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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
Q

What does AZ say about pregnant minors

A

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
Q

What is one way girls can get around the AZ laws

A

They can get care under the Federal Title X law at title X facilities- planned parenthood

27
Q

Things to consider when a minor wants HIV testing are

A

test them based on their ability to understand;

Do they understand the consequences? and the potential treatment if positive?

28
Q

What does AZ law say about chemical dependency

A

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
Q

What does AZ law say about minors and mental health treatment

A

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
Q

What is the AZ law on minors and abortions

A

they can NOT consent for abortion unless emancipated, authorized by a judge, result of sexual misconduct, or is harmful to patients health

31
Q

With adolescent healthcare, we should focus on

A

Documenting***
Education!
Giving appropriate care!

32
Q

During your adolescent encounter, approach the pt this way

A

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
Q

What cases require disclosure by law

A

Abuse
SI
HI
STI’s reportable to public health departments

34
Q

Adolescence interview tools include

A

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
Q

Why do we want to know about HEADSSS

A

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
Q

What is Bright Futures

A

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
Q

What is the most preventable and largest cost public health problem in adolescents

A

Substance use!
**Alcohol
Then cigarettes, then marijuana
75% of high school teens report using an addictive substance

38
Q

What personality challenges increase risk for substance abuse

A 
FHx 
childhood abuse, neglect, trauma, etc. 
Concurrent mental health problems 
victim of bullying 
Engage in other risky behaviors
39
Q

Substance use impacts development in regions of the brain associated with

A

Judgement
Attention
Memory
Reward seeking

40
Q

What are other substances that are abused

A 
Inhalants 
Dextromethorphan 
Salvia 
Synthetic cannabinoids 
Bath salts 
Prescription drugs
41
Q

What cultures factors play a role in adolescent substance use

A

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
Q

Look for these manifestations that point to substance use

A

Needle marks
Nasal mucosal injuries
S/p trauma (MVC, bike injuries, and violence), Impaired sensorium, and seizures

43
Q

What is the SBIRT approach to adolescent substance use

A

Screening
Brief Intervention
Referral
Treatment

44
Q

When does depression become more prevalent

A

After puberty
MC in women
Likely attributed to moodiness o PMS, so don’t miss this diagnosis!

45
Q

What is the leading cause of suicide in youth

A

Depression!

Gay and lesbian are 2x likely to attempt suicide at least once

46
Q

If concerned for depression, screen in this way

A

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
Q

How does depression present in teens

A 
Anhedonia 
Boredome
Hopelessness 
Weight changes 
Substance use 
Suicide attempts 
Parents report irritability
48
Q

How can you help treat depression in teens

A

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
Q

What is the 3rd MC chronic illness in adolescent girls

A

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
Q

S/Sx of anorexia nervosa are

A 
Decreased body temp (always cold) 
Bradycardia 
Dizziness 
Decreased peripheral perfusion (toes get mottled) 
Thin hair and nails 
Dry skin 
Early satiety 
Depression
51
Q

DSM5 for anorexia nervosa is

A
  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
Q

What are the types of anorexia nervosa

A

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
Q

What are S/Sx of bulimia nervosa

A 
Abdominal pain 
Early satiety 
Diarrhea/constipation 
Parotid pain/enlargement 
Depression 
Dehydration 
Tooth enamel loss 
Dental caries 
Bruising/thickening along joints of fingers
54
Q

When suspecting bulimia, keep in mind

A

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
Q

What is Diabulimia

A

Diabetic patients ski insulin to lose weight

56
Q

To diagnose bulimia, disease must be present for

A

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
Q

What are OSFED

A

Other specified feeding or eating disorders

Basically patients don’t meet the criteria for anorexia or bulimia but still have something

58
Q

Treatment of eating disorders depends on

A 
Severity of illness 
Length of illness 
Complications of disease state 
Previous Tx and outcomes 
Financial resources
59
Q

Should you discuss BMI with eating disorder patients

A

Yes! regardless of weight. But don’t discuss actual weight, weigh them backwards in office

Summer Disciplines 3 (9 decks)

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