Pretest Adolescent

Young mother pregnancy

• poor weight gain in the mother

• premature delivery

• low birth weight

• increased risk of pregnancy-induced hypertension

• The risk of violence is also elevated for teen mothers.

Tanner

Male:

• Tanner 2: sparse, thin, and long pubic hair with slight penile enlargement.

• Tanner 3: pubic hair becomes darker and begins to curl, and the penis lengthens.

• Tanner 4: it is starting to resemble adult pubic hair but without complete coverage, and the penis continues to grow.

• Tanner 5: pubic hair extends to the inner thigh and is in the typical adult configuration.

Female:

• Tanner 2: sparse pubic hair. Breasts start with buds and elevate.

• Tanner 3: larger breasts and areola without a separate areolar contour

• Tanner 4: Breasts will have elevation of the areola

• Tanner 5: areola is part of the general breast contour. No secondary elevation

Attempt suicide

• admit for full workup even if asymptomatic

Isotretinoin

• Dry skin, eyes, and mucous membranes are the most frequent complications of therapy.

• Other associated problems include musculoskeletal pain and hyperostosis, inflammatory bowel disease, pseudotumor cerebri, and corneal opacities.

• Often develop abnormal liver function tests, elevated triglyceride and cholesterol levels, and lowered levels of high-density lipoproteins.,

Acne

Studies have failed to demonstrate adverse effects of any particular foods on acne activity.

Contact Sport CI

• Having one eye is typically seen as a contraindication to playing contact sports like football or soccer. There are eye shields available, but in general these children are advised to avoid contact sports.

• Other reasons to recommend against contact sports participation include hemophilia, single kidney, and unexplained syncope (until evaluated).

• Stable, repaired congenital heart disease; obesity; girls with a single ovary; and controlled diabetics are routinely allowed to participate.

Urethritis

Urethritis in an adolescent male is almost always a sexually transmitted disease (STD), either gonococcal or nongonococcal urethritis (NGU).

• Chlamydia trachomatis

• Less frequently, NGU can be caused by Ureaplasma urealyticum, Trichomonas vaginalis, and yeast. Herpes simplex can cause an NGU, but it is considerably less likely than C trachomatis.

Testicular Torsion

• Cremaster reflex absent

• Prehn sign, although not totally reliable, is elicited by gently lifting the scrotum toward the symphysis.

  • Relief of the pain points to epididymitis; it’s worsening, to torsion.

• Doppler ultrasound (or surgical consultation) is a logical first step

  • demonstrating absence of flow in torsion

  • increased flow in epididymitis.

• Alternatively, a radionuclide scan will show

  • diminished uptake in torsion

  • increased uptake in epididymitis

• Treatment for torsion is surgical exploration and detorsion and scrotal orchiopexy.

• path: causative organisms for epididymitis include Neisseria gonorrhoeae, C trachomatis, and other bacteria. Treatment with appropriate antibiotics and rest is indicated.

Teenager Sleep

Changes due to puberty cause a phase delay in the normal sleep-wake cycle, meaning teens will almost universally prefer to stay up late.

Injuries

Swimmers

shoulder injuries are the most common type of problem seen. Rotator cuff tendinitis of the biceps and/or the supraspinatus muscles presents as shoulder pain and tenderness.,

Football

head and neck injuries are not uncommon, but, fortunately, serious injuries are rare. Knee injuries such as anterior cruciate, posterior cruciate, and collateral ligament tears do occur. In addition, turf toe, injury to the first metatarsophalangeal joint, is seen when play is on artificial turf.,

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Basketball and volleball

tend to produce lower extremity problems, including those of the knee, with such injuries as Osgood-Schlatter disease and sprains to the ligaments of the knee. Ankle injuries, too, are quite common in these sports.,

Running

frequently muscle strains in the hamstrings, adductors, soleus, and gastrocnemius muscles. Runner’s knee, anterior knee pain because of patellofemoral stress, is also seen.,

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Ballet

associated with delayed menarche and eating disorders (more commonly in the female dancers). In addition, a variety of mostly lower extremity problems can be seen, ranging from bunions to knee and ankle problems from serious overuse.,

Wrestlers

frequently seen in the upper extremities, especially shoulder subluxation, and in the knees, usually prepatellar bursitis from traumatic impact to the floor. Additionally, a variety of skin conditions are common, ranging from contact dermatitis and superficial fungal infections to herpes simplex (herpes gladiatorum), impetigo, and staphylococcus furunculosis or folliculitis.,

Ski

Thumb injuries during a fall, abduction and hyperextension of the thumb, causing a sprain of the ulnar collateral ligament, remains the most common injury seen.,

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Hockey

Range from mild contusions to significant lacerations. No particular type of injury (with the exception of, perhaps, loss of teeth) is characteristic of this sport.,