Adolescent Care Station

Question 1

After exploring the history of presenting complaint, how should you structure your adolescent care history?

Answer 1

HEEADSSS

Home and relationships
Education and employment
Eating
Activities and hobbies
Drugs, alcohol and tobacco
Sex and relationships
Self harm and depression
Safety and abuse

Question 2

What should you cover in ‘home and relationships’?

Answer 2

Can you describe your home life to me? Siblings? Own room?
Who do you feel you can turn to? Anyone you go to for advice or support?

Question 3

What should you cover in ‘education and employment’?

Answer 3

Are you currently at school? How do you find it? Get along with others? Friends? Any bullying?

Do you work? What is the work environment like?

Question 4

What should you cover in ‘eating’?

Answer 4

Can you describe what your diet is like to me?

Have you lost or gained any weight recently? Do you every worry about gaining weight?

Can you describe your body image to me?

Question 5

What should you cover in activities?

Answer 5

What do you do in your spare time?
Do you do anything to help you relax? Do you have have any hobbies? Do you get any exercise?

Question 6

What should you cover in drugs and alcohol?

Answer 6

Do you take any illicit drugs? Do you drink any alcohol?
Do you smoke or vape? Does anyone at home smoke or vape?
Does anyone in your social circle take drugs, drink alcohol or smoke? Do you ever feel pressured to join in?

Question 7

What should you cover in sex and relationships?

Answer 7

Are you currently in a romantic relationship? Are you sexually active? How many partners? Are you using contraception?

Question 8

What should you cover in ‘self harm and depression’?

Answer 8

How is your mood?
Do you ever feel bothered by low mood?
Have you ever thought of hurting yourself? Have you ever thought of taking your own life?

Question 9

What should you cover in ‘safety and abuse’?

Answer 9

Do you ever feel at risk from other people?
Do you feel safe at home/school?
Do you ever feel unsafe online?

Question 10

What do you need to cover in the history of presenting complaint if a parent has brought in their teenager with concerns that they are overweight?

Answer 10

Explore with the teenager:
how do you feel about your weight? Have you noticed a change in your weight recently? Is it something that you’re worried about?

Screen for eating disorders:
Can you talk me through what you normally eat in a day? Can you describe your body image to me?

Screen for hypothyroidism:
Have you noticed any changes in your skin/hair?
Any new neck lumps?
Do you ever feel particuarly bothered by the cold?
How are your energy levels? More tired?
Any changes in your bowel habit?

Screen for growth hormone deficiency:
Have you gone through puberty?
Have you had a growth spurt (height)?

Question 11

What can cause obesity in young people?

Answer 11

lifestyle
binge eating disorder
hypothyroidism
growth hormone deficiency
Prader Willi syndrome
Down’s syndrome

Question 12

What are the potential consequences of obesity in young people?

Answer 12

orthopaedic problems: SUFE, MSK pains
sleep apnoea
benign intracranial hypertension
long-term consequences: increased incidence of T2DM, hypertension and ischaemic heart disease

Question 13

What do you need to explore in the history of presenting complaint if a parent brings in their child saying that they are ‘tired all the time’ or ‘lazy’?

Answer 13

Explore with the child:
How have you been feeling at the moment? Do you feel more tired?

Screen for depression:
How is your mood at the moment?
SIGECAPS?

Anaemia:
Any light-headedness/dizziness?
Any chest pain/ palpitations?
Shortness of breath?

Hypothyroidism
Weight gain?
Skin/hair changes?
Cold intolerance?
Change in bowel habit?

Malignancy
New lumps/bumps? Weight loss?Nigth sweats?

Question 14

What should you explore in the presenting complaint if a parent brings their child in with suspected ADHD?

Answer 14

Ask the child what they think about what has been happening

I’d like to understand what prompted you to come in now - is this new for you? Has it recently started to cause problems?

Screen for sxs of inattention:
do you ever find it hard to concentrate on tasks? do you ever give up on tasks half way through? do you think you are forgetful? how often do you misplace possessions?

Screen for hyperactivity and impulsivity:
do you ever feel restless? do you find it hard to sit still? do you ever find it hard to wait your turn / answer questions before the person has finished asking?

Question 15

Give some key risk factors for ADHD. How could you screen for these in a history?

Answer 15

Prematurity
Low birth weight
Prenatal smoking
Maternal depression
Low parental education

Any problems during pregnancy? Did Mum smoke during pregnancy? Delivered at term?

Question 16

Give some differential diagnoses for ADHD

Answer 16

anxiety / depression
autism
learning disability
excessive caffiene intake / stimulant drug use
oppositional defiant disorder
conduct disorder
epilepsy

Question 17

What management options can you suggest for a teenager with ADHD?

Answer 17

conservative management:
* regular exercise
* diet: avoid foods with additives / caffeine or anything that seems to trigger them
* good sleep hygiene
* support at school e.g. extra time
* use to do lists and set reminders

medical management:
can offer methylphenidate

can offer parental support groups
ADHD focused parenting

Question 18

How would you explore the risks of untreated celiac disease to a patient?

Answer 18

when you eat gluten, it triggers your immune system to attack the lining of your bowels

this damages them, making it harder for them to do their job of absorbing nutrients from your food

this puts you at risk of being malnourished and your bones getting weaker and breaking more easily

if too much damage builds up you are at risk of developing bowel cancer

Question 19

What can you say if parent and teenager start arguing / talking over each other?

Answer 19

I can see emotions are heightened and this is a difficult conversation for everyone involved

…but we are all here for (name of patient) and we all want the same thing which is to make sure (name) is okay

what I’d like us to do is to take a breather, and I’d like to ask (name) what they are feeling at the moment because it is my job to put my patient first

mum/dad, I really value your input and I want to address all of your concerns, so I will come back to you at the end