Adolescent Flashcards
What is the likely diagnosis for pt with painless, erythematous, rounded ulcer with slightly raised, clean edges and clean base on penis?
Primary Syphilis
tx: IM penicillin 2.4 mil units
What is the most common cause of death in adolescents?
Unintentional injuries (second is suicide)
What is the most likely diagnosis for a teen with vulvar itching, hyperemic and edematous vulva, inflamed cervix with speckled petechial hemorrhages and thing yellowish-green frothy malodorous discharge?
Trichomonas
What are 3 common progesterone related side effects in OCPs?
- oily skin with acne
- noncyclical weight gain
- hirsuitism
What is the cause of dysmenorrhea (severe menstrual cramps)?
buildup of prostaglandins
tx: with NSAIDs 1-2 days prior to prevent buildup
What is the likely diagnosis of teen with fever, chills, generalized malaise, asymmetric polyarthralgias without purulent arthritis and lesions of the skin (painless pustules, or necrotic lesions)?
Tenosynovitis- dermatitis syndrome
due to disseminated N. gonorrhea
what is the best diagnostic test for detecting acute HIV infection?
HIV RNA
CD4 count can remain normal during this time
… sign is described as calluses that form on the knuckles due to the hand continually hitting the teeth at a specific site during self-induced vomiting.
Russell sign
occurs in eating disorders
What diagnostic tool has the greatest yield for identifying the cause of tenosynovitis dermatitis syndrome?
NAAT (nucleic acid amplification test) of endocervical swab
What antimicrobial treatment can decrease effectiveness of OCPs?
Rifampin
What is the metabolic derangement associated with bulimia (purging eating disorders)?
hypokalemic, hypochloremic metabolic alkalosis
low K, low Cl, elevated bicarb
What is the treatment for bacterial vaginosis?
Metronnidazole 500 mg BID for 7 days
What is the cause of a teen with primary amenorrhea found to have normal external genitalia (vulva, labia majora, clitorus), normal hormonal levels and normal breast and pubic hair development?
Mullerian aplaisa
Mayer-Rokitansky-Kuster-Hauser syndrome; MRKH
What is Prehn sign and what diagnosis is it associated with?
elevation of affected scrotum relieves testicular pain; epididymitis
Gram negative coccobacilli in the shape of a school of fish or railroad tracks appearance from a genital lesion with associated tender inguinal lymphadenitis is due to …
Haemophilus ducreyi
Chancroid
What are the EKG changes due to in patients with eating disorder?
hypokalemia (low K)
What is the recommended routine screening timeframe for depression?
Between ages 12-21
What are the 5 components that should be included in a testicular mass workup?
- beta HCG
- alpha feto protein
- LDH
- testicular ultrasound/ MRI
- chest and abdomen CT (to assess for metastasis)
What is the preferred treatment for pelvic inflammatory disease (PID)?
ceftriaxone 250 mg IM x 1 plus doxycycline 100 mg BID for 14 days
(can use azithromycin 1 g weekly x 2 weeks as alternative of doxy)
What is the diagnosis of nontender papules on genitals associated with unilateral inguinal/ femoral lymphadenopathy in patient from tropical location?
Lymphogranuloma venerem (LGV)
due to Chlamydia trachomatis
On average, how long after the first sign of puberty (thelarche) does menstruation start?
24-30 months
2-2.5 years
What makes up the triad of consequential outcomes in a female athlete?
- amenorrhea
- osteoporosis
- eating disorder
What is the most likely diagnosis for teen from Caribbean (of Africa) with genital ulcer or subcutaneous ulcer whose wright stain shows rod shaped, oval organism within cytoplasm of mononuclear phagocytes?
Klebisella granulomatosis
Donovan bodies
What is the most likely diagnosis for female with severe pain with sitting or walking that is worsen with sexual activity and has a mass at the 4 or 8 o’clock position of introitus?
Bartholin gland abscess
What is the timeframe for test of cure (TOC) for chlamydia should be done?
3 months
What is the most likely diagnosis for teen with punctate petechial lesions on vaginal wall and cervix?
Trichomoniasis
Strawberry cervix
What is the best treatment for uncomplicated gonococcal genital infection?
Ceftriaxone 250 mg IM plus azithromycin 1 g PO
What is the most common cause of abnormal uterine bleeding in a teen during initial 1-2 years of menarche?
anovulatory cycle (due to absence of LH mid-surge and absence of functional corpus luteum)
What is the most likely diagnosis for teen with PID symptoms along with severe RUQ pain that radiates to right shoulder and normal LFTs?
Fitz-Hugh- Curtis syndrome
inflammation of hepatic capsule- extrapelvic manifestation of PID
What is the most likely diagnosis for a homeless/ sexually active pt who presents with numerous pale bluish 0.5-1 cm macules on lower abdomen, proximal thigh and buttocks?
Pediculosis (pubic lice)
What is the abnormal HPA result of pt having female athlete triad?
loss of pulsatile GnRH and low FSH and LH
What causes the respiratory depression and cardiac failure in eating disorder patients during treatment?
Hypophosphatemia (low phos) in refeeding syndrome
What is the cause of a late systolic murmur heard best at apex preceded by click in anorexic patient?
mitral valve prolapse
For which chronic disease, should a patient avoid using combined OCPs?
Liver disease
estrogen processed by liver
What is the treatment for LGV (lymphogranuloma venerem)?
Doxycycline 100 mg BID for 3 weeks
due to Chlamydia
What is the sign of delayed puberty in boys?
Lack of testicular enlargement by 14 years old
A male pt with sudden severe testicular pain, high riding testicle in horizontal plain and no cremasteric reflex most likely suffers from…
Testicular torsion
A female pt presenting with secondary amenorrhea after endometritis most likely suffers from ….
Asherman Syndrome (avascular intrauterine adhesions and fibrosis)
What is the diagnostic test of choice for detecting Asherman syndrome?
hysteroscopy
What is a possible long term side effect of Depo (injectable progestin only contraceptive) other than decreased bone mineral density?
delayed return to fertility
up to 18 months
What is the gram stain appearance for Neisseria gonorrhea?
gram negative intracellular diplococci
What is the treatment for trichomoniasis?
Metronidazole
What is the peak height velocity for girls and boys respectively?
girls- 11.5 years old
boys- 13.5 years old
What is the first line treatment for premenstrual dysphoric disorder (PMD- causes significant impairment)?
SSRIs
Why is there higher incidence of HPV infection in sexually active adolescents compared to young adults?
Metaplasia within the cervical transformation zone (is higher in adolescents and complete in young adults)
What population of female patients should have PAP smear before the age of 21?
HIV positive
every 6 months for first year of diagnosis and then annually
What is the immediate treatment for abnormal uterine bleeding?
combined monophasic estrogen and progesterone oral contraceptive
(then treat resulting anemia)
What is the purpose of the progesterone challenge?
to assess whether there is adequate estrogen effect on uterine lining
When can an involuntary drug test be administered to an adolescent? (3)
- emergency (car accident)
- attempted suicide
- unexplained seizure
