O&G - General (History Taking and Examinations)

Question 1

Sexual History

Presenting Complaints
Menstrual History
Sexual Contact History
HIV Risk Assessment
Other Histories

Answer 1

1. ) Presenting Complaints
   - females (see gynae hx): pain, bleeding, discharge, vulval irritation, systemic sx, other sx
   - male: testicular pain/swelling, itching and/or sore skin, anogenital skin lesions, urethral discharge, dysuria
   - hx of PC: type, site, timing, onset, duration, cyclical? exacerbating/relieving factors, previous episodes

2.) Menstrual History - see gynae history

3. ) Sexual Contact History - enquire about last 3 months
   - timing of last sexual contact, was this consensual?
   - regular sexual partner or a one-off casual encounter
   - clarify the sex of the patient and country of origin
   - type of sex: penetrative? oral? drugs? no of people?
   - contraception: type, consistency, any issues
   - repeat questions for other sexual partners
4. ) HIV Risk Assessment - about partners/sex type
   - partners: HIV+, MSM, bisexual man, transactional sex
   - location: someone abroad or born in different country
   - drugs: injected drugs? previous partners injected?
5. ) Other Histories - PMH, DH, SH, FH, ICE
   - PMH: STIs, vaccines (HepB/A, HPV), gynae hx inc cervical screening, obstetric hx,
   - DH: contraception, HRT, recent abx use, allergies
   - SH: smoking, alcohol, recreational drug use, diet and weight, occupation, tattoos abroad
   - FH: STIs e.g. HIV, hepatitis, malignancy

Question 2

Gynaecological Presenting Complaints

Pain
Bleeding
Discharge 
Vulval Itching/Soreness
Other Symptoms

Answer 2

1. ) Pain
   - abdominal/pelvic pain: ectopic pregnancy, ruptured ovarian cyst, endometriosis, PID, ovarian torsion
   - superficial dyspareunia: genital herpes, vaginismus, lichen sclerosis, vaginal atrophy/menopause
   - deep dyspareunia: STI (gonorrhoea and chlamydia), PID, UTI, endometriosis, malignancy
2. ) Bleeding - abnormal vaginal bleeding
   - intermenstrual: contraception (IUS), ovulation, STI, miscarriage, perimenopause, fibroids, malignancy
   - post-coital: ectropion, cervical cancer, STI, vaginitis
   - post-menopausal: vaginal atrophy, HRT, STI, malignancy (uterine, cervical, vaginal)
3. ) Discharge - abnormal vaginal discharge
   - gonorrhoea and chlamydia
   - bacterial vaginosis: white and watery, strong fishy smell, w/o any soreness or irritation
   - trichomonas vaginalis: yellow frothy discharge with associated vaginal itching and irritation
   - candida: white, thick/curd-like, itchy, no smell
4. ) Vulval Itching/Soreness
   - chlamydia, gonorrhoea, genital herpes
   - Candida (thrush), vaginal atrophy, lichen sclerosis
5. ) Other Symptoms
   - urinary sx: frequency, urgency and dysuria
   - bowel sx: change in bowel habit or pain during defecation can be associated with endometriosis
   - abdominal distension: ascites due to ovarian cancer?
   - fever (PID), fatigue and weight loss (malignancy)

Question 3

Gynaecological History

Presenting Complaints
Menstrual History
Specific Gynae Questions 
Obstetric History
Other Histories

Answer 3

1. ) Presenting Complaints
   - pain: abdo/pelvic, dyspareunia (superficial, deep)
   - bleeding: intermenstrual, postmenopausal, postcoital
   - discharge: volume, consistency, colour, smell
   - vulval itching and/or anogenital skin changes
   - systemic sx: fever, fatigue/weight loss, rash, arthralgia
   - other sx: urinary/bowel sx, anal discharge
2. ) Menstrual History
   - duration: average is 5 days, >7 is prolonged
   - cycle length (28 +/- 7 days), is it consistent?
   - LMP: date of the first day of your LMP
   - blood flow: heavier than usual? blood clots (>10p coin)? impact on day to day life
   - pain: more painful than usual? affecting QoL?
   - age at menarche, menopause, menopause sx
3. ) Specific Gynae Questions
   - sexually active? contraception: type and brand name, previous types
   - HRT: duration, method, cyclical? combined?
   - reproductive plans: currently trying or in the future
   - past gynae conditions or surgeries
   - cervical screening: date, result, HPV vaccine
4. ) Obstetric History
   - gravidity and parity
   - current pregnancy: gestation, sx, complications
   - previous pregnancies: age of children, birth weight, mode of delivery, complications, breastfeeding?
5. ) Other Histories - PMH, DH, FH, SH, ICE
   - PMH: bleeding disorders, cancer, VTE, migraines
   - DH: contraceptives, HRT, NSAIDs, GnRH analogues
   - FH: cancer (ovarian, endometrial, breast), bleeding disorders, blood clots, diabetes
   - SH: general social context, smoking, alcohol, recreational drugs, diet and weight, occupation

Question 4

Obstetric History

Answer 4

1. ) Key Pregnancy Details - age, gravidity, parity,
   - gestational age, gravidity (no. of pregnancies regardless of outcome), parity (no of births >24wks)
2. ) Presenting Complaints
   - N+V: commonly mild, often resolves around 20wk, if persistent and severe can -> hyperemesis gravidarum
   - reduced fetal movements: women start to feel fetal movements between 16-24 wks, always enquire
   - vaginal bleeding or discharge: take a mini gynae hx
   - urinary sx: UTIs common in pregnancy
   - pre-eclampsia sx: headaches, visual disturbance, swelling, epigastric pain, reduced fetal movements
   - other sx: fever, fatigue, weight loss, pruritus
3. ) Current Pregnancy
   - gestational age, single or multiple? planned mode of delivery, use of folic acid, illnesses during pregnancy,
   - scan results: growth, placental position, anomalies
   - screening result (inc GDM), rhesus status, immunisation history
   - MH history: should be screened for psychiatric illness
4. ) Previous Obstetric History
   - gravidity and parity, gestation of any stillbirths
   - term pregnancies: gestation at delivery, birth weight, mode of delivery, complications, assisted reproduction
   - miscarriage: gestation, how and why?
   - abortion: gestation, method
   - ectopic: site, management method
5. ) Other Histories
   - PMH: gynae hx, DM, hypothyroidism, VTE, epilepsy, blood-borne viruses, genetic diseases,
   - DH: teratogenic drugs
   - FH: diabetes, genetic diseases, pre-eclampsia,
   - SH: general social context, smoking, alcohol, diet and weight, occupation, recreational drugs, domestic abuse

Question 5

Obstetric Presenting Complaints

Nausea and Vomiting
Reduced Fetal Movements
Vaginal Bleeding or Discharge
Urinary Symptoms
Pre-Eclampsia Symptoms
Other Symptoms

Answer 5

1. ) Nausea and Vomiting
   - commonly mild, often resolves around 20wk, if persistent and severe can -> hyperemesis gravidarum
2. ) Reduced Fetal Movements - women start to feel fetal movements between 16-24 wks, always enquire
   - if at 24wks have not yet felt fetal movements, they should be referred to a maternal fetal medicine unit
   - if >28wks, a handheld doppler is used to identify a HR (and CTG monitoring for >20 mins), if not present, an US must be performed

3.) Vaginal Bleeding or Discharge - take mini gynae hx

4. ) Urinary Symptoms - UTIs common in pregnancy
   - dysuria, frequency, urgency, fever
5. ) Pre-Eclampsia Symptoms
   - headaches, visual disturbance, swelling, epigastric pain, reduced fetal movements
6. ) Other Symptoms
   - fever, fatigue, weight loss, pruritus