Adol/Gyne SAQ

Question 1

14 year old adolescent female presents with genital pain. She also has occasional headaches, but does not have any other symptoms. On examination, she has two 0.5 cm lesions at her inner labia minora. Besides HSV, what are four other possible causes?

Answer 1

1. HPV
2. Bartholin cysts
3. Molluscum contagiosum
4. Behcet’s disease

Question 2

2. List 4 diagnostic criteria for Bulimia Nervosa.

Answer 2

1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
   
   1. Eating an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
   2. Sense of lack of control over eating during the episode
2. Recurrent inappropriate compensatory behaviours to prevent wt gain (self-induced vomiting, misuse of laxatives, diuretics, excessive exercise)
3. 1+2 occur on average at least 1X/wk for 3mo
4. Self-evaluation is unduly influenced by body shape + wt
5. Disturbance does not occur exclusively during episodes of anorexia nervosa

Question 3

3.AN girl with HR 42, Orthostatic changes, hypothermic, and family is not coping. What are FOUR things you want to do for management?

Answer 3

1. Admit with full cardioresp monitoring
2. Check lytes, BUN, Cr, glucose, Ca, Phos, Mg, albumin, liver enzymes
3. Fluids, slow refeeding, consider TPN
4. Multidisciplinary team approach: dietician, psychiatry, psychology, SW
5. Safety assessment

Question 4

4. Boy with marijuana use, what 5 things would make you worry?

Answer 4

1. Dangerous behaviours while driving
2. Impacting school performance + truancy
3. No longer interested in extracurriculars
4. Withdrawal from usual peer groups
5. Conflict with family
6. Use of other substances
7. Psychotic Sx

Question 5

8. Age for starting pap smears

Answer 5

21y old and sexually active, then Q3Y

Question 6

10. Admission criteria for anorexia nervosa (list 4)

Answer 6

1. HR<45 or cardiac arrythmia
2. Hypotension (<80/50) or postural hypotension
3. Hypothermia <36C
4. <80% IBW
5. Failed outpatient therapy
6. SI + plan

Question 7

11. You are seeing a 13 year old girl who has just recently become sexually active. She is asking for the birth control pill. You deduce that she has the capacity to understand the risks and benefits of birth control. She requests that you do not tell her parents. What should you do?

Answer 7

• Start contraception: first line IUD/IUS
• Discuss confidentiality and limits. Don’t tell parents, but encourage her to talk about it and offer to facilitate the conversation

Question 8

12. Teenage girl presents to your office with a 10 day history of heavy vaginal bleeding (Menarche at age 12). What are 4 things on your differential?

Answer 8

1. von Willebrand Disease
2. On anticoagulants
3. PCOS
4. Polyps or fibroids
5. Hypothyroidism

Question 9

13. Mom is worried her teen is doing cocaine. List 4 physical exam findings of cocaine use.

Answer 9

1. Tachycardia
2. Hypertension
3. Hyperthermia
4. Sweating
5. Mydriasis
6. Agitation

Question 10

14. List 4 recent signs marijuana use.

Answer 10

1. Nausea
2. Euphoria or irritability
3. Dry mouth
4. Appetite stimulation
5. Conjunctival injection

Question 11

15. What are the two most common causes of death in anorexic patients.

Answer 11

1. Suicide
2. Tachyarrhythmias

Question 12

16. A teenage girl presents to your office requesting emergency contraception. What is the latest time after intercourse that the pill is effective. What are two further steps in your management of this patient.

Answer 12

A. Ideally within 72H but up to 5d. Copper IUD up to 7d

B.

1. Discuss STI testing
2. Discuss regular contraceptive method

Question 13

17. List 3 signs on physical exam suggesting severe malnutrition in a teen with anorexia nervosa.

Answer 13

1. Bradycardia, orthostatic hypotension, hypothermia
2. Lanugo
3. Cachexia

Question 14

18. 14 y.o. female brought in by parents because she was found drunk. List five things that would increase your concern over her substance abuse.

Answer 14

CRAFFT

1. Have you ever ridden in a Car driven by seomeone (including yourself) who was high or had been using alcohol/drugs?
2. Do you ever use alcohol or drugs to Relax, feel better about yourself or fit in?
3. Do you ever use alcohol/drugs while you’re Alone
4. Do you ever Forget things you did while using alcohol or drugs?
5. Do your Friends/Family ever tell you that you should cut down?
6. Have you ever gotten in Trouble while using alcoho/drugs?

Question 15

23. 15 yo female with amenorrhea and falling off growth curve. List Ddx (4)

Answer 15

1. Anorexia nervosa
2. Female athlete’s triad
3. Craniopharyngioma
4. Pituitary adenoma
5. Hypothyroidism