Is the young man's height and weight normal for his developmental stage? What about his pubertal development? The comprehensive should answer these and other questions--opening the door to further investigation when needed.
As in any patient, the comprehensive physical exam in the adolescent male begins with an evaluation of vital signs. It then moves on to assessment of height, weight, and pubertal development. Although most male teenagers who are short for their age are physically normal, short stature can also be caused by bone defects, systemic illness, and hormonal deficiency. Tall stature also is usually normal, but can be associated with a syndrome or hormonal abnormality. Identifying overweight is important, and precocious or delayed puberty merits careful evaluation because these conditions may, like being extremely short or tall, indicate pathology or another abnormality
This article reviews elements of the male physical exam and normal and abnormal pubertal findings. The first part of this series, "Making the most of the adolescent male health visit Part 1: History and anticipatory guidance," May 2006, is available at www.contemporary pediatrics.com.
Begin with the basics
Before starting the examination, ask the adolescent to change into a gown while you step out of the room, or pull a curtain to provide privacy Avoid getting into a lengthy discussion while he is changing or in a gown. Instead, review with the patient what to expect during the exam before he changes and comment as the exam progresses about what you find or do not find. The use of gloves are a standard of care when needed for universal precautions, but also symbolizes professional integrity during the genital exam.
Begin the physical examination by reviewing the patient's vital signs, including pulse, respiratory rate, temperature, and blood pressure. Abnormal vital signs can provide initial clues to an underlying problem. A low temperature or bradycardia, for example, may suggest an eating disorder, while tachycardia can be a sign of thyroid disease or drug use. An abnormal respiratory rate can indicate poorly controlled asthma, and high blood pressure may signal essential hypertension, which is most common among older adolescent males. The younger the hypertensive male, the more likely he is to be diagnosed with secondary hypertension, most commonly renovascular. If the patient has high blood pressure, take ambulatory blood pressure readings and follow up in subsequent appointments. Refer to tables of appropriate blood pressure levels by gender, age, and height. (1) Keep in mind that unrecognized and silent hypertension and subsequent stroke is one of the leading causes of mortality among adult men in the United States, especially in African Americans.
Measure weight and height and plot them on a current growth chart (available at www.cdc.gov/growthcharts). (2) Also calculate body mass index (BMI)--now considered a routine fifth vital sign--and plot it. (3) (A BMI calculator is available at www.cdc.gov/nccdphp/dnpa/bmi/ calc-bmi.htm.)
Male adolescents are interested in how fast they are growing and want to know their final adult height. Discussing their expectations is a great way to connect with your patient, especially...