Clinical Skills Ob/gyn

Front 1

Gyne interview questions

Back 1

current age; age at menarche, last menstrual period, interval btw periods, duration of flow, amount flow, degree of discomfort, age at menopause

Gravidity (#preggers); Parity (#births); term deliveries; abortions; living kids etc

STDs, sexual history

chief complaint, HPI, Meds, social, fam hist

Front 2

Female gyne Exam

Back 2

Breasts & axillae: dimpling, color, redness, rash, infection, swelling, nodules (size, mobile?)

External genitalia: usual + perineum, urethral meatus, vaginal opening

Internal organs: cervix, uterus, ovaries.

Front 3

female pediatric vs. reproductive-age vs. postmenopausal

Back 3

pre-adolescent: elevation of nipple, no pubic hair

reproductive age: breast + pubic hair

postmenopausal: breast + pubic hair

Front 4

When/ how often: breast exam, pelvic exam, pap smear

Back 4

Breast exam: insuff evidence that breast exams should be conducted

Pelvic exam: palpate cervix, ovaries, uterus, examine external genitalia -- should be yearly

Papsmear: every 3yrs -- screen for cervical cancer

Front 5

Interview q's for Male exam

Back 5

age, STDs, sex his, chief complaint, HPI (enlarged breast, lumps in scrotum, bulges in groin, itching, ED), med social fam history

Front 6

Male Reproductive exam

Back 6

breast: nipple discharge, enlargement

lump in scrotum: redness, size

bulge in groin

Genital itching: scaling, inflam, sores (location, pain)

urinary retention: BPH- prostate exam

ED

Front 7

MALE pediatric vs. reproductive-age anatomy

Back 7

pediatric: no pubic hair, same size as childhood penis & scrotum

Reprod: pubic hair + incr size scrotum & penis

Front 8

When/ how often: testicular self exam; DRE; Prostate exam

Back 8

self exam: not recommended

DRE: men age over 50; annually -- prostate cancer

Prostate exam: same as DRE -- prostate cancer

Front 9

Serum Hormones in kids, reproductive aged women, post menopausal

FSH

Back 9

Kids: 5 - 10mIU/ml

Repro: 5-30

post: 40 - 250

Front 10

Serum Hormones in kids, reproductive aged women, post menopausal

LH

Back 10

kids: 5 - 10

reprod: 5 - 80

post: >75

Front 11

Serum Hormones in kids, reproductive aged women, post menopausal

Estradiol

Back 11

Kids: <2

reprod: 1.8 - 23.2

post: <1.5

Front 12

Serum Hormones in kids, reproductive aged women, post menopausal

Progesterone

Back 12

Kids: none

reprod: 37 - 1198

post: 10 - 22

Front 13

Lab values for
1. PCOS
2. Premature ovarian failure
3. eating disorders

Back 13

1. PCOS = high LH

2. POF = high FSH, high LH

3. low GnRH --> low FSH, low LH

Front 14

Lab values for infertility

Back 14

Progesterone is high during luteal phase, low testosterone, high FSH, low estradiol

Front 15

lab values for female; estrone vs. estradiol

Back 15

estrone is decr. during reproductive age

estradiol is incr during reprod age

Front 16

% of serum bioavail testost --- % of total that is FREE (young male vs. older male)

Back 16

YM: 2

OM: 2

Front 17

% of serum bioavail testost --- % total bioavail

Back 17

YM: 40

OM: 22

Front 18

% of serum bioavail testost --- albumin bound

Back 18

YM: 38

OM: 20

Front 19

% of serum bioavail testost --- bound to SHBG (sex horm binding globulin)

Back 19

YM: 60

OM: 78

Front 20

Best time to obtain testost level?

Back 20

early in the day. repeat after 1 week.

Front 21

Measures for BPH

Back 21

AUA symptom score: 0 - 35

DRE of prostate

Peak Urinary flow: >25ml/sec in YM
>10-15ml/sec in OM

Postvoid residual urine vol: normal is 0ml

Front 22

PSA testing

Back 22

screen for prostate cancer, yearly screen for those above 50yo

Hyperplasia = incr PSA