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Pediatrics > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

1
Q

Adrenarche vs Puberty?

A

Onset of adrenal androgen steroidogenesis (2 years before HPG axis) vs increase in gonadotropins

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2
Q

First sign of puberty in Males? First area of hair growth?

A

testicular enlargement at 11-12. Pubic

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3
Q

FSH in males vs females?

A

induces spermatogenesis vs simulates foillcular growth and E production from granulosa cells

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4
Q

LH in males vs females?

A

T production from leydig cells vs androgens from theca cells and progesterone from corpus luteum

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5
Q

Testosterone in males vs females

A
  1. linear growth
  2. muscle mass
  3. genital development
  4. hair
  5. deepens voice

vs

linear growth and hair

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6
Q

Estradiol in males vs females?

A

epiphyseal fusion vs

  1. epiphyseal fusion
  2. breast development
  3. LH surge in menstruation
  4. vaginal development
  5. endometrial growth
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7
Q

Progesterone in males vs females?

A

nothing vs converts endometrium to secretory endometrium

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8
Q

Adrenal androgens in males vs females?

A

linear and public hair growth in both

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9
Q

Tanner Stages: Testes?

A
  1. preadolescent - no hair, small testes
  2. larger testes, sparce/long hair
  3. larger testes, larger penis, darker/corser/curlier hair
  4. darkening of scrotal skin, larger penis, coarse pubic hair over symphisis pubis
  5. adult sized genitals, hair spreads to thighs
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10
Q

Tanner Stages: Breast?

A
  1. preadolescent
  2. small elevation/prjection
  3. areola emerges but no separation of areola and breast
  4. Areola and nipple project to form secondary mound
  5. Only nipple projects (areola retracts), adult breast size
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11
Q

Must report what infomation from confidential encouter?

A
  1. Sexual/physical abuse

2. Suicidal/homicidal thoughts

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12
Q

When to start complete plevic exams on females?

A

Sexually active, pelvic pain, vaginal discharge, abnormal bleeding or if over 18

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13
Q

Sexually active females should be screened for? How?

A
  1. Gonorrhoea by cervical culture
  2. Chlamydia by antibody test, urine ligase, or cervical fluid culture
  3. Syphilis by serologic test
  4. Cervial cancer via PAP smear
  5. Trichomonas vaginali with Vaginal wet mount
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14
Q

Depression diagnosis?

A 
5/9 SIG-E-CAPS for at least 2 weeks
Sleep changes
Interest (loss)
Guilt/worthlessness
Energy (lack)
Cognition/Concentration loss
Appetite Loss
Psychomotor (Anxiety/agitation)
Suicide preocp
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15
Q

Dysthymic Disorder?

A

1 year with 2/5:

SIG-E-CA

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16
Q

Problem drinking?

A

6+ intoxications within 1 year OR problems in school/relationships/driving drunk

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17
Q

Endocrin/Genetic causes of Obesity?

A

hypothyroid, Cushings, hypogonadism, Prader-Willie

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18
Q

Anorexia Nervosa Criteria?

A
  1. Weight 15% below ideal
  2. Fear of gaining weight
  3. Disturbed body image
  4. Absence of 3 consecutive menstrual cycles
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19
Q

Lab findings in Anorexia?

A

Anemia, Leukopenia, low thyroxine/glucose/calcium/phosphorus/sex hormones

High BUN, Transaminases

20
Q

Lab findings in Bulimia?

A

Low Cl, K

High BUN

21
Q

Signs of T. Vaginalis? Diagnosis? tx?

A

asymptomatic in 50%

  1. Friable cervix with petechiae (Strawberry Cervix)
  2. Malodorus, yellow-green discharge
  3. Itching
  4. Dyspareunia (pain with intercourse)
  5. Wet-mount showing flagellated protozoa
    • culture
  7. Vaginal pH <4.5

Metronidazole

22
Q

Signs of Bacterial vaginosis signs? Diagnosis? tx?

A
  1. Gray/white vaginal discharge
  2. Fishy odor
  3. Little inflammation
  4. Wiff Test - KOH increases odor
  5. Clue cells
  6. Vaginal pH >4.5

Metronidazole

23
Q

Signs of C trachomatis? Diagnose by? Tx?

A
  1. Purulent endocervical discharge
  2. Friable, edematous, erythematous vervix
  3. Dysuria
  4. GOLD STANDARD - Endocervix Culture
  5. Rapid antrigen detection by immunoassy or direct fluorescent antibody staining
  6. PCR, nucleic acid hybridization

Doxycycline or macrolides

24
Q

Signs of N Gonorrhoeae? Diagnose by? Tx?

A
  1. Purulent endocervical discharge
  2. Dysuria
  3. GOLD STANDARD - Endocervix Culture
  4. Gram Stain
  5. urine PCR, urine nucleic acid hybridization

Ceftriaxone

25
Q

PID more common when? Diagnosis criteria?

A

1st half of menstrual cycle (menstruation enhances spread of infection from lower GI tract)

  1. Lower ab pain
  2. Adenxal tenderness
  3. Fever OR WBC>10,500 OR Pelvic mass OR elevated ESR/C-reactive protein OR Lab findings

Inpatient: Cefoxitine, oral doxycycline
Outpatient: Ofloxacin + clindamycin OR Ceftriaxone and doxycycline

26
Q

Signs of Urethritis? Diagnose by?

A
  1. Dysuria
  2. Mucopurulent urethral dischrge
  3. Asymtomatic infections
  4. Mucopurulent urethral discharge
  5. Postive Leukocyte esterase
  6. 5+ WBCs on urethral sections or 10+ WBCs on on UA
27
Q

Genital Ulcers - causes?

A
  1. HSV
  2. Syphilis
  3. Chancroid
28
Q

Gential Warts caused by? Can Ccuase cervical CA but does not cause warts? Management?

A

HPV

HPV 16, 18

Topical podophyllin, trichloroacetic acid, cryotherapy, laser/surgery

29
Q

Tx of HSV vs Primary Syphilis vs Chancroid?

A

Acyclovir vss intramuscular penicillin vs macrolide/ceftriaxone

30
Q

Normal length of menstrual cycle? Duration of menstrual flow? Blood loss?

A

21-35 days; 2/8 days; 30-80 mL

31
Q

3 Phases of Ovulation?

A
  1. Follicular - FSH
  2. Ovulation - E leads to LH peak
  3. Luteal (secretory) phase - Progesterone creates secretory endometrium
32
Q

Causes of secondary dysmenorrhea? Tx?

A
  1. endometriosis
  2. PID
  3. Uterine polyps/fibroids
  4. bicornate uterus
  5. Protaglandin inhibitors
  6. NSAIDS
  7. OCP
33
Q

Primary Amenorrhea definition?

A
  1. No menstrual bleeding at 16+ with 2ndary sex characteristics
  2. No menstrual bleeding at 14+ without 2ndary sex characteristics
34
Q

Causes of Primary Amenorrhea with pubertal delay but normal genitalia? (Signs?)

A
  1. Turners (high FSH/LH)
  2. Ovarian failure (High FSH/LH)
  3. Hypothalamic/pituitary failure (low FSH/LH)
35
Q

Causes of Primary Amenorrhea with absent uterus and normal pubertal development? (Signs?)

A
  1. Testicular feminization syndrome - defect in andrgoen receptor (Low FSH and LH)
  2. Mayer-Rokitansky-Kuster-Kauser - absent vagina and uterus (normal FSH/LH)
36
Q

Primary/Secondary amenorrhea with normal genitalia and normal pubertal development?

A
  1. Hypothalamic supression - Meds/drugs/Stress/Exercise (Low FSH and LH)
  2. PCOS (high FSH, LH and FSH/LH ratio)
  3. Pituitary failure (Sheehans) (Low FSH, LH)
  4. Prolactinoma (Low FSH, LH)
  5. Outflow tract obstruction (inperforate hymen, tranverse vaginal septum, uterine adhesions) - Normal FSH/LH
  6. Premature ovarian failure (high FSH, LH)
  7. Pregnancy (high FSH, LH)
  8. Thyroid dz (high FSH, LH)
  9. Diabetes (high FSH, LH)
37
Q

Amenorrhea - steps?

A
  1. Measure FSH/LH
  2. Pregnancy Test
  3. TSH/T3
  4. Fasting prolactin levels
38
Q

Dysfunctional uterine Bleeding? Tx?

A

Frequent, irregular menstrual periods associated with prolonged, painless bleeding

  1. Hormonal therapy is anemic
  2. Iron
  3. D and C if hormonal therapies fail
39
Q
  1. Polymenorrhea
  2. menorrhagia
  3. Metrorhagia
  4. menometrorrhagia
  5. Oligomenorrhea
A
  1. regular intervals under 21 days
  2. excessive bleedings
  3. irregular intervals
  4. excessive and irregular
  5. regular but more than 35 days
40
Q

Gynecomastia - management? DDx?

A

Reassurance

DDx: meds, testicular tumors, thyroid/liver disease

41
Q

Torsion of spermatic cord - findings? Diagnosis? Treatment time?

A
  1. Sudden onset of pain with n/v
  2. Swollen, tender testicle and scrotal edema with absent cremasteric reflex on affected side
  3. pain relief on elevation of testicle

decreased uptake on technetium 99m or absent pulsations on doppler

Must be within 6 hours

42
Q

Testicular Torsion - findings? Diagnosis? tx?

A
  1. Acute or gradual onset of pain
  2. Blue dot sign (cyanotic appendage)

H&P makes diagnosis (Normal on doppler)

Rest and analgesia

43
Q

Epididymitis - Cause? Findings? Diagnosis?

A

Ghonorrhoea or trachomatis

  1. Acute onset
  2. Swollen/tender epididymis
  3. UA shows increased WBCs, positive gram stain, positive urethral discarge culture
  4. Increased flow on dopplers
  5. Increased uptake on radionuclide scan
44
Q

Indirect ingiunal hernia? (PE finding?)

A

Processus vaginalis fails to obliterate (bowl sounds in scrotum)

45
Q

Hydrocele - dx? tx?

A

Transillumination shows cystic mass. Reassurance

46
Q

First sign of puberty in females?

A

Breast bugs (Thelarche)

Pediatrics (38 decks)

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