Adolescent medicine Flashcards by Huda Abdulrhman

Adolescent male twin, whose female twin sibling is taller than he is, is worried about his height

Reassurance (growth spurt occurs at sexual maturity rating [SMR] II-III for girls, whereas at SMR IV for boys)

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The first sign of sexual development in boys

Testicular enlargement

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The first sign of sexual development in girls

Breast development

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Adolescent female is concerned about one breast being slightly larger than the other

Reassurance

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A 15-year-old obese male with a sometimes painful breast that is larger than the other, with an otherwise normal exam

Reassurance (benign gynecomastia)

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Adolescent female is worried about painful masses noted in both breasts; the pain improves after her menstrual cycle

Reassurance (fibrocystic changes)

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Adolescent female is concerned about a painless rubbery mass located in the upper outer quadrant that does not change in size throughout her cycle; a well-circumscribed, smooth, mobile lesion

Reassurance (fibroadenoma)

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The most common cause of breast mass in adolescent girls

Fibroadenoma

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The most common cause of mastitis in adolescent girls

Staphylococcus aureus

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When does a girl usually get her first period?

2–3years after breast development (12.5years is mean age)

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The drug of choice for treatment of dysmenorrhea in adolescent females

NSAID (cyclooxygenase inhibitors)

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The most common cause of secondary amenorrhea in adolescents

Pregnancy

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The most common reason for hospitalization in adolescents

Pregnancy

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Adolescent with amenorrhea, headaches, blurring of vision, galactorrhea

Prolactinoma

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A concerned parent brings her 12-year-old female due to irregular periods; menarche was 6months ago

Reassurance (likely due to an immature hypothalamic-pituitary-ovarian [HPO] axis)

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Adolescent girl with irregular menstrual periods, body mass index at the 98th percentile, acne, acanthosis nigricans, hirsutism, male pattern baldness/alopecia, elevated total and free testosterone

Polycystic ovary syndrome (PCOS)

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A female adolescent presenting with abrupt onset of severe, constant, unilateral pain located in the pelvis, associated with recurrent nonbilious vomiting; she has no fever, urinalysis is normal, and pregnancy test is negative

Ovarian torsion

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What is the best way to encourage adolescents to disclose information to their pediatrician?

Interview the adolescent alone and in a confidential manner when discussing drugs, contraception, STDs, suicidal ideation

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A 16-year-old adolescent girl presents to your clinic to discuss birth control options without parental consent. She is sexually active. You live in a state that allows minor consent for contraceptive services

She can receive birth control pills without parental consent at her current age

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The 3 most common causes of death in adolescents

Unintentional injuries, suicide, homicide

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What are the consequences of e-cigarette use among adolescents?

May lead to cigarette smoking as well as nicotine addiction

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What are the new alternative tobacco products (ATPs) most commonly used by high school students?

E-cigarettes (most common), hookahs, e-hookahs, and smokeless products such as snus (moist powder tobacco)

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What are the negative health impacts of ATPs?

May be equal to or even worse than those associated with cigarettes

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What is the best approach to adolescents who are smoking cigarettes or using ATPs?

Provide an accurate and judgment-free education addressing the dangers of e-nicotine delivery systems

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The risk of accidental consumption by young children, who may be drawn to brightly colored and flavored e-cigarette liquids

Severe toxicity and death upon consumption

What is the strongest predictor of serious problems with substance use disorder?

Early age drug abuse (the younger the child, the higher the risk)

Adolescent male presents to the ER with respiratory depression, euphoria, and pinpoint pupils

Opiates drug abuse, e.g., codeine

Adolescent who lost his financial support presents with excessive yawning, tearing, dilated pupil, insomnia, nausea, diarrhea, gooseflesh, and cramping

Opiate withdrawal syndrome

Treatment of choice to treat opiate overdose

Naloxone

Adolescent presents with conjunctival injection, gynecomastia, worsening school grades

Marijuana

Adolescent male with new-onset aggression, palpitations, confusion, and disorientation

Synthetic marijuana intoxication

Adolescent male presents with hypertension, hyperthermia, decreased appetite and difficulty sleeping

Amphetamine intoxication

Adolescent presents with drowsiness, dry mouth, flushing, mydriasis, hallucination, delusions, illusions, and body image distortion

Lysergic acid diethylamide (LSD) toxicity

Adolescent with recent schizophrenic thoughts, depression, aggressive language, ataxia, and nystagmus

Phencyclidine (PCP) toxicity

Adolescent inhales toluene, xylene, presents with chest pain and loss of consciousness

Myocardial infarction/cardiac arrhythmia

What is the significant risk of inhalant abuse, including those experimenting with inhalant abuse for the first time?

Sudden sniffing death syndrome (cardiac arrest)

Adolescent presents with euphoria, violent excitement, pulmonary hypertension, restrictive lung defect, peripheral neuropathy, rhabdomyolysis, and hematuria

Gasoline inhalation

Adolescent always absent from school presents with chest pain and myocardial infarction

Cocaine abuse

Adolescent with aggressive behavior, rage, anger, acne, hirsutism, testicular atrophy, gynecomastia, and libido alteration

Anabolic steroids

Adolescent presents with euphoria, increased emotional energy, nausea, jaw clenching, teeth grinding, blurred vision, anxiety, and psychosis

MDMA (ecstasy, methylenedioxymethamphetamine)

The following sexually transmitted infections need to be reported

HIV, chlamydia, gonorrhea, and syphilis

Annual screening is indicated for sexually active females for which STD?

Chlamydia trachomatis

Adolescent male presents with severe dysuria, profuse, purulent discharge

Gonococcal urethritis

What is the best diagnostic test in cases of suspected gonorrhea or chlamydia in sexually active adolescents?

Urine nucleic acid amplification testing for gonorrhea and chlamydia

Adolescent male presents with dysuria, purulent discharge, a petechial rash, as well as new-onset knee pain

Disseminated gonorrhea | Treatment: IV ceftriaxone

Adolescent male, sexually active, urethral discharge, Gram stain shows WBCs and no organism

Nongonococcal urethritis ( Chlamydia trachomatis)

Adolescent with profuse, frothy, malodorous yellow-green vaginal discharge, vulvar irritation, and strawberry cervix, vaginal pH

Trichomonas vaginalis infection | Treatment: metronidazole or tinidazole

Adolescent with a fishy odor, homogenous white vaginal discharge, epithelial cells with a ragged border on microscopic examination, vaginal pH > 4.5

Bacterial vaginosis Treatment: metronidazole (not considered STDs)

The most common cause of epididymitis in adolescents

Chlamydia trachomatis

Adolescent girl was sexually assaulted a few hours ago

Empiric treatment for chlamydia, gonorrhea, and Trichomonas

Adolescent female with lower abdominal pain, fever, chills, dysuria, cervical motion tenderness, and adnexal tenderness

Pelvic inflammatory disease

A 17-year-old female is hospitalized for pelvic inflammatory disease (PID) and has severe allergy to cephalosporin. What is the best choice of antibiotics?

Clindamycin and gentamicin

A sexually active female presents with right upper abdominal pain, fever, and vaginal discharge

Perihepatitis (Fitz–Hugh–Curtis syndrome)

A sexually active adolescent with large, painless, and expanding suppurative ulcers that are beefy and easily bleed on the coronal sulcus and balanopreputial region

Granuloma inguinale (caused by Klebsiella granulomatis)

A sexually active adolescent with painful genital ulcer and unilateral inguinal lymphadenopathy

Chancroid (Haemophilus ducreyi)

A sexually active adolescent with a painless ulcer on the dorsal penis, punched out, clean appearing, sharp, firm, slightly elevated borders, and bilateral, regional lymphadenopathy

Chancre (primary syphilis)

A sexually active female presents to the clinic due to a rash noted on the palms and soles, along with flu-like symptoms, and malaise

Secondary syphilis

A sexually active adolescent presents with several days’ history of hearing loss, altered mental status, and decreased sensation in both legs

Neurosyphilis

A pregnant adolescent with secondary syphilis has anaphylaxis to penicillin. What is the drug of choice?

Penicillin (desensitization)

Adolescent female, sexually active, presents with painful, itchy vesicular lesion on the vulvar area, low-grade fever, cervical motion tenderness, thin, white vaginal discharge

Herpes simplex infection

Two adolescents are ready to give birth; one has an active herpes genital lesion, and the other has genital wart. Which one should deliver by C-section?

Herpes simplex (genital warts are not an indication of C-section)

Adolescent boy discloses that on most days over the past month, he has been feeling irritable and sad, has decreased pleasure in activities, weight loss, lack of sleep, fatigue, and poor concentration. What is the drug of choice?

Fluoxetine

A 15-year-old gymnast female presents with thin body habitus, bradycardia, lanugo hair, amenorrhea. What do you suspect?

Anorexia nervosa

What are the most common electrolyte abnormalities in refeeding syndrome?

Hypophosphatemia, hypokalemia, and hypomagnesemia

Adolescent girl who has a BMI in the 93rd percentile with bilateral parotid enlargement, erosions of the lingual surface of the teeth, loss of enamel, dental caries?

Bulimia nervosa

SSRIs are more effective in treating which eating disorder?

Bulimia nervosa

Adolescent girl with migraine headaches wants birth control pill. What condition do you need to rule out?

Migraine with aura is an absolute contraindication to the use of combined oral contraceptive pills

What is the most highly effective birth control option available to an adolescent girl?

Long acting reversible contraceptives, including intrauterine devices and subdermal implants

The percentile of BMI that is considered childhood obesity

≥ 95th percentile for age and sex

The percentile of BMI that is considered overweight in children

Between the 85th and 95th percentiles for age and sex

Adolescent male with right breast enlargement that is tender to touch,

Reassurance (most cases of pubertal gynecomastia

A 13-year-old girl with left-sided thoracic scoliosis on exam with a scoliometer showing 8°. What is your next step?

Radiograph, and if Cobb angle ≥ 20°, refer to orthopedics

A 13-year-old adolescent presents for her third HPV vaccination

CDC now recommends that 11- to 12-year-old receive 2 doses of HPV vaccine instead of 3 doses (≥ 15 years of age require 3 doses)