MedU Clipp Cases 5 and 6

Question 1

(6) Signs of Hypothyrodism in the Adolescent?

Answer 1

• Cold Skin
• Slowness
• Fatigue
• Preferring Hot weather to Cold weather
• Doing poorly in School
• Coarse hair

Question 2

(5) What are the Symptoms of Depression in Adolescents?
(1) What is the extra one in Adults

Answer 2

• Feels down and doesn’t want to participate in normal activities
• Feels sad and often cries over small things
• Doesn’t want to participate in Friend’s activities
• Thinks about Suicide
• Feels grouchy and flat all the time

Adult

• Early morning waking, difficulty falling asleep at night

Question 3

Signs of Anorexia in Female Adolescents?

Answer 3

• Bradycarda
• -> Postural Hypotension
• Electrolyte Abnormalities
• Def. in Calcium and Magnesium
• -> Neurologic changes
• -> Increased Reflex Tone
• -> Compromised Cardiac Function

Question 4

(2) Signs of Bulimia?

Answer 4

• Dental Decay (from stomach acid)
• Finger Trauma from Self-induced vomiting

Question 5

(5) Differential Diagnosis for Fatigue
in an Adolescent Female?

Answer 5

• Anemia
  
  • Bleeding disorder, Iron Deficiency
• Bleeding Disorder
• Hypothyroidism
  
  • Menorrhagia and Shorter Menstrual Cycles
  • Constipation, Weight gain, Decreased Appetite
• Depression
• Substance Abuse

Question 6

When do Girls start Puberty?

Answer 6

• Girls Start between 8 and 13 y.o.
  
  • Breast Buds 10 - 11 y.o.
  • Pubic Hair 10 - 11 y.o
  • Growth Spurt 12 y.o.
  • Menarche 12 - 13 y.o.
  • Adult Height 15 y.o..

Question 7

When do Boys start Puberty?

Answer 7

• Boys start puberty between 10 and 15 y.o.
  
  • Growth of Testicles 12 y.o.
  • Pubic Hair 12 y.o.
  • Growth of Penis 13 - 14 y.o.
  • First Ejaculation 13 - 14 y.o.
  • Growth Spurt 14 y.o.
  • Adult Height 17 y.o.

Question 8

What tests do you order for Abnormal Bleeding Disorder?

Answer 8

• CBC w/ Platelets, RBC indices, and a smear
• Reticulocyte count
• PT and PTT
• Platelet function test
• Factor VIII activity
• von Willebrand Factor antigen
• von Willebrand Factor activity (Ristocetin cofactor)

Question 9

What are the Symptoms of vWD?

Answer 9

• Ecchymoses (small hematomas in areas of trauma)
• Epistaxis
• Menorrhagia
• Bleeding post-tonsillectomy and Dental Extractions
• Gingival bleeds

Question 10

Treatment for vWD?

Answer 10

• Intranasal or Intravenous Desmopressen
• Sometimes Human plasma-derived, virally inactivated von Willibrand’s Factor concentrate
• For Menorrhagia
  
  • Contraceptive pills
  • Levonorgestrel Intrauterine device

Question 11

What genetic dominance is vWD?

Answer 11

Autosomal Dominant

Question 12

Describe Tanner Stage I in Females?

Answer 12

• No Glandular Tissue and is Prepubertal
• No Pubic hair at all
• < 10 y.o.

Question 13

Describe Tanner Stage II in Females?

Answer 13

• Breast Buds form and Areola Begins to widen
• Long, Downy Hair w/ Slight pigmentation appears on the Labia majora

Question 14

Describe Tanner Stage III in Females?

Answer 14

• Breast buds elevated but do not have secondary mound characteristics
• Pubic hair extends laterally

Question 15

Describe Tanner Stage IV in Females?

Answer 15

• Breasts increased in size and elevation
• Areola and Papilla forma secondary mound that projects from the contour of the rest of the breast
• Pubic hair extends across the Mons Pubis and spares the Medial thigh

Question 16

Describe Tanner Stage V in Females?

Answer 16

• Breasts reach their adult size
• Areola returns to contour
• Central papilla remains projectings
• Pubic hair extends to the medial surface fo the thighs

Question 17

(2) Classic Symptoms of Hypotension?

Answer 17

• Dizziness
• Visual Disturbances

Question 18

(2) Common Triggers of Hypotension?

Answer 18

• Volume depletion
• Skipping meals

Question 19

What is Osgood-Schlatter Disease?

Answer 19

• A condition caused by irritation of the Growth Plate at the Tibial Tuberosity (Front of the Tibia Bone)
• Self-limited growing pain
• Resolves w/ Rest and Finishing of Growth Spurt

Question 20

Causes of Chest Pain in Children?

Answer 20

• Musculoskeletal are the most common cause of chest pain in children
  
  • Precordial Catch Syndrome and is of Unknown etiology
  • Sudden Sporadic Sharp pain along left sternal border - “Broken” by deep inspiration
  • Costochondritis due to inflammation and last hours to days

Question 21

What does OPQRSTAAA stand for?

Answer 21

• Onset
• Position
• Quality
• Radiation
• Severity
• Timing
• Aggravation
• Alleviation
• Associated Symptoms

Question 22

• Brief pain
• Unassociated w/ exertion
• Sporadic
• Sharp
  
  • Exacerbated by breathing

Answer 22

Precordial Catch Syndrome

Question 23

• Pain During Exercise
• Coughing
• Respiratory Distress
  
  • Wheezing

Answer 23

Exercise-induced Bronchospasm

or

Asthma

Question 24

• Retrosternal
• Burning
• Non-radiating
  
  • Associated w/ Meals

Answer 24

Gastritis

or

Esophagitis

Question 25

* Long Durational pain * Unassociated w/ Exertion * Sporadic * Sharp * Exacerbated by Breathing

Answer 25

Costochondritis

Question 26

What does HEEADSS stand for?

Answer 26

* Home * Education / Employment * Eating Disorders * Activities * Drug Use * Sex * Suicidality

Question 27

Which immunizations are given at the pre-adolescent evaluation?

Answer 27

* Tdap * used for adults and children 11 years of age and older who need booster doses of diphtheria, tetanus toxoid, and acellular pertusis * Meningococcal * 11 or 12 - first dose * 16 - booster dose

Question 28

Murmur Characteristics that require further investigation?

Answer 28

* Louder than Grade III / IV * Any Diastolic murmur * Any murmur that increases w/ standing or Valsalva

Question 29

(3) Parts of the Genitourinary Exam in Males?

Answer 29

* Prepartation Physical in Males * **Inguinal Hernia** (esp. w/ sprinting and weight lifting) * **Undescended Testicle** * if One Testicle --\> protective Cup is Req'd * Recommended that Men do **Monthly Testicular Self-exams after puberty**

Question 30

Male Phallus Tanner Development Stages?

Answer 30

1. Childlike Phallus, testicular volume \< 1.5 ml (prepubertal) 2. Childlike Phallus, Testicular volume 1.6 - 6 ml Reddened thinner and larger Scrotom 3. Increased Phallus Length Testicular Volume 6-12 ml Greater Scrotal enlargement 4. Increase Phallus ircumference, 12 - 20 ml Further Scrotal enlargment and Darkening 5. Adult Scrotum and Phallus, \> 20 ml

Question 31

Male Hair Growth Tanner Stages?

Answer 31

1. No Pubic Hair 2. Small amount of fine hair along the base of the Scrotum and Phallus 3. Moderate amount of curly, pigmented, Coarser hair extending laterally 4. Coarse curly adult like hair that doesn't yet extend to the medial surface of Thighs 5. Adult-type hair extending to Medial Surface of Thighs

Question 32

* One Week History of: * Complaints of Low-grade Fever * Malaise * Cervical Lymphadenopathy * Pharyngeal exudate

Answer 32

EBV testing suggestive of Mononucleosis