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Primary Care of Adolescents > Primary Care of Adolescents > Flashcards

Primary Care of Adolescents Flashcards

1
Q

Early Puberty/ Beginning of Puberty

HPA axis goes into a state of dormancy….when?

And how?

A
  • HPA axis goes into a state of dormancy shortly after birth.
  • Gonadatropins from the hypothalamus are suppressed by a CNS inhibitor and negative feedback of minute amounts of estrogen/testosterone
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2
Q

Early Puberty/Beginning of Puberty

Secretion of DHEA and other weakly androgenic hormones happens when and from where?

What does this cause? And what does that look like?

A
  • At approximately 6-8 years of age, secretion of DHEA and other weakly androgenic hormones from the adrenal glands increase which causes adrenarche.
    • Occurs several years prior to appearance of clinical effects but may cause oily skin & body odor.
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3
Q

Early Puberty/ Beginning of Puberty

At Puberty, the suppression of endogenous GnRH starts to disappear… what happens with estrogen/testosterone?

What happens during sleep?

What age does this happen?

A

At Puberty, the suppression of endogenous GnRH starts to disappear

  • Decreased sensitivity to negative feedback of estrogen/testosterone causes a pulsatile secretion of GnRH initially only during sleep
  • As the amplitude and frequency of the GnRH pulses increase, sleep associated secretion of LH into the blood stream also occurs which is the initiation of puberty
  • Girls = 9.6 years old
  • Boys = 11.6 years old
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4
Q

Early Puberty/ Beginning of Puberty

What happens to sexual organs as gonadatropins increase? What do they produce?

What is first clinical sign of puberty for girls and boys, and at what age?

A
  • As the gonadatropins increase, the ovaries/testes enlarge and begin to produce estrogen/testosterone
  • For girls the 1st clinical sign of puberty is thelarche (breast budding) at 9-10 years old
  • For boys = increase in testicular volume at 11-12 years old
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5
Q

Mid Puberty

Concentration of FSH/LH: Characteristics during wakefulness and sleep?

Testosterone highest when?

Esradiol highest when?

What happens to pulse frequency and amplitude?

A
  • An increase in the concentration of FSH/LH increases during wakefulness as well as sleep, however, FSH, LH and testosterone levels still highest during sleep
  • Estradiol significantly higher in the late afternoon than during sleep
  • GnRH Mean pulse frequency and amplitude also increases
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6
Q

Late Puberty

What happens to GnRH pulses?

FSH/LH concentration characteristics compared to adults?

Testosterone and estradiol concentration levels compared to adults?

A
  • Amplitude of GnRH pulses increases further
  • Peak concentrations of FSH and LH during sleep may exceed those seen at any time in an adult
  • Testosterone and estradiol levels also increase at the same time but do not exceed adult concentrations
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7
Q

End of Puberty

Concentrations of gonadotropins and sex steroids characteristics during sleep and wakefulness?

What happens to sleep augmentation phenomenon?

A
  • Concentrations of gonadotropins and sex steroids are the same during sleep and wakefulness
  • No longer see sleep augmentation phenomenon
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8
Q

Secondary Sexual Characteristics

What are they caused by?

How do they affect girls?

How do they affect boys?

A
  • Caused by an increase in FSH, LH, and sex hormones
  • Increased amounts of FSH and LH cause ovaries and testes to produce testosterone and estrogen
  • Girls
    • FSH: Ovarian Development
    • LH: enhances follicular production of estrogen, ovulation and corpus luteum formulation
  • Boys
    • FSH: influences sperm production
    • LH: Stimulates maturation of testicular cells and production of testosterone
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9
Q

Tanner Stages

Breasts

1.

2.

3.

4.

5.

A

Breasts

  1. None
  2. Breast bud
  3. Breast areola larger
  4. Secondary mound of areola nipple on breast
  5. Separation of areola and breast disappears
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10
Q

Tanner Stages - Girls Pubic Hair

Girls Pubic Hair

  4. 5.
A

Public Hair

  1. None
  2. Fine straight lateral borders of genitalia
  3. Coarse, curly, darker hair over pubic bone
  4. Coarser, curlier, triangle of hair
  5. Hair extends to thighs
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11
Q

Tanner Stages - Boys Genital

Boys Genital

  4. 5.
A

Boys Public Hair

  1. None
  2. Fine straight lateral borders of genitalia
  3. Coarse, curly, darker hair over pubic bone
  4. Coarser, curlier, triangle of hair
  5. Hair extends to thighs
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12
Q

Tanner Stages - Boys Pubic Hair

Boys Pubic Hair

  4. 5.
A

Boys Pubic Hair

  1. No changes from Childhood
  2. Penis and testes slightly larger, hair on lateral aspects, scrotum textured
  3. Pubic hair covers pubis, further enlargement of testes/scrotum. Penis Longer
  4. Abundant hair, resembles adult, gland larger and broader
  5. Hair extends to inner thighs, testes and scrotum adult size
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13
Q

Physical Growth

As GnRH levels rise, what happens to hGH?

How is GH secreted and when?

When is GH the highest?

How many GH pulses are common?

A

Physical Growth

  1. At the same time GnRH levels are rising, hGH levels rise on a 24 hour basis to initiate the growth spurt (childhood 5-6 cm/yr and 2-4 kg/yr)
  2. GH is secreted in a pulsatile manner associated with slow-wave sleep
  3. Highest GH pulse of the night usually occurs at the beginning of the 1st sleep cycle
  4. 2-3 subsequent pulses are common, usually lower
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14
Q

Girls Physical Growth

Age of:

  1. IGS (Initiation of Growth Spurt)
  2. PHV (Peak Height Velocity)
  3. PWV (Peak Weight Velocity)
  4. Completes at when?
A

Girls Physical Growth

Age of:

  1. IGS: **9.6 yrs **
  2. PHV: 11.8 yrs (9-10 cm/yr)
  3. PWV: 12 yrs (7kg/yr)
  4. Completes at 18
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15
Q

Boys Physical Growth

Age of:

  1. IGS (Initiation of Growth Spurt)
  2. PHV (Peak Height Velocity)
  3. PWV (Peak Weight Velocity)
  4. Completes at when?
A

Boys Physical Growth

Age of:

  1. IGS: 11.7 yrs
  2. PHV: 14 yrs (9.5 cm/yr)
  3. PWV: 14 yrs (8 kg/yr)
  4. Completes at 20.
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16
Q

Girls Physical Growth Pattern

  1. __.__ yrs = ___ (IGS/PWV/PHV), __ Stage__.
  2. __.__ yrs = ___ (IGS/PWV/PHV), __ Stage __, __Stage__.
  3. __.__yrs = ______
  4. Familial patterns of __/__ and _____ may/may not delay.
  5. (Physical growth/Sexual maturation) precedes (physical growth/sexual maturation)
A

Girls Physical Growth Pattern

  1. 9.6 years = initiation of growth spurt, breast development stage 1
  2. 11.8 Years = peak height velocity, breast stage 2-3, pubic hair stage 2-3
  3. 12.6 years = Menarche
  4. Familial patterns of mom/sisters and environmental factors may delay.
  5. Physical growth precedes sexual maturation.
17
Q

Boys Physical Growth Pattern

  1. __.__ yrs = __ Stage__.
  2. ___, __, ___, ___
  3. ___% of boys are at ___ when they reach their peak height velocity.
  4. (Physical growth/Sexual maturation) precedes (physical growth/sexual maturation)
A

Boys Physical Growth Pattern

  1. 11.6-11.7 years = Gondal stage 2-3
  2. PH2, G4, PH3, PHV
  3. 76% of boys are at G4 when they reach their peak height velocity
  4. Sexual maturation precedes physical growth.
18
Q

Ht Velocity Curves

Why are ht. velocity curves more useful in clinical assessment of growth & development than standard growth curves?

How do you do a Ht Velocity Curve?

A

​Ht Velocity Curves

  • You will be able to tell when the growth spurt has started and ended.
  • To do a height velocity curve you would do the following steps
    • Subtract the Heights that are a year apart and document the difference between them
    • Plot the differences on a graph at the midpoint between the two years.
19
Q

Explain Menstrual Cycle to 12 yr Old

A

12 yo:

As you get older, there are some changes that will happen to your body. One of those changes will be getting your period every month. Women get a period ever month because every month your body is preparing itself for the possibility of getting pregnant.

Your period will happen about every 28 days. At the beginning of your period cycle, your body releases substances called hormones, which makes one of your eggs release from your ovaries and makes the lining of your uterus thicker.

If you were to have sex without protection, the egg and the sperm from the man would meet and then go into the lining of your uterus to start to form a baby and you would be pregnant. If you did not have sex, at the end of your cycle, the egg breaks down and the lining of your uterus also breaks down and you have your period. This is when blood is coming out of your vagina.

20
Q

Explain Menstrual Cycle to Classmate

A

To classmate:

The menstrual cycle begins after your period beginning with the follicular phase. This is when the egg is maturing inside of your ovary. It begins with a release of GnRH from the hypothalamus, which stimulates the secretion of FSH and LH from the anterior pituitary. FSH and LH help to mature the egg within the ovary.

On day 5-7 a follicle, a mature egg, emerges in the ovary. Estrogen levels are increasing during this time, causing proliferation of the endometrium, the uterine lining. There is then a surge in LH and FSH and the mature egg cells is released from the follicle in the ovary.

The luteal phase starts after the release of the egg and lasts for about 14 days. The eggs releases progesterone, which causes further proliferation of the uterine lining.

If there is no pregnancy, the lack of the hormone HcG causes falling estrogen and progesterone levels. The falling estrogen and progesterone levels causes necrotic changes in the endometrium and you have menses.

21
Q

Initial cycles anovulary

  • Ovulation and regular, predictable cycles not established until when?
    • (Which usually occurs when?)
      • ___ years after initial growth spurt.
      • ____years after peak height velocity
    • Proceeded by ___ of ____.
A

Initial cycles anovulary

  • Ovulation and regular, predictable cycles not established for a few years after menarche
  • Menarche usually occurs at 12.6 years
    • 3.3 years after initial growth spurt
    • 1.1 years after peak height velocity
  • Proceeded by 6 months of mucoid discharge
22
Q

Stages of Menstruation - Follicular phase

  1. ____ released in pulses from the ____, which stimulates the ___ to release ___ and ___
    1. ___\_
      1. Increase of granulose cells in ovarian follicle
      2. Increase receptors for ___ on granulose cells
      3. Granulosa cells convert androgen precursors to estradiol causing greater effects of ___
    2. ___\_
      1. Acts on theca cells causing secretion of andostenedione, testosterone, and estradiol into the follicle and blood
  2. Dominant Follicle emerges (day ___)
  3. ___ level decreases secondary to negative feedback of increased ___ level
  4. Increased ___ receptors and increased secretion of estradiol, further proliferation of the endometrium
  5. ____ Surge
A

_Stages of Menstruation - Follicular phase _

  1. GnRH released in pulses from the hypothalamus, which stimulates the anterior pituitary to release FSH and LH
    1. FSH
      1. Increase of granulose cells in ovarian follicle
      2. Increase receptors for FSH on granulose cells
      3. Granulosa cells convert androgen precursors to estradiol causing greater effects of FSH
    2. LH
      1. Acts on theca cells causing secretion of andostenedione, testosterone, and estradiol into the follicle and blood
  2. Dominant Follicle emerges (day 5-7)
  3. FSH level decreases secondary to negative feedback of increased estrogen level
  4. Increased LH receptors and increased secretion of estradiol, further proliferation of the endometrium
  5. LH/FSH Surge
23
Q

What is Ovulatory Phase?

A

After Follicular phase, rupture of follicle and expulsion of oocyte

24
Q

Stages of Menstruation - Luteal Phase

  1. ____ ___ secretes _____ and 17-hydroxyprogesterone
  2. Increased ____ and ____ cause endometrium to further proliferate
  3. Maturation of endometrium ____ days after _____
  4. No Pregnancy
    1. Lack of ___ causes ____ estrogen and progesterone levels
    2. ___ changes in endometrium
    3. Menses
  5. Pregnancy
    1. ____ HCG
A

Stages of Menstruation - Luteal Phase

  1. Corpus Luteum secretes progesterone and 17-hydroxyprogesterone
  2. Increased progesterone and estrogen cause endometrium to further proliferate
  3. Maturation of endometrium 8-9 days after ovulation
  4. No Pregnancy
    1. Lack of HCG causes falling estrogen and progesterone levels
    2. Necrotic changes in endometrium
    3. Menses
  5. Pregnancy
    1. Increased HCG
25
Q
A

Primary Care of Adolescents (1 decks)

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