Pre-participation Physical

Question 1

T/F: sports physicals prevent morbidity and mortality associated with sports.

Answer 1

FALSE. They do not prevent but they may detect conditions and allow a time to educate of safety and injury prevention.

Question 2

PPE should be completed at least ______ prior to first practice to allow time for sufficient work up if needed.

Answer 2

6weeks

Question 3

What is the cornerstone of the PPE?

Answer 3

Medical History.

Question 4

During medical history for PPE, review:

Answer 4

Medications (including OTC, herbals, performance enhancement supplements and illicit drug use)
Immunization status (esp tetanus due to lacs and abrasions)
COVID status - past/current infections, vaccinations?

Question 5

What is important to know about COVID history when doing PPE?

Answer 5

Date of past infection, severity of the infection (were they hospitalized).

Question 6

Concussion history, heat injury history, anaphylactic reactions (do they have an epi pen for the field?), hematologic disorders/symptoms of bleeding/bruising, menstrual history.

Question 7

Marfan’s is an _____ disease that affects ______. Caused by mutation of FBN1 gene. Greatest concern with sports is_______

Answer 7

Autosomal-dominant
Multisystem disorder of connective tissues (skeletal, ocular and cardiovascular manifestations)
Aortic aneurysms, potential rupture with strenuous or contact sports.

Question 8

Dynamic vs static sports

Answer 8

Dynamic = sustained cardiac output (running, cycling) - potential enlargement of L ventricle and chamber size.
Static = bursts of energy. Enlarged LV with no increase in chamber size

Question 9

VS for PPE

Answer 9

BP! Ht, Wt and BMI, vision and hearing assessment, femoral pulses. Organomegally on abd exam (spleen and liver)

Question 10

What is important when listening to the heart for PPEs?

Answer 10

Listen in all positions! Lying down, LLD, lean forward,stand up and valsalva - find that murmur!!

Question 11

What is the most common cause of sudden cardiac death in athletes and what can be an indicator during exam?

Answer 11

Hypertrophic cardiomyopathy (hypertrophic obstructive cardiomyopathy - HOCM, and Brock disease).
Classic murmur - systolic murmur along systolic border which is accentuated by valsalva maneuver, standing. Murmur decreases with handgrip and squat maneuvers.

Question 12

ECG, labs, and scoliosis screening are not recommended for asymptomatic patients.

Question 13

Symmetry, bend down, stand on heels, stand on toes, Neck, shoulders, elbows, fingers, wrists, duck walk

Question 14

Slide 25 for contraindications for sports participation.

Question 15

What are the causes in order of sudden cardiac death?

Answer 15

HOCM
Carditis
Marfan
Long QT syndrome
Males 10x more likely than females.
Trained athletes 2xmore likely than non-trained
Football, basketball, soccer
<300/year out of 15 million athletes

Question 16

If you are concerned about cardiac conditions based on family or personal history, obtain _______

Answer 16

ECG, Echo, CXR and lipids.

Question 17

What is the recommendations for return to sport based on severity of COVID symptoms:
(Slide 30)

Answer 17

Asymptomatic/Mild:

Question 18

Sickle Cell TRAIT should have the following precautions with sports?

Answer 18

Altitude, dehydration, heat and during illness.

Question 19

What is RED-S syndrome?

Answer 19

Relative Energy Deficiency in Sport.

Triad of (1)Disordered eating (low availability energy), (2)amenorrhea (in women), (3)decreased bone mineral density. Eating too little food to support the amount of energy being expended by an athlete, often at the urging of a coach or other authority figure. Lifelong consequences and potentially fatal.
Treatment: address the nutritional status. Nutritional counseling, increased diet to restore normalization of body weight, resume menses and improve bone health.

Question 20

Check out Sanford University - Pediatric Sports Medicine Series (slide 49).

Question 21

What immunization history is important to know for PPE?

Answer 21

All Imms, but also tetanus if risk for abrasions, lacerations.

Question 22

Greatest concern with Marfan’s and sports?

Answer 22

Rupture of aortic aneurysm with strenuous or contact sports.

Question 23

What is unique about the systolic murmur associated with hypertrophic obstructive cardiomyopathy (HOCM)?

Answer 23

Accentuated with valsalva and standing, decreases with hand grip and squatting maneuvers.

Question 24

Most common cause of sudden cardiac death in athletes?

Answer 24

Hypertrophic obstructive cardiomyopathy (HOCM)

Question 25

Someone with Sickle cell. Trait can
SSD needs to limit sports to

Answer 25

Usuallly play any sports but be cautions with temperature extremes and elevation and dehydration.
Low-intensity activities