Cervical Mucus, Vaginal Secretions, and Pregnancy Test Flashcards

Flashcards about cervical mucus, vaginal secretions, and pregnancy tests.

What are vaginal secretions composed of?

Discharges coming from the uterus, vagina, and cervix.

What lines the endocervix?

Single folded layer of mucus-secreting columnar epithelium.

What is cervical mucus composed of?

Mucin glycoproteins.

What is the role of cell-surface and gel-forming mucin?

Prevent any foreign materials from entering the cervix and uterus.

What is the function of cervical mucus?

Lubricant during sexual intercourse and plays an important role in fertility studies.

What happens to cervical mucus when ovulation approaches?

Thinner and becomes watery until it resembles a raw egg white consistency.

What is the interaction of cervical mucus to spermatozoa?

Allows the spermatozoa to ascend into the uterine cavity.

When is cervical mucus examined in fertility studies?

At its peak of maximal sperm receptivity.

Maximal receptivity goes along with the surge in what?

Surge in serum LH.

What is the first change when serum LH surges?

Sudden marked decreased in cervical mucus viscosity.

What is the second change when serum LH surges?

Increase in leukocyte alkaline phosphate activity.

What is the third change when serum LH surges?

Lowest value of basal body temperature.

What is the fourth change when serum LH surges?

Changes in the fern test pattern.

Noticeable changes in the color, consistency, or quantity of vaginal secretions may be linked to what?

Various conditions and infections such as sexually transmitted diseases.

The most common gynecologic complaints encountered are what?

Vaginal discharge, vaginal discomfort, and vaginal odor.

What are the three major causes for vaginal symptoms?

Bacterial vaginosis, candidiasis, and trichomoniasis.

What may be performed when microscopic findings are negative despite clinical findings?

Culture or DNA probe analysis.

What are the patient complaints when healthy/normal?

None

What are the patient complaints in candidiasis?

Vulvovaginal itching and soreness, malodorous discharge, ‘external’ dysuria and dyspareunia

What are the patient complaints in bacterial vaginosis?

Malodorous discharge.

What are the patient complaints in trichomoniasis?

Vulvovaginal soreness, malodorous discharge, ’external’ dysuria, and dyspareunia.

What are the patient complaints in atrophic vaginitis?

Vaginal dryness and dyspareunia.

What are the discharge characteristics in healthy/normal?

Clear to slightly pale yellow.

What are the discharge characteristics in candidiasis?

White, curd-like

What are the discharge characteristics in bacterial vaginosis?

Foul-smelling thin, gray, homogenous; adherent to mucosa.

What are the discharge characteristics in trichomoniasis?

Copious, yellow-green, frothy; may be foul-smelling, adherent to mucosa.

What are the discharge characteristics in atrophic vaginitis?

No discharge observed.

What is the pH level in healthy/normal?

3.8 - 4.5

What is the pH level in candidiasis?

3.8 - 4.5

What is the pH level in bacterial vaginosis?

4.5

What is the pH level in trichomoniasis?

5.0 – 6.0

What is the pH level in atrophic vaginitis?

5.0 – 7.0

What are the direct wet mount microscopic findings in healthy/normal?

Bacteria: large rods predominate WBC: rare to 2+

What are the direct wet mount microscopic findings in candidiasis?

Bacteria: large rods predominate WBC: 3+ to 4+ Other findings: budding yeast, pseudohyphae.

What are the direct wet mount microscopic findings in bacterial vaginosis?

Bacteria: increase in gram-variable coccobacilli; rare to absent large rods WBC: rare Other findings: clue cells.

What are the direct wet mount microscopic findings in trichomoniasis?

Bacteria: mostly gram-positive coccobacilli WBC: 2+ to 4+ Other findings: motile trichomonads (60%).

What are the direct wet mount microscopic findings in atrophic vaginitis?

Bacteria: decreased large rods, increase in gram positive cocci and gram-negative rods WBC: 3+ to 4+ Other findings: parabasal cells present RBC: 1+ to greater.

What are the KOH mount findings in healthy/normal?

Negative.

What are the KOH mount findings in candidiasis?

Budding yeast, pseudohyphae

What are the KOH mount findings in bacterial vaginosis?

Negative.

What are the KOH mount findings in trichomoniasis?

Negative.

What are the KOH mount findings in atrophic vaginitis?

Negative.

What is the amine test result in healthy/normal?

Negative.

What is the amine test result in candidiasis?

Negative.

What is the amine test result in bacterial vaginosis?

Positive (pungent, fishy odor released).

What is the amine test result in trichomoniasis?

Positive, often.

What is the amine test result in atrophic vaginitis?

Negative.

What does dyspareunia refer to?

Persistent or recurrent pain in the vulva, vagina, or pelvis during or after intercourse.

What does dysuria refer to?

Pain or difficulty experienced with urination.

What does vulvovaginitis refer to?

Inflammation of the vulva and vagina or of the vulvovaginal glands.

What type of swab is recommended for specimen collection?

Sterile, polyester-tipped (e.g., Dacron) swab on a plastic shaft or alternately a sterile loop.

Why should a cotton tipped swab and a wooden shaft not be used?

Toxic to N. gonorrhoeae and Chlamydia trachomatis, respectively.

What is used to provide access to the vaginal fornices?

A nonlubricated speculum, moistened only with warm water.

Why are speculum lubricants avoided?

Many contain antimicrobial agents.

Where does the health care provider collect vaginal secretions from?

From the posterior vaginal fornix and the vaginal pool.

What should the requisition slip contain?

Complete name, age, sex and the appropriate patient history.

Why should the specimen be kept at room temperature in case of delay?

Refrigeration adversely affects the recovery of N. gonorrhoeae and the detection of trophozoite Trichomonas vaginalis.

When is refrigeration recommended?

For detection of Chlamydia trachomatis or viruses and when trying to prevent the overgrowth of normal flora.

What is the normal pH of vaginal secretions?

3.8 to 4.5

What maintains the normal pH of vaginal secretions?

Numerous lactobacilli and their major metabolic end product, lactic acid.

Lactobacilli produce hydrogen peroxide that enhances the acidity of the vaginal canal preventing the overgrowth of some indigenous microbe such as what?

Gardnerella vaginalis.

A pH greater than 4.5 is indicative of what?

Bacterial vaginosis, trichomoniasis, and atrophic vaginitis.

What does wet mount preparation involve?

Placing the swab into a 0.5 to 1.0 mL of sterile physiologic saline and is agitated to release the secretions from the swab.

What is evaluated in the wet mount preparation?

The amount and type of epithelial cells present.

Why should wet mount preparation be performed ASAP particularly for the detection of T. vaginalis?

Observing motile organisms.

What does the addition of 10% KOH directly into the drop of specimen on the microscopic slide suggest?

The release of a “fishy” odor.

What is the distinct odor caused by?

Trimethylamine, a volatilization product of polyamines, which results from the alkaline pH change when KOH is added.

Why may heat be applied to allow KOH?

To dissolve the epithelial cell and blood cells in the specimen enhancing visibility of fungal elements.

Why is gram staining method used?

To distinguish and classify bacterial species into gram-positive bacteria or gram-negative bacteria.

How do quantify 'rare' cells when performing Microscopic Examination?

<10 per slide

How do quantify 'occasional' cells when performing Microscopic Examination?

<1 per 10 hpf

How do quantify '1+' cells when performing Microscopic Examination?

<1 per hpf

How do quantify '2+' cells when performing Microscopic Examination?

1-5 per hpf

How do quantify '3+' cells when performing Microscopic Examination?

6-30 per hpf

How do quantify '4+' cells when performing Microscopic Examination?

30 per hpf

What is the normal amount of white blood cells observed in wet mounts of vaginal secretions?

Few to moderate/hpf

What causes variations in white blood cells in vaginal secretions?

Any variation encountered is often associated with a woman’s menstrual cycle, ovulation and menses.

What is the normal amount of red blood cells observed in wet mounts of vaginal secretions?

Usually not present

When may red blood cells be present?

Maybe present when collected around or during menstruation.

What is the normal amount of lactobacillus observed in wet mounts of vaginal secretions?

50% to 90% of the total microbe

What are lactobacillus?

Large, non-motile, gram (+) organism that produce lactic acid and H2O2.

What percentage does the remaining bacterial morphotype account for in vaginal secretions?

10 % to 50 %

Any decrease in the number of lactobacilli relative to the amount of squamous epithelial cells present in the preparation indicates what?

An imbalance in the microflora.

An increase number or predominance of other bacterial morphotype is what?

Abnormal.

What is the normal amount of yeast / blastoconidia observed in wet mounts of vaginal secretions?

Present occasionally

What is abnormal regarding yeast / blastoconidia?

Increased number or presence of hyphae or pseudohyphae.

What is the normal amount of trichomonads observed in wet mounts of vaginal secretions?

None

What are trichomonads?

Pear shaped unicellular bodies averaging 15 µm (5 – 30 µm) in length with flitting or jerky motion

What is the normal amount of squamous cells observed in wet mounts of vaginal secretions?

Most dominant

What are squamous cells?

Large, thin, flag stone-shaped element with small centrally located nuclei and large amount of cytoplasm that becomes finely granulated as cell ages.

What are clue cells?

Bacteria-laden cells with shaggy edge, appearing soft and finely stipple with indistinct cellular borders because of numerous bacteria adhering; nuclei may not be visible.

What is the normal amount of parabasal cells observed in wet mounts of vaginal secretions?

None or few; may be increased during menses or post-menopausal period

What are parabasal cells?

Reside below the surface or luminal squamous epithelium of the vaginal mucosa; 15 to 40 µm in diameter, oval to round with distinct cytoplasmic borders

When are parabasal cells increased?

Increased in atrophic vaginitis and desquamative inflammatory vaginitis.

What is the normal amount of basal cells observed in wet mounts of vaginal secretions?

None

What is spinnbarkeit?

Ability of the mucus to be drawn into a thread, the length of which is measured before it breaks

What does the spinnbarkeit stretchability test evaluate?

Evaluates the viscoelastic properties of ovulatory cervical mucus.

How far may mucus form a thread at ovulation?

Up to 9 cm and over.

What is term used for Arborization pattern?

Fern’s Test.

What is the benefit of the arborization pattern/ Fern's Test?

A good indicator of the midcycle elevation of LH and of ovulation.