Female health maintenance

Question 1

Adolescent Interview

Answer 1

H - home
E - employment/education
E - eating
A - activity/aspiration
D - drugs
S - sexuality
S - safety
S - suicide

Question 2

Signs of hypothyroidism in adolescents

Answer 2

Cold skin
Slowness
Fatigue
Poor school performance
Preferring hot over cold weather
Coarse hair
Myxedema

Question 3

Menses in adolescents

Answer 3

Often light and irregular with more cramping

• important to distinguish “extra” tampons or soaking through them
• timing of periods
• length of periods
• are they normal

Question 4

Infectious mono

Answer 4

“mono” caused by EBV virus (fatigue, sore throat, lymphadenopathy)
- infection of lymphocytes

Question 5

Depression in adolescents

Answer 5

Mood swings - can be normal
Adjustment reactions - can be normal
- evaluate if indicated
- screen for depression

Question 6

Symptoms of depression

Answer 6

1. Feeling down and don’t want to do normal acitvities
2. Crying over small things
3. Don’t want to hang out with friends
4. Suicide ideation
5. Feeling grouchy

Question 7

Inquiring about eating disorders

Answer 7

Most adolescents are honest when asked especially when you express confidentiality
- ask about both anorexia and bullimia

Question 8

Signs of anorexia

Answer 8

Weight loss/failure to gain weight

• bradycardia (can lead to hypotension)
• electrolyte abnormalities (malnutrition)
• arrhythmias
• death

Question 9

Signs of bullimia

Answer 9

Can be more difficult to diagnose than anorexia b/c in bullimia the weight remains normal
- look for 2nd manifestations –> tooth decay, finger trauma

Question 10

Treatment of eating disorders

Answer 10

need therapists and counselors, nutritionists,

Question 11

DDx for fatigue in adolescent female

Answer 11

1. Anemia - either bleeding disorder, heavy periods, iron-deficiency
2. Hypothyroidism - can cause menstrual abnormalities
3. Depression - fatigue can be sign of depression
4. Substance use

Question 12

Discussing confidentiality with adolescents

Answer 12

Be honest, talk about absolute and relative confidentiality,

Question 13

Evaluating a decrease in academic performance

Answer 13

Medical : hypothyroidism
Personal: substance abuse, death of loved one, family stressors
Psychosocial: depression

Question 14

Obtaining sexual history

Answer 14

You need to ask specific questions.

1. Are you sexually active?
2. Boys? Girls?
3. How many partners?
4. Protection? Always?

Question 15

Adolescent PE

Answer 15

Respect their shyness and privacy

- have a chaperone if appropriate or simply wait for physician to conduct the exam

Question 16

Puberty for girls

Answer 16

8-13 y.o.

1. Breast buds
2. Pubic hair
3. Growth spurt
4. Menarche
5. Adult height

Question 17

Puberty for boys

Answer 17

10-15 y.o.

1. Growth of testicles
2. Pubic hair
3. Growth of penis
4. First ejaculation (13-14 y.o.)
5. Growth spurt
6. Adult height

Question 18

Labs for a suspected bleeding disorder

Answer 18

CBC, PT, PTT
vWF (Ristocetin factor)
Factor VIII activity
Platelet function
Reticulocyte count

Question 19

von Willebrand Disease

Answer 19

*most common hereditary bleeding disorder
Autosomal dominance with variable penetrance
Sx = ecchymosis, epistaxis, menorrhagia, gingival bleeds, bleeding following minor procedures

Question 20

Diagnosis of vWD

Answer 20

Careful history and PE

• most blood tests can be normal
• make sure to check vWF antigen and Ristocetin

Question 21

Treatment of vWD

Answer 21

intranasal of IV desmopressin

- causes dose dependent increase in vWF which shortens bleeding time and PTT