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1. pediatrics > Adolescent and Gynecology > Flashcards

Adolescent and Gynecology Flashcards

1
Q

[Adol/Law/Minor]

Criteria for emancipated minors? (4)

A

For < 18 years
1. Married
2. Active duty status in the military
3. Have obtained a court order
4. Living separately and financially independent

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2
Q

[Adol/Law/Confidentiality]

Situations that have right to break confidentiality (3)

A
  1. Physical or sexual abuse
  2. Nonadherence with treatment of medical condition
  3. Treat of harm to self or others
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3
Q

[Adol/Screening/STD]

STI screening indications in female (1) and male (2)?

A

Female:
All sexually active < 25 years old

Male:
If increased risk (Include HIV/syphilis if high risk)

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4
Q

[Adol/STD]

Time to repeat test in C. trachomatis or N. gonorrhoeae?

A

3 months for re-infection
(No need for test of cure, 4 weeks, only for pregnancy)

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5
Q

[Adol/STD]

CDC recommends treating all sexual partners of GC/CT infection within the past ___ months

A

2 months

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6
Q

[Adol/Screening/STD]

STI screening recommendation for men sex with males (MSM)? (5)

A
  1. HIV
  2. Syphilis
  3. Urine GC/CT
  4. Rectal GC/CT
  5. Pharyngeal GC (no Chlamydia for oropharynx)
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7
Q

[Adol/Screening]

Cervical cancer screening begin at __ years of age regardless of sexual activity.

Earlier screening management to ___ patients (3)

A

Cervical cancer screening begin at 21 years of age regardless of sexual activity.

  1. History of high-grade precancerous cervical lesions, cervical cancer
  2. In utero exposure to diethylstilbestrol
  3. Immunocompromised or HIV positive
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8
Q

[Adol/Eating/AN]

Endocrinologic complications of anorexia nervosa? (3)

A
  1. Amenorrhea (hypogonadotropic hypogonadism, no progesteron withdrawal bleeding)
  2. Euthyroid hypothyroxinemia (Low T3, normal T4/TSH)
  3. Osteopenia
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9
Q

[Adol/Eating/AN]

Cardiac complications of anorexia nervosa? (5)

A
  1. Bradycardia
  2. Prolonged QT
  3. Mitral valve prolapse
  4. Pericardial effusion
  5. Heart failure (esp. refeeding syndrome)
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10
Q

[Adol/Eating/AN]

Refeeding syndrome symptoms? (4)

A
  1. Marked _hypo_phosphatemia -> reduced cardiac contractility -> heart failure
    Hyponatremia, hypokalemia
  2. Volume overload
  3. Arrhythmia
  4. Seizure
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11
Q

[Adol/Eating/AN]

Admission indication for anorexia nervosa?

SBP < ___
HR < ___ awake < ___ sleep
BMI < ___%
Hypothermia < ___
___

A

SBP < 90
HR < 50 awake < 45 sleep
Orthostatic hypotension
BMI < 75%
Hypothermia < 96
Dehydration, electric abnormality, refusal to eat, failure of outpt

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12
Q

[Adol/Menstruation/Amenorrhea]

Definition of primary amenorrhea? (3)

A
  1. By 15 years of age with normal growth and secondary sexual characteristics
  2. By 13 years of age with complete absence of secondary sexual characteristics
  3. > 3 years after onset of thelarche (breast)
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13
Q

[Adol/Menstruation/Amenorrhea]

Definition of secondary amenorrhea? (2)

A

> 3 months who previously regular
6 months who previously irregular

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14
Q

[Adol/Contraception/OCP]

Benefits of oral contraceptive pills? (4)

A
  1. Reduced Size of functional ovarian cysts
  2. Reduced risk of osteoporosis,
  3. Reduced risk of ovarian cancer, endometrial cancer
  4. Reduced risk of PID
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15
Q

[Adol/Contraception/OCP]

Drugs that reduce oral contraceptive pills efficacy? (5)

A

Antacids (when taken in 3 hours)
Many antiseizures (excpet levetiracetam, valproic acid, gabapentin)
Antibiotics: Rifampin
Most retrovirals
St. John’s warts

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16
Q

[Adol/Contraception]

Risk (2) and benefit (1) of depo provera (DMPA) injections?

A

Risk: Decreased bone density, weight gain
Benefit: Decreased endometrial cancer

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17
Q

[Adol/Contraception]

Emergency contraception medications? (2)

A
  1. Levonorgestrel 1.5 mg (Plan B) once
  2. Ulipristal acetate (Ella) once (prescription only)
    (When obesity > 70 kg)
18
Q

[Adol/Genital lesions]

Organism?
Treatment?

Painful grouped vesicles, shallow

A

HSV

  • Treatment:
    Acyclovir or valacyclovir (Valtrex)
19
Q

[Adol/Genital lesions]

Organism?
Treatment?

Painless, punched out ulcers

A

Syphilis (T. pallidum)

  • Treatment:
    Penicillin G
20
Q

[Adol/Genital lesions]

Organism?
Treatment?

Painful, shallow, soft, friable ulcer, ragged margin

A

Chancroid (H. ducreyi)

  • Treatment:
    Azithromycin or ceftriaxone
21
Q

[Adol/Genital lesions]

Organism?
Treatment?

Painless, friable, progressive, beefy-red ulceration

A

Granuloma inguinale (donovanosis),
Kelbsiella granulomatis

  • Treatment:
    Azithromycin, doxycycline, ciprofloxacin
22
Q

[Adol/Genital lesions]

Organism?
Treatment?

Painless ulcer, tender inguinal lymphadenopathy (groove sign)

A

Lymphogranuloma venerum (C. trachomatis)

  • Treatment:
    Doxycycline
23
Q

[Adol/STD]

Diagnosis?

1-2 months after the onset of the chancre
Scaly, hyperkeratotic palmar skin rash ‘nickel and dime’
Flu-like symptoms
Condylomata lata
Generalized lymphadenopathy, epitrochlear nodes

A

Secondary Syphilis

24
Q

[Adol/STD]

Diagnosis?

After 15-30 years of infection
Cardiac, ophthalmic, auditory abnormalities
Gummatous lesions

A

Tertiary syphilis

25
Q

[Adol/STD/Syphilis]

Treponemal vs non-treponemal tests

___ tests: therapeutic response
- Venereal Disease Research Laboratory (VDRL)
- Rapid Plasma Reagin (RPR)

___ tests: previous infection
- Flourescent treponemal antibody absorbed (FTA-ABS)
- T. Pallidum Particle Agglutination (TP-PA)
- Enzyme ImmunoAssays (EIA)
- Chemiluminescence Immunoassays (CIA)

A

Nontreponemal tests: therapeutic response
- Venereal Disease Research Laboratory (VDRL)
- Rapid Plasma Reagin (RPR)

Treponemal tests: previous infection
- Flourescent treponemal antibody absorbed (FTA-ABS)
- T. Pallidum Particle Agglutination (TP-PA)
- Enzyme ImmunoAssays (EIA)
- Chemiluminescence Immunoassays (CIA)

26
Q

[Adol/STD/Syphilis]

Nontreponemal test commonly become nonreactive within 3-12 months after treatment.
Some patients persist with low titers for life, which is known as ___ reaction

A

Serofast reaction

27
Q

[Adol/STD/Syphilis]

Name of reaction?

Acute febrile response 2-12 hours after initiation of therapy for syphilis: headache, myalgia, etc

A

Jarisch-Herxheimer reaction

28
Q

[Adol/STD/Syphilis]

Treatment options for syphilis for patients with penicillin allergy?

A

Oral doxycyline 100 mg 2/day for 14 days
(Consider desensitization of penicillin)

29
Q

[Adol/STD/Syphilis]

Management for failed therapy or reinfection for syphilis, latent syphilis, tertiary syphilis (not neurosyphilis)?
- Medication
- Additional investigation

A

Weekly IM injections of penicillin G benzathine for 3 weeks

  • Additional investigation:
    Check for HIV infection and CSF for neurosyphilis
30
Q

[Adol/STD]

Diagnosis?

Adolescent with sensorineural hearing loss (8th cranial nerve), uveitis, previous history of STI

A

Neurosyphilis

31
Q

[Adol/STD/CT]

Treatment options for Genital chlamydial infection?
Preferred: __
Alternative: __

A

Preferred: Doxycycline 100 mg PO 2/day for 7 days;
Alternative: Azithromycin 1 g PO 1 dose

32
Q

[Adol/STD/GC]

Diagnosis due to gonococcus?

Fever, tenosynovitis, dermatitis
Positive blood culture (30-40%), negative synovial fluid culture

A

Arthritis-dermatitis syndrome

33
Q

[Adol/STD/GC]

Diagnosis due to gonococcus?

Arthritis without systemic symptoms
Positive synovial fluid culture, negative blood culture

A

Suppurative mono/oligoarticular arthritis

34
Q

[Adol/STD]

___ reactions when patients on metronidazole have alcohol?

A

Disulfiram-like reaction

35
Q

[Adol/Vaginitis]

Treatment options for bacterial vaginosis? (3)

A

Metronidazole 500 mg PO 2/day for 7 days
Clindamycin 300 mg 2/day for 7 days
Or metronidazole intravaginal gel, clinamycin cream

36
Q

[Adol/Vaginitis]

Treatment options for trichomoniasis? (3)
For Female/pregnancy: ___
For male: ___

A

Metronidazole 500 mg PO 2/day for 7 days in female/pregnancy
Metronidazole 2 g PO 1 dose for men

37
Q

[Adol/STD/Epididymitis]

Treatment options for epididymitis?
Treatment of choice: ___
For insertive anal partner: ___

A
  • TOC:
    Ceftriaxone 500 mg IM 1 dose
    Plus doxycycline 100 mg 2/day for 10 days
  • If insertive partner in anal intercourse:
    Ceftriaxone 500 mg IM 1 dose
    Plus levofloxacin 500 mg PO 1/day for 10 days
38
Q

[Adol/STD]

Bacterial causes for proctitis, proctocolitis, and enteritis in sexual transmitted infection?

Proctitis: ___
Proctocolitis: ___
Enteritis: ___

A

Proctitis - GC/CT, syphilis, HSV
Proctocolitis - LGV, Chlamydia, campylobacter, shigella, E. histolytica
Enteritis - Giardia

39
Q

[Adol/Infection]

Diagnosis?
Treatment?

Localized pruritus in pubic hair
Maculae ceruleae: bluish discoloration

A

Pediculosis pubis

  • Treatment:
    1st: Permethrin 1% cream or pyrethrins
    2nd: oral ivermectin
    (Decontaminate bedding and clothing, treat sexual partner last month)
40
Q

[Adol/Sexual abuse]

Time period for sexual assault examination for forensic exam?

A

Within a week
(More than 72 hours, less than 1 week, depending on local authorities)

41
Q

[Adol/AUB]

Abnormal uterine bleeding definition (3)?

Last ___ days
Occurs cycle ___ days or ___ days
Large volume > ___ ml or ___ saturated pads or tampons/day, or causes anemia

A

Last > 7 days
Occurs cycle < 20 days or > 45 days
Large volume > 80 ml or 10 saturated pads or tampons/day, or causes anemia

1. pediatrics (22 decks)

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