This site is 100% ad supported. Please add an exception to adblock for this site.

Adolescent medicine and gynecology-XXIV


undefined, object
copy deck
height velocity in and around puberty
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
Order of puberty
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
no periods, when worry
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
median age of menarche, US
percent of females who achieve menarche by tanner 4
No tanner 2 by what age warrants investigation in females
Most common cause of persistant irregular menses
polycystic ovary syndrome
average age between thelarchy and menarche
2 yrs
average cycle
21-35 days
average bleeding time/amount
nl: 3-7 days, 30-40ml
abn: >8-10days, >80ml
average time to normalcy in cycles from menarche
Secondary amenorrhea
absence of 3 cycles or 6 months. Only applicable in someone who has established regular cycles.
Amenorrhea with delayed puberty: Dx
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.
Amenorrhea with normal puberty
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.
Amenorrhea with genital tract abnormalities
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)
Polycystic ovary Syndrome
Bad term. no ovulation, too much androgen (testosterone), hirsut, acne, obese, associated with insulin resistance, glucose intolerance, hi lipids.
Primary dysmenorrhea vs Secondary
Primary: prostaglandins
Secondary: pelvic pathology (endometriosis)
most prevalent STD in teens
HPV, almost 50% of young women
most common bacterial STD in teens
vaginitis treatments
Chlamydia = azithromycin
gonorrhea = cefixime
candida = clotrimazole
trichomonas = metronidazole.
gynecomastea, abnormal
older male (tanner 5)
lasting longer than 2 yrs.
liver and adrenal tumor, testicular neoplasm, thyroid, Klinefelter.
malodrous vaginal discharge
Trich, BV, candida, cervicitis (gonorrhea, Chlamydia, HSV)
cervicitis, dx, rx
friable cervix ith purulent dx: endocervicitis.
Azithromycin, Cefixime
Short stature and bone age, number of years off and still normal
up to 2 yrs delayed bone age from chrono is within normal
familial short stature
bone age = chrono
constitutional delay of growth
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.
Bacterial vaginosis
more common if sexually active.
Fishy odor, + whiff test
clue cells
Why measure androgen levels for amenorrhea
obese teen with signs of virilization. polycystic ovary syndrome.
why measure gonadotropin levels in amenorrhea
abnormal pubertal development suggestive of hypothalamic-pituitary-ovary axis problems.
Signs of Trichomoniasis in men and women
F: yellow-green frothy, malodorous discharge, bad itch.
M: usually asx. can have scant clear urethral discharge.
electrolytes in bolemia
vomiting: hypochloremic, hypokalemic, metabolic alkalosis (same as pyloric stenosis)
laxitives: acidosis
rape trauma syndrome
a form of PTSD, intense fear, re-experiencing trama, increased arousal,
absolute contrindications for oral contraceptives
thromboembolic disease, CVA, uterine cancer, CAD, pregnancy.
risk of thromboembolic phenom from the pill
increases risk 2-4 times. CVA, PE, DVT
Drugs that decrease efficacy of the pill
antiepileptics (phenytoin, carbamazepine, barbis)
Reasons teen choose not to use contraception
1. don't ming or want to become pregnant.
2. peer pressure.
3. weight gain concerns.
4. privacy.
leading causes of death in teens
accident (car and drowning), homicide (most common for black teens), suicide.
boys twice as likely to die in car than girls.
pubic hair devleopment
a couple months after thelarche.
stage 5 breasts, tanner 1-2 pubic hair
androgen insensitivity (testicular fem)
tanner 5 pubic hair, no thelarche
androgen excess, no estrogen, or congenial absence of breast tissue.
wet mount
trichomonads, bacteria.
vaginal pH
prepuberty: 6.5-7.5
during and after: <4.5 (acidic)
Poland S.
absence of pectoralis, breast and ipsi limb problems.
no signs of puberty at what age warrants investigation
F: 13
M: 14
increased risk to develop atopic disease if you already got one
three times greater than general public.
When does peak height velocity happe in boys
after tanner 4. 80% have it with tanner 5
testicular volume
tanner 1, <4ml
tanner 3, 8-10
tanner 4, 13
alkaline phosphatase in puberty
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)
Hb by age
rise after 12yrs. to adult levels:
M: 14-18
F: 12-16
black: 0.5 less on average.
cutoff for calling it precocious puberty
breat developmentbefor 6 in caucasian
before 5 in african american
acanthosis nigricans significance in teens
insulin resistancebut not specific
obese swith AN: increased risk for
dyslipidemia, type 2 DM, HTN
Abnormal tests with polycystic ovary syndrome
testosterone and other androgens elevated.
treatment for dysmenorrhea
prostaglandin inhibitors (NSAIDS)
exercise, tylenol, diet, rest don't work.
PID dx, rx
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
PID complications
tubo-ovarian abscess, infertility, EP.chronic pelvic pain.
routine testing for sexually active under 18yrs
perhaps no pap. Urine PCR for GC/Chlamyd is best generic screen.
Bulimia dx
recurrent binge eating twice a week for 3 months. lack f control over eating during the binge.
normal BP vs hypertension
<90% for gender, height, age
90-95% borderline
>95% HTN if on repeated measures
Delayed puberty defined as
F; 13 and tanner 1
M: 14 and tanner 1
constitutional delay in puberty
14-15yr old boy with fam hx of late bloomers. Can be superimposed on consitutional short stature (hard to tease apart).
Diff dx delayed puberty
constitutional delay
chronic illness
Pit (panhypopit, kallman)
Turner, Klinefelter
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)

Deck Info