[MS] Adolescent/GYN Flashcards
What accounts for nearly half of all deaths in adolescents?
Unintentional injuries
What is the first physical sign of puberty in women?
Telarche (breast budding)
What is the first physical sign of puberty in men?
Testicular enlargement
Why are men generally taller than females?
Delayed epiphyseal closure
What qualifies a patient as an emancipated minor?
Lives outside of the home and paying their own bills, married, or being a parent
When is it acceptable to perform a drug test on a minor without consent from the minor?
The adolescent lacks decision-making capacity, or there are strong concerns for a substance abuse problem
What are the important topics to discuss during an adolescent clinic visit?
Normal development, home environment, substance abuse, physical/sexual abuse, academics, peers, injury prevention, nutrition, physical activity, dental health, self-examination, skin protection, online behavior, and bullying
What are the criteria for diagnosing depression in an adolescent?
Failure to maintain weight, insomnia/hypersomnia, psychomotor changes, fatigue, worthlessness, excessive guilt, decreased concentration, and thoughts of self-harm
What are the laboratory findings associated with anorexia nervosa?
Low - K, Cl, WBC, Plt, RBC, PO4, Ca
High - AST, ALT, BUN, Cholesterol
What changes are seen with refeeding syndrome?
Hypophosphatemia, cardiac arrhythmias, hypokalemia, hypomagnesemia, volume overload, and edema
What is the pharmacologic therapy for Bulimia Nervosa?
Fluoxetine
What historical clues are associated with breast fibroadenomas?
Firm, painless, rubbery, and do not regress with periods
Do fibroadenomas have s risk of malignancy?
No
What is the most common adolescent breast mass?
A solitary cyst that resolves within 2 to 3 months
What are the indications for breast mass excision?
Persistent lesions greater than 3cm
What is the most common cause of adolescent mastitis?
Staphylococcus aureus
What is associated with GnRH deficiency?
Anosmia (Kallman syndrome)
What is the most common pituitary cause of amenorrhea?
Prolactinoma
What disease processes commonly result in secondary amenorrhea?
PCOS, Congenital Adrenal Hyperplasia, Cushing Syndrome, Anabolic Steroid Use, and Adrenal Adenomas
What is Rokitansky syndrome?
Mullerian agenesis, primary amenorrhea, and absence/hypoplasia of the vagina/cervix/uterus
What is the most common cause of secondary dysfunctional uterine bleeding?
Bleeding disorders such as von Willebrand disease
What is the first-line treatment for dysmenorrhea?
NSAIDs
What are the drugs of choice for severe PMS/PMDD?
SSRI
At what size gynecomastia should males be referred for surgery?
Greater than 5cm
What is the treatment for typical scrotal masses?
Surgery
Where are spermatoceles typically located?
Superior and posterior to the testicle
What diagnosis is associated with a blue dot on the scrotum?
Torsion of the appendix testis
In what age group are testicular tumors most common?
Males between 15 and 35 years of age
What testicular tumors have an increase in beta-HCG?
Choriocarcinomas and Mixed Germ-Cell Tumors
What types of testicular tumors produce and elevated alpha-fetoprotein?
Yolk Sac Tumors and Embyronal Carcinomas
What can occur after a testicle atrophies post-orchitis?
Cancer
What are the absolute contraindications to oral contraceptives?
Abnormal uterine bleeding of unknown cause Pregnancy Estrogen-dependent bleeding Liver disease Thromboembolic disease Cerebrovascular events Migraine with auras
What are the relative contraindications for Estrogen use?
Diabetes mellitus Seizures Vascular headaches Severe/Moderate hypertension Tobacco use
What STDs are reportable conditions in every state?
Syphilis, Gonorrhea, Chlamydia, and HIV
What are the symptoms of Acute Retroviral Syndrome?
Fever, headaches, pharyngitis, malaise, myalgias, lymphadenopathy, and a skin rash
What is the best test to diagnose HIV infection during an acute retroviral infection?
HIV plasma RNA
What is the diagnosis when tender, grouped genital vesicles are seen?
HSV
What is the test of choice for diagnosing HSV in the CSF?
HSV PCR
What is seen on a Tzanck smear for HSV?
Multinucleated giant cells
What is the preferred treatment for recurrent genital HSV?
Acyclovir BID
What are the screening tests for syphilis?
VDRL and RPR
What are the confirmatory tests for syphilis?
FTA-ABS and TP-PA
What is the cause of chancroid and how is it treated?
Haemophilus ducryei and treated with Azithromycin
What are the clinical presenting symptoms of Granuloma inguinale (Donovanosis)?
Painless, progressive, friable lesion without regional lymphadenopathy
What is the treatment for Donovanosis?
Doxycycline
What is the causative organism and presenting symptoms of lymphgranuloma venereum?
Caused by Chlamydia trachomatis (L1/L2/L3)
Presents as a painless genital ulcer with unilateral adenopathy
May present as proctocolitis in homosexual men
What is the chronic complication from lymphgranuloma venereum?
Chronic colorectal fistulas and strictures
What is the recommended first-line therapy for gonorrhea infection?
Ceftriaxone plus Azithromycin/Doxycycline
What causes an elevated vaginal pH?
Bacterial Vaginosis and Trichomonaisis
What appears as motile organisms on a wet mount preparation?
Trichomonas vaginalis
What disease process shows Clue cells?
Bacterial vaginosis
What disease process typically shows curved gram-negative rods?
Bacterial vaginosis (Mobiluncus)
What are the adverse outcomes of bacterial vaginosis during pregnancy?
Premature rupture of membranes
Chorioamnionitis
Pre-term birth
What are the clinical signs of Trichomonaisis?
Frothy, malodorous, yellow discharge with a strawberry cervix
What do you treat partners with who female parterns have Trichomonaisis?
Metronidazole
What strains of HPV cause the majority of genital warts?
HPV 6 and 11
What strains of HPV cause cervical neoplasia?
HPV 16, 18, 31, 33, and 35
When should women begin PAP screening?
Age 21
What strength of Permethrin is used to treat scabies?
5%
