PPOM 3 Wk 12 LEC 102-114 WORK IN PROGRESS

I honestly don't know what we're supposed to take away from lecture 102. I really tried.

(102) Exaggeration

Activating force applied into the barrier and ease of motion, hence both direct and indirect.

(102) Disengagement

Activating force is applied to separate sutures, i.e. occipital mastoid suture release or technique for venous sinuous drainage at the junction of the cranial sutures

(102) Molding

Application of external force to activate intrinsic forces (i.e. flexion and extension) to alter the contour and resiliency of bone

(102) Sympathetic innervation of the head and neck originate from:

T1-4

(102) Superior Cervical Ganglia

lateral to C1-2; sympathetic nerves travel from the thoracic region T1-4/5 to the head through here

(102) Cranial Parasympathetic ganglia

Nodose, otic, pterygopalatine, ciliary, submandibular, trigeminal ganglia

(104) Four quadrants of the breast

Upper outer, upper inner, lower outer, lower inner

(104) Tail of Spence

Extension of breast tissue into the axilla

(104) Nipple and areola

Central structures of breast containing lactiferous ducts

(104) Axillary lymph nodes

Important site for metastatic spread of breast cancer

(104) External examination (Gynecologic Examination)

major component of exam; Inspection of vulva and surrounding structures

(104) Speculum examination (Gynecologic Examination)

major component of exam; Visualization of vaginal walls and cervix

(104) Bimanual examination (Gynecologic Examination)

major component of exam; Palpation of uterus and adnexa, evaluates internal organs through palpation. Two fingers inserted into the vagina, Opposite hand placed on abdomen

(104) Speculum Examination

used to visualize internal structures; visualizes Vaginal walls, Cervix, Cervical os, Vaginal fornices

(104) Rectovaginal Examination

This exam is sometimes performed to evaluate posterior pelvic structures. Middle finger in rectum, Index finger in vagina.

(104) Key Topics of Menstrual history

Age at menarche, cycle frequency, duration, flow

(104) Key Topics of Sexual history

Partners, practices, STI history

(104) Key Topics of Obstetric history

Pregnancies, outcomes

(104) Key Topics of Contraceptive history

Current and prior methods

(104) Key Topics of Vulvovaginal symptoms

Discharge, itching, lesions

(104) Key Topics of Pelvic symptoms

Pain, bleeding

(104) Key Topics of Family history

Breast, ovarian, uterine cancers

(104) Menarche

Onset of menstruation

(104) Menopause

12 months without menstruation

(104) Dysmenorrhea

Painful menstruation

(104) Amenorrhea

Absence of menstruation

(104) Oligomenorrhea

Infrequent cycles

(104) Hypomenorrhea

Decreased menstrual bleeding

(104) Normal menstrual Cycle interval

21–35 days

(104) Normal menstrual Duration

3–7 days

(104) Normal menstrual Blood loss

<80–100 mL

(104) Menorrhagia

Excessive menstrual bleeding

(104) Metrorrhagia

Bleeding between periods

(104) Menometrorrhagia

Heavy and irregular bleeding

(104) Postmenopausal bleeding

Bleeding after menopause

(104) Causes of Abnormal Uterine Bleeding

Polyp, Adenomyosis, Leiomyoma, Malignancy, Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic, Not otherwise classified

(104) Gravida

Total number of pregnancies

(104) Para

Number of pregnancies reaching ≥20 weeks

(104) TPAL

Further breakdown of Para; Term births, Preterm births, Abortions (<20 weeks), Living children

(104) Mammography

Gold standard screening tool for Breast Cancer Screening

(104) MRI

Breast Cancer Screening tool Used for high-risk patients

(104) Ultrasound

Adjunct imaging for Breast Cancer Screening

(104) Tomosynthesis

3D mammography

(104) Typical Breast Cancer screening recommendations Age 40–44

Optional annual mammogram

(104) Typical Breast Cancer screening recommendations Age 45–54

Annual mammogram

(104) Typical Breast Cancer screening recommendations Age ≥55

Mammogram every 1–2 years

(104) Cervical Cancer Screening recommendations Age 21–29

Pap test every 3 years

(104) Cervical Cancer Screening recommendations Age 30–65

Pap test every 3 years OR Pap + HPV every 5 years

(104) Cervical Cancer Screening recommendations Age >65

Screening may stop if prior tests were adequate

(104) Human papillomavirus (HPV)

primary cause of cervical cancer; 9-valent vaccine protects against multiple oncogenic types

(105) Major physiologic actions of Insulin

Decreases blood glucose concentration; decreases circulating fatty acids and ketoacids; Promotes protein synthesis; Stimulates cellular potassium uptake through activation of Na⁺/K⁺-ATPase

(105) Major physiologic actions of Glucagon

Stimulates glycogenolysis; Stimulates gluconeogenesis; Promotes lipolysis; Increases ketone body production

(105) Diabetic Ketoacidosis (DKA)

life-threatening acute metabolic complication of Type 1 (most common) diabetes mellitus; A combination of Insulin deficiency as well as Excess glucagon and stress hormones (epinephrine, cortisol). Buildup of ketones accumulate in the blood and overwhelm buffering systems, producing metabolic acidosis

(105) Hyperosmolar Hyperglycemic State (HHS)

life-threatening Gradual metabolic complication of Type 2 diabetes mellitus; some insulin is still present, but not enough to maintain normal glucose metabolism. However, because small amounts of insulin suppress lipolysis, ketone production/acidosis remains minimal.

(105) Hyperglycemia

Condition that increases the filtered load of glucose in the kidney, eventually leading to glucosuria, Osmotic diuresis, Polyuria, Electrolyte loss, Severe dehydration and hypovolemia

(105) Distinctive signs of DKA

Kussmaul respirations (deep, labored breathing), Fruity breath odor from acetone, Tachycardia, Dry mucous membranes

(104) Clinical Features of HHS

presents primarily with severe dehydration and neurologic dysfunction; Abdominal pain, Vomiting, Kussmaul respirations are absent

(105) Laboratory Findings in DKA

hyperglycemia, ketosis, and metabolic acidosis; Potassium Elevated initially

(105) Laboratory Findings in HHS

extreme hyperglycemia and hyperosmolarity without significant ketosis

(105) Treatment of DKA

fluid resuscitation, insulin therapy, and electrolyte correction; Insulin should only be started if serum potassium ≥3.3 mEq/L

(105) Treatment of HHS

fluid resuscitation, insulin therapy, and electrolyte correction; emphasizes aggressive fluid replacement

(106) Examples of Rapid acting Insulin Preparations

Lispro, Aspart, Glulisine

(106) Examples of Short acting insulin

Regular Insulin: identical to human insulin. Crystalline zinc forms insulin hexamer which is slow to dissociate

(106) Examples of Immediate acting Insulin Preparations

NPH (Neutral Protamine, Hagedorn, or Isophane)

(106) Therapeutic Uses of Rapid acting Insulin Preparations

Imitate physiologic insulin response to a meal in rapid onset, early peak, and short duration. Used in insulin pump. ideal for postprandial hyperglycemia control

(106) Therapeutic Uses of Short acting insulin (Insulin regular)

Used IV in hospital for diabetic ketoacidosis.

(106) Therapeutic Uses of Immediate acting Insulin Preparations

Mixed with regular or rapid-acting insulins. Needs 2-4 injections per day

(106) Therapeutic Uses of Glargine

Administered 1-2 times a day to achieve a reliable insulin background. Rapid acting insulins are needed for mealtime.

(106) Therapeutic Uses of Detemir

Administered 1-2 times daily to obtain a reliable insulin background level.

(106) Therapeutic Uses of Degludec

Administered once a day to achieve stable basal coverage.

(106) Duration of Rapid acting Insulin Preparations

Less than 4-hour duration. Short acting enough to avoid later hypoglycemic episodes as insulin does not persists

(106) Duration of Short acting insulin

2-7 hours duration. Long duration risks late, after-meal hypoglycemia.

(106) Duration of Immediate acting Insulin Preparations

0-20 hours duration. Can be mixed with regular or rapid-acting insulin

(106) Duration of Glargine

24-hour duration. A peakless, maximum level for this duration

(106) Duration of Detemir

24-hour duration; longest action insulin preparation

(106) Duration of Degludec

42-hour duration, “ultra-long”; 25 hr half-life

(106) Onset of Rapid acting Insulin Preparations

5 –10 min onset SQ. 1 hr peak (most rapid peak). Mimic normal prandial insulin release profile. Injected immediately before a meal. No post-prandial hyperglycemia

(106) Onset of Short acting insulin

30 min. onset SQ. 2-3 hr peak. Must be given 30-45 min before a meal to match glucose rise. Post-prandial hyperglycemia

(106) Onset of Immediate acting Insulin Preparations

2–4 hr. onset SQ. 6-7 hr peak. A stable protamine-insulin complex must be degraded by proteolytic enzymes to release insulin.

(106) Onset of Glargine

0.5-1 hour onset SQ. Insulin molecules slowly dissolve away from the crystalline depot to provide a low, continuous level of circulating insulin.

(106) Onset of Detemir

1-2 hour onset SQ. Inclusions create a precipitate in tissue. Reversibly binds to albumin. Slow dissociation from albumin releases insulin for its long duration of action

(106) Onset of Degludec

30-90 min onset SQ. Complexed with phenol and zinc. When injected, dihexamers self- associate into multihexamer chains, which slowly dissolve in the subcutaneous tissue. Insulin monomers are steadily released into the systemic circulation