ࡱ>      4HbjbjBrBr 2J  r00sssssT|_h^^^^^^^adH^Es^ss6_"!"!"!ss^"!^"!"!Zo^0٥F\4^L_0|_\d @dho^o^ds^Xv T"!`D6^^ @|_d0 9: Adolescent Medicine**All Goals and Objectives for this rotation are identical across all PL years**Primary Goals for this Rotation CompetenciesGOAL I: Prevention, Screening and Counseling (Adolescent). Understand the role of the pediatrician in the prevention of adolescent health problems through screening, counseling and advocacy. Discuss and follow recommendations for the frequency, type and content of adolescent health care visits outlined by the Bright Futures, AAP Health Supervision Guidelines and GAPS guidelines, and describe the rationale behind these recommendations.K, PC, SBP, PBLIPerform adolescent health maintenance visits, demonstrating ability to: Organize the visits appropriate for situation (e.g., individualization according to the adolescent's developmental level, social, cultural, spiritual/religious, national [immigrant] background, and family characteristics). Obtain and interpret a history from the adolescent's parent(s), including: concerns about the adolescent's health, past medical history, family history, psycho-social history, spiritual or religious history, academic performance, needs for anticipatory guidance, etc. Obtain and interpret a detailed, sensitive, and private history from the adolescent (assessing current health concerns, bio-psycho-social history, spiritual or religious history, and behaviors that may affect health). Be familiar with questionnaires (e.g., Initial and Periodic Adolescent Preventive Services Visit Forms developed as an adjunct to GAPS), trigger questions (e.g., from Bright Futures), and structured interview techniques (e.g., HEADSS; HEADSFIRST). Complete a sensitive and skillful physical examination of male and female adolescents and young adults. Counsel and provide patient education in a developmentally-appropriate manner, remaining respectful of the adolescent's needs and privacy. Educate and counsel adolescents on sexual identity, including the development of healthy sexual relationships. Be familiar with resources for patients that identify themselves as homosexual, bisexual or transgender. Resources should also be available for family members and close friends. K, PC, IPC, P, SBPDiscuss how to make the office environment suitable to serve this age group and provide education and counseling to both adolescents and their parents (e.g., discussion of office consent and confidentiality policies for health visits and release of medical records, separate waiting rooms, extended hours, patient education methods).PC, IPC, PDiscuss and follow federal, state and local laws that apply to adolescent health care, such as consent for confidential services and release of medical records, times when confidentiality may be abrogated, refusal of medical care, contraception, access to abortion, mental health, STD and chemical dependence services. K, SBP, PExplain the differences in health supervision visits for adolescents with special needs, such as those with: Nontraditional living situations (e.g., detention centers, foster care, homeless) Chronic diseases (e.g., cystic fibrosis, mental retardation, diabetes) Financial, social, cultural or language barriers K, PC, SBPPerform and interpret adolescent screening according to guidelines by experts in the field (e.g., AAP, Bright Futures and GAP), and demonstrate familiarity with indications and timing, including: Physical examination screens (e.g., cardiovascular disease or risk, nutritional risk, dental disease, musculoskeletal problems and pre-participation sports physicals, sexual maturity ratings, skin problems, sexually transmitted diseases, scoliosis [using scoliometer], thyroid disease) Psychosocial screening (e.g., school performance, mood disorders, tobacco and substance abuse, sexual risks, media use, other risk taking behaviors) Laboratory or procedural screens (e.g., hearing, vision, anemia, hyperlipidemia, tuberculosis) K, PCEvaluate immunization status and administer indicated immunizations.K, PCIdentify, assess risks, and counsel adolescents and families in the context of health promotion and illness or problem care for common or important conditions according to recommended guidelines (e.g., AAP, Bright Futures and GAP). Example topics from these guidelines are: communication skills and self-esteem building; education and career or vocational planning; injury and violence prevention; substance abuse; nutritional issues; pregnancy prevention; etc.).K, PC, IPCEducate adolescents through demonstration and instruction to perform routine breast and testicular self-examination. K, PC, IPCHelp adolescents to use health services appropriately during their teens and guide them in their transition to adult care. K, PC, SBPEmpower adolescents to become increasingly responsible for their own health and well-being.K, PC, IPC, SBPDescribe ways to improve adolescent health and prevention services at the federal, state and/or local level. K, SBPDiscuss advocacy strategies you might use to improve or prevent at least one adolescent health problem you see in your patient population.K, SBPGOAL II: Normal Vs. Abnormal (Adolescent). Understand normal adolescent behavior, growth, development and physiology and recognize deviations from the norm. Recognize the wide range of normal patterns of physical growth and pubertal development during adolescence and appropriately counsel patients and their families about pubertal variations.K, PCDescribe the pathophysiology, evaluation and management of variations in growth patterns and pubertal changes, including indications for referral.K, PCRecognize the range of normal psychosocial development in adolescents; the stages of development across early, mid and late adolescent years; and appropriately identify when behaviors lie outside the norm, requiring special intervention or referral.K, PCOrder and interpret clinical and laboratory tests to identify adolescent disease versus non-disease, taking into account physiologic values for adolescents at different stages of maturity. K, PCGOAL III: Undifferentiated Signs and Symptoms (Adolescent). Evaluate and manage common signs, symptoms and situations or risks in adolescents, recognizing when referral is indicated. Develop a strategy to evaluate complaints in adolescents that may represent functional complaints or psychosocial problems. Recognize common patterns of functional complaints in adolescents (e.g., headaches, abdominal pain, fatigue, chest pains). Develop a sensitive, supportive approach to the evaluation of these concerns. Recognize characteristics in the adolescent's history or health course warranting further diagnostic tests versus watchful and supportive observation. K, PCEvaluate and manage the following signs, symptoms, and common adolescent situations, recognizing which can be managed by the general pediatrician and which ought to be referred to an adolescent subspecialist or other subspecialist: Behavioral/psychiatric: school avoidance, absenteeism, truancy and drop out; poor school behavior; poor school performance; sleep disturbance; somatic complaints; social avoidance; parent-adolescent disagreements; concerns about peer pressure; bullied adolescent; overscheduled/extended adolescents; emotional and educational needs of pregnant adolescents and adolescent parents; emotional and educational needs of gifted adolescents; recurrent injuries suspicious of risk taking behavior or abuse, recent loss (e.g., death of friend, parent), anxiety, depression, social isolation, rushed or pushed adolescents Cardiovascular: chest pain, syncope, murmurs, IHSS, hypertension Dental: mouth and tooth pain or injury; painful or swollen gums or mucosa, TMJ and facial pain Dermatologic: rashes, hair loss, pigment changes, changing moles GI: acute and chronic abdominal pain, acute and chronic diarrhea, dyspepsia, vomiting, constipation Growth/endocrine: abnormalities in growth rate or puberty; thyroid enlargement GU/Nephrology: dysuria, frequency, scrotal swelling; scrotal pain, feared STD, sexual concerns or dysfunction in male, need for contraception in male GYN: missed, irregular or excessive vaginal bleeding; vaginal discharge or pain; feared STD; lower abdominal pains; feared pregnancy; sexual concerns or dysfunction in female; need for contraception in female, breast asymmetry; also describe findings on history that would initiate a pelvic exam Hematology/oncology: fatigue, anemia, swollen glands, fear of cancer Infections: fever with no obvious cause, lymphadenopathy, upper respiratory symptoms including sore throat and ear pain, deficient immunizations, objections to recommended immunizations Musculoskeletal/Sports medicine: back pain, limp, joint pains, minor injuries/pains, excessive/rapid muscular development in an athlete; missed periods in a female athlete Neurologic: headaches, dizziness, passing out, head injury, altered behavior Nutritional: Obesity, weight loss, unusual eating habits (vegan diet, alternative diets or food supplements, diet changes during sports training to enhance performance) Otolaryngology: recurrent nasal congestion or drip, large tonsils, persistent laryngitis, hearing loss Pulmonary: shortness of breath, wheezing, cough K, PCGOAL IV: Common Conditions Not Referred (Adolescent). Diagnose and manage common conditions in adolescents that generally do not require referral. Recognize presenting symptoms, diagnose, describe the pathophysiology, and manage common presentations of the following conditions: Allergies: environmental and seasonal allergies Behavioral/psychiatric: mild cases of substance abuse (tobacco, alcohol, inhalant and illicit drugs), non-organic headaches, common migraines, mild to moderate Attention Deficit Hyperactivity Disorder (ADHD); mild manifestations of anxiety, mood and conduct disorders; chest pain related to anxiety Cardiovascular: risk for cardiovascular disease in adulthood, hyperlipidemia, hypertension, functional heart murmurs Dental: viral exanthems and apthous ulcers Dermatologic: acne, viral exanthems, dermatophytoses, eczema, pityriasis rosea, contact dermatitis, seborrhea, urticaria, acanthosis nigricans, body art including piercings and tattoos, hirsutism Endocrine: thyroid disease, galactorrhea, hirsutism, non-pathologic short or tall stature, male gynecomastia, polycystic ovary syndrome (PCOS) Gastrointestional: gastroesophageal reflux disease (GERD), mild gastritis, dyspepsia, peptic ulcer disease, rectal fissures, hemorrhoids, encopresis, constipation GU/ Nephrology: epididymitis, mild varicocele, UTI, proteinuria and hematuria, enuresis, urethritis GYN: dysmenorrhea, pre menstrual syndrome (PMS), mild dysfunctional uterine bleeding, amenorrhea, vaginitis, cervicitis, STDs, uncomplicated pelvic inflammatory disease (PID), pregnancy diagnosis, breast mass Hematology/oncology: iron deficiency anemia Infections: mononucleosis, strep throat, sinus infections, ear infections, common causes of infectious diarrhea and vomiting, mild cases of hepatitis Musculoskeletal/sports: kyphosis, scoliosis < 20 degrees by Cobb angle on x-ray, Osgood-Schlatter Disease, patello-femoral syndrome, back pain due to minor musculoskeletal strain, costochondritis, mild overuse syndromes Neurologic: common seizure disorders, uncomplicated tics, migraine headaches Nutritional: exogenous obesity, pre-eating disorder behaviors, vegetarian diet Pulmonary: mild, moderate, and exercise induced asthma, respiratory tract infectionsK, PCGOAL V: Conditions Generally Referred (Adolescent). Recognize, manage, and refer adolescent conditions that generally require consultation or referral. Conduct the initial assessment, develop a differential diagnosis, initiate treatment and/or referral as appropriate of the following conditions that affect adolescents: Allergy/Immunology: severe allergic reactions (bee, food), immunodeficiency disorders Behavioral/psychiatric: anorexia nervosa, bulimia, chronic fatigue syndrome, moderate-severe depression, suicidal/homicidal ideation, learning disabilities, substance abuse including performance enhancing medications, obsessive compulsive disorder (OCD), severe anxiety disorders, psychosis, conduct disorders, conversion reactions, drug overdoses Cardiovascular: mitral valve prolapse, pathologic heart murmurs, refractory hypertension Dental: abscess, caries, fractured or avulsed tooth, severe trauma to jaw and soft tissues, malocclusions Dermatologic: cystic or nodular acne, psoriasis, alopecia, pyoderma, hydradenitis suppurativa, hirsutism Endocrinology: thyroid disease, galactorrhea, hirsutism or virilism, abnormal growth, precocious and delayed puberty, diabetes mellitus types I and II, non-pathologic short or tall stature, Turner syndrome Gastrointestinal: appendicitis, inflammatory bowel disease (IBD), refractory encopresis/constipation, irritable bowel syndrome GU/Nephrology: nephrotic/nephrotic range proteinuria, testicular torsion, scrotal mass, moderate-severe varicocele, hydrocele, inguinal hernia, genitourinary trauma, obstructive uropathy, renal hypertension, chronic renal disease GYN: pregnancy, ectopic pregnancy and other complications of pregnancy, amenorrhea of undetermined etiology, dysfunctional uterine bleeding, polycystic ovary syndrome, ovarian cysts, tumors and torsion, Bartholin's abscess, suspected endometritis, complicated PID, PAP smear abnormalities, persistent breast masses, breast mass, endometriosis, congenital mullerian anomalies, contraception in teens with chronic disease Hematology/Oncology: hemoglobinopathies, bone marrow depression, cancer, clotting disorder, bleeding disorder Infectious Disease: appendicitis, severe or unusual infections, HIV Musculoskeletal: patellar dislocation, scoliosis > 20o by Cobb angle on x-ray, suspected bone tumors, fractures, refractory back pain, chronic joint pain Neurologic: uncommon and difficult to control seizures, serious head injury or concussion, acute and chronic neurology conditions, severe headaches Pulmonary: severe asthma, cystic fibrosis Other: Celiac disease, juvenile rheumatoid arthritis (JRA), systemic lupus erythematosis (SLE), chromosomal abnormalities K, PC, IPCWork effectively with a wide range of health professionals who care for adolescents with health care issues.K, PC, IPC, PDescribe the role and general scope of practice of adolescent-trained specialists, general pediatricians, family practitioners, and other providers (e.g., gynecologist, behavioral health counselors, school staff) who are involved with the care of adolescents.K, SBPRecognize situations where adolescents benefit from the skills of professionals trained in the care of adolescents.K, PCAdvocate for the adolescent and his/her family to secure effective, coordinated care for the adolescent using appropriate resources in the community and health profession. K, IPC, P, SBPMaintain an interactive and supportive primary care relationship with adolescents and their specialty consultants when patients are referred for management of specific disorders.K, PC, IPCGOAL VI: Demonstrate high standards of professional competence while working with adolescents. Provide sensitive support to adolescents and their families in all clinical settings (outpatient, continuity, adolescent clinic, school and community settings, mental health services, inpatient hospital services). IPC, PCommunicate skillfully with adolescents and their families, using effective interview, counseling and patient education strategies.PC, IPCMaintain accurate, legible, timely, confidential and legally appropriate medical records and consultation reports for adolescents in the outpatient and inpatient setting.IPC, PIdentify standardized guidelines for diagnosis and treatment of conditions common to adolescents and adapt them to the individual needs of specific patients.K, PCAdhere to ethical and legal principles of care; demonstrate appreciation of and understanding of issues pertinent to adolescents (treatment of minors, confidentiality, etc.).P, SBPBe sensitive to diversity and recognize one's own biases that may affect one's response to adolescents. PC, PIdentify key aspects of health care systems as they apply to care of adolescents and their families (e.g., challenges to access and continuity of care; factors affecting billing and reimbursement). SBPRecognize and advocate for adolescents who need assistance to deal with health care system complexities.PC, SBPProceduresGOAL VII: Technical and therapeutic procedures. Describe the following procedures, including how they work and when they should be used; competently perform those commonly used by the pediatrician in practice. Genital wart treatment K, PCGynecologic evaluation: postpubertal K, PCUrethral swab K, PCGOAL VIII: Diagnostic and screening procedures. Describe the following tests or procedures, including how they work and when they should be used; competently perform those commonly used by the pediatrician in practice. Scoliosis, scoliometer K, PCCore Competencies: K - Medical Knowledge PC - Patient Care IPC - Interpersonal and Communication Skills P - Professionalism PBLI - Practice-Based Learning and Improvement SBP - Systems-Based Practice Performance Expectations by Level of Training BeginningDeveloping Accomplished CompetentDescription of identifiable performance characteristics reflecting a beginning level of performance.Description of identifiable performance characteristics reflecting development and movement toward mastery of performance.Description of identifiable performance characteristics reflecting near mastery of performance.Description of identifiable performance characteristics reflecting the highest level of performance.Medical KnowledgePL1PL1, PL2PL2, PL3PL3Patient CarePL1PL1, PL2PL2, PL3PL3Interpersonal and Communication SkillsPL1PL1, PL2PL2, PL3PL3ProfessionalismPL1PL2, PL3PL3Practice-Based Learning and ImprovementPL1PL1, PL2PL2, PL3PL3Systems-Based PracticePL1PL1, PL2PL2, PL3PL3 Adolescent Medicine Rotation Joseph A.Puccio, MD Allison Eliscu, MD T11 Rm 087 all the way in the back T11 Rm 087 across from coffee pots 631.444.7811 631.444.9559  HYPERLINK "mailto:joseph.puccio@stonybrook.edu" joseph.puccio@stonybrook.edu  HYPERLINK "mailto:allison.eliscu@stonybrook.edu" allison.eliscu@stonybrook.edu Clinical Locations: 37 Research Way East Setauket 631.444.4660 2701 Sunrise Hway Islip Terrace 631.638.2375 Cody Center 631.632.3070 On the first day of the rotation please meet Dr. Puccio at 11am in his office near the coffee pots or page to find the office 631.279.2439. Will review: Schedule for Rotation: Will Be given on the first day Education Sessions: Dr.Puccio Tuesdays and Dr.Eliscu Thursdays ( In the event that you have continuity on one of those days we will make every effort to reschedule) Online Syllabus:  HYPERLINK "http://www.usc.edu/studentaffairs/Health_Center/adolhealth/index.php" http://www.usc.edu/studentaffairs/Health_Center/adolhealth/index.php Requirement to give lecture to residents and medical students during rotation Will discuss we assess and how we do our evaluations Be ready to discuss Psychosocial evaluations Adolescent Medicine Rotation Schedule DAY 4MONDAYTUESDAYWEDNESDAY THURSDAYFRIDAYTIME 68:30 AMMORNING REPORTMORNING REPORTMORNING REPORTMORNING REPORTPrimary Care Adolescent- Islip9:00 AMMeet with on-service Adolescent Attending immediately after Morning Report. Responsibilities from 9a.m. to Noon may include: Consults, In-patient Care, Formal reading reviews and/or assigned resident topic presentation.Primary Care Adolescent-Islip10:00 AMPrimary Care Adolescent-Islip11:00 AMPrimary Care Adolescent-Islip12 NOONTravel to Clinic/LunchEating Disorder - Tech ParkTravel to Clinic/LunchTravel to Clinic/LunchPrimary Care Adolescent-Islip1:00 PMHigh Risk Youth Clinic - Tech ParkEating Disorder - Tech ParkPrimary Care Adolescent-Tech ParkGYN - Pregnancy Prevention - Tech ParkPrimary Care - Young Adult & Adolescent - Islip2:00 PMHigh Risk Youth Clinic - Tech ParkEating Disorder - Tech ParkPrimary Care Adolescent-Tech ParkGYN - Pregnancy Prevention - Tech ParkPrimary Care - Young Adult & Adolescent - Islip3:00 PMHigh Risk Youth Clinic - Tech ParkEating Disorder - Tech ParkPrimary Care Adolescent-Tech ParkGYN - Pregnancy Prevention - Tech ParkPrimary Care - Young Adult & Adolescent - Islip4:00 PMHigh Risk Youth Clinic - Tech ParkPrimary Care - Young Adult - Tech ParkPrimary Care Adolescent-Tech ParkGYN - Pregnancy Prevention - Tech ParkPrimary Care - Young Adult & Adolescent - Islip5:00 PMHigh Risk Youth Clinic - Tech ParkPrimary Care - Young Adult - Tech ParkPrimary Care Adolescent-Tech ParkGYN - Pregnancy Prevention - Tech ParkPrimary Care - Young Adult & Adolescent - Islip6:00 PMPrimary Care - Young Adult - Tech Park7:00 PMPrimary Care - Young Adult - Tech Park Adolescent Medicine Psychosocial Evaluation Version 1a 8/3/04 Headdss Assessment Prior to beginning the psychosocial assessment it is imperative to inform the patient that during this part of the history taking that all their responses are confidential except for any history of danger to them from others, danger from their self or threatened danger to others. H Home Who do they live with? (Include everyone including pets) Where do they live? (include town and type of housing) Are they happy at home? If not why? Do they feel safe at home? If not why? Has there been any abuse experienced? E- Education/Employment Where do they go to school? (Name of school, what kind of school they are in and what town the school is in) What grade are they in? If not appropriate for age then ask have they ever experience any difficulties in school? What are their grades like? (Get a number or letter! Do not accept ok) Did they have to go to summer school? Do they like this school? How many days of school have they missed this past quarter, year? What is their favorite subject? What are their future plans? Do they have a job? If still in school, how many hours are they working per week? Does it interfere with school? If out of school, do they have a full time job? Part time job? If not, can they identify any obstacles to them obtaining employment? How do they support themselves if out of school and not working? A-Activities What kind of things do they do in their free time? Do they have a specific hobby? Do they belong to clubs at school? Do they play sports? Do they any close friends? What do they like to do when they are with their friends? Do they belong to any neighborhood groups? Do they know of anybody in a gang? Have they ever had any experience with anyone trying to get them into a gang? Have they ever had any experiences with law enforcement? D-Diet When they look in the mirror, are they happy with their appearance? If not are they actively trying to change it? Have they ever concentrated on gaining or loosing weight? If yes, what was their plan? If they are trying to loose weight, did they ever use any OTC aids? Laxatives? Diuretics? Vomiting? Enemas? Get a general idea of what their food intake is like for breakfast, lunch and dinner? D-Drugs Have they ever smoked cigarettes? (For how long? and how much are they smoking now?) Alcohol: See handout on CRAFFT Do they know of anyone that uses illicit drugs? Have they ever used illicit drugs? Give examples!!! Do they know of anyone that uses IV drugs Have they ever used IV drugs? If yes, have they ever been tested for Hep B, Hep C or HIV? Have they ever heard of club drugs like ecstasy (X), ketamine(K), Viagara (V) Crystal (Ice), etc? Do they know of anyone that uses these? Have you ever been around people using these drugs?. Have you ever used any of them? S-Sex Have you ever been sexually active with men, women or both? (Consider the developmental age of the patient prior to asking this question and rephrase the question appropriately.) For the concrete patient you may have to build up to this question by starting with a more innocent lead question like: A lot of times people as they become teenagers have new feelings towards certain people of the opposite sex, of the same sex or of both sexes , have you ever had these feelings? Have you ever acted on these feelings? Discussion about approaches. If sexually active, number of life time partners? (of each sex if necessary) Last intercourse date? Contraception used.just yes and no and if yes what kind? How was their sexual experience? And why? Have you ever had sex for exchange of drugs, money, gifts or shelter? Have they ever been pregnant? And what happen with that pregnancy? Get Menarche, LMP, cycle information ( frequency, duration, dysmenorrhea?), last gynecology exam, if you have not already obtained that information. Have they ever been forced to have sex when they really werent into it? Contraception? If not on any type of contraception, are they interested in learning about it? If they are not using either male or female condoms, are they aware that they are at risk for STIs? Ever hear of emergency contraception? Plan B and Birth control pills(more nausea) Ever have a sexually transmitted infection like gonorrhea, Chlamydia, HPV, herpes, syphilis, hepatitis b, trichomonas, HIV? Are they interested in getting tested for any of these? S-Suicide When was the last time they were very happy? When was the last time they were very sad? And what makes the very sad? When they were sad, did they ever have strange thoughts? Did they ever think of hurting themselves? If yes when was the last time? A year ago? A month ago? A week ago? Yesterday? This morning? How were they going to hurt themselves? Do they wish they would be better off not here? Do they have anyone they could speak with about this? (If a patient is visibly upset or has active thoughts of suicide, DO NOT LEAVE THEM ALONE BEHIND A CLOSE DOOR!!!!!!!!!!!!!!) Additional Rotation Readings (pedsportal.com)  HYPERLINK "http://pedsportal.com/Abnormal%20Vaginal%20Bleeding.pdf" Abnormal Vaginal Bleeding  HYPERLINK "http://pedsportal.com/Acne.pdf" Acne  HYPERLINK "http://pedsportal.com/Adolescent%20Growth%20and%20Development.pdf" Adolescent Growth and Development  HYPERLINK "http://pedsportal.com/Adolescent%20Psychological%20Development.pdf" Adolescent Psychological Development  HYPERLINK "http://pedsportal.com/Bacterial%20Vaginosis.pdf" Bacterial Vaginosis  HYPERLINK "http://pedsportal.com/Barbiturates.pdf" Barbiturates  HYPERLINK "http://pedsportal.com/Clinical%20Evaluation%20of%20Substance%20Abuse.pdf" Clinical Evaluation of Substance Abuse  HYPERLINK "http://pedsportal.com/Cocaine.pdf" Cocaine  HYPERLINK "http://pedsportal.com/Common%20GYN%20Problems%20in%20Prepubertal%20Girls.pdf" Common GYN Problems in Prepubertal Girls  HYPERLINK "http://pedsportal.com/Depression%20and%20Suicide.pdf" Depression and Suicide  HYPERLINK "http://pedsportal.com/Dx%20and%20Mgmt%20of%20STDs.pdf" Diagnosis and Management of STD's  HYPERLINK "http://pedsportal.com/Dx%20and%20Mgmt%20of%20SD%20Pathogens.pdf" Dx and Mgmt of STD Pathogens  HYPERLINK "http://pedsportal.com/Dx%20and%20Tx%20of%20Substance%20Abuse.pdf" Dx and Tx of Substance Abuse  HYPERLINK "http://pedsportal.com/Dysmenorrhea.pdf" Dysmenorrhea  HYPERLINK "http://pedsportal.com/Eating%20Disorders.pdf" Eating Disorders  HYPERLINK "http://pedsportal.com/Female%20Athlete%20Triad.pdf" Female Athlete Triad  HYPERLINK "http://pedsportal.com/Genital%20Warts.pdf" Genital Warts  HYPERLINK "http://pedsportal.com/Gonococcal%20Infections.pdf" Gonococcal Infections  HYPERLINK "http://pedsportal.com/Hallucinogens.pdf" Hallucinogens  HYPERLINK "http://pedsportal.com/HEADSSS.pdf" HEADSSS Exam  HYPERLINK "http://pedsportal.com/Hormonal%20Contraception.pdf" Hormonal Contraception  HYPERLINK "http://pedsportal.com/Management%20of%20Substance%20Abuse.pdf" Management of Substance Abuse  HYPERLINK "http://pedsportal.com/Precocious%20Puberty.pdf" Precocious Puberty  HYPERLINK "http://pedsportal.com/Secondary%20Amenorrhea.pdf" Secondary Amenorrhea  eghjX \ ] V f g h de9BCDglmn h( Bhhh[QQ h( Bh( B h? 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