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CPS Statements > Adolescent Health > Flashcards

Adolescent Health Flashcards

1
Q

What is an e-cigarette?

A
  • battery attached to a chamber containing liquid and energy from the battery heats the liquid and converts it to vapour which is inhaled
  • liquids can be flavoured, can contain multiple chemicals including propylene glycol, glycerol and nicotine
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2
Q

What are the “benefits” of e-cigarettes?

A
  • do not stain teeth or fingers
  • no bad breath
  • absence of strong tobacco taste
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3
Q

What are some of the dangers of e-cigarettes?

A
  • labels do not necessarily match the amount of nicotine contained
  • can get a bolus of nicotine which has potential for acute cardiac events
  • exposure to fine particulates in the aerosol generated
  • batteries have exploded on occasion
  • the e-cigarettes may include various metals, ceramics and rubber
  • nicotine poisoning from e-liquids and discarded cartilages among young kids is increasing
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4
Q

Are e-cigarettes approved in Canada?

A

-no Health Canada has not approved e-cigarette product

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5
Q

What are some recommendations for regulations at the government levels regarding e-cigarettes?

A
  • maximum dose of nicotine in liquids should be strictly enforced
  • should package them with warnings about the harmful effects
  • package e-liquids in child-resistant packaging
  • band advertising e-cigarettes
  • should tax all e-liquids with nicotine the same way tobacco is taxed
  • sell only where tobacco is sold legally
  • ban e-cigarettes in public spaces and work
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6
Q

What is the definition of street involved youth?

A

-youth who is not necessarily homeless but is exposed to and experiencing the physical, mental and emotional and social risks of street culture

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7
Q

What are some of the reasons youth turn to a life on the street?

A
  • poverty
  • dysfunctional family life
  • violence
  • sexual and physical abuse
  • underlying mental illness
  • parental drug use
  • curiosity
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8
Q

What is the ‘street economy’?

A

-sex trade, selling drugs, panhandling

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9
Q

What are some individual barriers to street youth seeking health care?

A
  • lack of money, transportation and knowledge to access appropriate health care
  • issues with trusting adults
  • worries about confidentiality
  • fear of being reported to authorities
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10
Q

What are formal or systems-level barriers to street youth seeking health care?

A
  • need to present a health card
  • need to supply a permanent address
  • perceived need for adult’s consent/involvment
  • lack of knowledge regarding mature minor protocols
  • services poorly coordinated or difficult to access
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11
Q

Given the challenges of street youth seeking health care what should be involved in the first visit with them?

A
  • comprehensive check up
  • prompt treatment of STIs without lab confirmation
  • mental health screen
  • ask them about housing and food security
  • ask if they are able to follow through with follow up appointments or referrals
  • ask about ability to pay for medications
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12
Q

What are some health problems that street youth are particularly at risk for?

A
  • respiratory problems, especially TB
  • dental disease
  • lice, scabies
  • acne
  • eczema
  • MRSA
  • foot problems
  • malnutrition
  • injuries (from intoxication, burns, violence)
  • lower sense of self
  • not fully immunized (increased risk for Hep B, HPV)
  • STIs
  • HIV (screen for this at minimum at initial visit)
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13
Q

What mental health issues are street youth at increased risk for?

A
  • mood disorders
  • bipolar
  • conduct disorder
  • PTSD
  • attempted suicide
  • substance use
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14
Q

What is pathological gambling?

A

-impulse control disorder, characterized by persistent and recurrent maladaptive gambling behaviour that leads to significant deleterious legal, financial, physical and psychosocial consequences (not better accounted for by a manic episode)

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15
Q

What are some different forms of gambling?

A
  • lottery tickets
  • playing cards and bingo for money
  • getting scratch tickets as gifts
  • sports betting
  • online gambling
  • slot machines
  • there is legalized gambling and self-organized gambling (e.g. dice games, sports pools)
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16
Q

What are risk factors that put someone at increased risk for having a gambling problem?

A
  • depression
  • loss
  • abuse
  • impulsivity
  • antisocial traits
  • learning disabilities
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17
Q

What comorbid disorders are commonly seen with people with gambling-related problems?

A

-personality disorders
-alcohol abuse
-life-time drug use
mood disorders
-conduct disorders
-ADHD
-depression
-anxiety

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18
Q

What are some red flags that should make you screen for gambling problems?

A
  • parents express concern about their youth’s emotional health
  • academic performance seems to be suffering
  • sleep problems
  • money or possessions in the home go missing or there is criminal activity (e.g. theft)
  • known or suspected that adolescent is misusing substances
  • impaired relationships with family or friends
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19
Q

What are some important roles we can play as paediatricians with gambling?

A
  • screen for it
  • become familiar with resources for treatment
  • advocate for advertising to be regulated and controlled
  • advocate for this to be talked about in school curriculum
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20
Q

What is the difference between UVA and UVB light?

A
  • UVA responsible for the immediate pigment darkening on exposure
  • UVB is responsible for further darkening of the skin in the days following exposure
  • erythema and sunburn are acute reactions to excessive amounts of UVR
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21
Q

Who is at increased risk for cutaneous malignant melanoma?

A
  • light skin colour
  • freckles
  • skin moles
  • red or blond hair colour
  • easy to burn skin that tans poorly
  • first degree relative or personal history of melanoma
  • early life exposure to UVR
  • increased risk with increased # of years and hours of tanning
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22
Q

What are the scary stats associated with melanoma?

A
  • not the most common of skin cancers but is the deadliest
  • accounts for 75% of deaths from skin cancer
  • rates are increasing
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23
Q

How does the WHO classify tanning beds?

A

Class I physical carcinogens

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24
Q

What are some reasons youth say they use tanning beds?

A
  • improved appearance

- sense of well-being and feeling of relaxation

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25
Q

What is tanorexia?

A

becoming obsessed with or addicted to tanning and believing oneself to be unattractively pale even when quite tanned

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26
Q

What are some side effects of tanning beds?

A
  • sunburn
  • more serious burn
  • skin dryness
  • pruritis
  • nausea
  • photodrug reactions
  • infections
  • skin-aging
  • increased skin cancer risk
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27
Q

What are the regulations around about of UVR exposure and age for tanning beds?

A
  • no enforceable limits to amount of artificial UVR exposure
  • can tan at multiple places in the same day
  • majority of provinces do not have a age limit for who can tan (only NS and vancouver island)
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28
Q

What are things paediatricians should advocate for with regards to tanning beds?

A

-kids

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29
Q

True or False. Young people with a serious chronic condition or with a disability are at increased risk of being sexually, physically and emotionally abused.

A

True :(

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30
Q

What are some risk factors that increase the risk of abuse in patients with a serious chronic condition or disability?

A
  • dependent on others for their care
  • little control over decisions that directly affect them
  • social stigma may lead to a false perception that their mistreatment is deserved or should not be reported
  • illness may limit freedom of movement, ability to have privacy or communication of abuse
  • lack of sexual health education in special needs classrooms
  • may have physical limitations like weakness or mobility
  • intellectual disability may increase vulnerability to manipulation or coercion
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31
Q

What are some clues on presentation that a patient with a disability may have been abused?

A
  • STIs (even if report consensual sex)
  • vaginal or anal trauma
  • unexplained UTIs
  • unexplained fear of physical or deny exam
  • avoidance of specific caregivers
  • self-harm
  • sleep disturbances
  • encopresis
  • sexualized behaviour
  • sexual experimentation with age-inappropriate partners
  • sexually abusive behaviour towards others
  • running away
  • somatic complaints with no organic cause
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32
Q

What are some things a paediatrician can do to help facilitate disclosure of abuse for a patient with a disability?

A
  • crease safe environment that is conducive to open communication
  • find a skilled interpreter who is trained in sexual abuse for pts with communication difficulties
  • still need to adhere to formal legal and reporting standards
  • always be respectful during physical exams for these patients even at a young age
  • anticipatory guidance to patient and parents
  • advocate for institutional policies to screen volunteers and employees who work with children with disabilities
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33
Q

What are some negative outcomes of treating adolescents as adults in the criminal justice system?

A
  • risk of trauma, violence, abuse
  • interferes with cognitive, emotional, psychological development
  • higher likelihood of reoffending
  • not aligned with the UN Convention on the Rights of a Child act
  • fewer developmentally appropriate resources in the adult system
  • worse staff-to-offender ratio
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34
Q

What is the window within which you can take emergency contraception?

A

120 hours (5 days) but it is most effective in the first 72 hours for PO and up to 7 days for the copper IUD

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35
Q

What are the different options for emergency contraceptions?

A
  • Plan B (progestin-only) - preferred
  • Yuzpe methods (combined hormonal)
  • ulipristal acetate (not available in Canada)
  • Copper IUD (can be used up to 7 days)
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36
Q

What are the effects of emergency contraception on a pregnancy that has already implanted?

A

none

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37
Q

What are some situations in which emergency contraception pills should be considered?

A
  • -totally unprotected sex
  • mistimed fertility awareness
  • ejaculation onto genitals
  • -coitus interruptus
  • condom breakage
  • IUD expulsion or midcycle removal
  • dislodgement of diaphragm or cervical cap during sex
  • one more more missed OCP during week 1 of the pill or 2 or more missed during week 2 or 3 of the pill package
  • one or more progesterone-only pills is missed or delayed by more than 3 hours
  • depot late by 2 weeks or more
  • transdermal patch detached for 24 hrs or longer during week 1 or for 72 hrs or longer during week 2 or 3
  • nuva ring expelled or removed for 3 hours or longer during week 1 or removed for 72 hrs or longer during week 2 or 3
  • nuva ring left in for more than 5 weeks in a row
  • start of OCP is delayed by 24 hr or more
  • sexual assault
  • condome alone or spermicide alone plus recent teratogen exposure
  • advance prescription for any girl who does not want to become pregnant and may find herself in one of the above situations
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38
Q

What are the absolute and relative contraindications to taking PO emergency contraception?

A
  • known pregnancy (b/c it won’t work) o known allergy to one of the components
  • in pts with RF for stroke it is preferred to use the progestin only emergency contraception (Plan B method) if possible but can give the estrogen-containing one (Yuzpe)
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39
Q

How do you instruct a patient to take emergency contraception?

A
  • as soon as possible after the event
  • can be any time in the menstrual cycle
  • can prescribe or is available OTC
  • for Plan B: take 2 pills (0.75 levonorgestrel each) at once
  • for Yuzpe (combined): take one pill and then repeat 12 hours later, if miss the second one then need to restart; can give gravel 1 hour before to help with nausea
  • if vomit within 1 hour of taking the pill then take it again
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40
Q

What are the side effects of progestin only (Plan B) and Yuzpe (combined) emergency contraception?

A
  • Plan B: headache, fatigue, nausea, dizziness

- Yuzpe: nausea and vomiting

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41
Q

What physical exam do you have to do before giving emergency contraception?

A

-none unless indicated by history (e.g. pregnancy test, pelvic exam, STI testing)

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42
Q

For whom is the copper IUD a good emergency contraception option?

A
  • up to 7 days after unprotected sex in women who are in a stable, mutually monogamous relationship and low risk for STIs
  • do need to exclude pregnancy before insertion
  • take swabs for STIs at time of insertion
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43
Q

When should you expect a period after taking emergency contraception?

A

usually within 7 days of expected period date

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44
Q

What are some barriers to emergency contraception use?

A
  • perceived pregnancy risk
  • motivation to prevent pregnancy
  • knowledge about emergency contraception
  • how and where to obtain it
  • resources to obtain it
  • being rural
  • lack of experience by doctors or pharmacists with giving it
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45
Q

When can you restart birth control pills after taking emergency contraception?

A
  • the day after taking emergency contraception
  • do warn pt that it works by delaying ovulation so there is a risk of becoming pregnant in the days following taking the emergency contraceptive pill
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46
Q

What % of young women experience an eating disorder before reaching adulthood?

A

5%

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47
Q

When does anorexia nervosa typically occur?

A

mid-adolescence

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48
Q

What is the most effective treatment for kids with anorexia nervosa?

A

-family-based treatment (outpatient)

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49
Q

What is family based treatment for anorexia nervosa?

A
  • parents are given the responsibility to return their child to physical health and ensure full weight restoration
  • outpatient model with a multidisciplinary team
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50
Q

What are the advantages of family based treatment for anorexia?

A
  • teen stays in own environment
  • stays connected with friends, family and activities
  • family becomes empowered
  • cheaper
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51
Q

What are key things to educate parents about with anorexia and family based therapy?

A
  • let parents know that the eating disorder is not heir fault but it is their responsibility to ensure their child gets well
  • ED is a combo of different factors (genetic and environmental)
  • child unable to care for themselves b/c are overwhelmed by this powerful illness
  • parents need to take a firm stand and insist on adequate nutrition
  • refeeding starts immediately but goes slowly and will be difficult
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52
Q

What are some ways to establish rapport with a teen with an eating disorder?

A
  • meet with them alone every single visit
  • confidentiality
  • can talk about the symptoms that may be bothering them (e.g. thin hair, always being cold, intrusive thoughts)
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53
Q

How often should you meet with a teen with an eating disorder?

A

-once every 1-2 weeks

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54
Q

What are the principles of nutrition for anorexia?

A
  • immediate nutritional rehabilitation but start slowly
  • goal is 0.2-0.5 kg per week
  • can use nutritional supplements, curtail exercise, etc
  • 3 meals and 2-3 snacks a day
  • parental support key during this
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55
Q

What type of disclosures might you have to share with parents if the teen is experiencing them?

A
  • recent syncope
  • hypokalemia
  • hematemesis
  • SI
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56
Q

How should you weigh the child with anorexia?

A
  • weight at each visit
  • put on gown, leave on underwear only
  • urine sample before weight
  • intermittently exam tanner staging
  • vitals with orthostatic vitals at every visit
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57
Q

Should you manage a patient with anorexia on your own in the community?

A

-always refer to a specialized pediatric eating disorder service where available but start by implementing family based treatment as an outpatient

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58
Q

When can a child do exercise and activities again if they have anorexia?

A
  • if are achieving weight restoration can slowly reintegrate back into usual activities provided they continue to gain weight
  • should stay in school, but may have to come home for lunches
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59
Q

What is more prevalent texting sexual messages or sexual images?

A

sexual messages

60
Q

What are risks associated with sexting?

A
  • often shared with non-intended recipients
  • not anonymous
  • cannot be easily deleted
  • can be easily disseminated
  • legal ramifications of possessing child pornography (even if it is of themselves)
61
Q

What are the legal implications of sexting?

A

-can be arrested, charged, convicted of possession or distribution of child pornography even if it is of themselves

62
Q

What are some ‘advantages’ (for teens) of sexting?

A
  • can conceal who they are
  • avoid face to face
  • less stressful then real life situations
63
Q

What are some messages for us to give to parents about sexting?

A
  • need to be more aware of their kids’ practices and explain why kids shouldn’t sext
  • be transparent that they are monitoring their kids use of cell phones
64
Q

What is our role as MDs with regards to sexting?

A
  • ask about it at teen visits

- integrate discussions on sage and responsible online and cell activity

65
Q

What is sexual orientation?

A

whether a person’s physical and emotional arousal is to people of the same or opposite sex

66
Q

What % of youth identify as gay, lesbian or bisexual?

A
  1. 5-3%

- 3.5-6.5% have had sex with someone on the same gender (this does not always mean they identify as LGB)

67
Q

What factors influencing ‘coming out’?

A
  • it is confusing
  • influenced by stigma
  • inaccurate knowledge
  • lack of knowledge
  • lack of role models
  • minimal opportunity to socialize with other youth with similar feelings
68
Q

What does it mean to be transgendered?

A

-gender identity does not match their anatomy (can be heterosexual, homosexual or bisexual)

69
Q

What are some psychological and social issues associated with being LGB?

A
  • can feel isolated and ashamed
  • low self esteem
  • increased risk of being threatened with weapons at school
  • increased risk of dropping out
  • more likley to be kicked out of their homes
  • more likeley to use tobacco, EtOH and other substances at early age
  • particularly increased risk of club drugs (e.g. ecstasy, ketamine)
  • increased risk of attempting suicide
70
Q

How much higher is the risk of attempted suicide in an LGB teen?

A

2-7x higher

71
Q

What are some family issues we need to be aware of when caring for teens who are LGB?

A
  • they may be distressed by idea of lying to their family but also scared of their reactions
  • introduce the subject in a casual way in front of parents by referring to the media or something not specific to the teen
  • recognize some parents may suspect their teen is gay but may feel awkward bringing it up
  • offer to role play with the teen to help with disclosure
72
Q

How do you respond to a parent who asks if their child is “going through a phase” related to being LGB?

A
  • often teens who come out to parents are quite certain about their sexual orientation
  • Parents and Friends of Lesbians and Gays (PFLAG) local chapters can be helpful for parents
73
Q

What are some relationship issues unique to LGB teens?

A
  • may benefit form support groups b/c is more complicated if do not have role models of same-sex relationships
  • helpful that Canada has legalized gay marriage
74
Q

What are some medical issues unique to LGB teens?

A

-normal teen health
-increased risk STIs b/c are more likely to have sex with more partners and have nonconsensual sex
(EXCEPT women who have sex with women and are not IVDU have the lowest risk of HIV and STIs than any other sexually active group)

75
Q

Should you screen lesbian teens for STIs?

A

yes esp if had sex with men or use penetrating sex toys

76
Q

What are some key things to know about anal sex?

A
  • not all gay teens have anal sex

- increased risk of HIV, parasites, HPV, Hep A/B/C if they do

77
Q

What is full STI screening in a male?

A
  • urethral/urein, pharynx and anal swabs for G+C
  • urethral/urine for CT
  • syphilis, hepatitis, stool Cx, Stool O+P and HIV testing
78
Q

What is a primary prevention strategy that is important for all teens related to STIs?

A

immunization for HPV (approved for boys and girls although funding not always available for both)

79
Q

What is harm reduction?

A
  • public health strategy aimed to reduce adverse consequences associated with certain risky behaviours
  • measures health, social, economic outcomes as opposed to measurement of the behaviour (i.e. drug consumption)
80
Q

What is an example of harm reduction?

A

needle exchange programs shown to decrease HIV transmission

methodone reduces overdoses

81
Q

What are examples of primary and secondary prevention as they relate to harm reduction in teens?

A
  • primary prevention (eg. education of preteens or young teens about risks of sex and substances)
  • secondary prevention (e.g. for teens already engaging the behaviour education about additional protection, providing free condoms, regular access to STI testing, etc)
82
Q

How effective are zero tolerance policies for reducing substance abuse?

A

not at all in the US

83
Q

Give some examples of harm reduction programs that have been implemented successfully?

A
  • condom machines in high schools (more effective than suggesting abstinence) to reduce STI and pregnancy
  • seat belt legislation
  • programs that promote sport safety (bike helmets, life bests, hockey visors)
84
Q

Give an example of primary, secondary and tertiary prevention?

A 
primary = implemented to prevent a disease from occurring; e.g..  immunization
secondary = presumptive identification of unrecognized disease or defect by the application of tests, exams or other procedures which can be applied rapidly eg. screening on pap tests, newborn screen
tertiary = treatment and rehabilitation of disease after it has been diagnosed so as to prevent progression and permeant disability (eg. ACEI for HTN, foot monitoring for diabetes)
85
Q

What is the benefit of motivational interviewing and who should it be used for?

A
  • guidelines for addressing resistance, ambivalence or resistance to change
  • emphasizes self-responsibility in changing one’s behaviour
  • helpful with older participants (17-20) to reduce alcohol related problems
  • can enhance adoption of harm reduction techniques
86
Q

What should we be doing as MDs for harm reduction in teens?

A
  • screen for risky behaviours
  • provide messages that encourage delay of initiation of potentially risky behaviours
  • promote risk reduction strategies
  • apply motivational interviewing
  • become familiar with resources in the community for hard reduction programs for substance use, pregnancy and injury prevention
87
Q

What % of hospital admissions in Canada are for teens?

A
  1. 5%

- usually related to acute illness and injury; duration is usually short

88
Q

How can chronic illness impact adolescent development?

A
  • puberty can be delayed or precocious
  • normal psychological and social changes are often delayed due to a reduction in developmentally normal activities (e.g. school)
  • separation from family is often delayed
89
Q

What is the impact of hospitalization of youth?

A
  • loss of control (can lead to anxiety, powerlessness, over dependence, loss of independence)
  • loss of privacy (at peak time of self-consciousness)
  • may behave defiantly
  • may regress to the state of a younger child
  • struggles may be amplified if are away from their cultural support
90
Q

What age can adolescents consent to medical treatment decisions?

A

-no specific age, it is based on their mental capacity not chronological age (except in quebec where it is 14 yrs)

91
Q

What is capacity and what are the key elements of capacity?

A
  • capacity is the ability to accept/refuse tx
  • depends on teens ability to understand
    1) their condition
    2) options available
    3) appreciate the risks and benefits of accepting or refusing tx

-confidentiality is a right for all competent ppl

92
Q

Under what circumstances is a physician obliged to break confidentiality with a teen?

A

1) suicidal intent
2) homicidal intent
3) disclosure of abuse or neglect of themselves or siblings

93
Q

What are some advantages of teen-specifc wards?

A
  • peer support activities
  • can address the complexity of medical, mental and social needs of teens
  • excellent environment for training, education and research
94
Q

What are some recommendations regarding the location where teens are hospitalized?

A
  • should be on teen specific wards if available
  • there should be youth-dedicated spaces for recreational activities
  • room them with other teens when possible
  • design rooms to respect their privacy
  • consider having a chaperone present when physical exams are done
  • allow opportunities for hospitalized teens to socialize with peers from home
95
Q

What % of youth in North America have a chronic condition?

A

15%

96
Q

What are some concerns adult health care providers have identified about patients who have transferred from paediatric health care?

A

-lack of adherence to proposed treatment plans
-deficienceies in knowledge about the condition
-limited self-care skills
-

97
Q

What comorbidities are teens with a chronic health condition at risk for?

A
  • increased rates of depression, social/isolation and higher levels of stress about death, body image, school
  • important to foster self-esteem
98
Q

What is an important area of health of children with special health care needs that often go unaddressed?

A
  • sexual health
  • effect of their condition on sexuality and reproduction
  • STIs
  • contraceptive options
99
Q

What are some health care goals associated with transition?

A
  • teen involved in the management of their condition
  • teen and family understand the condition
  • understand the personal potential for activity, education, recreation and vocation
  • completion of adolescent developmental tasks
  • attainment of self-esteem and self-confidence
100
Q

What is transition?

A
  • purposeful, planned movement of teens with chronic medical conditions from child-centerer to adult-oriented health care
  • goal is for this to be uninterrupted, coordinated and developmentally appropriate
101
Q

When should preparations for transition to adult health care start?

A
  • from early childhood

- should involve the teen regardless of their cognitive level

102
Q

What is the On-Trac transition framework?

A
  • program based on goals that change from early, mid and late transition at the teen’s pace
  • starts at 10 years of age
  • goals of self esteem, sexuality, educational and vocational attainment, future financial planning, autonomy, etc
  • see teen and parent together but also teen on their own
  • formal letter acknowledging the ‘graduation’
  • give transition letter to new facility
  • family MD is KEY
103
Q

What is HPV and how is it transmitted?

A

double stranded DNA virus

  • transmitted:
  • sexually (even just with skin to skin contact)
  • vertically (baby exposed to it in genital tract)
  • oral mucosal contact in head and neck infections
104
Q

What is the most common STI?

A

HPV

  • rates highest within the first 5 years of sexual activity
  • prevalence is 11-29%, peak in adolescence
105
Q

What are the manifestations of HPV?

A

-most are asymptomatic and self limited
-benign skin lesions
-malignant skin lesions (of anogenital or head and neck)
-

106
Q

Which strains in Gardisil cause cancer and which cause warts?

A

HPV 16 and 18 cause cervical cancer

HPV 6 and 11 cause genital warts and recurrent respiratory papillomatosis

107
Q

What are RF for HPV infection?

A

-age

108
Q

How effective is Gardisil?

A

-98-100% effective against dysplastic cervical lesions, high grade vaginal cancers and genital warts

109
Q

Who should get the HPV vaccine?

A
  • all girls btwn 9-13 years
  • really should be given as early as your local program will allow to ensure it is given before onset of sexual activity
  • can be given at 0, 2 and 6 months (can be given with Hep B)
  • should not be given to pregnant women
110
Q

What are side effects of HPV vaccine?

A
  • local reaction

- dizziness and syncope (observe for 15 mins post and ensure good hydration)

111
Q

In addition to all girls 9-13 years of age what additional groups should get the HPV vaccine?

A
  • girls >13 yrs as a catch up program
  • street-involved youth or in foster care
  • girls with hx of previously abnormal paps, hx of warts of known HPV infection
112
Q

Can immunocompromised ppl get the HPV vaccine?

A

-not enough data yet so offer based on expert opinion

113
Q

What % of teen pregnancies end in abortion?

A

50%

114
Q

What are the benefits of early detection of pregnancy?

A
  • more choices
  • better prenatal care
  • reduced complications
115
Q

What are some barriers to teens for early detection of pregnancy?

A
  • -denial

- irregular menses

116
Q

How do you diagnose pregnancy and how early can it be detected?

A
  • hcg in serum as early as 6 days post conception

- urine hcg at 10-14 days (can get a false negative)

117
Q

When is the uterus palpable above the pelvic bone?

A

at 9-12 weeks

118
Q

What are important things to explore on history when a teen finds out she is pregnant?

A
  • physical and emotional effects
  • determine her knowledge of options and feelings about those options
  • explore family, cultural or community issues
  • partner’s opinions and role in decision-making
  • support system
  • any health issues
  • substance use, high risk health behaviours
  • housing, school status, personal academic goals
119
Q

What are options if the teen decides she does not want to keep the baby?

A
  • adoption
  • medical abortion with MTX, misoprostol (early termination)
  • manual vacuum aspiration, dilatation and curettage, and vaccuum extraction can be done in first trimester and early into second
120
Q

If terminating a pregnancy, what are some key things to cover in your appointment?

A
  • provide education around choices and refer to medical and surgical services
  • be nonjudgemental
  • provide follow up after to review complications, support and contraception
  • anticipatory guidance about grief, relief and anger
121
Q

Which teens are at high risk for unprotected intercourse?

A
  • social and family difficulties
  • offspring of teen moms
  • early puberty
  • sexual abuse
  • frequent school absenteeism
  • o vocational goals
  • pregnant siblings
  • substance use
  • group homes
  • street involved
122
Q

What are some strategies to help a teen with a chronic condition become more independent and assertive?

A
  • prepare parents for the separation
  • allow teen to take control in simple ways (e.g. choosing the form of medication)
  • learn self-care skills
  • if need assistance seek a same sex caregiver who is not a family member
  • screen teens as you would any other teen (HEADSS)
  • encourage them to pursue interests and hobbies (may need OT to help with this)
123
Q

What are strategies to deal with social isolation or being teased for youth with chronic conditions?

A
  • help them develop strategies to deal with being teased (e.g. using humour)
  • advise them how to find supportive friends
  • support groups for parents and kids
124
Q

What should a MD do to help with school and work for kids with chronic conditions?

A
  • letters to teachers explaining the medical problems
  • encourage accommodations as needed
  • may need to help parents arrive at realistic expectations for their teen
125
Q

Need to address issues or concerns around death and dying in teens with chronic health conditions. True or false.

A

T.

126
Q

What benefits does educating a teen about there disease have?

A
  • they learn to avoid situations that exacerbate their condition
  • learn how to minimize the severity of an exacerbation
  • learn self-care skills to minimize the daily effects of their illness
127
Q

True or false. In Canada, 15-19 year old males are more likely to die from firearm injuries than from cancer, or from fires, falls and drowning combined.

A

True (the majority of these are suicide)

128
Q

What are the Canadian laws around guns?

A
  • need to be screened before can purchase one
  • firearm owners must be licensed and all firearms registered
  • gun has to be stored locked, unloaded and away from its ammunition
  • these laws do not apply to air guns, BB guns or paintball guns
129
Q

What are negative outcomes of having a gun in the home?

A
  • increased rates of homicide
  • increased rates of suicide
  • increased rates of unintentional injuries
130
Q

What is the most common type of injury from air, BB or paintball guns?

A
  • ocular injuries including enucleation, blindness, etc

- they have also caused death

131
Q

Are there laws around BB guns?

A

-only in some places

132
Q

True or false. School-based education programs about gun safety for children are effective.

A

false. there is no evidence to support this.

133
Q

What should a physician tell families about guns?

A
  • always ask about them

- recommend removing the gun if there are RF for teen suicide, unintentional injury or domestic violence

134
Q

Should air guns and BB guns be allowed? paintball guns?

A
  • not considered toys, are dangerous, should not be toys for kids or teens
  • paintball guns only in supervised areas with proper eye gear
135
Q

What are the most common health problems of youth in custody?

A
  • skin lesions
  • URTIs
  • STIs
  • contraception
  • pregnancy
  • mental health
  • violence issues
  • substance abuse
  • dental issues
  • urologic issues
  • endocrine issues
136
Q

Which branch of government is responsible for custodial facilities?

A

provincial

137
Q

What health policy things should be in place for youth in custodial facilities?

A
  • should be a staff overseeing the health program (does not need to be MD or RN)
  • need established policies and procedures, ideally set by an advisory committee, these should be periodically reviewed
  • larger facilities should have a physician
138
Q

When should the first medical evaluation for a teen going to jail be conducted and what does it encompass?

A
  • within 72 hours
  • acute illness, trauma, assess for withdrawal
  • behavioural questionnaire
  • screen and treat for infectious diseases
139
Q

True or False. All jails must have someone trained in BLS or CPR at all times.

A

True.

140
Q

True or False. All facilities need a 24/7 emergency plan for medical, behavioural and psych emergencies with a list of emergency contacts.

A

-True.

141
Q

What aspects of long-term health are especially important in youth in jail?

A
  • sexual history
  • psych hx
  • abuse hx
  • substance use
  • dental exam
  • gyne exam (if indicated)
  • consider screening for vision and hearing
  • consider psycho ed testing
  • immunizations
  • anticipatory guidance
  • transition once they leave the facility
142
Q

What is dieting?

A

-intentional, often temporary, change in eating to achieve weight loss

143
Q

What is extreme dieting?

A 
>10 diets in a year
self-induced emesis
skipping meals
laxative use
diet pills
144
Q

What is disordered eating?

A

behaviours aren’t severe enough to be an eating disorder but can be things like extreme dieting, laxatives, etc

145
Q

What are some RF for dieting?

A

-female
-overweight/obesity
-body image dissatisfaction
-low self esteem
-low sense of control over life
depression and anxiety
-vegetarianism
-early puberty
-low family connectedness
-absence of positive adult role models
-parental dieting
-parental endorsement to diet
-parental criticism of child’s weight
-weight related teaching
-poor involvement in school
-peer group endorsement of dieting
-involvement in weight-related sports (dance, gymnastics)
-certain chronic illnesses (e.g. diabetes, adhd)
-presence of other risk behaviours (e.g. smoking, unprotected sex)

146
Q

What are some consequences of dieting?

A
  • nutritional deficiencies (esp iron and Ca)
  • growth deceleration
  • menstrual irregularities and amenorrhea
  • osteopeneia and osteoporosis
  • medical complications of purging or laxatives (e.g. electrolyte disturbance)
  • negative impact on self esteem
  • fatigue
  • irritability, distractibility
  • food preoccupation
  • tendency to overeat or binge
  • excess weight gain (over time)
  • risk for eating disorder (5-18x fold increased risk)
147
Q

What is the most reliable way to assess whether a teen is in a healthy weight range?

A

-BMI percentile curve

CPS Statements (14 decks)

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