Pre-participation Exam

1. See Also
   1. Pre-participation History
   2. Pre-participation Special Circumstances
2. Exam: General
   1. Height
   2. Weight
   3. Body habitus
   4. Vital Signs
3. Exam: Eye
   1. Visual Acuity
      1. Blind in one eye OR
      2. Severe Myopia (Corrected worse than 20/50 in 1 eye)
   2. Protective eye wear (Glasses, contact lenses)
   3. Amblyopia
   4. Anisocoria
   5. Detached Retina
   6. Early Coronary Artery Disease changes
   7. Diabetic Retinopathy
4. Exam: Cardiovascular
   1. Examination points
      1. Blood Pressure
      2. Pulse
         1. Rate and rhythm
         2. Distal pulse quality and symmetry
      3. Cardiac auscultation
   2. Indications for Hypertension further evaluation
      1. Age <10 years old: Blood Pressure >130/75
      2. Age >10 years old: Blood Pressure >140/85
   3. Heart Murmurs
      1. Evaluate in 2 positions (e.g. Standing and squatting)
      2. Evaluate with Valsalva
      3. Indications for further evaluation
         1. Murmur grade 3 of 6 or louder
         2. Any Diastolic Murmur
         3. Murmur accentuated with Valsalva
            1. Suggests Hypertrophic Cardiomyopathy
      4. Further cardiac testing
         1. Electrocardiogram
         2. Stress EKG
         3. Echocardiogram
   4. Other findings requiring further evaluation
      1. Cyanosis
5. Exam: Pulmonary
   1. Diaphragm excursion
   2. Breath Sounds
   3. Asthma
   4. Bronchitis
6. Exam: Gastrointestinal
   1. Abdominal Masses
   2. Organomegaly
   3. Hepatosplenomegaly
   4. Kidney size
7. Exam: Dermatologic
   1. Acne Vulgaris
   2. Infectious rash (e.g. Herpes Simplex Virus)
   3. Atopic rash
   4. Suspicious nevi
   5. Surgical and traumatic Scars
8. Exam: Musculoskeletal
   1. Orthopedic screening: Brief Musculoskeletal Exam
   2. Back
      1. Scoliosis
      2. Kyphosis or Lordosis
   3. Knee and ankle (unstable)
   4. Shoulder (Recurrent dislocation)
   5. Assess elbow stability
   6. Painful Osgood Schlatter disease
   7. Marfan's Syndrome
9. Exam: Neurologic
   1. Gross coordination
   2. Gait abnormality
10. Exam: Genitourinary Male
    1. Testicles
       1. Single unpaired Testicle
       2. Undescended Testicle (Cryptorchidism)
       3. Testicular Masses
    2. Inguinal Hernia
    3. Tanner stage
       1. See Sexual Development in Boys
    4. Discuss Self-Testicle exam
       1. Testicular Cancer peak Incidence in age 18-35 years
11. Exam: Genitourinary Female
    1. No longer done routinely with Sports Physical now
    2. Schedule separate gynecologic exam if indicated
    3. Ask about Amenorrhea (Female Athlete Triad)
    4. Tanner Staging or Menstrual dating
       1. See Sexual Development in Girls