Who you are:
You are FY2 in GP,Who the patient is:
64 yr lady with some concerns
C/O-Sometimes,I notice bleeding when I wipe down there
History
- she noticed bleeding whenever she wipes after weeing for a couple of months, on and off, just
spotting of blood - no urinary symptoms, no back pain, no bowel problems
- FLAWS-negative
- menopause- for 10 yrs, no bleeding before after menopause
- no history of using OC pills, pap smear?
- Sexual history?,
- MMA-ok, not on hormonal therapy currently and before
- no family history
- Examination-vitals, general observation-ok, pelvic examination, speculum examination–examiner will not give finding
Concern
- I just want to know what happens ?
Approach
Data gathering
- Explore bleeding (duration, amount, color, any clot, bleeding in anywhere else)
- Anemic symptoms(fatigue, palpitation, tiredness,pallor)
- FLAWS
- Associated symptoms-pelvic pain, swelling in abdomen and genital area, ulcer in genital area
- UTI , STI symptoms
- P4 -detail history(period, pregnancy, pills and hormonal therapy, pap smear)
- P2- DM, HTN(risk factors for endometrial cancer-metabolic disease),bleeding disorder, similar problem
- Medications -blood thinners, hormonal therapy
- Family history of cancer
- DESA
- ICE
Examination
- vitals, general observation
- pelvic examination, speculum examination
- abdominal examination
- BMI
- RBS
Management
- Explain about provisional Diagnosis- postmenopausal bleeding is quite alarming features, we have to exclude sinister condition first,endometrial cancer(until proven otherwise)
- Urgent 2 weeks referral to be seen by specialist
- USG scan (trans-vaginal ultrasound)
- Investigations-FBC, clotting profile, LFT, Urine dipstick test
- Can arrange follow up appointment for blood test results
Safety Net
- Please contact us if you do not get the appointment within 2 weeks time
- If you have concerns and questions regarding your current condition