CPS Adolescent Flashcards Preview

CPS statements > CPS Adolescent > Flashcards

Flashcards in CPS Adolescent Deck (55):
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

31

Which of the following statements is true?
a) rates of homicide with handguns and shotguns have steadily declined since 1990
b) most handguns to commit homicides are legally acquired
c) handgun related deaths account for 2/3 of firearms related homicides
d) Canadian youth aged 17-19 account for 9% of those charged with homicide

c) true

the rest are false

a) the opposite - these with rifles and shotguns have decreased, those with handguns have stayed stable
b) most illegally acquired
d) 12-17 are 9% of homicide, and 43% of victims are aged 12-24 years

32

Which of the following is false of non powder firearms?
a) not regulated by federal gun control laws
b) have a projectile velocity <18 year old to buy ammunition for air guns

c) FALSE - BB guns and air guns are leading causes of enucleation, and paintball guns are cause of severe eye injuries; need to wear goggles and eye protection

some provinces do have laws for non powder firearms, i.e. in Ontario need to be 18 to buy ammunition for air guns

non powder firearms include air guns and BB guns; can cause significant internal injury; most have a velocity of 152 ms/s or less and therefore are not regulated by gun control law

paintball injuries, mostly happen at home, not at enforced facilities, those facilities usually include enforcement to wear goggles etc., injury usually happens when protection not worn properly.

33

Which of the following about physician counselling regarding firearms is most effective?
a) counselling parents of depressed teens to remove firearms from the home
b) office based counselling regarding safe storage of firearms
c) physician counselling about dangers of firearms
d) physician telling parents to remove firearms from home

a) the answer, most specific - 27% of parents removed firearms after recommending removal for adolescents diagnosed with depression

2 studies which looked at the effect of office based counselling on firearm storage showed no significant effect

34

Which of the following categories of interventions has not been demonstrated to have an effect on reducing firearm deaths/injuries or improving storage practice or behaviours around guns?
a) counselling
b) education plus environmental modifications
c) technological modifications
d) children's firearm safety education

d) children who had education no better at following safety behaviour, but better at verbalizing, may increase comfort level of children around guns; no childhood education program has been demonstrated to be effective in real life situations.

a - counselling, evidence above
b) distribution of gun safes and trigger locks distributed in one study - large increase in safe storage
c) safety devices could likely proven 44% of firearms deaths, devices include (allowing only the owner to fire the gun, loaded chamber indicators, magazine safeties

35

which of the following is not part of the correct definition of adolescence?
a) roughly aged 14-17 years old
b) from onset of puberty to when adult identity and behaviour
c) roughly age 10-19 years

a) NOT part of it

the definition is from roughly age 10-19, onset of puberty to when adult identity and behaviour are accepted, consisten with WHO guidelines, CPS favours this definition not based purely on chronological age.

36

In one study, how many teens admitted to sending sexually nude or semi nude pictures ?
a)1/5
b)1/10
c)1/20
d)1/25

a) 1/5 in one study
most sent to boyfriend/girlfriend (71/67%)
to individuals they wanted to hook up with
- girls (21%) boys 39%
- more likely to send sexually suggestive message in text than in person
- many teens feel pressured by boys to post messages
- 51% of teen girls

37

Which of the following statements is false?
a) health care providers should open the discussion into sexting and other online behaviours and help parents open the dialogue with their children regarding these issues.
b) no charges have been laid in connection with sexting in Canada
c) teens can be arrested for child pornography for sending naked pictures of themselves
d) It is possible to delete materials from cyberspace

d) false can't delete them, can be found forever, help teens understand this

c) true - even if photos of themselves
d) true - no charges laid yet, unlike other countries (the statement is from 2010)

38

The current Youth Criminal Justice Act in Canada:
a) supports putting teen offenders in adult facilities
b) supports reintegration and rehabilitation
c) maintains that adult and teen criminals have similar needs
d) is not based in evidence

b) is based in evidence and supports reintegration and rehabilitation

in Canada, respects the UN convention for the rights of the child, youth (under 18) have not fully developed moral and ethical responsibilities and cognitive abilities to process criminal intent. legally Canada must respect this. kids can't be in prison with adults.

39

Treating teens as adults in the criminal system has been shown to put them at increased risk of all but which of the following?
a) cognitive development
b) decreased risk of re offending
c) trauma
d) violent crime

b) increased risk of recidivism including violent crime; gaps in services and healthcare


trauma, violence and abuse, emotional , cognitive and psychological development

40

Which of the following statements is false?
a) teens do not have executive functioning to fully understand the consequences of their actions
b)70% of incarcerated adolescents may suffer from a mental disorder
c) rates of ADHD, depression, anxiety and substance abuse are higher amongst incarcerated youth than in the general population
d) adolescents in youth facilities are more likely to reoffend than those in adult facilities

d) the opposite, those in adult facilities are more likely to reoffend. - based on punishment, turn criminals into adversaries, may end up with older criminal mentors

youth facilities more developmentally appropriate, focus on rehabilitation.

41

Under the new Criminal Justice Act, offenders 14 and over will be all but the following:

a) tried as adults
b)may increase repeat offenders
c) sent to adult prisons
d)convicted of murder will no longer be anonymous

c) depending on if tried as adults, not based in evidence, may increase bad outcomes

42

Which of the following characterizes the HPV virus?
a)single stranded RNA
b)double stranded RNA
c)single stranded DNA
d)double stranded DNA

d) double stranded DNA virus
transmitted by direct epithelial contact, can be transmitted without intercourse

43

Which of the following about HPVis false?
a) there are 10 genotypes of HPV
b) can be transmitted vertically from mother to child
c) can be transmitted without sexual intercourse
d) can be transmitted from head and neck infections

a) 100 genotypes, 40 can infect the genital tract, transmitted by direct epithelial contact

44

Which of the following genotypes is not associated with cervical cancer?
a) 16
b) 18
c) 6
d) 31

c) is the answer

HPV 16 and 18 are associated with 70% of squamous cell carcinoma and 86% of adenocarcinoma of the cervix, need HPV for cervical cancer, also implicated in other GU cancers and oral cancers; 6 and 11 are not the cancerous types, 31,33, 35, 45, 52 and 58 are implicated in another 20% of cervical cancers

HPV 6 and 11 - implicated in anogenital warts, (90% of cases) and recurrent respiratory papillomatosis. (remember that seven 11 is warty)

45

Which of the following is the most common STI?
a) chlamydia trachomatis
b) HPV
c) neisseria gonorrhea
d) syphillis

b) HPV most common STI
in adolescents in Canada, prevalence 11-29%
peak prevalence in adolescents and young adults, highest risk in first five years after sexual activity, most cases unrecognized/self limited
higher in Inuit women

46

Which of the following is not a risk factor for HPV?
a) number of sexual partners
b) never being married
c) immunosuppression
d) multiple pregnancies

d) is the answer, not being pregnant is a risk factor

also, early age of first intercourse, more sexual partners, not being pregnant, immunosuppression, other STIs (relate to the cervical environment)

47

Which percentage of Canadian children have had sexual intercourse by grade 9?
a)1-4%
b)3-4%
c)17-23%
d)40-46%

c) by grade 9

grade 6 1-4%
grade7 3-4%
grade 9 17-23%
grade 11 40-46%
need to time the vaccine to precede sexual activity, sexual touching likely precedes intercourse by some time; not a therapeutic vaccine

48

Which of the following about the current HPV vaccine in Canada is false?
a) targets serotypes 6,11, 16 and 18
b) is a therapeutic vaccine
c) induces a robust immunogenic response, particularly in adolescents
d) have seen neutralizing antibodies in cervical secretions post vaccination

b) not therapeutic, need to get the vaccine before getting the virus

antibodies last at least 5 years
greater than 99.5% increase in antibody levels compared to natural infection
antibody titers higher in adolescents than adults

49

Which of the following is false of effectiveness of HPV vaccine?
a) 90% effective against high grade vulvar and vaginal lesions
b) 95.6% reduction in persistent HPV infection
c) 98% effective in preventing dysplastic lesions that precede cancer,
d) 99% effective in preventing genital warts

a) is the answer, 100% effective against these

based on a study of 20 000

95.6% reduction in persistent HPV infection by the serotypes in the vaccine

50

A woman aged 16-26 who was exposed to HPV 16 or 18 after receiving only the 1st dose of Gardasil has reduced the efficacy of the vaccine in preventing dysplastic precursors to cervical cancer to :
a) 10-20%
b) 20-30%
c) 30-40%
d) 44-55%

d) is the answer

even more reduction for preventing the neoplasia disease from all HPV genotypes

likely immunity sustained by 5 years (recent study), may be longer but no longer term studies yet, will likely provide long term immunity.

51

Which of the following is true of the Gardasil vaccine?
a) store between 5-10 C
b) given at 0, 2 and 6 months
c) can be used for pregnant women
d) can't be given with hepB vaccine

b) is true

the rest are false
store between 2-8 C
not for pregnant woman
can give with hepB vaccine

52

Which of the following is not a common side effect of the Gardasil vaccine?
a) systemic allergic reaction
b) local pain and redness
c) syncope and dizziness
d) swelling at site

a) no allergic reactions or immune mediated effects reported.

the rest have happened, slight higher local reaction than placebo, most mild to moderate, no difference in systemic reactions
in study, 5 severe reactions in the population
bronchospasm x 5
gastro - probably related, headache/hypertension, vaginal bleeding, injection site movement impairment

overall safe

some observed dizziness and syncope, can be mediated by good hydration.

53

Which of the following statements is false about the HPV vaccine ?
a) administer routinely to girls age 9-13 years
b) catch up program for unimmunized girls over age 13
c) boys are included in all Canadian HPV immunization program
d) give to women with previous pap abnormalities and genital warts

d) the answer, may not have had all the serotypes, should get the vaccine to protect against the other serotypes, pap abnormalities including cervical cancer


HPV vaccination found to be cost effective - studies so far funded by pharmaceutical companies; some provinces do include boys (i.e. Alberta)

54

A teen wants to terminate their pregnancy, what do you counsel them on?

1 .procedures available
2. anticipatory guidance about emotional responses
3. referral to appropriate medical and surgical services
appointments for follow up, including review of complications:
- these include: bleeding, fever, cramps after 1st 48 hours, abnormal discharge, physical and emotional concerns, and contraceptives follow up

55

Name 10 risk factors for unprotected sex

experiencing social and family difficulties;
whose mothers were adolescent mothers;
undergoing early puberty;
who have been sexually abused;
with frequent school absenteeism or lacking vocational goals;
with siblings who were pregnant during adolescence;
who use tobacco, alcohol and other substances; and
who live in group homes, detention centres or are street-involved.