Teens Flashcards
What is the exception to confidentiality in teens
harm to self or others
HEADSS exam
Home/Friends
(What do you do for fun)
Education
(How’s school going? )
Alcohol
(Are any of your friends drinking)
Drugs
“Are any of your friends doing drugs? )
Diet
(Are you trying dieting?”)
Sex
(Are you dating anyone? )
Suicide
(Have you felt so bad you’ve wanted to hurt yourself? .)
Ave age of puberty
11 (8-13 NML)
What is the threshold for precocious puberty
Precocious puberty: pubertal changes prior to age 6 in African Americans and age 7 in Caucasian
If a mass is found in puberty breasts
What is the next step
Breast cancer is rare in this age group Ultrasound eval (better for young, dense breasts)
Usually benign fibroademona or cyst
vaginal dc in tanner stage III
Think
Vaginal discharge -> Clear, no odor, no
Pruritus
Due to ovarian estrogen stimulation of uterus & vagina
If needed, obtain vaginal culture without speculum
What is the w/u for premature thelarche
Rule out early central precocious puberty, functional ovarian cysts, ovarian tumor
Refer to Endo if necessary
Run estrogen, LH/FSH labs and bone age
R/o tumor, pelvic US or MRI
What is the threshold for premature adrenarche
<8yo females or < 9yo males
W/u for premature adrenarche
Differential diagnosis—rule out excessive androgens
Congenital adrenal hyperplasia, Tumor (adrenal/gonadal), Cushing syndrome, environmental exposure
Refer to Endo if necessary
Labs: DHEAS< Andro/ Test, 17OH progesterone, bone age
If testes start to grow before what age? It’s abNML
Age 9
Endocrine emergency consult and get MRI - brain tumor
What is an Rx for Gynecomastia
Bromocriptine
What is the approach to severe or prolonged menstrual bleeding
Adolescent GI referral
What is the typical ovulation cycle for 1st time menses
A ovulatory
Primamry amenorhhea
No menses by age 16
Or 14 if no secondary characteristics
What is the most common cause of AUB in peds
Anovulation
What is the criteria for PCOS
Diagnosed w/ 2 of the following:
-Infrequent menstrual bleeding or secondary amenorrhea
- Clinical or biochemical hyperandrogenism
- Polycystic morphology of ovaries on ultrasound
Treatment for AUB
Treatment is indicated for heavy menses
Lab: CBC
Iron therapy if has iron deficiency anemia
Combo estrogen/progesterone tx
What is the mainstay tx for heavy bleeding is pts with bleeding d/o
Combo estrogen/progesterone
What is the approach to primary dysmenorrhea
First line NSAIDS
If NSAIDS fail then OCPS
If longer than 4 months on tx and no resolution consider alt dx
If a pt has HTN/poorly controlled on sports physical
What is the recommendation
Stage II HTN/poorly controlled: Disqualify until Nephrology evaluation
What is the sports restriction with mono
Mononucleosis: restrict for at least 28 days (increased risk splenic injury/rupture)
Approach to childhood obesity
Children <7 yo
-Goal is weight maintenance, not loss; let linear growth (height) catch up to weight
Children >7 yo
-Goal is 1lb/month until BMI <85%
SMART goals
Specific, Measurable, Attainable, Realistic, Timely
SIGECAPS
Sleep Interests Guilt Energy Concentration Appetite Psychomotor SI/HI
What is the greatest risk factor for successful suicide
Previous attempts
Screening tool for depression
PHQ-2
If score greater than 3= PHQ-9
PHQ-9 Scoring
0-4: minimal 5-9: mild 10-14: mod 15-19: mod/ severe 20-27: severe
Treatment approach to depression in adolece cents
Fluoxetine and escitalopram are the only meds approved for use for depression in children
What is the screening tool for Anxiety
SCARED
What is the mgmt for anxiety
Consider co-morbid conditions (ADHD)
Consider thyroid, substance abuse, meds
Mild-moderate:
-CBT + SSRI (fluoxetine, sertraline)
Mod-severe: refer to Psychiatry
What is the screening tool for adolescent substance abuse
CRAFT
Car -drugs and driving Relax -drugs to relax Alone - drugs alone Forgetting - forgetting from drugs Family/Friends - asked to stop Trouble -getting into 2.2 drugs
