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Year 3 Revision > Repro Investigations > Flashcards

Repro Investigations Flashcards

1
Q

What investigations would you do for dysfunctional uterine bleeding?

A 
FBC
Cervical smear
TSH
Coag screen
Renal/liver function tests
TVUS
Endometrial sampling (pipelle, hysteroscopic, dilatation and curettage)
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2
Q

What is used to assess ovarian reserve?

A

Antral follicle count or anti-mullerian hormone

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3
Q

What swab to take for candida culture and do you need to do it?

A

High vaginal swab

No often clinical

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4
Q

Gram stain appearance of gonnorheoa

A

Gram negative intracellular diplococci

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5
Q

Swab taken for gonococcal microscopy

A

Urethral/endocervical

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6
Q

Swabs taken for gonococcal culture

A

Endocervical
Rectal
Throat

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7
Q

Samples needed for nucleic acid amplification tests (standard test for gonococcus)

A

Urine specimen

Vulvovaginal swab

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8
Q

Gram stain appearance of chlamydia

A

Doesn’t gram stain

Intracellular organism

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9
Q

What is the test for both chlamydia and gonorrhea?

A

Combined NAAT or PCR

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10
Q

Wet mount microscopy findings for bacterial vaginosis

A

Absence of bacilli
Replacement with coccobacilli
Vaginal epithelial cells have edges obscured by bacteria (clue cells)
Few leukocytes

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11
Q

Syphilis (treponema pallidum) gram stain appearance

A

Trick question

Doesn’t gram stain

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12
Q

Non-specific serological tests for syphilis and purpose of them

A

VDRL (venereal diseases research laboratory)
RPR (rapid plasma reagin)

Monitor response to therapy

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13
Q

Primary syphilis diagnostic tests

A

Dark ground microscopy
PCR
IgM serology (not until chancre for 2 weeks)

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14
Q

Investigation done after home medical abortion and why?

A

Low-sensitivity urinary pregnancy test 2 weeks after

To identify incomplete or failed procedure

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15
Q

Should we test a woman with vaginal discharge >25 for chlamydia?

A

No, more likely to be candida or BV

Do test if had chlamydia in past year.

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16
Q

How long after exposure will chlamydia be testable?

A

14 days

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17
Q

Investigation for mycoplasma genitalium

A

NAAT test

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18
Q

If someone is symptomatic with gonorrhoea, what test do you do?

A

Microscopy (low sensitivity)

Culture if microscopy positive

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19
Q

What is the target of the 3rd generation HIV tests and how long does it take after infection to show up in tests?

A

HIV antibody

20-25 days

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20
Q

What is the target of 4th generation HIV tests and how long does it take after infection to show up in tests?

A

Combined antibody and antigen (p24)
Variable (14-28 days)

In reality do a 4th generation test 4 weeks after exposure

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21
Q

What genital infections do not need partner notification?

A

Warts
Herpes
Vaginal thrush
BV

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22
Q

At which scan would downs syndrome be screened for?

A

Booking scan (1st one)

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23
Q

If an ultrasound scan between 18-20 weeks shows placenta extending over the cervix, what should you do?

A

Offer another abdo scan at 32 weeks

If this is unclear, do vaginal scan

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24
Q

What components make up the first trimester downs syndrome risk assessment in pregnancy?

A

Nuchal thickness
Mother’s serum hCG and PAPP-A
Maternal age
Gestation

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25
Q

What components make up the second trimester downs syndrome risk assessment in pregnancy?

A

Mother’s serum hCG, AFP, unconjugated oestradiol (UE3), inhibin A
Maternal age
Gestation

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26
Q

What risk of downs syndrome from initial screening test is the cut off for amniocentesis?

A

> 1:250 risk.

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27
Q

What is the test for gestational diabetes?

A

2 hour oral glucose tolerance test (OGTT)

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28
Q

When would you do histology in miscarriage?

A

If repeated miscarriage

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29
Q

Serum beta hCG findings in ectopic pregnancy

A

In normal pregnancy doubles every 48 hours

In ectopic pregnancy it increases less than tha

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30
Q

Complete mole ultrasound appearance

A

Snowstorm appearance

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31
Q

Polyhydramnios USS criteria

A

Amniotic fluid index >25cm
OR
Deepest pool >8cm

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32
Q

Polyhydramnios investigations

A

OGTT
Serology (toxoplasmosis, CMV, parvovirus)
Antibody screen
USS (foetal survey, lips, stomach)

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33
Q

Dichorionic twin US sign

A

Lambda sign

34
Q

Monochorionic twin US sign

A

T sign

35
Q

At what gestation will an US scan confirm multiple pregnancy?

A

12 weeks gestation

36
Q

SIGN and NICE OGTT diagnostic values for gestational diabetes.

A

SIGN: fasting 5.1 or over, 2 hour 8.5 or over
NICE: fasting 5.6 or over, 2 hour 7.8 or over

37
Q

When should an OGTT be done to test for gestational diabetes?

A

1st trimester

24-28 weeks

38
Q

When should you screen for type 2 diabetes after gestational diabetes and what test is this?

A

6-8 weeks post-natally

Fasting blood glucose

39
Q

What is the cut off for low birth weight?

A

2.5kg

40
Q

Symmetrical growth restriction causes

A

Chromosomal abnormality

In-utero infection

41
Q

Asymmetrical growth restriction causes

A

Placental reasons (baby is diverting blood to brain)

42
Q

How many major/minor risk factors for SGA require US monitoring and what is this monitoring?

A

1 major risk factor or abnormal uterine artery doppler - serial growth scans
3 minor risk factors - scan at 34 weeks

43
Q

What factors are used to calculate estimated foetal weight?

A

Abdominal circumference
Head circumference
Femur length

44
Q

Is a V/Q or a CTPA recommended in PE in pregnancy?

A

V/Q scan (less radiation to maternal breast)

45
Q

What score is used to determine with IOL is safe?

A

Bishop’s score

46
Q

What are the normal number of contractions in 10 minutes in labour?

A

3-4

47
Q

Where is data about mother and foetus recorded in labour?

A

On a partogram

48
Q

What is a normal foetal blood pH on sampling?

A

> 7.25

49
Q

What is a borderline foetal blood pH on sampling and what should you do?

A

7.20-7.25

Repeat in 30 mins

50
Q

What is an abnormal foetal blood pH on sampling and what should you do?

A

<7.2

Deliver

51
Q

Hypertension in pregnancy diagnostic criteria

A

140/90 2 times

160/110 once

52
Q

What is the cut off date for early and late pre-eclampsia, and which is worse?

A

Before 34 weeks - early
34 weeks and later - late

Early is worse as associated with more severe disease

53
Q

Pre-eclampsia investigations

A 
FBC
U&amp;Es
LFTs
Serum urate
Coag screen
Urine protein:creatinine ratio (PCR)
Cardiotocography
Ultrasound of foetus
54
Q

What does the Kleihauer test measure?

A

Measures amount of foetal haemoglobin transferred from foetus to mother

55
Q

Investigations to diagnose placental abruption.

A

Trick question!

It’s a clinical diagnosis

56
Q

Investigations for placenta praevia

A

Check anomaly scan
Confirm by TVUS
Do an MRI to exclude placenta accreta

57
Q

Investigations for vasa praevia

A

TA and TV ultrasound with doppler

58
Q

Cut-offs for minor and major post-parum haemorrhage

A

Minor: 500-1000mls
Major:>1000mls or signs of cardiovascular shock or ongoing bleeding

59
Q

Amniotic fluid embolism investigation

A

Zinc coprophyrin levels (will be increased, not always available)

60
Q

Why may pre-natal testing of down’s syndrome give a false positive?

A

The placenta may have abnormal chromosomes but the foetus might not.

61
Q

What conditions can non-invasive prenatal testing pick up?

A

Any whole chromosome trisomy

62
Q

What are the two types of DNA testing done in pregnancy?

A

PCR

Occasionally southern blotting (takes longer)

63
Q

What is a first degree prolapse?

A

The lowest part of the prolapse descends halfway down the vaginal axis into the introitus

64
Q

What is a second degree prolapse?

A

The lowest part of the prolapse extends to the level of the introitus (exits introitus on straining)

65
Q

What is a third degree prolapse?

A

The lowest part of the prolapse extends through the introitus and outside the vagina

66
Q

What is a fourth degree uterine prolapse/procidentia?

A

Uterus lies outside the vagina

67
Q

Why do you need to do bimanual examination when examining prolapse?

A

To exclude pelvic masses

68
Q

Does menopause usually need to have laboratory tests to diagnose?

A

No

69
Q

When should you think about laboratory tests for menopause and what is this test?

A

Women age 40-45 with menopausal symptoms (inc change in menstrual cycle)
Women under 40 where menopause suspected

FSH levels

70
Q

How far apart should you do FSH tests?

A

6 weeks (single raised level does not confirm diagnosis)

71
Q

What are the 3 parts of the risk of malignancy index (RMI) for ovarian cancer?

A

Menopausal status
Ultrasound features
Serum Ca125

72
Q

What are the points for menopausal status in the RMI?

A 
Premenopausal = 1
Postmenopausal = 3
73
Q

What are the ultrasound features in the RMI which can score points?

A 
Multiloculated
Solid areas
Bilaterality
Ascites
Mets
74
Q

How are points scored for the ultrasound features in the RMI?

A

No features = o
One feature = 1
>1 feature = 3

75
Q

What value of the Ca125 do you put into the RMI equation?

A

The absolute level

76
Q

What is the equation for calculating the RMI?

A 
Menopausal status score
X
Ultrasound feature score
X
Serum Ca125
77
Q

What are CT and MRI scans used for in ovarian cancer investigation?

A

CT to look for all organs

MRI for finer details of the mass

78
Q

What conditions other than ovarian cancer can cause a raised CA125?

A 
Endometriosis
Peritonitis/infection
Pregnancy
Pancreatitis
Ascites from any cause
Other malignancy
79
Q

What is better out of FNA or core biopsy for breast pathology?

A

Core biopsy

Can tell if it is invasive

80
Q

What 3 prognostic calculators exist for breast cancer?

A

Nottingham prognostic index
Adjuvant! online
NHS PREDICT

81
Q

What things does NHS PREDICT take into account?

A 
Histopathology 
ER
Clinical factors
HER2
Mode of detection
82
Q

DCIS mammography findings

A

Malignant calcifications (pleomorphic and of the casting type)

Year 3 Revision (70 decks)

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