FEMALE HEALTH

Question 1

What investigations are used in early pregnancy

Answer 1

Urinary BHCG and serum HCG

Transvaginal US

Question 2

What is the difference between the urinary and serum HCG?

Answer 2

urinary HCG - qualitative result (positive/negative),
- very sensitive, accurate and reliable

Serum HCG - quantitative test i.e. the amount of of HCG in serum

• useful ~4-8wks, serial tests 48hrs apart (normal rises of around >66%
• reaches a peak around 11weeks and then steadily declines

Question 3

What are indications of TVUS?

Answer 3

diagnostic test in early pregnancy

• used to diagnose intrauterine pregnancy, viability, multiple pregnancy, ectopic pregnancy
• used also to diagnose miscarriage

Question 4

what are the two main gonadotropins investigated?

Answer 4

FSH and LH

- measured in amenorrhoea, oligomenorrhoea and menopause

Question 5

patterns of LF/FSH abnormalities?

Answer 5

1. elevated - excess production = ovarian resistance and then ovarian failure/menopause
2. reduced - lowered secretion - anorexia/pituitary failure
3. normal - PCOS

Question 6

what is the programme done to screen cervical cancer?

Answer 6

national cervical smear screening programme - detects cytological abnormalities in the PRE-CANCER phase

Question 7

what are the potential results for a cervical smear?

Answer 7

1. abnormal cells/ HRHPV +ve

2. normal cells

Question 8

what is done is cervical smear is abnormal?

Answer 8

cytology
-outcomes can be

1) normal
- 3yr recall

2) mild/moderate/severe dyskaryosis
- colposcopy - confirms the diagnosis and the likely stage of CIN

Question 9

what is hysteroscopy?

Answer 9

a procedure used to examine the inside of the womb/uterus

Question 10

hysteroscopy indications?

Answer 10

investigate abnormal symptoms of problems

• unusual bleeding patterns
• repeated miscarriages
• infertility

diagnose/treat fibroids, polyps, displaced IUDs and adhesions

Question 11

what is laparoscopy?

Answer 11

type of surgical procedure that allows access into the abdomen without making large incisions into the skin
- also referred to as keyhole surgery - minimally invasive surgery

small tube with a camera and light source - allows images of the abdomen and pelvis to be seen on a large monitor

Question 12

Pros and Cons of laparoscopy?

Answer 12

PROS = shorter hospital stay/quicker recovery, less pain/bleeding post-op and reduced scarring

CONS =
infection 
minor bleeding 
bruising - site of incision
nausea and vomiting

Question 13

What is colposcopy?

What are the indications of colposcopy?

Answer 13

simple procedure allowing visualisation of the cervix and the lower part of the womb

• confirms normal/abnormal cells on the cervix after smear
• allows targeted biopsies and treatment (removing cells) - LLTEZ
• cauterisation of ectropion or PCB

Question 14

what is laparotomy?

possible complications?

Answer 14

surgical incision made into the abdominal cavity

• examine abdominal organs and diagnose any problems
• larger incision made compared to laparoscopy

Possible complications:

• infection
• formation of scar tissue in abdo cavity

Question 15

what is a mammogram?

Answer 15

An X-ray of the breast - can often show abnormal areas of the breast
- 2 most common findings include = calcifications and masses

Question 16

What is the breast cancer screening programme?

Answer 16

aged 50-71 - mammogram every 3yrs

- stops automatically at 71

Question 17

What is a pre-natal US?

Answer 17

ultrasound scans during pregnancy
can be used to
- check the baby is developing as expected
- identify any birth defects or structural abnormalities

Question 18

what is a cervical biopsy?

Answer 18

procedure to remove tissues from the cervix to test for abnormal or precancerous conditions or cervical cancer

often done after abnormalities are picked up from colposcopy

Question 19

what is cervical ablation?

Answer 19

operation used to treat heavy periods

device is used to treat the endometrium - can be done whilst awake or under local anaesthetics or General anaesthesia

the endometrium is removed - reducing/stopping a women’s periods

Question 20

What is CA-125 and its uses?

Answer 20

tumour marker most associated with ovarian cancer

not all cancers secrete CA-125 - false negatives

Question 21

What can cause falsely raised CA-125?

Answer 21

• endometriosis
• menstruation
• pregnancy
• fibroids
• pelvic infections
• ascites

Question 22

What are the BRCA1 &2 genes

Answer 22

hereditary gene errors that increase the risk of cancers

autosomal dominant pattern of inheritance

Question 23

what can be done if BRCA1&2 genes are detected?

Answer 23

offer risk-reducing surgery = bilateral salpingo-oophorectomy

Question 24

What Investigations are done in pre-eclampsia?

Answer 24

• blood pressure = HTN >140/90
• urine dip = proteinuria
• Bloods - slightly high Hb, Low platelets, relatively high urea: creatinine, high ALT/low albumin, increased PCR/ACR,
• US - poor fetal growth, reduced amniotic fluid and high resistance to umbilical vessels

Question 25

What investigations are done in someone who has PMB?

Answer 25

1. abdo/pelvic examinations
2. TVUS - endometrial thickness (>4mm)
3. OP endometrial biopsy or hysteroscopy and biopsy