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ME 536- Patient Care II > The Adolescent > Flashcards

The Adolescent Flashcards

1
Q

Stages of adolescence

A

Early, middle, late

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2
Q

Early stage adolescent age range

A

10-14

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3
Q

Middle stage adolescent age range

A

15-16

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4
Q

Late stage adolescent age range

A

17-20

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5
Q

Issues to cover with adolescent visits

A

development, physical, cognitive, social/emotional

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6
Q

Puberty

A

transition from sexual immaturity to sexual maturity

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7
Q

First sign of puberty for girls

A

breast development

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8
Q

first sign of puberty for boys

A

testicular enlargement

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9
Q

Puberty occurs about a ______ earlier in girls than in boys

A

year

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10
Q

Mean age of puberty timing for girls

A

10.5 years (range 8-12)

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11
Q

Mean age of puberty timing for boys

A

11.5 years old (9-13)

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12
Q

Puberty occurs earlier in _____ girls than in _________

A

Black, white

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13
Q

Precocious puberty

A

onset of puberty 2-3 standard deviations before the mean

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14
Q

Precocious puberty in girls

A

breast development before age 8

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15
Q

precocious puberty in boys

A

testicular enlargement before age 9

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16
Q

Delayed puberty

A

absence of signs of puberty 2-3 standard deviations after the mean 99-97% have started

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17
Q

delayed puberty in girls

A

12 years old for breast development

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18
Q

delayed puberty in boys

A

14 years old for testicular enlargement

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18
Q

Growth spurt girls vs. boys

A

occurs 2 years earlier in girls than boys

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19
Q

Growth spurt in girls occurs when?

A

~6 months before onset of menses

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20
Q

how long do growth spurts last?

A

about 2 years for both genders

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21
Q

Tanner stages

A

sexual maturity stages

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22
Q

Development of secondary sexual characteristics: girls

A

breast development, public hair, external genitalia

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23
Q

Development of secondary sexual characteristics: boys

A

public hair, external genitalia

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24
Q

how many Tanner stages are there?

A

5 stages

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25
Q

Tanner stage 1Breast development

A

pre-pubital

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26
Q

Tanner stage 2 Breast development

A

breast bud enlargement and nipple, enlargement of areola

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27
Q

Tanner stage 3 Breast development

A

Further enlargement of breast and areola, no separation of their contour

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28
Q

Tanner stage 4 Breast development

A

Areola and nipple form a secondary mound above the level of the breast

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29
Q

Tanner stage 5 Breast development

A

Mature stage: projection of nipple only, related to recession of areola

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30
Q

Tanner stage 1 public hair

A

prepubertal: may have vellous hair

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31
Q

Tanner stage 2 pubic hair

A

sparse growth, slightly pigmented at base of penis or along labia

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32
Q

Tanner stage 3 pubic hair

A

Darker, coarser and more curled beginning to spread over pubis symphysis

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33
Q

Tanner stage 4 pubic hair

A

hair is adult in type, but covers less area than in adult, no spread to medial surface of thighs

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34
Q

Tanner stage 5 public hair

A

adult in type and quantity, horizontal upper border, spread over medial thighs

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35
Q

Tanner stage 1 Testes and scrotum

A

penis: pre-pubertal
scrotum: pre-pubertal

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36
Q

Tanner stage 2 Testes and scrotum

A

Penis: slight or no enlargement
Scrotum: testes larger, scrotum larger and somewhat reddened with altered texture

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37
Q

Tanner stage 3 Testes and scrotum

A

Penis: larger, especially in length
Scrotum: further enlargement

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38
Q

Tanner stage 4 testes and scrotum

A

Penis: further enlargement of length and breadth with development of the glans
Scrotum: further enlargement, scrotal skin darkened

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39
Q

Tanner stage 5 testes and scrotum

A

penis: adult in size and shape
Scrotum: adult in size and shape

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40
Q

Prader Orchidometer

A

measure for scrotum

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41
Q

Prader Orchidometer: pre-pubertal

A

1-3ml

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42
Q

Prader Orchidometer: pubertal

A

4-12ml

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43
Q

Prader Orchidometer: adult

A

12-25ml

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44
Q

Cognitive development

A

move from concrete thinking to formal operational thinking

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45
Q

Early cognitive development

A

concrete operational

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46
Q

Middle cognitive development

A

transition phase, often emotional and make emotional decisions

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47
Q

Late cognitive development

A

formal operational (nor everyone), reason logically and abstractly consider future implications of actions

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48
Q

The brain continues to develop into

A

20s (especially pre-frontal cortex)

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49
Q

Teens sometimes can’t see beyond ____ _____

A

simple solutions

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50
Q

Social/emotional development

A

transition from family dominated to autonomy and peer influence

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51
Q

Struggles of social/emotional development

A

identity
independence
intimacy

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52
Q

Early adolescent characteristics

A

concrete operational thought, am I normal? Peers important, ambivalence family, self, peers

53
Q

Health care approach to early adolescent

A

confidentiality, privacy, emphasis on short term, reassure and positive attitude, support growing autonomy

54
Q

Middle adolescent characteristics

A

males awkward, highly emotional thinking, who am I? introspection. limit testing, experimental behaviors, dating

55
Q

Health care approach to middle adolescent

A

support, problem solving, decision making, nonjudgemental acceptance

56
Q

Late adolescent characteristics

A

adult appearance, formal operational thought (most), what is my role with others? sexuality, future, separate from family and towards independence

57
Q

Health care approach to middle late adolescent

A

approach as an adult, encourage identity, support, anticipatory guidance

58
Q

Puberty is not necessarily synchronized with

A

cognitive, social and emotional development

59
Q

puberty can have a negative impact on psychosocial function especially in

A

girls who mature early and boys who mature late

60
Q

Many health issues start in

A

adolescence

61
Q

Major causes of morbidity and mortality in adolescents

A

car accidents, homicide and suicide, alcohol and drug use, unintended pregnancy and STI, obesity

62
Q

Need to consider _______ and ______ development in how you interact

A

cognitive, social

63
Q

Never promise what?

A

never promise unconditional confidentiality

64
Q

When do you have to report?

A

suicide, homicide, physical or sexual abuse, behaviors with significant risk of physical harm, reportable STDs

65
Q

Consent varies from

A

state to state
most states 18 is legal adult

66
Q

Different categories of minors

A

emancipated vs. medically emancipated v. mature minor

67
Q

In am emergency do you need consent?

A

no, you can treat without consent

68
Q

How should you make sure child/parents records are kept?

A

separate

69
Q

When taking and adolescent health history focus on

A

on the patient and show genuine interest

focus on them and not their problems

70
Q

Does silence work with adolescents

A

no. humor and empathy does

71
Q

HEADSS

A

Home
Education/employment
Activities
Drugs
Sexuality
Suicide/mental health

72
Q

HEADSS H questions

A

Home:
who lives with you? do you have your own room? what do your parents do?

73
Q

HEADSS E questions

A

Education:
school/grade performance? favorite subjects? suspension? future plans? relationships?

74
Q

HEADSS A questions

A

Activities:
sports? church? reading? TV? music? seatbelts? arrests?

75
Q

HEADSS D questions

A

Drugs:
alcohol? tobacco use? amount? how are you getting it?

76
Q

HEADSS S questions

A

Sexuality:
orientation, how many partners? masturbation (normalize)? History of pregnancy/abortion? Contraception? Pleasure with sex? History of abuse?

77
Q

HEADSS last S questions

A

Suicide/Depression:
sleep disorder? emotional outburst? History of past suicide attempts, depression, counseling? History of suicide attempts in family or peers?

78
Q

Physical exam in adolescents

A

same order as adults, vitals (including BP), assess sexual maturity (Tanner stage), use of chaperone for sensitive parts of the exam

79
Q

Adolescent genital exams: boys

A

same as with adult males
NO rectal exam unless there is a cause
Useful to have them sit cross-legged if uncomfortable

80
Q

Adolescent genital exams: girls

A

external exam
sit, frog leg
NO STIRRUPS
exam systematically
separate the labia
NO speculum exam in children unless suspect foreign body or trauma

81
Q

Speculum exams first should be with

A

first pelvic exam should be with an experienced provider

82
Q

Starting age for speculum exams ACOG

A

21

83
Q

When does cervical cancer screening start?

A

starts at age 25, regardless of sexual activity

84
Q

Do you need a pelvic exam to start birth control?

A

no

85
Q

What is an indication for an internal exam?

A

Abnormal bleeding, pain
pregnancy
STI screening

86
Q

Adolescent MSK exam

A

assess for scoliosis (usually start before age 9-10)

87
Q

When do you do the adolescent MSK exam

A

BEFORE the adolescent growth spurt

88
Q

Steps of adolescent MSK exam

A

inspect for symmetry of scapula, shoulders and hips
Adams forward bend test
Can measure with a scoliometer

89
Q

When is a Cobb Angle used?

A

Official scoliosis diagnosis: Cobb angle based off of XR evaluation needed for official diagnosis of scoliosis

90
Q

How to do Adam’s Bend test

A

patient stands and bends forward at the waist. Assess the back for symmetry from behind.
Back or rib cage abnormalities (rib hump) may be a sign of scoliosis

91
Q

What does a rib hump indicate?

A

scoliosis

92
Q

Routine immunizations for adolescents

A

annual flu shot
2 doses meningococcal vaccine (age 11-12) age 16
Tdap booster (usually 11-12 years old)
HPV series (2-3 dose series, depending on age started)

93
Q

What degree do you have to refer with a Cobb angle

A

10> degrees refer out

94
Q

Universal screening in adolescents
- 6 points

A

depression (start @12)
tobacco, alcohol, drug use (start @12)
Hearing: Once between 9-11, once between 15-17
Vision: age 12
HIV screening (once between 15-18 if + risk factors)
Lipids: once between 17-21

95
Q

PHQ-2 screens for what

A

depression

96
Q

PHQ-2 questions

A

Little interest or pleasure in doing things?

Feeling down, depressed, or hopeless?

97
Q

CRAFFT

A

Car
Relax
Alone
Forget
Friends
Trouble

98
Q

C in CRAFFT

A

Car: have you ever ridden in a car driven by someone who was high or using drugs/alcohol

99
Q

R in CRAFFT

A

Relax: do you ever use alcohol or drugs to relax, feel better or fit in

100
Q

A in CRAFFT

A

Alone: do you ever use drugs or alcohol by yourself, alone?

101
Q

F in CRAFFT

A

Forget: do you ever forget things you did while using alcohol or drugs?

102
Q

Second F in CRAFFT

A

Friends: do your family or friends ever tell you that you should cut down on your drinking/drug use?

103
Q

T in CRAFFT

A

Trouble: have you ever gotten in trouble while you were using alcohol or drugs?

104
Q

Pre-participation physical

A

goal is to maximize safe participation, identify problems that could be life threatening, rehab MSK

105
Q

Pre-Participation physical history

A

medical history
Injury history
Cardiovascular history
Family history
ROS
Many states also recommend depression screening

106
Q

Pre-participation physical history: medical history

A

PMH
PSH
loss of function in paired organs
History of heat related illness
meds
immunization
menstrual history in female athletes
rapid change in body weight

107
Q

Pre-participation physical history: injury history

A

past injuries, MSK injuries, head injury/concussions, spine injuries
Loss of time from participation if injured
Previous exclusion of sports for any reason

108
Q

Pre-participation physical history: cardiovascular history

A

identify risk of sudden death, HTN, high cholesterol, Kawasaki disease, heart infection
Exercise symptoms, family history of heart issues

109
Q

Brugada syndromes

A

Symptoms of Brugada syndrome
blackouts.
fits (seizures)
occasional noticeable heartbeats (palpitations), chest pain, breathlessness, or dizziness.

110
Q

HOCM

A

hypertrophy cardiomyopathy

111
Q

Sports exam:

A

stand
ROM neck
shrug against resistance
arms out against resistance
90 degree bend
hold arms out and straighten elbows
flex muscles
pronate/supinate forearms
make a fist/clench fingers
squat and duck walk
touch your toes
tippy toes, walk on heels

112
Q

Additional tests:

A

Single leg squat
Step drop test

113
Q

Adolescent cardiovascular exam

A

BP
resting HR
Auscultation: full evaluation of the valves
assess femoral pulses
signs of inherited disorders

114
Q

What is a sign of Marfan syndrome

A

aortic root dilation/dissection/aneurysm

115
Q

Arachnodactyly

A

Arachnodactyly is a condition in which the fingers are long, slender, and curved. They look like the legs of a spider (arachnid).

116
Q

Wrist sign in Marfans

A

wrap fingers around the wrist, thumb and 5th finger overlap

117
Q

Marfan thumb sign

A

make a fist with the thumb inside and the thumb sticks out the side

118
Q

Ectopic lentis

A

Ectopia lentis is the dislocation or displacement of the natural crystalline lens. The lens is defined as luxated (dislocated) when it lies completely outside of the hyaloid fossa, is free-floating in the vitreous, is in the anterior chamber, or lies directly on the retina.

119
Q

Marfan arms length

A

arms exceed span of height

120
Q

Benign adolescent murmers

A

Grade <2
minimal radiation
No gallop, clicks or rubs
no other findings
Normal O2
musical or vibratory
Normal S2
Quiet precordium
Normal vitals
Normal pulses

121
Q

Worrisome murmurs

A

Grade 3>
harsh or blowing quality
abnormal S2
Systolic click
Friction rub
abnormal vitals
abnormal pulses
hepatomegaly
skeletal abnormalities

122
Q

Other targeted exams

A

BMI
Eyes
Skin
Respiratory
Abdomen
GU
Neuro

123
Q

Balance Error scoring

A

six 20 second trials standing feet together, single leg, heel toe
on floor and foam

errors: hands off iliac cress, opening eyes, stumble

124
Q

Do you do an ECG on adolescents

A

routine mass screening with ECG/ECHO is NOT recommended

125
Q

When do you get a cardiology evaluation

A

recommended cardiology evaluation is any cardiovascular concerns (abnormal findings, risk factors, family history)

126
Q

American Heart Association 14 Element Cardiovascular Screen

A

Medical history (personal history family history) physical exam findings

127
Q

AHA 14 element CV screen bullets

A
  1. Exertional chest pain or discomfort
  2. Exertional syncope or near syncope
  3. Excessive exertion and unexplained fatigue/fatigue associated with exercise
  4. Prior recognition of a heart murmur
  5. Elevated systematic blood pressure
  6. Prior restriction from participating in sports
  7. Prior cardiac testing ordered by a physician
  8. Premature death- sudden/unexplained prior to age 50 from heart disease in 1+ relatives
  9. Disability from heart disease in a close relative <50
  10. Specific knowledge of CV conditions
  11. heart murmur: supine and standing with valsalva
  12. Femoral pulses
  13. Physical stigmata of Marfan syndrome
  14. brachial artery blood pressure (sitting, both arms)
128
Q

If you have positive/abnormal screen of 14 element CV means

A

12 lead and further evaluation by pediatric cardiology

129
Q

Adolescents seem like _____ but they are not _____

A

adults

ME 536- Patient Care II (8 decks)

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