Adolescent Medicine

Question 1

What do most teens die of?

Answer 1

accidents

Question 2

what occurs approximately 2 years before the onset of puberty?

Answer 2

Adrenarche (increase in steroid production by the adrenal glands) occurs ~2 yrs prior to the onset of secondary sexual development

Question 3

What is the first step in puberty?

Answer 3

Sleep-associated pulsatile GnRH and LH production is the first step in puberty

Question 4

how does lean body mass change in boys and girls

Answer 4

increases in boys

decreases in girls

Question 5

What is the HEADSS pneumonic?

Answer 5

Home
Education/employment
Activities
Drugs
Sexuality
Suicide
Safety
?Spirituality

Question 6

What is the AMA recommendation for physical exams during adolescence?

Answer 6

AMA recommends complete physical exam three times during adolescence in addition to annual screening for health risk behaviors and health guidance
11-13
15-17
18-21

Question 7

What are the screening recommendations for lipids?

Answer 7

Perform total cholesterol, if there are certain risk factors
Parent with cholesterol >240
Unknown family history

Fasting lipoprotein analysis if:
Parent or grandparent 55 years old or younger with documented MI, angina, peripheral vascular disease, CVA, sudden cardiac death, or CAD

Question 8

Describe when chlamydia, trichomonas, and HIV should be screened for:

Answer 8

Chlamydia trachomatis
All sexually-active males and females up to age 25

N. Gonorrhoeae
High risk individuals, esp if >2 partners

HIV
Individuals at risk

Question 9

how often should you screen for anemia

Answer 9

only once during adolescence

Question 10

when is anticipatory guidance performed?

Answer 10

Performed at the end of every well-child visit
Specific topics depend upon the age, developmental stage, examination, and issues identified throughout the entire exam

Important to point out areas of success:

• Reinforce positive behavior
• Congratulate healthy choices

Question 11

What six behaviors should be identified and addressed?

Answer 11

Use seat belts
Do not drink (use drugs) and drive
Use condoms when having sex
Do not smoke
Eat a low-fat diet
Engage in regular aerobic exercise

aka

1. B = BELTS
2. C = CONDOMS
3. D = DRINK/DRUGS
4. E= EXERCISE
5. F= FUMES
6. G = GUT

Question 12

What are the stages of adolescence?

Answer 12

1. early
2. middle
3. late

Question 13

Describe the early stage:

Answer 13

Chronological age: 10 to 13-14 years
Educational age: junior high school
SMR (Tanner Stage): 2-4

Self-identity is a major concern
Modest, easily embarassed
Clear delineation of the normality of pubertal changes

Question 14

Describe the middle stage

Answer 14

Chronological age: 15-17 years
Educational age: high school
SMR: 4-5

Increased autonomy, major conflicts over control
rebellious
concern about appearance increases

Question 15

Describe the late stage:

Answer 15

Chronological age: 18-21+ years
Educational age: college, work force
SMR: 5

Final transition into adulthood
Identity in relation to society
Achieve total independence from parents

Question 16

What are common medical problems in early adolescene?

Answer 16

eating disorders
acne
injuries

Question 17

what are common medical problems in middle?

Answer 17

Sexuality related problems – pregnancy, STD’s
Drug use, tobacco, alcohol
Intentional injury – homicide, suicide
Unintentional injury – overuse, vehicular accidents

Question 18

What are common medical problems of late?

Answer 18

Second peak of EDO’s
Continued risk of intentional and unintentional injury
MVA’s, suicide, homicide, etc
Stress-induced physical symptoms or illness