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.

1. Complete physical exam should be done
2. All sexually active females should have a pelvic exam and pap smear. After the age of 18, all females should have a yearly pelvic exam and pap smear whether they are sexually active or not.
3. If you are inexperienced at doing pelvic examinations, the patient should be referred to a gynecologist.

1. Cultures for GC and Chlamydia are recommended yearly for sexually active females even if they are asymptomatic.
2. Pap smear if sexually active
3. Hematocrit if diet is poor or have heavy menses.

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
   

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