Pathophysiology Test 3

lomotil

-Lomotil is a prescription medicine used to treat the symptoms of diarrhea -drowsiness, dizziness, feeling restless, headache, numbness in your hands or feet, depression, not feeling well, confusion, feelings of extreme happiness, red or swollen gums, dry mouth, nose or throat, nausea, vomiting, upset stomach, loss of appetite, skin rash, dry skin, and itching

barium enema

•A barium enema is an X-ray exam that can detect changes or abnormalities in the large intestine (colon). The procedure is also called a colon X-ray. •An enema is the injection of a liquid into your rectum through a small tube. In this case, the liquid contains a metallic substance (barium) that coats the lining of the colon. Normally, an X-ray produces a poor image of soft tissues, but the barium coating results in a relatively clear silhouette of the colon. •During a barium enema exam, air may be pumped into the colon. The air expands the colon and improves the quality of images. This is called an air-contrast (double-contrast) barium enema. •used to diagnose abnormal growths (polyps) as part of colorectal cancer screening and/or inflammatory bowel disease

cholesteatoma

•A cholesteatoma is a skin growth that occurs in an abnormal location, the middle ear behind the eardrum. It is usually caused by repeated infection that causes an ingrowth of the skin of the eardrum. Cholesteatomas often take the form of a cyst or pouch that sheds layers of old skin that builds up inside the ear. •Initially, the ear may drain, sometimes with a foul odor. As the cholesteatoma pouch or sac enlarges, it can cause a full feeling or pressure in the ear, along with hearing loss and tinnitus. An ache behind or in the ear, especially at night, may cause significant discomfort. Dizziness, or muscle weakness on one side of the face (the side of the infected ear) can also occur. •An examination by an otolaryngologist — head and neck surgeon can confirm the presence of a cholesteatoma. Initial treatment may consist of a careful cleaning of the ear, antibiotics, and eardrops. Therapy aims to stop drainage in the ear by controlling the infection. The extent or growth characteristics of a cholesteatoma must also be evaluated. •Large or complicated cholesteatomas usually require surgical treatment to protect the patient from serious complications. Hearing and balance tests, X-rays of the mastoid (the skull bone next to the ear), and CAT scans (3-dimensional X-rays) of the mastoid may be necessary. These tests are performed to determine the hearing level remaining in the ear and the extent of destruction caused by the cholesteatoma. •Surgery is performed under general anesthesia in most cases. The primary purpose of the surgery is to remove the cholesteatoma and infection, and achieve an infection-free, dry ear. Hearing preservation or restoration is the second goal of surgery. In cases of severe ear destruction, reconstruction may not be possible. Facial nerve repair or procedures to control dizziness are rarely required.

paget disease (osteitis deformans)

•A chronic bone disorder that typically results in enlarged, deformed bones due to excessive breakdown and formation of bone tissue that can cause bones to weaken and may result in bone pain, arthritis, deformities or fractures. •affected areas of bone produce new bone tissue faster than the old bone can be broken down •two stages: initial stage (Vascular stage)- bone tissue is broken down, but the spaces left are filled with blood vessels and fibrous tissue instead of new strong bone. second (sclerotic) stage- highly vascular fibrous tissue hardens and becomes similar to bone, but it is fragile instead of strong •most common sites are the pelvis, tibia, femur, spine, skull, and clavicle •no symptoms but may have local bone pain, aching is continuous and is worse at night, edema or deformity in one of the bones, may notice they need a larger hat size because the bones of the skull have enlarged, hearing loss or deafness may occur -diagnosis- a physical examination and a history of the patient's symptoms, several tests and blood work, radiographic imaging, bone scanning, and possibly a bone marrow biopsy •treatment includes analgesics, anti-inflammatory drugs, cytotoxic agents, or injections of a hormone called calcitonin, eating a high protein, high calcium diet, vitamin D supplementation, bisphosphonate medications such as alendronate (Fosamax), risedronate (Actonel), tiludronate, pamidronate (Aredia), and zoledronic acid (Reclast) •patients should receive 1000 to 1500 mg of calcium, adequate exposure to sunshine, and at least 400 units of vitamin D daily.

strangulated hernia

•A strangulated hernia is a hernia that is cutting off the blood supply to the intestines and tissues in the abdomen. •Symptoms of a strangulated hernia include pain near a hernia that gets worse very quickly and may be associated with other symptoms. •sudden pain that can quickly become excruciating, fever, general fatigue, inflammation and color changes in the skin near the hernia, burning feeling around the hernia, nausea, vomiting, inability to pass, gas, severe constipation or an inability to have a bowel movement, bloody stools, rapid heart rate •ultrasound •surgery

Treatment for peptic ulcer disease due to helicobacter pylori

•Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin •H2 blockers: cimetidine, ranitidine, famotidine, nizatidine •Proton pump inhibitors: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprozole •Stomach-lining protector: bismuth subsalicylate

spur

•Bone spurs are bony projections that develop along bone edges. Bone spurs (osteophytes) often form where bones meet each other — in your joints. They can also form on the bones of your spine. The main cause of bone spurs is the joint damage associated with osteoarthritis. Most bone spurs cause no symptoms and can go undetected for years. They might not require treatment. If treatment is needed, it depends on where spurs are located and how they affect your health. •pain and loss of motion in the joint

esophageal varices

•Dilated submucosal veins that develop in patients w/ underlying portal hypertension; S&S- superficial veins lining the esophagus become dilated and twisted at the distal end •hematemesis (vomiting of blood); melena (dark, tarry stools stained with digested blood); hypovolemic shock (blood in the circulatory system is decreased) •replacing the blood volume and maintaining the fluid and electrolyte balance to restore homeostasis, endoscopic scleropathy and ligation of bleeding varices, emergency portal decompression •illustrate how obstruction of blood flow causes back pressure in the esophageal varices. Teach the patient how to monitor for overt signs of upper-GI bleeding, explain the procedure and its purpose

diplopia

•Double vision can occur with one eye or both. If it's in one eye when the other is closed, it is less worrisome, but still serious. If it occurs when both eyes are open, it could signal a major disorder. •Misalignment of one or both eyes (a "wandering eye" or "cross-eyed" appearance), Pain when you move your eye, Pain around your eyes, like the temples or eyebrows, Headache, Nausea, Weakness in your eyes or anywhere else, Droopy eyelids •blood tests, a physical exam, and maybe an imaging test like computed tomography (CT) or magnetic resonance imaging (MRI). If weak eye muscles are to blame, or if a muscle has been pinched as a result of injury, surgery may help. Medications can treat myasthenia gravis. Surgery or medicine is available for Graves' disease. Medicines and insulin can control blood sugar in diabetes. Special eyewear, like an eye patch or prism glasses, can ease the effects.

pseudoaddiction

•Drug-seeking behaviors that may occur when a patient's pain is undertreated

GERD (gastroesophageal reflux disease)

•Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. •A burning sensation in your chest (heartburn), usually after eating, which might be worse at night, Chest pain, Difficulty swallowing, Regurgitation of food or sour liquid, Sensation of a lump in your throat, Chronic cough, Laryngitis, New or worsening asthma, Disrupted sleep •Upper endoscopy, Ambulatory acid (pH) probe test, Esophageal manometry, X-ray •Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief, Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR), Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC), surgery

hyperglycemia

•Hyperglycemia refers to high levels of sugar, or glucose, in the blood. It occurs when the body does not produce or use enough insulin, which is a hormone that absorbs glucose into cells for use as energy. •caused high sugar levels which will lead to diabetes •blood glucose levels higher than 130 milligrams per deciliter (mg/dl) before eating a meal or above 180 mg/dl 2 hours after the start of a meal, frequently needing to pass urine, feeling thirsty more often, a higher than average volume of glucose in the urine •treatment- managing diabetes

Hyperparathyroidism

•Hyperparathyroidism is when your parathyroid glands create too much parathyroid hormone in the bloodstream. blood tests, bone mineral density test, urine test, imaging tests of kidneys •surgery, calcimimetics (sensipar), hormone replacement therapy, Bisphosphonates (prevent the loss of calcium from bones and may lessen osteoporosis)

hallux valgus (bunion)

•Localized area of enlargement of the inner portion of the metatarsophalangeal joint at the base of the big toe. •can be associated with local inflammation and pain. If adjacent inflamed bursa develops, secondary to pressure and inflammation at the joint, it can become even more painful •great toe may override or undercut the second toe, causes crowding of the other toes and the possible development of hammer, claw, or mallet toe. •associated with RA, a flat foot, the wearing of improperly fitting shoes, high-heeled shoes, and familial tendency. Common in ballet dancers •physical examination, history of symptoms, and radiographic studies •management includes wearing shoes with a roomy "toe box"; wearing shoes with lower heels; using padding between the toes or around the bunion to relieve pressure; applying ice to the bunion to reduce the inflammation and lessen the pain; and resting the affected joints •analgesic medications (e.g. aspirin and acetaminophen) are given for pain. Intra-articular (joint) injections of a corticosteroid, surgical procedures (bunionectomy, osteotomy, and arthroplasty)

flagyl

•Metronidazole is an antibiotic that is used to treat a wide variety of infections. It works by stopping the growth of certain bacteria and parasites. •This antibiotic treats only certain bacterial and parasitic infections. It will not work for viral infections (such as common cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections. •Metronidazole may also be used with other medications to treat certain stomach/intestinal ulcers caused by a bacteria (H. pylori).

Ibuprofen (Advil, Motrin)

•NSAID •in addition to its use as an anti-inflammatory drug, ibuprofen is used in the treatment of menstrual cramps and ovulation pain

celebrex

•NSAID and COX-2 inhibitor (enzymes that are involved in the inflammatory process) •main advantage is that they have considerably less antiplatelet effect and there are fewer bleeding tendencies •used generally for arthritic conditions (??) •dosage- adults (oral) 100 to 200 mg twice daily

Hyperopia (farsightedness)

•Occurs when light that enters the eye is focused behind the retina rather than on the retina, which requires refocusing by the internal lens or the use of an external corrective lens to reposition the viewed object on the retina to sharpen the image •occurs when the eyeball is abnormally short as measured from front to back

myopia (nearsightedness)

•The result of light rays entering the eye being focused in front of the retina, causing blurred vision •distant objects are blurry, image being viewed cannot be sharpened by the internal lens of the eye •occurs when the eyeball is abnormally long as measured front front to back

stapedectomy

•The surgical removal of part of the stapes bone and its replacement with a small prosthetic device. •used for otosclerosis

osteomalacia

•a bone disease characterized by softening of the bones resulting from deficiency or ineffective use of Vitamin D •causes the bones to become increasingly soft, flexible, and deformed •early symptoms: general fatigue; progressive stiffness; tender, painful bones; backaches; muscle twitches and cramps; and the difficulty in standing up •as the disease progresses the patient may experience fractures, bowing of the legs, chest deformity, and shortening of the spine that leads to an overall reduction in height •other causes of the disease: inadequate exposure to sunlight, which prevents the body from synthesizing its own Vitamin D; intestinal malabsorption of Vitamin D; and chronic renal diseases •diagnosed by blood tests (e.g. serum calcium, serum alkaline phosphatase, vitamin D levels, and ESR), radiographic studies, bone scan, and possibly a bone biopsy •treated with vitamin D supplementation, adding dietary vitamin D, calcium, and calcitonin, and exposure to sunlight increases vitamin D metabolism and absorption

cretinism

•a congenital form of hypothyroidism, developing in infancy or early childhood; thyroid gland is absent or thyroid hormone is not synthesized by the thyroid gland (causes mental and growth retardation) •child develops as a dwarf, stocky in stature with a protruding abdomen, short forehead, a broad nose, small wide-set eyes with puffy eyelids; a wide-open mouth with a thick, protruding tongue; and expressionless face; and dry skin, sex organs fail to develop, lack of muscle tone contributes to an inability to stand or walk •blood test that indicates an absence or abnormally low amount of T4 in the presence of an elevated TSH level; thyroid scan •treatment with thyroid hormone promotes normal physical growth, but may not prevent mental retardation; replacement therapy continues throughout the life of the patient

ankylosing spondylitis

•a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae •pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue •no specific cause but it may be genetic •CT scan, MRI, radiographic tests, blood tests •Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as naproxen (Naprosyn) and indomethacin (Indocin, Tivorbex) — are the medications doctors most commonly use to treat ankylosing spondylitis. They can relieve your inflammation, pain and stiffness. However, these medications might cause gastrointestinal bleeding. If NSAIDs aren't helpful, your doctor might suggest starting a biologic medication, such as a tumor necrosis factor (TNF) blocker or an interleukin-17 (IL-17) inhibitor. TNF blockers target a cell protein that causes inflammation in the body. IL-17 plays a role in the body's defense against infection and also has a role in inflammation. TNF blockers help reduce pain, stiffness, and tender or swollen joints. They are administered by injecting the medication under the skin or through an intravenous line. The five TNF blockers approved by the Food and Drug Administration (FDA) to treat ankylosing spondylitis are: Adalimumab (Humira) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Golimumab (Simponi) Infliximab (Remicade) IL-17 inhibitors approved by the FDA to treat ankylosing spondylitis include secukinumab (Cosentyx) and ixekizumab (Taltz). TNF blockers and IL-17 inhibitors can reactivate untreated tuberculosis and make you more prone to infection. If you're unable to take TNF blockers or IL-17 inhibitors because of other health conditions, your doctor may recommend the Janus kinase inhibitor tofacitinib (Xeljanz). This drug has been approved for psoriatic arthritis and rheumatoid arthritis. Research is being done on its effectiveness for people with ankylosing spondylitis.

estrogen

•a general term for female steroid sex hormones that are secreted by the ovary and responsible for typical female sexual characteristics

marfan syndrome

•a group of inherited conditions featuring abnormal connective tissue with weakness of blood vessels and excessive length and flexibility of the extremities •characterized by abnormally long extremities and digits; subluxation of the lens of the eyes and heart and vascular anomalies; person with marfan syndrome is tall and slender with long, narrow digits; asymmetry of the skull; visual difficulties are encountered when lens dissociation occurs; scoliosis; joints can be hyperextensible; mitral valve prolapse and thickening of the heart valves and aortic aneurysm may be present; first indication of the syndrome occurs during exercise that precipitates rupture of an aortic aneurysm with catastrophic results •autosomal dominant genetic disorder; affected gene is on the long are of chromosome 15; the defective gene determines the structure of fibrillin, a protein that is an important component of connective tissue •patients may be confused with those who have homocystinuria (an amino acid disorder) because connective tissue abnormalities and abnormal movement of the lens of the eye are present in both conditions; born with this disorder; diagnosis is made based on the family history, the physical examination findings of abnormal length of the limbs and lens abnormality in the eye, and tests of the heart and blood vessels; clinical picture of a rapid growth spurt and scoliosis, coupled with the visual disturbance and mitral valve prolapse, leads to further investigation. Echocardiographic measures of the aortic diameter aid in detecting potential aortic dissection. Patients at risk for impending aortic dissection may be asymptomatic or may experience chest pain that is tearing in nature and radiates to the neck, back, and arms •treatment involves controlling excessive height with hormones before puberty, preventing glaucoma, controlling blood pressure, and preventing aortic dissection. Ophthalmic examinations should be conducted on a routine basis. Monitoring blood pressure and maintaining it at a normal level are essential. Close observation of aortic status is necessary, and surgical replacement of diseased portions may be indicated. Aortic and mitral valves may need to be replaced surgically. Echocardiography is used on a regular basis

iris

•a ring of muscle tissue that forms the colored portion of the eye around the pupil and controls the size of the pupil opening

vagotomy

•a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion (e.g. in treating peptic ulcers)

blood culture

•a test that checks for foreign invaders like bacteria, yeast, and other microorganisms in your blood. Having these pathogens in your bloodstream can be a sign of a blood infection, a condition known as bacteremia. A positive blood culture means that you have bacteria in your blood.

otosclerosis

•abnormal bone growth in the middle ear, primarily affects the stapes, the third bone or ossicle of the middle ear •causes hearing loss •symptoms are tinnitus, and a gradual hearing loss of low or soft sounds, unilateral at first but affects both ears at some point •idiopathic but there is evidence of familial tendency, suggesting genetic factors •diagnosis is based off of an audiogram, the patient history, and otoscopy •surgical procedure (stapedectomy) which involves the removal of the diseased stapes and replacement with prosthesis or a stapedotomy which is performed with a laser creating a hole in the stapes permitting placement of a prosthetic device

kyphosis (hunchback)

•abnormal outward curvature of the spine (convexity backward) •insidious onset and is asymptomatic until the hump becomes obvious; patient may begin to experience mild pain, fatigue, tenderness along the spine, and decreasing mobility of the spine; shoulders appear rounded and the head protrudes forward •kyphosis that occurs in very young children has no specific cause and is believed to be developmental; adolescent kyphosis usually is related to Scheuermann disease, a degenerative deformity of the thoracic vertebrae; additional diseases that contribute include tumors or tuberculosis of the vertebral bodies and ankylosing spondylitis; collapse of the vertebrae from the weakened bone of osteoporosis is often responsible for the hunchback (dowager's hump) that develops in the older person, particularly the postmenopausal woman. Wearing away of the anterior portion of the vertebrae in a wedge type of manner (anterior wedging) or deterioration of the vertebrae results in the excessive curvature with kyphosis •diagnosed based off of visual inspection, radiographic films, bone scans •treatment includes exercises to strengthen the muscles and ligaments, back braces, spinal fusion with instrumentation and temporary immobilization; kyphosis that is caused by a sudden collapse of a vertebrae because of osteoporosis is sometimes treated with a new procedure called vertebroplasty, in which a balloon is inflated within the vertebra and methyl methacrylate is inserted to provide a "cement" foundation to maintain reestablished vertebral height and reduce pain

gigantism

•abnormal pattern of growth and stature •hypersecretion of growth hormone (GH, somatotropin) occurs before puberty, a proportional overgrowth of all body tissue •an anterior pituitary adenoma is often the cause of over secretion of GH that results in gigantism •clinical picture of abnormal growth in a prepubescent child, levels of GH are elevated on lab tests, pituitary MRI, CT scan, bone radiographic films •surgery (transsphenoidal approach) with or without the addition of medications or radiation of the pituitary gland to reduce its size

cholelithiosis (gallstones)

•abnormal presence of calculi or gallstones that form in the bile •asymptomatic until the bile ducts become obstructed by the stones •colicky pain, biliary colic, signals the obstruction of the cystic duct or the common bile duct by one or more stones •pain is in the epigastric region or the right upper quadrant of the abdomen, often radiating to the right upper back in the area of the scapula •nausea, vomiting, severe pain, flatulence, clay-colored stools, jaundice •lab studies may show transient elevations of bilirubin and alkaline phosphate, AST, and ALT •ultrasonography •dietary changes, surgical removal of the gallbladder (cholecystectomy) •laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) is used to identify and remove stones in the common bile duct •oral preparations (bile acids (chenodeoxycholic or ursodeoxycholic)) to dissolve the gallstones •extracorporeal shock wave lithotripsy (ESWL) is nonsurgical

stye (hordeolum)

•acute, painful abscesses of an eyelash follicle, or in a sebaceous gland of the eyelid •pain, swelling, redness, and the formation of pus at the site, feeling of having "something in the eye" •result of staphylococcal infection and can be associated with and secondary to blepharitis •diagnosed with visual examination •warm compresses, topical antibiotics, and/or surgically drained

hashimoto thyroiditis

•also called chronic lymphocytic thyroiditis •chronic disease of the immune system that attacks the thyroid gland •gradual and painless lumpy enlargement of the thyroid gland, which causes a feeling of pressure in the neck and may result in difficulty with swallowing; symptoms (sensitivity to cold, weight gain, fatigue, depression, and mental apathy) appear as the disease progresses •heredity plays a prominent role in Hashimoto's. Antibodies appear to destroy thyroid tissue instead of stimulating it. The gland enlarges as a result of an inflammatory process, with infiltration by lymphocytes and plasma cells. As a result, gland tissue is replaced by fibrous tissue and a significant number of patients become hypothyroid •serum TSHs are elevated; autoantibodies against thyroid tissue are found in the blood, such as thyroid peroxidase antibodies (TPOs). Characteristic changes can be seen in the thyroid gland through needle biopsy (not necessary); a radioactive iodine uptake scan will show a low uptake (not necessary) •treatment is lifelong replacement of thyroid hormones in hypothyroid patients •no prevention

retinal detachment

•an elevation (separation) of the retina from the choroid •may be partial or complete and usually associated with a retinal tear or a hole in the retina •early symptoms: patient seeing many new floaters and light flashes. This persists and worsens and is followed by seeing a dark shadow that extends from the periphery inward. This may begin in either the lower or upper field of vision or in one of the side fields of vision. If the detachment extends to the central retina, the central vision also is blocked. Detachment often happens suddenly and without pain •commonly associated with severe diabetic retinopathy; people who are extremely nearsighted are more susceptible to retinal detachments; ocular trauma or retinal atrophy can predispose a person; usually begins with a tear in the retina. Fluid then leaks under the retina and separates it from the choroid. After the retina is separated from the choroid, that portion of the retina no longer functions visually. As the retina continues to detach, more and more vision is lost •ophthalmic examination •early treatment is advised; intervention is imperative •treatment consists of either photocoagulation or surgery. If the detachment has extended to the macula, the central retina, permanent reduction in central acuity often occurs. Photocoagulation or cryotherapy can be used to treat retinal tears if no significant detachment occurs. Photocoagulation is a relatively simple procedure, which can be used to seal retinal tears before the development of retinal detachment. Treatment may include a period of bed rest •no prevention

gastroscopy

•an examination of the esophagus (gullet or food pipe), stomach and duodenum (upper part of the small bowel) using a flexible telescope called a gastroscope

keratitis

•any inflammation or infection of the cornea •decreased visual acuity, irritation, tearing, photophobia, and mild redness of the conjunctiva, pain or numbness of the cornea •infection resulting from the herpes simplex virus; certain bacteria and fungi may also be responsible; contact lens wear increases the risk of bacterial keratitis; caused by corneal trauma, or exposure of the cornea to dry air or intense light •urgent treatment is necessary; administration of a broad spectrum antibiotic or an antiviral agent; ophthalmic moisturizing ointments and eye drops; eye patch •prevention involves following the recommended instructions for contact lens wear and care, such as proper handling and cleaning of the lenses, can reduce the risk of infection. Avoiding hand to eye contact can lessen transfer or infection to the eye from contaminated medication, makeup, or contact lenses

ganglion (cyst)

•benign saclike swelling that typically develops over a joint or tendon and is filled with a colorless, jelly-like fluid; formed from the tissue that lines a joint of tendon •most commonly develops on the back of the wrist as a single smooth lump; just under the surface of the skin; can develop near other joints, such as around the ankle joint; behind the knee, and on the fingers; may appear as multiples or in clusters; most are the size of a pea but they can grow as large as an inch or more in diameter; soft to the touch or firm, and they are usually either painless or only somewhat bothersome •diagnosed by visual examination, palpation, and observation of the appearance of the lump and the characteristic site, and/or needle aspiration; primary concern is whether or not underlying arthritis is present •if the ganglion does not cause pain and is not large enough to cause disfigurement or to interfere with wrist function, treatment is unnecessary. If the ganglion is causing pain, disfigurement, or impairment of the ROM, the physician may try to rupture the ganglion by applying firm pressure; needle aspiration followed by an instillation of a steroid, such as cortisone, or a sclerosing solution that helps to prevent recurrences; physician may recommend a surgical procedure called a ganglionectomy to remove the ganglion

simple fracture

•bone is broken cleanly; the ends do not penetrate the skin

extracorporeal shock wave lithotripsy (ESWL)

•breakdown of kidney stones using sound waves generated outside the body •Stones that are smaller than 2 cm in diameter are best

fracture

•broken bone, caused by stress on the bone resulting from a traumatic insult to the musculoskeletal system, severe muscle spasm, or bone disease •colles fracture- fracture of the distal head of the radius, with possible involvement of the ulnar styloid, results from a fall in which the person attempts to break the fall with an extended arm and open hand, closed reduction of the fracture and immobilization of the arm including the elbow, with a cast •fracture of the humerus- displacement of the bone of the upper arm along with shortening of the extremity and an abnormal mobility of the upper arm, closed reduction of the fracture is followed by immobilization in a hanging arm cast and sling and swathe •fracture of the pelvis- result of severe trauma, such as from a motor vehicle accident or a fall, complications include a lacerated colon, paralytic ileus, bladder and urethral injury, and intrapelvic hemorrhage; best rest, possible immobilization with a pelvic sling or skeletal traction, and open reduction and repair •fractured hip- result of a fall, outward rotation along with a shortening of the affected extremity, repaired by surgery that involved the insertion of a prosthesis or pins, or both •fracture of the femoral shaft- result of a severe direct impact related to motor vehicle accidents or severe trauma, notable angulation deformity and shortening of the affected leg is present, unable to move the knee or hip, stabilized by skeletal traction or internal fixation with a rod or a plate and screws •fracture of the tibia- result from a strong force resulted on the lower leg that causes soft tissue damage in addition to the fracture, open or closed reduction is employed, followed by immobilization with a cast •vertebral fracture- result of acceleration-deceleration trauma, immediate immobilization is imperative to prevent spinal cord damage and resulting paralysis, thoracic and lumbar vertebrae also can be fractured often from a direct fall onto the buttocks and associated with osteoporosis, immobilization may be followed by surgical repair and possible insertion of surgical hardware (rods, plates) for stabilization; in some cases, theres a less invasive orthopedic procedure called vertebroplasty that is used to repair fractured and compressed vertebrae, bone cement is injected into the area of compression to seal and stabilize the fracture •basilar skull fracture- fracture of the floor of the cranial vault, usually the result of massive trauma to the head from a motor vehicle accident •le fort fracture- bilateral horizontal fracture of the maxilla, often results when the face is forced against the steering wheel in a motor vehicle accident •in pott fracture- lower part of the fibula is fractured, lower tibial articulation sustains serious injury •clavicular fracture- fracture of the clavicle (collar bone), common sports injury (bicycling accidents) and occurs often in children of all ages •symptoms include pain, edema, tenderness, discoloration, and inability to move the affected part, deformity of the affected part is noted •treatment- depends on the location, severity, type, and cause of the fracture; simple fractures of long bones are reduced and immobilized; compound fractures are cleaned, debrided, reduced, and immobilized (splinting, casting, taping, and external or internal fixation (internal fixation included the use of surgically implanted pins, wires, rods, plates, screws, or other devices))

colorectal cancer

•cancer that arises in any part of the colon or rectum symptoms-abdominal pain, change in bowel habits (diarrhea, constipation), bloody stools, weakness, weight loss, or symptoms related to iron-deficiency anemia, abdominal distention, pallor, ascites, cachexia, lymphadenopathy, and hepatomegaly •increases with age, rare genetic disorders (familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer), history of large adenomatous polyps, diabetes mellitus, ulcerative colitis, crohn disease, a first-degree relative with colorectal cancer, cigarette smoking, and obesity •fecal occult test, double-contrast barium enema, colonoscopy, physical examination, CT scan of the chest, abdomen, and pelvis, endoscopic ultrasound; surgical resection of the affected part of the rectum, and any affected lymph nodes, chemotherapy, radiation therapy

diabetes mellitus

•chronic disorder of carbohydrate, fat, and protein metabolism caused by inadequate production of insulin by the pancreas or faulty use of insulin by the cells Type 1: •juvenile onset diabetes or insulin-dependant diabetes •early, abrupt onset, usually before 30 years of age, with little or no insulin being secreted by the patient and can be difficult to control •pruritus, fruity odor to the breath Type 2: •adult onset diabetes or non-insulin-dependent diabetes •most common form, gradual onset in adults over than 30, and more often in people over 55. In this form, some pancreatic function remains, permitting control of symptoms by dietary management; in addition, an oral hypoglycemic medicine is usually prescribed •diagnosed by at least 2 positive tests of fasting blood plasma glucose and the presence of glucose and acetone in the urine, blood insulin level determination and an ophthalmic examination for diabetic retinopathy •goal of treatment is to normalize blood glucose levels and thus prevent complications, well-balanced diet closely integrated with insulin administration or oral medication, exercise, blood and urine testing, and hygienic measures. Type 1 diabetes requires insulin replacement therapy that correlates closely with calculated carbohydrate intake on a regular schedule (methods include injection, insulin pump therapy, and insulin pens). Type 2 diabetics usually do not necessarily require insulin injections. Their regimen includes restricted calorie intake and exercise, or oral hypoglycemic medications. Meds include sulfonylureas and meglitinide drugs (oral hypoglycemic drugs), such as glipizide (Glucotrol), glyburide (DiaBeta or Micronase), repaglinide (Prandin), and nateglinide (Starlix) stimulate the pancreas to produce insulin. Meds are taken once or twice a day, and blood glucose levels must me monitored on a strict schedule. •screening for diabetes is recommended for those with risk factors such as genetic susceptibility, obesity, a history of gestational diabetes, and an age of 45 or older. Prediabetes has been identified as a risk factor for progression to type 2 diabetes.

gouty arthritis

•chronic disorder of uric acid metabolism that manifests as an acute, episodic form of arthritis; chronic deposits of uric acid forming hard nodules in tissues; and/or kidney impairment or stones. •overproduction or decreased excretion of uric acid and urate salts which leads to high levels of uric acid in the blood and also in the synovial fluid of joints. Deposits can be found in and around the joints and extremities, often leading to joint deformity and disability. Typically, gout affects the first metatarsal joint of the great toe (podagra), causing severe to excruciating pain. The joints of the feet, ankles, knees, and even hands can also be affected. Pain usually peaks after several hours, and then subsides gradually. A slight fever, chills, headache, or nausea may accompany the attack. Between attacks, the person is characteristically free from any symptoms. Also characterized by renal dysfunction, hyperuricemia, and renal calculi (kidney stones). Uncommon in children; appears in men after puberty; appears after menopause in women; and can develop secondary to cell breakdown resulting from drug therapy, especially with chemotherapy for malignant diseases (e.g. leukemia) •cause is most often an inherited abnormality of metabolism. May result from a deficiency of enzymes needed to completely metabolize purines in foods for excretion from the kidneys; leads to the buildup of uric acid in the tissues of the body. Body may produce levels of uric acid that are normal, but kidney function is insufficient to remove the product from the blood. Excessive weight gain, leukemias and lymphomas, and certain drugs including diuretics and tuberculosis medications can precipitate gout. •Patients with new-onset joint inflammation are evaluated to exclude many types of arthritis, such as RA, spondylitis, reactive arthritis, and joint infection. Microscopic examination of aspirated synovial joint fluid or material from soft tissue uric acid deposits (called tophi) demonstrates the presence of urate crystals and proves the diagnosis. A serum uric acid test can indicate hyperuricemia. Radiographic films may be used to assess the amount of damage done to the affected joints. •treatment for acute gout includes bed rest to lessen pressure on affected joints, immobilization of the affected limb, and the application of cold packs to the inflamed joints. Anti-inflammatory agent (NSAIDs), colchicine (Colcrys), and corticosteroids taken orally or injected into the gouty area are options that can reduce inflammation. Dietary modifications include a low-purine diet and adequate fluid intake. Dairy products reduce the frequency of attacks. Treatment for chronic gout includes antihyperuricemic medications, such as probenecid (Benemid), allopurinol (Zyloprim), and/or febuxostat (Uloric). Gradual weight reduction can be helpful. Chronic gouty deposits of uric acid (tophi) can be difficult to treat, so if they do not shrink with medication, they can be surgically resected.

crohn's disease (regional enteritis)

•chronic inflammatory disorder of the alimentary canal in which all layers of the bowel wall are edematous and inflamed. Any portion of the GI tract from mouth to anus can be affected •may also have chronic diarrhea or crampy, intermittent abdominal pain, often in the right lower quadrant of the abdomen; weight loss; malaise; nausea; anorexia; fever; and abdominal fullness. Abdomen is tender and distended, and patients may vomit and have blood in stools. Patients may have intermittent symptoms with varying periods of remission. If the condition is chronic, signs and symptoms of malnutrition begin to materialize; perianal fissures and fistulas usually develop. •diagnosis is based on symptoms, radiographic studies of the small and large intestine, colonoscopy, and enteroscopy (examination of the small intestine with an endoscope or swallowed pill-sized camera, a biopsy, and a CT scan •medically incurable •nutritional support, dietary supplements of vitamins, minerals, protein, and calories, intravenous nutrition (only w/ diarrhea), medication therapy (acute- antibiotics or steroids, chronic- azathioprine, methotrexate, infliximab, adalimumab, certolizumab, or natalizumab), drug therapy with anticholinergics and narcotic agents, mesalamine (for infections), immunosuppressive drugs, abscesses can be drained surgical resection

acromegaly

•chronic metabolic condition caused by hypersecretion of GH by the pituitary gland •when the hypersecretion of GH occurs after puberty, acromegaly (an overgrowth of the bone of the face, hands, and feet) occurs, with an excessive overgrowth of soft tissue because there is already epiphyseal closure; often seen in people 30 to 40 years old; patient notices that he or she must wear larger gloves, shoes, or both; jaw grows, causing larger spaces between the teeth; may experience joint pain resulting from osteoarthritis and a host of other clinical features in the body systems •a pituitary tumor or adenoma often is the cause of acromegaly; affects men and women with equal frequency •clinical picture of abnormal thickening of the bones of the face, hands, and feet leds the physician to perform diagnostic tests; levels of GH and IGF-1 are elevated; another reliable test is the glucose tolerance test because increased glucose levels fail to suppress GH levels; MRI of the pituitary and CT scan can detect the presence of a pituitary lesion •object of treatment is the reverse prevent tumor mass effects and reduce the amount of GH secreted. Correcting the disorder prevents further disfigurement and reduces the mortality that results from production of excess GH. This is performed by surgery (transsphenoidal approach) with or without the addition of medication or radiation to the pituitary gland to reduce its size. •no prevention

fibrositis (fibromyalgia)

•chronic pain condition associated with stiffness and tenderness that affects muscles, tendons, and joints throughout the body. Characterized by restless sleep, depression, fatigue, anxiety, and bowel dysfunction. •symptoms include diffuse aching or burning in the muscles, stiffness, disturbed sleep patterns, poor concentration, irritability, and depression. Patients may note extreme tenderness of various areas of the body. Other nonspecific symptoms include headaches, jaw pain, and sensitivity to odors, bright lights, and loud noises. Some patients experience irritable bowel syndrome or "spastic colon", including nausea, diarrhea, constipation, or abdominal pain with gas and distention. Urinary symptoms when present, include urinary urgency or frequency brought on by bladder spasms and irritability. Often, patients wake up feeling tired, even if they have slept all night. Others sleep lightly and wake up during the night. •Cause is unknown. Patients experience pain in response to stimuli that are normally not perceived as painful. Elevated levels of a nerve growth factor and a chemical signal, called substance P, in the spinal fluid of patients with fibromyalgia. The amount of serotonin is relatively low in these patients. Those with fibromyalgia experience impaired non-rapid eye movement (non-REM) sleep, which likely explains the common feature of waking up feeling fatigued and unrefreshed. The onset of fibromyalgia is sometimes associated with psychological distress, trauma, and infection. The condition may be aggravated by poor posture, inappropriate exercise, and smoking. •Blood testing and physical examination are important to exclude conditions such as hypothyroidism, hypoparathyroidism, and other muscle diseases, bone disease, virus infections, and cancer. There are no specific laboratory or imaging studies that can be used to diagnose fibromyalgia. Diagnosis is made purely on clinical grounds based on the thorough history and physical examination to reveal widespread tenderness and pain or aching commonly in at least 11 of 18 specific tenderness points. A widespread pain should exist for a minimum of 3 months before diagnosed as fibromyalgia (18 sites of tender points cluster in the regions of the neck, shoulders, chest, hips, knees, and elbows). •treatment can help alleviate symptoms and restore function. Treatment involves patient education, stress reduction, physical activity, and medications. Medications that can improve sleep patterns may be prescribed, such as low doses of the antidepressant amitriptyline (Elavil). Newer treatments include pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). For muscle and joint soreness, nonsteroidal anti-inflammatory drugs (NSAIDs) and/or muscle relaxants can be helpful. Stress reduction, relaxation techniques, massage therapy, acupressure, and exercise (walking, biking, swimming, or water aerobics).

systemic lupus erythematosus (SLE)

•chronic, inflammatory autoimmune disease characterized by unusual autoantibodies in the blood that target tissues of the body •can inflame and damage connective tissue anywhere in the body. Most commonly produces inflammation of the skin, joints, nervous system, kidneys, lungs, and other organs. A characteristic butterfly rash, or erythema, may be present on the face, spreading from one cheek, across the nose to the other cheek. Similar rashes may appear on other exposed areas of the body. Exposure to sun can aggravate the rash, a feature known as photosensitivity. May begin acutely with fever, fatigue, joint pain, and malaise, or may develop slowly over a period of years, with intermittent fever, malaise, joint deformities, and weight loss. Raynaud phenomenon and hair loss are common in SLE. Occurs most often in women in their 30s or 40s. •cause is unknown but it is thought to be an autoimmune disorder. Genetic, environmental, and hormonal factors may predispose a person. Stress, immunization reactions, pregnancy, and over-exposure to ultraviolet light •diagnosed if four or more of the following symptoms or positive lab tests are present either at the same time or sequentially: a butterfly rash on the face, a discoid skin lesion, photosensitivity, nasopharyngeal ulceration, polyarthritis without deformity, seizures or psychosis, chronic pleuritis or pericarditis, a false-positive serologic test result for syphilis or SNA or Sm (Smith, and uncharacterized nuclear antigen) antibodies in the blood or cardiolipin antibody, more than 0.5 g of protein in the urine in a 24 hour period, the presence of cellular casts in the urine, hemolytic anemia, thrombocytopenia, the presence of abnormal antibodies in the bloodstream, and the characteristic leukocytes (WBCs) called LE cells, which are not found in the circulation but are created in the lab as part of the testing. Diagnostic tests include a CBC with differential leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), antinuclear antibody determination, anti-DNA antibody, anti-Sm antibody, and anti-chromatin antibody. The anti-DNA test is the most specific test for SLE, but it is reliably positive more often with active disease. •treatment in mild cases includes anti-inflammatory drugs, including aspirin, nonsteroidal anti-inflammatory drugs, or prednisone, are effective to relieve constitutional symptoms such as fever and joint pain. Antimalarial agents are commonly added to control skin involvement and arthralgia. For more substantial symptoms, corticosteroids are indicated. Immunosuppressive agents are also helpful when the patient fails to respond to conventional therapy or when intolerable side effects develop

carafate (sucralfate)

•complex of sucrose and aluminum hydroxide aids the healing of ulcers with its topical, soothing effect •adheres to the ulcer itself, acting as a mechanical protectant against the action of acid and digestive enzymes •dosage- adults only (oral) 1 gm four times daily

ectropion

•condition in which the lower eyelid everts from the eyeball, and the exposed surface of the eyeball and the lining of the eyelid become dry and irritated •eversion of the eyelid exposes the conjunctival membrane lining the eyelid. Tears are diverted away from the tear duct and run down the cheeks instead. The patient reports dryness in the eye and tearing •usually occurs in the elderly as a result of decreased elasticity of the lower eyelid. A scar on the eyelid or cheek that contracts and pulls the eyelid downward can cause a cicatricial ectropion •diagnosed by visual examination and a history of symptoms •minor surgical procedure is all that is needed to correct the condition (surgery not named) •no prevention

cushing syndrome

•condition of chronic hypersecretion of the adrenal cortex, which results in excessive circulating cortisol levels •fatigue, muscular weakness, weight gain, and changes in body appearance, fat deposits form in the scapular area (buffalo humps) and in the trunk, causing a protruding abdomen, salt and water retention result not only in hypertension and edema, but also in the characteristic moon face noted in the patient with Cushing syndrome; patient may show clinical evidence of hyperlipidemia, hyperglycemia, osteoporosis, and atherosclerosis; changes in mood and cognition and decreased short-term memory are common; skin becomes thin, has a tendency to bruise easily, and develops red or purple striae (stretch marks); individual is predisposed to infection resulting from suppression of the immune response; other symptoms are excessive hair growth, amenorrhea (absence of menstruation), and impotence (inability to achieve an erection or experience an orgasm) •excessive levels of circulating cortisol can be caused by hyperplasia of the adrenal gland, excessive secretion of corticotropin (ACTH) from the pituitary gland, a tumor of the adrenal cortex, or production of corticotropin in another organ (such as cancer cells in the lungs). Iatrogenic conditions, such as prolonged administration or large doses of glucocorticoids used to treat other diseases, can induce Cushing syndrome •the typical picture of the moon face, buffalo hump, and gross obesity of the trunk, particularly the abdomen, continuous elevation of serum cortisol levels is found in Cushing syndrome, free cortisol levels are elevated in a 24-hr urine collection, CT or MRI may detect adrenal tumors •treatment depends on the cause of the over secretion of cortisol levels; when a tumor is the cause, surgical removal or radiation of the tumor in the pituitary gland or adrenal gland is indicated; drug therapy to suppress ACTH secretions can be used separately or as an adjunct to radiation •no prevention

hiatal hernia

•defect in the diaphragm that permits a segment of the stomach to slide into the thoracic cavity •heartburn, which is usually worse when reclining or after a large meal, chest pain, difficulty in swallowing, respiratory complications can develop as a result of aspiration •caused by a congenital defect in the diaphragm or a weakness that develops in the diaphragm (can be caused by obesity, age, trauma, intra-abdominal pressure) •radiographic chest film, barium radiographic studies, endoscopy, measurement of reflux pH and examination of the reflux contents for the presence of blood •dietary modifications (smaller, more frequent meals of a bland diet), minimize activities that increase intra-abdominal pressure, losing weight, antacids (Maalox and Mylanta) and medications that control the acid secretion in the stomach, such as H2 blockers or proton pump inhibitors (Prevacid or Nexium), cholinergic agent, which helps to control the episodes of reflux by strengthening the LES, smoking is discouraged, avoid laying down for 4 hours after eating, elevating the head of the bed helps, surgical repair of the hiatus

Periodontitis (periodontal disease)

•destructive gum and bone disease around one or more of the teeth; end result of gingivitis that was treated too late or not at all; the pockets that form between the teeth and gums in gingivitis gradually deepen, exposing the root. Plaque develops in this area, causing unpleasant tastes in the mouth and offensive breath (halitosis). As more root is exposed, the tooth or teeth become extremely sensitive to temperature extremes in food and pain may be experienced when chewing. Abscesses can form and eventually a tooth or several teeth become loose and possibly fall out •cause is plaque biofilm and unchecked gingivitis, commonly results from poor oral hygiene and lack of professional dental periodontal care. Over time, the bacteria in plaque destroy the bone surrounding and supporting the teeth. Contributing factors include smoking, certain medications, chemotherapy, diabetes, and human immunodeficiency virus (HIV) infection. Stress, poor nutrition, hormonal medications, and pregnancy may also contribute •to determine the extent of the disease, the dentist measures the depth of the pockets and obtains radiographic films •conservative treatments include thorough cleanings of root surfaces of teeth called scaling and root planing (SRP) and curettage. Multiple daily sessions of brushing and flossing of teeth are required. An oral or local application of a sub-antimicrobial dose of antibiotic may be prescribed; periodontal surgery called respective periodontal surgery requires the dentist to trim the gums to reduce the depth of the pockets and to remove any damaged bone; in certain situations, the dentist may graft bone and/or gum tissue to resolve the periodontal condition •prevention is based off the adherence to a schedule by the dentist for professional cleaning and examination of the teeth

darvon

•discontinued •intended for the management of mild to moderate pain •dosage- adults (oral) one 65 mg capsule every 4 hours (not to exceed 6 tablets per day)

polymyositis

•disease of muscle that features inflammation of the muscle fibers. The muscles affected are mostly those closest to the trunk or torso. This results in weakness that can be severe. It is a chronic illness with periods of increased symptoms, called flares or relapses, and decreased symptoms, known as remissions •Muscle weakness is the most common symptoms of polymyositis. The onset can be gradual or rapid. The results in varying degrees of loss of muscle power and atrophy. The loss of strength can be noted as difficulty in getting up from chairs, climbing stairs, or lifting above the shoulders. Trouble with swallowing and weakness in lifting the head from the pillow can occur. Occasionally, the muscles ache and are tender to the touch. This disease may be accompanied by skin inflammation, in which case it is referred to as dermatomyositis. In such cases, a rash may appear and spread over the face, shoulders, arms, and bony prominences (e.g. knuckles, elbows, and knees). Nearly two third of patients with this disease are women. The person with polymyositis may feel generally fatigued and unwell. •cause is unknown but it is thought to be an autoimmune disorder. Occurs when WBCs, the immune cells of inflammation, spontaneously invade and injure the muscles. •the history and physical examination should include a thorough search for muscle conditions, such as muscular dystrophy, drug toxicity (such as that caused by statin cholesterol drugs), thyroid disorder, sarcoidosis, and infections (e.g. HIV and parasites). Because polymyositis can sometimes accompany cancers, an intense screening for underlying cancer is crucial. A medical history and physical examination document weakness. Blood analysis is used to detect elevated levels of muscle enzymes (creatinine phosphokinase [CPK], aldolase, serum glutamate pyruvate transaminase [SGOT], serum glutamate oxaloacetate transaminase [SPGT], and lactate dehydrogenase [LDH]. An electromyography (EMG) demonstrates a typical abnormal pattern of electrical activity in the inflamed muscle, and muscle biopsy confirms the diagnosis. •treatment is directed towards stopping the inflammation and inhibiting the overactive immune system. High doses of steroids usually are prescribed to suppress the inflammation. Immunosuppressive agents, such as cyclophosphamide and methotrexate, as well as intravenous immunoglobulin are also used. Gradually, exercise therapy is added to rebuild strength and prevent muscle atrophy.

diabetes insipidus

•disturbance of water metabolism resulting in extreme thirst and excessive secretion of dilute urine •deficiency in the release of vasopressin (antidiuretic hormone) by the posterior pituitary gland, resulting in the excretion of copious amounts of dilute urine (polyuria) •excessive thirst (polydipsia), fatigue, symptoms of dehydration, dry mucous membranes, hypotension, dizziness, and poor skin turgor •may be hereditary or the result of an insult to the hypothalamus or to the pituitary gland resulting from head trauma, cerebral edema, or and intracranial lesion •diagnosed through urinalysis and a water-restriction test •treated with vasopressin injections, nasal spray, or oral desmopressin acetate (DDAVP)

cystocele

•downward displacement and protrusion of the urinary bladder into the anterior wall of the vagina •causes the female patient to experience pelvic pressure; urinary leakage, urgency, or discomfort with intercourse; in severe cases with urethral or bladder neck kinking, the bladder cannot be emptied completely which can cause overdistention of the bladder with resultant nerve and/or muscle damage, or an increased incidence of bladder infections •results from trauma to the fascia, muscle, and pelvic support structures during pregnancy and delivery or from atrophy of these structures with age and a genetic predisposition •diagnosis is based on the clinical picture and findings of the physical examination •treatment includes losing weight, reduction of coughing, or correction of constipation with excessive Valsalva maneuvers or targeted physical therapy, symptoms of incontinence may be improved by Kegel exercises; however, surgery or pessary insertion are the current methods of treatment. Surgery to return the bladder to its normal position may be done with or without surgical mesh •prevention includes exercises that strengthen the pelvic floor muscles after childbirth but the tissue changes associated with aging cannot be prevented; avoiding traumatic vaginal delivery may also help reduce the incidence of this condition

ipecac syrup

•emetic •administered orally to produce vomiting •important to give additional fluids, ideally 200 to 300 mL of a clear liquid, after the dose of ipecac. Milk inhibits the effect of ipecac •should not be produced when caustic substances, such as lye, have been ingested or after ingestion of petroleum distillates, such as gasoline, fuel oil, or paint thinners •if the second dose does not produce vomiting within 30 mins, gastric lavage should be performed •dosage- adults and children older than 12: (oral) 30 mL; may repeat in 20 mins children 1-11 years: (oral) 15 mL; may repeat in 20 mins •all doses should be followed by copious clear liquids to increase the effectiveness.

simple goiter

•enlargement of the thyroid gland usually evidenced by a swelling in the neck (results from a shortage of iodine in the diet) •asymptomatic in the early stages •as the hyperplasia increases, it presses on the esophagus, producing difficulty swallowing, and occasionally it can enlarge further, pressing onto the trachea and producing dyspnea. Weight loss, heat intolerance, tachycardia, anxiety, and increased sweating •diagnosis is made by examination of the neck. Blood studies indicate elevated thyrotropin levels and occasionally reduced levels of T3 and T4. Thyroid ultrasonography •administration of one drop per week of saturated solution of potassium iodide, addition of iodine to the diet, thyroid hormones such as T4 sometimes help

lordosis

•exaggerated inward curvature of the spine (aka a swayback or saddleback deformity) •excessive inward curvature occurs as the person compensates for added abdominal girth caused by pregnancy, obesity, or large abdominal tumors. Can also occur developmentally. •may have no symptoms but the patient may experience low back pain. •lordosis results in a protruding abdomen and buttocks and an arched lower back. •often noted in prepubescent girls •excessive abdominal weight gain and mass cause an individual to compensate by unconsciously tightening muscles in the low back to maintain balance when standing. •patients with persistent low back pain should be evaluated for degenerative and congenital disease of the spine, and inflammation of the spine (spondylitis) and conditions involving adjacent internal organs, such as the kidneys, prostate gland, aorta, and pancreas. •observation of the spine in various postural positions and an examination of the lower spine are the primary steps in diagnosis. Radiographic studies to determine the extent of lordosis, along with a thorough history and physical examination to discover the underlying cause of the condition. •when lordosis is caused by pregnancy, the delivery of the baby usually resolves the condition. When obesity is the cause, weight loss and exercises to strengthen the abdominal muscles are beneficial. Performing pelvic tilt exercises and maintaining good posture help to correct the condition. Progressive untreated lordosis can lead to degenerative lumbar disk disease or ruptured lumbar disks. Additional treatment can include the use of a brace. For severe lordosis, spinal fusion and displacement osteotomy are considered (requires the surgical division of a vertebra with shifting of the bone segments to change the alignment of, or alter weight bearing stress on, the spine.

alpha interferon

•family of proteins that possess complex antiviral, antineoplastic, and immunomodulating activities. •growth inhibiting effect on normal and malignant cells when used in cancer therapy, used in the treatment of hairy cell leukemia, Kaposi's sarcoma in patients with AIDS, renal cell carcinoma, bladder, cervical, and ovarian cancer, melanoma, and multiple myeloma. •used after surgical resection of melanoma •side effects- a flu-like syndrome, myalgia, arthralgia, anorexia, mental disturbances, elevated liver enzymes, and skin rashes •dosage- adults only (IM, subcut) 2 million units/m^2 three times per week

treatment of refractive errors

•fitting the patient with artificial lenses in the form of eyeglasses or contact lenses or performing corrective surgery. •Radial keratotomy- surgical procedure to reshape the eye, has been replaced by laser surgery, which results in more precise visual correction and has fewer complications •surgeries to correct myopia, hyperopia, and astigmatism: laser-assisted in-situ keratomileusis (LASIK), astigmatic keratotomy (AK), photorefractive keratotomy (PRK), laser thermal keratoplasty (LTK), conductive keratoplasty (CK), and intraocular contact lenses (lenses that are permanently placed in the eye)

dislocation

•forcible displacement of a bone from its joint, thereby causing loss of joint function •appears misshapen, is extremely painful, rapidly becomes edematous, ecchymotic, and immovable; dislocation of the spinal vertebrae can result in damage to the spinal cord and cause numbness, tingling, or paralysis below the injured area; a dislocation of a shoulder or hip can damage the nerve supply and cause paralysis of the limb; joints that have been dislocated tend to be susceptible to developing osteoarthritis in later years •cause of dislocation is usually a severe injury (e.g. a fall, automobile accident, or sports-related trauma); occasionally, the injury that causes the dislocation also causes a fracture; dislocations not caused by injury may result from congenital weakness of the joint structures or from a complication of arthritis; the jaw and shoulder joints are especially susceptible to recurrent dislocation; a rare congenital cause of recurrent dislocations is the inherited connective tissue disorder Ehlers-Danlos syndrome, which is characterized by joint hypermobility and skin laxity •diagnosis is based off the abnormal appearance of the affected joint, the history of the injury, and the physical examination; radiographic study •a physician should be seen immediately for proper repositioning of the joint; a dislocated joint may be so edematous and painful that reduction may have to be performed with the patient under general anesthesia; surgery

colles fracture

•fracture of the distal head of the radius, with possible involvement of the ulnar styloid, results from a fall in which the person attempts to break the fall with an extended arm and open hand, closed reduction of the fracture and immobilization of the arm including the elbow, with a cast

addiction

•habitual dependence on a substance that is beyond voluntary control

sodium bicarbonate (baking soda)

•home remedy used most often for gastric hyperacidity and heartburn •dosage- adults (IV) 1 mEg/kg, then titrated as necessary. Doses of 0.5 mEg/kg may be repeated as necessary children (IV) 0.5 to 1 mEg/kg, then titrated as necessary

myxedema

•hypothyroidism •disease characterized by clinical manifestations associated with a low metabolic rate due to deficient thyroid hormone •severe hypothyroidism with significant reduced levels of T4 and T3, especially in the older adult, leads to a slowing of function in multiple organs •excessive fatigue, muscular weakness, loss of hair, weight gain, constipation, and intolerance to cold, skin is dry and scaly, and there is a puffiness of the hands and face in addition to an enlarged tongue •the thyroid gland's ability to synthesize T4 is impaired. This can be the result of reduced amounts of thyrotropin, radiation destruction of the thyroid gland, surgical removal of the gland without T4 replacement therapy, tumor, or failure of the thyroid gland to function; a common cause of hypothyroidism in women is Hashimoto thyroiditis •the clinical features of myxedema in the adult or the retardation of physical and mental development in the child lead the physician to perform diagnostic tests. Blood studies indicate abnormally low levels of thyroid hormones (total T4, total T3, and free T4) and in most cases, significantly elevated TSH levels; rarely is the TSH level low due to a pituitary condition •goal of medical management is the achieve normal thyroid function with the lowest possible dose; replacement therapy is required for the rest of his/her life

presbyopia

•inability of the internal lens of the eye to focus on near objects due to loss of elasticity of the lends •related to aging and usually starts in people in their mid-40s

myringotomy

•incision into the tympanic membrane (ear drum) •performed to release pus or fluid and relieve pressure in the middle ear •also called tympanocentesis

GoLYTELY (electrolytes for oral solution)

•induces diarrhea, which rapidly cleanses the bowel, usually within 4 hours •side effects include nausea, abdominal distention, and pain •dosages- adults: (oral) 4 L at a rate of 8 oz every 10 to 15 mins children: (oral) 25mL/kg/hr until rectal effluent is clear

Metformin (Glucophage)

•ineffective in the absence of some endogenous insulin •believed to improve sensitivity to insulin at the receptor sites •dosage- adults: (oral) 500 mg twice daily or 850 mg once daily, up to 2550 mg/day in three divided doses with meals

dental caries

•infection resulting in erosion of the tooth surface •first appears as white spots on the tooth surface •mild toothache, with hypersensitivity to sweets and temperature extremes in food or beverages. If left untreated, an unpleasant taste in the mouth results from the accumulation of food and bacteria in the cavity area. Eventually, the pulp of the gum becomes inflamed, and the pain is persistent, feel a stabbing pain in jaw, and an abscess may form •occurs when bacteria in the mouth break down the sugars found in foods, converting them into acid plaque. Sugars in food include sucrose, glucose, and fructose found in fruits; lactose in milk products; and in the breakdown of simple carbs like chips, crackers, and breads. Acid plaque erodes the calcium in the tooth's enamel (demineralization), causing the formation of a cavity •other disorders that contribute to tooth decay: stomach acid from gastric esophageal reflux disorder (GERD) or episodes of the patient purging due to bulimia •diagnosed with radiographic films •treated with the dentist who removes the disease portion of the tooth enamel and pulp and fills the cavity with dental amalgam composite material (gold, silver, or porcelain fillings) to prevent further decay and to restore the tooth in size and shape; dentist may perform a root canal; tooth extraction and a dental implant may be inserted to support restorations that resemble a tooth or group of teeth

lyme disease (lyme arthritis)

•infectious disease caused by the spirochete bacterium. Ticks that bite the skin spread lyme disease by injecting the bacterium from their gut into the human body when securing a blood meal; can affect the skin, joints, heart, and nervous system •red, itchy rash with a dark red circle center resembling a bull's eye on a target (target lesion); can masquerade as arthritis and cause influenza-like symptoms, such as headache, fever, fatigue, joint pain, and general malaise; late complications of muscle weakness, paralysis, and neurologic conditions (e.g. learning difficulties, excessive fatigue, and muscle coordination problems) can occur; encephalitis, gastritis, or carditis may develop in some patients •a complete history, physical examination, and laboratory tests are important for excluding other infectious diseases, forms of arthritis, immune diseases, muscle diseases, and even cancer; diagnosis can be based on physical examination (the discovery of a tick on the skin), the presence of the classic target lesion, and the patient history; confirmation is attained by positive tests results for the lyme antibodies or by directly identifying the bacterium in the infected skin via biopsy •treatment begins with the removal of the tick; treatment in the early stages leads to a complete cure with simple oral antibiotics (doxycycline, amoxicillin, or cefuroxime); treatment in the later stages requires intravenous antibiotics such as ceftriaxone or penicillin, antipyretics are given for headache and fever; bed rest is necessary if neurologic symptoms are present and physical therapy is prescribed for impaired musculoskeletal mobility; joint symptoms are often treated with anti-inflammatory medications and hydroxychloroquine •prevention is directed toward preventing tick bites; when inhabiting locations known to harbor ticks, persons should wear long clothing to protect the skin; carefully examine all clothing first and then the entire body, including the scalp; close inspection of kids and pets is especially important; bathing the skin and scalp and washing clothing after possible exposure to ticks may prevent the bite and subsequent transmission of the disease

gingivitis

•inflammation and swelling of the gums •gums become red, soft, and shiny, bleed easily, can be painless, leads to the destruction of the gums and bone disease called periodontitis, can cause loss of healthy teeth •most common cause is plaque (a sticky deposit of mucus, food particles, and bacteria that builds up around the base of the teeth as a result of inadequate or incorrect technique when brushing or flossing; as the gums become inflamed and swollen, the plaque causes a pocket to form between the gums and the teeth and the space becomes a food trap •other causes: vitamin deficiencies, glandular disorders, blood diseases, viral infections, and the use of certain medications •pregnant women and diabetics are more susceptible •removal of plaque and calculus from a professional dental hygienist; doctor may prescribe an antibacterial mouthwash, such as chlorhexidine (Periogard); local anesthesia may be used to thoroughly clean teeth and exposed teeth roots, called root planing and subgingival curettage; oral antibiotics

bursitis COMPLETE

•inflammation of a bursa (a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body). Bursae are found between muscles and tendons and cover bony prominences to facilitate movement. They can be inflamed, infected, or traumatized. The major bursae are located adjacent to the tendons of the large joints, such as the shoulders, elbows, hips, and knees. •Classic symptoms are tenderness, pain when moving the affected part, flexion and extension limitation, and edema at the site of inflammation. Most frequently affected bursae are those of the shoulder, elbow, knee, hip, and between the tendons and muscles of the tibia. Point tenderness may be present, in which case the patient can point to the spot of greatest tenderness. If bursae are continually or chronically irritated and inflamed, calcifications can develop. Adhesions can occur around an affected bursa, which limits the movement on the tendons •can result from continual or excessive friction between the bursae and the surrounding musculoskeletal tissues. Systemic diseases (e.g. gout and rheumatoid arthritis) and infection and lead to the development of bursitis. In addition, repeated trauma from overuse of a joint can cause bursitis. •diagnosis is generally straightforward and can be made after evaluating information gained from the history and physical examination. Possible underlying gout or arthritis should be considered. In patients with abrasion or puncture wounds of the overlying skin, infection also must be considered. ROM (range of movement) may be impaired and the pain is acute. MRI indicates an enlarged bursa, and radiographic films may show calcified deposits at the affected site when the bursitis is chronic. Aspiration of fluid from an inflamed bursa can assist in diagnosing gouty or infectious bursitis (septic bursitis) •treatment for traumatic bursitis may include avoidance of activities until acute pain subsides, and application of moist heat, immobilization of the affected part, the use of aspirin or acetaminophen for pain, the administration of nonsteroidal anti-inflammatory agents (e.g. ibuprofen and indomethacin), and local injection of a corticosteroid. Drainage of the inflamed bursa and the use of antibiotics specific to the infectious microbe are critical. Active range-of-motion exercises to prevent adhesions and to maintain or regain motion are needed after the pain subsides. Surgical excision of the bursa and any accompanying calcified deposits can be required for either chronic noninfectious or infectious bursitis.

labrynthitis

•inflammation or infection of the labyrinth of the inner ear (labyrinth is a group of three fluid-filled chambers [the semicircular canals] in the inner ear that control balance) •onset is often acute and is associated with fever •main symptom is extreme vertigo, balance is affected, and nausea and vomiting, tinnitus, loss of hearing in one ear, and difficulty focusing his/her eyes •usually a result of a virus but can be caused by a bacterial infection or a result of meningitis •diagnosis is based off of an audiometry and blood, neurologic, caloric, and possibly imaging studies •bed rest, prescriptions for a tranquilizer, an antiemetic agent, and an antibiotic, antihistamines and/or corticosteroids

plantar fasciitis (calcaneal spur)

•inflammatory response at the bottom of the heel bone •dull, intermittent pain on the bottom of the foot, which can progress to a sharp persistent pain; pain is worse on getting out of bed and taking the first few steps in the morning, after sitting for a time, after standing or walking, and when beginning a sporting activity; can also occur at midsole or near the toes; plantar fascia is a thick, fibrous material on the bottom of the foot. It is attached to the calcaneus, fans forward toward the toes, and acts like a bowstring to maintain the arch of the foot •usually occurs when part of the inflexible fascia is repeatedly placed under tension (e.g. when running). This constant tension causes an inflammatory response, usually at the point where the fascia is attached to the calcaneus. The result is pain and the development of the spur •factors that contribute: flat (pronated) feet; high-arched, rigid feet; toe running or hill running; running on soft terrain (e.g sand); poor shoe support; sudden increase in activity level; sudden weight increase; increasing age; familial tendency; and possible underlying disease •physical examination and the patient history of symptoms usually provide enough information for making the diagnosis; bottom of the foot is typically very tender, typically at the heel; radiographic films sometimes show the spur; patients with PF are evaluated for possible reactive arthritis, inflammatory bowel disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis •treatment consists of resting, applying ice to the sore area, taking anti-inflammatory or analgesic medication, using heel pads (doughnut-shaped pads that equalize and absorb the shock on the heel and ease pressure on the plantar fascia), and wearing a shoe with good arch support, a local cortisone injection can reduce inflamed tissues, the physician may tape the foot to maintain the arch and help take some of the tension off the plantar fascia, shoe inserts called orthotics can also be prescribed; after the inflammation subsides, physical therapy to strengthen the small muscles of the foot can begin. If done regularly, this helps prevent re-injury. Surgery rarely is required and is considered only if all forms of more conservative treatment fail (surgery involves removing the bone spur and releasing the plantar fascia) •prevention is the use of proper footwear

tapazole (methimazole)

•inhibits the synthesis of thyroid hormones by preventing the incorporation of iodine into the hormone •used for palliative treatment of hyperthyroidism and preoperatively before surgical or radiation procedures •dosage- adults (oral) 15 to 60 mg daily children (oral) 0.4 mg/kg initially, then decreased

Dramamine (dimenhydrinate)

•inhibits vomiting and causes sedation •frequently used to relieve motion sickness and to control the nausea, vomiting and vertigo associated with other conditions and medical treatments such as electroconvulsive therapy, radiation sickness, and hypertension •dosage- adults: (oral) 50 to 100 mg every 4 to 6 hours to a maximum of 400 mg/day children 6-12: (oral,IM) 25 to 50 mg every 6 to 8 hours children 2-5: (oral,IM) 12.5 to 25 mg every 6 to 8 hours

nystagmus

•involuntary, repetitive, rhythmic movements of one or both eyes; eye movements can be horizontal, vertical, circular, or a combination of these; blurred or decreased vision can be associated •congenital or acquired; congenital is manifested before 6 months to 1 year of age and is the most common; acquired results when a disease process produces lesions in the brain or inner ear; alcohol use and abuse of certain drugs may also cause this condition; brain tumors and cerebrovascular lesions; or it can be the result of abnormal development of the nervous system •can usually be diagnosed clinically by external examination of the eyes and observation of any involuntary movements •managed by treating the underlying cause of the condition; congenital nystagmus can be lessened by using the Kestenbaum procedure in which the eyes are surgically rotated towards the null point of the eye •no prevention

astigmatism

•irregular focusing of the light rays entering the eye •caused by the cornea not being spherical; the front of the cornea may be more egg shaped than spherical, thereby causing light rays to be unevenly or diffusely focused across the retina; causes some images to appear clearly defined, whereas others appear blurred

humilin N (human insulin injection, isophane)

•isophane insulin, or NPH •intermediate acting insulin containing a suspension of zinc-insulin crystals and protamine sulfate •onset of action is within 1 1/2 hours, peak activity is expected from 4 to 12 hours, and the duration of action is up to 24 hours •given subcutaneously and intramuscularly or intravenously •pen contains 100 units of isophane insulin for self-administration

scoliosis

•lateral (sideways) curvature of the spine. Typically congenital, but some diseases also can cause it. •insidious presentation; in women, the first indication is often unequal bra strap lengths •back pain, fatigue, and sometimes shortness of breath with exertion. Observation reveals a lateral curve of the spine, one shoulder higher than the other, one scapula more prominent than the other, on hip higher than the other, and when the patient bends over, an enlarged muscle mass on one side of the back. •idiopathic scoliosis is the most common form; cause is postulated to be genetic. other causes can be deformities of the vertebrae, uneven leg lengths, and muscle degeneration of paralysis from diseases such as poliomyelitis, cerebral palsy, and muscular dystrophy •evaluated for muscle disease and weakness, congenital conditions, neurologic disorders, and degeneration of the bones and disks of the spine. •diagnosis is made from visual examination of the back, which reveals uneven shoulder and hip heights, a prominent scapula on one side, an enlarged muscle mass on one side, and a definite torsional curve of the vertebral column; radiographic films confirm diagnosis •mild scoliosis- exercise to strengthen the weak muscles, bracing of the back with a Milwaukee brace or a molded plastic clamshell jacket •severe scoliosis- (greater than 40 degrees) surgical intervention to decrease the curve and to realign and stabilize the spine; procedures include fusion of the vertebrae and internal fixation with instrumentation by means of rods, wires, or plates with pedicle screws; some patients are placed in body casts or plastic jackets

xenical (orlistat)

•lipase inhibitor for obesity management; acts by blocking absorption of dietary fats. When present in the lumen of the stomach, it forms a covalent bond with gastric and pancreatic lipases. The inactivated enzymes are unable to digest fat. •should be used with a reduced-calorie diet and exercise plan •side effects- weight loss, vitamin deficiencies, abdominal discomfort, and diarrhea •dosage- adults: (oral) 120 mg three times daily with each meal

citracal

•mineral that is necessary for many functions of the body, especially bone formation and maintenance

sclera

•outermost layer of the eye •consists of tough fibrous connective tissue that is visible as the white of the eye

cornea abrasion

•painful loss of surface epithelium, or outer layer of the cornea •pain, redness and tearing, sensation of having something in the eye, and may have vision impairment •caused by foreign bodies, or by direct trauma to the eye (poked in the eye, contact lenses that aren't cleaned) •ophthalmic antibiotic ointment, eye dressing, or broad-spectrum antibiotic therapy •prevented by wearing protective eyewear and avoiding overnight wear of contact lenses

Addison's disease

•partial or complete failure of adrenocortical function •adrenal insufficiency or hypoadrenalism •fatigue, weakness, anorexia, agitation, confusion, weight loss, and gastrointestinal disturbances, bronze skin color, cardiovascular difficulties (irregular pulse, reduced cardiac output, and orthostatic (postural) hypotension, depression, anxiety, and emotional distress, reduced levels of aldosterone cause an inability to retain salt and water; when dehydration, hyperkalemia (high blood potassium level), and electrolyte imbalance occur, the condition is life threatening •onset is gradual over weeks or months with progressive destruction of the adrenal gland and reduction in its important hormones; destruction can result. from an autoimmune process, tuberculosis, hemorrhage, fungal infections, neoplasms, or surgical resection of the gland; familial tendencies; secondary to hypopituitarism, in which there is a reduced output of corticotropin •blood and urine cortisol levels are low, as are serum sodium and fasting glucose levels. Serum potassium, blood urea nitrogen, lymphocyte, and eosinophil levels and hematocrit are elevated; adrenal calcification is identified by radiographic film •replacement of the natural hormones with glucocorticoid and mineralocorticoid drugs, and correction of salt and potassium levels; hormone replacement therapy with close medical supervision must continue for life; patient must be educated about the symptoms of overdosage and the role of stress and infection; insufficiency or a sudden decrease in adrenocortical hormone levels, such as from a sudden withdrawal of glucocorticoid therapy, can result in a life-threatening emergency, called an addisonian crisis •no prevention

gestational

•pertaining to pregnancy

diverticulosis

•progressive condition, common with age, characterized by defects in the muscular wall of the large bowel •condition in which outpouches (diverticula) of the mucosa penetrate weak points in the muscular layer of the large intestine; occurs particularly in the distal part of the colon, the sigmoid colon, because intraluminal pressures are higher in this region •usually causes no symptoms and brings no inflammation; occasionally the patient will experience nonspecific abdominal distress, such as pain and flatulence, and difficulty in defecation; may experience alternating constipation and diarrhea and even blood in the stool •causes are not clear; a diet that contains inadequate roughage and excessive amounts of highly refined food is thought to contribute; lack of roughage produces small-caliber, drier stools, which fail to distend the bowel lumen. The small volume stool causes higher intraluminal pressure during peristalsis and defecation, which in turn contributes to the small herniations or pouches through the mucosa of the muscular wall of the intestine •increases with age, ranging from 5% in those under age 40, to 30% at age 60, to more than 50% over age 80 in western societies •diagnosis is based on the clinical picture and an air-contrast barium enema radiographic study or colonoscopy •treatment is a diet that includes adequate fluids and roughage to produce a soft, formed stool daily; fiber supplements and stool softeners are helpful •onset cannot be prevented

rods and cones

•rods function best in dim light, thereby enabling night vision, whereas the cones function in bright light and also detect color and find detail. Within the rods and cones, the image initiates a chemical reaction and sends messages through the nerve fiber layer of the retina to the optic nerve where it is transmitted to the brain

osteomyelitis

•serious infection of the bone that requires aggressive antibiotic treatment •inflammation, swelling, localized heat, redness, pain, and local tenderness over and around the bone, chills, fever, sweating, and malaise, purulent subperiosteal abscess, causing pressure and eventual fracturing •staphylococcus aureus- 90% of osteomyelitic infections •aspiration and culture of material, blood culture, WBC count, and an erythrocyte sedimentation rate (ESR), MRI, CT, or bone scans •parenteral or locally administered antibiotics (eg aqueous penicillin, cephalosporin, and ampicillin), increased intake of proteins and vitamins A, B, and C to promote cell regeneration; bed rest, control of chronic conditions, immobilization of the affected part to prevent fracture of weakened bones, and analgesics, surgical drainage to remove purulent material and sequestrum, bone grafting, hyperbaric oxygen treatments

insulin

•serves three purposes: 1. aids in the use of glucose as energy, 2. stores excess glucose as glycogen in the liver, and 3. responsible for the conversion of glucose to fat •found in clusters of cells known as the islets of Langerhans and are found on the pancreas

dependence

•severe attachment to a drug or agent; an addiction

TMJ Syndrome (Temporomandibular Joint Syndrome)

•symptom complex related to the inflammation, disease, or dysfunction of the temporomandibular joint (TMJ); can be unilateral but is usually bilateral •clicking sounds during chewing, or experienced severe pain or aching in or around the ears and jaw joints that is made worse by chewing; headache, dizziness, a feeling of pressure, tinnitus, or a draining sensation may be present in one or both of the ears; deafness; sinus pain which is really muscle pain; a reduced ability to open the jaw which interferes with chewing and prevents adequate cleaning of the teeth and treatment of cavities •due to unbalanced activity of the jaw muscles caused by a number of conditions, including bruxism (the grinding of teeth emanating from the central pattern generator in the brain); malocclusion; poorly fitting dentures; rheumatoid, degenerative or traumatic arthritis; and neoplastic diseases; emotional stress, with clenching and grinding of the teeth, or habitual gum chewing is also a contributing factor •diagnosis is made by oral examination, patient history, and radiographic studies including computed tomography (CT) scan and magnetic resonance imaging (MRI) to analyze the hard and soft tissues; may be history of previous trauma to the jaws or fractured facial bones; in the case of a neoplasm, a biopsy would rule out a malignancy •symptoms of rheumatoid or traumatic arthritis will often subside after 3-5 days of immobilization of the mandible; for cases in which inflammation causes TMD, nonsteroidal anti-inflammatory drugs (NSAIDs) are often used; some patients wear special appliances to prevent them from grinding their teeth; if TMD is caused by jaw misalignment, a plastic bite plate called a splint may be used (the splint is worn over the teeth and establishes proper alignment, which can eliminate jaw locking, pain, and clicking sensations); intra-articular injections of hydrocortisone may be needed in more severe cases; when the teeth experience premature contact, the dentist adjusts the occlusion by grinding the surfaces of the teeth; physical therapy, stress counseling, and the use of muscle relaxants may be prescribed; as a last resort, TMJ arthroscopy, joint restructuring, and joint replacement are considered

withdrawal

•syndrome that occurs when a drug-dependent person discontinues the drug suddenly; characterized by anxiety, insomnia, irritability, and often physical illness that may be severe

occult blood test

•test used to detect hidden blood in the feces

entropion

•the eyelid margins (more often the margin of just the lower lid) turn inward, causing the lashes the rub the conjunctiva •sensation of a foreign body in the eye, tearing, itching, and redness; chronic irritation of the conjunctiva may cause conjunctivitis; can also damage the cornea, causing epithelial defects and vision problems •most often affects older people; with aging, the soft tissue on the lower eyelid loses elasticity, causing the eyelids to turn inward •visual examination reveals an inversion of the eyelid •minor surgery on the eyelid usually corrects the problem (surgery not named) •no prevention

greenstick fracture

•the fracture is on one side of the bone; the other side is bent

pathologic fracture

•the fracture results from weakening of the bone by disease

impacted fracture

•the fractured ends of the bone are driven into each other

inguinal hernia

•the inguinal canal is a common site for hernias •a loop of bowel protrudes into the inguinal canal and, in a male, may progress to fill the scrotal sac. The patient notices a lump or bulge in the inguinal area and may discover that pressing on the hernia to push it back into the abdomen can reduce it. A sharp pain in the groin is continuous or made worse when standing or straining

compound fracture

•the skin overlying the bone ends is not intact

short bowel syndrome

•the small bowel fails to absorb nutrients because of inadequate absorptive surface •depending on the amount of missing or damaged bowel, significant signs of malnutrition are noted, including pathologic changes in other organs and body systems. Because there is insufficient small bowel to digest and absorb food adequately, diarrhea and abnormal stools occur. The patient loses weight and feels weak, tired, and dizzy. The hair and nails become brittle and rashes develop •short bowel syndrome develops when the length of intact or functioning small bowel is altered significantly by disease or surgery. Crohn disease, intestinal infarction, radiation enteritis, volvulus, tumor resection, and trauma are conditions that may cause extensive resection of the small intestine. This loss of functioning small bowel interferes with the digestion and absorption of needed nutrients •the patient history initially may indicate the presence of bowel disease, with or without surgical intervention that has reduced the length or function of part of the small bowel. In short-bowel syndrome, the results of blood tests reflect abnormal electrolyte levels, pH disturbances, and anemia. Stool studies show an increased amount of fat •medical management includes prescription drugs for infection, diarrhea, vitamin and mineral deficiency, and pain as required. Food supplements are administered orally or intravenously as needed. Surgery may be performed to correct the underlying condition or to reconstruct the bowel. Postsurgical parenteral hyperalimentation is required for weeks or until the remaining gut adapts and becomes functional at which time oral feeding is gradually introduced

lens

•the transparent structure behind the pupil that changes shape to help focus images on the retina •focusing is accomplished by contraction and relaxation of the muscles of the ciliary body

signs and symptoms of malnutrition

•unintentional weight loss, reduced appetite, lack of interest in food and drink, feeling tired all the time, feeling weaker, getting ill often and taking a long time to recover, wounds taking a long time to heal, poor, concentration, feeling cold most of the time, low mood or depression

aspirin

•used as an analgesic and anti-inflammatory agent and it inhibits the synthesis of prostaglandins •relieve mild to moderate pain, treat headaches, act as an anti-inflammatory medication in arthritic conditions, and reduce platelet aggregation, preventing blood clot prevention •relationship between children taking aspirin and the development of Reye's syndrome, an often fatal condition characterized by encephalopathy and liver damage •dosage- adults: (oral, rectal) 325 to 650 mg every 4 hours children: (oral) 65mg/kg/day for inflammatory conditions only

prednisone

•used most often for immunosuppression •side effects- salt and water retention, with the characteristic moon facies and fat distribution notes and the administration is prolonged •dosage- adults (oral) 10 to 100 mg daily in divided doses

allopurinol (zyloprim)

•used to maintain a lower serum uric acid level in the blood and prevent attacks of acute gout •may be started after the acute attack of gout is treated with colchicine or probenecid •adverse effects include skin rash, elevation of liver enzymes, and leukopenia •dosages- adults (oral) 100 to 600 mg daily