Scs - Medical Conditions

Front 1

Two most common anomalies leading to SCD?

Back 1

1. Hypertrophic Cardiac Myopathy

2. Coronary Artery Abnormalities

Front 2

How do you screen for HCM?

Back 2

Very difficult b/c 55-80% of athletes are asymptomatic

Look out for dizziness, chest pain, fainting, SOB, family history

Echocardiogram if concerned

Front 3

Any reason to include EKGs in PPE?

Back 3

Yeah, 25 year Italian study found significantly less cardiac deaths with it

AHA does not endorse it - high costs and low incidence

Front 4

What things in the family history would warrant further consultation in PPE for CV concerns?

Back 4

Premature death before 50 in a relative

Disability from heart disease in a close relative < 50

Specific cardiac conditions in the family (long-QT, marfans, arrhythmias)

Front 5

Subjective medical history that may warrant further consultation in PPE for CV concerns?

Back 5

Exception chest pain/discomfort
Unexplained syncope
Excessive exertional dyspnea with ex
Prior recognition of heart murmur
Elevated systemic BP

Front 6

Physical examination findings that would warrant further consultation in PPE for CV concerns
?

Back 6

Heart murmur
Femoral pulses to exclude aortic contraction
Physical signs of Marfans
Brachial artery blood pressure

Front 7

Pertinent pulmonary function tests for asthma?

Back 7

FEV1: amount of air forcefully exhaled in 1 second
FVC: for 5 to 6 seconds
PEFR (peak exp flow rate): Measures flow rate as opposed to volume
FEV1/FVC dynamic function of lungs

Front 8

Difference between obstructive and restrictive lung disease with PFTs?

Back 8

Obstructive: FEV1 decreases while FVC remains the same, causing FEV1/FVC to decrease (80% is normal)

Restrictive: both FEV1 and FVC decrease, causing FEV1/FVC to remain the same

Front 9

Common controller medications for asthma

Back 9

Inhaled or systemic corticosteroids

Cromones

Long-active B2 agonists

Therophylline

Leukotriene modifiers

Front 10

Short acting asthma medications

Back 10

Usually a B2 agonist, but remember these are banned by many !

Also, inhaled anticholinergics

Short-active Theyophylline

Front 11

Difference between EIA and EIB

Back 11

EIA: exacerbation of chronic asthma

EIB: occurs with onset of exercise, but NO SYMPTOMS at rest with normal PFTs

These maybe due to cooling/warming phenomenon or drying phenomenon

Front 12

How to diagnose EIA or EIB

Back 12

Labroatory stress-demanding task

Controlled challenge test, Eucapnic Voluntary Hyperventilation (EVH)

Front 13

Signs/symptoms of Vocal Cord Dysfunction (VCD)?

Back 13

C/o throat tightness
Inspiratory stridor (high-pitched weekzing)
-Need to see psychologist and SLP with all of our breathing techniques

Front 14

S/S your athlete may be a diabetic?

Back 14

Polyuria
Polydipsia
Weight loss
Blurred vision

Front 15

What organs does DM usually effect?

Back 15

Eyes, kidneys, nerve, heart and BVs
Can lead to atherosclerosis, PAD and stroke

Front 16

Glucose levels for diagnosis DM

Back 16

>126 mg/dL fasting > 8 hours
>200 mg/dL casual or oral glucose tolerance test

Front 17

Symptoms of hypoglycemia?

Back 17

Tachycardia, sweating, hunger, palpitations, HA, trambling, dizziness

Can because blurred vision, fatigue, difficulty thinking, loss of motor control, aggressive behavior, seizures, and LOC

Front 18

How to treat mild hypoglycemia?

Back 18

15-20 g of fast acting sugar
Take BG
Wait 20 mins, and recheck BG

Repeat, activate EMS if BG doesn't go back to normal after 2nd administration of CHO

Front 19

Most helpful s/s for diagnosing HPYERglycemia in an athlete

Back 19

Fatigue
Fruity odor to breath (ketoacidosis - breaking down FFA b/c glucose won't go into cells)
Frequent urination

Front 20

Definitions of hypo and hyperglycemia

Back 20

Hypo: > 70 mg/dL

Hyper: > 180 mg/dL

Front 21

List of risk factors for Metabolic Syndrome? How many must be present?

Back 21

3 must be present

BP > 130/85
Fasting BG > 100 mg/dL
Large waist circumference (>50 men and >35 inches females)
Low HDL < 40 (men) or < 50 (women)
TGs > 150 mg/dL

Front 22

What is Marfan's Syndrome?

Back 22

Genetic disorder affecting CT within MSK, CV (aortic aneurysm), and ocular systems (lens dislocation)

Long limbs, lanky build, poor muscular strength

Front 23

Major criteria of MFS according to Ghen Nosology diagnostic paradigm

Back 23

Pectus carinaum or excavatum
Wrist and thumb sign (arachnodactily)
Scoilosis > 30%
Reduced elbow extension
Pes planus
Protrusio acetabulae

Front 24

Other things to look for that makes you think Marfans in the house

Back 24

joint hypermobility
High palate
Characteristic face
Long fingers and long bones

Front 25

What activities are appropriate for MFS?

Back 25

low-intensity including bowling, walking, and golf

Front 26

Pharmacology for MFS

Back 26

Beta blockers, Ca channel blockers and ACE inhibitors to decrease stress on CV system

Antibiotics if have MVP

Front 27

Whyat is Eherls-Danlos Syndrome (EDS)

Back 27

Triad of s/s including hyperextensibility, joint hypermobility, and tissue fagility

Can effect joints or vascular system (lots of bleeding - watch out for sports)

Diagnosed by skin extensibility (1 to 1.5 cm stretch) and joint hypermobility using Beighton Scale

*must rule out vascular involvement to allow participation

Front 28

Two types of seizures (in general)

Back 28

Partial (part of brain)

General (whole brain)

Front 29

When should EMS be activated for seizure?

Back 29

First time seizure
Breakthrough seizure
Status epilectius (>5 minutes)

Front 30

What sports should epilectics refrain from participating in?

Back 30

Scuba diving and skydiving

Front 31

Three types of juvenile rheumatoid arthritis (JRA)

Back 31

1. Pauciarticular: < 5 joints, usually larger joints

2. Polyarticular: > 5 joints, usually hands and feet

3. Systemic: affects multiple organs

Front 32

What tests may you recommend if you think JRA may be present?

Back 32

Erythrocyte Sedimentation Rate (ESR)
Complete blood count (CBC)
Antinuclear antibody (ANA0
Rheumatoid factor (RF)

Front 33

Top 10 conditions causing sudden cardiac death in athletes

Back 33

1. asthma
2. brain injury
3. C-sp injury
4. Diabetes
5. Heat stroke
6. Hyponatremia
7. Sickling
8. Head-down contact in football
9. Sudden cardiac arrest
10. Lightning

Front 34

NATA what must an EAP include?

Back 34

1. WRITTEN and STRUCTURED
2. Developed and coordinated with local EMS staff, school public safety officials, onsite first responders, school medical staff, and school administration
3. Should be specific to each athletic venue
4. Practiced at least annually
5. Instructions and expectations for athletes, coaches, ADs, etc
6. List out health care professionals there
7. Precise prevention, recognition, treatment, and RTP policies for common causes of sudden cardiac death

Front 35

Why should asthmatics perform a structured warm up?

Back 35

decrease reliance on medications and minimize asthmatic symptoms and exacerbations

Front 36

What should the PT educate the asthmatic athlete on?

Back 36

Prophylaxis use of meds before ex
Spirometry devices
ASthma triggers
Recognition of s/s
compliance with monitoring condition and taking meds

Front 37

Major signs of asthma issue?

Back 37

Confusing, sweating, drowsiness
FEV1 < 40%
Low O2 sat
Use of accessory mm
Wheezing, cyanosis, coughing
Hypotension, brady/tachycardia, mental status change
LOC, inability to lie supine
Inability to speak

Front 38

Magic number for improvement in FEV1 with field test on spirometry?

Back 38

12% improvement, probably have it and would benefit from a fast acting beta agonist

Front 39

When should an athlete with known asthma having an attack be referred to the hospital?

Back 39

3 administrations of B2 agonist (in an hours time)
If do not relieve distress, refer on to urgent care (if not dire)

Front 40

For an athlete that carries a peak flow meter, where should value be at to allow competition?

Back 40

80% of predicted values, or of his baseline value

Front 41

What to do if an athlete with no known asthma appears to be having an attack?

Back 41

Monitor for 5 minutes
-if no improvement, call 911, prepare for CPR

Front 42

Typical steps for an athlete having an asthma attack?

Back 42

1. Measure PEF
2. If PEF decreased 15% or less can keep giving SABA and allow RTP
3. 15-50% try twice, but on the second one rest them in a comfortable area and check vitals
4. PEF below 50%: Give SABA, place in comfortable position and check vitals

Front 43

Daily variability of what indicates poorly controlled asthma?

Back 43

20%

Front 44

RTP for asthma?

Back 44

No specific guidelines
Should be asymptomatic and progress through graded increase in activity
Lung function monitored with peak flow meter and compared to baseline measures
-treat asthmatic triggers and allergies

Front 45

Is it ok to give supplemental oxygen during an asthma attack?

Back 45

Yes, try to keep O2 sat above 92%

Front 46

NATA prevention recommendations for catastrophic brain injuries

Back 46

1. Educate everyone
2. Enfore use of certified helmtes - can prevent TBI, but not cerebral concussion

Front 47

NATA what should PT use for RTP with concussion?

Back 47

Battery that includes symptoms, cognitive, and balance measures. Represents one piece of the concussion puzzle

Front 48

S/S that would cause you to stabilize the C-spine right away?

Back 48

1. Unconscious or altered consciousness
2. Bilateral neuro signs
3. Midline spine pain with or without palpation
4. Obvious spinal deformity

Front 49

When should you NOT try to realign the cervical spine?

Back 49

1. Pain caused or increased
2. neuro symptoms
3. muscle spasm
4. airway compromise
5. physical difficulty repositioning the spine
6. encountered resistance
7. Apprehension expressed by the paitnet

Front 50

Signs/Symptoms of hypoglycemia

Back 50

Due to release of EPI and Acetycholine at BG drops

Nervousness, trembling, hunger, HA, dizziness

Can progress to: blurred vision, fatigue, difficulty thinking, loss of motor control, aggressive behavior, seizures, convulsions, and LOC

Front 51

Signs/symptoms of hyperglycemia

Back 51

With or without ketosis
Without: nausea, dehydration, reduced cognitive performance, sluggish, fatigue
With: Kussmaul breathing (abnormally deep, rapid sighing respirations), fruity odor to breath, unusual fatigue, sleepiness, loss of appetits, polyuria, polydipsia, loss of appetitie

Front 52

Where may Type I diabetics train/perform at?

Back 52

180 mg/dL to prevent hypoglycemia
Watch out for dehydration

Front 53

If BG > 250 mg/dL in athlete with type I?

Back 53

Test for ketones, if present ex is contraindicated

No ketones and > 300 mg/dL, may ex with caution and continue to monitor BG levels
*establish this with physician and as part of Diabetic Plan Care

Front 54

What is severe hypoglycemia?

Back 54

Athlete unconscious, unable to swallow or follow directions

Front 55

How often should Type I check BG?

Back 55

2-3x before, every 30 minutes during, every hour up to 4 hours after exercise

CHO should be eaten before, during, after exercise

Front 56

When may a Type I get hyperglycemia without ketosis?

Back 56

When insulin levels are adequate - hyperglycemia is usually transient in this case

Front 57

Typical 10-15 g CHO given?

Back 57

2 Tbsp honey or 4-8 glucose tabs

Front 58

What supplies should the PT have in their medical kit to treat diabetes-related emergencies?

Back 58

1. Copy of diabetes care plan for athlete
2. BG monitoring equipment/supplies. (check expiration date)
-BG testing strips
-BG meter
-supplies for urine or blood ketone testing
-spare batteries for BG meter or insulin pum
3. Fast acting sugar
4. Glucagon injection kit
5. Sharps container

Front 59

When should athletes with DM type I drink NON-CHO fluids?

Back 59

When BG levels exceed the renal glucose threshold (180 mg/dL), because may lead to increased urination, fluid loss, dehydration

So if > 100, give a CHO. If great than 180, only allow water and test for ketones if they get above 250

Front 60

Heat/cold conerns with insulin administration

Back 60

Extreme heat increases absorption, whereas extreme cold decrease absorption. Avoid modalities, especially with rapid acting (lispro, aspart, glulisine)

Front 61

Optimal BG for the athlete

Back 61

100-180 mg/dL

Front 62

what should the athlete with DM provide at the PPE?

Back 62

physician should provide assessment of current level of glycemic control, information concerning the ppresence and status of diabetes-related complications, and BG management strategies

Front 63

Types of insulin administration

Back 63

Basal: steady when not eating
Bolus: larger, with meals and CHO

Can do multiple daily injections or insulin pump

Front 64

Some common insulin adjustments in athletes?

Back 64

Reducing basal rate 20-50% 1 to 2 hr before ex
Reduce bolus up to 50% at the meal preceading ex
Suspend or disconnect insulin pump at start of ex (never longer than 60 minutes)

Front 65

Ex recommendations for prego?

Back 65

30 min or more of moderative intensity activity (3-5 METS) on most days (3-4 MPH walking)

20-60 min/day of intense ex 3-5 days/week

Front 66

lab tests to monitor JRA?

Back 66

ESR, CBC, ANA, RF

Front 67

RTP mono in off season athlete?

Back 67

intiate after 2 weeks if asymptomatic
No activities that increase intra abdominal pressure (weight lifting)
-Increase activity at 3 weeks to unrestricted aerobic
-full activity at 28 days if spleen size normal

Front 68

RTP mono in-season contact athlete

Back 68

2 weeks light activity
-spleen size normal? gradually increase activity from 2-3 weeks
-Resume full activities at 4 weeks

1 month is max as long as spleen is getting bigger

First 3 weeks is danger time