Female health ICM

Question 1

How is menopause investigated?

When do we do investigations?

Answer 1

usually clinical diagnosis , not routinely investiagted

Serum FSH measured when…
if 45+ with atypical symptoms
40-45 - menopausal symptoms and altered menses
<40yr POP

Question 2

How is Endometritis Investigated?

Answer 2

vaginal swabs - including chlamydia and gonorrhea

urine culture & sensitivities

Question 3

How is Endometriosis Investigated?

Answer 3

Gold standard - laparoscopy

pelvic US - reveal large endometriomas and chocolate cysts

Question 4

How is Adenomyosis Investigated?

Answer 4

TVUS

Question 5

How is Uterine Prolapse Investigated?

Answer 5

mainly clinical diagnosis, ?US

Question 6

How is Uterine Fibroid/Leimyoma Investigated?

Answer 6

Initial Ix = hysteroscopy
larger fibroid = TVUS
MRI = before surgical options

Question 7

How is Endometrial cancer Investigated?

Answer 7

First line = TVUS, <4mm normal endometrial value = high negative predictive value

Hysteroscopy with endometrial biopsy

Question 8

How is Cervicitis Investigated?

Answer 8

cervical smear - culture any discharge

Question 9

How is Cervical Dysplasia Investigated?

Answer 9

cervical smears and cytology

Question 10

How is Cervical/Nabothian Cysts Investigated?

Answer 10

clinically diagnosed , not routinely investigated

Question 11

How is Incompetent Cervix Investigated?

Answer 11

TVUS

Question 12

How is Cervical Ectropion Investigated?

Answer 12

clinical diagnosis upon speculum examination

Question 13

How is Cervical Carcinoma Investigated?

Answer 13

Colposcopy

Question 14

How is Ammenorrhoea Investigated?

Answer 14

1. exclude pregnancy - serum bHCG
2. Pelvic US
3. Serum Prolactin
4. Bloods - FBC, U&Es, TSH, FSH, LH, Total testosterone

Question 15

How is PCOS Investigated?

Answer 15

pelvic US

Bloods - FSH, LH, Prolactin, TSH, testosterone,
checked impaired glucose tolerance

Question 16

How is Vulval neoplasm Investigated?

Answer 16

Confirmation of diagnosis - biopsy will be needed

Question 17

How is Bartholin’s Cyst Investigated?

Answer 17

clinical diagnosis

Question 18

How is Ovarian Neoplasm Investigated?

Answer 18

Ca125 - raised above 35IU/mL - arrange an urgent US

normal US - consider other causes of Ca125

Question 19

How is Breast Abscess Investigated?

Answer 19

not routinely investigated, clinical diagnosis

Question 20

How is mastitis Investigated?

Answer 20

not routinely investigated, clinical diagnosis

Question 21

How is Fibroadenoma Investiagted?

Answer 21

not routinely investigated, clinical diagnosis

Question 22

How is Fibrocystic Disease Investigated?

Answer 22

not routinely investigated, clinical diagnosis

Question 23

How is Breast Cancer Investigated?

Answer 23

mammography and core biopsy

Question 24

How is Ectopic pregnanacy Investiagted?

Answer 24

Pregnancy test done - positive
or bHCG >1500 will point towards a diagnosis

Investiagtion of choice will be TVUS

Question 25

Investigations for suspected Gestational Diabetes

Answer 25

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

Question 26

Investigations for suspected Abruptio Placenta?

Answer 26

clinical diagnosis based on presentation

Question 27

Investigations for suspected Placenta previa?

Answer 27

20 wk scan is used to assess position - enables diagnosis of PP
- diagnosed at 32wks

Question 28

Investigations for suspected PROM?

Answer 28

Sterile speculum examination should be performed
- pooling of amniotic fluid in the posterior vault

US may also show oligohydramnios

Question 29

Early pregnancy investigations?

Answer 29

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

Question 30

interpretation of abnormal FSH/LH results in menopause?

Answer 30

sometimes elevated = suggest excess production 2° to overcoming resistance - ovarian failure/menopause

reduced = reduced secretion from pituitary = anorexia/pituitary failure

normal - usually PCOS

Question 31

Cervical cancer screening tests interpretation and process?

Answer 31

hrHPV neg = normal 3yr recall

hrHPV positive = repeat in 12months

• if positive reading persists = colposcopy
• if neg = normal recall

2 inadequate samples = colposcopy

Question 32

Prenatal US - what are they used for? when are they done?

Answer 32

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

Question 33

What is Cervical Ablation used for?

Answer 33

Endometrial ablation is used to treat heavy periods

- can be done using local/general anaesthetic

Question 34

Ca-125 associated with which malignancy in particular?

Answer 34

ovarian cancer

• not all cancers secrete so may be a false positive
• other causes include: endometriosis, menses, pregnancy, fibroids, pelvic infection and ascites

Question 35

Blood tests done in pre-eclampsia?

Answer 35

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