Orthopedic Surgery Board Review Sample Questions

The correct answer is E. American College of Sports Medicine does not recommend routine exercise stress-testing in children starting a vigorous exercise program.

Explanation: The pre-participation physical examination is utilized to screen athletes who are most at risk for sudden death during a sporting activity. A comprehensive medical history should include questions about both personal and family history of cardiovascular disease, neurological issues, or musculoskeletal problems. The critical part of any pre-participation examination is cardiac auscultation with provocative maneuvers that is used to screen patients for hypertrophic cardiomyopathy, the most common cause of sudden death in young male athletes. The most common coronary abnormality is an aberrant origination of the left main coronary artery, off of the right sinus. A complete pre-participation physical examination has been identified by the American Association of Orthopedic Surgeons, the American Academy of Pediatrics, the AFP, and AOSSM. The goal of a complete pre-participation physical is to identify all conditions that may predispose an athlete to injury or illness. It should be performed in all athletes. It has not been found effective in determination of the risk of sudden death in athletes. Orthopedic history and questionnaire are most useful for identification of 75% of musculoskeletal problems. In addition to a complete medical history and evaluation of OTC and prescription medications and supplements, family history and any prior symptoms are essential to identify potentially lethal conditions. If a patient has only a solitary organ in a paired-organ system, this should be identified. Height, weight, body mass, and vital signs; visual acuity; cardiorespiratory exam; musculoskeletal exam; and a male genital exam are all part of a complete physical. ECG, radiographs, exercise testing, and laboratory studies are not indicated for routine screening. Clinicians should particularly look out for murmurs, exertional dizziness, history of transient quadriplegia, heat-related illness, use of illegal supplements, and hypertension. Female athletes should be screened for anorexia and amenorrhea.