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Royal Super 4th Year Brain > Adolescent > Flashcards

Adolescent Flashcards

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1
Q

Age of consent

A

16 years old

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2
Q

x3 close age exceptions to consent

A
  • 14-15 years old = up to 5 years older
  • 12-13 years old = up to 2 years older
  • Not in a position of authority
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3
Q

What class of medications may reduce efficacy of OCP?

A

Anti-epileptics

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4
Q

What supplementation may you add if on Depo-Provera?

A

Calcium and vitamin D for BMD

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5
Q

Treatment for chlamydia STI

A

Doxycycline 100mg PO BID x7 days

Or Azithromycin 1g PO x1 dose

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6
Q

Treatment for gonorrhea STI

A

Ceftriaxone 250mg IM x1

Azithromycin 1g PO x1

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7
Q

PID complications if untreated

A
  • Ectopic pregnancy
  • Chronic pain
  • Infertility
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8
Q

Criteria for PID

A
  • Minimum = lower abdo pain PLUS either: adnexal, uterine, and/or cervical motion tenderness
  • Increased specificity = fever, vaginal discharge, WBC, ESR/CRP, +G/C
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9
Q

Age range for thelarche + how far ahead before menarche

A

8-14 years old

Precedes menarche by 2 years

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10
Q

Dosing schedule for HPV for child > 15 years old?

A

Three doses - now, x1 month, x6 months

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11
Q

Cannabis Withdrawal Syndrome criteria

A

2/5 psychological symptoms = irritable, anxiety, depressed mood, sleep disturbance, appetite change
1/6 physical symptoms = abdo pain, shaking, fever, chills, headache, diaphoresis

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12
Q

Nicotine replacement therapy - contraindication

A

None

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13
Q

Chlamydia trachomatis testing

A

First catch void urine
Vaginal swab
Endocervical/urethral swab

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14
Q

First line treatment for AN

A

Family based therapy

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15
Q

Only FDA approved medication for Bulimia Nervosa

A

Fluoxetine

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16
Q

Most common cause of abnormal uterine bleeding

A

Anovulatory bleeding

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17
Q

Best medications to consider for acute heavy menstrual bleeding

A
  • OCP
  • TXA
  • NSAIDs
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18
Q

For adolescents how much estrogen do you want in an OCP

A

At least 30 mcg

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19
Q

Two most important labs for heavy menstrual bleeding

A

B-HCG

CBC

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20
Q

MOA of contraception

A
  • Progestin = thickens cervical mucus, alter tubal transport time, inhibit ovulation
  • Estrogen = blunt FSH release
  • Endometrial atrophy
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21
Q

Fitz-Hugh-Curtis Syndrome = cause

A
  • Majority caused by Chlamydia, complication of PID
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22
Q

What type of urine sample is preferred for G+C testing?

A
  • First catch preferred over midstream
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23
Q

Most common cause of school absenteeism in females?

A

Dysmenorrhea

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24
Q

Classic definition for primary amenorrhea

A
  • No menses by 14 WITHOUT secondary sex characteristics

- No menses by 16 WITH secondary sex characteristics

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25
Q

First part of work-up for amenorrhea (first 4 steps)

A
  • Urine B-HCG
  • TSH/T4
  • Prolactin
  • Progesterone withdrawal bleed challenge
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26
Q

Complications of PCOS

A
  • Infertility
  • Metabolic syndrome
  • Unopposed estrogen (endometrial cancer, breast cancer)
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27
Q

HPV - clinical manifestations

A
  • Subclinical
  • Anogenital condyloma acuminata (genital warts, HPV 6+11)
  • Cervical dysplasia and cancer (HPV 16+18)
  • Cancer = vulvar, vaginal, oropharyngeal, penile, oral
  • Non-sexually transmitted warts
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28
Q

STI - why increase prevalence among adolescents?

A
  • Less likely to use barrier protection
  • Cervical ectropion (have more columnar epithelium, which is more vulnerable)
  • Cervical metaplasia in transformation zone (also more vulnerable)
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29
Q

Most common adolescent STI

A

HPV

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30
Q

Goal weight gain per week for eating disorders

A

0.2 - 0.5 kg

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31
Q

What information to consider for treatment goal weight?

A
  • Series of accurate anthropometric measurements (ht, wt, BMI)
  • Age, sex, race
  • Pre-morbid exercise and dietary history
  • Age at pubertal onset and current pubertal stage
  • Age at menarche and weight at which menses ceased
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32
Q

Physical complications of dieting

A
  • Growth deceleration
  • Menses irregularity
  • Excess weight gain + over-eating
  • Nutritional deficiencies
  • Bone health
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33
Q

Psych complications of dieting

A
  • Food pre-occupation
  • Irritable
  • Distractible
  • Fatigue
  • MH
  • Eating d/o
  • Worse self-esteem
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34
Q

PID critieria

A
  • Sexually active
  • Pelvic or lower abdo pain
  • Adnexal, cervical motion, and/or uterine tenderness
  • Other: fever, discharge, elevated CRP
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35
Q

PID bugs

A

G+C, mycoplasma, gram negative rods, CMV, gardenella, H.flu

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36
Q

PID outpatient treatment

A
  • x1 CTX IM
  • 14d of doxy
  • 14d of flagyl
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37
Q

PID complications

A
  • Chronic abdo pain
  • Ectopic pregnancy
  • Infertility
  • Recurrence
  • Abscess
  • Fitz-Hugh-Curtis syndrome = perihepatitis, PID+RUQ PAIN
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38
Q

Genital ulcer syndromes

A
  • HSV
  • Syphilis
  • Chancroid
  • Lymphogranuloma venereum
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39
Q

Most sensitive and specific test for G+C?

A

NAAT

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40
Q

What samples can you do NAAT testing for G+C?

A
  • First catch void (or midstream)
  • Vaginal or endocervical
  • Urethral
  • Pharyngeal
  • Anal
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41
Q

What kind of contact do you worry about for hep A?

A

Oral-anal

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42
Q

Indication to test for hep B?

A

No vaccine or low immunity

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43
Q

Indication for testing for hep C?

A

IVDU

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44
Q

Cannabis Use Disorder - definition

A

Problematic pattern of use that leads to clinically significant impairment in areas of function and distress within a 12 month period

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45
Q

Timeframe for Cannabis Withdrawal Syndrome - onset of symptoms, persistence of symptoms

A
  • Onset within 24-72 hours

- Persistent 1-2 weeks

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46
Q

Criteria/symptoms for Cannabis Withdrawal Syndrome

A
  • 1/6 physical sx = abdo pain, headache, fever, chills, diaphoresis, shaking
  • 2/5 psych sx = change in appetite, change in sleep, irritable, anxiety, decreased mood
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47
Q

Other substances commonly used with cannabis

A
  • Alcohol
  • Tobacco
  • Ecstasy
  • Synthetic cannabinoids
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48
Q

Associated mental health complications to cannabis use

A
  • Psychosis
  • Schizophrenia
  • Anxiety
  • Depression
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49
Q

x6 features to explore of suicide risk assessment

A
  • Hx of mental illness
  • Psychosocial support
  • Impulsivity
  • Precipitating factors
  • Previous attempt
  • Family factors
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50
Q

x4 ways to determine Treatment Goal Weight

A
  1. Based on previous growth
  2. Based on mBMI
  3. Based on weight + 2kg prior to menses cessation
  4. Weight at same as heigh percentile
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51
Q

Individual RF’s for dieting

A
  • Women and girls
  • Overweight and obesity
  • Distortion of body image and body dissatisfaction
  • Lower self-esteem
  • Low sense of control over life
  • Psychiatric symptoms - anxiety, depression
  • Vegetarianism
  • Early puberty
  • Certain chronic conditions (DM, asthma, ADHD, epilepsy)
  • Other risky behaviours (smoking, substance use, unprotected sex)
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52
Q

Family RF’s for dieting

A
  • Low family connectedness
  • Absence of positive adult role models
  • Parental dieting
  • Parental endorsement or encouragement to diet
  • Parental criticism of child’s weight
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53
Q

Factors that may make an individual more likely to quit smoking

A
  • Older teenager
  • Male sex
  • Pregnancy/parenthood
  • Scholastic success
  • Team sport participation
  • Peer + family support for cessation
  • CYP2A6 slow nicotine metabolizer
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54
Q

Options for NRT + x1 option that is NOT recommended

A
  • Gum, transdermal patch, lozenge, nasal spray

- E-cig = NO

55
Q

x3 main SE for NRT

A
  • Increased HR + BP

- Mouth/skin irritation

56
Q

x2 meds that could be considered for smoking cessation (+ contraindications of one)

A
  • Bupropion = not for seizure disorders or ED

- Varenicline

57
Q

x2 strongest factors to adolescent initiation of smoking

A
  • Parental smoking

- Parental nicotine dependence

58
Q

x6 chronic illnesses that are mentioned in the CPS statement to have specific consequences of smoking in adolescence

A
  • Asthma
  • CF
  • Sickle Cell
  • Cancer
  • JIA
  • Diabetes
59
Q

Resp complication of vaping

A

Vaping product use-associated lung injury = sterile inflammatory pneumonitis

60
Q

Risks/harms of vaping

A
  • Resp: VALI, chronic cough, asthma exacerbations, decreased exercise tolerance
  • Unintended injuries: burns, driving, ingestions
  • MH: inc of substance use, depression, nicotine toxicity, withdrawal
61
Q

What adolescent development stage: unable to perceive long term outcomes of decision making?

A

Early

62
Q

What adolescent development stage: Self-conscious about appearance + attractiveness?

A

Early

63
Q

What adolescent development stage: increased need for privacy + bid for independence?

A

Early

64
Q

What adolescent development stage: Seeks same sex peer affiliation

A

Early

65
Q

What adolescent development stage: peak of conflict

A

Middle

66
Q

What adolescent development stage: initiation of relationships + sexual activity

A

Middle

67
Q

What adolescent development stage: intense peer group involvement

A

Middle

68
Q

What adolescent development stage: future-orientated + able to think things through independently

A

Late

69
Q

What adolescent development stage: emotional + physical separation from family

A

Late

70
Q

What adolescent development stage: consolidation of sexual identity

A

Late

71
Q

What adolescent development stage: intimacy + commitment takes precedence with peer relationships

A

Late

72
Q

Age for “late adolescence”

A

17-19

73
Q

Age for “middle adolescence”

A

15-16

74
Q

Age for “early adolescence”

A

12-14

75
Q

x4 leading causes of unintentional injury leading to adolescent morbidity/mortality

A
  • MCV
  • Drowning
  • Poisoning
  • Falls
76
Q

Which of the biochemical abnormalities are you most likely to see in setting of binge eating + self-induced vomiting:

  • Urine alkalosis
  • Metabolic acidosis
  • HyperK
  • HypoPO4
A

-Urine alkalosis

77
Q

ARFID Criteria

A

Eating/feeding disturbance associated with failure to meet nutritional needs AND 1 of the following:

  • Weight loss or growth failure
  • Nutritional deficiency
  • Dependence on enteral feeds or liquid nutrition
  • Marked interference with psychosocial functioning
  • No evidence of body image disturbance
  • No medical illness to explain symptoms
78
Q

Criteria for Bulimia nervosa

A
  • Binge eating = eating an excessive amount of food and sense of lack of control during binge episode
  • Recurrent inappropriate compensatory behaviours for binge episode to prevent weight gain (purging, laxative use, fasting, excessive exercise)
  • Episodes occur on average once weekly for 3 months
  • Self-evaluation is unduly influenced by weight/shape
  • Does not meet criteria for AN - of normal or increased body weight
79
Q

Criteria for anorexia nervosa

A

A. Restriction of energy intake relative to requirements –> significantly low body weight for age, sex, developmental trajectory, and physical health

B. Intense fear of gaining weight or becoming fat OR persistent behaviour that interferes with weight gain even though at a significantly low weight

C. Disturbance in the way in which one’s body weight/shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight

80
Q

What is atypical anorexia nervosa?

A

When meets B + C criteria but has not developed significantly low body weight

81
Q

x3 biochemical findings of refeeding syndrome

A

HypoK, hypoPO4, hypoMg

82
Q

x4 risk factors for refeeding syndrome

A
  • Little or no intake x5-10 days prior to refeeding
  • Rapid weight loss
  • Extremely low weight (current weight <70% treatment goal weight)
  • Baseline low PO4, K, and Mg
83
Q

Endocrinology related complications for eating disorders

A
  • Bone loss
  • Sick euthyroid
  • Hypercortisolemia
  • Hypoglycemia
  • Hypothermia
84
Q

GI related complications for eating disorders

A
  • Constipation
  • Reflux
  • Decreased gastric motility
  • Elevated transaminases
85
Q

Heme related complications for eating disorders

A

Anemia > leukopenia > thrombocytopenia

86
Q

Derm related complications for eating disorders

A
  • Xerosis
  • Lanugo
  • Telogen effluvium
  • Carotenoderma
  • Acrocyanosis
  • Livedo reticularis
87
Q

Indications for hospitalization for eating disorders

A
  • Acute food refusal
  • Significantly low weight (<75% below mBMI)
  • VS: bradycardia (<50 day, <45 night), hypotension (<90/45), hypothermia (<35.6), orthostatic changes
  • Acute medical complications: arrhythmia, syncope, seizures, pancreatitis
  • Dehydration + lytes abnormalities
  • Comorbid condition that limits outpatient tx (T1DM, severe depression, SI)
  • Discontinue cycle of binge/purge
  • Failure of outpatient tx
  • Arrest of growth + development
88
Q

What is the new name and what is included within the female athlete triad?

A

=Relative energy deficiency in sport

-Oligo/amenorrhea, low bone mineral density, low energy availability

89
Q

Symptoms/signs of intoxication for (a) nicotine and (b) cannabis?

A

(a) Tachycardia, HTN, appetite suppression

(b) Tachycardia, HTN, increased appetite, conjunctival injection, dry mouth

90
Q

CRAFFT

A
  • Car
  • Relax
  • Alone
  • Forget
  • Family/friends
  • Trouble
91
Q

Definition for abnormal uterine bleeding?

A

Any menstrual bleeding that is out of the normal range for duration, frequency, or amount of bleeding

92
Q

What is the most common cause of non-amenorrhea AUB in adolescent patients?

A

Physiologic adolescent anovulation

93
Q

Why does physiologic adolescent anovulation occur?

A

Progesterone deficiency results in thick + unstable endometrium

94
Q

Causes of non-amenorrhea AUB (x7)

A
  • Physiologic anovulation
  • Pregnancy related (pregnancy, ectopic, loss, molar)
  • Contraception
  • Infection
  • Bleeding disorder
  • PCOS
  • Thyroid dysfunction
95
Q

Investigations for non-amenorrhea AUB

A
  • CBC
  • Ferritin + iron studies

Consider:

  • Pregnancy test
  • Bleeding d/o work-up
  • PCOS w/u: testosterone, DHEA
  • TSH
  • STI screen
96
Q

Tx for non-amenorrhea AUB

A
  • Physiologic cause: no tx needed unless acute bleed

- Hormonal tx, NSAIDs, TXA, iron supplementation

97
Q

Which of the following is an ABSOLUTE contraindication to estrogen for contraception?
A. Mild cirrhosis
B. SLE with unknown antiphospholipid Ab
C. Symptomatic gallbladder disease
D. Uses medication that interferes with estrogen metabolism

A

B

98
Q

MOA of estrogen containing contraception (x4)

A
  • Inhibits ovulation
  • Thick cervical mucous
  • Endometrial atrophy
  • Affects fallopian peristalsis
99
Q

Benefits of contraception (apart from pregnancy prevention)

A

Decreased:

  • Dysmenorrhea
  • Amount of bleeding
  • Acne
  • Hirsutism
  • Risk of endometrial cancer
  • Fibroids + ovarian cysts
  • Benign breast disease
100
Q

Estrogen SE’s

A
  • Irregular bleeding
  • Breast tenderness
  • Nausea
  • Headaches
  • Increased risk of VTE + stroke
101
Q

Absolute contraindications to estrogen (x12)

A
  • <6 weeks post-partum
  • HTN (>160/100)
  • Current or past history of VTE
  • Ischemic heart disease
  • Complex valvular heart disease (SBE, PHTN)
  • History of cerebrovascular accident
  • Migraine with focal neuro symptoms
  • Breast cancer (current)
  • DM with retinopathy, nephropathy, and neuropathy
  • Liver tumor
  • Severe cirrhosis
  • SLE with +/unknown antiphospholipid Ab
102
Q

Relative contraindications to estrogen

A

-Medications that interfere with OCP MOA
-HTN that is adequately controlled or 140-159/90-99)
-Migraine + >35 y/o
-Mild cirrhosis
-Symptomatic gall bladder disease
History of combined hormonal contraception related cirrhosis

103
Q

MOA of levo IUD

A
  • Prevent fertilization

- Increased cervical mucus thickening

104
Q

Contraindications for IUD

A
  • Pregnancy
  • Purulent cervicitis
  • AUB not w/u
  • Abnormal anatomy
  • Pelvic TB
  • Wilson’s disease (with copper IUD)
105
Q

SE’s of IUD

A
  • Bleeding (+ or amenorrhea)
  • Pain/cramping
  • Hormonal (acne, breast tenderness, headaches, mood lability)

Time of insertion:

  • Uterine perforation
  • Expulsion
106
Q

x3 emergency contraception options in order of effectiveness

A
  1. Copper IUD
  2. Ulipristal acetate
  3. Plan B (levonoregestrel)
107
Q

Timeframe when you can use copper IUD for emergency contraception

A

Up to 7 days

108
Q

Timeframe when you can use Ulipristal acetate

A

Up to 5 days

109
Q

Timeframe when you can use Plan B

A

Up to 3 days

110
Q

What emergency contraception options loose efficacy with increasing body weight?

A
  • Ulipristal acetate

- Plan B

111
Q

SE’s of Depoprovera (x5)

A
  • Mood lability
  • Weight gain
  • Decreased bone mineral density
  • Irregular bleeding + amenorrhea
  • Delay in return of fertility
112
Q

Complication of untreated chlamydia in females

A

PID

113
Q

Symptoms/signs in a G+C infection for M+F

A
  • Asymptomatic (60-80%)
  • Penile + vaginal discharge
  • Urethral pruritis/burning
  • Dysuria
  • Pelvic pain
  • Dyspareunia
  • Vaginal bleeding
  • Testicular pain/swelling
114
Q

Tx for chlamydia

A

Azithro 1g PO x1

115
Q

How often should we be screening for G+C?

A

Yearly in sexually active adolescents

116
Q

Reportable + non-reportable STIs

A
  • Reportable: HIV, syphilis, G+C

- Non-reportable: trichomonas, HPV, HSV

117
Q

Complication of untreated gonorrhea infection

A
  • PID
  • Epididymitis
  • Disseminated infection
118
Q

Tx for gonorrhea

A
  • Azithro 1g PO x1

- CTX 250mg IM x1 or cefixime 800mg PO x1

119
Q

Test of cure indications for C+G

A

Chlamydia:

  • Concern for compliance
  • High risk for re-infection
  • Second line therapy
  • Pregnancy

Gonorrhea - all of the above PLUS:

  • Previous tx failure
  • Disseminated
  • Pharyngeal or rectal infection
  • Abx resistance is of concern
120
Q

What infection if yellow/off-white vaginal discharge, strawberry cervix, and dysuria?

A

Trichomonas vaginalis

121
Q

x4 ddx for vaginal discharge

A
  • Physiologic
  • Vulvovaginal candidiasis
  • Bacterial vaginosis
  • Trichomonas
122
Q

Dx for vaginal discharge with clue cells

A

BV

123
Q

What is the dx for vaginal discharge if (a) thin-grey, (b) white + clumpy, and (c) thin green-yellow?

A

(a) BV
(b) Candida
(c) Trich

124
Q

Abx for BV and trich

A

metronidazole

125
Q

What tx modalities would you consider in gender affirming care for (a) early pubertal youth (SMR 2-3) vs (b) late pubertal youth (SMR 4-5)

A

(a) Pubertal suppression with GnRH agonist

(b) Menstrual suppression (GnRH agonist, contraception), gender affirming hormones, gender affirming surgery

126
Q

What is the recommended catch up schedule for >15 years old for HPV vaccination?

A

3 dose schedule - now, 1 month, and 6 months

127
Q

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

A

C - caffeine source

128
Q

If the patient vomits can they retake their emergency contraception?

A

Yes - if within 2 hours of initial dose

129
Q

When should you repeat the pregnancy test following emergency contraception?

A

If no bleeding within 3 weeks following EC

130
Q

How much ethinyl esterase should COC contain as a starting point?

A

30-35mcg of ethinyl esterase

131
Q

The x2 most closest mental health associations with cannabis?

A
  • Depression

- Psychosis

132
Q

What could you combine a nicotine patch with for best pharma management?

A

Short acting nicotine (gums, lozenges) to reduce breakthrough cravings

133
Q

x3 main categories of adverse effects of vaping (as per CPS statement)

A
  • Mental health: depression, suicidality, nicotine toxicity
  • Pulmonary: chronic cough, increased risk of infections, VALI
  • Injuries: MVC, burns, ingestions

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