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Speciality Medicine II > Lecture 3 (Pre-Participation)-Exam 1 > Flashcards

Lecture 3 (Pre-Participation)-Exam 1 Flashcards

1
Q

Timing & Frequency
* When do you do the exam?
* Allow time for what?
* _ Screening
* Most colleges require what?
* No data suggests what?

A
  • Ideally six weeks prior to preseason practice
  • Allows time for follow up evaluation/rehab etc.
  • Annual screening
  • All states require yearly examinations at HS level
  • Most colleges require yearly abbreviated annual exams & comprehensive entrance exam
  • No data suggests that more frequent exams decrease risk of injury or death
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2
Q

Mass Physicals:
* What are the pros? (3)
* What are the disadvantages (4)

A

Pros:
* Cost-effective
* Specialized attention per station
* Facilitate communication

Disadvantages:
* Noise & confusion
* No continuity of care
* Lack of time & privacy
* May not accurately or honestly disclose

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3
Q

Office based:
* What are the pros? (4)
* What are the disadvantages? (2)

A

Pros:
* Better privacy
* Continuity of care
* Knowledge of athlete’s history
* Better counseling

Disadvantages:
* Lack of office time
* Cost
* Less communication with trainers/coaches

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4
Q

Tips to Improve Station Setting PPEs
* How do you prepare?
* How do you have privacy? (3)

A

Preparation: Provide athletes information in advance about the exam

Privacy:
* Ensure separate & private areas for males/females/transgender athletes
* Require appropriate attire
* Ensure private counseling room for discussion of sensitive issues

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5
Q

Tips to Improve Station Setting PPEs
* What do for referrals? (2)
* What do you need to for medically Ineligible or limited student athletes? (2)

A

Referrals
* Establish a clear protocol for referral back to PCP or specialists
* Aid athletes needing assistance for referrals

Medically Ineligible or limited student athletes
* Maintain records of athletes who are ineligible/require further evaluation
* Follow through the diagnosis and counsel

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6
Q

What are the componesnts of the PPE? (3)

A
  • History
  • Physical Exam
  • Ancillary Tests
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7
Q

Medical History
* How do you parent involvement?
* Targeted what?
* Hx will identify what?
* Acuurate hx will identify what?
* Forms require what?

A
  • Parent involvement: Agreement between parents & children 19-33% medical history
  • Targeted review of systems
  • History will identify more than 75% of orthopedic problems
  • Accurate history will identify 88% of general medical conditions
  • Forms require a written history
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8
Q

General Questions
* What are the questions you need to ask? (7)

A
  • Medical illnesses since last exam
  • Hospitalizations
  • Surgeries
  • Medications & Supplements
  • Allergies (Meds, Insect Stings)
  • Chronic medical problems
  • Ever denied clearance for any reason
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9
Q
A

E.No clearance for sports. Reevaluate after an EKG, echocardiogram, & cardiologyclearance are completed
* Harsh, early systolic murmur best heard over the right upper sternal borderthat increases in intensity on standing= hyperotrophic cardio

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10
Q

CV History
* What are all the components? (8)

A
  • Palpitations
  • Chest pain
  • Dizziness
  • Syncope or Near syncope
  • Family History
  • Murmurs
  • Hx of HTN or hypercholesterolemia
  • Ever had an echo or ECG
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11
Q

CV History
* What should you know about chest pain? (2)
* What do you know about family hx?

A

Chest pain
* Frequently asthma
* Also consider pericarditis, Marfan

Family History
* Sudden Death before 50 y/o
* HCM, anomalous coronary arteries, CAD, Marfan, prolonged QT
* Sickle cell trait (20x increase risk of death in recruits with SC trait engaged in strenuous activity)

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12
Q

What is the leading cause of dealth among atheletes?

A

SCD is leading cause of death among athletes (26%)

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13
Q

Pulmonary History
* What do you need to know?

A
  • History of asthma or inhaler use
  • Identify signs and symptoms of EIA/EIB
  • Vocal cord dysfunction (mincs asthma but discomfort of throat and breathing with early expir-> inhaler to kid and not working)
  • Previous pneumothorax
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14
Q

What are the signs and symptoms of EIA/EIB?(5)

A
  • Wheezing
  • Chronic cough
  • Dyspnea on exertion
  • Seasonal allergies
  • Early fatigue
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15
Q

HEENT History
* What do you need to get from patients?
* What needs to be used?

A
  • Problems with vision
  • Best eye must be better than 20/40
  • Prior surgery or injury
  • Use of corrective lenses or protective eye wear ->ASTM F803 approved
  • Hearing loss
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16
Q

Neurological
* What hx do you need to get? (4-general)

A
  • Hx of head injury or concussion
  • Hx seizures
  • Hx frequent or severe headaches
  • Hx of burners/stingers
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17
Q

Neurological History
* What do you need to know about the hx of head injury or concussion?
* What do you need to know about the hx of seizures?
* What do you need to know about burners/stingers?

A

Hx of head injury or concussion
* Number of concussions
* Loss of consciousness
* Recovery time
* Ages of previous concussions

Hx seizures: Frequency, last episode, treatment, seizure character

Hx of burners/stingers->Red flag:bilateral, longer duration, multiple insame season.

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18
Q

Derm history:
* What history do you need?
* Focus on what?
* Increase in what?

A
  • History of Dermitching, rashes, acne, warts, fungus, or blisters
  • Focus on infectious conditions which may be contagious (herpes, scabies, lice, impetigo, molluscum contagiosum, etc.)
  • Increase in MRSA among athletes
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19
Q

GI/GU
* What fo you need to know about? (4)

A
  • Solitary/malpositioned organ
  • Groin or testicular pain->Painful bulge or hernia
  • Previous spleen or kidney injury
  • Organomegaly
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20
Q

MSK History
* What do you need to know the hx of? (3)
* Review what? (2)

A
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21
Q

Mental Health History
* What are three catorgies that you need to look for?

A
  • Stress
  • Body image
  • If there are red flags on screening:PHQ, GAD, CRAFT, BEDA-Q screening tool for disordered eating patterns
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22
Q

What do you need to know about body image? (3)

A
  • Satisfaction, desire to lose or gain weight
  • Rule out eating disorders (10% of college age women report symptoms of eating D/O)
  • Identify unhealthy methods used by athletes to achieve weight class (vomiting, laxative abuse, diuretics)
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23
Q

Other Questions
* What are some other important things to know? (5)

A
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24
Q
A
  • Answer: A - Clear him & recommend adequate breaks, hydration, conditioning, and avoidance of/acclimatization to high altitudes.
  • NCAA mandates testing for Sickle Cell/Hemoglobinopathies on all athletes
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25
Q

What are general things for the Physical Exam? (4)

A
  • Proper attire for examination (shorts & tank tops)
  • Height
  • Weight
  • BMI (may be inaccurate in muscular athletes)
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26
Q

HEENT PE:
* What should be the visual acuity be? (2)
* What needs to be noted?
* What do you need to look for with TM/s?
* What about the mouth?
* _pathy

A

Visual acuity
* Should be 20/40 or better in each eye
* Should have corrective sports lenses if <20/40

Pupil asymmetry (anisocoria)
* Cleared, should be noted

TM’s - look for scarring or perforation

Oral lesions, braces

Adenopathy

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27
Q

Pulmonary PE
* What should be clear?
* Pay attention to what?
* What do you need to counsel on?

A
  • Breath sounds should be clear
  • Pay attention to the smell of tobacco
  • Inhaler use counseling
28
Q

Abdomen PE
* What do you need to look for?(4)

A
  • Masses
  • Tenderness
  • Organomegaly
  • Gravid Uterus -> Pregnant uterus
29
Q

Genitalia
* Recommended or not?
* What do you need to look for and why?

A

GU exam no longer recommended

Hernias

Testicular abnormalities
* Testicular cancer
* Precautions/counseling for unpaired or undescended testes

30
Q

Skin PE:
* Pay attention to what?

A

Attention to rashes, infections, & infestations

31
Q

Musculoskeletal PE
* What is the sensitivity?
* Use what?
* What are the two types of exams?

A

General Screening Exam
* History has 92% sensitivity
* Use joint specific components for specific complaints

Joint-specific Exam (specific joint)

Sport-specific Exam (specific joint (s) that is used in a particular sport)

32
Q

General Screening Exam
* What are all of the components? (a lot lol)

A
33
Q

Why is this image important?

A

That image is setting up for an ACL tear therefore need to educate patietn on core work outs

34
Q

Spine PE:
* ROM of what
* Inspection for what?
* What need to look for with back flexion/extension? (3) ✨

A

ROM neck

Inspection for deformities - scoliosis, kyphosis, & lordosis

Back flexion/extension
* Rotatory deformities (asymmetry with flexion)
* Lumbar disc disease (painful or restricted flexion)
* Spondylolysis/spondylolisthesis (pain with extension)

35
Q

Upper Extremity PE:
* _ ROM
* what do you need to test the integrity of and how?
* _ Strength
* Test what for instability and how?
* What do you need to do for the elbow?
* What motions do you need to have?

A
36
Q

Lower Extremity PE
* What type of discrepancies?
* What needs a ROM? How?
* What do you need to test the tightness of?

A
37
Q

Lower Extremity PE:
* What do you need to check for the knee? (6)

A
  • Valgus angulation (<12 degrees in males or 18 degrees in females
  • Patellar location & hypermobility
  • Effusion
  • Joint line tenderness
  • ROM ( 0 to 140 degrees)
  • Ligament stability: ACL, PCL, MCL, LCL
38
Q

Lower Extremity
* What do you need to check for the ankle? (3)
* What do you ened to check for the foot (2)

A

Ankles
* ROM
* Ligament stability testing
* Achilles tightness (should dorsiflex to >15 degrees)

Foot
* Pes planus/cavus
* Toe deformities

39
Q

Neurological PE:
* What is not necessary?
* What do you need to evaluate in certain situations?

A

Routine screening not necessary if strength and gait are normal

Further evaluation in certain situations
* Hx recurrent stingers/burners
* Hx of multiple or severe concussions

40
Q

Sport-specific Exams:
* Includes what?
* More what?
* Requires more what?

A
  • Includes strength, endurance, & flexibility testing for various sports
  • More time consuming
  • Requires more in-depth knowledge of specific sports
41
Q

Determining Clearance
* What is the break down?

A
  • Unrestricted clearance >95%
  • Clearance after further evaluation - 3-14%
  • Not cleared (for certain sports or all sports)
    * ~1% denied clearance
42
Q

Determining Clearance
* What questions do you need to ask? (3)
* Can limit what?

A
  • Does the problem place the athlete at increased risk for injury?
  • Is another participant at risk for injury because of the problem?
  • Can the athlete safely participate with treatment?
  • Can limited participation be allowed while treatment is being completed
43
Q

Determining Clearance
* Participation in sports is precluded in three conditions?

A
  • Acute febrile illness (dehydration)
  • Vomiting/Diarrhea (dehydration)
  • Carditis (sudden death)
44
Q

What are the blood borne pathogens? (4)
What is not considered a reason for disqualification?

A
  • HIV
  • Hepatitis B, C, D
  • If asymptomatic than not considered a reason for disqualification (AASM, AAP, NCAA, and AMSSM)
45
Q

CV abnotmalities:
* What are the stages for HTN?
* Benign what?
* what cannot participation till work up?

A
46
Q
A

Answer: Do not clear her for sports until she is cleared by cardiology. and assist the family in expediting the cardiology evaluation.
* EKG does not rule out all potential SCD pathology
* What further work-up would she need?

47
Q

Cardiovascular abnormalities
* What is HCM?
* What are the channelopathies?

A
  • HCM: Asymmetrical left ventricle and septal hypertrophy
  • Channelopathies and accessory pathways: Brugada, Romano-Ward, Long QT syndrome, Short QT syndrome, WPW
48
Q

Dermatologic Disorders
* The presence of what?

A

The presence of infectious conditions precludes participation in certain contact/collision sports (wrestling, martial arts) until the condition is resolved or no longer contagious

49
Q

Eye disorders
* Proper protection for what?
* Previous significant what?
* What needs to be evaluated and corrected?

A
  • Proper protection for the “functionally one-eyed” (best corrected vision of less than 20/40 in one eye)
  • Previous significant eye injury or surgery - recommend complete evaluation and clearance by ophthalmology
  • Poor vision- have evaluated & corrected, then reevaluate with corrected lenses
50
Q
A
51
Q

Gynecologic disorders
* What is not necessary?
* What happens menstrual irregulatities? (2)

A

No restrictions are necessary for female athletes with a single ovary

Menstrual irregularities
* Cleared for participation while work up in progress
* Unless concern for pregnancy or severe anemia

52
Q

Testicular disorders
* Protections for what?
* Educate on what? (2)

A

Protection for athletes with a single or undescended testicle

Educate on
* Risk of testicular cancer (if undescended testicle)
* Risk of testicular injury/loss (option of sperm banking)

53
Q

Heat illness
* Focus on what?
* Documented Hx of what?

A
  • Focus on identification of risk factors & means for prevention
  • Documented Hx of heat stroke or heat related rhabdomyolysis requires further investigation - Clearance may be restricted to participation under temperate climates
54
Q

Diabetes
* What do you need to counsel on?

A

Counsel on Glucose control
* No participation if BS >300 or >250 with ketones in urine
* Keep carbs nearby
* If poor glucose control, no participation in high-risk sports (skydiving, open water swims, rock climbing)

55
Q

Organomegaly
* Participations in what?
* What should be assessed individually?

A
  • Participation in all sports should be avoided in acute cases of hepatomegaly or splenomegaly
  • Chronic conditions should be assessed individually
56
Q

Kidney abnormalities
* Special consideration is given to who?
* Education regarding what?
* Appropriate protection for what?

A
  • Special consideration is given to athletes with a single functioning kidney (especially abnormal single kidneys)
  • Education regarding risks & consequences of the loss of a kidney
  • Appropriate protection for pelvic or horseshoe kidneys
57
Q

MSK disorders
* Clearance depends on what? (3)

A

(1) The degree and type of injury
(2) The ability of the injured athlete to compete safely
(3) The requirements of a given sport

58
Q

MSK disorders
* For sprains, strains, subluxations, dislocations, & muscle contusions the following must be ruled out: (5)

A

(1) Effusion or swelling
(2) Decreased ROM
(3) Strength <85-90% of the uninjured side or insufficient for activity
(4) Ligamentous instability
(5) Loss or alteration of functional ability

59
Q

Overuse injuries
* Correct what?
* Educate on what?
* Council on what?

A
  • Correct improper body mechanics when present
  • Educate on proper training techniques
  • Council on rest and early sport specialization
60
Q

Fractures
* Clearance depends on what?
* Assess on what? (2)

A
  • Clearance depends on type & location of fracture
  • Assess the risk for re-injury or irreparable damage
  • Assess the need for protective gear
61
Q

Spinal deformities
* Clinical evidence of what?
* Caution with what?
* What is spondylolysis and spondylolisthesis?

A
  • Clinical evidence of spondylolysis or spondylolisthesis requires further evaluation with imaging
  • Caution with activities requiring heavy axial loading
62
Q
A
63
Q

Neurologic disorders
* Concussions: Familiarity with what? What type of syndromes (2)
* What requires c-spine evaluation?

A

Concussions
* Familiarity with management guidelines
* Post-concussion syndrome
* Second impact syndrome

Burners/stingers/transient quadriplegia
* Recurrent problems and all cases of transient quadriplegia require c-spine evaluation

64
Q

Neurologic disorders: Convulsive disorder
* Determine what?
* Clearance must be what?

A
  • Determine level of control
  • Clearance must be considered carefully in high-risk activities (high diving, gymnastics, riflery, archery)
65
Q

Pulmonary disorders
* EIA: Does not preclude what? Appropriate txt necessary for what?
* What requires prior participation?

A

EIA
* Does not preclude participation
* Appropriate treatment necessary to ensure optimal performance

Severe pulmonary insufficiency (FEV1< 50%) requires EST prior to participation

Speciality Medicine II (11 decks)

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