Adolescent, Gyn Flashcards
normal prepubertal testicular size
< 2.5 mL
Puberty >2.5cm or volume > 4cc
normal range for puberty
9-13
peak height velocity at what tanner stage
4
mound on mound, secondary mound breast development
4
delayed puberty in boy / girl
14 boy
13 girl
OR stall out of puberty with lack of progression within 4.5-5yrs after onset
first sign puberty in boy / girl
testicular enlargement / thelarche
growth velocity before and after puberty
before 5-6 cm/yr
peak adolescent height velocity 9-10 cm/yr
sequence of male puberty and when do they grow fastest
testicular growth -(1 yr later)-> pubarche –> penile growth -> peak height (stage 4)
puberty too early when in boys? girls?
9y males (pubarche or genital development) 8 yr girls (thelarche + pubarche) or menstruation before 10yrs = precocious
gynecomastia / unequal breasts are ok (reassure) UNLESS
exposure to ketoconazole or b/l in males.
galactorrhea can be caused by what in adol males
marijuana
growth prediction after menarche in females?
within 4cm / 2in of adult height
what is pseudo precocious puberty and what should you consider.
when things happen out of sequence usually from sex steroid production by adrenals, ovaries, or testes or exogenous.
Consider: late onset CAH, leydig cell tumors, anabolics, ocps
what is responsible for acne / axillarly hair?
androgens
ABsolute contraindications to OCPs
BC HELP: BRCA, Coronary artery/Cerebrovascular dz, hepatic dz, elevated lipids, pregnancy
typical LH: FSH ratio in PCOS?
> 2.5 LH: FSH
possible anti-androgen med for PCOS
spironolactone
most common bacterial std
chlamydia
fishy amine odor / whiff test
bacterial vaginosis: gardnerella vaginalis
clue cells
bacterial vaginosis, gardnerella vaginosis
strawberry cervix, burning, itching, pain.
Dx?
Tx?
Dx: trichomonas vaginalis
Tx: flagyl for pt and partners: 2g single dose!
(Think flagellated whiping cervix)
screening test for GC/Chlamydia
urine PCR (naat: nucleic acid amplific test)
outpt tx of PID?
CTX 250mg IM
Azithromax 1g
14 d
ovarian cyst size cutoff for aspiration vs follow up ultrasound
6cm
Decade peaks in substance abuse?
70s and 90s
How long can marijuana be detected in urine for single use, chronic use, daily use?
single use: 5 days
chronic use: 10 days
daily use: 1 month
Short acting bartiburate (secobarbital) Intermediate acting (Phenbarb)
How long detected in urine?
Secobarb: 1 day
Intermediate: 1 week or more
most common fatal complication of hydrocarbon inhalation?
arrhythmia
Ed presentation with tachycardia, tremulousness, htn, mydriasis (lg pupil)
cocaine
ED w/ combative behavior, agitation
alcohol
ED w/ “quick drunk” disinhibition, agitation, hallucinations, generalized muscle weakness, nystagmus
volatile hydrocarbon
agitation, combative, vertical and horizontal nystagmus, may have rigidity, may have distortion of body image and hallucinations
PCP
% of HS seniors who have used marijuana
used in past year
used in past month
use daily
40% ever, 33% past year, 21% past month, 5% daily
Acute physical effects of marijuana
dry mouth, dilated pupils, drowsy, distorted time (Ds)
effects of chronic marijuana
pulmonary, tachycardia, poor stamina