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AGPCNP Board Prep > Ch21: Adolescents > Flashcards

Ch21: Adolescents Flashcards

1
Q

what is the significance of the Hib vaccine

A

haemophilus influenza type B (virulent and capsulated form of h. flu)

before the vaccine, this was the leading cause of bacterial meningitis in young people <4yo

we don’t give this to folks >4yo because doesn’t affect folks after this age

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2
Q

meningitis vaccines (2)

A
  • Menactra (4 strains of meningococcal with type A but not B)
  • Trumenba (meningococcal type B organism)

both of these cover different types of Neisseria meningitis

folks need both

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3
Q

in females, tanner stage 2 to menarche usually takes….

A

2 years

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4
Q

in females, tanner stage 2 to full adult height usually takes…

A

3 years (or 1 year after menarche)

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5
Q

in males, tanner stage 2 to full adult height usually takes….

A

4 years

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6
Q

no secondary sex characteristics yet: Tanner stage

A

1

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7
Q

earliest pubertal changes - breast budding, beginning of pubic hair: tanner stage

A

2

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8
Q

growth spurt starts: tanner stage

A

3

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9
Q

peak of growth spurt, menarche: tanner stage

A

4

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10
Q

full adult: tanner stage

A

5

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11
Q

age range for onset of tanner 2 changes in females

A

normative as young as 7yo to have thelarche

normative for ages 8-13yo for adrenarche

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12
Q

most common alteration in puberty

A

early onset puberty in females (precocious puberty)

puberty that starts <7-8yo

> 85% is idiopathic, no pathologic disease

usually family history of early-onset menarche, child who is overweight or obese

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13
Q

factors related to late onset puberty

A
  • appearance-related sports
  • low weight/ nutrition
  • turner syndrome (45,XO)
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14
Q

most common cause of early puberty in males

A

CNS tumors

<40% are idiopathic

VERY rare to have alterations in puberty for males

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15
Q

males in puberty often go through physiologic gynecomastia when….

A

TANNER STAGE 3

50% of males during tanner stage 3-4, lasts 6-24 months, most of the time it is gone in 1 year

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16
Q

Fragile X syndrome

A

-occasionally not picked up until puberty because associated with a specific body habitus that becomes apparent at puberty

more common in males, which presents as:

  • large forehead, ears, and prominent jaw
  • tendency to avoid eye contact
  • large testes (macroorchidism)
  • large body habitus
  • history of learning differences
  • hyperactivity

in females, significantly less common with fewer prominent findings

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17
Q

most common known cause of autism in either gender

A

fragile X syndrome

however, majority of cases of autism have no known cause

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18
Q

47XXY

A

Klinefelter syndrome

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19
Q

Klinefelter syndrome

A

47XXY
only affects males

  • low testicular volume
  • hip and breast enlargement
  • infertility (do not make sperm)
  • most will have some
  • triangular shape pubic hair pattern (more female) vs. diamond which is more common in males (extends up to abdomen)
  • developmental issues, commonly language impairment
  • some males will not have any symptoms
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20
Q

45X

A

turner syndrome

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21
Q

Turner syndrome

A

45X
only affects females

  • short stature (5 ft or less)
  • usually evidence by 5yo, but more commonly being picked up at birth
  • wide, webbed neck
  • broad shield chest
  • absent menses
  • infertility (born without ovaries)
  • narrow, high-arched palate
  • lower jaw not prominent
  • low-set ears
  • edema of hands and feet

possible to have mosaic Turner syndrome may have more mild features

high spontaneous pregnancy loss with turner syndrome (most common abnormality found in miscarriage pathologic examination)

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22
Q

pathophysiology of acne

A

follicular epidermal hyperproliferation with subsequent follicle plugging, excess sebum production, presence of pathogenic Priopionibacterium acnes (P. acnes), accompanying inflammation

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23
Q

% prevalence of acne and severe acne with scarring

A

80% of all teens have acne

20% will develop scarring

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24
Q

all acne therapies take at least ______ to see effect

A

6-8 weeks

25
Q

should topical acne therapies be used in [specific spots vs. generalized entire area involved]

A

entire area involved

generally won’t work on a formed lesion, need to prevent new ones from forming

26
Q

overview of topical benzoyl peroxide for acne

A
  • general MOA: ANTIBACTERIAL, comedolytic
  • inexpensive, OTC
  • 2.5% formulation is just as effective as 10% formulation, but much less irritating
  • most helpful for mild acne, usually with a keratolytic acne wash with salicylic acid 2% (Neutrogena acne wash, Store-brand, Proactiv)
27
Q

overview of topical retinoids for acne

A
  • MOA: Keratolytic, ANTI-INFLAMMATORY
  • indicated in all acne types
  • with initial use, there is mild-to-moderate skin irritation (peeling) that will improve over time
  • cause photosensitivity, recommend using sunscreen regardless of skin tone, apply overnight
28
Q

example topical retinoids for acne

A
  • adapalene (Differin)
  • tazarotene (Tazorac)
  • tretinoin (Retin-A)
  • azelaic acid (Azelex)
29
Q

(3) topical antibiotics for acne

A
  • clindamycin
  • erythromycin
  • dapsone (sulfa-based)
30
Q

overview of topical antibiotics for acne

A
  • MOA: antibacterial and antiinflammatory
  • most effective for mild acne
  • less effective than oral antibiotics for moderate-severe acne
  • most often used in combination with benzoyl peroxide and retinoid
31
Q

(5) oral antibiotics for acne

A
  • doxycycline MOST COMMON (TERATOGENIC)
  • minocycline
  • erythromycin
  • TMP/SMX
  • azithromycin (SHE USES MOST COMMONLY FOR FEMALES; PREG CATEGORY B)
32
Q

overview of oral antibiotics for acne

A
  • both antibacterial and anti-inflammatory
  • work very well for moderate inflammatory acne
  • avoid protracted use of minocycline d/t risk for hyperpigmentation
33
Q

which oral antibiotic should not be used for a long time for the treatment of acne d/t risk for hyperpigmentation

A

minocycline

34
Q

example azithromycin oral regimen she uses for acne

A

azithromycin 500mg PO 1 tablet every 5 days

35
Q

how long should someone stay on oral antibiotics for acne?

A
  • usually takes at least 3 months for the skin to clear
  • taper off slowly over a few months while adding in topical antibiotic agents
  • rapid discontinuation will result in return of acne to pretreatment baseline
  • longer-term or repeat therapy is often needed
36
Q

overview of COCs for acne

A
  • MOA: reduces androgen levels and decreases sebum production
  • best suited for females with moderate-to-severe acne
  • about 3 months of continuous use prior to seeing significant acne improvement
  • with discontinuation, acne gradually returns to pretreatment baseline
37
Q

overview of isotretinoin (Accutane) for acne

A
  • MOA not well understood
  • indicated for treatment of severe, cystic acne that has not responded to other therapies such as oral antibiotics and topical retinoids
  • managed by derm specialist; need accutane license to prescribe
  • usual course of treatment is 4-6 months
  • careful monitoring for mood destabilization and/or suicidality
  • TERATOGEN
38
Q

most common cause of adolescent death in the US

A

accidental injury

39
Q

in ALL states, parental notification or consent is NOT required for an adolescent (typically starting at age 14) to receive care for (4)

A
  • contraceptive services
  • prenatal care
  • evaluation or treatment for STIs
  • evaluation or treatment for substance abuse
40
Q

screener for adolescent substance use

A

CRAFFT

41
Q

most commonly used contraceptive method for teens

A

male condom

42
Q

age of majority

A

18yo

43
Q

medically-emancipating conditions (5)

A
  • contraceptives
  • STIs
  • substance abuse
  • prenatal care
  • mental health
44
Q

who do you screen for diabetes in adolescence?

A

overweight or obese and one or more of the following risk factors:

  • family history of T2DM
  • race or ethnicity other than European/Caucasian
  • s/s of insulin resistance (acanthosis nigricans, hypertension, HLD, PCOS, SGA at birth)
  • maternal h/o DM or GDM
45
Q

CRAFFT questionnaire screeners

A

C - car: Have you ever ridden in a car driven by someone who was high or using drugs or alcohol

R - relax: do you ever use alcohol or drugs to relax or fit in?

A - alone: do you ever use alcohol or drugs when you are by yourself?

F - forget: do you ever forget things you did while using drugs or alcohol

F - friends/family: do your friends or family ever tell you you need to cut down on your drugs or alcohol use

T - trouble: have you ever gotten into trouble when you were using drugs or alcohol

2 or more positive answers indicates more serious problem

46
Q

central pathology of PCOS

A

insulin resistance

47
Q

surrogate marker for insulin resistance on labs

A

triglycerides

48
Q

sandpaper-like rash

A

strep pyogenes - group A strep associated

scarlet fever

49
Q

presentation of scarlet fever

A
  • exudative pharyngitis
  • fever
  • headache
  • tender
  • localized anterior cervical lymphadenopathy
  • rash usually erupts on day 2 of pharyngitis and often peels a few days layer
50
Q

classic presentation of rubella

A

aka German Measles

mild symptoms including fever, sore throat, malaise, nasal discharge, diffuse maculopapular rash lasting 3 days

posterior cervical and postauricular lymphadenopathy that begins 5-10 days before the rash and present during rash
- arthralgia in 25% of cases (mostly in females)

everything happens at once except the lymphadenopathy which happens earlier

51
Q

why do we care so much about preventing rubella?

A

one of the most teratogenic pathogens known to humankind

sick adults will recover fine, but devastating in pregnancy

52
Q

rubeola vs. rubella names

A

rubeola = measles

rubella = German measles

53
Q

Koplik’s spots are specific to…

A

rubeola (measles)

54
Q

true or false: rubella and rubeola are reportable diseases to the state public health authorities

A

true

55
Q

16yo presents with pharyngitis, diffuse lymphadenopathy, and bilateral RUQ/LUQ abdominal pain, you suspect….

A

infectious mono

56
Q

generic name for Monospot rapid test

A

heterophil antibody test

57
Q

how long do you need to avoid contact sports after mono

A

1 month

splenomegaly lasts 6-21 days after onset of illness

58
Q

what antibiotic should you avoid in mono?

A

amoxicillin or ampicillin

95% likelihood of getting an autoimmune flat-pink rash (not an allergy to amoxicillin)

AGPCNP Board Prep (21 decks)

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