Part One
“Kayla brings LF in for a sports physical, needed prior to the initiation of school, because LF would like to play volleyball. Mother is also concerned because LF had menarche at age 13 with 4 periods that year, but none since her 14th birthday. She is now 15 and ½ years old. LF will be a sophomore. She expresses angst at starting a new school and leaving her friends for the recent move. She sleeps 7-8 hours per night. She denies current sexual activity upon questioning or use of drugs and alcohol. She is currently dating a local boy she recently met. Her mother reports she would also like to begin LF on ‘the pill’, because “I don’t want her getting pregnant young like I did”. Her mother remains present throughout the gathering of the history. LF denies any concerning symptoms and she denies interest in contraception.
Immunizations: Mother states “She had all of her shots up to kindergarten, but I don’t think she has needed any since then.”
Allergies: None
Medications: None
Past Medical History: Includes being a full-term vaginal delivery weighing 6 lb 4 oz. She experienced a right radial fracture at age 8 and tonsillectomy and adenoidectomy at age 9.
Discussion Questions Part One:
We will begin by focusing on gathering history on an adolescent. What is one important item you learned about gathering a history on an adolescent? For a sports physical? Did you pick up any ‘red flags’ in the historical data? What information should always be gathered on an adolescent that you have not previously seen? What makes a sports physical unique from other exams? What are your differential diagnoses? What further history should be gathered today and why?
Questions:
When did she start having these concerns? How is she feeling about her parent’s separation, and moving into her grandparent’s home? Has she made any friends in this new area? How often are these concerns bothering her? Can she describe any physical or psychological symptoms that occur? Does anything make her concerns worse? Does anything make her concerns better? Has she done anything to relieve her concerns? And does it help? Has she participated in sports before? What kind? Did she have any problems playing sports, or injuries or overuse symptoms related to playing sports?
1. What is one important item you learned about gathering a history on an adolescent?
When gathering a history from an adolescent, it’s essential to create an environment of trust and confidentiality. Adolescents may be hesitant to share sensitive information if a parent is present, especially regarding topics like sexual activity, mental health, and substance use. Establishing a rapport and ensuring the adolescent that certain aspects of their history will remain confidential unless there is a risk of harm to themselves or others is crucial.
2. For a sports physical, did you pick up any ‘red flags’ in the historical data?
Yes, there are a few potential red flags in the historical data:
- Amenorrhea: LF had menarche at age 13 but has not had a period since her 14th birthday, which may indicate secondary amenorrhea. This warrants further investigation to rule out underlying conditions such as hormonal imbalances, stress, eating disorders, or excessive physical activity.
- Psychosocial Stress: LF expresses angst about starting a new school and leaving her friends, which could indicate emotional or psychological stress. This stress may also be contributing to her menstrual irregularities.
- Lack of Immunizations: The mother mentioned that LF hasn’t had any immunizations since kindergarten. It’s important to update her immunizations, especially considering her participation in sports.