Female Health

Question 1

Urinary βHCG

Answer 1

Qualitative test – Yes / No only

Ab vs β-unit of HCG

Very accurate and reliable

Very sensitive - detect very low HCG levels (down to 25IU)

5 minutes till result!!

Does NOT tell you:
Gestation
Viability
Location

It tells you Pregnancy Test positive / negative

Question 2

Serum HCG

Answer 2

Quantitative test (e.g. 1340miu/ml)
Useful 4 – 8 weeks gestation
Serial tests 48 hours apart
Normal should increase >66% in 48 hours

Levels reflect trophoblastic (placental) production minus urinary excretion

Overall trophoblastic activity

Question 3

Patterns of HCG are useful in …

Answer 3

Useful for management of :
ectopic pregnancies
Pregnancies of Unknown Location (PUL)

Trophoblastic disease (hydatidiform mole)

Question 4

Diagnostic test for early pregnancy

Answer 4

Transvaginal USS

Question 5

Serum HCG & diagnosis

Answer 5

Aids management and is often NOT diagnostic

Question 6

Indications for gonadotrophins

Answer 6

E.g:
Follicle stimulating hormone
Luteinising hormone

Indications:
Amenorrhoea
Oligomenorrhoea
Menopause

Question 7

Abnormal results for FSH & LH

Answer 7

Elevated – excess production to overcome ovarian resistance - ovarian failure i.e. menopause

Reduced – reduced secretion from the pituitary e.g. anorexia / pituitary failure

Normal – usually PCOS

Question 8

Cervical screening results

Answer 8

1. If negative – 3 yearly recall
2. If positive - reflex cytology
3. If abnormal cytology (i.e. dyskaryosis) – colposcopy referral
4. If normal cytology repeat HPV test in 12 months

Question 9

What does cervical smear look for ?

Answer 9

To detect cytological abnormalities in PRE-CANCER phase

HRHPV +ve

Question 10

Outcomes for cervical smear cytology

Answer 10

Normal - normal 3 year recall

Mild, moderate and severe dyskaryosis - colposcopy

Question 11

What can happen during colposcopy?

Answer 11

Targeted biopsy

Treatment to remove abnormal cells (LLETZ)

Cauterisation of ectropion for post-coital bleeding

Question 12

Indication for hysterscopy

Answer 12

Investigation of irregular and heavy bleeding – polyps, fibroids, cancer

Removal of polyps / fibroids

Question 13

2WW referral indication

Answer 13

Red-flag symptoms where cancer is considered the diagnosis until proven otherwise

• Postmenopausal bleeding – genital tract bleeding >12 months after menopause
• Erratic, constant bleeding >45
• Abnormal looking cervix
• Vulval / vaginal ulcers / masses
• Ovarian cancer symptoms – persistent bloating, distension, discomfort, change of bladder or bowel habit

Need to rule out cancer of the genital tract

Question 14

PMB hx, examination, Ix

Answer 14

History (risk factors for endometrial cancer – obesity, HT, NIDDM)

Abdo and pelvic examination – masses and lower genital tract

TVS for endometrial thickness (ET) – assess endometrium (> 4mm)

If speculum and TVS normal risk of cancer <1%

If ET >4mm – need to prove definitively if cancer or not
Outpatient endometrial biopsy or
Hysteroscopy and biopsy

Question 15

Ovarian cancer symptoms:

Answer 15

Persistent >3 weeks:
Bloating
Distension
Discomfort (not usually pain)
Change of bladder or bowel habit

Question 16

Ix for ovarian cancer

Answer 16

Transvaginal +/- transabdominal ultrasound

Tumour markers

Question 17

CA-125 associated with…

Answer 17

ovarian cancer

Question 18

Non-cancer causes of raised CA-125

Answer 18

Endometriosis, menstruation, pregnancy, fibroids, pelvic infection, ascites of any cause e.g. cirrhosis

Question 19

CA-125 beneficial in …

Answer 19

Can help diagnosis ovarian cancer (sometimes)

Can help to monitor response to treatment e.g. chemotherapy – falling levels

Can help to detect recurrence of disease – starts rising

Question 20

BRCA 1 & 2 associated with …

Answer 20

breast and tubo-ovarian

Question 21

Management of raised BRCA 1 & 2

Answer 21

Offer risk reducing surgery
Bilateral salpingo-oophorectomy

Reduces gynae risk to <1% cancer

Question 22

Pre-eclampsia symptoms

Answer 22

Hypertension >/= 140/90
Proteinuria
(>20/40 gestation )

Question 23

Pre-eclampsia Ix

Answer 23

Full blood count

• Relatively High Hb concentration
• Low platelets

U+E
- Relatively high urea and creatinine

LFTs
- High ALT / low albumin
Coagulation
- Prolonged coagulation time (DIC)

Protein: Creatinine Ratio (PCR)
- Reflection of degree of protein leak – increased PCR abnormal

US fetus and vessels

• Fetal growth may be poor
• Amniotic fluid reuced
• High resistance in umbilical vessels

Question 24

Indications for laprascopy

Answer 24

Diagnosis of common problems – endometriosis, pelvic inflammatory disease (PID)

Treatment of endometriosis, adhesions, ovarian cysts, ectopic pregnancies…..