Ch21: Adolescents Flashcards
what is the significance of the Hib vaccine
haemophilus influenza type B (virulent and capsulated form of h. flu)
before the vaccine, this was the leading cause of bacterial meningitis in young people <4yo
we don’t give this to folks >4yo because doesn’t affect folks after this age
meningitis vaccines (2)
- Menactra (4 strains of meningococcal with type A but not B)
- Trumenba (meningococcal type B organism)
both of these cover different types of Neisseria meningitis
folks need both
in females, tanner stage 2 to menarche usually takes….
2 years
in females, tanner stage 2 to full adult height usually takes…
3 years (or 1 year after menarche)
in males, tanner stage 2 to full adult height usually takes….
4 years
no secondary sex characteristics yet: Tanner stage
1
earliest pubertal changes - breast budding, beginning of pubic hair: tanner stage
2
growth spurt starts: tanner stage
3
peak of growth spurt, menarche: tanner stage
4
full adult: tanner stage
5
age range for onset of tanner 2 changes in females
normative as young as 7yo to have thelarche
normative for ages 8-13yo for adrenarche
most common alteration in puberty
early onset puberty in females (precocious puberty)
puberty that starts <7-8yo
> 85% is idiopathic, no pathologic disease
usually family history of early-onset menarche, child who is overweight or obese
factors related to late onset puberty
- appearance-related sports
- low weight/ nutrition
- turner syndrome (45,XO)
most common cause of early puberty in males
CNS tumors
<40% are idiopathic
VERY rare to have alterations in puberty for males
males in puberty often go through physiologic gynecomastia when….
TANNER STAGE 3
50% of males during tanner stage 3-4, lasts 6-24 months, most of the time it is gone in 1 year
Fragile X syndrome
-occasionally not picked up until puberty because associated with a specific body habitus that becomes apparent at puberty
more common in males, which presents as:
- large forehead, ears, and prominent jaw
- tendency to avoid eye contact
- large testes (macroorchidism)
- large body habitus
- history of learning differences
- hyperactivity
in females, significantly less common with fewer prominent findings
most common known cause of autism in either gender
fragile X syndrome
however, majority of cases of autism have no known cause
47XXY
Klinefelter syndrome
Klinefelter syndrome
47XXY
only affects males
- low testicular volume
- hip and breast enlargement
- infertility (do not make sperm)
- most will have some
- triangular shape pubic hair pattern (more female) vs. diamond which is more common in males (extends up to abdomen)
- developmental issues, commonly language impairment
- some males will not have any symptoms
45X
turner syndrome
Turner syndrome
45X
only affects females
- short stature (5 ft or less)
- usually evidence by 5yo, but more commonly being picked up at birth
- wide, webbed neck
- broad shield chest
- absent menses
- infertility (born without ovaries)
- narrow, high-arched palate
- lower jaw not prominent
- low-set ears
- edema of hands and feet
possible to have mosaic Turner syndrome may have more mild features
high spontaneous pregnancy loss with turner syndrome (most common abnormality found in miscarriage pathologic examination)
pathophysiology of acne
follicular epidermal hyperproliferation with subsequent follicle plugging, excess sebum production, presence of pathogenic Priopionibacterium acnes (P. acnes), accompanying inflammation
% prevalence of acne and severe acne with scarring
80% of all teens have acne
20% will develop scarring
all acne therapies take at least ______ to see effect
6-8 weeks
should topical acne therapies be used in [specific spots vs. generalized entire area involved]
entire area involved
generally won’t work on a formed lesion, need to prevent new ones from forming
overview of topical benzoyl peroxide for acne
- general MOA: ANTIBACTERIAL, comedolytic
- inexpensive, OTC
- 2.5% formulation is just as effective as 10% formulation, but much less irritating
- most helpful for mild acne, usually with a keratolytic acne wash with salicylic acid 2% (Neutrogena acne wash, Store-brand, Proactiv)
overview of topical retinoids for acne
- MOA: Keratolytic, ANTI-INFLAMMATORY
- indicated in all acne types
- with initial use, there is mild-to-moderate skin irritation (peeling) that will improve over time
- cause photosensitivity, recommend using sunscreen regardless of skin tone, apply overnight
example topical retinoids for acne
- adapalene (Differin)
- tazarotene (Tazorac)
- tretinoin (Retin-A)
- azelaic acid (Azelex)
(3) topical antibiotics for acne
- clindamycin
- erythromycin
- dapsone (sulfa-based)
overview of topical antibiotics for acne
- MOA: antibacterial and antiinflammatory
- most effective for mild acne
- less effective than oral antibiotics for moderate-severe acne
- most often used in combination with benzoyl peroxide and retinoid
(5) oral antibiotics for acne
- doxycycline MOST COMMON (TERATOGENIC)
- minocycline
- erythromycin
- TMP/SMX
- azithromycin (SHE USES MOST COMMONLY FOR FEMALES; PREG CATEGORY B)
overview of oral antibiotics for acne
- both antibacterial and anti-inflammatory
- work very well for moderate inflammatory acne
- avoid protracted use of minocycline d/t risk for hyperpigmentation
which oral antibiotic should not be used for a long time for the treatment of acne d/t risk for hyperpigmentation
minocycline
example azithromycin oral regimen she uses for acne
azithromycin 500mg PO 1 tablet every 5 days
how long should someone stay on oral antibiotics for acne?
- usually takes at least 3 months for the skin to clear
- taper off slowly over a few months while adding in topical antibiotic agents
- rapid discontinuation will result in return of acne to pretreatment baseline
- longer-term or repeat therapy is often needed
overview of COCs for acne
- MOA: reduces androgen levels and decreases sebum production
- best suited for females with moderate-to-severe acne
- about 3 months of continuous use prior to seeing significant acne improvement
- with discontinuation, acne gradually returns to pretreatment baseline
overview of isotretinoin (Accutane) for acne
- MOA not well understood
- indicated for treatment of severe, cystic acne that has not responded to other therapies such as oral antibiotics and topical retinoids
- managed by derm specialist; need accutane license to prescribe
- usual course of treatment is 4-6 months
- careful monitoring for mood destabilization and/or suicidality
- TERATOGEN
most common cause of adolescent death in the US
accidental injury
in ALL states, parental notification or consent is NOT required for an adolescent (typically starting at age 14) to receive care for (4)
- contraceptive services
- prenatal care
- evaluation or treatment for STIs
- evaluation or treatment for substance abuse
screener for adolescent substance use
CRAFFT
most commonly used contraceptive method for teens
male condom
age of majority
18yo
medically-emancipating conditions (5)
- contraceptives
- STIs
- substance abuse
- prenatal care
- mental health
who do you screen for diabetes in adolescence?
overweight or obese and one or more of the following risk factors:
- family history of T2DM
- race or ethnicity other than European/Caucasian
- s/s of insulin resistance (acanthosis nigricans, hypertension, HLD, PCOS, SGA at birth)
- maternal h/o DM or GDM
CRAFFT questionnaire screeners
C - car: Have you ever ridden in a car driven by someone who was high or using drugs or alcohol
R - relax: do you ever use alcohol or drugs to relax or fit in?
A - alone: do you ever use alcohol or drugs when you are by yourself?
F - forget: do you ever forget things you did while using drugs or alcohol
F - friends/family: do your friends or family ever tell you you need to cut down on your drugs or alcohol use
T - trouble: have you ever gotten into trouble when you were using drugs or alcohol
2 or more positive answers indicates more serious problem
central pathology of PCOS
insulin resistance
surrogate marker for insulin resistance on labs
triglycerides
sandpaper-like rash
strep pyogenes - group A strep associated
scarlet fever
presentation of scarlet fever
- exudative pharyngitis
- fever
- headache
- tender
- localized anterior cervical lymphadenopathy
- rash usually erupts on day 2 of pharyngitis and often peels a few days layer
classic presentation of rubella
aka German Measles
mild symptoms including fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting 3 days
posterior cervical and postauricular lymphadenopathy that begins 5-10 days before the rash and present during rash
- arthralgia in 25% of cases (mostly in females)
everything happens at once except the lymphadenopathy which happens earlier
why do we care so much about preventing rubella?
one of the most teratogenic pathogens known to humankind
sick adults will recover fine, but devastating in pregnancy
rubeola vs. rubella names
rubeola = measles
rubella = German measles
Koplik’s spots are specific to…
rubeola (measles)
true or false: rubella and rubeola are reportable diseases to the state public health authorities
true
16yo presents with pharyngitis, diffuse lymphadenopathy, and bilateral RUQ/LUQ abdominal pain, you suspect….
infectious mono
generic name for Monospot rapid test
heterophil antibody test
how long do you need to avoid contact sports after mono
1 month
splenomegaly lasts 6-21 days after onset of illness
what antibiotic should you avoid in mono?
amoxicillin or ampicillin
95% likelihood of getting an autoimmune flat-pink rash (not an allergy to amoxicillin)
