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reproductive system 2 > Paediatric and Adolescent Gynaecology > Flashcards

Paediatric and Adolescent Gynaecology Flashcards

1
Q

How is adolescent gynaecology different?

A
  • Usually a family consultation
  • Can be 3 generations present
  • Sometimes just with father
  • Ethnic minorities- child may speak English but parents do not
  • Often anxieties about confidentiality
  • Consultation often directed at Parents
  • Sometimes separate consultations
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2
Q

What types of changes do adolescents do through?

A
  • Psychological changes
  • Developing sexuality and individuality
  • Independence from parents
  • Peer acceptance
  • Making decisions about their futures
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3
Q

What changes do parents go through as their children grow up?

A
  • Devolve decision making
  • Encourage independence
  • Age of child at which this happens varies with families
  • May not be consistent
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4
Q

What is Gillick competence?

A
  • Child <16 years can give/withhold consent if doctor feels they fully understands what is involved in an intervention
  • Can sometimes be overridden by parents
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5
Q

What does Fraser competence refer to?

A

Contraceptive advice to under 16 year old girls

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6
Q

What are the components of Fraser competence?

A
  • Mature enough to understand advice and implications of treatment
  • Girl likely to begin or continue to have sex with or without treatment
  • Doctor tried to persuade girl to inform her parents or to allow her/him to inform them
  • Girl’s health would suffer without treatment/advice
  • In girl’s best interests to give treatment or advice
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7
Q

What is important to gather in a gynaecological history?

A

DEVELOP RAPPORT FIRST

  • Age of menarche
  • Cycle
  • Pain
  • Sexual activity
  • Contraception
  • Weight gain/loss
  • Exercise

Beware of sexual abuse

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8
Q

What is included in examination?

A

NEVER ON FIRST VISIT

  • General
  • Gynaecological
  • Breast
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9
Q

How can girls stage themselves (puberty)?

A

Using a Tanner staing system

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10
Q

What is amenorrhoea?

A

Absence of menstrual period

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11
Q

What are the 2 forms of primary amenorrhoea?

A

Primary amenorrhoea and normal secondary sexual characteristics
-Investigate at age 16

Primary amenorrhoea and absent secondary sexual characteristics
-Investigate at age 14

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12
Q

What investigations should be carried out for amenorrhoea prior to referral?

A
  • FSH, LH, PRL, TSH, testosterone, oestrogen

- Pelvic USG

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13
Q

What are the causes of a progesterone withdrawal bleed?

A
  • Pregnancy

- Not enough oestrogen

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14
Q

How can puberty be induced?

A
  • Gradual build up of oestrogen (high dose will cause misshapen breasts)
  • Breast will start to develop
  • Add progesterone once maximum height is reached and at at least 20mg of oestrogen dose
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15
Q

What are some causes for secondary amenorrhoea?

A
  • Weight
  • PCOS
  • Pregnancy
  • Fluctuating LH/ oestrogens
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16
Q

What is PCOS?

A

A syndrome of ovarian dysfunction along with the cardinal features: hyperandrogenism and polycystic ovary morphology

17
Q

What can the diagnosis of PCOS be made of the basis of?

A

2 out of 3

  • Oligo or anovulation
  • Clinical or biochemical signs of hyperandrogenism
  • Polycistic ovaries o US or direct inspection
18
Q

How can PCO in adolescents be treated?

A
  • Weight reduction and lifestyle changes

- OCP

19
Q

How are polycystic ovaries diagnosed?

A
  • FSH:LH

- TAS USS

20
Q

For how long is anovulation normal?

A

Normal for 2-4 years after post-menarche

21
Q

What bleeding disorders may impact menstruation?

A

Up to 10-20%

  • Von willebrand
  • Platelet defects
  • Leukaemia
22
Q

What is the treatment for menorrhagia?

A
  • Reassure
  • Talk to the girls directly
  • Progesterone only pill
  • Tranexamic Acid 1g qds
  • Mefenamic Acid
  • Combined Oral Contraceptive
  • Mirena
  • Treatment can be for months to years.Stop and see!
  • App
23
Q

What are small ovarian cysts usually?

A

Functional or dermoids

24
Q

How can ovarian cysts get injured?

A
  • Gravity allows them to drop to lowest point in the pelvis
  • Can then tort, turn gangrenous or rupture
  • Often subacute history
  • Usually tender to one side of pelvis or behind uterus and may feel a mass
25
Q

Who is vulvagintis common in?

A

Aged 2-7

26
Q

What are the causes o vulvovagintis?

A
  • Wetting pants
  • Other irritants
  • Sexual abuse
27
Q

What does treatment of vulvovagnitis include?

A

Toilet training

28
Q

How does labial agglutination present?

A
  • Adhesion of the labia minora in the midline is the usual presentation.
  • This vertical line of fusion distinguishes labial agglutination from imperforated hymen or vaginal atresia.
  • The agglutination encourages retention of urine and vaginal secretions and can lead to vulvovaginitis or urinary tract infection.
29
Q

How is labial agglutination managed?

A
  • If a symptomatic, improved hygiene may be all that is necessary.
  • Treatment is indicated if there is a chronic vulvovaginitis or difficulty urinating.
  • Lubrication of the labia with a bland ointment.
  • Topical estrogen.
  • Surgical separation is rarely necessary.
30
Q

What may unusual vaginal discharge be the result of?

A

Infection

31
Q

When is a mucoid discharge common in infants/children?

A
  • Common in infants for up 2 weeks after birth; it result from maternal oestrogen.
  • Common finding in prepubertal girls, who experience increased oestrogen production by maturing ovaries.
32
Q

What may pathological discharge be due to?

A
  • Infections with organisms, such as E.coli, Proteus, Pseudomonas.
  • Hemolytic streptococcal vaginitis.
  • Monial vaginitis.
  • A foreign body.
33
Q

How is pathological discharge managed?

A
  • Culture to identify causative organisms.
  • Urinanalysis to rule out cystitis.
  • Review proper hygiene.
  • Perianal examination with transparent tape to test for pinworms.
  • In cases of persistent discharge, examination under anesthesia is indicated to rule out foreign body
34
Q

Who is labial reduction not performed in?

A

Under 18s

reproductive system 2 (35 decks)

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