Adolescenct Medicine Flashcards
(63 cards)
1
Q
3 areas COGNITIVE development
A
- Reasoning skills (hypothetical and logical consequences)
- Abstract thinking (ex: love, spirituality)
- Think about thinking (feelings, how viewed by others)
2
Q
3 major tasks/ PSYCHOSOCIAL development
A
- Autonomy (independent of parents)
- Identity (self worth, strengths)
- Ability of future orientation/values (career, moral, religious, sexual)
3
Q
Early adolescence
A
12-14
4
Q
Middle adolescence
A
15-17
5
Q
late adolescence
A
18-21
6
Q
Separation from family
A
- separation and some rebellion is healthy step in development
- peer group imp step in separation from family
7
Q
Early adolescent peer group
A
12-14yo; same sex, how do I appear to friends, want to fit in, frequently change hair/clothes to fit in
8
Q
Middle adolescent peer group
A
15-17yo; mixed sex, importance of finding a mate
9
Q
Late adolescent peer group
A
18-21yo; move away from peer group and into relationships
10
Q
Teens who do not identify with any peer groups
A
“loners’; significant psychological difficulties during adolescence
11
Q
Early maturing boys
A
-seen as older/more responsible
-better at sports
-more popular
8if happens much earlier- may develop hostility and distress symptoms
12
Q
Early pubertal maturing girls
A
-higher risk of: conduct problems, depression, early substance use, poor body image, pregnancy, early sexual experimentation
13
Q
Question: Adolescent girl or boy with weight issue
A
“ask her what he/she thinks about her weight”
14
Q
leading cause morbidity and mortality in 16-20yo
A
MVA
15
Q
2 major cause death in 15-19yo
A
homicide, suicide
16
Q
MVA risks increased by
A
- inexperience
- risk taking behavior (speed, no seatbelt, drug/alcohol, texting, distractions..)
17
Q
Do teens perceive risk?
A
Yes.
- but this does not keep them from partaking in risk-taking behavior.
- from it they seem to gain emotional satisfaction
- concrete thinking adolescent (12-14yo) more concerned about how looks doing it than the risk involved–lack ability to link cause and effect
18
Q
concrete thinking adolescent
A
12-14yo
19
Q
Highest fatality rate of any mental health disorder
A
Anorexia Nervosa
20
Q
Hallmark of Anorexia Nervosa
A
inability or refusal to maintain a healthy body weight
21
Q
Anorexia Nervosa diagnosis
A
Four criteria must be met:
- Distorted body perception
- Weight 15% below expected
- Intense fear of gaining weight and restriction of energy intake
- Absence of 3 consecutive menstrual cycles
22
Q
Question: several signs and symptoms consistent with eating disorder, which is MOST imp in making dx
A
- *“patient THINKS they are fat despite weight being normal”;
- Don’t be fooled by other non-specific choices such as excessive exercise, depression, dieting, diuretics…
23
Q
Indications for hospital admission with Anorexia
A
- weight <75% ideal body weight
- continued wt loss despite intensive outpt management
- acute wt decline and refusal of food
- hypothermia
- hypotension
- bradycardia
- orthostatic changes in BP or pulse
- electrolyte abnormalities
- arrhythmia
- suicidality
24
Q
AN vs Crohsn’s vs hypothyroidism vs depression vs collagen vascular disease
A
use lab findings and info in the history
25
Bulemia Nervosa features
Binge eating coupled with INDUCED vomiting
| [binge eating = consumption of amount of food >most ppl eat in one sitting]
26
Bulemia Nervosa physiologic and lab findings
may be a result of vomiting:
- salivary gland enlargement
- dental enamel erosion
- bruises or caluses over knuckles from forced gagging
- low potassium
- low chloride
- metabolic alkalosis
27
Indications for hospital admission with Bulimia
- failure of outpt tx
- dehydration
- EKG abnormality
- Mallory Weiss tears
- suicidal ideation
28
Bulimia vs Achalasia
key information: INVOLUNTARY vomiting soon after ingested
29
When is parental consent NOT needed
- life threatening emergencies
- sexual assault services
- medical care during pregnancy/family planning
- treatment for STD; HIV testing
- treatment for substance abuse
* *Parental consent is needed for all other medical/surgical procedures, including blood donation
* *Still need informed consent (from minor)
30
Regarding HEADS, when can confidentiality be broken
patient is a danger to self or others
31
Which patients do not need parental consent to receive treatment?
emancipated minors
[a person under legal age who is no longer under their parent's control and regulation and who is managing their own financial affairs
32
SMR1 Male
Prepubertal:
- absent pubic hair
- childlike phallus size
- testicular size <2.5ml
33
SMR2 Male
Beginning of puberty
- fine pubic hair
- childlike phallus size (no change)
- increased testicular size and volume
- scrotum more textured
34
SMR3 Male
- coarse, curly, pigmented pubic hair
- increased phallus size
- increased testicular size
35
SMR4 Male
- denser and curled, but less abundant than adult pubic hair
| - closer to adult male phallus size
36
SMR5 Male
- pubic hair extends to the inner thigh, adult-like
- adult size phallus
- adult testicular size
37
SMR1 Female
Prepubertal:
- absent pubic hair
- no glandular breast tissue
38
SMR2 Female
Beginning of puberty:
- pubic hair along the labia
- small breast buds with glandular tissue
39
SMR3 Female
- coarse, curly, pigmented pubic hair
| - breast tissue extends beyond the areola
40
SMR4 Female
- denser and curled, but less abundant than adult pubic hair
| - enlarged areola and papilla form a secondary mound
41
SMR5 Female
- pubic hair extends to the inner thigh, adult-like
| - no longer a separate projection of the areola from the remainder of the breast
42
Onset of menses
- average: 2 years after thelarche (~ 12-13yo)
| - SMR stage 3 or 4 expected
43
Female peak height velocity
Before menarche
44
First few cycles of menses
- last 2-3 days
| - may occur only every 2-3 months
45
Abnormal menses
- persists >10 days
| - requires workup
46
Physiologic leukorrhea
= white, odorless, mucoid discharge that precedes menarche by 3-6months and can continue for several years
- no intervention needed
47
infrequent menstrual periods
- if during first 2 years post menarche- do NOT generally require workup
- just reassurance and follow up
48
height after menarche
girls are within 4cm/2inches of adult height
49
Question: 11yo girl SMR 2 with bloody vaginal discharge. What is etiology
DONT BE IMMEDIATELY FOOLED TO THINK MENSES/MENARCHE AND SAY "REASSURANCE".
- onset menses generally SMR 3-4
- so consider another option such as vaginal foreign body, common occurrence at this age (ie small piece toilet paper -> local irritation-> mild bleeding)
50
Most likely reason for not using contraception
desire to become pregnant
51
When do 50% of all pregnancies occur
within 6 months of the first time experiencing intercourse
52
When do 20% of all pregnancies occur
during the first month of the first time experiencing intercourse
53
Advantages of oral contraception
- contraception
- decrease risk for ovarian cysts
- decrease risk of endometrial + ovarian +colorectal cancer
- decrease risk of osteoporosis
- help reduce free testosterone levels and decrease hirsutism
- reduce risk of salpingitis and ectopic pregnancy
- some protection against acne and iron deficiency anemia
54
Indications for oral contraceptives
- dysmenorrhea
- dysfunctional uterine bleeding
- PCOS
- irregular menses
- menorrhagia
55
Absolute contraindications to oral contraceptives
- migraine HA with focal aura or neurologic changes
- pregnancy
- uncontrolled HTN
- liver disease
- breast cancer
- cerebrovascular disease
- history of DVT
- history of pulmonary embolism
- known factor V leiden mutation or other thrombophilic condition
56
Other contraceptives
- IUD
- subcutaneous slow release progesterone
- intravaginal rings
* *considered very effective as they do not require daily compliance
57
IUD
- newer ones safer than in the past: no longer increased risk of PID or infertility
- some groups advocate as the preferred method of contraception--**for all women regardless of age and parity
58
contraception vs preg/delivery
all contraceptive methods are associated with fewer health risks than pregnancy and delivery
59
Screening pap smear age
21 yo
| -regardless of age of first intercourse
60
Primary Amenorrhea Definition
= lack of menses by age 15, or 3 years following breast development
61
DDX to consider in primary amenorrhea
1. PREGNANCY (despite denying ever having sex!)- a girl can become pregnant before her first menstrual period, and therefore would present and be described as primary amenorrhea
2. Androgen Insensitivity Syndrome
3. Turner Syndrome
62
Androgen Insensitivity Syndrome/ Testicular Feminization
- normal breast development
| - NO pubic hair, NO menstruation
63
Turner Syndrome
- amenorrhea
- breast budding
- no pubic hair
- short stature
- low hairline
- low set ears
- heart murmur
- HTN
- lymphedema of hands/feet
* *karyotype study would be indicated
