Adolescent Medicine

Question 1

5 causes of breast masses in Females

Answer 1

Fibroadenoma (most common)
Fibrocystic change
Cyst
Abscess
Lipoma
Adenomatous hyperplasia

Question 2

Treatment of PCOS

Answer 2

Weight Loss
Exercise
OCP and Sprinolactone ( to act to decrease the amount of testosterone)
Metformin

Question 3

Diagnosis of PCOS

Answer 3

Testosterone level

used to be though it was FSH/LH Ratio

Question 4

Absolute Contraindications to combined OCP

Answer 4

History of DVT or PE 
Thromboembolism history
Migraine with focal findings
Breast Cancer 
Severe Hypertension
Pregnancy
Uncontrolled liver disease

Question 5

Emergency Contraception (also a CPS statement)

Answer 5

Ella - can be used within 5 days
Plan B - levoegonsterol
Yuzupe - combined Pill
Copper IUD

Need follow up; should for sure bleed within 3 weeks (usually within 7 days).

Need immediate follow up if patient has not bled in 7 days, or there is heavy bleeding.

Question 6

Consent Ages in Canada

Answer 6

16 (used to be 14 prior to 2008)
14-15 years: If relationship is within 5 years
12-13 years: If relationship within 2 years
Can not be in a relationship with someone of power or authority.
Any sexual exploitation of children <18 is child pornography.

Question 7

Differential for Genital Ulcers

Answer 7

Chancroid (painful)
Syphillis (painless)
Bechets
IBD
HSV (painful)
Drug Reaction
EBV, CMV

Question 8

Diagnosis and Treatment of PID

Answer 8

The minimal criteria required for the diagnosis of PID is cervical motion tenderness.
It is more likely when there is presence of abdominal pain (lower quadrants) and fever.

Mild to Modearte Treatment: Outpatient PI Ceftriaxone x 1 and doxy x 14 days with follow up in 72 hours.
If there is a gynecological instrumentation performed prior to PID then you need to add flaggyl x 14 days.
Inpatient treatment: Cefoxitin and doxy AND clinda and gent
Inpatient treatment: Significant illness, can not trust treatment regimen going to occur, abscess, living arrangements.

Question 9

Medical Termination of Pregnancy

Answer 9

<8 weeks: Misoprostil or Methotrexate or manual vaccuum.
<12-14 weeks: suction and curretage
14-20 weeks: Dilitation and evacuation

Question 10

CRAFFT Questionaire

Answer 10

1. Have you ever been in a car with someone under the influence.
2. Do you use to relax?
3. Annoyed when people tell you to quit
4. Family worried
5. Forgetting things as a result.
6. Trouble secondary to substance use.

Question 11

Psychosocial development in Teenagers

Answer 11

Early 12-14 years of age: Body image and being to step away from parents
Mid: 14-16 years: They are experts and immortality
>16 years: abstract thinking develops

Question 12

Normal Puberty ages and Development

Answer 12

Female: 8-13 years (7 years for african american)
Thelarche, Pubarche, Growth Spurt and Menses
Male: 9-14 years:
Testicular Growth, Pubic Hair, Growth Spurt and Penile growth

Question 13

Gender Dysphoria DSM Criteria

Answer 13

A marked incongruence between one’s experienced/expressed gender and assigned gender for at least 6 months and is manifested by at least 6 of the following:
Strong desire to be other gender
- Boys - cross dressing; girls - wearing masculine clothing
- cross gender rolls in make believe play
- toys and games of other gender
- Rejection of toys and games of presumed gender
- strong dislike for one’s sexual anatomy
- Desire for primary or secondary sex characteristcs that match their percieved gender.
Condition is associated with clinically significant distress or impairment.

Question 14

Indications for AN Hospitlizations

Answer 14

Impaired growth and development <75-80% of average body weight and height; Fluid and metabolic abnormalities
Cardiac Abnormalities
Behavioural - acute food refusal., uncontrolable binging and purging, psychatric emergency or comorbidities.

Question 15

Treatment of PID

Answer 15

Ceftriaxone, Doxycycline and if there has been uterine instrumentation then need metronidazole

In hospital: Cefoxitin and Doxycycline