Teens Flashcards
what are indicators of sexual abuse in children with disability?
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
what percent of babies born to mom with untreated chlamydia will develop the infection
50!
if a man is more symptomatic than a female, which STI could it be?
Gonorrhea
who should be screened for STI? in girls
all girls that are sexually active and or victims of sexual assault or abuse
At least ANNUALLY
who should be screened for STI? in boys
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
How do you test for Chlamydia?
first catch urine NAAT (nucleic acid amplification test)
who needs a test of cure test for chlamydia?
if pre-pubertal 3-4 wks post Rx
if post pubertal:
- poor compliance OR
- alt treatment was used OR
- likely reexposure OR
- pregnant
how often do you test a pt still at risk of chlamydia/gono?
q 6 month
how do you test for gonorrhea?
first catch urine is recommended
Culture if oral or anal
if possible, get culture BC or increasing resistance
when are gonnorrhea cultures suggested?
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
when is NAAT not validated
not validated in < 12 yrs or for medico-legal reasons
who gets TOC testing in gono
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
how do you screen for syphilis?
enzyme immunoassay
(some do serology first)
if + need treponemal confirmatory test
what are primary prevention measures for STI
HPV vaccine
HepB vaccine
condom use
behaviour change
what are secondary prevention measures for STI
partner notification
treatment and screening for STI in asympt
how do you treat anogenital infections
cetriaxone + azithromycin
is serology for chlamydia useful?
no, lots of cross reactivity
How do you do TOC in gonorrhea
CULTURE 3-7 days post treatment
or NAAT 2-3 weeks post if can’t get cultures
if you treated a patient for syphilis, what type of monitoring do you do?
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
if male has urethritis, what should you test for
urethral swab for stain and culture - Gono
and
urine NAAT for chlamydia
if woman has cervicitis, what testing do you do?
vag.C swab for gono and chlamydia cultures
swab for HSV if lesion
wet mount swab
what is an alternative treatment for anogenital infections
spectinomycin2 g IM x 1
+
Azithromycin 1g PO x 1
what can increase the injury risk of kids and ATVs
inexperience
inadequate size and strength
immature motor or cognitive dev
tending to engage in high risk behaviour
what is the age limit for ATV?
16 yr including for youth sized ones
what are the ATV recommendations for someone who is older than 16
wear helmet - gov certified eye protection protective wear and footwear NO passengers NOT under the influance NEED to complete approved training program
how should a firearm be stored - Canadian Firearm Act
locked - container or with a trigger lock
unloaded
separate from ammunition
at what velocity can you penetrate an eye?
39 m/s
NO regulation of nonpowder firearms
what are the 3 benefits to teaching teens about their chronic disease?
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
when should you start the conversation about transitioning to adult care?
10-12 yrs
how is adult care different from peds care?
patient focused
investigational
requires autonomous consumer skills
limited interdisciplinary resources
what are important steps in transitioning care to the adult system?
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
what are barriers to health care for street involved youth?
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
what are physical health issues that street involved youth face most often
TB Asthma dental disease malnutrition foot problems derm infections - lice, scabies... injuries lack of immunization - hep B, HPV for both sexes
what are approaches to harm reduction? 3
- discourage behaviour
- encourage teen to reduce the behaviour
- provide info aimed at reducing the behaviour
for young adults and pre-teens, how do we approach harm reduction?
primary prevention
- discourage behaviour
what are group ahs highest pgenancy rate:
a. 15-17
b. 18-19
c. younger than 15
18-19
most likely planned
what % of teen pregnancy end in induced abortions
> 50%
why might it be challenging to Dx teen pregnancy
- denial
- complex social situations
- tend to have menstrual irregularities
at what gestation can it be felt above the pubic bone
9-12 weeks
how do you counsel a pregnant teenager who wants to keep the baby
- must find a GP
- Provided appropriate resources
- encourage to stay in school
- encourage baby daddy if ok
when is a teen mom most likely to have a second pregnancy?
35% will in the following 2 yrs
How do you counsel a teen who plans to terminate
- explain the procedure
- anticipatory guidance about common emotions
- appropraite referral
- follow 48 hrs post
- discuss contraception
what kids are most at risk of unprotected sex?
- 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
what is the mechanism of action of both combo emergency contraceptives
suppression or delay in LH peak
delaying or inhibiting ovulation
disrupting follicular dev
interfering with maturation of corpus luteum
which is better, progestin only of combined when it comes to EC
Progestin only (plan B) - 1-3% pregnancy rate
VS
combined - 3-7%
what are the contraindications to EC
known pregnancy
allergy
In which situation is EC not considered
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
what work up is needed before prescribing EC
none
when can benadryl be taken if taking combined pill
1 hour before
if vomit within 1 hour of taking - needs to take it again!
patient comes to you because she dropped one of her EC combined pill. What should she do?
If miss second one at 12 hrs, need to redo entire course.
if pt has OCP and cannot afford Plan B or Yuzpe, what is an alternative plan
take 2 doses 12 hrs apart of 4-5 low dose OCP
what are 4 SE of progestin only EC
HA
fatigue
nausea
dizziness
if a woman comes to you 6 days after unprotected sex, what are EC options for her?
copper IUD up to 7 days
removed during or after next period
what WU is needed if you are about to insert a copper IUD for EC
NEED pregnancy test!
chlamydia
gono testing
may consider Rx
when counselling a patient about EC, what should be covered?
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
if a patient has taken EC, when should you see her again
one week post next expected period
if late by > 1 week - need BHCG
if abnormal period - needs BHCG
talk about contraception and STI
who is at inc risk of melanoma?
fair freckles skin moles easily burnt skin 1st degree relative with melanoma personal Hx Large # of typical or atypical nevi
what are complications of self tanning booth
sunburn dry skin pruritis photodrug Rx skin aging nausea
recommendations for tanning beds
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
for a child with ADHD, when is dietary mgnt potentially useful?
if allergy or migraines
what herbal remedy possibly inhibits thyroid hormones and should not be used in Graves’s disease
lemon balm
what does opiod withdrwal look like?
depression severe myalgia nausea/V/D chills autonomic instab
Kids in withdrawal from benzos, what are we worried about?
Seizures
how should we help teens admitted to hospital
teen ward
provide school
++ privacy and confidentiality
allow time and space for friends
what are some complications for teens admitted
pwerless loss of indep loose control over privacy can lead to regression rule defiance
gunshot wounds account for what percent of deaths in the 15-19 yrs group
8%of all deaths
is having a firearm at home a RF for suicide?
YES
in 15 - 24 yr
the presence of a fierarm in the home increases the risk of…3
suicide
homicide
unintentional injuries
is there a legal issue around sexting?
YES
Teens can be arrested, charged and convicted of possessing and distributing child porn even if it is of themselves
