DM 1

Question 1

indications for gnRH

Answer 1

1. differentiate causes of hypogonadism

2. evaluate disorders of puberty

Question 2

indications for FSH

Answer 2

1. diagnose menopause (test of choice)

2. other menstrual irregularities

Question 3

what type of collection is needed for FSH – 24h or single specimen?

Answer 3

24 hour (levels fluctuate during the day)

Question 4

indications for LH

Answer 4

predicts ovulation, evaluate infertility

Question 5

indications for progesterone

Answer 5

monitor ovulation induction, ectopic pregnancy evaluation, eval infertility, monitor placenta in high risk pregnancies

Question 6

indications for estrogen

Answer 6

index of fetal well-being, evaluate sexual maturity/infertility/menopausal status, tumor marker,

Question 7

indications for AMH

Answer 7

predict ovarian response to stimulation, determine ovarian reserve

Question 8

indications for testosterone

Answer 8

evaluate ambiguous sex characteristics, precocious puberty, virilizing disorders

note: free testosterone is follow up for normal total T

Question 9

progesterone withdrawal test indication

Answer 9

evaluate hypothalamic-pituitary-gonadal axis; secondary amenorrhea, etc

Question 10

prolactin indications

Answer 10

investigate amenorrhea, evaluate cause of galactorrhea, monitor pituitary tumors, eval hypo-pituitary disorders

Question 11

hCG indications

Answer 11

pregnancy

also eval ectopic, monitor after abortion, tumor marker

Question 12

which is more sensitive: serum or urine hcG?

Answer 12

serum

Question 13

what population is vaginal cancer suggested for?

Answer 13

s/p hysterectomy w h/o CIN (cervical intraepithelial neoplasia) 2, 3

Question 14

what are low-risk HPV strains associated with?

Answer 14

condylomata genital warts and low-grade cervical changes (mild dysplasia)

Question 15

what are high-risk HPV strains (in terms of #s) and what are they associated w?

Answer 15

6,11,16,18 + more

associated with intraepithelia neoplasia and are more likely to progress to severe lesions and cervical cancer

Question 16

what is the length of HPV DNA screening intervals for pts 30-65?

Answer 16

5 years

Question 17

where do you take the specimen source for PAP

Answer 17

squamocolumnar junction around the cervical os in nulliparous women

Question 18

Bethesda system is used for reporting what?

Answer 18

cervical and vaginal cytologic diagnoses

Question 19

does the colposcopy evaluate the endocervix and ectocervix?

Answer 19

no - not the endocervix

Question 20

what is a contraindication for colposcopy?

Answer 20

menses

Question 21

indications for endocervical curettage

Answer 21

1. suspected glandular lesions
2. unsatisfactory colposcopy
3. normal appearing ectocervix on colposcopy but pap indicates abnormal cytology

Question 22

contraindications for endocervical curettage

Answer 22

1. pregnacy

2. acute cervicitis

Question 23

indications for direct conization

Answer 23

1. colposcopy and endocervical curettage do not explain problem
2. entire transformation zone is not seen
3. lesion extends up in the cervical canal beyond colposcopic visualization

Question 24

indications of colposcopy

Answer 24

1. eval of abnormal pap tests
2. allows for biopsy of suspicious areas
3. f/u of previously treated individuals

Question 25

indications for endometrial biopsy (8)

Answer 25

r/o endometrial cancer when: 1. post-menopausal bleeding 2. AUB ages 45-menopause (intermenstral, frequent, heavy) or <45 if obese, persistent bleeding, etc 3. premenopausal women who are anovulatory with prolonged amenorrhea 4. atypical glandular cells on Pap (also needs colposcopy) 5. benign endometrial cell on pap if woman >40 and AUB 6. surveillance of women w known endometrial hyperplasia 7. eval of abnormal imaging

Question 26

contraindications of endometrial biopsy (3ish)

Answer 26

1. pregnancy 2. pelvic infection (treat 1st) 3. refer: bleeding diathesis, cervical stenosis, cervical cancer

Question 27

MC side effect of endometrial biopsy

Answer 27

cramping

Question 28

do you need abx ppx for endometrial biopsy?

Answer 28

nope

Question 29

indications for D and C (3)

Answer 29

1. irregular or heavy menstrual bleeding 2. post menopausal bleeding (when EB is not adequate) 3. incomplete or induced abortions

Question 30

what STI(s) is NAAT typically used for? what are acceptable specimens?

Answer 30

primarily used for gonorrhea & chlamydia cervical vaginal urine

Question 31

what STIs can you test for using serum?

Answer 31

HIV syphilis herpes hepatitis

Question 32

what STIs are tested for with a vaginal wet prep

Answer 32

trich bv yeast

Question 33

is a wet prep vaginal or cervical?

Answer 33

vaginal

Question 34

testing for vulvovaginal candidiasis? | what will you see?

Answer 34

wet prep + KOH budding yeast, mycelial tangles of yeast pseudohyphae pH is normal (4-4.5)

Question 35

testing for BV? what will you see

Answer 35

wet prep + KOH clue cells (fried egg with pepper appearance) and fishy odor pH typically > 4.5

Question 36

2 main testing options for HSV I & II

Answer 36

1. viral culture | 2. PCR (molecular techniques)

Question 37

when is herpes serology IgG useful? (3)

Answer 37

1. determining whether a pt has been previously exposed to type I and II 2. distinguishing between type I and II 3. determine susceptibility of a sexual partner of a pt w documented HSV infection

Question 38

indications for syphilis testing

Answer 38

1. painless ulcer 2. diffuse, symmetrical, macular or papular rash on trunk and extremities (palms and soles esp) 3. neuro symptoms

Question 39

syphilis serology testing uses what kind of testing?

Answer 39

immunologic Ab tests: 1. nontreponemal (detects Abs to reagin) 2. treponemal (detects Abs against specific treponemal antigens)

Question 40

what's an important thing to remember about the two syphilis serology tests?

Answer 40

must use BOTH (one alone is insufficient for diagnosis)

Question 41

when is gonorrhea culture preferred?

Answer 41

for detection of rectal, oropharyngeal, conjunctival

Question 42

4 methods for HIV testing what is preferred?

Answer 42

1. ABs to the virus 2. viral antigen 3. viral RNA 4. culture 4th generation combination HIV-1/HIV-2 antigen-antibody immunoassay

Question 43

gold standard testing for trichomonas

Answer 43

NAAT