INGLES MEDICO GUIA 2014-II.pdf

GUÍA DE CLASES INGLÉS MÉDICO

2014 – II

Lic. Geraldina Vallejos Torres Lic. Viviana Morales Sanchez Lic. Marita Quispe Cisneros Lic. Erika Matsusita Namabe

LIMA – PERU

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 2

OSTEOPOROSIS

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. A common result of osteoporosis is fractures — most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density. In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include:  Back pain, which can be severe if you have a fractured or collapsed vertebra  Loss of height over time, with an accompanying stooped posture  Fracture of the vertebrae, wrists, hips or other bones The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure. Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover. A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause. Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later. Three factors that you can influence are essential for keeping your bones healthy throughout your life:  Regular exercise  Adequate amounts of calcium  Adequate amounts of vitamin D, which is essential for absorbing calcium

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

A number of factors can increase the likelihood that you'll develop osteoporosis, including:  Your sex. Fractures from osteoporosis are about twice as common in women as they are in men. That's because women start out with lower bone mass and tend to live longer. They also experience a sudden drop in estrogen at menopause that accelerates bone loss. Slender, small-framed women are particularly at risk. Men who have low levels of the male hormone testosterone also are at increased risk. The risk of osteoporosis in men is greatest from age 75 on.  Age. The older you get, the higher your risk of osteoporosis. Your bones become weaker as you age.  Race. You're at greatest risk of osteoporosis if you're white or of Southeast Asian descent. Black and Hispanic men and women have a lower, but still significant, risk.  Family history. Osteoporosis runs in families. For that reason, having a parent or sibling with osteoporosis puts you at greater risk, especially if you also have a family history of fractures.  Frame size. Men and women who are exceptionally thin or have small body frames tend to have higher risk because they may have less bone mass to draw from as they age.  Tobacco use. The exact role tobacco plays in osteoporosis isn't clearly understood, but researchers do know that tobacco use contributes to weak bones.  Lifetime exposure to estrogen. The greater a woman's lifetime exposure to estrogen, the lower her risk of osteoporosis. For example, you have a lower risk if you have a late menopause or you began menstruating at an earlier than average age. But your risk of osteoporosis is increased if your lifetime exposure to estrogen has been deficient, such as from infrequent menstrual periods or menopause before age 45.  Eating disorders. Women and men with anorexia nervosa or bulimia are at higher risk of lower bone density in their lower backs and hips.  Corticosteroid medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, etc., is damaging to bone. These medications are common treatments for chronic conditions, such as asthma, rheumatoid arthritis and psoriasis. If you need to take a steroid medication for long periods, your doctor should monitor your bone density and recommend other drugs to help prevent bone loss.  Thyroid hormone. Too much thyroid hormone also can cause bone loss. This can occur either because your thyroid is overactive (hyperthyroidism) or because you take excess amounts of thyroid hormone medication to treat an underactive thyroid (hypothyroidism).  Selective serotonin reuptake inhibitors (SSRIs). Research published in 2007 showed lower bone mineral density among both men and women currently using SSRIs compared with study participants not taking these antidepressants. More research is needed to fully understand the association between SSRI use and low bone density.  Other medications. Long-term use of the blood-thinning medication heparin, the cancer treatment drug methotrexate, some anti-seizure medications, diuretics and aluminumcontaining antacids also can cause bone loss.  Breast cancer. Postmenopausal women who have had breast cancer are at increased risk of osteoporosis, especially if they were treated with chemotherapy or aromatase inhibitors such as anastrozole and letrozole, which suppress estrogen.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

 Low calcium intake. A lifelong lack of calcium plays a major role in the development of osteoporosis. Low calcium intake contributes to poor bone density, early bone loss and an increased risk of fractures.  Medical conditions and procedures that decrease calcium absorption. Stomach surgery (gastrectomy) can affect your body's ability to absorb calcium. So can conditions such as Crohn's disease, celiac disease, vitamin D deficiency, anorexia nervosa and Cushing's disease — a rare disorder in which your adrenal glands produce excessive corticosteroid hormones.  Sedentary lifestyle. Bone health begins in childhood. Children who are physically active and consume adequate amounts of calcium-containing foods have the greatest bone density. Any weight-bearing exercise is beneficial, but jumping and hopping seem particularly helpful for creating healthy bones. Exercise throughout life is important, but you can increase your bone density at any age.  Excess soda consumption. The link between osteoporosis and caffeinated sodas isn't clear, but caffeine may interfere with calcium absorption and its diuretic effect may increase mineral loss. In addition, the phosphoric acid in soda may contribute to bone loss by changing the acid balance in your blood. If you do drink caffeinated soda, be sure to get adequate calcium and vitamin D from other sources in your diet or from supplements.  Chronic alcoholism. For men, alcoholism is one of the leading risk factors for osteoporosis. Excess consumption of alcohol reduces bone formation and interferes with the body's ability to absorb calcium.  Depression. People who experience serious depression have increased rates of bone loss. Osteopenia refers to mild bone loss that isn't severe enough to be called osteoporosis, but that increases your risk of osteoporosis. Doctors can detect osteopenia or early signs of osteoporosis using a variety of devices to measure bone density. The best screening test is dual energy X-ray absorptiometry (DEXA). This procedure is quick, simple and gives accurate results. It measures the density of bones in your spine, hip and wrist — the areas most likely to be affected by osteoporosis — and it's used to accurately follow changes in these bones over time. Other tests that can accurately measure bone density include:  Ultrasound  Quantitative computerized tomography (CT) scanning

If you're a woman, the National Osteoporosis Foundation in USA recommends that you have a bone density test if you aren't taking estrogen and any of the following conditions apply to you:  You're older than age 65, regardless of risk factors.  You're postmenopausal and have at least one risk factor for osteoporosis, including having fractured a bone.  You have a vertebral abnormality.  You use medications, such as prednisone, that can cause osteoporosis.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

 You have type 1 diabetes, liver disease, kidney disease, thyroid disease or a family history of osteoporosis.  You experienced early menopause. Doctors don't generally recommend osteoporosis screening for men because the disease is less common in men than it is in women. Fractures are the most frequent and serious complication of osteoporosis. They often occur in your spine or hips — bones that directly support your weight. Hip fractures usually result from a fall. Although most people do relatively well with modern surgical treatment, hip fractures can result in disability and even death from postoperative complications, especially in older adults. Wrist fractures from falls also are common. In some cases, spinal fractures can occur without any fall or injury simply because the bones in your back (vertebrae) become so weakened that they begin to compress. Compression fractures can cause severe pain and require a long recovery. If you have many such fractures, you can lose several inches of height as your posture becomes stooped. Getting adequate calcium and vitamin D is an important factor in reducing your risk of osteoporosis. If you already have osteoporosis, getting adequate calcium and vitamin D, as well as taking other measures, can help prevent your bones from becoming weaker. In some cases you may even be able to replace bone you've lost. The amount of calcium you need to stay healthy changes over your lifetime. Your body's demand for calcium is greatest during childhood and adolescence, when your skeleton is growing rapidly, and during pregnancy and breast-feeding. Postmenopausal women and older men also need to consume more calcium. As you age, your body becomes less efficient at absorbing calcium, and you're more likely to take medications that interfere with calcium absorption. Premenopausal women and postmenopausal women who use HT should consume at least 1,000 milligrams (mg) of elemental calcium and a minimum of 800 international units (IU) of vitamin D every day. Postmenopausal women not using HT, anyone at risk of steroidinduced osteoporosis, and all men and women older than 65 should aim for 1,500 mg of elemental calcium and at least 800 IU of vitamin D daily. Getting enough vitamin D is just as important as getting adequate amounts of calcium. Not only does vitamin D improve bone health by helping calcium absorption, but it also may improve muscle strength. These measures also may help you prevent bone loss: 

Exercise. Exercise can help you build strong bones and slow bone loss. Exercise will benefit your bones no matter when you start, but you'll gain the most benefits if you start exercising regularly when you're young and continue to exercise throughout your life. Combine strength training exercises with weight-bearing exercises. Strength training helps strengthen muscles and bones in your arms and upper spine, and weight-bearing exercises — such as walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports — mainly affect the bones in your legs, hips and lower spine.

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Add soy to your diet. The plant estrogens found in soy help maintain bone density and may reduce the risk of fractures.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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Don't smoke. Smoking increases bone loss, perhaps by decreasing the amount of estrogen a woman's body makes and by reducing the absorption of calcium in your intestine.

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Consider

hormone

therapy. Hormone therapy can reduce a woman's risk of

osteoporosis during and after menopause. But because of the risk of side effects, discuss the options with your doctor and decide what's best for you. Testosterone replacement therapy works only for men with osteoporosis caused by low testosterone levels. Taking it when you have normal testosterone levels won't increase bone mass. 

Avoid excessive alcohol. Consuming more than two alcoholic drinks a day may decrease bone formation and reduce your body's ability to absorb calcium. There's no clear link between moderate alcohol intake and osteoporosis.

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Limit caffeine. Moderate caffeine consumption — about two to three cups of coffee a day — won't harm you as long as your diet contains adequate calcium.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 4

GALLSTONES Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine. Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time. People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don't cause any signs and symptoms typically don't need treatment. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:     

Sudden and rapidly intensifying pain in the upper right portion of your abdomen Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone Back pain between your shoulder blades Pain in your right shoulder Yellowing of your skin and the whites of your eyes

I's not clear what causes gallstones to form. Doctors think gallstones may result when: 

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Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones. Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation. Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated and this contributes to the formation of gallstones.

Types of gallstones that can form in the gallbladder include: 

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Cholesterol gallstones. It is the most common type of gallstone often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components. Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Complications of gallstones may include: 

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Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever. Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result. Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization. Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 5

ASTHMA Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes over time, it's important that you work with your doctor to track your signs and symptoms and adjust treatment as needed. If you have asthma, the inside walls of the airways in your lungs can become inflamed and swollen. In addition, membranes in your airway linings may secrete excess mucus. The result is an asthma attack. During an asthma attack, your narrowed airways make it harder to breathe and you may cough and wheeze. Asthma symptoms range from minor to severe and vary from person to person. Asthma signs and symptoms include:     

Shortness of breath Chest tightness or pain Trouble sleeping caused by shortness of breath, coughing or wheezing A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children) Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

For some people, asthma symptoms flare up in certain situations:   

Exercise-induced asthma, which may be worse when the air is cold and dry Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen

It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and genetic (inherited) factors. Asthma triggers Exposure to various substances that trigger allergies (allergens) and irritants can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:     

Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites Respiratory infections, such as the common cold Physical activity (exercise-induced asthma) Cold air Air pollutants and irritants, such as smoke Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) Strong emotions and stress Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat Menstrual cycle in some women

You may also be given lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include:  

Spirometry. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out. Peak flow. A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.

Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma. Other tests to diagnose asthma include: 

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Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal. Nitric oxide test. This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels. Imaging tests. A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems. Allergy testing. This can be performed by skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy. Provocative testing for exercise and cold-induced asthma. In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol. Medications The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control. Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary. Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you'll have an asthma attack. Types of long-term control medications include: 

Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid), ciclesonide (Alvesco), beclomethasone (Qvar) and mometasone (Asmanex).

You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use. 

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Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don't use them for an acute asthma attack. Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera) — contain a longacting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack.

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include: 

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Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex) and pirbuterol (Maxair). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece. Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks. Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they're used only on a short-term basis to treat severe asthma symptoms.

If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn't need to use your quick-relief inhaler very often. Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication. Allergy medications may help if your asthma is triggered or worsened by allergies. These include: Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years. Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system. Allergy medications. oral and nasal spray antihistamines and decongestants as well as corticosteroid and cromolyn nasal sprays.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 6 URINARY TRACT INFECTION (UTI)

The "urinary tract" consists of the various organs of the body that produce, store, and get rid of urine. These include the kidneys, the ureters, the bladder, and the urethra. Our kidneys are chemical filters for our blood. About one-quarter of the blood pumped by the heart goes through the kidneys. The kidneys filter this blood, and the "filtrate" is processed to separate out waste products and excess amounts of minerals, sugar, and other chemicals. Since it sees so much of the body's blood flow, the kidneys also contain pressure-sensitive tissue which helps the body control blood pressure, and some of the minerals and water are saved or discarded partly to keep your blood pressure in the proper range. The waste products and "extras" make up the urine, which flows through "ureters" (one per kidney) into the bladder, where it is held until you are ready to get rid of it. When you urinate, muscles in the bladder wall help push urine out of the bladder, through the urethra, and out. (In men, the urethra passes through the penis; in women, the urethra opens just in front of the vagina). When you aren't urinating (which is most of the time) a muscle called the "sphincter" squeezes the urethra shut to keep urine in; the sphincter relaxes when you urinate so that urine can flow out easily. Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and the tube that carries urine from the bladder (urethra). Urinary tract infections are also known as uncomplicated cystitis and the problem mainly affects women. About one in five women will experience a urinary tract infection. Infections can be caused by bacteria which get into the bladder via the urethra (small tube leading from the bladder). Sexual intercourse may be a trigger to this happening. This is more likely if sex has been vigorous or if lubrication is not good. In older, post-menopausal women, factors favoring urine infection relate more to changes involving the effects of less estrogen on the tissues around the bladder and vagina. It is believed women's genitals are more sensitive to infections because the urethra, vagina and anus are placed close together, making it easier for bacteria to infect the urethra. The urethra is also much shorter in women than in men. Sometimes underlying problems such as kidney stones or kidney abnormalities may lead to urine infections. Sometimes further tests are done to check for this, particularly if infections are recurring often. Pregnant women, people with diabetes and weak immune systems are also more at risk of infection.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Pain while urinating and a frequent urge to urinate are the main symptoms of a urinary tract infection. There may be a burning or scalding sensation when going to the toilet, passing only a small amount of urine, or not be able to go at all. You may feel the need to go again after having just been to the toilet. The urine may look cloudy. There may also be blood in the urine and an ache above the pelvic bone. The main complication of a bladder infection is that it can spread to the kidneys. A fever, rigors (shaking and shivering), and pain on the loin area (back of the abdomen), may mean the infection has reached the kidneys. Children with an infection may have a change in their toileting, experience incontinence, loose bowel movements, and have a fever. Children need a different approach to investigating urinary infection, as underlying abnormalities need to be excluded. Men with an infection often have a kidney stone, or an enlarged prostate gland. Men are usually investigated after a urinary infection to make sure there is no underlying problem. Laboratory tests of urine can confirm an infection. Inflammatory cells (white cells) are present in the urine and a culture of the urine usually shows which bacteria are present and which antibiotic they are sensitive to. A follow up test may be required in some cases. In general, the farther the organ in the urinary tract from the place where the bacteria enter, the less likely the organ is to be infected. 

Urethritis. This can be due to other things besides the organisms usually involved in UTI's; in particular, many sexually-transmitted diseases (STD's) appear initially as urethritis. However, stool-related bacteria (the most common bacteria on the skin near the meatus) will also often cause urethritis.  Cystitis. This is the most common form of UTI; it can be aggravated if the bladder does not empty completely when you urinate. (Some people have valves at the bladder end of the urethra as well as at the bladder ends of the ureters. You aren't supposed to have urethral valves except for the sphincter; these "extra" valves usually prevent complete bladder emptying and make cystitis more likely).  Ureteritis. This can occur if the bacteria entered the urinary tract from above, or if the ureter-to-bladder valves don't work properly and allow urine to "reflux" from the bladder into the ureters.  Pyelonephritis. This can happen with infection from above, or if reflux into the ureters is so bad that infected urine refluxes all the way to the kidney. The condition can be prevented in some cases by following this advice:           

Dab instead of wiping the genitals after urinating Do not use feminine hygiene products Avoid tight fitting garments like pantyhose. Wear cotton underwear. Wash your genitals with just water or mild soap Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine products). Cleanse the genital area before sexual intercourse. Change soiled diapers in infants and toddlers promptly. Drink plenty of water to remove bacteria from the urinary tract. Do not routinely resist the urge to urinate. Take showers instead of baths. Urinate after sexual intercourse. and drink water after having sex Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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Women and girls should wipe from front to back after voiding to prevent contaminating the urethra with bacteria from the anal area.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 7

Stroke A stroke occurs when the blood supply to part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and food. Within minutes, brain cells begin to die. It is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than even 15 years ago. Note when your signs and symptoms begin, because the length of time they have been present may guide your treatment decisions:   

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Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination. Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech. Paralysis or numbness of the face, arm or leg. especially on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile. Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.

When to see a doctor     

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think "FAST" and do the following: Face. Ask the person to smile. Does one side of the face droop? Arms. Ask the person to raise both arms. Does one arm drift downward? Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?

The longer a stroke goes untreated, the greater the potential for brain damage and disability. To maximize the effectiveness of evaluation and treatment, you'll need to be treated at a hospital within three hours after your first symptoms appeared. A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include: 

You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities hampered by paralysis, such as walking, eating and dressing. Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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A stroke may cause you to have less control over the way the muscles in your mouth and throat move, making it difficult for you to talk clearly, swallow or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech and language pathologist may help. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression. People who have had strokes may have pain, numbness or other strange sensations in parts of their bodies affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm. People also may be sensitive to temperature changes, especially extreme cold (central stroke pain or central pain syndrome). This complication generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, instead of a physical injury, there are few treatments. Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 9

Folliculitis, Furunculosis, and Carbunculosis

Definition and Etiology Folliculitis is a superficial infection of the hair follicles characterized by erythematous, follicularbased papules and pustules. Furuncles are deeper infections of the hair follicle characterized by inflammatory nodules with pustular drainage, which can coalesce to form larger draining nodules (carbuncles). Pathophysiology and Natural History S. aureus is the usual pathogen, although exposure to Pseudomonas aeruginosa in hot tubs or swimming pools can lead to folliculitis. In general, folliculitis is a self-limited entity. Occasionally, a pustule enlarges to form a tender, red nodule (furuncle) that becomes painful and fluctuant after several days. Rupture often occurs, with discharge of pus and necrotic material. With rupture, the pain subsides and the redness and edema diminish. Signs and Symptoms Folliculitis is generally asymptomatic, but it may be pruritic or even painful. Commonly affected areas are the beard, posterior neck, occipital scalp, and axillae (Fig. 1). Often a continuum of folliculitis, furunculosis (furuncles), arises in hair-bearing areas as tender, erythematous, fluctuant nodules that rupture with purulent discharge (Fig. 2). Carbuncles are larger and deeper inflammatory nodules, often with purulent drainage (Fig. 3), and commonly occur on the nape of the neck, back, or thighs. Carbuncles are often tender and painful and occasionally accompanied by fever and malaise.1-3 Diagnosis Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Diagnosis is by clinical presentation and confirmation by culture. Treatment Topical treatment with clindamycin 1% or erythromycin 2%, applied two or three times a day to affected areas, coupled with an antibacterial wash or soap, is adequate for most patients with folliculitis. Systemic antistaphylococcal antibiotics are usually necessary for furuncles and carbuncles, especially when cellulitis or constitutional symptoms are present.2 Small furuncles can be treated with warm compresses three or four times a day for 15 to 20 minutes, but larger furuncles and carbuncles often warrant incision and drainage. If methicillin-resistant S. aureus (MRSA) is implicated or suspected, vancomycin (1-2 g IV daily in divided doses) is indicated coupled with culture confirmation. Antimicrobial therapy should be continued until inflammation has regressed or altered depending on culture results. Treatment is summarized in Table. Table: Treatment of Folliculitis, Furunculosis, and Carbunculosis Folliculitis

Furunculosis/Carbunculosis

Dosing

First-Line Treatment Topical clindamycin/ erythromycin bid

Antibiotic wash (e.g. chlorhexidine) bid

Incision and drainage

bid

Dicloxacillin Amoxicillin plus calvulanic acid; cephalexin

250-500 mg PO qid for 5-7 days 25 mg/kg PO tid; 250-500 mg PO qid for 10 days

Clavulanic acid;

bid

Warm compresses

tid

Doxycycline

100 mg PO bid (2-8 weeks depending on severity)

Vancomycin

1-2 g IV daily in divided doses for 7 days

Second-Line Treatment (MRSA) Doxycycline (2-8 weeks depending on severity)

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 10

LASIK Q & A LASIK (laser assisted in situ keratomileusis) is a laser vision correction surgical procedure. Surgeons use the Excimer laser to alter the refractive power of the cornea. During the procedure, the surgeon creates a flap from the surface of the cornea. This flap is hinged and folded back. The surgeon then uses the Excimer laser to remove tissue in the corneal bed, and flatten and reshape the central cornea by a predetermined amount. Then the flap is repositioned. The cells begin healing and clear vision is reestablished. The flap adheres quickly to the cornea because of the physical and chemical properties of the tissue. Visual recovery usually takes less than 24 hours and full recovery within a few days to a week.

With LASIK patients recover their visual acuity, have less postoperative corneal haze, better healing and less corneal ulcers. After LASIK do patients need to limit activities? Immediately following LASIK it´s important not to rub the eye. Patients are given shields to wear at bedtime and told not to rub their eyes during the day. Patients should avoid being in a dirty or dusty environment for a few days as this may cause irritation. Swimming is not recommended during the first month. In general there is minimal discomfort with LASIK which is controlled with topical drop. Vision typically recovers during the first day.

The benefits of LASIK are to improve sight without the use of glasses or contact lenses. Within one week after the procedure, 98.8 percent of The University Physicians´ LASIK patients reached 20/40 or better without glasses or contact lenses. Many patients return to their natural vision of 20/20 within a short time. It is suggested that somebody drive the patient home as vision will be slightly hazy following surgery. After one night the majority of patients feel their vision is

clear enough to drive

themselves to their post-operative appointment the following day. Patients may return to work within 1 to 2 days.

Yes, The LASIK Center at The University Physicians chose the VISX ATAR S2 Excimer laser, which was approved for LASIK in 1999 by The U.S. Food and Drug Administration. VISX follow strict clinical protocols to establish safely and effectiveness. The LASIK Center evaluates the LASIK technique on an ongoing basis with assistance from the world-renowned University of Arizona Optical Sciences Department.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Robert Snyder, M.D., professor and head, UA College of Medicine Department of Ophthalmology, is a fellowship-trained, board-certified corneal-specialist and ophthalmic surgeon with 14 –years experience in corneal and refractive surgery. He has perfomed more than 2,000 Excimer- laser procedures since . The LASIK Center became the first FDA approved laser center in Arizona. Other corneal specialists work under Dr. Snyder.

The ophthalmologists who conduct surgery at The LASIK Center have participated in numerous research studies on laser vision correction over years. They have access to the highest technology available, including the UA Optical Sciences study currently underway. The ophthalmologist who performs your surgery will be the same person who will oversee your follow-up care for up to a year following the procedure.

The payment includes pre-screening, a refractive surgery exam, and pre-and post-operative and follow-up care for one year. The LASIK Center accepts various methods of payment including most major credit cards. Patients considering LASIK must:    

Be 21 years or older. Have realistic expectations of what LASIK can and cannot do. Have healthy eyes and stable vision. Be able to pay for procedure (many insurance companies consider ASIK an elective procedure). Be motivated for the procedure.

  Patients would be good LASIK candidates if:   

Their dependency on corrective lenses makes them feel handicapped. They wish to participate more freely in sports. They want more freedom to pursue activities without using corrective glasses or contact lenses. They are unable to wear contact lenses. They would look better without glasses. Their career opportunities might be enhanced if they had better vision. They can afford the treatment without sacrificing essentials.

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They are comfortable wearing glasses or contact lenses, see well and feel the glasses look good on them. They demand perfect vision, and visual irregularities would bother them. Wearing any corrective lenses for occasional activity would make them unhappy after they have has LASIK.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

What is a Neuro-Ophthalmologist? Dr. George Sandoz is an Eye Physician and Surgeon who specializes in the care and treatment of eye conditions. These conditions range from the routine eye exam and check-up to complex eye surgeries . In addition, Dr.

Sandoz is also a Neurologist treating a wide variety of

neurological conditions. This unique combination makes Dr. Sandoza Neuro-Ophthalmologist, one of only two in the state of South Carolina. This makes him uniquely qualified to treat even the most complex eye conditions

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Conditions treated             

Blurry Vision. Headaches due to Blurry Vision. Eye Pain. Blurry Vision due to Migraines. Glaucoma. Sudden Vision Loss. Crossed Eye. Seeing Flashing Lights. Droopy eye. Visual Field Loss. Macular Degeneration. Diplopia. Double vision.

RICHARD R. OBER, M.D. Vitreo-retinal Ophthalmologist Professor of Clinical Ophthalmology University of Arizona College of Medicine. Dr. Ober, board-certified in ophthalmology , is a retina and vitreous specialist. After graduating from medical school at George Washington University, Washington, DC, Dr. Ober completed his residency at the University of Southern California Medical Center in Los Angeles . He also has received fellowship training in diseases of the retina and Vitreous at Moorfields Eye Hospital in England and the Johns Hopkins University School of Medicine, Baltimore, Maryland. Before joining The University Physicians in 1993 he was a full-time faculty member at the University of Southern California.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Session 11

Diabetes

Diabetes is a disease in which the body does not make any insulin or can't use the insulin it does make as well as it should. Insulin is a hormone made in the body. It helps glucose (sugar) from food enter the cells where it can be used to give the body energy. Without insulin, glucose remains in the blood stream and cannot be used for energy by the cells. Over time, having too much glucose in the blood can cause many health problems. Diabetes is the leading cause of new blindness, kidney disease, and amputation, and it contributes greatly to the state's and nation's number one killer, cardiovascular disease (heart disease and stroke). People with diabetes are more likely to die from flu or pneumonia.

Diabetes is not caused by eating too much sugar; in fact there is no such thing as "having a touch of sugar," as some people believe. Only a doctor or health care provider can diagnose diabetes either by conducting a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT). The Diabetes Epidemic Diabetes is the most rapidly growing chronic disease of our time. It has become an epidemic that affects one out of every 12 adult New Yorkers. Since 1994, the number of people in the state who have diabetes has more than doubled, and it is likely that number will double again by the year 2050. More than one million New Yorkers have been diagnosed with diabetes. It is estimated that another 450,000 people have diabetes and don't know it, because the symptoms may be overlooked or misunderstood. The Centers for Disease Control and Prevention (CDC) has recently predicted that one out of every three children born in the United States will develop diabetes in their lifetime. For Hispanic/Latinos, the forecast is even more alarming: one in every two. Types of Diabetes Type 1 Diabetes Type 1 diabetes usually appears in children, teenagers or young adults, but it can also be diagnosed later in life. About 5% of people with diabetes have type 1 diabetes. People with type 1 diabetes don't make insulin. Insulin helps convert sugar, starches and other food into energy. People with type 1 diabetes must take insulin every day to live. Insulin is usually given by a shot or a small pump that is attached to the body.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

There is no known way to prevent or cure type 1 diabetes, but it can be controlled by keeping the level of glucose in the blood within a normal range. Keeping blood sugar at an ideal level helps prevent complications and also helps people feel better every day. For most people with diabetes, a healthy range is between 90 and 130 mg/dl before meals and less than 180 mg/dl at 1 to 2 hours after a meal. Type 2 Diabetes Type 2 diabetes is the most common form of diabetes and it has been described as an epidemic. The number of people with diabetes has nearly tripled since 1980, and most of this increase is in type 2 diabetes. About 95 percent of people with diabetes have type 2 diabetes. With type 2 diabetes, the body either doesn't make enough insulin or can't use the insulin it makes as well as it should. While its cause is unknown, type 2 diabetes has been associated with obesity, genetic risk factors, and inactivity. Some racial and ethnic groups are at higher risk for type 2 diabetes. These include American Indians, African Americans, Hispanic/Latinos, Asian Americans and Pacific Islanders. Of great concern is the fact that cases of type 2 diabetes, found most often in adults, are now being diagnosed in children and adults, especially in minority populations. Like adults, children have a greater risk of developing type 2 diabetes if they are overweight and inactive, and are from one of the racial and ethnic backgrounds mentioned above.

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There is no known way to cure type 2 diabetes, but it can be controlled by keeping blood sugar within a normal range. People with diabetes should talk with their doctor or health care provider to find out what their healthy blood glucose range is. For most people with diabetes, a healthy range is between 90 and 130 mg/dl before meals and less than 180 mg/dl at 1 to 2 hours after a meal. Some people with type 2 diabetes can control the disease by: Losing even small amounts of weight. Making healthier food choices. Being physically active 30 minutes a day, most days of the week. Other people may need to take one or more oral medications, and/or insulin, in addition to the suggestions listed above. Causes of Type 1 Diabetes In type 1 diabetes, the body no longer makes insulin because the body's own immune system has attacked and destroyed the cells where insulin is made. The cause of this isn't entirely clear but it may include genetic risk factors and environmental factors. One theory is that type 1 diabetes may occur after having a specific virus. Causes of Type 2 Diabetes The risk of having type 2 diabetes increases as a person gets older. The cause of type 2 diabetes is largely unknown, but genetics and lifestyle clearly play roles. Type 2 diabetes has been linked to obesity, genetic risk factors, and inactivity.

Risk factors for type 2 diabetes include:  Age (greater than age 45).  Overweight.

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Physical inactivity.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

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Family background that is American Indian, African American, Hispanic/Latino, Asian American, or Pacific Islander. Parent or sibling with diabetes. High blood pressure. Abnormal cholesterol levels.

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Having had a baby that weighed more than 9 pounds or having had gestational diabetes. Pre-diabetes. History of polycystic ovary disease (PCOS).

It is important for people at risk for type 2 diabetes to discuss with their doctor or health care provider whether they should be tested for diabetes. Diabetes often goes undiagnosed because many of its symptoms seem harmless or don't always appear right away. Recent studies show that early detection of diabetes symptoms and treatment can decrease the chance of developing the complications of diabetes. Symptoms of diabetes include:        

Increased thirst. Increased hunger. Having to urinate more often especially at night. Feeling very tired. Weight loss. Blurry vision. Sores that do not heal. Tingling/numbness in the hands and feet.

Complications If blood sugar is consistently high, over time it can affect the heart, eyes, kidneys, nerves, and other parts of the body. These problems are called complications. Sometimes people with diabetes don't realize that they have the disease until they begin to have other health problems. For example, a doctor or health care provider may detect signs of diabetes damage even though the patient does not know that he/she has the disease. Complications of diabetes include:  Heart Disease – People with diabetes have a higher risk for heart attack and stroke.  Eye Complications – People with diabetes have a higher risk of blindness and other vision problems.  Kidney Disease – Diabetes can damage the kidneys and may lead to kidney failure.  Nerve Damage (neuropathy) – Diabetes can cause damage to the nerves that run through the body.  Foot Problems – Nerve damage, infections of the feet, and problems with blood flow to the feet can be caused by diabetes.  Skin Complications – Diabetes can cause skin problems, such as infections, sores, and itching. Skin problems are sometimes a first sign that someone has diabetes.  Dental Disease – Diabetes can lead to problems with teeth and gums, called gingivitis and periodontitis. Diabetes is managed by keeping blood sugar under control and as close to normal as possible. Here are some ways to manage diabetes:

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, E.Matsusita

Exercise. Work up to at least 30 minutes a day, most days of the week. Regular physical activity helps to manage diabetes. People with diabetes should talk to their doctor or health care provider before starting any exercise plan. Some good ways to get exercise are to:       

Take a brisk walk (outside or inside on a treadmill). Go dancing. Take a low-impact aerobics class. Swim or do water aerobic exercises. Ice-skate or roller-skate. Play tennis. Ride a stationary bicycle indoors.

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Choose Healthy Food. Good nutrition is a very important part of diabetes management. People with diabetes should work with their diabetes healthcare team to develop an eating plan that meets their personal food preferences while keeping blood glucose in a healthy range. By choosing nutritious foods and balancing what and how much you eat with activity level, blood sugar levels can be kept as close to normal as possible. Here are a few tips on making healthy food choices for the entire family. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to add variety to your meals. Choose more non-starchy vegetables that have lots of vitamins and minerals such as spinach, carrots, broccoli or green beans with meals. Choose whole grain foods instead of processed grain products like white bread, white rice or regular pasta. Try brown rice with your stir-fry or whole wheat spaghetti with your favorite pasta sauce. Include fish in your meals two to three times a week and choose lean meats like chicken and turkey without the skin. To prepare meats and fish with less fat, trim any visible fat and use low-fat cooking methods such as broiling, grilling, roasting, poaching or stir-frying. Include dried beans (like kidney or pinto beans) and lentils in your meals. Choose low fat dairy products such as milk, yogurt and cheese (1 percent fat or less). Choose liquid oils such as canola, olive or peanut oil for cooking, instead of solid fats such as butter, lard and shortening. Remember that all fats are high in calories. If you're trying to lose weight, cut back on portion sizes of added fats. Choose fruit that is in-season for dessert – you'll get more flavor and pay less too! Try to cut back on high-calorie dessert and snack foods such as chips, cookies, cakes and ice cream that give you and your family little nutrition. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. Control your portion sizes. Remember that the amount of food you eat is important in getting to and staying at a healthy weight. Even eating too much healthy food can lead to weight gain.

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Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Session 12

Breast Cancer Breast cancer is the most common type of cancer among women in the United States. Cancer is a group of diseases. It occurs when cells become abnormal and divide without control or order. Every organ in the body is made up of various kinds of cells. Cells normally divide in an orderly way to produce more cells only when they are needed. This process helps keep the body healthy. If cells divide when new cells are not needed, they form too much tissue, called a tumor, can be benign or malignant. 

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Benign tumors are not cancer. They can usually be removed, and in most cases, they don’t come back. Most important, the cells in benign tumors do not invade other tissues and do not spread to other parts of the body. Benign breast tumors are not a threat to life. Malignant tumors are cancer. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how breast cancer spreads and forms secondary tumors in other parts of the body. The spread of the cancer is called metastasis.

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules and bulbs are all linked with thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts. There are no muscles in the breast but muscles lie under each breast and cover the ribs. Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found under the arm, above the collar bone, and in the chest. Lymph nodes are also found in many other parts of the body There are more than a hundred different types of cancer, including several types of breast cancer. The most common types of breast cancer begins on the lining of the ducts and is called ductal carcinoma. When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body – other lymph nodes and other organs, such as the bones, liver or lungs. Cancer that spreads is the same disease and has the same name as the original (primary cancer). When breast cancer spreads is called metastatic breast cancer, even though the secondary tumor is in another organ. Doctors may call this problem ¨distant¨ disease. When breast cancer is found and treated early a woman has more treatment choices and a good chance of complete recovery, so it is important to detect breast cancer as

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

early as possible. The National Cancer Institute encourages women to take an active part in early detection. They should talk with their doctor abourt this disease, the symptoms to watch for an appropriate schedule of checkups. The doctors advice will be based on the woman´s age, medical history and other factors. Women should ask the doctor about:   

Mammograms (x-ray of the breast) Breast exams by a doctor or nurse and Breast self examination (BSE)

A mammogram is a special kind of X- ray it is different from a chest X-ray or X –rays of other part of the body. Mammography involves two X-rays of each breast one taken from side and one from the top. The breast must be squeeze between two plates for the picture to be clear. While this squeezing may be a bit uncomfortable, it lasts only a few seconds. In many cases can show breast tumors before they cause symptoms or can be felt. A mammogram can also show small deposits of calcium in the breast. A cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.

Mammography should be done only by specially trained people using machines designed just for taking X-rays of the breast. The pictures should be checked by a qualified radiologist. Women should talk to their doctor or called the cancer information service for help in finding out where to get a mammogram. Mammography is an excellent tool, but we know that it cannot find every abnormal area in the breast. So another important step in early detection is for women to have the breast examined regularly by doctor or nurse. Between visits to the doctor women should examine their breasts every month. It is important to remember that every woman´s breasts are different. And each woman´s breasts change because of age, the menstrual cycle, pregnancy, menopause or taking birth control pills or other hormones. It is normal for the breasts to feel lumpy and uneven. Also, it´s common for a woman´s breasts to be swollen and tender right before or during her menstrual period. Early breast cancer usually does not cause pain. In fact, when it first develops, breast cancer may cause no symptoms at al. But as the cancer grows, it can cause changes that women should watch for:    

A lump or thickening in or near the breast or in the underarm area; A change in the size or shape of the breast; A discharge from the nipple; or A change in the color or feel of the skin of the breast, aureola, or nipple (dimpled, puckered or scaly)

A woman should see her doctor if she notices any of these changes. Most often, they are not cancer, but only a doctor can tell for sure.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

An abnormal area on a mammogram, a lump, or other changes in the breast can be caused by cancer or by other less serious problems. To find out the cause of any of these signs or symptoms, a woman´s doctor does a careful physical exam and asks about her personal and family medical history. In addition to checking general signs of health, the doctor may do one or more of the breast exams described below to help make a diagnosis.   

Palpation The doctor can tell a lot about a lump – its size, its texture, and whether it moves easily – by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones. Mammography X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional views may be needed. Ultrasonography Sometimes the doctor orders ultrasonography which can often show whether a lump is solid or filled with fluid. This exam uses high frequency sound waves, which cannot be heard by humans. The sound waves enter the breast and bounce back. The pattern of their echoes produces a picture called a sonogram, which is displayed on a screen. This exam is often used along with mammography.

Often, the doctor must remove fluid or tissue from the breast to make a diagnosis 

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Aspiration or needle biopsy. The doctor uses a needle to remove fluid or a small amount of tissue from a breast lump. This procedure may show whether the lump is a fluid –filled cyst (not cancer) or a solid mass (which may or may not be cancer). The material removed in a needle biopsy goes to a lab to be checked for a cancer cells. Surgical biopsy. The doctor cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.

Many treatment methods are used for breast cancer. Treatment depends on the size and location of the tumor in the breast, the results of lab tests (including hormone receptor tests) done on the cancer cells, and the stage (or extent) of the disease. Methods of treatment for breast cancer are local or systemic. Local treatments are used to remove, destroy or control cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments. A patient may have just one form of treatment or a combination, depending on her needs. Surgery is the most common treatment for breast cancer. An operation to remove the breast is a mastectomy; an operation to remove the cancer but not the breast is called breast-sparing surgery which is usually followed by radiation therapy to destroy any cancer cells that may remain in the area. In radiation therapy (also called radiotherapy), high-energy rays are used to damage cancer cells and stop them from growing. Radiation may come from a machine outside the body (external radiation). It can also come from radioactive materials placed directly in the breast in thin plastic tubes (implant radiation). Chemotherapy is the use of drugs to kill cancer cells. In most cases, breast cancer is treated with a combination of drugs. The drugs may be given by mouth or by injection into the vein or muscle. Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Session 13 STD´S

If you have sex, you may also have an STD, with subtle or noticeable STD symptoms. Straight or gay, married or single, you're vulnerable to STDs and STD symptoms, whether you engage in oral, anal or vaginal sex. Although condoms are highly effective for reducing transmission of STDs, keep in mind that no method is foolproof. STD symptoms aren't always obvious. If you think you have STD symptoms or have been exposed to an STD, see a doctor. Some STDs can be treated easily and eliminated, but others require more involved, long-term treatment. Either way, it's essential to be evaluated, and — if diagnosed with an STD, also known as a sexually transmitted infection (STI) — get treated. It's also essential to inform any partners so that they can be evaluated and treated. If untreated, STDs can increase your risk of acquiring another STD such as HIV. This happens because an STD can stimulate an immune response in the genital area or cause sores, either of which might make HIV transmission more likely. Some untreated STDs can also lead to infertility. STIs often asymptomatic You could have an STI and be asymptomatic — without any signs or symptoms. In fact, this happens with a lot of STIs. Even though you have no symptoms, you're still at risk of passing the infection along to your sex partners. That's why it's important to use protection, such as a condom, during sex. And visit your doctor on a regular basis for STI screening, so you can identify a potential infection and get treated for it before passing it along to someone else. Some of the following diseases, such as hepatitis, can be transmitted without sexual contact. Others, such as gonorrhea, can only be transmitted through sexual contact. Chlamydia symptoms Chlamydia is a bacterial infection of your genital tract. Chlamydia may be difficult for you to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, they usually start one to three weeks after you've been exposed to chlamydia. Even when signs and symptoms do occur, they're often mild and passing, making them easy to overlook. Signs and symptoms may include:      

Painful urination Lower abdominal pain Vaginal discharge in women Discharge from the penis in men Pain during sexual intercourse in women Testicular pain in men

Gonorrhea symptoms

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

Gonorrhea is a bacterial infection of your genital tract. The first gonorrhea symptoms generally appear within two to 10 days after exposure. However, some people may be infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea may include:      

Thick, cloudy or bloody discharge from the penis or vagina Pain or burning sensation when urinating Abnormal menstrual bleeding Painful, swollen testicles Painful bowel movements Anal itching

Trichomoniasis symptoms Trichomoniasis is a common STI caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. The organism usually infects the urinary tract in men, but often causes no symptoms in men. Trichomoniasis typically infects the vagina in women. When trichomoniasis causes symptoms, they may range from mild irritation to severe inflammation. Signs and symptoms may include:       

Clear, white, greenish or yellowish vaginal discharge Discharge from the penis Strong vaginal odor Vaginal itching or irritation Itching or irritation inside the penis Pain during sexual intercourse Painful urination

HIV symptoms HIV is an infection with the human immunodeficiency virus. HIV interferes with your body's ability to effectively fight off viruses, bacteria and fungi that cause disease and it can lead to AIDS, a chronic, life-threatening disease. When first infected with HIV, you may have no symptoms at all. Some people develop a flu-like illness, usually two to six weeks after being infected. Early signs Early HIV signs and symptoms may include:      

and

symptoms

Fever Headache Sore throat Swollen lymph glands Rash Fatigue

These early signs and symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, you are very infectious. More-persistent or -severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic signs and symptoms such as:     

Swollen lymph nodes — often one of the first signs of HIV infection Diarrhea Weight loss Fever Cough and shortness of breath

Later stage HIV Signs and symptoms of later stage HIV infection include:       

Persistent, unexplained fatigue Soaking night sweats Shaking chills or fever higher than 100.4 F (38 C) for several weeks Swelling of lymph nodes for more than three months Chronic diarrhea Persistent headaches Unusual, opportunistic infections

Lic. G. Vallejos, Lic. V. Morales, Lic. M. Quispe, Lic. E.Matsusita

infection

Universidad de San Martin de Porres Facultad de Medicina Humana

MEDICAL ABBREVIATIONS a.c.

before meals

_c

with

Dx

diagnosis

ACLS

advanced cardiac life support

c-spine

cervical spine

ED

emergency department

AD

right ear

CA

cancer

EEG

electroencephalogram

ADL

activities of daily living

CAD

coronary artery disease

EENT

eye, ear, nose, throat

ad lib

as desired

CAT

computerized axial tomography

electrocardiogram

AMA

against medical advine

CBC

complete blood count

EKG / ECG

chief complaint

esophageal obturator airway

acute myocardial infarction

CC

EOA

AMI

coronary heart disease

estimated

alert & oriented to person, time, place

CHD

est

AOx3

congestive heart failure

endotracheal

acute respiratory distress syndrome

CHF

ET

ARDS

complains of

estimated time of arrival

left ear

c/o

ETA

AS

chronic obstructive pulmonary disease

ethyl alcohol, intoxicated

both ears

COPD

ETOH

AU

cerebrospinal fluid

foreign body obstructed airway

axillary

CSF

FBOA

Ax

cerebrovascular accident (stroke)

fasting blood sugar

twice a day

CVA

FBS

bid

cardiovascular unit

family history

basic life support

CVU

FH

BLS

discontinue

fetal heart sounds

bowel movement

d/c

FHS

BM

dilation & curettage

fever undetermined origin

bag of waters

D&C

FUO

BOW

do not resuscitate

fracture

blood pressure

DNR

Fx

B/P

dead on arrival

gall bladder

beats per minute

DOA

GB

bpm

date of birth

gastrointestinal

bedrest

DOB

GI

BR

delirium tremens

genitourinary

bathroom privileges

DT's

GU

BRP

distilled water

drop(s)

breath sounds

DW

gtt(s)

BS

5% dextrose in water

hour of sleep, bedtime

bag-valve-mask

D5W

hs

BVM

ENGLISH III

Universidad de San Martin de Porres Facultad de Medicina Humana

Hct

hematocrit

Hgb

hemoglobin

HIV HOB HR Hx I&O ICP ICU IM IV IVP K+ KCl KUB L L&D

human immuno virus head of bed heart rate history intake and output intracranial pressure intensive care unit intramuscular intravenous intravenous pyelogram potassium potassuim chloride kidney, ureter, bladder lumbar labor and delivery

LUQ, LUL

left upper quadrant (abdomen), lobe (lung)

OD

right eye, overdose

MA

mental age

os

mouth

MAST

medical antishock trousers

OS

left eye

MCI

mass casualty incident

OT

occupational therapy

meds

medications

OU

both eyes

MI

myocardial infarction

_p

after

MICU

mobile intensive care unit

P

pulse

MS

morphine sulfate, multiple sclerosis

P&A

percussion & auscultation

MVA

motor vehicle accident

PAC

premature atrial contraction

NVD

nausea, vomiting, diarrhea

palp

palpation

Na+

sodium

PAT

paroxysmal atrial tachycardia

NaCl

sodium chloride

pc

after meals

N/C

nasal cannula, no complaints

pCO2

partial pressure of carbon dioxide

neg

negative

PDR

physician's desk reference

NGT

nasogastric tube

PE

physical exam, pulmonary embolism

nitro

nitroglycerine

per

by or through

NKA

no known allergies

PERL(A)

pupils equal & reactive to light (and accommodation)

noct

night

PET

positron emission tomography

NPO

nothing by mouth

PH

past history

NS

normal saline

pH

hydrogen ion concentration

lac

laceration

LD

lethal dose

LLQ, LLL

left lower quadrant (abdomen), lobe (lung)

LMP

last menstrual period

NSR

normal sinus rhythm

PID

pelvic inflammatory disease

LOC

level of consciousness

O

oxygen

PKU

phenylketonuria

LP

lumbar puncture

OB

obstetrics

po

by mouth

ENGLISH III

Universidad de San Martin de Porres Facultad de Medicina Humana

pO2

partial pressure of oxygen

Rx

take (prescription)

tr

tincture

PPD

purified protein derivative (TB test)

_s

without

TT

tetanus toxiod

prn

as needed, whenever necessary

S&S

signs & symptoms

TUR

transurethral resection

pt

patient, pint

Ss

1/2

TX

traction

PT

physical therapy

SA

sinoatrial

UA

urinalysis

PVC

premature ventricular contraction

SB

small bowel

umb

umbilicus

Px

physical exam, prognosis

SIDS

sudden infant death syndrome

unc.

unconscious

q

every

Sig:

label/write

unk

unknown

qd

every day

SL

sublingual

ung

ointment

qh

every hour

SOB

shortness of breath

URI

upper respiratory infection

q2h, q3h, ...

every two hours, every three hours,...

sp. gr.

specific gravity

US

ultrasonic

SQ, sub q

subcutaneous

USP

United States Pharmacopeia

qid

four times a day

stat

immediately

UTI

urinary tract infection

qod

every other day

STD

sexually transmitted disease

V fib

ventricular fibrillation

qs

quantity sufficient

SVT

supraventricular tachycardia

V tach

ventricular tachycardia

R

respirations, rectal

Sx

symptoms

VD

venereal disease

RBC

red blood cell/count

T

temperature, thoracic

vo

verbal order

RL

ringer's lactate

T&A

tonsillectomy and adenoidectomy

V/S

vital signs

RLQ, RLL

right lower quadrant (abdomen), lobe (lung)

tab

tablet

WBC

white blood cell/count

RML

right middle lobe (lung)

TB

tuberculosis

w/c

wheelchair

R/O

rule out

TIA

transient ischemic attack

WNL

within normal limits

ROM

range of motion

tid

three times a day

y/o

year(s) old

RUQ, RLL

right upper quadrant, lobe

TMJ

temporomandibular joint

TPR

temperature, pulse, respirations

ENGLISH III

Universidad de San Martin de Porres Facultad de Medicina Humana

ENGLISH III