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From Flashcardlet > Peds- Adolescent Med > Flashcards

Peds- Adolescent Med Flashcards

1
Q

What is the leading causes of mortality & morbidity in adolescents?

A

Behavioral

motor vehicle injuries & other unintentional or intentional injuries account for >75% of all deaths

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2
Q

Confidentiality caveats

A

suicidal intent
duty to warn (homicidal intent, +HIV, etc)
disclosure of physical/sexual abuse to law enforcement

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3
Q

Early adolescence

A

rapid physical & behavioral changes
greatly self-conscious; need for privacy
invincibility
profoundly concrete, no consideration for tmw
focus oh hx is physical & psychosocial health

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4
Q

middle adolescence

A

autonomy with limit-testin
development of identity
high risk experimentation common
focus of hx is interaction w/ family, school & peers

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5
Q

late adolescence

A 
individuality
planning for future
partnering
separation
focus of visit is pt's responsibility for their own health
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6
Q

menses typically follows thelarche by how many years

A

2 years

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7
Q

initial menses are most often anovulatory & may persist irregularly for how many years

A

2-5 years

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8
Q

primary amenorrhea

A

complete absence of menses by age 16 years w/ breast develop. or age 14 years w/o breast development

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9
Q

Some possible reasons for primary amenorrhea

A 
stress
exercise
eating d/o
abnormalities of hypothalamus
pituitary 
ovaries or uterus
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10
Q

secondary amenorrhea

A

cessation of menses for more than 3 consecutive months

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11
Q

secondary amenorrhea is most commonly caused by

A

pregnancy
anorexia
stress
PCOS

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12
Q

High risk assessment mneumonic- HEADDSS

A 
home/friends
education/employment
activities
drugs & smoking, alcohol
diet & eating d/o
sexual activity
suicidal (& homicidal) ideation & depression
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13
Q

PID

A

upper genital tract infxn caused by ascending spread of microorganisms

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14
Q

Characteristics of PID

A

polymicrobial dz

acute salpingitis

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15
Q

Risk factors for PID

A

<24 yo
multiple sexual partners
use of non-barrier types of contraception
douching
low socioeconomic status
inconsistent use of barrier contraception
lack of access to primary health care

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16
Q

Signs & symptoms of PID

A

usually- mild abdominal pain

other- dysmenorrhea, prolonged/increased menstrual periods, dysuria, increased vaginal d/c

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17
Q

“classic” PID S&S

A

lower abdominal pain
fever
n/v

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18
Q

DDx for PID

A 
appendicitis
ectopic pregnancy
ovarian torsion
UTI (cystitis, pyelonephritis)
constipation
renal colic
ovarian cyst
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19
Q

Minimum criteria for PID clinical diagnostic criteria

A

uterine tenderness or
adnexal tenderness or
CMT

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20
Q

Additional criteria for PID clinical diagnostic criteria

A

temp > 38.3 C
abnormal cervical/vaginal mucopurulent d/c
increased WBCs on microscopy of vaginal secretions
increased ESR, CRP
lab confirmation of cervical infxn w/
N. gonnorrhoeae
C. trachomatis

21
Q

PID definitive criteria

A

endometrial bx w/ histopathologic evidence of endometriosis
TVUL/ MRI showing thickened, fluid-filled tubes
laparoscopic evidence of PID

22
Q

Pelvic exam for PID

A

ask about pain vs. pressure
bimanual usually sufficient
speculum exam may be helpful if not necessary for dx of PID

23
Q

Lab studies for PID

A 
UA, UPT
urine cx
CBC, ESR, CRP
urine LCR for GC & chlamydia
consider abdominal ULS
24
Q

Abx for PID

A 
outpatient:
   ofloxacin or levofloxacin w/ or w/o 
   metronidazole
inpatient:
   cefoxitin & doxycycline
25
Q

PID sequelae

A

risk of infertility (10% after 1 episode, 50% after 3+ episodes)
ectopic pregnancy
pelvic pain
Fitz-Hugh-Curtis syndrome

26
Q

Puberty onset is marked by?

A

pubarche & gonadarche

27
Q

Adrenal maturation is called?

A

adrenarche

28
Q

Adrenarche precedes gonadarche by several years

A

heralded by rise in DHEA (dihydroepiandrosterone)
DHEA rise comes years before appearance of hair (pubarche)
causes increase in testicular size, which comes before pubarche

29
Q

Thelarche closely precedes?

A

pubarche

30
Q

Gonadarche

A

maturation of hypothalamic-pituitary-gonadal axis

increasing gonadal secretion of sexual steroids

31
Q

Menarche typically follows _____________ by 2-3 years

A

thelarche

32
Q

How many cm do girls generally grow after menarche?

A

2-3 cm

33
Q

Completion of Tanner stages typically takes how many years?

A

4-5

34
Q

Normal puberty onset marked by development of __________________ & ____________

A

secondary sexual characteristics

pubertal growth spurt

35
Q

Delayed puberty is defined in the US as

A

no sign of pubertal development by age 13 in girls and 14 in boys

36
Q

DDX for delayed puberty

A 
constitutional delay
hypogonadotropic hypogonadism
gonadotropin (GnRH) deficiency
CNS tumor (e.g. craniopharyngioma)
hypergonadotropic hypogonadism
37
Q

Hypogonadotropic hypogonadism

A

adrenarche occurs to some degree, but gonardarche does not

may accompany chronic illnesses, anorexia nervosa (malnourishment), athletic amenorrhea, hypothyroidism

38
Q

Gonadotropin (GnRH) deficiency

A

typically part of some larger syndrome or chronic illness

may also result from congenital hypopituitarism

39
Q

Hypergonadotropic hypogonadism (gonadal failure)

A

Turner (XO) Syndrome

Kleinfelter syndrome

40
Q

Precocious (premature) puberty defined classically as

A

secondary sexual development before 9 years in boys & 8 years in girls

41
Q

Mean age of thelarche (tanner II breast development)?

A

white girls- 10

African American girls- 9

42
Q

Mean age of pubarche (Tanner II pubic hair development)?

A

white girls-9

AA girls- 10.5

43
Q

Menarche usually occurs when?

A

12.2-12.9 yo

obesity appears to be lowering age

44
Q

Precocious puberty in a boy always warrants survey for __________?

A

Intracranial tumor

may be precipitated by almost any condition affecting the CNS, including trauma, epilepsy, and hydrocephalus

45
Q

Workup for precocious (premature) puberty includes

A

measurements of sex steroids and GnRH to determine central from peripheral precocious puberty

46
Q

Isolated premature thelarche or pubarche may not suggest what?

A

precocious puberty

47
Q

Fitz-Hugh-Curtis syndrome

A

Inflammation of the membrane lining the stomach (peritoneum) and the tissues surrounding the liver (perihepatitis).

48
Q

Common sx’s of Fitz-Hugh-Curtis syndrome

A 
severe pain of RUQ
fevers
chills
headaches 
malaise

this is a complication of PID

From Flashcardlet (8 decks)

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