9.1 Paeds Adolescent Gyne

Question 1

is labial agglutination common?

Answer 1

Yes 3% of prepubertal girls

Question 2

DDx of labial agglutination if no midline Raphe ?

Answer 2

• Imperforate hymen

- Disorder of sexual differentiation

Question 3

Labial agglutination Rx?

Answer 3

Reassurance

Question 4

Labial agglutination, manual separation?

Answer 4

Not recommended, 40% recurrence

Question 5

Labial agglutination treatment?

Answer 5

Oestrogen cream plus moituriser

Question 6

Vulvovaginal itch/soreness

What questions important?

Answer 6

How long
Discharge
Colour
Odour
Bleeding?

Question 7

Vulvovaginal itch/soreness PMhistory ?

Answer 7

URTI

Eczema, dermatitis, atopy

Question 8

Vulvovaginal itch/soreness irritants?

Answer 8

Soaps
Bubble baths
Irritants
Underwear
Leotards, tights
Hygiene

Question 9

DDx of vulvovaginitis?

Answer 9

Bacterial
Threadworms
Dermatoses
Chrohn’s
Ectopic ureter
Sexual abuse

Question 10

Vulvovaginal itch/soreness foreign body usually?

Answer 10

Toilet paper

Question 11

Vulvovaginal itch/soreness, swab when?

Answer 11

Only if discharge present

Question 12

Vulvovaginal itch/soreness examination, how to approach?

Answer 12

External genitalia
Swab if discharge
Check elbows, scalp
Vaginoscopy if bleeding occurred

Question 13

Vulvovaginal itch/soreness most common reason?

Answer 13

Non specific inflammation

Question 14

Management of Vulvovaginitis?

Answer 14

Perineal hygiene
Cotton underpants
Barrier creams
Reassurance
Vinegar baths dilute
Abx after swab

Question 15

Lichen sclerosis

Answer 15

Whitening of skin, ecchymoses and petechaie haemorrhage,

doesn’t involve vagina

Question 16

Why important to carefully dx Lichen sclerosis?

Answer 16

Lifetime steroids

Risk of vulvocarcinoma

Question 17

When girls get Lichen sclerosis?

Answer 17

Age 5-7

Question 18

Lichen sclerosis what kind of condition?

Answer 18

Autoimmune

Question 19

Lichen sclerosis after menarche?

Answer 19

75% improvement usually

Question 20

Lichen sclerosis Rx??

Answer 20

0.05% betamethasone for 6-12/52 until resolution then low potency for 3/12

Question 21

Dysmenorrhea, commonest cause?

Answer 21

Prostaglandin mediated from the shedding endometrium

Question 22

When do you get lethargy in Dysmenorrhea?

Answer 22

Typically with onset of menses, not preceding it

Question 23

Mx of Dysmenorrhea?

Answer 23

-NSAIDS
Maybe with paracetamol or codeine
-COCP

Question 24

What to think of if Dysmenorrhea and refractory symptoms?

Answer 24

Endometriosis

Abdo/pelvic ultrasound

Question 25

Adolescent menorrhagia, how to assess?

Answer 25

- How often changing tampon/pads - flooding (nocturnal) - missed school - FHx

Question 26

Adolescent menorrhagia most common cause?

Answer 26

Anovulation Bleeding disorders Pelvic pathology is uncommon

Question 27

Adolescent menorrhagia investigations?

Answer 27

``` FBE Platelets Iron studies Coags -Preg Chlamydia PCR Pelvic US ```

Question 28

Adolescent menorrhagia anovulation common causes?

Answer 28

Unopposed oestrogen due to immature hypothalamus pituitary ovarian axis -takes up to 3 years to establish cycles

Question 29

Adolescent menorrhagia other causes that affect HPO axis?

Answer 29

``` Chronic illness Eating disorders Sporting Drug abuse Thyroid ```

Question 30

Most common cause of Adolescent menorrhagia bleeding disorders?

Answer 30

- Platelets - Von Willebrand disease - involve haematologist

Question 31

Adolescent menorrhagia dose for tranexemic acid?

Answer 31

1g QID

Question 32

NSAIDS for Adolescent menorrhagia?

Answer 32

Not in acute setting but can reduce later on by 30%

Question 33

Adolescent menorrhagia hormone treatment?

Answer 33

COCP, prolonged extended cycles

Question 34

key points for discussion of periods for daughter with developmental delay

Answer 34

individualise open discussion booklet

Question 35

options for mentrual management in developmental delayed girls?

Answer 35

``` do nothing simple analgesia COCP Mirena - more and more surgery: last resort need court ```

Question 36

implanon /depo provera for menstrual mangement of girls with developmental delay?

Answer 36

not ideal

Question 37

overweight adolescent with irregular periods and hirsutism what ask in hx?

Answer 37

PCOS | DMII

Question 38

overweight adolescent with irregular periods and hirsutism what ask in Ix?

Answer 38

pelvic U/S Bloods: testosterone, 17 OH progesterone, androstenedione, DHEAS, LH, FSH, SHBF -fasting insulin/glucose -TSH

Question 39

management of PCOS?

Answer 39

- lifestyle is mainstay - weight loss - menstrual regulation - insulin sensitizers - treat hyperandrogenism

Question 40

PCOS pharmaco options?

Answer 40

1. COCP with monthly withdrawal 2. COCP with 3rd gen progesterone/cyproterone acetate 3. Metformin

Question 41

pelvic pain with amenorrhoea, may or may not be cyclical, think what dx?

Answer 41

imperforate hymen

Question 42

imperforate hymen how diagnosis? treatment?

Answer 42

ultrasound | surgery

Question 43

who to think of for imperforate/incomplete hymenal obstruction

Answer 43

14-16 year olds with well developed secondary sex characteristics, not having periods

Question 44

adnexal masses presents how?

Answer 44

1. increase abdo girth 2. Urinary symptoms 3. constipation, 4. pelvic pain - lower abdo fullness/heaviness/pressure 5. dysparunia 6. irregular periods

Question 45

adnexal masses broad categories?

Answer 45

1. hormone secreting non-hormone 2. solid/cystic

Question 46

physiological ovarian cysts? 2 main

Answer 46

1. functional fluid filled (follicles that fail to ovulate) | 2. Corpus luteum: possible bleeding into it

Question 47

ovarian cysts increase risk of

Answer 47

torsion

Question 48

ovarian masses management

Answer 48

1. monitoring 2. laparoscopic over drainage 3. cystectomy vs. oophrectomy

Question 49

sudden onset severe abdominal pain ddx?

Answer 49

1. appendicitis: more CRP, WBC? | 2. ovarian torsion: bloods and urine NAD, guarding, no rebound

Question 50

classic ovarian torsion symptom onset?

Answer 50

sudden onset pain, nausea, vomiting, low grade fever