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Tongue Carcinoma

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1541. Towards tailoring of KCE guidelines to end-users' needs

), Ward Rommel (Kom op tegen Kanker), Karin Rondia (KCE), Hans Van Brabandt (KCE), Thierry Van der Schueren (Société Scientifique de Médecine Générale – SSMG), Didier Vander Steichel (Fondation contre le cancer), Michel Vanhalewyn (SSMG), Inez Vanoverschelde (EBMPracticenet), Geneviève Veereman (KCE), Leen Verleye (KCE), Mieke Vermandere (Katholieke Universiteit Leuven, CEBAM, EBMPracticeNet), Joan Vlayen (KCE), Patrick Wérrion (Association de défense professionnelle de la kinésithérapie – AXXON (...) Institute for Health Care Improvement] CPG Clinical Practice Guideline EBM Evidence Based Medicine GDG Guideline development group GP General practitioners HAS Haute Autorité de Santé IKNL Integraal Kankercentrum Nederland [Netherlands Comprehensive Cancer. Organisation] IQWIG Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen [Insitute for Quality and Efficiency in Health Care] KNGF Koninklijk Nederlands Genootschap voor Fysiotherapie [ Royal Dutch Society for Physical Therapy] NHG

2017 Belgian Health Care Knowledge Centre

1542. Active B12 assay for diagnosing vitamin B12 deficiency

knowledge summary on anaemia, about 30% of people with it have a family history of pernicious anaemia. The condition is more common in people over 60 years, and in women and in people with other autoimmune conditions, such as primary myxoedema, thyrotoxicosis, Hashimoto's disease, Addison's disease and vitiligo. People with pernicious anaemia have a higher risk of developing gastric cancer. Malabsorption of vitamin B12 may occur in people with gastric, pancreatic or intestinal diseases (including (...) indicate cobalamin deficiency. However, levels may not accurately indicate a deficiency in people aged over 65 years with kidney disease, small bowel bacterial overgrowth or reduced fluid content of the blood because these conditions can also cause elevated MMA levels (Devalia et al. 2014; Hunt et al. 2014). T otal serum Hcy is an indicator of vitamin B12 deficiency because cobalamin is needed for the synthesis of methionine from Hcy, and low levels of vitamin B12 lead to increased total serum Hcy

2015 National Institute for Health and Clinical Excellence - Advice

1543. Oral Thrush - Guidelines for Prescribing Oral Nystatin

of age unless related to antibiotic use, immunosuppression or steroid inhaler use without post-use mouth rinsing. Risk factors: Medical conditions: Immunosuppression Malignancy Sjogren's disease Diabetes Cushings disease Medications: Inhaled corticosteroids (if not rinsing mouth properly) Recent broad-spectrum antibiotic use Chemotherapy or radiation therapy Age (newborns, or over 65) Pregnancy Dentures Poor oral hygiene Chronic dry mouth For photos and more information go to : Three types of oral (...) (e.g. chlorhexidine 0.12 % oral rinse) Burns will cause significant redness and swelling in the mouth, which should not be seen with oral thrush. Common in bottle-fed infants. causes chronic lesions seen mostly in smokers and males over 30. These are small, translucent white plaques, usually on the tongue. The plaques cannot be wiped off as easily as oral thrush. These lesions can be cancerous, so a biopsy is recommended if this condition is suspected. are one or more shallow, usually painful sores

2017 medSask

1544. Oral Aphthous Ulcer - Guidelines for Prescribing Triamcinolone Dental Paste

butterfly rash, usually painless oral ulcers Celiac disease - history of intolerance to gluten Squamous cell carcinoma - if ulcers persist without healing. Refer to patient's primary care provider if lesions are present for over 3 weeks. Drug related oral ulcers - NSAIDs, beta-blockers, cytotoxic agents such as methotrexate. Stomatitis caused by radiation therapy . Refer to attending physician for treatment. Patients with signs / symptoms typical of canker sores usually do not require further (...) in diameter Oval in shape Clearly defined outline with red and inflamed borders On lips, cheeks, floor of mouth, underside of tongue, and soft palate Painful Resolve spontaneously in 7 to 10 days Frequent recurrences possible Major (12%) Occur in clusters of 2 or more lesions More than 10 millimeters in diameter May be irregular in shape More common in patients with compromised immune system May take up to six weeks to heal May cause scarring Herpetiform (8 %) Often in clusters of 5 - 100 small sores 0.5

2017 medSask

1545. Herpes Zoster - Diagnosis

of age) exhibiting HZ, particularly in case of widespread multi- dermatomal or recurrent HZ, simultaneous lesions in different disease stages, or presence of other risk factors for HIV seroposi- tivity, it isrecommended to test for HIVinfection (Table 13). Searching for occult cancer in patients with HZ remains debated. In a large cohort of HZ patients, subsequent incidence rates of various types of cancer were analysed. Standardized inci- dence rates were not increased in this sample. 95 In contrast (...) are tested positive for VZV-DNA in up to 100% of cases 33 and may persist positive for weeks. 34 Other clinical specimens appropriate for PCR testing are biopsies, cerebro spinal ?uid (CSF), intra- ocular ?uids and blood samples for the detection of VZV vire- mia. 35 Real-time PCR, ideally in combination with serology on paired serum and CSF/intra-ocular ?uid in patients sampled at >2–3 weeks after onset of disease, is the method of choice for diagnosis of HZ with cerebral and ocular complications

2017 European Dermatology Forum

1546. Clinical practice guideline: evaluation of the neck mass in adults.

, potentially reduce risk of distant metastases through earlier cancer identification, psychological benefit of timely evaluation, facilitate further care Risks, harms, costs: False-positive clinical diagnosis resulting in subsequent tests and anxiety in patients with nonmalignant disease Benefit-harm assessment: Preponderance of benefit over harm Value judgments: The risk of missed or delayed diagnosis of malignancy is more important than the risk of a false-positive clinical diagnosis. Despite any direct (...) stage of disease, prioritize testing for increased-risk patients, potentially reduce risk of distant metastases through earlier cancer identification, psychological benefit of timely evaluation, facilitate further care Risks, harms, costs: False-positive clinical diagnosis resulting in subsequent tests and anxiety in patients with nonmalignant disease Benefit-harm assessment: Preponderance of benefit over harm Value judgments: The risk of missing or delaying diagnosis of malignancy in an increased

2017 National Guideline Clearinghouse (partial archive)

1547. CRACKCast E102 – Seizures

epilepticus can mimic Hypoglycemia CNS infection CNS vascular event Drug toxicity Psychiatric disorder Metabolic encephalopathy Migraine Transient global amnesia [4] What factors predict abnormal CT findings in seizure patients? See Box 92.3 – Differential Diagnosis of AMS in Patient Who Has Seized Focal abnormality on neurological examination Malignancy Closed head injury Neurocutaneous disorder Focal onset of seizure Absence of a history of alcohol abuse History of cysticercosis Altered mental status (...) damage Rhabdomyolysis Autonomic discharge & bulbar muscle involvement may result in Urinary or fecal incontinence Vomiting Tongue biting Potential airway impairment. Posterior shoulder dislocations or fractures [9] Describe the legal implications of diagnosis of new seizure According to the Government of British Columbia New onset seizure has a private driving restriction: With a seizure free period up to 6 months; Or Medical clearance to drive by a Neurologist Professional Drivers must be: Seizure

2017 CandiEM

1548. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

, Tornatore LA, Brancazio L, et al. Can children with autism spectrum disorders "hear" a speaking face? Child Dev. 2011 Sep-Oct;82(5):1397-403. doi: 10.1111/j.1467-8624.2011.01619.x. PMID: 21790542.X-1 682. Ishikawa T, Takahashi K, Ikeda N, et al. Transporter-Mediated Drug Interaction Strategy for 5-Aminolevulinic Acid (ALA)- Based Photodynamic Diagnosis of Malignant Brain Tumor: Molecular Design of ABCG2 Inhibitors. Pharmaceutics. 2011;3(3):615-35. doi: 10.3390/pharmaceutics3030615. PMID: 24310600.X-1 (...) . J Autism Dev Disord. 2011 Sep;41(9):1214-27. doi: 10.1007/s10803-010-1140-6. PMID: 21103917.X-1 695. Kim HJ, Lee JE, Shin SJ, et al. Analysis of the substantia innominata volume in patients with Parkinson's disease with dementia, dementia with lewy bodies, and Alzheimer's disease. J Mov Disord. 2011 Oct;4(2):68-72. doi: 10.14802/jmd.11014. PMID: 24868398.X-1 696. Kim WS. Mammalian target of rapamycin inhibitors for treatment in tuberous sclerosis. Korean J Pediatr. 2011 Jun;54(6):241-5. doi

2017 Effective Health Care Program (AHRQ)

1549. CRACKCast E110 – Thought Disorders

erythematosus Temporal (giant cell) arteritis ORGAN FAILURE Hepatic encephalopathy Uremia NEUROLOGIC DISORDERS Alzheimer’s disease Cerebrovascular disease Encephalitis (including HIV infection) Encephalopathies Epilepsy Huntington’s disease Multiple sclerosis Neoplasms Normal-pressure hydrocephalus Parkinson’s disease Pick’s disease Wilson’s disease ENDOCRINE DISORDERS Addison’s disease Cushing’s disease Panhypopituitarism Parathyroid disease Postpartum psychosis Recurrent menstrual psychosis Sydenham’s (...) chorea Thyroid disease DEFICIENCY STATES Niacin Thiamine Vitamin B12 and folate “Psychosis” Postpartum Sarcoid thYroid Calcium and Carbon (high) HypoNa/02/Glycemia SLE Itis – encephalItis Substrate deficiency states Niacin, thiamine, Vit b12. [2] List 10 pharmacologic agents that may cause acute psychosis (Box) BOX 100.2 Pharmacologic Agents That May Cause Acute Psychosis ANTIANXIETY AGENTS Alprazolam Chlordiazepoxide Clonazepam Clorazepate Diazepam Ethchlorvynol ANTIBIOTICS Isoniazid Rifampin

2017 CandiEM

1550. CRACKCast E105 – Brain and Cranial Nerve Disorders

= Carbamazapine 100mg PO BID. Other options: Phenytoin Baclofen Valproate sodium Lamotrigine Gabapentin Levetiracetam Disposition: Neurology with +/- Neurosurgery or ENT consult if surgical decompression is required [4] Facial nerve paralysis: List 6 differential diagnoses for facial (CN VII) paralysis Bell’s palsy Ramsey Hunt syndrome (herpes zoster oticus) Lyme disease (neuroborreliosis) Bacterial infections of the middle ear, mastoid, or external auditory canal Guillain-Barré syndrome HIV infection Tumor (...) risk factors Inflammatory disease: SLE, Behçet’s disease, GPanG, IBD, sarcoidosis Malignancy Hematologic conditions Procoagulant disease Antithrombin deficiency Protein C/S deficiency Factor V Leiden mutation Hyperhomocysteinemia Polycythemia Congenital heart disease Thyroid disease What CT findings may be seen in cerebral venous thrombosis? What is the most common CT finding? Delta Sign / Dense Triangle / Empty Triangle Sign Ref: Cerebral Edema Absent Venous Flow Hemorrhage secondary to venous

2017 CandiEM

1551. CRACKCast 107 – Peripheral Nerve Disorders

polyradiculoplexoneuropathy Malignant disease Human immunodeficiency virus (HIV) infection Hepatitis B Buckthorn Diphtheria [4] Describe the pathophysiology of GBS, and list common precipitating organisms According to UpToDate: “GBS is thought to result from an immune response to a preceding infection that cross-reacts with peripheral nerve components because of molecular mimicry. The immune response can be directed towards the myelin or the axon of peripheral nerve, resulting in demyelinating and axonal forms of GBS (...) [16] List 3 causes of a mononeuropathy multiplex Refer to box 97.8 in Rosen’s 9 th Edition for a list of etiologies of mononeuropathy multiplex Mononeuropathy multiplex etiologies: Vasculitis Systemic vasculitis Polyarteritis nodosa Rheumatoid arthritis Systemic lupus erythematosus Sjörgen’s syndrome (keratoconjunctivitis sicca) Nonsystemic vasculitis Diabetes mellitus Neoplastic Paraneoplastic Direct infiltration Infectious Lyme disease HIV infection Sarcoid Toxic (lead) Transiet (polycythemia

2017 CandiEM

1552. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

infiltration of exocrine glands [ ]. Patients characteristically complain of drying of the eyes and mucosal surfaces along with fatigue and arthralgia. There is an association with autoimmune thyroid disease, coeliac disease and primary biliary cirrhosis. Systemic features include inflammatory arthritis, scLE, immune thrombocytopenia (ITP), vasculitis with purpura, salivary gland inflammation, neuropathies, interstitial lung disease (ILD) and a 5–10% lifetime risk of B cell lymphoma [ , ]. NICE has (...) presenting with symptoms suggestive of SS are referred to a specialist centre for evaluation and treatment. In addition this guideline does not cover the detailed management of patients with secondary Sjögren’s. Where patients have secondary SS their systemic management should address the primary disease but the advice on topical management contained in these guidelines is applicable to sicca symptoms from any cause. This guideline does not cover the detailed management of patients with lymphoma, who

2017 British Society for Rheumatology

1553. CrackCAST E129 – Bacteria

support. Even with limited resources, mortality can be reduced to less than 50% with basic medication and experienced medical personnel. [7] List 5 differential diagnoses for Bell’s Palsy Common entities: CVA Trigeminal neuralgia Herpes zoster oticus (Ramsay Hunt syndrome) CNS tumour – acoustic neuroma; cerebellopontine angle lesions (meningioma); facial nerve schwanoma, parotid gland tumour, sarcoma Parotitis Malignant otitis externa Uncommon entities Cephalic tetanus Tick paralysis Botulism CN (...) , and lung (influenza associated). Risk Factors for Toxic Shock Syndrome (9 th Edition Box 121.8) Use of superabsorbent tampons Postoperative wound infections Post partum period Nasal packing Cancer Common bacterial infections Ethanol abuse Infection with Influenza A virus Infection with varicella virus Diabetes mellitus HIV Chronic cardiac disease Chronic pulmonary disease NSAID use [20] List criteria for toxic shock syndrome and describe management *these case definitions are not “foolproof or specific

2017 CandiEM

1554. CRACKCast E122 – Disorders of Hemostasis

to: Thrombocytopenia = too few Thrombocytosis = too many Thrombocytopathy = too broken [1] List 10 causes of Thrombocytopenia Here’s the approach: Decreased production: Decreased megakaryocytes secondary to drugs, toxins, or infection Chemo drugs, thiazides, alcohol, digoxin, septra, phenytoin, ASA Normal megakaryocytes with megaloblastic hematopoiesis or hereditary origin Malignant infiltration of bone marrow Increased destruction Immunologic Related to collagen vascular disease, lymphoma, leukemia Drug related (...) are helpful). Portal HTN [2] List 6 causes of thrombocytosis This is a platelet count > 600,000 / mm3. Most common causes = infection or iron deficiency (platelets still work normally) Autonomous (primary thrombocythemia) Reactive (secondary thrombocythemia) Iron deficiency Infection or inflammation Kawasaki’s disease Trauma Nonhematologic malignant disease Postsplenectomy Rebound from alcohol, cytotoxic drug therapy, folate or vitamin B12 deficiency [3] Describe the presentation and treatment of HIT, ITP

2017 CandiEM

1555. Spot the Diagnosis! The case of the Man with the Red Hat

have? Although it is unknown if this is true, Giamberti the temporal artery in this portrait is suspiciously torturous and inflamed – findings in keeping with temporal arteritis, also known as Giant Cell Arteritis (GCA). 2 Temporal arteritis encompasses many signs and symptoms, but the key feature of the disease depicted here is the tortuous temporal artery. The tortuous arteries of giant cell arteritis 3 What are the clinical manifestations of this disease? Temporal arteritis is a form (...) of autoimmune vasculitis which primarily impacts the medium and large vessels. It may present in various ways (cranial arteritis, extracranial arteritis, or polymyalgia); however, the most common symptoms typically include unilateral temporal headache, jaw/tongue claudication, scalp tenderness, proximal muscle weakness and constitutional symptoms such as fever, unintentional weight loss, anorexia, and malaise. 4 If left untreated, it can lead to blindness due to optic ischemic neuropathy in up to 15

2017 CandiEM

1556. Guideline for the management of adults with Systemic Lupus Erythematosus Full Text available with Trip Pro

Foundation Trust, Birmingham, Search for other works by this author on: Sue Brown Royal National Hospital for Rheumatic Diseases, Bath, Search for other works by this author on: Ian N. Bruce Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre,The Kellgren Centre for Rheumatology, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University (...) . Accreditation is valid for 5 years from 10 June 2013. More information on accreditation can be viewed at . For full details on our accreditation visit: . SLE (or lupus for short) is a multisystem, autoimmune disease, involving complex pathogenetic mechanisms that can present at any age. It most commonly presents in women in the reproductive age group, although lupus is increasingly recognized after the age of 40 years, particularly in Europeans [ ]. Lupus affected nearly 1 in 1000 of the population

2017 British Society for Rheumatology

1557. CRACKCast E119 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis

patients presenting to the ED. With proper management, however, these patients can be efficiently managed and discharged with relative ease. Shownotes – Also check out EMCases Rapid Review video on Rosen’s in Perspective This chapter covers disease states in which the immune system overreacts against typically harmless agents. These hypersensitivity reactions are manifested in clinical symptoms ranging from mildly inconvenient to fatal. For practical purposes, let’s define some terms: Allergy Used (...) in this chapter to refer to mast cell–mediated hypersensitivity reactions. For most allergic diseases to occur, predisposed individuals need to be exposed to allergens through a process called sensitization. Substances that elicit an allergic reaction are referred to as allergens, and those that elicit an antibody response (activated by B- and T-cell receptors) are called antigens. Urticaria A common allergic reaction to foods, drugs, or physical stimuli and is clinically characterized by an erythematous

2017 CandiEM

1558. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

the review to English- language references was a pragmatic decision, but the authors recognize this may exclude some important information pub- lished in other languages. 5.0 Plans for guideline revision The proposed revision for this set of recommendations is scheduled for 2022; where necessary, important interim changes will be updated on the BAD website. 6.0 Background PV is an acquired autoimmune disease in which immunoglob- ulin G (IgG) antibodies target desmosomal proteins to pro- duce (...) to the lack of diagnostic criteria, and inclusion of all subtypes of pemphigus and of other blistering disorders such as bullous pemphigoid, which have a better prognosis. However, not all cases of PV have such a dismal prognosis. Studies differentiating the clinical phenotypes have shown a lower mortality in patients with predominantly mucosal PV (1–17%) compared with those with mucocuta- neous PV (8–42%). 10–12 Mucocutaneous PV tends to be a more severe disease, proving slower to respond to treatment

2017 British Association of Dermatologists

1559. Primary & Secondary Prevention of CVD

FACTORS 5.2. MODIFIABLE CV RISK FACTORS 34 34 35 6. OTHER CONDITIONS ASSOCIATED WITH INCREASED CV RISK 40 6.1. CHRONIC KIDNEY DISEASE 6.2. INFECTIONS AND THE HEART 40 41 7. OTHER RISK MARKERS OF CVD 53 7.1. ELECTROCARDIOGRAM (ECG) 7.3. BIOCHEMICAL – HS-CRP 7.4. SUBCLINICAL VASCULAR DAMAGE 53 54 54 8. INTERVENTIONS TO PREVENT CVD 57 8.1. NUTRITION 57 8.2. PHYSICAL ACTIVITY 70 6.3. CANCER AND THE HEART 6.4. CONNECTIVE TISSUE DISEASE 43 44 6.5. SLEEP DISORDERS 6.6. PSYCHOSOCIAL FACTORS/DEPRESSION 45 47 (...) Primary & Secondary Prevention of CVD 2016 1 STATEMENT OF INTENT This guideline was developed to be a guide for best clinical practice in the prevention of cardiovascular disease, based on the best available evidence at the time of development. Specific attempts were made to use local data and publications to ensure local relevance. Adherence to this guideline does not necessarily lead to the best clinical outcome in individual patient care as this depends on other clinical factors like co

2017 Ministry of Health, Malaysia

1560. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards Full Text available with Trip Pro

. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine . 9th ed. Philadelphia, PA : Elsevier Health Sciences ; 2011 :1468–529. Loeys BL, Dietz HC, Braverman AC, et al. . The revised Ghent nosology for the Marfan syndrome. J Med Genet . 2010 ; 47 :476–85. National Cancer Institute Enterprise Vocabulary Server. Available at: . Accessed May 15, 2016. LOINC Test. Available at: . Accessed December 12, 2014. CDISC Glossary. Available at: . Accessed December 12, 2014. National Institute of Child Health (...) Hospital Association (www.childrenshospitals.org). †International Society for Nomenclature of Paediatric and Congenital Heart Disease Representative. ‡Child Health Corporation of America Representative. §Association of European Pediatric Cardiologists Representative. ‖The Society of Thoracic Surgeons Representative. ¶ ACC/AHA Task Force on Clinical Data Standards Liaison to the Writing Committee. #Congenital Heart Surgeons’ Society Representative. **National Association of Children’s Hospitals

2017 American Heart Association

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