Paediatric and Adult Gynaecology

Question 1

How is competency tested in children?

Answer 1

Gillick Competence test

Fraser guidelines

Question 2

What are the hormonal changes seen in puberty?

Answer 2

Increase in pulsatile LH secretion, due to increased GnRH secretion at night
Increased estradiol levels

Question 3

What physical changes are seen in puberty?

Answer 3

Tanner Stages

Breast size, pubic hair etc

Question 4

What changes are seen during the adolescent stage?

Answer 4

Hormonal changes
Behavioural changes
Independence
Peer acceptance
Decisions over future

Question 5

What is precocious puberty?

Answer 5

Appearance of secondary sexual characteristics before 8 in girls and 9 in boys

Question 6

What is delayed puberty?

Answer 6

No testicular descent in boys at 14

No breast budding by 13, periods not started by 15

Question 7

What is Vulvovaginitis?

Answer 7

Persistant vulval irritation/discharge

Peaks at 3 and 7 years

Question 8

How does Vulvovaginitis

Answer 8

Offensive discharge
Vaginal soreness
Itching
Red flush around vulva/anus

Question 9

What causes vulvovaginitis?

Answer 9

Poor perineal hygiene
Lack of estrogen
Chemical irritation (baths, detergents)

Question 10

How does Foreign body present?

Answer 10

Vaginal bleeding

Persistent foul smelling discharge

Question 11

When is the incidence of labial adhesions highest?

Answer 11

First year of life

Question 12

When is surgery indicated in labial adhesions?

Answer 12

Persistent urinary symptoms with failed estrogen therapy

Question 13

What are labial adhesions?

Answer 13

Thin membranous line where tissues fused, leading to a pinhole urethral opening

Question 14

What is Menorrhagia?

Answer 14

Overfrequent, heavy and irregular periods

Question 15

When are irregular periods normal?

Answer 15

First two years of periods in women

Question 16

What conditions should be excluded in women with severe menorrhagia?

Answer 16

von Willebrand disease

Immune thrombocytopenic purpura

Question 17

How is menorrhagia treated?

Answer 17

Combined oral contraceptive pill
Tranexamic acid
Mirena coil

Question 18

What is the cause of Dysmenorrhoea?

Answer 18

Higher levels of prostaglandins

Question 19

How is Dysmenorrhoea treated?

Answer 19

Anti-prostaglandin drugs (mefenamic acid)

Suppression of ovulation (combined pill)

Question 20

How is primary Amenorrhoea defined?

Answer 20

Failure to menstruate by 16 years in presence of normal secondary sexual characteristics (14 years in absence of other evidence of puberty)

Question 21

How is secondary amenorrhoea defined?

Answer 21

Absent periods for atleast 6 months in previously regular woman (12 months if oligomenorrhoeic woman)

Question 22

What should be investigated in amenorrhoeic women?

Answer 22

FSH
LH
PRL
TSH
Test + estrogen
Pelvic USS
Progesterone withdrawal bleed

Question 23

How is puberty induced in women?

Answer 23

Gradual build up with estrogen

Add progesterone once maximum height potential is reached

Question 24

What can cause secondary amenorrhoea?

Answer 24

Weight
PCOS
Pregnancy
Fluctuating LH/estrogens

Question 25

Why is PCOS hard to diagnose in adolescents?

Answer 25

Variable presentation similar to hypothalamic issues

Question 26

How is PCOS diagnosed?

Answer 26

FSH:LH USS Anovulation Hyperandrogenism

Question 27

How is PCOS managed?

Answer 27

Weight loss Lifestyle changes Oral contraceptive pill

Question 28

What is PCOS?

Answer 28

Ovarian dysfunction | Hyperandrogenism

Question 29

What else must be excluded in PCOS patients?

Answer 29

Other causes of Hyperandrogenism

Question 30

How should endometriosis be treated?

Answer 30

NSAIDs | Oral contraceptive pill

Question 31

What should be considered in girls with bleeding disorders?

Answer 31

``` Anovulation Sexual abuse/trauma Pregnancy Bleeding disorders (von willebrands, platelet defects) Leukaemia ```

Question 32

A ruptured ovarian cyst presents how?

Answer 32

Subacute Hx Tender to one side of pelvis May feel uterine mass

Question 33

What is the cause of a mucoid discharge in infants up to 2 weeks after birth?

Answer 33

Maternal estrogen

Question 34

What is the cause of a mucoid discharge prepubertal girls?

Answer 34

Increased estrogen production by maturing ovaries

Question 35

What can cause a pathological vaginal discharge?

Answer 35

E. coli, Proteus, Pseudomonas Hemolytic streptococcal vaginitis Monial vaginitis Foregin body

Question 36

How is vaginal discharge managed?

Answer 36

Find causative organisms (culture) Urinalysis (cystitis) Review hygiene Perianal examination (pinworms)

Question 37

How is persistent discharge managed?

Answer 37

Examination under anaesthesia to rule out foreign body

Question 38

What should be considered in adolescent transgender patients?

Answer 38

Sandyford clinics Support for individual Fertility preservation

Question 39

How is endometriosis diagnosed?

Answer 39

Laparoscopy