CH 20 primary care of well and sick infant, child, teen part B Flashcards
early adolescent social development
10-13 years
- Concrete thinking/black & white thinking
- progression of sexual identity development, reassessment of body image
- beginning to identify as a person other than parents’ child
-early strong peer identification, early exploration (drugs)
mid adolescence age
14-17 years
- Increased abstract thinking (right and wrong), I’m “bullet proof;”
- growing verbal abilities; identification of law with morality; start of fervent ideology (religious, political)
- strong peer identification, often increased health risk (smoking, alcohol, etc.); early educational and vocational plans
late adolescence ages
18-21 years
Complex abstract thinking, increased impulse control; f
further development of personal identity; further development or rejection of religious and political ideology
Development of social autonomy, increasingly complex intimate relationships, moving towards development of vocational capability
and financial independence
what medically emancipated conditions can adolescents to get help w/o parents?
all 50 states allow:
-Contraception
-Pregnancy
-Sexually transmitted infection
-Substance abuse (<20% of teens report they would get
treatment for STI, family planning, or substance
abuse if parent notification was required_
- Mental health (45% of teens report they would not get treatment for depression if parental notification was required.)
when is confidentiality broken for medically emancipated conditions?
if the PCP believes the teen is in a situation or has a condition that poses significant danger to the teen, family and/or greater society.
what do you have to disclose to guardian and adolescent at the initiation of relationship with PCP?
A policy guaranteeing confidentiality for the teenager should be clearly stated
14 year young woman and 15 boy have sex vs
but if 14 year old woman and 24 year boyfriend
you remain confidentiality! if 14 and 15 boyfriend but if 25 boyfriend =
satutatory rape ! can’t have sex with a minor
James is a 15-year-old who arrives for a well-teen visit with his mother. Prior to the beginning of the visit, his mother pulls you aside and states, “I want him checked for all drugs, but he said he is not using anything and does not want to be tested.” Which of the following is your most appropriate response?
A. “What drugs do you think James is taking?”
B. “I cannot force James to take a drug test.”
C. “Let’s discuss your concerns with James.”
D. “Since you are concerned, I can order the test without James’ consent.”
answer C:
he COULD turn down being tested. but he engages the convo and doesn’t ignore the problem
In which of the following scenarios is parental consent for care required?
A. An 18-year-old female who is seeking a pregnancy termination
B. A 16-year-old female requesting a prescription for oral contraceptives
C. A 15-year-old male requesting testing for sexually transmitted infection
D. A 17-year-old male who requests treatment for contact dermatitis
answer: D
18 year old is old enough to make decision
A 12-year-old boy presents with his mother for a well-child visit. What is the most helpful approach to this visit?
A. Interview and examine the child in the absence of the mother.
B. Interview the child with the mother, asking her to leave for the examination.
C. Ask the child if he wishes his mother to be there for the interview and examination.
D. Ask the mother if she wishes to be included in the interview and examination.
answer C
ask PATIENT!
screening test for adolescent substance abuse
similar to cage questionnaire
CRAFFT questions
-car in a under influence person,
drugs to Relax
drugs Alone?
Forgetful?
Friends tell you to cut down?
Trouble while doing drugs?
In the USA, which of the following is the most common cause of adolescent
death?
A. Suicide
B. Homicide
C. Accidental injury
D. Malignancy
C Accidental injury - COUNSEL about safety!
Tanner stage 1
pre puberty
tanner stage 2
early changes
males: Testes enlarge; scrotal skin reddening with change in texture; sparse growth of long, slightly
pigmented pubic hair at base of penis
female: Breast buds and papilla elevated, downy
pigmented pubic hair along labia majora
tanner stage 3
“middle finger” = ONSET of growth spurts
Male: - “pencil penis” stage (grows longer but not thicker)
-further scrotal enlargement
pubic hair darker, coarser, covers greater area
-pseudomastia (fat under breasts enlarges)
female: breast mount enlargement, darker, coaser, curling public hair on mons, labia major, onset of growth spurt
tanner stage 4
“ring finger” = peak of growth, menarche
male: Increase in penile length and width with
development of glans; further darkening of scrotal
skin; adult‐type pubic hair with no spread to
medial surface of thighs
female: Areola and papilla elevated to form a second
mound above level of rest of breast; adult‐type
pubic hair with no spread to medial surface of
thighs; menarche
tanner stage 5
full adult pubic
recession of areola to mound of breast, extension of pubic hair to medial thigh
once girl get 1st period, they grow for how much longer?
1 year!
but males have longer period of grown during adolescents than females do
most common pubertical alteration in female?
early onset puberty in girls ~ 7-8 years old. idiopathic in majority
- starting periods
can start GnRH agonist analog an option to delay progress, requires specialty evaluation for
treatment.
alteration in puberty female at > 13 years…
no signs of puberty (pubic hairs, budding)…
nutrition (low weight)
hormonal, genetic (turner syndrome [XO], etc)
alterations in males for puberty include?
< 9 years old, early onset puberty is < 40% idiopathic (CNS tumor most often implicated)
> 14 year old late (tanner 1) onset = nutrition, hormonal, genetic etc
You see Sharon for a well-child visit. She is a 12-year-old who is at Tanner stage 2–3 and states unhappily, “I am the shortest girl in my class.” When reviewing her growth chart, you notice she has been consistently between the 10th and 15th percentile for height and weight during her childhood. The rest of her examination is within normal limits. You advise that:
A. She should have an evaluation by a pediatric endocrinology specialist.
B. Her growth spurt will start soon.
C. Due to her age, she is likely near her adult height.
D. X-ray determination of bone age should be obtained.
B. Tanner 2-3 she will start her spurt soon within few inches next few years.
A & D implies something is wrong but nothing is wrong
Physiologic gynecomastia is usually found in which of the following?
A. A 14-year-old male who is at Tanner stage 3
B. A 12-year-old male who is at Tanner stage 2
C. A 17-year-old male who is at Tanner stage 5
D. A 10-year-old male who is at Tanner stage 1
A. seen in 50% of males age 13-14 / tanner 3 thru 4 lasgts 6-24 months
no further eval; reassure it’s normal
fragile X syndrome findings in males vs females
sx’s more prominant in males: Large forehead, ears, prominent jaw, tendency to avoid eye contact. Large testicles (macroorchidism), large body habitus, learning and behavioral differences
ADHD, autism - hyperactivity, developmental disability common
In females: Significantly less common with fewer prominent findings,
usually with less severe developmental issues
what is the most common cause of autism in either gender, in all racial and ethnic groups?
Fragile X syndrome
Klinefelter syndrome
XXY only males affected - extra “X” = more feminine features
SMALL testes, lowtesticular volume, hip and breast enlargement (gynecomastia) INFERTILITY
Mostly developmental issues, language impairment.
Blood testing for carrier state (genetic risk for having a child with
Klinefelter syndrome) or for diagnosis of the condition.
-Antenatal diagnosis possible.
Turner syndrome & findings
XO female (missing X/Y chromosome)
short (>5 ft ),
-usually evident by age 5 years
-wide, webbed neck; broad, shield-shaped chest, absent menses, infertility.
- Often noticeable at birth, narrow, high-arched palate, retrognathia (lower jaw not prominent), low-set ears, edema of and feet.
turner syndrome fetus
high rate of spontaneous pregnancy loss in XO female fetus
mild acne preferred treatment
-not highly inflammatory
-Topical retinoid alone or add topical antibiotic and/or
benzoyl peroxide
moderate acne preferred treatment
-Oral antibiotic with topical
retinoid to start, once lesions controlled usu within 3 months, can transition to topical antimicrobial with topical retinoid.
- Can consider combined hormonal contraception or
spironolactone (females only) or topical clascoterone (both genders)
severe acne preferred treatment
-Oral antibiotic with topical retinoid. If ineffective, oral
isotretinoin (Accutane®).
-For large, painful cysts = intralesional
corticosteroid injection
with cystic acne, consider if there is ___ use
anabolic (testosterone) steroid use
string of pearls in ovaries
PCOS - insulin resistance
