Women's investigations Flashcards
What is a hysteroscopy?
When is it indicated? (7 things)
Procedure done to examine the inside of the womb (uterus)
Indications:
- Menorrhagia
- Abnormal vaginal discharge
- ? fibroids
- Pelvic pain
- Post menopausal bleeding
- Repeated miscarriages
- Difficulty getting pregnant
What is a mammogram?
Low dose X-ray to visualise the breast tissue.
What is a colposcopy ? (3 things) When is it indicated? (2 things)
A procedure done to look at the cervix.
- it can provide treatment to remove abnormal cells
- targeted biopsy
- cauterisation for ectropion if the patient has post- coital bleeding
Indication:
- Abnormal cervical smear
- done to diagnose cervical cancer
What is serum HCG ?
Why is this helpful in ectopic pregnancies?
The activity of the trophoblasts cells (which will eventually become the placenta)
There should be a 50% increase in this number over a 24hr period
In ectopic’s it helps identify whether or not the patient needs to be operated on.
What is the difference between an inevitable and delayed miscarriage ?
Inevitable miscarriage:
The cervix will be open as you are examining the patient. It is a clinical diagnosis
Delayed miscarriage:
A scan diagnosis. The cervix may be closed but no foetal heartbeat is present. The body is yet to pass the foetus.
How would you know if the patient has had a complete miscarriage?
A previous intrauterine pregnancy must have been seen on TVUS first
What is the likely reason for a woman having high FSH and LH?
Menopause. The body is producing more of these hormones to try and stimulate the ovaries
What is the likely reason for a woman having low FSH and LH? (4 things)
- Anorexia
- Pituitary failure
- Excessive exercise
- Pituitary tumours
Note: if they are normal this Could be PCOS
If a patient has a high risk smear (for HPV) What would the next investigation be?
Then if these cells are abnormal (dyskaryosis) what is the next step?
- Cytology (visualise the cells under microscope)
if cytology is abnormal…..
- Colposcopy referral.
(test to look at the cervix at a magnified view. If the cervix is stained white that is abnormal)
if cytology is normal….
Another smear in 12 months
What is LLETZ? When would it be done?
- A type of ablation treatment to remove cells from the cervix
- Done in a colposcopy clinic, to treat abnormal cervical cells
Why would a laparoscopy be done for a woman?
Indications? (2 things)
To investigate what is going on in the abdomen. The procedure gives a direct view on the reproductive system from the outside.
Indications:
- Endometriosis
- PID
What results would you expect to see in a pregnant woman with preeclampsia? (5 things)
- Relatively high Hb
- Low platelets
- Relatively high urea and creatinine
- High ALT/ low albumin
- Prolonged coagulation time (DIC)
How is Bacterial vaginosis investigated? (6 things)
- Abdominal exam+ history
- for tenderness/ masses to rule out other pathology - Inspect the vulva
- For lesions, discharge, vulvitis, ulcers etc.
3. Speculum exam IN BV: -Thin, white/grey discharge - Fishy odor - Homogenous coating of the vaginal walls+ vulva
- Test vaginal pH
- collect discharge from vaginal wall and rub it on narrow range pH paper
- pH of >4.5 suggests BV - High or self taken low vaginal swab
- for gram staining - other STI testing if high risk
What is the first line investigation for Endometriosis ?
Laparoscopy to visualise the pelvis. ***GOLD
Remember the endometrial tissue grows on the outside of the uterus so an internal scan won’t show anything
In a woman that has tested high risk for HPV. if her second smear is now negative after 24months what would you do?
Go back to testing 3 yearly.
