adolescent health

Question 1

What is puberty?

Answer 1

• growth in stature
• development of secondary sexual characteristics
• achievement of fertility
• changes in most body systems:
  neuroendocrine axis, bone size and mineralization, CV system

Question 2

Factors that contribute to onset of puberty?

Answer 2

• controlled by many factors
• overall earlier onset of puberty has been attributed to increase in obesity
• proposed that critical body wt or composition is perhaps impt in development of pubertal events
• leptin is also responsible for initiation and progression of puberty and is produced by adipocytes

Question 3

Results of puberty that are in normal range but pt or family view as abnormal?

Answer 3

• anemia: Fe deficiency in menstruating females
• gynecomastia: 50% of teenage boys develop this, can last 6-18 months
• acne
• psych fxning: prevalence of depression is 2x as great in girls compared to boys
• musculoskeletal injuries: unique injuries during this time
• STIs (not really normal)

Question 4

What is delayed puberty? Classification?

Answer 4

• absence or incomplete development of secondary sexual characteristics by an age at which 95% of kids of that sex and culture have initiated sexual maturation
• classification:
• primary: due to hypogonadism and or defects in their receptors on membrane of gonadal cells
• secondary: gonads intact, problem with secretion of LH, FSH, or GnRH: defects can be because of:
  hypopituitarism
  hypothyroidism
  hyperprolactinemia

Question 5

3 primary values of a teenageer?

Answer 5

• freedom
• fun
• friends

Question 6

Goals of adolescence?

Answer 6

• become independent from parents
• develop a workable value system
• become comfortable with bodily changes
• build meaningful relationships
• begin est. economic independence

Question 7

Normal teen behaviors?

Answer 7

• express opinions
• test limits
• take risks
• experiment
• cognitive development:
  abstract operations - widened scope of intellectual activity and increased capacity for insight

Question 8

top 5 leading causes of mortality in 15-24 yo in US?

Answer 8

• 1: MVAs (46%)
• 2: homicide (15%)
• 3: suicide (13%)
• 4: cancer (5%)
• 5: heart disease (3%)

Question 9

Risky behaviors of teens?

Answer 9

• involved in behaviors that may have adverse health outcomes:
  alcohol, drug and tobacco use, sex and sedentary lifestyle
• alcohol most abused substance
• engaging in risky behaviors earlier
• most causes of serious morbidity and mortality are result of personal behaviors - preventable
• teens who engage in 1 risky behavior are more likely to engage in mult risk behaviors (teen smokers likely to be sexually active)
• all teens, across socioeconomic lines are at risk for health risk behaviors

Question 10

Most impressionable group of peds?

Answer 10

• teenagers
• as their provider: have to act as interested and caring advocate, not as their friend. Must listen carefully and see clues, instill responsibility

Question 11

Confidentiality with teens?

Answer 11

• critical for most
• est parameters of confidentiality with parents if possible
• always state you will alert parents if safety is a concern (suicide or homicide)
• always attempt to meet with teen alone regardless of issues to discuss
• begin to stress their own responsibility for their health

Question 12

What are preventive services that we should be offering teens?

Answer 12

immunizations:
varicella if no prior infection, booster
- Tdap around 11-12
- newer vaccines: MCV4 11-12 yo, Gardasil age 9
- may catch up on Hep B, IPV, MMR

Screening:

• HTN (BP on teens)
• obesity and eating disorder (plot BMI)
• hyperlipidemia and or metabolic syndrome if indicated
• TB if at risk
• abuse: physical, sexual, emotional: fighting, weapons
• learning or school probe
• substance abuse
• behaviors or emotions - indicate recurrent or severe depression, risk of suicide
• risky sexual behaviors: STI screen, HIV, pregnancy, cervical cancer (HPV)

Question 13

Anticipatory guidance for teen?

Answer 13

• healthy diet: Ca impt, still laying down bone 18-21
• safe wt management
• regular exercise
• min. TV and video games
• responsible sexual behaviors
• avoidance of tobacco, alcohol, other abusable substances, and anabolic steroids
• family involvement is critical

Question 14

Impt of parent-family connectedness?

Answer 14

• protective against every health risk behavior measure except pregnancy

Question 15

HEADS for screening?

Answer 15

• H: home, habits
• E: education, employment, exercise
• A: accidents, ambition, activity, abuse
• D: drugs (alcohol, tobacco, recreational), diet, depression
• S: sex, suicide, sports, shots

Question 16

What should be included in developmentally oriented approach with adolescents?

Answer 16

• body image
• peer relationships
• independence
• identity
• sexuality

Question 17

Issues in substance abuse?

Answer 17

• alcohol still most highly abused chemical: binge drinking more common
• tobacco hardest to stop if use started by 10-15 (#1 cause of preventable long term health consequences..not only lung cancer)
• use ugly side of smoking to help advise teens

Question 18

Common STIs in adolescents?

Answer 18

• gonorrhea and syphilis are seen, gonorrhea more
• HIV is particular concerm
• Chlamydia and HPV infection rates are increasing
• herpes and trichomonas
• ABSTINENCE is best!
• condoms 2nd best, should be used even if other BC being used
• Condoms prevent gonorrhea, chlamydia and HIV the most

Question 19

Sports injuries are most common in which age groups?

Answer 19

• older age adolescents
• injuries may be multiple: laceration and fracture
• sprains (ankles most common)

Question 20

Eating disorders in teens?

Answer 20

• anorexia and bulimia most common causes of wt loss in adolescence
• 3rd most common chronic illness of adolescence surpassed only by asthma and obesity
• 0.5-1% of teen girls develop anorexia
• around 2% of teen girls fit dx criteria for bulimia
• much higher percentage have reported binge eating at times with or w/o purging
• 90-95% female
• puberty related
• comorbid with rape, depression
• many excel in sports, often have perfectionist personality
• lower self esteem, current media suggesting that thin is best
• do it to be popular
• more commonly seen b/t 15-20, seeing as young as 8
• red flag: wt loss of more than 10% of previous wt

Question 21

When should you consider that a pt may be anorexic?

Answer 21

• refusal or inability to maintain body wt over min normal wt
• intense fear of gaining wt or becoming fat despite being under wt
• distortion in perception of body shape
• in post menarchal females if 3 consecutive periods missed

Question 22

Physical findings in anorexia?

Answer 22

• hypothermia
• bradycardia
• bradypnea
• hypotension
• BMI below 5th percentile
• russell’s sign: if bulimia present, erosions of inside of front teeth from vomiting
• often appear depressed

Question 23

What is Bulimia nervosa?

Answer 23

• recurrent episodes of binge eating
• feeling lack of control over binge behavior
• regular use of self induced vomiting, laxatives, diuretics, strict dieting
• 2 binge episodes/week last 3 months

Question 24

What is DSM-V dx criteria for anorexia nervosa?

Answer 24

• persistent restriction of energy intake leading to sig low body wt
• either intense fear of gaining wt or becoming fat, or persistent behavior that interferes with wt gain (even though sig low wt)
• disturbance in way ones body wt or shape is experienced, lack of recognition of seriousness of current low body wt

Question 25

Approach at tx eating disorder?

Answer 25

• team approach:
  pediatrician/internist - adolescent medicine subspecialist if available, nutritionist, counselor with eating D/O experience
• long term tx plan: over a year, intense inpt followed by maintenance

Question 26

What is an emancipated minor?

Answer 26

younger than 18 that is:

• married
• living independently of parents and supports him/herself
• has kids
• serves or served in military
• varies by state
• mature minor: based upon health providers assessment of adolescent’s maturity in their ability to make their own health care decisions
• generally around age of 15 or 16, can be younger