History taking Flashcards

1
Q

Where might you take a gynaecological history?

A

Outpatient clinic (general, infertility, colposcopy)
Pre-operative in theatre assessment unit
Inpatient ward (acute admission, post-operative)

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2
Q

What are the differences in gynaecological history taking?

A

Personal consultations
Ensure privacy and confidentiality
Time to talk, open questions
Majority of gynaecology is benign
- Effect on lifestyle/QoL
- Full discussion of management options

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3
Q

What is important to take account of in a gynaecological history?

A

Age - women have clear gynaecological and reproductive timeline (pre- and post-menopausal)
Hidden agenda - may be underlying psychological or sexual abuse

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4
Q

What are the key gynaecological symptoms?

A

Abdominal pain in early pregnancy
Abdominal pain not in pregnancy
- Dysmenorrhoea
- Dyspareunia
Bleeding in early pregnancy
Bleeding not in pregnancy
- Menorrhagia
- IMB, PCB, PMB
Discharge/infection
Fertility
Prolapse/incontinence

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5
Q

What are the key parts of a gynae history?

A

PC
HPC
PMH
PSH
Review of symptoms
Menstrual history
Contraception and future fertility plans
Sexual history
Smears
Past gynae history
Past obstetric history
Medical and surgical history
Family history
Social history

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6
Q

What is important to ask in a gynae pain history?

A

SOCRATES
Associated symptoms - PV bleeding/discharge/dyspareunia
LUTS
Change in bowel habit/dyschezia/haematochezia
Pregnant?
Cyclical (endometriosis)
Non-cyclical - PID/ectopic/ovarian cysts
Dyspareunia

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7
Q

What is important to about in a bleeding in pregnancy history?

A

Last menstrual period (1st day of bleeding) to estimate gestation
What are periods normally like?
How many days bleeding/how many days between eg 5/28 (number of days period lasts/number of days of cycle) - has it carried on from last period?
Quantify how heavy bleeding is - number of pads/tampons, flooding, symptoms of anaemia
Pain?

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8
Q

How can you quantify how heavy bleeding is?

A

Number of pads/tampons
Flooding
Symptoms of anaemia
Really heavy if filled a pad and soaking into clothes in 15 minutes or see it dripping into toilet - haemorrhaging level of bleeding
Heavy if too much for woman’s life

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9
Q

What should you ask in a bleeding outside of pregnancy history?

A

Period history (length/frequency/quantify)
IMB/PCB (red flags for endometrial/cervical cancer)
Other symptoms (pain, LUTS, bowels)
Any previous treatment (contraception/TXA/NSAIDs)
Symptoms of anaemia

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10
Q

What should you ask everyone in a obs and gynae history?

A

Gravidity - number of pregnancies regardless of outcome, included ectopic, miscarriages, terminations, includes current pregnancy
Parity - number of deliveries after 24 weeks regardless of outcome, does not matter if child alive, stillbirth, neonatal death
Modes of delivery (CS/instrumental/normal)
How many weeks child born?
Any problems in previous pregnancy or delivery?
LMP and period history
Menopause - when? when was last period?
Contraception - implant/coil how long there for? when started contraception?
Smears - starts at 25, UTD?, results?
Any STIs and BV and thrush

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11
Q

What should you ask in a fertility history?

A

Are they having sex? How often? How are they having sex?
Any previous children for either partner? - not eligible for IVF on NHS if one has previous child
Any pre-existing health problems
Medication (prescription and non-prescription)
- Lots of male factor infertility due to taking protein supplements and steroids

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12
Q

How many times does a couple have to have sex a week before they can be thought of as infertile?

A

At least 3 times a week before classified as infertile

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13
Q

What questions should you ask in a prolapse history?

A

Can come with urinary incontinence
Dragging/bulging sensation - when do you feel it? when did it start?
Urinary and bowel symptoms (continence)
Sexual symptoms - ask all women in sexually active - if still sexually active can alter management problems
ICE - what is their main concern as will guide management
- Do they care about the bulge?
- What is main issue? Might just be continence

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14
Q

What is stress incontinence?

A

Leak of urine when coughing/exercising
Increases in intra-abdominal pressure overcoming sphincter resistance

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15
Q

What is urge incontinence?

A

Overactive bladder
Key in lock
Unable to control urge to wee

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16
Q

What should you determine in an incontinence history?

A

Do you notice when you leak?
Which type of incontinence is more of a problem? Often multifactorial

17
Q

What is postmenopausal?

A

No periods for 1 year after the age of 50 (2 years if <50 years)