Adolescent Flashcards
When is menarche expected to occur
Within 2-3 years of thelarche
WHen breast are sexual maturity rating of 3-4
BMI > ___ is associated with earlier menarche
85%
Is linear growth spurt and peak height velocity before or after menarche?
BEFORE
High levels of estrogen promote epiphyseal closure (only 4-6 cm after menarche)
Vaginal discharge in young girl prior that has not had menarche. What is it called and when will she expect to have menarche?
physiologic leukorrhea
6-12 mo to menarche
Prepubertal vaginal pH vs. menarche
neutral (prepubertal) to acidic (<4.5)
Sequence of sexual maturation in girls
Breast budding (gonadarche) – estrogen from ovaries
then pubic hair growth, pubarche (adrenarche) – rise in adrenal androgens
Then height, then menarche
How long does pubertal development typically last
4 years from onset
Girl that has not had menses comes to office, sexual maturity rating 4. When will she have her menarche?
any day soon
When should HIV testing be done
Once between 13-18yo, and for all sexually active adolescents.
Chlamydia and gonorrhea screening guideline
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
STI prophylaxis for assault (5)
- Tx chlamydia, gonorrhea, trichomoniasis
- Hep B vacc for unvaccinated
- HPV vacc for unvaccinated
- Assess HIV risk, PEP within 72h of assault
- Emergency contraception to all women
In PREP, “risky behavior” is driven by
the pursuit of pleasure or excitement
Boys testicular growth
Increase size of testicle
Then increase in pubic hair + axillary
then growth spurt
then spermarche (like menarche) (SMR 3-4)
Completion of puberty in boys takes __ years
3
When is physiologic gynecomastia common in boys?
SMR G3
Less than 4 cm diameter of palpable breast tissue
Definition of delayed puberty in boys
How do you work it up
Failure of testicular enlargement to achieve SMR 2 by age 14
Karyotype, FSH, LH level
Testicular size and SMR stage
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
Precocious Puberty in boys, definition
Penile growth +/- testicular enlargement before age 9
Precocious Puberty in girls, definition
Menarche or breast enlargement <8 yo, over 4-6 mo with upward crossing of height percentiles
Presence of pubic hair in infancy
First step in management after diagnosing anorexia nervosa. What are other options?
Family based therapy
CBT, DBT
Medication that is approved for bulimia, not for anorexia
fluoxetine
Criteria for hospital admission in anorexia
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
Treatment for PID
CTX 500 IM, doxy 100 bid, metronidazole 500 bid
OR
Cefoxitin 2g IM, probenecid 1g (concurrent), doxy bid, metronidazone bid
Treatment for PID
CTX 500 IM, doxy 100 bid, metronidazole 500 bid
OR
Cefoxitin 2g IM, probenecid 1g (concurrent), doxy bid, metronidazone bid
Boys with relative early maturation have___ ___ height velocity
greater peak height velocity
usually end up shorter than expected
Muscle strength lags behind peak height velocity
Signs of initiation of puberty in boys
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)
Signs of initiation of puberty in girls
breast budding/thelarche
peak height velovity 8.3 cm/year (range 5-10)
Next step in management of dyspareunia
pelvic exam
most important thing to rule out in abnormal uterine bleeding is
pregnancy
Causes of AUB
PALM COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
Coagulopathy
Ovulatory dysfx
Endometrial
Iatrogenic
Not yet classified
What can elevate von willebrand levels iatrogenically?
meds containing estrogen (for 1 week)
Workup of delayed puberty in girls
No breast development by 13 yo
karyotype
Workup of delayed puberty in girls
No breast development by 13 yo
karyotype, LH, FSH, TSH, bone age
What is a concerning sign of underlying medical condition in delayed puberty?
Arrest/deviation in height
What is a concerning sign of underlying medical condition in delayed puberty?
Arrest/deviation in height
Most common breats mass in adolescence
fibroadenoma
Serum test for PCOS
testosterone (hyperandrogenism)
According to individuals with disabilities education act (IDEA), can parents’ input be incorporated to education?
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.
Primary dysmenorrhea vs. Mittelschmerz
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
If a child who meets admission criteria for anorexia/bulemia does not consent, what should you do next?
tell parents that they can consent for the child because they are minor and this is a life threatening condition
