ABIM Sports Medicine cheat sheet

Max heart rate estimate = 220 − age; maximal oxygen uptake (VO2max) reflects aerobic capacity and is the strongest predictor of endurance performance.

The Fick equation: VO2 = cardiac output × arteriovenous oxygen difference; stroke volume plateaus near 40-60% of VO2max while heart rate continues to rise.

Lactate threshold occurs at roughly 50-60% VO2max in untrained individuals and 70-80% in trained endurance athletes.

Concentric contraction shortens muscle and produces force at lower velocity; eccentric contraction lengthens muscle, generates higher force, and causes delayed-onset muscle soreness.

NSAIDs inhibit cyclooxygenase; selective COX-2 inhibition lowers GI ulcer risk but raises cardiovascular thrombotic risk.

WADA-prohibited classes include anabolic agents, peptide hormones, beta-2 agonists (by inhalation above threshold), diuretics, and stimulants; therapeutic use exemptions require documented medical need.

Carbohydrate loading (7-10 g/kg/day) raises muscle glycogen; pre-exercise meals are best consumed 3-4 hours before competition.

Preparticipation evaluation focuses on cardiovascular history (syncope, exertional chest pain, family sudden death) and a targeted physical exam; routine mass ECG screening remains debated.

Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young athletes; exertional syncope, family sudden death, and a harsh systolic murmur that changes with Valsalva are red flags.

Commotio cordis results from a blow to the precordial area during the vulnerable repolarization window (roughly 15-30 ms before the T-wave peak), triggering ventricular fibrillation.

Exercise-associated hyponatremia is dilutional; treat symptomatic cases with hypertonic (3%) saline, not free water or isotonic fluids.

Exercise-induced bronchoconstriction is diagnosed by a ≥10% fall in FEV1 after exercise challenge; beta-2 agonists are first-line.

Relative energy deficiency in sport (RED-S) impairs bone health, menstrual function, and metabolism; low energy availability is the central mechanism.

Sickle cell trait carriers have increased risk of exertional rhabdomyolysis and collapse, particularly in heat, altitude, and high-intensity conditions.

Athletes with infectious mononucleosis should avoid contact sports until clinical recovery and splenic risk resolves, typically a minimum of 4 weeks.

Diabetes: exercise lowers blood glucose; athletes should check glucose before, during, and after activity and carry fast-acting carbohydrate.

Anterior shoulder dislocation is most common; axillary nerve injury is assessed by deltoid sensation and contraction; recurrence risk is highest in young athletes.

The Neer and Hawkins-Kennedy tests assess subacromial impingement; the Jobe (empty can) test assesses supraspinatus.

AC joint separation is graded I-VI by the Rockwood classification; grades I-II are managed conservatively.

Lateral epicondylitis (tennis elbow) involves the extensor carpi radialis brevis origin; medial epicondylitis involves the flexor-pronator mass.

Ulnar collateral ligament injury of the elbow is common in throwing athletes; the moving valgus stress test is suggestive.

Scaphoid fractures risk avascular necrosis of the proximal pole; tenderness in the anatomic snuffbox warrants immobilization and imaging.

Skier's thumb is a rupture of the ulnar collateral ligament of the thumb MCP joint; Stener lesions require surgical repair.

Little leaguer's shoulder is proximal humeral physeal widening from repetitive throwing; treatment is rest and throwing restriction.

ACL injury is suggested by a positive Lachman test (most sensitive) and pivot shift; the mechanism is often noncontact deceleration with valgus and internal rotation.

Meniscal tears produce joint-line tenderness and a positive McMurray test; bucket-handle tears cause a locked knee.

Anterior knee pain in adolescents with a prominent tibial tubercle suggests Osgood-Schlatter disease; inferior patellar pole tenderness suggests Sinding-Larsen-Johansson.

Hip femoroacetabular impingement presents with groin pain and a positive FADIR (anterior impingement) test; cam and pincer morphology are defined on imaging.

Ankle inversion sprain most commonly injures the anterior talofibular ligament; the anterior drawer and talar tilt tests assess laxity.

Achilles tendon rupture yields a positive Thompson test (no plantar flexion on calf squeeze) and a palpable gap.

Medial tibial stress syndrome is diffuse posteromedial tibial tenderness; a focal tibial point with pain on hop testing raises concern for stress fracture.

Fifth metatarsal Jones fracture occurs at the metaphyseal-diaphyseal junction and has a high nonunion risk due to poor blood supply.

Spondylolysis is a stress fracture of the pars interarticularis, most often at L5; extension and single-leg hyperextension provoke pain.

Spondylolisthesis is graded I-V by the Meyerding classification based on the percentage of anterior vertebral translation.

Burners (stingers) are transient unilateral upper extremity paresthesias from brachial plexus traction or cervical root compression; bilateral symptoms suggest cord injury.

Cervical cord neurapraxia is defined by transient bilateral motor or sensory deficits after a cervical mechanism, with no evidence of fracture or dislocation.

Sacroiliac joint dysfunction presents with pain below the posterior superior iliac spine; pain above that level is more likely lumbar in origin.

Scoliosis with a Cobb angle under 20-25 degrees generally permits full sports participation with monitoring.

Discogenic back pain worsens with flexion, sitting, and Valsalva; extension-based pain suggests posterior element pathology.

Return to contact after cervical spine injury requires full painless range of motion, normal strength, and adequate canal dimensions when indicated.

Concussion is a functional, not structural, brain injury; loss of consciousness occurs in fewer than 10% of cases.

Red flags mandating emergency evaluation include worsening headache, repeated vomiting, focal deficits, seizure, and asymmetric pupils.

The Sport Concussion Assessment Tool evaluates symptoms, cognition, balance, and oculomotor function; baseline comparison is ideal.

Cervical spine immobilization is indicated for suspected injury with midline tenderness, neurologic deficit, or altered mental status after a high-risk mechanism.

Return-to-learn precedes return-to-play; a stepwise exertional progression begins only after symptom resolution.

Second impact syndrome is a rare, catastrophic diffuse cerebral edema from a second head injury before recovery from the first.

Orbital blowout fracture suggests entrapment when there is restricted upward gaze, diplopia, and cheek numbness (infraorbital nerve).

Nasal fractures are reduced after swelling subsides; epistaxis is managed with anterior pressure and packing if needed.

Sudden cardiac arrest response: recognize unresponsiveness, activate emergency response, start chest compressions at 100-120/min with 5-6 cm depth, apply an AED as soon as available.

The primary survey (ABCs) precedes the secondary survey; the on-field assessment is limited to ruling out life-threatening injury before transport.

Heat stroke is defined by core temperature typically above 40°C with central nervous system dysfunction; cold-water immersion is the treatment of choice.

Exertional heat exhaustion responds to rest in a cool environment and oral or intravenous rehydration when the athlete is alert.

Hypothermia is staged by core temperature; severe hypothermia requires gentle handling and active rewarming; defibrillation may be ineffective below 30°C.

Lightning safety follows the 30-30 rule: suspend activity when thunder is heard within 30 seconds of a flash, and wait 30 minutes after the last thunder.

Anaphylaxis is treated with intramuscular epinephrine into the anterolateral thigh; antihistamines are adjuncts, not first-line therapy.

Cervical spine injury management uses head immobilization, log-rolling, and spinal motion restriction with a rigid collar and backboard when indicated.

Tissue healing phases: inflammation (days 0-7), proliferation (weeks 1-6), and remodeling (weeks 6-12 and beyond); loading must match the phase.

The SAID principle (specific adaptation to imposed demands) governs exercise prescription; specificity drives adaptation.

Progressive loading follows the overload principle; the acute:chronic workload ratio above roughly 1.5 is associated with increased injury risk.

Return-to-play criteria include pain-free full range of motion, near-symmetric strength (often within 10%), and sport-specific functional testing.

Neuromuscular training programs reduce ACL injury risk in female athletes by approximately 50% or more.

Proprioceptive and balance training reduces recurrent ankle sprain risk; bracing or taping reduces reinjury during return.

RICE has largely been replaced by PEACE & LOVE (protection, elevation, avoid anti-inflammatory, compression, education; load, optimism, vascularization, exercise).

Bone stress injuries are graded by imaging; higher-grade injuries require prolonged non-weight-bearing and possibly surgical fixation.

The pediatric growth plate is the weakest link in the musculoskeletal unit, so physeal injuries are more common than ligamentous tears in children.

Youth resistance training is safe with proper supervision and technique; strength gains occur without a documented growth-plate injury risk when load is appropriate.

The female athlete triad consists of low energy availability, menstrual dysfunction, and low bone mineral density; it overlaps with RED-S.

Masters athletes have reduced VO2max and muscle mass but retain substantial trainability; screening should address cardiovascular risk.

The 2015 AHA/ACC eligibility guidance uses a shared decision-making model for athletes with cardiovascular disease rather than blanket exclusion.

Adaptive athletes: wheelchair athletes are at risk for autonomic dysreflexia, pressure injuries, and thermoregulatory impairment.

Athletes with a single kidney or solitary functioning kidney may participate in most sports with appropriate counseling and protection.

Return to play after infectious mononucleosis, myocarditis, or significant systemic illness requires individualized cardiopulmonary assessment.

Max heart rate estimate = 220 − age; maximal oxygen uptake (VO2max) reflects aerobic capacity and is the strongest predictor of endurance performance.

The Fick equation: VO2 = cardiac output × arteriovenous oxygen difference; stroke volume plateaus near 40-60% of VO2max while heart rate continues to rise.

Lactate threshold occurs at roughly 50-60% VO2max in untrained individuals and 70-80% in trained endurance athletes.

Concentric contraction shortens muscle and produces force at lower velocity; eccentric contraction lengthens muscle, generates higher force, and causes delayed-onset muscle soreness.

NSAIDs inhibit cyclooxygenase; selective COX-2 inhibition lowers GI ulcer risk but raises cardiovascular thrombotic risk.

WADA-prohibited classes include anabolic agents, peptide hormones, beta-2 agonists (by inhalation above threshold), diuretics, and stimulants; therapeutic use exemptions require documented medical need.

Carbohydrate loading (7-10 g/kg/day) raises muscle glycogen; pre-exercise meals are best consumed 3-4 hours before competition.

Preparticipation evaluation focuses on cardiovascular history (syncope, exertional chest pain, family sudden death) and a targeted physical exam; routine mass ECG screening remains debated.

Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young athletes; exertional syncope, family sudden death, and a harsh systolic murmur that changes with Valsalva are red flags.

Commotio cordis results from a blow to the precordial area during the vulnerable repolarization window (roughly 15-30 ms before the T-wave peak), triggering ventricular fibrillation.

Exercise-associated hyponatremia is dilutional; treat symptomatic cases with hypertonic (3%) saline, not free water or isotonic fluids.

Exercise-induced bronchoconstriction is diagnosed by a ≥10% fall in FEV1 after exercise challenge; beta-2 agonists are first-line.

Relative energy deficiency in sport (RED-S) impairs bone health, menstrual function, and metabolism; low energy availability is the central mechanism.

Sickle cell trait carriers have increased risk of exertional rhabdomyolysis and collapse, particularly in heat, altitude, and high-intensity conditions.

Athletes with infectious mononucleosis should avoid contact sports until clinical recovery and splenic risk resolves, typically a minimum of 4 weeks.

Diabetes: exercise lowers blood glucose; athletes should check glucose before, during, and after activity and carry fast-acting carbohydrate.

Anterior shoulder dislocation is most common; axillary nerve injury is assessed by deltoid sensation and contraction; recurrence risk is highest in young athletes.

The Neer and Hawkins-Kennedy tests assess subacromial impingement; the Jobe (empty can) test assesses supraspinatus.

AC joint separation is graded I-VI by the Rockwood classification; grades I-II are managed conservatively.

Lateral epicondylitis (tennis elbow) involves the extensor carpi radialis brevis origin; medial epicondylitis involves the flexor-pronator mass.

Ulnar collateral ligament injury of the elbow is common in throwing athletes; the moving valgus stress test is suggestive.

Scaphoid fractures risk avascular necrosis of the proximal pole; tenderness in the anatomic snuffbox warrants immobilization and imaging.

Skier's thumb is a rupture of the ulnar collateral ligament of the thumb MCP joint; Stener lesions require surgical repair.

Little leaguer's shoulder is proximal humeral physeal widening from repetitive throwing; treatment is rest and throwing restriction.

ACL injury is suggested by a positive Lachman test (most sensitive) and pivot shift; the mechanism is often noncontact deceleration with valgus and internal rotation.

Meniscal tears produce joint-line tenderness and a positive McMurray test; bucket-handle tears cause a locked knee.

Anterior knee pain in adolescents with a prominent tibial tubercle suggests Osgood-Schlatter disease; inferior patellar pole tenderness suggests Sinding-Larsen-Johansson.

Hip femoroacetabular impingement presents with groin pain and a positive FADIR (anterior impingement) test; cam and pincer morphology are defined on imaging.

Ankle inversion sprain most commonly injures the anterior talofibular ligament; the anterior drawer and talar tilt tests assess laxity.

Achilles tendon rupture yields a positive Thompson test (no plantar flexion on calf squeeze) and a palpable gap.

Medial tibial stress syndrome is diffuse posteromedial tibial tenderness; a focal tibial point with pain on hop testing raises concern for stress fracture.

Fifth metatarsal Jones fracture occurs at the metaphyseal-diaphyseal junction and has a high nonunion risk due to poor blood supply.

Spondylolysis is a stress fracture of the pars interarticularis, most often at L5; extension and single-leg hyperextension provoke pain.

Spondylolisthesis is graded I-V by the Meyerding classification based on the percentage of anterior vertebral translation.

Burners (stingers) are transient unilateral upper extremity paresthesias from brachial plexus traction or cervical root compression; bilateral symptoms suggest cord injury.

Cervical cord neurapraxia is defined by transient bilateral motor or sensory deficits after a cervical mechanism, with no evidence of fracture or dislocation.

Sacroiliac joint dysfunction presents with pain below the posterior superior iliac spine; pain above that level is more likely lumbar in origin.

Scoliosis with a Cobb angle under 20-25 degrees generally permits full sports participation with monitoring.

Discogenic back pain worsens with flexion, sitting, and Valsalva; extension-based pain suggests posterior element pathology.

Return to contact after cervical spine injury requires full painless range of motion, normal strength, and adequate canal dimensions when indicated.

Concussion is a functional, not structural, brain injury; loss of consciousness occurs in fewer than 10% of cases.

Red flags mandating emergency evaluation include worsening headache, repeated vomiting, focal deficits, seizure, and asymmetric pupils.

The Sport Concussion Assessment Tool evaluates symptoms, cognition, balance, and oculomotor function; baseline comparison is ideal.

Cervical spine immobilization is indicated for suspected injury with midline tenderness, neurologic deficit, or altered mental status after a high-risk mechanism.

Return-to-learn precedes return-to-play; a stepwise exertional progression begins only after symptom resolution.

Second impact syndrome is a rare, catastrophic diffuse cerebral edema from a second head injury before recovery from the first.

Orbital blowout fracture suggests entrapment when there is restricted upward gaze, diplopia, and cheek numbness (infraorbital nerve).

Nasal fractures are reduced after swelling subsides; epistaxis is managed with anterior pressure and packing if needed.

Sudden cardiac arrest response: recognize unresponsiveness, activate emergency response, start chest compressions at 100-120/min with 5-6 cm depth, apply an AED as soon as available.

The primary survey (ABCs) precedes the secondary survey; the on-field assessment is limited to ruling out life-threatening injury before transport.

Heat stroke is defined by core temperature typically above 40°C with central nervous system dysfunction; cold-water immersion is the treatment of choice.

Exertional heat exhaustion responds to rest in a cool environment and oral or intravenous rehydration when the athlete is alert.

Hypothermia is staged by core temperature; severe hypothermia requires gentle handling and active rewarming; defibrillation may be ineffective below 30°C.

Lightning safety follows the 30-30 rule: suspend activity when thunder is heard within 30 seconds of a flash, and wait 30 minutes after the last thunder.

Anaphylaxis is treated with intramuscular epinephrine into the anterolateral thigh; antihistamines are adjuncts, not first-line therapy.

Cervical spine injury management uses head immobilization, log-rolling, and spinal motion restriction with a rigid collar and backboard when indicated.

Tissue healing phases: inflammation (days 0-7), proliferation (weeks 1-6), and remodeling (weeks 6-12 and beyond); loading must match the phase.

The SAID principle (specific adaptation to imposed demands) governs exercise prescription; specificity drives adaptation.

Progressive loading follows the overload principle; the acute:chronic workload ratio above roughly 1.5 is associated with increased injury risk.

Return-to-play criteria include pain-free full range of motion, near-symmetric strength (often within 10%), and sport-specific functional testing.

Neuromuscular training programs reduce ACL injury risk in female athletes by approximately 50% or more.

Proprioceptive and balance training reduces recurrent ankle sprain risk; bracing or taping reduces reinjury during return.

RICE has largely been replaced by PEACE & LOVE (protection, elevation, avoid anti-inflammatory, compression, education; load, optimism, vascularization, exercise).

Bone stress injuries are graded by imaging; higher-grade injuries require prolonged non-weight-bearing and possibly surgical fixation.

The pediatric growth plate is the weakest link in the musculoskeletal unit, so physeal injuries are more common than ligamentous tears in children.

Youth resistance training is safe with proper supervision and technique; strength gains occur without a documented growth-plate injury risk when load is appropriate.

The female athlete triad consists of low energy availability, menstrual dysfunction, and low bone mineral density; it overlaps with RED-S.

Masters athletes have reduced VO2max and muscle mass but retain substantial trainability; screening should address cardiovascular risk.

The 2015 AHA/ACC eligibility guidance uses a shared decision-making model for athletes with cardiovascular disease rather than blanket exclusion.

Adaptive athletes: wheelchair athletes are at risk for autonomic dysreflexia, pressure injuries, and thermoregulatory impairment.

Athletes with a single kidney or solitary functioning kidney may participate in most sports with appropriate counseling and protection.

Return to play after infectious mononucleosis, myocarditis, or significant systemic illness requires individualized cardiopulmonary assessment.