Se trata de un paciente de 50 años que consulta por dolor en cara lateral de la cadera. Al examen físico se encuentra dolor a la palpación a nivel paravertebral derecho. No trae ningún examen paraclínico De acuerdo a la información dada. ¿Qué datos adicionales sobre la información personal del paciente es necesario conocer?

Genero, ocupación, actividad física.

¿Qué datos adicionales preguntaría usted sobre los antecedentes personales y familiares?

Antecedentes patológicos, quirúrgicos, alérgicos. Antecedentes familiares patológicos.

¿Qué preguntas adicionales haría sobre el dolor que refiere el paciente?

Tiempo de evolución, forma de aparición, si existe asociación con algún evento, cede con el reposo, que actividad lo aumenta, se acompaña de un sonido, sensacion de inestabilidad, localización exacta del dolor, irradiación del dolor.

¿Considera que el examen físico descrito es suficiente si es así, explique por qué y si no es suficiente enumere qué pruebas adicionales realizaría ?

No es suficiente. Evaluación de la marcha, arcos de movilidad de la cadera, Test de Ober, Prueba de Trendelenburg, palpación del trocánter mayor, región glútea y región inguinal. Examen neurológico de los miembros inferiores, prueba de Lasegue, movilidad de la columna lumbar.

Si cree que se trata de un dolor de cadera secundario a un síndrome doloroso del trocánter mayor¿ cuál sería la imagen diagnóstica de elección para solicitar en este/a paciente?

Resonancia magnética de la cadera

¿Además de un síndrome doloroso del trocánter mayor que otros diagnostico diferenciales consideraría ?

Artrosis de cadera, síndrome de pinzamiento femoro acetabular, lumbalgia mecánica

Evaluación inicial. Cirugía de cadera.

Evaluación Inicial

Evaluacion inicial a curso multidisciplinario

EVALUACIÓN PRIMER PARCIAL INICIAL 2 "A"

INITIAL EVALUATION

Farm animals-initial evaluation

B2. Initial evaluation.

Can you create an evaluation using this information PHONETICS VS. PHONOLOGY Whereas phonetics is the study of sounds that occur in language, phonology is the study of how these sounds are organized and how they function in language. It uses the classifications of sounds derived from phonetics to describe and analyze how sounds occur in speech. STRUCTURALIST PHONEMICS STRUCTURALIST PHONEMICS As linguists began to study sounds in fine detail, they recognized increasingly complex aspects of phonetic organization. For example, the sound /p/ appears in different varieties in English. STRUCTURALIST PHONEMICS One of the varieties of /p/ is indicated by [ph]. This sound is produced with an accompanying puff of air called aspiration, as in the words “pill,” and “peace.” Another sound, indicated by [p•], is produced when there is little or no aspiration; this sound occurs in a word like “spill.” A third major variety for the /p/ sound is the unreleased [p– ], which may occur at the end of a word like “stop.” To deal with these variations for the /p/ sound, the structuralists suggested the existence of an abstract unit which they termed a phoneme. STRUCTURALIST PHONEMICS A phoneme was defined by the structuralists as an abstract phonological unit that represents a class of real sounds, termed the allophones of a phoneme. The phoneme /p/ in English, then, is represented by the allophones [ph], [p•], and [p– ]. STRUCTURALISTS: MINIMAL PAIRS How do we know what these abstract units of sound called phonemes are? In order to find the phonemes of a language, the structuralists developed the concept of the minimal pair, defined as any two words that: a) Contain the same number of segments b) Differ in meaning c) Exhibit only one phonetic difference. STRUCTURALISTS: MINIMAL PAIRS In practical terms, phonemes distinguish meanings; and a phoneme can also be defined as the smallest meaning-distinguishing unit of sound. For instance, the words “pin” /pɪn/ and “bin” /bɪn/ mean different things, and the only one difference in these words occurs in the initial sounds. STRUCTURALISTS: MINIMAL PAIRS By using the concept of a minimal pair, we can determine that the three variations of the /p/ sound do not represent three phonemes. Certainly, it is possible to pronounce the word cap with either an aspirated [ph ] or unreleased [p– ]; however, the two forms [kæph ] and [kæp– ] are not a minimal pair, even though they involve different sounds, because they are identical in meaning. STRUCTURALISTS: FREE VARIATION The two forms [kæph ] and [kæp– ] are, therefore, said to exhibit free variation: that is, the pronunciation may vary without signifying a change in meaning. In other words, we may conclude that the unreleased [p– ] and the aspirated [ph ] are not representations of different phonemes in English; they are, in fact, allophones of one phoneme, /p/. STRUCTURALISTS: COMPLEMENTARY DISTRIBUTION When phonemes have more than one allophone in a language, the allophones are said to be in complementary distribution. Complementary distribution means that the allophones of a phoneme occur in different phonetic environments (that is, with different sounds surrounding them). TRANSFORMATIONAL- GENERATIVE PHONOLOGY TRANSFORMATIONAL-GENERATIVE PHONOLOGY Transformational-generative phonology is a relatively recent development in linguistic theory. Chomsky launched Transformational-Generative Grammar in 1957, but the earliest studies within this framework were largely concerned with syntax. A decade later, the first comprehensive transformational-generative treatment of English phonology appeared: Chomsky and Halle’s The Sound Pattern of English (1968). TRANSFORMATIONAL-GENERATIVE PHONOLOGY Transformational-generative phonologists strongly oppose the structuralists’ phonemic level. They replace this level by a series of rules that directly relate underlying representations to observed phonetic representations. The central mechanisms in transformational-generative phonology, then, are underlying representations and phonological rules. PHONOLOGICAL RULES A rule is an operational statement in which some linguistic entity is modified, resulting in a new linguistic entity. Rules may add elements, remove elements, or change elements. By using phonological rules, linguists attempt to demonstrate that there is order in linguistic phenomena and that linguistic patterns are systematic. PHONOLOGICAL DERIVATION A phonological derivation is an operation that begins with an underlying representation and, through the application of a set of specific rules, yields the actual sound the speaker produces. The representation of a phonological rule has the following general appearance. /A/ → [B] / C “A” changes to “B” under condition “C” PHONOLOGICAL RULE – EXAMPLE In most Southern dialects, the word ten is pronounced like the word tin. This is not an isolated fact, for den is pronounced like din and Ben is pronounced like bin, and so on. This very general fact can be represented by the phonological rule: /ɛ/ → [I] / ___ [n] den /dɛn/ → /dIn/ Ben /bɛn/ → /bIn/ ten /tɛn/ → /tIn/ /ɛ/ → [I] / ___ [n] - high - low - tense + front + high - tense + front + sonorant + anterior + coronal - continuant NOTATIONAL DEVICES IN PHONOLOGICAL RULES The statement of phonological rules can be complex, and linguists have developed several notational devices for writing them. Often, the following symbols will be necessary for stating the conditions under which rules apply: # indicates a word boundary + indicates an intraword boundary $ indicates a syllable boundary UNDERLYING REPRESENTATIONS AND RELATED ISSUES The transformational-generative description of phonology relates underlying representations to phonetic representations by rules. This can be represented in a simple example: In English, there are certain pairs of words like sign / signature, and malign / malignant that exhibit a regular alternation in their phonetic representations: [g] is present in the second member of the pairs but absent in the first member. UNDERLYING REPRESENTATIONS AND RELATED ISSUES To explain the relatedness of words such as sign / signature, we could claim that the underlying representation of the segment in all such pairs is /g/ and that a rule operates to delete /g/ before syllable-final nasals. Thus, the rule “/g/ is deleted before syllable-final nasal” would appear formally as: + voice - anterior →∅ ____ [+ nasal] $ - coronal UNDERLYING REPRESENTATIONS AND RELATED ISSUES On the left-hand side of the arrow, we place the features needed to uniquely specify /g/ among the consonants; that is, no other consonant has the features [+ voice], [- anterior], and [- coronal]. The symbols → mean that the sound /g/ changes to nothing or more properly “/g/ is deleted.” The horizontal line following the slash mark refers to the position of /g/ - namely, before a segment that is [+nasal]. Finally, this [+nasal] segment occurs before a syllable boundary, as indicated by $. A less formal way of writing this rule would be: /g/ → / _ [+nasal] $ Notice that this rule also helps describe such alternations as phlegm/phlegmatic and paradigm/paradigmatic. Application Activity: Think of other words in which this rule can be applied. Write the sound segments to prove /g/ is deleted. Another example is the process through which the prefix meaning “not” is added to words. This prefix alternates among the forms /Im/, /In/, and /Iŋ/, depending on the point of articulation of the initial segment of the following word. -If the segment begins in the extreme front part of the mouth (labials), the form is /Im/, as in improper. -If the segment begins in the extreme back part of the mouth (velars), the form is /Iŋ/, as in incomplete. -If the segment begins in the mid-region of the mouth (all other sounds), the form is /In/, as in indecent. *Exceptions:Words beginning with /r/ or /l/. Analyze the Word “in + complete,” for example. /n/ → [ŋ] / __ [k] - continuant - continuant - continuant + sonorant → + sonorant - sonorant + anterior - anterior - strident + coronal - coronal - coronal + tense THE VELAR SOFTENING RULE Still another example of alternation in English is found in pairs of words like “electric / electricity,” in which the segments /k/ and /s/ alternate. /k/ changes to [s] only before non- low, front vowels. THE VELAR SOFTENING RULE /k/ → [s] / __ - continuant + continuant - strident → - sonorant V - anterior + anterior - low - coronal + coronal - back

LOS MODELOS DEMOGRÁFICOS: LA TRANSICIÓN DEMOCRÁFICA. Para explicar la evolución de la población a lo largo de la historia, los geógrafos han recurrido a diversos modelos. El más aceptado es el modelo de la transición demográfica. Este modelo demográfico diferencia varias etapas: 1. Etapa inicial o preindustrial. Se caracteriza por una natalidad y una mortalidad muy elevadas, que limitan notablemente el crecimiento de la población. Además, la esperanza de vida es baja, en torno a 30 años, y la mortalidad infantil muy alta, por lo que es necesario tener un gran número de hijos. Es el período de las pestes, hambrunas y guerras, una etapa que caracterizó a toda la humanidad hasta finales del siglo xvi o principios del xvi. 2. Etapa de transición: Se caracteriza por el desequilibrio entre natalidad y mortalidad, lo que provoca un rápido crecimiento de la población. La esperanza de vida aumenta también de forma considerable. Se suele dividir en tres momentos diferenciados: * Fase inicial: desaparece la mortalidad catastrófica y la mortalidad infantil disminuye por mejoras en alimentación, higiene, avances médicos, etc. Las tasas de natalidad se mantienen elevadas. * Fase intermedia: la mortalidad desciende rápidamente y la natalidad sigue siendo alta, lo que origina un excedente de nacimientos sobre los fallecimientos. En esta fase se produce la verdadera explosión demográfica. * Fase final: la mortalidad desciende a un ritmo más lento, mientras que la natalidad cae rápidamente, lo que se traduce en un crecimiento reducido. 3. Etapa moderna. En esta etapa, la natalidad y la mortalidad permanecen en equilibrio generando un crecimiento muy bajo, como en la etapa preindustrial. La natalidad se mantiene baja debido al continuo incremento del nivel de vida, a la extensión de la educación y a las transformaciones económicas y sociales que han tenido lugar. La mortalidad, por su parte, también se mantiene baja. Tan solo en algunos países industrializados, con una elevada esperanza de vida, esta repunta debido al envejecimiento de su población. 4. Regresión demográfica. El progresivo envejecimiento de la población lleva a una cuarta etapa de «regresión demográfica», de la que solo se puede salir aumentando los efectivos de la población joven inmigrante.

Related quizzes

Related quizzes