Adolescence Flashcards
Girl with periods from April 2-7 and 23-30. Menstrual cycle length ?
A. 7
B. 14
C. 21
D. 28
C. 21
Count from the first day menstrual period starts until the next menstrual cycle
12 y.o F, menarche, multiple days of heavy bleeding, soaking through multiple pads. No FHx of bleeding disorder. She is now having to change pads every 1 hour. Management ?
A. D & C
B. High dose OCP
C. Some other hormone related thing
D. Tranexamic acid
B. High dose OCP
Teenage girl, previously with heavy use of marijuana. Now incarcerated. What symptom is most likely ?
A. Palpitations
B. Abdominal pain
C. No symptoms
D. Distorted perceptions
B. Abdominal pain
Cannabis withdrawal is manifested by a constellation of signs and symptoms occurring within one week after abrupt reduction or cessation of heavy and prolonged cannabis use, including:
- Irritability
- Anger
- Anxiety
- Depression
- Restlessness
- Sleep difficulty ie; insomnia
- Decreased appetite or weight loss
- Abdominal pain
- Shakiness or tremors
- Sweating
- Fever or chills
- Headache
You are seeing an adolescent transgender female patient. What anticipatory guidance should be discussed ?
A. Sperm banking
B. Eventual pap testing
C. Breast self exam
D. Oocyte preservation
A. Sperm banking
15 y.o F approaches you to start contraception. Which of the following methods do you advise her is the most effective ?
A. Transdermal patch
B. Progesterone containing IUD
C. Combined OCP
D. Progestin only pill
B. Progesterone containing IUD
An 8 year old anxious kid. No issues with body image or fear of gaining weight. He has become more selective with his eating and now only eats chocolate pudding. His weight has decreased from the 50th%ile to the 10th%ile. What is the diagnosis ?
A. Picky eater
B. Avoidant/restrictive food intake disorder
C. Anorexia nervosa
D. Bulimia
B. Avoidant/restrictive food intake disorder
At what age should screening begin with Pap smear ?
A. 21 years
B. 18 years
C. After sexual intercourse
A. 21 years
Adolescent girl with bulimia who smokes 1.5 packs/day wants to quit, and is interested in nicotine replacement. Which of the following is a contraindication ?
A. There is no contraindication
B. That she still smokes a few cigarettes once in a while
C. That she is <18 years old
D. Her eating disorder
A. There is no contraindication
Teen female with type 1 diabetes presents with decreasing weight, falling off the growth curve. Weight was previously at the 50th percentile and now is below the 10th. Doing well in school and gets all A’s in her classes. HbA1C 7.5%. What is the most likely cause ?
A. Eating disorder
B. Diabetic keto acidosis
C. Celiac disease
A. Eating disorder
Teenage boy with acne, currently on topical antibiotic and BP in the AM, and topical retinoids in the PM. No symptomatic improvement. What is your next step in management ?
A. Minocycline
B. Clindamycin
C. Isotretintoin
D. Cefazolin (I think )
A. Minocycline
15 year old girl who has undergone puberty, with a normal exam, who is in your office and shares that she feels that she has always identified more as a boy. She is very distressed by her breast growth and menstruation. Most appropriate plan:
A. Listen attentively and referral for gender dysphoria
B. LH, FSH, estrogen levels
C. Listen attentively and reassure that this is part of normal development
A. Listen attentively and referral for gender dysphoria
A 15 year old otherwise healthy female is sexually active and comes in for an annual health check. According to the Greig health record, which of the following should she get ?
A. Chlamydia, gonorrhea testing
B. Chlamydia, gonorrhea, and HIV testing
C. Chlamydia, gonorrhea, HIV testing and pap smear
B. Chlamydia, gonorrhea and HIV testing
17 year old male with a history of enthesitis related JIA comes to your office. Just had a new baby girl with his girlfriend and would like to quit smoking for her sake. What puts him MOST at risk of not being able to quit?
A. Chronic illness
B. Mae gender
C. Older adolescent
D. Parenthood
A. Chronic illness
What is the most common side effect of marijuana ?
A. Increased insulin secretion
B. Gynecomastia
B. Gynecosmastia
15 year old female with superficial marks on her arms. Admits to cutting behaviours. What would make you reassured ?
A. The cutting makes her feel better
B. She just broke up with her boyfriend
C. There is a family history of depression
D. Smokes marijuana regularly
A. The cutting makes her feel better
All of the others are risk factors for suicide
A 15 year-old female presents to you after her 17 year old partner was treated for gonorrhea. What do you need to do before you provide her with antibiotic treatment:
A. Provide right away
B. Call CAS
C. Call parents for consent
D. Call CAS and call the parents for consent
A. Provide right away
Within 5 years for 15 year old is legal, unless in a position of power
Nelson’s p31
There are public health reasons for allowing adolescents to consent to their own healthcare with regard to reproductive decisions, such as contraception, abortion, and treatment of sexually transmitted infections.
14 year old girl with new onset weight loss and amenorrhea. On exam you find lanugo hair. What is the diagnosis?
A. Addison’s disease
B. Hypothyroidism
C. Turner’s
D. Eating disorder
D. Eating disorder
A 15 year old healthy girl in your practice tells you that she plans to become sexually active soon. When does she need her first pelvic exam and Pap smear ?
A. Now
B. Before she starts OCPs, then every 1-2 years
C. 21 years of age
D. In 3 years then every 1-2 years
C. 21 years of age
Male teen who is a football player. Has gynecomastia, hepatitis, and jaundice. Most likely taking:
A. Anabolic steroids
B. Growth hormone
C. Creatine
A. Anabolic steroids
Anabolic- androgenic steroids - hepatic problems include elevated LFTs and GGT, chileststic jaundice, peliosis, hepatitis and a variety of tumors, including hepatocellular carcinoma
Kid with history of substance abuse. Needs medication for ADHD. What is BEST option ?
A. Vyvanse
B. Methylphenidate IR
C. Guanfacine
D. Ritalin SR
A. Vyvanse - long acting
I think answer is A (we had said C initially) - based on other questions we have had later on. Extended release doesn’t have increase risk of substance use and good treatment of ADHD actually decreases substance use. But you want to use an extended release form to decrease diversion
Amohetamines: Vyvanse, Biphentin, Adderall, Dexedrine
Methylphenidate: Ritalin
A 16 year old girl comes to you for contraception - which of the following would make you choose a progestin only option?
A. Smoking 1/2 pack per day of cigarettes
B. Hypercoagulanle state
B. Hyoercoagulable state
But really only if she had a DVT or PE.
Which of the following would be most likely presentation of chlamydia trachomatis infection in a post-pubertal girl ?
A. Normal vaginal exam
B. Vaginitis
C. Cervicitis
D. Adnexal tenderness
A. Normal vaginal exam
Mostly asymptomatic
Up to 75% of women with chlamydia have no symptoms of infection. C. Trachomatis can cause urethritis (acute urethral syndrome ), epididymitis, cervicitis, salpingitis, proctitis, and PID.
The symptoms of chlamydia genital tract infections are less acute than those of gonorrhea, consisting of a discharge that is usually mucous rather than purulent.
A teenager tells you he enjoys drinking energy drinks. You advise him against this because of the dangerous levels of:
A. Ginseng
B. Sodium chloride
C. Guarana
D. Vitamin B complex
C. Guarana
“Natural caffeine”
Teen girl has acne, sexually active. Want to choose birth control to help improve acne.
A. Depo
B. Combined OCP
C. Progestin only pill
D. Barrier
B. Combined OCP
A. Depo - can worsen acne
C. Progestin only - can worsen acne
D. Barrier - doesn’t do anything for acne
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 - hypoglycaemia with metabolic acidosis, normal pupils
Teen who is having cyclic vomiting and relief only by hot shower. Cause ?
A. Chronic marijuana use
Cannabinoid Hyperemesis syndrome
Essentials for diagnosis
- History of regular cannabis use for years
Major Clinical Features
- severe nausea and vomiting
- vomiting that recurs in a cyclic pattern over months
- resolution of symptoms after stopping cannabis use
Supportive Features
- compulsive hot baths with symptom relief
- colicky abdominal pain
- no evidence of gallbladder or pancreatic inflammation
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
D. Reassure
If it was less than 1 hour after you would give again
Yuzpe method - taking everyday birth control pills in two doses 12h apart
Anorexic, which do you worry most about ?
A. Hypokalemia
B. Metabolic alkalosis
A. Hypokalemia- not necessarily based on a specific resource but hypokalemia can lead to arrhythmia
Hypokalemia - this is most likely to be secondary to vomiting or laxative abuse. It can also occur with refeeding. Oral replacement should be sued initially, however, a potassium value below 2.5mmol/L requires intensive cardiac monitoring and intravenous replacement.
Girl with breast lump ? Most likely diagnosis ?
A. Fibroadenoma
15 year old girl is requesting emergency contraception at 60h after having had unprotected intercourse with her boyfriend. What is the best course of action ?
A. Refer for insertion of copper IUD
B. Yuzpe method
C. Plan B
D. She is too late for EC (within 72h)
C. Plan B
Plan B = progestin only method. = two tablets of 0.75 mg levonorgestrel taken together. Preferred method of EC due to higher efficacy and fewer side effects and more widely accepted than the combined method.
Yuzpe = combined hormonal method; dispensed in the form of multiple birth control pills
A 15 year 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 70bpm and 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- TTC and a small bowel X-ray
B. Consult a dietician and a psychologist
C. Admit for observation
D. Ask her parents to monitor her diet and to reduce her physical activity
D. Ask her parents to monitor her diet and to reduce her physical activity
There would be a very short duration between visits with admission of the next visit she did not gain weight.
A 15 year old girl comes 50 hours after having broken a condom during sexual relations. What do you need to do before giving her the emergency contraception ?
A. Pap test
B. Physical examination
C. Gonorrhea and chlamydia screen
D. Nothing
What to do with a 16 year old who requests emergency contraception?
A. Pregnancy test
B. Pap smear and pelvic exam
C. Chlamydia and gonorrhea screen
D. Nothing
D. Nothing - now you can buy it OTC
A 15 year old girl in your practice tells you that she plans to become sexually active soon. When does she need her first Pap smear ?
A. Now
B. In one year
C. In three years with q yearly follow-up
None of these are right, should start at age 21 is she has been sexually active. If not then 3 years after the first sexual encounter
Teenager (girl) with isolated breast lump. Most common cause ?
A. Fibroadenoma
B. Fibrocystic change
A. Fibroadenoma
What is the likely ECG abnormality found in anorexia nervosa ?
A. Prolonged QT
B. Tachycardia
C. Prolonged QRS
Teenager girl presents with weight loss of 22lbs over the last 4 months. She is amenorrheic. Heart rate is 40 and lanugo hair is seen in exam. Expected ECG finding ?
A. Peaked T waves
B. Prolonged QT
C. Prolonged PR interval
Answer: A and B - prolonged QT
Not very common
ECG findings in an anorexic girl
A. Long QTc
B. Elevated ST segment
C. Peak at wave
A. Long QT
Teenager presents to ED with suicide attempt. Greatest risk for attempting suicide again in a week ?
A. Recent relationship breakup
B. Homosexuality
B. Homosexuality- as per mental health questions. Both of these situations would be a risk but especially for homosexual teens
Kid with Down syndrome. Mense’s are troublesome. Management ?
A. OCP x 84 days
B. Progesterone pill
C. IUD with progesterone
D. Lupron
Mom asks for help with managing menses of a 15 year old Down syndrome girl. What would you recommend ?
A. 84 day OCP
B. Progesterone IUD
C. LHRH antagonist
D. Progesterone only contraceptive
Controversial -
OCP x 84 days vs progesterone IUD - both are reasonable options. But maybe go with safer option of OCP because of risk of general anesthesia if IUD
There is an AAP statement on menstrual management of adolescents with disabilities and they don’t fully commit to what the best option is. They say that progesterone only pill is not the best because the rate of amenorrhea is low and this is usually what we want to achieve. IUD needs to be inserted under general anesthesia so not without risk. And you don’t want to completely stop their puberty so not lupron
Teen with anorexia. Most worrisome clinical feature ?
A. Decrease temperature
B. HR 40
C. Hypokalemia
D. Alkalosis
Bad clinical feature in anorexic A. HR 40 B. Temp 35.4 C. Hypokalemia D. Hyponatremia
C. Hypokalemia
As per consensus and other groups
Very hard to find the answer to this question…there is one line in a peds in review article that says the following but this is for Bulimia….
Adolescents with bulimia may face life- threatening events. Of most concern are electrolyte disturbances (particularly hypokalemia ) and cardiac issues, such as syncope or a prolonged QTc interval
Teen with chlamydia urethritis. You are writing his prescription when he asks you when he should become sexually active again ? You tell him:
A. In 7 days
B. After treatment
C. After his partner receives treatment
D. Until retested and found to be negative
Teenage male treated for chlamydia with azithromycin. When can he resume sexual activity ?
A. Once he has completed his medication
B. Once his partner is treated
C. After seven days after completing treatment
D. Once his symptoms appear to have resolved
Answer: A and C in 7 days but technically also after the partner has been treated if the intercourse will be with that partner…ha ha
Up to date: patients should be counseled to avoid sexual activity until seven days after initiating treatment; they may subsequently resume having sex provided that their symptoms have resolved and their sex partners have been treated
Mom has difficulty managing her daughter’s menses (daughter has trisomy 21). What would you recommend ?
A. OCP - 84 day preparation
B. Depo-provera
C. Norgesterol something -something
A. OCP 84- day preparation
Teenage boy admits to smoking marijuana with friends. What to recommend ?
A. Warn about effects of drug use and discuss ways to reduce risk
B. Don’t hang out with those friends
A. Warn about effects of drug use and discuss ways to reduce risk
Harm reduction strategy
Teenage girl with severe acne thinking about starting systemic isotretinoin. What is the most important topic to discuss?
A. Need to monitor CBC and liver enzymes
B. Need to monitor triglycerides
C. Need for strict birth control
C. Need for strict birth control
AAP article on treatment of acne
Both fasting serum lipids and liver function tests should be obtained at baseline and monitored periodically thereafter. A major adverse effect of isotretinoin and a public health concern is its teratogenic potential. For this reason, the FDA mandated in 2007 the implementation of a computerized risk management program (iPledge) that registers all isotretinoin patients, physicians, pharmacies and manufacturers and ensures monthly monitoring of pregnancy status in females of childbearing potential.
Which of the following is true of adolescence ?
A. Preoccupation with body image occurs in mid adolescence
B. Parental conflict peaks in mid adolescence
C. Development of idealistic career goals in late adolescence
D. Abstract thinking develops in early adolescence
Answer: both B or C (lecturer said B)
A. Preoccupation with body image occurs in mid adolescence - no it’s early adolescence
B. Parental conflict peaks in mid adolescence - yes true
C. Development of idealistic career goals in late adolescence - yes also true
D. Abstract thinking develops in early adolescence- more like mid - to late adolescence
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 god ideal body weight
D. Gain weight to at least 10% ideal weight.
Mother of 15 year old girl with Down syndrome having a hard time dealing with menses. What would you recommend ?
A. 84/7 OCP
B. Depo Provera
C. GnRH agonist
D. Regular OCP
A. 84/7 OCP
Parents of a 15 year old boy suspects he is using drugs. They ask you to obtain a urine sample and “add this test on” after the sample is collected. What do you do ?
A. Refer the boy to psychology
B. Ask for a social work consult
C. Do as the parents ask
D. Ask to speak to the boy
D. Ask to speak to the boy
A female adolescent is diagnosed with gonorrhea on cervical culture. What is the best treatment ?
A. Clarithromycin and Cefixime
B. Cipro and azithro
C. Ceftriaxone
D. Cipro
Answer: none of the above. Older question
Chlamydia =azithromycin 1g PO x 1
Gonorrhea = ceftriaxone 250mg IM x 1 or cefixime 800mg PO x 1 + above. ALWAYS treat for chlamydia if has gonorrhea even if negative chlamydia test.
