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Pediatrics > Lecture 15: Pre-Participation Sports Physicals > Flashcards

Lecture 15: Pre-Participation Sports Physicals Flashcards

1
Q

What is the ultimate goal of Pre-Participation Physical Exam (PPE)

A

Promote health and safety of student athletes

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2
Q

When is a PPE usually done?

A

6-8 weeks prior

Perform annually

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3
Q

What are the 3 methods for doing a PPE?

A
  • Locker-room
  • Station
  • Office-based
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4
Q

Describe locker-room PPEs

A
  1. LINE UP single file
  2. Line inspection one by one
  3. Little privacy & loud but efficient!
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5
Q

When is the station method for PPE best?

A

Large numbers

Efficient, but little privacy also.

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6
Q

Pros and Cons of Office PPE

A
  • Pros: established relationship, private
  • Cons: Lack of consistency, unfamiliarity with sports, lack of cost effectiveness
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7
Q

What is the main issue with pediatric providers providing PPEs for sports?

A

They’re not sports med people!

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8
Q

What is the most important part of PPE?

A

Medical history

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9
Q

What do we mainly care about in CV Medical Hx for a PPE?

A

Anything that can predispose them to sudden death

Kawasaki, Heart infection, CP w/ exercise, Murmur, HTN

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10
Q

What FMHx is significant for potential cardiac complications in a PPE?

A
  • Premature deaths before 50 d/t heart dz
  • Disability before 50
  • FHx of PPM
  • Hypertrophic/dilated cardiomyopathy, Long QT, Marfan syndrome, arrhythmia
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11
Q

What associated symptoms make a concussion complicated?

A
  • Amnesia
  • Loss of consciousness
  • Seizure
  • Prolonged symptoms
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12
Q

When is a child able to return to learn after a concussion?

A
  • 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)

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13
Q

What are the requirements to begin return to play?

A
  • Successful return to school
  • Symptom-free and free meds
  • Normal neuro exam
  • Baseline balance and cognitive function
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14
Q

How long is each step of the Return to Play protocol?

A

1 day

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15
Q

What two indications mean you MUST retire from contact/collision sports?

A
  • Structural brain abnormality
  • Nonresolving/Prolonged neurocognitive defects

Post-concussion

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16
Q

What are the 3 accepted/appropriate indications for a kid to retire from contact sports?

A
  • Increased recovery times
  • Repeat concussions with decreased thresholds and persistent symptoms
  • Multiple concussions
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17
Q

What are the high-risk areas on the MSK exam for kids?

A
  • Shoulder
  • Knee
  • Ankle
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18
Q

Which murmur gets quieter upon standing?

A

Aortic stenosis/regurg

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19
Q

What murmur gets louder on standing?

A

Hypertrophic CM

20
Q

What is the MCC of sudden cardiac death in children?

A

HCM (1/3 of all cases)

21
Q

What characterizes HCM? what 4 physiologic things occur in this disease?

A

LVH with clinical manifestations and hemodynamic abnormalities

  1. LV outflow obstruction
  2. Diastolic dysfunction
  3. MI
  4. Mitral regurgitation
22
Q

I dont really understand whats happening in this chart

A
23
Q

What is the second MCC of sudden death in athletes?

A

Coronary artery abnormality

Left main coming off R sinus

Anomalous origin of LCA

24
Q

What congenital heart defects are most associated with anomalous coronary arteries?

A
  • TGA
  • ToF
  • Pulmonary atresia
25
Q

Why is ACA not caught early?

A

We don’t regularly cath kids, and there are rarely symptoms prior to a severe event.

26
Q

what are indicators of marfans syndrome

A
  • 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
27
Q

What is the most serious concern with Marfan’s?

A

Progressive aortic root dilation

also can cause MVP and progressive or acute valvular incompetence

28
Q

Can a student athlete with stage 1 HTN participate in sports? Stage 2?

A
  • Stage 1 with no end-organ damage can with appropriate subspecialist referral.
  • Stage 2 must lower BP.

ask about use of stimulants like caffeine

29
Q

What is a non-traumatic cause of death in athletes that is lung-related?

A

Status asthmaticus due to exercise induced bronchoconstriction

30
Q

what is the presentation of exercise induced bronchoconstriction

A
  • 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

31
Q

what is the pathophysiology behind exercise induced bronchoconstriction

A
  • 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
32
Q

What is the main environmental trigger for airway narrowing?

A

Dry/cold air

but also pollution, pollen, smoke, fumes ect.

33
Q

How do we tx exercise induced bronchoconstriction?

A
  • Albuterol inhaler 20 min prior to exercising
  • Singulair/montelukast
  • Proper warmup
  • stay aware of respiratory status
34
Q

When might DM be a concern with athletes?

A

If activity is longer than 30 minutes

35
Q

Enlargement of what abdominal organs is a contraindication to sports?

A
  • Liver
  • Spleen

Its gunna rupture

36
Q

Obese athletes are at increased risk of what

A

heat injuries

37
Q

What is the main concern with an obese child in sports?

A

Severe HTN

38
Q

What is osgood schlatter disease?

A
  • Pain localized to tibial tubercle
  • Aggravated by Quads
  • Causes pain, but resolves spontaneously as you mature.
39
Q

Who is osgood schlatter dz MC in?

A
  • Boys 12-15
  • Girls 11-13
40
Q

How do you manage the pain in Osgood Schlatter disease?

A
  • NSAIDs
  • PT
  • Stretching Hammies
  • Ice after workouts
41
Q

Is idiopathic scoliosis with no functional limitations a contraindication to sports?

A

No

as long as pain free and no functional limitations!

42
Q

What is the female athlete triad?

A
  • Low caloric intake
  • Menstrual dysfunction
  • Low bone density

Aka persistent exercise in malnourished, amenorrheic female

Common in lean sports (dance, cheerleading, gym, Cx Country)

43
Q

How do you restore the HPO axis in a female athlete?

A
  • 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

44
Q

What are the 3 recommendations for participation in sports for kids?

A
  1. Cleared, no restrictions
  2. Cleared, no restrictions but recommended to see specialists?
  3. Not cleared, pending further eval
45
Q

If a parent disagrees with your clearance to play, what happens?

A
  • Explain and have them sign a doc saying you explained
  • They can get a 2nd opinion
  • Ultimately up to provider/team doc

Pediatrics (41 decks)

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