GENERAL&ABDOMI

NALEXAMI
NATI
ON

ACTI
VITY/PROCEDURE: MARKS

Candi
dat
eisexpect
edt
o: 0 0.
25 0.
5 1

1Gr
eett
hepat
ient
. X
2.Introducehimsel f/her selftot hepat ient. X
3.Expl ai
nthepr oceduret ot hepat i
ent. X
4.Obt ainpermissiont oexami neher . X
GENERALEXAMI NATI ON( candi datet odemonst r
atepresenceofanaemi a,
stateofhy
drat
ion&pr
esence
ofoedema)
5.Pal l
ortobeobser vedint hef ollowingar eas:palpebralconj
uncti
va,pal
ms,buccal X
mucosa,
be
6.n
S e
tat
ath
eth
oe
ft
ho
yn
dg
rau
te
i,
oca
n:p
li
pi
l
lar
s ayr
nef
d i
ol
l
r.
al muc os amoi s t
ness;drynessofthes ki
n;skin
turgor ; X
presenceofsunkeney esi nsev erecases, characteri
sti
csofthepulse.(
0.25mar ks
ea
7.c hfo r4
Oedemaoft hef eet,ank le,ti
bia, presacralregion,anteri
orabdominalwall
,peri- X
i
te
orms
bit )
al
o
I
Ned
Sema
PECT.(
I0N
O.25mar kseachf or4i tems)
8.Shapeofabdomen X
9.Mov ementwi thr espi rat i
on X
10.Umbi li
cal stump( inver t
ed/ everted/fl
at) X
11.Presenceofst ri
ae/l i
neani gr
ae X
12.Hairdistribution X
13.Presenceofscar s( sur gicalornon- specifi
c)
PALPATI ON
14.Askf orsi teofpai ni fany X
15.Candidat eshoul dmai ntainey e-contactwiththepati
entandobserveherf
orpai
n X
Li
ghtpalpat ionf ort hepr esenceofmassesandt ender
ness
16.Proper l
ydone( 0.5) ;ifnotdonecor r
ectly(0) X
17.Repor ti
ngnot ender ness X
18.Repor ti
ngpr esenceofmass X
19.Deeppal pat i
onf oror ganomegal y(LSK) .Scorezer
oforwrongtechni
que
Li
v er-cor rectmet hod X
Spleen-cor rectmet hod X
Rightki dney-cor r
ectmet hod X
Leftkidney-cor rectmet hod X
Palpat
ionoft hemass
20.Palpatef rom xi phi sternum X
21.Assessmentofsi ze X
22.Goingbel owt hemass X
23.Definingt heedge X
24.Definingt hesurface X
25.Mobi li
tyi n2pl anes( l
ongi tudinal&t ransv erse)[ 0.25each] X
26.Attachmentt oskin X
27.Attachmentt oant eriorabdomi nalwal l
muscl es X
28.Differentialwar mt h X
29.Checkf orpr esenceoff l
uid.Techni que-shi f
ti
ngdul lnessorf l
uidthri
ll X
Reporti
ngt hef i
ndings:
30.Site X
31.Size X
32.Shape X
33.Surface X
34.Cangetabov eandbel ow? X
35.Mobi li
tyi nthet ransv erseandl ongitudinal planes X
36.Tender ness X
37.Mar gins X
38.Consi stency X
39.Attachmentt oskin X
40.Attachmentt oant eriorabdomi nalwal l X
41.Differentialwar mt h X
42.Presenceorabsenceoff luid X
QUESTI ONS
43.Quest ion: Whatot herexami nationwoul dy oul iket odo? X
Answer :Pelvicexami nation
44.Quest ion: Howwi llthepel v i
cexami nat ionhel pi nt hedi agnosi
soft hemass? X
Answer :Itwoul ddi f
ferent i
at ebetweenaut eri
nemassandanadnexal mass.
45.Followupquest ion: How? X
Answer :Wi ththe2exami ni ngfingersont hecer vix,themassi sdispl
aced
cephal adandt hecer vi
xmov esawayf r
om t heex am f ingersifi
tisuterine
.Thecer vixdoesnotmov ei fthemassi si ntheadnex ia.
mo ve i
f
46.Questt
hie
on: Whati st hepl aceofspecul um int hiscase? X
mas sis a
Answerd ne
: xali
no
Thecer vr
i
igin e
xandvxce p
agit i
fi
nalti
s
wala
ld he r
e
scanbeint t
ot
nshe
pecu
tt
eer
us
df o.
rmalignancy.Pap
smearscan
b
4et
7.ak
Que
eni
f
st
in
oo
nn
:e
Fr
oi
nt
m h
t
he
epa
hs
st
itf
oe
r
ywye
an ar
des
x.
ami
nat
iongi
ve2di
ff
erent
ial
diagnoses? X
Answer :Uter
inefi
broids/Ut er
inecar ci
noma/Ut erinesar coma/Ov ariancancer
48.Quest i
on: Supposingthemasst endsoutt obeuteri
nef ibroids,whatwi llaccount
forthebl eeding? X
Answer :Submucousnodul es,largeendomet r
ialsurface, i
ncr easedut eri
ne
bloodflow,abnor malinteract i
onbet weenendomet rialprost acycl
inand
thrombox ane
ab norma
49.Quest li
inte
on:ract
Whai
o
tn
ps
reb
te
r
etw
ateen
me ne
tn
id
nvo
eme
st
it
gr
i
aa
t
il
op
nr
o
sst
woac
uy
lcl
dy i
n
o &t
ud hr
oi o
f mb
heo
t x
maa
sn
seia
snd X
e
cnn
o df
o
ime
rme t
r
dia
tlbeut
o er
inefibroids? X
ulceration.
Answer
:a)Haemat
ologyandbi
ochemi
str
y(maxi
mum 0.
5)b)I
magi
ng:
abdomenand
pel
vicscan(maxi mum 0. 5)
50.Questi
on:Whatwi l
lbey ourdefinit
ivetreatmentforher? X
Answer:Mostpr obablymy omect omy
51.Questi
on:Ment ion4compl icat
ionsofmy omectomy ? X
Answer:bleedi
ng/woundsepsi s/i ntr
aperit
onealadhesi
onset c.(0.
25each)
52.Questi
on:Howwoul dy our educet heformationofadhesionsintr
aoperat
ivel
y?
Answer: Midli
neincision/Fastsur gery/gentleti
ssuehandling/adequat e X
peri
toneal
l
avage/useofcel lul
osemat erial
ov ertheut er
inewound/i nsti
l
lationofsali
neor
d
Te
Ox
Ttr
a
An
LMARKPERCOLUMN
i
ntothe
OVERAL p
Le
Tr
i
Ot
oTn
Aeal
L cav
MA Ri
t
Ky( 0.25each)
ACTI
VITY 7.AUB MARKS
0 0.
25 0.
5 1 2
1.Greet scl i
ent X
2.Introducessel fwi tht heex planat i
onofpur poseof X
interaction
3.Demogr aphicf eatur es:
•Na mea nda ge X
•Pl aceofa bode X
• Pa ri
ty X
• As k sL NMP X
4.Ref erral:from… X
Onaccountof … X
5.Present ingcompl aint
•I nterme nstrual ble edi ng X
•Pos t coi talbl eeding X
6.Dur ationofPC
•Dur ationofi ntermens trual bl
eeding X
•Dur ationofpos t
coi tal bleeding X
7.ODQ: ask s
•Se ve r
ityofbl ee ding X
•Pa ss a geofc lots X
•Howmanys anitaryt owel saday X
•Howmuc hs tainedar et hes t
aineds ani
tar
y X
towel s?
X
• Pa lpita tion s
X
• Di zz i
n e s s
X
•Ea syf a tigua bi l
ity
X
•Lowe rabdomi nal pai n
X
•Lowe rabdomi nal mas s
X
•Va gina ldis cha rge
8.Syst emi crev iew: ask sabout
•Re spir at orys y stem X
• GI T X
•Geni tour inar ys ystem ( dy suri
a,frequency) X
• CNS X
X
•Mus cul os ke letals ys t
e m
9.Gynaehi stor y:
Menst rual histor y:asks
•Agea tme na rche X
•Nor mal c yclel engt h X
•Dur a t
ionoff l
ow X
•Dy sme nor rhoe a X
X
•Numberofs ani t
ar ytowel saday
Sex ualhistor y: asks
X
• Coi t arc h e
X
•Numberl i
fetimes exual par t
ners
X
Prev i
ousPapsmear-whenl astdone
X
Resul t
X
HistoryofSTI
Cont r
acept i
vehi story :asks
 •Ty peus e di nt hepas t X
•Howl ongi twasus ed X
•Whyi twass toppe d X
•Me thodc ur rent l
yus ed X
10.Obstetrichi stor y
Pastobst etri
chi stor y:asks
•Ye arpr e gnanc ye nde d X
•Pr e gnanc ypl anne d? X
•I funpl anned, wasi twel come? X
•Anypr obl emsdur ingant enat alper
iod X
X
•Dur at i
onofpr egnanc y
X
•Out c omeofpr e gnanc y
X
•Sur gical proc e dur edone
X
•I ndi cationf orEOU
X
•Pos tabor tal c ompl icati
on
X
•Ant ibiot icsgi ve n X
•Dur at i
onofhos pitals t
ayaf terEOU
11.PMSH: asksaboutper sonal medi calcondit
ions X
12.Drughist or y:ask s
•me dicat ionsbe ingt ak en X
•he rba lme dic ation X
•a l
le rgie s X
13.Fami l
yhi story :ask sabout
• Si b ling s X
• Pa ren ts X
•Si gni fi
c antmedi cal conditi
oni nfamily X
14.Socialhist ory: ask s
•Ma rital sta tus X
•Woman’ sl ev elofeduc ati
on X
•Woman’ soc cupat i
on X
•Oc c upat ionofhus band X
•Us eofal cohol ort obac co X
X
• Re lig i
on
X
•St anc eonbl oodt r
ans fusion
Summar ydwel l
ingonsal ientf eat ures: X
NAME/AGE/PARI TY/REFERRALFROM DANSOMAN
POLYCLINIC/
ONACCOUNTOFCERVI CALPOLYP/PRESENTSWI TH
INTERMENSTRUALBLEEDI NGOF/3MONTHSDURATI ON/AND
POSTCOITALBLEEDI NGOF/1MONTHDURATI ON/FEELSNO
LOWERABDOMI NALMASS
(0.
2
Tot5ma
al rks ea
ma percoch -t
l
uot
mnal 2mar ks)
GRANDTOTAL /
19.
5
 7.AUB

ROLEPLAYER’
SBRI
EF

YouareMrsAli
ceMensah,a28-
yearol
dP0+1whol
i
vesatDansoman.Yourl
astnor
mal
menst
rual
per
iodwas7/
9/17.

Youhav ebeenbl
eedingbet
weenmensesforthepast3mont
hsandbl
eedi
ngaft
ersexf
orthepast
1mont h.Yousaw adoctoratDansomanPolycl
ini
c.Hedi
daspecul
um exami
nati
onand
foundagr owthatthecervi
x,whi
chhecalledapol y
p.Heref
err
edyoutoKBTH onthi
s
account.

Dur
ingtheseepi sodes,t
hebleedi
ngismoderate.Youuse3padsadaywhi chget
moderat
elysoaked,andyoupasssmal
lcl
ots(
aboutsi
zeof10-
peswewacoi
n).

Youfeelnolowerabdomi
nalmassandhavenol owerabdominalpai
n.Youhav
eno
vagi
naldi
schar
ge.Youhav
enodizz
iness,
pal
pit
ati
onsoreasyf
atiguabi
l
ity
.

Youhav
enoot
hersy
mpt
oms.

Yourfi
rstmenseswasat12y
earsofage.Unt
ilr
ecent
ly,y
ouhavehadaregul
ar28-
daycycl
e
duri
ngwhichyoubl
eedf
or5days.Youusetwopadsadayandhavenopai
nduri
ngmenses.

Youhadyourfi
rstsexat22year
s.Youhavehad3li
fet
imesexualpar
tner
s.Youhav
eno
hi
stor
yofSTI
.YoudidaPaptestf
ort
hefi
rstt
ime1y
earagoandi
twasnor mal
.

Youusedcombi
nedoralcontr
acepti
ves4y ear
sago.Youstoppedaf
ter6mont
hsbecause
yougai
nedwei
ght.Youarecur
rentl
yusingnocont
racept
ivemethod.

Yourf
irstandonlypregnancywas2y ear
sago. I
twasunpl annedbutwelcome.Youhad
epi
sodesofslightvaginal
bleedi
nginthefi
rsttr
imester.At5mont hsy
ouhadami scarr
iage.
Youhadsur gi
calevacuati
ondonebecauset heplacent
awasr etai
ned.Therewasno
compli
cationfol
lowingtheprocedur
e.Youreceiv
edant i
bioti
csandgotdischar
gedthe
fol
l
owingday .

Youhav
enochr
oni
cmedi
cal
condi
ti
onandhashadnosur
ger
y.

Youar
enotonanymedi
cat
ionatt
hemoment
.Youhav
enoal
l
ergi
esandy
oudonotuse
her
bal
prepar
ati
ons.

Youhavet
wosi
ster
swhoar
ebot
hwel
l
.Bot
hpar
ent
sar
eal
i
veandwel
l
.Nomedi
cal
condi
ti
oni
n
the
famil
y.

Youhavebeenmar r
iedfor3year
s.Youar
eat eacherwi
tht
ert
iar
yeducat
ion.Yourhusbandis
anadmi ni
str
ator.Noneofy outakesal
coholorsmok eci
garet
te.YouareaMet hodistand
accept
sbloodt r
ansfusi
on.
ACTI
VITY 5.I
NCOMPLETEABORTI
ON MARKS
0 0.
25 0.
5 1 2
1.Gr eetscl i
ent X
2.Introducesselfwiththeexpl
anat
ionofpur
poseof X
i
nteraction
3.Demogr aphicfeatur
es:
•Na mea nda ge X
•Pla ceofa bode X
•Gr avidi
tyandpar i
ty X
• Ask sL NMP X
X
•Det erminesges tati
onalage
4.Pr esentingcomplaint x
5.Dur ati
onofPC x
6.ODQ: ask s
vagi
nalbl
eedi
ng
•Col ourofblood X
•Se veri
tyofbleeding X
•Howmanys anit
arytowelsusedsinceons et X
•Howmuc hstai
nedwer ethestai
neds ani
tary X
t
owels?
X
•Pas sageofc l
otsorf et
alpr
oducts
X
•As soci
atedc r
ampi ng/l
owerabdominalpain
X
• Palpi
tati
ons
X
• Dizzi
ne ss
X
•Ea syfati
gabili
ty
mi
scar
ri
age
•I
sItspontaneousorinduc ed X
•I
fspontaneousanypr ec edingev
ent X
•Associ
atedvaginadisc harge X
•Odourofdischarge/bleedi ng X
•Associ
a t
edfe ver X
7.Systemi creview: asksabout
•Re spirat orys ys tem X
• GI T X
•Geni tour inar ysy stem (dysur
ia,
frequency
) X
• CNS X
X
•Mus c ulos ke l
etal system
8.Gynaehi story:
Menst rualhistor y:asks
•Agea tme na r
c he X
•Nor mal c y
c lele ngth X
•Dur ati
onoff low X
•Dy sme nor rhoe a X
X
•Int erme nstrual bleeding
Sexualhistory: asks
X
• Coi tarc h e
X
•Numberl i
fetimes exualpart
ners
X
Previ
ousPapsmear-whenl astdone
X
Result
X
 Vagi
naldischarge
Cont
raceptivehist
ory:asks
•Ty peus edi nthepas t X
•Howl ongi twasus ed X
•Whyi twass t
oppe d X
•Me thodc urr
entlyused X

9.Obs tetr
ichi stor y
Pastobst etri
chi stor y:asks
Indexpr egnancy : asks
•Waspr e gnanc yte stdone X
•WasPr e gnanc ypl anne d? X
•I funpl anned, wasi twel come? X
•Hasanyi nv esti
gat ionbeendonef ol
lowi
ngthe X
bl eeding
X
•Res ultsofi nv es t
igat ionifk nown
10.PMSH: ask s
•aboutper sonal medi cal condit
ions X
•Hi s toryoft rans fus ion X
•Ac c eptanc eofbl oodpr oduc t
s X
11.Drughist or y:ask s
•me dicat ionsbe i
ngt ak en X
•he rba lme dic at
ion X
•a lle rgie s X
12.Fami l
yhi story :ask sabout
• Si b ling s X
• Pa ren ts X
•Si gni fi
c antmedi cal c onditioninfamil
y X
13.Socialhist ory: ask s
•Ma rit
a l sta tus X
•Woman’ sl ev elofeduc ati
on X
•Woman’ soc cupat i
on X
•Oc c upat ionofhus band X
X
•Us eofal c ohol ort obac co
Summar ydwel l
ingonsal ientf eatur es: X
NAME/AGE/PARI TY/HASBEEN13WEEKSAMENORHOEI C/
COMPLAI NSOF2DAYSHI STORYOFMODERATEVAGI NAL
BLEEDING/ASSOCCI ATEDWI THLOWERABDOMI NALPAIN/
ACCOMPANI EDBYPASSAGEOFFETALTI SSUE/RHESUS
NEGATIVEANDNOTANAEMI C
(0.
25mar kseach-t otal 2mar ks)
Totalmarkspercol umn
GRANDTOTAL /
19.
5
 5.I
NCOMPLETE

ABORTI
ON

ROLEPLAYER’
SBRI
EF

1.Demogr aphi
cfeatures:NameandageMRSSOFIA,
28YRS
• PlaceofabodeMADI NA
• Gravidi
tyandpari
tyG1P0+0
• AsksLNMP21STJUNE, 2017
• Determinesgest
ationalage13WK+0DAYS
2.Pr esenti
ngcomplaintBLEEDINGFROM VAGI
NA
3.Dur ati
onofPC2DAYS
4.ODQ:
vagi
nabl
eedi
ng
• Colourofbl
oodDARKRED
• Severi
tyofbleedingNOTTOOHEAVY
•Howmanysani tarytowelsusedsinceonset3-
4/DAY
•Howmuchst ainedwer ethestai
nedsanitar
y
towels?MODERATELYSOAKED
•Passageofcl otsorf etalpr
oductsYES/FETAL
PRODUCTS/ FISTFULL
•Associ at
edcr amping/lowerabdominalpain
YES
• Palpi
tati
onsNO
• Dizzi
nessNO
• Easyf ati
gabi l
it
yNO
mi
scar
ri
age
•IsItspontaneousori nducedSPONTANEOUS
•Ifspontaneousanypr ecedingev
entNO
• Associ
atedv aginadischargeNO
• Odourofdischar ge/bleedi
ngNORMAL
• Associ
atedfev erNONE

5.Syst
emi crev iew:asksabout
• Respi ratorysy stem NO
• GITNO
•Geni tourinarysy stem (dysur
ia,
frequency
)NO
• CNSNO
• Muscul oskel etal system NO
6.Gy
naehi s t
or y:
Menstrual history:asks
• Ageatmenar che13YRS
• Nor mal cyclel engt h30DAYS
• Dur ationoff l
ow5DAYS
• Dy smenor rhoeaNO
•Int ermenst rual bleedingNO
 Sexualhistory:asks
• Coi tar
che21YR
• Numberl ifeti
mesexual partner
s4
Previ
ousPapsmear-whenl astdone1/LASTYEAR
ResultNORMAL
Vaginaldischarge
Contraceptivehistory:asks
• Ty peusedi nthepastCONDOM
• Howl ongi twasusedSI NCECOI TARCHE
DURI NGCOI TUS
• Whyi twasst oppedNOREASON
• Met hodcur r
entlyusedNONE

7.Obstet
ri
chi st
ory
Pastobstetr
ichi stor
y:asks
Indexpregnancy :asks
• Waspr egnancyt estdoneYES/UPT
• WasPr egnancypl anned?NO
•Ifunplanned, wasi twel
come?YES
•Hasanyi nvesti
gationbeendonef
oll
owi
ngthe
bl
eedingYES/BLOODTEST
•Resultsofi nvest
igati
onifknownNORMAL
BLOODLEVEL/ANDGROUPBNEGATI VE

8.PMSH: asksaboutper sonal medicalcondi

ti
ons
• TRANSFUSI ONHX: NO
• ACCEPTANCEOFBLOODPRODUCTS: YES
9.Drughistor y:ask s
• medi cati
onsbeingt akenPARACETAMOL
• herbal medicati
onNO
• all
er giesNO
10.Famil
yhi story:asksabout
• Siblings3BROTHERS
• Par entsBOTHDEAD/OLDAGE
•Si gnif i
cantmedical conditi
oni
nf amil
y
HYPERTENTI ONI NFATHER
11.Soci
alhist ory:asks
• Mar italstatusMARRI ED
•Woman’ slevel
ofeducat ionTERTIARY
•Woman’ soccupationLAWYER
• Occupat i
onofhusbandLAWYER
•Useofal coholortobaccoNO, BUTHUSBAND
DRI NKSOCCASI ONALLY.
•
Summar ydwelli
ngonsal i
entfeatures
ACTI
VITY 8.I
NFERTI
LITY MARKS
0 0.
25 0.
5 1 2
1.Gr eet scl i
ent X
2.Introducessel fwi tht heex planati
onofpur poseof X
i
nteract ion
3.Demogr aphi cf eat ures:
•Na mea nda ge X
•Pl aceofa bode X
• Pa ri
ty X
• Ask sL NMP X
4.Present ingcompl ai nt x
5.Dur at i
onofPC x
6.ODQ: ask s
•Ga lac tor rhoe a X
•Me ns trua lc ycle X
•I rre gul a rme ns es X
•Dy sme nor rhoe a X
•Dy spa re uni a X
X
•He atorc oldi ntol erance
X
•Abnor mal wei ghtl os sorwei ghtgai n
X
• Hi r
s u tism
X
•Smok i
ng, alc ohol ,rec r
eati
onal drugs
X
•Pr ev iousgy naec ol
ogi calsurger i
es
X
•Se xual fre que nc i
es X
•c ont ra c e ption X
Par
tner:
age, occupat ion, smoki ng, anychild, genit
ouri
nar
y
sur
geri
es, mumpsor chi ti
s, li
bido, erecti
ledy sf unct
ion
7.Sy stemi cr ev iew: ask sabout
•Re spi rat orys ys tem X
• GI T X
•Geni tour inar ys y s t
em ( dysuria, fr
equency) X
• CNS X
X
•Mus cul os ke l
etal system
8.Gy naehi stor y:
Menst r
ual hi stor y: asks
•Agea tme na rc he X
•Nor mal c yc l
el e ngth X
•Dur a ti
onoff low X
•Dy sme nor rhoe a X
X
•I nt erme ns trual bl eeding
Sex ual histor y: asks
X
• Coi ta rc h e
X
•Numberl if
et imes ex ualpar t
ner s
X
Prev i
ousPapsmear-whenl astdone
X
Resul t,anytreat ment?
X
Vagi nal dischar ge
Cont racept ivehi st ory: asks
X
•Ty peus e di nt hepas t
X
•Me thodc ur rent lyus ed
9.PMSH: asksaboutper sonal medical conditi
ons X
 10.Drughist or y
:ask s
•me dicationsbe ingtak en X
•he r bal me dication X
•a lle rgies X
11.Fami l
yhist ory:ask sabout
• Si b lings X
• Pa r ents X
•Si gni f
icantmedi calcondit
ioni
nfami
ly X
12.Socialhist ory:asks
•Ma rit
a lstatus X
•Woman’ slev elofeduc at
ion X
•Woman’ soc cupati
on X
•Oc c upationofhus band X
X
•Us eofal cohol ortobac co
Summar ydwel l
i
ngonsal ientfeatures: X
NAME/AGE/PARI TY/I NABI LI
TYTOCONCEI VEFORFIVE
YEARS/
I
RREGULARMENSESFORTHREEYEARS/WEI GHTGAIN/
HUSBANDHASNORMALSEMI NALFLUI DANALYSI
S
(
T0
o.
2
ta5ma
lmarr
k
ks
s e
pa
ec
rcho -
l
ut
ot
mnal2mar ks)
GRANDTOTAL /
16.
5
 8.I
NFERTI
LITY
ROLEPLAYER’
SBRI
EF
Mr sCeci l
iaOppong, a28- year
-oldwoman, mar riedsi ncel ast5y ears,
residentofKasoa,
presentedt othegy necol ogyout pati
entdepartmental ongwi t hherhusbandwi ththe
compl aintofinferti
l
ity.Thecoupl ehasbeenpr acticingr egularsexual i
ntercourse
si
ncel ast2y ears.Thewoman’ smenst r
ualhistor yrev ealedt hatshehasbeenhav i
ng
i
rregular
menst rualcyclessincel ast3y ears.Thecy cl
edur ationr angeswi t
hin30-35day s.The
cycleslastforappr oximat ely4-5day s.Howev er ,t
hewomanhasbeenobser v
inga
progressivedecr easei ntheamountofmenst rual bl oodf lowov erthepastf ewmont hs.
Thecoupl ehadpr eviouslyv i
sit
edani nf
ert
il
it
yspeci alist6mont hsbackwhohad
orderedasemenanal ysi
s.Ther esultofthisinv estigationwaswi t
hinnormal li
mits.

ACTIVI
TY
1.Gr eetscli
ent
2.Introducesselfwiththeexpl
anat
ionofpur
pose
ofinter
acti
on
3.Demogr aphi
cfeatures:Nameandage Cecil
i
aoppong,
28y
earol
d,
Placeofabode kasoa
•p ar i
ty Para0+0
• Ask sL NMP 5/09/17

4.Pr esenti
ngcompl aint I
nabi
l
ityt
oconcei
ve
5.Dur ati
onofPC Fi
veyear
s
6.ODQ: ask s
•Ga lactorrhoe a No
•Me ns t
rua lc ycl
e I
rregul
arf
ort
hreey
ear
s
•Dy s me nor rhoea No
•Dy s pare unia No
No
•He atorc oldi nt
oler ance
Weighgai
n
•Abnor mal weighlos sorwei ghgain
No
• Hi rs ut
is m
No
•Pr ev i
ouspr egnanciesandout come
No
•Smok i
ng, alcohol,rec r
eationaldrugs
No
•Pr ev i
ousgy naecologi calsurgeries
Threet
imesaweek
•Se x ualf r
eque ncies
•c ont r
a cept i
on No
Part
ner:
age, occupat ion,smoki ng, anychild, Husband35y earold,
geni
tour
inarysur geri
es, mumpsor chiti
s,li
bido,er
ect
il
e mechanic,
nosi gni
ficant
dysf
uncti
on medical
histor
y
7.Syst
emicrevi
ew:asksabout
•Re spir
ator
ys y
s t
em Notsi
gni
fi
cant
• GIT
•Geni t
ouri
narysystem (
dysur
ia,
frequency
)
• CNS
•Mus culoskel
etalsyst
em
8.Gy
naehistory:
 Menstrualhistory:asks
•Agea tme na r
c he 14year
s
•Nor mal c yclele ngth Regul
arunt
ilt
hreey
ear
sago
•Dur ati
onoff low Twodays
•Dy sme nor rhoe a No
•I nterme nstrual bleeding No
Sexualhistory:asks
Coi
tar
cheatage21
• Coi tarch e
Twoli
fel
ongsexualpar
tner
s
•Numberl i
fetimes exualpart
ners
No
Previ
ousPapsmear-whenl astdone
Result,anytr
eatment
?
No
Vaginaldischarge
No
Contraceptiv
ehi story:asks

9.PMSH: asksaboutper sonalmedicalcondi

ti
ons Notsi
gni
fi
cant
10.Drughi
stor y
:ask s Notsi
gni
fi
cant
•me dicationsbeingtake n
•he rba lme dicat
ion
•a l
le rgies
11.Famil
yhistory:asksabout Bothparentsali
ve
• Si
b lings Threesibl
ings
• Pa rents Nosignifi
cantmedical
•Signi f
icantmedi calcondit
ioninfamil
y condit
ion
12.Soci
alhi
st ory:asks
•Ma rit
a lstat
us Marr
iedfi
veyear
s
•Woman’ slevelofeduc at
ion JHS
•Woman’ soc cupati
on Seamstr
ess
•Oc c upationofhus band Mechani
c
•Us eofal coholortobac co None

Summarydwell
ingonsal
ientf
eat
ures:
(0.
25markseach-tot
al2marks)
Total
markspercol
umn
GRANDTOTAL
ACTI
VITY 6.POP MARKS
0 0.
25 0.
5 1 2
1.Greet scl i
ent X
2.Introducessel fwi tht heex planati
onofpurposeof X
i
nteract ion
3.Demogr aphi cf eatur es:
•Na mea nda ge X
•Pl aceofa bode X
• Par i
ty X
• Ask sL NMP X
4.Present ingcompl aint x
5.Dur at i
onofPC x
6.ODQ: ask s
•Si zeofma ss X
•I ncr eas i
ngorde cr
easing X
• Pa in X
• Bl ee din g X
• Ul ce ration X
X
• Re du cible
X
•Hass hes oughtanyt r
eatment
X
•F requ e n cy
X
• Ur g en cy
X
• He s itan cy
X
• St rain i
n g X
•Poors trea m X
•I ncompl et
ebl adderempt yi
ng X
•Ur i
nar yi ncont i
nence X
•Fae c al i
nc ontinence X
•St r
ai ningatde fecti
on X
•Feel i
ngofi nc ompleteemptyingof
7.Sy stemi cr r
evec
i t
ew:umask sabout
•Re spirat orys y stem X
• GI T X
• CNS X
8.Gynaehi story :
Menst r
ual histor y:asks
•Agea tme na rche X
•Nor mal c y
c lel ength X
•Dur ationoff l
ow X
•Dy sme nor rhoe a X
X
•I nt erme nstrual ble eding
Sex ual history: asks
X
• Coi ta r
c h e
X
•Numberl i
fet i
mes ex ualpart
ners
X
Prev i
ousPapsmear-whenl astdone
X
Breastex am
X
Vagi nal dischar ge

Cont
racept
ivehi
stor
y:asks
X
•Ty peus edinthepast
 9.Obs tetri
chi st or y
Pastobst etrichi stor y:asks
•Ageofc hildr en X
•Ca rrie dt ot erm X
•Pl a c eofde l
iv ery X
•Modeofde li
v ery X
X
•Dur a ti
onofl a bor
X
•Epi s iot omi esort ears
X
•We ightofba bies
X
•Cr iedaf te rde l
ive r
y
X
•Br e a stfe e ding
X
•Cur rentc ondi tionofc hi
ldren
10.PMSH: asksaboutper sonal medi cal
conditi
ons X
11.Drughi stor y: ask s
•me dic at ionsbe ingt aken X
•he rba lme dic ation X
•a l
le rg ie s X
12.Fami l
yhi stor y :ask sabout
•Chr oni ci llne ss es X
•Gy naemal ignanc i
e s X
•s i
b lin g s X
13.Socialhist ory : ask s
•Ma rita ls ta tus X
•Woman’ sl ev el ofeduc ation X
•Woman’ soc cupat ion X
•Us eofal cohol ortobac co X
X
• Re lig ion
X
•Ac c ept sbl oodt ransfusi
on
X
• NHI S
Summar ydwel li
ngonsal ientf eat ur
es: X
NAME/AGE/PARI TY/20YRSPOSTMENOPAUSAL/ PRESENCE
OF
MASSATVULVA/ DURATI ON/ CHRONI CCOUGH/ PEVIOUS
HISTORYOFPROLONGEDLABOR/ FORCEPSDELI VERY/AT
LEAST
RD
3
Tot D
aE
lGR
maE
rkEP
spE Rc
erINoElA
u LTEAR/
mn BIGBABY/ CHRONI CHTNAND
D M
GRANDTOTAL /
18.
5
(0.25mar kseach-t otal 2mar ks)
 6.POP
ROLEPLAYER’SBRI
EF
NAME:ELI
ZABETH MENSAH
AGE:
70YEARS
PARI
TY:PARA7
LMP:20YEARSAGO
RESI
DENCE:ALAJO

PC:
appear
anceofmassatv
ulv
aof1y
ear
’sdur
ati
on

HPC: Inherusual stateofhealthuntilayearagowhennot i

cedamassatherv ul
va
whenshev isit
edthebat hroom tourinat
e.Thiswaspr ecededbyaf eeli
ngof
heav inessinherv aginaofabout6mont h’
sdurati
on.Masshaspr ogr
essi v
ely
i
ncr easedi nsizeov erthelastoney earandiscurrentl
ythesi zeofanegg, i
s
painless
anddoesnotbl eed.Ithashowev erbeenul cer
atedov erthelast2mont hswith
associ atedy el
lowish,off
ensivedischarge.Masswasor i
ginallyspontaneously
reduci blebutiscur r
entl
yonl yr
educiblewithpressure.Shesawaher balist4
mont hsagowhogav ehersomeher bstoapplytomass, butsy mptomshav enot
i
mpr ov ed.

ODQ:
•Nobackpai n,nolowerabdomi nalpain
•Fr equency,urgency,hesitancy,str
aini
ng, poorst
ream,feel
i
ngofincompl
ete
bladderempt yi
ng,splint
ing(reducingmasst ovoi
d)butnouri
nary
i
ncont i
nence
• Const ipat
ion,strai
ningatdef ecation,feeli
ngofincompleteemptyi
ngbut
no
digi
tati
on(manual ev acuati
onofr ectum withfi
ngers)
• Nowei ghtloss

Systemi crevi
ew
RS:pr esenceofchroni
ccoughof5y
ear
sdur
ati
on,ot
her
wiseni
lof
noteGI T:nil
ofnot
e
CVS: nilofnote
CNS: nilofnote

GYNAEHx
•Menar cheat16yearsofage, hadnormalmonthl
ycy clesunti
l
menopause 20 y ears ago.Menses l ast
ed 5 day s and not
associat
edwi t
hdy smenorrhea.Used2sanitar
yr agsaday .Did
notbleedwithcl
ots.Noflooding.Noint
ermenst
rual bleedi
ng
• Nohi stor
yofcontr
acepti
v euse
 •Coi tar
cheat20y earsofage.Oneli
fet
imesexual
par
tner
.Hasn’
t
been
sexual
lyact
ivesinceherhusbandpassedaway15year
sago
• NoPapsmear s,
nobr eastexams

OBSTETRI CHx
Para7+0
Childrenaged50, 48,46,44, 42,40and38y ears
Allali
v eandwel l
,allmales
Allcar r
iedtoterm anddel i
veredathomeexceptf ort helastonewhich
wasdel i
ver
edinahospi talaftershelaboredathomef oroneday .
Shehadaf orcepsdel iveryandsust ainedat earthroughheranust hatwas
repaired.Haduncompl i
cat edsmal lper
inealtearsinprev i
ousdeli
ver
ies.
Allbabi escri
edi mmedi atelyaf t
erdeli
veryexceptt helastonewhohadt o
ber esuscit
atedbef orehecr ied.
Allbabi esofav eragewei ghtexceptl astonewhowasv ery
big.Nor malpuerper i
um.
Exclusivebreastfeedingfor6mont hs,breastfedfor2y earsintot
al

PMHx
•Hy per
tensi
on(30yrs)andDM (20y
rs)
• Noprevi
oushospit
aladmissi
ons
• Noprevi
oussurger
ies
• Nobloodtr
ansfusi
ons

DHx
• Noprescr
ipt
iondr ugs
• Takesher
bal preparat
ions
•Noknownal lergiestodrugorf
ood

FHx
•Nochroni
cill
nessesorgynaemalignanci
es
•Lastof10chi
ldren.Al
lsi
bli
ngsdeceasedfrom ol
dage

SHx
Widowed.Husbanddiedofol
dage.Li
veswithoneofhersonsandhisf
amilyi
n
Al
ajo.Used tof ar
m.No f or
maleducation.Neverdrank al
coholorsmoked
ci
garet
tes.Chr
ist
iananddoesnotobj
ectt
obl oodt
ransf
usi
on.Acti
veNHIS
ACTI
VITY 4.PMB MARKS
0 0.
25 0.
5 1 2
1.Greet scl ient X
2.Introducessel fwi tht heex planat i
onofpur poseof X
i
nteraction
3.Demogr aphi cf eat ures:
• Na me X
• Ag e X
•Pl aceofa bode X
• Par i
ty X
X
• Ask sL NMP
4.Present ingcompl ai nt x
5.Dur ationofPC x
6.ODQ: ask s
•Col ourofbl ood X
•Se v erityofbl ee ding X
•Howmanys ani taryt owel sus eds i
nc eaday X
•Howmuc hs tainedar et hes anitaryt owels? X
•X’ tic soft hebl eed: i
nt ermittent,ass oc.with
v agi nal di schar ge, l
owerabdomi nalpain. X
X
•Pr ov ok e dorunpr ov ok ed
X
• Pa lpita tion s
X
• Di z zin e ss
X
•Ea s yf a tigua bi l
ity
X
•L i
mbs we l
ling
X
• We i
gh tl os s
7.Sy stemi cr ev iew: ask sabout
•Res pirat or ys y stem ( cough, PND, Dy spnea,chest X
pai nt )
•GI T( Mel ena, Bl oodys tools,stool i
nc onti
nenc e) X
•Geni tour inar ys ystem ( dysuria,frequenc y, X
incont inence)
•CNS( headac hes ,hxofs eizures) X
X
•Mus cul os k elet alsy stem ( bac kpai n
8.Gynaehi s tor y:
Menst rual hi stor y: asks
•Agea tme na r che X
•Nor mal c yc l
el engt h X
•Dur ationoff low X
•Dy s me nor rhoe a X
X
•I nte rme ns trual bl
e edi ng
X
•AgeatMe nopaus e
Sex ualhi stor y: asks
X
• Coi ta rc h e
X
•Numberl if
et imes ex ualpar tners
X
Prev i
ousPapsmear-whenl astdone
X
Resul t

Cont
racept
ivehi
stor
y:asks
 •Ty peus e di nt hepas t X
•Howl ongi twasus ed X
•Whyi twass toppe d X
•Me thodc ur rentlyus e d X
9.Obs tetri
chi s tor y
Pastobst et r
ichi stor y
: asks
•Ye arpr e gnanc ye nde d X
•Anypr obl emsdur ingant enatalper
iod X
•Dur ationofpr egnanc y X
10.PMSH: asksaboutper sonal medi cal
condit
ionsHPT, X
D1
1M.Drughi stor y: ask s
•me di cat ionsbe ingt ake n X
• HRT X
•he rba lme dic ation X
•a llerg ie s X
12.Fami l
yhi st ory :ask sabout
• Si b li
n g s X
• Pa re n ts X
•Si gni fic antmedi calc ondit
ioninfamily(Ovar
ian, X
br eastorcol onca)
13.Socialhist or y: ask s
•Ma r i
ta l sta tus X
•Woman’ sl ev elofeduc at
ion X
•Woman’ soc cupat ion X
•Oc cupat ionofhus band X
X
•Us eofal cohol ort obac co
X
• Re ligion
X
•St anc eonbl oodt r
ans fusi
on
Summar ydwel li
ngonsal ientf eatures: X
NAME/AGE/PARI TY/10YEARSPOSTMENOPAUSAL/
PRESENTEDWI TH1WEEKHI STORYOFHEAVYBLEEDI NGPV/
ASSOCIATEDWI THSI GNSOFANAEMI A/FORWHI CHSHE
HAS
BEENONADMI TTI ONFOR4DAYS/ANDHASBEEN
TRANSFUSED
4U
TotNI
T
al SO
marF
ksWH
perOcLoEB
lumnLOOD
(0.
25ma rks
GRANDTOTAL eac h - total 2mar k s) /
18.
5
 4.PMB

ROLEPLAYER’
SBRI
EF

• Mr sMensah
• Age63y rs
• Livesi nTema
• Par a4+0
• LNMP10y rsago
• 1Weekhi storyofbl eedi ngPV
• Br ightr ed, moder at e,changespad3x/ day,verysoaked,i
ntermittent,
assoc.
withof fensivev agi naldi schar
ge&LAP
• Bleedi ngnotpr ovoked
• Nol egswel li
ng, nowei ghtl oss
• Sympt omat icofanaemi a
• Syst emi cenqui ry:Ni lofnot e
• Menar che age 11,r egularcy cl
e,29day s wi t
h 6 day bl eeds,no
dy
smenor rhea,
noI MP,
• Ageatmenopausei s53y rs
•Coi tar cheat15y rs, 6l i
fetimesexual part
ners
• Papsmearnone
•Cont racept i
vehi story: wi thdr
awal,can’tr
ememberanyot herthing
• 4chi ldrenaged30, 25,23, 20yrs.Normal bi
rths,nocomplicat
ionsatbi rt
hor
duringt hepr egnancy
• PMSH: Hy pertensive&di abeti
c
• DHx: Nilwi t
hnoal lergies
• Bot hpar entsar edead,Has2si bli
ngsallal i
veandwel l
,nof amil
y
hi
storyof
chroni cmedi cal condi tionorcancer s
•Mar riedf or30y rs,Pr i
mar yschool l
eaver,Far
mer ,Doesn’
tsmokenordr ink
•Husbandi saf armer ,dri
nksbutdoesn’ tsmoke

ACTI
VITY 1.THREATENEDABORTI
ON MARKS
0 0.
25 0.
5 1 2
1.Gr eetscl i
ent X
2.Introducesselfwiththeexpl
anat
ionofpur
poseof X
i
nteraction
3.Demogr aphicfeatur
es:
•Na mea nda ge X
•Pla ceofa bode X
•Gr avidi
tyandpar i
ty X
• Ask sL NMP X
X
•Det erminesges tati
onalage
4.Pr esentingcomplaint x
5.Dur ati
onofPC x
6.ODQ: ask s
•Col ourofbl ood X
•Se ve r
ityofbl ee ding X
•Howmanys ani t
aryt owelsus edsinceons et X
•Howmuc hs tainedwer ethes tai
neds ani
tary X
towel s?
X
• Pa lpita tion s
X
• Di z zin e s s
x
•Ea syf a tiga bili
ty
X
•Lowe rabdomi nal pai n
7.Systemi cr ev iew: ask sabout
•Re spir at orys y stem X
• GI T X
•Geni tour inar ys ystem ( dysur
ia,fr
equenc y
) X
• CNS X
X
•Mus cul os ke letals ystem
8.Gynaehi stor y:
Menst r
ual hi stor y:asks
•Agea tme na rche X
•Nor mal c yclel engt h X
•Dur a t
ionoff l
ow X
•Dy sme nor rhoe a X
X
•I nt erme ns t
rual bl
e eding
Sexual histor y: asks
X
• Coi ta rc h e
X
•Numberl i
fetimes exualpart
ner s
X
Previ
ousPapsmear-whenl astdone
X
Resul t
X
Vaginal dischar ge
Contracept ivehi story :asks
X
•Ty peus e dint hepas t
X
•Howl ongi twasus ed
X
•Whyi twass toppe d X
•Me thodc urre ntlyus ed
9.Obs t
etrichi s tor y
Pastobst et r
ichi story: asks
•Ye arpr egnanc ye nde d X
 •Anypr oblemsdur i
ngant enat alper
iod X
•Dur at i
onofpr e gnanc y X
•Ons etofl abour-s pontaneousori nduc ed X
•Modeofde live ry X
•I ndi c at i
onf orCs ecti
on X
•Dur ationofhos pi t
al st
ayaf terCS X
Baby : asks
•S e x X
• BW X
X
•Dur at ionofbr eas tfeeding
X
•Chi ld’spr es entc ondi t
ion
Indexpr egnancy :asks
X
•Pr egnanc ypl anne d?
X
•I funpl anned, isi twel come?
X
•Ges tational atwhi chfirsts candone
X
•Re s ultsoful tras ounds can X
•Pr obl emss of arbef oreons etofbleeding X
•Howl ongt hehos pit
al admi s si
onwasf orthe
ex cessi vev omi ting
10.PMSH: asksaboutper sonal medi calcondit
ions X
11.Drughist or y:ask s
•me dic ationsbe ingt ak en X
•he rbal me di cat ion X
•a l
le rg i
e s X
12.Fami l
yhi stor y:ask sabout
• Si b lin gs X
• Pa ren ts X
•Si gni ficantmedi cal conditioni nfamily X
13.Socialhist ory :ask s
•Ma rital sta tus X
•Woman’ sl ev el ofeduc ation X
•Woman’ soc cupat i
on X
•Oc c upat ionofhus band X
X
•Us eofal cohol ort obac co
Summar ydwel l
ingonsal ientf eat ures: X
NAME/AGE/PARI TY/PASTHI STORYOFCAESARREAN
SECTION
FORFAILURETOPROGRESS/NOW 12WEEKSPREGNANT/
PREVIUOSLYADMI TTEDFOR4DAYSWI THHYPEREMESI S
GRAVIDARUM/COMPLAI NSOF5HOURHI STORYOFSLI GHT
VAGINALBLEEDI NG/NOLOWERABDOMI NALPAI N
(
T0
o.
2
t5ma
almarkspea
ech
rco -t
l
uo t
al
mn 2mar ks)
GRANDTOTAL /
19.
75
 1.THREATENED
ABORTION
ROLEPLAYER’
SBRI
EF

YOU ARE36YEAR OLD MADAM LYDI

A

OSEIGRAVI
DA2P1

LMP21.
06.
2017

Youst
art
edex
per
ienci
ngPAI
NLESS,
UNPROVOKED,
BLEEDI
NGFROM THEVAGI
NA5

HOURSAGOYOUHAVECHANGED2LI
GHTLYSOAKEDPADS;
BLEEDI
NGI
SSCANTY;

BRI
GHTREDBLOOD

YOUARENOTEXPERI
ENCI
NGANYPALPI
TATI
ONS,
DIZZI
NESSOREASYFATI
GUABI
LITY

SYSTEMI
CREVI
EW -YOUHAVENOOTRHERSYMPTOMS

GYNAEHX

MENSTRUALHX

MENARCHE 14

YEARS CYCLE 28

DAYS

DURATI
ONOFFLOW 4DAYS

NODYSMENORRHOEA,
NOI
NTERMENSTRUALBLEEDI
NG

SEXUALHX

COI
TARCHE22YEARS

LI
FETI
MESEXUALPARTNERS-2

PAP SMEAR DONE 9 MONTHS AGO,NORMAL

RESULTNOVAGI
NALDI
SCHARGE

CONTRACEPTI
ON

YOUWEREONJADELLEFOR2YEARS

STOPPED8MONTHSAGO,
NOPROBLEMS;
STOPPEDI
NORDERTOCONCEI
VE

NOOTHERCONTRACEPTI
VEMETHODPREVI
OUSLYUSED.CURRENTLYUSI
NGNOCONTRACEPTI
VE.

OBSTETRI
CHI
STORY

LAST PREGNANCY ENDED 3 YEARS

AGOCARRI
EDTO9MONTHS
SPONTANEOUS ONSET OF LABOUR;CS ON ACCOUNT OF FAI
LURE TO

PROGRESSDI
SCHARGEDTHI
RDDAYPOSTOP

BABY:
MALE3.
7KG,
BREASTFEDEXCLUSI
VELYFOR6MONTHS,
(TOTAL1YEAR)
,CHI
LDI
SWELL

CURRENTPREGNANCY

PLANNED,
FIRSTSCANSAI
DBABYWASEI
GHTWEEKS(
SINGLETON)
,NOPROBLEMSNOTED

PROBLEMSIN CURRENTPREGNANCY:ADMITTED2WEEKSAGO ON ACCOUNTOF

EXCESSI
VEVOMITTING,
DISCHARGEDAFTER4DAYS

PAST MEDI
CALAND SURGI
CALHI
STORY:NI
LOF

NOTEDRUGHX:
FERSOLATE,
FOLI
CACI
D

NOHERBS,
NOALLERGI
ES

FAMI
LYHX

FI
RSTOF3SI
BLI
NGS;ALLOFYOU ARE

WELLBOTHPARENTSALI
VEANDWELL

NOCHRONI
CMEDI
CALCONDI
TIONI
NFAMI
LY

SOCI
ALHI
STORY:MARRI
EDFOR4YEARS,LI
VEWI
THHUSBANDATEAST

LEGONTERTI
ARYLEVELOFEDUCATI
ON;
BANKER

YOURHUSBANDI
SABUSI
NESSMAN

YOUDONOTUSETOBACCOORALCOHOL
ACTI
VITY 3.VVF MARKS
0 0.
25 0.
5 1 2
•Gr ee tsc l
ie nt X
•Introduc ess el fwi tht heex planati
onofpur poseof X
i
nteract i
on
•De mogr aphi cf eat ure s:
•Na mea nda ge X
•Pl aceofa bode X
• Pa ri
ty X
X
• Ask sL NMP
•Pr ese nti
ngc ompl aint x
•Dur a ti
onofPC x
• ODQ: a sks
•Se ve rityofl e akage X
•Howmanys anitaryt owe l
sus edaday X
•Unc ont rollabl eleak ageoff aeces X
X
•Ex cor iationofv agina, vul
va, perineum andthi
gh
X
•Hi s tor yoff eel i
ngmas sint hevagi na
X
•Dy s uria, fre que nc y,
X
•L i
mp in g
X
•F ootdr op
X
•F ev er/ c hil
ls X
•Lowe rabdomi nal pain
•Sy stemi cr ev iew: as ksabout
•Re s pirat orys ys tem X
• GI T X
•Geni tour i
nar ysy stem ( dysuri
a,frequenc y
) X
X
• CNS
X
•Mus c ul osk e l
e t
al sys tem
•Gy na ehi stor y :
Menst rual hist ory :asks
•Agea tme na rche X
•Nor mal cyc lele ngth X
•Dur a tionoff low X
•Dy s me nor r hoe a X
X
•I nte rme ns trual blee ding
Sex ualhist ory :asks
X
• Coi ta rc he
X
•Numberl ifetimes ex ualpar t
ners
X
Prev i
ousPapsmear-whenl astdone
X
Resul t
X
Vagi naldischar ge
Cont racept ivehi st ory:asks
X
•Ty peus edi nt hepas t
•Obs tetri
chi stor y
Pastobst et richi st ory:asks
•Ye arpr e gnanc ye nde d X
•Anypr obl emsdur ingant enat alperiod X
•Dur at ionofpr egnanc y X
X
 •Ons etofl abour-s pontaneousori nduc ed
•Modeofdel i
v eryofl astdeliver
y X
•Pl ac eofdel iv eryoflas tdeliv
ery X
•At tendantatl astde liv
e r
y X
X
•Compl icationf oll
owi ngdelivery
Baby:asks
X
•S e x
X
• BW
X
•Bi rthout c ome
•PMSH: asksaboutper sonal medi calcondit
ions X
•Sur geryforex tensi veendomet ri
osis,cervi
calcancer X
•Hi storyofr adi othe rapy X
•Dr ughi story :a sks
•me di cationsbe i
ngt ak en X
•he rbal me di cation X
•a llerg ies X
•Fami lyhi
s tory :as ksabout
• Sib l
in gs X
• Pa re n t
s X
•Signi ficantmedi cal conditi
oni nfamily X
•Soc i
al hi
stor y:as k s
•Ma rita lsta tus X
•Woman’ sl ev elofeduc ati
on X
•Woman’ soc cupat i
on X
•Oc cupat i
onofhus band X
X
•Us eofal cohol ort obac co
Summar ydwel l
i
ngonsal ientf eatures: X
NAME/AGE/PARI TY/LEAKAGEOFURI NE4- 5YEARS/
FOLLOWI NGHERLASTCHI LDBI TRHWHI CHWAS
COMPLI CATED
BYOBSTRUCTEDLABOUR/ANDRESULTEDI NASTI LLBIRTH/
SHE
H
ToA
tSD
alYS
marU
kR
sIAe
p/A
rcN
o DE
lumnXCORI ATIONOFTHEVULVAAND
TH I
GH S
GRANDTOTAL /
17.
25
(0.
25mar kseach-t otal2mar ks)
 3.VVF
ROLEPLAYER’
SBRI
EF

Greetscli
entandaskname Madam Vi
daFr
impong
I
ntroducesselfwi
ththeexplanat
ionofpur
poseof
i
nteract
ion
•Demogr aphicf
eatures:Nameandage Madam Vi
daFr
impong,
38y
ear
,Kasoa,
Pl
aceofabode
•Gr avidi
tyandparity Par
a4+0
• As ksL NMP 26August2017

•Present
ingc ompl aint I
nvol
unt
aryl
eakageofur
ine
•Durat
ionofPC 4-
5year
s
• ODQ:asks
•Unc ont r
oll
abl eleakageoffaeces No
•Ex cori
ationofv agi
na,vul
va,peri
neum Yes
andthigh
•Hi st
oryoff eelingmas sinthevagina No
•Dy suria,fr
e que ncy, Yes
No
•L imp ing
No
•F ootdr op
No
•F ever/ch i
l
ls
• Se v
e ri
ty
Fi
vet
imes
•Howmanys anitar
ytowelsusedaday
No
•Lowe rabdomi nalpain

•Systemi crev i
ew: as ksabout • Ni
lofnot
e
•Re spirat orys ys tem
• GI T
•Geni t
our i
nar ys ystem (dysur
ia,
frequency )
• CNS
•Mus culos ke l
etal system
•Gyna ehi story:
Menst rualhistor y:asks
•Agea tme na r
c he Menar
che14year
s
•Nor mal c yclele ngth 28days
•Dur ati
onoff low Fi
vedaysf
low
Yes
•Dy sme nor rhoe a
No
•I nterme nstrual bleeding
Sex ualhistory: asks
Coi
tarche18
• Coi tarc h e
4li
fet
imesexual
par
tner
s
•Numberl i
fetimes exualpart
ners
No
Prev i
ousPapsmear-whenl astdone
Result
No
Vagi naldischar ge
No
Cont raceptivehi story:asks
 •

•Obstetr
ichi story Par
a4+0
Pastobstetrichist
ory:asks
•Ye arpr egnancye nded Youhav ehadt hr
eechi l
dren,
all
nor
mal
•Anypr oblemsdur i
ngant enat alperi
od deli
ver
iesandal lweighi
ng3kg
Exceptthelastdeli
very
•Dur ationofpregnanc y
•Ons etoflabour- spontane ousor Spont
aneousl
abour
i
nduced
•Modeofde l
iv
e r
y Homedel i
very4.
3kgbaby ,di
ff
icul
t
•Indi cat i
onforCs ec t
ion/f orc eps/ del
iver
y,ai
dedbythetradi
ti
onal bi
rth
att
endantthenbythef
ourthdayst ar
ted
vacuum
l
eakinguri
neconti
nuously
.
•Dur ationofhos pi
tals t
ayaf terCS/
ruptur ed/caesareanhy st
er ectomy
Baby: asks
•S e x Female
• BW 4.3kg
Freshst
il
lbi
rt
h

•PMSH: asksaboutper sonalmedicalcondi

ti
ons Ni
lofnot
e
•Sur ger yforextens i
veendomet ri
osis,
cervi
cal None
cancer
•Hi storyofr adiotherapy None
•Dr ughi st
ory:as ks
•me dicationsbe ingtake n No
•he r
ba lme dic at
ion Yes
•a l
lergies No
•Fami lyhistory:asksabout
• Si bli
ngs Fi
veSi
bli
ngs
• Pa rents Bothal
i
veandwel
l
•Si gnifi
cantmedi calcondit
ioninfamil
y none
5 Soc ialhistory
: asks
•Ma ritalstatus Marri
edfor8y ears
•Woman’ slev elofeduc at
ion None
•Woman’ soc cupati
on Hair
dresserbutunemployedsince
•Oc cupat i
onofhus band fol
l
owingt heaboveprobl
em
HusbandisaCar pent
er,andtheybot
h
•Us eofal cohol ortobac co
don’
tsmokeort akealcohol
.
•
Husbandistheonesuppor t
ingher
.

Summar ydwellingonsali
entfeat
ures:
NAME/AGE/PARI TY/LEAKAGEOFURI NE4-
5YEARS/
HADDI FFICULTHOMEDELI VERYBYTBA/USING
HERBAL
MEDICINE/FRESHSTI LLBIRTH/
(
T0
o.
2
t5ma
almarkspea
ech
rco-
lt
o
utal
mn2mar ks)
GRANDTOTAL
ACTI
VITY. 5.CERVI
CALCA MARKS
0 0.
25 0.
5 1 2
1.Greet scl i
ent X
2.Intr
oducessel fwi ththeex pl
anati
onofpur
poseof X
i
nteraction
3.Demogr aphicfeatures:
•Na mea nda ge: X
•Pla ceofa bode: X
• Parity: X
• AsksL NMP X
4.Present ingcompl aint
: x
5.Dur ati
onofPC: x
6.ODQ: ask s
•Col ourofbl ood: X
•Howmanys anitarytowelsusedsi
nceonset
: X
•Hows t
ainedwer ethestai
nedsani
tar
ytowel
s? X

•Vagi
naldi
schar
ge X
•Quant
it
yofdischar
ge: X
X
•Col
ourofdi
scharge:
X
•Odorofdi
scharge:
X
•Abdomi na lma s s:
X
•Lowe rabdomi nal pai
n:
X
•Pa lpita tions :
X
• Diz zin e ss : X
•Ea syf a tigua bili
t y
: X
•F ev er
7.Systemicrev iew: asksabout
•Re spir at orys ys tem: X
• GI T X
•Geni tour inar ysy stem (dy
suri
a,f
requency
): X
• CNS X
•Mus cul os ke l
etal system: X
8.Gynaehistor y:
Menstrual histor y:asks
•Agea tme na r
c he: X
•Nor mal c yclele ngth: X
•Dur a t
ionoff low: X
•Numbe rofpads /
day: X
X
•Hows oc ked
X
•As soc i
at e dfloodi ng:
X
•As soc i
a te dc l
ot s:
X
•Dy sme nor rhoe a :
X
•I nterme ns t
rual bleeding:
Sex
ualhistor y: asks
X
• Coit arc h e: X
•Numberl i
fetimes exualpar
tner
s: X
•Pos tc oi talblee ding: X
•Dy s pa re uni a:
 PreviousPapsmear-whenl astdone: X
Resul t
: X
Cont r
acept i
v ehi stor y:asks
•Ty peus e di nt hepas t
: X
•Howl ongi twasus ed: X
•Whyi twass toppe d X
•Me thodc ur rentlyus e d: X
9.Obs tetri
chi stor y
Pastobst etrichi stor y
: asks
•Ye arpr egnanc ye nde d: X
•Anypr oblemsdur ingant enat alper
iod X
•Dur at i
onofpr egnanc y X
• On se tofl abou r- X
X
•Modeofde live r
y :
Baby : asks
X
•S e x :
X
• BW:
X
•Dur ationofbr e as t
fe eding:
X
•Chi ld’spr e sentc ondi t
ion:
Historyoft ermi at i
ons: asks
X
• Ti mi n g :
X
•Re as onf ort ermi nation: X
•Me thodoft ermi nat i
ons : X
•Anypos tabor tal compl i
c ation:
10.PMSH: asksaboutper sonal medi calcondit
ions: X
11.Drughi stor y:ask s
•me dic ationsbe ingt ak en: X
•he rbal me dicat i
on: X
•a l
le rgie s: X
12.Fami l
yhi stor y:ask sabout
• Si b ling s : X
•Pa re nt s:bot h X
•Si gni fi
c antmedi c alc ondi t
ioni nfamily: X
13.Socialhist ory :ask s
•Ma rital sta tus: X
•Woman’ sl ev elofeduc ation: X
•Woman’ soc cupat ion: X
•Oc c upat ionofhus band: X
•Us eofal cohol ort obac co: X
Summar ydwel li
ngonsal ientf eatures: X
NAME/AGE/PARI TY/PRESENTSWI THPAI NLESSSCANTY
I
NTERMENSTRUALBLEEDI NG/OF3MONTHS
DURATION/ ASSOCI ATEDWI THBROWNI SHOFFENSI VE
VAGINAL
DISCHARGE/ ANDHI STORYOFPOSTCOI TALBLEEDI NG/SHE
HAD
ANABNORMALCERVI CALSCREEN1YEARAGO/AND
H I
S
TotTO
alRYO
mar F
kspercol umn
MU LTI
PLES
GRANDTOTALE XU A L PARTNERS. /
21.
5
(0.
25mar kseach-t otal 2mar k s)
ACTI
VITY. MARKS
0 0.
25 0.
5 1 2
1.Greet scl ient X
2.I
nt r
oducessel fwi tht heexplanationofpurposeof X
interact i
on
3.Demogr aphicf eatur es: X
Name: Mr sGr aceDoe X
Age: 45y ears X
Placeofabode: JamesTown X
•Grav idityandpar i
ty: para1+4TOPS
•As ksLNMP: 3rdSept ember,2017
4.Present ingcompl aint:SPOTTI NGOFBLOOD x
5.Dur ationofPC: 3MONTHS x
6.ODQ: ask s
•Col ourofbl ood: dar
kr edors ometimespink X
•Howmanysani t
arytowel susedsinceonset: X
1/ day X
•Hows t
ai nedwer ethes tainedsanit
arytowel
s?:
Li ght
lyst ained
X
•Vaginadischarge:yes X
•Quanti
tyofdischarge:nott
oomuc h X
•Col
ourofdis charge:br
ownish X
•Odorofdischarge:quit
eunpleasant
X
X
•Abdomi nal mas s: No
X
•Lowe rabdomi nal pai n:No
X
•Pa lpita ti
ons :NO
X
•Di z zine s s: NO
X
•Eas yf at iguabi li
ty: NO
7.Sy •
st F
emieve
crv r:
i N
ew:O ask sabout
•Re spir ator ys ys t
e m: nil X
• GI Tn il X
•Geni tour inar ys ystem ( dysuri
a,f
requency
):ni
l X
• CNS: n il X
•Mus cul os keletal sy stem: ni
l X
8.Gynaehistor y:
Menstrual histor y:asks
•Ageatme nar c he: 13 X
•Nor mal c yc lelengt h:30DAYS X
•Dur ationoff low: 6DAYS X
•Numbe rofpads /day : 3 X
X
•Hows oc ke d:mode r
at el
y
X
•As soc iat edf loodi ng: no
X
•As soc i
at edc l
ot s:no
X
•As soc iat edf loodi ng: no
X
•Dy smenor rhoea: YES, MILD
X
•I ntermens trual bleeding: YES,SPOTTING
Sex
ualhistor y: asks
X
•Coi ta rche : 14YRS
 •Numberlif
eti
mes exualpart
ners:7 X
•Postcoi
talbl
eeding: yes,
spotti
ng X
•Dyspar
eunia:
yes,butnotal lt
het i
me X
•HXofSTI /
Inf
ecti
ons :NO X
Pr
evi
ousPapsmear-whenl astdone:yes/1y
ear
s
Result
: ABNORMAL

Cont
racepti
vehistory:asks
•Ty peus edint hepas t
:copperT
•Howl ongitwasus ed:4years
•Whyi twass topped: f
orlastchi
l
d
•Met hodc urrentl
yus ed:condoms

9.Obst
etri
chist or
y
Pastobstet
richistor
y :asks
•Yearpr egnanc yended: 3year
sago X
•Anypr oblemsdur i
ngant enat
alper
iodno X
•Dur ationofpr egnanc y9mont hs X
•Ons etoflabour- spontaneous X
X
•Modeofde l
iv
e ry:vagina

Baby:asks
X
• Se x: male
X
• BW: 3 kg
X
•Dur at i
onofbr eastfeeding:1&halfy
ears
X
•Chi ld’spresentc onditi
on: well
Hi
stor
yoft ermiat
ions:asks
X
•Ti ming: ongago1stonewasat15y
l ear
s
X
•Reasonf ort er
minat i
on: all
themenwer eusel
ess X
•Met hodoft erminations: al
lwerewitht
ablet
s X
•Anypos tabortalcompl icati
on:no

10.PMSH: asksaboutper sonalmedi calconditi

ons:PUDX X
l
ong
11.ag
Dron
u o
ght
i
s a
tn
ory
ymo
:asre
k s
•medi cationsbei ngtaken: nur i
fer X
•he rbal me di
c ation:no X
•a llergies : no X
12.Famil
yhi story:ask sabout
•Si blings :2s isters,1deadf r om RTA X
•Par ents: bot hdead, unk nownc aus e X
•Si gni f
icantmedi calconditioni nfamily:none X
13.Soci
alhistor y:ask s
•Mar itals tatus: CO-HABI TATI NGs i
nce7y rsnow X
•Woman’ sl evel ofeduc ation:JHS X
•Woman’ soc cupat i
on:fishmonger X
•Oc cupat ionofhus band: womani s er
/fisherman X
 •Useofal coholort obacco:husbandsmok es
3sti
cks
adayf orlongtime X
Summar ydwelli
ngonsal i
entfeat ur
es:
r
d
NAME/AGE/PARI TY/LNMP3 oft hi
smont h/PRESENTS
WI TH
PAI NLESSSCANTY/I NTERMENSTRUALBLEEDI NGOF
3MONTHS
DURATI ON/ ASSOCIATEDWI THBROWNI SHOFFENSI VE
VAGI NA
DISCHARGE/ ANDHI STORYOFPOSTCOI TALBLEEDI NG/SHE
H A
TotDalmarkspercolumn
A NA BNO R
GRANDTOTALMA LC ERVICALSCREEN/ANDHI STORYOF
MULTI PLE
SEXUALPATNERS.
(0.25mar kseach-t otal2mar k s)
ACTI
VITY 4.PI
D MARKS
0 0.
25 0.
5 1 2
1.Greet scli
ent X
2.Intr
oducessel fwi tht heex planati
onofpurposeof X
i
nteracti
on
3.Demogr aphicf eat ures:
• Na me X
• Ag e X
•Pla ceofa bode X
• Parity X
X
• AsksL NMP
4.Present i
ngcompl ai nt x
5.Dur ati
onofPC x
6.ODQ: asks
•X’ ticsoft hepa in X
•X’ ti
c soft hev agi naldischarge X
•as soc .wi tht heme ns es X
•Fe ver, chi l
ls , X
X
•d ysu ri
a
X
•Ri ghtuppe rquadr antpai n
X
•De epdy s par euni a,
X
•Pos tcoi talbl ee ding
7.Syst emicrev i
ew: ask sabout
•Res pirator ys ys tem ( cough,chestpai
n) X
• GI T X
•Ge nitour inar ys y stem X
•CNS( he ada c he s ) X
•Mus culos kel etal system (backpain) X
8.Gynaehi story :
Menst r
ualhistor y: asks
•Agea tme na rc he X
•Nor mal c yclel e ngth X
•Dur ationoff low X
•Dy sme nor rhoe a X
X
•I nterme ns t
r ual bl eeding
X
Sex
ualhist
ory
:asks
X
• Coit
arche
X
•Numberl i
fet
imesexual
par
tner
s
X
Pr
evi
ousPapsmear-whenl
astdone

Contr
acepti
vehistor
y :asks
X
•Ty peus edint hepas t
X
•Howl ongitwasus ed
X
•Me t
hodc urrentlyused
9.Obstetr
ichist
ory
Pastobstetr
ichist
ory: asks
•Ye arpregnanc ye nded X
 •Anypr oblemsdur ingant enatalper
iod X
•Dur ationofpr egnanc y X
10.PMSH: asksaboutper sonal medi cal
condit
ionsHPT, X
DM
11.Drughist or y
:ask s
•me dicationsbe ingt ake n X
•he rba lme dic at
ion X
•a l
le rgies X
12.Fami l
yhi story:ask sabout
• Si b lings X
• Pa rents X
•Si gni f
icantmedi cal condit
ioninfamily X
13.Socialhist ory:asks
•Ma rit
a lstatus X
•Woman’ slev elofeduc at
ion X
•Woman’ soc cupation X
•Oc c upationofpar tne r X
X
•Us eofal cohol ortobac co
Summar ydwel l
ingonsal ientfeatures: X
NAME/AGE/PARI TY/LNMP/PRESENTEDWI TH5DAY
HISTORY
OFSEVERELAP/ +OFFENSI VEVAGI NALDI SCHARGE
(
T0
o.
2
t5ma
almarkspea
ech
rco -t
l
uot
al
mn 2mar ks)
GRANDTOTAL /
15.
75
ACTI
VITY 4.PI
DROLEPLAYER’
SBRI
EF

1.Gr eetscli
ent
2.Introducesselfwi
ththeexpl
anat
ionofpur
pose
ofinter
acti
on
3.Demogr aphi
cfeat
ures:
• Na me MsVi daOppong
• Ag e 20yrs
•Pl aceofa bode Newt own
• Pa ri
ty P1+0
19thSept
ember,
2017
• Ask sL NMP

4.Presenti
ngcompl aint Sev
ereLAP+Vagi
nal
Dischar
ge
5.Durati
onofPC 3days
6.ODQ: asks
•X’ ti
csoft hepa in -Sever
e, nonradiat
ing,aggr
avat
edby
• mov ement ,r
eli
evedwith
•X’ ti
csoft hev aginal di
scharge+assoc. anal
gesi cs
wi
ththemenses -Moderat e,br
ownish,off
ensi
veaft
er
mymenses
•Fe ver
, chil
l
s,
-Fever
,chi l
l
s
•d ysuria
-Dysur
ia
•Ri ghtuppe rquadr antpain
-Yes
•Dy spa r
eunia ,
-Yes
•Pos tcoit
alble eding
-No

7.Syst
emicreview: asksabout Ni
lofnot
e
•Res pi
ratorys ys tem (cough,chestpai
n)
• GIT
•Ge nit
our i
nar ys y st
em
•CNS( he ada che s)
•Mus culos keletal syst
em (backpain)
8.Gy
naehistory:
Menstr
ualhistory:asks
•Agea tme na r
c he - 14y
rs
•Nor mal cy clele ngth - 28days
•Dur ati
onoff low - 5days
•Dy sme nor rhoe a - Yes
- No
•Interme nstrual bleeding

Sexualhi
stor
y:asks
- 14y
ear
s
• Coitar
c he
- 7
•Numberl i
fet
imes exualpart
ners
•
- No
Previ
ousPapsmear-whenl astdone
Resul
t,anytr
eatment

Cont
racept
ivehi
stor
y:asks
- I
UD
•Ty peusedinthepas t
- STI
LLUSI
NGI
T
•Howl ongitwasus ed
•Whyi twass t
oppe d
 •Met
hodcur
rent
lyused

9.Obst
etri
chistor
y
Pastobstet
ri
chist
ory
: asks
•Ye arpregnancye nded Youhav ehad1chi ld,2yrsago,poor
•Anypr oblemsdur i
ngantenat
alper
iod ANCat tendant,normaldeli
ver
yina
•Dur ati
onofpregnanc y hospit
al atter
m, uneventf
ul
pueperi
um
Chil
dfemal &isdoingwelli
nschool
10.PMSH:asksaboutper
sonalmedi
cal
condi
ti
ons Ni lofnote
HPT,DM
11.Dr
ughist
ory:asks
•me di
cationsbei
ngtaken - Br ufen400mgTDS
•herbalme di
cat
ion - N il
•a l
ler
gies - Ni l
12.Fami
lyhi
stor
y:asksabout
• Si
bli
ngs - 5sibl
ings(
3males&2f
emal
es
al
lali
ve&well
)
• Parents - Bothali
ve&well
•Signif
icantmedi calcondit
ioni
nfami
l
y - Nil
ofnote
13.Soci
alhi
story
: asks
•Ma rit
al stat
us - Notmar ri
edbutina
• rel
ati
onship
•Woman’ slevelofeduc at
ion - JSSgraduate
•Woman’ soc cupati
on - Unempl oyed
- Shoemaker
•Oc cupationofpar t
ne r
- Drinksbutdoesn’tsmoke
•Us eofal coholortobac co
- Support
ive
Summar ydwell
ingonsali
entf
eatur
es:
NAME/AGE/PARI TY/LNMP/PRESENTEDWI TH5
DAY
HISTORYOFSEVERELAP+OFFENSI VEVAGI
NAL
DISCHARGEANDONANALGESI CS
(
T0
o.
2
t5ma
almar e
kspa
ech
rco-
lt
o
utal
mn2marks)
GRANDTOTAL
 4.
POST-
ENCOUNTERSTATI
ON
1)MENTI
ON5RI
SKSFACTORSFORPI
DYOUFOUNDI
NTHI
SPATI
ENT?
(5MARKS)

2)HOW WI
LLYOUI
NVESTI
GATETHI
SPATI
ENT?
(
5MARKS)

3)-HOW WI LLYOUMANAGETHISPATI
ENT?
-LISTTHECRITERI
AFORI
NPATI
ENT&OUTPATI
ENTMANAGEMENT
OF
PID?
(10MARKS)

ACTI
VITY 2.UTERI
NEFI
BROI
D MARKS
0 0.
25 0.
5 1 2
1.Greet scl i
ent X
2.Intr
oducessel fwitht heex planat ionofpurposeof X
i
nteraction
3.Demogr aphi cf eatures:
•Na mea nda ge X
•Pla ceofa bode X
• Parity X
• AsksL NMP X
4.PC x
5.Dur ati
onofPC x
6.ODQ: ask s
•Col ourands ev erit
yofbl eeding X
•Howmanypadsar eus e d? X
•Hows oak edar et hepads ? X
• Pa lpi
ta tion X
• Di z zi
n e ss X
X
•Ea syf atiqua bil
ty
X
•I st hemas si ncreas i
ngi ns i
ze?
X
•Fr equenc y,Hes istanc y,dy suri
a
X
•Cons tipat i
on, dyspeps ia, anorexi
a
X
•LAPandi t
sXt er
istics
X
•Var icos ev einsonl egs,pedal swel
ling? X
•Gal ac torrhoea, spontaneousmi scarr
iages
7.Syst emicr eview: ask sabout
•Re spiratorys yst
e m X
• GI T X
•Ge nit
our i
narys ystem X
• CNS X
X
•Mus culos keletals yst
em
8.Gynaehi st
ory:
Menst r
ualhist
or y:asks
•Agea tme na r
che X
•Nor mal c y
c lelength X
•Dur ati
onoff low X
•Dy sme nor rhoea X
X
•Interme nstrualbleeding
Sexualhi
story
: asks
X
• Coitarch e
X
•Numberl i
fetimes exualpar
tner
s
X
Previ
ousPapsmear-
X
Vagi
naldischarge
Contr
aceptivehist
ory:asks
X
•Ty peus edi nthepas t
X
•Howl ongi twasus ed
X
•Whyi twass t
oppe d X
•Me thodc urr
entlyused
9.Obstetr
ichistory
 Pastobst
etri
chist
ory:asks
•Ye arpregnancye nded X
•Anypr oblemsdur i
ngantenatal
peri
od X
•Dur ati
onofpr egnancy X
•Ons etanddur ati
onoflabour-spont
aneousor X
i
nduced
•Modeofde l
ivery X
X
•Out comeofl astpregnancy

Baby: asks
X
•S e x
X
• BW
X
•Dur at i
onofbr eas t
feeding
X
•Chi ldren’ spr esentcondi t
ion
10.PMSH: asksaboutper sonalmedi cal
condi
ti
ons X
11.Dr ughi stor y
: ask s
•me dicat ionsbe ingtak en X
•he rba lme dic at
ion X
•a l
le rgie s X
12.Fami l
yhi story :ask sabout
• Sib ling s X
• Pa ren ts X
•Si gni f
ic antmedi calconditi
oninfamil
y X
13.Soci alhist ory: asks
•Ma rit
a l status X
•Woman’ slev elofeduc ati
on X
•Woman’ soc cupati
on X
•Oc c upat ionofhus band X
X
•Us eofal cohol ortobac co
Summar ydwel li
ngonsal ientfeatures: X
MRSEUNI CEKORSAH/39YEARSOLD/
P2+1ect opi c/PRESENTED
WITH5MONTHSHI STORYOFHEAVYMENSESWI THCLOTS
AND/
AL.ABDMASSOF2YEARSDURATI ON/SYMPTOMATI COF
ANEMI A/PATI ENTI SAKNOWNDM ONMEDI CATIONS/AND
H A
TotS
al mar kspercol umn
F
GER
RAT
NILI
DTTYWI
OTASLHES. /
18.
75
(0.
25mar kseach-t otal 2mar ks)
 2.UTERI
NEFI
BROI
D

ROLE PLAYER’
S

BRI
EF

Name:
Madam Euni
ceKor
sah

Age:
39y
rs

Locat
ion:
Dansoman

Par
it
y:P2+1ectopic

LMP:
6Mont
hsago

PC:
1.Heav
ymensesf
ort
hepast5mont
hs

2.Pel
vi
cmassof2y
rdur
ati
on

HPC:

Noticedamassinmyl owerabdomenwhichhasbeenincreasi
ngi
nsizefort
hepast2y ears.
Ithas
notbeenbot hersomeuntil5monthsago.Istartedbleedingpr
ofusel
yatmenses.The
mensesar e
associat
edwithclot
sandlastf
or10day
st o2weeks.Ichangepad4-5xaday,al
lgetsoaked.

Iam cur
rent
lyspot
ti
ngPVaft
er9daysofheavybl
eedi
ngwit
hclot
s.Ir
eportedt
oDansoman
P/Ca
week ago where some medi
cat
ions wer
e giv
en and was r
efer
red hereforfur
ther
management.

ODQ:
Posi
ti
vef
oronl
ythese(
Pal
pit
ati
on+,
LAP+,
)

S/
E:Ni
lforal
lquest
ions

GHxK13C528r
: egul
arunt
ilt
hel
ast6mont
hs.Dy
smenor
rhoe-
,I
MB-
,

Coitar
che 20yr
s,li
fet i
me sexualpartner
s 4,Pap smear-
,vagi
naldischar
ge-,
cont
racepti
on+,I
UD,for2year
saf
terlastchi
l
d,stoppedbcosIwant
edtoconcei
veagain,
BSE-
,

PastOBHx :Bot
hchil
frenaremale,14and10y rsold.Ihadlaparot
omy5y earsagoon
accountofrupt
uredectopi
cPregnancy.Laborandpueper i
um wereuneventful.Al
lSVD,
carr
iedtoterm.Can’
trememberBirthweight
s,didexclusi
vebreastfeedi
ng.

PMSHx:
Diabet
iconmet
for
min500mgbi
d.Hadl
apar
otomyf
orect
opi
cgest
ati
on5y
ear
s

ago.FHx2ndof4si
: bli
ngs.Al
lwel
l
,bot
hpar
entar
eal
i
ve.Fat
heri
sDM.

SHx
:Marri
ed,graduat
eteacher
,cathol
i
c.Husbandisanaccountantataprivat
ecompany.
Weoccasi
onall
ytakeinal
cohol.Nosmoking.Act
iveNHI
S.Hav ereproduct
ivewishes.

DHx
:OnMet
for
min.Noher
bal
medi
cat
ionuse,
noal
l
ergy
.
 2.

POST-
ENCOUNTER

SUPPOSI
NGTHEDIAGNOSI
SOFTHISWOMAN’
SCONDI
TIONI
SAUB2˚LEI
OMYOMAAND
SHEHASAGREEDTOMYOMECTOMY;

uSt
ate6mechani
smsbywhi
chherf
ibr
oidnodul
escausedheav
ymenst
rual
bleedi
ng

[
6mar
ks]

uGi
ve5way
stor
educebl
oodl
ossi
nmy
omect
omy

[
5mar
ks]

uGi
ve4meansofpr
event
ingadhesi
onsi
nmy
omect
omy

[
4mar
ks]

uGi
ve5compl
i
cat
ionsofmy
omect
omy

[
5mar
ks]
ACTI
VITY. 7.CERVI
CALCA MARKS
0 0.
25 0.
5 1 2
1.Gr eetscl i
ent X
2.Introducesselfwi ththeex pl
anati
onofpur
poseof X
i
nteraction
3.Demogr aphicfeatures:
•Na mea nda ge: X
•Pla ceofa bode: X
•Gr avidi
tyandpar i
ty: X
• Ask sL NMP X
4.Pr esentingcompl aint
: x
5.Dur ati
onofPC: x
6.ODQ: ask s
•Col ourofbl ood: X
•Howmanys anitarytowelsusedsi
nceonset
: X
•Hows t
ainedwer ethestai
nedsani
tar
ytowel
s? X

•Vagi
naldischarge X
•Quant
it
yofdi schar
ge: X
X
•Col
ourofdischarge:
X
•Odourofdischarge:
X
•Abdomi nalma s s:
X
•Lowe rabdomi nal pai
n:
X
•Pa l
pita tions:
X
• Dizzi
n e ss: X
•Ea syfa tigabil
ity: X
•F ever
7.Syst
emicreview: asksabout
•Re spi
r atorys ys tem: X
• GIT X
•Genitour inarysy stem (
dysur
ia,
frequency
): X
• CNS X
•Mus cul os kel
etal syst
em: X
8.Gy
naehistory:
Menstr
ualhistor y
:asks
•Agea tme na r
c he: X
•Nor mal cyclele ngth: X
•Dur at
ionoff low: X
•Numbe rofpads /
day: X
X
•Hows oc ked
X
•As soc i
at edfloodi ng:
X
•As soc i
a tedc l
ot s:
X
•Dy sme norrhoe a :

Sex
ualhist
ory:
asks
X
• Coit
arche:
X
•Numberl if
eti
mesexual
par
tner
s: X
•Pos tcoi
talbl
eedi
ng: X
•Dy spareuni
a:
 PreviousPapsmear-whenl astdone: X
Resul t
: X
Cont r
acept i
v ehi stor y:asks
•Ty peus e di nt hepas t
: X
•Howl ongi twasus ed: X
•Whyi twass toppe d X
•Me thodc ur rentlyus e d: X
9.Obs tetri
chi stor y
Pastobst etrichi stor y
: asks
•Ye arpr egnanc ye nde d: X
•Anypr oblemsdur ingant enat alper
iod X
•Dur at i
onofpr egnanc y X
• On se tofl abou r- X
X
•Modeofde live r
y :
Baby : asks
X
•S e x :
X
• BW:
X
•Dur ationofbr e as t
fe eding:
X
•Chi ld’spr e sentc ondi t
ion:
Historyoft ermi nat ions: asks
X
• Ti mi n g :
X
•Re as onf ort ermi nation: X
•Me thodoft ermi nat i
ons : X
•Anypos tabor tal compl i
c ation:
10.PMSH: asksaboutper sonal medi calcondit
ions: X
11.Drughi stor y:ask s
•me dic ationsbe ingt ak en: X
•he rbal me dicat i
on: X
•a l
le rgie s: X
12.Fami l
yhi stor y:ask sabout
• Si b ling s : X
•Pa re nt s:bot h X
•Si gni fi
c antmedi c alc ondi t
ioni nfamily: X
13.Socialhist ory :ask s
•Ma rital sta tus: X
•Woman’ sl ev elofeduc ation: X
•Woman’ soc cupat ion: X
•Oc c upat ionofhus band: X
•Us eofal cohol ort obac co: X
Summar ydwel li
ngonsal ientf eatures: X
NAME/AGE/PARI TY/PRESENTSWI THPAI NLESSSCANTY
I
NTERMENSTRUALBLEEDI NGOF3MONTHS
DURATION/ ASSOCI ATEDWI THBROWNI SHOFFENSI VE
VAGINAL
DISCHARGE/ ANDHI STORYOFPOSTCOI TALBLEEDI NG/SHE
HAD
ANABNORMALCERVI CALSCREEN1YEARAGO/AND
H I
S
TotTO
alRYO
mar F
kspercol umn
MU LTI
PLES
GRANDTOTALE XU A L PATNERS. /
21.
25
(0.
25mar kseach-t otal 2mar k s)
 7.CERVI
CALCA

ROLEPLAYER’
SBRI
EF

• Mr sMensah
• Age45y rs
• Livesi npaakoso
• Par a5+0
• LNMP14day sago
• 3mont hshi storyofi ntermenst rual bleedi ng.curr
entepisode3day sago
• Br ightr ed, moder at e,changespad3x/ day ,ver
ysoaked, i
nter
mi t
tent,assoc.
withof fensi vev agi nal dischar ge&LAP, dy spar
euniaandpost coi
talbleeding
• Nopr ecipitatingf act or
• Sympt omat i
cofanaemi a
• Syst emi cenqui ry:Ni lofnot e
•Menar cheage11, regul arcy cle, 29day swi th6daybleeds, nodysmenor rhea,
changespad2x/ day ,
•Coi tar cheat15y rs, 6l i
fetimesexual partner s
•Papsmear1y rago-abnor mal resul t
s,br eastscreeningnone.
•Cont racept i
v ehi story: wi thdrawal , can’trememberanyot herthi
ng
• 4chi ldrenaged25, 23,20, 17and15y rs.Nor malbir
ths,nocompl icat
ionsat
bir
thordur i
ngt hepr egnancy
• PMSH: Hy per t
ensi ve&di abetic
• DHx: Nil withnoal lergies
•Bot hpar entsar edead, Has2si blingsal l ali
veandwel l
,nof amil
yhistoryof
chroni cmedi cal condi tionorcancer s
•Mar riedf or25y rs,Pr i
mar yschool leaver ,Farmer,Doesn’tsmokenordr i
nk
•Husbandi saf armer ,drinksbutdoesn’ tsmoke
 7.

POST-
ENCOUNTERSTATI
ON

QUESTI
ON1:
WHATI
SYOURLI
KELYDI
AGNOSI
SFORTHI
SPATI
ENT [
5mar
ks]

QUESTI
ON2:
LISTTHESPECI
FICFI
NDI
NGSFROM YOURHI
STORYTOSUPPORTTHI
SDI
AGNOSI
S

[
10mar
ks]

QUESTI
ON3;
WHATAREYOURDI
FFERENTI
ALDI
AGNOSES [
5mar
ks]

QUESTI
ON 4:WHAT WILL BE THE SURGI
CAL MANAGEMENT OPTI
ONS FOR THI
S
PATI
ENTIFTHEPATHOLOGYISSTILLINTHEVERYEARLYSTAGES
[
5mar
ks
 HistoryofSTI X
Cont r
acept i
vehi stor y: asks
•Ty peus e di nt hepas t X
•Howl ongi twasus ed X
•Whyi twass toppe d X
•Me thodc ur rent lyus ed X
Previ
ousgy naecol ogi cal tr
eatment
• Di a gn os i
s X
• Tr e a t
me nt X
X
•Dur ationoft reat me nt
X
• Ou tc ome
9.PMSH: asksaboutper sonal medi calcondit
ions X
Dur ationofmedi calconditi
ons X
10.Drughist or y
: ask s
•me dicat ionsbe ingt ak en X
•he r ba lme di c ation X
•a lle rgie s X
11.Fami l
yhist ory :ask sabout
• Sib ling s X
• Pa r en ts X
•Signi f
ic antmedi cal conditi
oni nfamily X
•Hi s toryofbr e as tc anc er X
X
•Hi s toryofov arianc anc er
12.Socialhist ory: ask s
•Ma rit
a l sta tus X
•Woman’ sl ev el ofeduc ati
on X
•Woman’ soc cupat ion X
•Oc c upat ionofhus band X
X
•Us eofal cohol ort obac co
X
• Re ligion
X
•St anc eonbl oodt r
ans fusion
Summar ydwel l
i
ngonsal ientf eat ures: X
NAME/AGE/PARI TY/HI STORYOFPCOS/HYPERTENTI ON
AND
DIABETESMELLI TUS/PRESENTSWI THHEAVYI RREGULAR
MENSESOF3MONTHSDURATI ON/MOTHERHASHI STORY
OF
OV
TotA
aR
lI
ANC
marksA/
pS
eI
rS
c T
o E
l
uRH
mnASHI STORYOFBREASTCA
(0.
25ma rks
GRANDTOTAL each -tota l2ma rks) /
19.
75