Adolescent Medicine Flashcards
Adrenarche vs Puberty?
Onset of adrenal androgen steroidogenesis (2 years before HPG axis) vs increase in gonadotropins
First sign of puberty in Males? First area of hair growth?
testicular enlargement at 11-12. Pubic
FSH in males vs females?
induces spermatogenesis vs simulates foillcular growth and E production from granulosa cells
LH in males vs females?
T production from leydig cells vs androgens from theca cells and progesterone from corpus luteum
Testosterone in males vs females
- linear growth
- muscle mass
- genital development
- hair
- deepens voice
vs
linear growth and hair
Estradiol in males vs females?
epiphyseal fusion vs
- epiphyseal fusion
- breast development
- LH surge in menstruation
- vaginal development
- endometrial growth
Progesterone in males vs females?
nothing vs converts endometrium to secretory endometrium
Adrenal androgens in males vs females?
linear and public hair growth in both
Tanner Stages: Testes?
- preadolescent - no hair, small testes
- larger testes, sparce/long hair
- larger testes, larger penis, darker/corser/curlier hair
- darkening of scrotal skin, larger penis, coarse pubic hair over symphisis pubis
- adult sized genitals, hair spreads to thighs
Tanner Stages: Breast?
- preadolescent
- small elevation/prjection
- areola emerges but no separation of areola and breast
- Areola and nipple project to form secondary mound
- Only nipple projects (areola retracts), adult breast size
Must report what infomation from confidential encouter?
- Sexual/physical abuse
2. Suicidal/homicidal thoughts
When to start complete plevic exams on females?
Sexually active, pelvic pain, vaginal discharge, abnormal bleeding or if over 18
Sexually active females should be screened for? How?
- Gonorrhoea by cervical culture
- Chlamydia by antibody test, urine ligase, or cervical fluid culture
- Syphilis by serologic test
- Cervial cancer via PAP smear
- Trichomonas vaginali with Vaginal wet mount
Depression diagnosis?
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
Dysthymic Disorder?
1 year with 2/5:
SIG-E-CA
Problem drinking?
6+ intoxications within 1 year OR problems in school/relationships/driving drunk
Endocrin/Genetic causes of Obesity?
hypothyroid, Cushings, hypogonadism, Prader-Willie
Anorexia Nervosa Criteria?
- Weight 15% below ideal
- Fear of gaining weight
- Disturbed body image
- Absence of 3 consecutive menstrual cycles
Lab findings in Anorexia?
Anemia, Leukopenia, low thyroxine/glucose/calcium/phosphorus/sex hormones
High BUN, Transaminases
Lab findings in Bulimia?
Low Cl, K
High BUN
Signs of T. Vaginalis? Diagnosis? tx?
asymptomatic in 50%
- Friable cervix with petechiae (Strawberry Cervix)
- Malodorus, yellow-green discharge
- Itching
- Dyspareunia (pain with intercourse)
- Wet-mount showing flagellated protozoa
- culture
- Vaginal pH <4.5
Metronidazole
Signs of Bacterial vaginosis signs? Diagnosis? tx?
- Gray/white vaginal discharge
- Fishy odor
- Little inflammation
- Wiff Test - KOH increases odor
- Clue cells
- Vaginal pH >4.5
Metronidazole
Signs of C trachomatis? Diagnose by? Tx?
- Purulent endocervical discharge
- Friable, edematous, erythematous vervix
- Dysuria
- GOLD STANDARD - Endocervix Culture
- Rapid antrigen detection by immunoassy or direct fluorescent antibody staining
- PCR, nucleic acid hybridization
Doxycycline or macrolides
Signs of N Gonorrhoeae? Diagnose by? Tx?
- Purulent endocervical discharge
- Dysuria
- GOLD STANDARD - Endocervix Culture
- Gram Stain
- urine PCR, urine nucleic acid hybridization
Ceftriaxone
PID more common when? Diagnosis criteria?
1st half of menstrual cycle (menstruation enhances spread of infection from lower GI tract)
- Lower ab pain
- Adenxal tenderness
- 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
Signs of Urethritis? Diagnose by?
- Dysuria
- Mucopurulent urethral dischrge
- Asymtomatic infections
- Mucopurulent urethral discharge
- Postive Leukocyte esterase
- 5+ WBCs on urethral sections or 10+ WBCs on on UA
Genital Ulcers - causes?
- HSV
- Syphilis
- Chancroid
Gential Warts caused by? Can Ccuase cervical CA but does not cause warts? Management?
HPV
HPV 16, 18
Topical podophyllin, trichloroacetic acid, cryotherapy, laser/surgery
Tx of HSV vs Primary Syphilis vs Chancroid?
Acyclovir vss intramuscular penicillin vs macrolide/ceftriaxone
Normal length of menstrual cycle? Duration of menstrual flow? Blood loss?
21-35 days; 2/8 days; 30-80 mL
3 Phases of Ovulation?
- Follicular - FSH
- Ovulation - E leads to LH peak
- Luteal (secretory) phase - Progesterone creates secretory endometrium
Causes of secondary dysmenorrhea? Tx?
- endometriosis
- PID
- Uterine polyps/fibroids
- bicornate uterus
- Protaglandin inhibitors
- NSAIDS
- OCP
Primary Amenorrhea definition?
- No menstrual bleeding at 16+ with 2ndary sex characteristics
- No menstrual bleeding at 14+ without 2ndary sex characteristics
Causes of Primary Amenorrhea with pubertal delay but normal genitalia? (Signs?)
- Turners (high FSH/LH)
- Ovarian failure (High FSH/LH)
- Hypothalamic/pituitary failure (low FSH/LH)
Causes of Primary Amenorrhea with absent uterus and normal pubertal development? (Signs?)
- Testicular feminization syndrome - defect in andrgoen receptor (Low FSH and LH)
- Mayer-Rokitansky-Kuster-Kauser - absent vagina and uterus (normal FSH/LH)
Primary/Secondary amenorrhea with normal genitalia and normal pubertal development?
- Hypothalamic supression - Meds/drugs/Stress/Exercise (Low FSH and LH)
- PCOS (high FSH, LH and FSH/LH ratio)
- Pituitary failure (Sheehans) (Low FSH, LH)
- Prolactinoma (Low FSH, LH)
- Outflow tract obstruction (inperforate hymen, tranverse vaginal septum, uterine adhesions) - Normal FSH/LH
- Premature ovarian failure (high FSH, LH)
- Pregnancy (high FSH, LH)
- Thyroid dz (high FSH, LH)
- Diabetes (high FSH, LH)
Amenorrhea - steps?
- Measure FSH/LH
- Pregnancy Test
- TSH/T3
- Fasting prolactin levels
Dysfunctional uterine Bleeding? Tx?
Frequent, irregular menstrual periods associated with prolonged, painless bleeding
- Hormonal therapy is anemic
- Iron
- D and C if hormonal therapies fail
- Polymenorrhea
- menorrhagia
- Metrorhagia
- menometrorrhagia
- Oligomenorrhea
- regular intervals under 21 days
- excessive bleedings
- irregular intervals
- excessive and irregular
- regular but more than 35 days
Gynecomastia - management? DDx?
Reassurance
DDx: meds, testicular tumors, thyroid/liver disease
Torsion of spermatic cord - findings? Diagnosis? Treatment time?
- Sudden onset of pain with n/v
- Swollen, tender testicle and scrotal edema with absent cremasteric reflex on affected side
- pain relief on elevation of testicle
decreased uptake on technetium 99m or absent pulsations on doppler
Must be within 6 hours
Testicular Torsion - findings? Diagnosis? tx?
- Acute or gradual onset of pain
- Blue dot sign (cyanotic appendage)
H&P makes diagnosis (Normal on doppler)
Rest and analgesia
Epididymitis - Cause? Findings? Diagnosis?
Ghonorrhoea or trachomatis
- Acute onset
- Swollen/tender epididymis
- UA shows increased WBCs, positive gram stain, positive urethral discarge culture
- Increased flow on dopplers
- Increased uptake on radionuclide scan
Indirect ingiunal hernia? (PE finding?)
Processus vaginalis fails to obliterate (bowl sounds in scrotum)
Hydrocele - dx? tx?
Transillumination shows cystic mass. Reassurance
First sign of puberty in females?
Breast bugs (Thelarche)
