Adolescents Flashcards
Delayed puberty males
More than 5 years have elapsed since initiation completion of genital growth
Genital stage 1 beyond the age of 13.7 yrs and pubic stage 1 beyond age of 15.1 years
Delayed puberty female
Breast stage 1 persist beyond the age of 13.4 years, PH1 persists beyond the age of 14.1 years or there is a failure to menstruate beyond 16 years
More than 5 years have elapsed between initiation of breast growth and menarche
Labs for delayed puberty
CBC, UA, ESR; CMP, bone age, MRI, CT of head, TSH, T4, IGF-BP-3
Assess nutritional status, growth charts
Karotypes, GI series, celiac, pelvic ultrasound, gonadotorpin levels, GH levels, GnRH stimulation, hcg test
Short stature
Family members
Linear growth of less than 4-5 cm per year exists in the years before the Normal age of peak linear growth velocity
No evidence of a peak linear growth velocity year by age 16 males or 14 females
Height is more than 2 SD from mid parental height
W/o puberty delay- isolated GH deficiency, hypothyroidism, downs, hurler syndrome; familial short stature, intrauterine growth restriction, chondrodysplasia, chronic illness, HIV
W/- delay of puberty, panhypopituitarism, turners, mixed gonadal dysgenesis, hypogonadotropic hypogonadism, excess glucocorticoid, chronic illness, HIV
Constitution delay of puberty
90-95% of delayed puberty
Required and supporting feature
-detailed negative ROS
-evidence of proper nutrition
-linear growth of at least 3.7 cm/yr
-normal PE; include genitals, sense of smell, and U/L body segment ratio
-normal CBC, ESR, UA, T4, LH, FSH
-bone age delayed 1.5- 4 years compared with chronological age
- family history
-height between 3rd and 24th percentile
Other causes of delay
Turner syndrome
Gonoadal dysgenesis
Hypogonadal hypogonadism
Gonadal failure
Chronic illness
Labs for short stature
CBC, ESR, UA, T4,TSH, CMP, bone age; GH, IGF 1, IGF-BP-3, x rays of GI tract, GI panel for Celiac
Excessive growth
No definition for excessive height
Family historu
Bone age, SMR, GH, IGF-1
Hormone therapy to close bone growth
Close monitoring until epiphyseal plates close
Precocious puberty
Development of secondary characteristics before normal age
Isosexual precocity, heterosexual precocity, incomplete precocious puberty, complete precocious puberty-true and pseudoprecocious
Males before 9.5 years, females before 8
Assess for steroid use, disease, other sexual characteristics, head trauma, CNS radiation, mental or behavior status changes
Labs- GnRH stimulation test, bone age, endocrine referral if progressing rapidly
Abdominal pain
3 or more separate episodes over 3 months
Functional- stress and eating habits, Periumbilical, crampy, maybe n/v/d, HA, fatigue, dizziness
Labs- CBC, ESR, UA, BMP, LFT, stool sample, H pylori, KUB
Chest pain
Acute chest pain rarely cardiac in nature
Musculoskeletal, strain, costochondritis, fibromyalgia, thoracic outlet syndrome, bone disease, tietze syndrome, pulmonary, GI, Trauma, herpes, myocarditis
EKG, breast exam, labs
Red flags- worse with exercise, interrupts sleep, DOE, palps, dizziness, syncope
Fatigue
Stress, anxiety, depression, improper sleep, diet, pregnancy, meds, infections, allergies, systemic disease, fatigue syndrome
Chronic fatigue syndrome- new onset severe and disabling, joint pain, memory issues, sleep disturbances, HA, sore throat, tender lymph nodes
TX- low dose antidepressants, psychotherapy, physical therapy
HA
Stress, anxiety, depression, meningitis, hemorrhage: seizure, HTN, dental disease, migraine (aura, unilateral pain, n/v), clusters, chronic HA, tumor, pregnancy, drugs
Severe acute isolate is red flags
Sleep disorders
Insomnia, hypersomnia, parasomnias
Phobias
Management of school phobias and explore fears and provide safe environments to share
SSRIs
Academic performance problems
Diagnostics-audiometry, visual acuity, cognitive testing wechsler intelligent scale for children 16 and under, wechsler adult intelligent scale if 16 and older, woodcock Johnson psychoeducational battery, wechsler individual achievement test 2, Kaufman test of educational achievement
IQ test, neuropsychological testing, ADHD screen, child behavior checklist, behavior assessment system for children, screen for family issues using conflict behavior questionnaire
Chromosomal screening
ADHD
May be depressed and low self esteem
Genetic links, neurotransmitter involvement
Inattention or hyperactivity type
Can have coexisting disorders
Stimulants are first line
Early stage adolescents
11-14
Growth spurts
Begin sexual maturity
Increased interest in sexual anatomy
Anxieties about genitals
Self exploration and evaluation
Independent versus dependence struggle
Middle stage adolescent
15-17
Stronger sense of identity
Relates more to peers
More reflective thought
Transitioning between dependence and independence
Body image issues
Late stage adolescence
18 +
Body fills out more adult form
District identity, ideas and opinions more settled
Intimate and stable relationship focus
Plans for future
Adolescents assessment HEEADSSS
Home
Education/employment
Eating
Activities
Drugs
Sexuality
Suicide/depression
Safety
-strength, spirituality
CRAFFT questionnaire
Have you ever ridden in a car by someone who was high or has been using drugs or alcohol?
Do you ever use drugs or alcohol to relax or feel better about yourself?
Do you ever use drugs or alcohol when you are alone?
Do you forget things while using drugs or alcohol?
Do your family or friends ever tell you that you should cut down on your drinking or drug use?
Have you ever gotten into trouble while using drugs or alcohol?
Scoliosis
Lateral curvature greater than 11 degrees
Structural- does not correct with wide bending toward the convex side of the curve- Idiopathic, congenital, neuromuscular, miscellaneous
Non structural-curve that does correct with side bending toward the convex side of the curve-postural, hysterical, nerve root irritation, inflammatory, leg length discrepancies
Consider MRI
