PD E2- Adolescents

What is the period of transition from childhood to adulthood & the healthiest period of life?

Adolescence

What ages are adolescents?

11-20

What stage of adolescence involves formal operational thinking, acquiring an ability to reason logically and abstractly and consider future implications of current actions?

Early adolescence

What is the 2nd leading cause of death for adolescents?

Suicide

What are warning signs seen in adolescence?

School decline, cutting class, eat/sleep changes, affect, new group of friends, personality change, running away, violence, withdrawal from family activity/hobbies/sports, profanity, paraphernalia

What ages are in th early stage of adolescence?

10-13 years

What psychosocial growth occurs in early adolescence?

rapid growth sex characteristics, body image / self esteem fluctuates, preoccupied with physical changes, short stature in boys, breast development in girls, allegiance shifts to peers, thinks concretely

What ages are in the middle stage of adolescence?

14-16 years

What psychosocial growth occurs during the middle stage of adolescence?

Becomes more comfortable with new body, intense emotion & mood swings, peers determine standards for behavior & fashion, gains ability to think abstractly, self centered, contraception but not compliant

What ages are late adolescence?

≥ 17 yrs

What psychosocial growth occurs during late adolescence?

Less self centered, social shifts from peer groups to individuals, dating more intimate, thinks more realistically & outcomes associated with behavior, period of idealism & rigid concepts of right and wrong

What is the heart rate for 10-14 year olds?

55-115 bpm

What is the heart rate for ≥ 15 year olds?

60-100 bpm

What is the respiratory rate for adolescents?

12-18 bpm

What tanner stage does menarche usually occur?

Breast tanner stage 3-4

When does puberty occur in females?

Begin age 10, end age 14 (2 years earlier than males)

When does puberty occur in males?

Begin age 11, end age 16

What is the initial sign of puberty in males?

testicular growth

What is the initial sign of puberty in females?

breast development or pubic hair

What is a white head?

Closed comedone

What is a black head?

Open comedone

Around what age does acne vulgaris start?

10

Lymphoid tissues _____ with age

decrease

What HEENT changes occur with adolescence?

Voice deepens, thyroid cartilage enlarges, eyeballs lengthen, palpable nodes in neck

At what tanner stage does the breast exam begin?

Tanner stage II

What is gynecomastia associated with?

marijuana usage

What is a painless, slow growing rubbery mass in the upper outer quadrant of the breast, usually found in females ages 15-35?

Fibroadenomas

What kind of breast mass is tender, intermittent with cycles, spongy, & usually in multiples?

Cysts

When is an ultrasound indicated for a breast cyst?

Persists and ≥ 2.5 cm

How does gynecomastia present in adolescent males?

MC B/L (rarely U/L), transient, tender firm mass under areola

What are indications for a pelvic exam in an adolescent?

Sexual activity, abnormal discharge, menstrual or anatomic irregularities, pelvic pain

What is Adam’s bend test?

Child bends forward, if abnormality detected use a scoliometer (checks for scoliosis)

When might scoliosis first be suspected?

One shoulder seems higher than other or when clothes do not hang straight

Where is bartholin’s gland?

Inner edge of labia @ 5 & 7 o’clock

What are the 2 MCC of delayed puberty?

Anorexia nervosa & chronic disease

What might ≤ 3rd percentile in height signify?

Turner’s syndrome or chronic disease

What is pubertal development prior to normal age (refer to endo)?

Precocious puberty

When does menarche usually begin?

11-14 y/o

What is a congenital condition where the hymen is completely closed, blocking the flow of menstrual blood (can delay the onset of menarche)?

Imperforate hymen

What is the inability to retract foreskin?

Phimosis

What is the inability to reduce foreskin?

Paraphimosis

What is varicose veins in the scrotum, usually left side, described as “bag of worms”?

Varicocele

What is a bulge below the inguinal ligament when bearing down?

Femoral hernia

What is a bulge above the inguinal ligament when bearing down?

Inguinal hernia

What tanner stage is pre-pubertal?

Tanner stage 1

What tanner stage in females?

• small breast buds & scant pubic hair growth in pubic area

• 11-12 y/o

Tanner stage 2

What tanner stage in females?

• breast buds become larger & pubic hair growth continues, but it is mostly in the center, not on thighs or upward

• 13-14 y/o

Tanner stage 3

What tanner stage in females?

• noticeable growth of pubic hair now in triangular shape of adulthood

• underarm hair growth noticeable

• breasts now begin to take on mound form

Tanner stage 4

What tanner stage in females?

• hair is adult in quality & quantity, spreads out on medial surfaces of thighs but not up over abdomen

Tanner stage 5

What tanner stage in males?

• enlargement of scrotum/testis

• scrotum reddens

• sparse long hair

• 12 y/o

Tanner stage 2

What tanner stage in males?

• increased penile length

• scrotum & testes enlarge

• dark coarse hair to pubes

• 13 y/o

Tanner stage 3

What tanner stage in males?

• increase penile length & breadth

• rugose scrotum

• adult hair, not on thighs

• 14 y/o

Tanner stage 4

What tanner stage in males?

• adult genitals, no upward extension of pubic hair

• 15.75 y/o

Tanner stage 5

Who is more likely to have been a victim of physical or sexual dating violence?

Those who use prescription drugs w/o a prescription

What is drug use associated with?

Sexual risk behavior, violence, mental health & suicide risks

What is one of the MC used illicit drugs in the US that can cause cyclic vomiting, paranoia, mood lability, hallucinations, depersonalization, dysphoria, & recurrence of psychosis in a schizophrenic patient?

THC

What temporarily inhibits the release of DA in the brain, inducing “remarkable hypotonia,” deeper & slower respiration, & moderate, consistent bradycardia?

GHB “date rape drug”

After what time frame can GHB no longer be detected in urine after injection?

4-5 hours

What drug works like heroin?

Fentanyl

What drug is an analogue of methamphetamine?

Ecstasy

What drugs are cheap to produce, often with unknown ingredients and can cause fatal overdoses, seizures, & permanent personality disorders?

Fentanyl & MDMA (ecstasy, Molly)