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Adolescent med > General > Flashcards

General Flashcards

1
Q

Tanner stage for PH in girls

A
  1. nil
  2. sparce along labia - mean 11.7
  3. darker and coarser. curls. over pubes - mean 12.4
  4. as adult but sparse and NO spread - mean 13
  5. spreads to medial thighs - 14.4
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2
Q

Tanner stage of breast

A
  1. nil
  2. breast tissue palpable under areola - 11.2
  3. BT beyond areola - 12.2
  4. secondary mount - 13.1
  5. areola and BT form smooth contour - 15.3
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3
Q

tanner stage in boys1

A
  1. all same size. no PH. Testicle size is less than 3 ml and max length 2 cm
  2. scrotum and testes enlarge. redning of scrotum. sparse hair at base. - mean 11.4
  3. elongation of penis. more hair. mean 12.9
  4. enlargement of the penis. Dev of glans. testicular enlarg. almost adult PH but NO spread. Mean 13.8
  5. adult. Testicles 12-18 ml or 4-5 cm. hair spreads. Mean 14.9
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4
Q

Amenorrhea def

A

primary - if nil by 16 (if have breast dev or 14 if have no breast dev)
secondary - if nil for 3 cycles or 6 month

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5
Q

Definition of Yeast vaginitis

A

increased white DC
PH < 4.5
vulvar itching
Rx fluconazole or clotrimazole vaginal supp

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6
Q

Def of trichomoniasis

A

yellow green DC, smells bad
PH >5
Itching and inflammation
Dx with seeing motile trich on saline prep
Rx metronidazole x1 or 7 d and treat PARTNER

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7
Q

def of bacterial vaginosis

A

Diagnosis need 3/4:

  1. white-gray DC coats vaginal wall
    • Whiff test - add 10 % KOH and get fishy smell
  3. PH > 4.5
  4. > 20 % clue cells

RX - PO or Top flagyl or Clinda.
no need to treat partner

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8
Q

How do you approach smoking cessation

A

Ask, Advise, Assess, Assist, and Arrange

If ready - can do nicotine supp and behavioural therapy
bupropion are not approved for use under 18 yr old

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9
Q

What stage of adolescent:

  • worried about how they look compared to others
  • prefers to hang out with same sex
  • concrete thinking, don’t think about the future
A

early ado 10-13 yrs

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10
Q

What stage of adolescent:

  • mood swings
  • operational thinking
  • narcissistic and feel invincible
  • fight with parents
A

mid ado 14-16

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11
Q

What stage of adolescent:

  • think about future
  • less self centred
  • solid concept of right and wrong
A

late ado - abstract thinkers 17 and older

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12
Q

Risk factors for suicide

A

Mental health issues ie DEPRESSION, BP, anxiety…
(Among boys, conduct disorder and substance use convey increased risk)

Stressful situation or loss
history of acting out behavior ie promiscuity, delinquency
living out of the home (ie in correctional institute or group home)
history of physical or sexual abuse
Males
Access to firearms
Past suicide attempt
Exposure/FHx
Bullies/being bullied
Substance abuse
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13
Q

Absolute contraindication to OCP

A 
Pregnancy
Undiagnosed genital bleeding
Breast cancer
Past or present circulatory disease (for example, arterial or venous thrombosis, ischemic heart disease, and cerebral hemorrhage)
Thrombophilia
Pill induced hypertension
Migraine with aura
Active liver disease, cholestatic jaundice, Dubin-Johnson syndrome, acute porphyria
Systemic lupus erythematosus
Hemolytic-uremic syndrome
Thrombotic thrombocytopenic purpura
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14
Q

Electrolyte abnormalities with refeeding syndrome

A
  1. hypophosphatemia after the cellular uptake of phosphate during the 1st week and can produce weakness, rhabdomyolysis, neutrophil dysfunction, cardiorespiratory failure, arrhythmias, seizures, altered level of consciousness, or sudden death.
  2. hypokalemia
  3. hypomanesemia
  4. hyperglycemia
  5. thiamine defi
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15
Q

What are the complications of Low PO4?

A

At levels of ≤0.5 mmol/L can produce weakness, rhabdomyolysis, neutrophil dysfunction, cardiorespiratory failure, arrhythmias, seizures, altered LOC, or sudden death.

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16
Q

PID diagnosis - minimum criteria and routine

A
  • lower abd pain
  • adenexal tenderness (bilateral or unilateral)
  • cervical motion tenderness

Routine criteria

  • oral temp > 38.3
  • abn vag/cx/ d/c
  •  ESR or CRP
  • lab documentation of NG or Chlamydia
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17
Q

Treatment of PID

A

Outpatient:
cetriaxone 250 mg IM x1
+ doxy 100mg BID 14 d

In pt:
Cefoxitin 2g IV q 6 hrs +
Doxycycline 100 mg IV OR po q12 hrs

18
Q

What is PID

A

group of inf in upper genial tract - endometritis, salpingitis, Tubo-Ovarian Abscess, pelvic peritonitis

19
Q

Which drugs affect the efficacy of OCP?

A
  1. AED - EXCEPT VPA!!!!!

(2. Rifampin
3. Fluconazole, Griseofulvin, Itraconazole, Ketoconazole, Ritonavir
St John’s Wort (results in breakthrough bleeding)))))

20
Q

Which drugs have their efficacy decreased if taken with OCP

A

Lorazepam (Ativan)
Oxazepam
Salicylates

21
Q

Which AED affect OCP

A

All Except - VPA, Gabapentin, Keppra, Lamotrigine

22
Q

Side effects of anabolic steroids

A

endo - male get testicular atrophy, oligspermia, gynecomastia. females - amenorrhea, breast atrophy, cliteromegaly
MSK - prem epiphyseal closure
Derm - Acne, hirsutism, striae, male patern baldness
Hepatic - impaired excretory fct - cholestatic jaundice, elevated LFT, hepatitis, benign and malignant tumours
CVS - HTN, low HDL, thrombosis
Psych - aggressive, moody, depression

23
Q

Signs of recent Marijuana use

A 
Conjunctival injection, 
tachycardia, 
HTN 
hypothermia.
Alteration in perception ,  
hallucination, paranoia, 
short term memory loss, 
poor performance with decrease attention span, increased appetite.
Decrease sperm count and anovulation
24
Q

Risk factors for HPV infections

A 
sexual activity
# of partners
early age of 1st intercourse
never married
never pregnant
STI
immunosuppressed
25
Q

signs of self induced emesis

A

russels’ sign

26
Q

side effects of risperidone

A 
sedation
prolonged QT
neuroleptic malignant syndrome
hyperprolactinemia
tadive dyskenesia
hyperglycemia
27
Q

PTSD

A

traumatic event where actual death/injury or watched
re-experienced
avoid
anxiety

greater than month

28
Q

which teens are at risk of unprotected sex

A
  1. if have social/family issues
  2. mothers were teens
  3. undergoing early puberty
  4. Hx of sexual abuse
  5. GFrequent school absenteeism or lack of future goals
  6. siblings who where teen pregnant
  7. use of cigs, alcohol or other subs
    8 live in a group home
29
Q

what is the order of female puberty

A

Boobs
pubes
grow
flow

30
Q

What are the non contraceptive benefits of OCP?

A

Reduction in:

  • anemia
  • acne
  • hirsutism
  • certain Ca - endometrial and ovarian
  • dysmenorrhea and PMS
  • ovarian cysts
  • PID and future ectopic pregnancies
  • benign breast disease
31
Q

what are side effects of Depo-povera?

A

weight gain
reduced bone density
irregular bleeding for up to 12 mo
depression

32
Q

when is Depo-provera a good option

A

if high risk and poor compliance pt
if Oe is contraindicated
if want amenorrhea

33
Q

What else should you prescribe as you are prescribing Depo-provera?

A

Ca and Vitamin D

need bone density after being on it for a few yrs

34
Q

What are the contraindication to emergency contraception?

A

pregnancy

anaphylaxis

35
Q

Chlamydia treatment

A

azithromycin 1 gm PO x1

36
Q

Gonorrhea treatment

A

option 1: Ceftriaxone 250mg IM x1 + azith 1g PO
OR
Option 2: Cefixime 800mg PO x1 + azithr 1g PO

37
Q

What are diagnostic criteria for PID

A

lower abdo pain + one or more:

  • adnexal pain
  • uterine tenderness
  • Cx motion tenderness
increases specificity if also have:
fever
DC
WBC 
high ESR/CRP
\+ test fo GC or chlam
38
Q

what is the age of consent?

A

For nonexploitative activity is 16.

For exploitative sexual activity, the age is 18.

39
Q

what are the special considerations regarding consent?

A

1) 12 and 13 yrs old can consent to nonexploitative sexual activity when the age difference is no more than 2 years apart
2) Youth 14 or 15 can consent to nonexploitative sexual activity if the age difference is no more than 5 years of age

40
Q

what are the 3 key features for Dx of AN

A
  1. food restriction leading to low body weight
  2. fear of gaining weight
  3. Body distortion
41
Q

what are the 3 diagnostic criteria for bulimia nervosa

A
  1. recurrent episodes of binging
  2. recurrent episodes of purging
  3. self evaluation based on weight and body shape
42
Q

What are complications of PID?

A 
Infertility
Ectopic pregnancy
Tubo-ovarian abscess
Chronic pelvic pain
Dyspareunia
Fitz-Hugh-Curtis syndrome

Adolescent med (1 decks)

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