Clinical Evaluation Form

In military settings, tactical circumstances may limit the extent of evaluation of abdominal pain. Lab and imaging may not be possible at this moment, and the examiner may possess limited clinical skills in dealing with OBGYN issues.

That said, there is still much that can be done to reach a working diagnosis and begin effective therapy. Essential to this effort are these three lines of inquiry, each contributing to reaching a reliable clinical diagnosis:

  1. Vital Signs
  2. History (Ask the right questions.)
  3. Physical (Lower level physical exam skills, not higher level.)

Vital Signs

  • Temperature
  • Pulse
  • Respirations
  • Blood Pressure

Should you need additional guidance on obtaining accurate vital signs, help can be found here. (Taking Vital Signs)


History

Most healthcare providers will know many of the right questions to ask the patient. But there are some highly targeted questions that can prove very useful in clinically distinguishing the different causes of abdominal pain in women. They are listed below, but a downloadable single sheet is available here.

Where is the pain?

  • Whole abdomen
  • Upper Abdomen
  • Lower Abdomen
  • Right Lower Quadrant
  • Left Lower Quadrant
  • Suprapubic area
  • Different places at different times

Did the pain start suddenly (within a few minutes) or gradually (hours or days)?

  • Suddenly
  • Gradually

How long has the pain lasted?

  • Hours
  • Days
  • Months

How intense is the pain?

  • Mild
  • Moderate (Interferes with some activities)
  • Severe (Unable to function without extreme effort)

Is the pain constant?

  • Constant
  • Cramping
  • Intermittent

Is the pain getting worse?

  • Worse and worse
  • Better and better
  • Unchanging

How’s your appetite?

  • Decreased
  • Increased
  • Normal

Are you nauseated?

  • Yes
  • No

Have you vomited?

  • Yes
  • No

How are your bowel movements?

  • Normal
  • Constipated
  • Diarrhea
  • Bloody
  • Mucousy

Is your urination normal?

  • Painful
  • Frequent
  • Bloody
  • Normal

How do you feel?

  • Lightheaded
  • Cannot be upright
  • Doesn’t feel faint

Right shoulder pain is:

  • Present
  • Absent

The pain is worse with:

  • Coughing
  • Moving
  • Eating
  • Nothing
  • Other

The pain improves with:

  • Lying still
  • Antacids
  • Eating
  • Nothing

Has this happened before?

  • Yes
  • No

Past medical history?

  • Functional bowel syndrome
  • Diverticular illness
  • Other

Past surgical history:

  • None
  • Appendectomy
  • Bowel resection
  • Tubal Ligation
  • Ectopic pregnancy
  • Hysterectomy
  • One tube or ovary
  • Both ovaries
  • Negative laparoscopy in last 2 years

Past gynecologic history:

  • Cystitis
  • Pyelonephritis
  • Ovarian Cyst
  • Endometriosis
  • PID or some STD
  • Deep dysparunia
  • Dysmenorrhea
  • Fibroids
  • None
  • Other

Contraceptive History:

  • Previous IUD
  • Current IUD
  • Current OCPs – skips some
  • Current OCPs – never skips
  • Other hormonal contraceptive
  • Other
  • Using no contraception or seeking a pregnancy
  • No need for contraception

Sexual History:

  • Never had intercourse
  • No intercourse since her LMP
  • No intercourse in the last 3 months
  • Other

When did your last normal menstrual  begin?

________________________________


Physical Exam

Mood:

  • Normal
  • Anxious/worried
  • Confused/inappropriate
  • Lethargic

Patient’s color is:

  • Normal
  • Pale
  • Flushed
  • Jaundiced
  • Cyanotic

Greatest tenderness is: 

  • Entire abdomen
  • Upper abdomen
  • RLQ
  • LLQ
  • Suprapubic
  • Lower abdomen
  • No tenderness

The abdomen is:

  • Soft
  • Voluntary guarding
  • Involuntary guarding
  • Mild rebound tenderness
  • Moderate/marked rebound tenderness

On abdominal palpation:

  • No masses
  • Mass central lower abdomen
  • Mass RLQ
  • Mass LLQ
  • Mass upper abdomen

Bowel sounds are:

  • Normal
  • Silent
  • Hyperactive
  • High-pitched, rushes

CVA pain/tenderness is:

  • Present
  • Absent

The vagina contains:

  • Nothing abnormal
  • Small amounts of blood
  • Large amounts of blood
  • Clots
  • Pregnancy tissue
  • Other

The hymen is:

  • Intact
  • Not intact
  • Not visualized

The bladder is:

  • Tender
  • Non-tender

Cervix inspection:

  • No abnormal findings
  • Purple discoloration
  • Purulent (muco) discharge
  • Tissue protruding from the os
  • Bleeding from the os

Cervical Palpation:

  • No abnormal findings
  • Cervix is softer than expected
  • Tender to touch
  • Mild pain on movement
  • Moderate/severe pain on movement
  • Dilated at least 1 cm.
  • Other

The uterine size is:

  • Normal
  • Slightly enlarged
  • Moderately enlarged

Uterine palpation:

  • No abnormal findings
  • Soft
  • Irregular contour
  • Mildly tender
  • Mod/severe tenderness

Left adnexa:

  • Normal
  • Tender mass
  • Non-tender mass
  • Tenderness, no mass

Right adnexa:

  • Normal
  • Tender mass
  • Non-tender mass
  • Tenderness, no mass

Culdesac:

  • Normal
  • Tender mass
  • Non-tender mass
  • Tenderness, no mass
  • Tender nodules on uterosacral ligaments

Women's Healthcare in Operational Settings