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adolescent > adolescent > Flashcards

adolescent Flashcards

1
Q

risk factors with early pubertal maturation in girls (6)

A

higher risk of…

  • conduct problems
  • depression
  • early substance use
  • poor body image
  • pregnancy
  • experimenting with sex
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2
Q

what is the leading cause of morbidity and mortality of 16-20 y/os

A

MVA

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3
Q

criteria for anorexia

A

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

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4
Q

indictions for admission for anorexia (10)

A
  • 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
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5
Q

lab findings with bulimia nervosa

A

hypochloremic
hypokalemic
metabolic alkalosis

*just like pyloric stenosis!

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6
Q

menarche occurs ___ years after breast development (thelarche)

A

2 years

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7
Q

tanner stage during menarche

A

3-4

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8
Q

benefits of OCP (9)

A

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
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9
Q

age of first pap smear

A

21

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10
Q

contraindications to OCP (9)

A
  • 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
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11
Q

primary amenorrhea

A

no menses by age 15 OR 3 years following breast development

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12
Q

turner syndrome phenotypic features

A 
amenorrhea
breast buds
no pubic hair
short stature
low hair line
low set ears
hypertension 
heart murmur 
lymphedema
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13
Q

secondary amenorrhea

A

3 months of amenorrhea after menarche

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14
Q

female athlete triad

A

d/o eating
amenorrhea (low estradiol 2)
osteoporosis

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15
Q

labs in PCOS

A

LH:FSH >2.5

elevated androgen

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16
Q

treatment for PCOS (3)

A

weight loss
OCP
anti androgen med (spironolactone)

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17
Q

women with female athlete triad who smoke are at increased risk for…

A

stress fx

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18
Q

association of delayed puberty and bone density

A

delayed puberty causes low bone density

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19
Q

management of female athlete triad (3)

A

increase caloric intake
decrease exercise intensity
Ca supplements

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20
Q

cause of dysmenorrhea

A

prostaglandins

this is why NSAIDs help!

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21
Q

how to diagnosis endometriosis

A

laparoscopy

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22
Q

what is the most common cause of dysfunctional uterine bleedig in developing countries?

A

TB

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23
Q

menorrhagia

A

hypermenorrhea

heavy or porlonged bleeding at regular intervals

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24
Q

metorrhagia

A

irregular vaginal bleeding

think of a metronome keeping a regular timing

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25
Q

menometorrhagia

A

heavy vaginal bleeding at irregular intervals

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26
Q

polymenorrhea

A

frequent vaginal bleeding more often than every 21 ds

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27
Q

cause of heavy menstrual bleeding without pain

A

chlamydia

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28
Q

what is the most common cause of DUB

A

anovulation

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29
Q

definition of DUB

A

menses >10d

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30
Q

in what age group do you see vaginal adhesions

A

infancy and preschoolers

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31
Q

do you need to treat vaginal adhesions?

A

NO- typically resolve sponteously
unless symptomatic- dysuria, UTI
tx with estrogen cream

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32
Q

causes of vulvovaginitis (8)

A

STDs vs non STDs

STDs

  • GC
  • CT
  • trichomonas
  • herpes

non STDs

  • enterobius vermicularis (pinworms)
  • GAS
  • staph
  • candida
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33
Q

how to tx candidal vaginitis

A

topical clotrimazole

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34
Q

cause of condyloma acuminata

A

HPV

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35
Q

how does condyloma acuminata present?

A

non tender, flat papular lesions, pedunculated, bleed with minor trauma

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36
Q

treatment of condyloma acuminata

A
  • 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

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37
Q

what is the condyloma lata is 2/2…

A

secondary syphilis

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38
Q

what does condyloma lata look like?

A

whitish-gray papules that have coalesced

have systemic sx – fever

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39
Q

treatment for primary HSV

A

acyclovir

  • can also use famciclovir and valacyclovir
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40
Q

best test to dx HSV

A

viral culture

no tzank prep

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41
Q

what are maculae cerulea

A

blue grey dots seen with pediculosis pubis (crabs)

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42
Q

presentation of pediculosis pubis

A

red, crusted suprapubic maculs

blue-grey dots (maculae cerulea)

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43
Q

treatment of pediculosis pubis

A

permethrin 1% or 5%
pyrethrin with piperonyl butoxide
malathion

lindane- cannot use in pregnant women or children

44
Q

what causes bacterial vaginosis

A

gardnerella vaginalis

anything that disrupts the balance of nl vaginal flora-
abx or IUDs

45
Q

presentation of bacterial vaginosis (3)

A

1- copious grey/white dc
2- vaginal pH >4.5
3- clue cells under microscopy

46
Q

what does the whiff test, test for?

A

BV!

smell a fishy odor 2/2 amines after the addition of KOH

47
Q

what is the most prevalent nonviral STD in US teens

A

trichamoniasis

48
Q

how to males present with trichamoniasis

A

asymptomatic

49
Q

how to females present with trichamoniasis

A

burning and itching
abnormal vaginal odor
pain with sex (dyspareunia)

50
Q

findings with trichamoniasis

A

frothy yellow discharge with strawberry cervix (bc friable mucosa)

51
Q

treatment of trichamoniasis

A

flagyl

treat partner too

52
Q

how does gonorrhea present?

A

asymptomatic

53
Q

systemic presentation of gonorrhea

A

arthritis
pharyngitis
fever
cervical adenopathy

54
Q

what is he most common reportable STD

A

1- chlamydia

2- gonorrhea

55
Q

how does gonorrhea present in males with sx

A

dysuria
discharge
epididymitis
unilateral pain and swelling of the scrotum

56
Q

how does gonorrhea present in females with sx

A

urethritis and cervicitis
dysuria
malodorous discharge

worry about spread eading to peritonitis or peri hepatitis (fitz hugh curtis)

57
Q

findings with fitz hugh curtis

A

RUQ pain
peri hepatitis
LFTs nl

58
Q

gold standard for dx systemic gonoccal dz

A

culture

need empiric tx before results

59
Q

criteria for dx PID

A

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
60
Q

causes of PID

A

GC
CT
gram negatives
anaerobes

61
Q

other testing to do when you suspect PID

A

trichamoniasis
BV
HIV
syphilis

62
Q

outpt tx of PID

A

cephalosporin – cefoxitin, cefotetan or ceftriaxone
+ doxycycline 100 BID x14d
w/ or w/out flagyll 500 bid x14d

63
Q

when to follow up with pt with PID being managed as outpt

A

72h

64
Q

when do you need to hospitalize for PID?

A
  • cannot assure follow up
  • symptoms if not improve in 48h
  • cannot tolerate outpt management
  • sever illness
  • pregnant
65
Q

what further testing should be done in pt with PID with persistent sx 48 h after tx

A

US to look for TOA

66
Q

cause of fitz hugh curtis

A

CT or GC

67
Q

management for ovarian cyst <6cm

A

follow up US

68
Q

management for ovarian cyst >6cm

A

laparoscopic cyst aspiration

69
Q

management of ovarian torsion

A

1- call surgery

2- get US

70
Q

hymen damage

A

can be 2/2 sexual abuse

HOWEVER too nonspecific on its own

71
Q

cause of labial adhesions

A

sexual abuse

ALSO can be seen with trauma- like bike injury

72
Q

population that experience urethral prolapse

A

african american females

ages 3-8

73
Q

treatment for urethral prolapse

A

sitz bath

uro f/u

74
Q

what cause physiologic leukorrhea

A

desquamation of epithelial cells 2/2 estrogen

occurs pprior to menarche (age 11) can last several mos

75
Q

in what age group is evidence of congenital condyloma acuminata found

A

<3 years
2/2 birth canal transmission
manifensts typically by age 1

> 3y with condyloma accuminata- think ABUSE

76
Q

a 19 yo M is dx with gonorrhea- when do you retest?

A

3 mo

77
Q

what causes proctolitis and what is the tx

A

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

78
Q

at what age do you vision screen in adolescents

A

risk analysis yearly

screen at 12 and 15 yo

79
Q

at what age do you hearing screen in adolescents

A

risk assessment yearly

screen once in early adolescence (11-14y), once in mid (15-17y), once in late (18-21y)

80
Q

what is the side effect of depoprovera

A

decreased bone mineral density

81
Q

what drugs decrease the efficacy of OCP

A 
p450 inducers (will get rid of drug quickly)
CRAP GPS
Carbamazpine
Rifampin
Alcohol (chronic)
Phenytoin
Griseofulvin
Pheonobarb
Sulfonylmides
82
Q

how do OCPs effects TFTs

A

increase the TOTAL serum concentration of T3 and T4 but do not change the free levels

83
Q

what is the dx?

girl with anorexia had heart murmur- midsystolic click

A

MVP

84
Q

what are the weekly wt gain goals for treatment of anorexia

A

outpt 0.5-1 lb
inpt 2-3 lb
partial hospitalization 1-2 lb

85
Q

what are the indication for ordering a bone mineral density in an adolescent (5)

A 
1- eating do
2- low body wt/BMI
3- stress fx
4- weight loss >10%
5-menstrual dysfxn
86
Q

when do you see male gynecomastia

A

14 (10-16) typically SMR3

87
Q

adolescent boy with scrotal mass that increases with valsalva and standing and decreases while supine

A

varicocele- dilated scrotal vv d/t incompetent venous valves in internal spermatic vv

88
Q

teenager with excessive bleeding after delivery… what must you work about

A

sheehan syndrome

pituitary insufficiency post partum

89
Q

pt with history of D&C now with amenorrhea

A

asherman syndrome- uterine synechiae/adhesions

90
Q

what is the difference between androgen insensitivity syndrome and Swyer syndrome

A

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)

91
Q

what are the 2 most common causes of reiter syndrome in adolescent males

A

chlamydia and campylobacter

92
Q

what is the treatment for chlamydia urethritis or cervicitis

A

azithro, doxy 100mg bid x7d

93
Q

what is the treatment for chlamydia cervicitis in pregnancy

A

azithro 1g, amox 500mg tidx7d

94
Q

what groups need a test of cure for chlamydia infections

A

pregnant women

3 weeks after treatment

95
Q

what is the treatment for chlamydia epididymitis

A

doxy 100 bid x10d + ctx 250mg IMx1

not azithro

96
Q

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

A

positive synovial cx

blood cx is usually negative

97
Q

what are the 2 stages of lymphogranuloma venereum

A

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

98
Q

what is the minimum diagnostic criteria for PID

A

pelvic/lower abdominal pain with uterine tenderness or adnexal tenderness or CMT

99
Q

what is the inpt treatment for PID

A

cefoxitin or cefotetan PLUS doxy

OR clinda PLUS gent

100
Q

what is the outpt treatment for PID

A

CTX
OR cefoxitin PLUE doxy
WITH or WITHOUT metronidazole

do not use azithro for PID

101
Q

in what cases would you also uses flagyl for tx of PID

A

concern of anaerobes
- TOA
0 trich or BV
- h/o gynecological instrumentation in preceding 2-3 wks

102
Q

name the STD

discrete punched out, painless lesions with sharp, firm, raised, indurated margins

A

primary syphilis

can be accompanied with regional adenopathy

103
Q

name the STD

large grayish-white lesion in warm moist areas

A

condyloma lata, secondary syphilis

104
Q

name the STD

painful pus-filled ulcer, deep, ragged, purulent yellow base

A

chancroid

H ducreyi

105
Q

what is the treatment for chancroid

A

azithro + CTX

106
Q

what is granuloma inguinale (donovanosis) and what is the treatment

A

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

adolescent (2 decks)

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