Lecture 3 - Adolescent Medicine Flashcards

1
Q

SMR

A

Sexual Maturity Rating (SMR)
Females - Pubic hair + breast
Males - Pubic hair + testicular volume + penile changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

SMR 1 for females

A

no pubic hair

pre-pubertal breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SMR 2 for females

A

Sparse, vellus pubic hair

bud under areola

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SMR 3 for females

A

dark, burly, lateral spread pubic hair

mound beyond areola, single contour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SMR 4 for females

A

adult, no thigh extension pubic hair

secondary areolar mound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SMR 5 for females

A

adult, extends to thighs for pubic hair

adult size breast, single contour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is the average age of menarche for women?

A

between 12 and 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

By what age has SMR 5 been met for women?

A

typically by 15 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SMR 1 for males

A

no pubic hair
testicular volume <4
pre-pubertal penile changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SMR 2 for males

A

sparse, vellus pubic hair
>4ml testicular volume
slight increase in size of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SMR 3 for males

A

dark, curly, lateral spread of pubic hair
>8ml testicular volume
increase in length of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SMR 4 for males

A

adult, no thigh extension for pubic hair
>12ml testicular volume
increase in width of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SMR 5 for males

A

adult, extends to thighs for pubic hair, >16-20 testicular volume, adult size penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the definition of delayed puberty in females?

A

no thelarche by age 13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the definition of delayed puberty in males?

A

no testicular growth by age 14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In regards to abnormal puberty in females, which is more likely to be seen as benign, precocious or delayed?

A

Precocious puberty
SMR 2 prior to age 8

More likely to be constitutional (benign)

Delayed puberty - no thelarche by age 13 years - is more likely to be pathologic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Thelarche

A

The onset of female breast development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Delayed puberty in females

A

No thelarche by age 13
No pubic hair by age 14
No menarche by age 16
More than 3-5 years between thelarche to menarche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Precocious puberty in females?

A

Onset of puberty too early
Can be normal in females

SMR 2 prior to age 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which is more likely to be benign in men, precocious puberty or delayed?

A

Delayed puberty more constitutional in men

Precocious puberty (SMR 2 prior to age 9) is more concerning in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Precocious puberty in men?

A

SMR 2 prior to age 9 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Delayed puberty in men?

A

No testicular growth by age 14 years

No pubic hair by age 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

For a child who started their puberty early, what is the workup?

A
Ultrasensitive LH 
AM 17 hydroxyprogesterone 
Estradiol, testosterone 
Pelvic/testicular US 
Bone age
24
Q

Central vs peripheral precocious puberty

A

Central precocious puberty - sex steroid and gonadotropins will be ELEVATED, always evaluate CNS with MRI in boys; most girls do not have a CNS lesion, but check if CSN sxs

Peripheral - McCUne-Albright -Cafe au lait spots that don’t cross midline, jagged border
Typically gonadotropics are SUPPRESSED

25
Q

Constitutional delay

A

‘Late bloomer’ - benign reason to have delayed puberty

26
Q

Kallman Syndrome

A

Gonadotropin deficiency leading to delayed puberty

27
Q

Bone growth: ____accelerate before _____with ____limbs accelerating before _____

A

Limbs accelerate before trunk with distal limbs accelerating before proximal

“All hands and feet”

28
Q

Height Velocity ____% complete by SMR 4

A

95%

If a pt asks you “will i get taller?”, if they are at SMR 4 then probably not

29
Q

When do males peak in height?

A

13.5 years

30
Q

When do females peak?

A

11.5 years

31
Q

What lab levels would you expect to see in a female going through growth changes?

A

Alkaline phosphatase

Hemoglobin and ferritin decrease

HDL increase and LDL decrease
Serum creatinine increases

32
Q

What lab values do you expect to see in a growing male?

A

Alkaline phostaphatase increase

Hemoglobin and ferritin increase

HDL decrease
LDL increases

Serum creatinine increase

33
Q

Cognition and psychosocial development

A

Age related (not SMR)

Early (10-14 years)
Middle (15-17 years)
Late (18 - 21 years)
Emerging adulthood (24-26 years)

34
Q

During early adolescence what factors do you see in parents/family component?

A

10-14 years

Less interest in family activities 
Able to recognize parental flaws 
Less tolerant of parental criticism 
May be reluctant to accept parental advice 
Questions rules, authority figures
35
Q

During early adolescence, what do you expect to see in the peers component?

A

10-14 years

Same sex friendships, often emphasis on conformity
Self awareness and self consciousness
Feelings of sexual attraction, with interest&raquo_space; action
Curious about risk behaviors, with interest&raquo_space; action

36
Q

In early adolescence, what do you expect to see in the cognition component?

A

Concrete thinking (right vs wrong)
Early moral concepts
Real and unreal vocational goals
Cant perceive of long range implications of actions and decisions
Lack of impulse control with immediate gratification

37
Q

In the early adolescence, what do you expect to see in the emerging capacity to consent component of cognition and psychosocial development?

A

10-14 years

Understand risk/benefits
Difficulty considering multiple conflicting points
Decisions similar to adults

38
Q

What do you expect to see with middle adolescence in the parents/family and peers component?

A

15- 17 years

Parents/family
Amplification of early adolescent separation from family
Time of greatest parent/teen conflict

Peers
Friend group includes both sexes
Conformity with peer values and codes
Begin to explore role of self as unique within group
Dating and questions of sexual orientation, interest >= action
Increase in risk behaviors, interest >= action

39
Q

What do you expect to see in cognition and capacity to consent component in middle adolescence?

A

Cognition
Formal operational thinking, begin to abstract, concrete under stress
Fervent ideology, fantasy, idealism
Identification of law with morality
Few unrealistic vocational goals
Increased verbal abilities, creativity, intellect

Capacity to consent
Understand and process information in manner similar to adults
Decision making may be impaired in “hot” situations

40
Q

In late adolescence what do you expect to see in the parents/family and peers component of development?

A

18-21

Parents/family
Renegotiate relationship from child - parent to adult - adult
More positive interactions
Emancipation complete

Peers
Individual values/identity > peer group values
Individual friend relationships > large group relationships
Longer romantic involvement with plans for future family development

41
Q

If you had to put each age group of cognitive development into two words, what would they be?

A

Early adolescence - quest for autonomy

Middle adolescence - exploring identity

Late adolescence - realization of self

42
Q

How might rapid body changes alter the cognitive and social development in adolescents?

A

Rapid body changes

  • challenge to sense of self
  • self esteem
  • eating disorders
  • higher risk taking
43
Q

HEADDSS

A

Topics to remember when you are interviewing the adolescent

Home/fiends
Education 
Activities/Alcohol
Drugs
Diet
Sex
Suicide/depression
44
Q

Toxic stress

A

Stress during adolescence

Extreme, frequent, or extended activation of the body’s stress response in absence of supportive caregiving

Risk factors: neglect and abuse, extreme poverty, witnessing violence, parental substance abuse and mental health problems, experiencing bullying

45
Q

When does sex ed typically start?

A

5th or 6th grade

46
Q

Teenage pregnancy has higher rates of ______

A

Post partum depression

Also 2.6x greater chance of homicide

47
Q

What is the most effective form of birth control (no talking abstinence)?

A

Implant
IUD

Followed by 
Injectable 
Pill 
Patch 
Ring 
Diaphragm 

Least:
Condom (but should still be used to reduce risk of STIs)
Female condom
Withdrawal

48
Q

What is the leading cause of death between 15 - 19 years of age?

A

Injury is number 1

Followed by homicide

49
Q

When is bullying more common and how many kids get bullied?

A

30% get bullied

Middle school > high school

50
Q

What is the DSM 5 criteria for Anorexia Nervosa?

A

Persistent restriction of intake leading to lower than expected weight
Eating disorder cognitions are now equivalent to eating disorder behaviors
Body image distortion and undue influence on self esteem

Or

Refusal to recognize the seriousness of low body weight

51
Q

What is the DSM 5 criteria for bulimina nervosa?

A

Bulimia is more common but less fatal than AN

Recurrent episodes of binge eating
A sense of lack of control over eating during binge
Recurrent inappropriate compensatory behaviors to lose weight
Binging and purging behaviors occur >1x/week for > 3 months
Self evaluation is unduly influenced by body shape and weight

52
Q

What are some CV findings in AN and BN?

A
Sinus brady 
Hypotension 
Orthostatic 
Arrythmias 
Prolonged QT 
Edema (BN)
53
Q

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

A

Suicide

54
Q

MALPRACTICE mnemonic

A

For evaluation of suicidal child or adolescent

Mental Health 
Attempts 
Lethality 
Plans
Risk taking
Alcohol and drugs 
Conflict 
Trauma 
Impulsivity 
Community resources 
Exposure
55
Q

_____% of 12th graders have tried weed

A

44%

56
Q

What is the AAP recommendation fo screening EtOH use?

A

Ask about it at health maintenance visits

57
Q

CRAFT

A

Screening from problem use
Car - have you ever gotten in a car with someone drunk/hight?
Relax/fit in - have you used alcohol or drugs to relax of fit in?
Alone - have you used alcohol/drugs when you are alone?
Family/Friends - has anyone talked to you about cutting down?
Forget things - have you forgotten something youve done with you were drul/high?
Trouble - have you ever gotten in trouble or done something you regretted when drunk/high?