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Flashcards in Case 6 Deck (39):

What are symptoms of dizziness and visual disturbance classic for?



What is hypotension sometimes triggered by?

Volume depletion and skipping meals


What are the symptoms of Precordial Catch syndrome?

Chest pain, unrelated to exercise or meals. Chest pain reproducible with palpation. Otherwise, normal physical exam.


What is the differential diagnosis for chest pain?

Precordial catch syndrome, Musculoskeletal/costochondritis, GI/GERD, Cardiac, Respiratory/asthma.


What are the primary objectives of a sports pre participation physical exam?

Ensure adolescent athlete is healthy enough to participate in rigors of interscholastic competition. Meet legal and insurance requirements. Ensure cardiovascular health: In particular, the absence of undiagnosed cardiac illnesses such as hypertrophic cardiomyopathy, which could place the student athlete at significant risk of sudden cardiac death. Ensure neurological health. Detect conditions that may predispose to injury (eg musculoskeletal or neurological)


What are the secondary objectives of a sports pre participation physical exam?

Assess general health. Counsel on health-related issues. Assess fitness level for specific sports.


How do you evaluate chest pain in teenagers?

Chest pain is the second most common referral to pediatric cardiologists. In most cases, possible to make a correct diagnosis by careful history and examination.


What is a good mnemonic to use to assess for pain?

Aggravating factorsX
Alleviating factors
Associated symptomsX
X - especially important in differentiating chest wall pain (or pain of precordial catch syndrome) from cardiac, or ischemic, pain


What is different in onset between chest wall pain and cardiac pain?

Chest wall pain is sporadic and not associated with exertion. Cardiac pain is usually prompted by exertion or stress.


What is different in quality of pain between chest wall and cardiac?

Chest well pain is sharp and well localized. Cardiac pain is pressure and a crushing sensation.


What is the difference in timing between chest wall and cardiac pain?

Chest wall pain is very brief (seconds to a few minutes) and cardiac pain typically lasts 10-15 minutes.


What is the difference between aggravating factors for chest wall pain and cardiac pain?

Chest wall pain is made worse by deep inspiration and can be "broken" with forced deep inspiration. Cardiac pain is NOT affected by deep inspiration.


What associated symptoms with chest pain raises level of concern and requires prompt referral to cardiologist?

Syncope, difficulty breathing, or palpitations associated with chest pain.


What might the presence of fever with chest pain suggest?

Infectious etiology (pericarditis, pneumonia)


What does reproducibility of chest pain imply?

Musculoskeletal, not cardiac origin.


What is the Tdap?

("adult"). Tetanus, diphtheria, and acellular pertussis. First recommended to be given at the pre-adolescent visit (11-12 yrs). Used for adults and children 11 yrs and older who need booster doses of diphtheria, tetanus toxoid, and acellular pertussis.


What is the DTap?

("pediatric") Diphtheria, tetanus, and acellular pertussis. Contains three to five times more diphtheria toxoid than the "adult" Tdap.


What is the DT?

Used for children who cannot receive the pertussis component of the DTap vaccine.


What is the Meningococcal conjugate vaccine (MCV4)?

Recc. first at age 11-12 yrs. Booster dose at age 16. For adolescents who receive the first dose at age 13 through 15 years, one-time booster dose should be admin. preferably at age 16 through 18 years, before the peak in increased risk. Adolescents who receive their first dose of MCV4 at or after age 16 yrs do NOT need a booster dose. Routine vaccination of healthy ppl older than 21 yrs who are not at increased risk for exposure to neisseria meningitidis is not recommended.


What is the Human papillomavirus vaccine (HPV)?

It is recommended for all males and females starting at age 11-12 yrs. A second dose is rec. 2 months after the first dose and a third dose 6 mo after the first dose. The quadrivalent HPV vaccine (HPV4) is approved for men between the ages of 9 and 26 years to reduce their likelihood of acquiring genital warts, anal cancer and anal intraepithelial neoplasia (AIN). The bivalent HPV vaccine (HPV2) is approved only for women and only for the prevention of cervical cancer, not genital warts of other neoplasms.


Hepatitis A and B vaccines in adolescents?

Many will have completed the 2 dose series of hepatitis A given at 12 and 18 months of age. Most will have already completed the 3 dose series of Hep B vaccines in early infancy.


Inactivated polio vaccine (IPV) in adolescents?

Most adolescents will have received the four required doses of IPV in early childhood.


What is good advice to give to parents of adolescents?

Est. expectations and reach agreement with adolescent about rules, limits, consequences, and decision-making. Enhance adolescents's self esteem, minimize criticism, and respect privacy. Continue to show interest in adolescents plans and activities and continue to affirm family values. Be a role model for responsible behavior, safe driving practices and discuss healthy behavior, avoiding substance abuse and living responsibly.


How to assess for coarctation of the aorta?

Palpation of the radial and femoral pulses.


When is the murmur of hypertrophic cardiomyopathy louder?

While standing!


What types of murmurs require further evaluation?

Murmurs are common in healthy adolescents, but any murmur louder than a grade III/VI, any diastolic murmur, or any murmur that increases with standing or Valsalva deserves further evaluation.


When is checking the male athlete for inguinal hernia particularly important?

In sports that involve sprinting and weight lifting.


What is tanner stage 1 for a male?

Prepubertal. Childlike phallus, testicular volume < 1.5 ml. No pubic hair.


What is tanner stage 2 for a male?

Childlike phallus, testicular volume 1.6-6 mL, reddened, thinner and larger scrotum, small amount of fine hair along the base of the scrotum and phallus.


What is tanner stage 3 for a male?

Increased phallus length, testicular volume 6-12 mL, greater scrotal enlargement, and moderate amount of more curly, pigmented, coarser hair extending laterally.


What is tanner stage 4 for a male?

Increased phallus length and circumference, testicular volume 12-20 mL, further scrotal enlargement and darkening, and coarse curly adult-type hair that does not yet extend to the medial surface of thighs.


What is tanner stage 5 for a male?

Adult scrotum and phallus, testicular volume > 20 mL. Adult-type hair extending to medial surface of thighs.


What is on the differential diagnosis for precordial catch syndrome?

Costochrondritis, respiratory/asthma, GI/GERD, cardiac.


What is precordial catch syndrome?

Benign cause of chest wall pain. By far the most common cause of chest pain in children but of unknown etiology. It occurs most commonly in adolescents and is characterized by a sudden, sporadic onset of sharp pain, usually along the left sternal border, which is often exacerbated with deep inspiration. These pains are brief, lasting seconds to a few minutes, and resolve spontaneously. The pain can often be "broken" with a forced deep inspiration.


What is costochrondritis?

A benign cause of chest pain but is much less common than precordial catch syndrome. The pain of costochondritis is due to inflammation and typically will last for hours or days. The pain usually follows a recent viral infection, muscle strain, trauma or overuse. Reproducibility by direct pressure over costochondritis joints is diagnostic.


How can respiratory/asthma cause chest pain?

Pain during exercise can point to exercise-induced bronchospasm or asthma. These may also present with coughing, respiratory distress and wheezing.


How can GI/GERD cause chest pain?

Gastrointestinal causes of chest pain such as gastritis or esophagitis secondary to GERD may present as retrosternal, burning, non-radiating chest pain associated with meals.


How can cardiac cause chest pain?

Pain during exercise points to cardiac causes or exercise-induced bronchospasm or asthma.


When is an EKG (electrocardiogram) needs for adolescents with chest pain?

Indicated for any pt. with syncope. Impossible to rule out some important arrhythmic causes of syncope - such as Wolff-Parkinson-White syndrome and long QT syndrome - without an ECG. Hypertrophic cardiomyopathy is the most common cause of sudden death in young athletes and can first present with syncope. The ECG is abnormal in >90 percent of patients with hypertrophic cardiomyopathy and is thus an essential screening test.