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Special Tutorial Programme

Special Tutorial Programme. Professor Deirdre J Murphy Trinity College. Introduction to Gynaecology. Objectives. Gynaecological History Gynaecological examination Cervical screening Practice assessment. Gynaecological history. Menses Sexual/Contraception Cervical smear Urinary

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Special Tutorial Programme

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  1. Special Tutorial Programme Professor Deirdre J Murphy Trinity College

  2. Introduction to Gynaecology

  3. Objectives Gynaecological History Gynaecological examination Cervical screening Practice assessment

  4. Gynaecological history Menses Sexual/Contraception Cervical smear Urinary Prolapse Pregnancies

  5. Complete History Demographics Specific gynaecological history Past Obstetric history Past Medical/Surgical/Psych history Family history Social history Medication / Allergies Systems review

  6. Gynaecological history Heavy bleeding Pelvic pain Leaking urine Failure to conceive

  7. Heavy bleeding

  8. Heavy bleeding Menarche / LMP / Menopause How often / How long / Regularity Heavy / volume Intermenstrual bleeding Postcoital bleeding Vaginal discharge Pain [Intercourse / contraception /smear / urinary / prolapse / obstetric]

  9. Pelvic pain

  10. Pelvic pain Features – cyclical/acute/chronic pain Abnormal menses Vaginal discharge Dyspareunia [Intercourse / contraception /smear / urinary / prolapse / obstetric]

  11. Leaking urine

  12. Leaking urine Urgency Stress symptoms Frequency Nocturia Dysuria Bowel symptoms Prolapse symtoms [Menses /Intercourse / contraception /smear / obstetric]

  13. Failure to conceive

  14. Subfertility History of a couple Duration Intercourse Previous pregnancies

  15. Female Menses Pelvic pain Vaginal discharge Dyspareunia Hirsutism Medical Cervical treatment Previous pregnancies Lifestyle

  16. Male Infections Medical illnesses Lifestyle Sterilisation Impotence / Failure to ejaculate

  17. Intelligent history Comprehensive but efficient Differential diagnosis Targeted questioning Prioritising diagnosis Focus examination

  18. Gynaecological examination

  19. Consent / Chaperone / Dignity

  20. General examination Appearance Weight Vital signs pulse blood pressure temp Cardiovascular Respiratory Breast / Axillae Lymph nodes

  21. Abdomen Inspect scars /body hair / distension / herniae Palpate tenderness / masses / umbilicus down Percuss dull /resonant / shifting dullness Auscultate bowel sounds

  22. Pelvic examination Inspection Bimanual digital examination Speculum examination [Rectal examination]

  23. Inspection Position patient Vulva / Vagina Abnormal skin colour / ulceration /atrophy Lumps Prolapse

  24. Bimanual digital examination Cervix os shape / consistency Uterus size / position / consistency / regularity/ mobility / tenderness Adnexae palpable / size / consistency / tenderness

  25. Speculum examination Cuscoe’s bivalve speculum Sims’ speculum Positioning Inspect cervix – ulceration / bleeding /irregularity Inspect vaginal walls Removal

  26. Basic Gynaecological Skill Careful history Sensitivity Professional examination

  27. Further management Differential diagnosis Revise/Prioritise diagnosis Investigations Treatment / Management

  28. Objectives Gynaecological history Gynaecological examination Cervical screening Formative assessment

  29. Cervical screening

  30. What is Screening Apply test to asymptomatic individuals and classify likelihood of disease - early detection with subsequent tests - reduce disease severity/recurrence/mortality

  31. Criteria for screening Suitable Disease Serious Pre-symptomatic treatment better High prevalence Suitable test Cheap /painless/ easy to administer Valid sensitivity/specificity Reproducible reliable instrument /observer variability

  32. Practice assessment

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