Sports physical (pediatrics) Quiz: Ace Your Exams
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A 14-year-old girl presents to the primary care office with her parent for a sports physical. She recently recovered from stress fractures of her 4th and 5th metatarsals. She has no residual symptoms and follow-up x-ray demonstrated complete resolution. Dual-energy X-ray absorptiometry (DEXA scan) was done after the fractures and her Z-score was -2.0. The patient participates in gymnastics 5-6 days per week. She has never had a concussion and does not experience exertional symptoms with exercise. There is no family history of sudden cardiac death. Temperature is 37.0°C (98.6°F), respiratory rate is 18/min, and blood pressure is 116/70 mmHg. Height is 5 ft 1 inch (154.9 cm), weight is 83 lbs (37.6 kg), body mass index is 15.7 kg/m2 (4th percentile for her age). On examination, the patient is alert and conversant. Cardiovascular examination reveals no murmurs, gallops, or bruits. Pulmonary exam is within normal limits. The feet are non-tender bilaterally with full range of motion of all joints. Neurologic examination is within normal limits. Which of the following additional clinical findings is most likely to be present?
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