It is also connected to the somesthetic pathways like visual pathway pregnancy resources buy provera 5mg without a prescription, auditory pathway and equilibratory pathways vi women's health big book of exercises results buy discount provera 10mg. It also connects with the autonomic neurons of the hypothalamus menstruation normal buy provera 10mg without prescription, limbic system and the general visual efferent columns womens health 7 flat belly quality provera 5mg. Visceral control: It has great influence on the respiratory and cardiovascular functions whether stimulated or suppressed according to the needs through the reticular formation present in the medulla oblongata menopause 10 generic 10mg provera amex. It regulates the emotional menstruation through history discount provera 5mg with mastercard, behavioral and visceral activities through the limbic system. Neuroendocrine control: It regulates the activity of the adenohypophysis and neurohypophysis and also on the pineal body through the hypothalamus. It regulates conduction through the somatosensory pathways also in visual and auditory pathways. Morphine suppressed the corticoreticular pathways and stimulates the nonspecific thalamic system rhinencephalon and its projections iv. Connections of Limbic System Afferents Fibers Following are as receive afferents from: i. In the past, the limbic system considered with rhinencephalon having a predominetly olfactory in function ii. However, the olfactory function also plays important role which is concern with emotional expression. It controls emotional behavior or mood like feeling of fear, joy and sorrow, liking and disliking associated with a bodily alterations, this requires integration of olfactory, somatic and visceral impulses reaching the brain 4. Role in memory: It plays an important role in the storage of recent memory, through the papez circuit and hippocampus. A pyriform lobe, consisting of the uncus, anterior part of the parahippocampal gyrus and small areas in this region 4. Destruction of olfactory nerves produces loss of the sense of smell known as anosmia. Dissection Steps of Dissection Position of Body Body will be on supine position with, neck extended and rotated to the opposite side. A longitudinal incision is given from the lower part of symphysis menti to the jugular notch of manubrium sterni b. An oblique incision along the lower border of the mandible to its angle and then to the apex of the mastoid process of the temporal bone. Reflection of Skin the skin flaps thus mapped out and reflected laterally to the anterior margin of sternocleidomastoid. Anterior jugular veins being near the hyoid bone and descending down between the median plane and the anterior border of sternocleidomastoid. Then the platysma and the deep cervical fascia is reflected and exposed the boundaries of anterior triangle with its subdivisions. The inferior thyroid vein going down wards from the isthmus of thyroid gland to enter the thorax. Hypoglossal nerve: Going medially from jugular foramen crossing the carotid sheath and passing deep to mylohyoid ii. Spinal accessory nerve: Comes out through jugular foramen and then pierce the sternocleidomastoid muscle to reach the posterior triangle iii. Vagus nerve: Coming through jugular foramen lies in carotid sheath in between the carotid artery medially and internal jugular vein laterally iv. Glossopharyngeal nerve: Going from jugular foramen medially to supply the tongue, pharynx and carotid sinus, etc. Mylohyoid nerve: It lies between the mylohyoid and anterior belly of digastric muscles viii. Submandibular gland: Lying in the submandibular triangle divided into a superficial part by the portion of mylohyoid muscle. A transverse incision is given from the sternoclavicular joint to tip of acromion process along the clavicle 2. An oblique incision is given from the mastoid process to sternoclavicular joint along the anterior margin of sternocleidomastoid. Lymph vessels: the superficial fascia with platysma is cut and reflected like skin. Steps of Dissection Position of Body Body should be kept in supine position with the face turned to the opposite side. Steps of Dissection Position of Body Body should be in supine position and the face drawn to the opposite side. Another transverse incision is given from the angle of mouth to the lower margin of ear lobule. Structures of the parotid space can be identified if the parotid gland is removed. Another transverse incision is given from the lower end of first incision to laterally far three and half inches. Lesser occipital nerve: Arises from ventral rami of C2 and C3 nerves supplies the skin of mastoid and occipital region b. Greater occipital nerve is medial branch from posterior division of C2 nerve, supplies skin and semispinalis capitis, it is a mixed nerve c. The superficial layer of deep fascia is cut and reflected like skin and structures exposed: a. Splenius capitis: Lying obliquely partly at the deeper aspect of lower part of trapezius c. Semispinalis capitis: Lying obliquely at the upper part partially remaining hidden by the trapezius. Now the deeper layer of deep fascia is exposed, it is cut and reflected and structures exposed: a. Splenius capitis: Lying obliquely at the lower part, it is cut and reflected downwards. Steps of Dissection Position of Body Body should be placed in prone position with neck is flexed as far as possible (it will be convenient to place the chest upon a block, so that neck will be flexed fully). A longitudinal incision is given from the external occipital protuberance to midway between the protuberance and spine of C7 vertebra ii. A transverse incision is given from the upper end of first incision to laterally far three and half inches. Semispinalis capitis: Placed at the upper part, greater occipital nerve is coming out by piercing it. Boundaries Above and medially: Rectus capitis posterior major and minor Above and laterally: Obliquus capitis superior Below laterally: Obliquus capitis inferior. Two transverse incisions given one from medial end of the 1st incision up to the posterior fold of the axilla, another from the lateral end of the 1st incision up to the dissecting table iii. Following structures are seen in the superficial fascia: Lateral cutaneous branches of 2nd and 3rd intercostal nerves with their anterior and posterior branches behind the anterior fold of axilla. Incisions on Deep Fascia Deep fascia incised along the sulcus between deltoid and pectoralis major. Cephalic Vein Cut the fibers of pectoralis major and turn towards their insertion exposing the boundaries and contents of axilla. Posterior division of C1 or suboccipital nerve Third part of vertebral artery Suboccipital venous and lymphatic plexuses Some fibrofatty tissue. Steps of Dissection Position of the Body Body will be on supine position and arm at right angle to the body. A curve incision along the anterior fold of axilla, which extends medially up to 5th rib on the trunk and laterally carried up to the junction of upper onefourth and lower three fourths of the arm Dissection 639. It is formed by the following: Skin, superficial fascia and axillary fascia (deep fascia). Posterior axillary fold: It is formed by latissimus dorsi in medial part and teres major in lateral part. The three cords lies behind the axillary artery behind the clavicle 640 Human Anatomy for Students ii. In relations with the first part of the axillary artery the lateral and posterior cords lies laterally and medial cord posteriorly iii. In relations with the second part of the axillary artery the three cords occupies their respective positions. Median nerve: It is formed by union two roots from lateral and medial cords, lies anterior or lateral to the third part of the axillary artery. It runs downwards between the third part of the axillary artery laterally and axillary vein medially. It crosses the axilla, passing anterior or posterior to the axillary vein, to reach the medial side of it. It arises from the medial cord lies between the third part of the axillary artery and vein along with the unlar nerve ii. It arises from the lateral cord or may arise from the anterior divisions of upper and middle trunks ii. It arises from the medial cord and arises behind the first part of the axillary artery ii. Lower subscapular nerve: It arises from the posterior cord and enter the lower part of the subscapularis muscle. It arises from the posterior cord between the upper and lower subscapular nerves ii. It arises from the lateral cord of brachial plexus opposite the lower border of the pectoralis major ii. It pierces the coracobrachialis then descends laterally between the biceps and brachialis. The axillary and radial nerves are the terminal branches of the posterior cord arises behind the third part of axillary artery and lateral to the radial nerve, near the lower border of subscapularis ii. Then the nerve curves backwards at the lower border of subscapularis along with the posterior circumflex humeral artery and passes through the quadrangular space. It crosses the axilla to the medial side of the arm, join with a branch of the medial cutaneous nerve of the arm. It is the continuation of the subclavian artery, begins at the outer border of first rib b. It arises from the first part of the axillary artery near the lower border of subclavius Dissection 641 iii. It arises from the second part of the axillary artery deep to the pectoralis minor b. It arises from the second part of the axillary artery (in females it is larger) b. It descends along the lateral border of the pectoralis minor to the lateral thoracic wall Subscapular artery: a. It is the largest branch of the axillary artery arising from the third part of the axillary artery b. It arises from the lateral side of the third part of the axillary artery at the lower border of the subscapularis b. It runs horizontally deep to the coracobrachialis and short head of biceps brachii to reach anterior to the surgical neck of the humerus. It arises from the third part of the axillary artery at the lower border of the subscapularis b. A longitudinal incision is given joining the midpoints of the above two transverse incisions. The basilic vein is identified along the medial side of the biceps brachii up to the middle of the arm where it pierces the deep fascia iii. Upper lateal cutaneous nerve of the arm: this is continuation of the posterior division of the axillary nerve iv. Medial cutaneous nerve of the arm: It pierces the deep fascia in the middle of the arm. Medial cutaneous nerve of the forearm: It pierces the deep fascia with the basilic vein. Intercostobrachial nerve: It is the lateral cutaneous branch of the second intercostal nerve. It enters the axilla and descends obliquely across the axilla communicates with the medial cutaneous nerve of the arm and then pierces the deep fascia below the axilla to supply the skin on the upper posteromedial part of the arm. Now superficial fascia is incised and reflected like the skin-deep fascia is exposed: 1. Now cut the deep fascia vertically on the anterior surface of the arm, and reflect the deep fascia to uncover the biceps brachii muscle 2. Now lift the biceps brachii muscle forwards and identify the musculocutaneous nerve in between the biceps brachii and brachialis 3. The coracobrachialis muscle arises along with the short head of biceps brachii from the tip of the coracoid process and inserted into the middle of the medial surface of the humerus 4. A transverse incision is given at the junction of upper onefourth and lower threefourths of the front of the arm 642 Human Anatomy for Students. The radial nerve is accompanied by the profunda brachii artery which passes inferolaterally to the sulcus for the radial nerve on the posterior surface of humerus 7. The lower lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the arm arise from the radial nerve 8. The ulnar nerve, it passes backward by piercing the medial intermuscular septum near the middle of the arm into the posterior compartment of the arm 9. The median nerve and the brachial artery and vein present in the lower onethird of the arm are inclined, forwards in front of the brachialis. An incision is given along the lateral onethird of the spinous process of the scapula which extends to the junction of the upper one fourth and lower threefourths of the arm ii. A vertical incision is given from the medial end of the first incision extending to the inferior angle of the scapula. Upper lateral cutaneous nerve of the arm arises from the posterior division of the axillary nerve b. The posterior divisions of the lateral cutaneous branches of the upper intercostal nerves. Now expose the triangular and quadrangular spaces which are bounded by the muscles.
Code to 88 when the only information is that the patient was referred to an oncologist women's health clinic boca raton cheap provera 10 mg mastercard. No proper value is applicable in this context (no immunotherapy given) A proper value is applicable but not known menstruation starter kit 5mg provera for sale. This event occurred menopause formula buy 10mg provera with amex, but date is unknown (that is menstruation 3 days late buy generic provera 10 mg, immunotherapy was given but the date is unknown and cannot be estimated) women's health lexington ky cheap 10 mg provera mastercard. Data Field 3250: Transplant/Endocrine Code See page 227 Code the type of hematologic transplant and/or endocrine procedures the patient received as part of the first course of treatment at any facility menopause vomiting buy provera 5 mg with mastercard. Code 88 if the only information is that the patient was referred to a specialist for hematologic transplant or endocrine procedures. Endocrine surgery and/or endocrine radiation therapy as first course of therapy Combination of endocrine surgery and/or radiation with a transplant procedure. Transplant procedure and/or endocrine therapy was not recommended/ administered because it was contraindicated due to patient risk factors. Transplant procedure and/or endocrine therapy was recommended, but it is unknown if it was administered. It is unknown whether transplant procedure or endocrine therapy was recommended or administered because it is not documented in the medical record. If no other treatment was given or it is unknown if other treatment was given, leave the field blank. Cancer treatment that cannot be appropriately assigned to specific treatment data items (surgery, radiation, systemic). Code the treatment actually administered when the double-blind trial code is broken. It is unknown whether other treatment was recommended or administered, and there is no information in the medical record to confirm the recommendation or administration of other treatment. This event occurred, but the date is unknown and cannot be estimated (other treatment was given but the date is unknown). Data Field 1420: Other Treatment Code See page 234 Document and code the type of "other treatment" the patient received as part of the first course of treatment at any facility. In the "Other Pertinent Information" text area, document the patient is deceased and the date of death is not available. Data Field 570: Abstractor Initials See page 242 Record the initials of the abstractor. Obtain disease indices including both inpatient and outpatient admissions after medical records are completed and coded (monthly or quarterly). Other department logs/records (radiation therapy logs, emergency department logs, oncology unit records, surgery logs, etc. Pathology reports, including all histology, cytology, hematology and autopsy reports, should be reviewed to identify all reportable neoplasms. Benign carcinoid tumors Neoplasms of uncertain or unknown behavior (see "must collect" list for reportable neoplasms of uncertain or unknown behavior) Note: Screen for incorrectly coded malignancies or reportable by agreement tumors Neoplasm of uncertain or unknown behavior of other endocrine glands (see "must collect" list for D44. Note: Do not substitute synonyms such as "supposed" for presumed, or "equal" for comparable. Cases diagnosed at autopsy, with no suspicion prior to death that the cancer existed, should be reported. Abstract cases using the medical record from the first admission (inpatient or outpatient) to your facility with a reportable diagnosis. Use information from subsequent admissions to include all first course treatment information and to supplement documentation. Do not report cases diagnosed prior to 1995 Do not complete a report for each admission; submit one report per primary tumor. A patient is diagnosed with prostate cancer and has several admissions for treatment of the prostate cancer. A patient is diagnosed with two separate primary tumors, such as adenocarcinoma of the prostate and squamous cell carcinoma of the lung. Do not report basal or squamous cell carcinomas of the skin, except skin of genital sites. To ensure case ascertainment, review the disease indexes; pathology, cytology, hematology, and autopsy reports. Cases in which the disease is no longer active (such as leukemia in remission) should only be reported if the patient is still receiving cancer-directed therapy. Note: For specific instructions on coding this data field see page 212 of this manual Table H. It is unknown whether a chemotherapeutic agent(s) was recommended or administered because it is not stated in patient record. Note: For specific instructions on coding this data field see page 220 of this manual. Immunotherapy administered as first course of therapy Immunotherapy was not recommended/administered because it was contraindicated due to patient risk factors. The refusal was noted in patient record Immunotherapy was recommended, but it is unknown if it was administered. A bone marrow transplant procedure was administered, but the type was not specified. Stem cell harvest and infusion Endocrine surgery and/or endocrine radiation therapy Combination of endocrine surgery and/or radiation with a transplant procedure. Hematologic transplant and/or endocrine surgery/radiation were not recommended/administered because it was contraindicated due to patient risk factors. Hematologic transplant and/or endocrine surgery/radiation were not administered because the patient died prior to planned or recommended therapy. Hematologic transplant and/or endocrine surgery/radiation were recommended, but it is unknown if it was administered. It is unknown whether hematologic transplant and/or endocrine surgery/radiation were recommended or administered because it is not documented in the medical record. It is unknown whether nodes are positive, not applicable; not stated in patient record. Note: For specific instructions on coding this data field see page 156 of this manual. Regional lymph node removal was documented as a sampling, and the number of nodes is unknown/not stated. Regional lymph node removal was documented as a dissection, and the number of nodes is unknown/not stated. Regional lymph nodes were surgically removed, but the number of lymph nodes is unknown/not stated and not documented as a sampling or dissection; nodes were examined, but the number is unknown. It is unknown whether nodes were examined; not applicable or negative, not stated in record Note: For specific instructions on coding this data field see page 160 of this manual. There are literally millions of cancer-related webpages, blogs, and videos available at your fingertips. A cancer diagnosis can be disorienting, and for many, the overwhelming volume of information available can be more of a burden than an aid. This guide focuses all of the information available about contemporary prostate cancer research, treatment, and lifestyle factors into one consolidated resource. Lastly, as we are beginning to recognize the genetic underpinnings of cancer, this guide is for any family member who might want to understand how their shared genes affect their own short- and long-term risks factors-and whether they should be screened as well. Since being founded in 1993, the Prostate Cancer Foundation has funded key research leading to many of the treatments used by doctors today to improve the lives of patients, with the mission that someday, soon, no man will die of this disease. In general, cancer is a condition in which a normal cell becomes abnormal and starts to grow uncontrollably without having the signals or "brakes" that stop typical cell growth. Prostate cancer starts in the prostate gland, a small gland located below the bladder, that is responsible for secreting one of the components of semen. In general, the earlier the cancer is caught and treated, the more likely the patient will remain disease-free. In fact, many men with "low-risk" tumors, which are the most common type of prostate cancer, can safely undergo Active Surveillance, in which they are monitored without immediate treatment (and treatment-related side effects) while still preserving their chance of longterm survival if the cancer becomes aggressive enough to require treatment. Although only about 1 in 350 men under age 50 will be diagnosed, the rate shoots up to 1 in 52 for ages 50 to 59, 1 in 19 for ages 60 to 69, and 1 in 11 for men 70 and older. Prostate cancer, therefore, is when a normal prostate cell becomes altered and starts growing in an uncontrolled way. In many cases, prostate cancer is relatively slowgrowing, which means that it takes a number of years to become large enough to be detectable, and even longer to spread outside the prostate, or metastasize. Surviving Prostate Cancer Approximately 95% of all prostate cancers are detected when the cancer is confined to the prostate, so treatment success rates are high compared to most other types of cancer in the body. The 5-year survival rate in the United States for men diagnosed with prostate cancer is 99%. In other words, the chances of the cancer spreading or men dying from their prostate cancer is generally low. However, prostate cancer comes in many forms and some men can have aggressive prostate cancer even when it appears to be confined to the prostate. When people think about cancer treatment success, they often think of the word "cure. Unfortunately, in some men, prostate cancers can recur even 10 years after treatment. If the prostate cancer is caught at an early stage, most men will not experience any symptoms. Prostate cancer is the 2x Men with relatives with a history of prostate cancer are twice as likely to develop the disease. Risk Factors As indicated by the rates of diagnosis, age is the biggest-but not the only-risk factor for prostate cancer. Other important factors include family history, genetic factors, race, and lifestyle and dietary habits. Men who have a relative with prostate cancer are twice as likely to develop the disease, while those with 2 or more relatives are nearly 4 times as likely to be diagnosed. The risk is even higher if the affected family members were diagnosed before age 65. Men may also be at increased risk of prostate cancer if they have a strong family history of other cancers, such as breast cancer, ovarian cancer, colon cancer, or pancreatic cancer. Because family members share many genes, there may be multiple genetic factors that contribute to the overall risk of prostate cancer in a family. However, there are also some individual genes that we now know increase the risk of prostate cancer, and men with these genes may need to be screened differently or consider changes in treatment. It is also important to realize that not every African American man will get prostate cancer and that prostate cancer has a better chance of being managed effectively and cured if it is detected early. Other risk factors for prostate cancer are social and environmental factors-particularly a high fat, high processed carbohydrate diet-and lifestyle. Men who are overweight or obese are at greater risk of ultimately developing an aggressive form of prostate cancer. Research has shown that in obese men, recovery from surgery tends to be longer and more difficult, and the risk of dying from prostate cancer can be higher. The growing tumor does not push against anything to cause pain, so for many years the disease may be silent. In rare cases, prostate cancer can cause symptoms that include: It is still a scientific mystery, but African American men are 73% more likely to develop prostate cancer compared with white men, and 2. Again, this is most likely not caused by cancer but by other factors such as diabetes, smoking, cardiovascular disease, or just plain getting older. Modern prostate cancer research was framed in the 1940s by the discovery that hormones, primarily testosterone, were responsible for the growth of tumors. Over the next 5 decades, various types of chemotherapy, radiation therapy, surgical options, and hormone therapy were refined. Since 1993 when the Prostate Cancer Foundation began funding life-prolonging advancements in research, amazing strides have been made in finding therapies for treating advanced prostate cancer that are now part of an improved standard of care. There have been tremendous advancements, including: Because of these improvements and potentially other unknown factors, since 1993, deaths from prostate cancer have been cut in half (from 39. The prostate is only present in men and is important for reproduction, because it supplies the fluids needed for sperm to travel and survive (sperm is not made in the prostate; it is made in the testes). Most prostate cancer starts in the peripheral zone (the back of the prostate) near the rectum. The seminal vesicles are rabbit-eared structures that store and secrete a large portion of the ejaculate. The neurovascular bundle is a collection of nerves and vessels that run along each side of the prostate, helping to control erectile function. They are usually a short distance away from the prostate, but sometimes they attach to the prostate itself. The bladder is like a balloon that gets larger as it fills up, holding urine until the body is ready to void. The urethra, a narrow tube that connects to the bladder, runs through the middle of the prostate and along the length of the penis, carrying both urine and semen out of the body. The rectum is the lower end of your intestines that connects to the anus, and it sits right behind the prostate. Once prostate cancer forms it feeds on androgens and uses them as fuel for growth. In many cases, prostate cancer is a slow-growing cancer that does not progress outside of the prostate gland before the time of diagnosis. This does not mean you have "bone cancer" or "lung cancer," since these tumor cells came from the prostate and did not develop from bone or lung cells. Your treatment would be focused on prostate cancer rather than bone or lung cancer. Prostate cancers that are composed of very abnormal cells are much more likely to both divide and spread faster from the prostate to other regions of the body. Often, prostate cancer spreads first to tissues that are near the prostate, including the seminal vesicles and nearby lymph nodes.
In this position women's health tipsy basil lemonade cheap provera 10mg online, the mandible remains depressed and the person is unable to close their mouth iv women's health issues in bangladesh discount provera 5mg on line. The reduction can be corrected by manipulation by giving pressure of thumbs on the lower molar teeth and pushing the jaw backwards womens health uiuc buy discount provera 5 mg online. Temporomandibular joint arthritis: this joint may inflamed by degenerative arthritis which may cause dental malocclusion and joint clicking (crepitus) sound due to detached articular disk with pain during movements of jaw menstrual type cramps in late pregnancy buy provera 10 mg on line. The strong lateral temporomandibular ligament prevents dislocation of head of the mandible backwards and fracture of the tympanic plate when a severe blow falls on the chin menopause journal buy 5mg provera with mastercard. The head of the mandible occasionally dislocated forward caused by any sudden violence or during yawning due to sudden contraction of lateral pterygoid muscles ii womens health lansing mi provera 10 mg with visa. Epicranial aponeurosis or galea aponeurotica along with occipitofrontalis muscle iv. It is attached to the epicranial aponeurosis or galea aponeurotica through the dense superficial fascia. Posteriorly To the external occipital protuberance, and the superior nuchal lines. It is freely mobile on the pericranium along with the overlying adherent skin and fascia Attachments Anteriorly: It is attached to the insertion of the frontalis. Posteriorly: It is attached to the insertion of the occipitalis and also attached to the external occipital protuberance and to the highest nuchal lines. It is thin and continuous with the temporal fascia and attached to the zygomatic arch. Pericranium It is the periosteum of cranial bones and forms the fifth layer of the scalp. Attachments: It is loosely attached to the surfaces of the cranial bones and firmly attached to the sutures of the bones. Out of ten nerves, five nerves enter the scalp anterior to the auricle and remaining five nerves enter the scalp behind to the auricle. Posterior branch of great auricular nerve (sensory) from C2 and C3 of the cervical plexus b. Danger area (layer) of scalp: the layer of subaponeurotic loose areolar tissue (4th layer) is known as danger area of scalp. Any infection in this layer spreads quickly and may infect dural sinuses through the communicating emissary veins ii. Accumulation of blood due to any injury without producing much localized swelling. Wounds of scalp bleed profusely: When vessels of the scalp are torn in wounds they are unable to retract and produce profuse bleeding due to following reasons: i. The subcutaneous tissue of scalp (superficial fascia) is composed of dense fibrofatty tissue which prevents the retraction of blood vessels ii. It occurs due to bleeding into the loose areolar tissue (fourth) layer of the scalp after a blow on the skull ii. The blood gravitates gradually deep to the frontalis muscle and appears first in the upper eyelid and then the lower eyelid after few days. It occurs due to obstructions of the ducts of the sebaceous glands associated with hair follicles of the scalp ii. Scalp has profuse blood supply, so even small laceration can cause severe blood loss and it is often difficult to stop because the arterial wall are attached to fibrous septa in subcutaneous tissue. Infection of scalp usually remains localized and is usually painful, because of abundant fibrous tissue in the subcutaneous layer Occasionally, the infection may spread by the emissary veins, which are valveless, to the skull bone causing osteomyelitis 7. A partially detached scalp is relapsed with reasonable chance of healing if one of its vessels remain intact. Bones of the calvaria is mainly supplied by the middle meningeal artery and little by the arteries of the scalp; therefore loss of the scalp does not produce necrosis of the bones of the calvaria. The loose areolar tissue layer is known as danger area of the scalp because pus or blood spreads easily in this layer 452 Human Anatomy for Students ii. Infection in this layer can infect the intracranial structures like brain and meninges through the emissary veins that pass through the parietal foramina of the calvaria iii. Infections (with fluid, blood or pus) can also enter the eyelids and the root of the nose because the frontalis muscle attached into the skin and subcutaneous tissue of the forehead not to the bone, therefore may produce black eye, most of the blood enters the upper eyelid but some may also enter the lower eyelid. Scalp lacerations are the most common type of head injuries during vehicular or industrial accidents ii. These injuries are bleed profusely because the arteries entering through the periphery of the scalp bleed from both ends due to abundant anastomosis iii. The torn arteries does not retract because they held open by the dense fibrous connective tissue in the second layer of the scalp iv. The epicranial aponeurosis is very important because of its strength, which prevents gaping of the skin in a superficial laceration, because the margins of the laceration are held together by this aponeurosis ii. During suturing of a superficial scalp laceration deep sutures are not required because epicranial aponeurosis does not allow wide gaping of the skin iii. In a deep scalp laceration when epicranial aponeurosis is split or lacerated along the coronal plane the deep scalp wounds gape widely because of the pull of the frontal and occipital heads of the occipitofrontalis muscle anteriorly and posteriorly respectively 12. Sadness: anguli oris and zygomaticus minor by producing depth of naso-labial sulcus and Short Notes on Head, Neck and Face 453. Grief: Depressor anguli oris by depressing the angle of mouth assisted by platysma. Anger: Dilator naris and depressor septi by producing dilatation of anterior nasal aperture and depressing the mobile part of nasal septum. Frowning: Corrugator supercilii by producing vertical wrinkles of forehead and procerus producing wrinkles across the root of the nose. Surprise, horror, and fright: By frontalis elevating the eyebrows and horizontal wrinkles of forehead. Whistling: Buccinator by mingle medially with those of the orbicularis oris and by contraction of orbicularis oris. Nerve Supply of Face Motor Nerve the facial nerve itself is the motor nerve of the face (except the masseter). Human Anatomy for Students Features Carotid sheath is thick and dense over the arteries and nerve but thin over the vein. Posteriorly the cervical part of the sympathetic chain, closely attached to the prevertebral fascia. The vagus nerve Here the artery lies medially, vein laterally and nerve between and behind them. Situation Each tonsil lodges within the tonsillar fossa on the lateral wall of the oropharynx. It acts as first line defence and protects against the ingested and inspired organisms Measurements the sizes of the tonsils are variable according to age, individuality and tissue changes (because tonsils are frequently infected). Styloglossus accompanied with glossopharyngeal nerve (in anteroinferior one-third). Intratonsillar cleft: It is a deep semilunar fissure on the upper part of the medial surface. Supratonsillar fossa: It is the mouth of the intratonsillar cleft which is semilunar in shape. It extends backwards from the lower part of the palatoglossal arch down to the tongue iii. The deep surface is covered by a layer of fibrous tissue known as tonsillar hemicapsule. It is loosely attached to the muscular wall of the pharynx, formed by the superior constrictor and styloglossus b. Anteroinferiorly-Adheres to the side of the tongue just anterior to the palatoglossus and palatopharyngeus muscles (it maintains the position of tonsil during swallowing) c. In this region the tonsillar artery (branch of facial artery) pierces the superior constrictor to enter the tonsil accompanied by venae comitantes d. The external palatine or paratonsillar vein descends from the soft palate lateral to the tonsillar hemicapsule before piercing the wall of the pharynx, therefore during removal of tonsil or tonsillectomy this vein may be injured and causing complication. Tonsillar artery-it is the principal artery, which is a branch of facial artery ii. The palatopharyngeus and palatoglossus muscles attached to the fibrous capsules of the tonsils iii. Greater palatine branch of maxillary artery Venous Drainage Via the paratonsillar veins which drains into pharyngeal venous plexus. The outward proliferation of endodermal cells forms as solid buds, which are subsequently canalized to form tonsillar pits and crypts iii. After surgical removal of the tonsils sometimes glossopharyngeal nerve may be affected which results in the loss of taste sensation. Tonsils are common sites of infection, especially among the children, which may spread the surrounding tissue producing a peritonsillar abscess. Quinsy is a condition of suppuration in the peritonsillar area which is drained by making an incision in the most prominent point of the abscess. During removal of tonsil, the paratonsillar vein may be damaged resulting severe hemorrhage. Ligature of the tonsillar arteries especially inferior tonsillar artery is important during surgical removal of the tonsils 2. Tonsils prevent infection but when these are infected, act as the septic foci of the body which require surgical removal. During surgical removal of the tonsils the paratonsillar vein may be damaged causes excessive hemorrhage. Referred pain from the tonsils sometimes radiate into the middle ear due to same nerve supply (glossopharyngeal nerve). Action Abduction of the vocal cord or opening out of the glottis, so it is called safety muscle of larynx. The styloid process of temporal bone with its attached structures is called styloid apparatus ii. Styloglossus-arises from the posterior surface midway between the base and the tip c. The medial walls of the orbits are parallel and the lateral walls are meets at right angles to each other. The axis passing through the centers of anterior and posterior poles of the eyeball is known as visual axis b. Base the circumferential margin of the mouth of the funnel-shaped orbital cavity is its base. It is attached to the fibrous pulley or trochlea for the tendon of the superior oblique muscle. It transmits following structures Maxillary nerve Infraorbital vessels Infraorbital nerve Zygomatic nerve A few filaments from the pterygopalatine ganglion. Inferior oblique muscle: It arises from a depression on the anteromedial part of the floor. It is bounded anteriorly by the lacrimal crest of the frontal process of the maxilla and posteriorly by the crest of the lacrimal bone d. The groove inferiorly leads through the nasolacrimal duct to the inferior meatus of the nose. These are lies on the frontoethmoidal suture at the junction of roof and medial wall b. The orbit separates from the ethmoidal air sinuses by the orbital plate of the ethmoid bone iii. It is situated on the posterior part of the orbit at the junction of the roof and lateral wall which is divided into three compartments by the tendinous ring (annulus) for the origin of the four recti muscles of eyeball ii. It is an elevation on the zygomatic bone just behind the lateral orbital margin, and slightly below the fronto-zygomatic suture b. It gives attachments to the following lateral check ligament of the eyeball, lateral palpebral ligament, suspensory ligament of eyeball and levator palpebrae superioris muscle. Contents of Orbit the eyeball Fasciae-Orbital and bulbar Muscles-Muscles of orbit Vessels-Ophthalmic artery, superior and inferior ophthalmic veins and lymphatics v. Nerves-Optic, oculomotor with ciliary ganglion, trochlear, abducent, branches of ophthalmic nerve and sympathetic nerves vi. Recti Muscles Origin: All the four recti muscles arise from the posterior part of the orbit, from a common tendinous ring named as annulus tendinossus communis. Insertion: Each muscle after its origin passes forwards to their respective position on the eyeball and inserted by a tendinous expansion into the sclera, with the following distance, behind the sclerocorneal junction. Insertion: At the sclera, behind the equator of the eyeball on the superolateral posterior quadrant in between the superior and lateral recti muscles. Inferior oblique Origin: From the orbital surface of the maxilla, lateral to the nasolacrimal groove. Insertion: At the lateral part of sclera, behind the equator of the eyeball in its inferolateral posterior quadrant between the inferior and lateral recti muscles. Levator Palpebrae Superioris Origin: From the orbital surface of the lesser rectus. Its tendon divided into superior or voluntary and inferior or involuntary lamellae ii. Superior lamella inserted into the anterior surface of the superior tarsus and skin of the upper eyelid iii. Medial rectus, superior rectus, inferior rectus, inferior oblique and levator palpebrae superioris are supplied by the third cranial nerve (oculomotor). It results in diplopia (double vision), because light rays from an object does not focused on the identical areas on both retinae iii. In this case, the real image falls on the macula of the unaffected eye and falls image is mediated from peripheral part of the retina of the paralyzed eye. Paralytic squint: In paralytic squint movements are limited, diplopia and vertigo are present, head is turned in the direction of the function of paralyzed muscle. Concomitant squint: It is a congenital condition, there is no limitation of movement of eyeball and no diplopia. It is characterized by involuntary, rhythmical oscillatory movements of the eyes ii. It extends from the fascial sheath of the inferior rectus and inferior oblique to the lower margin of the inferior tarsus ii.
Make sure you at least discuss the note (especially the assessment and plan) with your intern or resident before you submit it pregnancy dreams generic provera 5mg amex. Patient contact: Stop in to see your patients at least one additional time throughout the day menstrual dysphoria discount 5mg provera otc, if not multiple times! The more involved with your patient (and their family best women's health tips buy provera 5mg overnight delivery, if they are around) you are women's health clinic kansas city mo purchase provera 10 mg otc, the better you will be able to help them with both their medical and social issues pregnancy help center generic provera 5mg. To be discharged women's health obamacare buy cheap provera 5mg line, the patient will need good follow-up from a primary care provider and/or specialist(s). Patients may also need to follow-up with consultants seen in the hospital, and you can help arrange this. However, you are not allowed to do anything to the discharge document at all because physicians need to receive training to do so, and errors in the discharge document can result in adverse patient events. Generally speaking, you are expected to follow the schedule of your team, with the exception being that your resident and/or intern may stay overnight and you will not. Always look to the senior resident on your team for direction regarding when to show up and how late to stay. However, the latest you should be staying is 9:00 pm on any service, which is tolerated if it happens once during 2-week block, but if it happens more frequently, you should contact one of the clerkship directors so adjustments can be made. In general, your team will alternate between picking up new patients and picking up patients admitted by an overnight team. Since the call schedule is a little confusing, you will receive a thorough explanation of the schedule from either Dr. Daily hours are typically from 7:00 am until 6:00 pm, but you can stay until 9:00 pm if you are admitting a new patient. You can usually leave earlier if work is complete, just make sure to check in with your team before leaving. Because the schedule is confusing and there are multiple admission days, you are expected to carry anywhere from 2 4 patients at a time (depending on what time of the year you are rotating on the medicine service). You do not have to admit a patient each day, but you should pick up patients regularly during the week. Most admissions will be accepted on long- call days (day 1) when the team is in the hospital the longest. You can stay from 7 am to 9 pm, but you may be able to leave before 9 pm when you have admitted a patient or two and your work is done. Post-call days (day 2), you will leave by 3 pm (unless there is mandatory teaching such as didactics, simulation, or physical exam rounds). On short-call days (day 3), you will generally stay from 7 am to 6 pm, and the team accepts some patients in the morning on this day. On "good days" (day 4), no patients are admitted and the team can leave when work is complete. On non-call days, most teams will wear "clinic clothes," typically a conservative skirt or dress, nice pants, blouse, and/or shirt and tie. Most teams will wear scrubs on call days and weekends, and often it will be permissible to ditch your white coat and wear a fleece or vest instead. However, you should discuss with your team whether scrubs are worn on call days before you do it. What to Put in Your White Coat Stethoscope Reflex Hammer Pen light More than one pen Pocket Medicine (very helpful for Medicine! If you do an outstanding job with your clinical responsibilities, and this is reflected in your evaluations, you will most likely do well in the course. You will also have a series of assignments over the course of the rotation, including two formal, typed patient write-ups as above. Tips for Studying for the Shelf the most challenging part of medicine shelf is finding time to study for it. You will need to study on most of your days off, so make sure to leave some time on those days to do work. Students that do well on the shelf exam have done a lot of questions to supplement their reading throughout the clerkship. Time is an issue during the exam, so practice doing the questions quickly and efficiently (you will want to do timed sets of questions to get yourself ready). Study Aids Try to use your patients and the write-ups that you have to hand in to learn about large topic areas. The questions are very similar to the shelf style, you can time yourself, and the explanations are very thorough. Especially if you do your medicine shelf early in the year, doing your best to get through as many of these as possible will really pay off. Each question has fantastic explanations that will teach you a lot of high-yield information. This is to say that it has all of the information you will need to do well on the shelf. However, realize that students who choose this route tend to take their time with the questions, reading each explanation thoroughly and usually taking notes on the high yield topics. Review Book: Very helpful for shelf exam review, and almost everyone refers to one of the ones listed below. This is one of the more demanding clerkships, but hopefully you will find the opportunities for learning and patient interaction to be some of the more satisfying. It can be difficult to spend long hours in the hospital, but do your best to remain positive and a be a team player throughout the clerkship. Often, your work ethic, team spirit, and (above all) dedication to patient care are what stand out to your team more than your clinical acumen or fund of knowledge. You will not know everything about their medical issues, but if you know the answers to questions such as where the patient lives, his/her family history, his/her baseline hemoglobin, etc. You have more time than anyone else on the team, and your patients are stuck in the hospital and could really use some friendly med student attention. If you have a good relationship with your patients, you will enjoy the rotation more, and you will provide an important service to the team. Feedback: Get frequent feedback on your performance from your residents and attendings. Peer Collaboration: If there is another med student on your team, treat him or her as a colleague. Otherwise, you will be scrambling at the end and may get overwhelmed and/or look disorganized. E-mails: Check your e-mail frequently, as room assignments or times for teaching sessions often change, and you want to make sure not to miss any of these. Concealing: Never keep information from your team that you plan to mention on rounds. Outside of rounds, you will probably not interact with your attending much, but your resident will. Your resident needs to have access to all information so that patients are well cared for. Otherwise, you may miss out on patient care opportunities and come across as not caring. Although some of the physicians with whom you work will have an inpatient service, you will be working mainly in the outpatient setting. You will be seeing patients presenting for routine check-ups and screening, well-child visits, ob/gyn concerns, chronic disease visits, sick visits, injuries, psychiatric concerns, and everything else you can think of. Depending on your site, you may have formal teaching sessions each day or on specific days during the week. You will be given their chief complaint and should attempt to place this within the 5 Visit Types focus your history on this complaint and its corresponding Visit Type; however, remember that family medicine is all about preventive care, and so you should not forget the rest of your history either and should do a pertinent physical exam. In these cases, your resident or attending may not want to hear an entire presentation. Presenting: After you see your patient, you will be expected to present him or her to your attending, resident, or both. This type of presentation is different from those on inpatient medicine in that it is done immediately after you see the patient. Keep it brief and focused, and use the opportunity to practice presenting without detailed notes or planning. It can, at first, be overwhelming to have to do a full presentation with little preparation. Even if the visit is just a checkup and the patient has no acute complaints, your plan can be along the lines of "continue all current medications, counseled on pertinent issues, refer for colonoscopy screening, and follow up again in 3-6 months", etc. Charting: Depending on the site, you may or may not be allowed to write in the chart. If you are told not to , you may want to take notes on an extra sheet while you interview the patient so that you can refer to these when you present. You will usually be done seeing your patients between 5 and 6 pm, and you will have no on-call or weekend responsibilities. You will have required didactics on campus every Friday (usually all day), and you will lose points if you miss any, except in the case of extenuating circumstances or excused absences. Bring your white coat on the first day and ask your supervising attending about whether to wear it. The exam that you will take at the end of the block is a standardized, nationally validated multiple choice exam which comes from the online cases that you are expected to work through during the clerkship. There is also a standardized patient portion of the exam where you will demonstrate a joint exam (usually the shoulder exam). If you have family medicine before you have pediatrics or ob/gyn or if you rotate at an internal medicine site, make sure to review these Aquifer cases in depth for the exam, since there is a good amount of Peds and Ob/Gyn on the exam. Doing the online Aquifer cases as practice for the exam and reviewing your notes from the lectures are both necessary and sufficient! Understanding Efficiency: Remember that you are working in a very busy office and that the faculty has invited you to learn there. On occasion, things may need to move quickly and you may not be given the opportunity to see your patient on your own or to give a full presentation. If the schedule is backed up, offer to help room patients, assist patients in getting labs done, or help with other "patient flow" issues to keep things moving. Openness to Feedback: Feedback will come in many different forms on this rotation: a preceptor telling you what she agrees and disagrees with after you present, a preceptor doing a physical exam and pointing to the location where she hears crackles on the lung exam so you can place your stethoscope there to listen, or a preceptor guiding your hand during a procedure. Leaving Early: Never ask to leave before you and/or your attending have seen every patient on the schedule. If you have a valid reason to leave early, just mention it early in the day or week for the most part, attendings are very understanding. If you are at a distant site and get caught up in traffic they will understand once, but be sure to leave plenty of time to get to your site. Each individual discipline will have its own teaching curriculum with didactic sessions and problem-based learning. This is a fun, though busy, rotation that most people enjoy, even if they are not planning a career in pediatrics. You will perform histories and physical exams and present your assessment and plan to the attending physician. You may be expected to write progress notes for each visit, depending on the site. You will also likely have the opportunity to assist with immunizations, hearing screens, visual testing, and other routine health checks. Some students may have the opportunity to spend a week in the Well Baby Nursery (depending on site). Make sure to try to incorporate yourself into the team and be friendly to everyone in the practice, including the receptionists, clerks, and nurses. Your day-today responsibilities during this part of the rotation are similar to those for Family Medicine, so take a look at the "Responsibilities" section for Family Med above. In July 2020, some of the teams might be changing, so consult the course directors/syllabus for the most up to date information. You will work most closely with the interns who, being tired, will definitely appreciate any help you can provide. In addition to your senior residents, you may encounter the teaching senior, a thirdyear resident whose entire role is to teach the med students on the rotation and grade your write-ups. They will help call nurses to rounds, obtain outside hospital labs and imaging, will call pediatricians, etc. It is important to let them know if you want to take ownership over these tasks for your patients. The only exception to the above description is the observation unit, which is an attending only service, who will care for "bread and butter" general pediatric patients. Medical students on this team will likely focus more on admissions, diagnosis, treatment plans, and discharge coordination. Chain of command Depending on the time of year you rotate in Pediatrics, it may be expected that you come up with your own assessment and plan before seeking guidance from your interns and residents. If you find out something new about your patient, make sure to share it with the intern. Even though it is "your patient", the intern is ultimately responsible, so never do anything behind his/her back. If the intern deems it necessary, he/she will go to the resident or attending to ask for help. As a 200 student, you will rarely call the attending directly with patient issues, but during rounds you should feel free to discuss your ideas with the attending. As most pediatrics floors include both a general pediatrics service and a specialty service, you will likely have a two attendings for each service at any time.
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