Adolescent Gynecology Flashcards
Choose all correct answers:
a) telarche is the first stage in pubertal development and is dependent on estrogen
b) the average age of menstruation in North America is 10
c) the development of axillary hair is dependent on DHEAS from the ovary
a) true
b) 12.5
c) false -DHEAS is made in the adrenal
Describe Tanner staging for breast development:
1: no breast development
2: areolar enlargement, bud formation
3: further enlargement
4: further enlargement and areolar secondary mound formation
5: further enlargement with recession of areola to general contour
Describe Tanner staging for pubic hair:
1: no pubic hair
2: sparse growth of long hairs
3: spreads sparsely over labia
4: adult type hair over mons
5: adult hair spreads to medial thighs
What is the definition of precocious puberty?
Breast or pubic hair development before age 8.
Revised definition: breast or pubic hair development in white girls before age 7 or black girls before age 6
What is the definition of delayed puberty?
Lack of telarche by age 13.
Maturation from beginning of breast development to monarche not complete after 3 years.
No menses by age 15.
List possible causes of delayed puberty:
androgen insensitivity syndrome constitutional hypergonadotropic hypogonadism hypogonadotropic hypogonadism mullerian agenesis chronic illness
What lab investigations should be ordered in the work-up of an adolescent with menorrhagia?
When in the cycle is this testing ideally done?
CBC with platelets, INR, PTT, Group and screen, Von Willebrand’s Factor antigen, ristocetin, factor VIII.
Should be done during periods of low estrogen (during menses or during placebo pills)
How would you direct a patient to use OCP taper to control acute menorrhagia.
OCP with 30-35mcg estrogen: 1 pill q6h for 2 days 1 pill q8h for 2 days 1 pill q12h for 12 days 1 pill daily anti-emetics often needed because of estrogen s/e
What are the primary treatments of primary dysmenorrhea?
1) NSAIDs -pain mediated by prostaglandins/leukotrienes
2) hormone therapy -OCP effective due to ovulation suppression and keeping endometrial lining thinner so there is less prostaglandin released at time of flow
List the typical exam findings, test findings, and tx for vaginitis caused by candida.
White, thickened discharge
ph < 4.5
“hyphae seen on microscope slide”
tx with one week of PV anti-fungal or single PO dose of fluconazole 150mg
List the typical exam findings, test findings, and tx for vaginitis caused by bacterial vaginosis.
thin, grey, malodorous discharge
ph > 4.5
“clue cells” on wet prep, + whiff test
tx with flagyl. 500mg PO BID x 7 days
List the typical exam findings, test findings, and tx for vaginitis caused by trichomonas.
frothy white/yellow discharge, punctate hemorrhages on cervix
pH > 4.5
wet prep with motile, flagellated organisms
tx with flagyl 2g PO in a single dose
