OBGYN Station 3

Setting:

You are a junior doctor working in GP/family medicine. This patient has presented complaining of incontinence.

Name: Janet Baker

Tasks:

1. Take a history from the patient.

2. Give your preferred diagnosis to the examiner.

3. Outline your management plan to the examiner.

You are not required to examine the patient.

Briefing

Diagnosis: Stress Incontinence
You have presented to the GP with incontinence.

For this scenario, your details are:
Patient Name: Janet Baker (age: 68)

Opening statement

“I’ve noticed that I’ve been leaking for the last couple of months”

Information to Give Freely

It happens whenever I’m laughing with my friends which is really embarrassing. It also happens when I sneeze or cough, and now that it’s hay fever season it’s happening more and more!

Presenting Complaint (bleeding)

Site – You’re sure that it is from you urethra and not the vagina
Onset – It started about 2 months ago, you thought it would go away by itself but it hasn’t.
Character – It looks like normal urine. It’s only a few drops when it happens. You haven’t noticed any blood and there’s no strong smell. The volume of urine is just a couple of drops.
Radiation – No discharge or incontinence elsewhere.
Associated symptoms – No lower urinary tract symptoms. No dragging sensations down below (this could suggest prolapse).
Exacerbating/relieving factors - coughing, sneezing, and laughing makes it worse.
Severity - You worry about going out, especially for drinks with your friends.

Gynae History

Last menstrual period - LMP was about 13 years ago, theres been no bleeding since.
Age of menarche/menopause - Started period at age 14, last period at age 55.
Relevant sexual history - In a monogamous relationship. No previous STIs. No STI symptoms. Not currently having sex.
Smear status - up to date, no abnormal results.

Obs History

Any previous pregnancies? - 4

Any problems during any of the pregnancies - No

How were each of the children born? - Vaginal birth

Any complications during delivery? - No

Did any of the children need to stay in hospital? - No

Any previous miscarriages or ToPs? - No

Past Medical and Drug History

Previous similar episodes - No
Other conditions? - No
Previous surgeries? - No
Prescribed - Nil
OTC - Nil
Allergies - Penicillin if asked you come out in a rash
Contraceptive use - Condoms

Family History

Nil

Social History

Smoking history - nil
Alcohol - drink 3 glasses of wine every weekend
Coffee/Tea - None (relevant in incontinence histories, particularly if considering urge incontinence).
Home - fully independent living in a house with your husband.

Systems Review

You are otherwise well apart, with no other symptoms. You rarely see the doctor.

Ideas / Concerns / Expectation

Ideas - “Is it something to do with my pelvic floor?”
Concerns - “It’s stopped me doing things like going out with friends or going anywhere there won’t be a bathroom nearby”
Expectations - “Anything that can stop it, ideally some medication”

Discussion and Questions

n/a