Gynecologic Diagnostics & Imaging

When should pregnancy test be considered?

amenorrhea, pelvic pain, and abnormal bleeding

What are the pros of a urine hCG?

Fast and Cheap

What are the pros of a blood hCG?

Quantitative, Ectopic evaluation, and Pregnancy viability

When is FSH obtained?

Menopause and Ovarian insufficiency

When is LH obtained?

PMOS (formerly PCOS) evaluation

When is Estradiol obtained?

Assess ovarian function

When is Prolactin obtained?

Amenorrhea workup

When are DHEAS obtained?

Adrenal androgen source

What is Nucleic acid amplification testing (NAAT)?

Detects genetic material from pathogens like chlamydia, gonorrhea, and trichomonas; has largely replaced culture

What is a wet mount?

bedside microscopic evaluation of vaginal discharge with immediate results for BV, Trichomonas, and candida; does not rule out infection

How is HPV tested for?

Molecular testing (DNA/RNA detection) to identify high risk types including HPV 16 and 18

What is the tumor marker for ovarian cancer?

CA-125

What are the tumor markers for germ cell tumors?

AFP and β-hCG

What is the tumor marker for dysgerminoma?

LDH

What is the imaging modality for most gynecologic complains?

Transvaginal Ultrasound for higher resolution and better visualization of uterus and ovaries

What is the imaging modality for large mass/pregnancy?

Transabdominal Ultrasound

What is the imaging modality for torsion?

Doppler

What is the imaging modality for polyps/fibroids?

Sonohysterography (saline infusion ultrasound)

What is the imaging modality for open tubes and feribility?

Hysterosalpingography (HSG)

When is MRI preferred for gynecological complaints?

Adenomyosis, Deep endometriosis, Fibroid mapping, and Pelvic malignancy staging

When is CT preferred for gynecological complaints?

Suspected malignancy spread, Acute abdomen, and Surgical planning

What is a Pap Test?

A screening test that collects cells from the transformation zone of the cervix for cytologic evaluation.

What is the purpose of a pap test?

Detect precancerous cervical changes, screen for cervical dysplasia, and prevent cervical cancer

What are the various results of a Pap Test?

NILM: normal cytology

ASC-US: Mild atypia

LSIL: low-grade dysplasia

HSIL: high-grade dysplasia

AGC: glandular abnormality

When are the recommendations for Pap Test screening?

Begin at age 21 with HPV testing playing an increasing role after age 30

When is colposcopy indicated?

when Pap is abnormal

What is endometrial biopsy indicated?

Age ≥45 with AUB or younger women with obesity, chronic anovulation, and persistent bleeding

When is diagnostic laparoscopy indicated?

Gold standard for Endometriosis; useful for chronic pelvic pain and infertility

What is the systematic approach to abnormal uterine bleeding?

1. Pregnancy test

2. CBC

3. TSH (if indicated)

4. TVUS

5. Endometrial biopsy when indicated

What is the systematic approach to amenorrhea?

1. Pregnancy test

2. TSH

3. Prolactin

4. FSH/LH

5. Imaging as indicated

What is the systematic approach to pelvic pain?

1. Pregnancy test

2 .STI testing

3. CBC

4. TVUS

What is the systematic approach to adnexal mass?

1. TVUS

2. Tumor markers if indicated

3. MRI if uncertain

4. Gynecology referral

What is the female evaluation approach to infertility?

Ovulation assessment, TSH, Prolactin, FSH/LH, and AMH

What is the structural evaluation approach to infertility?

HSG and TVUS