To clear or not to clear?
A 12 year old girl presents to your office with fatigue, maliase, headache, low grade fevers for the past week. You diagnose her with mononucleosis. She is an avid basketball player and is anxious to get back to playing. How do you counsel her on return to play?
Per AAP, patients may return to physical activity 3-4 weeks from symptom onset.
True or False: Routine screening with ECG is controversial and not universally recommended at this time.
True!
A 13-year-old male presents with a 3-week history of pain in the anterior right knee that is worse when descending stairs and jumping. He is active in sports but has no recent history of injury. On examination you note tenderness and swelling over the tibial tuberosity, but no redness or warmth. Which one of the following would be most appropriate before initiating treatment?
A) No imaging
B) Plain film radiographs
C) Ultrasonography
D) MRI
E) A bone scan
A) No imaging
True or False: Athletes with seizure disorders should be excluded from all sports participation.
False
What team has the oldest, continually used, unaltered, primary NFL logo?
The Dallas Cowboys (we dem boys i guess)
A patient presents to you for a PPE. He is a 13 yo male who has a pmhx significant for traumatic injury to the left eye with vision deficits in the left eye only. His corrected vision today with his glasses is 20/20 in the right eye and 20/50 in the left. What recommendations do you make regarding sports clearance for this child?
A. Clear the patient for sports, his vision overall is adequate. No other restrictions
B. Clear the patient for sports, however add a stipulation that he must wear protective eyewear even during low risk non-contact sports
C. Clear the patient for sports, however add a stipulation that he must wear protective eyewear only during contact sports
B. Clear the patient for sports, however add a stipulation that he must wear protective eyewear even during low risk non-contact sports
You volunteer to provide the preparticipation clearance evaluation of the athletes at your local middle school. You use the American Academy of Pediatrics preparticipation screening questionnaire that is sent by the school to be completed by the parents before the sports physical examination. The questionnaire contains individual and family history questions along with history of past sports injuries. You review each completed questionnaire before you perform the physical examination. Which one of the following requires targeted screening by a pediatric cardiologist before the sports participation clearance decision?
A. All athletes before participation in competitive team sports.
B. All athletes before participation in high-intensity sports.
C. All athletes before their 12th birthday.
D. Athletes who are first-degree relatives of sudden cardiac arrest/SCD victims.
E. Athletes with a history of vasovagal syncope.
D. Athletes who are first-degree relatives of sudden cardiac arrest/SCD victims.
A 17-year-old female sees you for a preparticipation evaluation for cross country running. She has not had any falls or other injuries and estimates that she runs 40 miles per week. Menarche occurred at age 12 but over the past year her periods have become irregular, with her last menses occurring about 4 months prior to presentation. She is not sexually active and a urine pregnancy test is negative. She and her parents tell you that she eats a healthy diet, although she does report an inadvertent weight loss of 15 lb as she has increased her running mileage over the past year. She takes a multivitamin and occasional acetaminophen for pain but does not take any chronic medications. A physical examination reveals a thin female who does not show any signs of acute distress. Her vital signs include a weight of 52 kg (115 lb), a height of 173 cm (68 in), a BMI of 18 kg/m2 , a heart rate of 50 beats/min, and a blood pressure of 85/44 mm Hg. Which one of the following is the most likely underlying cause of her condition?
A) Anemia
B) Anorexia nervosa
C) Low circulating estrogen levels
D) Low energy availability relative to needs
E) Vitamin D deficiency
D) Low energy availability relative to needs
Over/under: 7% of athletes have a significant finding that warrants further investigation.
Over! 10% of athletes have a significant finding that warrants further investigation.
What was the name of the female scientist whose research contributed to the discovery of the double helix structure of DNA?
Rosalind Franklin
You perform a health supervision visit for a 13-year-old boy in your practice and note obvious spinal asymmetry on physical examination. You obtain a PA radiograph of the spine that confirms the diagnosis of scoliosis. According to the Scoliosis Research Society, which of the following curvature measurements best represents the threshold for the diagnosis of scoliosis?
A. 5 with Cobb angle measurement of PA radiographs.
B. 5 with scoliometer measurement of ATR.
C. 7 with scoliometer measurement of ATR.
D. 10 with Cobb angle measurement of PA radiographs.
E. 15 with Cobb angle measurement of PA radiographs.
D. 10 with Cobb angle measurement of PA radiographs.
What is the correct way to perform the cardiac exam in a PPE as recommended by the AAP?
Listen to the patient while supine and standing OR with and without the Valsalva maneuver
A 14-year-old female is brought to your office for a well child check and a sports physical examination. During the substance abuse screening she says that she does not drink alcohol or smoke marijuana or traditional cigarettes, but occasionally uses e-cigarettes with her friends. Which one of the following statements describing e-cigarettes is true?
A) E-cigarettes do not contain heavy metals
B) The nicotine in e-cigarettes is not addictive
C) Teens who use e-cigarettes are less likely to use marijuana
D) More teens use traditional cigarettes than e-cigarettes
E) E-cigarette use among teens increases the likelihood of cigarette smoking
E) E-cigarette use among teens increases the likelihood of cigarette smoking
When should athletes be encouraged to get the PPE completed? Be specific!
6 weeks prior to the start of activity
What is a group of crows referred to as? (ie a group of rhinos is called a crash of rhinos)
A murder (spooky szn)
A 14-year-old boy comes to your office for his yearly physical and wants to return to play soccer in the fall. He has had 2 episodes of concussion in the previous season and has returned to baseline. He was referred to a sports medicine specialist the last time you saw him. You note that the sports medicine specialist ordered neurocognitive testing, which has not been done yet. Which of the following is the best recommendation to give the family today regarding neurocognitive testing in this patient?
A. Can be done at any time during the soccer season and will not hold his sports clearance today.
B. Is not a sensitive test and, therefore, is not indicated at this time or in the future.
C. It is not needed at this time because the patient has fully recovered and is asymptomatic.
D. Should be conducted now as a baseline before the next season.
E. Should be conducted only if he has another concussion episode in the future.
D. Should be conducted now as a baseline before the next season.
5. A 13-year-old boy is brought to the clinic for his yearly physical examination. His family history is negative for early cardiac deaths in family members. On physical examination you note a harsh, early systolic murmur best heard over the right upper sternal border that increases in intensity on standing. Pulses are normal and equal in all 4 extremities. Which of the following is the next best step in management in this patient?
A. Clear him for all sports and order an EKG to be performed in the future at the family’s convenience.
B. Clear him for all sports and reassure the family that this is a benign heart murmur.
C. Clear him for low-intensity sports, no further evaluation is indicated.
D. No clearance for sports and follow up on the murmur in 1 year.
E. No clearance for sports. Reevaluate after an EKG, echocardiogram, and cardiology clearance are completed.
E. No clearance for sports. Reevaluate after an EKG, echocardiogram, and cardiology clearance are completed.
A 14-year-old female is brought to your office after a school screening program identified possible scoliosis. She plays basketball at school and has no history of recent injuries. She is feeling well today and a review of systems is negative. A physical examination reveals an elevated right rib on the forward bend test. Radiography demonstrates a Cobb angle of 15°. Which one of the following would be most appropriate at this point?
A) Observation only
B) Suspension of sports participation
C) Bracing
D) Physical therapy
E) Surgical evaluation
A) Observation only
True or False: The entire PPE has a remarkably small evidence base to suggest any efficacy for improving the health of young athletes.
TRUE
Names the six flags that have been flown over Texas.
The Kingdom of Spain, the Kingdom of France, the Republic of Mexico, the Republic of Texas, the Confederate States of America, and the United States of America.
A 16-year-old female teenager, known to your practice, presents to the clinic for a sports physical. You saw her last month as a follow-up to an emergency department (ED) visit for fainting episodes. She has had multiple fainting episodes during the past 6 months without any known explanation. The episodes are not related to exertion or physical activity. Review of her ED records shows that she had a normal electrocardiogram (EKG), laboratory studies, and brain computed tomographic scan. A referral to cardiology was made by the ED and is pending at this point. Her appointment is 3 months away. The patient says “nothing is wrong” with her and is keen to start soccer in the fall. Her family is, however, worried. Which of the following is the next best step in management?
A. Do not clear her for sports until she is cleared by cardiology, and assist the family in expediting the cardiology evaluation.
B. Clear her for sports today and cancel the cardiology referral since her studies in the ED were normal.
C. Clear her for soccer practice today but not for competition until her cardiology evaluation is completed.
D. Clear her for sports today and recommend that she keeps the cardiology appointment in 3 months.
E. Clear her for sports today and recommend that she keeps the cardiology appointment in 3 months only if she had recurrence of her symptoms.
A. Do not clear her for sports until she is cleared by cardiology, and assist the family in expediting the cardiology evaluation.
A 17-year-old boy is seen for a sports preparticipation clearance physical examination. Review of his vital signs shows a blood pressure over the 99th percentile for his height and age. The blood pressure was confirmed by using a manual, appropriately sized cuff, with similar blood pressure readings on 3 separate occasions. He denies intake of any sports supplements, and he is taking no medications. Among the following, which is the most appropriate next step in the care of this patient?
A. Ambulatory blood pressure measurement.
B. Hospitalization for full evaluation of hypertension.
C. Follow-up visit in 6 months to recheck blood pressure.
D. Referral for consultation with a dietitian.
E. Restriction from participating in his weight-lifting class at school.
E. Restriction from participating in his weight-lifting class at school.
You are seeing a 12 yo African American boy for a yearly physical and sport pre-partcipation clearance. You note he has Sickle Cell Trait listed on his problem list diagnosed by his newborn screen. The rest of his history and exam are normal. Which of the following is the most appropriate clearance recommendation for the patient?
A. Clear him and recommend adequate breaks, hydration, conditioning, and avoidance of/acclimatization to high altitudes.
B. Clear him for all sports with no special recommendations because he can be treated the same as a healthy 12-year-old.
C. Clear him for only low-intensity sports with no special recommendations.
D. Exclude him from sport participation to prevent sickling, dehydration, and rhabdomyolysis.
E. Limit his exercise to early morning or late in the day when the temperature is cooler to avoid overheating.
A. Clear him and recommend adequate breaks, hydration, conditioning, and avoidance of/acclimatization to high altitudes.
Which part of the PPE is more sensitive for detecting abnormalities: the history portion or the physical exam portion?
History!
What is the water in a can of chickpeas called?
Aquafaba