Introduction to Adolescent Medicine

Question 1

Leading causes of adolescent mortality

Answer 1

1. Accidents - 45.4%
2. Homicide - 15.3 %
3. Suicide - 11.3 %
4. Other

Question 2

Stages of adolescence

Answer 2

Early adolescence (12-14 yrs)
Middle adolescence (15-17 yrs)
Late adolescence (18-21 yrs)

Question 3

What is a screening tool to prevent mortality in the adolescent population?

Answer 3

The interview… specifically using tools like HEADDS

Question 4

Where does the morbidity data come from?

Answer 4

Every 2 years the CDC does an interview of high school students - reporting bias; skewed result

Question 5

How many HS males carried a weapon?

Answer 5

1/3

Question 6

3 areas of development that we study

Answer 6

1. Physical
2. Cognitive
3. Psychosocial

Question 7

Puberty

Answer 7

1st sign in females - thelarche

1st sign in males - enlargement of testes

Question 8

Tanner staging

Answer 8

1 - prepubertal; 5 - fully developed

Question 9

Mound on mound

Answer 9

Tanner 3 (B3) - nipple sticks out more

Question 10

B2

Answer 10

Breast bud

Question 11

Sequence of tanner in males

Answer 11

G2->G3
P2->G4
P3
Peak height velocity
P4
G5->P5

Question 12

Sequence of tanner in females

Answer 12

B2->P2
Peak height velocity
B3->P3
B4->P4
Menarche
P5->B5

Question 13

Sequence of development summary comparison

Answer 13

• Peak height velocity later in males
• Peak height velocity precedes menarche in females
• Menarche occurs 2 years after onset of puberty

Question 14

Adolescent cognitive development

Answer 14

• Starts @ 12 yrs
• Concrete to abstract
• Moral choices
• “Ideal partner”
• Serial monogamy
• Physical and cognitive NOT simultaneous

Question 15

Changes in independence across adolescent dev

Answer 15

Early:

• decreased interest in parental activities
• wide mood swings

Middle:
- peak of parental conflicts

Late

• Re-acceptance of parental advice and values
• adult-adult interaction

Question 16

Body image changes

Answer 16

Early:

• Preoccupation with self and pubertal changes
• Uncertainty about appearance

Middle:

• Acceptance of body
• Concern over making body more attractive

Late:
- comfort with pubertal changes

Question 17

Changes with peers

Answer 17

Early:
- Intense friendship with same-sex friends

Middle:

• peak peer involvement
• conformity with peers
• sexual activity & experimentation

Late:

• Peers less important
• more time with intimate relationships

Question 18

When do kids begin to feel omnipotent?

Answer 18

Middle adolescence

Leads to risk-taking behavior

Question 19

What anticipatory guidance should you provide at early adolescence?

Answer 19

• Reassurance

- Encourage postponing coitus

Question 20

What anticipatory guidance should you provide at middle adolescence?

Answer 20

• Safe sex counseling

- Contraception

Question 21

What anticipatory guidance should you provide at late adolescence?

Answer 21

• Encourage
• Empower
• Ability to negotiate system

Question 22

When do you break confidentiality?

Answer 22

• Abuse
• Self-harm or harm to others
• Mandatory reportable diseases

Question 23

HEEADSSS

Answer 23

H = Home
E = Education & Employment
E = Eating
A = Activity
D = Drugs & Drinking
S = Suicide & Depression
S = Sexuality
S = Safety

Question 24

What stage do you interview the patient alone?

Answer 24

Do it gradually, ask them to step out for a few minutes, generally around 12-13.

Question 25

Questions to ask about home

Answer 25

1. Who lives at home?
2. Who do you trust?
3. Missing members?

Question 26

What question can you ask to screen for school?

Answer 26

How do your grades differ from last year to this year?

Question 27

What % of adolescents are depressed?

Answer 27

20%

Question 28

How should you conclude an interview with a teen?

Answer 28

• patient centered approach

- providing care to teens needs (interest, time, experience)