Adolescent Medicine

Question 1

Define adolescence

Answer 1

Ages 11-21

Physical growth, psychosocial and sexual development, increasing independence and risky behaviors

Question 2

What physical changes happen in puberty?

Answer 2

Secondary sexual characteristics (gender specific changes that don’t have to do with reproduction), pubertal growth/increase to “adult size” and reproductive capacity

Question 3

What is Tanner Staging used for?

Answer 3

Determining sexual maturity (breast in females, genitals in male and pubic hair in both)

Question 4

What are stages 1 and 5 in tanner staging?

Answer 4

1: preadolescence and 5: adult development

Question 5

Tanner staging of breast development in girls

Answer 5

1: prepubertal with no palpable breast tissue
2: breast and papilla elevated as small mound, areolar diameter increased
3: breast and areola enlarged but no contour separation
4: areola and papilla form secondary mound
5: mature, nipple projects, areola part of general breast contour

Question 6

Tanner staging for pubic hair growth in girls

Answer 6

1: none
2: sparse, slightly pigmented, straight, at medial border of labia
3: darker, begin to curl, increased amount
4: course, curly, abundant, but less than adult stage
5: adult feminine triangle, spread to medial surface of thigh

Question 7

What is the first sign in the development of boys?

Answer 7

Enlarging testicles

Question 8

What is the sequence of puberty in girls?

Answer 8

Thelarche (breast development)
Pubic hair growth
Peak height velocity (growth spurt)
Menarche
Completion
Tanner stagings don't have to match up

Question 9

Sequence of puberty in boys

Answer 9

Increased testicular volume
Penile and pubic hair growth
Peak height velocity
Nocturnal sperm emissions/ sperm in urine
Completion

Question 10

When do you want to worry about child’s puberty/development?

Answer 10

Precocious/early puberty (2-3 standard deviations below mean age of onset-might be tumor releasing hormones)
Delayed puberty

Question 11

What is the traditional definition of precocious puberty?

Answer 11

Breasts before 8 in girls and testicular enlargement before 9 in boys

Question 12

What is the upper limits of development for kids?

Answer 12

12-13 for breasts and 13-14 for testicular enlargement

Question 13

What are the leading causes of morbidity?

Answer 13

Pregnancy, STIs, drug/alcohol abuse, obesity, tobacco use

Question 14

What is the bulk of adolescent medicine?

Answer 14

Preventative services: screening, counseling to reduce risk, providing immunizations, general health guidance

Question 15

What are important screens to do?

Answer 15

HTN, obesity/eating disorders, abuse, learning problems, substance abuse, depression, sexual behavior, HIV
Hyperlipidemia and TB only if suspected

Question 16

What immunizations must you have by 11-12 yrs?

Answer 16

Having A Buddy Makes Me Realize How Much Puberty Varies In Teens
Hep A/B, MMR, HPV, Meningococcal, Pneumococcal (if high risk for infection), Varicella, Influenza, Tdap

Question 17

What questionnaires can we use?

Answer 17

HEEADSSS-general screening
CRAFFT- substance abuse
PHQ-2- mental health

Question 18

What is conditional confidentiality?

Answer 18

Explicitly defined circumstances in which confidentiality must be broken at initial visit
Required by law (if required discuss with pt who will be told and how)

Question 19

What are some exceptions to confidentiality?

Answer 19

Child abuse/neglect, suicidal/homicidal ideation or attempt, violent injuries, STIs, consensual sex, mental health care, parental notification

Question 20

What is unconditional confidentiality?

Answer 20

Everything will be kept private from anyone unless pt chooses otherwise
Not protected by low and not endorsed by guidelines of any organizations

Question 21

What are potential inadvertent threats to confidentiality?

Answer 21

Medical records, HIPAA, FERPA, HITECH, payment for services, pharmacists

Question 22

What are the different levels of status for minors?

Answer 22

Unemancipated, emancipated (legal), medically emancipated, mature minor

Question 23

How does consent relate for homeless?

Answer 23

Grant them ability to consent on own care and must lack a regular night time residence or live in supervised temporary accomodations

Question 24

What are mature minors?

Answer 24

They are able to consent to routine care and low risk txs, at least 14 and able to understand risks and benefits of the tx
Not recognized in AZ

Question 25

In what medical situations can minors consent for themselves?

Answer 25

Mental health services, pregancy/contraceptive, testing/tx of HIV, STI testing/tx, drug/alcohol addiction tx
Varies with states

Question 26

When an minors consent for care in AZ?

Answer 26

When 1 of the following applies:
Emancipated, homeless or married
Emergency
STIs/HIV testing
Sexual assault and pt is over 12 (only if cannot contact legal guardian within time exam is needed)
Substance abuse and pt is over 12 (parents must be notified when admitted and under influence is considered emergency so implied)

Question 27

What can minors consent to in AZ?

Answer 27

Pregnancy care, substance abuse care, family planning services and emergency contraceptions

Question 28

What CANT minors consent to in AZ?

Answer 28

Mental health screening/tx (exception to save the life), abortion (many exceptions)