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Reproductive > Paediatric and Adult Gynae > Flashcards

Paediatric and Adult Gynae Flashcards

1
Q

How does paediatric gynae differ?

A
  • Usually a family consultation
  • Sometimes just with father
  • Often anxieties about confidentiality
  • Consultation often directed at Parents
  • Sometimes separate consultations
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2
Q

What is Gillick competence?

A
  • Child <16 years can give/withhold consent if doctor feels she fully understands what is involved in an intervention
  • In certain situations, parents can override girls wishes
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3
Q

What is Fraser competence?

A

Covers contraceptive advice for girls under 16.

  • 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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4
Q

What needs to be features in a gynaecological history?

A

Gynae:

  • Age of menarche
  • Pain
  • Cycle

Sexual:

  • Sexual activity
  • Contraception

Weight gain/loss

Exercise

[sexual abuse]

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5
Q

What is involved with this examination?

A

General

  • Intimite examination is never done on first vist…
  • Must build rapport first

Breast examination

Gynae examination

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6
Q

What are the stages used to assess developement?

A

Tanner staging

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7
Q

What is amenorrhea?

What is primary and secondary amenorrhea?

A

The absense of menstruation.

Primary: fault in the cycle

Secondary: fault elsewhere

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8
Q

What are the causes of secondary amenorrhea?

A
  • Weight changes
  • PCOS
  • Pregnancy
  • Fluctuating LH/oestrogens
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9
Q

What are the features of PCOS?

A
  • Present in 1-5 girls
  • Rotterdam criteria
  • Be careful with diagnosis - can’t be diagnosed until a few years after puberty
  • Large spectrum
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10
Q

When do we need to investigate?

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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11
Q

What investigations are needed prior to referall?

A
  • Is there an outflow tract obstruction?
    • Imperforated hymen/septum
    • Present with cyclical abdominal pain and a big mass in the uterus (blood)
    • Bleed is occurring – it is just not coming out
    • They will have normal secondary sexual characteristics
  • Progesterone withdrawal bleed
    • If you don’t get blood on this challenge this means there is not enough oestrogen in the body
      • Not enough oestrogen due to ovary pathology/pregnancy
  • Full hormone profile
  • FSH, LH, PRL, TSH, testosterone and oestrogen
  • Pelvic USG
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12
Q

When do we induce puberty?

A
  • When girls present at the age of 16/18 and have no secondary sexual characteristics
  • Must induce puberty
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13
Q

How can we induce puberty?

A
  • Gradual build up with oestrogen
  • Effect on breast development
  • Add progesterone
    • Once maximum height potential is reached
    • At least 20mg of oestrogen dose
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14
Q

What are the main bleeding disorders in paeds gynae?

A
  • Anovulation – majority (normal for up to 2-4 years post-menarche)
  • Be aware of other factors if they have irregular bleeding e.g. sexual abuse, bullying, trauma etc.
  • Remember could be pregnancy complications
  • Bleeding disorders – up to 10-20% of cases
    • If history sounds like it, ask for clotting profile and clotting factors
    • E.g. Von Willebrands, platelet defects
    • Very very rarely = leukaemia
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15
Q

What is the treatment of menorrhagia? For how long?

A
  • Firstly, reassure
  • Talk to girl directly
  • Progesterone only pill - works for most girls
  • Tranexamic acid 1g
  • Mefenamic acid
  • Combined OCP
  • Mirina: only use in those who have other medical conditions eg wheelchair bound and cannot deal with periods

Length of treatment: usually for months or years (not lifelong)

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16
Q

What is PCOS?

A

Polycystic ovary syndrome

  • Syndrome of ovarian dysfunction along with cardinal features hyperandrogenism and polycystic ovary morphology
  • No single diagnostic criterion is sufficient
17
Q

What is needed to make a diagnosis of PCOS?

A

Made on 2 or 3 of the following:

  • Anovulation
  • CLinical/biochem signs of hyperandrogenism
  • Polycystic ovaries on ultrasound or direct investigation
  • Need to exclude other causes of hyperandrogenism
18
Q

What are the most common vaginal cysts?

Where are they found?

What can happen to them?

A
  • Small cysts are often functional or dermoids
  • Gravity allows them to drop to lowest point in the pelvis
  • Can then tort, turn gangrenous
19
Q

What is a common history for cysts?

A

Subacute history

Usually tender to one side of pelvis or behind

Uterus and may feel a mass

20
Q

What is vulvovaginitis? What ages are usually effected by vulvovaginitis? Causes?

A
  • Inflammation or infection of the vulva and vagina
  • 2 -7 years old
  • Rule out any trauma/sexual abuse/foreign body
  • Rule out urinary incontinence
21
Q

Treatment of vulvovaganitis?

A
  • Toilet training if urinary incontinent
22
Q

What are labial adhesions (agglutinations)?

A

Fusion of the labia minora in the midline, usually asymptomatic and treated typically conservatively

23
Q

How do we manage labial adhesions?

A
  • As long as the girl can pee then it is fine
  • No point trying to seperate it, as soon as the oestrogen levels rise it will sort it out itself
  • If you carry out surgery you are killing eggs (apparently)
  • If assymptomatic improved hygeine may be all that’s needed
  • Treatment is indicated if there is a chronic vulvovaginitis or difficulty urinating
  • Lubrication of the labia with a bland ointment
  • Topical oestrogen
  • Surgical separation is rarely necessary
24
Q

What vaginal discharges are common in paeds?

A
  • Mucoid discharge is common in infants for up to 2 weeks after birth – results from maternal oestrogen
  • Common finding in prepubertal girls who experience increased oestrogen production by maturing ovaries
25
Q

What are some pathological causes of discharge?

A
  • Infections with organisms
  • Haemolytic streptococcal vaginitis
  • Monial vaginitis
  • A foreign body
26
Q

What is the management of vaginal discharge?

A
  • Conservative
    • Culture to identify causative organsims such as E. coli, proteus, pseudomonas
    • Urinalysis to rule out cystitis
    • Review proper hygiene
      • Avoid nasty soaps
      • Ensure correct underwear etc.
    • Perianal examination with transparent tape to test for pinworms
    • In cases of persistent discharge – examination under anaesthesia to rule out foreign body
27
Q

At what age do we consider labial reduction?

A
  • No intervention until the age of 18 years old
    • Intervention only done if there is actually a problem from the labia
    • Intervention done by plastics

Reproductive (34 decks)

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