6 Flashcards
Preparticipation physical exam
(Cardiac and noncardiac)
(GU-3)
CV screening ( bp, brachial and femoral pulses, auscultation; murmur grade 3/6 or higher, diastolic murmur or murmur that gets worst with standing or valsava {hocm and MVP} requires further evaluation
Other non cardiac issues: A history of loss of consciousness or concussion (which may predispose the individual to neurologic injury)
Recovery from significant musculoskeletal injuries (accounts for 50% of the abnormal physical findings identified.)
Assessing general health
Counseling on health-related issues, and Assessing fitness level for specific sports.
Hernia, undescended testicles, demonstrate testicular exam
Vasovagal reflex
Prodrome
Syncope Evaluation (ecg and hocm)
Vasovagal syncope, often referred to as fainting, is caused by self-limited systemic hypotension due to altered neurocardiogenic reflexes leading to bradycardia and/or peripheral vasodilation (the brain is not being adequately perfused).
Children frequently describe prodromal symptoms that include dizziness, lightheadedness, sweating, nausea, weakness, and visual changes. Many times children experience the prodromal symptoms without syncope.
Often in response to a stressful event
Syncope is defined as the abrupt loss of consciousness and postural tone.
In any patient with syncope, an ECG should be obtained. Without an ECG, it is impossible to rule out some of the important arrhythmic causes of syncope, such as Wolf-Parkinson-White syndrome (abnormal fast accessory pathway from atria to ventricles) and long QT syndrome ( fam Hx -father died at young age, can lead to arrhythmia, often associated with congenital sensorineural deafness)
In addition, hypertrophic cardiomyopathy, the most common cause of sudden death in young athletes, can first present with syncope; the ECG is abnormal in more that 90% of patients with hypertrophic cardiomyopathy and is thus an essential screening test. An echocardiogram will show an asymmetrically thickened septum and dynamic obstruction of bf,
Osgood-schlatter disease
Treatment
Prognosis
Caused by irritation of the growth plateau the tibial tuberosity; from overuse. Usually self limited growing pain that resolves with rest and with finishing the growth spurt
Causes localized pain esp with quads contraction
Ice and NSAIDS can help with discomfort. It resolves after the bones are no longer growing and causes no long lasting health issues
Distinguishing types of chest pain 4 types:
Pcs, cc, gi, asthma
Precordial catch syndrome is the most common cause of chest pain in adolescents and is of unknown etiology. It is a benign condition characterized by sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be “broken” with a forced deep inspiration. It is often not associated with exercise - no further work up is needed for this
Costochondritis is also a benign cause of chest pain but less common. The pain of costochondritis is due to inflammation and typically will last for hours or days. (Cartilage that connects ribs to sternum) reproducibility of pain normally implies musculoskeletal issue
Gastrointestinal causes of chest pain include gastroesophageal reflux, gastritis, and esophagitis. These often cause pain that is described as:
Retrosternal
Burning
Non-radiating Associated with meals
A medication history is important in discerning a possible GI cause of chest pain and should include non-prescription meds, oral contraceptives, and those causing gastric irritation. Social history should inquire about the use of the following, all of which might potentially cause gastric or esophageal irritation: alcohol, tobacco, intoxicants, stimulants, cocaine or other drugs
Asthma or exercise-induced bronchospasm (EIB) may cause chest pain - usually in association with cough, wheezing, or respiratory distress.
Symptoms and signs of cardiac chest pain
Most common cause of CP in children
Onset
Pain triggered by exertion or stress
Quality
Pressure or crushing sensation
Duration
10-15 minutes
Associated symptoms
Syncope, palpitations
Exam findings
Murmur, thrill, hyperdynamic precordium
Chest pain is the second most common reason for referral to pediatric cardiologists. Although angina and other cardiac pain is very rare in children, it is often a concern for patients and parents.
In most patients, it is possible to make a correct diagnosis by a careful history and physical examination. The following features should prompt evaluation for cardiac causes of pain.
Musculoskeletal
Tanner stages for males -5
Prepubertal stage 1 childlike phallus, testicular v less than 1.5 ml, no pubic hair
Stage 2 Childlike phallus, testicular volume 1.6-6 ml, reddened thinner and larger scrotum, Small amount of fine hair along the base of scrotum and phallus
Stage 3 Increased phallus length, testicular volume 6- 12 ml, greater scrotal enlargement, Moderate amount of more curly, pigmented, coarser hair extending laterally
Stage 4 Increased phallus length and circumference, testicular volume 12-20 ml, further scrotal enlargement and darkening, Coarse curly adult like hair that doesn’t yet extend to the medial surface of thighs
Stage 5 Adult scrotum and phallus, testicular volume > 20 ml, Adult-type hair extending to medial surface of thighs
A 16-year-old male presents to your office requesting clearance to play football. You begin by taking his medical history. He says that he feels very well, but admits that he recently experienced one episode of syncope that occurred when he trained really hard for football tryouts with his friends. He denies any shortness of breath, or chest pain currently. Family history is significant for an uncle who died of heat stroke at the age of 30 while playing basketball. Physical examination reveals no abnormalities. What is the next best step in management?
Referral to cardiology is the absolute next best step! The combination of syncope with exertion and a family history of a young death is concerning for something like hypertrophic cardiomyopathy. Don’t be fooled about heat stroke. That is a positive family history for sudden death in a young person. This patient must be evaluated by cardiology, even if you don’t hear a cardiac murmur!
Anabolic steroids- synthetic variations of the male sex hormone testosterone
SE - 3
Acne
Change in testicular size
Increase risk of coronary heart disease
