Exam 9 Nmsk70 - Preparticipation Physical Exam

Front 1

... = 1st step toward maintaining health and safety of athletes
-If weak ankle found, do exercises to strengthen

Back 1

PPE (pre participation exam)

Front 2

... Goal = maintain health and safety of athlete in play and competition

Intent =
-A positive intervention
-Not to exclude athlete
-Not a substitute for health maintenance exam

*The only health assessment for 80% of athletes

Back 2

Primary

Front 3

PPE ... Objectives:

-Determine athlete’s general health
-Counsel the athlete re: health promotion and preventive medicine concepts
-Assess maturity (skeletal and developmental)
-Assess fitness level and performance
-Preventive medicine issues: seat belt use, helmets, BSE/TSE (Breast/Testicular self exams), drug/alcohol use, cholesterol screening, gyn exams
-Psychosocial issues: anxiety, depression, suicide, stress management

Back 3

Secondary

Front 4

PPE ... objectives:

-Detect conditions that could limit participation
-Detect any condition that could predispose an athlete to injury
-Detect potentially life threatening conditions
-Meet legal and insurance requirements

Back 4

primary

Front 5

Time/Frequency of PPE

Ideally, ... weeks before the season, before training and practice

Recommendations re: frequency vary:
-Annually
-When entering new program or sport
-Entry level complete exam; limited annual re-evaluation
*Height, weight, visual acuity, CV assessment, physical maturity
*Re-eval ... areas

Back 5

6
problem

Front 6

Medical History:

Gather data (forms completed by athlete and parent):
-Hospitalizations/surgeries
-Medications
-Allergies (any)
-Exercise related symptoms
-... problems: Heart murmur, sudden death, irregular heart rate, hypertension
-Skin problems
-Family history (esp. CVD): esp sudden cardiac death, MI before age 50, HCM (hypertrophic cardiomyopathy), Marfan’s Syndrome, HTN

Back 6

Cardiovascular

Front 7

medical history:

Gather data
-... injury, LOC, seizure
-... injury, “stinger”, “burner”
-Heat/muscle cramps, or related symptoms
-Cough/difficulty breathing during or after activity
-Use of special equipment
-Problems with eyes/vision, use corrective lenses
-Sprain/strain, dislocation, fracture, repeated swelling, bone or joint problems
-Other medical problems, especially since last physical exam
-Last tetanus shot, measles immunization
-When was first ...
-Most recent menses: amenorrhea, oligomenorrhea, history of stress fractures, bone injury, risk factors for osteoporosis
-Longest time between periods in last year
-Family or personal history of alcohol/other drug abuse, treatment
-... disorder

Back 7

Head
Nerve
menses
Eating

Front 8

What is the “female athlete triad”?

Back 8

Disordered eating
Altered menstrual function
Abnormal bone mineralization

Front 9

62% prevalence rate for ... in some groups

Incidence of ... in athletes 2-3 times of general population

Osteoporosis incidence unknown

Bone not formed or lost ... be completely regained – some women in their 20’s have bone densities comparable to norms for 60-80 year olds

Back 9

disordered eating
amenorrhea
may not

Front 10

PE for disordered eating:

... (starvation/dehydration)
-Decreased blood pressure, bradycardia, LE edema, dry skin/nails/hair, lanugo hair

... (purging)
-Parotid hypertrophy, dental caries/peridontal disease, look on back of front teeth (erosion), pharyngeal erythema, conjunctival petechiae, scars on dorsal hands, rectal fissure

Back 10

Anorexia nervosa
Bulima nervosa

Front 11

...:

-A screening exam to emphasize evaluation of areas of greatest concern and ID’d problems
-Males wear shorts
-Females wear shorts and tank/bikini tops

Back 11

Physical examination

Front 12

Physical examination cont.:

Height and weight
-Compare to norms
-Eating disorder?
-Weight loss issue?
-Body composition

Eyes
-VA (Snellen); at least correctable to ... (otherwise, they will be at risk for injury)
-Pupil size
-Conjunctiva (for ...)

Ears: esp for swimmers (otis externa), wrestlers (auricula hematoma), and divers (otic barotrauma)

Nose: if allergies or nasal trauma hx

Throat: if use smokeless tobacco

Back 12

20/50
anemia

Front 13

Physical examination:

CV System
-Blood pressure
-Caution if: over ... if under 10 years
over ... if over 10 years (hypertensive)

-Pulse
-Ausculate heart (seated & supine)
-Functional vs pathologic murmur
-HCM (can cause sudden death): systolic, loudest at left sternal border in standing; increase with Valsalva or squat-to-stand
-Further eval: systolic murmur > 3/6, any diastolic murmur, increase with Valsalva
-... of aorta (narrowing of aorta. High blood pressure in higher part of body, lower BP in lower part of body). Check radial pulse and femoral pulse on the same side at the same time.

Back 13

125/75
135/85
Coarctation

Front 14

Physical examination:

Skin
-Rash, fungal infection
-Impetigo, herpes, scabies, lice, molluscum
contagiosum

Genitalia
Male: ... exam
-Presence/absence (are they both descended)
-Masses
-Descended
-Inguinal hernia (if pain or if it’s huge, won’t get to play)
-... staging – controversial
Females: (none, unless there’s an issue)
-Tanner staging – controversial
-Amenorrhea/dysmenorrhea

Back 14

testicular
Tanner

Front 15

...:

Get C-spine radiographs (with flexion and extension views)
-Required by Special Olympics
-AAP acknowledges potential but cites unproven value of lateral plain films

Back 15

Down’s syndrome

Front 16

Medical problems = limitations:

... instability: get c-spine film
-No contact sport with repetitive flexion or extension stress

Acute illness:
-Risk of worsening illness?
-Communicable?
-Not allowed to compete if ...
-Limited due to risk of dehydration, etc.

...:
-Hypertension
-Murmurs
-Arrhythmias
-HCM

Visual impairment:
-One eye? No sports with no eye protection
-Lensed eye guard
-Sign special consent?

Back 16

Atlantoaxial
febrile
Cardiovascular

Front 17

Medical problems = limitations

No contact if ... – can bleed out really fast

Sickle Cell trait: If hemoglobin < ...

Back 17

splenomegaly
8.0

Front 18

potential medicolegal issues:

Athletes may have legal right to participate. AMA
-If they do, get ... to demonstrate athlete/parents fully informed of condition & risks

Back 18

prospective release

Front 19

... = ability to perform daily tasks with vigor and alertness, without undue fatigue and with ample energy to enjoy leisure pursuits and meet unforeseen emergencies

Back 19

Physical fitness

Front 20

fitness program objectives for adult:

Proper medical evaluation
Include ... exercise testing
Avoid ... and heavy resistance exercises (­ BP and mycardial O2 demand)
Watch for overuse!
... rate of progression
Adapt to wide range of settings
Must be enjoyable to ­ compliance
Focus on ... (key, especially for older athlete)

Back 20

graded
isometric
Gradual
movement without assistance