Female health maintenance Flashcards
Adolescent Interview
H - home E - employment/education E - eating A - activity/aspiration D - drugs S - sexuality S - safety S - suicide
Signs of hypothyroidism in adolescents
Cold skin Slowness Fatigue Poor school performance Preferring hot over cold weather Coarse hair Myxedema
Menses in adolescents
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
Infectious mono
“mono” caused by EBV virus (fatigue, sore throat, lymphadenopathy)
- infection of lymphocytes
Depression in adolescents
Mood swings - can be normal
Adjustment reactions - can be normal
- evaluate if indicated
- screen for depression
Symptoms of depression
- Feeling down and don’t want to do normal acitvities
- Crying over small things
- Don’t want to hang out with friends
- Suicide ideation
- Feeling grouchy
Inquiring about eating disorders
Most adolescents are honest when asked especially when you express confidentiality
- ask about both anorexia and bullimia
Signs of anorexia
Weight loss/failure to gain weight
- bradycardia (can lead to hypotension)
- electrolyte abnormalities (malnutrition)
- arrhythmias
- death
Signs of bullimia
Can be more difficult to diagnose than anorexia b/c in bullimia the weight remains normal
- look for 2nd manifestations –> tooth decay, finger trauma
Treatment of eating disorders
need therapists and counselors, nutritionists,
DDx for fatigue in adolescent female
- Anemia - either bleeding disorder, heavy periods, iron-deficiency
- Hypothyroidism - can cause menstrual abnormalities
- Depression - fatigue can be sign of depression
- Substance use
Discussing confidentiality with adolescents
Be honest, talk about absolute and relative confidentiality,
Evaluating a decrease in academic performance
Medical : hypothyroidism
Personal: substance abuse, death of loved one, family stressors
Psychosocial: depression
Obtaining sexual history
You need to ask specific questions.
- Are you sexually active?
- Boys? Girls?
- How many partners?
- Protection? Always?
Adolescent PE
Respect their shyness and privacy
- have a chaperone if appropriate or simply wait for physician to conduct the exam
Puberty for girls
8-13 y.o.
- Breast buds
- Pubic hair
- Growth spurt
- Menarche
- Adult height
Puberty for boys
10-15 y.o.
- Growth of testicles
- Pubic hair
- Growth of penis
- First ejaculation (13-14 y.o.)
- Growth spurt
- Adult height
Labs for a suspected bleeding disorder
CBC, PT, PTT vWF (Ristocetin factor) Factor VIII activity Platelet function Reticulocyte count
von Willebrand Disease
*most common hereditary bleeding disorder
Autosomal dominance with variable penetrance
Sx = ecchymosis, epistaxis, menorrhagia, gingival bleeds, bleeding following minor procedures
Diagnosis of vWD
Careful history and PE
- most blood tests can be normal
- make sure to check vWF antigen and Ristocetin
Treatment of vWD
intranasal of IV desmopressin
- causes dose dependent increase in vWF which shortens bleeding time and PTT