2 Adolescent Health
Theresa McHale: Adolescent Health
Case
Theresa McHale is a 15 year old female who comes to see you because she missed her period. Menarche occurred 4 years ago, she has no significant past medical history, and she takes no medications. She’s sexually active with a 17 year-old senior boy in her high school and says they use condoms. Her boyfriend is leaving to go to college next year and her grades have been down. Her parents had been fighting a lot recently and her father has been threatening to move out of the house. She is living with her mother Jill McHale, her brother Patrick McHale and her dad Brian McHale.
Physical Examination Findings:
Weight = 98 pounds. Height = 5’2”
Questions to Consider
- What additional history do you want to obtain from Theresa?
- What laboratory tests do you want to order?
- What is the most likely cause of her secondary amenorrhea?
The patient requests that you and she determine appropriate birth control in addition to condoms, and that you prescribe it without disclosing any information to her mother.
- Would you prescribe contraception? Do you have legal consent for treatment?
- Would you honor her request of confidentiality?
Learning Objectives
By the end of the session, the active participant will be able to:
- Identify adolescent risk factors and develop clinical strategies to screen for them.
- Describe clinical interventions for the prevention of teen pregnancy and STIs.
- Summarize medico-legal issues regarding medical care of adolescents, including confidentiality.
The Adolescent Interview
Useful questions when talking to adolescents – getting into teens’ HEADS
| HOME | Who lives with you at home? How do you get along with family members? Do you feel safe at home? (If teen lives with one parent) How often do you see the parent who does not live with you? What do you do together? What types of responsibilities do you have at home? What would you like to change about your family if you could? |
| EDUCATION | What grade are you in? At what school? What kind of grades do you make? What is your favorite class? What is your least favorite class? Do you have any particular goals for college or a career? |
| ACTIVITIES | What do you do for fun? What do you and your friends do outside of school? What kind of activities, organizations, or clubs do you participate in? What kind of exercise or organized sports do you do? Have you ever been injured in sports? How much screen time do you have daily? (computer, TV, video games) |
| DRUGS | Do you smoke cigarettes or use chewing tobacco? Do you drink alcohol? What is the most you have ever had to drink at one time? Have you ever done anything you later regretted after drinking? Have you ever tried other drugs? What type, and how often? Have you ever been in a car when the driver was impaired from alcohol or drugs? Have your friends ever tried to pressure you to do things that you don’t want to do? How did you handle that? |
| SEX | Is there anyone special in your life? Do you date or go out? With only one person or a lot of people? Do you have any concerns or questions about sex? Are you sexually active, or have you been in the past? With men, women, or both? Have you ever had sexually transmitted infection? Do you use any kind of birth control? What kind? Do you use condoms? Every time, or just sometimes? Has anyone ever touched you in a way you didn’t like? Forced you to have sex? |
| EMOTIONAL HEALTH | How do you cope with stress? What do you do to make yourself feel better when you are down or blue? Who do you talk to when you are upset or sad? Have you felt depressed in the past two weeks? Do you feel you have decreased interest in activities that you usually enjoy? |
Questions to Consider
- What additional information do you want?
- What are the most important components of the physical exam of this patient?
- What labs/studies are indicated?
- What treatment would you initiate?
Learning Objectives
- Develop a differential diagnosis for chronic cough.
- List treatment strategies for the most common causes of chronic cough.
- Address traditional medical practices in a culturally competent way.