Adolescent Medicine/ Ethics/ Palliative Medicine

Question 1

first visible sign of puberty among males

Answer 1

testicular enlargement

Question 2

first sign of puberty among females are usually seen in what age?

Answer 2

8-12 yo

Question 3

features are usually seen during middle adolescence:

Answer 3

males growth spurt, nocturnal emissions, voice changes

Question 4

Dylan is a male high school student. His father is an OFW and he was raised by his mother and grandmother, of whom he has good relationship with. He enjoys friendship with girl cousins and is not keen in doing sports and other activities. He oftentimes questions his sexual orientation. These thoughts are common in what adolescent stage?

Answer 4

middle

Question 5

Emergence of abstract thought is seen during this period of adolescence?

Answer 5

middle

Question 6

In females, when the areola and papilla form a second mound, the child is in what sexual maturity rating?

Answer 6

SMR 4

Question 7

You were called in the pedia ward by the intern because of an adolescent female who refused to be examined. After explaining to her, she agreed for you to do the physical examination. For her sexual maturity rating, you observed that pubic hair is coarse, abundant yet not as much as that of the adult’s. What would be her SMR stage?

Answer 7

SMR 4

Question 8

A male Dengue patient underwent HEADSSS screening. Reading the intern’s notes, he wrote that the child has enlarged scrotum, pink and altered texture. What SMR stage is he in?

Answer 8

SMR 2

Question 9

If a male patient has a larger penis, with increased glans and breadth, what SMR stage is he in?

Answer 9

SMR 4

Question 10

Based on DSM 5 Diagnostic Criteria for Gender Dysphoria, as adolescent should have at least how many manifestations (i.e. incongruence between experienced gender and anticipated sex characteristics) before he can be labeled GD?

Answer 10

2

Question 11

Which of the following is an identified protective factor for developing smoking behavior?

Answer 11

Perceived healthiness

Question 12

Based in the American Academy of Pediatrics guidelines on allowing medical treatment for adolescents without parental consent, which of the following is considered a “legal exception” for a parental consent?

Answer 12

Adolescent being married

Question 13

True or false: For new patients, parents should be interviewed either before or with the adolescents

Answer 13

true

Question 14

Evaluation for scoliosis is part of the required physical examination for adolescents. What would be an indication for referral to an orthopedist?

Answer 14

Curve measuring greater than 10 degrees

Question 15

In relation with WHO’s FISTS mnemonic for assessing adolescent’s risk of violence, the “second” S stands for:

Answer 15

Self Defense

Question 16

“Family risk factor” for adolescents developing a drinking problem

Answer 16

Low parental supervision
Family conflicts
Having a parent with alcohol drinking problem

Question 17

According to AAP CLinical Guidelines for care for adolescent parent and their children, which should be part of the contraceptive counseling?

Answer 17

Emphasize condom use

Question 18

the following statements regarding withholding and withdrawing treatment for pediatric patients is TRUE/FALSE:
Resuscitation may be done also to help address parental burden of not “withholding available life-saving resuscitations” to their child.

Answer 18

false

true:
A.This is ethically acceptable if it complements the plan for the patient, to improve quality at the end of life than cure.
B.The focus should be mainly in the child rather than the interests of the family.
C.The medical order regarding resuscitation is not irrevocable.

Question 19

This pertains to the concept that an action with good and bad effects is morally justifiable if the good effects is the only one intended, and the bad effect is foreseen and accepted but not desired.

Answer 19

doctrine of double effect

Question 20

This pertains to a standard government legislation prohibiting withholding of medically beneficial treatment for disabled infants

Answer 20

baby doe regulation

Question 21

In balancing maternal and fetal interests, it is generally acceptable for the physician to go ahead with treatment against the mother’s will in the following situations

Answer 21

risk to the pregnant woman is minimal
intervention is clearly effective
harm to the fetus/unborn child without the intervention would be certain, subtstantial and irrevocable

Question 22

Regarding participation of the pediatric patients in research, which of the following statements is true:

The welfare of an invidual child must always come before the scientific goals of the research study.

Answer 22

false:
Children should never be included with the exception of certain populations where specific diseases are more common.
All states require that important researches on children be allowed as long as the families are assured that risks are minimal.
Researches may proceed as long as the parents give full consent.

Question 23

Different religions have different practices, in some cases, issues arise due to these differences. In which situation can a pediatrician continue treatment despite parental objection?

Answer 23

If a child’s life is imminently threatened

false:
If the parents are not of legal age
If the hospital is training hospital
If parents have signed a revocable dissent form

Question 24

conditions appropriate for palliative care except:
A. Conditions where curative treatment is possible but may not succeed
B. Conditions where there is intensive long term treatment to prolong lige but risk of death is still possible
C. Progressive conditions where there is no curative option
D. Progressive conditions where family decided to do palliative care due to lack of resources

Answer 24

D. Progressive conditions where family decided to do palliative care due to lack of resources

Question 25

Palliative Home Care for the child with a life-threatening illness requires all of the following, EXCEPT:
A. 24 hours per day access to experts in pediatric palliative care
B. Identified coordinator who serves as a link between hospitals
C. Adequate home care support
D. 24 hours on duty nurse

Answer 25

D. 24 hours on duty nurse

Question 26

Which of the following is part of the recommended strategies and responses for dying children aged months to 3 years old:
A. Optimize comfort, and consistency; familiar persons, objects, routines
B. Be honest and provide specific details if they are requested
C. Help and support the child’s need for control
D. Permit and encourage the child’s participation in decision making

Answer 26

A. Optimize comfort, and consistency; familiar persons, objects, routines

Question 27

These are typical questions and statements about dying among 5-10 years old, EXCEPT:
A. "How will I die?"
B. "Will it hurt?"
C. "Is dying scary?"
D. "Why is God letting this happen?"

Answer 27

D. “Why is God letting this happen?”

Question 28

A child who suffers from Acute Myelogenous Leukemia was to be referred to palliative care. She seems to have an understanding of death as real and permanent. Death, according to her, means that your heart stops, your blood does not circulate, and you do not breathe. These are the usual insights of what particular age group?

Answer 28

5-10 yo

Question 29

Which of the following is one of the key elements of effective symptom management for palliative care?
A. Focus on the specific body part wher the patients complains the most
B. Pain management should be the focus of care
C. Understand pathophysiology of symptoms
D. Avoidance of nonpharmacological modalities to prevent giving false hope

Answer 29

C. Understand pathophysiology of symptoms

Question 30

In pain management, what is recommended to enhance analgesia from opioids?

Answer 30

Ketamine or Clonidine