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