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General Peds Boards > Adolescent/Substance Use/Gyn > Flashcards

Adolescent/Substance Use/Gyn Flashcards

1
Q

Normal order of puberty changes in girls

A
  1. Thelarche around 9.5 years
  2. Pubarche 1-1.5 years after thelarche
  3. Peak height velocity around 11.5 years (8.3 cm/year)
  4. Menarche around 12.5 years
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2
Q

Delayed menstruation definition

A
  • 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
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3
Q

Sexual orientation facts

A
  • Not a choice, it’s biologically based

- Homosexual teens are at higher risk of substance abuse, suicide, dropping out, and being homeless

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4
Q

Biggest risk with inhalant abuse

A
  • Sudden cardiac death
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5
Q

Normal order of puberty in boys

A
  1. Testicular enlargement (around age 10)
  2. Pubarche (around age 11.5)
  3. Peak height velocity (around 11.5 years of age)
  4. Spermarche
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6
Q

Peak height velocity in boys

A

Adolescent boys who mature early develop higher peak height velocities than those who mature later

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7
Q

Overall drug use statistics

A
  • Alcohol: 50% have tried by 10th grade
  • Tobacco: 35% of 12th graders have tried
  • Marijuana: 45% of 12th graders have tried
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8
Q

How long are drugs positive in the urine

A

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
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9
Q

Immediate effects of inhalants

A
  • 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
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10
Q

Extreme intoxication of inhalants

A

Generalized muscle weakness, confusion, hallucinations, ataxia, delirium, nystagmus, lack of coordination

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11
Q

Long term effects of inhalants

A

Asphyxia, cardiac arrhythmia, aspiration, pyschosis, dementia, bone marrow suppression, liver/kidney damage, encephalopathy

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12
Q

Acute effects of marijuana use

A
  • Dry mouth, dilated pupils, drowsiness, distortion of time
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13
Q

How to monitor discontinuiation of marijuana use

A

Serial measurements of urine THC:creatinine ratio which should decrease

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14
Q

Chronic effects of marijuana use

A
  • Learning problems, worse school performance
  • Compromised immune function, decreaesd sperm count, impaired coordination
  • Tachycarida, lung damage, gynecomastia
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15
Q

Withdrawal from marijuana symptoms

A
  • Irritability, insomnia, tremors, nystagmus

- Peaks at 4 days and can continue for 2 weeks

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16
Q

Acute alcohol toxicity symptoms

A
  • Ataxia, slurred speech, visual disturbance, nausea

- Sluggishly reactive pupils, excessive sweating, hypoglycemia

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17
Q

Chronic alcohol abuse symptoms

A

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
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18
Q

Short term symptoms of amphetamines

A
  • Tachycardia, hypertension, sweating, agitation, fever
  • Dilated pupils with slow reaction to light
  • Perception that insects are on skin
  • Arrhythmias
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19
Q

Treatment of amphetamine toxicity

A
  • Gastric lavage and activated charcoal
  • Benzos for HTN and agitation, haloperidol for psychosis
  • Cooling blanket, hemodialysis if arrhythmias
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20
Q

Symptoms of cocaine abuse

A
  • 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
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21
Q

Symptoms of opiate toxicity

A

Comatose teen responsive to painful stimuli with pinpoint but reactive pupils, cyanosis, respiratory depression, bradycardia, hypotension

Tx: naloxone

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22
Q

Symptoms of barbiturate toxicity

A
  • Bradycardia, bradypnea, hypotension, hypothermia, hypoactive bowel sounds, hyporeactive pupillary reflex
  • NORMAL pupil size
  • Slurred speech, unsteady gait, poor impulse control, nystagmus
23
Q

Symptoms of hallucinogen toxicity

A
  • 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
24
Q

Physiologic effects of nicotine

A

Increased alertness, muscle relaxation, enhanced memory, decreased appetite, decreased irritability

Bad things: peptic ulcer disease

25
Q

Side effect from MDMA abuse

A

Hyponatremia, altered mental status, seizure, rhabdomyolysis, hepatic toxicity

26
Q

Diagnostic criteria of anorexia

A
  • Distorted body perception
  • Weight down 15%
  • Intense fear of gaining weight
  • Absence of 3 consecutive menstrual cycles
27
Q

Labs/symptoms of bulimia

A

Salivary gland enlargement, dental enamel erosion, bruises/calluses over knuckles from forced gagging, low potassium, low chloride, metabolic alkalosis

28
Q

Indications when parental consent is not needed

A
  • Life threatening emergencies, sexual assault services
  • Medical care during pregnancy
  • Treatment for STIs and HIV
  • Treatment for substance abuse
29
Q

SMR pubic hair male and female

A

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

30
Q

SMR phallus size

A

1: childlike
3: increased size
5: adult size

31
Q

SMR testicular size

A

1: volume < 2.5 mL
2: increased volume, scrotum more textured

32
Q

SMR breast size

A

1: no glandular tissue
2: small breast buds
3: breast tissue extends beyond areola
4: enlarged areola and papilla form secondary mound

33
Q

Benefits of oral contraceptives

A
  • 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
34
Q

Absolute contraindications for oral contraceptives

A
  • 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
35
Q

Definition of primary amenorrhea

A
  • No menses by age 15 or 3 years following breast development
36
Q

Amenorrhea, normal breast development, absence of pubic hair

A

Androgen insensitivity syndrome

37
Q

Definition of secondary amenorrhea

A

3 months of amenorrhea after the onset of menarche

- MCC are PCOS, pregnancy, exercise induced amenorrhea

38
Q

Lab findings and symptoms of PCOS

A
  • Amenorrhea or dysfunctional bleeding, obesity, hirsutism, acne
  • LH:FSH ratio > 2.5 and elevated androgens
39
Q

Symptoms and labs of exercise induced amenorrhea

A

Heavy exercise with periods that become lighter and then just stop

  • Low serum estradiol –> risk for osteoporosis
  • Increase calories, reduce athletic training, calcium supplements
40
Q

Cause and treatment of primary dysmenorrhea

A
  • Pain with periods due to prostaglandins

- Tx with NSAIDs, OCPs if NSAIDs don’t work

41
Q

Definition and cause of dysfunctional uterine bleeding

A
  • 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
42
Q

Heavy menstrual bleeding without pain

A

Consider chlamydia

43
Q

Symptoms of imperforate hymen

A
  • Intermittent lower abdominal pain
  • Midline abdominal mass
  • Hydrometrocolpos is collection of fluid in the uterus
  • Bluish/bulging hymen
44
Q

Causes of vulvovaginitis

A
  • Enterobius (pinworms), GAS, Staph, Candida
  • Gonorrhea, chlamydia, trichomonas, herpes
  • Foreign body, chemical irritants, poor hygiene
45
Q

Mild curd vaginal discharge that is itchy

A

Candida vaginitis

- Tx with topical clotrimazole

46
Q

Flat papular lesions that are pedunculated in the genital or anal mucosa

A
  • 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
47
Q

Whitish gray papules that have coalesced in genital region

A
  • Condyloma lata (secondary syphilis)
48
Q

Genital ulcerative lesions that are painful and have tender inguinal nodes

A

Herpes simplex

  • Tx is oral acyclovir
  • Test with viral culture for herpes simplex
49
Q

Red, crusted suprapubic macules or blue-gray dots in pubic region

A

Pediculosis pubis (crabs)

  • Can also be in anal hairs, facial hair, eyelashes
  • Concern for sexual abuse in a child
  • Tx with permethrin, pyrethrin, malathion
50
Q

Triad of bacterial vaginosis

A
  • 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
51
Q

Frothy yellow discharge with strawberry cervix

A

Trichomonas (sx can including abnormal order, itching, burning) –> flagellated organisms

  • Can be asymptomatic in men
  • Tx flagyl (also need to treat partners)
52
Q

Symptoms of gonorrhea

A
  • 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
53
Q

Diagnostic criteria for PID

A
  • 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

General Peds Boards (24 decks)

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