lecture 3: medical issues Flashcards
1
Q
diabetes
A
- type 1 and type 2
2
Q
type 1 diabetes
A
- type 1 - 10% (aka juvenile diabetes
- problem: pancreas fails to produce enough endogenous insulin
- can’t get sugar out of blood and into cells
- filtered out by kidneys
- leads to dependence on exogenous insulin
3
Q
diabetes - type 2
A
- type 2 - 90%
- inadequate insulin produced by the pancreas and/or significant resistance at the cellular level
- there is insulin, however the issue is with insulin receptors
4
Q
hypoglycaemia
A
- hypoglycaemia (not enough sugar in the bloodstream)
- minimal sugar in the bloodstream
- too much insulin
- not enough food
- excessive exercise
- decreased nutrients to brain
- hunger
- double vision
- insulin shock/reaction
- hypo means low, minimal sugar in blood stream
5
Q
types of diabetic problems
A
- hypoglycaemia
- hyperglycaemia
6
Q
hyperglycaemia
A
- sugar present in blood stream, but can not get into tissue
- cells starving
- body starts converting fat
- acidosis
- ketacidosis present
- breath fruity smell
- frequent urination
- thirst
- possible coma
7
Q
typical presentation of hypoglycaemia and hyperglycaemia
A
- major signs are similar
- altered level of consciousness (dizzy, drowsy and or confused)
- rapid breathing
- rapid pulse
- feeling ill
8
Q
management of hypoglycaemia and hyperglycaemia
A
- ask if they have eaten or taken insulin
- give sugar (juice, hard candy, glucose tablets, non-diet soft drinks)
- monitor 5 minutes
- if hypoglycaemic they will improve
- if hyperglycaemic there will be no change
- refer for advanced emergency medical care
9
Q
epilepsy
A
- epilesy… is a condition defined by the recurrence of unproved seizures.
- a seizure is a result of a discharge of electrical activity within the brain
- must have more than 2 to be termed Epilepsy
10
Q
the epileptic athlete
A
- 10% of the population will have at least one seizure, but only 2% will go on to have recurrent unprovoked seizures or epilepsy.
- likely that many newly diagnosed patients will be participating in athletic at the time of diagnosis
11
Q
what are the 3 main types of seizures?
A
- focal onset
- generalized onset
- unknown onset
12
Q
focal seizures
A
- occur in one part of the brain and activate only a small number of neurons
1. aware - usually consisting of brief sensory, motor, or memory related symptoms.
2. impaired awareness - usually associated with behavioural arrest, staring, blinking, and automatisms, lasting minutes with postictal amnesia (having trouble remembering the events that comes before) - these may be motor or non motor and are classified by the first prominent sign or symptom
13
Q
generalized seizures
A
- bilateral discharge involving entire cortex. impaired awareness
1. generalized motor (i.e. tonic/clonic (formerly Grand Mal)- motor
- athlete falls to ground
- goes through a tonic phase of muscle stiffness
- followed by “clonic” phase of muscle twitches
- generalized non - motor (i.e. absence (formerly petite mal)
- non-motor
- sudden interruption of activity followed by a blank stare
- eye fluttering and head nodding
14
Q
unknown onset seizures
A
- do not know why it is happening, could be due to a lesion in the brain or other things)
1. motor- athlete falls to ground
- goes through a tonic phase of muscle stiffness
- followed by ‘clonic” phase of muscle twitches
- non- motor
- sudden interruption of activity followed by a blank stare
- may or may not realize it occured
15
Q
management for seizures
A
- protect their head
- remove objects close by
- do not restrain the athlete
- do not place object in their mouth
- position on side in recovery position ASAP
- time seizure (activate EAP if greater than 5 min
- assess for injury: (contusion, dislocation)
16
Q
epilepsy and exercise
A
- fatigue, exertion and stress may be a trigger of seizures
- only 2 of 400 listed exercise as a precipitant
- more commonly listed: stress (30%), sleep deprivation (18%), fever / illness (14%), menses (21%)
- 2% have seizures in more than 50% of training sessions
- intense activity
- most had structural lesion
17
Q
benefits of exercise for people with epilepsy
A
- multiple studies have shown that exercise actually decreases seizure frequency
- normalize the EEG = increase seizure threshold and decrease likelihood of seizures
- decrease in EEG during exercise
- patients who exercised regularly had significantly decreased seizures than those who did not
- physical activity also enhances alertness and focus, which increases the seizure threshold
18
Q
sports participation for people with epilepsy
A
- should avoid scuba, rock climbing, motor racing and downhill skiing
- frequency of seizures are important when considering activities such as swimming
- 4x more likely to be involved in submersion accidents
- swimming, ok with buddy
- no adverse effects with regards to contact sports
- shooting, archery, horseback riding
- must stress: proper diet, rest and adherence to medication for seizure control
19
Q
asthma
A
- chronic inflammatory disorder of the airways
- excess mucus production and bronchial smooth muscle constriction causing airway narrowing
- maximal expiratory flow rate is reduced as air is trapped behind the blocked airways
- the athlete must work harder to breath as the thorax becomes over-inflated
- with progression of the attack, the diaphragm and intercostal muscles must compensate, and muscle efficiency is eventually lost.
- leads to respiratory muscle fatigue and physical distress that may result in death.
20
Q
disruption of the expiratory flow
A
- they breath in and the mucus begins to block the lungs and basically the athletes can not breath in because of the blockages
21
Q
signs and symptoms of asthma
A
- chronic inflammation causes an increse in airway hyper-responsiveness, leading to:
- recurrent episodes of wheezing
- breathlessness
-chest tightness (or chest pain in children)
-coughing (dry)- particularly at night or in the early morning
- after exercise especially in cold, dry environments
22
Q
exercise induced bronchospasm
A
- by definition, a temporary narrowing of the airways (bronchospasm) induced by strenuous exercise in which the patient has no symptoms is known as EIB
- used to be used interchangeably with EIA - where an asthmatic has exercise as a trigger … that is changing.
-80% of asthmatics- 40% season allergies
- 12-15% in general population
23
Q
pathophysiology of EIB
A
- symptoms peak 8-12 minutes
- exercise triggers bronchoconstriction because it leads to dehydration of the lungs airways
- inhaled air is dry and cool
- air warmed/humidified in the lungs = drying out
- after exercise, the cells rehydrate via hyperaemia, leading to a cascade of biochemical changes that trigger bronchonconstriction
- the degree is dependent upon exercise intensity, the temperature and humidity of the inhaled air
24
Q
diagnosis of exercise induced Bronchospasm
A
- need 2 things to diagnose
- symptoms (shortness of breath, coughing, chest tightness/ wheezing)
- obstructed airways 10-15%
- both associated with exercise
- to test:
- athletes works 6-8 minutes at 80% maximum
- better if test is sport specific
- may need cold air, if testing winter athlete
25
Q
management/coping strategies for broncho
A
- educate on the signs, symptoms and triggers
- avoid exercising around or near irritant if possible
- using bronchodilators (beta 2 agonists) as prescribed, prior to exercise.
- if bronchospasm occurs:
- use bronchodilator as prescribed
- position for ideal breathing
- begin by slowing exhalation and then inhale
26
Q
what is a PPE?
A
- medical physical examination assessing the ability to safely participate in sport activity
- not intended to disqualify or exclude
- help maintain health and safety in training and competition
27
Q
objectives of PPE
A
- detect conditions that would restrict participation
- detect conditions that may be life threatening or disabling
- injury prevention evaluation
- meet legal and insurance requirement
- initiate and establish a rapport with the athlete
- provide an opportunity for counselling
- establish a data base and record keeping system
28
Q
when does a PPE occur?
A
- preferably 4-6 weeks prior to season
- this will allow time for any additional tests to be ocmpleted as well as treatment of any identified problems
- generally occurs closer to the start of the season
- end of preceding seasion
- usually 1 per year
29
Q
the PPE team
A
- may include:
- physician
- P.T./ A.T/ Kinesiology
- orthopedics surgeon
- nurse
- dentist
- sport psychologist
- dietician
- opthamologist
- coach?
30
Q
methods of evaluation for PPE
A
- office based
- station based
31
Q
office based method of PPE
A
- clinic or M.D’s office
- usually just one examiner
- may be one P.T. but consultation are necessary
- very time consuming for a large team
- more expensive
32
Q
station based method of PPE
A
- less expensive
- athletes meets more members
- divided into medial and MSK
- included M.D. and other health professionals
- fosters improved communication by medical team
- may reduce staff burn-out
- less personal
- bottom line
- there is no difference between office based and station based excluded or referred equal number of athletes
33
Q
typical PPE set up
A
- fees, drug education as per Usport
- history - self report form and questions
- trainer - height, weight, vision, SCAT5 (concussion)
- team PT/ Trainer - MSK screen
- team physician - medical exam
34
Q
medical history for PPE
A
- given 7-10 days in advance to facilitate complete family and past medical information
- symptoms with exercise (cardio/syncope) requiring further evaluation
- concussions
- meds, alcohol, drugs
- recent infections
- female athletes
- relative energy deficiency in sport (RED-S)
35
Q
red flags in athletes health
A
- if there is something about the history that does not fit the pattern, then consider alternative less common conditions.
- conditions
- bone and soft tissue tumors
-rheumatological conditions
-cardiovascular disorders
-infections
-genetic disorder
- bone and soft tissue tumors
36
Q
bone and soft tissue tumors
A
- primary malignant tumors are rare
- usually in young (2-3rd decade) but can be any age
-pain aggravated by activity
- usually in young (2-3rd decade) but can be any age
- red flags:
- night pain/sweats
- fever
- loss of appetite
-unwarranted fatigue - weight loss
-10-15 lb in a week
37
Q
Rheumatologic conditions
A
- Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis
- could report a single or multiple swollen joints
- no history of trauma or injury
- red flags:
- morning stiffness
- rashes
- fingernail pitting
- bowel disturbances
- eye irriation
- conjunctive, iritis
- could be a single joint, but is more common to have multiple joints affects
- it spreads to other joints without any physical trauma
38
Q
infection
A
- bone and joint infections/ osteomyelitis are uncommon
- may report a single or multiple swollen joints
- no history of trauma or injury
- red flags:
- bone pain in children both at night or with activity night sweats
- hot and swollen
- with no history of trauma
39
Q
vascular conditions
A
- deep vein thrombosis (blood clot)
- presents with single limb pain
- aggravated by exercise
- possible precipitants
- recent surgery
- air lavel
- red flags:
- tenderness on palpation over tissue
- warmth
- swollen
- red, pale or bluish
40
Q
medical examination
A
Physician
- observation (look for health markers)
- dermatologic conditions
- vital signs (HR, BP, RR, Temperature)
- cardiovascular examination (listen to heart sounds, Rule out hypertrophic Cardio-Myopathy, aortic stenosis, etc)
41
Q
Hypertrophic cardiomyopathy (HCM)
A
a condition in which the heart muscle becomes think. the thickening makes it harder for blood to leave the heart, forcing the heart to work harder to pump blood.
42
Q
aortic stenosis
A
- when the aortic valve does not open fully. this decreases the blood flow from the heart
43
Q
MSK examination
A
Physio/AT/Chiro
- screening exam
- specific tests based on history
- functional tests
- perfect area for clearing tests
- neurological scans
- the screening physical examination is 51% sensitive and 97% specific
44
Q
physical examinations
A
- previous injuries
- fractures, ligament and tendon injuries
- general strength/weakness
- laxity
- posture / scoliosis
45
Q
AAP committee on sports medicine
A
- individuals may be precluded from participation in contact sports or require further testing for any of the following reasons:
- atlantoaxial (Upper c-spine) instability
- history of significant head or spine trauma
- acute/contagious illnesses
- carditis
-congenital heart disease - pulmonary compromise
46
Q
carditis
A
- inflammation around your heart (was in issue coming out of covid because a lot of people were experiencing it)
47
Q
an effective screening test has been described by the United States Preventative Services Task Force as satisfying two requirements
A
- can detect target condition earlier than without screening
- screening and treating should improve likelihood of a favourable outcome
