Adolescent and Gyne Flashcards
T or F: parental conflict peaks in mid-adolescence.
True
Also: abstract thinking.
When does menstruation occur?
Tanner Stage 4
What occurs in Tanner Stage 4?
M:
- *- max penile growth
- axillary hair, voice change
F:
- *- double breast contour
- *- menarche
- coarse, curly hair
What occurs in Tanner Stage 2?
M:
- *- testicular enlargement
- pubic at base
F:
- *- breast bud
- hair on labia
What occurs in Tanner Stage 3?
M:
- *- penile growth
- voice break
F:
- breast + areola enlarged; no sep contour
- *- peak ht velocity
- acne
- dark hair start too curl
14 y.o. M 3cm unilateral tender breast.
- US
- F/U 6 mo
- Karyotype
- CT scan
F/U in 6 month
Pubertal Gynecomastia
When does preoccupation with body image occur?
Early adolescence
3 reasons to breach confidentiality:
- 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
5 things to help transition teen to adult care:
- see teen w/out parent for part of apt
- give increasingly level of responsibility or info
- peer support meetings
- provide transition letter
- collaborate w/ adult care provider
Which is more commonly seen in bulimia nervosa compared to anorexia nervosa:
- cachexia
- hypothermia
- low BP
- enlarge salivary glands
- extremely dry skin
Enlarged salivary glands
Kids with AN becomes osteopenia because:
Estrogen deficiency
+ high cortisol, low IGF-1, low lean body mass, low wt, nutritional, amenorrhea
Is lanugo or alopecia seen in anorexia nervosa?
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
List criteria for Anorexia Nervosa?
- Fear of gaining wt
- Disturbance in wt/shape
- Restricted intake for requirements (leading to low wt for age, sex, developmental trajectory)
List criteria for Bulimia Nervosa?
- 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.
What comorbidities do you see with Bulimia?
P/E findings?
- Depression
- Anxiety
- Substance use
- Cluster B/ borderline PD
P/E:
- Older
- large parotid
- oral ulcer
- dental enamel erosion
- russell sign (callus on knuckle)
What is ARFID?
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
List 3 DDX of eating disorders:
GI: IBD, Celiac, Infectious Gastro, HIV
Endo: Thyroid, DM, addison’s
Psychiatric: OCD, Substance use
Other: CNS lesion, SMA syndrome, CA
T or F: growth, atrophy, bone density issue are irreversible issues with eating disorder.
True
What is the tx target avg body weight for kids with ED?
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
Reasons to admit for eating disorder:
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
What are common comorbidities with anorexia nervosa?
- Anxiety
- Depression
Which is most worrisome in anorexic pt?
- low K
- WBC < 1000
- Met alkalosis
- low protein
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
How do you prevent osteoporosis in an anorexic?
- Ca
- Vit D
- Estrogen
- Gain wt to min. 10% ideal wt
Calcium
** always Ca+ and vit D supplement for risk of low bone mineral density.
White early teen F with above avg intelligence and is avoidant perfectionist struggling with mood or anxiety. Anorexia Nervosa or Bulimia Nervosa?
Anorexia Nervosa