The document outlines how to take a gynaecological history using the ABCD(I)F framework and how to perform a full gynaecological examination, including abdominal palpation, speculum examination of the vagina and cervix, and bimanual palpation of the uterus and adnexa. It also provides guidance on asking targeted questions regarding specific complaints like bleeding, pain, discharge, incontinence, and fertility. The goal is to obtain all relevant information from the history and physical exam in order to generate a differential diagnosis and plan appropriate next steps like labs, imaging, or procedures.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina. Cervical biopsies can be done in several ways.
A cervical biopsy is a procedure to remove tissue from the cervix to test for abnormal or precancerous conditions, or cervical cancer. The cervix is the lower, narrow part of the uterus. It forms a canal that opens into the vagina. Cervical biopsies can be done in several ways.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. LECTURE OVERVIEW
Taking a gynaecological history ABCD(I)F
Abdominal/ pelvic pain
Bleeding
Contraception
Discharge and itch
(E) Incontinence and prolapse
Fertility
Performing a gynaecological examination
Abdominal palpation
Speculum examination of vulva/ vagina/cervix
Bimanual palpation of uterus and adnexae
Approach to common gynaecological symtoms
3. GYNAECOLOGICAL HISTORY
Age
Past medical, surgical, gynaecological history
Medications
Allergies
Family History
Social History
4. GYNAECOLOGICAL HISTORY
Past Obstetric History
Have you ever been pregnant before?
Spontaneous abortions, terminations of pregnancy, ongoing
pregnancies, living children
What happened in those pregnancies?
Spontaneous, duration of pregnancy, type of labour and
delivery, outcome, complications
5. GYNAECOLOGICAL HISTORY
Gynaecological History
Abdominal pelvic pain
Bleeding
Contraception
Discharge (itch)
Incontinence and prolapse
Fertility
Screening history
7. (1) PELVIC PAIN
Pain with periods (dysmenorrhoea)
Pain with sex (dyspareunia)
Pain at other times
Site of pain, radiation
sudden or gradual
associated symptoms
fever, discharge
LNMP
8. (2) BLEEDING
Menstrual history
menarche
cycle length and regularity (5/28)
midcycle bleeding/pain/mucus change
excessively heavy or painful
LNMP
Abnormal bleeding
Abnormal menstrual bleeding
Abnormal non menstrual bleeding
intermenstrual bleeding, post coital bleeding, postmenopausal
bleeding
9. (2) BLEEDING
What causes abnormal menstrual bleeding?
‘Dysfunctional bleeding’ (ie abnormal menstrual bleeding
in response to reproductive hormones)
ovulatory
anovulatory
Uterine pathology which increases surface area of
endometrium
polyps
fibroids
Coagulopathy
11. (3) DISCHARGE AND ITCH
What causes discharge?
physiological discharge
tubal infection (PID)/ malignancy
uterine infection/malignancy
cervical infection/malignancy
vaginal infection (vaginitis, vaginosis)
vulval infection/ malignancy
Physiological discharge + bacterial
vaginosis and vaginitis + UGT infection =
95% of presentations with discharge
12. (3) DISCHARGE AND ITCH
Nature of discharge
amount
colour (bloody, offensive, yellow, brown)
offensive
relationship to period
Associated symptoms
vulval burning and itch, urinary frequency
13. (4) CONTRACEPTION AND
FERTILITY
Type of contraception, side-effects,
compliance, complications including
breakthrough pregnancies
Fertility
number of pregnancies
time taken to get pregnant
Infertility
duration
sexual history
history of anovulation, tubal disease or surgery, male factor
14. (5) PROLAPSE AND
INCONTINENCE
Vulval lump, dragging pain or pressure
Incontinence
urinary
stress
urgency
faecal incontinence or soiling
flatus incontinence
15.
16. GNAECOLOGICAL
EXAMINATION
Explain examination
Allow patient privacy to change
Chaperone
Ensure patient is draped, and room is warm and
comfortable
17. GNAECOLOGICAL
EXAMINATION
General examination
H&N, breasts, cardiorespiratory, abdominal, periphery
Abdominal palpation
Inspection external genitalia
Speculum examination vagina/cervix
Bimanual palpation of uterus and adnexae
18. Inspection
Hair distribution
Vulval skin
Look at the
perineum for
scars/tears
Gently part labia –
inspect urethra
Look for discharge,
prolapse, ulcers,
warts
20. Insertion
• Use lubricant and
warm speculum if
possible
• Hold speculum in
dominant hand
• Part labia with
nondominant hand
• Slowly insert and
open speculum
blades to visualize
the cervix.
21. Visualisation of Cervix
Inspect for:
• Discharge
• Warts
• Tumours
• Size of cervical os
• Bleeding
22.
23. Taking a cervical smear
Following insertion of bivalve speculum
Equipment prepared before examination begins:
gloves
Aylesbury spatula
Confirm name, DOB, hosp number etc
Label frosted end of slide
Fixative agent
Position equipment
24. Taking a Cervical smear
Rest point of spatula
within the os and
rotate clockwise
360° then rotate
360° anti-clockwise.
Exert light pressure
(pencil).
Ensure contact with
cervix throughout.
25. Concluding Cervical Smear
REMOVE the speculum!
Ensure patient comfort/safety
Spread both sides of the spatula onto the slide.
Perform similar procedure for cytobrush
Spray fixative immediately onto the labelled slide
surface
26. Bimanual Examination
Separate labia with
gloved left hand
Slowly insert index
finger and middle
finger into vagina
then palpate cervix
Left hand then
palpates uterus and
adnexa abdominally
27.
28.
29. Univalve Speculum Positioning
Position patient in
the left lateral
position
Left leg extended
Right Knee drawn up
to chest
Hold back anterior
vaginal wall with
lubricated speculum
30. Dear Dr,
Thank you for seeing Mary Smith who has
problematic vaginal bleeding.
Age
Hx of presenting complaint
Past Obstetric Hx (gravity, parity)
Past gynae Hx
PMHx, PSHx, PGHx
Medications, Allergies
FHx, SHx
31. Dear Dr,
Thank you for seeing Mary Smith who has
problematic vaginal bleeding.
History of bleeding
menstrual cycle; ? ovulating
amount
LNMP
contraception
sinister features: post coital, intermenstrual, post
menopausal bleeding
associated symptoms
pain, symptoms of anaemia
Remainder of gynae history
discharge, prolapse, incontinence, POHx, fertility,
PAP, breasts
32. Dear Dr,
Thank you for seeing Mary Smith who has
problematic vaginal bleeding.
O/Ex:
general examination
pallor
abdominal palpation
?enlarged or tender uterus
speculum examination
blood coming from os
normal vagina and cervix
Bimanual examination
size of uterus
adnexal pathology
33. Dear Dr,
Thank you for seeing Mary Smith who has
problematic vaginal bleeding.
Ix will depend on Hx and Ex, but
may involve:
hCG
PAP smear
FBE
Fe studies
Coagulation profile
Ultrasound
Endometrial sampling
Hysteroscopy, D&C
34. SUMMARY
How to take a ‘general’ gynaecological history
(A,B,C,D,I/P,F)
Reproductive screening
How to take a ‘targetted’ history of a specific presenting
complaint such as bleeding, pain, discharge, prolapse and
incontinence, infertility
3 parts of gynaecological examination
abdominal palpation
speculum examination
bimanual examination
Combining history and examination features to come up
with a differential diagnosis, and plan investigations
Editor's Notes
Hair extending towards umbilicus and onto inner thigh can be associated with disorders of androgen excess and clitoromegaly.
Vulva can be a site of chronic skin conditions such as eczema, psoriasis, Lichen sclerosis and warts, cysts of the Bartholin’s gland and cancers. Ulceration may imply herpes, syphilis, trauma or malignancy.
Perineal scars maybe secondary to childbirth.