Paediatric and adult gynaecology

Question 1

What is Gillick competence?

Answer 1

Child under 16 can consent to treatment if they have demonstrated sufficient understanding and intelligence to fully understand what is involved in treatment including its purpose, nature, risks, chance of success and availability of other options

Question 2

What are Fraser guidelines for contraception in under 16 girls?

Answer 2

Doctor can give contraceptive advice and treatment given they are satisfied on the following matters -
The girl will understand his advice
He cannot persuade her to inform her parents
She is likely to continue having intercourse
Her physical and mental health are likely to suffer if she does not receive advice or treatment
Her best interest require advice or treatment without parental consent

Question 3

What is the first stage of puberty?

Answer 3

Pubic hair and development of breast

Question 4

What are changes that occur during adolescence?

Answer 4

Psychological/behavioural
Hormonal changes - sexuality
Independence
Peer acceptance
Decisions over future

Question 5

What are changes for parents when their children go through puberty?

Answer 5

Devolve decision making
Encourage independence
Age of the child when this happens varies in families

Question 6

What is extremely important at the start of gynae history?

Answer 6

Establishing a very strong rapport

Question 7

What is menarche?

Answer 7

The first menstrual period a girl has

Question 8

What questions should be asked in a paediatric gynae history?

Answer 8

Age of menarche
Cycle
If they have any pain
In absence of parents - Sexual activity, contraception
Weight gain/loss
Exercise
DONT FORGET SEXUAL ABUSE

Question 9

What is precocious puberty?

Answer 9

Secondary sexual characteristics before 8 years in girls or 9 years in boys

Question 10

What is delayed puberty?

Answer 10

Boys have no sign of testicular development by 14 years

Girls have not started to develop breasts by 13 years or they have but periods have not started by 15

Question 11

What is the peak incidence of labial adhesions?

Answer 11

First year of life

Question 12

What is menorrhagia?

Answer 12

Frequent heavy periods

Question 13

What is used to treat menorrhagia?

Answer 13

Combined oral contraceptive pill

Question 14

What is dysmenorrhoea?

Answer 14

Pain during menstruation

Question 15

What class of drugs are given for dysmenorrhoea?

Answer 15

Anti-prostaglandin drugs

Question 16

What is primary amenorrhoea?

Answer 16

The girl has never had a period

Question 17

What is secondary amenorrhoea?

Answer 17

Absence of periods for at least 6 months in a woman who has previously had regular bleeds

Question 18

What would be clinical features for a girl with complication of a cyst?

Answer 18

Subacute history
Cyst may have torted, turned gangrenous or ruptured
Usually tender to one side of pelvis or behind uterus
May feel a mass