Diagnostic Testing Flashcards
Hormones in Gonadal Function
Testosterone
FSH
LH
Symptoms of Testosterone Deficiency
Decreased energy Decreased libido Decreased muscle mass Decreased body hair Hot flashes Gynecomastia Infertility
What is the single most important diagnostic test for male hypogonadism?
Testosterone
Test to Measure Testosterone
Serum total testosterone
What is measured with serum total testosterone
Free testosterone
Protein bound testosterone
Issues when Sex Hormone Binding Globulins (SHBG) is Increased & Less Free Testosterone
Aging Hyperthyroidism Increased estrogen Liver disease HIV Anti-seizure meds
Issues when Sex Hormone Binding Globulins (SHBG) is Decreased & More Free Testosterone
Obesity Insulin resistance T2DM Hypothyroidism Increased GH Exogenous androgens Glucocorticoids Nephrotic syndrome
When should one measure a testosterone level?
8 AM when testosterone levels are the highest
If testosterone is low twice, what should you measure next?
LH
FSH
What is the disorder if testosterone is low and LH & FSH is high?
Primary hypogonadism
Klinefelter
What is the disorder if testosterone is low and LH & FSH are not elevated?
Secondary hypogonadism
T2DM
Liver or kidney disease
Agining
Causes of Primary Hypogonadism
Klinefelter syndrome Cryptorchidism Varicocele Trauma Testicular torsion Medications Autoimmune damage
Causes of Secondary Hypogonadism
Prader Willi Hyperprolactinemia Glucocorticoids Opiates DM Benign tumors & cysts Trauma
Define PSA
Prostate specific antigen
Where is PSA secreted from?
Epithelial cells of the prostate
PSA Function
Liquefy semen in the seminal coagulum to allow sperm to swim freely
Causes of Elevated PSA
BPH
Prostate cancer
Prostatic inflammation or infection
Perineal trauma: bike riding, sexual activity, DRE (rare)
What is elevated PSA an indirect measurement of?
Prostate glandular size in men without cancer
Values increase with age
Causes of Decreased PSA
Obesity
Medications
Medications that Reduce PSA
5-alpha-reductase inhibitors (50% reduction)
NSAIDs
Statins
Thiazides
PSA & Prostate Cancer
Determine extent of cancer
Response to treatment
Screening method for detection??
What is most important for PSA values?
The trend of the individual
Parameters of PSA
PSA density (serum PSA/prostate volume) PSA velocity (change in PSA over time) Free/Total PSA (PSAII)
PSA Density (PSAD)
Levels higher in men with BPH
Higher PSAD indicates greater likelihood of cancer
How is PSAD measured?
Volume (size) of the prostate with a TRUS and divides the PSA number by the prostate volume
Define PSA Velocity (PSAV)
Rate of change in PSA over time
How is PSA velocity (PSAV) measured?
Transrectal prostate biopsy
Disorder with Free PSA Elevated Compared to Bound PSA
BPH
Disorder with High Level of Bound PSA
Likely prostate cancer
Semen Analysis
Mainstay in investigating male fertility potential Abstain from coitus 2-3 days Collect ejaculate Analyze within an hour Obtained via masturbation Provides immediate information
Macroscopic Semen Analysis
Viscosity
Volume
pH
Microscopic Semen Analysis
Sperm concentration/count Motility Morphology Viability Leukocyte count Search for immature germ cells
Normal Semen Analysis Values
Volume: >1 cc
Concentration: >2,000,000
Initial forward motility: >50%
Normal morphology: >60%
Define Azospermia
No measurable sperm in the semen
Define Oligospermia
Less than 20M sperm/mL
Disorders Resulting in Azospermia
Klinefelter’s
Hypogonadotropic-hypogonadism
Ductal obstruction
Disorders Resulting in Oligospermia
Anatomic defects
Endocrinopathies
Genetic factors
Exogenous (e.g. heat)
Disorders Resulting in Abnormal Volume of Semen
Retrograde ejaculation
Infection
Ejaculatory failure
Medications
When should a provider avoid a prostatic massage?
Acute bacterial prostatitis
Risk of Prostatic Massage
Induction of bacteremia or sepsis
Gold Standard of Significant Bacteriuria
Urine culture & sensitivity
Urine Sensitivity
Measurement of sensitivity of bacteria to antibiotics
Methods of Urine Sensitivity
Agar diffusion: Kirby-Bauer discs, Etest strips
Broth dilution
Bladder Cancer Presentation
Painless hematuria
Diagnostics of Bladder Cancer
UA
Some cytology
Cystoscopy
Cytology of Bladder Cancer
Saline bladder wash
More sensitive in high grade tumors or carcinoma in situ
Types of Urodynamic Testing
Uroflowmetry Post-void residual measurement (PVR) Cystometry Electromyography Video dynamics
Define Peak Flow Urine Rates
Measures how fast urine is passed
Define Pressure Flow Study
Measures pressure & urine flow during voiding
Reason for Urodynamic Assessment
Assess how well the bladder & urethra are functioning
Indications for Urodynamic Assessment
Urinary incontinence Frequent urination Sudden, strong urges to urinate Painful urination Problems starting a urine stream Problems emptying the bladder Recurrent UTI
Measurements of Cystometry
Bladder pressure
Leak point pressure
Pressure flow studies
Uroflowmetry
Screening tool for patients with suspected bladder outlet obstruction
Measures peak flow in mL/sec
Reason for Post- kid Residual (PVR)
Measure of amount of urine left in the bladder after urination
Normal PVR Values
Define Cystometrogram (CMG)
Graphic display of vesicle pressure
Pressure flow study can distinguish bladder outlet obstruction from impaired detrusor function
What does a cystometrogram assess?
Detrusor activity
Sensation
Capacity
Compliance
What does a urethral pressure profile measure?
Urethral pressures at multiple levels
Indications for Urethral Pressure Profile
Sphincter dysfunction
Urinary incontinence
Detrusor sphincter dyssynergia
Video Urodynamics
Measurement of pressures with uroflow & EMG measurements under radiographic guidance to evaluate interplay between all these functions
STI Testing for Chlamydia
Nucleic acid amplification tests (NAATs)
Chlamydia Sample for Women
Vaginal swab
Chlamydia Sample for Men
Urine
Urethral swab
When to Test Men for Gonorrhea
Suspected urethritis
When to Test Females for Gonorrhea
Suspected cervicitis or urethritis
