Adolescent Flashcards
Menarche in 95% of adolescents at what age range?
11-14.5
What % of girls are anovulatory in 1st year?
50%
By 3rd year after menarche, what percentage are ovulatory?
95%
How much blood loss
30ml/month
Define primary amenorrhea
No menarche by 16
No menarche if Tanner 5 for >1year
No menarche by 5yrs after breast development
Absence of menses
amenorrhea
Infrequent bleeding >45 day interval
Oligomenorrhea
Prolonged >7days excessive bleeding (80ml) bleeding at regular intervals
Menorrhagia
Bleeding at irregular but frequent intervals
Metorrhagia
Prolonged bleeding at irregular intervals
Menometrorrhagia
Define characteristics of abnormal vaginal bleeding
> 80cc loss, >frequent than 20 days, associated with anemia, if at menarche –> leads to transfusion, hospitalization or if other signs of bleeding, need to work up for bleeding
How do you work up abnormal vaginal bleeding
assess blood loss, evaluate need for surgical intervention/hospitalization, determine etiology and CBC, preg test, PT/PTT
Causes of dysmenorrhea?
endometriosis, chronic pelvic pain, DUB, painful defecation, dysparneuim, PID, benign uterine tumors, polyps, fibroids, IUD, abormality in anatomy.
What is dysmenorrhea and Rx for it
Painful period, NSAIDS, oral contraceptives
Rx of anorexia nervosa
Target co-morbid symptoms of depression/anxiety; may not be as effective in severely malnourished patients, maybe neuroleptics
Rx bulimia nervosa
SSRI, SNRI, TCAs, topiramte, aim for 50% BMI
What are the weight and diet based criteria for hospital admission for anorexia nervosa?
- 75% ideal body weight or ongoing loss
- Refusal to eat
- Body fat <10%
What are the vital sign based criteria for hospital admission for anorexia nervosa?
- HR <50 beats/min daytime; <45 beats/min nighttime
- Systolic bp <90mm Hg
- Orthostatic changes in pulse 30 beats/min or bp drop in systolic >10mm Hg
- Arrhythmia
- Temp <36.3 day and 36 at night
What are symptoms of bulimia that are criteria for hospital admission?
Syncope Esophageal tears Cardiac arrhythmias Hypothermia HR >110 supine Hematemesis Intractable vomiting Not responding to outpt therapy Suicide risk
What are lab work based criteria for hospital admission?
K <3.2mmol/L
Cl 88mmol/L
Hypophosphatemia
Emergency contraceptive can be given up to how many days
5 days
What is depa-provera made of
Progesterone only
What can estrogen cause
hypercoag, seizure, headaches
Screening of chlamydia/gonorrhea
screen for all high risk teens
Pattern: discharge between peiors esp after intercourse, mucopus from Ox, erosion friability, 10-30 WBC on gram stain of cervical os
GC/chlam
Pattern: bubbly discharge, strawberry cervix, unicellular organism, it moves
trichomoniasis
What are complications of Trichomoniasis
PID, pre-term labor, increased CA risk and infertility, high HIV acquisition
Pattern: gray-white homogenous discharge, no vulvar inflammation, odor reported, cheesy, fishy odor when KOH is added, clue cells
bacterial vaginoisis
Pattern: watery discharge, one joint involvment, pt can walk on joint, knee and elbow most common
gonorrhea
What does rash look like in gonorrhea versus syphillis
Gonorrhea - erythematous papules, pustules, necrotic lesion, acrally located near small joints of hand, feet, <20 lesions
Syphillis - on palm and feet
Describe tenosynovitis for gonorrhea
extensor tendons of hand, wrist, feet most common
Pattern: sudden right upper quadrant pain and liver tenderness, pt on OCP, increased liver enzymes
Fit Hugh Curtis
Best test for chlamydia/gonorrhea
NAATS
Cause of Reiter’s syndrome
chlamydia
Triad of Reiter’s syndrome
conjunctivitis, red joints, red urethra
What are complications of Reiter’s syndrome?
cardiac, pericarditis and/or valve disease, erythema nodosum, carcinate balantis, shallow painless ulcers on glans/shaft
Rx for Reiter’s
NSAIDs, 50% resolve in 6mo and most in 1 year
Rx for chlamydia
Azithro or doxy
Rx for gonorrhea
Ceftriaxone and azithro
Rx for bacterial vaginosis
Metronidazole or clinda
Rx for PID
Ceftriaxone, doxy +/- metronidazole oral
or parenteral cefotoxan and doxy
Rx for syphillis
Benzathine penicllin
Rx for chancroid - emophilus ducreyi
1 dose azithro
Rx for granuloma inguinal calymmatobacterium granulomatis
azithro x 3 weeks
Rx for chlamydia serovaus L1, L2, L3, lymphogranuloma venerum
Azithro x 3 weeks
What stage of syphillis: painless chancre
primary
What stage of syphillis: rash, condymata lata, cheeky rash
secondary
What stage of syphillis: internal organ involvement
tertiary
Indication for immediate colposcopy
high grade squamous intraepithelial, 3 paps smears with ASCUS or LGSIL, immunocompromised with LSIL
