US Army Medical Course MD0550-100 - Return To Duty

U.S.
ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

FORT SAM HOUSTON, TEXAS 78234-6100
RETURN TO
DUTY
SUBCOURSE MD0550 EDITION 100

DEVELOPMENT
This subcourse is approved for resident and correspondence course instruction. It

reflects the current thought of the Academy of Health Sciences and conforms to printed
Department of the Army doctrine as closely as currently possible. Development and
progress render such doctrine continuously subject to change.
ADMINISTRATION
For comments or questions regarding enrollment, student records, or shipments,

contact the Nonresident Instruction Branch at DSN 471-5877, commercial (210) 221-
5877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail
accp@amedd.army.mil, or write to:
COMMANDER
AMEDDC&S
ATTN MCCS HSN
2105 11TH STREET SUITE 4192
FORT SAM HOUSTON TX 78234-5064
Approved students whose enrollments remain in good standing may apply to the
Nonresident Instruction Branch for subsequent courses by telephone, letter, or e-mail.
Be sure your social security number is on all correspondence sent to the Academy of
Health Sciences.
CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY
When used in this publication, words such as "he," "him," "his," and "men" are intended
to include both the masculine and feminine genders, unless specifically stated otherwise
or when obvious in context.
.
TABLE OF CONTENTS
Lesson Paragraphs
INTRODUCTION
1 PERFORM A BASIC PHYSICAL ASSESSMENT 1-1--1-7

Exercises
2 TREAT COMMON HEADACHES AND TOOTHACHES 2-1--2-3

Exercises
3 PROVIDE SYMPTOMATIC RELIEF FOR COMMON COLD 3-1--3-8

Exercises
4 TREAT COMMON SKIN PROBLEMS 4-1--4-4

Exercises
5 INITIATE MEASURES TO PREVENT THE SPREAD OF

COMMUNICABLE DISEASES
Section I. SEXUALLY TRANSMITTED DISEASES (STD) 5-1--5-5

Section II. RESPIRATORY DISEASES--UPPER
RESPIRATORY INFECTIONS (URI) 5-6--5-10
Section III. GASTROINTESTINAL DISEASES 5-11--5-15
Exercises
MD0550 i
CORRESPONDENCE COURSE OF
THE ACADEMY OF HEALTH SCIENCES, UNITED STATES ARMY
SUBCOURSE 550
RETURN TO DUTY
INTRODUCTION
At any level of medical treatment, evaluation of the patient must come before
treatment. A good evaluation should be used to discover a condition rather than to
confirm it. Identify treatment and preventive measures are key words in this subcourse.
You, as a medical specialist, will become involved with the many diseases as
mentioned in this subcourse.
Subcourse Components:
The subcourse instructional material consists of the following:
Lesson 1, Perform a Basic Physical Assessment.

Lesson 2, Treat Common Headaches and Toothaches.
Lesson 3, Provide Symptomatic Relief for Common Cold.
Lesson 4, Treat Common Skin Problems.
Lesson 5, Initiate Measures to Prevent the Spread of Common, Communicable Diseases.
Study Suggestions:
Here are some suggestions that may be helpful to you in completing this
subcourse:
--Read and study each lesson carefully.

--Complete the subcourse lesson by lesson. After completing each lesson, work
the exercises at the end of the lesson, marking your answers in this booklet.
--After completing each set of lesson exercises, compare your answers with those
on the solution sheet that follows the exercises. If you have answered an exercise
incorrectly, check the reference cited after the answer on the solution sheet to
determine why your response was not the correct one.
Credit Awarded:
To receive credit hours, you must be officially enrolled and complete an

examination furnished by the Nonresident Instruction Branch at Fort Sam Houston,
Texas. Upon successful completion of the examination for this subcourse, you will be
awarded 7 credit hours.
You can enroll by going to the web site http://atrrs.army.mil and enrolling under
"Self Development" (School Code 555).
MD0550 ii
A listing of correspondence courses and subcourses available through the
Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet 350-59, Army
Correspondence Course Program Catalog. The DA PAM is available at the following
website: http://www.usapa.army.mil/pdffiles/p350-59.pdf.
MD0550 iii
LESSON ASSIGNMENT
LESSON 1 Perform a Basic Physical Assessment.
LESSON ASSIGNMENT Paragraphs 1-1 through 1-7.
LESSON OBJECTIVES After completing this lesson, you should be able to:
1-1. Identify general techniques of physical

assessment.
1-2. Identify the procedures and factors involved with

inspection of major body systems.
1-3. Record findings during a physical assessment.
SUGGESTION After completing the assignment, complete the

exercises at the end of this lesson. These exercises
will help you to achieve the lesson objectives.
MD0550 1-1
LESSON 1
PERFORM A BASIC PHYSICAL ASSESSMENT
1-1. GENERAL
As a medical specialist, there will be many times when you will be confronted to
physically evaluate a patient. This type of evaluation is called performing a basic
physical assessment, which is considered the first step in patient care. Procedures to
perform a standardized physical examination in a logical sequence will be presented in
this lesson. It will be to your advantage, as well as the patient and the medical staff, to
develop the techniques that will enable you to provide quality patient care.
1-2. ASSESSMENT TOOLS/EQUIPMENT
A penlight, stethoscope, blood pressure cuff, wrist watch with second hand, your
eyes for inspection, your ears for hearing, and your hands for palpation will be needed
to perform a complete physical assessment.
1-3. ENVIRONMENT CONDITIONS ON ASSESSMENT
a. Clinical (Hospital,Medical Treatment Facility, Troop Medical Clinic, and

so forth). A complete examination is possible in a clinical environment. The degree of
injury, illness, or condition will determine the extent of the examination.
b. Field. In a field setting, or environment, complete examination may not be

possible, therefore, some situations may necessitate incomplete or quick physical
examinations. Examples are as follows:
(1) Initial evaluation of front line battlefield casualties under fire.
(2) Initial evaluation of a casualty in mass casualty situations.
(3) Conditions of inadequate light or environment, such as power failure at

night, or tropical rains.
NOTE: If any of the above or similar situations prohibit a complete physical

evaluation, remember to document or inform your supervisor of the situations.
These situations may affect the physical findings or decisions.
NOTE: All data (what you see, feel, and/or hear) must be as objective as possible
and documented over a period of time so that changes in a patient's status
are readily observed and identified.
MD0550 1-2
1-4. GENERAL TECHNIQUES OF PHYSICAL ASSESSMENT
The general techniques of physical assessment are inspection, auscultation,

palpation, and percussion.
a. Inspection. This involves seeking of physical signs by observing the patient.

Inspection depends entirely upon the knowledge of the observer; we tend to see things
that have meaning for us. The two processes that are associated with inspection in this
lesson are general and local inspections.
(1) General inspection involves the initial inspection of the body as a whole.
In looking at the body as a whole, many facts may be noted about the patient's motor
activity, body build, outstanding anatomic malformation, behavior, speech, nutrition, and
appearance of illness (a complex defying description).
(2) Local inspection involves focusing a single anatomic region (head,

chest, abdomen, and so forth). This process of inspection can lead to many physical
signs; for example, a dermatologist relies entirely on the appearance of a wart to make
a decision.
b. Auscultation. This involves the process of listening with a stethoscope to

obtain a patient's physical signs. You will be mainly listening for vascular and breath
sounds.
(1) Vascular sounds. These sounds are caused by the heartbeat or flow of
blood. The heartbeat is normally heard and described as a "lubb-dubb" sound.
(2) Breath sounds. These sounds are respiratory sounds that are
transmitted through the lungs and chest wall. The sounds may be "low or "high-pitched"
and "soft" or "loud," depending on the location. A crackling or a raspy type sound may
also be heard.
c. Palpation. This involves the act of examination by using the sense of touch.
(1) Perceived signs. Signs are perceived by:
(a) Tactile sense. The tips of the fingers are used. They are sensitive
for fine tactile discriminations.
(b) Temperature sense. The back of the hand is used. The skin is
much thinner than elsewhere on the hand.
(c) Vibratory sense. The upper palm (the area just below the fingers)
is used.
MD0550 1-3
(d) Position and consistency sense. The grasping fingers are used.
You perceive from your joints and muscles.
(2) Structures examined by palpation. This includes every part of the body
accessible to the examining fingers.
(a) All external structures (that is, hair, extremities, and so forth).
(b) Internal structures. These may be felt beneath exterior covering

(for example, spleen, liver, bladder, testes, ribs, bones, masses, and so forth).
(3) Qualities elicited by palpation.
(a) Texture of skin and hair.
(b) Moisture of skin and mucosa.
(c) Skin temperature, various levels of the body.
(d) Masses (shape, size, consistency, motility, pulsatility).
(e) Tenderness of all accessible tissues.
(f) Crepitus (a crackling sound or grating/grinding sensation perceived

upon touch).
(g) Unusual vibrations, (for example, some heart murmurs produce

"thrills").
(h) Hydration.
1 Dehydration of tissues is described as loss of skin turgor (when

the skin does not resume its natural shape after pinching).
2 Overhydration of tissues (presence of edema) is demonstrated

by pressing your thumb into swollen skin (if indentation persists for a short time, it is
termed "pitting edema").
d. Percussion. This is a method of examination by which the surface of the

body is struck by one or more fingers to emit sounds that vary in quality according to the
density of underlying tissue.
(1) Example: Tap a hallow object and listen to the sound as opposed to
tapping a solid object.
MD0550 1-4
(2) Percussion is used during physical assessment to determine fluid
content in the abdomen, the lungs, and other body parts.
NOTE: Percussion can be a difficult skill to master, it requires a great deal of practice
and experience.
1-5. PROCEDURES TO PERFORM A PHYSICAL ASSESSMENT
a. Primary Survey. This is the first step taken to perform a patient assessment.
It is done to detect life-threatening problems and if any problems are detected,
lifesaving measures should be taken immediately. You will be concerned with the
following areas in performing a primary survey.
(1) Level of consciousness. Remember that consciousness may be lost

quickly, breathing may change, and circulation may stop. Shake the patient at his
shoulders and shout to him, "Are you okay?"..."Are you okay?"..."Are you okay?"...Ask
the patient what is his name? What is today's date? These questions are asked to
check the patient's orientation.
(2) Patient airway. Check for an opened airway. If the patient's airway is
closed, you should open it with manual maneuvers.
(a) Head tilt-chin lift. This technique provides a consistently more

effective method of opening the airway in the unconscious patient and is less tiring than
other methods. (See figure 1-1.)
Figure 1-1. Head tilt-chin lift.
(b) Jaw thrust. This technique is the safest first approach to opening
the airway of a patient who has a suspected neck injury; in most cases, it can be
accomplished without extending the neck. (See figure 1-2.)
MD0550 1-5
Figure 1-2. Jaw thrust.
NOTE: If the patient is making respiratory efforts, his airway may still be obstructed.
Many times opening the airway is all that is needed.
(3) Breathing. Look, listen, and feel for adequate breathing. (See
figure 1-3.) Place your ear close to the patient's mouth and:
(a) Look for chest movements that are associated with breathing.
(b) Listen for air moving at the patient's mouth and nose.
(c) Feel for air being expired through the patient's mouth and nose.
Figure 1-3. Check for breathing.
(4) Circulation. Check for a carotid pulse. (See figure 1-4.) The carotid
pulse is the most accessible, most reliable, and most easily learned and remembered.
You should begin cardiac compressions if there is no carotid pulse.
MD0550 1-6
Figure 1-4. Carotid pulse site.
(5) Bleeding (major hemorrhaging). Check for persistent, external bleeding.

If there is profuse bleeding, STOP bleeding by applying a field dressing, direct pressure,
elevation, tourniquet, and so forth.
b. Summary. Now that you have assured that the patient has an open airway,
adequate breathing, a carotid pulse, and any profuse bleeding is controlled, you are
ready to begin the secondary survey.
1-6. SECONDARY SURVEY
The secondary survey is performed to discover medical and injury-related

problems that do not pose an immediate threat to survival, but may, if allowed to go
untreated. You will begin by checking/examining the following areas:
a. Vital Signs. Measure and record the patient's pulse, respiration, blood
pressure, and temperature.
(1) Pulse. Normal pulse for adults is 60-80 heartbeats per minute, for
children 80-100, and for infants 120-160. Also observe for regularity and strength. (See
figure 1-5.)
(2) Respiration. Normal respiratory rates for adults are 12-20 per minute, a
higher rate for children is normal. Also observe for rhythm and depth.
(3) Blood pressure. Normal blood pressure for an adult is 110-146 mm/Hg
systolic and 60-90 mm/Hg diastolic. Infant readings are 50-80 mm/Hg systolic and 40-
58 mm/Hg diastolic.
(4) Temperature. Normal temperature is 98.6ºF (37.0ºC).
NOTE: Conduct the remainder of the secondary survey in an orderly pattern from
head to toe. Be sure to record all pertinent findings; for example, abnormal
vital signs, obvious fractures, profuse bleeding, and so forth.
MD0550 1-7
Figure 1-5. Sites for taking a pulse.
b. Head.
(1) Scalp. Examine the scalp for presence of bleeding or contusions

(bruises) and palpate for tenderness or depressions.
CAUTION. Do not move the patient's neck.
(2) Forehead. Touch (palpate) the forehead with the back of your hand to
check for temperature and moisture.
(3) Eyes.
(a) Check the eyelids for swelling and discoloration.
(b) Check the pupils for dilation, constriction, equality or inequality,

roundness, eye movement, and gross activity (have the patient to follow you finger).
MD0550 1-8
(c) Check the conjunctiva. Pull the lower eyelids down to check the
color on the inside of the lid, (color should be reddish pink).
(4) Nose. Check the nose for deformity, bleeding, or discharge.
(5) Ears. Inspect for drainage, bleeding, or torn tissue without turning the
patient's head.
(6) Mastoids (bony prominence of the skull directly behind the ears). Check
the mastoids for bruising or discoloration. (See figure 1-6.) This may indicate a skull
fracture.
(7) Facial bones. Check for lacerations or contusions. Palpate the

zygomatic arches, maxilla, and mandible for tenderness. (See figures 1-7 and 1-8.)
Figure 1-6. Looking for discoloration.
Figure 1-7. Palpating zygoma for Figure 1-8. Palpating mandible for
fractures. fractures.
MD0550 1-9
(8) Mouth. Examine for loose teeth, bleeding, and abnormal alignment.
The oral mucosa should be pink and surfaces moist.
NOTE: The mucosa membranes should be pink, regardless of skin color.
c. Neck.
(1) Trachea. Check for midline position, presence of a stoma and/or Medic
Alert "dog tags." (See figure 1-9.)
Figure 1-9. Midline position.
(2) Suprasternal area (area above sternum). Check for retractions and feel
for crepitus.
(3) Neck veins. Check for distension (swelling or bulging). (See figure
1-10.) This may be a sign of heart failure.
(4) Cervical spine. Check for deformity or midline point tenderness without
moving the patient. (See figure 1-11.)
Figure 1-10. Check neck veins for Figure 1-11. Palpating the cervical
distension. spine.
MD0550 1-10
d. Chest.
(1) Chest wall. Examine for paradoxical breathing.
(a) Flail chest. A portion of the chest wall goes in on inspiration and
out on expiration. (See figure 1-12.)
Figure 1-12. Checking for flail chest.
(b) Splinting. A patient uses his own muscles to immobilize an injured

area.
(c) Retraction. A patient's respiratory effort is great. This may be seen

by the pulling back of tissue between the ribs when the patient inspires.
(2) Ribs. Examine for bruises and tenderness during chest compression.
(See figure 1-13.)
CAUTION: Do not push/compress over any abrasive bruise.
Figure 1-13. Examining for rib tenderness.
MD0550 1-11
(3) Thoracic spine. Palpate for deformity or tenderness without moving the
patient.
(4) Breath sounds. Listen to both front and back of chest and both sides.
(5) Apical pulse. This can be taken by listening to the patient's heartbeat
and counting the rate.
e. Abdomen.
(1) External. Observe for sounds and/or distension, palpate lightly for
tenderness.
(2) Lumbar spine. Palpate for deformity or tenderness without moving the
patient or risking spinal injury.
(3) Pelvis. Gently compress the pelvis with your hands covering the
patient's hip joint and iliac crest, inspect for tenderness, discoloration, and incontinence.
(See figure 1-14.)
Figure 1-14. Testing pelvis for compression pain.
(4) Femoral pulse. Check for presence and bilateral equality.
f. Lower Extremities.
(1) Legs. Inspect and palpate for bleeding, tenderness, deformity,

discoloration, contusions, etc.
(2) Pedal pulses. Palpate both feet for either dorsalis pedis pulse or
posterior tibial pulse. (See figures 1-15, 1-16, and 1-17.)
MD0550 1-12
Figure 1-15. Palpating for pedal pulses.
Figure 1-16. Palpating for dorsalis Figure 1-17. Palpating for posterior
pedis pulse. tibial pulse.
(3) Foot movement. Examine the feet for movement and sensation by
having the patient demonstrate his ability to move both feet.
(4) Foot sensation. Ask the patient to determine which toes are touched.
g. Upper Extremities.
(1) Clavicles. Palpate both clavicles for tenderness and deformity.
MD0550 1-13
(2) Arms and forearms. Inspect and palpate both arms for bleeding,
tenderness, and deformity.
(3) Radial pulses. Compare radial pulses for presence and equality (if
unequal, compare blood pressure bilaterally).
(4) Hand movement. Instruct patient to move both hands to confirm flexion
(bending) and extension; check for movement of the fingers.
(5) Hand sensation. Ask patient to determine which finger(s) is touched by

you.
h. Posterior Wound. Logroll the patient (unless spinal injury is suspected) and
observe for any posterior wounds.
1-7. RECORDING PERTINENT FINDINGS
Record all pertinent findings as accurately as possible on DD Form 1380 (U.S.

Field Medical Card) or SF 600 (Chronological Record of Medical Care).
Continue with Exercises
MD0550 1-14
EXERCISES, LESSON 1
INSTRUCTIONS: Answer the following exercises by marking the lettered response that
best answers the question or best completes the incomplete statement or by writing the
answer in the space provided.
After you have completed all the exercises, turn to "Solutions to Exercises" at the
end of the lesson and check your answers..
1. Which of the following conditions would NOT prohibit a complete physical

assessment?
a. Frontline battlefield injuries.
b. Screening patient's at local TMC.
c. Light failure during a tropical storm.
d. Initial evaluation during a mass casualty situation.
2. List the two types of inspections.
________________________________.
________________________________.
3. ______________________, __________________, __________________, and
_________________ are considered general techniques of physical assessment.
4. What sounds are you listening for during auscultation?
_______________________ and __________________________.
5. What sounds are transmitted through the lungs and chest wall?
________________________________.
MD0550 1-15
6. During palpation, signs are percieved by your ______________________,
_________________, ___________________, and ___________________.
7. What three methods are used when checking a patient for breathing?
___________________, ___________________, and ____________________.
8. What patient areas would you check during a primary survey?
________________________________.
________________________________.
________________________________.
________________________________.
________________________________.
9. List the major areas to check/observe during the secondary survey.
________________________________.
________________________________.
________________________________.
________________________________.
________________________________.
________________________________.
________________________________.
10. ____________________ ___________________ is a condition when a portion
of a patient's chest wall goes in on inspiration and out on expiration.
MD0550 1-16
SPECIAL INSTRUCTIONS FOR EXERCISES 11 THROUGH 19. Match the areas
examined in Column A to what you would be checking for as listed in Column B. Mark
your answers in the blanks in Column A.
COLUMN A COLUMN B
____11. Arms and forearms a. Temperature, moisture
____12. Pelvis b. Posterior wounds
____13. Ribs c. Bleeding, tenderness, deformity
____14. Hand movement d. Stoma, Medic Alert "dog tags"
____15. Back logroll e. Bruises, tenderness
____16. Ears f. Bleeding, torn tissue, drainage
____17. Eyelids g. Tenderness, discoloration, incontinenc
____18. Forehead h. Swelling, discoloration
____19. Trachea i. Confirm flexion, extension
Check Your Answers on Next Page
MD0550 1-17
SOLUTIONS TO EXERCISES, LESSON 1
1. b (para 1-3b)
2. General, local (para 1-4a)
3. Inspection, auscultation, palpations, percussion (para 1-4)
4. Vascular, breath (para 1-4b)
5. Breath (para 1-4b(2))
6. Tactical sense, temperature sense, vibratory sense, position and consistency

sense (para 1-4c(1))
7. Look, listen, feel (para 1-5a(3))
8. Level of consciousness, patient airway, breathing, circulation, bleeding

(para 1-5a)
9. Vital signs, head, neck, chest, abdomen, lower extremities, upper extremities,
back logroll (para 1-6)
10. Flail chest (para 1-6d(1)(a))
11. c (para 1-6g(2))
12. g (para 1-6e(3))
13. e (para 1-6d(2))
14. i (para 1-6g(4))
15. b (para 1-6h)
16. f (para 1-6b(5))
17. h (para 1-6b(3a))
18. a (para 1-6b(2))
19. d (para 1-6c(1))
End of Lesson 1
MD0550 1-18
LESSON ASSIGNMENT
LESSON 2 Treat Common Headaches and Toothaches.
2-1. Identify the various types of headaches.
2-2. Identify the signs and symptoms associated with

headaches.
2-3. Identify the treatment provided for headaches.
2-4. Identify the signs and symptoms associated with

toothaches.
2-5. Identify the treatment provided for toothaches.

exercises of this lesson. These exercises will help you
to achieve the lesson objectives.
MD0 550 2-1

LESSON 2
TREAT COMMON HEADACHES AND TOOTHACHES
2-1. GENERAL
Headaches and toothaches are also common ailments and complaints by

patients. They both can be very disturbing and might cause a person to not function as
he normally would. It is your duty to assess these ailments and provide treatment for
relief.
2-2. HEADACHES
This section of the lesson will present the etiology of the different types of
vascular and sinus headaches, signs and symptoms, and treatment for the headaches.
a. Vascular Headaches. A term applied to a variety of entities produced by

reversible, segmental, arterial constriction and dilation; vascular headaches are all
characterized by their intermittence and throbbing pain. The components of the group
are distinguished by differences in cause, temporal sequences, and the location of the
affected blood vessels. Vascular headaches include migraine, cluster, muscle tension,
and hypertensive headaches.
(1) Types of vascular headaches.
(a) Migraine. A recurrent, intense headache usually confined to one

side of the head and associated with nausea, vomiting, and visual disturbances.
1 Etiology. The exact cause of a migraine is not known, it may be

hereditary; triggered by emotional stress, physical activity, fatigue, smoking,
consumption of certain foods, and excess of alcohol intake.
NOTE: The nature of attacks varies between persons and from time to time in the
same person.
2 Classic symptoms of migraines may appear in the following
sequence:
a Inability to see clearly, followed by seeing bright spots and

zigzag patterns. Visual disturbances may last several minutes or several hours, but
disappear once headache begins.
b Dull, boring pain in temple that spreads to entire side of

head. Pain becomes intense and throbbing (sometimes pain may affect both temples
simultaneously).
c Nausea and vomiting, sweating.
MD0 550 2-2

NOTE: In some cases, the classic symptoms, may be absent, or other symptoms
may be present; for example, dizziness, hypersensitivity to light and sound,
runny nose and/or eyes, and bloodshot eyes.
3 Treatment. The importance of early medication during an attack

cannot be overemphasized. The patient should be given mild analgesics, aspirin, or
acetaminophen. Additionally, the patient should:
a Lie down in a quiet, darkened room; decrease external

stimulation as much as possible; relax, but do not read.
b Apply a cold cloth or ice pack to the forehead and back of

neck until headache is completely relieved.
c Cover both eyes with cloth.
d Immobilize head by placing blankets or towels on each side

of the head.
e If available, drink hot liquids (such as tea) only if there is no

nausea and/or vomiting.
NOTE: Instruct patient to keep a record of activity or food eaten prior to a migraine,
this may indicate the cause of the headache.
4 Refer patient to a physician if the migraine attack persists longer

than 24 hours, despite treatment. Recurrent migraine headaches will, most likely,
interfere with duty performance.
NOTE: A more extensive work-up (tests) may be required.
(b) Cluster headache. This type of headache occurs in clusters of

several times a day or week for several weeks, with long intermissions between
clusters. The headache is unilateral, severe, boring, and throbbing. It occurs
consistently on the same side, usually in the orbital region, the temple, or on the side of
the face; it may spread to the neck and shoulder.
1 Etiology. Similar to the migraine headache. The exact cause is

unknown
2 Signs and symptoms:
a Severe and frequent attacks of short duration usually in

"cluster or groups"; sometimes as often as 20 or more per week followed by remission
for an indefinite period.
MD0 550 2-3

b Often occurs at same time of day and on same side behind
one eye.
c Described as "knifelike" or "like a hot poker in the eye."
d Pain is accompanied by tugging, pulling, or pressing

sensation behind one eye (unilateral).
e Other signs include nasal congestion, tearing; may have one

"bloodshot" eye.
f Duration ranges from few minutes to hours; rarely more than

2 hours; usual range is 30-90 minutes.
g Commonly precipitated by ingesting alcohol, oversleeping or

napping, but may occur without these triggers.
3 Treatment. Acetaminophen or Aminosalicylic Acid (ASA) given

as soon as the headache begins.
(c) Hypertensive headache. These headaches are related to high

blood pressure. They may be muscular contraction type or vascular.
1 Etiology. Increased blood pressure.
2 Signs and symptoms.
a Throbbing, suddenly increasing in intensity, frequently

located at top of head; may be generalized.
b Elevated blood pressure.
3 Treatment. Give mild analgesia, aspirin, or acetaminophen.

Also involves lowering the patient's blood pressure. Inform the patient to:
a Decrease stress, stress-producing situations.
b Maintain minimal ideal body weight.
c Rest if headache begins.
d Limit use of nicotine and caffeine (they cause

vasoconstriction and heart stimulation).
MD0 550 2-4

4 Referral. Refer patient to a physician if the headache increases
in severity, or lasts longer than 24 hours. If a patient has no history of high blood
pressure, refer him to a physician.
(d) Muscle tension headache. These headaches involve contraction of

the muscles of the neck, head, and shoulders causing fatigue and pain.
1 Etiology. Tension and emotional stress contribute greatly

towards these headaches. Pain results from constricted blood vessels in the head that
cause pressure on the walls of the blood vessels (dilated blood vessels in the brain).
2 Signs and symptoms.
a Pain is usually steady, over temples with feeling often stated

"a vise is over the back of my head."
b Unilateral or bilateral, often suboccipital by referring pain to

frontal region of face.
c Moderate pain in the front or back of the head, accompanied

by tight muscles in the neck or scalp.
d Throbbing pain all over the head.
NOTE: Persistent headaches may be a sign of pending combat stress reaction in

combat situations.
3 Associated causes.
a Overexertion.
b Tension-producing strain on muscles of neck, scalp, face,

and jaw.
c Sleep disturbances.
d Anxiety, depression.
e Low blood sugar.
f Allergic reactions.
g An environment that is noisy, stuffy, hot, poorly lit, or has

irritating odors.
MD0 550 2-5

4 Treatment.
a Mild analgesic, aspirin, or acetaminophen.
b Rest, relax in quiet room.
c Removal of anxiety-producing situation.
d Massage shoulders, neck, jaw, scalp.
e Take a hot bath or shower, allow water to massage tense

muscles.
f Have patient lie down, place warm or cold cloth, whichever

feels better, over painful area.
5 Referral. Refer patient to a physician if headache is

accompanied by:
a Fever 101º F (38.3ºC) or higher.
b Recent head injury.
c Drowsiness.
d Nausea and/or vomiting.
e Pain in one eye.
f Blurred vision.
g High blood pressure.
h Pain and tenderness around eyes and cheekbones that

worsens when leaning forward--may indicate sinus infection.
i Vision disturbances and vomiting prior to headache.
j Persistent headache pain longer than 24 hours.
(2) See figure 2-1 for the types of headaches.
MD0 550 2-6

Figure 2-1. Types of headaches.
b. Sinus Headache. This type of headache is frontal, dull, or severe; usually

worse in the morning, improved in the afternoon; and worse in cold, damp weather.
(1) Etiology. The sinus headache is caused by acute infection of the

sinuses. Pain radiation is associated with the affected sinus, and nasal congestion,
followed by gradual buildup of pressure in the affected sinus.
(2) Signs and symptoms.
(a) Aching pain, usually on face, that worsens when bending over.
(b) Possibly thick, yellow or green nasal discharge (may be associated

with sinusitis).
(c) Face extremely tender to touch over location of the affected sinus.
MD0 550 2-7

(3) Treatment.
(a) Alternate warm and cool compresses on forehead and cheeks;

keep alternating warm and cool compresses for 10 minutes.
(b) If available, give decongestant, such as Dristan, Contac, or

Sudafed, as directed on package.
(c) Repeat warm and cool compresses in an hour, as necessary.
(4) Referral. Refer patient to a physician if:
(a) Temperature is 101ºF (38.3º) or greater.
(b) Increased severity or intensity of the headache.
(c) Repeated visit to sick call is within 24 hours with same complaint.
NOTE: A sinus headache may be a symptom of sinusitis, the inflammation of the

mucous membranes that line the sinuses. Referral is necessary for this
condition.
NOTE: There are other headaches. However, vascular and sinus headaches are the
most common that will concern you.
2-3. TOOTHACHES
a. Pain from a toothache may be characterized in many ways, that is, dull and
throbbing, burning, piercing, and sharp. This pain could involve the teeth, obviously, the
bones of the mandible and maxilla (jawbones) that hold the teeth, and the gums and
soft tissue surrounding the tooth, including the nerves, blood vessels, and the
periosteum (covering of the bone).
b. Toothaches can occur, from exposed gum, a missing tooth, pain and/or
bleeding from tooth site, and swelling (edema) of gums with or without a history of
injury.
c. An abscess can also cause great pain. They are characterized by redness,
pain, swelling, warmth, or hardened area along the gum line near the affected tooth.
NOTE: An abscess is an accumulation of pus in an area where healthy tissue has

been invaded and broken down by bacteria. The pain caused by
inflammation of gum tissues and an accumulation of pus pressing against
adjoining nerves.
MD0 550 2-8

d. Treatment.
(1) Loose fillings and toothache.
(a) Mild analgesics (aspirin or acetaminophen).
(b) Warm packs to side of face to lessen pain.
(c) Soak tip of cotton swab in oil of cloves or whiskey and apply to
tooth.
(d) Have patient to rest in a comfortable position. Lying flat may

increase the pain. Use pillows or rolled blankets behind the head and shoulders.
(e) If dental care is not immediately available, melt or rub between your
palms a piece of paraffin or candle; mix in some strands of cotton--when wax mixture
begins to cool, apply to tooth as temporary filling.
(f) Have the patient to seek dental care to avoid the possibility of
infection developing or progressing.
(2) Lost or broken tooth.
(a) Do not throw tooth or tooth part away.
(b) Rinse tooth in water and wrap in wet gauze or plastic wrap and
submerge in cold water or ice.
NOTE: When a tooth falls out, a lot of the membrane to the tooth is still attached.
Keeping the tooth damp will provide a connection for what is remaining in the
bone to make reattachment possible.
(c) If patient is awake and has partial loss of tooth, place moistened
gauze on his tooth--can also place tooth in moistened gauze between his jaw and
cheek.
(d) Put moist gauze in empty socket and have patient bite on the
guaze.
NOTE: If the tooth is kept damp and protected, and the patient can get to a dentist
within three hours of the injury, there is a 60—75 percent success rate in
reimplanting the tooth.
(3) Abscess. Place warm packs to the patient's face to lessen the pain and
refer to a physician immediately.
MD0 550 2-9

e. Refer the patient to a physician if:
(1) There is increased mouth pain, swelling, redness, drainage, or bleeding.
(2) Signs of infection, (headache, muscle aches, dizziness, or general ill

feeling).
(3) Temperature, of 101ºF (38.3ºC) or higher.
MD0 550 2-10

EXERCISES, LESSON 2
1. Vascular headaches are characterized by ____________________ and
___________________________ pain.
2. List the four types of vascular headaches.
_________________________________________
_________________________________________
_________________________________________
_________________________________________
3. The inability to see clearly, followed by seeing bright spots and zigzag patterns is
one of the ________________ symptoms of a __________________ headache.
4. The ___________________ headache may be hereditary; triggered by emotional

stress, physical activity, fatigue, smoking, consumption of certain foods, and
excess of alcohol intake.
5. The ________________________ headache is unilateral, severe, boring, and

throbbing.
MD0 550 2-11

6. What is the usual range for a cluster headache?
a. 1 to 2 days.
b. 5 to 15 minutes.
c. 30 to 90 minutes.
d. 60 to 120 minutes.
7. _____________________headaches are closely related to high blood pressure.
8. Throbbing pain all over the head is one of the symptoms for ________________
headaches.
9. What headache usually affects a person in the morning and improves in the
afternoon? _______________________________________.
10. Mild analgesics are given to a patient who has loose fillings and/or a _________.
11. An __________________________ is characterized by redness, pain, swelling,

warmth, or hardened areas along the gum line near the affected tooth.
MD0 550 2-12

12. Label the following types of headaches:
A. _________________________________________________
B. _________________________________________________
C, _________________________________________________
D. _________________________________________________
E. _________________________________________________
MD0 550 2-13

1. Intermittence, throbbing (para 2-2a)
2. Migraine, cluster, hypertensive, muscle tension (para 2-2a)
3. Classic, migraine (para 2-2a(1)(a)2a)
4. Migraine (para 2-2a(1)(a)1)
5. Cluster (para 2-2a(1)(b))
6. c (para 2-2a(1)(b)2f)
7. Hypertensive (para 2-2a(1)(c))
8. Muscle tension (para 2-2a(1)(d)2d)
9. Sinus (para 2-2b)
10. Toothache (para 2-3d(1)(a))
11. Abscess (para 2-3c)
12. A. Migraine
B. Cluster
C. Paranasal sinus
D. Muscle contraction headache
E. Hypertension (figure 2-1)
End of Lesson 2
MD0 550 2-14

LESSON ASSIGNMENT
LESSON 3 Provide Symptomatic Relief for Common Cold.
3-1. Define a common cold.
3-2. Identify signs and symptoms of a common cold

and modes of transmission.
3-3. Identify the methods, treatment, and preventive

measures of a common cold.
3-4. Identify when a patient with a common cold will

be referred to a medical physician.

exercises at the end of this lesson. These exercises
will help you achieve the lesson objectives.
MD0550 3-1
LESSON 3
PROVIDE SYMPTOMATIC RELIEF FOR COMMON COLD
3-1. GENERAL
The common cold is one of the most common infectious diseases among people
of all ages. This will probably be the most frequent complaint that you will encounter as
you perform your duties as a medical specialist. More serious infectious respiratory
diseases may occur if treatment is not given in a timely and professional manner.
3-2. DEFINITION
The common cold is an acute, usually afebrile (no fever) viral infection that
causes inflammation of the upper respiratory system.
3-3. BACKGROUND INFORMATION
a. The common cold is more prevalent in children than adults.
b. It affects more boys than girls among teenagers and more women among
adults.
c. The common cold occurs more often in colder months in temperate zones,
and more often during rainy seasons in tropical zones.
d. There are over 100 different viruses that may be responsible for the common
cold. This makes the development of an effective vaccine highly unlikely.
e. Neither fatigue nor exposure to drafts increases susceptibility.
3-4. MODES OF TRANSMISSION
The common cold can be transmitted by:
a. Airborne respiratory droplets--most often.
b. Objects contaminated with respiratory droplets--less frequently.
c. Hand-to-hand--less often.
MD0550 3-2
3-5. SIGNS AND SYMPTOMS
a. Malaise.
b. Fever/chills.
c. Headache.
d. Nasal congestion/nasal discharge.
e. Hacking, nonproductive cough.
f. Burning, watery eyes.
g. "Stuffed up" feeling may persist for one week.
h. Sneezing.
i. Sore throat.
3-6. TREATMENT
There are no cures for the common cold. These are purely symptomatic
treatments.
a. Rest--logical response to fatigue and weakness.
b. Fluid--helps maintain hydration and loosen accumulated respiratory

secretions.
c. Aspirin--eases headache and muscle soreness.
d. Decongestants--relieve "stuffed up" feeling (for example, Sudafed, Contac,

Dristan).
e. Throat lozenges--relieves soreness.
NOTE: Many individuals advocate doses of vitamin C to help treat and/or prevent the
common cold. The role vitamin C plays remains controversial.
3-7. PREVENTION
a. Minimize contact with people who have colds.
b. Avoid spreading colds by washing hands often, cover coughs and sneezes,
and avoid sharing towels and drinking glasses.
MD0550 3-3
3-8. REFERRAL
The patient should be referred to a physician when he has or complains of the

following conditions:
a. Temperature 101ºF (38.3ºC) or greater.
b. Productive cough.
c. Dyspnea.
d. Tachycardia.
e. Loss of appetite.
NOTE: Remember to record all pertinent findings.
MD0550 3-4
EXERCISES, LESSON 3
1. List the modes of transmission of a common cold.
______________________________________.
______________________________________.
______________________________________.
2. The use of decongestants for a common cold relieves _______________feeling.
3. List six of the signs and symptoms of a common cold.
______________________________________.
______________________________________ .
______________________________________.
______________________________________.
______________________________________.
______________________________________.
4. _____________________ helps maintain hydration and loosen accumulated

respiratory secretions.
MD0550 3-5
5. Which of the following conditions of a common cold would you refer to a
physician?
a. Dyspnea.
b. Tachycardia.
c. Loss of appetite.
d. All of the above.
6. Minimizing contact with individuals who have colds is known as a ____________

measure.
MD0550 3-6
1. Airborne respiratory droplets

Objects contaminated with respiratory droplets
Hand-to-hand (para 3-4)
2. Stuffed up (para 3-6d)
3. Any of the following: (para 3-5)

Malaise
Burning, watery eyes
Fever/chills
"Stuffed up" feeling
Headache
Sneezing
Nasal congestion/nasal discharge
Sore throat
Hacking, nonproductive cough
4. Fluids (para 3-6b)
5. d (para 3-8)
6. Preventive (para 3-7a)
End of Lesson 3
MD0550 3-7
LESSON ASSIGNMENT
LESSON 4 Treat Common Skin Problems.
4-1. Identify types and effects of skin lessons.
4-2. Identify signs, symptoms, and treatment of

common skin disorders/diseases.
4-3. Identify medications used to treat common skin

disorders/diseases.

MD0550 4-1
LESSON 4
TREAT COMMON SKIN DISORDERS
4-1. GENERAL
a. As we all know, the skin covers the entire body, protecting the underlying
tissues from injury, infection, and dehydration. However, there are times when the skin
is affected by many common disorders causing some unsightly shapes and
arrangements on the surface of the skin. Your knowledge of recognition and
identification of common skin disorders will enable you to provide quality patient care.
b. A brief review of the layers of skin will help you throughout this lesson (see
figure 4-1). The skin is made up of the following three layers:
(1) Epidermis. The outer, thinner layer of skin. It has no blood vessels, but,
contains a limited distribution of nerve endings. The epidermis is made up of several
layers of cells. The outermost cells are flat and resemble scales. These dead cells are
constantly flaking off the surface, as this happens, inner epidermal cells are growing,
pushing up towards the surface to replace outer cells.
(2) Dermis or Corium. The inner layer of skin found beneath the epidermis.
It is rich in blood vessels and nerves.
(3) Subcutaneous tissues. The layer of fat and soft tissues found below the
dermis.
Figure 4-1. Principal parts of the skin.
MD0550 4-2
4-2. LESIONS
Lesions are any morbid changes in the structure or function of tissues due to
injury or disease. They may be life-threatening; that is, indicating tuberculosis, cancer,
or other diseases. They can cause disturbances of normal skin functions; represent
findings that are significant of internal diseases such as hepatitis or endocrine problems;
can cause severe itching and/or pain; and can cause psychological distress and social
problems because of unsightly appearance.
a. Primary Lesions. These are the most important to recognize and if

necessary, to biopsy. They are also the earliest changes that appear. Macule, papule,
nodule, tumor, wheal, plaque, vesicle, bulla, and pustule are all considered primary
lesions.
(1) Macule (see figure 4-2). This is a flat, localized change in the skin's
color. The area may be small or large, less than 1 cm in diameter. Macules occur in
many shapes and colors and is nonpalatable. Some examples of macules are freckles,
flat moles, tattoos, and the rashes of rubella and rubeola.
Figure 4-2. Macule.
(2) Papule (see figure 4-3). This is a solid, elevated lesion, about 0.5 cm to
1 cm or less in diameter. Their borders and tops may assume various forms. Some
papule lesions can occur in insect bites, acne, psoriasis, and atopic eczema.
Figure 4-3. Papule.
MD0550 4-3
(3) Nodule (see figure 4-4). This is a palpable solid, rounded or elevated
lesion extending deeper into the dermis than papule and greater than 0.5 cm but less
than 2 cm in diameter. Some typical nodules are keratinous cysts, small lipomas, and a
variety of neoplasms. Larger nodules are classified as tumors, benign or malignant.
Figure 4-4. Nodule.
(4) Tumor. This is an elevated, solid lesion greater than 2 cm in diameter.
(5) Wheal (see figure 4-5). An elevated lesion with increased tissue fluid
usually associated with itching. These are known as common allergic reactions from
drug eruptions, insect stings or bits, or sensitivity to cold, heat, pressure, or sunlight.
Figure 4-5. Wheal.
(6) Plaque. A collection of wheals that joined (coalesced) together to form a

larger area. The skin appears thickened, and the skin markings are accentuated.
(7) Vesicle (see figure 4-6). An elevated, fluid-filled lesion less than 0.5 cm
in diameter (small blister). Some examples of vesicles are found in acute eczematous
dermatitis and second degree burns.
MD0550 4-4
Figure 4-6. Vesicle/Bulla.
(8) Bulla (see figure 4-6). A fluid-filled elevation greater than 0.5 cm in
diameter (a burn blister).
(9) Pustule (see figure 4-7). A pus-filled lesion, which may have resulted
from infection of vesicles or bullae and may have had many forms and origins.
Figure 4-7. Pustule.
b. Secondary Lesions. These are the result of, or completion of, a primary
lesion. This can be caused by natural evolution of primary lesions (a vesicle bursts,
leaving an eroded area), or from the patients' manipulation of the primary lesion
(scratching a vesicle, leaving an eroded or ulcerated area).
(1) Crust (see figure 4-8). A dried residue of serous fluid, blood, or pus
overlying an area of lost or damaged epidermis. Crusting is the result in a wide variety
of inflammatory and infectious diseases.
Figure 4-8. Crust.
MD0550 4-5
(2) Scale (see figure 4-9). A buildup of dry cells (horny layer), higher than
normal; may be caused by excessive oils or disease processes. Some of the scaling
rashes are psoriasis, dermatitis, and superficial fungus infections.
Figure 4-9. Scale.
(3) Fissure (see figure 4-10). A crack in the epidermis that extends into the
dermis. This commonly occurs from trauma to thickened, dry, or inelastic skin.
Figure 4-10. Fissure.
(4) Erosion (see figure 4-11). A loss of the epidermis but does not extend
into the dermis.
Figure 4-11. Erosion.
MD0550 4-6
(5) Ulcer (see figure 4-12). An excavation into the dermis or deeper, always
results in a scar.
Figure 4-12. Ulcer.
(6) Scar. The result of healing after destruction of some of the dermis.
(7) Keloid. A sharply elevated, irregular-shaped, progressively enlarging

scar caused by the formation of excessive amounts of collagen in the corium during
connective tissue repair.
c. Special Lesions.
(1) Sebaceous cyst. A blocked sebaceous duct, where by the gland

continues with its activity.
(2) Folliculitis. An inflammation or infection of the hair follicles.
(3) Boil (furuncle). A well-localized staph infection of the hair follicle,

epidermis, and/or dermis.
(4) Abscess. A localized collection of pus.
(5) Petechiae. A ruptured capillary (micro-sized bruise).
(6) Ecchymosis. A ruptured vein (large bruise).
(7) Maceration. A softening of solid tissue by soaking; the tissue turns white
and breaks down easily.
MD0550 4-7
4-3. GENERAL METHODS TO HELP PREVENT SKIN DISEASES
a. Keep Skin Clean. Bathing removes dirt, decreases the number of

microorganisms, and body odors.
(1) Use soap and water when bathing; bathe no more than twice a day.
(2) Wash out helmet. If no shower facilities are available, use cold water to
wash helmet.
b. Keep Skin Dry. Keeping the skin dry in tropical regions helps decrease the
incidence of tropical skin diseases.
(1) Remove wet socks and boots as frequently as possible.
(2) Rinse mud off boots--mud prevents drying.
(3) Keep skin fold areas dry--underarms, groin, buttocks, and area between
toes; use talcum powder sparingly.
(4) Don't starch battle dress uniform (BDU's).
(5) Do not wear underwear if it aggravates an existing skin condition
NOTE: The above preventive measures applie to all patients/soldiers.
4-4. COMMON SKIN DISEASES
a. Eczema. This is the general name for a group of noncontagious,

inflammatory skin diseases that have a tendency toward erythema (redness), swelling
(edema), oozing, weeping, and crusting.
(1) Signs and symptoms. Includes scaling, crusting, and fissuring.
(2) Treatment. Apply cold, wet compresses, anti-itching medications and air
dry the affected area.
b. Contact Dermatitis. An inflammation to the skin produced by substances in

contact with the skin--may be acute or chronic, and is often sharply defined. This may
be caused by plants (that is, poison ivy, oak, or sumac), chemicals, cosmetics, fabrics,
and household items (that is, detergents, waxes, polish).
(1) Signs and symptoms. Includes itching, redness, burning, blisters,

oozing, crusty areas, and secondary bacterial infections.
MD0550 4-8
NOTE: Reaction is usually immediate, but may be delayed due to hypersensitivity
allergic reaction.
(2) Treatment. Remove offending agent immediately (that is, wash it off),
cool soak affected area; bathe affected area in lukewarm water.
(3) Referral. Refer patient to a physician if fever is more than 101ºF, or

signs of infection (smelling, tenderness, redness, or warmth) develops at site of
irritation.
c. Blisters. These are a collection of elevated fluids between the epidermis and
the dermis. They are caused by repeated friction and pressure against the skin, cold
injuries, and burns.
(1) Treatment.
(a) Blisters should be opened routinely unless there is severe pain or

infection. For blisters on the toe or foot, cover with petroleum jelly and adhesive tape or
moleskin wrapped completely around the toe or foot.
(b) Blisters on the heel can be protected with a donut-shaped piece of

felt or moleskin taped in place around margin of blister.
(2) Prevention.
(a) Wear properly fitted footgear, and wear gloves to protect hands.
(b) Avoid walking long distances in new shoes/boots.
(c) Wear cotton or cotton wool socks. They are less likely to cause
blisters than synthetic materials.
(d) Avoid tube socks.
(e) Put tape on vulnerable areas prior to exercise/use.
(3) Refer patient to a physician if:
(a) Signs of infection occur (increased heat, redness, swelling, or pus

in the blister).
(b) Patient is incapacitated, unable to perform mission.
MD0550 4-9
d. Callus. A usually painless thickening of skin caused by repeated pressure or
irritation. This is caused by repeated injury to skin, particularly on the feet and may be
caused by excessive perspiration, increased heat, friction of clothing, or poorly fitting
shoes.
(1) Signs and symptoms. A rough, thickened area of skin that appears after
repeated pressure or irritation.
(2) Treatment.
(a) Soften callus in warm water.
(b) Rub thickened area with pumice stone, sandstone, or sandpaper.
(c) Use callus pads to reduce pressure on irritated area.
(3) Prevention.
(a) Do not wear shoes that fit poorly.
(b) Avoid activities that create constant pressure on specific skin areas.
(c) Use callus pads to reduce pressure on irritated areas.
e. Chafing. A superficial inflammation which develops when skin is subjected to

friction from clothing or adjacent skin--may occur at underarm, groin, anal region, or
between digits of hands and feet, or at the neck or wrists. Chafing is caused by friction
from contact with another surface such as tight-fitting clothing, shoes, or another area of
body skin.
(1) Signs and symptoms. Include local pain, tenderness, and/or redness of
skin at areas of friction.
(2) Treatment. Relief may be obtained by liberal application of petroleum

jelly to the affected area.
(3) Prevention.
(a) Eliminate potential causes such as tight-fitting shoes, shorts, or

shirts.
(b) Prior to beginning activity, apply petroleum jelly to parts of the body
which may be most likely to become chafed (areas include inside of thighs, groin, and
feet).
MD0550 4-10
f. Prickly Heat. A noncontagious eruption of red pimples with itching and
tingling of the affected parts, usually seen in hot weather-- (also called miliaria). This is
caused by inflammation of the skin around the sweat glands.
(a) Itching, burning, or stinging of skin.
(b) Small red bumps or blisters suddenly develop during exercise in

hot, humid weather.
(2) Treatment. There is no specific treatment. Conditions are seldom

severe enough to cause major problems.
(3) Prevention.
(a) Minimize exercise and work on hot, humid days.
(b) Wear well ventilated clothing to minimize accumulation of sweat on

skin.
g. Psoriasis. Common genetically determined dermatitis consisting of discrete

pink or dull-red lesions. The cause is unknown.
(1) Signs and symptoms. Patches of thick skin with red base and white-
silvery scales/flakes usually on the elbows, knees, scalp, back, and penis.
NOTE: Psoriasis can become worse if exposed to sunshine TOO LONG; a small
amount of sun is good.
(2) Treatment. There is no known cure. Temporary relief can be obtained

by:
(a) Applying hydrocortisone cream 1/2 percent to skin four times a

day.
(b) Being exposed to mild sun--warm climates seem to exert a

favorable effect, humidity often aggravates.
h. Acne. This is a chronic inflammatory disease of the sebaceous glands and

hair follicles of skin. Acne is caused by excessive oils due to hormone stimulations and
bacteria that may be hereditary, and prime bacteria--staph and/or strep. Common
affected areas are the face, back, and chest.
MD0550 4-11
(a) Multiple spreading of pimples, cysts, and/or nodules with pain.
(b) Development of pus in many cases.
(2) Treatment.
(a) There are pros and cons about a number of foods contributing to
the severity of acne; those most often agreed upon are chocolates, nuts, and
carbonated cola beverages. Do not consume these foods or other foods if they are
suspected.
(b) Drying lotions such as white lotion or commercially prepared lotions

containing sulfur and resorcinol may be used.
i. Urticaria (hives). This is an acute or chronic inflammatory skin reaction of

allergic origin-eruptions of wheals or hives. It can be caused by ingestion of food or
drugs. Acute inflammation is less than 6 weeks duration. Chronic inflammation is
longer that 6 weeks duration. Common causes of the acute form are shellfish,
strawberries, eggs, chocolate, penicillin, and serum vaccines.
(a) Intolerable itching.
(b) Slight fever and malaise may be present.
(c) Wheals may vary in size, shape, and amount of swelling;

morphology of lesions may vary over period of minutes to hours.
CAUTION: Observe for laryngeal obstruction. Death could occur.
(2) Treatment.
(a) Avoid exposure to sensitizing drugs or foods.
1. Look for cause. A careful history may reveal recent prescription

of antibiotics, or a new food introduced into diet.
2. Eliminate cause. The cause may be antibiotics or other

medications; therefore, one would go back to the prescriber to change medication.
(b) Give epinephrine 1:1000 0.3-1.0 ml subcataneous (SQ), if laryngeal

spasm is suspected.
MD0550 4-12
(c) Give antihistamines. They often give prompt and sustained
symptomatic relief.
(d) Urticaria is usually self-limiting, lasting only a few days.
j. Tinea Pedis (Athlete's Foot). A common, contagious fungus infection of the

skin on the feet between the toes (usually the 4th and 5th toes).
(1) Causes.
(a) Infection by fungus or yeast.
(b) Infrequent washing of feet.
(c) Infrequent changes of shoes or socks.
(d) Hot, humid weather.
(e) Use of locker rooms and public showers.
(a) Moist, soft, gray-white or red scales on feet, especially between

toes.
(b) Dead skin between toes.
(c) Damp, musty foot odor.
(d) Small blisters on feet, caused by hypersensitivity to fungus (this

symptom is not always present).
(3) Treatment.
(a) Remove scales and material between toes daily.
(b) Keep affected areas cool and dry--go barefoot or wear sandals as
much as possible during treatment.
(c) Use nonprescription antifungal powders, creams, or ointments after

each bath.
MD0550 4-13
(4) Prevention.
(a) Observe good locker room hygiene.
(b) Bathe feet daily, and dry thoroughly.
(c) Wear socks made of cotton, wool, or other natural absorbent fibers.
k. Tinea Cruris (Jock Itch). Infection of the skin in the groin with one of
several fungus germs--these fungi thrive in the groin where darkness, warmth, and
moisture stimulate their growth.
(1) Causes and risk factors.
(a) Athlete's foot can spread to the groin.
(b) Contact with infected surfaces, such as towels and benches.
(c) Excessive sweating.
(d) Friction of skin against skin from constant movement.
(a) Scaling patches on skin of groin, thighs, and buttocks (patches

have well-defined edges).
(b) Occasionally small, pus-filled blisters appear.
(c) Itching of involved areas.
(d) Pain (if skin becomes secondarily infected with bacteria).
(3) Treatment.
(a) Bathe with clear water only. Soap irritates infected skin.
(b) Wear loose, cotton underwear.
(c) Use topical antifungal medications. They may be purchased over

the counter (jock itch powders or sprays).
MD0550 4-14
(4) Refer to physician:
(a) If symptoms do not improve after five days.
(b) If, after receiving prescription treatment, new unexplained

symptoms develop (drugs used in treatment may produce side effects).
(5) Prevention.
(a) Dry thoroughly after bathing.
(b) Wear clean, dry athletic supporters and underwear.
MD0550 4-15
EXERCISES, LESSON 4
1. _________________, _______________ , and__________________ tissues are

the three layers of skin.
2. Freckles, flat moles, and tattoos are examples of _______________________.
3. Define "lesion." ___________________________________________________
________________________________________________________________
4. List the three types of lesions.
______________________________________.
______________________________________.
______________________________________.
5. Which of the following lesions is the result of healing after destruction of some of
the dermis?
a. Boil.
b. Scar.
c. Abscess.
d. Keloid.
MD0550 4-16
6. Categorize the following lesions according to their group. Use the chart below:
Keloid Maceration Macule

Folliculitis Scale Ecchymosis
Crust Boil Plague
Bulla Ulcer Erosion
Abscess Vesicle Wheal
______ Primary______________ Secondary_________________ Special__________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
_______________________ _____________________ ____________________
7. What general methods are used to help prevent skin diseases?
_____________________________________________________.
_____________________________________________________.
8. What are the signs and symptoms of eczema?
_____________________________________________________.
_____________________________________________________.
_____________________________________________________.
MD0550 4-17
SPECIAL INSTRUCTIONS FOR EXERCISES 9 THROUGH 17. Match the name of the
common disease in Column A to its definition as listed in Column B.
COLUMN A COLUMN B
____ 9. Callus a. Dermatitis consisting of discrete pink or dull-red

lesions.
____10. Blister
b. Superficial inflamation that develops when skin is
____11. Prickly heat subjected to friction from clothing or adjacent skin.
____12. Chafing c. Chronic inflammatory diseases of the sebaceous

glands and hair follicles of the skin.
____13. Psoriasis
d. Painless thickening of skin caused by repeated
____14. Acne pressure or irritation.
____15. Tinea pedis e. Athletes' foot (contagious fungus infection of the

skin between the toes.
____16. Urticaria
f. Jock itch (infection of the skin in the groin).
____17. Tinea cruris
g. Noncontagious eruption of red pimples with itching
and tingling of the affected parts.
h. Acute or chronic inflammatory skin reaction of

allergic origin.
i. Collection of elevated fluid between the epidermis

and the dermis.
MD0550 4-18
1. Epidermis, dermis or corium, subcutaneous (para 4-1b)
2. Macule (para 4-2a(1)(a))
3. Any morbid change in the structure or functioning tissues due to injury or disease.
(para 4-2)
4. Primary, secondary, special para 4-2a, b, c)
5. b (para 4-2a(2)(f))
6. Primary Secondary Special
Bulla Erosion Folliculitis

Vesicle Ulcer Abscess
Wheal Scale Boil
Plaque Crust Ecchymosis
Macule Keloid Maceration (paras 4-2))
7. Keep skin clean, keep skin dry (paras 4-3a, b)
8. Scaling, crusting, fissuring (para 4-4a (1))
9. d (para 4-4d)
10. i (para 4-4c)
11. g (para 4-4f)
12. b (para 4-4e)
13. a (para 4-4g)
14. c (para 4-4h)
15. e (para 4-4j)
16. h (para 4-4i)
17. f (para 4-4k)
End of Lesson 4
MD0550 4-19
LESSON ASSIGNMENT
LESSON 5 Initiate Measures to Prevent the Spread of

Communicable Diseases.
5-1. Identify signs, symptoms, and procedures to

prevent spread of sexually transmitted diseases.

prevent the spread of communicable respiratory
diseases: upper respiratory infection (URI);
influenza; pneumonia; tonsillitis; mononucleosis.

prevent the spread of communicable
gastrointestinal diseases: diarrhea; dysentery.
5-4. Identify signs, symptoms, and procedures in

preventing the spread of hepatitis, malaria,
rabies, and meningitis.

MD0550 5-1
LESSON 5
INITIATE MEASURES TO PREVENT THE SPREAD OF COMMUNICABLE

DISEASES
SECTION I. SEXUALLY TRANSMITTED DISEASES
5-1. GENERAL
Sexually transmitted diseases (STD) (commonly known as venereal diseases)

are the most known common communicable diseases in the world and have steadily
increased in incidence for the past two decades. Although, progress has been made in
diagnosis and treatment of STD, factors responsible include changes in sexual behavior
(that is, widespread use of contraceptive pills and devices, the greater variety of sexual
practices; the increase of sexual activity; the infection of homosexual men, and
ignorance of the facts by doctors and educational materials). Sexually transmitted
diseases are almost always acquired by sexual contact with an infected individual. Of
the many STD, the Army is greatly concerned about gonorrhea, syphilis, herpes, and
acquired immunodeficiency syndrome (AIDS).
5-2. GONORRHEA
Gonorrhea is commonly known as clap, the drip, gleet, gonorrhea culture (GC),
strains, or running. This is the most prevalent reported disease among the STD cases
in the United States (US). It is spread by sexual intercourse and the highest incidence
ranges between the ages of 15 to 29 years old. Signs and symptoms for gonorrhea in
males and females may be similar, yet the appearance of the symptoms will differ.
Males will show symptoms where as 60 percent of females may show no symptoms.
a. Signs and Symptoms.
(1) Male.
(a) Usually starts 2 to 8 days after sexual exposure.
(b) Dysuria (painful or difficult urination).
1 Initially--tingling or burning on urination.
2 Hours to 3 days later pain is more pronounced.

(c) Purulent (pus-like) discharge from the penis.
1 May be milky in character.
2 Progresses to yellow-creamy discharge, sometimes blood-

tinged.
MD0550 5-2
(d) Area surrounding meatus may be red and swollen.
(e) Frequency in voiding/urination.
(2) Female.
(a) Usually starts 7 to 21 days after sexual exposure.
(b) Dysuria (painful or difficult urination).
(c) Frequency and increase in vaginal discharge, purulent (pus-like)

discharge from the urethra.
b. Preventive Measures.
(1) Report to the local health authority (Preventive Medicine Office for the
military and the Community Health Office for the civilian population).
(a) The infected person should identify and report all infected sexual
partners, if possible.
(b) He should also report visible signs of infection.
1 For males--sores on genitalia or discharge from penis.
2 For females--increased vaginal discharge, lesions of skin and

mucous membranes. Ask the female if she has burning during urination.
(2) Isolation not required.
(3) Quarantine not required.
(4) Refer infected person to a physician for treatment.
(5) Educate the public through health and sex education classes.
(6) Protect the community by control of prostitution (advise against

prostitution) and discourage sexual promiscuity.
(7) Use of personal prophylaxis; that is., condoms.
(8) Avoid sexual intercourse until released/okayed by doctor; (usually 6 to 8

weeks).
MD0550 5-3
NOTE: The medic should gain the patient's confidentiality and ensure his privacy.
Only tell those persons who have a need to know for all STD cases; that is,
doctor, local health authority, and so forth.
5-3. SYPHILIS
Of all sexually transmitted diseases, syphilis is potentially one of the most

destructive. Early symptoms disappear spontaneously and yet, years later, can return
with devastating consequences. Syphilis is a highly infectious disease and is spread by
sexual intercourse. It usually involves persons between 15 to 30 years old, and is more
prevalent in males than females.
(1) Purulent (pus-like) discharge from moist lesions of skin and mucous
membranes--lesions occur on lips, tongue, breast, fingers, and anal region.
(2) No pain is associated with syphilis.
(3) Patient may develop fever caused by infected lesions.
(4) If early signs and symptoms of syphilis are not treated appropriately and
immediately, more life-threatening conditions may occur.
(a) Blindness.
(b) Severe heart disease.
(c) Altered neurological status.
(1) Report to the local health authority (Preventive Medicine Office for the
military and the Community Health Office for the civilian population).
(a) The affected person should identify and report all infected sexual
partners.
(b) He should also report visible signs of infection.
(2) Isolation not required.
(3) Quarantine not required.
MD0550 5-4
(4) Educate the public through health and sex education classes; for
example, preparation for marriage and general physical examination includes having a
blood serology test.
(5) Protect the community by control of prostitution (advise against

prostitution) and discourage sexual promiscuity.
(6) Use of personal prophylaxis; that is, condoms.
(7) Avoid sexual intercourse until released/okayed by doctor.
5-4. HERPES SIMPLEX (FEVER BLISTER, COLD SORE)
a. General.
(1) Viral infection marked by its repeated recurrence of lesions.
(2) Lesions, after healing, are reactivated by:
(a) Trauma.
(b) Occurrence of infection.
(3) Location of lesions.
(a) Lips.
(b) Gums.
(c) Mouth area.
(d) Occasionally affects genitals.
(4) Two types of herpes simplex.
(a) Herpes Simplex Virus Type I (HSV-I)--usually occurs in childhood;

virus remain in body for life until triggered by infection.
(b) Herpes Simplex Virus Type II (HSV-II)--genital herpes; usually

occurs in adults; transmitted by some form of sexual contact.
b. Signs and Symptoms.
(1) Very small, painful blisters grouped together and surrounded by red ring.
(2) Fever.
MD0550 5-5
(3) Malaise.
(4) Experience pain or difficulty in voiding/urinating.
(5) Headache.
c. Causes. Herpes simplex virus may be triggered by:
(1) Injury to skin from friction with clothing or protective gear.
(2) Previous eczema.
(3) Illness that may lower individual's resistance.
(4) Some form of sexual contact--kissing an individual infected with the

herpes simplex virus.
d. Preventive Measures.
(1) Personal hygiene--bathing; wash you hands often during flare-up.
(2) Health and sex education classes directed toward minimizing transfer of
the infection.
(3) Avoid physical contact with others who have active lesions.
(4) Isolation--individuals with Herpes simplex virus lesions should be kept

away from patients with burns.
NOTE: Patients with burns are more prone to development of infections because of
an altered state in resistance to illnesses and/or infections.
5-5. Acquired Immune Deficiency Syndrome
a. Terminology.
(1) HTLV-III--Human T-cell Lymphotrophic Virus Type III--this virus attacks

certain white blood cells called the T-helper cells that regulate our immune system and
protect us from various infectious agents.
(2) Acquired Immune Deficiency Syndrome --AIDS—is a disease at least

moderately predictive of a defect in the immune system, occurring in a person with no
known cause for diminished resistance to that disease.
MD0550 5-6
NOTE: HTLV-III infection means that a person has been exposed to and infected with
the virus. Acquired immune deficiency syndrome means that the infection
has progressed to the point that the body's immune system has been
attacked and the person shows signs and symptoms of illness.
b. Background.
(1) HTLV-III--traced back to African Green Monkey--transmitted by scratch

or bite.
(2) Acquired immune deficiency syndrome --found and named

coincidentally--first seen as pneumonia of a rare type--in primarily, but
not limited to homosexual men.
c. Transmission of HTLV-III Virus.
(1) Sexual contact--heterosexual and/or homosexual.
(2) Sharing of needles—interveinous (IV) drug users.
(3) Contaminated blood--less of a problem now that blood is being tested for
HTLV-III.
(4) Maternal-child transmission--in uterus.
d. Signs and Symptoms of HTLV-III Virus. Signs and symptoms of HTLV-III

virus may range from no symptoms at all to symptoms of AIDS.
NOTE: There has been no cure found for the HTLV-III infection.
e. Signs and Symptoms of AIDS.
(1) Fever of unknown origin--fever may be low grade and persistent or it

may be episodic and spiking.
(2) Weight loss--can amount from 20 to 30 percent of body weight.
(3) Malaise.
(4) Diarrhea.
(5) Opportunistic infections—that is, Candida, Pneumocystis pneumonia,

toxoplasmosis, cytomegalovirus.
(6) Kaposils sarcoma.
MD0550 5-7
f. Treatment. There is no cure; the patient is treated to alleviate whatever
signs and symptoms, which is causing them to suffer.
g. Problems Unique to Military Personnel.
(1) Deployment--ready fighting force cannot be deployed worldwide.
(2) Battlefield injuries and transfusions if wounded, they can develop

infections, cannot fight, cannot give blood to others.
(3) Live virus inoculations, if given a live virus inoculation, they will become
infected with the virus and will not be able to fight.
h. Prevention.
(1) Avoid sexual contact with those at risk.
(a) Prostitutes.
(b) Drug users.
(c) Homosexuals.
(d) Bisexuals.
(e) Promiscuous individuals.
(2) Use a condom if you or your partner may be carrying the virus
(3) Limit number of sexual partners.
(4) Do not use IV drugs.
NOTE: Women who have the virus or think they may have the virus, should be
cautioned to avoid pregnancy. The virus can be transmitted to their unborn
child.
MD0550 5-8
SECTION II. RESPIRATORY DISEASES--UPPER RESPIRATORY INFECTIONS
5-6. GENERAL
There are many acute respiratory infections that are grouped together and given
a general title of Acute Viral Respiratory Diseases. They are associated with a large
number of viruses and each virus is capable of producing a wide variety of acute
respiratory illnesses. The greatest incidence of upper respiratory infections (URI)occurs
during the fall and winter months.
a. Signs and Symptoms. Upper respiratory infections are usually associated

with fever, chills, headaches, generalized body aches and pain (to include facial and
tooth pain), malaise, loss of appetite, possibly nasal congestion, sneezing, sore throat,
and coughing. The signs and symptoms may last from 2 to 5 days.
b. Common Treatment. Treatment includes mild analgesic--acetylsalicyclic

acid (ASA) (asprin), rest, fluids, and light diet.
c. Preventive Measures.
(1) Isolation. Infected persons should avoid direct or indirect exposure of

others, particularly patients with other illness. Avoid crowding in living and sleeping
quarters, especially in the barracks.
NOTE: In some cases of mild upper respiratory infections, soldiers will not be isolated
from their barracks. If a soldier's condition deteriorates and hospitalization is
required, isolate IAW STP-8-91A12-TQ-SM, 081-833-0009, Identify Basic
Principles of Isolation Techniques.
(2) Oral vaccines. This has been proven effective against type-specific (oral
polio) infections in military recruits.
(3) Education. Inform individuals on personal hygiene (that is, covering

mouth when coughing, cover nose when sneezing).
(4) Disposal. Dispose of discharge from mouth and nose. Get rid of tissues
or whatever else is used to hold discharge.
5-7. INFLUENZA (FLU)
Influenza is a highly contagious, acute disease caused by a virus. Recovery time

is between 2 to 7 days. Its mode of transmission is through direct contact--someone
coughing, failing to cover mouth or nose in crowded areas, or being in confined places
such as the barracks.
MD0550 5-9
a. Signs and Symptoms. Includes a slight fever that may last from 1 to 7 days
(usually 3 to 5 days), nonproductive and dry cough, headache, nasal
stuffiness/congestion, chills, generalized body aches and pain, and occasionally nausea
and diarrhea.
b. Treatment. Includes mild analgesic--ASA for aches, pains, and headaches;

fluids and bedrest.
c. Preventive Measures.
(1) Immunization. Flu vaccine.
(2) Isolation. Recommended for highly susceptible patients.
(3) Referral. Refer patient to higher level of medical care if condition

deteriorates (same complaint or no improvement upon return visit).
5-8. TONSILLITIS AND STREP THROAT
a. Definitions.
(1) Tonsillitis. A painful inflammatory disease caused by bacteria or viruses

that infect one or both of the tonsils. The highest incidence is people between the ages
of 10 to 40 years old.
(2) Strep throat (septic sore throat, acute streptococcal pharyngitis, and
acute streptococcal tonsillitis). An infectious disease that affects the membranes of the
throat and tonsils. It spreads from person to person through droplets of moisture
sprayed from the nose and mouth.
(1) Sore throat--classic symptom.
(2) Pain while swallowing.
c. Treatment. Includes rest, fluids, mild analgesic--ASA, light diet--mostly

liquids.
(3) Fever/chills.
(4) Headache.
MD0550 5-10
(5) Malaise.
(6) Red or swollen tonsils on examination.
d. Preventive Measures. None.
5-9. PNEUMONIA
Pneumonia is an acute infection of the air sacs in the lungs. It usually occurs as
a result from other infections (that is, injury to the respiratory mucosa with pneumonia
as a secondary infection, influenza, common cold, and bronchitis).
NOTE: Patients who are hospitalized and confined to the bed, post-operative patients
or patients with chest or abdominal trauma injuries, have a tendency not to
take deep breaths and cough due to pain associated with these procedures.
It would be better if the patient would cough or try to cough to loosen some of
the congestion and to expel it from the chest and mouth.
(1) Runny nose, sore throat several days before onset.
(2) Severe chest pain when coughing.
(3) Productive cough when able to cough--sputum slightly blood-tinged.
(4) Fever (103ºF or higher).
(5) Chills.
(6) Shortness of breath.
b. Treatment. Includes bedrest and fluids.
c. Referral. Refer patient to higher level of medical care if the patient's

condition deteriorates. If the patient has a severe case of pneumonia, refer to a
physician immediately.
(1) Good personal hygiene.
(2) Strongly encourage patients to cough and deep breathe when

bedridden.
(3) Avoid crowded living quarters.
MD0550 5-11
(4) Avoid contact with patients infected with upper respiratory infections.
(5) Immunization with flu vaccine.
5-10. MONONUCLEOSIS
Mononucleosis is an acute infectious disease. Its mode of transmission is

through close contact, kissing is the common route of transmission. The infection is
most common among college students. It usually occurs between the ages of 15 to 25
years old.
a. Signs and Symptoms. Includes fever, sore throat, and malaise.
b. Treatment. There is no specific treatment, however, rest and nourishment

are recommended.
c. Preventive Measures. Avoid contact with persons infected with other

respiratory diseases.
d. Referral. Refer to higher level of medical care if the patient's condition

worsens.
SECTION III. GASTROINTESTINAL DISEASES
5-11. DIARRHEA, DYSENTERY
a. Definition.
(1) Diarrhea. An abnormal frequency and liquidity of fecal discharges.
(2) Dysentery. A term given to a number of disorders marked by

inflammation of the intestines, especially the colon, and attended by pain in the
abdomen, tenesmus (straining), and frequent stools containing blood and mucus.
b. Mode of Transmission. Includes contaminated food and water, flies, and

infected individuals.
c. Signs and Symptoms.
(1) Frequent liquid or semi-liquid stools.
(2) May lead to dehydration (dry mouth and skin, failure to urinate, sunken
eyes, drowsiness).
MD0550 5-12
(3) Severe abdominal pain or cramps.
(4) Severe cases--stools contain blood, pus, and mucous.
(1) Eat only approved food and drink (only treated water).
(2) Dispose of waste matter properly.
(3) Maintain good personal hygiene.
(4) Practice insect and rodent control.
(5) Thorough terminal cleaning--to specifically include bathroom facilities.
5-12. HEPATITIS
Hepatitis is defined as inflammation of the liver. It is divided into two types:

Hepatitis Type A and Hepatitis Type B. The signs and symptoms for both types are the
same, the only difference is the mode of transmission.
a. Mode of Transmission.
(1) Type A--common vehicle outbreaks related to contaminated water and

food.
(2) Type B--common vehicle by parental route (intravenous, intramuscular,

or subcutaneous routes)--using contaminated needle and syringes.
(1) Fever.
(2) Malaise.
(3) Loss of appetite.
(4) Nausea, vomiting.
(5) Abdominal discomfort.
(6) Headache.
MD0550 5-13
(7) Skin, sclera of eyes become yellowish-tinged.
(8) Urine becomes dark yellow; may look brown.
c. Treatment. Involves bedrest, restricted activities, and a diet high in protein

and carbohydrates.
(1) Education to public directed toward good sanitation and good personal
hygiene.
(2) Special emphasis on sanitary disposal of feces/stools.
(3) Proper disposal of contaminated/used needles and syringes.
(4) Isolation--definitely--enteric precautions (good hand washing and

wearing gloves when handling the patients waste matter, feces, needles and syringes).
(5) Individuals who have history of hepatitis should be identified and

properly screened prior to blood donations.
NOTE: All military personnel PCS to Korea as of 1 October 1983 will receive the
Immune Serum Globulin Hepatitis B Antibody (Anti-BHs).
5-13. MALARIA
Malaria is an infectious, febrile disease caused by protozoa of the genus

plasmodium, which are parasites in the red blood cells, and are transmitted by bites of
infect mosquitoes of the genus anopheles.
(1) Fever.
(2) Chills and sweating.
(3) Headache.
(4) Shock, if the condition worsens.
(1) Keep immunizations current.
(2) Take prescribed prophylaxis (malaria pills).
MD0550 5-14
(3) Bathe daily and change clothing daily.
(a) Tuck your pants into boots.
(b) Button your shirt up entirely.
(c) Button you shirtsleeves.
(4) Use insect repellent; spray pesticides to eliminate or control insects.
(5) Blood donors should be question for history of malaria or possible

exposure to the disease.
(a) May not donate blood up to 6 months after return from a

susceptible area, if patient has not taken anti-malarial drugs, or has been symptom-free.
(b) If anti-malarial drugs are taken, definitely identified as having

malaria, individuals may be accepted as blood donors after three years.
5-14. RABIES
a. Rabies is an acute, infectious disease of the central nervous system to which

all warm-blooded animals and humans are susceptible.
(1) Wild animals include skunks, foxes, raccoons, and bats.
(2) Domestic animals include dogs, cats, pigs, horses, and mules.
b. Mode of Transmission. Bites from affected animals.
c. Signs and Symptoms.
(1) Slight temperature elevation.
(2) Headache.
(3) Malaise.
(4) Nervousness.
d. Treatment.
(1) Immediately wash wound with large amount of saline.
MD0550 5-15
(2) Cleanse with large amounts of soap.
(3) Debride wound if necessary.
e. Preventive Measures.
(1) Report to local health authority--date, time, type of animal; you must
bring animal with you, if possible.
(2) Isolation--strict isolation during time of illness.
(3) Wearing of gloves and protective gown required when handling infected
individual.
CAUTION: The infected individual's saliva/secretions are potentially hazardous.
NOTE: Vaccination of a person is NOT a preventive measure.
(4) The public should be instructed to have proper administration of

vaccines given to all domestic animals.
(6) State establishes source of preventive measures for appropriate wildlife

conservation.
5-15. MENINGITIS
Meningitis is an acute inflammation of the meninges of the brain or spinal cord.

The actual cause is not known.
NOTE: The signs and symptoms in most cases are related to an upper respiratory
type of infection.
(1) Headache.
(2) Back pain.
(3) Stiff neck.
(4) Chills.
(5) Fever, extremely high on some occasions.
(6) Loss of appetite.
MD0550 5-16
(7) Confusion.
(8) Drowsiness.
c. Treatment. Treat symptomatically and provide life-support, as necessary
(1) Report to local authority--community Health Nurse or Infection Control

Department must be notified.
(2) Isolation--isolate all patients during febrile (fever) period.
(3) Disinfect all eating and drinking utensils soiled by secretions and waste
matter of patients.
(4) Patients need to be treated for more definitive care in medical treatment
facility.
MD0550 5-17
EXERCISES, LESSON 5
1. What is the most prevalent reported STD in the world?
a. AIDS.
b. Syphilis.
c. Gonorrhea.
d. Herpes simplex.
2. Signs and symptoms of gonorrhea usually start in women within _________ after
sexual exposure.
a. 1 to 2 hours.
b. 8 to 12 hours.
c. 1 to 6 days.
d. 7 to 21 days.
3. ___________________ is the STD that is more prevalent in men than in women.
4. There is no pain associated with syphilis.
a. True.
b. False.
MD0550 5-18
5. Which of the following incidents could trigger the herpes simplex virus?
a. Previous eczema.
b. Vascular headaches.
c. Pain while urinating.
d. Previous aches and pains.
6. Which of the following modes of transmission are related to the HTLV-III virus?
a. Sexual contact, both hetero and/or homosexual.
b. Sharing of needles-IV drug users.
c. Contaminated blood.
d. All of the above.
7. __________________ is a highly contagious, acute disease caused by a virus.
8. Tonsillitis only affects one tonsil.
a. True.
b. False.
9. What is known as a classic symptom for strep throat?
a. Fever.
b. Chills.
c. Sore throat.
d. Pain while swallowing.
10. ______________________ is an acute infection of the air sacs in the lungs.
MD0550 5-19
11. Which of the following diseases common route of transmission is by kissing?
a. Meningitis.
b. Influenza.
c. Dysentery.
d. Mononucleosis.
12. What are two gastrointestinal diseases as listed below?
a. Pneumonia, diarrhea.
b. Diarrhea, dysentery.
c. Influenza, meningitis.
d. Herpes, hepatitis.
13. What are the signs and symptoms of malaria?
a. Headache, malaise, nervousness.
b. Fever, chills and sweating, headache.
c. Lost of appetite, nausea, abdominal pain.
d. Dryness of the mouth, fever, headache.
14. ________________ is an acute infectious disease of the central nervous system.
MD0550 5-20
1. c (para 5-2)
2. d (para 5-2a(2))
3. Syphilis (para 5-3)
4. a (para 5-3a(2))
5. a (para 5-4c)
6. d (para 5-5c)
7. Influenza (para 5-7)
8. b (para 5-8a(1))
9. c (para 5-8b(1))
10. Pneumonia (para 5-9)
11. d (para 5-10)
12. b (para 5-11)
13. b (para 5-13a)
14. Rabies (para 5-14a)
End of Lesson 5
MD0550 5-21

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ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

SUBCOURSE MD0550 EDITION 100

This subcourse is approved for resident and correspondence course instruction. It

For comments or questions regarding enrollment, student records, or shipments,

CLARIFICATION OF TRAINING LITERATURE TERMINOLOGY

1 PERFORM A BASIC PHYSICAL ASSESSMENT 1-1--1-7

2 TREAT COMMON HEADACHES AND TOOTHACHES 2-1--2-3

3 PROVIDE SYMPTOMATIC RELIEF FOR COMMON COLD 3-1--3-8

4 TREAT COMMON SKIN PROBLEMS 4-1--4-4

5 INITIATE MEASURES TO PREVENT THE SPREAD OF

Section I. SEXUALLY TRANSMITTED DISEASES (STD) 5-1--5-5

The subcourse instructional material consists of the following:

Lesson 1, Perform a Basic Physical Assessment.

--Read and study each lesson carefully.

To receive credit hours, you must be officially enrolled and complete an

LESSON 1 Perform a Basic Physical Assessment.

LESSON ASSIGNMENT Paragraphs 1-1 through 1-7.

1-1. Identify general techniques of physical

1-2. Identify the procedures and factors involved with

1-3. Record findings during a physical assessment.

SUGGESTION After completing the assignment, complete the

PERFORM A BASIC PHYSICAL ASSESSMENT

1-2. ASSESSMENT TOOLS/EQUIPMENT

1-3. ENVIRONMENT CONDITIONS ON ASSESSMENT

a. Clinical (Hospital,Medical Treatment Facility, Troop Medical Clinic, and

b. Field. In a field setting, or environment, complete examination may not be

(1) Initial evaluation of front line battlefield casualties under fire.

(2) Initial evaluation of a casualty in mass casualty situations.

(3) Conditions of inadequate light or environment, such as power failure at

NOTE: If any of the above or similar situations prohibit a complete physical

The general techniques of physical assessment are inspection, auscultation,

a. Inspection. This involves seeking of physical signs by observing the patient.

(2) Local inspection involves focusing a single anatomic region (head,

b. Auscultation. This involves the process of listening with a stethoscope to

(1) Perceived signs. Signs are perceived by:

(b) Internal structures. These may be felt beneath exterior covering

(3) Qualities elicited by palpation.

(a) Texture of skin and hair.

(b) Moisture of skin and mucosa.

(c) Skin temperature, various levels of the body.

(d) Masses (shape, size, consistency, motility, pulsatility).

(e) Tenderness of all accessible tissues.

(f) Crepitus (a crackling sound or grating/grinding sensation perceived

(g) Unusual vibrations, (for example, some heart murmurs produce

1 Dehydration of tissues is described as loss of skin turgor (when

2 Overhydration of tissues (presence of edema) is demonstrated

d. Percussion. This is a method of examination by which the surface of the

1-5. PROCEDURES TO PERFORM A PHYSICAL ASSESSMENT

(1) Level of consciousness. Remember that consciousness may be lost

(a) Head tilt-chin lift. This technique provides a consistently more

Figure 1-1. Head tilt-chin lift.

Figure 1-3. Check for breathing.

(5) Bleeding (major hemorrhaging). Check for persistent, external bleeding.

1-6. SECONDARY SURVEY

The secondary survey is performed to discover medical and injury-related

(4) Temperature. Normal temperature is 98.6ºF (37.0ºC).

(1) Scalp. Examine the scalp for presence of bleeding or contusions

CAUTION. Do not move the patient's neck.

(a) Check the eyelids for swelling and discoloration.

(b) Check the pupils for dilation, constriction, equality or inequality,

(4) Nose. Check the nose for deformity, bleeding, or discharge.

3. __, , , and

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10. __ _ is a condition when a portion