Adolescents

Question 1

• Stage 1 N/V, lethargy malaise,
• Stage 2 RUQ pain, elevate LFT, Pt, INR, nephrotoxicity, pancreatitis, deaths occur in 72 to 96 hours
  Tx - Antidote is N-acetylcysteine IV

Answer 1

Acetaminophen poisoning

Question 2

abrupt onset extremely painful and swollen red scrotum, N/V, affected testes higher and closer to body, the cremasteric reflex is missing, >not corrected in <6 hours permanent damage, if not corrected in 24 hours becomes gangrene, common in males with bell clapper deformity

Answer 2

Testicular torsion

Question 3

call 911, US doppler preferred test, manual reduction or surgery, elevated PSA, biopsy of prostate tissue, PSA level with DRE

Answer 3

Testicular torsion Dx

Question 4

Refer to urologist, individualize screen per risk factors

Answer 4

Testicular torsion Tx

Question 5

hard fixed, nodule, heaviness or aching, one testicle larger than other, hydrocele from tumor, painless asymptomatic until Metz,
Dx - Gold standard testicular biopsy, US of testes, refer to urology, for surgical removal (orchiectomy)

Answer 5

Testicular cancer

Question 6

cancer of b cells (Reed Sternberg cells), pruritic, painless supraclavicular lymph nodes with fever (pel-ebstein sign), night sweats, fever, pain with alcohol drinks, young adults.

Answer 6

Hodgkin’s lymphoma

Question 7

MV A suicide, homicide

Answer 7

Death adolescents

Question 8

female - breast bud areola develops
Male - testes scrotum start to
enlarge, scrotum gets darker

Answer 8

Tanner 2

Question 9

female - nipples and areola become elevated from breast, secondary
mound
Male - penis grows wider grows in length, darker scrotum

Answer 9

Tanner 4

Question 10

starts at age 12, irregular periods for several months up to 2 years

Answer 10

Menarche

Question 11

Tx - heating pads, NSAIDS

Answer 11

Dysmenorrhea

Question 12

1. minors give full consent without parental involvement
2. Legally married,
3. Active duty armed forces

Answer 12

Emancipated minor

Question 13

1. contraception,
2. Tx STD’s,
3. Diagnosis and
   management of pregnancy

Answer 13

Right to consent confidentiality

Question 14

no menarche at 15, chromosomal disorder (turner syndrome), Secondary amenorrhea- no menses for three cycles or 6 months, due to pregnancy, ovarian disorder, stress, anorexia PCOS TX educate caloric intake calcium and vitamin D 1200 to 1500 daily, refer to pediatric endocrinologist

Answer 14

Primary amenorrhea

Question 15

pregnancy test, prolactin level, TSH FSH, LH, bone density

Answer 15

Primary amenorrhea Dx

Question 16

educate caloric intake calcium and vitamin D 1200 to 1500 daily, refer to pediatric endocrinologist

Answer 16

Primary amenorrhea Tx

Question 17

onset during adolescence, irrational preoccupation with fear of gaining weight, patient engages in restriction (diet, exercise) or binge eating and purging (laxatives, enemas, diuretics, vomiting).

Answer 17

Anorexia nervosa

Question 18

weight loss >10% body weight loss or <18.5 BMI low pulse vital signs unstable, hypotension, lanugo, stress fractures, swollen feet (low albumin), dizzy, bloating

Answer 18

Anorexia nervosa Dx

Question 19

increase risk of bone loss

Answer 19

Deprovera

Question 20

excessive growth of breast tissues in males, one or both breasts, resolve spontaneously, round rubbery mobile mound under areola of both breasts
Tx - eval tanner stage, check for drug use, rule out etiology, recheck in 6 months

Answer 20

Gynecomastia

Question 21

bilateral enlarged breast is due to fatty tissue (adipose tissue), common in obese boys, soft tissue non-tender no breast bud or disc like breast tissue is palpable
Dx - clinical presentation

Answer 21

Pseudo gynecomastia

Question 22

lateral curvature of the spine accompanied by spinal rotation, painless, asymptomatic, rapid worsening of curvature is indicative of secondary cause,

Answer 22

Adolescent idiopathic scoliosis

Question 23

Adams forward bend test, check height, measure cobb angle, full spine x-ray to measure degree of curve

Answer 23

Adolescent idiopathic scoliosis Dx

Question 24

if <20 degrees observe and monitor, >20 bracing (Milwaukee brace), >40 surgical correction, Harrington rod used on spine refer to pediatric orthopedist

Answer 24

Adolescent idiopathic scoliosis Tx

Question 25

occurs during growth spurt and affects superior tibia, when quadriceps exert stress on the patellar tendon (tibial tubercle), anterior knee pain increases over time

Answer 25

Osgood-Schlatter

Question 26

Resolves spontaneously rule out avulsion fracture, if acute order lateral x-ray of knee, avoid aggravating activities, RICE

Answer 26

Osgood-Schlatter Tx