OBY-GYN Histories Flashcards
When is N&V (aka hyperemesis gravidarum) most common? [1]
Between 7-20 weeks
If N&V are the PC after 20 weeks, what are they key ddx? [3]
Liver condition
Gastroenteritis
Latent stage of labour
If a fetus has reduced movements after 20 weeks, what are the key ddx? [4]
- Acute or chronic fetal hypoxia
- fetal anaemia
- anyhydramnios
- fetal pain
- maternal perception & maternal anxiety
If the PC is vaginal bleeding at < 20 weeks, what are the key ddx? [5]
- threatened or actual miscarriage
- cervical ectropion
- cervical polyp
- cervical cancer
- trauma
- intercourse
- other sources of bleeding (haemorrhoids, UTI..)
If the PC is vaginal bleeding at > 20 weeks, what are the key ddx? [+]
- threatened preterm labour
- placenta praevia
- placental abruption
- vasa praevia
- cervical ectropion
- cervical polyp
- trauma
- intercourse
- other sources of bleeding (haemorrhoids, UTI..)
If the PC is abdominal pain bleeding at < 20 weeks, what are the key ddx? [+]
- Threatened miscarriage
- UTI
- constipation
- pelvic gridle pain (SPD)
- degenerating fibroids
- adnexal masses
- adhesions
- other surgical cause
If the PC is abdominal pain bleeding at > 20 weeks, what are the key ddx? [+]
Threatened preterm birth
placenta abruption
UTI
pelvic gridle pain (SPD)
degenerating fibroids
other surgical causes
If the PC is vaginal discharge at any pojnt during the pregnancy, what are the key ddx? [3]
Candidiasis, STI, premature preterm rupture of membranes
If headache +/- visual disturbances are they key symptoms at < 20 weeks, what are they key ddx? [+]
- Dehydration
- consider h/o migraines
- hypertension
- pituitary disorders
- idiopathic intracranial hypertension
- sub-arachnoid haemorrhage
- cerebral venous thrombosis
When should alarm bells about pre-eclampia ring when a patient presents to you? [1]
Frontal headache + hand & leg oedema, epigastric pain, hyperreflexia
Obstetric cholestasis presents how? [1]
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
60% of women will have leg oedema in pregnancy. When should you suspect pre-eclampsia? [1]
If above the knee
Chest pain and SOB - rule out? [1]
PE
How do you structure a history based on the timeline of a patient presenting to you? [1]
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).
Vaginal discharge - 3 ddx? [3]
BV
Candidiasis
Gonorrhoea
A patient presents with oligo-amenhoorhea. What are your top differentials? [5]
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
Dysmenorrhoea is characterised by excessive pain during the menstrual period
It is traditionally divided into primary amd secondary.
- How do they present? [2]
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.
What are causes of secondary dysmenorrhoea? [5]
Causes include:
* endometriosis
* adenomyosis
* pelvic inflammatory disease
* intrauterine devices
* fibroids
How do you manage primary dysmenorrhoea? [2]
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
A patient presents with intermenstrual bleeding.
What are the key differentials? [5]
Intermenstrual bleeding:
- contraception
- uterine fibroids
- polyps
- malignancy
- STI
A patient presents with menopausal symptoms. What are they likely to be? [5]
Hot flushes
vaginal atrophy
fatigue
insomnia
muscular pains
loss of libido
A patient presents with gyne lumps / skin conditions.
What are your key differentials? [4]
Bartholin’s cysts
vaginal atrophy
vaginal thrush
Herpes
gonorrhea
lichen sclerosus
Gyn Hx:
A patient presents with abdominal pain. What are the key differentials if they it is acute [5] or chronic [4] pain?
Acute: ectopic pregnancy, ruptured ovarian cyst, haemorrhagic corpus luteum, ovarian torsion
Chronic: endometriosis, pelvic inflammatory disease, adhesions, prolapse (gravity)
