B6.079 Preparticipation Physical Exams Flashcards
function of preparticipation sports physical
maximize safe participation
identify medical problems with risks to the athlete or another participant during participation
identify conditions requiring treatment before participation
remove unnecessary restrictions on participation
should the PPE serve as a sub for comprehensive health maintenance?
no
ugh
when to do a PPE
best within 6 weeks of a season
not at a station exam ideally
neurocognitive testing in athletes
impact or immediate post-concussive assessment and cognitive testing is the most common
computer based - takes 30 min
get a baseline test for athletes 12 and older before season begins
problems with neurocognitive testing system
athletes can “game” the test to get a low score so can return to play
should not replace clinical signs and symptoms
bleeding problems in athletes
important in patients who want to play contact sports
mononucleosis - spleen size peaks at one month
recent infections that are important to be aware of in athletes
mono hep B HIV -5-7 mil cases worldwide -first stage is asymptomatic -recurrent infections?
important PMH components to be aware of in athletes
sickle cell trait history
-extreme heat and exertion may be a risk
congenital or acquired absence of a kidney
-contraindications for contact sports questionable
congenital or acquired absence of a testicle
-mandatory protective cup use
history of a seizure disorder
-water sports athletes need full evaluation
female athlete triad
amenorrhea
anorexia (disordered eating)
osteoporosis
primary amenorrhea
no menses by 16
secondary amenorrhea
no menses for >6 months after onset
heat illness in athletes
feeling faint or dizzy in heat, can cause heat exhaustion
athletes tend to have recurring problems
water > sports drinks»_space;> energy drinks
symptoms with exercise requiring further evaluation
syncope (cardiac, neuro, endocrine)
coughing, wheezing (pulm causes, asthma, EIB)
important family history in athletes
cardiac death before age 50 (hold from participation until cleared)
asthma
diabetes
bleeding problems (contact sports)
2 main parts of PPE
MSK exam
-stress fracture history
general physical exam
components of general physical exam on PPE
mental status neuro growth parameters CV status lung exam
derm conditions in athletes
tattooing/piercings
common in athletes
-Hep C most common cause of liver transplant
-3.9 mil americans have hep C
marfans syndrome
autosomal dominant
tall, thin, arm span exceeds height
refer to cardiologist for EKG and echo
sexual maturity
determine rating
based on stage of sexual maturity, not age or size
if advancement is suspected, think anabolic steroid use (8-9% of high school seniors)
cardio exam in PPE
95% of all sports related fatalities are cardiac in nature
more than 50% of those are hypertrophic cardiomyopathy (auto dom)
patient and fam history are important
hypertrophic cardiomyopathy
disproportionate hypertrophy of the ventricular septum
most cases are previously asymptomatic
exercise induced bronchospasm
90-100% of asthmatics have EIB difficulty breathing during and/or immediately after exercise loss of FeV1 of at least 15% worse in summer and fall pollution can exacerbate
important points of an orthopedic exam in the PPE
recognizing any preexisting injuries
define injury patterns
identify areas of injury susceptibility
develop rehab strategies to prevent injuries from occurring
stance / symmetry instructions
stand with arms at sides
