CPS Adolescent health Flashcards

Question

Anorexia What are the Fx and management of the female athlete traid?

Answer 1

**Sx**: low energy availability, menstrual dysfunction, and reduced BMD in female athletes • caloric intake is insufficient for energy expenditure -\> hypothalamic amenorrhea (primary or secondary) -\> low estrogen state • **Inv**: Every female athlete with amenorrhea should have a complete history and physical examination to evaluate for an underlying eating disorder and to rule out other treatable causes of amenorrhea • **Treatment**: increase caloric intake, calcium and vitamin D supplementation, restricting the intensity of training (if necessary), and monitoring for resumption of menses

Answer 2

1. **Growth**: a. TGW of \< 75% b. Arrested growth and development 2. **FEN**: Electrolyes low(PO4, K+, Na+) and dehydration 3. **Physiological instability:** a. ECG- Long QTc or severe bradycardia b. HR \< 50 day/45 nocte; BP\< 90/45; temp \< 35.6; HR increase by 20/min **4. Management/behaviour:** a. Failure of OPD Rx b. Acute food refusal/uncontrollable binging/purging **5. Medical issues:** a. Syncope, fits, pancreatitis, heart failure b. psychiatric : Severe Depression, suicide, OCD, Type 1 DM

Answer 3

increase in body weight to within 10% of IBW

Answer 4

•Target Goal Weight (TGW) is the weight necessary to support: 1. puberty, growth and development, 2. physical activity and psychological and social functioning

Answer 5

1. Using previous growth charts 2. Outpatient setting (normal vitals, best %target goal weight \>75%)

Answer 6

A. An **eating or feeding disturbance as** manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following 4 Fx: B. The disturbance is not better explained by **lack of available food** or by an **associated culturally sanctioned practice.** C. The eating disturbance does not occur exclusively during the course of a**norexia nervosa or bulimia nervosa,** and there is no evidence of a disturbance in the **way in which one’s body weight or shape is experienced.** D. The eating disturbance is not attributable to a concurrent **medical condition** or not better explained by another **mental disorder.** When the eating disturbance occurs in the context of another condition or disorder, the **severity of the eating disturbance exceeds that routinely** associated with the condition or disorder and warrants additional clinical attention.

Answer 7

**Notes:** 1. For Cu IUCD - the latest you can insert it is 7 days 2. The **Morning after pill**/**Plan B** is same as **Levonorgestrel**

Answer 8

**1. Conseling:** Start discussing sexual health, fertility and contraception in early adolescence in a colaborative approach 2. **Contraception options:** a. _Specific options_ LARC's IUD Hormonal: OCP, injectable, patch, vaginal ring Methods at time of intercourse: condoms (male/female), diaphragms, sponges, spermicides, cervical caps b. _Hx, BP, wt (ALL) .pelvic exam & STI screening_ only if needed c. P_racticalities:_ - Give 12 mth Rx for hormonal options - Ensure quick start option - Offer technical advice eg condom usage - Provide Emerg Contraception advice

Answer 9

**A:** Active liver disease (Liver tumor, hepatitis, severe cirrhosis) **B:** **Breastfeeding** women \< 6 weeks postpartum or **nonbreastfeeding** \<6 weeks with other risk factors for VTE **C:** a. **Cancer**: Current breast cancer b. **Cardiovascular**; IHD, CVA, HTN \>160sBP \>100dBP, or vascular disease, Complicated valvular heart disease c. **Conditions**; Migraine with neurologic symptoms (includes aura), Complicated solid organ transplant **D: DVT** a. **VTE** (Past and not on anticoagulant, past and high risk for recurrent, acute DVT/PE, Major surgery with prolonged immobilization) b. **Antiphospholipid** antibodies positive or unknown (lupus)

Answer 10

1. There are **NO** absolute contraindications to the use of emergency hormonal contraception except **known pregnancy,** and this is **only** because it is ineffective… 2. Complete a **pregnancy** **test** if they do not experience normal menstrual bleeding by **21 days** following EC treatment or by 28 days if an OCP was started after taking hormonal EC 3. Repeat dose if vomit \< 1 hour

Answer 11

1. Depression 2. Loss 3. Abuse 4. Impulsivity 5. Antisocial traits 6. Learning disabilities

Answer 12

1. Frequency & Tendency to gamble more than planned (inability to respect personal limits) 2. Hiding gambling behavior from other people (ie. lying) 3. How are they doing in school? 4. Sleep problems? 5. Money or possessions in the home go missing? Theft? 6. Substance use? 7. Mood and Impaired relationships?

Answer 13

1. **STD**: HSV, Syphylis, Haemophilus ducreyi (chancroid) 2. **infection** -**Non STD:** EBV, mycoplasma 3. **Diseases**: Bechets, Crohns

Answer 14

It is available WITHOUT a doctor's prescription across Canada! Obtain from pharmacist over the counter. -dose: two pills at once (each = 0.75 mg levonorgestrel)

Answer 15

1. **\> 15 years** + - catch up program 2. If immunized with **HPV-2 or -4 c**an repeat full 3 doses of HPV 9 3. Immunocompromised/infected with HIV

Answer 16

1. **Vertical transmission** ‘juvenile-onset recurrent respiratory papillomatosis’ 2. **Asymptomatic** 3. **Warts** (HPV 6, 11) cause 90% genital warts 4. **Malignancies-** - cervical/vaginal/ vulvar cancers - penile and anal cancers

Answer 17

75% increased risk! -early life exposure has been associated with higher risks of CMM

Answer 18

1. How has this pregnancy affected you physically and emotionally? 2. What is your knowledge of the options and how do you feel about them? 3. Are there any family, cultural or community issues that may play a role in your decision making? 4. How does your partner feel about the options and what is his role in your decision-making process? 5. Tell me about your support system. 6. PMHx? 7. High risk health behaviours/substance abuse 8. Housing/school status/personal and academic goals \*\*\*\*A good thing to say: "When you have an unplanned pregnancy, there is no perfect choice. All you can do is think about what is best for you at this time. No matter what option you choose, it is unlikely that you will feel it is 100% right"

Answer 19

The highest rates of STIs in Canada are in the 15-24 year age group with girls 15-19 yo having the highest rate for chlamydia and gonorrhea

Answer 20

1. Refer her to support groups/maternity homes/drop in centers 2. Encourage her to continue education to enhance potential for positive maternal and child outcomes and decrease social isolation/depression 3. Encourage if appropriate involvement/presence of baby's father and/or current partner 4. Provide contraceptive counselling

Answer 21

1. Give info about specific details about procedures available 2. Anticipatory guidance about common emotional responses: grief, relief, anger 3. Refer to appropriate medical/surgical services 4. Make f/u appointments to review any possible complications (bleeding/cramps/fever/physical and emotional concerns)

Answer 22

**1. Gynae**: Infertility Dysfunctional bleeding Endometrial carcinoma **2. Medical/diseases:** Obesity/T2DM/Dyslipidemia Cardiovascular disease/Hypertension

Answer 23

1. Persistent elevation of serum **total and/or free testosterone** 2. **LH \> FSH** (2:1-3:1) * Low LH suggests a hypogonadotropic disorder of neuroendocrine origin, whereas high FSH suggests primary ovarian failure * Not diagnostic but helpful 3. **Dexamethasone androgen-suppression test** - permits a positive diagnosis of the characteristic ovarian and adrenal dysfunction of PCOS

Answer 24

1. **Pregnancy;** Beta HCG 2. **U/S** - ovarian imaging can be deferred during the diagnostic evaluation for PCOS (remember this is a transvaginal study), only reason would be to rule out a **virilizing ovarian tumor** if suspected **3. Endocrine blood tests:** a. 17-OHP (r/o non classical CAH) b. DHEAS - primarily to screen for an adrenal tumor c. Prolactin

Answer 25

1. **Abnormal uterine bleeding pattern** a. Abnormal for age or gynecologic age b. Persistent symptoms for one to two years 2. **Evidence of hyperandrogenism** a. Persistent testosterone elevation b. Moderate-severe hirsutism and acne vulgaris- indication to test for hyperandrogenemia 3. **Exclusion of other causes** a. Nonclassic congenital adrenal hyperplasia (NCCAH), b.Cushing's syndrome, c. prolactin excess, d. thyroid dysfunction, and acromegaly

Answer 26

1. **Insulin resistance** a. Insulin resistance and hyperinsulinemia should not be utilized as diagnostic criteria b. Insulin resistance and hyperinsulinemia can be considered as indications to investigate and treat potential comorbidities c. Insulin resistance out of proportion to that conferred by obesity 2. **Monitoring weight, height** 3. **Metabolic syndrome** - Monitoring - glucose, central (android) obesity, hypertension, and dyslipidemia

Answer 27

Guided by what px cares about! 1. **Hyperandrogenism:** a. Hirsutism- Shaving, waxing, bleaching laser therapy, electrolysis + Vaniqa (eflornithine) b. Acne – same as regular acne management c. Cutaneous hyperandrogenism-Combination OCP & Anti androgens **2. Gynae:** Periods-use the Combination OCP _a.Estrogen_: Inhibit HPO axis, reduces ovarian androgen production, increase SHBG levels b. _Progestin_: Inhibit proliferation c. Also OCP does _Normalize androgen levels_ **3. Metabolic management:** a. _Lifestyle_-Nutrition, exercise b. _Metformin_ for impaired glucose tolerance * Insulin sensitizer & Inhibits hepatic glucose output * Can suppress Inhibits hepatic glucose output • Can suppress appetite and enhance weight loss

Answer 28

1. **NAAT** is the most sensitive and specific test. Can be performed on urine, urethral swabs, vaginal or cervical swabs\* 2. A **culture** of cervical or urethral specimen is the test of choice for medico-legal cases (eg, child abuse). Confirmation by NAAT using a different set of primers or DNA sequencing may be used N.B. Serology should not be used for diagnosis

Answer 29

**NAAT 3-4 weeks after Tx** 1. Prepubertal/Pregnancy 2. Uncertain compliance/Likely re-exposure 3. Alternative treatment

Answer 30

**Culture 3-4 days** 1. **Risk factors;** - Prepubertal/Pregnancy - High re-exposure risks 2**. Treatment related:** - Second-line or alternative treatment is used - Antimicrobial resistance is suspected - Previous treatment has failed Pharyngeal infection signs or symptoms persist following treatment

Answer 31

1. **NAAT** can be used to detect gonorrhea from urine, and urethral, vaginal and cervical swabs in symptomatic and asymptomatic individuals\* 2. **Culture** allows for antimicrobial susceptibility testing and should be performed if a patient does not promptly respond to therapy, given concerns regarding antimicrobial resistance a. Cultures should be submitted for asymptomatic or symptomatic ***MSM***, who have an increased incidence of antibiotic resistance b. Culture preferred for ***throat*** specimens c. For **medico-legal** purposes, a positive result obtained from NAATs should be confirmed using culture or a different set of primers, or by DNA sequencing techniques

Answer 32

1. Abstain from sexual intercourse for 7 days after single-dose therapy or until completion of a 7-day regimen and resolution of symptoms if present. 2. To minimize risk for reinfection, patients also should be instructed to abstain from sexual intercourse until all of their sex partners are treated

Answer 33

1. For **Chlamydia & gonorrhoeae-** First-catch urine or Vaginal swab 2. **Serology** for:Syphilis, HIV ``` 3. Other **serological tests** to consider: Hepatitis A (particularly with oral-anal contact) Hepatitis B (if no history of vaccine) Hepatitis C (particularly in an injection drug user ```

Answer 34

1. For **Chlamydia & gonorrhoeae**- First-catch urine or Urethral swab 2. **Serology** for:Syphilis, HIV ``` 3. Other **serological test**s to consider: Hepatitis A (particularly with oral-anal contact) Hepatitis B (if no history of vaccine) Hepatitis C (particularly in an injection drug user) ```

Answer 35

1. **Vaginal or cervical swab** for Gram stain, N gonorrhoeae culture and C trachomatis (NAAT or culture) 2. Swab of cervical lesions (if present) for herpes simplex virus 3. Vaginal swab for wet-mount

Answer 36

**Urethral swab** for Gram stain and culture for gonorrhea (**NAAT** may also be used where available) AND **First-catch urine** for C trachomatis (NAAT)

Answer 37

**Swab** the **posterior pharynx and the tonsillar crypts** Use the swab to directly inoculate the appropriate culture medium, or place it in a transport medium

Answer 38

FALSE. There has been no evidence so far that these programs help. Lots of studies have shown they don't make a difference and that if a kid sees a gun, 50% will touch it, 50% will not regardless of whether they've been educated or not. Reasons why not: 1. Firearm safety education for children may increase their comfort level around guns (especially ones that include gun handling techniques) 2. Parents may have false sense of security and reduce their supervision or use of safe storage practices if they think their child learned gun safety at school

Answer 39

An **eating or feeding disturbance** (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: 1. **Significant weight loss** (or failure to achieve expected weight gain or faltering growth in children). 2. **Significant nutritional deficiency.** 3. Dependence on **enteral feeding or oral nutritional supplements.** 4. Marked **interference with psychosocial functioning.**

Answer 40

1. Explore your parents' possible reactions by thinking about how they talk about gay people, how they interact with gay people they meet and how they deal with unexpected info 2. Introduce the subject of homosexuality by bringing up a book you're reading reading or something that is in the news and see what your parents have to say 3. Consider telling one parent first and then getting their support to tell the other parent 4. Role playing can help the teen find the right words to use with their parents so they can avoid sounding like they are communicating bad news 5. Reassure your parents that you are the same person you always were 6. Not all teens should tell their parents about theiir orientation if there are possible negative repercussions

Answer 41

Teens who have chosen to come out to their parents are likely quite certain about their homosexual orientation and this is probably not "a phase". -it is important to let your teen know that you still love them while they are dealing with feelings about orientation-referral to Parents and Friends of Lesbians and Gays (PFLAG) (organization that helps parents whose children have come out to them)

Answer 42

1. Personalization device: allow only the owner to fire the gun 2. Loaded chamber indicators: show the gun is loaded 3. Magazine safeties: keeps a semiautomatic gun from firing when the ammunition magazine is removed even if there is a bullet left in the chamber

Answer 43

1. Hemorrhage 2. Infection 3. Uterine perforation

Answer 44

1. Unformed character 2. Susceptibility of peer influence 3. Diminished decision making capacity \*\*Prefrontal cortex does not fully mature until wel beyond age 18 and thus executive functions are still developing in adolescents

Answer 45

1. Lack money, transportation and knowledge to access appropriate health care 2. Issues with trusting adults/authority figures and have worries about confidentiality 3. Youth with child welfare status who have run away from their last placement and individuals with legal problems avoid health care facilities for fear of getting caught 4. Need to present health card or have a permanent address 5. Perceived need for adult's consent or involvement 6. Difficulties with arranging follow up or affording prescriptions

Answer 46

Headache, fatigue, nausea, dizziness

Answer 47

1. Asking open ended questions: "How does drinking on the weekend affect getting your homework done?" 2. Reflective listening: "It sounds like you are very upset about the recent break up with your girlfriend. Are you more likely to drink when you're upset?" 3. Affirmations: "Deciding not to go to that party sounds like a good choice. It may be difficult to avoid drinking if you went." 4. Summary statements: "It is important to be able to hang out with your friends. Are there other activities you do together?" 5. Eliciting change talk: "What are some of the things you would like to change?"

Answer 48

1. Societal factors: -lack of control over basic aspects of life and feeling of being externally controlled -social isolation by institutionalization, hospitalization, overprotection by families and thus more vulnerable to predators with little chance of detection -social stigma lead young victims to believe they deserve the mistreatment/abuse -sometimes seen as asexual beings and not potential targets for abusers and thus caregivers may not believe victim when abuse is disclosed 2. Educational factors -little priority for sex ed for this population -may lack terminology needed to report an abusive situation 3. Disability-specific factors -limited mobility/verbal abilities to fight off abuser 4. Health care factors -if regular procedures have been performed in a demeaning, insensitive or forcible way, the youth are more likely to tolerate abuse

Answer 49

1. Dental health 2. Malnutrition 3. Foot care 4. TB 5. Asthma 6. Derm infections (lice, scabies) 7. Lack of immunizations 8. Injuries

Answer 50

Individual factors: 1. Female 2. Overweight and obesity 3. Body image dissatisfaction and distortion 4. Low self esteem 5. Low sense of control over life 6. Psychiatric symptoms: depression/anxiety 7. Vegetarianism 8. Early puberty Family factors: 1. low family connectedness 2. Absence of positive adult role models 3. Parental dieting 4. Parental endorsement or encouragement to diet 5. Parental criticism of child's weight Environmental factors: 1. Weight-related teasing 2. Poor involvement in school 3. Peer group endorsement of dieting 4. Involvement in weight related sports Other factors: 1. Chronic illnesses: diabetes 2. Smoking/substance use/unprotected sex

Answer 51

1. Preparing parents for separation from their teenager 2. Make teenager aware of treatment choices and encourage active discussion and participation in decision making (ie. pill or liquid med?) 3. Help teenager learn self care skills to gain self-esteem and autonomy (if they need help, recommend they seek a caregiver who is not a family member)

Answer 52

1. Provide early anticipatory guidance on sexuality, personal empowerment and abuse risks 2. Interact with schools/communities to enhance/ensure sexual health education for this population 3. Ensure thorough screening and monitoring of employees/volunteers in schools/hospitals/etc. 4. Promote an institutional culture that promotes patient privacy during office/hospital visit so that child can be empowered 5. Advocate for institutional policies that prevent sexual abuse and facilitate a quick intervention if abuse has occurred.

Answer 53

1. Always start the visit by chatting alone with the teenager to let them know you value them as a person. Ask about other areas of life first to deliver the message that not everything is about their weight. 2. Try to find the few things that are unpleasant for the patient about their ED: ie. bothersome symptoms such as hair thinning, always feeling cold, preoccupation with weight/shape that has affected their ability to relax or think about other things \*\*Emphasize to the teenager that physical health and weight restoration are not negotiable and that parents/doctors are working together to make sure that this happens but try to help them understand why these changes are needed -remind them that parents and doctors are working together to fight the eating disorder, not to fight him/her.

Answer 54

1. Progestin-only (Plan B) -rate of pregnancy: 1-3% 2. Combined hormonal method (Yuzpe) -estrogen + progestin (levonorgestrel) -rate of pregnancy: 3-7% \*\*Preferred: Plan B = more effective and fewer side effects 3. Copper IUD insertion -can be used within 120 hr of unprotected sex

Answer 55

1. Already pregnant (ie. will be ineffective) 2. Allergy to one of the components of the product

Answer 56

-Adolescents released from adult facilities are more likely to reoffend than those sentenced to juvenile facilities -in juvenile facilities: more staff, staff attitude is more therapeutic, more rehab programs -in adult facilities: punishment based, older prisoners may be mentors in crime for younger offenders

Answer 57

1. History of clots: PE, DVT, strokes 2. Migraines with neurological symptoms 3. Known thrombophilia

Answer 58

Bulimia Nervosa DSM 5 A. **Recurrent episodes of binge eating**. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). B. R**ecurrent inappropriate compensatory behaviors in order to prevent weight gain,** such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both **occur, on average, at least once a week for** **3 months.** D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Answer 59

1. Screening process before purchase of firearm 2. All firearm owners must be licensed. 3. All firearms must be registered 4. All firearms must be kept in a locked container, unloaded and separate from ammunition

Answer 60

1. **Screening**: a. Ask routinely about presence of firearm in the home b. Screen as part of safety assessment for concern re: **suicide** c. If concern re: **Intimate partner violence,** screen for firearms 2. **Storage**: Counsel families - **firearms should not be** **present, i**f they are should be locked, unloaded, stored separate from ammunition 3. **Non-powder firearms:** a. Inform parents that **non-powder firearms are** **dangerous weapons** b. When **assessing children with injuries** caused by non-powder firearms, be aware that pellets can cause significant internal injury

Answer 61

1. Medical evaluation within 72 hrs of admission 2. Full medical, psychiatric, behavioural history to determine whether the youth is a danger to themselves or others 3. Assess for s/s of withdrawal in youth with history of recent substance use

Answer 62

1. Optical medical control 2. Adolescent involvement in management of condition 3. Adolescent and family understanding of the condition 4. Acknowledge of personal potential for activity, education, recreation and functioning 5. Completion of adolescent developmental tasks 6. Attainment of self esteem 7. Acknowledge of personal potential for a vocation or career

Answer 63

1. Adolescent involvement in management of the condition 2. Adolescent and family understanding of the condition 3. Understanding of personal potential for activity, education, recreation and vocation 4. The attainment of self-esteem and self-confidence

Answer 64

\*\*\*Studies have shown that FBT is the most effective treatment for children/teens with AN -Parents are given the responsibility to return their child to physical health = patient is treated as outpatient by interdiscplinary team -Main advantages: 1. Child gets to stay in their own environment to allow ongoing connection to friends/family/activities 2. Parents are empowered as they learn that they have the ability to help their child 3. Scarce inpatient resources can be directed to people whose eating disorder cannot be managed as an outpatient

Answer 65

1. Light skin color 2. Freckles 3. Skin moles (high nevus count) 4. Easy to burn skin 5. Red or blonde hair 6. Personal history of CMM or 1st degree relative with CMM

Answer 66

Class 1 physical carcinogens alongside chemical carcinogens such as cigarettes and asbestos

Answer 67

-UVA: causes immediate pigment darkening upon exposure -UVB causes further darkening of the skin in days following exposure (activates skin melanocytes) -BOTH damage DNA and induces discrete mutations

Answer 68

1. Adolescent's need for treatment 2. Parental overprotection 3. Physical appearance that is more youthful than the adolescent's chronological age 4. Limited physical freedom

Answer 69

1. Better disease detection 2. More skin exposure with current fashion 3. Leisure activities and vacations in sunny areas 4. Decrease in ozone layer 5. Increased sun seeking behaviour without adequate UVR protection 6. Increased popularity of tanning beds

Answer 70

On-Trac transition framework = begins at around 10 yo and has clinical pathways based on stage of transition to support the youth and family

Answer 71

Air gun injuries

Answer 72

-transgendered: a person's gender does not match their anatomy-transvestite: a person who gets pleasure from dressing in the clothing of the opposite sex

Answer 73

High dose norgestrel (250 mcg)-ethinyl estradiol (50 mcg): 1 pill now, then 1 pill 12 hrs later -timing of second dose is super important! Give gravol 1 hr before EC is taken because the estrogen makes people very nauseous -last resort if neither EC methods are available: 4-5 combined low dose OCP pills now, then repeat in 12 hrs

Answer 74

0.2-0.5 kg/week

Answer 75

1. \< 75% of TGW is indication for hospitalization – HIGH risk of refeeding syndrome 2. \<80% of TGW - likely SSRIs won’t work 3. Rate of gain shoudl be: - 1-2 kg per week **inpatient** **-**1-2 kg per MONTH **outpatient** 4. **Bone health consequences** won’t improve unless near target goal weight.

Answer 76

Erythema and sunburn

Answer 77

1. Anti epileptics 2. St. John's Wort 3. HIV meds 4. Rifampin 5. Griseofulvin

Answer 78

1. Urine sample 2. Weight check 3. Orthostatic vitals

Answer 79

\*\*\*2-7x more likely to commit suicide1. Acquisition of gay identity at a young age2. Family conflict`3. Run away or thrown out of home4. Feelings of conflict about own orientation5. Could not disclose orientation to anyone else

Answer 80

1. Chlamydia & Gonorrhea if sexually active and \> 15 yrs 2. HIV if sexually active and \> 15 yrs 3. \< 15 yrs for STI's if they have risk factors

Answer 81

1. Squamous cell carcinoma: chronic/total exposure increases risk 2. Basal cell carcinoma: early life UVR exposure increases risk 3. Cutaneous malignant melanoma: most deadly

Answer 82

Within 72 hrs of admission

Answer 83

Most effective within 72 hrs but effective up to 120 h

Answer 84

1. Live in group homes/detention centres/street involved 2. Substance abuse 3. Early puberty 4. Hx of sexual abuse 5. Moms were adolescent moms 6. Experiencing social/family difficulties 7. frequent school absenteeism or lacking vocational goals 8. Have siblings who were pregnant during adolescence

Answer 85

B! Tanning bed use among young girls doubles at age 14 and doubles again at age 17

Answer 86

D! The adolescent pregnancy rate is highest among 18-19 yo and many of these are PLANNED! -pregnancies among girls

Answer 87

A! It HAS been shown to increase rates of homicide and suicide! -for C, this is true: increased suicide rates for 15-24 yo and 65-84 yo but not other age groups (?impulsivity, depression, alcohol/substances)

Answer 88

Adolescent males = 98% of all firearm deaths among 15-19 yo -15-19 yo males are more likely to die from firearm injuries than cancer, falls, fires and drowning combined -most common cause of firearm death in adolescent males: suicide

Answer 89

Quebec! Fixed age of consent is 14 yo -for every other province, consent to medical treatment depends on mental capacity, not chronological age

Answer 90

Cutaneous malignant melanoma (not the most common type of skin cancer but accounts for most Canadian skin cancer deaths)

Answer 91

To delay future pregnancies OBVI -this is important to know though: 35% of teens who deliver will have another pregnancy within the following 2 years

Answer 92

1. Make contact with adult health care provider 2. Discuss the transfer with the family well in advance (ie. at 10-12 yo) 3. Give the teen a copy of the transfer summary 4. Follow up with the patient and facility to ensure that the transfer has gone smoothly

Answer 93

1. Let the parents know that the ED is not their fault and they are not to blame for their child's illness but they do need to take responsibility to ensure that their child gets well 2. Do not dwell on the cause of the symptoms: ED is both genetic and environmental 3. Tell them their child is unable to care for him or herself and has been overwhelmeed by a powerful illness = parents should take charge of their child's eating/exercise to ensure weight restoration 4. Expect the child to become angry and defiant with refeeding 5. Recommend resources: "Help your teenager beat an eating disorder" book by Lock and Le Grange 6. Parents are well within their authority to impose behavioural consequences (such as withdrawal of activities) to affect their child's choices. -behavioural modification strategies (rewarding desirable behaviours, consequences for undesirable behaviours) can be useful 7. Encourage parents or siblings to do something fun with the patient after the meal to help them distract themselves from "feeling fat" 8. Enforce 3 meals and 2-3 snacks per day (work with a dietician) and these MUST be supervised by parent 8. Parents can be angry at the eating disorder, NOT at their child who is suffering with an eating disorder.

Answer 94

1. There are NO absolute contraindications to the use of emergency hormonal contraception except known pregnancy, and this is onlybecause it is ineffective… 2. Complete a pregnancy test if they do not experience normal menstrual bleeding by 21 days following EC treatment or by 28 days if an oral contraceptive was started after taking hormonal EC 3. Repeat dose if vomit \< 1 hour

Answer 95

PID is an infection of the female upper genital tract involving any combination of the endometrium, fallopian tubes, pelvic peritoneum and contiguous structures. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines.html

Answer 96

**Sexually transmitted organisms** Chlamydia trachomatis Neisseria gonorrhoeae Viruses and protozoa (rare) Herpes simplex virus Trichomonas vaginalis **Endogenous organisms** Genital-tract mycoplasmas Mycoplasma genitalium Mycoplasma hominis Ureaplasma urealyticum N.B. Most cases of PID are associated with more than one organism. Pathogens can be categorized as sexually transmitted or endogenous organisms.

Answer 97

Lower abdominal tenderness Adnexal tenderness Cervical motion tenderness 2/3 have no Sx..

Answer 98

1. Oral temperature \>38.3°C (only 30%) 2. Presence of white blood cells on saline microscopy of **vaginal secretions/**wet mount 3. **Blood**: Elevated ESR or CRP 4. Laboratory documentation of cervical infection with **gonorrhoeae or Chlamydia**

Answer 99

1. **Endometrial biopsy** with histopathologic evidence of endometritis (at least 1 plasma cell per x120 field and at least 5 neutrophils per x400 field) 2. **Transvaginal sonography** or other imaging techniques showing thickened fluid-filled tubes, with or without free pelvic fluid or tubo-ovarian complex 3. **Gold standard:** Laparoscopy demonstrating abnormalities consistent with PID, such as fallopian tube erythema and/or mucopurulent exudates

Answer 100

1. A STAT beta HCG pregnancy test 2. Ultrasound - if tubo-ovarian abscess is suspected. (A normal US study does not rule out a diagnosis of PID.) 3. Detection of gram stain gonorrhea of endocervical secretions; positive results of NAAT for gonorrhoeae or Chlamydia (Negative laboratory results do not rule out a diagnosis of PID.) 4. **Other STD's** Syphylis and HIV

Answer 101

1. **Medical**: a. severe illness, nausea and vomiting, or high fever. b. The patient has a tubo-ovarian abscess. c. Surgical emergencies such as appendicitis cannot be excluded. 2. The patient is **pregnant/adolescent /HIV**(particularly if compliance is an issue) **3. Treatment:** a. The patient does not respond clinically to oral antimicrobial therapy. b. The patient is unable to follow or tolerate an outpatient oral regimen. Observed oral Rx in hospital may be needed for adolescents and HIV infection

Answer 102

1. Stat serum beta HCG to rule out ectopic pregnancy. 2. complete abdominal and bimanual pelvic exam + speculum The external genital area, vagina and cervix should all be inspected. 3. **speculum** -endocervical swabs-gonorrhoeae + Chlamydia and ? HSV 4. **Vaginal swabs** - for culture; pH testing; amine odour whiff testing; normal saline and potassium hydroxide wet preparations; and Gram stain. Clinical assessment for bacterial vaginosis

Answer 103

1. **Cefoxitin** 2 g **IV** every 6 hours PLUS **doxycycline** 100 mg **IV** or PO every 12 hours Parenteral therapy may be discontinued 24 hours after a patient improves clinically, and oral therapy with doxycycline (100 mg bid) should continue for a **total of 14 days** \*\*Most authorities recommend administering **doxycycline in oral form** even in hospitalized patients, because IV administration is painful and more costly, and because oral and IV administration provide similar bioavailability

Answer 104

**Ceftriaxone** 250 mg IM in a single dose PLUS **doxycycline** 100 mg PO bid for 14 days OR **Cefoxitin** 2 g IM PLUS **probenecid** 1 g PO in a single dose concurrently once PLUS **doxycycline** 100 mg PO bid for 14 days For the treatment options listed above, many experts recommend the addition of metronidazole 500 mg PO bid for 14 days to this regimen for additional anaerobic coverage and the treatment of bacterial vaginosis

Answer 105

1. Patients with conditions that are notifiable according to provincial and territorial laws and regulations should be reported to local public health authorities. 2. Sexual partners should be traced 60 days prior to symptom onset or date of specimen collection (if asymptomatic). 3. The length of time for the trace-back period should be extended: a. to include additional time up to the date of treatment b. if the index case states that there were no partners during the recommended trace-back period, then the last partner should be notified c. if all partners traced (according to recommended trace-back period) test negative, then the partner prior to the trace-back period should be notified. 4. After evaluation, sexual partners should be empirically treated with regimens effective against both gonorrhea and chlamydia regardless of clinical findings and without waiting for test results.

Answer 106

1. Following a diagnosis of PID, testing and counselling should be performed for other infections, including **HIV and syphilis**. 2. Immunization against h**epatitis B and HPV i**s recommended if not already immune.

Answer 107

1. Pain and tenderness resulting from acute PID should begin to resolve within **48-72** hours of initiating antibiotics. - If no improvement is observed, further work-up is essential. 2. Individuals treated as **OPD** need careful follow-up and should be re-evaluated 2 to 3 days after treatment is initiated. - If no clinical improvement has occurred, hospital admission for parenteral therapy and observation is required. 3. Following a diagnosis of PID, patients should be informed that they are at risk of both - short-term consequences such as **Fitz-Hugh-Curtis** syndrome (perihepatitis) and **tubo-ovarian abscess,** and - long-term sequelae, including **infertility, ectopic pregnancy and chronic pelvic pain.**

Answer 108

**Pregnancy** PID is uncommon in pregnancy, especially after the first trimester. -increased risk of adverse outcomes for both the mother and the pregnancy. - **HIV infection** -have longer hospital stays and are at higher risk for the development of tubo-ovarian abscesses and are more likely to require surgical intervention These women should be followed closely and managed aggressively, and consideration should be given to hospitalization. **IUCD's** IUCD should not be removed until after therapy has been initiated and at **least two doses of antibiotics** have been given.

Answer 109

Older age at time of parental smoking cessation (if parents are ex-smokers)[16] Low socio-economic status[15] Peer and family influence, including lack of parental support[14][17] Misinformation about the health consequences of smoking[18] Easy access to tobacco products[14] Influence of marketing, exposure to tobacco promotions[14][19] Previous experimentation[20] Depression and mental health conditions[21] Poor school performance[15] Adverse experiences such as: emotional, and physical or sexual abuse, parental separation or divorce, a household member who is substance abusing, mentally ill or incarcerated[22] Substance abuse (smoking often precedes the use of illicit drugs)[15]

Answer 110

1. teenagers develop nicotine addiction at much lower levels of consumption than adults, making smoking cessation potentially more difficult for this population. 2. Many adolescents develop a higher tolerance to nicotine and experience withdrawal symptoms (signalling dependence) after only days or weeks of exposure. 3. Early nicotine dependence is an important factor in determining which individuals become regular smokers after experimentation.I 4. withdrawal symptoms can appear sooner, sometimes after smoking only a few cigarettes. 5. Craving, which is often the first symptom of nicotine dependence, can emerge three months to four months after taking the first puff of cigarette smoke. 6. About 18 months after smoking their first whole cigarette, one-quarter of young smokers have lost confidence in their ability to quit.

Answer 111

1. nicotine induces persistent changes in neural connectivity in several brain areas, including the nucleus accumbens, the medial prefrontal cortex and the amygdala, all of which are involved with emotion regulation.[ 2. Adolescent smokers appear to be more sensitive to the rewarding effects of nicotine and have higher risks for addiction and affective disorders in adulthood. 3. Chronic nicotine usage increase the risks for future substance use.

Answer 112

1. **Individual**: a. Previous experimentation b. Depression and mental health conditions c. Poor school performance d. emotional, and physical or sexual abuse, e. Substance abuse (smoking often precedes the use of illicit drugs) 2. **Social**: a Low SEG/Peer and family influence, including lack of parental support b. Misinformation about the health consequences of smoking c. Easy access to tobacco products[14] d. Older age at time of parental smoking cessation (if parents are ex-smokers) e. Influence of marketing, exposure to tobacco promotions f. parental separation or divorce, g household member who is substance abusing, mentally ill or incarcerated

Answer 113

1. ‘**dripping**’, - trickle drops of a nicotine-containing fluid directly onto the heating element, is associated with tank systems. While generating a more potent vapour, the intense heat alters the chemical composition of e-liquids, creating new compounds. Changes in chemical structure affect the liquid nicotine, filler ingredients and any flavouring(s) that are present. The stronger the battery, the higher the temperature, making chemical reactions more complete.[14] 2. One significant **potential danger** of large boluses of nicotine, as generated by tank technology, is their potential for ***acute cardiac events***. A hypercoagulable state may be produced, which can, in turn**, *_promote thrombosis_***. 3. Exposure to **fine particulates** in the aerosol generated by e-smoking may ***impair respiratory function*** in users and bystanders (asthma and bronchitis). 4. impacts of nicotine on the developing brain and the potential for dependency 5. Aside from nicotine, e-cigarette aerosols may also contain **propylene glycol and glycerol/glycerin** as filler materials, **flavourings** and other chemical compounds. Aerosolized propylene glycol and glycerol are known to produce ***mouth and throat irritation, and dry cough;***

Answer 114

Short term • Impairment of short term memory, complex mental tasks, attention, judgment, reaction times, motor skills. • Doubled the risk of being in a motor vehicle accident * Psychosis (transient) * Studies from 1970’s say gynecomastia

Answer 115

1. **Brain**: Impairment of short term memory, complex mental tasks, attention, judgment, reaction times, motor skills. 2. Twice the risk of being in a **MVA** 3. **Medical**: Gynecomastia & Psychosis (transient)

Answer 116

1. **Brain**: Structural brain changes: lower brain volumes, different folding patterns and thinning of the cortex, less neural connectivity and lower white matter integrity + 2. **Psychiatric**: a. Use of other substances b. Relationship with mood & Psychotic disorders 3. **Education** lower educational attainment & Cognitive changes (?)

Answer 117

1. **cannabis-induced anxiety disorder** 2. substance/medication-induced **psychotic disorder** • hallucinations in the absence of intact reality testing 3. **Hallucinogens** in low doses 4. **Phencyclidine** -more likely to cause ataxia and aggressive behavior

Answer 118

A. A problematic pattern of cannabis use leading to clinically significant impairment or distress, as manifested by at **least two of the following,** occurring within a 12- month period: a. U***sage:*** - Cannabis is often taken in larger amounts or over a longer period than was intended. - A great deal of time is spent in activities necessary to obtain cannabis, use cannabis, or recover from its effects. b. **lack of control:** - There is a persistent desire or unsuccessful efforts to cut down or control cannabis use. - Recurrent cannabis use resulting in a failure to fulfill major role obligations at work, school, or home. - Craving, or a strong desire or urge to use cannabis. - Cannabis use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by cannabis. c. **Impact on life** - Important social, occupational, or recreational activities are given up or reduced because of cannabis use. - Recurrent cannabis use in situations in which it is physically hazardous.

Answer 119

**Tolerance**, as defined by either of the following: a) A need for markedly increased amounts of cannabis to achieve intoxication or desired effect. b) Markedly diminished effect with continued use of the same amount of cannabis. **Withdrawal**, as manifested by either of the following: a) The characteristic withdrawal syndrome for cannabis (refer to Criteria A and B of the criteria set for cannabis withdrawal, b) Cannabis (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Answer 120

A. Cessation of cannabis use that has been **heavy and prolonged** (i.e., usually daily or almost daily use over a period of at least a few months). B. **Three (or more)** of the following signs and symptoms develop **within approximately 1 week** after Criterion A: * Irritability, anger, or aggression. * Nervousness or anxiety. * Sleep difficulty (e.g., insomnia, disturbing dreams). * Decreased appetite or weight loss. * Restlessness. * Depressed mood. * At least one of the following physical symptoms causing significant discomfort: a**_bdominal pain,_** shakiness/tremors, sweating, fever, chills, or headache. C. The signs or symptoms in **Criterion B cause clinically significant distress or impairment** in social, occupational, or other important areas of functioning. D. The signs or symptoms are **not attributable to another medical condition** and are not better explained by **another mental disorder, including intoxication** or **withdrawal** from another substance.

Answer 121

**Cannabis hyperemesis syndrome Sx:** abdominal pain, vomiting, or nausea that is typically relieved by **_hot showers_** **•Treatment:** **1.**cessation of cannabis products (may take x 2 weeks +), 2. IV fluids, ondansetron, benzos, 3. topical capsaicin

Answer 122

1. **Main ingredients:** Caffeine, Guarana (“herbal caffeine”) 2. **Teenage vulnerability reason:** GH surge during puberty . slower metabolism of caffeine . potentially increased effect and complications 3. **Adverse effects of caffeine:** headache, restlessness, nervousness, insomnia, nausea, vomiting, seizures, cardiac arrhythmia + Withdrawal symptoms http: //www.cpsp.cps.ca/uploads/publications/Highlights-energy-drinks.pdf

Answer 123

1. P**hysical safety:** - 50% are verbally/physically assaulted in school - 2-4x more likely to be threatened with a weapon at school - 2-7x more risk of suicide **2. Social:** - Risk of school drop out/Kicked out of home, street involved - Earlier cigarettes/alcohol/club drugs at earlier age **3. Sex:** a. Increased risk of STI (risk of nonconsenual sex) b. Swab for **gonorrhea** (urethra/urine, pharynx, anus) , swab for **chlamydia** urethra/urine), VDRL, HIV, Stool culture and O+P

Answer 124

1. **Gender expression:** This is how you express your gender to others, whether through behaviour, clothing, hairstyle, or the name you choose to go by. Words to describe someone’s gender expression could be “masculine,” “feminine,” or “androgynous”. 2. **Gender expression:** This is how you express your gender to others, whether through behaviour, clothing, hairstyle, or the name you choose to go by. Words to describe someone’s gender expression could be “masculine,” “feminine,” or “androgynous”. 3. **Assigned sex:** When children are born, they are assigned “male” or “female” based on their external sex organs. When a child has a penis, the assigned sex is male. When a child has a vulva, the assigned sex is female. In rare cases, a child is born with external sex organs that are not clearly male or female. 4. Sexual orientation: This refers to the gender of the people to whom you are typically sexually and/or romantically attracted. A person can be attracted to those of the same gender and/or different gender(s). Your gender identity does not define your sexual orientation.

Answer 125

**1. Transgender:** When a person’s gender identity is not the same as their assigned sex at birth, they may be referred to as “transgender” (often shortened to “**trans**”). For example, a child born with female body parts may say that they are a boy. A child may also say that they are **not a boy or a girl**, but just “**themselves**” because they don’t want their sexual characteristics to define who they are. Indigenous people may use the term “two-spirit” to represent a person with a combination of masculine and feminine characteristics. **2. Gender dysphoria:** Describes the l***evel of discomfort or suffering associated*** with the conflict that can exist between a person's assigned sex at birth and their true gender. Some transgender children experience no distress about their bodies, but others may be very uncomfortable with their assigned sex, especially at the start of puberty when their body starts to change.

Answer 126

**1. Clinic layout:** Display trans-friendly and queer-friendly markers in your clinic/office * Provide access to non-gendered bathrooms * Have non-gendered intake forms, ask about parent 1/2 instead of mother/father **2. Communication:** Have staff ask about preferred name/pronoun for everyone * Introductions “Hi, my name is Dr. X, my pronouns are she/her. What can I call you?" * Reinforce confidentiality – who knows (i.e. should the referring doctor know? Which pronouns should you use around parents?) **3. Interview:** * Have non-gendered intake forms, ask about parent 1/2 instead of mother/father * Use non-gendered language in history taking (i.e. pregnant person, partner) * Reinforce confidentiality – who knows (i.e. should the referring doctor know? Which pronouns should you use around parents?) * Take a patient’s lead when discussing anatomy (some people prefer front-hole, chest tissue, etc) * Include question about gender identity in HEADS history * Don’t ask medically unnecessary questions, try to explain reason for a sensitive question * Do your best! Apologize and move on if you make a mistake

Answer 127

**Gender Dysphoria in Children** A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1): A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender). In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing. A strong preference for cross-gender roles in make-believe play or fantasy play. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender. A strong preference for playmates of the other gender. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and tumbleplay; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities. A strong dislike of one’s sexual anatomy. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender. The condition is associated with clinically significant distress or impairment in social, school,

Answer 128

A) **Recurrent episodes of binge eating**, characterized by bothof: 1) Eating **larger** than normal amounts of food in a discrete period of time (2hr) 2) Sense of **lack of control** during episode B) Recurrent use of **inappropriate compensatory behaviour** to prevent weight gain (vomiting, laxatives, exercise, diuretics, etc) C) Binge eating and compensatory behaviour occur **avg once/weekfor 3 months** D) **Self evaluation** unduly influenced by body shape and weight E) Disturbance **does not occur exclusively d**uring episodes of AN

Answer 129

**1. Education and empowerment:** - Adopt a stepwise plan of increasing responsibility of self-care for the patient - Provide materials on his condition -- Provide skills training in negotiation and communication **2. Professional matters:** - Ensure family doctor is involved in transition planning (refer to one if he doesn’t have one) - When time for transition, provide a detailed referral letter to the adult physician taking over care

Answer 130

a) History of LMP, time of unprotected sex b) Take BP; _determine need for pelvic exam_(unusual LMP; suspected pregnancy; concern RE STIs) and if STI possible, take swabs for culture c) Advise the patient to **return for a pregnancy test** if her next period does not arrive at the expected time or is unusual d) Advise her to **come back** if there is any _pain, heavy bleeding_ e. Give her an **antiemetic** to take at the same time f. **Bring her back** to _talk about contraception_

Answer 131

**1. Impact:** a. worsening school performance, use at school, b. Mental: depression, **2. Risk taking:** use before driving + high risk behavior while under influence, History of injuries/accidents 3. **Drinking pattern:** - Regular binge drinking (\>6 drinks in one sitting(, Regular blackouts, - Have a morning “eye-opener”, use alone,

Answer 132

**a. Mechanism:** If given before a menstrual period (or shortly after it begins), administration of a rapidly absorbed prostaglandin synthetase inhibitor, such as naproxen sodium, is effective in reducing prostaglandin production before they cause pain **b. Dose and frequency:** 2 tablets of 275 mg each taken with the onset of menses and 1 tablet taken every 6-8 hr after that for the 1st 24 hr).

Answer 133

1. - Connect him with **support** groups/family therapy 2. - Provide regular ongoing **follow-up** and address barriers to sobriety 3. - Encourage communication w/ **family and parents** 4. - Encourage **physical activity**