EM Adolescent

Question 1

What lab value is elevated with Anorexia Nervosa?

Answer 1

Growth hormone secretion is abnormally high.

Question 2

What lab value is low with Anorexia Nervosa?

Answer 2

TSH levels are low, and thyroxine and triiodothyronine levels are low. Low ESRs are common, possibly reflecting low fibrinogen production secondary to malnutrition. White blood cell counts are low due to bone marrow hypoplasia. Low potassium is very common due to vomiting and malnutrition.

Question 3

What are the EKG changes with Anorexia Nervosa?

Answer 3

EKG changes include low voltage; T-wave inversion and flattening; ST depression; and supraventricular and ventricular dysrhythmias

Question 4

Causes of death in Anorexia Nervosa ?

Answer 4

Death occurs in 10% of patients; it is usually caused by severe electrolyte disturbance, cardiac arrhythmia, or congestive heart failure.

Question 5

Vital signs in anorexia Nervosa ?

Answer 5

Bradycardia, postural hypotension, and hypothermia are common.

Question 6

Hereditary angioedema most commonly present as

Answer 6

intermittent, brawny, swelling of the extremities with recurrent facial and subglottic swelling as well as recurrent, crampy abdominal pain, and wheezing. Edema usually lasts 24-72 hours.

Question 7

Chronic fatigue syndrome, which is characterized by

Answer 7

at least 6 months of profound fatigue and may include impaired memory or concentration, headache, vertigo, and visual disturbances, can share many symptoms with orthostatic edema, but patients will also have enlarged nodes and frequent sore throat.

Question 8

cyclical, or idiopathic edema is a generalized systemic disorder that has a wide variety of presentations and many associated symptoms. Typically weight gain occurs throughout the day as edema collects in the lower extremities after prolonged sitting or standing.

Answer 8

Orthostatic edema (also known as retention),

Question 9

A 12-year-old boy is brought to you with short stature. Bone age, history and pharmacologic tests can be used to confirm or rule out

Answer 9

Growth hormone deficiency

Question 10

A 12-year-old boy is brought to you with short stature. Complete blood count, sedimentation rate, serum electrolytes, and BUN can be used to confirm or rule out what condition?

Answer 10

Chronic systemic disease

Question 11

____ is the most common breast mass in teens. Histology involves stromal proliferation surrounded by compressed or distorted ducts. - discovered while bathing or performing a self-exam. Most occur in teens age 14 - 16. For most patients, only 1 is present. Exam reveals a firm, non-tender, rubbery mass that is mobile, with well-demarcated margins. Average size is 2 - 3 cm. 2/3 will be in the upper outer quadrant.

Answer 11

A simple, juvenile fibroadenoma. The diagnosis is made by clinical exam, fine needle aspiration, core biopsy, or excisional biopsy. Treatment is surgical excision.

Question 12

___ is a syndrome associated with patchy cutaneous pigmentation and fibrous dysplasia of the skeletal system. Precocious puberty, particularly vaginal bleeding, has been described predominantly in girls with the mean age of 3 years, but it can be seen as early as 4 months of age.

Answer 12

McCune-Albright syndrome

Question 13

The initial sign is the development of the breasts. In boys, testicular enlargement is followed by penile enlargement. Erections are also common. Height, weight, and osseous maturation are advanced for both boys and girls. Precocious puberty is the onset of secondary sexual characteristics before the age.

Answer 13

of 8 for girls and 9 for boys. PP is more common in girls than in boys. 90% of PP in girls is idiopathic. A CT or MRI may demonstrate physiologic enlargement of the pituitary glands, as is seen in normal puberty.

Question 14

It can be seen among infants; 50% of cases appear before 10 years of age. The breasts become enlarged, and external genitalia resemble those of a normal girl at puberty. Precocious changes disappear a few months after the removal of tumor.

Answer 14

Ovarian tumors in childhood, particularly the granulose cell tumors, are the most common neoplasm of the ovary with estrogenic manifestations. It is very distinct from the adult type because the follicles are often irregular.

Question 15

Feminizing _____ tumors are common in girls from 6 months to 10 years of age.

Answer 15

Feminizing adrenal tumors. A majority of the tumors are adenomas.

Question 16

___ is the repeated regurgitation of one’s food that has persisted for at least 1 month. It is believed that a lack of stimulation, neglect, or a poor parent-child relationship may be responsible for an infant developing this disorder.

Answer 16

Rumination. It is usually associated with another mental disorder, such as Mental Retardation, when onset is in older children or adults.

Question 17

Which of the groups is most likely to reach early puberty?

Answer 17

menarche starts earliest in African-American girls. 50% will have menses by age 11.3 years, followed by Mexican-American girls at 11.5 years and Caucasian girls at 11.9 years.

Question 18

In the diagnosis of anorexia nervosa, various organic disorders have to be excluded by

Answer 18

obtaining complete blood count, thyroid studies, liver function tests

Question 19

What laboratory test is likely to be the most useful for monitoring the effect of treatment in Anorexia Nervosa?

Answer 19

Monitoring urine ketones can help to detect failure of the therapeutic partnership with the patient and continuation of fasting.

Question 20

There is no specific laboratory test for anorexia nervosa, but unlike in other forms of starvation, serum carotene (a precursor of vitamin A) level tends to be

Answer 20

higher. Rapid and significant weight loss, hypokalemia, hypotension, and prerenal azotemia are indications for hospitalization. At weights more than 35% below normal, sudden death may occur.

Question 21

Any female of childbearing age should have ____ even if they came in with nausea vomiting and had appendectomy 10 yrs ago.

Answer 21

a pregnancy test (serum or urine) as soon as possible as many presenting symptoms are related to pregnancy. Unnecessary studies can be avoided if the correct diagnosis of hyperemesis gravidarum is made on a timely basis.

Question 22

Lab testing for gynecomastia -

Answer 22

laboratory evaluation should include testosterone, estradiol and gonadotropins to assess levels. This would effectively rule out conditions that could cause markedly abnormal levels, such as Klinefelter syndrome, the most common sex chromosome disorder, and the most common cause of hypogonadism and infertility in men. There are decreased levels of testosterone and elevated follicle-stimulating and luteinizing hormones. Karyotype analysis will reveal 1 or more extra X chromosomes.

Question 23

A period of rapid growth in height and weight then ensues. Deviation from these means can have a significant

Answer 23

psychological impact on adolescents. Late-developing girls, however, do not appear to have significant difficulties on average.

Question 24

Early pubertal development in girls has

Answer 24

the opposite effect with feelings of low self-esteem and more concerns about body image. In one study, early breast development resulted in girls being more likely to be teased. Also, an increase in adiposity typically occurs, which is negatively received.

Question 25

Late-developing males, in contrast, were found to have a

Answer 25

poorer self-image, poorer school performance, and lower educational aspirations and expectations.

Question 26

Early-developing males compared to their late-developing peers tend to have greater

Answer 26

self-confidence and a greater likelihood of academic and social as well as predicted athletic success and increased popularity.

Question 27

Certain high risk factors and fewer protective factors cause some individuals to be more prone to develop extended substance use into their adult years. Of these, early onset of use has been shown to correlate significantly with a risk of

Answer 27

developing alcohol dependence later in life, especially those who begin drinking younger than 13 years of age, as suspected in this patient. They are 5 times more likely to have a lifetime diagnosis of alcohol dependence compared with those who delay until legal drinking age and beyond.

Question 28

Children of alcohol-dependent parents are 4-6 times more prone to developing similar dependence compared to those without a positive family history. In addition, studies of twins suggest a genetic predisposition involving chromosomes 9, 15, and 16.

Answer 28

Alcohol dependence from the time of first alcohol use develops quicker in adolescents than adults. Peer pressure to drink beer has been reported in about 30% of children in the 4th to 6th grades. Alcohol advertising is also a significant factor influencing adolescents’ use and the home is the most common source of alcohol for adolescents.

Question 29

Starting 1 hour after smoking marijuana, the enzyme-multiplied immunoassay technique detects marijuana and its metabolites D9-tetrahydrocannabinol (THC) and its carboxylic acid metabolite. This assay will remain positive up to

Answer 29

10 days after infrequent use and up to 30 days in heavy users.

Question 30

Adolescents least likely to use alcohol or other drugs are

Answer 30

emotionally close to their parents, receive advice, praise, and guidance, have drug intolerant siblings, and are expected to comply with clear, reasonable rules.