Pre-Participation Sports Physical - Exam 2

Question 1

What is the ultimate goal of the Preparticipation Physical Exam (PPE)?

Answer 1

Ultimate goal is to promote the health and safety of student athletes

Question 2

What are the 2 primary objectives for the PPE?

Answer 2

Primary objectives are to screen for conditions that may be life-threatening or disabling and for conditions that may predispose to injury or illness

Question 3

What are the primary goals of a PPE?

Answer 3

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

Question 4

What are the 2 secondary goals of a PPE? What is the ideal timing? How often should PPEs be completed?

Answer 4

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

Question 5

Are PPE and WCC interchangeable? What areas NOT directly related to sports?

Answer 5

NO!! PPE is not a replacement for the annual WCC

Teenage sexuality, substance abuse, immunizations, among others

Question 6

How do parents sometimes view the PPE? How do providers typically view the PPE? What can you do to combat the differences?

Answer 6

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

Question 7

What is the most important part of the PPE encounter? What percentage of medical issues does it catch?

Answer 7

the medical history!!

identifies 75% of medical issues that can restrict activity

Question 8

How should the hx portion of the PPE be completed?

Answer 8

The athlete and the parents should complete the form together to obtain a thorough and accurate history

Question 9

In the injury history portion, what would you want to specifically note?

Answer 9

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

Question 10

**What are the 14 personal CV medical history questions you would want to ask your patient?

Answer 10

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?

Question 11

What is Kawasaki dz?

Answer 11

Kawasaki disease causes swelling, called inflammation, in the walls of small to medium-sized blood vessels that carry blood throughout the body.

Question 12

What are the symptoms of Kawasaki dz?

Answer 12

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

Question 13

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?

Answer 13

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

Question 14

What are the two grades for concussions? What does each mean?

Answer 14

simple and complicated

complicated: amnesia, loss of consciousness, seizure, or prolonged symptoms

simple: none of the above symptoms

Question 15

What are the return to learn criteria post concussion?

Answer 15

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

Question 16

What are the requirements for a kiddo to start the return to play criteria?

Answer 16

successful return to school

symptom free and off any meds to help with symptoms

normal neuro exam

baseline balance and cognitive function

Question 17

According to WVSSAC, what is the RTP criteria? How long should each step in the progression take?

Answer 17

each step in the test should take 24 hours

Question 18

What are the 2 indications that a kiddo should be retired from contact sports?

Answer 18

1. for pt’s with structural brain abnormality on neuroimaging (intracranial bleed, skull fracture)
2. nonresolving/prolonged neurocognitive deficits

Question 19

What are the 3 criteria that would make you think about retiring the kiddo from contact sports?

Answer 19

1. increased recovery times
2. A pattern of decreased threshold for repeat concussions especially when associated with persistent prolong symptoms
3. Multiple concussions over the course of an athletic career

Question 20

**What systems need to be evaluated during a PPE?

Answer 20

MSK
Cardio
Neuro
height/weight
eyes
skin
lymph
respiratory
abdomen
GU

Question 21

During the CV exam, what needs to be evaluated?

Answer 21

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

Question 22

What positions should the patient be in when checking for heart murmurs?

Answer 22

supine

standing

valsalva

Question 23

**Will a HCMO murmur get louder/softer with valsalva?

Answer 23

HCMO murmur gets louder with valsalva

Question 24

**Will an aortic stenosis/regurgitation murmur get louder or softer with valsalva?

Answer 24

aortic stenosis/regurg the murmur will get quieter with valsalva

Question 25

What are the 2 important things to note during the abdominal exam?

Answer 25

looking for hepatic and splenic enlargement

Question 26

What are 3 important things to note during the GU portion of the exam?

Answer 26

presence of hernias, varioceles or testicular masses

Question 27

What are the recommendations for EKG/Echo in the PPE universe?

Answer 27

Routine use of ECG and echocardiogram in preparticipation cardiovascular screening is NOT recommended

Question 28

What is the leading cause of death in young athletes? What percentage?

Answer 28

Sudden cardiac arrest accounts for 75% of all sudden deaths

Question 29

What is the MC cause of sudden cardiac death in the US?

Answer 29

hypertrophic cardiomyopathy (HCM)

Question 30

What will a HCM murmur sound like on PE

Answer 30

systolic murmur: Turbulent flow of blood through a dynamic outflow tract obstruction from google: harsh, loud, crescendo-decrescendo systolic murmur

Question 31

What is the second most common cause of sudden death on the athletic field?

Answer 31

Coronary Artery Abnormalities

Question 32

What is the MC coronary artery abnormality?

Answer 32

is a left main coronary artery originating off the right sinus

Question 33

What is the pathophys behind coronary artery abnormalities? When do complications occur?

Answer 33

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

Question 34

Why does exercise leads to complication of coronary artery abnormalities?

Answer 34

Exercise leads to expansion of aortic root and pulmonary trunk, which can cause coronary artery compression

Question 35

What are the 3 organ systems involved in Marfan syndrome?

Answer 35

MSK, heart (aortic dilation and mitral valve prolapse) and eyes (retinal and lens detachment)

Question 36

How do you dx HTN in children under 12? How many readings do you need?

Answer 36

based on gender, age and height blood pressure must be examined on 3 different occasions

Question 37

**What are the different stages of BP for everyone 13 years old and older?

Answer 37

Question 38

**What are the criteria for dx HTN in kiddos 1-12 years old?

Answer 38

Question 39

What is the recommendation for athletes with prehypertension?

Answer 39

Athletes with prehypertension can participate in sports lifestyle modifications

Question 40

What is the recommendation for stage 1 HTN?

Answer 40

Stage 1 with no end organ damage can participate with appropriate subspecialist referral

Question 41

What is the recommendation for stage 2 HTN?

Answer 41

Stage 2 should not be cleared to participate in competitive sports until their bp is evaluated, treated, and under control

Question 42

When do symptoms of exercise induced bronchoconstriction occur? When can they sometimes have a second wave of s/s?

Answer 42

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

Question 43

What is the main trigger for airway narrowing in exercise induced bronchoconstriction? What are some additional ones?

Answer 43

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

Question 44

What is the tx for exercise induced bronchoconstriction? What medication works well in adjunct?

Answer 44

Can take albuterol inhaler approx 20 minutes before exercising Do proper warm up Singulair (montelukast) works well in conjunction with this

Question 45

What is the recommendation for DM pts to play sports? What if the activity lasts longer than ______. Who needs to follow with this pt?

Answer 45

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

Question 46

What is the recommendation for kiddos with acutely enlarged liver or spleens?

Answer 46

Persons with ACUTELY enlarged liver or spleens should avoid all sports b/c of risk of rupture

Question 47

What is the recommendation for kiddos with chronically enlarged liver or spleens?

Answer 47

Those with chronically enlarged spleens and livers need individual assessment before playing collision or contact or limited contact sports

Question 48

Is obesity a CI for sports? What are they at an increased risk for?

Answer 48

NO! unless comorbid finding of sever HTN is associated with it heat injury

Question 49

What is Osgood Schlatter disease? What makes the pain worse? What age ranges for males and females?

Answer 49

Pain localized to tibial tubercle Pain aggravated by quadriceps muscle movement Common in boys 12-15 and girls 11-13

Question 50

What is the tx for Osgood Schlatter dz? When does the pain resolve? Is it safe for these pts to participate in sports?

Answer 50

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

Question 51

Can pts with idiopathic scoliosis participate in sports?

Answer 51

YES!!! Adolescent idiopathic scoliosis that is not painful or causes no functional limitations is not a reason for limitation from sports

Question 52

What is the "female athlete triad" consistent of?

Answer 52

the combination of low caloric intake menstrual dysfunction low bone density

Question 53

What is the tx recommendation for the female athlete triad? What are the 2 goals of treatment?

Answer 53

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

Question 54

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?

Answer 54

he recommendations are to reduce training by 25%, and increase daily intake 200-600 calories Follow up in 1-2 weeks dietician

Question 55

What are the 3 options for recommendations for participation?

Answer 55

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