Adolescent Flashcards
Early puberty risk for
lower self-esteem and poor body image.
lower academic achievement, evidenced by lower high school grade point averages
How to diagnose BV
Accounts for 40-50% of all vag discharge cases
- homogeneous, thin, white discharge that adheres to the vaginal walls
- greater than 20% clue cells on microscopy
- vaginal pH greater than 4.5
- release of a fishy amine odor with the addition of 10% potassium hydroxide to a drop of vaginal discharge (ie, positive whiff test)
OR Nugent score 7-10
Delayed puberty in girls
- no breast development by age 13 years
- no menstruation by age 16 years
- more than 5 years between the initiation of breast development and menarche.
Peer role in Adolescence
During early adolescence, self-identity development is greatly influenced by peers and the need for group cohesion.
However, the influence of peers on self-identity decreases in later adolescence.
Pubertal Development in Girls
Thelarche -> Pubarche -> Peak Ht Velocity -> Menarche
Thelarche - due to ovarian estrogen (avg 8-10)
Pubarche - adrenal androgens (usually 1-1.5 yrs after thelarche)
Growth spurt and peak velocity
Menarche - about 2.5 yrs after thelarche (avg is 12.5 yrs)
Further eval if:
- no menarche by 14 WITHOUT breast dev
- no menarche by 16 WITH breast dev
- no menarche within 4 yrs after breast dev
Best prevention programs for school violence
Universal, school based prevention programs delivered to all students are more likely to be effective than those targeting at risk youth only.
Pubertal Development in Boys
Testicular enlargement -> pubarche -> peak height velocity -> spermarche
Usually begins 9-14 yrs
Further eval:
- puberty before 9
- absence of testicular enlargement by 14
Girls vs. Boys Growth spurt
GIrls have initiation of growth spurt 2 yrs earlier than boys. (9.5 compared to 11.5)
On average, girls are 10 cm shorter than boys.
Non-classical congenital adrenal hyperplasia vs. PCOS
NCCAH
- subclinical impairment of 21hydroxylase
- don’t have aldo or cortisol deficiency
- but does have androgen excess
- females: hirsuitism, menstrual irregularities, acne
Dx: early morning 17OHP > 200
Ano-ovulatory cycles due to HPA axis immaturity
Absence of LH surge leading to ovulation and the development of a functional corpus luteum
IUD risk
During insertion -> risk of uterine perforation
Disseminated Gonorrhea
- Tenosynovitis, Dermatitis, Polyarthralgia
- 2-10 painless pustular or vesiculopustular lesions - Purulent Arthritis of 1 or several joints
Dx: identification of N. gonorrhoeae thru NAAT of endocervical swab is best.
Blood, synovial and skin cultures are often negative. U culture does not isolate it.
DGI is ceftriaxone (1 g IV or IM every 24 hours) plus azithromycin (1 g PO in a single dose).
For patients without septic arthritis, treatment should be continued for 7 days; once clinical improvement has occurred, the course can be completed with ceftriaxone (250 mg IM daily) or, if susceptibility testing is performed, with an oral agent (e.g., cefixime).
Patients with septic arthritis require ceftriaxone for 7–14 days along with joint drainage.
Chancroid disease
Haemophilus Ducreyi
- gram neg rods in a chain “school of fish”
- papule -> pustule -> painful ulcer on erythematous base with exudate
Tx: Azithro or CTX
Granuloma Inguinale
Klebsiella granulomatis
Nodular lesions that form ulcers, which slowly enlarge and have friable, raised, and rolled margins
Micro: safety pin–shaped/rod shaped (deep purple) encapsulated bacilli (called Donovan bodies) that appear inside cytoplasm of infected cells
Usually in sexually active traveler from outside US
Peak height velocity
girls during SMR 2–3 at a mean age of 11.5 years
VS boy: PHV occurs during SMR 3–4 at a mean age of 13.5 years.
