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MCQ > Adolescent and paeds > Flashcards

Adolescent and paeds Flashcards

1
Q

Commonest cause of precocious puberty in girls is :

a) CAH
b) Ovarian
c) Adrenals
d) Tumours
e) Idiopathic

A

e) Idiopathic

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2
Q

17 year old sexually active on COCP 12 months with no problem now complains of vaginal spotting, BHCG negative. What next?

a) add 1.25 mg conjugated oestrogen to pill
b) change to higher dose oestrogen pill
c) change to higher dose progesterone pill
d) swab for genital tract infection

A

d) swab for genital tract infection

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3
Q
  1. A woman had an amniocentesis to exclude Downs syndrome and was found to have a normal 46 XY fetus. When the child was delivered it had normal female external genitalia. What is the most likely explanation?

a) lab error
b) mullerian agenesis (MRHS)
c) androgen insensitivity

A

c) androgen insensitivity

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4
Q
  1. Regarding transverse vaginal septum choose the correct option.

a) occurs at the junction of lower 2/3 and upper 1/3 of vagina
b) occurs commonly with abnormalities of upper Mullerian system
c) associated with inutero DES exposure
d) autosomal recessive inheritance
e) treated with Tompkin’s procedure

A

c) associated with inutero DES exposure

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5
Q
  1. An 18 yr old girl presents with primary amenorrhoea, no breast development and scant pubic hair. Examination shows normal vagina and vulva with a hypoplastic cervix and uterus. The karyotpye is 46 XY. The most likely diagnosis is:

a) pure gondal dysgenesis -
b) androgen insensitivity -
c) Noonan’s syndrome
d) CAH

A

a) pure gondal dysgenesis -

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6
Q
  1. You are performing a laparotomy for a ruptured right ectopic pregnancy in a 17 yo. A 10cm right ovarian cyst is noted. Left ovary appears normal. Optimal management is:

a) RSO
b) Aspiration of cyst
c) Cystectomy
d) Cystectomy and biopsy of other ovary
e) R oopherectomy

A

c) Cystectomy

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7
Q
  1. A 15 yr old girl presents with pelvic pain and an US shows a 4 cm ovarian cyst. What is the commonest cause?

a) Dermoid cyst
b) Follicular cyst
c) Corpus luteal cyst
d) Serous adenoma
e) Endometrioma

A

b) Follicular cyst

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8
Q
  1. 6 yo child with persistant PV bleeding. Next step.

a) EUA
b) Report re sexual abuse
c) Rectal exam to exclude foreign body
d) US pelvis
e) Swabs and antibiotics

A

a) EUA

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9
Q
  1. A child is born with ambiguous genitalie. What is the first test to perform?

a) U and E’s
b) Karyotype
c) Choose girl’s name
d) Check corticosteroids

A

a) U and E’s

CAH – congenital adrenal hyperplasia - Life threatening. Electrolyte imbalance from the ‘salt-losing’ type of CAH can appear within a few days of birth, and occurs in 75% those with virilizing adrenal hyperplasia. Salt-losing crisis develops 5-15 days after birth, with a refusal to feed, FTT, apathy, vomiting, then addisonian like crisis

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10
Q
  1. 14 yo bought by mother because of lack of periods. Which will be most helpful in establishing diagnosis?

a) Tanner stage 3 brest development
b) Mild obesity
c) Waist:hip ratio 0.6
d) Acanthosis nigricans

A

a Tanner stage 3 brest development

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11
Q
  1. A 160 cm normotensive 15 yo girl has been progressively virilized since age 7. Now shaving face regularly. OE clitoromegaly, posterior scrotal fusion, cervix present, no adnexal masses, tanner 2 breast, ammenorrhoeic. Karyotype most likely to be:

a) XX
b) XX/XY
c) XO
d) XXY
e) XY

A

a XX

A YES. Normal female karyotype. Likely late-onset CAH, this is the nonclassic type of 21-hydroxylaste def, represents a partial def, producing a late-onset, milder hyperandrogenemia. Typically presents at or just after puberty

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12
Q
  1. A tall eunachoid 18 yo girl is found to have 46 XY karyotype. OE sparse pubic and axillary hair, tanner stage 2 breasts, normal vagina and vulva, hypoplastic cervix and uterus. Likely cause of intersexd:

a) true gonadal dysgenesis
b) true hermaphrodite
c) testicular feminisation / AIS

A

a) true gonadal dysgenesis ( has mullerian structures but decreased testosterone and AMH)

a) true gonadal dysgenesis ( has mullerian structures but decreased testosterone and AMH)
b) true hermaphrodite ( mixed gonadal dysgenesis ) –dysgenetic testis on one side and streak gonad on the other
c) testicular feminisation / AIS ( no mullerian structures

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13
Q

The following are all causes of precocious puberty except:

a. astrocytoma
b. Frolich’s syndrome
c. Neruofibromatosis

A

b. Frolich’s syndrome

A IS. 20-30% of central PP cases are due to an intracranial mass lesion. Commonest are hypothalamic harmatomas, optic nerve gliomas, suprasellar arachnoid cysts, hydrocephalus, germinomas, and other sellar/suprasellar lesions. Central PP secondary to a astrocytoma also occurs.
B NOT. Usually presents with delayed puberty
C IS. NF type 1 is associated with PP, in those with optic chiasm tumours. NF is an inherited disorder in which nerve tumours (neurofibromas) form in the skin, subcut tissue, and nerves and spinal cord

Frolich’s syndrome
• Rare childhood metabolic disorder
• Characterised by feminine obesity, growth retardation, retarded sexual development, atrophy or hypoplasia of gonads, altered secondary sexual characteristics
• Usually assoc with tumours of the hypothalamus

McCune-Albright syndrome
• Genetic disease that affects the bones and colour of the skin
• Can get café-au-lait spots, but this different to neurofibromatosis

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14
Q

For the patient described give the most likely clinical findings:

  1. Turners Syndrome, 18 yrs old, no treatment
    1. AIS 18 yrs old

a) absent uterus, breasts underdeveloped
b) absent uterus, breasts developed
c) uterus present, breasts undeveloped
d) uterus present, breasts developed

A

c) uterus present, breasts undeveloped

Turner’s
• Gonadal dysgenesis, get streak ovaries and poor breast development
• No testes thus no AMH thus will get mullerian structures thus uterus present

14: b) absent uterus, breasts developed

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15
Q
  1. 13 yo girl presents with heavy menstrual bleeding for 6 months. What is the next most appropriate step?

a) combined OCP
b) hysteroscopy, D& C
c) cyclical progesterone
d) coagulation profile
e) expectant management

A

d) coagulation profile

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16
Q
  1. A 6 month old baby girl is noted to have labial fusion. The most appropriate management is:

a) gentle genital traction
b) topical oestrogen cream
c) exclude candidiasis
d) surgical incision
e) expectant mangement

A

e) expectant mangement

Labial fusion
• Common condition in young girls defined as partial or complete adherence of the labia minora
• Peak incidence 1-2 years age
• Cause – unknown, may be due to an inflame condition such as vulvovaginitis
• Rx – not usually needed, usually separates naturally by time of first menstrual period, happens slowly
• Medical or surgical rx to separate can be painful, and risk adhesions or fusion will return
• Can treat with topical oestrogen. High levels at <3/12 age, and >5 years
• Can get UTIs and asym bacteriuria

17
Q
  1. An 18 yo girl accompanied by her mother to see you concerned about recent weight loss from 54-32 kg in a period of 6 months. This was associated with secondary amenorrhoea. She is an intelligent girl and doing very well at school. She recently became more lethargic and lost her appetite. On examination there was no obvious cause for her weight loss. What is the next most appropriate management?

a) commence on oral progesterone
b) commence on oral oestrogen
c) hospitalisation for assessment
d) reassureance

A

c) hospitalisation for assessment

18
Q
  1. The most likely cause of vaginal bleeding in a 7 yo is ?

a) sexual abuse
b) foreign body
c) tumour
d) atrophic vaginitis

A

d) atrophic vaginitis

19
Q
  1. Most common cause of heterosexual precocious puberty

a) Idiopathic
b) adrenal
c) ovarian
d) tumour
e) pituitary

A

b) adrenal

Heterosexual PP (ie. boy feminised, girl masculinised)
• Exogenous estrogen – feminisation
• Adrenal pathology – adrenal causes of excess androgen production include andro-secreting tumours, enzymatic defects in adrenal steroid biosynthesis (CAH)
• Adrenal estrogen secreting tumours can also lead to feminisation
• Pituitary gndn-secreting tumours – rare in children, assoc with inc FSH and/or LH
• McCune-Albright syndrome – rare

20
Q
  1. A 6 yo girl presents with her mother with a several days of a blood stained vaginal discharge. Outline your initial management-

a) ask a senior colleague to RV re ? sexual abuse
b) take swabs and commence on antibiotics
c) perform a rectal examination to rule out a foreign body
d) arrange an EUA
e) pelvic US

A

d) arrange an EUA

21
Q
  1. A 16 yo woman presents asking for an STD check. Partner recently diagnosed with NGU, most appropriate management?

a) cervical swabs and review
b) doxycycline bd for 10/7
c) cervical swabs and oral doxycycline for 10 days
d) counsel and test for HIV

A

c) cervical swabs and oral doxycycline for 10 days

As likely has Chlamydia, but want swabs to confirm/make sure right treatment
NGU
• Non-gonococcal urethritis is inflammation of the urethra, which is not caused by gonorrhoea
• Most common bacterial cause is Chlamydia urethritis (23-55%)
• Can also be ureaplasma urealyticum, haemophilus vaginalis, mycoplasma genitalium
• HSV and trich rare causes

22
Q
  1. Young girl with PV discharge. Solitary kidney, 8cm paravaginal mass. It is?

a) gartners duct cyst
b) duplicate vagina
c) kidney
d) obstructed hemivagina

A

d) obstructed hemivagina

23
Q
  1. 14 yo, 145 cm tall, no breast, chm XO. The main advantage in treatment with oestrogen in Turners syndrome is to:

a) oocyte formation
b) increase her height
c) promote breast development
d) prevent hot flushes

A

c) promote breast development

24
Q
  1. Anorexia nervosa:

a) associated with high FSH and LH
b) may result in osteoporosis if prolonged

A

b) may result in osteoporosis if prolonged

25
Q
  1. 18 yo girl presented with hirsuitism. She is having regular cycles. Hormonal profile revealed normal testoserone, DHEA & DHEAS levels. Pelvic US normal. What is the most appropriate treatment?

a) COCP
b) Spironolactone and OCP
c) Progesterone
d) Oestrogen
e) Cyproterone acetate

A

a) COCP

26
Q
  1. An infant is just delivered and noted to have ambiguous genitalia. What is your first step in mangement?

a) pelvic US and dye to the urogenital sinus
b) karyotype
c) 17 OHP
d) FSH
e) Serum electrolytes

A

e) Serum electrolytes

27
Q
  1. Percentage of 5 year old who wet bed?

a) 2%
b) 7%
c) 15%
d) 25%
e) 45%

A

c) 15%

•	UpToDate says:
o	5 yrs		16%
o	6		13%
o	7		10%
o	8		7%
o	10		5%
o	12-14	2-3%
o	≥15		1-2%
28
Q
  1. Likely diagnosis in 5 yo girl with constant dribbling urine despite otherwise normal voiding pattern?

a) UTI
b) Urethral prolapse
c) Ectopic ureter
d) Labial fusion

A

c) Ectopic ureter

Ectopic ureter
• Girls usually present in infancy with UTI
• However after toilet training, girls often present with incontinence as the site of insertion of the ectopic ureter is distal to the external urethral sphincter
• Parents report child has normal voiding habits but is always wet
• May become wetter when sitting on parent’s lap as urine pools in the dilated ureter or vagina

The following are the most common terminal sites of female ureteric ectopy, including their relative frequency
●Bladder neck and upper urethra – 33 percent
●Vaginal vestibule between the urethra and vaginal opening – 33 percent
●Vagina – 25 percent
●Cervix and uterus – Less than 5 percent
Only girls with a ureteral orifice site at or above the bladder neck and upper urethra will be continent.

29
Q
  1. Definitive evidence of sexual abuse?

a) thick nodular labial adhesions not associated with diapering
b) unexplained ehaled injuries to fossa(?)
c) non-midline scars around anus and fourchette
d) absent or transacted hymen
e) asymmetriacal fourchette or hymen

A

d) absent or transacted hymen

30
Q
  1. Who must report suspected sexual abuse?

a) physicians
b) school teachers
c) social workers
d) all of above
e) none of above

A

d) all of above

31
Q
  1. 4 day old girl, 3.5 kg has vaginal PV bleeding

a) reassure and explain oestrogen withdrawal
b) organise US for uterine tumour
c) organise EUA for vaginal tumour
d) suprpubic puncture
e) examine stool for Hb

A

a) reassure and explain oestrogen withdrawal

MCQ (10 decks)

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