Paed and adult gynae

Question 1

describe the Gillick competence

Answer 1

• Child <16 can give / withhold consent if doctor feels she fully understands what is involved in an intervention
• In certain situations – parents can override child’s wishes

Question 2

what is the Fraser competence referring to?

Answer 2

contraceptive advice to girls < 16 years

Question 3

describe the Fraser competence

Answer 3

• mature enough to understand advice and implications of treatment
• Girl likely to begin / continue sex with or without treatment
• Doctor tried to persuade patient to tell her parents
• Patients health would suffer without treatment
• patient’s best interest to be given treatment

Question 4

when do you investigate primary amenorrhoea?

Answer 4

• if absent secondary sex characteristics
  
  • 14 years
• if present secondary sex characteristics
  
  • 16 years old

Question 5

how do you induce puberty?

Answer 5

• gradual build up w oestrogen
• add progesterone once max height is reached

Question 6

how do you diagnose PCOS in adolescents?

Answer 6

USS/ TAS (trans abdominal sonography)

Question 7

what is the best treatment for PCOS in adolescents?

Answer 7

COC + weight loss

Question 8

management of menorrhagia in adolescents?

Answer 8

• COC
• POP
• mefenamic acid / tranexamic acid