ADOLESCENT MEDICINE Flashcards
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)
The first sign of sexual development in boys
Testicular enlargement
The first sign of sexual development in girls
Breast development
Adolescent female is concerned about one breast being slightly larger than the other
Reassurance
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)
Adolescent female is worried about painful masses noted in both breasts; the pain improves after her menstrual cycle
Reassurance (fibrocystic changes)
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)
The most common cause of breast mass in adolescent girls
Fibroadenoma
The most common cause of mastitis in adolescent girls
Staphylococcus aureus
When does a girl usually get her first period?
2–3 years after breast development (12.5 years is mean age)
The drug of choice for treatment of dysmenorrhea in adolescent females
NSAID (cyclooxygenase inhibitors)
The most common cause of secondary amenorrhea in adolescents
Pregnancy
The most common reason for hospitalization in adolescents
Pregnancy
Adolescent with amenorrhea, headaches, blurring of vision, galactorrhea
Prolactinoma
A concerned parent brings her 12-year-old female due to irregular periods; menarche was 6 months ago
Reassurance (likely due to an immature
hypothalamic-pituitary-ovarian [HPO] axis)
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)
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
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
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
The 3 most common causes of death in adolescents
Unintentional injuries, suicide, homicide
What are the consequences of e-cigarette use among adolescents?
May lead to cigarette smoking as well as
nicotine addiction
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)
What are the negative health impacts of ATPs?
May be equal to or even worse than those associated with cigarettes
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
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
Chlamydia trachomatis
Adolescent with profuse, frothy, malodorous yellow-green vaginal discharge, vulvar irritation, and strawberry cervix, vaginal pH < 4.5
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, < 4 cm in size
Reassurance (most cases of pubertal
gynecomastia < 4 cm resolve within 3 years)
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)
