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Sydney Child Health Program > 9.1 Paeds Adolescent Gyne > Flashcards

9.1 Paeds Adolescent Gyne Flashcards

1
Q

is labial agglutination common?

A

Yes 3% of prepubertal girls

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2
Q

DDx of labial agglutination if no midline Raphe ?

A
  • Imperforate hymen

- Disorder of sexual differentiation

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3
Q

Labial agglutination Rx?

A

Reassurance

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4
Q

Labial agglutination, manual separation?

A

Not recommended, 40% recurrence

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5
Q

Labial agglutination treatment?

A

Oestrogen cream plus moituriser

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6
Q

Vulvovaginal itch/soreness

What questions important?

A 
How long
Discharge
Colour
Odour
Bleeding?
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7
Q

Vulvovaginal itch/soreness PMhistory ?

A

URTI

Eczema, dermatitis, atopy

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8
Q

Vulvovaginal itch/soreness irritants?

A 
Soaps
Bubble baths
Irritants
Underwear
Leotards, tights
Hygiene
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9
Q

DDx of vulvovaginitis?

A 
Bacterial
Threadworms
Dermatoses
Chrohn’s
Ectopic ureter
Sexual abuse
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10
Q

Vulvovaginal itch/soreness foreign body usually?

A

Toilet paper

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11
Q

Vulvovaginal itch/soreness, swab when?

A

Only if discharge present

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12
Q

Vulvovaginal itch/soreness examination, how to approach?

A

External genitalia
Swab if discharge
Check elbows, scalp
Vaginoscopy if bleeding occurred

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13
Q

Vulvovaginal itch/soreness most common reason?

A

Non specific inflammation

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14
Q

Management of Vulvovaginitis?

A 
Perineal hygiene
Cotton underpants
Barrier creams
Reassurance
Vinegar baths dilute
Abx after swab
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15
Q

Lichen sclerosis

A

Whitening of skin, ecchymoses and petechaie haemorrhage,

doesn’t involve vagina

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16
Q

Why important to carefully dx Lichen sclerosis?

A

Lifetime steroids

Risk of vulvocarcinoma

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17
Q

When girls get Lichen sclerosis?

A

Age 5-7

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18
Q

Lichen sclerosis what kind of condition?

A

Autoimmune

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19
Q

Lichen sclerosis after menarche?

A

75% improvement usually

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20
Q

Lichen sclerosis Rx??

A

0.05% betamethasone for 6-12/52 until resolution then low potency for 3/12

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21
Q

Dysmenorrhea, commonest cause?

A

Prostaglandin mediated from the shedding endometrium

22
Q

When do you get lethargy in Dysmenorrhea?

A

Typically with onset of menses, not preceding it

23
Q

Mx of Dysmenorrhea?

A

-NSAIDS
Maybe with paracetamol or codeine
-COCP

24
Q

What to think of if Dysmenorrhea and refractory symptoms?

A

Endometriosis

Abdo/pelvic ultrasound

25
Q

Adolescent menorrhagia, how to assess?

A
  • How often changing tampon/pads
  • flooding (nocturnal)
  • missed school
  • FHx
26
Q

Adolescent menorrhagia most common cause?

A

Anovulation
Bleeding disorders

Pelvic pathology is uncommon

27
Q

Adolescent menorrhagia investigations?

A 
FBE
Platelets
Iron studies
Coags
-Preg
Chlamydia PCR
Pelvic US
28
Q

Adolescent menorrhagia anovulation common causes?

A

Unopposed oestrogen due to immature hypothalamus pituitary ovarian axis
-takes up to 3 years to establish cycles

29
Q

Adolescent menorrhagia other causes that affect HPO axis?

A 
Chronic illness
Eating disorders
Sporting
Drug abuse
Thyroid
30
Q

Most common cause of Adolescent menorrhagia bleeding disorders?

A
  • Platelets
  • Von Willebrand disease
  • involve haematologist
31
Q

Adolescent menorrhagia dose for tranexemic acid?

A

1g QID

32
Q

NSAIDS for Adolescent menorrhagia?

A

Not in acute setting but can reduce later on by 30%

33
Q

Adolescent menorrhagia hormone treatment?

A

COCP, prolonged extended cycles

34
Q

key points for discussion of periods for daughter with developmental delay

A

individualise
open discussion
booklet

35
Q

options for mentrual management in developmental delayed girls?

A 
do nothing
simple analgesia
COCP
Mirena - more and more
surgery: last resort need court
36
Q

implanon /depo provera for menstrual mangement of girls with developmental delay?

A

not ideal

37
Q

overweight adolescent with irregular periods and hirsutism what ask in hx?

A

PCOS

DMII

38
Q

overweight adolescent with irregular periods and hirsutism what ask in Ix?

A

pelvic U/S
Bloods: testosterone, 17 OH progesterone, androstenedione, DHEAS, LH, FSH, SHBF
-fasting insulin/glucose
-TSH

39
Q

management of PCOS?

A
  • lifestyle is mainstay
  • weight loss
  • menstrual regulation
  • insulin sensitizers
  • treat hyperandrogenism
40
Q

PCOS pharmaco options?

A
  1. COCP with monthly withdrawal
  2. COCP with 3rd gen progesterone/cyproterone acetate
  3. Metformin
41
Q

pelvic pain with amenorrhoea, may or may not be cyclical, think what dx?

A

imperforate hymen

42
Q

imperforate hymen how diagnosis? treatment?

A

ultrasound

surgery

43
Q

who to think of for imperforate/incomplete hymenal obstruction

A

14-16 year olds with well developed secondary sex characteristics, not having periods

44
Q

adnexal masses presents how?

A
  1. increase abdo girth
  2. Urinary symptoms
  3. constipation,
  4. pelvic pain
    - lower abdo fullness/heaviness/pressure
  5. dysparunia
  6. irregular periods
45
Q

adnexal masses broad categories?

A
  1. hormone secreting
    non-hormone
  2. solid/cystic
46
Q

physiological ovarian cysts? 2 main

A
  1. functional fluid filled (follicles that fail to ovulate)

2. Corpus luteum: possible bleeding into it

47
Q

ovarian cysts increase risk of

A

torsion

48
Q

ovarian masses management

A
  1. monitoring
  2. laparoscopic over drainage
  3. cystectomy vs. oophrectomy
49
Q

sudden onset severe abdominal pain ddx?

A
  1. appendicitis: more CRP, WBC?

2. ovarian torsion: bloods and urine NAD, guarding, no rebound

50
Q

classic ovarian torsion symptom onset?

A

sudden onset pain, nausea, vomiting, low grade fever

Sydney Child Health Program (113 decks)

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