Repro Investigations Flashcards
What investigations would you do for dysfunctional uterine bleeding?
FBC Cervical smear TSH Coag screen Renal/liver function tests TVUS Endometrial sampling (pipelle, hysteroscopic, dilatation and curettage)
What is used to assess ovarian reserve?
Antral follicle count or anti-mullerian hormone
What swab to take for candida culture and do you need to do it?
High vaginal swab
No often clinical
Gram stain appearance of gonnorheoa
Gram negative intracellular diplococci
Swab taken for gonococcal microscopy
Urethral/endocervical
Swabs taken for gonococcal culture
Endocervical
Rectal
Throat
Samples needed for nucleic acid amplification tests (standard test for gonococcus)
Urine specimen
Vulvovaginal swab
Gram stain appearance of chlamydia
Doesn’t gram stain
Intracellular organism
What is the test for both chlamydia and gonorrhea?
Combined NAAT or PCR
Wet mount microscopy findings for bacterial vaginosis
Absence of bacilli
Replacement with coccobacilli
Vaginal epithelial cells have edges obscured by bacteria (clue cells)
Few leukocytes
Syphilis (treponema pallidum) gram stain appearance
Trick question
Doesn’t gram stain
Non-specific serological tests for syphilis and purpose of them
VDRL (venereal diseases research laboratory)
RPR (rapid plasma reagin)
Monitor response to therapy
Primary syphilis diagnostic tests
Dark ground microscopy
PCR
IgM serology (not until chancre for 2 weeks)
Investigation done after home medical abortion and why?
Low-sensitivity urinary pregnancy test 2 weeks after
To identify incomplete or failed procedure
Should we test a woman with vaginal discharge >25 for chlamydia?
No, more likely to be candida or BV
Do test if had chlamydia in past year.
How long after exposure will chlamydia be testable?
14 days
Investigation for mycoplasma genitalium
NAAT test
If someone is symptomatic with gonorrhoea, what test do you do?
Microscopy (low sensitivity)
Culture if microscopy positive
What is the target of the 3rd generation HIV tests and how long does it take after infection to show up in tests?
HIV antibody
20-25 days
What is the target of 4th generation HIV tests and how long does it take after infection to show up in tests?
Combined antibody and antigen (p24)
Variable (14-28 days)
In reality do a 4th generation test 4 weeks after exposure
What genital infections do not need partner notification?
Warts
Herpes
Vaginal thrush
BV
At which scan would downs syndrome be screened for?
Booking scan (1st one)
If an ultrasound scan between 18-20 weeks shows placenta extending over the cervix, what should you do?
Offer another abdo scan at 32 weeks
If this is unclear, do vaginal scan
What components make up the first trimester downs syndrome risk assessment in pregnancy?
Nuchal thickness
Mother’s serum hCG and PAPP-A
Maternal age
Gestation
What components make up the second trimester downs syndrome risk assessment in pregnancy?
Mother’s serum hCG, AFP, unconjugated oestradiol (UE3), inhibin A
Maternal age
Gestation
What risk of downs syndrome from initial screening test is the cut off for amniocentesis?
> 1:250 risk.
What is the test for gestational diabetes?
2 hour oral glucose tolerance test (OGTT)
When would you do histology in miscarriage?
If repeated miscarriage
Serum beta hCG findings in ectopic pregnancy
In normal pregnancy doubles every 48 hours
In ectopic pregnancy it increases less than tha
Complete mole ultrasound appearance
Snowstorm appearance
Polyhydramnios USS criteria
Amniotic fluid index >25cm
OR
Deepest pool >8cm
Polyhydramnios investigations
OGTT
Serology (toxoplasmosis, CMV, parvovirus)
Antibody screen
USS (foetal survey, lips, stomach)
Dichorionic twin US sign
Lambda sign
Monochorionic twin US sign
T sign
At what gestation will an US scan confirm multiple pregnancy?
12 weeks gestation
SIGN and NICE OGTT diagnostic values for gestational diabetes.
SIGN: fasting 5.1 or over, 2 hour 8.5 or over
NICE: fasting 5.6 or over, 2 hour 7.8 or over
When should an OGTT be done to test for gestational diabetes?
1st trimester
24-28 weeks
When should you screen for type 2 diabetes after gestational diabetes and what test is this?
6-8 weeks post-natally
Fasting blood glucose
What is the cut off for low birth weight?
2.5kg
Symmetrical growth restriction causes
Chromosomal abnormality
In-utero infection
Asymmetrical growth restriction causes
Placental reasons (baby is diverting blood to brain)
How many major/minor risk factors for SGA require US monitoring and what is this monitoring?
1 major risk factor or abnormal uterine artery doppler - serial growth scans
3 minor risk factors - scan at 34 weeks
What factors are used to calculate estimated foetal weight?
Abdominal circumference
Head circumference
Femur length
Is a V/Q or a CTPA recommended in PE in pregnancy?
V/Q scan (less radiation to maternal breast)
What score is used to determine with IOL is safe?
Bishop’s score
What are the normal number of contractions in 10 minutes in labour?
3-4
Where is data about mother and foetus recorded in labour?
On a partogram
What is a normal foetal blood pH on sampling?
> 7.25
What is a borderline foetal blood pH on sampling and what should you do?
7.20-7.25
Repeat in 30 mins
What is an abnormal foetal blood pH on sampling and what should you do?
<7.2
Deliver
Hypertension in pregnancy diagnostic criteria
140/90 2 times
160/110 once
What is the cut off date for early and late pre-eclampsia, and which is worse?
Before 34 weeks - early
34 weeks and later - late
Early is worse as associated with more severe disease
Pre-eclampsia investigations
FBC U&Es LFTs Serum urate Coag screen Urine protein:creatinine ratio (PCR) Cardiotocography Ultrasound of foetus
What does the Kleihauer test measure?
Measures amount of foetal haemoglobin transferred from foetus to mother
Investigations to diagnose placental abruption.
Trick question!
It’s a clinical diagnosis
Investigations for placenta praevia
Check anomaly scan
Confirm by TVUS
Do an MRI to exclude placenta accreta
Investigations for vasa praevia
TA and TV ultrasound with doppler
Cut-offs for minor and major post-parum haemorrhage
Minor: 500-1000mls
Major:>1000mls or signs of cardiovascular shock or ongoing bleeding
Amniotic fluid embolism investigation
Zinc coprophyrin levels (will be increased, not always available)
Why may pre-natal testing of down’s syndrome give a false positive?
The placenta may have abnormal chromosomes but the foetus might not.
What conditions can non-invasive prenatal testing pick up?
Any whole chromosome trisomy
What are the two types of DNA testing done in pregnancy?
PCR
Occasionally southern blotting (takes longer)
What is a first degree prolapse?
The lowest part of the prolapse descends halfway down the vaginal axis into the introitus
What is a second degree prolapse?
The lowest part of the prolapse extends to the level of the introitus (exits introitus on straining)
What is a third degree prolapse?
The lowest part of the prolapse extends through the introitus and outside the vagina
What is a fourth degree uterine prolapse/procidentia?
Uterus lies outside the vagina
Why do you need to do bimanual examination when examining prolapse?
To exclude pelvic masses
Does menopause usually need to have laboratory tests to diagnose?
No
When should you think about laboratory tests for menopause and what is this test?
Women age 40-45 with menopausal symptoms (inc change in menstrual cycle)
Women under 40 where menopause suspected
FSH levels
How far apart should you do FSH tests?
6 weeks (single raised level does not confirm diagnosis)
What are the 3 parts of the risk of malignancy index (RMI) for ovarian cancer?
Menopausal status
Ultrasound features
Serum Ca125
What are the points for menopausal status in the RMI?
Premenopausal = 1 Postmenopausal = 3
What are the ultrasound features in the RMI which can score points?
Multiloculated Solid areas Bilaterality Ascites Mets
How are points scored for the ultrasound features in the RMI?
No features = o
One feature = 1
>1 feature = 3
What value of the Ca125 do you put into the RMI equation?
The absolute level
What is the equation for calculating the RMI?
Menopausal status score X Ultrasound feature score X Serum Ca125
What are CT and MRI scans used for in ovarian cancer investigation?
CT to look for all organs
MRI for finer details of the mass
What conditions other than ovarian cancer can cause a raised CA125?
Endometriosis Peritonitis/infection Pregnancy Pancreatitis Ascites from any cause Other malignancy
What is better out of FNA or core biopsy for breast pathology?
Core biopsy
Can tell if it is invasive
What 3 prognostic calculators exist for breast cancer?
Nottingham prognostic index
Adjuvant! online
NHS PREDICT
What things does NHS PREDICT take into account?
Histopathology ER Clinical factors HER2 Mode of detection
DCIS mammography findings
Malignant calcifications (pleomorphic and of the casting type)
