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. % 1 chancre @ site of exposure; incubates 1 wk to 3 months;highly contagious; buttonlike papule (painless) % 2 rash (palms & soles), constitutional symptoms, nausea,loss of appetite, fever, sore throat, stomatitis, inflamedeyes, red-brown 2 3 cm lesions on genitals (foul, contagiousdischarge) % 3 destructive lesions to CV & neural systems114 04Gulick(F)-04 5/2/06 1:21 PM Page 115Copyright © 2006 by F.A.Davis.115HIV (Human Immunodeficiency Virus)AIDS (Acquired Immunodeficiency Syndrome)Transmission: blood products, CSF, semen, vaginal secretions,mom to childEarly HIV Signs Advanced HIV Signs % Fever, night sweats % Kaposi s sarcoma multiple % Chronic diarrhea purple skin blotches % Oral infections % Persistent cough % Vaginal candidiasis % Fever, night sweats % Cough % Easy bruising % SOB % Thrush % Skin/nail changes % Muscle weakness % Comorbidities: TB, pneu-monia, lymphoma, herpes,toxoplasmosisSource: Goodman C & Snyder T (2000).Neuropsychiatric DisordersSigns & Symptoms of Depression % Sadness; frequent/unexplained crying % Feelings of guilt, helplessness, or hopelessness % Suicide ideations % Problems sleeping % Fatigue or decreased energy; apathy % Loss of appetite; weight loss/gain % Difficulty concentrating, remembering, & making decisions % Bipolar disorder (manic-depression) Peak onset is late teenswith equal males/females with a strong genetic component.It may be a neurotransmitter abnormality.ADOLE-SCENTS 04Gulick(F)-04 5/2/06 1:21 PM Page 116Copyright © 2006 by F.A.Davis.ADOLE-SCENTSEating DisordersNote: Bradycardia in a thin adolescent is a red flag for anorexiaAnorexia Bulimia % Under minimal body weight % Binge eating % Fear of being fat % Self-induced vomiting % Frequent starving % Laxatives, diuretics % Depressed % Excessive exercise % Social withdrawal % Overeating alternating % Insomnia with period of starvation % “! Libido % Fear of fatness % Self-induced vomiting % May be obese % Excessive exercise % Erosion of dental enamel % Diuretics % Seizures % Amenorrhea % Weakness & fatigue % ‘! Cortisol, serotonin, growth % Lab metabolic acidosis,hormone, corticotropin- “! amylase, hypokalemia,releasing factor hypomagnesia % “! LH, FSH, TSH % Bradycardia % Hypotension % Arrhythmias % Dry skin, dental caries,anemia, osteoporosis % Lab hypokalemia, ‘! BUN,metabolic alkalosisSource: Boissonnault WG (2005).Signs & Symptoms of Panic Disorder % Pounding tachycardia % Hand wringing % Chest pain % Perceptual distortions % Dizziness, nausea % Sense of terror % Difficulty breathing, SOB % Extreme fear of losing control % Bilateral numbness % Fear of dying % Tingling in face % Feeling of choking/smothering % Sweats or chills % Vertigo116 04Gulick(F)-04 5/2/06 1:21 PM Page 117Copyright © 2006 by F.A.Davis.117Obsessive-Compulsive DisordersMedical brain disorder that causes problems in informationprocessing.Typically manifests from preschool to age 40.AssociatedTypes of Obsessions CompulsionsContamination fears (germs, dirt, etc) WashingImagining having harmed self/others RepeatingImagining losing control/aggressive urges CheckingIntrusive sexual thoughts/urges TouchingExcessive religious/moral doubt CountingForbidden thoughts Order/arrangingA need to have things just so Hoarding/savingA need to tell, ask, confess PrayingSource: http://www.ocfoundation.org/ADOLE-SCENTS The Mood Disorder Questionnaire (MDQ)Question: Yes No1.Has there ever been a period of time when you were not your usual self and & % you felt so good or so hyper that other people thought you were not yournormal self or you were so hyper that you got into trouble? % you were so irritable that you shouted at people or started fights orarguments? % you felt much more self-confident than usual? % you got much less sleep than usual and found that you didn t really miss it? % you were more talkative or spoke much faster than usual? % thoughts raced through your head or you couldn t slow your mind down? % you were so easily distracted by things around you that you had troubleconcentrating or staying on track? % you had much more energy than usual? % you were much more active or did many more things than usual? % you were much more social or outgoing than usual, for example, youtelephoned friends in the middle of the night? % you were much more interested in sex than usual? % you did things that were unusual for you or that other people might havethought were excessive, foolish, or risky? % spending money got you or your family in trouble?(Continued text on following page)Copyright © 2006 by F.A.Davis.118ADOLE-SCENTS04Gulick(F)-045/2/061:21 PMPage 118 The Mood Disorder Questionnaire (MDQ) (Continued)Question: Yes No2.If you checked YES to more than 1 of the above, have several of these everhappened during the same period of time?3.How much of a problem did any of these cause you like being able to work;having family, money, or legal troubles; getting into arguments or fights?None Minor Moderate Severe problem4.Have any of your blood relatives (i.e., children, siblings, parents, grandparents,aunts, uncles) had manic-depressive illness or bipolar disorder?5.Has a health professional ever told you that youhave manic-depressive illness or bipolar disorder?Scoring Algorithm:All 3 of the following criteria must be met for a Positive Screen: % Question 1 7 of 13 Yes responses % Question 2 Yes response % Question 3 Moderate or Severe responseSource: Hirschfeld RM et al.(2000).Copyright © 2006 by F.A.Davis.119ADOLE-SCENTS04Gulick(F)-045/2/061:21 PMPage 119 04Gulick(F)-04 5/2/06 1:21 PM Page 120Copyright © 2006 by F.A.Davis.ADOLE-SCENTSOther PathologyBacterial Meningitis medical emergency(especially in children)Infant Adult % Fever % H/A, fever, chills % Lethargy (hypotonia) % Photophobia % Poor feeding % Vomiting, nausea % Vomiting % URI symptoms % Respiratory distress % Seizures in 20 30% of cases % Apnea % Confusion % Cyanosis % ( ) Kernig sign hip flexed % Paradoxic irritability (quiet to 90 , pain reproduced withwhen stationary & cries knee extensionwhen held) % ( ) Brudzinski sign supine % Seizures in 30 40% of cases neck flexion reproduces pain % Stiff neck % SleepinessSource: Boissonnault WG (2005).Adolescent Cancer Screening % Osteosarcoma % Most common bone cancer in adolescence % Occurs in boys 2 girls % Most common bones are femur, tibia, fibula % Pain & swelling that gets worse with exercise or at night % Pathology fx may eventually occur % Leukemia % Difficult to diagnose because of the similarity to normalchildhood diseases % Onset can be slow or rapid % Fever & loss of appetite % Pale skin & frequent bruising % Enlarged cervical lymph nodes % Abdominal protrusion, 2 enlargement of spleen & liver % ‘! Irritability120 04Gulick(F)-04 5/2/06 1:21 PM Page 121Copyright © 2006 by F.A.Davis [ Pobierz caÅ‚ość w formacie PDF ]
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. % 1 chancre @ site of exposure; incubates 1 wk to 3 months;highly contagious; buttonlike papule (painless) % 2 rash (palms & soles), constitutional symptoms, nausea,loss of appetite, fever, sore throat, stomatitis, inflamedeyes, red-brown 2 3 cm lesions on genitals (foul, contagiousdischarge) % 3 destructive lesions to CV & neural systems114 04Gulick(F)-04 5/2/06 1:21 PM Page 115Copyright © 2006 by F.A.Davis.115HIV (Human Immunodeficiency Virus)AIDS (Acquired Immunodeficiency Syndrome)Transmission: blood products, CSF, semen, vaginal secretions,mom to childEarly HIV Signs Advanced HIV Signs % Fever, night sweats % Kaposi s sarcoma multiple % Chronic diarrhea purple skin blotches % Oral infections % Persistent cough % Vaginal candidiasis % Fever, night sweats % Cough % Easy bruising % SOB % Thrush % Skin/nail changes % Muscle weakness % Comorbidities: TB, pneu-monia, lymphoma, herpes,toxoplasmosisSource: Goodman C & Snyder T (2000).Neuropsychiatric DisordersSigns & Symptoms of Depression % Sadness; frequent/unexplained crying % Feelings of guilt, helplessness, or hopelessness % Suicide ideations % Problems sleeping % Fatigue or decreased energy; apathy % Loss of appetite; weight loss/gain % Difficulty concentrating, remembering, & making decisions % Bipolar disorder (manic-depression) Peak onset is late teenswith equal males/females with a strong genetic component.It may be a neurotransmitter abnormality.ADOLE-SCENTS 04Gulick(F)-04 5/2/06 1:21 PM Page 116Copyright © 2006 by F.A.Davis.ADOLE-SCENTSEating DisordersNote: Bradycardia in a thin adolescent is a red flag for anorexiaAnorexia Bulimia % Under minimal body weight % Binge eating % Fear of being fat % Self-induced vomiting % Frequent starving % Laxatives, diuretics % Depressed % Excessive exercise % Social withdrawal % Overeating alternating % Insomnia with period of starvation % “! Libido % Fear of fatness % Self-induced vomiting % May be obese % Excessive exercise % Erosion of dental enamel % Diuretics % Seizures % Amenorrhea % Weakness & fatigue % ‘! Cortisol, serotonin, growth % Lab metabolic acidosis,hormone, corticotropin- “! amylase, hypokalemia,releasing factor hypomagnesia % “! LH, FSH, TSH % Bradycardia % Hypotension % Arrhythmias % Dry skin, dental caries,anemia, osteoporosis % Lab hypokalemia, ‘! BUN,metabolic alkalosisSource: Boissonnault WG (2005).Signs & Symptoms of Panic Disorder % Pounding tachycardia % Hand wringing % Chest pain % Perceptual distortions % Dizziness, nausea % Sense of terror % Difficulty breathing, SOB % Extreme fear of losing control % Bilateral numbness % Fear of dying % Tingling in face % Feeling of choking/smothering % Sweats or chills % Vertigo116 04Gulick(F)-04 5/2/06 1:21 PM Page 117Copyright © 2006 by F.A.Davis.117Obsessive-Compulsive DisordersMedical brain disorder that causes problems in informationprocessing.Typically manifests from preschool to age 40.AssociatedTypes of Obsessions CompulsionsContamination fears (germs, dirt, etc) WashingImagining having harmed self/others RepeatingImagining losing control/aggressive urges CheckingIntrusive sexual thoughts/urges TouchingExcessive religious/moral doubt CountingForbidden thoughts Order/arrangingA need to have things just so Hoarding/savingA need to tell, ask, confess PrayingSource: http://www.ocfoundation.org/ADOLE-SCENTS The Mood Disorder Questionnaire (MDQ)Question: Yes No1.Has there ever been a period of time when you were not your usual self and & % you felt so good or so hyper that other people thought you were not yournormal self or you were so hyper that you got into trouble? % you were so irritable that you shouted at people or started fights orarguments? % you felt much more self-confident than usual? % you got much less sleep than usual and found that you didn t really miss it? % you were more talkative or spoke much faster than usual? % thoughts raced through your head or you couldn t slow your mind down? % you were so easily distracted by things around you that you had troubleconcentrating or staying on track? % you had much more energy than usual? % you were much more active or did many more things than usual? % you were much more social or outgoing than usual, for example, youtelephoned friends in the middle of the night? % you were much more interested in sex than usual? % you did things that were unusual for you or that other people might havethought were excessive, foolish, or risky? % spending money got you or your family in trouble?(Continued text on following page)Copyright © 2006 by F.A.Davis.118ADOLE-SCENTS04Gulick(F)-045/2/061:21 PMPage 118 The Mood Disorder Questionnaire (MDQ) (Continued)Question: Yes No2.If you checked YES to more than 1 of the above, have several of these everhappened during the same period of time?3.How much of a problem did any of these cause you like being able to work;having family, money, or legal troubles; getting into arguments or fights?None Minor Moderate Severe problem4.Have any of your blood relatives (i.e., children, siblings, parents, grandparents,aunts, uncles) had manic-depressive illness or bipolar disorder?5.Has a health professional ever told you that youhave manic-depressive illness or bipolar disorder?Scoring Algorithm:All 3 of the following criteria must be met for a Positive Screen: % Question 1 7 of 13 Yes responses % Question 2 Yes response % Question 3 Moderate or Severe responseSource: Hirschfeld RM et al.(2000).Copyright © 2006 by F.A.Davis.119ADOLE-SCENTS04Gulick(F)-045/2/061:21 PMPage 119 04Gulick(F)-04 5/2/06 1:21 PM Page 120Copyright © 2006 by F.A.Davis.ADOLE-SCENTSOther PathologyBacterial Meningitis medical emergency(especially in children)Infant Adult % Fever % H/A, fever, chills % Lethargy (hypotonia) % Photophobia % Poor feeding % Vomiting, nausea % Vomiting % URI symptoms % Respiratory distress % Seizures in 20 30% of cases % Apnea % Confusion % Cyanosis % ( ) Kernig sign hip flexed % Paradoxic irritability (quiet to 90 , pain reproduced withwhen stationary & cries knee extensionwhen held) % ( ) Brudzinski sign supine % Seizures in 30 40% of cases neck flexion reproduces pain % Stiff neck % SleepinessSource: Boissonnault WG (2005).Adolescent Cancer Screening % Osteosarcoma % Most common bone cancer in adolescence % Occurs in boys 2 girls % Most common bones are femur, tibia, fibula % Pain & swelling that gets worse with exercise or at night % Pathology fx may eventually occur % Leukemia % Difficult to diagnose because of the similarity to normalchildhood diseases % Onset can be slow or rapid % Fever & loss of appetite % Pale skin & frequent bruising % Enlarged cervical lymph nodes % Abdominal protrusion, 2 enlargement of spleen & liver % ‘! Irritability120 04Gulick(F)-04 5/2/06 1:21 PM Page 121Copyright © 2006 by F.A.Davis [ Pobierz caÅ‚ość w formacie PDF ]