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Corey A. Wulf, MD

• Clinical Professor, Sanford School, University of South Dakota,
• Vermillion, South Dakota

Anxiety fl Review Tell the parent/s to review the Understanding Anxiety handout Understanding after the session muscle relaxant cyclobenzaprine dosage purchase 60ml rumalaya liniment with amex, and finally muscle relaxant ratings rumalaya liniment 60ml overnight delivery, thank the parent enthusiastically for Anxiety Handout making the time to talk with you infantile spasms 6 months old generic 60 ml rumalaya liniment with mastercard. Helpful Tips fl If this is too much material muscle relaxant soma discount rumalaya liniment 60ml visa, it can be covered in two (or more) sessions muscle relaxant juice cheap 60ml rumalaya liniment with mastercard. The most important concepts are the false alarm idea and the importance of practice and monitoring muscle relaxant gas 60 ml rumalaya liniment free shipping. Many families are motivated for their child to improve, but do not have the time or resources to help. A better approach is to describe that treatment must be an important goal for both the parent and the child by using the words "high priority" instead. Parents should be encouraged to inform their therapist if they are not finding enough time to practise outside of the sessions, as well as to discuss any other difficulties they are having with treatment as such difficulties arise. Panic For a child with panic disorder, the "alarm" metaphor can be used to describe what happens when the child begins to notice sensations in his or her body (sweaty palms, heart beating, rapid breathing). The panic attack itself is really a "red light" alarm for the child, whereas the worry about having another panic attack may be more of a "yellow light" alarm. The false alarm of a panic attack may feel to the child very similar to a real alarm (having a heart attack, going crazy), so this may be a good time to identify the core fear the child has attached to the panic attacks. Because the alarm is so distressing, the child tries to turn it off by doing something in response (compulsions). However, the more he or she tries, the louder the alarm becomes and the more often it goes off. This is a good time to identify the behaviours that the child has developed to try and "turn off the alarm. Separation Anxiety For a child with separation anxiety, the alarm is likely to be false and the parent/child are likely to be fine. It can feel very real in the situation due to real alarms in the past related to epilepsy but nevertheless should be considered as false. Epilepsy At times it is very hard to distinguish between real and false alarms and some children have non-epileptic seizures which makes it even more complicated. If it is difficult to distinguish between the two, discuss the specific case with the neurologist. Goals fl the child will feel more comfortable through introductory get-acquainted activities fl the child will understand basic information about the treatment of anxiety fl the child will learn about the importance of homework, and regular attendance fl the parent/s and child will know how to use the Fear Thermometer Materials fl Fear Thermometer (p. Main steps fl Set an Agenda Remember to start by setting an agenda and reviewing any practice assignments. Discuss Ratings any difficulties with monitoring, usefulness of monitoring, what is being monitored etc. Explain that the main principle of the work you will be doing together is that it is possible to reduce feelings of anxiety in challenging situations by changing how one copes with and responds to those situations. Let the child know that during your work together, you might focus on skills that involve the ways he or she responds to anxiety, thinks about things, or both, and their parents will support them in this. Continue to reParticipation open this invitation periodically until the child begins to share his or her questions and concerns. Stress to the child that information from his or her point of view is very important. Be Treatment sure to cover the following points: Structure fl the activities that will happen in the various sessions. There is now strong research evidence that anxiety interventions can be delivered by the parent without the young person needing to be present. If the assessment indicates that this is a preferable option, then still use the following protocol but work via the parents. Example Script If you/your child were at home watching a favourite film, how scared or nervous would you/they be thenfl You may need to practise once or twice with sample anchors to make sure the child is giving accurate ratings. Ask the child what the number he or she chose means, in order to be sure he or she understands the concept. Ask the child to indicate, using the Fear Thermometer how afraid he or she would be of several other situations. Goals fl the child will identify situations that make him or her anxious fl the child will describe his or her reactions to signs of anxiety fl Together you will produce a list of feared items that will guide the practice exercises for subsequent modules fl the child will be interested in participating in and learning more about treatment Materials fl Fear Ladder (blank and unrated) (p. You will want to learn more about the types of situations that trigger anxiety, how the child reacts to anxiety, and how the child responds to the anxietyprovoking situations. This part of the programme is one of the most important parts of working together, and the better you do on this task together, the better the programme is likely to work. I know you can do really well with this, and the more you can help me learn about your anxious feelings, the more successful we will be in making those feelings go away fl Review Fear Review the Fear Thermometer if needed. You may need to Thermometer practise once or twice with examples to make sure the child can provide accurate ratings. Remember that it is better if the child can use the full range of the scale and not just the extremes. For example, if the primary problem is panic disorder the list should contain only items or triggers related to feelings of panic. If social phobia is the primary concern, the list should contain only items related to social or evaluative fears. If the primary problem is associated with anxiety related to the epilepsy the list should contain only items related to the epilepsy. As you agree on each item generated by the child or by you, tell the family to write it down on an index card/strip of paper and put it aside. The real trick to this is making a list of small steps on the way to conquering the fear. So, for example, if someone had a dog phobia, we might make a list that starts with looking for pictures of cute puppies on the internet and this would generate a fear of 1 perhaps on the fear ladder; step 2 might be looking at pictures of bigger dogs and then you would build up slowly to perhaps looking a dogs passing by which might be step 7 or 8, ending with patting a dog in the street at step 10. Can we start just by thinking of the situations that your child finds frighteningfl For a specific phobia or discrete social phobia, try to identify as many variations of the particular stimulus as possible. To introduce the procedure, model the process by imagining yourself in an anxietyprovoking situation while describing each step. The child can then be invited to "tag along" as you repeat the imagining process with another situation and, finally, to imagine himor herself in an anxiety-provoking situation, with you providing prompts as needed. This latter approach can be done by changing small features of the stimulus/situation. If you have gaps in the ratings associated with each item (2 or 3 point span with no items), go back to earlier steps, trying to generate items that fall into the missing scale points. Explain that you will now meet alone with his or her parent for a few moments and then you will meet with everyone together. Choose 10-12 items that (a) translate relatively easily into exposure or role play exercises and (b) suggest a logical sequence or progression of these exercises. Seek input from the parent or child when you are unclear about specific properties of an item being considered. In some rare cases, you will be forced to choose fewer than 10 items, but first be sure you have been as thorough as possible on earlier steps. For example, with social anxiety, try to put all the cards related to assertiveness together, then all the cards related to speaking in public, then all the cards related to conversations, etc. The number within each pile can then be reduced by taking out things that are too similar in content or severity. For example, it is best to keep things within a theme that are different in severity rating or different enough in content to be important for later practice exercises. If there appears to be Rewards low motivation for the child, then it may be useful to plan to discuss Rewards next session. It can be helpful to send the family a Fear Thermometer to use as a guide when completing the Fear Ladder. Special Cases Generalised the items on the ladder for generalised anxiety disorder should Anxiety focus as much as possible on feared consequences of the worry. For example, it is better to have an item such as "getting a bad grade" than "worrying about schoolwork. Therefore, you may need to conduct an interoceptive assessment to create the Fear Ladder. Explain to the child that you want to have a better understanding of what his or her panic attacks are like, so that you can practise together learning that panic attacks are uncomfortable, but not dangerous, and work together to complete the Learning Your Anxious Feelings worksheet. It is useful to have a list of both the feared stimuli and the behavioural responses the child currently engages in to neutralise the fear (compulsions). Practice will involve repeated exposure to the feared situations without engaging in the ritualised neutralising behaviours. Posttraumatic For a child with Posttraumatic stress, the Fear Ladder may include Stress "trauma reminder" items that have been inaccurately associated with the traumatic event (for example, all playgrounds for a child abused on a playground, or all men for a child whose assailant was male). However, actual people and places involved in the traumatic event that may truly be dangerous are not included. Keep in mind that these "trauma reminders" can be addressed using the Fear Ladder after the trauma narrative has been completed, and the specific memories of the traumatic event, which go in the narrative, need not be included on the Fear Ladder. Separation Anxiety For a child with separation anxiety, the child may not be intrinsically motivated to do a Fear Ladder and rewards will be particularly helpful. In most cases, separation anxiety will be due to a fear of something bad happening to their parent or to themselves during the separation. Anxiety specific to It may be the case that a young person with epilepsy has separation Epilepsy anxiety, posttraumatic stress etc. For example, they may have never slept in a room without a monitor and it would not be considered safe for them to do so. It is important to separate out real safety needs from excessive anxiety in the context of epilepsy. For example, a young person may fear falling over and it may be the case they are more likely to fall over than others. It is still possible to do a Fear Ladder but in conjunction with input from the neurological team. Goals fl the child will practise exposure to feared items or situations fl Over the course of several attempts, the child will show decreased ratings for these items or situations fl the child will understand the relationship between the practice performed and the decreased anxiety Materials fl Fear Thermometer and Fear Ladder (2 unrated copies, for anxiety/trauma), Feelings Thermometer (for depression) (pp. Main steps fl Set an Agenda Remember to start by setting an agenda together and by reviewing any practice assignments. If you have covered the Learning about Anxiety Module with the family, you can tie in concepts already covered. If necessary, discuss and modify the goal so that it is not so hard that the child will refuse. For extended or continuous behaviours, such as standing in a dark room, giving a speech, or touching a feared object, it is best to use the Startand-Stop Practice Record. Date the Practice Record, and write the name of the practice item in the leftmost empty space. During discrete exposure practices, take fear ratings only before and after each trial. During continuous exposure practices, take a rating when you start, then take additional fear ratings at about one minute intervals during the exercise (intervals can be longer if the exposure might run longer than 10 minutes), and take a final rating as you stop. Repeat the exposure until the fear rating is a 3 or less for items starting at a 5 or above, 2 or less for items starting at 4 or below, or until 30 minutes has elapsed. When finished, draw one line to connect the values within each trial and another line to connect the "before" or "start" values across trials. If fear ratings decreased Practice during the practice, ask the child what happened to his or her anxiety. Ask the child if he or she noticed whether the practice gets easier with repetition. Assign exposure practice to be Practise at Home completed during the week by filling out a new Practice Record. Typically, the child should be asked to practise on at least 4 different days that week. On the Practice Record, write the items selected and the appropriate instructions. If the Practice Record is too difficult for the child to use, have a parent assist. It may be necessary to give the parent a demonstration of how to use the form by doing a "minipractice" together. Make sure the parent is familiar with the concepts so that he or she can assist the child at home if needed. Helpful Tips fl Practice should progress from easy items to more challenging items across sessions. Special Cases Panic You will be using the Fear Ladder you created from information gathered in the interoceptive assessment. Remind the child that the goal of practising these feelings is to learn the difference between a real and a false alarm, and to get used to the feelings so that they no longer provoke panic attacks. When starting the practice, ask the child to focus on his or her physical sensations and to give a cue. Start taking ratings at that point, and remind the child to focus on the fear and not to distract themselves.

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The dissolved mixture is called a(n) and is taken at . Bromelain and Arnica Montana are herbal products that can be described as all of the following except: a. Each chapter begins with a description of normal structure and function because these form the basis for all medical studies. Identify and use the roots pertaining to the cardiovascular and lymphatic systems. This system forms a continuous circuit that delivers oxygen and nutrients to Ball cells and carries away waste products. Also functioning in circulation is the lymphatic system, which drains fluid and proteins from the tissues and returns them to the bloodstream. The Heart the heart is located between the lungs, with its point or apex directed toward the left (Fig. This is lined on the inside with a thin endocardium and is covered on the outside with a thin epicardium. The interventricular septum separates the two ventricles; the interatrial septum divides the two atria. The right side pumps blood to the lungs to be oxygenated through the pulmonary circuit. Blood Flow Through the Heart the pathway of blood through the heart is shown by the arrows in Figure 9-2. The right atrium receives blood low in oxygen from all body tissues through the superior vena cava and the inferior vena cava. The blood then enters the right ventricle and is pumped to the lungs through the pulmonary artery. From here it enters the left ventricle and is forcefully pumped into the aorta to be distributed to all tissues. Each cusp is shaped like a half-moon, so these valves are described as semilunar valves. The valve at the entrance to the pulmonary artery is speciflcally named the pulmonic valve; the valve at the entrance to the aorta is the aortic valve. The loudest of these, the familiar lubb and dupp that can be heard through the chest wall, are produced by alternate closing of the valves. The second heart sound (S2) is produced when the valves leading into the aorta and pulmonary artery close. Each time the heart beats, both atria contract and immediately thereafter both ventricles contract. The wave of increased pressure produced in the vessels each time the ventricles contract is the pulse. Contractions are stimulated by a built-in system that regularly transmits electrical impulses through the heart. Although the heart itself generates the heartbeat, factors such as nervous system stimulation, hormones, and drugs can influence the rate and the force of heart contractions. Blood Pressure Blood pressure is the force exerted by blood against the wall of a blood vessel. Both systolic and diastolic pressures are measured and reported as systolic then diastolic separated by a slash, such as 120/80. Pressure is expressed as millimeters of mercury (mm Hg), that is, the height to which the pressure can push a column of mercury in a tube. Capillaries, the smallest vessels, through which exchanges take place between the blood and the tissues. The small veins that receive blood from the capillaries and drain into the veins are venules. All veins, except the pulmonary vein (and the umbilical vein in the fetus), carry blood low in oxygen. Nervous system stimulation can cause the diameter of a vessel to increase (vasodilation) or decrease (vasoconstriction). The Lymphatic System the lymphatic system is a widely distributed system with multiple functions (Fig. Its role in circulation is to return excess fluid and proteins from the tissues to the bloodstream. Everyday examples are graham cracker, genus and species names of microorganisms Ferris wheel, and boycott. In A curie is a measure of radiation, derived from treatment, Doppler echocardiography is named the name of Marie Curie, a co-discoverer of for a physicist of the 19th century. The graaflan follicle in the ovary surwith more descriptive ones; for example, audirounds the developing egg cell. The eustachian tory tube instead of eustachian tube, ovarian foltube connects the middle ear to the throat. Shown are the cuff, the bulb for inflating the cuff, and the manometer for measuring pressure. The right lymphatic duct drains the upper right side of the body and empties into the right subclavian vein. Another function of the lymphatic system is to absorb digested fats from the small intestine (see Chapter 12). One other major function of the lymphatic system is to protect the body from impurities and invading microorganisms. Along the path of the lymphatic vessels are small masses of lymphoid tissue, the lymph nodes (see Fig. The lymph nodes and the remainder of the lymphatic system also play a role in immunity (see Chapter 10). Other organs and tissues of the lymphatic system include the tonsils, located in the throat (described in Chapter 11), the thymus gland in the chest, and the spleen in the upper left region of the abdomen (see Fig. All except the pulmonary and umbilical arteries carry oxygenated blood (root arter, arteri/o). It divides into the right and left bundle branches, which descend along the two sides of the septum; the bundle of His. The two loudest sounds are produced by alternate closing of the valves and are designated S1 and S2. All except the pulmonary van and umbilical veins carry blood low in oxygen (root ven, phleb/o). This system also aids in absorption of fats from the digestive tract and participates in immunity. Pertaining to the myocardium (-al; ending differs from adjective ending for the heart) 7. Pertaining to a valve (-ar) Following the example, write a word for each of the following deflnitions pertaining to the tissues of the heart: 11. Vasospasm (vas-o-spazm) means sudden contraction of a(n) . Plastic repair of a vessel Use the appropriate root to write a word with each of the following meanings: 19. Identify and deflne the root in each of the following words: Root Meaning of Root 7. Inflammation of a tonsil Clinical Aspects of the Circulatory System Atherosclerosis the accumulation of fatty deposits within the lining of an artery is termed atherosclerosis (Fig. This type of deposit, called a plaque, begins to form when a vessel receives tiny injuries, usually at a point of branching. Plaques gradually thicken and harden with flbrous material, cells, and other deposits, restricting the lumen (opening) of the vessel and reducing blood flow to the tissues, a condition known as ischemia. Other risk factors for atherosclerosis include smoking, high blood pressure, poor diet, inactivity, stress, and family history of the disorder. Philadelphia: Lippincott Williams & A Fat deposits B Occlusion C Blood clot Wilkins, 2000. Thrombosis and Embolism Atherosclerosis predisposes a person to thrombosis, the formation of a blood clot within a vessel. The clot, called a thrombus, interrupts blood flow to the tissues supplied by that vessel, resulting in necrosis (tissue death). Blockage of a vessel by a thrombus or other mass carried in the bloodstream is an embolism, and the mass itself is called an embolus. Usually the mass is a blood clot that breaks loose from the wall of a vessel, but it may also be air (as from injection or trauma), fat (as from marrow released after a bone break), bacteria, or other solid materials. Often a venous thrombus will travel through the heart and then lodge in an artery of the lungs, resulting in a life-threatening pulmonary embolism. Aneurysm An arterial wall weakened by atherosclerosis, malformation, injury, or other causes may balloon out, forming an aneurysm. In simple terms, hypertension is deflned as a systolic pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg. Hypertension causes the left ventricle to enlarge (hypertrophy) as a result of increased work. Drugs that are used include diuretics to eliminate fluids, vasodilators to relax the blood vessels, and drugs that prevent the formation or action of angiotensin, a substance in the blood that normally acts to increase blood pressure. This is a feeling of constriction around the heart or pain that may radiate to the left arm or shoulder, usually brought on by exertion. Often there is anxiety, diaphoresis (profuse sweating), and dyspnea (difflculty in breathing). Other drugs may be used to regulate the heartbeat, strengthen the force of heart contraction, or prevent formation of blood clots. If further intervention is required, the blocked vessel may be surgically bypassed with a vascular graft (Fig. Degenerative changes in the arteries predispose a person to thrombosis and sudden occlusion (obstruction) of a coronary artery. Patient outcome is based on the degree of damage and early treatment to dissolve the clot and re-establish normal heart rhythm. Bradycardia is a slower-than-average rate, and tachycardia is a higher-than-average rate. Cardioversion is the general term for restoration of a normal heart rhythm, either by drugs or application of electric current. Heart failure is one cause of shock, a severe disturbance in the circulatory system resulting in inadequate delivery of blood to the tissues. Heart failure is treated with rest, drugs to strengthen heart contractions, diuretics to eliminate fluid, and restriction of salt in the diet. The most common type of congenital heart defect is a hole in the septum (wall) that separates the atria or the ventricles. The result of a septal defect is that blood is shunted from the left to the right side of the heart and goes back to the lungs instead of out to the body. Failure of a valve to open or close properly is evidenced by a murmur, an abnormal sound heard as the heart cycles. Still other congenital defects result from failure of fetal modiflcations to convert to their adult form at birth. Blood can then flow from the aorta to the pulmonary artery and return to the lungs. Scar tissue fuses the leaflets of the valve, causing a narrowing or stenosis that interferes with proper function. Severe cases of rheumatic heart disease may require surgical correction or even valve replacement. The incidence of rheumatic heart disease has declined with the use of antibiotics. Disorders of the Veins A breakdown in the valves of the veins in combination with a chronic dilatation of these vessels results in varicose veins. Contributing factors include heredity, obesity, prolonged standing, and pregnancy, which increases pressure in the pelvic veins. This condition can impede blood flow and lead to edema, thrombosis, hemorrhage, or ulceration. Treatment includes the wearing of elastic stockings and, in some cases, surgical removal of the varicosities, after which collateral circulation is established. Phlebitis is any inflammation of the veins and may be caused by infection, injury, poor circulation, or damage to valves in the veins.

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His postoperative recovery was unremarkable, although he was at risk for deep vein thrombosis, that is, blood clots in his legs. He was discharged to a rehabilitation facility for several weeks of physical therapy and assistance with activities of daily living, such as personal hygiene, dressing, eating, ambulating, and toileting. The adjective for the operative time span from decision for surgery to placement on the operating room table is . The adjective for the operative time span from placement on the operating room table until transfer to postanesthesia recovery unit or intensive care unit is . The adjective for the operative time span from admission to postanesthesia is . Cells carry out metabolism, the sum of all of the physical and chemical activities that occur in the body. The main carbohydrate is the sugar glucose, which circulates in the blood to provide energy for the cells. Some hormones are derived from lipids, and adipose (fat) tissue is designed to store lipids. Within the cytoplasm that fllls the cell are subunits called organelles, each with a speciflc function. Genes control the formation of enzymes, the catalysts needed for metabolic reactions. When a body cell divides, by the process of mitosis, the chromosomes are doubled and then equally distributed to the two daughter cells (Fig. Sex cells (egg and sperm) divide by another process (meiosis) that halves the chromosomes in preparation for fertilization. Tissues Cells are organized into four basic types of tissues that perform speciflc functions (Fig. Included are adipose (fat) tissue, cartilage, bone (Chapter 19), and blood (Chapter 10). It coordinates and controls body responses by the transmission of electrical impulses. Mucous membranes secrete mucus, a thick fluid that lubricates surfaces and protects underlying tissue. Serous membranes, which secrete a thin, watery fluid, line body cavities and cover organs. The term is also ratory, as compared with studies done in livapplied to the specimen itself. Such combined forms that routinely appear as word endings will simply be described and used as sufflxes in this book. Exercise 4-2 Match the following terms and write the appropriate letter to the left of each number: 1. The ending -ose indicates that maltose is a(n) . Identify and deflne the root in each of the following words: Root Meaning of Root 7. The four basic tissue types are . The simple sugar that is the main energy source for metabolism is . The control center of the cell is the . The number of chromosomes in each human cell aside from the sex cells is . An organic compound that speeds the rate of metabolic reactions is a(n) . A cytotoxic substance is damaging or poisonous to . The term hydration refers to the relative amount of . A myxocyte is found in tissue that secretes . The study of form and structure . The formation of cells (use -genesis as an ending) . The specimens included several small containers of pink-tinged cloudy fluid labeled pelvic lavage (washing) for cytology, which R. She took all of the tissue specimens to the pathology laboratory for gross and microscopic evaluation. A test tube half-fllled with a cloudy gel and a cotton-tipped applicator labeled swab of pelvic fluid for culture and sensitivity and Gram stain was taken to the microbiology laboratory to be streaked on a culture plate and incubated to look for growth. Any organisms that grew out would be Gram-stained and tested for sensitivity to antibiotics that might be used in treatment. Three words that contain a root that means attract, absorb: 11. Three words with a root that means formation, molding, development: 12. In this stance, the terms illustrated in Figure 5-1 and listed in Display 5-1 are used to designate relative position. A frontal plane, also called a coronal plane, is made at right angles to the midline and divides the body into anterior and posterior parts. A transverse plane passes horizontally, dividing the body into superior and inferior parts. Body Cavities Internal organs are located within dorsal and ventral cavities (Fig. The dorsal cavity contains the brain in the cranial cavity and the spinal cord in the spinal cavity (canal). The uppermost ventral space, the thoracic cavity, is separated from the abdominal cavity by the diaphragm. There is no anatomical separation between the abdominal cavity and the pelvic cavity, which together make up the abdominopelvic cavity. Positions In addition to the anatomical position, there are other standard positions in which the body is placed for examination or medical procedures. This responsiradial artery, radial vein, and radial nerve are bility is lightened somewhat by the fact that we parallel, and all are located along the radius of are bilaterally symmetrical. Vessels are commonly named for some internal organs such as the liver, spleen, the organ they supply: the hepatic artery and stomach, pancreas, and intestine, nearly everyvein of the liver, the pulmonary artery and vein thing on the right side can be found on the left as of the lungs, the renal artery and vein of the well. Many blood vessels and nerves are medical terminology is a snap, but it could paired. Abdominal cavity 1 Abdominal pelvic cavity Cranial cavity Dorsal cavity Diaphragm 2 Pelvic cavity Spinal cavity (canal) 4 Thoracic cavity Ventral cavity 3 5 9 6 8 7 1. Epigastric region Hypogastric region Left hypochondriac region Left iliac region Left lumbar region Right hypochondriac region Right iliac region Right lumbar region Umbilical region 4 1 7 5 2 8 6 3 9 1. As she fell, two other cyclists collided with her, sending all three crashing to the ground. Other injuries included a cut on her face and on her right arm and an obvious deformity to both her shoulder and knee. After her bleeding was controlled and her injured extremities were immobilized, she was transported to the nearest emergency department. During transport, the paramedic in charge radioed ahead to provide a prehospital report to the charge nurse. His report included the following information: occipital and frontal head pain; laceration to right temple, superior and anterior to right ear; lumbar pain; bilateral thoracic pain on inspiration at midclavicular line on right and midaxillary line on the left; dull aching pain of the posterior proximal right thigh; bilateral paresthesia (numbness and tingling) of distal lower legs circumferentially; varus (knock-knee) adduction deformity of left knee; and posterior displacement deformity of left shoulder. Before the procedure, the radiology technologist positioned a lead gonadal shield centered on the midsagittal line above B. The technologist knew that gonadal shielding is important for female patients undergoing imaging of the lumbar spine, sacroiliac joints, acetabula, pelvis, and kidneys. Shields should not be used for any examination in which an acute abdominal condition is suspected. The term for the time span between injury and admission to the emergency department is: a. A cervical collar was placed on the victim to stabilize and immobilize the . Shade the area of the bilateral paresthesia of the distal lower legs, circumferentially. Draw an arrow to show the direction of the posterior displacement of the left shoulder. Draw a flg leaf to show the gonadal shield on the midsagittal line above the symphysis pubis. More speciflc information about how diseases affect individual systems and how these diseases are treated will be presented in Part 3. Compare the common types of infectious organisms, and list some diseases caused by each. Diseases can Abe grouped into a number of different but often overlapping categories. Common examples include arthritis, cardiovascular problems, and certain respiratory disorders such as emphysema. Structural malformations such as congenital malformations, prolapse (dropping), or hernia (rupture) may also result in degenerative changes. Malnutrition caused by inadequate intake of nutrients or inability of the body to absorb and use nutrients also upsets metabolism. In sickle cell anemia, red Some are named for the places where they were blood cells become distorted into a crescent first found, such as Lyme disease for Lyme, shape when they give up oxygen. Having lost Connecticut; West Nile disease and Rift Valley their smooth, round form, the cells jumble tofever for places in Africa; and hantavirus fever gether, blocking small blood vessels and deprivfor a river in Korea. Lupus erythematodisease; and Hodgkin disease of the lymphatic sus, a systemic autoimmune disorder, is named system. Yellesions known as tubercles in the lungs and low fever, scarlet fever, and rubella (German other tissues. Skin anthrax produces lesions that measles) are named for colors associated with turn black, and its name comes from the same the pathology of these diseases. They may be named according to their shape and by the arrangements they form (see Fig. They also are described according to the dyes they take up when stained in the laboratory. The most common laboratory bacterial stain is the Gram stain, with which grampositive organisms stain purple and gram-negative organisms stain red (see Fig. Microorganisms often produce disease by means of the toxins (poisons) they release. The presence of harmful microorganisms or their toxins in the body is termed sepsis. When cells are injured, they release chemicals that allow blood cells and fluids to move into the tissues. This inflow of blood results in the four signs of inflammation: heat, pain, redness, and swelling. The sufflx -itis indicates inflammation, as in appendicitis (inflammation of the appendix) and tonsillitis (inflammation of the tonsils). Certain white blood cells are capable of engulfing these materials and destroying them internally (Fig. Phagocytic cells are found circulating in the blood, in the tissues, and in the lymphatic system (see Chapters 9 and 10). The remains of phagocytosis consist of fluid and white blood cells; this is called pus.

Urine is stored in the bladder until fullness stimulates a reflex contraction of the bladder muscle and expulsion of urine through the urethra spasms during meditation buy rumalaya liniment 60ml with amex. The voiding (release) of urine muscle relaxant on cns buy 60ml rumalaya liniment fast delivery, technically called micturition or urination muscle relaxant lodine purchase rumalaya liniment toronto, is regulated by two sphincters (circular muscles) that surround the urethra muscle relaxer zoloft order rumalaya liniment paypal. The upper sphincter muscle relaxant neck generic rumalaya liniment 60ml without a prescription, just below the bladder muscle relaxant used in surgery purchase genuine rumalaya liniment line, functions involuntarily; the lower sphincter is under conscious control. The trigone is a triangle in the floor sphincter of the bladder marked by the openings of the ureters and the urethra. It consists of water, elecU-rin trolytes, urea, other metabolic wastes, and pigment. A variety of other substances may appear in urine in cases of disease (root ur/o). Box 13-1 Words That Serve Double Duty Some words appear in more than one body fundus means the back part or base of an organ. The the uterus has a fundus, the upper rounded medulla of the kidney is the inner portion of portion farthest from the cervix, and so does the organ. The fundus of the eye, examined gland, ovary, and lymph nodes, may also be for signs of diabetes and glaucoma, is the individed into a central medulla and outer cornermost layer where the retina is located. There is a macula in the eye, term is also applied to the bone marrow, to the which is the point of sharpest vision. There is spinal cord, and to the part of the brain that also a macula in the ear, which contains recepconnects with the spinal cord, the medulla tors for equilibrium. There are ventrioften important to know the context in which a cles in the brain and in the heart. Use the appropriate root to write a word for each of the following deflnitions: 22. The infecting organisms are usually colon bacteria carried in feces, particularly Escherichia coli. Cystitis is more common in females than in males because the female urethra is shorter than the male urethra and the opening is closer to the anus. As in cystitis, signs of this condition include dysuria, painful or difflcult urination, and the presence of bacteria and pus in the urine, bacteriuria and pyuria, respectively. Urethritis is inflammation of the urethra, generally associated with sexually transmitted diseases such as gonorrhea and chlamydial infections (see Chapter 14). Glomerulonephritis Although the name simply means inflammation of the kidney and glomeruli, glomerulonephritis is a speciflc disorder that occurs after an immunologic reaction. It is usually a response to infection in another system, commonly a streptococcal infection of the respiratory tract or a skin infection. The symptoms are hypertension, edema, and oliguria, the passage of small amounts of urine. Because of damage to kidney tissue, blood and proteins escape into the nephrons, causing hematuria, blood in the urine, and proteinuria, protein in the urine. Blood cells may also form into small molds of the kidney tubule, called casts, which can be found in the urine. In such cases, urea and other nitrogen-containing compounds accumulate in the blood, a condition termed uremia. These compounds affect the central nervous system, causing irritability, loss of appetite, stupor, and other symptoms. There is rapid loss of kidney function with oliguria and accumulation of nitrogenous wastes in the blood. Failure of the kidneys to eliminate potassium leads to hyperkalemia, along with other electrolyte imbalances and acidosis. Renal failure may lead to a need for kidney dialysis or, ultimately, renal transplantation. Dialysis refers to the movement of substances across a semipermeable membrane; it is a method used for removing harmful or unnecessary substances from the body when the kidneys are impaired or have been removed (Fig. In hemodialysis, blood is cleansed by passage over a membrane surrounded by fluid (dialysate) that draws out unwanted substances. Urinary Stones Urinary lithiasis (condition of having stones) may be related to infection, irritation, diet, or hormone imbalances that lead to an increased level of calcium in the blood. Most urinary stones, or calculi, are formed of calcium salts, but they may be composed of other materials as well. Causes of stone formation include dehydration, infection, abnormal pH of urine, urinary stasis, and metabolic imbalances. This results in great pain, termed renal colic, and obstruction that can promote infection and cause hydronephrosis (collection of urine in the renal pelvis). Because they are radiopaque, stones can usually be seen on simple radiographs of the abdomen. A cellophane membrane separates the blood compartment and dialysis solution compartment. This membrane is porous enough to allow all of the constituents except the plasma proteins and blood cells to diffuse between the two compartments. A semipermeable membrane richly supplied with small blood vessels lines the peritoneal cavity. With dialysate dwelling in the peritoneal cavity, waste products diffuse from the network of blood vessels into the dialysate. External shock waves are used to crush stones in the urinary tract in a procedure called extracorporeal (outside the body) shock wave lithotripsy (crushing of stones). Cancer Carcinoma of the bladder has been linked to occupational exposure to chemicals, parasitic infections, and cigarette smoking. Often the cancer can be seen by viewing the lining of the bladder with a cystoscope (Fig. If treatment is not effective in permanently removing the tumor, a cystectomy (removal of the bladder) may be necessary. In this case, the ureters must be vented elsewhere, such as directly to the surface of the body through the ileum in an ileal conduit (Fig. Additional means for diagnosing cancer and other disorders of the urinary tract include ultrasound, computed tomography scans, and radiographic studies such as intravenous urography (Fig. It may also reveal disturbances in other systems when abnormal byproducts are eliminated in the urine. In a routine urinalysis, the urine is grossly examined for color and turbidity (a sign of bacteria); speciflc gravity (a measure of concentration) and pH are recorded; test are performed for chemical components such as glucose, ketones, and hemoglobin; and the urine is examined microscopically for cells, crystals, or casts. In more detailed tests, drugs, enzymes, hormones, and other metabolites may be analyzed and bacterial cultures may be performed. One end of the segment is sealed, and the other drains through an opening in the abdominal wall (see Fig. Causes an imbalance in the cellular environment with edema and other disturbances. Calyx Pyramids of medulla Renal capsule 2 Renal medulla Renal pelvis Renal cortex Ureter 5 3 6 4 1 7 1. A microscopic working unit of the kidney is called a(n) . The cluster of capillaries within the glomerular capsule is the . The tube that carries urine from the kidney to the bladder is the . The main nitrogenous waste product in urine is . A solid mold of the renal tubule found in the urine is a(n) . Deflne each of the following words, and give the meaning of the word parts in each. Six months ago she had been prescribed calcium supplements for low bone density. Urinalysis revealed no albumin, glucose, bacteria, or blood; there was evidence of cells, crystals, and casts. Most of the staghorn was removed from the renal pelvis with no remaining stone in the renal calices. She was discharged 2 days later and ordered to strain her urine for the next week for evidence of stones. Case Study 13-3: Set-Up for Cystoscopy Renovations had been completed recently in the new surgical suite, and J. Each room had a new cystoscopy bed with padded knee crutches for lithotomy position, a drainage drawer for irrigation solution collection, and radiology capability. The instrument storage carts were stocked with rigid and flexible cystoscopes, sheaths with obturators, and resectoscopes with assorted fulgurating loops, connectors, guide wires, laser flbers, and flberoptic light cords. Sterile storage closets held assorted urethral and ureteral catheters, irrigation tubing and syringes, collection bags, biopsy needles and forceps, basic soft tissue instruments, and dressing supplies. Each room had a machine to collect and decontaminate the liquid waste, instead of the former floor drains. A surgical endoscope that can enter and visualize the bladder is a(n), whereas a scope that cuts tissue is called a(n) . A transurethral approach for examination or surgery always begins with inserting a catheter or scope: a. Label a diagram of the male reproductive tract and describe the function of each part. The gametes are generated by meiosis, a process of cell diTvision that halves the chromosome number from 46 to 23. When male and female gametes unite in fertilization, the original chromosome number is restored. The sex hormones aid in the manufacture of the gametes, function in pregnancy and lactation, and also produce the secondary sex characteristics such as the typical size, shape, body hair, and voice that we associate with the male and female genders. In females, the two systems become completely separate, whereas the male reproductive and urinary tracts share a common passage, the urethra. The Testes the male germ cells, the spermatozoa (sperm cells), are produced in the paired testes (singular, testis) that are suspended outside of the body in the scrotum (Fig. From puberty on, spermatozoa form continuously within the testes in coiled seminiferous tubules (Fig. Their development requires the aid of special Sertoli cells and male sex hormones, or androgens, mainly testosterone. These hormones are manufactured in interstitial cells located between the tubules. Transport of Spermatozoa After their manufacture, sperm cells are stored in a much-coiled tube on the surface of each testis, the epididymis (see Figs. Here they remain until ejaculation propels them into a series of ducts that lead out of the body. This duct ascends through the inguinal canal into the abdominal cavity and travels behind the bladder. A short continuation, the ejaculatory duct, delivers the spermatozoa to the urethra as it passes through the prostate gland below the bladder. Finally, the cells, now mixed with other secretions, travel in the urethra through the penis to be released. It enlarges at the tip to form the glans penis, which is covered by loose skin, the prepuce or foreskin. This may be performed for medical reasons, but is most often performed electively in male infants for reasons of hygiene, cultural preferences, or religion. Dorsal is also posterior; ventral could be occur because different names have been asanterior. Human growth hormone is also called signed at different times or places or because somatotropin. In the nervous system, the little swellings at the tube that leads from the testis to the urethe ends of axons that contain neurotransmitthra in males was originally called the vas deferters are variously called end-feet, end-bulbs, ens, vas being a general term for vessel. Formation of Semen Semen is the thick, whitish fluid in which spermatozoa are transported. It contains, in addition to sperm cells, secretions from three types of accessory glands. The flrst of these, the paired seminal vesicles, release their secretions into the ejaculatory duct. The second, the prostate gland, secretes into the flrst part of the urethra beneath the bladder. As men age, enlargement of the prostate gland may compress the urethra and cause urinary problems. The two bulbourethral (Cowper) glands secrete into the urethra just below the prostate gland. Together these glands produce a slightly alkaline mixture that nourishes and transports the sperm cells and also protects them by neutralizing the acidity of the female vaginal tract. Infection usually centers in the urethra, causing urethritis with burning, a purulent discharge, and dysuria. Gonorrhea is treated with antibiotics, but there has been rapid development of resistance to these drugs by gonococci. Other microorganisms can infect the reproductive tract as well, causing urethritis, prostatitis, orchitis, or epididymitis.

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