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Adolescent > Adolescenct Medicine > Flashcards

Adolescenct Medicine Flashcards

1
Q

3 areas COGNITIVE development

A
  1. Reasoning skills (hypothetical and logical consequences)
  2. Abstract thinking (ex: love, spirituality)
  3. Think about thinking (feelings, how viewed by others)
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2
Q

3 major tasks/ PSYCHOSOCIAL development

A
  1. Autonomy (independent of parents)
  2. Identity (self worth, strengths)
  3. Ability of future orientation/values (career, moral, religious, sexual)
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3
Q

Early adolescence

A

12-14

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4
Q

Middle adolescence

A

15-17

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5
Q

late adolescence

A

18-21

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6
Q

Separation from family

A
  • separation and some rebellion is healthy step in development
  • peer group imp step in separation from family
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7
Q

Early adolescent peer group

A

12-14yo; same sex, how do I appear to friends, want to fit in, frequently change hair/clothes to fit in

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8
Q

Middle adolescent peer group

A

15-17yo; mixed sex, importance of finding a mate

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9
Q

Late adolescent peer group

A

18-21yo; move away from peer group and into relationships

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10
Q

Teens who do not identify with any peer groups

A

“loners’; significant psychological difficulties during adolescence

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11
Q

Early maturing boys

A

-seen as older/more responsible
-better at sports
-more popular
8if happens much earlier- may develop hostility and distress symptoms

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12
Q

Early pubertal maturing girls

A

-higher risk of: conduct problems, depression, early substance use, poor body image, pregnancy, early sexual experimentation

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13
Q

Question: Adolescent girl or boy with weight issue

A

“ask her what he/she thinks about her weight”

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14
Q

leading cause morbidity and mortality in 16-20yo

A

MVA

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15
Q

2 major cause death in 15-19yo

A

homicide, suicide

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16
Q

MVA risks increased by

A
  • inexperience

- risk taking behavior (speed, no seatbelt, drug/alcohol, texting, distractions..)

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17
Q

Do teens perceive risk?

A

Yes.

  • but this does not keep them from partaking in risk-taking behavior.
  • from it they seem to gain emotional satisfaction
  • concrete thinking adolescent (12-14yo) more concerned about how looks doing it than the risk involved–lack ability to link cause and effect
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18
Q

concrete thinking adolescent

A

12-14yo

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19
Q

Highest fatality rate of any mental health disorder

A

Anorexia Nervosa

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20
Q

Hallmark of Anorexia Nervosa

A

inability or refusal to maintain a healthy body weight

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21
Q

Anorexia Nervosa diagnosis

A

Four criteria must be met:

  1. Distorted body perception
  2. Weight 15% below expected
  3. Intense fear of gaining weight and restriction of energy intake
  4. Absence of 3 consecutive menstrual cycles
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22
Q

Question: several signs and symptoms consistent with eating disorder, which is MOST imp in making dx

A
  • *“patient THINKS they are fat despite weight being normal”;
  • Don’t be fooled by other non-specific choices such as excessive exercise, depression, dieting, diuretics…
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23
Q

Indications for hospital admission with Anorexia

A
  • weight <75% ideal body weight
  • continued wt loss despite intensive outpt management
  • acute wt decline and refusal of food
  • hypothermia
  • hypotension
  • bradycardia
  • orthostatic changes in BP or pulse
  • electrolyte abnormalities
  • arrhythmia
  • suicidality
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24
Q

AN vs Crohsn’s vs hypothyroidism vs depression vs collagen vascular disease

A

use lab findings and info in the history

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25
Q

Bulemia Nervosa features

A

Binge eating coupled with INDUCED vomiting

[binge eating = consumption of amount of food >most ppl eat in one sitting]

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26
Q

Bulemia Nervosa physiologic and lab findings

A

may be a result of vomiting:

  • salivary gland enlargement
  • dental enamel erosion
  • bruises or caluses over knuckles from forced gagging
  • low potassium
  • low chloride
  • metabolic alkalosis
27
Q

Indications for hospital admission with Bulimia

A
  • failure of outpt tx
  • dehydration
  • EKG abnormality
  • Mallory Weiss tears
  • suicidal ideation
28
Q

Bulimia vs Achalasia

A

key information: INVOLUNTARY vomiting soon after ingested

29
Q

When is parental consent NOT needed

A
  • life threatening emergencies
  • sexual assault services
  • medical care during pregnancy/family planning
  • treatment for STD; HIV testing
  • treatment for substance abuse
  • *Parental consent is needed for all other medical/surgical procedures, including blood donation
  • *Still need informed consent (from minor)
30
Q

Regarding HEADS, when can confidentiality be broken

A

patient is a danger to self or others

31
Q

Which patients do not need parental consent to receive treatment?

A

emancipated minors
[a person under legal age who is no longer under their parent’s control and regulation and who is managing their own financial affairs

32
Q

SMR1 Male

A

Prepubertal:

  • absent pubic hair
  • childlike phallus size
  • testicular size <2.5ml
33
Q

SMR2 Male

A

Beginning of puberty

  • fine pubic hair
  • childlike phallus size (no change)
  • increased testicular size and volume
  • scrotum more textured
34
Q

SMR3 Male

A
  • coarse, curly, pigmented pubic hair
  • increased phallus size
  • increased testicular size
35
Q

SMR4 Male

A
  • denser and curled, but less abundant than adult pubic hair

- closer to adult male phallus size

36
Q

SMR5 Male

A
  • pubic hair extends to the inner thigh, adult-like
  • adult size phallus
  • adult testicular size
37
Q

SMR1 Female

A

Prepubertal:

  • absent pubic hair
  • no glandular breast tissue
38
Q

SMR2 Female

A

Beginning of puberty:

  • pubic hair along the labia
  • small breast buds with glandular tissue
39
Q

SMR3 Female

A
  • coarse, curly, pigmented pubic hair

- breast tissue extends beyond the areola

40
Q

SMR4 Female

A
  • denser and curled, but less abundant than adult pubic hair

- enlarged areola and papilla form a secondary mound

41
Q

SMR5 Female

A
  • pubic hair extends to the inner thigh, adult-like

- no longer a separate projection of the areola from the remainder of the breast

42
Q

Onset of menses

A
  • average: 2 years after thelarche (~ 12-13yo)

- SMR stage 3 or 4 expected

43
Q

Female peak height velocity

A

Before menarche

44
Q

First few cycles of menses

A
  • last 2-3 days

- may occur only every 2-3 months

45
Q

Abnormal menses

A
  • persists >10 days

- requires workup

46
Q

Physiologic leukorrhea

A

= white, odorless, mucoid discharge that precedes menarche by 3-6months and can continue for several years
- no intervention needed

47
Q

infrequent menstrual periods

A
  • if during first 2 years post menarche- do NOT generally require workup
  • just reassurance and follow up
48
Q

height after menarche

A

girls are within 4cm/2inches of adult height

49
Q

Question: 11yo girl SMR 2 with bloody vaginal discharge. What is etiology

A

DONT BE IMMEDIATELY FOOLED TO THINK MENSES/MENARCHE AND SAY “REASSURANCE”.

  • onset menses generally SMR 3-4
  • so consider another option such as vaginal foreign body, common occurrence at this age (ie small piece toilet paper -> local irritation-> mild bleeding)
50
Q

Most likely reason for not using contraception

A

desire to become pregnant

51
Q

When do 50% of all pregnancies occur

A

within 6 months of the first time experiencing intercourse

52
Q

When do 20% of all pregnancies occur

A

during the first month of the first time experiencing intercourse

53
Q

Advantages of oral contraception

A
  • contraception
  • decrease risk for ovarian cysts
  • decrease risk of endometrial + ovarian +colorectal cancer
  • decrease risk of osteoporosis
  • help reduce free testosterone levels and decrease hirsutism
  • reduce risk of salpingitis and ectopic pregnancy
  • some protection against acne and iron deficiency anemia
54
Q

Indications for oral contraceptives

A
  • dysmenorrhea
  • dysfunctional uterine bleeding
  • PCOS
  • irregular menses
  • menorrhagia
55
Q

Absolute contraindications to oral contraceptives

A
  • migraine HA with focal aura or neurologic changes
  • pregnancy
  • uncontrolled HTN
  • liver disease
  • breast cancer
  • cerebrovascular disease
  • history of DVT
  • history of pulmonary embolism
  • known factor V leiden mutation or other thrombophilic condition
56
Q

Other contraceptives

A
  • IUD
  • subcutaneous slow release progesterone
  • intravaginal rings
  • *considered very effective as they do not require daily compliance
57
Q

IUD

A
  • newer ones safer than in the past: no longer increased risk of PID or infertility
  • some groups advocate as the preferred method of contraception–**for all women regardless of age and parity
58
Q

contraception vs preg/delivery

A

all contraceptive methods are associated with fewer health risks than pregnancy and delivery

59
Q

Screening pap smear age

A

21 yo

-regardless of age of first intercourse

60
Q

Primary Amenorrhea Definition

A

= lack of menses by age 15, or 3 years following breast development

61
Q

DDX to consider in primary amenorrhea

A
  1. PREGNANCY (despite denying ever having sex!)- a girl can become pregnant before her first menstrual period, and therefore would present and be described as primary amenorrhea
  2. Androgen Insensitivity Syndrome
  3. Turner Syndrome
62
Q

Androgen Insensitivity Syndrome/ Testicular Feminization

A
  • normal breast development

- NO pubic hair, NO menstruation

63
Q

Turner Syndrome

A
  • amenorrhea
  • breast budding
  • no pubic hair
  • short stature
  • low hairline
  • low set ears
  • heart murmur
  • HTN
  • lymphedema of hands/feet
  • *karyotype study would be indicated

Adolescent (1 decks)

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