Pre-Participation Sports Physical - Exam 2 Flashcards
What is the ultimate goal of the Preparticipation Physical Exam (PPE)?
Ultimate goal is to promote the health and safety of student athletes
What are the 2 primary objectives for the PPE?
Primary objectives are to screen for conditions that may be life-threatening or disabling and for conditions that may predispose to injury or illness
What are the primary goals of a PPE?
Identify and rehabilitate old musculoskeletal injuries
Identify and treat conditions that interfere with performances (exercised-induced bronchospams)
Remove unnecessary restrictions on participation which can prevent children from establishing healthy lifestyle habits at a young age
What are the 2 secondary goals of a PPE? What is the ideal timing? How often should PPEs be completed?
Counsel athletes on health-related issues
Assess fitness level
Ideal timing is 6-8 weeks before training starts, which allows time to further evaluate, treat, or rehab any identified problems
should be done annually
Are PPE and WCC interchangeable? What areas NOT directly related to sports?
NO!! PPE is not a replacement for the annual WCC
Teenage sexuality, substance abuse, immunizations, among others
How do parents sometimes view the PPE? How do providers typically view the PPE? What can you do to combat the differences?
Parents: frequently think of the PPE as the only medical evaluation their child or adolescent needs, and they expect it to be comprehensive
providers: many providers view the PPE as a cursory exam that is only intended to detect conditions that might limit or impair athletic endeavors
parents must be advised about the intent of the PPE, and the PPE’s scope and purpose must be made clear to them
What is the most important part of the PPE encounter? What percentage of medical issues does it catch?
the medical history!!
identifies 75% of medical issues that can restrict activity
How should the hx portion of the PPE be completed?
The athlete and the parents should complete the form together to obtain a thorough and accurate history
In the injury history portion, what would you want to specifically note?
any past injuries?: msk, CONCUSSIONS and spine injuries
any loss of time from participation and current sequelae of prior injury
previous exclusion from any sports for any reason
**What are the 14 personal CV medical history questions you would want to ask your patient?
Kawasaki disease?
Heart infection?
Chest pain or discomfort with exercise?
Syncope or near syncope associated with exercise?
Excessive SOB or fatigue associated with exertion?
History of heart murmur?
History of elevated blood pressure?
Any chest pain?
Any history of unexplained fever?
Any history of cardiac testing? EKG or echo
Premature death before age 50 y/o d/t heart disease?
Disability from heart disease in a close relative younger than 50 y/o?
Family history of pacemaker?
Any knowledge of specific cardiac conditions?
What is Kawasaki dz?
Kawasaki disease causes swelling, called inflammation, in the walls of small to medium-sized blood vessels that carry blood throughout the body.
What are the symptoms of Kawasaki dz?
fever greater than 102.2
A rash on the main part of the body or in the genital area.
An enlarged lymph node in the neck.
Very red eyes without a thick discharge.
Red, dry, cracked lips and a red, swollen tongue.
Swollen, red skin on the palms of the hands and the soles of the feet. Later the skin on fingers and toes peels
What question would you want to ask your patient about when reviewing the CNS history? If the answer is yes, what should you do next?
History of frequent or exertional headaches, seizure disorders, concussion or head injuries, burners/stingers?
These conditions require further evaluation, rehabilitation, or informed decision making prior to clearance for sports participation
What are the two grades for concussions? What does each mean?
simple and complicated
complicated: amnesia, loss of consciousness, seizure, or prolonged symptoms
simple: none of the above symptoms
What are the return to learn criteria post concussion?
once a child can concentrate on a task and
tolerate visual and auditory stimulation for for 30-45 minutes then they can return to school
adjustments are made to the kiddos schedule/environment if needed
What are the requirements for a kiddo to start the return to play criteria?
successful return to school
symptom free and off any meds to help with symptoms
normal neuro exam
baseline balance and cognitive function
According to WVSSAC, what is the RTP criteria? How long should each step in the progression take?
each step in the test should take 24 hours
What are the 2 indications that a kiddo should be retired from contact sports?
- for pt’s with structural brain abnormality on neuroimaging (intracranial bleed, skull fracture)
- nonresolving/prolonged neurocognitive deficits
What are the 3 criteria that would make you think about retiring the kiddo from contact sports?
- increased recovery times
- A pattern of decreased threshold for repeat concussions especially when associated with persistent prolong symptoms
- Multiple concussions over the course of an athletic career
**What systems need to be evaluated during a PPE?
MSK
Cardio
Neuro
height/weight
eyes
skin
lymph
respiratory
abdomen
GU
During the CV exam, what needs to be evaluated?
Measurement of blood pressure and resting pulse in the seated position
heart murmur in supine and standing and with valsalva
location of PMI
palpation of radial and femoral pulses
What positions should the patient be in when checking for heart murmurs?
supine
standing
valsalva
**Will a HCMO murmur get louder/softer with valsalva?
HCMO murmur gets louder with valsalva
**Will an aortic stenosis/regurgitation murmur get louder or softer with valsalva?
aortic stenosis/regurg the murmur will get quieter with valsalva
What are the 2 important things to note during the abdominal exam?
looking for hepatic and splenic enlargement
What are 3 important things to note during the GU portion of the exam?
presence of hernias, varioceles or testicular masses
What are the recommendations for EKG/Echo in the PPE universe?
Routine use of ECG and echocardiogram in preparticipation cardiovascular screening is NOT recommended
What is the leading cause of death in young athletes? What percentage?
Sudden cardiac arrest
accounts for 75% of all sudden deaths
What is the MC cause of sudden cardiac death in the US?
hypertrophic cardiomyopathy (HCM)
What will a HCM murmur sound like on PE
systolic murmur: Turbulent flow of blood through a dynamic outflow tract obstruction
from google: harsh, loud, crescendo-decrescendo systolic murmur
What is the second most common cause of sudden death on the athletic field?
Coronary Artery Abnormalities
What is the MC coronary artery abnormality?
is a left main coronary artery originating off the right sinus
What is the pathophys behind coronary artery abnormalities? When do complications occur?
The subsequent course between the aorta and pulmonary artery to the left ventricle may result in compression of the vessel, myocardial ischemia, and sudden death
immediately after exercise
Why does exercise leads to complication of coronary artery abnormalities?
Exercise leads to expansion of aortic root and pulmonary trunk, which can cause coronary artery compression
What are the 3 organ systems involved in Marfan syndrome?
MSK, heart (aortic dilation and mitral valve prolapse) and eyes (retinal and lens detachment)
How do you dx HTN in children under 12? How many readings do you need?
based on gender, age and height
blood pressure must be examined on 3 different occasions
**What are the different stages of BP for everyone 13 years old and older?
**What are the criteria for dx HTN in kiddos 1-12 years old?
What is the recommendation for athletes with prehypertension?
Athletes with prehypertension can participate in sports
lifestyle modifications
What is the recommendation for stage 1 HTN?
Stage 1 with no end organ damage can participate with appropriate subspecialist referral
What is the recommendation for stage 2 HTN?
Stage 2 should not be cleared to participate in competitive sports until their bp is evaluated, treated, and under control
When do symptoms of exercise induced bronchoconstriction occur? When can they sometimes have a second wave of s/s?
Symptoms do NOT occur immediately at start and will NOT produce manifestations on resting exam
Begin during and will usually be worse 5-10 minutes after stopping
Some can have a second wave 4-12 hours after exercise
What is the main trigger for airway narrowing in exercise induced bronchoconstriction? What are some additional ones?
The dry/cold air is main trigger for airway narrowing
Exercise that exposes you to cold, pollution, high pollen counts, smoke/strong fumes can worsen symptoms, recent URI
What is the tx for exercise induced bronchoconstriction? What medication works well in adjunct?
Can take albuterol inhaler approx 20 minutes before exercising
Do proper warm up
Singulair (montelukast) works well in conjunction with this
What is the recommendation for DM pts to play sports? What if the activity lasts longer than ______. Who needs to follow with this pt?
ALL sports can be played with proper attention to diet, hydration, and insulin therapy!!!
special attention is needed if the activity is longer than 30minutes
endo needs to be involved
What is the recommendation for kiddos with
acutely enlarged liver or spleens?
Persons with ACUTELY enlarged liver or spleens should avoid all sports b/c of risk of rupture
What is the recommendation for kiddos with
chronically enlarged liver or spleens?
Those with chronically enlarged spleens and livers need individual assessment before playing collision or contact or limited contact sports
Is obesity a CI for sports? What are they at an increased risk for?
NO! unless comorbid finding of sever HTN is associated with it
heat injury
What is Osgood Schlatter disease? What makes the pain worse? What age ranges for males and females?
Pain localized to tibial tubercle
Pain aggravated by quadriceps muscle movement
Common in boys 12-15 and girls 11-13
What is the tx for Osgood Schlatter dz? When does the pain resolve? Is it safe for these pts to participate in sports?
Pain control with NSAIDS, physical therapy, stretching hamstrings, and ice after workouts are helpful
Typically resolves spontaneously as athlete reaches skeletal maturity
YES!! OSD is NOT a CI to sports partcipation
Can pts with idiopathic scoliosis participate in sports?
YES!!! Adolescent idiopathic scoliosis that is not painful or causes no functional limitations is not a reason for limitation from sports
What is the “female athlete triad” consistent of?
the combination of low caloric intake
menstrual dysfunction
low bone density
What is the tx recommendation for the female athlete triad? What are the 2 goals of treatment?
Recommendations for exercise restriction are aimed at restoring the positive energy balance by reducing energy expenditure and increasing energy intake
This will help restore the hypothalamic-pituitary-ovarian function, along with enhancing bone health
Females athletes who have been losing weight and no longer have a period, what is the specifically recommendation with regards to exercise and calorie intake? When should you follow-up? What other specialty may need to be involved?
he recommendations are to reduce training by 25%, and increase daily intake 200-600 calories
Follow up in 1-2 weeks
dietician
What are the 3 options for recommendations for participation?
Cleared for all sports without restrictions
Cleared for all sports without restrictions with recommendations for further evaluation or treatment
Not cleared: pending further evaluation, for any sports, or for certain sports
