For my mid-site evaluation, I presented an H&P on a peri-menopausal patient in the OB/GYN clinic who has an extensive family history of cancers, GYN Hx of fibrocystic breasts/fibroids/ovarian cysts, and was concerned about recent AUB and stress urinary incontinence. Given her FHx, age, and concerns, we discussed the most likely cause of her symptoms, which are hormonal changes due to the patient approaching menopause. Given her age and AUB, we are concerned about possible endometrial hyperplasia or carcinoma, for which a TVUS is the first-line imaging, with eventual need of endometrial biopsy if the endometrial stripe is measured >4mm.

For my final site evaluation, I presented an H&P on a 3-week postpartum patient who presented to L&D triage complaining of secondary PPH and abdominal pain that worsened over 2 days. Throughout my OB/GYN rotation, essential questions I’ve learned to ask are about the 1st day of LMP and the characteristics of their menstrual cycles (regularity, frequency, duration, volume). Some OB-focused questions are whether or not the mother feels any fetal movement, any vaginal bleeding, and any rupture of membranes. For this patient, bedside US was performed, which showed a thick endometrial lining with possible PROC, in which Cytotec was administered to expel any remaining POC, and the patient was re-evaluated with an official sonogram reading and observed overnight for any worsening of symptoms or changes.

Throughout the rotation, I received helpful feedback on how to make my H&P even better. One piece of feedback from my site evaluator was to be more descriptive in documenting a physical exam in terms of cysts/masses felt. For example, for the breast exams, I documented “palpable cysts in the top half and tenderness to palpation bilaterally”. I should have been more descriptive in terms of documenting the approximate size, location (which o’clock position), and whether it’s well-circumscribed vs. not.