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Millers > Sports LE > Flashcards

Sports LE Flashcards

1
Q

What is the staged return to play after concussion

A

Start after asymptomatic
5 stages - 24hrs each (therefore earliest RTP is 5days)

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2
Q

What is post concussion syndrome

A

Sx>3mo

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3
Q

What is the lucid interval

A

Temporary improvement of concussion sx
Beware epidural hematoma!

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4
Q

How to immobilize/transfer C spine injury

A

8 person lift > log roll
Helmet on, facemask off - taking helmet off can cause C spine hyper-lordosis

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5
Q

What are some C spine conditions that are CI to return to sports

A

Occipital cervical fusion
AA or C spine instab
Fusion >2 levels
Spear tackler’s spine

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6
Q

What is Spear Tackler’s spine

A

Congenital vs acquired C spine stenosis
Presents as less lordosis
Canal diameter <13mm (nml 17)

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7
Q

What is the workup for stingers

A

Nothing if 1 episode
Recurrent episodes: XR, voluntary F-E views
Bilateral - get MRI

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8
Q

Treat auricular hematoma

A

Aspirate
Tape

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9
Q

RTP for bloody nose

A

Must stop before RTP
Check for CSF leak - ring sign - CSF makes a ring in the blood on a surface

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10
Q

Septal hematoma
1. What is it
2. Treat
3. Complications

A

Subperiosteal hematoma
Treat = aspirate
Comp:
1. AVN septal cartilage - saddle nose deformity, collapse
2. Septal abscess

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11
Q

What to do for avulsed tooth

A

“Medical emergency”
Replace the root
Rinse saline, then in milk (buffer) solution
Hold by the top of the tooth (not the root)
Ideal replace within 1hr

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12
Q

What is the anatomy change for HOCM

A

Ventricle septum thickening
Will get a systolic murmur

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13
Q

What is the rhythm that develops for commotio cordis

A

V fib

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14
Q

Treat asthma

A

Beta 2 agonist (albuterol)

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15
Q

Where put a need for decompression tension PTX (adults vs peds)

A

Mid-axial line, 2nd vs 5th IC space
Peds: second intercostal space, midclavicular line

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16
Q

What is exercised induced laryngeal obstruction? Dx + trt

A

Exertional stridor
NO response to beta agonists (not exercise induced asthma)
Dx: laryngoscope during exercise
Trt: speech therapy (relaxation training)

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17
Q

Workup of exercise induced hematuria

A

Stop exercise
Repeat UA 48-72hrs
Further w/u
- Persists >7d after stopping exercise
- >50yo

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18
Q

Workup for suspected blunt kidney injury (think lower rib frx)

A

Sx: flank pain, hematuria
CT A/P
Remember single kidney si not a CI for RTP

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19
Q

Where do spleen injuries refer to

A

L shoulder

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20
Q

Difference in presentation testicular rupture vs torsion

A

Rupture: pain, hard voiding, doesn’t transilluminate

Torsion: rotated, high riding, lose cremasteric reflex
- Detorsion (manual vs OR) within 12hrs

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21
Q

Trt + RTP for herpes

A

Trt: -cyclovir
OK for RTP after 5 days
CI to RTP:
- Lesions within 48hrs

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22
Q

Bug + RTP impetigo

A

Beta hemolytic staph/strep
RTP
- All crusting gone
- Anti-virals for 72hrs
- No new lesions 48hrs

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23
Q

What is a gene specific to CA MRSA (vs HA)

A

PVL SCC Mec gene type 4

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24
Q

Trt + RTP CA-MRSA

A

TMP-SMX, clinda, doxy, linazolid
Often will require IV abx
RTP:
- 72hrs meds
- No new lesions 48hrs

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25
Bug, dx, treat ringworm
Tinea corporis Dx: fluoresces, KOH prep Trt: topical antifunal RTP: 72hrs meds
26
What is the female athlete triad
Period issues >3mo Energy deficiency (doesn't require formal eating disorder dx) Osteopenia (>2 stress frx)
27
What temp / sx differentiate heat exhaustion vs stroke
104F (40C) Stroke: - CNS dysfunction - No sweating
28
What is temp for hypothermia
<35C
29
Mechanism / complications of steroids
Increases mRNA -> increase muscle mass SE: - Testicular atrophy - Alopecia - Decrease HDL
30
What is: Isotonic Isokinetic Isometric
Tonic - constant force Kinetic - constant speed Metric - constant length
31
What are the 3 skeletal muscle fibers? What cell heals skeletal muscle
1 = slow ox (endurance training) 2a = fast ox 2b = glycolytic (anaerobic - produces lactic acid) Satellite cells
32
What is the difference between sickle cell trait and disease
Trait: heterozygous - Exertional risk of rhabdo or arrhythmia Disease: homozygous - Sickle crisis
33
Risks with ant, postlat, and ant lat hip scope portals
Ant: LFCN>femoral Ant-lat: SGN Post-lat: sciatic, esp if hip ER
34
Cam lesions hallmarks
Alpha angle >55 Femoral RV See a CARTILAGE inj - delam/flaps
35
Pincer lesions hallmarks
Tab RV = crossover sign Increased CEA Labral injury +/- ossification of the labrum (ant-sup most common) Contre coup lesion - postinf tab
36
What is the CEA on an XR What is normal vs dysplasia Why do you care
CEA = AP XR, vertical line center hip, line off edge of the lateral tab Nml 25-40 Dysplasia < 20 (aka shallow socket) Don't scope dysplasia!
37
What is the alpha angle (nml and CAM morphology)
Lateral XR Line middle neck Line where head exists perfect circle Nml <50 >55 = CAM
38
Comp FAI surgery
HO Frx if you take down >30% femoral neck diameter
39
What is ischiofemoral impingement? PE finding,
LT on ischium - entraps quad fem Worse with ext/add Diagnostic injection
40
What is athletic pubalgia (sports hernia) + trt
Lower abd pain 2/2 muscle imbalance PE: - Tight adductor longus - Pain with valsalva Trt: - Conservative - Pelvic floor repair vs adductor/rectus recession
41
What is the difference between external vs internal snapping hip
External - IT over GT - Snaps with hip add, knee ext - Conservative vs Z plasty lengthening Internal - IP over pelvis/prox fem - Hip ex - Conservative vs Z plasty
42
Diagnosis: Cyclist, leg pain after exercise Pulses in legs diminished after activity
External iliac artery endofibrosis US vs arteriogram for dx
43
Avulsion frx - name the muscle + innervation 1. ASIS 2. AIIS 3. IT
1. ASIS - sartorius (femoral n) 2. AIIS - rectus (femoral n) 3. IT - hamstrings (sciatic / tibial)
44
Trt avulsion frx pelvis
Min disp = nonop = NWB 4wks ORIF only with 1. High level athlete + 2-3cm displaced 2. Symptomatic non union
45
2 ACL bundles - Where tight - Primary role
ACL = AM/PM AM - tight in flexion, limits translation (Lachman) PM - tight in extension, limits rotation (pivot)
46
What is the lateral intercondylar vs bifurcate ridges?
Lateral femoral condyle ACL origin Bifurcate *bifurcates* the ACL bundles into ant/post Intercond is horizontal w/ knee flexed, dets anterior border of ACL
47
2 bundles PCL - when are they tight
PCL is your PAL AL - tight flexion PM - tight extension
48
What are the 2 meniscofemoral ligaments
*Alphabetical* Hemphry = anterior Wrisberg = posterior
49
Components of the post-med corner (3 layers)
Superficial : sartorius Middle : sMCL, POL, semi-mem Deep : dMCL
50
Components postero-lat corner
Biceps, IT LCL, popliteus, pop-fib lig
51
What ROM is the MPFL the primary restraint
0-20deg flexion
52
What is Schottle's point
MPFL repair here Back of Blumenstaats + posterior cortex femur
53
Describe pivot shift
Lat tib plateau starts subluxed anterior Clunk = relocated as move into flexion
54
What is the difference with valgus/varus stress at 30 vs 0 deg
30 = isolated LCL or MCL 0 = combined injury
55
Describe dial test
Supine, ER 30deg - PLC only 90deg - PLC + PCL
56
What is a Segond
Lateral capsule frx = ALL Indicates ACL injury
57
What is Insall Salvati and normal values
Patellar tendon length : patella height Nml: 0.8-1.2
58
What is Caton Deschamps and normal values
Patella cartilage to plateau : patella height Knee in 30deg flex Nml: <.3
59
What is TT-TG and normal values
Trochlear groove to posterior fem cond : tib tub to post fem cond CT better than MR (under-estimates) Nml: <20
60
Where is the trad bone bruising on MRI for ACL tear
LFC + posterior lat tib plateau
61
What is the double PCL sign
Bucket handle *medial* men
62
What is the double ant horn sign
Bucket handle *lateral* men tear
63
How do meniscus repairs heal
Inflam cell infiltration
64
Where are safe zones for dissection w/ outside in meniscus repair
Medial: anterior to satorius, avoid saphenous Lateral: anterior to biceps, avoid peroneal
65
CI to meniscus transplant
OA (flattening condyles, narrowing on WB XR) >50yo BMI >30 Lig instab RA
66
Dx discoid
3 consecutive MR cuts (4-5mm images)
67
Trt discoid
Only if sx: saucerization Otherwise observation only
68
Osteochondritis dissecans - Common location
Lateral MFC
69
What is a subchondral insuff frx - treat
Older patient with a cresentic lesion - in same category as AVN UKA or TKA
70
What is the ideal minimum ACL graft size
Min 8.5, less that this have increased failure rate
71
What happens if your ACL tunnel femur is too anterior vs posterior
Ant: tight in flexion Posterior: tight in extension
72
What happens if your ACL tibia tunnel is too anterior vs posterior
Tibial tunnel must be posterior to Blumenstaats line on hyper-ext XR Ant: limits full ext, tight in flexion = roof impingement Post: PCL impingement, lax in flex + ext
73
Structure at risk with hamstring harvest for ACL
Saphenous between gracilis and satorius Lose terminal knee flexion strength
74
What is a cyclops lesion
Anterior scar tissue Blocks *extension*
75
What tibial slope increases risk of graft fracture
Normal = >9 High risk >12 Think supra tubercle ant closing wedge osteotomy
76
Which sport is the only sport that ACL bracing is recommended
Skiiers
77
What compartments are higher risk OA with non op of PCL
Patello-fem AND medial
78
If you are going to treat PLC injury acutely how do you do it
Primary repair PLUS recon Vs delayed recon only Rehab avoid HS
79
How reduce + immobilize prox tib-fib dislocation
Most likely fib comes out anterior and lateral Reduce: flexion + pressure Immobilize in ext
80
Why do you aspirate pre-patellar bursitis in wrestlers
R/o MRSA
81
What is the J sign
Knee in full extension, patella deviates lateral out of the groove
82
RF for patellar instability
Hip AV Patella alta Valgus alignment
83
Chondral lesions for patellar instab
Medial patellar facet Lateral LFC
84
What is the Fulkerson osteotomy
Tibial tub osteotomy for patellar maltracking Ant+medial with tubercle Off loads the distal lateral patella
85
Indications for tubercle osteotomy for patellar maltracking
TT-TG > 20 + lateral tracking/tilt
86
What 2 procedures are the WRONG answers for patellar maltracking
Trochleoplasty Isolated lateral release
87
What structure may be interposed for an tibial spine fracture
Med meniscus
88
Treat tibial spine fracture
If reduces, keep in extension IF reduction needed, ORIF
89
Traction apophysitis: Osgood Sclatters vs Sinding-Larsen-Johnsson
OS: tib tub SLJ: inf patella
90
What is the most common distal femur physeal injury in kids
SH2 Hypertrophic zone MRI : stress XR
91
What are the abnormal measurements for exertional compartment syndrome
15 - 30 - 20 >15 at rest >30 1min post exercise >20 5min post exercise
92
Diagnose: Night pain Pain better with running Diffuse longitudinal update on bone scan
Medial tibial stress syndrome = periostitis of PT and soleus origins Non op
93
Ankle scope portals - structure at risk 1. AL 2. AM 3. PL
1. AL = SPN (dorsal int cut br) 2. AM = tib ant, saphenous v/n 3. PL = sural n/short saph v
94
Ankle exam / structure tested 1. Ant drawer 2. Lat tilt 3. ER stress test / squeeze test
1. ATFL 2. CFL 3. Syndesmosis
95
Treat longitudinal peroneal tears
<50% tubularize >50% tenodesis
96
Describe the difference in the following concussion tests: SCAT5 - sports concussion assessment tool ImPACT - immediate post concussion assessment and cognitive testing battery
SCAT5 - sideline tool ImPACT - computer test given as baseline and then after injury

Millers (29 decks)

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