5 Flashcards
Signs of hypothyroidism in adolescent
Cold skin
Slowness
Fatigue
Preferring hot weather to cold
Doing poorly at school
Coarse hair
Infectious mononucleosis aka mono
Symptoms
Labs
An infection of lymphocytes (a white blood cell type) caused by the Epstein-Barr virus.
Typical signs and symptoms include extreme fatigue, pharyngitis, and lymphadenopathy (especially posterior cervical), low grade fever, splenomegaly
Heterophil antibody (monospot)test
Ebv specific ab
Mild Thrombocytopenia and greater than 10% atypical t lymphocytes
Menses in adolescence
adolescent women, menses are often light and irregular (especially in the first two years), causing more cramping and discomfort. They normally do not produce clots.
Need to know about frequency of periods, duration of bleeding and whether the last menstrual period was normal
Adolescent depression symptoms
Feels down and doesn’t want to do his or her normal activities
Feels sad and often cries over small things
Doesn’t want to participate in friends’ activities
Thinks about suicide
Feels grouchy and flat all the time
Early morning waking; difficulty falling asleep at night - don’t have this compared to adults
Have to distinguish between regular mood swings and adjustment reactions
Bulimia
No weight loss usually, tooth decay from stomach acid, finger trauma from self induced vomiting, swelling of parotid glands or other salivary glands
Anorexia
4 things
Weight loss or failure to gain
amenorrhea in females
next finding is bradycardia - While mostly asymptomatic, the bradycardia may lead to decreased cardiac output severe enough to lead to postural hypotension. (Bradycardia is due to overactive parasympathetic system trying to conserve energy)
These children must be hospitalized at this point for intensive treatment to prevent further progression and for nutritional stabilization.
If illness progresses, can get electrolyte abnormalities- calcium and magnesium def can lead to neurological issues, increased reflex tone and cardiac function issues
Many times hide their appearance in baggy clothes
Sexual maturation/puberty
Girls 5
Boys 6
Girls start puberty between 8 and 13 years of age
Breast buds appear (age 10-11 years), then, Pubic hair appears (age 10-11 years) then, Growth spurt (age 12 years) then,
Periods begin/menarche (age 12-13 years) then, Attainment of adult height (age 15 years)
Boys start puberty between 10 and 15 years of age
Growth of testicles ( age 12 years) then,
Pubic hair appears (age 12 years) then,
Growth of penis, scrotum (age 13-14 years) then, First ejaculations (age 13-14 years) then, Growth spurt (age 14 years) then,
Attainment of adult height (age 17 years)
Von willebrand's disease (vWD) Epidemiology Symptoms Classification Dx Treatment
Epidemiology and Inheritance Pattern vWD is the most common hereditary bleeding disorder. Occurs in approximately 1% of the population. For most families, it is transferred to children via autosomal dominant inheritance with variable penetrance (Type 1 and all Type 2 subcategories). The much less common Type 3 is inherited as autosomal recessive. Symptoms Ecchymoses (small hematomas in areas of trauma) Epistaxis Menorrhagia (why vWD is diagnosed more often in women than men) Bleeding post-tonsillectomy and dental extractions Gingival bleeds In the absence of major trauma, bruising in non-exposed areas (buttocks, back, trunk) needs to be thought of as abnormal. (Remember that child abuse can also be the cause of such bruising.) Classification Type I vWD is the most common type (70%) and the mildest. The bleeding generally is not life- threatening. Diagnosis A careful clinical history is often the most sensitive indicator of the disease. The laboratory diagnosis of vWD can be challenging: Many textbooks state that a prolonged platelet function or bleeding time and mild prolongation of the aPTT point to the diagnosis of vWD. However, the aPTT may be normal and the patient will still have vWD. To confirm vWD, check the von Willebrand's factor antigen and/or platelet function analysis and factor VIII levels.
Treatment for most of the bleeding problems most often consists of intranasal or intravenous desmopressin. It causes the release of vwf from endothelial cells
Sometimes human plasma-derived, virally inactivated von Willibrand’s factor concentrate may be administered.
For menorrhagia, combination contraceptive pills, or levonorgestrel intrauterine device would be the treatment of choice.
Differential dx for fatigue in adolescent female
Anemia
Anemia should be a consideration in an adolescent female. This can be caused by:
A bleeding disorder (may result in heavy periods and significant fatigue) Iron deficiency (typically not as much fatigue associated, as a slow decline allows the body to compensate, such as by increasing blood volume; eventually the patient will be symptomatic, but it may be a while)
As long as the anemia is not associated with neutropenia or thrombocytopenia, the patient’s review of systems will also be negative.
A family history of anemia supports this diagnosis.
Should anemia be diagnosed without a bleeding disorder, further evaluation is necessary to delineate the exact cause.
Bleeding disorder
A bleeding disorder leading to anemia is a more specific diagnosis than just anemia.
Fatigue is a common problem with bleeding disorders. Because of the much more rapid loss of hemoglobin, fatigue is more likely to happen with a bleeding disorder than chronic anemia.
Bleeding disorders commonly cause menorrhagia. As many as 1 in 5 women with heavy prolonged periods have a bleeding disorder.
A patient with a bleeding disorder would have a negative ROS unless there is severe systemic illness leading to disseminated intravascular coagulation (DIC).
Bleeding disorders are confined to disorders of platelets and clotting factors.
Hypothyroidism
Thyroid disorders commonly cause menstrual abnormalities.
Hypothyroid is associated with menorrhagia and shorter menstrual cycles. Other common symptoms of thypothyroidism include constipation, weight gain, and decreased appetite.
Depression
Fatigue may be a symptom of depression
Substance abuse
Declining school performance may be an indicator
Treatment of eating d/o
Finding community-based therapists and nutritionists skilled with working with adolescent and their families or an eating disorder center or other facility skilled in management is essential to prevent death and to begin the difficult path toward correction of the altered body images.
Remember that it is NOT just girls who can be afflicted with anorexia; approximately 25% of cases happen in boys.
Tanner stages in females - 5
A. Tanner Stage I breast development consists of no glandular tissue and is prepubertal. Tanner Stage I consists of no pubic hair at all. This is usually around age 10 or younger.
B. Tanner Stage II breast development occurs when breast buds form and the areola begins to widen. A small amount of long, downy hair with slight pigmentation appears on the labia majora. This patient’s elevated breast buds and pubic hair distribution puts her beyond Tanner Stage II.
C. The patient in the vignette is at Tanner Stage III of development. Her breast buds are elevated but do not have the secondary mound characteristic of Tanner Stage IV. Her pubic hair distribution extends more laterally than Stage II but is not adult-like in hair quality and does not extend onto the mons pubis.
D. In Tanner Stage IV, breasts are increased in size and elevation and the areola and papilla form a secondary mound that projects from the contour of the rest of the breast, and the pubic hair extends across the mons pubis and spares the medial thighs.
E. In Tanner Stage V, breasts reach their adult size and the areola returns to the contour of the surrounding breast while the central papilla remains projecting and the pubic hair extends to the medial surface of the thighs.
