CLIPP 6 Flashcards
syncope in supine position is suggestive of
seizure
warm cyanotic or flushed skin vs pale and diaphoretic suggestive of
seizure
test indicated in any patient with syncope
ECG
Osgood-Schlatter disease
irritation of growth plate at tibial tuberosity that is self-limited and resolves with rest and resolves when the growth spurt ends. Ibuprofen can sometimes help. Typically no long term issues from this.
-may have swelling and tenderness below the knee
Has anyone in your family had an MI or stroke before age 50?
News that a first or second degree relative is affected should lead to further family history and further patient evaluation before approval of given to participate in sports
Do you have both kidneys?
Key to ask a) because it demonstrates the kid is not just saying no to everything and b) contact sports are not allowed if only one kidney
most common chest pain in adolescents
musculoskeletal
- precordial catch syndrome: of unknown etiology. A benign condition, it occurs most commonly in adolescents and is 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.
- costochondritis: benign cause of chest pain but less common. The pain of costochondritis is due to inflammation and typically will last for hours or days.
HOCM genetics
AD
GI sources of chest pain could be caused by meds causing GI irritation, such as
alcohol, intoxicants, stimulants, tobacco, cocaine
angina vs precordial catch CP differences in onset, quality, timing, aggravating factors and associated symptoms
onset: typically exertional/stress vs sporadic and can occur with exertion but just as frequently with rest
quality: pressure/crushing vs sharp/well-localized
timing: 5-10 min vs brief
aggravating factors: - vs pain with deep inspiration that can be broken with forced deep inspiration
associated symptoms: syncope/palpitations vs =
which exam accounts for ~50% of the abnormal findings found on pre participation exam
msk
two min ortho exam
is part of pre participation physicals and tests symmetry in strength, muscle bulk and ROM and should NOT be done if current or prior injury. abnormalities should –> more thorough eval
Tdap first recommended to be given at
11-12 yo, used as booster dose
DTap
contains 3-5x more diphertheroid toxoid than Tdap and is pediatric dose
DT
for kids who can’t get the acellular pertussis component
mcv4 = meningococal conjugate vaccine4
11-12yo w/ booster at 16, but if you get first dose at 13-15 yo then second dose should be at 16-18 yo
-if get it after age 16, you don’t need a booster and Routine vaccination of healthy persons who are not at increased risk for exposure to N. meningitidis is not recommended after age 21 years.
hep A
2 doses often done at 12 and 18 months
hep b
3 doses often in early infancy
HPV vaccine types
bivalent = women quadrivelanet = for mnen 9-26
worrisome heart murmurs in adolescents
diastolic, increases w/ standing, or louder than grade3-4
Is Tanner staging a routine part of the pre-participation physical exam?
No
Tanner staging of phallus development
1: childlike phallus, testicular vol20ml
EMV+ limits your sports participation due to…
splenic rupture risk if playing contact sports
strep throat no longer contagious after
24h of antimicrobials
hypoglycemia sx
diaphoresis, anxiety, tremors, feeling of hunger
congenital heart block can be caused by
congenital heart disease, AI disease in pregnant women, like lupus
postural hypotension sx
can commonly cause dizziness and visual changes and often triggered by vol depletion and skipping meals. Typically not associated with prolonged (>5 min) LOC or CP
prolonged QT sx
can lead to v fib. can be syndromic in assoc w/ sensorineural hearing loss. causes syncope in late childhood/adolescence
VSD could cause
eisenmeingers
is ECG sufficient work up in pt w/ exertion related syncope?
no - refer to cardiology, too!!
when is ecg not needed
if not real syncopal event or cp - for example if tacky with sunken eyes and almost fainted, could be dehydrated and need fluids and VS recheck
if pt w/ cp and recent viral URI/infecction, consider
pericarditis or pericardial effsuion
