Kin 191 B – General Medical Conditions
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Kin 191 B – General Medical Conditions Presentation Transcript

  • 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries General Medical Conditions
  • 2. Cardiopulmonary Conditions
  • 3. Cardiopulmonary Conditions
    • Clinical anatomy
    • Evaluation of cardiopulmonary conditions
    • Pathologies
  • 4. Anatomy
    • Pericardium – within mediastinum
      • Fibrous – dense outer layer
      • Serous – parietal layer lining fibrous layer and visceral layer attaching to heart
    • Heart chambers and great vessels
    • Valves – one way, prevent backflow
      • Tricuspid valve: R atrium and ventricle
      • Semilunar valve (pulmonary): R ventricle and pulmonary arteries
      • Mitral valve: L atrium and ventricle
      • Semilunar valve (aortic): L ventricle and aorta
  • 5. Pericardium
  • 6. Heart Valves
  • 7. Evaluation
    • History
      • Location of pain
      • Current symptoms
      • Previous history/symptoms
      • Onset of symptoms
      • Etiology
    • Inspection/Palpation
      • Conscious vs. unconscious individual
    • Special tests
  • 8. History
  • 9. Location of Pain
    • Cardiac conditions generally present with pain, tightness and/or squeezing to chest
    • May experience referred pain to left shoulder/arm, jaw or epigastric area
    • Pulmonary conditions generally present with dyspnea and/or pain with respirations
  • 10. Current Symptoms
    • Cardiac conditions
      • Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue
      • Abnormal heart rhythms, syncope
    • Pulmonary conditions
      • Chest congestion, fatigue
  • 11. Prior Symptoms
    • Prior cardiopulmonary condition symptoms must be evaluated and cleared by a physician prior to engaging in strenuous physical activity
    • Individuals often hesitate to communicate episodes for fear of the unknown and/or affect on participation
  • 12. Onset of Symptoms/Etiology
    • Cariopulmonary conditions are typically either congenital or acquired over significant periods of time – manifest in acute onset of symptoms/distress
    • Some arrhythmias may be associated with trauma to anterior chest
  • 13. Inspection and Palpation
  • 14. Inspection/Palpation – Unconscious Individual
    • Primary survey
      • A: airway
        • Look, listen and feel
      • B: breathing
        • Rate (tachypnea vs. bradypnea) and quality (dyspnea)
      • C: circulation
        • Carotid pulse
  • 15. Inspection/Palpation – Conscious Individual
    • Posture/positioning
      • May clutch chest, bend over to use secondary inspiratory muscles (SM, pecs)
    • Skin color
      • Pale or cyanotic when should be flushed
    • Airway
      • Verify patency
    • Breathing
      • Rate and quality of respirations assessed
  • 16. Inspection/Palpation – Conscious Individual
    • Circulation
      • Rate and quality of pulse assessed
    • Sweating
      • Diaphoresis is common symptoms, must differentiate from athletic activity
    • Responsiveness
      • Decreased oxygen to tissues
    • Nausea/vomiting
      • Often accompanies heart attack
  • 17. Special Tests
    • Activation of EMS
    • CPR or rescue breathing as necessary
    • Assessment of vital signs
  • 18. Pathologies
    • Syncope
    • Hypertrophic cardiomyopathy
    • Myocardial infarction
    • Arrythmias
    • Bradycardia
    • Tachycardia
    • Mitral valve prolapse
    • Hypertension
    • Asthma
    • Hyperventilation
  • 19. Cardiac Conditions
  • 20. Syncope
    • Five underlying causes of fainting (transient loss of blood flow/oxygen to brain)
      • Vasovagal reactions
        • Venous dilation secondary to anxiety
      • Decreased blood volume
        • Dehydration (vomiting, diarrhea), bleeding
      • Metabolic conditions
        • Hypoglycemia, especially in diabetics
      • Cardiac disorders
        • Arrhythmias
      • Drug reactions
        • Stimulant use or abuse
  • 21. Hypertrophic Cardiomyopathy
    • Most common cause of sudden death in young athletes
    • Enlargement of heart muscles without enlargement of heart chambers
    • Most significant risk factor is family history
    • May also present with significant heart murmur, Marfans syndrome characteristics and documented history of arrhythmia
    • Symptoms include fatigue, exertional syncope, dizziness, dyspnea, chest pain, arrhythmia while exercising
      • Difficult to evaluate and treat – must be referred for physician evaluation and clearance
  • 22. Hypertrophic Cardiomyopathy
  • 23. Myocardial Infarction
    • Caused by blockage of coronary arteries
      • Decreased oxygen and ultimate necrosis
    • Risk factors
      • Family history, hypertension, high cholesterol, smoking, obesity
    • Symptoms
      • Chest pain, referred pain, diaphoresis, cyanosis, nausea/vomiting, altered vital signs
    • Must recognize acute symptoms and refer immediately – increased risk of survival
  • 24. Myocardial Infarction
  • 25. Arrhythmias
    • Relatively common in athletic population
      • Most cases are benign, occasionally require medication for control
      • Potentially can be fatal
    • Must be thoroughly evaluated to screen for associated conditions and to determine safety of participation in physical activity
  • 26. Bradycardia
    • Defined as heart rate less than 60 bpm
    • Often present in conditioned athletes and is indicative of cardiopulmonary fitness and efficiency
    • If unable to relate to conditioning, must be evaluated by physician to rule out cardiopulmonary conditions
  • 27. Tachycardia
    • Increase in heart rate (no defined parameter)
    • Associated with anxiety and/or participation in physical activity
    • If heart rate abnormally high at inappropriate times, must refer for evaluation by physician
      • Heart becomes inefficient at sustained high pulse rates and can lead to fibrillation and death
  • 28. Mitral Valve Prolapse
    • Present in approximately 5% of population
    • Pressure from backflow of blood causes valve to collapse and blood can take reverse path through valve
    • Most individuals able to participate in vigorous physical activity with MVP, but some are limited to low-intensity activities
  • 29. Mitral Valve Prolapse
  • 30. Hypertension
    • Most common cardiac abnormality affecting athletes, especially African-Americans
    • Clinically defined as greater than 140/90
    • Control with diet, exercise, medications
    • If left untreated, can lead to MI, stroke, kidney failure, vision disturbances
  • 31. Pulmonary Conditions
  • 32. Asthma
    • Bronchoconstriction from bronchospasm and/or increased mucosal secretions
    • Extrinsic – caused by allergens
      • Attacks secondary to exposure to allergen/s
    • Intrinsic – commonly presents as EIA
      • Attacks secondary to exercise in cold, dry climate (triggers bronchospasm)
  • 33. Asthma
  • 34. Asthma
    • Characterized by dry wheezing with respirations, most difficulty with expiration
    • Most cases controlled via bronchodilator inhaler medications
    • Assessment and monitoring of condition via peak flow meter – measures maximal velocity of air forced from lungs after deep inhalation
  • 35. Hyperventilation
    • Caused by oxygen-carbon dioxide imbalance caused by asthma, anxiety, etc.
    • Symptoms include dizziness, tracheal spasm, increased heart rate, syncope
    • Manage with breathing into paper bag or only through one nostril
    • Symptoms quickly resolve with appropriate management of condition
  • 36. General Medical Conditions
  • 37. General Medical Conditions
    • Respiratory infections
    • Viral syndromes
    • Sexually transmitted diseases (STDs)
    • Bloodborne pathogens
    • Endocrine system disorders
    • Systemic disorders
    • Cancer
    • Neurologic disorders
    • Disordered eating
    • Skin conditions
  • 38. Respiratory Infections
    • Upper respiratory infections (URIs)
      • Influenza
      • Sinusitis
      • Laryngitis
      • Pharyngitis
      • Allergic rhinitis
    • Lower respiratory infections (LRIs)
      • Bronchitis
      • Pneumonia
  • 39. Upper Respiratory Infections
    • Describe viral or bacterial infections of nasal pathways, pharynx or bronchi
    • Common cold – rhinovirus (adults) or corona virus (children)
    • Symptoms generally last 10-14 days and usually don’t impact participation
    • Less risk with moderate exercise, but risk increases with fatigue associated with intense physical activity
  • 40. Influenza
    • Viral infection spread by water vapor and droplet transmission
    • Virus is constantly changing and produces annual outbreaks despite vaccination efforts
    • Typically only affects upper respiratory tract, but may also involve lower respiratory tract – usually has greater impact on participation than common cold
  • 41. Sinusitis
    • Inflammation/infection of nasal sinuses
    • Interferes with normal airflow and fluid/mucous drainage
    • Bacterial infection often secondary to viral infection/illness
    • Changes in pressure (air travel) and environmental conditions can increase symptoms
    • Pain and/or swelling over sinuses defines
  • 42. Sinusitis
  • 43. Laryngitis
    • Inflammation of vocal cords – often secondary to URI
    • May also result from overuse (yelling, etc.)
    • Voice becomes hoarse, raspy, weak or may be unable to speak
    • Rest is definitive treatment
  • 44. Pharyngitis
    • Commonly known as sore throat
    • In addition to pharynx pain, lymph node enlargement is classic symptom
    • Strep throat – pharyngitis from group A streptococcus bacteria
    • Tonsillitis – infection of large lymph nodes at back of throat
  • 45. Allergic Rhinitis
    • Occurs secondary to exposure to allergens in the environment
    • Generally referred to as “hay fever”
    • Most prevalent in hot, dry environments
    • Typical symptoms limited to sneezing, nasal discharge (usually clear), coughing – some individuals react more severely
  • 46. Lower Respiratory Infections
    • Less common than URIs
    • Generally more severe symptoms and increased morbidity
    • Affects bronchi of lungs, compromising exchange of gases and lung efficiency
  • 47. Bronchitis
    • Acute – viral infection of lower respiratory tract which inflames bronchi
      • Often leads to secondary bacterial infection (from prolonged URI)
    • Chronic – COPD (chronic obstructive pulmonary disease)
      • Long term exposure to smoke, pollution
    • Generally presents with dyspnea, wheezing, coughing, swelling of LE if prolonged
  • 48. Pneumonia
    • Inflammation of the lungs from bacteria, viruses and/or chemical irritants – may be primary infection or arise secondary to URI
    • Regardless of origin, condition is potentially lethal
    • Persistent coughing with pneumonia can lead to irritation of visceral pleura (pleurisy)
    • Chest radiograph amongst diagnostic tools
  • 49. Pneumonia
  • 50. Viral Syndromes
    • Mononucleosis
    • Measles
      • Rubeola
      • Rubella
    • Mumps
  • 51. Mononucleosis
    • Caused by Epstein-Barr virus (EBV) or cytomegalovirus (CMV) – both forms of herpes virus
    • EBV most commonly transmitted by mouth-to-mouth contact
    • CMV most commonly transmitted by blood transfusions
  • 52. Mononucleosis
    • Most common symptoms are malaise, fatigue, fever and swollen lymph nodes including spleen
    • Mono diagnosed via lab work – monospot
    • Splenomegaly predisposes spleen to rupture
      • Care must be taken when returning to activity post-mono, especially for contact sports
      • Ultrasound often used to assess splenic size
  • 53. Mononucleosis
  • 54. Measles
    • Rare outbreaks due to vaccinations
    • Rubeola
      • Viral infection spread by airborne droplets or direct/indirect mouth-to-mouth transmission
      • 1-2 week incubation period
      • Rash develops early on (splotches and red bumps on skin) – typically lasts 9 days
      • Koplik’s spots – white spots in mouth appear early on as well
  • 55. Measles
    • Rubella (German measles)
      • Milder viral infection and less infectious than rubeola
      • May or may not develop characteristic rash – if does, typically lasts 5 days
      • High risk of miscarriage, birth defects and mental retardation if expectant woman contracts during first trimester
  • 56. Mumps
    • Rare outbreaks due to vaccinations
    • Viral infection of parotid glands (parotitis)
      • Primary presentation is enlargement of parotid glands causing swelling of cheeks and jaw
      • Pharyngitis is common symptoms –affects intake of food/liquids
      • Men often experience testicular pain, lump and/or swelling in scrotum
      • Greater risks and symptoms with contraction of condition by elderly
  • 57. Mumps
  • 58. Sexually Transmitted Diseases (STDs)
    • Chlamydia
    • Genital warts
    • Gonorrhea
    • Syphilis
    • Herpes simplex
  • 59. Chlamydia
    • Most common STD in USA – more easily transmitted by men vs. women
    • Signs and symptoms similar to gonorrhea and the two conditions often occur simultaneously
    • Culture of cervix (women) and semen (men) provides diagnosis
    • If untreated, can lead to epididymitis and orchitis in men and PID in women
  • 60. Genital Warts
    • Outgrowths of skin of genitalia and anal area from human papillomavirus (HPV)
    • Generally have wart-like appearance
    • Diagnosis typically via inspection but may be cultured – Pap smear in women
    • Transmitted by close physical contact – prophylactics minimize risk of transmission
  • 61. Genital Warts
  • 62. Gonorrhea
    • Often referred to as “the clap” – second most common STD in USA
    • Bacterial infection affecting genitourinary system, mouth and rectum
    • Usually 2-5 day incubation period but symptoms may take 2 weeks to present
    • Diagnosis via Gram stain from cervix (women) and urethra (men)
  • 63. Syphilis
    • Enters body through skin and mucous membrane lesions
    • Has 3 distinct stages
      • Primary: formation of localized skin ulcer 3-5 weeks after exposure
      • Secondary: presence of purulent chancres on trunk and mucous membranes, resolves spontaneously after 3-13 weeks
      • Tertiary: onset of neurological, cardiovascular, soft tissue and/or skin symptoms
    • Diagnosis via lab test – not positive until 4-6 weeks post-infection
    • If not treated, can be lethal
  • 64. Syphilis
  • 65. Herpes Simplex
    • Type I (HSV1)
      • Viral infection affecting mouth, lips and face (cold sores, fever blisters)
      • Transmitted via oral contact or respiratory secretions
    • Type II (HSV2)
      • Viral infection affecting genitalia
      • Transmitted via sexual contact
  • 66. Herpes Simplex
  • 67. Herpes Simplex
    • After infection, virus remains dormant
    • Subsequent outbreaks secondary to stress, other illnesses/diseases, sunlight, foods and medications
    • Most people infected with HSV1 by age 20
    • With active symptoms, must refrain from contact with others
  • 68. Bloodborne Pathogens
    • Hepatitis
      • Hepatitis B
    • Human immunodeficiency virus (HIV)
    • Aquired immunodeficiency syndrome (AIDS)
  • 69. Hepatitis
    • Inflammation of liver from viral or bacterial infection, drug or alcohol abuse, parasite infestation or immune system disorders
    • Liver enlargement increases risk of injury
    • 5 classifications (A-E) – A-C most common and B/C are considered STDs
    • Common symptoms include darkening of urine/stool, jaundice, decreased appetite, generalized itching, low fever, nausea/vomiting
    • Prevention via universal precautions, vaccinations safe sex practices, hand washing in food service
  • 70. Hepatitis
    • Hepatitis A
      • Typically associated with poor sanitary conditions or lack of handwashing when handling food
    • Hepatitis B (HBV)
      • Primary form contracted by athletes and health care workers
      • Most common transmission is sexual contact and contact with bodily fluids
      • Can have long incubation period (up to 6 months)
      • May experience joint pain, liver tenderness, and abnormal tastes
    • Hepatitis C
      • Typically transmitted via blood transfusion
  • 71. Human Immunodeficiency Virus (HIV)
    • Type I (USA) vs. Type II (Europe/Africa)
    • Virus enters host cell (sexual contact, needle sharing), replicates and spreads – appear to target T-helper lymphocytes
    • Weakens immune system and predisposes individual to wide range of infections
  • 72. Human Immunodeficiency Virus (HIV)
    • Usually ~1 month latent period from infection to symptom onset
    • Initial symptoms mimic influenza/mono
    • May take 3 months to test positive for HIV antibody – high risk individuals should re-test every 3 months
  • 73. Acquired Immunodeficiency Syndrome (AIDS)
    • Most HIV+ individuals progress to AIDS
    • Diagnosis when T-cell count reaches identified level and patient displays classic symptoms
    • Reflects deterioration of immune system
    • No known cure but several medication regimens to minimize symptoms and/or cause remission
  • 74. Endocrine System Disorders
    • Diabetes mellitus
      • Type I
      • Type II
    • Hyperthyroidism
    • Hypothyroidism
    • Pancreatitis
  • 75. Diabetes Mellitus
    • Affects body’s ability to produce and utilize insulin – regulates carbohydrate metabolism, protein synthesis and fat storage
    • Decreased insulin levels lead to excess glucose in blood (hyperglycemia)
      • Water loss from excretion of excess glucose in urine leads to excessive thirst
  • 76. Diabetes Mellitus
    • Type I diabetes (insulin dependent)
      • Most commonly affects those under age 30 (juvenile onset)
      • Autoimmune disorder preventing insulin production in pancreas
      • Absence of insulin in blood causes ketoacidosis
      • Must be treated with insulin injections and monitoring of blood sugar (80-120 mg/dl)
  • 77. Diabetes Mellitus
    • Type II diabetes (non-insulin dependent)
      • Most common form, affects adults above age 40 and has slow onset of symptoms
      • Caused by decreased production or ability to use insulin in body
      • Excessive body fat causes insulin resistance leading to type II diabetes
      • Typically controlled via diet and exercise, may need to take insulin
  • 78. Diabetes Mellitus
    • Diabetic coma (ketoacidosis)
      • Caused by hyperglycemia, characterized by fruity odor of breath, dry/hot/red skin
      • Individual often confused or unconscious
      • Treat with insulin injection
    • Diabetic shock (insulin shock)
      • Caused by hypoglycemia, characterized by dizziness/light-headedness, cool/pale skin
      • Individual often irritable or hostile
      • Treat with carbohydrate ingestion/injection
  • 79. Hyperthyroidism
    • Caused by overproduction of thyroid hormone – accelerates basal metabolic rate causing need for increased caloric intake
    • Often presents with weight loss, fatigue, decreased muscular strength/endurance, intolerance to heat
    • Caused by tumors, inflammation of thyroid gland or excessive iodine
    • Managed with meds or removal/radiation of gland
  • 80. Hypothyroidism
    • Caused by decreased thyroid activity – decreases basal metabolic rate
    • Primary – occurs secondary to thyroid gland diseases
    • Secondary – occurs secondary to failure of pituitary gland to stimulate thyroid production of hormones
    • Common presentation is obesity
    • Managed with meds/hormone replacement
  • 81. Pancreatitis
    • Inflammation of pancreas
      • Acute – caused by trauma, gall stones, alcohol use, use/abuse of meds (steroids, Tylenol)
      • Chronic – usually associated with diabetes
    • Exrocrine function – secrete pancreatic juice to aid food digestion
    • Endocrine function – secrete insulin and glucogon to regulate carbohydrates
    • Primary presentation is L upper quadrant pain radiating to back and worse when supine
    • Diagnosed via lab work, CT scan, US imaging
  • 82. Systemic Diseases
    • Marfan syndrome
    • Anemia
      • Iron deficiency
      • Sickle cell trait/anemia
    • Lyme disease
    • Chronic fatigue syndrome
    • Fibromyalgia
  • 83. Marfan Syndrome
    • Congenital condition characterized by cardiovascular, musculoskeletal and ocular abnormalities
      • Arm span longer than height
      • Weakness in aortic tissue
      • Propensity for lens dislocation
    • Death usually attributable to cardiac issues (aortic aneurysm) – average life span ~30
    • Often precluded from participation due to high risk of cardiac complications
  • 84. Iron Deficiency Anemia
    • Iron essential for Hgb function of transporting oxygen in bloodstream
    • Most common form of anemia – higher risk for menstruating women, vegetarians, NSAID users
    • Presents with fatigue, shortness of breath, weakness, low energy levels
    • Managed with iron supplementation
  • 85. Sickle Cell Trait
    • Genetic condition affecting Hgb structure (characteristic sickle shape)
    • Most common in those of African-American descent (~10% in USA)
    • Not a disease, but can compromise exercise at high elevation, especially without proper acclimatization
    • No restrictions outside of common sense principles regarding acclimatization
  • 86. Sickle Cell Anemia
    • Genetic condition affecting function of red blood cells – cells collapse secondary to infection of dehydration, die and the clump affecting oxygen carrying capacity of blood
    • <1% of SCT population has SCA
    • High risk of fatal complications usually precludes these individuals from athletic participation – must avoid dehydration and minimize exposure to high altitude
  • 87. Lyme Disease
    • Viral infection transmitted by deer tick bite – less risk if tick removed within 24 hours
    • Early stage presents with rash at bite site (target appearance) and flu-like symptoms
    • If progresses to advanced stage, usually spreads to cardiac/CNS systems – can be fatal if left untreated
    • Treat with aggressive antibiotics to combat symptoms associated with secondary infection
  • 88. Chronic Fatigue Syndrome
    • Initially diagnosed as variant of mono virus (EBV syndrome) – now considered combination of that with clinical depression
    • Must have disabling fatigue x >6 months and also must present with 4 of the following symptoms
      • Sore throat, swollen/tender lymph nodes, arthralgia, myalgia, sleep difficulties, cognitive difficulties, headaches, increased symptoms 24 hours after increased physical/mental activity
    • Treatment often revolves around education and coping strategies, exercise, and may require medications
  • 89. Fibromyalgia
    • Pain syndrome characterized by at least 3 months of chronic pain, stiffness, fatigue - non-inflammatory condition
    • May be associated with CFS
    • Must meet 2 criteria for diagnosis
      • Report of widespread bilateral pain above and below waist involving axial skeleton and lasting at least 3 months
      • Must verbally declare pain on palpation in at least 11 of 18 palpation sites
    • Often treated holistically and may use meds
  • 90. Cancer
    • Leukemia
    • Lymphomas
    • Brain tumors
    • Melanoma
    • Oral cancer
    • Breast cancer
    • Cervical cancer
    • Ovarian cancer
    • Testicular cancer
    • Prostate cancer
    • Colon cancer
  • 91. Cancer
    • Uncontrolled growth/spreading of abnormal or atypical cells – mutation of DNA
    • Mass of cells = tumor
      • Benign – non-cancerous, resemble original tissue, localized, typically not fatal
      • Malignant – cancerous, abnormal cells, spread can be slow or fast, more likely to be fatal
        • Effects from obstruction of normal anatomical structures and/or depriving healthy tissue of adequate blood supply
  • 92. Cancer
    • >200 forms of cancer – classified by type of tissue involved
    • Carcinoma – primarily affects epithelial cells of skin and lining of body cavities
    • Sarcoma – associated with cells that form connective tissues, blood, blood cells and lymphatic system
    • Spread of cancer by direct invasion, metastasis (cancerous cells transported throughout body via bloodstream), body fluids, cellular membranes
  • 93. Cancer
    • Signs and symptoms of cancer: CAUTION
      • C: change in bowel/bladder habits
      • A: a sore throat that does not heal
      • U: unusual bleeding or discharge
      • T: thickening or lumps in tissues
      • I: indigestion or difficulty swallowing
      • O: obvious change in warts or moles
      • N: nagging cough or hoarseness
  • 94. Leukemia
    • Uncontrolled proliferation of immature, non-functional white blood cells (WBCs) originating in bone marrow
    • Decreased ability of marrow to produce normal, functional cells
    • Most common in children and young adults
    • Diagnosed via lab work and bone marrow biopsy – managed with chemotherapy and/or bone marrow transplant
  • 95. Leukemia
    • Classified as acute (high % of immature cells) or chronic (lower % of immature cells) and named according to type of cell involved
    • Symptoms reflect diminished blood cell function and include
      • Increased risk of infection, lymph node swelling, lethargy/fatigue, low fever, onset of anemia, longer time for blood to clot
  • 96. Lymphomas
    • Non-Hodgkin’s lymphoma (NHL)
      • Attacks B lymphocytes of lymph nodes and extranodal tissues
      • Very aggressive disease
      • Individuals have worse prognosis and shorter term survival rate than those with Hodgkin’s lymnphoma
  • 97. Lymphomas
    • Hodgkin’s lymphoma/disease
      • Growth of malignant tumors in lymph nodes, bone marrow, spleen and liver – spread via bloodstream from single lymph node origin
      • Diagnosis from biopsy of affected tissue
      • Stages I and II treated with radiation (excellent long term prognosis) and stages III and IV treated with chemotherapy
  • 98. Lymphomas
    • Classification of Hodgkin‘s lymphomas
      • Stage I – single lymph node/region involved
      • Stage II – two or more lymph nodes/regions on same side of diaphragm involved
      • Stage III – lymph nodes on both sides of diaphragm and the spleen are affected
      • Stage IV – lymphoma spreads beyond lymphatic system
  • 99. Brain Tumors
    • May be benign or malignant but either can be fatal due to confined space
    • Usually occur as metastasis of other cancers elsewhere in body
    • Symptoms similar to intracranial bleeding but latent period (lucid interval) is much longer – presentation of symptoms correlates to location relative to brain and function of that area
  • 100. Brain Tumor
  • 101. Melanoma
    • Malignant growth of melanin cells of skin – develops from mole that was previously normal
    • Aggressive condition which spreads rapidly
    • Increased risk with fair skin, freckles, moles, if sunburn easily and if regularly exposed to sunlight (occupation)
  • 102. Melanoma
    • Diagnosed with biopsy but can look for the following characteristics of moles
      • Asymmetry, irregular shaped borders, non-uniform color, diameter >6 mm, elevation of surface, enlargement over time, bleeding
    • Sunscreen (>SPF 15) and protective clothing are prophylactic measures
  • 103. Melanoma
  • 104. Oral Cancer
    • Most commonly involves lips, gums, tongue and/or palate
    • Increased risk with smoking, tobacco use, poor dental hygiene, excessive alcohol consumption
    • Initially will present with white or red lesions on affected tissue and become non-healing open wounds
    • Usually screened by dentist/oral surgeon
  • 105. Oral Cancer
  • 106. Breast Cancer
    • Most common in women, risk increases with age, early onset of menstruation, lack of or late childbirth, obesity and late onset of menopause – family history is strongest predictor
    • Initial symptoms typically palpable lump in breast from self-examination – may also present with nipple retraction, areolar discoloration, lymph node/arm swelling, discharge from nipple
  • 107. Breast Cancer
    • Mammograms are key to early detection, recommended annually for women over 40
    • Diagnosis via biopsy, many masses benign
    • Managed with chemotherapy, radiation, hormone therapy, lumpectomy or mastectomy
  • 108. Cervical Cancer
    • Often associated with HPV
    • Cervical cancer typically develops slowly, often over several years
    • Pap smear can provide early detection, although significant number of false positives
    • If identified and treated early, survival rate is excellent – usually excise abnormal tissue
  • 109. Ovarian Cancer
    • Aggressive form of cancer which spreads quickly – can also involve uterus, bladder, gut due to anatomic location
    • Personal history of breast cancer or family history of breast or ovarian cancer increases risk – also infertility, miscarriage, poor diets
    • No current screening test, often asymptomatic until late in progression
  • 110. Testicular Cancer
    • Most common form of cancer for men aged 20-35 – typically identified via self-exam
    • Symptoms include lump, enlargement of testicle and/or bloody ejaculate – may refer pain to lower abdomen/back
    • Other risk factors include undescended testicle, mumps or inguinal hernia
    • If identified and treated early, prognosis is excellent
  • 111. Prostate Cancer
    • Risk increases with age (>40) and African-American men at greatest risk
    • Other risk factors include family history, poor diets and increased testosterone levels
    • Prostate produces seminal fluids and connects anatomically with bladder, urethra and epididymis – increased likelihood of metastasis
  • 112. Prostate Cancer
    • Symptoms include difficulty and/or pain during urination or ejaculation – may also have hematuria
    • Lab tests evaluate for prostate-specific antigen (PSA) and diagnosis via biopsy
    • Annual prostate exam recommended after age 40 and PSA test after age 50
  • 113. Colon Cancer
    • Involves colon and/or rectum – one of most common cancers for those over age 50
    • Often asymptomatic until late stages and initial symptoms mimic other GI conditions
    • Increased risk with family history
    • Early detection and treatment gives excellent prognosis
    • Annual rectal exams recommended after age 40, sigmoidoscopy or colonoscopy every 3-5 years after age 50
  • 114. Colon Cancer
    • Duke’s classification of colon cancer
      • Duke’s A: involvement of mucosa and submucosal tissues
      • Duke’s B: involvement of local tissues
      • Duke’s C: regional lymph nodes affected
      • Duke’s D: metastases of tumors
  • 115. Neurologic Disorders
    • Migraine headaches
    • Epilepsy
    • Bacterial meningitis
  • 116. Migraine Headaches
    • Recurrent, sudden onset, severe headaches
    • Cause not fully understood but thought to be related to changes with circulatory structures of head and neck
    • Many individuals have aura period prior to onset of migraine – visual difficulties are most common
    • Usually have triggering event
      • Exercise, defecation, sex, computer use, anxiety, foods, alcohol
    • If chronic, often treated with meds but difficult since etiology not fully known
  • 117. Epilepsy
    • Chronic seizure disorder with no known cause – may or may not have aura period
    • Partial seizures affect one area of brain, generalized seizures affect whole brain
    • Most common presentations are petit mal and grand mal seizures
    • Diagnosis is via recurrent seizure episodes, EEG can reveal abnormal brain functions
    • Treat by maintaining airway and protecting individual during seizure, some use meds
  • 118. Bacterial Meningitis
    • Inflammation of meninges from bacterial infection
    • Usually managed aggressively with IV and then oral antibiotics – prophylactic doses typical for those coming in contact with affected person
    • Symptoms include fever, chills, malaise, headache, vomiting, stiffness/spasm
  • 119. Disordered Eating
    • Anorexia nervosa
    • Bulimia nervosa
    • Obesity
    • Onset influenced by biological, familial and psychosocial factors
    • Increased risk for those competing in sports where physical appearance is emphasized
  • 120. Anorexia Nervosa
    • Characterized by distorted body image and fear of getting fat
    • Highly aware of caloric intake and caloric expenditure – minimal food intake or fasting and excessive exercising
    • Often associated with amenorrhea from insufficient body fat to regulate hormone balance
    • Must treat both physiological and psychological components – can be fatal if left untreated
  • 121. Bulimia Nervosa
    • Characterized by binge and purge behavior – clinical definition if occurs 2x/week for at least 3 months
    • May purge with self-induced vomiting, laxatives or diuretics
    • Identify behavioral changes immediately following meals, dental/oral odors and conditions, abrasions on fingers
  • 122. Obesity
    • Overfat vs. overweight
    • May occur secondary to endrocrine system or metabolic disorders, but usually associated with sedentary lifestyle and poor eating habits
    • Most commonly identified relative to body mass index (BMI) – BMI>27.0 is threshold
      • (weight (lbs) x 705)/(height x height [in])
  • 123. Skin Conditions
    • Skin infestations
    • Inflammatory skin conditions
    • Infectious skin disorders
    • Skin growths
  • 124. Skin Infestations
    • Scabies – mites that burrow under skin
      • Infestation when eggs hatched under skin
      • Symptoms represent allergic reaction to mites or their eggs
    • Pediculosis (lice infection of head)
      • Parasites that attach eggs (nits) to body hair
      • Treat with medicated shampoo and combs to remove nits
      • If occurs in pubic hair is referred to as crab lice
  • 125. Infestations
  • 126. Inflammatory Skin Conditions
    • Acne vulgaris
    • Cellulitis
    • Folliculitis
    • Dermatitis
    • Urticaria (hives)
    • Psoriasis
  • 127. Acne Vulgaris
    • Infection and inflammation of sebaceous glands and hair follicles (pimples)
    • Most common in adolescent boys – generally associated with hormonal changes and their resulting affects
    • Usually treated with cleansing, topical ointments/creams, antibiotics
  • 128. Acne Vulgaris
  • 129. Cellulitis
    • Bacterial infection of skin’s connective tissue causing edema, redness and tightening of the skin
    • Requires immediate referral and administration of antibiotics with potential hospitalization required
    • If left untreated, can lead to gangrene, meningitis, lymphangitis, systemic infection
  • 130. Cellulitis
  • 131. Folliculitis
    • Infection of hair follicle from bacteria or fungus – presents as pimple like growth around hair follicle
    • African-American men often present with pseudofolliculitis where facial hair grows into adjacent follicle – aggravated by shaving
    • Usually managed with thorough cleansing, avoidance of tight fitting clothes and using sharp razors for shaving
  • 132. Dermatitis
    • Contact
      • Most common form, from contact with irritant (poison ivy/oak/sumac)
    • Seborrhic
      • Form of dandruff, dry or greasy white scales beneath hair growth
    • Stasis
      • Secondary to prolonged swelling of extremities, varicose veins, CHF – if left untreated can lead to ulcers and gangrene
    • Eczema
      • Dry, scaly and itchy skin
  • 133. Urticaria (Hives)
    • Characterized by presence of wheals (welts) in response to irritant or allergan
    • Most common causes include
      • Food allergies
      • Pollen
      • Animal dander
      • Insect bites
      • Medications
      • Stress
  • 134. Urticaria
  • 135. Psoriasis
    • Chronic skin condition – when active, appears as marked, raised, red patches followed by period of remission
    • Usually asymptomatic but may itch and become painful if patches crack and scale
    • Usually treated with topical ointments to decrease redness and scaling
  • 136. Infectious Skin Disorders
    • Impetigo
    • Tinea (fungal) infections - ringworm
      • Tinea corporis
      • Tinea pedis
      • Tinea cruris
    • Methicillin resistant staphylococcus aureus (MRSA)
  • 137. Impetigo
    • Bacterial skin infection (staph or strep) characterized by blisters and honey-colored crusting surrounded by red patches
    • Highly contagious – usually localized around mouth but can occur elsewhere
    • Treated with oral and/or topical antibiotics
    • Precluded from contact sport participation until healed
  • 138. Impetigo
  • 139. Ringworm
    • Tinea conditions are fungal conditions named for part of body affected
      • Tinea capitis – on head/face
      • Tinea corporis – on trunk
      • Tinea cruris – in groin (“jock itch”)
      • Tinea pedis – on feet (“athlete’s foot”)
      • Tinea versicolor – changes in skin coloration
    • Usually appear as red, circular, scaly patches – grow outward
    • Treat with antifungal meds – topical and oral
    • Highly contagious – withheld from participation
  • 140. Ringworm
  • 141. Skin Growths
    • Warts
      • Common warts (verucca vuglaris) are benign, hypertrophied areas of skin growth, commonly caused by papillomavirus – not contagious
      • Plantar warts (verucca plantaris) characterized as dark cores within a depression on plantar surface of foot in calloused areas – problematic if weight-bearing surface
    • Sebaceous cysts
      • Sebaceous glands filled with fatty secretion
      • Will often abscess and rupture or require drainage
      • Most common on posterior neck, scalp, chest and back
  • 142. Warts
  • 143. Methicillin-Resistant Staphylococcus Aureus (MRSA)
    • Staphylococcus aureus infections commonly found on skin and with mucous membranes (nose/mouth)
    • Development of antibiotic-resistant bacteria
      • Initial reported MRSA case in athletics in 1998
      • Steady increase in number of cases since – estimated that >100,000 cases occur annually
  • 144. Methicillin-Resistant Staphylococcus Aureus (MRSA)
    • Typically initially start as small, pimple-like lesion
    • Infected wound quickly enlarges and becomes very painful
    • Often exhibit other systemic symptoms (fever, etc.)
    • High transmission rate to others – very contagious
  • 145. Methicillin-Resistant Staphylococcus Aureus (MRSA)
    • Treatment
      • Typically treated with non-penicillin based antibiotics (tetracycline or sulfa families are most common)
      • Hospitalization may be required for severe systemic symptoms/pain management
    • Return to activity
      • Only allowed to return to activity once infection has resolved
    • Prevention
      • Best prevention method is appropriate cleansing and dressing of all open wounds
      • Sanitizing of common areas (locker rooms, weight rooms, athletic training rooms, clinics, etc.)