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Pediatrics Exam 3 > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

1
Q

Adolescence ages defined

A

11-12-years-old through 18-21 years-old
21% of US population

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2
Q

1, 2 and 3 causes of death in adolescents

A

1 Cause of Death = Accidents

  • 34.6% (MVA, Poisoning, etc.)
  • 23.4%
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3
Q

1 cause of death in adolescent girls

A

Motor vehicle accident

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4
Q

1 cause of death in adolescent boys

A

Suicide

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5
Q

↑ Risk factors for Poisoning

A
  • ↑ Access
  • Mental/medical illness
  • Peer group favorable attitudes
    toward drug use
  • Lack of competing reinforcers*
  • Lack of strong parental
    boundaries/disapproval
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6
Q

↑ Risk for homicide (firearms)

A
  • Physical/cognitive challenges
  • E.g., fetal alcohol syndrome,
    learning disorders
  • Impulsive or aggressive tendencies
  • Hx of trauma
  • Incl. foster care & homelessness
  • Exposure to violence
  • Involvement with drugs or alcohol
  • Parental authoritarian childrearing
  • Low parental involvement
  • Poor family functioning
  • Parental substance abuse or criminal
    involvement
  • Peer involvement in gangs
  • Social rejection by peers
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7
Q

Major causes of morbidity during adolescence are psychosocial & often correlate with ______

A

poverty

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8
Q

“Success Sequence” for influencing
Psychosocial & Poverty-related circumstances

A
  • Goals
    1. ↓ reduce poverty
    2. Help adolescents & young adults become
    self-sufficient adults
  • Aka “Launch!”
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9
Q

clear themes about what leads to the two
goals of the success sequence:

A
  1. Graduate from high school (minimum)
  2. Full-time work
  3. Marriage, then children
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10
Q

11-14 Years: normal development

A
  • Physical Growth: see chart, healthy eating
  • Onset of puberty & secondary sexual characteristics
  • Gross Motor Control: Active for at least an hour/day
  • Fine Motor Control: Continued refinement
  • Language: Articulate
  • Personal-Social
  • At least one relationship with a responsible adult
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11
Q

Fast Facts about Puberty

A
  • Weight ~doubles
  • Major organs double in size
  • Height ↑ ~15%–20%
  • Before puberty
  • Muscular strength, boys = girls
  • Muscle mass & strength
    ↑ during puberty
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12
Q
  • Onset of puberty is marked by _____
A

disinhibition
of Hypothalamic GnRH

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13
Q

Pituitary gonadotropins released during puberty:

A
  • Luteinizing hormone (LH)
  • Follicle-stimulating hormone (FSH)
  • Early/middle adolescence
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14
Q

Testosterone function during puberty

A
  • ↑ development of male reproductive
    system
  • ↑ development of male secondary
    sexual characteristics
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15
Q

Estrogen function during puberty

A
  • ↑ development of female reproductive system
  • ↑ development of female breasts &
    secondary sexual characteristics
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16
Q

Progesterone function during puberty

A
  • ↑ secretion of “uterine milk”
  • Endometrial secretion nourishes embryo
    until placenta attachment functions
  • ↑ development of secretory apparatus of
    breasts
17
Q

ADOLESCENT HEALTH SERVICES guidelines

A
  • Privacy should be respected by
    providers & the staff
  • Offer an opportunity for examination & counseling separate from parents/guardians.
  • Encourage the adolescent to involve parents or guardians in healthcare decisions.
  • Maintain confidentiality
  • Patients should be made aware that certain situations & circumstances create limitations on guaranteed confidentiality
18
Q

T/F If the adolescent has the legal
right to give consent, confidentiality must be
maintained

A

T

19
Q

Approach to the exam: Strengths-based approach

A
  1. Identify & build on strengths early
  2. Look for (+) examples of adaptation &
    overcoming difficulty
    * Adapting + Overcoming = Resiliency
    * Normal function during adversity
    * Growth in coping capacity
  3. Praise & encouragement
    * Not hollow lip service
    * Help them with self-perception
20
Q

Approach to the exam: Confidentiality

A
  • Not uncommon a patient is brought
    to the office against their wishes
  • Drug & alcohol use
  • Parent-child conflict
  • School failure
  • Depression
  • Suspected eating disorder
  • Foster a trust & comfort
  • Review expectations of
    confidentiality
  • Consider two meetings
  • One with only the teen
  • One with only the parents
21
Q

Approach to the exam: Psychosocial History (HEEADSSS)

A

H ome environment
E ducation
E mployment
E ating
A ctivities (with peers)
D rugs
S exuality
S uicide/depression
S afety (from injury & violence)

22
Q

Approach to the exam: The Physical Exam

A
  • Pt may be shy & modest
  • Address the purpose of the examination directly
23
Q

Good decision making requires both:

A
  • Socioemotional system
  • Cognitive-control system
24
Q

Medically emancipated (variable by state)

A
  • Process by which minors can attain legal
    adulthood before reaching the age of
    majority (>18)
    1. NOT legal status, but similar to the age of majority
    2. Minors who are married or were married
    3. Minors who have a child
    4. Minors who have reached a specific age (eg, 15 yrs)
    5. High school graduates
    6. Minors living away from home without parental
    permission/financial support
    7. Homeless minors & runaways
    8. “Mature minors”
25
Q

Mature Minors Defined

A
  • At least 14 years old (vary by state)
  • Ability to understand the risks &
    benefits of the proposed treatment
  • Ability to provide the same level of
    informed consent as an adult & actually give consent
26
Q

Mature minors may consent to
_____

A

routine, low-risk nonemergency
care

27
Q

Emergency Care & Consent of minors

A

adolescents
in need of emergency medical
treatment may be treated
without consent if an attempt
to secure such consent would
delay treatment risk the
patient’s life or health
* Patient should be treated & the parents or legal guardians are notified ASAP

28
Q

When minors & parents disagree
about treatment for substance abuse

A
  • Some states defer to the minor
  • Some states defer to the parent
  • Most states = Do not specify

Pediatrics Exam 3 (7 decks)

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