ADOLESCENT Flashcards by Bao Truong

Vulvar itching - with hyperemic and edematous vulva and thin, yellowish-green, frothy, malodorous discharge and punctate hemorrhages on the vagina / cervix. No cervical motion or adnexal tenderness

What is the condition? Treatment

Trhichomonas vaginalis

Flagyl x 7 days

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What are the criteria for diagnosis of bacterial vaginosis (BV)? (3 out of 4 criteria)

Treatment?

1 - Clue cells
2 - Vaginal pH > 4.5
3 - “Fishy” odor precedes or follows addition of KOH to vaginal discharge
4 -Grayish-white, milky vaginal discharge

Treatment = Flagyl x 7 days

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What bacterial vaginosis and vaginal trichomoniasis have in common ? (2)

What differentiates them?

Common: (1) elevated vaginal pH; (2) positive KOH test

Vaginal trichomoniasis presents with **intense inflammation of vaginal walls, punctate hemorrhages on vagina / cervix (“strawberry cervix”)

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Painless cyst-like nodule around the testicle that transilluminates

What is it ?

Spermatocele

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What is the recommendation to start Pap smear in asymptomatic, immunocompetent women?

Start at 21 years of age, regardless of age of sexual activity initiation

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What is the recommendation to start Pap smear in HIV-positive patient?

Starting within 1 year of onset of sexual activity

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Criteria for delayed puberty in males

SMR Stage 1 persists beyond 14 years
SMR Stage 2 persist > 2.5 years
SMR Stage 3 persist > 1.5 years
SMR Stage 4 persist > 2 years

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Medications that can cause gynecomastia (1)

1 - Steroids
2 - Cimetidine
3 - TCA
4 - Calcium channel blockers
5 - ACEIs
6 - Spironolactone
7 - Ketoconazole
8 - INH
9 - HIV anvirirals
10 - Opioids

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Male with dysuria, urinary frequency, mucopurulent urethral discharge

What is the STD? Treatment?

Gonoccoccal urethritis

IM Ceftriaxone 500mg (or cefixime) + PO Doxycycline (for Chlamydia) x 7d

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Smooth, skin-colored, well-circumscribed papules on the shaft of penis

What is the finding? Cause?

Genital warts

Human papillomavirus

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Small, grouped, painful vesicles on an erythematous base on the shaft of penis

What is the finding? Cause?

Hepertic lesions

HSV

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Indurated, punched-out, painless ulcer with slight elevated margins on the foreskin

What is the finding? Cause?

Chancre in syphillis

(Treponema pallidum)

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Painful, inflammed, shallow ulcer associated with grayish, fibrinous membrane and ragged, undermined border on the foreskin

What is the finding? Cause?

Bubo in Chancroid

Haemophilus ducreyi

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Gram stain of a penile lesion.

What is the organism? What is the disease? Treatment?

Haemophilus ducreyi

Chancroid
Azithromycin OR IM ceftriaxone

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Most common cause of abnormal uterine bleeding in adolescents (AUB)

Anovulatory cycles

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Tendon pain / inflammation, painless vesiculopustular lesion on skin, joint pain

What is the condition called? Organism?

Arthritis-dermatitis syndrome
(1 of 2 types of disseminated N.gonnorhea)

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ST depression, flat T wave, promient “U” wave on ECG

What is going on?

Hypokalemia

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Male with small, painless, shallow papules on penis which then disappears, then 2-3 weeks later has lymphadenopathy in groin.

What is the infection?

Chlamydia trachomatis

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Pathophysiology of athletic amennorhoea?

Loss of pulsatic GnRH -> low LH, FSH -> low estrogen

Patient on combined oral contraceptive has acne.

What to try first?

Switch to high-estrogenic low-androgenic OCP

Gram-negative intracellular diplococci

What is the organism?

N.gonorrhea

Clue cells seen on smear

What is the diagnosis?

Bacterial vaginosis

Most common cause of secondary amennorhoea?

Pregnancy

Treatment of primary syphillis

Single IM benzathine penicillin G 2.4 million units

Common electrolyte abnormalities caused by refeeding syndrome (3)

Hypokalemia Hypomagnesemia Hypophosphatemia

Exfoliation of outermost laysers of the skin with slight rubbing, forming a blister within minutes What is the sign? What are 2 associated conditions?

Nikolsky signs Associated with 1 - Staph scalded skin syndrome (SSSS) 2 - Pemphigus vulgaris

Calluses form on knuckles, in a teenage patient. What is the sign? What is the underlying problem?

Russell sign Bulimia nervosa

Pink or red transverse lines in skin creases (elbow, wrist, inguinal region) What is the sign? What is the associated condition?

Pastia sign Associated with the pre-eruptive stage of **scarlet fever**

First sign of puberty in male

Enlargement of testes

Treatment of uncomplicated gonococcal infections

Ceftriaxone 500mg IM x 1

What is the test of choice for diagnosing HIV infections? What is the exception, and what to use in that exception?

Test of choice = **HIV p24 antigen and HIV antibody** Exception = acute HIV infection (decreased test sensitivity during this window) -> use HIV viral RNA test instead

Medications that may decrease effectiveness of oral contraceptives (2 types)

1 - Antiseizure medications (via increase CYP450 activity) 2 - Rifampin

Average time of onset menarche following onset of puberty

2-2.5 years

Specific indications for hospitalization in adolescent with anorexia (10)

1 - Weight < 75% 2 - HR < 50 bmp (<45 at night) 3 - Orthostatic increase in pulse > 20 bpm 4 - SBP < 90 or Orthostatic decrease in BP (sys > 20, dias > 10) 5 - Temp < 96F (35.5C) 6 - Refusal to eat 7 - Uncontrollable binging / purging 8 - Acute medical complications 9 - Acute psychiatric emergencies 10 - Failure of outpatient therapy

Side effects associated with progestin-only contraception in adolescents (8)

1 - Delayed return to fertility (up to 18 months!) 2 - Weight gain 3 - Decreased bone density (should take calcium suppl) 4 - Irregular bleeding / spotting 5 - Acne 6 - Nausea 7 - Breast tenderness 8 - Mood changes 9 - Headache

Cauliflower-shaped, flesh-colored plaques in perianal area What is it? Most common causal organisms?

Genital warts HPV 6 & 11

A warm tender mass appx between 4 - 8 o'clock position with respect to the introitus, causing vaginal pain What is going on? Treatment?

Bartholin gland abscess Incision and drainage

Dental erosion, parotid enlargement, soft palate petechiae What is going on?

Bulimia nervosa

Nausea, shaking chills, severe right upper quadrant pain, adnexal and cervical motion tenderness What is going on?

Fitz-Hugh-Curtis syndrome (perihepatitis) - inflammation of the hepatic capsule and right diaphragm from PID (Chlamydia or Gonnorhea)

Rod-shaped oval organisms within cytoplasm of mononuclear phagocytes What is the finding called? Organism?

Donovan bodies Klebsiella granulomatous (cause of granuloma inguinale)

What is the definition for delayed puberty in adolescent males

Lack of testicular enlargement by 14 years of age

Nausea, vomiting, "heart racing", confused, skin flush ... after drinking alcohol with a medication What is going on ? What is the medication?

Disulfiram-like reaction The medication is metronidazole

When does peak height velocity (PHV) usually occurs in girls ? During which SMRs

Mean age 11.5 SMR 2-3

When does peak height velocity (PHV) usually occurs in boys ? During which SMRs

Meaen age 13.5 SMR 3-4

Teenager, sexually active, with testicular pain, scrotal edema What is going on ? Treatment?

Epididymis (from gonorrhea or chlamydia) Ceftriaxone + Doxycycline

What are the electrolyte abnormalities in patients with bulimia nervosa purging type?

HYPOkalemia and HYPOchloremia metabolic alkalosis

Definitions of an emancipated minor

1 - Age >= 18 2 - Married 3 - On active duy status in the military 4 - Obtained a court order 5 - Living separately from their parents or legal guardians AND independently managing their own financial affairs