CLPP 5 Flashcards
this symptom of depression is more common in adults than teens
early morning waking more common in adults than depressed adolescents
anorexia progression
BMI drops to postural hypotension), electrolyte imbalance (hypogly, hypo alb, hyponatremia due to high water intake, arrhythmia, circa collapse and death
-can also have low Mg and Cal that lead to increased reflex tone, neuro changes
subtle bulemia signs
finger callousses, dental decay
impact of hypothyroidism on menstrual cycle
short menstrual cycles + menorrhagia
puberty ages in boys vs girls
10-15, 8-13
Breast buds appear
10-11
pubic hair girls
10-11
growth spurt girls
12
periods/menarche
12-13
adult height in girls
15
Growth of testicles
12
Pubic hair appears in males
12
penis and scrotum growth
13-14
first ejacaulation
13-14
male growth spurt
14
Attainment of adult height
17
constitutional late bloomer
short / late blooming in puberty but ultimately reaches normal adult height just at a later age
generalizations of tanner staging of pubic hair
1 - no hair 2- thin fine straight hairs 3-curly hairs 4-adult but limited distribution 5-adult
bleeding disorder blood tests
Complete blood count (CBC) with platelets, red blood cell indices, and a smear
Reticulocyte count
Prothrombin time (PT) and partial thromboplastin time (PTT)
Platelet function test (which has largely replaced the bleeding time in most centers)
Factor VIII activity
von Willebrand factor antigen
von Willebrand factor activity (also known as Ristocetin cofactor)
most common bleeding disorder
vw disease
common genetics of vw dz
AD w/ variable penetrance (tho type 3 = recessive)
-most common is type 1
vw dz sx
Ecchymoses (small hematomas in areas of trauma)
Epistaxis
Menorrhagia (why vWD is diagnosed more often in women than men)
Bleeding post-tonsillectomy and dental extractions
Gingival bleeds
In the absence of major trauma, bruising in non-exposed areas (buttocks, back, trunk) needs to be thought of as abnormal. (Remember that child abuse can also be the cause of such bruising.
dx of vw dz
A careful clinical history is often the most sensitive indicator of the disease.
The laboratory diagnosis of vWD can be challenging:
Many textbooks state that a prolonged platelet function or bleeding time and mild prolongation of the aPTT point to the diagnosis of vWD.
However, the aPTT may be normal and the patient will still have vWD.
To confirm vWD, check the von Willebrand’s factor antigen and/or platelet function analysis and factor VIII levels.
tx vw dz
Treatment for most of the bleeding problems most often consists of intranasal or intravenous desmopressin.
Sometimes human plasma-derived, virally inactivated von Willibrand’s factor concentrate may be administered.
For menorrhagia, combination contraceptive pills, or levonorgestrel intrauterine device would be the treatment of choice.
cryoprecipitate
blood product containing fibrinogen, factor VIII, factor XIII, and von Willebrand factor. It is most commonly used to replace fibrinogen. It may also be used in certain scenarios for patients with von Willebrand’s disease. However, it is not as good as desmopressin as a first choice
desmopressin
relesaes VWF from endothelial cells
general female puberty sequence w/ ages
breast buds are the first sign (10–11 years), followed by pubic hair (10–11 years), then a growth spurt (12 years), and then menarche (12–13 years). Most girls reach adult height by approximately 15 years.
boys sequences of puberty
testicular enlargement, pubic hair, penis and scrotal enlargement, ejeaculations, growth spurt,
