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RC: Specialties Woo Hoo > Adolescent and Gyne > Flashcards

Adolescent and Gyne Flashcards

1
Q

T or F: parental conflict peaks in mid-adolescence.

A

True

Also: abstract thinking.

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2
Q

When does menstruation occur?

A

Tanner Stage 4

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3
Q

What occurs in Tanner Stage 4?

A

M:

  • *- max penile growth
  • axillary hair, voice change

F:

  • *- double breast contour
  • *- menarche
  • coarse, curly hair
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4
Q

What occurs in Tanner Stage 2?

A

M:

  • *- testicular enlargement
  • pubic at base

F:

  • *- breast bud
  • hair on labia
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5
Q

What occurs in Tanner Stage 3?

A

M:

  • *- penile growth
  • voice break

F:

  • breast + areola enlarged; no sep contour
  • *- peak ht velocity
  • acne
  • dark hair start too curl
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6
Q

14 y.o. M 3cm unilateral tender breast.

  • US
  • F/U 6 mo
  • Karyotype
  • CT scan
A

F/U in 6 month

Pubertal Gynecomastia

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7
Q

When does preoccupation with body image occur?

A

Early adolescence

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8
Q

3 reasons to breach confidentiality:

A
  • harm to self or others
  • harm to other children
  • communicable dx (reportable diseases)
  • impaired driving ability (report any >16 y.o. suffering condition that make it diff to drive)
  • gun shot wounds
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9
Q

5 things to help transition teen to adult care:

A
  1. see teen w/out parent for part of apt
  2. give increasingly level of responsibility or info
  3. peer support meetings
  4. provide transition letter
  5. collaborate w/ adult care provider
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10
Q

Which is more commonly seen in bulimia nervosa compared to anorexia nervosa:

  • cachexia
  • hypothermia
  • low BP
  • enlarge salivary glands
  • extremely dry skin
A

Enlarged salivary glands

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11
Q

Kids with AN becomes osteopenia because:

A

Estrogen deficiency

+ high cortisol, low IGF-1, low lean body mass, low wt, nutritional, amenorrhea

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12
Q

Is lanugo or alopecia seen in anorexia nervosa?

A

Lanugo

AN= full thinning scalp hair. 
Other AN signs
- orthostatic change
- low temp
- thinning hair
- draw skin, lanugo
- delayed pubertal
- atrophic breast
- cold limb
- orange skin (carotenemia)
- edema of limbs
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13
Q

List criteria for Anorexia Nervosa?

A
  • Fear of gaining wt
  • Disturbance in wt/shape
  • Restricted intake for requirements (leading to low wt for age, sex, developmental trajectory)
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14
Q

List criteria for Bulimia Nervosa?

A
  • Self-evaluation influenced by shape + wt
  • Binge eating (eat excessive amount + lack of control during episode)
  • Compensatory behaviour (vomit, laxative, diuretic, med, fasting)
  • 1X/ wk x 3 month

Note: Binge Eating Dix is just the binge without compensatory behaviour.

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15
Q

What comorbidities do you see with Bulimia?

P/E findings?

A
  • Depression
  • Anxiety
  • Substance use
  • Cluster B/ borderline PD

P/E:

  • Older
  • large parotid
  • oral ulcer
  • dental enamel erosion
  • russell sign (callus on knuckle)
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16
Q

What is ARFID?

A

Eating disturbance=
- Result in wt loss or nutritional deficiency or depend on enteral feed or interfere w/ f’n

  • No body image disturbance
  • Not due to other medical illness
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17
Q

List 3 DDX of eating disorders:

A

GI: IBD, Celiac, Infectious Gastro, HIV
Endo: Thyroid, DM, addison’s
Psychiatric: OCD, Substance use
Other: CNS lesion, SMA syndrome, CA

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18
Q

T or F: growth, atrophy, bone density issue are irreversible issues with eating disorder.

A

True

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19
Q

What is the tx target avg body weight for kids with ED?

A

90% of average body wt for sex, ht, age

Goal: nutritional rehab by parents -> then switch of responsibility to teen (wt already restored) -> focus on teen development

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20
Q

Reasons to admit for eating disorder:

A

Physical:

  • *- T < 36.1
  • *- HR < 50 bpm awake (< 45 asleep)
  • *- BP < 80/50
  • *- orthostatic BP
  • dehydration, syncope
  • *- rhythm/ long QT
  • < 75-80% body wt
  • body fat < 10%

Psych:

  • *- SI (intent + plant)
  • poor motivation to recover
  • coexisting psych d/o

Lab:

  • low K, Phos, BG, Cl
  • liver, cardiac, renal compromise

Other:

  • *- failed outpatient tx
  • *- refusal to eat/ intractable vomiting
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21
Q

What are common comorbidities with anorexia nervosa?

A
  • Anxiety

- Depression

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22
Q

Which is most worrisome in anorexic pt?

  • low K
  • WBC < 1000
  • Met alkalosis
  • low protein
A

Low K

BW AbN:
- usually low WBC, low Hb, low K, if ++ vomit then low Cl- and met alkalosis in severe vomiting, elevated liver enzyme, long QTc

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23
Q

How do you prevent osteoporosis in an anorexic?

  • Ca
  • Vit D
  • Estrogen
  • Gain wt to min. 10% ideal wt
A

Calcium

** always Ca+ and vit D supplement for risk of low bone mineral density.

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24
Q

White early teen F with above avg intelligence and is avoidant perfectionist struggling with mood or anxiety. Anorexia Nervosa or Bulimia Nervosa?

A

Anorexia Nervosa

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25
Q

List some effects of starvation:

A

Brain: hypothalamic, depression, irritable

Cardiac: sinus brady, long QTc, MV prolapse

Refeeding: risk low Phos, K, Na, Mg etc.

GI: delayed gastric emptying, constipation, SMA syndrome

Gonads: amenorrhea, erectile dysfunction

Bones/ Osteopenia

Growth failure

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26
Q

List bulimia BW

A
  • Low Na (can be hi/N)
  • Low K
  • Low Cl
  • Metabolic Alkalosis
  • Co2 up (compensation)
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27
Q

What is the most f cause of school absence of teen F:

  • h/a
  • dysmenorrhea
  • asthma
  • sore throat
A

Dysmenorrhea

AAP 1980 - “dysmenorrhea is leading cause of recurrent short term school absenteeism among teen F”

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28
Q

List a ddx for dysmenorrhea?

A
  • Primary dysmenorrhea
    • if pain between menses= NOT primary!
- Secondary 
> Endometriosis
>Pelvic inflammatory dx
>Preg complication
> Mullerian anomalies w/ partial outflow tract obstruction
> Abuse
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29
Q

Best for PCOS: increased LH/FSH, HTN or increased testosterone.

A

Testosterone ++

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30
Q

Just menarche. Pre and Post White vag d/c intermittent. Occasional irritation or itch. Likely dx?

A

Physiologic leukorrhea

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31
Q

Menometrorrhagia x 6 months. Bleed x 3 month.

  • LOW E
  • HIGH progesterone
  • vWF deficiency
  • LOW progesterone
A

=LOW progesterone.
(Remember E makes the grass and P is the lawn mower)

Menometrorrhagia= prolonged bleed irregular or more f than usual.

Irregular means not VWF

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32
Q

12 y.o. with T21. Menses hard to manage. Best option?

  • depo
  • IUD
  • Continuous OCP x 84 days
  • LHRH agonist
A

Continuous OCP x 84 weeks.

AAP 2016: OCP still most commonly used.

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33
Q

What excludes PID?

  • neg. preg test
  • neg. screen GC
  • neg. screen Chlam
  • no WBC on cervical d/c
A

Absence of WBC in cervical d/c

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34
Q

What is pelvic inflammatory dx?

A

Infection of F upper genital tract.

Etiology: polymicrobial.

  • STI (chlamydia, gonorrhoea, HSV)
  • mycoplasma, ureaplasma
  • anaerobic
  • other: E coli, gardnerella vaginalis, haemophils influenzae

CC: abdo pain + fever
- abdo + pelvic exam

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35
Q

Pelvic inflammatory disorder dx criteria:

A 
Clinical dx: 
Lower abdo Pain + 1= 
= adnexal tender
= cervical motion tenderness
= Uterine tenderness

To add specificity:

  • mucopurulent d/c or WBC on saline prep
  • fever
  • high ESR, CRP
  • document of infection

Definitive dx if endometrial bx, US show fluid filled tubes, or Laparoscopy show abnormalities w/ PID

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36
Q

Treat of pelvic inflammatory disease:

A

+/- Hospitalization
Cefotixin IV + doxy IV
then Doxy x 14d

Otherwise IV= PO
i.e. ceftriaxone x 1 and doxy x14d +/- flagyll

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37
Q

T or F: early dx and tx of PID key to maintain fertility.

A

True

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38
Q

What are PID complications:

A

CAFE PID

  • chronic pelvic pain
  • abscess
  • fitz-hugh-curtis syn
  • peritonitis
  • infertility
  • disseminated infection
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39
Q

Define precocious puberty

A

M < 9 (9-14 Norm)

F < 8 (8-13 Norm)

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40
Q

T or F: premature thelarche only if < 5.

A

False.
Only if < 2.
+ no ht acceleration, no adv bone age, no other sign.

If > 3= ensure no central cause.

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41
Q

T or F: premature menarche can be normal.

A

False!

Must always look for a cause!

42
Q

Dysmenorrhea. 3 causes? What two meds you can offer? How does it work?

A

3 Causes:

  • primary/ idiopathic
  • endometriosis
  • uterine polyps
  • ovarian cyst
  • PID
  • FB

Treatment:

  • Exercise
  • Well balanced Diet
  • Topical heat

Two med Classes:

  1. NSAID (take as soon as you know menses coming) (prostaglandin synthetase inhibitor)
  2. OCP
43
Q

Started menarche but irregular. No dysmenorrhea. Likely cause and 2 Tx?

A

Likely cause:
- anovulatory cycle due to immaturity of HPO axis

Tx:

  • Reassurance
  • Consider oral iron supplementation
  • Consider OCP if troublesome
44
Q

4 things on dx of vaginal bleeding in 8 y.o.

A
  • FB (toilet paper)
  • *- Sexual Abuse
  • ** Trauma
  • Central (Tumour affecting HPO axis)
  • *- Hypothyroidism

Other

  • Vulvovaginitis
  • McCune Albright Syn
  • genital tract malignancy
  • estrogen exposure
  • hemangioma
45
Q

Absolute contraindication to OCP

A

*Migraine w/ aura
*Severe cirrhosis
*Uncontrolled HTN
*DM w/ neuropathy, nephropathy, retinopathy
*Acute DVT or PE
Known thrombophilia
*Hx of Stroke
Valvular Heart Dx
*SLE w/ antiphospholipid antibodies
Current breast CA

Note: smoking RELATIVE and really if ++ older

46
Q

T or F: IUD cause infertility.

A

False.

47
Q

T or F: you must do urine beta HCG before taking morning after pill.

A

False.

Not necessary.

48
Q

What are absolute contraindication to morning after pill?

A
  1. Known pregnancy
    * can give without preg test as even if (+) won’t cause therapeutic abortion.
  2. Known allergy (anaphylaxis to product)
49
Q

Chlamydia urethritis teen. Before can have sex again:

  • must complete 7d of tx
  • after partner tx
  • after 6d
  • until retested and found negative.
A

Can resume sex activity ONCE HE completes 7d of TX

  • 1x azithro OR 7d course doxy
  • sexual partners should be treated if contact within 60d of symptom onset
  • most recent partner always treated
  • no sex until 7d after single dose or after complete 7d regiment
50
Q

T or F: most teenage pregnancies end in abortion

A

True

- just over 50%

51
Q

T or F: most pubertal teen with chlamydia are asymptomatic.

A

True

52
Q

Best tx of gonorrhoea?

A

Tx: Ceftriaxone (or cefixime) x1 and Azithro x 1 (*always tx presumptive chlamydia)

Other:

  • Gram neg. diplococcus
  • most F asymptomatic and most men symp.
  • NAAT
53
Q

T or F: you can immediately give contraception after an abortion. Versus 2 wk later.

A

True - give immediately!

54
Q

When do menses return after emergency contraception

A

Return within 7d within expected date

  • if next period more than 1 wk late = do pregnancy test
55
Q

Sexually active teen. Pruritic genital lesions. Red macule and papule and blue-grey. Dx? Tx?

A

Dx: Pubic Lice

Key: pruritus, bites (blue-grey; look like bruises)

Dx: ID egg (nits), nymphs, lice with make eye

Tx: 1% Permethrin Cream rinse
Eyelid: petrolatum ointment x 8-10d

Prevention:

  • machine wash + dryer everything hot
  • vacuum everything
  • avoid sex until tx
  • tell all sex partners in last month
56
Q

Most common bug of urethritis:

A
  • N. gonorrhea most likely

Other: ureaplasma urealyticum, mycoplasma genitalium, trichomonas

57
Q

Teen comes in for morning after pill. Latest after intercourse it is effective? Two things in management after?

A

*Maximum 72-120h

Subsequent:

  • counsel for pill failure
  • if period doesn’t return within 1 wk of usual timing then need preg testing
  • if becomes pregnant discuss options
  • counsel safe sex (does not protect against STI)
  • encourage barrier protection
58
Q

T or F: liver CA is one potential long-term sequelae of anabolic steroid use.

A

True

Other listed AE:

  • aggression, anxiety, depression + others
  • HTN
  • low glucose tolerance
  • hepatic transaminitis
  • poor sperm count and testicular atrophy
  • menstrual irregularities
59
Q

Most important reason to be concerned about teen alcohol abuse:

  • risk taking behav while drinking
  • assoc. depression
  • liver dx
  • poor school performace
A

Risk taking behaviour while drinking.

60
Q

List fives things that would increase concern for substance abuse in patient:

A
  • type of drug
  • circumstance (alone vs. group)
  • f and timing
  • premorbid mental health dx
  • general functioning

CRAFT Mnemonic: screen fo substance use in primary care. In last 12 months…

  • CAR- ridden in car who was high or using
  • RELAX- used to fit in
  • ALONE- use
  • FORGET- thing while using
  • FAMILY + FRIENDS- tell you to cut down
  • TROUBLE- while using
61
Q

4 clinical manifestations of cocaine use?

A
  • euphoria
  • psychosis
  • motor agitation
  • decreased fatiguability
  • mental alertness
  • sympathomimetic: all UP (pupils dilated, tachy, HTN, high T, high RR)
62
Q

T or F: antidepressants can cause sexual dysfunction in teens.

A

True- SSRI

Other: GI symptom, h/a, insomnia, appetite change, anxiety, increased SI thoughts

63
Q

Why are testes small if anabolic steroids used?

A 
Exogenous steroid
= suppress HPA
 = less FSH + LH
= less T and spermatogenesis
= less size of testes
64
Q

T or F: parenting classes do not affect rate of child abuse.

A

False.

HELP REDUCE RISK.

65
Q

Risk of depression recurrence within first year of d/c SSRI tx?

A

40%

66
Q

Child on fluoxetine and risperidone. High DTR + tremor + ataxia.

Which drug is the problem:
fluoxetine?
Risperidone?

A

** Serotonin= d/c +/- cyproheptadine

Serotonin Syndrome:
HARMED
- hyperthermia (all VS up)
- agitation
- reflexes ++, rigid
- myoclonus
- encephalopathy
- diaphoresis
Risperidone:
- EPS (dystonia, restless, tremor, tardive dyskinesia)
- long QT
- metabolic syn
- wt gain
-DM
- high lipid
- high prolactin
- hepatotoxicity
- low WBC, neut (= agranulocytosis)
- sz
- NMS
= FEVER (slow onset with more generalized rigidity)
- fever, encephalopathy, VS unstable, high CK, rigid (lead pie) muscles
67
Q

Suicide RF for teens. List what you remember.

A
  • M
  • Low SES
  • homosexual
  • mental health dx
  • substance abuse
  • impulsivity
  • low self-esteem
  • perfectionism
  • hopelessness
  • parental divorce or death
  • adverse childhood exerpeince
  • hx of abuse
  • bullying
  • parent mental health
  • fhx (+) suicide
68
Q

T or F: tourettes is min. 2 motor + 1 vocal x 6 month.

A

False.
x1 year
<18 y.o.

Co-morbid: ADHD, OCD, LD

if interfere w/ life= Tx= Clonidine

69
Q

T or F: oral sex is more common than sexual intercourse?

A

True

70
Q

T or F: 1/3 of grade 10 F and M have had sex.

A

True.

71
Q

How can you remember Age of Consent in Canada?

A

16 unless authority or exploitative.

Close age exception:
“2 and 2; 5 and 5”
12-13= consent with someone up to 2yr older
14-15= can consent up to 5yr older

72
Q

T or F: pregnancy rates among Canadian teens are rising.

A

False; declining.

73
Q

T or F: > 1/3 of teen who deliver will have another preg within 2yr.

A

True.

74
Q

T or F: post partum depression risk in teens > older mom.

A

False.

Post partum depression rate similar to non-teen mom.

75
Q

List the failure rate of the following contraceptive methods:

  • chance
  • withdrawal
  • condom
  • combined pill
  • depo
  • LARC
A 
Chance= 85%
Withdrawal= 22%
Condom=18%
Combined= 9%
Depo= 6%
LARC= 0.2 %

Note: if < 90kg combined pill even less effective.

76
Q

T or F: LARC fertility takes 6 month once its removed.

A

False.

1-2 cycles.

77
Q

T or F: there is a increase risk of STI or PID post LARC insertion.

A

True

BUT only for first 21d

78
Q

List IUD AE:

A

Increasing spotting

Amenorrhea

79
Q

List OCP Pro and Con:

A

Pro:

  • easy to use
  • shorter, less dysmenorrhea
  • less acne and hirsutism

Con:

  • breast tender
  • nausea
  • h/a
  • breakthrough bleed (resolves)

Serious AE:
- thrombosis (2X VTE or stroke risk but still very minimal. Increased if migraine w/ aura. Either= less than if got pregnant)

Troubleshooting: if frequent breakthrough= E up, too much nausea= E down; headache then lower E

80
Q

What are OCP drug interaction?

A 
- Anti-Sz
= decrease efficacy of OCP
i.e. carbamazepine, clobazam, fosphenytoin
- Rifampin
- St John's Wart

FINE:

    • VPA FINE
    • Abx FINE
81
Q

T or F: it is safe to do “Extended cycling” with the OCP.

A

True.
= 21-21-21-21- then no pills for 5 d
OR 12 week pill and 7 days off.

82
Q

List Depo-Provera AE:

A

Pro:

  • good if E contraindicated
  • amenorrhea

Con:

  • irregular bleed
  • wt gain (5-15 lb)
  • reduced bone density (**take with Vitamin D and Ca)
83
Q

T or F: in most children, gender dysphoria will persistent into adolescence.

A

False.
If (+) as child -> most don’t
If (+) in teen -> most do.

84
Q

T or F: highest risk of suicidal behaviour in transgender youth is while awaiting consult.

A

True.

85
Q

What is gender dysphoria?

A

Marked incongruence between experienced gender + assigned.

x 6 month.

min. 6 of:
- strong desire to be other gender
- cross-dressing
- cross-gender role in play
- presence toward stereotypical toys
- preference for playmate of other gender
- rejection of stereotypical toy of same sex
- dislike for sexual anomy
- desire for pubertal traits

+ significant distress or impairment in social, school or other

86
Q

For fun: options for transgender youth

A

Pubertal suppression
- Lupron

Menstrual suppression
- Continuous OCP

Masculinizing hormone= T

Feminizing hormone= Estrogen, sprinolactone

Sx: top- Sx as teen (can’t do bottom Sx till adult)

87
Q

T or F: you must always treat for chlamydia if Gonorrhea (+).

A

yes!

Ceftriaxone IM x1
+ Azithro x 1

OR cefixime PO + azithro.

88
Q

What is the most common STI?

A

HPV!

89
Q

What is the current recommendation for PAPs?

A

Start at age 21
Every 3 yr
If sexually active.

90
Q

When do you consider hospitalization for PID?

A
  • pregnancy
  • failed PO tx
  • adherence concern
  • severe illness, vomit, high fever
  • tuba-ovarian abscess
  • HIV infection
91
Q 
16 y.o. with unilateral PAINLESS breast mass. 
Likely dx?
- fibroadenoma
- adenocarcinoma
- fibrocystic change
- met tumour
- lipoma
A

Fibroadenoma

Most= BENIGN fibroadenoma!

Other: trauma , abscess, node.

Fibrocystic= Bilateral

< 1%= malignant

92
Q

Breast Pain. Thoughts?

A 
Common in puberty.
OCP may better or worsen it. 
R/O mass, infection
Avoid tight fitting bra during exercise
NSAID + supportive.
93
Q

What is the order of substance use prevalence for:

alcohol, high energy drinks, cannabis

A 
Alcohol Prev
> 
high energy drinks
> 
Cannabis
94
Q

Teen where symp get better w/ hot showers?

A

Hyperemesis Cannabinoid Syndrome.

95
Q

Heavy menstrual bleeding typically caused by an ovulation. Most common reasons:

A

1= HPO axis maturation

Other causes of an ovulation:

  • pregnancy
  • thyroid dx
  • chronic liver/renal dx
  • Cushing
  • PCOS, CAH
  • wt loss/stres/ exercise
  • premature ovarian failure
96
Q

Heavy menstrual bleeding. Tx options?

A
  • Contraception
  • NSAID (start few days before helps with pain and lightens menses)
  • Antifibrinolytic= Tranexamic Acid
97
Q

What is primary versus secondary amenorrhea?

A

Primary= no menses ever!
> no puberty + no menses by 13
> secondary trait but no menses by 15
** most commonly gonadal dysgenesis and mullerian agenesis.

Secondary= 3 months of amenorrhea.
** most commonly stress, wt loss, disordered eating or preg!

98
Q

List causes of amenorrhea:

A

Hypothal
> Chronic dx, familial delay, stress, ED, Kallmann, Tumour, Drugs

Pit
> Infarct, Sx, Radiation

Thyroid

Adrenal: CAH, cushing, tumour

Ovary: gonadal dysgenesis, AI failure, Fagile X, PCOS, irradiation

Uterus= pregnancy

And other gyne congenital anomalies (i.e. cervix genesis or transverse septum in vagina, imperforate hymen)

99
Q

Amenorrhea W/U

A 
beta-HCG
CBC
U/A
TSH, FT4
FSH, LH
Prolactin
Pelvic US

+/- androgen panel if think (PCOS, late CAH, Cushings etc.)

If high FSH= gonadal dysgenesis, ovarian failure

Low FSH= hypothalamic if pituitary issue.

Note: Progestin challenge= withdrawal bleed. Confirm E made. If negative= E not made!

100
Q

What should you do if you miss an OCP pill?

A

Take 1 pill ASAP and take daily until end of pack.

If missed 3 pills = back up contraception x 7d!

101
Q

List common RF for vulvovaginitis

A 
Tight clothes
Overweight
Bubble baths
Urinating knee together
Wipe back to front

RC: Specialties Woo Hoo (31 decks)

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