Adolescent/Endocrinology

Question 1

Mullerian agenesis (another name?); also which of the following (gonads and external genitalia) are present or absent?

Answer 1

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome; mullerian duct is responsible for the development of female gonads; so uterus/ovaries will be absent but external genitalia (vagina and breasts) will be present

Question 2

Testicular cancer tumor markers? Germinoma vs seminoma?

Answer 2

Germinoma (a-FP, LDH, b-HCG) vs seminoma (none). Most testicular cancers are germinomas.

Question 3

Empiric treatment for PID

Answer 3

Think about covering for N. gonorrhea, C. trachomatis, GNR, Gardranella, strep and anaerobes (usually if you had recent instrumentation such as D&C, pap smear).
Empiric tx IM Ceftriaxone 250mg x1 and Doxycycline 100mg BID x14 days (or AZT 1g po once) +/- Flagyl PO BID x14 days.

Question 4

Painless ulcer that’s very vascular, intracellular safety pin shaped bacteria, may have inguinal LAD, more common in developing countries

Answer 4

Donovaniasis (granuloma inguinale caused by Klebsiella granulomatis), intracellular safety pin shaped bacteria are called Donovan bodies

Question 5

Teenager with fever, myalgias, painless macular/vesicular/hemorrhagic lesions on hands and soles; pain on movement of wrists and ankles, can also have suppurative arthritis– what is the etiology?

Answer 5

Form of disseminated Neisseria gonorrhea known as cellulitis-tenosynovitis-dermatitis syndrome

Question 6

Which medication is known to decrease progesterone/estrogen concentrations from OCPs?

Answer 6

Rifampin

Question 7

Fishy odor associated with thin, grey vaginal discharge, elevated pH>4.5

Answer 7

Bacterial vaginosis

Question 8

Strawberry cervix

Answer 8

Trichomonas and BV

Question 9

RPR/VDRL testing vs Syphilis Ab testing (Fluores treponemal antibody absorption test vs Trep pallidum particle agluttination test)

Answer 9

RPR/VDRL- quantitative tests (non-specific, non-treponemal tests); have to confirm diagnosis with treponemal testing; can use RPR/VDRL for quantitative monitoring of treatment effectiveness (6/12/24 months)

Syphilis Ab testing- qualitative (non-reactive, minimally reactive, reactive); confirms diagnosis

Question 10

True or False. If FTA-ABS or TA-PA testing is positive once, it is positive for life.

Answer 10

True. Only would do quantitative non-treponemal testing to confirm titer levels and therefore effectiveness of treatment.

Question 11

PFAPA; age group?

Answer 11

Periodic Fever, Aphthous ulcers, Pharyngitis, Adenitis; 6 months to 7 years old

Question 12

Cryopyrin-associated periodic syndrome; what are the symptoms? What is a later finding of this syndrome? What is the preferred treatment?

Answer 12

Recurrent fevers, urticaria, joint pain with positive family history of similar symptoms (autosomal dominant); later in life, develop bilateral sensorineural hearing loss; preferred treatment IL-1 inhibitor (Anakinra); triggered by cold weather

Question 13

Behcet’s disease long-term complications?

Answer 13

CNS complications (vasculitis, stroke, seizures, meningoencephalitis)

Question 14

Chancre

Answer 14

Syphilis, chlamydia (painless ulcer)

Question 15

Chancroid

Answer 15

Hemophilus ducreyi (painful ulcer)

Question 16

Donovan bodies–intracellular inclusions are seen in what STI?

Answer 16

Klebsiella granulomatis

Question 17

What is the name of the disease caused by the infectious agent that is associated with Donovan bodies and pseudobuboes?

Answer 17

Granuloma inguinale– painless and friable ulcer, leading to pseudobuboes (subcutaneous granulomas that mimic tender inguinal LAD or buboes)

Question 18

STI with gram stain showing gram negative rods in chains– looks like a school of fish?

Answer 18

Haemophilus ducreyi

Question 19

Buboes are associated with which STI?

Answer 19

Tender lymphadenopathy that occurs as part of lymphogranuloma venereum (Chlamydia)

Question 20

Familial short stature

Answer 20

Normal height until 1-2 years of age and then drops height percentiles, but not below 3rd percentile. Grows normally along new height curve. Bone age matches chronological age.

Question 21

Constitutional short stature

Answer 21

Normal height until 1-2 years of age and then drops usually along the 5th percentile. Continues growth along this line. Delayed bone age, which matches expected height for that age, but overall patient will have pubertal delay and delayed bone age in relation to chronological age.

Question 22

Definition of primary amenorrhea?

Answer 22

One of three possible scenarios:

(1) No menses two years after onset of puberty (onset of puberty usually between 8-13 years old)
(2) No signs of puberty at all after age 13 years old
(3) No signs of menarche after age 16 years, even in the presence of secondary sex characteristics (breast development)

Question 23

Definition of secondary amenorrhea?

Answer 23

No menses for 6 months when previously had regular periods OR
No menses for 12 months when previously had irregular periods.

Question 24

What is Asherman Syndrome?

Answer 24

Secondary amenorrhea due to intrauterine adhesion development after uterine surgery.