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13 Cards in this Set

  • Front
  • Back
John is a 17-year-old presenting today for a pre-participation physical exam. During the interview, he reports a low-grade fever, malaise, and headache for one week. In the past few days, his fever has gotten worse and he complains of a sore throat. He denies cough or chest pain. On physical examination, he is found to have a temperature of 101.3° F, and cervical lymphadenopathy and oropharyngeal erythema with exudate are noted. His participation would be most likely affected by which of the following tests?

EBV serologies

When to do CXR

evidence of lower respiratory tract signs or symptoms

When to do EBV serologies?

  • patient's symptoms suggestive of infectious mononucleosis
  • low grade fever and malaise
  • cervical lymphadenopathy
  • pharyngeal exudate
  • if testing positive, restrict from strenous activity or contact sports
  • risk of splenic rupture

When to do antigen test?

  • for streptococcal pharyngitis
  • after 24 hours of antimicrobials patient with strep pharyngitis no longer contagious
A 17-year-old boy presents for a sports pre-participation physical. He reports that he occasionally gets short of breath and feels light-headed with exercise, and sometimes he experiences chest pain as well. He lost consciousness once last season during a playoff basketball game, but attributed it to feeling sick at the time. His grandfather died suddenly at age 35 of unknown etiology. Which of the following is the most likely diagnosis?

Prolonged QT syndrome

Hypglocemia features

  • diaphoresis
  • anxiety
  • trumlousness
  • feeling of hunger

Congenital heart block features

diagnosed early in life



Postural hypotension features


  • Dizziness
  • visual changes
  • triggered by volume depletion, skipping meals

Prolonged QT syndrome

  • syncopal episodes in late childhood or adolescence
  • elongated QT intervals on ECG
  • family history of sudden cardiac death

VSD features

Eisenmeiger syndrome: pulmonary hypertension, exercise intolerance, eventual heart failure

A 16-year-old male presents to your office requesting clearance to play football. You begin by taking his medical history. He says that he feels very well, but admits that he recently experienced one episode of syncope that occurred when he trained really hard for football tryouts with his friends. He denies any shortness of breath, or chest pain currently. Family history is significant for an uncle who died of heat stroke at the age of 30 while playing basketball. Physical examination reveals no abnormalities. What is the next best step in management?

ECG and referral to cardiology!


Due to combination of syncope with exertion and family history of young death




Concerning for hypertrophic cardiomyopathy



A 16-year-old previously healthy male comes to the Pediatrics Urgent Care Clinic having “almost fainted” at soccer practice. He says that he had not eaten much earlier in the day and it was very hot and muggy outside. He felt light-headed and sick to his stomach. He denies losing consciousness and did not fall to the ground. He denies any chest pain. When you examine him, his eyes are sunken and he is tachycardic. What would be your next step in his management?

Give fluids and recheck his vital signs

Claire is a 16-year-old female who presents for birth control management. Her review of symptoms is unremarkable except for chest pain. When you ask her more questions, she reveals the pains are intermittent, on and off for the past couple months. It is not associated with exertion, sharp, and well localized at the left sternal border. It is very brief, lasting only a few seconds, during which she says she sometimes notices it gets worse when she breathes in. She denies recent URI or viral illness. The family history is negative for early cardiac disease. Her vital signs and physical exam are normal. Which is the next best step in management?

Reassurance: likely pericordial catch syndrome. No further workup