M5: Vaginal Secretions (Part 2: Diagnostic Tests) Flashcards
(90 cards)
1
Q
What are the 3 diagnostic tests for vaginal fluid?
A
- pH test
- Wet mount preparation
- Amine whiff test
2
Q
What are the other (4) diagnostic tests mentioned?
A
- Gram stain
- Culture
- DNA Testing
- POCT
3
Q
3 diagnostic tests for vaginal fluid
- Uses litmus paper
A
pH test
4
Q
DIAGNOSTIC TEST
Factors that can interfere with pH test
a. cervical mucus
b. semen
c. blood
d. lactic acid
e. lactobacilli
f. a and e
g. a, b, d
h. a, b, c
i. ALL
j. NONE
A
h. a, b, c
lactic acid from glycogen metabolism
lactobacilli is part of normal flora
5
Q
If you see this card
A
twerk ka muna, eme please see the pH test procedure
6
Q
MICROSCOPIC PROCEDURES
How many glass slides are used?
if gram stain is requested
A
3 clean glass slides
7
Q
T or F
the three clean glass slides should be labelled with patient’s age and unique ID
A
F (should be labelled with patient’s name and unique IDentifier)
8
Q
For wet mount examinations, cells and organisms are observed under what objective?
A
quantified per high power field (hpf) (40×)
9
Q
for Gram stains, cells and organisms are observed under what objective?
A
reported per oil immersion field (100×)
10
Q
Microscopic examination of vaginal secretion are reported like?
A
urinary sediment
11
Q
T or F
One matter of reporting of microscope sediments found under vaginal secretion
A
T
12
Q
3 diagnostic tests for vaginal fluid
- Observed under LPO and HPO
- Uses NSS and Vaginal fluid
A
Wet mount examination
13
Q
WET MOUNT EXAMINATION
Typical constituents in vaginal fluid wet mounts
A
- squamous epithelial cells
- RBCs
- Clue cells
- parabasal cells
- basal cells
- bacteria
- yeast
- WBCs
- Clue cells
- basal cells
- motile T. vaginalis
- hyphae/pseudohyphae
14
Q
iF YOU SEE THIS CARD PATINGIN NALANG NG PROCEDURE SA WET MOUNT LAMAT
A
ok
15
Q
WET MOUNT EXAMINATION
How many drops of vaginal fluid specimen should be placed on slide?
A
1 drop
16
Q
WET MOUNT EXAMINATION
epithelial cells and any budding yeast cells or pseudohyphae shiuld be exmained under what objective
A
10 x (LPO)
17
Q
WET MOUNT EXAMINATION
quantifying organisms and cells should be observed under what objective
A
40 x (HPO)
18
Q
QUANTITATION SCHEME FOR MICROSCOPIC EXAMINATION
Determine result based of number of organisms:
Fewer than 10 organisms or cells/slide
A
RARE
19
Q
QUANTITATION SCHEME FOR MICROSCOPIC EXAMINATION
Determine result based of number of organisms:
Fewer than 1 organisms or cells/hpf
A
1+
20
Q
QUANTITATION SCHEME FOR MICROSCOPIC EXAMINATION
Determine result based of number of organisms:
1-5 organisms or cells/hpf
A
2+
21
Q
QUANTITATION SCHEME FOR MICROSCOPIC EXAMINATION
Determine result based of number of organisms:
6-30 organisms or cells/hpf
A
3+
22
Q
QUANTITATION SCHEME FOR MICROSCOPIC EXAMINATION
Determine result based of number of organisms:
> 30 organisms or cells/hpf
A
4+
23
Q
ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
- originate from the linings of the vagina and female urethra
- present in significant numbers in the vaginal secretions of a healthy female
A
Squamous EC
24
Q
ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
- abnormal variation of the squamous epithelial
- coccobacillus bacteria attached in clusters on the cell surface
- Bacterial Vaginitis (BV) caused by
G. vaginalis
A
Clue cells
25
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
These bacteria are attached in clusters on the cell surface
| Clue cells
Coccobacillus bacteria
26
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
T or F
In clue cells, bacteria should cover at least
85% of the epithelial cell
| Clue cells
F (atleast **75%** of EC)
27
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Clue cells are indications of bacterial vaginitis (BV) caused by?
| Clue cells
G. vaginalis
28
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
For WBCs be reported as abnormal what should the report be?
| clue: no.
3+ WBC
29
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
- vaginal candidiasis
- atrophic vaginitis
- infections with
Trichomonas
- Chlamydia
- N. gonorrhoeae,
- Herpes Simplex Vurus
(HSV)
WBC
30
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
menstruation or due to a desquamative inflammatory process
RBC
31
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
This substance is used to lyse RBC and differentiate it from WBC, bacteria, and yeast
KOH (Potassium Hydroxide)
32
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
* * marked basophilic granulation or amorphic basophilic structures (“blue blobs”) in the surrounding cytoplasm
* immature SEC
* Inc in Desquamative inflammatory vaginitis (DIV)
Parabasal cells
33
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
* located deep in the basal layer of the vaginal stratified epithelium
* Inc in Desquamative inflammatory vaginitis (DIV)
Basal cells
34
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
* vary with the age and hormonal status
* Hydrogen peroxide, produced by lactobacilli subgroups, also can help to suppress the overgrowth of other organisms
Bacteria
35
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
This substance produced by lactobacilli subgroups helps supress overgrowth of other organism
| Bacteria
H2O2
| Hydrogen peroxide
36
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
* The “jerky” motion of the flagella and undulating membrane characteristic is observed in wet mount
* Stored at room temperature
* Preserves up to 2 hours
Trichomonas vaginalis
37
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Trichomonas vaginalis should be stored at what temp?
room temp
38
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Trichomonas vaginalis can be preserved up to how many hours?
2 hours
39
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
Determine organism
* Candida albicans and non Candida spp. cause most fungal infections
* Occational organisms of these is considered part of the normal flora
Yeast cells
40
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
T or F
occasional yeast in vaginal secretions is considered part of the normal flora
T
41
# ORGANISMS FOUND IN VAGINAL FLUID WET MOUNTS
These (2) species cause most fungal infections
| Yeast cell
Candida albicans and non-Candida spp
42
IF YOU SEE THIS CARD, HINGA KA MUNA AND LOOK AT KOH PREPARATION SA TRANS
GAURRRRR
43
# KOH Preparation
Concentration of KOH used?
10% KOH
44
# KOH Preparation
(1) How many drops of vaginal fluid and 10% KOH should be used?
one drop both
45
# KOH Preparation
(2) After KOH preparation in slide, slide should be rest up to?
5 minutes
46
# KOH Preparation
For overall assessment and for yeast pseudohyphae, what objective is used?
10x objective (LPO)
47
# KOH Preparation
For examining for budding yeast
cells (smaller blastopore blastospore), what objective is used?
40x objective (HPO)
48
# KOH Preparation
Yeast or RBC?
If the round spots in the slide are still visible after addition of KOH
Yeast
49
# KOH Preparation
Yeast or RBC?
If the round spots in the slide are no longer visible after addition of KOH
RBCs
50
THE LACTOBACILLI ARE OFTEN REPLACED BY INCREASED NUMBERS OF ANY OF THE FOLLOWING SPECIES?
* Mobiluncus spp. (thin, curved, gram-negative, motile rods)
* Porphyromonas spp.
* Gardnerella vaginalis (short, gram-variable coccobacilli)
* Enterococcus spp. (gram-negative cocci)
* Ureaplasma urealyticum
* Prevotella spp.
* Bacteroides spp. (anaerobic gram-negative rods)
* Peptostreptococcus spp. (gram-positive cocci)
* Mycoplasma hominis
51
# 3 diagnostic tests for vaginal fluid
* The odor results from trimethylamine, a volatilization product of amines, when the KOH is added
* Detects increase in G. vaginalis in conjunction with Mobiluncus spp. and with T. vaginalis
Amine whiff test
52
# Amine whiff test
After KOH is added in vaginal fluid this causes volatilization product of amines called?
| Amine whiff test
trimethylamine
53
# Amine whiff test
Positive test for Amine whiff test indicates what condition?
Bacterial Vaginitis
## Footnote
increased G. vaginalis. mobiluncus spp, T. vaginalis
54
# Amine whiff test
IF YOU SEE THIS CARD TWERK MUNA, SEE THE PROCEDURE FOR AMINE WHIFF TEST PLEASEEE
PLEASE UWU
55
# Amine whiff test
How many drop of specimen and 10% KOH?
1 also
56
# Amine whiff test
T or F
One should vigorously wave their hand above the surface of slide to smell for any fishy amine odor
F (**GENTLY FAN** only)
57
# Amine whiff test
Positive or Negative result for amine whiff test?
The presence of a fishy odor after adding KOH
Positive
58
# Amine whiff test
Positive or Negative result for amine whiff test?
The absence of a fishy odor after adding KOH
Negative
59
# (4) Other diagnostic test
* Has more specified reporting
* gold standard in identifying the causative organisms for BV
Gram stain
60
Normal, Intermediate, Abnormal
Nugent score of 0 to 3 is considered?
| Gram staining
Normal
61
Normal, Intermediate, Abnormal
Nugent score of 4 to 6
Intermediate
62
Normal, Intermediate, Abnormal
Nugent score of >7
Abnormal (BV)
63
IF YOU SEE THIS CARD, PASEE NALANG NG NG BACTERIAS DETECTED AND CORRESPONDING AMOUNTS
thanks <3
64
PER FIELD RESULT ESTIMATION:
1/ field
| Gram stain
1+
65
PER FIELD RESULT ESTIMATION:
1-5/ field
| Gram stain
2+
66
PER FIELD RESULT ESTIMATION:
6-30/field
| Gram stain
3+
67
PER FIELD RESULT ESTIMATION:
30/ field
| Gram stain
4+
68
# (4) Other diagnostic test
* Diamond medium is required for determining the presence of T. vaginalis
* InPouch TV, Biomed Diagnostics, White City, OR
Culture
69
is required for determining the presence of T. vaginalis
| Culture
Diamond medium
70
InPouch TV, Biomed Diagnostics, White City, OR
a. 30 minutes of collection
b. incubated for 4 days in 37 c in CO2 atmosphere
c. both
d. NOTA
a. 30 minutes of collection
## Footnote
b. incubated for 4 days in 37 c in CO2 atmosphere - for **5 days** in 37 c in CO2 atmosphere
71
# (4) Other diagnostic test
* DNA probe testing system, Affirm VPIII (Becton, Dickinson, Franklin Lakes, NJ), is available for differential diagnosis of G. vaginalis, Candida spp., and T. vaginalis
* Results within 1 hr; 95% sensitivity
DNA Testing
72
DNA Testing results are within? what is its sensitivity?
results of DNA test are within 1 hour, sesitivity is 95%
73
# (4) Other diagnostic test
* Proline aminopeptidase activity in vaginal secretions can be detected by rapid antigen tests to identify G. vaginalis
* OSOM Trichomonas Rapid Test immunochromatographic strip test
* OSOM BVBLUE test
* Measure an elevated vaginal pH and the presence of amines
Point-of-care test (POCT)
74
# POINT-OF-CARE TEST (POCT)
This is in vaginal secretions can be detected by rapid antigen tests to identify G. vaginalis
Proline aminopeptidase activity
75
# POINT-OF-CARE TEST (POCT)
What are the (2) examples of POCT
* OSOM Trichomonas Rapid Test immunochromatographic
* OSOM BVBLUE test
76
# POINT-OF-CARE TEST (POCT)
strip test for T. vaginalis Ag (10 mins)
| (2) examples of POCT
OSOM Trichomonas Rapid Test immunochromatographic
| g vaginalis is also positive
77
# POINT-OF-CARE TEST (POCT)
detects vaginal fluid sialidase, an enzyme
produced by the bacterial pathogens associated with BV, such as Gardnerella, Bacteroides, Prevotella, and Mobiluncus (1 min.
OSOM BVBLUE test
78
# POINT-OF-CARE TEST (POCT)
OSOM Trichomonas Rapid Test immunochromatographic or OSOM BVBLUE test
T. vaginalis Ag , G. vaginalis
OSOM Trichomonas Rapid Test immunochromatographic
79
# POINT-OF-CARE TEST (POCT)
OSOM Trichomonas Rapid Test immunochromatographic or OSOM BVBLUE test
10 mins
OSOM Trichomonas Rapid Test immunochromatographic
80
# POINT-OF-CARE TEST (POCT)
OSOM Trichomonas Rapid Test immunochromatographic or OSOM BVBLUE test
1 min
OSOM BVBLUE test
81
# POINT-OF-CARE TEST (POCT)
OSOM Trichomonas Rapid Test immunochromatographic or OSOM BVBLUE test
Gardnerella, Bacteroides, Prevotella, and Mobiluncus
OSOM BVBLUE test
82
# POINT-OF-CARE TEST (POCT)
OSOM BVBLUE test
positive
negative
| what are the results
OSOM BVBLUE test
positive: blue/green
negative: yellow
83
# POCT KITS
PAMG-1 or IGFBP-1
- More in amniotic fluid> vaginal fluid
- Determine whether it is vaginal or amnioitc
- Premature rupture
(amniotic sac)
- 1,000 - 10,000 higher in
amniotic fluid
PAMG-1
84
If you see this card, look at the poct procedure
thx
85
# POCT PROCEDURE
Area in vagina where swab should be made contact
lower one-third of the vaginal wall
86
T or F
After specimen collection, it should be put in tube vessel and mix vigorously
F (**gently swirl** in tube vessel)
87
Let the BV test vessel containing the swab stand for how many minutes?
10 minutes
| between 17 and 37°C
88
After letting swab stand, one should add how many drops of developer solution?
1 drop of developer
89
POCT Positive or Negative?
A blue or green color in the BV test vessel or on the head of the swab
Positive
90
POCT Positive or Negative?
A yellow color in the BV test vessel
Negative
