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Gyn Labs 2

Gynecology

QuestionAnswer
Prolactin level: to dx: pituitary adenoma, amenorrhea, galactorrhea, hypothalamic pituitary disorders
PCOS: lab values LH, testosterone, prolactin high; progesterone, estrogen low. Also check FSH (to r/o premature ovarian failure), DHEA, TSH, lipids, A1c
Wet prep swab cotton swab; rotate over vaginal wall/inflammation; avoid cervical mucus/blood; in 1 mL saline; to lab within 20 min
Cervical testing no bathe 24 hrs; unlubricated speculum; remove cerv mucus w/cotton swab; sterile swab into canal 15-30 sec; plate or media
Gono cx plates TM, choc, or Jembec (CO2 reservoir); swab in Z pattern & cross streak; 36C (don’t refrigerate)
Gram stain for Gyn specimen urethra: Ca alginate 1-2 cm x 3-5 sec (females more shallow); cervical: cotton swab, usu not done (gold std for clue cells)
Oropharyngeal NG cx swab posterior pharynx & tonsillar crypts; include areas of inflammation or exudate
Urethral NG cx Collect ≥1 hr post urination; ideal: prior to first morning micturition; swab anterior urethra
HSV cx vesicle: unroof lesion (18 ga needle), abrade w/cotton swab; crusted: remove crust w/moist gauze, scrape w/cotton swab; transport medium, refrigerate if delay
HSV serology less sensitive; helpful if IgM or high IgG
4-fold rise in HSV titer = acute initial HSV infxn
Darkfield for syphilis pos = dx; not definitive if neg
Syphilis: nontreponemal tests RPR more sensitive than VDRL; VDRL pos 2 wks after inoculation, pos thru secondary and often in tertiary
All syphilis tests 100% sensitive in stage: secondary
Syphilis: treponemal test FTA; more specific, pos 4-6 wks post inoculation; FTA-Abs (sandwich): more sensitive = definitive test; MHA-TP
NG tests gram stain, cx (specify suspicion), NAAT (DNA by PCR)
Chancroid tests cx (specify suspicion), DNA PCR, no serology
Chlamydia tests NAAT (DNA by PCR); cx & sero outdated
LGV test complement fixation
GN bipolar rods encapsulated in mononuclear lymphs = Granuloma inguinale (donovan bodies)
Women <21 yo w/ASCUS or LSIL repeat pap in 12 mos
Women <21 yo w/ HSIL colposcopy +/- cytology
Adult women w/ASCUS (Atypical squamous cells of undetermined significance) repeat cyto (6 & 12 mos), HPV DNA, and colposcopy
Adult women w/ASCUS-H colposcopy; if neg: cyto (6 & 12 mos), HPV DNA q 12 mos
Adult women w/ LSIL (low-grade cervical intraepithelial neoplasia) Colpo, then endomet bx; if no CIN: cyto (6&12) & HPV DNA (12 mos)
Adult women w/ HSIL (high grade cervical intraepithelial neoplasia) immediate excision OR colpo, then observe or dx excision
Adult women w/ AGC (atypical glandular cells) endomet/endocerv bx, then colpo
indications for endometrial ca testing AUB >35-40 yo; AGC on Pap (also needs Colposcopy); Benign Endometrial Cells on pap if woman post menopausal
endomet bx advantages in office; minimal dilation; anesthesia not req; prophylactic Abx not req; low cost
amenorrhea labs HCG, FSH, estrogen, prolactin, testost; progesterone challenge to detn if suff estrogen
FSH of ___ is diagnostic of menopause >30 mIU/mL
Dysfunctional uterine bleeding labs CBC, Fe, coags, HCG, TFT, LFT, progesterone, prolactin, FSH
Dysfunctional uterine bleeding studies US, pap, endometrial bx
endometrial ca dx studies pap, endocervical curettage, endomet bx (90-95% accuracy); TVUS?
string of pearls within ovaries on US = PCOS
ovarian ca dx 5% BRCA1; CA-125; P53 tumor suppressor gene mutation; TVUS
Next test when colpo results unsat or endocervical curettage shows severe dz: conization
Infertility testing Semen analysis. Confirm ovulation. Luteal phase endometrial bx. FSH, prolactin, TSH. Serum progesterone at secretory phase midpoint (day 21). Hysterosalpingogram.
PID testing DNA probe for GC/CT; TVUS; poss dx culdocentesis
Chlamydia labs complement fixation or immunofluorescence; ELISA; or DNA probe
Tests for trichomonas OSOM rapid test. Affirm VP III (nucleic acid probe test). Both 83% sens, 97% spec.
Male vs female contributions to infertility Male in 40% of cases. Female: anovulatory cycles, congenital / acquired fallopian/cervical/uterine problems. 60% of couples PG within 3 years
Cervical cancer dx studies Pap. Colposcopy & bx for staging. Conization if colposcopy nondiagnostic. MRI, CT, pelvic lymphangiography to demonstrate pelvic involvement. Advanced dz: cystoscopy, sigmoidoscopy. CXR to r/o mets
LH:FSH ratio of 3:1 suggests: PCOS
Created by: Abarnard