Paediatric and Adult Gynaecology Flashcards

1
Q

Definition of the Gillick Competence

A

Child < 16 years can give/withhold consent if the doctor feels that they are fully understanding of what is involved in an intervention

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2
Q

Definition of Fraser Competence

A

A doctor can prescribe contraception/give contraceptive advise to a girl <16 y/o if

  • mature enough to understand advise and the implications of treatment
  • girl likely to begin or continue to have sex with or without treatment
  • doctor try to get her to inform parents or allow him to inform them
  • girls health would summer without treatment/advise
  • in the girls best interests to give treatment/advise
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3
Q

When to investigate primary amenorrhoea

A

Normal secondary sexual characteristics - investigate at age 16

Absent secondary sexual characteristics - investigate at age 14

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4
Q

Investigations prior to referral for amenorrhoea

A

FSH, LF, PRL, TSH, testosterone, oestrogen
Pelvic USG
Progesterone withdrawal bleed (pregnancy, not enough oestrogen)
Cyclical abdominal pain

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5
Q

Puberty induction treatment

A

Gradual build up of oestrogen (until stopped growing so breast shape is not altered)
Then add progesterone once the max height potential is reached

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6
Q

Secondary amenorrhoea definition

A

Had periods before and now they have stopped

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7
Q

Causes of secondary amenorrhoea

A

Weight gain (obstructed uterus)
PCOS
Pregnancy
Fluctuating LH/oestrogens

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8
Q

Menorrhagia definition

A

Heavy periods

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9
Q

Possible treatments of menorrhagia

A
POP
Tranexamic acid 
Medenamic acid 
COC
Mirena (usually when cant take pills)
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10
Q

Length of treatment in a patient for menorrhagia

A

A year or so then come off it as it will have settled down

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11
Q

Presentation of accidents to cysts

A

Subacute history
Usually tender to one side of the pelvis or behind
Uterus may feel a mass

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12
Q

Vulvovaginitis causes

A

Foreign body (e.g. toys)
Playing with genitals
Sexual abuse
Urinary incontinence

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13
Q

Age that you would get vulvovaginitis

A

2-7 years old

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14
Q

Labial agglutination definition

A

Adhesion of labia minora in midline (usually)

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15
Q

Presentation of labial agglutination

A

Vulvovaginitis
Retention of urine
Retention of vaginal secretions
UTI

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16
Q

Treatment of labial agglutination

A

Improve hygiene may all be thats needed
treatment indicated if chronic vulvovaginitis or difficulty urinating
lubrication of labia with a bland ointment
topical oestrogen
surgical separation (rarely necessary)

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17
Q

Vaginal discharge is common in

A

Infants up to 2 weeks after birth resulting from maternal oestrogen
Prepubertal girls who experience increasing oestrogen produced by maturing ovaries

18
Q

Episiotomy definition

A

Surgically planned incision on the perineum and posterior vaginal wall during the second stage of labour

19
Q

Purposes of episiotomy

A

Help normal vaginal birth

Help prevent tears towards the back passage

20
Q

Angles of episiotomy

A

Midline towards anus

Mediolateral

21
Q

Caesarean section definition

A

Delivery of the foetus through an incision in the abdominal and uterine walls

22
Q

Reasons for a hysterectomy

A

Fibroids
Malignancy
Heavy bleeding
Endometriosis

23
Q

The 3 approaches to hysterectomy

A

Open laparotomy
Laparoscopy
Transvaginal

24
Q

Endometritis vs Endometriosis

A
Endometritis = inflammation of endometrium 
Endometriosis = a medical condition
25
Q

Most common causes for Pelvic inflammatory Disease

A

Chlamydia
Gonorrhoea
Mycoplasma Genitalium

26
Q

Risk factors for pelvic inflammatory disease

A
If have more than 1 sexual partner 
Have a new sexual partner 
Have a history of STIs
Have had PID in the past 
under 25 y/o
Started having sex at a young age
27
Q

Definition of vulvovaginitis

A

Inflammation of the vulva and the vagina

28
Q

Presentation of PID

A
Pelvic pain 
Fever
Deep dyspareunia 
Vaginal discharge 
Dysuria 
Menstrual irregularities 
Cervical excitation on examination
29
Q

Presentation of ovarian torsion

A

Sudden onset lower unilateral abdominal pain
Nausea and vomiting
On examination
- unilateral, tender adnexal mass

30
Q

What may the onset of ovarian torsion coincide with?

A

Exercise

31
Q

Presentation of an ovarian cyst

A
Intermittent pain 
Iliac fossa pain 
Pain worse during intercourse 
Urinary frequency 
Feeling bloated
32
Q

Causes of vaginal discharge

A
Common 
- physiological 
- candida
- trichmonas vaginalis 
- bacterial vaginosis 
Less common 
- gonnorhoea 
- chlamydia
- ectropion 
- foreign body 
- cervical cancer
33
Q

Key features of candida

A

Cottage cheese discharge
Vulvitis
Itch
Associated with pain during sex

34
Q

Key features of trichomoniasis vaginalis

A

Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry cervix

35
Q

Key features of bacterial vaginosis

A

Offensive, thin white/grey “fishy discharge”

36
Q

How many women with bartholins abscess are pyrexial?

A

1 in 5

37
Q

Presentation of bartholins abscess

A
Worsening perineal pain 
Severe pain 
May have fever
Mass 
Erythmatous skin overlying mass
38
Q

Treatment of bartholins abscess

A

Marsupialisation procedure

39
Q

What are bartholins glands?

A

Pair of glands located at entrance to the vagina

40
Q

How does the uterus feel, fibroids vs adenomyosis?

A

Fibroids - bulky uterus

Adenomyosis - boggy uterus with subendometrial linear striations