Chapter 3: Clinical Exam In OBGYN Flashcards
CLINICAL EXAMINATION You are a trainee intern in an antenatal clinic with Mima, a 28-year -old para 1 Burmese refugee who you are seeing with her husband. Mima has only recently relocated to the city where you are a student. This is the first time Mima has been seen during this pregnancy. An interpreter has been booked but is running late. Mima’s husband speaks a little English. From the notes, Mima’s last pregnancy was seven years ago in Burma. She required a caesarean as her 3kg baby was ‘lying sideways’. This child is alive and well. Mima is 165cm tall and weighs 60kg. Mima is happy for you to perform a general and abdominal examination. Of the following options, which examination finding is MOST RELEVANT to this pregnancy?
Blood pressure is 120/80
Uterine distension of the lower abdomen from the pelvis to just below the umbilicus
Periumbilical striae gravidarum
A scar in the midline from the umbilicus to the symphysis pubis
Heart sounds are dual with a soft systolic ejection murmur
A scar in the midline from the umbilicus to the symphysis pubis
CLINICAL EXAMINATION You are a trainee intern in an antenatal clinic with Laveni, a 29-year-old Samoan woman at 36 weeks’ gestation. Laveni is para 1 and has had a previous spontaneous vaginal birth at term. Laveni is 165cm tall and weighs 60kg. On examination, Laveni’s blood pressure is 120/80mmHg. The fundal height is 36 cm. The baby’s lie is longitudinal. Of the following options, which clinical finding if confirmed on Laveni, would MOST influence her pregnancy management from now?
Fundus palpable just below the xiphisternum
Presenting part not engaged
Fetal heart rate 155 beats per minute
Linea nigra present
Head ballotable in the left hypochondrial region
Head ballotable in the left hypochondrial region
CLINICAL EXAMINATION You are a trainee intern in an antenatal clinic seeing Colleen, a 29-year-old nulliparous Pākehā woman who is 41 weeks pregnant. Her due date was confirmed at an early scan therefore certain. Colleen has had an uncomplicated pregnancy. She weighs 70kg. You have performed an abdominal palpation under the supervision of your consultant. You report that “the head is deeply engaged”. Of the following options, which describes the abdominal findings which should lead you to describe the fetal head as “deeply engaged”?
The head was fully palpable above the pelvic brim
Half the head was palpable above the pelvic inlet
Cephalic pole was ballotable on abdominal examination
Two finger breadths of head are estimated to have descended through the pelvic brim
One finger breadth of the fetal head was palpable abdominally
One finger breadth of the fetal head was palpable abdominally
CLINICAL EXAMINATION You are a trainee intern in a gynaecology clinic seeing Blessica, a 46-year-old para 2 Filipino woman presenting who has heavy periods. Blessica has consented for you to see her and perform a supervised gynaecological examination. Of the following options, what is the most important action from a diagnostic viewpoint, prior to the examination?
Asking her what she prefers to be called
Obtaining verbal consent for the examination
Taking a history before she changes for the examination
Offering her a chaperone for the examination
Introducing yourself
Taking a history before she changes for the examination
CLINICAL EXAMINATION You are a trainee intern in a gynaecology clinic seeing Bindy, a 46-year-old para 2 New Zealand European woman. Bindy’s presenting complain is that she has the feeling of a bulge at her introitus. This is worse at the end of the day. She has no associated urinary or bowel symptoms. Her GP has diagnosed her with pelvic organ prolapse. Bindy consents for you to undertake a supervised gynaecological examination. Of the following options, which part of the examination is the MOST IMPORTANT From the diagnostic viewpoint?
Examining with a Lucy (Sims) speculum
Testing for urine leakage by asking Bindy to cough
Performing a bimanual examination on Bindy in the left lateral position
Examining using a Cusco’s bivalve speculum in the lithotomy position
Performing a rectal examination
Examining with a Lucy (Sims) speculum
CLINICAL EXAMINATION You are a trainee intern in a gynaecology clinic seeing Christine, a 40-year-old para 2 Pākehā woman. Christine has presented with heavy menstrual bleeding and nocturia. She had a normal smear 6 months ago. When you take a more detailed history, you suspect that Christine has a fibroid uterus pressing on her bladder. Christine consents for you to undertake a supervised gynaecological examination. Of the following options, which of the following examination actions is the MOST IMPORTANT from a diagnostic viewpoint?
Performing a bimanual examination
Taking a cervical smear
Using a Lucy (Sim’s) speculum
Using a Cusco’s bivalve speculum
Using sterile gloves on both hands
Performing a bimanual examination
CLINICAL EXAMINATION You are a trainee intern in a general practice seeing Moon, a 40-year-old New Zealander of Chinese ethnicity who has attended for a flu vaccination. Moon’s last smear was 10 years ago. You discuss the indications for cervical screening and Moon agrees to have a smear. She is just at the end of her period. When you perform the smear, you can visualise the cervix well. There is some menstrual blood present. Of the following options, which is the BEST one to ensure adequate sampling when taking the smear?
Use a cytobrush to take the smear
Postpone the smear until Moon has had a course of vaginal oestrogen
Use liquid based cytology
Use a cervibroom to take the smear
Ask her to return next week when her period has finished
Use liquid based cytology
Allows for contaminants such as mucus, menstrual debris to be removed
CLINICAL EXAMINATION You are a trainee intern in an antenatal clinic seeing Mia, a 22-year-old Māori woman who is 34 weeks pregnant in her second pregnancy. She has a history of PET with her first pregnancy.
Mia’s nuchal translucency scan that was performed as part of her MSS1 Screening was consistent with her menstrual dates.
Mia keeps good health and is a non-smoker. She appears well. She is on low dose Aspirin.
You are asked to perform a ‘relevant clinical examination’.
Of the following options, which is MOST RELEVANT component of your clinical examination?
Neurological examination including reflexes
Blood pressure measurement
Ankle oedema
Urine for proteinuria
Fundoscopy
Blood pressure measurement
Proteinuria - investigation not an exam finding
