adolescent Flashcards
risk factors with early pubertal maturation in girls (6)
higher risk of…
- conduct problems
- depression
- early substance use
- poor body image
- pregnancy
- experimenting with sex
what is the leading cause of morbidity and mortality of 16-20 y/os
MVA
criteria for anorexia
inability/refusal to maintain a healthy body weight
1- distorted body perceptions
2- wt <15% below expected
3- intense fear or gaining weight with restriction of energy intake
4- absence of 3 consecutive menstrual cycles
indictions for admission for anorexia (10)
- wt <75% ideal body weight
- continued wt loss despite intensive outpt management
- acute weight decline and refusal of food
- hypothermia
- hypotension
- bradycardia
- orthostatic changes in BP or pulse
- electrolyte abnormalities
- arrhythmia
- SI
lab findings with bulimia nervosa
hypochloremic
hypokalemic
metabolic alkalosis
*just like pyloric stenosis!
menarche occurs ___ years after breast development (thelarche)
2 years
tanner stage during menarche
3-4
benefits of OCP (9)
decrease risk for
- ovarian cysts
- endometrial ca
- ovarian ca
- colorectal ca
- osteoporosis
- reduce free testosterone/dec hirsuitism
- reduce risk of salpingitis and ectopic
- protect against acne
- protect against iron deficiency
age of first pap smear
21
contraindications to OCP (9)
- migraine HA with focal aura/neuro changes
- pregnancy
- uncontrolled HTN
- liver dz
- breast ca
- cerebrovascular dz
- history of DVT
- history of PE
- factor V leiden mutation
primary amenorrhea
no menses by age 15 OR 3 years following breast development
turner syndrome phenotypic features
amenorrhea breast buds no pubic hair short stature low hair line low set ears hypertension heart murmur lymphedema
secondary amenorrhea
3 months of amenorrhea after menarche
female athlete triad
d/o eating
amenorrhea (low estradiol 2)
osteoporosis
labs in PCOS
LH:FSH >2.5
elevated androgen
treatment for PCOS (3)
weight loss
OCP
anti androgen med (spironolactone)
women with female athlete triad who smoke are at increased risk for…
stress fx
association of delayed puberty and bone density
delayed puberty causes low bone density
management of female athlete triad (3)
increase caloric intake
decrease exercise intensity
Ca supplements
cause of dysmenorrhea
prostaglandins
this is why NSAIDs help!
how to diagnosis endometriosis
laparoscopy
what is the most common cause of dysfunctional uterine bleedig in developing countries?
TB
menorrhagia
hypermenorrhea
heavy or porlonged bleeding at regular intervals
metorrhagia
irregular vaginal bleeding
think of a metronome keeping a regular timing
menometorrhagia
heavy vaginal bleeding at irregular intervals
polymenorrhea
frequent vaginal bleeding more often than every 21 ds
cause of heavy menstrual bleeding without pain
chlamydia
what is the most common cause of DUB
anovulation
definition of DUB
menses >10d
in what age group do you see vaginal adhesions
infancy and preschoolers
do you need to treat vaginal adhesions?
NO- typically resolve sponteously
unless symptomatic- dysuria, UTI
tx with estrogen cream
causes of vulvovaginitis (8)
STDs vs non STDs
STDs
- GC
- CT
- trichomonas
- herpes
non STDs
- enterobius vermicularis (pinworms)
- GAS
- staph
- candida
how to tx candidal vaginitis
topical clotrimazole
cause of condyloma acuminata
HPV
how does condyloma acuminata present?
non tender, flat papular lesions, pedunculated, bleed with minor trauma
treatment of condyloma acuminata
- OBSERVATION is initial manadement
- chemical cauterization with podophyllin or podofilox
- surgical excision
anogenital warts have a high spontaneous resolution rate- can observe for 1-2 yrs before treatment
what is the condyloma lata is 2/2…
secondary syphilis
what does condyloma lata look like?
whitish-gray papules that have coalesced
have systemic sx – fever
treatment for primary HSV
acyclovir
- can also use famciclovir and valacyclovir
best test to dx HSV
viral culture
no tzank prep
what are maculae cerulea
blue grey dots seen with pediculosis pubis (crabs)
presentation of pediculosis pubis
red, crusted suprapubic maculs
blue-grey dots (maculae cerulea)
treatment of pediculosis pubis
permethrin 1% or 5%
pyrethrin with piperonyl butoxide
malathion
lindane- cannot use in pregnant women or children
what causes bacterial vaginosis
gardnerella vaginalis
anything that disrupts the balance of nl vaginal flora-
abx or IUDs
presentation of bacterial vaginosis (3)
1- copious grey/white dc
2- vaginal pH >4.5
3- clue cells under microscopy
what does the whiff test, test for?
BV!
smell a fishy odor 2/2 amines after the addition of KOH
what is the most prevalent nonviral STD in US teens
trichamoniasis
how to males present with trichamoniasis
asymptomatic
how to females present with trichamoniasis
burning and itching
abnormal vaginal odor
pain with sex (dyspareunia)
findings with trichamoniasis
frothy yellow discharge with strawberry cervix (bc friable mucosa)
treatment of trichamoniasis
flagyl
treat partner too
how does gonorrhea present?
asymptomatic
systemic presentation of gonorrhea
arthritis
pharyngitis
fever
cervical adenopathy
what is he most common reportable STD
1- chlamydia
2- gonorrhea
how does gonorrhea present in males with sx
dysuria
discharge
epididymitis
unilateral pain and swelling of the scrotum
how does gonorrhea present in females with sx
urethritis and cervicitis
dysuria
malodorous discharge
worry about spread eading to peritonitis or peri hepatitis (fitz hugh curtis)
findings with fitz hugh curtis
RUQ pain
peri hepatitis
LFTs nl
gold standard for dx systemic gonoccal dz
culture
need empiric tx before results
criteria for dx PID
lower abdominal or pelvic pain
+ uterine, adnexal or CMT
Additional criteria
- WBC in vaginal secretions
- temp >38.3
- elevated ESR or CRP
- lab evidence of GC/chlamydia
- abnl cervical or vaginal mucopurlent dc
causes of PID
GC
CT
gram negatives
anaerobes
other testing to do when you suspect PID
trichamoniasis
BV
HIV
syphilis
outpt tx of PID
cephalosporin – cefoxitin, cefotetan or ceftriaxone
+ doxycycline 100 BID x14d
w/ or w/out flagyll 500 bid x14d
when to follow up with pt with PID being managed as outpt
72h
when do you need to hospitalize for PID?
- cannot assure follow up
- symptoms if not improve in 48h
- cannot tolerate outpt management
- sever illness
- pregnant
what further testing should be done in pt with PID with persistent sx 48 h after tx
US to look for TOA
cause of fitz hugh curtis
CT or GC
management for ovarian cyst <6cm
follow up US
management for ovarian cyst >6cm
laparoscopic cyst aspiration
management of ovarian torsion
1- call surgery
2- get US
hymen damage
can be 2/2 sexual abuse
HOWEVER too nonspecific on its own
cause of labial adhesions
sexual abuse
ALSO can be seen with trauma- like bike injury
population that experience urethral prolapse
african american females
ages 3-8
treatment for urethral prolapse
sitz bath
uro f/u
what cause physiologic leukorrhea
desquamation of epithelial cells 2/2 estrogen
occurs pprior to menarche (age 11) can last several mos
in what age group is evidence of congenital condyloma acuminata found
<3 years
2/2 birth canal transmission
manifensts typically by age 1
> 3y with condyloma accuminata- think ABUSE
a 19 yo M is dx with gonorrhea- when do you retest?
3 mo
what causes proctolitis and what is the tx
inflammation of the colonic mucosa 2/2 LGV (C trachomatis), campylobacter, shigella, entamoeba histolytica
p/w tenesmus, cramping, discharge and diarrhea
tx with doxy if dx with LGV
at what age do you vision screen in adolescents
risk analysis yearly
screen at 12 and 15 yo
at what age do you hearing screen in adolescents
risk assessment yearly
screen once in early adolescence (11-14y), once in mid (15-17y), once in late (18-21y)
what is the side effect of depoprovera
decreased bone mineral density
what drugs decrease the efficacy of OCP
p450 inducers (will get rid of drug quickly) CRAP GPS Carbamazpine Rifampin Alcohol (chronic) Phenytoin Griseofulvin Pheonobarb Sulfonylmides
how do OCPs effects TFTs
increase the TOTAL serum concentration of T3 and T4 but do not change the free levels
what is the dx?
girl with anorexia had heart murmur- midsystolic click
MVP
what are the weekly wt gain goals for treatment of anorexia
outpt 0.5-1 lb
inpt 2-3 lb
partial hospitalization 1-2 lb
what are the indication for ordering a bone mineral density in an adolescent (5)
1- eating do 2- low body wt/BMI 3- stress fx 4- weight loss >10% 5-menstrual dysfxn
when do you see male gynecomastia
14 (10-16) typically SMR3
adolescent boy with scrotal mass that increases with valsalva and standing and decreases while supine
varicocele- dilated scrotal vv d/t incompetent venous valves in internal spermatic vv
teenager with excessive bleeding after delivery… what must you work about
sheehan syndrome
pituitary insufficiency post partum
pt with history of D&C now with amenorrhea
asherman syndrome- uterine synechiae/adhesions
what is the difference between androgen insensitivity syndrome and Swyer syndrome
androgen insensitivity- normal testosterone, gonads are testest
Swyer syndrome: little/no testosterone produced, pure gonadal dysgenesis/undifferentiated streaks (need to remove d/t risk of malignancy)
what are the 2 most common causes of reiter syndrome in adolescent males
chlamydia and campylobacter
what is the treatment for chlamydia urethritis or cervicitis
azithro, doxy 100mg bid x7d
what is the treatment for chlamydia cervicitis in pregnancy
azithro 1g, amox 500mg tidx7d
what groups need a test of cure for chlamydia infections
pregnant women
3 weeks after treatment
what is the treatment for chlamydia epididymitis
doxy 100 bid x10d + ctx 250mg IMx1
not azithro
which one of the following findings is most likely to be identified in a pt with monoarticular suppurative arthritis due to disseminated gonococcal infection
a. multiple discrete painful skin lesions
b. positive synovial cx
c. positive blood cx
d. uveitis
e. tenosynovitis
positive synovial cx
blood cx is usually negative
what are the 2 stages of lymphogranuloma venereum
primary- painless herpetiform-like ulcer at site of innoculation 3-12 d after exposure
secondary- appears 2-6 wks, tender, unilateral suppurative matted inguinal nodes with inflamed overlying skin. Can see groove sign - separation of the inguinal and femoral nodes by the inguinal ligament
what is the minimum diagnostic criteria for PID
pelvic/lower abdominal pain with uterine tenderness or adnexal tenderness or CMT
what is the inpt treatment for PID
cefoxitin or cefotetan PLUS doxy
OR clinda PLUS gent
what is the outpt treatment for PID
CTX
OR cefoxitin PLUE doxy
WITH or WITHOUT metronidazole
do not use azithro for PID
in what cases would you also uses flagyl for tx of PID
concern of anaerobes
- TOA
0 trich or BV
- h/o gynecological instrumentation in preceding 2-3 wks
name the STD
discrete punched out, painless lesions with sharp, firm, raised, indurated margins
primary syphilis
can be accompanied with regional adenopathy
name the STD
large grayish-white lesion in warm moist areas
condyloma lata, secondary syphilis
name the STD
painful pus-filled ulcer, deep, ragged, purulent yellow base
chancroid
H ducreyi
what is the treatment for chancroid
azithro + CTX
what is granuloma inguinale (donovanosis) and what is the treatment
rare in the US- h/o travel to tropical/subtropical areas - new guinea, india, austrailia, caribbean
2/2 klebsiella granulomatosis
indurated subq nodule progresses to large extensive, painless ulcers with red, friable granulation tissue and raised, rolled margins
see intracytoplasmic inclusion bodies (donovan bodies)
tx with azithro x3wks
