Female health ICM Flashcards
How is menopause investigated?
When do we do investigations?
usually clinical diagnosis , not routinely investiagted
Serum FSH measured when…
if 45+ with atypical symptoms
40-45 - menopausal symptoms and altered menses
<40yr POP
How is Endometritis Investigated?
vaginal swabs - including chlamydia and gonorrhea
urine culture & sensitivities
How is Endometriosis Investigated?
Gold standard - laparoscopy
pelvic US - reveal large endometriomas and chocolate cysts
How is Adenomyosis Investigated?
TVUS
How is Uterine Prolapse Investigated?
mainly clinical diagnosis, ?US
How is Uterine Fibroid/Leimyoma Investigated?
Initial Ix = hysteroscopy
larger fibroid = TVUS
MRI = before surgical options
How is Endometrial cancer Investigated?
First line = TVUS, <4mm normal endometrial value = high negative predictive value
Hysteroscopy with endometrial biopsy
How is Cervicitis Investigated?
cervical smear - culture any discharge
How is Cervical Dysplasia Investigated?
cervical smears and cytology
How is Cervical/Nabothian Cysts Investigated?
clinically diagnosed , not routinely investigated
How is Incompetent Cervix Investigated?
TVUS
How is Cervical Ectropion Investigated?
clinical diagnosis upon speculum examination
How is Cervical Carcinoma Investigated?
Colposcopy
How is Ammenorrhoea Investigated?
- exclude pregnancy - serum bHCG
- Pelvic US
- Serum Prolactin
- Bloods - FBC, U&Es, TSH, FSH, LH, Total testosterone
How is PCOS Investigated?
pelvic US
Bloods - FSH, LH, Prolactin, TSH, testosterone,
checked impaired glucose tolerance
How is Vulval neoplasm Investigated?
Confirmation of diagnosis - biopsy will be needed
How is Bartholin’s Cyst Investigated?
clinical diagnosis
How is Ovarian Neoplasm Investigated?
Ca125 - raised above 35IU/mL - arrange an urgent US
normal US - consider other causes of Ca125
How is Breast Abscess Investigated?
not routinely investigated, clinical diagnosis
How is mastitis Investigated?
not routinely investigated, clinical diagnosis
How is Fibroadenoma Investiagted?
not routinely investigated, clinical diagnosis
How is Fibrocystic Disease Investigated?
not routinely investigated, clinical diagnosis
How is Breast Cancer Investigated?
mammography and core biopsy
How is Ectopic pregnanacy Investiagted?
Pregnancy test done - positive
or bHCG >1500 will point towards a diagnosis
Investiagtion of choice will be TVUS
Investigations for suspected Gestational Diabetes
OGTT - usually done as a screening test
- offered at 24-28wks to those who have RFs of GD or have had GD in prev preganancies
Investigations for suspected Abruptio Placenta?
clinical diagnosis based on presentation
Investigations for suspected Placenta previa?
20 wk scan is used to assess position - enables diagnosis of PP
- diagnosed at 32wks
Investigations for suspected PROM?
Sterile speculum examination should be performed
- pooling of amniotic fluid in the posterior vault
US may also show oligohydramnios
Early pregnancy investigations?
Urinary bHCG - sensitive but doesn’t inform gestation, viability or location
serum hCG - useful between 4-8, usually levels should be doubling as expected in early pregnancy
- begins to decline around 11wks
- helps to guide management but is not diagnostic
DIAGNOSTIC TEST - TVUS
interpretation of abnormal FSH/LH results in menopause?
sometimes elevated = suggest excess production 2° to overcoming resistance - ovarian failure/menopause
reduced = reduced secretion from pituitary = anorexia/pituitary failure
normal - usually PCOS
Cervical cancer screening tests interpretation and process?
hrHPV neg = normal 3yr recall
hrHPV positive = repeat in 12months
- if positive reading persists = colposcopy
- if neg = normal recall
2 inadequate samples = colposcopy
Prenatal US - what are they used for? when are they done?
imaging of the baby, amniotic sac, placenta and ovaries
early preg scans are done between 11-14ks
mid-pregnancy scans are done between 18-21wks
What is Cervical Ablation used for?
Endometrial ablation is used to treat heavy periods
- can be done using local/general anaesthetic
Ca-125 associated with which malignancy in particular?
ovarian cancer
- not all cancers secrete so may be a false positive
- other causes include: endometriosis, menses, pregnancy, fibroids, pelvic infection and ascites
Blood tests done in pre-eclampsia?
Pre-eclampsia = HTN >140/90, proteinuria and >20/40wks
- can have oedema
FBC, U+Es, LFTs, coag profile
- high Hb, low plts, high urea+creatinine
- prolonged coag time
protein-creatinine ratio
- increased PCR (abnormal)
US fetus and vessels
- poor fetal growth, amniotic fluid reduced, high resistance in umbilical vessels
