Adolescents Flashcards
- 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
Acetaminophen poisoning
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
Testicular torsion
call 911, US doppler preferred test, manual reduction or surgery, elevated PSA, biopsy of prostate tissue, PSA level with DRE
Testicular torsion Dx
Refer to urologist, individualize screen per risk factors
Testicular torsion Tx
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)
Testicular cancer
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.
Hodgkin’s lymphoma
MV A suicide, homicide
Death adolescents
female - breast bud areola develops
Male - testes scrotum start to
enlarge, scrotum gets darker
Tanner 2
female - nipples and areola become elevated from breast, secondary
mound
Male - penis grows wider grows in length, darker scrotum
Tanner 4
starts at age 12, irregular periods for several months up to 2 years
Menarche
Tx - heating pads, NSAIDS
Dysmenorrhea
- minors give full consent without parental involvement
- Legally married,
- Active duty armed forces
Emancipated minor
- contraception,
- Tx STD’s,
- Diagnosis and
management of pregnancy
Right to consent confidentiality
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
Primary amenorrhea
pregnancy test, prolactin level, TSH FSH, LH, bone density
Primary amenorrhea Dx
educate caloric intake calcium and vitamin D 1200 to 1500 daily, refer to pediatric endocrinologist
Primary amenorrhea Tx
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).
Anorexia nervosa
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
Anorexia nervosa Dx
increase risk of bone loss
Deprovera
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
Gynecomastia
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
Pseudo gynecomastia
lateral curvature of the spine accompanied by spinal rotation, painless, asymptomatic, rapid worsening of curvature is indicative of secondary cause,
Adolescent idiopathic scoliosis
Adams forward bend test, check height, measure cobb angle, full spine x-ray to measure degree of curve
Adolescent idiopathic scoliosis Dx
if <20 degrees observe and monitor, >20 bracing (Milwaukee brace), >40 surgical correction, Harrington rod used on spine refer to pediatric orthopedist
Adolescent idiopathic scoliosis Tx
occurs during growth spurt and affects superior tibia, when quadriceps exert stress on the patellar tendon (tibial tubercle), anterior knee pain increases over time
Osgood-Schlatter
Resolves spontaneously rule out avulsion fracture, if acute order lateral x-ray of knee, avoid aggravating activities, RICE
Osgood-Schlatter Tx
