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63 Cards in this Set
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height velocity in and around puberty
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F: before 5-6cm/yr. PHV 5-11(av. 9) cm/yr occures 6-12 mo prior to menses. 2yr decel to epiphysial closure
M: before 5-6cm/yr. PHV 6-13 (10) cm/yr |
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Order of puberty
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F: growth spurt, 1yr later thelarche and tanner 2, 1yr later PHV, 0-6mo later menarche, 2yrs more growth.
M: PHV around tanner 4-5 |
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no periods, when worry
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Primary amenorrhea: no menses by 16 with nl dev.
Different but concerning if: no menses and no dev by 14 no breast buds by 13 no menses 2yrs after tanner 4 |
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median age of menarche, US
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12.7
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percent of females who achieve menarche by tanner 4
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90%
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No tanner 2 by what age warrants investigation in females
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13yrs
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Most common cause of persistant irregular menses
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polycystic ovary syndrome
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average age between thelarchy and menarche
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2 yrs
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average cycle
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21-35 days
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average bleeding time/amount
abnormal |
nl: 3-7 days, 30-40ml
abn: >8-10days, >80ml |
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average time to normalcy in cycles from menarche
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1-1.5yrs
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Secondary amenorrhea
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absence of 3 cycles or 6 months. Only applicable in someone who has established regular cycles.
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Amenorrhea with delayed puberty: Dx
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Ovary problem: high FSH due to no neg feedback from ovary (no estrogens). Turner S. is most common
Hyp-Pit problem: most common stress, intense athletic training, inadequate nutrition., panhypopit, hypothyroid, prader willi. |
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Amenorrhea with normal puberty
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PREGNANT.
the pit-hypothalm problems causing delayed puberty can also cause this. Depo, Norplant. Asherman S: uterine stranding post abortion Sheehan S. Pit infarction from bleed/hypotension during labor. |
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Amenorrhea with genital tract abnormalities
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imperforate hymen: blueish hymen, midline abd mass, cyclic abd pain.
vaginal agenesis: Mayer-Rokitansky-Kuster-Hauser S., and testicular feminization. (norm breasts, no pubic hair) |
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Polycystic ovary Syndrome
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Bad term. no ovulation, too much androgen (testosterone), hirsut, acne, obese, associated with insulin resistance, glucose intolerance, hi lipids.
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Primary dysmenorrhea vs Secondary
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Primary: prostaglandins
Secondary: pelvic pathology (endometriosis) |
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most prevalent STD in teens
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HPV, almost 50% of young women
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most common bacterial STD in teens
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Chlamydia
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vaginitis treatments
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Chlamydia = azithromycin
gonorrhea = cefixime candida = clotrimazole trichomonas = metronidazole. |
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gynecomastea, abnormal
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older male (tanner 5)
lasting longer than 2 yrs. liver and adrenal tumor, testicular neoplasm, thyroid, Klinefelter. |
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malodrous vaginal discharge
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Trich, BV, candida, cervicitis (gonorrhea, Chlamydia, HSV)
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cervicitis, dx, rx
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friable cervix ith purulent dx: endocervicitis.
GC/Chlamyd Azithromycin, Cefixime |
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Short stature and bone age, number of years off and still normal
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up to 2 yrs delayed bone age from chrono is within normal
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familial short stature
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bone age = chrono
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constitutional delay of growth
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bone age and tanner stage is delayd
bone age corresponds to height-age. "late bloomers" FHx of delayed puberty. slow growth in first 2-3yrs, hug 5th% then sprout late. |
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Bacterial vaginosis
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more common if sexually active.
Fishy odor, + whiff test clue cells |
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Why measure androgen levels for amenorrhea
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obese teen with signs of virilization. polycystic ovary syndrome.
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why measure gonadotropin levels in amenorrhea
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abnormal pubertal development suggestive of hypothalamic-pituitary-ovary axis problems.
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Signs of Trichomoniasis in men and women
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F: yellow-green frothy, malodorous discharge, bad itch.
M: usually asx. can have scant clear urethral discharge. |
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electrolytes in bolemia
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vomiting: hypochloremic, hypokalemic, metabolic alkalosis (same as pyloric stenosis)
laxitives: acidosis |
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rape trauma syndrome
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a form of PTSD, intense fear, re-experiencing trama, increased arousal,
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absolute contrindications for oral contraceptives
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thromboembolic disease, CVA, uterine cancer, CAD, pregnancy.
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risk of thromboembolic phenom from the pill
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increases risk 2-4 times. CVA, PE, DVT
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Drugs that decrease efficacy of the pill
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antiepileptics (phenytoin, carbamazepine, barbis)
rifampin |
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risk of thromboembolic phenom from the pill
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increases risk 2-4 times. CVA, PE, DVT
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Reasons teen choose not to use contraception
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1. don't ming or want to become pregnant.
2. peer pressure. 3. weight gain concerns. 4. privacy. |
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leading causes of death in teens
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accident (car and drowning), homicide (most common for black teens), suicide.
boys twice as likely to die in car than girls. |
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pubarche
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pubic hair devleopment
a couple months after thelarche. |
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stage 5 breasts, tanner 1-2 pubic hair
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androgen insensitivity (testicular fem)
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tanner 5 pubic hair, no thelarche
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androgen excess, no estrogen, or congenial absence of breast tissue.
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wet mount
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trichomonads, bacteria.
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vaginal pH
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prepuberty: 6.5-7.5
during and after: <4.5 (acidic) |
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Poland S.
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absence of pectoralis, breast and ipsi limb problems.
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no signs of puberty at what age warrants investigation
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F: 13
M: 14 |
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increased risk to develop atopic disease if you already got one
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three times greater than general public.
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When does peak height velocity happe in boys
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after tanner 4. 80% have it with tanner 5
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testicular volume
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tanner 1, <4ml
tanner 3, 8-10 tanner 4, 13 |
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alkaline phosphatase in puberty
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varies greatly during rapid grosth. 105-420
usually rises with bile duct obstruction, GGt shouled also be up If not then think of small intestine, kidney, bone (rickets, osteomalacia, fx) |
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Hb by age
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rise after 12yrs. to adult levels:
M: 14-18 F: 12-16 black: 0.5 less on average. |
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cutoff for calling it precocious puberty
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breat developmentbefor 6 in caucasian
before 5 in african american |
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acanthosis nigricans significance in teens
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insulin resistancebut not specific
obese swith AN: increased risk for dyslipidemia, type 2 DM, HTN |
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Abnormal tests with polycystic ovary syndrome
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testosterone and other androgens elevated.
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treatment for dysmenorrhea
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prostaglandin inhibitors (NSAIDS)
exercise, tylenol, diet, rest don't work. |
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PID dx, rx
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vaginal discharge, irregular bleeding, RUQ pain (Fitz-Hugh-Curtis) perihepatitis. dishcarge, cervical motionand adnexal tenderness.
early therapy is important. Hospitalization is not needed always, but warranted if febrile, vomiting. inpatient for teens compliance |
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PID complications
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tubo-ovarian abscess, infertility, EP.chronic pelvic pain.
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routine testing for sexually active under 18yrs
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perhaps no pap. Urine PCR for GC/Chlamyd is best generic screen.
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Bulimia dx
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recurrent binge eating twice a week for 3 months. lack f control over eating during the binge.
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normal BP vs hypertension
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<90% for gender, height, age
90-95% borderline >95% HTN if on repeated measures |
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Delayed puberty defined as
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F; 13 and tanner 1
M: 14 and tanner 1 |
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constitutional delay in puberty
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14-15yr old boy with fam hx of late bloomers. Can be superimposed on consitutional short stature (hard to tease apart).
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Diff dx delayed puberty
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constitutional delay
chronic illness Pit (panhypopit, kallman) hypothyroid hyperprolactinemia Turner, Klinefelter |
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hypogonadism
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primary: testes don't work/absent, GnRH, LH, FSH hi, testosterone low (Noonan, Klinefleter)
secondary: hypo-pit doesn't work Low FSH, LH- Kallman S. (no smell, no GnRH) |