A 16-year-old girl is brought to the office for a routine health maintenance examination. She feels well and has no concerns. The patient is an honor student in tenth grade and plays varsity soccer. She eats a well-balanced diet. Depression screening is negative. The patient has tried marijuana "a few times" but does not use tobacco or alcohol. She has been sexually active with one partner for the past 2 years and takes an oral contraceptive daily. The patient's parents have type 2 diabetes mellitus but are otherwise healthy. Her maternal grandfather died of a myocardial infarction at age 68. BMI is 24 kg/m². Vital signs and physical examination are normal. Which of the following is the best next step in evaluation of this patient?

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11ec25c8_d291_cd09_bc81_2d02abbd7eba_MD0003_00 Routine screening tests identify patients with common and treatable diseases. Chlamydia trachomatis and Neisseria gonorrhoeae cause the most common bacterial sexually transmitted infections (STIs) in young adults but are often asymptomatic, particularly in young women. Both STIs can cause cervicitis, which if undetected and left untreated, can lead to pelvic inflammatory disease with its associated complications (eg, infertility, ectopic pregnancy, chronic pelvic pain) and increase the likelihood of HIV transmission. For these reasons, annual screening for chlamydia and gonorrhea is recommended in sexually active women age <25, as well as those with other risk factors (eg, multiple sexual partners, illicit drug use). Patients who test positive should receive antibiotics immediately and refrain from sexual intercourse until treatment is complete. All sexual partners from the preceding 2 months should also be tested and treated. (Choice B) Electrocardiographic screening in asymptomatic children may be indicated if there is a significant family history of premature cardiac death (ie, at age <50). Routine screening in children is not recommended due to the risk of false-positive results and low incidence. (Choice C) Routine lipid screening in children and young adults is performed at ages 9-11 and 17-21 because lipid levels are relatively stable just before and after puberty. This patient is age 16. (Choice D) Although this patient's parents both have type 2 diabetes mellitus, routine screening for this condition is not indicated in children without other risk factors (eg, obesity). (Choice E) Urine toxicology can detect marijuana if it is used within a few days of testing. However, this adolescent, who openly admits to prior experimentation, is more likely to benefit from counseling on the risks of regular drug use (eg, unintentional injury, abuse, dependence) than undergoing drug testing. Educational objective: Sexually active women age <25 are at increased risk of sexually transmitted infections and require annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae. References: USPSTF recommendations for STI screening. (http://www.ncbi.nlm.nih.gov/pubmed/18386598) Results of random drug testing in an adolescent substance abuse program. (http://www.ncbi.nlm.nih.gov/pubmed/17403828)

A 16-Year-Old Girl Is Brought to the Office for a Routine