Pediatric Gynecology

Question 1

The GnRH neurons develop in the olfactory placode in utero. They migrate through the forebrain to the actuate nucleus of the hypothalamus by how many weeks of gestation?

Answer 1

11 weeks

William’s Gyn p.318

Question 2

When is the peak number of oocytes (6-7 million) in females and what number of oocytes are they born with?

Answer 2

At 5 months gestation
They are born with 1-2 million oocytes

By puberty, 300 000 to 500 000 oocytes remain

William’s Gyn p.318

Question 3

What explains the symptoms of neonatal budding, minor bleeding from endometrial shedding, short-lived ovarian cysts and transient white vaginal mucous discharge in neonates?

Answer 3

The sudden drop in estrogen levels in neonates, leading to a significant rise in FSH and LH.

William’s Gyn p. 318

Question 4

Name in order the signs of puberty in a young women.

Answer 4

Adrenarche
Thelarche - breast budding (Normal btw 8-13)
Pubarche - public hair growth
Growth spurt
Menarche - period begins

William’s Gyn p.320

Question 5

What are 3 options for the treatment of labial agglutination?

Answer 5

1. Estradiol cream/Premarin cream applied to raphe twice daily for 2 weeks, then daily for another 2 weeks
2. Betamethasone 0.05% cream twice daily for 4-6 weeks
3. Physical separation (either in clinic with lidocaine ointment or in OR)

William’s Gyn p.322

Question 6

Lichen sclerosis is often associated with which autoimmune conditions?

Answer 6

Graves thyroiditis
Vitiligo
Pernicious anemia

William’s Gyn p.323

Question 7

If a patient complains of severe nocturnal pruritus, what is the most likely diagnosis?

Answer 7

Pinworms
Diagnosis with scotch tape test
Treat with Albendazole 200-400mg PO x 1

William’s gyn p324

Question 8

What is the most common infectious agent found in prepubertal females with vulvovaginitis?

Answer 8

Group A beta-hemolytic Streptococcus
Found in 7-20% of girls with vulvovaginitis

Treat with Amoxicillin 40mg/kg PO TID x 10 days

William’s Gyn p.324

Question 9

What is the most common culture result for prepubertal females with vulvovaginitis?

Answer 9

“Non-specific” and normal flora

William’s Gyn p.324

Question 10

What is the most common cause of bloody vaginal discharge in a prepubertal female?

Answer 10

Shigella
Often followed or concomitant diarrhea

William’s Gyn p.324

Question 11

What is the most common complex cyst found in childhood and adolescence?

Answer 11

Germ cell tumors, more specifically benign mature cystic teratoma

William’s Gyn p.325

Question 12

What is the most common cause of central precocious puberty?

Answer 12

Idiopathic

Need to rule out CNS tumors/anomalies/infections/head trauna/ischemia/iatrogenic (radiation, chemo, surgery)

William’s Gyn p.328

Question 13

What is the most common cause of peripheral precocious puberty?

Answer 13

Granulosa cell tumor (60% of cases)

William’s Gyn p.328

Question 14

What are 3 characteristics “triad” of the McCune-Albright syndrome?

Answer 14

1. Polyostotic fibrous dysplasia
2. Irregular cafe-au-lait spots
3. Endocrinopathies

**precocious puberty often associated from the estrogen production of the ovarian cysts that are often found in these girls

William’s Gyn p.328

Question 15

What are the definitions for

1. Precocious puberty
2. Delayed puberty?

Answer 15

1. Growth of pubic hair before age 8
2. No secondary sexual characteristics by age 13 OR no menses by age 16

William’s Gyn p.329

Question 16

What is the most common cause of delayed puberty?

Answer 16

Constitutional delay

William’s Gyn p.329

Question 17

What is the age of sexual consent in Canada?

Answer 17

16 years old

12-13 years old: up to 2 years difference
14-15 years old: up to 5 years difference

SOGC 327

Question 18

What are the 2 most common cause of emergency cesarean section in the adolescent population?

Answer 18

Non-reassuring fetal tracing and labor dystocia

SOGC 327

Question 19

What is the rate of chlamydia at the first prenatal visit in adolescent pregnancies? And what is the rate of recurrence after treatment?

Answer 19

11.8-31% at initial presentation
Recurrence rate if 11%

SOGC 327

Question 20

What is the rate of repeat adolescent pregnancies (pregnant again within 2 years of delivery)?

Answer 20

25% become pregnant again within 2 years
But 1/3 of those were wanted/planned pregnancies

SOGC 327