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Pediatric Board Review > Adolesents > Flashcards

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
Q

What is a simple rule for primary amenorrhea?

A

Lack of menses by age 16 years

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25
Q

What should the combination of amenorrhea and anosmia make you think of?

A

Kalimantan syndrome- isolated GnRH

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26
Q

What is the most likely etiology of galactorrhea and amenorrhea in an adolescent girl?

A

Prolactin-secreting adenoma

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27
Q

What is significant about the LH:FSH ratio in girls with polycystic ovary disease?

A

A clue of polycystic ovary disease is a ratio of 2.5:1 ratio (meaning elevated levels of testosterone

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28
Q

Describe signs of androgen excess in amenorrhea.

A

Amenorrhea, hirsutism, virilization, acne, voice changes, clitoromegaly

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29
Q

A girl presents with first menses and hemorrhage a to a hematocrit of 20%. What is the likely etiology?

A

Von Willebrand disease

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30
Q

What type of cancer is seen in daughters of mothers who took diethylstillbestrol?

A

Clear cell adenocarcinoma

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31
Q

What is the usual etiology for dysmenorrhea?

A

Due to prostaglandin production before menses. This causes vasoconstriction and muscular contraction.

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32
Q

Is gynecomastia in boys rare?

A

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

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33
Q

Gynecomastia in boys is usually tender and asymmetric?

A

Yes, usually < 4 cm and does not require work up

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34
Q

What is a hydrocele?

A

No tender and fluid-filled mass, usually no treatment is necessary

35
Q

What is a spermatocele?

A

A nodule above and posterior to the testes, they transluminate and there is no change with Valsalva

36
Q

What are varicoceles?

A

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
Q

What is torsion of the spermatic cord?

A

A diffuse lay swollen and tender testicle and an absent cremasteric reflex.

38
Q

What is a common cause of epididymis is in a male?

A

Usually due to an STD- C trachomatis, N gonorrhoeae, E. coli, pseudomonas or gram positive cocci

39
Q

What form of contraception is also effective in preventing STDs?

A

Condoms on the male.

40
Q

What is the absolute contraindication for using oral contraceptive pills?

A

Abnormal vaginal bleeding of unknown etiology, estrogen-dependent tumor, liver disease, thromboembolic disease, cerebrovascular events.

41
Q

How common is sex among adolescents?

A

> 50% have had sex by 16 years, 75% by age 19.

42
Q

Who has the highest prevalence rates of gonorrhea-males or females?

A

Females, age 15-19.

43
Q

What are the reportable diseases in all states?

A

Syphilis, gonorrhea, Chlamydia, and AIDS. Note-not every state requires HIV infection

44
Q

What screening labs should be offered to pregnant adolescents?

A

HIV, syphilis, Hep B surface antigen, Chlamydia, gonorrhoeae, Hep C, rubella and Pap smear.

45
Q

For which viral infection is C-section indicates?

A

HSV- only if active lesions are present, the presence of genital warts is NOT an indication for C- section.

46
Q

Describe acute HIV retro viral syndrome.

A

Fever, malaise, lymphadenopathy and skin rash. Usually occurs in the first few weeks of infection.

47
Q

What is the difference between the genital lesions of HSV and syphillis?

A

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
Q

What defines a positive Tzanck prep?

A

A positive test is multinucleated giant cells. But HSV is the preferred test, but it is PCR in CSF.

49
Q

Do patients on Herpes- suppressive therapy and who do not have active lesions still may shed virus?

A

Yes!

50
Q

Describe the Palmer rash of secondary syphillis.

A

A scaly hyper keratitis palmar rash, also deceived as “mickle and dime” and is also seen on the soles.

51
Q

How is syphillis diagnosed?

A

Non-treponema like testament-VDRL and RPR first test and then confirm with a treponema like test-FTA-ABS or a TP-PA

52
Q

What is the drug of choice to treat syphillis?

A

Penicillin G for all stages.

53
Q

Is a pregnant woman with primary syphillis has a history of anaphylaxis to penicillin what is the best treatment?

A

Desensitize. Cannot use doxycycline or tetracycline if pregnant.

54
Q

What is the treatment for primary, secondary and early latent Syphillis?

A

Pen G or doxycline or tetracycline if allergic and not pregnant

55
Q

What is the treatment for late latent tertiary or Syphillis of unknown duration?

A

Pen g x 3 weeks or doxycline/tetracycline for 28 days

56
Q

How is neuro syphillis diagnosed?

A

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
Q

How is neuro syphillis treated?

A

Pen G for 10-14 days, if pen-allergic then cetraxone.

58
Q

What does congenital syphillis look like?

A

No immune hydro ps, jaundice, hepatosplenomegaly, rhinitis, pseudo paralysis of an extremity, rash, uveitis/choriorrtinitis

59
Q

What is the treatment for congenital syphillis,

A

PenG x 7 days

60
Q

What are some classic congenital findings?

A

Hutchinson teeth, mulberry molar (dome shaped), snuffles

61
Q

What is the organism responsible for chancroid?

A

Hemophilia discretion

62
Q

Chancroid- description

A

Painful genital ulcer surrounded by erythematous halo and unilateral lymphadenopathy (bubo)

63
Q

What is the organism responsible for granule ms inguinal even?

A

Klebsiella grandulomatis

64
Q

How does grandulomatis inguinal even present?

A

Painless, progressive ulcerative lesion without lymphadenopathy. Can see Donovan bodies on tissue preps

65
Q

What organism is responsible for lymphogranuloma venerum?

A

Chlaymdia trachomatis

66
Q

How does lymphogranuloma present?

A

Painless genital ulcer with inguinal or femoral lymphadenopathy.

67
Q

What is Fitz-Hugh-Curtis syndrome?

A

Perihepititis- an adolescent with upper right quadrant abdominal pain. Seen in desseminated gonococcal infection.

68
Q

What is disseminated gonococcal infection?

A

Accompanies bacteremia in gonococcal infection, 1-3% and is most common in females within 1 week of last menses.

69
Q

What is the treatment for DGI?

A

Ceftriaxone for gonococcal

70
Q

What is the most common cause of vaginal discharge?

A

Bacterial vaginitis caused by lactobacillus. Treating male partners is of no use.

71
Q

What are some signs of bacterial vaginitis?

A

Fishy smell, clue cells, homogenous white discharge,

72
Q

What are the symptoms of Trichomoniasis?

A

Malodorous yellowish-green discharge with dyslexia, priorities, and vulvular irritation as well as strawberry cervix

73
Q

What is the treatment for Trichomoniasis?

A

Metronidazole

74
Q

What are some testing that can give a clue to PID?

A

Abnormal cervical discharge, WBCs on wet prep and cervical pain.

75
Q

What HPV types are associated with cervical neoplasia?

A

HPV types 16, 18, 31, 33, and 35

76
Q

Should wart removal occur during pregnancy?

A

Yes

77
Q

Should C-section be performed to prevent infection in the newborn?

A

No

78
Q

What are the treatments for HPV?

A

Cryotherapy (use also for pregnancy), podophyllin resin, TCA, surgical removal.

79
Q

Which adolescents should get Hep A?

A

All who are unvaccinated. All males who have sex with men should get Hep A. All who abuse IV drugs.

80
Q

How do you protect exposed to Hep A?

A

Hep A vaccine and IM dose of immune globulin.

81
Q

How do you treat someone exposed to Hep B exposure?

A

Hep B vaccine and Hep B immune globulin

82
Q

Is there an effective prophylaxis for Hep C?

A

No

83
Q

What treatment is contraindicated in pregnant women?

A

Lindane shampoo in pregnant and lactating women or children < 2 years

84
Q

What is an effective treatment for scabies?

A

Permethrin 5% cream

85
Q

What is the organism responsible for scabies and lice?

A

Lice-Phrhirus pubis: Scabies-Sarcoptes scabies

Pediatric Board Review (10 decks)

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