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69 Cards in this Set
- Front
- Back
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What are the indications for hospitalization in PID?
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Indications for admission include pregnancy, surgical emergencies cannot be excluded, suspected pelvic/tubo-ovarian abscess, uncertain diagnosis, nausea/vomitin preclude oral therapy or failure to respond to oral agents in 24-48 hours.
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During what Tanner Stage does a girls peak height velocity occur?
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Tanner 2-3
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What percent of testicular function is preserved if surgery occurs within 6-12 hours of torsion?
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60-65%
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What percent of testicular function is preserved if surgery occurs within 12-24 hours of torsion?
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20-40%
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What percent of testicular function is preserved if surgery is delayed more than 24 hours of torsion?
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10-15%
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When can an athlete with a grade I concussion return to play?
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When they are asymptomatic at rest and with exertion.
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When can an athlete with a grade II concussion return to play?
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1 week after they are asymptomatic at rest and with exertion.
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When can an athlete with a grade III concussion return to play?
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2 weeks after they are asymptomatic at rest and with exertion.
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What is the difference between grade I and grade II concussions?
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The length of time that patient is symptomatic. Less than 15 min in grade I and more than 15 min in grade II.
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What is the difference between grade II and grade III concussions?
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Loss of consciousness
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What type of thinking is prominent in late adolescents ?
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Cognition is complete
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What type of thinking is prominent in early adolescents ?
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Cognition is concrete
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What is the most important relationship for middle adolescents ?
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Peers
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What is the most important relationship for early adolescents?
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Peers (just starting)
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What is the most important relationship in a late adolescent ?
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Individual relationships
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What is a bigger concern at an adolescent visit, breast exam or testicular exam ?
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Testicular exam because testicular cancer does occur in adolescents while breast cancer is near zero
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What type of thinking is prominent in middle adolescence?
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Cognition begins to mature
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What STD should be screened for in all asymptomatic sexually active females ?
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Chlamydia
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What is the mean age of adolescent smoking ?
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12 yrs
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What is the mean age of adolescent acohol consumption ?
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12.6 yrs
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Who is most likely to smoke boys or girls ? Drink ?
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Girls smoke more than boys
Boys drink twice as often as girls |
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What percent of adolescents use marijuana? Cocaine ? Crack ?
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50% marijuana
10% cocaine 5% crack |
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What is concerning for young kids/adolescents with depression?
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The earlier a child is depressed, the more severe and recurrent the depression is likely to be.
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When is hospitalization appropriate for depression?
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- suicidal/ homicidal
- psychosis - mania -substance abuse - not responding to outpatient therapy |
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When is the peak incidence of anorexia nervosa ?
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Ages 14.5 and 18
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How is anorexia split between boys and girls ?
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Girls outnumber boys by 10:1
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What is the recommended daily intake of calcium and vitamin D ?
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Calcium 1,200 - 1,500
Vitamin D 400 IU |
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What EKG chances occur with anorexia ?
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- ST depression on exercise stress testing
- prolonged QT intervals - V tach - Bradycardia |
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When is the highest risk of heart faliure with anorexia nervosa?
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The first 2 wks of treatment (refeeding)
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What should daily wieght gain be limited to in treatment of anorexics ?
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0.2 - 0.4 kg/day
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What ECHO findings are consistent with anorexia ?
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Ventricular wall thickness MVP pencardial effusion
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When does menses return in anorexics ?
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After achieving 80% of ideal body wt
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Which is more common; anorexia or bulemia ?
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Bulemia
2 - 5% of girls W< 1% of boys |
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What are classic findings of bulemia ?
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- edema
- bilateral painless parotid swelling - calluses on the dorsum of fingers - loss of tooth enamel - possible hypoka and cardiac toxicity (from ipecac) - metabolic alkalosis and increase amylase |
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What is Russell sign(s) ?
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Calluses on the dorsum of fingers secondary to induced vomiting from bulemia
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Of the following, what is helpful to differentiate anorexia and bulemia
- metabolic alkalosis - hypokalemia - cardiac involvment - elevated amylase - enamel destruction |
Elevated amylase
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What is the role of SSRIs in bulemia ?
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They are much more effective than in anorexia - Fluoxetine has the best results.
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How common is polymastia/polythelia in adolescent girls ?
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1 - 2%
Polymastia (accessory breast tissue) Polythelia (accessory nipples) |
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What is the most common breast mass in the adolescent ?
What is the txt and course? |
A solitary cyst
> 50% resolve in 2 - 3 mos U/S if can not differentiate from solid mass |
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When should a breast mass be referred for surgery?
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Persistence of a mass over 3 menstrual cycles warrants referral to sugery for an aspiration
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Why is mammography a poor choice for evaluation of a breast mass in an adolescent ?
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Because adolescents do not have enough breast fat to make a mammogram redable
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What presents in adolescent females as a hard, fixed mass with overlaying skin changes, frequently under the nipple?
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Breast cancer - but it is extmeley rare with family history being extremeley important but only ~6% have breast cancer associated genes
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What are the procedures of choice for evaluation of breast mass with concern of cancer?
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Ultrasound and Biopsy
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What is the most common organism causing mastitis?
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Staph aureus
Tx with anti-staph abx, heat and analgesia |
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When is it considered primary ammenorrhea?
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1) 16 yrs of age
2) 14 yrs if breast development or stigmata of chromosomal abnormality such as Turners 3) Tanner Stage V for more than a year despite onset of thelarche 4 yrs prior |
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What are the three main groups of causes of amenorrhea?
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Central (hypothalamic or pitrutary)
Ovarian - or - Anatomic (uterus, cervix, vagina) |
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What is isolated GnRH deficienty and inability to smell caused by?
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Kallmann Syndrome
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What is the most common pituitary cause of amenorthea in women who are of reproductive age?
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Prolactin - secreting adenoma
(prolactinoma most commonly) |
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Can secondary amennorhea be caused by/in Rokitansley Syndrome?
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No but primary amennorhea can because it involes mullerian agenesis with absence/hypoplasia of the vagina, cervix and/or uterus
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What is the most common reason for 15-24 yr old outpatient visits?
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Pregnancy
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What is the most common reason for 10-14 yr old outpatient visits?
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Health supervision visits
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What are the five most common reasons for hospitalizations in adolescents (10-12 yr old) ?
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1) pregnancy
2) mental disorders 3) injuries 4) digestive tract disorder 5) respiratory tract diseases |
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What are the two leading causes of adolescent morbidity and mentality ?
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Automobile and motorcycle accidents
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What is the 2nd leading cause of death in adolescents, and the #1 cause of death in African-American adolescents ?
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Homicide
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What is the number one cause of mortality for 24-44 yr old Hispanics and African-Americans ?
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HIV
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How long does pubescence last in girls? boys?
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4 yrs for girls
3 yrs for boy |
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What is the mean age for the onset of pubescece in girls? boys?
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Girls 9.7 yrs
Boys 11.4 yrs |
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What is the mean age for the beginning of menses?
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12.75 ( 10-16.5 )
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When does axillary hair occur ?
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Mid-puberty
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How does the growth spurt of adolescents differ between boys and girls ?
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Boys - tanner 4 (~18)
Girls - tanner 2-3 (~16) |
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Can secondary amenorrhea occur in Asherman syndrome?
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Yes - it is due to uterine synechiae occuring after endometrial disruption/infection
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What commonly has an LH:FSH ratio > 2.5:1 and or elevated levels of free testosterone, androstenedione, and dehydroepiandosterone sulfate ( DHEAS )
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Polycystic ovarian syndrome
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What medication is used to treat a pitiutary microadenoma ?
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Bromocriptine
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When should ocps be started for dysfunctional bleeding
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With Hbg 10 - 12 if < 10, hospitalize
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What causes most dysmenorrhea?
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Prostaglandin production before menses, which cause vasoconstriction and muscular, contractions.
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What is the difference (in males) between normal pubertal gynecomastia and macrogynecomastia?
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SIZE
Normal <4 cm gynecomastia macrogynecomastia usually 75cm (needs surgical therapy) |
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What medications are useful in male macrogynecomastia?
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Tamoxifen and testtolactone
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What is associated with the "bag of worms " description?
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Varicoceles
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What is treatment of torsion of the spermatic cord?
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Surgical Emergency
(Exam :diffusely swollen and tender testicles with absent cremasteric reflex) |
