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N270.04: Pediatric Physical Assessment > Week 2: Adolescent Health History and Preparticipation Sports Physical > Flashcards

Week 2: Adolescent Health History and Preparticipation Sports Physical Flashcards

1
Q

What is different about interviewing an adolescent? (2)

A

(1) Rapid/variable cognitive and moral development

(2) Psychosocial issues of adolescence

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2
Q

Why interview adolescents about psychosocial issues?

A

The patient interview – “ a conversation with a purpose” (Bickley)

Establish a trusting and supportive relationship
Gather information
Offer information
Health promotion and counseling central to well adolescent care

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3
Q

Teens most want to discuss what 3 things?

A

drugs, smoking, healthy dietary habits

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4
Q

___% of teens engaging in risky behaviors have not spoken to provider about them

A

63

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5
Q

3 Leading causes of death for adolescents:

A
  1. accidents (MVA)
  2. murder
  3. suicide
  4. cancer
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6
Q

Why is the adolescent psycho-social screen confidential? (4)

A
  1. Mature minor (common law)
  2. Constitutional right to privacy
  3. Ethical principle of autonomy
  4. Utilitarian approach – importance of disclosure of sensitive information
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7
Q

Adolescent Consent/Privacy Rights in California

A

Right to consent = right to privacy
Teens control medical records to services for which they can consent

This is NOT true in every state

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8
Q

in CA, children and teens may consent to:

A

Contraception
Any services related to pregnancy, including prenatal care and abortion

There is no lower age limit in California law for these services

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9
Q

In CA, at age 12, a teen can consent to:

A
  • STD testing and treatment, including HIV
  • Exam, treatment for sexual assault
  • Discussions, counseling re drug use
  • Mental health services

Remember: Parental or court consent required for any psychiatric medications for anyone under 18

Parental or court consent required for hospitalization, some exceptions for emergencies

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10
Q

In CA, parental or court consent is required for any psychiatric medications for anyone under

A

18

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11
Q

Emancipated Minor

A
  • Legally married
  • Armed services
  • Legal income and legal emancipation
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12
Q

Mature Minor

A
  • Living apart with or w/o permission

- Managing own affairs in any way, income from any source

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13
Q

Limits to Confidentiality (3 major)

A
  1. Teen states intention to harm self (must inform parents/guardians)
  2. Teen states intention to harm someone else (must inform victim/call police)
  3. Teen discloses physical/sexual abuse/neglect (mandatory CPS report)
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14
Q

Late developers may have temporary popularity/esteem issues, but generally there is a ___ effect

A

protective

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15
Q

Early developers have ___  interest in risk-taking behaviors with ___ impulse control

A

increased risk taking

decreased impulse control

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16
Q

SSHADESS

A 
Strengths
School
Home
Activities
Drugs/substance use
Emotions/Depression
Sexuality
Safety
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17
Q

HEADSSS

A 
Home
Education/employment
Activities
Drugs/diet
Sexual Activity/Abuse
Suicidal ideation/depression
Safety
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18
Q

Points to remember about interviewing the early adolescent (10-14)

A
  • May never have been interviewed without a parent before
  • May not know crucial elements of own medical history
  • May never have been asked about confidential issues, such as drug use or sexuality
  • May need to ease into questions
  • VERY present-oriented
  • Limited independence, limited skills at self-care
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19
Q

Points to remember about interviewing the middle adolescent (14-16)

A
  • Still relatively concrete, may not have been asked independent/confidential questions before
  • May have more experience with confidential questions
    Increasing ability to remember details of own history, make and carry out plans
  • May have some independent skills (taking bus, filling prescription, making own purchases)
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20
Q

Points to remember about interviewing the late adolescent (16-23)

A
  • Cognitively similar to adults in ability to understand, answer questions, make plans
  • Brain development not yet complete, differences in reward centers, impact of emotions on frontal lobe
  • Less experience, much less familiarity with medical jargon, may not understand euphemisms
  • More familiarity with adolescent risks, even if not engaging in them: can ask more directly
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21
Q

How are teens different than adults in terms of drugs/alcohol/tobacco? (2 key points)

A
  • Binge use more common than daily use in teens

- Remorse about use less common than in adults, even with significant overuse

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22
Q

CRAFFT questions pertaining to drugs/alcohol for adolescents

A

Ridden in a CAR with someone high?

Drink/drugs to RELAX or fit in?

Drink/drugs while ALONE?

FORGET things you did on alcohol/drugs?

FAMILY/FRIENDS tell you to cut down?

TROUBLE from drinking/drugs?

23
Q

Structured depression screen now recommended yearly for teens ≥

A

12

24
Q

If a teen is < 14, how old of a sexual partner do you need to report?

A

14 or older

25
Q

If a teen is < 16, how old of a sexual partner do you need to report?

A

21 or older

26
Q

Adolescent Psychosocial Screen like GAPS (AMA)/AAP/SAHM should be done when?

A

yearly

Well exams
When care has been interrupted
When teen has a physical  complaint with possible psychosocial overlay
(Headache
GI complaints
Fatigue)
27
Q

Sports likely for weight loss/issues

A

Boxing, wrestling
Dance, gymnastics
Football (increase)

28
Q

Female Adolescent Triad

A

Disordered eating
Amenorrhea
Osteopenia

also an issue for distance endurance sports

29
Q

Sudden Cardiac Death

A

Sudden, nontraumatic, nonviolent death occurring within 6 hours of previously witnessed state of normal health

most previously undiagnosed

30
Q

Most common causes of Sudden Cardiac Death

A
  • Hypertrophic Cardiomyopathy (HCM) (26%)
  • Anomalous origin of coronary artery (14%)
  • other structural causes (e.g. Marfan Syndrome)
  • Arrhythmias (Prolonged QT, heart block)
31
Q

Hypertrophic Cardiomyopathy

A

Familial disease - unexplained L ventricular hypertrophy

Usually asymptomatic in adolescence

Characteristic murmur may not be present early in course

Screening ECG 80-90% accurate in detection
Echocardiogram to aid in diagnosis and for follow-up in those with family histories

32
Q

Severe Marfan Syndrome syndrome characterized by

A
  • Long thin extremities, often associated with hyper mobility
  • Reduced vision 2º dislocations of lenses
  • Aortic aneurysms – dissection leads to SCD

Incidence 1:10,000
Inherited as autosomal dominant trait, but up to 30% from spontaneous mutations

33
Q

Concussion definition (5 key points)

A
  1. Caused by direct head injury OR blow elsewhere w/ impulsive force to head
  2. Rapid onset short-lived neuro impairment w/ spontaneous resolution
  3. Functional injury
  4. Graded set of clinical symptoms – with or without LOC
  5. No abnormality on imaging
34
Q

Teens are ___ coordinated during periods of rapid growth

A

less

35
Q

Ligaments are ___ than bones in early puberty, so teens are more prone to fractures vs. sprains

A

stronger

36
Q

Menses are normally ____ during first 2 years after menarche

A

irregular

37
Q

Is powerlifting ok while growth plates open (could be ages 18-20 in boys)?

A

NO!

do more repetitions of small weights

38
Q

Growth spurt for girls normally happens at what Tanner Stage?

A

3-4

39
Q

Growth spurt for boys normally happens at what Tanner Stage?

A

4-5

40
Q

Skeletal maturity (T5) for girls happens when?

A

2 years post-menarche

they are 85% of adult height at menarche

41
Q

Skeletal maturity (T5) for boys happens when?

A

Age 18-20

42
Q

Menarche age range for girls

A

average: 12
range: 9-16

Tanner Stage: 3-4

43
Q

Spermarche age range for boys

A

average: 13
range: 11-15

Tanner Stage: 2-3

44
Q

BMI calculation

A

Weight in Kg ÷ (Height in meters)²

Weight in Pounds ÷(Height in inches)² X 703

plot for age and gender

45
Q

Signs of Marfan Syndrome that might appear during objective part of sports exam

A 
Armspan>height
Upper/lower segment ratio
Hyperflexible joints
Pectus deformity
Kyphoscoliosis
46
Q

Visual acuity concerns (2)

A

one eye only
or
best corrected vision >20/40

47
Q

Still’s murmur

A

LLSB, apex
Harsh, vibratory
increased when supine
decreased w/ Valsalva

48
Q

Murmur of HCM

A

LLSB, apex
May be soft
decreased when supine
increased w/ Valsalva

49
Q

“athletic heart” - Effects of dynamic training

A
  • increase in vagal tone, decrease in resting heart rate (<60)
  • increase in L ventricular size
  • increase in maximal oxygen consumption
50
Q

Detailed neurological exam NOT required if

A

Negative ROS
Mental status, general appearance WNL
Musculoskeletal exam WNL

51
Q

Order of sports physical exam (suggested) - 8

A
  1. HEENT (start sitting or standing)
  2. Nodes, thyroid
  3. Respiratory/lungs
  4. Cardiac: standing/sitting
  5. Cardiac: Lying (can check breast Tanner Stage)
  6. Abdomen, femoral pulses, Tanner Stage girls
  7. 14-point ortho (standing)
  8. Male GU
52
Q

Refer to cardiology for which murmurs? (5)

A
  1. All diastolic murmurs
  2. All holosystolic murmurs
  3. Murmurs greater than or equal to 3/6 in intensity
  4. Continuous murmurs (not venous hum)
  5. Murmurs which  when standing or w Valsalva
53
Q

Put down minimum information necessary/be careful what you write for school forms (not EMR) when doing sports physical – why?

A

Schools operate under FERPA NOT HIPAA:

  • Parents have access to all records
  • School may share health care information more freely than with HIPAA
  • Informal verbal dissemination of info among school staff allowed

N270.04: Pediatric Physical Assessment (2 decks)

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