Adolescent/Substance Use/Gyn Flashcards
1
Q
Normal order of puberty changes in girls
A
- Thelarche around 9.5 years
- Pubarche 1-1.5 years after thelarche
- Peak height velocity around 11.5 years (8.3 cm/year)
- Menarche around 12.5 years
2
Q
Delayed menstruation definition
A
- No menarche by age 14 without breast development
- No menarche by age 16 with breast development
- No menarche within 4 years of onset of breast development
3
Q
Sexual orientation facts
A
- Not a choice, it’s biologically based
- Homosexual teens are at higher risk of substance abuse, suicide, dropping out, and being homeless
4
Q
Biggest risk with inhalant abuse
A
- Sudden cardiac death
5
Q
Normal order of puberty in boys
A
- Testicular enlargement (around age 10)
- Pubarche (around age 11.5)
- Peak height velocity (around 11.5 years of age)
- Spermarche
6
Q
Peak height velocity in boys
A
Adolescent boys who mature early develop higher peak height velocities than those who mature later
7
Q
Overall drug use statistics
A
- Alcohol: 50% have tried by 10th grade
- Tobacco: 35% of 12th graders have tried
- Marijuana: 45% of 12th graders have tried
8
Q
How long are drugs positive in the urine
A
48 hours
- Except marijuana can be for several weeks (lipid soluble)
- Urine spec grav and creatinine can impact the validity
- Positive screens must be confirmed by further testing
- Should be collected under direct observation when possible
9
Q
Immediate effects of inhalants
A
- Decreased inhibition –> drowsiness and lightheadedness –> ataxia and disorientation
- Effects within seconds and last 5-15 minutes
- Exam: sluggish pupillary responses, bradycardia
- Will present with mental status changes with negative head CT and negative urine, may have abnormal odor on breath
10
Q
Extreme intoxication of inhalants
A
Generalized muscle weakness, confusion, hallucinations, ataxia, delirium, nystagmus, lack of coordination
11
Q
Long term effects of inhalants
A
Asphyxia, cardiac arrhythmia, aspiration, pyschosis, dementia, bone marrow suppression, liver/kidney damage, encephalopathy
12
Q
Acute effects of marijuana use
A
- Dry mouth, dilated pupils, drowsiness, distortion of time
13
Q
How to monitor discontinuiation of marijuana use
A
Serial measurements of urine THC:creatinine ratio which should decrease
14
Q
Chronic effects of marijuana use
A
- Learning problems, worse school performance
- Compromised immune function, decreaesd sperm count, impaired coordination
- Tachycarida, lung damage, gynecomastia
15
Q
Withdrawal from marijuana symptoms
A
- Irritability, insomnia, tremors, nystagmus
- Peaks at 4 days and can continue for 2 weeks
16
Q
Acute alcohol toxicity symptoms
A
- Ataxia, slurred speech, visual disturbance, nausea
- Sluggishly reactive pupils, excessive sweating, hypoglycemia
17
Q
Chronic alcohol abuse symptoms
A
Esophagitis, gastritis, peptic ulcer disease
- Cirrhosis DOES NOT happen in teenagers
- Adolescents who binge drink aren’t at risk for becoming alcoholics but they are at risk for having depression
18
Q
Short term symptoms of amphetamines
A
- Tachycardia, hypertension, sweating, agitation, fever
- Dilated pupils with slow reaction to light
- Perception that insects are on skin
- Arrhythmias
19
Q
Treatment of amphetamine toxicity
A
- Gastric lavage and activated charcoal
- Benzos for HTN and agitation, haloperidol for psychosis
- Cooling blanket, hemodialysis if arrhythmias
20
Q
Symptoms of cocaine abuse
A
- Irritability, insomnia, tremors, tachycardia, dilated pupils, flushing (at lower doses)
- Higher doses: aggression, arrhythmias, seizures, coma, myocardial infarction, stroke, renal failure
- Chronic use: choreoathetotic movements due to depletion of dopamine storage
21
Q
Symptoms of opiate toxicity
A
Comatose teen responsive to painful stimuli with pinpoint but reactive pupils, cyanosis, respiratory depression, bradycardia, hypotension
Tx: naloxone
22
Q
Symptoms of barbiturate toxicity
A
- Bradycardia, bradypnea, hypotension, hypothermia, hypoactive bowel sounds, hyporeactive pupillary reflex
- NORMAL pupil size
- Slurred speech, unsteady gait, poor impulse control, nystagmus
23
Q
Symptoms of hallucinogen toxicity
A
- Ex: mescaline, psilocybin, LSD, PCP, ecstasy, dextromethorphan
- Tachycardia, HTN, mydriosis (wide eyes), asymmetric pupils, flushing, vertical and horizontal nystagmus, ataxia, visual disturbances (but not auditory), paranoia, agitation
24
Q
Physiologic effects of nicotine
A
Increased alertness, muscle relaxation, enhanced memory, decreased appetite, decreased irritability
Bad things: peptic ulcer disease
25
Side effect from MDMA abuse
Hyponatremia, altered mental status, seizure, rhabdomyolysis, hepatic toxicity
26
Diagnostic criteria of anorexia
- Distorted body perception
- Weight down 15%
- Intense fear of gaining weight
- Absence of 3 consecutive menstrual cycles
27
Labs/symptoms of bulimia
Salivary gland enlargement, dental enamel erosion, bruises/calluses over knuckles from forced gagging, low potassium, low chloride, metabolic alkalosis
28
Indications when parental consent is not needed
- Life threatening emergencies, sexual assault services
- Medical care during pregnancy
- Treatment for STIs and HIV
- Treatment for substance abuse
29
SMR pubic hair male and female
1: none
2: fine hair
3: coarse, curly, pigmented
4: denser and curled but less abundant than adult
5: extends to inner thigh like adult
30
SMR phallus size
1: childlike
3: increased size
5: adult size
31
SMR testicular size
1: volume < 2.5 mL
2: increased volume, scrotum more textured
32
SMR breast size
1: no glandular tissue
2: small breast buds
3: breast tissue extends beyond areola
4: enlarged areola and papilla form secondary mound
33
Benefits of oral contraceptives
- Decrease risk for ovarian cysts, endometrial and ovarian cancers, osteoporosis
- Reduce free tesoterone and decrease hirsuitsm
- Reduce risk for salpingitis and ectopic pregnancy
- Protection against acne and iron deficiency anemia
34
Absolute contraindications for oral contraceptives
- Migraine headache with aura
- Pregnancy or < 21 days post partum
- Uncontrolled HTN or other heart disease
- Liver disease
- Breast cancer
- History of stroke, DVT, PE
- Factor V leiden mutation
- Major surgery with prolonged immobilization
35
Definition of primary amenorrhea
- No menses by age 15 or 3 years following breast development
36
Amenorrhea, normal breast development, absence of pubic hair
Androgen insensitivity syndrome
37
Definition of secondary amenorrhea
3 months of amenorrhea after the onset of menarche
| - MCC are PCOS, pregnancy, exercise induced amenorrhea
38
Lab findings and symptoms of PCOS
- Amenorrhea or dysfunctional bleeding, obesity, hirsutism, acne
- LH:FSH ratio > 2.5 and elevated androgens
39
Symptoms and labs of exercise induced amenorrhea
Heavy exercise with periods that become lighter and then just stop
- Low serum estradiol --> risk for osteoporosis
- Increase calories, reduce athletic training, calcium supplements
40
Cause and treatment of primary dysmenorrhea
- Pain with periods due to prostaglandins
| - Tx with NSAIDs, OCPs if NSAIDs don't work
41
Definition and cause of dysfunctional uterine bleeding
- Bleeding beyond 10 days
- Anovulation during initial months of menarche is most common cause
- Others: ectopic pregnancy, PID, thyroid disease, meds, bleeidng disorder, PCOS, trauma, systemic disease
42
Heavy menstrual bleeding without pain
Consider chlamydia
43
Symptoms of imperforate hymen
- Intermittent lower abdominal pain
- Midline abdominal mass
- Hydrometrocolpos is collection of fluid in the uterus
- Bluish/bulging hymen
44
Causes of vulvovaginitis
- Enterobius (pinworms), GAS, Staph, Candida
- Gonorrhea, chlamydia, trichomonas, herpes
- Foreign body, chemical irritants, poor hygiene
45
Mild curd vaginal discharge that is itchy
Candida vaginitis
| - Tx with topical clotrimazole
46
Flat papular lesions that are pedunculated in the genital or anal mucosa
- Condyloma acuminata (warts)
- Almost always sexually transmitted, caused by HPV
- Non-tender and will bleed with minor trauma
- Risk factor for cervical cancer
- Tx: observation for 1-2 years initially, medical treatment (chemical cauterization), surgical excision, vaccination
47
Whitish gray papules that have coalesced in genital region
- Condyloma lata (secondary syphilis)
48
Genital ulcerative lesions that are painful and have tender inguinal nodes
Herpes simplex
- Tx is oral acyclovir
- Test with viral culture for herpes simplex
49
Red, crusted suprapubic macules or blue-gray dots in pubic region
Pediculosis pubis (crabs)
- Can also be in anal hairs, facial hair, eyelashes
- Concern for sexual abuse in a child
- Tx with permethrin, pyrethrin, malathion
50
Triad of bacterial vaginosis
- Gray/white vaginal discharge, pH > 4.5, clue cells (often have fishy odor with whiff test)
- Tx with flagyl
- Bugs: gardnerella, ureaplasma, mycoplasma
- Risk factors include new/multiple sex partners, douching, lack of condom use
51
Frothy yellow discharge with strawberry cervix
Trichomonas (sx can including abnormal order, itching, burning) --> flagellated organisms
- Can be asymptomatic in men
- Tx flagyl (also need to treat partners)
52
Symptoms of gonorrhea
- Often asymptomatic
- Men can have dysuria, discharge, epididymitis (unilateral pain/swelling of the scrotum)
- Women can have urethritis and cervicitis, dysuria, malodorous discharge, peritonitis, peri-hepatitis
- Can be associated with arthritis or pharyngitis
- This is the second most common reportable STD
53
Diagnostic criteria for PID
- Abdominal/pelvic pain along with uterine, adnexal or cervical motion tenderness
- Other criteria: WBC in vaginal secretions, fever, elevated CRP, lab evidence of GC/chlamydia, abnormal cervical or vaginal mucopurulent discharge
- Tx: rocephin x 1, doxy x 14 days +/- flagyl
