Pelvic Pain



HISTORY_LIST

date of last menstrual period (LMP)

never had a period

onset of pain

duration of pain

location of pain

description of pain

regular cycle length between periods

metorrhagia

normal cycle length =

length of bleeding time regular

length of bleeding time irregular

bleeding time =

scant flow

moderate flow

severe flow (menorrhagia)

number of pads per day

no pain during periods

scant pain during periods

moderate pain during periods

severe pain during periods

sexually active

birth control method

birth control pills

rhythm method

condoms

diaphragm (IUD)

Depo-Provera

Norplant

pregnant

symptoms of pregnancy

nausea

vomiting

dizziness

diarrhea

INFECTIOUS DISEASES

STD's

pelvic infections

post partum infections

CHRONIC DISEASES OR DISORDERS

endometriosis

SURGERY/PREVIOUS HOSPITALIZATIONS

prior ectopic pregnancy

D & C

pelvic surgery

tubal surgery

post partum hemorrhage

PREVIOUS TESTS

pregnancy

TRAUMA OR INJURIES

head injury

SOCIAL HISTORY

smoking

alcohol

caffeine

illicit drugs - cocaine

ALLERGY

medications

foods

seasonal

FAMILY HISTORY

genetic abnormalities



MEDS_LAB_TESTS

**** MEDS

diethylstilbestrol exposure

**** LAB

quantitative beta HCG stat

quantitative beta HCG's q36-48 hr

consider serum progesterone

Electrolytes

CBC

type & match blood

Rh

UA with micro

culdocentesis

**** TESTS

abdominal ultrasound

intrauterine ultrasound

REVIEW_OF_SYSTEMS_1

GENERAL

weight changes

appetite changes

anorexia

difficulty sleeping

fever

chills

polyphagia

hypophagia

changes in thirst

sleeping habit change

bowel habit change

fatigue

hypertension

previous physical exams

SKIN

pigmentation changes

texture changes

lesions

eruptions

pruritis

easy bruising

easy bleeding

unusual hair loss

changes in hair distribution

skin masses

finger/toe nail change

rashes

hives

striae

skin atrophy

uremic frost

hirsutism

plethora

neurofibromatosis lesion

HEENT

head trauma

skull fractures

head masses

hearing loss

vertigo

chronic ear infection

ear discharge

ear pain

hearing aid use

loss of vision

recent change in vision

photophobia

diplopia (double vision)

glaucoma

exudates

dry eyes

eye pain

cataracts

eye surgery

itchy eyes

excessive tearing

corrective lenses

nose bleeds

chronic sinusitis

nasal fractures

nasal drainage

polyps

changes in sense of smell

edentulous (without teeth)

partial plate

full plate

recent dental work

oral lesions

tonsillitis

strep throat

tongue problems

voice changes

chronic hoarseness

chronic halitosis

NECK

neck masses

enlarged thyroid gland

brachial cleft cysts

neck injury



REVIEW_OF_SYSTEMS_2

CHEST

chronic coughing

sputum production

hemoptysis

wheezing

pneumonia

bronchitis

TB

TB exposure

SOB (altered by position?)

edema

chest pains

pacemaker

HEART

MI

coronary artery disease

heart murmur

heart valve disease

left ventricular hypertrophy

mistral valve stenosis

pericarditis

palpitations

DOE

paroxysmal nocturnal dyspnea

orthopnea

edema

hypertension

rheumatic fever

cardiomyopathy

ectopic heart beats

arrhythmia

exercise intolerance

claudication

heart medications

ABDOMEN

abdominal pain

nausea

vomiting

diarrhea

constipation

hematochezia

hematemesis

hemorrhoids

GI x-rays

GI scopings

rectal bleeding

ulcers

bowel polyps

bowel incontinence

gall bladder disease

gall stones

hepatitis

cirrhosis

hepatomegaly

splenomegaly

GU

renal insufficiency

renal failure

dialysis

kidney stones

kidney disease

kidney cyst

flank pain

hematuria

pyuria

dysuria

chronic cystitis

nocturia

anuria

hesitancy

enuresis

change in urine color

prostatitis

epididymitis

scrotal problems

TURP

pain on intercourse

genital lesions

genital discharge



REVIEW_OF_SYSTEMS_3

OB/GYN

Gravida

Para

miscarriages

abortions

living children

metorrhagia

menorrhagia

irregular menses

problems in pregnancy

use of contraception

breast masses

nipple discharge

breast skin changes

changes in axillary nodes

monthly breast exam

breast feeding children

EXTREMITIES

difficulty with gait

weakness

joint swelling

joint stiffness

muscle pain

muscle swelling

muscle injuries

sagittal plan scoliosis

coronal plane scoliosis

fractured bones

SLE

osteoarthritis

rheumatoid arthritis

fibromyalgia

NEURO

seizures

head injury

LOC

loss of coordination

difficulty in balance

sciatica

difficulty in fine motor skills

difficulty speaking

CVA (stroke)

weakness in arms

weakness in legs

tingling in legs and feet

tingling in arms

PSYCHIATRIC

depression

bipolar disorder

suicide attempts

psychiatric hospitalizations

personality disorders

ENDOCRINE

goiter

exophthalmos

dry skin

dry hair

intolerance to heat

intolerance to cold

changes in growth

sterility

impotence

decreased libido

LYMPHATIC AND HEMATOLOGICAL

lymphadenopathy

transfusion

anemia







PHYSICAL_EVAL_1

VITALS

BP

Pulse

Temp

GENERAL

rate of bleeding

obesity

SKIN

cold, clammy

pallor

HEENT

papilledema

optic atrophy



PHYSICAL_EVAL_2

NECK

thyroid palpable

thyroid nodules

trachea midline

trachea shifted

CHEST

breast development by Tanner staging

Tanner Stage I 

	(TEEN - no breast buds)

Tanner Stage II 

	(Breast & papilla - small mounds)

Tanner Stage III 

	(Breast & aerola enlarged; 

  	no contour separation)

Tanner Stage IV (Areola & papilla 

  form secondary mound)

Tanner Stage V (Mature breast)

normal symmetry and contour 

   of breast

asymmetry and contour of breast

discharge form nipple

breast mass

breast tenderness

HEART

Rate and rhythm are regular

ABDOMEN

hypoactive bowel sounds

Cullen's sign 

	(periumbilical darkening)

local tenderness

generalized tenderness

rebound tenderness

abdominal masses

GU

Pubic hair by Tanner staging

Tanner Stage I 

	(Preadolescent - no hair)

Tanner Stage II 

	(Sparse & lightly pigmented hair)

Tanner Stage III 

	(Darker, beginning to curl, 

  increased amount of hair)

Tanner Stage IV (Coarse, 

	curly, abundant hair 

  	but less than adult)

Tanner Stage V 

 Full adult hair triangle, 

 spread to medial surface of thighs

RECTAL

guaiac (occult blood)

OB/GYN

vaginal dryness

vulvar nodules

vaginal obstruction

uterine enlargement

uterine tenderness

uterine myomas

cervical tenderness on movement

Chadwick's sign 

   (vaginal & cervical cyanosis)

Hegar's sign 

   (softening of uterine isthmus)

adnexal masses

adnexal tenderness

ovarian cysts

ovarian tumors

cul-de-sac fullness



DIFF_DIAGNOSIS

Ectopic pregnancy

(rupture usually between 

    6 & 12 weeks)

Intrauterine pregnancy

Salpingitis

Endometriosis

Appendicitis

threatened abortion

dysmenorrhea

dysfunctional uterine bleeding

Ovarian cyst (corpus luteum)

ovarian torsion

Urinary tract infection

renal stone

diverticulitis

mesenteric lymphadenitis