Female Health - ICM Flashcards
What does serum bHCG tell you that urine bHCG doesn’t tell you?
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
How do you preform a serum bHCG?
- 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
What do the levels of serum bHCG reflect? (one mark)
Trophoblastic (placental) production minus urinary secretion
Name 3 reasons why serum bHCG tests are done? (3 marks)
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)
What is the diagnostic test for early pregnancies?
Transvaginal ultrasound
What 4 things can a transvaginal ultrasound show you?
1) Intrauterine pregnancy
2) Viability
3) Ectopic pregnancy
4) Multiple pregnancies
On a transvaginal ultrasound, how big does the baby get when you start seeing a heartbeat?
More than 7mm
What is a delayed miscarriage and what would you see on a transvaginal US?
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
What is an anembryonic pregnancy and how would it show on a transvaginal US?
Patient presents with bleeding
Shows big yolk sac but the embryo never developed inside it
What is a complete miscarriage and how would it show on a transvaginal US?
All products of conception have been expelled from the uterus
Should not see a sac and instead see the normal endometrial lining together
What is an incomplete miscarriage and how would it show on a transvaginal US?
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
What is the definition of a miscarriage?
Spontaneous loss of pregnancy before 24 weeks
What is an inevitable miscarriage?
Non-viable pregnancy where bleeding has begun and cervical os is open but products of conception remain in the uterus –> lead to incomplete/complete
What is a threatened miscarriage?
Bleeding with a viable pregnancy before 24 weeks - does not always mean the patient will miscarry
What is a missed pregnancy?
Non-viable pregnancy identified on US with no associated pain or bleeding
What is a pregnancy of unknown location?
Positive pregnancy test with no evidence of extra or intra uterine pregnancy
In what cases would you test FSH and LH? (3 marks)
- Amenorrhoea
- Oligomenorrhea
- Determining if a lady has reached menopause
When would you see elevated levels of FSH and LH?
Menopause
- Excess production of FSH and LH to overcome ovarian resistance
High = menopause
When would you see reduced FSH and LH levels?
Anorexia / excessive exercise / tumours
- Problem with the hypothalamus and pituitary axis causing reduced secretion of FSH and LH
Low = hypothalamus/pituitary
When would you see normal levels of FSH and LH?
PCOS
What is cervical screening?
Smear test to check the health of the cervix by taking a sample to send off and check for any evidence of HPV
If a patients smear test is negative, when do they have to come back for repeat smear?
3 years
What is the over process of cervical screening in general?
Smear sample – cytology – colposcopy – Biopsy/LLETZ
If a patient’s sample comes back as HPV positive, what is the next step?
Reflex cytology
If a patient’s reflex cytology result is normal, what is the next step for the patient?
Repeat smear in 12 months
If a patient’s reflex cytology is abnormal, what is the next step?
Colposcopy
What is dyskaryosis and what are the different levels?
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
What three procedures can happen during a colposcopy?
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
What is a hysteroscopy and when would it be done?
Hysteroscope goes through the cervix into the uterus to check/remove polyps or fibroids
Normal = flat and smooth
What is a laparotomy and when would it be done?
Incision made into the abdomen for different surgeries.
Able to locate the source of pain in the abdomen or pelvis
Endometriosis or ovarian cysts
What is a laparoscopy and when is it done?
Keyhole surgery to put gas into abdomen to lift up the abdominal wall to see the insides (ovary)
Endometriosis, PID, ovarian cysts, ectopic pregnancies
What is a colposcopy and when is it done?
Uses colposcope to look at the cervix in more detail
Biopsy’s, removal of ectropion or abnormal tissue
What is a mammogram and when is it done?
X-ray picture of the breast
Detect early signs of breast cancer
What is a prenatal ultrasound and when is it done?
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
What is a cervical biopsy and when is it done?
Procedure to remove tissue from the cervix
Test for abnormal pre-cancerous conditions or cervical cancer
What is cervical ablation and when is it done?
Procedure to surgically destroy the endometrial lining of the uterus
Menorrhagia - excessive menstrual blood loss
Help treat anaemia due to excessive blood loss
What tumour marker is associated with ovarian cancer, despite not being specific for it?
Ca-125
What are the signs of ovarian cancer that would make you want to send off for Ca-125?
Persistent for more than 3 weeks:
- Abdominal bloating and distention
- Discomfort
- Change in bladder or bowel habit
What else causes a raised Ca-125?
Endometriosis Menstruation Pregnancy Fibroids Ascites
What three things can Ca-125 help with?
- Help diagnose ovarian cancer
- Monitor response to chemo
- detect recurrence of disease
What are the BRCA1 and 2 genes and what are they related too?
Autosomal dominant hereditary gene error increasing risk of breast cancer and tubo-ovarian cancer
How do the BRCA genes cause an increase risk in cancer?
Reduce the suppression of the tumour suppressor gene p53
What is the gynaecological management for BRCA 1 & 2 genes and what would you need to check with the patient?
Bilateral salpingo-oophorectomy to reduce risk of cancer to <1%
Have to make sure if the patient is done having a family
What can you provide to younger women if they have not had breast cancer but have had their ovaries removed?
HRT
What is pre-eclampsia?
Condition seen in the third trimester of a pregnancy with high blood pressure and proteinuria
What physiological changes occur with pre-eclampsia?
Vessels become tight instead of dilated –> becomes leaky and causes oedema
First investigation for pre-eclampsia:
What would you expect to see on the FBC?
High HB concentration
Low platelets
Second investigation for pre-eclampsia:
What would you see in the U&Es?
High urea and creatinine
Third investigation for pre-eclampsia:
What would you see in the LFTs?
High ALT
Hypoalbuminaemia
Fourth investigation for pre-eclampsia:
What would you see in the coagulation screen?
Prolonged coagulation time
What are the impacts of pre-eclampsia on the foetus?
Poor foetal growth
Reduced amniotic fluid
High resistance in umbilical vessels (as seen in mothers vessels)
What 5 red flags would make you send a patient off for a two-week wait referral?
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
What investigations do you do for a patient presenting with post-menopausal bleeding?
Transvaginal US to check endometrial thickness
If a PMB patient’s speculum and transvaginal US was normal, what is the next step?
Cancer risk <1%
come back if more bleeding
If a PMB patient’s transvaginal US shows an endometrial thickness more than 4mm, what is the next step?
Endometrial biopsy
OR
Hysteroscopy
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
B - Progesterone
FSH & LH –> corpus luteum production –> surge of progesterone
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
B - 7 days before next period
- If more than >30nmol/l this indicates ovulation
In a healthy couple, when are investigations started to help them conceive?
After one year of regular attempts to conceive, with intercourse every 2-3 days
