Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Unit 2 CMN 571 > Adolescents Review - Leik > Flashcards

Adolescents Review - Leik Flashcards

1
Q

Acetaminophen Poisoning (Intentional Ingestion)

A

Acetaminophen damages the liver, resulting in mild to severe fulminant liver failure.
Acetaminophen also known as paracetamol and sold as Tylenol and others.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acetaminophen Poisoning (Intentional Ingestion)

A

Stage 1 (up to 24 hours after overdose): Patients are usually asymptomatic but may have nausea and vomiting and, with very large doses, lethargy, and malaise.

Stage II (24–72 hours after overdose): Patients complain of right upper quadrant pain and have high LFTs, PT, and INR, with possible nephrotoxicity (elevated BUN, creatinine) and/or pancreatitis (serum amylase and lipase elevated).

Most deaths from liver failure occur within 72 to 96 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment acetaminophen poisoning

A

With acute overdose, serum acetaminophen concentration should be measured as soon as
possible but at least 4 hours must have passed since ingestion to obtain accurate blood level
(if less than 4 hours, blood level is not accurate).

Antidote is N-acetylcysteine given intravenously.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Testicular Torsion (Acute Scrotum)

A

Pubertal male awakens with abrupt onset of unilateral testicular pain that increases in severity. Pain may radiate to the lower abdomen and/or groin. Almost all patients (90%) also have nausea and vomiting. Ischemic changes result in severe scrotal edema, redness, induration, and testicular pain. Ipsilateral (same-side) cremasteric reflex is absent.

Highest incidence is during puberty. UA is negative for WBCs. Doppler ultrasound is the initial diagnostic test.

Testicle is not functional after 24 hours if not repaired. Refer to ED. This is a surgical emergency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Testicular Cancer

A

Teenage to adult male complains of a testicular or scrotal mass that may be tender to touch
or asymptomatic. Some patients may have testicular discomfort, but not pain. The patient
reports a sensation of heaviness in the affected testicle. The affected testicle has a firm
texture. More common in males from the age of 15 to 35 years. Cryptorchidism is a strong
risk factor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adolescence

A

Defined as the onset of puberty until sexual maturity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Adolescence - most common cause of death

A

Accidents (i.e., motor vehicle crashes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Puberty

A

The period in life when secondary sexual characteristics start to develop because of
hormonal stimulation.

Girls’ ovaries start producing estrogen and progesterone.

Boys’ testes start producing testosterone. All of these changes result in reproductive capability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Girls

A

Precocious puberty if puberty starts before age 8 years

Delayed puberty if no breast development (Tanner stage II) by age 12 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Growth Spurt

A

Majority of somatic changes occur between the ages of 10 and 13 years.

Majority of skeletal growth occurs before menses. Afterward, growth slows down.

Girls start their growth spurts 1 year earlier than boys.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Growth Timeline

A

Breast development → peak growth acceleration → menarche.

Most of a girl’s height is gained before menarche.

Skeletal growth in girls is considered complete within 2 years after menarche.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mittelschmerz

A

Unilateral midcycle pelvic pain that is caused by an enlarged ovarian follicle (or ruptured follicle). Pain may last a few hours to a few days. May occur intermittently.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Menarche

A

Average age is about 12 years (12.34 years) in the United States (range age 8–15 years)

The first few months after the onset of menarche, it is common to have irregular periods because of irregular ovulation (may skip a month or longer intervals, lighter
bleeding)

After Tanner stage II starts (breast bud stage), girls start menses within 1 to 2 years

Delayed puberty if no secondary sexual characteristics appear by age 12 to 13 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Menstrual Cycle

A

Average duration is 28 days; in younger teens, cycles range from 21 to 45 days; in adults, they can range from 21 to 35 days

Average duration of menstrual bleeding is about 3 to 5 days (range 2–7 days)

Day 1 of the menstrual cycle starts as spotting, then blood flow becomes heavier for 2 to 3 days, and then bleeding lightens until it stops

The most fertile period in the cycle is about 3 days before and during ovulation (days 11–14)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dysmenorrhea

A

Painful periods due to severe menstrual cramps caused by high levels of prostaglandins

Treatment is use of heating pads and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Boys

A

Precocious puberty if starts before age 9 years

Delayed puberty if no testicular/scrotal growth by age 14 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Growth Spurt

A

Boys’ growth spurts are 1 year later than girls’ (ages 11–15 years)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Spermarche

A

Average age is 13.3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tanner Stages - Boys

A

Stage I: Prepuberty

Stage II: Testes begin to enlarge, with increased rugation of scrotum

Stage III: Penis elongates; testicular/scrotal growth continues; scrotal color starts to darken.

Stage IV: Penis thickens and increases in size; testes are larger and scrotal skin darker

Stage V: Adult pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tanner Stages - Girls

A

Stage I: Prepuberty

Stage II: Breast bud (onset of thelarche, or breast development)

Stage III: Breast tissue and areola are in one mound

Stage IV: Areola/nipples separate and form a secondary mound

Stage V: Adult pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pubic Hair (Both Genders)

A

Stage I: Prepuberty

Stage II: Sparse growth of straight hair that is easily counted

Stage III: Hair is darker and starts to curl

Stage IV: Hair is curly but not on medial thigh yet as in adult; hair is coarser

Stage V: Adult pattern; hair spreads to medial thigh and lower abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Immunization Schedule for Adolescents 7-18 years

A

see next cards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tdap (Boostrix, Adacel)

A

All 11- or 12-year-olds: Give Tdap as booster, then Td every 10 years for lifetime.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

HPV (Gardasil)

A 
All 11- or 12-year-olds: Give to girls and boys.
Minimum age (HPV vaccines): 9 years old

All 11- or 12-year-olds: Give first shot. Needs two doses, from 6 to 12 months apart.

From age 15 to 26 years needs three doses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Meningococcal (ACWY-D [Menactra],
MenACWY-CRM [Menveo], MenB-4C
[Bexsero], MenB-FHbp [Trumenba])

A

All at age 11–12 years, give single dose of Menactra or Menveo vaccine at age 11–12 years with booster at age 16 years.

Catch-up:

age 13–18 years, give Menactra or Menveo. If first dose at age

13–15 years, needs booster at age 16–18 years.

But if first dose at age 16 years, no booster dose is needed.

Clinical discretion:
Young adults 16–23 years may be vaccinated with either Bexsero or Trumenba.*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Influenza inactivated

A

Vaccinate everyone from age 6 months and older.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Hepatitis B (Recombivax HB)

A

Catch-up: Give the third dose if not completed.

28
Q

Hepatitis A (HAVRIX, VAQTA)

A

Recommended for children with certain health or lifestyle conditions placing them at risk.

29
Q

MMR

A

Catch-up: Give the second dose if not completed

30
Q

Varicella

A

If no reliable history of chickenpox (verbal OK). Live virus is contraindicated.

31
Q

Meningococcal vaccine is now required for all,

A

starting at age 11 to 12 years (not only for college freshmen living in dormitories).

32
Q

Antidote of acetaminophen poisoning

A

is IV N-acetylcysteine

33
Q

Vaccine Adverse Event Reporting System (VAERS):

A

Government program to report clinically adverse events.

34
Q

Centers for Disease Control and Prevention recommends HPV vaccine

A

for females until age 26 years;

for males until age 21 years (except males who have sex with males);

and for gay, bisexual, or males who have sex with males until age 26 years.

35
Q

Elevated Alkaline Phosphatase

A

Children and adolescents normally have higher blood levels compared to adults due to growing bone. It is produced by the osteoblasts.

36
Q

Right to Consent and Confidentiality

No parental (or guardian) consent is necessary for the following:

A

Contraception

Treatment for sexually transmitted diseases (STDs)

Diagnosis and management of pregnancy

37
Q

Emancipated Minor Criteria

These minors may give full consent as an adult without parental involvement:

A

Legally married

Active duty in the armed forces

38
Q

Confidentiality

Confidentiality can be broken in the following situations:

A

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 (especially mental health providers)

39
Q

“Mature Minor Rule”

A

A mature minor is an unemancipated minor (from 15 to 17 years of age) with the mental capacity (and intelligence) to understand the consequences of a decision (such as refusing a surgical procedure or medical treatment).

The mature minor has the right to refuse or to
request treatment (even if the parents disagree with this decision).

There are statutory and/or common laws at the state level. Each state has its own laws and statutes.

40
Q

During a physical examination or wellness visit, assess teenager for high-risk behaviors. Intensive behavior counseling is recommended. The following are high-risk behaviors to screen for:

A

Sexual activity: Use of condoms, birth control, intimate partner violence (i.e., rape), signs/symptoms of STDs

Safety: Driver safety, seatbelt/helmet use, smoking, alcohol and drug use

Social history: Family, peers, school performance, work

Signs/symptoms of depression and antisocial behaviors (i.e., gangs

41
Q

Puberty starts at

A

Tanner stage II in girls (breast bud) or boys (testicular enlargement and scrotal rugation/color starts to become darker).

42
Q

Puberty ends at

A

Tanner stage V

adult stage

43
Q

Tanner stage III in boys

A

is elongation of the penis (testes continues to grow).

44
Q

Adolescent health history is obtained from

A

both parent and child initially,

then the adolescent is interviewed alone without the parent.

45
Q

Primary amenorrhea:

A

No menarche by the age of 15 years (with or without development of secondary sexual characteristics). Half of cases are caused by chromosomal disorders
(50%) such as Turner syndrome.

• Puberty is delayed if there is no breast development by age 13 years, absence of pubic hair at age 14 years, and no menarche by age 15 years.

46
Q

Secondary amenorrhea:

A

No menses for three cycles, or 6 months if previously had menses. Most common cause is pregnancy. Others are ovarian disorders, stress,
anorexia, polycystic ovary syndrome (PCOS).

47
Q

Secondary Amenorrhea Associated With Exercise and Underweight

A

Excessive exercise and/or sports participation have a higher incidence of amenorrhea (and infertility) due to relative caloric deficiency

“Female athlete triad”; anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis

48
Q

Secondary amenorrhea - Labs

A

Pregnancy test (serum human chorionic gonadotropin [hCG])

Serum prolactin level (rule out prolactinoma-induced amenorrhea)

Serum TSH; also follicle-stimulating hormone (FSH) and luteinizing hormone (LH; rule out premature ovarian failure)

If amenorrhea for more than 6 months, measure bone density

49
Q

Secondary amenorrhea - treatment plan

A

Educate about increasing caloric intake and decreasing exercise

Prescribe calcium with vitamin D 1,200 to 1,500 mg daily and vitamin E 400 IU daily

50
Q

Secondary amenorrhea - complications

A

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 body mass index (BMI), cachexia, anemia, respiratory failure

51
Q

Anorexia Nervosa

A

Usual onset is during adolescence. Involves an irrational preoccupation with and intense
fear of gaining weight.

Two types: Patient engages in restriction (dieting, excessive exercise) or binge eating and
purging.

Some examples of purging are excessive use of laxatives, enemas, diuretics, vomiting.

52
Q

Anorexia Nervosa - clinical findings

A

Marked weight loss (BMI ≤18.5), low pulse (≤40 beats/min), vital signs unstable, hypotension

Lanugo (increased lanugo especially in the face, back, and shoulders)

Stress fractures (osteopenia or osteoporosis from estrogen depletion and low calcium
intake)

Swollen feet (low albumin), dizziness, abdominal bloating

53
Q

Recognize how anorexic patients present

A

(i.e., lanugo, peripheral edema, amenorrhea, significant weight loss >10% of body weight).

54
Q

anorexic

A

Increased risk of osteoporosis or osteopenia. For birth control, avoid Depo Provera and other progesterone-only contraceptives because they can cause bone loss.

55
Q

anorexic

A

Low albumin level results in peripheral edema

56
Q

Gynecomastia

A

Excessive growth of breast tissue in males. Can involve one or both breasts. Physiological
gynecomastia is benign and is more common during infancy and adolescence.

Normal in up to 40% of pubertal boys (peaks at age 14). Most cases resolve spontaneously within 6
months to 2 years.

Objective Findings
Round, rubbery, and mobile mound (disk-like) under the 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 suspect secondary cause, refer to specialist.

57
Q

Gynecomastia treatment

A

Evaluate for Tanner stage (check testicular size, pubic hair, axillary hair, body odor).

Check for drug use: both illicit and prescription (i.e., steroids, cimetidine, antipsychotics).

Rule out serious etiology (testicular or adrenal tumors, brain tumor, hypogonadism, etc.).

Recheck patient in 6 months to monitor for changes

58
Q

Pseudogynecomastia

A

Bilateral enlarged breast is due to fatty tissue (adipose tissue). Common in obese boys and
men. Both breasts feel soft to touch and are not tender. No breast bud or disk-like breast
tissue is palpable.

Labs
None. Diagnosed by clinical presentation

59
Q

Delayed Puberty

A

Absence of secondary sexual characteristics by the age of 13 years for girls (such as a breast bud) or at the age of 14 years for boys. The child remains in Tanner stage I (prepubertal).

Primary amenorrhea: Menarche has not occurred by age 15 years

60
Q

Delayed Puberty - Labs

A

Serum pregnancy test

Check prolactin level. If prolactin level is elevated, next step is to order a CT scan of the sella turcica (location of pituitary gland inside the skull).

For primary amenorrhea (no menses by age 15 years), rule out hypogonadism by checking hormone levels (i.e., estrogen, progesterone, dehydroepiandrosterone
[DHEA], FSH, TSH).

Rule out chromosomal disorders, absence of uterus/vagina, imperforate hymen.

X-ray of the hand is used for estimating “bone age”:

  • When the long-bone epiphyses (growth plates) are fused, skeletal growth is finished.
  • Refer to pediatric endocrinologist if no growth spurt, delayed puberty, others.
61
Q

If not related to sexual activity

A

then need parental consent (dysmenorrhea,

headache, upper respiratory infection [URI]).

62
Q
  1. The mother of a 16-year-old boy is concerned that her son is not developing normally. On physical exam, the patient is noted to have small testes with no
    pubic or facial hair. What is the most appropriate statement to the mother?
    A) Her son is developing normally
    B) Her son’s physical development is delayed and should be evaluated by a
    pediatric endocrinologist
    C) Her son should be rechecked in 3 months; if he still does not have secondary
    sexual characteristics, a thorough hormonal workup should be initiated
    D) Her son’s physiological development is slower than normal but is within the
    lower limit of normal for his age group
A

B) Her son’s physical development is delayed and should be evaluated by a pediatric endocrinologist Puberty may be delayed for several years and still
occur normally, in which case it is considered constitutional delay, a variation of healthy physical development.

Delay of puberty may also occur due to malnutrition, many forms of systemic disease, or to defects of the reproductive system
(hypogonadism) or the body’s responsiveness to sex hormones.

Hypogonadism occurs when the sex glands produce little or no hormones. In men, these glands
(gonads) are the testes. A 16-year-old male without secondary sexual characteristics
should be referred to an endocrinologist. If there is no testicular development by 14
years of age, an endocrinology consult is warranted.

63
Q
  1. An adolescent female’s areola, nipples, and breast tissue develop and become
    elevated as one mound. Which of the following is the correct Tanner stage for this
    phase of breast development?
    A) Tanner stage I
    B) Tanner stage II
    C) Tanner stage III
    D) Tanner stage IV
A

C) Tanner stage III During Tanner stage III, the breast and areola and nipples grow together in one mound. There is no separation yet.

At Tanner stage IV, the areola and the nipple separate to form a distinct mound. The most important clue is
“secondary mound.”

64
Q
  1. During a sports physical of a 14-year-old girl, you note her breast development.
    The areola and the breast tissue are all in one mound. In which Tanner stage is this
    patient?
    A) Tanner stage I
    B) Tanner stage II
    C) Tanner stage III
    D) Tanner stage IV
A 
C) Tanner stage III Tanner stages for breast development: I, prepuberty;
II,breast bud; 
III, breast and areola one mound; 
IV, breast and areola secondary mound; 
V, adult pattern.
65
Q 
636. According to Erik Erikson, adolescents are at what psychosocial developmental stage?
A) Autonomy versus shame
B) Industry versus inferiority
C) Identity versus role confusion
D) Intimacy versus isolation
A

C) Identity versus role confusion Adolescents (aged 12–18 years) are in the stage known as identity versus role confusion.

At this time, the teen is transitioning
into adulthood and reexamining his or her identity and beliefs.

The teen wonders about himself or herself (e.g., “who am I?”). Peers are highly valued.

Unit 2 CMN 571 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions