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Peds BRS > Adolescent Medicine > Flashcards

Adolescent Medicine Flashcards

1
Q

Changes in physical growth

A

Average growth spurt 2-3 yrs, controlled by GH (insulin, thyroid, sex steroids also influence. 50% body weight and 25% height gained in spurt, 18-24 months earlier in females

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2
Q

Genitalia/Secondary sex characteristics

A

3-4 years of puberty,
Adrenarche (adrenal androgen synthesis)- 2 years before HPG
True puberty when gonaotropins increase

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3
Q

Physical changes in male puberty

A

Testicular enlargement @11-12 y/o

Facial/armpit hair 2 years after pubic hair begins

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4
Q

Female physical changes

A

Thelarche @ 9.5 years
Pubarche
menarche 2-3 years after thelarche, 12.5

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5
Q

Tanner stages (male)

A

1- preadolescent, no pubes
2-testes larger, downy hair
3-testes even bigger, penis longer, darker/coarse hair
4-darkening scrotal skin, big/wider penis, glans develops, hair over symph pubis
5-adult…hair to medial thigh

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6
Q

FSH

A

M- spermatogenesis

F-ovarian follicle development, ovarian granulosa cells make estrogen

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7
Q

LH

A

M- induces testicular Leydigs to make testosterone

F- stim ovarian theca cells make androgens, corpus luteum makes prog, midcycle surge in ovulation

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8
Q

Testosterone

A

Increase linear growth/muscle mass, penis/scrotum/prostate/seminalvesicles, hair growth, deepns voice, increases libido

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9
Q

Estradiol

A

M- increased rate epiphyseal fusion
F- stim breast develop, trig midcycle LH surge, stim lab/vag/uterine development, prolif endometrium, low level stim linear growth, high level => g-plate fusion

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10
Q

Progesterone

A

Converts endo to secretory endometrium

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11
Q

Adrenal androgens

A

M/F- stim pubic hair + linear growth

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12
Q

Tanner Females

A

1-preadolescent, no hair
2- elevation of breast/nipple projections, sparse downy hair on labia
3- enlarged breast, areola enlarges, dark/coarse/curly hair
4- areola/nipple project to form secondary mound, cover pubic symphysis
5- only nipple projects, hair to thigs

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13
Q

Early adolescence

A

10-13 years, Early shift to independence from parents, less interest in fam activities, mood/behavior changes, worried abt body changing, same-sex peer relationships, beginning of abstract thinking, lack of impulse control

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14
Q

Middle adolescence

A

14-17 years
increased parental conflicts, less worried abt pubertal changes, but trying to look good
Intense peer group involvement, romance starts
Increased abstract reasoning and risks

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15
Q

Late adolescence

A

18-21
Self as distinct from parents, more likely to seek advice from parents, comfortable with own body image, shared intimate relationships, abstract thought processes, less risks, articulate goals

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16
Q

HEADS/SHADESS

A

home, education and employment, activities, drugs, sexual activity, suicide/depression

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17
Q

Physical exam for adoescent

A

Height, weight, bp, pulse, hearing, vision, skin (acne/fungal), teeth (malocclusion/hygiene), thryooid, back (scoliosis), tanner stage, teach testicular exam, pelvic exam if sexually active or sx or 18

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18
Q

Immunizations

A

Tet/dipth booster between 11-12 y/o and then every 10 years
MMR + hep B if not given before adolescence
Hep A if in endemic area
Varicella- if kid never got chickenpox

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19
Q

Labs

A

Hb, HCt, UA, cholesterol/fasting liid panel, HIV is hx, TB test, if active, STI testing, annual chlamydia test

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20
Q

Depression

A

Epi- 3rd leading cause of death, 5% geens clinically depressed, girls 2x more than boys
Risks- fam/peer confict, loss, substances, divorce, learning disable, abuse, fam hx, illness
Clin- behavioral sx (miss school, act out, lack of interest, withdrawn, substance), physical (ab pain, h/a, wl, overeat, insomnia, anxious), psych signs saddness

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21
Q

Dpression criteria

A

5/9 almost every day for at least 2 weeks, can’t function normally:
Depresed/irritable mood, diminished interest/pleasure, weight change, sleep change, psychomotor change, fatigue, worthless, can’t concentrate, suicide thoughts

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22
Q

Dysthymia

A

Chronic mood disturbance, at least 1 year, 2/5 criteria while depressed
Poor appetite/overating, sleep change, diminished energy, difficulty concentrating, hopeless feeling

23
Q

Substance Abuse

A

Epi-90% HS students try etoh, 50% illegal drug, 60% cigs, based on friends/fam/actingout, social.
Dx substance abuse if mood/sleep disturb, truancy, decline in school, change in relationships, wl, app change, depression, etc

24
Q

Alcohol

A 
Problem drinking = being drunk 6+ times in a year, problem in areas w/ driking- driving, argumentsin class
Binge drinking- 5+ nights drinking, fight, drive drunk, sex
Alcoholism = preoccupation with/impaired control over drinking
CAGE = felt need to cut down? annoyed by criticms of drinking? guilty? eye opener?
25
Q

Tobacco

A

Smoke? more likely to try other drugs, do worse in school, very addictive
Risk of CAD, stroke, cancers, CLD, asthma, ulcers, prego issues, 3 mil teens chew!

26
Q

Marijuana

A

Most widely used illicit drug- tachy, mydriasis, sleepiness, red eyes, dry mouth, hallucinations (aud/vis), increased appetite, impaired cognition.
Long term conseq = asthma, impaired memory/learning, truancy, less interactions, depression

27
Q

Obesity

A

20% over ideal body weight, BMI >95% for age/sex, body fat measure skin fold thickness at triceps/subscap, BMI>95% for age/sex
Why? genetic, calories, energy, underlying is only 5%(hypothy, cushin, praderwilli)
Effects- earlier puberty, htn, cvd, chol/trig, t2dm, gallbladder, ortho, poor image, depression
MGMT- tx challenging/multifaceted, promote behavior change, balance weight reduction

28
Q

Arex/Bulimia

A

Epi- Arex .5-1% , bulimia 1-5%
Dx- arex- calories insufficient, delusion of fat/obsession to be thing. Specific- refusal to maintian body weight, 15% below idea, intense fear of weight gain, disturbed BI, absence of 3 menses, excessive exercise, emotion waves, withdrawal peer/sfam, preoccupy w/ food
Dx- bulimia- binging, at least 2x week/3 months, lack of control, anxiety/guilt/sadness after, purging, fasting/rig exercise/diet pills, distrubed body image
MGMT- involve family, normal nutrtion established, hospitalization if severe complications or outpt failure

29
Q

AN labs/exams

A

Weight > 15% below level, hypotherm, hypotn, brady, delayed growth, malnourished, dehydrated,
anemia, leukopenia, low thyroxine, low gluc, low ca, low mag, low phosph, low sex, high BUN, high LFTs

30
Q

BN labs/exams

A

less ill-apperaing, normal weight, hypother/hypotn/brady if excessive purging, vom sequelae (trauma to palate/hands, loss of dental enamel, parotid swell)
low CL, low k+, high BUN if excessive vom

31
Q

Pregnancy

A

1 mil teen pregos every year, 1/5 pregnancies occur in first month after sex, 80% unintentional, 1/2 result in delivery, 1/3 abort, 1/6 miscarriage
High-risk prego, up incidence of helath probls, LBW, higher mortality, maternal anemia HTN PTL, dropping out of school, unemployment/need for assistance

32
Q

Contraception

A

1/2 kids don’t use anything-ignorance, denial, barriers to getting it, refual, religious believes, sorta want prego
Methods = abstinence, condom, female condom, vag diaphragm (can put in up to 6 hours before but risk of uti/awk), cervical cap (keep in 48 hours, but need paps more), IUD great!, OCP- hard to remember, no take if prego, breast/endo cancer, stroke, CAD, liver (sorta ci with migraines, htn, h/a, diabetes, sickle cell, lipids, smoke), depot

33
Q

Vaginitis

A

T. vag- yellow-green, smelly, strawberry cervix, inflamm, dyspar, or asx, dx w/ wet mount, + culter, vag ph >4.5, take metro
BV- most common, fishy, graw white thing discharge, whiff test, clue cells, ph> 4.5, tx metro
Candida- severe itch, white curdy, clin sx, fungal hyphae, normal pH, yeast! KOH microscopy

34
Q

Cervicitis

A

C. trachoma- pussy d/c, friable/red cervix, dysuria/frequency, 75% asx, culture gold standard, non/culture NAAT/immuno, PCR, complex - PID, TOA, fitz-hugh curtis, neonatal conjunctivits, pneumo, mgm w/ oral doxy, erythro, azithro
Gonorrhea- mucopurulent discharge, vag bleeding ? dysuria, frequency, dyspar, common asx in females, culture, gstain neg diplococci, non culture, same complications + asymmetric polyarthritis, pap/pustular lesions, mengingitis/endocarditis, septic. IM ceftriaxone, ofloxacin, cefixime, cirpoflox

35
Q

PID

A

Polymicro, maybe gon/chlamydia, more common infirst half menstrual cycle (yeeks!),
Dx- need lower ab, uterine/cerv motion tender, unilat bilat adnexal, and one of following- fever, wbc>10.5, elevated ESR/CRP, lab evidence gono/trach
MGMT- hospitalize if mass, uncertainty, prego, failed, inpt w/ IV cefoxitin + oral doxy or IV clinda + IV genta
Outpt- 14 day oflox/clinda or single dose IM cef + 14 doxy

36
Q

Urethritis

A

More common in males, in women typically cervicitis too
usually gono or non gonno, can be HSV<ureaplasma, mycoplasma, or t. vag
findings- dysuria, increased frequency, mucopus d/c, asx
Dx- with d/c, +5 wbc/field on d/c, 10+ on urine, positive leukocyte esterase
Def dx- swab urethra, or d/c
MGMT- tx same as for gon/chlamyd

37
Q

Genital ulcers

A

Usually hsv1/2, syphilis or chancroid

38
Q

Warts (genital)

A

most common STD< cased by HPV, direct contact, HPV 16/18 cervical carcinoma but no warts, external warts = condlomata acuminaa
itching, pain, dyspareunia, maybe external, maybe asx…mgmt annoying, topical podophyllin, tca, cryo, surgical/laster

39
Q

Diff dx

A

HSV1/2 = painful, shallow, culture with positize tzanck, hsv culture,
Primary syphilis- well demarcated, inguinal adeno, IM penicilli
Chancroid- red irregular border, purulent, haemophilus ducreyi, z-pack/eryhtro

40
Q

Menstrual issues

A

Follicular = 7-22 days, begins with pulsatile GnRH, LH /FSH mature ovarian follicles, estradiol,ovulation after surge, luteal = progresterone

41
Q

Dysmennorhea

A

most common, pain, primary = just general, secondary = pelvic abnormal, too much prostaglandin, pain spasms, n/v, diarrhea. NSAIDS/ocp

42
Q

Primary amenn w/ normal genitalia/pubertal delay

A

Turner (high fsh/lh), ovarian fail (high), hypothalamic (low fsh)

43
Q

Primary amenn w/ no uterus, normal puberty

A

Testic feminization 46 Xy, defect in andorgen receptor => inability to respond to testosterone, blind pouhc vagina, low fsh/lh.
MRKH- 46 XX, mullerian issue, ormal levels

44
Q

Primary/secondary w/ normal errythang

A 
hypothalamic supp- low fsh/lh
PCOS=high lh and high lh/fsh
pit infarct- low
prolactin - low fsh/lh, high prolactin
Outflow obstruction, normal
POF, endocrine- high fsh/lh
45
Q

Amenn

A

primary if age 16 and nada, or 14 w/ no sex char, 2ndary if later
Do prego test, tsh,thyroxine, fasting prolactin, FSH/LH levels

46
Q

Abnormal bleeding

A

DUB = 90% of stuff..polymenn too often, menorrhagia too much, metror irregular, oligo regular intervals but more than 35 days apart
Aovulation- endometrium too thick, bleeding spontaneously, or infections, prego, blood dyscrasia, cervica/vag polyps, uterine abnormal, meds, foreign bodies, trauma/assault, do hx, physical, lab test,
hormones if any anemia at all (ocp or progestin only), iron, and d&c if hormones fail

47
Q

Gynecomastia

A

60% male adolescents, etio unknown, maybe peripheral conversion, look at meds, testicular tumors, thyroid/liver disease potential
Lab studies not needed if normal growth, manage w/ reassurance, resolves in a year

48
Q

Painful scrotal mass

A

Torsion of spermatic cord = most serious/acute, sudden onset pain and n/v, swollen tender testicl/edema, no cremasteric reflex, pain relief when elevated
Dx w/ h/p, can tdo a techtenituim scan or doppler (absent pulsations)
tx- surgical detorsion and fix both testes, urologic emergency

49
Q

Torsion of testicular appendage

A

Gradual onset, testic/inguinal/suprapubic, blue dot sign on scrotum- cyanotic appendage. Doppler will be normal, rest/analgesia, resolves on it’s own

50
Q

Epidimytis

A

Infec/inflamm epidiymis, from gonorrhea/chlamydia
Acute onset pain/swelling w/ frequency, dysria/d/c
Swollen tender epididymis
Dx w/ ua wbcs, doppler w/ increased flow/scan w/ uptake up, manage like cervicits + bed rest

51
Q

Painless scrotal mass

A

Testicular neoplasm, most common SOLID tumor from germ cells. Cryptorchidism = testes failing to descent, higher malig risk
Firm/irreg painless nodule, solid mass on transillumination
Doppler the scrotum, look for HCG and AFT, MGMT = surgery/rads/chemo

52
Q

Indirect inguinal hernia

A

Processus vag fails to obliterate, pianless inguinl swelling, dx on h/p, elective repair, or emergent

53
Q

Hydrocele

A

Collection of fluid in tunica, transillum, painless soft cystic, reassure

54
Q

Varicocele

A

dilation/tortuos veins, most often LEFT half, bag of worms, valsalva, dx on h/p, if painful or w/ small testicle, urology referral

Peds BRS (8 decks)

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