Repro Investigations Flashcards by William MacDonald

What investigations would you do for dysfunctional uterine bleeding?

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

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What is used to assess ovarian reserve?

Antral follicle count or anti-mullerian hormone

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

High vaginal swab

No often clinical

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Gram stain appearance of gonnorheoa

Gram negative intracellular diplococci

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Swab taken for gonococcal microscopy

Urethral/endocervical

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Swabs taken for gonococcal culture

Endocervical
Rectal
Throat

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

Urine specimen

Vulvovaginal swab

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Gram stain appearance of chlamydia

Doesn’t gram stain

Intracellular organism

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What is the test for both chlamydia and gonorrhea?

Combined NAAT or PCR

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Wet mount microscopy findings for bacterial vaginosis

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

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Syphilis (treponema pallidum) gram stain appearance

Trick question

Doesn’t gram stain

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Non-specific serological tests for syphilis and purpose of them

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

Monitor response to therapy

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Primary syphilis diagnostic tests

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

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Investigation done after home medical abortion and why?

Low-sensitivity urinary pregnancy test 2 weeks after

To identify incomplete or failed procedure

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

No, more likely to be candida or BV

Do test if had chlamydia in past year.

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How long after exposure will chlamydia be testable?

14 days

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Investigation for mycoplasma genitalium

NAAT test

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

Microscopy (low sensitivity)

Culture if microscopy positive

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

HIV antibody

20-25 days

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

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

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

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What genital infections do not need partner notification?

Warts
Herpes
Vaginal thrush
BV

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At which scan would downs syndrome be screened for?

Booking scan (1st one)

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

Offer another abdo scan at 32 weeks

If this is unclear, do vaginal scan

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

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

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

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

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

>1:250 risk.

What is the test for gestational diabetes?

2 hour oral glucose tolerance test (OGTT)

When would you do histology in miscarriage?

If repeated miscarriage

Serum beta hCG findings in ectopic pregnancy

In normal pregnancy doubles every 48 hours | In ectopic pregnancy it increases less than tha

Complete mole ultrasound appearance

Snowstorm appearance

Polyhydramnios USS criteria

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

Polyhydramnios investigations

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

Dichorionic twin US sign

Lambda sign

Monochorionic twin US sign

T sign

At what gestation will an US scan confirm multiple pregnancy?

12 weeks gestation

SIGN and NICE OGTT diagnostic values for gestational diabetes.

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

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

1st trimester | 24-28 weeks

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

6-8 weeks post-natally | Fasting blood glucose

What is the cut off for low birth weight?

2.5kg

Symmetrical growth restriction causes

Chromosomal abnormality | In-utero infection

Asymmetrical growth restriction causes

Placental reasons (baby is diverting blood to brain)

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

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

What factors are used to calculate estimated foetal weight?

Abdominal circumference Head circumference Femur length

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

V/Q scan (less radiation to maternal breast)

What score is used to determine with IOL is safe?

Bishop's score

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

3-4

Where is data about mother and foetus recorded in labour?

On a partogram

What is a normal foetal blood pH on sampling?

>7.25

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

7.20-7.25 | Repeat in 30 mins

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

<7.2 | Deliver

Hypertension in pregnancy diagnostic criteria

140/90 2 times | 160/110 once

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

Before 34 weeks - early 34 weeks and later - late Early is worse as associated with more severe disease

Pre-eclampsia investigations

``` FBC U&Es LFTs Serum urate Coag screen Urine protein:creatinine ratio (PCR) Cardiotocography Ultrasound of foetus ```

What does the Kleihauer test measure?

Measures amount of foetal haemoglobin transferred from foetus to mother

Investigations to diagnose placental abruption.

Trick question! | It's a clinical diagnosis

Investigations for placenta praevia

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

Investigations for vasa praevia

TA and TV ultrasound with doppler

Cut-offs for minor and major post-parum haemorrhage

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

Amniotic fluid embolism investigation

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

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

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

What conditions can non-invasive prenatal testing pick up?

Any whole chromosome trisomy

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

PCR | Occasionally southern blotting (takes longer)

What is a first degree prolapse?

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

What is a second degree prolapse?

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

What is a third degree prolapse?

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

What is a fourth degree uterine prolapse/procidentia?

Uterus lies outside the vagina

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

To exclude pelvic masses

Does menopause usually need to have laboratory tests to diagnose?

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

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

How far apart should you do FSH tests?

6 weeks (single raised level does not confirm diagnosis)

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

Menopausal status Ultrasound features Serum Ca125

What are the points for menopausal status in the RMI?

``` Premenopausal = 1 Postmenopausal = 3 ```

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

``` Multiloculated Solid areas Bilaterality Ascites Mets ```

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

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

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

The absolute level

What is the equation for calculating the RMI?

``` Menopausal status score X Ultrasound feature score X Serum Ca125 ```

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

CT to look for all organs | MRI for finer details of the mass

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

``` Endometriosis Peritonitis/infection Pregnancy Pancreatitis Ascites from any cause Other malignancy ```

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

Core biopsy | Can tell if it is invasive

What 3 prognostic calculators exist for breast cancer?

Nottingham prognostic index Adjuvant! online NHS PREDICT

What things does NHS PREDICT take into account?

``` Histopathology ER Clinical factors HER2 Mode of detection ```

DCIS mammography findings

Malignant calcifications (pleomorphic and of the casting type)

Repro Investigations Flashcards

(82 cards)