Gynecology: Peds/adolescent

Front 1

At what age should you be concerned if secondary sexual characteristics, or if stages of puberty don't progress w/in 5 years?

Back 1

14

Front 2

What is thelarche?

Back 2

Breast development

Front 3

What are the 5 stages of Thelarche?

Back 3

1. Elevation of papilla only
2. Breast buds, areola enlarges, small mound of tissue elevates papilla
3. Further enlargement of papilla and increase in dm of areola w/ no separation of their contours.
4. Projection of areola and papilla to form a secondary mound of tissue above level of breast.
5. Mature adult stage; areola recessed to general contour of breast

Front 4

What is pubarche?

Back 4

Pubic hair development

Front 5

5 stages of pubarch?

Back 5

1. No pubic hair.
2. Sparse grwoth primarily along labia.
3. Darker, coarser growth over pubis.
4. Adult type, not onto thighs.
5. Adult type, extends onto thighs.

Front 6

What might you give to a pediatric patient before doing a pelvic exam?

Back 6

Pediatric cocktail:
Meperidine (demerol),
Promethazine (phenergan),
and chlorpromazine (anti-psych).

Provides anaglesia and amnesia

Front 7

What is lichen sclerosis et atrophicus?

Back 7

White papular lesion resembling leukoplakia, may cover vulva and perianal regions.
Self-limiting, benign. Rarely req therapy.
Biopsy.
Cortisone for temp itching.

Front 8

Treatment for trauma to genital area?

Back 8

Conservative: rest, heat analgesics.

Sexual abuse: abx as prophylaxis against STDs.

Front 9

What is labial agglutination?

Back 9

Adhesion of labia minora in midline, usually result of irritation or skin disease (epidermolysis bullosa).
Can see a line that extends vertically downard (distinguishes imperforate hymen or vaginal atresia).
Can result in retention of urine and infection.

Front 10

Treatment for labial agglutination?

Back 10

Topical estrogen BID (2-4 wks) - cornification and promotes spont separation. Watch for breast growth.

Surgical: if recurrent and not responding to topical estrogen.

Front 11

Presentation of imperforate hymen?

Therapy?

Back 11

Bulging introitus.

Surgical: prior to puberty imperative!
Cruciate incision into membrane maintains patency.

Front 12

What is a prolapsed urethra?

Back 12

Red mass at vaginal orifice. Occludes vagina and usually causes dysuria. Differentiate ureterocele.

Usually needs surgical reduction.

Front 13

Presentation of hemolytic streptococcal vaginitis?

Back 13

Bloody or serosanginous discharge, following strep infection.

Front 14

What is monilial vaginitis?

Back 14

Common in diabetic children or after antibiotic therapy.

Infection d/t yeast-like fungus: Monilia

Front 15

Presentation of vaginal foreign body?

Back 15

Persistent vaginal discharge,

Pain, bleeding, foul smell

Front 16

What is vaginal atresia?

Treatment

Back 16

Failure of caudal mullerian duct development of urogenital sinus.

Ovarian development normal, but uterus usually non-functional.

Treat w/ surgery.

Front 17

What is an ectopic ureter w/ vaginal terminus?

Back 17

MCC of vaginal cysts in infants!

Presents as ureterocele - appears as cystic mass protruding from vagina. If ureter is patent, constant irritation and vaginitis may be signs.
**Hydroureter and hydronephrosis may also develop.

Dx: IVP
Tx: surgical resection

Front 18

What is vaginal ectopic anus?

Back 18

Imperforate anus assoc w/ rectovaginal connection.

Only skin dimple found at normal anal site.

Tx: surgery

Front 19

Important thing to note about vaginal tumors?

Back 19

**Uncommon, but usually malignant.

Front 20

What is vaginal adenosis?

Back 20

Benign.

Strawberry red areas w/in vagina.

Dx: hx of maternal DES,
Cytology, colposcopy, bx

Front 21

What is clear cell adenocarcinoma?

Back 21

Vaginal bleeding, discharge, pain = mc symptoms.
Can also by asx.

Dx: malignancy assoc w/ maternal DES. rare.

Front 22

Ovarian tumors?

Back 22

Uncommon in kids.
Present as ovarian torsion.

Tx: surgery, or combo of RT and chemo dpending on tumor.

Front 23

What is congenital adrenal hyperplasia (pseudohermaphroditism)?

Back 23

**Impairment of synth of cortisol and aldosterone.
**Defect in 21-hydroxylase --> virilization of female.

Chromosomes, gonads, internal genitalia all female. Clitoral enlargement and enlarged labial folds. Progressive if untreated.
Dx: urinary pregnanetriol and 17-ketosteroids elevated.
Tx: hydrocortisone.

Front 24

What happens in maternal ingestion of synthetic progestins?

Back 24

**Can lead to masculinization of female.

Masculinization of external genitalia: enlarged clitoris, labial fusion, norm vagina tubes and uterus. Growth and development normal.
Progressive virilization does NOT occur.
Dx: history.
Tx: clitoral reduction and surg correction of fused labia.

Front 25

What is androgen insensitivity syndrome (testicular feminiation)?

Back 25

46XY genotype, but femal phenotype.
Vagina ends as blind pouch. Testicles present in labia.
Often reared as females.

Tx: surgical removal of testicles after puberty b/c increased risk of cancer.

Front 26

What is true hermaphroditism?

Back 26

46XX genotype. External: male, female or ambig.
Both male and female internal genitalia may be present.
Sex assignment should be consistent w/ dominant appearance of external genitalia.

Tx: surgery

Front 27

When is DUB most common?

Back 27

Perimenopausal

Front 28

MC symptom of DUB?

Back 28

Menometorrhagia

Front 29

MCC DUB in adolescents?

Back 29

Immature hypothalamic-pituitary axis

Front 30

Common cause of primary amenorrhea?

Back 30

Chromosomal abnormalities

Front 31

What constitutes secondary amenorrhea?

Back 31

No menses for greater than 3 cycles or 6 consecutive months.

Front 32

MCC secondary amenorrhea?

Back 32

Pregnancy

Front 33

What is Asherman's Syndrome***?

Back 33

Amenorrhea and secondary sterility d/t intrauteerine adhesions and uterine synechiae.
MC from D&C for retained products of conception or from uterine infection.

Tx: surgical lysis of adhesions for mild scarring.
Severe often refractory to tx and Estrogen is added to surgery to stimulate endometrial regeneration to "cover" uterine lesions.

Front 34

What is the MCC of secondary amenorrhea of anatomic origin?

Back 34

Asherman's syndrome

Front 35

What is the female athlete triad?

Back 35

Amenorrhea,
Eating disorders,
Premature osteoporosis in female athlete.

Front 36

Definition of delayed puberty?

Back 36

No menarche by age 16,

and No thelarche by age 13

Front 37

Definition of precocious puberty?

Back 37

Onset at any age that is 2.5 SD earlier than norm age for population. Usually before age 8.

Girls more than boys.

Front 38

Treatment of choice for precocious puberty?

Back 38

GnRH

Front 39

What is the Mature Minor Docrtrine?

Back 39

Common law rule that allows a minor to give consent for med care/procedures if they can show that they're mature enough to make the decision on their own.
Relatively new concept and only a few states have enacted it.
Must be age 16 or older usually.

Front 40

Definition of sexual abuse?

Back 40

Sexual touch by someone at least 5 years older than adolsecent.

Coerced seduction, violent assault, rape.