Adolescent + Psych Flashcards
average age of first intercourse
16.5
Age of consent
Exceptions
16 years old
Exceptions:
● 14-15 years can consent to sex with someone up to 5
years older
● 12-13 years can consent to sex with someone up to 2 years older
● Must not be in a position of authority (teacher, coach, clergy etc.)
- 18years for exploitative sex
- Prostitution
- Pornography
LARCs failure rate
- 2% hormonal
0. 9%
When is return to fertility after IUD removal
1 month
How long after IUD insertion is there increased risk of STI and PID
1 week
WHO - contraindications to OCP
Hypertension (uncontrolled) Migraine w aura VTE Known thrombogenic mutations 2 or more RF for arterial CVD (smoking, DM, htn) Smoking >35yo Known ischemic heart disease Hx stroke Complicated valvular heart disease Breast cancer Cirrhosis Hepatocellular adenoma or malignant hepatoma
Starting OCP
type and dose
Combined OCP
30-35mcg estrogen
Depo provera - dose and frequency
Medroxyprogesterone Acetate (150mg im q12 weeks)
What type of birth control can cause weight gain
Depo provera
Side effects of depo provera
Irregular bleeding
Amennorhhea
Weight gain
Reduced bone mineral density. should get concurrent Calcium and Vit D
Emergency contraception options
Ulipristal Acetate “Ella”
- 30 mg x1, req Rx
- Up to 120 hours after unprotected sex
- Does not reduce efficacy over time
Plan B (progesterone only)
- 0.75 levonorgestrel x2 q12h
- best within 3 days but up to 5days
Copper IUD
- first line but limited access
- insert within 5-7 days, remove next period
Anorexia Nervosa
A. Restriction of energy intake relative to requirements, leading to a SIGNIFICANTLY LOW BODY WEIGHT in the context of age, sex, developmental trajectory, and physical health.
B. Intense FEAR OF GAINING WEIGHT or of becoming fat or PERSISTANT BEHAVIOUR that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which ONE’S BODY WEIGHT OR SHAPE is experienced, undue influence of body weight or shape on self- evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Bulimia Nervosa
A. BINGE EATING
- Eating an excessive amount of food
- Sense of lack of control during binge episode
B. Recurrent inappropriate BEHAVIOURS TO COMPENSATE for binge episode (purging, laxative use, fasting, excessive exercise, insulin omission, others…)
C. Episodes occur on average 1/wk for 3 months
D. Self-evaluation is unduly influenced by weight and shape
E. Does not meet criteria for anorexia nervosa
ARFID
Eating or feeding disturbance associated with failure to meet nutritional needs AND 1 of the following
● Weight loss or growth failure
● Nutritional deficiency
● Dependence on enteral feeds or all liquid nutrition
● Marked interference with psychosocial functioning
● No evidence of body image disturbance
● No medical illness to explain the symptoms
Indications for hospitalization for ED
● Impaired/Arrested Growth and Development
- Severe malnutrition
- Weight ≤ 75 - 80% average body weight for age, sex, and height
● Fluid and Metabolic Abnormalities
- Dehydration
- Electrolyte disturbances
● Cardiac Abnormalities
- Arrhythmia/bradycardia HR <50 bpm daytime; <45 bpm at night
- Hypotension (<80/50 mm Hg)
- Hypothermia (body temperature <35.5 C)
- Orthostatic changes in HR (>20 bpm) or BP (>10 mm Hg)
● Behavioural
- Acute food refusal/uncontrolled bingeing/purging
- Suicidal ideation
Chlamydia - treatment
Azithromycin – 1 gm po x 1
Doxycycline 100mg PO bid x 7 days
Gonorrhea - treatment
(treat for chlamydia too)
● Option 1: Ceftriaxone 250 IM x 1, PLUS azithromycin 1 gram po
● Option 2: Cefixime (Suprax) 800 mg po x 1 PLUS azithromycin 1 gram po
PID
- diagnosis
Lower abdominal pain PLUS either
● Adnexal tenderness
● Uterine tenderness
● Cervical motion tenderness
● Increased specificity if also have ● fever >38.3 ● discharge ● WBC on microscopy ● elevated ESR or CRP ● positive testing for GC or chlamydia
PID
- complications if not treated
● Ectopic pregnancy
● Chronic pain
● Infertility
PID
- treatment
Ceftriaxone 250 mg IM in a single dose
PLUS
Doxycycline 100 mg PO bid for 14 days
Teen with unilateral painless breast mass
Fibroadenoma
Top three substances used by adolescents
Alcohol > high energy drinks > cannabis
What do you have to do before and after giving emergency contraception
nothing before
arrange followup after
What are the contraindications to nicotine replacement
none!
not even smoking or ED
Tasks of adolescences
- Achieving independence from parents
- Adopting peer codes and lifestyles
- Assigning increased importance to body image and acceptance of one’s body image
- Establishing sexual, vocational, and moral identities
PCOS - dx
- Abnormal uterine bleeding pattern
(abN for age or persistent for 1-2y) - Evidence of hyperandrogenism
(elevated testo, mod-severe hirsutism, mod-severe acne vulgaris)
When can you become sexually active after starting treatment for chlamydia
7 days
concerning substance in energy drinks
guarana
Mechanism of action for OCP
- Thickening of cervical mucus, blocks sperm penetration, progestin
- Inhibition of ovulation by inhibiting LH surge
- Endometrial changes
- Slowed tubal motility- progestin
Side effects of estrogen
- Breakthrough bleeding
- Breast tenderness
- Headaches
- Nausea
- Hypertension
- Thromboembolism
- Drug interactions (P450)
- Slight increased risk of cervical dysplasia (>5 yrs of use)
Girl vomited 90 minutes after Plan B. What do you do?
Reassure (after 60 minutes is ok)