DB The return MCQs PDF

DB The return MCQs Study online at https://quizlet.com/_be70za 1. Rugby player tooth avulsed and covered in dirt. Answer = B What is appropriate immediate treatment? From BK p 309 Cover/store tooth in gauze Critical time is fi...

DB The return MCQs Study online at https://quizlet.com/_be70za 1. Rugby player tooth avulsed and covered in dirt. Answer = B What is appropriate immediate treatment? From BK p 309 Cover/store tooth in gauze Critical time is first 15min Stick back into socket without cleaning Avulsed tooth should be re- Clean it carefully with water, whilst holding it by trieved and handled by the the roots crown Clean out socket thoroughly with gauze If dirty, irrigate with saline or Inject LA and Adrenaline into socket milk, or sucked clean under the tongue Debris should not be scraped off the root If patient alert, reimplant/splint the tooth then bite down on gauze Otherwise store in milk (pref skim) With suitable storage, tooth can be reimplanted by dentist with- in 2hrs of injury 2. Weight training for 12 year old C Significant hypertrophy expected From BK p 901-2 Most injuries occur to the growth plates Resistance training in children Significant prevention of sporting injuries · Enhances muscular strength Direct correlation between strength training and and power severity of sports-related injuries · Improves CVD risk profile Makes you fully sick bro · Improves motor skill perfor- mance · Increases young athlete's re- sistance to sports related in- juries 1 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za · Improve psychological wellbe- ing 3. Regarding hip arthroscopy for athlete B Benefit is low at 2 years afterwards Evidence of good effect up to 10 years Systematic review arthroscopy Good evidence when combining labral repair and in FAI, AJSM 2018 osteoplasty Complication rate 1-7% Significant complication rate of 20% 88% return to sport Labral tears definitely lead to OA Warwick consensus 2016 Physio-led rehab seems to be assoc with improvement of Sx for at least 2 years Reports of surgery describe sig- nificant improvement in symp- toms up to 5yrs Longer term re- sults reportedfor open surgery, including improved Sx persist- ing in most patients for at least 10yrs **association exists between cam morphology and OA hip **no similar association found between pincer morphology and OA hip **unable to say whether FAI syndrome associated with high- er risk OA hip **no evidence that treatment for FAI syndrome alters risk of 2 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za subsequent OA hip 4. Immobilisation of an injured limb and strength A loss 3-4% loss of muscle strength daily over first week Muscle atrophy following im- Fast twitch show greater atrophy than slow mobilisation. A review. Appell twitch 1990 Sports Med Start to lose strength after 24 hours of immobili- Muscle strength decreases sation most dramatically during the 1st Loss of strength increases after a week of week immobilisation (I think this stated that loss of Slow twitch show greater atro- strength/bulk was more inthe 2nd week than the phy than fast twitch 1st) Muscle loss is the same regardless of fiber type 5. Exertional headaches - most likely underlying B or C ?wording ?something cause cardiovascular... Aneurysms B and K book- 'It has Raised ICP? been postulated that exertion- Something cardiac al headache is due to dilataion Arnold Chiari malformation of the pain-sensitive venous si- Normal pressure hydrocephalus nusesat the base of the brain, as a result of increased cerebral arterial pressure due to exer- tion." P297 6. Exertional headaches (recent onset in a soccer D player, either during or shortly after activity) - what is the mostappropriate course of action https://americanmigrainefoun- Take 25-50mg Indocid an hour before exercise? dation.org/understanding-mi- Sumitriptan at onset of symptoms graine/primary-exertional- headache/ 3 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Ondansetron Gradual warm up This reference lists both grad- Tramadol ual warm up or pre-exercise NSAIDs.. ACSM p 209 Acute treatment of headaches is most commonly treated with typical nonsteroidal anti- in- flammatory drugs (NSAIDs),in- cluding ibuprofen and naprox- en. When the pattern is more typical of migraines, 5-hydrox- ytryptamine blockers, such as- sumatriptan or ergotamines, are effective. Prophylactic treat- ment may include medications such as indomethacin or other NSAIDs, amitriptyline, and SS- RIs. For difficult-to- manage pa- tients, several alternative treat- ments have been shown to be- effective. Botulinum toxin type A is effective and safe as pro- phylaxis for chronic headaches (3). A randomized controlled tri- alshowed that acupuncture im- proves quality of life and de- creases headache pain Treatment of migraines should be multifactorial. In order to 4 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za most effectively treat migraines, it is important to have anaccu- rate diagnosis. There are three main stages of treatment to in- clude prevention, acute treat- ment, and in some casespre- vention. Prevention is the most effec- tive form of treatment. A healthy lifestyle is essential to limit headaches, including a healthy, well-balanced diet, adequate sleep (8 hours a day), and good hydration. According to sever- al studies, the use of riboflavin 200 mgtwice a day and mag- nesium citrate 200 mg twice a day is beneficial. The riboflavin improves mitochondrial ener- gy and themagnesium decreas- es neurologic hyperexcit abili- ty. Proper warm-up and breath- ing techniques will help to limit theeffects of breath holding and Valsalva maneuver. 7. Regarding exercise for treatment of chronic hyper- D tension, which is incorrect: Evidence for exercise in HTN - Needs to be performed at >60% of VO2max Ghadieh 2015 High intensity exercise better than lower intensi- Physiology ty at lowering BP In aerobic exercise, SBP rises as 5 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Need to keep diastolic blood pressure below CO increases, DBP falls as result 105mmHg while exercising of decreased TPR Resistance exercise should be high weight, low In resistance exercise, SBP and repetitions? DBP rise Resistance exercise alone is effective in lowering Anti-HTN effects of exercise BP Enhanced baroreceptor sensi- tivity Decreased NAd level Reduced TPR Improved insulin sensitivity Alterations in expression of dila- tor/constrictor mediators 8. Regarding recovery of glycogen stores after train- A ing in soccer players, which is worst for restoring: If carbohydrates are not con- Fartlek tinued during endurance activi- Anaerobic sprints ties, glycogen stores are deplet- Aerobic running less than 60mins ed in approximately 60-90min- Eccentric training utes. Circuit training 9. Which is an absolute contraindication to an exer- A cise stress test? Unstable angina https://www.racgp.org.au/afp/2012/ Pulmonary hypertension diac-stress-testing/ Complete LAD obstruction(relative) Absolute contraindications to Ventricular arrhythmia (only if uncontrolled and cardiac stress testing in- causing sx) clude acute myocardial in- Uncontrolled diabetes farction (including the pres- ence of new left bundlebranch block [LBBB]), high risk unsta- 6 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za ble angina, symptomatic severe aortic stenosis, uncontrolled ar- rhythmia causing symptomsor haemodynamic instability, un- stable heart failure, acute pul- monary embolus and acute aor- tic dissection Relative contraindications in- clude left main coronary stenosis, severe arterial hy- pertension, electrolyte abnor- malities, hypertrophicobstruc- tive cardiomyopathy and un- controlled arrhythmia.3 In the presence of a relative con- traindication the test may still proceed ifthe benefit of identi- fying ischaemia outweighs the risk of performing the test. 10. Regarding frostbite C Should be rapidly rewarmed Appearance of large bullae after rewarming is Field warming should not be poor prognosis instituted until refreezing can Will undergo spontaneous necrosis and amputa- be prevented. The injured part tion 1-2 months afterwards should be protected witha loose Surgical amputation within first couple of weeks bulky splint during transport Hemorrhagic blisters should be drained for definitive care. Hypothermia should be treated first; smok- ing, ethanol, andmassage of the frozen part should be avoid- 7 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za ed. Definitive emergency de- part- ment care is outlined in Table 42.3. It is basedon the work of Heggers et al. (14) and McCauley et al. (17). Ad- juvant therapies with heparin, warfarin, steroids, dextran,vita- min C, and hyper- baric oxy- gen have not been proven to be helpful. Pentoxifylline (Trental) has been shown to beuseful in pedal frostbite (13). 11. Which of the following medications increase the E risk of heat illness by interfering with sweating? Antihistamines can have an- Amphetamine timuscarinic actions, affecting B-blocker parasympathetic system and Colchicine sweating response Calcium channel blocker Antihistamine Risk factors for exertional heat- stroke include obesity, low physical fitness, dehydration, fatigue, recent episode of heatillness, concomitant febrile illness, sleep deprivation, wear ofimpermeable garments, lack of acclimatization, and use ofmedicines or supplements that decrease sweating and in- crease thermogenesis (antihis- tamines, ephedra, caffeine, di- uretics) 8 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Interference with sweating, caused by: · anticholinergics, e.g. tri- cyclics antidepressants and benztropine · beta-blockers · antihistamines · phenothiazines · vasoconstrictors Interference with thermoregu- lation, caused by: · antipsychotics or neurolep- tics (e.g. risperidone, clozapine, olanzapine) · serotoninergic agonists · stimulants (amphetamine, co- caine) · thyroxin 12. 60 year-old bloke exercising and getting muscle D pain. Which of his meds is the LEAST likely cause of his myopathy? Drug induced myopathies, Cimetidine 1991 Metoprolol Myaesthenic syndromes - BB Statin Polymyositis - cimetidine - NSAID (used in GERD) Colchicine Statins are generally the worse Colchicine added on but can cause myopathy +- neuropathy 13. 9 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Which ECG change is not normal in athletes? E Early repolarisation Seattle criteria abnormal find- Type I second degree heartblock (Wenkebach) ings on the athlete ECG are Sinus bradycardia >30bpm Junctional escape rhythm T wave inversion > 1mm in 2 Ventricular couplets leads V2-V6, II and aVf or I and aVL (Excludes III, aVR and V1) ST segment depression - >0.5mm in >2 leads Pathological Q waves - > 3mm or >40ms in two more leads Complete LBBB Intraventricular conduction delay - any QRS duration >140ms Left axis deviation -30 to -90 degrees Left atrial enlargement RV hypertrophy pattern - R-V1 + S V5 >10.5mm AND right axis deviation >120 degrees Ventricular pre-excitation - PR interval 480ms (Females), QTc >500 ms is marked QT prolongation Short Qt interval - QTc /= 2 PVC's per 10 sec tracing Ventricular Arrhythmias - Cou- plets, triplets, non-sustained ventricular tachycardia (Elecrocardiographic interpre- tation in athletes the 'Seattle Criteria' BJSM 2013) 14. Which is an indication for surgery in radial head D fracture? 25% angulation Orthobullets: 20% articular surface involvement but undis- https://www.orthobul- placed lets.com/trauma/1019/radi- Small undisplaced fracture following elbow dislo- al-head-fractures? cation (been reduced) expandLeftMenu=true 11 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Mechanical block at 100deg of flexion 2mm displaced fracture o Mason Classification · Type I = non-displaced (1.5cm **malignant change in ~1% solitary lesions (5-25% with hereditarty multiple exostoses) 13 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za Note: non-ossifying fibroma: benign fibrogenic lesion that is the most common benign bone tumor in childhood 16. What is the quickest time you can adjust (per time B zone) when travelling west? (something like that) 6 hours The LANCET 12hours Jet lag: trends and coping 18 hours strategies 1 day Jim Waterhouse, Thomas Reilly, 2 days Greg Atkinson, Ben Edwards. More debilitating when travel- ling in an easterly direction Ideally one day per time zone crossed 17. Right-handed adolescent tennis player with 3 B weeks left lower back pain. What is the most likely diagnosis? BJSM 2006- Interesting arti- Pars defect cle, doesn't really give good an- Pars stress swer but suggests in adoles- Paravertebral muscle strain cencepushing technique to ad- Facet joint vance professionally, >1 week SIJ dysfunction back pain merits Ix... "Very com- petitivetennis is a risk factor for spondylolysis" 14 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za 18. With comparison to skiing which of the below is C true Average knee injury incidence Snowboarding has higher head injury rates is described as markedly lower for snowboarding when com- Ankle sprains and fractures are less common in pared with skiing,2 4 5 8 11 snowboarding 14 1517 22 while ankle in- juries are slightly more common Knee injuries are less common in snowboarding in snowboarding and include both sprains and fractures.2 4 5 Injuries due to landing from jumps are less com- 8 11 14 15 22 mon snowboarding Knee injuries are less com- ACL injuries are more common in snowboarding mon than in skiing. Snow- boarding and skiing have sim- ilar head injury rates, An- kle sprainsand fractures are more common in snowboard- ing, Knee injuries are less com- mon in snowboarding, Injuries due to landingfrom jumps are more common in snowboard- ing than skiing (Injuries in elite and recreational snowboarders BJSM 2014) 19. Exercise associated muscle cramps. Which is cor- E rect? Central neural cause Schwellnus articles... Peripheral neural cause Altered neuromuscular control Electrolyte disturbance cause theory 15 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za More common in dehydrated than euhydrated Central and peripheral neural causes According to this theory, EAMC is a result of altered neuro- muscular activity, and the un- derlying cause is muscle fa- tigue. Disturbances at various levels of the central and periph- eral nervous systems and skele- tal muscle are involved. Mus- cle fatigue disrupts the func- tioning peripheral muscle re- ceptors and causes increased excitatory afferent activity with- in the muscle spindle and re- duced inhibitory afferent activ- itywithin the Golgi tendon that the events along with the devel- oping muscle fatigue results in sustained motor neuron activity caused byabnormal motor neu- ron control at the spinal level, resulting in muscle cramp. 20. School children going on snowboarding trip. C Which of the following is correct? Hard boots better protection and less injuries Hip pads and knee pads de- Helmets and wristguards good evidence for chil- crease the overall risk of com- dren mon injuries and hip pads Hip pads decrease the risk of wrist fracture and specifically decrease the risk of shoulder dislocation wristfractures and GH joint dis- Elbow pads decrease the risk of common injuries location. Interestingly, none of Backbone guards decrease the risk of concussion the others (wrist guards, Hel- 16 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za mets, Elbow pads and back- bone pads)decreased overall risk of common injuries. (Re- duction of the overall risk of injuries in recreational snow- boarders, BJSM2012) Hip pads reduce the overall risk of injuries in recreational snow- boarders 21. Dancer with posterior ankle pain & crepitus en A pointe & demi pointe. What is the most likely di- agnosis? Flexor hallucis longus (FHL) FHL tenosynovitis tendonitis, or dancer's tendo- Achilles tendinopathy nitis, occurs from overuse and Tibialis posterior tendinopathy microtrauma resulting from- Os trigonum repetitive dorsiflexion and plan- Peroneal tendinopathy tarflexion. The FHL travels through the fibro-osseous tun- nel above the posterior talar- tubercle and can be injured by compressive forces during full plantarflexion and stretch- ing between the talar tubercle and sustentaculum tali during dorsiflexion. Over time, cumu- lative stress leads to postero- medial ankle pain, inflammato- rychanges, nodular tendinopa- thy, and potentially tissue de- generation. 17 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za FHL tenosynovitis is the most likely diagnosis due to the crepitus. (Posterior ankle pain on Dancers, Clin Sports Medicine 2008) agree with above. FHL more likely post-medial, post im- pingement most likely post- lat- eral. Peroneal tendinopathynot common in dancers. Os trigon- um not really a diagnosis. 22. Which Tanner stage? Coarse hair across pubis but D not on inner thighs. 1 2 3 4 5 23. What is the most common stress fracture in ballet A. dancers? Base 2nd MT A base of 2nd metatarsal is the Base 5th MT most common stress fracture Rib in dancers. (Forefoot injuries in Navicular Dancers, Clinics in sportsmedi- Medial malleolus cine, 2008) Australian Pro Dancers' In- juries (Garrick - AJSM 1993): 24% ankle (acute sprains - 18 / 171  DB The return MCQs Study online at https://quizlet.com/_be70za posterior impingement) 23% back (2/3 lumbar) 17% foot (>half = 2nd MT stress #) 15% knee (mostly PFJ) 12% leg (mostly stress #) (A dancer's fracture is a spi- ral fracture of the shaft of the fifth metatarsal. It is the most common acute, traumaticfrac- ture encountered in dancers and frequently results from an inversion injury while dancing en pointe.) 24. Athlete with vit D level of 25. Which is correct man- B agement? Nothing as it is normal (Vitamin D and health in adults 3000-5000 units daily then re-check in 10-12 in Australia and New Zealand: a weeks position statement, MJA 1000 units daily then re-check in 10-12 weeks 2012) Sun exposure only- Face and arms in summer Adequacy >50, Mild 30-49, 6-7 min Mid morning and afternoon, or in winter moderate 12.5-29, Severe 7-40minutes at noon.