Lecture 15: Pre-Participation Sports Physicals Flashcards
What is the ultimate goal of a Pre-Participation Physical Exam (PPE)?
Promote health and safety of student athletes
When is a PPE usually done?
6-8 weeks prior
Perform annually
Before whatever sport you wanna play
What are the 3 methods for doing a PPE?
- Locker-room
- Station
- Office-based
Describe locker-room PPEs
- LINE UP single file
- Line inspection one by one
- Little privacy & loud but efficient!
When is the station method for PPE best?
Large numbers
Efficient, but little privacy also. Conveyor belt
Splitting up duties.
Pros and Cons of Office PPE
- Pros: established relationship, privacy
- Cons: Lack of consistency, unfamiliarity with sports, lack of cost effectiveness
What is the main issue with pediatric providers providing PPEs for sports?
They’re not sports med people!
What is the most important part of PPE?
Medical history
What do we mainly care about in CV Medical Hx for a PPE?
Anything that can predispose them to sudden death
Kawasaki, Heart infection, CP w/ exercise, Murmur, HTN
What FMHx is significant for potential cardiac complications in a PPE?
- Premature deaths before 50 d/t heart dz
- Disability before 50
- FHx of PPM
- HOCM/DCM, Long QT, Marfan syndrome, arrhythmia
Age 50 seems important
What associated symptoms make a concussion complicated?
- Amnesia (either)
- Loss of consciousness (LOC)
- Seizure
- Prolonged symptoms
When is a child able to return to learn post concussion?
- Able to concentrate on a task
- Tolerable of visual and auditory stimulus for 30+ mins
- Return them with academic adjustments
Can they handle the noise/distractions of a classroom and focus
What are the requirements to begin return to play?
- Successful return to school
- Symptom-free and free off meds
- Normal neuro exam
- Baseline balance and cognitive function
How long is each step of the Return to Play protocol?
1 day
Must be symptom free for 24 hrs to move onto next step.
What two indications mean you MUST retire from contact/collision sports?
- Structural brain abnormality (AKA your brain is like permanently damaged)
- Nonresolving/Prolonged neurocognitive defects
Post-concussion
What are the 3 accepted/appropriate indications for a kid to retire from contact sports?
- Increased recovery times
- Repeat concussions with decreased thresholds and persistent symptoms
- Multiple concussions
AKA too many concussions and can’t recover well anymore.
What are the high-risk areas on the MSK exam for kids?
- Shoulder
- Knee
- Ankle
Which murmur gets quieter upon standing?
Aortic stenosis/regurg
so much blood, can’t close valves as hard
What murmur gets louder on standing?
Hypertrophic CM
More venous return
Imagine a stiff balloon getting filled more and then squeezing it so it pops even louder.
What is the MCC of sudden cardiac death in children?
HCM (1/3 of all cases)
What is the second MCC of sudden death in athletes?
Coronary artery abnormality
Left main coming off R sinus
Anomalous origin of LCA
What congenital heart defects are most associated with anomalous coronary arteries?
- TGA
- ToF
- Pulmonary atresia
The cyanotic CCHD
Why is ACA not caught early?
We don’t regularly cath kids, and there are rarely symptoms prior to a severe event.
Anomalous coronary artery
What is the most serious concern with Marfan’s?
Progressive aortic root dilation
also can cause MVP
CT Disorders = aortic dissection
Can a student athlete with stage 1 HTN participate in sports? Stage 2?
- Stage 1 with no end-organ damage can with appropriate subspecialist referral.
- Stage 2 must lower BP before they can participate
What is a non-traumatic cause of death in athletes that is lung-related?
Status asthmaticus due to exercise induced bronchoconstriction
What is the main environmental trigger for airway narrowing?
Dry/cold air
How do we tx EIA/B?
- Albuterol inhaler prior to exercising
- Singulair/montelukast
- Proper warmup
When might DM be a concern with athletes?
If activity is longer than 30 minutes
Vascular issue?
Enlargement of what abdominal organs is a contraindication to sports?
- Liver
- Spleen
Its gunna rupture
Think mono precautions
What is the main concern with an obese child in sports?
Severe HTN
What is osgood schlatter disease?
- Pain localized to tibial tubercle
- Aggravated by Quads
- Causes pain, but resolves spontaneously as you mature.
Who is osgood schlatter dz MC in?
- Boys 12-15
- Girls 11-13
How do you manage the pain in Osgood Schlatter disease?
- NSAIDs
- PT
- Stretching Hammies
- Ice after workouts
Same for a sore muscle
Is idiopathic scoliosis with no functional limitations a contraindication to sports?
No
What is the female athlete triad?
- Low caloric intake
- Menstrual dysfunction
- Low bone density
Aka persistent exercise in malnourished, amenorrheic female
Common in lean sports (dance, cheerleading, gym, Cx Country)
Not eating, wacky periods, weak bones
How do you restore the HPO axis in a female athlete?
- Restrict exercise by 25%
- Increase caloric intake by 200-600 calories
- F/u in 1-2 weeks
Can resume exercise fully if wt gain continues!
Eat more, exercise less.
What are the 3 recommendations for participation in sports for kids?
- Cleared, no restrictions
- Cleared, no restrictions but recommended to see specialists?
- Not cleared, pending further eval
If a parent disagrees with your clearance to play, what happens?
- Explain and have them sign a doc saying you explained
- They can get a 2nd opinion
- Ultimately up to provider/team doc
