kin 191b advanced assessment of upper extremity injuries
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KIN 191B Advanced Assessment of Upper Extremity Injuries

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If heart rate abnormally high at inappropriate times, must refer for evaluation by physician ... Heart becomes inefficient at sustained high pulse rates and ...

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cardiopulmonary conditions3
Cardiopulmonary Conditions
  • Clinical anatomy
  • Evaluation of cardiopulmonary conditions
  • Pathologies
anatomy
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
evaluation
Evaluation
  • History
    • Location of pain
    • Current symptoms
    • Previous history/symptoms
    • Onset of symptoms
    • Etiology
  • Inspection/Palpation
    • Conscious vs. unconscious individual
  • Special tests
location of pain
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
current symptoms
Current Symptoms
  • Cardiac conditions
    • Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue
    • Abnormal heart rhythms, syncope
  • Pulmonary conditions
    • Chest congestion, fatigue
prior symptoms
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
onset of symptoms etiology
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
inspection palpation unconscious individual
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
inspection palpation conscious individual
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
inspection palpation conscious individual16
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
special tests
Special Tests
  • 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

Pathologies
syncope
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
hypertrophic cardiomyopathy
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
myocardial infarction
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
arrhythmias
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
bradycardia
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
tachycardia
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
mitral valve prolapse
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
hypertension
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
asthma
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)
asthma34
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
hyperventilation
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
general medical conditions37
Respiratory infections

Viral syndromes

Sexually transmitted diseases (STDs)

Bloodborne pathogens

Endocrine system disorders

Systemic disorders

Cancer

Neurologic disorders

Disordered eating

Skin conditions

General Medical Conditions
respiratory infections
Respiratory Infections
  • Upper respiratory infections (URIs)
    • Influenza
    • Sinusitis
    • Laryngitis
    • Pharyngitis
    • Allergic rhinitis
  • Lower respiratory infections (LRIs)
    • Bronchitis
    • Pneumonia
upper respiratory infections
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
influenza
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
sinusitis
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
laryngitis
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
pharyngitis
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
allergic rhinitis
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
lower respiratory infections
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
bronchitis
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
pneumonia
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
viral syndromes
Viral Syndromes
  • Mononucleosis
  • Measles
    • Rubeola
    • Rubella
  • Mumps
mononucleosis
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
mononucleosis52
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
measles
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
measles55
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
mumps
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
sexually transmitted diseases stds
Sexually Transmitted Diseases (STDs)
  • Chlamydia
  • Genital warts
  • Gonorrhea
  • Syphilis
  • Herpes simplex
chlamydia
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
genital warts
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
gonorrhea
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)
syphilis
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
herpes simplex
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
herpes simplex67
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
bloodborne pathogens
Bloodborne Pathogens
  • Hepatitis
    • Hepatitis B
  • Human immunodeficiency virus (HIV)
  • Aquired immunodeficiency syndrome (AIDS)
hepatitis
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
hepatitis70
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
human immunodeficiency virus hiv
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
human immunodeficiency virus hiv72
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
acquired immunodeficiency syndrome aids
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
endocrine system disorders
Endocrine System Disorders
  • Diabetes mellitus
    • Type I
    • Type II
  • Hyperthyroidism
  • Hypothyroidism
  • Pancreatitis
diabetes mellitus
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
diabetes mellitus76
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)
diabetes mellitus77
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
diabetes mellitus78
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
hyperthyroidism
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
hypothyroidism
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
pancreatitis
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
systemic diseases
Systemic Diseases
  • Marfan syndrome
  • Anemia
    • Iron deficiency
    • Sickle cell trait/anemia
  • Lyme disease
  • Chronic fatigue syndrome
  • Fibromyalgia
marfan syndrome
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
iron deficiency anemia
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
sickle cell trait
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
sickle cell anemia
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
lyme disease
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
chronic fatigue syndrome
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
fibromyalgia
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
cancer
Leukemia

Lymphomas

Brain tumors

Melanoma

Oral cancer

Breast cancer

Cervical cancer

Ovarian cancer

Testicular cancer

Prostate cancer

Colon cancer

Cancer
cancer91
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
cancer92
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
cancer93
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
leukemia
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
leukemia95
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
lymphomas
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
lymphomas97
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
lymphomas98
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
brain tumors
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
melanoma
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)
melanoma102
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
oral cancer
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
breast 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
breast cancer107
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
cervical cancer
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
ovarian cancer
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
testicular cancer
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
prostate cancer
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
prostate cancer112
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
colon cancer
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
colon cancer114
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
neurologic disorders
Neurologic Disorders
  • Migraine headaches
  • Epilepsy
  • Bacterial meningitis
migraine headaches
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
epilepsy
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
bacterial meningitis
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
disordered eating
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
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
bulimia nervosa
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
obesity
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])
skin conditions
Skin Conditions
  • Skin infestations
  • Inflammatory skin conditions
  • Infectious skin disorders
  • Skin growths
skin infestations
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
inflammatory skin conditions
Acne vulgaris

Cellulitis

Folliculitis

Dermatitis

Urticaria (hives)

Psoriasis

Inflammatory Skin Conditions
acne vulgaris
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
cellulitis
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
folliculitis
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
dermatitis
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
urticaria hives
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
psoriasis
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
infectious skin disorders
Infectious Skin Disorders
  • Impetigo
  • Tinea (fungal) infections - ringworm
    • Tinea corporis
    • Tinea pedis
    • Tinea cruris
impetigo
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
ringworm
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
skin growths
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
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