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Clinical Medicine LAB - Professor Sample > GYN 2 > Flashcards

GYN 2 Flashcards

1
Q

Urine pregnancy test evaluates for pregnancy by looking for ?

A

HcG

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2
Q

Urine pregnancy test are _______, rapid and inexpensive, with a positive test threshold __________ ( of HcG in the serum), characterized by a color change.

A

reliable

between 5 and 50 mIU/mL

**not a lot of false positives

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3
Q

✪most common method to confirm pregnancy ?

A

Urine pregnancy test

**MC method is the urine test **

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4
Q

Urinalysis evaluates for ?

A

glucose and protein

** glucose for gestational diabetes
protein for preeclampsia - kidney damage - make sure we are not missing it **

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5
Q

Serum Beta-HCG testing qualitative ?

A

Measures whether the hormone is present

**yes or no

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6
Q

Serum Beta-HCG testing quantitative ?

A

Measures how much is present

infertility, in vito fertilization, twin gestation ( part of trisomy 21 screening exam )

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7
Q

3-4 weeks - average HcG is a big range ?

A

500-10,000

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8
Q

week _ of pregnancy is week of menses,

A

1

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9
Q

between _______ is ovulation and fertilization ( so when you get pregnancy you are already in week three of your pregnancy)

A

11-14 days

** week 4 is when you can finally start testing **

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10
Q

Landmarks for gestational age and beta-HCG by TV sonography: Discriminatory zone - weeks from LMP? Beta HCG ?

A

5-6

1500-200

  • *“discriminatory zone” - you can see something there
  • *
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11
Q

Landmarks for gestational age and beta-HCG by TV sonography: own notes ?

A

these tests are used in conjunction with US to look for ectopic , etc.

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12
Q

Landmarks for gestational age and beta-HCG by TV sonography: yolk sac - weeks from LMP? Beta HCG ?

A

6

2500

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13
Q

Landmarks for gestational age and beta-HCG by TV sonography: Upper discriminatory zone - weeks from LMP? Beta HCG ?

A

6-7

3000

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14
Q

Landmarks for gestational age and beta-HCG by TV sonography: Fetal pole - weeks from LMP? Beta HCG ?

A

7

5000

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15
Q

Landmarks for gestational age and beta-HCG by TV sonography: Fetal heart motion - weeks from LMP? Beta HCG ?

A

8

17,000

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16
Q

quant is 3000 and nothing on the US or in fallopian tubes - get a ?

A

Lap to look for the ectopic

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17
Q

high quant (20,000) and no fetal activity ( still yolk sac) then is will probably be a ?

A

miscarriage

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18
Q

Cervical Preps: Specific to use during pregnancy ?

A

Group B strep
Fern test
Fetal fibronectin

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19
Q

Group B strep:_____ of all pregnant women are colonized

A

10-30%

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20
Q

GBS screening between _______ weeks’ gestation.

A

35 and 37

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21
Q

_ GBS culture at 35–37 weeks, or _ urine culture for GBS anytime during the pregnancy, the patient is treated with abx at the time of ?

A

+

+

admission in labor

  • *to prevent infection in the newborn
  • *
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22
Q

Fern test: Assessment for ?

A

rupture of membranes (ROM) - water breakage

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23
Q

Fern test uses ________ paper or just a glass slide

A

nitrazine

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24
Q

Normal vaginal pH in pregnancy is ?

A

4.5-6.0

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25
Q

Amniotic fluid pH is ?

A

7.0-7.5 ( close to water)

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26
Q

NL pH of urine ?

A

pH of urine - 6-7.5 something ( more acidic then the amniotic fluid)

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27
Q

Fern Test own notes ?

A

this is good to evaluated for fluid secretions etc. or ig you thing there might be ROM

electrolytes and protein in the fluid on a glass slide and dried up will make a ferrying pattern

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28
Q

what is Fetal Fibronectin?

A

May help with implantation of fertilized egg

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29
Q

Fetal Fibronectin NL cannot be identified in vaginal secretions after ?

A

22 weeks gestation

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30
Q

Fetal Fibronectin Concentrations are ____ in amniotic fluid

A

high

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31
Q

Fetal Fibronectin own notes ?

A

this is a protein , glue that holds the amniotic sac to the Uterus

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32
Q

Fetal Fibronectin: when is it used ?

A

Pregnant women whose membranes are intact and cervical dilation is less than 3 cm.

Women who have signs or symptoms of labor

**if we think a women at risk of preterm labor

27 weeks and they start to dilate - run this test - when you get the ungluing of the U then the protein will be elevated\

not a good predictive value , it is a clue not a definitive answer **

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33
Q

Negative Fetal Fibronectin means ?

A

labor is unlikely within the next 2 weeks

**better for sure answer then a positive

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34
Q

Positive Fetal Fibronectin means ?

A

If positive- indeterminate

**heighten suspicion of early labor so maybe make them have bed rest or steroid for fetus lung development

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35
Q

Routine Prenatal Tests: early pregnancy - initial visit ?

A 
Blood type and Rh status
Rh antibody screen
Hemoglobin/ Hgb electrophoresis
Cystic fibrosis screening (not universal)
HIV (offered)
RPR 
Rubella titer
Hepatitis B
Chlamydia/Gonorrhea
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36
Q

Rh antibodies own notes ?

A

during birth some of the Rh + blood goes into the mother blood stream and form maternal ABS and during the second preg the ABS from the mother attack the fetus if it is Rh +

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37
Q

Rh Testing initial material blood type, Rh + ?

A

Done

  • *blood can tolerate a - fetus - your good
  • *
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38
Q

Rh Testing initial material blood type, Rh - ?

A

Needs Rh antibody tests ( to see if they have other ABS circulating)

** but a neg woman will make the ABS **

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39
Q

Rh antibody testing: ICT - Rh- women without Rh Ab should receive _____ at __ wks gestation

A

RhoGam

28

**Rogam at 28 weeks so they dont form ABS during labor and birth **

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40
Q

Rh antibody testing: IDCT - Rh- women with _____ should be followed closely to ensure that the fetus does not develop ______

A

Rh Ab

hemolytic anemia

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41
Q

Direct coombs test: own notes ?

A

testing the baby sample ( baby already has hemolytic anemia and has M ABS attacking RBC and we put it in reagent that has anti-ABS and they cause agglutination)

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42
Q

Indirect coombs test: own notes ?

A

test the maternal sample (maternal blood has ABS circulating, we take Rh+ RBC and mix it with her blood and the ABS will stick, it is then mixed with anti-ABS - agglutination)

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43
Q

H&H: Women with anemia should receive __ supplementation and repeat testing after ?

A

Fe

6 weeks

**cause iron deficit anemia is common during pregnancy **

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44
Q

H&H: Consider_______ with women at high risk of genetic hemoglobinopathy

A

Hgb electrophoresis

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45
Q

CF screening ?

A

Option for screening available

Genetic test looking for 23 of the most common CF gene mutations

46
Q

HIV testing ?

A

Offered at initial visit

Pt has to consent

Repeat at 36 weeks for women at high risk

Women with no prenatal care; rapid HIV while in labor

47
Q

HIV testing repeat at __ weeks for women at high risk

A

36

48
Q

HIV testing: ______ of women can pass HIV to fetus during pregnant, delivery, or breastfeeding

A

25-30%

49
Q

Syphilis: initial screening exam ?

A

RPR

Prevention of congenital syphilis

50
Q

Syphilis: repeat at _____ weeks if high risk

A

26-28

51
Q

Syphilis teeth sign ?

A

hutchinson sign

52
Q

Rubella Antibody Titer: Dx of Fetal Infxn ?

A

CVS

US for CRS

53
Q

Rubella Antibody Titer: Dx of Maternal infxn ?

A

+ IgM
4-fold rise in IgG
Done 7-10 days after rash onset

54
Q

Hepatitis B ?

A

Prevention of neonatal Hepatitis B infection

Infants born to carriers should get HBIg and vaccination within 12 hours of birth

55
Q

Gonorrhea/Chlamydia ?

A

Done at initial visit and then repeated at 36 weeks for women at high risk

56
Q

Glucose Screening ?

A

OGTT (24-28 weeks gestation)

late screening

57
Q

Urinalysis ?

A

every visit

late screening

58
Q

Group B strep

?

A

35-37 weeks gestation

late screening

59
Q

First Trimester screening tests ?

A

Nuchal Translucency
Β-hCG
AFP (α-fetoprotein)
Pregnancy associated plasma protein A (PAPP-A)

60
Q

1st trimester screening: Nuchal translucency is measured between ____ weeks gestation ?

A

11-14

**nuchal fold behind the neck and it is measure ( 11-14 weeks gestation) - done on routine US **

61
Q

Nuchal translucency increased ?

A

fetal aneuploidy 13, 18, 21, heart defects

62
Q

1st trimester screening: Alpha-fetoprotein: Glycoprotein synthesized by the ________ and then by the _________.

A

fetal yolk sac

fetal GI tract and liver

63
Q

AFP: Increases steadily in fetal serum and amniotic fluid until _______ gestation and then rapidly _______.

A

13 weeks

declines

64
Q

AFP: Conversely, _______ after 13 weeks gestation in maternal serum

A

increases

65
Q

AFP: Found in higher levels in maternal serum and amniotic fluid with ____.

A

NTD

** spina bifida, lymphfallocele, trsimoy 18,21**

**25/50 come back abnormal - a lot of false negatives

woman can opt in or out of this screening **

66
Q

PAPP-A is a product of the ?

A

placenta and endometrium and how health and able they are to support a pregnancy

67
Q

PAPP-A: Women with low levels have increased risk of ?

A

Stillborn birth

Trisomy 21

Intrauterine growth
restriction

Premature delivery

Fetal death in utero

68
Q

Second trimester screening ?

A

maternal serum quad screen

69
Q

Maternal serum quad screen involves ?

A

Serum β-hCG - increased with downs markedly

Unconjugated estriol - idea of placental health or any fetal distress, takes a devastating placental abnormality or stress so if it found it is usually a devastating diagnosis

AFP

Inhibin - secreted by O and inhibits FSH and it is 2x as high in Trisomy-21 (T21)

70
Q

Maternal serum quad screen:

Detection rates ?

A

Trisomy 21,18,13 (65-75%)

Open neural tube defects (80-85%)

71
Q

Inhibin secreted by ?

A

ovaries and inhibits FSH

72
Q

Inhibin originated in the ?

A

Placenta

73
Q

Inhibin is 2x as high in ?

A

Trisomy 21

74
Q

Inhibin is higher in women with ?

A

spontaneous abortions

75
Q

Amniocentesis what is it ?

A

Placing a needle through the abdominal wall into the amniotic cavity to withdraw fluid for analysis

  • *area not through the placenta!
  • *
76
Q

When is Amniocentesis used to gather information ?

A

fetal maturity, fetal distress, and risk for respiratory distress ( tell how mature the lungs are)

Genetic and chromosomal abnormalities

Maternal-fetal Rh incompatibility

Gender (sex-linked genetic disorders), Turners, etc.

Neural tube defects

After abnormal obstetric US

**usually done if parent have a genetic abnormality or if past child has had genetic problem - no part of poutine testing **

77
Q

Amniocentesis: Fetal Maturity Status - Lecithin and sphingomyelin (L/S ratio) ?

A

surfactant (required for alveolar ventilation)

Immature lungs sphingomyelin ↑

78
Q

At __ weeks gestation

Sphingomyelin ↓ and Lecithin ↑

A

35

later in preg S goes down and L goes up

79
Q

✪An L/S ratio of ___ indicates a mature fetal lung

A

2:1

higher ratio so more L and S means the lungs are more mature

80
Q

Amniocentesis: Fluorescence polarization ?

A

TDx fluorescence polarimeter

81
Q

Fluorescence polarization: Fluorescent ________ ________ is added to the fluid and then tested ?

A

phospholipid analogue

82
Q

Fluorescence polarization:Measures ________________ ratio

A

surfactant: albumin

83
Q

Fluorescence polarization: Polarization values↓ = Maturity of the lungs _ (more surfactant there)

A

↑

  • *meconium in the fluid - this test is less affected by that
  • *
84
Q

Minor component of surfactant

?

A

Phosphatidylglycerol (PG)

85
Q

Phosphatidylglycerol (PG):

is synthesized almost entirely by ?

A

mature lung alveolar cells

**also less affected by blood or meconium

indicates a more mature type of surfactant than the other two **

86
Q

Lamellar Body Count is produced by ?

A

type II pneuomcytes

87
Q

Lamellar Body Count:

_______ & ________ are indistinguishable from one another to cell counters

A

Lamellar bodies and platelets

88
Q

Lamellar Body Count: __________ has a 100% negative predictive value

A

> 30,000

  • *they willl not have RDS when they are born
  • *
89
Q

Lamellar Body Count: _______ has a 67% of RDS

A

<10,000

90
Q

Lamellar Body Count: own notes ?

A

represents storage of surfactant

higher the number the more mature neumocytes they have

91
Q

Microviscosity is a measurement of ?

A

lipid aggregates

92
Q

Microviscosity is it still used?

A

No

93
Q

Microviscosity: ____ during early pregnancy and _____ as lungs mature in late pregnancy

A

High

lowers

94
Q

Microviscosity depends on the ___ ratio ?

A

L:S

95
Q

PG and Lamellar Body Count is unaffected by _____ or ________ contamination

A

blood

meconium

96
Q

Amniocentesis contraindications ?

A

Abruptio placentae

Placenta Previa

Hx of premature labor
more relative not absolute
Contraindication

Incompetent cervix

97
Q

Amniocentesis potential complications ?

A

Fetal injury

Miscarriage

Leakage of amniotic fluid

Infection

Premature labor

Inadvertent damage to the bladder or intestines

98
Q

What is Chorionic Villus Sampling ?

A

Sample of chorionic villi are taken from the frondosum (origin of the placenta)

Present from 8-12 weeks and on.

Allow much earlier detection of abnormalities

** done early on to get alot of good information so the parent can make decisions ( maybe abort if they have genetic problem) **

99
Q

When is CVS used ?

A

Women older than 35

Have had frequent SA

Previous chromosomal abnormalities

Have genetic defect personally

100
Q

CVS potential complications ?

A

Accidental abortion

Infection

Bleeding

Amniotic fluid leakage

Fetal limb deformities

101
Q

Imaging in Obstetrics - Evaluates the________ and _____ the fetus

A

anatomy and well-being of

102
Q

Imaging in Obstetrics - Makes determinations about the ?

A

well-being or risks to the mother

103
Q

early on in pregnancy and during no pregnancy then do a ?

A

TVUS

104
Q

US: 1st trimester indications ?

A

Confirm IUP
-intraUterine pregnancy

Evaluate pelvic pain

Vaginal bleeding

Confirm gestational age
-measure quant with US

Uterine abnormalities

Genetic anomalies

Multiple gestation

105
Q

Transvaginal US: Measure cardiac activity when the fetal pole measures ?

A

4-5 mm (about 6.5 wks gestation)

106
Q

What can you see with US at the chest ?

A

4-chamber view of the heart

outflow tracts of the heart if feasible

107
Q

What can you see with US at the abdomen ?

A

stomach

kidneys

bladder

umbilical cord insertion (fetal abdomen)

umbilical cord vessel number

108
Q

What can you see with US at the spine ?

A

cervical, thoracic, lumber, and sacral

109
Q

What can you see with US at the head, face, and neck ?

A

cerebellum

chord plexus

cisterna magna

lateral cerebral ventricles

medicine falx

cave septum pellucidi

upper lip

nuchal fold

110
Q

US 2nd trimester evaluates for ?

A

anatomy ~ 14-18 weeks

**8-9 weeks = first US to confirm IUP and cardiac activity , dont look at the fetus in great detail **

111
Q

US 2nd trimester: down syndrome ?

A

Cardiac abnormalities

Duodenal atresia

Short femur or humerus length

112
Q

US fetal growth ?

A

Lack of growth associated with fetal demise

Macrosomia (large baby) is associated with shoulder dystocia, hemorrhage, and probability of cesarean delivery

**later on they try and measure how big the fetus is to see if it will fit throught the pelvis for birth **

Clinical Medicine LAB - Professor Sample (36 decks)

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