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Peds Exam 2 > Lecture 3 - Adolescent Medicine > Flashcards

Lecture 3 - Adolescent Medicine Flashcards

1
Q

SMR

A

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

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2
Q

SMR 1 for females

A

no pubic hair

pre-pubertal breast

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3
Q

SMR 2 for females

A

Sparse, vellus pubic hair

bud under areola

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4
Q

SMR 3 for females

A

dark, burly, lateral spread pubic hair

mound beyond areola, single contour

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5
Q

SMR 4 for females

A

adult, no thigh extension pubic hair

secondary areolar mound

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6
Q

SMR 5 for females

A

adult, extends to thighs for pubic hair

adult size breast, single contour

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7
Q

When is the average age of menarche for women?

A

between 12 and 13

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8
Q

By what age has SMR 5 been met for women?

A

typically by 15 years of age

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9
Q

SMR 1 for males

A

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

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10
Q

SMR 2 for males

A

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

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11
Q

SMR 3 for males

A

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

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12
Q

SMR 4 for males

A

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

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13
Q

SMR 5 for males

A

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

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14
Q

What is the definition of delayed puberty in females?

A

no thelarche by age 13

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15
Q

What is the definition of delayed puberty in males?

A

no testicular growth by age 14

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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

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17
Q

Thelarche

A

The onset of female breast development

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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

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19
Q

Precocious puberty in females?

A

Onset of puberty too early
Can be normal in females

SMR 2 prior to age 8

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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

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21
Q

Precocious puberty in men?

A

SMR 2 prior to age 9 years

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22
Q

Delayed puberty in men?

A

No testicular growth by age 14 years

No pubic hair by age 15 years

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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
Constitutional delay
‘Late bloomer’ - benign reason to have delayed puberty
26
Kallman Syndrome
Gonadotropin deficiency leading to delayed puberty
27
Bone growth: ____accelerate before _____with ____limbs accelerating before _____
Limbs accelerate before trunk with distal limbs accelerating before proximal “All hands and feet”
28
Height Velocity ____% complete by SMR 4
95% If a pt asks you “will i get taller?”, if they are at SMR 4 then probably not
29
When do males peak in height?
13.5 years
30
When do females peak?
11.5 years
31
What lab levels would you expect to see in a female going through growth changes?
Alkaline phosphatase Hemoglobin and ferritin decrease HDL increase and LDL decrease Serum creatinine increases
32
What lab values do you expect to see in a growing male?
Alkaline phostaphatase increase Hemoglobin and ferritin increase HDL decrease LDL increases Serum creatinine increase
33
Cognition and psychosocial development
Age related (not SMR) Early (10-14 years) Middle (15-17 years) Late (18 - 21 years) Emerging adulthood (24-26 years)
34
During early adolescence what factors do you see in parents/family component?
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
During early adolescence, what do you expect to see in the peers component?
10-14 years Same sex friendships, often emphasis on conformity Self awareness and self consciousness Feelings of sexual attraction, with interest >> action Curious about risk behaviors, with interest >> action
36
In early adolescence, what do you expect to see in the cognition component?
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
In the early adolescence, what do you expect to see in the emerging capacity to consent component of cognition and psychosocial development?
10-14 years Understand risk/benefits Difficulty considering multiple conflicting points Decisions similar to adults
38
What do you expect to see with middle adolescence in the parents/family and peers component?
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
What do you expect to see in cognition and capacity to consent component in middle adolescence?
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
In late adolescence what do you expect to see in the parents/family and peers component of development?
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
If you had to put each age group of cognitive development into two words, what would they be?
Early adolescence - quest for autonomy Middle adolescence - exploring identity Late adolescence - realization of self
42
How might rapid body changes alter the cognitive and social development in adolescents?
Rapid body changes - challenge to sense of self - self esteem - eating disorders - higher risk taking
43
HEADDSS
Topics to remember when you are interviewing the adolescent ``` Home/fiends Education Activities/Alcohol Drugs Diet Sex Suicide/depression ```
44
Toxic stress
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
When does sex ed typically start?
5th or 6th grade
46
Teenage pregnancy has higher rates of ______
Post partum depression Also 2.6x greater chance of homicide
47
What is the most effective form of birth control (no talking abstinence)?
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
What is the leading cause of death between 15 - 19 years of age?
Injury is number 1 | Followed by homicide
49
When is bullying more common and how many kids get bullied?
30% get bullied Middle school > high school
50
What is the DSM 5 criteria for Anorexia Nervosa?
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
What is the DSM 5 criteria for bulimina nervosa?
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
What are some CV findings in AN and BN?
``` Sinus brady Hypotension Orthostatic Arrythmias Prolonged QT Edema (BN) ```
53
What is the third leading cause of death in adolescents 15-19?
Suicide
54
MALPRACTICE mnemonic
For evaluation of suicidal child or adolescent ``` Mental Health Attempts Lethality Plans Risk taking Alcohol and drugs Conflict Trauma Impulsivity Community resources Exposure ```
55
_____% of 12th graders have tried weed
44%
56
What is the AAP recommendation fo screening EtOH use?
Ask about it at health maintenance visits
57
CRAFT
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?

Peds Exam 2 (11 decks)

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