Diagnostics Flashcards
Testosterone:
- sx of deficiency
- where is it produced?
- what stimulates production?
- describe negative feedback mechanisms.
Sx of deficiency:
- decreased energy, libido, muscle mass, body hair
- hot flashes, gynecomastia, infertility
Produced by the leydig cells in the testes.
Stimulated by LH.
Negative feedback:
testosterone inhibits production of LH and FSH.
What is the single most important dx test for male hypogonadism ?
TESTOSTERONE!!!!
Hypogonadism:
- what labs to order?
- what does it mean if SHBG is increased? decreased? consequences of both.
- what time of the day do you collect serum testosterone?
Lab:
- serum TOTAL testosterone (free + protein bound)
- -normal is 300-800ng/dL
if sex hormone binding globulins is increased then there is less free testosterone leading to aging, hyperthyroidism, increased estrogen, liver dz, HIV,
if SHBG is decreased then there is more free testosterone leading to obesity, insuline resisitance, T2DM, hypothyroidism, increased GH, exogenous androgens, glucocorticoids, nephrotic syndrome.
Serum testosterone is best collected at 8AM when testosterone levels are the highest.
If testosterone is low x2 what other labs are required in the work up of hypogonadism?
Describe hormone levels in primary and secondary hypogonadism, what are the most likely causes of each.
Check LH and FSH.
Primary hypogonadism:
- testosterone low, FSH and LH high
- MC cause = klinefelter, cryptochidism, and varicocele
Secondary Hypogonadism:
- testosterone low and LH and FSH not elevated
- MC cause: T2DM, liver or kidney dz, Aging
PSA:
- causes of an elevated PSA
- how is PSA used in Prostate CA?
Elevated PSA causes:
- BPH
- prostate CA
- prostatic inflamm or infection
- Perineal truama (biking, sexual activty)
- normal values increase with age
- blacks have higher PSA
- PSA directly related to the size of the prostate; bigger prostate = higher PSA.
PSA and prostate CA use:
- determine extent
- check response to tx
- screen for detection (controversial)
PSA:
- causes of decreased PSA
- whats a normal level?
Causes of Decreased PSA:
- obesity (obese men will have a lower PSA for a longer time even when they do have prostate CA leading to worse outcomes)
- Medications:
- -5-alpha reductase inhibitors (decrease PSA by 50%)
- -NSAIDS
- -Statins
- -Thiazides
Normal level: there is no normal level, you need to look at the PSA velocity and doubling time.
PSA:
- calculation of PSA density? what does a higher PSAD indicate?
- calculation of PSA velocity? what does a quickly rising PSAV indicate?
- how is free PSA affected in men with prostate CA?
PSA density = serum PSA/prostate volume.
–a higher PSA densisty indicates greater likelihood of CA.
PSA velocity =rate of change in PSA over time.
–a quickly rising PSA is more suspicious for cancer.
percentage of free PSA DECREASES as total PSA increase in serum of men with prostate CA.
*elevated PSA is more likely to be associated with cancer if it is highly bound.
Semen analysis:
- pt instructions
- analysis time frame
- macroscopic analysis
- microscopic analysis
Pt instructions:
- abstain from coitus for 2-3days
- collect all of ejaculate
Time frame : 1 hour
Macroscopic:
- viscosity
- volume (greater than 1cc)
- pH
Microscopic:
- sperm concentration/count (greater than 2x10^6/cc)
- motility (greater than 50%)
- morphology (greater than 60%)
- viability
- leukocyte count
- search for immature germ cells.
Define:
- azospermia
- oligospermia
- -DDX for each
azospermia: no measureable sperm in semen
oligospermia: less than 15-20mill sperm/ml
Azospermia DDX:
- klinfelters
- hypogonadiotropic-hypogonadism
- ductal obstruction (absence of vas deferens)
Oligospermia DDX:
- anatomic defects
- endocrinopathies
- genetic factors
- exogenous (heat)
Four Glass test of Prostate
- describe this procedure
- risks of this?
Procedure:
- allow pt first void of 5-10ml in one glass
- mid stream sample of 10ml in second glass, but done empty bladder completely.
- prostate massage and collect any secretions from that in the 3rd glass
- collect first voided urine directly after the massage in the 4th glass.
Risk for induction of bacteremia or sepsis
Urine Culture and Sensitivity:
- what type of urine collection is required fro this?
- what is the gold standard for significant bacteriuria?
- what methods are used to measure the sensitivity of bacteria to abx?
mid stream clean catch or suprapubic/catheterization (most reliable in children and infants)
traditional gold standard for significant bacteriuria is greater than 100,000cfu/ml of urine.
Methods to measure sensitivity of bacteria to abx:
- agar diffusion: Kirby-bauer- discs, Etest-strips
- broth dilution
Bladder Cancer:
- sx
- what test do you do?
- which test is diagnostic?
Sx: painless hematuria
Tests: UA and cytology
Test that is diagnostic: cystoscopy
Urodynamics:
- used to assess what?
- what two tests comprise a Urodynamics study?
- indications for testing
used to assess how well the bladder and urethra are functioning.
- -sphincter control
- -bladder filling/emptying
Urodynamics include:
- peak flow urine rates (how fast urine is passed)
- Pressure Flow study (measures pressure and urine flow during voiding)
Indications:
- urinary incontinence
- frequent urination
- sudden, strong urges to urinate
- painful urination
- difficulty initiating urine stream
- difficulty emptying bladder
- recurrent UTI
Urodynamic Testing:
- what tests are done?
- -MC indications for each test
Tests:
- uroflowmetry: pts with suspected bladder outlet obstruction
- post void residual measurement: post anesthesia; less than 50 is normal.
- cystometry: assessing detrusor muscle, sensation, capacity, and compliance of bladder. INVASIVE
- electromyography
- video dynamics: INVASIVE.
- urethral pressure profile: indicated for sphincter dysfunction, urinary incontinence, detrusor sphincter dyssynergia
STI testing:
- what test is used in each of the following?
- -chlamydia
- -gonorrhea
- -HPV
Chlamydia: Nucleic acid amplification tests. Vaginal/urine swabs in women and urine/urethral swab in men.
Gonorrhea: microscopy w/ gram stain of urethral swab in men or NAAT of urine. Vaginal swab for women.
HPV:
- usually included in pap smear in women
- may be able to do anal swab in men?
