due to indirect stimulation of the lower intestine during the exam. Many health care providers are under the false impression that only sterile water, or no lubricant at all, should be used to lubricate the speculum. This may result in unnecessary discomfort. A number of studies have shown that using a small amount of water-based gel lubricant does not interfere with, obscure, or distort the PapP smear. Further, cytology is not affected, nor are some STD testing. The health care worker

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2012 Wikipedia

37. Mental status examination

, or needle track marks from intravenous drug abuse. Observations can also include any odor which might suggest poor personal due to extreme self-neglect, or . Weight loss could also signify a depressive disorder, physical illness, anorexia nervosa or chronic anxiety. Attitude [ ] Attitude, also known as or cooperation, refers to the patient's approach to the interview process and the quality of information obtained during the assessment. Behavior [ ] Abnormalities of behavior, also called abnormalities (...) of immediate registration (repeating a set of words), short-term memory (recalling the set of words after an interval, or recalling a short paragraph), and long-term memory (recollection of well known historical or geographical facts). Visuospatial functioning can be assessed by the ability to copy a diagram, draw a clock face, or draw a map of the consulting room. Language is assessed through the ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response

Full Text available with Trip Pro

2012 Wikipedia

38. Carbon monoxide

of . Carbon monoxide consists of one atom and one atom, connected by a that consists of two as well as one covalent bond. It is the simplest and is with other triply-bonded diatomic molecules having ten valence electrons, including the anion, the cation and molecular . In the carbon monoxide is called . Contents History [ ] (384–322 BC) first recorded that burning coals produced toxic fumes. An ancient method of execution was to shut the criminal in a bathing room with smoldering coals. What was not known (...) heaters, and and room heaters; engine-powered equipment such as portable generators; fireplaces; and charcoal that is burned in homes and other enclosed areas. The American Association of Poison Control Centers (AAPCC) reported 15,769 cases of carbon monoxide poisoning resulting in 39 deaths in 2007. In 2005, the CPSC reported 94 generator-related carbon monoxide poisoning deaths. Forty-seven of these deaths were known to have occurred during power outages due to severe weather, including . Still

2012 Wikipedia

40. Study to Evaluate the Efficacy and Safety of GSK239512 in Alzheimer's Disease

for bilateral testing. During the testing, the participant wore a blind fold (a black sleeping mask was supplied with the kit). It was recommended that testing be performed in a well-ventilated room with little or no odor and no disturbances during testing. This test consists of a total of 12 pens and 12 multiple choice answers. Participants were presented with each of the 12 pens at an interval of 30 seconds between each and asked to identify each odorant. For each odorant, the Participant was able (...) to choose from 4 possible answers as to what the smell was. Participants had to identify the item that best described the presented odor. Participants had to choose an item even when they do not perceive an odor or do not feel that their decision was correct. Items identified by participants were noted on the recording sheet. The number of correct answers were recorded. Change from BL is the value at indicated time point minus the BL value Plasma concentrations of GSK239512 over period [ Time Frame: Up

2009 Clinical Trials

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