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Reproductive block > History taking > Flashcards

History taking Flashcards

1
Q

What are some common presenting complaints in obs and gynae?

A
  • Period abnormalities
  • Pelvic pain
  • Pain on intervourse
  • Urinary incontinence
  • Prolapse
  • Infertility
  • Sterilisation request
  • Bleeding/pain in early pregnancy
  • Post menopausal bleeding
  • Vaginal discharge
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2
Q

What are the period abnormalities?

A
  • Heavy period - menorrhagia
  • Painful period - dysmenorrhea
  • Irregular period
  • Absent period - amenorrhea
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3
Q

Demographic and reproductive identifiers

A
  • Pt name
  • Age
  • Marital/relationship status
  • Parity
  • Occupation
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4
Q

What qs do you ask in a menstrual hx?

A
  • First day of last menstrual period
  • No of days of bleeding/flow
  • Length and regularity of cycle
  • Any abnormal bleeding - intermenstrual or post coital bleeding
  • Age of first period - menarche
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5
Q

What questions do you ask about contraception?

A
  • Current method of contraception and duration of use
  • Previous methods
  • Any problems w contraception?
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6
Q

What qs do you ask about obstetric hx?

A
  • Gravidity
  • Parity
  • Pregnancy outcomes
  • Birth weights
  • Modes of delivery
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7
Q

Gravidity vs parity

A

Gravidity - no of times a woman has been pregnant
Parity - no of times a woman has given birth to a fetus >24 weeks

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8
Q

What questions do you ask in a gynaecological hx?

A
  • Past problems? - ix and treatment
  • Previous gynaecological operations
  • When had last smear and what was the result?
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9
Q

What other non specific qs do you ask?

A
  • PMH
  • DH and allergies
  • FH
  • SH
  • Systems review
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10
Q

What are the qs to ask about abnormal vaginal discharge?

A
  • Volume
  • Colour - green, yellow, grey, blood stained
  • Consistency - thickened or watery
  • Smell
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11
Q

What are the 6 Cs of a sexual history?

A
  1. Contraception - what using? if any
  2. Cycle - when did you have ur last period
  3. Children - have you ever been pregnant
  4. Cytology - when did you have your last smear
  5. Chlamydia - STIs risk assessment
  6. hepatitis C/B/HIV
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12
Q

What qs do you ask someone about their last sexual contact?

A
  • Male or female
  • Regular or casual sex?
  • How long have you been together
  • Did you use a condom
  • What country was the partner from
  • What type of sex - vaginal, oral, anal
  • Any suspected infection or sx in the partner
  • How many sexual partners in the last 3 months
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13
Q

What are the hepatitis C + B screening questions?

A
  • Sex w another man
  • IVDU?
  • Chemsex?
  • Paid for sex or been paid for sex?
  • Had sex w someone not from the UK
  • Medical procedures or blood transfusions
  • Tattoos or piercings in a dodgy place
  • Sexual assault?
  • Hep B vaccine?
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14
Q

What are the key pregnancy details in an obs history?

A
  • Gestational age
  • Gravidity - number of times a woman has been pregnant, regardless of the outcome eg. G2
  • Parity - number of times a woman has given birth to child w gestational age 24 weeks or more, regardless of if alive or not
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15
Q

What are some key obstetric presenting complaints?

A
  • N+V
  • Reduced fetal movements - fetal distress or early fetal demise
  • Vaginal bleeding
  • Abdo pain
  • Vaginal discharge - STI
  • Loss of fluid - rupture of amniotic membranes
  • Headache, vistual disturb, epigastric pain and oedema - pre eclampsia
  • Pruritis - obstetric cholestasis
  • Unilat leg swelling - DVT
  • Chest pain and SOB - PE
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16
Q

N+V in pregnancy

A

Starts: 4th-7th week
Peak: 9th-16th week
Resolves: 20th week
Persistent vomiting and severe nausea = hyperemesis gravidarum

17
Q

Reduced fetal movements

A
  • Start at 16-24 weeks
  • Mother knows the usual amount of movements and if they are reduced this should be taken very seriously
  • Associated w - stillbirth, fetal growth restriction, placental insufficiency
18
Q

Vaginal bleeding

A
  • Pain
  • Associated trauma - inc domestic violence
  • Fever/malaise
  • Recent US scan results - position of the placenta
  • Cervical screening history, sexual history, PMH
  • Fatigue if suspect anaemia
  • Symptoms of hypovolaemic shoc
19
Q

Vaginal discharge

A

Changes to:
- Volume
- Colour - green, yellow, blood stained = infection
- Consistency
- Smell

20
Q

Urinary symptoms

A

UTIs common in pregnancy and need to be treated promptly - untreated = increase risk fetal death, developmental delay and cerebral palsy.
Dysuria, freq, urgency, fever

21
Q

Pre eclampsia signs and symptoms

A

Headache - severe and frontal
Swelling of hands, feet and face
Epigastric tenderness
Visual disturb - blurred of flashing lights
Reduced fetal movements

22
Q

What are the normal extras for obs history?

A
  • ICE
  • Systemic enquiry
  • Immunisation history - flu, whooping cough, Hep B
  • Is pt taking folic acid, mode of delivery, medical illness in pregnancy, single or multiple gestation
  • Mental health history
23
Q

What information are you asking for about scan results in an obs history?

A
  • Growth of fetus - CRL expected for gestation age
  • Placental position - embedded in lower third of uterine cavity = increased risk placenta praevia
  • Fetal anomalies
24
Q

What do you screen for in pregnancy?

A

In obs history need to see if patient has had screening and what the results were:
- Down’s syndrome screening
- Rhesus status and presence of any ab ?
- Hep B, HIV, syphilis

25
Q

What do you ask in previous obs history?

A
  • Gravidity and parity
  • For term pregnancies - gestation at delivery, birth weight, mode of delivery, complications , assisted reproduction, stillbirth?
  • <24 week pregnancies - miscarriage and gestation, termination of pregnancy, ectopic pregnancy
26
Q

What are the different trimesters? What problems are associated with it?

A
  • 1st trimester - 0-13 weeks, nausea, breast tenderness, freq, fatigue
  • 2nd trimester - 14-26 weeks, less likely to have sleeping problems and nausea but maybe constipation, heartburn, back pain
  • 3rd trimester - 27-40 weeks, sleep problems, incontinence, varicose veins, haemorrhoids
27
Q

What PMH do you need to know about in an obs history?

A
  • Cervical screening
  • Previous gyneacological conditions and treatments
  • Any surgical history - abdo/pelvic surgery, C section, LETZ
  • Allergies
  • DH
28
Q

What FH medical conditions do you need to ask about?

A
  • Inherited genetic conditions
  • T2DM
  • Pre eclampsia
29
Q

What do you need to ask about in SH for obs history?

A
  • General social context
  • Smoking
  • Alcohol
  • Recreational drug use
  • Diet and weight
  • Occupation
  • Domestic abuse

Reproductive block (5 decks)

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