Lecture 3 (Pre-Participation)-Exam 1 Flashcards
Timing & Frequency
* When do you do the exam?
* Allow time for what?
* _ Screening
* Most colleges require what?
* No data suggests what?
- 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
Mass Physicals:
* What are the pros? (3)
* What are the disadvantages (4)
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
Office based:
* What are the pros? (4)
* What are the disadvantages? (2)
Pros:
* Better privacy
* Continuity of care
* Knowledge of athlete’s history
* Better counseling
Disadvantages:
* Lack of office time
* Cost
* Less communication with trainers/coaches
Tips to Improve Station Setting PPEs
* How do you prepare?
* How do you have privacy? (3)
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
Tips to Improve Station Setting PPEs
* What do for referrals? (2)
* What do you need to for medically Ineligible or limited student athletes? (2)
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
What are the componesnts of the PPE? (3)
- History
- Physical Exam
- Ancillary Tests
Medical History
* How do you parent involvement?
* Targeted what?
* Hx will identify what?
* Acuurate hx will identify what?
* Forms require what?
- 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
General Questions
* What are the questions you need to ask? (7)
- Medical illnesses since last exam
- Hospitalizations
- Surgeries
- Medications & Supplements
- Allergies (Meds, Insect Stings)
- Chronic medical problems
- Ever denied clearance for any reason
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
CV History
* What are all the components? (8)
- Palpitations
- Chest pain
- Dizziness
- Syncope or Near syncope
- Family History
- Murmurs
- Hx of HTN or hypercholesterolemia
- Ever had an echo or ECG
CV History
* What should you know about chest pain? (2)
* What do you know about family hx?
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)
What is the leading cause of dealth among atheletes?
SCD is leading cause of death among athletes (26%)
Pulmonary History
* What do you need to know?
- 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
What are the signs and symptoms of EIA/EIB?(5)
- Wheezing
- Chronic cough
- Dyspnea on exertion
- Seasonal allergies
- Early fatigue
HEENT History
* What do you need to get from patients?
* What needs to be used?
- 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
Neurological
* What hx do you need to get? (4-general)
- Hx of head injury or concussion
- Hx seizures
- Hx frequent or severe headaches
- Hx of burners/stingers
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?
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.
Derm history:
* What history do you need?
* Focus on what?
* Increase in what?
- 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
GI/GU
* What fo you need to know about? (4)
- Solitary/malpositioned organ
- Groin or testicular pain->Painful bulge or hernia
- Previous spleen or kidney injury
- Organomegaly
MSK History
* What do you need to know the hx of? (3)
* Review what? (2)
Mental Health History
* What are three catorgies that you need to look for?
- Stress
- Body image
- If there are red flags on screening:PHQ, GAD, CRAFT, BEDA-Q screening tool for disordered eating patterns
What do you need to know about body image? (3)
- 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)
Other Questions
* What are some other important things to know? (5)
- 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
What are general things for the Physical Exam? (4)
- Proper attire for examination (shorts & tank tops)
- Height
- Weight
- BMI (may be inaccurate in muscular athletes)
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
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
Pulmonary PE
* What should be clear?
* Pay attention to what?
* What do you need to counsel on?
- Breath sounds should be clear
- Pay attention to the smell of tobacco
- Inhaler use counseling
Abdomen PE
* What do you need to look for?(4)
- Masses
- Tenderness
- Organomegaly
- Gravid Uterus -> Pregnant uterus
Genitalia
* Recommended or not?
* What do you need to look for and why?
GU exam no longer recommended
Hernias
Testicular abnormalities
* Testicular cancer
* Precautions/counseling for unpaired or undescended testes
Skin PE:
* Pay attention to what?
Attention to rashes, infections, & infestations
Musculoskeletal PE
* What is the sensitivity?
* Use what?
* What are the two types of exams?
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)
General Screening Exam
* What are all of the components? (a lot lol)
Why is this image important?
That image is setting up for an ACL tear therefore need to educate patietn on core work outs
Spine PE:
* ROM of what
* Inspection for what?
* What need to look for with back flexion/extension? (3) ✨
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)
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?
Lower Extremity PE
* What type of discrepancies?
* What needs a ROM? How?
* What do you need to test the tightness of?
Lower Extremity PE:
* What do you need to check for the knee? (6)
- 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
Lower Extremity
* What do you need to check for the ankle? (3)
* What do you ened to check for the foot (2)
Ankles
* ROM
* Ligament stability testing
* Achilles tightness (should dorsiflex to >15 degrees)
Foot
* Pes planus/cavus
* Toe deformities
Neurological PE:
* What is not necessary?
* What do you need to evaluate in certain situations?
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
Sport-specific Exams:
* Includes what?
* More what?
* Requires more what?
- Includes strength, endurance, & flexibility testing for various sports
- More time consuming
- Requires more in-depth knowledge of specific sports
Determining Clearance
* What is the break down?
- Unrestricted clearance >95%
- Clearance after further evaluation - 3-14%
- Not cleared (for certain sports or all sports)
* ~1% denied clearance
Determining Clearance
* What questions do you need to ask? (3)
* Can limit what?
- 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
Determining Clearance
* Participation in sports is precluded in three conditions?
- Acute febrile illness (dehydration)
- Vomiting/Diarrhea (dehydration)
- Carditis (sudden death)
What are the blood borne pathogens? (4)
What is not considered a reason for disqualification?
- HIV
- Hepatitis B, C, D
- If asymptomatic than not considered a reason for disqualification (AASM, AAP, NCAA, and AMSSM)
CV abnotmalities:
* What are the stages for HTN?
* Benign what?
* what cannot participation till work up?
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?
Cardiovascular abnormalities
* What is HCM?
* What are the channelopathies?
- HCM: Asymmetrical left ventricle and septal hypertrophy
- Channelopathies and accessory pathways: Brugada, Romano-Ward, Long QT syndrome, Short QT syndrome, WPW
Dermatologic Disorders
* The presence of what?
The presence of infectious conditions precludes participation in certain contact/collision sports (wrestling, martial arts) until the condition is resolved or no longer contagious
Eye disorders
* Proper protection for what?
* Previous significant what?
* What needs to be evaluated and corrected?
- 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
Gynecologic disorders
* What is not necessary?
* What happens menstrual irregulatities? (2)
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
Testicular disorders
* Protections for what?
* Educate on what? (2)
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)
Heat illness
* Focus on what?
* Documented Hx of what?
- 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
Diabetes
* What do you need to counsel on?
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)
Organomegaly
* Participations in what?
* What should be assessed individually?
- Participation in all sports should be avoided in acute cases of hepatomegaly or splenomegaly
- Chronic conditions should be assessed individually
Kidney abnormalities
* Special consideration is given to who?
* Education regarding what?
* Appropriate protection for what?
- 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
MSK disorders
* Clearance depends on what? (3)
(1) The degree and type of injury
(2) The ability of the injured athlete to compete safely
(3) The requirements of a given sport
MSK disorders
* For sprains, strains, subluxations, dislocations, & muscle contusions the following must be ruled out: (5)
(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
Overuse injuries
* Correct what?
* Educate on what?
* Council on what?
- Correct improper body mechanics when present
- Educate on proper training techniques
- Council on rest and early sport specialization
Fractures
* Clearance depends on what?
* Assess on what? (2)
- Clearance depends on type & location of fracture
- Assess the risk for re-injury or irreparable damage
- Assess the need for protective gear
Spinal deformities
* Clinical evidence of what?
* Caution with what?
* What is spondylolysis and spondylolisthesis?
- Clinical evidence of spondylolysis or spondylolisthesis requires further evaluation with imaging
- Caution with activities requiring heavy axial loading
Neurologic disorders
* Concussions: Familiarity with what? What type of syndromes (2)
* What requires c-spine evaluation?
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
Neurologic disorders: Convulsive disorder
* Determine what?
* Clearance must be what?
- Determine level of control
- Clearance must be considered carefully in high-risk activities (high diving, gymnastics, riflery, archery)
Pulmonary disorders
* EIA: Does not preclude what? Appropriate txt necessary for what?
* What requires prior participation?
EIA
* Does not preclude participation
* Appropriate treatment necessary to ensure optimal performance
Severe pulmonary insufficiency (FEV1< 50%) requires EST prior to participation
