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Urology > Diagnostic Testing > Flashcards

Diagnostic Testing Flashcards

1
Q

Hormones in Gonadal Function

A

Testosterone
FSH
LH

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2
Q

Symptoms of Testosterone Deficiency

A 
Decreased energy
Decreased libido
Decreased muscle mass
Decreased body hair
Hot flashes
Gynecomastia
Infertility
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3
Q

What is the single most important diagnostic test for male hypogonadism?

A

Testosterone

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4
Q

Test to Measure Testosterone

A

Serum total testosterone

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5
Q

What is measured with serum total testosterone

A

Free testosterone

Protein bound testosterone

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6
Q

Issues when Sex Hormone Binding Globulins (SHBG) is Increased & Less Free Testosterone

A 
Aging
Hyperthyroidism
Increased estrogen
Liver disease
HIV
Anti-seizure meds
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7
Q

Issues when Sex Hormone Binding Globulins (SHBG) is Decreased & More Free Testosterone

A 
Obesity
Insulin resistance
T2DM
Hypothyroidism
Increased GH
Exogenous androgens
Glucocorticoids
Nephrotic syndrome
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8
Q

When should one measure a testosterone level?

A

8 AM when testosterone levels are the highest

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9
Q

If testosterone is low twice, what should you measure next?

A

LH

FSH

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10
Q

What is the disorder if testosterone is low and LH & FSH is high?

A

Primary hypogonadism

Klinefelter

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11
Q

What is the disorder if testosterone is low and LH & FSH are not elevated?

A

Secondary hypogonadism
T2DM
Liver or kidney disease
Agining

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12
Q

Causes of Primary Hypogonadism

A 
Klinefelter syndrome
Cryptorchidism
Varicocele
Trauma
Testicular torsion
Medications
Autoimmune damage
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13
Q

Causes of Secondary Hypogonadism

A 
Prader Willi
Hyperprolactinemia
Glucocorticoids
Opiates
DM
Benign tumors & cysts
Trauma
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14
Q

Define PSA

A

Prostate specific antigen

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15
Q

Where is PSA secreted from?

A

Epithelial cells of the prostate

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16
Q

PSA Function

A

Liquefy semen in the seminal coagulum to allow sperm to swim freely

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17
Q

Causes of Elevated PSA

A

BPH
Prostate cancer
Prostatic inflammation or infection
Perineal trauma: bike riding, sexual activity, DRE (rare)

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18
Q

What is elevated PSA an indirect measurement of?

A

Prostate glandular size in men without cancer

Values increase with age

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19
Q

Causes of Decreased PSA

A

Obesity

Medications

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20
Q

Medications that Reduce PSA

A

5-alpha-reductase inhibitors (50% reduction)
NSAIDs
Statins
Thiazides

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21
Q

PSA & Prostate Cancer

A

Determine extent of cancer
Response to treatment
Screening method for detection??

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22
Q

What is most important for PSA values?

A

The trend of the individual

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23
Q

Parameters of PSA

A 
PSA density (serum PSA/prostate volume)
PSA velocity (change in PSA over time)
Free/Total PSA (PSAII)
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24
Q

PSA Density (PSAD)

A

Levels higher in men with BPH

Higher PSAD indicates greater likelihood of cancer

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25
Q

How is PSAD measured?

A

Volume (size) of the prostate with a TRUS and divides the PSA number by the prostate volume

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26
Q

Define PSA Velocity (PSAV)

A

Rate of change in PSA over time

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27
Q

How is PSA velocity (PSAV) measured?

A

Transrectal prostate biopsy

28
Q

Disorder with Free PSA Elevated Compared to Bound PSA

A

BPH

29
Q

Disorder with High Level of Bound PSA

A

Likely prostate cancer

30
Q

Semen Analysis

A 
Mainstay in investigating male fertility potential
Abstain from coitus 2-3 days
Collect ejaculate
Analyze within an hour
Obtained via masturbation
Provides immediate information
31
Q

Macroscopic Semen Analysis

A

Viscosity
Volume
pH

32
Q

Microscopic Semen Analysis

A 
Sperm concentration/count
Motility
Morphology
Viability
Leukocyte count
Search for immature germ cells
33
Q

Normal Semen Analysis Values

A

Volume: >1 cc
Concentration: >2,000,000
Initial forward motility: >50%
Normal morphology: >60%

34
Q

Define Azospermia

A

No measurable sperm in the semen

35
Q

Define Oligospermia

A

Less than 20M sperm/mL

36
Q

Disorders Resulting in Azospermia

A

Klinefelter’s
Hypogonadotropic-hypogonadism
Ductal obstruction

37
Q

Disorders Resulting in Oligospermia

A

Anatomic defects
Endocrinopathies
Genetic factors
Exogenous (e.g. heat)

38
Q

Disorders Resulting in Abnormal Volume of Semen

A

Retrograde ejaculation
Infection
Ejaculatory failure
Medications

39
Q

When should a provider avoid a prostatic massage?

A

Acute bacterial prostatitis

40
Q

Risk of Prostatic Massage

A

Induction of bacteremia or sepsis

41
Q

Gold Standard of Significant Bacteriuria

A

Urine culture & sensitivity

42
Q

Urine Sensitivity

A

Measurement of sensitivity of bacteria to antibiotics

43
Q

Methods of Urine Sensitivity

A

Agar diffusion: Kirby-Bauer discs, Etest strips

Broth dilution

44
Q

Bladder Cancer Presentation

A

Painless hematuria

45
Q

Diagnostics of Bladder Cancer

A

UA
Some cytology
Cystoscopy

46
Q

Cytology of Bladder Cancer

A

Saline bladder wash

More sensitive in high grade tumors or carcinoma in situ

47
Q

Types of Urodynamic Testing

A 
Uroflowmetry
Post-void residual measurement (PVR)
Cystometry
Electromyography
Video dynamics
48
Q

Define Peak Flow Urine Rates

A

Measures how fast urine is passed

49
Q

Define Pressure Flow Study

A

Measures pressure & urine flow during voiding

50
Q

Reason for Urodynamic Assessment

A

Assess how well the bladder & urethra are functioning

51
Q

Indications for Urodynamic Assessment

A 
Urinary incontinence
Frequent urination
Sudden, strong urges to urinate
Painful urination
Problems starting a urine stream
Problems emptying the bladder
Recurrent UTI
52
Q

Measurements of Cystometry

A

Bladder pressure
Leak point pressure
Pressure flow studies

53
Q

Uroflowmetry

A

Screening tool for patients with suspected bladder outlet obstruction
Measures peak flow in mL/sec

54
Q

Reason for Post- kid Residual (PVR)

A

Measure of amount of urine left in the bladder after urination

55
Q

Normal PVR Values

A
56
Q

Define Cystometrogram (CMG)

A

Graphic display of vesicle pressure

Pressure flow study can distinguish bladder outlet obstruction from impaired detrusor function

57
Q

What does a cystometrogram assess?

A

Detrusor activity
Sensation
Capacity
Compliance

58
Q

What does a urethral pressure profile measure?

A

Urethral pressures at multiple levels

59
Q

Indications for Urethral Pressure Profile

A

Sphincter dysfunction
Urinary incontinence
Detrusor sphincter dyssynergia

60
Q

Video Urodynamics

A

Measurement of pressures with uroflow & EMG measurements under radiographic guidance to evaluate interplay between all these functions

61
Q

STI Testing for Chlamydia

A

Nucleic acid amplification tests (NAATs)

62
Q

Chlamydia Sample for Women

A

Vaginal swab

63
Q

Chlamydia Sample for Men

A

Urine

Urethral swab

64
Q

When to Test Men for Gonorrhea

A

Suspected urethritis

65
Q

When to Test Females for Gonorrhea

A

Suspected cervicitis or urethritis

Urology (12 decks)

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