Lab Med 3 Obgyn

Front 1

What subunit of hCG is measured & why?

Back 1

Beta; It has unique terminal 23 AA SEQUENCE

Front 2

What is the other subunit & what other hormones is it shared w?

Back 2

A; LH, FSH, TSH

Front 3

-How is hCG measured?
-Based on ___ properties
--Using what method?

Back 3

Urine & serum
-Based on antigenic properties
--Direct/indirect agglutination of sensitized RBCs

Front 4

Accuracy of hCG altered by?

Back 4

Proteinuria
Immunologic dz
Excess LH (antipsychotic, hypothyroid, menopause, renal failure)

Front 5

-hCG produce by ____ when ____

Back 5

Syncytiotrophoblast 8 d after fertilization

Front 6

-hCG detected in blood:
-in urine:

Back 6

-9 days post fertilizaiton
-w/in 4 d missed period

Front 7

-In early pregnancy hCG increases by how much & what time increment?
-Peaks?

Back 7

-Doubles every 2 days;
-65 d post conception

Front 8

-When does hCG decrease & by how much?
-Allows eval of ____

Back 8

-Halves every 2 days after abortion
--If abort was complete & involved placenta

Front 9

Qualitative hCG tests evaluate:

Back 9

-Viability of pregnancy
-Return to NL after abortion
-Following therapy for hydidatiform mole

Front 10

-hydidatiform mole
-What does this look like in US?

Back 10

-Malignant transformation of placenta; baby doesn't develop placenta does
-Cluster of grapes

Front 11

Bleeding in 1st trimester common or not?

Back 11

Common; 1/6 pts

Front 12

hCG of 1800-2000 would see what on US?

Back 12

Chorionic sac

Front 13

hCG of 1800-2000 w/o chorionic sac =?

Back 13

Ectopic hCG level

Front 14

Another hormone used for viabiliyt of pregnancy

Back 14

Progesterone

Front 15

Progesterone secreted by ___ in 1st tri, ___ in 2 & 3

Back 15

Corp lut; placenta

Front 16

-Length of luteal phase
-Progesterone level

Back 16

-12 d
-10 ng/mL

Front 17

Progesterone level in early pregnancy

Back 17

25 ng/ML (progest will be maintained past luteal phase if pregnant)

Front 18

Routine screens in pregnancy
RRBC HHC

Back 18

RPR
Rubella
Blood type Ag & Rh
CBC
HIV
Hep B surface Ag (HBsAG)
Coombs

Front 19

-Rubella titer to see:
-If none:
-If rash

Back 19

ID women at risk for developing rubella if exposed
-Do nothing unless rash develop
-Check Ab at end of preg to determine exposure

Front 20

Rh negative mom =

Back 20

Rhogam at 28 weeks

Front 21

Rhogam MOA

Back 21

prevents sensitization to baby's Rh+ RBCs

Front 22

Indirect Coombs =

Back 22

ID Ab present in mom that could cross placenta

Front 23

Tx of HIV mom

Back 23

Acyclovir & C section

Front 24

Screening for hemoglobinopathy done in:

Back 24

African, mediterrean, asian

Front 25

Asian or Mediterrean w/
-Hgb <
-MCV <
MCH <27
need ____ to look for ____

Back 25

-11
-80
-27%
-Hgb electrophoresis; Thalassema

Front 26

If mom Hcg electrophoresis abnl:
1.
2.

Back 26

1. Test father
2. If abnl --> amniocentesis for Thalassema major

Front 27

If Med mother Hgb electro is NL -->
1. If Asian mother Hgb electro is NL -->
-2.
--3.

Back 27

-Nothing
-DNA analysis for A globulin
--Abnl? --> Test father
---Father Abnl? --> amniocentesis

Front 28

If AA woman hemoglobin screen NL -->

Back 28

No futher testing

Front 29

Jewish, French Canada, Cajun, autosomal recessive dz of lysosomal storage --> neurologic dz & death in early childhood

Back 29

Tay Sachs

Front 30

-Alpha fetoprotein =
-Present where?

Back 30

Protein produced by fetus present in amnionic fluid & maternal serum

Front 31

-AFP measured when?
-High levels of serum AFP =

Back 31

-15 & 18 weeks
Neural tube defect

Front 32

-Steps after finding high AFP

Back 32

Draw another & do US --> if confirmed --> amniocentesis to confirm amniotic levels

Front 33

-Low serum AFP associated w/
-Indicates need for:

Back 33

-Down's
-Multi marker screening

Front 34

-Multi marker screening includes: (3)

Back 34

MSAFP
hCG
Serum unconjucated estriol

Front 35

Low MSAFP
High materal serum hCG
Low serum unconjugated estriol

Back 35

-Levels of Multi marker screening of Downs

Front 36

Glucose screen recommended from ___ to ___ weeks

Back 36

24-28

Front 37

Risk factors of glucose intolerance in pregnancy

Back 37

Previous gestation DM
DM
Other factors increasing risk of glycemic probs (obesity)

Front 38

-Glucose of 1 hour load
-If 1 hour glucose draw is greater than ___, 3 hour is done

Back 38

-50 g
-130-140

Front 39

-Glucose of 3 hour load
-if 2of 4 tests in 3 hours abnl =
-1/4 =

Back 39

100
Gestational DM
Still risk of macrosomia

Front 40

-Test of fetal lung maturity done when?
-Lung maturation usually complete when?

Back 40

-Baby needs delivery b4 full term
-35 weeks

Front 41

Tests of Fetal lung maturity are (2)

Back 41

L/S
PG

Front 42

Lecithin (L) & Sphingomyelin (S) are ___ found ___

Back 42

Phospholipids; amniotic fluid

Front 43

Levels of L/S throughout pregnancy

Back 43

S sits still, L leaps up at 35 weeks

Front 44

L/S ratio used for:
-Desired level

Back 44

-RDS
-High

Front 45

LS <1.5 = ___% risk of RDS

Back 45

73

Front 46

LS 1.5-1.9 = ___% risk of RDS

Back 46

50%

Front 47

LS >2= ___% risk of RDS

Back 47

Negligible

Front 48

LS is less reliable in?
--Do ___ instead

Back 48

-Diabetic
--Phosphatidyglycerol (PG)

Front 49

-Phosphatidylglycerol (PG)pres in ___; appears when?
-Should always be tested in?

Back 49

-Amniotic; 35 weeks
-Diabetic women

Front 50

In diabetics, if possible wait until PG is ___ & LS is ___ to deliver

Back 50

Pos; >2

Front 51

Primary amenorrhea defined as

Back 51

Absence of menstrual period by age 15

Front 52

-First step in Dx primary amenorrhea:

Back 52

US to rulle out anatomic

Front 53

-2 step in Dx primary amenorrhea:

Back 53

Testosterone & karyotype - eval for testicular feminizatino or mullerian agenesis

Front 54

Secondary amenorrhea defined as

Back 54

ABsence of menses in woman who has previously had periods

Front 55

Causes of Secondary amenorrhea: (4; HAAP)

Back 55

Hyperprolactinea
Anovulation
Asherman's syndrome
PCOS

Front 56

Asherman's syndrome

Back 56

Endometriopathy resulting from damage to uterus (labor) --> fusion of uterine lining

Front 57

Most freq. cz of amenorrhea:

Back 57

PCOS

Front 58

Elevation of ___ (hormone) can cause ^ prolactin

Back 58

TSH

Front 59

If TSH is NL in amenorrhea + galactorrhea -->

Back 59

Cone down view of sella turcica

Front 60

-Absent/irregluar periods, associated w/ infrequent heavy prolonged bleeding consistent w/
--Really heavy or skinny

Back 60

Anovulation

Front 61

Hormone characterization of anovulation

Back 61

Estrogen but no progesterone - build up of endometrial tissue (since not progest surge)

Front 62

First recommended test of amenorrhea

Back 62

Progesterone challenge

Front 63

If bleeding occurs after Progesterone challenge

Back 63

Amenorrhea (know pt is ovulatin)

Front 64

Anovulation often caused by disorder of (hormone)?

Back 64

FSH

Front 65

-LH fxn-
-Subunits of LH similar to:
-Half life

Back 65

-Triggers ovulation
-FSH, TSH, hCG
-1 hour

Front 66

-FSH fxn
-Half life

Back 66

-Maturation of follicle
-~3 hrs

Front 67

Low FSH results in:
--Cause?

Back 67

Hypogonadotropic anovultion (idiopathic)

Front 68

Most common cz of annovulation w/ NL FSH =

Back 68

PCOS

Front 69

NL FSH + progesterone challenge =

Back 69

bleeding

Front 70

Common LH/FSH ration of PCOS

Back 70

3:1

Front 71

Other causes of anovulation w/ NL FSH

Back 71

Hypertecosis
Adrenal hyperplasia (these limit male hormone
Hypothalamic disfunction

Front 72

-Cz of anovulation w/ high FSH
-HIgh FSH + progesterone challenge =

Back 72

-Ovarian failure or resistance (menopause!)
-No bleeding

Front 73

Summary of anovulation
1st visit

Back 73

TSH
Prolactin
Progesterone challange
Consider FSH (if progest challenge is neg

Front 74

Summary of anovulation
2nd visit
-If progest challange pos
-If progest challange neg
-FSH high

Back 74

-Assumed anovulatory
-Need FSH for further eval
-Menopause likely occured

Front 75

Infertility definition

Back 75

No pregnancy >1 yr unprotected sex
(6 m if > 30 yo)

Front 76

Progesterone in infertility
-Present in serum when:
-Tested on day __ of cycle

Back 76

-When ovulation has occurred
-25

Front 77

Measure progesterone @ day 21 of 28 d cycle --> >5 --> know:

Back 77

She's ovulating

Front 78

Lab tests for hirsutism

Back 78

Testosterone
DHEA-s
17-OHP

Front 79

Testosterone & DHEA-S elevated --> evaluate for

Back 79

Pelvic mass

Front 80

Testosterone & DHEA-S NL & menses NL eval for

Back 80

Idiopathic hirsutism

Front 81

Testosterone & DHEA-S NL & menses ABNL eval for

Back 81

Cushings
Hyperandronergic chronic anovulation
Late onsent 17 hydroxylase deficiency

Front 82

Menopause occurs when

Back 82

Fxnal ovarian follicles depleted

Front 83

Women on OCP's FSH should be measured on days ___ of cycle if menopause suspected

Back 83

5-7 of placebo (to avoid interference of OCP)

Front 84

Estradiol level of menopause
FSH

Back 84

<20
High