APPROACH TO AN GYNAECOLOGIC PATIENT

HISTORY HISTORY TAKING IS AN ART HISTORY TAKING IS AN ART SHOULD SPEND SUFFICENT TIME TAKING GOOD HISTORY FROM THE PATIENTS SHOULD SPEND SUFFICENT TIME TAKING GOOD HISTORY FROM THE PATIENTS

PARTICULARS OF THE PATIENTS NAME NAME AGE: menarche, menopause, malignancies, consider during hysterectomy AGE: menarche, menopause, malignancies, consider during hysterectomy ADDRESS ADDRESS MARITAL STATUS MARITAL STATUS DATE OF ADMISSION DATE OF ADMISSION DATE OF EXAMINATION DATE OF EXAMINATION

CHIEF COMPLAINTS CHIEF COMPLAINTS WITH DURATION IN CHRONOLOGICAL ORDER IN PATIENTS LANGUAGE CHIEF COMPLAINTS WITH DURATION IN CHRONOLOGICAL ORDER IN PATIENTS LANGUAGE MAY PRESENT WITH : MAY PRESENT WITH : 1.MENSTRUAL DISTURBANCES 2.VAGINAL DISCHARGE 3.PAIN LOWER ABDOMEN

CHIEF COMPLAINTS MAY PRESENT WITH : MAY PRESENT WITH : 4.MASS IN LOWER ABDOMEN 5.SOMETHING COMING OUT PER VAGINA 6.POST MENOPAUSAL BLEEDING 7.FAILURE TO CONCEIVE 8.DIFFICULTY IN MICTURATION

HISTORY OF PRESENT ILLNESS 1. MENSTRUAL DISTURBANCES How long? Menarche/menopause, LMP, dysmenorrhea 2. VAGINAL DISCHARGE: AMOUNT, COLOR, ODOUR, CONSISTENCY, ASSOCIATED PRURITUS.

HISTORY OF PRESENT ILLNESS 3.PAIN LOWER ABDOMEN: SITE, DURATION, ONSET, SEVERITY, NATURE, RADIATION, RELATIONSHIP WITH MENSTRUATION/COITUS/MICTURATION, ASSOCIATED SYMPTOMS MASS LOWER ABDOMEN 4. MASS LOWER ABDOMEN DURATION, RAPIDITY OF GROWTH, PAINFUL OR NOT.

HISTORY OF PRESENT ILLNESS 5. SOMETHING COMING OUT PER VAGINA: DURATION, PARITY, MENOPAUSE, OBSTETRIC H/O, MICTURATION / DEFECATION PROBLEM,VAGINAL DISCHARGE, ASSOCIATED MEDICAL ILLNESS POST MENOPAUSAL BLEEDING 6. POST MENOPAUSAL BLEEDING DURATION, AMOUNT, VAGINAL DISCHARGE, POST-COITAL BLEEDING,USE OF PESSARY, EXOGENOUS OESTROGEN USE

HISTORY OF PRESENT ILLNESS 7. FAILURE TO CONCEIVE: DURATION OF MARRIAGE, LIVING TOGETHER, SEXUAL PROBLEM (dyspareunia, premature ejaculation, impotency), H/O ABORTION, H/O CONTRACEPTION, H/O PELVIC SURGERY 8. DIFFICULTY IN MICTURATION: FREQUENCY, DYSURIA, DIFFICULTY IN EMPTYING THE BLADDER, SUPRAPUBIC PAIN, RETENTION OF URINE, INCONTINENCE, HAEMATURIA??

HISTORY OF PAST ILLNESS PAST MEDICAL HISTORY PAST MEDICAL HISTORY PAST SURGICAL HISTORY-PELVIC PAST SURGICAL HISTORY-PELVIC STDs STDs HTN, DM, PTB, ASTHAMA HTN, DM, PTB, ASTHAMA FAMILY HISTORY PERSONAL HISTORY DRUG HISTORY

MENSTRUAL HISTORY AGE OF MENARCHE AGE OF MENARCHE MENSTRUAL CYCLE MENSTRUAL CYCLE MENSTRUAL PERIOD MENSTRUAL PERIOD LMP LMP DYSMENORRHOEA DYSMENORRHOEA CONTRACEPTIVE HISTORY

OBSTETRICAL HISTORY S.N DAT E OF DEL IVE RY GES TATI ONA L AGE CO MPL ICA TIO N ANC / DEL IVE RY MO DE OF DEL IVE RY PUE RPE RIU M CHI LD / BRE AST FED IMM UNI SATI ON

PHYSICAL EXAMINATION PRE-REQUISITS: PRE-REQUISITS:CONSENT FEMALE ATTENDENT PRIVACY – CURTAIN EMPTY BLADDER ASEPTIC PRECAUTION PROPER-POSITION, ADEQUATE EXPOSURE, GOOD LIGHT

PHYSICAL EXAMINATION GENERAL PHYSICAL EXAMINATION : GENERAL PHYSICAL EXAMINATION :APPEARANCE ORIENTATION, MEMORY PALLOR, ICTERUS, LYMPH NODES, CYANOSIS, CLUBBING, OEDEMA, DEHYDRATION PALLOR, ICTERUS, LYMPH NODES, CYANOSIS, CLUBBING, OEDEMA, DEHYDRATION

PHYSICAL EXAMINATION VITAL SIGNS : VITAL SIGNS :PULSE BLOOD PRESSURE RESPIRATORY RATE TEMPERATURE BREAST EXAMINATION: SIZE, TENDERNESS, NODULARITY, DISCHARGE BREAST EXAMINATION: SIZE, TENDERNESS, NODULARITY, DISCHARGE SECONDARY SEXUAL CHARACTERS: SECONDARY SEXUAL CHARACTERS:

ABDOMINAL EXAMINATION INSPECTION: INSPECTION: SKIN CONDITIONS, SCAR MARKS, SHAPE SKIN CONDITIONS, SCAR MARKS, SHAPE PALPATION: PALPATION: SUPERFICIAL PALPATION: SUPERFICIAL PALPATION: TEMPERATURE, TENDERNESS DEEP PALPATION: DEEP PALPATION: LUMP, ASCITES, ORGANOMEGALY

ABDOMINAL EXAMINATION PALPATION: PALPATION: DEEP PALPATION: DEEP PALPATION: LUMP SITE, SIZE, CONSISTENCY, MARGINS, SURFACE, MOBILITY, TENDERNESS PERCUSSION: PERCUSSION: CONFIRM ASCITES –SHIFTING DULLNESS AUSCULTATION: AUSCULTATION: INTESTINAL SOUND – PRALYTIC ILEUS

PELVIC EXAMINATION INSPECTION OF VULVA: INSPECTION OF VULVA:ULCERATIONGROWTHDISCHARGE CONDITION O FPERINIUM EXTERNAL URETHRAL MEATUS

PELVIC EXAMINATION SPECULUM EXAMINATION: SPECULUM EXAMINATION: UNMARRIED GIRL WITH INTACT HYMEN – SPECULUM EXAMINATION CONTRAINDICATED CUSCO’S BIVALVE VAGINAL SPECULUM CUSCO’S BIVALVE VAGINAL SPECULUM SIM’S SPECULUM SIM’S SPECULUM INSPECTION OF VAULT OF VAGINA & CERVIX INSPECTION OF VAULT OF VAGINA & CERVIX COLLECTION OF DISCHARGE COLLECTION OF DISCHARGE PAP SMEAR – BY AYER’S SPATULA PAP SMEAR – BY AYER’S SPATULA

PELVIC EXAMINATION BIMANUAL EXAMINATION: BIMANUAL EXAMINATION: DORSAL LITHOTOMY POSITION RT HAND – PV EXAMINATION LT HAND – LOWER ABDOMEN 1.POSITION OF CERVIX, ANY GROWTH 2.SIZE, CONSISTENCY & MOBILITY OF UTERUS 3.ADENEXAL CONDITION

INVESTIGATIONS Hb estimation Hb estimation TLC, DLC, ESR TLC, DLC, ESR BLOOD GROUPING BLOOD GROUPING URINE Re/Me / URINE C/S URINE Re/Me / URINE C/S BLOOS SUGAR, UREA, CREATITINE BLOOS SUGAR, UREA, CREATITINE X-RAY CHEST X-RAY CHEST ECG ECG USG USG

INVESTIGATIONS SEROLOGICAL TESTS FOR VENERAL DIS. SEROLOGICAL TESTS FOR VENERAL DIS. VDRL, TPHT SERUM ELECTROLYTES SERUM ELECTROLYTES BLOOD HORMONE ESTIMATION BLOOD HORMONE ESTIMATION BLOOD CULTURE BLOOD CULTURE IVU IVU HYSTEROSALPINGOGRAM HYSTEROSALPINGOGRAM Tubal patency, Congenital anomalies

INVESTIGATIONS VAGINAL SWAB STUDY VAGINAL SWAB STUDY CYTOGENETIC STUDY CYTOGENETIC STUDY ENDOMETRIAL BIOPSY ENDOMETRIAL BIOPSY SEMEN ANALYSIS SEMEN ANALYSIS BIOPSY FROM SUSPICIOUS LESIONS BIOPSY FROM SUSPICIOUS LESIONS COLPOSCOPY/ HYSTEROSCOPY COLPOSCOPY/ HYSTEROSCOPY CYSTOSCOPY CYSTOSCOPY

DIAGNOSIS TREATMENT

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