Gynae history and vaginal exam

Question 1

What are 10 key areas to cover in the gynaecological history?

Answer 1

1. Patient identification (name, age, occupation, parity)
2. Key points to know straight away
3. Presenting complaint
4. Specific gynaecological questioning
5. Previous gynaecological history
6. Previous obstetric history
7. Past medical and surgical history
8. Family history
9. Social history
10. Drug/allergy histories

Question 2

What are 4 key parts of the patient identification at the start of gynaecological history taking?

Answer 2

1. Name
2. Age
3. Occupation
4. Parity

Question 3

What are the 5 points of useful information to know straight away in the gynaecological history?

Answer 3

1. Last menstrual period (LMP)
2. Pregnant or not pregnant
3. Contraception used/not used
4. Last cervical smear (if over 25 years)
5. Last mammogram (if over 50 years)

Question 4

What are 6 things to ask about the presenting complaint?

Answer 4

1. Nature
2. duration
3. Relationship to menstrual cycle
4. Relationship to bowels
5. Relationship to urinary symptoms
6. Any vaginal discharge or bleeding

Question 5

What are 7 aspects of the specific gynaecological questioning to perform?

Answer 5

1. Menses
2. Pain
3. Last cervical smear
4. Vaginal discharge
5. Urinary symptoms
6. Bowel symptoms
7. Contraceptive history

Question 6

What are 6 questions to ask regarding menses in the gynaecological history?

Answer 6

1. 1st day of last menstrual period (LMP)
2. Number of days of bleeding
3. Length of full cycle
4. Regularity of cycle
5. Heavy menstrual bleeding? indicated by clots, numerous pads, flooding
6. Any unscheduled bleeding - post-menopausal, inter-menstrual, post-coital

Question 7

What are 3 things to ask about that can indicate heavy menstrual bleeding?

Answer 7

1. Clots
2. Numerous pads
3. Flooding

Question 8

What are 3 types of unscheduled bleeding to ask about when considering menses in the gynaecogical history?

Answer 8

1. Post-menopausal
2. Inter-menstrual
3. Post-coital

Question 9

What should you ask a woman about her last cervical smear?

Answer 9

When was it, was it normal

Question 10

What are three things to consider when asking about vaginal discharge?

Answer 10

1. Abnormal colour?
2. Malodorous?
3. Itchy?

Question 11

What are 5 urinary symptoms to ask about?

Answer 11

1. Dysuria
2. Frequency
3. Nocturia
4. Urge
5. Incontinence (stress or urge symptoms)

Question 12

What are 4 bowel symptoms to ask about in the gynaecological history?

Answer 12

1. Bloatedness
2. Constipation
3. Relief of pain with bowel opening
4. Weight loss or appetite disturbance

Question 13

What should you ask about in the contraceptive history?

Answer 13

current and previous methods

Question 14

What are 3 things to ask about concerning pain in the gynaecological history?

Answer 14

1. Dyspareunia
2. Dysmenorrhoea
3. Cyclical/non-cyclical pelvic pain

Question 15

What are 3 important things to ask about in the previous gynaecological history?

Answer 15

1. Known disorders e.g. PID, STIs, ectopics, known endometriosis
2. Previous gynaecological surgery
3. Previous pregnancies ending <24 weeks miscarriages, ectopics, abortions, molar pregnancies

Question 16

What are 4 types of gynaecological history to ask about specifically?

Answer 16

1. previous PID
2. STIs
3. ectopics
4. known endometriosis

Question 17

In the case of previous pregnancies ending <24 weeks, what are 4 situations when this could happen?

Answer 17

1. Miscarriages
2. Ectopics
3. Abortions
4. Molar pregnancies (aka hydatidiform mole; abnormal growth of trophoblasts which normally form placenta

Question 18

What should you note about previous pregnancies ending <24 weeks?

Answer 18

date and mode of delivery, any complications

Question 19

What are 3 key conditions to ask about in family history in gynaecological history?

Answer 19

1. Cancer
2. Menstrual disorders like fibroids or endometriosis
3. DVT, PE

Question 20

What is the notation for gravidity and parity?

Answer 20

• Gravidity = total number of pregnancies experienced
• Parity = 2 parts.
  
  • 1st: number of deliveries >24 weeks and any pregnancies delivered <24 gestation if live born.
  • 2nd: number of pregnancies ended before 24 weeks i.e. miscarriage, ectopic, abortion and molar pregnancy
• e.g. G3, P2+1

Question 21

When do you mention gravidity and parity in summaries for obstetric and gynaecological histories?

Answer 21

• only mention gravidity (as well as parity) in obstetric history summaries
• in gynae consultations, only need to mention parity as patient is not pregnant

Question 22

When will the total for gravidity and parity differ?

Answer 22

if pregnant at time of consultation; total of G will exceed total of P by one

Question 23

What are 6 aspects of the gynaecological examination?

Answer 23

1. General examination
2. Abdominal examination
3. Pelvic examination:
   
   1. visual inspection
   2. speculum examination
   3. digital examination
   4. sim’s speculum

Question 24

What must you do before starting the gynaecological examination?

Answer 24

Check patient name and DOB, ask for consent, ask about any pain

Question 25

What are 4 aspects to the general gynaecological examination?

Answer 25

1. Hands: pulse 2. Conjunctivae: anaemia 3. Lymph nodes: if cancer suspected. supraclavicular, axillary, inguinal 4. Breasts: ask if self-examines. Not routine but may be part of it

Question 26

What does the abdominal part of a gynaecological examination involve?

Answer 26

* any palpable liver, spleen, kidneys * any abdominal or pelvic masses * can you get below the mass (i.e. not truly pelvic origin) * size, consistency of any mass

Question 27

What does visual inspection for the pelvic part of the examination involve?

Answer 27

look at vulva for any **lesions**, **inflammation**, **ulceration** or **prolapse**

Question 28

What type of speculum is used for the first part of the speculum examination?

Answer 28

Cusco's bivalve speculum

Question 29

How do you perform speculum examination with a Cusco's bivalve speculum?

Answer 29

* Use Aquagel to lubricate speculum tip prior to insertion * Labia are parted and speculum gently introduced into vagina in a rotational manoeuvre so tightening screw points upwards * Gently open blades to bring cervix into view * Inspect vagina and cervix * Close and withdraw speculum gently in opposite rotational manoeuvre to insertion

Question 30

How should a digital examination be performed as part of the pelvic examination?

Answer 30

* lubricated gloved finger (or 2 fingers) inserted in vagina to palpate cervix * Palmar aspect of contralateral hand placed over suprapubic area and attempt made to palpate uterus abdominally by digitally elevating the cervix/ posterior fornix vaginally * Similar technique used to assess pouch of Douglas (posterior fornix) and adnexae (lateral fornices) to assess size, shape, mobility and tenderness of the uterus and ovaries

Question 31

In what position should the patient be when examining with a Sim's speculum?

Answer 31

Sim's left lateral position

Question 32

When might you perform examination with a Sim's speculum?

Answer 32

anterior and posterior vaginal wall prolapses

Question 33

What additional type of examination may be performed along with the gynaecological examination?

Answer 33

Rectal examination