Preparticipation Physical Evaluation

Question 1

Objectives of PPE:

1. Primary or Essential? 4
2. Secondary or Ideal? 3

Answer 1

1. Primary or Essential
   - Detect conditions that may limit participation
   - Detect conditions that may predispose to injury
   - Meet legal and insurance requirements
   - Follow-up previous injuries, conditions, surgeries
2. Secondary or Ideal
   - Assess general health and identify health-risk behaviors – potential for discovering previously undetected condition
   - Assess physical maturity
   - Determine fitness and performance level

Question 2

Timing and Frequency of PPE
1. Should be performed at least _______ beginning of sports to allow adequate time to address any issues

2. Must be done how often for high school athletes by Montana regulations?
3. Comprehensive baseline PPE before initiating a sports season
   - Subsequent annual PPE’s may be limited to what? But you also NEED to review what?

Answer 2

1. 6 weeks
2. annually
3. recent injuries but also include review of
   - Cardiopulmonary system

Question 3

Stations for the sport physical?

6

Answer 3

1. Sign in
2. Height/weight
3. Vitals
4. Vision
5. HISTORY REVIEW
6. Physical exam

Question 4

1. What is the conerstone of the PPE?
2. CARDIOVASCULAR questions are the key questions to identify? 3
3. Identify at risk behaviors?

Answer 4

1. Cornerstone of the PPE and may identify 75% of problems affecting athletes
2. • Identify hypertrophic cardiomyopathy
   • Marfans
   • Premature atherosclerosis
3. Health –risk behaviors, female athletic triad

Question 5

Cardiovascular Causes of Sudden Death

7

Answer 5

1. Hypertrophic Cardiomyopathy
2. Anomalies of the coronary arteries
3. Atherosclerotic Heart Disease
4. Marfan’s syndrome: Aortic rupture
5. Aortic stenosis
6. Mitral valve prolapse
7. myocarditis

Question 6

HYPERTROPHIC CARDIOMYOPATHY

1. Primarily a disease of?
2. Onset?
3. Specific Questions? 2

Answer 6

1. Primarily a disease of the myocardium with hypertrophy without any obvious cause
2. Frequently asymptomatic until sudden cardiac death
3. • Have you ever passed out during or after exercise?
   • Has anyone in your family died of heart problems or sudden death before age of 50?

Question 7

HEENT special considerations for exam?

3

Answer 7

1. Pupils (for anisocoria) and visual acuity
2. Swimmers, scuba divers and wrestlers may require special evaluations
3. Smokeless tobacco users require oropharynx evaluation

Question 8

Cardiovascular
Blood pressure measurements with appropriate cuff size
1. Less than 10 yrs old, what should the blood pressure be?
2. over 10?
3. Palpation of upper and lower extremity pulses: What could this tell us?

Answer 8

Blood pressure measurements with appropriate cuff size

1. less than 10 years of age: > 125/75
2. > 10 years of age: >135/85
3. Palpation of upper and lower extremity pulses
   - Brachial-femoral delay may mean coarctation of aorta

Question 9

1. Heart auscultation in two positions and with provocative maneuvers such as? 3
2. What might this help catch?

Answer 9

1. • Valsava,
   • deep inspiration,
   • squatting
2. may help detect murmurs

Question 10

1. What arrhythmia is most commonly found?
2. How do we know an arrythmia is benign? 3
3. What may indicate myocarditis?

Answer 10

1. Isolated premature ventricular contractions (PVC’s) is most common found
   - Rarely of consequence
2. Benign arrhythmias\
   - Unifocal in origin
   - Disappear with exercise
   - No history of syncope with exercise
3. Coupling with PVC’s may indicate myocarditis

Question 11

Musculoskeletal exams
1. Important to identify musculotendinous, bone, or joint problems that may limit athletic participation or predispose to injury, such as? 3

2. Screening for? 2

Answer 11

1. • Shoulder instability,
   • ACL deficiency,
   • unrehabbed ankle instability
2. • Screening for flexibility
   • Screening for general neurologic exam, scoliosis

Question 12

Clearance for Participation
Must be familiar with demands of specific sports
Consider these questions? 4

Answer 12

1. Will the problem increase the athletes risk of morbidity or mortality?
2. Will other participants be at risk of morbidity?
3. Will further evaluation, treatment or rehab allow full participation?
4. Could the athlete be allowed limited participation?

Question 13

Diabetes – may participate if controlled

-specific concern for which activities?

Answer 13

those over 30 minutes

Question 14

Sickle Cell Trait

1. Linked to what?
2. Screening should be considered in who? 2

Answer 14

1. Linked to an increase risk for heat illness and sudden cardiac death
2. Screening should be considered in athletes
   - with a family history of sickle cell trait or
   - in athletes of African descent and a history of exertional rhabdomyolysis

Question 15

Sickle Cell Trait

Unlikely that they have an increased risk of sudden death or other medical problems with exception of what? 3

Answer 15

1. extreme conditions of heat,
2. humidity,
3. elevation

Question 16

RED FLAGS
on PPE?
5

Answer 16

1. History of exercise intolerance
2. Syncope or near syncope
3. Chest pain with exercise
4. A family history of unexplained death before age of 50
5. Family History of hyperlipidemia