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Special Tutorial Programme
Professor Deirdre J MurphyTrinity College
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Introduction to Gynaecology
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Objectives
Gynaecological History
Gynaecological examination
Cervical screening
Practice assessment
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Gynaecological history
Menses
Sexual/Contraception
Cervical smearUrinary
Prolapse
Pregnancies
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Complete History
Demographics
Specific gynaecological history
Past Obstetric historyPast Medical/Surgical/Psych history
Family history
Social historyMedication / Allergies
Systems review
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Gynaecological history
Heavy bleeding
Pelvic pain
Leaking urine
Failure to conceive
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Heavy bleeding
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Heavy bleeding
Menarche / LMP / Menopause
How often / How long / Regularity
Heavy / volume
Intermenstrual bleedingPostcoital bleeding
Vaginal discharge
Pain
[Intercourse / contraception /smear /urinary / prolapse / obstetric]
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Pelvic pain
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Leaking urine
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Leaking urine
Urgency
Stress symptoms
Frequency
NocturiaDysuria
Bowel symptoms
Prolapse symtoms[Menses /Intercourse / contraception/smear / obstetric]
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Failure to conceive
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Subfertility
History of a couple
DurationIntercourse
Previous pregnancies
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Female
Menses
Pelvic pain
Vaginal dischargeDyspareunia
Hirsutism
Medical
Cervical treatment
Previous pregnancies
Lifestyle
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Male
Infections
Medical illnesses
LifestyleSterilisation
Impotence / Failure to ejaculate
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Intelligent history
Comprehensive but efficient
Differential diagnosis
Targeted questioning
Prioritising diagnosis
Focus examination
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Gynaecological examination
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Consent / Chaperone / Dignity
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General examination
Appearance
Weight
Vital signs pulse
blood pressure
temp
Cardiovascular
Respiratory
Breast / Axillae
Lymph nodes
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Abdomen
Inspect
scars /body hair / distension / herniae
Palpatetenderness / masses / umbilicus down
Percuss
dull /resonant / shifting dullnessAuscultate
bowel sounds
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Pelvic examination
Inspection
Bimanual digital examination
Speculum examination
[Rectal examination]
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Inspection
Position patient
Vulva / Vagina
Abnormal skin
colour / ulceration /atrophy
Lumps
Prolapse
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Bimanual digital examination
Cervix
os shape / consistency
Uterussize / position / consistency /
regularity/ mobility / tenderness
Adnexaepalpable / size / consistency /
tenderness
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Speculum examination
Cuscoes bivalve speculum
Sims speculum
Positioning
Inspect cervix ulceration / bleeding/irregularity
Inspect vaginal wallsRemoval
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Basic Gynaecological Skill
Careful history
Sensitivity
Professional examination
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Further management
Differential diagnosis
Revise/Prioritise diagnosis
InvestigationsTreatment / Management
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Objectives
Gynaecological history
Gynaecological examination
Cervical screening
Formative assessment
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Cervical screening
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What is Screening
Apply test to asymptomatic individualsand classify likelihood of disease
- early detection with subsequent tests
- reduce diseaseseverity/recurrence/mortality
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Practice assessment