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.
Anorexia Hospitalization Indications
systolic BP < 90
weight < 75% ideal body weight
body fat < 10%
dehydration and/or electrolyte imbalances
cardiac arrythmias
orthostatics
hypothermia (core body temperature < 96.0° F (35.5° C) failure of outpatient intervention
acute psychiatric emergencies and suicidal ideations, refusal to eat.
G/C tx
Gonorrhea
ceftriaxone 250 mg intramuscularly
azithromycin 1 g orally in a single dose
Chlamydia
Just azithro
Retest in 3 months in order to determine if they’ve been reinfected
PID
ceftriaxone 250 mg intramuscularly
doxy 100 BID x 14d
+/- metronidazole 500 BID x 14d
Refeeding Syndrome
During refeeding, insulin secretion resumes in response to increased blood sugar, resulting in increased glycogen, fat and protein synthesis.
This process requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up.
depletion of intracellular adenosine triphosphate (ATP). As a result, a patient’s cardiorespiratory status may be adversely affected, placing them at risk for arrhythmias, decreased cardiac output, and/or respiratory compromise.
Hypophos, HypoMag, HypoK
Sport and injury associated
Tennis = lateral epicondylitis of humerus due to repetitive backhand motions
Golf and Little League = medial epicondylitis
Jumping (Bball/Vball) = avulsion of tibial tubercle
Testicular Cancer
Painless swelling or nodules in 1 testicle
“Heaviness” or dull aching pain in lower abd/scrotum
Additional sx with mets
Seminoma
Nonnseminomatous germ cell tumors
- associated with increased AFP, bHCG, LDH
Lymphogranuloma Venereum
L1, L2, and L3 serovars of Chlamydia trachomatis
Tx: doxycycline 100 mg PO bid × 21 days
Primary infection = asymptomatic genital ulcer(s) that often goes unrecognized and heals spontaneously within a few days.
Secondary stage presents 2–6 weeks later. It is due to local extension of the organism through the lymphatic channels to regional lymph nodes. This leads to an inflammatory reaction in the superficial and deep inguinal nodes, causing a characteristic “groove” sign.
When is pubertal gynecomastia?
Early (11-14) to middle (15-17) adolescence
Usually resolves over 6-24 months.
Lymphogranuloma Venereum
Chlamydia Trachomatis
- primary lesion - small painless papules that becomes painless ulceration that heals on it sown
- FEMORAL LAD 2-6 wks aftterwards (vs no nodes in syphilis)
Physiologic Leukorrhea
pH < 4-4.5 (higher is assoc. with BV and Trich)
normal vaginal lactobaccili
epithelial cells
Premenstrual Dysphoric Disorder
Depressive, anxiety, lability and irritability, etc.
Tx: Fluoxetine
Fibroadenoma
Fibroadenomas that are < 3 cm in size and without concerning features can be initially observed every 1–2 months for growth or regression.
Fibrotic tissue and/or cysts are most often located in the upper outer quadrant of the breast. Oral contraceptives improve symptoms in the majority of women. Limiting caffeine intake may provide pain relief for some patients.
Testicular Neoplasm
precocious puberty/androgen excess, gynecomastia
b-hCG, AFP, LDH, testicular US, and CT to look for mets
AAP recommends screening for in adolescents 12-21 yrs
Depression
Substance use
NOT anxiety
What side effects are known to be associated with use of the progestin in OCPS? of the estrogen?
Progestin:
- has varying degrees of androgenic activity (oily skin, acne, wt gain, hirsuitism)
- progestin effects (fatigue, bloating)
Estrogen:
- nausea, bloating
- migrane/headaches
- wt gain
- irritability
- cystic breast changes and breast tenderness
- hyperpigmentation
Vaginal Agenesis
MRKH syndrome = Mullerian agenesis
- congenital malformation characterized by a failure of the Müllerian duct to develop, resulting in a missing uterus and vagina
- external genitalia is normal
- normal karyotype, FSH and LH levels, ovaries
Why is adolescent cervix susceptible to HPV?
Transformation zone of cervix is undergoing metaplasia - transition from columnar epithelium to squamous epithelium.
This process is active during puberty and complete in early 20s
HPV infects the cervix in this area.
Pediculosis
Crab louse
- pale bluish 0.5-1cm macules (feedin sites of the louse)
- transmitted during sexual contact
- pubic hairs and hairs of abdomen, thighs, axilla may have the lice/nits along hair shafts
Tx: Permethrin
Sexual Assault
Empiric treatment for chlamydia, gonorrhea, and Trichomonas is recommended at the time of initial sexual assault evaluation.
In cases of sexual assault, postexposure human immunodeficiency virus prophylaxis should be individualized according to risk.
