DM 1 Flashcards
indications for gnRH
- differentiate causes of hypogonadism
2. evaluate disorders of puberty
indications for FSH
- diagnose menopause (test of choice)
2. other menstrual irregularities
what type of collection is needed for FSH – 24h or single specimen?
24 hour (levels fluctuate during the day)
indications for LH
predicts ovulation, evaluate infertility
indications for progesterone
monitor ovulation induction, ectopic pregnancy evaluation, eval infertility, monitor placenta in high risk pregnancies
indications for estrogen
index of fetal well-being, evaluate sexual maturity/infertility/menopausal status, tumor marker,
indications for AMH
predict ovarian response to stimulation, determine ovarian reserve
indications for testosterone
evaluate ambiguous sex characteristics, precocious puberty, virilizing disorders
note: free testosterone is follow up for normal total T
progesterone withdrawal test indication
evaluate hypothalamic-pituitary-gonadal axis; secondary amenorrhea, etc
prolactin indications
investigate amenorrhea, evaluate cause of galactorrhea, monitor pituitary tumors, eval hypo-pituitary disorders
hCG indications
pregnancy
also eval ectopic, monitor after abortion, tumor marker
which is more sensitive: serum or urine hcG?
serum
what population is vaginal cancer suggested for?
s/p hysterectomy w h/o CIN (cervical intraepithelial neoplasia) 2, 3
what are low-risk HPV strains associated with?
condylomata genital warts and low-grade cervical changes (mild dysplasia)
what are high-risk HPV strains (in terms of #s) and what are they associated w?
6,11,16,18 + more
associated with intraepithelia neoplasia and are more likely to progress to severe lesions and cervical cancer
what is the length of HPV DNA screening intervals for pts 30-65?
5 years
where do you take the specimen source for PAP
squamocolumnar junction around the cervical os in nulliparous women
Bethesda system is used for reporting what?
cervical and vaginal cytologic diagnoses
does the colposcopy evaluate the endocervix and ectocervix?
no - not the endocervix
what is a contraindication for colposcopy?
menses
indications for endocervical curettage
- suspected glandular lesions
- unsatisfactory colposcopy
- normal appearing ectocervix on colposcopy but pap indicates abnormal cytology
contraindications for endocervical curettage
- pregnacy
2. acute cervicitis
indications for direct conization
- colposcopy and endocervical curettage do not explain problem
- entire transformation zone is not seen
- lesion extends up in the cervical canal beyond colposcopic visualization
indications of colposcopy
- eval of abnormal pap tests
- allows for biopsy of suspicious areas
- f/u of previously treated individuals
indications for endometrial biopsy (8)
r/o endometrial cancer when:
- post-menopausal bleeding
- AUB ages 45-menopause (intermenstral, frequent, heavy) or <45 if obese, persistent bleeding, etc
- premenopausal women who are anovulatory with prolonged amenorrhea
- atypical glandular cells on Pap (also needs colposcopy)
- benign endometrial cell on pap if woman >40 and AUB
- surveillance of women w known endometrial hyperplasia
- eval of abnormal imaging
contraindications of endometrial biopsy (3ish)
- pregnancy
- pelvic infection (treat 1st)
- refer: bleeding diathesis, cervical stenosis, cervical cancer
MC side effect of endometrial biopsy
cramping
do you need abx ppx for endometrial biopsy?
nope
indications for D and C (3)
- irregular or heavy menstrual bleeding
- post menopausal bleeding (when EB is not adequate)
- incomplete or induced abortions
what STI(s) is NAAT typically used for?
what are acceptable specimens?
primarily used for gonorrhea & chlamydia
cervical
vaginal
urine
what STIs can you test for using serum?
HIV
syphilis
herpes
hepatitis
what STIs are tested for with a vaginal wet prep
trich
bv
yeast
is a wet prep vaginal or cervical?
vaginal
testing for vulvovaginal candidiasis?
what will you see?
wet prep + KOH
budding yeast, mycelial tangles of yeast pseudohyphae
pH is normal (4-4.5)
testing for BV? what will you see
wet prep + KOH
clue cells (fried egg with pepper appearance) and fishy odor
pH typically > 4.5
2 main testing options for HSV I & II
- viral culture
2. PCR (molecular techniques)
when is herpes serology IgG useful? (3)
- determining whether a pt has been previously exposed to type I and II
- distinguishing between type I and II
- determine susceptibility of a sexual partner of a pt w documented HSV infection
indications for syphilis testing
- painless ulcer
- diffuse, symmetrical, macular or papular rash on trunk and extremities (palms and soles esp)
- neuro symptoms
syphilis serology testing uses what kind of testing?
immunologic Ab tests:
- nontreponemal (detects Abs to reagin)
- treponemal (detects Abs against specific treponemal antigens)
what’s an important thing to remember about the two syphilis serology tests?
must use BOTH (one alone is insufficient for diagnosis)
when is gonorrhea culture preferred?
for detection of rectal, oropharyngeal, conjunctival
4 methods for HIV testing
what is preferred?
- ABs to the virus
- viral antigen
- viral RNA
- culture
4th generation combination HIV-1/HIV-2 antigen-antibody immunoassay
gold standard testing for trichomonas
NAAT
