Adolescent gynaecology

Question 1

what are the main causes of primary amenorrhoea?

Answer 1

delayed puberty 
kallman syndrome
imperforate hyemen 
transverse vaginal septum 
low BMI/ excessive exercise 
prolactinoma 
hypo/hyperthyroidism 
turners syndrome

Question 2

what are the main causes of secondary amenorrhoea?

Answer 2

excessive exercise
drastic weight loss or weight gain
stress
pregnancy
PCOS
bleeding disorders: leukaemia, platelet disorder, von willebrands

Question 3

when would you investigate a teenager with primary amenorrhoea?

Answer 3

primary amenorrhoea with secondary characteristics investigate at 16
primary amenorrhoea with absence of secondary characterises investigate at 14

Question 4

what questions would you ask in an adolescent gynaecological history?

Answer 4

gynaecological:
- menarche
- cycle
- pain 
sexual:
- sexual intercourse
- contraception 
weight loss/gain
exercise 
sexual abuse

Question 5

what are the different treatment options for menorraghia?

Answer 5

reassure
combined oral contraception 
progestogen only pill 
progesterone IUD (mirena)
tranexamic acid (TXA)
mifenamic acid

Question 6

what investigations would you carry out for a patient qho presents with abnormal vaginal discharge?

Answer 6

culture to identify organism
urinalysis - UTI?
rectal exam to test for pinworms
general anaesthesia to test for foreign bodies
encourage better hygiene

Question 7

what are the main causes of vulvovaginitis in children?

Answer 7

poor hygiene
lack of oestrogen
chemical irritation i.e. bubble baths

Question 8

what is the presentation of vulvovaginitis?

Answer 8

red flush appearance around vulva and anus
greenish/yellow offensive vaginal discharge
itchiness
sore vagina

Question 9

what is the peak age prevalence of vulvovaginitis?

Answer 9

3-7 years

Question 10

when is vaginal discharge normal?

Answer 10

up to 2 weeks after birth due to mothers oestrogen

pre pubertal girls due to increase in oestrogen produced from developing ovaries

Question 11

what are the complications of a function or dermoid cyst?

Answer 11

they can tort
gangrene
rupture

Question 12

what is the presentation of a dermoid cyst?

Answer 12

tender to one side of pelvis or behind the pelvis

may feel a mass

Question 13

what is the presentation of endometriosis in adolescent girls?

Answer 13

chronic pelvic pain

Question 14

what treatment would you give an adolescent for endometriosis?

Answer 14

NSAIDS

OCP

Question 15

what is a dermoid cyst?

Answer 15

sac-like growth that can be found in parts of the body such as the ovaries
they contain structures such as hair, teeth, bone etc
they are present from birth

Question 16

what investigations would you carry out to determine the cause of primary or secondary amenorrhoea?

Answer 16

LH
FSH
PRL
TSH
testosterone
oestrogen
pelvic USS
progesterone withdrawal bleed

Question 17

what treatment can be given for dysmenorrhagia and why?

Answer 17

anti-prostaglandins such as mifenamic acid

pain is caused by increase in prostaglandins