Tuesday, September 28, 2010

A case of Pityriasis Rosea

A 26-year-old female presents with this rash. She states the rash is minimally pruritic and developed over the last week. She has had some virus-like symptoms and reports the rash began as a large salmon-colored patch on her chest area. The most likely diagnosis is ??
A) tinea versicolor
B) pityriasis rosea
C) varicella
D) psoriasis
E) cocciodiomycosis

The answer is B. (Pityriasis rosea)
Pityriasis rosea is a self-limited, exanthematous skin disease that develops acutely and is characterized by the appearance of slightly inflammatory, oval, papulosquamous lesions on the trunk and proximal areas of the extremities. Pityriasis rosea is largely a disease of older children and young adults. It is more common in women than men.
A prodrome of headache, malaise, and pharyngitis may occur in a small number of cases, but except for itching, the condition is usually asymptomatic. The eruption commonly begins with a “herald patch”: a single round or oval, sharply demarcated pink or salmon-colored lesion on the chest, neck, or back, 2 to 5 cm in diameter. The lesion soon becomes scaly and begins to clear centrally, leaving the free edge of the scaly lesion directed inwards toward the center. A few days or a week or two later, oval lesions similar in appearance to the herald patch, but smaller, appear in crops on the trunk and proximal areas of the extremities The long axes of these oval lesions tend to be oriented along the lines of cleavage of the skin. This characteristic Christmas-tree pattern is most evident on the back, where it is emphasized by the oblique direction of the cleavage lines in that location.

Most cases of pityriasis rosea need no treatment other than reassurance and proper patient education. Topical steroids with moderate potency are helpful in the control of itching. They can be applied to the pruritic areas two or three times daily. Topical antipruritic lotions such as prax, pramagel, or sarna may also be helpful.

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The 5 Ts of Right to left shunt

The 5 Ts

1. Truncus arteriosus (1 vessel)
2. Transposition of great arteries (2 vessels transposed)
3. Tricuspid atresia (3 =Tri)
4. Tetralogy of fallot (4 =Tetra)
5. Total anomalous pulmonary venous return (5 =5 words)

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Higher Healthcare Costs in 2011

WASHINGTON :- The amount employers spend on their workers' healthcare costs will reach a 5-year high in 2011, and employees will also face larger out-of-pocket costs for their medical care next year, according to a forecast released Monday by the consulting group Hewitt Associates.

Because of higher medical claim costs, an aging population, and changes under the new healthcare reform law, employers can expect to pay nearly 9% more toward their employees' healthcare costs than they did in 2010.
The findings are in line with a recent survey by the National Business Group on Health that asked large employers what they expected to pay for their workers' medical costs in 2011. The answer: about 9% more than in 2010.

The average total healthcare premium per employee working at a large firm will be $9,821 in 2011 -- up from $9,028 in 2010.

Employees will contribute, on average, $2,209, or 22.5% of the total premium, which is a few hundred dollars more than in 2010, when the average employee at a large firm paid 21.8% of their total premium, to total slightly less than $2,000. Once out-of-pocket costs for co-pays and deductibles are factored in, employees can expect to pay about $486 more than they paid toward their medical costs in 2010.

The authors of the Hewitt report say that the new figures mean that healthcare premiums have more than doubled in the past decade and employees' share of their medical costs will have more than tripled.

The high 2011 cost projections are based on a number of factors, the study authors said. For one, employers haven't hired many new employees in recent years, which has resulted in a slightly older work force that is more prone to expensive medical conditions.

Certain insurance market reforms contained in the Affordable Care Act (ACA) -- such as covering dependents until age 26 and eliminating lifetime and annual limits -- contributed to about 1% to 2% to the 9% increase in what employers are likely to pay in 2011.

"After 18 months of waiting for healthcare reform to play out, employers find themselves in a very challenging cost position for 2011," said Ken Sperling, Hewitt's healthcare practice leader, in a press release. "Reform creates opportunities for meaningful change in how healthcare is delivered in the U.S., but most of these positive effects won't be felt for a few years. In the meantime, employers continue to struggle to balance the significant healthcare needs of an aging work force with the economic realities of a difficult business environment."

Hewitt's data came from a database with detailed census, cost, and plan design information for 350 large U.S. employers representing 14.4 million participants and $51.9 billion in 2010 healthcare spending.

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Take care of Depression among medical students!!

Medical students with moderate to severe depression more frequently endorsed several depression stigma attitudes than nondepressed students and had a higher rate of suicidal thoughts, according to a study in the September 15 issue of JAMA, a theme issue on medical education.

"Medical students experience depression, burnout, and mental illness at a higher rate than the general population, with mental health deteriorating over the course of medical training. Medical students have a higher risk of suicidal ideation and suicide, higher rates of burnout, and a lower quality of life than age-matched populations," the authors write. They add that medical students are less likely than the general population to receive appropriate treatment, perhaps because of the stigma associated with depression. "Students may worry that revealing their depression will make them less competitive for residency training positions or compromise their education, and physicians may be reluctant to disclose their diagnosis on licensure and medical staff applications."

Thomas L. Schwenk, M.D., of the University of Michigan, Ann Arbor, and colleagues conducted a study to assess the prevalence of self-reported depression and suicidal ideation among medical students and to assess the perceptions of depression stigma by both depressed and nondepressed students. In September-November 2009, the researchers surveyed all students enrolled at the University of Michigan Medical School (n = 769). The survey response rate was 65.7 percent (505 of 769).

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Emergencies in Urology

Emergencies in Urology
Publisher: Springer | ISBN: 3540486038 | edition 2007 | PDF | 679 pages | 41,5 mb

Emergencies in Urology is a comprehensive textbook covering one of the few remaining white spots on the map of urological literature. To date only a small number of publications have been dedicated to the topic of urgent and emergent problems in urology – important as these are in our daily clinical life.Therefore the editors, both of them internationally recognized urological experts, have taken the effort to present an in-depth study into virtually every possible urgent urological situation with which a urologist may be confronted today. Consequently, the book includes chapters on topics such as urological trauma, urosepsis, urinary obstruction, oncological emergencies, intra- and postoperative complications, acute problems in children, and many more.To obtain the best possible expertise in such a wide field, renowned expert authors have contributed their experience to this book. They did so not only by writing the regular book chapters but also by delivering short stories about urgent situations they encountered in their own professional life. These vignettes are one of the rare opportunities where experience can be relayed without restriction from one urological generation to the next.Much work has gone into the illustrations for the book. Foremost in this respect is the art of Stephan Spitzer, one of the leading medical illustrators of today.The result is a comprehensive, well-organized text, in which state-of-the-art know-how, didactic algorithms, personal experience and detailed illustrations are combined into a unique guide of how to manage urological emergencies.

For Free Download:

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Gallblader Ultrasound - Cholecystitis

Histopathology Lung--Bronchiectasis

Endoscopic Anterior Skull Base Resection by RRC

An endoscopic anterior skull base resection may be necessary in select neoplasms. Obviating the need for any external incisions, this approach has become increasingly valuable to address a number of sinonasal neoplasms affecting the anterior skull base, through a minimally invasive technique. This video reviews the endoscopic anterior skull base approach for a typical esthesioneuroblastoma. It also touches on the reconstructive technique using a free alloderm graft, which has been in use by us for over 10 years, and has yielded consistent results, with no CSF leaks.