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Block 4 - OBGYN > Clin Lab: Reproductive Disorders & Cancers > Flashcards

Clin Lab: Reproductive Disorders & Cancers Flashcards

1
Q

Site of infection

A
  • breast
  • vulva
  • vagina
  • uterine
  • intraabdominal
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2
Q

What are other symptoms of an intraabdominal infx?

A
  • pain
  • N/V
  • fever
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3
Q

Can be an infection of the…

A

outer tissue or abscess formation

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4
Q

Lab workup for reproductive system infx? (7)

A
  • CBC
  • BMP/CMP
  • ESR/CRP
  • Lactic acid (sepsis)
  • UA/urine culture
  • Vaginal wet mount
  • Blood cultures
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5
Q

Symptoms of PCOS

A
  • Hirsutism
  • Menstrual irregularity,
  • Acne
  • Central obesity (metabolic synd)
  • infertility

(male-pattern hair loss & alopecia)

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6
Q

Imaging for reproductive system infx?

A

US or CT

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7
Q

What must be ruled out in PCOS? (think oral)

A

medications
- steroid & anti-epileptics

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8
Q

PCOS: Rotterdam Criteria

A

2 of 3 criteria met
- Oligo/anovulation
- Clinical or biochemical evidence of hyperandrogenism
- Polycystic ovaries on US

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9
Q

Can PCOS be a clinical Dx?

A

YES

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10
Q

How do you prove ovulation?

A

LH levels

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11
Q

What other hyperandrogenism causes must be ruled out before a dx of PCOS?

A
  • thyroid dz
  • hyperprolactinemia
  • non-classical congenital adrenal hyperplasia
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12
Q

When should you do an initial workup for PCOS?

A

If pt has menstrual irregularity more than 2 years after menarche

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13
Q

What meds are confounding factors for PCOS?

A

Meds
- metformin
- OCPs
- spironolactone

Stop 4-6 wks before workup

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14
Q

What labs should you test initially if someone presents with possible PCOS? (6)

A
  • CBC
  • CMP
  • TSH
  • Prolactin
  • HCG
  • FSH
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15
Q

If testosterone is elevated, what should be done next?

A

screen for causes of hyperandrogenemia
- congential adrenal hyperplasia (17-hydroxyprogesterone 0- will be high)
- Adrenal carcinoma (DHEAS - will be high)
- Hyperprolactinemia - prolactin
- Cushing syndrome - cortisol
- Elevated growth hormone - IGF-1

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16
Q

PCOS workup includes:

A
  1. Total or free testosterone
  2. Transvaginal US
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17
Q

In PCOS, when should total or free testosterone be measured?

A
  • between 8-10 AM
  • days 4-10 of menstrual cycle (before ovulation)
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18
Q

Is a transvaginal US necessary to dx PCOS?

A

Not if other 2 dx criteria are met
- can help confirm dx

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19
Q

What are concerning features of breast cancer?

A
  • irregular borders
  • microcalcifications
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20
Q

Evidence of PCOS via transvaginal US?

A

12 or more cysts measuring 2-9mm in 1 ovary or incr ovarian volume

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21
Q

Does incidental finding of polycystic ovaries need a workup?

A

NO, if there are no signs/symptoms of PCOS

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22
Q

Additional testing after dx of PCOS include:

A
  • BMI, waist circumference
    –> Incr risk of metabolic synd
  • BP
  • Lipid panel
  • Oral glucose tolerance test
  • Screening for sleep apnea
  • Screening for depression
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23
Q

What are the 3 breast positioning for mammograms?

A
  • Craniocaudal (CC)
  • Mediolateral (ML)
  • Mediolateral oblique (MLO)
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24
Q

How many views are usually gotten with mammograms?

A

TWO

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25
Q

Screening guidelines for breast CA:

A
  • Age 40-49: depends on risk/benefit for each pt
  • Age 50-74: every 1-2yrs
  • 75+: depends on health / well-being of pt
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26
Q

Screening for breast CA includes:

A
  1. Mammogram
  2. Genetic testing
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27
Q

What is another type of mammogram what gives us better visualization of breast tissue?

A

breast tomosynthesis

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28
Q

What views are usually obtain for a mammogram?

A
  • craniocaudal + mediolateral
  • craniocaudal + mediolateral oblique
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29
Q

Describe a breast tomosynthesis test

A

Rotates the x-ray beam across several angles, more images
- Gives more 3D image w/o incr radiation exposure

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30
Q

What genes are assoc. w/ increased risk of breast CA?

A
  • BRCA 1/ BRCA 2
  • ATM
  • CDH1
  • CHEK2
  • PALB2
  • PTEN
  • TP53
  • STK11
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31
Q

Who gets tested for breast CA? (7)

A
  • Breast CA at an earlier age (<60yo)
  • Two or more different primary breast CAs
  • Invasive ovarian CA
  • Males w/ breast CA
  • Metastatic prostate CA
  • Ashkenazi Jew
  • 1st degree relative w/ above gene(s)
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32
Q

If area of concern detected on screening mammogram, what testing is next?

A

a dx mammogram, +/- US FU, then biopsy

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33
Q

BRCA 1/BRCA 2 genes increase risk for which cancers

A

ovarian CA > breast CA

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34
Q

What 3 things should be done as an evaluation of a breast mass?

A
  1. Imaging
  2. Biopsy
  3. Receptor expression
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35
Q

Breast Mass Evaluation Imaging:

A
  • Breast US (<30yo)
  • Bilateral dx mammogram (>30 + mass)
  • MRI
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36
Q

What are possible receptors that can be found on the surface of the breast mass?

A
  • estrogen receptor (ER)
  • Progesterone receptor (PR)
  • Human Epidermal Growth Factor receptor (HER2)
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37
Q

Describe ER (+) markers?

A

prognostic marker & predictive of who would benefit from adjuvant endocrine therapy

38
Q

What is a medication used to treat ER (+) breast CA?

A

tamoxifen

39
Q

Describe HER2 (+) marker

A
  • PROTEIN on surface of some breast CAs
  • Higher levels – cells respond better to HER2 directed medications
40
Q

What combination of markers has a better prognosis & response to tx?

A

ER+/PR+/HER2+

41
Q

What combination of markers has a worse prognosis & response to tx?

A

ER-/PR-/HER2-

42
Q

What are the two forms of cervical cancer?

A
  • squamous cell carcinoma
  • adenocarcinoma
43
Q

What are something that can prevent/help the dx of cervical cancer?

A
  • early detection/tx
  • Gardasil vax
44
Q

What are the pre-cancerous changes called in possible cervical cancer?

A

cervical intraepithelial neoplasia (CIN)

45
Q

Cervical cancer is usually due to what type of infx?

A

HPV infx

46
Q

What are the 3 grades of CIN?

A
  • CIN 1
  • CIN 2
  • CIN 3
47
Q

Describe CIN 1

A
  • abnl changes limited to < 1/3 total thickness of epithelial tissue
    –> low risk of developing into CA – nonprogressive HPV strain & gets cleared by body
48
Q

Describe CIN 2

A

abnl changes b/t 1/3 to 2/3 thickness

49
Q

Describe CIN 3

A

abnormal changes > 2/3 thickness
–> Highest risk of developing into CA

50
Q

What has happened that signified that cervical cancer is present?

A

invasion of basement membrane
–> progressed from epidermis into dermis

51
Q

Why are screening test done for cervical CA?

A

determine risk for CIN 3

52
Q

What do test can be done to screen for cervical cancer?

A
  • pap smear
  • HPV testing
53
Q

Describe a pap smear

A
  • Brush & swab samples obtained from outside & inside of cervix
  • Smears examined under a microscope – epithelial & glandular cells are graded for level of dysplasia
54
Q

Describe HPV testing

A

IDs presence of HPV strains assoc w/ cervical cancer

55
Q

What are the USPSTF screening guidelines for cervical cancer?

A

< 21 yrs – no screening
21-29 yrs – Pap smear every 3 yrs
30-65 yrs – 3 possibilities
–> Pap smear every 3 yrs
–> HPV testing every 5 yrs
–> Pap smear + HPV testing every 5 yrs
> 65 yrs – no screening if no abnormal screening in last 10 yrs

56
Q

What are the ACS screening guidelines for cervical cancer?

A
  • HPV testing preferred over Pap smear
    –> HPV test every 5 yrs b/t 25-65yo
57
Q

What does a typical pap smear report include?

A
  • Specimen type
  • Description of specimen adequacy
  • Interpretation of results
58
Q

Interpretation of results for a pap smear could include…

A
  • Negative for intraepithelial lesion or malignancy
    OR
  • A description of epithelial cell abnormality
    –> Squamous cell abnormalities and/or glandular cell abnormalities
59
Q

Squamous cells abnormalities are reported as:

A
  • Atypical squamous cells (ASC)
    –> Unknown significance (ASC-US)
    –> Cannot exclude lesion (ASC-H)
  • Low-grade squamous intraepithelial lesion (LSIL)
  • High-grade squamous intraepithelial lesion (HSIL)*
  • Squamous cell carcinoma in situ
60
Q

Describe an atypical squamous cells (ASC) report on Pap smear.

A

doesn’t look right, but not cancerous

61
Q

Describe an unknown significance (ASC-US) report on Pap smear.

A

little change, probably fine

62
Q

Describe a cannot exclude lesion (ASC-H) report on Pap smear.

A

might become cancerous, close watch

63
Q

Describe an low-grade squamous intraepithelial lesion (LSIL) report on Pap smear.

A

CIN 1 or early CIN 2

64
Q

Describe a high-grade squamous intraepithelial lesion (HSIL) report on Pap smear.

A
  • High CIN 2 or CIN 3
    –> more likely to go on & become CA
65
Q

Describe a squamous cells carcinoma in situ report on Pap smear.

A

THIS IS CANCER!

66
Q

What is glandular cell abnormalities reported on a pap smear?

A
  • Atypical – weird
  • Atypical, favor neoplastic – weird probably CA
  • Endocervical adenocarcinoma in situ - cancer
67
Q

Describe the make up of HPV?

A

double-stranded DNA virus

68
Q

Types of HPV testing

A
  • DNA analysis (PCR/NAAT)
  • RNA analysis
  • PRO detection
69
Q

What two PROs can be tested for in HPV?

A
  • P16
  • Ki-67
70
Q

If HPV is detected, what is done next?

A

genotyping to ID if it’s a high risk stain

71
Q

What is used to calculate risk of CIN 3+ to guide further follow up?

A
  • results of current or prior abnl pap smear
    AND/OR
  • HPV testing
72
Q

What are the 6 different risk cervical CA recommendations possible?

A

Expedited tx (excisional) (risk > 60%)
Either expedited tx or colposcopy (risk 25-59%)
Colposcopy w/ biopsy (risk 4-24%)

Surveillance (repeat testing) at 1yr (risk 0.5-3.9%)
Surveillance at 3yrs (risk 0.15-0.5%)
Surveillance at 5yrs (risk < 0.15%)

73
Q

Expedited treatment (excisional) risk % for cervical CA?

A

> 60%

74
Q

Either expedited tx or colposcopy risk % for cervical CA?

A

25 - 59%

75
Q

Colposcopy with biopsy risk % for cervical CA?

A

4 - 24%

76
Q

Surveillance (repeat testing) at 1 year risk % for cervical CA?

A

0.5 - 3.9%

77
Q

Surveillance at 3 yrs risk % for cervical CA?

A

0.15 - 0.5%

78
Q

Surveillance at 5 yrs % for cervical CA?

A

< 0.15%

79
Q

Describe how a colposcopy is done?

A

Acetic acid (vinegar) used to highlight abnl cells then…
Removal (excisional) vs biopsy (pinch)

80
Q

Are there any screening test for ovarian cancer?

A

NO

81
Q

What does the workup include for ovarian cancer?

A
  • Imaging
  • Markers
  • Surgical Evaluation
82
Q

What type of imaging can be done for ovarian cancer?

A

transabdominal or transvaginal US

83
Q

What are the markers for ovarian cancer?

A

CA-125

84
Q

What do we use the biomarker CA-125 for?

A

to evaluate tx effectiveness & screen for recurrence of ovarian CA

85
Q

Are there any screening test for uterine cancer?

A

NO

86
Q

Are there any biomarkers for uterine cancer?

A

NO

87
Q

How do you dx uterine cancer?

A

endometrial biopsy

88
Q

NOTE

A

Any postmenopausal women w/ spotting is concerning/high risk for endometrial CA

89
Q

How do you dx menopause?

A

Clinical dx
–> can do labs to support dx

90
Q

What hormones can be tested to confirm dx of menopause?

A

FSH & estradiol levels

91
Q

Describe lab levels of FSH and estradiol in a pt w/ menopause?

A

High FSH & low estradiol

92
Q

What is the FSH diagnostic level for menopause?

A

> 25

(or 12 consecutive months of no periods)

Block 4 - OBGYN (5 decks)

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