The MassGeneral Hospital for Children Adolescent Medicine Handbook (eBook)

Preface 7
Acknowledgments 9
Contents 11
Contributors 15
Part I General Adolescent Medicine 19
1: Adolescent Preventive Services 20
Recommendations 20
References and Additional Readings 26
2: The Adolescent Patient Interview 27
Confidentiality and Consent 30
References and Additional Readings 32
3: Tanner Staging 33
Introduction 33
Girls 33
Pearls 35
Boys 36
References and Additional Readings 38
4: Normal Adolescent Development 39
Psychosocial Development 39
Consequent Behaviors 39
Cognitive Development 40
Identity Development 42
References and Additional Readings 42
5: Male Genitourinary Exam 43
References and Additional Readings 51
6: The Pelvic Exam and Pap Smear 52
Who Needs a Pelvic Exam? 52
Who Needs a Pap smear? 53
Testing for Human Papillomavirus on the Pap Smear 53
Cervical Testing Methods 55
References and Additional Readings 57
7: Adolescent Dermatology 58
Acne 58
Tinea Pedis 60
Tinea Cruris 61
Tinea Versicolor 62
Pityriasis Rosea 63
References and Additional Readings 64
8: Obesity 65
Background 65
Definition 65
Etiology 66
Medical Evaluation 66
Treatment 68
References and Additional Readings 70
9: Adolescent Nutrition, IBD, IBS 71
Nutrition 71
Irritable Bowel Syndrome 74
Symptoms 74
Diagnosis 75
Treatment 75
References and Additional Readings 75
10: Sports Injuries in the Adolescent 77
Shoulder 78
Dislocations and Instability 78
Clinical Exam 78
Radiography 79
Treatment 79
Little League Shoulder 80
Epiphysitis 80
Radiography 80
Treatment 80
Rotator Cuff Tendonitis 80
Radiography 81
Treatment 81
Elbow 81
Little League Elbow 81
Treatment 82
Osteochondrosis of the Radiocapitellar Joint 82
Treatment 82
Lateral Epicondylitis 83
Radiography 83
Treatment 83
Knee 83
Patellofemoral Syndrome 83
Treatment 84
Osgood Schlatter Syndrome 84
Treatment 84
Anterior Cruciate Ligament Injuries 84
Treatment 85
Patellar Dislocations 85
Radiography 85
Treatment 85
Shin Splints 86
Treatment 86
Ankle Sprains 86
Radiography 87
Treatment 87
Concussions 87
References and Additional Readings 88
11: Cardiac Issues in Adolescence 89
Arrhythmias 89
Syncope 90
Chest Pain 92
Structural Heart Disease 93
References and Additional Readings 93
Part II Sexuality, Gynecology and Abnormal Growth and Development 94
12: Menstrual Irregularities: Amenorrhea 95
Diagnostic Studies 99
References and Additional Readings 101
13: Menstrual Irregularities:Abnormal Vaginal Bleeding 102
Diagnostic Testing 104
Management 104
Mild DUB 104
Moderate DUB 105
Severe DUB 105
References and Additional Readings 105
14: Basics of Hormonal Contraception 106
Counseling About the Hormonal Contraception 107
Medical History 107
The Oral Contraceptive Pill 107
Mechanism of COCP Action 108
Method of Use 108
Efficacy 109
Counseling about the OCP 109
Side Effects 109
Absolute Contraindications 110
Newer Oral Contraceptives 110
Transdermal Contraception 111
Mechanism of Action 111
Method of Use 111
Efficacy 112
Counseling about the Patch 112
Side Effects 112
Vaginal Ring 113
Mechanism of Action 113
Method of Use 113
Efficacy 113
Counseling about the Ring 113
Side Effects 113
Injectable Contraceptives 114
Mechanism of Action 114
Method of Use 114
Efficacy 114
Side Effects 114
Counseling about DMPA 115
Combined Injectable Contraception 115
Subdermal Contraceptive Implant 116
Mechanism of Action 116
Method of Use 116
Efficacy 117
Side Effects 117
Levonorgestrel-Releasing Intrauterine Contraceptive System 117
Mechanism of Action 117
Method of Use 118
Efficacy 118
Side Effects 118
Emergency Contraception 119
Progestin-only MethodMechanism of Action 119
Method of Use 119
Efficacy 120
Side Effects 120
References and Additional Readings 121
15: Adolescent Pregnancy 122
References and Additional Readings 124
16: Polycystic Ovary Syndrome 125
Background 125
Definition 125
Etiology 126
Evaluation 126
Treatment 127
References and Additional Readings 128
17: Sexually Transmitted Infections in Adolescents 129
General Information 129
Adolescents’ Unique Susceptibility to STI 130
Biological Factors 130
Behavioral Factors 130
Cognitive Factors 130
Other Factors 130
Special Adolescent Populations 131
Vaccine Preventable STI (Source: CDC) 132
Hepatitis A 132
Hepatitis B 132
Human Papillomavirus Vaccine 133
Testing 133
HIV 133
Syphilis 134
Chlamydia 134
Gonorrhea 135
Sexually Transmitted Infections 135
Office Testing 135
Vaginitis 135
Bacterial Vaginosis 135
Trichomoniasis 138
Vulvovaginal Candidiasis 139
Urethritis and Cervicitis 140
Pelvic Inflammatory Disease 143
Genital Lesions 145
Papules 145
Molluscum Contagiosum 145
Scabies 145
Vesicular and/or Ulcerative Lesions 147
Genital Herpes 147
Syphilis 148
Chancroid 149
Granuloma Inguinale (Donovanosis) 152
Lymphogranuloma Venereum 152
Verrucous Lesions 152
Genital Warts 152
Nongenital Lesions: Ectoparasites 153
Pubic Lice 153
Scabies 154
Hepatitis A 154
Hepatitis B 154
Hepatitis C 155
HIV 155
Epididymitis 155
References and Additional Readings 156
18: Delayed Puberty, Short Stature, and Tall Stature 157
References and Additional Readings 162
Part III Mental Health and Transition of Care Issues 163
19: Adolescent Substance Abuse 164
Risk Factors 164
The CRAFFT Screening Questions 167
Testing for Drug Use (Adapted from the American Academy of Pediatrics Policy) 168
Voluntary Drug Testing 168
Involuntary Drug Testing 168
Licit Drugs 170
Tobacco 170
Alcohol 171
Illicit Drugs 171
Marijuana (Joints, Blunts, Bongs) 171
Opiates 171
Cocaine (Crack) 172
Amphetamines (Speed) 172
Hallucinogens (Acid, Angel Dust, Shrooms) 172
Depressants 172
Inhalants 173
Club Drugs 173
Performance-Enhancing Drugs 173
References and Additional Readings 174
20: Adolescent Mental Health Disorders 175
Epidemiology 175
The presence of a disorder 176
The Role of the Primary Care Pediatrician 177
Prevalence 178
Evaluation 178
Management 180
Mood Disorders 183
Depression 183
Evaluation 184
Management 185
Bipolar Disorder 188
Anxiety Disorders 190
evaluation 192
Management 192
Summary (Table 3) 194
References and Additional Readings 194
21: Eating Disorders 197
Anorexia Nervosa DSM IV Criteria 198
Subtypes 198
Bulimia DSM IV Criteria 198
Eating Disorder Not Otherwise Specified (EDNOS) 199
Eating Disorder Evaluation 199
Physical Exam 199
Diagnostic Studies 200
Laboratory Tests 200
Female Athlete Triad 201
Calculation of Percent Ideal Body Weight 202
Ideal Body Weight 202
Result is in Kilograms 203
How to Calculate % of Ideal Body Weight 203
Calculate BMI 203
Treatment 203
References and Additional Readings 206
22: Adolescent Relationship Violence in Clinical Settings: Challenges for Identification and Intervention 207
Unique Characteristics of Adolescent Relationship Violence 208
Developmental Considerations 208
Teens and Electronic Media 209
Role of Adult Caregivers 209
Minor Consent Laws and Confidentiality 209
Assessment for Relationship Violence 210
Creating a Safe Environment for Possible Disclosure 211
Framing the “Right” Questions 211
Collaborative Model for Care 212
References and Additional Readings 212
23: Bullying 213
Definition 213
Screening 214
Interventions 214
References and Additional Readings 215
24: Transition of Care 216
References and Additional Readings 219
Appendix 220
Books of interest for adolescents and parents 250
Index 253