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Peds > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

1
Q

why focus on adolescents?

A

they have lowest annual rate of visit to office based clinicians

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2
Q

how are adolescent behaving?

A

3/4 report engaging in at least one risk behavior

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3
Q

what is adolescent morbidity related to?

A

drug, alcohol, tobacco use
risky sexual behaviors
poor nutrition
inadequate physical activity

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4
Q

what is the major cause of adolescent mortality?

A

Major: unintentional injury such as MVA
second: homicide

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5
Q

What is leading cause of death in adolescent?

A

unintentional injuries (accidents)

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6
Q

what is the common denominator for accident?

A

personal behavior which is preventable via education

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7
Q

what are some other causes of morbidity and mortality in adolescent?

A

intentional injuries like homicide and suicide
reproductive health issues like unintended pregnancies and STIs
alcohol and drug use
obesity

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8
Q

define adolescent.

A

~11-21 yo divided to early, middle and late

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9
Q

define puberty.

A

biological process in which a child becomes an adult

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10
Q

what are Tanner stages?

A

a sexual maturity rating for development in girls and boys

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11
Q

what is thelarche?

A

development of a breast bud, with elevation of the papilla and enlargement of the areolar diameter. Stage 2 of Tanner, ~8-12 yo

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12
Q

what is pubarche?

A

development of pubic hair in girls : sparse, straight hair along the lateral vulva ; Stage 2 of Tanner

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13
Q

what is menarche?

A

first menses; ~ 12 yo

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14
Q

what is the sequence of puberty in girls?

Note: PHV (Peak Height Velocity)

A

breast 2, pubic hair 2, PHV, breast 3, pubic hair 3, pubic hair 4, breast 4, menarche, pubic hair 5, breast 5

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15
Q

what is the first sexual developmental change in boys?

A

enlarged scrotum: Tanner (SMR) Stage 2

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16
Q

what is the sequence of puberty in boys?

A

genital 2, genital 3, pubic hair 2, genital 4, pubic hair 3, PHV, pubic hair 4, genital 5, pubic hair 5

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17
Q

compare puberty timing in girls vs boys?

A

girls are 3-4 yrs ahead : PHV 12 in girls, 15 in boys

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18
Q

list some of the characteristics of adolescent development?

A

a period of RAPID physical, emotional, social growth
often FRIGHTENING for adolescent
a period of INFALLIBILITY
adolescent begins to separate from the parent and establish INDEPENDENCE
adolescent is influenced PRIMARILY by his/her social groups
parent find it difficult to COMMUNICATE with them

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19
Q

how is cognitive development is adolescent?

A

it is a period of development. frontal lobe which helps with making the right decision is not developed fully –mid 20s. —so you can’t expect much from Miley Cyrus

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20
Q

what are some challenges for parents and clinicians?

A

health
safety
future
behaviors

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21
Q

why understanding normal vs. concerning behaviors are important for parents and clinicians?

A

To take action in time and prevent further injuries such as suicide

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22
Q

what are some of the concerning behaviors?

A

EXTREME withdrawal/antagonism
CONTINUED FAILURE to adapt several weeks-months later
ESCALATION of risk-taking behaviors

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23
Q

what are some challenges for adolescent with respect to healthcare?

A

confidentiality

9% of adolescent are uninsured

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24
Q

is parental consent required for HIV/AIDS testing and treatment?

A

Nope. minor can consent.

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25
Q

Is parental consent required for STIs testing and treatment?

A

Nope.

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26
Q

Is parental consent required for pregnancy and prenatal care?

A

Nope.

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27
Q

is parental consent required for chemical dependency services?

A

Nope.

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28
Q

Is parental consent required for mental health outpatient services?

A

nope.

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29
Q

under what condition minors may consent for care?

A 
the pt is an emancipated (separated from parents), homeless, or married minor.
emergencies
STIs
family planning 
substance abuse and the pt >=12yo
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30
Q

what is the status of minor consent for sexual assault?

A

pt may consent if >=12yo and only if legal guardian cannot be contacted within the short time the exam is necessary.

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31
Q

who is an adolescent in state of Arizona?

A

12-18 yo

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32
Q

what are the healthcare laws about minor chemical dependency in AZ?

A

minor can apply for treatment at a substance abuse facility

parents/guardians MUST be notified once admitted for tx

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33
Q

what if a minor pt is going thru withdrawal?

A

a pt under the influence of a substance including withdrawal is considered a MEDICAL EMERGENCY and consent is IMPLIED.

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34
Q

how is cognitive development is adolescent?

A

it is a period of development. frontal lobe which helps with making the right decision is not developed fully –mid 20s. —so you can’t expect much from Miley Cyrus

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35
Q

what are some challenges for parents and clinicians?

A

health
safety
future
behaviors

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36
Q

why understanding normal vs. concerning behaviors are important for parents and clinicians?

A

To take action in time and prevent further injuries such as suicide

How well did you know this?
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37
Q

what are some of the concerning behaviors?

A

EXTREME withdrawal/antagonism
CONTINUED FAILURE to adapt several weeks-months later
ESCALATION of risk-taking behaviors

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38
Q

what are exceptions to abortion laws concerning minors?

A

minor may consent if:

  1. pt emancipated
  2. judge authorizes “judicial bypass” : minor is mature or abortion is in her best interest
  3. pregnancy is the result of inappropriate sexual misconduct by parent, stepparent, uncle, siblings,..
  4. pregnancy is harmful to pt
39
Q

is parental consent required for HIV/AIDS testing and treatment?

A

Nope. minor can consent.

40
Q

Is parental consent required for STIs testing and treatment?

A

Nope.

41
Q

at what age do you start PAP screening?

A

21 not matter how long they have been sexually active, repeat every 3 yrs 30

42
Q

what are the goals of Pre-participation Physical Exam (PPE) also known as sport physical?

A
  1. maximize safe participation
  2. identify medical problems with risks of life threatening complications ( hypertrophic cardiomyopathy)
  3. identify condition that require a tx plan before or during participation (HTN)
43
Q

Is parental consent required for mental health outpatient services?

A

nope.

44
Q

under what condition minors may consent for care?

A 
the pt is an emancipated (separated from parents), homeless, or married minor.
emergencies
STIs
family planning 
substance abuse and the pt >=12yo
45
Q

how adolescent substance use is linked to brain development?

A

strongly linked. it impacts development in regions of the brain a/w: judgement, attention, memory, reward seeking

46
Q

what are some factors playing role in adolescent substance abuse?

A
  1. cultural/environmental –critical role
  2. parental influences
  3. media
  4. availability
47
Q

what are the healthcare laws about minor chemical dependency in AZ?

A

minor can apply for treatment at a substance abuse facility

parents/guardians MUST be notified once admitted for tx

48
Q

what if a minor pt is going thru withdrawal?

A

a pt under the influence of a substance including withdrawal is considered a MEDICAL EMERGENCY and consent is IMPLIED.

49
Q

Does inpatient mental tx require parental consent?

A

it does. except if emergent tx is necessary to prevent serious injury of a minor

50
Q

Does outpatient tx require parental consent?

A

outpatient laws are vague. AZ law generally requires parental consent for outpatient psychological tx or counseling of minors.

51
Q

when you use HEADSSS what is the next step if you get a + answer to alcohol/drug use?

A

additional screening indicated. use CRAFFT.

52
Q

can minor consent for abortion?

A

nope. parental consent IS REQUIRED.

53
Q

what is the best way to approach a pt with substance use according to SBIRT?

A

employing a pt-centered, EMPATHETIC & MOTIVATIONAL technique.

54
Q

what do you do if you cannot decide whether to abort pregnancy of a minor or not?

A

it is easier to give the care than to worry about laws ; however you must carefully document your thought process that the care was is minor’s best interest.

55
Q

what is the most common interview approach to adolescent pt?

A 
HEADSSS assessment:
Home
Education/Exercise
Activities/employment
Drugs
Suicidality
Sex
Safety: weapons at home
56
Q

do most adolescents receive proper intervention for depression?

A

No. >70% do not receive appropriate intervention b/c mood issues often attributed to “ moodiness” or “PMS” and/or parents simply miss the cues.

57
Q

what are the goals of Pre-participation Physical Exam (PPE) also known as sport physical?

A
  1. maximize safe participation
  2. identify medical problems with risks of life threatening complications ( hypertrophic cardiomyopathy)
  3. identify condition that require a tx plan before or during participation (HTN)
58
Q

what is the largest preventable and most costly public health problem in US?

A

adolescent substance use

59
Q

what are some personal challenges that increase the risk for substance use?

A
    • FH
  2. adverse childhood events like abuse neglect trauma
  3. co-occuring mental health problems
  4. peer victimization or bullying
  5. engaging in other risk behaviors
60
Q

how adolescent substance use is linked to brain development?

A

strongly linked. it impacts development in regions of the brain a/w: judgement, attention, memory, reward seeking

61
Q

what are some factors playing role in adolescent substance abuse?

A
  1. cultural/environmental –critical role
  2. parental influences
  3. media
  4. availability
62
Q

list some of the stuff available to adolescents to abuse?

A

inhalants, dextromethorphan (cough syrup) , saliva, synthetic cannabinoids, bath salts, prescription drugs

63
Q

what are some clinical presentation of depression?

A

dx criteria is same for adult and children however presentation may differ : anhedonia, boredom, hopelessness, weight changes, substance use, suicidal attempts, irritability (parents may report)

64
Q

what are clinical manifestations of adolescent substance use?

A
  1. vary
  2. often present with no obvious physical findings.
  3. may see needle marks or nasal mucosal injuries
65
Q

where is drug use more frequently detected in healthcare settings?

A

Emergency settings : trauma (MVA, bike injuries, violence), impaired sensorium, seizures

66
Q

when you use HEADSSS what is the next step if you get a yes answer to alcohol/drug use?

A

additional screening indicated. use CRAFFT.

67
Q

what is CRAFFT?

A 
Car
Relax
Alone
Forget
Friends/Family
Trouble
68
Q

what is the second step when treating depression in children?

A

monitor children closely for SUICIDALITY and develop a “safety plan” with the family (antidepressant increased the risk of suicidal thoughts in children, adolescents, and young adults)

69
Q

true or false?

Up to 15% of children and adolescents will experience some symptoms of depression.

A

True.

70
Q

does the incidence of depression increase or decrease after puberty?

A

increases.

71
Q

do most adolescents receive proper intervention for depression?

A

No. >70% do not receive appropriate intervention b/c mood issues often attributed to “ moodiness” or “PMS” and/or parents simply miss the cues.

72
Q

what is the leading cause of suicide in youth?

A

depression.

73
Q

how is the rate of depression among gay/lesbians?

A

gay and lesbian youth are TWICE as likely to attempt suicide at least once.

74
Q

true or false?

the majority of youth who suffer from depression have a co-morbid mental illness.

A

true.

75
Q

what is the main risk factor for depression in youths?

A

+FH of depression

76
Q

how do you screen for depression?

A

remember HEADSSS?

have you often felt sad or down, had difficulty sleeping, felt irritable, nothing to look forward to?

77
Q

what are some clinical presentation of depression?

A

dx criteria is same for adult and children however presentation may differ : anhedonia, boredom, hopelessness, weight changes, substance use, suicidal attempts, irritability (parents may report)

78
Q

what is the most effective tx for depression?

A

a combination of pharmacotherapy (medication) and psychotherapy

79
Q

what is the drug of choice for depression in children 8 and older?

A

fluoxetine (Prozac) is the ONLY SSRI approved by the FDA for tx of depression in children 8 and older

80
Q

How about Escitalopram (lexapro) for depression in children?

A

Escitalopram is approved for ages 12 and older

81
Q

what is minimum required for duration of therapy in depression of children?

A

duration of therapy is case-dependent however MINIMUM is 6 months.

82
Q

what is the second step when treating depression in children?

A

monitor children closely for SUICIDALITY and develop a “safety plan” with the family (antidepressant increased the risk of suicidal thoughts in children, adolescents, and young adults)

83
Q

what is scoliosis?

A

spinal deformity causing lateral curvature of the spine in the frontal plane– with a coronal plane curvature of >10 degrees

84
Q

what is the cause of scoliosis?

A

most commonly idiopathic ; may be congenital or a/w neuromuscular dz as well

85
Q

how is scoliosis classified and what are the classification?

A

classified according to age of onset

  1. infantile (rare, birth to 3yo)
  2. juvenile (3-10 yo)
  3. adolescent (>= 11yo)
86
Q

what is the most common type of scoliosis?

A

adolescent idiopathic scoliosis (AIS) is the most common ~70%

87
Q

what are common findings for scoliosis?

A

asymmetry of shoulder height, waistline, and elbow to flank distance are common findings.

88
Q

what is the first test for Dx of scoliosis?

A

Adams forward bend test.

89
Q

You are suspecting scoliosis in a 11 yo female. you think that the Adams forward bend test is positive. what is next?

A

PA and lateral XRAY of entire spine .

90
Q

what is the tx for scoliosis?

A
  1. observation –indicated for curves 30 degrees or rapidly progressing curves
  2. surgery !
91
Q

how do you determine the degree of curvature for scoliosis?

A

just know it is the COBB method.

92
Q

what is the goal of bracing in scoliosis?

A

the goal of bracing is to prevent progression of deformity.

93
Q

How long does a pt with scoliosis has to wear her brace?

A

at least 16 hrs/day

Peds (8 decks)

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