adolescent medicine

Question 1

genital warts

Answer 1

most common STD. caused by HPV. transmit by direct contact.
strains 16/18 cause cervical ca but not visible warts.
external warts= condylomata acuminate
P: itching, pain, dysparenunia, wart, asx
dx- 3% acetic acid wash in colposocy- turn white
tx: topical podophyllin, trichlomata, cryotherapy, laser removal. 25% spontaneously dissapear

Question 2

HSV1/2

Answer 2

painful, inguinal adenopathy.

Question 3

syphilis

Answer 3

painless well demarcated ulcer. - chancre. painless inguinal adenopathy
darkfield microsocpy
penicillin IM

Question 4

chancroid

Answer 4

painful, miltiple ulcer with irreg borders and purulent bases.
painful adenopathy
pos culture of homophiles decree
oral azithromycin, erythromycin, IM ceftriaxone

Question 5

primary dysmenorrhea

Answer 5

most common menstrual d in adolescents. due to inc production o prostaglandin by endometrium- excessive uterine contraction and systemic effects
P: N, spasm of pain

Question 6

primary amenorrhea

Answer 6

lack of menstrual bleed by 16yo with normal secondary sexual characteristics:
1) gonadal dysgenesis-turner syndrome
2) high FSH, LH: ovarian failure bf puberty caused by rad, chemo, infection,
3) hypothalamic or pituitary (low FSH and LH),
absence of flow at 14 w/o secondary sexual characteristics

Question 7

secondary amenorrhea

Answer 7

no menses for 3 cycles or 6mo

1: low FSH, LH: hypothalamic suppression, pituitary infarction-sheehan’s, prolactinoma
2. high FSH, LH: POS, preg, premature ovarian fluid, thyroid disease, DM
3) normal FSH, LH: obstructed outflow tract

Question 8

dysfunctional uterine bleeding (DUB)

Answer 8

90% of abn vaginal bleeding in adolescents.
freq, irreg menstrual periods associated with prolonged painless bleeding
result from anovulatory cycles.
endometrium becomes excessively thickened and unstable become of unopposed estrogen production. ovulation doesn’t occur so progesterone isn’t available to stabilize endometrium, bleeding spontaneously and freq and bleeding prolong bc of weaker utine and vasculature contractions
tx: hormone therapy. D&C if hormone fail

Question 9

abn vaginal bleeding etio

Answer 9

DUB, preg complication, infection (PID, vervicitis), blood dycrasias like vWD, cervical or gain polyps and hemangioma, uterine abn (leiomyoma, endometriosis, meds), foreign body, trauma

Question 10

spermatic cord torsion

Answer 10

sudden onset of scrotal, inguinal or suprapubic pain + N/V. swollen, tender testicle and scrotal edema with absent cremastic reflex on affected side
pain releif on elevation of twisted testicle
dx: hx and PE, doppler US no pulsation
tx: surgical detorsion, taxation of both testes within 6hr to preserve function

Question 11

testicular torsion

Answer 11

blue dot sign on scrotum. acute or gradual onset. doppler normal
rest and analgesia. self resolve in 2-12d

Question 12

epididymitis

Answer 12

infection and inflm. gonorrhea or chlamydia. acute onset of scrotal pain and swelling with urinary freq, dysuria, urethral d/c
swollen, tender epididymis
dx. US- incr WBC, pos gram stain, pos ulture of urethral dc. doppler-incr flow, radionucleotide- incr uptake

Question 13

painless scrotal mass

Answer 13

more common in cryptorchidism- undescended testes. one of most common malig solid tumor in male 15-35
firm, irreg, painless nodule on testes.
dx: solid mass seen on scrotal transillumination. doppler. serum tumor markers- human chorionic gonadotropin, alpha fetoprotein. evaluate for metastasis

Question 14

hydroceles

Answer 14

collection of fluid in tunica vaginalis, painless, soft, cystic scrotal mass. smaller in morning and larger in evening.
dx- hx and transillumination
reassure, surgical removval if big

Question 15

varicoceles

Answer 15

bag of worms on palpation, diminish when supine. incr when valsalva or stand