Pediatric gynecology

Question 1

How is a pediatric external exam performed?

Answer 1

Frog Leg, knee to chest or crossed legs in males

Question 2

Do we EVER do a speculum exam on a child?

Answer 2

NO– It is traumatic

Question 3

Most common pediatric GU problems inlcude?

Answer 3

UTI, vulvovaginitis, labial adhesions, anatomical differences in hymen, sexual abuse, amenorrhea, dysfunctional uterine bleeding

Question 4

How does vulvovaginitis present in children?

Answer 4

With dysuria, vulvovaginal pain or pruritis or both, and there could be erythema or even discharge

Question 5

Name 7 DDX for vulvovaginitis:

Answer 5

• contact irritant
• candida
• bacterial
• UTI
• Foreign body
• Sex abuse/ STI
• Infections agents (pinworms, GAS, Shigella)

Question 6

Symptom ANALYSIS of vulvovaginitis can include (6 things)?

Answer 6

dysuria, hematuria, abdominal pain, flank pain, fever, V/V

Question 7

When assessing vulvovagintis what questions do you ask about the night?

Answer 7

Enuresis, new or chronic

Question 8

Pediatric vaginal discharge questions?

Answer 8

How much, what color, odor?

Question 9

History for vulvovaginitis?

Answer 9

Have they ever had eczema or atophy?

Question 10

Are there concerns about?

Answer 10

Inappropriate physical contact

Question 11

A physical exam for pediatirc vulvovaginitis inlcudes?

Answer 11

Oropharyngeal exam (strep vagintis, sex abuse)
Abdominla exam, CVA tenderness
External GU exam

Question 12

How do you collect discharge samples from pediatrics during vaginal exam?

Answer 12

With q-tip for wet mount on outside only

Question 13

What diagnostic testing options do you have?

Answer 13

UA, C&S, tape test for pin worms, wet mount/ KOH

Question 14

Do we do STI screen on peds?

Answer 14

Very carefully, can be a legal issue

Question 15

Vulvovaginituis treatment includes?

Answer 15

-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

Question 16

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?

Answer 16

UA (for C, G, syphilis, HIV), empirical treatment for gonorrhea and chlamydia BECAUSE he is symptomatic

Question 17

What is the empirical treatment for gonorrhea and chlamydia that you will give this kid?

Answer 17

Ceftriaxone and azithromycin

Question 18

Amenorrhea– 15 years old, several months, sexually active, protuberant abdomen, uterine fundus 2 cm above abdomen?

Answer 18

Pregnancy 23 weeks confirmed with ultrasound

Question 19

What is the most appropriate action for 15 years old, 23-week pregnant teen??

Answer 19

Prenatal care and testing
Disclosure to parents
Cessation of ETOH, tobacco, drugs, herbal supplements
Healthy diet
Prenatal vitamins

Question 20

What considerations should the NP have when 23- week 15-year-old Ginny returns to primary care?

Answer 20

While pregnant she is emancipated but after pregnancy, she goes back to parents
BIRTH CONTROL
Emotional and physical postpartum assessments

Question 21

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?

Answer 21

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.

Question 22

With teen pelvic/ genitalia exam- who should be in the room?

Answer 22

Whomever they choose

Question 23

With abdominal exam in the GU focussed appointment, what are you looking for?

Answer 23

CVA tenderness
Masses
Bruits
Distended bladder
Edema ascites of abdomen

Question 24

What findings would concern you of more significant illness?

Answer 24

Tufts of hair, dimpling, abnormal skin openings

Question 25

What things increase risk for vulvovaginitis?

Answer 25

Bubble baths, friction, creams, lotions, tight clothing

Question 26

What are the 5 most common STI's effecting adloscents girls?

Answer 26

``` Gonorrhea Chlamydia Syphillis HSV HPV ```

Question 27

Gonorrhea dx, tx:

Answer 27

NAAT, or culture Ceftriaxone 250 mg IM 1 x AND azithromycin 1 gm PO 1x Report to the health department

Question 28

Chlamydia dx, tx:

Answer 28

NAAT and or culture Azithromycin 1 gm PO 1 x or doxycycline 100 mg PO bid 7 days Report to the health department

Question 29

Syphilis dx, tx:

Answer 29

VDRL (venereal disease research lab), AND RPR (rapid plasma reagin) Benzathine Penicillin G 2.4 million units IM 1x Report to health department

Question 30

Syphilis treatment if allergic to penicillin not pregnant?

Answer 30

doxycycline 100 mg PO BID 14 days or tetracycline 500 mg PO QID for 14 days

Question 31

Syphilis special note:

Answer 31

Test for Gonorrhea, chlamydia and HIV at time of infection and 3 mos later

Question 32

How often do you follow syphilis titers?

Answer 32

RPR, VDRL 6 mos, 12 mos and 24 mos

Question 33

HPV dx, tx:

Answer 33

Don't test teens for HPV

Question 34

HSV dx, tx:

Answer 34

a culture of a scraped vesicle, serologic testing not recommended if no symptoms. primary Acyclovir 400 mg TID for 7-10 days Not reportable

Question 35

What are reportable to the state health department:

Answer 35

Syphilis, gonorrhea, and chlamydia

Question 36

HSV comfort measures:

Answer 36

Sitz bath, dry heat, lidocaine jelly 2%