Lecture 15: Pre-Participation Sports Physicals Flashcards
What is the ultimate goal of Pre-Participation Physical Exam (PPE)
Promote health and safety of student athletes
When is a PPE usually done?
6-8 weeks prior
Perform annually
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.
Pros and Cons of Office PPE
- Pros: established relationship, private
- 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
- Hypertrophic/dilated cardiomyopathy, Long QT, Marfan syndrome, arrhythmia
What associated symptoms make a concussion complicated?
- Amnesia
- Loss of consciousness
- Seizure
- Prolonged symptoms
When is a child able to return to learn after a concussion?
- Able to concentrate on a task
- Tolerable of visual and auditory stimulus for 30+ mins
- Return them with academic adjustments
aka may need limited course load, short classes, increased rest time, aids for learning, postponing of any high stakes test (ACT/SAT)
What are the requirements to begin return to play?
- Successful return to school
- Symptom-free and free meds
- Normal neuro exam
- Baseline balance and cognitive function
How long is each step of the Return to Play protocol?
1 day
What two indications mean you MUST retire from contact/collision sports?
- Structural brain abnormality
- 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
What are the high-risk areas on the MSK exam for kids?
- Shoulder
- Knee
- Ankle
Which murmur gets quieter upon standing?
Aortic stenosis/regurg
What murmur gets louder on standing?
Hypertrophic CM
What is the MCC of sudden cardiac death in children?
HCM (1/3 of all cases)
What characterizes HCM? what 4 physiologic things occur in this disease?
LVH with clinical manifestations and hemodynamic abnormalities
- LV outflow obstruction
- Diastolic dysfunction
- MI
- Mitral regurgitation
I dont really understand whats happening in this chart
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
Why is ACA not caught early?
We don’t regularly cath kids, and there are rarely symptoms prior to a severe event.
what are indicators of marfans syndrome
- positive family hx
- suspicious skeletal findings or ophthalmologic conditions
- progressive scoliosis
- dysrhythmias
- long thin facies & down slanting palpebral fissures
- Bifid uvula and high arched palate w crowded dentition
What is the most serious concern with Marfan’s?
Progressive aortic root dilation
also can cause MVP and progressive or acute valvular incompetence
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.
ask about use of stimulants like caffeine
What is a non-traumatic cause of death in athletes that is lung-related?
Status asthmaticus due to exercise induced bronchoconstriction
what is the presentation of exercise induced bronchoconstriction
- coughing, wheezing, chest tightness, SOB
- coughing MC and maybe only symptom
- symtpoms dont happen immediatly. They start during exercise and worsen 5-10 min after stopping
can have a second wave 4-12 hrs after exercise
what is the pathophysiology behind exercise induced bronchoconstriction
- when you exercise you breathe faster and deeper d/t increased oxygen demands.
- breathing through mouth causes air to be cooler
- dry/cold air triggers airway narrowing
What is the main environmental trigger for airway narrowing?
Dry/cold air
but also pollution, pollen, smoke, fumes ect.
How do we tx exercise induced bronchoconstriction?
- Albuterol inhaler 20 min prior to exercising
- Singulair/montelukast
- Proper warmup
- stay aware of respiratory status
When might DM be a concern with athletes?
If activity is longer than 30 minutes
Enlargement of what abdominal organs is a contraindication to sports?
- Liver
- Spleen
Its gunna rupture
Obese athletes are at increased risk of what
heat injuries
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
Is idiopathic scoliosis with no functional limitations a contraindication to sports?
No
as long as pain free and no functional limitations!
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)
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, but increase caloric intake accordingly
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
