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Phase 2 PEDs > Adolescent medicine > Flashcards

Adolescent medicine Flashcards

1
Q

Adolescent psych development - stages?

A

Early 10-13yo - Ambivalent to independence
Middle - Abstract/identity/independent thoughts, risky
Late 18-21yo- Concern for future, commits sex partner

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2
Q

HEADDSS Mnemonic?

A 
H- Home/friends
E- Education
A- Alcohol
D- Drugs
D- Diet
S- Sex
S- SI/Depression
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3
Q

Female 1st sign of Secondary sexual characteristics?

A

Thelarche (breasts)

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4
Q

Male 1st sign of Secondary sexual characteristics?

A

Testicular enlargement

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5
Q

Average age of menarche?

A

12-13yo

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6
Q

Female - Tanner stage 1?

A

<10yo

Pre-pubertal - no glandular tissue

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7
Q

Female - Tanner stage 2?

A

10-11.5yo
Breast bud - under areola
Pubic hair - straight and on labia majora

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8
Q

Female - Tanner stage 3?

A

11.5-13yo
Breasts enlarge outside areola
Pubic hair - darkens/curls

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9
Q

Female - Tanner stage 4?

A

13-15yo
Areolae protrude from breast
Pubic hair - fills incompletely (not on thigh)

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10
Q

Female - Tanner stage 5?

A

14+yo
Areolae rejoins breast contour (most)
Pubic hair - fills completely (On medial thigh)

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11
Q

Male - Tanner stage 1?

A

<9yo
Pre-pubertal
Penis <3cm and no pubic hair

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12
Q

Male - Tanner stage 2?

A

9-11.5yo
Testes enlarge (1st sign) - redder/scrotum thins
Straight pubic hair appears

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13
Q

Male - Tanner stage 3?

A

11-13yo
Penis lengthens
Pubic hair darkens/curls

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14
Q

Male - Tanner stage 4?

A

12.5-15yo
Penis widens
Hair fills in (incomplete - no thigh)

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15
Q

Male - Tanner stage 5?

A

14+yo
Development complete
Hair fills in (completely, medial thigh)

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16
Q

Types of Puberty disorders?

A

Precocious puberty - (too soon)

Delayed puberty - ( late)

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17
Q

Types of Precocious puberty?

A

Central vs Peripheral

Central = CNS premature over production
Peripheral = Sex hormones synth independent of CNS
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18
Q

Reasons for delayed puberty?

A
  1. Inhibition of GnRH release from hypothalamus

2. Pituitary issues

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19
Q

When is precocious puberty considered? M/F?

A

<8yo female

<9yo male

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20
Q

Central precocious puberty is due to?

A

Brain or pituitary malfx

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21
Q

MC cause of central precocious puberty?

A

Idiopathic GnRH secretion

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22
Q

Causes of peripheral precocious puberty?

A

Gonad/Adrenal tumors/Hamartoma
Congenital adrenal hyperplasia
Familial Leydig cell maturation
McCune-Albright syndrome

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23
Q

MC cause of peripheral precocious puberty?

A

McCune-Albright syndrome

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24
Q

McCune-Albright syndrome is?

A

Ovarian hyperfunction causing precocious puberty w/ episodic estrogen secretion.

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25
Q

McCune-Albright syndrome is ass/w?

A

Bony d/o

Café au lait spots

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26
Q

TXT McCune-Albright syndrome w/?

A

Medroxyprogesterone acetate
Testolactone - bocks estrogen synthesis
Tamoxifen - antiestrogen

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27
Q

PE clues suggesting Peripheral precocious puberty?

A

Adrenarche dominantes
- pubic/axilla hair, acne, body odor
Testes <2.5cm - adrenal/non-testicular source

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28
Q

PE clues suggesting Central precocious puberty?

A

Testicular growth >2.5cm

Thelarche then Menarche

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29
Q

LH/FSH results of central precocious puberty?

A

Both Elevated = central

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30
Q

LSH/FSH results of peripheral precocious puberty?

A

Both decreased = peripheral

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31
Q

What other study is performed when central vs peripheral is considered?

A

Head MRI for central precocious puberty

CT or MRI for either

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32
Q

TXT of precocious puberty?

A

Endo referral

Leuprolide = GnRH analogues (Stops menses/suppress)

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33
Q

GnRH- dependent central precocious puberty is TXT w/?

A

GnRH agonists

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34
Q

Complications of un-TXT precocious puberty?

A

Short stature - bone epiphyses close early
Recurrent ovarian cysts
TXT SEs - radiation of tumor

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35
Q

1st question to ask considering central vs peripheral precocious puberty? Yes W/U? No W/U?

A

Did it start w/ testicular or breast development???
Yes -central- high LH/FSH, hormones and head MRI
No -periph- DHEAS, MRI of adrenal (acne/odor/hair)

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36
Q

Most cases of precocious puberty are?

A

Idiopathic and central

37
Q

Delayed onset puberty is AKA?

A

Hypogonadism

38
Q

Delayed onset puberty is defined as?

A

No pubertal development by age 13F or 14M

39
Q

What are two pathophys possibilities of Delayed onset puberty?

A

HYPO-gonadotropic HYPOgonadism- low LH/FSH

HYPER-gonadotropic HYPOgonadism - high LH/FSH

40
Q

HYPO-gonadotropic HYPOgonadism causes?

A

GnRH secretion inhibition - (Malnutrition,stress,chronic dz)

Hypothalamus/pituitary disease (idiopathic/tumors)

41
Q

HYPER-gonadotropic HYPOgonadism causes?

A

Gonadal failure - due to

  • Turner syndrome
  • Klinefelter syndrome
  • Androgen insensitivity
  • PCOS
42
Q

Female athletic triad can cause what pubertal d/o?

A

HYPO-gonadotropic HYPOgonadism from Malnutrition

43
Q

Delayed onset puberty W/U is?

A

LH/FSH
High (HYP)= Karyotype (Turner/klinefelters), U/S gonads
Low (HO)= TSH, PRL, head MRI

44
Q

TXT of Delayed onset puberty?

A

Endo refer guides TXT

45
Q

NL variants of Puberty?

A 
Breast asymmetry
- TTP pea sized mass below nipple
Breast mass - fibroadenoma/cyst (U/S)
Physiologic Leukorrhea - vaginal d/c due to estg
Irregular/anovulatory menses for 2-5yr
BOYS-gynecomastia
46
Q

U/S is best used for what female breast type?

A

Young, dense breasts

47
Q

Physiologic leukorrhea MC occurs in what Tanner stage?

A

Tanner Stage III

48
Q

Compared to thelarche Menses NL starts when?

A

2-3yrs after

49
Q

When should gynecomastia be evalued for boys?

A

Large, Hard, fixed or ass/w nipple d/c

50
Q

Gynecomastia is benign usually when?

A

<3cm

51
Q

Gynecomastia is trimodal

A

Infancy
11-14yo (tanner III-IV)
50-80yo

52
Q

Gynecomastia eval?

A

Hx - Constitutional S/S, Hepatic Dz, Rx
XXY klinfeleter
Testicular tumors
LABs - HCG, LH/FSH, Testo, LFT, TSH, creatinine

53
Q

NL amount of days during Menses cycles?

A

21-45d apart

54
Q

When is an organic abnormality considered for irregular bleeding in post-menarche females?

A

At least 1yr of regular cycles

55
Q

MC CC of early adolescent girls?

A

Irregular menses - MC

then, Dysmenorrhea (pain)

56
Q

Primary amenorrhea is?

A

Complete absence of menses by age 16 w/ thelarche
OR
Complete absence of menses by age 14 w/out thelarche

57
Q

Secondary amenorrhea is?

A

Menses cessation for 3mo anytime after menarche in girls w/ 2ndry sex characterisitics

58
Q

MC causes of 2ndy amenorrhea?

A

Pregnancy
Anorexia/stress (low LH/FSH, estradiol)
PCOS

59
Q

PCOS is dx w/?

A

At least 2

  1. Infreq menstrual bleeding or 2ndy amenorrhea
  2. Clinical/biochemical HYPERandrogenis,
  3. U/S polycystic morphology of ovaries
60
Q

PCOS is ass/w?

A

Hirtsutism, mod-severe acne
Irreg menses/amenorrhea
Polycystic ovaries
Obesity/insulin resistance

61
Q

TXT of amenorrhea?

A
  1. Anovulation= cyclic progesterone or combo OCP
  2. Hypothalamic amenorrhea/ovarian failure= E/P comb
  3. PCOS = wgt loss, exercise, withdraw prog, combo E/P
  4. Androgen excess = E/P combo
    - –Hirsutism = Spironolactone
    - – Insulin resistance= metformin
62
Q

Frequent menstrual bleeding is considered?

A

<21d

63
Q

Infrequent menstrual bleeding is considered?

A

> 35d

64
Q

Amenorrhea is defined as?

A

> 6mo menses absence

65
Q

Irregular menstrual bleeding is considered?

A

> 20d variation in cycle length

66
Q

Prolonged menstrual bleeding is considered?

A

> 8d of flow

67
Q

Shortened menstrual bleeding is considered?

A

<2d of flow

68
Q

Heavy menstrual bleeding is considered?

A

> 80cc

69
Q

Light menstrual bleeding is considered?

A

<5cc

70
Q

Intermenstrual bleeding is considered?

A

Bleeding between normally timed periods

71
Q

MC cause of ABNL uterine bleeding?

A

Anovulation - 20% have coag d/o

72
Q

TXT for ABNL uterine bleeding only occurs when?

A

Heavy menses

73
Q

TXT for ABNL uterine bleeding is?

A

Iron supplement - IDA
E/P combo (6-12mo until HPA matures)(vW Dz too)
Rarely - uterine cuttrage

74
Q

MC gynecologic CC of young women?

A

Dysmenorrhea

75
Q

Primary Dysmenorrhea is?

A

Pelvic pain during menses w/out pelvic pathology

76
Q

Primary Dysmenorrhea occurs when?

A

1-3y after menarche - increased incidence until 24yo

77
Q

Primary Dysmenorrhea is due to?

A

Progesterone declines >
Endometrium degenerates >
Increased PGs/Leukotrienes released >
Increased uterine tone/dysrhythmic contractions

78
Q

2ndy Dysmenorrhea is?

A

Menses pain ass/w pelvic pathology

79
Q

2ndy Dysmenorrhea is MC due to?

A

Endometriosis or PID

80
Q

Endometriosis is a sign of what severity of 2ndy Dysmenorrhea?

A

Mild to moderate unless completely obstructed (Severe)

81
Q

How to screen for vaginal outlet obstruction?

A

U/S

82
Q

Study for Dx PCOS?

A

U/S

83
Q

What is required to Dx endometriosis?

A

Laparoscopy (Or PID certainty if TXT failed)

84
Q

Dysmenorrhea TXT?

A

1L - NSAIDs (take before or as soon as menses begins)
Q/4h for 2-3d (Naproxen or Ibuprofen)
2L - E/P combo long acting
3L - if >4mo on OCP

85
Q

Sports physical w/ exclusive criteria CV PE finding?

A

Murmur that is louder w/ Valsalva or Standing

86
Q

CV problems CI for sports?

A 
Active myocarditis/pericarditis
HCM
Long QT synd
Severe HTN
SCA
CAD
87
Q

Other disorders CI for sports?

A 
Eating D/O
Acute Enlarged spleen/liver
Recent concussion - post-concussion S/S
Poorly controlled convulsive D/O
Burning/paresthesia of upper limb
88
Q

Adolescent Calcium requirement?

A

1300mg

Phase 2 PEDs (23 decks)

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