daily question
Scott Rand
Question: What does Chromium Picolonate do? While it may be factual an answer of ‘nothing’ is not acceptable
Scott E Rand, MD FAAFP CAQSM
Director, Primary Care Sports Medicine Fellowship
Co Director of Sports Medicine, Houston Methodist Orthopedics and Sports Medicine Willowbrook
Assistant Professor of Clinical Family Medicine Houston Methodist Academic Institute
Adjunct Assistant Professor of Family and Community Medicine, Texas A&M University
Assistant Professor of Family Medicine in Clinical Medicine Weill Cornell Medical College.
13802 Centerfield Dr Suite 300
Houston, TX 77070
Scott Rand
Which of the following is not felt to improve physical performance or considered an ergogenic aid?
A. Caffeine
B. Creatine
C. Anabolic steroids
D. Alcohol
Scott Rand
Which muscle is primarily responsible for unlocking the subtalar joint during gait?
A. Tibialis anterior
B. Peroneus longus
C. Tibialis posterior
D. Flexor hallucis longus
Scott Rand
How many bones does the navicular bone in the foot articulate with? Name them.
Scott Rand
A 38-year-old competitive slalom skier is making a turn to the left around a pole. The right ski sticks in the snow, causing external rotation of the right ski and boot. Which of the following ankle ligaments is most likely to be the initial structure injured?
1. Calcaneofibular ligament
2. Anterior inferior tibiofibular ligament
3. Deep deltoid ligament
4. Superficial deltoid ligament
5. Anterior
talofibular ligament
Scott Rand
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
Scott Rand
Which of the following is a current American Heart Association (AHA) recommendation regarding cardiac evaluation during the Preparticipation exam?
A. Auscultate for heart murmur during provocative maneuvers
B. Palpate bilateral brachial pulses
C. Obtain bilateral brachial blood pressure with the athlete standing
D. Perform electrocardiogram on all athletes
Scott Rand
Which of the following ECG findings in a trained athlete is considered a normal physiological adaptation rather than a pathological abnormality?
A. T-wave inversions in V1–V3
B. ST-segment depression
C. Sinus bradycardia
D. Pathologic Q waves
E. Right bundle branch block
Scott Rand
What is the primary physiological adaptation in an athlete's heart that leads to increased stroke volume?
A. Increased left ventricular wall thickness
B. Increased left ventricular cavity size
C. Decreased resting heart rate
D. Increased myocardial oxygen demand
Scott Rand
. What is the most common age for presentation for Legg Calve Perthes Disease
Scott Rand
A 16 year old male long jumper lands awkwardly with his R knee hyperextended, collapsing in the pit. He experiences acute swelling of the R knee immediately. PMH of resolved bilateral “jumper’s knee” and prominent tibial tubercles diagnosed two years ago. There is anterior deformity and swelling immediately distal to the patella. Which of the following statements is true regarding tibial tubercle apophyseal fracture?
A. patients with type 2 and 3 fractures of the tibial tubercle are able to actively extend the knee against gravity several degrees
B. Negative Lachman testing immediately after injury eliminates rupture of the anterior cruciate ligament as a possibility
C. Fracture at the tibial apophysis can be comminuted, displaced or involve the tibial articular surface
D. Osgood Schlatter’s disease is not associated with tibial tubercle fracture
Scott Rand
A 14 year old boy nears the end of a 5 minute mile track race during an indoor track meet. He has sudden sharp pain over the left hip just proximal to the inguinal ligament. He has mild nausea and even one episode of emesis.
In the office his exam shows left low back tenderness and limited forward flexion at the waist without neurologic or radicular findings. He also has tenderness to direct and firm palpation over the left superior ilium along its anterior third.
His physical exam also reveals no hernia, and the abdomen is benign.
His plain radiographs and an abdominal CT in the emergency room are normal. MRI reveals a mild avulsion of the apophysis over the left superior ileum as well as some mild edema indicating injury to the left quadratus lumborum. The plain film was read again showing the bony avulsion found on his MRI.
Proper recommendations include:
A. No running until radiologic healing is proven by plain x-ray
B. Refer to orthopedic surgeon
C. Conservative care, relative rest, return to running when pain has resolved and a full range of motion has returned
D. Limit his passive hip flexion to allow healing
E. Advise no further sprinting or racing on the track during this Track and Field season
Scott Rand
Scott Rand
What are the muscles that perform internal rotation at the glenohumeral joint?
Scott Rand
Posterior shoulder tightness can lead to a glenohumeral internal rotation deficit (GIRD). This has been linked most closely to which of the following shoulder pathologies?
1. Internal impingement
2. Humeral avulsion of the glenohumeral ligament
3. Subacromial impingement
4. Bicep tendinitis
5. Hill-Sachs lesion
Scott Rand
Your 24-year-old stud baseball pitcher
complains of vague right shoulder pain. It is most noticeable at the late
cocking phase of windup. On physical exam the patient is noted to have weakness
with external rotation. EMG findings are consistent with quadrilateral space
syndrome. Along with the deltoid, what other muscle is affected?
1. Teres major
2. Teres minor
3. Pectoralis major
4. Supraspinatus
5. Subscapularis
Scott Rand
Internal impingement commonly occurs in overhead athletes and is very common amongst elite baseball pitchers. In which phase of throwing does this pathologic process occur?
1. Wind-up
2. Early cocking
3. Late cocking
4. Deceleration
5. Follow-through