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Department of Obstetrics/ Gynecology

Reading/ Learning Activities

Textbook:

At the beginning of the rotation, you will need to obtain the core textbook for the clerkship from Brenda McDowney Please take care of these books because they will be used by your classmates for a number of years to follow. The main textbook is: Beckmann CR, Ling FW et al: Obstetrics and Gynecology, 4th edition. Lippincott Williams & Wilkins, Philadelphia PA, 2002.

This book also includes 1800 questions with answers. You will be expected to have read this book cover to cover at least once during the course of the rotation. Please keep in mind that although there are other textbooks and review books in bookstores, you should not be studying solely from a review book. You will need to turn in the core textbook to Brenda McDowney on the last day of the clerkship as an ADMISSION TICKET to your written exam.

HISTORY AND PHYSICAL EXAM

A. PARITY

  1. Number of deliveries - not number of babies!!
    1. Therefore, quadruplets is Para 1
  2. A more complete description of past pregnancies:
    1. Term deliveries
    2. Premature deliveries
    3. Abortions
    4. Living children
      1. Example: 4-2-0-1

        4 term deliveries
        2 premature deliveries
        0 abortions
        1 living child
      2. A woman with 5 pregnancies including 1 abortion, 1 ectopic pregnancy, one normal infant delivery at 26 weeks, 1 set of twins at 36 weeks, and 1 C-section at 41 weeks is a: G5P3Ab2
  3. Good history taking is an art, yet important to have a methodical approach to avoid important omissions.
  4. Prenatal forms are helpful.
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B. CHIEF COMPLAINT

  1. In words of patient and include duration.

C. HISTORY OF PRESENT ILLNESS

  1. Expansion of chief complaint
  2. Determine exact dates of LMP and PMP
  3. Abnormal bleeding should be described as to time of occurrence, duration, pain, amount.
  4. Questions concerning sexual function are helpful - Don't avoid.
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D. PAST MEDICAL HISTORY

  1. Previous hospitalizations of interest, especially if for pelvic surgery, location of hospital, date of surgery and surgeon. Helpful in advisability of anesthesia, etc.
  2. All pregnancies listed in order by year with length of pregnancy, type delivery, fetal weight and complications.

E. FAMILY HISTORY

  1. Look for diabetes, cancer (esp. breast) or HCVD.

F. SOCIAL HISTORY

  1. Religion, occupation, # marriages, natural descent, health of husband.

G. SYSTEMIC REVIEW

  1. Eliminate bowel or bladder disease
  2. Date of onset, interval and duration of menstrual periods - 12+28+4-5.
  3. Vaginal discharge.
  4. Allergies to drugs, antibiotics, anesthesia.
  5. Previous embolic disease.
  6. Endocrine disorders.

H. PHYSICAL EXAM

  1. Weight, blood pressure and pulse.
  2. Inspection of head and neck and palpation of thyroid and supraclavicular areas.
  3. Thorough exam of breasts.
    1. Sitting with arms raised - especially apex of axilla.
    2. Supine position - systematic exam - arms raised.
    3. Nipple discharge. Exam varies with menses.
  4. Chest
    1. Lungs, heart.
  5. Abdomen
    1. Inspection - striae, distension, systemic palpation of viscera, especially liver, gallbladder, diaphragm and spleen.
    2. Palpation of cecum, rt. colon and sigmoid, tender LLQ throughout if diverticulitis.
    3. May need to cath bladder if midline mass.
    4. Ovarian cysts vs. ascites - by percussion.
    5. Cyst is dull, with ascites small intestine floats and is tympanitic.
  6. Costovertebral Angle (CVA) evaluation for renal colic, etc.
  7. Inguinal areas inspected and palpated.
  8. Extremities
    1. For edema, ulcerations, scars, varicose veins.

I. PELVIC EXAM

  1. Most important for gynecologist.
  2. Performed on exam table with legs supported and abducted, head raised slightly, buttocks extended just beyond edge of table. Need good light; empty bladder.
  3. Inspect external genitalia.
  4. Labia majora and minora - look for edema, ulceration, deformity, atrophy, hair distribution.
  5. Clitoris - enlargement or adhesions.
  6. Separate labia and inspect vaginal opening and urethra, especially Skene's glands and Bartholin's glands.
  7. Have patient strain and evaluate cystocele and rectocele.
  8. Index finger milk urethra.
  9. Note condition of hymen.

J. SPECULUM EXAM

  1. Peterson - Narrow
    Graves - Wide
    Pediatric sizes: Above, Huffman
  2. Warm and lubricate speculum.
  3. Insert with posterior pressure and oblique angle, then set lateral screw.
  4. Then do Pap smears - endocervical and ectocervical specimens.
  5. Cervical cultures for GC and chlaymdia.
  6. Note color, size and configuration of cervix and lesions.
  7. Inspect vaginal walls as speculum is slowly withdrawn.

K. INTERNAL EXAM - (Bimanual exam)

  1. One or two fingers left or right hand, finger elevate and support uterus and adnexa while abdominal hand used to feel anatomic details. If one learns to exam with one finger, can examine almost all patients.
  2. Move cervix laterally and see if pain is produced.
  3. Normal uterus is anteverted or retroverted.
  4. Feel uterus and each adnexa. Be gentle!
  5. Always exam painful side last.
  6. Finish with recto-vaginal exam.

List of Abbreviations

A list of common abbreviations in OB/GYN is available. The download is an Adobe .PDF file, so you will need the Adobe Reader to view it.

Download Abbreviations

 

For further information, please contact Dr. Samuel Jacobs, the Director of Undergraduate Medical Education for OB/GYN or Dawn Maziarz at (856)342-3006. We are located in 3 Cooper Plaza in Suite 221.

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