Physical Examination for Sports Participation Flashcards
What bodily changes may impact the adolescent’s functional and athletic abilities?
- 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
How soon should a PPE be performed?
at least 6 weeks before planned sport
What should the history focus on?
the type of sport that the athlete has chosen and the risks associated
Should a HPI be included in a PPE?
Only if the athlete is being evaluated for clearance to return after an injury or illness
What should be assessed if the athlete has a chronic disease?
number of exacerbations influence of chosen sport on disease if sports participation occurred previously complications r/t chronic disease previous restrictions
What guidelines should be utilized to perform a PMH during a PPE?
American Heart Association Cardiovascular Screening Checklist
Why is medication history critical in older school-aged or adolescent groups?
Routine OTC medications, prescriptions, and energy supplements or herbals have certain side effects which the athlete needs to be educated on.
What should be included in the medical history of a PPE?
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)
What familial risk factors should be priority during a PPE?
risk factors associated with CV, RESP, and MUSC disorders
What specific questions should be included in a family history?
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?
What risk factors need to be addressed in a social history?
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
What is the purpose of a social history during a PPE?
to identify opportunities for anticipatory guidance and provide additional support resources as needed
What is an important component of social history?
nutritional history to identify eating disorders
What is the purpose of the ROS in a PPE?
to help detect any additional disorders that may be present
What are some preventative care considerations for a PPE?
immunizations diet strength/flexibility coping and stress familial/peer relationships dental care substance abuse avoidance risk-taking behaviors
How should BP check be performed in a PPE?
sitting and standing
both arms
several minutes apart
What is the most common condition affecting athletes?
hypertension
Can the athlete be allowed to participate in the sport if their blood pressure is elevated?
yes. elevated blood pressures need to be evaluated over several days to ensure sustained elevation
At what point should an athlete be restricted from the sport for hypertension?
If the athlete has stage I or stage II HTN with signs of target organ damage.
How will the athlete with HTN be able to return to the sports activity?
If TWO blood pressure readings are UNDER 130/80 and are performed at least TWO weeks apart.
What should be assessed during a general inspection?
overall appearance facial features mood skin respiratory effort posture gait symmetry limb length
What skin abnormalities would prevent an athlete from being cleared?
tinea corporis or herpes simplex in a wrestler
How will visual acuity be tested during a PPE?
With the Snellen and Rosenbaum eye charts
How will hearing be assessed during a PPE?
whisper test
What would indicate Marfan syndrome?
asymmetrical chest expansion
prominent cardiac pulsation
hyperflexibility of small joints in hands and wrists
elongated skeleton
Why is Marfan syndrome a risk for athletes?
It is often accompanied by cardiac risk factors such as dilated aorta
If the arm span is ___ than the height, ____ ____ should be considered.
Greater, Marfan syndrome
The USPSTF currently recommends ____ routine screening of asymptomatic adolescents for scoliosis.
against
What is assessed during the musculoskeletal exam?
ROM
hindfoot deformity
ankle instability
wrist-thumb sign
What is assessed during the neurological exam?
cranial nerve abnormalities muscle symmetry gait posture balance coordination
How is the neurological exam performed on an athlete with a recent concussion?
visual acuity and reaction time should be tested
What is assessed during palpation?
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
What should be of special focus during palpation?
Areas of previous injury
What heart sound could indicate hypertrophic cardiomyopathy?
A harsh crescendo-decrescendo systolic murmur in the left lower sternal border and/or apex
How should heart sounds be auscultated during a PPE?
With the athlete in multiple positions. Sitting, standing, and squatting or performing a valsalva maneuver.
What requires further testing or evaluation during a PPE?
any abnormal finding
How are sports classified?
by intensity
When should restriction from sports be considered?
In student athletes with: uncontrolled chronic disease concussion with persistent symptoms cardiac disorders enlarged liver or spleen missing limb or organ unresolved previous injury
What are some laboratory considerations for athletes?
- 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)
What is the most common cause of sudden cardiac death in adolescent athletes?
pathologic hypertrophic cardiomyopathy
Pathologic hypertrophic cardiomyopathy
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.
What is the most effective tool for diagnosing pathological hypertrophic cardiomyopathy?
cardiac MRI
What is Marfan syndrome caused by?
An autosomal-dominant mutation in the FBN1 gene on chromosome 15
What is the greatest concern for those with Marfan syndrome?
aortic aneurysm or rupture
What is the female athlete triad characterized by?
menstrual, energy, and bone density abnormalities
