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Medical Conditions Flashcards

1
Q

What is the most common cause of sudden death in athletes?

A
  • Cardiac (56%)

- Followed by blunt trauma (22%)

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2
Q

What are the two most common cardiac problems causing sudden death in athletes?

A
  • Hypertrophic Cardiac Myopathy (#1 cause of cardiac death in athletes)
  • Coronary Artery Abnormalities
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3
Q

What is Hypertrophic Cardiac Myopathy? Common Symptoms?

A
  • Walls of the ventricles become thickened, reducing the pumping capacity of the heart
  • Often asymmetrical, affecting only one side of the heart
  • Typically genetic in nature
  • Symptoms include dizziness, chest pain, fainting, shortness of breath and fatigue
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4
Q

How do you screen for Hypertrophic Cardiac Myopathy? Manage it once found?

A
  • Hard to screen, 55-80 percent are asymptomatic until cardiac event
  • Family History due to genetic component
  • Manage with beta-blockers, antiarrhythmics and blood thinners
  • Athletes usually disqualified from sports regardless of management techniques
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5
Q

What are the most common coronary artery abnormalities?

A
  • Anomalous origin of the left main coronary artery and the right coronary artery
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6
Q

What are common symptoms of coronary artery abnormalities?

A
  • Usually asymptomatic

- May present with syncope, angina and cardiac arrhythmia

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7
Q

What are the American Heart Associations recommendations for pre-participation cardiovascular screening of competitive athletes.

A

• Medical history
1. Exceptional chest pain/discomfort
2. Unexplained syncope/near-syncope
3. Excessive exertional and unexplained dyspnea with exercise
4. Prior recognition of heart murmur
5. Elevated systemic blood pressure
• Family history
6. Premature death (sudden and unexpected, or otherwise)
before age 50 years due to heart disease in one relative.
7. Disability from heart disease in a close relative < 50 years of age
8. Specific knowledge of certain cardiac conditions in family members: hypertropic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
• Physical examination
9. Heart murmur
10. Femoral pulses to exclude aortic contraction
11. Physical stigmata of Marfan syndrome
12. Brachial artery blood pressure (sitting position)
* A finding of one or more warrants referral to cardiovascular
specialist.

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8
Q

What is Asthma? Symptoms?

A
  • Chronic inflammatory disease of the airways during all activities of daily living
  • Wheezing, breathlessness, chest tightness and coughing due to airway obstruction and often reverse spontaneously or with treatment.
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9
Q

What are some environmental triggers of Asthma?

A
  • Cold temperature
  • Allergens
  • Pollution
  • Tobacco smoke
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10
Q

What are the most common tests to measure Pulmonary Function?

A
  • Forced expiratory volume in one second (FEV1)
  • Forced vital capacity (FVC)
  • Peak expiratory flow rate (PEFR)
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11
Q

What are Forced Expiratory Volume in One Second, Forced Vital Capacity, and Peak Expiratory Flow Rate?

A
  • FEV1: The amount of air forcefully exhaled in one second
  • FVC: The maximal amount of expired air beyond the two second mark (usually five to six seconds)
  • PEFR: Maximal flow rate in L/sec or L/min out of the airways
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12
Q

How is dynamic function of the Lungs assessed?

A
  • FEV1/ FVC
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13
Q

How is dynamic function of lungs affected by Exercise Induced Asthma and Exercise Induced Bronchospam?

A
  • EIA and EIB are obstructive airway disorders whereby airways constrict the outflow of air
  • In these conditions, the FEV1 decreases while the FVC remains the same, causing the FEV1/FVC to decrease
  • This indicates an obstructive pulmonary disease
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14
Q

What levels of predicted FEV1/ FVC are considered normal?

A
  • 80 Percent
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15
Q

How do Obstructive pulmonary diseases differ from Restrictive pulmonary diseases when it comes to FEV1/ FVC?

A
  • Obstructive: FEV1 decrases while FVC stays same

- Restrictive: FEV1 and FVC decrease causing FEV1/ FVC to stay the same in restrictive

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16
Q

What are the Peak Flow Zones for Asthma?

A
  • Green
  • Yellow
  • Red
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17
Q

Describe the “Green” Peak Flow Zone for Asthma Management

A
  • Peak expiratory flow rate (PEFR) values are between 80 percent and 100 percent of personal best
  • No asthma management changes are necessary at this time
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18
Q

Describe the “Yellow” Peak Flow Zone for Asthma Management

A
  • PEFR values are between 50 percent and 80 percent of personal best
  • Caution is warranted; use of medication is required
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19
Q

Describe the “Red” Peak Flow Zone for Asthma Management

A
  • PEFR values are less than 50 percent of personal best

- Danger: emergency action is needed, including medication or hospital visit

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20
Q

How do you determine if management is needed in an asthma patient

A
  • Take Peak Expiratory Flow Rate (PEFR) Using a peak flow meter and compare with baseline measures
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21
Q

What are common “controller” medications used to treat Asthma?

A
  • Inhaled corticosteroids
  • Systemic corticosteroids
  • Cromones (Inhaled NSAIDS)
  • Long-acting B2-agonists
  • Therophylline
  • Leukotriene modifiers
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22
Q

What “controller” medication is banned by anti doping agencies?

A
  • Long Acting B2 Agonists
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23
Q

What do Leukotriene Modifiers do and when are they used for Asthma?

A
  • Block leukotriene receptors to control allergens, aspirin and Exercise Induced Bronchospasm (EIB)
  • Used as a second line of defense and in conjunction with other agents
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24
Q

What type of medications are used in Rescue Inhalers?

A
  • Rapid-acting B2-agonists
  • Inhaled anticholinergics
  • Short-acting theophylline
25
Q

What are the most frequently used reliever medications for treatment of chronic Asthma and EIB?

A
  • Rapid acting B2 Agonists
26
Q

Differentiate between EIA and EIB

A
  • EIA is an exacerbation of chronic asthma symptoms with onset of activity, although the athlete may also have symptoms both during exercise and at rest
  • EIB only occurs with onset of activity and no symptoms present at rest
27
Q

How do you test for Exercise Induced Asthma?

A
  • Stress Test
  • Drop of 10-15% of FEV1 after exertion confirms diagnosis
  • Can Also Use Eucapnic Voluntary Hyperventilation (EVH) Test
  • Hyperventilate a controlled mixture of gases for siz minutes
  • It is the IOC Recommended Test for prescription of bronchodilator inhalers
28
Q

What is Vocal Chord Dysfunction and How does it mimic Exercise Induced Bronchospasm?

A
  • Involuntary paradoxical adduction of the vocal chords during exercise-restricting airflow, without a specific underlying cause
29
Q

What type of individual most often suffers from Vocal Chord Dysfunction?

A
  • Female; Freshman Collegiate Athlete

- May also complain of gastric reflux disease or postnasal drip as well as high anxiety

30
Q

What are diagnostic symptoms of VCD? Treatment?

A
  • Typically a Diagnosis of exclusion
  • Should be considered if treatment for EIB is not working
  • Athletes complain of throat tightness and may have an inspiratory stridor (high-pitched wheezing)
  • Treatment requires a coordinated, multidisciplinary team including psychologists and speech and language pathologists.
31
Q

What are self management interventions for VCD?

A
  • Diaphragmatic Breathing

- Inhaling through the nose, exhaling through pursed lips

32
Q

What are the three tests and criteria for diagnosis of Diabetes Mellitus?

A
  • Fasting plasma: glucose > 126 mg/dl (7.0 mmol/L) after eight hours of fasting
  • Casual plasma glucose (any time during the day): >200 mg/dl (11.1 mmol/L)
  • Two-h plasma glucose: >200 mg/dl (11.1 mmol/L) during an oral glucose tolerance test
33
Q

What is the primary cause of Type 1 Diabetes?

A
  • cellular mediated auto-immune disorder destroying the B-cells of the pancreas.
34
Q

What are Symptoms of Hypoglycemia?

A
  • Tachycardia, sweating, hunger, palpitations, headache, trembling and dizziness
  • As glucose levels continue to drop, more significant symptoms develop, including blurred vision, fatigue, difficulty thinking, loss of motor control, aggressive behavior, seizures and loss of consciousness.
35
Q

What are the treatment guidelines for Mild Hypoglycemia (Conscious Athlete)?

A
  1. Provide fifteen to twenty grams of fast-acting simple carbohydrates (fruit juice, hard candy, pretzels, etc.)
  2. Measure blood glucose
  3. Wait twenty minutes and re-check blood glucose
  4. Repeat simple carbohydrate treatment if glucose levels are still low or symptoms remain
  5. Re-check blood glucose in twenty minutes
  6. If glucose levels do not return to normal, activate emergency medical services
  7. If glucose levels return to normal, have athlete follow up with meal or snack intake
36
Q

What are the treatment guidelines for Severe Hypoglycemia (Unconscious Athlete)?

A
  1. Activate emergency medical system (EMS)
  2. Prepare and inject glucagon
    • Provide carbohydrates if athlete regains consciousness and is able to swallow
37
Q

What are some symptoms of Hyperglycemia?

A
  • Nausea, delayed cognitive abilities, sluggishness, fatigue and slowed reaction time
  • As glucose levels continue to rise, the body may switch to fatty-acid metabolism, releasing acidic ketones
  • If so, symptoms include short rapid breath known as
    Kussmaul respiration, fatigue, a fruity odor to the breath, increased thirst (due to the changes in osmolality) and frequent urination.
38
Q

What symptoms of Hyperglycemia help determine the glycemic nature of the diabetic athlete in distress? (Hyper or Hypo)

A
  • Fruity Odor of Breath
  • Increased Thirst
  • Frequent Urination
39
Q

What are Blood Glucose Levels associated with Hypo and Hyperglycemia?

A
  • Hypo - <70 mg/dL [3.9 mmol/L])

- Hyper - >180 mg/dL [10 mmol/L])

40
Q

What are some diagnostic criteria for Metabolic Syndrome?

A 
- 3 or more of:
• Blood pressure ³ 130/85 mmHg
• Fasting blood sugar (glucose) ³100 mg/dL
• Large waist circumference
Men > or equal to 50 inches
Women > or equal to 35 inches
• Low high density lipoprotein (HDL) cholesterol:
Men< under 40 mg/dL
Women< under 50 mg/dL
• Triglycerides > or equal to 150 mg/dL
41
Q

What is Marfans Syndrome?

A
  • Genetic disorder abnormally affecting connective tissue that is often transmitted from parent to child.
  • One of the most commonly inherited genetic disorders affecting connective tissue within the musculoskeletal, CV and ocular systems.
42
Q

What are some typical Marfan Like Characteristics?

A
  • Long limbs
  • Lanky build
  • Poor muscular strength
  • May see Marfans more in sports where height is a desirable trait (basketball, volleyball, Swimming)
43
Q

What is the Triad of Pathologic Features associated with Marfans Syndrome?

A
  • Musculoskeletal changes (long limbs, loose joints, and arachnodactyly)
  • Lens dislocation (eye)
  • Aortic aneurysm (most common cause of death)
44
Q

What are some other genetic abnormalities that can present similarly to Marfans Syndrome?

A
  • Ehlers-Danlos syndrome (EDS)
  • Giantism
  • Loeys-Deitz syndrome
  • Klinefelter syndrome
  • Fragile X syndrome
45
Q

What are the common pharmacologic interventions for Marfans Syndrome?

A
  • Beta Blockers
  • Calcium Channel Blockers
  • Angiotensin Converting Enzyme
46
Q

What are best diagnostic tests for an Aortic Dissection in a Marfans Patient?

A
  • Computed tomography angiography (CTA)

- Trans esophageal electrocardiogram

47
Q

What is the most important factor in preventing early death in Marfans patients with an Aortic Aneurysm?

A
  • Surgical repair of the aorta and aortic root
48
Q

What is Ehlers Danlos Syndrome? Vascular Type EDS?

A
  • Genetic disorder affecting connective tissue
  • Symptoms include hyperextensibility, joint hypermobility and tissue fragility
  • Can affect vascular system and cause arterial and intestinal bleeding, leading to early death, and cerebral arteries can be involved, affecting cognition that can be mistaken for a drug overdose.
  • Vascular Type EDS needs to be ruled out in patients with EDS symptoms
49
Q

How is Ehlers Danlos Diagnosed?

A
  • Skin Extensibility Test

- Beighton Scale (Sensitive, may lead to false positives)

50
Q

What is the difference between partial and generalized seizures associated with Epilepsy?

A
  • Partial - Involves part of the brain

- Generalized - Involves the whole brain

51
Q

What is an Absent Seizure? (Generalized)

A
  • Subtle in nature
  • Brief (usually less than fifteen seconds)
  • Individual may stop talking in midsentence, assume staring episodes and have changes in muscle activity (hand fumbling, fluttering eyes, lip smacking, etc.)
52
Q

What is a Tonic Clonic Seizure? (Generalized)

A
  • Significant manifestation of epilepsy and involve muscle rigidity, muscle contraction and loss of consciousness.
53
Q

How do you manage a Tonic Clonic Seizure in progress?

A
  • Do not restrain individual
  • Remove potentially hazardous objects from area
  • A pad can be used to protect the individual’s head
  • A recovery position should be assumed with the individual in side-lying to make sure a clear airway is
    established if needed
54
Q

What is Status Epiliepticus?

A
  • seizure lasting for more than 30 minutes, or having two discrete seizures without recovering consciousness
  • Constitutes seven percent of all seizures admitted to ER, ten percent mortality rate.
  • Parenteral anti-convulsant medication is treatment of choice in ER
55
Q

Can Epileptics participate in Contact Sports and other sports?

A
  • Yes, but should avoid SCUBA and Skydiving
56
Q

What are the three types of Juvenile Rheumatoid Arthritis (JRA)?

A
  • Pauciarticular - 50% of cases - Less than 5 joints affected
  • Polyarticular - 30% of cases - More than 5 joints affected
  • Systemic - 20% - affects multiple systems - Heart, Liver, GI, Spleen: Highest death rate of children due to cardiac and pleural Inflammation
57
Q

What blood work should be ordered to test for Juvenile Rheumatoid Arthritis (JRA)?

A
  • Erythrocyte sedimentation rate (ESR)
  • Complete blood cell count (CBC)
  • Antinuclear antibody (ANA)
  • Rheumatoid factor (RF)
58
Q

What are some common complaints of individuals with JRA?

A
  • Chronic Joint Pain
  • Limited Function
  • Gait Deviations
59
Q

Describe Infectious Mononucleosis. Cause, Symptoms. Length of Infection, Other Side Effects

A
  • Caused by Epstein Barre Virus
  • In young adults, disease often results in fever, sore throat, enlarged lymph nodes in the neck, and tiredness
  • Most people get better in 2-4 weeks but can last months
  • May also result in enlargement of the spleen (splenomegaly) or enlargement of the liver
  • In less than one percent, splenic rupture may occur

SCS (36 decks)

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