Adolescent Medicine - Exam 2 Flashcards
Rapid changes in physical appearance (secondary sex characteristics) and behavior are major changes in , leading to more self-consciousness and need for privacy
10 -13
More comfortable with members of same sex
10-13
Body image and self-esteem fluctuate
10-13
Peer relationships increasingly important
10-13
Limited thought of future and if so, vague and unrealistic goals likely
10-13
Struggle for autonomy and sense of identity are the major characteristics of
14-16
High risk behaviors as a result of experimentation are common
14-16
Intense emotions and mood swings typical
14-16
Moves from concrete thinking to more abstract
14-16
Self-centered
14-16
Peers in…parents out
14-16
History focuses on interaction with family, school and peers
14-16
Individuality and planning for the future are the major characteristics of
14-16
Less self-centered and more caring for others
17-21
Idealism with rigid concepts of right and wrong with moral reasoning
17-21
More serious relationships
17-21
Greater emphasis is placed on the responsibility for his or her health
17-21
What is the leading cause of morbidity and mortality in adolescence?
automobile crashes
than homicide/suicide
When should you start screening kids for risk taking behavior? What does this practically look like?
We screen all kids 10 and older
Speak with them in the room with parents and also without parents if they prefer
What are the key characteristics of mature minor?
their competence and capacity to understand, NOT their chronological age
What are 3 issues that cannot be kept confidential?
such as suicidal intent
positive HIV status
disclosure of sexual or physical abuse
When is sex education taught in public schools?
6th grade in any public school but at any age in office
What age should you start screening for drug related issues?
Screen at any age, but 11 and older is key
What are the 3 ways to become an emancipated minor?
get married
join the military
go to court and have the judge declare you emancipated
What is the mature minors doctrine?
a minor over the age of 14 is allowed to consent or refuse to consent to his medical treatment if it is established that the minor is sufficiently mature to understand, discern and appreciate the benefits and risks of the proposed medical treatment.
the intervention is neither a major one nor for the benefit of another
need to document
How old do you need to be in order to be eligible to petition the courts to be emancipated?
Child over age 16 who has petitioned a court to be declared emancipated
needs to be physically and financially independent of family
What are the 4 categories of preventative services for adolescent medicine?
Screening
Counseling to reduce risk
Immunizations
General health guidance
What are the guidelines for asking a parents to leave the room?
Even if parents accompany the adolescent to the appointment - ask the patient if ok to ask them to leave the room to discuss more private issues with the patient. BUT have chaperone for exam.
aka okay to leave for questions but have to be present for PE
What are the 9 topics that should be screened for?
Diet
Exercise
Seatbelts / Helmets / Texting
Sleep
Sexual behaviors
Substance abuse
Online behavior issues
Bullying
Sports
While regards to immunizations in adolescent medicine, always check _____ vaccine status. When does the Tdap need to be given?
Hep A
given at age 10-12
What are the 2 types of meningococcal vaccines?
Menactra, Menveo, Menomune - serogroup A, C, W and Y
Newest is MenB - Trumenba and Bexsero - serogroup B
Need to screen for _____ is there is any suspicion. What are some kiddo signs?
depression/anxiety
Drop in grades or school performance
Neglect of personal appearance
Neglect of responsibilities
Outbursts, severe anger or irritability
Getting into trouble, impulsive
______ is the second leading cause of death in ages 15-19 years old. _____ have mental health issues
suicide
90%
and most have a mood disorder (either bipolar or depression)
When it comes to suicide, boys are _____ and girls are ______. What are the top 2 methods?
Boys 3X greater rate of COMPLETED suicide
Girls 2X greater ATTEMPTS
suffocation and firearms
What is considered school avoidance?
Missing 1 week or more of school for an illness which would not require serious treatment
and continues despite parents and care providers encouragement to attend
How long does the Tanner Staging typically take to complete? When do girls typically end? boys?
between 4-5 years
Girls typically 10.5 and boys 11.5
What is considered precocious puberty in girls? in boys?
Secondary sexual characteristics starting before age 8 in Caucasian females or age 7 in African American or Hispanic females
before age 9 in boys
What gender is precocious puberty more likely to be idiopathic?
Idiopathic in 80-90% girls
only 25-60% boys
What age is normal for breast development in girls? testicular enlargement in boys?
12 - 13 years in girls for breast development
13 - 14 years in boys for testicular enlargement
Draw the Tanner Stages of development chart know this slide very well
What stage?
I
What stage?
II
What stage?
III
What stage?
IV
What stage?
V
What stage? How long? What volume?
I
less than 2.5cm
3ml
What stage? How long? What volume?
II
2.5-3.3cm long
4ml
What stage? How long? What volume?
III
3.4-4cm
10ml
What stage? How long? What volume?
IV
4.1-4.5cm
16ml
What stage? How long? What volume?
V
greater than 4.5cm
greater than 20ml (said 25 on the slide)
When should you screen for delayed puberty? What does sexual development mean in this context?
Absence or incomplete development of sexual characteristics by age 12 - 13 in girls (no menses by 16) or by age 14 in boys
Sexual development meaning: increased testicular size in boys and breast size in girls
___ high school teens admit to being sexually active. ____ will contract an STD. What are the top 3 MC STDs?
½
¼
HPV, chlamydia and trichomoniasis
What are ways to screen adolescent with regards to their sexual activity?
Screen all teens alone in the room without a parent present if possible
Ask open ended questions and ensure confidentiality
What is the AAP recommendation with regards to screening for STD in sexually active teens? What should you do before starting any oral contraceptive?
Urine gonorrhea and chlamydia yearly
pregnancy test
