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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 całość 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 całość w formacie PDF ]
