Ingles Medico 2014

8/20/2019 Ingles Medico 2014

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GUÍA DE CLASESINGLÉS MÉDICO

2014 – II


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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.


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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


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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


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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


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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.

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.

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.


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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:

Your bile contains too much cholesterol. Normally, your bile contains enough chemicals todissolve 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.

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Complications of gallstones may include:

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 andfever.

Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bileflows 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 thecommon 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 usuallyrequires hospitalization.

Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladdercancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the

likelihood of gallbladder cancer is still very small.


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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 andwheeze. 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

T bl l i d b h f b h hi h i


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Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) andnaproxen (Aleve)

Strong emotions and stress

Sulfites and preservatives added to some types of foods and beverages, including shrimp, driedfruit, processed potatoes, beer and wine

Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into yourthroat

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 airyou 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:

Methacholine challenge. Methacholine is a known asthma trigger that, when inhaled, will cause

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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.

Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) andformoterol (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 long-

acting 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.

Q i k li f ( ) di i d d d f id h li f d i


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Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune systemreaction 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, isspecifically 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 ascorticosteroid and cromolyn nasal sprays.


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Session 6

URINARY TRACT INFECTION (UTI)

The "urinary tract" consists of the various organs of the body that produce, store, and get rid ofurine. 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 theheart 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-sensitivetissue which helps the body control blood pressure, and some of the minerals and water aresaved 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 perkidney) 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 thevagina). 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 urinecan flow out easily.

Urinary tract infection (UTI) is a common infection that usually occurs when bacteria enter theopening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the


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Pain while urinating and a frequent urge to urinate are the main symptoms of a urinary tractinfection. There may be a burning or scalding sensation when going to the toilet, passing only asmall 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 anache 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 theinfection 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 urinaryinfection, as underlying abnormalities need to be excluded. Men with an infection often have akidney stone, or an enlarged prostate gland. Men are usually investigated after a urinaryinfection to make sure there is no underlying problem.

Laboratory tests of urine can confirm an infection. Inflammatory cells (white cells) are present inthe urine and a culture of the urine usually shows which bacteria are present and which antibioticthey 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, theless likely the organ is to be infected.

Urethritis. This can be due to other things besides the organisms usually involved inUTI'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) willalso often cause urethritis.

C titi


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


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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 amedical emergency. Prompt treatment is crucial. Early action can minimize brain damage andpotential 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 presentmay guide your treatment decisions:

Trouble with walking. You may stumble or experience sudden dizziness, loss of balanceor loss of coordination.

Trouble with speaking and understanding. You may experience confusion. You may sluryour words or have difficulty understanding speech.

Paralysis or numbness of the face, arm or leg. especially on one side of your body. Try toraise both your arms over your head at the same time. If one arm begins to fall, you maybe 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 blackenedvision in one or both eyes, or you may see double.

A sudden, severe headache, which may be accompanied by vomiting, dizziness or


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A stroke may cause you to have less control over the way the muscles in your mouth andthroat move, making it difficult for you to talk clearly, swallow or eat. You also may havedifficulty 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 severalweeks after a stroke, and it may improve over time. But because the pain is caused by aproblem 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 becomemore withdrawn and less social or more impulsive.


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Session 9

Folliculitis, Furunculosis, and Carbunculosis

Definition and Etiology

Folliculitis is a superficial infection of the hair follicles characterized by erythematous, follicular-

based 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

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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

Incision and drainage bid

Dicloxacillin 250-500 mg PO qid for 5-7 days

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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 corneabecause 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.


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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.


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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 complexeye 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


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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.


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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 toomuch 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

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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 DiabetesType 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


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Family background that is AmericanIndian, African American,

Hispanic/Latino, Asian American, orPacific Islander. Parent or sibling with diabetes. High blood pressure. Abnormal cholesterol levels.

Having had a baby that weighed morethan 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 healthcare provider whether they should be tested for diabetes.

Diabetes often goes undiagnosed because many of its symptoms seem harmless ordon't always appear right away. Recent studies show that early detection of diabetessymptoms and treatment can decrease the chance of developing the complications ofdiabetes.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.


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Exercise. Work up to at least 30 minutes a day, most days of the week. Regularphysical 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 toget 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.

. Choose Healthy Food. Good nutrition is a very important part of diabetes

management. People with diabetes should work with their diabetes healthcareteam to develop an eating plan that meets their personal food preferences whilekeeping blood glucose in a healthy range. By choosing nutritious foods andbalancing 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 healthyfood choices for the entire family. Eat lots of vegetables and fruits. Try pickingfrom the rainbow of colors available to add variety to your meals. Choose morenon-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 wheatspaghetti with your favorite pasta sauce.


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Session12

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 dividewithout 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 areneeded. This process helps keep the body healthy.

If cells divide when new cells are not needed, they form too much tissue, called atumor, can be benign or malignant.

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 invadeother tissues and do not spread to other parts of the body. Benign breast tumorsare 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 thebloodstream or lymphatic system. That is how breast cancer spreads and formssecondary tumors in other parts of the body. The spread of the cancer is calledmetastasis.

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of adaisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that


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early as possible. The National Cancer Institute encourages women to take an activepart 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 willbe 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 ofother part of the body.

Mammography involves two X-rays of each breast one taken from side and one fromthe 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. Amammogram can also show small deposits of calcium in the breast. A cluster of verytiny specks of calcium (called microcalcifications) may be an early sign of cancer.

Mammography should be done only by specially trained people using machinesdesigned just for taking X-rays of the breast. The pictures should be checked by aqualified radiologist. Women should talk to their doctor or called the cancer information


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An abnormal area on a mammogram, a lump, or other changes in the breast can becaused 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 asksabout her personal and family medical history. In addition to checking general signs ofhealth, the doctor may do one or more of the breast exams described below to helpmake a diagnosis.

Palpation The doctor can tell a lot about a lump – its size, its texture, and whether itmoves 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 abouta 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 oftenshow whether a lump is solid or filled with fluid. This exam uses high frequencysound waves, which cannot be heard by humans. The sound waves enter thebreast and bounce back. The pattern of their echoes produces a picture called asonogram, 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

Aspiration or needle biopsy. The doctor uses a needle to remove fluid or a smallamount of tissue from a breast lump. This procedure may show whether the lumpis 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


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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 effectivefor 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 havebeen exposed to an STD, see a doctor. Some STDs can be treated easily andeliminated, but others require more involved, long-term treatment.

Either way, it's essential to be evaluated, and — if diagnosed with an STD, also knownas a sexually transmitted infection (STI) — get treated. It's also essential to inform anypartners 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 canstimulate an immune response in the genital area or cause sores, either of which mightmake 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. Infact, this happens with a lot of STIs. Even though you have no symptoms, you're still atrisk of passing the infection along to your sex partners. That's why it's important to use


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Gonorrhea is a bacterial infection of your genital tract. The first gonorrhea symptomsgenerally appear within two to 10 days after exposure. However, some people may beinfected for months before signs or symptoms occur. Signs and symptoms ofgonorrhea 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 calledTrichomonas vaginalis. This organism spreads during sexual intercourse with someonewho already has the infection. The organism usually infects the urinary tract in men, butoften causes no symptoms in men. Trichomoniasis typically infects the vagina inwomen. 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


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As the virus continues to multiply and destroy immune cells, you may develop mildinfections 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 infectionSigns 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


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Universidad de San Martin de PorresFacultad de Medicina Humana

ENGLISH III

MEDICAL ABBREVIATIONS

a.c. before meals

ACLS advanced cardiac life support

AD right ear

ADL activities of daily living

ad lib as desired

AMA against medical advine

AMI acute myocardial infarction

AOx3 alert & oriented to person, time, place

ARDS acute respiratory distress syndrome

AS left ear

AU both ears Ax axillary

bid twice a day

BLS basic life support

BM bowel movement

BOW bag of waters

B/P blood pressure

bpm beats per minute

BR bedrest

BRP bathroom privileges

BS breath sounds

BVM bag-valve-mask

_ c with

c-spine cervical spine

CA cancer

CAD coronary artery disease

CAT computerized axial tomography

CBC complete blood count

CC chief complaint

CHD coronary heart disease

CHF congestive heart failure

c/o complains of

COPD chronic obstructive pulmonary diseaseCSF cerebrospinal fluid

CVA cerebrovascular accident (stroke)

CVU cardiovascular unit

d/c discontinue

D & C dilation & curettage

DNR do not resuscitate

DOA dead on arrival

DOB date of birth

DT's delirium tremens

DW distilled water

D5W 5% dextrose in water

Dx diagnosis

ED emergency department

EEG electroencephalogram

EENT eye, ear, nose, throat

EKG /ECG electrocardiogram

EOA esophageal obturator airway

est estimated

ET endotracheal

ETA estimated time of arrival

ETOH ethyl alcohol, intoxicated

FBOA foreign body obstructed airway

FBS fasting blood sugar

FH family history

FHS fetal heart sounds

FUO fever undetermined origin

Fx fracture

GB gall bladder

GI gastrointestinal

GU genitourinarygtt(s) drop(s)

hs hour of sleep, bedtime


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ENGLISH III

Hct hematocrit

Hgb hemoglobin

HIV human immuno virus

HOB head of bed

HR heart rate

Hx history

I & O intake and output

ICP intracranial pressure

ICU intensive care unit

IM intramuscular

IV intravenous

IVP intravenous pyelogram

K+ potassium

KCl potassuim chloride

KUB kidney, ureter, bladder

L lumbar

L & D labor and delivery

lac laceration

LD lethal dose

LLQ, LLLleft lower quadrant (abdomen), lobe(lung)

LMP last menstrual period

LOC level of consciousness

LP lumbar puncture

LUQ, LULleft upper quadrant (abdomen), lobe(lung)

MA mental age

MAST medical antishock trousers

MCI mass casualty incident

meds medications

MI myocardial infarction

MICU mobile intensive care unit

MS morphine sulfate, multiple sclerosis

MVA motor vehicle accident

NVD nausea, vomiting, diarrhea

Na+ sodium

NaCl sodium chloride

N/C nasal cannula, no complaints

neg negative

NGT nasogastric tube

nitro nitroglycerine

NKA no known allergies

noct night

NPO nothing by mouth

NS normal saline

NSR normal sinus rhythm

O oxygen

OB obstetrics

OD right eye, overdose

os mouth

OS left eye

OT occupational therapy

OU both eyes

_ p after

P pulse

P & A percussion & auscultation

PAC premature atrial contraction

palp palpation

PAT paroxysmal atrial tachycardia

pc after meals

pCO2 partial pressure of carbon dioxide

PDR physician's desk reference

PE physical exam, pulmonary embolism

per by or through

PERL(A)pupils equal & reactive to light (andaccommodation)

PET positron emission tomography

PH past history

pH hydrogen ion concentration

PID pelvic inflammatory disease

PKU phenylketonuria

po by mouth


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ENGLISH III

pO2 partial pressure of oxygen

PPD purified protein derivative (TB test)

prn as needed, whenever necessary

pt patient, pint

PT physical therapy

PVC premature ventricular contraction

Px physical exam, prognosis

q every

qd every day

qh every hour

q2h, q3h,...

every two hours, every three hours,...

qid four times a day

qod every other day

qs quantity sufficient

R respirations, rectal

RBC red blood cell/count

RL ringer's lactate

RLQ, RLLright lower quadrant (abdomen), lobe(lung)

RML right middle lobe (lung)

R/O rule out

ROM range of motion

RUQ, RLL right upper quadrant, lobe

Rx take (prescription)

_ s without

S & S signs & symptoms

Ss 1/2

SA sinoatrial

SB small bowel

SIDS sudden infant death syndrome

Sig: label/write

SL sublingual

SOB shortness of breath

sp. gr. specific gravity

SQ, sub q subcutaneous

stat immediately

STD sexually transmitted disease

SVT supraventricular tachycardia

Sx symptoms

T temperature, thoracic

T & A tonsillectomy and adenoidectomy

tab tablet

TB tuberculosis

TIA transient ischemic attack

tid three times a day

TMJ temporomandibular joint

TPR temperature, pulse, respirations

tr tincture

TT tetanus toxiod

TUR transurethral resection

TX traction

UA urinalysis

umb umbilicus

unc. unconscious

unk unknown

ung ointment

URI upper respiratory infection

US ultrasonic

USP United States Pharmacopeia

UTI urinary tract infection

V fib ventricular fibrillation

V tach ventricular tachycardia

VD venereal disease

vo verbal order

V/S vital signs

WBC white blood cell/count

w/c wheelchair

WNL within normal limits

y/o year(s) old


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ENGLISH III

Ingles Medico 2014

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Transcript of Ingles Medico 2014