Chapter 2 Preparticipation Examination Flashcards

Question

What encompasses the neurological examination?

Answer 1

Pupillary examination and reaction to light Cranial nerve assessment Brief sensorimotor examination of UE and LE Deep tendon reflexes Baseline concussion testing Important for sports at higher risk of concussions First: motor control (BESS), cognitive function (reaction time, ability to concentrate, delayed/working memory), mental status (LOC, ability to concentrate, time and space, overall memory function) Questions: past head injuries, LOC, amnesia, seizures, brachial plexus injuries, paresthesia, loss of sensation Seizure disorders – document onset, frequency, duration of episodes, medications: those with epilepsy should be discouraged from activities involving head trauma or falling (rock climbing, football, skiing, scuba diving, parachuting) Neurosurgeon – narrow cervical spine canal, a straightened or reversed cervical lordosis, spear tackler’s spine

Answer 2

I==> olfactory ==> smell II ==> optic ==> visual acuity/reading III ==> occulomotor ==> PEARRLA IV ==> Trochlear ==> Eye movement V ==> trigeminal ==> facial sensation VI ==> abducens ==> lateral eye movement VII ==> facial ==> smile/frown VIII ==> acoustic/ vestibulocochlear ==> hearing (snap fingers and balance) IX ==> glossopharyngeal ==> gag reflex and swallow X ==> vagus ==> gag reflex, swallow, say "ah" XI ==> spinal/accessory ==> C/s RROM XII ==> hypoglossal ==> tongue movement

Answer 3

Reflex ==> site of stimulation ==> normal response ==> nerve segment Jaw ==> mandible ==> mouth closure ==> CNV Biceps ==> biceps tendon ==> biceps contraction ==> C5-C6 Brachioradialis ==> brachioradialis tendon ==> elbow flexion and/or pronation ==> C5-C6 Triceps ==> triceps tendon ==> elbow extension ==> C7-C8 Patellar ==> quadriceps tendon ==> knee extension ==> L3-L4 Medial hamstring ==> semimembranosus tendon ==> knee flexion ==> L5-S1 Lateral hamstring ==> biceps femoris tendon ==> knee flexion ==> S1-S2 Tibialis posterior ==> tib post tendon behind medial malleolus ==> plantarflexion and inversion ==> L4-L5 Achilles ==> achilles tendon ==> plantarflexion ==> S1-S2

Answer 4

Have you ever had a head or neck injury? Have you ever been knocked out, been unconscious or been diagnosed with a concussion? Do you have frequent or repeated headaches? Have you ever had a seizure or been told you have epilepsy? Have you ever had a burner, stinger or one of your limbs feels numb or fall asleep during activity? Have you ever experienced unexplained muscle weakness?

Answer 5

More than one concussion Cervical spine instability Functional cervical spine stenosis History of frequent or repeated headaches History of seizures History of amnesia or tinnitus History of head injuries History of burners, stingers or neurapraxia History of spinal cord shock or transient quadriplegia History of nerve palsy

Answer 6

Visual acuity – Snellen or common eye charts Emmetropia – 20/20 vision Myopia – nearsightedness, light rays are focused in front of the retina making objects close to the eye distinguishable Hypermetropia – farsightedness, light rays are focused in behind the retina making objects far from the eye distinguishable Assess monocularly and binocularly Wear corrective glasses or contact lenses during exam Nystagmus – involuntary cycling of eye movement Pupil size – equal in size and shape, difference in pupil size = anisocoria Nystagmus and pupil size important if head injury occurs Glasses during activity – plastic, polycarbonate, heat-treated to prevent shattering Contact lenses during activity – soft type

Answer 7

Have you had problems with blurring or double vision? Have you ever injured your eyes or the area around your eyes? Do you wear glasses, contact lenses, or protective eyewear on a regular basis? What type? Is your vision totally or partially impaired in either eye? Are you colour blind? Do you have good peripheral vision?

Answer 8

Corrected vision greater than 20/50 Vision in one eye only May participate in sports if informed of risks, potential injury – don’t participate in activities where eyes can’t be protected Severely limited peripheral vision Severe myopia Retinal detachment or tear

Answer 9

Performed by a dentist Determine number of teeth and time of last dental examination – potential for teeth to be avulsed during participation Gum condition Presence of cavities Importance of properly fitted mouth guards

Answer 10

When did you last see a dentist? Have you ever had any problems with your teeth or gums? Have you ever experienced bleeding gums after brushing or flossing your teeth? Have you ever had any teeth knocked out, damaged or extracted? Do you wear dentures, crowns, or caps or have a partial plate? Do you wear a mouth guard? Do you smoke cigarettes or chew tobacco? Have you ever had an injury to the jaw or face?

Answer 11

Bleeding gums Lesions in the mouth Loose or displaced teeth Loose caps or crowns Dental appliances in poor condition

Answer 12

Digestive system, eating habits, nutrition Supine, lower ribs exposed to the anterosuperior iliac spines Physician palpates for tenderness, masses, or organomegaly No inflammation of liver or spleen, especially for contact sports Nutritional status – weight control sports Anorexia, bulimia, disordered eating Record 3-day food intake

Answer 13

Do you eat regularly or have a balanced diet? Do you skip meals? Are there any food groups that you predominantly eat? Do you view yourself as too thin, too fat or just right? Have you tried to control your weight? If so, how was this done? Have you ever had excessive heartburn or indigestion? Have you ever had an ulcer or vomited blood? Have you ever had mononucleosis or hepatitis? Have you ever been constipated or had diarrhea? Do you have any food allergies or sensitivities?

Answer 14

Organomegaly History of hepatitis or infectious mononucleosis History of repeated episodes of diarrhea or constipation History of gastritis or burning sensation in the stomach (ulcers) Extreme tenderness over appendix, liver or spleen Suspicion of anorexia or bulimia

Answer 15

Varies depending on sex of individual Females – menstrual history Oligomenorrhea/amenorrhea – osteopenia, stress fractures, osteoporosis Dysmenorrhea, lower abdominal pain, unusual vagina discharge, pain during urination, use of BC Oral contraceptives – alter vaginal pH, increase risk of pelvic inflammatory disease and hypertension Kidney assessment

Answer 16

Have you ever had a problem with your kidneys or genitourinary organs? Have you ever had a kidney or bladder infection? Does it hurt to urinate? Have you ever had an STD? If so, when? What medication was prescribed? Have you noticed any skin lesions on the genitalia or any vaginal or penile discharge? Have you ever been diagnosed as having sugar, albumin or blood in urine? Females: Pregnancy and menstrual cycle details? Males: Testicle details?

Answer 17

One kidney or diseased kidney Absent or undescended testicle Hernia (femoral or inguinal) Pain with urination Possible exercise-induced amenorrhea or pregnancy Endometriosis and pelvic inflammatory disease Possible STI Hematuria Albuminuria Hemoglobinuria Nephroptosis

Answer 18

Contagious lesions – herpes simplex, molluscum contagiousum, tinea capitis or corporis, furuncles, impetigo, secondary syphilis Removal from participation, identified and treated Lesions such as warts, fungal infections, contact dermatitis, psoriasis, seborrhea and nevi (birthmarks) – further evaluation but not excluded from participation

Answer 19

Have you ever had problems with acne? Have you ever had any skin rashes, itching or scaling in areas covered by clothing, equipment or footwear? Do you have any unusual blemishes that have changed in size or colour over the past year?

Answer 20

Herpes Impetigo Molluscum contagiosum Tinea capitis or corporis Furuncles Secondary syphilis Severe acne Dermatitis Warts Fungal infections psoriasis

Answer 21

Activities that take place under high temperature, high humidity History of cramping, syncope, exhaustion, heat stroke, sickle cell trait Athletes with sickle cell trait – higher risk of sustaining a sickling episode when dehydrated or in high heat stress conditions Medications being used important – impair bodies ability to release heat (antihistamines) Regular caffeine consumption – excessive caffeine intake can increase the risk for heat disorders At risk – poorly trained individuals, children, overweight or large individuals, individuals with excessive muscle mass

Answer 22

Have you ever suffered from heat illness or heat cramps? Do you have sickle cell trait? Have you ever participated in an activity in a high-temperature, high-humidity environment? Have you ever passed out or become dizzy in the heat? Do you have a heart problem, uncontrolled diabetes, hypertension or poor eating habits? Are you on any medications (diuretics, antihistamines, beta-blockers)? Do you drink more than two alcoholic or caffeinated beverages per day?

Answer 23

Cardiac diseases Uncontrolled diabetes Hypertension Drug use (amphetamines, cocaine, hallucinogens, laxatives, narcotics) Medication use (anticholinergics, diuretics, antihistamines, beta-blockers) Excessive muscle cramps during participation in heat Heat exhaustion Heat stroke

Answer 24

Not always part of PPE Urine analysis – protein, blood, glucose Costs involved and low incidence of renal pathology – not used often No evidence supports routine use of blood work – hemoglobin, hematocrit, complete blood count, blood chemistry

Answer 25

Determine whether the individual possesses the attributes, skills and abilities necessary to meet demands of the activity Identify weaknesses that may hinder performance or predispose to injury Body composition; maturation and growth; flexibility, strength, power, speed; agility, balance and reaction time; and CV endurance Test – easy to perform, measure and reproduce, inexpensive Should be standardized, controlled and repeated to see improvements

Answer 26

Anthropometry – determines individuals body type and suitability for a desired activity/sport/position Body composition – details of individual’s muscle, fat and bone mass Determine amount of weight individual may safely lose or gain Total body weight composed of non-fat or lean tissue – includes muscles, tendons, bones and connective tissue  lean body weight Hydrostatic weighting (more accurate), skinfolds (easier, faster and reliable) Most male and females – 12-17% body fat Males > 14%, females > 17% - weight-loss program or weight-training program to increase lean body mass Additional: girth measurements, bone diameter measurements, ultrasound measurements, arm radiograph measurement, computed tomographic assessment of fat

Answer 27

Developmental stage of the individual Adolescents – growth can affect performance – injury Growth spurt in girls = 12, growth sport in boys = 14 Pubertal growth accounts for 20-25% of final adult height and 50% of ideal adult weight Tanner scale – five stages Breast development and pubic hair for females Genitalia and pubic hair for males Conducted by PCP in the presence of a parent

Answer 28

Total range of motion at a joint that occurs pain-free in each of the planes of motion Most cases: less flexibility is better than too much, but certain sports require excessive flexibility Limitations: bony block, joint adhesions, muscle tightness, tight skin or an inelastic, dense scar tissue, muscle bulk, swelling, pain, presence of fat or other soft tissue, gender (female > male), dominant limb less mobile, age (dec. with age), race, genetic makeup Measure: goniometer, flexometer, tape measure Hamstrings, quadriceps, gastrocnemius, shoulder, low back

Answer 29

Hypermobile traits: Passive opposition of thumb can reach the flexor aspect of the forearm Passive hyperextension of the fingers so that they lie parallel with the extensor aspect of the forearm Ability to hyperextend the elbow/knee at least 10 degrees Excessive passive dorsiflexion of the ankle and eversion of the foot Laxity doesn’t mean hypermobility in all joints Genetic makeup or stress on joints Loose-jointed individuals – ligament sprains, dislocations, CLBP, disk prolapse, spondylolisthesis, pes planus, joint effusion, tendinitis ==> avoid stretching and focus on proper positioning, balance and strengthening Tight-jointed individuals (hypomobile) – muscle strains, nerve pinch syndromes, overstress tendinitis ==> stretch tight muscles, restore ROM

Answer 30

Strength – ability of a muscle or group of muscles to produce form in one maximal resistance (1 RM) effort, either statically or dynamically Measures: isometric, isotonic, or isokinetic testing through MMT, grip strength, sit-ups, push-ups and pull-ups – relate to activity

Answer 31

Power – ability for a muscle to produce force in a given time Measure: medicine ball throwing, vertical jump and reach, single or two-legged hop for distance and stair climbing – relate to activity

Answer 32

Speed – ability to move body mass over time Measure – timed sprints (40 m, 100 m, 400 m)

Answer 33

Agility – ability to change directions when moving at a high rate of speed

Answer 34

Balance – body’s coordinated neuromuscular response to maintain a defined position of equilibrium in response to changing visual, tactile or kinesthetic stimuli

Answer 35

Reaction time measured by the ability to respond to a stimulus Run and cut drills, carioca, shuttle runs, pivoting drills, front to back, side to side hops, figure-eight running drills, etc.

Answer 36

The body’s ability to sustain sub-maximal exercise over an extended period of time and it depends on the efficiency of the pulmonary and cardiovascular systems Selection of test depends on demands on the sport Harvard step test

Answer 37

Will the condition increase the risk of injury to the individual or other participants? Can participation be allowed if medication, rehabilitation, or protective bracing or padding is used? If so, can limited participation be allowed in the interim? If clearance is denied for a particular activity, are there other activities in which the individual can participate safely?