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CASEM > Med Yield > Flashcards

Med Yield Flashcards

1
Q

What are effective chest compressions?

A

Compress by 5cm
Allow complete chest recoil
Rate 100-120/ min
Minimise pauses in compressions
Switch out compressors

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2
Q

management of Shockable rhythm (VF, pVT)

A

Give shock (biphasic 200J, monophasic 360J)
Continue CPR x 2min
Get IV/ IO access
Epinephrine 1mg q3-5 mins
Consider advanced airway + capnography (if CO2 <10, improve CPR)
Amiodarone 300mg bolus then 150mg second dose
Lidocaine 1mg/kg first dose then 0.5mg/kg second dose

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3
Q

management of non shockable rhythm (asystole, PEA)

A

IV/ IO
Epinephrine 1mg q3-5 mins
Consider advanced airway + capnography

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4
Q

What are the reversible causes or cardiac arrest?

A

Hypovolemia
Hypoxia
H+ acidosis
Hypo/hyperkalemia
Hypothermia
Tension PNA
Tamponade
Txoins
Thrombosis - pulmonary, coronary

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5
Q

How to manage ROSC

A

Maintain O2 sats
Treat hypotension
12 lead ECG ?STEMI - if present, coronary reperfusion

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6
Q

How to manage bradycardia w/ a pulse

A

Maintain airway
Oxygen if needed
Cardiac monitor
BP + sats
IV access
ECG
Assess for signs of decompensation

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7
Q

What are the signs of decompensation?

A

Hypotension
Altered mental status
Signs of shock
Ischemic chest discomfort
Acute HF

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8
Q

What to do If decompensation signs are present in bradycardia

A

Atropine 0.5mg bolus, repeat every 3-5mins, max 3mg
If ineffective, dopamine or epinephrine infusion or transcutaneous pacing
Dopamine 2-20mcg/kg/min
Epinephrine 2-10mcg/min

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9
Q

How to manage tachycardia w/ pulse

A

Maintain airway
Oxygen if needed
Cardiac monitor
BP + sats
Assess for signs of decompensation

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10
Q

What to do If decompensation signs are present in tachycardia

A

Consider sedation
If regular narrow complex = adenosine 6mg IV rapid push, 2nd dose 12mg

If wide QRS (>0.12s):
IV access + 12 lead ECG
Adenosine if regular + monomorphic
Antiarrhythmic infusion
Amiodarone 150mg over 10 mins then 1mg/ min for 6 hrs
Procainamide 20-50mg/min until arrhythmia suppressed, hypotension ensures, QRS duration increases >50% or max dose 17mg/kg given

If irregular narrow complex:
IV access + 12 lead ECG
Vagal manoeuvres
BB or CCB

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11
Q

What is the grading of hypothermia?

A

Systemic cold injury
Mild - 32-35 degrees
Mod - 30-32
Severe - <30

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12
Q

What ix are needed in hospital following a drowning

A

CXR - localised, perihilar or diffuse pulmonary edema
ABG, lytes, Cr, ECG, continuous core temp monitoring

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13
Q

RF for szs

A

Fam hx
Cerebrovascular dz
Brain tumors
Alcohol or substance use
Prev head injury
Malformations of cortical development
Infections

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14
Q

Commonly associated conditions w/ szs

A

Personality disorders
Haem disorders - sickle cell, antiphospholipid syndrome
Learning disabiities
Migraines
Mood disorders
Systemic autoimmune conditions - SLE

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15
Q

Ix for szs

A

Lytes, glucose, ex lytes, kidney + liver function, ammonia, CBC
UA
Blood + urine toxicology
CT or MRI brain
EEG - may need to do sleep deprived
ECG
Consider spinal tap to r/o infection + raised ICP

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16
Q

Proposed classification of sport categories based on potential risk of injury/ death if sz occurred:

A

Group 1 (no significant risk to person w/ epilepsy or bystanders)
Athletics, bowling, judo, collective sports on ground (football, soccer, cricket, baseball), XC skiing, dancing, golf, racquet sports
Group 2 (mod risk to person w/ epilepsy but no risk to bystanders)
Alpine skiing, archery, canoeing, karate, cycling, fencing, gymnastics, hockey, swimming, shooting
Group 3 (high risk to person w/ epilepsy or risk to bystanders)
Aviation, climbing, diving, motor sports, rodeo, ski jumping, freestyle skiing, surfing, rodeo, scuba diving

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17
Q

RTP in szs based on classification of sports

A

One or more acute symptomatic szs
Group 1 permitted, group 2 + 3 at neuro discretion
Single unprovoked sz
Group 1 permitted after neuro assessment, 2 + 3 after 1 yr sz free
Sleep related szs only
Group 1 permitted, group 2 at neuro discretion, group 3 banned
Szs w/o impaired awareness
Group 1 permitted, group 2 at neuro discretion, group 3 banned

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18
Q

What ix are needed in anaphylaxis

A

Not needed
ABG if ongoing resp distress
Tryptase levels to confirm - must be drawn within 3 hrs of sx onset, must be placed on ice, rarely elevated in food induced anaphylaxis
Consider ECG

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19
Q

RF for post concussion syndrome

A

4 or more initial sx >1 wk
Prior concussion + sx >1 wk
Sx of drowsiness, nausea, reduced consciousness >1 wk
Sensitivity to light + noise >1 wk
Amnesia associated w/ sx >1wk in males

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20
Q

How does the direction of the blow change the structure likely to be damaged in a nasal bone #?

A

Blow to inferior nose more likely to injure cartilagenous septum + nasal tip
Lateral blow more likely to # nasal bone, can cause fracture displacement + septal dislocation
Direct blows can lead to nasal obstruction

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21
Q

Low vs high velocity trauma causes what pattern of nasal fracture?

A

Low velocity trauma causes simple fracture pattern
High velocity trauma causes complex comminuted # and associated injuries to face, head, C spine

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22
Q

Other forms of dental injury other than # + management

A

Extrusion (tooth moved out of socket) - dentist within 24hrs unless tooth cannot be repositioned, in which case immediate dentist
Intrusion (tooth moved inward) - dentist within 3 hrs
Lateral luxation (tooth moved laterally) - dentist within 24hrs unless tooth cannot be repositioned, in which case immediate dentist
Avulsion - dentist immediately

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23
Q

Complications of dental trauma

A

Mandibular condyle #s (anterior open bite, malocclusion, limited mandibular opening)

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24
Q

Monitoring in AS

A

Monitor with BASDAI score (fatigue, spinal pain, joint pain/ swelling, areas of tenderness, duration of morning stiffness) - rated 0-10 then divided by 5. Score >4 = suboptimal treatment

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25
Q

Complications of AS

A

Fusion of vertebrae leading to restrictive lung disease
Aortitis or aortic insufficiency
Hip arthritis
Increased risk of achilles tendinopathy

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26
Q

RF for AS

A

Positive fam hx of SpA or HLA-B27
Reactive arthritis triggered by chlamydia or certain enteric infections

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27
Q

Pathophysiology of Spondylosis

A

Discs undergo desiccation when they age, lose compressibility + bulge causing loss of disc height
Osteophytes form
Ligamentum flavum undergoes hypertrophy
Changes cause narrowing of neural foramen

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28
Q

Pathophysiology of disc herniation

A

Annular fibers around nucleus pulposus degenerate
Nucleus pulposus can herniate through fibers (usually due to mechanical force)
Herniated disc impacts + compresses nerve root

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29
Q

Where do nerve roots exit compared to their numbered pedicles?

A

Nerve roots exit above their corresponding pedicle (i.e. C6 nerve root exits between C5 + C6)

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30
Q

Types of scoliosis

A

Neuromuscular
Congenital
Idiopathic

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31
Q

Tanner stages

A

Stage 1: no pubic hair, no breast tissue palpable, testicular volume <4ml
Stage 2: downy hair, breast bud palpable under areola, testicular volume 4-8ml
Stage 3: scant terminal hair, breast tissue palpable outside areola, testicular volume 9-12ml
Stage 4: terminal hair that fills entire triangle overlying pubic region, areola elevated above contour of breast, testicular volume 15-20ml
Stage 5: terminal hair extending beyond inguinal crease, areola hyperpigmentation + papillae development, nipple protrusion, testicular volume >20ml or >4.5cm long

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32
Q

DDx for scoliosis

A

Leg length discrepancy
Postural abnormalities

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33
Q

What is Atlantoaxial Instability?

A

Increased motion at joint between 1st + 2nd vertebrae
Can e congenital, inflammatory, traumatic or infections that weaken structures leading to it

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34
Q

Sx of Atlantoaxial Instability

A

Usually asymptomatic
Can present after injury w/ gait changes, progressive weakness, fatigue, neck pain

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35
Q

RF for Atlantoaxial Instability

A

Downs
RA
JIA
Dwarfism
Marfan’s syndrome

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36
Q

Ix for Atlantoaxial Instability

A

Lateral cervical XR w/ flexion + extension views

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37
Q

Physical for Atlantoaxial Instability

A

Hyperreflexia
Sensory changes
Weakness
Gait disturbance

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38
Q

DDx for Atlantoaxial Instability

A

Neck sprain
Cervical disc herniation
Vertebral #

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39
Q

Management of Atlantoaxial Instability

A

Restrict from contact sports if symptomatic
If asymptomatic, may be restricted from butterfly stroke, diving, high jump, squat lifts, gymnastics, skiing
Avoid blind ET intubation - use flexible bronchoscope
Can consider atlantoaxial fusion if progressive sx or myelopathy

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40
Q

Most common rotator cuff tears

A

Supraspinatus + infraspinatus

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41
Q

What is the action of the pectoralis?

A

Adductor
Internal rotation
Flexor of humerus

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42
Q

RF for Pec Major tendon rupture

A

Males 20-40 years old
Weightlifting
Steroid use
CTD
Diabetes

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43
Q

MOI Pec Major tendon rupture

A

Usually complete avulsion of pec tendon at humeral insertion
Downward portion of bench press with shoulder in last 30 degrees of extension against heavy resistance.

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44
Q

Sx of Pec Major tendon rupture

A

Pain and weakness of shoulder
Will often feel a pop

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45
Q

Physical for Pec Major tendon rupture

A

Swelling and significant bruising of chest wall and upper arm
Asymmetric pec muscle
Loss of axillary contour - asymmetric muscle outline (retracted medially)
Shoulder ROM limited d/t pain
Dropped nipple sign
Weakness in adduction and internal rotation

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46
Q

Ix for Pec Major tendon rupture

A

XR to r/o # - soft tissue swelling + loss of pec major shadow seen
MRI w/ dedicated sequence gold standard
US can be helpful in meantime

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47
Q

Management of Pec Major tendon rupture

A

NSAIDs, ice, sling
Refer to ortho urgently
Partial tears, sternoclavicular tears, muscle belly tears - usually non surgical
Shoulder ROM once tolerated
Strengthening from 6wks post injury
Unrestricted activity 2-3mo after injury
Complete tears = surgical
Acute repair within 3 wks optimal

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48
Q

DDx for Pec Major tendon rupture

A

Long head bicep subluxation
Proximal humerus #
Rotator cuff tear

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49
Q

Classification of clavicle #s

A

1 = # of middle ⅓
2 = # of distal ⅓
3 = fracture of proximal ⅓

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50
Q

What is PIN compression syndrome?

A

Posterior interosseous nerve syndrome
PIN is deep branch of radial nerve
Overuse pronation + supination, trauma (Monteggia or radial head #), inflammatory dz, lipoma/ neuroma/ ganglion

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51
Q

RF for PIN compression syndrome

A

Manual labourers, body builders, racquet sports
Males

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52
Q

Sx of PIN compression syndrome

A

Painful spontaneous weakness of extensor muscles
Fatigue during finger extension, elbow supination, wrist extension
Dull, aching pain 5-10cm distal to lateral epicondyle

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53
Q

Physical for PIN compression syndrome

A

Tenderness on palpation of proximal radius
Sensation normal
Weakness in wrist extension in ulnar deviation but okay in radial deviation
Weak extension of MCP joints
3rd + 4th digits most affected (“rock on” sign)

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54
Q

Ix for PIN compression syndrome

A

XRs + US
EMG studies

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55
Q

DDx for PIN compression syndrome

A

Radial nerve palsy
C7 radiculopathy
Lateral epicondylitis

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56
Q

Management of PIN compression syndrome + time frame for recovery

A

Conservative - rest, NSAIDs, immobilization, steroid shot
Surgery in refractory cases
Activity modification recommendations + home exercises
ROM
Strengthening
Time frame for recovery
3-4mo usually

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57
Q

MOI Elbow dislocation

A

Wrestling, gymnastics, football, falls, MVA

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58
Q

Conditions commonly associated w/ Elbow dislocation

A

Radial #, epicondyle avulsion #, coronoid process #

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59
Q

Physical for Elbow dislocation

A

Visual deformity normally seen
Prominent olecranon = posterior
Long extended forearm = anterior

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60
Q

Ix for Elbow dislocation

A

AP + lateral XR

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61
Q

Management of Elbow dislocation (sideline + in hosp)

A

On field reduction
Supine pt, forearm traction, humeral counter traction, anterior force on olecranon, forearm supination
Full passive ROM indicates successful reduction
Post reduction XRs + neurovascular exam
Sling x3 days
If unable to reduce immediately
Immobilize in posterior splint in 90 degrees flexion in pronation
FU XRs 1 + 2 wks after injury
May need surgery if recurrent instability
Time frame for recovery
1-3mo

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62
Q

What is little leaguer’s elbow?

A

(medial apophysitis)
Catch all phrase for elbow pain in young athlete but traditionally:
Valgus stress lesion of medial epicondylar physis
On a continuum w/ avulsion # of medial epicondyle

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63
Q

RF for medial apophysitis

A

Pitchers
Number of pitches

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64
Q

Management of medial apophysitis

A

4-6 wks rest w/ ROM + stretching
NSAIDs + ice
Pitch count

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65
Q

What is Nurse maids elbow?

A

Traumatic subluxation of radial head by sudden forcible traction on pronated hand or wrist w/ elbow extended

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66
Q

MOI + RF nurse maids elbow

A

MOI
Child suddenly pulling away or dropping to ground with hand held
Pulling child up or swinging by hand
RF
Kids <4y/o

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67
Q

Sx of nurse maids elbow

A

Immediate pain
Child not using affected limb

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68
Q

Physical for nurse maids elbow

A

Arm held in pronated + partially flexed position
Tenderness over radial head
Supination limited

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69
Q

Management of nurse maids elbow

A

Reduction:
Flexion-supination
Thumb over radial head
Rotate arm into full supination
Flex elbow to 90 degrees
Hyperpronation
Pronate forearm further as elbow is moved into full extension
If function not normal in 15mins, repeat reduction or get XRs

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70
Q

MOI UCL elbow injury

A

Repetitive valgus overload
Acute trauma (extreme valgus stress)

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71
Q

RF for UCL elbow injury

A

High velocity throwing or overhead activity sports
Contact sports

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72
Q

Sx of UCL elbow injury

A

Acute: sudden pain, audible pop
Chronic: persistent, insidious medial elbow pain

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73
Q

Physical for UCL elbow injury

A

Tenderness along sublime tubercle
Valgus stress test positive

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74
Q

Ix for UCL elbow injury

A

XRs - joint widening
MRI or MRA

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75
Q

Management of UCL elbow injury

A

Acute
NSAIDs, rest, ice
High grade partial tears + complete ruptures = surgery (if throwing athlete)
Activity modification recommendations + home exercises
ROM
Wrist flexor + extensor strengthening
Restricted throwing + valgus stress x6 wks

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76
Q

Prevention of UCL elbow injury

A

Throwing athletes should have 3-4mo rest every year

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77
Q

Conditions associated with scapholunate ligament injury

A

intra-articular distal radius and other carpal fractures

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78
Q

Levels of scapholunate ligament injury

A

Occult instability - XR negative, wrist pain usually only w/ mechanical loading
Dynamic instability - will be evident on stress XRs
SL dissociation - SL widening seen on XR
SL advanced collapse (SLAC)

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79
Q

MOI lunate dislocation

A

FOOSH
high energy injury that occurs when wrist is in extension and ulnar deviation.

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80
Q

RF for lunate dislocation

A

Chronic crutch walkers
Gymnasts, football, collision sports

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81
Q

Sx of lunate dislocation

A

Dorsal wrist pain
Decreased grip strength
Decreased ROM
May have carpal tunnel symptoms (25%)

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82
Q

Physical for lunate dislocation

A

Wrist effusion in acute injuries
Tenderness to palpation of lunate + radial aspect of wrist
May have positive median nerve compression tests, as lunate can dislocate into the carpal tunnel
Finger extension test positive - hold wrist in flexion, test active finger extension against resistance - pain over lunaate
Kleinman shear stress test positive (lunotriguetral instability) - wrist in neutral position, examiner’s contralateral thumb over dorsal lunate while ipsilateral thumb loads the pisotriquetral joint with a dorsally directed force - pain = positive

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83
Q

Ix for lunate dislocation

A

X-rays: PA, oblique, and lateral wrist inc clenched fist view
Gap >3mm / increased gap compared to contralateral side
CT for ligament injuries
Arthroscopy is gold standard

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84
Q

DDx for lunate dislocation

A

Scaphoid fracture
Colles fracture
Scaphoid impaction syndrome
Dorsal wrist ganglion cyst
Other carpal bone injury

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85
Q

Complications of lunate dislocation

A

AVN
median nerve palsy
compartment syndrome and long term issues.

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86
Q

Management of lunate dislocation

A

Urgent reduction and surgery needed then prolonged immobilization
Partial tears can be treated conservatively w/ splinting
Refer to ortho/ plastics emergently

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87
Q

Zones of flexor tendons in hand

A

Zone 1: distal to FDP insertion (FDP tendon only)
Zone 2: proximal A2 pulley to FDS insertion (no man’s land - poorer outcomes)
Zone 3: distal carpal tunnel to proximal A2 pulley (contains lumbricals)
Zone 4: carpal tunnel (contains flexors + median nerve)
Zone 5: Proximal to carpal tunnel (different repairs if muscle belly involved)

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88
Q

Zones of extensor tendons in hand

A

Zone 1: DIPJ (mallet injury)
Zone 2: middle phalanx (can involve central slip insertion)
Zone 3: PIPJ (Boutonierre deformity)
Zone 4: Proximal phalanx (can involve central slip + lateral bands)
Zone 5: MCPJ (can involve sagittal band + joint capsule)
Zone 6: metacarpals (distal to junctura (tendon can retract))
Zone 7: wrist joint (involvement of extensor retinaculum)
Zone 8: distal ⅓ of forearm (can involve musculotendinous junction)
Zone 9: proximal ⅔ of forearm (can involve muscle belly)

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89
Q

What is IP collateral ligament strain + degrees of severity

A

Injury to a collateral ligament at the interphalangeal (IP) joint of the finger, usually the proximal interphalangeal (PIP) joint:
1st degree: pain but no laxity
2nd degree: pain and laxity but firm end point when ligament is stressed
3rd degree: pain and loss of firm end point when ligament is stressed

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90
Q

MOI + RF IP collateral ligament strain

A

MOI
axial loading with radial or ulnar stress applied to the finger, usually while extended

RF
Ball handling, collision, and contact sports: football, basketball, volleyball, wrestling
Prior injury or dislocation of the PIP joint

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91
Q

Sx of IP collateral ligament strain

A

​​Finger struck by player or ball during play
Axial trauma causing forced ulnar or radial deviation
Usually presents acutely but may become chronic

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92
Q

Physical for IP collateral ligament strain

A

Pain and swelling over radial or ulnar aspects of PIP joint
Decreased range of motion (ROM) secondary to pain and edema
​​Assess function of flexor and extensor tendons by isolating MCP, PIP, and distal interphalangeal (DIP) joints separately to rule out tendon injury.
Loss of active ROM may be due to either pain or volar plate/central slip injury, so digital block may be necessary to test ROM

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93
Q

DDx for IP collateral ligament strain

A

Phalangeal fracture
IP dislocation
Central slip injury
Volar plate injury

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94
Q

Management of IP collateral ligament strain

A

Buddy tape for 3 wks
Surgery if:
Displaced intra-articular
Large avulsion #
Instability w/ active ROM
Tissue interpoisition limiting ROM
FU 1-2 wks to r/a

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95
Q

What is Climbers finger?

A

Flexor tendon pulley rupture (especially A2 and A4)
Manage with splints or surgical pulley reconstruction

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96
Q

What does dysplasia, subluxation, dislocation, teratologic dislocation + unstable hip mean in relation to the hip

A

Dysplasia refers to an acetabulum that is shallow or underdeveloped.
Subluxation refers to a femoral head that is not centered within the acetabulum.
Dislocation refers to a femoral head that is completely out of the acetabulum.
Teratologic dislocation refers to a femoral head that is in a fixed dislocated position usually associated with a genetic, developmental, or neuromuscular disorder.
An unstable hip refers to a femoral head that can be subluxed or dislocated on physical examination.

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97
Q

RF for DDH

A

Firstborn
Breech presentation
Oligohydramnios
Underlying ligamentous laxity
Swaddling
Caucasians
Females
Family history

98
Q

Conditions commonly associated w/ DDH

A

Torticollis
Metatarsus adductus

99
Q

Physical for DDH

A

Barlow (Adduction and internal rotation of hip, palpable clunk is positive sign as hip dislocates)
Ortolani (Abduction and external rotation of hip with examiner’s middle finger over greater trochanter, palpable clunk is positive sign produced by reduction of dislocated hip)

100
Q

Ix + screening for DDH

A

US best
Screen at 4-6 wks if RF present or clunk on exam

101
Q

Management of DDH

A

Pavlik harness for week 3 - 6mo
Hip spica cast for 6-18mo (change cast q6wks)
Surgery if closed reduction fails or excessive abduction present

102
Q

Complications of DDH

A

Failed reduction
Osteonecrosis of femoral head
Hip labral pathology
OA

103
Q

Types of FAI

A

Cam type: malformation of the femoral head resulting in neck widening and asphericity
Pincer type: malformation of the acetabulum that results in over-coverage of the anterosuperior acetabular wall and abnormal retroversion of the acetabulum
Mixed type: most common type, combination of cam and pincer lesions

104
Q

Distal femur # types

A

Supracondylar: Zone is from the femoral condyles to the junction of the metaphysis and femoral shaft.
Intracondylar.
Condylar.

105
Q

MOI, hx + sx for ischial tuberosity avulsion #

A

intense athletic activity, such as sprinting, or with excessive passive lengthening of the hamstring muscles, as often occurs during cheerleading or gymnastics.
The patient may experience a popping sensation at the time of injury and typically presents with severe posterior thigh or gluteal pain and complains of difficulty walking.

106
Q

Types of pelvic # + direction of force

A

Lateral compression - rami #, iliac wing #, sacral #, coccygeal #
Anterior posterior compression - symphisis diastasis #, open book #, 2x ipsilateral ischiopubic rami #,
Avulsion # e.g. ischial tuberosity

107
Q

What ix for ?pelvic #

A

CT
FAST

108
Q

Management of pelvic #

A

Immobilize w/ pelvic binder
Low grade: protected wt bearing, bed rest, NSAIDs, XRs after 2-5 days
High grade: surgery

109
Q

Complications of pelvic #

A

Vascular injury leading to blood loss
Closed head injuries
Visceral injury (bladder and urethral, small bowel, diaphragm)
Nerve injury
Deep venous thrombosis
Atelectasis/pneumonia
Musculoskeletal back pain
Sexual dysfunction
Malunion/nonunion of pelvic fracture

110
Q

Structures that make up the Posterolateral Corner (static vs dynamic)

A

Static structures:
Lateral cruciate ligament (LCL)
Popliteus tendon (PT)
Popliteus ligament
Lateral capsule
Arcuate ligament (variable)
Fabellofibular ligament and fibula (variable)

Dynamic structures:
Biceps femoris
Popliteus muscle
Iliotibial (IT) tract
Lateral head of gastrocnemius

111
Q

What are the 3 primary stabilizers of the lateral knee found in the PLC?

A

Fibular collateral ligament (FCL). It serves as the primary varus stabilizer of the knee in late knee flexion.
Popliteus tendon. This structure resists external rotation of the knee.
Popliteofibular ligament (PFL). This ligament acts like a sling to hold the popliteus muscle/tendon complex down against the posterior lateral portion of the tibia. It is a varus stabilizer of the knee in extension.

112
Q

injuries associated w/ PLC injury

A

ACL or PCL injuries
Knee dislocation
Fibular nerve injury
Popliteal artery injury
In elderly, can be associated w/ tibial plateau #

113
Q

MOI PLC injury

A

Falls, land on fully extended lower extremity. Knee then “fails” in varus, hyperextended position then buckles
Knee hyperextension
Varus blow to flexed knee

114
Q

RF for PLC injury

A

Female gender
Sports competition (vs. practice)
Contact sports
American football
Prior knee or ankle injury

115
Q

Physical for PLC injury

A

Grading of PLC injuries is done in full knee extension and then with 30 degrees of knee flexion; this can be affected by presence of effusion or pain.
Place a varus stress with knee in extension; if opens up over 4 mm compared to opposite side, impacts the PCL tear
Then test at 30 degrees and compare to other side. If point of care ultrasound (POCUS) is available, it adds accuracy to exam
Must have a neuro (fibular nerve) exam, specifically ankle dorsiflexion + great toe extension
Must have a vascular exam; “two-second” capillary refill and palpitation of posterior tibialis, dorsalis pedis pulse
External rotation recurvatum test (if positive, think PLC + ACL)
Patient is in supine position; the examiner stabilizes the femur by pushing downward in the quadriceps area just proximal to the patella. With the other hand, the examiner grasps the patient’s great toe and lifts. A measurement is taken from the heel of the raised leg and the table. The opposite leg is also tested, and any difference over a centimeter indicates a positive test
Dial test
Patient is in prone position. The examiner grabs the patient’s forefoot while allowing their heels to touch. The knees are flexed 30 degrees, then externally rotated by the examiner. The knees are then flexed 90 degrees, and the same test is done. If there is >10 degrees difference with the other knee at either position, result is a positive test. If the difference is at 30 degrees of flexion, it implicates the PLC. If the difference is 90 degrees of flexion, it implicates both the PLC and the PCL

116
Q

DDx for PLC injury

A

ACL tear
PCL tear
Knee dislocation
Tibial plateau fracture
Growth plate injury
Bone contusion
Lateral meniscus tear
IT band subluxation at knee
Fibular nerve injury
Vascular injury to geniculate artery system

117
Q

Grading + treatment of PLC injury

A

Grade 1 = 0-5mm lateral opening
Hinge brace x4-5 wks, crutches, allow knee flexion
Grade 2 = 5-10mm lateral opening
Knee immobilizer, non wt bearing x3 wks then treat as grade 1
Grade 3 = >10mm lateral opening
Knee immobilizer, non wt bearing, refer to ortho for surgery

118
Q

Complications of PLC injury

A

Fibular nerve injury
Vascular injury
Physical injury
Multiple ligament injury
If ACL or PCL is repaired and PLC injury is missed, early arthritis and graft failure occur.

119
Q

Ottawa knee rules

A

55 yr of age or older.
Isolated tenderness over patella.
Tenderness over head of fibula.
Inability to flex knee to 90 degrees.
Inability to bear weight four steps.

120
Q

Ix for PLC injury

A

XR: AP, lateral, sunrise, varus stress views if injury is chronic
look for arcuate sign, an avulsion fracture for the fibular head associated with PLC injury and ACL injury
Look for Segond fracture, avulsion fracture from lateral tibial plateau associated with ACL injury
MRI

121
Q

What is a patella sleeve #?

A

Cartilage of the inferior pole of the patella is pulled off, often with a small avulsed bone fragment. This occurs with a vigorous contraction of the quadriceps muscle group when the knee is in a flexed position
Occur usually between 8-12 y/o

122
Q

Types of patella # + MOI

A

Transverse - usually displaced (usually from strong quadriceps contraction (partial fall, jumping sports) or direct trauma)
Stellate - usually comminuted + nondisplaced (usually from high impact direct trauma)
Longitudinal (usually d/t trauma or dislocation of patella)
Stress # - weightlifters + gymnasts

123
Q

Hx + sx of patella #

A

Activity (partial fall, exertional strain, etc.)
Trauma (object, direction, force)
Subluxation or dislocation
Popping or snapping
Locking or joint instability
Loss of range of motion (ROM)
Difficulty weight-bearing
Speed and extent of swelling
Characterization of pain

124
Q

Physical for patella #

A

Tenderness to palpation
Pain with passive motion of the patella.
Limited range of active leg extension owing to disruption of soft tissues.
Palpable step-off defect
Effusion or soft tissue swelling
Distal neurovascular status

125
Q

Investigations for patella #

A

XR: AP, lateral, sunrise
CT for ?occult #
MRI for patella sleeve + osteochondral #

126
Q

DDx for patella #

A

Bipartite patella: usually bilateral and not associated with point tenderness, with rounded edges at the superior and lateral corners of the patellae
Patella dislocation
Proximal tibia or distal femur #
ACL tears
In peds:
Sinding-Larsen-Johansson syndrome: Overuse injury of the inferior pole of the patella typically occurring between 10 and 14 yr of age may be misdiagnosed as a patellar fracture.

127
Q

Management of patella # (acute, non op vs surgical, indications for each, rehab after)

A

Acute
Aspiration of hemarthrosis + injection of LA
Icem elevation
NSAIDs
Immobilization (usually in slight flexion)

Non operative treatment
If:
Displacement of <3 mm in any plane or <2 mm at the articular surface
Full range with active knee extension as compared to the contralateral side
Compressive dressings and aspiration of hemarthrosis (if present) before cast application may help to control edema and discomfort.
Immobilization in full extension in a locked knee brace with early weight-bearing as tolerated for initial 2 to 3 wk
Early active ROM with hinged knee brace with progression in flexion after 2 to 3 wk
Weekly radiographs should be obtained to evaluate for possible fracture displacement and appropriate healing
Progressive ROM and strengthening are used until the patient can perform a straight-leg raise against gravity without extension lag

Surgery
If:
Displacement of >2 mm of articular step-off or >3 mm in any plane of fracture separation
Disruption of extensor mechanism is indicated by lack of full extension against gravity.
ORIF
Long leg cast x3-6 wks post op
Wt bearing as tolerated in cast or locked brace: reduces quadriceps contraction and fragment distraction
Isometric exercises and straight-leg raises: started within days of cast application or surgical fixation
ROM exercises such as continuous passive motion may be started immediately after stable internal fixation
Active flexion and passive extension are performed until the fracture is healed and then progress with resistance exercises
Resistance exercises: Several months of resistance exercises may be required to achieve full strength and ROM.

128
Q

RTP after patella #

A

Return to play when bony healing is demonstrated on AP, lateral, and merchant radiographs; complete and painless ROM are achieved; 90% of quadriceps strength is achieved; and balance and proprioception are restored
Usually 3-6mo

129
Q

Complications of patella #

A

​​Patellofemoral arthritis
A slight decrease in flexion
Painful hardware: common complication; managed by removal after fracture union (minimum 6 mo) or tendon healing (minimum 3 mo).
Infection
AVN
Loss of fixation

130
Q

Describe the blood supply to the meniscus

A

The peripheral 1/3 zone (red-red) has good vascular supply
Central third zone (red-white) has limited vascular supply
Inner third zone (white) is avascular

131
Q

What is a Tibial plafond #

A

Distal tibia #

132
Q

MOI + sx of Tibial plafond #

A

MOI
Usually high impact axial force that drives talus into plafond

Hx
Ankle pain

133
Q

Management of Tibial plafond #

A

Surgery

134
Q

What is the nerve supply, muscles involved and muscle action for the anterior compartment?

A

Deep peroneal
Muscles: Tibialis anterior, EHL, Extensor digitorum longus
Muscle action: ↓DF ankle, ↓toe extension, ↓sensation 1st dorsal web space

135
Q

What is the nerve supply, muscles involved and muscle action for the lateral compartment?

A

Superficial peroneal
Muscles: Peroneal longus, brevis, tertius
Muscle action: ↓PF, ↓eversion, ↓sensation to dorsum of foot

136
Q

What is the nerve supply, muscles involved and muscle action for the deep posterior compartment?

A

Posterior tibial
Muscles: Tibialis posterior, long flexors, soleus
Muscle action: ↓PF ankle, ↓inversion, ↓toe flexion, ↓sensation sole of foot

137
Q

What is the nerve supply, muscles involved and muscle action for the superficial posterior compartment?

A

Sural
Muscles: Gastrocnemius complex
Muscle action: ↓PF ankle, ↓sensation lateral foot

138
Q

Classification of strains

A

Mild strain (1st degree): stretch type injury with few muscle fibers injured, causing only minor swelling/pain and minimal loss of strength/motion
Moderate strain (2nd degree): partial tear with strength loss and functional limitations due to more extensive muscle injury
Severe strain (3rd degree): extensive or complete tear across whole muscle with disabling loss of muscle function

139
Q

What is Kohler’s?

A

Pediatric osteochondrosis of tarsal navicular that causes necrosis

140
Q

Who gets Kohler’s?

A

Children 2-7 y/o
Boys more common

141
Q

Sx of Kohler’s

A

Insidious onset midfoot pain
Limp
Aggravated by activity
Repetitive microtrauma

142
Q

Physical for Kohler’s

A

Localised edema, warmth around tarsal navicular
Tenderness medial midfoot

143
Q

DDx for Kohler’s

A

​​Osteochondritis dissecans

144
Q

Ix for Kohler’s

A

XRs (AP, lateral, oblique)
Navicular sclerosis
Diminished size or flattening of navicular
Bone scan shows decreased uptake

145
Q

Management of Kohler’s

A

Ice, NSAIDs, immobilization x2-3mo
Refer to ortho if sx not improved w/ this

146
Q

What is it called when adults get navicular osteonecrosis?

A

Mueller Weiss disease

147
Q

Causes of posterior ankle impingement syndrome

A

Repeated hyperplantar flexion
Os trigonum syndrome (congenital accessory bone that becomes inflamed, particular w/ repetitive plantar flexion)
Talar compression syndrome
Prominent bone (medial malleoli process, posterior process of calcaneus)

148
Q

Causes of anterior ankle impingement syndrome

A

Repetitive hyperdorsiflexion (kicking a ball)
Tibial or talar osteophytes impinge soft tissue

149
Q

RF for posterior ankle impingement syndrome

A

acute or recurrent hyperplantar flexion (ballet on pointe), recurrent ankle sprains, or ankle instability.
Athletes: ballet dancers (“en pointe” and “demi pointe”), cheerleaders, running downhill (forced plantar flexion)
Poor shoe wear without appropriate support
Overuse injury is more common than traumatic injury

150
Q

RF for anterior ankle impingement syndrome

A

sports requiring recurrent forceful dorsiflexion of the ankle, recurrent ankle sprains (supination and plantar flexion) and/or chronic ankle instability, and acute ankle sprains/fractures.
Athletes: soccer players, gymnasts, basketball players, football players, high jumpers, running uphill

151
Q

Sx of anterior ankle impingement syndrome

A

pain w/ dorsiflexion (uphill running/walking)
Pain with kicking a soccer ball, especially a dead ball
Popping or snapping sensation of isolated soft tissue lesions
Subjective feeling of limited range of motion or blocking on dorsiflexion

152
Q

Sx of posterior ankle impingement syndrome

A

Pain is difficult to localize, typically anterior to the Achilles tendon.
Pain described as consistent, sharp, dull and/or radiating
Prior history of inversion (supination) and plantar flexion injury
Posterior ankle pain exacerbated by either plantar flexion (compression of soft tissues or bony prominence) or dorsiflexion (stretching of the posterior capsule and ligaments)

153
Q

Physical of anterior ankle impingement syndrome

A

Tenderness to palpation over the anterior, anterolateral, or anteromedial ankle (most important clinical finding)
Pain in the anterior aspect of the ankle with either forced plantar flexion or dorsiflexion
Possible palpable mass with tenderness to palpation

154
Q

Physical of posterior ankle impingement syndrome

A

Tenderness to palpation in the posterior aspect of ankle, typically anterior to and not involving the Achilles tendon
Possible palpable soft tissue thickening with tenderness to palpation
Positive plantar flexion test: pain in posterior ankle with plantar flexion (pathognomonic)
Reproducible pain with pressure over posteromedial aspect of the ankle during passive inversion and plantar flexion

155
Q

Ix for ankle impingement syndrome

A

XRs - wt bearing ankle XR (AP, lateral, oblique)
MRI

156
Q

DDx for anterior ankle impingement syndrome

A

Lateral ankle ligament sprain
Synovial thickening/synovitis
Loose/intra-articular bodies, avulsion fragments
Chondral or osteochondral lesions of anterior tibial plafond or talar dome
Osteoid osteoma of the talus
Ganglion cyst
Osteoarthritis

157
Q

DDx for posterior ankle impingement syndrome

A

Deltoid ligament sprain
Posterior tibial tendonitis/tenosynovitis
Flexor hallucis tendonitis/tenosynovitis
Achilles tendonitis/tenosynovitis
Peroneal tendonitis/tenosynovitis
Retrocalcaneal bursitis
Haglund deformity
Tarsal coalition
Thickening of posteromedial ankle capsule
Tarsal tunnel syndrome
Osteochondral lesions of talar dome (medial)
Shepherd fracture (acute fracture of the posterolateral process of the talus)
Ganglion cyst
Osteoarthritis

158
Q

Management inc PT exercises + when to refer to surgeon for ankle impingement syndrome

A

Relative rest, avoid provoking activities
Ice
NSAIDs
Steroid shot +/- LA
Shoe modifications, heel lifts, orthotics

PT
Range of motion exercises, proprioceptive (balance) training, and strengthening exercises to improve ankle stability
Address core/gluteal weakness.
Modalities: electrotherapy, transcutaneous electrical nerve stimulation (TENS) unit, deloading taping, soft tissue massage

Refer to surgeon if 6mo failed conservative therapy
Surgical excision of os trigonum or other debridement

159
Q

Prevention of ankle impingement syndrome

A

Good technique w/ ballet - “forcing turnout” can predispose to this
Preventing recurrent ankle sprains
Early exercise protocol for acute ankle sprain
Proper rehabilitation, including ankle strengthening, range of motion, and proprioception
Proper footwear/orthotics

160
Q

What is Sever’s dz?

A

Apophysitis at insertion of achilles tendon into calcaneus in teens
Overuse syndrome

161
Q

RF for Sever’s dz

A

Occurs during growth spurts (9-12 y/o)
Males more common
Common in repetitive running + jumping
Hard surface running

162
Q

Sx of Sever’s dz

A

Heel pain worse w/ activity
Can be uni or bilateral

163
Q

Physical for Sever’s dz

A

No swelling or ecchymosis
Pain w/ single heel rise test (Sever sign)
Tenderness with medial and lateral compression of the calcaneus (heel squeeze test)
Tenderness at Achilles insertion on heel

164
Q

DDx for Sever’s dz

A

​​Nerve entrapment (plantar)
Neuroma (plantar)
Plantar fasciitis (plantar)
Heel pad syndrome (plantar)
Calcaneal stress fracture (plantar)
Peroneal tendinopathy (midfoot/lateral)
Sinus tarsi syndrome (midfoot/lateral)
Tarsal tunnel syndrome (midfoot/medial)
Achilles tendinopathy (posterior)
Haglund deformity (posterior)

165
Q

Management + time frame for recovery of Sever’s dz

A

Rest, reduce activity
Ice, NSAIDs
Heel lifts
Stretching calf muscles
Strengthen ankle plantar flexors once pain free
Persistent pain may require 3-4 wk immobilization
Correct any biomechanical abnormalities

Time frame for recovery
6-12mo, sometimes sx persist up to 2 yrs

166
Q

What is Haglund’s deformity?

A

Prominence of posterior superior calcaneal tuberosity

167
Q

What is Haglund’s disease?

A

Retrocalcaneal bursitis, insertional Achilles tendinitis, and pre-Achilles (superficial) bursitis. These occur due to compression of the distal Achilles tendon and the surrounding soft tissues.

168
Q

RF for Haglund’s disease

A

Common in hockey players, sports w/ shoes w/ stiff/ closed heels
Heel varus
Pes cavus
Rigid plantarly flexed 1st ray
Rigid or poorly shaped heel counters
Tight Achilles tendon

169
Q

Ix for Haglund’s disease

A

Bilateral foot XRs

170
Q

Management of Haglund’s disease

A

Open heel shoes
Ice, NSAIDs
Soft tissue massage
Achilles stretching
Orthotics, heel pads
Immobilisation boot
Can refer for surgery

171
Q

Types + characteristics of sesamoid injury/ dysfunction

A

Stress fractures:
Most common sesamoid pathology
More common in athletes than in general population

Sesamoiditis:
General term that encompasses multiple conditions including osteonecrosis, chondromalacia, or inflammatory changes
Usually involves the medial (tibial) sesamoid

Acute fracture:
Typically caused by forced dorsiflexion
Often, a transverse fracture line is seen on imaging with sharp edges

172
Q

RF for sesamoid injury

A

Repetitive, forceful dorsiflexion, or loading (pushing off) of the MTP joint
At-risk sports include dancing (especially ballet), running, gymnastics, volleyball, basketball, high-impact aerobics, and soccer
Asymmetrical sesamoids
Overpronation
Playing on artificial turf
Wearing shoes without adequate forefoot support (i.e., high heels)

173
Q

Sx of sesamoid injury

A

Gradual onset of pain on the plantar surface of the 1st hallux
Pain with dorsiflexion or weight-bearing
Unilateral symptoms are typical.
Pain typically is located at the medial sesamoid.
Acute fracture usually occurs with a history of hyperextension injury of the big toe

174
Q

Physical for sesamoid injury

A

Tenderness with direct palpation of the sesamoids ± swelling or ecchymosis
Pain with resisted plantarflexion of the 1st hallux
Pain with passive dorsiflexion of the 1st MTP
Pain with “pushing off” while walking or running
Decreased range of motion and/or strength of the 1st MTP

175
Q

Ix for sesamoid injury

A

XR (AP, lateral, medial + lateral oblique (wt bearing)
Axial view of 1st MTP in dorsiflexion
CT or SPECT best for #

176
Q

Management of sesamoiditis or stress #

A

Sesamoiditis or stress fracture/nonunion:
Initially, conservative therapy is recommended for at least 4 to 6 wk
Relative rest with immobilization by offloading the 1st MTP complex with orthotics or rocker sole shoes (forefoot unloader shoe), a dancer’s pad, or metatarsal bar; taping the great toe in plantarflexion may be considered for severe symptoms
Ice
NSAIDs
Rarely, injections with corticosteroids can be considered
Avoid wearing high-heeled shoes

Long-term treatment includes:
Correction of any mechanical abnormalities with the use of taping, orthotics, or a stiff-soled shoe to limit dorsiflexion of the 1st MTP joint.
Eliminating or minimizing the stressing activity
Surgery, usually to excise the sesamoid, to treat prolonged symptoms despite several months of conservative management

177
Q

Management of acute sesamoid #

A

Non–weight-bearing immobilization with a short leg cast/ankle foot orthosis (AFO) for 6 to 8 wk, followed by protected weight-bearing in cast/AFO for 4 to 6 additional weeks
Open reduction and internal fixation or percutaneous fixation are surgical options

178
Q

Complications of sesamoid injury

A

Nonunion of fractures
Development of stress fractures or avascular necrosis in untreated sesamoiditis

179
Q

RF for tibialis posterior tendon rupture

A

More common in older adults

180
Q

MOI of tibialis posterior tendon rupture

A

The mechanism is typically an eversion ankle injury instead of the more common inversion ankle injury.

181
Q

Sx of tibialis posterior tendon rupture

A

Pain
Medial ankle bruising and swelling

182
Q

Physical for tibialis posterior tendon rupture

A

Antalgic gait
Asymmetric pes planus (more severe on affected side)
Loss of normal alignment of the heels when standing on toes (normal is calcaneal varus alignment)
Weakness with resisted inversion
Medial ankle bruising and swelling

183
Q

Ix for tibialis posterior tendon rupture

A

US to confirm dx

184
Q

Complications of tibialis posterior tendon rupture

A

Can lead to severe arch collapse

185
Q

Management of tibialis posterior tendon rupture

A

Refer to ortho for surgery

186
Q

RF for tibialis posterior tendinopathy

A

Recent increase or change in training or type of activity
Surgical or accidental trauma to the foot
60% of cases in patients >50 yr of age associated with hypertension (HTN), diabetes, and obesity; no association of these factors with younger patients
Severe pronation of the foot with planovalgus foot deformity
Association with rheumatoid arthritis and seronegative inflammatory disease
Prior exposure to steroids; local injection reported as a possible cause of rupture

187
Q

Sx of tibialis posterior tendinopathy

A

Pain along the length of the posterior tibialis tendon, particularly near the medial malleolus
May relate to a recent change in activity frequency, type, and intensity
Medial arch pain
Occasional radiation of pain into the medial calf area
Symptoms usually worsen with prolonged or strenuous activity, especially activities with a strong push-off motion.
Initially painful but normal heel raise progressing to gait changes and inability to toe-raise

188
Q

Physical for tibialis posterior tendinopathy

A

Tender posterior tibialis tendon, especially posterior to the medial malleolus
Medial ankle and possible foot swelling
Flattened longitudinal arch compared with unaffected foot
Increased hindfoot valgus and “too many toes sign,” where more toes are seen laterally when viewing the patient from behind (late finding)
Single-limb heel-rise test: Patient stands on affected foot and attempts to rise up on the ball of the foot while the other foot is off the ground. With tendinopathy, patients will be able to raise the affected heel, although with pain. Repetitive heel raises may show some weakness and pain in the tendon with persistent valgus hindfoot position through the toe raise.
Tendon strength testing: foot plantarflexed and everted, then resist patients attempt to invert the foot (Avoid dorsiflexion because anterior tibialis may help to invert the foot.)

189
Q

Management of tibialis posterior tendinopathy

A

Stage 1 + 2
Unloading: over-the-counter (OTC) or custom orthotics for medial arch support; relative rest (cross-training—pool running or swimming as tolerated). It is preferred to use an orthosis with ankle stirrup support and medial longitudinal arch support
Reloading: controlled reloading with focused concentric or eccentric exercises, transition to weight-support training (treadmill in pool) and weaning from unloading braces or orthotics.
3-4mo therapy needed

If fixed hindfoot deformity present = need surgery

190
Q

What is Freiberg’s dz?

A

Osteonecrosis of superior portion of metatarsal head
Commonly in teens

191
Q

Sx of Freiberg’s dz

A

Dull, aching pain over metatarsal head
May have reduced ROM
Pain worse w/ activity + wt bearing

192
Q

Physical for Freiberg’s dz

A

Tenderness over metatarsal head

193
Q

Ix for Freiberg’s dz

A

XR - joint space widening then flattening + collapse
Bone scan

194
Q

Management of Freiberg’s dz

A

Restrict wt bearing
Rest
Heals in 6-12 wks
Surgery if failed conservative therapy

195
Q

How to measure rating of perceived exertion?

A

Subjectively rate how hard you’re working using Borg scale, where six is no effort and 20 is maximal exertion.

196
Q

How to measure maximum heart rate?

A

208 - (0.7 x age)

197
Q

What is a MET

A

Metabolic equivalent
MET is defined as the energy cost of sitting idly and is equivalent to caloric consumption of 1 calorie/kg/hour

198
Q

Describe mitral valve prolapse

A

Most common congenital valve disorder
Affects 5% population
Most people asymptomatic

199
Q

When would you be concerned re SCD in people with mitral valve prolapse?

A

Low risk of SCD unless hx of syncope, ventricular arrhythmias, family hx of SCD, chest pain during exertion or mod-severe mitral regurg

200
Q

Describe congenital long QT syndrome

A

Inherited autosomal dominant
Abnormalities in K+ or Na+ channels
Adrenergic surges provoke arrhythmia

201
Q

What sport can commonly cause SCD in pts with congenital long QT syndrome?

A

Swimming d/t adrenergic surge associated w/ diving into cold water

202
Q

Sx of congenital long QT syndrome

A

Palpitations, dizziness, syncope

203
Q

How to manage congenital long QT syndrome in athletes

A

Avoid sports w/ adrenergic surge
Rx w/ BB

204
Q

Describe presentation + dx of myocarditis

A

Febrile illness w/ coryza prodrome, CP, palpitations
Raised troponin, non specific ECG changes (ST + T wave abnormalities)

205
Q

Management of myocarditis in athlete

A

No strenuous exertion or sports for 6mo

206
Q

Describe WPW

A

Accessory conduction pathway between atria and ventricles
Predisposes pt to re-entrant supra-ventricular tachycardia - can switch to VFib

207
Q

Describe ECG changes for WPW

A

Short PR interval
Delta wave (slurred upstroke of QRS)

208
Q

How to treat WPW + when to RTP

A

Radiofrequency ablation of accessory pathway
3mo post op

209
Q

Describe Brugada syndrome

A

Genetic disorder causing sodium ion channel dysfunction
Higher incidence in Asians

210
Q

Describe ECG changes in Brugada syndrome

A

ST elevations in V1-3
Inverted T waves
Gradually descending ST wave

211
Q

Management of Brugada syndrome

A

High risk of VFib so no sports
Implantable defib

212
Q

RTP for atrial flutter

A

If no flutter in 3mo can RTP
If co-existing structural heart defects, okay to do low risk sports
If ablation or surgery + no heart defects, RPT 2-4 wks

213
Q

What is Marfans syndrome?

A

Autosomal dominant collagen disorder

214
Q

What are the cardinal features of Marfans?

A

Aortic root aneurysm + dislocated lenses

215
Q

What are the stigmata of Marfans syndrome?

A

Thumb sign - entire distal phalanx extends beyond ulnar border of palm when thumb fully extended
Wrist sign - grasp wrist + thumb covers entire nail of 5th finger
Pectus carinatum or excavatum
Hindfoot valgus with forefoot abduction
Pes planus
++ Tall
Severe myopia
Spontaneous pneumothorax
Striae
Mitral valve prolapse
Aortic regurg
Dissection of ascending aorta
Scoliosis or kyphosis
Reduced elbow extension
Arachnodactyly
High arched palate
Long, narrow head
Span to height >1.05 (arm span>height)

216
Q

RTP w/ Marfans

A

Athletes can participate in low to moderate dynamic sports unless they have severe mitral regurg, aortic root dilatation or aortic dissection
Should not participate in wt lifting or contact sports

217
Q

Complications of Marfans

A

Aortic dissection or aortic rupture
Aortic valvular insufficiency owing to aortic root dilatation
Mitral valve insufficiency, often associated with myxomatous change
Bacterial endocarditis
Spontaneous pneumothorax
Retinal detachment

218
Q

Sx of measles

A

Acute, viral, resp illness
Prodrome of fever + malaise
Cough, coryza, conjunctivitis
Koplik spots on buccal mucosa then generalised maculopapular rash

219
Q

Infectivity period in measles and + complications

A

Infectivity
Contagious 4 days before + after onset of rash
Incubation 1-3 wks

Complications - encephalitis

220
Q

Infectivity, sx + complications of mumps

A

Infectivity
Viral infection involving parotid gland
Sx 2-3 wks after exposure

Sx
Swollen, painful parotid glands, fever, HA, weakness, fatigue, myalgias

Complications
Orchitis, pancreatitis, oopheritis, mumps encephalitis, hearing loss

221
Q

Cause + transmission of Zika, + sx

A

Transmitted by aedes mosquito (same as dengue fever)
Can be transmitted via sex - wait 8 wks (female) or 6mo for men (lasts longer in semen)

Fever, rash, joint pain

222
Q

Complications + prevention of Zika

A

Can lead to Guillain-Barre
Causes microcephaly if passed to fetus

Long sleeved clothes, insect repellant w/ deet, don’t go to areas while pregnant, mosquito bed at night, safe sex practices

223
Q

Causes of traveler’s diarrhea

A

viral (rotavirus, norovirus), E coli, salmonella, shigella, cryptosporidium, giardia, campylobacter

224
Q

What are the four most common MRI sequences?

A

T1 weighted : provides Sharp and atomic detail, good for meniscal pathology, lacks sensitivity to detect soft tissue injury
Proton density, weighted: good for menisci and ligaments
T2 weighted: highly sensitive for soft tissue injury, especially tendons
STIR: highlights access water which can occur due to bone stress, joint fluid and soft tissue pathology. Imaging of choice for subtle fractures.

225
Q

What are the phases of muscle loading?

A

Concentric - muscle tensioning + shortening at same time
Isometric - muscles tensioned and contracted but no movement
Eccentric - muscles acting while lengthening to control or slow down muscle

226
Q

Food sources of vitamin D

A

Portobello mushrooms, salmon, mackerel, tuna, sardines, egg yolk, liver, dairy

227
Q

Food sources of B12

A

Liver, sardines, lamb, salmon, eggs, milk, cheese, nutritional yeast.

228
Q

Food sources of calcium

A

Sardines, dairy, tofu, white beans, kale, bok choy, almonds, broccoli

229
Q

Food sources of magnesium

A

Spinach, brown rice, macro, dark chocolate, pumpkin seeds, almonds, black beans, avocado, yoghurt

230
Q

Food sources of potassium

A

Avocado, spinach, sweet potato, tomato paste, salmon, tuna, dried apricot, white beans, banana

231
Q

Food sources of iron

A

Liver, beef, sardines, turkey, lentils, tofu, beans, dark chocolate, spinach, pistachios, quinoa

232
Q

Food sources of zinc

A

Oysters, lamb, beef, lentils, chickpeas, cashews, yoghurt, mushrooms, spinach, chicken

233
Q

Carb strategy day before, after and on match day

A

Day before: high glycaemic index carbs
Breakfast day of: low glycaemic index carbs
Pre-match: low glycaemic index carbs 3 to 4 hours before match
During match: high glycaemic index drinks or gels
Post match: high glycaemic index food and drink for several hours
Day after: high glycaemic index food and drinks

234
Q

Pros and cons of casein protein

A

Slow release protein can increase muscle protein synthesis overnight if taken before bed, protein has been shown to be better and taken regularly

235
Q

Pros and cons of whey protein

A

Protein is essential for muscle protein synthesis, unnecessary if sufficient protein is consumed in diet

236
Q

Pros and cons of Creatine

A

Improve speed, strength, power and high intensity exercise capacity. Can increase mass which may not be wanted, can possibly increase cramping

237
Q

Pros and cons of Caffeine

A

Prolong endurance performance, increase lipid oxidation, increase mental alertness
Side effects like nausea, headache, tremors

238
Q

Potential nutritional concerns and actions needed for vegan athletes

A

Below energy intake, low protein intake, low B12, low iron, low calcium, low vitamin D
Educate about risk of nutrition deficiencies, full dietary review, consider B12 supplement, consider creatine supplement, may need labs

239
Q

Potential nutritional concerns and actions needed for injured athlete

A

Loss of lean muscle mass, increasing body fat, increased inflammation
Increase protein intake, consider omega-3 supplements, consider collagen supplements if bone, ligament or tendon injury, consider calcium or vitamin D supplements if bone injury, avoid alcohol intake

240
Q

Potential nutritional concerns and actions needed for travelling athlete

A

Becoming ill, lack of appropriate food, danger of meat contamination, dangerous drinking tapwater
Promote and sanitisation, plan ahead and take food for flight, stay hydrated on flight

241
Q

Potential nutritional concerns and actions needed for athlete with allergies

A

Risk of allergic reaction
Ensure team is aware, label food accurately with allergens, consider referring to allergist for confirmation

242
Q

Potential nutritional concerns and actions needed for athlete with minor illness

A

Performance impaired, potential spread illness, reduced appetite, dehydration
Considers zinc, lozenges and vitamin C, consider electrolytes, consider using smoothies if appetite suppressed, increased hand sanitisation for whole team

CASEM (13 decks)

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