Lecture 14: Adolescent Medicine Flashcards

1
Q

When do girls begin puberty and what is the usual first sign?

A
  • Begins at around age 10
  • First sign: Breast development
  • Height (girls might be taller at 5th grade)
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2
Q

When are high risk behaviors common in adolescents?

A

14-16 (Middle adolescence)

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3
Q

What are the biggest concerns during late adolescence?

A
  • Individuality
  • Planning for the future
  • Health
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4
Q

What is the leading cause of death for adolescents?

A

MVA

75% of all deaths for adolescents

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5
Q

When do we begin screening risk taking behaviors?

A

10

Same age as when a girl begins puberty

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6
Q

What issues cannot be kept confidential if a minor informs you?

A
  • Suicidal intent
  • Positive HIV status
  • Disclosure of physical/sexual abuse
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7
Q

When can birth control be given at the earliest?

A

Must demonstrate maturity

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8
Q

When can HIV testing be done for an adolescent?

A

Any age

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9
Q

When do we usually screen for drug use in adolescents?

A

11 or older

But screening at any age is doable.

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10
Q

What are the 3 ways a minor can become emancipated?

Essentially legally independent

A
  1. Get married
  2. Join the military
  3. Go to court and have a judge emancipate you
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11
Q

What is the mature minor doctrine?

A

A minor can consent/refuse if they are mature

Must demonstrate competence, etc

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12
Q

What age can you become emancipated?

A

16

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13
Q

When is the earliest you can be considered a mature minor?

A

14

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14
Q

What are the 4 preventative services?

A
  • Screening
  • Counseling to reduce risk
  • Immunizations
  • General health guidance
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15
Q

What are the two meningococcal vaccines?

A
  • ACWY
  • Men B
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16
Q

What is the second leading cause of death in adolescents aged 15-19?

A

Suicide

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17
Q

Who is more likely to complete suicide? (gender)

A

Boys

Girls try more, but boys are more successful at their attempts :/

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18
Q

NSHIATT

A

No suicidal or homicidal ideations at this time

19
Q

Missing how much school is considered avoidance?

A

1 week with a mild illness

20
Q

How often is BP measured in an adolescent?

A

Annually at WCC, but every visit if RFs or obese.

Begin at age 3 per AAP

21
Q

What is considered HTN in an adolescent aged at least 13?

A

130/80 on at least 3 separate measurements 1-2 weeks apart.

See chart below for specifics;
You use percentiles if younger.

22
Q

What is the f/u and restriction for asymptomatic Stage 1 HTN in an adolescent?

A
  • Recheck in 1-2 weeks after lifestyle mods
  • Recheck in 3 months, if elevated; labs + radiographs + meds
  • May still participate in sports.

Essentially, it should go down after 3 months if they do lifestyle mods.

23
Q

What is the f/u and restriction for asymptomatic Stage 2 HTN in an adolescent?

A
  • Repeat in 1 week but start lifestyle modifications
  • If elevated: labs + radiographs + meds
  • May not participate in sports until cleared

No 3m check?, no sports

24
Q

What are the radiographs for an adolescent with HTN?

A
  • Renal US
  • Echocardiogram

Kidneys & Heart

25
Q

What are the typical starting meds for adolescent HTN?

A
  • Lisinopril 5mg
  • Losartan
  • HCTZ
  • Amlodipine
26
Q

What are the goal SBP reductions for adolescents?

A
  1. Reduction of SBP & DBP to < 90th percentile.
  2. < 130/80 if over 13 yrs old.
27
Q

What characterizes thelarche?

A
  • Breast buds: onset of female breast development
  • Testicular growth

10 for girls, 12-13 for boys

28
Q

What characterizes pubarche?

A
  • Axillary and pubic hair
  • Growth spurt

pubarche = pubic

29
Q

What characterizes adrenarche?

A
  • Body odor
  • Acne
  • Pubic hair increases
30
Q

What is considered precocious puberty?

A
  • Before 7 in AA/hispanic females
  • Before 8 in white females
  • Before 9 in boys

Primarily idiopathic for females

31
Q

What is considered delayed puberty?

A
  • No breast development until 12-13
  • No testicular growth until 13-14
32
Q

What is tanner stage 1 encompassing?

A

Childhood size

33
Q

Describe tanner stage 2?

A
  • Breast buds
  • Testicular growth
34
Q

Describe tanner stage 3?

A
  • Areolar diameter enlargement
  • Penis begins lengthening also
35
Q

Describe Tanner stage 4?

A
  • Secondary mound + Separation of contours
  • Darkening of scrotum
36
Q

Describe Tanner Stage 5?

A

Mature

37
Q

How does gynecomastia typically present?

A
  • Bilateral
  • Tender
  • Not greater than 4 cm
  • Spontaneous resolution between 1-2 yrs
38
Q

How do we check bone age?

A

LEFT hand and wrist XR

39
Q

Which sex steroid hormone comes solely from the adrenal gland?

A

DHEA-S

40
Q

For boys, what is generally the underlying cause of delayed puberty?

A

GnRH deficiency

41
Q

How do we treat delayed puberty?

A

Testosterone or estrogen

42
Q

What are the 3 MC STDs among high schoolers?

A
  • HPV
  • Chlamydia
  • Trichomoniasis

HS College Teens

43
Q

What is the primary reason for amenorrhea?

A

Pregnancy

So screen them even if they’re teens or deny sexual activity