Peds 5 Flashcards
Adolescent c/o cold skin, coarse hair, fatigue, slowness, doing poorly in school, preferring hot weather to cold
Dx?
hypothyroidism
S/s: extreme fatigue, pharyngitis, and lymphadenopathy
Dx?
infectious mononucleosis
What is infectious mononucleosis (mono) caused by?
Epstein Barr virus –> infection of lymphocytes
What’s the average age range that girls begin puberty?
8-13 years old
What’s the average age range that girls begin puberty?
10-15 years old
What is the typical order of girls' stages of puberty? 10-11yo 10-11yo 12yo 12-13yo 15yo
Breast buds appear (age 10-11 years), then,
Pubic hair appears (age 10-11 years) then,
Growth spurt (age 12 years) then,
Periods begin/menarche (age 12-13 years) then,
Attainment of adult height (age 15 years)
What is the typical order of boys' stages of puberty? 12yo 12yo 13-14yo 13-14yo 14yo 17yo
Growth of testicles ( age 12 years) then,
Pubic hair appears (age 12 years) then,
Growth of penis, scrotum (age 13-14 years) then,
First ejaculations (age 13-14 years) then,
Growth spurt (age 14 years) then,
Attainment of adult height (age 17 years)
What lab tests to order to test for bleeding disorder?
Complete blood count (CBC) with platelets, red blood cell indices, and a smear
Reticulocyte count
Prothrombin time (PT) and partial thromboplastin time (PTT)
Platelet function test (which has largely replaced the bleeding time in most centers)
Factor VIII activity
von Willebrand factor antigen
- von Willebrand factor activity (also known as Ristocetin cofactor)
Treatment for von Willebrand disease?
-Desmopression (IN or IV)
- human plasma-derived, virally inactivated von Willibrand’s factor concentrate
- For menorrhagia, combination oral contraceptive pills (OCPs), or levonorgestrel intrauterine device (IUD) would be the treatments of choice
Lab tests that point to von Willebrand dz?
Confirmation test?
-prolonged platelet function or bleeding time
-mild prolongation of the aPTT point
Sometimes, aPTT may be normal and the patient will still have vWD.
To confirm vWD, check the von Willebrand factor antigen and/or platelet function analysis and factor VIII levels
A 15-year-old female comes to the clinic with a chief complaint of feeling tired for one month. She has also been complaining of frequent nosebleeds while at school and bruising easily. She had menarche at the age of 9 and her periods have always been heavy and irregular. Her mother and grandmother also have heavy periods and easy bruising. What is the pattern inheritance of the bleeding disorder in this patient?
A. Autosomal dominant
B. Autosomal recessive
C. Mitochondrial
D. X-linked recessive
A. Autosomal dominant
A 14-year-old girl presents to your office wondering why she has not had her period yet. Her mother states that she and the patient’s grandmother reached menarche at 13 years of age. The patient is concerned she is behind her friends in terms of development. She is doing well in school and has not had developmental problems in the past. On physical examination, her breasts are elevated without a secondary mound, and curly, coarse pubic hair is present on the labia majora in a triangular shape but does not reach the mons pubis. What Tanner stage would you assign this girl?
Tanner Stage III
A 16-year-old female presents to clinic complaining of worsening fatigue. Family history is significant for hypothyroidism and heavy periods in the grandmother. Her exam reveals mild tachycardia and oozing around a recent piercing, but is otherwise normal. Labs reveal Hgb 8.5 g/dL, MCV 58, PT 12.5, PTT 44, and low von Willebrand factor activity. Which of the following is the most appropriate treatment for her underlying disorder?
Desmopressin
A 10-year-old female comes to the clinic for a well child exam. Her mom asks about puberty and wants to know in what order she should expect to see normal pubertal changes in her daughter. Which of the following sequences is correct?
A. breast bud -> pubic hair -> growth spurt -> menarche
B. breast bud -> pubic hair -> menarche -> growth spurt
C. pubic hair -> breast bud -> growth spurt -> menarche
D. pubic hair -> breast bud -> menarche -> growth spurt
E. pubic hair -> menarche -> breast bud -> growth spurt
A. breast bud -> pubic hair -> growth spurt -> menarche
A 16-year-old male comes to clinic because of concerns about being one of the smallest students in his class. He says that people think that he looks like he should be in middle school rather than high school. His mother says that until about four years ago, she did not notice much difference between the patient and his friends. However, in the past two years, he has become the shortest person in his class. When assessing for pubertal development, what is the first physical exam finding expected in this patient if puberty has started?
Testicular enlargement
