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Adolesents Flashcards

0
Q

What is the leading cause of morbidity and mortality in the adolescent age range?

A

Automobile and motorcycle accidents

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1
Q

What age ranges encompass adolescents?

A

10-21 years

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2
Q

What is the leading cause of death in the African-American adolescents?

A

Homicides

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3
Q

What is the most common reason for out-patient visits in the 10-14 year old population?

A

Heath supervision

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4
Q

What is the most common reason for out-patient visits for the 15-24 olds?

A

Pregnancy

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5
Q

What is the mean age for puberty in Caucasian girls? African-American girls?

A

9.7 years and 8.1 years for blacks

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6
Q

Do boys or girls have their pubescence growth spurts first?

A

Girls before boys, puberty is shorter for boys

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7
Q

What is an emancipated minor?

A

Moved out of the home and pay their own bills. Also those in the military or married.

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8
Q

What are the medical exceptions for notifying parents against adolescent wishes?

A

If they have the ability to self-consent. The exception is abuse or where the person can cause damage to self or others.

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9
Q

If an adolescent has had only 1 MMR shot when should the second one be given?

A

By age 12 years

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10
Q

Td immunization a are given at what age?

A

11-11 years and every 10 years

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11
Q

When is the 22-Valent pneumococcal vaccine given?

A

Chronic cardiovascular or pulmonary disease, nephrotic syndrome, apple is, HIV, and hemoglogulinopathy

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12
Q

How often should adolescents see a medical person for health supervision?

A

Annually

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13
Q

Who is more likely to smoke? Or drink?

A

Girls smoke more than boys but boys drink more than girls

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14
Q

What are the nine symptoms for depression?

A 
1-dramatic change in weight
2-decrease or increase in appetite
3-insomnia or hypersonic
4-psychomotor agitation or retardation
5-fatigue and energy loss
6-feelings of worthlessness
7-excessive/inappropriate feeling of guilt
8-decrease ability to concentrate/think
9-recurrent thoughts of death
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15
Q

At what point should you hospitalize with psychological problems?

A

Suicidal or homicidal, psychotic, manic, or abusing substances

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16
Q

In anorexics, what ECG changes suggest increased risk for ventricular arrhythmias?

A

ST segment depression on exercise stress tests or prolonged QT intervals

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17
Q

Bulimic girls are usually what weight pattern?

A

Normal weight or slightly overweight

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18
Q

What is more common-bulimia or anorexic nervous?

A

Bulimia

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19
Q

What are common findings I’m bulimia?

A

Edema, bilateral painless parotid swelling, calluses on dorsum of the fingers (Russell signs), loss of tooth enamel

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20
Q

What is the most common breast mass in an adolescent?

A

Solitary cyst, 50% resolve in 2-3 months

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21
Q

When do you refer a patient with a breast mass?

A

A mass that is persistent for 3 menstrual cycles

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22
Q

What is the most common cause of mastitis?

A

Staphylococcus aureus

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23
Q

What is the most common reason for secondary amenorrhea?

A

Pregnancy

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24
What is a simple rule for primary amenorrhea?
Lack of menses by age 16 years
25
What should the combination of amenorrhea and anosmia make you think of?
Kalimantan syndrome- isolated GnRH
26
What is the most likely etiology of galactorrhea and amenorrhea in an adolescent girl?
Prolactin-secreting adenoma
27
What is significant about the LH:FSH ratio in girls with polycystic ovary disease?
A clue of polycystic ovary disease is a ratio of 2.5:1 ratio (meaning elevated levels of testosterone
28
Describe signs of androgen excess in amenorrhea.
Amenorrhea, hirsutism, virilization, acne, voice changes, clitoromegaly
29
A girl presents with first menses and hemorrhage a to a hematocrit of 20%. What is the likely etiology?
Von Willebrand disease
30
What type of cancer is seen in daughters of mothers who took diethylstillbestrol?
Clear cell adenocarcinoma
31
What is the usual etiology for dysmenorrhea?
Due to prostaglandin production before menses. This causes vasoconstriction and muscular contraction.
32
Is gynecomastia in boys rare?
No, 50% of boys ages 10-16 have it . It is due to the decreases ratio of androgen to estrogen. It usually resolves in 3 years
33
Gynecomastia in boys is usually tender and asymmetric?
Yes, usually < 4 cm and does not require work up
34
What is a hydrocele?
No tender and fluid-filled mass, usually no treatment is necessary
35
What is a spermatocele?
A nodule above and posterior to the testes, they transluminate and there is no change with Valsalva
36
What are varicoceles?
Varicoceles are usually left sided, increase with Valsalvia, a bag of worms. Loss of testicular volume or failure of testes to grow means surgery
37
What is torsion of the spermatic cord?
A diffuse lay swollen and tender testicle and an absent cremasteric reflex.
38
What is a common cause of epididymis is in a male?
Usually due to an STD- C trachomatis, N gonorrhoeae, E. coli, pseudomonas or gram positive cocci
39
What form of contraception is also effective in preventing STDs?
Condoms on the male.
40
What is the absolute contraindication for using oral contraceptive pills?
Abnormal vaginal bleeding of unknown etiology, estrogen-dependent tumor, liver disease, thromboembolic disease, cerebrovascular events.
41
How common is sex among adolescents?
> 50% have had sex by 16 years, 75% by age 19.
42
Who has the highest prevalence rates of gonorrhea-males or females?
Females, age 15-19.
43
What are the reportable diseases in all states?
Syphilis, gonorrhea, Chlamydia, and AIDS. Note-not every state requires HIV infection
44
What screening labs should be offered to pregnant adolescents?
HIV, syphilis, Hep B surface antigen, Chlamydia, gonorrhoeae, Hep C, rubella and Pap smear.
45
For which viral infection is C-section indicates?
HSV- only if active lesions are present, the presence of genital warts is NOT an indication for C- section.
46
Describe acute HIV retro viral syndrome.
Fever, malaise, lymphadenopathy and skin rash. Usually occurs in the first few weeks of infection.
47
What is the difference between the genital lesions of HSV and syphillis?
Lesions in HSV are tender grouped vesicles that are painful, itchy. Syphillis is usually a painless ulcer or chancre at the site of infection. In Chancriod the lesion is painful with inguinal lymphadenopathy.
48
What defines a positive Tzanck prep?
A positive test is multinucleated giant cells. But HSV is the preferred test, but it is PCR in CSF.
49
Do patients on Herpes- suppressive therapy and who do not have active lesions still may shed virus?
Yes!
50
Describe the Palmer rash of secondary syphillis.
A scaly hyper keratitis palmar rash, also deceived as "mickle and dime" and is also seen on the soles.
51
How is syphillis diagnosed?
Non-treponema like testament-VDRL and RPR first test and then confirm with a treponema like test-FTA-ABS or a TP-PA
52
What is the drug of choice to treat syphillis?
Penicillin G for all stages.
53
Is a pregnant woman with primary syphillis has a history of anaphylaxis to penicillin what is the best treatment?
Desensitize. Cannot use doxycycline or tetracycline if pregnant.
54
What is the treatment for primary, secondary and early latent Syphillis?
Pen G or doxycline or tetracycline if allergic and not pregnant
55
What is the treatment for late latent tertiary or Syphillis of unknown duration?
Pen g x 3 weeks or doxycline/tetracycline for 28 days
56
How is neuro syphillis diagnosed?
Can occur at any stage-cognitive dysfunction, motor or sensory defects, ophthalmic or auditory symptoms, cranial nerve palsied or meningitis. Adolescent with hearing loss.
57
How is neuro syphillis treated?
Pen G for 10-14 days, if pen-allergic then cetraxone.
58
What does congenital syphillis look like?
No immune hydro ps, jaundice, hepatosplenomegaly, rhinitis, pseudo paralysis of an extremity, rash, uveitis/choriorrtinitis
59
What is the treatment for congenital syphillis,
PenG x 7 days
60
What are some classic congenital findings?
Hutchinson teeth, mulberry molar (dome shaped), snuffles
61
What is the organism responsible for chancroid?
Hemophilia discretion
62
Chancroid- description
Painful genital ulcer surrounded by erythematous halo and unilateral lymphadenopathy (bubo)
63
What is the organism responsible for granule ms inguinal even?
Klebsiella grandulomatis
64
How does grandulomatis inguinal even present?
Painless, progressive ulcerative lesion without lymphadenopathy. Can see Donovan bodies on tissue preps
65
What organism is responsible for lymphogranuloma venerum?
Chlaymdia trachomatis
66
How does lymphogranuloma present?
Painless genital ulcer with inguinal or femoral lymphadenopathy.
67
What is Fitz-Hugh-Curtis syndrome?
Perihepititis- an adolescent with upper right quadrant abdominal pain. Seen in desseminated gonococcal infection.
68
What is disseminated gonococcal infection?
Accompanies bacteremia in gonococcal infection, 1-3% and is most common in females within 1 week of last menses.
69
What is the treatment for DGI?
Ceftriaxone for gonococcal
70
What is the most common cause of vaginal discharge?
Bacterial vaginitis caused by lactobacillus. Treating male partners is of no use.
71
What are some signs of bacterial vaginitis?
Fishy smell, clue cells, homogenous white discharge,
72
What are the symptoms of Trichomoniasis?
Malodorous yellowish-green discharge with dyslexia, priorities, and vulvular irritation as well as strawberry cervix
73
What is the treatment for Trichomoniasis?
Metronidazole
74
What are some testing that can give a clue to PID?
Abnormal cervical discharge, WBCs on wet prep and cervical pain.
75
What HPV types are associated with cervical neoplasia?
HPV types 16, 18, 31, 33, and 35
76
Should wart removal occur during pregnancy?
Yes
77
Should C-section be performed to prevent infection in the newborn?
No
78
What are the treatments for HPV?
Cryotherapy (use also for pregnancy), podophyllin resin, TCA, surgical removal.
79
Which adolescents should get Hep A?
All who are unvaccinated. All males who have sex with men should get Hep A. All who abuse IV drugs.
80
How do you protect exposed to Hep A?
Hep A vaccine and IM dose of immune globulin.
81
How do you treat someone exposed to Hep B exposure?
Hep B vaccine and Hep B immune globulin
82
Is there an effective prophylaxis for Hep C?
No
83
What treatment is contraindicated in pregnant women?
Lindane shampoo in pregnant and lactating women or children < 2 years
84
What is an effective treatment for scabies?
Permethrin 5% cream
85
What is the organism responsible for scabies and lice?
Lice-Phrhirus pubis: Scabies-Sarcoptes scabies

Pediatric Board Review (10 decks)

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