Nice slide gain information and knowledge

1. KABWE CENTRAL HOSPITAL
OBGYN
“HISTORY TAKING & PHYSICAL EXAM”
Wisdom’s Lecture Notes
Banda Wisdom Chilufya
MBChB

2. CORRECT WAY OF RELATING TO THE PATIENT
• HIPPOCRATIC OATH
• .”
• I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all
the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
• To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if
necessary, to share my goods with him; To look upon his children as my own brothers, to teach them
this art; and that by my teaching, I will impart a knowledge of this art to my own sons, and to my
teacher's sons, and to disciples bound by an indenture and oath according to the medical laws, and no
others.
• I will prescribe regimens for the good of my patients according to my ability and my judgment and never
do harm to anyone.
• I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not
give a woman a pessary to cause an abortion.
• But I will preserve the purity of my life and my arts.
• I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be
performed by practitioners, specialists in this art.
• In every house where I come I will enter only for the good of my patients, keeping myself far from all
intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be
they free or slaves.
• All that may come to my knowledge in the exercise of my profession or in daily commerce with men,
which ought not to be spread abroad, I will keep secret and will never reveal.
• If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all humanity and in all
times; but if I swerve from it or violate it, may the reverse be my life

3. HIPPOCRATIC OATH - Highlights
• Respect for ones teachers [30-40% unwritten]
• Obligation to pass on medical knowledge
• Never to do harm [ignorance]
• Never to use ones skills and knowledge to kill
• Need to leave operations to specialists
• Guard against 3W = Wine/Women/Wealth
• Never breach confidentiality

4. ADDITIONS TO THE OATH
• Why medical degrees are not graded?
• Patients live with their diseases 24/7 – listen to
them.
• Patients have rights
• Ask for permission before taking history-doing
physical examination-doing pelvic exam-before
doing any procedure:-
• IV canulation, Foley, NGT, Lumbar puncture

5. CLINICAL THINKING
IS THE PROCESS THAT HAS BEEN DEVELOPED
BY THE MEDICAL PROFESSION OVER
THOUSANDS OF YEARS BY WHICH WE TRY TO
ANSWER THE QUESTION “WHAT IS WRONG
WITH THE PATIENT?”

6. STEPS IN CLINICAL THINKING
1. HISTORY TAKING (contribute 80% to the
diagnosis) – provides subjective data
2. PHYSICAL EXAMINATION (contribute 10%)–
provides objective data
3. INVESTIGATIONS (contribute 10%) – provide
objective data
4. ASSESSMENT – tries to make sense of the above
data
5. PLAN AND TREATMENT

7. THEREFORE HISTORY TAKING
• IS THE FIRST STEP IN TRYING TO ANSWER
THE QUESTION: “WHAT IS WRONG WITH THE
PATIENT?”

8. 1 DEMOGRAPHY
• Name
• Age
• Marital Status
• Address
• Religion
• Tribe
• Occupation
• LMP/LNMP
• Gravidity
• Parity
• EGA
• Level of Education

9. 2 PRESENTING COMPLAINTS
• Starting of symptoms
• Duration of symptoms
• HISTORY OF PRESENING COMPLAINTS
• Aggravating/Relieving factors
• Effect of symptoms on normal chores

10. 3 RELEVANT SYSTEMIC REVIEW
• CVS;
– Chest pain
– Dyspnoea
– Exertion dyspnoea
– Orthopnoea
– Paroxysmal nocturnal
dyspnoea
– dizziness
– Easy fatigability
– Palpitations
– Syncope
• RS;
• breathlesness
• Cough
• Productive/non productive
• Sputum
• Color
• Consistence
• amount
• Wheeze
• Chest pain
• Haemoptysis

11. • GIT;
• Abdominal pain
• Appetite
• nausea
• Vomiting
• Haematemesis
• Heart burn
• Diarrhoea
• Constipation
• Steatorrhoea
• Malaena
GUT;
• Pain
• Haematuria
• Oliguria
• Anuria
• Polyuria
• Frequency
• Nocturia
• Dysuria
• Urgency
• Incontinence
• Enuresis
• Slow stream
• Hesitancy

12. • CNS;
• Headache
• fainting
• Weakness/paralysis
• convulsions
• Double vision
• MSS;
• Skin rash
• Joint/bone pains
• Joint swellings
• Yellowing of
eyes/palms

13. 4 RELEVANT CURRENT OBSTETRIC HX
• Gravidity
• Parity
• LMP/LNMP
• EGA
• EDD
• ANC date of booking and gestational age
• Number of ANC visits
• Booking BP
• Any complications of pregnancy so far
• Prophylactic treatment

14. 1. GRAVIDA => ANY PREGNANCY REGARDLESS OF
OUTCOME
2. PARITY => OUTCOME OF PREGNANCY

15. PAST OBSTETRIC HISTORY
• Hx of every pregnancy
• Place of delivery (home, clinic, or hospital), mode
and duration of labour
• Birth weight where possible
• Breast feeding and duration
• Any miscarriages-spontaneous/induced
• Any MVA done
• Any post abortal sepsis
• Any complications in the puerperium

16. 5 RELEVANT GYNECOLOGICAL HX
• Age at menarche
• Regularity of menses
• Duration and interval of menses
• Any dysmenorrhea
• Contraceptive use and duration
• Age at sex debut
• Number of partners
• Any STI’s
• Spouse circumcision status
• Any Pap smear/VIA and when

17. 6 RELEVANT PAST MEDICAL AND SURGICAL HX
INCLUDING HIV STATUS OF SELF AND SPOUSE
• Hx of similar illness in the past
• Any hospital admissions in the past
• Any other illnesses in the past
• Hx of past surgery
• DM, Epilepsy, Asthma, TB, HTN, SCD, Blood
dyscrasias, HIV status

18. 9 DRUG HX
• Drugs being taken
• Any herbs being taken
• Any allergies
• Any side effects noted

19. 7 RELEVANT FAMILY HX
• DM, Epilepsy, Asthma, TB, HTN, SCD, Blood
dyscrasias
• Twinning

20. 8 SOCIAL HX
• Marital Status
• Social habits: Smoking, alcohol
• Occupation
• Size of house
• Number of occupants
• Sanitation methods
• Use of ITN

21. 10 SUMMARY of HISTORY
• Important positives
• Important negatives
• Eg
• In summary CM F/23, G2P1 at 32 weeks self
referral who presented with spontaneous onset
progressive suprapubic pain started six hours
prior. She has associated frequency, fever and
dysuria. However no hematuria and perceiving
fetal movement

22. 11 IMPRESSION – FROM HX
• Differential diagnosis from HX

23. 12 GENERAL PHYSICAL EXAMINATION
General Condition: Pt was conscious/not conscious
• Febrile
• Pallor
• jaundice
• Cyanosis
• oedema
• lymphadenopathy
• dehydration

24. RS:
INSPECTION: chest; ?symmetrical,
deformities
• scars; ?tatooes, surgical
PALPATION: tenderness
• trachea; ?central
• chest mvts
PERCUSSION: percussion
AUSCALTATION: breath sounds;
?bronchial, vesicular
• added sounds
• vocal resonance
CVS:
• Distended neck veins
• Precordium
• Apex beat
• S1, S2
• Added sounds

25. 13 OBSTETRIC PHYSICAL EXAMINATION
• Symphysial Fundal Height (SFH)
• Presentation
• Number of gestations
• Lie
• Descent
• Adequacy of liquor volume
• Fetal heart sounds
• Baby’s back in relation to mother

26. 14 GYNECOLOGICAL EXAMINATION
• Any visible sores or warts on vulva
• Any visible vagina discharge/PVB
• Condition of Cervix
• Soft
• Firm
• Hard
• regularity
• Any cervical excitation tenderness
• Any PVD/Contact bleeding (Pelvic vaginal
discharge)

27. • MMS:
• Oedema
• Urinalysis:
• SG:
• Leukocytes:
• Nitrites:
• Bilirubin:
• Glucose:
• pH:
• blood:
• ketones:
• proteins:

28. 15 SUMMARY OF HISTORY AND PHYSICAL
EXAMINATION
• Important positives
• Important negatives

29. 16 CONCLUSION
• Final Impression
• Differential Diagnosis
• Investigations

30. DETERMINING THE AGE OF A PREGNANCY
• USING ABDOMINAL LANDMARKS :-
1. 12 WEEKS FUNDUS AT PUBIC
SYMPHYSIS
2. 16 WEEKS FUNDUS BETWEEN THE
PUBIS AND UMBILICUS
3. 20 WEEKS FUNDUS AT THE
UMBILICUS
4. 36 WEEKS FUNDS AT THE XIPHOID
STERNUM

31. DETERMINING THE AGE OF A PREGNANCY
• USING MEASURING TAPE:-
1. AFTER 20 WEEKS EVERY 1 CM FROM THE PUBIS
TO THE FUNDUS IS EQUIVALENT TO 1 WEEK
GESTATION
2. ENGAGEMENT OF THE PRESENTING PART
DISTORTS THESE MEASUREMENT
3. AND CANNOT BE USED FOR A TRANSVERSE
LYING FETUS

32. Raison d’^etre
• Is a French expression which means the most
important reason for somebody’s or something’s
existence.
• Our raison d’^etre as a medical profession is the
PATIENT.
• Without the PATIENT we are all out of work.