Property:Explanation
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A physician is bound ethically and legally to maintain patient information confidentiality. He is not supposed to discuss this information with anyone, unless specifically requested by the patient. General principles for exceptions to Confidentiality are: <br>
* Potential physical harm to others is serious and imminent<br>
* Likelihood of harm to self is great<br>
* No alternative means exists to warn or to protect those at risk<br>
* Physicians can take steps to prevent harm <br>
In the scenarios mentioned above, the patient diagnosed with HIV needs to inform his girlfriend about his condition. If not it is physicians duty to inform her to prevent harm.<br/>
'''Educational Objective:''' A physician is bound ethically and legally to maintain patient information confidentiality. There are a few important cases in which the physician may share patient information.<br/>
'''References:''' First Aid 2014 Page 59,60 +
Pimozide is used to control tics in Tourette Syndrome.<br/>
'''Educational Objective:''' Pimozide is used to control tics in tourette Syndrome.<br/>
'''References:''' http://www.wikidoc.org/index.php/Tourette_syndrome
http://www.ncbi.nlm.nih.gov/pubmed/19370666 +
Selective mustism is suspected when the symptoms are restricted to a particular environment and child is otherwise normal.<br/>
'''Educational Objective:''' Selective mustism is suspected when the symptoms are restricted to a particular environment and child is otherwise normal.<br/>
'''References:''' http://www.wikidoc.org/index.php/Selective_mutism
http://www.wikidoc.org/index.php/Learning_disabilities
http://www.wikidoc.org/index.php/Social_phobia +
Delirium is treated conservatively, if non pharmacological techniques fail, or if de-escalation techniques are inappropriate, only then pharmacological treatment is indicated.<br/>
'''Educational Objective:''' Delirium is treated conservatively, if non pharmacological techniques fail, or if de-escalation techniques are inappropriate, only then pharmacological treatment is indicated.<br/>
'''References:''' http://www.wikidoc.org/index.php/Delirium_medical_therapy +
Egocentrism is characterized by preoccupation with one's own internal world. Egocentrics regard themselves and their own opinions or interests as being the most important or valid. To them, self-relevant information is seen to be more important in shaping one’s judgments than are thoughts about others and other-relevant information. Egocentrism is thus the child's inability to see other people's viewpoints. The child at this stage of cognitive development assumes that their view of the world is the same as other peoples', e.g. a little girl does not see that taking another child's ball is wrong because she does not understand that taking the ball would hurt the other child’s feelings.<br/>
'''Educational Objective:''' Egocentrism is characterized by preoccupation with one's own internal world. Egocentrics regard themselves and their own opinions or interests as being the most important or valid. To them, self-relevant information is seen to be more important in shaping one’s judgments than are thoughts about others and other-relevant information. Egocentrism is thus the child's inability to see other people's viewpoints. The child at this stage of cognitive development assumes that their view of the world is the same as other peoples', e.g. a little girl does not see that taking another child's ball is wrong because she does not understand that taking the ball would hurt the other child’s feelings.<br/>
'''References:''' https://www.youtube.com/watch?v=OinqFgsIbh0
http://link.springer.com/article/10.1007%2FBF01538718 +
Pica is characterized by an appetite for substances largely non-nutritive, such as ice, clay, chalk, dirt, or sand. According to DSM-IV criteria, for these actions to be considered pica, they must persist for more than one month at an age where eating such objects is considered developmentally inappropriate, not part of culturally sanctioned practice and sufficiently severe to warrant clinical attention.Subtypes are characterized by the substance eaten for example:
* Amylophagia (consumption of starch)
* Coprophagy (consumption of feces)
* Geophagy (consumption of soil, clay, or chalk)
* Hyalophagia (consumption of glass)
* Consumption of dust or sand has been reported among iron-deficient patients.
* Lithophagia (a subset of geophagia, consumption of pebbles or rocks
* Mucophagia (consumption of mucus)
* Odowa (soft stones eaten by pregnant women in Kenya)
* Consumption of paint.
* Pagophagia (pathological consumption of ice)
* Trichophagia (consumption of hair or wool)
* Urophagia (consumption of urine)
* Xylophagia (consumption of wood or paper)<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.dsm5.org/Pages/Default.aspx
http://www.ncbi.nlm.nih.gov/pubmed/15332352 +
DSM-5, unlike DSM4 TR do not limit the use of an MDD diagnosis between 2 weeks and 2 months.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.ncbi.nlm.nih.gov/pubmed/24042244
http://www.dsm5.org/Pages/Default.aspx +
An suicidal attempt is always taken seriously and admission to hospital is done, even if it's against patient's wishes.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.ncbi.nlm.nih.gov/pubmed/22369082
www.ncbi.nlm.nih.gov/pubmed/11434483 +
This a case of atypical depression, it is treated by MAOIs.<br/>
'''Educational Objective:''' <br/>
'''References:''' pg 510 MTB-CK +
In delusional disorder the patient is focused on a single delusion.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html +
Papillary carcinoma is the most common type of thyroid cancer. It occurs more frequently in women and presents in the 30-40 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck (in this group, the cancer tends to be multifocal with early lymphatic spread, and portends a relatively poor prognosis). Thyroglobulin can be used as a tumor marker for well-differentiated papillary thyroid cancer.
Surgery is the primary mode of therapy for patients with papillary thyroid cancer. In minimal diseases (diameter up to 1.0 centimeters), hemithyroidectomy (or unilateral lobectomy) and isthmectomy may be sufficient. There is some discussion whether this is still preferable over total thyroidectomy for this group of patients. In gross diseases (diameter over 1.0 centimeters), total thyroidectomy, and central compartment lymph node removal is the therapy of choice. Total thyroidectomy reduces the risk of recurrence, avoids any residual disease since papillary carcinoma is a multifocal disease, allows easy monitoring with thyroglobulin since sensitivity for picking up recurrence is increased following total thyroidectomy, and allows for easy detection of metastatic disease by thyroid and neck node ultrasound.
Post-thyroidectomy, radioiodine is used as an adjuvant in the ablation of residual thyroid tissue and possible microscopic residual cancer. It also serves in the detection of possible metastatic disease, and further treatment of known residual or metastatic thyroid cancer during followup. Post-thyroidectomy, whether or not the patient receives radioiodine therapy, levothyroxine therapy is administered in all in order to prevent hypothyroidism and to minimize the potential tumor regrowth due to TSH stimulation.<br/>
'''Educational Objective:''' Total thyroidectomy is the initial treatment of choice in the management of papillary carcinoma of thyroid along with an adjuvant radioiodine therapy for the ablation of residual thyroid tissue and possible microscopic residual cancer. Radioiodine is also used to detect a metastatic disease and in the further treatment of a known residual or metastatic thyroid cancer during followup. Post-thyroidectomy, whether or not the patient receives radioiodine therapy, levothyroxine therapy is administered in order to prevent hypothyroidism and to minimize the potential tumor regrowth due to TSH stimulation.<br/>
'''References:'''
Thyroxine activates osteoclasts, which results in osteoporosis. Vertebral fracture is one of the most common manifestation of osteoporosis.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.wikidoc.org/index.php/Hyperthyroidism_pathophysiology
http://www.ncbi.nlm.nih.gov/pubmed/24570805 +
Thyroxine activates osteoclasts, which results in osteoporosis. Therefore the next step in the management of osteoporosis in this patient should be reduction of levothyroxine.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.wikidoc.org/index.php/Hyperthyroidism_pathophysiology
http://www.ncbi.nlm.nih.gov/pubmed/24570805 +
Osteoporosis is followed up with bone density scan or DXA.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.ncbi.nlm.nih.gov/pubmed/18334497 +
The American Endocrine Society recommends, HbA1C 6.5% or higher as the primary criterion for the diagnosis of diabetes mellitus.<br/>
'''Educational Objective:''' <br/>
'''References:''' https://www.aace.com/files/position-statements/a1cpositionstatement.pdf +
As seen in the given MRI, syringomyelia will show the syrinx in the spine.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.ninds.nih.gov/disorders/syringomyelia/detail_syringomyelia.htm
http://asap.org/index.php/disorders/syringomyelia/ +
Clomipramine is the only FDA approved treatment of obsessive compulsive disorder, besides SSRIs.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://ocd.stanford.edu/treatment/pharma.html
http://www.ncbi.nlm.nih.gov/pubmed/6159865 +
The first step in the management of the primary and secondary amenorrhea is pregnancy test.<br/>
'''Educational Objective:''' <br/>
'''References:''' http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CDQQFjAB&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F222515877_Primary_amenorrhoea_investigation_and_treatment%2Ffile%2F9fcfd50ad5f01d0a89.pdf&ei=9saHU_D7IZGYqAbjgIK4Dg&usg=AFQjCNFoc-ARvg4kXl0jZJZDD9geicFA1g&bvm=bv.67720277,d.b2k +
The patient in this this vignette has a T3 colorectal tumor. Colorectal tumors often bleed, particularly during bowel movements. Because bleeding occurs late in the digestive tract, the blood typically remains bright. Chronic bleeding from a colorectal tumor can cause anemia and fatigue, often the sole presenting symptom. In this case, the patient also experienced constipation, likely due to obstruction from the colorectal mass. A left-sided (descending colon) colorectal tumor is more likely to cause obstruction than a right sided colorectal tumor, due to the smaller lumen size on the left.
The T-score of the tumor is determined by the depth of invasion of the tumor in relation to key micro-anatomic landmarks, as summarized in the Figure below.
<img src="http://static.wikidoc.org/e/ee/WJG_Colorectal_Staging_copy.svg"/>
The T-score is combined with information about the number of lymph nodes with tumor and the number of detectable metastases to assign a tumor stage (see Table below).
<table border="1" cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;">
<tr>
<td align="center" style="background:#f0f0f0;"><b>Stage</b>
</td>
<td align="center" style="background:#f0f0f0;"><b>TNM Value</b>
</td></tr>
<tr>
<td> <b>0</b></td>
<td>Tis, N0, M0
</td></tr>
<tr>
<td> <b>I</b></td>
<td>T1, N0, M0; T2, N0, M0
</td></tr>
<tr>
<td> <b>IIA</b></td>
<td>T3, N0, M0
</td></tr>
<tr>
<td> <b>IIB</b></td>
<td>T4, N0, M0
</td></tr>
<tr>
<td> <b>IIIA</b></td>
<td>T1, N1, M0; T2, N1, M0
</td></tr>
<tr>
<td> <b>IIIB</b></td>
<td>T3, N1, M0; T4, N1, M0
</td></tr>
<tr>
<td> <b>IIIC</b></td>
<td>Any T, N2, M0
</td></tr>
<tr>
<td> <b>IV</b></td>
<td>Any T, Any N, M1
</td></tr>
</table>
The stage of the tumor is of critical importance in determining the proper treatment for the tumor.<br/>
'''Educational Objective:''' Invasion beyond the thick muscular layer of the bowel wall (muscularis propria) indicates a T3 tumor.<br/>
'''References:''' AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th ed, Edge, SB, Byrd, DR, Compton, CC, et al (Eds), Springer, New York 2010. p 143.