adolescent Flashcards Preview

US Pediatric Boards Edited > adolescent > Flashcards

Flashcards in adolescent Deck (45):
1

What is the comparison between bone age and chronological age in constitutional growth delay?

Bone age < chronological age

2

What drug may cause galactorrhea in males?

Marijuana

3

When would you consider abnormal premature pubertal development in a male?

Prior to age 9

4

What is the first stage of male pubertal development?

Testicular growth >2.5 cm

5

What should you consider in a Male with pubic hair development and Penis enlargement in the absence of testicular enlargement ?

Extragonadal androgen stimulation

6

At what age would you consider it abnormal for a female to begin puberty?

Prior to age 7

7

What genetic syndrome may be associated with gynecomastia ?

Klinefelter

8

What is the first sign of pubertal development in females and at what age should this occur by?

Thelarche (development of Breast tissue) - workup indicated if no thelarche by age 13

9

What stage of development occurs after thelarche ?

Pubarche then menarche

10

What diagnosis should you consider in a patient who goes through thelarche but does not have pubarche?

Testicular feminization aka androgen insensitivity

11

When do you find pubarche without development of thelarche ?

Androgen excess

12

You are presented with an 11 y/o female at sexual maturity stage 2 who presents with bloody discharge, what is the most likely diagnosis ?

Foreign body (menses should not occur until sexual maturity stage 3 or 4)

13

What is pseudo precocious puberty? What is this due to?

When the sequence of pubertal development occurs out of order - due to exogenous hormones or steroid production by adrenals or gonads

14

What is the appropriate sequence of male pubertal development ?

Testicular growth --> pubarche --> penile growth --> peak height velocity

15

What should you do if a patient presents with signs of premature adrenarche ?

Bone age

16

What are 4 possible causes of pseudo precocious puberty?

Late onset CAH
Leydig cell tumor
Anabolic steroids
OCPs

17

What testing would be appropriate in a patient who presents with visual field deficits and precocious puberty?

MRI brain to look for pituitary mass

18

What are 6 absolute contraindications for the use of oral contraceptives?

Pregnancy
Liver disease
Elevated lipids
Breast cancer
Coronary artery disease
Cerebrovascular disease

19

What are 5 relative contraindications for using oral contraceptives? (you can still use them but they may not be as effective)

HTN
Depression
Migraines
Breast feeding
Anticonvulsant use

20

What are 5 advantages of oral contraceptive use (other than birth control)?

Decreased risk of ovarian cysts, endometrial cancer, colorectal cancer, ectopic pregnancy and acne

21

When would you consider the diagnosis of primary amenorrhea?

Lack of menses by age 16 or 2 years following sexual maturation

22

What are 3 most common causes of primary amenorrhea ?

Polycystic ovary disease
Testicular feminization
Turner syndrome

23

What are the 2 common lab findings associated with polycystic ovary disease?

LH:FSH >2.5
Elevated androgen levels

24

What are the 3 most common causes of secondary amenorrhea?

Pregnancy, excessive exercise/weight loss, PCOS

25

What abnormal lab values should you expect in a teenager with exercise induced amenorrhea? What does this place the patient at high risk for?

Low serum estradiol -->
Low bone density

26

What are 4 common pathological causes of dysfunctional uterine bleeding ?

Tubal pregnancy
PID
Hyperthyroidism
Bleeding disorder

27

What 4 criteria must be met to diagnose anorexia nervosa?

Distorted body perception
Weight <15% expected
Intense fear of gaining weight
Absence of 3 consecutive menstrual cycles

28

What are 6 potential complications / lab findings associated with bulimia nervosa?

Salivary gland enlargement
Dental enamel erosion
Bruises over knuckles
Low K
Low Cl
Metabolic alkalosis

29

What are 5 indication for hospital admission in patients With bulimia ?

Failure of outpatient treatment
Dehydration
EKG abnormalities
Mallory Weiss tear
Suicidal ideation

30

What lab abnormality would you see in refeeding syndrome ?

Hypophospatemia

31

What is the most common STD in adolescents ?

HPV (genital warts is not the correct answer because most males with HPV are asymptomatic)

32

What is the appropriate treatment for anogenital warts? (3 answers)

Observation 1-2 years
Podophyllin
Surgical excision

33

What bacteria causes bacterial vaginosis? How would you make the diagnosis of BV by clinical exam and wet mount?

Gardnerella vaginalis - fishy odor and clue cells

34

What diagnosis should you consider in a patient with vaginal itching, frothy yellow discharge and strawberry cervix?

Trichomonas

35

What do you see on wet mount in a patient with trichomonas?

Flagellated organisms

36

What is the treatment for trichomonas?

Metronidazole 2g X1

37

What diagnosis presents with vaginal itching and white frothy discharge?

Candida

38

What diagnosis should you consider in a male with dysuria and unilateral pain & swelling of the scrotum?

Gonorhhea causing epididymitis

39

What is fitz Hugh Curtis?

Perihepatitis (normal LFTs) caused by gonorrhea or chlamydia

40

What would you expect to find on gram stain in a patient with gonorrhea?

Intracellular gram negative diplococci

41

What is the recommended treatment for suspected PID?

Ceftriaxone 250 mg IM x1
Doxycycline 100 mg BID x14 days
+/-
Metronidazole 500 mg BID x14 days

42

What should be done in a patient with suspected PID who continues with pain after treatment ?

Abdominal US to look for tubo-ovarian abscess

43

What should you do in a sexually active patient who presents with RUQ abdominal pain and vomiting ?

Pelvic exam! (Must rule out fitz hugh curtis)

44

What should you do for a patient who presents with an ovarian cyst >6 cm or significant symptoms ?

Laparoscopic cyst aspiration

45

At what age would you be concerned about delayed puberty ?

If no pubertal development by age 14 in boys or age 13 in girls