Themes 1 and 2: Family and Adolescence

Question 1

what impacts can illness have on families?

Answer 1

can lead to feelings of powerlessness and mental health issues in members of the family.
loss of sleep directly or indirectly
financial impacts- loss of income from ill person or from family members having to spend time caring
less time for socialising and leisure activities due to hospital appointments, caring
impact on siblings- less parental input, may feel neglected, can have an impact on education

Question 2

what are some factors that can influence how and when people access care?

Answer 2

attractiveness and appropriateness of services
attitudes towards services
previous experiences
lay referral systems
Zola’s triggers- sanctioning, temporalising, interference with social, vocational and physical factors, inter-personal crisis

Question 3

what are some coping strategies for dealing with illness?

Answer 3

educating oneself
access resources- care, support groups, diability grants
symptom management- treatment, medication
become aware of triggers
goal setting and providing structure
discover new interests
identify and resolve emotions towards illness
communication skills

Question 4

what are the different family structures?

Answer 4

nuclear family- traditional, two parents and biological children
blended nuclear family- result of divorces and remarriages
single parent family
extended family- includes relatives living together and caring for eachother. can form due to financial difficulties or to help with caring for older family member
childless family
grandparent family

Question 5

what does “young people” mean according to the GMC and WHO?

Answer 5

GMC- more experienced children who are more likely to make decisions for themselves
WHO- ages 10-24

Question 6

what are the challenges for the patient relating to consultations with young people?

Answer 6

fear of confidentiality breach/ parental presence- may be reluctant to speak about sensitive issues
maturity level- may not be able to express themselves or fully understand information
concordance- may find it difficult to take control of ones own medication/ appoitments
may find it hard to come to terms with a diagnosis

Question 7

what are the challenges for the doctor relating to consultations with young people?

Answer 7

lack of awareness of young peoples issues
increased time needed for- confidentiality reassurance, rapport building, explanations and shared decision making.
identifying safeguarding issues- whether confidentiality should be breached
assessing competence, capacity and best interests

Question 8

according to the GMC 0-18 guide when does someone have capacity to consent to investigation or treatment?

Answer 8

a person has capacity to consent if they are able to understand, retain, use and weigh relevant information and communicate their decision to others

Question 9

what are the Fraser guidelines we must consider before prescribing contraceptive treatment to a person under the age of 16?

Answer 9

practitioners should be satisfied that:

• the young person understands the advice
• the young person cannot be persuaded to inform their parents that they are seeking advice/ treatment
• the young persons physical or mental health is likely to suffer without the advice/ treatment
• it is in the young persons best interests to receive the advice/treatment with or without a parents consent
• the young person is very likely to start or continue having sex with or without contraceptive treatment

Question 10

how can aspects of family life protect and promote health?

Answer 10

organisation, clear rules/ expectations/ routines, good generational boundaries, good example of relationships, good communication, modelling healthy habits (healthy diet, exercise)

Question 11

how can families improve the managing of illness?

Answer 11

good expressive communication
routines- structured but able to be flexible
balancing both the needs of the person with the illness and the needs of the rest of the family

Question 12

what is a lay referral system?

Answer 12

the social network that can influence a persons response to symptoms and decision to seek professional advice.

Question 13

what are the tanner stages of physical development?

Answer 13

they are a classification system that tracts the development of secondary sexual characteristics during puberty in relation to male external genitalia, female breast development, male and female pubic hair

Question 14

what are the tanner stages in male external genitalia development during puberty?

Answer 14

stage 1 (pre-pubertal)- testes less than 2.5cm
stage 2- scrotum and testes enlarge and scrotal skin reddens 
stage 3- continued growth of penis and testes
stage 4- development of the glans, continued growth and scrotal skin darkens 
stage 5 (post-pubertal)- adult size and morphology

Question 15

what are the tanner stages in relation to female breast development?

Answer 15

stage 1 (pre-pubertal)- elevation of papilla only
stage 2- areola enlarges and breast bud appears
stage 3- breast tissue grows beyond areola but without contour separation
stage 4- projection of areola and papilla forms a secondary mound
stage 5- adult breast contour with projection of papilla only

Question 16

what are the tanner stages in relation to pubic hair development?

Answer 16

stage 1- villus hair only
stage 2- sparse hair growth at base of penis and along labia
stage 3- thicker hair spreads to mons pubis
stage 4- adult pattern without spread to medial thigh
stage 5- adult pattern with spread to medial thigh

Question 17

when do growth spurts occur?

Answer 17

girls- 10.5- 17 years

boys- 12.5- 21 years

Question 18

what is the hormonal changes causing a growth spurt?

Answer 18

the increase in sex steroids (testosterone and oestrodiol) during puberty has a positive effect of the pulsatile release of growth hormone (GH) from the anterior pituitary. the rise in GH causes a rise in the anabolic hormone insulin-like growth factor-1 (IGF-1) which causes somatic growth via its metabolic actions e.g. increased trabecular bone growth

Question 19

what are the main hormonal changes in puberty?

Answer 19

the pulsatile release of GnRH from the hypothalamus increases causing a rise in the pulsatile release of FSH and LH. the rise in FSH stimulates increased oestrogen sythesis which triggers oogenesis and spermatogenesis. the rise in LH stimulates increased progesterone release in females and increased testosterone in males. the physical changes of puberty start to develop as a result of these hormonal changes

Question 20

what are the theories about what induces the change in the pulsatile release of GnRH during puberty?

Answer 20

accelerator theory- maturation and activation stimulatory centres in the CNS that induce pulsatile GnRH production. generally accepted theory
brake release theory- the sensitivity of the gonadostat (in hypothalamus) to negative feedback by steroids decreasing to higher levels are needed to inhibit GnRH release. evidence against this- turners syndrome (underdeveloped ovaries), FSH/LH levels increase at puberty in absence of increase in steroids, castrated monkeys undergo puberty

Question 21

what are kisspeptin neurones?

Answer 21

they are the inducers of pulsatile release of GnRH release. they are found in the hypothalamus. the levels of Kiss1 increase at puberty

Question 22

what is the relationship between age of menarche and weight?

Answer 22

high BMI- early menarche

low BMI- late menarche

Question 23

what are some causes of primary amenorrhea?

Answer 23

1. idiopathic/contstitiutional delay in growth and puberty (CDPG)
2. impaired HPO axis- kallmans syndrome
3. chronic illness- chrons disease
4. malnutrition
5. excessive exercise
6. stress

Question 24

how does stress impact the menstrual cute?

Answer 24

stress can activate the hypothalamic- pituitary- adrenal axis (HPA). activation of the HPA axis has an inhibitory effect on the hypothalamic- pituitary- ovarian axis (HPO)

Question 25

what is the definition of adolescence?

Answer 25

the period following the onset of puberty during which a young person develops from a child to an adult 12-20 years

Question 26

what are body schemata?

Answer 26

‘lenses’ through which we filter information about our body. people with negative body schemata habitually make unfavourable comparisons with media images and are more likely to engage in unhealthyy weight control behaviours