Adolescent Medicine- Routine Screening 

Case
Maria, a 17 year old girl is in your office for a routine exam prior to her senior year in high school. She has been in good health and has a history of mild asthma which she treats with an albuterol inhaler. Her father has hypertension. She denies sexual activity and tells you that she has had an occasional beer. She wants to know if she needs any immunizations for college? 

Discussion topics

  1. How is school going?
    1. grades: Any changes in school performance are significant
  2. How are you getting along with friends and family members?
  3. You need to discuss contraception even though she is presently not sexually active. How well does she understand STDs? Teenagers often have misunderstandings about the effectiveness of various forms of contraception.
  4. Where are her support systems and are they adequate?
  5. Driving while drinking and going into cars when the driver is intoxicated. Use seat belt at all times, even in the back seat.
  6. Drug abuse. Most 18 year olds have experimented with drugs and/or alcohol and an open discussion is welcomed by them. Encouraging them that abstinence is possible may be helpful. 
  7. Discussion of skin care and treatment of acne. Sun protection must be stressed
  8. Smoking. You must emphasize the significance of smoking and that adolescents become addicted more rapidly and they will have more difficulty quitting.
  9. Menstrual history and are there any problems?
  10. Diet and exercise. Eating disorders should be discussed..
  11. Dental care and hygiene.
  12. HEADSS assessment
    1. Home
    2. Education
    3. activities
    4. drugs and alcohol
    5. Sex
    6. suicide
    7. safety (physical and sexual abuse)
Physical exam
  1. Complete physical exam should be done
  2. Pap smears are recommended for women who have been sexually active for three years or older than 21
  3. Pelvic exam for sexually active females with abdominal pain
Lab evaluation
  1. Nucleic acid amplification tests(NAAT) are recommended to evaluate for Chlamydia and Gonorrhea.
  2. Hematocrit if diet is poor or have heavy menses.
Immunizations
  1. Three hepatitis B shots
  2. Make sure has had 2 MMRs
  3. Adult TdaP- includes acellular pertussis booster.  Every 10 years
  4. Two Varicella vaccines if hasn't had clinical chickenpox
  5. Meningococcus vaccine
  6. Human Papillomavirus Vaccine (HPV) in females older than eleven.  Three dose schedule at 0,2, and 6 months.  Can be given as ealry as 9 years of age
  7. Two Hepatitis A vaccines
References
  1. Orr, Donald. Helping adolescents toward adulthood. Contemporary Pediatrics. May 1998
  2. Reif CJ and Elster AB. Adolescent Preventive Services. Primary Care; Clinics in Office Practice. 1998; 25(1):1-21.
  3. Metzl Jordan. Preparticipation  Examination of the Adolescent Athlete: Part 1  Pediatrics in Review June 2001
  4. Metzl Jordan Preparticipation Examination of the Adolescent Athlete: Part 2 Pediatrics in Review July 2001.
  5. Koch Jason. Performance enhancing Substances and Their Use Among Adolescent Athletes.  Ped In Review September 2002
  6. Conrad L. et al. Pharmacists' Attitude Toward And Practices with Adolescents.  Archives of Pediatrics and Adolescent Medicine. Vol 157 Aporil 2003
  7. Rosen D. Physiologic Growth and Development during Adolescence.  Pediatrics in Review June 2004
  8. Rosen D. Foster C. Delayed Puberty.  Pediatrics in Review 2001; 22
  9. 2009 Redbook
  10. http://www.ahwg.net/resources/toolkit/htm   Adoloescent Health Working Groups toolkits.  Good resource for teens