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CASEM > High Yield 6 > Flashcards

High Yield 6 Flashcards

1
Q

What is a pulmonary contusion?

A

Syndrome following blunt chest trauma of CP + resp difficulty w/ confirmation on imaging

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2
Q

Sx of pulmonary contusion

A

Usually within hours of injury, peak at 72hrs, resolves within 1 wk
SOB, CP, hemoptysis

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3
Q

Physical for pulmonary contusion

A

Serial vitals
Palpable + pleuritic CP
Auscultation usually normal (consider hemothorax if lung sounds abnormal)
Inspect naso-oro-pharynx for bleeding
Clear C spine
Abdo exam

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4
Q

Ix for pulmonary contusion

A

peripheral infiltrate in area of trauma when significant contusion occurs:
Generally seen within 6 hr but may take up to 48 hr for radiographic changes
The infiltrate may not correlate to lobular architecture.

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5
Q

DDx for pulmonary contusion

A

Pulmonary emboli
Traumatic pneumothorax or hemothorax
Diaphragmatic, splenic, or hepatic injury
Pulmonary laceration or hematoma
Spontaneous pneumothorax
Rib fracture or contusion
Naso-oropharyngeal trauma

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6
Q

Management of pulmonary contusion

A

ABCs
C spine
Transport if SOB
O2
Condition self resolves, rest from strenuous exercise
RTP: 1-2 wks if no SOB or hemptysis

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7
Q

Complications of pulmonary contusion

A

Posttraumatic empyema
ARDS
Pneumonia

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8
Q

Prevention of pulmonary contusion

A

Protective equipment + padding
Seat restraints in motor sports

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9
Q

RF for pulmonary contusion

A

Collision/contact sports
Sports with high speeds or where the athlete is airborne:
Cycling, equestrian, winter sports, auto and motorcycle racing, extreme sports, and so forth

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10
Q

Sx of splenic trauma

A

LUQ pain, left shoulder pain

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11
Q

Physical for splenic trauma

A

vitals, postural vitals
Auscultate + palpate abdo
Cullen sign - discoloration of periumbilical area (sign of intra-abdominal bleeding)
Turner sign - discoloration of flank (sign of intra-abdominal bleeding)

Spleen exam:
Place the patient in the right lateral decubitus position, permitting gravity to anteriorly displace the spleen.
Ensure that the patient’s hips and knees are flexed to relax the abdominal muscles.
Proceed with gentle palpation during deep inspiration.
Palpation of the spleen over 2 cm below the left costal margin is an abnormal finding in adults.

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12
Q

Ix for splenic trauma

A

CBC, lytes, type + crossmatch, serial Hb
Thoracic + pelvic XR
CT abdo pelvis if stable
If unstable, FAST

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13
Q

DDx for splenic trauma

A

Rib fracture
Diaphragmatic injury
Thoracic aorta rupture
Peritonitis due to liver injury or ruptured hollow viscus
Rectus sheath hematoma
Spontaneous splenic rupture secondary to splenomegaly associated with infectious mononucleosis

Splenomegaly with rupture secondary to:
Congestion: liver disease
Infiltration: amyloidosis; hematologic malignancies such as leukemia, lymphoma, myeloproliferative disorder
Inflammation: acute or chronic such as HIV, tuberculosis, parasitic diseases
Extramedullary hematopoiesis

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14
Q

Management inc RTP of splenic trauma

A

Conservative (monitoring) vs surgical
If splenectomy, imms administered 2 wks post op
Consider abx prophylaxis
RTP - 8-10 wks

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15
Q

Complications of splenic trauma

A

Delayed rupture
Splenic pseudocyst
Overwhelming postsplenectomy infection

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16
Q

MOI + sx of renal trauma

A

MOI
Usually direct impact to abdo or flank, blow to back, fall from height or rapid deceleration

Hx - Gross hematuria

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17
Q

Physical for renal trauma

A

Vitals
Abdo exam

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18
Q

Ix for renal trauma

A

CBC, Cr, eGFR
UA
CT abdo pelvis

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19
Q

DDx for hematuria

A

Glomerular disease (post infectious, SLE, vasculitis, HUS, TTP, Alport’s syndrome, meds)
Hydronephrosis
Polycystic kidney disease
Trauma
Urethral stricture
Urogenital stones
Urogenital neoplasms
Hematologic disorders (e.g., sickle cell disease or trait, Renal artery thrombus, coagulopathies)
Connective tissue disease, inflammation
Infection (UTI, pyelonephritis)
Pregnancy
BPH
NSAIDS/Ibuprofen especially with dehydration
Pseudohematuria due to drugs (Levodopa, Nitrofurantoin, Rifampin, Septra), vegetable dyes, beets, berries

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20
Q

Management of renal trauma

A

Conservative - monitoring, bed rest til hematuria resolves
Surgery if hemodynamically unstable

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21
Q

Complications of renal trauma

A

The leading complication is extravasation of urine and infection of this urinoma

Early (acute, <1 mo):
worsening flank pain, uncontrolled bleeding, abdominal distention

Late:
Page kidney phenomenon/arterial hypertension (up to 40% of cases): extrinsic compression of renal parenchyma leading to intrarenal ischemia and activation of the renin-angiotensin system
Hypertension and renal impairment develop and can occur in native kidneys and renal allografts.
Hydronephrosis, stones, chronic pyelonephritis

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22
Q

Causes of hematuria in sport

A

Exercise induced hematuria
Trauma
Hypoxic damage to nephron

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23
Q

Hx + sx for hematuria

A

EIH is most pronounced on first void
Relation of hematuria to stream (beginning, throughout, at end)
Flank trauma or pain, frequency, urgency, nocturia, dysuria
Prior stones, UTI, vaginal or penile discharge, sexual activity, relation to menstruation
Recent sore throat
Fever, rashes, wt loss

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24
Q

Physical for hematuria

A

Usually normal exam for EIH
Vitals
Abdo + flank exam
Genitourinary exam

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25
Q

Management of hematuria associated w/ exertion + RTP

A

Step 1: If pt <40 y/o, observe + repeat UA in 48hrs
If normal, no further ix warranted
If hematuria persists, move to step 2

Step 2: urine culture, Cr, eGFR, PT, PTT, CK
If normal, move to step 3

Step 3: cystoscopy
If normal, proceed to step 4

Step 4: US or CT KUB
If normal, consider renal arteriogram or renal biopsy

RTP 48hrs if hematuria has resolved

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26
Q

Risk factors for malignancy/urologic cancer in hematuria

A

age >40 years, tobacco use, analgesic abuse, pelvic irradiation, occupational exposure to dyes or rubber compounds, constitutional symptoms (weight loss, fatigue, anorexia)

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27
Q

What is exercise induced proteinuria?

A

Transient increase in urine protein, resolves over 24-48hrs
D/t increased glomerular permeability

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28
Q

What are the 3 categories of proteinuria?

A

Glomerular:
Increased filtration of macromolecules across the glomerular capillary wall
Seen with mild-to-moderate exercise

Tubular:
Decreased resorption of filtered proteins
Seen in strenuous exercise in combination with glomerular proteinuria

Overflow:
Increased production of low-molecular-weight proteins (e.g., multiple myeloma)
Unless preexisting condition is present, not seen in exercise-induced proteinuria

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29
Q

Hx qs for exercise induced proteinuria

A

Exercise type, intensity, duration
Hx of renal dz
Hx of recent illness

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30
Q

Physical for exercise induced proteinuria

A

Signs of underlying renal dz:
Elevated blood pressure (BP)
Peripheral edema
Flank pain
Abdominal bruits

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31
Q

Ix for exercise induced proteinuria

A

UA
CBC, Cr, eGFR
If persistent, renal US

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32
Q

DDx of proteinuria

A

Orthostatic proteinuria (elevated protein when upright)
Fever
Stress
Pregnancy
Szs
Glomerular causes (e.g., minimal change disease, membranous glomerulonephritis)
Tubular causes (e.g., hypertensive nephrosclerosis)
Overflow (e.g., multiple myeloma, hemoglobinuria)
Postrenal causes in patients with inflammation of the urinary tract (e.g., urinary tract infection (UTI), nephrolithiasis, tumors)

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33
Q

Sx + hx qs for anemia

A

Symptoms: Fatigue, weakness, decrease in performance, light headedness, palpitations, SOB, pica (iron), paresthesias (B12)
Diet (vegetarian, restrictions, gluten free, meat, leafy greens)
Menstrual history in females
Blood in stool, melena, bowel habits, bloating & gas
Hematuria
Family history (Celiac, bleeding disorders)

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34
Q

Physical for anemia

A

Pallor-check conjunctiva
Flow Murmur
Tachycardia
Abdominal/rectal exam if appropriate

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35
Q

Ix for anemia

A

Fatigue work-up: CBC, ESR, ferritin, serum iron, TIBC, B12, folate, TSH, peripheral smear (optional: B-HCG, monospot, drug screen, Hep screen)
If suspect GI cause then stool for occult blood, endoscopy/colonoscopy
Celiac screen if GI symptoms or FHx: TTG
Urinalysis, C&S if hematuria
Retic count
Stools for occult blood

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36
Q

DDx of anemia

A

Microcytic:
Iron deficiency
Thalassemia
ACD

Normocytic
Iron deficiency
ACD
B12 or folate def
Drug induced
Infection
Liver dz or alcohol use
Hemolysis
Hypothyroidism

Macrocytic
B12 or folate def
Drug induced
MDS
Liver dz or alcohol use
Hypothyroidism
High retic count

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37
Q

Management of anemia

A

Treat cause! (dietician if poor diet, OCP if heavy periods, gluten free diet etc.)

Iron supplementation for iron deficiency anemia
Ferrous fumarate 300 mg OD-BID, ferrous sulphate or gluconate 300mg BID-TID, Hb should increase by 1g/dL per week. If not then check retic count
Continue therapy for at least 3 months then monitor.
IM iron can increase Hb faster but no proof that improves performance.

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38
Q

Hx qs for palpitations/ ?pSVT

A

Syncope - rest or exertion?
Associated symptoms: chest pain, dyspnea, lightheaded, n/v, diaphoresis, syncope
Symptoms of hyperthyroidism (increased energy, diarrhea, increase appetite, ophthalmopathy)
Caffeine intake
Smoking
Drug and alcohol use inc cocaine
Eating disorder
Stress
Fever
Meds: cold or flu meds inc ephedra

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39
Q

Physical for palpitations/ ?pSVT

A

Vitals
Listen to heart sounds - dynamic (supine + standing)
Peripheral pulses
Listen to chest
Check thyroid

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40
Q

Ix for palpitations

A

12 lead ECG + Holter
Echo
Exercise stress test
CBC, lytes, TSH

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41
Q

DDx for palpitations

A

Anxiety disorder, panic attacks
Angina
Costochondritis
Neurocardiogenic syncope
Heat stroke
Seizure
Thyroid dysfunction

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42
Q

Management of pSVT

A

Reassure
Avoid caffeine, alcohol, tobacco, stress
Educate re: valsalva, carotid massage
Consider ablation if symptomatic
BB are banned in some competitive sports
If symptoms controlled, no restrictions to sport participation

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43
Q

Sx of angina

A

Left shoulder pain
Relieved w/ rest
Associated sx: SOB, pre syncope, N/V, palpitations, sweating

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44
Q

Ix for angina

A

ECG
Stress test
Cholesterol, glucose

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45
Q

RF for angina

A

Smoking, cholesterol, HTN, fam hx

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46
Q

Management of angina

A

Rx
GTN

Referrals
Cardiology

FU
Go to ED if sx not resolving
FU w/ GP

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47
Q

BMI for obesity

A

> 30

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48
Q

Secondary causes of obesity

A

Hypothyroidism
Hypercortisolism
Hypothalamic dysfunction
Growth hormone deficiency
Prader-Labhart-Willi syndrome
Bardet-Biedl syndrome
Pseudohypoparathyroidism
Polycystic ovary syndrome (PCOS)
Hypogonadism
Insulinoma
Menopause

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49
Q

Primary causes of obesity

A

Socio economic factors, genetic factors, insulin resistance, poor diet, insufficient activity, insufficient sleep, associated medical illnesses, medications, smoking session, excess alcohol intake

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50
Q

Hx qs for obesity

A

Wt history
Diet
Eating patterns
Exercise
Mental health

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51
Q

Physical for obesity

A

BMI
Waist to hip ratio
Thyroid exam

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52
Q

Ix for obesity

A

CBC, fasting glucose, LFTs, lipids, TSH, T4, morning cortisol, UA, a1c
DEXA body fat composition

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53
Q

Management of obesity

A

Diet: calorie restricted/low-fat or low carb.
Reduce sugar sweetened drinks, reduce starchy foods, reduced processed grains, reduce foods with hidden sugars.
Behavioural therapy.
Medications: appetite suppressants (phentermine, liraglutide) or orlistat (pancreatic + gastric lipase inhibitor)
Bariatric surgery (gastric banding, gastric bypass, gastrectomy)

Exercise prescription
Moderate intensity 5-6 days per week, 45-60mins
Focus on large muscle group aerobic activities

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54
Q

How to manage obesity in a population (i.e. public health measures)

A

Inform and educate people, counselling and healthcare, healthy urban design, improving food and drink supply, marketing restrictions, labelling and packaging, incentives for healthy living, school meals

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55
Q

What is included in prescription

A

Physical activity recommendations - frequency, intensity, time, type
Progression
Exercise is good for mental health
Improving fitness is more important than losing weight

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56
Q

Lifestyle modifications for losing weight

A

Brisk dog walks
Take stairs
Park far away
Yard work
Cleaning w/ weights

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57
Q

Advice to prevent GI symptoms before exercise.

A

Train at least three hours after a meal
Limit fat and protein content in the meal before exercise.
Prevent dehydration eat small amounts before and during exercise.
Avoid high fibre foods prior to competition.
If pre-comp anxiety is likely cause, see sports psychologist

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58
Q

Exercise recommendations + considerations in diabetes

A

Aim to expend at least 1000 calories/ week
Progressive resistance training with lower resistance + intensity, use major muscle groups
Check sugars pre + post exercise and during if prolonged
Reduce insulin that will be acting at time of exercise
Exercise approximately 60 mins after meal
Increase carb intake pre + post exercise
Avoid injecting sites involved in activity
Wear medic alert bracelet
Educate on signs of hypoglycemia
Always have supply of fast acting glucose
Exercise with a buddy

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59
Q

Exercise recommendations + considerations in diabetic peripheral neuropathy, autonomic neuropathy + proliferative retinopathy

A

Peripheral neuropathy
Avoid trauma to feet, non wt bearing activity preferred

Autonomic neuropathy
Recommend exercise testing to document BP, HR, temp, blood sugar response
Emphasise Borg scale of rating perceived exertion

Proliferative retinopathy
Avoid activity that may increase BP >180 + avoid scuba diving

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60
Q

Exercise recommendations + considerations in HTN

A

Recommend moderate aerobic activity 2.5 hrs per week
Muscle strengthening >2 days per week once aerobic fitness has improved
Daily flexibility
Start slow, slow cool down, avoid breath holding, avoid head lower than heart exercises
Stop if feeling dizzy, sick, unwell
FU w/ doc if getting CP, palpitations, SOB, blackouts

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61
Q

Exercise recommendations + considerations in arthritis

A

Focus on functionality exercises
Repeated short bouts of low intensity activity daily
Exercise affected joints with pain free ROM
Avoid overstretching
Avoid vigorous, repetitive exercise on affected joints
Avoid morning exercise in RA

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62
Q

Exercise recommendations + considerations in peripheral vascular dz

A

Exercise stress test first

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63
Q

Exercise recommendations + considerations in osteoporosis

A

Moderate impact within limits of pain 4-5/wk
High intensity resistance training 2/wk
Balance training 4/ wk
Avoid deep forward spine flexion.
Avoid explosive movements and high impact loading + dynamic abdo exercise

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64
Q

Exercise recommendations + considerations in pulmonary dz

A

Daily exercise
Walking strongly recommended
PRT with emphasis on shoulder girdle and inspiratory and upper extremity muscles is important

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65
Q

Exercise recommendations + considerations in obesity

A

Focus on daily activity that use large muscle groups and increase total energy expenditure
Equipment modifications
Hyperthermia risk increases, emphasize importance of hydration + proper clothing

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66
Q

Exercise recommendations + considerations in cancer

A

Slower progression needed.
Maybe immune compromised so should avoid public gyms and swimming pool
Heart rate may be less reliable for monitoring intensity
Patience with lymphoedema should wear compression sleeves during resistance training
Several short of exercise may be better than one single bout
Increased risk of fractures due to bony mats
Patients undergoing radiation should avoid chlorine exposure

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67
Q

Exercise recommendations + considerations in the elderly

A

Aerobic exercise five days a week, resistance training two days a week, balance three days a week and flexibility twice a week

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68
Q

Exercise recommendations + considerations post MI

A

Check CI
Stress test + echo

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69
Q

Activity suggestions for rigidity in Parkinson’s

A

Kayaking, golfing, side bends, bow and arrow, rowing, latissimus pulldown, yoga, chest stretches

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70
Q

Activity suggestions for impaired sensory integration in Parkinson’s

A

balance on different surfaces, reduce reliance on vision and external cues stability exercises, exercises with eyes closed, exercises with head turns

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71
Q

Activity suggestions for bradykinesia in Parkinson’s

A

Walking, agility exercises, lunging

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72
Q

Activity suggestions for hypokinesia (small movements, narrow base) in Parkinson.

A

Boxing, kettlebell swings

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73
Q

Activity suggestions for akinesia (freezing) in Parkinson’s

A

Obstacle courses, quick tens in corners, lunging, boxing, kettle bell swings.

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74
Q

Activity suggestions for impaired balance.

A

Stability ball exercises, kettlebell, lunging, tai chi, boxing

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75
Q

What are important considerations for physical activity for people with MS?

A

Uhthoff’s effect can cause worsening of neurological symptoms if body temperature rises, therefore environment is important, call shower before and after, wearing cooling vest, activities are good

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76
Q

What are important considerations for physical activity for people with epilepsy?

A

Climbing, flying, hang gliding, shooting, diving, archery, skydiving and motor racing all contraindicated. Skiing, cycling and swimming or contraindicated unless under supervision.

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77
Q

What conditions is exercise contraindicated?

A

Myocarditis, cardiomyopathy, coronary artery anomalies, vascular Ehlers Danlos

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78
Q

What is PAR-Q?

A

Questionnaire for ages 15-69 to assess readiness to exercise

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79
Q

Describe the health benefits of regular physical activity?

A

Reduced risk of premature death, cardiovascular disease, stroke, high blood pressure, high cholesterol, type two diabetes, gestational diabetes, metabolic syndrome, depression and anxiety.
Reduced risk of bladder, breast, colon, endometrial, esophageal, renal and gastric cancer
Prevention of weight gain, decreased pain improved physical function in arthritis, prevention of fools, improve cognitive function, improve to sleep quality, lower risk of hip fracture and lung cancer, increased bone mineral density

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80
Q

What are the risks with physical activity?

A

MSK injuries including strains, tears, fractures, tended of these, dislocations and bursitis.
Rhabdomyolysis, acute M.I, malignant arrhythmias, sudden cardiac death.
Exercise induced bronchoconstriction.
Heat stroke, dehydration.

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81
Q

What are the five A’s of behaviour change?

A

Assess, advise, agree, assist, arrange.

82
Q

Describe resistance exercises by body region.

A

Chest and shoulders: push-up, bench press, overhead press
Back: pull up or chin up, latissimus pulldown, bent over row
Core: plank, side plank, bicycle crunch
Arms: arm, tricep pull down
Lower body: squats, dead left, seated leg press, side leg raise, car raise

83
Q

Describe the WHO recommendations for physical activity

A

150 minutes of moderate intensity aerobic activity through the week.
Aerobic activity should be in about at least 10 minutes.
Muscle strengthening activities involving major muscle groups on two or more days a week.
Adults over 65 with poor mobility should perform activity on three or more days a week to enhance balance and prevent falls

84
Q

How can intensity be measured?

A

Rating of perceived exertion (RPE)
Heart rate
Oxygen consumption (VO2 max)

85
Q

Strategies to minimise sedentary behaviour.

A

Reduce all forms of screen time.
When using a screen, schedule five minute breaks every 45 minutes to go for a walk during TV ads, perform exercises.
Only watch TV when on a stationary bike or treadmill
Walk to work
Park further away
Take the stairs
Standing desk

86
Q

What are the barriers to physical activity?

A

Physical ailments or chronic conditions
Fear of becoming injured.
Lack of time.
Lack of knowledge
Self-consciousness.
Low social economic factors
Lonely safety
Poor weather
Lack of walking and cycling networks
Lack of open public greenspaces
Financial costs
Transport
Lack of availability or access to physical activity programs
Lack of motivation
Low self efficacy

87
Q

Sx of pneumothorax

A

SOB
Localised chest pain, worse w/ deep inspiration - may radiate to neck, back, shoulder or abdo
May be asymptomatic

88
Q

Physical for pneumothorax

A

Decreased/ absent breath sounds on affected side
Decreased tactile fremitus
Unequal expansion of chest w/ inspiration
Hyperresonance to percussin SC emphysema
Tension pneumothorax: distended neck veins, displacement of cardiac apex beat to non affected side, deviation of trachea to non affected side

89
Q

RF for pneumothorax

A

Tall, thin, young, males
Smoking
Substance use (heroin, ecztasy, marijuana, cocaine)
Underlying lung dz (COPD, CF, TB)
Connective tissue disorder (Marfans)
Trauma (commonly first 4 and last 2 rib #, multiple rib #, flail segments, scapular #)

90
Q

Ix for pneumothorax

A

CXR - upright PA + lateral chest films
White visceral pleural line seen
Rib XRs
ECG - right axis deviation, decreased QRS amplitude, precordial T wave inversion

91
Q

DDx for pneumothorax

A

Lung contusion
Costochondral separation
Muscle strain
#

92
Q

Management of pneumothorax

A

Support ABCs
O2
Semi-Fowler position
Needle decompression w/ 18G into 2nd IC space at midclavicular line
If small, no chest tube needed - just monitor for min 6 hrs, FU CXR in 12-48 hrs

If large, pleural aspiration
If this fails, or if pt unstable, insert chest tube (16-22Fr)
Use lidocaine

If hemothorax, insert chest tube
VATS indications:
If pleural aspiration fails
Recurrent primary spontaneous pneumothorax after chest tube insertion

93
Q

Air travel recommendations in pneumothorax

A

CI in presence of acute, unresolved pneumothorax
No travel for 2-3 wks after radiographic resolution of pneumothorax

94
Q

RTP after pneumothorax

A

3-6 wks

95
Q

Prevention of recurrent pneumothorax

A

avoid scuba, contact sports + trauma

96
Q

What is athletic heart syndrome?

A

Benign condition of physiologic adaptation d/t increased cardiac workload

97
Q

Physical exam findings in athletic heart syndrome?

A

Bradycardia, midsystolic murmurs which resolve w/ valsalva, 3rd + 4th HS

98
Q

ECG findings in athletic heart syndrome?

A

Sinus brady

Early repolarization:
J-point elevation, ST elevation, J waves, or terminal QRS slurring in the inferior and/or lateral leads
Normal when present in isolation

Juvenile T wave inversion in leads V1-3

Sinus arrhythmia:
Physiologic heart rate variation associated with respirations (increased with inspiration; decreased with expiration)
Resolves with onset of exercise

Junctional escape rhythm:
QRS rate faster than resting P wave
Regular R-R interval
Sinus rhythm should resume with activity.

1st degree or Mobitz 1 2nd degree AV block present at rest
Increased QRS voltage (LV hypertrophy)
Incomplete RBBB

99
Q

Echo + CXR findings in athletic heart syndrome?

A

Echo findings
Biventricular hypertrophy

CXR findings
Cardiomegaly
Globular appearance
Increased pulmonary vascular markings

100
Q

What are borderline ECG findings?

A

Left axis deviation
Left atrial enlargement
Right axis deviation
Right atrial enlargement
Complete RBBB

101
Q

What should you do with borderline ECG findings?

A

In isolation, no need for further evaluation.
Two or more, further evaluation needed

102
Q

Possible cardiac causes and evaluation needed for syncope or presyncope during exercise?

A

Cardiomyopathy, congenital coronary artery anomalies, ion channel disorders (eg Brugada)
ECG, echo, stress test, consider cardiac MRI

103
Q

Possible cardiac causes and evaluation needed for exertional chest pain?

A

Coronary artery arthrosclerosis, congenital coronary artery anomalies, cardiomyopathy
ECG, echo, stress test, consider cardiac MRI

104
Q

Possible cardiac causes and evaluation needed for palpitations?

A

SVT, ventricular arrhythmias, premature atrial and ventricular contractions, sinus tachycardia, cardiomyopathy, ion channel disorders
ECG, echo, stress test

105
Q

Possible cardiac causes and evaluation needed for excessive SOBOE?

A

Cardiomyopathy, myocarditis
ECG, echo, stress test, consider pulmonary function testing

106
Q

Preferred anti-hypertensive in athletes?

A

ACE inhibitors

107
Q

Describe vocal cord dysfunction symptoms

A

Throat tightness, choking, SOB, cough, wheeze, worse during exercise resolves after five minutes. Inspiratoire stridor
No sx outside of exercise

108
Q

Evaluation + management of vocal cord dysfunction

A

Laryngoscopy
Treat underlying causes eg laryngeal polyps
Speech therapy

109
Q

RF for septic arthritis

A

Recent joint injection or surgery
Trauma
RA
OA
Joint replacement
IVDU
Intravascular devices
STI risk
Diabetes, immunocompromised
Young or old

110
Q

Sx + hx qs for septic arthritis

A

Rapid onset for arthritis but can be insidious w/ bursitis
Knee > hip > shoulder, ankle, wrist, elbow
Fever/ chills
Recent infection elsewhere (URTI, UTI, strep throat, PNA, STD, diarrhea)

111
Q

Physical for septic arthritis

A

Hip held in flexed + externally rotated position
Febrile, tachycardic
Warm, swollen joint
Reduced ROM
Pain

112
Q

Ix for septic arthritis

A

Blood culture, CBC, CRP, uric acid, blood glucose
Aspirate for gram stain, culture, leuks, glucose, crystals. PCR if ?lyme dz

113
Q

DDx for septic arthritis

A

Cellulitis
Allergic reaction to injection
Reactive synovitis
Gout
Pseudogout
RA
Osteomyelitis
Lyme disease

114
Q

Management of septic arthritis

A

Admit
Empiric broad spectrum abx (ceftriaxone if gram negative, vancomycin if gram positive)
4 wks
Assess therapeutic response w/ serial synovial fluid analysis

115
Q

Complications of septic arthritis

A

Death
Impaired joint function
Septic necrosis
Ankylosis
Osteomyelitis

116
Q

How to do subacromial aspiration

A

Clean skin
Freeze w/ lidocaine (25G needle)
Find the posterior tip of the acromion and insert 18G needle about 1 cm below that landmark
Completely advance the needle in a perpendicular direction under the acromion, aiming in a slightly cephalad direction

117
Q

Synovial fluid interpretation

A

Normal
Transparent, clear
WBC <50 / <200
<25% polymorphonuclear leukocytes
Negative culture
Glucose similar to serum

Noninflammatory
Transparent, yellow
WBC 50-1000 / 200-300
<25% polymorphonuclear leukocytes
Negative culture
Glucose similar to serum

Inflammatory
Translucent to opaque
Yellow to opalescent
WBC 1000-75,000 / 300-50,000
>50% polymorphonuclear leukocytes
Negative culture
Lower than serum

Purulent
Opaque
Yellow to green
WBC >75,000 / >50,000
>75% polymorphonuclear leukocytes
Positive culture
Much lower than serum

Hemorrhagic

118
Q

RF for osteomyelitis

A

Open or compound fracture
Surgical manipulation (orthopedic, colorectal, genitourinary procedures)
Intravenous (IV) drug abuse
Immunosuppression (AIDS, chronic steroid use)
Peripheral vascular disease/peripheral neuropathy (diabetes mellitus)
Sickle cell disease
Genitourinary or biliary tract infection
Chronic joint disease
Presence of prosthetic orthopedic device
Low socioeconomic status
Infancy
Elderly
Alcoholism
History of tuberculosis (Pott disease)

119
Q

Sx of osteomyelitis

A

Fever, chills, fatigue
Restricted ROM, pain, edema
Limp
Ulcers

120
Q

Physical for osteomyelitis

A

Fever (temperature >100.4°F) but not always present
Tenderness to palpation, swelling, erythema, warmth over involved area
Fluctuance
Decreased use of extremity, refusal to bear weight
Limited movement of adjacent joint

121
Q

Ix for osteomyelitis

A

CBC, CRP, ESR
Blood culture
Bone biopsy - gram stain, culture
XR - osseous changes appear 2 wks after sx onset
MRI if <2 wks sx

122
Q

DDx for osteomyelitis

A

Acute leukemia
Acute rheumatic fever
Rheumatoid arthritis (adult or juvenile)
Acute gout, pseudogout
Cellulitis
Malignant bone tumors (Ewing sarcoma, osteosarcoma)
Septic arthritis
Multiple myeloma (elderly)
Sepsis
Deep vein thrombosis, thrombophlebitis
Intervertebral disk disorders
Fracture
Aseptic bone infarction
Neuropathic joint disease (Charcot arthropathy)
Transient synovitis

123
Q

Management of osteomyelitis

A

Empiric abx - vancomycin + ciprofloxacin
Duration
Kids - 4 days IV then 4 wks PO
Adults - 6 wks IV - can then do PO for 3-4mo if hardware is infected
Surgery if abx fail or infected surgical hardware
Hyperbaric oxygen may be helpful
Immobilization of affected part

124
Q

Complications of osteomyelitis

A

Include bone abscess, bacteremia, fracture, loosening of hardware, overlying cellulitis, and draining soft tissue tracts.

Sinus tract formation may be associated with neoplasms, especially with long-standing infection:
Squamous cell carcinoma (Marjolin ulcer) most common tumor associated with chronic osteomyelitis

Recurrence

125
Q

Cause of mono

A

Epstein Barr virus

126
Q

Sx of mono + hx qs to ask

A

Prodrome of malaise, fatigue
Sore throat, fever, lymphadenopathy
HA
LLQ pain
Infectious contacts

127
Q

Physical for mono

A

Fever
HEENT
Exudative pharyngitis
Enlarged cervical, axillary, inguinal lymph nodes
Palatal petechiae
Periorbital edema
Hepatomegaly, percussion tenderness common
Splenomegaly

128
Q

Ix for mono

A

Labs - CBC, liver function
>50% lymphocytes
10% atypical lymphocytes
Mono spot - repeat 1 wk later - if negative but strongly suspicious, do IgM ab to EBV
Throat C+S
US abdo for spleen size

129
Q

DDx for mono

A

Primarily must be differentiated from nonspecific viral syndromes, lymphoma, leukemia, and Streptococcus pharyngitis.
Concomitant Streptococcus infection is not uncommon.
Many infectious agents may cause mononucleosis-like syndromes: cytomegalovirus, adenovirus, hepatitis A, human herpesvirus 6, HIV, rubella, toxoplasmosis.
Medications causing mononucleosis-like syndromes: phenytoin, sulfa drugs

130
Q

Management of mono (exc RTP)

A

Supportive
Prednisone if impending airway obstruction from ++ tonsils, or enlarged spleen, myocarditis or hemolytic anemia
Avoid alcohol
Infectious precautions
Discuss splenic rupture sx
Avoid amox - gives rash

131
Q

RTP for mono

A

As soon as asymptomatic for light, non contact sport (usually 3 wks)
1mo for contact unless splenomegaly evident or ongoing sx, consider US at 1mo before RTP
<12cm normal spleen size
Spleen to kidney ratio should be <1.25

132
Q

Complications of mono

A

Airway obstruction
PNA
Szs, meningoencephalitis
GBS
Hemolytic anemia, thrombocytopenia
Bacteremia
Hepatitis
Splenic rupture

133
Q

Ix for traveler’s diarrhea

A

Stool cultures
Peripheral blood smear

134
Q

Management of traveler’s diarrhea

A

If <5% dehydration - give oral rehydration
If >5% dehydration - IV NS
Ciprofloxacin 500mg PO BID x3/7 OR azithromycin 1000mg PO x 1 dose
Imodium (consider for comp)
Pepto bismol

135
Q

Prevention of traveler’s diarrhea

A

Pepto bismol 2 tabs at meals + 2 tabs QHS - take while on trip - reduces risk by 65%
SE: darkening of stool + tongue
Don’t take longer than 4 wks
Interferes w/ doxycycline (used as a malaria prophylaxis - stagger meds)

136
Q

Management of bleeding during play

A

Leave playing field, only return once given medical clearance (bleeding controlled, lacerations covered)
Uniform should be disinfected or changed if bloody

137
Q

RTP for hep B

A

Acute infection (fatigue, fever) - remove from play
Remove from close combat sports until loss of infectivity known (HBV antigen - can last up to 20 wks)
HBAg + - remove athlete indefinitely from contact sport

138
Q

Recommendations to minimise transmission of blood infections

A

Hepatitis B vaccine
Clean dressing rooms
Washing soiled clothing, equipment, and services
Avoid sharing towels and drinks
Manage cuts and abrasions
No sharing of razors and toothbrushes
Cover broken skin
Wear disposable gloves when coming in contact with blood

139
Q

Advice to athletes to reduce infections

A

Keep stresses to a minimum
Well balanced diet
Avoid over training
Adequate sleep
Avoid rapid wt loss
Keep hands away from eyes + nose
Avoid sick contacts
Moderate training decreases risk but intense training increases risk

140
Q

What causes herpes gladitorum?

A

HSV 1 + 2

141
Q

RF for herpes gladitorum

A

Abrasions or physical trauma increase the likelihood of acquiring infection.
Physical and mental stressors (i.e., weight loss, sleep deprivation, competition, school responsibilities) may increase likelihood of recurrence.
Close skin contact sports like wrestling

142
Q

Sx of herpes gladitorum

A

Prodrome of burning, stinging, itching then clusters of vesicles
Can get fever, lymphadenopathy, malaise, pharyngitis w/ initial episodes

143
Q

Ix for herpes gladitorum

A

Viral culture or Tzanck smear
PCR is gold standard

144
Q

DDx for herpes gladitorum

A

Impetigo
Herpes zoster
Folliculitis
Allergic or contact dermatitis
Tinea gladiatorum
Cellulitis

145
Q

Management of acute herpes gladitorum

A

Acyclovir 200 mg 5 times a day or 400 mg TID for 10 days
Valacyclovir 1 g BID for 10 days
During the ulcer stage, benzoyl peroxide and use of a hair dryer can help dry crusts more rapidly and minimize secondary bacterial infections.

146
Q

RTP for herpes gladitorum

A

Scabbed over, no discharge, no evidence of secondary bacterial infection
No new lesions in 48-72hrs
No lymph node swelling in affected area
Primary episode - should be treated for 5-10 days, 14 days if systemic sx present
Recurrent episode - should be treated for 5 days

147
Q

Prevention of herpes gladitorum

A

Isolate infected wrestler to prevent skin contact with other wrestlers (control outbreaks among previously infected wrestlers).
Regular wrestling matt cleaning and general hygiene (e.g., avoid sharing towels, soap, razors)
Consider using prophylactic antiviral medications during the season or before competition
Acyclovir 200 mg BID
Valacyclovir 500 mg or 1 g daily
Famciclovir 250 mg BID
Teach skin hygiene (e.g., showering after activity), and protect other skin abrasions from secondary contact.
Educate athletes on how to identify lesions/recurrence, and seek early treatment

148
Q

Types + differences for impetigo

A

bullous + non bullous

Bullous
Caused by epidermolytic toxin from S. aureus
Favors intertriginous areas
Is a localized form of scalded skin syndrome
Starts as a vesicular eruption that develops into bullae and then may rupture to form honey crusts

Non bullous
more contagious
Caused by S. aureus and group A β-hemolytic streptococcus (GAS)
Starts as macules or papules and progresses to vesicular eruption, which rupture to form erosions with honey crusts

149
Q

RF for impetigo

A

Abrasions or cuts
Sweat or water soaked clothes
Poor hygiene

150
Q

Prevention of impetigo

A

Avoid sharing equipment, towels, tape, and ointments.
Avoid dispensing ointments from common containers.
Clean equipment and clothes daily.
Shower immediately after sports activity with antibacterial soap.
Avoid communal hot tubs.
Wear moisture-wicking, synthetic clothing.
Discourage body shaving in contact sports.
Frequent skin checks by athletic trainers and athletes in contact sports
Frequent handwashing by athletic trainers and affected athletes
Cover any injured skin immediately.
Use topical triple antibiotic for skin wounds

151
Q

Sx of impetigo (for both types)

A

Bullous:
Starts with superficial vesicles, which progress to flaccid bullae without surrounding erythema
When the bullae rupture, they ooze and create honey-colored crusts.
Self-limited and may spontaneously resolve in weeks if left untreated

Nonbullous:
Starts as a single macule or papule that develops into a vesicle
Vesicle may rupture and form an erosion, and the contents become honey-colored crusts that are often pruritic.
May spontaneously resolve without scarring if left untreated for weeks

152
Q

Management of impetigo

A

Soak affected skin in warm water for 5 to 10 min 3 times daily until cleared.
Gently remove honey-colored crusts to improve antibiotic penetration.
Topical mupirocin BID x5
If widespread, add amox-clav or keflex x7/7
If MRSA, clindamycin x7/7

153
Q

RTP for wrestling for impetigo

A

Oral abx x72hrs
No new lesions for 48hrs
No moist or exudative lesions

154
Q

Complications of impetigo

A

Poststreptococcal glomerulonephritis up to 3 wk after skin infection:
Occurs in 20% of nonbullous-type impetigo
Risk not decreased with antibiotic treatment
Hyperpigmented area after healed lesions mostly in dark-skinned athletes
Cellulitis
Lymphangitis
Guttate psoriasis
Toxic shock syndrome
Staphylococcal scalded skin syndrome
Sepsis
Osteomyelitis
Pneumonia

155
Q

RTP + management of carbuncles, abscess, folliculitis etc for wrestling for

A

RTP: 72 hrs of treatment, 48 hrs of no new lesions
Carbuncle/ abscess - needs I+D

156
Q

RTP for contact sports + management of molluscum

A

Watchful waiting - usually resolve within 6-12mo
Can use LN2, curettage, salicylic acid
Wait 24hrs after lesions resolve to compete in contact sports

157
Q

Rx + RTP for tinea pedis

A

Rx w/ topical terbinafine 1% BID x1 wk
If severe or extensive, oral terbinafine 250mg daily x2-6 wks
No limits for RTP
Educate re footwear in showers, drying, don’t share towels

158
Q

Rx + RTP for tinea corporis

A

Rx w/ topical clotrimazole 1% or terbinafine 1% BID x2-4 wks
oral/topical antifungal tx x 72 hrs on skin

159
Q

Rx + RTP for tinea capitis

A

Terbinafine 250mg PO daily x2-4 wks
oral/topical antifungal tx x 14 days on scalp

160
Q

Rx + RTP for tinea cruris

A

Jock itch
Rx w/ topical clotrimazole 1% or terbinafine 1% BID x2-4 wks
oral/topical antifungal tx x 72 hrs on skin
If coverable, and under treatment, can participate earlier

161
Q

RTP for Hiradenitis suppurativa in wrestling

A

No extensive or purulent draining lesions, covering not permissible

161
Q

RTP for verruca

A

If cannot be covered, cannot wrestle
Solitary or scattered lesions can be curetted prior - no seeping

162
Q

Management of closed blister + open blister

A

drain fluid w/ needle + syringe, inject space w/ diluted betadine, leave until stinging stops then drain betadine. Create foam donut and place around blister, cover hole in middle w/ 2nd skin, secure dressing w/ tape

Management of open blister
Clean, dry, leave open when not training, offload w/ foam donut when training

163
Q

What should be included in a pre season medical?

A

Family history
Screen for RED-S
Screen for CV dz (syncope, palpitations, signs of marfans)
Provide education, counselling, intervention for general wellness and injury prevention

164
Q

What are training related ECG changes?

A

Early repolarisation
Incomplete RBBB
Sinus bradycardia
First degree AV block
Voltage criteria for LVH

165
Q

What are the issues with screening ECGs?

A

High false positive rate
Lack of qualified interpreters of young athlete ECGs

166
Q

What to include when making travel plans as a team doc

A

Athletes + staff
PMH
Injuries
Illnesses
Allergies - epi pen
Med list
Ensure no banned substances
Meds in original bottles
Immunisations
Dental check up
Medic alert bracelets
Passport expiry dates
Visa requirements
Medical insurance
Emergency contacts

Food + water
Avoid uncooked foods, unpeeled veggies, street food, unpasteurised dairy
Bottled water only
Avoid ice cubs
Wash hands w/ alcohol gel

Hygiene + infection control
No fresh water swimming
Walk in shower w/ sandals
Mosquito repellant, long sleeve shirts
No contact w/ animals

General Advice
Sun protection
No tattoos
Safe sex, condoms

Doc + supplies
Malpractice insurance
Contact host medical, embassy, hospitals, physicians
Disaster planning
Transfer of care/ medical records
Forms (Wada list, TUE, rx pad, encounter notes, SCAT6)
Jet lag
Sleep
Nutrition
Acclimatisation

Travel
Hydration
illness prevention

Med bag
Cover letter for medical kit
Prophylaxis meds (malaria, altitude, travels diarrhea, probiotics, STIs)
Be familiar with medical kit

Post trip
Check in re illness

167
Q

What immunisations are recommended for travel

A

MMR
TdaP
Varicella
Hep B
Hep A
Meningococcal
HPV
BCG
Cholera
Japanese encephalitis
Rabies
Tick borne encephalitis
Influenza
Post splenectomy - add:
Pneumovax
HiB

168
Q

What factors should you think about when making travel plans

A

Location
Urban/ rural, domestic/ international
Proximity to local medical resources
Medical conditions (malaria, zika)
EAP for each venue

Customs/ regulations/ culture
Different anti doping rules
Language

Environment
Climate, altitude

Sport
Athletes, gender, age, support staff

Communication
Between athletes + staff
SIM card/ internet access

169
Q

What should be included when thinking about event planning?

A

Who
Athletes
Numbers
Skill level
Ages
Prior information
Crowd
Numbers
Seated or mobile
Medical care
Staff
Roles
Medical
AT, chiro, PT, RMT, ED doc, sports med doc
Notify ED dept
Credentials
Attire
What
Sport
Type of event
Most common type of injury
Duration of event
Where
Venue
Med room, change rooms
AED location
Meal areas
Fenced or unfenced, access points
Paramedics, access points + exit, aid stations
Medical
Local ED
Environment
Weather - temp, humidity
Altitude, water, terrain

How
Procedures:
Roles
Call, charge, control
Scope of care
When to send for further care
Location of medical staff
Record keeping
Orientation
Practice scenarios
EAP
Transportation
Weather, appropriate vehicle, monitoring during transport, medical personnel on transport

Equipment + supplies

Communication
radios, phones
Universal signs

Mitigate risks
Ensure adequate access to water for athletes + spectators and communication strategy to stay hydrated
Prevent exposure w/ water sprinklers, shade, advisories to wear a hat, blankets, heated areas
Identify and fence off hazards, guide pedestrian flow to safer areas, adequate lighting, signage, ensure no overload of structures
Worst possible scenario
Disaster planning

170
Q

What are the universal signs?

A

Arms crossed over chest - no help needed
1 arm raised straight in air - require extra assistance
2 arms raised + crossed overhead - activate EAP, require EMS

171
Q

What equipment + supplies are needed for events?

A

General: chairs, tables, exam beds, stretchers, garbage, toilets, sheets, towels, curtains/dividers, disinfectant, gloves, masks, gowns, computer, paper/pens for documentation
Diagnostics: stethoscope, BP cuff, O2 sat, POC glucose, POC Na, ophthalmoscope, otoscope, rectal thermometer
Emergency: oral airways, resuscitation masks, AED, O2 tank and equipment, spinal board, ice water tub, water, ice, IV equipment, IV fluid (NS, 3-5% hypertonic solution, D50), glucose, electrolyte drinks, drinking cups, urine dipsticks, blankets
Medications: epi 1:1000, dexamethasone, dextrose 50% (D50), cardiac meds (atropine, lidocaine), local anesthetic (xylocaine); salbutamol; ASA, APAP, NSAID, nitroglycerine, loperamide, antihistamine; lubricant for chafing, proparacaine (eye)
Wound care: gauze, bandaids, tensors, tape, slings, disinfectant, splints, suture kits, syringes, needles, scalpel, scissors, eye pads, dental kit

172
Q

What should be included in an EAP and when to activate it

A

Transportion from venue to medical facility
Map of facility inc exits + access points, AED location, location of staff
Addresses of facilities nearby
Contact phone numbers, radio channels
Call (calls 911, calls venue organizers, calls ahead to ED, calls athlete emergency contact), charge (enters field of play, in charge of medical care) + control person (controls crow, clears pathway for EMS)
Identify + list emergency equipment + roles
GPS coordinates for helicopter
When to activate EAP?
If athlete not breathing, no pulse, bleeding profusely, impaired consciousness, injured neck, back or head or visible major trauma to limb

173
Q

How to reduce the risk in open water swimming

A

Mandate a maximum group size
Regulate the start line/course with
Time the gaps between waves
Consider the number and visibility of boys
Consider straight line distance before requiring swimmers to take a turn, allowing them to spread out
Ask swimmers to select into waves of appropriate ability
Facilitate a climatisation and anxiety reduction, including pre-race immersion
Increase the amount of cover in the first part of the swim

174
Q

Considerations for organising events in the heat

A

Adapt schedule (early AM or late PM)
Communicate information to athletes about the weather and how to prepare
Event modification in case of extreme environmental conditions (extra breaks, reduced climbing/ distance)

175
Q

What is the criteria for a substance to be banned?

A

2 out of 3:
Potential to enhance performance.
Potential to be detrimental to health
Violate the spirit of sport

176
Q

What are the criteria for a therapy to be medically justified?

A

Pt requires it to stay healthy
No reasonable alternatives
Pt will not surpass a normal state of health

177
Q

What are the types of violations?

A

Presence of a substance
Use of a substance
Evading or reducing
Whereabouts failures
Tampering
Possession
Trafficking
Administration
Complicity
Prohibited association

178
Q

What are the sanctions?

A

Suspension for 2-4 yrs to life

179
Q

What is on the prohibited list?

A

Substances and methods prohibited at all times, in and out of competition
Nonapproved substances, anabolic agents, peptide hormones, growth factors, beta 2 agonists, hormone and metabolic modulators, diuretics and masking agents

Prohibited methods (in + out of comp)
Manipulation of blood and blood components, chemical and physical manipulation, gene doping

Prohibited classes of substances (in comp only)
Stimulants, narcotics, cannabinoids, glucocorticosteroids

Substances prohibited in particular sports
beta blockers

180
Q

Benefits + SE of EPO

A

Increased endurance, increased blood viscosity, MI

181
Q

Benefits + SE of Human growth hormone

A

possible increased growth, allergic reactions, acromegaly

182
Q

Benefits + SE of beta 2 agonists

A

Possible anabolic effects, tachycardia, tremor, palpitations

183
Q

Benefits + SE of Diuretics

A

Rapid weight loss, decreases concentration of drugs in urine
Electrolyte imbalance, dehydration, muscle cramps

184
Q

Benefits + SE of Stimulants

A

Increased alertness, improved performance
Anxiety, insomnia, hypertension, arrhythmias

185
Q

Benefits + SE of blood doping

A

Improved endurance, transfusion reaction, increase blood viscosity

186
Q

What stimulants are banned?

A

ADHD meds, ephedrine, epinephrine, cocaine

187
Q

What qs to ask in a hx when someone is using ergogenic aids or has qs about them

A

Training - duration, results, goals
Diet - food groups, calories
Meds + supplements
Prior steroid use

188
Q

Benefit vs adverse effects of steroids

A

Benefits - increase wt, muscle bulk, psychological
Adverse
Performance
Short term - acne, aggression, HTN, high cholesterol, arrhythmias, infertility, cost
Long term - carcinogenic, cardiovascular issues

189
Q

What steroids are banned + what are the limits to use?

A

Systemic use prohibited - IM/IV/PO/rectal (rectally inserted hemorrhoid cream or suppository)
Topical use allowed (derm or hemorrhoidal), local intra-articular injection allowed

Inhaled allowed for asthma but daily max limit
Symbicort, advair, combivent, serevent - max 200mcg/ 24hrs
Singulair (montelukast) not prohibited

190
Q

What are the restrictions on beta agonists + what are the exceptions?

A

LABA/ SABAs
All are banned at all times
Exceptions for inhaled salbutamol (1600mcg/ 24hr, not to exceed 800mcg/ 12 hrs) - 1 puff inhaler = 100mcg - 1 puff diskus = 200mcg
Formoterol - max 54mcg/ 24hrs
Salmeterol - 200mcg/ 24hrs

191
Q

What are the IV fluid rules?

A

IV infusion >50ml in any 6hr period are prohibited unless:
Used legitimately during hospital admission, surgical procedure or approved clinical investigation
Prohibited at all times, in and out of competition

192
Q

What sports ban beta blockers?

A

In + out of competition
Archery
Shooting

In competition
Ski jumping, freestyle, snowboard halfpipe + big air
Automobile
Billiards
Darts
Golf
Underwater sports (spearfishing, target shooting)

193
Q

What is the athlete biological passport?

A

To monitor selected biological variables over time that indirectly reveal effects of doping
Hematological modules - profile of haem variables for detection of blood doping
Steroidal modules - urinary steroid concentrations over time

194
Q

What is information vs intelligence?

A

Information = knowledge in raw form
Intelligence = information plus analysis

195
Q

What is ADAMS?

A

Anti doping administration + management systems
Monitor athlete’s whereabouts, biological passport, competition schedules, TUEs, prior tests

196
Q

When is EtOH prohibited?

A

In competition for air sports, archery, automobile, powerboating

197
Q

Epi pen rules in comp

A

Okay to use in emergency but WADA requires emergency TUE be submitted following treatment

198
Q

When is a TUE needed + what is the duration it lasts for

A

Required before using prohibited substance or method
Valid for duration of treatment, max 4 yrs

199
Q

What is needed in an application for a TUE?

A

Form completed by athlete + physician
Comprehensive medical hx
Results of exams/ tests/ imaging/ investigations
Independent medical opinion in the case of non-demonstrative condition
Relevant correspondence between physicians regarding dx + rx

200
Q

What is needed for a TUE for ADHD?

A

Dx by a specialist in management of ADHD
Must have evidence of standard diagnostic criteria
Evidence of sx onset before 12
Athlete ideally on stable dose of medication
Evidence of other interventions (psych, behaviour management)
Regular review (min annually) by the same specialist physician

201
Q

What is the rule relating to diuretics + threshold substances?

A

Any quantity of substance subject to threshold limits (asthma, epherine, pseudoephidrine) in conjunction w/ diuretic (or masking agent) requires a TUE for both diuretic + threshold substance

CASEM (13 decks)

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