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GYNE CLERKSHIP > PEDIATRIC GYNECOLOGY > Flashcards

PEDIATRIC GYNECOLOGY Flashcards

1
Q

How long is the PREPUBERTAL VAGINA

A

4-6 cm

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2
Q

These are positions used in examining the pediatric patient for gynecologic anomalies

A

Frog leg position

Knee chest position

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3
Q

How would you instruct the mother and the pediatric patient to assume that the knee chest position

A

Dapa po si Camille tapos dapat po mas mataas po ang pwet so nakabend po yung knees. Maari niya pong rest ang ulo niya sa kamay niya.

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4
Q

Give the visualization techniques for inspecting the vestibule and hymen

A

Supine lateral spread method

Supine lateral traction method

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5
Q

VISUALIZATION TECHNIQUES FOR THE VAGINE

A

Otoscope - into the vaginal introitus with truncated earpiece removed,

Nasal Speculum - visualize vagina and cervix, preferrable done under anesthesia, though PAINFUL

VAGINOSCOPY - endoscope is used (5 mm smalles diameter) anesthesia used in the OR; least traumatizing to the hymen

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6
Q

If you would like to examine the internal pelvic organs in a child, which maneuver or examination would you do?

A

Recto Abdominal Examination

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7
Q

Indications of doing a rectoabdominal exam

A
  1. You are suspecting Vaginal foreign body
  2. Pelvicoabdominal mass or pain
  3. Abnormal pubertal development
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8
Q

Normal vaginal length of late childhood and adulthood

A

7-8.5 cm

8-12 cm

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9
Q

Most common gynecologic complaints in pediatric patients

A

Vaginal discharge

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10
Q

Info for vaginitis it is only the Volver that is usually inflamed together with a vagina. It is never the cervix and beyond that are inflamed. True or false

A

True

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11
Q

Why does a child with vulvovaginitis present with urinary problems

A

Technically it is not due to urinary tract in origin but the secondary when you’re in passes through an inflamed vulva

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12
Q

Why are prepubertal girls at risk?

Explain anatomic, physiologic and behavioral causes?

A

Hypoestrogenic (hormonal milieu)
Labia minora is think (barrier to introitus is weak)
Anus close to vaginal opening

Children’s tendency to poor hygiene
Explore bodies
Irritabts against vulva (🧼harsh soap, bubble baths)

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13
Q

Etiology of NON SPECIFIC VULVOVAGINITIS

A

no particular etiology; usually combination of normal microbiologic flora

There is alteration in the local microbiologic Florida or host defense and homeostatic Mechanisms secondary to poor perineal and fecal hygiene

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14
Q

What are the treatment options for non-specific vulvovaginitis

A
  1. 2 to 3 week regimen of hygienic measures and avoidance of any identified irritates
  2. MILD INFLAMMATION - SITZ BATH TO improve pruritis symptoms (ins: He was a basin of lukewarm water just enough to submerge the vulvar area for 15 to 20 minutes twice a day for 2 to 3 weeks)
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15
Q

If this church is still persistent recurrent despite the measures after non-specific for vaginitis what would you consider now?

A

Foreign body

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16
Q

What causative Asians are known to cause bacterial vulvovaginitis

A

Group a beta hemolytic streptococcus
Haemophilus influenza. Both are respiratory pathogen’s.

Shigella- blood tinged mucopurulent

17
Q

Viral causative agents for specific vulvovaginitis

A

HSV, HPV

HPV - maternal and child transmission occurs before 3 yo
Finger ng mom may warts tapos pepe ng bata may warts rin

18
Q

Why are candida infections rare in the non-estrogenenized prepubertal
girl

A

If lacking estrogen there would be no source of glycogen which is food for candida

Risk factors would include recent antibiotic use immunosuppression juvenile on site that diabetes

19
Q

What are parasitic causes of infective vulvovaginitis

A

Enterobius vermicularis or the pinworm

PATHOGNOMONIC: Severe nocturnal perineal and perianal pruritus is pathognomonic

20
Q

What is the diagnostics and treatment for Enterobius vermicularis

A

Scotch tape swab usually demonstrates the D shape ova

Mebendazole 30 mL oral suspension is given to >2 yo, 2 doses, 2 weeks apart

Albendazole <2 yo, 1 dose

DONT FORGET to TREAT HOUSEHOLD MEMBERS

CHANGE BED COVERS

21
Q

“absent vaginal opening”

Give DDX
If it is LABIAL FUSION. (Adhesive Vilvitis), what is the pathognomic sign?)

A

Impeforate hymen vs Transverse vaginal septum vs Vaginal agenesis vs Adhesive Vulvitis

(+) Translucent vertical midline “fusion line”

22
Q

What is pathognomonic for adhesive vulvitis

A

Translucent vertical midline “fusion kune”

Not treatment necessary unless there is already recurrent vulvovaginitis, pain/discomfort, bleeding, voiding problems

23
Q

Treatment for Adhesive Vulvitis

A

ESTROGEN CREAM applied 2x a day for 2-8 weeks

hygiene

Surgical treatment

24
Q

Common causes of VAGINAL BLEEDING give 5 discussed during lecture

A
  1. Vaginal Foreign Body
  2. Urethral Prolapse
  3. Straddle Injury. (Vulvar Trauma)
  4. Embryonal Rhabdomyosarcome (Sarcoma Botryoides)
  5. Endodermal Sinus Tumor - occurs before 2 yo
25
Q

Most common vaginal foreign body

A

Tissue

26
Q

Presents as recurrent foul smelling, blood tinged mucopurulent vaginal discharge

A

Vaginal foreign body

27
Q

If vaginal foreign body is lodged in the lower vaginal canal, what examination would be helpful

A

You can ”milk” the foreign body out with Rectoabdominal Examination

28
Q

For vaginal foreign body, if milking with rectoabdominal maneuver does not work, what can be done?

A

Direct visualization of the vaginal canal and FB extraction may be done under anesthesia

29
Q

In urethral prolapse, what prolapses beyond the meatus?

A

Mucosa from the distak urethral lumen

30
Q

When there is “vaginal mass” what would you think of other than foreign body?

A

Urethral prolapse

31
Q

History to elicit in urethral prolapse

A

Blood staining in undergarments

Dysuria, hematuria, urinary retension

32
Q

Observed during PE in urethral prolapse

A

Ring or bud of beefy friable red tissue arising from the urethra

Very inflamed urethral opening

33
Q

GIVE THE MANAGEMENT FOR URETHRAL PROLAPSE

A

Tub soaks or sitz bath
eliminate need for valsalva
TOPICAL ESTRogen - without estrogen, structures ar not rigid and urethral easier to prolapse

SURGICAL EXCISION under anethsia When conservative or medical therapy fails or when recurrent
Patient is post pubertal

34
Q

When you see this, you rule in the possibility of sexual abuse?

A

HYMENAL TRANSECTIONS between 4 to 8 oclock positions and injuries POSTERIOr to the humen

35
Q

On PE you see a prolapsing GRAPELIKE MULTICYSTIC MASS seen at the introitus. What is this?
This occurs usually prior to age ___

Give treatment

A

Sarcoma Botryoides

6 yo

Conservative surfery + chemotherapy (VINCRISTINE, ACTINOMYCIN, CYCLOPHOSPHAMIDE) + radiation

36
Q

On PE you see a prolapsing fleshy mass protruding from the vagina. What is it?
Histologic pattern : (+) characteristic Schiller Duval bodies, elevated AFP

What labs to request give treatment
Give treatment

A

ENDODERMAL SINUS TUMOR

Serum AFP dapat ELEVATED

Conservative surgery + Chemotherapy (Cisplatin, Bleomycin, Etoposide)

GYNE CLERKSHIP (14 decks)

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