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Peds Boards > Adolescent > Flashcards

Adolescent Flashcards

1
Q

If a girl has breast buds and no pubic hair, what is the problem?

A

Androgen insensitivity - testicular feminization (XY chromosome)

  • Receptor insensitivity to androgens
  • No male external genitalia
  • Blind ending vagina, lack of uterus, lack of ovaries
  • Testes in inguinal canal
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2
Q

If a girl has no breast buds but has pubic hair, what is the problem?

A

Androgen excess

OR

Low Estrogen

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3
Q

What is the first step in evaluation of a patient with pubic hair but no breasts or testicular enlargement?

A

Bone age films

If within 1-2 years of chronological age, observe.
If not -> endocrinologist

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4
Q

What is the first step in evaluation of precocious puberty?

A

Check for ovarian or testicular tumors

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5
Q

What tests would you do to differentiate between Central versus peripheral precocious puberty?

A

LH
FSH
Adrenal steroids

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6
Q

What are the features of gonadotropin independent precocious puberty?

A
  • Normal LH and FSH levels
  • Puberty occurring in the proper timeline except for one abnormality
  • There is sex steroid production somewhere else in the body
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7
Q

How would you treat central precocious puberty in girls?

A
  • Breasts + vaginal bleeding or accelerated growth
  • If idiopathic (elevated LH and FSH)
  • Tx: GnRH analogue
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8
Q

What feature must be present in order to diagnose a boy with precocious puberty?

A

Testicular enlargement

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9
Q

What can cause a boy to have signs of precocious puberty who does not yet have testicular enlargement?

A
  • Evidence of extra hair, penile enlargement, growth spurt
  • Non-Central and non-gonadal problem
  • Late onset congenital adrenal hyperplasia, virilizing tumor, exogenous steroids
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10
Q

What is the definition of delayed puberty in girls?

A

No breast buds by the age of 13

OR

No menses within two years of the presence of both SMR 4 breasts and pubic hair

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11
Q

What are the features of Kallmann syndrome?

A
  • Hypogonadotropic hypogonadism
  • Anosmia
  • Hypoplasia of the optic nerve
  • Absence of septum pellucidum
  • The only Disease with a smelling problem
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12
Q

What is the normal discrepancy between a bone age film and chronological age?

A

2 years

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13
Q

What is the formula for midparental height?

A

[Dad’s height + Mom’s height +/- 5 inches or 13 cm] / 2

Add length for boys
Subtract length for girls

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14
Q

How is growth hormone deficiency diagnosed?

A

Noting a lack of GH release following insulin or arginine stimulation.

Findings will include micropenis or clitoris and hypoglycemia.

Decelerated growth rate.

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15
Q

What stimulates the production of progesterone?

A

LH

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16
Q

What stimulates the production of estrogen?

A

FSH

17
Q

What is the first step in an amenorrhea work up?

A

Rule out pregnancy, anatomic obstruction, malformation

18
Q

What is the second step in an amenorrhea work up?

A

Progesterone Challenge:

  • If positive (bleeding within 2 weeks of administration) = plenty of estrogen, missing progesterone -> get LH level
    • High LH: PCOS
    • Low LH: Get prolactin and TSH
      • High PRL and TSH: hypothyroidism
      • High PRL: prolactinoma
  • If negative = not enough estrogen -> get FSH
    • High FSH: Ovarian failure (Turner’s, autoimmune, chemo, premature menopause),
    • Low FSH: central problem (mass, prolactinoma, craniopharyngioma, hypothyroid)
19
Q

What is the definition of secondary amenorrhea?

A
  • Six months without menses after a patient was regular

- 12 months without menses if the patient was previously irregular

20
Q

What is the differential diagnosis for secondary amenorrhea?

A 
Asherman's syndrome (intrauterine adhesions)
Cystic fibrosis
Sarcoidosis
Phenothiazines
Nutrition
Brain tumor
Tuberculosis
21
Q

What percentage of suicide attempts are successful?

A

90%

22
Q

How long are exogenous anabolic steroids detectable in the blood?

A
  • If IM: 6 + months

- If PO: 1 month

Peds Boards (24 decks)

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