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Flashcards in Female health maintenance Deck (21):
1

Adolescent Interview

H - home
E - employment/education
E - eating
A - activity/aspiration
D - drugs
S - sexuality
S - safety
S - suicide

2

Signs of hypothyroidism in adolescents

Cold skin
Slowness
Fatigue
Poor school performance
Preferring hot over cold weather
Coarse hair
Myxedema

3

Menses in adolescents

Often light and irregular with more cramping
*important to distinguish "extra" tampons or soaking through them
- timing of periods
- length of periods
- are they normal

4

Infectious mono

"mono" caused by EBV virus (fatigue, sore throat, lymphadenopathy)
- infection of lymphocytes

5

Depression in adolescents

Mood swings - can be normal
Adjustment reactions - can be normal
- evaluate if indicated
- screen for depression

6

Symptoms of depression

1. Feeling down and don't want to do normal acitvities
2. Crying over small things
3. Don't want to hang out with friends
4. Suicide ideation
5. Feeling grouchy

7

Inquiring about eating disorders

Most adolescents are honest when asked especially when you express confidentiality
- ask about both anorexia and bullimia

8

Signs of anorexia

Weight loss/failure to gain weight
- bradycardia (can lead to hypotension)
- electrolyte abnormalities (malnutrition)
- arrhythmias
- death

9

Signs of bullimia

Can be more difficult to diagnose than anorexia b/c in bullimia the weight remains normal
- look for 2nd manifestations --> tooth decay, finger trauma

10

Treatment of eating disorders

need therapists and counselors, nutritionists,

11

DDx for fatigue in adolescent female

1. Anemia - either bleeding disorder, heavy periods, iron-deficiency
2. Hypothyroidism - can cause menstrual abnormalities
3. Depression - fatigue can be sign of depression
4. Substance use

12

Discussing confidentiality with adolescents

Be honest, talk about absolute and relative confidentiality,

13

Evaluating a decrease in academic performance

Medical : hypothyroidism
Personal: substance abuse, death of loved one, family stressors
Psychosocial: depression

14

Obtaining sexual history

You need to ask specific questions.
1. Are you sexually active?
2. Boys? Girls?
3. How many partners?
4. Protection? Always?

15

Adolescent PE

Respect their shyness and privacy
- have a chaperone if appropriate or simply wait for physician to conduct the exam

16

Puberty for girls

8-13 y.o.
1. Breast buds
2. Pubic hair
3. Growth spurt
4. Menarche
5. Adult height

17

Puberty for boys

10-15 y.o.
1. Growth of testicles
2. Pubic hair
3. Growth of penis
4. First ejaculation (13-14 y.o.)
5. Growth spurt
6. Adult height

18

Labs for a suspected bleeding disorder

CBC, PT, PTT
vWF (Ristocetin factor)
Factor VIII activity
Platelet function
Reticulocyte count

19

von Willebrand Disease

*most common hereditary bleeding disorder
Autosomal dominance with variable penetrance
Sx = ecchymosis, epistaxis, menorrhagia, gingival bleeds, bleeding following minor procedures

20

Diagnosis of vWD

Careful history and PE
- most blood tests can be normal
- make sure to check vWF antigen and Ristocetin

21

Treatment of vWD

intranasal of IV desmopressin
- causes dose dependent increase in vWF which shortens bleeding time and PTT