Miscellaneous cases in adolescence

Chapter 12 Miscellaneous cases in adolescence



Case 12.1


Madeleine is a 16-year-old who has lost a reasonably large amount of weight over the last 6 months. She states that she actually feels very well, although finds it difficult to get up in the mornings. Madeleine admits that she is ‘careful’ about what she eats, and avoids sugary and fatty foods. She has become very involved in swimming training, is a member of the school rowing team, and jogs every day. She has not yet reached menarche.




Questions



1. What questions do you need to ask, prior to making your differential diagnosis?

2. Would she be classified as having primary amenorrhoea?

3. What information would you need regarding her physical appearance in order to make a differential diagnosis?

4. If Madeleine is 170 cm tall, and 48 kg, what is her body mass index (BMI)?

5. What are some of the possible reasons for not having reached menarche?

6. Explain the possible mechanisms by which athletes often have a delayed menarche.

7. How can you determine if Madeleine has an eating disorder?


Case 12.2


Carly is a 14-year-old with a 1-day history of dysuria and frequency of urination. There have been no previous episodes resembling this. She states that her urine has appeared cloudy over this period of time. She has no fever.




Questions



1. What is the most likely diagnosis?

2. Which investigation is required in order to choose the most appropriate medication for her problem?

3. Why is this disorder so much more common in females, as compared to males?

4. If untreated, what are the possible complications?


Case 12.3


Faith is a 15-year-old girl who presents with cubitus valgus. While examining her you observe some signs which concern you. Faith is short in stature, has a rather broad neck, and she has hyperconvex nails. You also note that she has no obvious breast development.




Questions



1. What diagnosis do these signs suggest? Why does it occur?

2. What is ‘cubitus valgus’?

3. What questions would be relevant to ask Faith and her mother?

4. Name other disorders which occur more frequently in individuals with this condition.


Case 12.4


Dylan is a 17-year-old who asks your advice about what he calls ‘an embarrassing problem’. For the last 24 hours, he has had some burning pain when he urinates, and this morning he noticed a small amount of a thick, yellow fluid at the opening of his urethra.




Questions



1. What questions must you ask Dylan?

2. What is your differential diagnosis?

3. What advice will you give him?

4. What investigations does he need?

5. Compile a table which lists the most common sexually transmitted infections (STIs), their causative agents and their clinical features.


Case 12.5


A 17-year-old has painful periods. Menarche was 4 years earlier. Her periods were at first irregular, but painless. However, over the last 2 years they have become regular, but painful. This is maximal on the first and second days of bleeding.




Questions



1. Define ‘menarche’ and ‘dysmenorrhoea’.

2. What type of dysmenorrhoea does she have?

3. What is the pathophysiological basis for her pain?

4. Why are irregular cycles so common during adolescence?


Case 12.6


A 13-year-old boy is brought in for a wellness check. You observe that he has a small mass in his neck which was not present 1 year ago. It is midline, smooth, not painful or tender, and does not interfere with swallowing or with speech. He has no symptoms of any kind. The mass is shown in Figure 12.1.


image

Figure 12.1


(Source: Mir, MA. Atlas of Clinical Diagnosis [2nd edn]. Edinburgh: Saunders; 2003:132, Fig 6.16)




Questions



1. Describe how you will examine the mass.

2. The mass moves in an upward direction when he swallows. Name two possible causes of midline masses with this property.

3. Considering its site, which of these two disorders is most likely? What simple action can you ask the patient to do to confirm this diagnosis?

4. How does this lesion develop?


Case 12.7



History


Ben is a 17-year-old boy who presents with a 6 week history of a sore throat. It was most severe at the onset, when it was severe enough to make swallowing difficult. It is now less worrisome.


He now complains of general lassitude, lack of energy, loss of concentration, ‘fuzzy thinking’, nausea and anorexia. Ben states that he often wakes during the night feeling feverish and sweating profusely.


He also states that over the last few weeks his neck has been ‘sore’, and over the last 2 weeks he has had a ‘dragging feeling’ in his abdomen.


Ben has otherwise been very healthy, and has had the usual ‘childhood illnesses’. There is no-one in his family with a similar condition.


He has a steady girlfriend, and is a non-smoker. He is on no medications, but regularly drinks alcohol in the weekend and occasionally uses cannabis.



Questions



1. Using only this information, list the possible causes of Ben’s clinical presentation.

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Dec 26, 2016 | Posted by in MANUAL THERAPIST | Comments Off on Miscellaneous cases in adolescence

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