KIN 191B – Advanced Assessment of Upper Extremity Injuries General Medical Conditions

Cardiopulmonary Conditions

Cardiopulmonary Conditions Clinical anatomy Evaluation of cardiopulmonary conditions Pathologies

Clinical anatomy

Evaluation of cardiopulmonary conditions

Pathologies

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

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

Pericardium

Heart Valves

Evaluation History Location of pain Current symptoms Previous history/symptoms Onset of symptoms Etiology Inspection/Palpation Conscious vs. unconscious individual Special tests

History

Location of pain

Current symptoms

Previous history/symptoms

Onset of symptoms

Etiology

Inspection/Palpation

Conscious vs. unconscious individual

Special tests

History

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

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

Current Symptoms Cardiac conditions Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue Abnormal heart rhythms, syncope Pulmonary conditions Chest congestion, fatigue

Cardiac conditions

Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue

Abnormal heart rhythms, syncope

Pulmonary conditions

Chest congestion, fatigue

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

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

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

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

Inspection and Palpation

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

Primary survey

A: airway

Look, listen and feel

B: breathing

Rate (tachypnea vs. bradypnea) and quality (dyspnea)

C: circulation

Carotid pulse

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

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

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

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

Special Tests Activation of EMS CPR or rescue breathing as necessary Assessment of vital signs

Activation of EMS

CPR or rescue breathing as necessary

Assessment of vital signs

Pathologies Syncope Hypertrophic cardiomyopathy Myocardial infarction Arrythmias Bradycardia Tachycardia Mitral valve prolapse Hypertension Asthma Hyperventilation

Syncope

Hypertrophic cardiomyopathy

Myocardial infarction

Arrythmias

Bradycardia

Tachycardia

Mitral valve prolapse

Hypertension

Asthma

Hyperventilation

Cardiac Conditions

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

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

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

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

Hypertrophic Cardiomyopathy

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

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

Myocardial Infarction

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

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

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

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

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

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

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

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

Mitral Valve Prolapse

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

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

Pulmonary Conditions

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)

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)

Asthma

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

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

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

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

General Medical Conditions

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

Respiratory infections

Viral syndromes

Sexually transmitted diseases (STDs)

Bloodborne pathogens

Endocrine system disorders

Systemic disorders

Cancer

Neurologic disorders

Disordered eating

Skin conditions

Respiratory Infections Upper respiratory infections (URIs) Influenza Sinusitis Laryngitis Pharyngitis Allergic rhinitis Lower respiratory infections (LRIs) Bronchitis Pneumonia

Upper respiratory infections (URIs)

Influenza

Sinusitis

Laryngitis

Pharyngitis

Allergic rhinitis

Lower respiratory infections (LRIs)

Bronchitis

Pneumonia

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

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

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

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

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

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

Sinusitis

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

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

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

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

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

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

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

Less common than URIs

Generally more severe symptoms and increased morbidity

Affects bronchi of lungs, compromising exchange of gases and lung efficiency

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

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

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

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

Pneumonia

Viral Syndromes Mononucleosis Measles Rubeola Rubella Mumps

Mononucleosis

Measles

Rubeola

Rubella

Mumps

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

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

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

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

Mononucleosis

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

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

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

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

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

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

Mumps

Sexually Transmitted Diseases (STDs) Chlamydia Genital warts Gonorrhea Syphilis Herpes simplex

Chlamydia

Genital warts

Gonorrhea

Syphilis

Herpes simplex

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

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

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

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

Genital Warts

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)

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)

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

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

Syphilis

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

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

Herpes Simplex

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

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

Bloodborne Pathogens Hepatitis Hepatitis B Human immunodeficiency virus (HIV) Aquired immunodeficiency syndrome (AIDS)

Hepatitis

Hepatitis B

Human immunodeficiency virus (HIV)

Aquired immunodeficiency syndrome (AIDS)

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

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

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

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

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

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

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

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

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

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

Endocrine System Disorders Diabetes mellitus Type I Type II Hyperthyroidism Hypothyroidism Pancreatitis

Diabetes mellitus

Type I

Type II

Hyperthyroidism

Hypothyroidism

Pancreatitis

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

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

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)

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)

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

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

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

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

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

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

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

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

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

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

Systemic Diseases Marfan syndrome Anemia Iron deficiency Sickle cell trait/anemia Lyme disease Chronic fatigue syndrome Fibromyalgia

Marfan syndrome

Anemia

Iron deficiency

Sickle cell trait/anemia

Lyme disease

Chronic fatigue syndrome

Fibromyalgia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cancer Leukemia Lymphomas Brain tumors Melanoma Oral cancer Breast cancer Cervical cancer Ovarian cancer Testicular cancer Prostate cancer Colon cancer

Leukemia

Lymphomas

Brain tumors

Melanoma

Oral cancer

Breast cancer

Cervical cancer

Ovarian cancer

Testicular cancer

Prostate cancer

Colon cancer

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

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

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

>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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Brain Tumor

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)

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)

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

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

Melanoma

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

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

Oral Cancer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Neurologic Disorders Migraine headaches Epilepsy Bacterial meningitis

Migraine headaches

Epilepsy

Bacterial meningitis

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

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

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

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

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

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

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

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

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

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

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

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

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])

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])

Skin Conditions Skin infestations Inflammatory skin conditions Infectious skin disorders Skin growths

Skin infestations

Inflammatory skin conditions

Infectious skin disorders

Skin growths

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

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

Infestations

Inflammatory Skin Conditions Acne vulgaris Cellulitis Folliculitis Dermatitis Urticaria (hives) Psoriasis

Acne vulgaris

Cellulitis

Folliculitis

Dermatitis

Urticaria (hives)

Psoriasis

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

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

Acne Vulgaris

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

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

Cellulitis

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

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

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

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

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

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

Urticaria

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

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

Infectious Skin Disorders Impetigo Tinea (fungal) infections - ringworm Tinea corporis Tinea pedis Tinea cruris Methicillin resistant staphylococcus aureus (MRSA)

Impetigo

Tinea (fungal) infections - ringworm

Tinea corporis

Tinea pedis

Tinea cruris

Methicillin resistant staphylococcus aureus (MRSA)

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

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

Impetigo

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

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

Ringworm

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

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

Warts

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

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

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

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

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.)

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.)