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Laughing Pedi > Adolescent, Gyn > Flashcards

Adolescent, Gyn Flashcards

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0
Q

normal prepubertal testicular size

A

< 2.5 mL

Puberty >2.5cm or volume > 4cc

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1
Q

normal range for puberty

A

9-13

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2
Q

peak height velocity at what tanner stage

A

4

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3
Q

mound on mound, secondary mound breast development

A

4

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4
Q

delayed puberty in boy / girl

A

14 boy
13 girl

OR stall out of puberty with lack of progression within 4.5-5yrs after onset

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5
Q

first sign puberty in boy / girl

A

testicular enlargement / thelarche

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6
Q

growth velocity before and after puberty

A

before 5-6 cm/yr

peak adolescent height velocity 9-10 cm/yr

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7
Q

sequence of male puberty and when do they grow fastest

A

testicular growth -(1 yr later)-> pubarche –> penile growth -> peak height (stage 4)

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8
Q

puberty too early when in boys? girls?

A 
9y males (pubarche or genital development) 
8 yr girls (thelarche + pubarche) or menstruation before 10yrs = precocious
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9
Q

gynecomastia / unequal breasts are ok (reassure) UNLESS

A

exposure to ketoconazole or b/l in males.

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10
Q

galactorrhea can be caused by what in adol males

A

marijuana

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11
Q

growth prediction after menarche in females?

A

within 4cm / 2in of adult height

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12
Q

what is pseudo precocious puberty and what should you consider.

A

when things happen out of sequence usually from sex steroid production by adrenals, ovaries, or testes or exogenous.

Consider: late onset CAH, leydig cell tumors, anabolics, ocps

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13
Q

what is responsible for acne / axillarly hair?

A

androgens

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14
Q

ABsolute contraindications to OCPs

A

BC HELP: BRCA, Coronary artery/Cerebrovascular dz, hepatic dz, elevated lipids, pregnancy

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15
Q

typical LH: FSH ratio in PCOS?

A

> 2.5 LH: FSH

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16
Q

possible anti-androgen med for PCOS

A

spironolactone

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17
Q

most common bacterial std

A

chlamydia

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18
Q

fishy amine odor / whiff test

A

bacterial vaginosis: gardnerella vaginalis

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19
Q

clue cells

A

bacterial vaginosis, gardnerella vaginosis

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20
Q

strawberry cervix, burning, itching, pain.
Dx?
Tx?

A

Dx: trichomonas vaginalis
Tx: flagyl for pt and partners: 2g single dose!

(Think flagellated whiping cervix)

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21
Q

screening test for GC/Chlamydia

A

urine PCR (naat: nucleic acid amplific test)

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22
Q

outpt tx of PID?

A

CTX 250mg IM
Azithromax 1g
14 d

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23
Q

ovarian cyst size cutoff for aspiration vs follow up ultrasound

A

6cm

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24
Decade peaks in substance abuse?
70s and 90s
25
How long can marijuana be detected in urine for single use, chronic use, daily use?
single use: 5 days chronic use: 10 days daily use: 1 month
26
``` Short acting bartiburate (secobarbital) Intermediate acting (Phenbarb) ``` How long detected in urine?
Secobarb: 1 day Intermediate: 1 week or more
27
most common fatal complication of hydrocarbon inhalation?
arrhythmia
28
Ed presentation with tachycardia, tremulousness, htn, mydriasis (lg pupil)
cocaine
29
ED w/ combative behavior, agitation
alcohol
30
ED w/ "quick drunk" disinhibition, agitation, hallucinations, generalized muscle weakness, nystagmus
volatile hydrocarbon
31
agitation, combative, vertical and horizontal nystagmus, may have rigidity, may have distortion of body image and hallucinations
PCP
32
% of HS seniors who have used marijuana used in past year used in past month use daily
40% ever, 33% past year, 21% past month, 5% daily
33
Acute physical effects of marijuana
dry mouth, dilated pupils, drowsy, distorted time (Ds)
34
effects of chronic marijuana
pulmonary, tachycardia, poor stamina
35
sx of marijuana w/d? | Big s/e?
w/d: irritability, insomnia, tremors, nystagmus **Gynecomastia
36
% HS seniors who have used alcohol?
80%
37
Alcohol and pupils?
normal size, sluggish reaction
38
alcohol and blood sugar?
hypoglycemia assoc w. alcohol use
39
propoxyphene can cause what?
opiate - cardiac arrhythmia
40
opiate effect on temp and bp?
low temp and low bp
41
pt w/ hx anxiety, poor school performance, rhinorrhea, insomnia, stomach cramps?
opiate w/d
42
drug that can cause rhabdo and why?
PCP: muscle rigidity
43
other drug that can cause rhabdo from hyperpyrexia and muscle rigidity?
acute cocaine "coke fever"
44
Drug suspected from sympathomimetic and cholinergic effects? | What other sx would you see?
PCP: tachy, htn, incr reflexes / miosis, flushing, diaphoresis + cerebellar
45
Two things NOT to do if PCP intox is suspected?
1. acidify urine: risk of precipitating myoglobin | 2. restraints: can worsen rhabdo
46
Tx of PCP intox?
cooling blanket, haloperidol, chlorpromazine, lorazepam
47
most common substance abused by teens? | most common illicit substance abused by teens?
alcohol / marijuana
48
acute cocaine overdose at low vs high doses?
low: euphoria and overconfidence high: aggressive / violent behavior
49
tx of htn in cocaine tox? | tx of psychosis w/ cocaine tox?
nitroprusside | haldol
50
physiologic effects of nicotine? (5) adverse effects?
Alertness, muscle relaxation, enhanced memory, decr appetite, decr irritability PUD!
51
giggling, slow speech, ataxia and negative urine tox and blood alcohol level?
organic solvent abuse
52
distinguish between pityriasis rosea and secondary syphilis
syphilis would involve palms and soles
53
arthritis, conjunctivitis, urethritis Cause? Tx?
reactive arthritis, Reiter syndrome: C. trachomatis | Tx: 1g azithro or 100 doxy BID x 7.
54
TX of gonorrhea?
CTX 125 IM x 1 | cefixime 400mg PO x 1
55
mean puberty onset in boys and girls
boys 11.6y | girls 11.2y
56
premature thelarche or adrenarche are normal variants of puberty that can be distinguished from precocious HOW, and what will test show?
Bone age! No height acceleration or advancement in bone age in normal pubertal variant. Precocious level will be advanced bone age
57
secondary mound is what Tanner stage?
Stage 4
58
Stage V testes in boys is what volume
20cc
59
estrogen nonstimulated vs stimulated vaginal mucosa
stimulated: pink | not stimulated: glistening red
60
test for central precocious puberty
GnRH stim test. Will have brisk rise in LH and FSH but those who are prepubertal or have peripheral precocious will not.
61
high suspicion for central precocious puberty demographics
all boys and girls < 5
62
Treatment of central precocious puberty
GnRH agonist: continuous stimulation prevents LH, FSH
63
board cause of delayed puberty - most common - board one
common: constitutional growth delay board: Kallmann syndrome (anosmia)
64
bone age in constitutional growth delay? Final height? | What is constitutional growth delay?
delayed, normal final height | Just short stature in childhood, usu + FH
65
peak height velocity boys compared to girls
2 yrs later
66
pubertal growth accounts for what % of adult height?
17-18%
67
average prepubertal, then pubertal ht veloc
5-6cm/yr --> 9-10cm/yr
68
early vs late adolescent in cognitive thinking
late should do abstract reasoning
69
proportion of syphilis exposed individuals who contract infx
1/3
70
Jarish Herxheimer rxn
fever, HA, myalgia, tachy, hypotension | All the syphilils spriochetes dying with treatment
71
chancroid? bug Tx
painful ulcer or tender node H. ducreyii CTX 250mg IM or Azithro 1 gram or Erythro 500 QID x7d
72
painless chancre ulcer, painless nodes
syphilis
73
painful ulcer and tender nodes
chancroid
74
painful vesicle/ulcer, tender nodes
HSV
75
Tx of pediculosis pubis
permethrin creme lindane shampoo pyrethins w/ piperonyl butoxide
76
secondary amenorrhea def?
no menstruation 3 mos after previously established menstruation
77
Kallman syndrome?
anosmia | GnRH def
78
Asherman syndrome | best dx?
scarification of lining of uterus, often after endometritis | Fails progesterone challenge
79
mullerian agenesis
congenital absence of vagina and uterus, but normal ovaries so normal pubertal development (2nd most common amenorrhea after XO)
80
stippled membrane epithelial cell covered with adherent bacteria seen in what
clue cell, bacterial vagniosis: Gardnerella | tx w flagyl
81
peak height velocity at what age and tanner stage in boys vs girls
girls: 11.5, tanner 2 boys: 13.5, tanner 3-4
82
pubertal growth accounts for what percent of final adult ht?
20%
83
average height diff between m/f, why
epiphyseal closure occurs 2 yrs later in boys.. 10 cm height diff
84
adolescent substance abuse stages
``` 0- curious 1- weekend tries 2 - seeks it on weekends regularly, purchases 3 - legal trouble/ stealing to habit 4 - burnout zombie ```
85
ptx and pneumomediastinum seen in what drug abuse
cocaine
86
lateral nystagmus and decr reflexes with what drug abuse
barbiturates, tranquilizer
87
lateral and vertical nystagmus with what drug?
PCP
88
average time from puberty onset to menarche?
2.6 yrs

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