Pediatric gynecology Flashcards
How is a pediatric external exam performed?
Frog Leg, knee to chest or crossed legs in males
Do we EVER do a speculum exam on a child?
NO– It is traumatic
Most common pediatric GU problems inlcude?
UTI, vulvovaginitis, labial adhesions, anatomical differences in hymen, sexual abuse, amenorrhea, dysfunctional uterine bleeding
How does vulvovaginitis present in children?
With dysuria, vulvovaginal pain or pruritis or both, and there could be erythema or even discharge
Name 7 DDX for vulvovaginitis:
- contact irritant
- candida
- bacterial
- UTI
- Foreign body
- Sex abuse/ STI
- Infections agents (pinworms, GAS, Shigella)
Symptom ANALYSIS of vulvovaginitis can include (6 things)?
dysuria, hematuria, abdominal pain, flank pain, fever, V/V
When assessing vulvovagintis what questions do you ask about the night?
Enuresis, new or chronic
Pediatric vaginal discharge questions?
How much, what color, odor?
History for vulvovaginitis?
Have they ever had eczema or atophy?
Are there concerns about?
Inappropriate physical contact
A physical exam for pediatirc vulvovaginitis inlcudes?
Oropharyngeal exam (strep vagintis, sex abuse) Abdominla exam, CVA tenderness External GU exam
How do you collect discharge samples from pediatrics during vaginal exam?
With q-tip for wet mount on outside only
What diagnostic testing options do you have?
UA, C&S, tape test for pin worms, wet mount/ KOH
Do we do STI screen on peds?
Very carefully, can be a legal issue
Vulvovaginituis treatment includes?
-Avoid irritants
-Wash well with warm water
-Low potency corticosteroid/ antifungal combo less than one week
Baking soda sitz bath
Cotton underpants
ABX if indicated with culture
What testing and treatment for a male sexually active 17-year-old male that reports burning with urination, mild erythema at urethral meatus and non-tender inguinal lymphadenopathy?
UA (for C, G, syphilis, HIV), empirical treatment for gonorrhea and chlamydia BECAUSE he is symptomatic
What is the empirical treatment for gonorrhea and chlamydia that you will give this kid?
Ceftriaxone and azithromycin
Amenorrhea– 15 years old, several months, sexually active, protuberant abdomen, uterine fundus 2 cm above abdomen?
Pregnancy 23 weeks confirmed with ultrasound
What is the most appropriate action for 15 years old, 23-week pregnant teen??
Prenatal care and testing Disclosure to parents Cessation of ETOH, tobacco, drugs, herbal supplements Healthy diet Prenatal vitamins
What considerations should the NP have when 23- week 15-year-old Ginny returns to primary care?
While pregnant she is emancipated but after pregnancy, she goes back to parents
BIRTH CONTROL
Emotional and physical postpartum assessments
12-year-old sexually active good grades, very active in sports, want Mom to not know, would like birth control? Tells you she can’t remember to take meds, does not want to put anything in her vagina, what are the options? What is best for her?
Birth control, emergency contraceptives, OCP’s combined or progestin only pills, the patch, nuva ring, depot provera, nexplanon or IUD.
She needs Depot, implant or IUD because she cannot remember to take pills.
With teen pelvic/ genitalia exam- who should be in the room?
Whomever they choose
With abdominal exam in the GU focussed appointment, what are you looking for?
CVA tenderness Masses Bruits Distended bladder Edema ascites of abdomen
What findings would concern you of more significant illness?
Tufts of hair, dimpling, abnormal skin openings
What things increase risk for vulvovaginitis?
Bubble baths, friction, creams, lotions, tight clothing
What are the 5 most common STI’s effecting adloscents girls?
Gonorrhea Chlamydia Syphillis HSV HPV
Gonorrhea dx, tx:
NAAT, or culture
Ceftriaxone 250 mg IM 1 x
AND azithromycin 1 gm PO 1x
Report to the health department
Chlamydia dx, tx:
NAAT and or culture
Azithromycin 1 gm PO 1 x or doxycycline 100 mg PO bid 7 days
Report to the health department
Syphilis dx, tx:
VDRL (venereal disease research lab), AND RPR (rapid plasma reagin)
Benzathine Penicillin G 2.4 million units IM 1x
Report to health department
Syphilis treatment if allergic to penicillin not pregnant?
doxycycline 100 mg PO BID 14 days
or
tetracycline 500 mg PO QID for 14 days
Syphilis special note:
Test for Gonorrhea, chlamydia and HIV at time of infection and 3 mos later
How often do you follow syphilis titers?
RPR, VDRL 6 mos, 12 mos and 24 mos
HPV dx, tx:
Don’t test teens for HPV
HSV dx, tx:
a culture of a scraped vesicle, serologic testing not recommended if no symptoms.
primary Acyclovir 400 mg TID for 7-10 days
Not reportable
What are reportable to the state health department:
Syphilis, gonorrhea, and chlamydia
HSV comfort measures:
Sitz bath, dry heat, lidocaine jelly 2%
