Gynaecological history Flashcards
What pain is associated with ectopic pregnancies?
Shoulder tip pain
What are causes of abdominal and pelvic pain?
- Ectopic pregnancy
- Ruptured ovarian cyst
- Endometriosis
- Pelvic inflammatory disorder
- Ovarian torsion
What are causes of post-coital vaginal bleeding?
- Cervical ectropion
- Cervical cancer
- Gonorrhoea
- Chlamydia
- Vaginitis
What are causes of intermenstrual vaginal bleeding?
- Contraception
- Ovulation
- Miscarriage
- Gonorrhoea
- Chlamydia
- Uterine fibroids
- Perimenopause
- Malignancy (e.g. uterine cancer, cervical cancer, vaginal cancer)
What are causes of post-menopausal bleeding?
- Vaginal atrophy
- Hormone replacement therapy
- Malignancy (e.g. uterine cancer, cervical cancer and vaginal cancer).
What are causes of abnormal vaginal discharge?
Bacterial vaginosis, chlamydia and gonorrhoea.
What are causes of dyspareunia?
- Endometriosis
- Vaginal atrophy
- Gonorrhoea
- Chlamydia.
What are causes of vulval skin changed and itching?
- Vaginal atrophy
- Vaginal thrush
- Gonorrhoea
- Lichen sclerosus.
What would you ask about discharge?
- Volume
- Colour
- Consistency
- Smell
How can you recognise different diseases based on discharge?
- Gonorrhoea and chlamydia may present with abnormal vaginal discharge.
- Bacterial vaginosis typically presents with an offensive, fishy-smelling vaginal discharge, without any associated soreness or irritation.
- Trichomonas vaginalis typically presents with yellow frothy discharge with associated vaginal itching and irritation.
What are important symptoms to cover during a gynaecology history?
- Urinary symptoms
- Bowel movements
- Fever
- Fatigue
- Unintentional weight loss
- Abdominal distension
- PV bleeding, PV discharge, pain, pregnancy
What systemic enquiry would you do for a gynaecology history?
- Systemic: fatigue (e.g. anaemia), fever (e.g. pelvic inflammatory disease, urinary tract infection), weight loss (e.g. endometrial cancer)
- Respiratory: dyspnoea (e.g. anaemia), haemoptysis (e.g. endometriosis)
- Gastrointestinal: abdominal pain (e.g. ectopic pregnancy, dysmenorrhoea), painful defecation (e.g. endometriosis), abdominal bloating (e.g. ovarian cancer)
- Genitourinary: urinary frequency, dysuria and urgency (e.g. urinary tract infection), abnormal vaginal discharge (e.g. vaginal candidiasis, gonorrhoea)
- Musculoskeletal: shoulder tip pain (e.g. ectopic pregnancy)
- Dermatological: white patches on the vulva/vagina associated with pruritis (e.g. lichen sclerosus)
What extra bits would you consider during a gynaecology history?
Think MOSC
- Menstrual cycle
- Obstetric history
- Sexual history
- Cervical smear and contraception history
What would you clarify about menstrual cycle?
- Duration
- Frequency and predictability
- Menstrual blood flow
- Menstrual pain
- Date of last menstrual period
- Age at menarche
- Menopause
What would you clarify about the obstetric history ?
- Contraception
- Number of children
- Miscarriages
- Terminations
What would you clarify about the sexual history ?
- Regular partner and their sex
- Number of partners in last 3/6/12 months?
- Intercourse: pain
- Infertility
What would you clarify about the cervical smear and contraception history ?
- Smear: date of last smear, results
2. Contraception
What questions are important to ask in the past medical history?
- Migraine with aura
- Previous venous thromboembolism (VTE)
- Breast cancer (current or previous)
- Bleeding disorders
What questions are important to ask in the family history?
“Is there any history of cancer of the womb, ovaries or breasts in your close relatives?” (e.g. BRCA gene)
“Is there any history of bleeding disorders in your family?” (menorrhagia can be the first presenting symptom of an inherited bleeding disorder e.g. Von Willebrand disease)
“Have any of your close family members had blood clots in the past?”
