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Rarely, a brain tumor could explain an adolescent with new onset of behavior changes. A previously undiagnosed psychiatric history mania or bipolar disease , too, must be considered. A history, family history, physical examination especially the neurologic and psychological portions , and screening laboratory will help provide clarity. Information can come from the patient, his family, or other interested parties teachers, coaches, and friends. Direct questioning of the adolescent alone about substance abuse is appropriate during routine health visits or when signs and symptoms are suggestive of abuse.
Children at risk for drug use include those with significant behavior problems, learning difficulties, and impaired family functioning. Cigarettes and alcohol are the most commonly used drugs; marijuana is the most commonly used illicit drug.
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Direct questions can identify drug or alcohol use and their effect on school performance, family relations, and peer interactions. Should problems be identified, an interview to determine the degree of drug use experimentation, abuse, or dependency is warranted. Historical clues to drug abuse include significant behavioral changes at home, a decline in school or work performance, or involvement with the law.
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Risk-taking activities trading sex for drugs, driving while impaired can be particularly serious and may suggest serious drug problems. Alcohol or other drug users usually have a normal examination, especially if the use was not recent. Needle marks and nasal mucosal injuries are rarely found. An adolescent with recent alcohol or drug use can present with a variety of findings Table A urine drug screen UDS can be helpful to evaluate the adolescent who: 1 presents with psychiatric symptoms, 2 has signs and symptoms commonly attributed to drugs or alcohol, 3 is in a serious accident, or 4 is part of a recovery monitoring program.
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Treatment then is directed at the offending agent if known. After stabilization, a treatment plan is devised. For some, inpatient programs that disrupt drug use allow for continued outpatient therapy.
For others, an intensive outpatient therapy program can be initiated to help develop a drug-free lifestyle. It would be an invaluable aid to medical students doing anesthesia clerkships or junior anesthesia trainees who need a quick review for an emergency case in the middle of the night. The 53 high-yield cases in Anesthesiology will help you excel on the clerkship and improve your shelf-exam score.
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With this system, you will learn in the context of real patients, rather than merely memorize facts. Subsequently, she obtained an M.
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Case Files Anesthesiology (Lange Case Files)
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