Pedia Gynecology, Precocious Puberty

Question 1

Most common position for gynecologic exam

Answer 1

Frog leg

Question 2

Position for gynecologic exam of older children Also used for children with foreign body or discharge

Answer 2

Knee chest

Question 3

Most common shape of hymen

Answer 3

Crescent

Question 4

Most common gynecologic problem in prepubertal females

Answer 4

Vulvovaginitis

Question 5

Most common cause of vulvovaginitis

Answer 5

Poor perineal hygiene

Question 6

Pathognomonic sign of labial adhesion

Answer 6

Midline vertical line

Question 7

Treatment for labial adhesion

Answer 7

Topical estrogen cream

Question 8

Most common symptom of urethral prolapse

Answer 8

Prepubertal bleeding

Question 9

Treatment for urethral prolapse

Answer 9

Topical estrogen cream

Question 10

Thinning of vulvar epithelium with loss of rete pegs common in prepubertal and postmenopausal women

Answer 10

Lichen sclerosus

Question 11

Treatment for lichen sclerosus

Answer 11

Avoid trauma or irritants Topical steroids Sitz bath

Question 12

Majority of foreign body cases are within the ages of

Answer 12

3 and 9 years old

Question 13

Classic symptom of foreign body in the vagina

Answer 13

Foul smelling bloody discharge

Question 14

Treatment for vulvar lacerations

Answer 14

Bed rest for 24 hours Ice pack Analgesics

Question 15

Treatment for vulvar hematoma if less than 4cm non expanding

Answer 15

Bed rest Compress Analgesic

Question 16

Treatment for vulvar hematoma if more than 4cm and expanding

Answer 16

Evacuate clot

Question 17

High index of suspicion for sexual abuse if the child presents with

Answer 17

Posterior fourchette injury Hymenal laceration Transections from 3 and 9 o clock position

Question 18

Most common type of ovarian cysts

Answer 18

Functional cysts

Question 19

Surgical intervention done if the patient has torsion of the ovarian cyst to preserve fertility

Answer 19

Cystectomy

Question 20

Most common benign ovarian tumor

Answer 20

Teratoma

Question 21

Most common malignant germ cell tumor of the ovary

Answer 21

dysgerminoma, endodermal sinus tumor & immature teratoma

Question 22

Goal of treatment in precocious puberty

Answer 22

Induce pseudomenopause

Question 23

LH levels of ____ is diagnostic of precocious puberty

Answer 23

LH >5 mIU/ml

Question 24

Most common cause of precocious puberty

Answer 24

Idiopathic

Question 25

Most common ovarian tumor that can cause precocious puberty

Answer 25

Granulosa cell tumor

Question 26

This syndrome causes precocious puberty due to mutation in G3 protein activating adenylate cyclase that leads to constant secretion of FSH, LH, TSH and GH

Answer 26

McCune Albright syndrome

Question 27

First symptom of McCune Albright syndrome

Answer 27

Vaginal bleeding

Question 28

Triad of McCune Albright

Answer 28

3 Ps- pigment, polyostotic, pockets Cafe au lait spots Polyostotic fibrous dysplasia Cysts of skull and long bones

Question 29

This test differentiates incomplete from true precocious puberty

Answer 29

GnRH agonist stimulation test

Question 30

Indications for medical treatment of precocious puberty is when menarche happens before _____ or bone age is more than _____ of chronological age

Answer 30

Menarche \<8 years old Bone age \>2 years of chronological age

Question 31

GnRH dependent drug of choice in precocious puberty

Answer 31

Leuprolide

Question 32

Excessive terminal hair growth is dependent on what hormones

Answer 32

Androgens

Question 33

In females, testosterone is secreted by what organ?

Answer 33

Ovaries

Question 34

In females, adrenal gland secretes this hormone

Answer 34

DHEAS

Question 35

This disease occurs when you have bilaterally enlarged ovaries (5-7cm) with gradual onset Theca cells produce testosterone and virilization happens around 4th decade of life

Answer 35

Stromal hyperthecosis

Question 36

Drug of choice for hirsutism

Answer 36

Spironolactone