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Gyn Labs 1


If find mass on CBE: Order a diagnostic mammogram (not screening), unless age <30, then order U/S
fibroadenoma Dx FNA; Cyto study of bloody fluid or solid tumor aspirate; U/S to differentiate solid from cystic mass; excisional bx
Age <30 yo, palpable lump, still there after menses, order: unilateral breast U/S
Age > 30yo, palpable lump, order: unilateral dx mammogram & U/S;
Palpable lump, age >40 yo & due for screening mammo: get mammogram on unaffected side at same time
BI-RADS category 0-4: Needs additional imaging evaluation
BI-RADS category 4: Suspicious abnormality
BI-RADS category 6: biopsy-proven malignancy
Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is: less than 15%
Primary diagnosis of syphilis Darkfield microscopy of chancre
Diagnosis of neurosyphilis CSF examination recommended in symptomatic, late-latent, HIV co-infection (lumbar puncture)
VDRL becomes positive __ after inoculation with syphilis About 2 weeks
Gram stain with a “school of fish” appearance is probably what Chancroid (Haemophilus ducreyi)
Best source of HSV for testing Unroofing the vesicle
Gold standard for HSV testing Culture
__% of US have positive herpes Abs on serological testing 50
Most appropriate way to test for herpes Culture (not serological)
Primary test of menopause: FSH
GnRH Low: hypothalamic hypogonadism, dopamine, opiates
GnRH high: primary hypopituitary hypogonadism, epinephrine
GnRH testing: avoid: steroids, ACTH, gonadotropin or estrogen medications for ≥48hrs
FSH low: secondary gonadal failure, stress, malnutrition/anorexia, severe illness, hyperprolactinemia, PG
FSH high: primary gonadal failure, castration, alcoholism
LH low = pit or hypothalamic failure, severe stress, anorexia, malnutrition, severe illness, PG, hemochromatosis, sickle cell anemia, hyperprolactinemia
LH high = gonadal failure, precocious puberty, pituitary adenoma, menopause, PCOS
LH: Best time to obtain single specimen between 11am and 3pm
Progesterone low = preeclampsia, threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction, PCOS
Progesterone High = ovulation, PG, hyperadrenocorticalism, adrenocortical hyperplasia, luteal cysts, molar pregnancy, choriocarcinoma
FSH assays done to dx: menopause, menstrual irregularities, gonadal failure, predicting ovulation, evaluating infertility, pituitary disorders
Estrogen: high = precocious puberty, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis, liver necrosis, hyperthyroidism
Estrogen: Low = failing PG, Turner syndrome, hypopituitarism, hypogonadism, Stein-Leventhal syndrome, menopause, anorexia, PCOS
Max testosterone values when: around 7am and 8pm
testosterone high = ovarian tumors, adrenal tumor, congenital adrenocortical hyperplasia, trophoblastic tumor, PCOS, idiopathic hirsutism, drugs
testosterone low = primary/ secondary ovarian failure, drugs
Progesterone w/drawal test evaluates: H-P-gonadal axis
Progesterone withdrawal test: in normal cycle, progesterone surge: inhibits FSH/LH and leads to withdrawal bleeding
Progesterone withdrawal test: probs causing failure of bleeding: Estrogen production inadequate; Hypothalamic dysfunction; Uterus abnormal
Prolactin high = pit adenoma, 2d amenorrhea, galactorrhea, hypothyroid, hypoglycemia, PCOS, anorexia, paraneoplastic syndromes, dz of hypothalamus /pituitary stalk, renal fail, drugs lowering dopamine, high estrogen
Prolactin low = Sheehan syndrome, pituitary destruction by tumor
Prolactin levels should be collected: 3-4hrs after waking
Ovarian cancer workup US (if pos: CXR for mets). CA-125. HCG. Ex-lap. CT or MRI prn. Colonoscopy. Mammogram if breast mass.
Ovarian failure / amenorrhea: associated hormones elevated FSH / LH
Created by: Abarnard