Notes: Beware hypophosphatemia from refeeding syndrome
Question: What eating disorder is associated with these findings?
Bone Age Films
Category: generalpediatrics-Adolescent Care
Findings: breast development before age 8
Notes: Ok to observe if bone age films are within 1-2 years of chronologic age
Question: What do you order if an adolescent female has the following?
Chlamydia Trachomatis
Category: generalpediatrics-Adolescent Care
Findings: most prevalent bacterial STD
Question: Which organism has this characteristic?
Chlamydia Trachomatis And Neisseria Gonorrhea
Category: generalpediatrics-Adolescent Care
Findings: for which requires annual screening for sexually active females younger than 25 years of age, usually minimally symptomatic, may lead to pelvic inflammatory disease if untreated
Question: Which organisms are associated with these findings?
Congenital Adrenal Hyperplasia
Category: generalpediatrics-Adolescent Care
Findings: premature closure of growth plates, accelerated growth but lower final height, hyperandrogenism
Constitutional Growth Delay
Category: generalpediatrics-Adolescent Care
Findings: delayed bone age, delayed puberty, family history of condition
Notes: Patient should eventually reach normal adult height
Desensitization To Penicillin
Category: generalpediatrics-Adolescent Care
Findings: pregnant woman with syphilis and history of anaphylaxis to penicillin
Notes: Doxycycline not safe for fetus as it may affect skeletal growth and teeth abnormalities
Question: What do you do in this case?
Exercise-induced Amenorrhea
Category: generalpediatrics-Adolescent Care
Findings: athlete, delayed puberty, low LH and FSH, no menstruation
Question: What fits these findings?
Fibroadenoma
Category: generalpediatrics-Adolescent Care
Findings: worsened with oral contraceptives, unilateral, most common solid breast mass in adolescent female, rubbery
Notes: Obtain ultrasound for breast abnormalities in adolescents. Observe if asymptomatic and less than 3 cm. Refer for excisional biopsy if persistent, symptomatic, or larger.
Question: Which disease is associated with these findings?
GnRH Analogue
Category: generalpediatrics-Adolescent Care
Findings: elevated LH and FSH, tunnel vision
Notes: Central precocious puberty is evidenced by neurological symptoms as well as elevated central hormones
Question: What class of medication do you use to treatment a disease with the following findings?
Growth Hormone Deficiency
Category: generalpediatrics-Adolescent Care
Findings: small penis or clitoris, hypoglycemia, seizures, decelerating growth curve
HCG
Category: generalpediatrics-Adolescent Care
Findings: amenorrhea
Notes: If hCG is negative, try a progesterone challenge. If positive and patient bleeds, get a LH level and look for PCOS. A low LH may indicate prolactinoma or hypothyroidism. If progesterone challenge is negative, get a FSH to look for deficiencies in estrogen production. High FSH may indicate ovarian failure and Turner's while low FSH could indicate a prolactinoma or other central issue.
Question: What lab should you order for the following symptom
Hydrocele
Category: generalpediatrics-Adolescent Care
Findings: mass superior and anterior to testes, changes position with position and valsalva, resolves by one year old, painless
Notes: Also transluminates
Question: What issue is associated with these findings?
Inguinal Hernia
Category: generalpediatrics-Adolescent Care
Findings: painful scrotal mass that changes with position, does not transilluminate
Notes: Does not transilluminate
Question: Which disease is associated with these findings?
Findings: abdominal pain and cramping before or during menstruation, absence of other disease
Notes: Treat with NSAIDs or COX inhibitors. Take as soon as possible, ideally a few days before predicted onset of pain. Caused by excess prostaglandins.
Question: Which disease is associated with these findings?
Steroids
Category: generalpediatrics-Adolescent Care
Findings: liver dysfunction, high LDL, low HDL, hypertension, labile mood
Notes: Males will have acne and gynecomastia. Girls with have hirsutism and deeper voice.
Question: Use of which substance is associated with these findings?
Tanner Stage 2
Category: generalpediatrics-Adolescent Care
Findings: breast bud, coarse hair or sparse curly hair only along labia, palpable areola
Question: What tanner stage does the following occur?
Tanner Stage 3
Category: generalpediatrics-Adolescent Care
Findings: curly hair at pubis, elevation of breast contour, acne, axillary hair
Question: Which tanner stage would you see with the following in a female?
Tanner Stage 4
Category: generalpediatrics-Adolescent Care
Findings: mound on mound breasts, enlarged areola, dense hair not at thighs, menses
Question: At which tanner stage do females achieve the following?
Testicular Cancer
Category: generalpediatrics-Adolescent Care
Findings: painless scrotal mass, elevated hCG or AFP
Notes: Obtain scrotal ultrasound and CT abdomen for staging.
Testicular Torsion
Category: generalpediatrics-Adolescent Care
Findings: nausea, severe unilateral pain, swollen and tender left testicle, absent cremasteric reflex
Notes: Needs urgent urologic evaluation as this is surgical emergency. Ultrasound would show decreased perfusion on affected side. Needs immediate surgical detorsion and fixation of both testicles.
Question: Which disease is associated with these findings?
Torsion Of Appendix Testes
Category: generalpediatrics-Adolescent Care
Findings: blue dot sign, painful
Notes: Treated by NSAIDs
Varicocele
Category: generalpediatrics-Adolescent Care
Findings: dilated scrotal veins, increases with valsalva
Notes: Usually left sided because of spermatic vein connection to left renal vein perpendicularly. Right sided may indicated issue with IVC. If painful or does not grow or even atrophy, will need surgery. Look for 2 mL or more difference between testicles.
Question: Which issue is associated with these findings?