Assessment of vaginal bleeding

Question 1

Causes of post coital bleeding

Answer 1

Cervical ectropion
Cervical polyp
Cervical cancer
Cervicitis
Vaginal cancer
Vaginitis

Question 2

Hx of miscarriage

Answer 2

Missed period
Reproductive age
Suprapubic pelvic pain
Moderate to severe vaginal bleeding
Post coital bleeding

Question 3

Hx of PID

Answer 3

Discharge
STI + Sexual partners
Lower abdominal pain
Intermenstrual bleeding
Fever

Question 4

Ix for miscarriage

Answer 4

Serum / Urinary hCG = Positive
USS = confirms viability of fetus
Rhesus = identifies if -ve present

Question 5

Ix for PID

Answer 5

Cervical excitation test
WWC elevated
Culture for gonorrhoeae or chlamydia

Question 6

Hx of uterine fibroids

Answer 6

Bowel/bladder change due to mass/pressure
Pelvic pain/pressure

↑alcohol and red meat
Black
Nulliparous

Question 7

Ix for uterine fibroids

Answer 7

TVUS = myomas

Question 8

Exam of uterine fibroids

Answer 8

Bulky pelvic mass palpable on bimanual

Question 9

Hx of endometrial polyp

Answer 9

Irregular spotting/bleeding between periods

Question 10

Ix for endometrial polyp

Answer 10

TVUS - endometrial thickening

Question 11

Hx of cervical polyp

Answer 11

Contact bleed - post coital / examination

Question 12

Ix for cervical polyp

Answer 12

Speculum reveals polyp
Hysteroscopy visualises polyp
TVUS - visualises further

Question 13

Ix of ectropion

Answer 13

Contact bleed

Question 14

Exam of ectropion

Answer 14

Speculum shows red rather than pink outer cervix due to shift in transformational zone

Question 15

Hx of menorrhagia

Answer 15

Heavy excessive menstrual bleeding

Question 16

Findings on exam of menorrhagia

Answer 16

Signs of underlying etiology e.g.

PCOS - acne, weight, hirsuitism
Anaemia - pallor

Question 17

Hx of PCOS

Answer 17

Irregular cycles
Interspersed amenorrhoea
Obesity, hirsuitism, acne, obesity

Question 18

Ix for PCOS

Answer 18

Serum LH: Elevated
Serum prog: decreased
Serum test: elevated

Question 19

Hx of DUB

Answer 19

Irregular menstrual period
Painless bleeding
Peripubertal / perimenopausal

Question 20

Hx of Endometrial cancer

Answer 20

> 50 years
Intermenstrual bleeding

Obesity, nulliparity, late menopause, unopposed estrogen use, tamoxifen use

Smoking
Hx or FHx of HNPCC

Question 21

Exam findings of endometrial cancer

Answer 21

Uterine enlargement and irregularity on bimanual

Question 22

Ix finding of endometrial cancer

Answer 22

TVUS - focally thickened endometrium

Biopsy - adenocarcinoma

Question 23

Hx of ovarian cancer

Answer 23

FHx of Ovarian Ca or Breast Ca
BRCA1 / BRCA2
No previous use of COCP

Non-specific GI Sx more prominent than gyne sx

e. g.
- Bloating
- Dyspepsia
- Nausea
- Diarrhoea
- Constipation

Urinary urgency is common

Question 24

Exam findings in ovarian cancer?

Answer 24

Ascites with shifting dullness
Abdominal distension w dullness to percussion
Pleural effusion with diminished breath sounds
Pelvic mass

Question 25

Hx of vaginal cancer

Answer 25

contact bleed

Question 26

Hx of ectopic pregnancy

Answer 26

``` Missed period / Amenorrhoea Pelvic pain Recent intercourse Reproductive age Known gynecological anatomic abnormality Hx of ectopic or pelvic infections (STI / appendicitis) ```

Question 27

Exam findings of ectopic

Answer 27

Tenderness on lower abdominal palpation Pain and palpable mass on bimanual Guarding Shoulder tip pain referred

Question 28

Ix findings of ectopic?

Answer 28

USS (Abdominal and TV) = gestational sac in extra-uterine location hCG = positive

Question 29

Hx of gestational trophoblastic disease (choriocarcinoma)

Answer 29

``` Missed period / amenorrhoea Reproductive age Abdominal distention Hx of hydatiform moles / molar pregnancy Acute onset vaginal bleeding ```

Question 30

Ix of choriocarcinoma?

Answer 30

hCG: positive USS: snowstorm appearance

Question 31

Hx of placental abruption

Answer 31

``` 2nd or 3rd trimester Smoking / cocaine use Trauma Hypertension Thrombophilia C-section Vaginal bleeding (may be concealed) Woody hard placental abruption ```

Question 32

Ix findings for placental abruption

Answer 32

Fetal monitoring: - late deceleration - loss of variability - sinusoidal fetal heart rate - fetal bradycardia (persistently <110)

Question 33

Hx for placenta praevia

Answer 33

``` 2nd / 3rd trimester Hx of scarred uterus Smoking Hx of multiple / missed pregnancies Advanced maternal age ``` Painless PV bleeding No uterine tenderness

Question 34

Hx of endometriosis

Answer 34

20-40 yrs Cramping cyclical pelvic pain Dysparenuia