Obs and gynae Flashcards

1
Q

What to establish early on in obstetric consultation?

A

Gravidity and parity
Gravidity= the number of times a woman has been pregnant, regardless of outcome
Parity= total number of times a woman has given birth to a child with a gestational age of 24 weeks or more- regardless of whether the child was born alive or not

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2
Q

Key obstetric symptoms?

A

Nausea and vomiting, reduced fetal movements, vaginal bleeding, abdominal pain, vaginal discharge or loss of fluid, headache+ visual disturbance+ epigastric pain+ oedema= pre-eclampsia, pruritis, unilateral leg swelling- rule out DVT, chest pain+SOB, systemic symptoms

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3
Q

When is nausea and vomiting common in pregnancy? When can fetal movements be felt?

A

Between 4th and 7th week of gestation, peak 9th-16th week, resolve by 20th week
Start between 16-24 weeks

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4
Q

What to ask about with vaginal bleeding?

A

Pain, associated trauma, fever/ malaise, recent USS results, cervical screening hx, sexual hx, past medical hx, fatigue if anaemia suspected, symptoms of hypovolaemic shock

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5
Q

Changes in what for vaginal discharge? Common symptoms of UTIs?

A

Volume, colour, consistency, smell

Dysuria, frequency, urgency, fever

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6
Q

Weight loss symptom of? Pruritis?

A

Hyperemesis gravidarum, obstetric cholestasis

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7
Q

Systemic enquiry for ob hx?

A

Systemic: fatigue- anaemia, fever- chorioamnionitis, UTI
Resp: dyspnoea e.g. PE, anaemia, chest pain- PE
Gastro: abdo pain- placental abruption, vomiting e.g. hyperemesis gravidarum
GU: urinary freq, dysuria and urgency- UTI, abnormal discharge- vaginal candidiasis, gonorrhoea
Neuro: visual changes, motor/ sensory changes, headache
MSK: pelvic pain e.g. symphysis pubis dysfunction
Derm: rashes, skin lesions, linea nigra

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8
Q

Things for current pregnancy?

A

Gestation and EDD- using USS to measure crown-rump length, scan results between 18+0 and 20+6 weeks, screening- Down’s, rhesus status+ ABs, hepatitis B, HIV and syphilis, other details: singleton/ multiple, folic acid before conception and during 1st trimester, planned mode of delivery, medical illness, immunisation hx- flu, whooping cough, hep B, mental health

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9
Q

Things for previous ob hx?

A

Gravidity and parity, term pregnancies> 24 weeks: gestation at delivery, birth weight, mode of delivery, complications, assisted reproduction, any stillbirths (24+ weeks born dead,) other pregnancies< 24weeks: miscarriages- gestation, other management, termination- gestation and management method, ectopic pregnancy- site and how managed

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10
Q

Gynae hx in ob hx?

A

Cervical screening- date and result of last one, tx if abnormal, previous conditions and tx

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11
Q

Past medical hx in ob hx?

A

Especially diabetes, hypothyroidism, epilepsy, previous VTE, blood-borne viruses, genetic disease
Abdo/ pelvic surgery, previous c-section, LETZ, allergies

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12
Q

Drug hx? Teratogenic drugs? Common in pregnancy?

A

Current/ stopped meds, contraceptions, SEs
ACEi, sodium valproate, methotrexate, retinoids, trimethoprim
Folic acid, oral iron, antiemetics, antacids, aspirin

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13
Q

Family hx?

A

Genetic conditions, type 2 diabetes, pre-eclampsia

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14
Q

Social hx?

A

Living, smoking, alcohol, drug use, diet and weight, occupation, domestic abuse

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15
Q

Key initial gynae details in hx?

A

Last menstrual period, gravidity and parity

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16
Q

Key gynae symptoms?

A

Abdo and pelvic pain, post-coital vaginal bleeding, IM bleeding, post-menopausal bleeding, abnormal vaginal discharge, dyspareunia, vulva skin changes and itching, systemic symptoms

17
Q

Examination details?

A

Intro, hygiene, explain, verbal consent, chaperone, bimanual, speculum

18
Q

Qs for dyspareunia?

A

Superficial on genitalia or deep within the pelvis

Duration, location, nature

19
Q

Causes of vulval skin changes?

A

Infections- candida, bacterial vaginosis and STIs, vaginal atrophy, lichen sclerosis

20
Q

Menstrual hx within gynae hx?

A

Duration of periods- average= 5 days, frequency- regular+ predictable?, volume of flow (heavy= >80mls or >7 days,) menstrual pain, 1st day of last period, age of menarche, age of menopause- hot fluses+ vaginal dryness if perimenopausal

21
Q

Contraception in gynae hx? Reproductive plans?

A

Combined, POP, depot injection, long-acting reversible contraceptives- coil, implant and copper coil, barrier methods, previous hx
Considering having children in the future

22
Q

Past medical hx for gynae hx? Relevant to gynae?

A

Ectopic pregnancy, STIs, endometriosis, Bartholin’s cyst, cervical ectropion, malignancy
Surgeries, cervical screening- date+ result, treatment, vaccinated against HPV
Migraine w/ aura, previous VTE, breast cancer, bleeding disorders

23
Q

Obstetric hx?

A

Gravidity and parity, current pregnancy, previous pregnancies- age, birthweight, mode of delivery, complications

24
Q

Drug hx? Common for gynae conditions?

A

St John’s wart–> increases metabolism of COCP reducing its effectiveness, ABx may cause secondary vaginal thrush
HRT- duration, method of delivery, frequency, type
Tranexamic acid- menorrhagia, contraceptives, HRT, NSAIDs, GnRH analogues- endometriosis

25
Q

Family hx in gynae hx?

A

Ovarian, endometrial/ breast cancer, bleeding disorders, blood clots