Sports Physical Evaluation

Question 1

What is an important first step in assisting athletes in maintaining health & ensuring safe participation in training & competition?

Answer 1

Pre-participation physical evaluation

Question 2

Primary/Essential Objectives of Pre-Participation Physical Evaluation

Answer 2

Detect conditions that may limit participation or predispose to injury
Meet legal & insurance requirements
Follow-up previous injuries, conditions, surgeries

Question 3

Secondary/Ideal Objectives of Pre-Participation Physical Evaluation

Answer 3

Assess general health & identify health-risk behaviors
Assess physical maturity
Determine fitness & performance level

Question 4

Timing & Frequency of Pre-Participation Physical Evaluations

Answer 4

6+ weeks prior to beginning sports

Annually in Montana

Question 5

Advantages of Office-Based Sports Physicals

Answer 5

Physician-patient familiarity
Privacy
Continuity of care

Question 6

Disadvantages of Office-Based Sports Physicals

Answer 6

Cost
Limited appointment time
Lack of communication back to school staff

Question 7

Advantages of Group Screening Sports Physicals

Answer 7

Specialized personnel

Time & cost efficiency

Question 8

Disadvantages of Group Screening Sports Physicals

Answer 8

Rushed
Lack of privacy
Potential for poor follow-up of identified problems

Question 9

Stations of Group Screening Sports Physicals

Answer 9

Sign in
Height/weight
Vitals
Vision
History review
Physical exam

Question 10

Medical History of Sports Physicals

Answer 10

Cornerstone
CV questions are key
Health-risk behaviors, female athletic triad

Question 11

Cardiovascular Causes of Sudden Death

Answer 11

Hypertrophic cardiomyopathy
Anomalies of the coronary arteries
Atherosclerotic heart disease
Marfan's syndrome: aortic rupture
Aortic stenosis
Mitral valve prolapse
Myocarditis

Question 12

Describe Hypertrophic Cardiomyopathy

Answer 12

Disease of the myocardium with hypertrophy without any obvious cause

Question 13

Specific CV Questions

Answer 13

Have you ever passed out during or after exercise?

Has anyone in your family died of heart problems or sudden death before age 50?

Question 14

Key Physical Exam Points for HEENT

Answer 14

Pupils (anisocoria)
Visual acuity
Swimmers, scuba divers, wrestlers may need special evals
Oropharynx: smokeless tobacco

Question 15

Define Anisocoria

Answer 15

Condition where the pupil in one eye differs in size from the pupil of the other

Question 16

Key Physical Exam Points for Cardiovascular

Answer 16

Blood pressure
Palpation of upper & lower extremity pulses
Heart auscultation: 2 positions + provocative maneuvers
Arrythmias

Question 17

Benign Arrhythmias

Answer 17

Unifocal in origin
Disappear with exercise
No history of syncope with exercise

Question 18

Musculoskeletal Exam Findings

Answer 18

Identify musculotendinous, bone, or joint problems that may limit participation or predispose to injury
Screen for flexibility
Screen for general neurologic exam, scoliosis

Question 19

Medicolegal Considerations with Sports Physicals

Answer 19

Athlete has legal right to participate AMA
Use a waiver
Medical liability doesn’t cover sports physicals

Question 20

Specific Medical Conditions that Require Special Clearance

Answer 20

Atlantoaxial instability
Bleeding disorders
Heart murmurs
DM: controlled

Question 21

Sickle Cell Trait

Answer 21

Heat illness
Sudden cardiac death
Extreme conditions of heat, humidity, & elevation

Question 22

Absence of Kidney

Answer 22

Counseling

Protection for contact

Question 23

Red Flags During Sports Physicals

Answer 23

Hx of exercise intolerance
Syncope or near syncope
Chest pain with exercise
Family Hx of unexplained death prior to 50
Family Hx of hyperlipidemia