Lecture 14: Adolescent Medicine Flashcards
When do girls begin puberty and what is the usual first sign?
- Begins at around age 10
- Breast development
- Height (girls might be taller at 5th grade)
When are high risk behaviors common in adolescents?
14-16 (Middle adolescence)
What are the biggest concerns during late adolescence?
- Individuality
- Planning for the future
- Health
What is the leading cause of death for adolescents?
MVA
75% of all deaths for adolescents
When do we begin screening risk taking behaviors?
age 10
What issues cannot be kept confidential?
- Suicidal intent
- Positive HIV status
- Disclosure of physical/sexual abuse
When can birth control be given at the earliest?
Must demonstrate maturity
no minimum age for giving condoms either!
When can HIV testing be done for an adolescent?
Any age
When do we usually screen for drug use in adolescents?
11 or older
But screening at any age is doable.
What are the 3 ways a minor can become emancipated
- Get married
- Join the military
- Go to court and have a judge emancipate you
What is the mature minor doctrine?
A minor can consent/refuse if they are mature
What age can you become emancipated?
16
When is the earliest you can be considered a mature minor?
14
NOT for major decisions/decisions affecting others/STD or STD tx
What are the 4 preventative services?
- Screening
- Counseling to reduce risk
- Immunizations
- General health guidance
What are the two meningococcal vaccines?
What other vaccinations may be checked during adolescence
- ACWY (Menactra, menveo, menomune serogroup)
- Men B (Trumenba and bexsero - serogroup)
- Tetanus can be given at age 10 or 11
- HPV/gardasil vaccine 2 at 15 or younger. otherwise 3.
- ALWAYS check Hep A vaccination status
What is the second leading cause of death in adolescents aged 15-19?
Suicide
Who is more likely to complete suicide?
Boys
Girls try more, but boys are more successful at their attempts :/
NSHIATT
No suicidal or homicidal ideations at this time
Missing how much school is considered avoidance?
1 week with a mild ilness
How often is BP measured in an adolescent?
Annually at WCC, but every visit if RFs or obese.
Begin at age 3 per AAP
What is considered HTN in an adolescent aged at least 13?
130/80 on at least 3 separate measurements 1-2 weeks apart.
See chart below for specifics
What is the f/u and restriction for asymptomatic Stage 1 HTN in an adolescent?
- Repeat in 1-2 weeks but initiate lifestyle changes.
- If still elevated @ f/u, recheck in 3 months w counseling of nutrition/l;ifestyle changes again
- if elevated still at next f/u; labs + radiographs + meds
- May still participate in sports.
What is the f/u and restriction for asymptomatic Stage 2 HTN in an adolescent?
- Repeat in 1 week but start lifestyle modifications
- If elevated: labs + radiographs + meds
- May not participate in sports until cleared
What are the radiographs for an adolescent with HTN?
- Renal US
- Echocardiogram
What are the typical starting meds for adolescent HTN?
- Lisinopril 5mg
- Losartan
- HCTZ
- Amlodipine
What are the goal SBP reductions for adolescents?
- Reduction of SBP & DBP to < 90th percentile.
- < 130/80 if over 13 yrs old.
What characterizes thelarche?
- Breast buds: onset of female breast development
- Testicular growth
10 for girls, 12-13 for boys
What characterizes pubarche?
- Axillary and pubic hair
- Growth spurt
What characterizes adrenarche?
- Body odor
- Acne
- Pubic hair increases
What is considered precocious puberty?
- Before 7 in AA and hispanic females
- Before 8 in white females
- Before 9 in boys
Primarily idiopathic for females
What is considered delayed puberty?
- No breast development until 12-13
- No testicular growth until 13-14
What is tanner stage 1 encompassing?
Childhood size
Describe tanner stage 2?
- Breast buds
- Testicular growth
Describe tanner stage 3?
- Areolar diameter enlargement
- Penis begins lengthening also
Describe Tanner stage 4?
- Secondary mound + Separation of contours
- Darkening of scrotum
Describe Tanner Stage 5?
Mature
How does gynecomastia typically present?
- Bilateral
- Tender
- Not greater than 4 cm
- Spontaneous resolution between 1-2 yrs
How do we check bone age?
LEFT hand and wrist XR
Which sex steroid hormone comes solely from the adrenal gland?
DHEA-S
For boys, what is generally the underlying cause of delayed puberty?
GnRH deficiency
How do we treat delayed puberty?
Testosterone or estrogen
What are the 3 MC STDs among high schoolers?
- HPV
- Chlamydia
- Trichomoniasis
What is the primary reason for amenorrhea?
Pregnancy
So screen them even if they’re teens or deny sexual activity
