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Laughing Pedi > Adolescent, Gyn > Flashcards

Adolescent, Gyn Flashcards

0
Q

normal prepubertal testicular size

A

< 2.5 mL

Puberty >2.5cm or volume > 4cc

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1
Q

normal range for puberty

A

9-13

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2
Q

peak height velocity at what tanner stage

A

4

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3
Q

mound on mound, secondary mound breast development

A

4

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4
Q

delayed puberty in boy / girl

A

14 boy
13 girl

OR stall out of puberty with lack of progression within 4.5-5yrs after onset

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5
Q

first sign puberty in boy / girl

A

testicular enlargement / thelarche

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6
Q

growth velocity before and after puberty

A

before 5-6 cm/yr

peak adolescent height velocity 9-10 cm/yr

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7
Q

sequence of male puberty and when do they grow fastest

A

testicular growth -(1 yr later)-> pubarche –> penile growth -> peak height (stage 4)

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8
Q

puberty too early when in boys? girls?

A 
9y males (pubarche or genital development) 
8 yr girls (thelarche + pubarche) or menstruation before 10yrs = precocious
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9
Q

gynecomastia / unequal breasts are ok (reassure) UNLESS

A

exposure to ketoconazole or b/l in males.

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10
Q

galactorrhea can be caused by what in adol males

A

marijuana

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11
Q

growth prediction after menarche in females?

A

within 4cm / 2in of adult height

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12
Q

what is pseudo precocious puberty and what should you consider.

A

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

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13
Q

what is responsible for acne / axillarly hair?

A

androgens

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14
Q

ABsolute contraindications to OCPs

A

BC HELP: BRCA, Coronary artery/Cerebrovascular dz, hepatic dz, elevated lipids, pregnancy

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15
Q

typical LH: FSH ratio in PCOS?

A

> 2.5 LH: FSH

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16
Q

possible anti-androgen med for PCOS

A

spironolactone

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17
Q

most common bacterial std

A

chlamydia

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18
Q

fishy amine odor / whiff test

A

bacterial vaginosis: gardnerella vaginalis

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19
Q

clue cells

A

bacterial vaginosis, gardnerella vaginosis

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20
Q

strawberry cervix, burning, itching, pain.
Dx?
Tx?

A

Dx: trichomonas vaginalis
Tx: flagyl for pt and partners: 2g single dose!

(Think flagellated whiping cervix)

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21
Q

screening test for GC/Chlamydia

A

urine PCR (naat: nucleic acid amplific test)

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22
Q

outpt tx of PID?

A

CTX 250mg IM
Azithromax 1g
14 d

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23
Q

ovarian cyst size cutoff for aspiration vs follow up ultrasound

A

6cm

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24
Q

Decade peaks in substance abuse?

A

70s and 90s

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25
Q

How long can marijuana be detected in urine for single use, chronic use, daily use?

A

single use: 5 days
chronic use: 10 days
daily use: 1 month

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26
Q 
Short acting bartiburate (secobarbital)
Intermediate acting (Phenbarb)

How long detected in urine?

A

Secobarb: 1 day
Intermediate: 1 week or more

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27
Q

most common fatal complication of hydrocarbon inhalation?

A

arrhythmia

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28
Q

Ed presentation with tachycardia, tremulousness, htn, mydriasis (lg pupil)

A

cocaine

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29
Q

ED w/ combative behavior, agitation

A

alcohol

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30
Q

ED w/ “quick drunk” disinhibition, agitation, hallucinations, generalized muscle weakness, nystagmus

A

volatile hydrocarbon

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31
Q

agitation, combative, vertical and horizontal nystagmus, may have rigidity, may have distortion of body image and hallucinations

A

PCP

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32
Q

% of HS seniors who have used marijuana
used in past year
used in past month
use daily

A

40% ever, 33% past year, 21% past month, 5% daily

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33
Q

Acute physical effects of marijuana

A

dry mouth, dilated pupils, drowsy, distorted time (Ds)

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34
Q

effects of chronic marijuana

A

pulmonary, tachycardia, poor stamina

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35
Q

sx of marijuana w/d?

Big s/e?

A

w/d: irritability, insomnia, tremors, nystagmus

**Gynecomastia

36
Q

% HS seniors who have used alcohol?

37
Q

Alcohol and pupils?

A

normal size, sluggish reaction

38
Q

alcohol and blood sugar?

A

hypoglycemia assoc w. alcohol use

39
Q

propoxyphene can cause what?

A

opiate - cardiac arrhythmia

40
Q

opiate effect on temp and bp?

A

low temp and low bp

41
Q

pt w/ hx anxiety, poor school performance, rhinorrhea, insomnia, stomach cramps?

A

opiate w/d

42
Q

drug that can cause rhabdo and why?

A

PCP: muscle rigidity

43
Q

other drug that can cause rhabdo from hyperpyrexia and muscle rigidity?

A

acute cocaine “coke fever”

44
Q

Drug suspected from sympathomimetic and cholinergic effects?

What other sx would you see?

A

PCP: tachy, htn, incr reflexes / miosis, flushing, diaphoresis
+ cerebellar

45
Q

Two things NOT to do if PCP intox is suspected?

A
  1. acidify urine: risk of precipitating myoglobin

2. restraints: can worsen rhabdo

46
Q

Tx of PCP intox?

A

cooling blanket, haloperidol, chlorpromazine, lorazepam

47
Q

most common substance abused by teens?

most common illicit substance abused by teens?

A

alcohol / marijuana

48
Q

acute cocaine overdose at low vs high doses?

A

low: euphoria and overconfidence
high: aggressive / violent behavior

49
Q

tx of htn in cocaine tox?

tx of psychosis w/ cocaine tox?

A

nitroprusside

haldol

50
Q

physiologic effects of nicotine?
(5)
adverse effects?

A

Alertness, muscle relaxation, enhanced memory, decr appetite, decr irritability

PUD!

51
Q

giggling, slow speech, ataxia and negative urine tox and blood alcohol level?

A

organic solvent abuse

52
Q

distinguish between pityriasis rosea and secondary syphilis

A

syphilis would involve palms and soles

53
Q

arthritis, conjunctivitis, urethritis
Cause?
Tx?

A

reactive arthritis, Reiter syndrome: C. trachomatis

Tx: 1g azithro or 100 doxy BID x 7.

54
Q

TX of gonorrhea?

A

CTX 125 IM x 1

cefixime 400mg PO x 1

55
Q

mean puberty onset in boys and girls

A

boys 11.6y

girls 11.2y

56
Q

premature thelarche or adrenarche are normal variants of puberty that can be distinguished from precocious HOW, and what will test show?

A

Bone age! No height acceleration or advancement in bone age in normal pubertal variant.
Precocious level will be advanced bone age

57
Q

secondary mound is what Tanner stage?

58
Q

Stage V testes in boys is what volume

59
Q

estrogen nonstimulated vs stimulated vaginal mucosa

A

stimulated: pink

not stimulated: glistening red

60
Q

test for central precocious puberty

A

GnRH stim test. Will have brisk rise in LH and FSH but those who are prepubertal or have peripheral precocious will not.

61
Q

high suspicion for central precocious puberty demographics

A

all boys and girls < 5

62
Q

Treatment of central precocious puberty

A

GnRH agonist: continuous stimulation prevents LH, FSH

63
Q

board cause of delayed puberty

  • most common
  • board one
A

common: constitutional growth delay
board: Kallmann syndrome (anosmia)

64
Q

bone age in constitutional growth delay? Final height?

What is constitutional growth delay?

A

delayed, normal final height

Just short stature in childhood, usu + FH

65
Q

peak height velocity boys compared to girls

A

2 yrs later

66
Q

pubertal growth accounts for what % of adult height?

67
Q

average prepubertal, then pubertal ht veloc

A

5-6cm/yr –> 9-10cm/yr

68
Q

early vs late adolescent in cognitive thinking

A

late should do abstract reasoning

69
Q

proportion of syphilis exposed individuals who contract infx

70
Q

Jarish Herxheimer rxn

A

fever, HA, myalgia, tachy, hypotension

All the syphilils spriochetes dying with treatment

71
Q

chancroid?
bug
Tx

A

painful ulcer or tender node
H. ducreyii
CTX 250mg IM or Azithro 1 gram or Erythro 500 QID x7d

72
Q

painless chancre ulcer, painless nodes

73
Q

painful ulcer and tender nodes

74
Q

painful vesicle/ulcer, tender nodes

75
Q

Tx of pediculosis pubis

A

permethrin creme
lindane shampoo
pyrethins w/ piperonyl butoxide

76
Q

secondary amenorrhea def?

A

no menstruation 3 mos after previously established menstruation

77
Q

Kallman syndrome?

A

anosmia

GnRH def

78
Q

Asherman syndrome

best dx?

A

scarification of lining of uterus, often after endometritis

Fails progesterone challenge

79
Q

mullerian agenesis

A

congenital absence of vagina and uterus, but normal ovaries so normal pubertal development (2nd most common amenorrhea after XO)

80
Q

stippled membrane epithelial cell covered with adherent bacteria
seen in what

A

clue cell, bacterial vagniosis: Gardnerella

tx w flagyl

81
Q

peak height velocity at what age and tanner stage in boys vs girls

A

girls: 11.5, tanner 2
boys: 13.5, tanner 3-4

82
Q

pubertal growth accounts for what percent of final adult ht?

83
Q

average height diff between m/f, why

A

epiphyseal closure occurs 2 yrs later in boys.. 10 cm height diff

84
Q

adolescent substance abuse stages

A 
0- curious
1- weekend tries
2 - seeks it on weekends regularly, purchases
3 - legal trouble/ stealing to habit
4 - burnout zombie
85
Q

ptx and pneumomediastinum seen in what drug abuse

86
Q

lateral nystagmus and decr reflexes with what drug abuse

A

barbiturates, tranquilizer

87
Q

lateral and vertical nystagmus with what drug?

88
Q

average time from puberty onset to menarche?

Laughing Pedi (24 decks)

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