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ISCE BOOST OBSTETRICS AND GYNAECOLOGY Devon WardWhat is your biggest concern about O+G scenarios? Menti: 4736 4610Our Series and Rough Timeline W/B 20 Nov – Introduction and CBDs W/B 27 Nov – SBAR and Important Conditions th W/B 4 Dec – Pharmacology (how to explain and which ones?) W/B 11 Dec – Paeds ------- st W/B 1 Jan – O+G W/B 8 Jan – Data interpretation (ABGs, FBC, LFTs, TFTs) th W/B 26 Feb – Neuro W/B 11 Mar – Psych W/B 25 Mar – Imaging (CXR, CT head, MSK) th W/B 8 Apr – Common and Important PresentationsCBD Review We heard you! CBDs are difficult to know if you’ve picked the right topic and if you’ve got the right content Email us and we can review your topic and/or CBD document! Email: wardde1@cardiff.ac.ukOverview Today, we will look at: • How to structure O+G histories • Important conditions to know • Example stations Any questions put them in the chat and we’ll get to them as we can!O+G HISTORIES Menti: 4736 4610 Where does O+G fit in? Acute 4 min data station 4 min history 2 min summary 4 min skill interpretation + and DDx Qs x2 SBAR 4 min data station 4 min history 1 min write up 4 min SBAR interpretation + x1 Qs Comms 4 min data 7 min history 2 min summary interpretation + station and DDx Qs x1 Menti: 4736 4610 Obstetric Cheat Sheet Less similar to other histories than other specialties Will have less relevant detail in other categories! PV bleeding LMP PV discharge Assess current Scans and Ix 4 Ps! Pain pregnancy Problems Pregnancy Vomiting Gravida and para Screen for GI and IBS, cancer, appendicitis Gain obstetric Miscarriages, ectopics and UTI, incontinence terminations Uro causes history (GMC) Children Menti: 4736 4610 Gynae Cheat Sheet Similar to normal histories but with a few extra steps PV bleeding PV discharge 4 Ps! Pain Pregnancy Menstrual Gynae focus Obstetric MOSC Sexual Contraception and smears Screen for GI and IBS, cancer, appendicitis UTI, incontinence Uro causesMOSC Menti: 4736 4610 st 1 day of last menstrual period LMP Menstrual When they started their period (menarche) MENARCHE If they’ve been through menopause MENOPAUSE Cycle length and regularity LENGTH GMC Number of pregnancies, number of births G+P Obstetric Miscarriages,ectopic pregnancies,terminations MISCARRIAGES CHILDREN Living children - ages, delivery, difficulties Are they sexually active, if so with who SEX Sexual Any pain or bleeding during intercourse FERTILITY Any issues with fertility Contraception and Do they use contraception, if so, what and how CONTRACEPTION Last cervical smear and results SMEARS Cervical SmearIMPORTANT CONDITIONS Not an exhaustive list! Obstetric Conditions to consider Ectopic pregnancy Miscarriage Pre-eclampsia Gestational diabetes Post-partum PPROM haemorrhage Not an exhaustive list! Gynae Conditions to consider PID STI Endometriosis Cervical cancer Endometrial cancer PCOS NoMenti: 4736 4610ist! O+G Conditions Ectopic pregnancy Miscarriage PID STI Pre-eclampsia Gestational diabetes Endometriosis Cervical cancer Post-partum haemorrhage PPROM Endometrial cancer PCOS NoMtane:hau6si61list! O+G Emergencies Ectopic pregnancy Miscarriage PID STI SHOCK SEPSIS Pre-eclampsia Gestational diabetes ECLAMPSIA Endometriosis Cervical cancer Post-partum haemorrhage PPROM Endometrial cancer PCOS HAEMORRHAGESTATIONS Menti: 4736 4610 Menti: 4736 4610 Case 1 28-year-old Ms Pond is brought into the early pregnancy unit with abdo pain. You are the medical student that reviews her. Menti: 4736 4610 Case 1 – History 28yo F Severe, crampy right-sided abdominal pain Feels dizzy No change in appetite No changes to bowel habits Menstrual – LMP 6 weeks ago, normally 30 days and regular Obstetric – never been pregnant before Sexual – sexually active with male partner, no recent STIs Contraception and smears– uses COCP, did not attend her smear appointment Menti: 4736 4610 Case 1 28-year-old Ms Pond is brought into the early pregnancy unit with abdo pain. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 4736 4610 Case 1 – Interpretation Ms Pond DOB: XX/XX/XXXX Blood test results: Hb: 100 (120-150) WBC: 9.2 (3.6-11.0) Plt: 220 (140-400) MCV: 92 (80-100) Beta-hCG: 3500 (<5) Menti: 4736 4610 Case 1 28-year-old Ms Pond is brought into the early pregnancy unit with abdo pain. How do you manage this patient? Menti: 4736 4610 Case 2 35-year-old Mx Noble attends the GP with vaginal discharge. You are the medical student that reviews her. Menti: 4736 4610 Case 2 – History 35yo F Vaginal discharge has become yellow and smells bad, not normal for her Dull lower abdominal pain Menstrual – some irregularity, vary between 24-28 days, no heavy bleeding Obstetric – never been pregnant before Sexual – regular sex with male partner, pain during penetrative sex vaginally and anally Contraception and cervical smears – uses condoms, smears normal for past decade Smokes 25/day Menti: 4736 4610 Case 2 35-year-old Mx Noble attends the GP with vaginal discharge. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 4736 4610 Case 2 – Interpretation Mx Noble DOB: XX/XX/XXXX Sample: vaginal swab Chlamydia trachomatis: positive Neisseria gonorrhoeae: negative Bacterial vaginosis: positive Menti: 4736 4610 Case 2 35-year-old Mx Noble attends the GP with vaginal discharge. How do you manage this patient? Menti: 4736 4610 Case 3 30-year-old Mrs Khan attends the emergency department with abdominal pain in her nd 22 week of pregnancy. You are the medical student that reviews her. Menti: 4736 4610 Case 3 – History 30yo F Severe right lower quadrant pain Started suddenly this morning, getting worse Feels nauseous but hasn’t been sick Not feeling hungry and hasn’t eaten anything Menstrual: previously regular at 32 days, LMP 22 weeks ago Obstetric: G2P1, previous C-section Sexual: not sexually active currently, has one male partner Contraception and cervical smears: up to date on smears, not used contraception whilst trying to get pregnant Worried about early labour Menti: 4736 4610 Case 3 30-year-old Mrs Khan attends the emergency department with abdominal pain in her nd 22 week of pregnancy. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 4736 4610 Case 3 – Interpretation Mrs Khan DOB: XX/XX/XXXX Blood test results: Hb: 110 (100-140) WBC: 13.2 (3.6-11.0) Plt: 250 (140-400) MCV: 95 (80-100) CRP: 12 (<3) Menti: 4736 4610 Case 3 30-year-old Mrs Khan attends the emergency department with abdominal pain in her nd 22 week of pregnancy. How do you manage this patient? Menti: 4736 4610 Case 4 68-year-old Ms Sheridan presents to primary care with per vaginal bleeding. You are the medical student that reviews her. Menti: 4736 4610 Case 4 – History 68yo F Noticed occasional vaginal bleeding for the past 2 months Normally dark brown blood, no fresh blood About a teaspoon every day or so Otherwise well, no pain, weight loss or fatigue Menstrual: cycles stopped 17 years ago, went through menopause Obstetric: had 2 children, vaginal deliveries, no complications, no miscarriages Sexual: occasionally sexually active but stopped after first episode of bleeding Contraceptives and smears: barrier protection, previous smears have been normal Menti: 4736 4610 Case 4 68-year-old Ms Sheridan presents to primary care with per vaginal bleeding. What are your top differentials now? What skills might they ask you to do? What investigations do you want? Menti: 4736 4610 Case 4 – Interpretation Mrs Khan DOB: XX/XX/XXXX Blood test results: Hb: 125 (120-150) WBC: 8.4 (3.6-11.0) Plt: 280 (140-400) ALT: 25 (7-56) AST: 30 (5-40) ALP: 70 (44-147) CA-125: 35 (<35) Menti: 4736 4610 Case 4 68-year-old Ms Sheridan presents to primary care with per vaginal bleeding. How do you manage this patient?QUESTIONS Menti: 4736 4610