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UROLOGY > DIAGNOSTIC TESTING > Flashcards

DIAGNOSTIC TESTING Flashcards

1
Q

TESTOSTERONE DEFICIENCY SYMPTOMS

A 
⦁	decreased energy
⦁	decreased libido
⦁	decreased muscle mass
⦁	decreased body hair
⦁	hot flashes
⦁	gynecomastia
⦁	infertility
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2
Q

testosterone is produced in the testes by the

A

Leydig cells

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3
Q

_____ stimulates production of testosterone

A

LH

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4
Q

Negative feedback loop = testosterone inhibits the production of ____________ and therefore

A

GnRH

and therefore FSH / LH

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5
Q

Single most important diagnostic test for male hypogonadism

A

TESTOSTERONE

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6
Q

what testosterone test is ordered

A

serum total testosterone

= free testosterone + protein bound testosterone

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7
Q

normal serum total testosterone range

A

300-800 ng/dL

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8
Q

Abnormal testosterone binding to the sex hormone binding globulins (may need a free testosterone test)

If SHBG increased then____ free testosterone

If SHBG decreased then _____ free testosterone

A

less

more

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9
Q

If SHBG increased then less free testosterone: seen in what conditions

A

Aging, hyperthyroidism, increased estrogen, liver disease, HIV, antiseizure drugs

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10
Q

If SHBG decreased then more free testosterone: seen in what conditions

A

Obesity, insulin resistance, T2DM, hypothyroidsm, increased GH, exogenous androgens, glucocorticoids, nephrotic syndrome

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11
Q

when are testosterone levels the highest

A

morning

  • so collect sample at 8AM when testosterone levels are the highest
  • If normal – stop testing
  • If abnormal – repeat 1-2 more times to confirm
    ⦁ 1st time = abnormal, 2nd time = abnormal = stop
    ⦁ 1st time = abnormal, 2nd time = normal = need a 3rd test
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12
Q

if testosterone is actually low, check

A
  • check LH & FSH
  • when testosterone is low & LH/FSH are high = primary hypogonadism (Klinefelter)
  • when testosterone is low & LH/FSH are not elevated = secondary hypogonadism (DM, liver or kidney disease, aging)
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13
Q

primary hypogonadism = testosterone is ____ and FSH/LH are

A

low

high

(Klinefelters)

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14
Q

secondary hypogonadism = testosterone is ____ and FSH/LH are _______

A

low

not elevated

(DM, liver or kidney disease, aging)

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15
Q

PSA is secreted by the

A

epithelial cells of the prostate

PSA is present in low levels in the serum & present in the semen

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16
Q

function of prostate

A

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

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17
Q

CAUSES OF AN ELEVATED PSA

A

PSA = Indirect measurement of prostate glandular size in men without cancer

⦁ Normal values increase with age
⦁ Values can vary by race: Blacks have higher PSA levels than white
⦁ BPH
⦁ Prostate Cancer
⦁ Prostatic inflammation or infection
⦁ Perineal trauma (rarely DRE, bike riding, sex - persists for 48-72 hrs post-sex)

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18
Q

PSA & PROSTATE CANCER

A
  • used to determine extent of cancer
  • used to track response to treatment
  • used as a screening method for detection
    ⦁ controversial; lacks sensitivity & specificity
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19
Q

CAUSES OF DECREASED PSA

A

⦁ Obesity (delays early detection - may partially explain the worse outcomes in obese men with early prostate cancer)

⦁ Meds

- 5-ARIs (50% or more) - which is why you're supposed to double their PSA value
- NSAIDS
- Statins
- Thiazides
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20
Q

which meds decrease PSA

A

5- ARIs

NSAIDS

STATINS

THIAZIDES

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21
Q

free PSA = __________ when there is no cancer,

________with aggressive forms of cancer

A

higher

lower

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22
Q

rate of change in PSA values over time

A

PSA VELOCITY

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23
Q

time it takes to double the PSA

A

PSA DOUBLING TIME

24
Q

(serum PSA/ prostate volume

A

PSA DENSITY

25
Q

PSA DENSITY

A

(serum PSA/ prostate volume); if ratio > 1:1 = increased risk for prostate cancer

  • PSA = higher in men with BPH
  • PSA density = sometimes used for men with BPH to try to adjust for this
  • PSAD measures the volume (size) of the prostate with TRUS and divides the PSA number by prostate volume
  • a higher PSA density indicates a greater likelihood of cancer*
26
Q

to adjust for the fact that men with BPH have higher PSA, sometimes use _____________ instead

A

PSAD = PSA density

27
Q
  • a higher PSA density indicates a greater likelihood of
A

cancer

28
Q

PSA VELOCITY

A
  • the rate of change in PSA over time
  • a PSA that is quickly rising = more suspicious for cancer
  • however, a PSA that is already high or quickly rises to a concerning level will quickly lead to further evaluation
  • usually perform a transrectal prostate biopsy
29
Q

FREE / TOTAL PSA (PSA II)

A
  • the % of free PSA decreases as total PSA increases in serum of men with prostate cancer (lower free PSA = cancer, high free PSA = non-cancer; so if free PSA decreases (meaning bound PSA increases = will increase total PSA = cancer))
  • the ratio of free / total PSA, especially in men with normal PSA values, can be helpful in diagnosing those with possible cancer
  • the question is…what is the percentage cutoff?

so if free decreases and total increases = think cancer

30
Q

high free PSA = think

A

BPH

high bound PSA (low free PSA) = more likely to be from prostatic cancer cells

31
Q

Free and total prostate-specific antigen:

Only useful with PSA of

A

4-10

32
Q

MAINSTAY OF INVESTIGATING MALE FERTILITY POTENTIAL

A

semen analysis

33
Q

process of semen analysis

A

⦁ abstain from sex for 2-3 days
⦁ collect all ejaculate; obtained by masturbation
⦁ analyze within 1 hour
⦁ provides immediate information

34
Q

macroscopic sperm analysis

A
  • viscosity
  • volume
  • pH
35
Q

microscopic sperm analysis

A
  • sperm concentration / count
  • motility
  • morphology
  • viability (supravital stain)
  • leukocyte count
  • search for immature germ cells
36
Q

normal semen analysis

  • volume
  • concentration
  • initial forward motility
  • normal morphology
A

o volume > 1cc
o concentration > 2 x 106/ cc
o initial forward motility > 50%
o normal morphology > 60%

37
Q

No measurable sperm in the semen

A

AZOSPERMIA

38
Q

Less than 15 million sperm/ml

A

OLIGOSPERMIA

39
Q

conditions with azospermia

A 
Klinefelters
Hypogonadotrophic -hypogonadism
ductal obstruction (absence of vas deferens)
40
Q

conditions with oligospermia

A

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

41
Q

PROSTATIC SECRETIONS PROCESS

A
  • four-glass test = first void 10mL, then mid-stream sample 10mL, then expressed prostatic secretion, then first voided 10mL after massage
  • this is quite uncomfortable/painful for the patient
  • compare voided urine before prostatic massage to urine voided after prostatic massage to see if prostatic massage causes any leakage of white cells / bacteria into the urine

**Avoid this procedure in acute bacterial prostatitis = risk for induction of bacteremia or sepsis

42
Q

DIAGNOSIS OF UTI

A

UA WITH CULTURE

43
Q

URINE CULTURE COLLECTION

A
  • in adults & older children, a mid stream urine sample usually reliiable represents the urine in the bladder (clean catch)
  • do NOT use samples from urinary bags, pedi-bags or bedpans to diagnose UTI (all are contaminated)
  • most reliable sample = obtained via catheterization or suprapubic aspiration in infants (often less traumatic than catheterization)
44
Q

MOST RELIABLE URINE SAMPLE

A

obtained via catheterization or suprapubic aspiration in infants (often less traumatic than catheterization)

45
Q

Traditional gold standard for significant bacteriuria __________ cfu/mL of urine

A

> 100,000

Some argue criteria for bacteriuria is only 100 cfu/mL of a uropathogen in symptomatic females or 1,000 in symptomatic males.

46
Q

measuring sensitivity of bacteria to antibiotics in urine

A

Measure sensitivity of bacteria to antibiotics
⦁ agar diffusion = Kirby-Bauer Test (disc diffusion test) OR E-test (strip test)
⦁ broth dilution

For solid media = use disc diffusion test (Kirby-Bauer Test)

For liquid media = use MIC test (minimum inhibitor concentration) - cloudiness means that the bacteria can grow that concentration antibiotic

47
Q

when concerned about bladder cancer

A

get urine cytology & cystoscopy

initial = urine cytology

diagnosis of bladder cancer = cystoscopy

48
Q

process of urine cytology

A
  • perform microscopic cytology of urinary sediment, or saline bladder wash to detect malignant cells (saline wash = more accurate)
  • microscopic cytology = more sensitive in high grade tumors or carcinoma in situ, but can be falsely negative in 20% of cases
49
Q

Peak flow urine rates = measures

A

how fast urine is passed

50
Q

pressure flow study

A

have a urodynamic catheter in the bladder that allows the measurement of pressure & urine flow during voiding

51
Q

urodynamics can be done to assess symptoms such as

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

urodynamic testing

A
  • uroflowmetry
  • PVR
  • Cystometry (measures bladder pressure, leak point pressure, and pressure flow studies)
  • Electromyography
  • Video dynamics
53
Q

UROFLOWMETRY

A
  • screening tool for patients with suspected bladder outlet obstruction; measures peak flow (speed of urine in mL/sec)
  • reserved for patients with severe symptoms where invasive therapy is considered; this is done by a urologist
  • used in urethral stricture
54
Q

normal PVR value

A

< 50 mL

unless pt is > 60 = then normal PVR = 50-100

55
Q

Can distinguish bladder outlet obstruction from impaired detrusor function

A

cystometry

  • Assesses detrusor activity, sensation, capacity and compliance

Cystometry is rarely done, because it is invasive; Urologist referral for this!

UROLOGY (12 decks)

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