History taking in O and G Flashcards
Never forget to ask these in an O and G history
Last menstrual period (LMP) First day of last period Cycle (time from 1st day of last period to 1st day of current period) Contraception/sexually active Last smear
History questions to include for menorrhagia
How often change pads/tampons Clots size of tampons/pads/nighttime pads etc Time off work Flooding (blood so heavy it goes through clothes) Getting up at night
Where can you get referred pain in an ectopic pregnancy?
Shoulder tip pain
Why can you get shoulder tip pain in an ectopic pregnancy?
Fluid or blood in belly irritates the diaphragm which is innervated by the phrenic nerve -> therefore pain in the shoulder
What does a vaginal examination look at?
Size of uterus Position of uterus Cervical excitation/tenderness Mobility of uterus Adnexal masses
What extra questions are asked in an obstetric history?
Parity Gynae history POH FH/genetic history Other children (who looks after them) Smoker Domestic abuse
Parity equation
no of deliveries after 24 weeks + no of deliveries before 24 weeks
Questions asked about previous pregnancies and outcomes
Date Type of delivery LB/SB Weight and sex Any problems in pregnancy/delivery/post natally
If think there is a sexual problem, what must you ask about?
Urinary symptoms
If the patient has pelvic pain, what should be asked about?
Bowel movements
In a gynae history, what is very important that must be asked about?
IMB
What should be asked when exploring dysmenorrhoea?
When
- Before period?
- 1st day of period?
- Between cycles?
When is the most common time to get dysmenorrhoea?
1st day of cycle
What does pain before the period come suggest?
Endometriosis
What to ask in a sexual history
Sexually active? Contraception? How compliant? Gender of partner Recent new partners Type of sex No. of partners in the last 3 months Any STIs - treatment - if partner was treated Paternity history of STI Last unprotected intercourse Pregnant? Dyspuria Post coital bleeding Drug abuse - sharing needles? Possibly ask about ethnicity/background of partner Outside / in country Payment for sex
