Gyn&Obs

Question 1

DDx for Amenorrhea

Answer 1

Primary
1. Genetics (i.e. Turner’s, Testosterone insensitivity)

Secondary

1. Pregnancy***
2. Hypo/Hyperthiroidism
3. Premature menopause
4. Prolactinoma/Hypothalamic tumors
5. PCOS
6. Cushing’s
7. Drugs/Steroids
8. Anorexia nervosa
9. Psychological stresses/Excessive exercises.

Question 2

MGOS: Questions for Menstrual

Answer 2

• When was your LMP? Similar to previous ones?
• Regular? How often do you get your periods?
• How long do they last?
• Amount? How many pads? Blood clots?
• Painful periods?
• Any spotting or bleeding between your periods?
• At what age did you get your first period?

Question 3

MGOS: Questions for Gynecological

Answer 3

• Do you have history of any gynec disease (e.g. polyps)? What about FH?
• Pelvic surgery or instrumentation?
• Do you use contraceptives/HRT? What? How long?

Screening

• When was your last Pap? Reason? What result? Any other Pap’s?
• > 40: mammogram before?
• > 65 y: Bone mineral density done?

Question 4

MGOS: Questions for Obstetrical

Answer 4

• Have you ever been pregnant before? If yes:
  - How many times? Abortions? Miscarriages?
  - Number of babies delivered? Twins? Babies with congenital abnormalities?
  - For each delivery: full-term or pre-term? Vaginal or CS? Complications?
  - Family history of congenital abnormalities.

Question 5

MGOS: Questions for Sexual hx

Answer 5

• Who do you live with?
  - If alone or family: Are you in a relationship? How do you describe it? / Are you sexually active? If no, have you ever been?
  - If with partner: How do you describe it?
• Do you practice safe sex?
• At what age did you become sexually active?
• How many partners?
• What is your sexual preference? Males, females, both?
• What type of sexual activity?
• Have you ever been diagnoses with an STI?
• Fever? Discharge? etc.

Question 6

PBGOS: Questions for pregnancy

Answer 6

• How many weeks have you been pregnant?
• What is your expected delivery date?
• Was this pregnancy planned?
• Are you taking any vitamins?
• Have you been going for your regular f/u visits? When last visit?
• Any headache, leg swelling, abdominal pain or cramps?

ABCDE
A: Activity of the baby. is your baby kicking like before?
B: Bleeding
C: Contractions / pain
D: Dripping / Discharge
E: EDD (expected date of delivery)

Question 7

PBGOS: Questions for Baby

Answer 7

• Is the baby moving? How often?
• When was your last U/S? Location of planceta?
• What is your blood group? Baby?

Question 8

HPI Obstetrics

Answer 8

1. Contractions: Freq,strength, closer?
2. Bleeding: Amount, clots, # pads
3. Leaking: Amount, color, big gush?
4. Baby movements (>20 weeks)

Current pregnancy:

1. Previous US? How many>
2. Problems with blood tests?
3. Issues in pregnancy? Correct growth? Diabetes, HTA.

Past OB history

1. All previous deliveries, VD vs CS? Preterm, term.
2. Diseases

Question 9

HPI Gynecological

Answer 9

Bleeding:
-LMP, how far apart, how long do they last, how heavy (how many pads, how frequently you change them)? Bleeding in between? Bleeding with intercourse?

Pain:
-Do you have pelvic pain, pain with periods, painful intercourse.

Discharge: COCA+B, itchiness

SEX!
-Partners, contraception, new partner, partner’s symptoms, fever/sweats/chills

PAST Gyn
LMP
Gyne surgeries
History PAP smears-every 3 years if normal
Sexual activities: STIs
HRT?

Ostetrics hx

Question 10

Prompt for physical exam

Answer 10

OBGYN-Physical

• Vitals
• Fetal HR
• General appearance
• Leopolds-position baby (US)
• SFH
• Cervix for dilation

Gynecologic:
*Vitals
*General appearance
*Quick cardio resp exam
*Abdominal
PELVIC:
1. Inspection - external genitalia (warts, redness)
2. Speculum exam!!! (look at cervix and vagina, PAP smear!!!)
3. Bimanual exam: Uterus, cervix, adnexa

Question 11

Abnormal bleeding

Answer 11

Structural (huge amounts)

1. Fibroids
2. Polyps
3. Hyperplasia
4. Endometrial cancer
5. Cervical lesions (polyps, cancer)
6. Infection
   - >U/S, endometrial biopsy (anyone >40 AUB), PAP smear

Hormonal/ovulatory (irregular rather than huge amounts)

1. PCOS: Hirsutism, acne, irregular/oligo/amenorrhea/infertility
2. Prolactin-headaches, blurry vision, breast discharge
3. Thyroid
4. Medications - ICP (Iatrogenic)
5. Perimenopause/DUB
6. Premature ovarian failure - hot flashes
   - > ALWAYS ask for BHCG, TSH, estrogen, FSH/LH (go up), prolactin