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Royal College Exam > Adolescent > Flashcards

Adolescent Flashcards

1
Q

DSM-5 criteria for bulimia nervosa?

A

• Recurrent episodes of binge eating characterized by BOTH of the following:
o Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
o Sense of lack of control over eating during an episode.

  • Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging).
  • The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.
  • Self-evaluation is unduly influenced by body shape and weight.
  • The disturbance does not occur exclusively during episodes of anorexia nervosa.
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2
Q

Age of consent to sexual activity in Canada?

A

16 years old

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3
Q

Side effects of anabolic steroids?

A

decreased endogenous testosterone production (due to exogenous testosterone) resulting in gynecomastia, testicular atrophy, decreased libido

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4
Q

What ADHD medications have low abuse potential?

A

Strattera
Intuniv (long-acting guanfacine)
Vyvance
Concerta

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5
Q

What is guarana?

A

“natural” caffeine product in energy drinks

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6
Q

DSM-V criteria for anorexia nervosa

A
  1. Restriction of energy intake relative to requirements, leading to significantly low body weight in context of age, sex, development
  2. Intense fear of gaining weight or persistent behaviour that interferes with weight gain
  3. Disturbance in way in which one’s body weight/shape is experienced, or undue influence of body weight/shape on self-evaluation, or denial of seriousness of current low weight
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7
Q

DSM-V Bulimia Nervosa

A
  1. Recurrent episodes of binge eating
  2. Recurrent inappropriate compensatory behaviours in order to prevent weight gain
  3. Binge eating and inappropriate compensatory behaviours both occur, on average, once a week for 3 months
  4. Self-evaluation unduly influenced by body weight and shape
  5. Disturbance not exclusively during episode of AN
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8
Q

Clinical signs of bulimia nervosa

A
  1. Russell’s sign (calluses on dorsum of hand)
  2. Dental enamel erosion
  3. Parotid gland enlargement
  4. Edema
  5. Fluctuating weight (healthy/overweight)
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9
Q

What lab test is diagnostic for bulimia?

A

elevated amylase

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10
Q

DSM-V criteria for binge eating disorder

A
  1. Recurrent episodes of binge eating
  2. Binge-eating episodes associated with at least 3 of:
    - Eating more rapidly than normal
    - Eating until feeling uncomfortably full
    - Eating large amounts of food when not feeling physically hungry
    - Eating alone out of embarrassment at volume eating
    - Feeling disgusted with oneself, guilty, or depressed after eating
  3. Marked distress regarding binge eating present
  4. Binge eating occurs on average at least 1x/wk x 3 months
  5. No compensatory behaviours, no BN or AN
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11
Q

Risk factors for refeeding syndrome

A

– Low weight (less than 70% of IBW)
– Rapid weight loss
– Low levels of phosphate, potassium or magnesium prior to refeeding
– Limited nutritional intake for 5-10 days preceding refeeding

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12
Q

Hallmark electrolyte abnormality of refeeding syndrome

A

hypophosphatemia

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13
Q

What metabolic abnormality do you see with vomiting?

A

hypokalemia, metabolic alkalosis

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14
Q

What metabolic abnormality do you see with laxative abuse?

A

hypokalemia, metabolic acidosis (non-anion gap)

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15
Q

SMA syndrome

A

– Compression of 3rd portion of duodenum by abdominal aorta & overlying superior mesenteric artery
– Due to lack of retroperitoneal fat - cushions duodenum

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16
Q

Factors contributing to osteoporosis in eating disorders

A

–Poor nutrition (protein, Vit. D, calcium)
–Amenorrhea (low estrogen)
–High cortisol
–Low IGF-1

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17
Q

Hematologic abnormalities associated with ED?

A

anemia
leukopenia
thrombocytopenia

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18
Q

indications for hospitalization in ED?

A 
•Weight ≤75%-80% expected
•Dehydration
•Electrolyte disturbance
•Cardiac dysrhythmia
•Physiologic instability
–HR<50, BP<80/50, T<36, extreme orthostatic changes (HR change >35 bpm, BP change > 20 mmHg)
•Acute food refusal
•Uncontrollable binging and purging
•Suicidal ideation
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19
Q

Management of ED

A

family based therapy

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20
Q

Female athlete triad in ED

A
  1. Amenorrhea
  2. Decreased BMD
  3. Disordered eating
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21
Q

When can you give contraception after an abortion?

A

immediately!

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22
Q

What is gonorrhea?

A

An intracellular diplococcus

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23
Q

Sequelae of gonorrhea in females?

A

–PID, infertility, ectopic pregnancy, chronic pelvic pain, perihepatitis (Fitzhugh Curtis Syndrome), reactive arthritis (more common with chlamydia), disseminated GC infection (DGI)

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24
Q

Sequelae of gonorrhea in males?

A

Epididymo-orchitis, reactive arthritis, infertility (rare), DGI

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25
Q

gonorrhea treatment

A

Cefixime (Suprax) 800 mg po single dose OR Ceftriaxone 250mg IM single dose
+
Azithromycin 1gm PO single dose OR
Doxycycline 100mg PO bid x 7 days

26
Q

which is more common, chlamydia or gonorrhea?

A

chlamydia

27
Q

how do you make the diagnosis of chlamydia?

A

NAAT

culture for medico-legal issues

28
Q

chlamydia treatment

A

Azithromycin 1 gm single dose
or
Doxycycline 100 mg bid x 7d

29
Q

what is primary HSV?

A

first clinically evident episode in a patient seronegative for antibody to HSV-1 or HSV-2

30
Q

what is non-primary first episode HSV?

A

First clinically evident episode in a person who, by testing, is demonstrated to have pre-existing heterologous antibody (ie. first outbreak HSV2 in patient with Ab for HSV1)

31
Q

recurrent HSV

A

An episode of genital HSV in a patient with pre-existing homologous antibody (ie. culture of HSV-2 from lesions in an individual with demonstrable HSV-2 Ab)

32
Q

what is the most common STI?

A

HPV

33
Q

most common HPV forms implicated in cervical cancer?

A

16, 18

34
Q

what HPV types does the vaccine protect against?

A

6, 11, 16, 18

35
Q

DDX genital lesions

A
  • Herpes
  • HPV
  • Molluscum
  • Primary syphilis (chancre)
  • Chancroid (Haemophilus ducreyi)
  • ‘Pearly papules’ - normal
36
Q

What is the best option for ADHD in a kid with substance abuse issues?

A

Vyvanse

37
Q

Markers of risk for substance abuse among youth

A

street-involved, concurrent mental health disorder, LGBTQ, family hx of substance abuse, family dysfunction

38
Q

How do you screen for substance abuse?

A

CRAFFT questionnaire

39
Q

what is the crafft questionnaire?

A
  • C: Have you ever ridden in a CAR driven by someone impaired?
  • R: Do you use drugs to RELAX or fit in?
  • A: Do you use drugs ALONE?
  • F: Do you ever FORGET things you did while using drugs?
  • F: Do your family or FRIENDS tell you to cut down?
  • T: Have you gotten in TROUBLE while using drugs?
40
Q

what is a life-threatening effect of inhalants?

A

Sudden sniffing death syndrome – likely due to primary cardiac arrhythmia

  • inhalants disrupt myocardial electrical propagation (enhanced by hypoxia)
  • sensitize heart to adrenaline (death after startle or with vivid hallucinations)
41
Q

side effects of OCP

A

breast tenderness
breakthrough bleeding
nausea
h/a

42
Q

interacts with OCP

A

anti-epileptic drugs (decrease efficacy of OCP) - valproate not affected

43
Q

contraindications to OCP

A

pregnancy, unexp vaginal bleeding, migraine with aura, hx of thrombosis, hypertension
(caution with SLE, liver disease)

44
Q

hormone in mirena/jaydess IUD

A

progesterone only, locally acting

45
Q

side effects of depo-provera

A
  • irregular bleeding
  • amenorrhea
  • weight gain
  • reduced bone density (if underlying medical condition, consider bone mineral density testing before! Rx calcium + vit D)
  • depression
46
Q

contraindications to emergency contraception

A

pregnancy (won’t be effective), prev anaphylaxis to product

- need to ensure follow up!

47
Q

tx of chlamydia

A

azithromycin 1g PO x 1 dose

48
Q

tx of gonorrhea

A

ceftriaxone 250 mg IM x 1 + treatment for chlamydia (often co-infected, azithro 1g PO x 1)

49
Q

diagnosis of PID

A

lower abdo pain + ONE OF:

  • adnexal tenderness
  • uterine tenderness
  • cervical motion tenderness
50
Q

tx of PID

A

ceftriaxone, doxycycline

OR if hospitalized:
cefoxitin, doxycycline

51
Q

solitary, painless, mobile breast mass - no change with menses.
what is this?

A

fibroadenoma

52
Q

cystic breast mass, tender, worse prior to menses. what is this?

A

fibrocystic changes

53
Q

top three substances used by adolescents

A
  1. alcohol 66%
  2. cannabis 30%
  3. tobacco 24%
54
Q

two main aspects of substance dependence

A

tolerance (need to increase amount to achieve effect) and withdrawal (symptoms when substance is withdrawn)

55
Q

substance abuse

A

adverse consequences related to use of substance (missing school, risky behaviours, conflict, neg health consequences)

56
Q

ARFID diagnostic criteria

A

eating disturbance associated with failure to meet nutrition needs AND one of following:

  • wt loss / growth failure
  • nutritional deficiency
  • dependence on enteral feeds or liquid nutrition
  • interference with social fxn

NO body image disturbance
NO medical illness

57
Q

anorexia DSM5

A

A. restriction of energy/food
B. intense fear of gaining weight
C. disturbance of body image perception, undue influence of weight on self-evaluation

58
Q

bulimia nervosa DSM5

A

A. binge eating
B. compensatory behaviour (purging, laxatives, exercise)
C. 1x/wk x 3 months
D. self-evaluation unduly influenced by weight
E. NOT anorexia

59
Q

medical symptom associated with vomiting/purging (PE + lab finding)

A

parotid swelling, increased amylase

60
Q

endo abnormalities in eating disorders

A

low estrogen, GH resistance, high cortisol, low Ca/Vit D

Royal College Exam (32 decks)

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