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adolescent Flashcards

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1
Q

risk factors with early pubertal maturation in girls (6)

A

higher risk of…

  • conduct problems
  • depression
  • early substance use
  • poor body image
  • pregnancy
  • experimenting with sex
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2
Q

what is the leading cause of morbidity and mortality of 16-20 y/os

A

MVA

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3
Q

criteria for anorexia

A

inability/refusal to maintain a healthy body weight

1- distorted body perceptions
2- wt <15% below expected
3- intense fear or gaining weight with restriction of energy intake
4- absence of 3 consecutive menstrual cycles

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4
Q

indictions for admission for anorexia (10)

A
  • wt <75% ideal body weight
  • continued wt loss despite intensive outpt management
  • acute weight decline and refusal of food
  • hypothermia
  • hypotension
  • bradycardia
  • orthostatic changes in BP or pulse
  • electrolyte abnormalities
  • arrhythmia
  • SI
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5
Q

lab findings with bulimia nervosa

A

hypochloremic
hypokalemic
metabolic alkalosis

*just like pyloric stenosis!

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6
Q

menarche occurs ___ years after breast development (thelarche)

A

2 years

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7
Q

tanner stage during menarche

A

3-4

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8
Q

benefits of OCP (9)

A

decrease risk for

  • ovarian cysts
  • endometrial ca
  • ovarian ca
  • colorectal ca
  • osteoporosis
  • reduce free testosterone/dec hirsuitism
  • reduce risk of salpingitis and ectopic
  • protect against acne
  • protect against iron deficiency
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9
Q

age of first pap smear

A

21

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10
Q

contraindications to OCP (9)

A
  • migraine HA with focal aura/neuro changes
  • pregnancy
  • uncontrolled HTN
  • liver dz
  • breast ca
  • cerebrovascular dz
  • history of DVT
  • history of PE
  • factor V leiden mutation
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11
Q

primary amenorrhea

A

no menses by age 15 OR 3 years following breast development

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12
Q

turner syndrome phenotypic features

A 
amenorrhea
breast buds
no pubic hair
short stature
low hair line
low set ears
hypertension 
heart murmur 
lymphedema
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13
Q

secondary amenorrhea

A

3 months of amenorrhea after menarche

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14
Q

female athlete triad

A

d/o eating
amenorrhea (low estradiol 2)
osteoporosis

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15
Q

labs in PCOS

A

LH:FSH >2.5

elevated androgen

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16
Q

treatment for PCOS (3)

A

weight loss
OCP
anti androgen med (spironolactone)

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17
Q

women with female athlete triad who smoke are at increased risk for…

A

stress fx

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18
Q

association of delayed puberty and bone density

A

delayed puberty causes low bone density

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19
Q

management of female athlete triad (3)

A

increase caloric intake
decrease exercise intensity
Ca supplements

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20
Q

cause of dysmenorrhea

A

prostaglandins

this is why NSAIDs help!

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21
Q

how to diagnosis endometriosis

A

laparoscopy

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22
Q

what is the most common cause of dysfunctional uterine bleedig in developing countries?

A

TB

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23
Q

menorrhagia

A

hypermenorrhea

heavy or porlonged bleeding at regular intervals

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24
Q

metorrhagia

A

irregular vaginal bleeding

think of a metronome keeping a regular timing

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25
menometorrhagia
heavy vaginal bleeding at irregular intervals
26
polymenorrhea
frequent vaginal bleeding more often than every 21 ds
27
cause of heavy menstrual bleeding without pain
chlamydia
28
what is the most common cause of DUB
anovulation
29
definition of DUB
menses >10d
30
in what age group do you see vaginal adhesions
infancy and preschoolers
31
do you need to treat vaginal adhesions?
NO- typically resolve sponteously unless symptomatic- dysuria, UTI tx with estrogen cream
32
causes of vulvovaginitis (8)
STDs vs non STDs STDs - GC - CT - trichomonas - herpes non STDs - enterobius vermicularis (pinworms) - GAS - staph - candida
33
how to tx candidal vaginitis
topical clotrimazole
34
cause of condyloma acuminata
HPV
35
how does condyloma acuminata present?
non tender, flat papular lesions, pedunculated, bleed with minor trauma
36
treatment of condyloma acuminata
- OBSERVATION is initial manadement - chemical cauterization with podophyllin or podofilox - surgical excision anogenital warts have a high spontaneous resolution rate- can observe for 1-2 yrs before treatment
37
what is the condyloma lata is 2/2...
secondary syphilis
38
what does condyloma lata look like?
whitish-gray papules that have coalesced | have systemic sx -- fever
39
treatment for primary HSV
acyclovir - can also use famciclovir and valacyclovir
40
best test to dx HSV
viral culture no tzank prep
41
what are maculae cerulea
blue grey dots seen with pediculosis pubis (crabs)
42
presentation of pediculosis pubis
red, crusted suprapubic maculs | blue-grey dots (maculae cerulea)
43
treatment of pediculosis pubis
permethrin 1% or 5% pyrethrin with piperonyl butoxide malathion lindane- cannot use in pregnant women or children
44
what causes bacterial vaginosis
gardnerella vaginalis anything that disrupts the balance of nl vaginal flora- abx or IUDs
45
presentation of bacterial vaginosis (3)
1- copious grey/white dc 2- vaginal pH >4.5 3- clue cells under microscopy
46
what does the whiff test, test for?
BV! | smell a fishy odor 2/2 amines after the addition of KOH
47
what is the most prevalent nonviral STD in US teens
trichamoniasis
48
how to males present with trichamoniasis
asymptomatic
49
how to females present with trichamoniasis
burning and itching abnormal vaginal odor pain with sex (dyspareunia)
50
findings with trichamoniasis
frothy yellow discharge with strawberry cervix (bc friable mucosa)
51
treatment of trichamoniasis
flagyl | treat partner too
52
how does gonorrhea present?
asymptomatic
53
systemic presentation of gonorrhea
arthritis pharyngitis fever cervical adenopathy
54
what is he most common reportable STD
1- chlamydia | 2- gonorrhea
55
how does gonorrhea present in males with sx
dysuria discharge epididymitis unilateral pain and swelling of the scrotum
56
how does gonorrhea present in females with sx
urethritis and cervicitis dysuria malodorous discharge worry about spread eading to peritonitis or peri hepatitis (fitz hugh curtis)
57
findings with fitz hugh curtis
RUQ pain peri hepatitis LFTs nl
58
gold standard for dx systemic gonoccal dz
culture need empiric tx before results
59
criteria for dx PID
lower abdominal or pelvic pain + uterine, adnexal or CMT Additional criteria - WBC in vaginal secretions - temp >38.3 - elevated ESR or CRP - lab evidence of GC/chlamydia - abnl cervical or vaginal mucopurlent dc
60
causes of PID
GC CT gram negatives anaerobes
61
other testing to do when you suspect PID
trichamoniasis BV HIV syphilis
62
outpt tx of PID
cephalosporin -- cefoxitin, cefotetan or ceftriaxone + doxycycline 100 BID x14d w/ or w/out flagyll 500 bid x14d
63
when to follow up with pt with PID being managed as outpt
72h
64
when do you need to hospitalize for PID?
- cannot assure follow up - symptoms if not improve in 48h - cannot tolerate outpt management - sever illness - pregnant
65
what further testing should be done in pt with PID with persistent sx 48 h after tx
US to look for TOA
66
cause of fitz hugh curtis
CT or GC
67
management for ovarian cyst <6cm
follow up US
68
management for ovarian cyst >6cm
laparoscopic cyst aspiration
69
management of ovarian torsion
1- call surgery | 2- get US
70
hymen damage
can be 2/2 sexual abuse | HOWEVER too nonspecific on its own
71
cause of labial adhesions
sexual abuse | ALSO can be seen with trauma- like bike injury
72
population that experience urethral prolapse
african american females | ages 3-8
73
treatment for urethral prolapse
sitz bath | uro f/u
74
what cause physiologic leukorrhea
desquamation of epithelial cells 2/2 estrogen | occurs pprior to menarche (age 11) can last several mos
75
in what age group is evidence of congenital condyloma acuminata found
<3 years 2/2 birth canal transmission manifensts typically by age 1 >3y with condyloma accuminata- think ABUSE
76
a 19 yo M is dx with gonorrhea- when do you retest?
3 mo
77
what causes proctolitis and what is the tx
inflammation of the colonic mucosa 2/2 LGV (C trachomatis), campylobacter, shigella, entamoeba histolytica p/w tenesmus, cramping, discharge and diarrhea tx with doxy if dx with LGV
78
at what age do you vision screen in adolescents
risk analysis yearly | screen at 12 and 15 yo
79
at what age do you hearing screen in adolescents
risk assessment yearly | screen once in early adolescence (11-14y), once in mid (15-17y), once in late (18-21y)
80
what is the side effect of depoprovera
decreased bone mineral density
81
what drugs decrease the efficacy of OCP
``` p450 inducers (will get rid of drug quickly) CRAP GPS Carbamazpine Rifampin Alcohol (chronic) Phenytoin Griseofulvin Pheonobarb Sulfonylmides ```
82
how do OCPs effects TFTs
increase the TOTAL serum concentration of T3 and T4 but do not change the free levels
83
what is the dx? girl with anorexia had heart murmur- midsystolic click
MVP
84
what are the weekly wt gain goals for treatment of anorexia
outpt 0.5-1 lb inpt 2-3 lb partial hospitalization 1-2 lb
85
what are the indication for ordering a bone mineral density in an adolescent (5)
``` 1- eating do 2- low body wt/BMI 3- stress fx 4- weight loss >10% 5-menstrual dysfxn ```
86
when do you see male gynecomastia
14 (10-16) typically SMR3
87
adolescent boy with scrotal mass that increases with valsalva and standing and decreases while supine
varicocele- dilated scrotal vv d/t incompetent venous valves in internal spermatic vv
88
teenager with excessive bleeding after delivery... what must you work about
sheehan syndrome | pituitary insufficiency post partum
89
pt with history of D&C now with amenorrhea
asherman syndrome- uterine synechiae/adhesions
90
what is the difference between androgen insensitivity syndrome and Swyer syndrome
androgen insensitivity- normal testosterone, gonads are testest Swyer syndrome: little/no testosterone produced, pure gonadal dysgenesis/undifferentiated streaks (need to remove d/t risk of malignancy)
91
what are the 2 most common causes of reiter syndrome in adolescent males
chlamydia and campylobacter
92
what is the treatment for chlamydia urethritis or cervicitis
azithro, doxy 100mg bid x7d
93
what is the treatment for chlamydia cervicitis in pregnancy
azithro 1g, amox 500mg tidx7d
94
what groups need a test of cure for chlamydia infections
pregnant women | 3 weeks after treatment
95
what is the treatment for chlamydia epididymitis
doxy 100 bid x10d + ctx 250mg IMx1 not azithro
96
which one of the following findings is most likely to be identified in a pt with monoarticular suppurative arthritis due to disseminated gonococcal infection a. multiple discrete painful skin lesions b. positive synovial cx c. positive blood cx d. uveitis e. tenosynovitis
positive synovial cx blood cx is usually negative
97
what are the 2 stages of lymphogranuloma venereum
primary- painless herpetiform-like ulcer at site of innoculation 3-12 d after exposure secondary- appears 2-6 wks, tender, unilateral suppurative matted inguinal nodes with inflamed overlying skin. Can see groove sign - separation of the inguinal and femoral nodes by the inguinal ligament
98
what is the minimum diagnostic criteria for PID
pelvic/lower abdominal pain with uterine tenderness or adnexal tenderness or CMT
99
what is the inpt treatment for PID
cefoxitin or cefotetan PLUS doxy | OR clinda PLUS gent
100
what is the outpt treatment for PID
CTX OR cefoxitin PLUE doxy WITH or WITHOUT metronidazole do not use azithro for PID
101
in what cases would you also uses flagyl for tx of PID
concern of anaerobes - TOA 0 trich or BV - h/o gynecological instrumentation in preceding 2-3 wks
102
name the STD discrete punched out, painless lesions with sharp, firm, raised, indurated margins
primary syphilis can be accompanied with regional adenopathy
103
name the STD large grayish-white lesion in warm moist areas
condyloma lata, secondary syphilis
104
name the STD painful pus-filled ulcer, deep, ragged, purulent yellow base
chancroid | H ducreyi
105
what is the treatment for chancroid
azithro + CTX
106
what is granuloma inguinale (donovanosis) and what is the treatment
rare in the US- h/o travel to tropical/subtropical areas - new guinea, india, austrailia, caribbean 2/2 klebsiella granulomatosis indurated subq nodule progresses to large extensive, painless ulcers with red, friable granulation tissue and raised, rolled margins see intracytoplasmic inclusion bodies (donovan bodies) tx with azithro x3wks

adolescent (2 decks)

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