Complete physical exams – do once in early adolescence, once in mid-adolescence, and once in late adolescence
Adolescent Health Maintenance
- Td booster – at 11-12, then every 10 years. Tdap is recommended in place of one booster for adolescents and adults
- Varicella if haven’t had chickenpox or been vaccinated before
- MMR if the patient didn’t receive a booster at 4-6 years
- Start HPV (strains 6 & 11 cause warts, 16 & 18 cause cervical dysplasia)
- Hep A if living in an area with high infection rates, travel to at-risk areas, have chronic liver disease, or inject IV drugs, or gay men
- TB tests for high risk – exposures, live in a high-risk area, live in shelters, etc
- Pap smears start at 21 unless extenuating circumstances – symptomatic, immunocompromised, or pregnant
- Screened for gonorrhea and chlamydia by urine nucleic acid amplification in any teen who is sexually active and symptomatic or high risk.
- Screen everyone for BP, screen high risk for lipids
- Hypertrophic cardiomyopathy is the most common cause of sudden death. Suspect if when ventricular filling is decreased (valsalva) → murmur gets louder because of more obstruction. When ventricular filling is increased → murmur becomes quiet.
- Cardiology referral if: suspect Marfan syndrome (risk of aortic root dilation or dissection), murmur suggesting hypertrophic cardiomyopathy, grade 3/6 or louder systolic murmur, or diastolic murmur. Absolute contraindications to sports are rare.
- Murmur grading:
- Grade 1 = barely audible
- Grade 2 = faint but immediately audible with stethoscope on chest
- Grade 3 = readily audible but no palpable thrill
- Grade 4 = readily audible with palpable thrill
- Grade 5 = audible with just the corner of the stethoscope on the chest + palpable thrill
- Grade 6 = audible with stethoscope actually lifted above the chest + palpable thrill
- Murmur grading: