PPE

Question 1

Which organizations author the PPE consensus statement (5th ed.)?

Answer 1

AAFP, AAP, ACSM, AMSSM, AOSSM, AOASM. [Consensus]

Question 2

Optimal timing of a PPE before competition?

Answer 2

≈6 weeks prior to allow workup/interventions. [Logistics]

Question 3

How often should PPEs be performed?

Answer 3

High school: annual; AHA suggests every 2 years; many recommend with each new level. [Frequency]

Question 4

Office vs mass PPE—one advantage of office setting?

Answer 4

Privacy, continuity, counseling on sensitive topics (e.g., disordered eating, STIs, drugs), esp. in COVID era. [Setting]

Question 5

Mass PPE—one advantage & one challenge?

Answer 5

Efficient and coordinated with ATs/coaches, but logistically challenging (esp. during pandemics). [Setting]

Question 6

Key cardiac history red flags to capture on PPE (name ≥3)?

Answer 6

Exertional chest pain/dyspnea, exertional syncope/presyncope, palpitations, seizures, family hx SCD <50 or cardiomyopathy/channelopathy. [Cardiac]

Question 7

Physical exam cardiac pearls on PPE?

Answer 7

Quiet room, dynamic murmur maneuvers (standing/valsalva ↑ HCM murmur), bilateral BPs, Marfan stigmata, femoral pulses. [Cardiac]

Question 8

What % of athletes will likely have no issues on PPE?

Answer 8

≈97%+, but we screen to catch the ~3% with red flags. [Principle]

Question 9

Are routine labs indicated on PPE?

Answer 9

No routine labs; ferritin screening for young female endurance athletes has been proposed but not standard. [Labs]

Question 10

NCAA sickle cell policy?

Answer 10

NCAA mandates SCT testing (since 2009); many expert groups disagree; not required for non‑NCAA athletes. [Policy]

Question 11

Down Syndrome cervical spine films—AAP stance (2011)?

Answer 11

AAP no longer recommends routine c‑spine films in asymptomatic DS; Special Olympics still requires screening and restricts certain high‑risk sports with AAI. [Neuro]

Question 12

ESC vs US on ECG screening in PPE?

Answer 12

ESC mandates ECG; U.S. does not systematically—cost/false positive concerns remain. [ECG]

Question 13

Evidence sometimes cited for ECG screening efficacy?

Answer 13

Italian data: lower SCD rates after ECG screening; U.S. studies (Drezner et al.) suggest improved sensitivity vs history+exam alone. [ECG]

Question 14

What criteria are taught for athlete ECG interpretation?

Answer 14

Seattle/International criteria; AMSSM ECG modules available. [ECG]

Question 15

HCM—leading cause of SCD in young US athletes: 2 classic findings?

Answer 15

Murmur ↑ with Valsalva/standing; pathologic Q waves/LVH on ECG (echo shows septal thickness >15 mm; 12–14 mm gray zone). [HCM]

Question 16

Marfan—3 screening features to recall on PPE?

Answer 16

Tall with long limbs, lens dislocation/vision issues, aortic disease/MVP; genetics 50% AD. [Marfan]

Question 17

Athlete’s heart—3 benign adaptations?

Answer 17

LVH, first‑degree AV block, aortic root dilation scaled to body size; no EF drop, no pathologic QRS widening. [Athlete’s Heart]

Question 18

ARVC—why is it emphasized in Italian data?

Answer 18

Leading cause of SCD there; arrhythmias from fibro‑fatty RV replacement. [ARVC]

Question 19

Brugada—ECG pattern to know?

Answer 19

Coved ST elevation in V1–V3 with RBBB features; risk in young men. [Brugada]

Question 20

Long QT—ballpark threshold on PPE ECG?

Answer 20

QTc ≥450–460 ms flagged; risk of torsades; congenital or acquired causes. [LQTS]

Question 21

WPW—PPE ECG clue?

Answer 21

Short PR (<120 ms) + delta wave (slurred upstroke) before QRS. [WPW]

Question 22

Syncope on PPE—when to restrict?

Answer 22

Syncope during exertion or without prodrome → restrict pending ECG/echo/EST workup. [Syncope]

Question 23

Hypertension—screening nuance in teens?

Answer 23

Use age‑based nomograms; lower absolute pressures may be abnormal; track year to year. [HTN]

Question 24

Bethesda/ACC—conditions commonly excluded from sport (one not excluded)?

Answer 24

HCM, LQTS, Brugada, WPW may be restricted; Mitral valve prolapse is not automatically excluded. [Eligibility]

Question 25

Concussion—clearance principles referenced?

Answer 25

Remove from play by law in most states; integrated clearance: symptom‑free, normal neuro exam/cognitive testing, graded return without symptoms. [Concussion]

Question 26

Seizure disorders—participation rule of thumb?

Answer 26

Well‑controlled seizures generally not a contraindication; poorly controlled → further evaluation. [Neuro]

Question 27

Stingers/burners—when to investigate?

Answer 27

Recurrent episodes → c‑spine MRI for stenosis or demyelination; single transient episode may be cleared. [Spine]

Question 28

Transient quadriparesis—Watkins criteria to clear?

Answer 28

No cord changes on MRI; adequate canal diameter (≈14 mm at C4; ≥8 mm cord diameter); recurrent episodes → do not clear. [Spine]

Question 29

Prior MSK injury—what to capture?

Answer 29

Missed time, surgeries/rehab timelines, imaging, braces/assist devices; targeted focused exam. [MSK]

Question 30

What is the 'orthopedic dance' on PPE?

Answer 30

A systematic sequence to efficiently screen major MSK regions in asymptomatic athletes. [MSK]

Question 31

Single paired organs—how handled today vs 1980s AMA list?

Answer 31

Past blanket exclusions (one eye/kidney/testicle/ovary); now individualized decisions with protection and sport risk assessment. [Eligibility]

Question 32

Why is education/prevention emphasized during PPE?

Answer 32

Private setting allows counseling on nutrition, RED‑S/disordered eating, STIs, drugs, sleep, mental health—impact beyond clearance. [Counseling]