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Phase 2 PEDs > Adolescent medicine > Flashcards

Adolescent medicine Flashcards

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1
Q

Adolescent psych development - stages?

A

Early 10-13yo - Ambivalent to independence
Middle - Abstract/identity/independent thoughts, risky
Late 18-21yo- Concern for future, commits sex partner

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2
Q

HEADDSS Mnemonic?

A 
H- Home/friends
E- Education
A- Alcohol
D- Drugs
D- Diet
S- Sex
S- SI/Depression
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3
Q

Female 1st sign of Secondary sexual characteristics?

A

Thelarche (breasts)

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4
Q

Male 1st sign of Secondary sexual characteristics?

A

Testicular enlargement

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5
Q

Average age of menarche?

A

12-13yo

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6
Q

Female - Tanner stage 1?

A

<10yo

Pre-pubertal - no glandular tissue

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7
Q

Female - Tanner stage 2?

A

10-11.5yo
Breast bud - under areola
Pubic hair - straight and on labia majora

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8
Q

Female - Tanner stage 3?

A

11.5-13yo
Breasts enlarge outside areola
Pubic hair - darkens/curls

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9
Q

Female - Tanner stage 4?

A

13-15yo
Areolae protrude from breast
Pubic hair - fills incompletely (not on thigh)

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10
Q

Female - Tanner stage 5?

A

14+yo
Areolae rejoins breast contour (most)
Pubic hair - fills completely (On medial thigh)

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11
Q

Male - Tanner stage 1?

A

<9yo
Pre-pubertal
Penis <3cm and no pubic hair

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12
Q

Male - Tanner stage 2?

A

9-11.5yo
Testes enlarge (1st sign) - redder/scrotum thins
Straight pubic hair appears

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13
Q

Male - Tanner stage 3?

A

11-13yo
Penis lengthens
Pubic hair darkens/curls

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14
Q

Male - Tanner stage 4?

A

12.5-15yo
Penis widens
Hair fills in (incomplete - no thigh)

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15
Q

Male - Tanner stage 5?

A

14+yo
Development complete
Hair fills in (completely, medial thigh)

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16
Q

Types of Puberty disorders?

A

Precocious puberty - (too soon)

Delayed puberty - ( late)

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17
Q

Types of Precocious puberty?

A

Central vs Peripheral

Central = CNS premature over production
Peripheral = Sex hormones synth independent of CNS
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18
Q

Reasons for delayed puberty?

A
  1. Inhibition of GnRH release from hypothalamus

2. Pituitary issues

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19
Q

When is precocious puberty considered? M/F?

A

<8yo female

<9yo male

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20
Q

Central precocious puberty is due to?

A

Brain or pituitary malfx

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21
Q

MC cause of central precocious puberty?

A

Idiopathic GnRH secretion

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22
Q

Causes of peripheral precocious puberty?

A

Gonad/Adrenal tumors/Hamartoma
Congenital adrenal hyperplasia
Familial Leydig cell maturation
McCune-Albright syndrome

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23
Q

MC cause of peripheral precocious puberty?

A

McCune-Albright syndrome

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24
Q

McCune-Albright syndrome is?

A

Ovarian hyperfunction causing precocious puberty w/ episodic estrogen secretion.

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25
McCune-Albright syndrome is ass/w?
Bony d/o | Café au lait spots
26
TXT McCune-Albright syndrome w/?
Medroxyprogesterone acetate Testolactone - bocks estrogen synthesis Tamoxifen - antiestrogen
27
PE clues suggesting Peripheral precocious puberty?
Adrenarche dominantes - pubic/axilla hair, acne, body odor Testes <2.5cm - adrenal/non-testicular source
28
PE clues suggesting Central precocious puberty?
Testicular growth >2.5cm | Thelarche then Menarche
29
LH/FSH results of central precocious puberty?
Both Elevated = central
30
LSH/FSH results of peripheral precocious puberty?
Both decreased = peripheral
31
What other study is performed when central vs peripheral is considered?
Head MRI for central precocious puberty | CT or MRI for either
32
TXT of precocious puberty?
Endo referral | Leuprolide = GnRH analogues (Stops menses/suppress)
33
GnRH- dependent central precocious puberty is TXT w/?
GnRH agonists
34
Complications of un-TXT precocious puberty?
Short stature - bone epiphyses close early Recurrent ovarian cysts TXT SEs - radiation of tumor
35
1st question to ask considering central vs peripheral precocious puberty? Yes W/U? No W/U?
Did it start w/ testicular or breast development??? Yes -central- high LH/FSH, hormones and head MRI No -periph- DHEAS, MRI of adrenal (acne/odor/hair)
36
Most cases of precocious puberty are?
Idiopathic and central
37
Delayed onset puberty is AKA?
Hypogonadism
38
Delayed onset puberty is defined as?
No pubertal development by age 13F or 14M
39
What are two pathophys possibilities of Delayed onset puberty?
HYPO-gonadotropic HYPOgonadism- low LH/FSH | HYPER-gonadotropic HYPOgonadism - high LH/FSH
40
HYPO-gonadotropic HYPOgonadism causes?
GnRH secretion inhibition - (Malnutrition,stress,chronic dz) | Hypothalamus/pituitary disease (idiopathic/tumors)
41
HYPER-gonadotropic HYPOgonadism causes?
Gonadal failure - due to - Turner syndrome - Klinefelter syndrome - Androgen insensitivity - PCOS
42
Female athletic triad can cause what pubertal d/o?
HYPO-gonadotropic HYPOgonadism from Malnutrition
43
Delayed onset puberty W/U is?
LH/FSH High (HYP)= Karyotype (Turner/klinefelters), U/S gonads Low (HO)= TSH, PRL, head MRI
44
TXT of Delayed onset puberty?
Endo refer guides TXT
45
NL variants of Puberty?
``` Breast asymmetry - TTP pea sized mass below nipple Breast mass - fibroadenoma/cyst (U/S) Physiologic Leukorrhea - vaginal d/c due to estg Irregular/anovulatory menses for 2-5yr BOYS-gynecomastia ```
46
U/S is best used for what female breast type?
Young, dense breasts
47
Physiologic leukorrhea MC occurs in what Tanner stage?
Tanner Stage III
48
Compared to thelarche Menses NL starts when?
2-3yrs after
49
When should gynecomastia be evalued for boys?
Large, Hard, fixed or ass/w nipple d/c
50
Gynecomastia is benign usually when?
<3cm
51
Gynecomastia is trimodal
Infancy 11-14yo (tanner III-IV) 50-80yo
52
Gynecomastia eval?
Hx - Constitutional S/S, Hepatic Dz, Rx XXY klinfeleter Testicular tumors LABs - HCG, LH/FSH, Testo, LFT, TSH, creatinine
53
NL amount of days during Menses cycles?
21-45d apart
54
When is an organic abnormality considered for irregular bleeding in post-menarche females?
At least 1yr of regular cycles
55
MC CC of early adolescent girls?
Irregular menses - MC | then, Dysmenorrhea (pain)
56
Primary amenorrhea is?
Complete absence of menses by age 16 w/ thelarche OR Complete absence of menses by age 14 w/out thelarche
57
Secondary amenorrhea is?
Menses cessation for 3mo anytime after menarche in girls w/ 2ndry sex characterisitics
58
MC causes of 2ndy amenorrhea?
Pregnancy Anorexia/stress (low LH/FSH, estradiol) PCOS
59
PCOS is dx w/?
At least 2 1. Infreq menstrual bleeding or 2ndy amenorrhea 2. Clinical/biochemical HYPERandrogenis, 3. U/S polycystic morphology of ovaries
60
PCOS is ass/w?
Hirtsutism, mod-severe acne Irreg menses/amenorrhea Polycystic ovaries Obesity/insulin resistance
61
TXT of amenorrhea?
1. Anovulation= cyclic progesterone or combo OCP 2. Hypothalamic amenorrhea/ovarian failure= E/P comb 3. PCOS = wgt loss, exercise, withdraw prog, combo E/P 4. Androgen excess = E/P combo - --Hirsutism = Spironolactone - -- Insulin resistance= metformin
62
Frequent menstrual bleeding is considered?
<21d
63
Infrequent menstrual bleeding is considered?
>35d
64
Amenorrhea is defined as?
>6mo menses absence
65
Irregular menstrual bleeding is considered?
>20d variation in cycle length
66
Prolonged menstrual bleeding is considered?
>8d of flow
67
Shortened menstrual bleeding is considered?
<2d of flow
68
Heavy menstrual bleeding is considered?
>80cc
69
Light menstrual bleeding is considered?
<5cc
70
Intermenstrual bleeding is considered?
Bleeding between normally timed periods
71
MC cause of ABNL uterine bleeding?
Anovulation - 20% have coag d/o
72
TXT for ABNL uterine bleeding only occurs when?
Heavy menses
73
TXT for ABNL uterine bleeding is?
Iron supplement - IDA E/P combo (6-12mo until HPA matures)(vW Dz too) Rarely - uterine cuttrage
74
MC gynecologic CC of young women?
Dysmenorrhea
75
Primary Dysmenorrhea is?
Pelvic pain during menses w/out pelvic pathology
76
Primary Dysmenorrhea occurs when?
1-3y after menarche - increased incidence until 24yo
77
Primary Dysmenorrhea is due to?
Progesterone declines > Endometrium degenerates > Increased PGs/Leukotrienes released > Increased uterine tone/dysrhythmic contractions
78
2ndy Dysmenorrhea is?
Menses pain ass/w pelvic pathology
79
2ndy Dysmenorrhea is MC due to?
Endometriosis or PID
80
Endometriosis is a sign of what severity of 2ndy Dysmenorrhea?
Mild to moderate unless completely obstructed (Severe)
81
How to screen for vaginal outlet obstruction?
U/S
82
Study for Dx PCOS?
U/S
83
What is required to Dx endometriosis?
Laparoscopy (Or PID certainty if TXT failed)
84
Dysmenorrhea TXT?
1L - NSAIDs (take before or as soon as menses begins) Q/4h for 2-3d (Naproxen or Ibuprofen) 2L - E/P combo long acting 3L - if >4mo on OCP
85
Sports physical w/ exclusive criteria CV PE finding?
Murmur that is louder w/ Valsalva or Standing
86
CV problems CI for sports?
``` Active myocarditis/pericarditis HCM Long QT synd Severe HTN SCA CAD ```
87
Other disorders CI for sports?
``` Eating D/O Acute Enlarged spleen/liver Recent concussion - post-concussion S/S Poorly controlled convulsive D/O Burning/paresthesia of upper limb ```
88
Adolescent Calcium requirement?
1300mg

Phase 2 PEDs (23 decks)

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