APPROACH TO AN

GYNAECOLOGIC PATIENT

HISTORY

HISTORY TAKING IS AN ART

SHOULD SPEND SUFFICENT TIME

TAKING GOOD HISTORY FROM THE
PATIENTS

PARTICULARS OF THE
PATIENTS

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

CHIEF COMPLAINTS

CHIEF COMPLAINTS WITH DURATION

IN CHRONOLOGICAL ORDER IN
PATIENTS LANGUAGE

MAY PRESENT WITH :

MENSTRUAL DISTURBANCES
VAGINAL DISCHARGE
PAIN LOWER ABDOMEN

1.
2.
3.

CHIEF COMPLAINTS

MAY PRESENT WITH :

4.

MASS IN LOWER ABDOMEN

SOMETHING COMING OUT PER VAGINA
POST MENOPAUSAL BLEEDING
FAILURE TO CONCEIVE
DIFFICULTY IN MICTURATION

5.
6.
7.
8.

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/MICTURATI
ON, ASSOCIATED SYMPTOMS
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
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,

HISTORY OF PAST ILLNESS

PAST MEDICAL HISTORY

PAST SURGICAL HISTORY-PELVIC
STDs
HTN, DM, PTB, ASTHAMA

FAMILY HISTORY
PERSONAL HISTORY
DRUG HISTORY

MENSTRUAL HISTORY

AGE OF MENARCHE
MENSTRUAL CYCLE
MENSTRUAL PERIOD
LMP
DYSMENORRHOEA

CONTRACEPTIVE HISTORY

OBSTETRICAL HISTORY
S.N DAT
E
OF
DEL
IVE
RY

GES
TATI
ON
AL
AGE

CO
MPL
ICA
TIO
N

AN
C/
DEL
IVE
RY

MO
DE
OF
DEL
IVE
RY

PUE
RPE
RIU
M

CHI
LD /
BRE
AST
FED

IMM
UNI
SAT
ION

PHYSICAL EXAMINATION

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

PHYSICAL EXAMINATION

GENERAL PHYSICAL EXAMINATION :

APPEARANCE
ORIENTATION, MEMORY

PALLOR, ICTERUS, LYMPH NODES,

CYANOSIS, CLUBBING, OEDEMA,
DEHYDRATION

PHYSICAL EXAMINATION

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

ABDOMINAL EXAMINATION

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

ABDOMINAL EXAMINATION

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

PELVIC EXAMINATION

INSPECTION OF VULVA:
ULCERATION
GROWTH
DISCHARGE
CONDITION O FPERINIUM
EXTERNAL URETHRAL MEATUS

PELVIC EXAMINATION

SPECULUM EXAMINATION:
UNMARRIED GIRL WITH INTACT HYMEN
SPECULUM EXAMINATION CONTRAINDICATED

CUSCOS BIVALVE VAGINAL SPECULUM

SIMS SPECULUM

INSPECTION OF VAULT OF VAGINA & CERVIX

COLLECTION OF DISCHARGE
PAP SMEAR BY AYERS SPATULA

PELVIC EXAMINATION

BIMANUAL EXAMINATION:
DORSAL LITHOTOMY POSITION
RT HAND PV EXAMINATION
LT HAND LOWER ABDOMEN

1.
2.
3.

POSITION OF CERVIX, ANY GROWTH

SIZE, CONSISTENCY & MOBILITY OF
UTERUS
ADENEXAL CONDITION

INVESTIGATIONS

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

INVESTIGATIONS

SEROLOGICAL TESTS FOR VENERAL DIS.

VDRL, TPHT
SERUM ELECTROLYTES
BLOOD HORMONE ESTIMATION
BLOOD CULTURE
IVU
HYSTEROSALPINGOGRAM
Tubal patency, Congenital anomalies

INVESTIGATIONS

VAGINAL SWAB STUDY

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

DIAGNOSIS

TREATMENT

THANK YOU!!!