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The Adolescent

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A 15-year-old girl presents to your office for missed menses. Menarche was at age 12, and for the last year she has had menses every 30 days. She has missed her last menses. Her urine pregnancy test is positive. After informing her of the pregnancy, you continue to explain that young mothers have a higher risk of several pregnancy-related complications, including which of the following?

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a. Twin gestation

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b. Low-birth-weight infants

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c. Hypotension

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d. Excessive weight gain

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e. Infants with genetic defects

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The answer is b. (Hay et al, pp 143-144. Kliegman et al, pp 699-702. McMillan et al, pp 566-567. Rudolph et al, pp 299-300.) Adolescents are typically healthy and do not have chronic disease. However, several pregnancy complications occur more frequently in teens, including poor weight gain in the mother, premature delivery, low-birth weight, and an increased risk of pregnancy-induced hypertension. The risk of violence is also elevated for teen mothers. As both parents age, the risk of genetic defects in their infant increases. Teen mothers have a lower risk of twin gestation.

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A 12-year-old boy has scant, long, slightly pigmented pubic hairs; slight enlargement of his penis; and a pink, textured, and enlarged scrotum. He is most likely at which sexual maturation rating (SMR, also called Tanner) stage?

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a. SMR 1

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b. SMR 2

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c. SMR 3

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d. SMR 4

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e. SMR 5

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The answer is b. (Hay et al, pp 113-114. Kliegman et al, pp 649-651. McMillan et al, pp 531-536. Rudolph et al, pp 265-266.) Normal sexual maturation during puberty follows a consistent pattern. The first sign of puberty in boys is scrotal and testicular growth; penis growth usually occurs about a year after. Pubic hair growth is more variable. In girls, the first sign of puberty is the development of breast buds. The SMRs are not synchronized, in that a girl with SMR 3 pubic hair does not always have SMR 3 breasts.

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The description in the question is typical of SMR 2 in boys: sparse, thin, and long pubic hair with slight penile enlargement. In SMR 3, pubic hair becomes darker and begins to curl, and the penis lengthens. In SMR 4, it is starting to resemble adult pubic hair but without complete coverage, and the penis continues to grow. At SMR 5, pubic hair extends to the inner thigh and is in the typical adult ...

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