Adolescents Flashcards

Question

Immunization Schedule for Adolescents (ages 11-18): Influenza Inactivateds

Answer 1

Vaccinate everyone from age 6 months and older annually

Answer 2

Recombivax HB) - Catch-up: Give remaining doses if not completed

Answer 3

HAVRIX, VAQTA - Catch-up: give 2nd dose if not completed - Recommended for children w/ certain health/lifestyle conditions placing them at risk

Answer 4

Catch-up: Give 2nd dose if not completed

Answer 5

- If no reliable hx of chickenpox (verbal okay) - live virus precautions

Answer 6

government program to report clinically adverse events

Answer 7

- children and adolescents normally have higher blood levels compared w/ adult d/t growing bone - produced by osteoblasts

Answer 8

No parental (or guardian) consent is necessary for the following: - Contraception - Treatment for STDs - Diagnosis and management of pregnancy ** No parental consent is needed for health services r/t sexual activity (STD testing, pregnancy tests, birth control prescriptions) * If not related to sexual activity, then need parental consent (dysmenorrhea, headache, upper respiratory infection [URI])

Answer 9

These minors may give full consent as an adult without parental involvement - Legally married - active duty in armed forces ** Memorize criteria for an emancipated minor - Do NOT confuse right to confidentiality w/ emancipated minor status

Answer 10

Confidentiality can be broke in the following situations: - Gunshot wounds and stab wounds, which must be reported to the police (regardless of victim's age) - Child abuse (actual or suspected abuse), which must be reported to the authorities - Suicidal ideation and/or attempt (discharge to parents/guardians or hospital) - Homicidal ideation or intent (esp mental health providers)

Answer 11

Adolescent health history is obtained from both parent and child initially; then the adolescent is interviewe4d alone w/out parent During physical exam or wellness visit, assess teenager for high-risk behaviors - Intensive behavior counseling is recommended Following are high-risk behaviors to screen for: - Sexual activity → use of condoms, birth control, intimate partner violence (e.g., rape), s/sx of STDs - Safety → driver safety (seatbelt/helmet use); assess to guns/gun safety; smoking, alcohol, and drug use - Mental health → s/sx of depression and antisocial behaviors (e.g., gangs)

Answer 12

1. - absence of secondary sexual characteristics by age of 13 for girls (such as breast bud) or at the age of 14 for boys - child remains in Tanner stage I (prepubertal) 2. - Serum pregnancy test - Check prolactin level; if prolactin level is ↑, next step is to order CDT scan of sella turcica (location of pituitary gland inside skull) - For primary amenorrhea 9no menses by age 15), R/O hypogonadism by checking hormone levels (e.g., FSH, LH, TSH) - R/O chromosomal disorders, absence of uterus/vagina, and imperforate hymen - X-ray of the hand is used for estimating "bone age" → when long-bone epiphyses (growth plates) are fused, skeletal growth is finished → Refer to pediatric endocrinologist if no growth spurt, delayed puberty, others

Answer 13

1. Primary amenorrhea → No menarche by age 15 year sin presence of normal growth and secondary sex characteristics - nearly half of cases are caused by chromosomal disorders (43%) such as Turner syndrome Secondary amenorrhea → no menses for > 3 cycles or 6 months if previously had menses - most common cause is pregnancy - others are ovarian disorders, stress, anorexia, and PCOS Secondary Amenorrhea associated w/ Exercise and Underweight - excessive exercise and/or sports participation has a higher incidence of amenorrhea (and infertility) because of relative caloric deficiency - "Female athlete triad" → anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis 2. - Pregnancy test (serum human chorionic gonadotropin [HCG]) - serum prolactin level (R/O prolactinoma-induced amenorrhea) - serum TSH; also FSH and LH (R/O premature ovarian failure) - If amenorrhea for >6 months, measure bone density 3. - Educate about ↑ caloric intake and ↓ exercise - Prescribed calcium w/ Vit D 1,200-1,500 mg daily and vit E 400 IU daily 4. - Osteopenia/osteoporosis (stress fractures) - Myocardial atrophy, arrhythmia (sudden death), bradycardia, hypotension - Hypoglycemia, dehydration, electrolytes - Lanugo (fine, downy hair), telogen effluvium (hair loss), xerosis (dry skin), infertility - Low BMI, cachexia, anemia, respiratory failure

Answer 14

1. - usually onset is during adolescence - involves an irrational preoccupation w/ and intense fear of gaining weight 2 types: - patient engages in restriction (dieting, excessive exercise) - binge eating and purging Ex of purging → excessive use of laxatives, enemas, diuretics, and vomiting 2. - Marked weight loss (BMI ≤18.5), bradycardia (40-49 bpm), VS unstable, hypotension - Lanugo (↑ lanugo, esp in face, back, and shoulders) - Osteoporosis or osteopenia - Swollen feet (low albumin), dizziness, abdominal bloating Exam tip* recognize how anorexia pts present (e.g., lanugo, peripheral edema, amenorrhea, significant weight loss >10% of body weight) - ↑ risk of osteoporosis or osteopenia → For birth control, avoid Depo Provera and other progesterone-only contraceptives because they can cause bone loss - Low albumin level results in peripheral edema

Answer 15

1. - Excessive growth of breast tissue in males - can involve 1-2 breasts - physiologic gynecomastia is benign - more common during infancy and adolescence - normal in up to 40% of pubertal boys (peaks at 14 years) - most cases resolve spontaneously within 6 months-2 years 2. - gradual onset of enlarged breasts - or asymmetrical breast tissue (one may be larger) - child is embarrassed and scared about breast changes - affected breast may be tender to palpation 3. - Round, rubbery, and mobile mound (dislike) under areola of both breasts - skin has no dimpling, redness, or changes - if mass is irregular, fixed, or hard, or rapid growth in breast size or if suspect secondary cause → refer to specialist 4. - Evaluate for Tanner stage (check testicular size, pubic hair, axillary hair, body odor) - Check for drug use: Both illicit and prescription (e.g., steroids, cimetidine, antipsychotics) - R/O serious etiology (e.g., testicular or adrenal tumors, brain tumor, hypogonadism) - Recheck patient in 6 months to monitor for changes

Answer 16

1. - bilateral enlarged breast is d/t fatty tissue (adipose tissue) - common in obese boys and men - both breasts feel soft to touch and are not tender - no breast bud or disklike breast tissue is palpable 2. None. Diagnosed by clinical presentation

Answer 17

1. - Lateral curvature of the spine that may be accompanied by spinal rotation - more common in girls (80%) - Scoliosis will most likely worsen (66% of cases) if it starts in beginning of the growth spurt - Rapid worsening of curvature is indicative of secondary causes (e.g., Marfan or Ehlers-Danlos syndrome, cerebral palsy, myelomeningocele) 2. - painless and asymptomatic - may c/o that one hip, shoulder, breast, or scapula is higher than the other - no complaints of pain 3. - Adam's Forward Bend Test - Bend forward w/ both arms hanging free - look for asymmetry of spine, scapula, thoracic, and lumbar curvature - check height - measure the Cobb angle (degree of spinal curvature) - full spine x-rays are used to measure degree or curvature 4. - Curves <20º → observe and monitor for changes in spinal curvature - Curves of 20-40º → bracing (e.g., Milwaukee brace) - Curves of >40º → Surgical correction w/ Harrington rod used on spine and other options 5. - Check Tanner stage (Tanner stages II-V) - Order spinal x-ray (posteroanterior [PA] view) to measure Cobb angle - Refer ALL patients w/ scoliosis to a pediatric orthopedic specialist! ** Scoliosis treatment needed for a ≥20º curve; for curves <20 º, observe for worsening

Answer 18

1. - common cause of knee pain in young athletes - caused by overuse of knee - repetitive stress on patellar tendon by quadriceps muscles causes pain, tenderness,and swelling at tendon's insertion site (tibial tuberosity) - usually affects one knee but can be bilateral - most common during rapid growth spurts in teenage males who are physically active and/or play sports that stress the patellar tendon (e.g., basketball, soccer, running) - condition abates when growth stops 2. - teen undergoing rapid growth spurt c/o tender bony mass over anterior tubercle of one knee - pain is worsened by some activities (squatting, kneeling, jumping, climbing up stairs) - knee pain improves w/ rest and avoidance of aggravating activity - reports presence of bony mass on anterior tibial tubercle; slightly tender - almost all causes resolve spontaneously within a few weeks to months - R/O avulsion fracture (tibial tubercle) if acute onset of pain posttrauma → order lateral x-ray of knees 3. - RICE (Rest affected knee; use ice pack 3x daily - avoid aggravating activities/sports that typically reduce or resolve pain - may continue to play based on degree of pain after sports participation - play doe snot necessarily worsen condition - use acetaminophen (Tylenol) or NSAIDs for pain PRN - Quadriceps strengthening and quadriceps/hamstring stretching exercises aimed at stabilizing knee joint may also be beneficial

Answer 19

1. condition in which males are born w/ extra X chromosome (e.g., 47, XXY) - condition occurs approx in 1/1,000 live births - one of the causes of primary hypogonadism (deficiency in testosterone)\ 2. - testicles are small and firm w/ small penis - tall stature, wider hips, and reduced facial/body ahir, higher risk of osteoporosis (compared w/ normal males) 3/4. Treatment includes testosterone replacement and fertility treatment

Answer 20

1. females w/ complete or partial absence of second sex chromosome (45, X); - occurs in approx 1/2,5000 live-born females - congenital lymphedema of hands and feed, webbed neck, high-arched palate, and short fourth metacarpal 2. - short stature (height usually below 50th percentile) - Ovarian failure, cardiovascular and renal issue sor ear malformations and other health problems (as well as amenorrhea d/t premature ovarian failure [infertility])