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3rd Year - Reproductive Diseases > 9. Adolescent Gynaecology > Flashcards

9. Adolescent Gynaecology Flashcards

1
Q

How is Adolescent Gynaecology different?

A
  1. Usually a Family Consultation
  2. Can be 3 Generations Present
  3. Sometimes just with Father
  4. Ethnic Minorities - Child may Speak English but Parents not
  5. Anxieties about Confidentiality
  6. Consultation often Directed at PArents
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2
Q

What changes occur in Adolescent Gynaecology?

A
  1. Physiological Changes
  2. Developing Sexuality
  3. Independence from Parents
  4. Peer Acceptance
  5. Descisions over the Future
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3
Q

How do Presentations Vary between in Adolescent Gynaecology?

A
  1. Embarrassment / Secrecy
  2. Identify whos problem it is
  3. Confusion
  4. May talk to Parents and Friends
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4
Q

Who do Adolescent Gynaecology cases often present to?

A
  1. School Nurses
  2. Family Planning Clinics
  3. G.P. / A&E
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5
Q

What is Gillick Competence?

A

A Child younger than 16 can give / withhold consent if a doctor feels she fully understands what is involves in an intervention
Note - In certain situations parents can override the girls wishes

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6
Q

What is Fraser Competence?

A

Contraceptive Advice to under 16 year old girls

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7
Q

What is needed in Fraser Competence?

A
  1. Mature enough to understand the advice / implications
  2. Girl likely to begin / continure to have sex with / without treatment
  3. Doctor tried to persuade girl to inform parents
  4. Girls health would suffer without treatment / advice
  5. In girls best interest to give treatment / advice
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8
Q

What is included in the important Gynaecological History?

A
  1. Gynaecological - Age of Menarche / Cycle / Pain
  2. Sexual - Sexual Activity / Contraception
  3. Weight Gain / Loss
  4. Exercise
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9
Q

What is included in a Gynaecological Examination?

A
  1. General Examination
  2. Breasts
  3. Gynaecological
    Note - This is never done in the 1st visit
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10
Q

What is the Self-Staging method used?

A

Tanner Stages

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11
Q

What is Ammenorrhoea?

A

Absence of Menstruation

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12
Q

When are investigations carries out for Primary Ammenorrhoea and:

  1. Normal Secondary Sexual Characteristics?
  2. Absent Secondary Sexual Characteristics?
A
  1. 16 years old

2. 14 years old

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13
Q

What investigations of Primary Ammenorrhoea will occur, prior to referral to a Gynaecology Clinic?

A
  1. Blood Hormone Levels - Follicular Stimulating Hormone / Luteinizing Hormone / Prolactin / Thyroid Stimulating Hormone / Testosterone / Oestrogen
  2. Pelvic Ultrasound
  3. Progesterone Withdrawal Bleed
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14
Q

How is a Diagnosis of Hypogonadotrophic Hypogonadism reached?

A
  1. History / Examination - No Secondary Sexual Characteristics
  2. Low FHS and LH - <5 IU per L
  3. Diagnosis Made
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15
Q

How is a Diagnosis of Premature Ovarian Failure reached?

A
  1. History / Examination - No Secondary Sexual Characteristics
  2. High FSH (>20 IU per L) and LH (>40 IU per L)
  3. Hypergonadotrophic Hypogonadism Diagnosis
  4. Karyotype Analysis - 46, XX
  5. Diagnosis Made
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16
Q

How is a Diagnosis of Turners Syndrome made?

A
  1. History / Examination - No Secondary Sexual Characteristics
  2. High FHS (>20 IU per L) and LH (>40 IU per L)
  3. Hypergonadotrophic Hypogonadism Diagnosis
  4. Karyotype Analysis - 45, XO
  5. Diagnosis Made
17
Q

How is a Diagnosis of Androgen Insensitivity Syndrome made?

A
  1. History / Examination - Secondary Sexual Characteristics
  2. Ultrasound of Uterus - Uterus Absent / Abnormal
  3. Karyotype Analysis - 46, XY
  4. Diagnosis Made
18
Q

How is a Diagnosis of Mullerian Agenesis made?

A
  1. History / Examination - Secondary Sexual Characteristics
  2. Ultrasound of Uterus - Uterus Absent / Abnormal
  3. Karyotype Analysis - 46, XX
  4. Diagnosis Made
19
Q

When should Evaluation for Secondary Ammenorrhoea take place?

A
  1. History / Examination - Secondary Sexual Characteristics
  2. Ultrasound of Uterus - Uterus Present / Normal
  3. No Outflow Obstruction
  4. Tests for Secondary Ammenorrhoea performed
20
Q

How is a Diagnosis of Imperforate Hymen (or Transverse Vaginal Septum) made?

A
  1. History / Examination - Secondary Sexual Characteristics
  2. Ultrasound of Uterus - Uterus Present / Normal
  3. Outflow Obstruction
  4. Diagnosis made
21
Q

What happens in Puberty Induction?

A
  1. Gradual Build up of Oestrogen
  2. Effects on Breast Development
  3. Add Progesterone - once Max. Height, At least 20mg of Oestrogen Dose
22
Q

How do / are Polycystic Ovaries:

  1. Present?
  2. Diagnosed?
  3. Treated?
A
  1. Switch between Hypothalamic and PCOS
  2. Diagnose with FSH:LH and Ultrasound
  3. Weight reduction / Lifestyle Changes / Oral Contraceptive Pill
23
Q

What can cause Bleeding Disorders in Adolescent Gynaecology?

A
  1. Anovulation - Majority
  2. Pregnancy Complications
  3. Bleeding Disorders - Von Williebrands / Platelet Defects / Leukaemia
    Note - Be aware of other Factors - Sexual Abuse / Bullying / Trauma
24
Q

What is the treatment of Menorrhagia?

A
  1. Reassure / Talk to Girls Directly
  2. Medication:
  3. a) Progesterone Only Pill / Compined Oral Contraceptive Pill / Mirena
  4. b) Tranexamic / Mefenamic Acid
25
Q

What is the Pathology of Cysts?

A
  1. Small Cysts are often Functional / Dermoids
  2. Gravity allows them to drop to the Lowest Pelvic Point
  3. Can then Tort / Turn Gangrenous / Rupture
    Note - Often Subacute History - Tender on 1 side of the Pelvis and Mass may be felt
26
Q

What is the most common age, in Adolescent Gynaecology, to present with Vulvovaginitis?

A

2-7 years old

27
Q

What is the cause of Vulvovaginitis?

A

Labial Adhesions - C. Labial Aggulutination (Adhesion of the Labia Minora in the Midline)

28
Q

What is the management of C. Labial Aggulutination?

A
  1. If asymptomatic - Improved Hygiene

2. Difficulty Urinating - Lubrication / Topical Oestrogen / Surgical Separation

29
Q

What can cause Pathological Mucoid Discharge in Infants?

A
  1. Infections with Organisms
  2. Haemolytic Stroptococcal Vaginitis
  3. Monial Vaginitis
  4. Foreign Body
30
Q

How is Pathological Mucoid Discharge in Infants managed?

A
  1. Culture to identify Causative Organism
  2. Urinalysis to rule out Cystitis
  3. Review Proper Hygiene
  4. Perianal Examination with Transparent Tape (Pinworms)
  5. Examination (under anaesthesia) for Foreign Body

3rd Year - Reproductive Diseases (41 decks)

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