Gyn&Obs Flashcards
DDx for Amenorrhea
Primary
1. Genetics (i.e. Turner’s, Testosterone insensitivity)
Secondary
- Pregnancy***
- Hypo/Hyperthiroidism
- Premature menopause
- Prolactinoma/Hypothalamic tumors
- PCOS
- Cushing’s
- Drugs/Steroids
- Anorexia nervosa
- Psychological stresses/Excessive exercises.
MGOS: Questions for Menstrual
- When was your LMP? Similar to previous ones?
- Regular? How often do you get your periods?
- How long do they last?
- Amount? How many pads? Blood clots?
- Painful periods?
- Any spotting or bleeding between your periods?
- At what age did you get your first period?
MGOS: Questions for Gynecological
- Do you have history of any gynec disease (e.g. polyps)? What about FH?
- Pelvic surgery or instrumentation?
- Do you use contraceptives/HRT? What? How long?
Screening
- When was your last Pap? Reason? What result? Any other Pap’s?
- > 40: mammogram before?
- > 65 y: Bone mineral density done?
MGOS: Questions for Obstetrical
- Have you ever been pregnant before? If yes:
- How many times? Abortions? Miscarriages?
- Number of babies delivered? Twins? Babies with congenital abnormalities?
- For each delivery: full-term or pre-term? Vaginal or CS? Complications?
- Family history of congenital abnormalities.
MGOS: Questions for Sexual hx
- Who do you live with?
- If alone or family: Are you in a relationship? How do you describe it? / Are you sexually active? If no, have you ever been?
- If with partner: How do you describe it? - Do you practice safe sex?
- At what age did you become sexually active?
- How many partners?
- What is your sexual preference? Males, females, both?
- What type of sexual activity?
- Have you ever been diagnoses with an STI?
- Fever? Discharge? etc.
PBGOS: Questions for pregnancy
- How many weeks have you been pregnant?
- What is your expected delivery date?
- Was this pregnancy planned?
- Are you taking any vitamins?
- Have you been going for your regular f/u visits? When last visit?
- Any headache, leg swelling, abdominal pain or cramps?
ABCDE A: Activity of the baby. is your baby kicking like before? B: Bleeding C: Contractions / pain D: Dripping / Discharge E: EDD (expected date of delivery)
PBGOS: Questions for Baby
- Is the baby moving? How often?
- When was your last U/S? Location of planceta?
- What is your blood group? Baby?
HPI Obstetrics
- Contractions: Freq,strength, closer?
- Bleeding: Amount, clots, # pads
- Leaking: Amount, color, big gush?
- Baby movements (>20 weeks)
Current pregnancy:
- Previous US? How many>
- Problems with blood tests?
- Issues in pregnancy? Correct growth? Diabetes, HTA.
Past OB history
- All previous deliveries, VD vs CS? Preterm, term.
- Diseases
HPI Gynecological
Bleeding:
-LMP, how far apart, how long do they last, how heavy (how many pads, how frequently you change them)? Bleeding in between? Bleeding with intercourse?
Pain:
-Do you have pelvic pain, pain with periods, painful intercourse.
Discharge: COCA+B, itchiness
SEX!
-Partners, contraception, new partner, partner’s symptoms, fever/sweats/chills
PAST Gyn LMP Gyne surgeries History PAP smears-every 3 years if normal Sexual activities: STIs HRT?
Ostetrics hx
Prompt for physical exam
OBGYN-Physical
- Vitals
- Fetal HR
- General appearance
- Leopolds-position baby (US)
- SFH
- Cervix for dilation
Gynecologic: *Vitals *General appearance *Quick cardio resp exam *Abdominal PELVIC: 1. Inspection - external genitalia (warts, redness) 2. Speculum exam!!! (look at cervix and vagina, PAP smear!!!) 3. Bimanual exam: Uterus, cervix, adnexa
Abnormal bleeding
Structural (huge amounts)
- Fibroids
- Polyps
- Hyperplasia
- Endometrial cancer
- Cervical lesions (polyps, cancer)
- Infection
- >U/S, endometrial biopsy (anyone >40 AUB), PAP smear
Hormonal/ovulatory (irregular rather than huge amounts)
- PCOS: Hirsutism, acne, irregular/oligo/amenorrhea/infertility
- Prolactin-headaches, blurry vision, breast discharge
- Thyroid
- Medications - ICP (Iatrogenic)
- Perimenopause/DUB
- Premature ovarian failure - hot flashes
- > ALWAYS ask for BHCG, TSH, estrogen, FSH/LH (go up), prolactin
