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Flashcards in CPS Adolescent Deck (55)
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1

Which of the following statements is false?
a) women who have a history of being sexually abused are 2.5 x more likely to run away from home.
b) the longer youth live away from home, the more likely they are to be involved in the sex trade
c) in order to obtain health care, a teenager must have an adults approval
d) early identification of street involved youth/youth at risk can help reduce barriers to care

c)
one of the big barriers is perceived need for adult involvement/consent, other barriers include no permanent address, poorly coordinated/hard to access services

In Ontario, consent is based on mental capacity rather than chronological age of patient, these consent laws do vary per province.
there is typically provincial legislation to protect youth from victimization (i.e. from the drug and sex trades)

2

A teenage girl who is currently "couch surfing for the last 2 years" attends your clinic and is diagnosed with strep throat, which of the following is the best treatment?
a) oral penicillin x 10 days
b)IV penicillin x 1 dose
c) clarithromycin PO x 5 days
d) IV ceftriaxone x 3 doses

b) IV benzathine penicillin if available, since patient will likely not buy the drug

3

Which of the following health problems are street involved youth not at increased risk for?
a) MRSA
b) tuberculosis
c) asthma
d) hepatitis A
e) incomplete immunizations
f) mental health conditions

d) hepatitis B at increased risk in this population - 40% of street involved youth susceptible to hep B infection

the others
resp - TB and asthma
derm - including MRSA, lice, scabies, acne
dental disease - oral care, poor hygienic, smoking
foot problems
malnutrition

ensure they get complete vaccinations, especially hep B and HPV (increased cervical cancer and genital warts) , may have missed it at school

4

Which of the following is true?
a) street involved youth are 9x more likely to get chlamydia trachomatis (CT)
b)youth between age 20-28 account for 2/3 of the cases of chlamydia in Canada
c) street involved youth have increased rate of HIV infection, HSV1, Neisseria gonorrhoea
d) IV drug use increases the risk of hepatitis A and B

a) true
- other correlates of increased risk: aboriginal, foster care, no fixed address, self perceived risk.

b) 15-24 are 2/3 of cases
c) HSV2 not 1
d) hep B and Hep C

always important to elucidate living conditions, including where money is coming for, at risk behaviours (drug and sex, particularly sex for money), legal involvement, safety, mental health, dental health, immunizations, history of abuse, learning disorders/ ADHD (see table for details); on P/E, be complete, include feet, GU exam for STIs, vision/hearing, needle marks/self harm.
need special clinics for this population - those for adult homeless don't work since adolescents may not perceive that these are appropriate for them, also other interventions like accessible housing.
if risk for Hepatitis or HIV suspected, at minimum screen for HIV at initial visit since it can prevent spread.

5

Which of the following statements is false?
a) proportion of pathological gamblers in adolescents is 3x that of adults
b) the legal age for gambling is 15 year old in most Canadian provinces
c) the majority of adolescents have gambled
d) the mean age of gambling was found to be 13 years old in one study in a group of pathological gamblers.
e) gambling is the most prevalence risky health behaviour in Quebec schools with 28.2% endorsing gambling

b) false, is usually 18 or 19, but youth can access lots of gambling i.e. online, machines, casinos, lottery tickets,

youth who gamble regularly - at least once per week, more likely to get pathological gambling.

increased with age, boys more likely to gamble

6

Which of the following groups is most likely to be a pathological gamblers?
a) mood disorders
b) alcohol abuse
c) drug use
d) personality disorders

d) personality disorders 8.3x more likely to gamble; alcohol abuse - 6.0 x; drug use - 4.4x, mood disorder - 4.4 x

have also been associated with conduct disorders, ADHD, depression/anxiety and marijuana use.

how to tell if gambling is a problem -
frequency at least once per week, gamble more often than planned, lying about gambling behaviours.

7

Which of the following is not a risk factor for gambling problems?
a) lower parental monitoring
b) parental gambling problems
c) higher parental attachment
d) inadequate discipline

c)

the others are risk factors, parental attachment, good discipline and monitoring leads to lower problems.

screen for depression and suicide risk since risk of financial debt.

8

A 14 year old girl comes to your clinic 3 days after having unprotected sexual intercourse with her boyfriend, which of the following is the best method of emergency contraception for her?
a) Yuzpe
b)Plan B
c) copper IUD
d) mifepristone

b) plan B - progestin only method (2x Levonorgestrol)- recommended for adolescents, higher efficacy and less side effects works 72-120 hrs after sexual intercourse

not the others
Yuzpe - combined hormonal method (synthetic estrogen and progestin)
copper IUD can work up until 1 week after , not easily available for adolescents
mifepristone - anti progestin, not currently available in Canada

mechanism not fully known, generally includes suppressing or delaying LH peak, delaying/inhibiting ovulation, disrupting follicle development, disrupting corpus luteum; don't affect an already implanted pregnancy, don't affect implantation

9

Which of the following is the pregnancy rate in women who use the progestin only method of emergency contraception?
a)1-2%
b)3-5%
c) 3-7%
d) 8%

a) 1-2%for progestin only, vs 3-7% for combined

rate of pregnancy in women without EC is 8/100 (with sex in middle 2 weeks of cycle)

10

Which of the following is a contraindication to emergency contraception
a) migraines with neurological symptoms
b) past DVT/PE/stroke
c) known thrombophilia
d) known pregnancy

d) the only absolute contraindications are known pregnancy and allergy to a component of the medication

the others are contraindications to combined contraception; if the patient has these, likely more prudent to offer a progestin only method of EC, if not available, combined EC is okay.

see list of what is considered unprotected intercourse/grounds for EC

11

A teenage girl had unprotected sex 6 days ago and is presenting to your clinic for EC, which is the best choice?
a) copper IUD
b) plan B
c) Yuzpe method
d) mifepristone

a)
copper IUD (although baby nelson says that copper IUD not great for teens)

plan B works best at 120 hours but hard for teenagers

12

Which of the following tests should be done prior to prescribing EC?
a) pregnancy test
b)pap smear and pelvic exam
c) STI testing
d)none of the above

d) should prescribe without requiring teens to get any of these tests done

13

How should plan B be taken?
a) 1 dose of levonorgestrel 0.75 mg and second dose 12 hours later
b) 2 doses of levonorgestrel 0.75 mg at the same time
c) 2 tablets of levonorgestrel 075mg 12 hours apart with dimenhydrinate
d) none of the above

b) is the answer, manufacturer does not recommend dimenhydrinate but no evidence that it diminishes efficacy. less nausea with plan B but 1/4 women report it

for Yuzpe method, should take 2 pills of norgestrel ethinyl estradiol 12 hours apart and can give with dimenhydrinate, if second dose is missed need to start over completely

14

Which of the following statements is true?
a) emergency contraception is more effective when prescribed by a physician
b) monitoring by a physician decreases the number of side effects from emergency contraception
c) emergency contraception is available in Canadian pharmacies without a prescription
d) teens should get medical counselling to take emergency contraception

c) true

the rest are false, studies show that teens can use plan B and combined method without medical evaluation and counselling, no difference in side effects or efficacy, does not require clinical screening

15

Which of the following is the most common side effect report in the first week of taking progestin only emergency contraception?
a) dizziness
b) fatigue
c) nausea
d) headache

d) side effects reported by adolescent girls in the first week after taking plan B
headache (50%), nausea (38%), dizziness (27%), fatigue (21%)

but better tolerated than combined method, menses returned within 1 week in 62.5% of teens studied

16

A teenager takes combined EC and vomits 1.5 hours after taking the medication. What should you do?
a) give the medication again
b) give antiemetic and another dose of the medication
c) nothing

c) if vomit

17

Which of the following statements is true?
a) plan B is affected by concurrent use of rifampin
b) plan B doesn't increase the chance of adverse pregnancy outcomes
c) plan B is affected by the concurrent use of certain anti-epileptic medications


b) a recent prospective cohort study showed that plan B doesn't increase risk of major congenital malformations, pregnancy complications or adverse pregnancy outcomes

combined oral contraceptives are affected by rifampin, St John's wort, certain anti epileptic medications, HIV meds, rifampin and griseofulvin, no current evidence that combined EC is the same.

18

Which of the following should be done prior to inserting a copper IUD?
a) urine pregnancy test
b) endocervical swab for chlamydia and gonorrhea
c) determine if woman is at low risk for STIs
d) all of the above

d)

can use 120 hrs to 7 days for women that are in monogamous relationships low risk for STIs
may not always be available
should do the tests at left, may also want to consider prophylactic antibiotics for chlamydia/gonorrhea, can remove at next period

post coital use of progestin IUD not studied, not to be used for EC

19

Which of the following statements about EC is true?
a) limited knowledge about EC by many teens
b) increases rate of unprotected sex amongst teens
c) increases rates of sexual activity in teens
d) risks can outweigh benefits for most teens

a) is the answer, the rest are false

confidentiality is important since dealing with teens

20

Which of the following is not part of the routine assessment for EC?
a) offer to all patients of sexual assault
b) determine LMP and last sexual intercourse
c) do a blood pressure
d) do a pelvic exam and test for gonorrhea/chlamydia
e) assess contraindications to combined oral contraceptives

d) only do if unusual lMP, suspect pregnant or signs of STI.

should discuss routinely at visit, explain how it works, side effects, time of method, where to get it, safety, emphasize that it should be for emergency only, should offer to all SA victims
also determine if using contraception and any contraindications to combined oral contraceptives.

21

Which of the following is false of EC?
a) increased risk of pregnancy in the days after taking EC since it delays ovulation
b) can start birth control pills the day after taking EC
c) it is normal for the next period to be one week or more late
d) if having sex before the next period, should use a barrier method with spermicide

c) should come in if next period is a week or more late, (next period can be early, on time or late) or if unusual period (to test for pregnancy)

can start new pack of pills the day after taking EC
not 100% effective so should follow up, schedule an appointment for 1 week after next expected menstrual period, commend the teen for coming in and counsel them.

should ensure that teens are aware of availability - i.e. pamphlets, info in the office etc. should communicate with teens at routine visits.

22

Which age group has the highest number of teen pregnancies?
a) 18-19 year old
b)15-17 year old
c) <15 year old

a) 18-19 year old have the largest number, many of these are planned

overall rate < 20 year old 27.1/1000
18-19 year old 54.1/1000
15-17 year old 16.8/1000
<15 year old 2.0/1000

23

Which of the following statements is false?
a) 50% of adolescent pregnancies end in abortion
b) sensitive immunoassays can detect pregnancy as early as 10 days post conception
c) increased rate of complications in pregnancies in 15-19 year olds related to poor prenatal care
d) urine pregnancy tests can detect a pregnancy 10-14 days after ovulation

b) as early as 6 days post conception

the rest are true, d) they may not detect a pregnancy until 1 week after missed period

24

Which of the following is true?
a) if a patient has a negative urine pregnancy test, but pregnancy is highly suspected, should do a serum hCG
b) the uterus is palpable after 6 weeks gestation
c) early Ultrasound should be done routinely to confirm pregnancy in all teens
d) physical exam can detect pregnancy before lab tests.

a) is true, can have false negatives.

b) false - 9-12 weeks gestation
c) should consider if irregular period or if suspect ectopic pregnancy

25

Which of the following statements about abortion options is true?
a) medical abortion using methotrexate and misoprostol has been extensively studied in teens and found to be the best option
b)risks of surgical abortion in teens outweighs the risk of pregnancy
c) risk of abortion is inversely proportional to gestational age
d) 35 % of teens who deliver a baby with have another pregnancy within 2 years

d) is true, very important to provide contraception, the teen who is most likely to get pregnant is the one that just had a baby

a) false - recent Cochrane review found that it is effective and safe to terminate first trimester pregnancy, but not much evidence in teens. also needs lots of follow up and monitoring, so may not be the best for teens
b)false risk of pregnancy is higher in this age group; main risks of surgical abortion are uterine perforation, hemorrhage and infection
c) proportional to GA

26

Which of the following is not a risk factor for teenage pregnancy?
a) sexually abused
b) delayed puberty
c) school absenteeism
d) having mothers and siblings that were adolescent mothers

b) early puberty is a risk factors

also family difficulties, social problems, group homes, substance abuse

should also always ask about intentionality of pregnancy

if a health care provider can't provide non judgemental counselling of all aspects of contraception and pregnancy, need to refer to a health care provider who can do so and ensure that they keep their appointment, also follow up as needed.

27

Which of the following is the most common cause of death of the following, in 15-19 year old Canadian males?
a) firearms
b) cancer
c) drowning
d) falls

a) firearms injuries more likely to kill men 15-19 year old than cancer, drowning, fires and falls combined

caused 8% of deaths in 15-19 year old age group in 2002
majority are suicides - 79% of all firearms deaths in 15-19 year old, more likely to be homicides and unintentional in the <14 year old category

28

Which of the following is false of Canadian gun laws?
a) need to be screened before buying a gun
b) firearm owners must be licensed
c) multiple firearms can be registered together
d)must be stored locked, unloaded with ammunition stored separately

c) each firearm must be registered separately

locked, either in locked container or trigger lock

29

Which of the following provinces has the highest rate of gun ownership?
a) Ontario
b) Yukon and NWT
c) Alberta
d) Newfoundlant

b) Yukon and NWT - 67%

15% in Ontario
most own a rifle or a shotgun, only 12% own a handgun

30

Which of the following statements is false?
a) there is a strong correlation between gun ownership in provinces and death rates from unintentional injury by firearms
b) the presence of firearms in a home increase the rates of homicide and suicide in teens compared to homes without a firearm
c) the majority of Canadian child and adolescent homicide victims are killed by family members
d) firearms are the leading cause of homicide in

d) leading cause in 12-18 year olds



youth without firearm less likely to attempt or use a less lethal method
increases rates of suicide in 15-24 year old, and 65-84 year old