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A 17-year-old boy presents to your office for an acute care visit. He has come without his parents’ knowledge or consent. He recently started having sexual intercourse and has not always been using a condom. He would really prefer that his parents not know that he has started having sex. He states that he has had some yellow discharge from his penis and is concerned he may have a sexually transmitted infection (STI). What is your next step?

A. Call his parents and explain the situation without telling him that you are calling.

B. Call his partner and explain the situation without telling him that you are calling.

C. Tell him that you cannot see him without notifying his parents.

D. Explain the rules of confidentiality in the state where you practice and offer confidential STI testing and treatment as able.

E. Explain to him that under federal law, you cannot treat him for an STI without notifying his parents.

Answer: D

In the 1960s, in order to prevent foregone treatment of adolescent STIs, all state legislatures enacted statutes allowing minors to receive treatment for STIs without parental involvement. These laws vary in specifics state to state and are not mandated by federal law. You should be able to see an adolescent and discuss their concerns confidentially without parental involvement, and thus do not need to call the parent to discuss these issues. Billing for these services, however, may not be confidential depending on the insurance carrier and state regulations.

A 14-year-old African American boy presents to your office for an urgent care visit. He presents with sudden onset of severe left-sided hip and thigh pain and is unable to bear weight. His body mass index (BMI) is 35 kg/m2. You are concerned he might have a slipped capital femoral epiphysis (SCFE). If he does in fact have an SCFE, which sexual maturity rating (SMR) would you expect on physical examination?

A. SMR 1

B. SMR 3

C. SMR 4

D. SMR 5

E. SMR 6

Answer: B

The musculoskeletal system is affected significantly by the biological changes of ...

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