Adolescents

A set of Question-and-Answer style flashcards covering the major topics from the adolescent medicine notes (overdose, puberty, reproductive health, scoliosis, eating disorders, immunizations, and confidentiality).

What is the antidote for acetaminophen poisoning and how is it administered?

N-acetylcysteine given intravenously.

What characterizes Stage I (up to 24 hours) of acetaminophen overdose?

Often asymptomatic; may have nausea and vomiting; very large doses can cause lethargy and malaise.

What characterizes Stage II (18–72 hours) of acetaminophen overdose?

Right upper quadrant pain; elevated LFTs, prolonged prothrombin time, and bilirubin; possible nephrotoxicity (high BUN/creatinine).

What characterizes Stage III (72–96 hours) of acetaminophen overdose?

Hepatic necrosis with jaundice, coagulopathy, hypoglycemia, hepatic encephalopathy; AKI with oliguria; most deaths occur in this window.

What characterizes Stage IV (4 days–3 weeks) after acetaminophen overdose?

If survived, signs of organ failure resolve.

What is Pel-Ebstein fever and with which disease is it associated?

A fever pattern described in Hodgkin lymphoma, often with night sweats and fatigue.

What are typical presenting features of Hodgkin lymphoma in adolescents?

Enlarged, painless lymph nodes (cervical/axillary/inguinal/supraclavicular) with fever, fatigue, weight loss, night sweats; may have alcohol-related pain in affected nodes.

What are the most common cancers in teens aged 15–19 years?

Hodgkin lymphoma and germ cell tumors (testicular and ovarian cancer).

What are the typical signs of testicular cancer?

Heaviness in the scrotum or a hardened, usually painless mass; sometimes discomfort; firm affected testicle.

What is a strong risk factor for testicular cancer?

Cryptorchidism (undescended testicle).

What are the hallmark features of Testicular Torsion?

Acute unilateral testicular pain in a pubertal male with nausea/vomiting; absent ipsilateral cremasteric reflex; high-riding testicle with transverse lie; urgent with Doppler ultrasound.

What is the initial diagnostic test of choice for Testicular Torsion?

Doppler ultrasound.

What is the definition of adolescence as used in these notes?

The period from the onset of puberty to sexual maturity.

What hormonal changes drive puberty?

Ovaries produce estrogen and progesterone; testes produce testosterone; these changes enable reproductive capability.

At what Tanner stage does puberty typically begin and end?

Begins at Tanner stage II and ends at Tanner stage V.

What changes occur at Tanner stage II in girls and in boys?

Girls: breast buds; Boys: testes enlarge and scrotal rugation/color darkens.

What is precocious puberty as defined here?

Puberty starting before age 9 years.

What is delayed puberty as defined here?

Lack of any breast development by age 13 in girls or lack of testicular enlargement by age 14 in boys.

What is spermarche and its typical age?

First ejaculation; average age about 13.3 years.

What is menarche and its typical age?

The first menstrual period; average age about 12 years (range 8–15).

What are the key features of the menstrual cycle in adolescents?

Average cycle length ~28 days (21–45 in younger teens; 21–35 in young adults); menses last ~3–5 days (2–7); most fertile window is days 11–14 (about 3 days before/during ovulation).

What causes dysmenorrhea and its recommended treatment?

Due to high prostaglandin levels; treat with heating pads and NSAIDs (e.g., ibuprofen, naproxen).

What is the recommended approach to obtaining an adolescent health history?

Obtain history from parent/guardian and child together, then interview the adolescent alone.

What test is used to screen for scoliosis and how is curvature quantified?

Adams Forward Bend Test; Cobb angle is used to measure curvature on full-spine radiographs.

What are the Cobb angle thresholds and corresponding management for scoliosis?

What is Osgood-Schlatter disease and how is it managed?

Knee pain in teens due to overuse at the tibial tubercle; Rest, RICE, NSAIDs, and quadriceps/hamstring stretching; usually resolves with growth.

How is Primary Amenorrhea defined?

No menarche by age 15 with normal growth and secondary sexual characteristics.

How is Secondary Amenorrhea defined?

No menses for more than 3 cycles or 6 months after previously having menses; pregnancy is the most common cause.

What is the Female Athlete Triad?

Anorexia nervosa/restrictive eating, amenorrhea, and osteoporosis.

What initial labs are used to evaluate amenorrhea?

Pregnancy test (β-hCG), prolactin, TSH, and FSH/LH; bone density if amenorrhea >6 months.

What is gynecomastia and how common is it in adolescence?

Excessive growth of breast tissue in males; physiologic in infancy and adolescence; about 40% of pubertal boys; typically resolves in 6 months to 2 years.

What differentiates gynecomastia from pseudogynecomastia?

Gynecomastia is glandular breast tissue; pseudogynecomastia is fatty facial tissue without a glandular mass.

What are Turner's syndrome features?

45,X; webbed neck, short stature, ovarian failure, congenital lymphedema; risk of cardiovascular/renal issues and amenorrhea.

What are Klinefelter syndrome features and management?

47,XXY; tall, long limbs with narrow shoulders; small firm testes; reduced body hair; infertility; managed with testosterone replacement and fertility treatment.

What is the typical presentation and management of Pseudogynecomastia?

Bilateral breast enlargement due to fatty tissue; no glandular mass; managed by evaluating weight status; not requiring treatment for tissue itself.

What is the recommended vaccination schedule for meningococcal disease in adolescents?

Single dose at age 11–12 with booster at age 16; catch-up for ages 13–18 if not previously vaccinated; if first dose at 16 or later, no booster needed.

What is VAERS and why is it mentioned?

Vaccine Adverse Event Reporting System; government program to report adverse events after vaccination.

What are the three core doses and schedule for HPV vaccination as outlined here?

Minimum age 9; for 11–12-year-olds: two doses 6 months apart; ages 15–45: three doses at 0, 1–2, and 6 months.

What is the key difference between adolescent confidentiality and emancipated minor status?

Confidentiality protects sensitive issues (like STI care), while emancipated minors have full consent rights similar to adults (e.g., married, in military, self-supporting).