Lab Diagnostics

Question 1

normal vaginal pH

Answer 1

3.8 - 4.5

Question 2

pH paper is placed on the ________________ of the vagina

Answer 2

lateral wall

Question 3

use pH paper with a pH range of

Answer 3

4.0 - 5.0

Question 4

what conditions often have a pH > 4.5

Answer 4

• bacterial vaginosis (> 4.5)
• trichomoniasis (5.0 - 6.0)
• atrophic vaginitis

Question 5

indications for a vaginal wet mount

Answer 5

vaginal

• itching
• burning
• rash
• odor
• discharge changes

Question 6

Interfering factors of a vaginal wet mount

Answer 6

• cannot be done during menses
• should avoid vaginal meds 2-3 days prior to wet mount
• vaginal irritation from tampons or intercourse can alter the results

Question 7

vaginal wet mount technique

Answer 7

use speculum - swab vaginal secretions
place secretions onto slide, use drop of saline, examine under microscope

can also use 1mL of saline in test tube and place swab into test tube - this is used when vaginal secretions are too thick to put onto slide; use saline to dilute secretions before examining under microscope
(with slide cover on top)

Question 8

what can you see on microscopic evaluation of saline wet mount

Answer 8

• white cells
• clue cells
• lactobacilli
• trichomonads

Question 9

WHITE CELLS

Answer 9

should just be a few white cells (WBCs)

should be more squamous epithelial cells present than white cells on sample

Question 10

CLUE CELLS ARE INDICATIVE OF

Answer 10

BACTERIAL VAGINOSIS

Question 11

what are clue cells

Answer 11

clue cells are vaginal epithelial cells covered in bacteria

Question 12

what do clue cells look like

Answer 12

Normal epithelial cells have sharp, distinct borders

Clue cells have shaggy borders and the epithelial cells take on a stippled appearance

Question 13

lactobacilli are

Answer 13

NORMAL!

part of the normal vaginal flora

Question 14

there will be less lactobacilli seen in conditions such as

Answer 14

yeast & bacterial vaginosis

Question 15

TRICHOMONADS

Answer 15

have tails
are mobile - zoom around on the slide

trichomonads are slightly larger than WBCs on slide

Question 16

KOH PREP

Answer 16

A few drops of10% potassium hydroxide solution is added to vaginal secretions on a microscope slide

Heating the slide will hasten the process of destruction of cellular debris but the test may be completed without heating

The potassium hydroxide removes normal cells and bacteria clearing the field so that yeast buds and hyphae may be seen

Question 17

KOH PREP is testing for

Answer 17

yeast (fungal) infection

Question 18

what are you looking for on KOH prep

Answer 18

budding yeast & branching hyphae

Question 19

KOH whiff test

Answer 19

When preparing the KOH slide to evaluate for yeast, note whether or not there is an amine (fishy) odor after the addition of the KOH

The presence of this odor is indicative of bacterial vaginitis
- could be either bacterial vaginosis or trichomoniasis

Question 20

KOH whiff test has same _____________ for bacterial vaginosis & trichomoniasis, but is more _______________________ for ___________

Answer 20

sensitivity

but KOH whiff test is more specific for bacterial vaginosis than trichomoniasis

Question 21

PCR TESTING

Answer 21

NAAT = NUCLEIC ACID AMPLIFICATION TESTING

test for gonorrhea & chlamydia

Question 22

NAAT is testing for ________ & __________

Answer 22

gonorrhea & chlamydia

Question 23

NAAT can use what samples

Answer 23

vaginal, cervical, or urine

but is more sensitive/specific for vaginal & cervical samples; if cannot obtain those, can do urine

Swab of the vaginal fluid or endocervix
If unable to obtain the above can be done on a urine sample

NAATs typically detect 20%–50% more chlamydial infections than could be detected by culture or earlier nonculture tests (identification of the organism on micro)

Question 24

NAAT urine sample

Answer 24

want first-catch instead of clean catch

Specimens should be obtained as directed by the test manufacturer in the package insert and use the swab supplied by the test manufacturer

First-catch urine (e.g., the first 10–30 cc voided after initiating the stream) should be used

Question 25

NAAT urine sample should be read __________ after voiding

Answer 25

> 1 hr