Adolescent Medicine - Exam 2

Question 1

Rapid changes in physical appearance (secondary sex characteristics) and behavior are major changes in , leading to more self-consciousness and need for privacy

Answer 1

10 -13

Question 2

More comfortable with members of same sex

Answer 2

10-13

Question 3

Body image and self-esteem fluctuate

Answer 3

10-13

Question 4

Peer relationships increasingly important

Answer 4

10-13

Question 5

Limited thought of future and if so, vague and unrealistic goals likely

Answer 5

10-13

Question 6

Struggle for autonomy and sense of identity are the major characteristics of

Answer 6

14-16

Question 7

High risk behaviors as a result of experimentation are common

Answer 7

14-16

Question 8

Intense emotions and mood swings typical

Answer 8

14-16

Question 9

Moves from concrete thinking to more abstract

Answer 9

14-16

Question 10

Self-centered

Answer 10

14-16

Question 11

Peers in…parents out

Answer 11

14-16

Question 12

History focuses on interaction with family, school and peers

Answer 12

14-16

Question 13

Individuality and planning for the future are the major characteristics of

Answer 13

14-16

Question 14

Less self-centered and more caring for others

Answer 14

17-21

Question 15

Idealism with rigid concepts of right and wrong with moral reasoning

Answer 15

17-21

Question 16

More serious relationships

Answer 16

17-21

Question 17

Greater emphasis is placed on the responsibility for his or her health

Answer 17

17-21

Question 18

What is the leading cause of morbidity and mortality in adolescence?

Answer 18

automobile crashes

than homicide/suicide

Question 19

When should you start screening kids for risk taking behavior? What does this practically look like?

Answer 19

We screen all kids 10 and older

Speak with them in the room with parents and also without parents if they prefer

Question 20

What are the key characteristics of mature minor?

Answer 20

their competence and capacity to understand, NOT their chronological age

Question 21

What are 3 issues that cannot be kept confidential?

Answer 21

such as suicidal intent

positive HIV status

disclosure of sexual or physical abuse

Question 22

When is sex education taught in public schools?

Answer 22

6th grade in any public school but at any age in office

Question 23

What age should you start screening for drug related issues?

Answer 23

Screen at any age, but 11 and older is key

Question 24

What are the 3 ways to become an emancipated minor?

Answer 24

get married

join the military

go to court and have the judge declare you emancipated

Question 25

What is the mature minors doctrine?

Answer 25

a minor over the age of 14 is allowed to consent or refuse to consent to his medical treatment if it is established that the minor is sufficiently mature to understand, discern and appreciate the benefits and risks of the proposed medical treatment. the intervention is neither a major one nor for the benefit of another need to document

Question 26

How old do you need to be in order to be eligible to petition the courts to be emancipated?

Answer 26

Child over age 16 who has petitioned a court to be declared emancipated needs to be physically and financially independent of family

Question 27

What are the 4 categories of preventative services for adolescent medicine?

Answer 27

Screening Counseling to reduce risk Immunizations General health guidance

Question 28

What are the guidelines for asking a parents to leave the room?

Answer 28

Even if parents accompany the adolescent to the appointment - ask the patient if ok to ask them to leave the room to discuss more private issues with the patient. BUT have chaperone for exam. aka okay to leave for questions but have to be present for PE

Question 29

What are the 9 topics that should be screened for?

Answer 29

Diet Exercise Seatbelts / Helmets / Texting Sleep Sexual behaviors Substance abuse Online behavior issues Bullying Sports

Question 30

While regards to immunizations in adolescent medicine, always check _____ vaccine status. When does the Tdap need to be given?

Answer 30

Hep A given at age 10-12

Question 31

What are the 2 types of meningococcal vaccines?

Answer 31

Menactra, Menveo, Menomune - serogroup A, C, W and Y Newest is MenB - Trumenba and Bexsero - serogroup B

Question 32

Need to screen for _____ is there is any suspicion. What are some kiddo signs?

Answer 32

depression/anxiety Drop in grades or school performance Neglect of personal appearance Neglect of responsibilities Outbursts, severe anger or irritability Getting into trouble, impulsive

Question 33

______ is the second leading cause of death in ages 15-19 years old. _____ have mental health issues

Answer 33

suicide 90% and most have a mood disorder (either bipolar or depression)

Question 34

When it comes to suicide, boys are _____ and girls are ______. What are the top 2 methods?

Answer 34

Boys 3X greater rate of COMPLETED suicide Girls 2X greater ATTEMPTS suffocation and firearms

Question 35

What is considered school avoidance?

Answer 35

Missing 1 week or more of school for an illness which would not require serious treatment and continues despite parents and care providers encouragement to attend

Question 36

How long does the Tanner Staging typically take to complete? When do girls typically end? boys?

Answer 36

between 4-5 years Girls typically 10.5 and boys 11.5

Question 37

What is considered precocious puberty in girls? in boys?

Answer 37

Secondary sexual characteristics starting before age 8 in Caucasian females or age 7 in African American or Hispanic females before age 9 in boys

Question 38

What gender is precocious puberty more likely to be idiopathic?

Answer 38

Idiopathic in 80-90% girls only 25-60% boys

Question 39

What age is normal for breast development in girls? testicular enlargement in boys?

Answer 39

12 - 13 years in girls for breast development 13 - 14 years in boys for testicular enlargement

Question 40

**Draw the Tanner Stages of development chart** know this slide very well

Answer 40

Question 41

What stage?

Answer 41

I

Question 42

What stage?

Answer 42

II

Question 43

What stage?

Answer 43

III

Question 44

What stage?

Answer 44

IV

Question 45

What stage?

Answer 45

V

Question 46

What stage? How long? What volume?

Answer 46

I less than 2.5cm 3ml

Question 47

What stage? How long? What volume?

Answer 47

II 2.5-3.3cm long 4ml

Question 48

What stage? How long? What volume?

Answer 48

III 3.4-4cm 10ml

Question 49

What stage? How long? What volume?

Answer 49

IV 4.1-4.5cm 16ml

Question 50

What stage? How long? What volume?

Answer 50

V greater than 4.5cm greater than 20ml (said 25 on the slide)

Question 51

When should you screen for delayed puberty? What does sexual development mean in this context?

Answer 51

Absence or incomplete development of sexual characteristics by age 12 - 13 in girls (no menses by 16) or by age 14 in boys Sexual development meaning: increased testicular size in boys and breast size in girls

Question 52

___ high school teens admit to being sexually active. ____ will contract an STD. What are the top 3 MC STDs?

Answer 52

½ ¼ HPV, chlamydia and trichomoniasis

Question 53

What are ways to screen adolescent with regards to their sexual activity?

Answer 53

Screen all teens alone in the room without a parent present if possible Ask open ended questions and ensure confidentiality

Question 54

What is the AAP recommendation with regards to screening for STD in sexually active teens? What should you do before starting any oral contraceptive?

Answer 54

Urine gonorrhea and chlamydia yearly pregnancy test