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Sports Medicine Boards 2015

  1. What is Cushing's Triad? (Increased Intracranial Pressure)
    • Increased systolic BP/Widened pulse pressure
    • Abnormal respiratory pattern
    • Bradycardia
  2. Tibialis Anterior:  Origin and Insertion
    • Origin: anterolateral tibia and interosseus membrane
    • Insertion: base of 1st metatarsal and medial cuneiform
  3. Type I vs Type II muscle fibers (differences)
    • Type I:  (slow twitch)
    • Endurance
    • High conc mitochondria
    • High ratio of capillaries to volume
    • Aerobic--triglycerides are main fuel source

    • Type II:  (fast twitch)
    • Power
    • Higher force production
    • Short bursts
  4. What type of spinal cord lesion is usually associated with a FLEXION-INJURY of the cervical spine?
    • Anterior spinal cord injury: 
    • Upper extremity paralysis will be less than bilateral lower extremity paralysis
    • Bilateral loss of sensation to temperature and pain
    • Vibratory and proprioception will be intact
  5. Pudendal neuropathy is common (>91%) of cyclists.  What are some factors/mechanisms?
    • Cyclist’s weight
    • Tilt of the saddle
    • Vertical (downward) and Shear (backward) force of the perineum on the saddle
    • Shape of the saddle
    • Angle and height between the handlebars and the saddle
  6. Difference between Pulmonary and Cardiac Rehabilitation Programs?
    • Pulmonary: 
    • Poorer baseline level of conditioning
    • Older age due to complex nature of pathophysiology of chronic pulmonary disease
    • Cardiac: 
    • Potentially more and immediate life-threatening risks c/w pulmonary rehabilitation
  7. The Guyon canal is formed from what 2 bones?
    • Hamate
    • Pisiform
  8. What is the most common nerve injury associated with shoulder (gleno-humeral) dislocations?




    C) Axillary nerve

    • Axillary nerve injury highly associated with anterior shoulder dislocations
    • Suprascapular --> Stretch
    • Long Thoracic --> Direct blow
    • Musculocutaneous --> compression with excessive resistive elbow extension (eg, push-ups)
  9. What is proprioceptive neuromuscular facilitation type of stretching?
    Using a partner to passively stretch the hamstring, followed by pushing against the partner by isometrically contracting the muscle, and then stretching farther in the same range of motion
  10. Give an example of static stretching:
    Slowly moving into a stretched position and holding the stretch for up to 30 seconds
  11. Give an example of a dynamic stretching technique:
    • Maximal joint motion secondary to muscle contraction
    • Athlete uses controlled swinging of a limb and then gradually increases the distance, intensity,and speed without exceeding his or her range of motion
  12. It is well-known that multiple concussions can lead to permanent neurocognitive dysfunction.  How many and in what time frame is considered high risk?
    • The results from 1 study revealed a 3-fold higher risk for concussion if a player had 3 or more concussions in a 7-year period.
    • Further risks, which are not fully understood, can include neurocognitive dysfunction and second-impact syndrome.
  13. A volleyball player presents to you with pain in her right shoulder. Upon presentation, she is holding her arm in slight abduction and external rotation. She says that the pain started after she spiked the volleyball during practice. The humeral head is anteriorly palpated.  What should your first step be in this scenario?

    a) Evaluate the supraclavicular nerve by testing sensation over the clavicular area.
    b) Evaluate the axillary nerve by testing sensation across the lateral aspect of the shoulder.
    c) Evaluate the radial nerve by testing sensation across the inferolateral arm.
    d) Evaluate the medial cutaneous nerve by testing sensation across the medial aspect of arm.
    b) Evaluate the axillary nerve by testing sensation across the lateral aspect of the shoulder.

    • An injury to the axillary nerve is a known complication of anterior shoulder dislocations.
    • Prior to obtaining x-rays, reduction, or both, the health care professional must document the patient's neurovascular status. This is done by evaluating the patient's sensation across the superior lateral aspect of the arm (ie, across the deltoid).
  14. Which of the following is NOT in the carpal tunnel?




    E. Flexor carpi radialis
  15. Anatomical borders of the Quadrilateral Space
    • Teres Minor--Superior
    • Teres Major--Inferior
    • Triceps (Long head)--Medial
    • Humerus--Lateral
    • Image Upload 2
  16. Parsonage-Turner Syndrome most often affects/involves which nerves?
    • Most often upper trunk, pure motor nerves
    • Suprascapular Nerve
    • Long Thoracic Nerve
    • Anterior Interosseous Nerve
    • Axillary Nerve
  17. Etiology of the condition shown in the photograph below:  Typical presentation/complaint.Image Upload 4
    • Suprascapular nerve injury at the level of the spinoglenoid notch (Supraspinatus NL, Infraspinatus atrophic). If both the supra and infraspinatus muscles are atrophied, lesion must be more proximal in the suprascapular notch.
    • Mechanism:  Ganglion cyst near a labral tear or traction/microtrauma.
    • Presentation/complaints:  Posterolateral shoulder pain, weakness of shoulder ER; +/- Abduction (if atrophy present) 
    • Image Upload 6
  18. Presentation for an AIN (Anterior Interosseous Nerve) injury.
    • Pure Motor Nerve (branch off of the Median N)
    • Innervates:  FPL, FDP, Pronator Quadratus
    • PE:  Difficulty making "OK" Sign (secondary to weakness of FPL and FDP)

    Image Upload 8
  19. Contents of the Carpal Tunnel:
    • 9 tendons and 1 nerve
    • FDP (4), FDS (4), FPL (1), Median N
  20. What are the LOAF muscles?  What condition would affect them?
    • Lateral two Lumbricals
    • Opponens pollicis
    • Abductor pollicis brevis
    • Flexor pollicis brevis
    • Image Upload 10

    CTS can cause weakness of these (median innervated) muscles.
  21. A RHD 16 yo F tennis c/o chronic aching pain distal to the lateral epicondyle of the elbow.  Her symptoms are worst after tennis practice.  She denies any numbness or tingling.  On PE she has painless weakness with supination and wrist extension.  Pulses are normal.  Sensation and DTRs are WNL.  The remainder of her hand examination is WNL.  She has entrapment of which nerve?



    C) PIN
  22. What is Wartenberg's Sign?  Etiology?
    • 5th finger ADDuction weakness secondary to ulnar neuropathy
    • Image Upload 12
  23. Contents of the four fascial compartments of the leg:
    Anterior
    Lateral
    Deep Posterior
    Superficial Posterior
    • Anterior:  EHL, EDL, TA, Peroneus tertius, Deep Peroneal Nerve, Anterior tibial artery & vein
    • Lateral:  Peroneus Longus & Brevis, Superficial Peroneal Nerve
    • Deep Posterior:  FDL, TP, Tibial Nerve (Artery & Vein) "Dick, Tom and a very nervous Harry"
    • Superficial Posterior: Gastroc, Soleus, Sural N
  24. Signs and symptoms of Acute Compartment Syndrome?  Diagnostic criteria?  Treatment?
    • Persistent or progressive SEVERE pain after fxc or soft tissue injury due to impaired tissue perfusion-->ischemia-->tissue necrosis
    • Pain with PASSIVE motion
    • Paresthesias and Weakness
    • Pulselessness and Palor (late finding)
    • Diagnostic Criteria:  Compartment Pressure (CP) Testing  >30 mm Hg or <30 mm Hg difference btwn DBP-CP
    • Treatment:  Emergent fasciotomy
  25. What is the (Master) knot of Henry?  What condition can occur here?
    • An intersection point in the medial foot distal to the Tarsal Tunnel where the FHL tendons cross over the FDL tendons and is therefore a potential site of tenosynovitis (Intersection syndrome). 
    • Condition:  Jogger's foot (compression of the Medial Plantar Nerve
  26. Morton's Neuroma:
    Most common site(s)?
    Etiology (caused by which anatomical part)?
    • Interdigital Neuroma most commonly affecting the 2nd and 3rd webspaces
    • Impingement of the INTERDIGITAL N by the INTERMETATARSAL ligament, MTP joint synovitis, metatarsal hypermobility, high heels or tight shoes
  27. What attaches to the Z-line?
    What is the M-line?  What attaches?
    What is the A-band?
    What is the I-band?
    What is the H-zone?
    Which of the above gets smaller with contraction?
    • Actin (thin filaments) attaches to the Z-line (Think ZAppos)
    • M-line = Middle of Sacromere; Myosin (thick filaments) attaches
    • A-band (dark band):  Contains both Actin & Myosin (think "A" for "All" both Actin and Myosin
    • I-band contains only Actin
    • Both the I-band and H-zone get smaller during muscle contraction
    • Image Upload 14
  28. Number of ATP produced from Glycolysis (anaerobic)?  Oxidative phosphorylation (aerobic)?
    • Glycolysis (from glucose) = 2
    • Glycolysis (from glycogen) = 3
    • Oxidative phosphorylation (aerobic) = 36

    Net total 38 or 39 (beginning with glucose vs glycogen)
  29. Number of ATP produced from one palmitic acid molecule via free fatty acid metabolism?
    129

    Triglycerides broken down into glycerol and 3 free fatty acids by lipolysis
  30. What is Cardiac Drift?
    • Increase in HR and a DECREASE in SV at any given work load seen during prolonged aerobic exercise
    • Due to decreased blood volume secondary to fluid loss from sweating and opening of the skin capillary beds for heat dispersion
  31. VO2 max (VO2max = COmax x (O2a-O2v) is trainable due to what variables?
    • Increases in SV
    • Increases in oxygen extraction
    • Lower resting HR
  32. What is the Anaerobic Threshold?
    As exercise intensity increases anaerobic metabolism becomes the predominant energy source.  Lactate will get produced faster than it can get cleared.  Usually at 4 mmol/L of blood lactate.  Occurs at 50-60% VO2max if untrained; at 80-90% VO2max if trained; hence is trainable
  33. Prior to adolescents strength gains are similar between boys and girls.  Why?  And why does this strength gain similarity cease after adolescents?
    • Prior to adolescents strength gains are primarily achieved via neural factors and NOT due to muscular hypertrophy.
    • Once puberty starts, signif increased muscle mass in boys secondary to 10 fold increase in testosterone compared to girls.  Strength gains are signif greater in boys after puberty.
  34. Difference between Simple and Complex Seizures?
    Difference between Partial and Generalized Seizures?
    • Simple vs Complex = MS change No/Yes
    • Simple Seizure - no altered MS (limb twitch, sensory disturbance, psychic symptoms)
    • Complex Seizure - impaired consciousness

    • Partial vs Generalized = Part(s) of brain; Uni vs bilateral
    • Partial Seizures - Localized in a specific part of the brain
    • Generalized Seizures - Bilateral cortical discharge (complex in nature thus will have impaired MS) (tonic-clonic, myoclonic, Atonic, Absence)
  35. Symptoms (Presentation) of Autonomic Dysreflexia (and why/mechanism)?
    • Headache (vasodilation above lesion)
    • HTN (abnormal sympathetic response)
    • Bradycardia (compensatory parasymp (vagal) response)
    • Blurred Vision, Nasal Congestion, Anxiety, Piloerection, Flushing, Diaphoresis

    • SCI T6 or above; Noxious stimulus below level of lesion --> Abnl sympathetic discharge--> Increase BP --> Compensatory parasymp/vagal response
    • Image Upload 16
  36. What artery is involved?  What is the definition of the lucid period?
    Image Upload 18
    • Image is a CT of the brain revealing an epidural hematoma. 
    • Artery involved is the MIDDLE MENINGEAL ARTERY (OR VEIN)
    • 90% of epidural hematomas are caused by head trauma with a skull fracture that crosses a portion of the middle meningeal artery or vein
    • Lucid Period (Interval) - After the injury, the patient is momentarily dazed or knocked out, and then becomes relatively lucid for a period of time which can last minutes or hours
  37. Epidural vs Subdural Hematomas
    • Epidural - Middle Meningeal Artery ruptures and tears dura from the skull (blood is above (epi = above or over) (or outside of) the dura) aka Extradural Bleed bleeding pattern resembles a lemon
    • Subdural - Bridging Veins - dura is still attached to the skull (blood is below (inside of) the dura) bleeding pattern resembles a banana
    • Image Upload 20
    • Image Upload 22
Author
rsloan
ID
303760
Card Set
Sports Medicine Boards 2015
Description
Neurology, Rehabilitation, Anatomy and Kinesiology
Updated

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