gynae history taking

8/12/2019 Gynae History Taking

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Special Tutorial Programme

Professor Deirdre J MurphyTrinity College


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Introduction to Gynaecology


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Objectives

Gynaecological History

Gynaecological examination

Cervical screening

Practice assessment


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Gynaecological history

Menses

Sexual/Contraception

Cervical smearUrinary

Prolapse

Pregnancies


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Complete History

Demographics

Specific gynaecological history

Past Obstetric historyPast Medical/Surgical/Psych history

Family history

Social historyMedication / Allergies

Systems review


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Heavy bleeding

Pelvic pain

Leaking urine

Failure to conceive


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Heavy bleeding


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Heavy bleeding

Menarche / LMP / Menopause

How often / How long / Regularity

Heavy / volume

Intermenstrual bleedingPostcoital bleeding

Vaginal discharge

Pain

[Intercourse / contraception /smear /urinary / prolapse / obstetric]


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Pelvic pain


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Leaking urine


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Leaking urine

Urgency

Stress symptoms

Frequency

NocturiaDysuria

Bowel symptoms

Prolapse symtoms[Menses /Intercourse / contraception/smear / obstetric]


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Failure to conceive


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Subfertility

History of a couple

DurationIntercourse

Previous pregnancies


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Female

Menses

Pelvic pain

Vaginal dischargeDyspareunia

Hirsutism

Medical

Cervical treatment

Previous pregnancies

Lifestyle


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Male

Infections

Medical illnesses

LifestyleSterilisation

Impotence / Failure to ejaculate


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Intelligent history

Comprehensive but efficient

Differential diagnosis

Targeted questioning

Prioritising diagnosis

Focus examination


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Consent / Chaperone / Dignity


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General examination

Appearance

Weight

Vital signs pulse

blood pressure

temp

Cardiovascular

Respiratory

Breast / Axillae

Lymph nodes


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Abdomen

Inspect

scars /body hair / distension / herniae

Palpatetenderness / masses / umbilicus down

Percuss

dull /resonant / shifting dullnessAuscultate

bowel sounds


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Pelvic examination

Inspection

Bimanual digital examination

Speculum examination

[Rectal examination]


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Inspection

Position patient

Vulva / Vagina

Abnormal skin

colour / ulceration /atrophy

Lumps

Prolapse


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Bimanual digital examination

Cervix

os shape / consistency

Uterussize / position / consistency /

regularity/ mobility / tenderness

Adnexaepalpable / size / consistency /

tenderness


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Speculum examination

Cuscoes bivalve speculum

Sims speculum

Positioning

Inspect cervix ulceration / bleeding/irregularity

Inspect vaginal wallsRemoval


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Basic Gynaecological Skill

Careful history

Sensitivity

Professional examination


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Further management

Differential diagnosis

Revise/Prioritise diagnosis

InvestigationsTreatment / Management


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Objectives



Cervical screening

Formative assessment


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Cervical screening


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What is Screening

Apply test to asymptomatic individualsand classify likelihood of disease

- early detection with subsequent tests

- reduce diseaseseverity/recurrence/mortality


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Practice assessment

gynae history taking

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