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OBG: Functional Gynaecology > Gynae history and vaginal exam > Flashcards

Gynae history and vaginal exam Flashcards

1
Q

What are 10 key areas to cover in the gynaecological history?

A
  1. Patient identification (name, age, occupation, parity)
  2. Key points to know straight away
  3. Presenting complaint
  4. Specific gynaecological questioning
  5. Previous gynaecological history
  6. Previous obstetric history
  7. Past medical and surgical history
  8. Family history
  9. Social history
  10. Drug/allergy histories
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2
Q

What are 4 key parts of the patient identification at the start of gynaecological history taking?

A
  1. Name
  2. Age
  3. Occupation
  4. Parity
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3
Q

What are the 5 points of useful information to know straight away in the gynaecological history?

A
  1. Last menstrual period (LMP)
  2. Pregnant or not pregnant
  3. Contraception used/not used
  4. Last cervical smear (if over 25 years)
  5. Last mammogram (if over 50 years)
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4
Q

What are 6 things to ask about the presenting complaint?

A
  1. Nature
  2. duration
  3. Relationship to menstrual cycle
  4. Relationship to bowels
  5. Relationship to urinary symptoms
  6. Any vaginal discharge or bleeding
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5
Q

What are 7 aspects of the specific gynaecological questioning to perform?

A
  1. Menses
  2. Pain
  3. Last cervical smear
  4. Vaginal discharge
  5. Urinary symptoms
  6. Bowel symptoms
  7. Contraceptive history
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6
Q

What are 6 questions to ask regarding menses in the gynaecological history?

A
  1. 1st day of last menstrual period (LMP)
  2. Number of days of bleeding
  3. Length of full cycle
  4. Regularity of cycle
  5. Heavy menstrual bleeding? indicated by clots, numerous pads, flooding
  6. Any unscheduled bleeding - post-menopausal, inter-menstrual, post-coital
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7
Q

What are 3 things to ask about that can indicate heavy menstrual bleeding?

A
  1. Clots
  2. Numerous pads
  3. Flooding
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8
Q

What are 3 types of unscheduled bleeding to ask about when considering menses in the gynaecogical history?

A
  1. Post-menopausal
  2. Inter-menstrual
  3. Post-coital
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9
Q

What should you ask a woman about her last cervical smear?

A

When was it, was it normal

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10
Q

What are three things to consider when asking about vaginal discharge?

A
  1. Abnormal colour?
  2. Malodorous?
  3. Itchy?
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11
Q

What are 5 urinary symptoms to ask about?

A
  1. Dysuria
  2. Frequency
  3. Nocturia
  4. Urge
  5. Incontinence (stress or urge symptoms)
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12
Q

What are 4 bowel symptoms to ask about in the gynaecological history?

A
  1. Bloatedness
  2. Constipation
  3. Relief of pain with bowel opening
  4. Weight loss or appetite disturbance
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13
Q

What should you ask about in the contraceptive history?

A

current and previous methods

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14
Q

What are 3 things to ask about concerning pain in the gynaecological history?

A
  1. Dyspareunia
  2. Dysmenorrhoea
  3. Cyclical/non-cyclical pelvic pain
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15
Q

What are 3 important things to ask about in the previous gynaecological history?

A
  1. Known disorders e.g. PID, STIs, ectopics, known endometriosis
  2. Previous gynaecological surgery
  3. Previous pregnancies ending <24 weeks miscarriages, ectopics, abortions, molar pregnancies
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16
Q

What are 4 types of gynaecological history to ask about specifically?

A
  1. previous PID
  2. STIs
  3. ectopics
  4. known endometriosis
17
Q

In the case of previous pregnancies ending <24 weeks, what are 4 situations when this could happen?

A
  1. Miscarriages
  2. Ectopics
  3. Abortions
  4. Molar pregnancies (aka hydatidiform mole; abnormal growth of trophoblasts which normally form placenta
18
Q

What should you note about previous pregnancies ending <24 weeks?

A

date and mode of delivery, any complications

19
Q

What are 3 key conditions to ask about in family history in gynaecological history?

A
  1. Cancer
  2. Menstrual disorders like fibroids or endometriosis
  3. DVT, PE
20
Q

What is the notation for gravidity and parity?

A
  • Gravidity = total number of pregnancies experienced
  • Parity = 2 parts.
    • 1st: number of deliveries >24 weeks and any pregnancies delivered <24 gestation if live born.
    • 2nd: number of pregnancies ended before 24 weeks i.e. miscarriage, ectopic, abortion and molar pregnancy
  • e.g. G3, P2+1
21
Q

When do you mention gravidity and parity in summaries for obstetric and gynaecological histories?

A
  • only mention gravidity (as well as parity) in obstetric history summaries
  • in gynae consultations, only need to mention parity as patient is not pregnant
22
Q

When will the total for gravidity and parity differ?

A

if pregnant at time of consultation; total of G will exceed total of P by one

23
Q

What are 6 aspects of the gynaecological examination?

A
  1. General examination
  2. Abdominal examination
  3. Pelvic examination:
    1. visual inspection
    2. speculum examination
    3. digital examination
    4. sim’s speculum
24
Q

What must you do before starting the gynaecological examination?

A

Check patient name and DOB, ask for consent, ask about any pain

25
Q

What are 4 aspects to the general gynaecological examination?

A
  1. Hands: pulse
  2. Conjunctivae: anaemia
  3. Lymph nodes: if cancer suspected. supraclavicular, axillary, inguinal
  4. Breasts: ask if self-examines. Not routine but may be part of it
26
Q

What does the abdominal part of a gynaecological examination involve?

A
  • any palpable liver, spleen, kidneys
  • any abdominal or pelvic masses
  • can you get below the mass (i.e. not truly pelvic origin)
  • size, consistency of any mass
27
Q

What does visual inspection for the pelvic part of the examination involve?

A

look at vulva for any lesions, inflammation, ulceration or prolapse

28
Q

What type of speculum is used for the first part of the speculum examination?

A

Cusco’s bivalve speculum

29
Q

How do you perform speculum examination with a Cusco’s bivalve speculum?

A
  • Use Aquagel to lubricate speculum tip prior to insertion
  • Labia are parted and speculum gently introduced into vagina in a rotational manoeuvre so tightening screw points upwards
  • Gently open blades to bring cervix into view
  • Inspect vagina and cervix
  • Close and withdraw speculum gently in opposite rotational manoeuvre to insertion
30
Q

How should a digital examination be performed as part of the pelvic examination?

A
  • lubricated gloved finger (or 2 fingers) inserted in vagina to palpate cervix
  • Palmar aspect of contralateral hand placed over suprapubic area and attempt made to palpate uterus abdominally by digitally elevating the cervix/ posterior fornix vaginally
  • Similar technique used to assess pouch of Douglas (posterior fornix) and adnexae (lateral fornices) to assess size, shape, mobility and tenderness of the uterus and ovaries
31
Q

In what position should the patient be when examining with a Sim’s speculum?

A

Sim’s left lateral position

32
Q

When might you perform examination with a Sim’s speculum?

A

anterior and posterior vaginal wall prolapses

33
Q

What additional type of examination may be performed along with the gynaecological examination?

A

Rectal examination

OBG: Functional Gynaecology (7 decks)

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