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Pediatrics > Adolescent > Flashcards

Adolescent Flashcards

1
Q

When is menarche expected to occur

A

Within 2-3 years of thelarche
WHen breast are sexual maturity rating of 3-4

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2
Q

BMI > ___ is associated with earlier menarche

A

85%

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3
Q

Is linear growth spurt and peak height velocity before or after menarche?

A

BEFORE

High levels of estrogen promote epiphyseal closure (only 4-6 cm after menarche)

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4
Q

Vaginal discharge in young girl prior that has not had menarche. What is it called and when will she expect to have menarche?

A

physiologic leukorrhea
6-12 mo to menarche

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5
Q

Prepubertal vaginal pH vs. menarche

A

neutral (prepubertal) to acidic (<4.5)

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6
Q

Sequence of sexual maturation in girls

A

Breast budding (gonadarche) – estrogen from ovaries
then pubic hair growth, pubarche (adrenarche) – rise in adrenal androgens

Then height, then menarche

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7
Q

How long does pubertal development typically last

A

4 years from onset

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8
Q

Girl that has not had menses comes to office, sexual maturity rating 4. When will she have her menarche?

A

any day soon

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9
Q

When should HIV testing be done

A

Once between 13-18yo, and for all sexually active adolescents.

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10
Q

Chlamydia and gonorrhea screening guideline

A

Annually with NAAT from vaginal swab (preferred) or urine sample

Repeat if there is new sexual partner and 3 mo after tx of chlamydial infection

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11
Q

STI prophylaxis for assault (5)

A
  1. Tx chlamydia, gonorrhea, trichomoniasis
  2. Hep B vacc for unvaccinated
  3. HPV vacc for unvaccinated
  4. Assess HIV risk, PEP within 72h of assault
  5. Emergency contraception to all women
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12
Q

In PREP, “risky behavior” is driven by

A

the pursuit of pleasure or excitement

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13
Q

Boys testicular growth

A

Increase size of testicle
Then increase in pubic hair + axillary
then growth spurt
then spermarche (like menarche) (SMR 3-4)

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14
Q

Completion of puberty in boys takes __ years

A

3

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15
Q

When is physiologic gynecomastia common in boys?

A

SMR G3
Less than 4 cm diameter of palpable breast tissue

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16
Q

Definition of delayed puberty in boys
How do you work it up

A

Failure of testicular enlargement to achieve SMR 2 by age 14

Karyotype, FSH, LH level

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17
Q

Testicular size and SMR stage

A

I (<3 ml)
II Change in scrotal skin, (4-6ml)
III increase length of penis
IV enlargement of penis with development of GLANS, 9-10, then 11-16
Adult 18-25ml

18
Q

Precocious Puberty in boys, definition

A

Penile growth +/- testicular enlargement before age 9

19
Q

Precocious Puberty in girls, definition

A

Menarche or breast enlargement <8 yo, over 4-6 mo with upward crossing of height percentiles

Presence of pubic hair in infancy

20
Q

First step in management after diagnosing anorexia nervosa. What are other options?

A

Family based therapy

CBT, DBT

21
Q

Medication that is approved for bulimia, not for anorexia

A

fluoxetine

22
Q

Criteria for hospital admission in anorexia

A

HR <50 awake, <45 asleep
SBP <90
Temp <35.6C
Prolonged QTc or other arrhythmia
Orthostatic changes in BP >10 mmHg
Orthostatic changes in P >20 bpm
syncope
electrolyte abnormalities
Esophageal tears/hematemesis
Intractable emesis
Suicide risk
Weight <75% of expected body weight or body fat 10%
Ongoing wt loss despite intensive management
Acute wt loss and food refusal
Failure to respond to outpatient tx

23
Q

Treatment for PID

A

CTX 500 IM, doxy 100 bid, metronidazole 500 bid

OR

Cefoxitin 2g IM, probenecid 1g (concurrent), doxy bid, metronidazone bid

23
Q

Treatment for PID

A

CTX 500 IM, doxy 100 bid, metronidazole 500 bid

OR

Cefoxitin 2g IM, probenecid 1g (concurrent), doxy bid, metronidazone bid

24
Q

Boys with relative early maturation have___ ___ height velocity

A

greater peak height velocity

usually end up shorter than expected
Muscle strength lags behind peak height velocity

25
Q

Signs of initiation of puberty in boys

A

testicle 4ml or more
Increased length of 2.5 cm or more in a year

Average Peak height velocity is 9.5 cm/year (6-12 range)

26
Q

Signs of initiation of puberty in girls

A

breast budding/thelarche
peak height velovity 8.3 cm/year (range 5-10)

27
Q

Next step in management of dyspareunia

A

pelvic exam

28
Q

most important thing to rule out in abnormal uterine bleeding is

A

pregnancy

29
Q

Causes of AUB

A

PALM COEIN

Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia

Coagulopathy
Ovulatory dysfx
Endometrial
Iatrogenic
Not yet classified

30
Q

What can elevate von willebrand levels iatrogenically?

A

meds containing estrogen (for 1 week)

31
Q

Workup of delayed puberty in girls

A

No breast development by 13 yo

karyotype

32
Q

Workup of delayed puberty in girls

A

No breast development by 13 yo

karyotype, LH, FSH, TSH, bone age

33
Q

What is a concerning sign of underlying medical condition in delayed puberty?

A

Arrest/deviation in height

34
Q

What is a concerning sign of underlying medical condition in delayed puberty?

A

Arrest/deviation in height

35
Q

Most common breats mass in adolescence

A

fibroadenoma

36
Q

Serum test for PCOS

A

testosterone (hyperandrogenism)

37
Q

According to individuals with disabilities education act (IDEA), can parents’ input be incorporated to education?

A

yes, but only in regards to goals, objectives and service needs.

Does not require school to place child in specific program or guarantee specific program desired by the parent.

38
Q

Primary dysmenorrhea vs. Mittelschmerz

A

PD: cramps begin 1-3 years after menarche, worse in the first few days, n/v/d lower back cramping

Mittelschmerz: during ovulation, not menses

39
Q

If a child who meets admission criteria for anorexia/bulemia does not consent, what should you do next?

A

tell parents that they can consent for the child because they are minor and this is a life threatening condition

Pediatrics (26 decks)

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