Adolescent

Question 1

Tanner stage one

Answer 1

Pre-puberty

Question 2

Tanner stage two

Answer 2

Boys –testicles in large, scrotal skin right ends with change in texture, sparse growth in long slightly pigmented pubic hair at base of penis

Girls- breast buds and nipples elevated, lightly pigmented pubic hair along labia majora

Question 3

Tanner stage three

Answer 3

Boys: Increase in penile length but minimal change in Web, commonly called the pencil penis stage. Further scrotal enlargement, pubic hair darker, courser, covers greater area.

Onset of growth spurt for both!

Girls: Breast mound enlargement, darker, coarser, curlier pubic hair on Mons, labia majora.

Question 4

Tanner stage four

Answer 4

Males: Increase in penile length and width with development of glands. Further darkening of scrotal skin, adult tight pubic hair with no spread to medial surface of the thighs

Females: areola and papilla elevated to form a second mound above level rest of brass. Adult tight pubic hair with no spread to medial surface of thighs. Begin of menarche!

Question 5

Tanner stage five

Answer 5

Boys: full adult genitalia, adult type pubic hair with spread to medial surface of dies and possibly abdomen

Girls: recession of areola to mound of breast, extension of pubic hair to medial thigh.

Full adult stage

Question 6

Mild acne vulgaris

Answer 6

Large number of lesions but not a lot of infm

Treatment: topical retinoid alone often helpful, consider additional of topical benzyl peroxide, then topical antibiotic.

Question 7

Moderate acne vulgaris

Answer 7

Large number of lesions and a lot more inflammation

Treatment: once topicals have failed… Oral antibiotic with topical retinoid to start, once lesions have been controlled, can transition to topical anti-microbial with topical retinoid. Taper oral abx dose decode discontinuation.

Also consider COC or androgen reducing agents spirolactone.

Question 8

Severe acne vulgaris

Answer 8

Large number of cystic lesions.

Treatment: once oral antibiotics and topicals have failed oral isotretinoln (Accutane). LAST RESORT!
We are large, painful cyst and consider intralesional corticosteroid injection. Permanent intention of skin can result from injection.

Question 9

Medically emancipated conditions

Answer 9

Entitles adolescents to consent to care without parental consent.

Contraception, pregnancy, sexually transmitted infection, substance abuse, mental health.

Confidentiality should only be broken if provider believes the team is in a situation or condition that poses a significant danger to the teen or others

Question 10

AOM diagnosis

Answer 10

Moderate or severe bulging of TM OR new onset of ear discharge not related to otitis externa with pain.

Mild bulging of TM AND recent (less than or equal to 48 hours)
OR intense TM redness with pain

Question 11

Severe vs nonsevere AOM

Answer 11

Non-severe illness: mild otalgia for LESS than 48 hours or fever LESS than 39°C (102.2) in the past 24 hours

severe illness: moderate to severe otalgia
OR otalgia more than 48 hours
OR fever greater than or equal to 39°C (102.2)

Question 12

When is watchful watching appropriate for AOM

Answer 12

Only appropriate in children six months or older with non-severe illness with unilateral AOM.

Examples: unilateral AOM with...
Fever Less than 39
Pain less than 48
& older than 6 months 
Mild otalgia

Ensure close follow up with the ability to start antibiotics within 48 to 72 hours if child fails to improve or worsen

Question 13

Recommended abx treatment for AOM

Answer 13

Amoxicillin OR augmentin

With pcn allergy: cefdinir or cefuroxime or cefpodoxime or cephtriaxone

Abx treatment after 48 hours with failure or initial antibiotic treatment: augmentin or ceftriaxone or clindamyocin

Question 14

Precocious puberty

Answer 14

Onset of secondary sex characteristics by age 8 and girls and by age 9 and boys.