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Urology > Diagnostic Testing > Flashcards

Diagnostic Testing Flashcards

1
Q

Sxs of testosterone deficiency in adult males?

A
  • decreased: energy, libido, muscle mass, body hair

- hot flashes, gynecomastia, infertility

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2
Q

Source of testosterone? Negative feedback loop?

A
  • produced in testes by Leydig cells
  • LH stimulates production
  • negative feedback loop: testosterone inhibits production of LH and FSH
  • single most impt dx test for male hypogonadism
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3
Q

What tests should be ordered if you suspect hypogonadism? Diff in causes of increased and decreased SHBG?

A
  • 1st: serum total testosterone (Normal range: 300-800 ng/dl)
  • abnormal testosterone binding to sex hormone bidning globulins ( may need free testosterone test) - if SHBG increased then less free testosterone - aging, hyperthyroidism, increased estrogen, liver disease, HIV, anti-seizure drugs
  • if SHBG decreased then more free testosterone - obesity, insulin resistance, T2DM, hypothyroidism, increased GH, exogenous androgens, glucocorticoids, nephrotic syndrome
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4
Q

When should testosterone be drawn? Results?

A
  • collect sample at 8am when testosterone levels are highest
  • if normal - stop testing
  • if abnormal - repeat 1-2 more times to confirm
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5
Q

What should be done if testosterone is low on 2 tests?

A
  • check LH and FSH
  • if testosterone low and FSH and LH high = primary hypogonadism - ex: klinefelter, cryptorchidism, varicocele. glucocorticoids
  • testosterone low and LH and FSH not elevated = secondary hypogonadism - ex: T2DM, liver or kidney disease, aging
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6
Q

What is PSA? Where can it be found? Fxn?

A
  • prostate specific antigen
  • secreted by epithelial cells of the prostate
  • present in low levels in the serum
  • present in the semen
  • fxn is to liquify semen in seminal coagulum to allow sperm to swim freely
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7
Q

Causes of an elevated PSA?

A
  • BPH
  • prostate cancer
  • prostatic inflammation or infection
  • perineal trauma:
    rarely DRE
    bike riding
    sexual activity (persists for 48-72 hrs post)
  • indirect measure of prostate glandular size in men w/o cancer
  • normal values increase w/ age
  • values can vary by race: blacks have higher PSA levels than whites
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8
Q

Causes of decreased PSA?

A
  • obesity: elevated BMI levels may cause lower PSA levels
  • delayed early detection may partially explain worse outcomes in obese men with early prostate cancer
  • meds that reduce PSA:
    5-alpha-reductase inhibitors: 50% or greater reductions
    NSAIDs
    statins (17.4%)
    thiazides (26%)
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9
Q

Use of PSA for prostate cancer?

A
  • determine extent of cancer
  • response to tx
  • screening method for detection:
    controversial
    lacks sensitivity and specificity
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10
Q

Why are normal values of PSA controversial?

A
  • in past a value of less than 4 ng/ml was normal
  • men with prostate cancer were found to have values of less than 4
  • men w/o prostate cancer were found to have values greater than 4
  • impt to follow trend - how much has PSA increased over the last yr?
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11
Q

Diff studies of PSA?

A
  • age specific reference ranges
  • free vs total PSA: lower portion of free PSA may be correlated w/ more aggressive forms of cancer
  • PSA velocity and PSA doubling time: rate of change in PSA values over time, time it takes to double PSA
  • pro-PSA: more strongly assoc w/ prostate cancer than BPH
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12
Q

Research on PSA screening?

A
  • for q 1000 men ages 55-69 that get screening PSAs yearly for a decade- 100-120 get positive results leading to prostate bx
  • 110 get prostate cancer - and of these at least 60 have tx complication, 4-5 die from prostate cancer and 5 die who weren’t screened
  • 0-1 deaths from prostate cancer are avoided by screening - causes more harm than good
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13
Q

What is PSA density (PSAD)?

A
  • PSA levels are higher in men with BPH
  • PSAD is sometimes used for men with BPH to try to adjust for this - amt of PSA should be proportional to size of prostate
  • it measures volume (size) of prostate w/ TRUS and divides PSA number by prostae volume
  • a higher PSAD indicates greater likelihood for cancer
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14
Q

Use of PSA velocity?

A
  • PSAV
  • rate of change in PSA over time
  • PSA that is rising quickly is more suspicous for cancer
  • however a PSA that is already high or quickly rises to a concerning level will quickly lead to further eval
  • usually with transrectal prostate bx
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15
Q

What is Free/total PSA (PSAII)? BPH vs cancer findings?

A
  • percentage of free PSA decreases as total PSA increases in serum of men with prostate cancer
  • ratio of f/t PSA, especially in men w/ normal PSA values can be helpful in dx those w/ possible CA
  • only useful when PSA 4-10 ng/dl
  • if free PSA is elevated in respect to bound PSA - then PSA is probably being produced by BPH
  • if there is high level of bound PSA then it is likely to be manufactured by prostate cancer cells
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16
Q

USPSTF statement on PSA testing?

A
  • small pontential benefit and significant potential harms - don’t screen pt with PSA test unless individual being screened understands what is known about PSA screening and makes personal decision that even a small possibility of benefit outweighs known risk of harms
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17
Q

Impt of semen analysis? What needs to be done?

A
  • remains mainstay in investigating male fertility potential
  • abstain from coitus 2-3 days
  • collect all ejaculate
  • analyze w/in 1 hr
  • obtained by masturbation
  • provides immediate information
18
Q

What are the diff parts to semen analysis?

A 
- macroscopic:
viscosity, volume and pH
- microscopic:
spem concentration/count 
motility
morphology
viability (supravital stain)
leukocyte count
search for immature germ cells
19
Q

Normal semen analysis?

A
  • volume: over 1 cc
  • concentration: over 20 mill/cc
  • initial forward motility: over 50%
  • normal morphology: over 60%
20
Q

What is azospermia? oligospermia?

A
  • azospermia: no measurable sperm in semen

- oligospermia: less than 15 mill/ml

21
Q

Causes of azospermia?

A
  • klinefelters (1/500)
  • hypogonadotropic-hypogonadism
  • ductal obstruction (absence of vas deferens)
22
Q

Causes of oligospermia?

A
  • anatomic defects
  • endocrinopathies
  • genetic factors
  • exogenous (heat)
23
Q

Causes of abnormal volume of semen?

A
  • retrograde ejaculation
  • infection
  • ejaculatory failure
  • meds
24
Q

How is dx of chronic prostatitis made?

A
  • analyzing specimens obtained following prostatic massage
  • first periurethral area is cleaned and pt allowed to void
  • initial 5-10 ml and midstream specimen are obtained for quantitative culture
  • the pt should stop voiding b/f bladder is empty and prostate should be massaged - any prostatic secretions that are expressed should be cultured as well as first 5-10ml of subsequently voided urine
25
Q

When should a prostatic massage be avoided?

A
  • in acute bacterial prostatits

- risk for induction of bacteremia or sepsis

26
Q

How is a UTI dx?

A
  • in adults and older kids - mid stream urine sample usually reliably represents the urine in bladder (clean catch)
  • samples collected from urinary bags, pedi-bags or bedpans shouldn’t be used to dx UTI as they are most likely contaminated
  • most reliable sample is obtained via cath or or suprapubic aspiration in infants (often less traumatic than cath - do if unable to cath)
27
Q

Traditional gold std for sig bacteriuria, test used for what pts?

A
  • urine culture and sensitivity - over 100,000 cfu/ml of urine
  • some argue criteria for bacteriuria is only 100 cfu/ml of uropathogen in sx females or 1,000 in symptomatic males
  • bacterial identification from urine C&S - key in males and females w/ complicated UTIs
28
Q

Methods of urine sensitivity?

A 
- measurement of sensitivity of bacteria to abx 
 methods:
-agar diffusion: 
kirby-bauer - discs
Etest - strips
-broth dilution
  • solid media: disc diffusion technique
  • liquid media: minimum inhibitory concentration (MIC) test
29
Q

Presentation of bladder cancer? What tests do you want to run?

A
  • pts usually present w/ painless hematuria (hallmark)
  • Will get UA and some cytology
  • real dx test: cystoscopy
    (gold std: cystoscopy and bx)
30
Q

How do you dx bladder cancer w/ cytology?

A
  • microscopic cytology of urinary sediment or saline bladder wash to detect malignant cells ( saline bladder washes more accurate)
  • microscopic cytology is more sensitive in high grade tumors or carcinoma in situ but can be falsely negative in 20% of cases
31
Q

What is urodynamics? Who does this?

A
  • bladder fxn
  • peak flow urine rates: measures how fast urine is passed
  • pressure flow study: urodynamic catheter in bladder, allows measurement of pressure and urine flow during voiding
  • done by urologists
32
Q

What is urodynamic assessment?

A
  • used to assess how well bladder and urethra are fxning:
    sphincter control
    bladder filling/emptying
33
Q

Indications for urodynamic assessment?

A

to assess sxs such as:

  • urinary incontinence
  • frequent urination
  • sudden, strong urges to urinate
  • painful urination
  • problems starting a urine stream
  • problems emptying the bladder
  • recurrent UTI
34
Q

What are the components of urodynamic testing?

A
  • uroflometry
  • post-void residual measurement
  • cystometry:
    measurement of bladder pressure
    measurement of leak pt pressure
    pressure flow studies
  • electromyography
  • video dynamics
35
Q

What is uroflowmetry? Used for what pts?

A
  • screening tool for pts with suspected bladder outlet obstruction
  • measures peak flow in mL/sec
  • reserved for pts with severe sxs where invasive therapy is considered - done by urologist
  • ex of abnormal uroflow report: BPH - problems initiating and maintaining stream
36
Q

When is post-void residual (PVR) used?

A
  • when pt is unable to completely empty bladder: bladder obstruction (sig BPH), or women with cystoceles
  • can use US or cath
  • use after anesthesia
  • normal values:
    is under 50 ml
    if pt is older than 60 normal: 50-100 ml
37
Q

What is a cystometogram (CMG)? Assesses what?

A
  • graphic display of vesical pressure: bladder is filled w/ water at steady state, pressure flow study compared w/ uroflow can distinguish bladder outlet obstruction from impaired detrusor fxn
  • assesses:
    detrusor activity
    sensation
    capacity
    compliance
  • rarely done - invasive - urologist referral
38
Q

What is a urethral pressure profile? Indications for testing?

A 
- measures urethral pressures at multiple levels
indications for testing:
-sphincter dysfxn
-urinary incontinence
-detrusor sphincter dyssynergia
39
Q

What is video urodynamics?

A
  • aka multichannel fluoroscopic urodynamics
  • combines measurement of pressures w/ uroflow and EMG measurements under radiographic guidance to eval interplay b/t all these fxns
  • invasive
40
Q

Testing for chlamydia?

A
  • NAATs detect small amts of chlamydia nucleic acid
  • vaginal swab for women
  • urine or urethral swab for men: urine ok for women too but vaginal sample more sensitive, rectal swabs may also be obtained
  • some available NAATs include ability to detect Neisseria gonorrhea from same specimen
41
Q

Testing for gonorrhea?

A
  • males with suspected urethritis:
    microscopy w/ gram stain of urethral swab performs well in men w/ suspected urethritis , noninvasive method: NAAT of urine
  • females with suspected cervicitis or urethritis:
    vaginal swab specimen has best overall sensitivity and specificity
42
Q

HPV testing?

A
  • women - pap smear

- men: no approved HPV test for men - some use cervical swabs in anal region for eval of MSM

Urology (12 decks)

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