GYNECOLOGIC PROBLEMS OF CHILDHOOD 1.2 (AB) Flashcards
When does breast development begin during gestation?
Around week 5 of gestation.
When do initial lactiferous ducts form during gestation?
Between week 10 and 20 of gestation.
When does the breast bud become palpable in gestation?
At week 34 of gestation.
When does the areola appear during gestation?
At 5 months of gestation.
When does the nipple appear in a newborn?
Shortly after birth.
What is thelarche?
Onset of pubertal breast development.
At what age does thelarche usually occur?
Between ages 8 and 13 years.
How long does normal breast development take after thelarche?
2 to 4 years.
What is menarche?
First menstruation.
When does menarche usually occur relative to thelarche?
Around 2 years after breast development starts.
What is neonatal breast hypertrophy?
Breast enlargement in term infants of either sex due to maternal hormones.
What is “witch’s milk”?
Clear or cloudy nipple discharge in neonates due to maternal hormone withdrawal.
What is a common cause of neonatal mastitis?
Staphylococcal or streptococcal infection.
How is neonatal mastitis treated?
IV antibiotics.
What is polymastia?
Presence of supernumerary breast tissue.
What is polythelia?
Presence of accessory nipples.
What causes polymastia and polythelia?
Incomplete involution.
When might accessory breast tissue need to be removed?
If causing pain or for cosmetic reasons.
What is amastia?
Complete absence of the breast.
What syndrome is associated with amastia?
Poland syndrome.
How is amastia treated?
Surgical correction.
In which population is mastitis most common?
Lactating mothers.
Which organisms commonly cause mastitis?
Staphylococcus aureus and Bacteroides.
How is neonatal mastitis managed?
IV antibiotics for MRSA or based on culture results.
What are some common causes of galactorrhea?
Medications
When is cytologic evaluation of milky nipple discharge recommended?
Not usually recommended.
What tests are ordered to rule out pregnancy
prolactinoma
List common causes of nipple discharge.
Pregnancy
What imaging is preferred for evaluating breast abnormalities in pediatrics?
Ultrasound.
What lifestyle changes may reduce breast cancer risk?
Regular exercise
How does breastfeeding affect breast cancer risk?
Breastfeeding for at least 1 year may slightly lower the risk.
What screening is recommended for women in their 20s and 30s?
Clinical breast exam every 1-3 years.
What screening is recommended for women over 40?
Annual clinical breast exam and mammogram.
What screening is recommended for young adults with BRCA mutations?
Clinical breast exam every 6 months
What screening is recommended for those with thoracic radiation between 10-30 years old?
Annual mammography and MRI with breast exams every 6-12 months starting 8-10 years after radiation or age 25.
What are neonatal and pediatric ovarian cysts usually caused by?
Maternal estrogen stimulation.
How are pathologic ovarian cysts treated?
Ultrasound-guided laparoscopic cystectomy
What is the most common complication of ovarian cysts?
Ovarian torsion.
What is the most common ovarian neoplasm in children and adolescents?
Mature cystic teratoma (dermoid cyst).
How is ovarian teratoma diagnosed?
Ultrasound.
What symptoms are associated with ovarian teratoma?
Abdominal mass or pain (torsion or rupture).
What is the preferred treatment for benign ovarian teratoma?
Detorsion (to preserve the ovary).
What are cystadenomas?
Benign ovarian tumors (serous
What is endometriosis?
Presence of ectopic endometrial tissue outside the uterus.
What symptoms are associated with endometriosis?
Severe dysmenorrhea
How are endometriomas treated?
Suppressive therapy (NSAIDs
What is tubo-ovarian abscess (TOA)?
Adnexal mass associated with PID.
What symptoms suggest PID with TOA?
Fever
How is tubo-ovarian abscess treated?
IV antibiotics and imaging-guided abscess drainage.
What is adnexal torsion?
Twisting of the ovary and/or fallopian tube.
What are symptoms of adnexal torsion?
Acute lower abdominal pain
How is adnexal torsion diagnosed?
Pelvic ultrasound with “whirlpool sign” or “beak sign”.
What is the treatment for adnexal torsion?
Prompt surgical intervention (laparoscopic detorsion).
What are benign causes of breast masses in pediatrics?
Fibroadenoma
What are malignant causes of breast masses in pediatrics?
Cystosarcoma phyllodes
What is the imaging modality of choice for breast masses in children?
Ultrasound.
What systemic conditions can cause amastia?
Poland syndrome.
What can juvenile hypothyroidism cause in relation to breast development?
Pubertal delay or premature breast development.
What is the mainstay of treatment for juvenile hypothyroidism?
Thyroid hormone replacement (levothyroxine).
What is the primary treatment goal for ovarian cystectomy in children?
Ovarian preservation to maintain fertility.
What causes neonatal ovarian cysts?
Maternal estrogen stimulation.
What screening is recommended for women with BRCA mutations?
Semiannual breast exams
What condition should be considered in a sexually active adolescent with adnexal mass and pain?
Pelvic inflammatory disease (PID).
What is the imaging modality of choice for diagnosing ovarian torsion?
Pelvic ultrasound.
What is the most common ovarian malignancy in children and adolescents?
Dysgerminoma
What percentage of dysgerminoma cases are bilateral?
10-20%
Which ovarian malignancy is most sensitive to chemotherapy and radiation?
Dysgerminoma
What genetic conditions are associated with dysgerminoma?
Gonadal dysgenesis and androgen insensitivity
What are the 3 main diagnostic criteria components for PCOS according to the Rotterdam criteria?
Oligoovulation or anovulation
How many follicles must be present in 1 ovary to meet the Rotterdam criteria for polycystic ovaries?
12 or more follicles
What is the minimum ovarian volume in PCOS according to the Rotterdam criteria?
> 10 mm³
What syndrome was originally described by Stein and Leventhal in 1935?
Stein-Leventhal Syndrome
What classic triad is associated with Stein-Leventhal Syndrome?
Amenorrhea
What metabolic abnormalities are commonly associated with PCOS?
Obesity
What is a key ovarian pathophysiologic defect in PCOS?
Impaired follicular response to FSH
Which hormone is oversecreted in PCOS?
Luteinizing hormone (LH)
What liver protein is decreased in PCOS contributing to androgen excess?
Sex hormone-binding globulin (SHBG)
What adrenal hormone is increased in PCOS?
Dehydroepiandrosterone sulfate (DHEAS)
Which enzyme converts testosterone to dihydrotestosterone (DHT)?
5α-reductase
What environmental and genetic factors contribute to PCOS pathogenesis?
Ovarian dysfunction
What endocrine axis is dysfunctional in PCOS?
Hypothalamic-pituitary-ovarian (HPO) axis
What two diagnostic criteria does the NIH use for PCOS?
Oligoovulation or anovulation AND clinical or biochemical hyperandrogenism
What diagnostic criteria does the Androgen Excess Society emphasize?
Clinical/biochemical hyperandrogenism and either polycystic ovaries or oligoovulation/anovulation
Which diagnostic criteria for PCOS is most commonly used worldwide?
Rotterdam criteria
What are the clinical hallmarks of PCOS?
Menstrual abnormalities and hyperandrogenism
What scoring system assesses hirsutism in PCOS?
Modified Ferriman-Gallwey Score
What Ferriman-Gallwey score is diagnostic for hirsutism in Filipino women?
7 or higher
What ultrasound finding is characteristic of PCOS?
String of pearls (rosary beads) appearance
What disorder must be excluded when diagnosing PCOS?
Thyroid disease
What thyroid lab test may be ordered when evaluating for PCOS?
TSH
What hormone level screens for non-classic congenital adrenal hyperplasia?
Serum 17-hydroxyprogesterone (17-OHP)
What makes diagnosing PCOS difficult in adolescents?
Rotterdam criteria change post-puberty and HPO axis immaturity
What criteria must be present for PCOS diagnosis 3 years post-menarche?
Menstrual irregularity
What is first-line therapy for adults with PCOS not desiring fertility?
Combined hormonal contraceptives (estrogen + progestin)
What medication is commonly prescribed for insulin resistance in PCOS?
Metformin
What medication class is often used adjunctively to reduce hirsutism in PCOS?
Antiandrogens
What type of diet has evidence for improving PCOS outcomes?
Low-fat
What percentage of weight loss can restore menses in PCOS?
5-10%
What type of diet is sometimes used but may be difficult to sustain long term in PCOS?
Ketogenic diet
What lifestyle intervention is key for managing overweight and obesity in PCOS?
Exercise
What inflammatory markers improve with weight loss in PCOS?
CRP and homocysteine
What hormone-binding protein increases with weight loss in PCOS?
SHBG
What should families of patients with PCOS be encouraged to do?
Adopt similar healthy diet and increased physical activity
What message from ‘The Ministry of Healing’ emphasizes the physician’s role?
The true physician is an educator; restorative power is in nature
What was the diagnosis in the 16-year-old patient with severe acne and irregular menses?
PCOS
What was the initial treatment for the 16-year-old patient with PCOS?
Low-dose combined contraceptive pills and lifestyle management
What was the outcome for the 16-year-old patient after 4 years?
Clear skin
