Adolescent Flashcards

Question

what is binge eating disorder?

Answer 1

No compensatory behaviour occurs 1/week for 3 months eating an excessive amount of food sense of lack of control during binge episode 1. Eating, in a discrete period of time (e.g., within any 2 hr period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

Answer 2

Binge eating + compensatory behaviour! A. Recurrent episodes of binge eating. B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 mo. D. Self-evaluation is unduly influenced by body shape and weight. E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Answer 3

A. An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following: 1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning. NO evidence of body image disturbance!!

Answer 4

severe malnutrition: weight <75-80% average body weight for age, sex and height arrested growth and development fluid and electrolyte abnormalities - dehydration - hypokalemia, hyponatremia, hypophosphatemia cardiac abnormalities - arrhythmia - bradycardia <50bpm anytime, <45bpm at night - hypotension (<80/50 mmHg) - hypothermia (body temp <35.5) - orthostatic changes in HR (>20bpm) or BP (>10mm Hg) Behavioral - acute food refusal - uncontrollable binging ad purging - acute psychiatric emergencies (suicidal ideation) - comorbid diagnosis

Answer 5

NO, most are asymptomatic!!!

Answer 6

``` asymptomatic dysuria vaginal discharge abdominal pain vaginal spotting (especially after sex) ```

Answer 7

``` HPV then chalmydia (most common bacterial STI) ```

Answer 8

Azithromycin 1g PO x1 dose *** treatment of choice for teens | other options: doxycycline, erythromycin, tetracycline

Answer 9

Ceftriaxone or Cefixime AND Azithromycin or Doxycycline

Answer 10

21 then every 3 years if sexually active

Answer 11

``` ectopic pregnancy chronic pelvic pain infertility (tubal factor infertility) peri-hepatitis (may present with RUQ pain as first symptom) tubo-ovarian abscess ```

Answer 12

lower abdominal pain plus either: adnexal tenderness cervical motion tenderness uterine tenderness

Answer 13

``` Ceftriaxone 250mg IM in a single dose PLUS doxycycline 100mg PO BID x 14 days consider adding metronidazole close F/U!! * make sure you treat the partner!! ```

Answer 14

``` concerns regarding adherence pregnancy failure to respond to oral treatment severe illness, vomiting or high fever tubo-ovarian abscess HIV infection ```

Answer 15

Cefoxitin 2g IV every 6 hours PLUS | doxycycline 100mg IV or PO every 12 hours

Answer 16

fibroadenomas | 2nd- fibrocystic disease (bilateral)

Answer 17

alcohol energy drinks cannabis

Answer 18

psychosis mood disorders Lower lifetime achievement cannabis use disorder

Answer 19

MVA | psychosis

Answer 20

simplify once daily dosing long acting meds no treatments during school day take into account sleeping in on weekend and sleepovers with friends meds should not be associated with eating or not eating minimize side effects patient physician relationship- the single most important modifiable predictor of adherence!! - continuity of care - friendly clinic space and staff - time spent with their MD - direct conversations about adherence - be on time - after school appointments - their MD takes a personal interest in them

Answer 21

prolonged QT

Answer 22

achieving independence from their parents adopting peer codes and lifestyles assigning increased importance to body image and acceptance of ones body image establishing sexual, vocational and moral identities

Answer 23

Early - body image issues begin - start to separate from parents Middle - experimentation - sense of immortality Late - abstract thinking - less egocentric

Answer 24

``` abnormal uterine bleeding pattern (<19d or >90d always abnormal) evidence of hyperandrogenism - elevated testosterone - hirsutism - mod-severe inflammatory acne ```

Answer 25

1st line- combined oral contraceptive pill - normalize endometrial cycling - inhibit ovarian function (normalize serum androgens) alternative: 1) progestin mono therapy (regulates periods only!) 2) insulin lowering therapy- either weight reduction or medication such as Metformin- have 50% probability of improving menstrual cyclicity

Answer 26

- thickens cervical mucous - blocks sperm penetration - progestin - inhibits ovulation by inhibiting LH surge

Answer 27

``` decreases dysmenorrhea decreases menorrhagia reduces anemia improvement in acne, hirsutism reduces risk of ovarian, endometrial cancers may help with ovarian cysts decrease benign breast disease ```

Answer 28

"functional spermicide" copper ions interfere with sperm motility, transport, capacitation, cause sperm head-tail disconnection foreign body inflammatory reaction

Answer 29

Depot provera reduces acute sickle cell crisis by 70%

Answer 30

1. Russell's sign (calluses on dorsum of hand) 2. dental enamel erosion 3. parotid gland enlargement 4. edema 5. fluctuating weight (healthy/overweight)

Answer 31

``` temperature cardiac refeeding syndrome fluids/electrolytes osteopenia linear growth endocrine- amenorrhea, sick euthyroid, high cortisol GI Neurologic ```

Answer 32

electrocardiographic - sinus bradycardia - prolonged QTc (Corrects within 3 days of re-feeding) ``` orthostatic changes hypotension poor myocardial contractility mitral valve prolapse reduced LV thickness and mass silent pericardial effusion congestive failure (Aggressive fluid rehydration) cardiomyopathy- ipecac abuse ```

Answer 33

hypokalemia hypomagnesemia hypophosphatemia- shifts from extracellular to intracellular results in depleted ATP

Answer 34

1) delayed gastric emptying 2) slowed GI motility 3) SMA syndrome- compression of the 3rd portion of the duodenum by abdominal aorta and overlying superior mesenteric artery (due to a lack of retroperitoneal fat) 4) constipation after stopping laxatives 5) with binging and purging - gastric dilation and rupture - rectal prolapse - mallory-weiss tear - GERD - dental enamel erosion

Answer 35

LOW WEIGHT OR ABSENCE OF WEIGHT GAIN FOR PROLONGED PERIOD OF TIME - early onset of amenorrhea - long duration of amenorrhea - low protein intake - low calcium intake - smoking TX: WEIGHT RESTORATION TO A LEVEL WHERE MENSES RESUMES - additional treatments include calcium 1300mg/day, vitamin d, do not use OCP

Answer 36

due to hypothalamic suppression | - weight at resumption of menses used as one marker of health **

Answer 37

medical/nutrition management - restoration of weight and healthy nutrition patterns - avoidance/correction of medical complications family based therapy NOT individual therapy

Answer 38

1. not their fault 2. AN is a serious condition that probably would not improve without treatment 3. be angry at the eating disorder but not at the child 3. parent must take charge of child's eating, exercise and weight gain 5. supervise 3 meals, 2-3 snacks per day 6. weight restoration first, thoughts/attitudes take longer

Answer 39

``` PID infertility chronic pelvic pain ectopic pregnancy perihepatitis ``` ``` males epididymo-orchitis reactive arthritis infertility (rare) disseminated gonococcal infection (DGI) ```

Answer 40

repeat in 6 months as reinfection risk is high!!

Answer 41

1st episode: acyclovir for 7-10, famicyclovir for 5d, or valacyclovir for 7-10 days recurrence: valacyclovir for 3 d best if started within 12 hours of first lesion or during prodrome

Answer 42

``` imiquimod (aldera) cryotherapy podophyllin trichloroacetic acid laser ```

Answer 43

``` herpes HPV molluscum primary syphilis (chancre)- painless chancroid- painful pearly papules ```

Answer 44

fever >38.3 po many wbc's on saline microscopy of vaginal fluid elevated ESR elevated CRP lab documentation of cervical infection with GC or CT

Answer 45

Chlamydica, gonorrhoea, bacterial vaginosis, anaerobes

Answer 46

``` street- involved concurrent mental health disorder gay, lesbian, bisexual, or transgendered family history of substance abuse family dysfunction ```

Answer 47

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

Answer 48

drastic and irreversible neurologic effects - brainstem dysfunction - motor, cognitive, sensory deficits - signs may include irritability, tremor, ataxia, nystagmus, slurred speech, decreased visual acuity and deafness ``` cardiomyopathy distal RTA hepatitis dyspnea, emphysema bone marrow toxicity- leukaemia aplastic anemia teratogenic ```

Answer 49

respiratory arrest from CNS depression sudden sniffing death syndrome- likely to due primary cardiac arrhythmia dangerous behaviour from disinhibition and feeling of invincibility aspiration, suffocation

Answer 50

odour on breath stain, paint, glitter on skin or clothing personal dryness or pyoderma (huffer's rash) facial, oral, esophagopharyngeal freezing or burning edema of lips, oropharynx, trachea confusion, moodiness, irritability pulmonary- wheezing, emphysema, dyspnea

Answer 51

Higher rates of other substance abuse (alcohol, ecstacy) MVA accidents Lower academic functioning and educational achievement Risk of psychosis More anxiety symptoms Associated with Depression

Adolescent Flashcards

(76 cards)