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Boards - Adloescent GYN
OBGYN Qualifying exam
68
Other
Post-Graduate
06/30/2020

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Term
% adolescents that forgo care so their parents don't know
Definition
56%
Term
mean age of menarce
Definition
12.7
Term
mean adolescent cycle length
Definition
21-45d
Term
average adolescent bleeding length
Definition
<7d
Term
average pads/tampons a day in adolescent
Definition
4-6 pads or tampons
Term
normal adolescent vaginal pH
Definition
6.5-7.5
Term
cause of most discharge in newborns
Definition
milky to slight bloody due to maternal estrogen
Term
incidence of labial adhesions
Definition
1-10%
Term
usual age of labial adhesions
Definition
13-23mo
Term
conservative treatment labial adhesions - 4
Definition
observe, avoid irritants, sits baths, emmolient 6-12mo
Term
how to do topical estrogen for labial adhesions
Definition
apply twice a day to gray median raphae for 2-6wk followed by nightly emollient
Term
when do surgically remove labial adhesion
Definition
urinary obstruction or failure of medical management
Term
prognosis labial adhesions - observation
Definition
80% resolve in 1y
Term
prognosis of labial adhesions - estrogen
Definition
80-100% resolve but 41% recur
Term
recueence rate after surgery for labial adhesions
Definition
10%
Term
average age of urethral prolapse
Definition
5-8yo
Term
risks for urethral prolapse - 4
Definition
AA, Hispanic, chronic constipation, chronic lung disease
Term
treatment urethral prolapse
Definition
sits baths, estrogen BID 1-4wk
Term
when do you biopsy lichen sclerosis
Definition
atypical presentation, not responding to therapy
Term
initial management for lichen sclerosis
Definition
eliminate irritants, improve hygiene, emollient, twim nails, consider hydroxyzine PRN
Term
if fails initial management what is second step for lichen sclerosis
Definition
topical Clobetasol 0.05% BID x2wk then daily x2wk then 3x/d x2wk
Term
prognosis lichen sclerosis
Definition
75% resolves with puberty
Term
#1 foregin body
Definition
toilet paper
Term
management foregin body
Definition
remove, irrigate, vaginoscopy, all preferred under anesthesia
Term
types of vulvovaginitis and incidence
Definition
non-infectious/specific - 75%
infectious - 25%
Term
causes of non-specific vulvovaginitis (physiology) - 6
Definition
thin epithelium, pH elevated, lack of fat pads, pubic pain, hygiene, obesity
Term
treatment of non-specific vulvovaginitis - 6
Definition
hygiene, loose cotton underware, treat constipation, avoid irritants, sits baths, petroleum jelly
Term
#1 cause of vulvovaginitis it is an infection
Definition
S. pyogenes or shigella
Term
signs of S. pyogenes vulvovaginitis
Definition
14% associated with scarlet fever, purulent discharge
Term
treatment S. pyogenes vulvovaginitis
Definition
PCN/erythromycin
Term
which vulvovaginitis has satellite lesions
Definition
candidia
Term
treatment of candidia in kids
Definition
nystatin, miconazole, clotrimazole, tetraconazole
Term
pinworm aka
Definition
enterobiasis vermicularis
Term
diagnosis pin worm
Definition
tape test
Term
treatment pinworm - 2
Definition
albendazole, melbendazole
Term
labial hypertrophy 1st line therapy - 3
Definition
reassurance, barriers/emollient, tucking
Term
labial hypertrophy #1 complication of second line therapy
Definition
labiaplasty #1 complication regret
Term
#1 female reproductive tract anomaly
Definition
imperforate/abnormal hymen
Term
incidence of imperforate hymen
Definition
1:1000
Term
cause of imperforate hymen
Definition
urogenital sinus forms lower vagina, vaginal plate cells have incomplete degeneration
Term
describe the types of imperforate hymen 9
Definition
complete - no opening
microperforate - very tiny opening
cribiform - multiple pokes
septate - two larger openings
crescentric - shallow moon
fimbriated - thin armed star
labial - thin strip in middle
annular - hole bigger than microperforate
denticular - larger wavy hole
dentate - smaller wavy hole
lunar - dramatic crescent
Term
management of imperforate hymen
Definition
office resection at puberty
Term
signs of straddle injury - 3
Definition
vulvar hematoma, lacerations, abrasions
Term
management of straddle injury - 6
Definition
mark edges, serial HCT, serial rectal exams, foley, ice, surgery
Term
when do you do surgery for straddle injury 2
Definition
expanding, necrosis
Term
when do you do a vaginoscopy for a penetrating injury
Definition
bleeding is above hymen but without obvious lacerations in the vaginal vault
Term
when do you do a laparoscopy for a penetrating injury
Definition
lacerations in the vaginal vault
Term
forensic evidence should be taken woth ___h of a sexual assault
Definition
72h
Term
condyloma >__yo is concerning for abuse
Definition
2yo (<2yo probabby from maternal child)
Term
cancers that may cause bleeding in adolescent - 6
Definition
hemangioma, granulosa cell, sarcoma, adenocarcinoma, endodermal sinus tumor, Mullerian papilloma
Term
% of adolescents with AUB
Definition
75% within 2y of menarche
Term
when to initiate work up for adolescent AUB- 4
Definition
intermenstrual period >3mo, >7d bleeding, pads needed every 1-2h, hBG <12
Term
___ and a HBG <__ is associated with coagulopathy __% of the time
Definition
HMB, HBG <10, 20-30%
Term
#1 management of HMB in girls with HBG <___ is ___
Definition
OCPs, HBG <9-11
Term
#1 inherited bleeding disorder
Definition
von wilebrands
Term
incidence VWd
Definition
1% population 13% of HMB
Term
VWF is associated with what clotting factor
Definition
VIII
Term
3 types of VWd and their inheritance and cause
Definition
1 - AD, most common, quantative
2 - AD, qualitative
3 - AR, severe, no VWF
Term
signs of VWd
Definition
HMB 95%, bleeding with minor injury or syrgery 92%, gum bleeding 76%, menses >7d, anemia
Term
what can interfere with VWd testing
Definition
estrogen
Term
treatment of VWd - 4
Definition
DDAVP/vasopressin, clotting factor infusions, hormonal contraception, TXA
Term
#1 cause of CPP in adolescents
Definition
somatization - stress, sexual abuse, violence in the home, family/personal substance abuse, other psychosocial factors
Term
definition of adolesent CPP
Definition
recurrent or persistent pain for at least 3mo
Term
__% of CPP not responsive to medical management is _____
Definition
70% endometriosis
Term
% of adolescents reporting dysmenorrhea
Definition
40-50%
Term
first line treatment for adolescent dysmenorrhea
Definition
NSAIDS
Term
second line treatment for adolescent dysmenorrhea
Definition
OCPs
Term
when to proceed with laparoscopy for CPP/dysmenorrhea in adolescent - 5
Definition
unresponsive to OCPs/NSAIS for 3-6mo, suspect PID/appendicitis, painful irregular VB, progressive pain, pelvic mass
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