Adolescence And Puberty

Question 1

Brain development in adolescence

Answer 1

Between 12-24 yrs the brain significantly prunes the neural connections in the frontal lobe

During adolescence this part of the brain is poor so judgement, impulse control and decision making is poor
- the frontal and prefrontal lobes are always last to mature

Cortical gray matter volume peaks in preadolescence (age 9-10)

Cerebral white matter volume increases until mid-late adolescence (age 12-16)

Question 2

What causes puberty hormone wise

Answer 2

Maturation fo the GnRH pulse generator in the anterior pituitary releasing LH and FSH

above releasesAndrogens however mainly DHEAS is responsible for secondary characteristics
- starts to work at 6 yrs and this when faint genital hair and underarm odor starts to develop

Boys = puberty at 10-17

Females = 7-14

Question 3

Tanner stages

Answer 3

Show the progression of secondary sex characteristics by a “sexual maturity rating (SMR) scale”
- ranges from 1 (preadolescence) -> 5 (sexual maturity)

Scales 1-2

• approximately 10-13
• shows secondary sex characteristics in females and start of growth spurt
• shows only the beginning of genital growth in males

Scales 3-4

• approximately 14-17yr
• shows peak growth velocity and the beginning of menarche (sometimes sooner) in females
• shows growth spurt and secondary sexual characteristics in males develop
• also acne in both sexes at this stage

Scale 5

• approximately 18yrs
• shows physical maturation in everything especially lean muscle mass in males

Question 4

What is the hallmark of tanner stage/ SMR 2 in males?

Answer 4

Testicular enlargement

Question 5

What stage does penile growth begin in males?

Answer 5

tanner/SMR 3

Question 6

How does the normal growth spurt occur?

Answer 6

Starts distally and works inwards to the trunk and chest

Question 7

What are examples of somatic growth changes

Answer 7

Cardiovascular = increased heart size, higher BP and increased hematocrit

Lung = greater aerobic capacity and vital capacity

Androgenic = sebaceous and apocrine gland development (acne and body odor)

Voice = enlargement of the larynx, pharynx and lungs leads to vocal instability

Question 8

What is the recommended time of sleep a night a teen should get

Answer 8

9-10 hrs

Question 9

What si the hypothesis behind increased risk taking in puberty teens?

Answer 9

They are highly sensitive to the effects fo dopamine

Question 10

Does cognitive or psychosocial development more correlate with puberty status?

Answer 10

Psychosocial
- this is also more greatly influenced by environmental and cultural influences

the hallmark for psychosocial development in adolescents = separation from parents

Adolescents tend to cultivate in same sex groups

Female peer groups = more relationship oriented
Male peer groups = more interest or activity oriented

Question 11

Which sex tends to experience more negative self-image during puberty?

Answer 11

Females (especially early maturing)

Question 12

What are the most red-flag psychosocial symptoms for mental illness in a adolescent

Answer 12

Extreme withdrawal from all activities or antagonizing others

Also escalation of risk-taking behaviors

Question 13

What are the most common types of mental illness in adolescence

Answer 13

Major depression

Schizophrenia

Bipolar disorder

Social anxiety disorder

Panic disorder

Eating disorders

Addictions

1/5 teens will suffer from a mental illness

**suicide is the 2nd leading cause of death in this age group)

Question 14

Whata re questions to ask to a teen potentially dealing with mental illnesses

Answer 14

Do you often worry or feel nervous

Do you often feel sad or upset most days

Are you concerned about how to act when you get angry

Have you ever done reckless things that could harm you or others

Do you think your mind is out of control or being controlled

Question 15

CRAFFT screening substance criteria

Answer 15

A score (answer of yes) to 2 or more indicates a substance abuse problem

1) have you ever ridden in a CAR driven by someone who was high or drunk?
2) do you ever use alcohol or drugs to RELAX to feel better about yourself or fit in?
3) do you ever use alcohol or drugs while you are ALONE?
4) do you ever FORGET things you did while using alcohol or drugs?
5) do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6) Have you ever gotten into TROUBLE while you were using alcohol or drugs

Question 16

HEADSS interview outline

Answer 16

Is often used to organize a adolescent interview. Starts with fairly neutral topics and progress to more sensative issues

Home 
Education and Employment if applicable 
Activities 
Drugs 
Sexuality 
Suicide and mental health 

• *make sure to maintain trust in the doctor-patient relationship and you MUST ask the questions. There is no correlation with asking and something and the patient being more likely to do a negative action**
• also try to find at least 1 thing to praise the teen on

Question 17

Klinefelter syndrome (47-XXY)

Answer 17

Is the most common single cause of hypogonadism and infertility in males (1:500)

Males are tall, thin with a eunuchoid habitus (underweight and skinny)

• the testicles are always 5 mL or lower and the phallus is undersized most of the time also
• near 100% infertility
• also sometimes produce breast hair and often have no/little facial hair
• **often have clinodactyly of the 5th finger (varius deformity of the 5th digit) and taurodontism (enlargement of the pulp of teeth with thinning of the tooth surface

Always shows a increased risk in older maternal fathers age

Mean IQ = 85-90
- verbal IQ is usually higher than performance IQ though

25-50% have a mild intention tremor also

Psychosocial issues

• behavior problems, immaturity , shyness, poor judgement, boastful and assertive personalities
• also increase risks for autism and schizotypal personality

Mortality is also 50% increased on average since they are predisposed to infections and nervous system issues

Treatment = testosterone therapy

Question 18

What cancer is much higher in Klinefelter syndrome males compared to normal males?

Answer 18

Breast cancer

- 20x more likely and affects 1:5000 cases

Question 19

Fragile X syndrome

Answer 19

X-linked disorder which is the most common inherited cause of mental retardation and Autism

• males ALWAYS pass onto females
• women have 50% chance

Rare mutation in the FMR1 gene which causes a CGG nucleotide repeat which is unstable

• full mutation = 1:3600 male and 1:6000 females
• permutation = 1:250 males and 1: 100 females (you dont have it but your kids will)

Clinical symptoms in males (females have a super large variety of symptoms)

• large low set “seashell ears”
• low IQ and autism (IQ = 40 usually)
• prominent forehead with long chin and jaw
• macroorchidism in puberty

Early diagnosis is key to try and live a normal life. Also can discuss other reproductive options if needed
- treatment = supportive and education intervention. Also pharmacotherapy if the psychiatric and behavioral manifestations are too much