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SUPPORT The previous editions were supported proscar 5mg visa prostate cancer urethra, in part buy proscar 5mg lowest price man health daily shopping category, by grants from Teaching Resources Services of the University of Ottawa. The present edition received support from CRC Press. The colors have a functional role in clear connection between the structures being discussed this atlas, in that they are used consistently for the pre- and a clinical disease, for example, Parkinson’s disease sentation of sensory, motor, and other components. In Section C, the vascular ter- following is the color coding used in this atlas, as shown ritories are discussed and the deficits associated with on the opposite page: occlusion of these vessels is reviewed. Textbooks of neurology should be consulted for a detailed review of clinical diseases (see the Annotated Bibliography). Man- agement of the disease and specific drug therapies are Sensory (nuclei and tracts) not part of the subject matter of this atlas. Dorsal Column – Medial Cobalt Blue Lemniscus Anterolateral System (Pain and Deep Blue ADDITIONAL DETAIL Temperature) On occasion, a structure is described that has some Trigeminal Pathways Purple Special Senses (Audition, Violet importance but may be beyond what is necessary, at this Vision, Taste) stage, for an understanding of the system or pathway Reticular Formation Yellow under discussion. In other cases, a structure is labeled in an illustration but is discussed at another point in the Motor (nuclei and tracts) atlas. Voluntary Cadmium Orange Parasympathetic Orange Other Motor (e. This is particularly so for the Substantia Nigra Brown spinal cord, as well as for the ventricular system. Knowl- Red Nucleus (and tract) Red edge of development is also relevant for the cerebral Other (e. For students who enjoy a different learning approach, a black and white photocopy of the illustration can be NOTE TO THE LEARNER made and then the color added, promoting active learning. Sometimes, consulting other texts REFERENCE TO OTHER FIGURES is suggested. Of course, this is advice only, and each Reference is made throughout the atlas to other illus- student will approach the learning task in his or her own trations that contain material relevant to the subject way. Although this may be somewhat disruptive to the learner reading a page of THE CD-ROM text, the author recommends looking at the illustration and the accompanying text being referenced, in order The CD-ROM adds another dimension to the learning to clarify or enhance the learning of the subject matter process. Ideally, the student is advised to read the text, or structure. In addition, animation has been added to certain illustrations, such as the pathways, where understanding and seeing the tract that is being described, along with the xix © 2006 by Taylor & Francis Group, LLC relays and crossing (decussation), can hopefully assist the name of the structure is seen when the cursor is on the student in developing a 3-dimensional understanding of area, or when the cursor is over the label, the named the nervous system. Labeling of structures on the CD-ROM has been accomplished using “rollover” technology, so that the xx © 2006 by Taylor & Francis Group, LLC FOREWORD We are about to embark on an amazing and challenging (Part II), which has both sensory and motor aspects. The com- Included as part of the motor systems are the major con- plexity of the brain has not yet been adequately described tributors to motor function, the basal ganglia and the cer- in words. The analogies to switchboards or computers, ebellum. The brain functioning as a whole is infinitely omy, includes a neurological orientation and detailed neu- more than its parts. Our brains encompass and create a roanatomical information, to allow the student to work vast universe. We knew that brain function was developing closely to the functional neuroanatomy, the blood supply throughout childhood and this has been extended into the to the brain is presented in some detail, using photographs teen years, and even into early adulthood. The emphasis in this section is on the brain- beginning to understand that the brain has the potential to stem, including a select series of histological cross-sec- change throughout life, in reaction to the way we live and tions of the human brainstem. In addition, there is a sum- our personal experiences in this world. The generic term mary of the spinal cord nuclei and tracts, along with a for this is plasticity, and the changes may significantly histological view of levels of the human cord. New photographs of limbic structures it generates thoughts and feelings. This material is sometimes taught within the context of other systems in the curricu- lum. ORGANIZATION The Atlas is divided into four sections, each with an intro- ANNOTATED BIBLIOGRAPHY ductory text.

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Specific phobias are irrational fears generic 5mg proscar free shipping androgen hormone knives, usually accompanied by avoidance of the feared stimulus order proscar 5mg otc prostate cancer in bones. A 34-year-old man comes to your clinic complaining of a recurrent headache. The headache is located posteriorly and is constant, dull, and nonthrobbing. The patient says that it lasts for several hours and that the use of acetaminophen provides some relief. He has been experiencing these symptoms for the past 8 months. On review of systems, the patient reports that he has been having difficulty falling asleep at night and that he has been experiencing fatigue. He describes himself as a stressed person but denies feeling depressed. The patient smokes cigarettes and drinks alcohol socially. Basic laboratory studies, including a complete blood count, a metabolic profile, and thyroid function tests, are normal. What therapeutic intervention would you recommend for this patient? Reassurance Key Concept/Objective: To know the different presentations of generalized anxiety disorder (GAD), as well as its treatment The defining characteristic of GAD is persistent excessive and uncontrollable worry about everyday situations. GAD can be highly debilitating and may predispose to the development of other anxiety or mood disorders. GAD is the most common anxiety dis- order seen in primary care settings; patients often present with sleep disturbance or somatic symptoms such as muscle aches and tension headaches. GAD is similar to other anxiety disorders in that it often goes undiagnosed and untreated. Venlafaxine is con- sidered by most experts to be the first-line treatment. SSRIs have been found efficacious, and benzodiazepines have also been used to treat GAD. However, these drugs are gen- erally not used as first-line treatments. Although cognitive-behavioral psychotherapy for GAD has been less studied than for other anxiety disorders, this approach appears promising. A 29-year-old medical resident is often late for daily rounds. When asked for an explanation, he blames the traffic and his need for taking care of different issues at home before coming to the hospital. It has been noticed that he disappears during rounds, and he has been found several times washing his hands for several minutes before coming back to rounds. What is the most likely diagnosis for this resident, and what would be the best therapeutic interven- tion to try first? Obsessive-compulsive disorder (OCD); start clomipramine B. Social phobia; start an SSRI Key Concept/Objective: To understand OCD and its treatment OCD is characterized by repeated intrusive thoughts, ideas, or images (obsessions) and by repeated ritualistic behaviors (compulsions). Affected individuals recognize the irra- tionality of their thoughts but are powerless to control them. OCD is diagnosed when obsessions and compulsions are present for at least an hour a day or at a level that inter- feres with functioning. It is important to note that this disorder is often associated with considerable shame, and patients who have it may be reluctant to reveal their habits. Serotonin-active antidepressants, including clomipramine, are the first-line agents for OCD. Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram also have demon- strated efficacy in the treatment of OCD. Cognitive-behavioral therapy is also highly effective. Social phobia and substance abuse are in the differential diagnosis of this patient. However, the presence of ritualistic behaviors (washing of hands) makes OCD more likely.

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Other less prevalent but relatively common causes of visual impairment include macular degeneration associated with age (1 cheap 5 mg proscar with amex prostate cancer young living. HISTORY General Eye History When a patient complains of some concern related to the eye(s) and/or vision purchase 5mg proscar with visa prostate cancer in women, it is necessary to obtain a thorough analysis of that symptom, as well as a general history related to the eyes. Ask about symptoms such as scotoma; floaters; decreased, blurred, or double vision; eye pain, discharge, and redness; lid weakness, masses, or changes. It is important to ask about eye disorders during the past medical history. Past Medical History Determine whether the patient has been prescribed corrective lenses and, if so, how they are worn and whether they successfully correct the vision. The past medical history should include disorders specific to the eyes, such as glaucoma, strabismus, amblyopia, cataracts, retinopathy, and macular degeneration, as well as a prior history of eye surgery. Any current or previous diagnoses of systemic disorders 51 Copyright © 2006 F. A history of all diagnostic procedures related to the eye and surrounding structures should be determined, as well as responses or find- ings. In addition to identifying drugs that are prescribed or used to control diseases of the eyes or surrounding structures, the medication history also identifies varied agents that can alter vision. Box 4-1 includes a list of commonly pre- scribed drugs that affect the eyes or vision. Finally, knowing what medications the patient routinely takes may suggest the need for a more detailed medical history if it is found that the patient is taking drugs for disorders that were not disclosed earlier. Family History Identify the family history of eye disorders, including those conditions mentioned in the preceding paragraphs. Determine whether immediate relatives have refractive errors requir- ing correction. Habits Obtain a history of any recreational or occupational activities that expose the patient to trauma or to other contact that might place the eyes at risk, as well as the use of protec- Copyright © 2006 F. The Eye 53 Box 4-1 Examples of Drugs with Oculotoxic Effects Amiodarone Gold salts Anticholinergic agents Hydroxychloroquine Antihistamines Isoniazid Chloramphenicol Phenothiazines Chloroquine Quinine Contraceptives (oral) Rifampin Corticosteroids Sympathomimetics Digitalis Tamoxifen Ethambutol tive equipment. If the patient wears contact lenses, determine how long the lenses are worn and when they are changed, as well as how they are cleansed and stored between wearings. PHYSICAL EXAMINATION Order of the Examination The eye examination begins with determination of the patient’s visual acuity. Next, it is typical for the examiner to inspect the external and accessory structures and then move inward to include the eye. Inspection is the primary technique used in the eye exam. However, when a mass or lesion is discovered, palpation of the area is indicated. If the patient has complained of discharge, palpation of the punctum, lids overlying meibomian glands, and in the region of the medial canthus may express the discharge. The globe also can be palpated gently to determine tone. If the patient has experienced sudden onset of eye pain, it is important not to dilate the eyes before determining whether acute angle glau- coma is present because dilating the eye may increase the intraocular pressure. Visual Acuity Visual acuity should, at a minimum, be measured, with the patient’s corrective lenses in place, if corrective lenses are used, and in a well-lighted area. Testing the visual acuity assesses a patient’s central vision and should be performed one eye at a time and then with both eyes simultaneously. Visual acuity is typically assessed with a Snellen chart, with the patient standing 20 feet from the chart. There are times when the patient cannot read even the top line of the Snellen chart from 20 feet. In this case, you may have the patient move progressively closer to the chart and record the distance at which the top line can be read, if needed. If the patient cannot read the chart at a near distance, record whether the patient can count fingers, identify gross hand motion, or detect light.

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