KIN 191B – Advanced Assessment of Upper Extremity Injuries General Medical Conditions
Cardiopulmonary Conditions
Cardiopulmonary Conditions <ul><li>Clinical anatomy </li></ul><ul><li>Evaluation of cardiopulmonary conditions </li></ul><...
Anatomy <ul><li>Pericardium – within mediastinum </li></ul><ul><ul><li>Fibrous – dense outer layer </li></ul></ul><ul><ul>...
Pericardium
Heart Valves
Evaluation <ul><li>History </li></ul><ul><ul><li>Location of pain </li></ul></ul><ul><ul><li>Current symptoms </li></ul></...
History
Location of Pain <ul><li>Cardiac conditions generally present with pain, tightness and/or squeezing to chest </li></ul><ul...
Current Symptoms <ul><li>Cardiac conditions </li></ul><ul><ul><li>Dizziness, nausea, vomiting, dyspnea, lightheadedness, f...
Prior Symptoms <ul><li>Prior cardiopulmonary condition symptoms must be evaluated and cleared by a physician prior to enga...
Onset of Symptoms/Etiology <ul><li>Cariopulmonary conditions are typically either congenital or acquired over significant ...
Inspection and Palpation
Inspection/Palpation – Unconscious Individual <ul><li>Primary survey </li></ul><ul><ul><li>A: airway </li></ul></ul><ul><u...
Inspection/Palpation –  Conscious Individual <ul><li>Posture/positioning </li></ul><ul><ul><li>May clutch chest, bend over...
Inspection/Palpation –  Conscious Individual <ul><li>Circulation </li></ul><ul><ul><li>Rate and quality of pulse assessed ...
Special Tests <ul><li>Activation of EMS </li></ul><ul><li>CPR or rescue breathing as necessary </li></ul><ul><li>Assessmen...
Pathologies <ul><li>Syncope </li></ul><ul><li>Hypertrophic cardiomyopathy </li></ul><ul><li>Myocardial infarction </li></u...
Cardiac Conditions
Syncope <ul><li>Five underlying causes of fainting (transient loss of blood flow/oxygen to brain) </li></ul><ul><ul><li>Va...
Hypertrophic Cardiomyopathy <ul><li>Most common cause of sudden death in young athletes </li></ul><ul><li>Enlargement of h...
Hypertrophic Cardiomyopathy
Myocardial Infarction <ul><li>Caused by blockage of coronary arteries </li></ul><ul><ul><li>Decreased oxygen and ultimate ...
Myocardial Infarction
Arrhythmias <ul><li>Relatively common in athletic population </li></ul><ul><ul><li>Most cases are benign, occasionally req...
Bradycardia <ul><li>Defined as heart rate less than 60 bpm </li></ul><ul><li>Often present in conditioned athletes and is ...
Tachycardia <ul><li>Increase in heart rate (no defined parameter) </li></ul><ul><li>Associated with anxiety and/or partici...
Mitral Valve Prolapse <ul><li>Present in approximately 5% of population </li></ul><ul><li>Pressure from backflow of blood ...
Mitral Valve Prolapse
Hypertension <ul><li>Most common cardiac abnormality affecting athletes, especially African-Americans </li></ul><ul><li>Cl...
Pulmonary Conditions
Asthma <ul><li>Bronchoconstriction from bronchospasm and/or increased mucosal secretions </li></ul><ul><li>Extrinsic – cau...
Asthma
Asthma <ul><li>Characterized by dry wheezing with respirations, most difficulty with expiration </li></ul><ul><li>Most cas...
Hyperventilation <ul><li>Caused by oxygen-carbon dioxide imbalance caused by asthma, anxiety, etc. </li></ul><ul><li>Sympt...
General Medical Conditions
General Medical Conditions <ul><li>Respiratory infections </li></ul><ul><li>Viral syndromes </li></ul><ul><li>Sexually tra...
Respiratory Infections <ul><li>Upper respiratory infections (URIs) </li></ul><ul><ul><li>Influenza </li></ul></ul><ul><ul>...
Upper Respiratory Infections <ul><li>Describe viral or bacterial infections of nasal pathways, pharynx or bronchi </li></u...
Influenza <ul><li>Viral infection spread by water vapor and droplet transmission </li></ul><ul><li>Virus is constantly cha...
Sinusitis <ul><li>Inflammation/infection of nasal sinuses </li></ul><ul><li>Interferes with normal airflow and fluid/mucou...
Sinusitis
Laryngitis <ul><li>Inflammation of vocal cords – often secondary to URI </li></ul><ul><li>May also result from overuse (ye...
Pharyngitis <ul><li>Commonly known as sore throat </li></ul><ul><li>In addition to pharynx pain, lymph node enlargement is...
Allergic Rhinitis <ul><li>Occurs secondary to exposure to allergens in the environment </li></ul><ul><li>Generally referre...
Lower Respiratory Infections <ul><li>Less common than URIs </li></ul><ul><li>Generally more severe symptoms and increased ...
Bronchitis <ul><li>Acute – viral infection of lower respiratory tract which inflames bronchi </li></ul><ul><ul><li>Often l...
Pneumonia <ul><li>Inflammation of the lungs from bacteria, viruses and/or chemical irritants – may be primary infection or...
Pneumonia
Viral Syndromes <ul><li>Mononucleosis </li></ul><ul><li>Measles </li></ul><ul><ul><li>Rubeola </li></ul></ul><ul><ul><li>R...
Mononucleosis <ul><li>Caused by Epstein-Barr virus (EBV) or cytomegalovirus (CMV) – both forms of herpes virus </li></ul><...
Mononucleosis <ul><li>Most common symptoms are malaise, fatigue, fever and swollen lymph nodes including spleen </li></ul>...
Mononucleosis
Measles <ul><li>Rare outbreaks due to vaccinations </li></ul><ul><li>Rubeola </li></ul><ul><ul><li>Viral infection spread ...
Measles <ul><li>Rubella (German measles) </li></ul><ul><ul><li>Milder viral infection and less infectious than rubeola </l...
Mumps <ul><li>Rare outbreaks due to vaccinations </li></ul><ul><li>Viral infection of parotid glands (parotitis) </li></ul...
Mumps
Sexually Transmitted Diseases (STDs) <ul><li>Chlamydia </li></ul><ul><li>Genital warts </li></ul><ul><li>Gonorrhea </li></...
Chlamydia <ul><li>Most common STD in USA – more easily transmitted by men vs. women </li></ul><ul><li>Signs and symptoms s...
Genital Warts <ul><li>Outgrowths of skin of genitalia and anal area from human papillomavirus (HPV) </li></ul><ul><li>Gene...
Genital Warts
Gonorrhea <ul><li>Often referred to as “the clap” – second most common STD in USA </li></ul><ul><li>Bacterial infection af...
Syphilis <ul><li>Enters body through skin and mucous membrane lesions </li></ul><ul><li>Has 3 distinct stages </li></ul><u...
Syphilis
Herpes Simplex <ul><li>Type I (HSV1) </li></ul><ul><ul><li>Viral infection affecting mouth, lips and face (cold sores, fev...
Herpes Simplex
Herpes Simplex <ul><li>After infection, virus remains dormant </li></ul><ul><li>Subsequent outbreaks secondary to stress, ...
Bloodborne Pathogens <ul><li>Hepatitis </li></ul><ul><ul><li>Hepatitis B </li></ul></ul><ul><li>Human immunodeficiency vir...
Hepatitis <ul><li>Inflammation of liver from viral or bacterial infection, drug or alcohol abuse, parasite infestation or ...
Hepatitis <ul><li>Hepatitis A </li></ul><ul><ul><li>Typically associated with poor sanitary conditions or lack of handwash...
Human Immunodeficiency Virus (HIV) <ul><li>Type I (USA) vs. Type II (Europe/Africa) </li></ul><ul><li>Virus enters host ce...
Human Immunodeficiency Virus (HIV) <ul><li>Usually ~1 month latent period from infection to symptom onset </li></ul><ul><l...
Acquired Immunodeficiency Syndrome (AIDS) <ul><li>Most HIV+ individuals progress to AIDS </li></ul><ul><li>Diagnosis when ...
Endocrine System Disorders <ul><li>Diabetes mellitus </li></ul><ul><ul><li>Type I </li></ul></ul><ul><ul><li>Type II </li>...
Diabetes Mellitus <ul><li>Affects body’s ability to produce and utilize insulin – regulates carbohydrate metabolism, prote...
Diabetes Mellitus <ul><li>Type I diabetes (insulin dependent) </li></ul><ul><ul><li>Most commonly affects those under age ...
Diabetes Mellitus <ul><li>Type II diabetes (non-insulin dependent) </li></ul><ul><ul><li>Most common form, affects adults ...
Diabetes Mellitus <ul><li>Diabetic coma (ketoacidosis) </li></ul><ul><ul><li>Caused by hyperglycemia, characterized by fru...
Hyperthyroidism <ul><li>Caused by overproduction of thyroid hormone – accelerates basal metabolic rate causing need for in...
Hypothyroidism <ul><li>Caused by decreased thyroid activity – decreases basal metabolic rate </li></ul><ul><li>Primary – o...
Pancreatitis <ul><li>Inflammation of pancreas </li></ul><ul><ul><li>Acute – caused by trauma, gall stones, alcohol use, us...
Systemic Diseases <ul><li>Marfan syndrome </li></ul><ul><li>Anemia </li></ul><ul><ul><li>Iron deficiency </li></ul></ul><u...
Marfan Syndrome <ul><li>Congenital condition characterized by cardiovascular, musculoskeletal and ocular abnormalities </l...
Iron Deficiency Anemia <ul><li>Iron essential for Hgb function of transporting oxygen in bloodstream </li></ul><ul><li>Mos...
Sickle Cell Trait <ul><li>Genetic condition affecting Hgb structure (characteristic sickle shape) </li></ul><ul><li>Most c...
Sickle Cell Anemia <ul><li>Genetic condition affecting function of red blood cells – cells collapse secondary to infection...
Lyme Disease <ul><li>Viral infection transmitted by deer tick bite – less risk if tick removed within 24 hours </li></ul><...
Chronic Fatigue Syndrome <ul><li>Initially diagnosed as variant of mono virus (EBV syndrome) – now considered combination ...
Fibromyalgia <ul><li>Pain syndrome characterized by at least 3 months of chronic pain, stiffness, fatigue - non-inflammato...
Cancer <ul><li>Leukemia </li></ul><ul><li>Lymphomas </li></ul><ul><li>Brain tumors </li></ul><ul><li>Melanoma </li></ul><u...
Cancer <ul><li>Uncontrolled growth/spreading of abnormal or atypical cells – mutation of DNA </li></ul><ul><li>Mass of cel...
Cancer <ul><li>>200 forms of cancer – classified by type of tissue involved </li></ul><ul><li>Carcinoma – primarily affect...
Cancer <ul><li>Signs and symptoms of cancer: CAUTION </li></ul><ul><ul><li>C: change in bowel/bladder habits </li></ul></u...
Leukemia <ul><li>Uncontrolled proliferation of immature, non-functional white blood cells (WBCs) originating in bone marro...
Leukemia <ul><li>Classified as acute (high % of immature cells) or chronic (lower % of immature cells) and named according...
Lymphomas <ul><li>Non-Hodgkin’s lymphoma (NHL) </li></ul><ul><ul><li>Attacks B lymphocytes of lymph nodes and extranodal t...
Lymphomas <ul><li>Hodgkin’s lymphoma/disease </li></ul><ul><ul><li>Growth of malignant tumors in lymph nodes, bone marrow,...
Lymphomas <ul><li>Classification of Hodgkin‘s lymphomas </li></ul><ul><ul><li>Stage I – single lymph node/region involved ...
Brain Tumors <ul><li>May be benign or malignant but either can be fatal due to confined space </li></ul><ul><li>Usually oc...
Brain Tumor
Melanoma <ul><li>Malignant growth of melanin cells of skin – develops from mole that was previously normal </li></ul><ul><...
Melanoma <ul><li>Diagnosed with biopsy but can look for the following characteristics of moles </li></ul><ul><ul><li>Asymm...
Melanoma
Oral Cancer <ul><li>Most commonly involves lips, gums, tongue and/or palate </li></ul><ul><li>Increased risk with smoking,...
Oral Cancer
Breast Cancer <ul><li>Most common in women, risk increases with age, early onset of menstruation, lack of or late childbir...
Breast Cancer <ul><li>Mammograms are key to early detection, recommended annually for women over 40 </li></ul><ul><li>Diag...
Cervical Cancer <ul><li>Often associated with HPV </li></ul><ul><li>Cervical cancer typically develops slowly, often over ...
Ovarian Cancer <ul><li>Aggressive form of cancer which spreads quickly – can also involve uterus, bladder, gut due to anat...
Testicular Cancer <ul><li>Most common form of cancer for men aged 20-35 – typically identified via self-exam </li></ul><ul...
Prostate Cancer <ul><li>Risk increases with age (>40) and African-American men at greatest risk </li></ul><ul><li>Other ri...
Prostate Cancer <ul><li>Symptoms include difficulty and/or pain during urination or ejaculation – may also have hematuria ...
Colon Cancer <ul><li>Involves colon and/or rectum – one of most common cancers for those over age 50 </li></ul><ul><li>Oft...
Colon Cancer <ul><li>Duke’s classification of colon cancer </li></ul><ul><ul><li>Duke’s A: involvement of mucosa and submu...
Neurologic Disorders <ul><li>Migraine headaches </li></ul><ul><li>Epilepsy </li></ul><ul><li>Bacterial meningitis </li></ul>
Migraine Headaches <ul><li>Recurrent, sudden onset, severe headaches </li></ul><ul><li>Cause not fully understood but thou...
Epilepsy <ul><li>Chronic seizure disorder with no known cause – may or may not have aura period </li></ul><ul><li>Partial ...
Bacterial Meningitis <ul><li>Inflammation of meninges from bacterial infection </li></ul><ul><li>Usually managed aggressiv...
Disordered Eating <ul><li>Anorexia nervosa </li></ul><ul><li>Bulimia nervosa </li></ul><ul><li>Obesity </li></ul><ul><li>O...
Anorexia Nervosa <ul><li>Characterized by distorted body image and fear of getting fat </li></ul><ul><li>Highly aware of c...
Bulimia Nervosa <ul><li>Characterized by binge and purge behavior – clinical definition if occurs 2x/week for at least 3 m...
Obesity <ul><li>Overfat vs. overweight </li></ul><ul><li>May occur secondary to endrocrine system or metabolic disorders, ...
Skin Conditions <ul><li>Skin infestations </li></ul><ul><li>Inflammatory skin conditions </li></ul><ul><li>Infectious skin...
Skin Infestations <ul><li>Scabies – mites that burrow under skin </li></ul><ul><ul><li>Infestation when eggs hatched under...
Infestations
Inflammatory Skin Conditions <ul><li>Acne vulgaris </li></ul><ul><li>Cellulitis </li></ul><ul><li>Folliculitis </li></ul><...
Acne Vulgaris <ul><li>Infection and inflammation of sebaceous glands and hair follicles (pimples) </li></ul><ul><li>Most c...
Acne Vulgaris
Cellulitis <ul><li>Bacterial infection of skin’s connective tissue causing edema, redness and tightening of the skin </li>...
Cellulitis
Folliculitis <ul><li>Infection of hair follicle from bacteria or fungus – presents as pimple like growth around hair folli...
Dermatitis <ul><li>Contact </li></ul><ul><ul><li>Most common form, from contact with irritant (poison ivy/oak/sumac) </li>...
Urticaria (Hives) <ul><li>Characterized by presence of wheals (welts) in response to irritant or allergan </li></ul><ul><l...
Urticaria
Psoriasis <ul><li>Chronic skin condition – when active, appears as marked, raised, red patches followed by period of remis...
Infectious Skin Disorders <ul><li>Impetigo </li></ul><ul><li>Tinea (fungal) infections - ringworm </li></ul><ul><ul><li>Ti...
Impetigo <ul><li>Bacterial skin infection (staph or strep) characterized by blisters and honey-colored crusting surrounded...
Impetigo
Ringworm <ul><li>Tinea conditions are fungal conditions named for part of body affected  </li></ul><ul><ul><li>Tinea capit...
Ringworm
Skin Growths <ul><li>Warts </li></ul><ul><ul><li>Common warts (verucca vuglaris) are benign, hypertrophied areas of skin g...
Warts
Methicillin-Resistant Staphylococcus Aureus (MRSA) <ul><li>Staphylococcus aureus infections commonly found on skin and wit...
Methicillin-Resistant Staphylococcus Aureus (MRSA) <ul><li>Typically initially start as small, pimple-like lesion </li></u...
Methicillin-Resistant Staphylococcus Aureus (MRSA) <ul><li>Treatment </li></ul><ul><ul><li>Typically treated with non-peni...
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Kin 191 B – General Medical Conditions

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Kin 191 B – General Medical Conditions

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

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