Adolescent Flashcards
Age of consent
16 years old
x3 close age exceptions to consent
- 14-15 years old = up to 5 years older
- 12-13 years old = up to 2 years older
- Not in a position of authority
What class of medications may reduce efficacy of OCP?
Anti-epileptics
What supplementation may you add if on Depo-Provera?
Calcium and vitamin D for BMD
Treatment for chlamydia STI
Doxycycline 100mg PO BID x7 days
Or Azithromycin 1g PO x1 dose
Treatment for gonorrhea STI
Ceftriaxone 250mg IM x1
Azithromycin 1g PO x1
PID complications if untreated
- Ectopic pregnancy
- Chronic pain
- Infertility
Criteria for PID
- Minimum = lower abdo pain PLUS either: adnexal, uterine, and/or cervical motion tenderness
- Increased specificity = fever, vaginal discharge, WBC, ESR/CRP, +G/C
Age range for thelarche + how far ahead before menarche
8-14 years old
Precedes menarche by 2 years
Dosing schedule for HPV for child > 15 years old?
Three doses - now, x1 month, x6 months
Cannabis Withdrawal Syndrome criteria
2/5 psychological symptoms = irritable, anxiety, depressed mood, sleep disturbance, appetite change
1/6 physical symptoms = abdo pain, shaking, fever, chills, headache, diaphoresis
Nicotine replacement therapy - contraindication
None
Chlamydia trachomatis testing
First catch void urine
Vaginal swab
Endocervical/urethral swab
First line treatment for AN
Family based therapy
Only FDA approved medication for Bulimia Nervosa
Fluoxetine
Most common cause of abnormal uterine bleeding
Anovulatory bleeding
Best medications to consider for acute heavy menstrual bleeding
- OCP
- TXA
- NSAIDs
For adolescents how much estrogen do you want in an OCP
At least 30 mcg
Two most important labs for heavy menstrual bleeding
B-HCG
CBC
MOA of contraception
- Progestin = thickens cervical mucus, alter tubal transport time, inhibit ovulation
- Estrogen = blunt FSH release
- Endometrial atrophy
Fitz-Hugh-Curtis Syndrome = cause
- Majority caused by Chlamydia, complication of PID
What type of urine sample is preferred for G+C testing?
- First catch preferred over midstream
Most common cause of school absenteeism in females?
Dysmenorrhea
Classic definition for primary amenorrhea
- No menses by 14 WITHOUT secondary sex characteristics
- No menses by 16 WITH secondary sex characteristics
First part of work-up for amenorrhea (first 4 steps)
- Urine B-HCG
- TSH/T4
- Prolactin
- Progesterone withdrawal bleed challenge
Complications of PCOS
- Infertility
- Metabolic syndrome
- Unopposed estrogen (endometrial cancer, breast cancer)
HPV - clinical manifestations
- 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
STI - why increase prevalence among adolescents?
- Less likely to use barrier protection
- Cervical ectropion (have more columnar epithelium, which is more vulnerable)
- Cervical metaplasia in transformation zone (also more vulnerable)
Most common adolescent STI
HPV
Goal weight gain per week for eating disorders
0.2 - 0.5 kg
What information to consider for treatment goal weight?
- 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
Physical complications of dieting
- Growth deceleration
- Menses irregularity
- Excess weight gain + over-eating
- Nutritional deficiencies
- Bone health
Psych complications of dieting
- Food pre-occupation
- Irritable
- Distractible
- Fatigue
- MH
- Eating d/o
- Worse self-esteem
PID critieria
- Sexually active
- Pelvic or lower abdo pain
- Adnexal, cervical motion, and/or uterine tenderness
- Other: fever, discharge, elevated CRP
PID bugs
G+C, mycoplasma, gram negative rods, CMV, gardenella, H.flu
PID outpatient treatment
- x1 CTX IM
- 14d of doxy
- 14d of flagyl
PID complications
- Chronic abdo pain
- Ectopic pregnancy
- Infertility
- Recurrence
- Abscess
- Fitz-Hugh-Curtis syndrome = perihepatitis, PID+RUQ PAIN
Genital ulcer syndromes
- HSV
- Syphilis
- Chancroid
- Lymphogranuloma venereum
Most sensitive and specific test for G+C?
NAAT
What samples can you do NAAT testing for G+C?
- First catch void (or midstream)
- Vaginal or endocervical
- Urethral
- Pharyngeal
- Anal
What kind of contact do you worry about for hep A?
Oral-anal
Indication to test for hep B?
No vaccine or low immunity
Indication for testing for hep C?
IVDU
Cannabis Use Disorder - definition
Problematic pattern of use that leads to clinically significant impairment in areas of function and distress within a 12 month period
Timeframe for Cannabis Withdrawal Syndrome - onset of symptoms, persistence of symptoms
- Onset within 24-72 hours
- Persistent 1-2 weeks
Criteria/symptoms for Cannabis Withdrawal Syndrome
- 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
Other substances commonly used with cannabis
- Alcohol
- Tobacco
- Ecstasy
- Synthetic cannabinoids
Associated mental health complications to cannabis use
- Psychosis
- Schizophrenia
- Anxiety
- Depression
x6 features to explore of suicide risk assessment
- Hx of mental illness
- Psychosocial support
- Impulsivity
- Precipitating factors
- Previous attempt
- Family factors
x4 ways to determine Treatment Goal Weight
- Based on previous growth
- Based on mBMI
- Based on weight + 2kg prior to menses cessation
- Weight at same as heigh percentile
Individual RF’s for dieting
- 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)
Family RF’s for dieting
- Low family connectedness
- Absence of positive adult role models
- Parental dieting
- Parental endorsement or encouragement to diet
- Parental criticism of child’s weight
Factors that may make an individual more likely to quit smoking
- Older teenager
- Male sex
- Pregnancy/parenthood
- Scholastic success
- Team sport participation
- Peer + family support for cessation
- CYP2A6 slow nicotine metabolizer