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109 Cards in this Set
- Front
- Back
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When is strength training contraindicated? |
-Severe hypertension -Anyone who is receiving medications that are potentially cardiotoxic -Hypertrophic cardiomyopathy -severe pulmonary hypertension -Marfan's syndrome -Seizure disorder |
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What would you advise an athlete with uncontrolled hypertension regarding activity? |
–Aperson with uncontrolled hypertension would need to be advised againstparticipation in sports with high dynamic demand and static pressure until Blood Pressure is controlled. -Examples: Cycling,football and wrestling |
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What is a dynamic sport, its physiologic changes and give an example? |
Definition–Musclelength changes with rhythmic contractions and smallintramuscular forces generated -PhysiologicChanges: Increasedstroke volume and oxygen consumption, systolicblood pressure increases, diastolicblood pressure decreases and loweredperipheral resistance |
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What is a static sport, its physiologic changes, and give an example? |
Definition: Large intramuscular forces generated, and little change in muscle length Physiologic changes: Little change in cardiovascular parameters (oxygen consumption, stroke volume, and peripheral resistance). Both systolic and diastolic blood pressure increased |
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What is clearance with notification of the coach, trainer, or team physician? |
Allows participation of the athlete but needs special treatment on occasion (Athlete with mild to mod and well controlled asthma) |
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What is deferred clearance? |
–Suspicioussymptoms or signs indicate further workup should be conducted before clearance Example: Newheart murmur (may need echocardiogram and Cardiologist clearance) or an Individualwith recent concussion and post concussion syndrome |
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What is disqualification? |
Known condition that prohibits an athlete's participation in a given sport. Decision is not reversible |
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What is the most important part of the history, review of systems, and physical exam?
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Cardiovascular (Any positives will require more in depth evaluation)
-Note any history of cardiac murmurs -Any chest pains at rest or with exertion -Any dizziness or collapse with exertion -Syncopal episodes or sudden fatigue -SOB or recent illness with chest pain |
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An abnormality in menstrual function can be a clue to what in young females? |
Female athletic triad, pregnancy, drug abuse, psychiatric conditions, amenorrhea, eating disorders, and osteoporosis |
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What is the most common cause of death in young athletes? |
Hypertrophic cardiomyopathy |
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How is a heart murmur assessed? |
Auscultated both supine and standing in order to pick up murmurs of dynamic left ventricle outflow tract obstruction
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In the event of a head injury, what should be noted about the eyes regarding history? |
Pupil reactivity should be noted, especially aniscoria (uneven pupils). These preexisting abnormalities can be useful information at a later time in the event of a head injury |
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Explain 15 hops during a physical exam |
Do this prior to auscultating for heart murmurs. 15 hops: Assess heart rate before, immediately after and 2 minutes later. The healthy heart should return its heart rate to baseline after 2 minutes |
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If you have aortic stenosis, what are the current recommendations when participating in sports? |
Mild: <20mmHg (can participate in all sports if asymptomatic) Moderate: Limited sports Severe: No competitive sports |
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If a type 1 diabetic was to engage in vigorous exercise, what is your recommendation? |
25% reduction in insulin with 15 to 30 grams of carbs before and every 30 minutes during exercise |
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If a type 1 diabetic was to engage in strenuous exercise, what is your recommendation? |
May require 80% reduction in insulin with extra carbs |
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How long should you avoid exertion when diagnosed with mononucleois? |
–Avoidany form of exertion during the first 3 weeks after onset of symptoms –After3 weeks, if nonfebrile,symptom free, may return to light non contact activities –Generallyafter 4 weeks after symptomonsetit is safe to return to sports, if sports require increased in intraabdominalpressure, abstain from sports longer –Spleenrupture is rare 6 to 7 weeks after onset of symptoms |
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What are your recommendations for sports and hemophilia? |
Avoid contact and collision sports |
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What are your recommendations for sickle cell and sports? |
Avoid high exertion, collision, or contact sports Prevent overheating, over chilling, and dehydration |
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What are your recommendations for sickle cell trait and sports? |
No restrictions if well controlled. Avoid dehydration and acclimate to altitude. There is a known association between exercise and sudden death |
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What sports can trigger Exercised Induced Asthma (EIA)? |
Soccer, basketball, ice and field hockey, and long distance running |
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What sports lessen Exercised Induced Asthma? |
Swimming, walking, hiking, football, wrestling, gymnastics (sports with short bursts of energy) |
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What is the time period for exercise induced asthma? |
-Reachespeak 5 to 10 minutes after stopping the activity and resolves after another 20to 30 minutes -Thereis a refractory period of up to 1 hour after an EIA episode that allows for anasthma symptom free interval after warm up exercises |
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What is the gold standard for diagnosing asthma? |
Spirometry |
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What quick acting medication can help with asthma? |
Albuterol HFA 2 puffs 15 to 30 minutes before sports (will last 3 to 4 hours) |
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What other medications are helpful in controlling asthma? |
Stepwise approach: 1) Inhaled corticosteroid (Flovent, Pulmicort) 2) Leukotriene Inhibitor (Singulair) 3) Mast cell Stabilizer (Cromolyn or nedocromil before exercising) |
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What medication can you use daily if exercised induced asthma is not controlled? |
Monteleukast (singulair) |
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What is the female athlete triad? |
Anorexia, Amenorrhea, and Osteoporosis -Begins with anorexia and ends with osteoporosis -Anorexia (eating disorder, loss of body fat) -Amenorrhea (including oligomenorrhea) |
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What is the management for female's athlete triad? |
-Activeteens need to exceed their baseline caloric needs by 1,500 to 3,000 calories. -Childrenneed 60 kcal/kg of ideal body weight per day to maintain normal growth -Allyouth: Calcium 1200-1500 mg/day•Reduceexercise to 3 days/week if less than 85% ideal body weight•Ifamenorrhea has been prolonged may need estrogen/progesterone replacement |
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What is the black box warning for Depo Provera use? |
Women who use Depo-Provera contraceptive injection may lose significant bone mineral density. Consider using depo provera for long term use (longer than 2 years) only if other birth control methods are inadequate |
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How can a murmur sound in hypertropic cardiomyopathy? |
Murmur will increase in intensity with any maneuver that decreases the volume of blood in the left ventricle. -Have the patient stand or strain in the valsalva maneuver -Murmur will decrease with handgrip and squat maneuvers |
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Where is hypertrophic cardiomyopathy heard best? |
Heard best at the left parasternal border in the 4th intercostal space |
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What are the symptoms of hypertrophic cardiomyopathy? |
-Most do not have symptoms -Dyspnea (with exertion) -Chest pain (with exertion and relieved with rest) -Fainting or near fainting (syncope) with exertion -Palpitation (arrhythmias) -Sudden collapse and possible death (onset of V Tach, A fib, or other arrhythmias) |
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What does a normal murmur sound like? |
–Increases inintensity with any maneuver that increases venous return to the heart,left ventricular size and stroke volume (Squatting) -Decreases withmaneuvers that decrease volume the volume of blood in the left ventricle,reduce left ventricular size and stroke volume (standing orthe strain of Valsalvamaneuver) |
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What does a hypertrophic cardiomyopathy murmur sound like? |
-Increasesinintensity with any maneuver that decreases the volume of blood in the leftventricle (Standingand Valsalva maneuver) |
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Describe what other condition you need to rule out in regards to hypertrophic cardiomyopathy. |
–If murmur is heard softer with squatting and louder with standing then hypertrophic cardiomyopathy or mitral valve prolapse needs to be ruled out -Have patient squat and stand at least 4 times while you listen -Heard best left parasternal border 4th intercostal space |
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What is the cardiac workup for hypertrophic cardiomyopathy? |
-EKG -Echo (most common test to diagnose) -Cardiac magnetic resonance imaging (Gold standard to evaluate the left ventricular wall) -Holter monitor (24hour) -Stress test -Chest xray |
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What is the treatment of hypertrophic cardiomyopathy? |
-Medications to control arrhythmias: Beta blockers or calcium channel blockers (Verapamil) -Anticoagulants to control the risk of blood clots -Permanent pacemaker -Implanted defibrillators -Surgery |
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When is hypertension diagnosed? |
After 3 elevated BP readings on separate occasions |
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What is pre-hypertension? |
Any adolescent with BP reading of >120/80 -No exclusion from sports -No target organ disease |
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What is Stage 1 hypertension? |
Greater than the 95th percentile, but less than or equal to the 99th percentile plus 5mmhg -Excluded from sports until cleared by renal or cardiologist |
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What is Stage 2 hypertension? |
Greater than the 99th percentile plus 5mmhg -Excluded from sports until cleared by renal or cardiologist -Avoid heavy weightlifting, power lifting, body building, and high static component sports |
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What is true about grade 1 to 2 systolic murmurs? |
These are innocent murmurs and if they do not have significant cardiovascular history, they do not need further evaluation |
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Which murmurs would need further evaluation? |
Diastolic murmurs, grade 3 or greater murmurs, wide splitting of S2, clicks, and increased loudness with standing |
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When would you need to refer to cardiology? |
History of presyncope or syncope with exertion, palpitations, exertional chest pain, right ventricular dysplasia, prolapsed mitral valve, exertional SOB, family history of: marfan's, hypertrophic cardiomyopathy, prolonged QT, athersclerosis, and sudden unexpected death in someone younger than 50 years old |
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What must the athlete demonstrate prior to returning to a sport? |
-Minimal swelling or joint effusion -Pain free at full range of motion -At least 90% normal strength -Ability to perform all motions and actions for sports -Confidence in ability to do the sport |
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Who is the highest risk group for mild traumatic brain injuries? |
Infant and children (0 to 4 years) Children and young adults (5 to 24 years) Older adults (greater than 75 years) |
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What are the classic physical presentation for brain injuries? |
Headache, N/V, balance problems, visual problems, fatigue, photophobia, phonophobia, dazed and stunned |
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What are the classic cognitive presentation for brain injuries? |
Mental fog, feeling slowed down, difficulty concentrating, difficulty remembering, forgetful of recent information, confused about recent events, answers questions slowly, and repeats questions |
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What are the classic emotional presentation for brain injuries? |
Irritability, sadness, more emotional, and nervousness |
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What are the classic sleep presentation for brain injuries? |
Drowsiness, sleeping more, sleeping less, and difficulty falling asleep |
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How will infant and young children present with a brain injury? |
Frequently asymptomatic signs -Check scalp for hematoma, tenderness, or depression -Check for bulging anterior fontanel -Check for focal neurologic abnormality: weakness in left arm, paresis or plegia, focal seizures, and unsteady gait |
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What are signs of basilar skull fracture? |
-Periorbital ecchymosis -Battle's sign: Mastoid ecchymosis (fracture of the middle cranial fossa) -Hemotympanum -CSF otorrhea -CSF rhinorrhea |
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If the history of trauma is uncertain, what test can you run? |
Skull radiograph -Can do a skeletal survey in the evaluation of suspected abuse |
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What should you remember prior to ordering a CT scan of the head in children and infants? |
The estimated lifetime risk of cancer mortality from a head CT is higher for children than for adults |
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When should you order a CT scan of the head in children and infants? |
-If there is a fracture on the skull x-ray -For those at high risk for intracranial injury (skull fractures, focal neurologic findings, and depressed mental status) -Younger than 2 years old with high risk for intracranial injury or with suspected skull fracture should have a head CT |
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What are high risk signs or symptoms of an intracranial head injury? |
•Focalneurologic findings •Acuteskull fracture–Includingdepressed or basilar fracture •Depressedmental status •Irritability •Bulgingfontanel •Persistentvomiting •Seizure •Definiteloss of consciousness •Suspicionof child abuse |
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If the patient is at intermediate risk after a head injury, how should you monitor them? |
Close observation for 4 to 6 hours after the injury. Obtain imaging for any worsening condition |
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What are intermediate risk signs and symptoms? |
-Vomiting -Loss of consciousness that is uncertain or very brief -History of lethargy or irritability now resolved -Behavioral change reported by caregiver -Injury cased by high risk mechanism of injury (falling more than 3 to 4 feet, patient ejection, rollover or high impact head injury), scalp hematoma, skull fracture more than 24 hours old, unwitnessed trauma that may be significant) |
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When should you order an CT scan regarding an intermediate risk head injury? |
Presence of more than 1 of the intermediate-risk factors noted above and: -Vomiting that is delayed by several hours after injury or occurs multiple times -Large nonfrontal scalp hematomas (especially in children younger than 12 months) -Infants less than 3 months old with notrivial trauma |
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When should you not perform imaging in <2 years of age at very low risk for brain injury? |
-Normal neuro exam -No history of seizure -no persistent vomiting -no suspicion for abuse -normal skull exam -No loss of consciousness -No evidence of skull fracture -No high risk mechanisms of injury |
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When should you not perform imaging in >2 years of age? |
-Normal mental status -No loss of consciousness -No vomiting -No signs of basilar skull fracture -No severe headache -No high risk mechanism of injury |
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When should you consult neurology? |
Brain injury detected by CT scan, depressed, basilar, or widely diastatic skull fracture, and deteriorating clinical condition |
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What is a diastatic skull fracture? |
fracture causing the suture to separate |
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What are some post-concussive assessment tools? |
Heads UP, postconcussion symptoms scale, maddocks, and BESS |
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What test should you run if you suspect an intracranial bleed? Carotid dissection or stroke? and if individual has persistent symptoms? |
Suspected intracranial bleed: CT scan without contrast Carotid dissection or stroke: MRI Persistent symptoms: PET scan |
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What is a grade 1 concussion? |
-No loss of consciousness -Transient confusion or absent confusion -Duration of mental status abnormalities <30 minutes |
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What is a Grade 2 Concussion? |
-Transient confusion -Loss of consciousness <1minute -Duration of mental status abnormalities (post traumatic amnesia) >30 minutes but less than 24 hours |
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What is a Grade 3 concussion? |
Loss of consciousness for >1 minute Post traumatic amnesia >24 hours |
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Explain the 6 stages of cognitive rehab. |
Stage 1: No activity. Complete physical and cognitive rest Stage 2: Light aerobic activity. Walking, swimming, stationary cycling. No resistance Stage 3: Sport-specific exercise. Sport drills but no head impact Stage 4: Noncontact training drills. More complex drills and light resistance training Stage 5: Full contact practice. After medical clearance, can participate in normal training Stage 6: Return to play. Normal game play |
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How long should each stage of cognitive rehab last? |
-Each stage should last at least 24 hours -Stages 1 to 6 should be no less than 5 days -Repeat concussion in 1 season may result in retirement |
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What is second impact syndrome? |
-Second brain injury that occurs before symptoms of the prior head injury have resolved -Occurs while an athlete is still symptomatic from an earlier concussion -Recovery can take days to months -Can result in massive brain swelling and herniation-significant morbidity and death out of proportion to the impact of the second injury |
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When should you use car seats, booster seats, and seat belts in children and infants? |
Child safety seat until they can go in a booster seat (around 40 pounds). Continue with booster seat until the lap/shoulder belts fit properly (4''9) |
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When should you seek immediate medical attention in children? |
-Headachethat gets worse and does not go away -Weakness,numbness or decreased coordination -Repeatedvomiting or nausea -Slurredspeech -Lookvery drowsy or cannot be awakened -Haveone pupil (the black part in the middle of the eye) larger than the other -Haveconvulsions or seizures -Cannotrecognize people or places -Aregetting more and more confused, restless, or agitated -Loss of consciousness (even if brief) -Will not stop crying and cannot be consoled -Will not nurse or eat |
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What is a post-concussion syndrome? |
A symptom complex that occurs following mild traumatic brain injury. There may be both short term functional morbidity and long term cognitive and behavioral difficulties -S/S: headache, dizziness, neuropsychiatric symptoms, and cognitive impairment |
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If an athlete or parent disagrees with your recommendations, what should you do? |
•Have theparent or athlete sign an informedconsent statement acknowledging understanding of the advice and potentialdangers of participation |
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What are side effects of using androgen in men? |
Acne, impaired liver function (decreased HDL and increase in LDL, peiliosis hepatitis), major mood disorder, aggresive behavior, impotency, gynecomastia, increased estrogen, erectile dysfunction, suppresses sperm count, increased sex drive, and male pattern baldness, and tendon rupture |
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What are side effects of using androgen in women? |
–Hirsutism –Temporalhair recession in a male pattern –Clitoromegaly –Deepeningof the voice –Increasedcoarseness of the skin –Menstrualcycle irregularities –Prematureclosure of the epiphysis |
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What is the most popular non-hormonal performance enhancement besides caffeine? |
Creatine-the most popular nutritional supplement. Side effects: Weight gain, acute interstitial nephritis, with more rapid progression of chronic renal disease |
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What are the stages of sleep? |
1) Rapid eye movement sleep 2) Non-rapid eye movement sleep, which has 4 stages -Usually 4 to 5 cycles per night -Normal order: N1-N2-N3 and 4- REM |
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What is REM sleep? |
Rapid Eye movement -Occurs throughout the night increased in latter half -Muscle tone relaxed, nerve impulses to the spinal cord are blocked, body is paralyzed except for twitching -Dreaming phase -If awoken in REM phase, you are more likely to remember your dreams |
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Describe stage 3 and 4 of non-rem sleep |
-Deep sleep. Body is relaxed. Hard to arouse. -Develops during the 3 to 4 months of life -Most of bedwetting occurs during this sleep |
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How long does a neonate sleep? |
16.5 to 20 hours of sleep each day. Longest stretch is 2.5 to 4 hours |
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How long does a 3 month old sleep? |
15 hours a day |
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How long does a 6 month old sleep? |
Most can sleep through the night and have morning and afternoon naps |
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How long does a 12 month old sleep? |
13.9 hours (morning nap is given up between 12 and 24 months) |
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How long do 2 year and 6 year olds sleep? |
2 year old: Sleeps 11 to 12 hours with nap after lunch 6 years old: Sleeps 10 hours |
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When is melatonin produced in an infant? |
Established between 4 and 6 months |
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How do you promote sleep in an infant? |
–Environmentthat is dark, quiet and slightly cool –Regularschedule for waking, naps and bedtime –Trynot to rock to sleep because this will be what is expected |
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how do you promote sleep in a child? |
–Establisha bedtime routine (Bath,Brush teeth, read a book, pray) –Roomtemperature less than 75 degrees F. –Lightturned out |
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What position is recommended for the infant to sleep in? |
Use a crib All infants should sleep in a supine position Side sleeping not recommended "back to bed" |
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What is tummy time? |
-Placing baby on stomach while awake, which encourages upper body motor development -Prevents positional plagiocephaly (flat head syndrome) |
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What is positional plagiocephaly? |
Flat head syndrome -Make sure to rule out craniosynostosis -Mostly a cosmetc problem without life threatening or disabling neurological deficits |
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How is positional plagiocephaly diagnosed? |
•Basedon serial evaluations of the skull up to 1 year of age •Lookdown at the top of the head, view the position of the ears, look for symmetryof cheekbones •Assessneck movements (r/o torticollis) |
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How should you instruct parents to reduce or prevent positional plagiocephaly? |
•Alternatinginfant's sleep position (from theback to the sides and putting infants on their stomachwhen they are awake for almost 30 min a day) -Encourage tummy time may also help prevent and treat positional plagiocephaly -Reduce the time spent in thesame positionin car seat and buggies -Activerepositioningis inexpensive butneeds strictcompliance, daily and consistent involvement |
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When do you use skull-molding helmets? |
-Use when severe deformities are not responding to therapeutic physical adjustments -Helps achieve a symmetric head shape -Best response occurs between 4 and 12 months -There is little change in cranial shape when used after 12 months of age -Helmets should be worn for at least 23 hours a day for at least 2 to 6 months -Follow up weekly to ensure proper head growth |
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Describe the symptoms of obstructive sleep apnea. |
Can result in frequent sleep arousals, hypoxemia, hypoventilation Symptoms: Loud snoring, chest retractions, morning headaches, dry mouth, daytime sleepiness. -Highest peak in childhood between 2 and 6 years old |
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What is obstructive sleep apnea associated with? |
-ADHD -Cardiovascular complications -Impaired growth -Learning problems -Behavioral problems |
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When should you screen for obstructive sleep apnea? |
Any child who snores on most or all nights should be referred for diagnostic evaluation -Assess for potential symptoms of OSA including: ADHD, behavioral problems, poor school problems, cardiovascular problems (HTN), chronic sleepwalking or sleep terrors |
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What are some daytime symptoms of obstructive sleep apnea? |
Mouth breathing, hyponasal speech, morning headache, daytime sleepiness, inattentiveness, poor memory recall, and lower scores on standardized tests |
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What are some night time symptoms of obstructive sleep apnea? |
Pauses during breathing, snoring, mouth breathing, night time sweats, restless sleep, agitated sleep, and presence of nocturnal enuresis |
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What will the physical exam look like in someone with obstructive sleep apnea? (Growth, head and neck, nose and mouth) |
Growth: Obese or failure to thrive Head & Neck: Craniofacial anomalies: obstructive septal deformity, intranasal mass, macroglossia, and oropharyngeal crowding Nose: Mucosal, turbinate swelling (allergic rhinitis) Mouth: High arched mouth, narrow hard palate, cross bite, overbite, small jaw. Poor pharyngeal tone (neuromotor disease, cerebral plasy, muscular dystrophy) , tongue size, adenotonsillar hypertrophy |
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What will the cardiac physical exam look like in someone with obstructive sleep apnea? |
Cor pulmonale -Increased S2 -Pulmonary hypertension -Check for digital clubbing -Check for pectus excavatum (due to labored breathing) -RIGHT ventricular hypertrophy -Heart failure |
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What is the gold standard for obstructive sleep apnea? |
Nocturnal polysomnography is gold standard for diagnosing sleep apnea -Use if there are more than 1 obstructive apneas or hypopneas per hour of sleep and either of the following: -Periods of hypercapnia, oxygen desat associated with snoring |
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What is the first line of treatment in someone with obstructive sleep apnea? |
ENT evaluation -Tonsillectomy with or without adenoidectomy is considered first line of treatment Can do CPAP, weight loss |
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When do night terrors occur? |
Within 2 hours of falling asleep during NREM sleep and usually associated with sleepwalking |
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What will the child look like with night terrors? |
They sit up in bed screaming and thrashing about. Will exhibit rapid breathing, tachycardia, and sweating. They will have no memory of occurrence -Majority between 18 months to 6 years |
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When is sleepwalking common? |
Occurs during NREM sleep between 4 and 8 years of age. |
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What is headbanging and body rocking in children? |
Rhymthmic movement disorder Occur in 2/3 of normal children More common in males Most resolve by age 5 No intervention is necessary |
