Pediatric Board Review - Adolescent And Gynecology

Front 1

What is the normal age range for pubertal development?

Back 1

9-13yo for both boys and girls

Front 2

How long does it take to go from Tanner stage 2-5?

Back 2

5 years

Front 3

True or False.
Adolescent peak height velocity has more to do with Tanner stage than age.

Back 3

True

Front 4

I have no pubic hair, a childlike penis and my testicles are < 2.5ml. What is my SMR?

Back 4

1.

Front 5

I have fine pubic hair and wrinkles on my scrotum. What is my SMR?

Back 5

2

Front 6

I have coarse, curly pubic hair and my scrotum and penis have grown. What is my SMR?

Back 6

3.

Front 7

I have dense, curly pubic hair and a full size penis, what distinguishes me between SMR 4 and 5.

Back 7

SMR 5 has adult size scrotum, penis and testicles and hair is also on inner thigh.

Front 8

I have fine hair along my labia and breast buds. What is my SMR?

Back 8

2

Front 9

I am flat chested and have no pubic hair. What is my SMR?

Back 9

1, unless I am a supermodel waif who has been waxed.

Front 10

My breasts go beyond the areola and my pubic hair is coarse and curly. What is my SMR?

Back 10

3

Front 11

My SMR is 4. What is my pubic hair and breast situation?

Back 11

Pubic hair is dense, coarse and curly but not extending to thigh. Breasts have a secondary mound and papilla now.

Front 12

My SMR is 5.What is my pubic hair and breast situation?

Back 12

Hair extends to inner thigh. Areola is no longer a separate projection from the breast.

Front 13

What is classified as delayed puberty?

Back 13

No development by 14 for a boy and 13 for a girl.

Front 14

What is the pre-puberty height velocity?

What is the pre-adolescent height velocity?

Back 14

5-6 cm/year

9-10 cm/year

Front 15

When does growth spurt begin?

Back 15

At breast development for girls and at testicular enlargement for boys.

Front 16

A 13yo girl is found to have an elevated alkaline phosphatase on routine screen. What is your next step?

Back 16

Reassurance.

Front 17

What is bone age vs. chronological age in constitutional growth delay?

Back 17

Bone age < Chronological age. The bones catch up later

Front 18

True or False.
Boys reach SMR 4 prior to peak height velocity.

Back 18

True

Front 19

True or False.
HCT increases with growth spurt.

Back 19

True.

Front 20

What is the sequence of male pubertal development?

Back 20

Testicular growth then pubarche then penile growth then peak height velocity

Ball then bat then height.

Front 21

What is the most common cause of delayed puberty in boys?

Back 21

Constitutional delay

Front 22

At what age is pubertal development considered too early? What is normal onset?

Back 22

Age 9 is too early. Age 10-11 is normal

Front 23

When do boys develop axillary hair?

Back 23

After SMR 5.

Front 24

A boy has pubic hair development and penis enlargement but no testicular gland enlargement. What does this mean?

Back 24

Androgen stimulation is coming from outside the gonadal area.

Front 25

What is the difference in pubic hair development between boys and girls?

Back 25

Pubarche occurs 1 year after testicular growth in boys vs. girls where it occurs parallel to breast development.

Front 26

A 13yo complains of breast development with milk from his breasts. He is otherwise healthy but does smoke marijuana. What do you advise?

Back 26

Stop the marijuana.

Front 27

What is the sequence of puberty in girls?

Back 27

Breast bud then Pubarche then Peak Height Velocity then Menarche

Front 28

What is too early puberty for girls?

Back 28

Younger than 8yo is too early.

Front 29

What is the first sign of puberty in girls? What age does it occur? By when should it occur?

Back 29

Thelarche (breast tissue development). Usually occurs at age 11, but should occur by age 13.

Front 30

Which hormone(s) are responisible for breast and pubic hair development in girls?

Back 30

Estrogen for breast and Androgen for pubic hair

Front 31

How long after thelarche do you expect menarche?

Back 31

2 years

Front 32

In which SMR does a girl have peak height velocity?

Back 32

SMR 3 or 4.

Front 33

How far from adult height are girls at menarche?

Back 33

2 inches.

Front 34

An 11yo girl who is in SMR 2 has bloody vaginal discharge. What do you do?

Back 34

Look for vaginal foreign body, such as toilet paper.

Front 35

True or False.
If thelarche occurs without pubarche, think androgen insensitivity.

Back 35

True

Front 36

True or False.
If Pubarche occurs without thelarche, think excess androgen/low estrogen.

Back 36

True

Front 37

A 3yo has developed breast buds. Her mother is very worried. What is your response?

Back 37

This is okay, as long as there is no further development and there is no pubarche. This may be due to obesity.

Front 38

Which of the following kids is undergoing precocious puberty? Pick all that apply.
A) A 9yo girl who has started menarche with breasts and pubic hair.
B) A 10 yo boy who has developed pubic hair and genitals.
C) A 7yo with thelarche and pubarche but no menarche
D) A 9yo with thelarche and pubarche but no menarche
E) A 7yo girl with thelarche but no pubarche and no menarche

Back 38

A) yes
B) no
C) yes
D) no
E) no

Front 39

What is premature pubarche without thelarche due to?

Back 39

Adrenal androgen production

Front 40

Which hormone is responsible for axillary hair and acne?

Back 40

Androgen

Front 41

You evaluating a girl for precocious puberty and note that she also has visual field defects. What is the likely cause of precocious puberty?

Back 41

CNS lesion...pituitary

Front 42

You are evaluating a boy for precocious puberty and not acne, facial hair and muscle bulk. What is the cause?

Back 42

Excess androgen from outside of the gonads.

Front 43

A prominant labia minora or a change in vaginal color is due to which hormone?

Back 43

estrogen

Front 44

A girl has premature breast development. What is your test of choice?

Back 44

Ovarian ultrasound

Front 45

A boy has premature pubarche what is your test of choice?

Back 45

Adrenal ultrasound

Front 46

How do you differentiate peripheral vs. central causes of precocious puberty?

Back 46

LH, FSH and adrenal steroids and MRI.

Front 47

What is the most likely reason not to use contraception?

Back 47

Desire for pregnancy

Front 48

True or false.
50% of all pregnancies occur within 6 months of first time experiencing intercourse and 20% occur in 1st month.

Back 48

True

Front 49

What are absolute contraindications to OCP?

Back 49

Breast Cancer
CAD or Cerebrovascular Disease
Hepatic Disease
Elevated
Lipids
Pregnancy

Front 50

Of the following patients who would you not give OCPs to?
A) A sickle cell patient
B) A epilepsy patient
C) A girl whose mother has breast cancer
D) A girl with lymphoma
E) A girl with hyperlipidemia

Back 50

E.

Front 51

How often do you screen for HPV?

Back 51

If Sexually active, every year.
If not sexually active, start at age 18 then repeat every 3 years.

Front 52

When do you start workup for amenorrhea?

Back 52

No period by age 16
No thelarche or pubarche or menarche by age 14.
No period for 3 months in a 6 month span.

Front 53

What are the expected Lab findings in PCOS?

Back 53

LH:FSH ratio > 2.5 and elevated androgen level.

Front 54

What is the treatment for PCOS?

Back 54

OCP, weight loss, and anti-androgen medications like spironolactone

Front 55

A 13yo girl presents with amenorrhea, your partner saw her and dismissed her 6 months ago without doing a pelvic exam, but you notice she does not have any pubic hair despite having developed breasts. What is the likely problem?

Back 55

Androgen insensitivity

Front 56

An amenorrheic 13yo girl has breast buds but no pubic hair. What should be your next step?

Back 56

Karyotype for Turner's syndrome

Front 57

A 15yo marathon runner has not had a period in 6 months. What do you expect on her labs? What is she also at risk for?

Back 57

Low estradiol. Osteoperosis and Anorexia nervosa.

Front 58

Does resumption of menses reduce the risk of osteoperosis in a girl with stress induced amenorrhea?

Back 58

yes

Front 59

What is the pathophysiology of primary dysmenorrhea? How do you treat it?

Back 59

Excess prostaglandins. Treat with NSAIDs

Front 60

True or False.
Primary dysmenorrhea is a significant cause of school absence.

Back 60

True

Front 61

True or False.
Exercise, healthy diet and tylenol may help in reducing primary dysmenorrhea.

Back 61

False.

Front 62

How do you distinguish endometriosis from primary dysmenorrhea?

Back 62

Endometriosis pain occurs any time in cycle, not just during menses.

Front 63

A teenager presents with recurrent nightmares, fear of being alone, diminished appetite, and diminished interest in school. She is otherwise healthy but was raped on campus last year and has been depressed since then. What is her diagnosis?

Back 63

PTSD

Front 64

What is the leading cause of death among teenagers?

Back 64

Accidents (MVA)
Homicide
Suicide

Front 65

Which of the following is not a requirement to diagnose anorexia nervosa?
A) Distorted body perception
B) Poor caloric intake
C) Intense fear of weight gain
D) Weight below 15% expected
E) Absence of 3 consecutive menstrual cycles.

Back 65

B.

Front 66

Which of the following is required to diagnose anorexia nervosa?
A) Depression
B) Excess exercise
C) Poor caloric intake
D) Distorted body perception
E) Diuretic abuse

Back 66

D.

Front 67

Which is not an indication for inpatient admission in a patient with bulemia nervosa?
A) Failure of outpatient treatment
B) Dehydration
C) ECG abnormalities
D) K+ of 3.0
E) Suicide ideation

Back 67

D

Front 68

How do you distinguish achalasia from bulemia?

Back 68

Achalasia is involuntary

Front 69

What is the metabolic risk in refeeding an anorexic or bulemic patient?

Back 69

Hypophosphatemia

Front 70

What is the most prevalent STD among teens?

Back 70

HPV

Front 71

What is the most common bacterial STD?

Back 71

Chlamydia

Front 72

True or False.
Genital warts caused by the HPV is the most prevalent STD.

Back 72

False. Even though HPV is most transmitted STD, genital warts are not.

Front 73

A young mother is devastated that her daughter has been diagnosed with gardenerella vaginalis and thinks her 12yo daughter has been sexually active. The girl swears she has not been. How do you explain the infection?

Back 73

This is BV. It can be passed non-sexually even from toilet seats and door knobs.

Front 74

You do a pelvic exam on a 15yo sexually active woman. You quickly note a fishy odor on applying KOH to the smear. In addition, you note clue cells on the smear. What is your diagnosis?

Back 74

BV

Front 75

True or False.
Males do not get trichomoniasis.

Back 75

False. They can get it, but are asymptomatic usually.

Front 76

A 15yo girl complains of vaginal itching and burning along with dyspareunia. On exam you not a frothy yellow discharge with a strawberry cervix. What do you expect on wet mount?

Back 76

Flagellated organisms.

Front 77

What is the treatment for trichomoniasis? Do you need to treat the partner?

Back 77

Treat with 2 grams metronidazole. Treat the partner too.

Front 78

True or false.
Gonorrhea is usually asymptomatic.

Back 78

True.

Front 79

What is the major complication of untreated GC in men and in women?

Back 79

Men can lead to severe epididymitis. Women can get peri-hepatitis, AKA Fitz-Hugh Curtis.

Front 80

What are symptoms of disseminated gonococcal infection?

Back 80

Rash, arthritis, possible meningitis and endocarditis.

Front 81

What is the treatment for genital herpes ulcers?

Back 81

7 days po acyclovir.

Front 82

An asymptomatic sexually active 15yo has now changed her sexual partner since her last exam. What is the most appropriate study at this time?

Back 82

Urine PCR for chamydia and gonorrhea.

Front 83

What are the diagnostic criteria for PID?

Back 83

Lower abdominal or Pelvic pain AND EITHER

Uterine or Adenexal tenderness

OR

Cervical motion tenderness.

Front 84

Which of the following tests are required when doing a pelvic exam and drawing blood for PID evaluation?
A) Chlamydia culture
B) GC culture
C) Pap smear
D) Vaginal swab for Trichomoniasis
E) Vaginal swab for BV
F) RPR
G) HIV

Back 84

All of them. And you must counsel on the HPV vaccine.

Front 85

What is the outpatient treatment regimen for PID?

Back 85

Azithromycin 1gram x 1 and Ceftriaxone 250mg IM x 1

Front 86

What do you do if pain persists despite outpatient treatment?

Back 86

Do U/S to look for TOA and admit.

Front 87

A 16yo girl comes in with lower abdominal dyscomfort. On pelvic exam, she has no cervical tenderness and only the right adenexa is tender. There is no discharge and the wet mounts are normal. This is the ultrasound. What is the treatment?

Back 87

If less than 6cm diameter, just do followup ultrasound. If > 6cm, then do laproscopic cyst aspiration.

Front 88

When do you expect resolution of RUQ pain upon treatment of Fitz-Hugh Curtis?

Back 88

Within 2 days.

Front 89

A 15yo girl comes in with fever, RUQ pain that radiates to her shoulder, and nausea. Her abdominal ultrasound is normal. She is otherwise healthy and her only medication is an OCP. What is your next step?
A) ERCP
B) Abdominal CT
C) Pelvic exam
D) Surgical consult
E) Serum amylase and lipase

Back 89

C.

Front 90

Which of the following require parental informed consent?
A) Life threatening emergency
B) Medical Care during pregnancy
C) Blood Donation
D) Substance Abuse Treatment
E) STD treatment
F) HIV testing
G) Sexual assault management
H) Any care for an emancipated minor

Back 90

C.