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Pediatric Board Prep > Adolescent > Flashcards

Adolescent Flashcards

1
Q

What are the 3 clinical symptoms required to make up a minimal set of clinical criteria for PID (pelvic inflammatory disease) to initiate empiric therapy?

A
  1. Cervical motion tenderness
  2. Uterine tenderness
  3. Adnexal tenderness
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2
Q

What is the most common orthopedic complication of repetitive tennis playing?

A

Lateral epicondylitis
(Tennis elbow)
-reproducible pain on and around lateral epicondyle, & with resisted wrist extension and supination
-no warmth or erythema

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3
Q

What is the most common orthopedic complication of repetitive golfing?

A

Medial epicondylitis
(Golfer’s elbow)
-pain on and around medial epicondyle and during wrist flexion

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4
Q

What accounts for the high incidence of new HPV infections in sexually active adolescents?

A

Metaplasia within cervical transformation zone (columnar epithelium transform into squamous epithelium)

  • very active during puberty until early 20’s
  • 90% of infections are transient & clear w/in 2 years
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5
Q

What is the criteria to be an emancipated minor? (3)

A

1) < 18 years old
2) married/ previously married, a parent, serving in military, living independently
3) managing own finances

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6
Q

What is Asherman syndrome?

A

secondary amenorrhea due to avascular intrauterine adhesions (synechiae) & fibrosis after endometritis
-diagnosis with hysteroscopy or sonohysterography

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7
Q

What is the best initial treatment of a non-pregnant patient with Chlamydia infection?

A

Azithromycin 1 gram orally with retest in 3 months (to assess for reinfection)
-test of cure done in pregnant pt’s after 3 weeks

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8
Q

What is Fitz-Hugh-Curtis syndrome?

A

extrapelvic manifestation of PID due to ascending infection

  • infection & inflammation of hepatic capsule & right diaphragm
  • LFT normal, elevated acute phase reactions
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9
Q

What medication used to treat STIs results in a disulfiram-like reaction if the patient consumes alcohol?

A

Metronidazole

  • used for bacterial vaginosis (500 mg BID for 7 days)
  • flushing, tachycardia, palpitations, nausea, vomiting
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10
Q

What is the most common bacteria that causes breast abscesses in newborns?

A

Staph aureus

-tx w/ Clindamycin, Bactrim, Vanc if MRSA risk

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11
Q

What antimicrobial medication can result in decrease serum estrogen & progrestin levels from OCPs; and, therefore, backup method of contraception should be used?

A

Rifampin

-remember anti-seizure meds (phenytoin, carbamazepine, barbituates, topamax, oxcarbazepine) can have same effect

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12
Q

What is the best initial treatment for pt with fibrocystic breast changes (tender cystlike mobile mass associated with fibrotic tissue, pain worse just prior to menses)?

A

NSAIDs (ibuprofen) and recheck in 1-2 months

  • usually resolve over 1-2 menstrual cycles
  • caffeine can make worse
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13
Q

What are the 3 most common causes of death in adolescents?

A
  1. Unintentional injury (MVA, drowning, ATV, guns accidents)
  2. homicide
  3. suicide
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14
Q

What is the preferred outpatient treatment for gonococcal urethritis (or vaginitis)?

A

Cefriaxone 250 mg IM with azithromycin 1gram oral

treat for gonorrhea and presumptive chlamydia coinfection

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15
Q

What is the most common cause of death in adolescents?

A

Unintentional injuries (~40% of deaths)

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16
Q

What is the treatment for congenital syphillis?

A

1) Aqueous penicillin G 50K units/kg IV q 8-12 hrs for 10 days
2) Procaine penicillin G 50K units/kg IM for 10 days

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17
Q

A child aged weeks to 2 years old presents with diffuse reddish papulosquamous rash that fades to copper, hepatomegaly, lymphadenolpathy, jaundice, hemorrhagic rhinitis, elevated LFTs, hemolytic anemia, thrombocytopenia most likely suffers from…?

A

Congenital Syphillis

check VDRL and RPR

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18
Q

What lab abnormalities is associated with bulimia/ purging disorder? (2)

A

1) Hypokalemia

2) Hypochloremic metabolic acidosis

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19
Q

What is the lab abnormality associated with cardiac failure (arrhythmias) ad respiratory compromise in severe anorexics undergoing treatment?

A

hypophosphatemia

refeeding syndrome- phosphate needed for myocardial & diaphragm contractility

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20
Q

What organism is characterized as rod-shaped, oval organisms (safety pin shaped encapsulated bacilli) within the cytoplasm of mononuclear phagocytes on Wright Stain and can cause painless genital ulcers?

A

Klebsiella granulomatous

  • Donovan bodies
  • aka granuloma inguinale (Donovanosis)
  • more common in India, Carribbean, south Africa
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21
Q

During which sexual maturity rating is the peak height velocity for girls?

A

SMR 2-3 (~11.5 years)

-boys occur during SMR 3-4 (~13.5)

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22
Q

What diagnosis is characterized by the triad of migratory arthritis, tenosynovitis, and dermatitis (painless pustules) especially in a sexually active pt?

A

Disseminated gonococcal infection

  • 2-3 weeks of primary GU infection, often w/ menses
  • dxw/ nucleic acid amplification testing (NAAT)
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23
Q

What is the outpatient treatment for PID (pelvic inflammatory disease)?

A

IM Ceftriaxone 250 mg plus Doxycycline 100 mg BID to complete 14 day course
or
Azithromycin (500 mg once followed by 250 mg to complete 7 days)

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24
Q

What is the most common cause of abnormal uterine bleeding (AUB) in adolescents during initial 1-2 years of menarche?

A

Anovulatory cycle

  • due to immarturity of hypothalamic-pituitary-ovarian axis
  • tx w/ monophasic OCPs at set interval until bleeding stops
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25
Q

What is the cause of vaginal discharge that is most often associated with increase vaginal pH?

A 
Bacterial vaginosis
(vaginal pH > 4.5, clue cells on wet mount, positive Whiff test, thin grayish-white discharge)
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26
Q

What is the average peak height velocity in girls?

A

8.3 cm per year

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27
Q

What is the average peak height velocity in boys?

A

9.5 cm per year

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28
Q

What disease is the groove sign (tender femoral lymphadenopathy and inguinal lymphadenopathy) characteristic of?

A

Lymphogranuloma venereum

-due to Chlamydia trachomatis (L1, L2, L3)

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29
Q

True or false. Women should be encouraged to used OCPs for birth control if they have liver disease.

A

False

-OCPs are metabolized by liver so should discourage if have liver disease or tumor

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30
Q

An athlete who develops peripheral edema, insulin resistance, hyperglycemia, and HTN most likely using what performance-enhancing drug?

A

Recombinant human growth hormone

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31
Q

What is the most common structural cardiac complication among pt’s with anorexia nervosa?

A

mitral valve prolapse

-late systolic murmur at apex preceded by a click

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32
Q

What is Russell sign and what diagnosis is it associated with?

A

calluses on knuckles due to hand continually hitting teeth associated with self induced vomiting in bulimia

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33
Q

What is the first sign of puberty in boys?

A

increased testicular size

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34
Q

What is the diagnostic finding for bacterial vaginosis?

A

Clue cells (vaginal epithelial cells with a stippled membrane covered with adherent bacteria)

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35
Q

What is the treatment for primary syphillis infection?

A

single dose of Penicillin G benzathine 2.4 mil units IM

36
Q

What is the likely diagnosis for an adolescent presenting with mobile, painless, rubbery, well circumscribed breast mass?

A

juvenile fibroadenma

  • if < 3 cm w/out concerning features, can be observed for 1-2 months
  • ultrasound if large or uncharacteristic
37
Q

What is the initial manifestation of puberty in females?

A

Thelarche (Breast/ areolar development)

38
Q

How long after thelarche does menarche usually occur?

A

2-2.5 years

39
Q

What is the most common cause for a painful ulcerative lesion (mainly single, but can be multiple) with grayish-yellow exudate and inguinal lymphadenopathy?

A

Haemophilus ducreyi

  • small papule that erodes over days
  • tx w/ Azithromycin 1g PO or Ceftriaxone 250 mg IM
40
Q

What is the most appropriate management of a breastfeeding baby when mother has mastitis?

A

continue to breastfeed from both breast

  • helps mother resolve infection
  • avoid if there is open wound (from I&D)
41
Q

Delayed development in boys is defined by lack of testicular enlargement by ___ years old.

A

14

2.5 standard deviations beyond average age of onset of 11.6 years

42
Q

What is the most concerning side effect related to use of oral contraceptives?

A

Deep vein thrombosis (DVT)

-history of thromboembolism is contraindication for estrogen-containing contraceptives

43
Q

What is the most common cause for postcoital bleeding in female with normal Pap smear?

A

Endocervical polyp

44
Q

Does the sexual partner need to be treated if a female is diagnosed with bacterial vaginosis?

A

No

45
Q

What are the two mainstay treatments for dysmenorrhea (N/V, abdominal cramps, headaches) associated with menses?

A
  1. NSAIDs

2. OCPs

46
Q

What is Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome?

A

mullerian aplasia

  • vagina and uterus are underdeveloped (primary amenorrhea)
  • still have breast and axillary/ pubic hair development
  • can have abnormal kidneys and urinary tract
47
Q

What is the organism responsible for tender papule with surrounding erythema (chancroid) with gram stain showing gram negative rods in chains (with appearance of school of fish, railroad tracks, fingerprints)?

A

Haemophilus ducreyi

48
Q

What is the likely diagnosis for a patient presenting with purulent, malodorous, green-yellow thin discharge, pruritis, dysuria, urinary frequency dyspareunia, and cervix with punctate hemorrhages?

A

Trichomoniasis (due to trichomonas vaginalis)

-tx w/ metronidazole

49
Q

What is the most common cause of epididymitis (scrotal edema, swollen tender epididymis)?

A

Chlamydia trachomatis and/or Neisseria gonorrhoeae

-tx w/ Ceftriazone plus doxycycline/ azithromycin

50
Q

What are the indications for hospitalization for pt with anorexia nervosa? (9)

A
  1. wt < 75% ideal body wt
  2. body fat < 10%,
  3. dehydration or electrolyte imbalance
  4. cardiac arrythmias
  5. orthostatic hypotension (pulse increase by > 20, or SBP decreased by > 10)
  6. hypothermia (temp < 96)
  7. failed outpatient tx
  8. psych emergencies or suicidal ideation
  9. refusal to eat
51
Q

What is the female athletic triad associated with increase risk of stress fractures?`

A
  1. menstrual disturbances (hypothalamic amenorrhea)
  2. disordered eating (inadequate Ca intake)
  3. decreased bone mineral density (osteoporosis)
52
Q

What is the testicular volume associated with the various sexual maturity rating (SMR) level for boys?

A 
SMR 1: < 4ml
SMR 2: 4-8 ml
SMR 3: 8-12 ml
SMR 4: 12-20 ml
SMR 5: ~20ml
53
Q

What diagnosis is associated with numerous pale blue 0.5-1cm macules over the lower abdomen, proximal thighs and buttocks?

A

Pediculosis due to pubic lice

-tx with permethrin 1% cream

54
Q

What is the best pharmacologic method of birth control for a patient who has a seizure disorder and on anti-seizure therapy?

A

Depo medroxyprogesterone acetate (DMPA)

-may have intrinsic antiseizure properties & efficacy not affected by antiseizure meds

55
Q

What is the best post-exposure prophylaxis for individuals exposed to Hep A infected individual?

A

administer hep A vaccine or immunoglobulin to unimmunized exposed individuals

56
Q

What are common side effects of progestins in OCPs? (3)

A
  1. oily skin and acne
  2. weight gain
  3. hirsuitism
57
Q

What is the pathophysiologic cause for anovulatory menstruation in pt who experienced menarche < 2 years?

A

absence of LH midsurge so no ovulation and no functional corpus luteum formation

58
Q

What is the most likely diagnosis for a pt with acute testicular pain, swollen testicle, tenderness to palpation of testes, absent cremasteric reflex on affected side and affected testicle high riding?

A

Testicular torsion

  • twisting of the testis and spermatic cord
  • usually 12-18 years of age
59
Q

What is the prehn sign?

A

relief of pain following elevation of scrotum

-associated with epididymitis

60
Q

What is the likely diagnosis of a pre-menstruating female who presents with grayish-white vaginal discharge, wet prep showing numerous lactobacilli and few leukocytes, and vaginal pH 4-4.5?

A

Physiologic leukorrhea

-occurs 6-12 months prior to menarche

61
Q

What is the gram stain for Neisseria gonorrhea?

A

gram negative intracellular diplococci

62
Q

True or False. Females with Mullerian agenesis have normal levels of luteinizing hormone and follicle-stimulating hormone.

A

True

63
Q

What are the indications for hospitalization for pelvic inflammatory disease (PID)?

A
  1. pregnancy
  2. surgical emergency (appendicitis, etc)
  3. suspected pelvic/tuboovarian abscess
  4. N/V precluding oral therapy
  5. failed oral tx after 24-48 hrs
64
Q

What is the most likely diagnosis of adolescent who presents with generalized rash (macular & papulosquamous rash characterized by reddish-brown, sharply demarcated lesions following lines of cleavage), lymphadenopathy (rubbery firm painless lymph nodes), and flu-like symptoms?

A

Secondary syphilis

65
Q

What is the “female athlete triad”? And what is the treatment?

A
  1. eating disorder
  2. amenorrhea
  3. osteoporosis

Increasing caloric intake with dietitian assistance

66
Q

What are the absolute contraindications to combined hormonal OCPs? (7)

A
  1. hx of DVT, PE, and known thrombogenic mutation (Factor V Leiden, Protein S/C deficiency)
  2. Migraine with aura or focal neuro deficit
  3. complicated valvular disease
  4. Hypertension (SBP> 160, DBP > 100)
  5. active liver disease
  6. hepatic tumor
  7. breast cancer
67
Q

What is a relatively likely complication of a post-partum women who had significant post-partum hemorrhage?

A

Sheehan syndrome

Hypopituitarism due to pituitary infarction from postpartum hemorrhage and shock

68
Q

What is spondylolysis?

A

vertebral injury involving fracture of pars interarticularis is due to overuse and repetitive stress

69
Q

What is the purpose of the 10 day progestin challenge for an adolescent with secondary amenorrhea (absence of menses > 3months if have regular menses or 6 months if had irregular cycles)?

A

to assess adequate uterine endometrial lining due to adequate endogenous estrogen

(if no withdrawal bleed, consider eating disorder, excessive stress/ exercise)

70
Q

What is the treatment for lymphogranuloma venereum?

A

Doxycycline 100 mg PO BID for 3 weeks

asymptomatic genital ulcer followed by lymph node inflammation

71
Q

A female who presents with severe pain & swelling that interferes with walking/ sitting and worsens with sex with a tender mass at the 4 or 8 o clock position with respect to the vaginal opening most likely has ….

A

Bartholin gland abscess

tx: I&D, warm compresses, sitz baths

72
Q

What are the benefits of Depo (IM progestin only birth control)?

A
  1. protection against endometrial hyperplasia
  2. protection against PID
  3. regulation of menstrual cycle or amenorrhea
73
Q

What is the mean age of onset for male gynecomastia?

A

13 years old

74
Q

A male who presents with weight loss, proximal lower extremity pain, elevated alpha-fetoprotein/ beta-HCG and painless nodule/ swelling of testicle most likely suffers from ….

A

Testicular cancer

75
Q

What is the function of the progesterone challenge in secondary amenorrhea?

A

to assess adequate estrogen effect on the building of the uterine lining
(PCOS- would have estrogen but no progesterone)

76
Q

What are the most common complications of intrauterine devices (IUD)? (3)

A
  1. uterine perforation
  2. menstrual cycle abnormality
  3. IUD explusion
77
Q

What is a common side effect of Depo (injectable progesterone only)?

A

delayed return to fertility

78
Q

What is the most likely diagnosis for male presenting with painless cystic like nodule above the upper pole of the testicle which transilluminates?

A

Spermatocele

79
Q

What is the best step in management of individuals exposed to a Hep A positive close contact?

A

Provide Hep A vaccine (or Immunoglobulin if vaccine not available) to unimmunized individuals

80
Q

What are the 3 indications for involuntary drug testing?

A

1) unexplained seizure
2) emergency (accident)
3) attempted suicide

81
Q

What are indications for breaking confidentiality with a mature minor/ teen? (3)

A

1) sexual/ physical abuse
2) threat of harm to self or others
3) nonadherence to treatment for chronic disease

82
Q

How long after the onset of puberty (usually thelarche) does menarche begin?

A

2-2.5 years later

83
Q

What is a common cardiac complication of anorexia nervosa?

A

Mitral valve prolapse

end systolic murmur at apex followed by click

84
Q

What is the female athlete triad?

A

1) dysmenorrhea/ amenorrhea
2) low bone density
3) disordered eating/ energy deficiency

85
Q

What is a common laboratory finding in patients with athlete triad?

A

low FSH and low LH

86
Q

What are the 3 definitions for abnormal uterine bleeding (AUB)

A

1) cycle occurs less than 20 days or more than 45 days apart
2) menses lasts more than 8 days
3) large amount of blood loss per period (more than 80 ml or 6 pads a day or results in anemia)

87
Q

What is the most likely diagnosis for patient (likely homeless or unkempt) who presents with numerous pale bluish 0.5 to 1 cm macules on abdomen, thigh, and buttocks?

A

Pubic Lice

Pediatric Board Prep (26 decks)

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