Paediatric gynae

Question 1

What is Gillick competence?

Answer 1

A child under 16 years old can give/withhold consent if the doctor feels that she fully understands what is involved in an intervention.

Question 2

When Fraser competence relevant, and what criteria must be filled?

Answer 2

When giving contraceptive advice to a girl under 16 years old, she must be:

• mature enough to understand the advice and the implications of treatment
• likely to begin/continue to have sex regardless of treatment
• the doctor must have tried to persuade her to inform her parents (or allow the doctor to inform them)
• her health would suffer without treatment/advice
• it must be in the girl’s best interest to give treatment/advice

Question 3

What parts of a gynae history are relevant to young girls?

Answer 3

Age of menarche, cycle, pain
Development
 - Tanner stages to estimate development
 - ask about bra size
Sexual activity, contraception
Weight changes, exercise

Question 4

Give three reasons for delayed puberty in girls

Answer 4

Constitutional delay; normal but delayed
Hypogonadotrophic hypogonadism; defect of GnRH secretion
Primary ovarian failure; usually associated with chromosomal abnormalities (e.g. Turner syndrome)

Question 5

What are the characteristic features of Kallmann syndrome?

Answer 5

A cause of hypogonadotropic hypogonadism.

Anosmia + hypogonadism

Question 6

What is precocious puberty? Give two subtypes

Answer 6

Early onset puberty; appearance of signs of sexual maturation before age 8 (girls)

• gonadotropic-dependent precocious puberty (GDPP)
• gonadotropic-independent precocious puberty (GIPP)