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Adult Primary Care > Adolescent Primary Care - Exam 1 > Flashcards

Adolescent Primary Care - Exam 1 Flashcards

1
Q

Puberty is defined as the development of __________ and the biologic process that ultimately leads to _________.

A

secondary sexual characteristics; fertility

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2
Q

The hormonal regulatory systems in the (4) undergo major changes between the prepubertal and adult states

A

hypothalamus, pituitary, gonads, adrenal glands

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3
Q

However, even though the timing and progression of adolescent development varies, the _______ is orderly

A

sequence of events

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4
Q

________ refers to the psychosocial and emotional transition from childhood to adulthood and is influenced by social, genetic, and environmental aspects

A

Adolescence

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5
Q

of tanner stages

A

5

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6
Q

First non-visible physical change pf puberty

A

increase in ovary size

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7
Q

First visible physical change of puberty

A

breast budding (thelarche)

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8
Q

Thelarche

A

onset of breast budding

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9
Q

Menarche

A

onset of menses

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10
Q

Adrenarche

A

onset of pubic hair

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11
Q

Average range for thelarche

A

8-13 yo (av. 10.3)

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12
Q

Most females will experience breast budding ______ months before pubic hair and _________ years before menarche

A

6 months before pubic hair; 2-2.5 years before menarche

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13
Q

Typically females have completed their linear growth spurt by age….

A

15yo

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14
Q

Final height is determined by the amount of bone growth at the …

A

epiphyses of the long bones

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15
Q

Breast budding (thelarche) begins as a result of _______ secretion

A

estradiol

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16
Q

Average range for menarche

A

9-15 yo (av. 12.5)

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17
Q

Body fat is an important mediator for the onset of menstruation and regular ovulatory cycles. An average of ____% of body fat is needed for menarche, and about ___% is needed to initiate and maintain regular ovulatory cycles.

A

17%; 22%

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18
Q

First visible sign of puberty for males

A

testicular enlargement

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19
Q

Average age of testicular growth for males

A

11.5 yo

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20
Q

Growth of the testes occurs about _____ months before adrenarche for males

A

6 months

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21
Q

If testicular enlargement does not precede other changes, the provider should consider whether the adolescent is….

A

taking exogenous anabolic steroids

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22
Q

Once puberty begins, the ______ testis generally hangs lower.

A

left

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23
Q

Most males finish linear growth by age…

A

17yo

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24
Q

Between ________% of males experience gynecomastia, a transient benign unilateral or bilateral enlargement of breast tissue. Gynecomastia generally lasts _______ and resolves completely by late puberty in nearly all cases.

A

50% and 75%; 12 to 18 months

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25
Q

the process of psychosocial, emotional, and cognitive development in adolescents is a transition that is (2)

A

continual; typically smooth

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26
Q

disruptive family conflict is vs. is not the norm

A

is not

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27
Q

In adolescence, the quality of thinking changes from concrete to ….

A

formal operational

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28
Q

Type of thinking characterized by the use of propositional thinking and abstract reasoning

A

formal operational

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29
Q

teenagers acquire increasing sophistication in abstract thought after they are _______ years old

A

14 yo

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30
Q

As “mandatory reporters,” primary health care providers are required by law to report information that ….

A

puts the child or others in danger (i.e., physical or sexual abuse)

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31
Q

Some states require reporting teen sexual activity, even if consensual, if an age difference of _____ years or more exists between the two

A

3 years

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32
Q

Testicular growth can be directly assessed by palpation of the testes in the scrotum and comparison of their size with a standardized _________

A

orchidometer

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33
Q

HEEADSSS is a screener for….

A

risk taking behavior

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34
Q

What does HEEADSSS stand for

A

Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidality, Safety

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35
Q

The biologic process that ultimately leads to fertility

A

puberty

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36
Q

(3) axes facilitating puberty

A

1) hypothalmic-pituitary-adrenal
2) hypothalmic-pituitary-gonadal
3) growth hormone

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37
Q

Screener for classifying stages of secondary sexual characteristics

A

Sexual maturity rating (SMR; aka Tanner stages)

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38
Q

Average length of puberty

A

1.5-8 years (av. 4)

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39
Q

Precocious puberty would describe onset of breast budding or pubic hair before age….

A

8yo in females; 10yo in males

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40
Q

Explain to parents at the ____yo visit that you will begin to speak privately with the adolescent at the next year’s visit

A

11yo

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41
Q

Parental consent is needed to see any patient under the age of…

A

18yo (exceptions: emergencies, adoptive parents, emancipated minor, mature minor, abuse)

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42
Q

If an adolescent needs STI testing/contraceptives but does not want their parents to receive the itemized insurance bill, where should you send them?

A

public health department (free services)

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43
Q

How often/who should you screen for hypertension

A

everyone, annually

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44
Q

How often/who should you plot height and weight on the growth curve

A

everyone, annually

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45
Q

> ___% percentile is considered obesity for adolescents

A

95%

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46
Q

AAP guidelines recommend screening lipids at ages …

A

10yo and 20yo

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47
Q

How often/who should you screen for tuberculosis

A

at-risk, annually

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48
Q

How often/who should you screen for substance use

A

everyone, annually

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49
Q

Screening tool for substance abuse in adolescents

A

CRAFFT

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50
Q

What does CRAFFT stand for

A

Car, Relax, Alone, Forget, Friends/Family, Trouble

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51
Q

How often/who should you screen for depression

A

Ages 11-21, annually

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52
Q

Screener for depression in adolescents

A

PHQ2

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53
Q

Who should you do a pelvic exam with

A

sexually active or >20 yo, if requested, or if there are symptoms (pain, discharge, AUB)

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54
Q

Guidelines to check for up to date immunization schedules

A

ACIP (advisory committee on immunization practices)

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55
Q

What does Tdap/Dtap cover?

A

tetanus, diphtheria, acellular pertussis

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56
Q

Tdap vaccine schedule

A

initiate age 11, Td booster Q10 years

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57
Q

Meningococcal vaccine schedule

A

initiate age 11, booster age 16

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58
Q

2-dose HPV vaccine schedule

A

initiate age 11 (range 9-14) with 2 doses 6 months apart

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59
Q

3-dose HPV vaccine schedule

A

if age 15 or older at initiation, 3 doses at 0, 1-2 months later, and 6 months later

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60
Q

Number of HPV vaccine doses depends on….

A

age at initial vaccination

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61
Q

HPV vaccine is most effective if given when

A

before onset of sexual contact (younger patients achieve a better immune response)

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62
Q

HPV subtypes that most commonly cause cancer

A

16, 18

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63
Q

HPV subtypes that commonly cause genital warts

A

6, 11

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64
Q

The strongest motivator to vaccinate is ______, and the primary obstacle is _________

A

provider recommendation; lack of knowledge

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65
Q

The leading causes of illness and death among adolescents are largely….

A

preventable

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66
Q

Leading cause of death in developing countries (2)

A

road injuries, HIV/AIDS

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67
Q

Leading cause of death in developed countries (1)

A

mental health disorders, especially depression

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68
Q

(3) leading causes of death for adolescents ages 15-19yo

A

accidents, suicide, homicide

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69
Q

The proportion of adolescents who have ever had sex is trending…..

A

down (green)

70
Q

The proportion of adolescents who have had 4 or more sexual partners is trending…..

A

down (green)

71
Q

The proportion of adolescents who are currently sexually active is trending…..

A

down (green)

72
Q

The proportion of adolescents who used a condom during last intercourse is trending…..

A

down (red) [but the STI lecture says increased]

73
Q

The proportion of adolescents who used effective hormonal birth control and a condom is trending….

A

stable (yellow)

74
Q

The proportion of adolescents who ever used or injected illicit drugs is trending….

A

down (green)

75
Q

The proportion of adolescents who experienced depression and suicidality is trending….

A

up (red)

76
Q

___% of adolescents who report being in excellent, very good, or good health

A

98%

77
Q

High school enrollment is trending _____ while dropout rates are trending _______

A

up; down (green)

78
Q

College enrollment is trending ….

A

up (green)

79
Q

Poverty rate is trending….

A

stable (yellow)

80
Q

% of adolescents who live in poverty

A

17.8%

81
Q

Leading cause of death in adolescents ages 10-24 in the US

A

Motor vehicle accidents (18% mortality, 23-40% involved alcohol)

82
Q

Second leading cause of death in adolescents ages 10-24 in the US

A

suicide (more deadly for males, more attempts for females)

83
Q

Third leading cause of death in adolescents ages 10-24 in the US

A

homicide (82% from firearms, mostly males)

84
Q

Exercise levels for adolescents are trending….

A

stable (yellow)

85
Q

Sedentary activity (3 or more hours per day of television?) is trending….

A

down (green)

86
Q

Obesity rates are trending…..

A

up (red; tripled)

87
Q

% of adolescents who are overweight or obese in US in 2017

A

31%

88
Q

(3) worrisome trends that are increasing in adolescents

A

hearing impairment, excess UV exposure, e-cig use

89
Q

% of adolescents with a chronic condition

A

30%

90
Q

Sensitivity of urine vs. cervical NAAT for chlamydia or gonorhrea

A 
urine = 81% sensitive
cervix = 85% sensitive
91
Q

How often/who should you screen for chlamydia and gonorrhea

A

sexually active people, annually

92
Q

Who should you screen for syphilis

A

MSM, pregnant

93
Q

How can you test for urethritis

A

UA with microscopy, urine GC/CT probe, urine or urethral culture

94
Q

CDC recommended regimens for treatment of uncomplicated genital chlaymdia

A

Azithromycin 1g PO single dose (preferred); doxycycline 100mg PO BID x7 days

95
Q

Clinical presentation of chlamydia-related urethritis in males

A

asymptomatic (>50%), or discharge (mucoid or clear) and dysuria

96
Q

When you see urethritis in people and you don’t know the underlying diagnosis yet, treat empirically for….

A

chlamydia/gonorrhea

97
Q

Dx: Swollen, painful testicles with pain that goes away when you lift the scrotum

A

epididymitis

98
Q

Epididymitis is usually caused by…. (2)

A

chlamydia/gonorrhea

99
Q

Clinical presentation of chlamydia-related cervicitis in females

A

asymptomatic (70-80%), or mucopurulent endocervical discharge and edematous cervical ectopy with erythema and friability

100
Q

Clinical presentation of chlamydia-related urethritis in females

A

asymptomatic, or dysuria, urinary frequency, and pyuria

101
Q

Dx: Elevated liver enzymes, RUQ pain, NAAT positive for chlamydia

A

Fitz High Curtis Syndrome

102
Q

Dx: Joint pain, hand pain, elbow pain, NAAT positive for chlamydia

A

Reactive arthritis

103
Q

Treatment for LGV (lymphogranuloma venereum) lymphadenopathy

A

doxycycline 100mg BID x21 days

104
Q

LGV (lymphogranuloma venereum) lymphadenopathy is caused by long-term infection with….

A

chlamydia

105
Q

Classic presentation of gonorrhea-related urethritis in males

A

purulent white discharge from penis

106
Q

Treatment regimen for gonorrea

A

Ceftriaxone 250mg IM one time AND azithromycin 1g PO one time (or doxycycline 100mg PO BID x7 days)

107
Q

When should you re-test after treatment of gonorrhea/chlamydia

A

test of reinfection at 2-3 months after therapy

108
Q

A gonorrhea/chlamydia NAAT will take at least ______ to become negative after resolution

A

4 weeks

109
Q

50% of the time, if someone has a bartholin gland abscess they also have…

A

gonorrhea

110
Q

Treatment for disseminated gonorrhea

A

hospitalization for IV antibiotics

111
Q

Dx: Triad of tenosynovitis, dermatitis, and polyarthralgias + purulent arthritis with skin lesions, suspect….

A

disseminated gonorrhea

112
Q

Treatment for disseminated gonorrhea

A

ceftriazone 1g QD and step down to cefixime PO x 7 days

113
Q

How do you diagnose suspected disseminated gonorrhea

A

blood cultures, culture of the mucosal surfaces, NAAT urethral swab, tap the infected joint for culture

114
Q

Adnexal tenderness is the most sensitive sign for….

A

acute salpingitis/PID

115
Q

The CDC recommends treatment for suspected PID for ANY sexually active adolescent who presents with…

A

lower abdominal/pelvic pain AND

  • CMT, or….
  • adnexal tenderness, or…
  • uterine tenderness
116
Q

Treatment regimen for PID

A

ceftriaxone 250mg IM single dose AND doxycycline 100mg PO BID x14 days AND consider metronidazole 500mg PO BID x 14 days

117
Q

How soon should you reassess after starting treatment for PID

A

within 72 hours (some need hospitalization)

118
Q

Condyloma lata is caused by….

A

syphilis

119
Q

Condyloma accuminata is caused by….

A

HPV

120
Q

Treatment for pediculosis pubis

A

permethrin 1% cream

121
Q

Main differences between a herpes vs. syphilis lesion (2)

A

herpes lesions are painful and multiple; and syphilis usually is not painful and solitary lesion

122
Q

Are antibodies present at primary infection of HSV?

A

No, they are not present when symptoms appear but should be present upon later recurrence of symptoms

123
Q

Clinical presentation of primary HSV infection

A

malaise, fever, burning with urination, herpes lesions on erythematous base that are more severe or bilateral. There may be vaginal or urethral discharge and or tender inguinal adenopathy

124
Q

Lesion progression in HSV

A

papules > vesicles > pustules > ulcers > crusts > healed

125
Q

How long does primary HSV infection typically last without treatment

A

2-4 weeks

126
Q

Gold standard for diagnosis of herpes, though not often used in practice

A

viral culture (unroof a lesion for swab)

127
Q

Treatment for primary genital HSV infection

A

7-10 day course of: Acyclovir 400mg TID, famicyclovir 250mg TID, or valacyclovir 1000mg BID

128
Q

Benefits to antiviral therapy for HSV first episode

A

Compared with untreated disease, oral antiviral therapy decreases the duration and severity of disease by days to weeks (particularly among those with primary infection) with minimal adverse drug effects. It appears to reduce viral shedding (transmissability). However, treating the first episode of genital HSV does not eradicate latent virus

129
Q

Preferred regimen for HSV suppressive therapy

A

valacyclovir 500 mg once daily

130
Q

Most genital HPV infections are…. (3)

A

transient, asymptomatic, no clinical consequences

131
Q

(2) low risk HPV types that cause genital warts

A

6, 11

132
Q

(2) high risk HPV types that can cause cancer

A

16, 18

133
Q

(5) ways HPV infection can present

A

asymptomatic; genital warts; cervical cell abnormalities; anogenital cancers; recurrent respiratory papillomatosis

134
Q

Dx: genital warts with cauliflower-like appearance that are skin-colored, pink, or hyperpigmented

A

condyloma acuminata (HPV)

135
Q

Diagnosis of HPV-related genital warts is usually a ______ diagnosis

A

clinical (visual inspection; biopsy can be used when diagnosis is uncertain, patient is immunocompromised, or persistent symptoms after treatment)

136
Q

Treatment options for HPV genital warts

A

podophyllotoxin 0.15-0.5% solution at home every other day for 2-3 weeks; imiquimod 5% 3x weekly overnight; or in-office treatment with TCA acid or podophyllin

137
Q

Dx: genital warts with smooth, rounded, moist surface

A

secondary syphilis

138
Q

Dx: genital warts with central dimple, sparing the mucosal surfaces

A

molloscum contagiosum

139
Q

Dx: Solitary, painless, indurated ulcer with clean base to genital area. On physical exam, found to have rubbery, painless, bilateral inguinal lymphadenopathy

A

primary syphilis

140
Q

Primary syphilis will heal without treatment in ______ weeks

A

1-6 weeks

141
Q

Secondary syphilis symptoms occur how long after primary infection

A

3-6 weeks

142
Q

Most common manifestation of secondary syphilis

A

mucocutaneous lesions

143
Q

Manifestations of secondary syphilis

A

rash (75-100%); lymphadenopathy (50-86%); malaise; mucous patches; condyloma lata; alopecia

144
Q

Secondary syphilis is ALWAYS treated with ______: if they are allergic, go to hospital for densensitization

A

penicillin

145
Q

Classic rash for secondary syphilis

A

palmar/plantar rash (nickle and dime rash of the hands and feet)

146
Q

(3) types of NON-treponemal tests for syphilis

A

RPR, VDRL, TRUST (results are in titer form, positive or negative)

147
Q

(3) types of treponemal tests for syphilis (diagnostic)

A

FTA-ABS, MHA-TP, TP-IgG (based on antibody response)

148
Q

Diagnostic test of choice at VUMC for syphilis diagnosis

A

TP-IgG (treponemal IgG)

149
Q

Treatment regimen of choice for syphilis

A

benzathine penicillin G 2.4 million units IM in a single dose

150
Q

Dx: Pt presents with palmar/plantar nickle and dime rash, and tests positive for syphilis. You treat with penicillin in office. They return the next morning with fever, malaise, n/v. You suspect…..

A

jarisch-herxheimer reaction (occurs within 24 hours of treatment, is not an allergic reaction, will be self-limited)

151
Q

According to ACOG, the initial reproductive health visit should take place between the ages of….

A

13-15yo

152
Q

Psychiatric illness with the highest mortality rate in adolescents

A

anorexia nervosa

153
Q

(3) DSM-5 criteria for anorexia nervosa (must meet all 3)

A

restriction of energy intake relative to requirements leading to significantly low weight; intense fear of gaining weight; disturbance in body image

154
Q

(2) subtypes of anorexia nervosa

A

restricting; binging/purging

155
Q

Definition of a binge

A

consumption of an excessive quantity of food accompanied by a loss of control followed by a feeling of distress

156
Q

(4) DSM-5 criteria for bulimia nervosa

A

recurrent episodes of binge eating; recurrent compensatory behaviors to prevent weight gain (vomiting, laxatives, fasting, exercise); behaviors that occur at least 1x per week for 3 months; self-evaluation is influenced by body shape and weight

157
Q

Individuals with a primary relative with an eating disorder have a _____x increased risk of developing an eating disorder

A

6-10x

158
Q

During puberty, body fat levels are expected to ______ for males vs. females

A 
males = decrease
females = increase
159
Q

Screening tool for eating disorders

A

SCOFF

160
Q

What does SCOFF screener stand for

A

Sick (vomit), Control, One stone (15 lbs in 3 months), Fat, Food

161
Q

Abrasions of the proximal knuckles is called….

A

russel’s sign (purging, vomiting)

162
Q

Initial laboratory assessment for suspected eating disorder

A

CBC, electrolytes, TSH, LFTs, kidney function, beta HCG, UA

163
Q

Metabolic _______ is often seen in eating disorders

A

metabolic acidosis

164
Q

First line therapy for anorexia

A

family based therapy

165
Q

First line therapy for bulimia

A

CBT

166
Q

FDA-approved medication for bulimia

A

fluoxetine (SSRI; can decrease frequency of binge-purge cycle)

167
Q

Estrogen replacement role in eating disorders

A

Can restore menses but does not improve bone mineral density

168
Q

Reasons to hospitalize someone with an eating disorder

A

severe malnutrition (weight < 75% expected), ongoing weight loss despite treatment, dehydration, electrolyte abnormalities, syncope, bradycardia, hypothension (SBP <90), orthostatis, refusing food, uninterrupted binge-purge cycle, hypothermia, hematemesis, suicidality

169
Q

(3) signs of recovery from eating disorder

A

normalized eating pattern and flexibility; restoration of body weight; resumption of menses

170
Q

Median time to recovery from eating disorder

A

5 years

171
Q

(3) protective factors conferring better prognosis for an eating disorder

A

earlier age at onset, shorter duration of symptoms before treatment, strong family relationship

172
Q

(4) factors associated with poorer prognosis for eating disorder

A

purging behaviors, physical hyperactivity, significant weight loss, disease chronicity

Adult Primary Care (6 decks)

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