Adolescent Med Flashcards
When does growth velocity, and peak velocity occur for boys and for girls.
11 years for boys and 9 for girls, peak height velocity occurs mean of 13.5 years for boys (Tanner 3-4) and 11.5 for girls (Tanner 2-3).
Definition of emancipated minor
Less than 18 years of age but, is either financially independent, married, in the military or has their own children
What are exceptions to adolescent confidentiality
abuse, activity causing harm to others or to self
What are indicators for obesity that require intervention
BMI> 95th = obesity
or 85th to 95th = overweight
and
family history of premature CAD, obesity, HTN or DM
Cholesterol > 200
increase in > 2 points in BMI in 12 months
adolescent expresses concern
What are indicators for eating disorder that require intervention
BMI < 5th
weight loss > 10% of prior weight
distorted body image
dieting when not overweight
When should vision be tested
at 12, 15 and 18 or when clinically indicated
referral is vision < 20/30 in either or both eyes
When is a pelvic exam indicated
Sexually active
over 21
symptoms: pelvic pain, vaginal discharge refractory to treatment, menstrual problems
What is the recommended annual screening for sexually active adolescents?
NAAT for gonorrhea and chlamydia
If positive repeat in 3 months
HIV testing, especially annually for those who are high risk
Other screening such as syphilis for MSM and possibly HIV more often every 3-6 months depending on risk
What other laboratory testing should be considered in adolescents?
anemia: girls with heavy menses, vegetarians, underweight, chronic illness
Cholesterol: once between 9 and 11. Again once 17-21
If non HDL > 145 or HDL < 40, obtain 2 fasting lipid panels and take an average of results
MMR and varicella recommendations
If they have not gotten 2 of each, give 2nd dose as soon as you can.
When to give Tdap?
Due at 11-12 and then once every 10 years
Recommendations for Hepatitis B?
If they haven’t gotten the series, give it.
Recommendations for HPV
May start at age 9 particularly those who with history of sexual assault, abuse or HIV
Recommended age: 11-12
2 dose series if started between ages 9-14
Give at 0 and 6-12 months, invalid second dose if given before 5 months
3 dose series if started age 15 and up
give at 0, 1-2 and then 6 months after. Minimum of 4 weeks between 1st and 2nd dose and 12 weeks between 2nd and 3rd, minimum of 5 months between 1st and 3rd.
Recommendations for MCV 4
11-12 years with booster at 16 years
13-15 years give 1 dose and then repeat dose at 16 years of age with minimum of 8 weeks in between
16 year old and up just get one dose
Must be given either before or at same time as dtap
Recommendations for Meningococcal B
May be given to those who want it 16-18 years of age.
can be given up to 23 years old
Bexsero: 2 doses 1 month apart
Trumenba: 2 doses 6 months apart
Recommendations for pneumococcus
Single dose of PCV 13, if asplenic, HIV, cochlear implant, CSF leak, immunocompromised.
PPV23 8 weeks later.
Repeat PPV23 5 years later.
reasons to drug screen
Unexplained accident or trauma Loss of interest in activities that were once important New onset psychiatric symptoms deterioration in school performance Unexplained chronic illness Increased absenteeism Suicide attempt Altered mental status
List complications of refeeding the anorexic patient
hypophosphatemia hypokalemia hypomagnesemia cardia arrhythmia volume overload, edema Vitamin deficiency, thiamine
Criteria for hospitalization of anorexic patient
< 75% of ideal body weight, despite intensive outpatient care refusal to eat, uncontrolled binging and purging, dehydration Body fat < 10% Medical complications (pancreatitis, heart failure) Hypotension < 80/50 HR < 50 Orthostatic Hypothermic < 96 Electrolyte disturbances Arrhythmia Suicidal ideation failure of outpatient treatment
What cardiac changes are seen in the anorexic patient
ST segment depression QT prolongation Bradycardia U waves (hypo k) Risk of heart failure is greatest in first 1-2 weeks of refeeding. Limit weight gain to 2-3 lbs per week
What are the criteria for hospitalization of the bulimic patient?
syncope K < 3.2 Cl< 88 esophageal tears cardiac arrhythmias, prolonged Qtc hypothermia suicidality intractable vomiting hematemesis not responding to outpatient therapy
Describe most common breast mass and management in an adolescent
solitary cyst
more than 50% resolve in 2-3 months
Follow with serial exams
Ultrasound if can not tell if cystic or solid
Persistent cystic lesions can be evaluated and treated with needle aspiration
persistent larger or suspicious lesions should be excised
Asymptomatic solid mass < 3 cm and consistent with fibroadenoma can be observed
Definition of primary amenorrhea
no menses by 16 with normal secondary sexual development
by 14 with no secondary sexual development
by 14 with clinical or karyotype consistent with Turner’s syndrome
no menses with sexual maturity rating of 5 for > than 1 year or no menses with thelarche 4 years prior
By 12-13 if cyclical pelvic pain is present
Definition of secondary amenorrhea
loss of menses for 6 consecutive months in those with regular periods
length of time equal to three cycles in some one with irregular cycles
Causes of central amenorrhea
Inhibition of GnRH (gonadotropin releasing hormone
functional hypothalamic amenorrhea: nutritional deficiencies / weight loss / stress / medications
panhypopit: tumor, infiltrative disorder (sarcoidosis, hemochromatosis, TB.
Sheehan syndrome: infarction
definition of microadenoma and macroadenoma and treatment.
micro: < 10 mm
macro > 10 mm
Bromocriptine
