CLIN SKILLS peds: sports physical Flashcards
Most exercise-related syncope is _____, but it can be the only preceding symptom in what?
benign, but it can be the only preceding symptom in sudden cardiac death (hypertrophic cardio-myopathy)
do you need a workup with exercise-related syncope?
yes!
is post-exertional syncope or exercise- induced syncope more worrisome?
during exercise
What are the causes of sudden death in athletes ?
95% are cardiac
should we screen athletes with echo?
No, the majority of asymptomatic pts would show FALSE positives.
AHA 2007 guidelines for personal history of exercise-syncope (5)
- Exertional chest pain/discomfort
- Unexplained syncope/near-syncope**
- Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
- Prior recognition of a heart murmur
- Elevated systemic blood pressure
AHA 2007 guidelines for family history of exercise-syncope (3)
- Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in >1 relative
- Disability from heart disease in a close relative <50 years of age
- Specific knowledge of certain cardiac conditions in family members:
AHA 2007 guidelines for physical exam of exercise-syncope (4)
- Heart murmur
- Femoral pulses to exclude aortic coarctation
- Physical stigmata of Marfan syndrome
- Brachial artery blood pressure (sitting position)§
why do you worry about a kid having a single paired-organ? (i.e. kidney)
should not do contact sports- b/c if they damage the only kidney they have, thats bad)
what pulmonary history might we care about for sports physical?
EIB (exercise-induced bronchospasm)
10 % of population affected after 3 to 8 minutes
important history for athlete: neuro, illness, meds, female
neuro: burning (potential brachial plexus injury),
illness: mono (spleen!)
meds: show underlying conditions
female: triad
what is the female athlete triad?
Classical definition with eating disorder (anorexia or bulimia), amenorrhea, osteoporosis
what has been added recently to the female athlete triad?
Now a little broader, including: “low energy availability” (i.e. inadequate energy intake
concussion: a mild form a TBI, has what longterm effects for how many years?
history of earlier concussion= a decline in their mental and physical processes up to more than 30 years later
what are “stingers and burners” referring to?
Injury to cervical nerve root or plexus, causing stinging or burning pain (“lightning bolt”) that spreads from the shoulder to the hand
- usually only seconds to minutes, but can last up to days
- Frequent occurrence may indicate cervical spinal stenosis
cardiac family history questions:
Family history of premature death or CVD in 1st-2nd degree relative < 50yo.
syncope, SOB and fatigue w/ exercise are all questions centering around what issue?
cardiac history for athlete
4 “areas of high yield” for PE
musculoskeletal (knees, spine, post-concussive neck)
cardiovascular
eyesight ( worse than 20/40, need glasses for sport)
abdomen
what positions do you need to have the pt in to listen for a murmur of dynamic LV outflow tract obstruction?
Supine and standing
hypertrophic cardiomyopathy causes a murmur that increases with ___ and decreases with _____ (pt positioning)
increases with standing/Valsalva
decreases with squatting
4 parameters of muscle activity
Flexibility
Strength
Power
Endurance
do you need labs for sports physical?
overall- dont need except maybe an echo and EKG for suspicions (family, pt history)
do all kids have a “right to participate” in sports?
NO legal “right to participate”
If choose to participate against medical advice – informed consent by all
