August week 2: Sports PE


Peterson, Andrew R. “The Preparticipation Sports Evaluation.” Pediatrics in Review. 32 (5) May 2011. e53 (online only).

1. A 13 y/o girl presents to your office with mom for a preparticipation sports physical for soccer. Her history is significant for an episode of syncope and exercise induced asthma.

What historical aspects of the syncopal episode would necessitate further evaluation?
Does exercise induced asthma disqualify her from sports participation?
What kind of cardiac diagnoses would disqualify her from sports?
What kind of events in the family history would necessitate further cardiology evaluation? 
Can she participate in sports if she has chronic mild hypertension? Uncontrolled stage II hypertension?
Which physical examination findings require an echocardiogram for further evaluation:
1. Tall, long limbs relative to trunk, long fingers, pectus deformity, poor vision
2. Poorly palpable femoral pulses and HTN
3. 3/6 harsh systolic murmur loudest at the left sternal border 
4. 1/6 vibratory LUSB SEM, improves w/ sitting up
5. 2/6 diastolic murmur

2. A 17 y/o boy presents to your office with dad for a preparticipation sports physical for football. 2 weeks ago he was tackled during a game and sustained a one minute loss of consciousness. He had an ER evaluation at the time and CT of head was normal. Since then he has been having some intermittent dizziness, memory difficulties, and still has a mild headache on a daily basis. 

When can he return to play if this was his first head injury?
What should you counsel the family about the risk of repeat head injury?

3. A 14 y/o girl soccer player presents for evaluation of sore throat and fatigue for 1 week. She is afebrile, has an erythematous oropharynx with mild exudative tonsillitis and splenomegaly on exam.

What should you tell her regarding playing soccer?
What should you counsel parents about allowing children to participate in sports while febrile?

4. A 15 y/o boy with a seizure disorder presents for annual physical exam. He has had no seizures for 1 year on Keppra. He wants to play baseball. 

What will you recommend?

5. A 11 y/o boy with Trisomy 21 presents for preparticipation physical for the special Olympics. He had a VSD at birth that was repaired and has mild mental retardation. Otherwise is healthy and asymptomatic.

Besides a thorough history and physical exam with vision screening what test do you need to order? 
What restrictions are there if the testing is normal? What if it is abnormal but patient is asymptomatic?