Adolescence Flashcards

Question

14 year old girl hanging at party with friends then becomes dizzy then not responsive. Pupils equal and reactive, normal reflexes, normal vital signs, temp 35.6? Glucose 2.1. Metabolic acidosis. Likely cause ?

Answer 1

A. Ethanol - hypoglycaemia with metabolic acidosis, normal pupils

Answer 2

A. Chronic marijuana use Cannabinoid Hyperemesis syndrome Essentials for diagnosis - History of regular cannabis use for years Major Clinical Features - severe nausea and vomiting - vomiting that recurs in a cyclic pattern over months - resolution of symptoms after stopping cannabis use Supportive Features - compulsive hot baths with symptom relief - colicky abdominal pain - no evidence of gallbladder or pancreatic inflammation

Answer 3

D. Reassure If it was less than 1 hour after you would give again Yuzpe method - taking everyday birth control pills in two doses 12h apart

Answer 4

A. Hypokalemia- not necessarily based on a specific resource but hypokalemia can lead to arrhythmia Hypokalemia - this is most likely to be secondary to vomiting or laxative abuse. It can also occur with refeeding. Oral replacement should be sued initially, however, a potassium value below 2.5mmol/L requires intensive cardiac monitoring and intravenous replacement.

Answer 5

A. Fibroadenoma

Answer 6

C. Plan B Plan B = progestin only method. = two tablets of 0.75 mg levonorgestrel taken together. Preferred method of EC due to higher efficacy and fewer side effects and more widely accepted than the combined method. Yuzpe = combined hormonal method; dispensed in the form of multiple birth control pills

Answer 7

D. Ask her parents to monitor her diet and to reduce her physical activity There would be a very short duration between visits with admission of the next visit she did not gain weight.

Answer 8

D. Nothing - now you can buy it OTC

Answer 9

None of these are right, should start at age 21 is she has been sexually active. If not then 3 years after the first sexual encounter

Answer 10

A. Fibroadenoma

Answer 11

Answer: A and B - prolonged QT Not very common

Answer 12

A. Long QT

Answer 13

B. Homosexuality- as per mental health questions. Both of these situations would be a risk but especially for homosexual teens

Answer 14

Controversial - OCP x 84 days vs progesterone IUD - both are reasonable options. But maybe go with safer option of OCP because of risk of general anesthesia if IUD There is an AAP statement on menstrual management of adolescents with disabilities and they don’t fully commit to what the best option is. They say that progesterone only pill is not the best because the rate of amenorrhea is low and this is usually what we want to achieve. IUD needs to be inserted under general anesthesia so not without risk. And you don’t want to completely stop their puberty so not lupron

Answer 15

C. Hypokalemia As per consensus and other groups Very hard to find the answer to this question...there is one line in a peds in review article that says the following but this is for Bulimia.... Adolescents with bulimia may face life- threatening events. Of most concern are electrolyte disturbances (particularly hypokalemia ) and cardiac issues, such as syncope or a prolonged QTc interval

Answer 16

Answer: A and C in 7 days but technically also after the partner has been treated if the intercourse will be with that partner...ha ha Up to date: patients should be counseled to avoid sexual activity until seven days after initiating treatment; they may subsequently resume having sex provided that their symptoms have resolved and their sex partners have been treated

Answer 17

A. OCP 84- day preparation

Answer 18

A. Warn about effects of drug use and discuss ways to reduce risk Harm reduction strategy

Answer 19

C. Need for strict birth control AAP article on treatment of acne Both fasting serum lipids and liver function tests should be obtained at baseline and monitored periodically thereafter. A major adverse effect of isotretinoin and a public health concern is its teratogenic potential. For this reason, the FDA mandated in 2007 the implementation of a computerized risk management program (iPledge) that registers all isotretinoin patients, physicians, pharmacies and manufacturers and ensures monthly monitoring of pregnancy status in females of childbearing potential.

Answer 20

Answer: both B or C (lecturer said B) A. Preoccupation with body image occurs in mid adolescence - no it’s early adolescence B. Parental conflict peaks in mid adolescence - yes true C. Development of idealistic career goals in late adolescence - yes also true D. Abstract thinking develops in early adolescence- more like mid - to late adolescence

Answer 21

D. Gain weight to at least 10% ideal weight.

Answer 22

A. 84/7 OCP

Answer 23

D. Ask to speak to the boy

Answer 24

Answer: none of the above. Older question Chlamydia =azithromycin 1g PO x 1 Gonorrhea = ceftriaxone 250mg IM x 1 or cefixime 800mg PO x 1 + above. ALWAYS treat for chlamydia if has gonorrhea even if negative chlamydia test.

Answer 25

Answer: dysmenorrhea Nelson’s Painful menstrual cramps experienced by nearly 65% postmenarchal teens in the US. More than 10% of this group suffers enough to miss school making dysmenorrhea the leading cause of school absenteeism in female adolescents

Answer 26

Answer: A and D - physiological leukorrhea - although typically not itchy...but with no other description typical of the other things I would chose that Physiological leukorrhea- in reproductive ages women, normal vaginal discharge consists of 1-4 ml of fluid (per 24 hours), which is white or transparent, thick or thin, and mostly odourless. Candida - thick, white, curd-like discharge with marked pruritis Bacterial vaginosis - minimal inflammation or irritation but thin, grey, yellow, malodorous (fishy -smelling ) discharge. Gardenerella vaginitis = bacterial vaginosis Trichomonas- purulent, yellow/greenish, thin burning, pruritis, dysuria

Answer 27

Answer: A - should be bradycardic. But I mean you can’t rule it out if she has a normal heart rate. Physiologic changes in anorexia - Bradycardia - hypotension/orthostatic changes - hypothermia RR irregularities are not commonly seen so this would not help you. Normal HR is more helpful in determining severity of diagnosis etc.

Answer 28

Answer: B- high risk behaviour while abusing alcohol From Nelson’s - alcohol contributes to more deaths in young individuals than all the illicit drugs combined. Amount studies of adolescent trauma victims, alcohol is reported to be present in 32-45% of hospital admissions. Motor vehicle crashes are the most frequent type of event a/w alcohol use, but the injuries spanned several types including self - inflicted wounds.

Answer 29

Answer: probably C - you don’t need a pregnancy test unless your period is late

Answer 30

Answer: I am not sure that any of these are the appropriate answer ?? Answer should be decreased progesterone in my opinion (or unopposed estrogen). But I suppose C could be possible but usually have regular but heavy menses.

Answer 31

B. Asymptomatic Majority of women with C. Trachomatis infection are asymptomatic

Answer 32

A. Immediately

Answer 33

Answer? Would need more choices but answer is NOT “treated ADHD” but could be B. Behaviours such as rebelliousness, poor school performance, delinquency, and criminal activity and personality traits such as low self- esteem, anxiety, and lack of self-control are frequently a/w or predate the onset of drug use.

Answer 34

Answer: C ? I don’t believe it would be poverty as lower SES seems to be a/w earlier sexual behaviour; later onset puberty seems to be a/w delayed sexual behaviour rather than precocious puberty; not sure that it would be strict parenting (open communication and healthy relationships with parents seems to be more predictive of delayed sexual behaviour) so perhaps the answer is sexual abuse, but I couldn’t find any evidence to back this up.

Answer 35

Answer: probably A (but should be worded “7 days after treatment is complete “ ) but B is also true Treatment regimens for chlamydia Azithromycin 1g PO x 1 dose OR Doxycycline 100mg PO BID x 7 days Abstinence is recommended for at least 7 days after both patient and partner are treated (ie; 7 days after treatment is complete) Nelson’s chapter 120 (sexually transmitted infections).

Answer 36

D. Absence of white cells in cervical discharge (cervical wet mount negative for WBCs) If the cervical discharge appears normal and no WBCs are observed in the wet prep of vaginal fluid, the diagnosis of PID is unlikely and alternative causes of pain should be investigated. Nelson’s chapter 120 - STIs

Answer 37

Answer: C - slow refeeding Risk of refeeding syndrome - rapid weight loss - baseline abnormal electrolytes - quick refeeding

Answer 38

Not a fair question but looking back I would say E. Liver disease as seems to be more clear Explanation A. Family history of stroke - only a persona history of DVT or PE or stroke B. DM - complicated DM is a contraindication- nephropathy, retinopathy or other vascular disease or duration > 20 years C. Hypertension (BP > 160/100 or HTN with vascular disease D. Migraine - only with aura E. Liver disease - severe decompensated cirrhosis, hepatocellular adenopathy, malignant liver tumor, viral hepatitis - acute or flare )

Answer 39

Answer: A it is 75% effective at preventing pregnancy- depending on method Dr. Sortini said she would choose A but it is usually more effective The Yuzpe and levonorgestrel- only regimens have been shown to reduce the risk of pregnancy by about 75% to 89%, respectively.

Answer 40

Answer: A. Delay motivational lecture until patient shows interest - is true but not enough info. B is false - Nicotine replacement products (gums, patches, lozenges, sprays) - recommended only for regular smokers 12-18 years of age.

Answer 41

B. Antidepressants Sexual dysfunction is a known side effect of antidepressants

Answer 42

Answer: A - undiagnosed vaginal bleeding (although not in the list of contraindications from Nelson)

Answer 43

Answer: A In females - menses typically begins 2.5 years after the onset of puberty during Tanner stage III-IV B. Maximal penile growth in stage II - penile growth in stage III C. Axillary hair in males stage III - pubic hair is stage II- III D. Voice change at Tanner stage III - I think voice change occurs later E. Double breast contour in stage III - occurs in stage IV

Answer 44

Answer: D enlarged salivary glands - BN develop enlarged salivary glands (parotid > submandibular) which is relatively non-tender (sign of chronic binge eating and induced vomiting) A. Cachexia- AN tends to be thin to cachetic vs BN are thin to overweight B. Hypothermia - AN will exhibit energy conserving low body temp with slow blood flow most notable peripherally - cold extremities, acrocyanosis, slow cap refill (signs of hypometabolism and cardiovascular dysfunction) vs. BN where this does not occur C. Low blood pressure - AN will exhibit bradycardia, hypotension and orthostatic pulse differential > 25bom resulting from central hypothalamic and intrinsic cardiac function (more prominent if a/w purging and hypovolemia vs BN where hypotension can occur as a result of hypovolemia if dehydrated E. Extremely dry skin - AN develop dry skin due to lack of adequate blood flow vS BN where this does not occur

Answer 45

Answer: C - estrogen deficiency Reduced gonadal function occurs in males and females - amenorrhea in females and erectile dysfunction in males. Cortical suppression of hypothalamic axis due to physical and emotional stress. Amenorrhea predates significant dieting and weight loss I’m up to 30% of females with AN. The primary health concern is the negative effect of decreased ovarian function and estrogen on bones.

Answer 46

Answer: A - lanugo Lanugo type hair growth on face and upper body occurs as a way to conserve energy

Answer 47

Answer: A and B are both right - infection and pregnancy Likely an old question and the lecturer said that back in 1999 they were probably looking for infection as the right answer

Answer 48

Answer C: ceftriaxone This question is older than the CPS statement and single agent therapy was probably appropriate back then - now add Azithromycin 1g PO x 1 to cover chlamydia

Answer 49

Answer A: physiologic leukorrhea Group A strep - - uncommon cause of vulvovaginitis - prepubertal girls - mother of children who have active GAS infection or GAS carriers - acute onset frankly purulent discharge - pruritis, soreness, erythema, labial edema, dysuria from burning skin

Answer 50

Answer: A. iV cefoxitin and PO doxycycline for 7 days - but should be for 14 days...maybe the 7 days is outdated Inpatient treatment 1) cefoxitin IV q6h + doxycycline IV/PO q12h - doxy PO recommended x 14 days - can d/c cefoxitin 24h after clinical improvement 2) Clindamycin IV q8h + gentamycin IV load and then q8h - can d/c IV meds 24h after clinical improvement - continue PO doxy or PO clindamycin x 14 days Outpatient treatment - Ceftriaxone IM x 1 + doxycycline PO x 14 days +\- flagyl x 14 days - cefoxitin 2g IM x 1 + probenecid PO x1 + doxycycline PO x 14 days +\- flagyl - other third gen cephalosporin IM x 1 + doxycycline PO x 14 days +\- flagyl Note: probenecid is not an antibiotic, it is a med that increases uric acid excretion. Used in gout

Answer 51

Answer: C. Mainly because of the abnormal and heavy cycles. If just heavy think VWD JELD said that vWD could have been right because they thought that anovulation would not cause bleeding this severe - I disagree - Nelson’s said that the mc reason for DUB leading to hospital admission was anovulation. Also, is she had vWD, there would have been severe bleeding from the start of menses. Also menses would still be regular, just heavy.

Answer 52

C. It is not necessary to do a urine beta- HCG before giving it Morning after pill is most effective within 72h after intercourse and up to 120h after

Answer 53

A. Excess estrogen - but really it’s excess unopposed estrogen

Answer 54

Answer C: large testicles

Answer 55

E. Increased testosterone

Answer 56

Answer: A tetracycline vs B acetominophen Dr. Stortini said it could be Acetominophen as it does increase the activity of COC but probably old question Antibiotics such as amoxicillin, ampicillin, erythromycin and tetracycline affect the re-absorption of estrogen. These abx alter the gut flora and ethinyloestradiol is not conjugated. There is more ethinyloestradiol passed in the stool. Pregnancy and breakthrough bleeding can occur.

Answer 57

Answer B: liver cancer

Answer 58

Answer: A Fitz- Hugh- Curtis Perihepatitis (FHC ) occurs in the setting of PID when there is inflammation of the liver capsule and peritoneal surfaces of the anterior RUQ. There is generally minimal stromal hepatic involvement. It occurs in approximately 10% of women with acute PID and is characterized by RUQ abdo pain with a distinct pleuritic component, sometimes referred to the right shoulder. Marked tenderness in the RUQ can be seen in exam. The severity of pain in this location may mask the diagnosis of PID and lead to concerns regarding cholecystitis. Aminotransferases are usually normal or only slightly elevated.

Answer 59

B. F/u in 6 months

Answer 60

A. Gynecomastia

Answer 61

A) two signs in a neonate 1. Bulging introitus 2. Mucoculpos B). Two symptoms adolescent 1. Amenorrhea 2. Cyclic abdominal pain 3. Hematocolpus (not a symptom)

Answer 62

1. Verbal or physical assault 2. School drop out 3. Homelessness 4. Substance use 5. Mood disorders: depression, anxiety, poor self-esteem 6. Suicide: 2-7 x more likely to attempt suicide; highest risk when: - teen acquired a gay identity at a young age - when there is a family conflict - the teen has run away or been thrown out of the house - if he or she is conflicted about his or her orientation - or if he or she has not been able to disclose his or her orientation to anyone

Answer 63

A. When is the time frame you can give her hormonal contraception ? - Plan B - most effective within 72h, can be given until 120h B. Copper IUD, when’s the latest time you can insert it ? - up to 7 days C. What are two management options for her ? 1. Advise her how to take it and that she can take it with gravel for nausea 2. Advise on options for contraception including that barrier method should be used in addition to OCP, etc until next menses 3. Advise that if no menses > 1 week after expected date, should be seen to r/o pregnancy 4. Advise that she should come back if any significant pain or heavy/unusual bleeding 5. Consider pelvic exam and testing for STIs

Answer 64

3 long-term negative consequences Nelson’s Chronic adverse effects 1. Cannabis dependence syndrome (in around 1/10 users) 2. Chronic bronchitis and impaired respiratory function in regular smokers 3. Psychotic symptoms and disorders in heavy users, especially those with a history of psychotic symptoms or a family history of these disorders 4. Impaired educational attainment in adolescents who are regular users. 5. Subtle cognitive impairment in those who are daily users for 10 years or more. Acute adverse effects: - anxiety and panic, especially in naive users - psychotic symptoms (at high doses) - road crashes if a person drives while intoxicated Article 1. At risk for long- lasting cognitive impairments 2. Higher unemployment levels, involvement in criminal activity, greater social assistance, less likely to complete Highschool 3. Risk for developing a psychotic outcome of any nature increased by 40% 4. Increased risk of substance abuse - ecstasy, tobacco, problem drinking 5. Increased risk of anxiety disorders 6. Increased risk of depression

Answer 65

A. Two elements of history to make diagnosis 1. Presence of either an intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain (even though significantly low weight) 2. Disturbance in the way one’s body weight or shape is experienced, undue influence of body shape and weight on self- evaluation. B. What is the ddx ? 1. ARFID 2. Anorexia Nervosa (restrictive type)

Answer 66

A. Max age of partner of 14 y.o - 19 year old ``` 12-13y.o = not older than 2 years 14-15y.o = not older than 5 years 16y.o = any person but not authority or exploitive 18y.o = exploitive ``` B. In what situation can a 16 y.o NOT consent to have sex with someone who is older ? 1. Person is in position of authority or trust (coach, teacher etc) 2. 16 year old is dependent to person (caregiver, support person 3. For money, drugs (exploitive)

Answer 67

A . Most likely dx - lichen sclerosus B. How would you treat this ? - topical corticosteroids C. 2 other causes of vulvar itching in a prepubertal girl ? 1. Irritation from bubble bath or harsh soap 2. Non-specific vulvovaginitis 3. Poor hygiene, improper wiping, vaginal voiding, tight panties

Answer 68

Up to date: approach to the patient with genital pain 1. HSV-1 and HSV-2 - painful, classically begin as one or more grouped vesicles on an erythematous base 2. Treponema pallidum (syphillis) - painless, single insurated, well circumscribed 3. Haemophilus ducreyi (chancroid) - painful papules that go on to ulcerate, deep and ragged with a purulent, yellow- gray base, and an undermined, violaceous border. 4. Chlamydia trachomatis (LGV - lymphogranuloma venereum )- painless, single papule or a shallow ulcer 5. Klebsiella granulomatosis (granuloma inguinale - donovanosis- painless, one or more modular lesions that ulcerate 6. EBV, TB, amebiasis, leishmaniasis 7. Non- sexually acquired genital ulceration (NAGU) - EBV, mycoplasma, Lyme disease 8. Non- infectious - fixed drug eruption, behcet syndrome, neoplasm, trauma, Behcet’s = oral and genital ulcers, autoimmune, vascular problems ``` AAFP - ddx of genital ulcers Infectious (most common) - genital HSV - syphilis - chancroid - lymphogranuloma venereum - granuloma inguinale (donovanosis) - fungal infection (candida) - secondary bacterial infection ``` Non - infectious (less common) - behcet syndrome - fixed drug eruption - psoriasis - sexual trauma - wegener granulomatosis

Answer 69

DSM V Bulimia Nervosa 1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: - Eating in a discrete period of time (ie; within any 2h period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. - A sense of lack of control over eating during the episode (ie; a feeling that one cannot stop eating or control what or how much one is eating. 2. Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self- induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise 3. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week x 3 months 4. Self-evaluation is unduly influenced by body shape and weight 5. The disturbance does not occur exclusively during episodes of Anorexia Nervosa

Answer 70

Management 1. Admit to hospital 2. Strict bed rest 3. Continuous cardiac monitoring 4. Daily lytes and extended lytes for refeeding syndrome 5. ECG 6. Baseline investigations: CBC, BUN, Cr, lytes, ext lytes, Fasting glucose, Fasting lipids (chol, LDL, HDL, TG), ALT/AST, total protein, ALB, Amylase, TSH, Vit D (25-OH), vit B12, Ferritin, INR, ESR, serum osmolality, U/A, Estradiol, FSH/LH, Prolactin

Answer 71

Cannabis use disorder is defined as a problematic pattern of cannabis use leading to clinically significant impairment in areas of function or distress within a 12 month period. Usually adolescents experience the following functional impairments: 1) reduced academic performance 2) truancy 3) reduced participation and interest in extracurricular activities 4) withdrawal from their usual peer groups 5) conflict with family

Answer 72

1. Social anxiety 2. Generalized anxiety 3. Depression 4. Schizophrenia 5. Substance abuse 6. PTSD

Answer 73

WHO precautions for the use of oral contraceptive pills Category 4 (refrain from use) 1. Venous thromboembolism 2. Cerebrovascular or Coronary artery disease 3. Structural heart disease 4. Diabetes with complications 5. Breast cancer 6. Pregnancy 7. Lactation (<6 weeks postpartum) 8. Liver disease 9. Headaches with focal neurologic symptoms 10. Major surgery with prolonged immobilization 11. Age >35 years and smokes 20 cigarettes or more per day 12. Hypertension (blood pressure of > 160mmHg with concomitant vascular disease)

Answer 74

Age 21 if sexually active or 3 years after being sexually active.

Answer 75

Transition to adult care from CPS statement 1. See teens without parents for part of the appointment to give opportunity to learn how to present a history, ask and answer questions, and advocate for themselves. 2. Provide books, newsletters and magazines that deal with youth issues and youth living with health conditions. 3. Peer support meetings in person, via newsletter or through the Internet can connect teens. Parent and sibling support groups are also important. 4. Family or teen education days allow teens to meet each other, get information and talk about transition to the adult system 5. A formal acknowledgment of ‘graduation’, such as a certificate from the Pediatrics’s facility can mark transfer as a rite of passage. 6. Give a transition letter explaining the location of the new facility, staff, and fleshy to expect.

Answer 76

Admission criteria for AN 1. Failed outpatient management 2. Orthostatic viral changes (>20 beats HR or drop 20 systolic BP) 3. Bradycardia <40 and symptomatic 4. Dehydration Up to date; 1. Unstable vital signs 2. Bradycardia <40bpm and hypotension or symptoms of lightheaded symptomsness 3. Orthostatic increase in pulse (> 20bpm) or decrease in SBP (>20mmHg) 4. Hypothermia (core temp <35C or 95F) 5. Cardiac dysrhythmia (ie; QTc > 0.499msec) or any any rhythm other than sinus bradycardia 6. Weight < 70 percent ideal body weight or body mass index < 15kg/m2, especially if weight loss was rapid. However, extenuating circumstances may rarely lead us to not hospitalize these patients (ie; patients who refuse admission, do not meet criteria for certification into the hospital, do not have severe general medical comorbidity, and are willing to be treated in a less restrictive setting that can adequately monitor the patient). 7. Marked dehydration 8. Acute medical complication of malnutrition (ie; syncope, seizures, cardiac failure, liver failure, pancreatitis, hypoglycaemia, or electrolyte dosturbance) 9. Moderate to severe refeeding syndrome 10. Marked edema 11. Serum phosphorous < 2mg/dL 12. Poor response to outpatient treatment

Answer 77

Don’t tell them ! But encourage her to be honest with her parents, do safe sex teaching etc.

Answer 78

1. Pregnancy/miscarriage 2. VWD 3. Polyp 4. Hypothyroidism 5. PCOS 6. Fibroids

Answer 79

Cocaine use: 1. Dilated pupils 2. Tachycardia 3. Hypertension 4. Nausea/vomiting 5. Sweating/chills (diaphoresis) 6. Evidence of weight loss 7. Chest pain 8. Convulsions 9. Euphoria 10. Hallucinations

Answer 80

Recent signs of marijuana use - Nelson’s 1. Euphoria, panic/anxiety 2. Impaired short term memory 3. Decreased coordination 4. Distortion of time perception 5. Visual hallucinations 6. Poor performance on tasks requiring divided attention (driving) 7. Loss of critical judgement Up to date 1. Tachycardia 2. HTN 3. Tachypnea 4. Conjunctival injection 5. Dry mouth 6. Increased appetite 7. Nystagmus 8. Ataxia 9. Slurred speech

Answer 81

1. Suicide 2. Cardiac (tachyarrhythmia) With long-term malnutrition, the myocardium appears to be more prone to tachyarrhythmias, the second most common cause of death after suicide Nelson’s

Answer 82

A. Latest time after intercourse that the pill is effective ? - 120h (per Nelson’s - as soon as possible after unprotected intercourse or contraceptive failure with a window up to 120h) B. Two further steps in your management of this patient 1. Advise her how to take it and that she can take gravol for nausea 2. Advise on options for contraception including that barrier method should be used in addition to OCP, etc until next menses 3. Advise that she should come back if any significant pain or heavy/unusual bleeding 4. Advise that is no menses > 1 week after expected date, should be seen to r/o pregnancy 5. Discuss risks of STIs (+\- testing and pelvic exam)

Answer 83

3 signs of physical exam for AN 1. Cachexia 2. Hypothermia 3. Bradycardia 4. Hypotension 5. Dry skin, delayed healing, easy bruising, goose flesh, orange-yellow skin on hands 6. Lanugo- type hair and increased loss of scalp hair 7. Slow growth 8. Dizziness, syncope 9. Cold, acrocyanosis, slow cap refill 10. Edema of feet 11. Loss of muscle, SC fat tissue Nelson’s

Answer 84

List 5 things that would increase your concern over her substance abuse 1. Risky behaviour a/w EtOH use (driving, sex) 2. Comorbid mood disorder 3. Suicidality 4. Concurrent drug use 5. Binge drinking (risk of OD) Or maybe things from the CRAFT questionnaire Car - driving and drinking Relax - drinking in order to relax Alone - drinking alone Forget - do you blackout when you drink Family and friends telling you to cut down Trouble - gotten into trouble

Answer 85

List the type, dose, frequency and the mechanism by which this medication works. 1) Type = NSAIDS - ibuprofen or Naproxen - first line, should be started at onset of menses and continued for first 1-2 days or for usual duration of cramps pain - pts with severe symptoms should be taking NSAIDS 1-2 days prior to onset of menses 2) Dose and frequency - Ibuprofen 400mg PO q4-6h - Naproxen sodium 550mg loading dose, then 275mg PO q6h (or 550mg PO q 12h) 3) mechanism = prostaglandin synthetase inhibitors, thus they decrease the levels of prostaglandins Second line = combined OCP, prevent menstrual pain by suppressing ovulation, thereby decreasing uterine prostaglandin levels. An additional mechanism may result from the reduction of menstrual flow after several months of use. May be considered first line in sexually active females since it has a dual purpose of prevention of pregnancy and dysmenorrhea Combo of UTD and Nelson’s - primary dysmenorrhea in adolescents

Answer 86

4 factors to prevent him from drinking again 1. Motivational Interviewing 2. Provide or refer for cognitive behavioural therapy 3. Individual or group counseling 4. Refer to rehabilitation program 5. Provide regular follow-up 6. Advocate for school based interventions and community - based interventions in his community 7. Family- Centers interventions

Answer 87

A . Effective up to 120hours after intercourse. Alternatively the copper IUD is effective for up to 7days after intercourse. B. Management 1. Counsel that they may have N/V (especially if using Yuzpe); for Yuzpe take 1 gravol 1 hour before. For plan B, ~25% have nausea, so can take gravol if needed 2. If last period was abnormal or concerns for STI, do pelvic exam and send swabs for G&C 3. Advise that she may be at risk for pregnancy in first few days following EC because EC delays ovulation. Discuss contraception: if patient is going to have sexual intercourse before her next period, she should use a barrier method with spermicide. Or discuss option of birth control pill - which can be started the day after she takes EC 4. Discuss that EC is not 100% effective. Advise that she return for a pregnancy test if the next period is more than one week later or if it’s unusual in any way. Arrange follow up appt for one week after next period is due 5. Discuss her options should she become pregnant 6. Counsel that EC does not prevent against STIs

Answer 88

Primary amenorrhea - absence of menses by 15 years of age - complete absence of menses by 16 y.o if breast development - complete absence of menstruation by 14 y.o if NO breast dvlp Secondary amenorrhea- absence of menses for - - >3 months in girls who have had regular menses OR - 6 months in girls with irregular menses Nelson’s - ddx x 4 1. Eating disorders 2. Female athlete triad/ strenuous exercise 3. Turner syndrome 4. Diabetes mellitus 5. IBD 6. Cystic fibrosis 7. Cyanotic congenital heart disease 8. Celiac disease 9. Hyperthyroidism 10. Brain tumor (craniopharyngioma, prolactinoma)

Answer 89

A. 3 diagnostic criteria 1. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight less than minimally normal or, for children and adolescents, less than that minimally expected 2. Intense fear of fainting weight or of becoming fat or persistent behaviour that interferes with weight gain, even though at a significantly low weight 3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self- evaluation, or persistent lack of recognition of the seriousness of the current low body weight. B. List one irreversible consequence of AN 1. Loss of bone mineral density may not completely resolve after nutritional rehab (lecturer said to choose this ) 2. Persistent grey matter deficits following recovery have been reported - related to the degree of weight loss. - Up to date says that the brain atrophy seen on MRI is reversible

Answer 90

A. What is the diagnosis ? - pubic lice aka pediculosis pubis - organism is phthirus pubis - usually transmitted by sexual contact - itching is the main complaint - see pale bluish 0.5- 1cm macules (maculae ceruleae) - from the injection of louse anticoagulant with feeding - important to evaluate patient for other STIs - other thing a to consider is scabies - see itching, can have urticaria, vesicular or bullous lesions in children, can also be nodular (erythematous, firm, pruritic dome shaped lesions) B. Treatment = permethrin 1% cream

Answer 91

This is hard because different methods of purging lead to different electrolyte abnormalities. I did the ones below assuming it was vomiting. Nelson’s and up to date -in severe vomiting, you get hypochloremic hypokalemic metabolic alkalosis - Na = decreased - according to up to date - k = decreased - Cl = decreased - pH = increased - HCO3 = increased - CO2 = increased - compensation Also get hypoMg and hypoP04 Purging leads to loss of K and acid - hypochloremia and hypokalemia + metabolic alkalosis Table of different purging methods Vomiting - only what differs from above - Na = decreased, increased or normal. Laxatives - Na = increased or normal - k = decreased - Cl = increased or decreased - HCO3 = increased or decreased - pH = increased or decreased Diuretics - Na = decreased or normal - K = decreased - Cl = decreased - HCO3 = increased - pH = increased

Answer 92

C. Copper IUD

Answer 93

4 conditions of heavy bleeding 1. Pregnancy/ miscarriage 2. Polyps 3. Hypothyroidism 4. PCOS 5. Fibroids

Answer 94

Answer D - Varicocele - painless + irregular + paratesticular mass + left side + increased size with standing and valsalvaw B - inguinal hernia - smooth firm mass C- epididymitis- painful

Answer 95

A. Unexplained vaginal bleeding - different from previous

Answer 96

C. NSAIDS and bed rest

Answer 97

Likelier to quit 1. Older teenager 2. Male sex 3. Teen pregnancy and parenthood 4. Scholastic success 5. Team sport participation 6. Peer and family support for cessation 7. CYP2A6 slow nicotine metabolizer Less likely to quit 1. Nicotine addiction 2. Mental health conditions, including ADHD 3. Drug and/or alcohol use 4. Chronic illness 5. Family stress 6. Peer and family tobacco use 7. Overweight or weight preoccupation 8. Developmental drive to experiment 9. Fear of peer rejection 10. Perceived lack of privacy and autonomy

Adolescence Flashcards

(121 cards)