General Medical Conditions

1
General Medical Conditions

• History and Basic Disease
• Cardiac
• Pulmonary
• Cancer
• Steve Petty M.D.
• March 15, 2006

2
Historyand Disease Basics

• Hx History
• OLDCART
• Onset
• Location
• Duration
• Character
• Aggravating factors
• Relieving factors
• Temporal association

• Disease Basics
• Risks common?
• Sxs symptoms OLDCART
• Dx diagnosis
• Tx treatment
• Prognosis

3
Cardiopulmonary Issues

• Syncope
• Hypertrophic Cardiomyopathy (CMP)
• MI Heart Attack
• Arrhythmias including Brady, tachy
• MVP Mitral Valve Prolapse
• HTN hypertension high BP
• Asthma
• Hyperventolation

4
Sudden Cardiac Death

• 30 years old MI
• Always know if they collapse before or after the
  finish line.

5
Cardiopulmonary Red FlagsNeed immediate
referrals

• Exert ional chest pain
• Chest tightness, pressure
• Shortness of breath especially at rest
• Wheezing, dry cough
• Syncope- passed out
• Palpitations
• Medical conditions i.e. diabetes, CAD, szs
• Heart Murmur

6
Unconscious?

• Airway look listen and feel
• Breathing rate, look listen and feel
• Circulation feel for a pulse!

7
Assessing the Unconscious

• 1 ABCs
• CPR or rescue breathing
• Activate EMS
• Vital signs BP, HR, RR

8
MI myocardial infarction Heart Attack1
cause of death in United States
9
MI Risk Factors

• Smoking
• Diabetes
• High blood pressure Hypertension
• Family history
• Obesity
• Lack of regular exercise
• High cholesterol

10
MI SymptomsChest pain History OLD CART

• Onset sudden, gradual
• Location substernal
• Duration usually constant
• Character squeezing, pressure,10/10
• Aggrav activities that increase HR
• Relieving rest, unless MI
• Temporal gradually increasing

11
Myocardial Infarction

• Most common cause of SCD 30
• Sxs
• Risk factors
• Activate EMS aspirin, oxygen, IV
• Pathology occluded coronary artery

12
Myocardial Infarction
13
Hypertrophic CMP

• Most common cause of SCD
• Risks Autosomal Dominant - Fm hx
• Any red flag sxs refer for eval often sxs are
  vague and commonly present with SCD.
• Pathology enlarging of heart muscle without
  increase chamber size, decreases outflow
• Usually heart murmur

14
Hypertrophic Cardiomyopathy
15
Arrhythmias

• Bradycardia
• HR
• Common in healthy athletes
• Symptomatic slow HR, elderly, light headed needs
  evaluation

• Tachycardia
• HR 100 level of fitness will determine how
  quickly HR returns to baseline
• Symptomatic High HR Always needs evaluation

16
Mitral Valve Prolapse

• History/Sx Palpitations Most are asymptomatic
• DX auscultation, cardiac echo
• TX usually not needed, unless sxs
• If asymptomatic no contraindications to sports
• Some with sxs are on medications
• Red Flag symptomatic palpitations need referral

17
MVP Mitral Valve Prolapse
18
Hypertension

• Definition 2 readings 135/85
• Risks for HTN obese, sedentary kidney disease.
• HTN is risk factor for end organ damage MI,
  Stroke, renal vascular eye problems, aneurisms
• Treatment lose weight!, exercise, diet,
  medications
• Prognosis -

19
High numbers but getting lower
20
Pulmonary Conditions

• Asthma
• Colds upper respiratory tract infect
• Pneumonia/Bronchitis
• The Flu

21
Asthma

• Asthma bronchoconstriction
• EIA Exercised Induced Asthma
• Sx wheezing, dry cough, often worse during
  allergy season and with colds
• Tx albuterol puffer 20 minutes before exercise,
  inhaled steroids, oral steroids
• Dx clinical, Peek Flow Meters, PFTs with pre
  and post brochodilators

22
Asthma bronchiole constriction
23
Respiratory Infections

• Upper (URIs)
• Colds, sinusitis, pharyngitis, laryngitis,
• Above Neck symptoms often can participate in
  sports
• Lower
• Pneumonia, bronchitis
• Below Neck symptoms should not participate in
  sports i.e. flu symptoms

24
The Flu

• Usually caused by influenza virus
• Vaccine is helpful in prevention
• Risks its Contagious fomites, hands, door
  knobs, counter tops
• Symptoms general fatigue, fever, diarrhea, dry
  cough, myalgias
• Not amenable to sports participation
• -some viruses may infect heart muscle and cause
  dilated CMP

25
Sinusitis

• Bacterial infect in maxillary, frontal and or
  other sinuses
• Risks allergies, a cold, exposure
• Sx Fever, frontal headache, sputum green/yellow,
  erythema, sinus tenderness
• Suspect if a cold lasts longer than a week
• Treatment antibiotics, decongestants

26
Sinusitis
27
Laryngitis

• Vocal cord inflammation
• Causes overuse (yelling coaches), or viral infect
• Sx loss of voice, hoarse, raspy
• Tx voice rest is usually all that is required
  for full recovery

28
Pharyngitis

• Also called tonsillitis, sore throat, strep
  most are viruses
• Risks contagious
• Sx Strep triad Streptococcus A bacteria
• 1. red tonsils with exudates,
• 2. swollen tender glands
• 3. fever
• Diagnosis History, exam, rapid strep
• Treatment penicillin
• No resistant cases ever reported
• Not all sore throats are strep
• Rapid strep test

29
Allergic Rhinitis

• Also called Allergies, seasonal allergies, hay
  fever
• Symptoms runny itchy nose and eyes, clear nasal
  discharge, ears plugged, fatigue, sneezing
• Treatments benadryl, claritin, shots, accupunture

30
Pneumonia

• Pneumonia
• Walking usually mycoplasma high HR, fatigue,
  low to no fever, dry cough, insidious often over
  weeks
• Classic Pneumococcal pneumonia - High fever,
  productive cough with phlegm, chills, fatigue,
  SICK
• Get both evaluated

31
Pneumonia
32
Bronchitis

• Most common lower respiratory infect
• Most are caused by viruses, unless a secondary
  bacterial infection sets in
• Symptoms cough, sneezing, wheezing, and usually
  with regular cold symptoms
• Treatment cough meds, albuterol, rest often
  takes two weeks or longer to resolve.

33
Cancer

• Moderate regular exercise can decrease risk for
  cancer!
• Localized like some skin cancer
• Metastatic spreads to other parts of body
• Cause infections i.e. cervical cancer and HPV
  (warts), i.e sun exposure, Cigarette smoking,
  genetic i.e breast CA

34
Cancers 2 cause of death

• Lung
• Breast
• Prostate
• Colon
• Testicular
• Skin
• Leukemia/lymphoma

35
Cancer

• Definition uncontrolled growth of atypical cells
  from DNA mutation
• Tumor mass of cells
• Malignant very atypical and potential to grow
  locally and spread

36
Lung Cancer

• Risks smoking, Asbestos,
• Sxs wt loss, pneumonia that wont resolve
• Loss of appetite
• Diagnosis Chest x-ray, CT, biopsy
• Treatment surgery, chemo, radiation
• Prognosis 6 months

37
Skin Cancer

• Melanoma dark
• Basal Cell light
• Squamous Cell light/red

38
Basal Cell Skin Cancer
39
Malignant Melanoma

• A asymmetry, irregular shape
• B borders irregular
• C color is varied
• D diameter 6mm
• E Elevation and Enlarging

40
ABCDs of Melanoma
41
Prevention of skin Cancer

• Avoid 10-2 sun exposure
• Sun block
• Protective clothing
• Increase risk of skin cancer with one sun burn

42
Leukemia

• More common in children and young adults
• Proliferation of immature white blood cells
• Sxs swollen nodes, fatigue, fever, pale,
• Diagnosis blood work, bone marrow biopsy
• Treatment Chemo, bone marrow transplant

43
Lymphoma

• Non-Hodgkin's
• Aggressive, lower survival rates

• Hodgkin's Lymphoma
• (Hodgkin's Disease)
• Etiol viral?
• Sx non-tender node
• Dx biopsy of node
• TX Radiation and chemotherapy
• Prognosis good

44
Brain Tumors

• Primary tumors are uncommon
• Most are spread from distant sites i.e., lung,
  breast
• Sxs gradually increase in headache, neurological
  changes, i.e. new onset seizures
• Do CT/MRI
• Treatment varies

45
Oral Cancer

• Risk family hex, tobacco, ethos, poor dentition,
  dentures
• Sxs white or red plaque, persistent sore
  throat,
• Diagnosis biopsy
• Treatment surgery, radiation,

46
Oral Cancer
47
Breast Cancer

• Most common cancer in women
• Risks 1 is family history!, increased age,
  obesity, no children, late menopause (more
  estrogen exposure)
• Six lump painless 2-3 cm, 75 found by pt, skin
  or nipple retraction, lymph node enlarged,
  discharge
• Prevention self exams start at 20, mammograms
  starting 35-40 you
• MD exams, every 2-3 years

• Six Painless lump 2-3 cm, 75 found by pt,
• skin or nipple retraction,
• lymph node enlarged, discharge
• Prevention
• Self exams start at 20, mammograms start 35-40
  you
• MD exams, every 2-3 years

48
Breast Cancer Diagnosis

• Self exams, MD, Mammogram
• Biopsy, then look for metastasis for staging
• Treatment
• Surgery
• Chemo
• Radiation

49
Breast Cancer

• Changes to look for in your breasts
• Any new lump (which may or may not be painful or
  tender)
• Unusual thickening of your breasts
• Sticky or bloody discharge from your nipples
• Any changes in the skin of your nipples or
  breasts, such as puckering or dimpling
• An unusual increase in the size of one breast
• One breast unusually lower than the other

50
Monthly self breast exams
51
Cervical and Ovarian CA

• Cervical
• Risks multiple partners, HPV
• Six none, to mass effect
• Do pap smear, box
• Treatment surgery, ablations, cry therapy

• Ovarian
• Risks family hex
• Usually found late, due to lack of sis,
• No screening tests

52
Testicular Cancer

• More common teens and young adults
• Six enlarging painless lump, or testicle
• Risks undescended testicle,
• Diagnosis self exam, MD, ultrasound
• Treatment surgery, work up to eval. Spread
• Prognosis excellent if found early

53
Prostate Cancer

• Risks 40, African American
• Sxs usually none until spreads
• Do routine rectal exam starting at 40, biopsy,
  blood test (PSA)
• Treatment radiation, surgery, orchectomy

54
Colon Cancer

• Descending colon and rectum most common.
• Risks family hx, polyps, 50,
• Sxs weight loss, blood in stool, abdominal pain,
  diarrhea, obstruction
• Diagnosis stool guiac, screening sigmoidoscopy
  at 50, biopsy, or polyps
• Treatment surgery, chemo

55
Most Important

• Syncope before the finish line?
• Red Flags Cardiopulmonary
• Does the athlete cross finish line?
• Chest pain and shortness of breath
• Cancer screening, skin, breast, testicular

56
(No Transcript)