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Sports and Exercise Medicine iBSc > Unwell Athlete > Flashcards

Unwell Athlete Flashcards

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1
Q

Tall young men can have

A

Spontaneous pneumothorax

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2
Q

Intense training is associated with

A

higher level of infection

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3
Q

The J Curve

A

Theory that regular moderate exercise decreased risk of URTI, while strenuous exercise increased it

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4
Q

Infection may compromise athletic performance by

A

Affecting muscle enzyme activity and muscle strength

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5
Q

Exercise that is performed during illness requires more

A

Cardiorespiratory effort

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6
Q

athletes with symptoms restricted to one system vs. generalised symptoms

A

One system affected (e.g. URTI or skin) vs generalised symptoms affecting more than one system should be considered separately when deciding whether or not to train or compete

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7
Q

Athlete with URTI symptoms of sore throat, runny nose, but otherwise afebrile

A

Can be allowed to continue with mild-moderate training

Such exercise in people who are moderately fit and active is not thought to prolong or intensify the llness

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8
Q

Symptoms that mean athlete should avoid athletic activity

A

Systemic symptoms of generalised malaise
Muscle pains
Temperature in excess of 38
Raised HR more than 10 beats above normal
–> until both systemic symptoms and signs have returned to normal
–> should then gradually resume activity, opposed to going straight back into previous leel

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9
Q

Athletes who engage in intense exercise during such infections have an increased risk of

A

Heat exhaustion
Post-viral fatigue
Viral myocarditis

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10
Q

Infections which are common in athletes but do not cause them to become severely unwell

A

Herpes simplex virus
Fungal infections
Skin warts on hands + feet caused by HPV

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11
Q

Herpes simplex virus

A

Wrestlers- herpes gladiatorum

Rugby forwards- scrum pox

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12
Q

Fungal skin infections

A 
Tinea pedis (athletes foot)
Tinea cruris (jock itch)
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13
Q

Influenza

A

Common viral infection- winter
Number of strains varies yet to year
Can be debilitating with systemic symptoms causing fever, malaise and myalgia
Elderly + chronic illnesses susceptible- immunisation
Athletes may wish to be immunised to stop spread in team
Some of symptomatic treatment options such as pseudoephedrine banned by WADA

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14
Q

Infectious Mononucleosis caused by

A

Epstein-Barr Virus (EBV)

Causes ‘glandular fever’

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15
Q

Infectious Mononucleosis severity

A

Appears to increase with age

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16
Q

Children infected by EBV

A

Typically develop a flu-like illness

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17
Q

Young adults and adolescents infected by EBV

A 
Fatigue
Sore throat
Malaise
Headache 
Myalgia
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18
Q

EBV clinical examination

A

Exudative pharyngitis
Swollen, tender cervical lymph notes
High fever 39-40 common

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19
Q

Splenomegaly and EBV

A

Lymphocytic infiltration within spleen gives rise to splenomegaly in about half the cases

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20
Q

EBV has similarities with clinical picture with

A

Cytomegalovirus
Toxoplasmosis
Primary HIV infection

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21
Q

Treating Infectious Mononucleosis

A

Ampicillin or amoxycillin

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22
Q

Infectious mononucleosis treatment SE (ampicillin or amoxycillin)

A

Defuse macular rash
Older patients in addition can also develop complications such as hepatitis or thrombocytopoenia (decreased platelet count)

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23
Q

Infectious mononucleosis incubation period

A

30-50 days after exposure

Illness lasting for up to 15 days

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24
Q

Infectious mononucleosis treatment athletes

A

Systemic treatment to reduce fever and sore throat
Not particularly contagious and no need for isolation of athlete who has it
Many people already have adequate antibody levels because of previous childhood exposure
Rest from all sporting activity until all acute symptoms have resolved

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25
Q

Infectious mononucleosis contact and collision

A

Should be avoided whilst spleen is enlarged

Risk of splenic rupture increased (from 0.1 to 0.2%) and can be fatal

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26
Q

Infectious mononucleosis cases tend to occur

A

During first 3 weeks of illness

27
Q

Acute gastroenteritis causes

A

Common
Often caused by Norovirus (RNA virus)
Causes approximately 90% of epidemic non-bacterial outbreaks of gastroenteritis world-wide

28
Q

Acute gastroenteritis transmission

A

Virus transmitted via contaminated food, water surfaces, or person to person
Can quickly spread amongst sports teams where athletes are in close contact

29
Q

Acute gastroenteritis symptoms

A

Usually between 12 to 48 hours after initial infection
Nausea initially
Projectile vomiting
Watery diarrhoea

30
Q

Acute gastroenteritis how long do symptoms last

A

Tend to last 12 to 60 hours

31
Q

How can norovirus be deactivated

A

Sufficient heating or chlorine-based disinfectant

32
Q

Acute gastroenteritis treatment

A

Adequate hydration
Paracetamol for high temp
Hand hygiene
Isolation of the unwell until he/she has been symptom-free for at least 48 hours

33
Q

Travellers’ diarrhoea infective agents

A 
E-Coli
Campylobacter
Rotavirus
Salmonella
Shigella
Giardia
34
Q

High incidence of travellers’ diarrhoea thought to arise due to

A

Changes in normal bacteria in flora, food and water in foreign countries

35
Q

Travellers’ diarrhoea is mostly

A

Bacterial in nature

Travelling athlete is exposed to different bacteria to which he or she is not already immune

36
Q

Travellers’ diarrhoea symptoms

A 
Mild fever
Abdo pain
Malaise
Onset within first week of arrival
Often last between 24-48 hours
37
Q

Travellers’ diarrhoea antibiotic prophylaxis

A

Antibiotic prophylaxis debatable
Various regimes include ciprofloxacin or norfloxacin which should commence on arrival in foreign country + should continue until athlete has returned home for 48 hours
Antibiotics for treatment can shorten symptoms but are only indicated if diarrhoea is bloody and severe
Local antibiotic resistance should be kept in mind

38
Q

Traveller’s diarrhoea treatment

A

Adequate fluid + electrolyte replacement

Anti-diarrhoea meds such as loperamide (imodium) can also be used

39
Q

Loperamide

A

Immodium

Anti-diarrhoea

40
Q

Viral agents which can cause inflammation of liver

A 
Hep A-E
EBV
CMV
Herpes Simplex
Adenovirus
41
Q

Faeco-oral route virus

A

Hep A

42
Q

Needle or sexual transmission

A

Hep B + C

43
Q

Consider prophylactic immunisations for

A

Hep A + B

44
Q

Zika Virus

A

Most people don’t have any symptoms

If symptoms do occur, usually mild and last around 2-7 days

45
Q

Zika Virus symptoms

A 
Rash
Itching all over body
Fever
Headache
Joint pain (with possible swelling, mainly in smaller joints of hands + feet)
Muscle pain
Conjunctivitis (red eyes)
Lower back pain
Pain behind eyes
46
Q

How do you catch Zika

A 
Infected mosquitoes biting humans
Affected mosquitoes (the Aedes mosquito) mostly active during day, especially during mid-morning, then late afternoon to dusk
Small no. of reports that passed on through sex
47
Q

Zika virus treatment

A

No specific treatment for symptoms
Drink plenty of water
Paracetamol
Seek help if coming back from country that also has active malaria if feeling unwell, to rule it out

48
Q

Overtraining syndrome is also known as

A

Underperformance or unexplained underperformance syndrome (UUPS)

49
Q

Overtraining syndrome

A

Common cause of persistent tiredness in athletes
Reflects accumulative fatigue periods of excessive training with inadequate recovery
Develops when failed adaptation to overload training due to inadequate regeneration

50
Q

Overtraining

A

Process of excessive training in athletes that can lead to persistent fatigue, poor performance, neuroendocrine changes, changes to mood states and frequent illness such as URTIs

51
Q

Overtraining syndrome manifestation

A

Several ways, including impaired performance
Athletes make mistake by reacting to impaired performance by trying to increase intensity of training
Viscous cycle

52
Q

Other causes of fatigue in athletes

A 
Viral Illness
Inadequate carbs, protein or iron
Dehydration
Nutritional deficiencies- vit d, b, zinc, mag)
Medications- BB, insulin, antihistamines
Hypothyroidism
Anxiety + depression
Anaemia
Insufficient sleep
Jet lag
Chronic fatigue
53
Q

Physiological variables which can indicate over training

A
  • Performance decline despite continued training
  • Decreased work rate and lactate threshold
  • Cardiovascular changes (E.g. Increased early morning heart rate, increased resting BP)
  • Decreased serum ferritin
  • Hormonal changes (decreased catecholamine production, changes in serum free testosterone to cortisol ratio)
  • Frequent illness (E.g. URTI)
  • Persistent muscle soreness
  • Decrease in body mass
54
Q

Physiological changes that may be associated with over training

A
  • Mood state changes (utilising the Profile of Mood States Questionnaire (PoMS)
  • Apathy
  • Lack of motivation
  • Loss of appetite
  • Sleep disturbance
  • Increased stress levels
  • Irritability
  • Depression
55
Q

Overtraining syndrome management

A

History + exam
Training diary
Baseline investigations to exclude other conditions
Monitor physiological + psychological parameters

56
Q

Advice as doctor

A 
Complete rest in short term
Sleep
Nutrition
Adequate fluid + hydration
Psychological support
Sports massage to aid muscle relaxation
Cross training after few days
Speak to fam if confidentiality allows
57
Q

How long does complete recovery from overtraining take

A

Few weeks

Sometimes longer

58
Q

Polyarthralgia

A

Multiple painful joints

59
Q

Polyarthritis

A

Multiple painful joints with synovitis

60
Q

History between polyarthralgia and polyarthritis

A

o Must distinguish between polyarthritis with joint pain, stiffness and swelling from polyarthralgia alone.
o Joint inflammation characterised by night pain, prominent morning stiffness (at least 60 mins but often hours), swelling, warmth and loss of function.
o Key diagnostic is the onset of joint involvement.

61
Q

rheumatoid arthritis

A

Onset occurs in weeks or months and has symmetrical involvement of small joint

62
Q

Reactive arthritis

A

Follows genitourinary or gastrointestinal infection
More rapid onset
Asymmetrical involvement of large joints, enthesitis or dactylitis
Duration of symptoms should be recorded

63
Q

Parvovirus B19 Polyarthritis

A

Common in young women who care for small kids who develop parvovirus B19 infection
Can be indistinguishable from early rheumatoid arthritis
Symptoms usually settle within 6 weeks
Rheumatoid arthritis often has a chronic and progressive course.
The pattern of joint involved in polyarticular pseudogout or psoriatic arthritis often resembles rheumatoid arthritis but WITHOUT nodulosis, vasculitis, or other systemic features seen in rheumatoid arthritis

Sports and Exercise Medicine iBSc (13 decks)

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