OBY-GYN Histories

Question 1

When is N&V (aka hyperemesis gravidarum) most common? [1]

Answer 1

Between 7-20 weeks

Question 2

If N&V are the PC after 20 weeks, what are they key ddx? [3]

Answer 2

Liver condition
Gastroenteritis
Latent stage of labour

Question 3

If a fetus has reduced movements after 20 weeks, what are the key ddx? [4]

Answer 3

• Acute or chronic fetal hypoxia
• fetal anaemia
• anyhydramnios
• fetal pain
• maternal perception & maternal anxiety

Question 4

If the PC is vaginal bleeding at < 20 weeks, what are the key ddx? [5]

Answer 4

• threatened or actual miscarriage
• cervical ectropion
• cervical polyp
• cervical cancer
• trauma
• intercourse
• other sources of bleeding (haemorrhoids, UTI..)

Question 5

If the PC is vaginal bleeding at > 20 weeks, what are the key ddx? [+]

Answer 5

• threatened preterm labour
• placenta praevia
• placental abruption
• vasa praevia
• cervical ectropion
• cervical polyp
• trauma
• intercourse
• other sources of bleeding (haemorrhoids, UTI..)

Question 6

If the PC is abdominal pain bleeding at < 20 weeks, what are the key ddx? [+]

Answer 6

• Threatened miscarriage
• UTI
• constipation
• pelvic gridle pain (SPD)
• degenerating fibroids
• adnexal masses
• adhesions
• other surgical cause

Question 7

If the PC is abdominal pain bleeding at > 20 weeks, what are the key ddx? [+]

Answer 7

Threatened preterm birth
placenta abruption
UTI
pelvic gridle pain (SPD)
degenerating fibroids
other surgical causes

Question 8

If the PC is vaginal discharge at any pojnt during the pregnancy, what are the key ddx? [3]

Answer 8

Candidiasis, STI, premature preterm rupture of membranes

Question 9

If headache +/- visual disturbances are they key symptoms at < 20 weeks, what are they key ddx? [+]

Answer 9

• Dehydration
• consider h/o migraines
• hypertension
• pituitary disorders
• idiopathic intracranial hypertension
• sub-arachnoid haemorrhage
• cerebral venous thrombosis

Question 10

When should alarm bells about pre-eclampia ring when a patient presents to you? [1]

Answer 10

Frontal headache + hand & leg oedema, epigastric pain, hyperreflexia

Question 11

Obstetric cholestasis presents how? [1]

Answer 11

Clinical presentation: Intrahepatic cholestasis of pregnancy presents in the second or third trimester with the sudden onset of severe pruritus that starts on the palms and soles and quickly becomes more generalized.

Worse at night

Question 12

60% of women will have leg oedema in pregnancy. When should you suspect pre-eclampsia? [1]

Answer 12

If above the knee

Question 13

Chest pain and SOB - rule out? [1]

Answer 13

PE

Question 14

How do you structure a history based on the timeline of a patient presenting to you? [1]

Answer 14

It’s also worth noting that before 18 weeks gestation, most obstetric conditions are unlikely, therefore your history should be gynaecology focussed (e.g. abdominal pain at 8 weeks gestation could be an ectopic pregnancy).

Question 15

Vaginal discharge - 3 ddx? [3]

Answer 15

BV
Candidiasis
Gonorrhoea

Question 16

A patient presents with oligo-amenhoorhea. What are your top differentials? [5]

Answer 16

Pregnancy
PCOS
Low and High BMI
Hyperprolactinaemia
Graves’ disease
Turner’s syndrome

Oligoamenorrhoea refers to infrequent menstrual periods, with intervals exceeding 35 days but less than six months

Question 17

Dysmenorrhoea is characterised by excessive pain during the menstrual period

It is traditionally divided into primary amd secondary.
- How do they present? [2]

Answer 17

Primary dysmenorrhoea there is no underlying pelvic pathology:
* pain typically starts just before or within a few hours of the period starting
* suprapubic cramping pains which may radiate to the back or down the thigh

Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology.
- In contrast to primary dysmenorrhoea the pain usually starts 3-4 days before the onset of the period.

Dysmenorrhoea is characterised by excessive pain during the menstrual period.

Question 18

What are causes of secondary dysmenorrhoea? [5]

Answer 18

Causes include:
* endometriosis
* adenomyosis
* pelvic inflammatory disease
* intrauterine devices
* fibroids

Question 19

How do you manage primary dysmenorrhoea? [2]

Answer 19

NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production

combined oral contraceptive pills are used second line

Question 20

A patient presents with intermenstrual bleeding.

What are the key differentials? [5]

Answer 20

Intermenstrual bleeding:
- contraception
- uterine fibroids
- polyps
- malignancy
- STI

Question 21

A patient presents with menopausal symptoms. What are they likely to be? [5]

Answer 21

Hot flushes
vaginal atrophy
fatigue
insomnia
muscular pains
loss of libido

Question 22

A patient presents with gyne lumps / skin conditions.

What are your key differentials? [4]

Answer 22

Bartholin’s cysts
vaginal atrophy
vaginal thrush
Herpes
gonorrhea
lichen sclerosus

Question 23

Gyn Hx:

A patient presents with abdominal pain. What are the key differentials if they it is acute [5] or chronic [4] pain?

Answer 23

Acute: ectopic pregnancy, ruptured ovarian cyst, haemorrhagic corpus luteum, ovarian torsion

Chronic: endometriosis, pelvic inflammatory disease, adhesions, prolapse (gravity)