OBGYN Exam 1

 

Exam 1

 

Some worrying spotting.

Candidate Instructions

Setting:

You are a Foundation Year doctor working in General Practice. This patient has presented with abnormal bleeding.


Lucy Jones


Tasks:

1. Take a brief history from the patient.

2. Perform a speculum examination.

3. Interpret and describe the findings provided to the examiner.

4. Explain your diagnosis to the patient.

Simulated Patient Instructions

Briefing

Diagnosis: Cervical Ectropion - vaginal bleed

You are Lucy Jones, .

You have presented to General Practice with abnormal bleeding.

Opening statement

“‘I’ve noticed that I’ve been bleeding after sex and I’m not sure why”

Information to Give Freely

For the past couple of months you have noticed that you have been bleeding every time you have sex. You didn’t think anything of it at first but it has kept happening so you have come to the doctor to get it checked out.

Presenting Complaint

Site – Vaginal bleeding
Onset – 2 months ago
Characterisation of bleeding
-- Bright red blood
-- Amount - using a pad everytime it occurs, only requires 1
-- Clots - nil
-- Pelvic pain - nil
-– Relation to period - nil
Radiation – Bleeding from any other areas? - No
Associated symptoms
-- NO Weight loss/night sweats/fevers
-- NO Anaemia symptoms e.g. dizziness, SoB, palpitations
-- NO abnormal or increased discharge
-- Dyspareunia present, slightly uncomfortable deep inside during sex but not enough to stop
Timing – it is happening every time you have sex but the amount of blood has not changed
Exacerbating factors - triggered by sex
Severity – you’re worried that this is a sign that something serious is going on, you're worrying about it contantly.

Gynae History

Last menstrual period - 16 days ago
Age of menarche - 12 years old
How long are your cycles? - 28 days
Are they regular? - Yes
Any menorrhagia or dysmenorrhea? - No
Relevant sexual history/current status - Has been in relationship with boyfriend for 2 years
Smear status - 1 previous smear which was negative
Previous STI- none, last tested over 2 years ago

Obstetric History

Any previous pregnancies- No

Any previous terminations of pregnancy- No

Past Medical History

None

Drug History

Takes no regular medication other than COCP

Allergies - NKDA.

Contraceptive methods used - COCP which you started 3 months ago, you have good compliance, currently on day 9 of the packet

Family History

Nil significant.

Social History

No smoking, alcohol, or drug history.

Fully independent, works as a teacher.

Systems Review

No other issues.

Ideas / Concerns / Expectation

Ideas: Is this something serious?
Concerns: I googled this and it mentioned cancer?
Expectations: Please could you run some tests and see what is going on?

Discussion / Questions

After the history is complete, the doctor will ask if they can perform a speculum examination which you should agree to.

Start the Timer and Begin

Intro

 

Presenting complaint

 
  • Weight loss
  • Dyspareunia
  • Abnormal or increased vaginal discharge
  • Vaginal itching
  • Anaemia Sx 
    ?
    • Shortness of breath
    • Palpitations
    • Lightheadedness
  • Fevers or Malaise

    • Gynae History

     

    Obstetric History

     

    Past Medical History

     

    Drug History

     

    Family History

     

    Social History

     

    Systems Review

     

    General/Red Flags (e.g. fevers, weight loss, night sweats)
    Cardio (e.g. palpitations, chest pain)
    Resp (e.g. cough, breathlessness)
    GI (e.g. D+V, abdo pain)
    GU (e.g. frequency, urgency, dysuria, haematuria)

    Ideas, Concerns, Expectations

     

    Examination

     

    At the time where the candidate visualises the cervix please show them the below finding:

    Diagnosis

     

    Please inform the candidate of the correct diagnosis once they have given their differentials, regardless of whether their answer was correct or not

    Management

     

    Submit for Scoring

    Summar

    In this case benign cervical ectropion is the most likely cause. With a careful history we can see that the COCP was started just prior to symptoms, and the COCP can cause ectropion. Despite this further investigations e.g. triple swabs and a pregnancy test to rule out other causes should be undertaken.

    Ectropions are not contraindications to the COCP but for symptom control it may be worth discussion alternatives such as the progesterone only pill. Other treatment options are cautery, cryo or nitrate during colposcopy.

    Tags | OBGYN | vaginal bleeding | ectropion | PV bleeding

     Station Written by: Dr Olivia Byrne

    Peer Reviewed by: Dr Megan Burns