Unwell Athlete

Question 1

Tall young men can have

Answer 1

Spontaneous pneumothorax

Question 2

Intense training is associated with

Answer 2

higher level of infection

Question 3

The J Curve

Answer 3

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

Question 4

Infection may compromise athletic performance by

Answer 4

Affecting muscle enzyme activity and muscle strength

Question 5

Exercise that is performed during illness requires more

Answer 5

Cardiorespiratory effort

Question 6

athletes with symptoms restricted to one system vs. generalised symptoms

Answer 6

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

Question 7

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

Answer 7

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

Question 8

Symptoms that mean athlete should avoid athletic activity

Answer 8

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

Question 9

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

Answer 9

Heat exhaustion
Post-viral fatigue
Viral myocarditis

Question 10

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

Answer 10

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

Question 11

Herpes simplex virus

Answer 11

Wrestlers- herpes gladiatorum

Rugby forwards- scrum pox

Question 12

Fungal skin infections

Answer 12

Tinea pedis (athletes foot)
Tinea cruris (jock itch)

Question 13

Influenza

Answer 13

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

Question 14

Infectious Mononucleosis caused by

Answer 14

Epstein-Barr Virus (EBV)

Causes ‘glandular fever’

Question 15

Infectious Mononucleosis severity

Answer 15

Appears to increase with age

Question 16

Children infected by EBV

Answer 16

Typically develop a flu-like illness

Question 17

Young adults and adolescents infected by EBV

Answer 17

Fatigue
Sore throat
Malaise
Headache 
Myalgia

Question 18

EBV clinical examination

Answer 18

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

Question 19

Splenomegaly and EBV

Answer 19

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

Question 20

EBV has similarities with clinical picture with

Answer 20

Cytomegalovirus
Toxoplasmosis
Primary HIV infection

Question 21

Treating Infectious Mononucleosis

Answer 21

Ampicillin or amoxycillin

Question 22

Infectious mononucleosis treatment SE (ampicillin or amoxycillin)

Answer 22

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

Question 23

Infectious mononucleosis incubation period

Answer 23

30-50 days after exposure

Illness lasting for up to 15 days

Question 24

Infectious mononucleosis treatment athletes

Answer 24

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

Question 25

Infectious mononucleosis contact and collision

Answer 25

Should be avoided whilst spleen is enlarged | Risk of splenic rupture increased (from 0.1 to 0.2%) and can be fatal

Question 26

Infectious mononucleosis cases tend to occur

Answer 26

During first 3 weeks of illness

Question 27

Acute gastroenteritis causes

Answer 27

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

Question 28

Acute gastroenteritis transmission

Answer 28

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

Question 29

Acute gastroenteritis symptoms

Answer 29

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

Question 30

Acute gastroenteritis how long do symptoms last

Answer 30

Tend to last 12 to 60 hours

Question 31

How can norovirus be deactivated

Answer 31

Sufficient heating or chlorine-based disinfectant

Question 32

Acute gastroenteritis treatment

Answer 32

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

Question 33

Travellers' diarrhoea infective agents

Answer 33

``` E-Coli Campylobacter Rotavirus Salmonella Shigella Giardia ```

Question 34

High incidence of travellers' diarrhoea thought to arise due to

Answer 34

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

Question 35

Travellers' diarrhoea is mostly

Answer 35

Bacterial in nature | Travelling athlete is exposed to different bacteria to which he or she is not already immune

Question 36

Travellers' diarrhoea symptoms

Answer 36

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

Question 37

Travellers' diarrhoea antibiotic prophylaxis

Answer 37

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

Question 38

Traveller's diarrhoea treatment

Answer 38

Adequate fluid + electrolyte replacement | Anti-diarrhoea meds such as loperamide (imodium) can also be used

Question 39

Loperamide

Answer 39

Immodium | Anti-diarrhoea

Question 40

Viral agents which can cause inflammation of liver

Answer 40

``` Hep A-E EBV CMV Herpes Simplex Adenovirus ```

Question 41

Faeco-oral route virus

Answer 41

Hep A

Question 42

Needle or sexual transmission

Answer 42

Hep B + C

Question 43

Consider prophylactic immunisations for

Answer 43

Hep A + B

Question 44

Zika Virus

Answer 44

Most people don't have any symptoms | If symptoms do occur, usually mild and last around 2-7 days

Question 45

Zika Virus symptoms

Answer 45

``` 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 ```

Question 46

How do you catch Zika

Answer 46

``` 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 ```

Question 47

Zika virus treatment

Answer 47

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

Question 48

Overtraining syndrome is also known as

Answer 48

Underperformance or unexplained underperformance syndrome (UUPS)

Question 49

Overtraining syndrome

Answer 49

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

Question 50

Overtraining

Answer 50

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

Question 51

Overtraining syndrome manifestation

Answer 51

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

Question 52

Other causes of fatigue in athletes

Answer 52

``` 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 ```

Question 53

Physiological variables which can indicate over training

Answer 53

* 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

Question 54

Physiological changes that may be associated with over training

Answer 54

* 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

Question 55

Overtraining syndrome management

Answer 55

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

Question 56

Advice as doctor

Answer 56

``` 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 ```

Question 57

How long does complete recovery from overtraining take

Answer 57

Few weeks | Sometimes longer

Question 58

Polyarthralgia

Answer 58

Multiple painful joints

Question 59

Polyarthritis

Answer 59

Multiple painful joints with synovitis

Question 60

History between polyarthralgia and polyarthritis

Answer 60

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.

Question 61

rheumatoid arthritis

Answer 61

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

Question 62

Reactive arthritis

Answer 62

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

Question 63

Parvovirus B19 Polyarthritis

Answer 63

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