Council on Medical Student Education in Pediatrics

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COMSEP Clinical Cases

ISSUES UNIQUE TO ADOLESCENCE

  1. A fourteen-year-old female is seen in the clinic with her mother for acute onset of dysuria and urinary frequency. How would you evaluate and manage this patient?
  2. The parents of a fifteen-year-old boy bring him to your clinic after he threatened to take a bunch of pills. Although his affect seems depressed, he is not currently suicidal. Explain your approach to this young man, including important history, physical exam findings, diagnostic studies, management principles and advice to his parents.
  3. A seventeen-year-old female sees you for a pre-college physical. Describe your approach to history, physical exam and guidance/counseling.
  4. A sixteen-year-old boy presents to your clinic with polyuria and weight loss over the past three weeks. Describe the important aspects of the history and physical exam, diagnostic considerations, differential diagnosis and basic management principles.
  5. The mother of a thirteen-year-old female expresses concern that her daughter has not yet had the onset of menses. How would you counsel her?
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  6. A sixteen-year-old male presents with fever, fatigue and sore throat for a four days. Discuss what aspects of physical exam and lab data that will help establish a diagnosis.
  7. A fourteen-year-old female well known to your practice makes an appointment to see you alone regarding a desire for contraception. What advice would you give her? What are her rights to confidentiality? What are your responsibilities to inform her parents?
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  8. A fourteen-year-old male presents for a football sports physical. What are the important points to cover in the history and physical exam?
  9. The parents of a previously healthy fifteen-year-old male bring him to you for a visit. The previous weekend he returned home from a party confused and combative. They are asking for your advice. Describe your approach to this clinical problem.
  10. A fifteen-year-old boy is concerned that he is not yet developing facial hair and is now considerably shorter than most of his peers. How would you evaluate and counsel him?
  11. A sixteen-year-old girl presents with fever and lower abdominal pain but denies urinary urgency or frequency. She is sexually active and uses condoms infrequently. How would you evaluate this patient?
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  12. A fifteen year-old female comes to your clinic with complaints of bilateral leg pain. On physical examination, you notice that she has lost fifteen pounds since her last visit one year ago and she has missed her last six periods. Her BMI is 15. How would you evaluate this patient?
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  13. A previously healthy sixteen-year-old girl presents for a routine health care supervision visit with her mother. When you ask the mother to leave the room she refuses. How would you approach this situation?
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  14. A twelve-year-old boy presents with scrotal pain. He has associated nausea and vomiting but no fever. On examination, the left hemiscrotum is enlarged and slightly bluish in hue. It is exquisitely tender to palpation. What is your differential diagnosis? What is the first step in evaluation and management?
  15. A sixteen-year-old boy presents with a chief complaint of urethral discharge. He states that he notices it most in the morning. He has mild burning with urination. On examination, you note mucoid discharge at the urethral meatus and slightly enlarged inguinal nodes. What other historical questions do you need to ask? What laboratory testing will you order?

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