Adol/Gyne Flashcards
1
Q
- 13 year old girl presents with 2 year history of white vaginal discharge, sometimes itchy and uncomfortable. Onset of menarche at age 12.5 yo. Not sexually active. What is likely diagnosis?
a. Physiological leucorrhea
b. Candida vaginitis
c. Chlamydia cervicitis
d. Gardnerella vaginitis
——————-
13 yr old with menses for 6 months and 18 month hx of intermittent milky vaginal discharge. Occasionally a bit itchy. Not sexually active.
a. Candida
b. Bacterial vaginosis
c. Chlamydia
d. Physiologic leukorrhea
A
Physiological leukorrhea
- Neonates + peripubertal
- White or clear or mucous discharge
- Reassure
- R/O vaginal FB
2
Q
- When can you give contraception after an abortion?
a. Immediately
b. 2 weeks later
c. 1 month later
A
Immediately
- An uncomplicated abortion has no negative consequences on a woman’s future fertility
- Safe and recommended for women who desire contraception to begin the method at the same time the abortion occurs
CPS
Recommends
- 1st tier: IUS (Mirena) or copper IUD
- 2nd tier: OCP, POP, transdermal patch, vaginal ring, injectable contraceptives
- 3rd tier (used at time): condoms, diaphragms, cervical caps, sponges, spermicide
Quick start:
- Do Hx + BP
- Don’t need a pelvic exam, Pap, or STI screening
- Exception is IUDs - preg + STI screening pre-insertion
- Start immediately after menses
- Alternatively, if > 7d after onset of menses, screen for preg and start contraceptives that same day if neg
- 2nd preg test is recommended 21 days later to verify no pregnancy
- Back-up use of condoms are advised for a minimum of 7 days because ovulation may still occur in first several days following initiation of contraception
Provide year long Rx
3
Q
- Girl vomited 90 mins after plan B, what do you do
a) Give Yuzpe
b) Give plan B again in 12 hours
c) Give another dose now
d) Reassure
A
Reassure
Emergency Contraception
- Ideally within 72 hours of unprotected sex but may be effective up to 5 days after for hormonal types and 7 days for copper IUD
- Plan B (progestin only): 2 doses of 750 mcg levonorgestrel taken together
- Yuzpe (combined hormonal): 2 doses of 100mcg EE + 500mcg levonorgestrel taken 2 hours apart
- SE: H/A, fatigue, N, dizziness. Plan B better tolerated
- Adol who vomit >1H after taking a dose do not need to retake those pills b/c absorption likely occurred and N/V likely result of Tx
4
Q
- Teen with anorexia. Most worrisome clinical feature?
a. Decrease temperature
b. HR 40
c. Hypokalemia
d. Metabolic alkalosis
————-
Bad clinical feature in anorexic:
a. HR 40
b. Temp 35.4
c. Hypokalemia
d. Hyponatremia
———————- - The most concerning finding in anorexia nervosa is:
a. neutropenia
b. hypokalemia
c. hypochloremic metabolic alkalosis
d. hypoalbuminemia
——————-
Which of the following laboratory results is very worrisome in an anorexic patient?
a. Hypokalemia
b. WBC <1000
c. Metabolic alkalosis
d. Low protein
A
Hypokalemia
High risk fo assoc’d mortality
5
Q
- What is the likely ECG abnormality found in Anorexia Nervosa?
a. prolonged QT
b. tachycardia
c. prolonged QRS
- —————– - Teenage girl present with weight loss of 22 lbs over the last four months. She is amenorrheic. Heart rate is 40 and lanugo hair is seen on exam. Expected ECG finding:
a. peaked T waves
b. prolonged QT
c. prolonged pr interval
- ———————- - ECG findings in an anorexic girl
a. long QTc
b. elevated ST segment
c. peak T wave
- ————————– - Description of an anorexic teenage girl. What would be the most likely finding on ECG?
a. peaked T waves
b. prolonged QT
c. right axis deviation
d. ST elevation
A
Prolonged QTc
- Sinus brady (physiologic adaptation to starvation)
- junctional escape rhythm
- low QRS voltage
- long QTc
- ST + T wave abN
6
Q
- 15 year old female with anorexia, which feature would be LEAST suggestive of this diagnosis?
a. HR 70 bpm
b. Temperature 34.5C
c. RR 14 bpm
d. BP 95/65
————-
Girl with anorexia. Which vital sign is least likely to be correct (or helpful?) with the diagnosis?
a. HR 70
b. RR 14
c. BP 95/65
d. T 34.5
A
RR 14
Resp irregularities are uncommon and so they would not be helpful
7
Q
- Which of the following helps to decrease osteoporosis in adolescents with anorexia nervosa?
a. oral ca
b. oral vit d
c. oral estrogen
d. increase in body weight to within 10% of IBW
—————-
Prevention of osteoporosis in anorexic?
a. Calcium
b. Vit D
c. Estrogen
d. Gain weight to at least 10% ideal weight
A
Increase BW to within 10% of IBW
- Weight gain and restoration of menstrual cycles can independently improve BMD, and they remain the primary goal
- Still should have adequate Ca + Vit D in diet + supplements
8
Q
- A 15 yr old girl presents with a 6 month history of 8 kg weight loss. She does not have any other symptoms. She is not bothered by the weight loss and has no difficulties with eating. She is doing well in school, participates in gymnastics 5 times per week, is happy and has a good family life. On exam, her HR is 70 bpm and her BP is 100/60. Her BMI is 15 kg/m2. She has a normal physical exam. You request a CSF (colony stimulating factor), electrolytes, urea, creatinine, ferritin and albumin, and they are all normal. What should you do next:
a. Request anti-TTG and a small bowel xray
b. Consult a dietitian and a psychologist
c. Admit for observation
d. Ask her parents to monitor her diet and to reduce her physical activity
A
Ask her parents to monitor her diet and to reduce her physical activity
9
Q
- An adolescent girl with diabetes for the last ten years is seen in diabetes follow up clinic. Her HbA1c is 7.6%. She is a straight A student. She has no complaints. Her weight has dropped from the 25th to the 5th percent. What is the most likely cause of her symptoms?
a. Eating disorder
b. Celiac disease
c. Hypothyroidism
A
Eating disorder
Warning signs
- Extremely high A1C test results
- Frequent bouts of and hospitalizations for poor blood sugar control
- Anxiety about or avoidance of being weighed
- Frequent requests to switch meal-planning approaches
- Frequent severe low BG
- Widely fluctuating BG without obvious reason
- Delay in puberty or sexual maturation or irregular or no menses
- Binging with food or alcohol at least twice a week for 3 months
- Exercise more than is necessary to stay fit
- Severe family stress
10
Q
What is the diagnostic criteria for AN?
A
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (<85% of IBW)
B. Intense fear of gaining weight or becoming fat, even though underweight
C. Disturbance in the way one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
D. In post-menarchal females, amenorrhea
- Restrictive subtype: no binge-eating or purging behaviours (self-induced vomiting, laxatives, diuretics, enemas)
- Binge-Eating/Purging Type: during the current episode of AN, the person has regularly engaged in binge-eating or purging behaviours
11
Q
When to admit for AN?
A
Clinical
- HR <45 or cardiac arrhythmia
- BP <80/50
- Postural hypotension (>10mmHg drop + >20bpm increase)
- Body temp <36C
- <80% healthy body weight
- Dehydration
- Hepatic, cardiac, or renal compromise
Labs
- HypoK
- HypoP
- Hypoglycemia
Psychiatric
- SI + plan
- Very poor motivation to recover
- Preoccupation with ego-syntonic thoughts
- Coexisting psychiatric disorders
- Requires supervision with meals + while using washroom
- Failed day Tx
12
Q
What are the complications of EDs?
A
- Suicide
- Sinus bradycardia, hypotension
- Refeeding syndrome
- Hypothalamic dysfunction (thermoregulation, satiety, sleep, autonomic)
- Amenorrhea
- Osteoporosis
13
Q
What is the goal of Tx?
A
Wt gain of 0.2-0.5kg per week
Nutrition is the priority
14
Q
- Alcohol abuse in adolescent. Why do you worry about most?
a. high risk behaviour when drinking
b. poor school performance
c. depression
d. liver disease
A
high risk behaviour when drinking
15
Q
- 14 year old girl hanging at party with friends then becomes dizzy then not responsive. Pupils equal and reactive, normal reflexes, normal vital signs, temp 35.6? glucose 2.1. Metabolic acidosis. Likely cause?
a) ethanol
A
Ethanol
CPS: 3 prevention approachs
- Discourage the behaviour
- Encourage teen to reduce the behaviour
- Provide teen with information aimed at decreasing harmful consequences of the behaviour when it occurs
