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84 Cards in this Set
- Front
- Back
What subunit of hCG is measured & why?
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Beta; It has unique terminal 23 AA SEQUENCE
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What is the other subunit & what other hormones is it shared w?
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A; LH, FSH, TSH
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-How is hCG measured?
-Based on ___ properties --Using what method? |
Urine & serum
-Based on antigenic properties --Direct/indirect agglutination of sensitized RBCs |
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Accuracy of hCG altered by?
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Proteinuria
Immunologic dz Excess LH (antipsychotic, hypothyroid, menopause, renal failure) |
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-hCG produce by ____ when ____
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Syncytiotrophoblast 8 d after fertilization
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-hCG detected in blood:
-in urine: |
-9 days post fertilizaiton
-w/in 4 d missed period |
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-In early pregnancy hCG increases by how much & what time increment?
-Peaks? |
-Doubles every 2 days;
-65 d post conception |
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-When does hCG decrease & by how much?
-Allows eval of ____ |
-Halves every 2 days after abortion
--If abort was complete & involved placenta |
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Qualitative hCG tests evaluate:
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-Viability of pregnancy
-Return to NL after abortion -Following therapy for hydidatiform mole |
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-hydidatiform mole
-What does this look like in US? |
-Malignant transformation of placenta; baby doesn't develop placenta does
-Cluster of grapes |
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Bleeding in 1st trimester common or not?
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Common; 1/6 pts
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hCG of 1800-2000 would see what on US?
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Chorionic sac
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hCG of 1800-2000 w/o chorionic sac =?
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Ectopic hCG level
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Another hormone used for viabiliyt of pregnancy
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Progesterone
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Progesterone secreted by ___ in 1st tri, ___ in 2 & 3
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Corp lut; placenta
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-Length of luteal phase
-Progesterone level |
-12 d
-10 ng/mL |
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Progesterone level in early pregnancy
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25 ng/ML (progest will be maintained past luteal phase if pregnant)
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Routine screens in pregnancy
RRBC HHC |
RPR
Rubella Blood type Ag & Rh CBC HIV Hep B surface Ag (HBsAG) Coombs |
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-Rubella titer to see:
-If none: -If rash |
ID women at risk for developing rubella if exposed
-Do nothing unless rash develop -Check Ab at end of preg to determine exposure |
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Rh negative mom =
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Rhogam at 28 weeks
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Rhogam MOA
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prevents sensitization to baby's Rh+ RBCs
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Indirect Coombs =
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ID Ab present in mom that could cross placenta
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Tx of HIV mom
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Acyclovir & C section
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Screening for hemoglobinopathy done in:
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African, mediterrean, asian
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Asian or Mediterrean w/
-Hgb < -MCV < MCH <27 need ____ to look for ____ |
-11
-80 -27% -Hgb electrophoresis; Thalassema |
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If mom Hcg electrophoresis abnl:
1. 2. |
1. Test father
2. If abnl --> amniocentesis for Thalassema major |
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If Med mother Hgb electro is NL -->
1. If Asian mother Hgb electro is NL --> -2. --3. |
-Nothing
-DNA analysis for A globulin --Abnl? --> Test father ---Father Abnl? --> amniocentesis |
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If AA woman hemoglobin screen NL -->
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No futher testing
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Jewish, French Canada, Cajun, autosomal recessive dz of lysosomal storage --> neurologic dz & death in early childhood
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Tay Sachs
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-Alpha fetoprotein =
-Present where? |
Protein produced by fetus present in amnionic fluid & maternal serum
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-AFP measured when?
-High levels of serum AFP = |
-15 & 18 weeks
Neural tube defect |
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-Steps after finding high AFP
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Draw another & do US --> if confirmed --> amniocentesis to confirm amniotic levels
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-Low serum AFP associated w/
-Indicates need for: |
-Down's
-Multi marker screening |
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-Multi marker screening includes: (3)
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MSAFP
hCG Serum unconjucated estriol |
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Low MSAFP
High materal serum hCG Low serum unconjugated estriol |
-Levels of Multi marker screening of Downs
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Glucose screen recommended from ___ to ___ weeks
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24-28
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Risk factors of glucose intolerance in pregnancy
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Previous gestation DM
DM Other factors increasing risk of glycemic probs (obesity) |
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-Glucose of 1 hour load
-If 1 hour glucose draw is greater than ___, 3 hour is done |
-50 g
-130-140 |
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-Glucose of 3 hour load
-if 2of 4 tests in 3 hours abnl = -1/4 = |
100
Gestational DM Still risk of macrosomia |
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-Test of fetal lung maturity done when?
-Lung maturation usually complete when? |
-Baby needs delivery b4 full term
-35 weeks |
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Tests of Fetal lung maturity are (2)
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L/S
PG |
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Lecithin (L) & Sphingomyelin (S) are ___ found ___
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Phospholipids; amniotic fluid
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Levels of L/S throughout pregnancy
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S sits still, L leaps up at 35 weeks
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L/S ratio used for:
-Desired level |
-RDS
-High |
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LS <1.5 = ___% risk of RDS
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73
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LS 1.5-1.9 = ___% risk of RDS
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50%
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LS >2= ___% risk of RDS
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Negligible
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LS is less reliable in?
--Do ___ instead |
-Diabetic
--Phosphatidyglycerol (PG) |
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-Phosphatidylglycerol (PG)pres in ___; appears when?
-Should always be tested in? |
-Amniotic; 35 weeks
-Diabetic women |
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In diabetics, if possible wait until PG is ___ & LS is ___ to deliver
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Pos; >2
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Primary amenorrhea defined as
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Absence of menstrual period by age 15
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-First step in Dx primary amenorrhea:
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US to rulle out anatomic
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-2 step in Dx primary amenorrhea:
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Testosterone & karyotype - eval for testicular feminizatino or mullerian agenesis
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Secondary amenorrhea defined as
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ABsence of menses in woman who has previously had periods
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Causes of Secondary amenorrhea: (4; HAAP)
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Hyperprolactinea
Anovulation Asherman's syndrome PCOS |
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Asherman's syndrome
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Endometriopathy resulting from damage to uterus (labor) --> fusion of uterine lining
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Most freq. cz of amenorrhea:
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PCOS
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Elevation of ___ (hormone) can cause ^ prolactin
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TSH
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If TSH is NL in amenorrhea + galactorrhea -->
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Cone down view of sella turcica
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-Absent/irregluar periods, associated w/ infrequent heavy prolonged bleeding consistent w/
--Really heavy or skinny |
Anovulation
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Hormone characterization of anovulation
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Estrogen but no progesterone - build up of endometrial tissue (since not progest surge)
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First recommended test of amenorrhea
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Progesterone challenge
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If bleeding occurs after Progesterone challenge
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Amenorrhea (know pt is ovulatin)
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Anovulation often caused by disorder of (hormone)?
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FSH
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-LH fxn-
-Subunits of LH similar to: -Half life |
-Triggers ovulation
-FSH, TSH, hCG -1 hour |
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-FSH fxn
-Half life |
-Maturation of follicle
-~3 hrs |
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Low FSH results in:
--Cause? |
Hypogonadotropic anovultion (idiopathic)
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Most common cz of annovulation w/ NL FSH =
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PCOS
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NL FSH + progesterone challenge =
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bleeding
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Common LH/FSH ration of PCOS
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3:1
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Other causes of anovulation w/ NL FSH
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Hypertecosis
Adrenal hyperplasia (these limit male hormone Hypothalamic disfunction |
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-Cz of anovulation w/ high FSH
-HIgh FSH + progesterone challenge = |
-Ovarian failure or resistance (menopause!)
-No bleeding |
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Summary of anovulation
1st visit |
TSH
Prolactin Progesterone challange Consider FSH (if progest challenge is neg |
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Summary of anovulation
2nd visit -If progest challange pos -If progest challange neg -FSH high |
-Assumed anovulatory
-Need FSH for further eval -Menopause likely occured |
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Infertility definition
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No pregnancy >1 yr unprotected sex
(6 m if > 30 yo) |
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Progesterone in infertility
-Present in serum when: -Tested on day __ of cycle |
-When ovulation has occurred
-25 |
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Measure progesterone @ day 21 of 28 d cycle --> >5 --> know:
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She's ovulating
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Lab tests for hirsutism
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Testosterone
DHEA-s 17-OHP |
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Testosterone & DHEA-S elevated --> evaluate for
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Pelvic mass
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Testosterone & DHEA-S NL & menses NL eval for
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Idiopathic hirsutism
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Testosterone & DHEA-S NL & menses ABNL eval for
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Cushings
Hyperandronergic chronic anovulation Late onsent 17 hydroxylase deficiency |
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Menopause occurs when
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Fxnal ovarian follicles depleted
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Women on OCP's FSH should be measured on days ___ of cycle if menopause suspected
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5-7 of placebo (to avoid interference of OCP)
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Estradiol level of menopause
FSH |
<20
High |