Adolescent Medicine Flashcards
HEADDSSS
- H - home (relationship w/ parents and sibs)
- E - education (performance, suspensions, goals)
- A - activity (hobbies, exercise, screen time, friends)
- D - drugs (them or friends)
- D - diet (typical habits, purging / binging)
- D - depression (what do you do when sad or stressed? suicidality?)
- S - sexuality (STIs, partners)
- S - safety (helmets, weapons, seatbelt, riding under influence, bullying)
CRAFFT
(substance use screening tool)
- C - car (ever ridden in car driven by someone high?)
- R - relax (ever use substances to relax?)
- A - alone (ever use alone?)
- F - forget (do you ever forget things while using substances?)
- F - family/friends (ever tell you to cut down?)
- T - trouble (ever gotten in trouble)
**2 + means high risk and need further assessment
Androgen Insensitivity Syndrome
- androgen receptor defect
- XY but androgens cannot cause Wolffian structures or external genitalia to form; have testes but phenotypically female
- Low estrogen unopposed by androgens - breast development
- Blind vaginal pouch
- No pubic hair (androgens)
Mullerian Agenesis
- congenital absence of uterus, fallopian tubes, upper vagina
- XX and phenotypically female
- Normal ovaries –> estrogen production –> breast development
- Blind vaginal pouch
Imperforate Hymen
- often have cyclic abdominal pain w/o period because normal shedding but no flow
- hematocolpos (menstrual blood trapped in vagina)
- see bulging membrane on exam
Late CAH v. PCOS
Both can cause secondary amenorrhea
- Late CAH - clitoromegaly, virilization (excess androgens)
- PCOS - more acne, hirsutism, wt gain, obesity, acanthosis nigricans (very rarely clitoromegaly or virilization because not enough androgens)
Testicular Torsion v. Epididymitis
- Torsion
- Acute pain (may radiate to abdomen)
- Nausea and vomiting
- No fever, no d/c
- Testis elevated (horizontal lie)
- Absent cremasteric reflex
- Testis tender
- Testicle may be engorged
- Epididymitis
- Gradual onset pain (may radiate to abdomen)
- May have fever, d/c or dysuria
- Normal testis position and normal cremasteric reflex
- Less common to have nausea and vomiting
- Pain in epididymis and inflammation of epididymis
Tanner Breast Development
I - pre-pubertal, no glandular tissue
II - Breast bud beneath areola
III - Glandular tissue extends beyond areola
IV - Areola forms projecting mound
V - Adult breast; areola in same plane
Tanner Male Genitalia
I - Testis volume < 4 mL
Child-like penis and scrotum
II - Testis 4-6 mL
Red, thin, large scrotum
III - Testis 6-12 mL
Scrotum cont to enlarge
Penis inc length
IV - Testis 12-20 mL
Scrotum darker
Penis inc length and circum
V - Testis > 20 mL
Adult penis and scrotum
Tanner Pubic Hair
I - none
II- Downy, slightly-pigmented hair at base of penis or along labia
III - Curlier, pigmented, coarse
IV - Across mons pubis but NO thigh
V - medial thigh
Anorexia Nervosa (PE and Complications)
- Restrictive diet + intense fear of gaining wt
- PE - cachetic, hypothermia, orthostatic hypotension, bradycardia, dry skin, lanugo hair, cold extremities
- Complications - arrhythmia, amenorrhea, anemia, thrombocytopenia, leukopenia, osteoporosis, hypoglycemia, growth retardation, abnormal LFTs
Bullimia Nervosa (PE and Complications)
- Binge eating (lack of control or larger than normal portion) + compensation (purging or excessive exercise) 2X/wk for 3 mo
- PE - Salivary gland enlargement (inc amylase), dental erosions, knuckle calluses
- Complications - hypochloremic metabolic alkalosis (vomiting) or hyperchloremic metabolic acidosis (if laxative), Mallory Weiss tears, GERD, esophagitis
Delayed Puberty (definition and causes)
Def - no testicular enlargement in boys > 14 yo; no thelarche in girls > 13 yo
- Constitutional Delay (50%)
- Family hx - puberty of parents and siblings
- Hypogonadotropic hypogonadism
- Kallman - ansomnia too
- Systemic illness (Chrons, celiac, etc), anorexia, excessive exercise
- Pituitary deficiency, may be due to craniopharyngioma
- Hypergonadotropic hypogonadism
- Klinefelter (XXY) or Turner (XO)
- Testicular radiation
- Chemo / alkylating agents
- Autoimmune ovarian failure
Precocious Puberty (definition and 2 main categories)
- Def - b/f 8 yo in girls (thelarche - breast buds) and b/f 9 yo in boys (testicular enlargement)
- Central / True (gonadotropin dependent)
- HPA axis activation
- High LH and FSH
- Causes - think CNS (hypothalamic hamartoma, tumors, cysts)
- Peripheral (gonadotropin independent)
- No HPA axis activation
- Low or normal FSH and LH
- Elevated testosterone, estradiol or DHEA
- Causes - ovarian cysts, ovarian tumors, Leydig cell tumors, adrenal tumors, CAH, exogenous androgen or estrogens (topical), HCG secreting tumors
- HCG tumors - hepatoblastoma
Tx of Precious Puberty
- long-acting GnRH agonist (so not pulsatile)
* IM q 4 weeks or subnormal implants
