Adolescent/Substance Use/Gyn Flashcards
Normal order of puberty changes in girls
- Thelarche around 9.5 years
- Pubarche 1-1.5 years after thelarche
- Peak height velocity around 11.5 years (8.3 cm/year)
- Menarche around 12.5 years
Delayed menstruation definition
- No menarche by age 14 without breast development
- No menarche by age 16 with breast development
- No menarche within 4 years of onset of breast development
Sexual orientation facts
- Not a choice, it’s biologically based
- Homosexual teens are at higher risk of substance abuse, suicide, dropping out, and being homeless
Biggest risk with inhalant abuse
- Sudden cardiac death
Normal order of puberty in boys
- Testicular enlargement (around age 10)
- Pubarche (around age 11.5)
- Peak height velocity (around 11.5 years of age)
- Spermarche
Peak height velocity in boys
Adolescent boys who mature early develop higher peak height velocities than those who mature later
Overall drug use statistics
- Alcohol: 50% have tried by 10th grade
- Tobacco: 35% of 12th graders have tried
- Marijuana: 45% of 12th graders have tried
How long are drugs positive in the urine
48 hours
- Except marijuana can be for several weeks (lipid soluble)
- Urine spec grav and creatinine can impact the validity
- Positive screens must be confirmed by further testing
- Should be collected under direct observation when possible
Immediate effects of inhalants
- Decreased inhibition –> drowsiness and lightheadedness –> ataxia and disorientation
- Effects within seconds and last 5-15 minutes
- Exam: sluggish pupillary responses, bradycardia
- Will present with mental status changes with negative head CT and negative urine, may have abnormal odor on breath
Extreme intoxication of inhalants
Generalized muscle weakness, confusion, hallucinations, ataxia, delirium, nystagmus, lack of coordination
Long term effects of inhalants
Asphyxia, cardiac arrhythmia, aspiration, pyschosis, dementia, bone marrow suppression, liver/kidney damage, encephalopathy
Acute effects of marijuana use
- Dry mouth, dilated pupils, drowsiness, distortion of time
How to monitor discontinuiation of marijuana use
Serial measurements of urine THC:creatinine ratio which should decrease
Chronic effects of marijuana use
- Learning problems, worse school performance
- Compromised immune function, decreaesd sperm count, impaired coordination
- Tachycarida, lung damage, gynecomastia
Withdrawal from marijuana symptoms
- Irritability, insomnia, tremors, nystagmus
- Peaks at 4 days and can continue for 2 weeks
Acute alcohol toxicity symptoms
- Ataxia, slurred speech, visual disturbance, nausea
- Sluggishly reactive pupils, excessive sweating, hypoglycemia
Chronic alcohol abuse symptoms
Esophagitis, gastritis, peptic ulcer disease
- Cirrhosis DOES NOT happen in teenagers
- Adolescents who binge drink aren’t at risk for becoming alcoholics but they are at risk for having depression
Short term symptoms of amphetamines
- Tachycardia, hypertension, sweating, agitation, fever
- Dilated pupils with slow reaction to light
- Perception that insects are on skin
- Arrhythmias
Treatment of amphetamine toxicity
- Gastric lavage and activated charcoal
- Benzos for HTN and agitation, haloperidol for psychosis
- Cooling blanket, hemodialysis if arrhythmias
Symptoms of cocaine abuse
- Irritability, insomnia, tremors, tachycardia, dilated pupils, flushing (at lower doses)
- Higher doses: aggression, arrhythmias, seizures, coma, myocardial infarction, stroke, renal failure
- Chronic use: choreoathetotic movements due to depletion of dopamine storage
Symptoms of opiate toxicity
Comatose teen responsive to painful stimuli with pinpoint but reactive pupils, cyanosis, respiratory depression, bradycardia, hypotension
Tx: naloxone
Symptoms of barbiturate toxicity
- Bradycardia, bradypnea, hypotension, hypothermia, hypoactive bowel sounds, hyporeactive pupillary reflex
- NORMAL pupil size
- Slurred speech, unsteady gait, poor impulse control, nystagmus
Symptoms of hallucinogen toxicity
- Ex: mescaline, psilocybin, LSD, PCP, ecstasy, dextromethorphan
- Tachycardia, HTN, mydriosis (wide eyes), asymmetric pupils, flushing, vertical and horizontal nystagmus, ataxia, visual disturbances (but not auditory), paranoia, agitation
Physiologic effects of nicotine
Increased alertness, muscle relaxation, enhanced memory, decreased appetite, decreased irritability
Bad things: peptic ulcer disease
Side effect from MDMA abuse
Hyponatremia, altered mental status, seizure, rhabdomyolysis, hepatic toxicity
Diagnostic criteria of anorexia
- Distorted body perception
- Weight down 15%
- Intense fear of gaining weight
- Absence of 3 consecutive menstrual cycles
Labs/symptoms of bulimia
Salivary gland enlargement, dental enamel erosion, bruises/calluses over knuckles from forced gagging, low potassium, low chloride, metabolic alkalosis
Indications when parental consent is not needed
- Life threatening emergencies, sexual assault services
- Medical care during pregnancy
- Treatment for STIs and HIV
- Treatment for substance abuse
SMR pubic hair male and female
1: none
2: fine hair
3: coarse, curly, pigmented
4: denser and curled but less abundant than adult
5: extends to inner thigh like adult
SMR phallus size
1: childlike
3: increased size
5: adult size
SMR testicular size
1: volume < 2.5 mL
2: increased volume, scrotum more textured
SMR breast size
1: no glandular tissue
2: small breast buds
3: breast tissue extends beyond areola
4: enlarged areola and papilla form secondary mound
Benefits of oral contraceptives
- Decrease risk for ovarian cysts, endometrial and ovarian cancers, osteoporosis
- Reduce free tesoterone and decrease hirsuitsm
- Reduce risk for salpingitis and ectopic pregnancy
- Protection against acne and iron deficiency anemia
Absolute contraindications for oral contraceptives
- Migraine headache with aura
- Pregnancy or < 21 days post partum
- Uncontrolled HTN or other heart disease
- Liver disease
- Breast cancer
- History of stroke, DVT, PE
- Factor V leiden mutation
- Major surgery with prolonged immobilization
Definition of primary amenorrhea
- No menses by age 15 or 3 years following breast development
Amenorrhea, normal breast development, absence of pubic hair
Androgen insensitivity syndrome
Definition of secondary amenorrhea
3 months of amenorrhea after the onset of menarche
- MCC are PCOS, pregnancy, exercise induced amenorrhea
Lab findings and symptoms of PCOS
- Amenorrhea or dysfunctional bleeding, obesity, hirsutism, acne
- LH:FSH ratio > 2.5 and elevated androgens
Symptoms and labs of exercise induced amenorrhea
Heavy exercise with periods that become lighter and then just stop
- Low serum estradiol –> risk for osteoporosis
- Increase calories, reduce athletic training, calcium supplements
Cause and treatment of primary dysmenorrhea
- Pain with periods due to prostaglandins
- Tx with NSAIDs, OCPs if NSAIDs don’t work
Definition and cause of dysfunctional uterine bleeding
- Bleeding beyond 10 days
- Anovulation during initial months of menarche is most common cause
- Others: ectopic pregnancy, PID, thyroid disease, meds, bleeidng disorder, PCOS, trauma, systemic disease
Heavy menstrual bleeding without pain
Consider chlamydia
Symptoms of imperforate hymen
- Intermittent lower abdominal pain
- Midline abdominal mass
- Hydrometrocolpos is collection of fluid in the uterus
- Bluish/bulging hymen
Causes of vulvovaginitis
- Enterobius (pinworms), GAS, Staph, Candida
- Gonorrhea, chlamydia, trichomonas, herpes
- Foreign body, chemical irritants, poor hygiene
Mild curd vaginal discharge that is itchy
Candida vaginitis
- Tx with topical clotrimazole
Flat papular lesions that are pedunculated in the genital or anal mucosa
- Condyloma acuminata (warts)
- Almost always sexually transmitted, caused by HPV
- Non-tender and will bleed with minor trauma
- Risk factor for cervical cancer
- Tx: observation for 1-2 years initially, medical treatment (chemical cauterization), surgical excision, vaccination
Whitish gray papules that have coalesced in genital region
- Condyloma lata (secondary syphilis)
Genital ulcerative lesions that are painful and have tender inguinal nodes
Herpes simplex
- Tx is oral acyclovir
- Test with viral culture for herpes simplex
Red, crusted suprapubic macules or blue-gray dots in pubic region
Pediculosis pubis (crabs)
- Can also be in anal hairs, facial hair, eyelashes
- Concern for sexual abuse in a child
- Tx with permethrin, pyrethrin, malathion
Triad of bacterial vaginosis
- Gray/white vaginal discharge, pH > 4.5, clue cells (often have fishy odor with whiff test)
- Tx with flagyl
- Bugs: gardnerella, ureaplasma, mycoplasma
- Risk factors include new/multiple sex partners, douching, lack of condom use
Frothy yellow discharge with strawberry cervix
Trichomonas (sx can including abnormal order, itching, burning) –> flagellated organisms
- Can be asymptomatic in men
- Tx flagyl (also need to treat partners)
Symptoms of gonorrhea
- Often asymptomatic
- Men can have dysuria, discharge, epididymitis (unilateral pain/swelling of the scrotum)
- Women can have urethritis and cervicitis, dysuria, malodorous discharge, peritonitis, peri-hepatitis
- Can be associated with arthritis or pharyngitis
- This is the second most common reportable STD
Diagnostic criteria for PID
- Abdominal/pelvic pain along with uterine, adnexal or cervical motion tenderness
- Other criteria: WBC in vaginal secretions, fever, elevated CRP, lab evidence of GC/chlamydia, abnormal cervical or vaginal mucopurulent discharge
- Tx: rocephin x 1, doxy x 14 days +/- flagyl
