Gynaecological problems

Abstract

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are in the gynaecology clinic and your next patient is Rachel Sawyer a 38- year- old woman suffering from heavy and irregular periods. She has a BMI of 42 and has been diagnosed with PCOS in the past. Your task is … ● To take a focussed history ● Explain what examination and investigations need to be performed to Rachel ● Make a management plan … You have 10 minutes for this task (+ 2mins initial reading time). Please read instructions to candidate and actor. Allow the candidate to conduct the interview undisturbed unless they are straying off the track of the question (in which case you can show them their instructions again). This patient has heavy and irregular periods. The history of presenting complaint should cover: … ● The extent, duration, and inconvenience caused by the bleeding ● Establish the menstrual history from menarche ● Last menstrual period and present menstrual cycle ● Past gynaecological history, including PCOS ● No medical, surgical, family history ● No allergies ● Normal and regular smears ● Nulliparous ● Wants to preserve fertility … Once the candidate has taken a relevant history, they are expected to explain that they will need to perform a speculum examination and bimanual examination to Rachel. They should explain that this is to rule out any obvious abnormality in the vagina/ cervix and to assess the uterus and adnexa. Abdominal examination— unremarkable: … ● Speculum examination— cervix satisfactory ● Bimanual examination— uterus bulky, retroverted, mobile, no adnexal masses Investigations ● Endometrial sampling— either at this consultation or accept another appointment- This is to assess the endometrium as, although 38, Rachel has risk factors of High BMI, PCOS, and nulliparity ● TVS- as Rachel has a high BMI, the sensitivity of an internal examination is reduced, TVS, not TAS will be useful due to high BMI.