MedU Clipp Cases 5 and 6 Flashcards
(6) Signs of Hypothyrodism in the Adolescent?
- Cold Skin
- Slowness
- Fatigue
- Preferring Hot weather to Cold weather
- Doing poorly in School
- Coarse hair
(5) What are the Symptoms of Depression in Adolescents?
(1) What is the extra one in Adults
- Feels down and doesn’t want to participate in normal activities
- Feels sad and often cries over small things
- Doesn’t want to participate in Friend’s activities
- Thinks about Suicide
- Feels grouchy and flat all the time
Adult
- Early morning waking, difficulty falling asleep at night
Signs of Anorexia in Female Adolescents?
- Bradycarda
- -> Postural Hypotension
- Electrolyte Abnormalities
- Def. in Calcium and Magnesium
- -> Neurologic changes
- -> Increased Reflex Tone
- -> Compromised Cardiac Function
(2) Signs of Bulimia?
- Dental Decay (from stomach acid)
- Finger Trauma from Self-induced vomiting
(5) Differential Diagnosis for Fatigue
in an Adolescent Female?
- Anemia
- Bleeding disorder, Iron Deficiency
- Bleeding Disorder
- Hypothyroidism
- Menorrhagia and Shorter Menstrual Cycles
- Constipation, Weight gain, Decreased Appetite
- Depression
- Substance Abuse
When do Girls start Puberty?
- Girls Start between 8 and 13 y.o.
- Breast Buds 10 - 11 y.o.
- Pubic Hair 10 - 11 y.o
- Growth Spurt 12 y.o.
- Menarche 12 - 13 y.o.
- Adult Height 15 y.o..
When do Boys start Puberty?
- Boys start puberty between 10 and 15 y.o.
- Growth of Testicles 12 y.o.
- Pubic Hair 12 y.o.
- Growth of Penis 13 - 14 y.o.
- First Ejaculation 13 - 14 y.o.
- Growth Spurt 14 y.o.
- Adult Height 17 y.o.
What tests do you order for Abnormal Bleeding Disorder?
- CBC w/ Platelets, RBC indices, and a smear
- Reticulocyte count
- PT and PTT
- Platelet function test
- Factor VIII activity
- von Willebrand Factor antigen
- von Willebrand Factor activity (Ristocetin cofactor)
What are the Symptoms of vWD?
- Ecchymoses (small hematomas in areas of trauma)
- Epistaxis
- Menorrhagia
- Bleeding post-tonsillectomy and Dental Extractions
- Gingival bleeds
Treatment for vWD?
- Intranasal or Intravenous Desmopressen
- Sometimes Human plasma-derived, virally inactivated von Willibrand’s Factor concentrate
- For Menorrhagia
- Contraceptive pills
- Levonorgestrel Intrauterine device
What genetic dominance is vWD?
Autosomal Dominant
Describe Tanner Stage I in Females?
- No Glandular Tissue and is Prepubertal
- No Pubic hair at all
- < 10 y.o.
Describe Tanner Stage II in Females?
- Breast Buds form and Areola Begins to widen
- Long, Downy Hair w/ Slight pigmentation appears on the Labia majora
Describe Tanner Stage III in Females?
- Breast buds elevated but do not have secondary mound characteristics
- Pubic hair extends laterally
Describe Tanner Stage IV in Females?
- Breasts increased in size and elevation
- Areola and Papilla forma secondary mound that projects from the contour of the rest of the breast
- Pubic hair extends across the Mons Pubis and spares the Medial thigh
Describe Tanner Stage V in Females?
- Breasts reach their adult size
- Areola returns to contour
- Central papilla remains projectings
- Pubic hair extends to the medial surface fo the thighs
(2) Classic Symptoms of Hypotension?
- Dizziness
- Visual Disturbances
(2) Common Triggers of Hypotension?
- Volume depletion
- Skipping meals
What is Osgood-Schlatter Disease?
- A condition caused by irritation of the Growth Plate at the Tibial Tuberosity (Front of the Tibia Bone)
- Self-limited growing pain
- Resolves w/ Rest and Finishing of Growth Spurt
Causes of Chest Pain in Children?
-
Musculoskeletal are the most common cause of chest pain in children
- Precordial Catch Syndrome and is of Unknown etiology
- Sudden Sporadic Sharp pain along left sternal border - “Broken” by deep inspiration
- Costochondritis due to inflammation and last hours to days
What does OPQRSTAAA stand for?
- Onset
- Position
- Quality
- Radiation
- Severity
- Timing
- Aggravation
- Alleviation
- Associated Symptoms
- Brief pain
- Unassociated w/ exertion
- Sporadic
- Sharp
- Exacerbated by breathing
Precordial Catch Syndrome
- Pain During Exercise
- Coughing
- Respiratory Distress
- Wheezing
Exercise-induced Bronchospasm
or
Asthma
- Retrosternal
- Burning
- Non-radiating
- Associated w/ Meals
Gastritis
or
Esophagitis
- Long Durational pain
- Unassociated w/ Exertion
- Sporadic
- Sharp
- Exacerbated by Breathing
Costochondritis
What does HEEADSS stand for?
- Home
- Education / Employment
- Eating Disorders
- Activities
- Drug Use
- Sex
- Suicidality
Which immunizations are given at
the pre-adolescent evaluation?
- Tdap
- used for adults and children 11 years of age and older who need booster doses of diphtheria, tetanus toxoid, and acellular pertusis
- Meningococcal
- 11 or 12 - first dose
- 16 - booster dose
Murmur Characteristics that require further investigation?
- Louder than Grade III / IV
- Any Diastolic murmur
- Any murmur that increases w/ standing or Valsalva
(3) Parts of the Genitourinary Exam in Males?
- Prepartation Physical in Males
- Inguinal Hernia (esp. w/ sprinting and weight lifting)
-
Undescended Testicle
- if One Testicle –> protective Cup is Req’d
- Recommended that Men do Monthly Testicular Self-exams after puberty
Male Phallus Tanner Development Stages?
- Childlike Phallus, testicular volume < 1.5 ml (prepubertal)
- Childlike Phallus, Testicular volume 1.6 - 6 ml
Reddened thinner and larger Scrotom - Increased Phallus Length
Testicular Volume 6-12 ml
Greater Scrotal enlargement - Increase Phallus ircumference, 12 - 20 ml
Further Scrotal enlargment and Darkening - Adult Scrotum and Phallus, > 20 ml
Male Hair Growth Tanner Stages?
- No Pubic Hair
- Small amount of fine hair along the base of the Scrotum and Phallus
- Moderate amount of curly, pigmented, Coarser hair extending laterally
- Coarse curly adult like hair that doesn’t yet extend to the medial surface of Thighs
- Adult-type hair extending to Medial Surface of Thighs
- One Week History of:
- Complaints of Low-grade Fever
- Malaise
- Cervical Lymphadenopathy
- Pharyngeal exudate
EBV testing suggestive of Mononucleosis
