Women’s Health

You are seeing Cindy Albrecht, a 19 year old female, for amenorrhea. Please take a focused history for her complaint.

History

• Distinguishes primary vs. secondary amenorrhea (patient has had previous menstrual periods)
• Age of menarche
• Onset of last menstrual period
• Amount and changes in flow in recent menstrual periods
• Length of menstrual period
• Menorrhagia
• Dysmenorrhea
• Current use of birth control pills or other oral hormones
• Presence of vaginal discharge/itching
• Morning sickness
• Abdominal pain/discomfort
• Recent dieting
• Recent fractures
• Excessive exercise
• Galactorrhea
• Symptoms of hyperthyroidism (sweating, palpitations, heat intolerance)
• Symptoms of hypothyroidism (feels slow, cold intolerance, constipation)
• Symptoms of hypoestrogen state (hot flashes, night sweats, vaginal dryness)
• Personal history of chronic disease
• Pregnancy history
• Current and past sexual history, including partners, method of intercourse, and contraception
• Smoking and alcohol history
• Family history of genetic abnormalities and infertility

You are seeing Stacey Holland, a 23 year old female, for vaginal discharge. Please take a focused history for her complaint.

History

• Onset and duration of vaginal discharge
• Appearance of discharge
• Association with menstruation
• Presence of blood
• Itching
• Dyspareunia
• Pain on defecation
• Fever
• Nausea/vomiting
• Perineal/vaginal sores
• Abdominal pain/discomfort
• Rash or other lesions
• Swollen joints
• Vision changes
• Dysuria
• Hematuria
• Increased frequency of urine
• Last menstrual period
• Menorrhagia
• Dysmenorrhea
• Regularity of menstruation
• Past abdominal surgery
• Pregnancy history
• Current and past sexual history, including partners, method of intercourse, and contraception
• Smoking and alcohol history
• Medications – especially oral contraceptive pill
• Allergies
• Personal history of sexually transmitted infections and related investigations/treatment
• Last Pap smear and result

You are seeing Mrs. Thompson, a 56 year old woman, in your outpatient clinic today. She is worried about a left breast mass, and would like your reassurance that it isn’t cancer. Take a focused history of her complaint and perform a focused physical exam.

History

• Onset of awareness of mass
• Size of the mass and change in size
• How mass was identified
• Mastalgia
• Associated discharge, including pus and blood (none)
• Size/tenderness association with menstrual cycle
• Nipple changes
• Skin changes (on affected breast)
• Systemic symptoms – weight loss, low energy, anorexia
• Associated shortness of breath or chest pain
• Changes in personality – suggestive of brain metastases
• Bone pain – suggestive of bone metastases
• Inquires about date of menopause
• Pregnancy history
• Breastfeeding history
• History of chest radiation
• Age of menarche
• Alcohol history
• Smoking history (quantity in pack-years)
• Past and current use of hormone replacement and oral contraceptive pills
• Family history of breast, ovarian, or colon cancer
• Past history of breast masses
• Past mammography results
• Addresses patient’s concerns regarding the mass

Physical Examination

Inspection

• Drapes patient appropriately
• Inspects breast skin for discoloration, retraction, peau d’orange, or bruising
• Comments on presence of asymmetry
• Examines nipples, commenting on absence of discharge, irregularities, or retraction
• Examines areolas (no abnormalities)

Palpation

• Uses radial or strip method to palpate both breasts,
• Comments on texture, size, firmness, and mobility of any palpated masses
• Palpates axillary nodes bilaterally
• Palpates infraclavicular and supraclavicular nodes