Adolescent med

Question 1

What arrhythmia are anorexics at risk for?

Answer 1

prolonged QT

Question 2

Lab abnormalities found in AN

Answer 2

Low WBC, normal hub and dif
mildly elevated liver enzymes, cholesterol and cortisol
low gonadotropins and blood glucose

Question 3

electrolyte disturbance with laxatives

Answer 3

hyperchloremic metabolic acidosis

Question 4

electrolyte abnormality with vomiting, laxative or diuretics

Answer 4

hypokalemia, hypophosphatemia

Question 5

lab abnormality with vomiting in AN

Answer 5

hypochloremic hypokalemic metabolic alkalosis

Question 6

symptoms of referring syndrome

Answer 6

acute tachycardia, heart failure, neurologic symptoms with rapid drop of phos, mag, and potassium

Question 7

best way to restore bone mineral density in AN

Answer 7

weight gain and restoration of menstrual cycles, +vitamin D and calcium

Question 8

2 most common causes of death in AN

Answer 8

1) suicide
2) tachyarythmias

Question 9

9 indications for hospitalization in AN

Answer 9

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

Question 10

Time frame for buliemia

Answer 10

weekly x 3 months

Question 11

most common cause of secondary dysmenorrhea

Answer 11

endometriosis

Question 12

3 treatments for menorrhagia

Answer 12

high dose combined OCP, IV estrogen, TXA

Question 13

What are 3 features of Rotterdam criteria for PCOS. How many features do you need to have?

Answer 13

need 2/3 of
1) oligo-ovulation or anovulation (irregular periods)
2) hyperandrogenism–clinical or biochemical
3) polycystic ovaries on ultrasound

Question 14

How should impaired glucose tolerance in PCOS be evaluated?

Answer 14

2 hour glucose tolerance test

Question 15

when can you have contraception after abortion?

Answer 15

immediately

Question 16

at what age is a Pap smear recommended?

Answer 16

age 21 then q 3 yr once sexually active (changing to starting at 25 yrs)

Question 17

If you vomit within what time frame should you take another plan B?

Answer 17

1 hr

Question 18

up to what time after sex can you use copper IUD for emergency contraception?

Answer 18

7 days

Question 19

levonorgestrel (plan B) can be used up to how many days after intercourse?

Answer 19

5 days (120 hrs), efficacy decreases with time and increasing body weight

Question 20

Within what time frame can ulipristal acetate be used? (Ella)

Answer 20

5 days, efficacy dose not decrease with increasing body weight, 2nd most effective emergency contraception after copper IUD

Question 21

Within what time frame should Yuzpe be used?

Answer 21

72 hrs

Question 22

within what time frame should pt have a period after emergency contraception

Answer 22

3 weeks

Question 23

which types of OCPs may exacerbate acne?

Answer 23

progestin only

Question 24

how long does someone need to experience gender dysphoria for to meet DSM criteria?

Answer 24

6 months

Question 25

how long should someone obstain from sex after chlamydia treatment?

Answer 25

7 days

Question 26

treatment options for gonorrhoea?

Answer 26

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

Question 27

when testing for G&C, who should get urine and who should get swabs?

Answer 27

sexual assault of boys, non-vaginal symptoms of girls, treatment failure should do culture otherwise can do urine for screen and diagnosis

Question 28

which adolescents should get HIV screening?

Answer 28

all sexually active >=15 yrs or those <15 yrs with risk factors (essentially everything is a risk factor ex. unprotected sex)

Question 29

acute and chronic side effects of anabolic steroids

Answer 29

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

Question 30

Growth hormone acute and chronic effects

Answer 30

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)

Question 31

side effects of taking creatine

Answer 31

weight gain (water retention), reduced joint mobility, muscle cramping

Question 32

features making teens more (7) or less (10) likely to quit smoking

Answer 32

Question 33

who is nicotine replacement recommended for in pediatrics?

Answer 33

regular smokers age 12-18 -side effects: local mucosal irritation, increased HR and higher BP readings

Question 34

contraindication for bupropion for smoking cessation in adolescents?

Answer 34

seizures, eating disorders

Question 35

differentiate between fibroadenoma and fibrocystic change in breasts

Answer 35

Question 36

toxidrome wet and dilated

Answer 36

sympathomimetic

Question 37

toxidrome wet and pinpoint

Answer 37

cholinergic

Question 38

toxidrome dry and dilated

Answer 38

anticholinergic

Question 39

toxidrome dry and pinpoint

Answer 39

opioid

Question 40

treatment for chlamydia?

Answer 40

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

Question 41

how often should you screen for G&C in adolescents?

Answer 41

yearly

Question 42

treatment for genital herpes?

Answer 42

Question 43

2 treatment options for PID

Answer 43

Question 44

who can 12/13 yo consent to have sex with? 14/15 year old? 16+ year old? 18+?

Answer 44

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

Question 45

3 elements of informed consent

Answer 45

understand appropriate information, capacity, voluntariness

Question 46

4 reasons to break confidentiality

Answer 46

risk of serious harm to self risk of serious harm to other abuse of any child reportable illness

Question 47

which antibiotic used to treat chlamydia is contraindicated in pregnancy?

Answer 47

doxycycline