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Self Skin Exam

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61. Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments (PubMed)

Management of Pediatric Skin Abscesses in Pediatric, General Academic and Community Emergency Departments To compare the evaluation and management of pediatric cutaneous abscess patients at three different emergency department (ED) settings.We conducted a retrospective cohort study at two academic pediatric hospital EDs, a general academic ED and a community ED in 2007, with random sampling of 100 patients at the three academic EDs and inclusion of 92 patients from the community ED. Eligible (...) patients were ≤18 years who had a cutaneous abscess. We recorded demographics, predisposing conditions, physical exam findings, incision and drainage procedures, therapeutics and final disposition. Laboratory data were reviewed for culture results and antimicrobial sensitivities. For subjects managed as outpatients from the ED, we determined where patients were instructed to follow up and, using electronic medical records, ascertained the proportion of patients who returned to the ED for further

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2011 Western Journal of Emergency Medicine

62. Non-allergic rhinitis

guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998 Nov;81(5 Pt 2):478-518. http://www.ncbi.nlm.nih.gov/pubmed/9860027?tool=bestpractice.com It is a chronic condition that should be distinguished from a common cold, which can manifest with symptoms of NAR but is self-limiting. History and exam presence of risk factors nasal congestion post-nasal drainage rhinorrhoea sore throat ear plugging sinus headaches postural change triggers (...) , cobblestoning of posterior pharynx from chronic post-nasal drainage, and retraction of tympanic membranes indicating congestion. A diagnosis of NAR requires negative specific IgE responses by skin or serological testing. Differentiation between non-allergic rhinitis with eosinophilia syndrome and other sub-types of NAR is determined by the presence or absence of eosinophilia in the nasal passage. Treatment is based on symptoms, and all patients should be counselled on avoidance of triggers. Symptom control

2019 BMJ Best Practice

63. Pityriasis rosea

Pityriasis rosea Pityriasis rosea - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pityriasis rosea Last reviewed: February 2019 Last updated: March 2019 Summary An inflammatory skin disease with unclear aetiology, although an infectious cause has been suggested. Can present in patients of any age but most often in people aged 10 to 35 years. Manifests as an acute, self-limiting, inflammatory eruption characterised (...) by a single larger lesion, the herald patch, followed by eruption of smaller papulosquamous oval lesions. Spontaneous resolution, usually over several weeks, but can persist for up to 5 months. Symptoms treated by topical corticosteroids and/or oral antihistamines, or UV therapy. Definition Pityriasis rosea (PR) is an inflammatory skin condition of uncertain aetiology, although an unknown infectious agent has been suggested. PR manifests as an acute, self-limiting, inflammatory eruption characterised

2019 BMJ Best Practice

64. Langerhans cell histiocytosis

(i.e., syndrome characterised by the abnormal proliferation of histiocytes). Weitzman S, Egeler RM. Histiocytic disorders of children and adults: introduction to the problem, overview, historical perspective and epidemiology (adapted from Favara BE, et al. Med Pediatr Oncol 1997). In: Weitzman S, Egeler RM, eds. Histiocytic disorders of children and adults. Cambridge, UK: Cambridge University Press; 2005:3. History and exam age <15 years bone pain and/or swelling skin rash polyuria and polydipsia (...) to immune dysregulation. Clinical presentation is heterogeneous and ranges from self-healing bone lesions to multi-system, life-threatening disease. Tissue biopsy of lesional cells showing the presence of CD1a and langerin (CD207) is definitive for diagnosis in the correct clinical setting. Multi-system disease is treated with systemic, multi-agent chemotherapy. Treatment of relapsed disease and central nervous system neurodegenerative disease remains a challenge. Prognostic factors include rapid

2019 BMJ Best Practice

65. Regional Models of Care for Systemic Treatment: Standards for the Organization and Delivery of Systemic Treatment

of the certification exam offered by the Canadian Nurses Association and attainment of the distinction Certified in Oncology Nursing Canada CON(C). The Specialized Oncology Nurse works in a specialized inpatient setting such as an oncology unit or bone marrow transplant unit, an ambulatory setting focused on the delivery of cancer care; a screening program, or a supportive care setting or community setting offering palliative care. There are many environments where the enhanced specialty knowledge and skill (...) of the nurse can be utilized to manage symptoms and side effects of treatment, counsel patients in coping strategies, teach self-care behaviours, and monitor the responses to treatment and interventions. [1] Systemic Treatment – Any oral or parenteral anticancer agent including but not limited to hormonal, biological, immunotherapeutic, or chemotherapeutic, agents. Guideline 12-10 Version 2 Section 2: Evidence Summary – July 5, 2019 Page 14 Regional Models of Care for Systemic Treatment: Standards

2019 Cancer Care Ontario

66. Chronic pancreatitis

pancreatitis: patients have relapsing pain not recognised clinically as chronic pancreatitis (no hallmark features) but have pathological changes in tissue specimens. (4) Established chronic pancreatitis: hallmark features of chronic pancreatitis are present, including reduced pancreatic exocrine function, malabsorption, diabetes, and pancreatic calcifications. History and exam presence of risk factors abdominal pain steatorrhoea jaundice weight loss and malnutrition nausea and vomiting skin nodules (...) . Underlying causes and precipitating factors are treated. There is no definitive therapy; treatment is otherwise aimed at symptoms. Common complications include narcotic addiction, pancreatic pseudocysts, pancreatic calcification, diabetes mellitus, and malabsorption. Definition Pancreatitis is a clinical diagnosis defined by pancreatic inflammation. Although not always clinically distinguishable, pancreatitis can be defined as acute or chronic. Acute pancreatitis is a self-limiting and reversible

2018 BMJ Best Practice

67. Overview of sexually transmitted infections

=bestpractice.com Lack of or inadequate treatment risks possible ascending infection and further complications, as well as possible spread of the infection to sexual partners. The most commonly reported STI after chlamydial infection. Classic presentation is a man with a urethral discharge; women are often asymptomatic but may have vaginal discharge. If left untreated, Neisseria gonorrhoeae can disseminate to cause skin and synovial infections. Rarer complications include meningitis, endocarditis (...) , and perihepatic abscesses. High rates of antimicrobial resistance have been reported, and antibiotic treatment should be guided by local and national guidelines. A common sexually transmitted infection caused by a spirochetal bacterium. Clinical presentation is often asymptomatic but can manifest in a number of ways. Diagnosis is usually straightforward after clinical exam and serological testing; treatment is with penicillin. Untreated syphilis facilitates HIV transmission and causes considerable morbidity

2018 BMJ Best Practice

68. Bulimia nervosa

, enemas, or other medication. Binge-eating episodes typically occur, on average, at least weekly for 3 months. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. History and exam presence of risk factors recurrent episodes of binge eating recurrent inappropriate compensatory behaviour eating disturbance not exclusively during periods of anorexia nervosa depression and low self-esteem concern (...) about weight and body shape dental erosion parotid hypertrophy Russell's sign arrhythmia age 20 to 35 years menstrual irregularity drug-seeking behaviour deliberate misuse of insulin self-injurious behaviour GI symptoms history of dieting marked fluctuations in weight shoplifting behaviour use of ipecac needle marks on skin vomiting in pregnancy female sex personality disorder body-image dissatisfaction history of sexual abuse impulsivity family history of alcoholism family history of depression

2018 BMJ Best Practice

69. Laryngitis

commonly hoarseness, generally arise over a period of <7 days, are usually preceded by a viral upper respiratory infection (URI), and are ordinarily self-limiting. Patients may present with airway distress and high fever. Exudative tonsillopharyngitis with fever and anterior cervical lymphadenitis is highly suggestive of a bacterial origin. The airway should be assessed first. Diligence and promptness are key, as they can be lifesaving. Chronic laryngitis presents with hoarseness lasting >3 weeks (...) , infectious or non-infectious. Accompanying signs of infectious laryngitis include odynophagia, cough, fever, and respiratory distress. The most common variant is acute viral laryngitis, which is self-limiting and usually related to an upper respiratory infection. Bacterial laryngitis can be life-threatening. Haemophilus influenzae is one of the most frequently isolated bacteria. Other causes include tuberculosis (TB), diphtheria, syphilis, and fungi. Non-infectious causes of laryngitis include reflux

2018 BMJ Best Practice

70. Pressure ulcer

surfaces. They may be small, superficial wounds or blisters involving only epidermal elements or larger (sometimes massive) wounds, often covered or filled with necrotic tissue and involving deeper tissues, including fascia, muscle, or bone. History and exam presence of risk factors use of non-pressure-relieving support surface localised skin changes on areas subjected to pressure shallow open wound or tissue loss on areas subjected to pressure full-thickness wound on areas subjected to pressure (...) prominences but can develop on any part of the body subjected to sustained localised pressure. Pressure damage varies from small superficial lesions to extensive wounds with bony involvement that contain a mass of necrotic tissue. Prevention is better than cure; all patients at risk of sustaining pressure damage should be assessed and provided with appropriate pressure-reducing strategies. Using support surfaces, repositioning the patient, optimising nutritional status, and moisturising sacral skin

2018 BMJ Best Practice

71. Erythema multiforme

of underlying infection remain the mainstay of therapy. Definition Erythema multiforme (EM) is typically an acute, self-limiting but often relapsing, mucocutaneous inflammatory condition. It is a hypersensitivity reaction associated with certain infections, vaccinations, and, less commonly, medications. The disease is characterised clinically by target lesions, which can be described as annular erythematous rings with an outer erythematous zone and central blistering sandwiching a zone of normal skin tone (...) ://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2011.05348.x/full http://www.ncbi.nlm.nih.gov/pubmed/22788803?tool=bestpractice.com History and exam presence of risk factors target lesions of the extremities recurrent disease mucosal erosions targetoid lesions rapid onset of lesions self-limiting course clustered vesicles on an erythematous base rhonchi, rales, and/or wheezes red tympanic membranes hepatomegaly prior occurrence herpes simplex virus (HSV) infection cytomegalovirus (CMV) infection Epstein-Barr virus

2018 BMJ Best Practice

72. Amfetamine overdose

. The consequences may be substance-related legal problems, depression, failure to fulfil occupational, family, or social obligations, and continued use despite danger to self or destructive effects on quality of life. History and exam presence of risk factors agitation, irrationality, restlessness, sometimes aggressive behaviour hyperthermia >38°C (>100°F) but <39.5°C (<103°F) hyperthermia >39.5°C (>103°F) seizures diaphoresis, flushed facial skin tachycardia and palpitations traumatic injury headache serotonin

2018 BMJ Best Practice

73. Folliculitis

various populations of inflammatory cells around the pilosebaceous unit. Folliculitis commonly occurs in areas with terminal hair growth, such as the head and neck region, axillae, groin and buttocks; it also favours areas under occlusion. History and exam recent history of immersion in spa water man with dark skin and curly hair recent ingestion of drugs known to be associated with folliculitis recent history of shaving umbilicated, flesh-coloured papules papules on one side of the face (...) Folliculitis Folliculitis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Folliculitis Last reviewed: February 2019 Last updated: June 2018 Summary Causes include bacterial, fungal, viral, and parasitic microorganisms. Most commonly superficial and resulting from infection by Staphylococcus aureus; use of antibacterial soaps may suffice as treatment for uncomplicated folliculitis, which is self-limited. Deeper

2018 BMJ Best Practice

74. Stevens-Johnson syndrome and toxic epidermal necrolysis

care as soon as the diagnosis is suspected or made. The majority of SJS patients recover (mortality 1% to 5%). SJS can recur either with the same medicine or with another medicine. TEN has a higher mortality (25% to 30%). In the long term, patients should ensure they are not re-exposed to the trigger medicine and be careful of self-medicating. They should avoid sunlight during healing and moisturise their skin. Currently, patients at risk may need HLA screening if they are to receive medications (...) . 2013;69:187. http://www.ncbi.nlm.nih.gov/pubmed/23866879?tool=bestpractice.com History and exam presence of risk factors rash mucosal involvement Nikolsky's sign blisters anticonvulsant medicines recent infection recent antibiotic use other medicines SLE AIDS radiotherapy bone marrow transplantation HLA and genetic predisposition smallpox vaccination Diagnostic investigations skin biopsy blood cultures FBC urea LFTs arterial blood gases and saturation of oxygen serum electrolytes serum creatinine

2018 BMJ Best Practice

75. Kawasaki disease

of age in the US and other developed countries. History and exam presence of risk factors polymorphous rash conjunctival injection mucositis skin changes in the peripheral extremities enlarged cervical lymph nodes coronary artery aneurysms fever and extreme irritability pericarditis with effusion congestive heart failure joint pain or oedema neurological manifestations gastrointestinal manifestations urological manifestations other dermatological manifestations Asian ancestry age 3 months to 4 years (...) in the second week. Unilateral non-purulent cervical lymphadenopathy is present in about 40% of cases. Coronary aneurysms develop in 20% to 25% of untreated patients. Standard treatment includes intravenous immunoglobulin and/or aspirin. In resistant cases, corticosteroids or a tumour necrosis factor (TNF)-alpha inhibitor may be necessary. Definition Kawasaki disease (KD) is an acute, febrile, self-limiting, systemic vasculitis of unknown origin that almost exclusively affects young children

2018 BMJ Best Practice

76. Chronic pancreatitis

pancreatitis: patients have relapsing pain not recognised clinically as chronic pancreatitis (no hallmark features) but have pathological changes in tissue specimens. (4) Established chronic pancreatitis: hallmark features of chronic pancreatitis are present, including reduced pancreatic exocrine function, malabsorption, diabetes, and pancreatic calcifications. History and exam presence of risk factors abdominal pain steatorrhoea jaundice weight loss and malnutrition nausea and vomiting skin nodules (...) . Underlying causes and precipitating factors are treated. There is no definitive therapy; treatment is otherwise aimed at symptoms. Common complications include narcotic addiction, pancreatic pseudocysts, pancreatic calcification, diabetes mellitus, and malabsorption. Definition Pancreatitis is a clinical diagnosis defined by pancreatic inflammation. Although not always clinically distinguishable, pancreatitis can be defined as acute or chronic. Acute pancreatitis is a self-limiting and reversible

2018 BMJ Best Practice

77. Overview of sexually transmitted diseases

=bestpractice.com Lack of or inadequate treatment risks possible ascending infection and further complications, as well as possible spread of the infection to sexual partners. The most commonly reported STI after chlamydial infection. Classic presentation is a man with a urethral discharge; women are often asymptomatic but may have vaginal discharge. If left untreated, Neisseria gonorrhoeae can disseminate to cause skin and synovial infections. Rarer complications include meningitis, endocarditis (...) , and perihepatic abscesses. High rates of antimicrobial resistance have been reported, and antibiotic treatment should be guided by local and national guidelines. A common sexually transmitted infection caused by a spirochetal bacterium. Clinical presentation is often asymptomatic but can manifest in a number of ways. Diagnosis is usually straightforward after clinical exam and serological testing; treatment is with penicillin. Untreated syphilis facilitates HIV transmission and causes considerable morbidity

2018 BMJ Best Practice

78. Type 2 diabetes in adults

/Supplement_1/S1 History and exam presence of risk factors asymptomatic candidal infections skin infections urinary tract infections fatigue blurred vision polydipsia polyphagia polyuria paraesthesias nocturia unintentional weight loss acanthosis nigricans older age overweight/obesity gestational diabetes pre-diabetes family history of type 2 diabetes African, Hispanic, or Native American ancestry physical inactivity polycystic ovary syndrome hypertension dyslipidaemia cardiovascular disease Diagnostic (...) Type 2 diabetes in adults Type 2 diabetes in adults - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Type 2 diabetes in adults Last reviewed: February 2019 Last updated: July 2018 Summary The cornerstone of therapy for all patients with diabetes is a personalised self-management programme, usually developed with the patient by a diabetes education nurse or nutritionist. Lifestyle changes plus metformin are initial

2018 BMJ Best Practice

79. Non-allergic rhinitis

guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998 Nov;81(5 Pt 2):478-518. http://www.ncbi.nlm.nih.gov/pubmed/9860027?tool=bestpractice.com It is a chronic condition that should be distinguished from a common cold, which can manifest with symptoms of NAR but is self-limiting. History and exam presence of risk factors nasal congestion post-nasal drainage rhinorrhoea sore throat ear plugging sinus headaches postural change triggers (...) , cobblestoning of posterior pharynx from chronic post-nasal drainage, and retraction of tympanic membranes indicating congestion. A diagnosis of NAR requires negative specific IgE responses by skin or serological testing. Differentiation between non-allergic rhinitis with eosinophilia syndrome and other sub-types of NAR is determined by the presence or absence of eosinophilia in the nasal passage. Treatment is based on symptoms, and all patients should be counselled on avoidance of triggers. Symptom control

2018 BMJ Best Practice

80. Food poisoning

Food poisoning Food poisoning - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Food poisoning Last reviewed: February 2019 Last updated: May 2018 Summary Typically mild, self-limiting, and improves with supportive non-specific symptomatic treatments. Most patients present with gastrointestinal symptoms such as abdominal pain or cramps, nausea and vomiting, and/or diarrhoea. Foodborne disease outbreak is a cluster (...) Foundation, Centers for Disease Control and Prevention, et al. Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004 Apr 16;53(RR-4):1-33. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm http://www.ncbi.nlm.nih.gov/pubmed/15123984?tool=bestpractice.com History and exam presence of risk factors diarrhoea nausea and vomiting abdominal pain bloating fever dehydration blood or mucus in stool profuse rice-water stool reactive

2018 BMJ Best Practice

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