Specialist & Consultant Sports Medicine oral assessment prep

Knowledge: Sinus bradycardia and isolated voltage criteria are normal training-related findings, but inferolateral T-wave inversion of 1 mm or more in two or more contiguous leads is abnormal under the International Recommendations for ECG Interpretation in Athletes. A septum of 13 to 15 mm sits in the grey zone between physiological remodelling and hypertrophic cardiomyopathy. Features favouring HCM include asymmetric hypertrophy, a small cavity, impaired diastolic function, late gadolinium enhancement on cardiac MRI and a family history of sudden death. Other causes of lateral T-wave inversion include arrhythmogenic cardiomyopathy and myocarditis. The ESC 2020 sports cardiology guideline allows individualised decisions in low-risk, mildly expressed HCM rather than automatic disqualification.

Management: I would arrange cardiac MRI with gadolinium as the key next test. I would add an exercise test, 24 to 48 hour ambulatory ECG and a detailed family history. If uncertainty remains, I would discuss genetic testing through a cardiogenetics service and, where appropriate, a supervised detraining period with repeat imaging. He should stop high-intensity training until assessment is complete. If HCM is confirmed, I would calculate the ESC HCM Risk-SCD score with the cardiologist. Any return to sport would be a shared decision based on risk, with an emergency action plan and an automated external defibrillator at training and matches. I would not clear him on echocardiography alone or to meet the transfer deadline. First-degree relatives should be offered screening.

Ethics and communication: My duty is to the player, not to the club's timetable. I would explain the uncertainty honestly and obtain his consent before sharing results with the club, telling the club only his fitness status unless he agrees to more. Genetic results need careful counselling, as they affect his relatives. I would document the advice in line with UAE law and facility policy.

Reference: ESC 2020 Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease; Drezner JA et al, International Recommendations for Electrocardiographic Interpretation in Athletes (2017)

Knowledge: This is a sport-related concussion: a traumatic brain injury, here with amnesia and unsteadiness. Red flags that need emergency imaging include deteriorating consciousness, worsening headache, repeated vomiting, seizure, focal deficit and severe neck pain, and none is present. Adolescents recover more slowly than adults and are at risk of a second injury while symptomatic. The Amsterdam 2022 consensus advises a short period of relative rest of 24 to 48 hours, then symptom-limited light activity. Return to learn comes before return to full contact. Persisting symptoms beyond four weeks in children need multidisciplinary assessment.

Management: I would take a full history including previous concussions, migraine and mood, examine cervical spine, balance and eye movements, and record a symptom score with SCAT6 or the child version where appropriate. I would advise light aerobic activity that does not more than mildly worsen symptoms and limit screens. I would write to the school for temporary adjustments such as shorter days and extra time. Once fully back at school without symptoms, he would start the graded return-to-sport strategy, with at least 24 hours per step and return to symptoms prompting a step back. Full contact training requires medical clearance. I would not clear him for the final on a fixed date. If symptoms persist, I would refer for vestibular, cervical and psychological assessment.

Ethics and communication: He is under 18, so consent for treatment and for sharing information comes from his guardian, while I still involve him fully in the discussion. I would explain to the father and, with his agreement, to the coach that the decision is medical and not negotiable by match schedule. I would document the advice and clearance criteria.

Reference: Patricios JS et al, Consensus Statement on Concussion in Sport: the 6th International Conference on Concussion in Sport, Amsterdam 2022 (2023); Brukner and Khan's Clinical Sports Medicine (5th ed, 2017)

Knowledge: Core temperature above 40.5 C with central nervous system dysfunction in an exercising person is exertional heat stroke until proven otherwise. Survival depends on the time spent above the critical threshold, so cooling within 30 minutes is the priority. Cold-water immersion is the most effective and preferred cooling method. Differentials to exclude are exercise-associated hyponatraemia, hypoglycaemia, cardiac arrest or arrhythmia, and head injury. Oral and tympanic temperatures are unreliable after exertion. Complications include rhabdomyolysis, acute kidney injury, liver injury and disseminated intravascular coagulation.

Management: I would secure the airway, check breathing and circulation, and immerse him to the neck in an ice-water tub at the medical tent with continuous rectal temperature monitoring. If a tub is unavailable, I would use rotating ice-water towels and continuous dousing. I would remove him from the water at about 38.6 to 39 C to avoid overshoot hypothermia. I would check sodium with a point-of-care analyser before giving any intravenous fluid, and give isotonic fluid if he is hypotensive and not hyponatraemic. Antipyretics have no role. Once cooled and stable, I would transfer him to hospital for creatine kinase, renal and liver function and coagulation monitoring. Return to activity would be gradual once symptoms and laboratory values normalise, with heat acclimatisation and a sports medicine review. For future events I would plan wet-bulb globe temperature monitoring, cooling stations and start times.

Ethics and communication: He lacks capacity, so I would act in his best interests under emergency provisions and explain events to him and his family once he recovers. I would record times, temperatures and treatment precisely, as this protects the patient and the team. I would report the case to the organiser and review whether event conditions were safe, without blaming the runner.

Reference: Roberts WO et al, ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity (2021); Casa DJ et al, National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses (2015)

Knowledge: Femoral neck stress fractures are high-risk because displacement can lead to avascular necrosis. Compression-side injuries on the inferomedial neck with a line under 50 percent of the width are usually managed non-operatively, while tension-side, wider or displaced fractures need urgent orthopaedic fixation. Amenorrhoea, low BMI, weight loss and low bone density point to relative energy deficiency in sport, in which low energy availability affects bone, endocrine, metabolic and psychological health. The IOC 2023 consensus provides the REDs Clinical Assessment Tool version 2 to grade risk. Functional hypothalamic amenorrhoea is a diagnosis of exclusion. An eating disorder must be screened for.

Management: I would stop running at once and start protected weight bearing with crutches until pain-free walking, and discuss with an orthopaedic surgeon in case of progression. I would repeat imaging if pain worsens. I would check pregnancy test, thyroid function, prolactin, FSH, LH, oestradiol, vitamin D, full blood count and electrolytes, and an ECG if bradycardic. The core treatment is restoring energy availability with a sports dietitian and, if disordered eating is present, a psychologist or eating disorder service. I would ensure adequate calcium and vitamin D. I would not use the combined oral contraceptive pill to treat bone health, as it masks amenorrhoea without improving bone density, though transdermal oestradiol with cyclic progesterone can be considered if recovery stalls. Return to running would follow a graded, pain-free programme with REDs criteria met.

Ethics and communication: She is an adult and decides who is told about her diagnosis, including her coach and parents. I would explain the risk of displacement and of long-term bone loss honestly. If she declines dietetic or psychological care, I would keep her engaged and document the advice and her decision.

Reference: Mountjoy M et al, 2023 International Olympic Committee's (IOC) Consensus Statement on Relative Energy Deficiency in Sport (REDs); Brukner and Khan's Clinical Sports Medicine (5th ed, 2017)

Knowledge: All injectable routes of glucocorticoid administration, including intra-articular, are prohibited in-competition, and WADA publishes washout periods that apply before the in-competition period. Use within that window needs a therapeutic use exemption, granted only if there is a diagnosed condition, no reasonable permitted alternative, and no performance enhancement beyond return to health. Intravenous infusions or injections of more than 100 mL per 12-hour period are prohibited at all times unless legitimately received during hospital treatment, surgery or clinical investigation. Routine recovery infusions do not meet that exception. Athlete support personnel, including doctors, can commit anti-doping rule violations such as administration and complicity. Clinically, a post-traumatic effusion needs assessment for haemarthrosis, fracture or ligament injury before any injection.

Management: I would first examine the knee properly and arrange imaging, as an injection into an undiagnosed traumatic knee could mask a serious injury. I would offer permitted treatment such as ice, compression, aspiration if tense and simple analgesia, and advise withdrawal if he cannot ride safely. If a corticosteroid injection were genuinely indicated, I would check the WADA washout rules and apply for a therapeutic use exemption. I would decline the routine infusions and offer oral rehydration and nutrition instead. I would record every treatment accurately. I would explain my position to the manager in writing. If pressure continued, I would escalate to the team's medical lead or federation as appropriate.

Ethics and communication: My first duty is to the rider's health, and an unnecessary prohibited injection risks both harm and a ban for him and for me. Concealing treatment would breach professional standards and medical record-keeping duties. I would obtain the rider's informed consent for any treatment and be open with him about the rules. I would not let employment by the team compromise my clinical independence.

Reference: World Anti-Doping Code (2021); WADA Prohibited List; WADA International Standard for Therapeutic Use Exemptions

Knowledge: This is likely a moderately severe depressive episode, with injury, loss of athletic identity and relationship loss as triggers. Elite athletes have rates of mental illness similar to or higher than the general population, and injury is a recognised risk factor. I would screen for alcohol and substance use, bipolar features and psychotic symptoms. Passive suicidal ideation without plan or intent indicates lower immediate risk but needs a structured risk assessment and a safety plan. The IOC consensus on mental health in elite athletes supports treatment within a multidisciplinary team. Selective serotonin reuptake inhibitors and psychological therapy are effective and are not prohibited by WADA.

Management: I would do a full risk assessment, asking about plans, means, previous attempts, protective factors and support. I would agree a written safety plan, including how to contact me and emergency services. I would refer him urgently to a psychiatrist or psychologist experienced with athletes, and discuss cognitive behavioural therapy and an SSRI. I would review him within one week. I would keep him connected with the team if he wishes. If his risk rose to active intent, I would arrange urgent psychiatric assessment. I would offer to tell the coach only that he is under medical care and his training status, without the diagnosis.

Ethics and communication: My duty of confidentiality is to the player, not the club, and I would share nothing without his consent, in line with Federal Law No. 2 of 2019 on health data. I would break confidentiality only if there were a serious risk to his life. Involuntary admission is governed by Federal Law No. 10 of 2019 on Mental Health and requires a mental disorder with serious risk. I would declare my dual role openly.

Reference: Reardon CL et al, Mental Health in Elite Athletes: International Olympic Committee Consensus Statement (2019); WMA Declaration of Lisbon on the Rights of the Patient