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Medical And Dermatological Considerations Flashcards

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1
Q

What condition accounts for ~50% of all deaths in sports in those less than 35 years?

A

Sudden Cardiac Death

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2
Q

What condition accounts for the majority of Sudden Cardiac Deaths?

A

Hypertrophic Cardiac Myopathy

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3
Q

What is the most common symptom of Hypertrophic Cardiac Myopathy?

A

Exertional dyspnea is most common reported symptom. Often asymptomatic (55-80%).

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4
Q

Which of the following conditions has a genetic contribution: Hypertrophic Cardiac Myopathy, Coronary Artery Anomalies, Myocarditis, Marfan Syndrome, Sickle Cell Trait?

A

HCM, MS, SCT

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5
Q

What test can be used to confirm Myocarditis?

A

Endomyocardial biopsy (gold standard). Also can use ECG

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6
Q

What is Marfan syndrome? How does it affect the cardiovascular system?

A

A connective tissue disorder. Cardiac changes = dilation of aorta, valve prolapse, proximal pulmonary artery enlargement

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7
Q

What serious conditions are more likely to occur in those with Sickle Cell Trait due excessive exercise in hot and humid environments?

A

Heat related illness, rhabdomyolysis, splenic infarct, renal dysfunction and vascular occulusions

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8
Q

What serious cardiovascular conditions would exclude those athletes from high intensity, competitive sport?

A

Hypertrophic Cardiac Myopathy, coronary artery anomalies, Marfan Syndrome (depends on cardiac function and aortic size - low to moderate competitive sports may be allowed)

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9
Q

What are the signs and symptoms of Exertional Rhabdomyolysis?

A

-Painful, swollen muscles -Excessive weakness -Altered gait -Brownish urine (inc creatine kinase levels = can lead to acute renal failures = EMERGENCY)

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10
Q

What condition can splenic infarct be a result of? What are the signs and symptoms of splenic infarct?

A

-Sickle Cell Trait -Severe muscle cramping -Collapse -Epigastric pain -Nausea

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11
Q

What is the RETURN TO PLAY guideline for post EXERTIONAL RHABDOMYOLYSIS?

A

-Post hospital D/C - avoid exertion for 2 weeks -Progress through 3-week long phases (stretching and light aerobic progressing to light resistance activity) -VERY SLOW recovery due to increased risk for recurrence for weeks to months *requires consistent monitoring and medical management

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12
Q

What is a likely mechanism for Exercise Induced Bronchospasm? (Not exercise or asthma)

A

Dry, cool air

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13
Q

What test is used to diagnose Exercise Induced Bronchospasm?

A

Forced Expiratory Volume in 1 sec-> if reduced by 10% = positive (tested pre and within 30 min post exercise)

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14
Q

Other than short term b2-agonists and other medications, what is one way to reduce the incidence of Exercise Induced Bronchospasm ?

A

Warm up - breathe through nose

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15
Q

What are some guidelines to prevent hypoglycemia?

A

-Consume CHO pre-exercise if blood glucose <100mg/dL -Decrease insulin 25-50% 1-2 hours per-exercise AND 50% at meal preceding exercise (NATA recommendation)

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16
Q

What are the signs and symptoms of hypoglycemia?

A

Mild= Headache, dizziness, hunger, tremors, anxious, tachycardia Severe = confusion, blurred vision, loss of motor control, seizures, aggressive behavior, LOC

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17
Q

What are the treatment guidelines for an athlete with mild hypoglycemia?

A
  1. If <100 mg/dL, provide 15-20 grams of simple CHO 2. Wait 15 min - recheck glucose and if <100, give another 15-20 gram serving 3. Repeat every 15 min *if levels don’t increase =EMS *if levels return to normal = follow up with meal or snack
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18
Q

After activating EMS for an athlete suffering from a severe case of hypoglycemia (unconscious), what actions should you take?

A

Inject glucagon - buttock, thigh or arm - per manufacturers instructions

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19
Q

What are the signs and symptoms of hyperglycemia?

A

Nausea, dehydration, altered cognition and/or lethargy, fruity breath (with keto acidosis) Treatment = non CHO hydration

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20
Q

What activities should be avoided with the pregnant athlete?

A

Activities with increased risk of: falling, collision *supine activities after 1st trimester (compression of inferior vena cava)

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21
Q

What measures should be utilized to guide exercise prescription with the pregnant athlete?

A

HR (vs RPE) -> HR target <20 yrs = 140-155 (goes down 5 every decade)

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22
Q

What is the primary concern with athletes returning to play post MONONUCLEOSIS diagnosis?

A

SPLENOMEGALY = can rupture from return to contact sports RTP = gradual When asymptomatic and normal energy level = RTP min 3 weeks post symptom onset (4 weeks for contact sports)

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23
Q

Which layer of skin is responsible for regulating body temperature and HOW?

A

-Dermis -regulated via ANS -sweat glands secrete fluid with cooling via evaporation -superficial capillaries dilate/constrict to increase/reduce heat loss

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24
Q

What is the primary function of the EPIDERMIS?

A

protects - barrier against external environment

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25
Q

What is the primary function of the SUBCUTANEOUS LAYER?

A

-insulate and help with temperature regulation

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26
Q

What factors increase RISK for developing BLISTERS? What areas of the body are these more common?

A
  • Risks = moist skin, poor fitting equipment, increased temp, increased intensity and duration of activity - Areas = distal extremities where skin is thicker (palmas soles)
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27
Q

How should BLISTERS be TREATED?

A

-Small = leave intact; cover to protect (second skin, moleskin) -Large = clean, drain (leave skin roof), clean (antibiotic ointment), use donut pad to protect -Large with skin flap = remove flap, clean (soap and water), antiseptic, cover (occlusive dressing),

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28
Q

What are some methods for PREVENTING blisters?

A

-Keep skin dry (double up socks, talcum powder, moisture wicking material) -break in shoes/equipment gradually -proper fitting equipment

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29
Q

What is another term for HYPERKERATOSIS? What is is?

A
  • Callus -thickening of epidermal layer of skin due to friction
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30
Q

How should CALLUSES be treated?

A
  • if not painful - leave alone - if painful or excessive = soak, puma stone/emery file, urea cream/salycytic acid
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31
Q

What are CORNS? How are they managed?

A
  • hyperkeratosis at focal areas (usually bony prominences) -proper fitting footwear, correct poor mechanics, control excessive sweating
32
Q

What is INTERTRIGO? How does it present? How is it treated? How is it prevented?

A

-Chafing - skin rubbing together with other skin or material (e.g., shirt) -S+S = red plaques; red, raw skin in advanced case - TX = clean skin, OTC corticosteroid (for inflammation); refer if advanced (possible infection) -Prevent = decrease friction (loose, soft clothing), keep skin dry (talcum powder, petroleum jelly)

33
Q

What is ACNE MECHANICA? How is it managed?

A

-acne due to: heat, increased pressure, repetitive forces on skin (due to tight uniforms/equipment) -TX = remove/modify irritant, refer to dermatologist

34
Q

What is AURICULAR HEMATOMA?

A

-blood pools between skin and cartilage of pinna (anteriorly) due to direct trauma -TX = may be left alone (may lead to infection ,necrosis) OR can drain (aspirate OR catheter, incision if larger, or 2-7 days post injury)

35
Q

Define and classify each type of wound: Laceration, Abrasion, Avulsion, Puncture, Contusion

A
  • Laceration = tearing of skin (uneven borders) - Abrasion = friction trauma where top layer of skin is sheared off - Avulsion = skin torn off (partial or complete) - Puncture = piercing of skin - Contusion = direct blunt force to skin causing hematoma
36
Q

Which wounds should be referred to MD?

A

Laceration, Puncture (increased risk for infection), Avulsion (with full thickness tear)

37
Q

What is the common treatment for all wounds?

A
  • Clean (soap and water), dressing * abrasion = topical antibiotics if bad (monitor for infection) * contusion = PRICE
38
Q

What types of sports have the highest skin infection incidence? Give one example.

A

Contact sports (wrestling ~ 73.6%)

39
Q

What is bacteria? What are the two most frequent pathogens causing skin infections?

A
  • Bacteria = single cell prokaryotic microorganisms (no membrane encloses nucleus) - staphylococcus and streptococcus
40
Q

What is the cause of IMPETIGO (bacterial infection)? What part of the skin is infected? What are the 3 variants of IMPETIGO?

A
  • Poor hygiene - epidermis - NON-BULLOUS (kids- face, nose, mouth and extremities; honey coloured lesion) - BULLOUS (trunk, buttocks; “arch” looking lesion) - ECTHYMA (affects dermis; “punched out” lesion; may have systemic symptoms - fever, malaise, pruritis/itching)
41
Q

Who is at increased risk for ERYSIPELAS (bacterial infection)? What treatment is recommended for this condition?

A
  • Athletes who have trauma/friction injury that hasn’t been treated properly (clean, dressed) - Penicillin
42
Q

Which bacterial skin infection is commonly seen on SKIN FOLDS? What diagnostic tool is used to identify this condition?

A
  • Erythrasma - Wood’s Lamp (UV light = organism is fluorescent coral, red)
43
Q

What is the difference between bacterial infections FOLLICULITIS, FURUNCLES, CARBUNCLES, SKIN ABCESS?

A
  • Folliculitis = infection of hair follicle at epidermis - Furuncles = infection of hair follicle at dermis, subcutaneous tissue (with abscess) - Carbuncles = collection of furuncles (drain from many follicles) - Skin Abscess = pus collection in dermis and deep layers
44
Q

How is FOLLICULITIS, FURUNCLES, CARBUNCLES, SKIN ABCESS treated?

A
  • Folliculitis = abstain from shaving, usually spontaneous recovery (persistent = topical antibiotics; if widespread = oral)
  • Other conditions = if small –> warm compress to encourage drainage; if large –> incision, drain, antibiotics (oral)
45
Q

How long does it take for HOT TUB FOLLICULITIS (bacterial infection) to appear after exposure to pool/hot tub not properly treated? How long does it take to clear up?

A
  • ~48 hours - ~1 week
46
Q

What is the NAME of a bacterial INFECTION of the tissue around a nail? How is it TREATED?

A
  • Paronychia - TX = warm saline solution, topical anti-bacterial, incision and drain (if purulent)
47
Q

CELLULITIS (bacterial infection): how is it acquired? Who is at increased risk of developing it?

A
  • Pathogen enters break in the skin and colonizes - Immunocompromised, DM
48
Q

What are the signs and symptoms of CELLULITIS (bacterial infection)? How is it treated?

A
  • red, swollen, glossy, warm and pain to touch - TX: keep skin hydrated (reduce cracking); elevate to control edema; refer to MD
49
Q

Which organism causes most of the common FUNGAL SKIN INFECTIONS?

A
  • DERMATOPHYTOSIS - requires keratin to grow - “Ringworm” when it affects hair and skin
50
Q

What bacterial skin infection presents initially with a single painful deep nodule that can rupture and form abscess (that drains purulent material)? How is it classified/graded? Is is a bacterial condition?

A
  • Hydradenitis Suppurativa - Hurley Staging System - Not bacterial *refer to MD
51
Q

How does OTITIS EXTERNA (bacterial infection) present? How is it caused?

A
  • inflammation of external auditory canal, auricle (sometimes infected); pain when pulling on ear - caused by: water polluted with bacteria; scratching or sticking foreign objects in ear
52
Q

What are some TREATMENTS for OTITIS EXTERNA (bacterial infection)? How can it be prevented?

A
  • TX = acetic acid or eardrops (antibiotic or steroid); AVOID GETTING EARS WET - Prevent = don’t stick objects in ears; clear ears of water after swimming; use ear plugs when swimming
53
Q

Why should you always REFER TO MD with athlete suspected of skin bacterial infection?

A
  • any bacterial infection can be methicillin resistant and IF NOT TREATED PROPERLY = FATAL
54
Q

How is MRSA transmitted?

A

Skin to skin contact; increased susceptibility with broken/injured skin

55
Q

What are some precautions to take to prevent spread of skin BACTERIAL INFECTIONS among athletes?

A
  • Cover skin lesions - clean and DISINFECT showers, weight rooms, mats - encourage showering after competition, practices - Don’t share uniforms, towels, equipment (and clean in hot water) - Report skin lesions to medical personnel immediately
56
Q

What skin VIRUS presents as small pearly papules, usually <20 in athletes? How is it acquired?

A
  • MOLLUSCUS CONTAGIOSUM - spread via skin to skin contact OR if towels/equipment infected
57
Q

What VIRUS is responsible for COMMON WARTS (verracuae vulgaris, plantaris)? What is a hallmark sign?

A
  • HPV - “black seeds” (when paired with blade)
58
Q

List some different TREATMENT OPTIONS for common warts.

A
  • cryotherapy (liquid nitrogen) - debride and use salicylic acid - silver nitrate (topical) * per MD decision
59
Q

How is HSV transmitted? How does it travel through the body and where is it stored?

A
  • Herpes simplex Virus = contact with active infected area - travels via sensory nerves; stays dormant in neural ganglia
60
Q

What type of HERPES affects the head, face and upper body? What are the signs and symptoms?

A
  • Gladitorum (wrestlers herpes or mat pox)- a form of HSV-1 - S+S = painful vesicular lesions that ulcerate
61
Q

What is the GOAL of treating HSV? How is it treated?

A
  • Goal of treatment = decrease duration, decrease transmission - Anti-viral therapy within 48 hours - can treat symptoms with antibiotics
62
Q

Which organism causes most of the common FUNGAL SKIN INFECTIONS?

A
  • DERMATOPHYTOSIS
  • requires keratin to grow
  • “Ringworm” when it affects hair and skin
63
Q

What is a disorder caused by FUNGI that affects the nail?

A
  • OMYCHOMYCOSIS
64
Q

What are two primary testing methods for diagnosing FUNGAL infections of the skin?

A
  • KOH preparation
  • fungal culture
65
Q

What is the difference between TINEA - capitis, corporis, cruris, unguium, pedis?

A
  • CAPITIS (scalp, hair; contact with pillows, hats, combs; associated with poor hygiene) - CORPORIS (direct contact or contact with contaminated objects; red ring-shape) - CRURIS (“jock itch”; males>females; red patches) - UNGUIUM (nail; thick, yellow, lifting of nail) - PEDIS (“athletes foot”; pruritis/burning, scales or blisters; common b/t digits)
66
Q

What is a recommendation for those athletes with TINEA CORPORIS?

A
  • Avoid practice, matches to avoid spreading
67
Q

How do you treat FUNGAL infections?

A
  • Topical (cream) or oral anti-fungal medications
68
Q

What determines how much UV light is required to burn skin (melanin)?

A
  • How much melanin (color) - distance from sun - medications that increase sensitivity to sun (NSAIDs, tetracycline antibiotics)
69
Q

What are the different types of SUNBURN?

A
  • superficial - superficial partial thickness - deep partial thickness (blistering)
70
Q

How should SUNBURNS be treated?

A
  • Relieve symptoms (aloe, cold compress, NSAIDs)
  • Refer to MD if signs of infection (pussy discharge, temp >100.4 deg
71
Q

Why is it important to RECOGNIZE and correctly REMOVE TICKS? How should they be REMOVED?

A
  • Ticks feed for hours to transmit disease (Lyme)
  • Use FINE tweezers; get close to skin; pull FIRM but GENTLE

* Monitor S+S = if systemic illness, neuro symptoms, paresthesia, paralysis –> refer to MD

72
Q

How are MOSQUITO BITES treated?

A
  • Antihistamines = stop allergy symptoms (i.e., Benadryl)
  • Corticosteroids (more serious cases)
73
Q

How are BEE/WASP STINGS treated?

A
  • Remove stinger
  • Cold compress, wash skin, topical anesthetic (maybe)

*IF ALLERGIC = EPI-PEN and REFER TO MD

74
Q

What are the two types of CONTACT DERMATITIS?

A
  • Allergic: allergen contacts skin -> hypersensitivity rxn (i.e., poison ivy)
  • Irritant: disruption of skin via substance (environmental - cold, water; chemical - acids, alkalis) = causes inflammation
75
Q

What are the signs and symptoms of ALLERGEN CONTACT DERMATITIS

A
  • Usually PRURITIS (itching), and red plaques
  • May start 24-48 hours after exposure

*symptoms vary depending on irritant

76
Q

How should you TREAT Contact Dermatitis?

A
  • REMOVE from ALLERGEN/IRRITANT
  • Clean with soap and water
  • Topical corticosteroids (allergen and irritant)
  • Moisturizers PRN (irritant)
77
Q

What are some PRECAUTIONS the SCS can take to prevent SKIN INFECTIONS in athletes?

A
  • Good hygiene (showering after activity)
  • Frequent hand washing
  • Uniforms and clothes = launder after use
  • Clean equipment and facilities frequently
  • EDUCATE athletes and coaches (high contact sports like wrestling = check for lesions frequently)
  • Cover = dress lesions to avoid contact with others (wound or seepage)
  • HOLD athletes from competition (if can’t be covered properly AND/OR not healed); some competitions may require MD clearance

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