Daily CAQ Questions Flashcards
Question: Give 3 effects beta blockers have on the physiology of exercise
- Decrease cardiac output
- Reduce maximal HR
- Decrease VO2 max
- May induce bronchoconstriction
- Decrease lipolysis
- Decrease glycogenolysis
Question: List three effects of hyaluronic acid in osteoarthritis viscosupplementation.
- Reduction of arachidonic acid release from fibroblasts in synovial tissue
- Reduction of pain either by direct pain receptor inhibition or binding of substance P
- Suppresses production and activity of matrix-degrading enzymes
- Inhibits inflammatory cytokines
- Blocks movement of inflammatory cells that perpetuate the immune response and causes more inflammation – inhibits macrophage phagocytosis and neutrophil adherence
Question: Which of the following is not felt to improve physical performance or considered an ergogenic aid?
- Caffeine
- Creatine
- Anabolic steroids
- Alcohol
Answer: Alcohol
The ingestion of alcohol has negative effects on psychomotor skills such as reaction time, hand to eye coordination, and balance. It does not improve muscular work capacity and may actually decrease performance level, and impair temperature regulation particularly in a cold environment.
Anabolic steroids are well known to improve performance.
Creatine is felt to increase the intramuscular concentration of phosphocreatine and therefore enhance anaerobic power, speed recovery from high intensity exercise, increase muscular strength and increase lean body mass.
Caffeine can increase work and power via increased mobilization of free fatty acids, thus sparing glycogen and prolonging endurance. Caffeine also directly affects muscle contraction by potentiating calcium release from the muscle.
Which of the following is NOT a property of anabolic steroids?
A. Reverse the actions of glucocorticoids and help metabolize ingested proteins, converting a negative nitrogen balance into a positive one
B. Gives the athlete a state of euphoria and decreased fatigue that allows the athlete to train harder and longer
C. Anabolic effects increase the number of muscles in the body for larger size and strength and better performance
D. May induce hypertension, liver tumors, hirsutism, and premature closure of growth plates
E. Androgenic effects may increase or decrease libido along with other side effects like gynecomastia
Correct: C
Anabolic steroids are testosterone derivatives with three main mechanisms of action. The anticatabolic effects reverse the actions of glucocorticoids and help metabolize ingested proteins, converting a negative nitrogen balance into a positive one. The anabolic effects directly induce skeletal muscle synthesis, but they do not increase the number of muscles in the body. When muscle synthesis is increased, athletes experience better strength and performance as well as larger mass of muscles. The “steroid rush” is a state of euphoria and decreased fatigue that allows the athlete to train harder and longer.
A randomized double-blind study of 40 men examined the effects of supraphysiologic testosterone doses and compared placebo with or without weight training with testosterone doses with or without weight training. The subjects in the exercise plus testosterone group had a 9% increase in mass and 23 % increase in strength compared with 3% and 9% in the exercise plus placebo group. These doses were comparable with the doses that many athletes who use steroids take.
Adverse effects of steroids include: sexual side effects like decreased or increased libido, decreased sperm production, gynecomastia, and hirsutism; psychiatric effects like euphoria, aggression or personality disorders; and serious irreversible side effects including hypertension, severe tendon ruptures, liver tumors, psychosis, premature closure of growth plates and irreversible hirsutism and voice changes in women.
Most sports organizations have rules that ban the use of anabolic steroids for any reason.
Question: What is supposed to happen with supplementation with Bovine Colostrum?
It is supposed to increase insulin-like growth factor-1 and improve exercise performance in short burst activity
Bovine colostrum (early milk) is the initial milk produced by cows, usually obtained within the first 48 h postpartum.
It contains a rich source of nutrition, both in terms of macronutrients and micronutrients but is also abundant in bioactive components including immune, growth, and antimicrobial factors
A number of studies have sought to determine whether daily supplementation provides any benefit to exercise performance, such as potential direct effects on physical performance and/or recovery or indirect effects via improving health outcomes, protecting the gut against stressors/insult, maintaining optimal immune function, and reducing illness risk
In summary, there is some positive evidence for beneficial effects on body composition and physical performance (including recovery from demanding exercise). However, there are few studies, and sometimes potential confounding factors were not well controlled. The evidence base for this therefore remains minimal at present.
The balance of available evidence is strong for beneficial effects in protecting against exercise-induced increases in gut permeability
Question: How many bones does the navicular bone in the foot articulate with? Name them.
The Navicular bone articulates with the Talus, Cuboid and all three Cuneiform bones, totaling 5 articulations
The acetabulum pedis is another name for the talocalcaneonavicular joint and forms the subtalar articular complex along with the posterior talocalcaneal joint.
The navicular is one of the five midfoot bones and is the LAST bone in the foot to fully ossify.
A 45-year-old male presents with altered sensation on the sole of his foot and has weakness in the ability to plantarflex his ankle. Which nerve is involved in his symptoms?
A. Sural
B. Superficial peroneal
C. Deep peroneal
D. Femoral
E. Tibial
ANSWER: E
E. TRUE: The tibial nerve provides cutaneous sensation to the sole of the foot and innervates the muscles involved in plantar flexion of the foot at the ankle (the gastrocnemius and soleus). In the foot, the tibial nerve divides into medial and lateral plantar branches.
A. FALSE: The sural nerve is a sensory nerve in the leg made up of collateral branches from the tibial nerve and common fibular nerve. It has no motor function.
B and C. FALSE: The superficial and deep peroneal nerves are the two divisions of the common peroneal nerve. The superficial peroneal nerve innervates the peroneus longus and peroneus brevis muscles, as well as most the skin over the greater part of the dorsum of the foot. The deep peroneal nerve supplies muscular branches to the tibialis anterior and the extensors of the digits (which mediate dorsiflexion of the ankle and extension of the foot respectively). It provides sensory innervation to the ankle joint as well as to the webbing between the first and second digits. Damage to the deep fibular nerve, as occurs with traumatic injury to the lateral knee, results in foot drop.
D. FALSE: The femoral nerve is located more proximally. It provides motor innervation to the anterior and some of the medial compartments of the thigh. It provides cutaneous sensation to the anterior and lateral thigh via the anterior and lateral femoral cutaneous nerves, respectively.
One of the new athletes to your college lists on his health history that he takes methylphenidate (Ritalin) for his attention deficit, hyperactivity disorder (ADHD). Regarding intercollegiate athletes taking stimulant medications, which of the following is a true statement.
A. The NCAA does not ban methylphenidate (Ritalin, Concerta) or amphetamine (Adderral) because their common use for the treatment of ADHD
B. A medical exemption must be applied for and granted by the NCAA prior to athletic participation when stimulant medications are used for medical reasons
C. The NCAA requires the institution maintain, in the student-athlete’s on-campus medical record, a copy of the physician’s signed prescription for dispensing the medication
D. The NCAA requires the institution to maintain, in the student-athlete’s on-campus medical record, documentation from the prescribing physician detailing medical history, diagnosis, verification of that diagnosis through standard assessment, and dosing
E. The NCAA tests for only anabolic substances and not stimulant medications
Correct: D
The NCAA requires the institution to maintain, in the student-athlete’s on-campus medical record, documentation from the prescribing physician detailing medical history, diagnosis, verification of that diagnosis through standard assessment, and dosing information.
Amphetamine and methylphenidate are banned substances by the NCAA and the U.S. Ant-Doping Agency (Olympic committee) and these substances are included in testing programs. The NCAA provides for medical exemption of stimulant medications as long as the institution maintains documentation from the prescribing physician that the standard assessment to diagnose ADHD as been completed. This documentation would be requested by the NCAA if there is a positive sample. Currently only anabolic and peptide hormone medications require approval by the NCAA prior to participation.
Question: What are the contents of the Tarsal Tunnel?
The tarsal tunnel is bordered by the lacunate ligament superiorly, and by the plantar surface of the tarsal bones and the metatarsal heads distally.
Contents:
1. Tibialis posterior tendon
2. Flexor Digitorum Longus (FDL)
3. Flexor Hallucis Longus (FHL)
4. Posterior Tibial Artery
5. Posterior Tibial Vein
6. Posterior Tibial Nerve (L4-S3)
Tarsal tunnel syndrome sometimes referred to as tibial nerve dysfunction or posterior tibial nerve neuralgia, is an entrapment neuropathy that is associated with the compression of the posterior tibial nerve or one of its two branches, the lateral or medial plantar nerve, within the tarsal tunnel.
The posterior tibial nerve passes between the FDL and FHL muscles before it bifurcates in the tarsal tunnel, forming the medial and lateral plantar nerves.
The medial plantar nerve passes deep to the abductor hallucis and FHL muscles and provides sensation to the medial half of the foot and first 3.5 digits and motor function to the lumbricals, abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis.
The lateral plantar nerve passes directly through the abductor hallucis muscle belly and provides sensory innervation of the medial calcaneus and lateral heel and motor function to the flexor digitorum brevis, quadratus plantae, and abductor digiti minimi.
The medial calcaneal nerve typically branches off of the posterior tibial nerve proximal to the tarsal tunnel and provides sensory innervation to the posteromedial heel
Question: Which metatarsal is the most common to have a stress fracture?
Second Metatarsal
Question: What is Freiberg’s infarction?
Answer: A vascular insult to the primary growth center of the second metatarsal head. This typically occurs in the second decade of life.
Question: Give 3 physical exam cardiac auscultation maneuvers that can help distinguish hypertrophic cardiomyopathy murmurs from benign flow murmurs.
- Valsalva increases HCM murmur, Decreases flow murmur
- Standing increases HCM murmur, Decreases flow murmur
- Squatting Decreases HCM murmur, Increases Flow murmur
On the way to a recompression chamber, what is the recommended initial medical treatment?
For severe decompression illness, aggressive IV hydration is recommended.
For all cases breathing 100% oxygen by non-rebreather mask helps reabsorb nitrogen bubbles in the tissue.
Briefly differentiate type1 and type 2 decompression sickness
Type I DCS is characterized by one or a combination of the following: (1) mild pains that begin to resolve within 10 minutes of onset (niggles); (2) pruritus, or “skin bends,” that causes itching or burning sensations of the skin; and (3) cutis marmorata.
Type II decompression sickness
The following characterizes type II DCS: (1) pulmonary symptoms, (2) hypovolemic shock, or (3) nervous system involvement. Pain occurs in only about 30% of cases. Because of the anatomic complexity of the central and peripheral nervous systems, signs and symptoms are variable and diverse. Symptom onset is usually immediate but may occur up to 36 hours later.
The spinal cord is the most common site affected by type II DCS; symptoms mimic spinal cord trauma. Low back pain may start within a few minutes to hours after the dive and may progress to paresis, paralysis, paresthesia, loss of sphincter control, and girdle pain of the lower trunk. Patients with the worst outcomes (still having multiple neurological sequelae with less than 50% resolution after hyperbaric oxygen therapy) were those who had onset of symptoms within 30 minutes of surfacing.
Vertebral back pain after a dive is a poor prognostic sign and can be a hallmark of spinal DCS with anticipated poor long-term outcome.
You and your friends were out fishing in the gulf and had a great day catching mackerel and grouper. You decide to have the fish for dinner and even experiment with some sushi that used the fish. By the next day, everyone in your group is experiencing nausea and vomiting and odd neurological symptoms. The cold beer you are drinking feels incredibly hot and the hot coffee feels strangely cold as you hold the cups. What is wrong and what is the treatment?
Ciguatera fish poisoning (or ciguatera) is an illness caused by eating fish that contain toxins produced by a marine microalgae called Gambierdiscus toxicus. People who have ciguatera may experience nausea, vomiting, and neurologic symptoms such as tingling fingers or toes. They also may find that cold things feel hot and hot things feel cold. Ciguatera has no cure. Symptoms usually go away in days or weeks but can last for years. People who have ciguatera can be treated for their symptoms.
