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ICM/FCM > Female Health - ICM > Flashcards

Female Health - ICM Flashcards

1
Q

What does serum bHCG tell you that urine bHCG doesn’t tell you?

A

Urine bHCG –> only tells you if you’re pregnant

Serum bHCG –> tells you the level of bHCG and whether it is a normal pregnancy or not

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2
Q

How do you preform a serum bHCG?

A
  • More useful during 4-8 weeks of pregnancy
  • Take two serial tests 48 hours apart
  • Assess to see if the bHCG is increasing or decreasing
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3
Q

What do the levels of serum bHCG reflect? (one mark)

A

Trophoblastic (placental) production minus urinary secretion

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4
Q

Name 3 reasons why serum bHCG tests are done? (3 marks)

A

1) Management of ectopic pregnancies
2) Pregnancies of unknown location that can’t be found on scans
3) Trophoblastic disease (abnormal pregnancies with high levels of hCG)

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5
Q

What is the diagnostic test for early pregnancies?

A

Transvaginal ultrasound

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6
Q

What 4 things can a transvaginal ultrasound show you?

A

1) Intrauterine pregnancy
2) Viability
3) Ectopic pregnancy
4) Multiple pregnancies

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7
Q

On a transvaginal ultrasound, how big does the baby get when you start seeing a heartbeat?

A

More than 7mm

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8
Q

What is a delayed miscarriage and what would you see on a transvaginal US?

A

Baby is bigger than 7mm with no visible heart beat, meaning pregnancy hasn’t continue through the early stage

Mother will eventually miscarry

Will show baby within the uterus

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9
Q

What is an anembryonic pregnancy and how would it show on a transvaginal US?

A

Patient presents with bleeding

Shows big yolk sac but the embryo never developed inside it

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10
Q

What is a complete miscarriage and how would it show on a transvaginal US?

A

All products of conception have been expelled from the uterus

Should not see a sac and instead see the normal endometrial lining together

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11
Q

What is an incomplete miscarriage and how would it show on a transvaginal US?

A

There are still retained products of conception and tissue within the uterus and bleeding has begun

Should see a small sac and products on US

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12
Q

What is the definition of a miscarriage?

A

Spontaneous loss of pregnancy before 24 weeks

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13
Q

What is an inevitable miscarriage?

A

Non-viable pregnancy where bleeding has begun and cervical os is open but products of conception remain in the uterus –> lead to incomplete/complete

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14
Q

What is a threatened miscarriage?

A

Bleeding with a viable pregnancy before 24 weeks - does not always mean the patient will miscarry

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15
Q

What is a missed pregnancy?

A

Non-viable pregnancy identified on US with no associated pain or bleeding

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16
Q

What is a pregnancy of unknown location?

A

Positive pregnancy test with no evidence of extra or intra uterine pregnancy

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17
Q

In what cases would you test FSH and LH? (3 marks)

A
  • Amenorrhoea
  • Oligomenorrhea
  • Determining if a lady has reached menopause
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18
Q

When would you see elevated levels of FSH and LH?

A

Menopause
- Excess production of FSH and LH to overcome ovarian resistance

High = menopause

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19
Q

When would you see reduced FSH and LH levels?

A

Anorexia / excessive exercise / tumours
- Problem with the hypothalamus and pituitary axis causing reduced secretion of FSH and LH

Low = hypothalamus/pituitary

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20
Q

When would you see normal levels of FSH and LH?

A

PCOS

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21
Q

What is cervical screening?

A

Smear test to check the health of the cervix by taking a sample to send off and check for any evidence of HPV

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22
Q

If a patients smear test is negative, when do they have to come back for repeat smear?

A

3 years

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23
Q

What is the over process of cervical screening in general?

A

Smear sample – cytology – colposcopy – Biopsy/LLETZ

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24
Q

If a patient’s sample comes back as HPV positive, what is the next step?

A

Reflex cytology

25
Q

If a patient’s reflex cytology result is normal, what is the next step for the patient?

A

Repeat smear in 12 months

26
Q

If a patient’s reflex cytology is abnormal, what is the next step?

A

Colposcopy

27
Q

What is dyskaryosis and what are the different levels?

A

Dyskaryosis refers to the change of appearance in cells that cover the surface of the cervix

Mild –> CIN 1
Moderate –> CIN2
Severe –> CIN3

Levels refer to how deep into the tissue the abnormality is

28
Q

What three procedures can happen during a colposcopy?

A

1) Targeted biopsy
- Uses acitic acid to stain abnormal tissue

2) LLETZ (large loop excision of the transformation zone)
- electrical loop cuts out abnormal tissue

3) Cauterisation of ectropion for post-coital bleeding
- More marked if a patient is on COCP

29
Q

What is a hysteroscopy and when would it be done?

A

Hysteroscope goes through the cervix into the uterus to check/remove polyps or fibroids

Normal = flat and smooth

30
Q

What is a laparotomy and when would it be done?

A

Incision made into the abdomen for different surgeries.

Able to locate the source of pain in the abdomen or pelvis

Endometriosis or ovarian cysts

31
Q

What is a laparoscopy and when is it done?

A

Keyhole surgery to put gas into abdomen to lift up the abdominal wall to see the insides (ovary)

Endometriosis, PID, ovarian cysts, ectopic pregnancies

32
Q

What is a colposcopy and when is it done?

A

Uses colposcope to look at the cervix in more detail

Biopsy’s, removal of ectropion or abnormal tissue

33
Q

What is a mammogram and when is it done?

A

X-ray picture of the breast

Detect early signs of breast cancer

34
Q

What is a prenatal ultrasound and when is it done?

A

Ultrasound that uses high frequency waves to look inside the abdomen

Show images of the baby, sac, placenta and ovaries to detect any abnormalities or birth defects

35
Q

What is a cervical biopsy and when is it done?

A

Procedure to remove tissue from the cervix

Test for abnormal pre-cancerous conditions or cervical cancer

36
Q

What is cervical ablation and when is it done?

A

Procedure to surgically destroy the endometrial lining of the uterus

Menorrhagia - excessive menstrual blood loss
Help treat anaemia due to excessive blood loss

37
Q

What tumour marker is associated with ovarian cancer, despite not being specific for it?

A

Ca-125

38
Q

What are the signs of ovarian cancer that would make you want to send off for Ca-125?

A

Persistent for more than 3 weeks:

  • Abdominal bloating and distention
  • Discomfort
  • Change in bladder or bowel habit
39
Q

What else causes a raised Ca-125?

A 
Endometriosis 
Menstruation
Pregnancy 
Fibroids 
Ascites
40
Q

What three things can Ca-125 help with?

A
  • Help diagnose ovarian cancer
  • Monitor response to chemo
  • detect recurrence of disease
41
Q

What are the BRCA1 and 2 genes and what are they related too?

A

Autosomal dominant hereditary gene error increasing risk of breast cancer and tubo-ovarian cancer

42
Q

How do the BRCA genes cause an increase risk in cancer?

A

Reduce the suppression of the tumour suppressor gene p53

43
Q

What is the gynaecological management for BRCA 1 & 2 genes and what would you need to check with the patient?

A

Bilateral salpingo-oophorectomy to reduce risk of cancer to <1%

Have to make sure if the patient is done having a family

44
Q

What can you provide to younger women if they have not had breast cancer but have had their ovaries removed?

A

HRT

45
Q

What is pre-eclampsia?

A

Condition seen in the third trimester of a pregnancy with high blood pressure and proteinuria

46
Q

What physiological changes occur with pre-eclampsia?

A

Vessels become tight instead of dilated –> becomes leaky and causes oedema

47
Q

First investigation for pre-eclampsia:

What would you expect to see on the FBC?

A

High HB concentration

Low platelets

48
Q

Second investigation for pre-eclampsia:

What would you see in the U&Es?

A

High urea and creatinine

49
Q

Third investigation for pre-eclampsia:

What would you see in the LFTs?

A

High ALT

Hypoalbuminaemia

50
Q

Fourth investigation for pre-eclampsia:

What would you see in the coagulation screen?

A

Prolonged coagulation time

51
Q

What are the impacts of pre-eclampsia on the foetus?

A

Poor foetal growth
Reduced amniotic fluid
High resistance in umbilical vessels (as seen in mothers vessels)

52
Q

What 5 red flags would make you send a patient off for a two-week wait referral?

A

1) Post-menopausal bleeding >12 months after menopause
2) Erratic, constant bleeding
3) Abnormal looking cervix
4) Vaginal ulcers/masses
5) Symptoms of ovarian cancer

53
Q

What investigations do you do for a patient presenting with post-menopausal bleeding?

A

Transvaginal US to check endometrial thickness

54
Q

If a PMB patient’s speculum and transvaginal US was normal, what is the next step?

A

Cancer risk <1%

come back if more bleeding

55
Q

If a PMB patient’s transvaginal US shows an endometrial thickness more than 4mm, what is the next step?

A

Endometrial biopsy
OR
Hysteroscopy

56
Q 
What hormone can be measured on day 21 of a "typical" 28 day cycle to test for ovulation?
A - LH 
B - Progesterone 
C - Oestrogen 
D - Gonadotrophin releasing hormone
E - Follicle stimulating hormone
A

B - Progesterone

FSH & LH –> corpus luteum production –> surge of progesterone

57
Q

When should serum progesterone be checked for ovulation?
A - 14 days before period
B - 7 days before period
C - first day of period
D - Day after unprotected sexual intercourse

A

B - 7 days before next period

- If more than >30nmol/l this indicates ovulation

58
Q

In a healthy couple, when are investigations started to help them conceive?

A

After one year of regular attempts to conceive, with intercourse every 2-3 days

ICM/FCM (16 decks)

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