repro

Question 1

obstetric abdominal examination: inspection

Answer 1

scars
striae gravidarum
linea nigra

note for swelling of uterus from end of the bed

Question 2

obstetric abdominal examination: palpation

Answer 2

upper and lateral edges of mass
feel for fetal poles (head and breech) to find lie
use side of hands to find highest point of uterus (fundus)

Question 3

obstetric abdominal examination: measuring fundal height

Answer 3

after 20wks
tape measure face fown, measure to top of symphysis pubis

fundal height should be equivalent to gestation in weeks +/-3cm

Question 4

obstetric abdominal examination: feel for presenting part

Answer 4

place both hands at base of uterus, above pubic bone - warn of possible discomfort

ballot the head gently or note if not possible

Question 5

obstetric abdominal examination: feel for engagement

Answer 5

after 36wks

estimate how much of head is still palpable on abdominal examination

Question 6

obstetric abdominal examination: auscultation

Answer 6

listen for fetal heart over baby’s anterior shoulder

Question 7

female sexual health + repro history qs

Answer 7

• menstrual Hx: age first/last, length + pattern cycle, intermenstrual or post-coital bleeding
• LMP
• dysmenorrhea, menorrhagia
• pelvic + sexual infections: discharge, pelvic pain, dyspareuria, rash, ulcers
• cervical smear hx
• obstetric hx: parity, gravity, terminations, miscarriages
• infertility: duration of trying to conceive, frequency UPSI
• past + present use contraception
• incontinence: stress + urge
• sexual history: current/prev partners, type of sex, high risk partners

Question 8

male sexual and repro history qs

Answer 8

• erectile dysfunction: how long, can they develop erection, can they have sex
• premature or delayed ejaculation
• urinary symptoms: dysuria, frequency, nocturia, dibbling, flow
• penile discharge
• testicular swelling, pain, rash
• penile rash, ulcer, lump
• if infertility: duration of time trying to conceive, frequency UPSI
• sexual history: current/prev partners, protection, high-risk partners, prev STI

Question 9

gravidity

Answer 9

number of times a woman has been pregnant, regardless of outcome

Question 10

parity

Answer 10

total number of times a woman has given birth to a child with a gestational age 24wks+
regardless of whether child was born alive or not

Question 11

gynae causes of abdo/pelvic pain

Answer 11

ectopic pregnancy
PID
endometriosis
ruptured ovarian cyst

Question 12

gynae causes of post-coital bleeding

Answer 12

cervical Ca
gonnorhea
chlamydia
vaginitis

Question 13

gynae causes of intermenstural bleeding

Answer 13

contraception 
ovulation 
misscarriage
gonnorhea 
chlamydia 
malignancy 
uterine fibroids

Question 14

gynae causes of post-menopausal bleeding

Answer 14

vaginal atrophy
HRT
malignancy

Question 15

gynae causes of abnormal vaginal discharge

Answer 15

BV
chlamydia
gonorrhea

Question 16

gynae causes of dyspareunia

Answer 16

endometriosis
chlamydia
gonorrhea

Question 17

gynae causes of vulval skin changes + itching

Answer 17

gonorrhea

thrush

Question 18

determining whether vaginal discharge is normal or abnormal

Answer 18

volume - change in amount

colour - green, yellow, blood-stained

consistency - thickened, watery

smell

Question 19

menstrual hisotry

Answer 19

• duration of periods
• frequency of periods/length of cycle
• volume of blood - heavy/light
• dysmenorrhoea
• date LMP
• age at menarche
• menopause if relevant

Question 20

what to ask about current pregnancies

Answer 20

gestation
any symptoms - nausea, vomiting, backpain
complications - pre-eclampsia, cervical neck incompetence
-recent scan results

Question 21

what to ask about previous pregnancies

Answer 21

age of kids
birth weight
mode delivery
complication: antenatal, perinatal, postnatal
if relevant, are they breastfeeding - contraindication to COC

Question 22

causes of reduced fetal movements

Answer 22

fetal distress

early fetal demise

Question 23

obstetric causes vaginal bleeding

Answer 23

placenta praevia

placental abruption

Question 24

typical clinical features of pre-eclampsia

Answer 24

headache
visual disturbance
epigasric pain
oedema

Question 25

previous obstetric history

Answer 25

gravidity and parity term pregnancies: gestation at delivery, birth weight, mode of delivery, complications, assisted reproduction stillbirth misscarriages terminations ectopic pregnancies

Question 26

asking about last sexual contact

Answer 26

when was it? was it consensual? regular or casual partner partner demographics - sex and nationality type of sex involved contraception used and consistency of usage other sexual partners in past 3mo

Question 27

pelvic bimanual examination: inspection of vulva

Answer 27

``` hair distribution ulcers vaginal discharge masses e.g. bartholin's cysts swelling prolapse ```

Question 28

pelvic bimanual examination: palpation

Answer 28

walls of vagina - irregularities, masses cervix - consistency, pain uterus - smooth, nodular, tenderness, mobility adnexa (R + L lateral fornices) - feel for any masses

Question 29

vaginal speculum exam: visualise cervix

Answer 29

``` cervical os - if open may indicate miscarriage look for erosions around os cervical masses ulceration abnormal discharge ```

Question 30

indications for pelvic examination

Answer 30

to assess pathology related to external genitalia, vaginal walls, cervix, uterus and adnexa to perform e.g. high vaginal or endocervical swabs, cervical cytology in labour to assess dilatation of cervix, rupture of membranes and to assess progress in labour