adolescent Flashcards
What is the comparison between bone age and chronological age in constitutional growth delay?
Bone age < chronological age
What drug may cause galactorrhea in males?
Marijuana
When would you consider abnormal premature pubertal development in a male?
Prior to age 9
What is the first stage of male pubertal development?
Testicular growth >2.5 cm
What should you consider in a Male with pubic hair development and Penis enlargement in the absence of testicular enlargement ?
Extragonadal androgen stimulation
At what age would you consider it abnormal for a female to begin puberty?
Prior to age 7
What genetic syndrome may be associated with gynecomastia ?
Klinefelter
What is the first sign of pubertal development in females and at what age should this occur by?
Thelarche (development of Breast tissue) - workup indicated if no thelarche by age 13
What stage of development occurs after thelarche ?
Pubarche then menarche
What diagnosis should you consider in a patient who goes through thelarche but does not have pubarche?
Testicular feminization aka androgen insensitivity
When do you find pubarche without development of thelarche ?
Androgen excess
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 ?
Foreign body (menses should not occur until sexual maturity stage 3 or 4)
What is pseudo precocious puberty? What is this due to?
When the sequence of pubertal development occurs out of order - due to exogenous hormones or steroid production by adrenals or gonads
What is the appropriate sequence of male pubertal development ?
Testicular growth –> pubarche –> penile growth –> peak height velocity
What should you do if a patient presents with signs of premature adrenarche ?
Bone age
What are 4 possible causes of pseudo precocious puberty?
Late onset CAH
Leydig cell tumor
Anabolic steroids
OCPs
What testing would be appropriate in a patient who presents with visual field deficits and precocious puberty?
MRI brain to look for pituitary mass
What are 6 absolute contraindications for the use of oral contraceptives?
Pregnancy Liver disease Elevated lipids Breast cancer Coronary artery disease Cerebrovascular disease
What are 5 relative contraindications for using oral contraceptives? (you can still use them but they may not be as effective)
HTN Depression Migraines Breast feeding Anticonvulsant use
What are 5 advantages of oral contraceptive use (other than birth control)?
Decreased risk of ovarian cysts, endometrial cancer, colorectal cancer, ectopic pregnancy and acne
When would you consider the diagnosis of primary amenorrhea?
Lack of menses by age 16 or 2 years following sexual maturation
What are 3 most common causes of primary amenorrhea ?
Polycystic ovary disease
Testicular feminization
Turner syndrome
What are the 2 common lab findings associated with polycystic ovary disease?
LH:FSH >2.5
Elevated androgen levels
What are the 3 most common causes of secondary amenorrhea?
Pregnancy, excessive exercise/weight loss, PCOS
What abnormal lab values should you expect in a teenager with exercise induced amenorrhea? What does this place the patient at high risk for?
Low serum estradiol –>
Low bone density
What are 4 common pathological causes of dysfunctional uterine bleeding ?
Tubal pregnancy
PID
Hyperthyroidism
Bleeding disorder
What 4 criteria must be met to diagnose anorexia nervosa?
Distorted body perception
Weight <15% expected
Intense fear of gaining weight
Absence of 3 consecutive menstrual cycles
What are 6 potential complications / lab findings associated with bulimia nervosa?
Salivary gland enlargement Dental enamel erosion Bruises over knuckles Low K Low Cl Metabolic alkalosis
What are 5 indication for hospital admission in patients With bulimia ?
Failure of outpatient treatment Dehydration EKG abnormalities Mallory Weiss tear Suicidal ideation
What lab abnormality would you see in refeeding syndrome ?
Hypophospatemia
What is the most common STD in adolescents ?
HPV (genital warts is not the correct answer because most males with HPV are asymptomatic)
What is the appropriate treatment for anogenital warts? (3 answers)
Observation 1-2 years
Podophyllin
Surgical excision
What bacteria causes bacterial vaginosis? How would you make the diagnosis of BV by clinical exam and wet mount?
Gardnerella vaginalis - fishy odor and clue cells
What diagnosis should you consider in a patient with vaginal itching, frothy yellow discharge and strawberry cervix?
Trichomonas
What do you see on wet mount in a patient with trichomonas?
Flagellated organisms
What is the treatment for trichomonas?
Metronidazole 2g X1
What diagnosis presents with vaginal itching and white frothy discharge?
Candida
What diagnosis should you consider in a male with dysuria and unilateral pain & swelling of the scrotum?
Gonorhhea causing epididymitis
What is fitz Hugh Curtis?
Perihepatitis (normal LFTs) caused by gonorrhea or chlamydia
What would you expect to find on gram stain in a patient with gonorrhea?
Intracellular gram negative diplococci
What is the recommended treatment for suspected PID?
Ceftriaxone 250 mg IM x1
Doxycycline 100 mg BID x14 days
+/-
Metronidazole 500 mg BID x14 days
What should be done in a patient with suspected PID who continues with pain after treatment ?
Abdominal US to look for tubo-ovarian abscess
What should you do in a sexually active patient who presents with RUQ abdominal pain and vomiting ?
Pelvic exam! (Must rule out fitz hugh curtis)
What should you do for a patient who presents with an ovarian cyst >6 cm or significant symptoms ?
Laparoscopic cyst aspiration
At what age would you be concerned about delayed puberty ?
If no pubertal development by age 14 in boys or age 13 in girls
