Peds 2: Adolescence
Terms in this set (70)
When does physical growth begin in girls?
When does physical growth begin in boys?
When will most complete puberty?
How do adolescents develop cognitively?
from concrete to abstract thinking
4 areas of adolescent development
1. Completion of puberty & somatic growth
2. Developing socially, emotionally, and cognitively
3. Establishing independent identity and separating from family
4. Preparing for career/vocation
Provider role in career/vocational preparation in well-child visits
give a vision for life (ie. complete highschool)
Major cause of MORBIDITY in adolescence
(e.g. unintended pregnancy, STDs, substance abuse, school drop-out, physical violence, runaway from home, juvenile delinquency)
What is often correlated with adolescent morbidity?
Leading causes of death in 15-19 yo.
homicide, suicide, and unintentional (MVC)
Factors affecting teen healthcare
ability to pay, distance to clinic, availability of transportation, accessibility of services (hours of operation), time away from school, and PRIVACY/confidentiality
What age group is least likely to be insured?
Adolescents and young adults
Problems of uninsured teens
1. No usual source of health care
2. More likely to have unmet needs
3. More likely to go without a physician contact over the course of a year
How has society attempted to address uninsured teens?
School based clinics
Who is the provider obligated to, in the matter of adolescent/teen reproductive health?
Patient not the parent
What topics should be covered in the History?
Nutrition (sports enhancing supplements), Sleep, Safety (access to firearms), self care (breast/testicular exam), relationships, school, career planning, substance abuse (include tobacco), sexuality, emotional health
Emotional health topics
depression, anxiety, coping mechanisms
Indications for pelvic exam
hx of intercourse
abnormal vaginal d/c
suspect an anatomic abnormality (e.g. imperforate hymen)
At what age is gender identity thought to be established
When is sense of masculinity/femininity usually present?
5-6 yo. (start of kindergarten)
What is not a predictor of future sexual orientation?
Past sexual behavior
Percent of teens who consider themselves gay or bisexual?
2.5% unsure, 1.3% gay/lesbian, 3.7% bisexual.
Experimentation common during early/middle adolescence.
What are gay/bisexual youths at greater risk for?
Suicide, especially males.
Incidence of depression in children?
Incidence of depression in teens
What gender is more likely to have depression?
What percent of depressed children/teens have a comorbid psychiatric disorder?
What percent of depressed children/teens have 2 or more comorbid psychiatric disorders?
Why is missed dx of depression due to provider overlooking it?
Teens do not present with "masked" depression.
Signs/symptoms of depression
irritable mood/affect, tantrums, verbal outbursts, behavior changes, poor school performance, sleep, appetite and somatic complaints.
3rd leading cause of death in US.
What gender is more likely to be successful in their suicide attempt?
What gender plans and attempts suicide more often?
Attempt to success rate of suicide
What methods do men use to commit suicide?
1. firearms (40-60%)
2. suicide by cop
What methods do females use to commit suicide?
Suicide risk factors
Psychiatric d/o, previous attempt, FHx of mood disorder or suicidal behavior, Hx of sexual abuse, exposure to violence/victimization, or biological factors (serotonin)
Precipitating factors for suicide
Access to means, etoh and drug use, exposure to suicide (copy catting), social stress and isolation, emotional and cognitive factors
Why do kids and teens make poor decisions when it comes to substance abuse? (not the same as true substance abuse)
They're socially and cognitively immature.
What is the key to managing substance abuse in teens and kids?
prevent initial use or prevent use from becoming abuse.
List the 2 most common complications of eating disorders
constipation, fluid and electrolyte abnormalities
Recent studies on eating disorders indicate what possible complications
1. reduced bone mineral density
2. cortical atrophy of the brain
3. effect on future children
Eating disorder treatment (general)
psychotherapy (individual and family)
Which eating disorder has the greatest risk of early mortality
What is the 3rd leading chronic condition among teen females?
What criteria is no longer required under DSM V for a diagnosis of anorexia nervosa?
What eating disorder is characterized by recurrent episodes of both binge eating and inappropriate compensatory behaviors to prevent weight gain (laxatives, vomiting)
What eating disorder is characterized by: eating rapidly, eating until uncomfortable, eating large amounts of feed when not hunry, eating alone due to amount of food, self disgust depression or guilt, and no use of inappropriate compensatory behaviors.
Binge eating disorder
Which eating disorder is more prevalent among men than women?
eating disorder NOS
Causes of school failure
limited intellectual abilities
specific learning disabilities
lack of ability to concentrate
Physical limitations (hearing, vision)
Lack of motivation
depression or emotional problems
Most common breast lesion in teens
Breast cyst clinical presentation
tender spongy mass that worsens before and after menses.
How long should a cystic breast mass be followed for?
2-3 menses cycles
What is needed for dx of a fibroadenoma of the breast?
U/S if needed;
Refer for biopsy/excision if lesion changes
Who usually experiences fibrocystic breast changes?
Can be seen in older adolescents but usually in females during reproductive years.
What causes fibrocystic breast changes
estrogen and progesterone levels
Most common pathogen causing a breast abscess
Causes of galactorrhea
chronic stimulation or irritation
childbirth or abortions
Pathologic causes (prolactinomas, hypothyroidism)
lack of onset of menses when normally anticipated (no menses or secondary sex characteristics by 13 yo. or no menses with secondary sex characteristics by 15 yo.)
no menses for at least 3 cycles or 6 months in a patient with irregular cycles
MCC of secondary amenorrhea
Most common gyn complaint in teens
Which is uncommon in teens: primary or secondary dysmenorrhea?
Dysfunctional Uterine Bleeding (DUB) is caused by _____________________________.
unopposed estrogen stimulation during anovulatory cycles.
midcycle pain due to irritation of the peritoneum from spillage of fluid from the a ruptured follicular cyst during ovulation.
Most common type of ovarian cyst
What should always be on your differential list for children who have started menstruating?
Transient sub-areolar breast tissue during Tanner stage III and IV.
What percent of males develop pubertal gynecomastia?
Up to 70%
Generalized breast enlargement secondary to endocrine, neoplasm, chronic disease, trauma, or medicines. Associated with Klinefelter's syndrome (which is assoc. w/ increased risk of breast cancer).
Excessive fat tissue or prominent pectoralis muscles.