G17 65y.o PV bleed + lower abdo discomfort

Question 1

list the differential diagnosis for this condition

Answer 1

looking at her age, she is most likely menopausal. so main differentials to be ruled out would be endometrial cancer.

• endometrial hyperplasia/polyp
• HRT
• other gynae cancers: ovarian, cervical, vaginal (rare)
• atrophic vaginitis

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Question 2

describe the history you would take

Answer 2

confitm vaginal bleeding 1

. ask about the bleeding; amount, appearance, clots

2. LMP: menopausal/perimenoupausa + sx (vaginal dryness), IMB, PCB, dyspareunia
3. abdominal pain; SOCRATES

associated sx: weight loss, appetite, energy, night sweats

4. past obstetric history
5. past smear
6. past STI; urinary sx; dysuria, discharge, itchy
7. contraception; irregular bleeding
8. PMHx; cancers + surgical hx, PCOS

fam Hx

9. medications; HRT
10. smoking

Question 3

what examination would you perform

Answer 3

1 general wellbeing

2. BMI
3. Obs; pulse, BP, temp
4. abdominal examination;
5. pelvic examination; speculum; appearance of cervic, estroneginastion

bimanual; enlargement of uterus or cervix/adnexal mass

Question 4

investigation

Answer 4

1. FBC; anemia, CRP; infection U+E
2. cervical smear /pipelle
3. swabs if cervisitis
4. TVUS and abdo USS; pelvix/adnexal mass, endometrial thickness <5 in post menopausal

Question 5

management

Answer 5

1. if normal: atrophic -> OVESTIN
2. if scan show abnormal thockened endometrium, abnormal pipelle, smear, abnormal cercix on examination and USS refer to gynae

if ovarian cysts -> do CA125, gynae