Adolescent med Flashcards
What arrhythmia are anorexics at risk for?
prolonged QT
Lab abnormalities found in AN
Low WBC, normal hub and dif
mildly elevated liver enzymes, cholesterol and cortisol
low gonadotropins and blood glucose
electrolyte disturbance with laxatives
hyperchloremic metabolic acidosis
electrolyte abnormality with vomiting, laxative or diuretics
hypokalemia, hypophosphatemia
lab abnormality with vomiting in AN
hypochloremic hypokalemic metabolic alkalosis
symptoms of referring syndrome
acute tachycardia, heart failure, neurologic symptoms with rapid drop of phos, mag, and potassium
best way to restore bone mineral density in AN
weight gain and restoration of menstrual cycles, +vitamin D and calcium
2 most common causes of death in AN
1) suicide
2) tachyarythmias
9 indications for hospitalization in AN
1) severe malnutrition: weight 75-80% average for sex, height, and age
2)Dehydration
3) electrolyte disturbance
4)Arrhythmia/bradycardia <50bmp daytime, <45bmp nighttime
5) Hypotension (<80/50)
6) Hypothermia
7) Orthostatic changes in HR (>20bpm) or BP (>10mmg)
8) acute food refusal, bingeing purging etc
9) SI
Time frame for buliemia
weekly x 3 months
most common cause of secondary dysmenorrhea
endometriosis
3 treatments for menorrhagia
high dose combined OCP, IV estrogen, TXA
What are 3 features of Rotterdam criteria for PCOS. How many features do you need to have?
need 2/3 of
1) oligo-ovulation or anovulation (irregular periods)
2) hyperandrogenism–clinical or biochemical
3) polycystic ovaries on ultrasound
How should impaired glucose tolerance in PCOS be evaluated?
2 hour glucose tolerance test
when can you have contraception after abortion?
immediately
at what age is a Pap smear recommended?
age 21 then q 3 yr once sexually active (changing to starting at 25 yrs)
If you vomit within what time frame should you take another plan B?
1 hr
up to what time after sex can you use copper IUD for emergency contraception?
7 days
levonorgestrel (plan B) can be used up to how many days after intercourse?
5 days (120 hrs), efficacy decreases with time and increasing body weight
Within what time frame can ulipristal acetate be used? (Ella)
5 days, efficacy dose not decrease with increasing body weight, 2nd most effective emergency contraception after copper IUD
Within what time frame should Yuzpe be used?
72 hrs
within what time frame should pt have a period after emergency contraception
3 weeks
which types of OCPs may exacerbate acne?
progestin only
how long does someone need to experience gender dysphoria for to meet DSM criteria?
6 months
how long should someone obstain from sex after chlamydia treatment?
7 days
treatment options for gonorrhoea?
Ceftriaxone 250mg IM x 1 and azithromycin 1 g PO (2 mechanisms to slow resistance (synergy)
OR
cefizime PO once with azithro PO one
OR
??doxycycline 100mg PO BID x 7 days
Alternative treatment as per nelsons is Cefixime
when testing for G&C, who should get urine and who should get swabs?
sexual assault of boys, non-vaginal symptoms of girls, treatment failure should do culture otherwise can do urine for screen and diagnosis
which adolescents should get HIV screening?
all sexually active >=15 yrs or those <15 yrs with risk factors (essentially everything is a risk factor ex. unprotected sex)
acute and chronic side effects of anabolic steroids
Acute: Increased muscle mass/strength, gynecomastia, acne, small testes, low sperm density, behaviour changes (irritability, depression, aggression),
Long term: cholestasis/liver tumors, cardiomyopathy & HTN, lipoprotein changes, hair loss/male pattern baldness, brain remodeling in adolescents, premature growth plate closure
Growth hormone acute and chronic effects
Acute effects: headaches/IIH, inc intraocular pressure, SCFE, scoliosis exacerbation,
Rare: transient gynecomastia, pancreatitis, insulin & glucose intolerance, growth & pigmentation of nevi, decreased efficacy (due to neutralizing antibodies)
side effects of taking creatine
weight gain (water retention), reduced joint mobility, muscle cramping
features making teens more (7) or less (10) likely to quit smoking
who is nicotine replacement recommended for in pediatrics?
regular smokers age 12-18
-side effects: local mucosal irritation, increased HR and higher BP readings
contraindication for bupropion for smoking cessation in adolescents?
seizures, eating disorders
differentiate between fibroadenoma and fibrocystic change in breasts
toxidrome wet and dilated
sympathomimetic
toxidrome wet and pinpoint
cholinergic
toxidrome dry and dilated
anticholinergic
toxidrome dry and pinpoint
opioid
treatment for chlamydia?
azithromycin 1g PO once OR doxy 100mg PO BID x 7 days
(NB dont need ceftriaxone)
Test of cure
3-4 weeks later if NAAT
3-7 days later if culture
Repeat screening in 6 months or sooner
how often should you screen for G&C in adolescents?
yearly
treatment for genital herpes?
2 treatment options for PID
who can 12/13 yo consent to have sex with?
14/15 year old?
16+ year old?
18+?
less than 12 never
12&13 –> 2 yrs
14&15 –> 5 yrs
16+ –> consent to anyone as long as not in position of trust/authority, not dependent on person for care/support, sex trafficking/pornography
18+ pornography, sex work etc
3 elements of informed consent
understand appropriate information, capacity, voluntariness
4 reasons to break confidentiality
risk of serious harm to self
risk of serious harm to other
abuse of any child
reportable illness
which antibiotic used to treat chlamydia is contraindicated in pregnancy?
doxycycline
