Adolescent/Gyne Flashcards
Which is true of adolescence:
b. parental conflict peaks in mid adolescence
(early, middle and late changes; physical, cognitive, moral, self-concept, family, peers, sexuality all evolve)
When does menstruation usually start in puberty?
Menstruation at Tanner stage IV
when does a boys’ voice crack
tanner 3
order of pubertal development in girls
boobs, pubes, grow, flow
14 year old male with 3cm unilateral tender breast swelling. What do you do?
F/U in 6mo
Pubertal Gynecomastia
- Up to 60% of males
- Transient imbalance of estrogen and androgen
- Onset 10-13y (SMR 3-4)
- Usually regresses within 18-24 mo
3 reasons you could breach confidentiality.
Intention to harm themselves, intention to harm others
Harm to other children
Communicable disease, conditions that impairs driving ability, GSW
- 15 year old boy with T1DM. You can only follow him in your clinic until 18 years of age. 5 things you
would do to try to help him transition to adult care.
- See teens without parents for part of appointment
- Give increasing levels of responsibility and information
- Teach skills of negotiation and communication required in the adult system
- Providing a transition letter explaining the location of the new facility, staff and what to
expect - Collaboration with GPs and adult care provider
- An adolescent is in the ED who is 65% of her ideal body weight. HR 40, T35.8, BP 90/P. What to do:
- Slow refeeding- at risk for refeeding <80% of ideal body weight
- Patients with anorexia nervosa become osteopenic due to:
c) estrogen deficiency- plus high cortisol, low IGF-1, low lean body mass, low weight,
nutritional deficiency- amenorrhea is a risk factor
- Skin change seen in anorexia nervosa:
a) lanugo
DSM V criteria for anorexia nervosa
- A. restricted intake vs requirements → low body weight (age, sex,
developmental trajectory, health) that is less than minimally expected - B. fear of gaining weight/becoming fat/ behaviour interfering with weight
gain (despite low weight) - C. disturbance in weight/shape experience/ undue influence on
self-evaluation/ lack of seriousness of current low weight - Types
- Restricting- no binge/purge
- Binge-Eating/ Purging (w.i. 3 mo)
- Stage of remission
- Severity (adults)
- Mild >17
- Mod 16-17
- Severe 15-16
DSM V criteria for bulimia nervosa
- A. episodes of binge eating
- eating more than what most would eat
- lack of control
- B. compensatory behaviours (vomiting, laxatives, diuretics, medications,
fasting, exercise) - C. 1x/wk x3 mo
- D. self-eval influenced by shape and weight
- E. not AN
- Stage of remission
What are some features of ARFID (Avoidant Restrictive Food Intake Disorder)
- restrictive due to adverse feeling resulting in nutritional deficiences/ weight loss
- psychosocial dysfunction
- no body image disturbance
What is on the differential diagnosis for eating disorder?
Differential (CBC, ESR, lytes, Ca, Mg, PO, VBG, TSH, ECG +/-LFTS, albumin, lipids, cortisol,
LH/FSH)
- GI
- IBD
- Celiac
- Infectious Gastroenteritis
- HIV, TB
- Endocrine
- Hyper/Hypothyroidism
- DM
- Addison’s
- Hypopituitarism
- Psychiatric
- OCD
- Substance Use
- Other
- CNS lesions
- SMA
What are features of refeeding syndrome?
Refeeding syndrome (intracellular shift of phosphate)
- most common in 1st week, with enteral nutrition
- low PO, K, Mg
- CHF and neurologic sx
- risky if <80% of expected weight for height
Medical reasons to admit a patient with anorexia?
- Physical
- HR <50 bpm awake (<45 asleep)
- BP < 80/50
- Rhythm disturbance/ Prolonged QT
- Orthostatic (BP >10, HR >25)
- <75-80% healthy body weight (or ongoing wt loss despite Rx)
- Laboratory
- Hypokalemia
- Hypophosphatemia
- Hypoglycemia
- Hypochloremia (BN)
- Liver, cardiac, renal compromise
Suicidality
Complete refusal to eat
- Which of the following laboratory results is very worrisome in an anorexic patient?
Hypokalemia
What leads to death in anorexia? (5-20% lifetime mortality rate)
#1 - suicide - 50% #2 - prolonged QTc and can get tachyarrhythmias
- Prevention of osteoporosis in an anorexic?
e. Calcium
Target weight related outcome for treatment of eating disorder?
- target 90% of average body weight for sex, age and height
note some patients may need over 4000 calories per day to gain weight
- standard balance of 15-20% calories protein, 50-55% carbs and 25-30% fat is appropriate
- calcium and vitamin D supplements to attain 1300mg/day calcium, for risk of low bone
mineral density
- if weight is less than 80% of expected weight for height, higher risk of refeeding syndrome and
consider restarting feeds in hospital
A mother is concerned that her teenage daughter has lost 20 pounds, has had amenorrhea for 4
months and has a poor appetite. She has complained of some vague abdominal pain. Which of the
following is not consistent with a diagnosis of anorexia nervosa:
a. HR 70
Signs of metabolic effects of eating disorders (vital sign changes)?
o metabolism:
▪ hypothermia (temp <35.5)
▪ pulse <60 bpm, and orthostatic increase >25bpm
▪ slowed psychomotor response with very low core temperature
▪ hypotension
- Teenage girl present with weight loss of 22 lbs over the last four months. She is amenorrheic. Heart
rate is 40 and lanugo hair is seen on exam. Expected ECG finding:
2) prolonged QT
What are the expected electrolyte changes associated with bulimia? (Na, K, Cl, pH, HCO3, CO2)
Na low most classic, but can be normal or high
K low
Cl low
Hypochloremic metabolic alkalosis (pH high, HCO3 high, CO2 high to compensate)
- An 11 year old boy who has had recent personality changes, decline in school performance and visual
changes. Which is the first diagnosis to rule out:
a. Brain tumour
- What is the most frequent cause of school absence in teenage girls:
(b) dysmenorrhea
- Best test to detect PCOS:
e. increased testosterone (not increased LH/FSH)
- A 13 year old female. Menarche has occurred. White vaginal discharge for several
month which is occasionally itchy and irritating. Most likely diagnosis is:
a. Physiologic leukorrhea
Causes of menorrhagia and irregular periods in an adolescent?
Continued endometrial proliferation Decreased progesterone (needed to support endometrial lining) excess estrogen
*consider heme issue if periods are regular but heavy
Causes of abnormal uterine bleeding?
Broad strokes categories:
- ovulatory dysfunction
- coagulopathy
- NYD
- A family comes in with their 12y daughter who has Down Syndrome. Menses have started and are
becoming difficult to manage. Which agent would be best to manage this?
c. 84/7 pill - will need to plan periods 3-4 times per year; no major risks
Which anti epileptic medication is made less effective when taken with combined hormonal OCP?
lamotrigine
- What would exclude PID?
d) absence of white cells in cervical discharge
Diagnostic criteria for PID?
Lower abdominal pain + either cervical motion tenderness, uterine tenderness or adnexal tenderness
- if you have this in an adolescent female, treat on spec for PID
How do you treat PID?
Ceftriaxone 250mg IM x1 dose, doxycycline 100mg po BID x14 days +/- metronidazole 500 po BID x14 days
- 6 year old child with vaginal bleeding, no foreign body, no exogenous estrogen sources. Has bone age of 7.5 years, 17-OHP normal, what is dx
b. craniopharyngioma (precocious puberty, not CAH as 17-OHP normal)
● Note: Do Pelvic US if isolated vaginal bleeding ( to R/O ovarian cyst or tumour)
- Teenager with painful menses. What medication do you offer? List the dose, frequency and the
mechanism by which this medication works.
NSAIDs (ibuprofen 200mg q4-6h) - prostaglandin synthetase inhibitor
OCPs (low dose, cyclic) - inhibition of ovulation eliminates progesterone production OR decrease of endometrial lining thickness decreased prostaglandin production
- 14 year old girl has severe dysmenorrhea and has missed 2-3 days of school with each period. What
are three causes of dysmenorrhea (3)?
○ Primary → absence of a specific pelvic pathology and the most common
■ Prostaglandins are produced by the endometrium and stimulate vasoconstriction and myometrial contractions leading to pain
○ Secondary results from an underlying structural abnormality of the cervix or the
uterus, foreign body (ie IUD), endometriosis or endometritis
How do you treat endometriosis?
leuprolide: create an environment of acyclic low dose estrogen to prevent bleeding and further seeding into the pelvis
- Girl started menarche 10 months ago, irregular every 1-3 months and heavy flow. No dysmennorhea.
What is the most likely cause and name 2 suggestions for management.
Immature HPG axis (no LH surge mid cycle leads to anovulation and abnormal bleeding)
- ddx: ectopic pregnancy, threatened abortion, endometritis
- mgmt: iron supplementation
- reassurance that expect this to resolve with time given only 10 months post menarchal and likely have anovulatory cycles
- consider OCPs
- You see an 8 year old girl in your office with a history of vaginal bleeding for the past 3 days. Name 4
diagnoses on your differential.
- Abuse or trauma
- Central - tumor affecting the HPO axis
- Infections - GAS or shigella vaginitis
- Foreign body
What are absolute contraindications to oral contraceptives?
- Absolute
o DVT or PE (high recurrence risk)
o <3 weeks post-partum
o Surgery with prolonged immobilization
o Severe hypertension (>160/100)
o Hypercoaguability disorders (factor V leiden, protein C deficiency etc)
o SLE with +APLAS (or unknown)
o Thrombogenic mutation
o Liver disease (severe cirrhosis, tumors, active viral hepatitis)
o Migraine with aura
o CVA or disease
o Ischemic heart disease
o Breast cancer
o Vascular disease
o Complicated valvular heart disease
o Complicated solid organ transplantation
o DM with complications
*cigarette smoking is not a contraindication in adolescents
List some medications that decrease the effectiveness of oral contraceptives:
Rifampin
Oxcarbazepine
Phenytoin
Phenobarb (barbiturates)
Carbamazepine
Topiramate
St John’s wort
- Which of the following is true regarding the morning after pill:
c. it is not necessary to do a urine beta-HCG before giving it
a. It is 75% effective at preventing pregnancy
- ideally taken with 72 hours of unprotected sex but can take within 120 hours
Indications for inpatient management of PID
Suspect tubo-ovarian abscess, pregnancy, severe pain, failed outpatient management
Treatment with Cefoxitin IV q6h and doxycycline 100mg po/IV q12h
- A sexually active adolescent female with sickle cell disease and a history of previous transfusions
presents with an acute history of fever, jaundice and vomiting. She also develops right shoulder pain.
Hbg 79 (prev 89), AST and ALT slightly elevated. Unconjugated bilirubin is increased. What is the
most likely diagnosis?
b) cholecystitis
Liver enzymes should be normal with Fitz-Hugh-Curtis because it is a perihepatitis (liver capsule, not the liver itself)
- You are treating a 17 year old male for Chlamydia urethritis. Which of the following do you tell him
regarding when he can resume sexual activity?
e) Once he completes 7 days of treatment
- Which is true regarding pregnancy and abortion in adolescents:
a ) the majority of teenage pregnancies end in abortion (50%)
b) proper counseling of post-abortion teenagers will prevent psychosocial problems
c) there is increased post-abortion mortality in teenagers compared with adult women
d) there is a similar rate of post-abortion infection in adolescents and adult women
a ) the majority of teenage pregnancies end in abortion (50%) - as per CPS statement
- What is the most common presentation of Chlamydia in a postpubertal adolescent?
b) asymptomatic
long incubation 7-21 days
- up to 75% of women with chlamydia have no symptoms
- asymptomatic urethral infection is common in men
- common symptoms: dysuria, vaginal discharge, abdo pain, vaginal spotting (esp after sex)
- can cause urethritis, epididymitis, cervicitis, salpingitis, proctitis, PID
- systemic sx rare (joints and eyes)
- less acute symptoms compared to gonorrhea (mucoid discharge, not purulent)
What is the treatment of chlamydia?
azithromycin 1g PO x1 dose OR doxycycline 100mg
PO BID x7 days
o doxy and quinolones are contraindicated in pregnant women
- sexual partners of patients with non-gonococcal urethritis should be treated if they have had
sexual contact with the patient within 60 days of symptom onset
- most recent sexual partner should be treated regardless of how long ago that sexual contact was
- patients and their partners should abstain from sex until 7 days after a single-dose regimen
or after completion of a 7 day regimen
What is the treatment of gonorrhoea?
o evaluate for concurrent syphilis, Hep C, HIV and chlamydia
o sexual partners in preceding 60 days should be cultured and started on presumptive
treatment
o combo therapy with ceftriaxone 250mg IM x1 AND azithro 1g PO x1 dose or doxy
100mg po BID x7 days
▪ if no ceftriaxone can used cefixime
- A teenage girl presents with a one week history of periumbilical pain, fever of 39.2 degrees. She
looks unwell and a blood C&S shows gram negative rods. Which antibiotic will you treat her with:
Reminder of some Gram negative rods from up to date:
- E. coli
- hemophilus
- klebsiella
- pseudomonas
- salmonella - diarrhea, crampy abdominal pain, fevers
o sustained or intermittent bacteremia can occur
o tx: amox or septra if susceptible (increasing resistance)
▪ fluoroquinolone or azithro usually good for resistant bugs
- in general, empiric treatment of gram negative bacilli bacteremia would be ceftriaxone or
pip-tazo
- When can you give contraception after an abortion?
a) Immediately
You can get pregnant soon after an abortion, even before your period returns. Most birth control methods
can be started on the same day of an abortion. However, you need to wait about 6 weeks after a
second-trimester abortion to use a cervical cap or a diaphragm to give the cervix time to return to its
normal size.
What are side effects of Plan B (Levonorgestrel)?
o side effects: headache, fatigue, nausea, dizziness
When would you counsel a teen who took plan B to expect her period to return?
- menses return within 7 days of expected date in 62.5% of patients - CPS statement
o “explain to the adolescent the next period may be early, on time or late”
o should return for a pregnancy test if their next period is more than 1 week late or is
unusual in any way
- The estrogen part of the OCP causes what?
b. salt and water retention (fluid retention)
- Kid with signs of increased ICP, teased at school because of obesity and acne. PE reveals
papilledema, MRI head normal. No sexual activity. What is the most likely cause?
b. Minocycline ( tetracycline Abx, used for acne, AE include raised ICP (IIH), bleeding, oliguria, N/V,
pancreatitis and skin rashes)
- What is the most likely finding on physical examination after a girl has been sexually assaulted?
b. normal vaginal exam
Physical findings specific to previous genital trauma only in 2.5% of abused children.
- Teenager, sexually active, pruritic genital lesions. On exam there are macules and plaques with
erythema, crusting and blue-grey 3-5 mm papules. What is the diagnosis (1). What is your treatment (1)
● Pediculosis Pubis (lice)
- examine all areas with coarse hair (eyelashes, eyebrows, beard, axilla, perianal area)
● tx: manually remove lice and their eggs (or hair shaved to limit infestation)
● tx: 1% permethrin cream rinse
- treat eyelash lice with petrolatum ointment 2-4x daily x10 days
● prevention: very contagious
○ machine-wash bedding, towels, clothes in hot water; dry in hot dryer
○ vacuum home, including mattresses
○ avoid sexual contact until successfully treated
○ tell all sex partners in last month about pubic lice
- Teenage girl with trisomy 21 is interested in Depo-provera. Name 2 long term side effects to this
medication.
decreased BMD
amenorrhea
- 15yo M with symptomatic urethritis, homosexual, yellow discharge when glans compressed?
a) what is the most likely
b) list 4 other causes
a) N. gonorrhea
b) mycoplasma genitalium, ureaplasma
urealyticum, trichomonas, HSV
What is post-OCP amenorrhea? how is it managed?
- failure to resume menstruation within six months after discontinuation of oral contraceptives
- mgmt: only needed if pregnancy desired - bromocriptine and clomiphene; otherwise reassure (do rule out pituitary tumours and endo abnormalities)
- 13 year old girl is sexually active. She sees you and has a normal pap smear with no STIʼs and uses
barrier protection. She doesn’t want you to tell her parents. What do you do? (3 lines)
Counsel on safe sex practices, encourage the use of oral contraception and reassure that you will not
speak to her parents about this. She is entitled to complete confidentiality unless there is a situation that
may harm her or harm others
- Side effects of marijuana include all of the following except:
- large testicles
Actual side effects include: bronchospasm, conjunctival injection, tachycardia
- no longer thought to be associated with gynecomastia
- A 15-year-old athletic boy comes in for his regular check up, and he tells you that he is using anabolic
steroids. Which of the following is a potential long-term sequelae of anabolic steroid use:
b) liver cancer
- The most important reason to be concerned about adolescent alcohol abuse is:
a. Risk-taking behaviour while drinking
- What is associated most with adolescents and illicit drug use?
b) decreased school performance
Early warning signs of teen substance abuse:
- change in mood appetite or sleep pattern
- decreased interest in school or school performance
- weight loss
- secretive behaviour about social plans
- valuables (money/jewelry) missing from home
- 14 y.o. female brought in by parents because she was found drunk. List five things that would increase
your concern over her substance abuse.
● Historical questions can determine severity of drug problem
o Type of drug used ( MJ, beer, wine lowest risk; whiskey, opiates, cocaine, barbiturates highest risk; hallucinogens and amphetamines in middle)
o using alcohol alone
o using alcohol before or during school
o Premorbid mental health status ( depressed vs. happy)
o sad affect prior to alcohol use
- family history of drug abuse
- worsening school performance
- use before driving
- positive history for accidental injury associated with use
- A mom is worried because her adolescent child is doing poorly in school, is stealing money from her
purse, etc. What are 4 clinical manifestations of cocaine use?
- Euphoria
- Psychosis
- Motor agitation
- Decreased fatigability
- Mental alertness
Sympathomimetic → pupillary dilatation, tachycardia, hypertension, hyperthermia
Snorting cocaine → loss of sense smell, nosebleeds and chronic rhinorrhea
Chronic users will have anxiety, irritability and sometimes paranoid psychosis
- Parents come to you worried that their teenaged son has a problem with alcohol. (3) What are four
signs of problem drinking in teenagers?
● CRAFT Mnemonic designed to screen for adolescents’ substance use in primary setting= CAR,
RELAX, ALONE, FORGET, FAMILY and FRIENDS, TROUBLE= During the past 12 months…
o Ridden in car driven by someone (incld. Yourself) who was high or had been using
alcohol or drugs?
o Used drugs to relax, feel better about yourself, or fit in?
o Used alcohol or drugs while you were by yourself?
o Ever forget things you did while using alcohol or drugs?
o Family and friends ever tell you to cut down your drinking or drug use?
o Ever gotten into trouble while using alcohol or drugs?
- Which medication class causes sexual dysfunction in adolescents?
b) antidepressants (specifically SSRIs)
- 15 year old high school student is being bullied at school because he is a homosexual. His parents tell
you they keep their meds in a locked cabinet after an incident where he took some of their meds. What
should be done
b. he is at increased risk for suicide because he is a homosexual (per CPS disclosure of homosexual orientation is a common precipitating factor for suicide)
- 16 yo boy has admitted to using anabolic steroids. His testes appear small. Why are his testes small?
(1 line) What test(s) would you do to confirm your suspicion of why testes are small.
Anabolic steroid-induced hypogonadism
Exogenous steroid suppresses the
hypothalamic-pituitary axis, thus decreasing the release FSH/LH = decrease stimulation to
produce endogenous testosterone and spermatogenesis, thus decreasing size of testes
o Test to confirm: LH/FSH levels
- 15 year old boy with a history of significant school absenteeism. He has had symptoms of intermittent
abdominal pain and recently has developed daily headaches with onset in the later afternoon. He
continues to get As despite missing 40% of the days in school. His height and weight continue along the
same percentiles as previously. What is the most likely diagnosis:
a. Anxiety
- A mother who has been abused as a child asks you about advice for preventing child abuse. What is
the evidence
a. nurse home visitor program reduces the risk of child abuse
Child abuse can be prevented by: supportive family environments and supportive social networks,
parental employment, adequate housing, access to healthcare and social services
- Autism. Risk for recurrence?
y. Slightly higher than general population
Risk Factors for autism:
- FHX: high recurrence risk in siblings (2-19%)
- Closer spacing of pregnancies
- Advanced maternal or paternal age
- Extreme prem birth (< 26 wk GA)
- FHX (+) for LD, psychiatric dx or social disability
- A teenage boy admits to having violent thoughts that overwhelm him. He says the thoughts are
frequent and that he has not hurt anyone yet but fears he will soon. What diagnosis is most likely?
b. OCD - thoughts are egodystonic
- A 6 y/o boy with 2 weeks of sudden onset of OCD behaviours. Which infectious agent would you be
concerned about:
- Group A Strep - team Pandas is back!
PANDAS - pediatric autoimmune neuropsychiatric disorder associated with strep infection
- sudden onset neuropsychiatric disorders (particularly OCD, tic, tourettes) with possible
relationship with GAS- hypothesized (not proven)
- Pt treated with prozac for 2 years. What is the chance of recurrence of depression once she is taken
off this medication.
- 40%
Response rates to SSRIs in the treatment of depression are 40-70%.
- once treatment started, should continue for 6-12 months to decrease relapse risk
- risk of recurrence is 34-50% in first year after discontinuation
- A teen in your practice has been on fluoxetine and risperdal. He presents to your office with
hyper-reflexia and tremor and ataxia and 5 or 6 more symptoms. What to do you do?
b) stop fluoxetine
- serotonin syndrome: usually rapid onset, mild symptoms incld increased HR, shivering,
diaphoresis, dilated pupils, myoclonus, hyperreflexia, hypervigilance, insomnia, agitation
o severe symptoms include shock and hyperthermia with metabolic acidosis,
rhabdomyolysis, seizures, renal failure, and DIC
- 15 year old girl with frequent brief attacks where she feels short of breath and vaguely uneasy. Which
of the following would support your diagnosis:
d. Fear of episodes recurring and sudden onset of episodes (panic attacks)
- What are suicide risk factors for teenagers
- low SES
- LGBT
- parental separation
- hx physical or sexual abuse
- family hx suicide attempts/completions
- bullying
- depression, anxiety, ADHD
- drug and alcohol abuse
- hopelessness
- 14 year old boy recently has had two weeks of behaviour change. Saying weird things. Staying in his
room. Not going to school. No comments on any physical symptoms. (4) what are four possibilities in
your differential diagnosis?
Ddx of psychotic disorders
● Medical Conditions
o ADEM (Acute disseminated encephalomyelitis)
o SLE (Systemic lupus erythematosus)
o Seizures (non convulsive or convulsive)
o Brain tumour
o Hyperthyroid, B12 deficiency
o Drugs of abuse: intoxication, overdose, withdrawal
o Depressive disorder with psychotic features
o Bipolar disorder
o OCD
o schizophrenia
- A10 yo brother of boy with AML, decision for palliative care at home. Brother going out to play with his
friends rather than spending time with family. Counsel the parents. (1 – one line given!
● Important to sit down with developmentally appropriate language and explain the situation
honestly and involve the brother w/ appropriate decisions, while providing support as all
members experience emotions in different ways.
- Girl with PTSD – list 4 characteristics of PTSD
exposure to significant event + intrusive symptoms (e.g. flashbacks, dreams) + avoid triggers (thought,
memory, feeling, people, places) + negative cognition and mood (forget, anhedonia, detachment) + hyperarousal or
hypervigilance (reckless, irritable, startled easily)
- Child comes to the office because his teacher wants him investigated for disruptive behaviour and is
concerned about ADHD. Parents may have some concerns about his attention but none about his
behaviour.
A) What do you think is the diagnosis?
B) What are 4 things to request to investigate for this diagnosis?
ADHD- possibly inattentive or combined type. Two setting of inattention clear.
● Additional information: SNAP-IV questionnaires, reports cards
● Hearing Test
● Vision Test
● Psychoeducational assessment
- Guidance counselor calls you about 12 y.o. from Inuit population. Thinks he may have ADHD. Give
four other things on your differential diagnosis.
● Neurodevelopmental: ASD, FASD, Fragile X
● Psych : Depression, Anxiety, Neglect
● Neuro: Seizure disorder
● Hearing or vision impairment
● Substance abuse
● Other organic: Iron deficiency anemia, Sleep apnea, lead poisoning
- List 3 serious side effects of Risperdol in addition to weight gain.
● +/- Metabolic syndrome: weight gain, diabetes, dyslipidemia
● Prolonged QTc syndrome
● Agranulocytosis - neutropenia, leukopenia
● Extrapyramidal side effects (dyskinesia, akinesia, akathesia (inner restlessness), dystonia
(involuntary contractions), pseudoparkinsons (tremor, rigidity, postural instability))
- Description of a child with florid autism.
A) Name 3 tests you should order.
B) Which 2 consultants or services would you involve to help you with your diagnosis?
A)
● Hearing Test
● Fragile X
● Microarray
B) Developmental Pediatrician + SLP
31. A 13 year old boy presents to your office with a history of being argumentative with his teachers at school, skipping class and refusing to obey his parents rules at home. What is the most likely diagnosis? Name 2 treatment modalities that may be beneficial in this situation.
Oppositional Defiant Disorder
- triple P positive parenting program; CBT, family therapy
- medications: stimulants or atypical antipsychotics (risperidone)
What are 2 treatment modalities for panic disorder?
1) SSRI & 2)CBT
- Tourette’s syndrome.
a. ) List 3 criteria for diagnosis.
b. ) List 3 associated conditions.
a) 2 motor + 1 vocal tic
- X 1 year minimum (present most days)
- < 18 y.o. at onset
- not due to other dx
b) ADHD, OCD, LD
List associations with teen pregnancy
Majority are unintended
- Lower lifetime educational achievement
- Lower income
- Increased reliance on social support programs
What is the biggest barrier to accessing contraceptives?
Cost
What are the rates of sexual intercourse in teens?
- By age 17, over 1/2 of teens are sexually active
- Oral sex is more common than sexual intercourse
- Approximately 1/3 youth report having more than one partner
- Rates of reported sexual intercourse are increasing amongst teens
Which of the following is false about LARCs?
A. LARCs offer 3-5 years of protection against pregnancy
B. Return to fertility after removal is ~6 months
C. Pain on insertion and expulsion rates are higher among younger women
D. Beyond first 21 days after insertion, there is no increased risk of STIs or PID in adolescent females
E. IUDs can be immediately inserted in post-partum period for teens
B is false: usually return to fertility is within a month (once they get their menses again)
What are common drug interactions with OCP and how to get around it?
- Anticonvulsants (cytochrome P450 is enhanced so will metabolize OCP faster and will make OCP less effective, except valproate)
- LARCs is best to bypass this
- Use higher dose estrogen (35mcg) as a trial but can tell if not working if there is break through bleeding (risk to still get pregnant)
What is not an effect of combined birth control?
A. Reduced blood loss
B. Reduced PMS symptoms and ovarian cysts
C. Reduced acne and hirsutism
D. Reduction in certain cancers
E. Weight gain
E. weight gain = not due to OCP (there is reduction in some gyne cancers)
