General Medicine Conditions

General Medicine ConditionsRhinovirus Common Cold100+ strainsMost common communicable diseaseUpper respiratory infectionSelf-limitinglasts 5-10 days regardless of txInfluenza - FluAcute infectious respiratory viral diseaseTypes:Type A: assoc w/ worldwide epidemics (most common)Type B: geographic epidemicsType C: mild fluRecovery in about 7-10 daysFever, chills, headache, myalgia, loss of appetiteAvoid aspirin in children Reyes syndrome

Infectious Mononucleosis - MonoAcute infection caused by Ebstein-Barr virusTypically found in young adultsMild when it occurs in young childrenOlder adults are typically immune Transmitted by respiratory secretionsSx:Fever, sore throat, swollen lymph nodes, malaise, hepatomegaly, splenomegaly(50-70% have enlarged spleen)Infection usually ensures permanent immunityYou carry virus, but typically dont get symptoms when virus occasionally becomes active (you can give it to others when active & asymptomatic)

Bronchitis90% of acute bronchitis = viral infection of the lungsLasts 1-3wksTypically doesnt need tx unless you have severe or persistent sxSy: SOB, chest pain/tightness, fatigue, muscle achesSx: Possible fever, difficulty breathing, coughing (possibly w/ mucus)PneumoniaLung infection caused by bacteria or virusSx: Chest pain, spitting up blood, fever, difficulty breathing, coughing up yellow/greenish sputumTx:Antibiotics for bacteria (sometimes viral to prevent complications) Most can be treated at home with lots of restIt often clears up in 2 to 3 weeksAsthma Constriction of air passages in the lungsCauses: cold, smoke, allergic reaction/allergies, exerciseSy: Tightness in the chest, SOBSx: Trouble breathing, increased RR, wheezing, bluish skin, increased pulse, tingling?Tx: Inhaler, monitor, calm the athlete down, EMS?MeningitisInflammation of the coverings around brain & spinal cordUsually caused by a bacterial or viral infectionViral: most common, usually not as seriousCan cause prolonged fever & seizuresBacterial: not as common, but very seriousCan cause brain damage & deathTypically seen in children, teens, and young adultsContagious passed via coughing, sneezing, & close contactSx:A stiff & painful neck, especially w/ neck flexionFeverHeadacheSeizuresIron-Deficient AnemiaCauses:Excessive loss of blood (can be seen w/ menstrual cycles)Deficient intake of ironPoor absorption of iron

Sx: Weakness/Feeling tiredFeeling grumpyHeadachesDifficulty concentrating Light-headednessDifficulty breathing

SeizurePhysical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brainOften used interchangeably w/ "convulsions" Convulsions are uncontrollable body shaking/contracting & relaxing of muscles There are many types of seizuresnot all have convulsionsTreatment for Seizure w/ ConvulsionsRemain calmCushion fallClear areaLoosen restrictive clothingPlace soft cloth between teethAllow patient to awaken normallyDo not restrain patient during seizureCall 911 if:First seizureLasts more than 2 to 5 minThe person remains unconscious More then one seizureCaused by head injury or has diabetesAtypical seizure for themHyperventilationDue to rapid breathing, levels of carbon dioxide are low (compared to O2) in bloodstreamBody responds to lower CO2 by constricting blood vessels in brain Sx: Lightheaded, headache Rapid heartbeat & RRNumbness or tingling in hands, feet, or mouthShaking/seizuresTx: Slow respiratory rateBreath in through nose & out through mouthInhale/exhale through one nostril w/ the other pinched and mouth closedBreath into a paper or plastic bag

Anaphylactic ShockSevere allergic reactionSy: Chest tightness, difficulty breathing, dizzinessSx: Wheezing, swollen tongue/lips/throat, bluish skin, hives, nausea, vomiting, confusionTx: Epi-pen, monitor, activate EMSPrevention: Know athletes Hx

Kidney StonesStones may form in any part of UT, most occur in kidneyDissolved urine salts begin to solidifyMay increase in size & result in obstructionIntense radiating pain from kidney area to groinTx: US waves, ureteroscopic removal, allow to pass on own

UTIUTI or Kidney InfectionCaused by bacteriaObstruction or holding it paves way for infection due to stagnation of urineSx: pain w/ urination, increased urgency & frequency, fever & chills possibleTx: antibiotics

AppendicitisInflammation of the appendixNot sure what it does & we can live without itMedical emergency - requires prompt surgery to remove the appendixWill eventually burst, or perforate, spilling infectious materials into abdominal cavityIn U.S. affects 1:15, usually between 10-30 y/oSx: Pain in LR abdomen, fever, loss of appetite, nausea or vomiting

HerniaProtrusion of any organ or tissue through the wall of the cavity that contains it

Sports Hernia: Athletic PubalgiaTypically no lump felt on exam, will worsen if not properly treatedTx: PT, Surgery?Strangulated Hernia: Blood supply to hernia is cut off, can lead to necrosis/gangrene (tissue death)

Ruptured SpleenDirect blow to left side Mono may enlarge the spleen, making contact sports extremely riskyProfuse internal bleedingEarly stage: pain in upper left quadrant, tenderness, bruisingLife threatening stage: Pain in left neck/shoulder, faintness, dizziness, pale skin, rapid pulse, vomiting, low BP, SOB, rigid abdominal musclesBruised KidneyBlow to flank/mid backEarly stage: Pain at site, bruisingAdvanced stage: faintness, dizziness, increased HR, bloody or cloudy urine, vomiting, rigid back muscles, pale and cool skin, frequent and burning urinationPancreatic PathologyDiabetes Mellitus (DM):Most common pancreatic disorderType IType IIGestational

Diabetes Stats(2007 ADA Fact Sheet most recent year available)7th leading cause of death in U.S. in 2006

23.6 million children & adults in US (7.8%)Diagnosed: 17.9 million peopleUndiagnosed: 5.7 million peoplePre-diabetes: 57 million peopleNew Cases: 1.6 million adults each yearChildren w/ Diabetes22% of all people 130/80 or used medsBlindnessLeading cause of new cases of blindness among adults 2074 y/o

25ComplicationsKidney diseaseLeading cause of kidney failure, accounting for 44% of new casesAmputation >60% of non-traumatic lower-limb amputations occur in people with diabetesFrom poor wound healing and poor circulationHigh cholesterolErectile dysfunction

Cost of Diabetes$174 billion: Total costs of diagnosed diabetes in US

Medical expenses were 2.3xs higher than people s diabetes

$218 billion: Factoring costs of undiagnosed diabetes, pre-diabetes, and gestational diabetes

Diabetes DefinedBody cannot effectively regulate blood glucoseCharacterized by hyperglycemia

Type 1: bodys failure to produce insulin due to autoimmune pathology (5-10%)Type 2: cell insulin resistance or failure of the pancreas to produce enough insulin (90-95%)Gestational: glucose intolerance during pregnancyPre-Diabetic: blood glucose levels are higher than normal but not high enough for a diagnosis

28High blood glucoseInsulinBody converts food to glucose, if not used it is stored as glycogen in the liver & muscles

Insulin produced in the pancreas, facilitates glucose transport in the cells for energy metabolism & storage2929Type 1 DiabetesAutoimmune body fights itselfJuvenile onset5-10% of diabetes incidenceUnderweight or normalLow insulin levelsFHx usually negative

3030Type 1 Insulin DependentUsually diagnosed in children and young adults Previously known as juvenile diabetesOnly 5% of people with diabetes have this form of the diseaseIn type 1 diabetes, the body does not produce insulin, a hormone that is needed to convert sugar, starches & other food into energyType 2 DiabetesInsulin resistantAdult onset (typically)90-95% of diabetes incidenceRisk factors: OverweightSedentary lifestylePoor dietFHx

3232Type 2 Insulin ResistantMost common form of diabetesPreviously known as adult onsetThe body does not use insulin properlyInitially the pancreas makes extra insulin to make up for it, but over time the body cant make enough to keep your blood glucose at normal levels

Diagnostic CriteriaFasting plasma glucose - p 8hr fastNormal = 100 mg/dLPre-diabetic = 100-126 mg/dLDiabetic = >126 mg/dL

Casual plasma glucose > 200 mg/dL

3434Signs & SymptomsIncreased thirstIncreased urination (polyuria)Unexplained weight lossIncreased hungerTingling in hands and feetBlurry visionGlucose in the urine3535ManagementType 1:

DietExerciseInsulinRegular blood sugar monitoring

Type 2:

DietExerciseOral anti-diabetic agentsRegular blood sugar monitoringInsulin???36Diet: carbs in moderation (different carbs spike glucose levels in different people) Type 2 can lessen the oral meds and keep themselves off insulin by watching diet and exercising regularly (drop weight = less strain on pancreas)Exercise: extremely important for type 2, type 1 needs to monitor glucose levels carefullyIf sugar is too high, hold off on exercise (250-300)If sugar is too low or near normal, ingest some carbs prior to exercise or decrease insulin intake36Diabetic GoalsPre-meal blood sugar: