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Peds COMAT > adolescent > Flashcards

adolescent Flashcards

1
Q

What is the comparison between bone age and chronological age in constitutional growth delay?

A

Bone age < chronological age

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2
Q

What drug may cause galactorrhea in males?

A

Marijuana

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3
Q

When would you consider abnormal premature pubertal development in a male?

A

Prior to age 9

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4
Q

What is the first stage of male pubertal development?

A

Testicular growth >2.5 cm

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5
Q

What should you consider in a Male with pubic hair development and Penis enlargement in the absence of testicular enlargement ?

A

Extragonadal androgen stimulation

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6
Q

At what age would you consider it abnormal for a female to begin puberty?

A

Prior to age 7

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7
Q

What genetic syndrome may be associated with gynecomastia ?

A

Klinefelter

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8
Q

What is the first sign of pubertal development in females and at what age should this occur by?

A

Thelarche (development of Breast tissue) - workup indicated if no thelarche by age 13

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9
Q

What stage of development occurs after thelarche ?

A

Pubarche then menarche

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10
Q

What diagnosis should you consider in a patient who goes through thelarche but does not have pubarche?

A

Testicular feminization aka androgen insensitivity

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11
Q

When do you find pubarche without development of thelarche ?

A

Androgen excess

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12
Q

You are presented with an 11 y/o female at sexual maturity stage 2 who presents with bloody discharge, what is the most likely diagnosis ?

A

Foreign body (menses should not occur until sexual maturity stage 3 or 4)

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13
Q

What is pseudo precocious puberty? What is this due to?

A

When the sequence of pubertal development occurs out of order - due to exogenous hormones or steroid production by adrenals or gonads

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14
Q

What is the appropriate sequence of male pubertal development ?

A

Testicular growth –> pubarche –> penile growth –> peak height velocity

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15
Q

What should you do if a patient presents with signs of premature adrenarche ?

A

Bone age

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16
Q

What are 4 possible causes of pseudo precocious puberty?

A

Late onset CAH
Leydig cell tumor
Anabolic steroids
OCPs

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17
Q

What testing would be appropriate in a patient who presents with visual field deficits and precocious puberty?

A

MRI brain to look for pituitary mass

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18
Q

What are 6 absolute contraindications for the use of oral contraceptives?

A 
Pregnancy 
Liver disease 
Elevated lipids 
Breast cancer 
Coronary artery disease
Cerebrovascular disease
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19
Q

What are 5 relative contraindications for using oral contraceptives? (you can still use them but they may not be as effective)

A 
HTN
Depression
Migraines 
Breast feeding
Anticonvulsant use
20
Q

What are 5 advantages of oral contraceptive use (other than birth control)?

A

Decreased risk of ovarian cysts, endometrial cancer, colorectal cancer, ectopic pregnancy and acne

21
Q

When would you consider the diagnosis of primary amenorrhea?

A

Lack of menses by age 16 or 2 years following sexual maturation

22
Q

What are 3 most common causes of primary amenorrhea ?

A

Polycystic ovary disease
Testicular feminization
Turner syndrome

23
Q

What are the 2 common lab findings associated with polycystic ovary disease?

A

LH:FSH >2.5

Elevated androgen levels

24
Q

What are the 3 most common causes of secondary amenorrhea?

A

Pregnancy, excessive exercise/weight loss, PCOS

25
Q

What abnormal lab values should you expect in a teenager with exercise induced amenorrhea? What does this place the patient at high risk for?

A

Low serum estradiol –>

Low bone density

26
Q

What are 4 common pathological causes of dysfunctional uterine bleeding ?

A

Tubal pregnancy
PID
Hyperthyroidism
Bleeding disorder

27
Q

What 4 criteria must be met to diagnose anorexia nervosa?

A

Distorted body perception
Weight <15% expected
Intense fear of gaining weight
Absence of 3 consecutive menstrual cycles

28
Q

What are 6 potential complications / lab findings associated with bulimia nervosa?

A 
Salivary gland enlargement
Dental enamel erosion
Bruises over knuckles
Low K
Low Cl
Metabolic alkalosis
29
Q

What are 5 indication for hospital admission in patients With bulimia ?

A 
Failure of outpatient treatment 
Dehydration 
EKG abnormalities 
Mallory Weiss tear
Suicidal ideation
30
Q

What lab abnormality would you see in refeeding syndrome ?

A

Hypophospatemia

31
Q

What is the most common STD in adolescents ?

A

HPV (genital warts is not the correct answer because most males with HPV are asymptomatic)

32
Q

What is the appropriate treatment for anogenital warts? (3 answers)

A

Observation 1-2 years
Podophyllin
Surgical excision

33
Q

What bacteria causes bacterial vaginosis? How would you make the diagnosis of BV by clinical exam and wet mount?

A

Gardnerella vaginalis - fishy odor and clue cells

34
Q

What diagnosis should you consider in a patient with vaginal itching, frothy yellow discharge and strawberry cervix?

A

Trichomonas

35
Q

What do you see on wet mount in a patient with trichomonas?

A

Flagellated organisms

36
Q

What is the treatment for trichomonas?

A

Metronidazole 2g X1

37
Q

What diagnosis presents with vaginal itching and white frothy discharge?

A

Candida

38
Q

What diagnosis should you consider in a male with dysuria and unilateral pain & swelling of the scrotum?

A

Gonorhhea causing epididymitis

39
Q

What is fitz Hugh Curtis?

A

Perihepatitis (normal LFTs) caused by gonorrhea or chlamydia

40
Q

What would you expect to find on gram stain in a patient with gonorrhea?

A

Intracellular gram negative diplococci

41
Q

What is the recommended treatment for suspected PID?

A

Ceftriaxone 250 mg IM x1
Doxycycline 100 mg BID x14 days
+/-
Metronidazole 500 mg BID x14 days

42
Q

What should be done in a patient with suspected PID who continues with pain after treatment ?

A

Abdominal US to look for tubo-ovarian abscess

43
Q

What should you do in a sexually active patient who presents with RUQ abdominal pain and vomiting ?

A

Pelvic exam! (Must rule out fitz hugh curtis)

44
Q

What should you do for a patient who presents with an ovarian cyst >6 cm or significant symptoms ?

A

Laparoscopic cyst aspiration

45
Q

At what age would you be concerned about delayed puberty ?

A

If no pubertal development by age 14 in boys or age 13 in girls

Peds COMAT (23 decks)

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