Sunday, October 10, 2010

Rectum Exam by Proctoscope

Case Files Internal Medicine, Third Edition (LANGE Case Files)

Real-Life Cases for the Internal Medicine Clerkship and the USMLE Step 3
You need exposure to high-yield cases to excel on the Internal Medicine clerkship and the shelf-exam. Case Files: Internal Medicine presents 60 real-life cases that illustrate essential concepts in Internal Medicine. Each case includes a complete discussion, clinical pearls, references, definitions of key terms, and USMLE-style review questions. With this system, you’ll learn in the context of real patients, rather than merely memorize facts.
* 60 clinical cases, each with USMLE-style questions
* Clinical pearls highlight key concepts
* Primer on how to approach clinical problems and think like a doctor
* Proven learning system improves your shelf-exam scores

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Cauliflower ear

Cauliflower ear is an acquired deformity of the external ear to which wrestlers and boxers are particularly vulnerable.

The condition itself is the result of untreated or poorly treated auricular hematoma. The clinical picture progresses from :
(1) injury to the ear causing persistent, throbbing pain that lasts long after the causative event.
(2) possible fibrocartilage fracture.
(3) swelling, local heat, tenderness, followed by the development of a hematoma after several hours, initially between cartilage and overlying skin, visible to the naked eye
(4) tissue hardening and the development of early fibrous tissue in about 14 days, and
(5) the resulting keloid mass, development of new cartilage, and permanent deformity of the external ear characterized by skin wrinkling, thickening, and contraction at the site of injury.

To prevent the formation of a cauliflower ear, initial treatment of an acute hematoma should include ice packs and pressure bandages. Aspiration, or several drainings with application and frequent changing of a pressure dressing may be necessary.

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Blue Hives

A 77-year-old woman underwent surgical resection of a 1.5-cm papillary carcinoma of the right breast. Isosulfan blue dye (8 ml) was used intraoperatively to define the associated lymphatic drainage.
Three sentinel nodes were excised from her axilla 5 minutes later, followed by the lumpectomy. By the time of wound closure, blue hives had developed on both upper arms and the chest as a result of an allergic reaction to the dye. Her cardiorespiratory system remained stable.

She was treated with intravenous phenylephrine (50 mg), had an uneventful recovery, and was discharged home 4 hours later. Blue hives occur in up to 1.5% of patients injected with this dye; the cause is probably a type I, IgE-mediated hypersensitivity to the dye.

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