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Summer Disciplines 3 > Adolescent medicine > Flashcards

Adolescent medicine Flashcards

1
Q

What ages is adolescence

A

Usually 10/12 until 18/21

12-18 in AZ legally

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2
Q

What is adolescence

A

period of rapid physical, emotional, cognitive, and social development

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3
Q

Why do adolescents have the lowest rates of presenting to the office for visit

A

because they “feel” healthy

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4
Q

What are the top 5 causes of death among teens

A 
1. Accidents (MVC) 
homicide 
suicide 
cancer 
heart disease 
Other: substance use, eating disorders, obesity
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5
Q

Most causes of death among teens are…

A

Preventable!!!

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6
Q

Healthy People 2020 focuses on

A

priorities, public awareness, understanding determinants of health, setting objectives or goals, practicing with EBM, identifying research needs

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7
Q

High priority issues (leading health indicators) according to healthy people 2020 are

A 
tobacco use 
substance use 
social determinants of health 
reproductive health 
oral health 
obesity, physical activity, and nutrition
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8
Q

How can you prevent car related injuries in adolescents

A

Reduce alcohol consumption when driving
Reduce kids who ride with an adult who drank
increase use of seat belt in high school
Must be 13 to ride in the front seat

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9
Q

How can we improve reproductive health

A

reduce chlamydia prevalence and HIV/AIDS
increase non-sexually active teens
Of the sexually active, increase condom use

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10
Q

Explain adolescence vs puberty

A

Adolescence is the period of development

Puberty is the biologic process in which a kid becomes an adult

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11
Q

What initiates puberty

A

Activation of HPG(gonadal) axis

Amplitude of FSH&LH increases in middle adolescence- stimulates gonads to produce estrogen or testosterone

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12
Q

When does puberty (growth) begin

A

Girls: 11.5-12 peak velocity, end of max growth by 11.
Boys: 13.5-14, end of max growth at 12
-in general, girls growth spurt is 2 years before boys

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13
Q

What are the stages of adolescence

A

Early: 10-13 y/o
Middle: 14-16 y/o
Late: >17 y/o

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14
Q

What are key things that happen in early adolescence

A

Only interested in present, limited thought to future (if someone is mad at them this is the end of the world)
Feel awkward about self and body
They realize parents aren’t perfect and increase conflict with them
Desire independence
Return to childish behavior, esp when stressed
moody
private

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15
Q

What are key things that happen in middle adolescence

A

Greater capacity for setting goals moral reasoning
think about meaning of life
intense self involvement
worry about being “normal”
drive for independence (farther from parents)
peers gain importance
Feelings of love and passion emerge

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16
Q

What are key things that happen in late adolescence

A 
ability to think ideas through 
delay gratification (put others before self) 
concerned for future 
interest in moral reasoning 
firmer self identity 
emotional stability 
concern for others 
independence and self reliance 
peer relationships remain
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17
Q

What are the Tanner stages of puberty for girls

A

1: pre-pubertal
2: elevation of breast and papilla, sparse pubic hair along labia. 9-10
3: menses, enlargement of breasts, dark pubic hair over mons. 11
4: Secondary mound above breast, adult hair but only on mons. 12
5. Recession of areola. adult hair. 13-14

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18
Q

When does menses usually occur

A

2 years after thelarche (tanner 3-4)
but NOT associated with ovulation- it is caused by effects of estradiol on endometrial lining
When menses become regular is caused by E&P from ovaries

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19
Q

What are tanner stages of development for boys

A

1: prepubertal
2: Enlarged scrotum (9-10 y/o)
3: darker sparse hair. penis lengthens.
4: adult hair but sparse. larger penis, larger and darker scrotum. (14-15)
5: adult hair. adult size penis and testes

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20
Q

How can you tell appropriate from concerning adolescent behavior

A

Appropriate: want autonomy, avoid family, demand privacy, argumentative (Concern: extreme withdrawal even from peers)
Appropriate: bewildered/dysphoric at start of middle school (Concern: fail to adapt after weeks-months)
Appropriate: Risk taking is limited (Concern: escalation in risk taking behavior)

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21
Q

What are common challenges in adolescence

A

Consent and confidentiality (don’t want to tell parents)
Reluctance to admit their behaviors
Access to healthcare (transportation and cost)

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22
Q

In AZ, minor consent is

A

Minor can be given care only if parent consents or is in an emergency UNLESS:
Emancipated, marries, or homeless
Care is related to STI, rape (12+), substance use (12+), alcoholism, or HIV testing

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23
Q

What does AZ law say about minors and STI testing

A

minors may consent for evaluation and treatment

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24
Q

What does AZ law say about sexual assault

A

12+ y/o may consent for Tx is parents are unreachable.

BUT, clinicians must report to CPS/DCS

25
What does AZ say about pregnant minors
Nothing specific. They can get Tx as "mature minors" or in an emergency Adolescent moms can consent to their kids care, but not to their own
26
What is one way girls can get around the AZ laws
They can get care under the Federal Title X law at title X facilities- planned parenthood
27
Things to consider when a minor wants HIV testing are
test them based on their ability to understand; | Do they understand the consequences? and the potential treatment if positive?
28
What does AZ law say about chemical dependency
minors can apply for Tx at a substance abuse facility, but have to tell parents once they are admitted 12+ under the influence (or withdrawing) are a medical emergency so consent is implied
29
What does AZ law say about minors and mental health treatment
Inpatient Tx requires parents, except if emergent Tx is necessary to prevent injury laws are vague; generally you need parental consent for outpatient Tx or counseling of minors
30
What is the AZ law on minors and abortions
they can NOT consent for abortion unless emancipated, authorized by a judge, result of sexual misconduct, or is harmful to patients health
31
With adolescent healthcare, we should focus on
Documenting*** Education! Giving appropriate care!
32
During your adolescent encounter, approach the pt this way
Discuss confidentiality and consent; explain importance of confidentiality to patient and their guardian Listen without interrupting Observe nonverbal communication Ask for explanation for unfamiliar slang terms Avoid making judgements based on appearance
33
What cases require disclosure by law
Abuse SI HI STI's reportable to public health departments
34
Adolescence interview tools include
HEADSSS; Home- Education/exercise- Activities/job- Drugs- Suicidality- Sex- Safety SAFE TEENS; Sexuality- Accidents/abuse- Firearms/homicide- Emotions/suicide- Toxins- Environment- Exercise- Nutrition- Shots/school/vaccines
35
Why do we want to know about HEADSSS
H: home life has an impact on teen's ability to succeed E: bullying and future plans are very important A: look for disengagement and withdrawal D: don't judge but you need to know if you need a further workup S: don't judge, ask about oral sex, normalize sexual feelings even when not sexually active. avoid assumptions S: psychosocial history can reveal depression idications
36
What is Bright Futures
Program of principles, strategies, and tools that can be used to improve health and well being of all kids Includes universal screening for Dyslipidemia in late adolescence (19-21)
37
What is the most preventable and largest cost public health problem in adolescents
Substance use! **Alcohol Then cigarettes, then marijuana 75% of high school teens report using an addictive substance
38
What personality challenges increase risk for substance abuse
``` FHx childhood abuse, neglect, trauma, etc. Concurrent mental health problems victim of bullying Engage in other risky behaviors ```
39
Substance use impacts development in regions of the brain associated with
Judgement Attention Memory Reward seeking
40
What are other substances that are abused
``` Inhalants Dextromethorphan Salvia Synthetic cannabinoids Bath salts Prescription drugs ```
41
What cultures factors play a role in adolescent substance use
living with a parent who engages in risky behavior parents thinking it is unrealistic that their kid WONT try marijuana social media availability of drugs
42
Look for these manifestations that point to substance use
Needle marks Nasal mucosal injuries S/p trauma (MVC, bike injuries, and violence), Impaired sensorium, and seizures
43
What is the SBIRT approach to adolescent substance use
Screening Brief Intervention Referral Treatment
44
When does depression become more prevalent
After puberty MC in women Likely attributed to moodiness o PMS, so don't miss this diagnosis!
45
What is the leading cause of suicide in youth
Depression! | Gay and lesbian are 2x likely to attempt suicide at least once
46
If concerned for depression, screen in this way
have you felt sad or down? Difficulty sleeping? Feeling irritable? Feel like you have nothing to look forward to? -If yes to any, use Beck's depression inventory (12-18 y/o) or Child's depression inventory (7-17 y/o)
47
How does depression present in teens
``` Anhedonia Boredome Hopelessness Weight changes Substance use Suicide attempts Parents report irritability ```
48
How can you help treat depression in teens
Refer to peds behavioral health Psychotherapy *Prozac (Fluoxetine) is the only FDA approved SSRI for kid 8+ (must be on therapy for 6 months min.) Give them the link, text and call line to the help line
49
What is the 3rd MC chronic illness in adolescent girls
Eating disorders (obesity and asthma are first) Adolescent:Adult is 5:1 F:M is 10:1 However, gay men and wrestlers are higher risk than average male population
50
S/Sx of anorexia nervosa are
``` Decreased body temp (always cold) Bradycardia Dizziness Decreased peripheral perfusion (toes get mottled) Thin hair and nails Dry skin Early satiety Depression ```
51
DSM5 for anorexia nervosa is
1. Restrict energy intake, leading to low BW for sex, age, development trajectory, and physical health 2. Intense fear of gaining weight even though weight is significantly low 3. Disturbance in self image
52
What are the types of anorexia nervosa
Restricting: weight loss through dieting, fasting, or excessive exercise Binge/purge: In the last 3 months, pt has had recurrent eating and purging behavior
53
What are S/Sx of bulimia nervosa
``` Abdominal pain Early satiety Diarrhea/constipation Parotid pain/enlargement Depression Dehydration Tooth enamel loss Dental caries Bruising/thickening along joints of fingers ```
54
When suspecting bulimia, keep in mind
They are average or even over weight Parents can notice food is missing Screen patient on their views on food and eating Ask direct questions
55
What is Diabulimia
Diabetic patients ski insulin to lose weight
56
To diagnose bulimia, disease must be present for
1x week for at least 3 months No compensatory behaviors -Eat more rapidly than normal and until they are uncomfortably full, or when not even hungry -Eat alone 2/2 embarrassment, and then feel disgusted with themselves
57
What are OSFED
Other specified feeding or eating disorders | Basically patients don't meet the criteria for anorexia or bulimia but still have something
58
Treatment of eating disorders depends on
``` Severity of illness Length of illness Complications of disease state Previous Tx and outcomes Financial resources ```
59
Should you discuss BMI with eating disorder patients
Yes! regardless of weight. But don't discuss actual weight, weigh them backwards in office

Summer Disciplines 3 (9 decks)

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