Adolescent

Question 1

The adolescent period is considered by most to be what age range?

Answer 1

11-19 years of age

Question 2

What is the main cause of death in adolescents?

Answer 2

Unintentional injuries (MVA, discharge of firearm, drowning, or poisoning)

Question 3

What is the major cause of hospitalizations among adolescents?

Answer 3

Pregnancy and related conditions

Question 4

What is the main age for puberty in Caucasian girls? African American girls?

Answer 4

10 years, 8-9 years

Question 5

True or false? Boys have their pubescent growth spurt before girls.

Answer 5

False.

Question 6

What is the average age of peak height velocity in boys? in girls?

Answer 6

13.5 years; 11.5 years

Question 7

Define an emancipated minor.

Answer 7

• Moved outside of the home and financially independent

- Married or members of the military

Question 8

What are the medical exceptions for notifying parents against an adolescent’s wishes?

Answer 8

Physical or sexual abuse, nonadherence with treatment of a chronic disease, threat of harm to self or others

Question 9

How often should adolescents see a medical professional for health supervision and guidance?

Answer 9

Annually; at minimum at each stage (early, middle, late)

Question 10

Starting at what age should adolescents be seen alone for at least part of the visit?

Answer 10

12-14 years old

Question 11

What parts of the physical examination are important to focus on in an adolescent boy or girl?

Answer 11

Questions about peer and family relationships, depression, sexual relationships, substance use, and eating disorders.

Question 12

How many MMR and Varicella inoculations should an adolescent have?

Answer 12

2

Question 13

How common is AN in girls? What is the ratio of girls to boys diagnosed with an eating disorder?

Answer 13

Lifetime Prevalence 0.5%; 10:1

Question 14

What are the DSM-5 Diagnostic criteria for AN?

Answer 14

• Significantly low body weight
• intense fear of gaining weight or of becoming “fat”
• Disturbance in the way in which one’s body weight or shape is experienced

Question 15

In patients with AN, and ECG changes suggest increased risk for ventricular arrhythmia?

Answer 15

Prolonged QTc intervals or ST-segment depression on exercise stress testing

Question 16

Under what conditions should you hospitalize an adolescent with AN?

Answer 16

• Marked cachexia
• Refusal to eat; binging/purging; dehydration
• ECG changes
• Acute medical complications of malnutrition
• Hypotension
• Orthostatic changes
• Hypothermia
• Severe electrolyte disturbances
• Seizures
• Comorbidity that prevents adequate outpatient care
• SI or other psychiatric emergency

Question 17

True or false? Patients with BN are commonly underweight.

Answer 17

False.

Question 18

What type of breast mass is the most common in an adolescent girl?

Answer 18

Fibroadenoma

Question 19

When should you further investigate a breast mass?

Answer 19

Persistent, larger, or suspicious lesions

Question 20

What organism is the most common cause of acute mastitis?

Answer 20

S. aureus

Question 21

What is the most common cause of secondary amenorrhea?

Answer 21

Pregnancy

Question 22

Amenorrhea and anosmia should make you consider what syndrome?

Answer 22

Kallman Syndrome

Question 23

List 2 physical signs of androgen excess in patients with amenorrhea.

Answer 23

Acne, hirsutism

Question 24

What is the most common cause of dysmenorrhea?

Answer 24

Prostaglandin production from secretory endometrium before menses, which causes vasoconstriction and muscular contractions.

Question 25

A girl presents with her 1st menses and hemorrhages to a hemoglobin of 9%. What is the likely etiology for her excessive blood loss?

Answer 25

von Willebrand disease

Question 26

What type of cancer is seen in daughters of mothers who took DES?

Answer 26

Clear cell adenocarcinoma

Question 27

True or False? Gynecomastia in boys is always symmetric.

Answer 27

False, typically asymmetric

Question 28

Characterize hydroceles, spermatoceles, and varicoceles.

Answer 28

Hydroceles: soft, fluctuant, non-tender, transilluminates Spermatoceles: Smooth cystic mobile nodule above and posterior to the testes Varicoceles: p/w sensation of pressure, heaviness, or engorgements; "bag of worms"

Question 29

True or False? Torsion of the spermatic cord is a surgical emergency. Describe expected clinical findings.

Answer 29

True

Question 30

Describe typical clinical findings of epididymitis in an adolescent male.

Answer 30

swollen and tender, cremasteric reflex is present, pain is relieved with elevation of testis

Question 31

What is the 1st line birth control method recommend for teens by the AAP?

Answer 31

LARC (long-acting reversible contraception)

Question 32

Which form of contraception, besides abstinence, is the most effective method for preventing STIs?

Answer 32

Males - condoms | Females - LARC

Question 33

Name the conditions in which estrogen-containing OCPs are contraindicated.

Answer 33

``` Current breast cancer Severe cirrhosis, malignant liver tumor, hepatocellular adenoma Acute DVT Known thrombogenic mutations Major surgery with prolonged immobilization HTN Ischemic heart disease Complicated valular heart disease Peripartum cardiomyopathy Postpartum <21 days Breastfeeding <12 days postpartum SLE with antiphospholipid antibody Migraine with aura ```

Question 34

You are told that a 4-yo child is masturbating in the bathtub. What is the appropriate parental approach for this behavior?

Answer 34

Advise parents to counsel children to keep this behavior private. With religious prohibition, advise parents to provide simple teaching and to redirect behavior, avoid negative reactions or punishments

Question 35

A 5-yo girl shows her mother how her 2 dolls "Barb" and "Kyle" kiss each other. The mother is upset that the child shows barb kissing Kyle's genital area. Is this normal behavior for a 5yo?

Answer 35

No.

Question 36

Define gender nonconformity.

Answer 36

Variation from the cultural norms of gender behavior or expression.

Question 37

True or False? Most tomboys have gender nonconformity.

Answer 37

False

Question 38

True or False? LGBTQ youth make up large percentage of youth who are homeless.

Answer 38

True; 25-40%

Question 39

How common is sex among adolescents?

Answer 39

***

Question 40

What are the "reportable" STIs in every state in the US?

Answer 40

***

Question 41

What screening lab tests should be done on a pregnant adolescent?

Answer 41

***

Question 42

For which viral infection is prophylactic cesarean delivery indicated? Under what conditions?

Answer 42

*

Question 43

Describe acute retroviral syndrome.

Answer 43

*

Question 44

Differentiate the genital lesions of HSV, sphilis, and chancroid.

Answer 44

*

Question 45

What defines a positive Tzanck prep?

Answer 45

*