PPOM 3 Wk 13 LEC 115-128 WORK IN PROGRESS

(115) Burning Mouth Syndrome (BMS)

A chronic pain syndrome characterized by a burning sensation of the oral mucosa without visible clinical findings. Most common in middle-aged women

(115) Notalgia Paresthetica (NP)

A chronic neuropathic condition causing localized itching and pain in the scapular region (T2–T6 dermatomes).

(115) Primary Hyperhidrosis

Excessive sweating lasting ≥6 months with characteristic features.

(115) Brachioradial Pruritus (BP)

A neuropathic itch disorder affecting the outer forearms (brachioradialis region).

(115) Stasis Dermatitis

Inflammatory skin condition due to chronic venous insufficiency.

(115) Atopic Dermatitis (Eczema)

A chronic inflammatory skin disease characterized by pruritic, eczematous lesions.

(115) Diagnostic Criteria for Primary Hyperhidrosis

Symmetric sweating (palms, axillae, soles, face); No nocturnal sweating; Weekly episodes; Onset ≤25 years; Positive family history; Impaired daily function

(115) Clinical Features of Burning Mouth Syndrome (BMS)

Burning pain (tongue, buccal mucosa), Dysgeusia (phantom taste), Xerostomia (dry mouth), Symptoms improve with eating

(115) Clinical Features of Notalgia Paresthetica (NP)

Pruritus between shoulder blades, Hyperpigmented patch (from chronic scratching), Possible burning or pain

(115) Clinical Features of Brachioradial Pruritus (BP)

Bilateral itching; Often worsened by sun exposure; Evidence of scratching (excoriations)

(115) Clinical Features of Stasis Dermatitis

Edematous legs, Hyperkeratosis and scaling, Ulcers (commonly medial malleolus), Verrucous skin changes

(115) Clinical Features of Atopic Dermatitis (Eczema)

Flexural involvement (elbows, knees); Facial lesions in children;Chronic relapsing course; triad of Eczema, Asthma, Allergies; Elevated IgE

(115) Pathophysiology of Burning Mouth Syndrome (BMS)

Dysfunction of cranial nerves, especially CN V (trigeminal), CN VII (facial), CN IX (glossopharyngeal); Considered an autonomic neuropathy

(115) Pathophysiology of Notalgia Paresthetica (NP)

Likely due to nerve entrapment. Strong association with Cervical/thoracic spine pathology, Degenerative disc disease or herniation

(115) Pathophysiology of Primary Hyperhidrosis

Autonomic dysregulation; Hyperactivity of sympathetic fibers (T2–T3 ganglia)

(115) Pathophysiology of Brachioradial Pruritus (BP)

Cervical nerve root compression (C5–C6); Possible UV-induced spinal dysfunction

(115) Pathophysiology of Stasis Dermatitis

Venous hypertension → fluid extravasation; Secondary lymphatic obstruction

(115) Techniques to balance Sympathetic Nervous System

;Decrease tone; Rib raising, stellate ganglion release

(115) Techniques to balance Parasympathetic Nervous System

Enhance function; Suboccipital release, cranial OMT

(115) Techniques to Improve Lymphatic Flow

Enhance immune response and reduce inflammation; Thoracic inlet release, Diaphragm doming, Pedal pump

(115) Techniques to Correct Somatic Dysfunction

Improve mechanical and neurologic function; BLT (Balanced Ligamentous Tension), MET (Muscle Energy), FPR (Facilitated Positional Release), MFR (Myofascial Release), Counterstrain

(115) Absolute Contraindication to OMT: Deep Vein Thrombosis (DVT)

Lymphatic or pump techniques can dislodge a thrombus → pulmonary embolism

(115) Clinical Signs Suggesting DVT

Unilateral leg swelling, Erythema, Pain with passive dorsiflexion, Elevated D-dimer, Positive venous ultrasound

(115) Sympathetic Function of T1–T4 Region

Upper extremities, sweating

(115) Sympathetic Function of T2–T6 Region

Scapular/pruritic regions

(115) Sympathetic Function of T5–T9 Region

GI (relevant for some derm associations)

(117) Sexual Health

Concept that includes Sexual orientation (partners: men, women, both); Sexual practices (oral, vaginal, anal); Number of partners (current and lifetime); Protection use (condoms, frequency); Contraception use; History of STIs/STDs

(117) Key Questions/Significance of Penile discharge

Color? amount? associated symptoms?; Suggests infection (e.g., STI)

(117) Key Questions/Significance of Penile Lesions/rashes

Painful vs painless? duration?; Suggests STI, malignancy, dermatologic disease

(117) Key Questions/Significance of Scrotal pain

Acute vs chronic? severity?; Suggests Torsion (emergency), epididymitis

(117) Key Questions/Significance of Lower Pelvic Swelling/masses

Onset? unilateral vs bilateral?; Suggests Hydrocele, hernia, tumor

(117) Hypogonadism (“Low T”)

A condition of decreased testosterone production.

(117) History Findings of Hypogonadism (“Low T”)

Low energy, Low libido, Erectile dysfunction

(117) Physical Exam Findings of Hypogonadism (“Low T”)

Small testes, Decreased body hair, Gynecomastia

(117) Phimosis

inability to retract foreskin

(117) Paraphimosis

retracted foreskin stuck

(117) Balanitis

inflammation of Penis glans

(117) Hypospadias

abnormal ventral opening of the Urethral meatus

(117) Palpation Technique of Testes

Between thumb and fingers; Should be Smooth, firm, non-tender

(117) Palpation Technique of Epididymis

Posterior testis; Should be Cord-like, non-tender

(117) Palpation Technique of Spermatic cord

From epididymis upward; Should be Smooth, slightly firm

(117) Special Maneuver to identify Varicocele

Palpate spermatic cord while patient performs Valsalva; Feels like a “bag of worms” (usually left-sided)

(117) Transillumination

Special Maneuver of shining light through scrotum. Hydrocele → glows red; Tumor/hernia → does NOT transilluminate

(117) Hernia Examination - Inspection

Look for bulge (standing)

(117) Hernia Examination - Palpation

Invaginate scrotum toward inguinal canal

(117) Hernia Examination - Dynamic test

Ask patient to cough

(117) Indirect Hernia

Located at Internal inguinal ring; Congenital cause

(117) Direct Hernia

Located at Hesselbach’s triangle; Caused by Acquired weakness

(117) Femoral Hernia

Located at Femoral canal; Higher strangulation risk

(117) Examples of Penile Abnormalities

Hypospadias, Peyronie disease (fibrous plaques → curvature), Carcinoma

(117) Key Features of Hydrocele

Fluid-filled, transilluminates

(117) Key Features of Varicocele

“Bag of worms”

(117) Key Features of Scrotal edema

Diffuse swelling

(117) Key Features of Scrotal Hernia

Bulge, may be reducible

(117) Cryptorchidism

Testicular Abnormality of Undescended testis

(117) Testicular Tumor

Testicular Abnormality of Painless mass

(117) Orchitis

Testicular Abnormality of Painful inflammation

(118) Menstrual Cycle

hormonally regulated process involving coordinated changes in the ovaries (ovarian cycle) and uterus (uterine cycle)

(118) Cycle length of normal menstrual cycle

24–38 days (avg ~28 days)

(118) Menses duration of normal menstrual cycle

3–7 days

(118) Blood loss of normal menstrual cycle

35–50 mL

(118) Day 1 of normal menstrual cycle

First day of menstrual bleeding

(118) Ovarian Cycle

Part of menstrual cycle with 2 phases: Follicular Phase and Luteal Phase

(118) Follicular Phase of Ovarian Cycle

Phase of follicle development under estrogen influence. Days 1–14, variable length. Cycle variability is due to changes in the follicular phase length.

(118) Luteal Phase of Ovarian Cycle

Post-ovulation phase dominated by progesterone. Days 14–28, constant ~14 days. Cycle variability is due to changes in the follicular phase length.

(118) Mechanism of Follicular Phase of Ovarian Cycle

FSH stimulates multiple follicles; Granulosa cells produce estrogen; Estrogen → negative feedback ↓FSH; Selection of dominant (Graafian) follicle (Day 5–7); Rising estradiol → positive feedback → LH surge; LH surge → ovulation

(118) Mechanism of Luteal Phase of Ovarian Cycle

Ruptured follicle → corpus luteum; Corpus luteum → progesterone production; Progesterone → inhibits LH; If no pregnancy → corpus luteum regresses → hormone withdrawal → menses

(118) Hormone of Proliferative Phase of Uterine Cycle

Estrogen; induces Endometrial growth

(118) Hormone of Secretory Phase of Uterine Cycle

Progesterone; induces Preparation for implantation

(118) Hormone of Menstrual Phase of Uterine Cycle

Hormone withdrawal; induces Shedding of functionalis

(118) Pathophysiology of menstruation

Progesterone withdrawal → vasospasm of spiral arteries; Ischemia → breakdown of functionalis layer; Sloughing → menstrual bleeding

(118) Pathophysiology of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Hormonal sensitivity (Abnormal response to normal estrogen/progesterone fluctuations); Serotonin dysregulation (Central role in mood symptoms); GABA changes (Affects anxiety and mood); ↓ Endorphins (Increased symptom severity)

(118) Premenstrual Syndrome (PMS)

Cyclic physical + emotional symptoms before menses. Symptoms are not due to abnormal hormone levels, but abnormal CNS response to normal cycles.

(118) Premenstrual Dysphoric Disorder (PMDD)

Severe form of PMS with significant mood disturbance and functional impairment. Symptoms are not due to abnormal hormone levels, but abnormal CNS response to normal cycles.

(118) Primary Dysmenorrhea

Painful menses without underlying pathology. Younger age, Normal pelvic exam, functional cause

(118) Secondary Dysmenorrhea

Painful menses due to underlying pathology. >25 years, abnormal pelvic exam, Structural/pathologic cause

(118) Pathophysiology of Primary Dysmenorrhea

↑ Prostaglandin (PGF2α); → uterine hypercontractility + vasoconstriction; → ischemic pain

(118) Uterine Causes of Secondary Dysmenorrhea

fibroids, adenomyosis, PID

(118) Extrauterine Causes of Secondary Dysmenorrhea

endometriosis, adhesions

(118) Menstrual migraine

Headache triggered by hormonal fluctuations (usually estrogen withdrawal)

(118) Catamenial conditions

Disorders linked to menstrual cycle timing; Epilepsy, Pneumothorax (thoracic endometriosis syndrome)

(118) Menorrhagia

Heavy bleeding (>80 mL)

(118) Metrorrhagia

Bleeding between periods

(118) Menometrorrhagia

Heavy + irregular bleeding

(118) Oligomenorrhea

Cycles >38 days

(118) Polymenorrhea

Cycles <24 days

(118) Hypomenorrhea

Light bleeding

(118) Amenorrhea

No menses >90 days

(118) Labs for Menstrual Disorders

β-hCG, CBC, TSH, prolactin, coagulation

(118) Imaging for Menstrual Disorders

Transvaginal ultrasound (first-line)

(118) Advanced imaging for Menstrual Disorders

SIS, MRI

(118) Procedures for Menstrual Disorders

Hysteroscopy, D&C

(118) Biopsy for Menstrual Disorders

Endometrial biopsy

(118) Treatments for PMS/PMDD

First line: NSAIDs, OCPs, SSRIs; Calcium, Vitamin D, Diuretics, Lifestyle changes

(118) Treatments for Dysmenorrhea

NSAIDs (↓ prostaglandins), Hormonal contraception

(118) Common Causes of Pre-menarche abnormal uterine bleeding

Trauma, infection

(118) Common Causes of Adolescent abnormal uterine bleeding

Anovulation, coagulopathy

(118) Common Causes of Reproductive age abnormal uterine bleeding

Pregnancy, STDs, fibroids

(118) Common Causes of Perimenopause abnormal uterine bleeding

Anovulation (HPO dysfunction), neoplasia

(118) Common Causes of Postmenopause abnormal uterine bleeding

Atrophy, cancer (must rule out malignancy)