April 30, 2020 - Quiz 35

14. Which of the following patients would you advise further evaluation prior to initiation of an exercise program? (A) Patient with stable CAD wanting to restart their moderate exercise regimen (B) COPD patient with dyspnea at rest (C) A young, well-controlled hypertensive patient without risk factors and no evidence of organ damage (D) A well-controlled patient with epilepsy wanting to take up running for exercise

Correct Answer is B (B) COPD patient with dyspnea at rest

20. Which of the following statements is true regarding athletic equipment and the prevention of injury? (A) Ankle bracing is better than taping in prevention of recurrent ankle sprains (B) Mouthpieces help prevent concussion (C) Soccer Headgear helps prevent concussion (D) Knee bracing helps prevent ACL injury

Correct Answer is A (A) Ankle bracing is better than taping in prevention of recurrent ankle sprains

21. You are the medical director for a marathon race and in your review of the epidemiologic data on the common causes of mortality among marathon runners, you find that the most common cause of death during a marathon in the United States is? (A) Coronary artery disease (CAD) (B) Hypertrophic cardiomyopathy (C) Exercise-associated hyponatremia (EAH) (D) Cardiac arrhythmias

Correct Answer is A (A) Coronary artery disease (CAD)

19. Which of the following is true of exercise in patients with osteoporosis? (A) In postmenopausal women, impact exercises can increase BMD in the hip and spine. (B) Weight bearing exercises are more beneficial than non-weight bearing high force exercises in preventing bone loss and fractures in post-menopausal women. (C) Swimming can improve BMD in post-menopausal women (D) Smoking cessation will improve overall health but will not reduce risk of osteoporosis.

Correct Answer is A (A) In postmenopausal women, impact exercises can increase BMD in the hip and spine.

17. Which of the following is true regarding exercise in type 2 diabetes? (A) Muscular contractions stimulate blood glucose transport via an additive mechanism not impaired by insulin resistance or type 2 diabetes (B) Blood glucose remains stable during physical activity due to an increased reliance on fat to fuel muscular activity as intensity increases (C) There is little risk of hypoglycemia with moderate aerobic exercise, even in patients using exogenous insulin or insulin secretagogues (D) Persons with type 2 diabetes should undertake no more than 120 min/week of moderate to vigorous aerobic exercise, spread out during at least 3 days during the week

Correct Answer is A (A) Muscular contractions stimulate blood glucose transport via an additive mechanism not impaired by insulin resistance or type 2 diabetes

22. In the planning and preparation for a large mass participation international sporting event, there are many factors that should be considered. One environmental consideration is that of severe inclement weather. Which of the following should be part of the planning for such an occurrence? (A) Appropriate number of medical supplies should be monitored (B) Lead medical physicians should have good communication with local weather reporters (C) A safe area must be designated for athletes and spectator protection in the event evacuation is required due to inclement weather (D) Environmental planning should be managed by local authorities, not the medical personnel

Correct Answer is C (C) A safe area must be designated for athletes and spectator protection in the event evacuation is required due to inclement weather

15. A 30 year old male with T6 paraplegia presents to the office with a desire to begin a wheelchair exercise program. He has been gaining weight due to a lack of activity since the injury several years ago. He wants your advice on how to safely begin an exercise program. Along with advising proper equipment, carrying water, and avoiding hot or humid days, you also advise which of the following? (A) Wear tight leg straps to increase sympathetic tone (B) Take 10 grams of carbohydrates every 30 minutes during exercise (C) Empty his bladder and bowels before each workout (D) Have cervical x-rays to rule out atlantoaxial instability

Correct Answer is C (C) Empty his bladder and bowels before each workout

16. An obese patient (BMI > 30) without other comorbidities presents to your office. To improve compliance, one strategy for the patient's exercise prescription could include which of the following? (A) Incorporating high-impact aerobic activities (B) Emphasizing exercising after their morning (am) meal (C) Strict cardiovascular prescription at 85% maximum HR for at least 30 minutes five times per week (D) Increasing weight-bearing activities very rapidly to increase metabolism (E) Start with non-weight bearing activities such as swimming and recumbent bike

Correct Answer is E

10. Which of the following 2D echocardiographic measurements is one of the criteria for hypertrophic cardiomyopathy? A. Septal wall/ posterior wall thickness > 1.3 cm B. left ventricular outflow gradient < 25mmHg C. pericardial thickness >15mm D. atrial enlargement <4cm

Correct Answer: A

9.20 year-old male basketball player collapses and dies suddenly during a recreational basketball game. He was evaluated by a physician prior to participation in division I college athletics, and family reports the doctor noted no cardiac problems and "cleared him" for all sports. His height was 6 feet 7 inches. The family reports his grandfather was also tall and died of "heart problems" in his 60s. What is the most likely cause of death? A. Hypertrophic cardiomyopathy B. Coronary anomalies C. Myocarditis D. Aortic dissection E. Arrhythmia

Correct Answer: A

7. Which of the following statements is true about hypertension in athletes? A. Pre-hypertension is diagnosed when a patient is 95-99%ile + 5 mmHg B. Pre hypertension diagnosis does not restrict from play - it just needs close follow up with recheck within 6 months and diet management C. Stage 1 hypertension should be started on medications within 1 week D. Stage 2 hypertension is diagnosed as >99%ile plus 10 mmHg

Correct Answer: B

8. A 19 year old basketball player has an episode of unexplained syncope during practice. Patient adamantly denies any previous cardiac history and believes he was just dehydrated. He does admit, however that a cousin died suddenly at age 20 of cardiac causes. An EKG is obtained. Which abnormality would be suggestive of right ventricular dysplasia? A. normal EKG B. T-wave inversion C. Prolonged QT interval D. Q waves with ectopy E. Pre-excitation

Correct Answer: B

3. The following should always warrant further evaluation: A. Splitting of S2 B Resting heart rate of 45 C. The presence of an S4 D. Isolated large voltage QRS on EKG E. notched p wave on EKG

Correct Answer: C

5. The following are all features of Marfan's syndrome except A. Tall and thin body habitus B. Pectus deformity C. Long thin fingers D. Low arched palate E. Myopia

Correct Answer: D

1. The following are all common EKG findings in an athletic heart except: A. Sinus Brady B. sinus arrhythmia C. First degree AV block D. Partial RBBB E. left atrial enlargement

Correct Answer: E

2. True or false: T wave inversions in v1 and 2 are always abnormal in a pediatric athlete.

Correct Answer: False

4. True or false: The murmur of HCM decreases with Valsalva or moving from squat to stand.

Correct Answer: False

6. True or false: the typical murmur with mitral valve prolapse is a mid-systolic click.

Correct Answer: True

13. What is the evidence-based proportion of fat in a typical diet for natural body builders? (A) 15 to 30 % (B) 10 to 15% (C) 15 to 20% (D) 30 to 40%

Correct answer is A (A) 15 to 30 %

12. Which one of the following is correct about vitamin D in athletes? (A) Supplementation for an athlete with a vitamin D level below 20 ng/ml is achieved with 2000 IU of vitamin D2 daily (B) Maximum sports health benefit is achieved at a vitamin D level of 50 ng/ml (C) Screening athletes for vitamin D deficiency includes obtaining a serum (1,25) dihydroxyvitamin D level (D) Dietary supplementation with vitamin D2 is more advantageous than cutaneous synthesis of vitamin D

The Correct Answer Is: B (B) Maximum sports health benefit is achieved at a vitamin D level of 50 ng/ml

11. A 33 year old female runner returns to your clinic to follow up for patellofemoral syndrome of the left knee. As you are about to leave the room after her visit, she asks for your opinion on Vitamin C supplementation in athletes to help with immune function. Which of the following is the most appropriate response? (A) Vitamin C is an essential component to the diet and athletes should try to consume over 1 gram per day to optimize performance (B) Vitamin C is not an essential component to the diet and athletes should avoid supplementation for optimal performance (C) Vitamin C is an essential component to the diet and athletes should try to consume approximately 200 milligrams per day for optimal performance (D) Vitamin C is an essential component to the diet and athletes should try to consume under 100 milligrams per day to optimize performance

The Correct Answer Is: C (C) Vitamin C is an essential component to the diet and athletes should try to consume approximately 200 milligrams per day for optimal performance

26. Which of the following is true regarding sports participation in the athlete with a solitary kidney? (A) Before clearing an athlete with a solitary kidney for sports, testing should be undertaken to ensure normal kidney function (B) Kidney injuries are a common occurrence in sports (C) Traumatic kidney injuries in sports usually warrant urgent surgery and have high potential to be catastrophic (D) Athletes with one kidney should be discouraged from participation in contact or collision sports (E) Specialized padding has been proven to be beneficial in protecting a solitary kidney from injury

The Correct Answer is A (A) Before clearing an athlete with a solitary kidney for sports, testing should be undertaken to ensure normal kidney function

32. During the pre-participation exam for athletes, you should look for non-cardiac signs of cardiovascular disease. Which of the following is a physical finding of Marfan's syndrome? (A) Thumb sign (B) Elbow hyperextension (C) Fibrillin-1 mutation (D) Pes cavus

The Correct Answer is A (A) Thumb sign

23. You are responding as part of the medical team to athletes and spectators that have been victims of a mass causality in a sports arena due to an active shooter. Local authorities have cleared the area to begin medical treatment. There are multiple victims with extremity as well as chest wounds. Which of the following is the best course of action? (A) Begin CPR on any patient without a pulse (B) Apply tourniquets to all extremity wounds high and tight. Label the time and move on to the next patient (C) Apply pressure to chest wounds in sight only (D) Begin CPR on any patients without a pulse and look for an AED

The Correct Answer is B (B) Apply tourniquets to all extremity wounds high and tight. Label the time and move on to the next patient

29. A 25 year old male Italian soccer player presents to you for his pre-participation physical. He complains of some shortness of breath with exercise. His family history is significant for an older brother who died from a heart related issue while training in the military. Physical exam was within normal limits. Because of his family history you decide to order a 12-lead EKG. The EKG shows T wave inversion in leads V1 to V3. A terminal notch in the QRS complex is noted. You refer your patient to the cardiologist and he undergoes a two dimensional echocardiogram which shows an enlarged, hypokinetic right ventricle with a thin RV free wall. Your patient undergoes a cardiac biopsy and several days later, you get a pathology report which reads "fibro-fatty infiltration of right ventricular free wall." Based on the above, you diagnose this patient with? (A) Hypertrophic cardiomyopathy (B) Arrythmogenic right ventricular dysplasia (C) Anomalous coronary artery (D) Prolonged QT syndrome

The Correct Answer is B (B) Arrythmogenic right ventricular dysplasia

28. Which of the following statements regarding participation in competitive sports is most accurate in a patient with aortic stenosis (AS)? (A) Patients with mild AS may participate in all sports and require no follow up after initial testing (B) Patients with moderate AS are allowed to participate in moderate intensity static sports if an exercise tolerance test demonstrates satisfactory exercise capacity without symptoms or EKG changes, and has a normal blood pressure response to exercise (C) Patients with asymptomatic severe AS may participate in low static and low dynamic intensity competitive sports (D) Patients with symptomatic moderate AS may participate in low static and low dynamic intensity sports with serial evaluations of AS severity on at least an annual basis (E) Patients with severe AS should not engage in a low intensity recreational walking program after being excluded from competitive sports due to increased risk for syncope

The Correct Answer is B (B) Patients with moderate AS are allowed to participate in moderate intensity static sports if an exercise tolerance test demonstrates satisfactory exercise capacity without symptoms or EKG changes, and has a normal blood pressure response to exercise

18. A pregnant woman wants to learn more about what activities she can participate in during pregnancy. Which of the following activities should be avoided during pregnancy? (A) Swimming (B) Elliptical machine (C) Cycling (D) Light exercise including weight training

The Correct Answer is C (C) Cycling

35. Which of the following statements regarding Endurance & Fluid Replacement exercise is true? (A) Older athletes have increased thirst sensitivity when dehydrated. (B) Prehydration has not been proven to help prevent dehydration during exercise. (C) Hydration plans should have a goal of preventing >2% weight loss from water deficit (D) Body size and speed should be disregarded when developing Hydration plans.

The Correct Answer is C (C) Hydration plans should have a goal of preventing >2% weight loss from water deficit

31. During the athletic pre-participation evaluation, which of the following findings would be concerning for hypertrophic cardiomyopathy? (A) Normal auscultation findings (B) Widening of second heart sound (C) Midsystolic murmur that gets louder with standing or Valsalva maneuver (D) Systolic ejection murmur at the upper right sternal border

The Correct Answer is C (C) Midsystolic murmur that gets louder with standing or Valsalva maneuver

30. As part of a pre-participation evaluation, a 20 year old previously healthy asymptomatic African-American male college long distance runner has an EKG performed. Which of the following EKG findings is abnormal in athletes and warrants additional testing? (A) Sinus arrhythmia (B) Incomplete Right Bundle Branch Block (C) Mobitz Type II Second Degree AV Block (D) QRS Voltage Criteria for LVH

The Correct Answer is C (C) Mobitz Type II Second Degree AV Block

33. While evaluating a child for a pre-participation physical, you auscultate a murmur at the upper left sternal border. It is a crescendo-decrescendo murmur, and you are debating between a pathological murmur and an innocent murmur. Which of the following is true? (A) An atrial septal defect (ASD) would have a murmur that has a normal S2 split and moves with respiration (B) Pulmonic stenosis would present as a quiet murmur that can also be confused with an innocent murmur (C) Patients with an ASD may also have a diastolic murmur that sounds like a rumble across the tricuspid valve area (D) This murmur may be the initial finding in a patient with aortic stenosis (E) If this murmur decreases in intensity when the patient stands, it could be a finding of hypertrophic cardiomyopathy

The Correct Answer is C (C) Patients with an ASD may also have a diastolic murmur that sounds like a rumble across the tricuspid valve area

34. A 13 year male middle school soccer player presents for a pre-participation exam. He is asymptomatic, has a normal physical exam, and his family history is negative for cardiovascular disease. His pre-participation exam should include? (A) An electrocardiogram because he is male (B) An electrocardiogram because he plays soccer (C) An electrocardiogram because he is 13 years old (D) An electrocardiogram is not routinely indicated

The Correct Answer is D (D) An electrocardiogram is not routinely indicated

25. The parents of a young female soccer player solicit your advice regarding general injury prevention strategies during an office visit. In providing recommendations, which of the following injury prevention methods has been proven effective? (A) Neck strengthening programs for concussion (B) Mouthguards for concussion (C) Bracing for anterior cruciate ligament injury (D) Neuromuscular training programs for anterior cruciate ligament injury (E) Stretching programs for groin injury

The Correct Answer is D (D) Neuromuscular training programs for anterior cruciate ligament injury

24. Which of the following is true regarding children and sports activity? (A) Preteen athletes most commonly injure lower limbs where teenagers injure upper limbs (B) Salter Harris II fractures generally require surgical intervention (C) Joint dislocations and ligamentous injuries are more common than buckle and other types of fractures (D) Physes close on average at 14.5 years in girls and 16.5 years in boys (E) Non-union of fractures are common in the immature skeleton

The Correct Answer is D (D) Physes close on average at 14.5 years in girls and 16.5 years in boys

27. You are performing a pre-participation physical on the new college quarterback. It is noted in his history that he has cystic fibrosis. He played a full 4 years of high school football prior to matriculating to the school without a problem. Which of the following recommendations would you make as team physician? (A) The athlete is not cleared because he has cystic fibrosis (B) The athlete is cleared for full participation without further testing (C) The athlete is required to have pulmonary function testing prior to clearance to evaluate lung capacity (D) The athlete is required to have an exercise treadmill test prior to clearance to evaluate oxygen saturation during exercise (E) The athlete is required to have an induced sputum culture to see if he needs prophylactic antibiotics during play

The Correct Answer is D (D) The athlete is required to have an exercise treadmill test prior to clearance to evaluate oxygen saturation during exercise