Adol Med, Poisoning, Pharma and Environmental hazards Flashcards
first visible sign of maturity in males
testicular enlargement
- hallmark of SMR 2
in females, this is the first visible sign of puberty
appearance of breast buds (thelarche)
menses in females begins within __ yr of thelarche
three years
this hormone normally stimulates gynecomastia that occurs in many newborn males
Maternal estrogen
incidence of pubertal gynecomastia in males peaks at what tanner stage
Tanner Stage 3-4
normal cycle length
21-35 days (can be 21-45 days during the 1st 3 yr after menarche)
Menarche usually occurs during what SMR stage
4
most common cause of secondary dysmenorrhea
endometriosis
brief severe pain with ovulation which occurs at mid-cycle
Mittelschmerz
role of prostaglandin in dysmenorrhea
stimulates local vasoconstriction, uterine ischemia and pain, smooth muscle contraction
mainstay of treatment of primary dysmenorrhea
NSAIDs
-beginning at or preferably the day before menstruation
most prevalent viral STI
Herpes simplex virus type 2
most commonly identified pathogens in urethritis
Chlamydia trachomatis
Neisseria gonorrhoeae
these 2 symptoms suggest the presence of STI unless proven otherwise in the typical sexually active adolescent male
Dysuria
Urethral discharge
most common organisms associated with genital ulcer syndromes
HSV
Treponema pallidum (syphilis)
HPV types that can cause cervical cancer
HPV Type 16 and 18
treatment of chlamydia trachomatis STI
Azithromycin 1 g OD or Doxycyline 100 mg PO 2x a day for 7 days
treatment of Neisseria gonorrhea
Ceftriaxone 250 mg IM + Azithromycin 1 g PO 1 dose
Treatment of Trichomonas vaginalis STI
Metronidazole 2 g orally x 1 dose
treatment of HSV STI
Treat for 7-10 days with Acyclovir/Valacyclovir/Famciclovir
4 principles of management of poisoned patients
1 Decontamination
2 Enhance elimination
3 Antidotes
4 Supportive care
GI decontamination strategies are most likely effective in how many hours after an acute ingestion?
1 or 2 hours
Even rapid institution of GI decontamination with activated charcoal will at best bind only approximately how many percentage of the ingested substance?
30%
Antidote of Acetaminophen
N-acetylcysteine
Antidote of beta blockers
Glucagon
Antidote of Calcium channel blockers
Insulin
Antidote of Isoniazid (INH)
Pyridoxine
Antidote of Opioids
Naloxone
what are the substances poorly adsorbed by activated charcoal?
alcohols
caustics such as alkalis and acids
cyanide
heavy metals such as lead
hydrocarbons
Iron
Lithium
single acute toxic dose of Acetaminophen
> 200 mg/kg in children
7.5 - 10 g in adolescents and children
if a toxic ingestion is suspected, a serum acetaminophen level should be measured __ hour after the reported time of ingestion
4 hour
golden period of institution of NAC in patients with acetaminophen poisoning
no later than 8 hours from the time of ingestion
Antidote of Salicylates
Sodium bicarbonate
antidotes of organophosphates and carbamates
Atropine and Pralidoxime
most common complication of bite injuries regardless of the species of biting animal
Infection
All ___ wounds are at high risk for infection from animal bites
Hand
Bites from these animals carry a high risk of rabies and PEP is indicated
Bats
Foxes
Skunks
Raccoons
expected blood gas in salicylate poisoning
respiratory alkalosis + elevated anion gap metabolic acidosis
acute toxic dose of salicylates
> 150 mg/kg
Acute liver failure based on king’s college criteria which warrants referral for liver transplant
- acidemia (pH <7.3) after adequate fluid resuscitation
- coagulopathy (INR >6)
- renal dysfunction (creatinine >3.4 mg/dL)
- grade III or IV hepatic encephalopathy
highlight of each stage of adolescence in terms of neurologic/cognitive/moral development
Early: characterized by egocentricity
Middle: considerate of the needs and feelings of other people, sense of immortality and immunity
Late: future oriented and able to delay gratification
gender identity develops at what age
2-3 yr of age
stages of adolescent substance abuse
Stage I: Potential for abuse
Stage II: Experimentation — learning the euphoria
Stage III: Regular use — seeking the euphoria
Stage IV: Regular use — preoccupation with the “high”
Stage V: Burnout — use of drugs to feel normal
Pathophysio of Alkalis and Acids in poisoning
Alkalis produce liquefactive necrosis —> possible perforation
Acids produce coagulative necrosis
Treatment of carbon monoxide poisoning
100% oxygen
most common pathway for lead to enter the body in children
nonnutritive hand-to-mouth activity
excellent choice for empiral oral therapy for human and animal bite wounds (cat/dog)
Amoxicillin-clavulanate
drug of choice for prophylaxis and treatment of rat-inflicted injuries
Penicillin G
alternative: Tetracycline for patients with penicillin-allergy
