Adolescent and Gynecology

Question 1

[Adol/Law/Minor]

Criteria for emancipated minors? (4)

Answer 1

For < 18 years
1. Married
2. Active duty status in the military
3. Have obtained a court order
4. Living separately and financially independent

Question 2

[Adol/Law/Confidentiality]

Situations that have right to break confidentiality (3)

Answer 2

1. Physical or sexual abuse
2. Nonadherence with treatment of medical condition
3. Treat of harm to self or others

Question 3

[Adol/Screening/STD]

STI screening indications in female (1) and male (2)?

Answer 3

Female:
All sexually active < 25 years old

Male:
If increased risk (Include HIV/syphilis if high risk)

Question 4

[Adol/STD]

Time to repeat test in C. trachomatis or N. gonorrhoeae?

Answer 4

3 months for re-infection
(No need for test of cure, 4 weeks, only for pregnancy)

Question 5

[Adol/STD]

CDC recommends treating all sexual partners of GC/CT infection within the past ___ months

Answer 5

2 months

Question 6

[Adol/Screening/STD]

STI screening recommendation for men sex with males (MSM)? (5)

Answer 6

1. HIV
2. Syphilis
3. Urine GC/CT
4. Rectal GC/CT
5. Pharyngeal GC (no Chlamydia for oropharynx)

Question 7

[Adol/Screening]

Cervical cancer screening begin at __ years of age regardless of sexual activity.

Earlier screening management to ___ patients (3)

Answer 7

Cervical cancer screening begin at 21 years of age regardless of sexual activity.

1. History of high-grade precancerous cervical lesions, cervical cancer
2. In utero exposure to diethylstilbestrol
3. Immunocompromised or HIV positive

Question 8

[Adol/Eating/AN]

Endocrinologic complications of anorexia nervosa? (3)

Answer 8

1. Amenorrhea (hypogonadotropic hypogonadism, no progesteron withdrawal bleeding)
2. Euthyroid hypothyroxinemia (Low T3, normal T4/TSH)
3. Osteopenia

Question 9

[Adol/Eating/AN]

Cardiac complications of anorexia nervosa? (5)

Answer 9

1. Bradycardia
2. Prolonged QT
3. Mitral valve prolapse
4. Pericardial effusion
5. Heart failure (esp. refeeding syndrome)

Question 10

[Adol/Eating/AN]

Refeeding syndrome symptoms? (4)

Answer 10

1. Marked _hypo_phosphatemia -> reduced cardiac contractility -> heart failure
   Hyponatremia, hypokalemia
2. Volume overload
3. Arrhythmia
4. Seizure

Question 11

[Adol/Eating/AN]

Admission indication for anorexia nervosa?

SBP < ___
HR < ___ awake < ___ sleep
BMI < ___%
Hypothermia < ___
___

Answer 11

SBP < 90
HR < 50 awake < 45 sleep
Orthostatic hypotension
BMI < 75%
Hypothermia < 96
Dehydration, electric abnormality, refusal to eat, failure of outpt

Question 12

[Adol/Menstruation/Amenorrhea]

Definition of primary amenorrhea? (3)

Answer 12

1. By 15 years of age with normal growth and secondary sexual characteristics
2. By 13 years of age with complete absence of secondary sexual characteristics
3. > 3 years after onset of thelarche (breast)

Question 13

[Adol/Menstruation/Amenorrhea]

Definition of secondary amenorrhea? (2)

Answer 13

> 3 months who previously regular
6 months who previously irregular

Question 14

[Adol/Contraception/OCP]

Benefits of oral contraceptive pills? (4)

Answer 14

1. Reduced Size of functional ovarian cysts
2. Reduced risk of osteoporosis,
3. Reduced risk of ovarian cancer, endometrial cancer
4. Reduced risk of PID

Question 15

[Adol/Contraception/OCP]

Drugs that reduce oral contraceptive pills efficacy? (5)

Answer 15

Antacids (when taken in 3 hours)
Many antiseizures (excpet levetiracetam, valproic acid, gabapentin)
Antibiotics: Rifampin
Most retrovirals
St. John’s warts

Question 16

[Adol/Contraception]

Risk (2) and benefit (1) of depo provera (DMPA) injections?

Answer 16

Risk: Decreased bone density, weight gain
Benefit: Decreased endometrial cancer

Question 17

[Adol/Contraception]

Emergency contraception medications? (2)

Answer 17

1. Levonorgestrel 1.5 mg (Plan B) once
2. Ulipristal acetate (Ella) once (prescription only)
   (When obesity > 70 kg)

Question 18

[Adol/Genital lesions]

Organism?
Treatment?

Painful grouped vesicles, shallow

Answer 18

HSV

• Treatment:
  Acyclovir or valacyclovir (Valtrex)

Question 19

[Adol/Genital lesions]

Organism?
Treatment?

Painless, punched out ulcers

Answer 19

Syphilis (T. pallidum)

• Treatment:
  Penicillin G

Question 20

[Adol/Genital lesions]

Organism?
Treatment?

Painful, shallow, soft, friable ulcer, ragged margin

Answer 20

Chancroid (H. ducreyi)

• Treatment:
  Azithromycin or ceftriaxone

Question 21

[Adol/Genital lesions]

Organism?
Treatment?

Painless, friable, progressive, beefy-red ulceration

Answer 21

Granuloma inguinale (donovanosis),
Kelbsiella granulomatis

• Treatment:
  Azithromycin, doxycycline, ciprofloxacin

Question 22

[Adol/Genital lesions]

Organism?
Treatment?

Painless ulcer, tender inguinal lymphadenopathy (groove sign)

Answer 22

Lymphogranuloma venerum (C. trachomatis)

• Treatment:
  Doxycycline

Question 23

[Adol/STD]

Diagnosis?

1-2 months after the onset of the chancre
Scaly, hyperkeratotic palmar skin rash ‘nickel and dime’
Flu-like symptoms
Condylomata lata
Generalized lymphadenopathy, epitrochlear nodes

Answer 23

Secondary Syphilis

Question 24

[Adol/STD]

Diagnosis?

After 15-30 years of infection
Cardiac, ophthalmic, auditory abnormalities
Gummatous lesions

Answer 24

Tertiary syphilis

Question 25

# [Adol/STD/Syphilis] Treponemal vs non-treponemal tests ___ tests: therapeutic response - Venereal Disease Research Laboratory (VDRL) - Rapid Plasma Reagin (RPR) ___ tests: previous infection - Flourescent treponemal antibody absorbed (FTA-ABS) - T. Pallidum Particle Agglutination (TP-PA) - Enzyme ImmunoAssays (EIA) - Chemiluminescence Immunoassays (CIA)

Answer 25

_Nontreponemal_ tests: therapeutic response - Venereal Disease Research Laboratory (VDRL) - Rapid Plasma Reagin (RPR) _Treponemal_ tests: previous infection - Flourescent treponemal antibody absorbed (FTA-ABS) - T. Pallidum Particle Agglutination (TP-PA) - Enzyme ImmunoAssays (EIA) - Chemiluminescence Immunoassays (CIA)

Question 26

# [Adol/STD/Syphilis] Nontreponemal test commonly become nonreactive within 3-12 months after treatment. Some patients persist with low titers for life, which is known as ___ reaction

Answer 26

Serofast reaction

Question 27

# [Adol/STD/Syphilis] Name of reaction? Acute febrile response 2-12 hours after initiation of therapy for syphilis: headache, myalgia, etc

Answer 27

Jarisch-Herxheimer reaction

Question 28

# [Adol/STD/Syphilis] Treatment options for syphilis for patients with penicillin allergy?

Answer 28

Oral doxycyline 100 mg 2/day for 14 days (Consider desensitization of penicillin)

Question 29

# [Adol/STD/Syphilis] Management for failed therapy or reinfection for syphilis, latent syphilis, tertiary syphilis (not neurosyphilis)? - Medication - Additional investigation

Answer 29

Weekly IM injections of penicillin G benzathine for 3 weeks - Additional investigation: Check for HIV infection and CSF for neurosyphilis

Question 30

# [Adol/STD] Diagnosis? Adolescent with sensorineural hearing loss (8th cranial nerve), uveitis, previous history of STI

Answer 30

Neurosyphilis

Question 31

# [Adol/STD/CT] Treatment options for Genital chlamydial infection? Preferred: __ Alternative: __

Answer 31

Preferred: Doxycycline 100 mg PO 2/day for 7 days; Alternative: Azithromycin 1 g PO 1 dose

Question 32

# [Adol/STD/GC] Diagnosis due to gonococcus? Fever, tenosynovitis, dermatitis Positive blood culture (30-40%), negative synovial fluid culture

Answer 32

Arthritis-dermatitis syndrome

Question 33

# [Adol/STD/GC] Diagnosis due to gonococcus? Arthritis without systemic symptoms Positive synovial fluid culture, negative blood culture

Answer 33

Suppurative mono/oligoarticular arthritis

Question 34

# [Adol/STD] ___ reactions when patients on metronidazole have alcohol?

Answer 34

Disulfiram-like reaction

Question 35

# [Adol/Vaginitis] Treatment options for bacterial vaginosis? (3)

Answer 35

Metronidazole 500 mg PO 2/day for 7 days Clindamycin 300 mg 2/day for 7 days Or metronidazole intravaginal gel, clinamycin cream

Question 36

# [Adol/Vaginitis] Treatment options for trichomoniasis? (3) For Female/pregnancy: ___ For male: ___

Answer 36

Metronidazole 500 mg PO 2/day for 7 days in female/pregnancy Metronidazole 2 g PO 1 dose for men

Question 37

# [Adol/STD/Epididymitis] Treatment options for epididymitis? Treatment of choice: ___ For insertive anal partner: ___

Answer 37

- TOC: Ceftriaxone 500 mg IM 1 dose Plus doxycycline 100 mg 2/day for 10 days - If insertive partner in anal intercourse: Ceftriaxone 500 mg IM 1 dose Plus levofloxacin 500 mg PO 1/day for 10 days

Question 38

# [Adol/STD] Bacterial causes for proctitis, proctocolitis, and enteritis in sexual transmitted infection? Proctitis: ___ Proctocolitis: ___ Enteritis: ___

Answer 38

Proctitis - GC/CT, syphilis, HSV Proctocolitis - LGV, Chlamydia, campylobacter, shigella, E. histolytica Enteritis - Giardia

Question 39

# [Adol/Infection] Diagnosis? Treatment? Localized pruritus in pubic hair Maculae ceruleae: bluish discoloration

Answer 39

Pediculosis pubis - Treatment: 1st: Permethrin 1% cream or pyrethrins 2nd: oral ivermectin (Decontaminate bedding and clothing, treat sexual partner last month)

Question 40

# [Adol/Sexual abuse] Time period for sexual assault examination for forensic exam?

Answer 40

Within a week (More than 72 hours, less than 1 week, depending on local authorities)

Question 41

# [Adol/AUB] Abnormal uterine bleeding definition (3)? Last ___ days Occurs cycle ___ days or ___ days Large volume > ___ ml or ___ saturated pads or tampons/day, or causes anemia

Answer 41

Last > 7 days Occurs cycle < 20 days or > 45 days Large volume > 80 ml or 10 saturated pads or tampons/day, or causes anemia