CLINICAL & TEACHING CASES
OBSTETRICS & GYNECOLOGy
TABLE OF CONTENTS / LINKS TO INDIVIDUAL CASES
1. History
2. Examination
3. Pap Smear and
... [Show More] Cultures
4. Personal Interaction / Communication Skills
5. Legal Issues / Ethics in Obstetrics & Gynecology
6. Preventive Care and Health Management
7. Maternal-Fetal Physiology
8. Preconception Care
9. Antepartum Care
10. Intrapartum Care
11. Immediate Care of the Newborn
12. Postpartum Care
13. Lactation
14. Ectopic Pregnancy
15. Spontaneous Abortion
16. Medical & Surgical Conditions in pregnancy
17. Preeclampsia-Eclampsia Syndrome
18. Isoimmunization
19. Multifetal Gestation
20. Fetal Death
21. Abnormal Labor
22. Third-Trimester Bleeding
23. Preterm Labor
24. Premature Rupture of Membranes
25. Intrapartum Fetal Surveillance
26. Postpartum hemorrhage
27. Postpartum Infection
28. Anxiety and Depression
29. Postterm Pregnancy
30. Fetal Growth Abnormalities
31. Obstetric Procedures
32. Contraception and Sterilization
33. Abortion
34. Vulvar and Vaginal Disease
35. Sexually Transmitted Infections & Urinary Tract Infections
36. Pelvic Relaxation & Urinary Incontinence
37. Endometriosis
38. Chronic Pelvic Pain
39. Disorders of the Breasts
40. Gynecological Procedures
41. Puberty
42. Amenorrhea
43. Hirsutism and Virilization
44. Normal and Abnormal Uterine Bleeding
45. Dysmenorrhea
46. Climacteric / Menopause
47. Infertility
48. Premenstrual Syndrome & Premenstrual Dysphoric Disorder
49. Gestational Trophoblastic Neoplasia
50. Vulvar Neoplasms
51. Cervical Disease and Neoplasia
52. Uterine Leiomyomas
53. Endometrial Carcinoma
54. Ovarian Neoplasms
55. Sexuality and Modes of Sexual Expression
56. Sexual Assault
57. Domestic Violence
1. History
2. Examination
3. Pap Smear and Cultures
4. Personal Interaction / Communication Skills
5. Legal Issues / Ethics in Obstetrics & Gynecology
6. Preventive Care and Health Management
History
This tool is designed to help the teacher lead an interactive session during which the students collectively develop a history taking format they can practice and internalize throughout the rotation. It is geared to taking a complete gynecologic history.
Approximate duration: 60 minutes
Resources needed: Large blackboard or erasable board vs. 2 to 3 flip charts Suggested curricular timing: First day or week of the rotation
Rationale for inclusion in the curriculum:
1. History taking gets little formal curricular attention
2. It is a skill students must have
3. It is a skill that students can actually do, giving them a legitimate role on the health care team and building self-esteem
4. Opportunities to record things in charts is often limited
5. Many institutions have adopted pre-printed history “check-lists” into their
formal medical records, encouraging students to become passive “box checkers,” rather than active information gatherers. In attempts to be concise, these forms often are poorly organized and leave little room for the students to record the patient’s actual story.
QUESTION 1:
What is the first thing that gets recorded in a patient’s history?
ANSWER:
The chief complaint.
QUESTION 2:
Outside of prenatal care, why do patients come to see an obstetrician-gynecologist? ANSWER:
Going around the room, the students create a list of around 30-40 reasons girls and women seek gynecologic care. It helps set the stage for what they will be expected to learn the rest of the rotation. Their list typically includes:
Annual exams Menopause
Abnormal Pap smears Infertility
Missed periods Pre-conception counseling
Heavy periods STD checks
Painful periods Vulvar pain
Bleeding between periods Vulvar lesions
Irregular periods Breast pain
Needs contraception Breast masses
Contraceptive complaints Postmenopausal bleeding
Pelvic Pain Leiomyomata
Dysmenorrhea Bartholin’s duct cysts
Dyspareunia Pelvic prolapse
Vaginal discharge Urinary incontinence
Vaginal itching Post-operative care
Vaginal odor Wound infections
Ovarian cysts Sexual assault
QUESTION 3: What comes next in the history? ANSWER: The HPI.
Indicate that each item they have listed has its own unique HPI. Describe what you want to hear at the beginning of every HPI, i.e.
“The patient is a 26 year old gravida X para Y with a last menstrual period on DATE here today for . . . “
Introduce helpful mnemonics, i.e. “An Alphabet of Pain for the HPI” P = Pain
Q = Quality
R = Region and radiation S = Severity
T = Timing
U = Undiagnosed?
V = Vomiting and other associated symptoms W = What makes it better /worse
OR, the ten “B’s” of the post-partum visit
Bladder Bowel
Bottom (episiotomy/lacerations) Bleeding (lochia /periods) Breasts
Blues
Birth control
Boinking (OK-not technically acceptable, but it starts with a B) Baby (doing well?)
Beaten/battered
QUESTION 4: What is the next component of the history during this rotation? Answer: The past ob-gyn history
Then present this to the students in the format and order you want them to collect and recorded during the rotation.
QUESTION 5: What are the next components of the history that you will need to collect?
Answer: Record these on the board in the order you want them collected and presented during the rotation:
Past medical history Past surgical history Past psychiatric history Medications Medication allergies Family history
Social history
QUESTION 6: Small group activity. Break the students into the following four groups:
1. Past medical history
2. Past surgical history
3. Past psychiatric history
4. Family history
Each group generates a list of ten common diseases or conditions that they can specifically ask their patients about in their assigned area. When all of the groups are done (5-10 minutes), they report these back to the group as a whole. Teacher records lists on the board.
Past Medical History - Lists typically include:
Asthma Headaches IBD
Allergies SLE GERD
Seizure disorders URI’s Hepatitis
UTI’s /pyelo Thyroid diseases CVA
Hypertension DVT’s/ PE Coagulopathies
Diabetes Anemia Hypercholesterolemia
From this list (limit to 10), brainstorm why each disease matters to a practicing ob-gyn. Issues typically include associated menstrual abnormalities, symptoms mimicking gynecologic conditions, potentially teratogenic therapies, high-risk pregnancy status, operative risks and impact on birth control decisions.
Past Surgical History (non-gynecologic) - Lists typically include:
Appendectomy Tooth extractions
Tonsillectomy Thyroidectomy
Pressure equalization tubes Hernia repair
ACL repair Correction of congenital anomalies
Breast biopsy Carpal tunnel release
Cholecystectomy Plastic surgery
From this list (limit to 10), brainstorm why each disease matters to a practicing ob-gyn. Issues typically include anesthetic complications, bleeding abnormalities, blood transfusions and post-operative intra-abdominal adhesions. [Show Less]