Paediatric and Adult Gynaecology

Question 1

Definition of the Gillick Competence

Answer 1

Child < 16 years can give/withhold consent if the doctor feels that they are fully understanding of what is involved in an intervention

Question 2

Definition of Fraser Competence

Answer 2

A doctor can prescribe contraception/give contraceptive advise to a girl <16 y/o if

• mature enough to understand advise and the implications of treatment
• girl likely to begin or continue to have sex with or without treatment
• doctor try to get her to inform parents or allow him to inform them
• girls health would summer without treatment/advise
• in the girls best interests to give treatment/advise

Question 3

When to investigate primary amenorrhoea

Answer 3

Normal secondary sexual characteristics - investigate at age 16

Absent secondary sexual characteristics - investigate at age 14

Question 4

Investigations prior to referral for amenorrhoea

Answer 4

FSH, LF, PRL, TSH, testosterone, oestrogen
Pelvic USG
Progesterone withdrawal bleed (pregnancy, not enough oestrogen)
Cyclical abdominal pain

Question 5

Puberty induction treatment

Answer 5

Gradual build up of oestrogen (until stopped growing so breast shape is not altered)
Then add progesterone once the max height potential is reached

Question 6

Secondary amenorrhoea definition

Answer 6

Had periods before and now they have stopped

Question 7

Causes of secondary amenorrhoea

Answer 7

Weight gain (obstructed uterus)
PCOS
Pregnancy
Fluctuating LH/oestrogens

Question 8

Menorrhagia definition

Answer 8

Heavy periods

Question 9

Possible treatments of menorrhagia

Answer 9

POP
Tranexamic acid 
Medenamic acid 
COC
Mirena (usually when cant take pills)

Question 10

Length of treatment in a patient for menorrhagia

Answer 10

A year or so then come off it as it will have settled down

Question 11

Presentation of accidents to cysts

Answer 11

Subacute history
Usually tender to one side of the pelvis or behind
Uterus may feel a mass

Question 12

Vulvovaginitis causes

Answer 12

Foreign body (e.g. toys)
Playing with genitals
Sexual abuse
Urinary incontinence

Question 13

Age that you would get vulvovaginitis

Answer 13

2-7 years old

Question 14

Labial agglutination definition

Answer 14

Adhesion of labia minora in midline (usually)

Question 15

Presentation of labial agglutination

Answer 15

Vulvovaginitis
Retention of urine
Retention of vaginal secretions
UTI

Question 16

Treatment of labial agglutination

Answer 16

Improve hygiene may all be thats needed
treatment indicated if chronic vulvovaginitis or difficulty urinating
lubrication of labia with a bland ointment
topical oestrogen
surgical separation (rarely necessary)

Question 17

Vaginal discharge is common in

Answer 17

Infants up to 2 weeks after birth resulting from maternal oestrogen
Prepubertal girls who experience increasing oestrogen produced by maturing ovaries

Question 18

Episiotomy definition

Answer 18

Surgically planned incision on the perineum and posterior vaginal wall during the second stage of labour

Question 19

Purposes of episiotomy

Answer 19

Help normal vaginal birth

Help prevent tears towards the back passage

Question 20

Angles of episiotomy

Answer 20

Midline towards anus

Mediolateral

Question 21

Caesarean section definition

Answer 21

Delivery of the foetus through an incision in the abdominal and uterine walls

Question 22

Reasons for a hysterectomy

Answer 22

Fibroids
Malignancy
Heavy bleeding
Endometriosis

Question 23

The 3 approaches to hysterectomy

Answer 23

Open laparotomy
Laparoscopy
Transvaginal

Question 24

Endometritis vs Endometriosis

Answer 24

Endometritis = inflammation of endometrium 
Endometriosis = a medical condition

Question 25

Most common causes for Pelvic inflammatory Disease

Answer 25

Chlamydia Gonorrhoea Mycoplasma Genitalium

Question 26

Risk factors for pelvic inflammatory disease

Answer 26

``` If have more than 1 sexual partner Have a new sexual partner Have a history of STIs Have had PID in the past under 25 y/o Started having sex at a young age ```

Question 27

Definition of vulvovaginitis

Answer 27

Inflammation of the vulva and the vagina

Question 28

Presentation of PID

Answer 28

``` Pelvic pain Fever Deep dyspareunia Vaginal discharge Dysuria Menstrual irregularities Cervical excitation on examination ```

Question 29

Presentation of ovarian torsion

Answer 29

Sudden onset lower unilateral abdominal pain Nausea and vomiting On examination - unilateral, tender adnexal mass

Question 30

What may the onset of ovarian torsion coincide with?

Answer 30

Exercise

Question 31

Presentation of an ovarian cyst

Answer 31

``` Intermittent pain Iliac fossa pain Pain worse during intercourse Urinary frequency Feeling bloated ```

Question 32

Causes of vaginal discharge

Answer 32

``` Common - physiological - candida - trichmonas vaginalis - bacterial vaginosis Less common - gonnorhoea - chlamydia - ectropion - foreign body - cervical cancer ```

Question 33

Key features of candida

Answer 33

Cottage cheese discharge Vulvitis Itch Associated with pain during sex

Question 34

Key features of trichomoniasis vaginalis

Answer 34

Offensive, yellow/green, frothy discharge Vulvovaginitis Strawberry cervix

Question 35

Key features of bacterial vaginosis

Answer 35

Offensive, thin white/grey "fishy discharge"

Question 36

How many women with bartholins abscess are pyrexial?

Answer 36

1 in 5

Question 37

Presentation of bartholins abscess

Answer 37

``` Worsening perineal pain Severe pain May have fever Mass Erythmatous skin overlying mass ```

Question 38

Treatment of bartholins abscess

Answer 38

Marsupialisation procedure

Question 39

What are bartholins glands?

Answer 39

Pair of glands located at entrance to the vagina

Question 40

How does the uterus feel, fibroids vs adenomyosis?

Answer 40

Fibroids - bulky uterus | Adenomyosis - boggy uterus with subendometrial linear striations