What are the absolute contraindications to combined OCPs?
- <6 weeks postpartum
- Hypertension (>160/100)
- Current or past history of venous thromboembolism
- Ischemic heart disease
- History of cerebrovascular accident
- Complicated valvular heart disease (pulmonary hypertension,
atrial fibrillation, history of subacute bacterial endocarditis) - Migraine with focal neurological symptoms
- Breast cancer (current)
- Diabetes with retinopathy/nephropathy/neuropathy
- Severe cirrhosis
- Liver tumor
- Systemic lupus erythematous with positive or unknown antiphospholipid antibody
What is the diagnostic criteria for ARFID?
- An eating or feeding disturbance (e.g. apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with 1+ of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
- Significant nutritional deficiency
- Dependence on enteral feeding or oral nutritional supplements
- Marked interference with psychosocial functioning
What are the recommended interventions for smoking cessation?
- Brief counselling (in person, individual or group) - recommended
- CBT - recommended
- Phone or distance counseling - recommended
- Mobile phone interventions (text reminders) - recommended in combination w/ other interventions
- Self-help, noninteractive audio-visual material - recommended in combination w/ other interventions
- NRT (gums, patches, lozenges, sprays) - recommended ONLY for regular smokers 12-18yo
- Bupropion - recommended in some cases (use with caution)
- Varenicline - recommended in some cases (use with caution)
- E-cigarettes - NOT recommended
What are the contraindications for bupropion and varenicline for smoking cessation?
Eating disorders & seizure disorders (for bupropion)
What is the recommended treatment for gonococcal & chlamydia co-infection, ano-genital infections?
- Ceftriaxone 250mg IM single dose + azithromycin 1g PO single dose
- OR
- Cefixime 800mg PO single dose + azithromycin 1g PO single dose
What is the recommended treatment for pharyngeal infections?
Preferred: Ceftriaxone 250mg IM single dose + azithromycin PO single dose
Alternative: Cefixime 800mg PO single dose + azithromycin 1g PO single dose OR –Azithromycin 2g PO single dose
What is the recommended treatment for genital / perianal HSV, 1st episode?
- Valacyclovir 1000mg PO twice daily for 10 days
- OR
- Famciclovir 250mg three times daily for 5 days
- OR
- Acyclovir 200mg PO five times daily for 5-10 days
What is the recommended treatment for genital / perianal HSV, recurrent lesions?
- Valacyclovir 500mg PO twice daily OR 1000mg PO daily for 3 days
- OR
- Famciclovir 125mg twice daily for 5 days
- OR
- Acyclovir 200mg PO five times daily for 5 days (800mg three times daily for 2 days may be as efficacious)
What is the recommended treatment for trichomonas infection?
Metronidazole 2g PO in a single dose OR Metronidazole 500mg PO twice daily for 7 days
Match the key feature to stage of adolescence: 1. Cognitive - future oriented & idealistic; 2. Identity - preoccupied with changing body; 3. Family - peak of conflicts and struggle for autonomy; 4. Peers - Intense group peer involvement, conformity; 5. Sexual - questions sexual orientation, starts relationships; 6. Identity - consolidation of identity; 7. Increased privacy, exploration of independence
- Late adolescence
- Early adolescence
- Mid adolescence
- Mid adolescence
- Mid adolescence
- Late adolescence
- Early adolescence
You are assessing a 12 year old female who presented to you with a 10kg weight loss over the last 3 months. Which of the following would best support a diagnosis of anorexia nervosa?
a) Food refusal for 5 days
b) Her resting HR is 40 bpm
c) She is afraid of gaining weight
d) Hypophosphatemia on BW
Answer: C - part of the diagnostic criteria for anorexia nervosa
DSM 5 criteria:
- A - low body weight secondary to nutritional restriction
- B - fear of gaining weight
- C - distortion of body image
- Subtypes: restriction, binge-eating/purging
You are assessing a 15 year old patient with bulimia nervosa who reports that she binge eats and self-induces vomiting at least daily. Regarding frequent binge eating and self-induced vomiting, which of the following abnormalities would you be most likely to see on laboratory investigations?
a) Metabolic acidosis
b) Hyperkalemia
c) Urine alkalosis
d) Hypophosphatemia
Answer: C - signs of chronic vomiting: hypochloremic, hypokalemic metabolic alkalosis +/- hypovolemia
Bulimia nervosa - DSM criteria:
Binge eating and purging at least once weekly
- Body weight is normal or increased
- Self-evaluation is closely linked to body image
You are assessing a 12 year old female who presents to you with a 10 kg weight loss over the last 3 months. After a complete history
and physical examination you make a diagnosis of anorexia nervosa. Regarding the treatment of anorexia nervosa, which of the following is a criteria for inpatient hospitalization?
a) Resting HR 55 bpm
b) Hypophosphatemia on BW
c) Nutritional intake of 500 kcal per day
d) Abdominal pain after meals
Answer: B
Criteria for Inpatient Hospitalization
- ≤75% median BMI for age and sex
- Dehydration
- Electrolyte disturbance (hypokalemia, hyponatremia, hypophosphatemia)
- EKG abnormality (prolonged QTc or severe bradycardia)
- Physiologic instability: Severe bradycardia (HR < 50bpm awake, < 45 bpm sleeping); hypotension (<90/45), hypothermia (T< 35.6), orthostatic increase in HR (>20 bpm) or decrease in BP (>20 sBP, or >10 dBP)
- Arrested growth & development
- Failure of outpatient treatment
- Acute food refusal
- Uncontrolled binge eating and purging
- Acute medical complications of malnutrition (syncope, seizures, cardiac failure, pancreatitis)
- Comorbid condition that limits appropriate outpatient treatment (severe depression, suicidal ideation, OCD, type 1 DM)
You are assessing a 12 year old female who presents to you with a 10 kg weight loss over the last 3 months. After a complete history and physical examination you make a diagnosis of anorexia nervosa. Regarding anorexia nervosa in children and adolescents, which of the following is a common method used to determine treatment goal weight?
a) Tx goal weight based on FHx
b) Tx goal weight based on mid-upper arm circumference
c) Tx goal weight based on prior growth
d) Tx goal weight based on parental decision
Answer: C - Calculating Treatment Goal Weight (TGW)
- Approach is individualized based on premorbid weight, height, BMI %, growth trajectory, pubertal stage, and weight at return of menses
- 4 common methods:
- TGW based on prior growth
- TGW based on weight at same percentile as height percentile
- TGW based on median BMI (mBMI) for age
- TGW based on menstrual threshold +2kg
What is “Relative energy deficiency in sport (RED-S)”?
- Previously known as female athlete triad
- Can occur in boys or girls
- Findings: 1. oligomenorrhea/amenorrhea, 2. low bone mineral density, 3. low energy availability
*ONLY treatment for low BMD and amenorrhea is weight restoration → do NOT use OCPs unless patient needs contraception
You are assessing a 16 year old female who tells you that she wants to reduce her cannabis use but is not able to sustain a decreased level of use. You suspect that she is experiencing cannabis withdrawal. Which of the following is a feature of cannabis withdrawal?
a) Elevated mood
b) Hyperphagia
c) Dry mouth
d) Insomnia
Answer - D
- CWS = at least 2 of 5 psychological symptoms (anxiety, irritability, depressed mood, sleep disturbance, appetite changes)
- AND at least 1 of 6 physical symptoms (abdominal pain, shaking, fever, chills, headache, diaphoresis)
- AFTER cannabis cessation
- Withdrawal symptoms usually occur within 24-72 hours
- Persists for 1-2 weeks (up to 1 month for sleep disturbance)
- Tx: motivational interviewing
What does the CRAFFT screening tool stand for?
- CRAFFT
- Have you ridden in a CAR driven by someone or yourself who had been using substances?
- Do you use substances to RELAX or feel better about yourself?
- Do you use substances while you are ALONE?
- Do you FORGET things you did when using substances?
- Do your FAMILY OR FRIENDS tell you to cut down your substance use
- Have you ever gotten into TROUBLE while you were using alcohol or drugs?
- Changes in mood, appetite, sleep pattern, decreased interest in school, loss of weight, secretive behaviour, valuables missing from home
You are assessing a 12 year old female who underwent menarche 3 months ago. She reports that her menstruation is “heavy and irregular”. She does not experience dysmenorrhea. What the most likely diagnosis?
a) Bleeding disorder
b) PCOS
c) Physiologic anovulation
d) Thyroid dysfunction
Answer: C
Normal Adolescent Menstrual Cycle
- Duration: 21-45 days
- 2-7 days of bleeding
- 30-80cc of blood
You are assessing a 12 year old female who underwent menarche 3 months ago. She reports that her menstruation is “heavy and irregular”. She does not experience dysmenorrhea. What the most likely diagnosis?
a) Bleeding disorder
b) PCOS
c) Physiologic anovulation
d) Thyroid dysfunction
Answer: C
Normal Adolescent Menstrual Cycle
- Duration: 21-45 days
- 2-7 days of bleeding
- 30-80cc of blood
What are examples of abnormal uterine bleeding? What is a differential diagnosis?
- Amenorrhea
- Menses at irregular intervals
- Menses that are more frequent than every 21 days or less frequent than every 45 days
- Excessive duration (> 7 days)
- Heavy menstrual bleeding
- Intermenstrual bleeding
DDx:
- *Physiological adolescent anovulation*
- Infection
- Pregnancy related (pregnancy, pregnancy loss, ectopic pregnancy, molar pregnancy)
- Bleeding disorder (including related to systemic disease)
- PCOS
- Thyroid dysfunction
You are discussing contraception with a 15 year old female. Regarding long acting reversible contraception (LARC), which of the following is true?
A) Adolescent must be sexually active for LARC insertion
B) LARCs are the first-line option for adolescent contraception
C) Migraine with focal neurological symptoms is a contraindication to LARCs
D) Adolescents need parental consent for LARC insertion
Answer: B
You are assessing a 13 year old female patient who has a history of
3 positive urine NAAT’s for chlamydia. She initially tested positive 5 months ago and was treated with azithromycin 1 gram orally. She tested
positive again 2 months later and was treated with azithromycin 1 gram orally. Three months later she has tested positive again. What is the most likely explanation for recurrent positive chlamydia urine NAAT’s?
A) Chlamydia urine NAAT is not a specific test
B) Non-adherence to treatment
C) The strain of chlamydia is resistant to azithromycin
D) Reinfected after treatment
Answer: D
Which STIs are reportable to public health?
- Chlamydia trachomatis
- Neisseria gonorrhea
- T pallidum (syphilis)
- HIV
Which STIs are reportable to public health?
- Chlamydia trachomatis
- Neisseria gonorrhea
- T pallidum (syphilis)
- HIV
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