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Self Skin Exam

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161. Taping: knee osteoarthritis

Taping: knee osteoarthritis RACGP - Knee taping for osteoarthritis Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP Fellowship Fellowship International graduates FRACGP (...) exams RACGP offer courses and events to further develop the knowledge you need to develop your GP career Re-entry to general practice Supervisors and examiners Mental Health (GPMHSC) Research Discover a world of educational opportunities to support your lifelong learning Courses and events QI&CPD Online learning Conferences Become a provider with the QI&CPD Program and be recognised for the quality education and training you offer GPs Curriculum for Australian General Practice Programs for educators

2016 Handbook of Non-Drug interventions (HANDI)

162. Pain management strategies for childhood immunisation

Pain management strategies for childhood immunisation RACGP - Pain management strategies for childhood immunisation Search Become a student member today for free and be part of the RACGP community A career in general practice Starting the GP journey Enrolments for the 2019.1 OSCE FRACGP exams closing 29 March 2019 Fellowship FRACGP exams Research Practice Experience Program is a self-directed education program designed to support non vocationally registered doctors on their pathway to RACGP (...) Fellowship Fellowship International graduates FRACGP exams RACGP offer courses and events to further develop the knowledge you need to develop your GP career Re-entry to general practice Supervisors and examiners Mental Health (GPMHSC) Research Discover a world of educational opportunities to support your lifelong learning Courses and events QI&CPD Online learning Conferences Become a provider with the QI&CPD Program and be recognised for the quality education and training you offer GPs Curriculum

2016 Handbook of Non-Drug interventions (HANDI)

163. Lymphoma

, kidney, adrenal, or symptoms referable to CNS or nerve roots. Consider for elevated LDH, ECOG 2-4, and >1 ENS. ENT exam Suprahyoid cervical lymph node or stomach UGI & SBFT W a l d e y e r ’ s ring involvement Ophthalmologic (slit lamp) exam Primary brain lymphoma HIV serology If any HIV risk factors. Lymphomas with unusual presentations or aggressiveness including Primary CNS. Cardio-oncology imaging (MR or Echocardiogram) All patients who are planned to receive anthracycline or high dose

2016 CPG Infobase

164. Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups

helminthiases are endemic and where sanitation is inadequate, parasite eggs are excreted in the faeces of infected individuals and contaminate the soil. Humans become infected through ingestion of eggs or larvae that are passed in the faeces of infected people. In addition, hookworm eggs hatch in the soil, releasing larvae that mature into a form that can actively penetrate the skin. There is no direct person-to-person transmission, or infection from fresh faeces, because eggs passed in faeces need about 3

2017 World Health Organisation Guidelines

165. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

and less likely to achieve remission off-treatment than purely mucosal PV. 13 6.1 Clinical presentation The diagnosis of PV should be suspected in any patient with mucocutaneous erosions or blisters. The oral mucosa is the ?rst site of involvement in the majority of cases, and PV may remain con?ned to the mucosal surfaces or extend to involve the skin (average lag period of 4 months). 14–16 Diagnostic delay is very common when PV is con?ned to the oral mucosa. 17 A minority of patients will present (...) with cutaneous erosions, but oral erosions will, eventually, occur in most cases. PV presents across a wide age range with peak fre- quency in the third to sixth decades. 7.0 Laboratory diagnosis Perilesional skin biopsies should be taken for histology and direct immuno?uorescence (DIF). In patients with isolated oral disease, a histology specimen should be taken from per- ilesional mucosa and a DIF sample taken from an uninvolved area, ideally from the buccal mucosa. 18 Suprabasal acantholysis with blister

2017 British Association of Dermatologists

166. CRACKCast E095 – Large Intestine

….translocation of bacteria..from a compromised bowel can lead to sepsis. Perforation of the bowel wall follows if the process is not interrupted.” – From Rosen’s. In these patients, the rectal exam is crucial – because you may find a hard mass or stool, which may explain the cause for the obstruction! Management: Rehydration Electrolyte replacement Pain and nausea control Antibiotics (if perforated, sick, etc.) Gastric decompression and NPO Surgical consultation 6) What are the four types of GI volvulus (...) * Clinical features (differences are underlined!) ● Abdo pain ● Tenesmus ● Bloody diarrhea (4-6 or more stools per day) ● Weight loss ● Rectal bleeding ● Pallor / fatigue ● Abdo pain ● Tenesmus ● Bloody diarrhea (4-6 or more stools per day) ● Nausea / vomiting ● Nocturnal diarrhea ● Fissures ● Anorectal abscesses ● Ulcerated hemorrhoids ● Strictures ● Growth and pubertal delay in children ● Weight loss ● Rectal bleeding ● Pallor / fatigue ● Peri-anal skin tags ● Dry mucous membranes 9) List 4 categories

2017 CandiEM

167. Palliative Care in the Outpatient Setting

on the noted benefits. Overall, the evidence describing outpatient palliative care’s benefit is stronger for QoL, resource utilization outcomes, patient satisfaction, and mood outcomes, with more limited evidence suggesting benefits on survival, symptom burden, psychosocial, and caregiver outcomes. These observations are consistent with the fact that outpatient palliative care programs are designed to increase patient social support, patient self-advocacy, and coordinated medical care; while palliative

2017 California Technology Assessment Forum

168. CrackCAST E136 – Bone and Joint Infections

of bloodwork? One liner: If the history and exam looks like osteomyelitis, only really need a ESR w/ XRAY and probe-to-bone test. In general labs are not useful in completely well looking patients. Gold standard is bone biopsy & culture!!! See the Rosen’s algorithm Figure 128.2 in 9 th Edition Lab notes: With acute osteomyelitis, WBC can be up, but neither sensitive nor specific Chronic osteomyelitis can have normal WBC The ESR (or CRP) = more helpful than the WBC count. Can help RULE IN, but cannot RULE (...) arthritis Joint Complications Destruction of articular cartilage Destruction of joint Ankylosis Growth plate disruption or destruction AVN, especially from vascular occlusion in neonatal femoral heads Surrounding structure infection Bursae Tendons Ligaments Muscles Skin Systemic Complications Sepsis Endocarditis Pneumonia Abscesses [11] What is the triad of disseminated Gonococcal disease? Gonococcal disease can present as either: Mono-oligoarticular arthritis True disseminated gonococcal infection

2017 CandiEM

169. Responding to children and adolescents who have been sexually abused

, depression, externalizing symptoms, eating disorders, problems with relationships, sleep disorders and suicidal and self-harm ideation and behaviours (19, 28). A study of adult women who were exposed to sexual abuse as children found that those who had been abused on multiple occasions over a longer period of time had higher levels of mental health symptoms as compared to those who were abused at only one point in their life (29). Another study of adult women (18–64 years) in the USA with histories

2017 World Health Organisation Guidelines

170. A Basic, Practical Approach to Toxicology

was last seen normal. (1) Paramedics are often able to provide additional information about the patient’s environment, including substances and pill bottles surrounding the patient that can facilitate toxidrome determination and dose estimation. Physical exam: All patients with suspected toxic ingestions should undergo a full physical examination. Beyond usual exam findings, additional findings that are helpful in toxidromes include signs of self-harm in the form of healed scars and track marks from (...) A Basic, Practical Approach to Toxicology A Basic, Practical Approach to Toxicology - CanadiEM A Basic, Practical Approach to Toxicology In by Kelly Lien July 11, 2017 A 16-year-old girl is found in her bedroom unresponsive by her mother. The patient had texted her friends earlier in the day, telling them that she was going to “go away forever.” The mother reports that her daughter has a history of depression and several episodes of self-harm but no previous overdose attempts. Her mother

2017 CandiEM

171. CRACKCast E098 – Sexually Transmitted Infections

ulcers Genital herpes Primary syphilis Chancroid Lymphogranuloma venereum (rare) Granuloma inguinale (rare) Neoplasm/Trauma Genital discharge Gonorrhea Chlamydia Nongonococcal urethritis (NGU) Pelvic inflammatory disease (PID) Trichomoniasis Bacterial vaginosis Epithelial cell lesions Genital warts Secondary syphilis Molluscum contagiosum Neoplasm Nevi Skin tags Ectoparasites Pubic lice Scabies Body/Head lice Mites (chiggers) Ticks Question 2) List the differential diagnosis of painful and painless (...) symptoms of itching, burning, and paresthesias common prior to development and skin and mucosal lesions. Duration Generally lasts 2-4 weeks if untreated before spontaneous resolve. Generally shorter duration than primary with decreasing frequency and severity over time. Question 4) List 4 techniques for the diagnosis of herpes and how it is managed? Clinical: History of similar lesions in same distribution supports clinical diagnosis though insensitive and nonspecific. PCR diagnostic test of choice

2017 CandiEM

172. CRACKCast E077 – Pleural Disease

resting on a bedside table for support. If the patient is unable to maintain the position on their own have an someone available to assist them. Alternatively, if the patient is unable to sit erect, place them in a supine position with the arm abducted above the head. Step 4.)Verify the procedure is to be performed on the correct side of the thorax using physical exam and radiography. Step 5.) Before prepping and draping the area, use the low frequency US transducer to identify the superior border (...) injury when the needle is inserted. For reference, the inferior tip of the scapula is at the 7th rib in the average, upright adult with the arms by the side. During this step, the depth of the superficial border of the pleural space and the center of the fluid collection should be measured to estimate the depth of needle insertion. Step 6.) The operator should then mimic the angle of insertion of the needle by placing the US transducer flush at the skin mark and verify the window is safe

2017 CandiEM

173. Consolidated guideline on sexual and reproductive health and rights of women living with HIV

and resource access (including food security), integration of SRHR and HIV services, empowerment and self-efficacy around safer sex and reproductive decision-making, facilitating safe disclosure for women living with HIV who fear or experience violence, modes of delivery for best maternal and perinatal outcomes (specifically caesarean section), and safe medical and surgical abortion. Development of the new recommendations and good practice statements to respond to these eight topic areas began (...) Recommendation (REC) Strength of recommendation, quality of evidence Sexual health counselling and support REC B.1 (NEW): WHO recommends that for women living with HIV , interventions on self-efficacy and empowerment around sexual and reproductive health and rights should be provided to maximize their health and fulfil their rights. Strong recommendation, low- quality evidence REC B.2: Brief sexuality-related communication (BSC) is recommended for the prevention of sexually transmitted infections among

2017 World Health Organisation Guidelines

174. CRACKCAST E065 – Forensic Emergencies

layers of epidermis (as occurs in some bite trauma) Lacerations Tears in the skin Abraded or crushed skin Sharp force injury patterns Incised wound = longer than it is deep Sharp wound = deeper than it is wide These have clean wound margins. May be important for ER physicians to be able to differentiate self-inflicted wound patterns from those sustained during an assault: Self inflicted: Multiple, parallel superficial incisions Non-dominant side of the body Sparing sensitive areas Thermal force (...) by the University of Louisville, but with little exposure in Canada; more of it in the USA and elsewhere The British have the FFLM – with a certification after 2 years of study See: for more information! An excellent 90 page FREE e-book on the “evaluation of the sexually assaulted and abused patient” This is an excellent primer on the subject, highlighting why it is relevant for all emergency medicine providers! The forensic exam consists of: History, physical examination photographs and anatomic diagrams

2017 CandiEM

175. CRACKCast E071 – Ophthalmology Part A

on the eye (Episodes 21 and 22) Check out the eye exam on Episode 22: VVEEP + slit lamp + fundoscopy And ALWAYS ask about contact lens use 1) Differentiate between alkaline and acid ocular burns – What is the treatment? Chemical burns Alkali burns – liquefactive necrosis Drain cleaners, chemical detergents, solvents, lime, etc. Rare to cause injury unless pH >12 Acid burns — coagulation necrosis Rare to cause injury unless pH <2 Treatment Irrigation for at least 30 mins With or without morgan lens May (...) , Treatment: Warm compresses Topical ophthalmic antibiotics ***usually self-limiting without abx but they can lead to improved remission rates Trimethoprim/polymyxin; ciprofloxacin; erythromycin x 7 days AVOID steroids Culture only in cases of treatment failure Complications Corneal ulcers Keratitis Corneal perforation Key diagnoses not to miss: Neisseria Gonorrhoeae: Rapidly progressive pain and copious discharge (17-16B) Need IV abx Irrigation Topical abx Treat for chlamydia as well Viral causes: #1

2017 CandiEM

176. Guidelines for care of patients with actinic keratosis

Dermatological Nursing Group, the Primary Care Dermatological Society, the British Society for Skin Care in Immunosuppressed Individuals, and Age U.K. for comments. These comments were actively considered by the GDG, and peer reviewed by the Clinical Standards Unit of the BAD (made up of the Therapy & Guidelines Subcommit- tee) prior to publication. 3.0 Methodology This set of guidelines has been developed using the BAD rec- ommended methodology, 1 with reference to the Appraisal of Guidelines Research (...) of this set of recommendations is scheduled for 2021; where necessary, important interim changes will be updated on the BAD website. 6.0 Background Actinic keratoses (synonymous with solar keratoses) are kera- totic lesions occurring on chronically light-exposed adult skin. They represent focal areas of abnormal keratinocyte prolifera- tion and differentiation that carry a low risk of progression to invasive SCC. A spectrum of histology is seen, but the cardinal feature of an AK is epithelial dysplasia

2017 British Association of Dermatologists

177. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

to diagnose CLI by using TBI with waveforms, transcutaneous oxygen pressure (TcPO 2 ), or skin perfusion pressure (SPP). 112–116 See Online Data Supplement 5. The toe pressure and TBI may be discordant with the ABI 0.90 to 1.40 in some patients with diabetes mellitus and a nonhealing wound (Figure 2). 115,116 A TBI =0.70 is considered diagnostic of PAD. 101,104,105 Doppler or plethysmographic waveforms taken at the toe supplement the toe pressure and TBI measurement and may be severely dampened (...) to activity level or present at rest Modified from Norgren L et al. 35 PAD indicates peripheral artery disease. Table 7. Alternative Diagnoses for Nonhealing Wounds With Normal Physiological Testing (Not PAD-Related) Condition Location Characteristics and Causes Venous ulcer Distal leg, especially above medial mellolus Develops in regions of skin changes due to chronic venous disease and local venous hypertension Typically wet (ie, wound drainage) rather than dry lesion Distal small arterial occlusion

2017 American Heart Association

178. Ankle and Foot Surgical Guideline

of employment is defined in Washington State statute as “a sudden and tangible happening, of a traumatic nature, producing an immediate or prompt result, and occurring from without, and such physical conditions as result therefrom.” d A legal test for whether the department or self-insured employer is liable for the care that a worker receives for an injury is whether the workplace injury is “a proximate cause” of the accepted condition being treated. An injury may be a proximate cause of a condition being (...) . A thorough occupational and non-occupational exposure history is essential for determining whether a condition is work-related and whether it is due to an acute or chronic exposure. For chronic exposures, it is important to document where, when, and for how long they occurred, as they could span multiple employers who would then share liability for an occupational disease. Providers should submit the Occupational Disease and Employment History form to the department or self-insurer as soon as possible

2017 Washington State Department of Labor and Industries

179. Early pregnancy loss

, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479. Refer to online version, destroy printed copies after use Page 2 of 39 Queensland Clinical Guideline: Early pregnancy loss Flow Chart: Assessment of suspected early pregnancy loss Haemodynamically stable? Assessment • History • Confirm pregnancy • Physical Exam • Serial ß-hCG • USS (TVS preferred) • FBC and blood group • MSU as indicated • STI screen as indicated Ectopic pregnancy Refer to flowchart: Ectopic pregnancy Confirm (...) to MFM for follow-up— direct injection of potassium chloride may be indicated Advice for women • Refer to Section 1.2 for information/advice requirements • Provide information about usual cytotoxic precautions post treatment with methotrexate • Avoid: o Sun exposure (to limit skin inflammation) o Foods and vitamins containing folate/folic acid • Advise: o Pelvic examination and sexual intercourse carry risk of rupture in acute phase of resolution o Common side effects of methotrexate include: nausea

2017 Queensland Health

180. Screening for Atrial Fibrillation: 2017 European Heart Rhythm Association (EHRA) Consensus Document

quality of life. Its natural evolution usually progresses from short self-terminating rare episodes with little or no symptoms to longer, more frequent, more prolonged and usually clinically detectable ones, even if individ- ual variations can also be observed. 8 An earlier detection of AF could thus allow an earlier adequate management to avoid later complications. 9,10 Screening for AF is not yet recommended by all scientific AF guide- lines, even in specific ‘at risk’ populations. The present (...) , with or without known AF cases in the screened population), which limits the comparability of the results. Four of these studies relied on self-reporting to ascertain AF history, rather than conducting a search of individual patient records. 82,88,90,92 In two others, it was unclear whether or not patient records were searched. 76,86 In general the highest yields were observed in the studies with the highest expected baseline prevalence of AF, as indicated by the age range and/or number of AF risk factors

2017 Heart Rhythm Society

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