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Adolescence (case studies)
Peak height velocity (males) on average between - correct answer ✔13 ½ and 14 years (SMR or Tanner 4), but can vary from 13-17 ½ yrs First sign of puberty in females - correct answer ✔breast enlargement First sign of puberty in males - correct answer ✔testicular and penile enlargement, followed by pubic hair Females puberty precedes males by... - correct answer ✔6 months Pubertal growth spurt is an ______ in female puberty and a _______ in male puberty. - correct answer ✔early event; late event Boys pubertal growth spurt usually lasts... - correct answer ✔2-4 years Normal variations in short stature - correct answer ✔short stature is considered to be 2 SD below mean Male below 5'4" Females below 4'11" Growth rate during puberty is... - correct answer ✔9.5 cm/yr (4 inches) Normal growth rate during adolescence is... - correct answer ✔6 - 8 cm/yr (2- 3 inches)
Familial short stature - correct answer ✔Curve may be at or below 5% Bone age consistent w/ chronological age Growth curve follows the child's normal pattern. Does NOT reach average adult height. Constitutional short stature - correct answer ✔Average weight at birth but slows down during infancy and childhood Bone age lags behind chronological age Delayed adolescent growth spurt but reaches normal adult height One or both parents had same growth pattern. Accelerated growth - correct answer ✔2 SD above mean but normal growth velocity Rule out Klinefelters with accelerated growth - correct answer ✔small penis & testes, normal pubic hair Rule out Marfans with accelerated growth - correct answer ✔long fingers and toes, hypermobility of joints Early maturers - correct answer ✔growth also stops earlier and usually do not reach same height as normal maturers Pelvic exam recommended at - correct answer ✔age 21 Reasons for pelvic exam earlier - correct answer ✔menstrual disorders vaginal discharge
-wear white cotton socks, change socks at least daily -wear sandals when possible and avoid sneakers & plastic shoes. -can prevent by using Tinactin or Caldesene powder, using shower shoes in public showers, and not lending or borrowing shoes Acne causes - correct answer ✔Androgen influences increased production of sebum, an oily, lipid-containing substance produced by sebaceous glands Noninflammatory acne - correct answer ✔Open Comedones - blackheads Closed Comedones - whiteheads Inflammatory acne: papules - correct answer ✔inflammatory reaction within the follicle and appears as a red bump under the surface Inflammatory acne: Pustules - correct answer ✔inflammation around the comedone - occurs in superficial portion of dermis Inflammatory acne: Cysts - correct answer ✔swollen, tender follicles within the dermis. Management & teaching of Non-inflammatory acne - correct answer ✔Treatment is critical to prevent inflammation and scarring. Wash twice daily with antibacterial soap. OTC Salicytic acid; benzoyl peroxide Management & teaching of MILD Inflammatory acne - correct answer ✔•Rx benzoyl peroxide gel •Retin-A
•topical antibiotics Rx benzoyl peroxide gel - correct answer ✔MILD ACNE Higher concentrations have no real advantage over 2.5% and cause greater irritation Causes follicular desquamation and is a potent antimicrobial. Available OTC, but lacks stability and efficacy - should use Rx Retin-A (retinoic acid) - correct answer ✔MILD ACNE Vitamin A derivative which inhibits formation of comedones and increases cell turnover; Start with lowest preparation (0.025% or 0.05%); Educate teen to expect some erythema, peeling, and dryness; Exposure to sun may worsen acne so use at night; Adapalene (Differen) is a newer retinoid-like compound that is less irritating. Topical antibiotics (acne) - correct answer ✔MILD ACNE Work by reducing number of P. acnes on skin; Also have anti-inflammatory effects Clindamycin (Cleocin-T 1% solution, gel, or lotion) Erythromycin - (Benzamycin - erythromycin and benzoyl peroxide) Mild Inflammatory acne - correct answer ✔small number of lesions on face; papular acne, pustular acne; comedomal lesions Moderate Inflammatory acne - correct answer ✔larger amount of lesions on face; some on back; papular, pustular, some scarring
Accutane - correct answer ✔If no improvement with traditional treatment or if has severe inflammatory acne Refer to a dermatologist 4 month course may clear a severe case. Patient, physician, and pharmacy must be registered in iPledge Program. Highly teratogenic (requires a negative pregnancy test; should maintain contraceptive use 1 month prior to therapy, during therapy, and 1 month after therapy.) Gynecomastia - correct answer ✔peak incidence at 14 years usually bilateral and non-tender Usually resolves within 1-2 years. Felt as a rubbery nodule under the nipple, but can also occur as striking breast development, approaching Tanner 3 female breasts (may require surgical intervention). Diff dx for gynecomastia - correct answer ✔Adrenal or testicular tumors Klinefelter's syndrome chronic liver or renal disease hyperthyroidism Causes of gynecomastia: - correct answer ✔May result from imbalance between estrogen and testosterone Pseudogynecomastia (fatty rather than breast tissue) Spermatogenesis - First nocturnal ejaculation usually occurs between 11 & 15 years, with average of about 13.
Menses assessment for severe cramping - correct answer ✔Description of pain, other types of abdominal pain, nausea, vomiting, dysuria, anorexia, dizziness, and syncope. Find out when menarche occurred and typical pattern of periods (duration & flow), whether she is sexually active. Dysmenorrhea - correct answer ✔Regular ovulatory cycles do not usually occur until 1-2 years after menarche. Primary dysmenorrhea - correct answer ✔occurs in the absence of pelvic pathology and involves painful menstruation, lower abdominal pain usually in the first few days of bleeding, and may be accompanied by lower back pain, N & V, fatigue, headache, and diarrhea; symptoms usually begin 6-12 months after menarche. Symptoms are due to prostaglandins, which are produced during ovulatory cycles. Secondary dysmenorrhea - correct answer ✔Associated with underlying pelvic pathology (endometriosis, PID, uterine fibroids, ovarian neoplasms). Occurs usually at a later age than primary; may persist after menses are over. If adolescent has a severe dysmenorrhea, especially from the onset of menarche, consider obstructing lesions of the genital tract. Dysmenorrhea management - correct answer ✔ibuprofen (inhibiting prostaglandin effect) 400 mg q 6 hrs, taken at start of menstrual cycle and continued for 24-72 hours. For moderate to severe pain, try stronger NSAIDS- Naproxen (Aleve, Naprosyn), Naproxen sodium (Anaprox), or Mefenamic acid (Ponstel). Discuss side effects - primarily N&V and dyspepsia. Noncontraceptive advantages to the use of hormonal contraception - correct answer ✔protection for endometrial and ovarian cancer, a decreased risk of
