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Advanced Health Assessment > Physical Examination for Sports Participation > Flashcards

Physical Examination for Sports Participation Flashcards

1
Q

What bodily changes may impact the adolescent’s functional and athletic abilities?

A
  • surge in growth hormone and gender specific hormones
  • increasing muscle mass
  • increasing subcutaneous adipose tissue
  • increased joint flexibility
  • lack of coordination
  • denser, more brittle bones
  • increased size and capacity of the heart and lungs
  • late-onset frontal lobe development resulting in lack of impulse control
  • increased dopamine and serotonin release resulting in mood swings
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2
Q

How soon should a PPE be performed?

A

at least 6 weeks before planned sport

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3
Q

What should the history focus on?

A

the type of sport that the athlete has chosen and the risks associated

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4
Q

Should a HPI be included in a PPE?

A

Only if the athlete is being evaluated for clearance to return after an injury or illness

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5
Q

What should be assessed if the athlete has a chronic disease?

A 
number of exacerbations
influence of chosen sport on disease
if sports participation occurred previously
complications r/t chronic disease
previous restrictions
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6
Q

What guidelines should be utilized to perform a PMH during a PPE?

A

American Heart Association Cardiovascular Screening Checklist

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7
Q

Why is medication history critical in older school-aged or adolescent groups?

A

Routine OTC medications, prescriptions, and energy supplements or herbals have certain side effects which the athlete needs to be educated on.

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8
Q

What should be included in the medical history of a PPE?

A

Allergies (prior testing, type of reaction, management)
Past hospitalizations or sugeries
Concussions/TBIs
Changes in mood, emotions, cognitive function, memory, behavior, sleep
Sensory deficits (hearing or vision loss)

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9
Q

What familial risk factors should be priority during a PPE?

A

risk factors associated with CV, RESP, and MUSC disorders

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10
Q

What specific questions should be included in a family history?

A 
In a relative <50 years of age:
premature death due to heart disease?
premature disability due to heart disease?
hypertrophic or dilated cardiomyopathy?
long QT syndrome?
Marfan syndrome?
cardiac arrhythmias?
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11
Q

What risk factors need to be addressed in a social history?

A 
cigarette use
illicit substance use
alcohol use
medications other than those prescribed
seat belt use
extracurricular activities
stress
coping
PP sports equipment
employment
sexual activity
peer relationships
nutritional habits
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12
Q

What is the purpose of a social history during a PPE?

A

to identify opportunities for anticipatory guidance and provide additional support resources as needed

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13
Q

What is an important component of social history?

A

nutritional history to identify eating disorders

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14
Q

What is the purpose of the ROS in a PPE?

A

to help detect any additional disorders that may be present

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15
Q

What are some preventative care considerations for a PPE?

A 
immunizations
diet
strength/flexibility
coping and stress
familial/peer relationships
dental care
substance abuse avoidance
risk-taking behaviors
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16
Q

How should BP check be performed in a PPE?

A

sitting and standing
both arms
several minutes apart

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17
Q

What is the most common condition affecting athletes?

A

hypertension

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18
Q

Can the athlete be allowed to participate in the sport if their blood pressure is elevated?

A

yes. elevated blood pressures need to be evaluated over several days to ensure sustained elevation

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19
Q

At what point should an athlete be restricted from the sport for hypertension?

A

If the athlete has stage I or stage II HTN with signs of target organ damage.

20
Q

How will the athlete with HTN be able to return to the sports activity?

A

If TWO blood pressure readings are UNDER 130/80 and are performed at least TWO weeks apart.

21
Q

What should be assessed during a general inspection?

A 
overall appearance
facial features
mood
skin
respiratory effort
posture
gait
symmetry
limb length
22
Q

What skin abnormalities would prevent an athlete from being cleared?

A

tinea corporis or herpes simplex in a wrestler

23
Q

How will visual acuity be tested during a PPE?

A

With the Snellen and Rosenbaum eye charts

24
Q

How will hearing be assessed during a PPE?

A

whisper test

25
Q

What would indicate Marfan syndrome?

A

asymmetrical chest expansion
prominent cardiac pulsation
hyperflexibility of small joints in hands and wrists
elongated skeleton

26
Q

Why is Marfan syndrome a risk for athletes?

A

It is often accompanied by cardiac risk factors such as dilated aorta

27
Q

If the arm span is ___ than the height, ____ ____ should be considered.

A

Greater, Marfan syndrome

28
Q

The USPSTF currently recommends ____ routine screening of asymptomatic adolescents for scoliosis.

A

against

29
Q

What is assessed during the musculoskeletal exam?

A

ROM
hindfoot deformity
ankle instability
wrist-thumb sign

30
Q

What is assessed during the neurological exam?

A 
cranial nerve abnormalities
muscle symmetry
gait
posture
balance
coordination
31
Q

How is the neurological exam performed on an athlete with a recent concussion?

A

visual acuity and reaction time should be tested

32
Q

What is assessed during palpation?

A

Skin moisture, temperature
lymph nodes for size, shape, masses, tenderness
thyroid for symmetry, size, nodules, tenderness
organs for size, shape, masses, tenderness
joints for clicking, crepitus, or grating

33
Q

What should be of special focus during palpation?

A

Areas of previous injury

34
Q

What heart sound could indicate hypertrophic cardiomyopathy?

A

A harsh crescendo-decrescendo systolic murmur in the left lower sternal border and/or apex

35
Q

How should heart sounds be auscultated during a PPE?

A

With the athlete in multiple positions. Sitting, standing, and squatting or performing a valsalva maneuver.

36
Q

What requires further testing or evaluation during a PPE?

A

any abnormal finding

37
Q

How are sports classified?

A

by intensity

38
Q

When should restriction from sports be considered?

A 
In student athletes with:
uncontrolled chronic disease
concussion with persistent symptoms
cardiac disorders
enlarged liver or spleen
missing limb or organ
unresolved previous injury
39
Q

What are some laboratory considerations for athletes?

A
  • Female athletes with absence of menses or history of irregular menses: pregnancy test, FSH, TSH, Prolactin, CBC, ferritin, electrolytes, glucose, UA, ECG
  • Athletes with chronic illness may need labs to determine compliance and stability (ex: spirometry for someone with asthma)
40
Q

What is the most common cause of sudden cardiac death in adolescent athletes?

A

pathologic hypertrophic cardiomyopathy

41
Q

Pathologic hypertrophic cardiomyopathy

A

An autosomal-dominant disorder in which the walls within the left ventricle become enlarged and unable to fill completely causing electrical abnormalities and diastolic dysfunction.

42
Q

What is the most effective tool for diagnosing pathological hypertrophic cardiomyopathy?

A

cardiac MRI

43
Q

What is Marfan syndrome caused by?

A

An autosomal-dominant mutation in the FBN1 gene on chromosome 15

44
Q

What is the greatest concern for those with Marfan syndrome?

A

aortic aneurysm or rupture

45
Q

What is the female athlete triad characterized by?

A

menstrual, energy, and bone density abnormalities

Advanced Health Assessment (7 decks)

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