Adolescents & Contraception Flashcards
GAPS
guidelines for adolescent preventative services
- screening, vaccines, counseling to pt (health risk and
guidance)
Interview method used when taking psychosocial history with adolescent
HEEADSSS
Home environment Education and employment Eating Activities, peer-related Drugs Sexuality suicide/depression Safety from injury and violence
How many hours of sleep per night do teenagers need?
8-10
Additional history to Ask teens/ parents
sleep (causing trouble in school? Driving while sleepy?), food security
healthy eating
exposure to loud music
self & resiliency
PE on teenager
PE: scoliosis, breast exam on both genders, height, weight, and BMI, acne, piercings/ tattoos, signs of self injury, acanthosis, visual exam on female genatalia, male = visual inspection + palpate testicles+ inspect for hernia,
What age to start screening for depression?
Age 12 (Adolescent PHQ-9)
when should lipids start to be checked?
age 9-11
when is hearing usually checked in adolescents?
Btw 11-14 using audiometry
risk assessment topics to ask adolescents about?
Risk assessment (HIV, STI, oral health, IPV, violence through social media, tuberculosis, ) Tobacco, alcohol, and drug use (ask first about exposure through family and friends); vaping
when is vision screening done in adolescent years? what chart?
around age 12- Snellen Chart
Vaccines to give/ discuss with adolescents?
Flu
Tdap (btw ages 11-12)
HPV
MenACWY (meningococcal. Quadrivalent recommended)
What is included in sports physicals?
Hx
Cardiac exam
musculoskeletal exam
skin
billing - not covered by health insurance but can be covered if pt has not had a wellness exam within 12 months - usually cash pay with price set by clinic
What to do with adolescent with acne?
ID type and severity
treatment for acne
Topical: benzoyl peroxide, antibiotics, retinoids
Oral ABX: should see results in 5 days. topical first (should be mixed with benzoyl peroxide). Limit use to 3 months and if no results send to derm (ABX resistance concern)
Hormonal agents → estrogen-containing contraceptives; spironolactone
Oral isotretinoin (Accutane); must be on birth control
Other
Evaluating for precocious puberty
Evaluation:
Bone age x-ray - both hand and wrist recommended
LH/FSH and estradiol levels (females)
LH/FSH and testosterone (males) early morning
Lack of features of puberty on exam or failure of progression of changes (Tanner Stages) at least age 14
Delayed puberty
how to evaluate for delayed puberty?
Bone age x-ray
Free T4 and TSH
Serum prolactin, LH, and FSH`
Girls should have had their first cycle within __ years of getting breast buds?
5 years
Boys should get to Tanner stage 5 within ____ years of puberty?
4-5 years
6-12 months after menarche
Primary (idiopathic) no underlying pathology
Consider endometriosis if family hx
Sx: cramping, pelvic pain, n/v/d, HA, fatigue
Workup: almost never need pelvic exam
Only really done if family hx or if fail basic tx
Dysmenorrhea
Tx options for dysmenorrhea
Tx: NSAIDs (do different categories), hormonal contraception may be used
Black cohash, heat, rest
Difference between functional and structural scoliosis
Functional: curvature without rotation poor posture, pain. Reversible
Structural: rotation of spine with curvature.
How to diagnose and examine scoliosis
Diagnoses by AP/lat x-ray of spine (at least 10 degree curvature for diagnosis)
If less than 20 degree curve just monitor.
Exam spine, scapula, shoulders, waist
Adam’s test: lean completely forward and drop head low. Observe from front and side
TBI d/t biomechanical forces, either direct or indirect trauma
Usu rapid onset of short lived impairment of sx
Neuroimaging is usually normal. Most do not lose consciousness
s/s:
HA, nausea, dizziness, vision changes, light/noise sensitivity, concentration
Concussion
How to evaluate and tx concussion
Evaluation: ACE or scap tool. LOC, posturing, or balance problem immediate remove from the area for further evaluation
Rest: physical and brain rest for 24-48hrs (some take 7-14 days)
No school, no screens, no reading, no sports
Long term issues: HA, anxiety, sleep problems possible
12-18 years old
May develop into bipolar disorder
PHQ-2 or PHQ-9 modified for adolescents
Suicide #2 cause of death in adolescents → be straightforward
Depression
(male sterilization) → interrupts the vas deferens, preventing the passage of sperm into seminal fluid
vasectomy
Advantages of vasectomy
ADVANTAGES:
Highly effective, non-hormonal. Preformed in clinic with local anesthetic.
Cost effective
No effect on sexual function
disadvantages of vasectomy
DISADVANTAGES Takes 2-4 months for effectiveness Requires f/u Post-procedure discomfort, short term Procedure complications: infection, hematoma, granulation, swelling, persistent pain Non-reversible Not STI protection