When assessing an adolescent, it’s important to gather comprehensive information, including:
- Social History: Details about the adolescent’s relationships, social interactions, and living situation. This includes assessing for stressors related to school, friendships, and family dynamics.
- Mental Health History: Screening for signs of depression, anxiety, eating disorders, or other mental health concerns. Adolescents often face significant emotional changes, and early detection of mental health issues is crucial.
- Sexual History: Even if the adolescent denies current sexual activity, it’s important to discuss sexual health, contraception, and safe sex practices.
- Substance Use: Inquire about the use of tobacco, alcohol, and drugs, even if the adolescent denies current use.
- Physical Activity and Nutrition: Assess the level of physical activity, dietary habits, and any history of eating disorders, especially if there are concerns like amenorrhea.
4. What makes a sports physical unique from other exams?
A sports physical is focused on evaluating an adolescent’s physical ability to safely participate in sports. It involves a detailed assessment of the musculoskeletal system, cardiovascular health, respiratory function, and overall physical fitness. Additionally, the sports physical considers any history of injuries or conditions that could be exacerbated by physical activity, such as asthma or joint issues. The goal is to ensure the adolescent is physically prepared and to identify any conditions that may require further evaluation or intervention.
5. What are your differential diagnoses?
Given LF’s history, the following differential diagnoses should be considered:
- Secondary Amenorrhea: Possible causes include stress, polycystic ovary syndrome (PCOS), thyroid dysfunction, or eating disorders.
- Psychosocial Stress: The stress of moving, starting a new school, and leaving friends could be impacting LF’s overall health, including her menstrual cycle.
- Delayed Puberty: Although less likely given her history of menarche, it’s important to rule out any endocrine disorders.
- Nutritional Deficiency: Lack of proper nutrition or an undiagnosed eating disorder could be contributing to her amenorrhea and overall health concerns.
6. What further history should be gathered today and why?
Further history should include:
- Detailed Menstrual History: Inquire about the nature of her periods before they stopped (e.g., regularity, flow, associated symptoms).
- Diet and Exercise Patterns: Assess her diet, weight changes, exercise routines, and any signs of disordered eating.
- Stress and Mental Health: Explore her feelings about the move, new school, and any signs of anxiety or depression. Understand how she is coping with these changes.
- Sexual History: Even though she denies current sexual activity, it’s important to discuss her understanding of contraception, safe sex, and the implications of her mother’s request for birth control.
- Immunization Records: Verify and update her immunization status to ensure she is protected, especially before participating in sports.