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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
Q

Bug, dx, treat ringworm

A

Tinea corporis
Dx: fluoresces, KOH prep
Trt: topical antifunal
RTP: 72hrs meds

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26
Q

What is the female athlete triad

A

Period issues >3mo
Energy deficiency (doesn’t require formal eating disorder dx)
Osteopenia (>2 stress frx)

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27
Q

What temp / sx differentiate heat exhaustion vs stroke

A

104F (40C)
Stroke:
- CNS dysfunction
- No sweating

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28
Q

What is temp for hypothermia

A

<35C

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29
Q

Mechanism / complications of steroids

A

Increases mRNA -> increase muscle mass
SE:
- Testicular atrophy
- Alopecia
- Decrease HDL

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30
Q

What is:
Isotonic
Isokinetic
Isometric

A

Tonic - constant force
Kinetic - constant speed
Metric - constant length

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31
Q

What are the 3 skeletal muscle fibers? What cell heals skeletal muscle

A

1 = slow ox (endurance training)
2a = fast ox
2b = glycolytic (anaerobic - produces lactic acid)
Satellite cells

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32
Q

What is the difference between sickle cell trait and disease

A

Trait: heterozygous
- Exertional risk of rhabdo or arrhythmia
Disease: homozygous
- Sickle crisis

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33
Q

Risks with ant, postlat, and ant lat hip scope portals

A

Ant: LFCN>femoral
Ant-lat: SGN
Post-lat: sciatic, esp if hip ER

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34
Q

Cam lesions hallmarks

A

Alpha angle >55
Femoral RV
See a CARTILAGE inj - delam/flaps

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35
Q

Pincer lesions hallmarks

A

Tab RV = crossover sign
Increased CEA
Labral injury +/- ossification of the labrum (ant-sup most common)
Contre coup lesion - postinf tab

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36
Q

What is the CEA on an XR
What is normal vs dysplasia
Why do you care

A

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!

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37
Q

What is the alpha angle (nml and CAM morphology)

A

Lateral XR
Line middle neck
Line where head exists perfect circle
Nml <50
>55 = CAM

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38
Q

Comp FAI surgery

A

HO
Frx if you take down >30% femoral neck diameter

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39
Q

What is ischiofemoral impingement? PE finding,

A

LT on ischium - entraps quad fem
Worse with ext/add
Diagnostic injection

40
Q

What is athletic pubalgia (sports hernia) + trt

A

Lower abd pain 2/2 muscle imbalance
PE:
- Tight adductor longus
- Pain with valsalva
Trt:
- Conservative
- Pelvic floor repair vs adductor/rectus recession

41
Q

What is the difference between external vs internal snapping hip

A

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
Q

Diagnosis:
Cyclist, leg pain after exercise
Pulses in legs diminished after activity

A

External iliac artery endofibrosis
US vs arteriogram for dx

43
Q

Avulsion frx - name the muscle + innervation
1. ASIS
2. AIIS
3. IT

A
  1. ASIS - sartorius (femoral n)
  2. AIIS - rectus (femoral n)
  3. IT - hamstrings (sciatic / tibial)
44
Q

Trt avulsion frx pelvis

A

Min disp = nonop = NWB 4wks
ORIF only with
1. High level athlete + 2-3cm displaced
2. Symptomatic non union

45
Q

2 ACL bundles
- Where tight
- Primary role

A

ACL = AM/PM
AM - tight in flexion, limits translation (Lachman)
PM - tight in extension, limits rotation (pivot)

46
Q

What is the lateral intercondylar vs bifurcate ridges?

A

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
Q

2 bundles PCL - when are they tight

A

PCL is your PAL
AL - tight flexion
PM - tight extension

48
Q

What are the 2 meniscofemoral ligaments

A

Alphabetical
Hemphry = anterior
Wrisberg = posterior

49
Q

Components of the post-med corner (3 layers)

A

Superficial : sartorius
Middle : sMCL, POL, semi-mem
Deep : dMCL

50
Q

Components postero-lat corner

A

Biceps, IT
LCL, popliteus, pop-fib lig

51
Q

What ROM is the MPFL the primary restraint

A

0-20deg flexion

52
Q

What is Schottle’s point

A

MPFL repair here
Back of Blumenstaats + posterior cortex femur

53
Q

Describe pivot shift

A

Lat tib plateau starts subluxed anterior
Clunk = relocated as move into flexion

54
Q

What is the difference with valgus/varus stress at 30 vs 0 deg

A

30 = isolated LCL or MCL
0 = combined injury

55
Q

Describe dial test

A

Supine, ER
30deg - PLC only
90deg - PLC + PCL

56
Q

What is a Segond

A

Lateral capsule frx = ALL
Indicates ACL injury

57
Q

What is Insall Salvati and normal values

A

Patellar tendon length : patella height
Nml: 0.8-1.2

58
Q

What is Caton Deschamps and normal values

A

Patella cartilage to plateau : patella height
Knee in 30deg flex
Nml: <.3

59
Q

What is TT-TG and normal values

A

Trochlear groove to posterior fem cond : tib tub to post fem cond
CT better than MR (under-estimates)
Nml: <20

60
Q

Where is the trad bone bruising on MRI for ACL tear

A

LFC + posterior lat tib plateau

61
Q

What is the double PCL sign

A

Bucket handle medial men

62
Q

What is the double ant horn sign

A

Bucket handle lateral men tear

63
Q

How do meniscus repairs heal

A

Inflam cell infiltration

64
Q

Where are safe zones for dissection w/ outside in meniscus repair

A

Medial: anterior to satorius, avoid saphenous
Lateral: anterior to biceps, avoid peroneal

65
Q

CI to meniscus transplant

A

OA (flattening condyles, narrowing on WB XR)
>50yo
BMI >30
Lig instab
RA

66
Q

Dx discoid

A

3 consecutive MR cuts (4-5mm images)

67
Q

Trt discoid

A

Only if sx: saucerization
Otherwise observation only

68
Q

Osteochondritis dissecans
- Common location

A

Lateral MFC

69
Q

What is a subchondral insuff frx - treat

A

Older patient with a cresentic lesion - in same category as AVN
UKA or TKA

70
Q

What is the ideal minimum ACL graft size

A

Min 8.5, less that this have increased failure rate

71
Q

What happens if your ACL tunnel femur is too anterior vs posterior

A

Ant: tight in flexion
Posterior: tight in extension

72
Q

What happens if your ACL tibia tunnel is too anterior vs posterior

A

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
Q

Structure at risk with hamstring harvest for ACL

A

Saphenous between gracilis and satorius
Lose terminal knee flexion strength

74
Q

What is a cyclops lesion

A

Anterior scar tissue
Blocks extension

75
Q

What tibial slope increases risk of graft fracture

A

Normal = >9
High risk >12
Think supra tubercle ant closing wedge osteotomy

76
Q

Which sport is the only sport that ACL bracing is recommended

A

Skiiers

77
Q

What compartments are higher risk OA with non op of PCL

A

Patello-fem AND medial

78
Q

If you are going to treat PLC injury acutely how do you do it

A

Primary repair PLUS recon
Vs delayed recon only
Rehab avoid HS

79
Q

How reduce + immobilize prox tib-fib dislocation

A

Most likely fib comes out anterior and lateral
Reduce: flexion + pressure
Immobilize in ext

80
Q

Why do you aspirate pre-patellar bursitis in wrestlers

A

R/o MRSA

81
Q

What is the J sign

A

Knee in full extension, patella deviates lateral out of the groove

82
Q

RF for patellar instability

A

Hip AV
Patella alta
Valgus alignment

83
Q

Chondral lesions for patellar instab

A

Medial patellar facet
Lateral LFC

84
Q

What is the Fulkerson osteotomy

A

Tibial tub osteotomy for patellar maltracking
Ant+medial with tubercle
Off loads the distal lateral patella

85
Q

Indications for tubercle osteotomy for patellar maltracking

A

TT-TG > 20
+ lateral tracking/tilt

86
Q

What 2 procedures are the WRONG answers for patellar maltracking

A

Trochleoplasty
Isolated lateral release

87
Q

What structure may be interposed for an tibial spine fracture

A

Med meniscus

88
Q

Treat tibial spine fracture

A

If reduces, keep in extension
IF reduction needed, ORIF

89
Q

Traction apophysitis: Osgood Sclatters vs Sinding-Larsen-Johnsson

A

OS: tib tub
SLJ: inf patella

90
Q

What is the most common distal femur physeal injury in kids

A

SH2
Hypertrophic zone
MRI : stress XR

91
Q

What are the abnormal measurements for exertional compartment syndrome

A

15 - 30 - 20
>15 at rest
>30 1min post exercise
>20 5min post exercise

92
Q

Diagnose:
Night pain
Pain better with running
Diffuse longitudinal update on bone scan

A

Medial tibial stress syndrome
= periostitis of PT and soleus origins
Non op

93
Q

Ankle scope portals - structure at risk
1. AL
2. AM
3. PL

A
  1. AL = SPN (dorsal int cut br)
  2. AM = tib ant, saphenous v/n
  3. PL = sural n/short saph v
94
Q

Ankle exam / structure tested
1. Ant drawer
2. Lat tilt
3. ER stress test / squeeze test

A
  1. ATFL
  2. CFL
  3. Syndesmosis
95
Q

Treat longitudinal peroneal tears

A

<50% tubularize
>50% tenodesis

96
Q

Describe the difference in the following concussion tests:
SCAT5 - sports concussion assessment tool
ImPACT - immediate post concussion assessment and cognitive testing battery

A

SCAT5 - sideline tool
ImPACT - computer test given as baseline and then after injury

Millers (29 decks)

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