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Wednesday, November 12, 2008
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Airway Burns

NORMAL

ABNORMAL


DESCRIPTION
* Airway Burns occur when an individual is trapped in a poorly ventilated space and inhales smoke, steam, superheated air, or toxic fumes.




* At risk are those caught in fires, fire fighters, explosives experts, toxic chemical cleaning crews, miners, and factory workers working with chemicals or steam.
* Exposure may result in charred mouth; burned lips; burns on the face, head, and neck; singed eyebrows and hair (nose, scalp); burns on other parts of the skin and clothing; cough productive of black or tar-stained mucus; difficulty breathing; wheezing or coughing.
* Exposure victims must be immediately attended to, the nature of the fumes identified, and appropriate measures taken to assure that their airways are open (for normal breathing) and that they are hemodynamically stable.

TREATMENT
* Requires emergency treatment


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Air in the Lungs



ALSO KNOWN AS
Pneumothorax, air in the chest, collapsed lung or collapsed chest

DESCRIPTION
* The lungs are covered by a saclike membrane known as the pleura, which separates the lungs from the chest wall (ribs). The pleurae have two layers: one covers the lungs (visceral), the other is attached to the inside of the chest cavity (parietal). Between the two layers there is a thin film of fluid that lubricates the lungs, allowing them to move smoothly during respiration (breathing). Under normal conditions, there should be no air between the lungs and the chest cavity. The introduction of air into this cavity will cause the lung to collapse, and compromise breathing.



* The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax (p.).


SYMPTOMS
* Depends on the size of p.
* Chest pain:

1. Sudden
2. Sharp or stabbing
3. Chest tightness
4. Made worse by breathing or coughing

* Shortness of breath
* Cyanosis or bluish color to the skin and lips due to hypoxia (low oxygen level)
* Rapid rate of breathing
* Fatigue
* Wheezing
* Anxiety
* Patient may be in Shock or unconscious, especially with trauma or tension p.

CAUSE
* Primary p. -- in healthy individuals this occurs without any underlying diseases
* Secondary -- complication of underlying lung disease
* Spontaneous p. -- often occurs after the rupture of a bulla (a.k.a bleb) or blister (not found in normal lungs), which are small air-filled sacs in the lungs of individuals with certain risk factors. Could be primary or secondary.

HOW THE DIAGNOSIS IS MADE
* History:

1. Symptoms
2. Injuries
3. Procedures or surgeries
4. Illnesses
5. Medications
6. Habits
7. Occupation
8. Allergies

* Medical exam:

1. Skin may show the site of trauma
2. Low Blood Pressure
3. Fever may be present
4. Cyanosis
5. Air can leak under the skin (subcutaneous Emphysema) and has a spongy feel
6. Pallor -- pale skin
7. Rapid heart and respiration rate
8. The chest movements are not symmetrical
9. The trachea (major airway -- located in the center of the neck) may be shifted in tension p.
10. When the doctor listens to the heart or the lungs, the normal sounds may be diminished or absent.

* Tests:

1. Chest X-Ray will show the abnormal air pocket, and Collapsed Lung or structures that have been pushed to one side.
2. CAT scan, using computer imaging, shows detailed views of the chest and lungs.
3. Blood tests may show low oxygen levels (<80 acidosis =" pH">30%:

1. Objective is to remove the air.
2. General physician may consult with a surgeon or a pulmonologist (lung doctor).
3. A needle may be used to remove the air.
4. Aspiration involves inserting a catheter (Teflon tube) into the chest cavity (between the ribs) and attaching to a simple bottle (vacuum inside with no air). This may be enough to expand the Collapsed Lung.
5. A plastic chest tube is inserted through an incision in the chest (between the ribs) and then connected to suction. This method may take few days to drain the trapped air and expand the Collapsed Lung.

* Multiple episodes of Pneumothorax may require surgery or injection of medicines (talc or Doxycycline) into the pleural space.

IF YOU SUSPECT THIS CONDITION
* Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk to your doctor before high altitude climbing, flying, or scuba diving.

SIMILAR CONDITION
* Pericarditis -- inflammation of the sac covering the heart
* Pleurisy -- inflammation of the pleura
* Pulmonary Embolism -- blood clot in the lungs
* Myocardial Infarction -- heart attack


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Air in the Chest

ALSO KNOWN AS
Pneumothorax, collapsed lung, or collapsed chest

DESCRIPTION
* The lungs are covered by a saclike membrane known as the pleura, which separates the lungs from the chest wall (ribs). The pleurae have two layers: one covers the lungs (visceral), the other is attached to the inside of the chest cavity (parietal). Between the two layers there is a thin film of fluid that lubricates the lungs, allowing them to move smoothly during respiration (breathing). Under normal conditions, there should be no air between the lungs and the chest cavity. The introduction of air into this cavity will cause the lung to collapse, and compromise breathing.



* The air may leak from a cut or hole in the visceral pleura (i.e., lung problem) or in the parietal pleura (i.e., bullet or knife wound). When air enters the chest cavity, the condition is known as Pneumothorax (p.).


NORMAL

ABNORMAL


SYMPTOMS
* Depends on the size of p.
* Chest pain:

1. Sudden
2. Sharp or stabbing
3. Chest tightness
4. Made worse by breathing or coughing

* Shortness of breath
* Cyanosis or bluish color to the skin and lips due to hypoxia (low oxygen level)
* Rapid rate of breathing
* Fatigue
* Wheezing
* Anxiety
* Patient may be in Shock or unconscious, especially with trauma or tension p.

CAUSE
* Primary p. -- in healthy individuals this occurs without any underlying diseases
* Secondary -- complication of underlying lung disease
* Spontaneous p. -- often occurs after the rupture of a bulla (a.k.a bleb) or blister (not found in normal lungs), which are small air-filled sacs in the lungs of individuals with certain risk factors. Could be primary or secondary.

HOW THE DIAGNOSIS IS MADE
* History:

1. Symptoms
2. Injuries
3. Procedures or surgeries
4. Illnesses
5. Medications
6. Habits
7. Occupation
8. Allergies

* Medical exam:

1. Skin may show the site of trauma
2. Low Blood Pressure
3. Fever may be present
4. Cyanosis
5. Air can leak under the skin (subcutaneous Emphysema) and has a spongy feel
6. Pallor -- pale skin
7. Rapid heart and respiration rate
8. The chest movements are not symmetrical
9. The trachea (major airway -- located in the center of the neck) may be shifted in tension p.
10. When the doctor listens to the heart or the lungs, the normal sounds may be diminished or absent.

* Tests:

1. Chest X-Ray will show the abnormal air pocket, and Collapsed Lung or structures that have been pushed to one side.
2. CAT scan, using computer imaging, shows detailed views of the chest and lungs.
3. Blood tests may show low oxygen levels (<80 acidosis =" pH">30%:

1. Objective is to remove the air.
2. General physician may consult with a surgeon or a pulmonologist (lung doctor).
3. A needle may be used to remove the air.
4. Aspiration involves inserting a catheter (Teflon tube) into the chest cavity (between the ribs) and attaching to a simple bottle (vacuum inside with no air). This may be enough to expand the Collapsed Lung.
5. A plastic chest tube is inserted through an incision in the chest (between the ribs) and then connected to suction. This method may take few days to drain the trapped air and expand the Collapsed Lung.

* Multiple episodes of Pneumothorax may require surgery or injection of medicines (talc or Doxycycline) into the pleural space.

IF YOU SUSPECT THIS CONDITION
* Contact 911 and seek immediate medical attention. If you've had previous episodes, Quit Smoking and talk to your doctor before high altitude climbing, flying, or scuba diving.

SIMILAR CONDITIONS
* Pericarditis -- inflammation of the sac covering the heart
* Pleurisy -- inflammation of the pleura
* Pulmonary Embolism -- blood clot in the lungs
* Myocardial Infarction -- heart attack




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Aging Eyes



ALSO KNOWN AS
Presbyopia or old eyes

DESCRIPTION
* This is a condition that affects most people as they age. It is due to the loss of the normal elasticity (ability to bounce back to it's normal shape) of the lens of the eye. Over time, Presbyopia results in the inability to see close objects, as when reading a newspaper.



CAUSE
* Age -- affects most people over the age 45

SYMPTOMS
* Headache when reading
* Eyes get tired when reading
* Difficulty reading in dim light
* Letters on a page may appear fuzzy

HOW THE DIAGNOSIS IS MADE
* A doctor or an optometrist can diagnose the problem.
* History of symptoms
* Exam will include a vision test with an eye chart (visual acuity).
* Optometrist will have equipment to do other tests, such as a slit lamp exam using a special microscope to look inside the eye, or a refraction test for those with blurred vision.

RISK FACTORS
* Age -- may start as early as age 30

TREATMENT
* Glasses and contact lenses are the best treatment.
* Improve lighting when reading
* Rest the eyes often between readings.
* Consult with an ophthalmologist (eye doctor) to see if new treatments or surgeries are for you.
* At the present time, laser surgery is not effective for Presbyopia, but new techniques are being investigated.

IF YOU SUSPECT THIS CONDITION
* Contact your optometrist or your doctor.

SIMILAR CONDITIONS
* Farsightedness


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African Trypanosomiasis



ALSO KNOWN AS
Sleeping sickness

DESCRIPTION
* This disease is caused by the parasites Trypanosoma brucei rhodesiense or Trypanosma brucei gambeinse. They are transmitted to humans by the bites of tsetse flies, found in the moist climate regions in Africa.




SYMPTOMS
* Stage 1: The area of the bite causes an itching pain and swollen glands that lasts 2-4 weeks.
* Stage 2: Occurs 3-10 days after stage 1. The infection goes into the bloodstream and lymph system. Symptoms include high fever, severe headache, joint pains, lack of energy, and rashes. Weight loss may also occur. Symptoms may temporarily disappear for two weeks at a time, only to return for a second go around.
* Stage 3: "Sleeping Sickness Stage" occurs from 6 months to years after the original infection. Symptoms may include Insomnia (instead of sleepiness), loss of appetite, personality changes, lack of energy, and headaches. Severe sleepiness occurs late. This is followed by severe weight loss and coma. Death occurs from infections from other diseases.

HOW THE DIAGNOSIS IS MADE
* Stage 1: Examination may show inflammation of the bite site and swollen lymph glands nearby.
* Stage 2: Examination may show mild enlargement of the liver and spleen, lower extremity edema, Ascites (fluid in the abdomen), pleural effusions (fluid in the lungs) and enlarged rubbery lymph nodes. Cardiac involvement (myocarditis) may occur.
* Stage 3: Examination may reveal tremors, Speech Problems, gait disturbances, and abnormal reflexes.
* Laboratory:

1. Wet films after Giemsa staining from bite lesion, lymph node aspirates, bone marrow, or CSF
2. Blood specimens need to be examined daily for 15 days because the number of trypanosomes in the blood can vary.
3. Cerebrospinal fluid shows increased lymphocytes and protein. A centrifuge of CSF may be needed to find the parasites.
4. Serologic (blood) testing for IgM and IgG antibodies may be performed
5. Other findings may include increased sedimentation rates, anemia, decreased platelets, decreased total serum protein, and increased serum globulin.

TREATMENT
* Suramin for both parasites (rhodesiense and gambiense)
* Eflornithine (DMFO) is a drug of choice for gambiense. An alternative is Pentamidine.
* A third choice for both parasites is Melarsoprol, but it has a severe amount of toxicity.
* Late stage diseases with Central Nervous System Involvement: Melarsoprol for both parasites or Eflornithine for gambeinse, are the leading drugs of choice. Alternative drugs for gambiense are Eflornithine or Tryparsamide plus Suramin.

IF YOU SUSPECT THIS CONDITION
* Seek treatment as soon as possible. This disease is often fatal if untreated.

PREVENTION
* Wear long sleeves and trousers and avoid dark clothing.
* Use mosquito nets while sleeping because repellents have no effect.
* Pentamidine may be used for gambiense type.

SIMILIAR CONDITIONS
* Malaria
* Pneumonia
* Influenza
* Mononucleosis
* Lymphoma
* Leukemia
* Viral Encephalitis
* Cerebral Tumor
* Psychiatric Diseases


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Affective Disease



ALSO KNOWN AS
Bipolar disorder, mood disorder or manic depression

DESCRIPTION
* A Bipolar disorder is a psychiatric disease characterized by episodes of extreme mood swings of both Depression and mania. Mania is characterized by elation, fast moving ideas, little need for sleep, and grandiose thoughts and behavior.




* Depression in the patient is defined by feelings of hopelessness, low energy, and no desire or interest in everyday activities. He may become suicidal, or he may develop mania, characterized by excess activity to the point of exhaustion, euphoria, aggressiveness, and at times, a feeling of being super human. Examples of manic behavior might be suddenly quitting your job and going to Hollywood to become an actor (even though you have no previous acting history or interest); or deciding to run for president of the United States, even though you have no previous political experience. An individual in a manic phase may suddenly go on a massive shopping spree, buying items that are not really needed.
* Hypomania is a less severe form of mania that can occur with bipolar disorders. The disorder can affect any age, but it is often triggered between ages of 25-44. Both men and women are equally affected.

SYMPTOMS
* Depression

1. Sadness
2. Low self-esteem
3. Lack of interest in work, sex, family, or other interests
4. Excessive sleep or Insomnia
5. Difficulty with focus
6. Inability to concentrate
7. Thoughts of suicide or dying
8. Feelings of worthlessness
9. Changes in appetite
10. There may be unexplained pains or aches

* Mania

1. Boundless energy
2. Grandiose thoughts
3. Thinking that one is important and powerful
4. Irrational, fearless behavior
5. Fast moving thoughts
6. Difficulty concentrating
7. Speaking too fast
8. Going on spending sprees
9. Drug or alcohol abuse
10. Going long periods without sleep
11. Loss of self-control and good judgment with a desire to engage in risky behavior.

CAUSE
* Unknown -- however, chemical imbalances in the brain may be the cause.
* There may be a genetic component. Having a parent with bipolar disorder may increase the chance of having children with the condition.
* See Depression and mania sections.

TREATMENT
* The goal of treatment is to stabilize mood and restore one's normal (prior to manic Depression) state.
* The two medications most commonly used to stabilize the mood swings in manic Depression are Depakote and Lithium. Other medications may be added or used, some of which are listed below. All treatments are administered under the supervision of a psychiatrist, and are part of an organized treatment plan. Psychotherapy can be added to the treatment, and is very helpful.
* Depression:

1. Antidepressants -- Prozac, Paxil, Effexor, Wellbutrin, Zoloft.
2. Psychotherapy

* Mania:

1. Acute treatment
2. Haldol
3. Clonazepam

* Chronic (long-term prevention)

1. Lithium
2. Depakote
3. Tegretol

SIMILIAR CONDITIONS
* Depression
* Schizophrenia
* Cyclothymic disorder



Saturday, November 8, 2008
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Adult RF



ALSO KNOW AS
Rheumatic fever or RF

DESCRIPTION
* Rheumatic Fever is an inflammation that may follow an infectious episode of the group Streptococcus bacteria -- usually of the throat. In RF there may be heart (carditis) and multiple joint (polyarthritis) damage. RF also may affect the skin (rash, nodules) and the nervous system (e.g., abnormal involuntary movements).



SYMPTOMS
* Joint swelling and tenderness
* May involve many joints
* Fever
* Skin rash (erythema marginatum) and nodules (painless, hard swellings under the skin and overlying bones)
* Nose bleeds (epistaxis)
* Symptoms of RF often occur within 7-35 days after infection.
* In some, symptoms of RF may last 3 months or longer.
* Vomiting
* Abdominal pain
* Sydenham's chorea -- jerky, involuntary, purposeless movements (of legs and arms), muscle weakness, Speech Problems, and emotional instability

CAUSE
* Throat infection with the group A Streptococcus (pharyngitis, scarlet fever) may start an
autoimmune reaction in which the body's defenses, in the process of attacking the bacteria (using Proteins known as antibodies), may damage or cause inflammation -- swelling, irritation, and pain -- to certain body parts, such as the skin, heart valves, joints, and brain.
* The autoimmune response leads to RF.

HOW THE DIAGNOSIS IS MADE
* History of symptoms, illnesses, recent infections, allergies, surgeries, habits
* Medical exam:

1. Fever
2. Rash or nodules
3. Swollen tender joints
4. Chorea may be present
5. Using a stethoscope, the doctor may hear an abnormal flow of blood (murmur) across a damaged heart valve (endocarditis).
6. If the sac that covers the heart is inflamed (pericarditis) there may be chest pain with each breath (pleuritic chest pain), shortness of breath, and a characteristic friction rub may be heard (with a stethoscope) over the chest.

* Tests:

1. Throat (swabbed sample of the throat) cultures may reveal the bacteria early in the disease.
2. Blood tests -- C-reactive protein and ESR indicate ongoing inflammation. ASO (antistreptolysin O) and DNase indicate infection with group A streptococcus.
3. Anemias (low red blood cell count) may be present.
4. Electrocardiogram -- measures the electrical activity of the heart -- may show changes indicating damage to the electrical pathways inside the heart (prolonged P-R interval).
5. Echocardiography -- using sound waves may show fluid around the heart and show the diseased valves.

RISK FACTORS
* Children between ages of 5 -15
* Crowded places like schools, work
* Untreated strepthroat
* Rheumatic Fever

TREATMENT
* Bed rest
* Penicillin is the antibiotic of choice and is given to all patients except those with allergy to penicillin, who receive alternative drugs.
* NSAIDs (such as aspirin) may reduce inflammation of the joints and relieve pain and fever.
* Irregular heart rhythms can be corrected with medications.
* Steroids, such as Prednisone, are used if there is a severe form of carditis (heart inflammation).
* Chorea can be treated with medications such as Haldol.
* Patients often receive penicillin (monthly injections) until adulthood or up to 5 years after an attack of RF.
* Some experts recommend treatment with antibiotics for life, especially if there is severe valve damage.
* The patient with a damaged heart valve may need to take antibiotics before dental and other major procedures.

IF YOU SUSPECT THIS CONDITION
* Contact your physician as soon as you can. If there is high fever, chorea, chest pain, fainting, or shortness of breath, contact 911.

SIMILAR CONDITIONS
* Viral myocarditis
* Kawasaki's syndrome
* Lyme disease
* Infectious arthritis
* Endocarditis or murmurs from other causes



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