History taking and physical examination in gynaecology

1. Big picture

History taking and physical examination are the first diagnostic tools in gynaecology. In the exam, the examiner wants to hear that you can:

1. Recognize the clinical pattern: bleeding, pain, discharge, infertility, amenorrhoea, prolapse, urinary symptoms, vulval symptoms, breast symptoms.
2. Always check pregnancy status in reproductive-age patients.
3. Identify emergencies first: ectopic pregnancy, ovarian torsion, pelvic inflammatory disease with sepsis, ruptured ovarian cyst, heavy bleeding, sexual assault, malignancy red flags.
4. Perform a respectful, consent-based examination: privacy, explanation, chaperone, consent, trauma-informed approach.
5. Choose the correct examination: abdominal, external genital, speculum, bimanual, rectovaginal, breast examination, ultrasound, swabs, cytology, biopsy.

The golden oral-exam sentence:

“In any woman of reproductive age with pelvic pain, bleeding, collapse, or amenorrhoea, I first assess stability and perform a pregnancy test before assuming a purely gynaecological diagnosis.”

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