MT Flashcards
1
Q
two main types of studies
A
descriptive (PO)
-survey and qualitative
analytic (PICO and PECO)
-experimental or observational anaytic
2
Q
what does PICO stand for?
A
patient/problem
intervention
comparison
outcome
3
Q
how to determine study design
A
Q1: descriptive (PO) or quantifying a relationship (PICO)?
Q2: random allocation? if yes, RCT, if not observational analytic
Q3: observational:
if outcomes determined after intervention: cohort/perspective
if at the same time, cross sectional/survey
if before exposure, case-control/retrospective
4
Q
randomised control trial
A
comparison study where participants are randomly assigned to treatment/intervention group or control/placebo group advantages: -unbiased distribution of confounders -blinding more likely -randomization facilitates statistical analysis disadvantages: -expensive (time and money) -volunteer bias -can be ethically problematic
5
Q
crossover design
A
controlled trial where each participant has both therapies (randomized order)
advantages:
-subjects are their own controls and error variance is reduced (smaller sample size needed)
-all subjects receive treatment
-blinding, statistical test assuming randomization
disadvantages
-all subjects receive alternative treatment or placebo at some point
-cannot be used for treatments w/permanent effects
6
Q
cross-sectional survey
A
-examines relationship b/t diseases and other variables in a population at one particular time
advantages: cheap and simple, ethical
disadvantages
-establishes association at most, not causality
-recall bias susceptibility
-confounders unequally distributed
-group sizes unequal
7
Q
case-control study
A
compares patient w/a disease to controls and determines which people have been exposed to the factor under investigation
advantages
-quick and cheap
-the only feasible method for rare disorders or long lag time b/t exposure and outcome
disadvantages
-reliance on recall or records to determine exposure
-confounders
-control group selection is difficult
8
Q
cohort
A
data from groups who have been exposed or not exxposed to new factor (from databases), no allocation of exposure made by experimenter
advantages
-ethically safe
-subjects can be matched
-can establish timing and directional of events
-standardized eligibility and outcome assesment
disadvantages
-controls may be difficult to identify
-exposure may be linked to a hidden confounder
-blinding difficult
-no randmization
-large sample size needed
9
Q
selection bias
A
error in choosing individuals or groups taking part
10
Q
measurement bias
A
poorly measuring outcome (calibration)
11
Q
interviewer bias
A
opinion or predudice or influence of the interviewer, affecting behavior
12
Q
response bias
A
respondents answer in the way they think the investigator wants them to answer
13
Q
referral bias
A
- preferences or local practices influencing recruitment
- eg more severe cases sent to academic centers
14
Q
reporting bias
A
selective reporting or suppression of information (eg publication bias against negative studies)
15
Q
sensitivity
A
of all individuals with the condition, the percentage that will test positive (true positives/all cases)
-highly sensitive tests good for ruling things OUT
16
Q
specificity
A
off all individuals who DO NOT have he condition, the percentage that will test negative
eg true neg/true neg + false pos
-highly specific good for ruling things IN
17
Q
three symptoms that could contribute to upper respiratory symptoms
A
anemia, anxiety, asthma
18
Q
what does anemia not effect?
A
saturation %: it’s number of Hb, not number occupied
19
Q
wheeze
A
strained breathing out
20
Q
stridor
A
strained breathing in
crackling sound
21
Q
what’s the difference b/t asthma and exercise induced asthma
A
- asthma is chronic and brought on by many triggers
- eg smoke, allergies, exercise could be a trigger, cold air, dry air, cats, mold
- exercised induced bronchospasm=reaction brought on by exercise
22
Q
asthma
A
chronic inflammatory disease of airways
-variable and recurring symptoms: reversible airflow obstruction and bronchospasm
23
Q
EIAB
A
intermittent narrowing of airways + decrease in airflow
-wheezing, chest tightness, coughing, dyspnoea triggered by exercise
in 50-90% of asthmatics
24
Q
how does transient airway narrowing occur?
A
thickened bronchi lining–>narrower airway
- expiration relies more on elasticity of chest wall and pressure leads to smaller airway collapse
- higher Ve leads to more water loss
- changes in airway –> inflammatory cascade and sm contraction
25
what is often the first symptom of EIB?
poor performance for given level of conditioning
| -season and climate related
26
EIB signs and symptoms
wheeze, cough, dyspnoea, chest tightness
for 1-2 hrs after exercise
-chlorine and exhaust are aggravators
27
EIB test
field test: make symptoms occur, then measure lung function
also chemical ways to trigger attack (insensitive)
and osmotic challenge, which causes drying of lungs and mimics exercise
28
eucapnic voluntary hyperpnea
mimic exercise breathing
-breathe in some CO2 so they can breathe at the same rate as heavy level
exercise
-sensitive and specific
29
treatment for EIB
- ideal activities in warm, humid environment
- extend warm-up, low to moderate intensity
- use refractory period (less risk of attack after 1 attack)
- increase intensity in steps
30
asthma treatment
stabalize w/bronchodilators, corticosteroids
| -salbutabol b/f exercise and as rescue medication
31
what should be considered when EIB treatment fails?
vocal chord dysfunction
| pulmonary embolism
32
vocal chord dysfunction
paradoxical vocal chord adduction obstructing inspiration
| -females and younger patients more common
33
vocal chord dysfunction signs and symptoms
throat tightness, stridor, chest tightness, air hunger, coughing/hoarseness
-often at very high exercise intensity
34
how is VCD treated?
treatment of aggravating factors (eg gerd, post nasal drip) may be enough
-vocal chord resynchronization w/coughing or panting, RMT?
-postural techniques and stress
management
35
pulmonary embolism
rare cause of exertional dyspnoea
axillary vein thrombosis common (more so in elite athletes and throwers) is possible
-clot goes from R side of heart through hole (20% of ppl have it)
36
thromboembolism risk factors
use of elicit substances
ritual dehydration (lightweight, boxers)
effort-induced thrombosis (trauma to vessel wall?)
37
symptoms of pulmonary embolism
- pain, swelling, numbness in distal limb
- poor exercise performance
- profound arterial desaturation during exercise
38
distinguishing factors of pulmonary embolism
no wheeze, stridor, or abnormal spirometry
| -affects blood, not lungs
39
possible adverse effects of pollution
cancer, heart disease, stroke
40
pollution componenets
gaseous: ozone, CO, oxides of N
particulate: eg diesel
41
does increased exercise intensity add to effects of pollution?
no, increases in Ve and O2 consumption at low but not high as a result of exposure
no effect on norepinephrine, endothelial function, heart rate variability
42
concussion considerations
short term impact
post concussion syndrome
dementia, parkinsons, depression/suicide
cost to professional sports teams
43
concussion
functional head injury w/symptoms that usually last a short period of time.
acute clinical symptoms reflect functional disturbance, not structural injury
may not involve loss of consciousness
44
mechanisms of concussion
direct blow to head
coup contrecoup
-whiplash motion of head results in axonal shearing and damage to neurons/release of chemicals
-acceleration/decceleration of brain w/in skull
45
final determination regarding concussion diagnosis
based on clinical judgement
* there are no grades
1. can't prove someone has it so certainly can't prove how severe
2. initial injury doesn't correlate to symptoms so grading is even more useless
46
SCAT assessment
- LOC
- balance/coordination
- disorientation or confusion
- loss of memory
- blank or vacant look
47
Maddocks score
for sideline assessment
| -questions about game + game last week
48
SCAT 3
for further assessment
-involves orientation questions (month/year/time)
concentration task (count digits or months backward)
-memory task (repeat words)
-balance test
49
when to refer to emergency
- worsening headache
- very drowsy
- can't recognize ppl or places
- significant nausea/vomitting
- confusion/irritability
- seizures
- weakness in limbs
- slurred speech or unsteadiness
- pupils would be UNCHANGED (no swelling or bleeding)
50
reasons for not returning to sports the same day
1. brain may be in state of neurometabolic crisis, increased energy demand slowing healing
2. window of vulnerability for second worse injury
51
how long does concussion recovery take?
about 10 days
symptom free w/daily activity before sports
gradual return
-go back one step if symptoms return
52
how many canadians have pre or type II diabetes
9 mil
53
legacy effect
early knowledge and control (being talked to about prevention) usually puts people in a better situation
early control results in fewer complications 10 years later
54
what's blood sugar for diabetes diagnosis
7mmol/L
55
practical advice for reducing diabetes risk
150min of exercise/week
5-7% weight loss
-reduces risk by 60%!!!
56
metabolic syndrome
elevated waist circumference + any 2 other risk factors (elevated TG, BP, or fasting glucose, reduced HDL)
57
normal values
men: <93 waist
women: <79cm waist
BP <130/85
HDL >1 for males, 1.3 for females
glucose <5.6
triglycerides <1.7
58
why is glycated hemoglobin a good measure for prediabetes diagnosis?
Hb picks up coating
59
glucose and FFA metabolism in obesity and IR
inc. adipose tissue results in increase FFA and FFA oxidation
- ->decreased glucose oxidation and increased gluconeogenesis
- ->insulin resistance
60
beta cell dysfunction
overstimulation of cells leads to overproduction of insulin
-glucose desensitization/toxicity
-lipotoxicity
-amyloid deposition
leads to beta cells crapping out and blood sugar skyrocketing
50% are gone at diabetes diagnosis
61
screening recomendations
screen ALL ppl over 40 yrs every 3 yrs
-earlier and more w/risk factors
recommend medication if 1 risk factor is present + glucose 5.6-6.9
62
long term diabetes complications
- retinopathy, neuropathy, nephropathy
- atherosclerosis
- NAFLD fatty liver/liver cirrhosis
63
short term diabetes complications
hypoglycemia, hyperglycemia
| comorbidities are hypertension, elevated cholesterol
64
targets for glycemic control
pre meal: 4-7 (6 in normal)
| 2 hours post meal : 5-10 (8 in normal)
65
vascular protection checklist
1. glycemic control
2. blood pressure control
3. cholesterol LDL less than 2
4. drugs to protect heart
5. exercise/diet
6. smoking cessation
66
nutrition basics
- more fat from things that grow and less from things w/mothers
- weight loss with IR is harder b/c it drives hunger
- NO muffins, chinese takeout, juicing, cheerios
- double veg
- plan afternoon snack
67
nutrition starting advice
1. breakfast
2. where carbs come from + labels
3. focus on biggest meal
4. for weight loss: no starch at dinner, plate, food tracking
68
areas for nutritional improvement
1. balanced meals (breakfast lunch and dinner)
2. fueling need for instant energy
3. calorie dense foods (muffins, scones, beverages)
4. eating from bordom/habit/stress
5. less filling foods (low fiber/bulk)
69
what must the body compensate for at altitude?
ambient pressure decreases, so O2 levels and saturation decrease
-50% at everest base camp
70
4 points
respiratory: increased frequency and volume
cardiovascular: increased HR and volume and increases BP
haematological: reduced plasma volume-->eventual new blood cells
renal: increased bicarbonate to acidify blood and compensate for mild respiratory alkalosis
71
acute mountain sickness
2-12 hours after ascent
- headache
- sleep disturbance, insomnia
- anorexia, nausea, vomiting
- light-headedness, dizzy
- fatique
72
AMS Risk factors
rate of ascent
exertion
obesity
possible other factors
-previous neck dissection (chemoreceptor damage)
-dehydration: poorer water quality + GI symptoms at altitude + lose water through breathing
-infection-have to melt snow
73
other possible causes of AMS symptoms
dehydration, hangover, migraine, overexertion, virus, subarachnoid hemmorhage, CO exposure
*diagnosis of exclusion
74
treatment of AMS
stop ascent until symptoms resolve
- tylenol, rest and rehydrate
- mod to severe: descent, O2, hyperbaric bag, dexamethasone (lower inflammation), acetaxolamide (doesn't work)
75
gamow bag
```
simulated descent (1600m)
by inflation
```
76
high altitude cerebral aedema
- severe end of AMS spectrum
| - AMS symptoms + lethargy, confusion, altered LOC
77
HACE treatment
```
descent
O2
hyperbaric bag
drugs
evacuation
```
78
high altitude pulmonary adema
```
onset 2-5 days
aggravated by cold and exertion
shortness of breath, bloody cough, poor exercise tolerance, tachypnoea
crackles in lungs
may be febrile
low O2 sat
```
79
HAPE risk factors
```
rate of ascent
exertion
previous history
primary pulmonary hypertension
unilateral pulmonary artery
```
80
non risk factors for altitude
```
age
gender
fitness
asthma-although other considerations like wood smoke exposure and puffer dysfuntion
hypertension
```
81
how slowly should people ascend?
300-400m/day, rest every 1000m for a day
- w/adequate hydration and not overexerting themselves
- avoid alcohol and slow descent if GI symptoms occur
82
acetazolamide
carbonic anhydrase inhibitor
- increase Ve by acidifying blood through kidneys
- MAY be good for AMS prevention
83
HAPE prevention
nifedipine 90% effective for recurrent
| salmeterol (2 puffs) 50% effective for recurrent
84
considerations for competing at altitude
- high exertion in low O2 environment-decrease aerobic capacity and poor recovery
- UV exposure
- jet lag, disturbed sleep
- increased breathing, dyspnoea during exercise
- vaccinations
- supplements and medication
85
for brief acclimatization
-overcome: dehydration and sleep deprivation
reset training intensity
-respiratory and renal acclimatization
-rule out iron-deficiency anemia and other anemia
86
diffuse cerebral edema
also secondary-impact syndrome
- post-concussive symptoms following head injury and then return to play and secondary injury
- may be fatal
87
skull fracture
not always visible
| -swelling and tenderness around impact, facial bruising, and bleeding from nose/ears
88
intracranial hemorrhage
=accumulation of blood in skull cavity
- sub, epi (middle meningeal artery) dural (bridging veins) hemmorhage
- intraventricular hemmorhage
- or hemmorhagic stroke
89
epidural hematoma
may have initial lucidity followed by decline in function
- may have LOC
- pupilary reaction changes
90
subdural hematoma
more in older adults
symptoms take longer
nausea, headache, vomiting, etc.
91
prevention of head injuries
- head gear
- technique in contact sports
- education on concussion and symptoms
92
hyperglycemia symptoms
```
flushed skin
frequent urination
irregular breathing
nausea
drowsiness
fruity breath
```
93
hypoglycemia
```
hunger
shakiness
nervousness
pallor
cool skin
sleepiness
confusion anxiety
weakness
```
94
prevention of diabetes emergencies
- wear ID bracelet
- adhere to meds
- inform other staff
- eat regular meals and snacks, hydrate
- check glucose before and during activities
95
when should a diabetic avoid exercise??
if less than 100mg/dL
| if greater than 250 w/ketones or 300 w/out
96
treatment of diabetic emergency (hypoglycemia)
if conscious: administer CHO high GI, hydrate, monitor
if unconscious-activate EMS, if trained, administer glucagon
97
c-spine suspected
- LOC
- bilateral neurological findings
- significant pain along spine
- obvious deformity
* stabalize in neutral position and maintain airways
- manually re-align if treating airway is difficult but NOT if it causes inc. pain, neurological symptoms, or mm spasm
98
what's the cause of death from head down tackling
cervical fx above C4
- vulnerable in 30deg flexion
- cause of fx=axial loading
99
exertional sickling
SCT associated with sudden death from exertional sickling collapse
**usually in heat
100
sickle cell trait
1 copy of the gene is usually benign but may be provoked w/ intense exercise, altitude, or heat
-they usually maintain normal Hb, some are affected
101
sickle cell anemia
=two copies of gene
RBC's get sickled and trapped in spleen
-spleen can't replace w/ new RBC's fast enough
-->body becomes anemic
102
sickle cell disease symptoms
painful episodes
swelling in hands and feet
joint pain
blood clots
103
prevalence of SCD
- most common inherited blood disorder
| - 1 in 12 black people have the trait, 1 in 500 the disease
104
symptoms of exertional sickling collapse
- mm WEAKNESS, not pain, which distinguishes it from heat cramps
- athletes "slump" to the ground
- initially communicative (distinguishable from grave cardiac arrhthmia)
- muscles look and feel normal (unlike locked up from heat cramps)
- rapid tachypnea from lactic acidosis but good air movement breathing
- rectal temp less than 103
105
Prevention of SC emergencies
- allow longer rest periods
- allow exclusion from intense tests or if feeling ill
- adjust work-rest cycles in heat
- hydrate and altitude
- control asthma if applicable
106
exertional heat stroke
```
rectal temp above 104 post collapse
CNS dysfunction
-headache
-confusion
-GI upset
-dehydration, mm cramps
-collapse, staggering
-profuse sweating
-rapid pulse, low BP, rapid breathing
```
107
exercising in heat
- blood transported to periphery for cooling-->central fluid deficit
- smaller SV and increased HR for given intensity
- splachnic vasoconstriction to compensate for blood going to periphery
- ->leads to GI and kidney issues
108
heat stroke treatment
- remove equipment and excess clothing
- cool via whole body immersion/towels if not available
- 911
- vitals (rectal temp)
- cease cooling when 101-102
109
RTP after heat stroke
after 1 week
longer if more severe
w/clearance and normal lab values and symptoms
graduated return
110
should you exercise w/ a fever?
no.
- mm strength and endurance decreased
- fatigue increased
- ability to regulate temp impaired
111
hyponatremia
over-hydration
| -Na<135mmol/L
112
early signs hyponatremia
bloating, puffiness, nausea, vomiting, headache
113
serious hyponatremia signs
altered mental status, obtundation, coma, seizures, respiratory distress (PE)
**should be suspected if an athlete collapses where heat is not a factor
114
hyponatremia risk factors
- excessive drinking
- low body weight
- female
- slow performance pace
- event inexperience
- NSAID use
115
treatment for hyponatremia
- if severe, 3% hypertonic saline due to risk of cerebral edema
- if not, salty foods
116
lightning
- are safe to touch and should be moved to safer environment
- ABCs, CPR and defib if needed
- then orthopedic, burn, wound, neurological assessments
117
sudden cardiac arrest risks
- personal or family history of heart disease
- congenital heart defect
- drugs that affect heart rhythm (cocaine)
- fever may be (viral infections w/fever may cause myocarditis)
- history of syncope
118
hypertrophic cardiomyopathy
- ventricle wall thickens
- may obstruct blood flow and cause disruption of electrical signals
- may be asymptomatic but have ECG abnormalities
- in in 500 ppl
119
what would be a more sensitive test for serious heart conditions?
ECG
120
Cardiac event symptoms
- unexpected collapse + unresponsive
- myoclonic jerking may be present
- occasional breathing may be present (but not normal)
121
Commotio cordis
sudden death from direct impact to chest wall that triggers a fatal arrythmia
-happens during vunerable period in cardiac cycle just before T-wave
122
female triad
- disordered eating
- menstrual dysfunction
- osteoporosis (influenced by mensstrual halt)
123
amenorrhea causes
high levels of growth hormone and cortisol
low levels of insulin and leptin
primary (delayed getting period) and 2ndary(stops for 3 mo)
124
functional hypothalamic amenorrhea
loss of period from lack of energy
| -supression of ovarian response w/out a identifiable anatomic or organic cause
125
what effect do leptin levels have?
levels the GnRH pulse further
126
what is estrogen's function in terms of bone health?
protects from bone reabsorbtion (osteoblast-clast)
127
osteopenia
reduced bone mass
128
osteoporosis
brittle bones from tissue loss, more severe
129
screening for triad
if one is present, look for other two (especially diet)
- examine for bradycardia, hypotension, hypothermia
- signs of disordered eating (ie decaying enamal)
- palpate (stress fx common on spine and shins)
130
what (besides eat more, train less) can be part of triad treatment?
Vit D/Ca2+ supplimentaion
-hormones
leptin injections
