Adolescent/GYN Flashcards
- absent pubic hair
- childlike phallus
- testicular volume <2.5mL
SMR 1 (prepubertal)
- fine pubic hair
- childlike phallus
- inrceased testicular size and volume
- scrotum more textured
SMR 2 (beginning of puberty)
- coarse, curly, and pigmented pubic hair
- increased phallus size
- increased testicular size
SMR 3
- denser and curled pubic hair, but less abundant than adult
- phallus size closer to adult male
SMR 4
- pubic hair extends to the inner thigh, adult like
- adult size phallus
- adult size testicles
SMR 5
- absent pubic hair
- no glandular breast tissue
SMR 1 (prepubertal)
- hair along the labia
- small breast buds, with glandular tissue
SMR 2 (beginning of puberty)
- coarse, curly and pigmented pubic hair
- breast tissue extends beyond the areola
SMR 3
- pubic hair denser and curled but less abundant than adult
- enlarged areola and papilla form a secondary mound
SMR 4
- pubic hair extends to the inner thigh, adult like
- no longer a separate projection of the areola from the remainder of the breast
SMR 5
pre-puberty height velocity
5-6 cm/yr
peak adolescent height velocity
9-10 cm/yr
-no pubertal development by 14 in a girl, 13 in a boy
Delayed Puberty
-what the female growth spurts begins and ends with
Breast development, menarche
-first sign of puberty in males
Testicular enlargement
-2 labs that increase with growth spurt
Alk Phos and Hematocrit
-sequence of male pubertal development
Testicular growth->pubarche->penile growth->peak height velocity
- MC for delayed puberty in males
- bone age < constitutional age
Constitutional Growth Delay
-sequence of female sexual development
Breast buds (thelarche)->pubarche->peak height velocity->menarche
- when thelarche occurs without pubarche
- breast tissue without pubic hair
Androgen insensitivity
- pubarche without thelarche
- pubic hair without breast development
low estrogen or excess androgens
- white, odorless, mucoid discharge that precedes menarche by 3-6 months and can continue for several years
- requires no intervention
Physiologic leukorrhea
-when secondary sexual characteristics appear before age 9 in males and 8 in females
Precocious Puberty
Breast cancer Coronary Artery Disease Hepatic disease Elevated Lipids Pregnancy
Absolute contraindications for OCPs
- amenorrhea, obesity, hirsutism, and acne
- LH:FSH >2.5, elevated androgens
- Tx: wt loss, OCPs, spironolactone, metformin
Polycystic Ovary Disease
-best study to order in a girl with breast development but no pubic hair
Karyotype
- female involved in heavy athletic training
- menstrual cycles gradually become lighter then stop
- low serum estradiol
- increased risk for low bone density and osteoporosis
- Tx: reduce training, stop smoking, calcium, increase calories
Female athlete triad
- crampy lower abdominal pain and pelvic pain that occurs with menses and is not due to other pelvic etiology
- due to prostaglandins produced during the ovulatory cycle
- Tx: NSAIDs
Primary Dysmenorrhea
- pelvic pain that occurs other times besides menstruation
- due to underlying pelvic pathology
Secondary dysmenorrhea
- recurrent nightmares, fear of being alone, diminished interest in school, decreased appetite
- lower abdominal pain and vaginal discharge
PTSD
-top 3 leading causes of death in teens
- MVA/accidents
- Homicide
- Suicide
- distorted body perception
- weight 15% below expected
- intense fear of gaining weight
- absence of 3 consecutive menstrual cycles
- excessive exercise, use of diuretics, depression
Anorexia Nervosa
- binging and purging
- salivary gland enlargement
- dental enamel erosion
- calluses over knuckles
- low K, Cl, metabolic alkalosis
Bulimia Nervosa
- failure of outpt Tx
- dehydration
- EKG abnl
- Mallory Weiss tears
- Suicidal ideation
Indications for hospital admission for eating disorders
-which electrolyte abnl are eating disorder pts at risk for during refeeding
hypophosphatermia
-tx for trichomoniasis
Metronidazole 2g po x1
- rash, joint/tendon involvement, meningitis, endocarditis
- Dx: gram stain with intracellular gram negative diplococci
- Tx: CTX and Azithro
Disseminated gonococcal infection
- lower abd or pelvic pain
- uterine or adenexal tenderness or CMT
- WBC in vaginal secretions
- temp >101F
- elevated ESR or CRP
- lab evidence of GC/CTT at cervix
- vaginal discharge
PID
-outpatient treatment for PID
Ceftriaxone 250mg IM x1 and
Azithromycin 1g po x1
-if pain persists after treatment for PID, must obtain an US to look for this complication
Tubo-ovarian abscess
-what size ovarian cyst would need laproscopic aspiration
6mm or causing significant discomfort
- RUQ pain that radiates to the right shoulder, nausea
- US will be negative
- Dx: pelvic exam
- Tx: same as for PID
- pain should resolve 2 days after treatment
Fitz Hugh Curtis
-when is parental consent not needed?
- life threatening emergencies
- sexual assault services
- medical care during pregnancy and family planning
- std treatment and testing
- substance abuse treatment
-a person under legal age who is no longer under their parent’s control and regulation who is allowed to give informed consent instead of the parent
Emancipated minor
- low self esteem and coping skills
- alienation from conventional norms
- homosexuality
- use of performance enhancing drugs
Risk factors for drug abuse
How long can marijuana can be detected in the urine?
5 days for single use
10 days for chronic use
1 month for daily use
How long can short acting and long acting barbituates be detected in the urine?
24 hours
1 week or longer
- causes drowsiness, decreased inhibition, and light-headedness, ataxia, and disorientation
- muscle weakness, nystagmus, and loss of coordination
- asphyxia, cardiac arrhythmia, and aspiration, leading to death
- chronic use leads to encephalopathy
- MC in lower SEC groups and Hispanic and Native Americans
Inhaled hydrocarbons
- tachycardia
- tremulousness
- HTN
- mydriasis
- euphoria and overconfidence
- agressive and violent behavior at high doses
Cocaine
- combative behavior and agitation
- tremulousness is not common
Alcohol
- characterized as a “quick drunk” with disinhibition and agitation
- hallucinations, generalized muscle weakness and nystagmus
Volatile hydrocarbons
- agitation w/o tremulousness or tachycardia
- depressed sensorium, resp depression, miosis, indifference to pain, euphoria
- hypotension, low temp, constipation, urinary retention
Opiates
- combative, tachycardia, mydriasis
- NO nystagmus
Amphetamines
- combative
- vertical and horizontal nystagmus
- muscle rigidity
- normal pupils
- distortion of body image, paranoia, hallucinations
- tachycardia, HTN, increased DTRs
- miosis, flushing, and diaphoresis
- can lead to rhabdo, then renal failure
- Tx: do not acidify urine or use physical restraints
- Tx: cooling blanket, chemical restraints
PCP
-memory loss, decreased reading comprehension, and poor interpersonal skills
Behavioral consequences of marijuana use
- dry mouth
- dilated pupils
- drowsiness
- distortion of time
Acute effects of marijuana use
- ataxia, slurred speech, visual disturbance, vomiting, nausea, sluggish pupils, excessive sweating, flushed skin, hypoglycemia
- irritability, stupor, and coma
Alcohol intoxication
- circulatory collapse
- coma
- hypertensive crisis
- seizure
- elevated temp
- cerebral hemorrhage
- arrhythmias
Amphetamine abuse
-anxiety, poor school performance, rhinorrhea, insomnia, stomach cramps
Opiate withdrawal
- sleepiness and sedation
- pupils are slow to react but normal size
Benzo abuse
-alertness, muscle relaxation, enhanced memory and alertness, decreased appetitie, decreased irritability
Physiologic effects of nicotine
- giggling, slurred speech, and ataxia
- death from asphyxia or arrhythmia
Organic solvent abuse
