The Adolescent Flashcards
(130 cards)
1
Q
Stages of adolescence
A
Early, middle, late
2
Q
Early stage adolescent age range
A
10-14
3
Q
Middle stage adolescent age range
A
15-16
4
Q
Late stage adolescent age range
A
17-20
5
Q
Issues to cover with adolescent visits
A
development, physical, cognitive, social/emotional
6
Q
Puberty
A
transition from sexual immaturity to sexual maturity
7
Q
First sign of puberty for girls
A
breast development
8
Q
first sign of puberty for boys
A
testicular enlargement
9
Q
Puberty occurs about a ______ earlier in girls than in boys
A
year
10
Q
Mean age of puberty timing for girls
A
10.5 years (range 8-12)
11
Q
Mean age of puberty timing for boys
A
11.5 years old (9-13)
12
Q
Puberty occurs earlier in _____ girls than in _________
A
Black, white
13
Q
Precocious puberty
A
onset of puberty 2-3 standard deviations before the mean
14
Q
Precocious puberty in girls
A
breast development before age 8
15
Q
precocious puberty in boys
A
testicular enlargement before age 9
16
Q
Delayed puberty
A
absence of signs of puberty 2-3 standard deviations after the mean 99-97% have started
17
Q
delayed puberty in girls
A
12 years old for breast development
18
Q
delayed puberty in boys
A
14 years old for testicular enlargement
18
Q
Growth spurt girls vs. boys
A
occurs 2 years earlier in girls than boys
19
Q
Growth spurt in girls occurs when?
A
~6 months before onset of menses
20
Q
how long do growth spurts last?
A
about 2 years for both genders
21
Q
Tanner stages
A
sexual maturity stages
22
Q
Development of secondary sexual characteristics: girls
A
breast development, public hair, external genitalia
23
Q
Development of secondary sexual characteristics: boys
A
public hair, external genitalia
24
how many Tanner stages are there?
5 stages
25
Tanner stage 1Breast development
pre-pubital
26
Tanner stage 2 Breast development
breast bud enlargement and nipple, enlargement of areola
27
Tanner stage 3 Breast development
Further enlargement of breast and areola, no separation of their contour
28
Tanner stage 4 Breast development
Areola and nipple form a secondary mound above the level of the breast
29
Tanner stage 5 Breast development
Mature stage: projection of nipple only, related to recession of areola
30
Tanner stage 1 public hair
prepubertal: may have vellous hair
31
Tanner stage 2 pubic hair
sparse growth, slightly pigmented at base of penis or along labia
32
Tanner stage 3 pubic hair
Darker, coarser and more curled beginning to spread over pubis symphysis
33
Tanner stage 4 pubic hair
hair is adult in type, but covers less area than in adult, no spread to medial surface of thighs
34
Tanner stage 5 public hair
adult in type and quantity, horizontal upper border, spread over medial thighs
35
Tanner stage 1 Testes and scrotum
penis: pre-pubertal
scrotum: pre-pubertal
36
Tanner stage 2 Testes and scrotum
Penis: slight or no enlargement
Scrotum: testes larger, scrotum larger and somewhat reddened with altered texture
37
Tanner stage 3 Testes and scrotum
Penis: larger, especially in length
Scrotum: further enlargement
38
Tanner stage 4 testes and scrotum
Penis: further enlargement of length and breadth with development of the glans
Scrotum: further enlargement, scrotal skin darkened
39
Tanner stage 5 testes and scrotum
penis: adult in size and shape
Scrotum: adult in size and shape
40
Prader Orchidometer
measure for scrotum
41
Prader Orchidometer: pre-pubertal
1-3ml
42
Prader Orchidometer: pubertal
4-12ml
43
Prader Orchidometer: adult
12-25ml
44
Cognitive development
move from concrete thinking to formal operational thinking
45
Early cognitive development
concrete operational
46
Middle cognitive development
transition phase, often emotional and make emotional decisions
47
Late cognitive development
formal operational (nor everyone), reason logically and abstractly consider future implications of actions
48
The brain continues to develop into
20s (especially pre-frontal cortex)
49
Teens sometimes can't see beyond ____ _____
simple solutions
50
Social/emotional development
transition from family dominated to autonomy and peer influence
51
Struggles of social/emotional development
identity
independence
intimacy
52
Early adolescent characteristics
concrete operational thought, am I normal? Peers important, ambivalence family, self, peers
53
Health care approach to early adolescent
confidentiality, privacy, emphasis on short term, reassure and positive attitude, support growing autonomy
54
Middle adolescent characteristics
males awkward, highly emotional thinking, who am I? introspection. limit testing, experimental behaviors, dating
55
Health care approach to middle adolescent
support, problem solving, decision making, nonjudgemental acceptance
56
Late adolescent characteristics
adult appearance, formal operational thought (most), what is my role with others? sexuality, future, separate from family and towards independence
57
Health care approach to middle late adolescent
approach as an adult, encourage identity, support, anticipatory guidance
58
Puberty is not necessarily synchronized with
cognitive, social and emotional development
59
puberty can have a negative impact on psychosocial function especially in
girls who mature early and boys who mature late
60
Many health issues start in
adolescence
61
Major causes of morbidity and mortality in adolescents
car accidents, homicide and suicide, alcohol and drug use, unintended pregnancy and STI, obesity
62
Need to consider _______ and ______ development in how you interact
cognitive, social
63
Never promise what?
never promise unconditional confidentiality
64
When do you have to report?
suicide, homicide, physical or sexual abuse, behaviors with significant risk of physical harm, reportable STDs
65
Consent varies from
state to state
most states 18 is legal adult
66
Different categories of minors
emancipated vs. medically emancipated v. mature minor
67
In am emergency do you need consent?
no, you can treat without consent
68
How should you make sure child/parents records are kept?
separate
69
When taking and adolescent health history focus on
on the patient and show genuine interest
focus on them and not their problems
70
Does silence work with adolescents
no. humor and empathy does
71
HEADSS
Home
Education/employment
Activities
Drugs
Sexuality
Suicide/mental health
72
HEADSS H questions
Home:
who lives with you? do you have your own room? what do your parents do?
73
HEADSS E questions
Education:
school/grade performance? favorite subjects? suspension? future plans? relationships?
74
HEADSS A questions
Activities:
sports? church? reading? TV? music? seatbelts? arrests?
75
HEADSS D questions
Drugs:
alcohol? tobacco use? amount? how are you getting it?
76
HEADSS S questions
Sexuality:
orientation, how many partners? masturbation (normalize)? History of pregnancy/abortion? Contraception? Pleasure with sex? History of abuse?
77
HEADSS last S questions
Suicide/Depression:
sleep disorder? emotional outburst? History of past suicide attempts, depression, counseling? History of suicide attempts in family or peers?
78
Physical exam in adolescents
same order as adults, vitals (including BP), assess sexual maturity (Tanner stage), use of chaperone for sensitive parts of the exam
79
Adolescent genital exams: boys
same as with adult males
NO rectal exam unless there is a cause
Useful to have them sit cross-legged if uncomfortable
80
Adolescent genital exams: girls
external exam
sit, frog leg
NO STIRRUPS
exam systematically
separate the labia
NO speculum exam in children unless suspect foreign body or trauma
81
Speculum exams first should be with
first pelvic exam should be with an experienced provider
82
Starting age for speculum exams ACOG
21
83
When does cervical cancer screening start?
starts at age 25, regardless of sexual activity
84
Do you need a pelvic exam to start birth control?
no
85
What is an indication for an internal exam?
Abnormal bleeding, pain
pregnancy
STI screening
86
Adolescent MSK exam
assess for scoliosis (usually start before age 9-10)
87
When do you do the adolescent MSK exam
BEFORE the adolescent growth spurt
88
Steps of adolescent MSK exam
inspect for symmetry of scapula, shoulders and hips
Adams forward bend test
Can measure with a scoliometer
89
When is a Cobb Angle used?
Official scoliosis diagnosis: Cobb angle based off of XR evaluation needed for official diagnosis of scoliosis
90
How to do Adam's Bend test
patient stands and bends forward at the waist. Assess the back for symmetry from behind.
Back or rib cage abnormalities (rib hump) may be a sign of scoliosis
91
What does a rib hump indicate?
scoliosis
92
Routine immunizations for adolescents
annual flu shot
2 doses meningococcal vaccine (age 11-12) age 16
Tdap booster (usually 11-12 years old)
HPV series (2-3 dose series, depending on age started)
93
What degree do you have to refer with a Cobb angle
10> degrees refer out
94
Universal screening in adolescents
- 6 points
depression (start @12)
tobacco, alcohol, drug use (start @12)
Hearing: Once between 9-11, once between 15-17
Vision: age 12
HIV screening (once between 15-18 if + risk factors)
Lipids: once between 17-21
95
PHQ-2 screens for what
depression
96
PHQ-2 questions
Little interest or pleasure in doing things?
Feeling down, depressed, or hopeless?
97
CRAFFT
Car
Relax
Alone
Forget
Friends
Trouble
98
C in CRAFFT
Car: have you ever ridden in a car driven by someone who was high or using drugs/alcohol
99
R in CRAFFT
Relax: do you ever use alcohol or drugs to relax, feel better or fit in
100
A in CRAFFT
Alone: do you ever use drugs or alcohol by yourself, alone?
101
F in CRAFFT
Forget: do you ever forget things you did while using alcohol or drugs?
102
Second F in CRAFFT
Friends: do your family or friends ever tell you that you should cut down on your drinking/drug use?
103
T in CRAFFT
Trouble: have you ever gotten in trouble while you were using alcohol or drugs?
104
Pre-participation physical
goal is to maximize safe participation, identify problems that could be life threatening, rehab MSK
105
Pre-Participation physical history
medical history
Injury history
Cardiovascular history
Family history
ROS
Many states also recommend depression screening
106
Pre-participation physical history: medical history
PMH
PSH
loss of function in paired organs
History of heat related illness
meds
immunization
menstrual history in female athletes
rapid change in body weight
107
Pre-participation physical history: injury history
past injuries, MSK injuries, head injury/concussions, spine injuries
Loss of time from participation if injured
Previous exclusion of sports for any reason
108
Pre-participation physical history: cardiovascular history
identify risk of sudden death, HTN, high cholesterol, Kawasaki disease, heart infection
Exercise symptoms, family history of heart issues
109
Brugada syndromes
Symptoms of Brugada syndrome
blackouts.
fits (seizures)
occasional noticeable heartbeats (palpitations), chest pain, breathlessness, or dizziness.
110
HOCM
hypertrophy cardiomyopathy
111
Sports exam:
stand
ROM neck
shrug against resistance
arms out against resistance
90 degree bend
hold arms out and straighten elbows
flex muscles
pronate/supinate forearms
make a fist/clench fingers
squat and duck walk
touch your toes
tippy toes, walk on heels
112
Additional tests:
Single leg squat
Step drop test
113
Adolescent cardiovascular exam
BP
resting HR
Auscultation: full evaluation of the valves
assess femoral pulses
signs of inherited disorders
114
What is a sign of Marfan syndrome
aortic root dilation/dissection/aneurysm
115
Arachnodactyly
Arachnodactyly is a condition in which the fingers are long, slender, and curved. They look like the legs of a spider (arachnid).
116
Wrist sign in Marfans
wrap fingers around the wrist, thumb and 5th finger overlap
117
Marfan thumb sign
make a fist with the thumb inside and the thumb sticks out the side
118
Ectopic lentis
Ectopia lentis is the dislocation or displacement of the natural crystalline lens. The lens is defined as luxated (dislocated) when it lies completely outside of the hyaloid fossa, is free-floating in the vitreous, is in the anterior chamber, or lies directly on the retina.
119
Marfan arms length
arms exceed span of height
120
Benign adolescent murmers
Grade <2
minimal radiation
No gallop, clicks or rubs
no other findings
Normal O2
musical or vibratory
Normal S2
Quiet precordium
Normal vitals
Normal pulses
121
Worrisome murmurs
Grade 3>
harsh or blowing quality
abnormal S2
Systolic click
Friction rub
abnormal vitals
abnormal pulses
hepatomegaly
skeletal abnormalities
122
Other targeted exams
BMI
Eyes
Skin
Respiratory
Abdomen
GU
Neuro
123
Balance Error scoring
six 20 second trials standing feet together, single leg, heel toe
on floor and foam
errors: hands off iliac cress, opening eyes, stumble
124
Do you do an ECG on adolescents
routine mass screening with ECG/ECHO is NOT recommended
125
When do you get a cardiology evaluation
recommended cardiology evaluation is any cardiovascular concerns (abnormal findings, risk factors, family history)
126
American Heart Association 14 Element Cardiovascular Screen
Medical history (personal history family history) physical exam findings
127
AHA 14 element CV screen bullets
1. Exertional chest pain or discomfort
2. Exertional syncope or near syncope
3. Excessive exertion and unexplained fatigue/fatigue associated with exercise
4. Prior recognition of a heart murmur
5. Elevated systematic blood pressure
6. Prior restriction from participating in sports
7. Prior cardiac testing ordered by a physician
8. Premature death- sudden/unexplained prior to age 50 from heart disease in 1+ relatives
9. Disability from heart disease in a close relative <50
10. Specific knowledge of CV conditions
11. heart murmur: supine and standing with valsalva
12. Femoral pulses
13. Physical stigmata of Marfan syndrome
14. brachial artery blood pressure (sitting, both arms)
128
If you have positive/abnormal screen of 14 element CV means
12 lead and further evaluation by pediatric cardiology
129
Adolescents seem like _____ but they are not _____
adults
