Adolescent Medicine

Question 1

Delayed puberty in girls? Boys?

Answer 1

Girls = after 13 yo, Boys = after 14 yo

Question 2

Peak height velocity during puberty

Answer 2

9-10 cm/year

Question 3

Pre-pubertal height velocity

Answer 3

5-6 cm/year

Question 4

When does the growth spurt in females occur?

Answer 4

Begins with breast development and ends around menarche

Question 5

When does the growth spurt in males occur?

Answer 5

Begins with testicular enlargement, around SMR4

Question 6

Sequence of male pubertal development?

Answer 6

Testicular growth, pubic hair, increased penile length, then growth spurt

Question 7

Pubertal dvmt in males < what age is considered premature?

Answer 7

9 yo

Question 8

Male with pubic hair and penis enlargement, without testicular enlargement, what does this signify?

Answer 8

That androgen stimulation is coming from outside the gonads

Question 9

Sequence of female pubertal development?

Answer 9

Breast bud, pubarche, growth spurt, then menarche

Question 10

Premature puberty occurs in girls less than what age?

Answer 10

7 yo

Question 11

If thelarche does not occur by age ?, then a workup is indicated.

Answer 11

13 yo (8 is great, 13 is too late)

Question 12

If thelarche occurs without pubarche, what to consider?

Answer 12

Androgen insensitivity, testicular feminization

Question 13

After menarche, girls are within ?cm/?in of adult height?

Answer 13

4cm/ 2 inches

Question 14

Menarche occurs during which SMR stages?

Answer 14

SMR 3 and 4

Question 15

What is the rule of 24 for growth velocity?

Answer 15

1st year = growth is 24cm/yr 2nd year= growth is 12cm/yr 3rd year= growth is 8cm/yr

Question 16

Pubertal delay and anosmia

Answer 16

Kallman’s Syndrome

Question 17

Absolute contraindications to OCP?

Answer 17

Pregnancy, Liver disease, CAD, elevated lipids, breast cancer, or cerebrovascular disease

Question 18

Primary amenorrhea = lack of menses by what age

Answer 18

16 yo, or 2 years following sexual development

Question 19

PCOS LH:FSH ratio?

Answer 19

>2.5, also elevated androgen levels

Question 20

Ideal body weight for males? Females?

Answer 20

Males= 50kg + 2.3kg (each inch over 5 feet) Females= 45.5kg + 2.3kg (each inch over 5 feet)

Question 21

What 2 electrolyte abnormalities result from laxative abuse?

Answer 21

Hyperuricemia, hypocalcemia

Question 22

Malodorous fishy vaginal discharge. Dx? Tx?

Answer 22

Bacterial vaginosis. Dx with clue cells.

Question 23

Dyspareunia, burning/itching, bright red cervix, frothy yellow discharge. Dx and Tx?

Answer 23

Trichomonas vaginalis. Dx flagellated organisms on wet mount. Tx flagyl (tx partners too)

Question 24

Outpatient tx of PID

Answer 24

Ceftriaxone + Doxycycline

Question 25

Ovarian cyst size that requires lap cyst aspiration?

Answer 25

\>6cm or significant sx

Question 26

2/3 of tenosynovitis or arthritis in adolescents is secondary to what organism?

Answer 26

Gonorrhea

Question 27

Most common cause reactive arthritis

Answer 27

Chlamydia

Question 28

Vaginal discharge with pH \>5

Answer 28

Bacterial vaginosis

Question 29

Male with painless ulcer on penis. Tx?

Answer 29

Syphilis chancre. Tx azithromycin

Question 30

Confirmatory test for syphilis?

Answer 30

FTA-ABS

Question 31

Female with flat-topped, smooth, raised bumps that may coalesce. Dx?

Answer 31

Syphilis condyloma lata. Dx with VDRL

Question 32

Indications for immediate colposcopy

Answer 32

High grade lesion, 3 paps with ASCUS or LSIL, immunocompromised with LSIL

Question 33

If a patient has premature adrenarche (pubic hair), what is the most appropriate test? And how to interpret?

Answer 33

Bone age; If \< 1 yr advanced, can observe. If \>1 yr advanced, check ACTH stim test and testosterone

Question 34

Normal male phenotype, possible cryptorchidism, and finding on US are uterus or upper vagina or fallopian tubes

Answer 34

Persistent Mullerian duct syndrome

Question 35

Girl with primary amenorrhea, no uterus or ovaries, normal looking vagina, testes palpated in canal. XY on karyotype. +Breat development

Answer 35

Testicular feminization/Androgen Insensitivity (X-linked); Breasts develop from excess estrogen converted from Testosterone

Question 36

Child with fatigue, weight loss, hyperkalemia, hyponatremia, darkened skin. First test?

Answer 36

ACTH (cosyntropin) stimulation test. If cortisol does not increase, it's primary adrenal insufficiency (addisons). If cortisol increases, likely secondary adrenal insufficiency (pituitary)

Question 37

Once girls have reached menarche, how close are they to adult height?

Answer 37

1-2 inches

Question 38

How to get cm from inches

Answer 38

Multiply by 2.5

Question 39

Chubby boy with sharp decline in height percentile, significant delay in bone age, decreased muscle mass, hypoglycemia. How to dx?

Answer 39

Growth hormone deficiency; dx with low IGF-1, low IGF-BP3

Question 40

Child with occasional loose stools, abdominal discomfort, growth delay and elevated ESR

Answer 40

Crohns disease

Question 41

15 yo boy with low SMR, short for age, normal growth velocity, father with similar issue which he received shots for. Dx?

Answer 41

Constitutional growth delay

Question 42

Child with short stature for age, normal growth velocity and bone age equal to chronological age. Parents short

Answer 42

Familial short stature

Question 43

Short female with scant breast tissue, webbed neck. Tx?

Answer 43

Turner Syndrome. Tx short stature with growth hormone

Question 44

Lab studies to order in a girl with Turner Syndrome

Answer 44

LH/FSH would be elevated 2/2 to ovarian failure; TSH and free T4 because higher risk of hypothyroidism

Question 45

11 yo child with height of 9 year old, bone age of a 7 year old, overweight

Answer 45

Hypothyroidism

Question 46

Child tall for age. Most important predictor of ultimate adult height?

Answer 46

SMR rating; Bone age can help determine how much growth is left

Question 47

Girl with primary amenorrhea and virilization at puberty, no uterus or ovaries, normal looking vagina, testes palpated in canal. XY on karyotype.

Answer 47

5-alpha reductase deficiency

Question 48

Painless herpetiform-like ulcerative lesion that often goes unrecognized until discovered during physical examination in a patient complaining of tender inguinal lymphadenopathy, what is the etiology?

Answer 48

Lymphogranuloma venereum caused by Chlamydia

Question 49

Sexually active male with painless, erythematous, rounded ulcer with slightly raised, clean edges and a clean base on shaft of penis, and tender inguinal lymphadenopathy. Dx? Tx?

Answer 49

Syphilis. Tx IM Benzathine PCN G 2.4 million units 1 dose

Question 50

What is normal vaginal pH?

Answer 50

\<4 to 4.5

Question 51

Congenital mullerian agenesis/aplasia. How does it present?

Answer 51

Usually a teenage girl with primary amenorrhea. Has normal ovaries and secondary sex characteristics, but vaginal agenesis, variable fallopian tube and uterine development.

Question 52

What 2 antibiotics decrease effectiveness of OCPs?

Answer 52

Griseofulvin and Rifampin