Orthopaedic Sports Medicine Sports Emergencies: Review Questions Francis H. Shen, MD, and Peter W. Thompson, BA Dr Shen is an assistant professor, Department of Orthopaedic Surgery, and Mr. Thompson is a medical student; both are at the University of Virginia, Charlottesville, VA. Choose the single best answer for each question.
	1. A 19-year-old male basketball player collapses suddenly while jogging down the court during a preseason training session. The team’s trainer finds him unresponsive, without pulse or respiration. All attempts at resuscitation are unsuccessful. The coach, who witnessed the incident, said his player “seemed just fine” until he collapsed and had not complained of headaches or other maladies. The player’s past medical history is unremarkable. What is this patient’s most likely cause of death? Aortic dissection Commotio cordis Diabetic hypoglycemia Heat stroke Hypertrophic cardiomyopathy (HCM) Click here to compare your answer. 2. A 31-year-old male football defensive back fails to return to his feet and lies motionless on his back following a play in which he employed a “spear tackle” (ie, an illegal maneuver in which the tackler drives his head into the opponent’s body). The team trainer rushes onto the field, and finds the patient unconscious. A pulse is present, but he does not appear to be breathing. What is the next step in the on-field management of this patient? Remove the mouthpiece (if present) and helmet immediately to reestablish airway and breathing as quickly as possible. Carefully remove the helmet to allow for proper immobilization with a spine board and cervical collar and then begin rescue breathing. Immobilize the player with spine board and cervical collar, gently remove the helmet, and begin cardiopulmonary resuscitation. Remove the mouthpiece (if present) and face mask only, leaving the helmet in place. Reassess airway and breathing and begin rescue breathing, if necessary. Leave the patient in the position in which he lies-any body movement may exacerbate a possible spinal cord injury. Click here to compare your answer.		3. An 18-year-old man participated in a regional amateur boxing tournament. In his first bout, he sustained several blows to the head and received a standing 8 count from the referee. After the bout, the young man complained of a persistent headache and dizziness; however, he participated in his next bout 2 days later. In the first round, he received a light jab to the head. On the way back to his corner after the first round, he suddenly collapsed and became semicomatose with respiratory failure and fixed, dilated pupils. He died before medical attention could be obtained. What would this patient’s head computed tomography (CT) scan likely reveal? Bilateral frontal lobe atrophy Moderate edema localized to the area of injury Significant cervical spinal canal stenosis Skull fracture and massive epidural hematoma Widespread edema and uncal herniation Click here to compare your answer. 4. A 23-year-old hockey player is checked and strikes her helmeted head sharply on the boards, hyperextending her neck. She recalls that initially she could not move and had no sensation below the neck. After approximately 5 minutes, sensation and motor function returned, beginning in the fingers and toes and eventually to the extent that she was able to skate off of the ice without assistance. A neurologic examination revealed slightly reduced strength throughout, 1+ upper extremity reflexes, 2+ lower extremity reflexes, and slight sensory deficits for pinprick, vibration, and position sense. Radiographs, CT scans, and magnetic resonance images were obtained, revealing cervical spinal canal stenosis, edema of the spinal cord, and surprisingly, congenital atlanto-occipital fusion. Based on these findings, what is the best recommendation for this patient’s return to play? Immediate but conditional return to competition Individualized counseling for risk assessment leading to eventual return Permanent discontinuation of participation in contact sports Return following complete cessation of all neurologic symptoms Temporary discontinuation and a thorough rehabilitation regimen Click here to compare your answer.
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