Kin 191b advanced assessment of upper extremity injuries l.jpg
Advertisement
This presentation is the property of its rightful owner.
1 / 142

KIN 191B Advanced Assessment of Upper Extremity Injuries PowerPoint PPT Presentation

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

Download Presentation

KIN 191B Advanced Assessment of Upper Extremity Injuries

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Kin 191b advanced assessment of upper extremity injuries l.jpg

KIN 191B – Advanced Assessment of Upper Extremity Injuries

General Medical Conditions


Cardiopulmonary conditions l.jpg

Cardiopulmonary Conditions


Cardiopulmonary conditions3 l.jpg

Cardiopulmonary Conditions

  • Clinical anatomy

  • Evaluation of cardiopulmonary conditions

  • Pathologies


Anatomy l.jpg

Anatomy

  • Pericardium – within mediastinum

    • Fibrous – dense outer layer

    • Serous – parietal layer lining fibrous layer and visceral layer attaching to heart

  • Heart chambers and great vessels

  • Valves – one way, prevent backflow

    • Tricuspid valve: R atrium and ventricle

    • Semilunar valve (pulmonary): R ventricle and pulmonary arteries

    • Mitral valve: L atrium and ventricle

    • Semilunar valve (aortic): L ventricle and aorta


Pericardium l.jpg

Pericardium


Heart valves l.jpg

Heart Valves


Evaluation l.jpg

Evaluation

  • History

    • Location of pain

    • Current symptoms

    • Previous history/symptoms

    • Onset of symptoms

    • Etiology

  • Inspection/Palpation

    • Conscious vs. unconscious individual

  • Special tests


History l.jpg

History


Location of pain l.jpg

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 l.jpg

Current Symptoms

  • Cardiac conditions

    • Dizziness, nausea, vomiting, dyspnea, lightheadedness, fatigue

    • Abnormal heart rhythms, syncope

  • Pulmonary conditions

    • Chest congestion, fatigue


Prior symptoms l.jpg

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 l.jpg

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 and palpation l.jpg

Inspection and Palpation


Inspection palpation unconscious individual l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Special Tests

  • Activation of EMS

  • CPR or rescue breathing as necessary

  • Assessment of vital signs


Pathologies l.jpg

Syncope

Hypertrophic cardiomyopathy

Myocardial infarction

Arrythmias

Bradycardia

Tachycardia

Mitral valve prolapse

Hypertension

Asthma

Hyperventilation

Pathologies


Cardiac conditions l.jpg

Cardiac Conditions


Syncope l.jpg

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 l.jpg

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


Hypertrophic cardiomyopathy22 l.jpg

Hypertrophic Cardiomyopathy


Myocardial infarction l.jpg

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


Myocardial infarction24 l.jpg

Myocardial Infarction


Arrhythmias l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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


Mitral valve prolapse29 l.jpg

Mitral Valve Prolapse


Hypertension l.jpg

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


Pulmonary conditions l.jpg

Pulmonary Conditions


Asthma l.jpg

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)


Asthma33 l.jpg

Asthma


Asthma34 l.jpg

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 l.jpg

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 conditions l.jpg

General Medical Conditions


General medical conditions37 l.jpg

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 l.jpg

Respiratory Infections

  • Upper respiratory infections (URIs)

    • Influenza

    • Sinusitis

    • Laryngitis

    • Pharyngitis

    • Allergic rhinitis

  • Lower respiratory infections (LRIs)

    • Bronchitis

    • Pneumonia


Upper respiratory infections l.jpg

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 l.jpg

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 l.jpg

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


Sinusitis42 l.jpg

Sinusitis


Laryngitis l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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


Pneumonia49 l.jpg

Pneumonia


Viral syndromes l.jpg

Viral Syndromes

  • Mononucleosis

  • Measles

    • Rubeola

    • Rubella

  • Mumps


Mononucleosis l.jpg

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 l.jpg

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


Mononucleosis53 l.jpg

Mononucleosis


Measles l.jpg

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 l.jpg

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 l.jpg

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


Mumps57 l.jpg

Mumps


Sexually transmitted diseases stds l.jpg

Sexually Transmitted Diseases (STDs)

  • Chlamydia

  • Genital warts

  • Gonorrhea

  • Syphilis

  • Herpes simplex


Chlamydia l.jpg

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 l.jpg

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


Genital warts61 l.jpg

Genital Warts


Gonorrhea l.jpg

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 l.jpg

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


Syphilis64 l.jpg

Syphilis


Herpes simplex l.jpg

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 simplex66 l.jpg

Herpes Simplex


Herpes simplex67 l.jpg

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 l.jpg

Bloodborne Pathogens

  • Hepatitis

    • Hepatitis B

  • Human immunodeficiency virus (HIV)

  • Aquired immunodeficiency syndrome (AIDS)


Hepatitis l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Endocrine System Disorders

  • Diabetes mellitus

    • Type I

    • Type II

  • Hyperthyroidism

  • Hypothyroidism

  • Pancreatitis


Diabetes mellitus l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Systemic Diseases

  • Marfan syndrome

  • Anemia

    • Iron deficiency

    • Sickle cell trait/anemia

  • Lyme disease

  • Chronic fatigue syndrome

  • Fibromyalgia


Marfan syndrome l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Leukemia

Lymphomas

Brain tumors

Melanoma

Oral cancer

Breast cancer

Cervical cancer

Ovarian cancer

Testicular cancer

Prostate cancer

Colon cancer

Cancer


Cancer91 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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


Brain tumor l.jpg

Brain Tumor


Melanoma l.jpg

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 l.jpg

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


Melanoma103 l.jpg

Melanoma


Oral cancer l.jpg

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


Oral cancer105 l.jpg

Oral Cancer


Breast cancer l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Neurologic Disorders

  • Migraine headaches

  • Epilepsy

  • Bacterial meningitis


Migraine headaches l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

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 l.jpg

Skin Conditions

  • Skin infestations

  • Inflammatory skin conditions

  • Infectious skin disorders

  • Skin growths


Skin infestations l.jpg

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


Infestations l.jpg

Infestations


Inflammatory skin conditions l.jpg

Acne vulgaris

Cellulitis

Folliculitis

Dermatitis

Urticaria (hives)

Psoriasis

Inflammatory Skin Conditions


Acne vulgaris l.jpg

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


Acne vulgaris128 l.jpg

Acne Vulgaris


Cellulitis l.jpg

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


Cellulitis130 l.jpg

Cellulitis


Folliculitis l.jpg

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 l.jpg

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 l.jpg

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


Urticaria l.jpg

Urticaria


Psoriasis l.jpg

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 l.jpg

Infectious Skin Disorders

  • Impetigo

  • Tinea (fungal) infections - ringworm

    • Tinea corporis

    • Tinea pedis

    • Tinea cruris


Impetigo l.jpg

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


Impetigo138 l.jpg

Impetigo


Ringworm l.jpg

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


Ringworm140 l.jpg

Ringworm


Skin growths l.jpg

Skin Growths

  • Warts

    • Common warts (verucca vuglaris) are benign, hypertrophied areas of skin growth, commonly caused by papillomavirus – not contagious

    • Plantar warts (verucca plantaris) characterized as dark cores within a depression on plantar surface of foot in calloused areas – problematic if weight-bearing surface

  • Sebaceous cysts

    • Sebaceous glands filled with fatty secretion

    • Will often abscess and rupture or require drainage

    • Most common on posterior neck, scalp, chest and back


Warts l.jpg

Warts


  • Login