Medical Issues Final Flashcards
holistic patient care
care for the whole patient, not just their problem
clinical presentation vs. diagnosis
presentation
-overall “picture” of signs, symptoms, medical history, and clinical exam
diagnosis
-determination of the problem using the clinical presentation
pathology vs. pathogenesis vs. etiology
pathology -science concerned with disease including structural and functional changes pathogenesis -the underlying cause of a disease etiology -study of pathogenesis
clinical decision making
similar to diagnostic reasoning
determines the best course of action
not a final diagnosis
three stages of prevention
primary -analyzing risk factors secondary -early detection teriatry -disease management
six components of a medical history
patient's age and gender patient's chief complaint past medical history current health status family history review of systems
diagnostic imaging and testing
x-ray radionuclide bone scan fluoroscopy -live-image x-ray computed tomography position emession tomography magnetic resonancy imaging diagnostic ultrasound
pharmacology
LECTURE
plaque psoriasis
- common location
- treatment
inflammatory condition where the skin cells overproduce -common -elbows -knees -knuckles common S/S -silvery scales treatment -topical and oral
bacterial skin infections types
impetigo
staph infections
impetigo
- treatment
- RTP
causes blisters
leads to a honey colored crust
treatment
-antibiotic
RTP
-no new skin lesions for at least 48 hours
-completion of a 72-hour course of directed antibiotic therapy
-no further drainage or exudate from the wound
-active infections cannot be covered for competition
MRSA
-S/S
methicillin-resistant Staphylococcus aureus
S/S
-abscess with red streaks - emergency room
-size
-redness extends out from the injury
CA-MRSA
community acquired
- contagious
- common among sports teams
RTP for MRSA
no new lesions for at least 72 hours
completion of a 72-hour course of directed antibiotic therapy
no further drainage or exudate from wound
active infections may not be covered for competition
tinea (fungal infections)
-RTP
tinea pedis (athlete's foot) tinea cruris (jock itch) tinea corporis (ringworm) timea capitis (on head) tinea versicolor (change in skin color) RTP -72 hours -cover lesions
Tinea Capitis RTP
two weeks of anti fungal biotics
Tinea Corporis
circular plaque with clear center
can be covered if in small enough area
Tinea Pedis
-treatment
most common fungal and skin infection treatment -common sense prevention --dry feet after shower --change out of socks after exercise
Tinea Cruris
scaly plaques
viral infections
herpes simplex
herpes simplex
-S/S
very contagious S/S -blisters -fatigue and fever treatment -antiviral
herpes simplex RTP
athlete must be free of systemic symptoms
no new blisters for 72 hours
all lesions must be surmounted by a firm adherent crust
have completed 5 days of antivirals
molluscum contagiosum
lesion with a hard center
main treatment is having them removed
-must be removed for competition
warts
caused by HPV
categorized by location and appearance
treatment
-removal
plantar warts
grow into skin instead of out
parasitic infections
scabies
pediculosis
scabies
itches
most common between fingers
mites that lay eggs and burrow beneath the skin
treated with prescription strength cream
pediculosis
lice
-head, body, and genital lice
cannot compete until treatment is complete
NATA position statement on prevention of skin disease
evidence-based recommendations
- clean environment
- hand hygiene
- overall hygiene
- no sharing
- whirlpools
- report all open wounds and lesions to an ATC
S/S of neurological pathology
syncope coma paresthesia abnormal motor control, coordination, or tone headache changes in senses changes in mental status
ALS
-cause
-S/S
Tx
fatal, progressive neurological disease that slowly attacks neurons responsible for voluntary muscle actions
S/S
-tired or clumsy, often begin in one limb, difficulty with swallowing and speech
-may be spasticity or hyperflexia
-weight loss
Tx
-can be treated with drugs but is not curable
Bell’s Palsy
disease typically affects CN 7 S/S -bilateral or unilateral facial weakness Tx -corticoseroids
epilepsy
> 2 seizures in lifetime
caused by abnormal activity in brain
Tx
-combo of medicine or surgery
multiple sclerosis
neurodegerative lifelong chronic disease
-can lead to permanent disability in affected nerves
S/S
-problems w/ balance and coordination
-spasticity and fatigue, visual problems, dizziness, pain, numbness, bladder + bowel dysfunction
-cognitive and emotional changes
Tx
-relapsing + progressing symptom management w/ medication
vascular headache
caused by spasms of the vellels surrounding the brain
include migraines
S/S: rapid onset, unilateral throbbing pain in frontal or temporal area
-start in morning and peak 2 hrs later (migraine)
-begins with aura and accompanied w/ increased sensitivity to light/sound (migraine)
migraine
type of vascular headache that may present w/ or w/o neurological symptoms
stroke (CVA)
lack of oxygen to the brain - may lead to reversible or irreversible paralysis and other damage
S/S
-numbness or weakness on one side of the body
-confusion, trouble speaking or understanding
-headache, dizziness
Tx
-acute: designed to reverse or lessened the amount of tissue death
-rehab to improve function so that the stroke survivor can continue an independent lifestyle
GBS (Guillain-Barre)
acute demyelinating disorder of the spinal roots and peripheral nerves
S/S
-progressive weakness distal to proximal pain in movement of the affected area and nocturnal muscle cramps
Tx
-no cure
-rehab to make things better and lessen severity of symptoms
bacterial and viral miningitis
inflammation of the meninges by bacteria or viruses
docorticate rigidity
indication of cerebral cortex damage
arms in flexion, legs in extension
decerebrate rigidity
indication of cerebellum damage
arms and legs in extension
meningeal irritation tests
kernig test -patient in supine -passively raising one leg at a time -keep knee fully extended -raise leg until symptoms are felt -flex knee to relieve symptoms -dorsiflex foot -if dorsiflexion recreates symptoms, meningeal irritation is present Brudzinski Test -perform the above test with neck passively or actively flexed
ocular palpation areas
orbital margin
frontal bone
nasal bones
zygomatic bones
pupillary reaction to light
-PEARL
pupils equal and reactive to light
red flags for eye referral
blurred vision diplopia - double foreign object protruding into the eye restricted eye movement distorted pupil hyphema unilateral pupil dilation or constriction large lacerations of the eyelids lacerations that involve the margins of the eyelids persistent floaters
refractive errors
- -cause
- types
caused by length of eye and shape or curvature of cornea
types
-myopia - hard to see distance
-hyperopia - hard to see close up
conjunctivitis
- contagious?
- other S/S
can be contagious
-viral or bacterial
other respiratory problems
conjunctivitis RTP
48-72 hours after starting antibiotic eyedrops
stye
-S/S
inflammation of duct or hair follicle on the eyelid S/S -pain -swelling -redness
glaucoma
increased intraocular pressure
- build up of aqueous humor
- can lead to damage to the optic nerve
eyelid laceration
-question to ask
bleed profusely
can you approximate the wound?
-harder to do over the eyelid
periorbital contusions
- DDx
- RTP
black eye
test the eye early before swelling develops
DDx
-orbital fracture
-concussion
RTP
-as soon as possible if there are not major problems
orbital fracture
-S/S
blow to the eye or the bones around the eye
blowout fracture
-fracture to the walls or floor of the orbit
S/S
-pain with eye movement
-possible inability to look up if bottom is fractured
-pain when blowing nose
-diplopia
refer
dislocated contact lens
evert eyelid
wash with sterile saline solution
locate lens
replace once the lens is clean or with a new one
corneal and conjunctival foreign bodies
may need to evert the upper eyelid to visualize the foreign bodies
corneal abrasions
feels with something in the eye
can lead to decreased to vision, pain, tearing
how to diagnose a corneal abrasion
fluorescein - dye
shine pen light with attachment
abrasion will be visible
will resolve within a few days to a week
corneal laceration
puncture wound to the eye
“open globe”
automatic referral
can use an eye shield
subconjunctival hemorrhage
benign
can occur from trauma (straining, high BP)
hyphema
bleeding in the anterior chamber of the eye not benign shows up over the iris and pupil S/S pain, blurred vision 911 -keep them upright Tx -bedrest in an elevated position resolve in about a week will require eye protection
detached retina
high chance of disrupting optic nerve S/S -"curtain" over their field of vision -floaters -blurred vision can be caused by a severe jarring force immediate referral
retinal tears
similar S/S to detached retina
immediately refer
chemical burns
flush continuously
refer
traumatic iritis
blunt trauma S/S -photophobia -sluggish pupil reaction refer
proptosis
direct trauma bulging of the eye caused by swelling swelling can damage the optic nerve S/S -bulging -decreased motility -diplopia -can't close eyelids fully -pain -nausea immediate referral
ruptured globe
blunt trauma directly to the glove rupture of the cornea or the sclera resulting in the inner contents spilling out S/S -pain -eyeball may look out of place -marked edema -hyphema possibly shield and refer
examination of the ear
patient history general observation palpate pinna and mastoid process conduct a hearing test if necessary -determine difference between sensorineural loss and conductive hearing loss using the Weber test Otoscope evaluation
auricular hematoma
buildup of fluid between the skin and the certilage of the pinna MOI -repeated trauma to the site S/S -buildup of fluid -sometimes painful Tx -ice and compression -referral if they have a visible buildup of fluid RTP -clear to play -drain and cover
ruptured tympanic membrane
MOI -change in pressure -puncture wound -direct blow to the head S/S -painful -tinnitus -hearing loss Tx -will heal on it's own refer out RTP -depends on the sport -self-limiting in most sports
otitis externa
inflammation and/or infection of the external auditory canal swimmer's ear, or cleaning the ear too much cerumen dries out - dries the ear out S/S -pain -itching -burning -possible swelling of pinna Tx -antibiotics RTP -usually within 24 hours of beginning antibiotics
otitis media
presence of fluid in the middle ear accompanied by S/S of infection S/S -earache -fullness in the ear -fever -ringing in the ears -dizziness -hearing loss -tympanic membrane is red when looking with an otoscope Tx RTP -24 hours after starting antibiotics
impacted cerumen
build of earwax in the external canal S/S -hearing loss -ear's "plugged up" Dx -use otoscope Tx -referral to have it removed -manual removal
nose exam
ask questions look for drainage examine the nose palpate the nose palpate the facial bones and sinuses
allergic rhinitis
hypersensitivity to inhaled allergens S/S -clear mucus -sneezing -runny nose -congestion -itchy, watery eyes Tx -send in if they have a fever -antihistamines -avoid allergens -humidifier, air filter
non-allergic rhinitis
caused by virus, bacteria or vasomotor-related inflammation or infection of the nasal passages
S/S
-same as allergic but won’t react to same Tx
sinusitis
inflammation of mucus membranes lining the paranasal sinuses S/S -sinus pain Tx -referral -antibiotics RTP -can play without fever
exam of the mouth and throat
inspect the face, head and neck
palpate the lymph nodes
examine the lips both open and closed
inspect the tongue and mucosal lining of the mouth, gingivae, and back of throat
gingivitis
Bacterial infection of the gums S/S -swollen and red gums -possible bleeding -pain -haltosis: bad breath Tx -referral -oral hygiene is important for oral health
oral candidiasis
"thrush" fungal infection of the mucous membranes in the mouth S/S -white/yellow tongue -can turn into red lesions of the gums Tx -referral
oral cancer
direct link between tobacco use and oral cancer
individuals who use tobacco products and alcohol are at 15x more risk
S/S
-hoarseness
-pain or difficulty swallowing or chewing
-masses in the mouth or neck
Tx
-chemo
-radiation
phayngitis and tonsillitis
inflammation of either/or can be caused by bacteria or viruses streptococcus is the main culprit -strep throat S/S -white spots in the back of the throat -sore throat -painful swallowing -fever/chills depending on infection type Tx -bacterial: refer --strep test, antibiotics -viral: rest RTP -depends on if they have a fever -no fever for 24 hours
laryngitis
inflammation of the larynx -direct blow to the throat -can accompany upper respiratory infection -common in smokers S/S -loss of voice -tickling in back of throat Tx -humid environment -cough drops RTP -self-limiting in absence of fever
lymphatic system
olymphics
what is athlete’s heart
the concept that the heart of athletes enlarges as a result of cardiovascular training
normal physiological response to exercise
- acute
- chronic
acute -increased HR and SV -increased systolic BP -increased breathing chronic -decreased HR -decreased breathing -decreased BP
SCD common causes
HCM - hypertrophic cardiomyopathy
sickle cell trait/anemia
commotio cordis
coronary artery abnormalities
cardiac pathology S/S
chest pain dyspnea fatigue palpitations syncope claudication skin and nail temperature, color and appearance edema
what creates the “lub dub” sounds you hear when ausculating
heart sounds 1 and 2 S1 -closure of mitral and tricuspid valves S2 -closure of aortic and pulmonic valves
heart failure
decrease in cardiac output -heart has developed an insufficient heart pump hear failure can be -left -right -acute -chronic acute is immediately life threatening chronic heart failure displays gradual but systemic failure
heart failure S/S
cyanosis
shortness of breath
low BP
myocardial ischemia
- S/S
- may be cause by
decreased blood supply to the myocardium S/S -angina -dyspnea -snycope coronary artery disease can cause this -the myocardium can become ischemic and necrotic causing a myocardial infarction
myocardial infarction
-S/S
most MI's happen during moderate to heavy activity S/S -angina -fatigue -dizziness -syncope quick response and referral is necessary
hypertrophic cardiomyopathy
enlargement of the heart -general -left ventricle leads to -heart failure -ischemic damage -fatal arrhythmia pathological -LV wall thickness > 15mm leading cause of SCD
hypertrophic cardiomyopathy S/S
syncope angina dyspnea murmur that increases with Valsalva Maneuver family history
valve disorders
- stenosis or prolapse
- sports participation
stenosis or prolapse -stenosis: narrowing of the valve; restricts blood flow -prolapse: allows backflow of blood often allowed to participate in sports may result in arrhythmias -withheld from sports
MVP
mitral valve prolapse
most common valve abnormality
Marfan’s Syndrome
genetic defect that leads to abnormalities in the body's connective tissue signs -tall stature and long extremities -pectus deformity -scoliosis -spontaneous pneumothorax -myopic (nearsighted) 80-90% will develop fatal artery abnormalities
Marfan’s Syndrome complications
Mitral Valve Prolapse (MVP)
Aortic Valve Disease
Aortic Rupture
-vessel walls weaken and dilate
Marfan’s diagnosis
hard
complete family hx is important
commotio cordis
sudden blow to the chest
during repolarization
15% resuscitation rate without immediate AED application
congenital abnormalities of coronary arteries
abnormal origin of the left main coronary artery
-may cause a “kinking” of the artery or force it to pass through the aorta and pulmonary artery
–blood flow is restricted to the heart tissue
S/S
-Chest pain
-arrhythmias
-syncope
congenital abnormalities of coronary arteries
Hypoplasia (underdevelopment) of the R and L circumflex coronary arteries
absence of the left coronary artery
myocardial bridging
-artery goes through tissue instead of over the top
testing
-ECG
-treadmill stress test (if both are +, further investigate)
coronary angiography
deep vein thrombosis (DVT)
blood clot lodged in a vein results in venous blockage most common in the lower leg S/S -limb pain and swelling Dx -ultrasound Tx -anticoagulants may lead to a pulmonary embolism
disorders of the blood
anemia
sickle cell anemia
sickle cell trait
anemia
defines as a decreased # of RBC’s or a decreased hemoglobin concentration in the blood
3 general categories
-microcytic: iron deficiency
-normocytic: normal sized RBC (blood loss)
-macrocytic: enlarged; don’t function properly
S/S and hx of anemia
vague symptoms -weakness, fatigue, dizziness and headache -decreased performance -craving ice or crunchy raw veggies signs -tachycardia, orthostatic hypotension, dyspnea, tachypnea and pallor -bruises easily hx -dietary habits -menstrual cycle and amount of flow -NSAID use and antibiotic use
treatment for anemia
refer to doctor for CBC to determine type of anemia first
identify and correct any sources of blood loss
look at diet and ensure athlete is getting good sources of iron
take 325mg 3x per day of ferrous sulfate
-2 week response is good
-after 3-6 weeks hemoglobin is back to normal
sickle cell anemia
occurs as a recessive genetic trait, producing abnormally shaped RBC’s that inhibit binding of O2
creates a decreased O2 carrying capacity of the blood
sickle cell trait
20-40% of the hemoglobin is HbS; the rest of the hemoglobin is normal
1 in every 400-600 African Americans have anemia
1 in every 10 AA have the trait
the risk of SD is 27x higher in AA that have the SCT
SCT is a risk factor for
-exertional rhabdomyolysis
-splenic infarction
-cardiac arrhythmias
-kidney failure
SCT S/S
tachycardia
hypotension
hyperventilation
LOC
athletes with SCT are advised to…
avoid dehydration and acclimatize gradually to heat and humidity
condition gradually for several weeks before engaging in exhaustive exercise regimens
acclimate to altitude over an appropriate amount of time
refrain from extreme exercise during acute illness, especially if fever is involved
effects of exercise on respiratory system
increased blood to the lungs
increased oxygen demand to muscles
increased carbon dioxide produced by muscles
increase in ventilation
S/S of pulmonary disease
dyspnea cough cyanosis abnormal breathing patterns thorax pain
peak flow meter
establish a baseline for your patient test patient upon suspicion of bronchospasm -green zone: 80-100% of baseline -yellow zone: 50-80% of personal best --medication is necessary -red zone: below 50% --call 911
pulmonary pathology disease classification
obstructive
-limits airflow
restrictive
-limits lung expansion
pulmonary pathology sources
environmental influences
trauma
genetic factors
immune response
flail chest injury
multiple fractures that result in displacement of the ribs
can also sprain the joint between the rib and cartilage
pneumothorax
collaped lung (air in the pleural space) commonly caused by trauma S/S -pain -trouble breathing -would hear hyper-resonance during percussion Tx -referral
hemothorax
blood in the pleural space S/S -similar to pneumothorax -coughing up blood (frothy) -percussion and auscultation differences Tx -referral
asthma
produces -bronchial spasms -chronic bronchial inflammation -bronchial edema symptoms -chest constriction -fatigue -anxiety clinical signs: symptoms worsen at night
asthma cont.
onset -begins early, genetic predisposition to severe allergic responses causes -allergens -infection -cold/dry air -emotional states -exercise Tx -patient education is important -limit inflammation (corticostaroids) -treat bronchospasms (short and long acting beta-2 agonist) -control symptoms -prevent exacerbation by controlling known triggers
management of an acute asthma attack
seated position take deep breaths exhale through pursed lips (whistle) tell them to remain calm administer inhaler ER is all else fails
exercise induced bronchospasm
exercise-induced asthma
more common than asthma
-15% of the population
-90% of people with asthma
-35-40% of people with allergies
occurs 5-10 minutes into exercise, worsens with activity
spontaneous recovery occurs 30-60 minutes after stopping exercise
exercise induced bronchospasm
- triggers
- S/S
triggers -cold, dry air -allergens -pollutions -infection S/S -unusual dyspnea -central chest pain during exercise -coughing
Acute EIB management
similar to an asthma attack
remove from exercise
reassure
assess and monitor
when to refer w/ EIB
cyanosis
syncope
symptoms >60 minutes
exercise induced anaphylaxis
breathing disorder + chronic use of NSAIDs produces an abnormal immune response S/S -flushing -urticaria -cough, croup (deep "honking" cough) -stridor --harsh wheezing sound -hypotension & tachycardia (shock)
EIA treatment
administer Epipen
call 911
acute bronchitis
caused by infection or irritant that produces an inflammatory response -most commonly viral early S/S -fever -nonproductive cough -sore throat -chest pain progresses to -productive cough -wheezing treatment -cough suppressants -rest -hydration
chronic bronchitis
caused by prolonged or repeated exposure to irritants
inflammation of the bronchial mucous membranes
S/S
-wheezing
-dyspnea
-cough that is more productive in the mornings and evenings
symptoms present from 3 months - 2 years
treatment
-avoid irritants
pneumonia
every year more than 60,000 Americans die of pneumonia
infection and inflammation in the lungs
recognition and early treatment is the best option
pleurisy
inflammation of the pleura
may develop secondary to other infections
fluid can accumulate at the site of the inflammation
can cause coughing, dyspnea, tachypnea, cyanosis, and retractions
diagnosis
-auscultation
-pain at one site with laughing, coughing
influenza
the "Flu" viral S/S -high fever -headache/body aches -cough -chest pain -shortness of breath -fatigue -loss of appetite -nasal congestion -sore throat refer when -close contact with other person's diagnosed influenza -symptomatic diagnosis -clinincal grounds mainly -antigen testing -CBC's -sputum cultures -fever is generally the hallmark
upper respiratory infections
rhinovirus
very easily spread through cough or sneeze
mild symptoms very similar to influenza but don’t last as long
secondary bacterial infection can happen
7-10 day duration
tuberculosis
highly contagious bacterial infection -mycobacterium tuberculosis airborne droplets cause infection immunocompromised people are more likely to get active TB S/S -fatigue -fever -weight loss -cough -hemoptysis -shortness of breath/wheezing diagnosis -skin test -symptomatic -positive radiograph
pulmonary obstructive disorders (COPD)
Chronic obstructive pulmonary disease is a classification of diseases involving partially blocked airways
-asthma
-bronchitis
-emphysema
-cystic fibrosis
decreased vital capacity, increased CO2, decreased O2, thus disrupting the diffusion gradient across the alveoli
emphysema
complication of chronic pulmonary disease + prolonged smoking
causes destruction of alveolar walls, capillaries, and lung elasticity
S/S
-SOB
-increased exhalation effort
-infection
-Cor pulmonale (right sided heart failure)
irreversible, poor prognosis
