Basic Practical Skills - Gynaecology Flashcards
What should be covered when taking a history in gynaecology
History of presenting complaint Menstrual history Previous gynaecological history Obstetric history Previous medical history Family history Social history
What should be covered when taking a menstrual history
Date of LMP
Age of onset of menarche (significant if <9 or >16 years)
Length of the menstrual cycle (between 21 and 42 days is normal)
How many days they bleed for on their period
- amount of blood lost (feels normal to them?)
- number of pads/tampons they go through
Menopause - what age
Any history of bleeding between periods or after sex
What should be covered when taking a previous gynaecological history
Any gynae problems and their associated treatments Gynae surgery Contraception - for women of a reproductive age - method - may be related to presentation e.g. bleeding on IUD Smear - date of last - result
What obstetrics history should be covered during a gynaecological history
Previous pregnancies and their outcome - miscarriage - ectopic - delivery after 24 weeks Current children and ages Any abortions
Definition of gravidity and parity
Gravidity
- number or times a women has been pregnant regardless of the outcome
- current pregnancy (if any) is included in this count
Parity
- how many pregnancies reached viable gestation age (include live births and still births)
- roughly 20 weeks considered the cut off
- twins count as 1
Importance of a social history in gynaecology
Smoking
- how many a day (>40 a day means COCP contraindicated)
- women >35 smoking >15 cigarettes a day is also a contraindication
- how long have they smoked for
Alcohol and recreational drugs
- units/week
- type, volume and strength
- types of drugs
Weight
- obesity associated with PCOS and increased risk of endometrial cancer
- raised BMI is a contraindication for some treatments (inc COCP)
- anorexia can cause oligo/amenorrhoea
Home situations
- who they live at home with and are they well supported
- independent?
- impact on ADL and QoL
- important when assessing how to manage the health problem
Occupation
- impacting ability to work
- exposure to any industrial carcinogens
Definition of last menstrual period
The date on which she started her most recent menstrual period
- important to clarify it’s the date she STARTED, not finished
- first day of bright red bleeding
How to take a sexual history
HPC
Last sexual contact
- timing
- consent
- regular partner or casual encounter
- partner demographics (sex and country or origin)
- type of sex (oral or anal - give or receive, and vaginal)
- contraception
Other sexual partners
- in the last 3 months
- for each repeat as above
PMHx
DHx
Social Hx
HIV risk Hx
- partner known to be HIV+
- sex with a bisexual man/male homosexual activity
- sex with someone abroad/born in a different country
- ever injected drugs
- had sex with someone who has injected drugs
- paid someone for sex, or been paid for sex
Describe the STI swabs that can be taken from the vagina, and what they are for
Endocervical chlamydia swab (NAATs)
- rotate swab 10-15 times in the endocervix
- remove swab and break off in transport tube
- screens for chlamydia and gonorrhoea
Endocervical charcoal media swab
- gonorrhoea
- rotate swab 10-15 times in the endocervix
High vaginal swab
- taken from posterior fornix (where discharge often pools)
- rotate swab for 10 seconds
- screens for bacterial vaginosis, trichomonas vaginalis, candida and group B strep
Vulvo-vaginal swab
- taken by the patient
- screens for chlamydia and gonorrhoea
What would you comment on when assessing the uterus in a bimanual examination
Size - approximately orange sized in an average woman
Shape - may be distorted by masses such as fibroids
Position - anteverted vs retroverted
Surface characteristics - smooth vs nodular
Not any tenderness during palpation
Mobility
What would you comment on when assessing the adnexa in a bimanual examination
Feel for any palpable masses, noting their size and shape
e.g. ovarian cyst/ovarian tumour/ovarian fibroid
Position
Mobility
Ensure to repeat on both sides
Ovaries may be palpable if the patient is thin
Tubes only palpable if significantly enlarged
