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CPS > Teens > Flashcards

Teens Flashcards

1
Q

what are indicators of sexual abuse in children with disability?

A 
unexplained fear of gyn exam
sexualized behaviour
sexually abusive behaviour
behavioural changes
avoiding specific care givers
self-harming
sleep issues
encopresis
sexual experimentation with age inappropriate partner
running away
somatic complaints
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2
Q

what percent of babies born to mom with untreated chlamydia will develop the infection

A

50!

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3
Q

if a man is more symptomatic than a female, which STI could it be?

A

Gonorrhea

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4
Q

who should be screened for STI? in girls

A

all girls that are sexually active and or victims of sexual assault or abuse
At least ANNUALLY

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5
Q

who should be screened for STI? in boys

A

any with one or more:

  • contact with STI
  • previous STI
  • STI clinic patients
  • new partner or > 2 partners in a year
  • drug use
  • unsafe sex
  • anonymous sex partner
  • sex workers and clients
  • homelessness
  • detention facility exposure
  • experience of sex assault
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6
Q

How do you test for Chlamydia?

A

first catch urine NAAT (nucleic acid amplification test)

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7
Q

who needs a test of cure test for chlamydia?

A

if pre-pubertal 3-4 wks post Rx

if post pubertal:

  • poor compliance OR
  • alt treatment was used OR
  • likely reexposure OR
  • pregnant
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8
Q

how often do you test a pt still at risk of chlamydia/gono?

A

q 6 month

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9
Q

how do you test for gonorrhea?

A

first catch urine is recommended
Culture if oral or anal
if possible, get culture BC or increasing resistance

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10
Q

when are gonnorrhea cultures suggested?

A 
if oral or anal sex
if suspect sexual abuse of assault
if MSM
if presumed treatment failure
if ? PID
if infection occured in place of high resistance
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11
Q

when is NAAT not validated

A

not validated in < 12 yrs or for medico-legal reasons

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12
Q

who gets TOC testing in gono

A

if prepubertal - CULTURE 3-7 days post Rx
if alt treat used
if Hx of failure of Rx
if resistance suspected
if high re exposure rate
if pregnant
if signs of pharyngeal infection post ABX

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13
Q

how do you screen for syphilis?

A

enzyme immunoassay
(some do serology first)
if + need treponemal confirmatory test

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14
Q

what are primary prevention measures for STI

A

HPV vaccine
HepB vaccine
condom use
behaviour change

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15
Q

what are secondary prevention measures for STI

A

partner notification

treatment and screening for STI in asympt

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16
Q

how do you treat anogenital infections

A

cetriaxone + azithromycin

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17
Q

is serology for chlamydia useful?

A

no, lots of cross reactivity

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18
Q

How do you do TOC in gonorrhea

A

CULTURE 3-7 days post treatment

or NAAT 2-3 weeks post if can’t get cultures

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19
Q

if you treated a patient for syphilis, what type of monitoring do you do?

A

Can now do RPR ( can be negative in early cases of primary):
for infectious cases - repeat test at 1, 3, 6, 12 mo
for latent - repeat at 12 and 24 mo

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20
Q

if male has urethritis, what should you test for

A

urethral swab for stain and culture - Gono
and
urine NAAT for chlamydia

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21
Q

if woman has cervicitis, what testing do you do?

A

vag.C swab for gono and chlamydia cultures
swab for HSV if lesion
wet mount swab

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22
Q

what is an alternative treatment for anogenital infections

A

spectinomycin2 g IM x 1
+
Azithromycin 1g PO x 1

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23
Q

what can increase the injury risk of kids and ATVs

A

inexperience
inadequate size and strength
immature motor or cognitive dev
tending to engage in high risk behaviour

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24
Q

what is the age limit for ATV?

A

16 yr including for youth sized ones

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25
Q

what are the ATV recommendations for someone who is older than 16

A 
wear helmet - gov certified
eye protection
protective wear and footwear
NO passengers
NOT under the influance
NEED to complete approved training program
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26
Q

how should a firearm be stored - Canadian Firearm Act

A

locked - container or with a trigger lock
unloaded
separate from ammunition

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27
Q

at what velocity can you penetrate an eye?

A

39 m/s

NO regulation of nonpowder firearms

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28
Q

what are the 3 benefits to teaching teens about their chronic disease?

A

learn to avoid situation that exacerbate their condition
learn how to minimize the severity of an exacerbation
learn self care to minimized daily effect of their illness

29
Q

when should you start the conversation about transitioning to adult care?

A

10-12 yrs

30
Q

how is adult care different from peds care?

A

patient focused
investigational
requires autonomous consumer skills
limited interdisciplinary resources

31
Q

what are important steps in transitioning care to the adult system?

A

transition should occur at the youth’s pace
teen involvement in mgnt
family understanding of the condition
understanding personal potentials - ed, recreation, vocation
talk to teen on their own
ask about sex…
provide info that deals with youth issues
formal acknowledgement
Give transition letter

32
Q

what are barriers to health care for street involved youth?

A 
lack of money
lack of transportation
lack of knowledge about available health care
lack of trust of authorities
fear of being reported
need for health card
need for permanent address
lack of knoweldge about the mature minor protocol
33
Q

what are physical health issues that street involved youth face most often

A 
TB
Asthma
dental disease
malnutrition
foot problems
derm infections - lice, scabies...
injuries
lack of immunization - hep B, HPV for both sexes
34
Q

what are approaches to harm reduction? 3

A
  1. discourage behaviour
  2. encourage teen to reduce the behaviour
  3. provide info aimed at reducing the behaviour
35
Q

for young adults and pre-teens, how do we approach harm reduction?

A

primary prevention

- discourage behaviour

36
Q

what are group ahs highest pgenancy rate:

a. 15-17
b. 18-19
c. younger than 15

A

18-19

most likely planned

37
Q

what % of teen pregnancy end in induced abortions

A

> 50%

38
Q

why might it be challenging to Dx teen pregnancy

A
  • denial
  • complex social situations
  • tend to have menstrual irregularities
39
Q

at what gestation can it be felt above the pubic bone

A

9-12 weeks

40
Q

how do you counsel a pregnant teenager who wants to keep the baby

A
  1. must find a GP
  2. Provided appropriate resources
  3. encourage to stay in school
  4. encourage baby daddy if ok
41
Q

when is a teen mom most likely to have a second pregnancy?

A

35% will in the following 2 yrs

42
Q

How do you counsel a teen who plans to terminate

A
  • explain the procedure
  • anticipatory guidance about common emotions
  • appropraite referral
  • follow 48 hrs post
  • discuss contraception
43
Q

what kids are most at risk of unprotected sex?

A
  • social and family difficulties
  • mothers were teen moms
  • early puberty
  • Hx of sexual abuse
  • frequent school absenteeism
  • lack od vocational goals
  • siblings who were teen moms
  • alcohol, smoking and drug use
  • live in group home/street/detention
44
Q

what is the mechanism of action of both combo emergency contraceptives

A

suppression or delay in LH peak
delaying or inhibiting ovulation
disrupting follicular dev
interfering with maturation of corpus luteum

45
Q

which is better, progestin only of combined when it comes to EC

A

Progestin only (plan B) - 1-3% pregnancy rate
VS
combined - 3-7%

46
Q

what are the contraindications to EC

A

known pregnancy

allergy

47
Q

In which situation is EC not considered

A

a. coitus interruptus
b. ejaculation onto genitals
c. spermacide use only and in midcycle
d. Missed 1 OCP in week 3 of package* 2
e. vaginal ring in for . 5 weeks
f. depo shot late by > 2 weeks

48
Q

what work up is needed before prescribing EC

A

none

49
Q

when can benadryl be taken if taking combined pill

A

1 hour before

if vomit within 1 hour of taking - needs to take it again!

50
Q

patient comes to you because she dropped one of her EC combined pill. What should she do?

A

If miss second one at 12 hrs, need to redo entire course.

51
Q

if pt has OCP and cannot afford Plan B or Yuzpe, what is an alternative plan

A

take 2 doses 12 hrs apart of 4-5 low dose OCP

52
Q

what are 4 SE of progestin only EC

A

HA
fatigue
nausea
dizziness

53
Q

if a woman comes to you 6 days after unprotected sex, what are EC options for her?

A

copper IUD up to 7 days

removed during or after next period

54
Q

what WU is needed if you are about to insert a copper IUD for EC

A

NEED pregnancy test!
chlamydia
gono testing
may consider Rx

55
Q

when counselling a patient about EC, what should be covered?

A 
explain what it is
how it works
when to use it
how well does it work
how safe is it
what are SE
what is the tie limit for it
where and how to get it
***** talk about general contraception
56
Q

if a patient has taken EC, when should you see her again

A

one week post next expected period
if late by > 1 week - need BHCG
if abnormal period - needs BHCG
talk about contraception and STI

57
Q

who is at inc risk of melanoma?

A 
fair
freckles
skin moles
easily burnt skin
1st degree relative with melanoma
personal Hx
Large # of typical or atypical nevi
58
Q

what are complications of self tanning booth

A 
sunburn
dry skin
pruritis
photodrug Rx
skin aging
nausea
59
Q

recommendations for tanning beds

A 
NOT for < 18
need public education
need industry to admit that it causes cancer
Tax should be applied
do not allow unsuppervised tanning beds
MD screen and advocate
60
Q

for a child with ADHD, when is dietary mgnt potentially useful?

A

if allergy or migraines

61
Q

what herbal remedy possibly inhibits thyroid hormones and should not be used in Graves’s disease

A

lemon balm

62
Q

what does opiod withdrwal look like?

A 
depression
severe myalgia
nausea/V/D
chills
autonomic instab
63
Q

Kids in withdrawal from benzos, what are we worried about?

A

Seizures

64
Q

how should we help teens admitted to hospital

A

teen ward
provide school
++ privacy and confidentiality
allow time and space for friends

65
Q

what are some complications for teens admitted

A 
pwerless
loss of indep
loose control over privacy
can lead to regression
rule defiance
66
Q

gunshot wounds account for what percent of deaths in the 15-19 yrs group

A

8%of all deaths

67
Q

is having a firearm at home a RF for suicide?

A

YES

in 15 - 24 yr

68
Q

the presence of a fierarm in the home increases the risk of…3

A

suicide
homicide
unintentional injuries

69
Q

is there a legal issue around sexting?

A

YES

Teens can be arrested, charged and convicted of possessing and distributing child porn even if it is of themselves

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