Pediatric emergency medicine trisk 1004 1004
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development of breasts and genitalia should be checked. If a history of
galactorrhea is suspected, attempt to express fluid manually from the patient’s
breasts. The completed examination will separate the majority of patients who
have no notable abnormalities from a minority that may point to a specific
medical cause.
Pregnancy
Pregnancy is the first diagnosis to consider when evaluating an adolescent with
one or several missed menstrual periods ( Fig. 51.1 ). Prompt diagnosis and
exclusion of a life-threatening ectopic pregnancy is critical. Referral is then
important; early and regular prenatal care is associated with reduced morbidity
and mortality among pregnant teenagers and their offspring; early diagnosis also
affords the pregnant adolescent time to consider all options including therapeutic
abortion. If the patient is not pregnant, evaluation can proceed at a more
deliberate pace.
