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Pediatrics > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

1
Q

what age is considered early adolescence?

A

10-13 years

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2
Q
  • Rapid changes in physical appearance (secondary sex characteristics) and behavior are major changes in early adolescence, leading to more self-consciousness and need for privacy
  • More comfortable with members of same sex
  • Body image and self-esteem fluctuate
  • Peer relationships increasingly important
  • Limited thought of future and if so, vague and unrealistic goals likely

what stage of adolescence is this?

A

early adol

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3
Q
  • Struggle for autonomy and sense of identity are the major characteristics of middle adolescence
  • High risk behaviors as a result of experimentation are common
  • Intense emotions and mood swings
  • Moves from concrete thinking to more abstract
  • Self-centered
  • Peers in…parents out
  • History focuses on middle adolescent’s interaction with family, school and peers

what stage of adolescence?

A

middle adol - 14-16 y/o

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4
Q
  • Individuality and planning for the future are the major characteristics of late adolescence
  • Less self-centered and more caring for others
  • Idealism with rigid concepts of right and wrong with moral reasoning
  • More serious relationships
  • Greater emphasis is placed on the late adolescent’s **responsibility for his or her health **

what stage of adolescence?

A

late adol - 17-21 y/o

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5
Q

Leading causes of morbidity and mortality of adolescent medicine?

A
  • Automobile crashes (75% of all deaths MVA related)
  • Homicide / Suicide
  • Reproductive Health (STDs, unwanted pregnancies)
  • Alcohol / Drug Use, tobacco use
  • Obesity / Type 2 Diabetes
  • Hypertension
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6
Q

when to screen kids for risk-tasking behavior?
how to discuss?

A
  1. all kids 10 and older
  2. Speak with them in the room with parents and also without parents if they prefer
  3. Confidentiality
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7
Q

Key characteristics in mature minors are?

A

their competence and capacity to understand, not their chronological age

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8
Q

Some issues cannot be kept confidential such as:

A

uicidal intent, positive HIV status, and disclosure of sexual or physical abuse

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9
Q

If you are unsure if disclosing confidential information is in question it is wise to ?

A

seek legal, ethical or social worker consultation.

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10
Q

Sexual education and birth control for adolescents?

A
  • 6th grade in any public school but at any age in office
  • Birth control - if demonstrates maturity. No minimum age for purchasing condoms
  • HIV testing - no age limit
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11
Q

Drug related issues are screened when?

A

at any age, but 11 and older is key

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12
Q

three ways a child can become emancipated:

A
  1. get married
  2. join the military
  3. go to court and have the judge declare you emancipated
    - over age 16 who has petitioned a court to be declared emancipated
    - Physically and Financially independent of family
    - Childbirth (does not automatically make them emancipated, but may apply)
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13
Q
  • Child over age 14 who demonstrates maturity and decision-making capacity
  • Intervention is neither a major one nor for the benefit of another
  • In the case of an STD or treatment thereof
  • Thorough documentation of the above in the medical record

what type of minor?

A

mature minors

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14
Q

4 categories of preventative services

A
  1. Screening
  2. Counseling to reduce risk
  3. Immunizations
  4. General health guidance: Even if parents accompany the adolescent to the appointment - ask the patient if ok to ask them to leave the room to discuss more private issues with the patient. BUT have chaperone for exam.
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15
Q

components to screen for

A
  1. Diet
  2. Exercise
  3. Seatbelts / Helmets / Texting
  4. Sleep
  5. Sexual behaviors
  6. Substance abuse
  7. Online behavior issues
  8. Bullying
  9. Sports
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16
Q

how to approach adolescents while screening

A
  1. Use a non-judgemental approach
  2. Open ended questions
  3. Be truthful and genuine
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17
Q

what to check for in immunizations

A
  1. Always check Hep A
  2. Tetanus may be given at age 10 or 11
  3. Meningococcal vax
    - Menactra, Menveo, Menomune - serogroup A, C, W and Y
    - MenB (newest) - Trumenba and Bexsero - serogroup B
  4. HPV / Gardasil vaccine
    - Originally 3 separate vaccines
    - now if vaccinated before age 15 - may receive only 2 - one at initial visit and one 6 months later
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18
Q

components of anticipatory guidance

A
  1. Healthy diet
  2. Seatbelts / helmet
  3. Exercise
  4. Sleep
  5. Sexual behaviors
  6. Avoid substance abuse
  7. Online behavior issues
  8. Bullying
  9. Electronics - Limiting to 1-2 hours a day
  10. Sunscreen
  11. Bug spray
  12. Breast exams / testicular exams
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19
Q

depression/anxiety should be screened if any suspicion such as:

A

changes in activty, emotions, and behavior

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20
Q

mgmt for depression/anxiety

A
  1. Medication / and or counseling
  2. Lab studies
  3. Follow-up regularly
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21
Q

scoring of PH9 and GAD7 and their perspective tx?

A
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22
Q

Second leading cause of death ages 15 - 19 yo?
MC in which sex?

A

suicide - 90% have mental health issues

Boys > Girls
Boys 3X greater rate of completed suicide
Girls 2X greater attempts

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23
Q

most adolescents have what two mood disorders?

A

bipolar or depression

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24
Q

MC ways of suicide seen in adolescents?

A
  1. firearm
  2. suffocation
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25
Q

suicide RF

A
  1. Family hx of suicide or suicidal ideation
  2. History of adoption
  3. Male gender
  4. Parental mental health problems
  5. Lesbian, gay, bisexual, transgender, or questioning of sexual orientation
  6. History of sexual abuse
  7. Previous attempt
  8. Sleep disturbances
  9. Stressful life events
  10. Depression, bipolar, panic attacks, psychosis
  11. Substance abuse disorders
  12. PTSD
  13. Pathologic internet use
  14. NSSI - Non-suicidal self injury (cutting)
  15. Bullying
  16. Impaired parent-child relationship
  17. Living outside the home
  18. Difficulties in school, not attending school, social isolation
26
Q

suicide mgmt

A
  • Screening: Depression / Anxiety, NSSI, Social aspects (Bullying, family stressors, school, friends), Substance abuse
  • Medication and counseling: Treat the underlying disorder; Document - NSHIATT; Close follow-up
27
Q

definition of school avoidance?

A
  • Missing 1 week or more of school for an illness which would not require serious treatment
  • Continues despite parents and care providers encouragement to attend
  • Excessive absences in the past or separation anxiety history
  • Recurrent somatoform complaints
  • Returning to school quickly should be emphasized - So overwhelmed with catching up they get more anxious
  • Parents feel helpless in getting them to attend
  • Homebound/ now virtual options
28
Q

AAP recommends BP measurement with height for every child how old?
how often?

A
  • >= 3 yo
  • Yearly at WCC
  • Every visit if RF or obese
29
Q

dx elevated BP is based on ?

A

patient plotting in the >95% according to age, sex, and height

30
Q

New standards now classify those >13 years as adult with elevation of blood pressure measurement of ?

A

> 130/80

Considered positive if elevated on 3 separate occasions at least 1-2 weeks apart

31
Q

nml, elevated, Stage I, stage II BP for < 13 y/o?

A
  • Nml - < 90th percentile
  • Elevated - 90-95th percentile or between 120/80 and < 95th percentile (whichever is lower)
  • Stage I- Between ≥95th and < 95th percentile+12 mm Hg or between 130/80 and 139/89 mmHg (whichever is lower)
  • Stage II - ≥95th p+12 mm Hg or ≥140/90 mmHg
32
Q

nml, elevated, Stage I, stage II BP for < 13 y/o?

A

nml - < 120/80
elevated - 120/80 - 129/80
Stage I - 130/80 - 139/89
Stage II - >140/90

33
Q

diagnostics for Stage I HTN - if asx

A
  • Repeat in 1-2 weeks but initiate lifestyle modification
  • If still elevated at f/u - recheck again in 3 months w/ counseling on nutrition and lifestyle changes again
  • If elevated at f/u in 3 months - order labs, radiographic workup, and begin medication (ABPM may be ordered via referral if available)
  • Pt MAY participate in sporting activities
34
Q

diagnostics for Stage II HTN - if asx

A
  • Repeat in 1 week but initiate lifestyle modification
  • If elevated at f/u - order labs, radiographic workup, and refer to specialist for ABPM
  • Begin medication
  • MAY NOT participate in sporting activities until cleared by specialist
35
Q
  • Elevated Blood Pressure - Workup
  • additional for obese?
A
  • CBC
  • CMP
  • UA
  • Lipids
  • Renal U/S - normal weight children >8 y/o or <6 y/o with any abnormal urinalysis or renal function
  • Cardiac ECHO - LVH
  • If obese (BMI >95%): HbA1C, AST/ALT - screen for fatty liver
  • Other possible studies: TSH, Sleep study
36
Q

mgmt for elevated BP

A
  1. Medications
    - ACE - Lisinopril MC
    - ARBs - Losartan
    - Thiazides - HCTZ
    - CCB - Amlodipine
  2. Anticipatory Guidance
    - Nutritional counseling and DASH diet
    - Exercise
  3. Follow-up
    - q 4-6 wks to titrate dose PRN, then q 3 mo
    - Goal: SBP and DBP < 90th percentile or
    < 130/80 if >13 y/o
37
Q

Breast buds - onset of female breast development

A

Thelarche

38
Q

Early pubertal changes around 10.5 years of age (appearance of axillary and pubic hair) and growth spurt

A

Pubarche

39
Q

onset of androgen-dependent body changes such as body odor and acne and pubic hair increases

A

Adrenarche

40
Q

Beginning of menstruation - starts about 2-½ years after onset of puberty

A

Menarche

41
Q

tanner staging of girls and boys?

A
  • Completion typically takes between 4-5 years
  • Girls - 10.5
  • boys - 11.5
42
Q

precocious puberty - Secondary sexual characteristics starting before age ___ in Caucasian females or age ___ in African American or Hispanic females / < age ____ in boys

A
  • 8
  • 7
  • 9

screen!

43
Q

precocious puberty is idiopathic MC in who?

A

girls

44
Q

definition of delayed puberty?
often associated with what deficiency?
tx?

A
  • 12 - 13 years in girls for breast development (no menses by 16); 13 - 14 years in boys for testicular enlargement
  • Typically associated with GnRH deficiency
  • Exogenous testosterone or estrogen (boys >14 or girls >12 with no signs of sexual development)
45
Q
  • Benign symmetrical glandular breast tissue with no terminal alveolar development
  • 65% males going through puberty
  • Imbalance between androgens and estrogens
  • bilateral but may be unilateral
  • Tender to palpation
  • Regresses spontaneously between 1 - 2 years (70%), and usually not past age 17 yo
  • not greater than 4 cm in diameter

dx?
mgmt?

A
  • Gynecomastia
  • Watch and wait (12-14 mo); Persistent with psych trauma - surgical; meds controversial - testosterone, tamoxifen
46
Q

w/u for precocious puberty

A
  • Bone Age - XR of L hand and wrist to compare chronological age with skeletal maturity age
  • LH
  • FSH
  • DHEA-S - sex steroid hormone exclusively of adrenal origin
  • Estradiol (females) - sex steroid hormone
  • Testosterone (males)
  • Prolactin - pituitary hormone which can detect adenomas
  • MRI brain - evaluate for CNS lesions
  • Other testing - GnRH stimulation test, HCG, TSH, pelvic U/S or testicular U/S
47
Q

Sexual development meaning in boys and girls:

A

increased testicular size in boys
breast size in girls

48
Q

w/u for delayed puberty

A
  1. CBC, ESR, CMP
  2. Estradiol (females)
  3. Testosterone (males)
  4. Prolactin
  5. TSH
  6. DHEA-S
  7. Bone age studies
  8. MRI brain
49
Q

wha number of high school teens admit to being sexually active?
how many will contract an STD? which are MC?

A
  • ½ of HS teens
  • ¼ - HPV, chlamydia and trichomoniasis
50
Q

how to address sexual activity with HS teens?

A
  • Screen all teens alone in the room without a parent present if possible
  • Ask open ended questions and ensure confidentiality
  • urine screen for gonorrhea and chlamydia yearly on any teen who has been sexually active in the past
  • Screen any teen for pregnancy before starting any type of OC
  • Complete urine pregnancy test on any adolescent female ℅ amenorrhea or persistent vomiting, despite disclosure of not being sexually active
51
Q

what age to start cervical-cancer screening? (unless started to have sex much sooner or have HIV and are on antivirals)

A

21

52
Q

what age to stop cervical-cancer screening?

A

65

53
Q

what age range recommended to get pap test q3yrs

A

21-29

54
Q

what age range is recommended to get either a pap test q3y or both the HPV and the pap test q5y

A

30-65

55
Q

for all ages, when can you skip the annual pelvic exam?

A

if no sx and not pregnant

56
Q

tanner stage 1 for female, male, both?

A

female - preadolescent
male - childhood size
both - none

57
Q

tanner stage 2 - female, male, both?

A

female - breast buds
male - enlargement of scrotum/testes
both - sparse, long, straight

58
Q

tanner stage 3 - female, male, both?

A

female - areolar diameter grows
male - penis grows in length, test continue to grow
both - darker, curling, increased amount

59
Q

tanner stage 4 - female, male, both?

A

female - secondary mound; separation of contour
penis grows in length/breadth; scrotum darker, testes enlarge
both - coarse, curly adult type

60
Q

tanner stage 5 - female, male, both

A

female - mature female
male - adult shape/size
both - adult, extends to thighs

Pediatrics (23 decks)

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