GYNECOLOGIC PROBLEMS OF CHILDHOOD 1.1 (AB) Flashcards
What is the most common age range for gynecologic problems in children?
“Childhood to early adolescence”
What approach should be taken when discussing gynecologic issues with adolescents?
“Non-biased and developmentally appropriate discussions”
What type of history should be taken if a gynecologic problem is suspected to be due to another disease?
“Comprehensive history”
Why is it important to encourage adolescent patients to ask their own questions during consultations?
“To ensure they understand. provide feedback and explore their insights”
What should you do if a family member cannot be present during a genital examination?
“Ask a female colleague to assist with the examination”
What option can be offered to older children during genital exams to increase their understanding?
“Watching the examination with a handheld mirror”
What are the indications for a genital examination in children?
“Vaginal bleeding. vaginal discharge. vulvar trauma. foreign body. perineal/pelvic masses. vulvovaginal lesions. congenital anomalies. suspected sexual abuse”
What is the recommended positioning for genital exams in children younger than 4 years old?
“Sitting on parent’s lap with legs straddling parent’s thighs”
What is the frog-leg position used for in pediatric gynecologic exams?
“Supine position with hips fully abducted and feet together”
What is the knee-chest position used for in pediatric gynecologic exams?
“Elevation of buttocks and hips”
What should be documented after a genital examination?
“Findings. each structure visualized and sketches or photographs with patient/caregiver consent”
At what age is the first Pap test recommended?
“21 years old”
What are some indications for pelvic examination in adolescents?
“Unexplained menstrual irregularities. severe dysmenorrhea. unexplained abdominal/pelvic pain. unexplained dysuria. abnormal vaginal discharge. IUD placement. foreign body removal. inability to place tampons”
At what age should the first gynecologic evaluation occur?
“Between 13 and 15 years old”
What is the focus of the first gynecologic visit between 13-15 years old?
“Patient education. no pelvic exam unless indicated”
What is the most common gynecologic problem in prepubertal children?
“Vulvovaginitis”
What is the incidence of vulvovaginitis in prepubertal children?
“17-50%”
What are common causes of vulvovaginitis in children?
“Inadequate/excessive hygiene or chemical irritants”
At what ages does vulvovaginitis peak?
“4 and 8 years old”
What are some clinical manifestations of vulvovaginitis?
“Diaper dermatitis. physiologic leukorrhea. labial agglutination. genital ulcers. dermatoses”
What is the primary treatment for vulvovaginitis?
“Hygiene measures and education”
What type of soap is recommended for children with vulvovaginitis?
“Mild. hypoallergenic soap”
What does molluscum contagiosum look like?
“1-5mm discrete. skin-colored. dome-shaped. umbilicated lesions with a cheesy plug”
How is molluscum contagiosum usually diagnosed?
“Visual inspection”
What is the usual treatment for molluscum contagiosum in children?
“Self-limited; may resolve spontaneously”
What are treatment options for molluscum contagiosum if intervention is needed?
“Cryosurgery. laser. curettage. podophyllotoxin. silver nitrate. imiquimod. potassium hydroxide”
What does condyloma acuminata look like?
“Skin-colored papules. some with shaggy. cauliflower-like appearance”
How is condyloma acuminata usually diagnosed?
“Visual inspection”
Is HPV DNA testing helpful for diagnosing condyloma acuminata in children?
“No”
What is the usual approach to condyloma acuminata in children?
“Wait and see (many resolve in 60 days)”
What topical treatments can be used for condyloma acuminata?
“Imiquimod cream. podophyllotoxin”
When is surgical treatment considered for condyloma acuminata?
“For symptomatic or large lesions”
What does herpes simplex look like in the genital area?
“Blisters that break. leaving tender ulcers”
How is genital herpes confirmed?
“Culture from lesion”
What is the treatment for disseminated neonatal herpes?
“Acyclovir 20 mg/kg IV q8h for 21 days”
What is the first-line treatment for genital herpes in children 2-12 years old (first episode)?
“Acyclovir 1200 mg/day divided q8h for 7-10 days”
What condition presents as adherent labia with a central semi-translucent line?
“Labial agglutination”
When does labial agglutination require treatment?
“If symptomatic (vulvitis. urinary dribbling
What is the treatment for symptomatic labial agglutination?
“Topical estrogen cream or betamethasone ointment”
What should be done if breast budding occurs during estrogen treatment for labial agglutination?
“Stop estrogen treatment”
What should be applied to prevent recurrence after resolving labial agglutination?
“Emollient like petroleum jelly at bedtime”
What is the appearance of lichen sclerosus in children?
“Sclerotic. atrophic. parchment-like plaque with hourglass/keyhole appearance”
What symptoms can lichen sclerosus cause?
“Perineal itching. soreness. dysuria”
What is the first-line treatment for lichen sclerosus?
“Ultrapotent topical corticosteroids (clobetasol propionate 0.05%)”
How long is clobetasol usually applied for lichen sclerosus?
“Once or twice daily for 4-8 weeks”
What is the long-term outlook for lichen sclerosus in girls?
“Often resolves with puberty but may require long-term follow-up”
What immunomodulators can be used for lichen sclerosus?
“Tacrolimus 1%. Pimecrolimus 1%”
What is the most common dermatologic problem in infancy?
Diaper dermatitis
What is the most common cause of diaper dermatitis?
Moisture and contact with urine and feces, with colonization by Candida spp.
What is the first-line treatment for diaper dermatitis?
Hygiene measures: frequent diaper changes, frequent bathing, water-repellant barriers like zinc oxide
What treatment is added if satellite lesions of Candida are present in diaper dermatitis?
Topical antifungal
What is the typical presentation of genital ulcers in prepubertal girls?
Painful red or white lesions that evolve into sharply demarcated red-rimmed ulcers with a necrotic or eschar-like base
What prodromal symptoms can accompany genital ulcers in non-sexually active young girls?
Flu-like symptoms: fever, nausea, abdominal pain
What are common causes of vaginal bleeding in prepubertal children?
Vulvovaginitis, dermatologic conditions, vaginal foreign bodies, urethral prolapse
What are less common causes of vaginal bleeding in prepubertal children?
Endogenous or exogenous estrogen (pseudomenses)
What are the least common causes of vaginal bleeding in prepubertal children?
Neoplasms and trauma
What is the hallmark of lichen sclerosus in children?
Chronic inflammation, intense pruritus, thinning and whitening of vulvar and perianal skin
What is the diagnostic method for lichen sclerosus?
Tissue biopsy
What is the first-line treatment for lichen sclerosus?
Ultrapotent topical steroids (clobetasol propionate 0.05%)
What is the most common vaginal foreign body in prepubertal girls?
Retained toilet paper
What symptom is commonly associated with vaginal foreign bodies in children?
Blood-tinged, foul-smelling discharge
What procedure facilitates removal of vaginal foreign bodies in children?
Vaginoscopy
What condition presents as a friable hemorrhagic mass protruding from the external urethral meatus in children?
Urethral prolapse
What is the treatment for urethral prolapse in children?
Twice-daily sitz baths and topical estrogen cream (e.g., Estrace 0.01%) for 2 weeks
What condition is characterized by vaginal bleeding as a presenting sign, often with premature pubertal development?
Precocious puberty
What is the age cutoff for concern about precocious puberty in non-African-American girls?
Before age 7 years
What is the age cutoff for concern about precocious puberty in African-American girls?
Before age 6 years
What is the most common source of premature development in precocious puberty?
Gonadotropin-dependent (central) precocious puberty
What condition can cause both pubertal delay and premature vaginal bleeding in severe cases?
Juvenile hypothyroidism
What is the treatment for juvenile hypothyroidism?
Thyroid hormone replacement (Levothyroxine)
What is the most common benign vascular neoplasm of infancy?
Infantile hemangiomas
What is the first-line topical treatment for infantile hemangiomas?
Topical beta-blockers (Timolol 0.5%) 2-3 times daily for 6-12 months
What are additional treatment options for infantile hemangiomas besides topical beta-blockers?
Intralesional corticosteroids (triamcinolone) or laser ablation/surgical excision
What are the characteristic lesions of psoriasis in the vulva of children?
Pruritic, well-demarcated, non-scaly, brightly erythematous symmetric plaques
What is the first-line treatment for vulvar psoriasis in children?
Low- to medium-potency topical corticosteroids
Where else might psoriasis lesions be found in children?
Scalp, nasolabial folds, behind ears
What is the characteristic presentation of atopic dermatitis in children?
Crusty, weepy lesions with intense pruritus and erythema
What is the recommended treatment for atopic dermatitis in children?
Avoid irritants, use topical corticosteroids for flare-ups, moisturizers for dry skin
What condition is associated with exposure to perfumed soaps, bubble bath, or elastic bands of undergarments?
Contact dermatitis
What is the treatment for contact dermatitis?
Avoid irritants and use topical corticosteroids for flare-ups
What condition presents with erythematous, greasy, yellowish scaling on the vulva and labial crural folds?
Seborrheic dermatitis
What is the treatment for seborrheic dermatitis in the vulva?
Gentle cleaning, topical clotrimazole with 1% hydrocortisone
What condition presents as sharply demarcated hypopigmented patches often symmetric around vaginal and anal regions?
Vitiligo
What associated illnesses should be considered in a child with vitiligo?
Thyroid disease, Addison disease, pernicious anemia, diabetes mellitus
What is the treatment for limited vitiligo lesions?
Low-potency corticosteroids or tacrolimus
When should a child with extensive vitiligo lesions be referred to a dermatologist?
If no improvement after 2-4 weeks of treatment
