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Pediatric Board Exam > Adolescent Medicine and Gynecology > Flashcards

Adolescent Medicine and Gynecology Flashcards

1
Q

Name the components of SMR (Tanner stage) 1 for a male.

A

Absent pubic hair
Childlike phallus
Testicular volume <2.5mL

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2
Q

Name the components of SMR (Tanner stage) 2 for a male.

A

Fine pubic hair
Childlike phallus
Increased size and volume of testicles
More textured scrotum

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3
Q

Name the components of SMR (Tanner stage) 3 for a male.

A

Carse, curly and pigmented pubic hair
Increased Phallus size
Increased testicular size

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4
Q

Name the components of SMR (Tanner stage) 4 for a male.

A

Denser and curled pubic hair, but less than an adult

Phallus closer to adult size

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5
Q

Name the components of SMR (Tanner stage) 5 for a male.

A

Pubic hair extending to the inner thigh, adult like
Adult sized phallus
Adult sized testicles

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6
Q

What is the normal age range for pubertal development for boys and girls?

A

9-13

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7
Q

What is the maximum amount of time it should take to go from SMR 2-5?

A

5 years

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8
Q

Name the components of SMR (Tanner stage) 1 for a female.

A

Absent pubic hair

No glandular breast tissue

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9
Q

Name the components of SMR (Tanner stage) 2 for a female.

A

Pubic hair along labia

Small breast buds, with glandular tissue

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10
Q

Name the components of SMR (Tanner stage) 3 for a female.

A

Coarse, curly and pigmented pubic hair

Breast tissue extending beyond the areola.

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11
Q

Name the components of SMR (Tanner stage) 4 for a female.

A

Denser and curled pubic hair, less than adult

Enlarged areola and papilla for a secondary mound

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12
Q

Name the components of SMR (Tanner stage) 5 for a female.

A

Pubic hair extending to the inner thigh, adult like

Breasts without a separate projection of the areola from the remainder of the breast

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13
Q

At what age is no pubertal development considered “delayed” in males? In females?

A

Males-age 14

Females-age 13

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14
Q

What is the first sign of puberty in males? In females?

A

2 “bumps” getting bigger
Males-testicular growth
Females-breast budding

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15
Q

What lab values should increase during the growth spurt?

A

Alk Phos and hematocrit

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16
Q

What is pre-pubertal height velocity? Peak velocity?

A

Pre-pubertal is 5-6 cm/yr

Peak is 9-10 cm/yr

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17
Q

What is the sequence of male pubertal development?

A

Testicular growth > Pubarche > Penile growth > Peak height velocity

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18
Q

Below what age is onset of puberty considered abnormal in a male? In a female?

A

Males-age 9

Females-age 8

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19
Q

Does early puberty result in taller or shorter adult height?

A

Shorter

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20
Q

What is the most common cause for delayed puberty in boys?

A

Constitutional delay

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21
Q

How does bone age correlate with chronological age in constitutional delay?

A

Bone age lags behind initially, then catches up later

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22
Q

At what age does puberty typically occur in males?

A

Age 10-11

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23
Q

After which SMR stage does peak height velocity occur in males? in females?

A

Males-Stage 4

Females-Stage 3-4

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24
Q

After which SMR stage does axillary hair develop in males?

A

Stage 5

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25
Q

In relationship to testicular growth, when does pubarche typically occur?

A

About 1 year after

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26
Q

What does it indicate if a male develops pubic hair and penile enlargement in the absence of testicular enlargement?

A

Extragonadal androgen stimulation

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27
Q

In what scenarios is pubertal male gynecomastia considered abnormal?

A

Hx of ketoconazole exposure
Bilateral gynecomastia
Galactorrea (in marijuana users)

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28
Q

Is unilateral gynecomastia in males and asymmetric breast development in females considered normal?

A

Yes

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29
Q

What is the sequence of female pubertal development?

A

Breast budding > Pubarche > Peak height velocity > Menarche

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30
Q

What is the average age at thelarche?

A

Age 11

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31
Q

In relationship to thelarche, when does pubarche typically occur in females?

A

1-2 years later

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32
Q

At what age is it considered abnormal for no breast development to have occurred?

A

Age 13

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33
Q

Which hormone is responsible for breast development? Pubic and axillary hair development?

A

Breast-estrogen

Hair-Androgen

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34
Q

Which hormonal abnormality is associated with thelarche without pubarche?

A

Androgen insensitivity

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35
Q

Which hormonal abnormalities are associated with pubarche without thelarche?

A

Excessive androgens or Low estrogen

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36
Q

In relationship to thelarche, when should menarche occur? At what age?

A

~2 years later, age 12-13

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37
Q

In relationship to menarche, when does peak height velocity occur in females?

A

Before

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38
Q

How many days is considered a normal menstruation?

A

2-10 days

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39
Q

How do you advise/work up a a female within 2 years post-menarche who is having infrequent or longer than 28 days between menstrual cycles?

A

Provide reassurance and follow up

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40
Q

Describe physiologic leukorrhea. When does this occur in relationship to menarche?

A

White, odorless, mucoid dishcarge

Usually precedes menarche by 3-6 months and can continue for several years after

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41
Q

What has to be considered in a pre-menarche female with bloody vaginal discharge?

A

Foreign body
Straddle injury
Abuse

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42
Q

How much is a post-menarche female expected to grow?

A

~4cm

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43
Q

Define premature thelarche.

A

The development of breast tissue without the appropriate appearance of pubic hair

44
Q

How do you advise a parent with concern of breast buds in a 3 y/o female?

A

Reassurance. This is normal in females <4.

45
Q

Define precocious puberty in males. In females.

A

The appearance of secondary sexual characteristics (thelarche and pubarche or pubarche and genital development) before the age of 9 in males or 8 in females.

46
Q

Define premature pubarche.

A

Presence of pubic hair without breast tissue. (Premature Adrenarche)

47
Q

Define true precocious puberty.

A

Normal sequence of puberty, just early.

48
Q

Define pseudo precocious puberty.

A

Puberty out of sequence. (menarche without pubarche or development of secondary sexual characteristics without testicular enlargement.

49
Q

What are the underlying causes of pseudo precocious puberty?

A

Over production of sex steroid hormones by ovaries or testes (Germ cell tumors)
Over production of sex steroid hormones by adrenals (CAH)
Exogenous sex hormones (OCPs or anabolic steroids)

50
Q

Which hormone class is responsible for axillary hair and acne development?

A

Androgens

51
Q

How do you advise a parent whose child has axillary hair, but not other evidence of adrenalization?

A

Quarterly f/u and growth velocity monitoring

52
Q

Precocious puberty in combination with each of the following leads to which cause:

  1. Optic fundus abnormality
  2. Acne
  3. Visual field defects
  4. Change in vaginal color
  5. Facial or axillary hair
  6. Prominence of the labia minora
  7. Muscle bulk
A
  1. CNS lesion
  2. Androgenic (testicular or adrenal)
  3. CNS lesion
  4. Estrogenic (ovarian)
  5. Androgenic (testicular or adrenal)
  6. Estrogenic (ovarian)
  7. Androgenic (testicular or adrenal)
53
Q

In precocious puberty, what types of abnormalities are likely to be diagnosed by US?

A

Adrenal or ovarian masses

54
Q

What lab testing is helpful in differentiating causes of precocious puberty?

A

LH, FSH, adrenal steroids

55
Q

What imaging modality is best to dx central precocious puberty?

A

MRI

56
Q

What is the DDx of central precocious puberty?

A 
Hamartomas
Hydrocephalus
Arachnoid or ventricular cysts
Meningitis
Encephalitis
Neoplasms
CNS trauma
57
Q

What is the most likely reason for not using contraception?

A

The desire to become pregnant

58
Q

What percentage of pregnancies occur within the first 6 months after coitarche?

A

50%

59
Q

What percentage of pregnancies occur within the first month after coitarche?

A

20%

60
Q

What are the absolute contraindications to OCPs?

A

BC HELP

Breast Cancer, Coronary artery disease and Cerebrovascular disease, Hepatic Disease, Elevated Lipids, Pregnancy

61
Q

What are the relative contraindications to OCPs?

A

HTN, Depression, Migraines, Breast-feeding, Drugs that interfere with absorption (anti-convulsants)

62
Q

Which is safer: Contraceptives or Pregnancy and delivery?

A

Contraception

63
Q

What are the indications for Pap Smear in a sexually active female? Non-sexually active?

A

Sexually active: any age yearly

Non-sexually active: age 18 every 3 years

64
Q

What are the causes of primary amenorrhea?

A

Polycystic ovary disease
Androgen insensitivity
Turner syndrome
Anatomical Obstruction

65
Q

What are the presenting symptoms of PCOS?

A

Amenorrhea
Obesity (not always)
Hirsutism
Acne

66
Q

What lab findings are to be expected in PCOS?

A

LH:FSH ratio >2.5

Elevated Androgen levels

67
Q

What is the treatment for PCOS?

A

Weight loss, OCPs and anti-androgen medication (spironolactone)

68
Q

What are the presenting symptoms of androgen insensitivity?

A

Normal breast development, amenorrhea, no pubic hair

69
Q

What are the presenting symptoms of Turner’s Syndrome?

A

Amenorrhea, Breast budding without further development, No pubic hair

70
Q

How is Turner’s syndrome dx?

A

Karyotype

71
Q

What is the DDx of secondary amenorrhea?

A

Pregnancy
Exercise-induced
Anorexia

72
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

73
Q

Describe the classic pt dx with exercise-induced amenorrhea.

A

Female teenager, heavy athletic training, menstrual cycles gradually become shorter and lighter until they stop.

74
Q

What lab abnormality is likely to be seen in exercise-induced amenorrhea?

A

Low serum estradiol (E2)

75
Q

Pt’s with exercise-induced amenorrhea have an increased risk for what?

A

Anorexia nervosa

Low Bone density and osteoporosis

76
Q

Describe the management of exercise-induced amenorrhea.

A
  1. Reduction in the intensity of exercise
  2. Stop smoking as it increases the risk of stress fractures
  3. Calcium supplementation
  4. Increase caloric intake
77
Q

Is hormone replacement useful in the treatment of exercise-induced amenorrhea?

A

No

78
Q

What is proven to reduce the risk of bone demineralization in pt’s with exercise-induced amenorrhea?

A

Resumption of menses

79
Q

In addition to exercise-induced amenorrhea, what other process can cause low bone density in an otherwise healthy adolescent female?

A

Delayed puberty

80
Q

Describe primary dysmenorrhea.

A

Crampy, lower abdominal pain and pelvic pain occurring with menses but not due to any other pelvic pathology.

81
Q

What is the cause of primary dysmenorrhea?

A

Prostaglandins produced during the ovulatory cycle

82
Q

How is primary dysmenorrhea treated?

A

Prostaglandin inhibitors (NSAIDs)

83
Q

In true primary dysmenorrhea, is treatment with exercise, healthy diet, tylenol, and rest effective?

A

No

84
Q

Describe secondary dysmenorrhea.

A

Pain occurring at all times in the menstrual cycle due to pelvic pathology such as endometriosis

85
Q

What are the si/sx of PTSD?

A

Recurrent nightmares
Fears of being alone
Diminished interest in school
Decreased appetite

86
Q

What are the leading causes of morbidity and mortality of of adolescents?

A

Accidents (MVA)
Homicide
Suicide

87
Q

What are the 4 diagnostic criteria for anorexia nervosa?

A
  1. Distorted body perception
  2. Weight 15% below expected
  3. Intense fear of gaining weight
  4. Absence of 3 consecutive menstrual cycles
88
Q 
Of the following, which is the most important criterion for making the diagnosis of anorexia nervosa? 
Excessive exercise
Thinking he/she is despite normal weight
Using diuretics
Depression
Dieting over several months
A

Thinking he/she is fat despite having normal weight

89
Q

What is the hallmark of bulimia nervosa?

A

Binge eating and induced vomiting

90
Q

Name 3 physical exam findings associated with bulimia.

A

Salivary gland enlargement, dental enamel erosion, bruises or calluses over the knuckles

91
Q

Name 3 lab findings associated with bulimia.

A

Hypokalemia
Hypochloremia
Metabolic alkalosis

92
Q

What are the indications for hospital admissions with bulimia?

A 
Failure of outpatient treatment
Dehydration
EKG abnormalities
Mallory Weiss tear
Suicidal ideation
93
Q

What is an eating disorder patient at risk for during treatment?

A

Hypophosphatemia from refeeding syndrome

94
Q

Which is the most prevalent STI among adolescents?

A

HPV

95
Q

Which is the most common bacterial STI?

A

Chlamydia

96
Q

True or False: Genital Warts are often asymptomatic in males.

A

True

97
Q

What is the primary organism associated with Bacterial vaginosis?

A

Gardnerella vaginalis

98
Q

What is the “Whiff test” looking for to diagnose BV?

A

the presence of amines after the addition of potassium hydroxide

99
Q

What is the diagnostic microscopic finding for BV?

A

Clue cells

100
Q

True or False: Trichomonas Vaginalis causes significant symptoms in males.

A

False

101
Q

Symptoms of Trichomonas in a female include:

A

Vaginal burning/itching, Abnormal vaginal odor, Dyspareunia

102
Q

Physical exam findings of Trichomonas in a female include:

A

Frothy yellow discharge and strawberry cervix

103
Q

What is the diagnostic microscopic finding of trichomonas?

A

Flagellated organisms on slides

104
Q

What is the treatment of choice for trichomonas?

A

2 gram single dose of flagyl for patient and partner

105
Q

True or False: Gonorrhea is most commonly assymptomatic.

A

True

106
Q

How does Gonorrhea present in males? In females?

A

Males: dysuria and discharge. Can get epididymitis with unilateral scrotal pain and swelling
Females: dysuria and malodorous discharge. Urethritis and Cervicitis

107
Q

What are some complications of Gonorrhea infection in a female?

A

PID and Fitz-Hugh-Curtis Syndrome

Pediatric Board Exam (31 decks)

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