[01.03] - CMD Approach to the Adolescent Patient V2.pdf

10-19 years

What is the age range defined as an adolescent?

Transition from childhood to adulthood

How is the adolescent period described in terms of life stages?

Physical, cognitive, moral, and psychosocial

What four types of changes occur simultaneously during adolescence?

Time of change, time of challenge, and time of health risks

What are the three core themes used to describe adolescence?

Innocence

What does an adolescent lack that a child possesses?

Experience and awareness

What does an adolescent lack that an adult possesses?

Nervous

How do adolescents generally feel about seeing a physician?

6th sense

What do adolescents possess regarding how a clinical encounter will go?

Foster a relationship of trust

What is one of the most important roles for a health professional when caring for an adolescent?

Peak

At what level are risk-taking behaviors during adolescence?

Finding oneself, struggling with independence, and emerging sexuality

What developmental tasks contribute to health risks in adolescence?

4 out of 10

How many causes of mortality and morbidity in adolescence are psychosocial in nature?

Lifestyle and choices

Why are most adolescent health issues psychosocial in origin?

Confidentiality and privacy

What two factors are critical for increasing health-seeking behavior in adolescents?

Alone

How should a clinician talk to an adolescent to encourage openness?

Antagonize the parents

What must a clinician avoid doing when speaking to the adolescent alone?

Shared information

What type of information is gathered because it comes from both parents and the adolescent?

Developmentally appropriate

What type of language should be used during an adolescent interview?

Third person approach or hypothetical questions

What are two techniques used to discuss sensitive topics based on cognitive maturity?

Adolescent friendly

How should the clinic staff, facilities, and services be characterized?

24

How many recommendations are included in the Guidelines on Adolescent Preventive Services?

AMA and CDC

Which two organizations developed GAPS?

11-20

GAPS was intended to redefine healthcare delivery for what age range?

Annual

How often should adolescents have a preventive health visit according to GAPS?

Biomedical and psychosocial

What two aspects of health should be addressed during annual preventive visits?

Health assessment and services, screening, anticipatory health guidance, and immunization

What are the four components of GAPS?

History taking and physical examination

What are the two parts of the Health Assessment component of GAPS?

Gynecologic or obstetric history and HEEADSSSS

What two specific add-ons are required for adolescent history taking?

Obesity, vision, hearing, and hypertension

What are four medical conditions screened for in GAPS?

Tuberculosis, anemia, urinalysis, and dyslipidemia

What are four laboratory-related items screened for in GAPS?

Sexual behavior, STI, and HIV

What sexual health items are included in GAPS screening?

Injury prevention, nutrition, and physical activity

What are three topics in the GAPS anticipatory guidance component?

Social media use and internet safety

What two digital-age topics are covered in anticipatory guidance?

Adequate sleep and sleep hygiene

What sleep-related topics are covered in anticipatory guidance?

Boosters and catch-up

What is the focus of the immunization component in GAPS?

General Data

Which section includes name, age, and gender?

Problem according to the patient

Besides the parent's concern, what other problem must be documented in General Data?

Birth history and growth and development

What two history sections from pediatrics remain important for adolescents?

SAFE TEENS and HEEADSSSS

What are the two primary tools/checklists used for adolescent history taking?

Sexuality, Accident/abuse, Firearms/homicide, Emotions, Toxins, Environment, Exercise, Nutrition, Shots

What does SAFE TEENS stand for?

Home, Education/Employment, Eating and exercise, Activities, Drugs, Sexuality, Suicide, Safety, Spirituality/Strength

What does HEEADSSSS stand for?

Risk factors and protective factors

What two types of factors does the HEEADSSSS structure screen for?

Relationships among housemates

What is the primary focus of the Home section in HEEADSSSS?

Who makes the rules

What question helps identify the authority figure in the Home section?

Learning problems and psychoemotional concerns

In Education, what is assessed besides grades?

Changes in behavior or grades

What school-related sign often manifests psychoemotional concerns?

Sports, music, arts, and leadership roles

What are four examples of extracurricular protective factors?

Eating disorders

What is a primary screening focus in the Eating and Exercise section?

Interactive media and gadget use

What modern activity is explored in the Activities and Peers section?

Virtual friends

What type of social media relationship should be investigated?

Alcohol, tobacco, and prohibited drugs

What three categories of substances are screened in the Drugs section?

Third person approach

How should you start asking about drugs to reduce defensiveness?

Regrets

What should you ask the adolescent about their experience with drugs or alcohol?

Crushes or who they like

How should you ask about sexuality for early to middle adolescents?

Inappropriate touching

What safety issue related to sexuality must be screened for?

1-10

What scale is used to rate usual mood in the Suicide/Depression section?

Coping mechanisms and social support

What two things are assessed alongside depression risk?

Do you have a plan

What is the critical follow-up question if an adolescent mentions self-harm?

Motor-vehicle accidents

What is the number one cause of death for teenagers worldwide?

Number 2

What is the rank of motor-vehicle accidents as a cause of death for teenagers in the Philippines?

Violence exposure

Besides accidents, what other safety concern is assessed?

Protective factor

Spirituality and strengths act as what in Filipino society?

Rapport

What is one of the three functions of the psychosocial history?

Empowers the adolescent

What is the primary benefit of inviting the adolescent to see you alone?

Avoid appearing allied with parents

Why is it better to see the patient alone first?

Mature response

Talking to an adolescent alone invites what kind of response?

Respect

What does defining the basis of confidentiality reflect?

Harm to self or others and being harmed by someone else

What are the two main exceptions to confidentiality?

Get permission

A clinician should not repeat information unless it helps the patient and they do what?

Duty to ensure safety

What is the clinician's duty if an exception to confidentiality occurs?

Assent

What must you get from the adolescent in addition to parental consent?

A Form of Words

What is the title of the text by Kang regarding confidentiality?

Empathy

How should you respond if a patient seems irritable during the initial reaction?

Open-ended

What type of question is "What brings you to my office today?"

Solution

What should you ask the adolescent if they have in mind regarding their complaint?

Artificial barrier

Coming out from behind the desk removes what?

Anticipatory guidance

What should you provide instead of passing judgment on risky behavior?

Information about health risks

What should you provide to address behavior instead of being authoritative?

Neutral and sensitive

What two qualities must the clinician maintain regarding family needs?

Nod head and maintain eye contact

What are two examples of non-verbal support?

Interactive

Which style is preferred over an interrogative style?

Neutral to sensitive

How should the progression of topics move during an interview?

Ask permission

What should you do before asking very personal questions?

Picture of overall health

What reason should you give for asking sensitive questions?

Simple and honest

How should you answer an adolescent's questions?

It's all in your head

What phrase should you never say to an adolescent regarding their concerns?

Wrap up

In which part of the interview do you summarize the assessment and define concerns?

What to tell mom and dad

What should be discussed with the adolescent before the parents return?

Written and verbal

In what two formats should instructions be given?

Annually

How often should a well adolescent have a physical exam?

Inform the adolescent

What must you do before starting the physical examination?

Weight in kg / (height in meters)2

What is the formula for BMI?

WHO z-scores

What chart is used to plot adolescent BMI?

Overweight

A BMI z-score beyond +1 indicates what?

Obese

A BMI z-score beyond +2 indicates what?

Thin

A BMI z-score beyond -2 indicates what?

Severely thin

A BMI z-score beyond -3 indicates what?

Muscular

For what type of individual might BMI overestimate fatness?

Both arms

On which arms should blood pressure be taken?

Seated

What position should the patient be in for BP?